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Andereggen L, Bosshart SL, Marbacher S, Grüter BE, Berberat J, Schubert GA, Anon J, Diepers M, Steiger HJ, Remonda L, Gruber P. Long-Term Hemorrhage and Reperfusion Rates of Coiled Aneurysms: A Single-Center Experience. J Clin Med 2024; 13:5223. [PMID: 39274436 PMCID: PMC11396093 DOI: 10.3390/jcm13175223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 08/24/2024] [Accepted: 09/02/2024] [Indexed: 09/16/2024] Open
Abstract
Background: The endovascular approach has emerged as standard therapy for many intracranial aneurysms (IAs) to prevent hemorrhage, yet its long-term durability varies considerably. The aim of this study was to evaluate the safety and effectiveness of an initially deliberate endovascular approach regarding IA hemorrhage rates over a long-term follow-up period. Methods: This retrospective single-center study included all consecutive patients with endovascularly treated IAs who presented between January 2008 and December 2020 with a follow-up of at least 12 months. The primary endpoint was the proportion of patients with long-term IA hemorrhage rates and reperfusion. The secondary endpoint was treatment-related morbidity and mortality. Independent risk factors for IA reperfusion over the long term were analyzed using multivariate logistic regression. Results: Endovascular treatment was the therapy of choice for 333 patients with IAs, among whom 188 (57%) experienced rupture upon presentation. Complete coiling (Raymond I) was noted in 162 (49%) of the patients, with primary supportive devices being used in 51 (15%) patients. After a median (±SD) follow-up time of 34 ± 41 months (range 12-265 months), IA reperfusion was noted in 158 (47%), necessitating retreatment in 105 (32%) of the patients. Over the long term, hemorrhage was noted in four (1%) patients. Multivariate analysis revealed aneurysmal multilobarity (HR 1.8, 95%CI 1.2-2.7; p = 0.004) and a patient age of ≥50 years (HR 1.7, 95% CI 1.1-2.5, p = 0.01) as independent predictors of reperfusion over time. Intervention-related morbidity was noted in 16 (4.8%) patients, namely, thrombosis formation and contrast extravasation in 8 (2.4%) patients each, while no intervention-induced mortality was observed. Conclusion: In the long term, the hemorrhage rate in patients with IA with an initially more conservative endovascular approach is low. Therefore, a deliberate endovascular treatment approach might be justified.
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Affiliation(s)
- Lukas Andereggen
- Department of Neurosurgery, Kantonsspital Aarau, 5001 Aarau, Switzerland
- Faculty of Medicine, University of Bern, 3012 Bern, Switzerland
| | - Salome L Bosshart
- Department of Neurosurgery, Kantonsspital Aarau, 5001 Aarau, Switzerland
- Department of Neurosciences, University of Calgary, Calgary, AB T2N 1N4, Canada
- Faculty of Medicine, University of Zürich, 8006 Zürich, Switzerland
| | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, 5001 Aarau, Switzerland
- Faculty of Medicine, University of Bern, 3012 Bern, Switzerland
| | - Basil E Grüter
- Faculty of Medicine, University of Zürich, 8006 Zürich, Switzerland
- Department of Neuroradiology, Kantonsspital Aarau, 5001 Aarau, Switzerland
| | - Jatta Berberat
- Department of Neuroradiology, Kantonsspital Aarau, 5001 Aarau, Switzerland
| | - Gerrit A Schubert
- Department of Neurosurgery, Kantonsspital Aarau, 5001 Aarau, Switzerland
- Department of Neurosurgery, RWTH Aachen University, 52062 Aachen, Germany
| | - Javier Anon
- Department of Neuroradiology, Kantonsspital Aarau, 5001 Aarau, Switzerland
| | - Michael Diepers
- Department of Neuroradiology, Kantonsspital Aarau, 5001 Aarau, Switzerland
| | - Hans-Jakob Steiger
- Department of Neurosurgery, Kantonsspital Aarau, 5001 Aarau, Switzerland
| | - Luca Remonda
- Faculty of Medicine, University of Bern, 3012 Bern, Switzerland
- Department of Neuroradiology, Kantonsspital Aarau, 5001 Aarau, Switzerland
| | - Philipp Gruber
- Faculty of Medicine, University of Zürich, 8006 Zürich, Switzerland
- Department of Neuroradiology, Kantonsspital Aarau, 5001 Aarau, Switzerland
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Cho YH, Choi J, Huh CW, Kim CH, Chang CH, KWON SC, Kim YW, Sheen SH, Park SQ, Ko JK, Ha SK, Jeong HW, Kang HS. Imaging follow-up strategy after endovascular treatment of Intracranial aneurysms: A literature review and guideline recommendations. J Cerebrovasc Endovasc Neurosurg 2024; 26:1-10. [PMID: 38523549 PMCID: PMC10995472 DOI: 10.7461/jcen.2024.e2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/30/2023] [Accepted: 03/03/2024] [Indexed: 03/26/2024] Open
Abstract
OBJECTIVE Endovascular coil embolization is the primary treatment modality for intracranial aneurysms. However, its long-term durability remains of concern, with a considerable proportion of cases requiring aneurysm reopening and retreatment. Therefore, establishing optimal follow-up imaging protocols is necessary to ensure a durable occlusion. This study aimed to develop guidelines for follow-up imaging strategies after endovascular treatment of intracranial aneurysms. METHODS A committee comprising members of the Korean Neuroendovascular Society and other relevant societies was formed. A literature review and analyses of the major published guidelines were conducted to gather evidence. A panel of 40 experts convened to achieve a consensus on the recommendations using the modified Delphi method. RESULTS The panel members reached the following consensus: 1. Schedule the initial follow-up imaging within 3-6 months of treatment. 2. Noninvasive imaging modalities, such as three-dimensional time-of-flight magnetic resonance angiography (MRA) or contrast-enhanced MRA, are alternatives to digital subtraction angiography (DSA) during the first follow-up. 3. Schedule mid-term follow-up imaging at 1, 2, 4, and 6 years after the initial treatment. 4. If noninvasive imaging reveals unstable changes in the treated aneurysms, DSA should be considered. 5. Consider late-term follow-up imaging every 3-5 years for lifelong monitoring of patients with unstable changes or at high risk of recurrence. CONCLUSIONS The guidelines aim to provide physicians with the information to make informed decisions and provide patients with high-quality care. However, owing to a lack of specific recommendations and scientific data, these guidelines are based on expert consensus and should be considered in conjunction with individual patient characteristics and circumstances.
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Affiliation(s)
- Yong-Hwan Cho
- Department of Neurosurgery, Dong-A University Hospital, Busan, Korea
- Department of Neurosurgery, Busan-Ulsan Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Korea
| | - Jaehyung Choi
- Department of Neurosurgery, Dong-A University Hospital, Busan, Korea
- Department of Neurosurgery, Busan-Ulsan Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Korea
| | - Chae-Wook Huh
- Department of Neurosurgery, Dong-Eui Hospital, Busan, Korea
| | - Chang Hyeun Kim
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Chul Hoon Chang
- Department of Neurosurgery, Yeungnam University Medical Center, Daegue, Korea
| | - Soon Chan KWON
- Department of Neurosurgery, Ulsan University Hospital, Ulsan, Korea
| | - Young Woo Kim
- Department of Neurosurgery ,The Catholic University of Korea, Uijeongbu St. Mary’s Hospital, Uijeongbu, Korea
| | - Seung Hun Sheen
- Department of Neurosurgery, CHA Bundang Medical Center of CHA University, Seongnam, Korea
| | - Sukh Que Park
- Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jun Kyeung Ko
- Department of Neurosurgery, Pusan National University Hospital, Busan, Korea
| | - Sung-kon Ha
- Department of Neurosurgery, Korea University Medical Center Ansan Hospital, Ansan, Korea
| | - Hae Woong Jeong
- Department of Neurosurgery, Inje University Busan Paik Hospital, Busan, Korea
| | - Hyen Seung Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
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Marosfoi M, Orrù E, Rabinovich M, Newman S, Patel NV, Wakhloo AK. Endovascular Treatment of Intracranial Aneurysms. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00068-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Chen PR, Lopez-Rivera V, Conner CR, Sanzgiri A, Sheth SA, Erkmen K, Kim DH, Day AL. Utility of skull X-rays in identifying recurrence of coiled cerebral aneurysms. J Cerebrovasc Endovasc Neurosurg 2021; 23:108-116. [PMID: 33902273 PMCID: PMC8256019 DOI: 10.7461/jcen.2021.e2020.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/15/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE A high rate of cerebral aneurysm recurrence following endovascular coiling has prompted the use of digital subtraction angiography (DSA) for interval follow-up. However, the utility of skull x-rays as an alternative screening method for aneurysm recurrence is unproperly characterized. METHODS Retrospective review of a prospective registry of ruptured and unruptured cerebral aneurysms. Anteroposterior and lateral skull x-rays were obtained immediately at the end of the procedure and at 6-month follow-up. Aneurysm recurrence was defined by comparing post-procedure and 6-month DSA imaging. A true positive was defined as a change in coil mass morphology on at least one projection with aneurysm recurrence on DSA, and a true negative defined as a stable coil mass on both projections and no recurrence on DSA. Receiver operating characteristic area under the curve (AUC) statistics was used to assess the performance of skull x-rays in identifying aneurysm recurrence. RESULTS A total of 118 cerebral aneurysms were evaluated with DSA imaging and skull x-rays. A change in coil mass morphology on one projection of skull x-rays correctly detected all true recurrences with a sensitivity of 100% (95% confidence interval [CI], 91-100%). Skull x-rays failed to identify a stable aneurysm coil mass in 15 cases, with a specificity of 79% (68-88%). Skull x-rays performed with AUC 0.8958 (95% CI, 0.8490-0.9431) in identifying aneurysm recurrence. CONCLUSIONS The findings of our study suggest that skull x-rays may represent a lowcost, non-invasive screening tool to rule out aneurysm recurrence, which can potentially aid in decreasing the utilization of DSA in the follow-up of patients with coiled cerebral aneurysms.
