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Abstract
Introduction/Purpose Aneurysm packing until no more coils could be introduced or until microcatheter kickback was experienced used to be considered the end point in an embolization. Complete filling of the aneurysm with coils was assumed to be required to achieve aneurysm occlusion. We dare to challenge these concepts and the need for multiple coils to achieve aneurysm obliteration in aneurysms ≤10mm.
Materials and Methods We retrospectively reviewed our neurointerventional database between January 2018 and June 2022 and identified all patients who underwent coil embolization for treatment of a ruptured or unruptured intracranial aneurysms. Of those, we further selected the ones in whom only one single 0.014-inch detachable coil was used. Patient characteristics, procedural data, complications, and imaging follow up information was also collected.
Results We identified a total of 17 patients (13 females) with a mean age of 61 years (range 36 to 78 years). One aneurysm was ruptured. None of the aneurysms was previously treated. The procedure was performed via femoral access in 11 cases and transradial access in 6 cases. Most aneurysms were seen in the anterior circulation (n=13) and along the MCA (n=9). Four aneurysms were seen in the posterior circulation. Mean aneurysm size was 4.5 mm and mean neck with was 3.1 mm. In addition to a single 0.014-inch detachable coil placed, a stent was placed in 5 cases and a Comaneci device was used in 1 case. Mean aneurysm packing density was 21.3% (range 6/7% to 45.5%). No procedural complications were encountered. One patient died prior to follow-up, one moved out of state and 1 patient was lost to follow-up. One patient’s follow-up is due in 1 month. Of the remaining 13 patients, 6-month follow up was available for 9 patients. Angiogram follow-up showed complete or near complete occlusion (Raymond Roy Class 1 and 2) in all cases (100%). Two more patients without 6-month follow-up showed complete aneurysm occlusion at a 1-year (MR angiogram) and 3-year (CT angiogram) follow-up.
Conclusion Complete occlusion of very small and small aneurysms can be achieved using a single 0.014-inch detachable coil. Adequate coverage of the aneurysm neck with coil loops will result in a barrier for blood flow to enter the aneurysm sac (flow disrupting effect) and lead to intrasaccular thrombosis.
Disclosures A. Kuhn: None. J. Singh: None. M. Garcia: None. S. Sarid: None. A. Puri: 1; C; NIH, Microvention, Cerenovus, Medtronic Neurovascular and Stryker Neurovascular. 2; C; Medtronic Neurovascular, Stryker NeurovascularBalt, Q’Apel Medical, Cerenovus, Microvention, Imperative Care, Agile, Merit, CereVasc and Arsenal Medical. 4; C; InNeuroCo, Agile, Perfuze, Galaxy and NTI.