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Updated: Jan 24, 2026
18:50
Microsurgical Clip Obliteration of Middle Cerebral Aneurysm Using Intraoperative Flow Assessment
Published on: September 25, 2009
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Optimal Coil Packing Density for Aneurysmal Complete Obliteration in Flow Diversion Stenting: A Retrospective Study
Ryosuke Maeoka1,2, Hiroyuki Ohnishi2, Shohei Yokoyama1
1Department of Neurosurgery Nara Medical University Nara Japan.
Stroke (Hoboken, N.J.)
|January 23, 2026
Summary
Optimal packing density (PD) for flow diverter stent (FDS) with coil embolization (CE) in large aneurysms may be 8.9%. Reaching this PD may achieve complete obliteration, potentially reducing unnecessary CE procedures.
Area of Science:
- Neurosurgery
- Interventional Radiology
- Vascular Neurology
Background:
- Flow diverter stent (FDS) deployment combined with coil embolization (CE) is effective for treating cerebral aneurysms.
- Optimal packing density (PD) for FDS and CE in large or giant aneurysms remains undefined.
- This study investigates the ideal PD for maximizing treatment efficacy.
Purpose of the Study:
- To determine the optimal packing density (PD) for flow diverter stent (FDS) deployment with coil embolization (CE).
- To assess the association between PD and complete obliteration (CO) in large or giant intracranial aneurysms.
Main Methods:
- Retrospective multicenter study of 97 patients with large/giant unruptured aneurysms treated with FDS alone or FDS + CE.
- Coil PD calculated as volume embolization ratio; complete obliteration defined by O'Kelly-Marotta grading scale D at 6 months.
- Analysis of associations between PD and CO using univariable and multivariable models.
Main Results:
- A volume embolization ratio (PD) of ≥ 8.9% was significantly associated with complete obliteration (CO).
- Higher PD showed a strong correlation with CO in both univariable (OR 14.3) and multivariable (OR 10.5) analyses.
- While the FDS + CE group showed higher CO rates (82.3% vs 50.0%), the key finding was the PD threshold.
Conclusions:
- A packing density of 8.9% volume embolization ratio may be sufficient for achieving complete obliteration in large or giant intracranial aneurysms treated with FDS + CE.
- Further coil embolization beyond this threshold may not be necessary, potentially streamlining the procedure.
- This finding could guide clinical decision-making for optimizing FDS and CE treatment strategies.
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