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Musmar B, Adeeb N, Gendreau J, Horowitz MA, Salim HA, Sanmugananthan P, Aslan A, Brown NJ, Cancelliere NM, McLellan RM, Algin O, Ghozy S, Dibas M, Orscelik A, Senol YC, Lay SV, Guenego A, Renieri L, Carnevale J, Saliou G, Mastorakos P, El Naamani K, Shotar E, Premat K, Möhlenbruch M, Kral M, Doron O, Chung C, Salem MM, Lylyk I, Foreman PM, Vachhani JA, Shaikh H, Župančić V, Hafeez MU, Catapano J, Waqas M, Tutino VM, Gokhan Y, Imamoglu C, Bayrak A, Rabinov JD, Ren Y, Schirmer CM, Piano M, Kühn AL, Michelozzi C, Elens S, Starke RM, Hassan AE, Ogilvie M, Nguyen A, Jones J, Brinjikji W, Nawka MT, Psychogios M, Ulfert C, Bengzon Diestro JD, Pukenas B, Burkhardt JK, Huynh T, Martinez-Gutierrez JC, Essibayi MA, Sheth SA, Spiegel G, Tawk R, Lubicz B, Panni P, Puri AS, Pero G, Nossek E, Raz E, Killer-Oberfalzer M, Griessenauer CJ, Asadi H, Siddiqui A, Brook AL, Altschul D, Ducruet AF, Albuquerque FC, Regenhardt RW, Stapleton CJ, Kan P, Kalousek V, Lylyk P, Boddu S, Knopman J, Aziz-Sultan MA, Tjoumakaris SI, Clarençon F, Limbucci N, Bydon M, Hasan D, Cuellar-Saenz HH, Jabbour PM, Pereira VM, Patel AB, Dmytriw AA. Creation of a predictive calculator to determine adequacy of occlusion of the woven endobridge (WEB) device in intracranial aneurysms-A retrospective analysis of the WorldWide WEB Consortium database. Interv Neuroradiol 2024:15910199241267320. [PMID: 39127463 DOI: 10.1177/15910199241267320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Endovascular treatment with the woven endobridge (WEB) device has been widely utilized for managing intracranial aneurysms. However, predicting the probability of achieving adequate occlusion (Raymond-Roy classification 1 or 2) remains challenging. OBJECTIVE Our study sought to develop and validate a predictive calculator for adequate occlusion using the WEB device via data from a large multi-institutional retrospective cohort. METHODS We used data from the WorldWide WEB Consortium, encompassing 356 patients from 30 centers across North America, South America, and Europe. Bivariate and multivariate regression analyses were performed on a variety of demographic and clinical factors, from which predictive factors were selected. Calibration and validation were conducted, with variance inflation factor (VIF) parameters checked for collinearity. RESULTS A total of 356 patients were included: 124 (34.8%) were male, 108 (30.3%) were elderly (≥65 years), and 118 (33.1%) were current smokers. Mean maximum aneurysm diameter was 7.09 mm (SD 2.71), with 112 (31.5%) having a daughter sac. In the multivariate regression, increasing aneurysm neck size (OR 0.706 [95% CI: 0.535-0.929], p = 0.13) and partial aneurysm thrombosis (OR 0.135 [95% CI: 0.024-0.681], p = 0.016) were found to be the only statistically significant variables associated with poorer likelihood of achieving occlusion. The predictive calculator shows a c-statistic of 0.744. Hosmer-Lemeshow goodness-of-fit test indicated a satisfactory model fit with a p-value of 0.431. The calculator is available at: https://neurodx.shinyapps.io/WEBDEVICE/. CONCLUSION The predictive calculator offers a substantial contribution to the clinical toolkit for estimating the likelihood of adequate intracranial aneurysm occlusion by WEB device embolization.
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Affiliation(s)
- Basel Musmar
- Departement of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, LA, USA
| | - Nimer Adeeb
- Departement of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, LA, USA
| | - Julian Gendreau
- Departement of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, LA, USA
| | - Melanie Alfonzo Horowitz
- Departement of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, LA, USA
| | - Hamza Adel Salim
- Departement of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, LA, USA
| | - Praveen Sanmugananthan
- Departement of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, LA, USA
| | - Assala Aslan
- Departement of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, LA, USA
| | - Nolan J Brown
- Departement of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, LA, USA
| | - Nicole M Cancelliere
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Rachel M McLellan
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, MA, USA
| | - Oktay Algin
- Department of Radiology, Medical Faculty of Ankara University, Ankara, Turkey
| | - Sherief Ghozy
- Departments of Radiology and Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Mahmoud Dibas
- Departement of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, LA, USA
| | - Atakan Orscelik
- Departments of Radiology and Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Yigit Can Senol
- Departments of Radiology and Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Sovann V Lay
- Service de Neuroradiologie Diagnostique et Thérapeutique, Centre Hospitalier de Toulouse, Hôpital Purpan, Toulouse, France
| | - Adrien Guenego
- Service de Neuroradiologie Interventionnelle, Hôpital Universitaire Erasme, Bruxelles Belgique, Belgium
| | - Leonardo Renieri
- Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy
| | - Joseph Carnevale
- Neurosurgery & Interventional Neuroradiology, New York Presbyterian Hospital, Weill Cornell School of Medicine, New York, NY, USA
| | - Guillaume Saliou
- Service de radiodiagnostic et radiologie interventionnelle, Centre Hospitalier Vaudois de Lausanne, Lausanne, Switzerland
| | | | - Kareem El Naamani
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Eimad Shotar
- Department de Neuroradiologie, Hôpital Pitié-Salpêtrière. Université Sorbonne, Paris, France
| | - Kevin Premat
- Department de Neuroradiologie, Hôpital Pitié-Salpêtrière. Université Sorbonne, Paris, France
| | - Markus Möhlenbruch
- Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Michael Kral
- Department of Neurosurgery, Christian Doppler University Hospital & Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Omer Doron
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, MA, USA
| | - Charlotte Chung
- Departments of Radiology & Neurosurgery, NYU Langone Health Center, New York, NY, USA
| | - Mohamed M Salem
- Department of Neurosurgery, University of Pennsylvania Medical Center, Pennsylvania, PA, USA
| | - Ivan Lylyk
- Equipo de Neurocirugía Endovascular y Radiología Intervencionista, Clínica La Sagrada Familia, Buenos Aires, Argentina
| | - Paul M Foreman
- Neurosurgery Department, Orlando Health Neuroscience and Rehabilitation Institute, Orlando, FL, USA
| | - Jay A Vachhani
- Neurosurgery Department, Orlando Health Neuroscience and Rehabilitation Institute, Orlando, FL, USA
| | - Hamza Shaikh
- Departments of Radiology & Neurosurgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Vedran Župančić
- Subdivision of Interventional Neuroradiology, Department of Radiology, Clinical Hospital Center 'Sisters of Mercy', Zagreb, Croatia
| | - Muhammad U Hafeez
- Department of Neurosurgery, UTMB and Baylor School of Medicine, Houston, TX, USA
| | - Joshua Catapano
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Muhammad Waqas
- Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY, USA
| | - Vincent M Tutino
- Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY, USA
| | - Yuce Gokhan
- Department of Radiology, Medical Faculty of Ankara University, Ankara, Turkey
| | - Cetin Imamoglu
- Department of Radiology, Medical Faculty of Ankara University, Ankara, Turkey
| | - Ahmet Bayrak
- Department of Radiology, Medical Faculty of Ankara University, Ankara, Turkey
| | - James D Rabinov
