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The authors evaluated a total of 426 unruptured aneurysms and 169 ruptured aneurysms that underwent coil embolization in their institution between January 2009 and December 2017. Recanalization occurred in 38 (8.9%) of 426 unruptured aneurysms and 37 (21.9%) of 169 ruptured aneurysms. The Modified Raymond-Roy Classification on DSA was used to categorize the recanalization type. In untreated recanalized aneurysms, class IIIb aneurysms ruptured significantly more frequently than class II and IIIa. In the ruptured group, the median follow-up term was 28.0 months. Retreatment for recanalization was performed in 16 aneurysms. Four of 21 untreated recanalized aneurysms (2.37% of total coiled aneurysms) ruptured. Class IIIb aneurysms ruptured significantly more frequently than class II and IIIa. Coiled aneurysms with class IIIb recanalization should undergo early retreatment because of an increased rupture risk.

This study included 520 consecutive patients with a clinical diagnosis of acute ischemic stroke (49.4% men; mean age, 72 years) who underwent CTA to evaluate large-vessel occlusion of the proximal anterior circulation. CTA scans were retrospectively reviewed by a consensus panel of 2 neuroradiologists. The prevalence of large-vessel occlusion was 16% (84/520 patients); 20% (17/84) of large-vessel occlusions were missed atthe initial CTA evaluation. In multivariate analysis, non-neuroradiologists were more likely to miss large-vessel occlusion compared with neuroradiologists, and occlusions of the M2 segment were more likely to be missed compared with occlusions of the distal internal carotid artery and/or M1 segment. Calcified emboli were present in 4 of 17 (24%) initially missed or misinterpreted large-vessel occlusions.