Angiographic morphologies of wide-necked cerebral aneurysms for predicting immediate incomplete occlusion after coil embolization.

Background: Wide-necked cerebral aneurysms present unique challenges in endovascular treatment, with immediate incomplete occlusion posing significant risks for recurrence and mortality. However, the predictive factors of immediate incomplete occlusion after coil embolization of wide-necked aneurysms have not been identified. Thus, this study aimed to identify specific angiographic morphologies predictive of immediate incomplete occlusion after coil or stent-assisted embolization for wide-necked aneurysms.

Methods: This retrospective case-control study evaluated all patients diagnosed with cerebral wide-necked aneurysms who underwent endovascular treatment between January 2009 and December 2019. The case was defined as wide-necked aneurysms with immediate incomplete occlusion, while control was defined as those with immediate complete occlusion. The cases and controls were compared in a 1:3 ratio. Angiographic morphologies as the predictors of immediate incomplete occlusion were analyzed using multivariable logistic regression with adjusted odds ratio (aOR) and 95% confidence interval (CI).

Results: There were 73 and 226 cases and controls, respectively. Aneurysm height ≥5.6 mm (aOR, 8.14; 95% CI, 4.21-15.75; P < 0.001), absent shoulder (aOR, 4.22; 95% CI, 1.74-10.25; P = 0.001), one-sided shoulder (aOR, 2.54; 95% CI, 1.26-5.15; P = 0.009), and presence of vessel incorporation (aOR, 2.2; 95% CI, 1.02-4.73; P = 0.044) were independent risk factors of immediate incomplete occlusion.

Conclusion: Aneurysm height ≥5.6 mm, absent two-sided shoulder, and presence of vessel incorporation significantly predict immediate incomplete occlusion after coil embolization for wide-necked aneurysms.