Related Experiment Video
Updated: Jan 28, 2026
18:50
Microsurgical Clip Obliteration of Middle Cerebral Aneurysm Using Intraoperative Flow Assessment
Published on: September 25, 2009
14.0K
Aneurysm Remnants after Flow Diversion: Clinical and Angiographic Outcomes
T P Madaelil1, J A Grossberg2, B M Howard1
1From the Departments of Neurointerventional Radiology and Neurosurgery (T.P.M., J.A.G., B.M.H., C.M.C., F.C.T.), Emory University School of Medicine, Atlanta, Georgia.
AJNR. American Journal of Neuroradiology
|March 9, 2019
Summary
Aneurysm remnants after flow diversion treatment are uncommon and rarely cause clinical issues. Overlapping devices and adjunctive coiling may improve complete occlusion rates for complex intracranial aneurysms.
Area of Science:
- Endovascular neurosurgery
- Cerebrovascular disease management
- Medical device technology
Background:
- Flow diversion is a standard treatment for complex intracranial aneurysms.
- The long-term outcomes of flow diversion failure, specifically aneurysm remnants, require further definition.
Purpose of the Study:
- To characterize the clinical and angiographic features of intracranial aneurysms with residual filling after flow diversion treatment.
- To evaluate the natural history and clinical impact of aneurysm remnants post-flow diversion.
Main Methods:
- Retrospective analysis of a prospectively maintained database of Pipeline Embolization Device treatments.
- Inclusion criteria: aneurysms with residual filling on follow-up imaging.
- Angiographic assessment using the O'Kelly-Marotta scale; statistical analysis with Fisher exact and Mann-Whitney U tests.
Main Results:
- Complete occlusion (O'Kelly-Marotta class D) was achieved in 62.4% of patients at 6 months.
- Aneurysm remnants were identified in 25 cases (median follow-up 16 months).
- No clinical sequelae or delayed rupture occurred in patients with aneurysm remnants (median follow-up 31 months).
Conclusions:
- Aneurysm remnants following flow diversion are infrequent and appear to have minimal clinical significance.
- Adjunctive coiling and the use of multiple overlapping devices may increase the likelihood of complete aneurysm occlusion.
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