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Progressive Occlusion of Small Saccular Aneurysms Incompletely Occluded After Stent-Assisted Coil Embolization

Analysis of Related Factors and Long-Term Outcomes
  • Jeong Wook Lim
  • Jeongjun Lee
  • Young Dae Cho
Original Article

Abstract

Purpose

Incompletely occluded aneurysms after coil embolization are subject to recanalization but occasionally progress to a totally occluded state. Deployed stents may actually promote thrombosis of coiled aneurysms. We evaluated outcomes of small aneurysms (<10 mm) wherein saccular filling with contrast medium was evident after stent-assisted coiling, assessing factors implicated in subsequent progressive occlusion.

Methods

Between September 2012 and June 2016, a total of 463 intracranial aneurysms were treated by stent-assisted coil embolization. Of these, 132 small saccular aneurysms displayed saccular filling with contrast medium in the immediate aftermath of coiling. Progressive thrombosis was defined as complete aneurysmal occlusion at the 6‑month follow-up point. Rates of progressive occlusion and factors predisposing to this were analyzed via binary logistic regression.

Results

In 101 (76.5%) of the 132 intracranial aneurysms, complete occlusion was observed in follow-up imaging studies at 6 months. Binary logistic regression analysis indicated that progressive occlusion was linked to smaller neck diameter (odds ratio [OR] = 1.533; p = 0.003), hyperlipidemia (OR = 3.329; p = 0.036) and stent type (p = 0.031). The LVIS stent is especially susceptible to progressive thrombosis, more so than Neuroform (OR = 0.098; p = 0.008) or Enterprise (OR = 0.317; p = 0.098) stents. In 57 instances of progressive thrombosis, followed for ≥12 months (mean 25.0 ± 10.7 months), 56 (98.2%) were stable, with minor recanalization noted once (1.8%) and no major recanalization.

Conclusion

Aneurysms associated with smaller diameter necks, hyperlipidemic states and LVIS stent deployment may be inclined to possible thrombosis, if occlusion immediately after stent-assisted coil embolization is incomplete. In such instances, excellent long-term durability is anticipated.

Keywords

Aneurysm Coil embolization Stent Recanalization Progressive occlusion 

Notes

Conflict of interest

J.W. Lim, J. Lee and Y.D. Cho declare that they have no competing interests.

Supplementary material

62_2017_612_MOESM1_ESM.docx (13 kb)
Supplemental TABLE. Logistic regression model assessing the risk of progressive thrombosis in coiled aneurysms with stent

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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Department of Neurosurgery, Chungnam National University HospitalChungnam National University College of MedicineDaejeonKorea (Republic of)
  2. 2.Department of Radiology, Seoul National University HospitalSeoul National University College of MedicineJongno-gu, SeoulKorea (Republic of)

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