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Rajendran K, Madhavan AA. Optimizing Photon-Counting Detector CT for Imaging Intracranial Aneurysms. AJNR Am J Neuroradiol 2024:ajnr.A8400. [PMID: 39122465 DOI: 10.3174/ajnr.a8400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2024]
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Otgonbaatar C, Kim H, Jeon PH, Jeon SH, Cha SJ, Ryu JK, Jung WB, Shim H, Ko SM, Kim JW. A preliminary study of super-resolution deep learning reconstruction with cardiac option for evaluation of endovascular-treated intracranial aneurysms. Br J Radiol 2024; 97:1492-1500. [PMID: 38917414 PMCID: PMC11256923 DOI: 10.1093/bjr/tqae117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 04/22/2024] [Accepted: 06/06/2024] [Indexed: 06/27/2024] Open
Abstract
OBJECTIVES To investigate the usefulness of super-resolution deep learning reconstruction (SR-DLR) with cardiac option in the assessment of image quality in patients with stent-assisted coil embolization, coil embolization, and flow-diverting stent placement compared with other image reconstructions. METHODS This single-centre retrospective study included 50 patients (mean age, 59 years; range, 44-81 years; 13 men) who were treated with stent-assisted coil embolization, coil embolization, and flow-diverting stent placement between January and July 2023. The images were reconstructed using filtered back projection (FBP), hybrid iterative reconstruction (IR), and SR-DLR. The objective image analysis included image noise in the Hounsfield unit (HU), signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and full width at half maximum (FWHM). Subjectively, two radiologists evaluated the overall image quality for the visualization of the flow-diverting stent, coil, and stent. RESULTS The image noise in HU in SR-DLR was 6.99 ± 1.49, which was significantly lower than that in images reconstructed with FBP (12.32 ± 3.01) and hybrid IR (8.63 ± 2.12) (P < .001). Both the mean SNR and CNR were significantly higher in SR-DLR than in FBP and hybrid IR (P < .001 and P < .001). The FWHMs for the stent (P < .004), flow-diverting stent (P < .001), and coil (P < .001) were significantly lower in SR-DLR than in FBP and hybrid IR. The subjective visual scores were significantly higher in SR-DLR than in other image reconstructions (P < .001). CONCLUSIONS SR-DLR with cardiac option is useful for follow-up imaging in stent-assisted coil embolization and flow-diverting stent placement in terms of lower image noise, higher SNR and CNR, superior subjective image analysis, and less blooming artifact than other image reconstructions. ADVANCES IN KNOWLEDGE SR-DLR with cardiac option allows better visualization of the peripheral and smaller cerebral arteries. SR-DLR with cardiac option can be beneficial for CT imaging of stent-assisted coil embolization and flow-diverting stent.
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Affiliation(s)
- Chuluunbaatar Otgonbaatar
- Department of Radiology, College of Medicine, Seoul National University, Seoul, 03080, Republic of Korea
- Medical Imaging AI Research Center, Canon Medical Systems Korea, Seoul, 06173, Republic of Korea
| | - Hyunjung Kim
- Department of Radiology, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University of Korea, Wonju 26426, Republic of Korea
| | - Pil-Hyun Jeon
- Department of Radiology, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University of Korea, Wonju 26426, Republic of Korea
| | - Sang-Hyun Jeon
- Department of Radiology, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University of Korea, Wonju 26426, Republic of Korea
| | - Sung-Jin Cha
- Department of Radiology, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University of Korea, Wonju 26426, Republic of Korea
| | - Jae-Kyun Ryu
- Medical Imaging AI Research Center, Canon Medical Systems Korea, Seoul, 06173, Republic of Korea
| | - Won Beom Jung
- Korea Brain Research Institute (KBRI), Daegu, 41062, Republic of Korea
| | - Hackjoon Shim
- Medical Imaging AI Research Center, Canon Medical Systems Korea, Seoul, 06173, Republic of Korea
- ConnectAI Research Center, Yonsei University College of Medicine, Seoul, 03772, Republic of Korea
| | - Sung Min Ko
- Department of Radiology, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University of Korea, Wonju 26426, Republic of Korea
| | - Jin Woo Kim
- Department of Radiology, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University of Korea, Wonju 26426, Republic of Korea
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Kaur H, Yuki I, Shimizu T, Paganini-Hill A, Xu J, Golshani K, Hsu FPK, Nguyen T, Jin CM, Suzuki S. Follow-up care compliance among patients diagnosed with unruptured intracranial aneurysms. J Stroke Cerebrovasc Dis 2024; 33:107786. [PMID: 38782166 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107786] [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: 11/30/2023] [Revised: 05/09/2024] [Accepted: 05/20/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVES Periodic imaging follow-up for patients with unruptured intracranial aneurysms (UIA) is crucial, as studies indicate higher rupture risk with aneurysm growth. However, few studies address patient adherence to follow-up recommendations. This study aims to identify compliance rates and factors influencing follow-up adherence. METHODS Patients with a UIA were identified from our institution's database from 2011-2021. Follow-up imaging (CT/MR Angiogram) was advised at specific intervals. Patients were categorized into compliant and non-compliant groups based on first-year compliance. Factors contributing to compliance were assessed through multivariate logistic regression. Phone interviews were conducted with non-compliant patients to understand reasons for non-adherence. RESULTS Among 923 UIA diagnosed patients, 337 were randomly selected for analysis. The median follow-up period was 1.4 years, with a 42% first-year compliance rate. The mean aneurysm size was 3.3 mm. Five patients had a rupture during follow-up, of which 4 died. Compared with patients consulting specialists at the initial diagnosis, those seen by non-specialists exhibited lower compliance (OR 0.25, p < 0.001). Loss to follow-up was greatest during transition from emergency service to specialist appointments. Patients who spoke languages other than English exhibited poorer compliance than those speaking English (OR 0.20, p = 0.01). CONCLUSIONS Significant amounts of UIA patients at low rupture risk were lost to follow-up before seeing UIA specialists. Main non-compliance factors include inadequate comprehension of follow-up instructions, poor care transfer from non-specialists to specialist, and insurance barriers.
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Affiliation(s)
- Hemdeep Kaur
- Department of Neurosurgery, University of California, Irvine, CA, United States
| | - Ichiro Yuki
- Department of Neurosurgery, University of California, Irvine, CA, United States.
| | - Timothy Shimizu
- Department of Neurosurgery, University of California, Irvine, CA, United States
| | | | - Jordan Xu
- Department of Neurosurgery, University of California, Irvine, CA, United States
| | - Kiarash Golshani
- Department of Neurosurgery, University of California, Irvine, CA, United States
| | - Frank P K Hsu
- Department of Neurosurgery, University of California, Irvine, CA, United States
| | - Tracy Nguyen
- Department of Neurosurgery, University of California, Irvine, CA, United States
| | - Chloe M Jin
- Department of Neurosurgery, University of California, Irvine, CA, United States
| | - Shuichi Suzuki
- Department of Neurosurgery, University of California, Irvine, CA, United States
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Morishita M, Takada H, Yamazaki T, Moriwaki H, Senoo M, Nishiya M. Anterior inferior cerebellar artery aneurysm with proximal parent artery stenosis: A case report. Radiol Case Rep 2024; 19:974-977. [PMID: 38204933 PMCID: PMC10776914 DOI: 10.1016/j.radcr.2023.11.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/23/2023] [Accepted: 11/30/2023] [Indexed: 01/12/2024] Open
Abstract
Hemodynamic factors are associated with the progression of cerebral aneurysms. We report a 78-year-old woman with an anterior inferior cerebellar artery aneurysm and proximal stenosis of the anterior inferior cerebellar and basilar arteries. The aneurysm exhibited growth on annual follow-up imaging. Aneurysmal rupture occurred 4 years after diagnosis. Coil embolization resulted in aneurysm occlusion with parent artery preservation. Aneurysms adjacent to a more proximal region of severe stenosis in the parent vessel should be considered at high risk for growth or rupture. Such aneurysms require careful monitoring. Particular attention should be paid to posterior circulation aneurysms that occur at anatomically vulnerable sites.
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Affiliation(s)
- Masahiro Morishita
- Department of Neurosurgery, Hakodate Neurosurgical Hospital, Hakodate, Hokkaido, Japan
| | - Hidekazu Takada
- Department of Neurosurgery, Hakodate Neurosurgical Hospital, Hakodate, Hokkaido, Japan
| | - Takaaki Yamazaki
- Department of Neurosurgery, Hakodate Neurosurgical Hospital, Hakodate, Hokkaido, Japan
| | - Hiroshi Moriwaki
- Department of Neurosurgery, Hakodate Neurosurgical Hospital, Hakodate, Hokkaido, Japan
| | - Makoto Senoo
- Department of Neurosurgery, Hakodate Neurosurgical Hospital, Hakodate, Hokkaido, Japan
| | - Mikio Nishiya
- Department of Neurosurgery, Hakodate Neurosurgical Hospital, Hakodate, Hokkaido, Japan
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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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Yan Y, Kaderali Z, Chowdhury T, Shankar J. Feasibility of intraoperative MRI for endovascular coiling of intracranial aneurysms: A single centre experience. Interv Neuroradiol 2023; 29:520-524. [PMID: 35538892 PMCID: PMC10549709 DOI: 10.1177/15910199221100962] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/24/2022] [Accepted: 04/27/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Intraoperative magnetic resonance imaging system (iMRIS) surgical theatre is a highly integrated operating room with an intraoperative magnetic resonance imaging (iMRI) designed originally for brain tumour surgery. Its use in neurointerventional procedures, particularly in the setting of endovascular coiling of intracranial aneurysms, has not been discussed in the literature to date. We present our initial experience about the safety and feasibility of iMRI to assess post operative complications and provide baseline imaging post coiling of intracranial aneurysms. METHODS Consecutive patients who underwent iMRI between 2015 and 2018 were included in the study. Demographic, clinical details, endovascular technique and surgical outcomes were collected. Details of anesthesia during the procedure were also collected. RESULTS Fifteen patients underwent iMRI with MRA to assess post coiling status of their elective endovascular coiling of intracranial aneurysms. The mean age in this cohort was 61 years and 46.7% were male. No immediate complications were seen either from the endovascular procedures or from the iMRI. All iMRI scans were performed as planned with no aborted or truncated scans. The image quality of the iMRI/MRA was adequate to detect the residual aneurysm, if present. There was no residual aneurysm on the angiogram that were not detected on the iMRIs. Of the 15 patients, 10 were safely discharged the following day and other 5 were discharged 2 days after their surgery. CONCLUSIONS The iMRI is an advantageous tool which can be integrated into neurointerventional workflow resulting in early post peri-procedural feedback and potentially reduced post-operative hospital stay.
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Affiliation(s)
- Yi Yan
- Rady Faculty of Health Sciences, Radiology Department, University of Manitoba, Winnipeg, MB, Canada
| | - Zul Kaderali
- Section of Neurosurgery, Health Sciences Centre, University of Manitoba, Winnipeg, MB, Canada
| | - Tumul Chowdhury
- Rady Faculty of Health Sciences, Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Jai Shankar
- Rady Faculty of Health Sciences, Radiology Department, University of Manitoba, Winnipeg, MB, Canada
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Fillingham P, Romero Bhathal J, Marsh LMM, Barbour MC, Kurt M, Ionita CN, Davies JM, Aliseda A, Levitt MR. Improving the accuracy of computational fluid dynamics simulations of coiled cerebral aneurysms using finite element modeling. J Biomech 2023; 157:111733. [PMID: 37527606 PMCID: PMC10528313 DOI: 10.1016/j.jbiomech.2023.111733] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/26/2023] [Accepted: 07/18/2023] [Indexed: 08/03/2023]
Abstract
Cerebral aneurysms are a serious clinical challenge, with ∼half resulting in death or disability. Treatment via endovascular coiling significantly reduces the chances of rupture, but the techniquehas failure rates of ∼20 %. This presents a pressing need to develop a method fordetermining optimal coildeploymentstrategies. Quantification of the hemodynamics of coiled aneurysms using computational fluid dynamics (CFD) has the potential to predict post-treatment outcomes, but representing the coil mass in CFD simulations remains a challenge. We use the Finite Element Method (FEM) for simulating patient-specific coil deployment for n = 4 ICA aneurysms for which 3D printed in vitro models were also generated, coiled, and scanned using ultra-high resolution synchrotron micro-CT. The physical and virtual coil geometries were voxelized onto a binary structured grid and porosity maps were generated for geometric comparison. The average binary accuracy score is 0.8623 and the average error in porosity map is 4.94 %. We then conduct patient-specific CFD simulations of the aneurysm hemodynamics using virtual coils geometries, micro-CT generated oil geometries, and using the porous medium method to represent the coil mass. Hemodynamic parameters including Neck Inflow Rate (Qneck) and Wall Shear Stress (WSS) were calculated for each of the CFD simulations. The average relative error in Qneck and WSS from CFD using FEM geometry were 6.6 % and 21.8 % respectively, while the error from CFD using a porous media approximation resulted in errors of 55.1 % and 36.3 % respectively; demonstrating a marked improvement in the accuracy of CFD simulations using FEM generated coil geometries.
