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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.

In Part I of this study, articles reporting the reliability of CTA up to May 2018 were systematically searched and evaluated. In Part II, 11 raters independently graded 17 arterial segments in each of 50 patients with SAH for the presence of vasospasm using a 4-category scale. Raters were additionally asked to judge the presence of any moderate/severe vasospasm and whether findings would justify augmentation of medical treatment or conventional angiography ± balloon angioplasty. The systematic review revealed few studies with heterogeneous vasospasm definitions. In Part II, the authors found interrater reliability to be moderate at best (ϰ > 0.6), even when results were stratified according to specialty and experience. They conclude that the diagnosis of vasospasm using CTA alone was not sufficiently repeatable among observers to support its general use to guide decisions in the clinical management of patients with SAH.