Rabbit Elastase Aneurysm Model Mimics the Recurrence Rate of Human Intracranial Aneurysms following Platinum Coil Embolization

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FIG 1.
Angiographic and histopathologic evaluation of a completely occluded aneurysm on day 180. DSA images of the aneurysm before treatment (A), immediately after treatment showing complete occlusion (B), and before sacrifice demonstrating stable occlusion (C). Photomicrograph of an aneurysm section shows the aneurysm dome filled with organized connective tissue (D, H&E staining, original magnification ×12.5) and the neck interface lined with a single layer of endothelium (arrows) (E, enlarged view of the box in D; H&E staining, original magnification ×40).
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FIG 2.
Angiographic and histopathologic evaluation of a recanalized aneurysm on day 180. DSA images of the aneurysm before treatment (A), immediately after treatment showing complete occlusion (B), and before sacrifice shows near-complete occlusion demonstrating recanalization (C). Photomicrograph of an aneurysm section shows a long, deep neck remnant that was wide open to parent artery connective tissue (D, H&E staining; original magnification ×12.5). The tissue interface at the neck remnant appears to be macroconcave in relation to the tissues filled in the dome (D) and contains poorly organized thrombus (E, enlarged view of arrow in D; H&E staining, original magnification ×40).

Table 1:

Characteristics of the included aneurysms

Table 2:

Summary of different outcomes following treatment

Variables	Balloon Used
	No		Yes		Total
	Count	%	Count	%	Count	%	P Value
Angio after treatment
Complete	46	69.7	106	90.6	152	83.1	<.001^{^a}
Incomplete	3	4.5	2	1.7	5	2.7	<.001^{^a}
Near-complete	17	25.8	9	7.7	26	14.2
Angio before sacrifice
Complete	41	62.1	105	89.7	146	79.8	<.001^{^a}
Incomplete	13	19.7	3	2.6	16	8.7	<.001^{^a}
Near-complete	12	18.2	9	7.7	21	11.5
Angio comparative score
Progressive	3	4.5	6	5.1	9	4.9	<.001^{^a}
Recurrence	19	28.8	9	7.7	28	15.3	<.001^{^a}
Stable	44	66.7	102	87.2	146	79.8
Cross loop sign (coil bridging the neck)
No	55	83.3	116	99.1	171	93.4	<.001^{^a}
Yes	11	16.7	1	0.9	12	6.6
Packing density (mean) (%)	24.8 (SD, 14.0)		30.5 (SD, 14.6)		28.5 (SD, 14.6)		.004^{^a}
Total histologic healing score (mean)	5.6 (SD, 2.5)		5.4 (SD, 2.4)		5.5 (SD, 2.5)		.429

Table 3:

Predictors of aneurysm recurrence^{^a}

Note:—SD, standard deviation.
↵a Model metrics: Akaike information criterion (AIC) = 135.5, C-statistic = 0.809, The Hosmer–Lemeshow test (H&L) = χ² (8) 4.62 (P = .798).
↵b Statistically significant.

Table 4:

Predictors of aneurysm occlusion^{^a}

Predictors	Occlusion
Predictors	No	Yes	OR (Univariable)	OR (Multivariable)
Packing density (mean) (SD) (%)	20.4 (11.9)	30.5 (14.5)	1.07 (1.03–1.11, P value <.001^{^b})	1.05 (1.02–1.10, P value = .008^{^b})
Follow-up time point (mean) (SD) (mo)	2.5 (2.1)	2.2 (2.5)	0.96 (0.84–1.12, P value = .576)	1.11 (0.89–1.42, P value = .398)
Neck (mean) (SD) (mm)	4.7 (6.5)	2.8 (1.1)	0.60 (0.44–0.80, P value = .001^{^b})	0.68 (0.45–1.02, P value = .065)
Width (mean) (SD) (mm)	3.7 (1.1)	3.6 (1.0)	0.89 (0.63–1.28, P value = .536)	5.45 (1.54–19.76, P value = .008^{^b})
Height (mean) (SD) (mm)	9.1 (2.5)	7.7 (2.2)	0.76 (0.64–0.90, P value = .002^{^b})	0.80 (0.60–1.05, P value = .123)
Volume (mean) (SD) (mm³)	79.5 (65.1)	60.3 (44.1)	0.99 (0.99–1.00, P value = .039^{^b})	0.98 (0.96–1.01, P value = .229)
Balloon used (mean) (SD)
No	25 (37.9)	41 (62.1)	Reference
Yes	12 (10.3)	105 (89.7)	5.34 (2.50–11.95, P value <.001^{^b})	6.88 (2.58–20.37, P value <.001^{^b})

Note:—SD, standard deviation.
↵a Model metrics: Akaike information criterion (AIC) =146.3, C-statistic =0.849, The Hosmer–Lemeshow test (H&L) = χ² (8) 11.22 (P = .190).
↵b Statistically significant.