Elsevier

Neurologia i Neurochirurgia Polska

Volume 51, Issue 4, July–August 2017, Pages 304-310
Neurologia i Neurochirurgia Polska

Original research article
The effectiveness of Penumbra 400 micro-coils in the embolization of large cerebral aneurysms

https://doi.org/10.1016/j.pjnns.2017.05.002Get rights and content

Abstract

Background

The objective of this work is to analyze the effectiveness of Penumbra 400 micro-coils in the embolization of large cerebral aneurysms.

Material and methods

A retrospective analysis has been conducted in a group of 32 patients at the average age of 54.5 years (30–84) for whose embolization the P400 micro-coils (P400) have been used. A control group consisted of 44 patients at the average age of 52.7 years (24–82) in whose aneurysm embolization the 18 micro-coils (MC) have been utilized.

Results

The respective percentages of micro-coil packing density in aneurysm sacs were 31.5% for P400 and 29% for MC. The average P400 fluoroscopy time was 21 min, and 34 min in case of MC. The average number of used micro-coils was 3.9 for P400 and 5.6 for MC. The radiation dose received by a patient was 1.7 Gy/2.2 Gy, respectively. The recanalization of P400 has occurred in 14/31 cases (45%), and for MC it has occurred in 23/44 (52%) patients. One patient died due to early recanalization after P400 aneurysm embolization.

Conclusion

Procedures with use of the P400 demonstrate minimally higher effectiveness of large aneurysms embolization in comparison with the MS with a not much shorter duration and reduction of a radiation dose that a patient receives.

Section snippets

Background

It is believed that occurrence of recanalization in long-term follow up is connected mostly with a primary low packing density of coils in the aneurysm sac expressed as a percentage of closing aneurysm volume using given coils [1], [2], [3], [4]. This appears to be particularly important in case of large aneurysms.

The above encourages works on developing coils of greater softness and volume. Such features can be found in the new generation of Penumbra 400 (P400) coils that was first introduced

Material and methods

We have retrospectively analyzed a group of 32 patients at a mean age of 54.5 (30–84) years in whom embolization was performed using P400 micro-coils. The control group has consisted of 44 patients at an average age of 52.7 years (24–82) and in whose aneurysm embolization 18 micro-coils were used. The latter's initial fiber diameter was ranging from 0.014 to 0.015 in. In all cases, the treatment applied to aneurysms whose sacs were equal or larger than at least 10 mm in one dimension. All the

Results

All the treated patients were over 50 years old, and women dominated in both the groups. The vast minority of procedures were performed due to subarachnoid hemorrhages, with exceeding 80% of patients who were treated electively in the two groups. Because of the wide aneurysm neck in, respectively 2, (6%) and 6 (14%) patients in the P400 and MC groups, the embolization has been complemented by the implantation of intracranial stents of the LVIS Jr., Leo baby or Solitaire AB type. Furthermore, in

Discussion

At the end of November 2015, only a few reports on the use of the P400 type in the embolization of cerebral aneurysms were available [7]. None of these reports compared the use of 18 type micro-coils available in the market as the largest in primary diameter after the P400. In order to ensure the homogeneity of the groups analyzed in the study, only large aneurysms were qualified in which at least one dimension was 10 mm or more. Furthermore, for the analysis purposes only those cases have been

Conclusion

The use of P400 micro-coils in the embolization of large aneurysm gives a high percentage of micro-coils packing density volume and, at the same time, reduces their number, which results in a faster examination, and hence reduces a radiation dose that a patient receives during the procedure. At the same time, the complication rate is comparable to a control group.

It shall be further emphasized that a difference between the P400 and the MC in terms of the micro-coil packing density, a received

Conflict of interest

None declared.

Acknowledgment and financial support

The authors declare the study was funded by departmental resources.

Ethics

The work described in this article has been carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki) for experiments involving humans; Uniform Requirements for manuscripts submitted to Biomedical journals.

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