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Affiliation(s)
- Peng Roc Chen
- Department of Neurosurgery, University of Texas McGovern Medical School, Houston, TX, USA
| | - Victor Lopez-Rivera
- Department of Neurology, University of Texas McGovern Medical School, Houston, TX, USA
| | - Christopher R Conner
- Department of Neurosurgery, University of Texas McGovern Medical School, Houston, TX, USA
| | - Aditya Sanzgiri
- Department of Neurosurgery, University of Texas McGovern Medical School, Houston, TX, USA
| | - Sunil A Sheth
- Department of Neurology, University of Texas McGovern Medical School, Houston, TX, USA
| | - Kadir Erkmen
- Department of Neurosurgery, Temple University, Philadelphia, PA, USA
| | - Dong H Kim
- Department of Neurosurgery, University of Texas McGovern Medical School, Houston, TX, USA
| | - Arthur L Day
- Department of Neurosurgery, University of Texas McGovern Medical School, Houston, TX, USA
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Patzig M, Forbrig R, Gruber M, Liebig T, Dorn F. The clinical value of ceMRA versus DSA for follow-up of intracranial aneurysms treated by coil embolization: an assessment of occlusion classifications and impact on treatment decisions. Eur Radiol 2020; 31:4104-4113. [PMID: 33221944 DOI: 10.1007/s00330-020-07492-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/10/2020] [Accepted: 11/10/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was a detailed analysis of the value of contrast-enhanced magnetic resonance angiography (ceMRA) compared to digital subtraction angiography (DSA) for follow-up imaging of intracranial aneurysms treated by coil embolization. METHODS Patients with coiled aneurysms and follow-up exams including both DSA and 3 T ceMRA were retrospectively identified. In blinded readings, both modalities were graded according to the modified Raymond-Roy classification (MRRC) and the Meyers scale. Additionally, readers were asked to make a decision regarding retreatment/follow-up based on the respective imaging findings. RESULTS The study comprised 92 patients harboring 102 coiled aneurysms. There was good intermethod agreement of DSA and ceMRA concerning both the MRRC (κ = 0.64) and the Meyers scale (κ = 0.74). Agreement regarding occlusion of < 90% of the aneurysm (Meyers grade ≥ 2) was very good (κ = 0.87). Regarding the detection of a remnant with contrast between the coil mass and the aneurysm wall (MRRC IIIb), there were 12 discrepant findings and agreement was good (κ = 0.70). Comparing treatment/follow-up decisions, the two methods agreed very well (κ = 0.92). In seven patients with discrepant treatment decisions, the authors concurred with DSA in four cases and with ceMRA in three cases when evaluating both modalities together. Interval aneurysm growth was found in more cases with ceMRA (n = 19) than with DSA (n = 16). CONCLUSIONS CeMRA is very unlikely to miss a relevant aneurysm remnant and thus could be suitable as the primary follow-up method. In case of remnant growth or recurrence, however, additional DSA might be required to guide treatment decisions. KEY POINTS • There is high accordance between ceMRA and DSA regarding the evaluation of intracranial aneurysms treated by endovascular coil embolization, but closer analysis also revealed relevant differences. • CeMRA could be suitable as the primary follow-up imaging modality, potentially eliminating the need for routine DSA. • DSA will still be required in case of aneurysm remnant growth or recurrence as detected by ceMRA.
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Affiliation(s)
- Maximilian Patzig
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital, LMU Munich, Marchioninistr. 15, D-81377, Munich, Germany.
| | - Robert Forbrig
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital, LMU Munich, Marchioninistr. 15, D-81377, Munich, Germany
| | - Margaretha Gruber
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital, LMU Munich, Marchioninistr. 15, D-81377, Munich, Germany
| | - Thomas Liebig
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital, LMU Munich, Marchioninistr. 15, D-81377, Munich, Germany
| | - Franziska Dorn
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital, LMU Munich, Marchioninistr. 15, D-81377, Munich, Germany
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Lee SH, Cho YD, Mun JH, Yoo DH, Yeon EK, Kang HS, Kim JE, Cho WS, Han MH. Does Systemic Hypertension Impact Recanalization of Coiled Aneurysms? Clin Neuroradiol 2019; 31:117-124. [PMID: 31468079 DOI: 10.1007/s00062-019-00830-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 08/10/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE It is well known that hypertension is a significant factor in the formation, growth, and rupture of aneurysms and recanalization of coiled aneurysms is affected by hemodynamic stress. At present, however, the impact of hypertension on recanalization of coiled aneurysms has not been adequately investigated. This study examined the relation between hypertension and subsequent outcomes of coiled aneurysms, using a matched patient analysis. METHODS A total of 715 subjects undergoing coil embolization of intracranial aneurysms between 2011 and 2013 were selected for study. Time-of-flight magnetic resonance or conventional angiography was used (singly or together) to gauge degrees of occlusion after coiling, applying the Raymond classification in grading recanalization. Patients with hypertension were grouped as controlled or uncontrolled, based on blood pressure readings at outpatient clinics. Hypertensive and non-hypertensive subjects were matched (1:1) for several relevant variables. RESULTS Overall, 484 patients (67.7%) were hypertensive (controlled 338; uncontrolled 146). During the follow-up period (28.6 ± 9.7 months), 129 aneurysms (18.0%) displayed recanalization (minor 58; major 71). Patient age, concomitant diabetes, hyperlipidemia, aneurysm size, neck size, depth-to-neck ratio, and aneurysm type differed significantly in hypertensive and non-hypertensive groups; however, group incidences of cumulative recanalization were similar (p = 0.297). After 1:1 matching the cumulative recanalization rate (13.5%) in hypertensive and non-hypertensive counterparts (14.3%) again proved similar (p = 0.578). In the hypertensive group, in addition, recanalization showed no relation to controlled and uncontrolled subgroup (odds ratio, OR = 1.000, p > 0.999). CONCLUSION Unlike other aspects of evolving aneurysms (e.g. formation, growth, or rupture), recanalization of coiled aneurysms seems to be unaffected by systemic hypertension.
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Affiliation(s)
- Su Hwan Lee
- Department of Neurosurgery, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea (Republic of)
| | - Young Dae Cho
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, 110-744, Seoul, Korea (Republic of).
| | - Jong Hyeon Mun
- Department of Neurosurgery, Kwangju Christian Hospital, Gwangju, Korea (Republic of)
| | - Dong Hyun Yoo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, 110-744, Seoul, Korea (Republic of)
| | - Eung Koo Yeon
- Department of Radiology, KyungHee University Medical Center, KyungHee University College of Medicine, Seoul, Korea (Republic of)
| | - Hyun-Seung Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea (Republic of)
| | - Jeong Eun Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea (Republic of)
| | - Won-Sang Cho
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea (Republic of)
| | - Moon Hee Han
- Department of Radiology, Veterans Health Service Medical Center, Seoul, Korea (Republic of)
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Noureddine Y, Kraff O, Ladd ME, Wrede K, Chen B, Quick HH, Schaefers G, Bitz AK. Radiofrequency induced heating around aneurysm clips using a generic birdcage head coil at 7 Tesla under consideration of the minimum distance to decouple multiple aneurysm clips. Magn Reson Med 2019; 82:1859-1875. [DOI: 10.1002/mrm.27835] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 05/08/2019] [Accepted: 05/10/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Yacine Noureddine
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg‐Essen Essen Germany
- MR:comp GmbH, MR Safety Testing Laboratory Gelsenkirchen Germany
| | - Oliver Kraff
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg‐Essen Essen Germany
| | - Mark E. Ladd
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg‐Essen Essen Germany
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ) Heidelberg Germany
- Faculty of Physics and Astronomy and Faculty of Medicine University of Heidelberg Heidelberg Germany
| | - Karsten Wrede
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg‐Essen Essen Germany
- Department of Neurosurgery University Hospital Essen Essen Germany
| | - Bixia Chen
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg‐Essen Essen Germany
- Department of Neurosurgery University Hospital Essen Essen Germany
| | - Harald H. Quick
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg‐Essen Essen Germany
- High Field and Hybrid MR, University Hospital Essen Essen Germany
| | - Gregor Schaefers
- MR:comp GmbH, MR Safety Testing Laboratory Gelsenkirchen Germany
- MRI‐STaR – Magnetic Resonance Institute for Safety, Technology and Research GmbH Gelsenkirchen Germany
| | - Andreas K. Bitz
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ) Heidelberg Germany
- Faculty of Electrical Engineering and Information Technology FH Aachen University of Applied Sciences Aachen NRW Germany
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Ahmed SU, Mocco J, Zhang X, Kelly M, Doshi A, Nael K, De Leacy R. MRA versus DSA for the follow-up imaging of intracranial aneurysms treated using endovascular techniques: a meta-analysis. J Neurointerv Surg 2019; 11:1009-1014. [PMID: 31048457 DOI: 10.1136/neurintsurg-2019-014936] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 04/10/2019] [Accepted: 04/15/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Treated aneurysms must be followed over time to ensure durable occlusion, as more than 20% of endovascularly treated aneurysms recur. While digital subtraction angiography (DSA) remains the gold standard, magnetic resonance angiography (MRA) is attractive as a non-invasive follow-up technique. Two different MRA techniques have traditionally been used: time-of-flight (TOF) and contrast-enhanced (CE) MRA. We analysed data from studies comparing MRA techniques with DSA for the follow-up of aneurysms undergoing endovascular treatment. Subgroup analysis of stent-assisted coiling (SAC) and flow diversion (FD) techniques was completed. METHODS Comprehensive searches using the Embase, PubMed, and Cochrane databases were performed and updated to November 2018. Pooled sensitivity and specificity were calculated using aneurysm occlusion status as defined by the Raymond-Roy occlusion grading scale. RESULTS The literature search yielded 1579 unique titles. Forty-three studies were included. For TOF-MRA, sensitivity and specificity of all aneurysms undergoing endovascular therapy were 88% and 94%, respectively. For CE-MRA, the sensitivity and specificity were 88% and 96%, respectively. For SAC and FD techniques, sensitivity and specificity of TOF-MRA were 86% and 95%, respectively. CE-MRA had sensitivity and specificity of 90% and 92%. CONCLUSION MRA is a reliable modality for the follow-up of aneurysms treated using endovascular techniques. While the data are limited, MRA techniques can also be used to reliably follow patients undergoing FD and SAC. However, clinical factors must be used to optimize follow-up regimens for individual patients.