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Affiliation(s)
- Patrick Fillingham
- Department of Neurological Surgery, University of Washington, Seattle, WA, United States.
| | | | - Laurel M M Marsh
- Department of Mechanical Engineering, University of Washington, Seattle, WA, United States
| | - Michael C Barbour
- Department of Mechanical Engineering, University of Washington, Seattle, WA, United States
| | - Mehmet Kurt
- Department of Mechanical Engineering, University of Washington, Seattle, WA, United States
| | - Ciprian N Ionita
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY, United States
| | - Jason M Davies
- Department of Neurosurgery, University at Buffalo, Buffalo, NY, United States
| | - Alberto Aliseda
- Department of Mechanical Engineering, University of Washington, Seattle, WA, United States
| | - Michael R Levitt
- Department of Neurological Surgery, University of Washington, Seattle, WA, United States; Department of Mechanical Engineering, University of Washington, Seattle, WA, United States; Department of Radiology, University of Washington, Seattle, WA, United States
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Oliver AA, Koons EK, Trester PS, Kleinow JE, Jonsgaard RS, Vercnocke AJ, Bilgin C, Kadirvel R, Leng S, Lu A, Dragomir-Daescu D, Kallmes DF. Medical Imaging Compatibility of Magnesium- and Iron-Based Bioresorbable Flow Diverters. AJNR Am J Neuroradiol 2023; 44:668-674. [PMID: 37169543 PMCID: PMC10249688 DOI: 10.3174/ajnr.a7873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/16/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND AND PURPOSE Bioresorbable flow diverters are under development to mitigate complications associated with conventional flow-diverter technology. One proposed advantage is the ability to reduce metal-induced artifacts in follow-up medical imaging. In the current work, the medical imaging compatibility of magnesium- and iron-based bioresorbable flow diverters is assessed relative to an FDA-approved control in phantom models. MATERIALS AND METHODS Bioresorbable flow diverters, primarily composed of braided magnesium or antiferromagnetic iron alloy wires, were compared with an FDA-approved control flow diverter. The devices were assessed for MR imaging safety in terms of magnetically induced force and radiofrequency heating using 1.5T, 3T, and 7T field strength clinical scanners. The devices were deployed in phantom models, and metal-induced image artifacts were assessed in the 3 MR imaging scanners and a clinical CT scanner following clinical scan protocols; device visibility was assessed under fluoroscopy. RESULTS The magnesium-based bioresorbable flow diverter, iron-based bioresorbable flow diverter, and the control device all demonstrated MR imaging safety in terms of magnetically induced force and radiofrequency heating at all 3 field strengths. The bioresorbable flow diverters did not elicit excessive MR imaging artifacts at any field strength relative to the control. Furthermore, the bioresorbable flow diverters appeared to reduce blooming artifacts in CT relative to the control. The iron-based bioresorbable flow diverter and control device were visible under standard fluoroscopy. CONCLUSIONS We have demonstrated the baseline medical imaging compatibility of magnesium and antiferromagnetic iron alloy bioresorbable flow diverters. Future work will evaluate the medical imaging characteristics of the bioresorbable flow diverters in large-animal models.
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Affiliation(s)
- A A Oliver
- From the Department of Biomedical Engineering and Physiology (A.A.O., E.K.K., S.L., D.D.-D, D.F.K.), Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota
- Departments of Radiology (A.A.O., E.K.K., P.S.T., J.E.K., R.S.J., A.J.V., C.B., R.K. S.L., A.L., D.F.K.)
- Physiology and Biomedical Engineering (A.A.O., D.D.-D.)
| | - E K Koons
- From the Department of Biomedical Engineering and Physiology (A.A.O., E.K.K., S.L., D.D.-D, D.F.K.), Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota
- Departments of Radiology (A.A.O., E.K.K., P.S.T., J.E.K., R.S.J., A.J.V., C.B., R.K. S.L., A.L., D.F.K.)
| | - P S Trester
- Departments of Radiology (A.A.O., E.K.K., P.S.T., J.E.K., R.S.J., A.J.V., C.B., R.K. S.L., A.L., D.F.K.)
| | - J E Kleinow
- Departments of Radiology (A.A.O., E.K.K., P.S.T., J.E.K., R.S.J., A.J.V., C.B., R.K. S.L., A.L., D.F.K.)
| | - R S Jonsgaard
- Departments of Radiology (A.A.O., E.K.K., P.S.T., J.E.K., R.S.J., A.J.V., C.B., R.K. S.L., A.L., D.F.K.)
| | - A J Vercnocke
- Departments of Radiology (A.A.O., E.K.K., P.S.T., J.E.K., R.S.J., A.J.V., C.B., R.K. S.L., A.L., D.F.K.)
| | - C Bilgin
- Departments of Radiology (A.A.O., E.K.K., P.S.T., J.E.K., R.S.J., A.J.V., C.B., R.K. S.L., A.L., D.F.K.)
| | - R Kadirvel
- Departments of Radiology (A.A.O., E.K.K., P.S.T., J.E.K., R.S.J., A.J.V., C.B., R.K. S.L., A.L., D.F.K.)
- Neurosurgery (R.K.), Mayo Clinic, Rochester, Minnesota
| | - S Leng
- From the Department of Biomedical Engineering and Physiology (A.A.O., E.K.K., S.L., D.D.-D, D.F.K.), Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota
- Departments of Radiology (A.A.O., E.K.K., P.S.T., J.E.K., R.S.J., A.J.V., C.B., R.K. S.L., A.L., D.F.K.)
| | - A Lu
- Departments of Radiology (A.A.O., E.K.K., P.S.T., J.E.K., R.S.J., A.J.V., C.B., R.K. S.L., A.L., D.F.K.)
| | - D Dragomir-Daescu
- From the Department of Biomedical Engineering and Physiology (A.A.O., E.K.K., S.L., D.D.-D, D.F.K.), Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota
- Physiology and Biomedical Engineering (A.A.O., D.D.-D.)
| | - D F Kallmes
- From the Department of Biomedical Engineering and Physiology (A.A.O., E.K.K., S.L., D.D.-D, D.F.K.), Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota
- Departments of Radiology (A.A.O., E.K.K., P.S.T., J.E.K., R.S.J., A.J.V., C.B., R.K. S.L., A.L., D.F.K.)
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9
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Hannan CJ, Islim AI, Alalade AF, Bacon A, Ghosh A, Dalton A, Abouharb A, Walsh DC, Bulters D, White E, Chavredakis E, Kounin G, Critchley G, Dow G, Patel HC, Brydon H, Anderson IA, Fouyas I, Galea J, St George J, Bal J, Patel K, Kamel M, Teo M, Fanning N, Mukerji N, Grover P, Mitchell P, Whitfield PC, Trivedi R, Crockett MT, Brennan P, Javadpour M. Radiological follow-up of endovascularly treated intracranial aneurysms: a survey of current practice in the UK and Ireland. Acta Neurochir (Wien) 2023; 165:451-459. [PMID: 36220949 DOI: 10.1007/s00701-022-05379-4] [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: 09/05/2022] [Accepted: 09/27/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Due to the risk of intracranial aneurysm (IA) recurrence and the potential requirement for re-treatment following endovascular treatment (EVT), radiological follow-up of these aneurysms is necessary. There is little evidence to guide the duration and frequency of this follow-up. The aim of this study was to establish the current practice in neurosurgical units in the UK and Ireland. METHODS A survey was designed with input from interventional neuroradiologists and neurosurgeons. Neurovascular consultants in each of the 30 neurosurgical units providing a neurovascular service in the UK and Ireland were contacted and asked to respond to questions regarding the follow-up practice for IA treated with EVT in their department. RESULTS Responses were obtained from 28/30 (94%) of departments. There was evidence of wide variations in the duration and frequency of follow-up, with a minimum follow-up duration for ruptured IA that varied from 18 months in 5/28 (18%) units to 5 years in 11/28 (39%) of units. Young patient age, previous subarachnoid haemorrhage and incomplete IA occlusion were cited as factors that would prompt more intensive surveillance, although larger and broad-necked IA were not followed-up more closely in the majority of departments. CONCLUSIONS There is a wide variation in the radiological follow-up of IA treated with EVT in the UK and Ireland. Further standardisation of this aspect of patient care is likely to be beneficial, but further evidence on the behaviour of IA following EVT is required in order to inform this process.
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Affiliation(s)
| | | | | | - Andrew Bacon
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, UK
| | - Anthony Ghosh
- Department of Neurosurgery, Queen's Hospital Romford, Romford, UK
| | - Arthur Dalton
- Department of Neurosurgery, Charing Cross Hospital, London, UK
| | - Ashraf Abouharb
- Department of Neurosurgery, Royal Victoria Hospital, Belfast, UK
| | | | - Diederik Bulters
- Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton, Southampton, UK
| | - Edward White
- Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, UK
| | - Emmanouil Chavredakis
- Department of Neurosurgery, The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - George Kounin
- Department of Neurosurgery, Hull Royal Infirmary, Hull, UK
| | - Giles Critchley
- Department of Neurosurgery, University Hospitals Sussex, Brighton, UK
| | - Graham Dow
- Department of Neurosurgery, Queen's Medical Centre, Nottingham, UK
| | - Hiren C Patel
- Manchester Centre for Clinical Neurosciences, Manchester, UK
| | - Howard Brydon
- Department of Neurosurgery, Royal Stoke University Hospital, Stoke, UK
| | - Ian A Anderson
- Department of Neurosurgery, Leeds General Infirmary, Leeds, UK
| | - Ioannis Fouyas
- Department of Neurosurgery, Western General Hospital, Edinburgh, UK
| | - James Galea
- Department of Neurosurgery, University Hospital Wales, Cardiff, UK
| | - Jerome St George
- Department of Neurosurgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Jarnail Bal
- Department of Neurosurgery, Royal London Hospital, London, UK
| | - Krunal Patel
- Department of Neurosurgery, University Hospital Coventry, Coventry, UK
| | - Mahmoud Kamel
- Department of Neurosurgery, Cork University Hospital, Cork, Ireland
| | - Mario Teo
- Department of Neurosurgery, Southmead Hospital, Bristol, UK
| | - Noel Fanning
- Department of Neurosurgery, Cork University Hospital, Cork, Ireland
| | - Nitin Mukerji
- Department of Neurosurgery, James Cook University Hospital, Middlesbrough, UK
| | - Patrick Grover
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Patrick Mitchell
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle, UK
| | - Peter C Whitfield
- South West Neurosurgery Centre, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Rikin Trivedi
- Department of Neurosurgery, Addenbrookes Hospital, Cambridge, UK
| | | | - Paul Brennan
- Department of Neuroradiology, Beaumont Hospital, Dublin, Ireland
| | - Mohsen Javadpour
- Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
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10
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Morrish R, Corcoran R, Cooke J, Eesa M, Wong JH, Mitha AP. Fluoroscopy, CT, and MR imaging characteristics of a novel primarily bioresorbable flow-diverting stent for aneurysms. Interv Neuroradiol 2022; 28:660-667. [PMID: 34787481 PMCID: PMC9706267 DOI: 10.1177/15910199211060979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 09/18/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Five to ten percent of the global population have unruptured intracranial aneurysms, and ruptured brain aneurysms cause approximately 500,000 deaths a year. Flow-diverting stent treatment is a less invasive intracranial aneurysm treatment that induces aneurysm thrombosis. The imaging characteristics of a novel primarily bioresorbable flow-diverting stent (BFDS) are assessed in comparison to the leading metal stent using fluoroscopy, CT, and MRI. METHODS X-ray/fluoroscopic images of stents were taken using a human cadaveric skull model. CT and MRI were acquired using silicone flow models of residual aneurysms. Images were analyzed with Likert scales in anonymous surveys by neurointerventionalists. Quantitative measurements of radiographic density (CT) and artifact boundary size (CT & MRI) were also obtained. RESULTS Visibility of the BFDS on X-ray was less than the metal stent but deemed adequate for deployment and intraprocedural assessment. The metal stent was more radiopaque than the BFDS on CT, but qualitative assessment was not significantly different for the two stents. MRI imaging was significantly better using the BFDS in terms of overall artifact and intraluminal assessment. CONCLUSIONS The BFDS has adequate visualization on X-ray/fluoroscopy and should be clinically acceptable for fluoroscopic deployment. On MRI, there is less quantitative artifact as well as overall improved qualitative assessment that will allow for more detailed non-invasive imaging follow-up of treated aneurysms, potentially reducing the need for digital subtraction catheter angiography.
