Di Salle Gianfranco, Atallah Alexis, van Dokkum Liesjet Eh, Gascou Gregory, Dargazanli Cyril, Lefevre Pierre Henri, Collemiche Francois-Louis, Varnier Quentin, Checkouri Thomas, Chnafa Christophe, Rene Amandine, Radu Razvan Alexandru, Costalat Vincent, Cagnazzo Federico
Neuroradiology Department, Gui de Chauliac, University Hospital Centre of Montpellier, Montpellier, France.
Sim&Cure, Montpellier, France.
Interv Neuroradiol. 2025 May 21:15910199251341652. doi: 10.1177/15910199251341652.
BackgroundCoil embolization is a standard therapeutic approach for intracranial aneurysms. Recurrence risk during follow-up is not negligible, with inadequate packing density identified as a potential risk factor. This study aims to identify patient- and procedure-related factors contributing to recurrence.MethodsWe retrospectively enrolled consecutive patients with unruptured intracranial aneurysms treated only with coils between January 2021 and December 2022. Aneurysms were included if 3D-rotational angiography and follow-up imaging were available. For each patient, the volume embolization ratio (VER) was computed using Sim&Size (Sim&Cure, France) for both the framing coil (First-coil VER) and the entire coiling procedure (Global VER). Patient demographics and aneurysm characteristics were also recorded. Follow-up imaging classified patients into adequate- or inadequate-occlusion groups. Multivariate analyses assessed independent factors associated with recurrence.ResultsSeventy-nine unruptured aneurysms from 79 patients were included. At follow-up, = 69 (87%) demonstrated adequate occlusion, defined as modified Raymond-Roy classification I-II. Adequate- and inadequate-occlusion groups differed in First-coil (13.5 ± 5.5% vs 7.1 ± 4.0% respectively, = .002) and Global VER (24.5 ± 6.8% vs 17.3 ± 5.7% respectively, = .004). Posterior aneurysm location ( = .013), aneurysm height ( = .007), and neck diameter ( = .018) were significantly associated with recurrence. In multivariate analysis, Global- ( = .029) and First-coil VER ( = .025) remained significant risk factors for recurrence, with their interaction term being statistically significant as well ( = .020).ConclusionsFirst-coil and Global VER computed using Sim&Size are predictive of aneurysm occlusion at follow-up. These results highlight the potential value of virtual simulation in optimizing coil packing density to improve mid- to long-term occlusion outcomes.
背景
弹簧圈栓塞术是治疗颅内动脉瘤的标准方法。随访期间的复发风险不容忽视，填塞密度不足被认为是一个潜在风险因素。本研究旨在确定导致复发的患者相关因素和手术相关因素。
方法
我们回顾性纳入了2021年1月至2022年12月期间仅接受弹簧圈治疗的连续未破裂颅内动脉瘤患者。如果有三维旋转血管造影和随访影像，则纳入动脉瘤病例。对于每位患者，使用Sim&Size（法国Sim&Cure公司）计算成篮弹簧圈的体积栓塞率（VER）（初始弹簧圈VER）和整个弹簧圈栓塞过程的体积栓塞率（整体VER）。还记录了患者的人口统计学资料和动脉瘤特征。随访影像将患者分为栓塞充分组和栓塞不充分组。多因素分析评估与复发相关的独立因素。
结果
纳入了79例患者的79个未破裂动脉瘤。随访时，69个（87%）显示栓塞充分，定义为改良Raymond-Roy分级I-II级。栓塞充分组和栓塞不充分组在初始弹簧圈VER（分别为13.5±5.5%和7.1±4.0%，P = 0.002）和整体VER（分别为24.5±6.8%和17.3±5.7%，P = 0.004）方面存在差异。动脉瘤位于后循环（P = 0.013）、动脉瘤高度（P = 0.007）和瘤颈直径（P = 0.018）与复发显著相关。在多因素分析中，整体VER（P = 0.029）和初始弹簧圈VER（P = 0.025）仍然是复发的显著风险因素，它们的交互项也具有统计学意义（P = 0.020）。
结论
使用Sim&Size计算的初始弹簧圈VER和整体VER可预测随访时动脉瘤的栓塞情况。这些结果凸显了虚拟模拟在优化弹簧圈填塞密度以改善中长期栓塞效果方面的潜在价值。
