Reappraisal of Anatomic Outcome Scales of Coiled Intracranial Aneurysms in the Prediction of Recanalization

Abstract

ObjectiveSeveral scales are currently used to assess occlusion rates of coiled cerebral aneurysms. This study compared these scales as predictors of recanalization.MethodsClinical data of 827 patients harboring 901 aneurysms treated by coiling were retrospectively reviewed. Occlusion rates were assessed using angiographic grading scale (AGS), two-dimensional percent occlusion (2DPO), and volumetric packing density (vPD). Every scale had 3 categories. Followed patients were dichotomized into either presence or absence of recanalization. Kaplan-Meier analysis was conducted, and Cox proportional hazards analysis was performed to identify surviving probabilities of recanalization. Lastly, the predictive accuracies of three different scales were measured via Harrell's C index.ResultsThe cumulative risk of recanalization was 7% at 12-month, 10% at 24-month, and 13% at 36-month of postembolization, and significantly higher for the second and third categories of every scale (p<0.001). Multivariate-adjusted hazard ratios (HRs) of the second and third categories as compared with the first category of AGS (HR : 3.95 and 4.15, p=0.004 and 0.001) and 2DPO (HR : 4.87 and 3.12, p<0.001 and 0.01) were similar. For vPD, there was no association between occlusion rates and recanalization. The validated and optimism-adjusted C-indices were 0.50 [confidence (CI) : -1.09-2.09], 0.47 (CI : -1.10-2.09) and 0.44 (CI : -1.10-2.08) for AGS, 2DPO, and vPD, respectively.ConclusionTotal occlusion should be reasonably tried in coiling to maximize the benefit of the treatment. AGS may be the best to predict recanalization, whereas vPD should not be used alone.

Large Residual Volume, Not Low Packing Density, Is the Most Influential Risk Factor for Recanalization after Coil Embolization of Cerebral Aneurysms

“…AV and rupture status has already been identified as a significant risk factor for recanalization in previous studies [ 3 , 7 , 12 , 18 , 21 , 22 ]. Our results are consistent with those findings.…”

Optimal first coil selection to avoid aneurysmal recanalization in endovascular intracranial aneurysmal coiling

“…More cautious follow-up is indispensable for large, ruptured, or wide-necked aneurysms. For a good angiographic result immediately after treatment, advanced techniques such as the balloon-assisted technique4 14 15 and newly developed devices such as complex-shaped coils,16 unique configuration coils,17 thick coils,18 bioactive coils, and hydrogel-coated coils19 20 have been used. An operator technique that has been found to avoid compaction is to insert as many coils as possible in cerebral aneurysms.…”

Predictors of treatment failure following coil embolization of intracranial aneurysms

“…There has been some evidence, however, that PD is not as influential in certain subgroups [26][27][28]. In 2005, Goddard et al found that PD (or coil-embolization ratio, as it was named in their study) was not predicative of recurrence, specifically for small intracranial aneurysms (defined as <7 mm) [27].…”