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Research ArticleInterventional

Packing Density Necessary to Reach a High Complete Occlusion Rate in Circumferential Unruptured Intracranial Aneurysms Treated with Stent-Assisted Coil Embolization

R.T. Tosello, U.C. Batista, B.J.A. Pereira and R.L. Piske
American Journal of Neuroradiology October 2017, 38 (10) 1973-1977; DOI: https://doi.org/10.3174/ajnr.A5303
R.T. Tosello
aFrom the Centro de Neuro-Angiografia, Hospital Beneficência Portuguesa de São Paulo-SP, Paulo-SP, Brazil.
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  • ORCID record for R.T. Tosello
U.C. Batista
aFrom the Centro de Neuro-Angiografia, Hospital Beneficência Portuguesa de São Paulo-SP, Paulo-SP, Brazil.
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B.J.A. Pereira
aFrom the Centro de Neuro-Angiografia, Hospital Beneficência Portuguesa de São Paulo-SP, Paulo-SP, Brazil.
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R.L. Piske
aFrom the Centro de Neuro-Angiografia, Hospital Beneficência Portuguesa de São Paulo-SP, Paulo-SP, Brazil.
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Abstract

BACKGROUND AND PURPOSE: This study is a homogeneous series of circumferential unruptured intracranial aneurysms with large necks treated with stent-assisted coil embolization. Our purpose was to demonstrate which value of packing density is required to produce a durable occlusion.

MATERIALS AND METHODS: We retrospectively evaluated all patients with unruptured intracranial aneurysms who were treated with stent-assisted coil embolization having late angiographic control between 2004 and 2014, in a single large cerebrovascular referral center. To calculate the packing density, aneurysm volume, and coil volume, we used an on-line system.

RESULTS: In 49 circumferential unruptured intracranial aneurysms treated with stent-assisted coil embolization, 38.7% (n = 19) had complete occlusion in the immediate control. Of those with incomplete occlusion, 80% (n = 24) progressed to complete occlusion in the late angiographic follow-up. At late angiographic control, 87.7% (n = 43) of aneurysms were completely occluded. All aneurysms with a packing density of ≥19% were completely occluded. Packing density was the only statistically significant predictor of complete occlusion. None of the aneurysms with complete occlusion at immediate control or at late angiographic control had recurrence.

CONCLUSIONS: In circumferential aneurysms treated with stent-assisted coil embolization, packing density is the main predictor of complete occlusion. In this type of aneurysm, a packing density of ≥19% was enough to reach complete occlusion; knowing this is important to avoid higher packing densities that have more risk.

ABBREVIATIONS:

PD
packing density
SACE
stent-assisted coil embolization
UIA
unruptured intracranial aneurysm
  • © 2017 by American Journal of Neuroradiology
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American Journal of Neuroradiology: 38 (10)
American Journal of Neuroradiology
Vol. 38, Issue 10
1 Oct 2017
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Packing Density Necessary to Reach a High Complete Occlusion Rate in Circumferential Unruptured Intracranial Aneurysms Treated with Stent-Assisted Coil Embolization
R.T. Tosello, U.C. Batista, B.J.A. Pereira, R.L. Piske
American Journal of Neuroradiology Oct 2017, 38 (10) 1973-1977; DOI: 10.3174/ajnr.A5303

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Packing Density Necessary to Reach a High Complete Occlusion Rate in Circumferential Unruptured Intracranial Aneurysms Treated with Stent-Assisted Coil Embolization
R.T. Tosello, U.C. Batista, B.J.A. Pereira, R.L. Piske
American Journal of Neuroradiology Oct 2017, 38 (10) 1973-1977; DOI: 10.3174/ajnr.A5303
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