126 Chapter 7 H I Figure 4. 45-year-old woman with late reopening of a previously ruptured basilar tip aneurysm. A and B. Anteroposterior and lateral DSA projection at presentation shows a 6-mm basilar tip aneurysm C and D. Directly after coiling DSA shows adequate aneurysm occlusion E and F. Stable complete occlusion at 6-month follow-up DSA G. MRA 5 years after coiling still shows a complete occlusion of the aneurysm, with signal loss due to coil mass (arrow) H and I. Source image and volume rendered 3D image of MRA 9 years after coiling shows 2mm aneurysm reopening at right of coil mass (arrow) Table 3. Details of MUMC patients and aneurysms in present study with late reopening Aneurysm Size Previous Size Retreat- No M/F Age location mm rupture reopening (mm) ment 1 F 42 PcomA 5 Y 4x3 N§ 2 F 61 SCA 10 Y 9x7 N§ 3 F 45 Basilar tip 7 Y 1x2 N* PcomA: Posterior Communicating Artery, SCA: Superior Cerebellar Artery, Y: yes, N: no § Patient refused retreatment * Retreatment not judged indicated by multidisciplinary team All three recanalized aneurysms had been judged as completely occluded at the end of the coiling procedure and at six months follow-up. None of the 17 residual neck aneurysms seen at six months follow-up showed further recanalization at late follow-up (Table 4). Table 4. Two by two table comparing aneurysm occlusion status (R&R class) at six months follow-up with adequacy of occlusion at long term follow-up in the present study. Occlusion at long term follow-up Adequate (1 or 2) Inadequate (3) Occlusion at six Complete (1) 51 3 54 months Incomplete (2) 17 0 17 68 3 71 This is in concordance with the data from the multicenter LOTUS study: of 325 aneurysms the initial and six months occlusion status were specified according to the R&R classification. (Table 5). No correlation
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