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, MA, USA
| | - Yifan Ren
- Interventional Radiology and Neurointerventional Services, Department of Radiology, Austin Health, Melbourne, Victoria, Australia
| | - Clemens M Schirmer
- Department of Neurosurgery and Radiology, Geisinger Hospital, Danville, PA, USA
| | - Mariangela Piano
- Interventistica Neurovascolare, Ospedale Niguarda Cà Granda, Milano, Italy
| | - Anna L Kühn
- Department of Neurointerventional Radiology, UMass Memorial Hospital, Worcester, MA, USA
| | | | - Stéphanie Elens
- Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy
| | - Robert M Starke
- Deparment of Neurosurgery, University of Miami, Miami, FL, USA
| | - Ameer E Hassan
- Deparment of Neuroscience, Valley Baptist Neuroscience Institute, Harlingen, TX, USA
| | - Mark Ogilvie
- Deparments of Neurosurgery and Radiology, University of Alabama at Birmingham, Tuscaloosa, AL, USA
| | - Anh Nguyen
- Department of Interventional Neuroradiology, Interventional Neuroradiology, University Hospital of Basel, Basel, Switzerland
| | - Jesse Jones
- Deparments of Neurosurgery and Radiology, University of Alabama at Birmingham, Tuscaloosa, AL, USA
| | - Waleed Brinjikji
- Departments of Radiology and Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Marie T Nawka
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marios Psychogios
- Department of Interventional Neuroradiology, Interventional Neuroradiology, University Hospital of Basel, Basel, Switzerland
| | - Christian Ulfert
- Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Jose Danilo Bengzon Diestro
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Bryan Pukenas
- Department of Neurosurgery, University of Pennsylvania Medical Center, Pennsylvania, PA, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, University of Pennsylvania Medical Center, Pennsylvania, PA, USA
| | - Thien Huynh
- Departments of Radiology and Neurosurgery, Mayo Clinic, Jacksonville, FL, USA
| | - Juan Carlos Martinez-Gutierrez
- Departments of Radiology, Neurology, and Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Muhammed Amir Essibayi
- Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sunil A Sheth
- Departments of Radiology, Neurology, and Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Gary Spiegel
- Departments of Radiology, Neurology, and Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Rabih Tawk
- Departments of Radiology and Neurosurgery, Mayo Clinic, Jacksonville, FL, USA
| | - Boris Lubicz
- Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy
| | - Pietro Panni
- Interventistica Neurovascolare, Ospedale San Raffaele, Milano, Italy
| | - Ajit S Puri
- Department of Neurointerventional Radiology, UMass Memorial Hospital, Worcester, MA, USA
| | - Guglielmo Pero
- Interventistica Neurovascolare, Ospedale Niguarda Cà Granda, Milano, Italy
| | - Erez Nossek
- Departments of Radiology & Neurosurgery, NYU Langone Health Center, New York, NY, USA
| | - Eytan Raz
- Departments of Radiology & Neurosurgery, NYU Langone Health Center, New York, NY, USA
| | - Monika Killer-Oberfalzer
- Department of Neurosurgery, Christian Doppler University Hospital & Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Christoph J Griessenauer
- Department of Neurosurgery, Christian Doppler University Hospital & Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Hamed Asadi
- Departments of Radiology & Neurosurgery, NYU Langone Health Center, New York, NY, USA
| | - Adnan Siddiqui
- Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY, USA
| | - Allan L Brook
- Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - David Altschul
- Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Andrew F Ducruet
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA
| | | | - Robert W Regenhardt
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, MA, USA
| | - Christopher J Stapleton
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, MA, USA
| | - Peter Kan
- Department of Neurosurgery, UTMB and Baylor School of Medicine, Houston, TX, USA
| | - Vladimir Kalousek
- Subdivision of Interventional Neuroradiology, Department of Radiology, Clinical Hospital Center 'Sisters of Mercy', Zagreb, Croatia
| | - Pedro Lylyk
- Equipo de Neurocirugía Endovascular y Radiología Intervencionista, Clínica La Sagrada Familia, Buenos Aires, Argentina
| | - Srikanth Boddu
- Service de radiodiagnostic et radiologie interventionnelle, Centre Hospitalier Vaudois de Lausanne, Lausanne, Switzerland
| | - Jared Knopman
- Service de radiodiagnostic et radiologie interventionnelle, Centre Hospitalier Vaudois de Lausanne, Lausanne, Switzerland
| | | | | | - Frédéric Clarençon
- Department de Neuroradiologie, Hôpital Pitié-Salpêtrière. Université Sorbonne, Paris, France
| | - Nicola Limbucci
- Neurosurgery & Interventional Neuroradiology, New York Presbyterian Hospital, Weill Cornell School of Medicine, New York, NY, USA
| | - Mohamad Bydon
- Departments of Radiology and Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - David Hasan
- Department of Neurosurgery, Duke University Hospital, Durham, NC, USA
| | - Hugo H Cuellar-Saenz
- Departement of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, LA, USA
| | - Pascal M Jabbour
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Vitor Mendes Pereira
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, MA, USA
| | - Aman B Patel
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, MA, USA
| | - Adam A Dmytriw
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, MA, USA
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Marsool Marsool MD, Bharadwaj HR, Ali SH, Aderinto N, Shah MH, Shing N, Dalal P, Huang H, Wellington J, Chaudri T, Awuah WA, Pacheco-Barrios N, Macha-Quillama L, Fernandez-Guzman D, Hussien Mohamed Ahmed KA. Exploring the Landscape of Intracranial Aneurysms in South America: A Comprehensive Narrative Review Intracranial Aneurysms in South America. World Neurosurg 2024; 185:3-25. [PMID: 38286319 DOI: 10.1016/j.wneu.2024.01.108] [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: 12/15/2023] [Accepted: 01/19/2024] [Indexed: 01/31/2024]
Abstract
Exploring the landscape of intracranial aneurysms in South America unravels a complex interplay of epidemiological factors, clinical manifestations, and therapeutic challenges. The study methodically conducts a comprehensive literature review spanning the years 2003 to 2023, focusing on English-language articles obtained from diverse databases to elucidate the multifaceted nature of intracranial aneurysms in the region. Results and discussions categorize outcomes into positive domains, emphasizing successful treatments, favorable recoveries, and high survival rates, while also shedding light on negative aspects such as residual aneurysms and complications. The research illuminates significant gaps in pathological typing of intracranial aneurysms and exposes challenges in healthcare accessibility, notably the disparities in neurosurgical resources. Management challenges, including constrained infrastructure access, a neurosurgeon shortage, and gender disparities, are underscored. Transitioning to future prospects, the study advocates for strategic interventions, proposing expanded neurosurgical training, multidisciplinary approaches, improved funding, enhanced access to care, and fostering international collaborations. The study concludes by emphasizing the pivotal role of collaborative efforts, intensified training programs, and global partnerships in propelling intracranial aneurysm management forward in South America, ultimately contributing to enhanced patient outcomes across the region.
