Entry remnants in flow-diverted aneurysms: Does branch geometry influence aneurysm closure?

Objective Numerous studies have suggested a relationship between delayed occlusion of intracranial aneurysms treated with the Pipeline Embolization Device (PED) and the presence of an incorporated branch. However, in some cases, flow diversion may still be the preferred treatment option. This study...

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Bibliographic Details
Published in:	Interventional neuroradiology Vol. 24; no. 6; pp. 624 - 630
Main Authors:	Zetchi, M Akli, Dmytriw, Adam A, Chiu, Albert H, Drake, Brian J, Alizadeh, Niki V, Bharatha, Aditya, Kulkarni, Abhaya V, Marotta, Thomas R
Format:	Journal Article
Language:	English
Published:	London, England SAGE Publications 01-12-2018
Subjects:	Adult Aged Aneurysm Angiography, Digital Subtraction Anticoagulants - therapeutic use Blood Vessel Prosthesis Embolization, Therapeutic - methods Female Humans Intracranial Aneurysm - diagnostic imaging Intracranial Aneurysm - surgery Male Middle Aged Neurosurgical Procedures - methods Radiography, Interventional Retrospective Studies Risk Assessment Tomography, X-Ray Computed Treatment Outcome intracranial aneurysm neurosurgery flow diversion Pipeline Embolization Device Interventional neuroradiology
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Summary:	Objective Numerous studies have suggested a relationship between delayed occlusion of intracranial aneurysms treated with the Pipeline Embolization Device (PED) and the presence of an incorporated branch. However, in some cases, flow diversion may still be the preferred treatment option. This study sought to determine whether geometric factors pertaining to relative size and angulation of branch vessel(s) can be measured in a reliable fashion and whether they are related to occlusion rates. Methods Eighty aneurysms treated at a single neurovascular center from November 2008 to June 2014 were identified. Two blinded raters prospectively reviewed the imaging performed at the time of the procedure and measured the following geometric variables: inflow jet/incorporated branch direction angle and branch artery/ parent artery ratio. Delayed occlusion was defined as the absence of complete aneurysmal occlusion at one year. Analysis was performed using logistic regression and intra-class correlation co-efficient (ICC). Results Twenty-four (30%) aneurysms with 28 incorporated branches were identified. A trend toward higher inflow jet/incorporated branch direction angle was found in the group of aneurysms demonstrating delayed occlusion when compared to the group with complete occlusion. ICC revealed high correlation. Overall lower one-year occlusion rates of 53% versus 73% for aneurysms with and without incorporated branches, respectively, were also noted. Conclusions The presence of an incorporated branch conferred a 20% absolute risk increase for delayed aneurysmal occlusion. Incorporated branches with a larger angle between the inflow jet and the incorporated branch direction exhibited a trend toward lower occlusion rates. This might be further investigated using a multicenter approach in conjunction with other potentially relevant clinical and angiographic variables.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1591-0199 2385-2011
DOI:	10.1177/1591019918779229