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Fujii S, Fujita K, Ishikawa M, Shigeta K, Aizawa Y, Yoshimura M, Hirota S, Ito K, Yoshino Y, Yamada K, Takahashi S, Sagawa H, Kinoshita Y, Kobayashi Y, Hirai S, Sumita K. Postoperative Time-of-Flight Magnetic Resonance Angiography Classification is a Predictor of Postoperative Recanalization of Unruptured Cerebral Aneurysms. World Neurosurg 2025; 194:123496. [PMID: 39579932 DOI: 10.1016/j.wneu.2024.11.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2024] [Accepted: 11/15/2024] [Indexed: 11/25/2024]
Abstract
BACKGROUND Endovascular treatment has become the preferred approach for managing unruptured cerebral aneurysms, with simple and balloon-assisted coil embolization as the standard first-line therapy. However, recanalization after coil embolization remains a major clinical concern. This study aimed to evaluate the predictive factors for recanalization using time-of-flight magnetic resonance (TOF-MR) angiography. METHODS This retrospective multicenter study analyzed data from 241 patients with unruptured cerebral aneurysms who underwent coil embolization at 5 stroke centers. Aneurysms were evaluated using TOF-MR angiography within 7 days postprocedure and at follow-up. The study investigated the role of aneurysm characteristics and the Postoperative TOF-MR Angiography (PTMA) classification in predicting recanalization. RESULTS Of the 241 aneurysms analyzed, 79 (32.7%) exhibited recanalization, and 15 (6.2%) required retreatment. Aneurysms with a maximum diameter of ≥10 mm were associated with a higher risk of recanalization (odds ratio, 3.27; 95% confidence interval (CI), 1.38-7.75; P < 0.01). The PTMA classification, which indicated incomplete occlusion (small residual neck/residual neck/partial occlusion), also showed a significant association with recanalization (odds ratio, 4.82; 95% confidence interval, 2.17-10.7; P < 0.01). The modified Raymond-Roy classification (Class IIIb) also contributed to the prediction of recanalization (odds ratio, 3.09; 95% confidence interval, 1.50-6.38; P < 0.01). CONCLUSIONS Aneurysm size, the modified Raymond-Roy classification, and PTMA classification within 7 days of coil embolization were significant predictors of recanalization. This study suggests that TOF-MR angiography may be accurate, and that PTMA classification may serve as an appropriate predictor of aneurysm recanalization. Further prospective studies with larger cohorts are required to validate our findings.
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Affiliation(s)
- Shoko Fujii
- Department of Endovascular Surgery, Institute of Science Tokyo, Tokyo, Japan
| | - Kyohei Fujita
- Department of Endovascular Surgery, Institute of Science Tokyo, Tokyo, Japan
| | - Mariko Ishikawa
- Department of Neurosurgery, Ome Medical Center, Tokyo, Japan
| | - Keigo Shigeta
- Department of Neurosurgery, National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Yuki Aizawa
- Department of Neurosurgery, National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Masataka Yoshimura
- Department of Neurosurgery, Tsuchiura Kyodo General Hospital, Ibaraki, Japan; Department of Endovascular Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Shin Hirota
- Department of Neurosurgery, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Kei Ito
- Department of Neurosurgery, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Yoshikazu Yoshino
- Department of Endovascular Surgery, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Kenji Yamada
- Department of Endovascular Surgery, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Satoru Takahashi
- Department of Endovascular Surgery, Institute of Science Tokyo, Tokyo, Japan
| | - Hirotaka Sagawa
- Department of Endovascular Surgery, Institute of Science Tokyo, Tokyo, Japan
| | - Yuki Kinoshita
- Department of Endovascular Surgery, Institute of Science Tokyo, Tokyo, Japan
| | - Yusuke Kobayashi
- Department of Endovascular Surgery, Institute of Science Tokyo, Tokyo, Japan
| | - Sakyo Hirai
- Department of Endovascular Surgery, Institute of Science Tokyo, Tokyo, Japan
| | - Kazutaka Sumita
- Department of Endovascular Surgery, Institute of Science Tokyo, Tokyo, Japan.