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Affiliation(s)
| | - J Mocco
- The Mount Sinai Health System, New York, New York, USA
| | - Xiangnan Zhang
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael Kelly
- Royal University Hospital, University of Saskatchewan, Neurosurgery, Saskatoon, Saskatchewan, Canada
| | - Amish Doshi
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kambiz Nael
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Reade De Leacy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Kiriki M, Jomoto W, Ikeda T, Kotoura N. [Imaging Parameter Optimization of 3D Phase Contrast-MRA to Reduce Susceptibility-artifact and Radiofrequency-shielding around the Intracranial Stent]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2019; 74:1293-1301. [PMID: 30464097 DOI: 10.6009/jjrt.2018_jsrt_74.11.1293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose of this study was to evaluate the degree of signal attenuation generated around the stent by the susceptibility artifacts and radiofrequency (RF) shielding in phase contrast-magnetic resonance angiography (PCA) images and construct optimal PCA imaging parameters for intracranial stent lumen images. The two types of PCA images of stents (Neuroform, Enterpraise II) placed in the vascular flow phantom were imaged with different the flip angle (FA) and echo time (TE). Each original image of the vascular flow phantom was reconstructed into a coronal multiplanar reconstruction (MPR) image and a profile curve along the long axis of the stent was calculated. The reduction of in-stent signal was assessed by relative in-stent signal (RIS) calculated by comparing intra-stent signal intensity to the reference tube in the original images. When the TE was 2.3 ms, the profile curve was the highest signal intensity. However, RIS had not changed by the extension of TE. When the FA was high, the RIS showed a high value, but when it exceeded 25 degrees, the signal attenuated in the distal part of the slab.The susceptibility artifacts and RF shielding generated around the stent can be reduced by the shortest TbE (2.3 ms) and 20 degrees of FA in the PCA imaging.
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Affiliation(s)
- Masato Kiriki
- Department of Radiological Technology, Hyogo College of Medicine College Hospital
| | - Wataru Jomoto
- Department of Radiological Technology, Hyogo College of Medicine College Hospital
| | - Takashi Ikeda
- Department of Radiological Technology, Hyogo College of Medicine College Hospital
| | - Noriko Kotoura
- Department of Radiological Technology, Hyogo College of Medicine College Hospital
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Ikemura A, Yuki I, Suzuki H, Suzuki T, Ishibashi T, Abe Y, Urashima M, Dahmani C, Murayama Y. Time-resolved magnetic resonance angiography (TR-MRA) for the evaluation of post coiling aneurysms; A quantitative analysis of the residual aneurysm using full-width at half-maximum (FWHM) value. PLoS One 2018; 13:e0203615. [PMID: 30192859 PMCID: PMC6128576 DOI: 10.1371/journal.pone.0203615] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 08/23/2018] [Indexed: 11/19/2022] Open
Abstract
Magnetic resonance image (MRI) is now widely used for imaging follow-up for post coiling brain aneurysms. However, the accuracy on the estimation of residual aneurysm, which is crucial for the retreatment planning, remains to be controversial. The purpose of this study is to evaluate a new post-processing technique that provides improved estimation of the residual aneurysm after coil embolization. One hundred aneurysms on 93 patients who underwent coil embolization for brain aneurysm were evaluated using the 1.5 Tesla time-resolved magnetic resonance angiography (TR-MRA) one year after the treatment. To minimize the inter-observer variability caused by the window level adjustment, an automatic post processing protocol using the full-width at half-maximum (FWHM) value was utilized. The result was then compared with that from the conventional cerebral angiography. Of the 97 aneurysms that underwent both TR-MRA and DSA, 23 (23.7%) showed residual neck / dome during follow-up. After window level adjustment, the size of the parent artery in the TR-MRA was consistent with that in the DSA. The reconstructed Volume Rendering images provided clear contours of the residual aneurysms and contributed to the understanding the configuration of residual aneurysm. The largest and the smallest diameter of the residual aneurysms was larger in the TR-MRA than in the DSA (8.05 vs. 7.72 mm, p = 0.0004; 4.99 vs. 4.19 mm, p = 0.007 respectively). The sensitivity, specificity, and positive and negative predictive values of TR-MRA compared to DSA were 100%, 97%, 73%, and 100%, respectively. Using the FWHM value to optimize the window level adjustment, the size of the residual component observed in the TR-MRA was larger compared to that in the DSA whereas the size of neck and the parent artery showed consistency between the two modalities. This image processing technique can be used as an effective screening tool for evaluating residual component in post-coiling brain aneurysms.
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Affiliation(s)
- Ayako Ikemura
- Department of Neurosurgery, The Jikei University Hospital, Tokyo, Japan
| | - Ichiro Yuki
- Department of Neurosurgery, The Jikei University Hospital, Tokyo, Japan
- * E-mail:
| | - Hiroaki Suzuki
- Department of Radiology, The Jikei University Hospital, Tokyo, Japan
| | - Tomoaki Suzuki
- Department of Neurosurgery, The Jikei University Hospital, Tokyo, Japan
| | | | - Yukiko Abe
- Department of Radiology, The Jikei University Hospital, Tokyo, Japan
| | - Mitsuyoshi Urashima
- Department of Molecular Epidemiology, The Jikei University School of Medicine, Tokyo, Japan
| | | | - Yuichi Murayama
- Department of Neurosurgery, The Jikei University Hospital, Tokyo, Japan
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van Rooij S, Peluso JP, Sluzewski M, Kortman HG, Boukrab I, van Rooij WJ. Mid-term 3T MRA follow-up of intracranial aneurysms treated with the Woven EndoBridge. Interv Neuroradiol 2018; 24:601-607. [PMID: 30001648 DOI: 10.1177/1591019918788346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Angiography is the standard follow-up modality for treated aneurysms with the Woven EndoBridge (WEB), and magnetic resonance angiography (MRA) is useful for extended follow-up. We present the results of WEB-treated aneurysms with angiographic follow-up at three months and at least 18 months' 3T MRA follow-up. MATERIALS AND METHODS Included were 52 patients with 53 aneurysms treated with the WEB between February 2015 and July 2016. There were 29 women and 23 men with a mean age of 60 years (median 62, range 23-76). Mean aneurysm size was 6.2 mm (median 6, range 3-16 mm). RESULTS 3T MRA follow-up was mean 19.6 months (median 18, range 18-36 months). One patient had an aneurysm remnant at three-month angiography that was additionally coiled and with stable complete occlusion at 18 months' 3T MRA follow-up. At three-month follow-up angiography, 44 aneurysms were completely occluded and eight had a neck remnant. At latest 3T MRA, stable complete occlusion was present in 43 aneurysms and stable neck remnant in eight. One posterior cerebral artery (PCA) dissection aneurysm was stable at three and six months but was enlarged and reopened at 18 months, confirmed with angiography. Focal signal loss by the proximal marker of the WEB was apparent in four patients without compromising diagnostic evaluation. CONCLUSION WEB-treated aneurysms with adequate occlusion at three-month angiography remained stable during serial 3T MRA follow-up of 18-36 months. One PCA aneurysm reopened during the 6- to 18-month interval. Once the WEB-treated aneurysm is adequately occluded in the short term, later reopening is uncommon.
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Affiliation(s)
- Sbt van Rooij
- 1 Department of Radiology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
| | - J P Peluso
- 2 Department of Radiology, Elisabeth Tweesteden Ziekenhuis, Tilburg, the Netherlands
| | - M Sluzewski
- 2 Department of Radiology, Elisabeth Tweesteden Ziekenhuis, Tilburg, the Netherlands
| | - H G Kortman
- 2 Department of Radiology, Elisabeth Tweesteden Ziekenhuis, Tilburg, the Netherlands
| | - I Boukrab
- 2 Department of Radiology, Elisabeth Tweesteden Ziekenhuis, Tilburg, the Netherlands
| | - W J van Rooij
- 2 Department of Radiology, Elisabeth Tweesteden Ziekenhuis, Tilburg, the Netherlands
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Ernst M, Buchholz A, Bourcier R, Desal H, Le Floch PY, Möhlenbruch M, Bendszus M, Fiehler J. Voxel based analysis of recurrence dynamics in intracranial aneurysms after coiling. J Neurointerv Surg 2017; 10:571-576. [PMID: 29089416 DOI: 10.1136/neurintsurg-2017-013311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 09/08/2017] [Accepted: 09/08/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND Understanding aneurysm growth is critical for the appropriate follow-up of patients after coil embolization and the need for retreatment. The purpose of the study was to stratify the growth dynamics of aneurysm recurrences after coiling by volumetric analysis and to determine predictive factors for aneurysm recurrences. METHODS Source images of follow-up three-dimensional time of flight MR angiography (ToF-MRA) scans were compared with the first post-interventional ToF-MRA scan and analyzed for residual flow after co-registration using ANALYZE-software. In the event of incomplete occlusion, the residual volume was segmented and calculated. Growth dynamic was determined for each aneurysm after embolization. RESULTS We analyzed 326 patients with 345 aneurysms from two centers. Each case had at least two ToF-MRA examinations after endovascular therapy. The mean observation interval was 59 months. Volumetric analysis of 1139 follow-up MRAs revealed that 218/345 aneurysms (63.2%) showed complete occlusion on initial follow-up imaging, and of these 95.0% remained stable. A steady increase in intra-aneurysmal flow was observed in 83/345 (24.1%). Less frequent observations were a steep increase (21/345; 6.1%) and a decrease (27/345; 7.8%). Independent predictors of increasing residual flow were greatest aneurysm diameter, total coil length, and incomplete occlusion. CONCLUSIONS Volumetric analysis of registered three-dimensional ToF-MRA follow-up datasets allows the detection of different growth patterns with high precision, avoids the low inter-rater reliability, and represents a promising approach for future studies that include analysis of more complex predictors of residual flow. In cases of aneurysm recurrence after coiling, the major pattern seems to be a steady increase in intra-aneurysmal flow over several months.
