Volume versus standard coils in the treatment of intracranial aneurysms.
BACKGROUND
Volume coils were developed to improve occlusion rates of intracranial aneurysms. Previous studies have shown increased packing density and comparable occlusion rates, but subgroup analyses of aneurysm size have not been carried out.


OBJECTIVE
To evaluate the safety and efficacy of the Penumbra Coil 400 (PC400) system in treating intracranial aneurysms compared with standard diameter coils.


METHODS
A monocentric retrospective case review of 260 aneurysms in 233 patients was carried out. In 37 aneurysms the PC400 system was used, while 223 aneurysms were treated with conventional coils. Previously treated aneurysms and aneurysms treated with flow diverters were excluded. Aneurysm and procedure characteristics, packing density, postprocedural and follow-up occlusion grades as well as coil compaction were evaluated.


RESULTS
Aneurysms treated with PC400 coils had higher volume (218.9 vs 47.1 mm(3), p<0.001), wider necks (3.0 vs 2.5 mm, p=0.005), and greater dome/neck ratio (2.0 vs 1.6, p=0.001) in comparison with aneurysms treated with conventional coils. Compared with controls, in the PC400 group we achieved higher packing densities (43.2% vs 34.4%, p<0.001; in aneurysms ≥7 mm 42.2% vs 27.8%, p<0.001). On follow-up angiography we observed less coil compaction (23.8% vs 64.3%, p=0.003) and less aneurysm recurrence (14.3% vs 40.5%, p=0.046) in aneurysms ≥7 mm when using the PC400 system.


CONCLUSIONS
Use of the PC400 system as opposed to conventional coils suggests that the PC400 system is safe and effective in treating intracranial aneurysms. Despite having been applied in a potentially more difficult-to-treat group, the use of PC400 was associated with less coil compaction and aneurysm recurrence in aneurysms ≥7 mm.
Abteilung für diagnostische und interventionelle Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Johannes
J
Kaesmacher
Abteilung für diagnostische und interventionelle Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Christina
C
Müller-Leisse
Abteilung für diagnostische und interventionelle Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Thomas
T
Huber
Abteilung für diagnostische und interventionelle Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Tobias
T
Boeckh-Behrens
Institut für Statistik und Epidemiologie (IMSE), Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Bernhard
B
Haller
Klinik für Neurochirurgie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Ehab
E
Shiban
Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Leipzig, Leipzig, Germany.
Benjamin
B
Friedrich
Abteilung für diagnostische und interventionelle Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Claus
C
Zimmer
Abteilung für Neuroradiologie, Klinikum Großhadern, Ludwig-Maximilians-Universität München, Munich, Germany.
Franziska
F
Dorn
Abteilung für diagnostische und interventionelle Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Sascha
http://orcid.org/0000-0002-3964-3885
S
Prothmann
D000368:Aged; D001807:Blood Vessel Prosthesis / Q000009:adverse effects; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome
Aneurysm; Angiography; Catheter; Coil; Device