Large residual volume, not low packing density, is the most influential risk factor for recanalization after coil embolization of cerebral aneurysms

Akiyo Sadato, Motoharu Hayakawa, Kazuhide Adachi, Ichiro Nakahara, Yuichi Hirose

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Tight coil packing with density of at least 20%-25% is known to be important for preventing recanalization after embolization of cerebral aneurysms. However, large aneurysms sometimes recanalize regardless of the packing density, suggesting that the absolute residual volume which is determined by aneurysm volume and packing density may be more important risk factor for recanalization. To validate this hypothesis, we analyzed the factors affecting the outcomes of treated aneurysms at our institute. Methods and Findings: We included 355 small and large aneurysms. The following six factors were obtained from every case: aneurysm volume (mL), neck size (mm), packing density (%), residual volume (mL), rupture status at presentation, and stent assistance (with or without stent). The data were then subjected to multivariate logistic regression analysis to identify significant risk factors for recanalization. Recanalization occurred in 61 aneurysms (17.2%). Significant predictors for recanalization were aneurysm volume (odds ratio, 15.3; P < 0.001) and residual volume (odds ratio, 30.9; P < 0.001), but not packing density (odds ratio, 0.98; P = 0.341). These results showed that for each 0.1-mL increase in aneurysm volume and residual volume, the risk of recanalization increased by 1.3 times and 1.4 times, respectively. Conclusions: The most influential risk factor for recanalization after coil embolization was residual volume, not packing density. The larger the aneurysm volume, the greater the packing density has to be to minimize the residual volume and risk of recanalization. Since tight coil packing has already been aimed, further innovation of coil property or embolization technique may be needed. Otherwise, different treatment modality such as flow diverter or parent artery occlusion may have to be considered.

Original languageEnglish
Article numbere0155062
JournalPloS one
Volume11
Issue number5
DOIs
Publication statusPublished - 01-05-2016

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aneurysm
Residual Volume
Intracranial Aneurysm
Aneurysm
risk factors
Stents
odds ratio
Odds Ratio
Regression analysis
Logistics
Innovation
Rupture
Neck
Arteries
arteries
Logistic Models
neck
Regression Analysis
regression analysis

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

@article{a02efd14eb054d7885882cb646b14305,
title = "Large residual volume, not low packing density, is the most influential risk factor for recanalization after coil embolization of cerebral aneurysms",
abstract = "Background: Tight coil packing with density of at least 20{\%}-25{\%} is known to be important for preventing recanalization after embolization of cerebral aneurysms. However, large aneurysms sometimes recanalize regardless of the packing density, suggesting that the absolute residual volume which is determined by aneurysm volume and packing density may be more important risk factor for recanalization. To validate this hypothesis, we analyzed the factors affecting the outcomes of treated aneurysms at our institute. Methods and Findings: We included 355 small and large aneurysms. The following six factors were obtained from every case: aneurysm volume (mL), neck size (mm), packing density ({\%}), residual volume (mL), rupture status at presentation, and stent assistance (with or without stent). The data were then subjected to multivariate logistic regression analysis to identify significant risk factors for recanalization. Recanalization occurred in 61 aneurysms (17.2{\%}). Significant predictors for recanalization were aneurysm volume (odds ratio, 15.3; P < 0.001) and residual volume (odds ratio, 30.9; P < 0.001), but not packing density (odds ratio, 0.98; P = 0.341). These results showed that for each 0.1-mL increase in aneurysm volume and residual volume, the risk of recanalization increased by 1.3 times and 1.4 times, respectively. Conclusions: The most influential risk factor for recanalization after coil embolization was residual volume, not packing density. The larger the aneurysm volume, the greater the packing density has to be to minimize the residual volume and risk of recanalization. Since tight coil packing has already been aimed, further innovation of coil property or embolization technique may be needed. Otherwise, different treatment modality such as flow diverter or parent artery occlusion may have to be considered.",
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Large residual volume, not low packing density, is the most influential risk factor for recanalization after coil embolization of cerebral aneurysms. / Sadato, Akiyo; Hayakawa, Motoharu; Adachi, Kazuhide; Nakahara, Ichiro; Hirose, Yuichi.

