Impact of Coil Packing Density and Coiling Technique on Occlusion Rates for Aneurysms Treated with Stent-Assisted Coil Embolization.

BACKGROUND AND OBJECTIVE: Stent-assisted coil embolization is an established endovascular technique for wide-necked intracranial aneurysms. Although recanalization after coil embolization is reduced with the use of a stent, the impact of aneurysm packing density is less clear in stent-coiled aneurysms. The purpose of the present study was to assess packing density in stent-coiled aneurysms and evaluate its effect on recanalization and retreatment. METHODS: A retrospective analysis of consecutive aneurysms treated with stent-assisted coiling was performed at 2 academic institutions between 2007 and 2015. Aneurysm occlusion was assessed using digital subtraction angiography. Packing density was calculated using the AngioCalc app. RESULTS: Two hundred fifty-three aneurysms were identified (median age, 59 years). The median packing density was 35.3%. At last follow-up, 72.7% of aneurysms were completely obliterated and 19.4% had a neck remnant. Complete occlusion was associated with smaller aneurysms and coiling through stent interstices. A higher packing density was associated with increased rate of complete occlusion when analyzed as continuous variable. After adjustment for confounding variables, packing density was no longer predictive of complete occlusion (odds ratio = 1.018, P = 0.122). Similarly, there was no significant association between aneurysm occlusion, retreatment, and packing density when assessed by categories of high (>22%), moderate (12%-22%), and low (<12%) packing density. CONCLUSIONS: Aneurysm size remains the most important predictor of aneurysm recanalization and retreatment after stent-assisted coiling. Although higher packing densities were associated with increased rates of aneurysm occlusion in unadjusted statistical comparisons, this finding was no longer significant after adjusting for confounders.

Estudo e classificaçäo das membranas neovasculares subretinianas na degeneraçäo macular relacionada à idade pela angiografia digital com indocianina verde / Study and classification of subretinal neovascularization in age-related macular degeneration by digital angiography with indocyanine green

Objetivo: analisar por meio da angiografia digital com indocianina verde (ICV) casos de membrana neovascular subretiniana (MNSR) oculta ou mal definida, diagnosticada pela angiofluoresceinografia (AF) em degeneraçäo macular relacionada à idade. Material e método: pacientes com MNSR oculta ou mal definida, diagnosticada pela AF foram analisados por meio do ICV, excluindo-se olhos com tratamento prévio com raio laser ou outra doença ocular. Resultados: trinta e quatro olhos foram estudados. Foi encontrada placa com hiperfluorescência difusa em 18 olhos (52,9 por cento) em 11 olhos (32,3 por cento) a existência de um ponto focal hiperfluorescente, sendo que estas alteraçöes näo foram detectadas pela angiofluoresceinografia. Conclusäo: a ICV em alguns casos detecta a presença de membrana neovascular subretiniana presumível näo-evidenciada ao exame

[The usefulness of digital angiography in performing coronary angioplasty. An analysis of 100 cases]. / Utilidade da angiografia digital na realização da angioplastia coronária. Análise de 100 casos.

PURPOSE: To analyse the actual contribution of digital angiography in the angioplasty setting and to assess its utility to optimize angioplasty results. METHODS: One hundred patients with single vessel coronary artery disease, without previous angioplasty or coronary artery bypass graft surgery, who underwent angioplasty from January to December 1990. Views were obtained in standard films and also in digitized angiograms. The latter was acquired before angioplasty in order to precisely quantify the stenosis and also to measure the reference diameter of the artery that was used and to choose the balloon catheter for each case. New acquisitions were done during and after the end of the procedure to confirm the residual stenosis and to measure the final diameter. RESULTS: The mean stenosis pre angioplasty was 78.2%, the mean reference diameter 2.8 mm and the mean diameter at the stenotic site 0.8 mm. The balloon artery relation was 0.9:1. After angioplasty the residual stenosis was 13.6% and the dilated segment had a final diameter of 2.6 mm. There were no complications in any patient. CONCLUSION: Digital angiography is a useful method for laboratories devoted to coronary interventions for it allows confirmation of the severity of the stenosis, optimizes the balloon/artery relation, monitors partial results and measures the residual stenosis as well as the final diameter.

Utilidade da angiografia digital na realizaçäo da angioplastia coronária: análise de 100 casos / Utility of Digital Angiography in the Coronary Angioplasty. Analysis of 100 Cases

Objetivo - Analisar a real contribuição da angiografia digital para a realização da angioplastia coronária e como ela ajudaria na otimização dos resultados da dilatação. Métodos - Cem pacientes uniarteriais, sem angioplastia ou cirurgia de revascularização prévias, submetidos à dilatação de estenoses coronárias entre janeiro e dezembro de 1990. Além do registro cinecoronariográfico convencional foram feitas aquisições digitais antes do procedimento, para medir o diâmetro da artéria, escolhendo-se, dessa forma, o cateter balão mais adequado para cada caso, e também para quantificar a importância da estenose coronária a ser tratada. Novas aquisições eram feitas durante o procedimento para medir o diâmetro no local dilatado e, logo após a retirada do sistema dilatador, um novo registro digital permitia a quantificação da lesão residual e o diâmetro final do segmento tratado. Resultados - A estenose média pré-angioplastia era de 78,2%. O diâmetro de referência médio era de 2,8mm e no local estenosado 0,8mm. A relação balão/artéria era 0,9:1. A lesão residual pós-angioplastia foi de 13,6% e o diâmetro no local dilatado aumentou para 2,6mm. Não houve complicações em qualquer paciente. Conclusão - A angiografia digital é um método útil para os laboratórios que se dedicam a intervenções coronárias pois permite a confirmação da severidade anatômica da estenose, otimizar a escolha do cateter-balão a ser utilizado e monitorar os resultados obtidos, quantificando a lesão residual e medindo o diâmetro final atingido

Purpose - To analyse the actual contribution of digital angiography in the angioplasty setting and to assess its utility to optimize angioplasty results. Methods - One hundred patients with single vessel coronary artery disease, without previous angioplasty or coronary artery bypass graft surgery, who underwent angioplasty from January to December 1990. Views were obtained in standard films and also in digitized angiograms. The latter was acquired before angioplasty in order to precisely quantify the stenosis and also to measure the reference diameter of the artery that was used and to choose the balloon catheterfor each case. New acquisitions were done during and after the end of the procedure to confirm the residual stenosis and to measure the final diameter. Results - The mean stenosis pre angioplasty was 78.2%, the mean reference diameter 2.8 mm and the mean diameter at the stenotic site 0.8mm. The balloon artery relation was 0.9:1. After angioplasty the residual stenosis was 13.6% and the dilated segment had a final diameter of 2. 6mm. There were no complications in any patient. Conclusion - Digital angiography is a useful methodfor laboratories devoted to coronary interventions forit allows confirmation of the severity of the stenosis, optimizes the balloon/artery relation, monitors partial results and measures the residual stenosis as well as the final diameter.