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Related Experiment Video

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Microsurgical Clip Obliteration of Middle Cerebral Aneurysm Using Intraoperative Flow Assessment
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Entry remnants in flow-diverted aneurysms: Does branch geometry influence aneurysm closure?

M Akli Zetchi1, Adam A Dmytriw2,3, Albert H Chiu4

  • 11 Neurovascular Program, St. Michael's Hospital, University of Toronto, Toronto, Canada.

Interventional Neuroradiology : Journal of Peritherapeutic Neuroradiology, Surgical Procedures and Related Neurosciences
|June 7, 2018
PubMed
Summary

Intracranial aneurysms treated with flow diversion devices are at higher risk of delayed occlusion if they have incorporated branches. Larger angles between the inflow jet and branch direction further increase this risk, impacting treatment outcomes.

Keywords:
Interventional neuroradiologyPipeline Embolization Deviceflow diversionintracranial aneurysmneurosurgery

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Area of Science:

  • Neuroendovascular surgery
  • Cerebrovascular disease management

Background:

  • Delayed occlusion of intracranial aneurysms treated with Pipeline Embolization Device (PED) is often linked to incorporated branches.
  • Flow diversion remains a key treatment, necessitating understanding of factors influencing occlusion rates.

Purpose of the Study:

  • To assess if geometric factors of branch vessels, specifically size and angulation, can be reliably measured.
  • To determine the relationship between these geometric factors and intracranial aneurysm occlusion rates after PED treatment.

Main Methods:

  • Retrospective analysis of 80 aneurysms treated with PED.
  • Measurement of inflow jet/incorporated branch direction angle and branch artery/parent artery ratio by blinded raters.
  • Logistic regression and intra-class correlation coefficient (ICC) analysis for delayed occlusion (defined as absent at one year).

Main Results:

  • Twenty-four aneurysms (30%) had incorporated branches.
  • A trend towards higher inflow jet/incorporated branch direction angle was observed in aneurysms with delayed occlusion.
  • Aneurysms with incorporated branches showed lower one-year occlusion rates (53%) compared to those without (73%).

Conclusions:

  • The presence of an incorporated branch increases the absolute risk of delayed aneurysm occlusion by 20%.
  • Larger angles between the inflow jet and incorporated branch direction correlate with a trend toward lower occlusion rates.
  • Further multicenter investigation incorporating clinical and angiographic variables is warranted.