Intracranial aneurysms: treatment with bare platinum coils--aneurysm packing, complex coils, and angiographic recurrence.

PURPOSE

To retrospectively assess, with three-dimensional rotational angiography, the relationship between packing, complex coils, and angiographic recurrence of aneurysms treated with coils.

MATERIALS AND METHODS

Informed consent was waived by the institutional review board that approved the study. Results at follow-up angiography of 255 aneurysms in 223 patients (161 female and 62 male patients; mean age, 48 years) were dichotomized into presence or absence of recurrence. The degree of packing of aneurysms treated with complex coils alone, with complex and helical coils, and with helical coils only was compared for significant differences. With generalized estimating equations analysis, relative risk (RR) for recurrence was calculated for mode of manifestation, duration of follow-up, aneurysm volume, packing, initial angiographic result, percentage of complex coils, aneurysm location, and multiplicity of aneurysms.

RESULTS

Follow-up angiography revealed recurrence in 28.6% of aneurysms at a mean follow-up of 12 months; 5.5% were amenable to re-treatment. Aneurysms treated with complex and those treated with helical coils only had a mean packing of 27% and 26%, respectively. There was no significant difference between packing of aneurysms treated with complex and those treated with helical coils (P = .538). Recurring and stable aneurysms both had a mean packing of 27%. Generalized estimating equations analysis showed significant differences between duration of follow-up and recurrence (P = .001, RR = 3.39), between aneurysm volume and recurrence (P < .001, RR = 6.15), and between hemorrhagic manifestation and recurrence (P = .002, RR = 3.17). There was no significant difference between packing and recurrence, between initial angiographic result and recurrence, between percentage of complex coils and recurrence, between aneurysm location and recurrence, or between multiplicity of aneurysms and recurrence.

CONCLUSION

More angiographic recurrences are detected over time. Complex coils do not augment aneurysm packing. Packing is not related to protection against recurrence.