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Affiliation(s)
- Rosalie Morrish
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | | | | | - Muneer Eesa
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - John H Wong
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Alim P Mitha
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
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11
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Mizuno H, Aihara M, Sato K, Negishi C, Sasaguchi N, Kurihara H, Yoshimoto Y. Usefulness of 3D T1-Turbo Spin Echo Imaging for the Evaluation of Intracranial Stent Placement. JOURNAL OF NEUROENDOVASCULAR THERAPY 2022; 17:1-7. [PMID: 37501886 PMCID: PMC10370516 DOI: 10.5797/jnet.oa.2022-0039] [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: 06/22/2022] [Accepted: 09/15/2022] [Indexed: 07/29/2023]
Abstract
Objective Evaluation of intracranial stent placement by MRI suffers the problems of signal artifacts during time-of-flight MRA (TOF-MRA). Therefore, angiographic examination is required for detailed intravascular assessment of the stent placement site. Recently, 3D T1-turbo spin echo (3D-TSE) has been developed for evaluation of carotid artery stent placement. We investigated the use of the 3D-TSE imaging method for the evaluation of intracranial vascular stent placement. Methods The subjects consisted of nine patients who underwent intracranial vascular stent placement between April 2015 and December 2019. Postoperatively, the lumens of the placed stents were measured by TOF-MRA, DSA, and 3D-TSE imaging. Analysis was performed by type of stent and placement site. Results The stents used were Neuroform Atlas (3 patients), LVIS (3 patients), LVIS Jr (2 patients), and Integrity (1 patient). TOF-MRA of the stent placement site showed defects in the image or poor visualization in all nine patients, whereas 3D-TSE imaging visualized the lumen at the stent indwelling site in all patients. The blood vessel diameter measured by the DSA and 3D-TSE imaging exhibited positive correlations regardless of the stent type and placement site. Conclusion 3D-TSE imaging allows visualization of the lumen of the site of an intracranial vascular stent, regardless of the type of stent or the vessel. Thus, this method may be useful for evaluating the vascular lumen of a lesion.
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Affiliation(s)
- Hiroyuki Mizuno
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Masanori Aihara
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Koji Sato
- Department of Neurosurgery, National Hospital Organization Takasaki General Medical Center, Takasaki, Gunma, Japan
| | - Chikashi Negishi
- Department of Radiation Diagnosis, National Hospital Organization Takasaki General Medical Center, Takasaki, Gunma, Japan
| | - Nobuo Sasaguchi
- Department of Neurosurgery, National Hospital Organization Takasaki General Medical Center, Takasaki, Gunma, Japan
| | - Hideyuki Kurihara
- Department of Neurosurgery, National Hospital Organization Takasaki General Medical Center, Takasaki, Gunma, Japan
| | - Yuhei Yoshimoto
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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12
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Necarsulmer J, Reed S, Arhin M, Shastri D, Quig N, Yap E, Ho J, Sasaki-Adams D. Cumulative Radiation Exposure in Aneurysmal Subarachnoid Hemorrhage: A Single-Institution Analysis. World Neurosurg 2022; 165:e432-e437. [PMID: 35738532 DOI: 10.1016/j.wneu.2022.06.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Diagnosis and management of aneurysmal subarachnoid hemorrhage (aSAH) depend heavily on imaging modalities that repeatedly expose patients to ionizing radiation. There is limited literature on cumulative radiation exposure in this patient population, which is a problem compounded by wide variation among institutions. The present study quantifies the cumulative cranial exposure to ionizing radiation resulting from diagnostic medical imaging and medical procedures during initial hospitalization for ruptured aSAH at a single academic institution and estimates the risk of future adverse events related to radiation injury. METHODS We performed a retrospective observational study of adults who presented to our institution during a nearly 3-year period with acute-onset aSAH, which was confirmed with diagnostic imaging, and had the aneurysm treated with either surgical clip ligation or endovascular embolization. RESULTS A total of 131 patients met the inclusion criteria. Eighty-eight patients (67%) were treated with endovascular embolization and 43 (32%) were treated with clip ligation. We found the average radiation dose to the head during the incident hospitalization for aSAH to be 4.40 Gy (95% confidence interval, 3.91-4.89). Angiography and interventional radiology procedures accounted for most of this exposure. CONCLUSIONS Most patients were exposed to levels of ionizing radiation that put them at considerable risk of deterministic radiation injury. Providers should be aware of the potential consequences of acute and long-term radiation exposure in this patient population, so they can monitor and counsel individuals accordingly and take steps to safely limit radiation exposure during aSAH management.
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Affiliation(s)
- Julie Necarsulmer
- Department of Neurosurgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA; Department of Neurology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Samuel Reed
- Department of Neurosurgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Martin Arhin
- Department of Neurosurgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Darshan Shastri
- Department of Neurosurgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Nathan Quig
- Department of Neurosurgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Edward Yap
- Department of Neurosurgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - James Ho
- Department of Neurology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA; Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Deanna Sasaki-Adams
- Department of Neurosurgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA.
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13
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Kim TH, Ko JH, Chung J. Angiographic Follow-Up for Small Ruptured Intracranial Aneurysm Treated by Endovascular Treatment : Follow-Up Plan and Long-Term Follow-Up Results. J Korean Neurosurg Soc 2022; 65:710-718. [PMID: 36000212 PMCID: PMC9452379 DOI: 10.3340/jkns.2022.0088] [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: 04/23/2022] [Accepted: 06/28/2022] [Indexed: 11/27/2022] Open
Abstract
Objective Although endovascular treatment for intracranial aneurysms is considered effective and safe, its durability is still debated. Also, few studies have described angiographic follow-up plan after endovascular treatment of intracranial aneurysm, especially in ruptured cases. Hence, we report the long-term results of follow-up angiography protocol.
Methods Radiological records of 639 cases of coil embolization with ruptured aneurysms from March 2003 to December 2016 were retrospectively reviewed. Patients who received treatment of a saccular aneurysm less than 7 mm resulted with near complete occlusion were included. Two hundred thirty-eight aneuryms which received the follow-up angiography at least once were enrolled. We classified four periods of follow-up as follows : post-treatment 1 year (defined as the first period), from 1 to 2 years (the second period), 2 to 5 years (the third period), and over 5 years (long-term).
Results We identified 14 cases (6.4%) of recurrence from 218 aneurysms in follow-up angiography in the first period. Among 143 aneurysms in the second period, five cases (3.5%) of recurrence were identified. There were no findings suspicious of recanalization in 97 patients in the third period. Of the total 238 cases, there were 19 recurrences, for a recurrence rate of 8.0%. Six (31.6%) out of 19 recurrences showed a tendency toward repeat recurrences even after additional treatment. Twenty-eight received long-term follow-up over 5 years and there was no recurrence.
Conclusion Most of the recurrence were found during the first and the second year. We suggest that at least one digital subtraction angiography examination may be necessary around post-treatment 2 years, especially in ruptured cases. If the angiographic results are favorable at 2 years post-treatment, long-term result should be favorable.
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Affiliation(s)
- Tae Hyung Kim
- Department of Neurosurgery, Dankook University Hospital, Cheonan, Korea
| | - Jung Ho Ko
- Department of Neurosurgery, College of Medicine, Dankook University, Cheonan, Korea
| | - Jaewoo Chung
- Department of Neurosurgery, College of Medicine, Dankook University, Cheonan, Korea
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14
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Wang LL, Mahammedi A, Vagal AS. Imaging of Headache Attributed to Vascular Disorders. Neurol Clin 2022; 40:507-530. [PMID: 35871782 DOI: 10.1016/j.ncl.2022.02.004] [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: 11/19/2022]
Abstract
Imaging is essential in the diagnosis of vascular causes of headaches. With advances in technology, there are increasing options of imaging modalities to choose from, each with its own advantages and disadvantages. This article will focus on imaging pearls and pitfalls of vascular causes of headaches. These include aneurysms, vasculitides, vascular malformations, and cerebral venous thrombosis.
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Affiliation(s)
- Lily L Wang
- Department of Radiology, University of Cincinnati, University of Cincinnati Medical Center, 234 Goodman Street, Cincinnati, OH 45219, USA.
| | - Abdelkader Mahammedi
- Department of Radiology, University of Cincinnati, University of Cincinnati Medical Center, 234 Goodman Street, Cincinnati, OH 45219, USA
| | - Achala S Vagal
- Department of Radiology, University of Cincinnati, University of Cincinnati Medical Center, 234 Goodman Street, Cincinnati, OH 45219, USA
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15
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Shahrouki P, Gupta R, Belani P, Chien A, Doshi AH, De Leacy R, Fifi JT, Mocco J, Nael K. Differential Subsampling with Cartesian Ordering-MRA for Classifying Residual Treated Aneurysms. AJNR Am J Neuroradiol 2022; 43:887-892. [PMID: 35672082 DOI: 10.3174/ajnr.a7532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 04/14/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Differential Subsampling with Cartesian Ordering (DISCO), an ultrafast high-spatial-resolution head MRA, has been introduced. We aimed to determine the diagnostic performance of DISCO-MRA in grading residual aneurysm in comparison with TOF-MRA in patients with treated intracranial aneurysms. MATERIALS AND METHODS Patients with endovascular treatment and having undergone DISCO-MRA, TOF-MRA, and DSA were included for review. The voxel size and acquisition time were 0.75 × 0.75 × 1 mm3/6 seconds for DISCO-MRA and 0.6 × 0.6 × 1 mm3/6 minutes for TOF-MRA. Residual aneurysms were determined using the Modified Raymond-Roy Classification on TOF-MRA and DISCO-MRA by 2 neuroradiologists independently and were compared against DSA as the reference standard. Statistical analysis was performed using the κ statistic and the χ2 test. RESULTS Sixty-eight treated intracranial aneurysms were included. The intermodality agreement was κ = 0.82 (95% CI, 0.67-0.97) between DISCO and DSA and 0.44 (95% CI, 0.28-0.61) between TOF and DSA. Modified Raymond-Roy Classification scores matched DSA scores in 60/68 cases (88%; χ2 = 144.4, P < .001 for DISCO and 46/68 cases (68%; χ2 = 65.0, P < .001) for TOF. The diagnostic accuracy for the detection of aneurysm remnants was higher for DISCO (0.96; 95% CI, 0.88-0.99) than for TOF (0.79; 95% CI, 0.68-0.88). CONCLUSIONS In patients with endovascularly treated intracranial aneurysms, DISCO-MRA provides superior diagnostic performance in comparison with TOF-MRA in delineating residual aneurysms in a fraction of the time.
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Affiliation(s)
- P Shahrouki
- From the Department of Radiological Sciences (P.S., A.C., K.N.), University of California Los Angeles, Los Angeles, California
| | - R Gupta
- Department of Radiology (R.G., P.B., A.D., K.N.), Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
| | - P Belani
- Department of Radiology (R.G., P.B., A.D., K.N.), Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
| | - A Chien
- From the Department of Radiological Sciences (P.S., A.C., K.N.), University of California Los Angeles, Los Angeles, California
| | - A H Doshi
- Department of Radiology (R.G., P.B., A.D., K.N.), Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
| | - R De Leacy
- Department of Neurosurgery (R.D.L., J,F., J.M.), Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
| | - J T Fifi
- Department of Neurosurgery (R.D.L., J,F., J.M.), Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
| | - J Mocco
- Department of Neurosurgery (R.D.L., J,F., J.M.), Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
| | - K Nael
- From the Department of Radiological Sciences (P.S., A.C., K.N.), University of California Los Angeles, Los Angeles, California .,Department of Radiology (R.G., P.B., A.D., K.N.), Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
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16
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Shaban S, Huasen B, Haridas A, Killingsworth M, Worthington J, Jabbour P, Bhaskar SMM. Digital subtraction angiography in cerebrovascular disease: current practice and perspectives on diagnosis, acute treatment and prognosis. Acta Neurol Belg 2022; 122:763-780. [PMID: 34553337 DOI: 10.1007/s13760-021-01805-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/15/2021] [Indexed: 12/12/2022]
Abstract
Digital Subtraction Angiography (DSA) is the gold-standard imaging modality in acute cerebrovascular diagnosis. The role of DSA has become increasingly prominent since the incorporation of endovascular therapy in standards of care for acute ischemic stroke. It is used in the assessment of cerebral vessel patency; however, the therapeutic role of DSA from a prognostic standpoint merits further investigation. The current paper provides an update on current practice on diagnostic, therapeutic and prognostic use of DSA in acute cerebrovascular diseases and various indications and perspectives that may apply, or limit its use, in ongoing surveillance or prognosis. Pre-clinical and clinical studies on the aspects, including but not limited to the morphology of cerebrovasculature in acute ischaemic stroke, are required to delineate and inform its prognostic role.
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Affiliation(s)
- Shirin Shaban
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, Australia
- University of New South Wales (UNSW), South Western Sydney Clinical School, Liverpool, NSW, Australia
| | - Bella Huasen
- Department of Interventional Radiology, Lancashire University Teaching Hospitals, Lancashire Care NHS Foundation Trust, Preston, UK
| | - Abilash Haridas
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, Australia
- Baycare Medical Group, Pediatric Neurosurgery, Cerebrovascular and Skull Base Neurosurgery, St Joseph's Hospital, Tampa, FL, USA
| | - Murray Killingsworth
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, Australia
- University of New South Wales (UNSW), South Western Sydney Clinical School, Liverpool, NSW, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, Australia
- Department of Anatomical Pathology, Correlative Microscopy Facility, NSW Health Pathology, Sydney, Australia
| | - John Worthington
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, Australia
- RPA Comprehensive Stroke Service and Department of Neurology, Royal Prince Alfred Hospital, Camperdown, Sydney, Australia
| | - Pascal Jabbour
- Division of Neurovascular Surgery and Endovascular Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA
| | - Sonu Menachem Maimonides Bhaskar
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, Australia.
