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Bae JW, Oh HS, Hong CE, Kim KM, Yoo DH, Kang HS, Cho YD. Extended monitoring of re-coiled cerebral aneurysms after initial postcoiling recanalization: Safety and durability of repeat coil embolization. J Neuroradiol 2024; 51:59-65. [PMID: 37247754 DOI: 10.1016/j.neurad.2023.05.006] [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: 05/05/2023] [Accepted: 05/26/2023] [Indexed: 05/31/2023]
Abstract
PURPOSE In the endovascular era, postcoiling recanalization of cerebral aneurysms is occurring with greater frequency. Repeat coiling is usually done to prevent rebleeding, although long-term outcomes of re-embolization have yet to be adequately investigated. The present study was undertaken to assess clinical and radiographic outcomes of re-embolization in recanalized aneurysms, focusing on procedural safety, efficacy, and durability. METHOD In this retrospective review, we examined 308 patients with 310 recurrent aneurysms. All lesions were re-coiled, once major recanalization (after initial coil embolization) was established. Medical records and radiologic data amassed during extended follow-up were then subject to review. Cox proportional hazards regression analysis was undertaken to identify risk factors for subsequent recurrence. RESULT During a lengthy follow-up (mean, 40.2 ± 33.0 months), major recanalization developed again in 87 aneurysms (28.1%). Multivariable Cox regression analysis linked re-recanalization to initial saccular neck width (p=.003) and autosomal dominant polycystic kidney disease (ADPKD; p<.001). Stent implantation (p=.038) and successful occlusion at second coiling (p=.012) were protective against later recanalization in this setting. The more recent the second embolization was performed, the lower the risk of further recurrence (p=.023). Procedure-related complications included asymptomatic thromboembolism (n = 9), transient ischemic neurologic deficits (n = 2), procedural bleeding (n = 1), and coil migration (n = 1), but there were no residual effects or deaths. CONCLUSION Repeat coil embolization is a safe therapeutic option for recanalized cerebral aneurysms. Wide-necked status and ADPKD emerged as risks for subsequent recanalization, whereas successful occlusion and stent implantation seemed to reduce the likelihood of recurrence after re-embolization procedures.
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Affiliation(s)
- Jin Woo Bae
- Department of Neurosurgery, Inha University Hospital, Incheon, Korea
| | - Han San Oh
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chang-Eui Hong
- Department of Neurosurgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Kang Min Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Hyun Yoo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun-Seung Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Young Dae Cho
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
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Patra DP, Syal A, Rahme RJ, Abi-Aad KR, Singh R, Turcotte EL, Jones BA, Meyer J, Hudson M, Chong BW, Dabus G, James RF, Krishna C, Bendok BR. A comparison of treating physician versus independent core lab assessments of post-aneurysm treatment imaging outcomes: an analysis of prospectively collected data from a randomized trial. J Neurosurg 2023; 139:85-93. [PMID: 36681980 DOI: 10.3171/2022.10.jns22841] [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: 05/18/2022] [Accepted: 10/25/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Aneurysm occlusion has been used as surrogate marker of aneurysm treatment efficacy. Aneurysm occlusion scales are used to evaluate the outcome of endovascular aneurysm treatment and to monitor recurrence. These scales, however, require subjective interpretation of imaging data, which can reduce the utility and reliability of these scales and the validity of clinical studies regarding aneurysm occlusion rates. Use of a core lab with independent blinded reviewers has been implemented to enhance the validity of occlusion rate assessments in clinical trials. The degree of agreement between core labs and treating physicians has not been well studied with prospectively collected data. METHODS In this study, the authors analyzed data from the Hydrogel Endovascular Aneurysm Treatment (HEAT) trial to assess the interrater agreement between the treating physician and the blinded core lab. The HEAT trial included 600 patients across 46 sites with intracranial aneurysms treated with coiling. The treating site and the core lab independently reviewed immediate postoperative and follow-up imaging (3-12 and 18-24 months, respectively) using the Raymond-Roy occlusion classification (RROC) scale, Meyer scale, and recanalization survey. A post hoc analysis was performed to calculate interrater reliability using Cohen's kappa. Further analysis was performed to assess whether degree of agreement varied on the basis of various factors, including scale used, timing of imaging, size of the aneurysm, imaging modality, location of the aneurysm, dome-to-neck ratio, and rupture status. RESULTS Minimal interrater agreement was noted between the core lab reviewers and the treating physicians for assessing aneurysm occlusion using the RROC grading scale (k = 0.39, 95% CI 0.38-0.40) and Meyer scale (k = 0.23, 95% CI 0.14-0.38). The degree of agreement between groups was slightly better but still weak for assessing recanalization (k = 0.45, 95% CI 0.38-0.52). Factors that significantly improved degree of agreement were scales with fewer variables, greater time to follow-up, imaging modality (digital subtraction angiography), and wide-neck aneurysms. CONCLUSIONS Assessment of aneurysm treatment outcome with commonly used aneurysm occlusion scales suffers from risk of poor interrater agreement. This supports the use of independent core labs for validation of outcome data to minimize reporting bias. Use of outcome tools with fewer point categories is likely to provide better interrater reliability. Therefore, the outcome assessment tools are ideal for clinical outcome assessment provided that they are sensitive enough to detect a clinically significant change.