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Affiliation(s)
- Marielle Ernst
- Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Anika Buchholz
- Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Romain Bourcier
- Service de Neuroradiologie Diagnostique et Interventionnelle, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Hubert Desal
- Service de Neuroradiologie Diagnostique et Interventionnelle, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Pierre-Yves Le Floch
- Service de Neuroradiologie Diagnostique et Interventionnelle, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Markus Möhlenbruch
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Zuckerman SL, Lakomkin N, Magarik JA, Vargas J, Stephens M, Akinpelu B, Spiotta AM, Ahmed A, Arthur AS, Fiorella D, Hanel R, Hirsch JA, Hui FK, James RF, Kallmes DF, Meyers PM, Niemann DB, Rasmussen P, Turner RD, Welch BG, Mocco J. Evaluation of previously embolized intracranial aneurysms: inter-and intra-rater reliability among neurosurgeons and interventional neuroradiologists. J Neurointerv Surg 2017; 10:462-466. [PMID: 28918386 DOI: 10.1136/neurintsurg-2017-013231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/17/2017] [Accepted: 08/21/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND The angiographic evaluation of previously coiled aneurysms can be difficult yet remains critical for determining re-treatment. OBJECTIVE The main objective of this study was to determine the inter-rater reliability for both the Raymond Scale and per cent embolization among a group of neurointerventionalists evaluating previously embolized aneurysms. METHODS A panel of 15 neurointerventionalists examined 92 distinct cases of immediate post-coil embolization and 1 year post-embolization angiographs. Each case was presented four times throughout the study, along with alterations in demographics in order to evaluate intra-rater reliability. All respondents were asked to provide the per cent embolization (0-100%) and Raymond Scale grade (1-3) for each aneurysm. Inter-rater reliability was evaluated by computing weighted kappa values (for the Raymond Scale) and intraclass correlation coefficients (ICC) for per cent embolization. RESULTS 10 neurosurgeons and 5 interventional neuroradiologists evaluated 368 simulated cases. The agreement among all readers employing the Raymond Scale was fair (κ=0.35) while concordance in per cent embolization was good (ICC=0.64). Clinicians with fewer than 10 years of experience demonstrated a significantly greater level of agreement than the group with greater than 10 years (κ=0.39 and ICC=0.70 vs κ=0.28 and ICC=0.58). When the same aneurysm was presented multiple times, clinicians demonstrated excellent consistency when assessing per cent embolization (ICC=0.82), but moderate agreement when employing the Raymond classification (κ=0.58). CONCLUSIONS Identifying the per cent embolization in previously coiled aneurysms resulted in good inter- and intra-rater agreement, regardless of years of experience. The strong agreement among providers employing per cent embolization may make it a valuable tool for embolization assessment in this patient population.
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Affiliation(s)
- Scott L Zuckerman
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nikita Lakomkin
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Jordan A Magarik
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jan Vargas
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Marcus Stephens
- Department of Neurosurgery, University of Arkansas, Little Rock, Arkansas, USA
| | | | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Azam Ahmed
- Department of Neurosurgery, University of Wisconsin, Madison, Wisconsin, USA
| | - Adam S Arthur
- Department of Neurosurgery, Semmes-Murphey Clinic, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
| | - David Fiorella
- Department of Neurosurgery, Cerebrovascular Center, Stony Brook University Medical Center, Stony Brook, New York, USA
| | - Ricardo Hanel
- Department of Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA
| | - Joshua A Hirsch
- Neurointerventional Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ferdinand K Hui
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Robert F James
- Department of Neurosurgery, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - David F Kallmes
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Philip M Meyers
- Columbia University Medical Center, Departments of Neurosurgery and Radiology, New York, USA
| | - David B Niemann
- Department of Neurosurgery, University of Arkansas, Little Rock, Arkansas, USA
| | - Peter Rasmussen
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Raymond D Turner
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Babu G Welch
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - J Mocco
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
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Follow-up CT and CT angiography after intracranial aneurysm clipping and coiling—improved image quality by iterative metal artifact reduction. Neuroradiology 2017; 59:649-654. [DOI: 10.1007/s00234-017-1855-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 05/17/2017] [Indexed: 10/19/2022]
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Shang S, Ye J, Luo X, Qu J, Zhen Y, Wu J. Follow-up assessment of coiled intracranial aneurysms using zTE MRA as compared with TOF MRA: a preliminary image quality study. Eur Radiol 2017; 27:4271-4280. [PMID: 28382536 DOI: 10.1007/s00330-017-4794-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 02/15/2017] [Accepted: 03/07/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To prospectively assess coiled intracranial aneurysms using a novel non-contrast enhanced zero echo time (zTE) MR angiography (MRA) method, and compare its image quality with time-of-flight (TOF) MRA, using digital subtraction angiography (DSA) as reference. METHODS Twenty-five patients (10 males and 15 females; age 53.96 ± 12.46 years) were enrolled in this monocentric study. MRA sequences were performed 24 h before DSA. Susceptibility artefact intensity and flow signal within the parent artery were carried out using a 4-point scale. Occlusion status was assessed using the 3-grade Montreal scale. RESULTS Scores of zTE were higher than TOF for both susceptibility artefact intensity (3.42 ± 0.64, 2.92 ± 0.63, P = 0.01) and flow signal (3.66 ± 0.95, 3.24 ± 1.24, P = 0.01). DSA revealed 17 complete occlusions, five residual neck aneurysms and two residual aneurysms. Inter-observer agreement was excellent (weighted κ: 0.89) for zTE and good (weighted κ: 0.68) for TOF. Intermodality agreement was excellent for zTE (weighted κ: 0.95) and good for TOF (weighted κ: 0.80). Correlations of both MRA sequences with DSA were high (zTE, Spearman's ρ: 0.91; TOF, Spearman's ρ: 0.81). CONCLUSIONS zTE MRA showed promising results for follow-up assessment of coiled intracranial aneurysms and was superior to TOF MRA for visualizing the parent artery and evaluating occlusion status. KEY POINTS • Various MRA sequences were applied for follow-up assessment of coiled intracranial aneurysms. • zTE MRA was less sensitive to susceptibility artefacts and haemodynamics. • In this monocentric study, zTE MRA was equivalent to DSA. • zTE MRA maybe an alternative to TOF MRA for follow-up assessment.
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Affiliation(s)
- Song'an Shang
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Jing Ye
- Department of Radiology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, 225001, China
| | - Xianfu Luo
- Department of Radiology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, 225001, China
| | - Jianxun Qu
- MR Enhanced Application, GE Healthcare, Beijing, 100176, China
| | - Yong Zhen
- Department of Neurosurgery, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, 225001, China
| | - Jingtao Wu
- Department of Radiology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, 225001, China.
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Noureddine Y, Kraff O, Ladd ME, Wrede KH, Chen B, Quick HH, Schaefers G, Bitz AK. In vitro and in silico assessment of RF-induced heating around intracranial aneurysm clips at 7 Tesla. Magn Reson Med 2017; 79:568-581. [DOI: 10.1002/mrm.26650] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 01/11/2017] [Accepted: 01/26/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Yacine Noureddine
- Erwin L. Hahn Institute for Magnetic Resonance Imaging; University Duisburg-Essen; Essen Germany
- MR:comp GmbH, MR Safety Testing Laboratory; Gelsenkirchen Germany
| | - Oliver Kraff
- Erwin L. Hahn Institute for Magnetic Resonance Imaging; University Duisburg-Essen; Essen Germany
| | - Mark E. Ladd
- Erwin L. Hahn Institute for Magnetic Resonance Imaging; University Duisburg-Essen; Essen Germany
- Division of Medical Physics in Radiology (E020); German Cancer Research Center (DKFZ); Heidelberg Germany
| | - Karsten H. Wrede
- Erwin L. Hahn Institute for Magnetic Resonance Imaging; University Duisburg-Essen; Essen Germany
- Department of Neurosurgery; University Hospital Essen; Essen Germany
| | - Bixia Chen
- Erwin L. Hahn Institute for Magnetic Resonance Imaging; University Duisburg-Essen; Essen Germany
- Department of Neurosurgery; University Hospital Essen; Essen Germany
| | - Harald H. Quick
- Erwin L. Hahn Institute for Magnetic Resonance Imaging; University Duisburg-Essen; Essen Germany
- High Field and Hybrid MR Imaging; University Hospital Essen; Essen Germany
| | - Gregor Schaefers
- MR:comp GmbH, MR Safety Testing Laboratory; Gelsenkirchen Germany
- MRI-STaR-Magnetic Resonance Institute for Safety, Technology and Research GmbH; Gelsenkirchen Germany
| | - Andreas K. Bitz
- Erwin L. Hahn Institute for Magnetic Resonance Imaging; University Duisburg-Essen; Essen Germany
- Division of Medical Physics in Radiology (E020); German Cancer Research Center (DKFZ); Heidelberg Germany
- Faculty of Electrical Engineering and Information Technology; FH Aachen-University of Applied Sciences; Aachen NRW Germany
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Ueda F, Uchiyama N, Mohri M, Misaki K, Matsui O, Kida S, Sanada J, Yoshikawa J, Aburano H, Yoshie Y, Gabata T. Long-term predictive factors of the morphology based outcome in bare platinum coiled intracranial aneurysms: Evaluation by pre- and post-contrast 3D time-of-flight MR angiography. Neurol Neurochir Pol 2017; 51:116-126. [PMID: 28256206 DOI: 10.1016/j.pjnns.2017.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 11/06/2016] [Accepted: 01/09/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE Our aim was to identify long-term predictive factors of the morphology-based outcome (MBO) of bare platinum coiled intracranial aneurysms. MATERIALS AND METHODS A retrospective analysis of 96 bare platinum coiled intracranial aneurysms followed up from 1997 to 2016 using pre- and post-contrast 3D time-of-flight MR angiography (MRA) was performed. Logistic regression analysis was used to identify factors associated with a positive history of surrounding coil mass enhancement (SCME) and poor MBO. Spearman's rank correlation test was used to analyze the relationship between the initial angiographic result (IAR) class, sequential change of the SCME category, and MBO grade. RESULTS Factors independently associated with poor MBO were incomplete IAR (OR=14.94, 95%CI: 2.46, 289.21, P=0.002) and a history of SCME (OR=4.13, 95% CI: 1.05, 18.65, P=0.043). The MBO grade strongly correlated with the IAR class (correlation coefficient [r]=0.84, P<0.0001). MBO grade correlated with sequential change of the SCME category (r=0.56, P<0.0001). The sequential change of the SCME category correlated with IAR class (r=0.53, P<0.0001). CONCLUSION Although IAR and its class were strong long-term predictive factors of MBO, a history of SCME and upgrading of sequential change of SCME category were also long-term predictive factors of the MBO of bare platinum coiled intracranial aneurysms.
