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The role of coil packing density in stable occlusion of intracranial aneurysms treated with balloon or stent-assistance

Year 2020, Volume: 45 Issue: 2, 408 - 413, 30.06.2020
https://doi.org/10.17826/cumj.689986

Abstract

Purpose: Many studies are showing that coil package density (CPD) is an important predictive factor in intracranial aneurysm recurrence. In this study, we aimed to show the role of CPD in aneurysm stable occlusion according to the endovascular technique used in the treatment.
Materials and Methods: Retrospective analysis of 31 intracranial aneurysms in 30 patients treated with the balloon or stent-assisted coil embolization was made between 2018-2019. After the treatment, Raymond-Roy classification was used for aneurysm occlusion assessment. AngioCalc cerebral and peripheral aneurysm calculator was used for the assess packing density of the treated aneurysms.
Results: Thirty-one intracerebral aneurysms in 30 patients were included in the study. The number of aneurysms with balloon-assisted coil embolization was 18, while the number of aneurysms with stent-assisted embolization was 13. Recanalization was detected in the control image of 38.8% of patients in the balloon group and 7.7% of patients in the stent group. In our study, mortality was not observed, and the morbidity rate was 3.3%.
Conclusion: CPD is a significant factor in providing Raymond-Roy Class 1 aneurysm occlusion. However, as the aneurysm volume increases in size, it becomes difficult to achieve high CPD, which increases the risk of recanalization. Studies with a larger patient group could show that the use of stents reduces the risk of recurrence in aneurysms treated with stent assistance.