- University of New South Wales (UNSW), South Western Sydney Clinical School, Liverpool, NSW, Australia.
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, Australia.
- Department of Neurology and Neurophysiology, Liverpool Hospital and South Western Sydney Local Health District, Sydney, Australia.
- Department of Neurology and Neurophysiology, Clinical Sciences Building, Liverpool Hospital, Elizabeth St, Liverpool, NSW, 2170, Australia.
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17
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Thamburaj K, Zammar S, Tsay A, Tun K, Simon S, Kalapos P, Fiorelli M, Cockroft K. Magnetic Resonance Angiography after Flow Diversion: The use of complementary MRA techniques to monitor aneurysm occlusion as well as device and arterial branch patency after flow diverter placement. World Neurosurg 2022; 162:e147-e155. [PMID: 35248768 DOI: 10.1016/j.wneu.2022.02.096] [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: 11/30/2021] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Few studies have been performed to evaluate flow diversion with MRA. They have shown better success for MRA to assess the aneurysm response but limited success for the stent patency. Further, the patency of arterial branches on MRA remains to be explored. METHODS 31 consecutive cases of carotid aneurysms treated with flow diversion were retrospectively evaluated with noncontrast time of flight (TOF), contrast enhanced TOF (CTOF) and cine MRA (TWIST) independently by two investigators for aneurysm occlusion, stent patency and arterial branch patency. DSA served as the gold standard technique. RESULTS There were 6 males and 25 females in the age range of years (mean ±SD). Stent patency, aneurysm occlusion and branch patency, mostly revealed substantial to perfect interobserver agreement (k >0.60). The sensitivity, specificity, positive and negative predictive values for the stent patency on source images of TOF were 0.99,0.84, 0.42 and 0.99 and on CTOF were 0.99, 0.89, 0.50 and 0.99 respectively.Sensitivity for the aneurysm response on the three MRAs ranged from 0.88 to 0.93,specificity from 0.64 to 0.75, positive predictive value from 0.69 to 0.79 and negative predictive value from 0.86 to 0.90. Sensitivity for the arterial branch patency among the three MRAs, ranged from 0.55 to 0.93, specificity from 0.61 to 0.68, positive predictive value from 0.79 to 0.93 and negative predictive value from 0.22 to 0.90. CONCLUSIONS Aneurysm occlusion, stent patency and arterial branch patency in flow diversion can be successfully evaluated with the combination of three MRA techniques.
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Affiliation(s)
| | - Samer Zammar
- Department of Neurosurgery PennState Health Milton S Hershey Medical Center and PennState College of Medicine PennState University, Hershey, PA 17033
| | - Annie Tsay
- Internal Medicine Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA 02139
| | - Kyaw Tun
- Pennstate Health Department of Radiology, Community Practice Division
| | - Scott Simon
- Department of Neurosurgery PennState Health Milton S Hershey Medical Center and PennState College of Medicine PennState University, Hershey, PA 17033
| | | | - Marco Fiorelli
- Department of Human Neurosciences, Sapienza University of Rome, Viale del Universita, 30, 00185, Rome, Italy
| | - Kevin Cockroft
- Department of Neurosurgery PennState Health Milton S Hershey Medical Center and PennState College of Medicine PennState University, Hershey, PA 17033
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18
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Burel J, Gerardin E, Vannier M, Curado A, Verdalle-Cazes M, Magne N, Lefebvre M, Papagiannaki C. Follow-up of Intracranial Aneurysms Treated by Flow Diverters: Evaluation of Parent Artery Patency Using 3D-T1 Gradient Recalled-Echo Imaging with 2-Point Dixon in Combination with 3D-TOF-MRA with Compressed Sensing. AJNR Am J Neuroradiol 2022; 43:554-559. [PMID: 35241422 PMCID: PMC8993198 DOI: 10.3174/ajnr.a7448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/03/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE MRA assessment of parent artery patency after flow-diverter placement is complicated by imaging artifacts produced by these devices. The purpose of this study was to assess the accuracy of liver acquisition with volume acceleration-flex technique (LAVA-Flex) MRA in combination with 3D-TOF with HyperSense MRA for the evaluation of parent vessel status after intracranial flow-diverter placement. MATERIALS AND METHODS Fifty-six patients treated by flow diversion and followed with both DSA and 3T MRA between November 2020 and August 2021 were included. All patients were evaluated for parent artery patency using the same imaging protocol (DSA, noncontrast MRA including 3D-TOF with HyperSense and LAVA-Flex, and contrast-enhanced MRA, including time-resolved imaging of contrast kinetics MRA and delayed contrast-enhanced MRA). RESULTS With DSA as a criterion standard to evaluate the patency of the parent vessel, noncontrast MRA had a good specificity (0.83) and positive predictive value (0.65), better than contrast-enhanced MRA (0.55 and 0.41, respectively). Both had excellent sensitivity and negative predictive value: noncontrast MRA, 0.93 and 0.97, respectively; contrast-enhanced MRA, 0.93 and 0.96, respectively. Specificity and positive predictive value tended to be lower for patients treated with additional devices than for those treated with flow diverters exclusively and for patients treated with a specific type of flow diverter. CONCLUSIONS Noncontrast MRA can be used for noninvasive follow-up of intracranial aneurysms treated by flow diverters. The combined use of LAVA-Flex and 3D-TOF with HyperSense sequences allows monitoring the status of the parent artery and aneurysm occlusion.
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Affiliation(s)
- J Burel
- From the Department of Radiology (J.B., E.G., A.C., M.V.-C., N.M., M.L., C.P.)
| | - E Gerardin
- From the Department of Radiology (J.B., E.G., A.C., M.V.-C., N.M., M.L., C.P.)
| | - M Vannier
- Biostatistics (M.V.), Rouen University Hospital, Rouen, Normandie, France
| | - A Curado
- From the Department of Radiology (J.B., E.G., A.C., M.V.-C., N.M., M.L., C.P.)
| | - M Verdalle-Cazes
- From the Department of Radiology (J.B., E.G., A.C., M.V.-C., N.M., M.L., C.P.)
| | - N Magne
- From the Department of Radiology (J.B., E.G., A.C., M.V.-C., N.M., M.L., C.P.)
| | - M Lefebvre
- From the Department of Radiology (J.B., E.G., A.C., M.V.-C., N.M., M.L., C.P.)
| | - C Papagiannaki
- From the Department of Radiology (J.B., E.G., A.C., M.V.-C., N.M., M.L., C.P.)
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19
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Repeated Aneurysm Intervention. Adv Tech Stand Neurosurg 2022; 44:277-296. [PMID: 35107686 DOI: 10.1007/978-3-030-87649-4_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Over the past 25 years the endovascular treatment of cerebral aneurysms has gained preference in some countries over the traditional surgical procedures. The review part of the article clearly demonstrates that the clinical results of both modalities are similar and the difference is seen only in technical effectivity. Surgical techniques fail far less frequently than the endovascular ones. Incompletely occluded or growing aneurysms after the endovascular approach expose the patient to the risk of rebleeding with all possible consequences. Markedly repeated procedures are much more common for endovascularly treated aneurysms, again with all the risks.In the authors institution over the past 20 years, a total of 2032 aneurysms were treated. In 1263 endovascularly managed aneurysms the regrowth or inclomplete initial occlusion necessitated 159 repeated propcedures (12.6%). In surgical group the total of 27 aneurysms needed retreatment (3.5%). The difference is statistically significant. In nine patients in endovascular group the rebleeding was the reason for repeated procedures. No rebleeding was seen in the surgical group.This fact, also shown in the review part of the article, is important in patients counseling. Given the similar clinical results of both modalities the patient should be advised on the necessity of repeated follow-ups and of possible technical failure and eventual repeated procedure which is more likely if endovascular procedure is chosen.
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20
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Kim YN, Choi JW, Lim YC, Song J, Park JH, Jung WS. Usefulness of Silent MRA for Evaluation of Aneurysm after Stent-Assisted Coil Embolization. Korean J Radiol 2022; 23:246-255. [PMID: 35029075 PMCID: PMC8814699 DOI: 10.3348/kjr.2021.0332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 08/20/2021] [Accepted: 08/22/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the usefulness of Silent MR angiography (MRA) for evaluating intracranial aneurysms treated with stent-assisted coil embolization. MATERIALS AND METHODS Ninety-nine patients (101 aneurysms) treated with stent-assisted coil embolization (Neuroform atlas, 71 cases; Enterprise, 17; LVIS Jr, 9; and Solitaire AB, 4 cases) underwent time-of-flight (TOF) MRA and Silent MRA in the same session using a 3T MRI system within 24 hours of embolization. Two radiologists independently interpreted both MRA images retrospectively and rated the image quality using a 5-point Likert scale. The image quality and diagnostic accuracy of the two modalities in the detection of aneurysm occlusion were further compared based on the stent design and the site of aneurysm. RESULTS The average image quality scores of the Silent MRA and TOF MRA were 4.38 ± 0.83 and 2.78 ± 1.04, respectively (p < 0.001), with an almost perfect interobserver agreement. Silent MRA had a significantly higher image quality score than TOF MRA at the distal internal carotid artery (n = 57, 4.25 ± 0.91 vs. 3.05 ± 1.16, p < 0.001), middle cerebral artery (n = 21, 4.57 ± 0.75 vs. 2.19 ± 0.68, p < 0.001), anterior cerebral artery (n = 13, 4.54 ± 0.66 vs. 2.46 ± 0.66, p < 0.001), and posterior circulation artery (n = 10, 4.50 ± 0.71 vs. 2.90 ± 0.74, p = 0.013). Silent MRA had superior image quality score to TOF MRA in the stented arteries when using Neuroform atlas (4.66 ± 0.53 vs. 3.21 ± 0.84, p < 0.001), Enterprise (3.29 ± 1.59 vs. 1.59 ± 0.51, p = 0.003), LVIS Jr (4.33 ± 1.89 vs. 1.89 ± 0.78, p = 0.033), and Solitaire AB stents (4.00 ± 2.25 vs. 2.25 ± 0.96, p = 0.356). The interpretation of the status of aneurysm occlusion exhibited significantly higher sensitivity with Silent MRA than with TOF MRA when using the Neuroform Atlas stent (96.4% vs. 14.3%, respectively, p < 0.001) and LVIS Jr stent (100% vs. 20%, respectively, p = 0.046). CONCLUSION Silent MRA can be useful to evaluate aneurysms treated with stent-assisted coil embolization, regardless of the aneurysm location and type of stent used.
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Affiliation(s)
- You Na Kim
- Department of Radiology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
| | - Jin Wook Choi
- Department of Radiology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
| | - Yong Cheol Lim
- Department of Neurosurgery, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
| | - Jihye Song
- Department of Neurosurgery, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
| | - Ji Hyun Park
- Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, Korea
| | - Woo Sang Jung
- Department of Radiology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea.,Department of Radiology, Kangwon National University College of Medicine, Chuncheon, Korea.