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Affiliation(s)
- Devi P Patra
- 1Department of Neurological Surgery, Mayo Clinic, Phoenix
- 2Precision Neurotherapeutics Innovation Lab, Mayo Clinic, Phoenix
- 3Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona
| | - Arjun Syal
- 4New York Medical College, Valhalla, New York
| | - Rudy J Rahme
- 5Department of Neurosurgery, Global Neuroscience Institute, Philadelphia, Pennsylvania
| | | | - Rohin Singh
- 7Mayo Clinic Alix School of Medicine, Scottsdale, Arizona
| | - Evelyn L Turcotte
- 1Department of Neurological Surgery, Mayo Clinic, Phoenix
- 2Precision Neurotherapeutics Innovation Lab, Mayo Clinic, Phoenix
- 3Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona
| | - Breck A Jones
- 3Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona
- 8Division of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Jenna Meyer
- 1Department of Neurological Surgery, Mayo Clinic, Phoenix
- 2Precision Neurotherapeutics Innovation Lab, Mayo Clinic, Phoenix
- 3Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona
| | - Miles Hudson
- 1Department of Neurological Surgery, Mayo Clinic, Phoenix
- 2Precision Neurotherapeutics Innovation Lab, Mayo Clinic, Phoenix
- 3Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona
| | - Brian W Chong
- 12Department of Radiology, Mayo Clinic, Phoenix, Arizona
| | - Guilherme Dabus
- 9Department of Neuroradiology, Miami Neuroscience Institute, Baptist Health South Florida, Miami, Florida
| | - Robert F James
- 10Department of Neurosurgery, IU Health Physicians Neurosurgery, Indianapolis, Indiana
| | - Chandan Krishna
- 1Department of Neurological Surgery, Mayo Clinic, Phoenix
- 2Precision Neurotherapeutics Innovation Lab, Mayo Clinic, Phoenix
- 3Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona
| | - Bernard R Bendok
- 1Department of Neurological Surgery, Mayo Clinic, Phoenix
- 2Precision Neurotherapeutics Innovation Lab, Mayo Clinic, Phoenix
- 3Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona
- 11Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Phoenix
- 12Department of Radiology, Mayo Clinic, Phoenix, Arizona
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Lakhani DA, Zhou X, Tao S, Westerhold EM, Eidelman BH, Singh Sandhu SJ, Middlebrooks EH. Clinical application of ultra-high resolution compressed sensing time-of-flight MR angiography at 7T to detect small vessel pathology. Neuroradiol J 2023; 36:335-340. [PMID: 36173305 PMCID: PMC10268099 DOI: 10.1177/19714009221129576] [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: 11/16/2022] Open
Abstract
3D time-of-flight (TOF) MR angiography (MRA) benefits from ultra-high-field MRI (≥7 T) due to improved contrast and increased signal-to-noise ratio. However, high-resolution TOF MRA at 7T usually requires longer acquisition times. In addition, relatively higher specific absorption rate (SAR) at 7T limits the choice of optimal pulse sequence parameters, especially if venous saturation is employed. Here, we illustrate the clinical application of ultra-high resolution cerebral 7T TOF MRA using compressed sensing in cases of artery of Percheron and lacunar infarcts, which showed superior resolution and exquisite details pertinent to the clinical diagnosis. The technical challenges associated with high-resolution 7T imaging were alleviated by optimization of sequence parameters and utilization of compressed sensing acceleration.
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Affiliation(s)
- Dhairya A Lakhani
- Department of Radiology, West Virginia University, Morgantown, WV, USA
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Xiangzhi Zhou
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Shengzhen Tao
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
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Yeon EK, Cho YD, Yoo DH, Kim JE, Kim KM, Lee SH, Cho WS, Kang HS. Midterm Outcomes After Low-Profile Visualization Endoluminal Support or Atlas Stent-Assisted Coiling of Intracranial Aneurysms: A Propensity Score Matching Analysis. Neurosurgery 2021; 89:862-866. [PMID: 34382660 DOI: 10.1093/neuros/nyab302] [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] [Received: 09/16/2020] [Accepted: 06/09/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The interplay of various commercially available stents during coil embolization of intracranial aneurysms and their ultimate impact are subject to debate. OBJECTIVE To compare midterm outcomes of Low-Profile Visualization Endoluminal Support (LVIS) (MicroVention Inc) and Atlas (Stryker) stent-assisted coiling procedures. METHODS A total of 459 intracranial aneurysms subjected to coil embolization using LVIS (n = 318) or Atlas stents (n = 141) between April 2015 and December 2019 were eligible for study. To assess occlusive status postembolization, magnetic resonance angiography and/or conventional angiography were used. The Raymond classification was applied to categorize recanalization. Our analysis was propensity score matched according to probability of stent type deployed. RESULTS Eventually, 41 aneurysms (8.9%) displayed recanalization (minor, 28; major, 13) 6 mo after coiling. Patient age (P = .018), sex (P = .015), aneurysmal location (P < .001), and type of aneurysm (P < .001) differed significantly by group. Overall and major recanalization rates at midterm were similar in both groups (9.1% and 8.5% vs 3.1% and 2.1%, respectively), and there was no significant difference even after 1:1 propensity score matching (odds ratio [OR] = 0.75 [P = .514] and OR = 0.75 [P = .706], respectively). CONCLUSION In stent-assisted coil embolization of intracranial aneurysms, midterm outcomes of LVIS and Atlas device groups were similar, despite theoretic LVIS superiority. Further randomized comparative studies are needed to confirm our findings.
