nach oben

Erschienen in:

10.07.2023 | Original Article

Aneurysm Isolation is Associated with Complete Occlusion of Aneurysms After Flow Diverter Treatment

verfasst von: Shigeta Fujitani, Wataro Tsuruta, Arisa Tomioka, Daiichiro Ishigami, Tomokazu Sekine, Hisayuki Hosoo, Yuki Kamiya, Yuji Matsumaru

Erschienen in: Clinical Neuroradiology | Ausgabe 4/2023

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Some aneurysms remain patent after treatment with flow diverters (FD) due to residual blood flow in the aneurysm. Several studies have proposed that branches and residual flow are associated with delayed aneurysm occlusion. We propose that aneurysm isolation (i.e., the complete disconnection of the aneurysm from surrounding vessels) might be a possible factor facilitating aneurysm occlusion. This study aimed to determine if aneurysm isolation was a factor associated with aneurysm occlusion after FD treatment.

Methods

We reviewed 80 internal carotid artery (ICA) aneurysms treated with FDs between October 2014 and April 2021. Aneurysm isolation was assessed in high-resolution cone-beam computed tomograms at the end of each treatment. Aneurysms with incorporated branches and those with connections to other branches due to stent malapposition were deemed to be nonisolated. Other factors, such as patient age, sex, anticoagulant use, aneurysm size, adjunct coil use, and the presence of incorporated branches, were considered. The degree of aneurysm occlusion (complete or incomplete) was assessed by follow-up angiograms 12 months after treatment.

Results

Complete occlusion was achieved in 57 of 80 aneurysms (71%). Completely occluded aneurysms had a significantly higher ratio of isolation compared to incompletely occluded aneurysms (91.2% vs. 69.6%, P = 0.032). Multivariate logistic regression analysis showed that aneurysm isolation was the sole significant predictor of complete aneurysm occlusion (odds ratio, OR 19.38; 95% confidence interval, CI 2.280–164.657; P = 0.007).

Conclusion

Aneurysm isolation is a significant factor contributing to complete occlusion after FD treatment.

Becske T, Brinjikji W, Potts MB, Kallmes DF, Shapiro M, Moran CJ, et al. Long-term clinical and angiographic outcomes following pipeline embolization device treatment of complex internal carotid artery aneurysms: five-year results of the pipeline for Uncoilable or failed aneurysms trial. Neurosurgery. 2017; https://doi.org/10.1093/neuros/nyw014.CrossRefPubMed

Kallmes DF, Brinjikji W, Cekirge S, Fiorella D, Hanel RA, Jabbour P, et al. Safety and efficacy of the pipeline embolization device for treatment of intracranial aneurysms: a pooled analysis of 3 large studies. J Neurosurg. 2017; https://doi.org/10.3171/2016.8.JNS16467.CrossRefPubMed

Dinc H, Saatci I, Oguz S, Baltacioglu F, Yildiz A, Donmez H, et al. Long-term clinical and angiographic follow-up results of the dual-layer flow diverter device (FRED) for the treatment of intracranial aneurysms in a multicenter study. Neuroradiology. 2021; https://doi.org/10.1007/s00234-020-02627-1.CrossRefPubMed

Maragkos GA, Ascanio LC, Salem MM, Gopakumar S, Gomez-Paz S, Enriquez-Marulanda A, et al. Predictive factors of incomplete aneurysm occlusion after endovascular treatment with the pipeline embolization device. J Neurosurg. 2020; https://doi.org/10.3171/2019.1.JNS183226.CrossRef

Paliwal N, Tutino VM, Shallwani H, Beecher JS, Damiano RJ, Shakir HJ, et al. Ostium ratio and neck ratio could predict the outcome of sidewall Intracranial aneurysms treated with flow diverters. Am J Neuroradiol. 2019; https://doi.org/10.3174/ajnr.A5953.CrossRefPubMedPubMedCentral

Trivelato FP, Salles Rezende MT, Ulhôa AC, de Castro-Afonso HL, Nakiri GS, Abud DG. Occlusion rates of intracranial aneurysms treated with the Pipeline embolization device: the role of branches arising from the sac. J Neurosurg. 2019; https://doi.org/10.3171/2017.10.JNS172175.CrossRef

O’Kelly CJ, Krings T, Fiorella D, Marotta TR. A novel grading scale for the angiographic assessment of intracranial aneurysms treated using flow diverting stents. Interventional neuroradiology 2010;16(2):133–7. https://doi.org/10.1177/159101991001600204

Kan P, Duckworth E, Puri A, Velat G, Wakhloo A. Treatment failure of fetal posterior communicating artery aneurysms with the pipeline embolization device. J Neurointervent Surg. 2016; https://doi.org/10.1136/neurintsurg-2015-011959.CrossRef

Tsang ACO, Fung AMY, Tsang FCP, Leung GKK, Lee R, Lui WM. Failure of flow diverter treatment of Intracranial aneurysms related to the fetal-type posterior communicating artery. Neurointervention. 2015; https://doi.org/10.5469/neuroint.2015.10.2.60.CrossRefPubMedPubMedCentral

10.