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21
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Kaiser DPO, Abdalkader M, Berberich A, Sporns PB, Nguyen TN. Acute shortage of iodinated contrast media: implications and guidance for neurovascular imaging and intervention. Neuroradiology 2022; 64:1715-1718. [PMID: 35716206 PMCID: PMC9206091 DOI: 10.1007/s00234-022-02999-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 06/10/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Daniel P. O. Kaiser
- grid.4488.00000 0001 2111 7257Else Kröner Fresenius Center for Digital Health, TU Dresden, Dresden, Germany ,grid.4488.00000 0001 2111 7257Institut Und Poliklinik Für Diagnostische Und Interventionelle Neuroradiologie, Universitätsklinikum Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Mohamad Abdalkader
- grid.239424.a0000 0001 2183 6745Department of Radiology, Boston Medical Center, Boston, MA USA
| | - Anne Berberich
- grid.5253.10000 0001 0328 4908Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Peter B. Sporns
- grid.410567.1Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland ,grid.13648.380000 0001 2180 3484Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thanh N. Nguyen
- grid.239424.a0000 0001 2183 6745Department of Neurology, Radiology Boston Medical Center, Boston, MA USA
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22
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Pierot L, Barbe C, Thierry A, Bala F, Eugene F, Cognard C, Herbreteau D, Velasco S, Chabert E, Desal H, Aggour M, Rodriguez-Regent C, Gallas S, Sedat J, Marnat G, Sourour N, Consoli A, Papagiannaki C, Spelle L, White P. Patient and aneurysm factors associated with aneurysm recanalization after coiling. J Neurointerv Surg 2021; 14:1096-1101. [PMID: 34740986 PMCID: PMC9606530 DOI: 10.1136/neurintsurg-2021-017972] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/20/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND One limitation of the endovascular treatment of intracranial aneurysms is aneurysm recanalization. The Analysis of Recanalization after Endovascular Treatment of intracranial Aneurysm (ARETA) study is a prospective multicenter cohort study evaluating the factors associated with recanalization after endovascular treatment. METHODS The current analysis is focused on patients treated by coiling or balloon-assisted coiling (BAC). Postoperative, mid-term vascular imaging, and evolution of aneurysm occlusion were independently evaluated by two neuroradiologists. A 3-grade scale was used for aneurysm occlusion (complete occlusion, neck remnant, and aneurysm remnant) and for occlusion evolution (improved, stable, and worsened). Recanalization was defined as any worsening of aneurysm occlusion. RESULTS Between December 2013 and May 2015, 16 French neurointerventional departments enrolled 1289 patients. A total of 945 aneurysms in 908 patients were treated with coiling or BAC. The overall rate of aneurysm recanalization at mid-term follow-up was 29.5% (95% CI 26.6% to 32.4%): 28.9% and 30.3% in the coiling and BAC groups, respectively. In multivariate analyses factors independently associated with recanalization were current smoking (36.6% in current smokers vs 24.5% in current non-smokers (OR 1.8 (95% CI 1.3 to 2.4); p=0.0001), ruptured status (31.9% in ruptured aneurysms vs 25.1% in unruptured (OR 1.5 (95% CI 1.1 to 2.1); p=0.006), aneurysm size ≥10 mm (48.8% vs 26.5% in aneurysms <10 mm (OR 2.6 (95% CI 1.8 to 3.9); p<0.0001), wide neck (32.1% vs 25.8% in narrow neck (OR 1.5 (95% CI 1.1 to 2.1); p=0.02), and MCA location (34.3% vs 28.3% in other locations (OR 1.5 (95% CI 1.0 to 2.1); p=0.04). CONCLUSIONS Several factors are identified by the ARETA study as playing a role in aneurysm recanalization after coiling: current smoking, aneurysm status (ruptured), aneurysm size (≥10 mm), neck size (wide neck), and aneurysm location (middle cerebral artery). This finding has important consequences in clinical practice. TRIAL REGISTRATION NUMBER URL: http://www.clinicaltrials.gov; Unique Identifier: NCT01942512.
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Affiliation(s)
| | - Coralie Barbe
- Research on Health University department, University of Reims Champagne-Ardenne, Reims, France
| | | | - Fouzi Bala
- Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | | | - Christophe Cognard
- Diagnostic and Therapeutic Neuroradiology, CHU Toulouse, Toulouse, Occitanie, France
| | | | | | - Emmanuel Chabert
- Neuroradiologie, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Mohamed Aggour
- Neuroradiology, CHU Saint-Étienne, Saint-Etienne, France
| | | | - Sophie Gallas
- Diagnostic and Interventional Neuroradiology, Hopital Bicetre, Le Kremlin-Bicetre, France
| | | | - Gaultier Marnat
- Interventional and Diagnostic Neuroradiology, CHU Bordeaux GH Pellegrin, Bordeaux, France
| | | | - Arturo Consoli
- Diagnostic and Interventional Neuroradiology, Hospital Foch, Suresnes, France.,Interventional Neurovascular Unit, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | | | - Laurent Spelle
- NEURI Interventional Neuroradiology, APHP, Paris, France.,Neuroradiology, Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, France
| | - Phil White
- Institute for Ageing & Health, Newcastle University, Newcastle Upon Tyne, UK.,Neuroradiology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
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23
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Lauzier DC, Cler SJ, Kansagra AP. Examining the Value of Neurointerventional Follow-up. World Neurosurg 2021; 155:191-192. [PMID: 34724733 DOI: 10.1016/j.wneu.2021.08.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- David C Lauzier
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Samuel J Cler
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Akash P Kansagra
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA; Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USA; Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
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24
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Salem MM, Salih M, Nwajei F, Williams N, Thomas AJ, Moore JM, Ogilvy CS. Longitudinal Cost Profiles of Pipeline Embolization Device Versus Stent-Assisted Coiling in Propensity-Matched Unruptured Small Anterior Circulation Aneurysms. Neurosurgery 2021; 89:867-872. [PMID: 34383055 DOI: 10.1093/neuros/nyab304] [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: 12/11/2020] [Accepted: 06/09/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The cost profiles of stent-assisted coiling (SAC) vs Pipeline embolization device (PED) in small unruptured anterior circulation aneurysms have not been studied. OBJECTIVE To compare the 2 modalities cost profiles in a propensity-matched cohort controlling for potential technical complexity confounders including size and location. METHODS Patients treated with either SAC or PED at our institution were identified. Following propensity-score algorithm, 46 patients, 23 in each group were matched. The procedural and follow-up costs in each group were analyzed and compared. RESULTS Median maximal aneurysm size in the SAC and PED cohort were 5.3 vs 5.1 mm, respectively. Costs of access guide materials were significantly higher in the SAC group (P < .01). The average implant cost was not significantly different between the SAC and PED cohorts (${\$}$13973.2 ± ${\$}$2886.2 vs ${\$}$14,760.7 ± ${\$}$3782.1, respectively; P = .43). Similarly, total procedural costs were not different (${\$}$18341.5 ± 4104 vs ${\$}$17484.3 ± 2914.1, respectively, P = .42). Although there were significantly more total follow-ups (P = .02) and longer follow-up duration (P = .01) in SAC cohort, no significant difference in follow-up costs between the 2 groups was identified (${\$}$20557 ± ${\$}$9247 vs ${\$}$18958 ± ${\$}$9171.9, P = .56). Overall cost was similar between the SAC (${\$}$38898.9 ± ${\$}$9645.5) and PED groups (${\$}$36442.4 ± ${\$}$9076) (P = .38). CONCLUSION In small unruptured anterior circulation aneurysms (excluding anterior communicating artery aneurysms) matched for technical complexity confounders, SAC and PED offer an overall equivalent economic cost profile. Postprocedural noninvasive imaging was more frequent in the SAC group. However, follow-up costs and total costs were not significantly different.
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Affiliation(s)
- Mohamed M Salem
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Mira Salih
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Felix Nwajei
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Natalie Williams
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ajith J Thomas
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Justin M Moore
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher S Ogilvy
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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25
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Städt M, Holtmannspötter M, Eff F, Voit-Höhne H. Non-visualizable stent-occlusion after treatment of a fusiform PCA-aneurysm-a case report. Radiol Case Rep 2021; 16:2573-2578. [PMID: 34306290 PMCID: PMC8283140 DOI: 10.1016/j.radcr.2021.06.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/12/2021] [Accepted: 06/14/2021] [Indexed: 10/25/2022] Open
Abstract
We report the case of a 17-year-old woman with extensive subarachnoidal hemorrhage due to a ruptured fusiform aneurysm of the right PCA (posterior cerebral artery). Endovascular treatment was successfully performed using a LVIS-EVO-Stent (Microvention Incorporation, Tustin, USA) as well as several coils. Short-term angiographic follow-up demonstrated extensive aneurysm progression and dilatation of the coil package, the stent could no longer be visualized and was not passable. Despite excellent distal vascular perfusion, a non-visible stent occlusion was suspected and subsequent occlusion of the patent artery was performed. We conclude that rapid progression of fusiform aneurysms after stent-assisted coiling may lead to expansion of the coil packages and non-assessability of the stent. Even with excellent distal perfusion, a stent-occlusion should be suspected in these cases. Therefore, we suggest short-term angiographic follow-up, especially after deploying multiple coil packages in fusiform aneurysms.
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Affiliation(s)
- Michael Städt
- Institute of Radiology und Neuroradiology, Paracelsus Medical University, Nuremberg South Hospital, Germany
| | - Markus Holtmannspötter
- Institute of Radiology und Neuroradiology, Paracelsus Medical University, Nuremberg South Hospital, Germany
| | - Florian Eff
- Institute of Radiology und Neuroradiology, Paracelsus Medical University, Nuremberg South Hospital, Germany
| | - Heinz Voit-Höhne
- Institute of Radiology und Neuroradiology, Paracelsus Medical University, Nuremberg South Hospital, Germany
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26
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"Trapped labelled spins"-related signal on arterial spin labelling in the assessment of flow-diverted aneurysms: preliminary experience. Neuroradiology 2021; 64:77-93. [PMID: 34128085 DOI: 10.1007/s00234-021-02721-y] [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: 01/20/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate ASL-MRI features of flow-diverted aneurysms, review their haemodynamic surrogates, and discuss their pertinent clinical implications. METHODS Retrospective single institutional analysis was performed on the clinical and imaging data of patients who underwent digital subtraction angiography (DSA) and ASL-MRI after endovascular flow diversion for cerebral aneurysms. Pseudo-continuous ASL-MRI was performed with post-label delays of 1525-1800 ms. Intra-aneurysmal "trapped labelled spins" (TLS)-related hypersignal, as seen on cerebral blood flow (CBF)-weighted maps of ASL-MRI, was investigated. Intermodality equivalence with DSA [O'Kelly-Marotta (OKM) grading for occlusion], 3D-TOF-MRA, and 3D spin-echo T1-weighted ("black-blood") images was assessed. RESULTS Ten cases were included. "TLS" signal was demonstrable in 7/8 (87.5%) of the DSA-visible flow-diverted aneurysms (OKM grade B3, n = 6; OKM grade A3, n = 2). No TLS was seen in both OKM-D (excluded) aneurysms. TLS was not visualised in an OKM-B3 aneurysm with < 3 mm opacifying remnant. 3D-TOF-MRA and ASL-MRI were discordant at 5 instances (45.4%; TOF-MRA false negative, n = 4; false positive, n = 1). Loss of flow void on black-blood images corresponded to the absence of TLS and vice versa in all cases but one. CONCLUSION "Trapped labelled spins"-related signal on ASL-MRI occurs in patent large aneurysms that have undergone successful endovascular flow diversion. This phenomenon likely represents an interplay of a multitude of haemodynamic factors including decelerated intra-aneurysmal inflow and outflow restriction. Serial intra-saccular TLS signal changes may hold diagnostic value, including contexts where 3D-TOF-MRA interpretation becomes dubious. "Trapped labelled spins"-related signal as a non-invasive proxy marker of aneurysm patency can possibly obviate unnecessary DSA.
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27
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Gomyo M, Tsuchiya K, Goto S, Hosoi S, Tahara T, Yokoyama K. Usefulness of black-blood magnetic resonance angiography generated from vessel wall imaging after the stent-assisted treatment of intracranial arterial diseases. Neuroradiol J 2021; 35:36-41. [PMID: 34096395 PMCID: PMC8822195 DOI: 10.1177/19714009211021775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE After stent-assisted treatment for intracranial diseases, three-dimensional time-of-flight magnetic resonance angiography is a noninvasive follow-up method, but susceptibility artifacts prevent accurate evaluations of stented arteries. Sampling perfection with application-optimized contrast using different flip angle evolution (SPACE) sequence often used for vessel wall imaging is less susceptible to susceptibility artifacts, since it is a spin-echo sequence. Hence, we evaluated the feasibility of black-blood magnetic resonance angiography generated from vessel wall imaging data obtained using the SPACE sequence in the depiction of stented arteries by comparing with three-dimensional time-of-flight magnetic resonance angiography and digital subtraction angiography. METHODS Our study group comprised 11 consecutive patients. For both three-dimensional time-of-flight magnetic resonance angiography and black-blood magnetic resonance angiography, the contrast ratio obtained from the stented artery and the normal artery proximal to the stent were calculated. And the depiction of stented arteries was visually evaluated. Additionally, the relative diameter index obtained from the stented artery and the normal artery proximal to the stent were calculated for three-dimensional time-of-flight magnetic resonance angiography, black-blood magnetic resonance angiography and digital subtraction angiography. RESULTS The contrast ratio of the stented artery was significantly lower than that of the normal artery on three-dimensional time-of-flight magnetic resonance angiography, but no significant difference was seen using black-blood magnetic resonance angiography. Regarding both the diameter index and the visual assessment score, black-blood magnetic resonance angiography was significantly better than three-dimensional time-of-flight magnetic resonance angiography. On black-blood magnetic resonance angiography, the diameter index was equal to that of digital subtraction angiography, and the flow signal was homogeneous and continuous in most the cases.