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Affiliation(s)
- Eung Koo Yeon
- Department of Radiology, National Medical Center, Seoul, Korea
| | - Young Dae Cho
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Hyun Yoo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Eun Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kang Min Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Ho Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Won-Sang Cho
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun-Seung Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Lim J, Cho YD, Hong N, Lee J, Yoo DH, Kang HS. Follow-up outcomes of intracranial aneurysms treated using braided or laser-cut stents with closed-cell design: a propensity score-matched case-controlled comparison. J Neurointerv Surg 2020; 13:434-437. [PMID: 32817345 DOI: 10.1136/neurintsurg-2020-016165] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND The impact of various stents on patients with intracranial aneurysms who undergo stent-assisted coiling has been debated. We conducted this study to compare follow-up outcomes of coiling procedures involving braided or laser-cut stents with closed-cell design. A propensity score-matched case-controlled analysis was applied. METHODS A total of 413 intracranial aneurysms consecutively coiled using laser-cut (n=245) or braided stents (n=168) in procedures performed between September 2012 and June 2017 were eligible for study. Time-of-flight magnetic resonance angiography, catheter angiography, or both were used to gauge occlusive status after coiling. Recanalization was determined by Raymond classification (complete occlusion vs recanalization). A propensity score-matched analysis was conducted, based on probability of stent type in use. RESULTS Ultimately, 93 coiled aneurysms (22.5%) showed some recanalization (minor, 51; major, 42) during the follow-up period (mean 21.7±14.5 months). Patient gender (P=0.042), hyperlipidemia (P=0.015), size of aneurysm (P=0.004), neck size (P<0.001), type of aneurysm (P<0.001), and packing density (P=0.024) differed significantly by group. Midterm and cumulative recanalization incidence rates in the braided-stent group were initially lower than those of the laser-cut stent group (P=0.009 and P=0.037, respectively) but they did not differ significantly after 1:1 propensity score matching (midterm OR=0.88, P=0.724; cumulative HR=0.91, P=0.758). CONCLUSION In stent-assisted coiling of intracranial aneurysms, laser-cut and braided stent groups produced similar outcomes in follow-up. Consequently, product selection may hinge on suitability for deployment rather than anticipated results.
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Affiliation(s)
- JeongWook Lim
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Young Dae Cho
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Jongno-gu, Seoul, South Korea
| | - Noah Hong
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jeongjun Lee
- Department of Neurosurgery, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, South Korea
| | - Dong Hyun Yoo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Jongno-gu, Seoul, South Korea
| | - Hyun-Seung Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
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Ahmed SU, Mocco J, Zhang X, Kelly M, Doshi A, Nael K, De Leacy R. MRA versus DSA for the follow-up imaging of intracranial aneurysms treated using endovascular techniques: a meta-analysis. J Neurointerv Surg 2019; 11:1009-1014. [PMID: 31048457 DOI: 10.1136/neurintsurg-2019-014936] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 04/10/2019] [Accepted: 04/15/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Treated aneurysms must be followed over time to ensure durable occlusion, as more than 20% of endovascularly treated aneurysms recur. While digital subtraction angiography (DSA) remains the gold standard, magnetic resonance angiography (MRA) is attractive as a non-invasive follow-up technique. Two different MRA techniques have traditionally been used: time-of-flight (TOF) and contrast-enhanced (CE) MRA. We analysed data from studies comparing MRA techniques with DSA for the follow-up of aneurysms undergoing endovascular treatment. Subgroup analysis of stent-assisted coiling (SAC) and flow diversion (FD) techniques was completed. METHODS Comprehensive searches using the Embase, PubMed, and Cochrane databases were performed and updated to November 2018. Pooled sensitivity and specificity were calculated using aneurysm occlusion status as defined by the Raymond-Roy occlusion grading scale. RESULTS The literature search yielded 1579 unique titles. Forty-three studies were included. For TOF-MRA, sensitivity and specificity of all aneurysms undergoing endovascular therapy were 88% and 94%, respectively. For CE-MRA, the sensitivity and specificity were 88% and 96%, respectively. For SAC and FD techniques, sensitivity and specificity of TOF-MRA were 86% and 95%, respectively. CE-MRA had sensitivity and specificity of 90% and 92%. CONCLUSION MRA is a reliable modality for the follow-up of aneurysms treated using endovascular techniques. While the data are limited, MRA techniques can also be used to reliably follow patients undergoing FD and SAC. However, clinical factors must be used to optimize follow-up regimens for individual patients.