References

  • 1. Dengler J, Maldaner N, Glasker S, Endres M, Wagner M, Malzahn U, et al. Outcome of surgical or endovascular treatment of giant intracranial aneurysms, with emphasis on age, aneurysm location, and unruptured aneurysms—a systematic review and meta-analysis. Cerebrovasc Dis 2016;41:187–98.
  • 2. Hauck EF, Welch BG, White JA, Replogle RE, Purdy PD, Pride LG, et al. Stent/coil treatment of very large and giant unruptured ophthalmic and cavernous aneurysms. Surg Neurol 2009;71:19–24.
  • 3. Cognard C, Weill A, Spelle L, Piotin M, Castaings L, Rey A, et al. Long-term angiographic follow-up of 169 intracranial berry aneurysms occluded with detachable coils. Radiology 1999; 212:348-56.
  • 4. Murayama Y, Nien YL, Duckwiler G, Gobin YP, Jahan R, Frazee J, et al. Guglielmi detachable coil embolization of cerebral aneurysms: 11 years' experience. J Neurosurg 2003; 98:959–66.
  • 5. Raymond J, Guilbert F, Weill A, Georganos SA, Juravsky L, Lambert A, et al. Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 2003; 34:1398–403.
  • 6. Kai Y, Hamada J, Morioka M, Yano S, Kuratsu JI. Evaluation of the stability of small ruptured aneurysms with a small neck after embolization with Guglielmi detachable coils: correlation be- tween coil packing ratio and coil compaction. Neurosurgery 2005; 56:785–92.
  • 7. Yagi K, Satoh K, Satomi J, Matsubara S, Nagahiro S. Evaluation of aneurysm stability after endovascular embolization with Guglielmi detachable coils: correlation between long-term stability and volume embolization ratio. Neurol Med Chir (Tokyo) 2005; 45:561–65.
  • 8. Guglielmi G, Viñuela F, Sepetka I, Macellari V. Electrothrombosis of saccular aneurysms via endovascular approach. Part 1: electro- chemical basis, technique, and experimental results. J Neurosurg 1991; 75(1):1–7.
  • 9. Guglielmi G, Viñuela F, Dion J, Duckwiler G. Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: preliminary clinical experience. J Neurosurg 1991; 75(1):8–14.
  • 10. Johnston SC, Dowd CF, Higashida RT, Lawton MT, Duckwiler GR, Gress DR. Predictors of rehemorrhage after treatment of ruptured intracranial aneurysms: the cerebral aneurysm rerupture after treatment (CARAT) study. Stroke 2008; 39:120–25.
  • 11. Sluzewski M, van Rooij WJ, Slob MJ, Bescós JO, Slump CH, Wijnalda D. Relation between aneurysm volume, packing, and compaction in 145 cerebral aneurysms treated with coils. Radiology 2004; 231:653–58.
  • 12. Piotin M, Spelle L, Mounayer C, Salles-Rezende MT, Giansante-Abud D, Vanzin-Santos R, et al. Intra- cranial aneurysms: treatment with bare platinum coils—aneurysm packing, complex coils, and angiographic recurrence. Radiology 2007; 243:500–08.
  • 13. Grunwald IQ, Papanagiotou P, Struffert T, Politi M, Krick C, Gül G, et al. Recanalization after endovas- cular treatment of intracerebral aneurysms. Neuroradiology 2007; 49:41–7.
  • 14. Ries T, Siemonsen S, Thomalla G, Grzyska U, Zeumer H, Fiehler J. Long-term follow-up of cerebral aneurysms after endovascular therapy prediction and outcome of retreatment. AJNR Am J Neuroradiol 2007; 28:1755–61.
  • 15. Chalouhi N, Jabbour P, Singhal S, Drueding R, Starke RM, Dalyai RT, et al. Stent-assisted coiling of intracranial aneurysms: predictors of complications, recanalization, and outcome in 508 cases. Stroke 2013; 44:1348–53.
  • 16. Geyik S, Yavuz K, Yurttutan N, Saatci I, Cekirge HS. Stent-assisted coiling in endovascular treatment of 500 consecutive cerebral aneurysms with long-term follow-up. AJNR Am J Neuroradiol. 2013;34(11):2157-62.
  • 17. Johnson AK, Munich SA, Tan LA, Heiferman DM, Keigher KM, Lopes DK. Complication analysis in nitinol stent-assisted embolization of 486 intracranial aneurysms. J Neurosurg. 2015;123(2):453-59.
  • 18. Lawson MF, Newman WC, Chi YY, Mocco JD, Hoh BL. Stent-associated flow remodeling causes further occlusion of incompletely coiled aneurysms. Neurosurgery. 2011;69(3):598-603.
  • 19. Piotin M, Blanc R, Spelle L, Mounayer C, Piantino R, Schmidt PJ, Moret J. Stent-assisted coiling of intracranial aneurysms: clinical and angiographic results in 216 consecutive aneurysms. Stroke. 2010;41 (1):110-15.
  • 20. Tosello RT, Batista UC, Pereira BJA, Piske RL. Packing density necessary to reach a high complete occlusion rate in circumferential Unruptured intracranial aneurysms treated with stent-assisted coil embolization. American Journal of Neuroradiology, 2017; 38(10), 1973-77.
  • 21. Iosif C, Biondi A. Braided stents and their impact in intracranial aneurysm treatment for distal locations: from flow diverters to low profile stents. Expert review of medical devices, 2019; 16(3), 237-51.
  • 22. Akmangit, I., Aydin K, Sencer S, Topcuoglu OM, Topcuoglu ED, Daglioglu E, et al. Dual stenting using low-profile LEO baby stents for the endovascular management of challenging intracranial aneurysms. American Journal of Neuroradiology, 2015;36(2), 323-29.
  • 23. White PM, Lewis SC, Gholkar A, Sellar RJ, Nahser H, Cognard C, et al. Hydrogel-coated coils versus bare platinum coils for the endovascular treatment of intracranial aneurysms (HELPS): a randomised controlled trial. The Lancet, 2011;377(9778), 1655-62.
  • 24. Sadato A, Adachi K, Hayakawa M, Kato Y, Hirose Y. Effects of anatomic characteristics of aneurysms on packing density in endovascular coil embolization: analysis of a single center’s experience. Neurosurgical review, 2016; 39(1), 109-14.

Balon ya da stent yardımlı intrakranial anevrizma tedavisi stabil okluzyonunda koil paket dansitesinin rolü

Year 2020, Volume: 45 Issue: 2, 408 - 413, 30.06.2020
https://doi.org/10.17826/cumj.689986