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Affiliation(s)
| | | | - Syed Hasham Ali
- Faculty of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Nicholas Aderinto
- Internal Medicine Department, LAUTECH Teaching Hospital, Oyo, Nigeria
| | | | - Nathanael Shing
- School of Medicine, University of Central Lancashire, Preston, United Kingdom
| | - Priyal Dalal
- School of Medicine, University of Central Lancashire, Preston, United Kingdom
| | - Helen Huang
- University of Medicine and Health Science, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jack Wellington
- Department of Neurosurgery, Bradford Teaching Hospital NHS Foundation Trust, Bradford, United Kingdom
| | | | | | | | - Luis Macha-Quillama
- Alberto Hurtado Medical School, Cayetano Heredia Peruvian University, Lima, Peru
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Pettersson SD, Khorasanizadeh M, Maglinger B, Garcia A, Wang SJ, Taussky P, Ogilvy CS. Trends in the Age of Patients Treated for Unruptured Intracranial Aneurysms from 1990 to 2020. World Neurosurg 2023; 178:233-240.e13. [PMID: 37562685 DOI: 10.1016/j.wneu.2023.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND The decision for treatment for unruptured intracranial aneurysms (UIAs) is often difficult. Innovation in endovascular devices have improved the benefit-to-risk profile especially for elderly patients; however, the treatment guidelines from the past decade often recommend conservative management. It is unknown how these changes have affected the overall age of the patients selected for treatment. Herein, we aimed to study potential changes in the average age of the patients that are being treated over time. METHODS A systematic search of the literature was performed to identify all studies describing the age of the UIAs that were treated by any modality. Scatter diagrams with trend lines were used to plot the age of the patients treated over time and assess the presence of a potential significant trend via statistical correlation tests. RESULTS A total of 280 studies including 83,437 UIAs treated between 1987 and 2021 met all eligibility criteria and were entered in the analysis. Mean age of the patients was 55.5 years, and 70.7% were female. There was a significant increasing trend in the age of the treated patients over time (Spearman r: 0.250; P < 0.001), with a 1-year increase in the average age of the treated patients every 5 years since 1987. CONCLUSIONS The present study indicates that based on the treated UIA patient data published in the literature, older UIAs are being treated over time. This trend is likely driven by safer treatments while suggesting that re-evaluation of certain UIA treatment decision scores may be of great interest.
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Affiliation(s)
- Samuel D Pettersson
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - MirHojjat Khorasanizadeh
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Benton Maglinger
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Alfonso Garcia
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - S Jennifer Wang
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Philipp Taussky
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher S Ogilvy
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
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Khumtong R, Thuncharoenkankha T, Riabroi K, Sakarunchai I, Wichaitum J, Liabsuetrakul T. Changes in Modified Raymond-Roy Classification Occlusion Classes and Predictors of Recurrence-Free Survival in Patients with Intracranial Aneurysms after Endovascular Coil Embolization. J Vasc Interv Radiol 2022; 34:685-693. [PMID: 36539153 DOI: 10.1016/j.jvir.2022.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 12/08/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To assess changes in modified Raymond-Roy classification (MRRC) occlusion classes and recurrence rates over time and evaluate recurrence-free survival after coil embolization and its predictors. MATERIALS AND METHODS During 2007-2016, 201 patients (mean age, 57.1 ± 13.4 years; 75.5% women) with 240 aneurysms treated with coil embolization were enrolled. MRRC Class I (n = 210), Class II (n = 14), Class IIIa (n = 10), and Class IIIb (n =6) closures were assessed. Recurrence was defined as recanalization in MRRC Class I closures or an increase of at least 20% in any of the dimensions of the remnants of the other classes. Recurrence-free survival and its predictors were analyzed using survival analysis. RESULTS Most changes in MRRC class occurred in the first year after treatment. MRRC Class I closures had a slightly lower probability of change than that associated with other classes within 1-5 years, whereas Class IIIb closures remained unchanged. Rates of recurrence or regression for all classes were highest within the first year. The median recurrence-free survival times among patients with Class IIIa and Class IIIb closures were 11.56 and 5.55 months, respectively. Significant predictors of recurrence included aneurysm size of 13-24 mm, ruptured or wide-necked aneurysms, and MRRC Class IIIa or IIIb closures. CONCLUSIONS Class changes and recurrence rates for all MRRC classes were highest in the first year. MRRC Class IIIb closures had the highest recurrence rate and the shortest recurrence-free survival. Recurrence risk increased in Classes IIIa and IIIb and with large, ruptured or wide-necked aneurysms.
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Affiliation(s)
- Rujimas Khumtong
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
| | - Thunyatorn Thuncharoenkankha
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Kittipong Riabroi
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Ittichai Sakarunchai
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Jarudetch Wichaitum
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Tippawan Liabsuetrakul
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Nambu I, Misaki K, Uno T, Yoshikawa A, Uchiyama N, Mohri M, Nakada M. Recurrence pattern predicts aneurysm rupture after coil embolization. PLoS One 2022; 17:e0261996. [PMID: 36129919 PMCID: PMC9491535 DOI: 10.1371/journal.pone.0261996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/15/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Hemorrhage from a recurrent aneurysm is a major concern after coiling for intracranial aneurysms. We aimed to identify aneurysm recurrence patterns associated with hemorrhage. MATERIAL AND METHODS We investigated radiological data of patients who underwent coiling for intracranial aneurysms in 2008-2016 and were followed-up for at least 6 months. Aneurysm recurrence patterns were classified as: type Ⅰ, enlargement of aneurysm neck; type Ⅱ, recurrent cavity within the coil mass; type Ⅲ, recurrent cavity along the aneurysm wall; and type Ⅳ, formation of a daughter sac. We evaluated the incidence of various recurrence patterns with or without hemorrhage. RESULTS Of the 173 aneurysms included in the study (mean follow-up period, 32 months; range, 6-99 months), 22 (13%) recurred and required re-treatment. The recurrence patterns included type Ⅰ, Ⅱ, Ⅲ, and Ⅳ in 7 (4%), 4 (2%), 9 (5%), and 2 (1%) cases, respectively. Most of the type Ⅰ, Ⅱ, and Ⅲ recurrences occurred within 1 year, and type Ⅳ occurred at 7 years after coiling. Three aneurysms exhibited hemorrhage, one with type Ⅲ and two with type Ⅳ pattern. The two aneurysms with type Ⅳ recurrence initially occurred as type Ⅰ; however, the recurrent neck enlarged gradually, resulting in new sac formation. CONCLUSIONS We recommend prompt re-treatment for aneurysms recurring with type Ⅲ or Ⅳ patterns, as such patterns were associated with hemorrhage. Furthermore, we need a special care to type Ⅰ recurrence with enlargement of recurrent neck because this specific pattern may develop to type Ⅳ.
