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How long does it take to coil an intracranial aneurysm?

ABSTRACT: INTRODUCTION: The change in the treatment of choice for intracranial aneurysms from clipping to coiling has been associated with an important change in logistics. The time needed for coiling is variable and depends on many factors. In this study, we assessed the procedural time for the coiling of 642 aneurysms and tried to identify predictors of a long procedural time. METHODS: The procedural time for coiling was defined as the number of minutes between the first diagnostic angiographic run and the last angiographic run after embolization. Thus, induction of general anesthesia and catheterization of the first vessel were not included in the procedural time. A long procedural time was defined as the upper quartile of procedural times (70-158 min). Logistic regression analysis was performed for several variables. RESULTS: The mean procedural time was 57.3 min (median 52 min, range 15-158 min). More than half of the coiling procedures lasted between 30 and 60 min. Multiple logistic regression analysis identified the use of a supportive device (OR 5.4), procedural morbidity (OR 4.5) and large aneurysm size (OR 3.0) as independent predictors of a long procedural time. A poor clinical condition of the patient, the rupture status of the aneurysm, gender, the occurrence of procedural rupture, and aneurysm location were not related to a long procedural time. The mean time for the first 321 coiling procedures was not statistically significantly different from mean time for the last 321 procedures. CONCLUSION: With optimal logistics, coiling of most intracranial aneurysms can be performed in one to two hours, including patient handling before and after the actual coiling procedure.

SUBMITTER: de Gast AN

PROVIDER: S-EPMC2151779 | biostudies-other | 2008 Jan

REPOSITORIES: biostudies-other

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Project description:BackgroundRecurrence of intracranial aneurysms after endovascular coiling is a serious clinical concern.ObjectiveWe hypothesized that recurrence is associated with aneurysm morphology and flow, as well as the coil intervention and the induced flow modifications.MethodsWe collected 52 primary-coiling aneurysm cases that were either occluded (n=34) or recurrent (n=18) at >1 year follow-up. We created aneurysm models from pre-coiling digital subtraction angiographic images, calculated aneurysm morphology, simulated pre-coiling hemodynamics, modeled coil deployment, and obtained post-coiling hemodynamics for each case. We performed univariable analysis on 26 morphologic, treatment-specific, and hemodynamic parameters to distinguish between recurrent and occluded groups, and multivariable analysis to identify independently significant parameters associated with recurrence. Univariable analysis was also performed on ruptured and unruptured aneurysm subcohorts separately to investigate if they shared specific significant parameters.ResultsRecurrence was associated with pre-coiling aneurysm morphologic and flow parameters including larger size (maximum dimension and volume), larger neck (diameter, area, and neck-to-parent-artery ratio), and higher flow momentum and kinetic energy. Recurrence was also associated with lower coil packing (packing density and uncoiled volume), higher post-treatment flow (velocity, momentum, and kinetic energy), lower post-treatment washout time, and higher post-treatment impingement force at the neck. Multivariable analysis identified two aneurysmal characteristics (neck diameter and pre-coiling flow kinetic energy), one coil packing parameter (uncoiled volume), and one post-treatment hemodynamic parameter (flow momentum) that were independently associated with recurrence. In ruptured aneurysms, recurrence was associated with larger neck (diameter and area), whereas in unruptured aneurysms, recurrence was associated with larger size (maximum dimension and volume). In both subcohorts, recurrence was associated with higher post-coiling flow momentum and kinetic energy.ConclusionRecurrence at >1 year after coil treatment is associated with intrinsic aneurysm characteristics, coiling itself, and flow changes induced by coiling. Larger aneurysm size and neck, less coil packing, and higher intra-aneurysmal flow before and after coiling predict recurrence.

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How long does it take to coil an intracranial aneurysm?

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