AJDRAJNR - American Journal of Neuroradiology

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Factors Influencing Successful Angiographic Occlusion of Aneurysms Treated by Coil Embolization

J. K. Ayton HopeGo,a, James V. Byrnea and Andrew J. Molyneuxa

a From the Department of Neuroradiology (J.K.A.H., J.V.B., A.J.M.), Radcliffe Infirmary, Oxford, England; and the Department of Neuroradiology, Auckland Public Hospital, Auckland, New Zealand (J.K.A.H.).



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FIG 1. Aneurysmal growth.

A, Pretreatment angiogram of a large, wide-necked, basilar sidewall aneurysm occurring as a mass lesion. This image is traced onto calibrated paper, with the margins of the aneurysmal lumen delineated in D as the solid black line. From the tracing, and using the linear reference value "D," luminal size "A," luminal width "B," and neck size "C" are calculated (as shown in D).

B, Posttreatment angiogram after coil placement. This image was used to trace the margin of the coil ball in D and to calculate the percentage of occlusion (94%) and rest size ("E " in D).

C, Follow-up angiogram at 10 months shows aneurysmal growth. After tracing this image, the new aneurysmal lumen is delineated by the outer gray line in D. The compacted coil-ball mass is now delineated by the oblique lines.

D, Traced superimposed representations of A–C (artist's rendition). For clarity, only the 1-cm grid lines are portrayed (a portion of the figure shows the 1-mm calibrations as a reference). The shaded area at the aneurysmal neck represents the residual uncoiled aneurysm. The area filled with oblique lines represents the compacted coil-ball mass. "D" is the linear reference value for the calculation of "A" (maximum luminal size, 20 mm), "B" (maximum luminal width, 12.7 mm), "C" (neck size, 4.8 mm), and "E" (rest size after treatment, 5.2 mm).



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FIG 2. Coil compaction.

A, Pretreatment angiogram.

B, Posttreatment angiogram.

C, Follow-up angiogram at 7 months of a wide-necked (4.6 mm) carotid termination aneurysm.

D, Traced image (artist's rendition) derived from A, B, and C. The shaded area represents the residual uncoiled lumen at the time of treatment. The area filled by oblique lines is the additional lumen exposed by coil compaction. This is an example of initial treatment success (rest size < 2 mm) converting to failure at follow-up (rest size = 3.4 mm). For clarity, only the 1-cm calibrations have been rendered, with a portion of the figure showing the full 1-mm grid lines. "D" = linear reference diameter; "A" = luminal size (12.2 mm); "B" = luminal width (8.6 mm); "C" = neck size (4–6 mm); "E" = rest size at follow-up (3.4 mm).



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FIG 3. Illustration showing the sometimes poor correlation between percentage of occlusion and rest size (length of exposed aneurysmal wall after coiling). Aneurysms 1 through 4 are identical tracings. Aneurysm 1 has 100% occlusion and no rest. Aneurysms 2 through 4 all have 95% occlusion, but quite different rest sizes. The largest rest is in aneurysm 3 and the smallest in aneurysm 2. Aneurysm 5 is a magnified image of aneurysm 4, with the same percentage of occlusion but a larger rest size