title: Use of Hydrocoil in small aneurysms: procedural safety, treatment efficacy and factors predicting complete occlusion.
abstract: Coil technology has been directed to reduce recurrence rates and we have seen the introduction of trials comparing the efficacy of surface modified versus bare platinum coils (BPC). This article reports on one treatment strategy in the treatment of small aneurysms by the placement of Hydrocoil across the neck of the aneurysm. Procedural safety, treatment efficacy and factors which predict complete occlusion are evaluated. We retrospectively identified a subgroup of small aneurysms treated over a four-year period. Analysis comparing aneurysms treated with Hydrocoil and BPC versus Hydrocoil alone was undertaken. Eighty-five aneurysms were coiled; 62% with Hydrocoil alone, 38% in combination with BPC. At six-month follow-up, overall 50% were completely occluded, 39.5% had a neck remnant and 10.5% had a residual aneurysm. Complete occlusion was identified in 39% in the Hydrocoil and BPC group compared to 56% in the Hydrocoil alone group. In 56/76 (74%) cases analysed, Hydrocoil loop successfully bridged the neck of the aneurysm in which 38/76 (68%) of these were completely occluded at six-month follow-up. Thirteen procedure-related complications occurred. Aneurysms treated with Hydrocoil alone resulted in fewer recurrences compared with a combination of Hydrocoil and BPC. These data suggest that the technique of positioning Hydrocoil at the neck of the aneurysm increases the probability of complete occlusion and is therefore a strong predictor of aneurysm occlusion. In our experience, this technique did not demonstrate an increased risk of intra-procedural rupture or thrombo-embolic complications compared to conventional embolization with BPC.
authors.affiliation: Southampton General Hospital; Southampton, United Kingdom - amanda.williams@uhs.nhs.uk.
authors.forename: Amanda
authors.initials: A
authors.lastname: Williams
authors.affiliation: Southampton General Hospital; Southampton, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: Millar
authors.affiliation: Southampton General Hospital; Southampton, United Kingdom.
authors.forename: Adam
authors.initials: A
authors.lastname: Ditchfield
authors.affiliation: Brighton and Sussex University Hospitals NHS Trust; Brighton, United Kingdom.
authors.forename: Sriram
authors.initials: S
authors.lastname: Vundavalli
authors.affiliation: Southampton General Hospital; Southampton, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Barker
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000401:mortality* / Q000517:prevention & control*; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000401:mortality*; D004867:Equipment Design; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D015995:Prevalence; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
keywords: embolization; small aneurysms