Comparison of 2-Year Angiographic Outcomes of Stent- and Nonstent-Assisted Coil Embolization in Unruptured Aneurysms with an Unfavorable Configuration for Coiling

Hwang, Gyojun; Park, H.; Bang, Jung Soo; Jin, Sung-Chul; Kim, B.C.; Oh, Chang Wan; Kang, Hyun-Seung; Han, Moon Hee; Kwon, O-Ki

doi:10.3174/ajnr.a2592

Cited by 57 publications

(53 citation statements)

References 16 publications

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“…There was no difference in the rate of recanalization between the stent-assisted (17.5%) and non-stent-assisted coil groups (21%, p = 0.895). 12 In a commentary on the report by Piotin et al 23 addressing general concerns about stenting aneurysms, Raymond and Darsaut 26 concluded that no credible data support the use of stents and that randomized trials are sorely needed.…”

Section: Evolution Of Treatmentmentioning

confidence: 99%

“…In the group with repeat imaging, 145 patients (24.3%) had mi- nor postcoiling residuals and 127 (22.1%) had significant aneurysm residual or growth. In the latter group, initial treatment with coiling resulted in complete occlusion in 68.5% (87), subtotal occlusion in 22.0% (28), and incomplete occlusion in 9.4% (12). The fact that the 68.5% of the patients with significant aneurysm residual or growth on follow-up were documented to have had complete aneurysm obliteration after initial treatment is troublesome and emphasizes the risk of recurrence of coil-treated aneurysms and the need for continued follow-up.…”

Section: Obliteration and Rebleeding Of Aneurysmsmentioning

confidence: 99%

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The Barrow Ruptured Aneurysm Trial: 3-year results

Spetzler

McDougall

Albuquerque

et al. 2013

JNS

284

176

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Object The authors report the 3-year results of the Barrow Ruptured Aneurysm Trial (BRAT). The objective of this ongoing randomized trial is to compare the safety and efficacy of microsurgical clip occlusion and endovascular coil embolization for the treatment of acutely ruptured cerebral aneurysms and to compare functional outcomes based on clinical and angiographic data. The 1-year results have been previously reported. Methods Two-hundred thirty-eight patients were assigned to clip occlusion and 233 to coil embolization. There were no anatomical exclusions. Crossovers were allowed based on the treating physician's determination, but primary outcome analysis was based on the initial assignment to treatment modality. Patient outcomes were assessed independently using the modified Rankin Scale (mRS). A poor outcome was defined as an mRS score > 2. At 3 years' follow-up 349 patients who had actually undergone treatment were available for evaluation. Of the 170 patients who had been originally assigned to coiling, 64 (38%) crossed over to clipping, whereas 4 (2%) of 179 patients assigned to surgery crossed over to coiling. Results The risk of a poor outcome in patients assigned to clipping compared with those assigned to coiling (35.8% vs 30%) had decreased from that observed at 1 year and was no longer significant (OR 1.30, 95% CI 0.83–2.04, p = 0.25). In addition, the degree of aneurysm obliteration (p = 0.0001), rate of aneurysm recurrence (p = 0.01), and rate of retreatment (p = 0.01) were significantly better in the group treated with clipping compared with the group treated with coiling. When outcomes were analyzed based on aneurysm location (anterior circulation, n = 339; posterior circulation, n = 69), there was no significant difference in the outcomes of anterior circulation aneurysms between the 2 assigned groups across time points (at discharge, 6 months, 1 year, or 3 years after treatment). The outcomes of posterior circulation aneurysms were significantly better in the coil group than in the clip group after the 1st year of follow-up, and this difference persisted after 3 years of follow-up. However, while aneurysms in the anterior circulation were well matched in their anatomical location between the 2 treatment arms, this was not the case in the posterior circulation where, for example, 18 of 21 posterior inferior cerebellar artery aneurysms were in the clip group. Conclusions Based on mRS scores at 3 years, the outcomes of all patients assigned to coil embolization showed a favorable 5.8% absolute difference compared with outcomes of those assigned to clip occlusion, although this difference did not reach statistical significance (p = 0.25). Patients in the clip group had a significantly higher degree of aneurysm obliteration and a significantly lower rate of recurrence and retreatment. In post hoc analysis examining only anterior circulation aneurysms, no outcome difference between the 2 treatment cohorts was observed at any recorded time point. Clinical trial registration no.: NCT01593267 (ClinicalTrials.gov).

