Systemic Hypertension and Predictors of Recanalization After Endovascular Coil Embolization of Intracranial Aneurysms: A Retrospective Cohort Study

Objective: Systemic hypertension is a well-established risk factor for the development, growth, and rupture of intracranial aneurysms. However, its association with aneurysm recanalization after endovascular coil embolization remains unclear. This study aimed to evaluate the relationship between systemic hypertension and recanalization after coil embolization, and to identify additional risk factors associated with recanalization. Methods: We retrospectively analyzed 226 patients with 239 intracranial aneurysms treated by endovascular coil embolization between January 2010 and December 2017. Clinical, angiographic, and procedural variables were assessed. Hypertension was defined according to the Korean Society of Hypertension criteria based on a documented diagnosis or regular antihypertensive treatment. Radiological follow-up was performed primarily with magnetic resonance angiography, with digital subtraction angiography findings reviewed when available. Recanalization was assessed using the Raymond–Roy classification. Hierarchical multivariable logistic regression models were constructed using clinically selected covariates. Results: Of 239 aneurysms, 171 (71.5%) were treated in patients with hypertension, and recanalization occurred in 76 (31.8%) during a mean follow-up of 30.9 ± 14.0 months. Hypertension was not independently associated with recanalization (adjusted odds ratio (OR), 0.929; 95% confidence interval (CI), 0.447–1.930; p = 0.843). Ruptured presentation, larger aneurysm size, lower packing density, and an initial residual sac were independently associated with recanalization. Conclusions: Clinically defined systemic hypertension was not independently associated with recanalization after coil embolization. Ruptured presentation, larger aneurysm size, lower packing density, and an initial residual sac were independently associated with recurrence and may help inform post-treatment surveillance.