Article Figures & Data
Figures
- Fig 1.
The concept of the maze-making and solving technique. The microcatheter for larger diameter coils (MC1) is placed in the center of the aneurysm, and the catheter for traditional coils (MC2) is placed following the aneurysmal wall to reach beyond the orifice (A). As many as possible larger diameter coils are inserted (B). Cross-section illustrations reveal random interspaces still left unembolized and the movement of MC2 (C–E). Note the elevation of MC2 by stent placement and the second marker of MC2 buried in larger diameter coils (C). Traditional coils from MC2 fill the dead space left unembolized (D). After sufficient filling, the microcatheter is moved back to follow the wall and finds a new space. Note the altered position of the tip and the course of MC2 (E). If we repeat these dead space–filling and wall-follower methods in a stepwise fashion, the aneurysm is tightly embolized (F).
- Fig 2.
Maze-solving algorithms. The dead space–filling algorithm changes a complex maze (A) to a simple path to reach a goal (B). In combination with the dead space–filling algorithm, the wall-follower algorithm can fill all the spaces inside the maze.
- Fig 3.
Representative case. Cerebral angiography reveals a left internal carotid artery large aneurysm in anteroposterior (A) and lateral (B) views. The Penumbra Coil 400 makes a maze with random interspaces between the coils (C), which is solved by the addition of traditional coils (D). Postoperative cerebral angiography reveals complete obliteration in anteroposterior (E) and lateral (F) views.
Tables
Case Age/Sex Positiona Size (mm) Vol (mL) Symptoms Raymond Class (Immediate) Postoperative Course PA Follow-Up AG (mo) Larger Coils Total 1 77/F L-ICA (C7) 20 × 14 × 15 1.528 None 1 Cerebral infarction (mild hemiparesis and dysesthesia), mRS 1 34.5 41.2 12 2 72/F L-ICA (C4/5) 24 × 15 × 7 3.522 Chronic oculomotor nerve palsy 2 mRS 0 29.1 30.4 12 3 55/F R-ICA (C4) 17 × 16 × 13 1.574 None 2 mRS 0 35.7 38.8 19 4 55/F L-ICA (C6) 25 × 24 × 21 4.991 Progressive visual disturbance 2 Cerebral infarction (temporary dysarthria), worsening of visual disturbance, mRS 1 26.4 32.5 17 5 80/M L-ICA (C7) 16 × 12 × 11 0.865 None 1 mRS 0 24.6 40 12 6 53/F L-ICA (C5) 15 × 14 × 11 0.921 None 1 mRS 0 20.2 33.9 12 7 73/F R-ICA (C7) 13 × 10 × 9 0.748 None 2 Transfusion (hemorrhage from puncture site), mRS 0 29.3 33.8 3 8 54/F L-ICA (C4/5) 22 × 14 × 15 2.116 None 1 mRS 0 37.5 48.6 3 Note:—R indicates right; L, left; PA, packing attenuation; Vol, volume; AG, angiography.
↵a The ICA segments are defined according to the classification of Bouthillier et al.4
Maze Group (n = 8) Conventional Group (n = 30) Conventional Group Using Intracranial Stents (n = 15) P Value between Maze Group and Conventional Group P Value between Maze Group and Conventional Group Using Intracranial Stents Age 65 ± 11.5 65.4 ± 13.0 68.3 ± 13.2 .93 .56 Sex (male:female) 1:7 8:22 3:12 .29 .41 Location (ICA:others) 8:0 20:10 8:7 .064 .026a Packing attenuation (%) 37.4 ± 5.9 26.2 ± 5.6 27.9 ± 4.6 <.01a <.01a Maximum diameter (mm) 19 ± 4.4 13.4 ± 3.8 13.9 ± 5.0 <.01a .02a Aneurysm volume (mL) 2.03 ± 1.40 1.09 ± 1.52 1.38 ± 2.12 .13 .41 No. of coils 33.3 ± 16.1 15.5 ± 10.1 18.7 ± 12.4 .017a .047a Angiographic recurrence 0 11 3 .036a .26 Perioperative complications 3 2 5 .31 .34 Periprocedural death or major stroke 0 5 3 .28 .26 Reintervention 0 4 2 .34 .41 ↵a Significant P value.
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