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AJNR - American Journal of Neuroradiology

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Endovascular Treatment of Intracranial Wide-Necked Aneurysms Using Three-Dimensional Coils: Predictors of Immediate Anatomic and Clinical Results

Jean-Noël Vallée^a, Laurent Pierot^b, Alain Bonafé^c, Francis Turjman^d, Pierre Flandroy^e, Jérôme Berge^f, Georges Rodesch^g and Serge Bracard^h

^a Department of Diagnostic and Interventional Neuroradiology, Hôpital la Pitié-Salpétrière, Paris, France
^b Department of Radiology, Hôpital Maison Blanche, Reims, France
^c Department of Diagnostic and Interventional Neuroradiology, Hôpital Gui de Chauillac, Montpellier, France
^d Department of Diagnostic and Interventional Neuroradiology, Hôpital Neurologique, Lyon, France
^e Department of Diagnostic and Interventional Neuroradiology, Centre Hospitalier, Liège, Belgique
^f Department of Diagnostic and Interventional Neuroradiology, Groupe Hospitalier Pellegrin, Bordeaux, France
^g Department of Diagnostic and Interventional Neuroradiology, Hôpital Fosch, Paris, France
^h Department of Diagnostic and Interventional Neuroradiology, Hôpital Neurologique, Nancy, France

View larger version (130K): [in a new window]   FIG 1. Pre- and posttreatment images of an unruptured intracranial aneurysm in a 46-year-old woman who underwent occlusion with 3D Micrus coils. A and B, Lateral (A) and anteroposterior (B) 3D angiograms of the right internal carotid artery show a periophthalmic aneurysm with a maximum sac size of 9 mm and a neck size of 6 mm. C and D, Lateral road mapping image (C) and oblique unsubtracted angiogram (D) of the right internal carotid artery after placement of the first spherical coil (9-mm coil loop diameter) show that the 3D configuration of the coil provides an anatomically compliant frame within the aneurysm and a scaffold that covers the neck. E and F, Lateral (E) and anteroposterior (F) subtracted posttreatment angiograms show complete occlusion of the aneurysm.

View larger version (33K): [in a new window]   FIG 2. Graph shows percentage of aneurysms according to degree of angiographic aneurysmal occlusion at completion of the initial endovascular treatment, in group A ([dark gray bars] aneurysms with a neck 4 mm) and group B ([medium gray bars] aneurysms with a neck >4 mm). Degree of angiographic occlusion was not significantly different between the two groups (P = .696).

View larger version (51K): [in a new window]   FIG 3. Graph shows percentage of completely occluded aneurysms according to sac size at completion of the initial endovascular treatment in group A (neck 4 mm) and group B (neck >4 mm). Black bars indicate sac size <5 mm; dark gray bars, sac size 5–10 mm; medium gray bars, sac size 10–15 mm; light gray bars, sac size 15–25 mm.

View larger version (47K): [in a new window]   FIG 4. Graph shows percentage of completely occluded aneurysms according to sac-to-neck size ratio at completion of the initial endovascular treatment in group A (neck 4 mm) and group B (neck >4 mm). Dark gray bars indicate ratio 3; medium gray bars, ratio 1.5–3; light gray bars, ratio <1.5.

View larger version (50K): [in a new window]   FIG 5. Graph shows the mean percentage of volumic aneurysmal occlusion according to degree of angiographic occlusion at completion of the initial endovascular treatment in group A (neck 4 mm) and group B (neck >4 mm). Percentage of volumic occlusion was not significantly different between the two groups (P = .247). Dark gray bars indicate complete occlusion; medium gray bars, near complete occlusion; light gray bars, incomplete occlusion.

View larger version (50K): [in a new window]   FIG 6. Graph shows the mean percentage of volumic aneurysmal occlusion according to sac size at completion of the initial endovascular treatment in group A (neck 4 mm) and group B (neck >4 mm). Black bars indicate sac size <5 mm; dark gray bars, sac size 5–10 mm; medium gray bars, sac size 10–15 mm; light gray bars, sac size 15–20 mm.

View larger version (56K): [in a new window]   FIG 7. Graph shows the mean percentage of volumic aneurysmal occlusion according to the sac-to-neck size ratio at completion of the initial endovascular treatment in group A (neck 4 mm) and group B (neck >4 mm). Dark gray bars indicate ratio 3; medium gray bars, ratio 1.5–3; light gray bars, ratio <1.5.