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Original research
Safety and effectiveness of large volume coils in the treatment of small aneurysms
  1. Zsolt Kulcsár1,2,
  2. Isabel Wanke2,3,4,
  3. Daniel Rüfenacht2,3,
  4. Stephan G Wetzel3,
  5. Sophia Göricke4,
  6. Kiriaki Kolia3,
  7. Steven Quarfordt5,
  8. Justin Calvert5,
  9. Harris Hawk5,
  10. Blaise Baxter5,6
  1. 1Service of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
  2. 2Interventional Work Research, CABMM, University of Zurich, Zurich, Switzerland
  3. 3Department of Neuroradiology, Swiss Neuro Institute, Klinik Hirslanden, Zurich, Switzerland
  4. 4Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital of Essen, Essen, Germany
  5. 5Department of Radiology, Erlanger Health System, Chattanooga, Tennessee, USA
  6. 6Department of Radiology, University of Tennessee, College of Medicine Chattanooga, Tennessee, USA
  1. Correspondence to Dr Zsolt Kulcsár, Service of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Gabrielle-Perret Gentil 5, Geneva 1211, Switzerland; kulcsarzsolt22{at}


Background and purpose Large volume soft design coils facilitate quicker aneurysm filling and high packing density. Our purpose was to analyze the feasibility, safety, and effectiveness of the Penumbra Coil 400 (PC400) system in the treatment of small aneurysms.

Materials and methods A retrospective analysis of prospective data collected at three different centers was performed on consecutive aneurysms <10 mm treated with the PC400 system. A total of 92 aneurysms were included in the study. Feasibility, procedure safety, angiographic and clinical results, and follow-up results were evaluated.

Results Mean aneurysm size was 5.8±2.0 mm. An average of 2.5±1.3 coils with a mean length of 18±16 cm per aneurysm was used, resulting in a mean packing density of 45.6±14.4%. The thromboembolic event rate was 3.3% and no procedural aneurysm rupture was observed. Immediate adequate occlusion was achieved in 66% of aneurysms. During a mean follow-up period of 7.4 months the number of adequate occlusions increased to 91%.

Conclusions Large volume PC 400 coils are safe and effective in the treatment of small aneurysms with a low thromboembolic complication rate and no hemorrhagic events. High packing densities are achieved with a low average number of coils used per aneurysm treated. The aneurysms demonstrated progressive occlusion over time, which probably suggests stability in the long term.

  • Aneurysm
  • Coil
  • Subarachnoid
  • Hemorrhage

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  • Contributors ZK designed the study, finalized data collection and statistical analysis, performed procedures and imaging analysis. SWG, IW, SG, KK, SQ, JC, BB and HH participated in interventional procedures and data collection. ZK analysed the data and drafted the manuscript. DR, IW and BB revised the manuscript. ZK initiated the multicentric collaborative work.

  • Competing interests ZK and BB are consultant/speaker's bureau for Penumbra Inc.

  • Ethics approval The study was approved by the local Institutional Review Board or by the regional ethics committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.