Angiographic and Clinical Outcomes in 200 Consecutive Patients with Cerebral Aneurysm Treated with Hydrogel-Coated Coils

T. Gunnarsson; F.C. Tong; P. Klurfan; C.M. Cawley; J.E. Dion

doi:10.3174/ajnr.A1691

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Fig 1.
A, A 43-year-old woman with elective coiling of a 9-mm ophthalmic artery aneurysm. Postembolization angiogram shows residual posterior and inferior filling of the lumen. B, A 13-month follow-up angiogram shows complete obliteration of the aneurysm lumen.
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Fig 2.
A, A 56-year-old woman with an incidentally discovered 6-mm medially oriented cavernous segment aneurysm with adjacent sphenoid sinus erosion. The procedure required balloon remodeling for a 5.4-mm neck. Immediate postembolization angiogram shows residual aneurysm filling centrally. B, Follow-up angiogram at 20 months shows no aneurysm filling.
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Fig 3.
A, A 59-year-old woman with an incidentally discovered 12-mm right A1 segment anterior cerebral artery aneurysm. Immediate postembolization image shows residual aneurysm filling and coil loops protruding into the parent A1 segment. B, A 6-week surveillance angiogram shows interval obliteration of the aneurysm lumen and diminished flow within the adjacent A1 segment. C, A 13-month angiogram shows A1 parent-vessel occlusion and no aneurysm filling.
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Fig 4.
A, A 51-year-old woman with a 5-mm ruptured left pericallosal aneurysm. Postembolization angiogram shows minimal residual aneurysm filling. B, A 2-year angiogram shows significant aneurysm recurrence at the base. This patient had her aneurysm surgically clipped.
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Fig 5.
A, A 44-year-old man with a 20-mm basilar tip aneurysm embolized at an outside institution with rapid recanalization. The patient was retreated using this posttreatment angiogram. B, A 10-month follow-up angiogram shows a second recurrence at the right base. C, Angiogram obtained immediately following the second retreatment. D, A third recurrence at 20 months after the second retreatment in the same location.

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Table 1:
Demographics of patients treated with HydroCoils
Mean Minimum Maximum Median
Age (yr) 54 4 87 54
Male 48
Female 139
Unruptured 104
Ruptured 96
Hunt and Hess grade 2.94 1 5 3
Fisher grade 2.77 1 4 4

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Table 2:

Baseline aneurysm characteristics

Artery Location	Left	Right	Total (%)
Anterior circulation			151 (75.5)
Ophthalmic	25	10	35 (17.5)
Posterior communicating	17	16	33 (16.5)
Anterior communicating			20 (10)
Superior hypophyseal	15	8	23 (11.5)
Internal carotid^*	8	11	19 (9.5)
Middle cerebral	5	5	10 (5)
Carotid termination	3		3 (1.5)
Anterior choroidal	2	1	3 (1.5)
Pericallosal	2	1	3 (1.5)
Anterior cerebral	1	1	2 (1)
Posterior circulation			49 (24.5)
Basilar tip			37 (18.5)
Superior cerebellar			5 (2.5)
Vertebrobasilar junction			2 (1)
Posterior cerebral			2 (1)
Basilar trunk			1 (0.5)
Posterior inferior cerebellar			1 (0.5)
Vertebral			1 (0.5)

* Includes the cavernous/carotid cave/paraclinoid.

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Table 3:

Angiographic recurrences and aneurysm characteristics for both small (<10 mm) and large (10–25 mm) aneurysms

	No. Patients	No. Patients in Subgroup (%)	Average % HydroCoil Length (%)	Average Maximal Diameter (mm)	Dome-Neck Ratio
All Patients	121 (100%)		55	9.0	1.82
Recurrence		26 (21.5)	64	10.4	1.85
No recurrence		95 (78.5)	53	8.6	1.8
Small aneurysms	79 (65.3%)
Recurrence		14 (17.7)	58	7.0	1.56
No recurrence		65 (82.3)	51	6.6	1.56
Large aneurysms	42 (34.7%)
Recurrence		12 (28.6)	70	14.3	2.11
No recurrence		30 (71.4)	58	13.0	2.26

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Table 4:

Small-aneurysm Roy score distribution for initial result and subsequent follow-up angiograms

Initial Roy Grade	No. Aneurysms with Initial Result (%)	Class 1 on Follow-Up (%)	Class 2 on Follow-Up (%)	Class 3 on Follow-Up (%)	Recurrence (%)
Class 1: complete occlusion	45 (57.0)	35 (77.8)	7 (15.6)	3 (6.7)	10 (22.2)
Class 2: residual neck	25 (31.6)	14 (56.0)	9 (36.0)	2 (8.0)	2 (8.0)
Class 3: residual aneurysm	9 (11.4)	4 (44.4)^*	3 (33.3)	2 (22.2)	2 (22.2)
Total	79 (100)	53 (67.1)	19 (24.1)	7 (75.9)	14 (17.7)

* One of these 4 patients had parent-vessel occlusion on the follow-up angiogram, which was graded as Roy class 1.

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Table 5:

Large-aneurysm Roy score distribution for initial result and subsequent follow-up angiograms

Initial Roy Grade	No. Aneurysms with Initial Result (%)	Class 1 on Follow-Up (%)	Class 2 on Follow-Up (%)	Class 3 on Follow-Up (%)	Recurrence (%)
Class 1: complete occlusion	18 (42.9)	11 (61.1)	1 (5.6)	6 (33.3)	7 (38.9)
Class 2: residual neck	16 (38.1)	8 (50.0)	6 (37.5)	2 (12.5)	2 (12.5)
Class 3: residual aneurysm	8 (19.0)	3 (37.5)^*	0 (0)	5 (62.5)	3 (37.5)
Total	42 (100)	22 (52.4)	7 (16.7)	13 (31.0)	12 (28.6)