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Acta Neurochirurgica

, Volume 155, Issue 2, pp 231–236 | Cite as

Aneurysm embolization grade: a predictive tool for aneurysm recurrence after coil embolization

  • Amit Singla
  • Mark R. Villwock
  • Walter Jacobsen
  • Eric M. DeshaiesEmail author
Clinical Article - Vascular

Abstract

Background

Coil embolization has gained importance in the management of intracranial aneurysms over the past decade. However, the recurrence risk after embolization mandates closer follow-up than surgical clip ligation. Currently, there is no reliable system for predicting aneurysm sac thrombosis. An aneurysm embolization grade (AEG) reported previously by the senior author (EMD) has been proposed as a tool for predicting the durability of aneurysm occlusion based on hemodynamic characteristics. Here, we present our internal validity results.

Methods

AEG and Raymond–Roy Occlusion Classification (RROC) scores were prospectively assigned to all aneurysms coiled from June 2008 to June 2011. The prospectively assigned AEG and RROC scores from the cerebral angiograms were collected for data analysis and validity assessment of the AEG system. 110 consecutive patients who had aneurysm coil embolization were included in this study.

Results

The post-coiling AEG significantly predicted follow-up angiographic filling characteristics. Pairwise comparisons revealed that the follow-up AEG for those initially scored ‘A’ (complete obliteration) was significantly better than the contrast-flow groups. Significant differences were also noted between contrast-stasis and contrast-flow groups. A pairwise comparison between RROC scores demonstrated that only the RROC Type 1 could be used to predict follow-up occlusion durability. Stent placement in wide-neck aneurysms had no effect on initial AEG, RROC, or long-term occlusion durability. Packing density significantly predicted initial AEG and RROC, but had no effect on long-term occlusion.

Conclusions

The AEG system is uniquely based on angiographic filling characteristics of the aneurysm, and this study demonstrated its high predictive value for determining aneurysm sac thrombosis. Assigning an AEG to the aneurysm can guide the neurointerventionalist in discussions with the patient regarding the probability of aneurysm recurrence and potential need for retreatment.

Keywords

Aneurysm Coils Embolization Occlusion Recurrence 

Notes

Acknowledgments

The authors would like to thank Margaret Riordan (Department of Neurosurgery, SUNY Upstate Medical University, Syracuse NY) and Sarah Dewitt (Department of Neurosurgery, SUNY Upstate Medical University, Syracuse NY) for their assistance with the collection of data for this manuscript.

Conflicts of interest

Eric M. Deshaies is a Physician Consultant for eV3/Covidien, Integra, and Microvention.

