Risk factors for recanalization of dense coil packing for unruptured cerebral aneurysms in endovascular coil embolization: Analysis of a single center's experience

Michiyasu Fuga; Toshihide Tanaka; Koreaki Irie; Ikki Kajiwara; Rintaro Tachi; Akihiko Teshigawara; Toshihiro Ishibashi; Yuzuru Hasegawa; Yuichi Murayama

doi:10.1016/j.jocn.2022.02.009

Risk factors for recanalization of dense coil packing for unruptured cerebral aneurysms in endovascular coil embolization: Analysis of a single center's experience

J Clin Neurosci. 2022 Apr:98:175-181. doi: 10.1016/j.jocn.2022.02.009. Epub 2022 Feb 17.

Authors

Michiyasu Fuga¹, Toshihide Tanaka², Koreaki Irie³, Ikki Kajiwara⁴, Rintaro Tachi², Akihiko Teshigawara², Toshihiro Ishibashi⁵, Yuzuru Hasegawa², Yuichi Murayama⁵

Affiliations

¹ Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan. Electronic address: fugamichiyasu@icloud.com.
² Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan.
³ Department of Neurosurgery, Japan Red Cross Medical Center, Tokyo, Japan.
⁴ Department of Neurosurgery, National Center for Global Health and Medicine Kounodai Hospital, Chiba, Japan.
⁵ Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan.

PMID: 35183894
DOI: 10.1016/j.jocn.2022.02.009

Abstract

In coil embolization of cerebral aneurysms, inadequate packing is known to increase the probability of recanalization. Even tightly embolized aneurysms may be recanalized, but predictive factors for recanalization have not been fully investigated. This retrospective study aimed to identify risk factors for recanalization of treated aneurysms with a volume embolization ratio (VER) ≥ 25%. A total of 301 unruptured aneurysms in 248 patients who underwent coil embolization between March 2012 and January 2021 were analyzed. Cases involving dissecting aneurysm, intraluminal thrombosis, parent artery occlusion, intraoperative rupture, re-treatment, rupture the day after surgery, postoperative coil migration, and postoperative parent artery occlusion were excluded due to the inaccuracy of VER. A total of 105 aneurysms (34.9%) treated with VER ≥ 25% were extracted. Clinical features (age, sex, medical history, family history), anatomical features (shape, location, aneurysm size, inflow angle, and volume), procedural features (stent-assisted, Raymond-Roy occlusion classification [RROC] immediately after treatment, re-treatment rate), and follow-up period were compared between Recanalization and Non-recanalization groups. Predictors of recanalization were determined using logistic regression and receiver operating characteristic (ROC) curve analyses. Eleven aneurysms were recanalized. In multivariate analysis, RROC class 3 (odds ratio [OR] 11.0; 95% confidence interval [CI] 2.03-59.4) and aneurysm volume (OR 1.005; 95%CI 1.001-1.008) were independent predictors of recanalization. ROC curve analysis showed optimal cutoff values for aneurysm volume of 69.5 mm³ (sensitivity, 81.8%; specificity, 72.3%). In coil embolization of unruptured aneurysms that VER ≥ 25%, cases with RROC class 3 or high aneurysm volume may be associated with a higher risk of recanalization, and should be carefully followed-up.

Keywords: Aneurysm volume; Endovascular treatment; Predictor; Raymond-Roy occlusion classification; Recurrence; Volume embolization ratio.

MeSH terms

Cerebral Angiography
Embolization, Therapeutic* / adverse effects
Follow-Up Studies
Humans
Intracranial Aneurysm* / diagnostic imaging
Intracranial Aneurysm* / therapy
Retrospective Studies
Risk Factors
Treatment Outcome