Three-dimensional aneurysm volume measurements show no correlation between coil packing density and recurrence

Abstract

Objective Endovascular treatment is the mainstay therapy for brain aneurysms. About 15% of patients need re-treatment within six months due to early recanalization. In this study, we investigate risk factors associated with treatment failure. Methods This retrospective cohort study includes endovascularly treated aneurysm cases between July 2012 and December 2015 at the University of California Davis Medical Center with pre-treatment and early post-treatment imaging. Thin cut 3D aneurysm volume rendering was used for morphologic analyses. Univariate and bivariate analyses were conducted to evaluate differences between patients and clinical factors by treatment failure. Results Of the 50 patients who met the inclusion criteria, 41 (82.0%) were female, with an average age of 61 years. Most aneurysms were on the anterior communicating artery (40%) or posterior communicating artery (22.0%), and 34 (68%) aneurysms were ruptured. Early treatment failure was observed in 14 (28.0%) of endovascularly treated patients. Raymond-Roy class (RRC) was significantly associated with treatment failure (p = 0.0052), with 10 out of the 14 cases (71.4%) with early recanalization having an RRC of 3. Coil packing density did not associate with aneurysm recanalization (p = 0.61). Conclusion In our single institution series, patient characteristics, aneurysm characteristics, or coil packing density did not affect early aneurysm recanalization. RRC was the best predictor of early recanalization; however, further confirmation with additional studies are required. Although this study focused on early treatment failure, late recanalization has been shown with longer follow up. Further investigation into factors associated with late treatment failure will need further investigation. New intrasaccular devices and flow diverters will also likely play a role in reducing recurrence in the future as these treatments gain usage.

Mid-term safety and efficacy in small intracranial aneurysm coiling: results from TARGET® nano prospective independent core lab adjudicated multicenter registry

“…However, treatment with ≥2/3 Nano coils did result in a higher packing density. The relationship between packing density and recurrence is currently being debated in the literature, but historically has been thought to be inversely related to aneurysm recurrence ( 21 , 22 ). The ULTRA registry’s core lab reported a major recurrence rate of 13% between 6 and 9 months, of which 10% required retreatment ( 9 ).…”

“…A total of 12 clinical sites within the United States with active IRB approval to participate in the TARGET Registry with 11 centers enrolling at least 1 patient, the median [IQR] aneurysms per clinical site was 12 [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Mercy St. Vincent Medical Center, Toledo, Ohio served as the coordinating center for TARGET Nano Registry.…”

Small Number of Coils With Extended Length in the Endovascular Treatment of Cerebral Aneurysm: Experience of 108 Cases in a Single-Center

“…The number of coils needed in the endovascular treatment of aneurysms is influenced by several factors, such as coil length, thickness, type, aneurysmal shape, as well as operator's skill and experience [7,15]. Endovascular treatment with larger coils can prevent failure in the complete occlusion of aneurysms, and a stiffer framing coil or a larger coil diameter can help prevent aneurysm recanalization [16,17]. The percentage of framing coil from total coil volume has been demonstrated to be a statistically significant predictor of aneurysm recurrence post-coiling [18].…”