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Affiliation(s)
- Iku Nambu
- Department of Neurosurgery, Kanazawa University School of Medicine, Ishikawa, Japan
| | - Kouichi Misaki
- Department of Neurosurgery, Kanazawa University School of Medicine, Ishikawa, Japan
| | - Takehiro Uno
- Department of Neurosurgery, Kanazawa University School of Medicine, Ishikawa, Japan
| | - Akifumi Yoshikawa
- Department of Neurosurgery, Kanazawa University School of Medicine, Ishikawa, Japan
| | - Naoyuki Uchiyama
- Department of Neurosurgery, Kanazawa University School of Medicine, Ishikawa, Japan
| | - Masanao Mohri
- Department of Neurosurgery, Kanazawa University School of Medicine, Ishikawa, Japan
| | - Mitsutoshi Nakada
- Department of Neurosurgery, Kanazawa University School of Medicine, Ishikawa, Japan
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Fuga M, Tanaka T, Irie K, Kajiwara I, Tachi R, Teshigawara A, Ishibashi T, Hasegawa Y, Murayama Y. Risk factors for recanalization of dense coil packing for unruptured cerebral aneurysms in endovascular coil embolization: Analysis of a single center's experience. J Clin Neurosci 2022; 98:175-181. [PMID: 35183894 DOI: 10.1016/j.jocn.2022.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 11/15/2022]
Abstract
In coil embolization of cerebral aneurysms, inadequate packing is known to increase the probability of recanalization. Even tightly embolized aneurysms may be recanalized, but predictive factors for recanalization have not been fully investigated. This retrospective study aimed to identify risk factors for recanalization of treated aneurysms with a volume embolization ratio (VER) ≥ 25%. A total of 301 unruptured aneurysms in 248 patients who underwent coil embolization between March 2012 and January 2021 were analyzed. Cases involving dissecting aneurysm, intraluminal thrombosis, parent artery occlusion, intraoperative rupture, re-treatment, rupture the day after surgery, postoperative coil migration, and postoperative parent artery occlusion were excluded due to the inaccuracy of VER. A total of 105 aneurysms (34.9%) treated with VER ≥ 25% were extracted. Clinical features (age, sex, medical history, family history), anatomical features (shape, location, aneurysm size, inflow angle, and volume), procedural features (stent-assisted, Raymond-Roy occlusion classification [RROC] immediately after treatment, re-treatment rate), and follow-up period were compared between Recanalization and Non-recanalization groups. Predictors of recanalization were determined using logistic regression and receiver operating characteristic (ROC) curve analyses. Eleven aneurysms were recanalized. In multivariate analysis, RROC class 3 (odds ratio [OR] 11.0; 95% confidence interval [CI] 2.03-59.4) and aneurysm volume (OR 1.005; 95%CI 1.001-1.008) were independent predictors of recanalization. ROC curve analysis showed optimal cutoff values for aneurysm volume of 69.5 mm3 (sensitivity, 81.8%; specificity, 72.3%). In coil embolization of unruptured aneurysms that VER ≥ 25%, cases with RROC class 3 or high aneurysm volume may be associated with a higher risk of recanalization, and should be carefully followed-up.
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Affiliation(s)
- Michiyasu Fuga
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan.
| | - Toshihide Tanaka
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Koreaki Irie
- Department of Neurosurgery, Japan Red Cross Medical Center, Tokyo, Japan
| | - Ikki Kajiwara
- Department of Neurosurgery, National Center for Global Health and Medicine Kounodai Hospital, Chiba, Japan
| | - Rintaro Tachi
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Akihiko Teshigawara
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Toshihiro Ishibashi
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Yuzuru Hasegawa
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
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7
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Yamaguchi S, Ito O, Osaki M, Haruyama H, Nitta T, Sayama T, Arakawa S, Iihara K. Narrowing of the angle of the parent artery after coil embolization increases the risk for aneurysm recurrence. Clin Neurol Neurosurg 2021; 203:106568. [PMID: 33677365 DOI: 10.1016/j.clineuro.2021.106568] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/05/2021] [Accepted: 02/21/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Aneurysm recurrence after coiling is a major complication in some cases, including cases of repeated recurrences. In this study, we identified a relationship between the recurrence of a coiled aneurysm and angle change of the parent artery. METHODS From April 2008 to December 2019, we performed 283 coil embolizations to treat 256 aneurysms in 251 patients. Among these, 21 cases of recurrent saccular aneurysms were selected. The parent artery angle changes between the initial treatment and the first re-treatment were compared between those who underwent single re-treatment and showed no recurrence after the first re-treatment (Group SR, n = 14) and those who required multiple re-treatments (Group MR, n = 7). RESULTS The parent artery angles at the first treatment [medians (interquartile ranges)] were 121.6° (109.3-135.6°) in Group SR and 104.9° (89.9-131.0°) in Group MR; at the second treatment, these angles were 121.2° (105.5-132.7°) and 81.9° (67.0-111.4°), respectively, revealing angle changes of -2.2° (-4.0 to -0.4°) and -16.4° (-30.1 to -8.6°) in Groups SR and MR between the first and second treatments. The between-group differences in the parent artery angles at the second treatment and the changes in the parent artery angle between the first and second treatments were statistically significant. CONCLUSION In patients with recurrent aneurysms, simple aneurysm coiling is not effective when the angle of the parent artery becomes narrower after treatment, relative to that before treatment. Stent placement should be considered for straightening the parent artery or diverting blood flow.
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Affiliation(s)
- Shinya Yamaguchi
- Department of Neurosurgery, Steel Memorial Yawata Hospital, 1-1-1, Harunomachi, Yahatahigashi-Ku Kitakyushu, Fukuoka, 805-0050, Japan.
| | - Osamu Ito
- Department of Neurosurgery, Fukuoka Kieikai Hospital, 5-11-5 Chihaya, Higashi-ku, Fukuoka, 813-0044, Japan
| | - Masato Osaki
- Department of Cerebrovascular Disease, Steel Memorial Yawata Hospital, 1-1-1, Harunomachi, Yahatahigashi-Ku Kitakyushu, Fukuoka, 805-0050, Japan
| | - Hironori Haruyama
- Department of Neurosurgery, Steel Memorial Yawata Hospital, 1-1-1, Harunomachi, Yahatahigashi-Ku Kitakyushu, Fukuoka, 805-0050, Japan
| | - Tomohiko Nitta
- Department of Cerebrovascular Disease, Steel Memorial Yawata Hospital, 1-1-1, Harunomachi, Yahatahigashi-Ku Kitakyushu, Fukuoka, 805-0050, Japan
| | - Tetsuro Sayama
- Department of Neurosurgery, Steel Memorial Yawata Hospital, 1-1-1, Harunomachi, Yahatahigashi-Ku Kitakyushu, Fukuoka, 805-0050, Japan
| | - Shuji Arakawa
- Department of Cerebrovascular Disease, Steel Memorial Yawata Hospital, 1-1-1, Harunomachi, Yahatahigashi-Ku Kitakyushu, Fukuoka, 805-0050, Japan
| | - Koji Iihara
- National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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8
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Krag CH, Speiser L, Dalby RB. Long-term outcomes of endovascular simple coiling versus neurosurgical clipping of unruptured intracranial aneurysms: A systematic review and meta-analysis. J Neurol Sci 2021; 422:117338. [PMID: 33596532 DOI: 10.1016/j.jns.2021.117338] [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: 10/25/2020] [Revised: 12/27/2020] [Accepted: 02/05/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Previous studies on ruptured intracranial aneurysms have shown favourable long-term outcomes of patients undergoing endovascular coiling compared to neurosurgical clipping. We aimed to evaluate if these results also apply to patients with unruptured intracranial aneurysms (UIAs). METHODS Embase, PubMed, and Cochrane Library were systematically searched for all studies reporting long-term (≥3 years) follow-up after coiling or clipping of UIAs. Thirteen studies involving 16,622 coiled patients and 13,606 clipped patients were included. Short-term outcome was defined as death ≤30 days after treatment. Long-term outcomes (>3 years) included all-cause mortality, morbidity (defined as modified Rankin Score 3-5 or Glasgow Outcome Score 2-3), cerebrovascular accident, intracerebral haemorrhage, additional repairs, and lost to follow-up. We calculated relative risk (RR), incidence and mortality rates (IR and MR), together with incidence and mortality rate ratio (IRR and MRR). RESULTS Patients treated with simple coiling had lower short-term mortality than clipped patients (RR = 0.62 (95%CI 0.42-0.91)), but this difference disappeared after long-term follow-up ((MRR) = 0.89 (95%CI: 0.78-1.02). Coiled patients had higher retreatment rates than clipped patients (IRR = 1.70 (95%CI 1.50-1.93)). CONCLUSIONS This systematic review and meta-analysis reports benefits and drawbacks of simple coiling versus neurosurgical clipping of UIAs. Future studies with longer follow-up time should account for differences in coiling techniques and confounding factors such as size and location of UIAs.
