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Research ArticleNeurointervention
Open Access

Does Increasing Packing Density Using Larger Caliber Coils Improve Angiographic Results of Embolization of Intracranial Aneurysms at 1 Year: A Randomized Trial

J. Raymond, J. Ghostine, B.A. van Adel, J.J.S. Shankar, D. Iancu, A.P. Mitha, P. Kvamme, R.D. Turner, A. Turk, V. Mendes-Pereira, J.S. Carpenter, S. Boo, A. Evans, H.H. Woo, D. Fiorella, A. Alaraj, D. Roy, A. Weill, P. Lavoie, M. Chagnon, T.N. Nguyen, J.L. Rempel and T.E. Darsaut
American Journal of Neuroradiology January 2020, 41 (1) 29-34; DOI: https://doi.org/10.3174/ajnr.A6362
J. Raymond
aFrom the Department of Radiology (J.R., J.G., D.R., A.W.), Service of Interventional Neuroradiology, Centre Hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
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J. Ghostine
aFrom the Department of Radiology (J.R., J.G., D.R., A.W.), Service of Interventional Neuroradiology, Centre Hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
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B.A. van Adel
bDepartment of Surgery/Medicine (B.A.v.A), McMaster University, Hamilton, Ontario, Canada
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J.J.S. Shankar
dDepartment of Radiology (J.J.S.S.), University of Manitoba, Winnipeg, Manitoba, Canada
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D. Iancu
eDepartment of Radiology, Service of Interventional Neuroradiology (D.I.), University of Ottawa Hospitals, Civic Campus, Ottawa, Ontario, Canada
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A.P. Mitha
fDepartment of Clinical Neurosciences (A.P.M.), University of Calgary, Calgary, Alberta, Canada
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P. Kvamme
gDepartment of Radiology (P.K.), University of Tennessee Medical Center, Knoxville, Tennessee
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R.D. Turner
hDepartment of Neurosurgery (R.D.T., A.T.), Prisma Health–Upstate, Greenville, South Carolina
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A. Turk
hDepartment of Neurosurgery (R.D.T., A.T.), Prisma Health–Upstate, Greenville, South Carolina
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V. Mendes-Pereira
iDivision of Neuroradiology (V.M.-P.), Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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J.S. Carpenter
jDepartment of Neuroradiology (J.S.C., S.B.), West Virginia University, Rockefeller Neuroscience Institute, Morgantown, West Virginia
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S. Boo
jDepartment of Neuroradiology (J.S.C., S.B.), West Virginia University, Rockefeller Neuroscience Institute, Morgantown, West Virginia
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A. Evans
kDepartment of Interventional Neuroradiology (A.E.), University of Virginia Medical Center, Charlottesville, Virginia
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H.H. Woo
lDepartments of Neurosurgery and Radiology, Northwell Health System (H.H.W., D.F.), Manhasset, New York
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D. Fiorella
lDepartments of Neurosurgery and Radiology, Northwell Health System (H.H.W., D.F.), Manhasset, New York
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A. Alaraj
mDepartment of Neurosurgery (A.A.), University of Illinois Hospital and Health Sciences System, Chicago, Illinois
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D. Roy
aFrom the Department of Radiology (J.R., J.G., D.R., A.W.), Service of Interventional Neuroradiology, Centre Hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
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A. Weill
aFrom the Department of Radiology (J.R., J.G., D.R., A.W.), Service of Interventional Neuroradiology, Centre Hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
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P. Lavoie
nDepartment of Neurosurgery (P.L.), Hôpital Enfant-Jésus, Quebec City, Quebec, Canada
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M. Chagnon
oDepartment of Mathematics and Statistics (M.C.), University of Montreal, Montreal, Quebec, Canada
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T.N. Nguyen
pDepartments of Neurology, Neurosurgery, and Radiology (T.N.N.), Boston Medical Center, Boston, Massachusetts
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J.L. Rempel
qDepartment of Radiology and Diagnostic Imaging (J.L.R.)
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T.E. Darsaut
rDivision of Neurosurgery (T.E.D.), Department of Surgery, Mackenzie Health Sciences Centre, University of Alberta Hospital, Edmonton, Alberta, Canada.
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    Fig 1.

    Trial profile. SAEs indicates severe adverse events.

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    Fig 2.

    Effect of packing density and immediate angiographic results. From left to right, decreasing packing density has an impact, but it depends on inferior immediate angiographic results. From upper to lower rows, increasing packing density, given the same initial angiographic results, has no impact on long-term angiographic results.

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    Fig 3.

    Effect of packing density and immediate angiographic results. Packing density is better thought of as an index compounding many causal factors, such as aneurysm and neck sizes and immediate angiographic results, rather than a true causal factor in long-term angiographic results.

