Abstract
Background and PurposeIn recurrent cerebral aneurysms treated by coil embolization, coil compaction is regarded as the presumptive mechanism. We test the hypothesis that aneurysm growth is the primary recurrence mechanism. We also test the hypothesis that the coil mass will translate a measurable extent when recurrence occurs.MethodsAn objective, quantitative image analysis protocol was developed to determine the volumes of aneurysms and coil masses during initial and follow-up visits from 3D rotational angiograms. The population consisted of 15 recurrence and 12 non-recurrence control aneurysms initially completely coiled at a single center. An investigator sensitivity study was performed to assess the objectivity of the methods. Paired Wilcoxon tests (p<0.05, one-tailed) were performed to assess for aneurysm and coil growth. The translation of the coil mass center at follow-up was computed. A Mann Whitney U-Test (p<0.05, one-tailed) was used to compare translation of coil mass centers between recurrence and control subjects.ResultsImage analysis protocol was found to be insensitive to the investigator. Aneurysm growth was evident in the recurrence cohort (p=0.003) but not the control (p=0.136). There was no evidence of coil compaction in either the recurrence or control cohorts (recurrence: p=0.339; control: p=0.429). The translation of the coil mass centers was found to be significantly larger in the recurrence cohort than the control cohort (p=0.047).ConclusionAneurysm sac growth, not coil compaction, was the primary mechanism of recurrence following successful coil embolization. The coil mass likely translates to a measurable extent when recurrence occurs and has the potential to serve as a non-angiographic recurrence marker.
Highlights
Identifying the mechanism underlying cerebral aneurysm recurrence will improve patient selection for coil embolization treatment, as well as impact coil device design.[1,2,3] Raymond et al [4] and Murayama et al.[5] reported recurrence rates of 33% and 21% over longitudinal followup
In recurrent cerebral aneurysms treated by coil embolization, coil compaction is regarded as the presumptive mechanism
The translation of the coil mass centers was found to be significantly larger in the recurrence cohort than the control cohort (p=0.047)
Summary
Identifying the mechanism underlying cerebral aneurysm recurrence will improve patient selection for coil embolization treatment, as well as impact coil device design.[1,2,3] Raymond et al [4] and Murayama et al.[5] reported recurrence rates of 33% and 21% over longitudinal followup. Growth of the aneurysm sac is an alternative recurrence mechanism, but reports about it in the literature are scarce.[1, 6,7,8] the primary goals of this study were to perform an assessment of the relative incidences of sac growth and coil compaction in a study population larger than that used in our earlier report [9], but more importantly, to develop an objective image analysis protocol and demonstrate its fidelity by including non-recurrence controls. We test the hypothesis that the coil mass will translate a measurable extent when recurrence occurs
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