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Affiliation(s)
- Miho Gomyo
- Department of Radiology, Saitama Medical Center, Saitama Medical University, Japan.,Department of Radiology, Faculty of Medicine, Kyorin University, Japan
| | - Kazuhiro Tsuchiya
- Department of Radiology, Saitama Medical Center, Saitama Medical University, Japan
| | - Shun Goto
- Department of Radiology, Saitama Medical Center, Saitama Medical University, Japan
| | - Shinsuke Hosoi
- Radiology Service, Saitama Medical Center, Saitama Medical University, Japan
| | - Takahiro Tahara
- Radiology Service, Saitama Medical Center, Saitama Medical University, Japan
| | - Kenichi Yokoyama
- Department of Radiology, Faculty of Medicine, Kyorin University, Japan
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28
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Zheng J, Zhou R, Meng B, Li F, Liu H, Wu X. Knowledge framework and emerging trends in intracranial aneurysm magnetic resonance angiography: a scientometric analysis from 2004 to 2020. Quant Imaging Med Surg 2021; 11:1854-1869. [PMID: 33936970 DOI: 10.21037/qims-20-729] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background As magnetic resonance angiography (MRA) has been increasingly used in the follow-up of intracranial aneurysms (IAs) as a non-invasive technique, the knowledge framework and areas of research interest in intracranial aneurysms magnetic resonance angiography (IAMRA) change approximately every 10 years. However, few studies have quantitatively analyzed the published literature in this field. In the present study, we used scientometrics to survey the knowledge field, development trends, and research focus of IAMRA with the aim of providing a reference for further study. Methods We collected articles on IAMRA published from 2004 (Jan 1, 2004) to 2020 (May 24, 2020). Web of Science Core Collection databases (WoSCCd) including the Science Citation Index Expanded were searched. An experienced staff member from the Department of Radiology at Southern Medical University, assisted in screening articles for relevant articles. We used ArcGIS (a mapping and location analytics platform) to perform geographic visualization. Excel 2016 was used to analyze the literature data, including number of publications, impact factor (IF), and publication year. CiteSpace V was used to conduct a series of literature feature clustering, including author co-citation analysis, reference co-citation analysis (RCA), and burst keywords analysis. Results A total of 1,272 articles on IAMRA published between 2004 and 2020 were included. Of 257 journals, American Journal of Neuroradiology (IF 2018: 3.256) published the most IAMRA articles (109 publications, 8.57%), followed by Journal of Neurosurgery (IF 2018: 4.131, 51 publications, 4.16%), and Neuroradiology (IF 2018: 2.504, 51 publications, 4.01%). Of 56 countries, the USA published the most, with 347 articles [27.28%, IF: 3.14 (average IF of all journals in the country)], followed by Japan (242 articles, 19.03%, IF: 2.38), Germany (135 articles, 10.61%, IF: 3.21), and China (101 articles, 7.94%, IF: 2.86). A total of 1387 institutions published articles, with the Mayo Clinic publishing the most (33 articles, 2.59%), followed by Shanghai Jiao Tong University (25 article, 1.97%), Seoul National University (23 articles, 1.81%), and University Medical Center Utrecht (19 articles, 1.49%). Of 399 authors, Rinkel ranked first with 19 articles, followed by Li MH (18 articles), Uchino A (15 articles), and Saito N (13 articles). Cluster RCA showed that the first cluster was "#0 growth", followed by "#1 Guglielmi detachable coils". Timeline views showed that the time span of "#0 growth" was the closest to today. The modularity value was 0.6971, and the mean silhouette value was 0.5477. According to the burst keyword analysis, "risk factors associated to rupture" was the topic with the strongest burst since 2017. Studies conducted in several countries suggested that age is inversely related to the risk of rupture, which implies the importance of MRA follow-up for patients of different age. Conclusions From 2004 to 2020, the number of published IAMRA-related articles gradually increased. The USA and Western Europe lead in the field, with a concentration of cutting-edge talents and high-level scientific research institutions. A synthesis of the clustering results of RCA and burst keyword analysis indicated that unruptured IA growth, stent-assisted coil embolization, and risk factors associated to rupture were the current hotspots in IAMRA research.
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Affiliation(s)
- Jiazhen Zheng
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
| | - Rui Zhou
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
| | - Bingyao Meng
- Department of Radiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
| | - Furong Li
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
| | - Huamin Liu
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
| | - Xianbo Wu
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
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29
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Hostetter J, Miller TR, Gandhi D. Imaging for Treated Aneurysms (Including Clipping, Coiling, Stents, Flow Diverters). Neuroimaging Clin N Am 2021; 31:251-263. [PMID: 33902878 DOI: 10.1016/j.nic.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Intracranial aneurysms are common in the adult population and carry a risk of rupture leading to catastrophic subarachnoid hemorrhage. Treatment of aneurysms has evolved significantly, with the introduction of new techniques and devices for minimally invasive and endovascular approaches. Follow-up imaging after aneurysm treatment is standard of care to monitor for recurrence or other complications, and the preferred imaging modality and schedule for follow-up are areas of active research. The modality and follow-up schedule should be tailored to treatment technique, aneurysm characteristics, and patient factors.
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Affiliation(s)
- Jason Hostetter
- Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene Street, Baltimore, MD 21201, USA.
| | - Timothy R Miller
- Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene Street, Baltimore, MD 21201, USA
| | - Dheeraj Gandhi
- Neurology and Neurosurgery, Department of Radiology, Interventional Neuroradiology, CMIT Center, University of Maryland School of Medicine, 22 S Greene Street, Baltimore, MD 21201, USA
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30
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Lee KS, Zhang JJY, Nguyen V, Han J, Johnson JN, Kirollos R, Teo M. The evolution of intracranial aneurysm treatment techniques and future directions. Neurosurg Rev 2021; 45:1-25. [PMID: 33891216 PMCID: PMC8827391 DOI: 10.1007/s10143-021-01543-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/21/2021] [Accepted: 04/07/2021] [Indexed: 01/06/2023]
Abstract
Treatment techniques and management guidelines for intracranial aneurysms (IAs) have been continually developing and this rapid development has altered treatment decision-making for clinicians. IAs are treated in one of two ways: surgical treatments such as microsurgical clipping with or without bypass techniques, and endovascular methods such as coiling, balloon- or stent-assisted coiling, or intravascular flow diversion and intrasaccular flow disruption. In certain cases, a single approach may be inadequate in completely resolving the IA and successful treatment requires a combination of microsurgical and endovascular techniques, such as in complex aneurysms. The treatment option should be considered based on factors such as age; past medical history; comorbidities; patient preference; aneurysm characteristics such as location, morphology, and size; and finally the operator’s experience. The purpose of this review is to provide practicing neurosurgeons with a summary of the techniques available, and to aid decision-making by highlighting ideal or less ideal cases for a given technique. Next, we illustrate the evolution of techniques to overcome the shortfalls of preceding techniques. At the outset, we emphasize that this decision-making process is dynamic and will be directed by current best scientific evidence, and future technological advances.
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Affiliation(s)
- Keng Siang Lee
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, UK. .,Department of Neurosurgery, Bristol Institute of Clinical Neuroscience, Southmead Hospital, Bristol, UK.
| | - John J Y Zhang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Vincent Nguyen
- Department of Neurosurgery, Bristol Institute of Clinical Neuroscience, Southmead Hospital, Bristol, UK.,Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, TN, USA
| | - Julian Han
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Jeremiah N Johnson
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Ramez Kirollos
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore.,Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Addenbrooke's Hospital, Cambridge, UK
| | - Mario Teo
- Department of Neurosurgery, Bristol Institute of Clinical Neuroscience, Southmead Hospital, Bristol, UK
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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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Nguyen HA, Soize S, Manceau PF, Vudang L, Pierot L. Persistent Blood Flow inside the Woven EndoBridge Device More Than 6 Months after Intracranial Aneurysm Treatment: Frequency, Mechanisms, and Management-A Retrospective Single-Center Study. AJNR Am J Neuroradiol 2020; 41:1225-1231. [PMID: 32527839 DOI: 10.3174/ajnr.a6593] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/14/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Due to its high safety and great efficacy, flow disruption with the Woven EndoBridge (WEB) device is increasingly used to treat intracranial aneurysms. We recently identified patients with intracranial aneurysm treated with the WEB who presented with residual blood flow inside the device ("contrast-in-WEB" phenomenon) more than 6 months posttreatment. This series reports the frequency and underlying mechanisms and discusses management of this phenomenon. MATERIALS AND METHODS All patients presenting with the contrast-in-WEB phenomenon in the prospectively collected data base of patients with aneurysm treated with the WEB were retrospectively collected and analyzed. RESULTS From June 2011 to February 2019, one hundred twenty-seven patients with 133 aneurysms were treated with the WEB and had DSA follow-up at 6 months or later. Eight patients (6.3%) presented with the phenomenon. All aneurysms were wide-neck bifurcation aneurysms, including 7 unruptured and 1 ruptured aneurysm located at the MCA (5 aneurysms), anterior communicating artery (2 aneurysms), and basilar artery (1 aneurysm). All except 1 patient received dual-antiplatelet therapy preprocedure. All except 1 patient received dual-antiplatelet therapy postoperatively for at least 1 month. The most likely mechanism of the phenomenon is the absence of intradevice thrombosis related to perioperative dual-antiplatelet medication. The phenomenon is also likely associated with a low risk of bleeding except when there is residual blood flow against the aneurysm wall or in the dome. CONCLUSIONS Contrast-in-WEB is a relatively rare phenomenon possibly induced by dual-antiplatelet therapy continued post-WEB procedure. In most cases, no additional treatment is required.
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Affiliation(s)
- H A Nguyen
- From the Department of Radiology (H.A.N., L.V.), Bach Mai Hospital, Hanoi, Vietnam
- Department of Neuroradiology (H.A.N., S.S., P.-F.M., L.P.), Hôpital Maison-Blanche, Reims, France
| | - S Soize
- Department of Neuroradiology (H.A.N., S.S., P.-F.M., L.P.), Hôpital Maison-Blanche, Reims, France
| | - P-F Manceau
- Department of Neuroradiology (H.A.N., S.S., P.-F.M., L.P.), Hôpital Maison-Blanche, Reims, France
| | - L Vudang
- From the Department of Radiology (H.A.N., L.V.), Bach Mai Hospital, Hanoi, Vietnam
| | - L Pierot
- Department of Neuroradiology (H.A.N., S.S., P.-F.M., L.P.), Hôpital Maison-Blanche, Reims, France.
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Rizvi A, Seyedsaadat SM, Alzuabi M, Murad MH, Kadirvel R, Brinjikji W, Kallmes DF. Long-Term Rupture Risk in Patients with Unruptured Intracranial Aneurysms Treated with Endovascular Therapy: A Systematic Review and Meta-Analysis. AJNR Am J Neuroradiol 2020; 41:1043-1048. [PMID: 32467181 DOI: 10.3174/ajnr.a6568] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 03/19/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Surveillance imaging of previously unruptured, coiled aneurysms remains routine even though reports of rupture of these aneurysms are extremely rare. PURPOSE We performed meta-analysis to examine long-term rupture risk over ≥1-year follow-up duration in patients with unruptured intracranial aneurysm who underwent endovascular therapy. DATA SOURCES Multiple databases were searched for relevant publications between 1995 and 2018. STUDY SELECTION Studies reporting outcome of long-term rupture risk over ≥1-year follow-up in treated patients with unruptured intracranial aneurysms were included. DATA ANALYSIS Random effects meta-analysis was used, and results were expressed as long-term rupture rate per 100 patient-year with respective 95% CIs. For ruptured aneurysms during follow-up, data were collected on size and completeness of initial Treatment. DATA SYNTHESIS Twenty-four studies were identified. Among 4842 patients with a mean follow-up duration of 3.2 years, a total of 12 patients (0.25%) experienced rupture of previous unruptured intracranial aneurysms after endovascular treatment. Nine of these 12 patients harbored aneurysms that were large, incompletely treated, or both. A total of 2 anterior circulation, small, completely coiled aneurysms subsequently ruptured. The long-term rupture rate per 100 patient-year for unruptured intracranial aneurysms treated with endovascular therapy was 0.48 (95% CI, 0.45-0.51). Retreatment was carried out in 236 (4.9%) of these 4842 patients. LIMITATIONS A limitation of the study is that a lack of systematic nature of follow-up and mean follow-up duration of 3.2 years are not sufficient to make general recommendations about aneurysm followup paradigms. CONCLUSIONS Given a 5% retreatment rate, postcoil embolization spontaneous rupture of previously unruptured, small- and medium-sized, well-treated aneurysms is exceedingly rare.
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Affiliation(s)
- A Rizvi
- From the Department of Radiology (A.R., S.M.S., M.A., R.K., W.B., D.F.K.) .,Department of Medicine (A.R.), University of Texas Medical Branch, Galveston, Texas
| | - S M Seyedsaadat
- From the Department of Radiology (A.R., S.M.S., M.A., R.K., W.B., D.F.K.)
| | - M Alzuabi
- From the Department of Radiology (A.R., S.M.S., M.A., R.K., W.B., D.F.K.)
| | - M H Murad
- Evidence-Based Practice Center (M.H.M.), Mayo Clinic, Rochester, Minnesota
| | - R Kadirvel
- From the Department of Radiology (A.R., S.M.S., M.A., R.K., W.B., D.F.K.)
| | - W Brinjikji
- From the Department of Radiology (A.R., S.M.S., M.A., R.K., W.B., D.F.K.).,Joint Department of Medical Imaging (W.B.), Toronto Western Hospital, Toronto, Ontario, Canada
| | - D F Kallmes
- From the Department of Radiology (A.R., S.M.S., M.A., R.K., W.B., D.F.K.)