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Affiliation(s)
| | - J Mocco
- The Mount Sinai Health System, New York, New York, USA
| | - Xiangnan Zhang
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael Kelly
- Royal University Hospital, University of Saskatchewan, Neurosurgery, Saskatoon, Saskatchewan, Canada
| | - Amish Doshi
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kambiz Nael
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Reade De Leacy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Jiang S, Xie X. Early interventional embolization in the treatment of cerebral aneurysm rupture. Pak J Med Sci 2018; 34:1463-1467. [PMID: 30559804 PMCID: PMC6290242 DOI: 10.12669/pjms.346.15786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: To analyze the clinical effectiveness and safety of early interventional embolization in the treatment of ruptured cerebral aneurysm. Methods: Eighty-eight patients with cerebral aneurysm rupture who were admitted to the hospital between February 2015 and October 2016 were selected as the research subjects and were randomly divided into a control group (N=44) and an observation group (N=44) using random number table. Patients in the control group were given interventional embolization three days after admission, while patients in the observation group were given interventional embolization within three days after admission. The complete, sub complete and incomplete embolization rates were compared between the two groups. The prognosis of the patients was evaluated using modified Rankin scale and modified Barthel index. The incidences of complications were recorded. Results: The complete, sub-complete and incomplete embolization rates of the observation group and control group were significantly different (P<0.05). The modified Rankin score of the observation group was remarkably lower than that of the control group, and the modified Barthel index of the observation group was remarkably higher than that of the control group; the differences had statistical significance (P<0.05). The incidence of complications of the observation group was lower than that of the control group, and the difference had statistical significance (P<0.05). Conclusion: Early interventional embolization has satisfactory effect in the treatment of cerebral aneurysm rupture and effectively improve prognosis; hence it is worth promotion in clinical practice.
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Affiliation(s)
- Song Jiang
- Song Jiang, Department Interventional Treatment, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, 250014, China
| | - Xiufen Xie
- Xiufen Xie, Department Interventional Treatment, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, 250014, China
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Lim JW, Lee J, Cho YD. Progressive Occlusion of Small Saccular Aneurysms Incompletely Occluded After Stent-Assisted Coil Embolization : Analysis of Related Factors and Long-Term Outcomes. Clin Neuroradiol 2017; 28:569-577. [PMID: 28791434 DOI: 10.1007/s00062-017-0612-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 07/18/2017] [Indexed: 12/23/2022]
Abstract
PURPOSE Incompletely occluded aneurysms after coil embolization are subject to recanalization but occasionally progress to a totally occluded state. Deployed stents may actually promote thrombosis of coiled aneurysms. We evaluated outcomes of small aneurysms (<10 mm) wherein saccular filling with contrast medium was evident after stent-assisted coiling, assessing factors implicated in subsequent progressive occlusion. METHODS Between September 2012 and June 2016, a total of 463 intracranial aneurysms were treated by stent-assisted coil embolization. Of these, 132 small saccular aneurysms displayed saccular filling with contrast medium in the immediate aftermath of coiling. Progressive thrombosis was defined as complete aneurysmal occlusion at the 6‑month follow-up point. Rates of progressive occlusion and factors predisposing to this were analyzed via binary logistic regression. RESULTS In 101 (76.5%) of the 132 intracranial aneurysms, complete occlusion was observed in follow-up imaging studies at 6 months. Binary logistic regression analysis indicated that progressive occlusion was linked to smaller neck diameter (odds ratio [OR] = 1.533; p = 0.003), hyperlipidemia (OR = 3.329; p = 0.036) and stent type (p = 0.031). The LVIS stent is especially susceptible to progressive thrombosis, more so than Neuroform (OR = 0.098; p = 0.008) or Enterprise (OR = 0.317; p = 0.098) stents. In 57 instances of progressive thrombosis, followed for ≥12 months (mean 25.0 ± 10.7 months), 56 (98.2%) were stable, with minor recanalization noted once (1.8%) and no major recanalization. CONCLUSION Aneurysms associated with smaller diameter necks, hyperlipidemic states and LVIS stent deployment may be inclined to possible thrombosis, if occlusion immediately after stent-assisted coil embolization is incomplete. In such instances, excellent long-term durability is anticipated.
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Affiliation(s)
- Jeong Wook Lim
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea (Republic of)
| | - Jeongjun Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, 03080, Jongno-gu, Seoul, Korea (Republic of)
| | - Young Dae Cho
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, 03080, Jongno-gu, Seoul, Korea (Republic of).
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Binyamin TR, Dahlin BC, Waldau B. Comparison of 3D TOF MR angiographic accuracy in predicting Raymond grade of flow-diverted versus coiled intracranial aneurysms. J Clin Neurosci 2017; 42:182-185. [PMID: 28457861 DOI: 10.1016/j.jocn.2017.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 03/05/2017] [Indexed: 10/19/2022]
Abstract
The accuracy of 3D time of Flight Magnetic Resonance Angiography (TOF MRA) has been studied extensively for following coiled intracranial aneurysms. It is used by many clinicians for non-invasive follow-up because of its adequate sensitivity in predicting aneurysmal recanalization compared to diagnostic cerebral angiography. The data on the accuracy of 3D TOF MRA for the Pipeline™ Embolization Device (PED) are sparse. In a retrospective chart review, we compared the accuracy of 3D TOF MRA of PED to coil embolization at our institution. 3D TOF MRA had a lower sensitivity and positive predictive value in detecting aneurysmal filling in PED-treated versus coiled aneurysms (57% versus 87% and 80% versus 100%, respectively). Analysis of discrepancies between conventional diagnostic angiography and 3D TOF MRA revealed that 3D TOF MRA was inaccurate in the setting of small residual necks and slow residual filling of the dome with fluid-fluid layers. Therefore, contrasted studies such as contrast-enhanced MRA may be preferred for non-invasively following PED-treated aneurysms to increase accuracy.
