Packing density and long-term occlusion after transcatheter vessel embolization with soft, bare-platinum detachable coils

Abstract

Objective: The objective of this study was to examine packing density and long-term recanalization rates after embolization with soft, bare-platinum ruby coils in the gastroduodenal artery (GDA). Materials and Methods: Retrospective case review of patients with hepatic malignancy who underwent coil occlusion of the GDA for radioembolization or hepatic arterial infusion chemotherapy between November 2013 and July 2018. Data on patient demographics, GDA diameter, length of coil pack, and distance between GDA origin and most proximal coil were collected. Packing density was calculated as the ratio between the volume of inserted coils and the volume of the vessel area that were filled with coil. The primary outcome was the rate of GDA recanalization, determined by review of hepatic arteriograms at follow-up. Results: Long-term occlusion free of recanalization was observed in 97.8% (88/90) of patients over a median follow-up time of 13.4 ± 11.3 months. Median vessel packing density was 55% (interquartile range 41–71) and procedural technical success was achieved in 100% (90/90) of patients. Of the 90 patients (72 men; mean age 63.8 ± 7.5 years), mean GDA diameter was 4.0 ± 0.8 mm and the proximal coil distance from GDA origin was 8.6 ± 3.0 mm. Mean coil pack length was 21.2 ± 7.6 mm. Recanalization occurred in 2.2% (2/90) of patients. No increase in recanalization rates with distal coil placement was observed. Conclusions: The study demonstrates high levels of technical success and low rates of recanalization (2.2%) when high packing densities (55%) are achieved using soft, bare-platinum ruby coils. The rate of recanalization at follow-up compares favorably to previously reported literature.