Angiographic characteristics of ruptured paraclinoid aneurysms: risk factors for rupture

Oh, Se Yang; Kim, Do Young; Kim, Byung Moon; Lee, Kwan Sung; Kim, Bum Soo; Shin, Yong Sam

doi:10.1007/s00701-013-1794-x

Cited by 16 publications

(9 citation statements)

References 40 publications

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“…However, approximately one-third of patients with their OA occluded/narrowed meanwhile experienced new complications. Considering that paraclinoid aneurysms can grow to a large size and have a lower rate of rupture compared to other aneurysms, the source of new symptoms—either from OA occlusion or mass effect caused by coils or IA thrombogenesis—is difficult to pinpoint 71 . Additionally, no new symptoms were observed in patients with a PICA covered by FDSs.…”

Section: Discussionmentioning

confidence: 99%

Flow-diverter stents in intracranial aneurysm treatment: impact on covered cerebral artery branches

Liu,

Cao,

Zhenmei

et al. 2023

International Journal of Surgery

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Objective: Flow diverter stents (FDSs) have attracted interest for intracranial aneurysm (IA) treatment; however, occlusion of side branches and related complications have been reported. This study aimed to investigate the effects of FDSs in IA management when different branches of intracranial arteries are covered. Materials and methods A cross-sectional study was conducted using PUBMED, Embase, Web of Science, and Cochrane databases to include randomized or non-randomized comparative designed studies from January 2000 to August 2022 which reported outcomes of occlusion/narrowing of branches after IA treatment using FDSs. The PRISMA guidelines were used for data abstraction and assessing data quality and validity. Random-effects meta-analysis was conducted to pool the outcomes included incidence rates of occlusion/narrowing of FDS-covered branches, branch occlusion-related symptoms, obliteration of IAs, and ideal clinical outcomes (modified Rankin Scale score ≤ 2). Results: We identified 57 studies involving 3789 patients with IA managed by FDSs covering different branches. During the median imaging follow-up at 12 months, the IA obliteration rate was satisfactory (>70%) when covering the ophthalmic artery (OA), posterior communicating artery (PComA), anterior choroidal artery (AChoA) or anterior cerebral artery (ACA), but not the middle cerebral artery-M2 segment (MCA-M2; 69.5%; 95% CI, 50.8%–77.5%) and posterior inferior cerebellar artery (PICA; 59.1%, 13/22). The overall ideal clinical outcome was observed in 97.4% of patients (95% CI, 95.5%–98.9%). Higher rates of occlusion/narrowing of branches were identified when FDSs covered the ACA (66.6%; 95% CI, 45.1%–85.3%), PComA (44.3%; 95% CI, 34.2%–54.6%), or MCA-M2 (39.2%; 95% CI, 24.5%–40.8%); the risks were lower when covering the OA (13.0%; 95% CI, 9.7%–16.7%), PICA (6.8%; 95% CI, 1.5%–14.5%), and AchoA (0.5%; 95% CI, 0.0%–2.9%). The risk of branch-occlusion-related complications was low (incidence rate <5%) for each of the six evaluated branches. Conclusions: Acceptable outcomes were identified following treatment of IAs when FDSs were placed across each of the six studied cerebral arteries. Treatment decisions regarding FDS placement across branch arteries should be made with the risk of complications from branch occlusion in mind.

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Section: Discussionmentioning

confidence: 99%

Flow-diverter stents in intracranial aneurysm treatment: impact on covered cerebral artery branches

Liu,

Cao,

Zhenmei

et al. 2023

International Journal of Surgery

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“…There was no significant correlation between recurrence rates depending on the projection of aneurysm in our study. Oh et al 19) reported that superiorly located paraclinoid aneurysms appear more likely to rupture than other locations in an analysis of 265 paraclinoid aneurysms. Lee et al 12) reported rupture in four out of eight dorsal wall aneurysms which showed rapid growth and configurational change.…”

Section: Discussionmentioning

confidence: 99%

Simple Coiling versus Stent-Assisted Coiling of Paraclinoid Aneurysms : Radiological Outcome in a Single Center Study