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    Table 1:

    Patient demographics and aneurysm characteristicsa

    10-Caliber Coils (n = 106)15-Caliber Coils (n = 104)
    Female sex81 (76.4%)82 (78.8%)
    Age (mean) (SD) (yr)57 (11)58 (10)
    mRS at baseline >22 (1.9%)3 (2.9%)
    Multiple aneurysms (No.) (%)29 (27.4%)29 (27.9%)
    Ruptured aneurysms
     (No.) (%) of treatment group35 (33.0%)36 (34.6%)
     (No.) (%) recurrence01 (1.0%)
    Unruptured aneurysms
     (No.) (%) of treatment group71 (67.0%)68 (65.4%)
     (No.) (%) recurrence4 (3.8%)3 (2.9%)
     (No.) (%) symptomatic7 (6.6%)5 (4.8%)
    Aneurysm size (maximal dimension)
     Mean (SD) (mm)7.7 (2.6)7.8 (2.3)
    Aneurysm neck
     Mean (SD) (mm)3.2 (1.1)3.3 (1.3)
     Neck ≥4.0 (mm)39 (36.8%)31 (29.8%)
    Aneurysm location, anterior (No.) (%)81 (76.4%)88 (84.6%)
     Internal carotid36 (34.0%)42 (40.4%)
     Anterior cerebral32 (30.2%)31 (29.8%)
     Middle cerebral13 (12.3%)15 (14.4%)
    Aneurysm location, posterior (No.) (%)25 (23.6%)16 (15.4%)
     Basilar18 (17.0%)12 (11.5%)
     Other posterior7 (6.6%)4 (3.8%)
    • ↵a No significant difference was found between groups on any of the parameters.

    • View popup
    Table 2:

    Primary outcomea

    10-Caliber Coils (n = 106)15-Caliber Coils (n = 104)
    Primary outcome met36 (34.0%)37 (35.6%)
     Major recurrence20 (18.9%)26 (25.0%)
     Retreatment4 (3.8%)4 (3.8%)
     Initial treatment failure6 (5.7%)4 (3.8%)
     SAH1 (0.9%)0
     Related mortality5 (4.7%)2 (1.9%)
     Related morbidity01 (1.0%)
    Good outcome64 (60.4%)64 (61.5%)
    Not attributed6 (5.7%)3 (2.9%)
     Lost to follow-up4 (3.8%)3 (2.9%)
     Unrelated mortality2 (1.9%)0
    • ↵a No significant difference between groups was found in the primary outcome. Data are (No.) (%).

    • View popup
    Table 3:

    Serious adverse events

    10-Caliber Coils (n = 106)15-Caliber Coils (n = 104)
    Mortality, total (No.) (%)7 (6.6%)2 (1.9%)
     Aneurysm rupture during procedure2 (1.9%)1 (1.0%)
     Stroke, periprocedural2 (1.9%)0
     Stroke, related to SAH at presentation1 (0.9%)0
     Related to SAH during follow-up01 (1.0%)
     Unrelated to aneurysm or its treatment2 (1.9%)0
    Morbidity, total (No.) (%)11 (10.4%)5 (4.8%)
     Aneurysm rupture during procedure4 (3.8%)3 (2.9%)
     Stroke6 (5.7%)2 (1.9%)
     SAH during follow-up1 (0.9%)0
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American Journal of Neuroradiology: 41 (1)
American Journal of Neuroradiology
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J. Raymond, J. Ghostine, B.A. van Adel, J.J.S. Shankar, D. Iancu, A.P. Mitha, P. Kvamme, R.D. Turner, A. Turk, V. Mendes-Pereira, J.S. Carpenter, S. Boo, A. Evans, H.H. Woo, D. Fiorella, A. Alaraj, D. Roy, A. Weill, P. Lavoie, M. Chagnon, T.N. Nguyen, J.L. Rempel, T.E. Darsaut
Does Increasing Packing Density Using Larger Caliber Coils Improve Angiographic Results of Embolization of Intracranial Aneurysms at 1 Year: A Randomized Trial
American Journal of Neuroradiology Jan 2020, 41 (1) 29-34; DOI: 10.3174/ajnr.A6362

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Does Increasing Packing Density Using Larger Caliber Coils Improve Angiographic Results of Embolization of Intracranial Aneurysms at 1 Year: A Randomized Trial
J. Raymond, J. Ghostine, B.A. van Adel, J.J.S. Shankar, D. Iancu, A.P. Mitha, P. Kvamme, R.D. Turner, A. Turk, V. Mendes-Pereira, J.S. Carpenter, S. Boo, A. Evans, H.H. Woo, D. Fiorella, A. Alaraj, D. Roy, A. Weill, P. Lavoie, M. Chagnon, T.N. Nguyen, J.L. Rempel, T.E. Darsaut
American Journal of Neuroradiology Jan 2020, 41 (1) 29-34; DOI: 10.3174/ajnr.A6362
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