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Affiliation(s)
- Fumiaki Ueda
- Department of Radiology, Division of Cardiovascular Medicine, Graduate School of Medical Science, Kanazawa University, Japan.
| | - Naoyuki Uchiyama
- Department of Neurosurgery, Division of Neuroscience, Graduate School of Medical Science, Kanazawa University, Japan
| | - Masanao Mohri
- Department of Neurosurgery, Division of Neuroscience, Graduate School of Medical Science, Kanazawa University, Japan
| | - Kouichi Misaki
- Department of Neurosurgery, Division of Neuroscience, Graduate School of Medical Science, Kanazawa University, Japan
| | - Osamu Matsui
- Department of Advanced Medical Imaging, Graduate School of Medical Science, Kanazawa University, Japan
| | - Shinya Kida
- Department of Neurosurgery, Fukui Prefectural Hospital, Japan
| | - Junichiro Sanada
- Department of Radiology, Division of Cardiovascular Medicine, Graduate School of Medical Science, Kanazawa University, Japan
| | - Jun Yoshikawa
- Department of Radiology, Fukui Prefectural Hospital, Japan
| | - Hiroyuki Aburano
- Department of Radiology, Division of Cardiovascular Medicine, Graduate School of Medical Science, Kanazawa University, Japan
| | - Yuichi Yoshie
- Department of Radiology, Division of Cardiovascular Medicine, Graduate School of Medical Science, Kanazawa University, Japan
| | - Toshifumi Gabata
- Department of Radiology, Division of Cardiovascular Medicine, Graduate School of Medical Science, Kanazawa University, Japan
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Fargen KM, Soriano-Baron HE, Rushing JT, Mack W, Mocco J, Albuquerque F, Ducruet AF, Mokin M, Linfante I, Wolfe SQ, Wilson JA, Hirsch JA. A survey of intracranial aneurysm treatment practices among United States physicians. J Neurointerv Surg 2017; 10:44-49. [DOI: 10.1136/neurintsurg-2016-012808] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 11/22/2016] [Accepted: 01/12/2017] [Indexed: 11/04/2022]
Abstract
BackgroundRecent surveys have failed to examine cerebrovascular aneurysm treatment practices among US physicians.ObjectiveTo survey physicians who are actively involved in the care of patients with cerebrovascular aneurysms to determine current aneurysm treatment preferences.MethodsA 25-question SurveyMonkey online survey was designed and distributed electronically to members of the Society of NeuroInterventional Surgery, Society of Vascular and Interventional Neurology, and the American Association of Neurological Surgeons/Congress of Neurological Surgeons Combined Cerebrovascular Section.Results211 physicians completed the survey. Most respondents recommend endovascular treatment as the first-line management strategy for most ruptured (78%) and unruptured (71%) aneurysms. Thirty-eight per cent of respondents indicate that they routinely treat all patients with subarachnoid hemorrhage regardless of grade. Most physicians use the International Study of Unruptured Intracranial Aneurysms data for counseling patients on natural history risk (80%); a small minority (11%) always or usually recommend treatment of anterior circulation aneurysms of <5 mm. Two-thirds of respondents continue to recommend clipping for most middle cerebral artery aneurysms, while most (51%) recommend flow diversion for wide-necked internal carotid artery aneurysms. Follow-up imaging schedules are highly variable. Neurosurgeons at academic institutions and those practicing longer were more likely to recommend clipping surgery for aneurysms (p<0.05).ConclusionsThis survey demonstrates considerable variability in patient selection for intracranial aneurysm treatment, preferred treatment strategies, and follow-up imaging schedules among US physicians.
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Follow-up of intracranial aneurysms treated with stent-assisted coiling: Comparison of contrast-enhanced MRA, time-of-flight MRA, and digital subtraction angiography. J Neuroradiol 2017; 44:44-51. [DOI: 10.1016/j.neurad.2016.10.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 10/04/2016] [Accepted: 10/10/2016] [Indexed: 11/24/2022]
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Gupta R, Griessenauer CJ, Adeeb N, Chua MH, Moore JM, Patel AS, Thomas AJ, Ogilvy CS. Evaluating Imaging Follow-Up Strategies and Costs of Unruptured Intracranial Aneurysms Treated with Endovascular Techniques: A Survey of Academic Neurovascular Centers in the United States. World Neurosurg 2016; 94:360-367. [DOI: 10.1016/j.wneu.2016.07.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 07/07/2016] [Accepted: 07/08/2016] [Indexed: 10/21/2022]
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21
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Time-of-Flight Magnetic Resonance Angiography With Sparse Undersampling and Iterative Reconstruction. Invest Radiol 2016; 51:372-8. [DOI: 10.1097/rli.0000000000000221] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Wu X, Li Y, Huang Q, Liu J. Morphological Characteristics of the Vertebrobasilar Arterial System Are Associated with Vertebrobasilar Dolichoectasia. Med Sci Monit 2016; 22:1709-15. [PMID: 27206494 PMCID: PMC4915323 DOI: 10.12659/msm.895714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Vertebrobasilar dolichoectasia (VBD) is characterized by abnormal dilation, distortion, and extension of the vertebral artery (VA) and basilar artery (BA). This study investigated whether BA and VA morphological characteristics were factors predicting VBD. Material/Methods Individuals aged ≥18 years undergoing contrast-enhanced magnetic resonance angiography (CE-MRA) of the head/neck were enrolled in 2012 at Changhai Hospital, Shanghai. Data concerning cardiovascular risk factors were recorded. Bilateral VA diameter and lateral displacement, BA diameter and lateral displacement, VA confluence displacement, and dominant VA (DVA) presence/absence were determined from CE-MRA. VBD was diagnosed using established criteria. DVA and no-DVA groups were compared. Logistic regression analysis was used to identify variables independently associated with VBD. Results Our study included 1153 individuals, of which 614 (53.3%) had DVA. The DVA group had higher mean age, hypertension prevalence (44.6% vs. 37.5%), and VBD prevalence (8.1% vs. 4.5%), and lower smoking prevalence (24.3% vs. 30.6%), than no-DVA patients. Univariate analysis revealed that age, female sex, hypertension, hyperlipidemia, smoking, alcohol consumption, and DVA presence were associated with VBD occurrence. Multivariate analysis showed that age and presence of a DVA were independently associated with VBD. Conclusions Age and presence of DVA are independently associated with VBD.
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Affiliation(s)
- Xi Wu
- Department of Neurosurgery, Changhai Hospital, Shanghai, China (mainland)
| | - Yanjun Li
- Department of Medical Imaging, Nanjing General Hospital of Nanjing Military Command, Nanjing, Jiangsu, China (mainland)
| | - Qinghai Huang
- Department of Neurosurgery, Changhai Hospital, Shanghai, China (mainland)
| | - Jianmin Liu
- Department of Neurosurgery, Changhai Hospital, Shanghai, China (mainland)
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Timsit C, Soize S, Benaissa A, Portefaix C, Gauvrit JY, Pierot L. Contrast-Enhanced and Time-of-Flight MRA at 3T Compared with DSA for the Follow-Up of Intracranial Aneurysms Treated with the WEB Device. AJNR Am J Neuroradiol 2016; 37:1684-9. [PMID: 27102311 DOI: 10.3174/ajnr.a4791] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 02/28/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Imaging follow-up at 3T of intracranial aneurysms treated with the WEB Device has not been evaluated yet. Our aim was to assess the diagnostic accuracy of 3D-time-of-flight MRA and contrast-enhanced MRA at 3T against DSA, as the criterion standard, for the follow-up of aneurysms treated with the Woven EndoBridge (WEB) system. MATERIALS AND METHODS From June 2011 to December 2014, patients treated with the WEB in our institution, then followed for ≥6 months after treatment by MRA at 3T (3D-TOF-MRA and contrast-enhanced MRA) and DSA within 48 hours were included. Aneurysm occlusion was assessed with a simplified 2-grade scale (adequate occlusion [total occlusion + neck remnant] versus aneurysm remnant). Interobserver and intermodality agreement was evaluated by calculating the linear weighted κ. MRA test characteristics and predictive values were calculated from a 2 × 2 contingency table, by using DSA data as the standard of reference. RESULTS Twenty-six patients with 26 WEB-treated aneurysms were included. The interobserver reproducibility was good with DSA (κ = 0.71) and contrast-enhanced-MRA (κ = 0.65) compared with moderate with 3D-TOF-MRA (κ = 0.47). Intermodality agreement with DSA was fair with both contrast-enhanced MRA (κ = 0.36) and 3D-TOF-MRA (κ = 0.36) for the evaluation of total occlusion. For aneurysm remnant detection, the prevalence was low (15%), on the basis of DSA, and both MRA techniques showed low sensitivity (25%), high specificity (100%), very good positive predictive value (100%), and very good negative predictive value (88%). CONCLUSIONS Despite acceptable interobserver reproducibility and predictive values, the low sensitivity of contrast-enhanced MRA and 3D-TOF-MRA for aneurysm remnant detection suggests that MRA is a useful screening procedure for WEB-treated aneurysms, but similar to stents and flow diverters, DSA remains the criterion standard for follow-up.
