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Importance of the First Coil in the Embolization of Intracranial Aneurysms

A Case Control Study

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Abstract

Purpose

Endovascular therapy for the treatment of cerebral aneurysms has a higher incidence of rebleeding and a lower occlusion rate than microsurgical clipping. This study investigated whether first coil volume packing density (1st VPD) and first loop diameter of the first coil (1st LD) are associated with recanalization after endovascular coiling.

Methods

The study included 174 initial saccular aneurysm cases from 2010 to 2015. Between the recanalization and non-recanalization groups, we compared age, sex, aneurysm location, rupture occurrence, shape, maximum aneurysm size, neck width, dome-to-neck ratio, aneurysm volume, coil volume, VPD, 1st VPD, 1st LD, relation of the first loop diameter of the first coil and the maximum aneurysm size (RLAS), types of assistance techniques, and the Raymond scale score at initial and follow-up angiography.

Results

Recanalization occurred in 41 cases (23.6%). The factors associated with recanalization were irregular shape, maximum aneurysm size, neck width, dome-to-neck ratio, aneurysm volume, VPD, 1st VPD and 1st LD smaller than the maximum aneurysm size. The cut-off values for aneurysmal recanalization were 92%, 11% and 37% for RLAS, 1st VPD and VPD, respectively.

Conclusion

The 1st VPD and 1st LD were associated with aneurysmal recanalization after embolization. These factors provide a helpful index for coil programming.

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Authors and Affiliations

  1. Universidade de Brasília (UNB), Brasília, Brazil

    Emerson Brandão Sousa & Iruena Moraes Kessler

  2. Fundação Municipal de Saúde, Teresina, Brazil

    Laise Franco de Sousa Brandão

  3. Hospital São Marcos, Teresina, Brazil

    Emerson Brandão Sousa, Cléciton Braga Tavares & José Nazareno Pearce de Oliveira Brito

  4. Unidade do Sistema Neuromuscular, Hospital Universitário do Piauí, Campus Universitário Ministro Petrônio Portela, SG07, s/n, Ininga, 64049-550, Teresina, PI, Brazil

    Emerson Brandão Sousa

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  1. Emerson Brandão Sousa
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  2. Laise Franco de Sousa Brandão
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Correspondence to Emerson Brandão Sousa.

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Conflict of interest

E.B. Sousa, L.F. de S. Brandão, C.B. Tavares, J.N.P. de O. Brito and I.M. Kessler declare that they have no conflicting interests.

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Sousa, E.B., Brandão, L.F.d., Tavares, C.B. et al. Importance of the First Coil in the Embolization of Intracranial Aneurysms. Clin Neuroradiol 29, 733–740 (2019). https://doi.org/10.1007/s00062-018-0710-4

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  • DOI: https://doi.org/10.1007/s00062-018-0710-4

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