To the Editor:
I read with great interest the article by Monteiro et al.1 The authors have demonstrated successful use of stent-assisted coiling with the deployment of the Atlas and Low-profile Visualized Intraluminal Support (LVIS) Jr devices for the treatment of intracranial aneurysms.
In all sincerity, I would like to write concerning the authors’ statement on page E171 with the citation of Mascitelli et al2 that “the modified Raymond-Roy (RR) scale was used to evaluate the efficacy of aneurysm coiling, in which Class 1 represents complete occlusion, Class 2 represents residual neck, and Class 3 represents residual aneurysm and treatment failure.” As is well known, Mascitelli et al2 suggested that a class 3 residual aneurysm of the Raymond-Roy Occlusion Classification3 (RROC) presents a heterogeneous behavior in their coil embolization experience, so they proposed the Modified Raymond-Roy Classification3 (MRRC), according to which class 3 is divided into 2 subclasses to indicate progression to occlusion and risk for recurrence: class 3a represents contrast opacification within the coil interstices of a residual aneurysm and class 3b represents contrast opacification outside the coil interstices, along the residual aneurysm wall. However, I could not find class 3a and class 3b, which the authors identified with the modified Raymond-Roy (RR) scale in the methodology.
In this case, as an angiographic classification, class 1 (RR 1), class 2 (RR 2), and class 3 (RR 3) could be found in the context and the immediate/follow-up results in Table 2 on page E173; should I assume that the authors might have used the RROC3 to evaluate the efficacy of aneurysm coiling instead? Please accept my sincere apologies if I have misunderstood.
This study did not receive any funding or financial support.
The author has no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.
1. Monteiro A, Cortez GM, Aghaebrahim A, Sauvageau E, Hanel RA. Low-profile Visualized Intraluminal Support Jr braided stent versus Atlas self-expandable stent for treatment of intracranial aneurysms: a single center experience. Neurosurgery. 2021;88(2):E170-E178.
2. Mascitelli JR, Moyle H, Oermann EK, et al. An update to the Raymond-Roy occlusion classification of intracranial aneurysms treated with coil embolization. J NeuroIntervent Surg. 2015;7(7):496-502.
3. Roy D, Milot G, Raymond J. Endovascular treatment of unruptured aneurysms. Stroke. 2001;32(9):1998-2004.