In: PloS one, Vol. 11, No. 5, e0155062, 01.05.2016.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Large residual volume, not low packing density, is the most influential risk factor for recanalization after coil embolization of cerebral aneurysms

AU - Sadato, Akiyo

AU - Hayakawa, Motoharu

AU - Adachi, Kazuhide

AU - Nakahara, Ichiro

AU - Hirose, Yuichi

PY - 2016/5/1

Y1 - 2016/5/1

N2 - Background: Tight coil packing with density of at least 20%-25% is known to be important for preventing recanalization after embolization of cerebral aneurysms. However, large aneurysms sometimes recanalize regardless of the packing density, suggesting that the absolute residual volume which is determined by aneurysm volume and packing density may be more important risk factor for recanalization. To validate this hypothesis, we analyzed the factors affecting the outcomes of treated aneurysms at our institute. Methods and Findings: We included 355 small and large aneurysms. The following six factors were obtained from every case: aneurysm volume (mL), neck size (mm), packing density (%), residual volume (mL), rupture status at presentation, and stent assistance (with or without stent). The data were then subjected to multivariate logistic regression analysis to identify significant risk factors for recanalization. Recanalization occurred in 61 aneurysms (17.2%). Significant predictors for recanalization were aneurysm volume (odds ratio, 15.3; P < 0.001) and residual volume (odds ratio, 30.9; P < 0.001), but not packing density (odds ratio, 0.98; P = 0.341). These results showed that for each 0.1-mL increase in aneurysm volume and residual volume, the risk of recanalization increased by 1.3 times and 1.4 times, respectively. Conclusions: The most influential risk factor for recanalization after coil embolization was residual volume, not packing density. The larger the aneurysm volume, the greater the packing density has to be to minimize the residual volume and risk of recanalization. Since tight coil packing has already been aimed, further innovation of coil property or embolization technique may be needed. Otherwise, different treatment modality such as flow diverter or parent artery occlusion may have to be considered.

AB - Background: Tight coil packing with density of at least 20%-25% is known to be important for preventing recanalization after embolization of cerebral aneurysms. However, large aneurysms sometimes recanalize regardless of the packing density, suggesting that the absolute residual volume which is determined by aneurysm volume and packing density may be more important risk factor for recanalization. To validate this hypothesis, we analyzed the factors affecting the outcomes of treated aneurysms at our institute. Methods and Findings: We included 355 small and large aneurysms. The following six factors were obtained from every case: aneurysm volume (mL), neck size (mm), packing density (%), residual volume (mL), rupture status at presentation, and stent assistance (with or without stent). The data were then subjected to multivariate logistic regression analysis to identify significant risk factors for recanalization. Recanalization occurred in 61 aneurysms (17.2%). Significant predictors for recanalization were aneurysm volume (odds ratio, 15.3; P < 0.001) and residual volume (odds ratio, 30.9; P < 0.001), but not packing density (odds ratio, 0.98; P = 0.341). These results showed that for each 0.1-mL increase in aneurysm volume and residual volume, the risk of recanalization increased by 1.3 times and 1.4 times, respectively. Conclusions: The most influential risk factor for recanalization after coil embolization was residual volume, not packing density. The larger the aneurysm volume, the greater the packing density has to be to minimize the residual volume and risk of recanalization. Since tight coil packing has already been aimed, further innovation of coil property or embolization technique may be needed. Otherwise, different treatment modality such as flow diverter or parent artery occlusion may have to be considered.

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U2 - 10.1371/journal.pone.0155062

DO - 10.1371/journal.pone.0155062

M3 - Article

VL - 11

JO - PLoS One

JF - PLoS One

SN - 1932-6203

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