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Research ArticleNeurointervention

Packing Density Necessary to Reach a High Complete Occlusion Rate in Circumferential Unruptured Intracranial Aneurysms Treated with Stent-Assisted Coil Embolization

R.T. Tosello, U.C. Batista, B.J.A. Pereira and R.L. Piske
American Journal of Neuroradiology October 2017, 38 (10) 1973-1977; DOI: https://doi.org/10.3174/ajnr.A5303
R.T. Tosello
aFrom the Centro de Neuro-Angiografia, Hospital Beneficência Portuguesa de São Paulo-SP, Paulo-SP, Brazil.
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  • ORCID record for R.T. Tosello
U.C. Batista
aFrom the Centro de Neuro-Angiografia, Hospital Beneficência Portuguesa de São Paulo-SP, Paulo-SP, Brazil.
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B.J.A. Pereira
aFrom the Centro de Neuro-Angiografia, Hospital Beneficência Portuguesa de São Paulo-SP, Paulo-SP, Brazil.
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R.L. Piske
aFrom the Centro de Neuro-Angiografia, Hospital Beneficência Portuguesa de São Paulo-SP, Paulo-SP, Brazil.
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    Fig 1.

    A 62-year-old man presenting with a small, incidental aneurysm of the anterior communicating artery. A 3D rotational angiogram (A) was obtained before the embolization. Measurements were made of the neck (blue line), diameter parallel to the neck (green line), height (red line), and largest diameter (yellow line). Projection work after a right internal carotid contrast injection (B) shows the relation of the anterior communicating artery aneurysm to the anterior cerebral arteries. Final control after simultaneous contrast injections in the internal carotid artery. C and D, Residual neck flow (white arrow) after stent-assisted coil embolization (stent, white arrows; coils, black arrow). Six-month angiographic controls (E and F) show the evolution to complete occlusion (black and white arrows).

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    Fig 2.

    Results of the Pearson test, demonstrating that above 19% packing density, all aneurysms had complete occlusion. Regarding the volume, aneurysms above 179.6 mm3 had a higher rate of incomplete occlusion when the packing density was below 19%. If >1 aneurysm is overlapping, note the following symbols: Embedded Image, 2 aneurysms, Embedded Image, 3 aneurysms, Embedded Image, 4 aneurysms.

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    Table 1:

    Relationship between the location and number of the aneurysms

    LocationNo.%
    Middle cerebral artery1122.4%
    Anterior communicating artery918.4%
    Basilar artery510.2%
    Posterior communicating artery510.2%
    Bifurcation of the internal carotid artery510.2%
    Internal carotid artery36.1%
    Pericallosal artery24.1%
    Others918.4%
    Total49100%
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    Table 2:

    Multivariate analysis of predictive factors for complete occlusion

    Relative Risk95% CIP Value
    Sex0.9330.254–6.045.929
    Age0.7460.089–2.345.684
    Volume of the aneurysm1.0011.000–1.002.079
    Packing densitya0.8760.657–0.955.012
    Volume of the coils1.0050.998–1.011.123
    • ↵a Significance level is .05.

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American Journal of Neuroradiology: 38 (10)
American Journal of Neuroradiology
Vol. 38, Issue 10
1 Oct 2017
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Cite this article
R.T. Tosello, U.C. Batista, B.J.A. Pereira, R.L. Piske
Packing Density Necessary to Reach a High Complete Occlusion Rate in Circumferential Unruptured Intracranial Aneurysms Treated with Stent-Assisted Coil Embolization
American Journal of Neuroradiology Oct 2017, 38 (10) 1973-1977; DOI: 10.3174/ajnr.A5303

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Packing Density Necessary to Reach a High Complete Occlusion Rate in Circumferential Unruptured Intracranial Aneurysms Treated with Stent-Assisted Coil Embolization
R.T. Tosello, U.C. Batista, B.J.A. Pereira, R.L. Piske
American Journal of Neuroradiology Oct 2017, 38 (10) 1973-1977; DOI: 10.3174/ajnr.A5303
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