Ahead of Print: Is Packing Density Important in Stent-Assisted Coiling?
Background: Recent reports have shown that stent-assisted coiling (SAC) is associated with lower aneurysm recanalization rates compared to conventional coiling, raising questions about the necessity of achieving high packing density (PD) in stented aneurysms.
Objective: To assess the impact of PD on follow-up obliteration rates of stented aneurysms and attempt to determine the optimal range of PD in SAC.
Methods: This is a retrospective analysis of a single, large, cerebrovascular referral center’s experience over a 5-year period in SAC using 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%).
Results: There 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 to 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.
Conclusion: High 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 seem to provide equivalent angiographic obliteration rates at follow-up.
From: Is Packing Density Important in Stent-Assisted Coiling? by Chalouhi et al.