ArticleJournal of neuroendovascular therapy2026
Efficacy and Limitations of Stent-Free Coil Embolization for Internal Carotid-Posterior Communicating Artery Aneurysms, Primarily Based on the Double-Catheter Technique: A Study Reflecting Current Endovascular Practice.
Article in Journal of neuroendovascular therapy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: Stent-free coil embolization has advantages such as a low periprocedural risk and elimination of the need for antiplatelet therapy. Recent advancements in coil technology and adjunctive techniques, including the double-catheter method, may have contributed to improved outcomes. This study aimed to evaluate the safety, efficacy, and limitations of stent-free coil embolization for internal carotid-posterior communicating artery (IC-Pcom) aneurysms in current endovascular practice. Methods: Between January 2017 and March 2024, 65 unruptured IC-Pcom aneurysms were initially treated with coil embolization at our institution. Of these, 58 cases without neck-bridging stents were analyzed. Final embolization status was assessed by follow-up MRA and classified according to the Raymond classification. Results: The double-catheter coil embolization (DCC) was performed in 42 cases (72%). The mean follow-up duration was 42 months. Retreatment was required in 3 patients (5.2%), and 4 patients ultimately had residual aneurysms. Residual aneurysm was significantly associated with aneurysm size (dome, p = 0.033; height, p = 0.014; neck, p = 0.004) and postoperative embolization status (p = 0.002). Cutoff values predictive of residual aneurysm were: neck, 4.83 mm (area under the curve [AUC], 0.94; sensitivity, 1.0; specificity, 0.87); height, 5.35 mm (AUC, 0.88); and dome, 7.29 mm (AUC, 0.82). Complete obliteration was significantly associated with younger age (p = 0.042), absence of PcomA incorporation (p = 0.017), smaller PcomA diameter (p = 0.037), smaller aneurysm dimensions, and favorable embolization status (p <0.001). In multivariate analysis, a neck diameter <4.25 mm emerged as the sole independent predictor of complete obliteration (odds ratio, 6.33; 95% confidence interval, 1.27-31.4; p = 0.024). Conclusion: Stent-free coil embolization achieved high rates of complete occlusion in aneurysms with a neck diameter <4.25 mm. However, despite the adoption of modern coils and advanced techniques such as the double-catheter method, larger aneurysms exceeding this cutoff may recur during midterm follow-up, underscoring the need for alternative treatment strategies.
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