Three-dimensional packing with complex orbit coils for the endovascular treatment of intracranial aneurysms

Endovascular treatment of intracranial aneurysms is too often associated with aneurysm recurrence due to coil compaction. High packing of coils prevents compaction. To increase the packing attenuation, we sought to evaluate the results of selective embolization of aneurysms with complex-shaped coils alone.

Twenty consecutive patients with an intracranial aneurysm were treated by selective embolization. There were 12 women and eight men, with a mean age of 48 years. Fourteen patients presented with subarachnoid hemorrhage, whereas six were asymptomatic. Mean size of aneurysms was 5 mm (range, 3-11 mm). In all cases, we tried to pack the aneurysm with complex coils only (Orbit, Cordis, Miami Lakes, FL), delivered in a concentric fashion. Remodeling technique was used in two cases of wide-neck aneurysms. Clinical and anatomic outcome were assessed by using the modified Glasgow outcome scale and 6-month MR angiography (MRA).

From two to five complex coils were delivered within the aneurysms. Occlusion by using complex coils alone was successful in 16 patients, and resulted in 14 complete occlusions and two neck remnants. In four patients, additional helical Orbit coils or Guglielmi detachable coils were required to complete aneurysm obliteration. No technical complication occurred, and clinical outcome was excellent in 14 cases and good in two. Follow-up MRAs were obtained in all patients and showed only one slight recanalization.

Intracranial aneurysms may be treated by selective embolization with complex coils only. Imaging follow-up at 6 months shows a low rate of coil compaction.