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Is Packing Density Important in Stent-Assisted Coiling?
MedLine Citation:
PMID:  22569059     Owner:  NLM     Status:  Publisher    
BACKGROUND:: Recent reports have shown that stent-assisted coiling (SAC) is associated with lower aneurysm recanalization rates compared to conventional coiling, raising questions about the necessity of achieving high packing density (PD) in stented aneurysms. OBJECTIVE:: To assess the impact of PD on follow-up obliteration rates of stented aneurysms and attempt to determine the optimal range of PD in SAC. METHODS:: This is a retrospective analysis of a single, large, cerebrovascular referral center's experience over a 5-year period in SAC using Neuroform and Enterprise stents. The rate of complete obliteration on follow-up angiograms was compared for 3 different PD groups: High PD (>22%), moderate PD (12-22%), and low PD (<12%). RESULTS:: There were 292 stent-coiled aneurysms (36 ruptured, 256 unruptured) with available angiographic follow-up. Mean PD was 15.2% and complete obliteration rate was 79.5% at latest follow-up. The rates of complete obliteration were significantly higher in the moderate (86.4%; OR=2.58; p=.006) and high PD groups (85.3%; OR= 2.35; p=.037) compared to the low PD group (71.1%). However, no statistically significant difference was found between the moderate and high PD groups (OR= 0.91; p=.84). In multivariate analysis, PD was a significant predictor of complete obliteration (p=.007) along with smaller aneurysm volumes (p=.004). Ruptured (p=.002) and cavernous aneurysms (p<.001) had significantly lower obliteration rates. CONCLUSION:: High obliteration rates at follow-up were observed despite modest packing of stented aneurysms. Although PD is a definite factor in SAC, moderate and high packing of stented aneurysms seem to provide equivalent angiographic obliteration rates at follow-up.
Nohra Chalouhi; Aaron S Dumont; David Hasan; Stavropoula Tjoumakaris; L Fernando Gonzalez; Robert M Starke; Richard Dalyai; Sedeek El Moursi; Robert Rosenwasser; Pascal Jabbour
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-5-7
Journal Detail:
Title:  Neurosurgery     Volume:  -     ISSN:  1524-4040     ISO Abbreviation:  -     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-5-9     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
1Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania 2Department of Neurosurgery, University of Iowa, Iowa City, Iowa 3 Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia.
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