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letter . 2003 Nov;24(10):2122.
Small Aneurysm Size Is a Risk Factor for Perforation during Coiling
With interest we read the meta-analysis of Cloft and Kallmes (1) on perforation during coiling of cerebral aneurysms. The discussion mentions that “data in the reports of perforation in the literature are incomplete regarding aneurysm location and size” and “size of all of the aneurysms that did not become perforated also must be known to evaluate for differences in risk that are dependent on the specific location and size (page 239).” In our article regarding risk factors for procedural perforation (2), we compared the sizes of the seven aneurysms that were perforated with 257 aneurysms that were not. A statistically significant relation between small aneurysm size and perforation was found. Although our study was cited, this important finding was apparently overlooked by the authors.
In the choice between surgery and coiling, we believe it is important to know that small aneurysm size indeed is a risk factor for perforation during coiling.
References
1.Cloft HJ, Kallmes DF. Cerebral aneurysm perforations complicating therapy with Guglielmi detachable coils: a meta-analysis.
AJNR Am J Neuroradiol
2002;23:1706–1709 [PMC free article] [PubMed] [Google Scholar]
2.Sluzewski M, Bosch JA, van Rooij WJ, et al. Rupture of intracranial aneurysms during treatment with Guglielmi detachable coils: incidence, outcome, and risk factors.
J Neurosurg
2001;94:238–240 [DOI] [PubMed] [Google Scholar]
We appreciate the interest of Drs. Sluzewski and van Rooij in our report (1). The purpose of our meta-analysis was to quantitatively evaluate specific characteristics of perforations complicating aneurysm therapy. The technique of meta-analysis allows for the collection and pooling of data from similar studies to try to answer questions that none of the studies have sufficient sample size to answer alone (2). Our goal was to pool data from all of the available case series that reported aneurysm perforation during endovascular therapy to more precisely determine the risk of this complication. Other than the report by Sluzewski et al (3), the reports used in our meta-analysis did not report data that would allow us to evaluate size of aneurysm as a risk factor for perforation. Therefore, the relationship of aneurysm size to rate of perforation was not amenable to meta-analysis. We did state that small aneurysm size may be associated with an increased risk of perforation (1). Random or accidental displacements of endovascular devices by a few millimeters that are trivial in a large aneurysm might lead to catastrophic rupture in the more confined lumen of a small aneurysm.
References
1.Cloft HJ, Kallmes DF. Cerebral aneurysm perforations complicating therapy with Guglielmi detachable coils: a meta-analysis.
AJNR Am J Neuroradiol
2002;23:1706–1709 [PMC free article] [PubMed] [Google Scholar]
2.Domanski MJ, Friedman LM. Relative role of meta-analysis and randomized controlled trials in the assessment of medical therapies.
Am J Cardiol
1994;74:395–396 [DOI] [PubMed] [Google Scholar]
3.Sluzewski M, Bosch JA, van Rooij WJ, et al. Rupture of intracranial aneurysms during treatment with Guglielmi detachable coils: incidence, outcome, and risk factors.
J Neurosurg
2001;94:238–240 [DOI] [PubMed] [Google Scholar]