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Affiliation(s)
- C Timsit
- From the Department of Neuroradiology (C.T., S.S., A.B., L.P.), Hôpital Maison Blanche, Université de Champagne-Ardenne, Reims, France
| | - S Soize
- From the Department of Neuroradiology (C.T., S.S., A.B., L.P.), Hôpital Maison Blanche, Université de Champagne-Ardenne, Reims, France
| | - A Benaissa
- From the Department of Neuroradiology (C.T., S.S., A.B., L.P.), Hôpital Maison Blanche, Université de Champagne-Ardenne, Reims, France
| | - C Portefaix
- CReSTIC SIC EA3804 (C.P.), Université de Champagne-Ardenne, Reims, France
| | - J-Y Gauvrit
- Department of Neuroradiology (J.-Y.G.), Hôpital Pontchaillou, Rennes, France Unité VISAGES U746 INSERM-INRIA (J.-Y.G.), IRISA UMR CNRS 6074, University of Rennes, Rennes, France
| | - L Pierot
- From the Department of Neuroradiology (C.T., S.S., A.B., L.P.), Hôpital Maison Blanche, Université de Champagne-Ardenne, Reims, France
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Jeon JP, Cho YD, Rhim JK, Yoo DH, Kang HS, Kim JE, Cho WS, Han MH. Do Contrast-Fill Patterns Immediately After Coil Embolization of Small Saccular Aneurysms Impact Long-Term Results? Clin Neuroradiol 2015; 27:205-211. [PMID: 26608741 DOI: 10.1007/s00062-015-0485-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 11/12/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE It is generally accepted that filling of a saccular aneurysm with contrast immediately after coil embolization predisposes to later recanalization. However, not all such scenarios evolve similarly over time. We investigated outcomes of small (≤ 7 mm) aneurysms with contrast-filled sacs immediately after coil embolization, evaluating the impact of pattern and degree of filling on subsequent recanalization. METHODS Between January, 2008 and December, 2010, 186 small (≤ 7 mm) saccular aneurysms that retained contrast after coil embolization accrued for this study. Lesions were categorized by pattern (eccentric vs. concentric) and degree of filling on working projections. Clinical and morphologic factors were also analyzed to assess impact on subsequent recanalization. Morphologic outcomes at 6 months or more were assessed. RESULTS In 93.5 % (174/186) of aneurysms with visible contrast retention, complete occlusion was evident on follow-up imaging studies at 6 months. Multiple logistic regression analysis indicated that eccentric (vs. concentric) contrast filling carried greater risk of subsequent recanalization (p = 0.020). Stent placement and progressive occlusion were also linked, falling short of statistical significance (p = 0.089). Of 166 progressively occluded aneurysms followed for more than 12 months (mean, 30.8 ± 7.3 months), 158 (95.2 %) exhibited stable occlusion. CONCLUSION Small (≤ 7 mm) aneurysms that retain contrast immediately after coil embolization are more likely to become completely occluded over time through progressive thrombosis. However, an eccentric fill pattern may predispose to recanalization.
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Affiliation(s)
- J P Jeon
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, Korea
| | - Y D Cho
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu Seoul, Seoul 110-744, Seoul, Korea.
| | - J K Rhim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu Seoul, Seoul 110-744, Seoul, Korea
| | - D H Yoo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu Seoul, Seoul 110-744, Seoul, Korea
| | - H-S Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - J E Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - W S Cho
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - M H Han
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu Seoul, Seoul 110-744, Seoul, Korea.,Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Diagnostic value of 3D time-of-flight MRA in trigeminal neuralgia. J Clin Neurosci 2015; 22:1343-8. [DOI: 10.1016/j.jocn.2015.02.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 01/30/2015] [Accepted: 02/04/2015] [Indexed: 12/15/2022]
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Pierot L, Klisch J, Liebig T, Gauvrit JY, Leonardi M, Nuzzi NP, Di Paola F, Sychra V, Mine B, Lubicz B. WEB-DL Endovascular Treatment of Wide-Neck Bifurcation Aneurysms: Long-Term Results in a European Series. AJNR Am J Neuroradiol 2015; 36:2314-9. [PMID: 26228882 DOI: 10.3174/ajnr.a4445] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 04/15/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Flow disruption with the WEB-DL device has been used safely for the treatment of wide-neck bifurcation aneurysms. The stability of aneurysm occlusion after this treatment was evaluated in the short and midterm, but not in the long term. This retrospective multicenter European study is the continuation of an already published series dealing with short- and midterm anatomic results and analyzes long-term data in patients treated with the WEB-DL. MATERIALS AND METHODS Twelve European neurointerventional centers initially participated in the study. In addition to data collected for the initial publication, images obtained at long-term follow-up were collected and independently analyzed by the same experienced interventional neuroradiologist. RESULTS Of the initial 45 patients, 26 (20 women and 6 men; 35-73 years of age; mean, 55.2 ± 10.6 years; median, 55.5 years) with 26 aneurysms treated with the WEB-DL device had long-term follow-up (median, 27.4 months). Three of 26 patients (11.5%) were retreated between short- and midterm follow-up, and none, between mid- and long-term follow-up. Long-term aneurysm occlusion in the 19 patients treated with the WEB only and not retreated during follow-up was complete occlusion in 13/19 patients (68.4%), including aneurysms with opacification of the proximal recess in 9/19 patients (47.4%), neck remnant in 3/19 patients (15.8%), and aneurysm remnant in 3/19 patients (15.8%). In all patients (100.0%), aneurysm occlusion was stable between midterm and long-term follow-up. CONCLUSIONS The results suggest that WEB treatment of wide-neck bifurcation aneurysms offers long-term stable occlusion.
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Affiliation(s)
- L Pierot
- From the Department of Neuroradiology (L.P.), Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne, Reims, France
| | - J Klisch
- Department of Diagnostic and Interventional Radiology and Neuroradiology (J.K., V.S.), Helios General Hospital, Erfurt, Germany
| | - T Liebig
- Department of Neuroradiology (T.L.), Universitätsklinikum Köln, Cologne, Germany
| | - J-Y Gauvrit
- Department of Neuroradiology (J.-Y.G.), CHU Rennes, Rennes, France
| | - M Leonardi
- Department of Neuroradiology (M.L.), Ospedale Bellaria, Bologna University, Bologna, Italy
| | - N P Nuzzi
- Department of Neuroradiology (N.P.N.), Ospedale Galliera, Genova, Italy
| | - F Di Paola
- Department of Neuroradiology (F.D.P.), Ospedale Santa Maria, Treviso, Italy
| | - V Sychra
- Department of Diagnostic and Interventional Radiology and Neuroradiology (J.K., V.S.), Helios General Hospital, Erfurt, Germany
| | - B Mine
- Department of Neuroradiology (B.M., B.L.), Erasme University Hospital, Brussels, Belgium
| | - B Lubicz
- Department of Neuroradiology (B.M., B.L.), Erasme University Hospital, Brussels, Belgium
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Thompson BG, Brown RD, Amin-Hanjani S, Broderick JP, Cockroft KM, Connolly ES, Duckwiler GR, Harris CC, Howard VJ, Johnston SCC, Meyers PM, Molyneux A, Ogilvy CS, Ringer AJ, Torner J. Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2015; 46:2368-400. [PMID: 26089327 DOI: 10.1161/str.0000000000000070] [Citation(s) in RCA: 642] [Impact Index Per Article: 71.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE The aim of this updated statement is to provide comprehensive and evidence-based recommendations for management of patients with unruptured intracranial aneurysms. METHODS Writing group members used systematic literature reviews from January 1977 up to June 2014. They also reviewed contemporary published evidence-based guidelines, personal files, and published expert opinion to summarize existing evidence, indicate gaps in current knowledge, and when appropriate, formulated recommendations using standard American Heart Association criteria. The guideline underwent extensive peer review, including review by the Stroke Council Leadership and Stroke Scientific Statement Oversight Committees, before consideration and approval by the American Heart Association Science Advisory and Coordinating Committee. RESULTS Evidence-based guidelines are presented for the care of patients presenting with unruptured intracranial aneurysms. The guidelines address presentation, natural history, epidemiology, risk factors, screening, diagnosis, imaging and outcomes from surgical and endovascular treatment.
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Ernst M, Yoo AJ, Kriston L, Schönfeld MH, Vettorazzi E, Fiehler J. Is visual evaluation of aneurysm coiling a reliable study end point? Systematic review and meta-analysis. Stroke 2015; 46:1574-81. [PMID: 25944331 DOI: 10.1161/strokeaha.114.008513] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 04/10/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Angiographic occlusion as a surrogate marker of satisfactory aneurysm treatment is commonly used in clinical trials although some pitfalls have to be considered. To investigate the inter-rater reliability of visual rating of aneurysm occlusion as study end point, we performed a systematic review and meta-analysis. METHODS Electronic databases (MEDLINE, EMBASE, PubMed, and the Cochrane Library) were searched up to June 2014. Assessment of risk for bias was based on the Quality Appraisal Tool for Studies of Diagnostic Reliability and the Guidelines for Reporting Reliability and Agreement studies. Inter-rater reliability estimates were pooled across studies using meta-analysis, and the influence of several factors (eg, imaging methods, grading scales, and occlusion rate) was tested with meta-regression. RESULTS From 1193 titles, 644 abstracts and 87 full-text versions were reviewed. Twenty-six articles met the inclusion criteria and provided 77 reliability estimates. Twenty-one different rating scales were used, and statistical analysis varied. Mean inter-rater agreement of the pooled studies was substantial (κ=0.65; 95% confidence interval, 0.60-0.69). Reliability varied significantly as a function of imaging methods, grading scales, occlusion rates, and their interaction. Observer agreement substantially increased with increasing occlusion rate in digital subtraction angiography but not in MR angiography. Reliability was higher in studies using 2- or 3-value grading scales than in studies with 4-value grading scales. CONCLUSIONS There is significant heterogeneity between studies evaluating the reliability of visual evaluation of aneurysm coiling. On the basis of our analysis, we found that the combination of magnetic resonance angiography, 3-value grading scale, and 2 trained raters seems most promising for usage as surrogate study end points.
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Affiliation(s)
- Marielle Ernst
- From the Department of Diagnostic and Interventional Neuroradiology (M.E., M.H.S., J.F.), Department of Medical Psychology (L.K.), and Department of Medical Biometry and Epidemiology (E.V.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston (A.J.Y.).
| | - Albert J Yoo
- From the Department of Diagnostic and Interventional Neuroradiology (M.E., M.H.S., J.F.), Department of Medical Psychology (L.K.), and Department of Medical Biometry and Epidemiology (E.V.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston (A.J.Y.)
| | - Levente Kriston
- From the Department of Diagnostic and Interventional Neuroradiology (M.E., M.H.S., J.F.), Department of Medical Psychology (L.K.), and Department of Medical Biometry and Epidemiology (E.V.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston (A.J.Y.)
| | - Michael H Schönfeld
- From the Department of Diagnostic and Interventional Neuroradiology (M.E., M.H.S., J.F.), Department of Medical Psychology (L.K.), and Department of Medical Biometry and Epidemiology (E.V.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston (A.J.Y.)
| | - Eik Vettorazzi
- From the Department of Diagnostic and Interventional Neuroradiology (M.E., M.H.S., J.F.), Department of Medical Psychology (L.K.), and Department of Medical Biometry and Epidemiology (E.V.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston (A.J.Y.)
| | - Jens Fiehler
- From the Department of Diagnostic and Interventional Neuroradiology (M.E., M.H.S., J.F.), Department of Medical Psychology (L.K.), and Department of Medical Biometry and Epidemiology (E.V.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston (A.J.Y.)
