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Selective occlusion of splenic artery aneurysms with the coil packing technique: the impact of packing density on aneurysm reperfusion correlated between contrast-enhanced MR angiography and digital subtraction angiography

La radiologia medica volume 124, pages 450–459 (2019)Cite this article

Abstract

Purpose

The aim was to evaluate the relationship between coil packing densities after splenic artery aneurysm (SAA) treatment using detachable microcoils and rates of SAA reperfusion and to suggest a post-treatment surveillance protocol using contrast-enhanced MRA.

Materials and methods

Evaluated were 16 patients (4 men; mean age 46.7), who underwent true SAA embolization using detachable microcoils (Concerto, Medtronic). SAAs were treated by selective coil packing (CP) or stent-assisted coil exclusion (SAC). Contrast-enhanced magnetic resonance angiography (CE-MRA) and digital subtraction angiography (DSA) were performed at 3 months post-procedure and correlated.

Results

Primary CP was used in 13 patients, while SAC was used in three patients. On follow-up, complete aneurysm occlusion was seen in seven patients (43.8%). Sac reperfusion occurred in nine patients (56.2%) and was demonstrated in all CE-MRA and six DSA studies. Mean aneurysm packing density was 20.10 ± 8.05% for the CP group and 32.90 ± 11.95% for the SAC group (p = 0.038). There was a significant difference in the incidence of aneurysm sac reperfusion on CE-MRA study between CP and SAC (9 vs. 0). No sac reperfusion was seen in aneurysms with packing densities ≥ 29%, irrespective of either embolization method.

Conclusion

Favorable midterm results for coil packing of SAAs seem to depend on the coil packing density with a coil volume approximately a quarter of the aneurysm volume being most effective. Follow-up should involve the use of CE-MRA as this modality has been shown to be superior over DSA in detecting aneurysm reperfusion and coil compaction.

Level of evidence

Level IV, therapeutic study.

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Authors and Affiliations

  1. 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a Street, 02-097, Warsaw, Poland

    Mikołaj Wojtaszek, Krzysztof Lamparski, Emilia Wnuk, Rafał Maciąg, Edyta Maj, Krzysztof Milczarek, Krzysztof Korzeniowski & Olgierd Rowiński

  2. Vascular Unit, Kent & Canterbury Hospital, East Kent Hospital University NHS Trust, Canterbury, Kent, CT1 3NG, UK

    Mikołaj Wojtaszek & Thomas Rix

  3. Department of General and Endocrine Surgery, Medical University of Warsaw, Banacha 1a Street, 02-097, Warsaw, Poland

    Tomasz Ostrowski

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  1. Mikołaj Wojtaszek
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  2. Krzysztof Lamparski
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Correspondence to Mikołaj Wojtaszek.

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Conflict of interest

Mikołaj Wojtaszek and Rafał Maciąg have proctoring, speaking and training agreements with Medtronic. The remaining authors declare no pending conflicts of interests.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Informed consent was obtained from all individual participants included in the study.

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Wojtaszek, M., Lamparski, K., Wnuk, E. et al. Selective occlusion of splenic artery aneurysms with the coil packing technique: the impact of packing density on aneurysm reperfusion correlated between contrast-enhanced MR angiography and digital subtraction angiography. Radiol med 124, 450–459 (2019). https://doi.org/10.1007/s11547-019-00993-2

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Keywords

  • Splenic artery aneurysm
  • Visceral aneurysm
  • Aneurysm embolization
  • Selective coiling
  • Stent-assisted coiling
  • Packing density
  • MRA follow-up protocol