Three-Dimensional Quantitative Color-Coding Analysis in Predicting the Outcome of Flow Diverter Treatment for Large...

It is important to predict complete obliteration of symptomatic aneurysms after flow diverter (FD) treatment, such as large or giant internal carotid artery aneurysms at the cavernous portion (IC-cav ANs) during the perioperative period for the symptom resolution. Because 3D quantitative color-coding analysis (QCA) is an application of 4D digital subtraction angiography that can evaluate the flow change before and after FD treatment, the aim of this study was to predict the FD treatment outcome for large or giant IC-cav ANs using 3D-QCA during the perioperative period.

3D-QCA images were acquired before and after the FD deployment. The ROIs were set in the terminal bifurcation and petrous segment of the internal carotid artery, and the 3D-QCA transit time was measured by comparing the peak contrast intensities in 2 ROIs (Δtransit time). We investigated the change rate in 3D-QCA transit time before and after placing FD (change rate = post-FD Δtransit time/pre-FD Δtransit time). Treatment outcomes were evaluated using the O'Kelly-Marotta (OKM) grading scale with DSA at 6 months after treatment.

The FD was successfully deployed in all 10 cases without coils. The number of OKM grades B, C, and D with DSA at 6 months after treatment was 3, 3, and 4, respectively. The change rate in 3D-QCA transit time was significantly lower in OKM grade D cases compared with grade B and C (57.8% versus 90.1%; P = .01).

3D-QCA may be effective in predicting the treatment outcome of large or giant IC-cav ANs after FD treatment.