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Research ArticleNeurointervention

Endovascular Treatment of Intracranial Wide-Necked Aneurysms Using Three-Dimensional Coils: Predictors of Immediate Anatomic and Clinical Results

Jean-Noël Vallée, Laurent Pierot, Alain Bonafé, Francis Turjman, Pierre Flandroy, Jérôme Berge, Georges Rodesch and Serge Bracard
American Journal of Neuroradiology February 2004, 25 (2) 298-306;
Jean-Noël Vallée
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Laurent Pierot
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Alain Bonafé
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Francis Turjman
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Pierre Flandroy
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Jérôme Berge
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Georges Rodesch
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Serge Bracard
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  • Fig 1.
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    Fig 1.

    Pre- and posttreatment images of an unruptured intracranial aneurysm in a 46-year-old woman who underwent occlusion with 3D Micrus coils.

    A and B, Lateral (A) and anteroposterior (B) 3D angiograms of the right internal carotid artery show a periophthalmic aneurysm with a maximum sac size of 9 mm and a neck size of 6 mm.

    C and D, Lateral road mapping image (C) and oblique unsubtracted angiogram (D) of the right internal carotid artery after placement of the first spherical coil (9-mm coil loop diameter) show that the 3D configuration of the coil provides an anatomically compliant frame within the aneurysm and a scaffold that covers the neck.

    E and F, Lateral (E) and anteroposterior (F) subtracted posttreatment angiograms show complete occlusion of the aneurysm.

  • Fig 2.
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    Fig 2.

    Graph shows percentage of aneurysms according to degree of angiographic aneurysmal occlusion at completion of the initial endovascular treatment, in group A ([dark gray bars] aneurysms with a neck ≤ 4 mm) and group B ([medium gray bars] aneurysms with a neck >4 mm). Degree of angiographic occlusion was not significantly different between the two groups (P = .696).

  • Fig 3.
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    Fig 3.

    Graph shows percentage of completely occluded aneurysms according to sac size at completion of the initial endovascular treatment in group A (neck ≤ 4 mm) and group B (neck >4 mm). Black bars indicate sac size <5 mm; dark gray bars, sac size 5–10 mm; medium gray bars, sac size 10–15 mm; light gray bars, sac size 15–25 mm.

  • Fig 4.
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    Fig 4.

    Graph shows percentage of completely occluded aneurysms according to sac-to-neck size ratio at completion of the initial endovascular treatment in group A (neck ≤ 4 mm) and group B (neck >4 mm). Dark gray bars indicate ratio ≥3; medium gray bars, ratio 1.5–3; light gray bars, ratio <1.5.

  • Fig 5.
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    Fig 5.

    Graph shows the mean percentage of volumic aneurysmal occlusion according to degree of angiographic occlusion at completion of the initial endovascular treatment in group A (neck ≤ 4 mm) and group B (neck >4 mm). Percentage of volumic occlusion was not significantly different between the two groups (P = .247). Dark gray bars indicate complete occlusion; medium gray bars, near complete occlusion; light gray bars, incomplete occlusion.

  • Fig 6.
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    Fig 6.

    Graph shows the mean percentage of volumic aneurysmal occlusion according to sac size at completion of the initial endovascular treatment in group A (neck ≤ 4 mm) and group B (neck >4 mm). Black bars indicate sac size <5 mm; dark gray bars, sac size 5–10 mm; medium gray bars, sac size 10–15 mm; light gray bars, sac size 15–20 mm.

  • Fig 7.
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    Fig 7.

    Graph shows the mean percentage of volumic aneurysmal occlusion according to the sac-to-neck size ratio at completion of the initial endovascular treatment in group A (neck ≤ 4 mm) and group B (neck >4 mm). Dark gray bars indicate ratio ≥3; medium gray bars, ratio 1.5–3; light gray bars, ratio <1.5.

Tables

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    TABLE 1:

    Aneurysms treated with 3D spherical coils in eight interventional neuroradiology centers

    AneurysmGroup AGroup BTotal
    Ruptured80 (69)22 (50)102 (64)
    Unruptured36 (31)22 (50)58 (36)
     Total11644160
    • Note.— Group A included aneurysms with a neck ≤4 mm, and group B, aneurysms with a neck >4 mm.

