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E-091 Progressive oclusion of incompletely occluded small saccular aneurysms after stent-assisted coil embolization: analysis of related factors and long-term follow-up
  1. J Lim1,
  2. Y Cho2,
  3. H Kang2,
  4. M Han3
  1. 1Neurosurgery Department, Chungnam National University hospital, Daejeon, Korea, Republic Of
  2. 2Neurosurgery Department, Seoul National University Hospital, Seoul, Korea, Republic Of
  3. 3Radiology Department, Seoul National University Hospital, Seoul, Korea, Republic Of.

Abstract

Introduction Although aneurysms incompletely occluded after coil embolization are subject to recanalization, complete occlusion may evolve in some aneurysms during follow-up in clinical practice, even though the sac fills with contrast immediately after coiling. Stent usage may augment the progressive thrombosis within coiled aneurysms. We evaluated outcomes of small aneurysms (<10 mm) that showed filling of the sac with contrast immediately after stent-assisted coiling and assessed factors implicated in subsequent the progressive occlusion.

Methods Between September 2012 and June 2016, a total of 463 intracranial aneurysms were treated by stent-assisted coil embolization. Of these, 132 small saccular aneurysms displayed filling of the sac by contrast immediately after the coiling. TOF-MRA or conventional angiography were used for postoperative monitoring according to our institutional protocol. Progressive thrombosis was defined as complete occlusion of these aneurysms at the 6-month follow-up. Progressive occlusion rates and related risk factors were assessed using binary logistic regression analysis.

Results In 101 (76.5%) of the 132 aneurysms that showed filling of the sac with contrast, complete occlusion was observed on follow-up imaging studies at 6 months. Binary logistic regression analysis demonstrated that progressive occlusion was linked to smaller neck diameter (p=0.003; OR=1.533), hyperlipidemia (p=0.036; OR=3.329) and stent type (p=0.031). LVIS stent is susceptible to progressive thrombosis than Neuroform stent (p=0.008; HR=10.204) or Enterprise stent (p=0.098; HR=3.154). In 57 progressively thrombosed aneurysms with follow-up evaluations ≥12 months (mean, 25.0±10.7 months, median 18 months), 56 aneurysms (98.2%) exhibited stable occlusion, whereas minor recanalization was observed in only one (1.8%) instances, and major recanalization occurred in none.

Conclusion In small saccular aneurysms occluded incompletely after stent-assisted coil embolization, aneurysms with smaller neck diameters or hyperlipidemia, and LVIS deployment seem predisposed to progressive intra-aneurysmal thrombosis over the course of time.

Disclosures: J. Lim: None. Y. Cho: None. H. Kang: None. M. Han: None.

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