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Stent-Associated Flow Remodeling Causes Further Occlusion of Incompletely Coiled Aneurysms.
MedLine Citation:
PMID:  21430583     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND:: Incomplete coil occlusion is associated with increased risk of aneurysm recurrence. We hypothesize that intracranial stents can cause flow remodeling that promotes further occlusion of an incompletely coiled aneurysm. Objective: We studied our hypothesis by comparing the follow-up angiographic outcomes of stented versus non-stented incompletely coiled aneurysms. METHODS:: From January 2006 through December 2009, the senior author performed 324 initial coilings of previously untreated aneurysms, 145 of which were Raymond classification 2 and 3. Follow-up angiographic studies were available for 109 of these aneurysms (75%). Angiographic outcomes for stented vs. non-stented incompletely coiled aneurysms were compared. A multivariate analysis was performed to identify factors related to progression of occlusion at follow-up, adjusting for aneurysm location, size, neck size, Hunt-Hess grade, stent use, initial Raymond score, packing density, age, gender, and medical comorbidities. RESULTS:: Of the 109 aneurysms, 37 were stented and 72 were not stented. With a median follow-up time of 15.4 months, 33 stented aneurysms (89%) progressed to complete occlusion versus 29 non-stented aneurysms (40%). Recanalization rates were lower in the stent group (8.1%) compared to the non-stent group (37.5%) (p<0.0001). On multivariate analysis, stent use (OR: 18.5, 95% CI: 4.3-76.9) and packing density (OR: 1.093, 95% CI: 1.021-1.170) were significant predictors of progression of occlusion. Aneurysm size negatively correlated with progression of occlusion (OR: 0.844, 95% CI: 0.724-0.983). CONCLUSIONS:: Stent-assisted coiling causes progression of occlusion, possibly by a flow remodeling effect. The odds of progression of occlusion of stent-coiled aneurysms were 18.5 times that of non-stented aneurysms.
Authors:
Matthew F Lawson; William C Newman; Yueh-Yun Chi; J D Mocco; Brian L Hoh
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-3-23
Journal Detail:
Title:  Neurosurgery     Volume:  -     ISSN:  1524-4040     ISO Abbreviation:  -     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-3-24     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1 University of Florida Department of Neurosurgery; 2 University of Florida College of Medicine; 3 University of Florida Department of Epidemiology and Health Policy Research.
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