Factors Influencing Successful Angiographic Occlusion of Aneurysms Treated by Coil Embolization

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).