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Fuga M, Ishibashi T, Aoki K, Tachi R, Irie K, Kato N, Kan I, Hataoka S, Nagayama G, Sano T, Tanaka T, Murayama Y. Intermediate catheter use is associated with complete occlusion and dense packing in coil embolization of unruptured cerebral aneurysms: a propensity score matched study. J Neurointerv Surg 2025; 17:174-180. [PMID: 38262727 PMCID: PMC11877021 DOI: 10.1136/jnis-2023-021258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/09/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND An intermediate catheter (IMC) can improve the maneuverability and stability of the microcatheter. OBJECTIVE To investigate the efficacy and safety of using an IMC in triaxial systems for coil embolization of unruptured cerebral aneurysms (UCAs). METHODS A total of 2430 consecutive saccular UCAs (2259 patients) that underwent initial coil embolization at three institutions between November 2003 and May 2023 were retrospectively reviewed. Patients were classified into two groups: with IMC (IMC(+)) and without IMC (IMC(-)). To investigate whether IMC use increased the rate of complete occlusion and the packing density, a propensity score-matched analysis was used to control for clinical, anatomical, and procedural features. RESULTS Ultimately, 595 (24.5%) coil embolization used an IMC. Propensity score matching was successful for 424 paired IMC(+) and IMC(-) aneurysms. Compared with the IMC(-) group, the IMC(+) group had significantly higher rate of Raymond-Roy Occlusion Classification class 1 immediately after treatment (30.0% vs 20.8%, P=0.003) and at 6 months (28.8% vs 20.0%, P=0.004) and a higher volume embolization ratio (27.2% (SD 6.5%) vs 25.9% (SD 6.2%), P=0.003). Re-treatment rates were not significantly different between the two groups (0.7% vs 0.2%, P=0.624). No significant differences in the incidences of ischemic and hemorrhagic complications and IMC-related parent artery dissection were found between the two groups. CONCLUSION Use of IMCs in triaxial systems can provide effective and safe support in coil embolization of UCAs because complete occlusion and dense coil packing can be achieved without increased complications.
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Affiliation(s)
- Michiyasu Fuga
- Department of Neurosurgery, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Toshihiro Ishibashi
- Department of Neurosurgery, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Ken Aoki
- Department of Neurosurgery, The Jikei University Katsushika Medical Center, Katsushika-ku, Tokyo, Japan
| | - Rintaro Tachi
- Department of Neurosurgery, The Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Koreaki Irie
- Department of Neurosurgery, Japanese Red Cross Medical Center, Shibuya, Tokyo, Japan
| | - Naoki Kato
- Department of Neurosurgery, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Issei Kan
- Department of Neurosurgery, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Shunsuke Hataoka
- Department of Neurosurgery, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Gota Nagayama
- Department of Neurosurgery, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Tohru Sano
- Department of Neurosurgery, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Toshihide Tanaka
- Department of Neurosurgery, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
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Tachi R, Fuga M, Tanaka T, Teshigawara A, Kajiwara I, Irie K, Ishibashi T, Hasegawa Y, Murayama Y. The white-collar sign after Neuroform Atlas stent-assisted coil embolization of unruptured intracranial aneurysms. Neuroradiol J 2024; 37:593-602. [PMID: 38549037 PMCID: PMC11444327 DOI: 10.1177/19714009241242657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2024] Open
Abstract
PURPOSE Although stent-assisted technique is expected to help provide a scaffold for neointima formation at the orifice of the aneurysm, not all aneurysms treated with stent-assisted technique develop complete neointima formation. The white-collar sign (WCS) indicates neointimal tissue formation at the aneurysm neck that prevents aneurysm recanalization. The aim of this study was to explore factors related to WCS appearance after stent-assisted coil embolization of unruptured intracranial aneurysms (UIAs). METHODS A total of 59 UIAs treated with a Neuroform Atlas stent were retrospectively analyzed. The WCS was identified on digital subtraction angiography (DSA) 1 year after coil embolization. The cohort was divided into WCS-positive and WCS-negative groups, and possible predictors of the WCS were explored using logistic regression analysis. RESULTS The WCS appeared in 20 aneurysms (33.9%). In the WCS-positive group, neck size was significantly smaller (4.2 (interquartile range (IQR): 3.8-4.6) versus 5.4 (IQR: 4.2-6.8) mm, p = .006), the VER was significantly higher (31.8% (IQR: 28.6%-38.4%) versus 27.6% (IQR: 23.6%-33.8%), p = .02), and the rate of RROC class 1 immediately after treatment was significantly higher (70% vs 20.5%, p < .001) than in the WCS-negative group. On multivariate analysis, neck size (odds ratio (OR): 0.542, 95% confidence interval (CI): 0.308-0.954; p = .03) and RROC class 1 immediately after treatment (OR: 6.99, 95% CI: 1.769-27.55; p = .006) were independent predictors of WCS appearance. CONCLUSIONS Smaller neck size and complete occlusion immediately after treatment were significant factors related to WCS appearance in stent-assisted coil embolization for UIAs using the Neuroform Atlas stent.
