| Stent-Associated Flow Remodeling Causes Further Occlusion of Incompletely Coiled Aneurysms. | |
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MedLine Citation:
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PMID: 21430583 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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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. |
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Authors:
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Matthew F Lawson; William C Newman; Yueh-Yun Chi; J D Mocco; Brian L Hoh |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-3-23 |
Journal Detail:
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Title: Neurosurgery Volume: - ISSN: 1524-4040 ISO Abbreviation: - Publication Date: 2011 Mar |
Date Detail:
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Created Date: 2011-3-24 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7802914 Medline TA: Neurosurgery Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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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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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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