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Affiliation(s)
- Tamar R Binyamin
- Department of Neurological Surgery, University of California, Davis, Sacramento, CA 95811, United States
| | - Brian C Dahlin
- Department of Radiology, University of California, Davis, Sacramento, CA 95811, United States
| | - Ben Waldau
- Department of Neurological Surgery, University of California, Davis, Sacramento, CA 95811, United States.
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10
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Jeon JP, Cho YD, Rhim JK, Park JJ, Cho WS, Kang HS, Kim JE, Hwang G, Kwon OK, Han MH. Stent-Assisted Coil Embolization of Vertebrobasilar Dissecting Aneurysms: Procedural Outcomes and Factors for Recanalization. Korean J Radiol 2016; 17:801-10. [PMID: 27587971 PMCID: PMC5007409 DOI: 10.3348/kjr.2016.17.5.801] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 04/24/2016] [Indexed: 12/26/2022] Open
Abstract
Objective Outcomes of stent-assisted coil embolization (SACE) have not been well established in the setting of vertebrobasilar dissecting aneurysms (VBDAs) due to the low percentage of cases that need treatment and the array of available therapeutic options. Herein, we presented clinical and radiographic results of SACE in patients with VBDAs. Materials and Methods A total of 47 patients (M:F, 30:17; mean age ± SD, 53.7 ± 12.6 years), with a VBDA who underwent SACE between 2008 and 2014 at two institutions were evaluated retrospectively. Medical records and radiologic data were analyzed to assess the outcome of SACE procedures. Cox proportional hazards regression analysis was conducted to determine the factors that were associated with aneurysmal recanalization after SACE. Results Stent-assisted coil embolization technically succeeded in all patients. Three cerebellar infarctions occurred on postembolization day 1, week 2, and month 2, but no other procedure-related complications developed. Immediately following SACE, 25 aneurysms (53.2%) showed no contrast filling into the aneurysmal sac. During a mean follow-up of 20.2 months, 37 lesions (78.7%) appeared completely occluded, whereas 10 lesions showed recanalization, 5 of which required additional embolization. Overall recanalization rate was 12.64% per lesion-year, and mean postoperative time to recanalization was 18 months (range, 3–36 months). In multivariable analysis, major branch involvement (hazard ratio [HR]: 7.28; p = 0.013) and the presence of residual sac filling (HR: 8.49, p = 0.044) were identified as statistically significant independent predictors of recanalization. No bleeding was encountered in follow-up monitoring. Conclusion Stent-assisted coil embolization appears feasible and safe for treatment of VBDAs. Long-term results were acceptable in a majority of patients studied, despite a relatively high rate of incomplete occlusion immediately after SACE. Major branch involvement and coiled aneurysms with residual sac filling may predispose to recanalization.
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Affiliation(s)
- Jin Pyeong Jeon
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon 24253, Korea
| | - Young Dae Cho
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Korea
| | - Jong Kook Rhim
- Department of Neurosurgery, Jeju National University College of Medicine, Jeju National University Hospital, Jeju 63241, Korea
| | - Jeong Jin Park
- Department of Neurology, Konkuk University Hospital, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Won-Sang Cho
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Korea
| | - Hyun-Seung Kang
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Korea
| | - Jeong Eun Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Korea
| | - Gyojun Hwang
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - O-Ki Kwon
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Moon Hee Han
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Korea.; Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Korea
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Wrede KH, Matsushige T, Goericke SL, Chen B, Umutlu L, Quick HH, Ladd ME, Johst S, Forsting M, Sure U, Schlamann M. Non-enhanced magnetic resonance imaging of unruptured intracranial aneurysms at 7 Tesla: Comparison with digital subtraction angiography. Eur Radiol 2016; 27:354-364. [DOI: 10.1007/s00330-016-4323-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 03/02/2016] [Accepted: 03/05/2016] [Indexed: 11/25/2022]
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Jeon JP, Cho YD, Rhim JK, Yoo DH, Kang HS, Kim JE, Cho WS, Han MH. Do Contrast-Fill Patterns Immediately After Coil Embolization of Small Saccular Aneurysms Impact Long-Term Results? Clin Neuroradiol 2015; 27:205-211. [PMID: 26608741 DOI: 10.1007/s00062-015-0485-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 11/12/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE It is generally accepted that filling of a saccular aneurysm with contrast immediately after coil embolization predisposes to later recanalization. However, not all such scenarios evolve similarly over time. We investigated outcomes of small (≤ 7 mm) aneurysms with contrast-filled sacs immediately after coil embolization, evaluating the impact of pattern and degree of filling on subsequent recanalization. METHODS Between January, 2008 and December, 2010, 186 small (≤ 7 mm) saccular aneurysms that retained contrast after coil embolization accrued for this study. Lesions were categorized by pattern (eccentric vs. concentric) and degree of filling on working projections. Clinical and morphologic factors were also analyzed to assess impact on subsequent recanalization. Morphologic outcomes at 6 months or more were assessed. RESULTS In 93.5 % (174/186) of aneurysms with visible contrast retention, complete occlusion was evident on follow-up imaging studies at 6 months. Multiple logistic regression analysis indicated that eccentric (vs. concentric) contrast filling carried greater risk of subsequent recanalization (p = 0.020). Stent placement and progressive occlusion were also linked, falling short of statistical significance (p = 0.089). Of 166 progressively occluded aneurysms followed for more than 12 months (mean, 30.8 ± 7.3 months), 158 (95.2 %) exhibited stable occlusion. CONCLUSION Small (≤ 7 mm) aneurysms that retain contrast immediately after coil embolization are more likely to become completely occluded over time through progressive thrombosis. However, an eccentric fill pattern may predispose to recanalization.