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Affiliation(s)
- Rintaro Tachi
- Department of Neurosurgery, The Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Michiyasu Fuga
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Toshihide Tanaka
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Akihiko Teshigawara
- Department of Neurosurgery, The Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Ikki Kajiwara
- Department of Neurosurgery, National Center for Global Health and Medicine, Kohnodai Hospital, Chiba, Japan
| | - Koreaki Irie
- Department of Neurosurgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Toshihiro Ishibashi
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuzuru Hasegawa
- Department of Neurosurgery, The Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
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Ozaki S, Imamura H, Niwa A, Tsutsui T, Yamada N, Ikedo T, Hamano E, Yamada K, Mori H, Iihara K, Kataoka H. Treatment Outcome of Flow Diverter Device for Medium-Sized Cerebral Aneurysms: A Single-Center Report. JOURNAL OF NEUROENDOVASCULAR THERAPY 2024; 18:231-239. [PMID: 39309174 PMCID: PMC11412774 DOI: 10.5797/jnet.oa.2024-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/24/2024] [Indexed: 09/25/2024]
Abstract
Objective Flow diverters (FDs), first introduced in Japan in 2015, were initially limited to wide-necked large cerebral aneurysms, which pose a high treatment risk. However, based on the results of the PREMIER study, the indications have expanded since 2020, and the number of treatment cases is increasing in Japan. At our hospital, FD placement with adjunctive coil embolization has been actively performed for medium-sized cerebral aneurysms, as indicated in the PREMIER study; herein, we report the outcomes of this treatment. Methods Of the 25 patients with 28 aneurysms who underwent FD placement at our institution between April 2022 and June 2023, 15 with 17 wide-necked unruptured cerebral aneurysms with a maximum diameter of <12 mm in the internal carotid artery (ICA) or vertebral artery (VA) were included. Postoperative complications were investigated in each case, and the aneurysm occlusion status was assessed using ultrashort echo time (UTE)-MRA at 3 months postoperatively and angiography at 6 months postoperatively. Fifteen patients who underwent coiling or stent-assisted coiling (SAC) for the same criteria during the same period were compared. Baseline characteristics and treatment results were compared between FD and coiling/SAC cases. Results Four males and 11 females with a mean age of 61.7 ± 12.8 years were included, and the median follow-up period was 9 months (6-18 months). There were 14 aneurysms of the ICA and 3 of the VA, and the mean maximum aneurysm diameter was 7.9 ± 1.7 mm. All patients were treated using the Pipeline Flex with Shield Technology (Medtronic, Minneapolis, MN, USA), and 14 aneurysms (82.4%) were treated with adjunctive coil embolization. There were no symptomatic strokes in the perioperative period; only one patient receiving corticosteroid therapy for thyroid eye disease had asymptomatic ICA occlusion at 3 months. Fifteen aneurysms (88.2%) were not visible on UTE-MRA at 3 months postoperatively, and angiography at 6 months showed complete occlusion in 16 (94.1%) aneurysms. The coiling/SAC group had a smaller neck size and higher volume embolization ratio than the FD group; however, complete occlusion was higher in the FD group. Conclusion FD placement with adjunctive coil embolization for medium-sized cerebral aneurysms is expected to result in good occlusion rates in the early postoperative period.
