Postcoil Followupcoil Compression And Recanalization

Recurrent hemorrhage in the case of incompletely treated aneurysms is well known. A study of occlusion stability and long-term efficacy versus rebleeding in aSAH patients who were initially successfully treated with coil embolization discovered rebleeding in 7.9% of patients with recurrent aneurysms, and one case (0.4%) of rebleeding in patients who were stable by angiography, demonstrating the need for periodic follow-up angiography in order to identify patients with aneurysmal recurrence and high risk of rebleeding (124 ).

Despite posttreatment angiography, which demonstrates total aneurysmal occlusion, rebleeding is still a very real possibility. Recurrent aneurysms can be due to coil compaction, migration, or dislocation. Seven patients, 4 of whom received coiling, experienced recurrent aneurysmal ruptures, with a mean latency of 9.5 months from initial treatment (125 ). Several other cases have been reported in which rerupture of aneurysms occurred months to years after embolization—in some cases, despite angiographic occlusion on immediate post-procedural and 6-month angiographies (126). Reperfusion of the aneurysmal neck after coiling is not a rare complication and often necessitates renewed intervention (127). One study found major aneurysmal recurrences in 20.7% of coiled patients that appeared at a mean of 16.49 months after treatment, a small percentage of whom bled at a mean of 31.32 months after treatment (128). Because additional coiling of previously coiled aneurysms has a low procedural complication rate and decreases the risk of rebleeding (129), long-term monitoring of patients treated by endosaccular coiling is important to ensure optimal patient care.

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