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Affiliation(s)
- J P Jeon
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, Korea
| | - Y D Cho
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu Seoul, Seoul 110-744, Seoul, Korea.
| | - J K Rhim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu Seoul, Seoul 110-744, Seoul, Korea
| | - D H Yoo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu Seoul, Seoul 110-744, Seoul, Korea
| | - H-S Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - J E Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - W S Cho
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - M H Han
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu Seoul, Seoul 110-744, Seoul, Korea.,Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Jeon JP, Cho YD, Rhim JK, Park JJ, Cho WS, Kang HS, Kim JE, Han MH. Effect of stenting on progressive occlusion of small unruptured saccular intracranial aneurysms with residual sac immediately after coil embolization: a propensity score analysis. J Neurointerv Surg 2015; 8:1025-9. [DOI: 10.1136/neurintsurg-2015-011947] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 09/28/2015] [Indexed: 11/03/2022]
Abstract
BackgroundTo examine the effect of stenting on progressive occlusion of small and incompletely occluded unruptured intracranial aneurysms (UIAs) ≤10 mm in size using a propensity score matched case controlled analysis.Methods715 small UIAs consecutively treated by coiling between 2008 and 2010 were eligible for study. Time of flight MR angiography and/or catheter angiography were used to estimate extent of occlusion after coiling. Complete occlusion at 6 months post embolization of a sac filled with contrast immediately after coiling constituted progressive occlusion. A propensity score matched analysis was conducted, based on the probability of stent deployment.Results206 (28.8%) small UIAs showed residual sac filling directly after coiling. Of these, 182 (88.3%) displayed progressive occlusion at 6 months. Aneurysm size (p<0.01), neck size (p<0.01), and embolization attempt (p<0.01) differed significantly for stented and non-stented lesions, but the incidence of progressive occlusion did not differ (p=0.78) between the groups. After 1:1 propensity score matching, however, the rate of complete occlusion in stented subjects (97.5%) surpassed that of the non-stented counterparts (OR=9.75, p=0.01).ConclusionsSmall UIAs with residual sac filling after coiling showed a complete occlusion rate of 88.3% at 6 months post embolization. Stent deployment seems to promote complete occlusion in such lesions.
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Ernst M, Yoo AJ, Kriston L, Schönfeld MH, Vettorazzi E, Fiehler J. Is visual evaluation of aneurysm coiling a reliable study end point? Systematic review and meta-analysis. Stroke 2015; 46:1574-81. [PMID: 25944331 DOI: 10.1161/strokeaha.114.008513] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 04/10/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Angiographic occlusion as a surrogate marker of satisfactory aneurysm treatment is commonly used in clinical trials although some pitfalls have to be considered. To investigate the inter-rater reliability of visual rating of aneurysm occlusion as study end point, we performed a systematic review and meta-analysis. METHODS Electronic databases (MEDLINE, EMBASE, PubMed, and the Cochrane Library) were searched up to June 2014. Assessment of risk for bias was based on the Quality Appraisal Tool for Studies of Diagnostic Reliability and the Guidelines for Reporting Reliability and Agreement studies. Inter-rater reliability estimates were pooled across studies using meta-analysis, and the influence of several factors (eg, imaging methods, grading scales, and occlusion rate) was tested with meta-regression. RESULTS From 1193 titles, 644 abstracts and 87 full-text versions were reviewed. Twenty-six articles met the inclusion criteria and provided 77 reliability estimates. Twenty-one different rating scales were used, and statistical analysis varied. Mean inter-rater agreement of the pooled studies was substantial (κ=0.65; 95% confidence interval, 0.60-0.69). Reliability varied significantly as a function of imaging methods, grading scales, occlusion rates, and their interaction. Observer agreement substantially increased with increasing occlusion rate in digital subtraction angiography but not in MR angiography. Reliability was higher in studies using 2- or 3-value grading scales than in studies with 4-value grading scales. CONCLUSIONS There is significant heterogeneity between studies evaluating the reliability of visual evaluation of aneurysm coiling. On the basis of our analysis, we found that the combination of magnetic resonance angiography, 3-value grading scale, and 2 trained raters seems most promising for usage as surrogate study end points.