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Affiliation(s)
- Christian H Krag
- Health, Aarhus University, Vennelyst Boulevard 4, DK-8000 Aarhus C., Aarhus, Denmark
| | - Lasse Speiser
- Department of Radiology, Section of Neuroradiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, DK-8200 Aarhus N., Denmark
| | - Rikke B Dalby
- Department of Radiology, Section of Neuroradiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, DK-8200 Aarhus N., Denmark.
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9
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Marbacher S, Wanderer S, Strange F, Grüter BE, Fandino J. Saccular Aneurysm Models Featuring Growth and Rupture: A Systematic Review. Brain Sci 2020; 10:brainsci10020101. [PMID: 32069946 PMCID: PMC7071455 DOI: 10.3390/brainsci10020101] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 01/25/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Most available large animal extracranial aneurysm models feature healthy non-degenerated aneurysm pouches with stable long-term follow-ups and extensive healing reactions after endovascular treatment. This review focuses on a small subgroup of extracranial aneurysm models that demonstrated growth and potential rupture during follow-up. METHODS The literature was searched in Medline/Pubmed to identify extracranial in vivo saccular aneurysm models featuring growth and rupture, using a predefined search strategy in accordance with the PRISMA guidelines. From eligible studies we extracted the following details: technique and location of aneurysm creation, aneurysm pouch characteristics, time for model creation, growth and rupture rate, time course, patency rate, histological findings, and associated morbidity and mortality. RESULTS A total of 20 articles were found to describe growth and/or rupture of an experimentally created extracranial saccular aneurysm during follow-up. Most frequent growth was reported in rats (n = 6), followed by rabbits (n = 4), dogs (n = 4), swine (n = 5), and sheep (n = 1). Except for two studies reporting growth and rupture within the abdominal cavity (abdominal aortic artery; n = 2) all other aneurysms were located at the neck of the animal. The largest growth rate, with an up to 10-fold size increase, was found in a rat abdominal aortic sidewall aneurysm model. CONCLUSIONS Extracranial saccular aneurysm models with growth and rupture are rare. Degradation of the created aneurysmal outpouch seems to be a prerequisite to allow growth, which may ultimately lead to rupture. Since it has been shown that the aneurysm wall is important for healing after endovascular therapy, it is likely that models featuring growth and rupture will gain in interest for preclinical testing of novel endovascular therapies.
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Affiliation(s)
- Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Aarau 5000, Switzerland (B.E.G.)
- Cerebrovascular Research Group, Department for BioMedical Research, University of Bern, Bern 3000, Switzerland
- Correspondence: ; Tel.: +41-62-838-5970
| | - Stefan Wanderer
- Department of Neurosurgery, Kantonsspital Aarau, Aarau 5000, Switzerland (B.E.G.)
- Cerebrovascular Research Group, Department for BioMedical Research, University of Bern, Bern 3000, Switzerland
| | - Fabio Strange
- Department of Neurosurgery, Kantonsspital Aarau, Aarau 5000, Switzerland (B.E.G.)
- Cerebrovascular Research Group, Department for BioMedical Research, University of Bern, Bern 3000, Switzerland
| | - Basil E. Grüter
- Department of Neurosurgery, Kantonsspital Aarau, Aarau 5000, Switzerland (B.E.G.)
- Cerebrovascular Research Group, Department for BioMedical Research, University of Bern, Bern 3000, Switzerland
| | - Javier Fandino
- Department of Neurosurgery, Kantonsspital Aarau, Aarau 5000, Switzerland (B.E.G.)
- Cerebrovascular Research Group, Department for BioMedical Research, University of Bern, Bern 3000, Switzerland
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10
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Amelot A, Saliou G, Benichi S, Alias Q, Boulouis G, Zerah M, Aghakhani N, Ozanne A, Blauwblomme T, Naggara O. Long-term Outcomes of Cerebral Aneurysms in Children. Pediatrics 2019; 143:peds.2018-3036. [PMID: 31068385 DOI: 10.1542/peds.2018-3036] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/26/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Our aim was to report the long-term clinical and imaging outcomes of ≤15-year-old children treated for ruptured or symptomatic cerebral aneurysms and to identify prognostic factors for clinical outcome, recurrence, and rebleeding. METHODS We retrospectively identified all pediatric cases of cerebral aneurysm from 2000 to 2015 and then prospectively evaluated long-term occlusion using brain MRI and clinical outcome measures: outcome was considered favorable if King's Outcome Scale for Childhood Head Injury score was ≥5. We performed univariate analysis and logistic binary regression to identify variables associated with clinical and imaging outcomes. RESULTS Fifty-one children (aged 8.5 ± 1.1 years [mean ± SD], with 37 ruptured and 14 symptomatic aneurysms) were included, and endovascular treatments (84%) or microsurgical procedures (16%) were performed. Despite a 19.6% death rate, at a mean follow-up of 8.3 years, 35 children (68.6%) had a favorable outcome. Annual bleeding and aneurysm recurrence rates were 1.4% ± 1.1% and 2.6% ± 1.8%, respectively. Cerebral ischemia, whether initial or delayed within the first month, was predictive of poor clinical outcome in multivariate analysis (odds ratio: 25; 95% confidence interval: 0.43-143; P < .0001), whereas aneurysm size >5 mm was the only factor associated with recurrence (odds ratio: 14.6; 95% confidence interval: 2.4-86.1; P = .003). CONCLUSIONS Two-thirds of studied ≤15-year-old children suffering from ruptured or symptomatic cerebral aneurysms had long-term favorable outcome. Annual bleeding and aneurysm recurrence rates have shown to be low after endovascular or surgical treatment. Long-term imaging follow-up helps to depict aneurysm recurrence or de novo aneurysm formation and to prevent rebleeding.
