ORIGINAL RESEARCH article
Front. Surg.
Sec. Neurosurgery
Presence of Small and Large Branch Vessels from Intracranial Aneurysms Increases Risk of Post-Treatment Recurrence and Retreatment Following Endovascular Coiling: Insights From a Propensity Score-Matched Cohort
Provisionally accepted
Naveen Arunachalam Sakthiyendran
Allison R PellegrinoEvan P McNeil
Patrick BarhouseShashvat Purohit
Felipe Ramirez VelandiaOmar Alwakaa
Justin Granstein
Christopher S. Ogilvy
Philipp Taussky*- Beth Israel Deaconess Medical Center Cancer Center, Boston, United States
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Objective: Aneurysms with involvement of a branch vessel within their sac represent a particularly challenging morphological feature in the context of coil embolization. The aim of this propensity score-matched cohort study was to determine the impact of branch vessel involvement on angiographic occlusion, clinical outcomes, recurrence, and retreatment after endovascular coiling. Methods: We conducted a single-center retrospective cohort study of intracranial aneurysms treated with conventional, balloon-assisted, or stent-assisted coiling. Propensity score matching was performed to reduce confounding. Packing density was computed using Angiosuite. Regression models were used to analyze immediate and final Raymond–Roy Occlusion Classification grade, recurrence, and retreatment in the matched cohort. Results: Out of 330 patients with 330 aneurysms, 39 aneurysms (11.8%) had branch involvement. Propensity score matching yielded 31 branch-involving aneurysms (BVAs) matched to 31 non-BVAs. Immediate Raymond-Roy grade (OR: 2.57, 95% CI: 0.96–7.13, p = 0.063) and packing density (mean difference −3.04%, 95% CI: −8.14–2.06, p = 0.247) did not differ significantly between groups. At follow-up, BVAs had worse final Raymond-Roy grade (OR: 6.33, 95% CI: 2.15– 20.83, p = 0.0013) and lower odds of complete occlusion (OR: 0.085, 95% CI: 0.024–0.26, p < 0.001). Complete occlusion without recurrence was achieved in 20/30 (66.7%) non-BVAs compared to 6/30 (20.0%) BVAs during the follow-up period. Recurrence (OR: 5.55, 95% CI: 1.78–19.86, p = 0.005) and retreatment (OR: 4.44, 95% CI: 1.19–21.69, p = 0.034) were also higher in BVAs. Conclusion: BVAs exhibit significantly worse long-term angiographic outcomes with higher recurrence and retreatment rates. Branch vessel incorporation is an intrinsic risk factor for unfavorable angiographic durability post-coiling that warrants awareness and novel treatment strategies. Specifically, BVAs may warrant intensified imaging surveillance and consideration of neck-reconstruction strategies or primary clipping when branch vessel preservation is feasible.
Keywords: Branch vessel, Endovascular, Intracranial Aneurysm, Packing density, Recurrence
Received: 12 Dec 2025; Accepted: 16 Feb 2026.
Copyright: © 2026 Arunachalam Sakthiyendran, Pellegrino, McNeil, Barhouse, Purohit, Ramirez Velandia, Alwakaa, Granstein, Ogilvy and Taussky. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Philipp Taussky
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