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Park BS, Shin SH, Kwon WJ, Kang BS, Kwon SC. Motion Correction of Dual Volume Reconstruction of Three‑dimensional Digital Subtraction Angiography for Follow‑up Evaluation of Intracranial Coiled Aneurysms. Neurol India 2020; 68:111-115. [PMID: 32129258 DOI: 10.4103/0028-3886.279652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Purpose To evaluate the usefulness of the "Motion Correction" function of the dual volume-3D-volume-rendering technique (DV-3D-VRT) in follow-up digital subtraction angiography (DSA) of intracranial coiled aneurysms. Materials and Methods This study used data collected from consecutive, follow-up DSAs after the coiling of 64 intracranial aneurysms in 59 patients. We performed subtracted 3D-rotational angiographies (3D-RAs) on all DSAs and obtained DV-3D-VRT images. We then assessed recurrence using DV-3D-VRT images with and without the motion correction functions (MC(+) vs. MC(-)) and observed which method showed better agreement with the reference assessment (using a combination of 2D DSA and TOF MRA images). Results The recurrence of MC(-) DV-3D-VRT images showed 51.6% (33/64) agreement with the reference assessment, whereas the MC(+) DV-3D-VRT images showed 78.1% (50/64) (P = 0.035, McNemar test). Conclusion Motion correction is a useful complementary imaging technique in evaluating aneurysm recurrence after endovascular embolization. MC(+) DV-3D-VRT image showed higher inter-observer agreement than MC(-) DV-3D-VRT.
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Affiliation(s)
- Byeong-Su Park
- Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojin Sunhwando-ro, Dong-gu, Ulsan, Republic of Korea
| | - Shang Hun Shin
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojin Sunhwando-ro, Dong-gu, Ulsan, Republic of Korea
| | - Woon-Jung Kwon
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojin Sunhwando-ro, Dong-gu, Ulsan, Republic of Korea
| | - Byeong Seong Kang
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojin Sunhwando-ro, Dong-gu, Ulsan, Republic of Korea
| | - Soon Chan Kwon
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojin Sunhwando-ro, Dong-gu, Ulsan, Republic of Korea
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35
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Abdel Samad AM, Ibrahim YA, Othman AIA. Added value of three-dimensional digital subtraction angiography, using dual-volume reconstruction technique, in post-treatment follow-up of cerebral aneurysms. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0037-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To assess the added value of the dual-volume technique when used with the routine single-volume 3D DSA in the follow-up of endovascularly treated aneurysms.
Results
Seventeen patients (10 females and 7 males) who underwent coiling of their cerebral aneurysms were assessed by 3D DSA using single- and dual-volume techniques. Recanalization of the aneurysm was depicted in 10 cases on the dual-volume technique, only 4 of which were detected on the single-volume 3D DSA technique. Thus, the use of the dual-volume technique upgraded our management plan from follow-up to re-treatment in 6 cases (35%)
Conclusion
The dual-volume technique of 3D DSA is superior to the single-volume technique in visualization of the endovascular devices distinctly, resulting in better evaluation of the aneurysm recanalization and its relation to the parent vessel and occluding device.
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36
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Raymond J, Januel AC, Iancu D, Roy D, Weill A, Carlson A, Darsaut TE. The RISE trial: A Randomized Trial on Intra-Saccular Endobridge devices. Interv Neuroradiol 2019; 26:61-67. [PMID: 31690151 DOI: 10.1177/1591019919886412] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Wide-necked bifurcation aneurysms (WNBA) are a difficult subset of aneurysms to successfully repair endovascularly, and a number of treatment adjuncts have been designed to improve on the results of coiling, including stenting and flow diversion of the parent vessel. Surgical clipping is commonly performed for certain WNBAs, such as middle cerebral aneurysms, in some centres. Intra-saccular flow diversion (ISFD) using the Woven Endo-Bridge (WEB) or similar devices, has been developed as a new endovascular alternative to coiling for WNBAs. Meta-analyses of case series suggest satisfactory results, both in terms of safety and efficacy, but in the absence of randomized evidence, whether ISFD leads to better outcomes for patients with WNBA remains unknown. There is a need to offer ISFD within the context of a randomized care trial. METHODS The proposed trial is a multicentre, randomized controlled care trial comparing ISFD and best conventional management option (surgical or endovascular), as determined by the treating physician prior to randomized allocation. At least 250 patients will be recruited in at least 10 centres over a four-year period, and followed for one year, to show that ISFD can increase the incidence of successful therapy from 75 to 90% of patients, defined as complete or near-complete occlusion of the aneurysm AND a good clinical outcome (mRS ≤ 2) at one year. The trial will be followed by an independent data safety monitoring committee to assure the safety of participants. CONCLUSION Introduction of intra-saccular flow diversion can be accomplished within a care trial context.
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Affiliation(s)
- Jean Raymond
- Department of Radiology, Service of Neuroradiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Anne-Christine Januel
- Department of Neuroradiology, Service de Neuroradiologie Diagnostique et Thérapeutique du CHU de Toulouse, University Hospital of Toulouse, Toulouse, France
| | - Daniela Iancu
- Department of Radiology, Service of Neuroradiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Daniel Roy
- Department of Radiology, Service of Neuroradiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Alain Weill
- Department of Radiology, Service of Neuroradiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Andrew Carlson
- Department of Neurological Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Tim E Darsaut
- Department of Surgery, Division of Neurosurgery, University of Alberta hospital, Mackenzie Health Sciences Center, Edmonton, Alberta, Canada
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Ryu KH, Baek HJ, Moon JI, Choi BH, Park SE, Ha JY, Park H, Kim SS, Kim JS, Cho SB, Carl M. Usefulness of Noncontrast-Enhanced Silent Magnetic Resonance Angiography (MRA) for Treated Intracranial Aneurysm Follow-up in Comparison with Time-of-Flight MRA. Neurosurgery 2019; 87:220-228. [DOI: 10.1093/neuros/nyz421] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/29/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Flow visualization in time-of-flight magnetic resonance angiography (TOF MRA) is limited for treated intracranial aneurysms owing to magnetic susceptibility and radiofrequency shielding.
OBJECTIVE
To assess the clinical usefulness of noncontrast-enhanced magnetic resonance angiography (MRA) using a silent scan (silent MRA) as a follow-up imaging modality in patients with treated intracranial aneurysms.
METHODS
A total of 119 patients with 126 treated aneurysms underwent silent MRA and TOF MRA during the same scan session. Two neuroradiologists independently assessed overall image quality and visualization of the treated site using a 5-point Likert scale to compare the 2 image sets. We used receiver operating characteristic (ROC) curve analysis to investigate the diagnostic performance of the 2 MRA methods in evaluating aneurysm occlusion. Interobserver reliability was also assessed using weighted kappa statistics.
RESULTS
The overall image quality scores of silent MRA and TOF MRA were 4.04 ± 0.22 and 4.64 ± 0.48, respectively (P < .001), and interobserver agreement was substantial (P < .001). For the treated site, the score of flow visualization on silent MRA was higher than that on TOF MRA, 3.94 ± 0.94 vs 2.59 ± 1.37 (P < .001), with substantial interobserver agreement (P < .001). ROC curve analysis showed that silent MRA was superior to TOF MRA in diagnostic performance (area under the curve [AUC] = 0.962; 95% CI: 0.931-0.982 vs AUC = 0.843; 95% CI: 0.792-0.886; P < .001).
CONCLUSION
Silent MRA can be useful to evaluate treated intracranial aneurysms during follow-up without radiation exposure and use of contrast material. It is characterized by higher diagnostic performance and superior visualization for the treated site.
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Affiliation(s)
- Kyeong Hwa Ryu
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Hye Jin Baek
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
- Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Jin Il Moon
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Bo Hwa Choi
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
- Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Sung Eun Park
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Ji Young Ha
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Hyun Park
- Department of Neurosurgery, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
- Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Seung Soo Kim
- Department of Neurosurgery, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Jung-Soo Kim
- Department of Neurosurgery, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Soo Buem Cho
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Michael Carl
- Applied Science Lab, GE Healthcare, San Diego, CA, United States
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Twitchell S, Wilde HW, Taussky P, Karsy M, Grandhi R. Initial Treatment for Unruptured Intracranial Aneurysm and Its Follow-up: A Cost Analysis of Pipeline Flow Diverters versus Coiling. Cureus 2019; 11:e5692. [PMID: 31720160 PMCID: PMC6823005 DOI: 10.7759/cureus.5692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose Intracranial aneurysms are relatively common epidemiological problems for which the surveillance, treatment, and follow-up are costly. Although multiple studies have evaluated the treatment cost of aneurysms, the follow-up costs are often not examined. In our study, we analyzed how follow-up costs after treatment affected the overall cost of different endovascular techniques for treating aneurysms. Materials and methods An institutional database was used to evaluate the upfront and follow-up costs incurred by patients who underwent elective coiling or placement of a pipeline embolization device (PED) for the treatment of unruptured intracranial aneurysms from July 2011 to December 2017. Results A total of 114 patients (coiling, n = 37; PED, n = 77 ) were included in the study. There was no significant difference among patients in mean age [61.3 (±12.8 years) vs. 57.0 (±14.5 years); probability value (p) = 0.2], sex (male: 32.4% vs. 22.1%; p = 0.2), American Society of Anesthesiologists (ASA) grade (p = 0.5), discharge disposition (p = 0.1), mean length of stay [3.1 days (±5.5) vs. 2.4 days (±2.6); p = 0.2) or follow-up period [22.7 months (±18.5) vs. 18.6 months (±14.9); p = 0.2). There were no differences in costs during admission (p = 0.5) or in follow-up (p = 0.3) between coiling and PED treatments. Initial costs were predominantly related to supplies/implants (56.1% vs. 63.7%) for both treatments. Follow-up costs mostly comprised facility costs (68.2% vs. 67.5%), and there were no differences in costs of subgroups such as supplies/implants (10.5% vs. 9.4%), imaging (17.0% vs. 17.8%), or facilties between coiling and PED. Conclusion These results suggest that the upfront and follow-up costs are mostly similar for the treatment of intracranial aneurysms irrespective of whether the providers used coiling or PED endovascular techniques. Hence, we conclude that follow-up costs should not be a deciding factor when considering these treatments.
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Affiliation(s)
- Spencer Twitchell
- Neurosurgery, University of Utah School of Medicine, Salt Lake City, USA
| | - Herschel W Wilde
- Neurosurgery, University of Utah School of Medicine, Salt Lake City, USA
| | - Philipp Taussky
- Neurosurgery, University of Utah School of Medicine, Salt Lake City, USA
| | - Michael Karsy
- Neurosurgery, University of Utah School of Medicine, Salt Lake City, USA
| | - Ramesh Grandhi
- Neurosurgery, University of Utah School of Medicine, Salt Lake City, USA
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Pierot L. [Place of interventional neuroradiology in the prevention of hemorrhagic stroke]. Presse Med 2019; 48:672-683. [PMID: 31153681 DOI: 10.1016/j.lpm.2019.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The risk of bleeding of unruptured aneurysms is increasing with aneurysm size. Small unruptured aneurysms can be treated conservatively with a regular MRI/MRA follow-up to detect a potential increase in size. If coiling is still the main endovascular technique for the treatment of unruptured aneurysms, several other techniques are now available including stent-assisted coiling, flow diversion, and flow disruption. After ARUBA study, there is no recommendation to treat unruptured brain AVMs. According to their hemorrhagic risk, dural arteriovenous fistulas with cortical venous drainage have to be treated, generally by endovascular approach through an arterial route.
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Affiliation(s)
- Laurent Pierot
- Hôpital Maison-Blanche, service de neuroradiologie, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
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40
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Berg P, Voß S, Janiga G, Saalfeld S, Bergersen AW, Valen-Sendstad K, Bruening J, Goubergrits L, Spuler A, Chiu TL, Tsang ACO, Copelli G, Csippa B, Paál G, Závodszky G, Detmer FJ, Chung BJ, Cebral JR, Fujimura S, Takao H, Karmonik C, Elias S, Cancelliere NM, Najafi M, Steinman DA, Pereira VM, Piskin S, Finol EA, Pravdivtseva M, Velvaluri P, Rajabzadeh-Oghaz H, Paliwal N, Meng H, Seshadhri S, Venguru S, Shojima M, Sindeev S, Frolov S, Qian Y, Wu YA, Carlson KD, Kallmes DF, Dragomir-Daescu D, Beuing O. Multiple Aneurysms AnaTomy CHallenge 2018 (MATCH)-phase II: rupture risk assessment. Int J Comput Assist Radiol Surg 2019; 14:1795-1804. [PMID: 31054128 DOI: 10.1007/s11548-019-01986-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 04/23/2019] [Indexed: 01/10/2023]
Abstract
PURPOSE Assessing the rupture probability of intracranial aneurysms (IAs) remains challenging. Therefore, hemodynamic simulations are increasingly applied toward supporting physicians during treatment planning. However, due to several assumptions, the clinical acceptance of these methods remains limited. METHODS To provide an overview of state-of-the-art blood flow simulation capabilities, the Multiple Aneurysms AnaTomy CHallenge 2018 (MATCH) was conducted. Seventeen research groups from all over the world performed segmentations and hemodynamic simulations to identify the ruptured aneurysm in a patient harboring five IAs. Although simulation setups revealed good similarity, clear differences exist with respect to the analysis of aneurysm shape and blood flow results. Most groups (12/71%) included morphological and hemodynamic parameters in their analysis, with aspect ratio and wall shear stress as the most popular candidates, respectively. RESULTS The majority of groups (7/41%) selected the largest aneurysm as being the ruptured one. Four (24%) of the participating groups were able to correctly select the ruptured aneurysm, while three groups (18%) ranked the ruptured aneurysm as the second most probable. Successful selections were based on the integration of clinically relevant information such as the aneurysm site, as well as advanced rupture probability models considering multiple parameters. Additionally, flow characteristics such as the quantification of inflow jets and the identification of multiple vortices led to correct predictions. CONCLUSIONS MATCH compares state-of-the-art image-based blood flow simulation approaches to assess the rupture risk of IAs. Furthermore, this challenge highlights the importance of multivariate analyses by combining clinically relevant metadata with advanced morphological and hemodynamic quantification.
