Is packing density important in stent-assisted coiling?

Nohra Chalouhi, Aaron S. Dumont, David Hasan, Stavropoula Tjoumakaris, L. Fernando Gonzalez, Robert M. Starke, Richard Dalyai, Sedeek El Moursi, Robert Rosenwasser, Pascal Jabbour

Research output: Contribution to journalArticlepeer-review

52 Scopus citations

Abstract

BACKGROUND: Recent reports have shown that stent-assisted coiling (SAC) is associated with lower aneurysm recanalization rates compared with conventional coiling, raising questions about the necessity of achieving high packing density (PD) in stented aneurysms. OBJECTIVE: To assess the impact of PD on follow-up obliteration rates of stented aneurysms and attempt to determine the optimal range of PD in SAC. METHODS: This is a retrospective analysis of a single, large, cerebrovascular referral center's experience over a 5-year period in SAC with the use of Neuroform and Enterprise stents. The rate of complete obliteration on follow-up angiograms was compared for 3 different PD groups: high PD (>22%), moderate PD (12-22%), and low PD (<12%). RESULTS: There were 292 stent-coiled aneurysms (36 ruptured, 256 unruptured) with available angiographic follow-up. Mean PD was 15.2%, and complete obliteration rate was 79.5% at latest follow-up. The rates of complete obliteration were significantly higher in the moderate (86.4%; OR = 2.58; P = .006) and high PD groups (85.3%; OR = 2.35; P = .037) compared with the low PD group (71.1%). However, no statistically significant difference was found between the moderate and high PD groups (OR = 0.91; P = .84). In multivariate analysis, PD was a significant predictor of complete obliteration (P = .007) along with smaller aneurysm volumes (P = .004). Ruptured (P = .002) and cavernous aneurysms (P < .001) had significantly lower obliteration rates. CONCLUSION: High obliteration rates at follow-up were observed despite modest packing of stented aneurysms. Although PD is a definite factor in SAC, moderate and high packing of stented aneurysms seems to provide equivalent angiographic obliteration rates at follow-up.

Original languageEnglish (US)
Pages (from-to)381-386
Number of pages6
JournalNeurosurgery
Volume71
Issue number2
DOIs
StatePublished - Aug 2012
Externally publishedYes

Keywords

  • Aneurysm
  • Coils
  • Intracranial
  • Packing density
  • Stenting

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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