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Section: Evolution Of Treatmentmentioning

confidence: 99%

Section: Obliteration and Rebleeding Of Aneurysmsmentioning

confidence: 99%

The Barrow Ruptured Aneurysm Trial: 3-year results

Spetzler

McDougall

Albuquerque

et al. 2013

JNS

284

176

View full text Add to dashboard Cite

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“…In a single-center series comparing outcomes for aneurysms treated with and without adjunctive stent placement, angiographic recanalization rates at an average time of 15 months were lower in the stented group (8.1%) compared with the nonstented group (37.5%; P Ͻ .001). 47 Another single-center study found no significant difference in recurrence rates between patients coiled with adjunctive stent placement and those coiled without stent placement, 48 which may have been due to achievement of similar high packing attenuation by using the double-microcatheter technique and balloon remodeling in the patients not treated with stent placement. Stent placement might offer an indirect mechanism of reducing aneurysm recurrence by allowing greater packing attenuation.…”

Section: Stent-assisted Coil Embolizationmentioning

confidence: 99%

Review of 2 Decades of Aneurysm-Recurrence Literature, Part 1: Reducing Recurrence after Endovascular Coiling

Crobeddu

Lanzino

Kallmes

et al. 2012

AJNR Am J Neuroradiol

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SUMMARY:Angiographic recurrence following endovascular therapy is an indirect measure of the potential for hemorrhage. Because patients and physicians consider recurrence to be a suboptimal outcome with some chance of future hemorrhage, much effort has been expended to reduce the incidence of recurrence. The literature regarding aneurysm recurrence following endovascular therapy, spanning 2 decades, is extensive. We will review and summarize the effort to reduce recurrence following endovascular treatment of cerebral aneurysms.

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“…Greater packing helps to avoid coil compaction 10) and diminishes the intra-aneurysmal blood flow velocity and wall shear stress, 11) even in cases with stent assistance. 8) Use of stents reduced the risk of coil protrusion to the parent vessel, but restricted the movement of the microcatheter. In cases where microcatheter movement is restricted, it is important to understand the role of the coil's shape memory and the stiffness of the coil on coil distribution.…”

Section: Introductionmentioning

confidence: 99%

“…2,3) Recurrence following coil embolization is likely related to the packing density of coils within the aneurysm, as low coil packing density is associated with an increased risk of aneurysm recurrence. [4][5][6][7] Despite the improvements in coil embolization techniques, including stent-assisted coil embolization, coil embolization for wide-necked 8) and bilobulated aneurysms 9) remains technically challenging. Greater packing helps to avoid coil compaction 10) and diminishes the intra-aneurysmal blood flow velocity and wall shear stress, 11) even in cases with stent assistance.…”

Section: Introductionmentioning

confidence: 99%

The utility of low shape memory coil as first coil during stent-assisted embolization in wide-necked and bilobulated cerebral aneurysm model

Matsumoto¹,

Nakai

Tsutsumi

et al. 2014

JNET

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• Abstract • Objective: Coil embolization for wide-necked and bilobulated aneurysms remains a technical challenge even with stent assistance. Stent assistance prevents coil protrusion to the parent vessel, but restricts microcatheter movement. The restriction of microcatheter movement makes the role of the coil's shape memory important on the coil distribution within the aneurysm. We aimed to determine which coils are appropriate for wide-necked and bilobulated aneurysms with stent assistance by investigating the distribution of coils with differing shape memory. Methods: A silicone bilobulated aneurysm model was used to compare three types of coils (ED coil Infini, Axium Helix, and Axium 3D). Coil performance was assessed using three parameters: (1) the effect of stent assistance on coil distribution, (2) the difference in first coil distribution caused by a difference in shape memory, and (3) the influence of first coil distribution on second coil distribution. Results: Without stent assistance, coil protrusion into the parent vessel was detected immediately after beginning coil insertion for ED coil Infini; however, this coil protrusion was prevented using stent assistance. With stent assistance, the lowest shape memory coil resulted in the most homogenous distribution. The distribution of second coil was influenced by first coil. Conclusion: Without stent assistance, low shape memory coil was more likely to prolapse into the parent vessel compared to higher shape memory coil. When combined with a stent, the low shape memory coil demonstrated more homogenous distribution of the aneurysm compared to the higher shape memory coil, and allowed denser packing.•

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Comparison of 2-Year Angiographic Outcomes of Stent- and Nonstent-Assisted Coil Embolization in Unruptured Aneurysms with an Unfavorable Configuration for Coiling

Cited by 57 publications

References 16 publications

The Barrow Ruptured Aneurysm Trial: 3-year results

The Barrow Ruptured Aneurysm Trial: 3-year results

Review of 2 Decades of Aneurysm-Recurrence Literature, Part 1: Reducing Recurrence after Endovascular Coiling

The utility of low shape memory coil as first coil during stent-assisted embolization in wide-necked and bilobulated cerebral aneurysm model

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