Purpose

After coil embolization of intracranial aneurysms, it is currently not well understood whether the initial coil packing density or the type of aneurysm residual perfusion, depicted by the modified Raymond-Roy occlusion classification, primarily effects the rate of aneurysm recurrence. We hypothesized that these factors interact and only one remains an independent risk factor.

Methods

In this single center retrospective study, 440 patients with intracranial ruptured and unruptured aneurysms between 2010 and 2017 were screened. A total of 267 patients treated with stand-alone coiling, with or without stent or balloon assistance were included (age 54.1 ± 12.2 years, sex 70.4% female). Flow diverter or Woven EndoBridge (WEB) device implantation were exclusion criteria.

Results

Using a binary logistic regression model, independent risk factors for aneurysm recurrence were postinterventional modified Raymond-Roy occlusion classification class (Odds ratio [OR] 1.747, 95% confidence interval [CI] 1.231–2.480) and aneurysm diameter (OR 1.145, CI 1.032–1.271). A trend towards a higher recurrence in ruptured aneurysms did not reach significance (OR 1.656, CI 0.863–3.179). Aneurysm localization, packing density, and neck width were not independently associated with aneurysm recurrence.

Conclusion

Independent risk factors for aneurysm recurrence after coil embolization with and without stent or balloon assistance were aneurysm diameter and postinterventional grading within the modified Raymond-Roy occlusion classification. Packing density interacted with the latter and was not independently associated to recurrence.

中文翻译：

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初始 Raymond-Roy 闭塞分类而不是填充密度定义了动脉瘤缠绕后复发的风险。

目的

在颅内动脉瘤线圈栓塞后，目前尚不清楚初始线圈填充密度或动脉瘤残留灌注的类型（由改良的 Raymond-Roy 闭塞分类描述）是否主要影响动脉瘤复发率。我们假设这些因素相互作用，只有一个仍然是独立的风险因素。

方法

在这项单中心回顾性研究中，筛查了 2010 年至 2017 年间 440 名颅内破裂和未破裂动脉瘤患者。总共有 267 名接受独立线圈治疗的患者，有或没有支架或球囊辅助（年龄 54.1 ± 12.2 岁，性别 70.4% 女性）。分流器或 Woven EndoBridge (WEB) 装置植入是排除标准。

结果

使用二元逻辑回归模型，动脉瘤复发的独立危险因素是介入后改良 Raymond-Roy 闭塞分类类别（优势比 [OR] 1.747，95% 置信区间 [CI] 1.231–2.480）和动脉瘤直径（OR 1.145，CI 1.032） –1.271）。破裂动脉瘤复发率较高的趋势没有达到显着性（OR 1.656，CI 0.863–3.179）。动脉瘤定位、填充密度和颈部宽度与动脉瘤复发不独立相关。

结论

使用和不使用支架或球囊辅助弹簧圈栓塞后动脉瘤复发的独立危险因素是动脉瘤直径和改良 Raymond-Roy 闭塞分类内的介入后分级。堆积密度与后者相互作用并且与复发没有独立关联。