Abstract

Amaç: Koil paket dansitesinin (KPD) intraktaniyal anevrizma nüksünde önemli bir prediktif faktör olduğu ile ilgili birçok çalışma vardır. Çalışmamızda KPD yoğunluğunun tedavide kullanılan endovasküler tekniğe göre, anevrizma stabil okluzyonundaki rolünü göstermeyi amaçladık.
Gereç ve Yöntem: 2018-2019 tarihleri arasında balon ya da stent yardımlı koil embolizasyon ile tedavi edilmiş anevrizmaların retrospektif analizi yapıldı. Tedavi sonrası anevrizma okluzyon değerlendirmesinde Raymond-Roy sınıflaması, anevrizmaların paketleme yoğunluğu için ise AngioCalc serebral ve periferik anevrizma hesaplayıcısı kullanıldı.
Bulgular: Çalışmaya 30 hastadaki 31intraserebral anevrizma dahil edildi. Balon yardımlı koil embolizasyon yapılan anevrizma sayısı 18 iken, stent yardımlı embolizasyon yapılan anevrizma sayısı ise 13 idi. Yapılan kontrol görüntülemede balon yardımı kullanılan hastaların %38.8’inde, stent yardımı kullanılan hastaların ise %7.7’sinde rekanalizasyon saptandı. Çalışmamızda mortalite izlenmemiş olup, morbidite oranı %3.3 idi. 
Sonuç: KPD yoğunluğu, Raymond-Roy Class 1 anevrizma okluzyonu sağlamak için oldukça önemli bir faktördür. Bununla birlikte, anevrizma hacmi arttıkça, yüksek KPD sağlamak zorlaşmakta ve bu durum rekanalizasyon riskini arttırmaktadır. Daha büyük hasta grupları ve daha uzun süreli takipler ile yapılacak çalışmalar, stent yardımlı tedavi edilen anevrizmalarda, stent kullanımının da nüks riskini azalttığını gösterilebilir.

