Coiling, a minimally invasive procedure to treat brain aneurysms, is successful in preventing recurrent or first-time bleeding years after initial treatment in those aneurysms considered "untouchable" by the traditional surgical option according to a study presented at the annual meeting of the American Society of Interventional & Therapeutic Neuroradiology.
The findings are the most significant since the groundbreaking 2002 release of the International Subarachnoid Aneurysm Trial (ISAT) that established coiling as a safe and effective treatment. This study is regarded as highly valuable because it includes a combination of a large patient population and lengthy post-procedure follow-up, something other post-ISAT studies have not featured.
This retrospective analysis includes 154 consecutive patients who underwent coiling over an 11-year period (January 1995 - August 2006) on aneurysms on the tip of the basilar artery, located in front of the brain stem. About 8 percent of brain aneurysm are basilar tip aneurysms, which pose particular difficulties as their position deep in the brain makes a traditional, open neurosurgical approach more dangerous for the patient. Coiling, achieved by placing a mesh of platinum wires in the aneurysm prevents the aneurysm from rupturing.
Of the 154 patients undergoing the procedure, 114 (or 74 percent) of the aneurysms had ruptured and 40 (or 26 percent) had not. Following treatment, 144 surviving patients received clinical follow-up up to 144 months, adding up to a total of 637 patient years. Angiographic follow-up (actually viewing the site of the aneurysm using X-ray and MRI technology) conducted on 138 patients up to 122 months revealed that 27 aneurysms (17.5 percent) re-opened over time; these patients underwent additional coiling. Of this number, 11 aneurysms repeatedly re-opened and were coiled up to a total of six times. Re- bleeding occurred in only two patients, indicating an overall annual risk of 0.3 percent for re-bleeding after treatment. In all cases, aneurysm size greater than 10 mm was the only significant predictor for re-treatment at follow-up.
Approximately 2 million people in the United States have an unruptured aneurysm. It is estimated that approximately 30,000 Americans suffer from subarachnoid hemorrhage each year.