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Affiliation(s)
| | - Samuel Voß
- University of Magdeburg, Magdeburg, Germany
| | | | | | | | | | | | | | | | | | | | | | - Benjamin Csippa
- Budapest University of Technology and Economics, Budapest, Hungary
| | - György Paál
- Budapest University of Technology and Economics, Budapest, Hungary
| | - Gábor Závodszky
- Budapest University of Technology and Economics, Budapest, Hungary
| | | | | | | | | | | | | | - Saba Elias
- Houston Methodist Research Institute, Houston, TX, USA
| | | | | | | | | | - Senol Piskin
- The University of Texas at San Antonio, San Antonio, TX, USA
| | - Ender A Finol
- The University of Texas at San Antonio, San Antonio, TX, USA
| | | | | | | | | | - Hui Meng
- State University of New York, Buffalo, NY, USA
| | | | | | | | | | | | - Yi Qian
- Macquarie University, Sydney, Australia
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41
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Gawlitza M, Soize S, Manceau PF, Pierot L. An update on intrasaccular flow disruption for the treatment of intracranial aneurysms. Expert Rev Med Devices 2019; 16:229-236. [DOI: 10.1080/17434440.2019.1584035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Matthias Gawlitza
- Service de neuroradiologie, Hôpital Maison Blanche, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Sébastien Soize
- Service de neuroradiologie, Hôpital Maison Blanche, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Pierre-François Manceau
- Service de neuroradiologie, Hôpital Maison Blanche, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Laurent Pierot
- Service de neuroradiologie, Hôpital Maison Blanche, Centre Hospitalier Universitaire de Reims, Reims, France
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42
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Kim S, Kang M, Kim DW, Choi JH. Usefulness of Vessel Wall MR Imaging for Follow-Up after Stent-Assisted Coil Embolization of Intracranial Aneurysms. AJNR Am J Neuroradiol 2018; 39:2088-2094. [PMID: 30262640 DOI: 10.3174/ajnr.a5824] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 07/30/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Follow-up with MRA for intracranial aneurysms after stent-assisted coiling is complicated by imaging artifacts. We evaluated the usefulness of an alternative method: vessel wall MR imaging. MATERIALS AND METHODS We conducted a single-center, retrospective review of medical records of 47 patients who underwent 3D TOF-MRA, vessel wall MRI, and DSA after stent-assisted coiling between March 2016 and January 2018. We evaluated the mean value of the signal intensity in the stented artery and the contralateral normal artery on vessel wall MRI. The quality of visualization was further compared between TOF-MRA and vessel wall MRI. Furthermore, we evaluated the diagnostic accuracy and concordance rate of TOF-MRA and vessel wall MRI for assessing the patency of the stented parent artery. DSA was used as a reference test. RESULTS The mean signal intensities of the stented and normal arteries on vessel wall MRI were not significantly different (P = .133). The mean scores for the visualization of the stented parent artery on vessel wall MRI were significantly superior to those of TOF-MRA images (P < .001). Vessel wall MRI reached an excellent positive predictive value (100%). However, TOF-MRA had a poor positive predictive value (11%; 95% CI, 9%-12%). The likelihood ratios of vessel wall MRI and TOF-MRA were 27.36 (P < .001) and 2.98 (P = .225), respectively. The concordance rate of vessel wall MRI and TOF-MRA with DSA for evaluating the state of the stented artery was 100% (κ = 1) and 28% (κ = 0.038), respectively. CONCLUSIONS Vessel wall MRI may be useful in evaluating the patency of stented arteries after stent-assisted coil embolization for intracranial aneurysms.
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Affiliation(s)
- S Kim
- From the Departments of Radiology (S.K., M.K., D.W.K.)
| | - M Kang
- From the Departments of Radiology (S.K., M.K., D.W.K.)
| | - D W Kim
- From the Departments of Radiology (S.K., M.K., D.W.K.)
| | - J-H Choi
- Neurosurgery (J.-H.C.), Dong-A University Medical Center, Busan, Korea
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43
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Raoult H, Eugène F, Le Bras A, Mineur G, Carsin-Nicol B, Ferré JC, Gauvrit JY. CT angiography for one-year follow-up of intracranial aneurysms treated with the WEB device: Utility in evaluating aneurysm occlusion and WEB compression at one year. J Neuroradiol 2018. [PMID: 29524499 DOI: 10.1016/j.neurad.2018.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE The WEB is an innovative flow disruption device for cerebral aneurysm embolization with rapidly expanding indications. Our purpose was to evaluate the diagnostic performance of computed tomography angiography (CTA) at 1-year follow-up of aneurysms treated with the WEB. MATERIALS AND METHODS Between April 2014 and May 2016, the study prospectively included patients treated with the WEB at our institution, and followed up within 24hours by CTA and at 1year by CTA, time-of-flight magnetic resonance angiography (TOF MRA) and digital subtraction angiography (DSA). The diagnostic quality of imaging data was assessed based on the confidence index, artifacts, and WEB shape depiction. The imaging diagnostic performance was assessed using 3 criteria at 1year: aneurysm occlusion status and worsening, and WEB shape compression. Interobserver and intermodality agreement was determined by calculating κ values. RESULTS The study ultimately included 16 patients (9 women, mean age 53±7.6years). CTA quality confidence was scored as 2/2, artifacts 0.4/2 and WEB shape depiction 1.9/2, superior to TOF MRA for the latter two criteria. Aneurysm occlusion was adequate in 93.7% of patients, with CTA showing excellent interobserver reproducibility and agreement with DSA on a 4-grade scale (κ=1.00), while TOF MRA yielded good reproducibility (κ=0.76) and agreement with DSA (κ=0.69). CTA also identified aneurysm occlusion worsening (43.7%) and WEB compression (81.2%) in excellent agreement with DSA (κ=0.85 and 1.00). CONCLUSIONS CTA is a reproducible and reliable technique for the follow-up of aneurysms treated with the WEB device.
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Affiliation(s)
- Hélène Raoult
- Rennes University Hospital, Department of Neuroradiology, 2, rue Henri-Le-Guilloux, 35033 Rennes, France.
| | - François Eugène
- Rennes University Hospital, Department of Neuroradiology, 2, rue Henri-Le-Guilloux, 35033 Rennes, France
| | - Anthony Le Bras
- Rennes University Hospital, Department of Neuroradiology, 2, rue Henri-Le-Guilloux, 35033 Rennes, France
| | - Géraldine Mineur
- Rennes University Hospital, Department of Neuroradiology, 2, rue Henri-Le-Guilloux, 35033 Rennes, France
| | - Béatrice Carsin-Nicol
- Rennes University Hospital, Department of Neuroradiology, 2, rue Henri-Le-Guilloux, 35033 Rennes, France
| | - Jean-Christophe Ferré
- Rennes University Hospital, Department of Neuroradiology, 2, rue Henri-Le-Guilloux, 35033 Rennes, France
| | - Jean-Yves Gauvrit
- Rennes University Hospital, Department of Neuroradiology, 2, rue Henri-Le-Guilloux, 35033 Rennes, France
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44
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Unruptured intracranial aneurysms: It is not a bomb! Rev Neurol (Paris) 2017; 173:530-531. [DOI: 10.1016/j.neurol.2017.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 05/12/2017] [Indexed: 11/24/2022]
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45
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Pierot L, Gawlitza M, Soize S. Unruptured intracranial aneurysms: management strategy and current endovascular treatment options. Expert Rev Neurother 2017; 17:977-986. [DOI: 10.1080/14737175.2017.1371593] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Laurent Pierot
- Department of Neuroradiology, CHU Reims, University Reims-Champagne-Ardenne, Reims, France
| | - Matthias Gawlitza
- Department of Neuroradiology, CHU Reims, University Reims-Champagne-Ardenne, Reims, France
| | - Sébastien Soize
- Department of Neuroradiology, CHU Reims, University Reims-Champagne-Ardenne, Reims, France
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46
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Unruptured intracranial aneurysms: An updated review of current concepts for risk factors, detection and management. Rev Neurol (Paris) 2017; 173:542-551. [PMID: 28583271 DOI: 10.1016/j.neurol.2017.05.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 12/03/2016] [Accepted: 05/12/2017] [Indexed: 02/07/2023]
Abstract
The management of patients with unruptured intracranial aneurysms (UIAs) is a complex clinical challenge and constitutes an immense field of research. While a preponderant proportion of these aneurysms never rupture, the consequences of such an event are severe and represent an important healthcare problem. To date, however, the natural history of UIAs is not completely understood and there is no accurate means to discriminate the UIAs that will rupture from those that will not. Yet, a good understanding of the recent evidence and future perspectives is needed when advising a patient with IA to tailor any information to the given patient's level of risk and psychoaffective status. Thus, this review addresses the current concepts of epidemiology, risk factors, detection and management of UIAs.
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47
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Zhang Q, Jing L, Liu J, Wang K, Zhang Y, Paliwal N, Meng H, Wang Y, Wang S, Yang X. Predisposing factors for recanalization of cerebral aneurysms after endovascular embolization: a multivariate study. J Neurointerv Surg 2017; 10:252-257. [PMID: 28377443 DOI: 10.1136/neurintsurg-2017-013041] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 03/09/2017] [Accepted: 03/10/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND The recanalization of cerebral aneurysms after endovascular embolization (coiling or stent-assisted coiling) has been a matter of concern. OBJECTIVE To systematically evaluate the predisposing factors for cerebral aneurysm recanalization using multidimensional analysis in a large patient cohort. METHODS In 238 patients with 283 aneurysms, patient baseline characteristics, aneurysm morphological characteristics, treatment-related factors, and changes in flow hemodynamics after endovascular treatment (coiling or stent-assisted coiling) were compared between the recanalization and non-recanalization groups. Multivariate logistic regression analysis was performed to determine independent risk factors correlated with recanalization. RESULTS 16 aneurysms treated by coiling recanalized, with a recurrence rate of 18.6%, and 24 recanalized in the lesions treated by stent-assisted coiling, with a recanalization rate of 12.2%. Large aneurysms (>10 mm, p=0.002) and a follow-up interval >1 year (p=0.027) were shown to be statistically significant between the recanalization and non-recanalization groups. For flow hemodynamic changes, three parameters (velocity on the neck plane, wall shear stress on the neck wall, and wall shear stress on the whole aneurysm) showed a relatively lower amplitude of decrease after endovascular treatment in the recanalization group. Interestingly, the velocity on the neck plane and wall shear stress on the neck wall may be elevated after treatment. Specifically, the reduction ratio (RR) of velocity on the neck plane showed significant difference between the groups in the multivariate analysis (p=0.013), and was considered an independent risk factor for recanalization. CONCLUSIONS The aneurysm size, follow-up interval, and flow hemodynamic changes, especially the RR of velocity on the neck plane, have important roles in aneurysm recanalization.
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Affiliation(s)
- Qianqian Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Linkai Jing
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Jian Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Kun Wang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ying Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Nikhil Paliwal
- Toshiba Stroke and Vascular Research Center, University at Buffalo, The State University of New York, Buffalo, New York, USA.,Department of Mechanical and Aerospace Engineering, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Hui Meng
- Toshiba Stroke and Vascular Research Center, University at Buffalo, The State University of New York, Buffalo, New York, USA.,Department of Mechanical and Aerospace Engineering, University at Buffalo, The State University of New York, Buffalo, New York, USA.,Department of Neurosurgery, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Yang Wang
- Department of Neurosurgery, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, China
| | - Shengzhang Wang
- Institute of Biomechanics, Department of Aeronautics and Astronautics, Fudan University, Shanghai, China
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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48
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Wallaert L, Soize S, De Beule T, Tomas C, Pierot L. Perianeurysmal edema: Prevalence, risk factors and clinical significance. J Neuroradiol 2017. [DOI: 10.1016/j.neurad.2016.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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49
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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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50
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Can we now dispense with DSA in the evaluation of aneurysm occlusion even in the most crucial first follow-up after endovascular treatment? Clin Neurol Neurosurg 2016; 149:136-42. [DOI: 10.1016/j.clineuro.2016.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/27/2016] [Accepted: 08/01/2016] [Indexed: 11/21/2022]
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