Clinical Neuroradiology

, Volume 29, Issue 4, pp 733–740 | Cite as

Importance of the First Coil in the Embolization of Intracranial Aneurysms

A Case Control Study
  • Emerson Brandão SousaEmail author
  • Laise Franco de Sousa Brandão
  • Cléciton Braga Tavares
  • José Nazareno Pearce de Oliveira Brito
  • Iruena Moraes Kessler
Original Article



Endovascular therapy for the treatment of cerebral aneurysms has a higher incidence of rebleeding and a lower occlusion rate than microsurgical clipping. This study investigated whether first coil volume packing density (1st VPD) and first loop diameter of the first coil (1st LD) are associated with recanalization after endovascular coiling.


The study included 174 initial saccular aneurysm cases from 2010 to 2015. Between the recanalization and non-recanalization groups, we compared age, sex, aneurysm location, rupture occurrence, shape, maximum aneurysm size, neck width, dome-to-neck ratio, aneurysm volume, coil volume, VPD, 1st VPD, 1st LD, relation of the first loop diameter of the first coil and the maximum aneurysm size (RLAS), types of assistance techniques, and the Raymond scale score at initial and follow-up angiography.


Recanalization occurred in 41 cases (23.6%). The factors associated with recanalization were irregular shape, maximum aneurysm size, neck width, dome-to-neck ratio, aneurysm volume, VPD, 1st VPD and 1st LD smaller than the maximum aneurysm size. The cut-off values for aneurysmal recanalization were 92%, 11% and 37% for RLAS, 1st VPD and VPD, respectively.


The 1st VPD and 1st LD were associated with aneurysmal recanalization after embolization. These factors provide a helpful index for coil programming.


Effect modifier, epidemiologic Endovascular procedures Therapeutic embolization Treatment failure Treatment outcome 


Conflict of interest

E.B. Sousa, L.F. de S. Brandão, C.B. Tavares, J.N.P. de O. Brito and I.M. Kessler declare that they have no conflicting interests.


