Contemporary Results of Bare Platinum Coil Embolization for Wide‐Necked Ruptured Aneurysms: A Subset Analysis of the SMART Registry
Bibliographic record
Abstract
Background Rupture status and presence of a wide neck are important factors that adversely impact angiographic occlusion after endovascular coiling. A potential strategy to improve occlusion rates in wide‐necked, ruptured aneurysms (WNRA) is modification of coil technology. Methods WNRA were chosen from the SMART registry that comprises 905 intracranial aneurysms treated with SMART bare platinum coils (Penumbra Inc., Alameda, USA) in the US and Canada. WNRA were defined as neck ≥4 mm, dome‐to‐neck ratio <2, or both. Clinical and angiographic data at presentation and follow‐up were assessed. Outcomes included adequate occlusion rate (Raymond–Roy occlusion class I or II), occlusion at 1 year, and good functional outcome (modified Rankin score 0–2) at 1 year. Angiographic outcome was compared for neck≥4 mm versus <4 mm. Results A total of 143 patients (mean age 59.3, 74.1% female) with 143 WNRA were included. Median aneurysm size was 5.8 mm. 46.2% had a neck≥4 mm. Balloon remodeling was used in 35.7% (51/143) and stents in 10.5% (15/143). Intraoperative thromboembolic complication rate was 7.0% (10/143). Overall immediate adequate occlusion rate was 78.3% (112/143); postprocedure occlusion rates were lower (62.1%, 41/66 versus 92.2%, 71/77) for aneurysms with necks ≥4 mm than those with necks <4 mm. At 1 year follow‐up, adequate occlusion was achieved in 82.4% (75/91) patients. Aneurysm occlusion improved in 31.9% (29/91) but worsened in 20.9% (19/91) of all patients at 1 year. Retreatment rate among patients who completed the study was 20.2% (20/99). One instance of intraoperative rupture (0.7%) was noted. Good functional outcome was achieved in 57.7% (41/71). Conclusion These results suggest that successful embolization of WNRA with new generation SMART coils can be achieved safely. WNRA continue to require assistive techniques at presentation and also retreatment over time. In addition, neck width may have an adverse impact on angiographic outcome.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".