Imaging Follow-Up of Intracranial Aneurysms Treated by Endovascular Means

Soize, Sébastien; Gawlitza, Matthias; Raoult, Hélène; Piérot, Laurent

doi:10.1161/strokeaha.115.011414

Cited by 67 publications

(49 citation statements)

References 45 publications

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“…In clinical practice, the first follow-up is routinely performed at 6 months as an index of occlusion,3 22 while there is high interpersonal variability for follow-up beyond 6 months, with no safe time interval recommended 22 23. Nguyen et al 16 reported follow-up strategies of 6 months, 1 year, and then every year until 5 years for ruptured aneurysms, and 1 month, 3 months, and then 5 years from initial coiling for unruptured aneurysms.…”

Section: Discussionmentioning

confidence: 99%

Predisposing factors for recanalization of cerebral aneurysms after endovascular embolization: a multivariate study

Zhang

Jing

Liu

et al. 2017

J NeuroIntervent Surg

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Background The recanalization of cerebral aneurysm after endovascular embolization (coiling or stent-assisted coiling) has been a matter of concern. We systematically evaluated the predisposing factors for cerebral aneurysm recanalization using multidimensional analysis in a large patient cohort. Methods In 238 patients with 283 aneurysms, patient baseline characteristics, aneurysm morphological characteristics, treatment-related factors, and changes in flow hemodynamics after endovascular treatment (coiling or stent-assisted coiling) were compared between the recanalization and non-recanalization groups. Multivariate logistic regression analysis was performed to determine independent risk factors correlated with recanalization. Results 16 aneurysms treated by coiling recanalized, with a recurrence rate of 18.6%, and 24 recanalized in the lesions treated by stent-assisted coiling, with a recanalization rate of 12.2%. Large aneurysm (>10 mm, P=0.002) and follow-up interval >1 year (P=0.027) were demonstrated statistically significant between the recanalization and non-recanalization groups. Regarding flow hemodynamics changes, three parameters (velocity on the neck plane, wall shear stress on the neck wall and wall shear stress on the whole aneurysm) showed relatively lower amplitude of decrease after endovascular treatment in the recanalization group. Interestingly, the velocity on the neck plane and wall shear stress on the neck wall may elevated after treatment. Specifically, the RR of velocity on the neck plane showed significant difference in the multivariate analysis (P=0.013), which was considered an independent risk factor for recanalization. Conclusions Besides the aneurysm size and follow-up interval, flow hemodynamic changes, especially the RR of velocity on the neck plane, played important roles in aneurysm recanalization.

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Section: Discussionmentioning

confidence: 99%

Predisposing factors for recanalization of cerebral aneurysms after endovascular embolization: a multivariate study

Zhang

Jing

Liu

et al. 2017

J NeuroIntervent Surg

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“…6 Contrast-enhanced MRA has been reported to yield better results than TOF-MRA for the evaluation of aneurysm occlusions, but the ability of contrast-enhanced MRA to evaluate stented-artery status remains unclear. 7 Furthermore, the use of contrast materials in contrast-enhanced MRA is associated with anaphylactic shock and nephrogenic systemic fibrosis; the frequency of all acute, adverse events after an injection of 0.1 or 0.2 mmol/kg of gadolinium chelate ranges from 0.07% to 2.4%. 8 To reduce this risk, we attempted to find a useful imaging technique to evaluate the stented parent artery as an alternative to both contrast agents and DSA.…”

mentioning

confidence: 99%

Usefulness of Vessel Wall MR Imaging for Follow-Up after Stent-Assisted Coil Embolization of Intracranial Aneurysms