Shapiro M, Becske T, Nelson PK. Learning from failure: persistence of aneurysms following pipeline embolization. J Neurosurg. 2017; https://doi.org/10.3171/2015.12.JNS152065.CrossRefPubMed

11.

Kan P, Srinivasan VM, Mbabuike N, Tawk RG, Ban VS, Welch BG, et al. Aneurysms with persistent patency after treatment with the pipeline embolization device. J Neurosurg. 2016; https://doi.org/10.3171/2016.6.JNS16402.CrossRefPubMed

12.

Chiu AHY, Cheung AK, Wenderoth JD, de Villiers L, Rice H, Phatouros CC, et al. Long-term follow-up results following elective treatment of unruptured Intracranial aneurysms with the pipeline embolization device. Am J Neuroradiol. 2015; https://doi.org/10.3174/ajnr.A4329.CrossRefPubMedPubMedCentral

13.

Puffer RC, Kallmes DF, Cloft HJ, Lanzino G. Patency of the ophthalmic artery after flow diversion treatment of paraclinoid aneurysms. J Neurosurg. 2012; https://doi.org/10.3171/2011.11.JNS111612.CrossRefPubMed

14.

Vedantam A, Rao VY, Shaltoni HM, Mawad ME. Incidence and clinical implications of carotid branch occlusion following treatment of internal carotid artery aneurysms with the pipeline embolization device. Neurosurgery. 2015; https://doi.org/10.1227/NEU.0000000000000595.CrossRefPubMed

15.

Dodier P, Frischer JM, Wang W‑T, Auzinger T, Mallouhi A, Serles W, et al. Immediate flow disruption as a prognostic factor after flow diverter treatment: long-term experience with the pipeline embolization device. World Neurosurg. 2018; https://doi.org/10.1016/j.wneu.2018.02.096.CrossRefPubMed

16.

Mut F, Raschi M, Scrivano E, Bleise C, Chudyk J, Ceratto R, et al. Association between hemodynamic conditions and occlusion times after flow diversion in cerebral aneurysms. J Neurointervent Surg. 2015; https://doi.org/10.1136/neurintsurg-2013-011080.CrossRef

17.

Chen J, Zhang Y, Tian Z, Li W, Zhang Q, Zhang Y, et al. Relationship between haemodynamic changes and outcomes of intracranial aneurysms after implantation of the pipeline embolisation device: a single centre study. Interv Neuroradiol. 2019; https://doi.org/10.1177/1591019919849673.CrossRefPubMedPubMedCentral

18.

King RM, Brooks OW, Langan ET, Caroff J, Clarençon F, Tamura T, et al. Communicating malapposition of flow diverters assessed with optical coherence tomography correlates with delayed aneurysm occlusion. J Neurointervent Surg. 2018; https://doi.org/10.1136/neurintsurg-2017-013502.CrossRef

19.

Nossek E, Chalif DJ, Chakraborty S, Lombardo K, Black KS, Setton A. Concurrent use of the Pipeline Embolization Device and coils for intracranial aneurysms: technique, safety, and efficacy. J Neurosurg. 2015; https://doi.org/10.3171/2014.12.JNS141259.CrossRefPubMed

20.

Park MS, Nanaszko M, Sanborn MR, Moon K, Albuquerque FC, McDougall CG. Re-treatment rates after treatment with the Pipeline Embolization Device alone versus Pipeline and coil embolization of cerebral aneurysms: a single-center experience. J Neurosurg. 2016; https://doi.org/10.3171/2015.7.JNS15582.CrossRefPubMed

21.

Zhang M, Tian Z, Zhang Y, Zhang Y, Wang K, Leng X, et al. How to perform intra-aneurysmal coil embolization after Pipeline deployment: a study from a hemodynamic viewpoint. J Neurointervent Surg. 2022; https://doi.org/10.1136/neurintsurg-2021-018361.CrossRef

22.

Rouchaud A, Ramana C, Brinjikji W, Ding Y‑H, Dai D, Gunderson T, et al. Wall apposition is a key factor for aneurysm occlusion after flow diversion: a histologic evaluation in 41 rabbits. AJNR Am J Neuroradiol. 2016; https://doi.org/10.3174/ajnr.A4848.CrossRefPubMedPubMedCentral

23.

Flood TF, van der Bom IMJ, Strittmatter L, Puri AS, Hendricks GM, Wakhloo AK, et al. Quantitative analysis of high-resolution, contrast-enhanced, cone-beam CT for the detection of intracranial in-stent hyperplasia. J Neurointervent Surg. 2015; https://doi.org/10.1136/neurintsurg-2013-010950.CrossRef

Titel: Aneurysm Isolation is Associated with Complete Occlusion of Aneurysms After Flow Diverter Treatment
verfasst von: Shigeta Fujitani
Wataro Tsuruta
Arisa Tomioka
Daiichiro Ishigami
Tomokazu Sekine
Hisayuki Hosoo
Yuki Kamiya
Yuji Matsumaru
Publikationsdatum: 10.07.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: Clinical Neuroradiology / Ausgabe 4/2023
Print ISSN: 1869-1439
Elektronische ISSN: 1869-1447
DOI: https://doi.org/10.1007/s00062-023-01312-z

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Aneurysm Isolation is Associated with Complete Occlusion of Aneurysms After Flow Diverter Treatment