• Neurosurgery · Aug 2012

    Is packing density important in stent-assisted coiling?

    • Nohra Chalouhi, Aaron S Dumont, David Hasan, Stavropoula Tjoumakaris, L Fernando Gonzalez, Robert M Starke, Richard Dalyai, Sedeek El Moursi, Robert Rosenwasser, and Pascal Jabbour.
    • Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania 19107, USA.
    • Neurosurgery. 2012 Aug 1;71(2):381-6; discussion 386-7.

    BackgroundRecent reports have shown that stent-assisted coiling (SAC) is associated with lower aneurysm recanalization rates compared with conventional coiling, raising questions about the necessity of achieving high packing density (PD) in stented aneurysms.ObjectiveTo assess the impact of PD on follow-up obliteration rates of stented aneurysms and attempt to determine the optimal range of PD in SAC.MethodsThis is a retrospective analysis of a single, large, cerebrovascular referral center's experience over a 5-year period in SAC with the use of Neuroform and Enterprise stents. The rate of complete obliteration on follow-up angiograms was compared for 3 different PD groups: high PD (>22%), moderate PD (12-22%), and low PD (<12%).ResultsThere were 292 stent-coiled aneurysms (36 ruptured, 256 unruptured) with available angiographic follow-up. Mean PD was 15.2%, and complete obliteration rate was 79.5% at latest follow-up. The rates of complete obliteration were significantly higher in the moderate (86.4%; OR = 2.58; P = .006) and high PD groups (85.3%; OR = 2.35; P = .037) compared with the low PD group (71.1%). However, no statistically significant difference was found between the moderate and high PD groups (OR = 0.91; P = .84). In multivariate analysis, PD was a significant predictor of complete obliteration (P = .007) along with smaller aneurysm volumes (P = .004). Ruptured (P = .002) and cavernous aneurysms (P < .001) had significantly lower obliteration rates.ConclusionHigh obliteration rates at follow-up were observed despite modest packing of stented aneurysms. Although PD is a definite factor in SAC, moderate and high packing of stented aneurysms seems to provide equivalent angiographic obliteration rates at follow-up.

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