References

  1. 1.
    Cha KS, Balaras E, Lieber BB, Sadasivan C, Wakhloo AK (2007) Modeling the interaction of coils with the local blood flow after coil embolization of intracranial aneurysms. J Biomech Eng 129:873–879PubMedCrossRefGoogle Scholar
  2. 2.
    Cloft HJ (2007) HydroCoil for Endovascular Aneurysm Occlusion (HEAL) study: 3–6 month angiographic follow-up results. AJNR Am J Neuroradiol 28:152–154PubMedGoogle Scholar
  3. 3.
    Deshaies EM, Adamo MA, Boulos AS (2007) A prospective single-center analysis of the safety and efficacy of the hydrocoil embolization system for the treatment of intracranial aneurysms. J Neurosurg 106:226–233PubMedCrossRefGoogle Scholar
  4. 4.
    Gaba RC, Ansari SA, Roy SS, Marden FA, Viana MAG, Malisch TW (2006) Embolization of intracranial aneurysms with hydrogel-coated coils versus inert platinum coils: effects on packing density, coil length and quantity, procedure performance, cost, length of hospital stay, and durability of therapy. Stroke 37:1443–1450PubMedCrossRefGoogle Scholar
  5. 5.
    Kallmes DF, Altes TA, Vincent DA, Cloft HJ, Do HM, Jensen ME (1999) Experimental side-wall aneurysms: a natural history study. Neuroradiology 41:338–341PubMedCrossRefGoogle Scholar
  6. 6.
    Kawanabe Y, Sadato A, Taki W, Hashimoto N (2001) Endovascular occlusion of intracranial aneurysms with Guglielmi detachable coils: correlation between coil packing density and coil compaction. Acta Neurochir (Wien) 143:451–455CrossRefGoogle Scholar
  7. 7.
    Lawson MF, Newman WC, Chi Y-Y, Mocco JD, Hoh BL (2011) Stent-associated flow remodeling causes further occlusion of incompletely coiled aneurysms. Neurosurgery 69:598–603, discussion 603–604PubMedCrossRefGoogle Scholar
  8. 8.
    Luo B, Yang X, Wang S, Li H, Chen J, Yu H, Zhang Y, Zhang Y, Mu S, Liu Z, Ding G (2011) High shear stress and flow velocity in partially occluded aneurysms prone to recanalization. Stroke 42:745–753PubMedCrossRefGoogle Scholar
  9. 9.
    Mawad ME, Mawad JK, Cartwright J Jr, Gokaslan Z (1995) Long-term histopathologic changes in canine aneurysms embolized with Guglielmi detachable coils. AJNR Am J Neuroradiol 16:7–13PubMedGoogle Scholar
  10. 10.
    Mehra M, Hurley MC, Gounis MJ, King RM, Shaibani A, Dabus G, Labdaq FE, Levy EI, Bendok BR (2011) The impact of coil shape design on angiographic occlusion, packing density and coil mass uniformity in aneurysm embolization: an in vitro study. J Neurointerv Surg 3:131–136PubMedCrossRefGoogle Scholar
  11. 11.
    Molyneux AJ, Kerr RSC, Yu L-M, Clarke M, Sneade M, Yarnold JA, Sandercock P, International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group (2005) International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366:809–817PubMedCrossRefGoogle Scholar
  12. 12.
    Murayama Y, Nien YL, Duckwiler G, Gobin YP, Jahan R, Frazee J, Martin N, Viñuela F (2003) Guglielmi detachable coil embolization of cerebral aneurysms: 11 years’ experience. J Neurosurg 98:959–966PubMedCrossRefGoogle Scholar
  13. 13.
    Piotin M, Spelle L, Mounayer C, Salles-Rezende MT, Giansante-Abud D, Vanzin-Santos R et al (2007) Intracranial aneurysms: treatment with bare platinum coils–aneurysm packing, complex coils, and angiographic recurrence. Radiology 243:500–508PubMedCrossRefGoogle Scholar
  14. 14.
    Raymond J, Guilbert F, Weill A, Georganos SA, Juravsky L, Lambert A, Lamoureux J, Chagnon M, Roy D (2003) Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 34:1398–1403PubMedCrossRefGoogle Scholar
  15. 15.
    Satoh K, Matsubara S, Hondoh H, Nagahiro S (1997) Intracranial aneurysm embolization using interlocking detachable coils. correlation between volume embolization rate and coil compaction. Interv Neuroradiol 3(Suppl 2):125–128PubMedGoogle Scholar
  16. 16.
    Wakhloo AK, Gounis MJ, Sandhu JS, Akkawi N, Schenck AE, Linfante I (2007) Complex-shaped platinum coils for brain aneurysms: higher packing density, improved biomechanical stability, and midterm angiographic outcome. AJNR Am J Neuroradiol 28:1395–1400PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Wien 2012

Authors and Affiliations

  • Amit Singla
    • 1
  • Mark R. Villwock
    • 1
  • Walter Jacobsen
    • 2
  • Eric M. Deshaies
    • 1
    • 3
    • 4
    • 5
    • 6
    Email author
  1. 1.Department of NeurosurgerySUNY Upstate Medical UniversitySyracuseUSA
  2. 2.Department of NeurosurgeryAlbany Medical CenterAlbanyUSA
  3. 3.SUNY Upstate Neurovascular InstituteSUNY Upstate Medical UniversitySyracuseUSA
  4. 4.Cerebrovascular, Endovascular, and Skull Base NeurosurgerySUNY Upstate Medical UniversitySyracuseUSA
  5. 5.Neuroendovascular Fellowship ProgramSUNY Upstate Medical UniversitySyracuseUSA
  6. 6.Neurosurgery, Neuroscience & PhysiologySUNY Upstate Medical UniversitySyracuseUSA

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