Introduction:
Computational and experiential analyses of coil packing density (CPD) for intracranial aneurysms have demonstrated that higher packing densities, ranging from 20% up, have a lower rates of recurrence. Aneurysms with lower packing densities are prone to coil compaction, recurrence, and often require retreatment due to ineffective induction of stasis and changes in hemodynamic factors within the aneurysm that lead to thrombosis.
Methods:
We present a case of a woman with a large anterior circulation aneurysm measuring 21x17x17mm that underwent 6 successive coil embolizations over the course of 5 years. For each treatment, embolization was terminated once complete stasis of dye was observed within the aneurysm sac. We compared the coil packing density after each embolization.
Results:
A total of 41 embolization coils were deployed over the course of 5 treatments. CPD after the initial session of 15 coils was 12.2%. Dye stasis within the aneurysm was observed, but upon followup compaction was observed and an additional 6 coils were added, improving CPD to 13.9%. This was repeated an additional 4 times with 6 coils for 16.8%, 9 coils for 18.0%, 5 coils for 20.3%, and 9 coils for 23.3%.
Conclusions:
Coil embolization of large and giant aneurysms represents a challenge due to high volume to surface area ratios. Framing coils can opacify the exterior and lead to difficulty in visualizing and obliterating interior pockets. CPD can be a useful treatment planning adjunct in such circumstances to reduce the risk of recurrence.
Patient Care:
Reduce risk of recurrence, recanalization, and retreatment.
Learning Objectives:
Understanding the utility of coil packing density in guiding treatment decisions for large and giant aneurysms