  1. 1.
    Frösen J, Piippo A, Paetau A, Kangasniemi M, Niemelä M, Hernesniemi J, Jääskeläinen J. Remodeling of saccular cerebral artery aneurysm wall is associated with rupture: histological analysis of 24 unruptured and 42 ruptured cases. Stroke. 2004;35:2287–93.CrossRefGoogle Scholar
  2. 2.
    Connolly ES Jr, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, Hoh BL, Kirkness CJ, Naidech AM, Ogilvy CS, Patel AB, Thompson BG, Vespa P; American Heart Association Stroke Council; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; Council on Cardiovascular Surgery and Anesthesia; Council on Clinical Cardiology. Guidelines for the management of Aneurysmal Subarachnoid hemorrhage: a guideline for Healthcare professionals from the American heart association/American stroke association. Stroke. 2012;43:1711–37.CrossRefGoogle Scholar
  3. 3.
    Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, Holman R; International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet. 2002;360(9342):1267–74.CrossRefGoogle Scholar
  4. 4.
    Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, Sandercock P; International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms. A randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet. 2005;366(9488):809–17.CrossRefGoogle Scholar
  5. 5.
    Guglielmi G, Viñuela F, Sepetka I, Macellari V. Electrothrombosis of saccular aneurysms via endovascular approach. Part 1: Electrochemical basis, technique, and experimental results. J Neurosurg. 1991;75:1–7.CrossRefGoogle Scholar
  6. 6.
    Guglielmi G, Viñuela F, Dion J, Duckwiler G. Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: Preliminary clinical experience. J Neurosurg. 1991;75:8–14.CrossRefGoogle Scholar
  7. 7.
    CARAT Investigators. Rates of delayed rebleeding from intracranial aneurysms are low after surgical and endovascular treatment. Stroke. 2006;37:1437–42.CrossRefGoogle Scholar
  8. 8.
    Johnston SC, Dowd CF, Higashida RT, Lawton MT, Duckwiler GR, Gress DR; CARAT Investigators. Predictors of Rehemorrhage after treatment of ruptured Intracranial aneurysms: the cerebral aneurysm rerupture after treatment (CARAT) study. Stroke. 2008;39:120–5.CrossRefGoogle Scholar
  9. 9.
    Ishida W, Sato M, Amano T, Matsumaru Y. The significant impact of framing coils on long-term outcomes in endovascular coiling for intracranial aneurysms: how to select an appropriate framing coil. J Neurosurg. 2016;125:705–12.CrossRefGoogle Scholar
  10. 10.
    Kawanabe Y, Sadato A, Taki W, Hashimoto N. Endovascular occlusion of intracranial aneurysms with Guglielmi detachable coils: correlation between coil packing density and coil compaction. Acta Neurochir (Wien). 2001;143:451–5.CrossRefGoogle Scholar
  11. 11.
    Singla A, Vilwock MR, Jacobsen W, Deshaies EM. Aneurysm embolization grade: a predictive tool for aneurysm recurrence after coil embolization. Acta Neurochir (Wien). 2013;155:231–6.CrossRefGoogle Scholar
  12. 12.
    Ries T, Groden C. Endovascular treatment of intracranial aneurysms: long-term stability, risk factors for recurrences, retreatment and follow-up. Klin Neuroradiol. 2009;19:62–72.CrossRefGoogle Scholar
  13. 13.
    Raymond J, Guilbert F, Weill A, Georganos SA, Juravsky L, Lambert A, Lamoureux J, Chagnon M, Roy D. Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke. 2003;34:1398–403.CrossRefGoogle Scholar
  14. 14.
    Misaki K, Uchiyama N, Nambu I, Aida Y, Kamide T, Mohri M, Ueda F, Nakada M. Optimizing the volume of the initial framing coil to facilitate tight packing of intracranial aneurysms. World Neurosurg. 2016;90:397–402.CrossRefGoogle Scholar
  15. 15.
    Slob MJ, Sluzewski M, van Rooij WJ. The relation between packing and reopening in coiled intracranial aneurysms: a prospective study. Neuroradiology. 2005;47:942–5.CrossRefGoogle Scholar
  16. 16.
    Neki H, Kohyama S, Otsuka T, Yonezawa A, Ishihara S, Yamane F. Optimal first coil selection to avoid aneurysmal recanalization in endovascular intracranial aneurysmal coiling. J Neurointerv Surg. 2018;10:50–4.CrossRefGoogle Scholar
  17. 17.
    Higashida RT, Lahue BJ, Torbey MT, Hopkins LN, Leip E, Hanley DF. Treatment of unruptured intracranial aneurysms: a nationwide assessment of effectiveness. AJNR Am J Neuroradiol. 2007;28:146–51.PubMedGoogle Scholar
  18. 18.
    Shapiro M, Becske T, Sahlein D, Babb J, Nelson PK. Stent-supported aneurysm coiling; a literature survey of treatment and follow-up. AJNR Am J Neuroradiol. 2012;33:159–63.CrossRefGoogle Scholar
  19. 19.
    Li H, Pan R, Wang H, Rong X, Yin Z, Milgrom DP, Shi X, Tang Y, Peng Y. Clipping versus coiling for ruptured intracranial aneurysms: a systematic review and meta-analysis. Stroke. 2013;44:29–37.CrossRefGoogle Scholar
  20. 20.
    Murayama Y, Nien YL, Duckwiler G, Gobin YP, Jahan R, Frazee J, Martin N, Viñuela F. Guglielmi detachable coil embolization of cerebral aneurysms: 11 years’ experience. J Neurosurg. 2003;98:959–66.CrossRefGoogle Scholar
  21. 21.
    Piotin M, Iijima A, Wada H, Moret J. Increasing the packing of small aneurysms with complex-shaped coils: an in vitro study. AJNR Am J Neuroradiol. 2003;24:1446–8.PubMedGoogle Scholar
  22. 22.
    Mascitelli JR, Patel AB, Polykarpou MF, Patel AA, Moyle H. Analysis of early angiographic outcome using unique large diameter coils in comparison with standard coils in the embolization of cerebral aneurysms: a retrospective review. J Neurointerv Surg. 2015;7:126–30.CrossRefGoogle Scholar
  23. 23.
    Berenstein A, Song JK, Niimi Y, Namba K, Heran NS, Brisman JL, Nahoum MC, Madrid M, Langer DJ, Kupersmith MJ. Treatment of cerebral aneurysms with hydrogel-coated platinum coils (HydroCoil): early single-center experience. AJNR Am J Neuroradiol. 2006;27:1834–40.Google Scholar
  24. 24.
    Lubicz B, Leclerc X, Gauvrit JY, Leieune JP, Pruvo JP. Three-dimensional packing with complex orbit coils for the endovascular treatment of intracranial aneurysms. AJNR Am J Neuroradiol. 2005;26:1342–8.PubMedGoogle Scholar
  25. 25.
    Khatri R, Chaudhry SA, Rodriguez GJ, Suri MF, Cordina SM, Qureshi AI. Frequency and factors associated with unsuccessful lead (first) coil placement in patients undergoing coil embolization of intracranial aneurysms. Neurosurgery. 2013;72:452–8.CrossRefGoogle Scholar
  26. 26.
    White JB, Ken CG, Cloft HJ, Kallmes DF. Coils in a nutshell: a review of coil physical properties. AJNR Am J Neuroradiol. 2008;29:1242–6.CrossRefGoogle Scholar
  27. 27.
    International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms—risk of rupture and risks of surgical intervention. N Engl J Med. 1998;24:1725–33.Google Scholar
  28. 28.
    Sluzewski M, Bosch JA, van Rooij WJ, Nijssen PC, Wijnalda D. Rupture of intracranial aneurysms during treatment with Guglielmi detachable coils: incidence, outcome, and risk factors. J Neurosurg. 2001;94:238–40.CrossRefGoogle Scholar
  29. 29.
    van Rooij WJ, Keeren GJ, Peluso JP, Sluzewski M. Clinical and angiographic results of coiling of 196 very small (< or = 3 mm) intracranial aneurysms. AJNR Am J Neuroradiol. 2009;30:835–9.CrossRefGoogle Scholar
  30. 30.
    Rezek I, Mousan G, Wang Z, Murad MH, Kallmes DF. Coil type does not affect angiographic follow-up outcomes of cerebral aneurysm coiling: a systematic review and meta-analysis. AJNR Am J Neuroradiol. 2013;34:1769–73.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Emerson Brandão Sousa
    • 1
    • 3
    • 4
    Email author
  • Laise Franco de Sousa Brandão
    • 2
  • Cléciton Braga Tavares
    • 3
  • José Nazareno Pearce de Oliveira Brito
    • 3
  • Iruena Moraes Kessler
    • 1
  1. 1.Universidade de Brasília (UNB)BrasíliaBrazil
  2. 2.Fundação Municipal de SaúdeTeresinaBrazil
  3. 3.Hospital São MarcosTeresinaBrazil
  4. 4.Unidade do Sistema NeuromuscularHospital Universitário do Piauí, Campus Universitário Ministro Petrônio PortelaTeresinaBrazil

Personalised recommendations