• Kun Zhang, Zi-Liang Wang, Bu-Lang Gao, Jiang-Yu Xue, Tian-Xiao Li, Tong-Yuan Zhao, Dong-Yang Cai, and Ying-Kun He.
• Henan Provincial Cerebrovascular Hospital, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, Henan Province, China.
• World Neurosurg. 2019 Jul 1; 127: e685-e691.

ObjectiveTo investigate effects of using a large-sized coil first on embolizing cerebral aneurysms compared with conventional coils.Materials And MethodsForty-six patients with 51 saccular intracranial aneurysms who underwent embolization with a large-sized coil first were enrolled as the large-sized coil group. There were 33 female and 13 male patients with a mean age of 56.9 ± 8.8 years. The treatment modality was coiling alone in 30 aneurysms and stent-assisted coiling in 21. Meanwhile, 50 patients with 53 intracranial aneurysms who were treated with conventional-sized coils were selected as the control conventional-sized coil group, including 36 female and 14 male patients with a mean age of 54.6 ± 5.8 years. The treatment modality was coiling alone in 29 aneurysms and stent-assisted coiling in 24 aneurysms. The occlusion rate, percent packing volume, total coil number and length, and follow-up occlusion rate were compared between the 2 groups.ResultsSignificantly (P < 0.001) decreased percent packing volume (19.54% ± 6.44% vs. 27.39% ± 5.68%), decreased coil number (2.98 ± 1.09 vs. 6.38 ± 1.65), and length (26.20 ± 26.57 vs. 44.35 ± 35.88 cm) were achieved in the large versus the conventional coil group. At angiographic follow-up of 8 months, only 1 aneurysm (2.2%) recurred in the large coil group compared with 5 aneurysms recurrent (11.1%) in the conventional coil group.ConclusionsThe use of a large-sized coil as the first one for embolizing cerebral aneurysms may be a better embolization strategy because it achieves similar initial occlusion rates, decreased packing density, decreased coil numbers and lengths, and reduced recurrence prevalence at follow-up.Copyright © 2019 Elsevier Inc. All rights reserved.

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