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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 28:1395-1400, August 2007
DOI 10.3174/ajnr.A0542
© 2007 American Society of Neuroradiology

INTERVENTIONAL

Complex-Shaped Platinum Coils for Brain Aneurysms: Higher Packing Density, Improved Biomechanical Stability, and Midterm Angiographic Outcome

A.K. Wakhloo^a,b,c, M.J. Gounis^a, J.S. Sandhu^d, N. Akkawi^a, A.E. Schenck^d and I. Linfante^a,c

^a Department of Radiology, University of Massachusetts Medical School, Worcester, Mass
^b Department of Neurosurgery, University of Massachusetts Medical School, Worcester, Mass
^c Department of Neurology, University of Massachusetts Medical School, Worcester, Mass
^d Department of Radiology, University of Miami, Miami, Fla

Address correspondence to Ajay K. Wakhloo, Division of Neuroimaging and Intervention, Departments of Radiology and Neurological Surgery, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA 02481; e-mail: wakhlooA{at}ummhc.org

BACKGROUND AND PURPOSE: Five to 60% of coiled brain aneurysms recanalize, generally because of coil compaction. In vitro exclusive use of complex-shaped coils allows better packing of the aneurysmal sac and the neck as compared with helical coils. We report a single-center, prospective study using complex coils. Safety, packing density, and recanalization rate were evaluated.

MATERIALS AND METHODS: Seventy-seven aneurysms were embolized using complex coils alone. Aneurysms had a volume of 265 mm³ (diameter: 7.1 ± 3.3 mm) and a neck size of 4.1 ± 1.8 mm (range: 1.5–12 mm). Average follow-up available in 31 patients was 10.5 ± 7.6 months (range: 3–36 months). Primary angiographic endpoints included aneurysmal recanalization and (re)rupture. Primary adverse events included stroke or death.

RESULTS: Complete or near-complete occlusion was achieved in all of the aneurysms but required balloon assistance in 24.6%. The packing density was computed as 37% ± 13%. No rerupture was observed during the follow-up interval. Recanalization was seen in 4 (12.9%) of 31. Two basilar tip aneurysms underwent a safe and complete recoiling. Periprocedural nondevice-related neurologic deficits were seen in 2 (2.9%) of 69 patients.

CONCLUSIONS: The use of complex-shaped coils allows higher packing density, which may improve the recanalization rate. Basilar tip aneurysms remain a challenge.