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Benaissa A, Pierot L. Rebleeding of a neck remnant in a case of ruptured aneurysm initially treated with coils. J Neurointerv Surg 2015; 8:e17. [PMID: 25895511 DOI: 10.1136/neurintsurg-2014-011601.rep] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2015] [Indexed: 11/03/2022]
Abstract
The follow-up and indications for retreatment of intracranial aneurysms treated endovascularly are still a matter of debate. We report the case of a patient with a ruptured aneurysm who was treated twice with coils and regularly followed up with MRI/MR angiography which showed a neck remnant that finally rebled.
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Affiliation(s)
| | - Laurent Pierot
- Department of Radiology, University Hospital Reims, Reims, France
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Benaissa A, Pierot L. Rebleeding of a neck remnant in a case of ruptured aneurysm initially treated with coils. BMJ Case Rep 2015; 2015:bcr-2014-011601. [PMID: 25878224 DOI: 10.1136/bcr-2014-011601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The follow-up and indications for retreatment of intracranial aneurysms treated endovascularly are still a matter of debate. We report the case of a patient with a ruptured aneurysm who was treated twice with coils and regularly followed up with MRI/MR angiography which showed a neck remnant that finally rebled.
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Affiliation(s)
| | - Laurent Pierot
- Department of Radiology, University Hospital Reims, Reims, France
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Progressive thrombosis of small saccular aneurysms filled with contrast immediately after coil embolization: analysis of related factors and long-term follow-up. Neuroradiology 2015; 57:615-23. [PMID: 25808124 DOI: 10.1007/s00234-015-1514-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/13/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Although it is well-known that incomplete occlusion of aneurysms after coil embolization predisposes to later recanalization, not all aneurysms will be fully occluded by coiling. In follow-up, we evaluated outcomes of small aneurysms (<10 mm) that showed filling of the sac with contrast immediately after coil embolization and assessed factors implicated in subsequent progressive thrombosis. METHODS Between January 2008 and December 2010, a total of 1035 aneurysms in 898 patients were treated by endovascular coiling. Of these, 210 small aneurysms displayed filling of the sac by contrast immediately after coil embolization. Time-of-flight magnetic resonance angiography (TOF-MRA; at 6, 12, 24, and 36 months) and digital subtraction angiography (as needed) were used for postoperative monitoring. Complete occlusion of these aneurysms at the 6-month follow-up point was attributed to progressive thrombosis. RESULTS In 186 (88.5 %) of the 210 aneurysms that showed filling of the sac with contrast, complete occlusion was observed on follow-up imaging studies at 6 months. Multiple logistic regression analysis indicated that progressive thrombosis was linked to aneurysmal neck diameter ≤4 mm (p < 0.001) and packing density >30 % (p = 0.016). Aneurysms originating from non-branching vessels were of marginal statistical significance (p = 0.056). In 179 progressively thrombosed aneurysms with follow-up evaluations of ≥12 months (mean, 31.9 ± 7.6 months), 168 aneurysms (93.9 %) exhibited stable occlusion, whereas minor recanalization was observed in 6 (3.3 %) instances, and major recanalization occurred in 5 (2.8 %). CONCLUSIONS In aneurysms where filling of the sac with contrast was demonstrable after coil embolization, aneurysms with small neck diameters or high coil packing density, and non-branching aneurysms seem predisposed to progressive intra-aneurysmal thrombosis over the course of time.
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Attali J, Benaissa A, Soize S, Kadziolka K, Portefaix C, Pierot L. Follow-up of intracranial aneurysms treated by flow diverter: comparison of three-dimensional time-of-flight MR angiography (3D-TOF-MRA) and contrast-enhanced MR angiography (CE-MRA) sequences with digital subtraction angiography as the gold standard. J Neurointerv Surg 2014; 8:81-6. [DOI: 10.1136/neurintsurg-2014-011449] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 10/13/2014] [Indexed: 11/04/2022]
Abstract
Background and purposeFollow-up of intracranial aneurysms treated by flow diverter with MRI is complicated by imaging artifacts produced by these devices. This study compares the diagnostic accuracy of three-dimensional time-of-flight MR angiography (3D-TOF-MRA) and contrast-enhanced MRA (CE-MRA) at 3 T for the evaluation of aneurysm occlusion and parent artery patency after flow diversion treatment, with digital subtraction angiography (DSA) as the gold standard.Materials and methodsPatients treated with flow diverters between January 2009 and January 2013 followed by MRA at 3 T (3D-TOF-MRA and CE-MRA) and DSA within a 48 h period were included in a prospective single-center study. Aneurysm occlusion was assessed with full and simplified Montreal scales and parent artery patency with three-grade and two-grade scales.ResultsTwenty-two patients harboring 23 treated aneurysms were included. Interobserver agreement using simplified scales for occlusion (Montreal) and parent artery patency were higher for DSA (0.88 and 0.61) and CE-MRA (0.74 and 0.55) than for 3D-TOF-MRA (0.51 and 0.02). Intermodality agreement was higher for CE-MRA (0.88 and 0.32) than for 3D-TOF-MRA (0.59 and 0.11). CE-MRA yielded better accuracy than 3D-TOF-MRA for aneurysm remnant detection (sensitivity 83% vs 50%; specificity 100% vs 100%) and for the status of the parent artery (specificity 63% vs 32%; sensitivity 100% vs 100%).ConclusionsAt 3 T, CE-MRA is superior to 3D-TOF-MRA for the evaluation of aneurysm occlusion and parent artery patency after flow diversion treatment. However, intraluminal evaluation remains difficult with MRA regardless of the sequence used.
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Lopes DK, Johnson AK, Kellogg RG, Heiferman DM, Keigher KM. Long-term radiographic results of stent-assisted embolization of cerebral aneurysms. Neurosurgery 2014; 74:286-91. [PMID: 24335816 DOI: 10.1227/neu.0000000000000263] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Aneurysmal subarachnoid hemorrhage is a disabling disease. Endovascular coiling provides minimally invasive, effective, and safe treatment of both ruptured and unruptured intracranial aneurysms. Intracranial stents have improved the endovascular treatment of complex aneurysms, but the long-term durability of this treatment modality needs clarification. OBJECTIVE To elucidate the long-term success of intracranial stent use in the treatment of aneurysms. METHODS Four hundred ten patients were treated with stent-assisted endovascular management of 464 aneurysms. Treatment of 363 small aneurysms, 88 large aneurysms, and 13 giant aneurysms was analyzed with respect to both long-term anatomic results with digital subtraction angiography and magnetic resonance angiography over the follow-up period. RESULTS The 6-month angiographic results of 387 aneurysm treatments revealed complete aneurysm occlusion in 282 (72.9%), residual aneurysm neck in 50 (12.9%), and residual aneurysm filling in 55 (14.2%). Long-term radiographic follow-up, performed in 262 patients (mean, 3.63 years), showed significant recurrence of only 3 aneurysms after 6-month follow-up imaging. Forty-eight aneurysms (11.9%) were considered radiographic failures during the follow-up period. CONCLUSION The aneurysm recurrence rate after stent-assisted embolization in this series was similar to published data using only coil embolization for the period between treatment and the initial follow-up imaging. For aneurysms that do not initially recur, the presented data suggest improved durability in the subsequent long-term follow-up period. ABBREVIATIONS DSA, digital subtraction angiographyMRA, magnetic resonance angiography.
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Benaissa A, Barbe C, Pierot L. Analysis of recanalization after endovascular treatment of intracranial aneurysm (ARETA trial): presentation of a prospective multicenter study. J Neuroradiol 2014; 42:80-5. [PMID: 25012816 DOI: 10.1016/j.neurad.2014.04.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 04/15/2014] [Accepted: 04/18/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE Aneurysm recanalization is a main concern after endovascular treatment of intracranial aneurysms. But to date, no systematic analysis of the risk factors affecting its occurrence has been conducted in a large series of patients. Analysis of Recanalization after Endovascular Treatment of intracranial Aneurysm (ARETA) is a multicenter, prospective trial whose aim is to collect a large series of patients treated endovascularly to analyze factors affecting aneurysm recanalization. STUDY DESIGN Patients with ruptured or unruptured aneurysms treated endovascularly will be enrolled from December 2013 to December 2014 in 19 participating centers in France. Patient and aneurysm characteristics will be recorded as well as the type of endovascular treatment and the occurrence of procedural or post-procedural complications. Post-procedural and follow-up imaging after one year will be analyzed independently by two readers using a 3-grade scale (complete occlusion, neck remnant, or aneurysm remnant). The progression of aneurysm occlusion will also be evaluated (improved, stable, or worsened). Aneurysm occlusion at one year and progression of aneurysm occlusion will be analyzed in light of patient, aneurysm, and treatment factors. CONCLUSION ARETA is a large, prospective, multicenter trial designed to assess predictive factors of aneurysm recanalization after endovascular treatment of intracranial aneurysms.
