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Relationship between aneurysm volume and histologic healing after coil embolization in elastase-induced aneurysms: a retrospective study.

ABSTRACT: There are, to our knowledge, no histologic data correlating aneurysm volume with histologic healing following coil embolization of aneurysms. We report a retrospective study comparing histologic outcome with aneurysm volume in elastase-induced aneurysms in rabbits.Aneurysm volume and histologic healing after coil embolization were retrospectively analyzed in 37 elastase-induced aneurysms in rabbits. Aneurysm dimensions (including neck, width, height, and volume) were measured and calculated. Packing density (PD) was calculated. Angiographic results were evaluated as recurrence, stable, and progressive occlusion. An ordinal grading system was used to evaluate the histologic healing after embolization. Correlations among aneurysm volume, PD, and histologic healing were analyzed by conducting linear regression analysis.For all the aneurysms in this study, mean aneurysm volume was 80.8 +/- 48.6 mm(3) (from 22 to 192 mm(3)), mean PD was 30.4 +/- 8.3% (from 17% to 49%), and mean histologic score was 6.1 +/- 2.0 (from 0.5 to 9.5), respectively. Correlations between aneurysm volume and PD, aneurysm volume and histologic healing, and aneurysm packing and histologic healing were all significant (P < .01).In this study, aneurysms with smaller volumes and higher PD were associated with the most complete histologic healing. The incomplete healing seen in the larger aneurysms is consistent with the higher incidence of recurrences after endovascular treatment that is seen in large human aneurysms.

SUBMITTER: Ding YH

PROVIDER: S-EPMC2614357 | biostudies-literature | 2008 Jan

REPOSITORIES: biostudies-literature

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Relationship between aneurysm volume and histologic healing after coil embolization in elastase-induced aneurysms: a retrospective study.

Ding Y H YH Dai D D Kadirvel R R Lewis D A DA Cloft H J HJ Kallmes D F DF

AJNR. American journal of neuroradiology 20071009 1

<h4>Background and purpose</h4>There are, to our knowledge, no histologic data correlating aneurysm volume with histologic healing following coil embolization of aneurysms. We report a retrospective study comparing histologic outcome with aneurysm volume in elastase-induced aneurysms in rabbits.<h4>Materials and methods</h4>Aneurysm volume and histologic healing after coil embolization were retrospectively analyzed in 37 elastase-induced aneurysms in rabbits. Aneurysm dimensions (including neck, ...[more]

PMID: 17925370

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Project description:ObjectiveOutcomes of stent-assisted coil embolization (SACE) have not been well established in the setting of vertebrobasilar dissecting aneurysms (VBDAs) due to the low percentage of cases that need treatment and the array of available therapeutic options. Herein, we presented clinical and radiographic results of SACE in patients with VBDAs.Materials and methodsA total of 47 patients (M:F, 30:17; mean age ± SD, 53.7 ± 12.6 years), with a VBDA who underwent SACE between 2008 and 2014 at two institutions were evaluated retrospectively. Medical records and radiologic data were analyzed to assess the outcome of SACE procedures. Cox proportional hazards regression analysis was conducted to determine the factors that were associated with aneurysmal recanalization after SACE.ResultsStent-assisted coil embolization technically succeeded in all patients. Three cerebellar infarctions occurred on postembolization day 1, week 2, and month 2, but no other procedure-related complications developed. Immediately following SACE, 25 aneurysms (53.2%) showed no contrast filling into the aneurysmal sac. During a mean follow-up of 20.2 months, 37 lesions (78.7%) appeared completely occluded, whereas 10 lesions showed recanalization, 5 of which required additional embolization. Overall recanalization rate was 12.64% per lesion-year, and mean postoperative time to recanalization was 18 months (range, 3-36 months). In multivariable analysis, major branch involvement (hazard ratio [HR]: 7.28; p = 0.013) and the presence of residual sac filling (HR: 8.49, p = 0.044) were identified as statistically significant independent predictors of recanalization. No bleeding was encountered in follow-up monitoring.ConclusionStent-assisted coil embolization appears feasible and safe for treatment of VBDAs. Long-term results were acceptable in a majority of patients studied, despite a relatively high rate of incomplete occlusion immediately after SACE. Major branch involvement and coiled aneurysms with residual sac filling may predispose to recanalization.

Project description:ObjectivePrevious reports have revealed a high incidence of type II endoleak (T2EL) after endovascular aneurysm repair (EVAR). The incidence of T2EL after EVAR is reduced by pre-emptive embolization of aneurysm sac side branches (ASSB) and aneurysm sac coil embolization (ASCE). This study aimed to investigate whether different preventive interventions for T2EL were correlated with suppression of aneurysm sac expansion and reduction of the re-intervention rate.MethodsThe PubMed, Web of Science, MEDLINE and Embase databases, and conference proceedings were searched to identify articles on EVAR with or without embolization. The study was developed in line with the Participants, Interventions, Comparisons, Outcomes, and Study design principles and was conducted and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. We used network meta-analysis based on multivariate random-effects meta-analysis to indirectly compare outcomes of different strategies for embolization during EVAR.ResultsA total of 31 studies met all inclusion criteria and were included in the qualitative and quantitative syntheses. The included studies were published between 2001 and 2022 and analyzed a total of 18,542 patients, including 1,882 patients who received prophylactic embolization treatment during EVAR (experimental group) and 16,660 who did not receive prophylactic embolization during EVAR (control group). The effect of pre-emptive embolization of the inferior mesenteric artery (IMA) (IMA-ASSB) in preventing T2EL was similar (relative risk [RR] 1.01, 95% confidence interval [CI] 0.38-2.63) to the effects of non-selective embolization of ASSB (NS-ASSB) and ASCE (RR 0.88, 95% CI 0.40-1.96). IMA-ASSB showed a better clinical effect in suppressing the aneurysm sac expansion (RR 0.27, 95% CI 0.09-2.25 compared with NS-ASSB; RR 0.93, 95% CI 0.16-5.56 compared with ASCE) and reducing the re-intervention rate (RR 0.34, 95% CI 0.08-1.53 compared with NS-ASSB; RR 0.66, 95% CI 0.19-2.22 compared with ASCE). All prophylactic embolization strategies improved the clinical outcomes of EVAR.ConclusionProphylactic embolization during EVAR effectively prevents T2EL, suppresses the aneurysm sac expansion, and reduces the re-intervention rate. IMA embolization demonstrated benefits in achieving long-term aneurysm sac stability and lowering the risk of secondary surgery. NS-ASSB more effectively reduces the incidence of T2EL, while IMA embolization alone or in combination with ASCE enhances the clinical benefits of EVAR. In addition, as network meta-analysis is still an indirect method based on a refinement of existing data, more studies and evidence are still needed in the future to establish more credible conclusions.

Dataset Information

Relationship between aneurysm volume and histologic healing after coil embolization in elastase-induced aneurysms: a retrospective study.

Publications

Relationship between aneurysm volume and histologic healing after coil embolization in elastase-induced aneurysms: a retrospective study.

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