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Introduction There is limited data to guide operators with coil selection to predict long term excellent Raymond Roy occlusion classification (RROC) during coil embolization of an intracranial aneurysm. Variables such as packing density and framing coiling percentage have been associated with long term angiographic success in limited retrospective studies. This study analyzed the relationship of first coil packing density (FCPD) to RROC and the need for re-treatment.Methods A total of 298 patients across 25 hospitals were included in the ATLAS IDE trial; a prospective, multicenter, single-arm, open label study of stent-assisted coiling (SAC) of wide neck intracranial aneurysms. Operators used their discretion on coil type and size while embolizing aneurysms. RROCs at 12 months were evaluated. Mean FCPDs were calculated for each RROC as well as for those who required re-treatment vs those who did not.Results Higher FCPD was statistically significant with complete occlusion. This was represented by RROC 1 group having a mean FCPD of 12%, RROC 2 group having a mean FCPD of 10%, and RROC 3 having a mean FCPD of 5% (p=0.035). Lower FCPD was statistically significant with the need for re-treatment. The mean FCPDs for the retreatment vs treatment group were 7% and 11% respectively (p=.046).Conclusion Larger mean FCPDs were associated with excellent and adequate 12 month RROC rates, while lower mean FCPDs were associated with the need for re-treatment. More studies are needed to evaluate a FCPD that can predict long term excellent RROC.Disclosures T. Snyder: None. O. Zaidat: None. A. Jadhav: None. A. Moreno-Koehler: 5; C; Department of Clinical Affairs at Stryker.