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Affiliation(s)
- Marielle Ernst
- From the Department of Diagnostic and Interventional Neuroradiology (M.E., M.H.S., J.F.), Department of Medical Psychology (L.K.), and Department of Medical Biometry and Epidemiology (E.V.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston (A.J.Y.).
| | - Albert J Yoo
- From the Department of Diagnostic and Interventional Neuroradiology (M.E., M.H.S., J.F.), Department of Medical Psychology (L.K.), and Department of Medical Biometry and Epidemiology (E.V.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston (A.J.Y.)
| | - Levente Kriston
- From the Department of Diagnostic and Interventional Neuroradiology (M.E., M.H.S., J.F.), Department of Medical Psychology (L.K.), and Department of Medical Biometry and Epidemiology (E.V.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston (A.J.Y.)
| | - Michael H Schönfeld
- From the Department of Diagnostic and Interventional Neuroradiology (M.E., M.H.S., J.F.), Department of Medical Psychology (L.K.), and Department of Medical Biometry and Epidemiology (E.V.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston (A.J.Y.)
| | - Eik Vettorazzi
- From the Department of Diagnostic and Interventional Neuroradiology (M.E., M.H.S., J.F.), Department of Medical Psychology (L.K.), and Department of Medical Biometry and Epidemiology (E.V.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston (A.J.Y.)
| | - Jens Fiehler
- From the Department of Diagnostic and Interventional Neuroradiology (M.E., M.H.S., J.F.), Department of Medical Psychology (L.K.), and Department of Medical Biometry and Epidemiology (E.V.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston (A.J.Y.)
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15
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Douglas AC, Wippold FJ, Broderick DF, Aiken AH, Amin-Hanjani S, Brown DC, Corey AS, Germano IM, Hadley JA, Jagadeesan BD, Jurgens JS, Kennedy TA, Mechtler LL, Patel ND, Zipfel GJ. ACR Appropriateness Criteria Headache. J Am Coll Radiol 2014; 11:657-67. [PMID: 24933450 DOI: 10.1016/j.jacr.2014.03.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 03/30/2014] [Indexed: 10/25/2022]
Abstract
Most patients presenting with uncomplicated, nontraumatic, primary headache do not require imaging. When history, physical, or neurologic examination elicits "red flags" or critical features of the headache, then further investigation with imaging may be warranted to exclude a secondary cause. Imaging procedures may be diagnostically useful for patients with headaches that are: associated with trauma; new, worse, or abrupt onset; thunderclap; radiating to the neck; due to trigeminal autonomic cephalgia; persistent and positional; and temporal in older individuals. Pregnant patients, immunocompromised individuals, cancer patients, and patients with papilledema or systemic illnesses, including hypercoagulable disorders may benefit from imaging. Unlike most headaches, those associated with cough, exertion, or sexual activity usually require neuroimaging with MRI of the brain with and without contrast to exclude potentially underlying pathology before a primary headache syndrome is diagnosed. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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Affiliation(s)
| | | | | | | | - Sepideh Amin-Hanjani
- University of Illinois College of Medicine, Chicago, Illinois; American Association of Neurological Surgeons, Rolling Meadows, Illinois/Congress of Neurological Surgeons, Schaumburg, Illinois
| | | | | | - Isabelle M Germano
- Mount Sinai School of Medicine, New York, New York; American Association of Neurological Surgeons, Rolling Meadows, Illinois/Congress of Neurological Surgeons, Schaumburg, Illinois
| | - James A Hadley
- Physicians Regional Medical Center, Naples, Florida; American Academy of Otolaryngology-Head and Neck Surgery, Alexandria, Virginia
| | | | - Jennifer S Jurgens
- Walter Reed National Military Medical Center, Bethesda, Maryland, Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
| | | | - Laszlo L Mechtler
- Dent Neurologic Institute, Amherst, New York; American Academy of Neurology, Minneapolis, Minnesota
| | | | - Gregory J Zipfel
- Washington University School of Medicine, St. Louis, Missouri, American Association of Neurological Surgeons, Rolling Meadows, Illinois/Congress of Neurological Surgeons, Schaumburg, Illinois
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Neuroimaging follow-up of cerebral aneurysms treated with endovascular techniques. RADIOLOGIA 2014. [DOI: 10.1016/j.rxeng.2014.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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17
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Non-enhanced MR imaging of cerebral aneurysms: 7 Tesla versus 1.5 Tesla. PLoS One 2014; 9:e84562. [PMID: 24400100 PMCID: PMC3882245 DOI: 10.1371/journal.pone.0084562] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 11/22/2013] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To prospectively evaluate 7 Tesla time-of-flight (TOF) magnetic resonance angiography (MRA) in comparison to 1.5 Tesla TOF MRA and 7 Tesla non-contrast enhanced magnetization-prepared rapid acquisition gradient-echo (MPRAGE) for delineation of unruptured intracranial aneurysms (UIA). MATERIAL AND METHODS Sixteen neurosurgical patients (male n = 5, female n = 11) with single or multiple UIA were enrolled in this trial. All patients were accordingly examined at 7 Tesla and 1.5 Tesla MRI utilizing dedicated head coils. The following sequences were obtained: 7 Tesla TOF MRA, 1.5 Tesla TOF MRA and 7 Tesla non-contrast enhanced MPRAGE. Image analysis was performed by two radiologists with regard to delineation of aneurysm features (dome, neck, parent vessel), presence of artifacts, vessel-tissue-contrast and overall image quality. Interobserver accordance and intermethod comparisons were calculated by kappa coefficient and Lin's concordance correlation coefficient. RESULTS A total of 20 intracranial aneurysms were detected in 16 patients, with two patients showing multiple aneurysms (n = 2, n = 4). Out of 20 intracranial aneurysms, 14 aneurysms were located in the anterior circulation and 6 aneurysms in the posterior circulation. 7 Tesla MPRAGE imaging was superior over 1.5 and 7 Tesla TOF MRA in the assessment of all considered aneurysm and image quality features (e.g. image quality: mean MPRAGE7T: 5.0; mean TOF7T: 4.3; mean TOF1.5T: 4.3). Ratings for 7 Tesla TOF MRA were equal or higher over 1.5 Tesla TOF MRA for all assessed features except for artifact delineation (mean TOF7T: 4.3; mean TOF1.5T 4.4). Interobserver accordance was good to excellent for most ratings. CONCLUSION 7 Tesla MPRAGE imaging demonstrated its superiority in the detection and assessment of UIA as well as overall imaging features, offering excellent interobserver accordance and highest scores for all ratings. Hence, it may bear the potential to serve as a high-quality diagnostic tool for pretherapeutic assessment and follow-up of untreated UIA.