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Affiliation(s)
- Aymeric Amelot
- Department of Neurosurgery, La Pitié-Salpétrière Hospital, Université Paris Sorbonne, Paris, France; .,Departments of Pediatric Neurosurgery and
| | - Guillaume Saliou
- Departments of Neuroradiology and.,Department of Neuroradiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; and
| | | | | | - Grégoire Boulouis
- Pediatric Radiology, Necker Hospital for Sick Children, Université Paris Descartes, Paris, France.,Department of Neuroradiology, Sainte-Anne Hospital and Université Paris Descartes, INSERM UMR S894, Paris, France
| | | | - Nozar Aghakhani
- Neurosurgery, Kremlin-Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | | | | | - Olivier Naggara
- Pediatric Radiology, Necker Hospital for Sick Children, Université Paris Descartes, Paris, France.,Department of Neuroradiology, Sainte-Anne Hospital and Université Paris Descartes, INSERM UMR S894, Paris, France
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11
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Mendenhall SK, Sahlein DH, Wilson CD, Filley AC, Ordaz J, Ahluwalia RK, Bakare WA, Huh A, Dancour E, Zaazoue MA, Shapiro SA, Cohen-Gadol AA. The Natural History of Coiled Cerebral Aneurysms Stratified by Modified Raymond-Roy Occlusion Classification. World Neurosurg 2019; 128:e417-e426. [PMID: 31042602 DOI: 10.1016/j.wneu.2019.04.167] [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: 01/24/2019] [Revised: 04/18/2019] [Accepted: 04/19/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The natural history and long-term durability of Guglielmi detachable coil (GDC) embolization is still unknown. We hypothesize a stepwise decrease in durability of embolized cerebral aneurysms as stratified by the Modified Raymond-Roy Classification (MRRC). METHODS First-time GDC-embolized cerebral aneurysms were retrospectively reviewed from 2004 to 2015. Loss of durability (LOD) was defined by change in aneurysm size or patency seen on serial radiographic follow-up. Kaplan-Meier survival analysis was performed to evaluate embolization durability. Multivariate Cox regression modeling was used to assess baseline aneurysm and patient characteristics for their effect on LOD. RESULTS A total of 427 patients with 443 aneurysms met the inclusion criteria. Overall, 89 (21%) aneurysms met LOD criteria. Grade 1 aneurysms had statistically significantly greater durability than did all other MRRC grades. Grade 3b aneurysms had significantly worse durability than did all other aneurysm grades. There was no difference in durability between grade 2 and 3a aneurysms. Of aneurysms with LOD, 26 (29%) experienced worsening of MRRC grade. Thirty-five (24%) initial MRRC grade 2, 72 (45%) initial MRRC grade 3a, and 6 (22%) initial MRRC grade 3b aneurysms progressed to MRRC grade 1 without retreatment. In our multivariate analysis, only initial MRRC grade was statistically significantly associated with treatment durability (P < 0.001). CONCLUSIONS MRRC grade is independently associated with first-time GDC-embolized cerebral aneurysm durability. Achieving MRRC grade 1 occlusion outcome is significantly associated with greater long-term GDC durability. Although few aneurysms experience further growth and/or recanalization, most incompletely obliterated aneurysms tend to remain stable over time or even progress to occlusion. Grading scales such as the MRRC are useful for characterizing aneurysm occlusion but may lack sensitivity and specificity for characterizing changes in aneurysm morphology over time.
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Affiliation(s)
- Stephen K Mendenhall
- Department of Neurological Surgery, Indiana University School of Medicine, Goodman Campbell Brain and Spine, Indianapolis, Indiana, USA
| | - Daniel H Sahlein
- Department of Neurological Surgery, Indiana University School of Medicine, Goodman Campbell Brain and Spine, Indianapolis, Indiana, USA
| | - Christopher D Wilson
- Department of Neurological Surgery, Indiana University School of Medicine, Goodman Campbell Brain and Spine, Indianapolis, Indiana, USA
| | - Anna C Filley
- Department of Neurological Surgery, Indiana University School of Medicine, Goodman Campbell Brain and Spine, Indianapolis, Indiana, USA
| | - Josue Ordaz
- Department of Neurological Surgery, Indiana University School of Medicine, Goodman Campbell Brain and Spine, Indianapolis, Indiana, USA
| | - Rahul K Ahluwalia
- Department of Neurological Surgery, Indiana University School of Medicine, Goodman Campbell Brain and Spine, Indianapolis, Indiana, USA
| | - Wale A Bakare
- Department of Neurological Surgery, Indiana University School of Medicine, Goodman Campbell Brain and Spine, Indianapolis, Indiana, USA
| | - Andrew Huh
- Department of Neurological Surgery, Indiana University School of Medicine, Goodman Campbell Brain and Spine, Indianapolis, Indiana, USA
| | - Elie Dancour
- Department of Neurological Surgery, Indiana University School of Medicine, Goodman Campbell Brain and Spine, Indianapolis, Indiana, USA
| | - Mohamed A Zaazoue
- Department of Neurological Surgery, Indiana University School of Medicine, Goodman Campbell Brain and Spine, Indianapolis, Indiana, USA
| | - Scott A Shapiro
- Department of Neurological Surgery, Indiana University School of Medicine, Goodman Campbell Brain and Spine, Indianapolis, Indiana, USA
| | - Aaron A Cohen-Gadol
- Department of Neurological Surgery, Indiana University School of Medicine, Goodman Campbell Brain and Spine, Indianapolis, Indiana, USA.
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12
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Nambu I, Misaki K, Uchiyama N, Mohri M, Suzuki T, Takao H, Murayama Y, Futami K, Kawamura T, Inoguchi Y, Matsuzawa T, Nakada M. High Pressure in Virtual Postcoiling Model is a Predictor of Internal Carotid Artery Aneurysm Recurrence After Coiling. Neurosurgery 2018; 84:607-615. [DOI: 10.1093/neuros/nyy073] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 02/16/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Iku Nambu
- Department of Neurosurgery, Kanazawa University School of Medicine, Ishikawa, Japan
| | - Kouichi Misaki
- Department of Neurosurgery, Kanazawa University School of Medicine, Ishikawa, Japan
| | - Naoyuki Uchiyama
- Department of Neurosurgery, Kanazawa University School of Medicine, Ishikawa, Japan
| | - Masanao Mohri
- Department of Neurosurgery, Kanazawa University School of Medicine, Ishikawa, Japan
| | - Takashi Suzuki
- Department of Mechanical Engineering, Tokyo University of Science, Tokyo, Japan
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Hiroyuki Takao
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Kazuya Futami
- Department of Neurosurgery, Mattoh-Ishikawa Central Hospital, Ishikawa, Japan
| | - Tomoki Kawamura
- Japan Advanced Institute of Science and Technology, Ishikawa, Japan
| | - Yasushi Inoguchi
- Japan Advanced Institute of Science and Technology, Ishikawa, Japan
| | - Teruo Matsuzawa
- Japan Advanced Institute of Science and Technology, Ishikawa, Japan
| | - Mitsutoshi Nakada
- Department of Neurosurgery, Kanazawa University School of Medicine, Ishikawa, Japan
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13
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Lyon KA, Arrey EN, Haider AS, Jeevan DS, Benardete EA. Endovascular treatment of a large ruptured middle cerebral artery bifurcation aneurysm in a 5-week-old infant: case report. J Neurosurg Pediatr 2017; 20:357-363. [PMID: 28777036 DOI: 10.3171/2017.5.peds17116] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Ruptured intracranial aneurysms are extremely rare in infants. The optimal treatment strategy is not well established. Both microsurgical and endovascular techniques and strategies have been tried, and in the literature there is a significant variability in outcome. The authors report the presentation and successful endovascular treatment of a large, ruptured, middle cerebral artery bifurcation aneurysm in a 5-week-old girl, one of only a few reported in the literature. Clinical and radiological findings at follow-up are also presented. The authors then review the literature on aneurysmal subarachnoid hemorrhage in infants, with particular regard to outcome after either endovascular or open surgical management. They also provide recommendations for follow-up in pediatric patients whose intracranial aneurysms have been treated with coil embolization.
