Abstract
PurposeAfter coil embolization of intracranial aneurysms, it is currently not well understood whether the initial coil packing density or the type of aneurysm residual perfusion, depicted by the modified Raymond-Roy occlusion classification, primarily effects the rate of aneurysm recurrence. We hypothesized that these factors interact and only one remains an independent risk factor.MethodsIn this single center retrospective study, 440 patients with intracranial ruptured and unruptured aneurysms between 2010 and 2017 were screened. A total of 267 patients treated with stand-alone coiling, with or without stent or balloon assistance were included (age 54.1 ± 12.2 years, sex 70.4% female). Flow diverter or Woven EndoBridge (WEB) device implantation were exclusion criteria.ResultsUsing a binary logistic regression model, independent risk factors for aneurysm recurrence were postinterventional modified Raymond-Roy occlusion classification class (Odds ratio [OR] 1.747, 95% confidence interval [CI] 1.231–2.480) and aneurysm diameter (OR 1.145, CI 1.032–1.271). A trend towards a higher recurrence in ruptured aneurysms did not reach significance (OR 1.656, CI 0.863–3.179). Aneurysm localization, packing density, and neck width were not independently associated with aneurysm recurrence.ConclusionIndependent risk factors for aneurysm recurrence after coil embolization with and without stent or balloon assistance were aneurysm diameter and postinterventional grading within the modified Raymond-Roy occlusion classification. Packing density interacted with the latter and was not independently associated to recurrence.
Highlights
The advent of endovascular embolization techniques for intracranial aneurysms in the last 30 years has led to continuously decreased complication and treatment failure rates
Large trials in 2003 and 2005 found similar or lower rates of morbidity and mortality compared to microsurgical aneurysm clipping [1,2,3,4,5,6]; patients with subarachnoid hemorrhage due to ruptured aneurysms subjected to endovascular coil embolization were found to be at higher risk for rebleeding, which in turn is mainly attributed to aneurysm recurrence [7]
We were able to show on this retrospective cohort of ruptured and unruptured intracranial aneurysms that independent risk factors for aneurysm recurrence after coil embolization are aneurysm diameter and postinterventional modified Raymond–Roy occlusion classification (MRRC) class
Summary
The advent of endovascular embolization techniques for intracranial aneurysms in the last 30 years has led to continuously decreased complication and treatment failure rates. Beyond the aneurysm packing density, a classification system was implemented which allows characterization of residual aneurysm perfusion, named the modified Raymond–Roy occlusion classification (MRRC). It is the current gold standard for qualitative aneurysm occlusion evaluation. According to this system, an aneurysm with a class IIIb residual perfusion was shown to be associated with a higher risk of residual perfusion over time (80.8% vs 46.4%) and a higher recanalization rate (65.1% vs 27.4%), compared to class IIIa and II residual perfusions [15,16,17] An aneurysm with a class IIIb residual perfusion was shown to be associated with a higher risk of residual perfusion over time (80.8% vs. 46.4%) and a higher recanalization rate (65.1% vs. 27.4%), compared to class IIIa and II residual perfusions [15,16,17]
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