References

  • 1. Dengler J, Maldaner N, Glasker S, Endres M, Wagner M, Malzahn U, et al. Outcome of surgical or endovascular treatment of giant intracranial aneurysms, with emphasis on age, aneurysm location, and unruptured aneurysms—a systematic review and meta-analysis. Cerebrovasc Dis 2016;41:187–98.
  • 2. Hauck EF, Welch BG, White JA, Replogle RE, Purdy PD, Pride LG, et al. Stent/coil treatment of very large and giant unruptured ophthalmic and cavernous aneurysms. Surg Neurol 2009;71:19–24.
  • 3. Cognard C, Weill A, Spelle L, Piotin M, Castaings L, Rey A, et al. Long-term angiographic follow-up of 169 intracranial berry aneurysms occluded with detachable coils. Radiology 1999; 212:348-56.
  • 4. Murayama Y, Nien YL, Duckwiler G, Gobin YP, Jahan R, Frazee J, et al. Guglielmi detachable coil embolization of cerebral aneurysms: 11 years' experience. J Neurosurg 2003; 98:959–66.
  • 5. Raymond J, Guilbert F, Weill A, Georganos SA, Juravsky L, Lambert A, et al. Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 2003; 34:1398–403.
  • 6. Kai Y, Hamada J, Morioka M, Yano S, Kuratsu JI. Evaluation of the stability of small ruptured aneurysms with a small neck after embolization with Guglielmi detachable coils: correlation be- tween coil packing ratio and coil compaction. Neurosurgery 2005; 56:785–92.
  • 7. Yagi K, Satoh K, Satomi J, Matsubara S, Nagahiro S. Evaluation of aneurysm stability after endovascular embolization with Guglielmi detachable coils: correlation between long-term stability and volume embolization ratio. Neurol Med Chir (Tokyo) 2005; 45:561–65.
  • 8. Guglielmi G, Viñuela F, Sepetka I, Macellari V. Electrothrombosis of saccular aneurysms via endovascular approach. Part 1: electro- chemical basis, technique, and experimental results. J Neurosurg 1991; 75(1):1–7.
  • 9. Guglielmi G, Viñuela F, Dion J, Duckwiler G. Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: preliminary clinical experience. J Neurosurg 1991; 75(1):8–14.
  • 10. Johnston SC, Dowd CF, Higashida RT, Lawton MT, Duckwiler GR, Gress DR. Predictors of rehemorrhage after treatment of ruptured intracranial aneurysms: the cerebral aneurysm rerupture after treatment (CARAT) study. Stroke 2008; 39:120–25.
  • 11. Sluzewski M, van Rooij WJ, Slob MJ, Bescós JO, Slump CH, Wijnalda D. Relation between aneurysm volume, packing, and compaction in 145 cerebral aneurysms treated with coils. Radiology 2004; 231:653–58.
  • 12. Piotin M, Spelle L, Mounayer C, Salles-Rezende MT, Giansante-Abud D, Vanzin-Santos R, et al. Intra- cranial aneurysms: treatment with bare platinum coils—aneurysm packing, complex coils, and angiographic recurrence. Radiology 2007; 243:500–08.
  • 13. Grunwald IQ, Papanagiotou P, Struffert T, Politi M, Krick C, Gül G, et al. Recanalization after endovas- cular treatment of intracerebral aneurysms. Neuroradiology 2007; 49:41–7.
  • 14. Ries T, Siemonsen S, Thomalla G, Grzyska U, Zeumer H, Fiehler J. Long-term follow-up of cerebral aneurysms after endovascular therapy prediction and outcome of retreatment. AJNR Am J Neuroradiol 2007; 28:1755–61.
  • 15. Chalouhi N, Jabbour P, Singhal S, Drueding R, Starke RM, Dalyai RT, et al. Stent-assisted coiling of intracranial aneurysms: predictors of complications, recanalization, and outcome in 508 cases. Stroke 2013; 44:1348–53.
  • 16. Geyik S, Yavuz K, Yurttutan N, Saatci I, Cekirge HS. Stent-assisted coiling in endovascular treatment of 500 consecutive cerebral aneurysms with long-term follow-up. AJNR Am J Neuroradiol. 2013;34(11):2157-62.
  • 17. Johnson AK, Munich SA, Tan LA, Heiferman DM, Keigher KM, Lopes DK. Complication analysis in nitinol stent-assisted embolization of 486 intracranial aneurysms. J Neurosurg. 2015;123(2):453-59.
  • 18. Lawson MF, Newman WC, Chi YY, Mocco JD, Hoh BL. Stent-associated flow remodeling causes further occlusion of incompletely coiled aneurysms. Neurosurgery. 2011;69(3):598-603.
  • 19. Piotin M, Blanc R, Spelle L, Mounayer C, Piantino R, Schmidt PJ, Moret J. Stent-assisted coiling of intracranial aneurysms: clinical and angiographic results in 216 consecutive aneurysms. Stroke. 2010;41 (1):110-15.
  • 20. Tosello RT, Batista UC, Pereira BJA, Piske RL. Packing density necessary to reach a high complete occlusion rate in circumferential Unruptured intracranial aneurysms treated with stent-assisted coil embolization. American Journal of Neuroradiology, 2017; 38(10), 1973-77.
  • 21. Iosif C, Biondi A. Braided stents and their impact in intracranial aneurysm treatment for distal locations: from flow diverters to low profile stents. Expert review of medical devices, 2019; 16(3), 237-51.
  • 22. Akmangit, I., Aydin K, Sencer S, Topcuoglu OM, Topcuoglu ED, Daglioglu E, et al. Dual stenting using low-profile LEO baby stents for the endovascular management of challenging intracranial aneurysms. American Journal of Neuroradiology, 2015;36(2), 323-29.
  • 23. White PM, Lewis SC, Gholkar A, Sellar RJ, Nahser H, Cognard C, et al. Hydrogel-coated coils versus bare platinum coils for the endovascular treatment of intracranial aneurysms (HELPS): a randomised controlled trial. The Lancet, 2011;377(9778), 1655-62.
  • 24. Sadato A, Adachi K, Hayakawa M, Kato Y, Hirose Y. Effects of anatomic characteristics of aneurysms on packing density in endovascular coil embolization: analysis of a single center’s experience. Neurosurgical review, 2016; 39(1), 109-14.
There are 24 citations in total.

Details

Primary Language Turkish
Subjects Radiology and Organ Imaging
Journal Section Research
Authors

Yılmaz Önal 0000-0001-7703-141X

Murat Velioğlu 0000-0001-9384-2378

Publication Date June 30, 2020
Acceptance Date March 6, 2020
Published in Issue Year 2020 Volume: 45 Issue: 2

Cite

MLA Önal, Yılmaz and Murat Velioğlu. “Balon Ya Da Stent yardımlı Intrakranial Anevrizma Tedavisi Stabil Okluzyonunda Koil Paket Dansitesinin Rolü”. Cukurova Medical Journal, vol. 45, no. 2, 2020, pp. 408-13, doi:10.17826/cumj.689986.