Kim

Park

et al. 2017

J Korean Neurosurg Soc

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ObjectiveParaclinoid aneurysms are a group of aneurysms arising at the distal internal carotid artery. Due to a high incidence of small, wide-necked aneurysms in this zone, it is often challenging to achieve complete occlusion when solely using detachable coils, thus stent placement is often required. In the present study, we aimed to investigate the effect of stent placement in endovascular treatment of paraclinoid aneurysms.MethodsData of 98 paraclinoid aneurysms treated by endovascular approach in our center from August 2005 to June 2016 were retrospectively reviewed. They were divided into two groups: simple coiling and stent-assisted coiling. Differences in the recurrence and progressive occlusion between the two groups were mainly analyzed. The recurrence was defined as more than one grade worsening according to Raymond-Roy Classification or major recanalization that is large enough to permit retreatment in the follow-up study compared to the immediate post-operative results.ResultsComplete occlusion was achieved immediately after endovascular treatment in eight out of 37 patients (21.6%) in the stent-assisted group and 18 out of 61 (29.5%) in the simple coiling group. In the follow-up imaging studies, the recurrence rate was lower in the stent-assisted group (one out of 37, 2.7%) compared to the simple coiling group (13 out of 61, 21.3%) (p=0.011). Multivariate logistic regression model showed lower recurrence rate in the stent-assisted group than the simple coiling group (odds ratio [OR] 0.051, 95% confidence interval [CI] 0.005–0.527). Furthermore there was also a significant difference in the rate of progressive occlusion between the stent-assisted group (16 out of 29 patients, 55.2%) and the simple coiling group (10 out of 43 patients, 23.3%) (p=0.006). The stent-assisted group also exhibited a higher rate of progressive occlusion than the simple coiling group in the multivariate logistic regression model (OR 3.208, 95% CI 1.106–9.302).ConclusionUse of stents results in good prognosis not only by reducing the recurrence rate but also by increasing the rate of progressive occlusion in wide-necked paraclinoid aneurysms. Stent-assisted coil embolization can be an important treatment strategy for paraclinoid aneurysms when considering the superiority of long term outcome.

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“…7 Several studies identified irregular dome morphology as an independent risk factor of aneurysm rupture when compared with single-sac aneurysm configuration. [8][9][10][11] Although aneurysms with irregular dome shape or multiple sacs account for 30% of UIAs, data on their particular treatment are rare. 12 A widespread classification of aneurysm shape was proposed by the authors of International Study of Unruptured Intracranial Aneurysms (ISUIA) dividing aneurysms into single-sac aneurysms with smooth or irregular margin and aneurysms with daughter sacs as well as multilobe aneurysms.…”

Section: Postoperative Cerebral Ischemiamentioning

confidence: 99%

Predictors of Intraoperative Aneurysm Rupture, Aneurysm Remnant, and Brain Ischemia following Microsurgical Clipping of Intracranial Aneurysms: Single-Center, Retrospective Cohort Study

Świątnicki¹,

Szymański

Szymańska

et al. 2021

J Neurol Surg A Cent Eur Neurosurg

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Background and Study Aims Complete microsurgical clip occlusion of an aneurysm is one of the most important challenges in cerebrovascular surgery. Incorrect position of clip blades as well as intraoperative aneurysm rupture can expose the patient to serious complications such as rebleeding in case of aneurysm remnant and cerebral ischemia in case of occlusion of branching arteries or perforators. The aim of this study was to identify independent predictors of surgery-derived complications (aneurysm remnant and brain ischemia) as well as intraoperative aneurysm rupture in an institutional series of patients. Material and Methods This is a single-institution, retrospective cohort study including 147 patients with 162 aneurysms that were selected for microsurgical clipping due to intracranial aneurysm in a 5-year period. Bivariate and multivariate analyses were performed to identify independent predictors among demographic, clinical, and radiographic factors. Results Increasing aneurysm size with a cutoff value at 9 mm (p = 0.009; odds ratio [OR]: 0.644) and irregular dome shape (p = 0.003; OR: 4.242) were independently associated with brain ischemia and aneurysm remnants that occurred in 13.6 and 17.3% of patients in our group, respectively. Intraoperative rupture was encountered in 27% of patients and its predictors were patient's age (p = 0.002; OR: 1.073) and increasing aneurysm size with a cutoff value at 7 mm (p = 0.003; OR: 1.205). Conclusion Aneurysm size, patient's age, and irregular dome shape were the most important risk factors of aneurysm remnant, brain ischemia, and intraoperative aneurysm rupture in our series of patients. We were not able to define a cutoff value for patient's age, but our results showed that with increasing age the risk of intraoperative aneurysm rupture increased.

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Angiographic characteristics of ruptured paraclinoid aneurysms: risk factors for rupture

Cited by 16 publications

References 40 publications

Flow-diverter stents in intracranial aneurysm treatment: impact on covered cerebral artery branches

Flow-diverter stents in intracranial aneurysm treatment: impact on covered cerebral artery branches

Simple Coiling versus Stent-Assisted Coiling of Paraclinoid Aneurysms : Radiological Outcome in a Single Center Study

Predictors of Intraoperative Aneurysm Rupture, Aneurysm Remnant, and Brain Ischemia following Microsurgical Clipping of Intracranial Aneurysms: Single-Center, Retrospective Cohort Study

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