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Delgado F, Saiz A, Hilario A, Murias E, San Román Manzanera L, Lagares Gomez-Abascal A, Gabarrós A, González García A. [Neuroimaging follow-up of cerebral aneurysms treated with endovascular techniques]. RADIOLOGIA 2013; 56:118-28. [PMID: 24144295 DOI: 10.1016/j.rx.2013.06.003] [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: 03/12/2013] [Revised: 06/25/2013] [Accepted: 06/25/2013] [Indexed: 11/25/2022]
Abstract
There are no specific recommendations in clinical guidelines about the best time, imaging tests, or intervals for following up patients with intracranial aneurysms treated with endovascular techniques. We reviewed the literature, using the following keywords to search in the main medical databases: cerebral aneurysm, coils, endovascular procedure, and follow-up. Within the Cerebrovascular Disease Group of the Spanish Society of Neuroradiology, we aimed to propose recommendations and an orientative protocol based on the scientific evidence for using neuroimaging to monitor intracranial aneurysms that have been treated with endovascular techniques. We aimed to specify the most appropriate neuroimaging techniques, the interval, the time of follow-up, and the best approach to defining the imaging findings, with the ultimate goal of improving clinical outcomes while optimizing and rationalizing the use of available resources.
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Affiliation(s)
- F Delgado
- Sección de Neurorradiología, Servicio de Radiodiagnóstico, Hospital Reina Sofia, Córdoba, España
| | - A Saiz
- Sección de Neurorradiología, Servicio de Radiodiagnóstico, Hospital Universitario Central de Asturias, Oviedo, España
| | - A Hilario
- Sección de Neurorradiología, Servicio de Radiodiagnóstico, Hospital 12 de Octubre, Madrid, España
| | - E Murias
- Sección de Neurorradiología, Servicio de Radiodiagnóstico, Hospital Universitario Central de Asturias, Oviedo, España
| | - L San Román Manzanera
- Sección de Neurorradiología, Servicio de Radiodiagnóstico, Hospital Clinic, Barcelona, España
| | | | - A Gabarrós
- Servicio Neurocirugía, Hospital de Bellvitge, Barcelona, España
| | - A González García
- Sección de Neurorradiología, Servicio de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, España.
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van Amerongen MJ, Boogaarts HD, de Vries J, Verbeek ALM, Meijer FJA, Prokop M, Bartels RHMA. MRA versus DSA for follow-up of coiled intracranial aneurysms: a meta-analysis. AJNR Am J Neuroradiol 2013; 35:1655-61. [PMID: 24008171 DOI: 10.3174/ajnr.a3700] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
MR angiography is proposed as a safer and less expensive alternative to the reference standard, DSA, in the follow-up of intracranial aneurysms treated with endovascular coil occlusion. We performed a systematic review and meta-analysis to evaluate the accuracy of TOF-MRA and contrast-enhanced MRA in detecting residual flow in the follow-up of coiled intracranial aneurysms. Literature was reviewed through the PubMed, Cochrane, and EMBASE data bases. In comparison with DSA, the sensitivity of TOF-MRA was 86% (95% CI: 82-89%), with a specificity of 84% (95% CI: 81-88%), for the detection of any recurrent flow. For contrast-enhanced MRA, the sensitivity and specificity were 86% (95% CI: 82-89%) and 89% (95% CI: 85-92%), respectively. Both TOF-MRA and contrast-enhanced MRA are shown to be highly accurate for detection of any recanalization in intracranial aneurysms treated with endovascular coil occlusion.
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Affiliation(s)
- M J van Amerongen
- From the Departments of Neurosurgery (M.J.v.A., H.D.B., J.d.V., R.H.M.A.B.)
| | - H D Boogaarts
- From the Departments of Neurosurgery (M.J.v.A., H.D.B., J.d.V., R.H.M.A.B.)
| | - J de Vries
- From the Departments of Neurosurgery (M.J.v.A., H.D.B., J.d.V., R.H.M.A.B.)
| | | | - F J A Meijer
- Radiology/Neuroradiology (F.J.A.M., M.P.), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - M Prokop
- Radiology/Neuroradiology (F.J.A.M., M.P.), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - R H M A Bartels
- From the Departments of Neurosurgery (M.J.v.A., H.D.B., J.d.V., R.H.M.A.B.)
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