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Affiliation(s)
- Kristopher A Lyon
- Department of Neurosurgery, Scott and White Medical Center, Texas A&M University Health Science Center College of Medicine, Temple; and
| | - Eliel N Arrey
- University of Texas Health Science Center, McGovern Medical School, Houston, Texas
| | - Ali S Haider
- Department of Neurosurgery, Scott and White Medical Center, Texas A&M University Health Science Center College of Medicine, Temple; and
| | - Dhruve S Jeevan
- Department of Neurosurgery, Scott and White Medical Center, Texas A&M University Health Science Center College of Medicine, Temple; and
| | - Ethan A Benardete
- Department of Neurosurgery, Scott and White Medical Center, Texas A&M University Health Science Center College of Medicine, Temple; and
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14
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Recurrence of endovascularly and microsurgically treated intracranial aneurysms—review of the putative role of aneurysm wall biology. Neurosurg Rev 2017; 42:49-58. [DOI: 10.1007/s10143-017-0892-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/10/2017] [Accepted: 08/04/2017] [Indexed: 10/19/2022]
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15
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Rinaldo L, Lanzino G. Increased Age Associated with Reduced Likelihood of Recurrence After Coiling of Ruptured Aneurysms. World Neurosurg 2017; 100:381-387. [DOI: 10.1016/j.wneu.2017.01.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 01/06/2017] [Accepted: 01/09/2017] [Indexed: 12/01/2022]
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16
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Sugiyama SI, Niizuma K, Sato K, Rashad S, Kohama M, Endo H, Endo T, Matsumoto Y, Ohta M, Tominaga T. Blood Flow Into Basilar Tip Aneurysms. Stroke 2016; 47:2541-7. [DOI: 10.1161/strokeaha.116.013555] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 08/15/2016] [Indexed: 12/28/2022]
Abstract
Background and Purpose—
Hemodynamic forces may play a role in the recanalization of coiled aneurysms. The purpose of this study was to investigate the influence of presurgical hemodynamics on the efficacy of coil embolization for basilar tip aneurysms.
Methods—
We identified 82 patients who underwent endovascular coil embolization for basilar tip aneurysms with a follow-up of >1 year. Presurgical hemodynamics were investigated using computational fluid dynamics with 3-dimensional data derived from rotational angiography. During postprocessing, we quantified the rate of net flow entering the aneurysm through its neck and calculated the proportion of the aneurysmal inflow rate to the basilar artery flow rate. In addition, we investigated the correlation between the basilar bifurcation configuration and the hemodynamics.
Results—
Twenty-five of the 82 patients were excluded because of difficult vascular geometry reconstruction. Among the 57 examined patients, angiographic recanalization was observed in 19 patients (33.3%). The proportion of the aneurysmal inflow rate to the basilar artery flow rate and a coil packing density <30% were independent and significant predictors for the recanalization of coiled aneurysms. Additional investigation revealed that a small branch angle formed by the basilar artery and the posterior cerebral artery increased blood flow into the aneurysm.
Conclusions—
The proportion of the aneurysmal inflow rate to the basilar artery flow rate, influenced by the basilar bifurcation configuration, was an independent and significant predictor for recanalization after coil embolization in basilar tip aneurysms.
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Affiliation(s)
- Shin-ichiro Sugiyama
- From the Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan (S.-i.S., K.N., S.R., T.T.); Graduate School of Biomedical Engineering (S.-i.S., M.O.) and Institute of Fluid Science (M.O.), Tohoku University, Sendai, Japan; and Department of Neuroanesthesia (S.-i.S., M.K.), Department of Neuroendovascular Therapy (K.S., Y.M.), and Department of Neurosurgery (H.E., T.E.), Kohnan Hospital, Sendai, Japan
| | - Kuniyasu Niizuma
- From the Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan (S.-i.S., K.N., S.R., T.T.); Graduate School of Biomedical Engineering (S.-i.S., M.O.) and Institute of Fluid Science (M.O.), Tohoku University, Sendai, Japan; and Department of Neuroanesthesia (S.-i.S., M.K.), Department of Neuroendovascular Therapy (K.S., Y.M.), and Department of Neurosurgery (H.E., T.E.), Kohnan Hospital, Sendai, Japan
| | - Kenichi Sato
- From the Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan (S.-i.S., K.N., S.R., T.T.); Graduate School of Biomedical Engineering (S.-i.S., M.O.) and Institute of Fluid Science (M.O.), Tohoku University, Sendai, Japan; and Department of Neuroanesthesia (S.-i.S., M.K.), Department of Neuroendovascular Therapy (K.S., Y.M.), and Department of Neurosurgery (H.E., T.E.), Kohnan Hospital, Sendai, Japan
| | - Sherif Rashad
- From the Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan (S.-i.S., K.N., S.R., T.T.); Graduate School of Biomedical Engineering (S.-i.S., M.O.) and Institute of Fluid Science (M.O.), Tohoku University, Sendai, Japan; and Department of Neuroanesthesia (S.-i.S., M.K.), Department of Neuroendovascular Therapy (K.S., Y.M.), and Department of Neurosurgery (H.E., T.E.), Kohnan Hospital, Sendai, Japan
| | - Misaki Kohama
- From the Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan (S.-i.S., K.N., S.R., T.T.); Graduate School of Biomedical Engineering (S.-i.S., M.O.) and Institute of Fluid Science (M.O.), Tohoku University, Sendai, Japan; and Department of Neuroanesthesia (S.-i.S., M.K.), Department of Neuroendovascular Therapy (K.S., Y.M.), and Department of Neurosurgery (H.E., T.E.), Kohnan Hospital, Sendai, Japan
| | - Hidenori Endo
- From the Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan (S.-i.S., K.N., S.R., T.T.); Graduate School of Biomedical Engineering (S.-i.S., M.O.) and Institute of Fluid Science (M.O.), Tohoku University, Sendai, Japan; and Department of Neuroanesthesia (S.-i.S., M.K.), Department of Neuroendovascular Therapy (K.S., Y.M.), and Department of Neurosurgery (H.E., T.E.), Kohnan Hospital, Sendai, Japan
| | - Toshiki Endo
- From the Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan (S.-i.S., K.N., S.R., T.T.); Graduate School of Biomedical Engineering (S.-i.S., M.O.) and Institute of Fluid Science (M.O.), Tohoku University, Sendai, Japan; and Department of Neuroanesthesia (S.-i.S., M.K.), Department of Neuroendovascular Therapy (K.S., Y.M.), and Department of Neurosurgery (H.E., T.E.), Kohnan Hospital, Sendai, Japan
| | - Yasushi Matsumoto
- From the Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan (S.-i.S., K.N., S.R., T.T.); Graduate School of Biomedical Engineering (S.-i.S., M.O.) and Institute of Fluid Science (M.O.), Tohoku University, Sendai, Japan; and Department of Neuroanesthesia (S.-i.S., M.K.), Department of Neuroendovascular Therapy (K.S., Y.M.), and Department of Neurosurgery (H.E., T.E.), Kohnan Hospital, Sendai, Japan
| | - Makoto Ohta
- From the Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan (S.-i.S., K.N., S.R., T.T.); Graduate School of Biomedical Engineering (S.-i.S., M.O.) and Institute of Fluid Science (M.O.), Tohoku University, Sendai, Japan; and Department of Neuroanesthesia (S.-i.S., M.K.), Department of Neuroendovascular Therapy (K.S., Y.M.), and Department of Neurosurgery (H.E., T.E.), Kohnan Hospital, Sendai, Japan
| | - Teiji Tominaga