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Affiliation(s)
- Saya Ozaki
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hirotoshi Imamura
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Akihiro Niwa
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Taishi Tsutsui
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Naoto Yamada
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Taichi Ikedo
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Eika Hamano
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kiyofumi Yamada
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hisae Mori
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Koji Iihara
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hiroharu Kataoka
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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Ren X, Li H, Xu K, Li Z, Gao B, Lu W, Yang G, Wang Y, Yin Y, Chen T. Hemodynamic study on the therapeutic effects of varying diameter embolic coils in the treatment of intracranial aneurysms. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2024; 40:e3807. [PMID: 38281812 DOI: 10.1002/cnm.3807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/13/2023] [Accepted: 01/14/2024] [Indexed: 01/30/2024]
Abstract
Endovascular coiling is the predominant method for treating cerebral aneurysms. Extensive reports on selecting coil length, hardness, and material are available. However, the impact of coil diameter on postoperative outcomes remains unclear. This study enrolled six personalized geometric models of intracranial aneurysms: three bifurcation aneurysms and three sidewall aneurysms. Four coil models were constructed by changing the coil diameter. Coil embolization was simulated using the finite element method. Computational fluid dynamics was used to characterize hemodynamics in the aneurysms after embolization. Evaluation parameters included velocity reduction, wall shear stress (WSS), low WSS (LWSS), oscillatory shear index (OSI), relative residence time (RRT), and residual flow volume in the aneurysms. At the peak time (t = 0.17 s), the proportion of LWSS area in bifurcation aneurysms increase with the rise in coil diameter: 0.8D, 71.28 ± 12.62% versus 1D, 74.97 ± 19.17% versus 1.2D, 78.88 ± 18.56% versus 1.4D, 84.00 ± 11.53% (mean ± SD). The proportion of high OSI area decreases as the coil diameter increases: 0.8D, 4.41% ± 2.82% versus 1.0D, 3.78 ± 3.33% versus 1.2D, 2.28% ± 1.77% versus 1.4D, 1.58% ± 1.11% (mean ± SD). The proportion of high RRT area increases as the coil diameter rises: 0.8D, 3.40% ± 1.68% versus 1.0D, 7.67 ± 4.12% versus 1.2D, 9.84% ± 9.50% versus 1.4D, 22.29% ± 14.28% (mean ± SD). Side wall aneurysms do not exhibit the aforementioned trend. Bifurcation aneurysms plugged with a coil of 1.4 times the diameter have the largest RFVs (<10 mm/s) within the group. Aforementioned patterns are not found in sidewall aneurysms. In the treatment of aneurysms with coiling, varying coil diameters can result in different hemodynamic environments within the aneurysm. Larger coil diameters have improved hemodynamic performance for bifurcation aneurysms. However, coil diameter and embolization effectiveness have no significant relationship for sidewall aneurysms.
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Affiliation(s)
- Xiaoyu Ren
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Haoran Li
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Kaihang Xu
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Zhongkai Li
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Bin Gao
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Wangsheng Lu
- Union Strong (Beijing) Technology Co. Ltd., Beijing, China
| | - Guangming Yang
- Union Strong (Beijing) Technology Co. Ltd., Beijing, China
| | - Yunjie Wang
- Union Strong (Beijing) Technology Co. Ltd., Beijing, China
| | - Yin Yin
- Union Strong (Beijing) Technology Co. Ltd., Beijing, China
| | - Tao Chen
- Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
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Pettersson SD, Khorasanizadeh M, Maglinger B, Garcia A, Wang SJ, Taussky P, Ogilvy CS. Trends in the Age of Patients Treated for Unruptured Intracranial Aneurysms from 1990 to 2020. World Neurosurg 2023; 178:233-240.e13. [PMID: 37562685 DOI: 10.1016/j.wneu.2023.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND The decision for treatment for unruptured intracranial aneurysms (UIAs) is often difficult. Innovation in endovascular devices have improved the benefit-to-risk profile especially for elderly patients; however, the treatment guidelines from the past decade often recommend conservative management. It is unknown how these changes have affected the overall age of the patients selected for treatment. Herein, we aimed to study potential changes in the average age of the patients that are being treated over time. METHODS A systematic search of the literature was performed to identify all studies describing the age of the UIAs that were treated by any modality. Scatter diagrams with trend lines were used to plot the age of the patients treated over time and assess the presence of a potential significant trend via statistical correlation tests. RESULTS A total of 280 studies including 83,437 UIAs treated between 1987 and 2021 met all eligibility criteria and were entered in the analysis. Mean age of the patients was 55.5 years, and 70.7% were female. There was a significant increasing trend in the age of the treated patients over time (Spearman r: 0.250; P < 0.001), with a 1-year increase in the average age of the treated patients every 5 years since 1987. CONCLUSIONS The present study indicates that based on the treated UIA patient data published in the literature, older UIAs are being treated over time. This trend is likely driven by safer treatments while suggesting that re-evaluation of certain UIA treatment decision scores may be of great interest.
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Affiliation(s)
- Samuel D Pettersson
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - MirHojjat Khorasanizadeh
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Benton Maglinger
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Alfonso Garcia
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - S Jennifer Wang
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Philipp Taussky
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher S Ogilvy
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
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