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Results of endovascular treatment of aneurysms depending on their size, volume and coil packing density
- Zakład Radiodiagnostyki i Radiologii Zabiegowej, Samodzielny Publiczny Centralny Szpital Kliniczny im. prof. Kornela Gibińskiego, Śląski Uniwersytet Medyczny w Katowicach
- Katedra Anestezjologii i Intensywnej Terapii Uniwersytet Jagielloński Collegium Medicum w Krakowie.
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Abstract
In contrast to neurosurgery, which is more efficient, endovascular treatment (EVT) is less invasive. The main purpose of EVT is complete occlusion of the aneurysm and protection from subarachnoid haemorrhage. Accurate measurements of the aneurysm (size, volume) obtained using a 3D digital subtraction angiography (DSA) workstation can assist in the proper assessment of coil packing density (CPD), which affects possible distant recanalization. The main disadvantage of endovascular treatment of intracranial aneurysms compared to neurosurgery is the high recurrence rate. We evaluated the results of endovascular treatment of aneurysms depending on their size, volume and coil packing density.
Material and methodsThirty-five patients with intracranial aneurysms underwent endovascular embolization with bare platinum coils. Three-dimensional DSA was used to evaluate aneurysms’ morphology. Eighteen patients underwent 3D DSA follow-up 6-45 months after treatment. Initial and follow-up results of embolization were assessed with the Raymond-Montreal scale. The impact of aneurysms’ morphology, volume and initial CPD on endovascular treatment was evaluated.
ResultsAmong 35 patients, complete initial embolization was achieved in 74%. Mean initial aneurysm volume in 3D DSA was 0.517 mL and decreased significantly after embolization. Initial CPD varied from 74% to 2% depending on aneurysm diameter (12.1% for aneurysms ≥ 10 mm, 22.5% for aneurysms < 10 mm). Results of embolization on the Raymond-Montreal scale significantly depended on aneurysms’ CPD. Aneurysms’ recanalization rate on 3D DSA follow-up was 36%, with complete recanalization in 3.3%.
ConclusionsWe can achieve a better outcome if size and volume of the aneurysm sac is smaller and if CPD is higher.
Abstract
In contrast to neurosurgery, which is more efficient, endovascular treatment (EVT) is less invasive. The main purpose of EVT is complete occlusion of the aneurysm and protection from subarachnoid haemorrhage. Accurate measurements of the aneurysm (size, volume) obtained using a 3D digital subtraction angiography (DSA) workstation can assist in the proper assessment of coil packing density (CPD), which affects possible distant recanalization. The main disadvantage of endovascular treatment of intracranial aneurysms compared to neurosurgery is the high recurrence rate. We evaluated the results of endovascular treatment of aneurysms depending on their size, volume and coil packing density.
Material and methodsThirty-five patients with intracranial aneurysms underwent endovascular embolization with bare platinum coils. Three-dimensional DSA was used to evaluate aneurysms’ morphology. Eighteen patients underwent 3D DSA follow-up 6-45 months after treatment. Initial and follow-up results of embolization were assessed with the Raymond-Montreal scale. The impact of aneurysms’ morphology, volume and initial CPD on endovascular treatment was evaluated.
ResultsAmong 35 patients, complete initial embolization was achieved in 74%. Mean initial aneurysm volume in 3D DSA was 0.517 mL and decreased significantly after embolization. Initial CPD varied from 74% to 2% depending on aneurysm diameter (12.1% for aneurysms ≥ 10 mm, 22.5% for aneurysms < 10 mm). Results of embolization on the Raymond-Montreal scale significantly depended on aneurysms’ CPD. Aneurysms’ recanalization rate on 3D DSA follow-up was 36%, with complete recanalization in 3.3%.
ConclusionsWe can achieve a better outcome if size and volume of the aneurysm sac is smaller and if CPD is higher.
Keywords
intracranial aneurysms, embolization, recanalization, coil packing density
Title
Results of endovascular treatment of aneurysms depending on their size, volume and coil packing density
Journal
Neurologia i Neurochirurgia Polska
Issue
Pages
467-475
Page views
272
Article views/downloads
342
DOI
10.5114/ninp.2013.38226
Bibliographic record
Neurol Neurochir Pol 2013;47(5):467-475.
Keywords
intracranial aneurysms
embolization
recanalization
coil packing density
Authors
Daniel Knap
Katarzyna Gruszczyńska
Robert Partyka
Damian Ptak
Małgorzata Korzekwa
Miłosz Zbroszczyk
Jan Baron