- From the Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan (S.-i.S., K.N., S.R., T.T.); Graduate School of Biomedical Engineering (S.-i.S., M.O.) and Institute of Fluid Science (M.O.), Tohoku University, Sendai, Japan; and Department of Neuroanesthesia (S.-i.S., M.K.), Department of Neuroendovascular Therapy (K.S., Y.M.), and Department of Neurosurgery (H.E., T.E.), Kohnan Hospital, Sendai, Japan
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Kaesmacher J, Müller-Leisse C, Huber T, Boeckh-Behrens T, Haller B, Shiban E, Friedrich B, Zimmer C, Dorn F, Prothmann S. Volume versus standard coils in the treatment of intracranial aneurysms. J Neurointerv Surg 2015; 8:1034-40. [PMID: 26491040 DOI: 10.1136/neurintsurg-2015-012014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 09/28/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND Volume coils were developed to improve occlusion rates of intracranial aneurysms. Previous studies have shown increased packing density and comparable occlusion rates, but subgroup analyses of aneurysm size have not been carried out. OBJECTIVE To evaluate the safety and efficacy of the Penumbra Coil 400 (PC400) system in treating intracranial aneurysms compared with standard diameter coils. METHODS A monocentric retrospective case review of 260 aneurysms in 233 patients was carried out. In 37 aneurysms the PC400 system was used, while 223 aneurysms were treated with conventional coils. Previously treated aneurysms and aneurysms treated with flow diverters were excluded. Aneurysm and procedure characteristics, packing density, postprocedural and follow-up occlusion grades as well as coil compaction were evaluated. RESULTS Aneurysms treated with PC400 coils had higher volume (218.9 vs 47.1 mm(3), p<0.001), wider necks (3.0 vs 2.5 mm, p=0.005), and greater dome/neck ratio (2.0 vs 1.6, p=0.001) in comparison with aneurysms treated with conventional coils. Compared with controls, in the PC400 group we achieved higher packing densities (43.2% vs 34.4%, p<0.001; in aneurysms ≥7 mm 42.2% vs 27.8%, p<0.001). On follow-up angiography we observed less coil compaction (23.8% vs 64.3%, p=0.003) and less aneurysm recurrence (14.3% vs 40.5%, p=0.046) in aneurysms ≥7 mm when using the PC400 system. CONCLUSIONS Use of the PC400 system as opposed to conventional coils suggests that the PC400 system is safe and effective in treating intracranial aneurysms. Despite having been applied in a potentially more difficult-to-treat group, the use of PC400 was associated with less coil compaction and aneurysm recurrence in aneurysms ≥7 mm.
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Affiliation(s)
- Johannes Kaesmacher
- Abteilung für diagnostische und interventionelle Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Christina Müller-Leisse
- Abteilung für diagnostische und interventionelle Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Thomas Huber
- Abteilung für diagnostische und interventionelle Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Tobias Boeckh-Behrens
- Abteilung für diagnostische und interventionelle Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Bernhard Haller
- Institut für Statistik und Epidemiologie (IMSE), Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Ehab Shiban
- Klinik für Neurochirurgie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Benjamin Friedrich
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Claus Zimmer
- Abteilung für diagnostische und interventionelle Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Franziska Dorn
- Abteilung für Neuroradiologie, Klinikum Großhadern, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Sascha Prothmann
- Abteilung für diagnostische und interventionelle Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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18
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Predictors of treatment failure following coil embolization of intracranial aneurysms. J Clin Neurosci 2015; 22:1275-81. [DOI: 10.1016/j.jocn.2015.03.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 03/02/2015] [Indexed: 11/23/2022]
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19
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Mascitelli JR, Oermann EK, Mocco J, Fifi JT, Paramasivam S, Stapleton CJ, Patel AB. Predictors of success following endovascular retreatment of intracranial aneurysms. Interv Neuroradiol 2015; 21:426-32. [PMID: 26092439 DOI: 10.1177/1591019915590070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Although approximately one in every 10 patients undergoing coil embolization of intracranial aneurysms requires retreatment, the factors that are associated with outcome following retreatment remain to be fully elucidated. METHODS This is a single-center, retrospective review of 43 patients with 58 intracranial aneurysms that were retreated from 2004 to 2014. Aneurysms undergoing first time or microsurgical retreatment were excluded. Retreatment types were grouped into those without permanent parent vessel support (stand-alone and balloon-assisted coiling) versus those with permanent parent vessel support (stent-assisted coiling, stand-alone stenting, and flow diversion). The Modified Raymond Roy Classification was used to group aneurysms at all angiographic follow-up points either in the successful outcome group (Class I or II) or the unsuccessful outcome group (Class IIIa or IIIb). RESULTS Of aneurysms with follow-up, 50% were in the successful group and 50% in the unsuccessful group. In univariate analysis, small aneurysm size (p < 0.001), previous treatment type (p = 0.022), retreatment type (p = 0.001), and initial occlusion class (p = 0.005) were all associated with angiographic outcome. In multivariate analysis, small aneurysm size (p = 0.005, odds ratio (OR) 24.56, confidence interval (CI) 2.68-225.4) and retreatment type with permanent parent vessel support, namely stent-assisted coiling (p = 0.017, OR 31.1, CI 1.89-517.7), were associated with retreatment success. CONCLUSIONS Small aneurysm size and retreatment with permanent parent vessel support, namely stent-assisted coiling, are predictors of success following endovascular retreatment of intracranial aneurysms. These findings could be useful in the effort to both prevent and predict treatment failure following endovascular retreatment.
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Affiliation(s)
- Justin R Mascitelli
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Eric K Oermann
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - J Mocco
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Johanna T Fifi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | | | - Christopher J Stapleton
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Aman B Patel
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, USA
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20
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Mascitelli JR, Oermann EK, De Leacy RA, Moyle H, Patel AB. Angiographic outcome of intracranial aneurysms with neck remnant following coil embolization. J Neurointerv Surg 2014; 7:484-9. [PMID: 24792578 DOI: 10.1136/neurintsurg-2014-011226] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 04/15/2014] [Indexed: 11/04/2022]
Affiliation(s)
- Justin R Mascitelli
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Eric K Oermann
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Reade A De Leacy
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Henry Moyle
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Aman B Patel
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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