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Affiliation(s)
| | - Coralie Barbe
- Departments of Neuroradiology, CHU de Reims, Reims, France
| | - Laurent Pierot
- Departments of Neuroradiology, CHU de Reims, Reims, France
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Cho WS, Kim SS, Lee SJ, Kim SH. The effectiveness of 3T time-of-flight magnetic resonance angiography for follow-up evaluations after the stent-assisted coil embolization of cerebral aneurysms. Acta Radiol 2014; 55:604-13. [PMID: 24003259 DOI: 10.1177/0284185113502335] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Artifacts introduced by stents limit the value of magnetic resonance (MR) imaging as a follow-up modality after the stent-assisted coil embolization of cerebral aneurysms. PURPOSE To investigate the usefulness of 3 Tesla (3T) time-of-flight (TOF) MR angiography (MRA) for the follow-up evaluation. MATERIAL AND METHODS Twenty-two aneurysms of 20 patients treated with stent-assisted coil embolization were followed up with 3T TOF MRA and digital subtraction angiography (DSA) with three-dimensional rotational angiography (3DRA). The status of coiled aneurysms was compared with 3T TOF MRA and DSA with 3DRA in terms of complete occlusion, residual neck, and residual aneurysm. TOF MRA at 3T was performed 1 day before DSA with 3DRA, with a mean follow-up period of 20.1 ± 10.8 months. RESULTS Twenty (90.9%) of 22 cases were concordant between the two modalities. The degree of agreement and correlation between them were high (κ=0.771, P<0.001; r=0.832 and P<0.001). When evaluating the status of residual neck, the sensitivity was 80% (4/5 cases); specificity was not available because there were no cases of complete occlusion. For the status of residual aneurysm, the sensitivity and specificity were 94.1% (16/17 cases) and 100% (all 5 cases), respectively. CONCLUSION TOF MRA at 3T with source images could be useful as a non-invasive follow-up modality after the stent-assisted coil embolization of cerebral aneurysms. Further study with a larger patient sample is needed to confirm the effectiveness of 3T TOF MRA.
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Affiliation(s)
- Won-Sang Cho
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sam Soo Kim
- Department of Radiology, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Seung Jin Lee
- Department of Neurosurgery, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Sung Hun Kim
- Department of Radiology, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon-si, Gangwon-do, Republic of Korea
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Lubicz B, Klisch J, Gauvrit JY, Szikora I, Leonardi M, Liebig T, Nuzzi NP, Boccardi E, Paola FD, Holtmannspötter M, Weber W, Calgliari E, Sychra V, Mine B, Pierot L. WEB-DL endovascular treatment of wide-neck bifurcation aneurysms: short- and midterm results in a European study. AJNR Am J Neuroradiol 2014; 35:432-8. [PMID: 24457823 DOI: 10.3174/ajnr.a3869] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Flow disruption with the WEB-DL device has been used safely for the treatment of wide-neck bifurcation aneurysms, but the stability of aneurysm occlusion after this treatment is unknown. This retrospective multicenter European study analyzed short- and midterm data in patients treated with WEB-DL. MATERIALS AND METHODS Twelve European neurointerventional centers participated in the study. Clinical data and pre- and postoperative short- and midterm images were collected. An experienced interventional neuroradiologist independently analyzed the images. Aneurysm occlusion was classified into 4 grades: complete occlusion, opacification of the proximal recess of the device, neck remnant, and aneurysm remnant. RESULTS Forty-five patients (34 women and 11 men) 35-74 years of age (mean, 56.3 ± 9.6 years) with 45 aneurysms treated with the WEB device were included. Aneurysm locations were the middle cerebral artery in 26 patients, the posterior circulation in 13 patients, the anterior communicating artery in 5 patients, and the internal carotid artery terminus in 1 patient. Forty-two aneurysms were unruptured. Good clinical outcome (mRS < 2) was observed in 93.3% of patients at the last follow-up. Adequate occlusion (complete occlusion, opacification of the proximal recess, or neck remnant) was observed in 30/37 patients (81.1%) in short-term follow-up (median, 6 months) and in 26/29 patients (89.7%) in midterm follow-up (median, 13 months). Worsening of the aneurysm occlusion was observed in 2/28 patients (7.1%) at midterm follow-up. CONCLUSIONS The results suggest that the WEB endovascular treatment of wide-neck bifurcation aneurysms offers stable occlusion in a class of aneurysms that are historically unstable. Additionally, our data show that opacification of the WEB recess can be delineated from true neck or aneurysm remnants.
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Affiliation(s)
- B Lubicz
- From the Department of Neuroradiology (B.L., B.M.), Erasme University Hospital, Brussels, Belgium
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Cho YD, Kim KM, Lee WJ, Sohn CH, Kang HS, Kim JE, Han MH. Time-of-flight magnetic resonance angiography for follow-up of coil embolization with enterprise stent for intracranial aneurysm: usefulness of source images. Korean J Radiol 2014; 15:161-8. [PMID: 24497808 PMCID: PMC3909851 DOI: 10.3348/kjr.2014.15.1.161] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 09/23/2013] [Indexed: 11/15/2022] Open
Abstract
Objective The aim of this study was to determine the interobserver and intermodality agreement in the interpretation of time-of-flight (TOF) MR angiography (MRA) for the follow-up of coiled intracranial aneurysms with the Enterprise stent. Materials and Methods Two experienced neurointerventionists independently reviewed the follow-up MRA studies of 40 consecutive patients with 44 coiled aneurysms. All aneurysms were treated with assistance from the Enterprise stent and the radiologic follow-up intervals were greater than 6 months after the endovascular therapy. Digital subtraction angiography (DSA) served as the reference standard. The degree of aneurysm occlusion was determined by an evaluation of the maximal intensity projection (MIP) and source images (SI) of the TOF MRA. The capability of the TOF MRA to depict the residual flow within the coiled aneurysms and the stented parent arteries was compared with that of the DSA. Results DSA showed stable occlusions in 25 aneurysms, minor recanalization in 8, and major recanalization in 11. Comparisons between the TOF MRA and conventional angiography showed that the MIP plus SI had almost perfect agreement (κ = 0.892, range 0.767 to 1.000) and had better agreement than with the MIP images only (κ = 0.598, range 0.370 to 0.826). In-stent stenosis of more than 33% was observed in 5 cases. Both MIP and SI of the MRA showed poor depiction of in-stent stenosis compared with the DSA. Conclusion TOF MRA seemed to be reliable in screening for aneurysm recurrence after coil embolization with Enterprise stent assistance, especially in the evaluation of the SI, in addition to MIP images in the TOF MRA.
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Affiliation(s)
- Young Dae Cho
- Department of Radiology, Seoul National University College of Medicine, Seoul 110-744, Korea
| | - Kang Min Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul 110-744, Korea
| | - Woong Jae Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul 110-744, Korea
| | - Chul-Ho Sohn
- Department of Radiology, Seoul National University College of Medicine, Seoul 110-744, Korea
| | - Hyun-Seung Kang
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul 110-744, Korea
| | - Jeong Eun Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul 110-744, Korea
| | - Moon Hee Han
- Department of Radiology, Seoul National University College of Medicine, Seoul 110-744, Korea. ; Department of Neurosurgery, Seoul National University College of Medicine, Seoul 110-744, Korea
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Mordasini P, Kraehenbuehl AK, Byrne JV, Vandenberghe S, Reinert M, Hoppe H, Gralla J. In vitro and in vivo imaging characteristics assessment of polymeric coils compared with standard platinum coils for the treatment of intracranial aneurysms. AJNR Am J Neuroradiol 2013; 34:2177-83. [PMID: 23721897 DOI: 10.3174/ajnr.a3589] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Conventional platinum coils cause imaging artifacts that reduce imaging quality and therefore impair imaging interpretation on intraprocedural or noninvasive follow-up imaging. The purpose of this study was to evaluate imaging characteristics and artifact production of polymeric coils compared with standard platinum coils in vitro and in vivo. MATERIALS AND METHODS Polymeric coils and standard platinum coils were evaluated in vitro with the use of 2 identical silicon aneurysm models coiled with a packing attenuation of 20% each. DSA, flat panel CT, CT, and MR imaging were performed. In vivo evaluation of imaging characteristics of polymeric coils was performed in experimentally created rabbit carotid bifurcation aneurysms. DSA, CT/CTA, and MR imaging were performed after endovascular treatment of the aneurysms. Images were evaluated regarding visibility of individual coils, coil mass, artifact production, and visibility of residual flow within the aneurysm. RESULTS Overall, in vitro and in vivo imaging showed relevantly reduced artifact production of polymeric coils in all imaging modalities compared with standard platinum coils. Image quality of CT and MR imaging was improved with the use of polymeric coils, which permitted enhanced depiction of individual coil loops and residual aneurysm lumen as well as the peri-aneurysmal area. Remarkably, CT images demonstrated considerably improved image quality with only minor artifacts compared with standard coils. On DSA, polymeric coils showed transparency and allowed visualization of superimposed vessel structures. CONCLUSIONS This initial experimental study showed improved imaging quality with the use of polymeric coils compared with standard platinum coils in all imaging modalities. This might be advantageous for improved intraprocedural imaging for the detection of complications and posttreatment noninvasive follow-up imaging.
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Affiliation(s)
- P Mordasini
- Institute of Diagnostic and Interventional Neuroradiology
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Affiliation(s)
- Laurent Pierot
- Service de Radiologie, Hôpital Maison Blanche, CHU Reims, Reims Champagne-Ardenne University, Reims, France.
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Pereira VM, Bijlenga P, Marcos A, Schaller K, Lovblad KO. Diagnostic approach to cerebral aneurysms. Eur J Radiol 2012; 82:1623-32. [PMID: 23158462 DOI: 10.1016/j.ejrad.2012.10.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 10/25/2012] [Indexed: 10/27/2022]
Abstract
Cerebral aneurysms are an important cause of morbidity and mortality due to their causal effect in non-traumatic subarachnoid hemorrhage. Neurosurgical progress in the 20th century helped to improve patient outcomes greatly. In recent years, techniques such as intravascular treatment by coiling and/or stenting have found an additional place in the management of the disease. With the development of less and less invasive surgical and endovascular techniques, there has also been a continuous development in imaging techniques that have led to our current situation where we dispose of CT and MR techniques that can help improve treatment planning greatly. CT is able to detect and together with its adjunct techniques CT angiography and CT perfusion, it can allow us to provide the physicians in charge with a detailed image of the aneurysm, the feeding vessels as well as the status of blood flow to the brain. Angiography has evolved by becoming the standard tool for guidance during decision making for whatever therapy is being envisioned be it endovascular procedures and or surgery and has even progressed more recently due to the development of so-called flat panel technology that now allows to acquire CT-like images during and directly after an intervention. Thus nowadays, the diagnostic and interventional techniques and procedures have become so much entwined as to be considered a whole.
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Affiliation(s)
- Vitor Mendes Pereira
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Switzerland
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