      Data are number (%) of aneurysms.

    • View popup
    TABLE 2:

    Aneurysm location

    Aneurysm LocationGroup AGroup BTotal
    Anterior circulation 98 (84)40 (91)138 (86)
     Internal carotid artery462369
      Paraclinoid121325
      PcoA241034
      AchA202
      Bifurcation808
     Anterior cerebral artery39847
     Middle cerebral artery13922
    Posterior circulation 18 (16)4 (9)22 (14)
     Posterior cerebral artery202
     Basilar artery12416
     Superior cerebellar artery101
     PICA303
    Total11644160
    • Note.—PcoA indicates posterior communicating artery; AchA, anterior choroidal artery; PICA, posterior inferior cerebellar artery.

      Data are number (%) of aneurysms.

    • View popup
    TABLE 3:

    Mean percentage of volumic occlusion of aneurysms according to degree of angiographic occlusion at completion of the initial endovascular treatment

    MeasurementDegree of Angiographic Occlusion
    CompleteNear CompleteIncompleteOverall
    No. (%) of aneurysms114 (71)43 (27)3 (2)160
    Percentage of volumic occlusion (mean ± SD)32.0 ± 7.627.4 ± 8.218.0 ± 0.630.4 ± 8.2
    • View popup
    TABLE 4:

    Degree of angiographic occlusion and mean percentage of volumic occlusion of aneurysms according to aneurysmal sac and neck sizes and the ratio of sac to neck size at completion of the initial endovascular treatment

    MeasurementSac SizeNeck SizeSac-to-Neck Ratio
    <10 mm10–24 mm≤4 mm>4 mm≥31.5–3<1.5
    Percentage of volumic occlusion (mean ± SD)31.5 ± 7.826.0 ± 8.530.9 ± 8.529.2 ± 7.232.8 ± 8.130.4 ± 7.527.2 ± 9.6
    Degree of angiographic occlusion*
     Complete93 (72)21 (68)84 (72)30 (68)28 (80)67 (68)19 (73)
     Near complete35 (27)8 (26)30 (26)13 (30)7 (28)30 (30)6 (23)
     Incomplete1 (1)2 (6)2 (2)1 (2)0 (0)2 (2)1 (4)
    No. of aneurysms1293111644359926
    • * Data are number (%) of aneurysms.

    • View popup
    TABLE 5:

    Number of aneurysms completely, near completely, or incompletely occluded according to a demarcation line for percentage of volumic occlusion drawn at 25% at completion of the initial endovascular treatment

     Degree of Angiographic OcclusionGroup AGroup BOverall Study Population
    PVO ≤25%PVO >25%TotalPVO ≤25%PVO >25%TotalPVO ≤25%PVO >25%Total
    Complete15 (18)69 (82)846 (20)24 (80)3021 (18)93 (82)114
    Near complete13 (43)17 (57)307 (54)6 (46)1320 (47)23 (53)43
    Incomplete2 (100)0 (0)21 (100)0 (0)13 (100)0 (0)3
    Overall30 (26)86 (74)11614 (32)30 (68)4444 (28)116 (72)160
    • Note.—PVO indicates percentage of volumic occlusion.

      Data are number (%) of aneurysms.

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American Journal of Neuroradiology: 25 (2)
American Journal of Neuroradiology
Vol. 25, Issue 2
1 Feb 2004
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Cite this article
Jean-Noël Vallée, Laurent Pierot, Alain Bonafé, Francis Turjman, Pierre Flandroy, Jérôme Berge, Georges Rodesch, Serge Bracard
Endovascular Treatment of Intracranial Wide-Necked Aneurysms Using Three-Dimensional Coils: Predictors of Immediate Anatomic and Clinical Results
American Journal of Neuroradiology Feb 2004, 25 (2) 298-306;

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Endovascular Treatment of Intracranial Wide-Necked Aneurysms Using Three-Dimensional Coils: Predictors of Immediate Anatomic and Clinical Results
Jean-Noël Vallée, Laurent Pierot, Alain Bonafé, Francis Turjman, Pierre Flandroy, Jérôme Berge, Georges Rodesch, Serge Bracard
American Journal of Neuroradiology Feb 2004, 25 (2) 298-306;
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