A Novel Grading Scale for the Angiographic Assessment of Intracranial Aneurysms Treated Using Flow Diverting Stents

O’Kelly, Cian; Krings, Timo; Fiorella, David; Marotta, Thomas R.

doi:10.1177/159101991001600204

Cited by 362 publications

(219 citation statements)

References 3 publications

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“…18 On follow-up DSA, we used the technique proposed by O'Kelly and Marotta 16 (OKM grading scale) to evaluate the angiographic result, which was categorized as total filling of the aneurysm (Grade A), subtotal filling (Grade B), entry remnant (Grade C), or no filling (Grade D).…”

Section: Imaging Evaluationmentioning

confidence: 99%

Diffusion-weighted imaging–detected ischemic lesions associated with flow-diverting stents in intracranial aneurysms: safety, potential mechanisms, clinical outcome, and concerns

Iosif

Camilleri²,

Saleme

et al. 2015

JNS

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abbreviatioNs ACA = anterior cerebral artery; AChA = anterior choroidal artery; ACoA = anterior communicating artery; ARU = aspirin reaction unit; cICA = cavernous segment of the internal carotid artery; DSA = digital subtraction angiography; DWI = diffusion-weighted imaging; ECA = external carotid artery; MCA = middle cerebral artery; mRS = modified Rankin Scale; OKM = O'Kelly and Marotta; PCoA = posterior communicating artery; PRU = P2Y12 reactivity unit; SAH = subarachnoid hemorrhage; VA = vertebral artery. submitted November 22, 2013. accepted October 7, 2014. iNclude wheN citiNg Published online January 6, 2015; DOI: 10.3171/2014.10.JNS132566. disclosure The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. obJect It was initially considered safe for flow-diverting stents to cover the ostia of branching vessels during endovascular procedures for the treatment of intracranial aneurysms. As more recent evidence suggests, however, their use is not always free of ischemic concerns in terms of covered arterial ostia. The authors sought to determine the frequency of silent and clinically evident diffusion-weighted imaging (DWI)-detected abnormalities related to stent placement as a means of elucidating potential clinical risks. methods This is a prospective single-center study on a series of patients with intracranial aneurysms that were treated with flow-diverting stents. All patients systematically underwent an MRI protocol that included DWI before treatment, between 24 and 48 hours postprocedure, and 3 months postembolization. Effectiveness of anticoagulation treatment was assessed for all patients. Lesions seen on DWI were correlated to the parent artery and the side-branch territories and were statistically analyzed in relation to their time of occurrence and clinical presentation. The authors compared the DWI findings in these patients to findings obtained in patients treated with a stent-assisted coiling technique during the same time period. results Over the course of 18 consecutive months, 38 consecutive patients (7 males and 31 females) with 49 intracranial aneurysms were treated using flow-diverting stents. Overall, 81.6% of the DWI spots found remained clinically silent during the follow-up period. Five ischemic clinical complications (13.2%) occurred in the postprocedural period. No statistically significant correlation could be established between DWI spots or aneurysm location and clinical complications or follow-up modified Rankin Scale score at 3 months. The complication rate was 7.8% (n = 3) at the 3-month follow-up, and mortality was 0%. Compared with stent-assisted coiling, use of flow-diverting stents showed a statistically significant correlation with silent DWI findings postintervention. coNclusioNs Lesions seen on DWI resulting from the procedure are far more common than anticipated, but the technique remains safe and effective, providing an interesting alternative for "difficult" aneurysms, regardless of ...

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Section: Imaging Evaluationmentioning

confidence: 99%

Diffusion-weighted imaging–detected ischemic lesions associated with flow-diverting stents in intracranial aneurysms: safety, potential mechanisms, clinical outcome, and concerns

Iosif

Camilleri²,

Saleme

et al. 2015

JNS

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“…A new grading scale specifically tailored to the angiographic assessment of aneurysms treated with flow-diverting stents was published by O'Kelly et al, 2 termed the O'Kelly Marotta grading scale. This novel grading scale incorporates 2 dimensions as pa-rameters, which reflect the mechanism by which flow-diverting devices accomplish aneurysm protection: reduction in aneurysm sac filling (filling grade), which reflects an anatomic aspect, and promotion of stasis within the aneurysm sac (stasis grade), which reflects a more dynamic or physiologic parameter (Fig 1).…”

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confidence: 99%

Observer Variability of an Angiographic Grading Scale Used for the Assessment of Intracranial Aneurysms Treated with Flow-Diverting Stents

Joshi¹,

O’Kelly²,

Krings³

et al. 2013

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Novel angiographic grading scales for the assessment of intracranial aneurysms treated with flowdiverting stents have been recently developed because previous angiographic grading scales cannot be applied to these aneurysms. The purpose of this study was to evaluate the inter-and intraobserver variability of the novel O'Kelly Marotta grading scale, which was developed specifically for the angiographic assessment of aneurysms treated with flow-diverting stents.

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“…12) The results were categorized as Grade A: total filling of the aneurysm with contrast (>95%), Grade B: subtotal filling (5%-95%), Grade C: entry remnant (<5%), and Grade D: no filling (0%). Findings such as stent migration, in-stent stenosis, and stent occlusion were also recorded.…”

Section: Assessmentmentioning

confidence: 99%

A Pipeline Embolization Device for the Treatment of Large and Giant Intracranial Aneurysms: Initial Experience at a Single Center

Nakae

Suzuki

Hirata

et al. 2017

JNET

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Objective: The Pipeline Embolization Device (PED) (Covidien, Irvine, CA, USA) is an endovascular microcatheter delivery system for the curative reconstruction of parent arteries harboring large/giant, wide-necked, and fusiform intracranial aneurysms. Here, we describe our initial experience with the PED to evaluate its safety, complications, and effectiveness. Results: A total of 11 complications were experienced by nine patients with a mean follow-up period of 6.5 months. Five major complications defined as ipsilateral stroke in four patients were encountered: two procedure-related ischemic strokes, one delayed ischemic stroke, and two intracerebral hemorrhages. In one patient, the symptom was persistent 3 months post-procedure. Of the other five patients with complications, four went on to recover completely 3 months post-procedure. Overall, the total complication rate for treatment with PED was 39.1% (9/23). Morbidity rate at 3 months post-procedure was 8.7% (2/23), and mortality rate 3 months post-procedure was 0%. Angiographic follow-up examination was carried out in 10 patients at 6 months and revealed no filling (0%) of aneurysm in four patients, entry remnant (<5%) in five, and subtotal filling (5%-95%) in another patient. Conclusion:The PED placement is effective therapy for the treatment of large/giant and wide-necked intracranial aneurysms. Despite the relatively low rate of permanent complications associated with the PED, it is important to note that the total complication rate was not negligible.

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A Novel Grading Scale for the Angiographic Assessment of Intracranial Aneurysms Treated Using Flow Diverting Stents

Cited by 362 publications

References 3 publications

Diffusion-weighted imaging–detected ischemic lesions associated with flow-diverting stents in intracranial aneurysms: safety, potential mechanisms, clinical outcome, and concerns

Diffusion-weighted imaging–detected ischemic lesions associated with flow-diverting stents in intracranial aneurysms: safety, potential mechanisms, clinical outcome, and concerns

Observer Variability of an Angiographic Grading Scale Used for the Assessment of Intracranial Aneurysms Treated with Flow-Diverting Stents

A Pipeline Embolization Device for the Treatment of Large and Giant Intracranial Aneurysms: Initial Experience at a Single Center

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