Kim¹,

Kang²,

Kim³

et al. 2018

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Follow-up with MRA for intracranial aneurysms after stent-assisted coiling is complicated by imaging artifacts. We evaluated the usefulness of an alternative method: vessel wall MR imaging. MATERIALS AND METHODS: We conducted a single-center, retrospective review of medical records of 47 patients who underwent 3D TOF-MRA, vessel wall MRI, and DSA after stent-assisted coiling between March 2016 and January 2018. We evaluated the mean value of the signal intensity in the stented artery and the contralateral normal artery on vessel wall MRI. The quality of visualization was further compared between TOF-MRA and vessel wall MRI. Furthermore, we evaluated the diagnostic accuracy and concordance rate of TOF-MRA and vessel wall MRI for assessing the patency of the stented parent artery. DSA was used as a reference test. RESULTS: The mean signal intensities of the stented and normal arteries on vessel wall MRI were not significantly different (P ϭ .133). The mean scores for the visualization of the stented parent artery on vessel wall MRI were significantly superior to those of TOF-MRA images (P Ͻ .001). Vessel wall MRI reached an excellent positive predictive value (100%). However, TOF-MRA had a poor positive predictive value (11%; 95% CI, 9%-12%). The likelihood ratios of vessel wall MRI and TOF-MRA were 27.36 (P Ͻ .001) and 2.98 (P ϭ .225), respectively. The concordance rate of vessel wall MRI and TOF-MRA with DSA for evaluating the state of the stented artery was 100% (ϭ 1) and 28% (ϭ 0.038), respectively. CONCLUSIONS: Vessel wall MRI may be useful in evaluating the patency of stented arteries after stent-assisted coil embolization for intracranial aneurysms.

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“…However, when the aneurysm rupture risk exceeded 1.7% annually, earlier coiling treatment was found to be more effective from an overall healthcare-cost perspective. Several limitations in these studies included heterogeneity of treated aneurysm types (e.g., size, location, rupture status, treatment modality), factoring of upfront risk, limited long-term follow-up, and limited availability of direct financial cost [30]. Our results add to the available literature by suggesting that follow-up costs did not differ between coiling and PED cohorts for the treatment of various unruptured aneurysms; furthermore, these costs were a small fraction of the overall treatment costs.…”

Section: Discussionmentioning

confidence: 99%

Initial Treatment for Unruptured Intracranial Aneurysm and Its Follow-up: A Cost Analysis of Pipeline Flow Diverters versus Coiling

Twitchell

Wilde

Taussky

et al. 2019

Cureus

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PurposeIntracranial aneurysms are relatively common epidemiological problems for which the surveillance, treatment, and follow-up are costly. Although multiple studies have evaluated the treatment cost of aneurysms, the follow-up costs are often not examined. In our study, we analyzed how follow-up costs after treatment affected the overall cost of different endovascular techniques for treating aneurysms.Materials and methodsAn institutional database was used to evaluate the upfront and follow-up costs incurred by patients who underwent elective coiling or placement of a pipeline embolization device (PED) for the treatment of unruptured intracranial aneurysms from July 2011 to December 2017.ResultsA total of 114 patients (coiling, n = 37; PED, n = 77 ) were included in the study. There was no significant difference among patients in mean age [61.3 (±12.8 years) vs. 57.0 (±14.5 years); probability value (p) = 0.2], sex (male: 32.4% vs. 22.1%; p = 0.2), American Society of Anesthesiologists (ASA) grade (p = 0.5), discharge disposition (p = 0.1), mean length of stay [3.1 days (±5.5) vs. 2.4 days (±2.6); p = 0.2) or follow-up period [22.7 months (±18.5) vs. 18.6 months (±14.9); p = 0.2). There were no differences in costs during admission (p = 0.5) or in follow-up (p = 0.3) between coiling and PED treatments. Initial costs were predominantly related to supplies/implants (56.1% vs. 63.7%) for both treatments. Follow-up costs mostly comprised facility costs (68.2% vs. 67.5%), and there were no differences in costs of subgroups such as supplies/implants (10.5% vs. 9.4%), imaging (17.0% vs. 17.8%), or facilties between coiling and PED.ConclusionThese results suggest that the upfront and follow-up costs are mostly similar for the treatment of intracranial aneurysms irrespective of whether the providers used coiling or PED endovascular techniques. Hence, we conclude that follow-up costs should not be a deciding factor when considering these treatments.

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Imaging Follow-Up of Intracranial Aneurysms Treated by Endovascular Means

Cited by 67 publications

References 45 publications

Predisposing factors for recanalization of cerebral aneurysms after endovascular embolization: a multivariate study

Predisposing factors for recanalization of cerebral aneurysms after endovascular embolization: a multivariate study

Usefulness of Vessel Wall MR Imaging for Follow-Up after Stent-Assisted Coil Embolization of Intracranial Aneurysms

Initial Treatment for Unruptured Intracranial Aneurysm and Its Follow-up: A Cost Analysis of Pipeline Flow Diverters versus Coiling

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