Impact of individual intracranial arterial aneurysm morphology on initial obliteration and recurrence rates of endovascular treatments: a multivariate analysis

Songsaeng, Dittapong; Geibprasert, Sasikhan; Brugge, Karel G. ter; Willinsky, Robert A.; Tymianski, Michael; Krings, Timo

doi:10.3171/2010.8.jns10241

Cited by 63 publications

(44 citation statements)

References 14 publications

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“…However, dome/ neck ratio >2 was associated with major recurrence in the univariate analysis which is not in line with the literature 5,[30][31][32][33][34][35] . This is explained by dome/neck ratio ≤2 being significantly more frequent in our unruptured subcohort while representing an indication for stent placement in our center (selection bias).…”

Section: Discussioncontrasting

confidence: 69%

“…This is explained by dome/neck ratio ≤2 being significantly more frequent in our unruptured subcohort while representing an indication for stent placement in our center (selection bias). Compared to other studies 5,30,34,35 , ours has a relatively higher percentage of stent-assisted procedures. Even though the baseline degree of occlusion was not different among our three types of coiling technique, this multivariate analysis shows that stent-assist technique protects aneurysms against major recurrence, similar to prior studies 17,36 .…”

Section: Discussionmentioning

confidence: 60%

“…We found no significant difference between the ruptured and unruptured subcohorts in terms of baseline class III remnant. Some authors have shown the association between rupture at presentation with any recurrence in general 18,41 or with major recurrence in particular 5 , while others have not [33][34][35] . The larger dimension of the unruptured aneurysms 7,42 seen in our cohort, with significantly more baseline occlusion class I, is proposed as a possible cause of the lack of such an association.…”

Section: Discussionmentioning

confidence: 99%

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Survival Analysis of Risk Factors for Major Recurrence of Intracranial Aneurysms after Coiling

Santos

Sabri

Dowlatshahi

et al. 2015

Can. J. Neurol. Sci.

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Background: Recurrence after intracranial aneurysm coiling is a highly prevalent outcome, yet to be understood. We investigated clinical, radiological and procedural factors associated with major recurrence of coiled intracranial aneurysms. Methods: We retrospectively analyzed prospectively collected coiling data . We recorded characteristics of aneurysms, patients and interventional techniques, pre-discharge and angiographic follow-up occlusion. The Raymond-Roy classification was used; major recurrence was a change from class I or II to class III, increase in class III remnant, and any recurrence requiring any type of retreatment. Identification of risk factors associated with major recurrence used univariate Cox Proportional Hazards Model followed by multivariate regression analysis of covariates with P < 0.1. Results: A total of 467 aneurysms were treated in 435 patients: 283(65%) harboring acutely ruptured aneurysms, 44(10.1%) patients died before discharge and 33(7.6%) were lost to follow-up. A total of 1367 angiographic follow-up studies (range: 1-108 months, Median [interquartile ranges (IQR)]: 37[14-62]) was performed in 384(82.2%) aneurysms. The major recurrence rate was 98(21%) after 6(3.5-22.5) months. Multivariate analysis (358 patients with 384 aneurysms) revealed the risk factors for major recurrence: age > 65 y (hazard ratio (HR): 1.61; P = 0.04), male sex (HR: 2.13; P < 0.01), hypercholesterolemia (HR: 1.65; P = 0.03), neck size ≥4 mm (HR: 1.79; P = 0.01), dome size ≥7 mm (HR: 2.44; P < 0.01), non-stent-assisted coiling (HR: 2.87; P = 0.01), and baseline class III (HR: 2.18; P < 0.01). Conclusion: Approximately one fifth of the intracranial aneurysms resulted in major recurrence. Modifiable factors for major recurrence were choice of stent-assisted technique and confirmation of adequate baseline occlusion (Class I/II) in the first coiling procedure. La classification Raymond-Roy a été utilisée: une récidive majeure était définie comme un changement de la classe I ou II à la classe III, une augmentation résiduelle de classe III et une récidive nécessitant tout type de réintervention. Les facteurs de risque associés à une récidive majeure ont été identifiés au moyen du modèle des risques proportionnels de Cox suivi d'une analyse de régression multivariée des covariables, p < 0,01. Résultats: Au total, 467 anévrismes ont été traités chez 435 patients: 283 patients (65%) présentaient une rupture aiguë de l'anévrisme, 44 patients (10,1%) sont décédés avant le congé hospitalier et 33 (7,6%) ont été perdus au suivi. En tout, 1367 études angiographiques de suivi (écart de 1 à 108 mois ; médiane 37 ; écarts interquartiles de 14 à 62 mois) ont été effectuées pour 384 anévrismes (82,2%). Le taux de récidive majeure a été de 21% (98) après 6 mois (3,5 à 22,5 mois). L'analyse multivariée (358 patients porteurs de 384 anévrismes) a montré que les facteurs de risque d'une récidive majeure étaient: l'âge > 65 ans (risque relatif (RR): 1,61 ; p = 0,04), le sexe masculin (RR: 2,13 ; p < 0,01), l'hypercho...

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Section: Discussioncontrasting

confidence: 69%

Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

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Survival Analysis of Risk Factors for Major Recurrence of Intracranial Aneurysms after Coiling

Santos

Sabri

Dowlatshahi

et al. 2015

Can. J. Neurol. Sci.

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“…6,[9][10][11][12] This analysis on the HELPS control arm confirms these as risk factors for recurrence. Aneurysms with a small D/N are prone to have neck remnants after coiling, which can result in recanalization of the aneurysm, because they are exposed to high wall shear stress and blood-flow velocities.…”

Section: Discussionsupporting

confidence: 49%

HydroCoils Are Associated with Lower Angiographic Recurrence Rates Than Are Bare Platinum Coils in Treatment of “Difficult-to-Treat” Aneurysms: A Post Hoc Subgroup Analysis of the HELPS Trial

Brinjikji

White

Nahser

et al. 2015

AJNR Am J Neuroradiol

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“…15 Aneurysm orientation was not studied for this analysis given most of the data came from orthogonal DSA images that precluded measurement of true 3D orientation angles.…”

Section: Discussionmentioning

confidence: 99%

Effects of Circle of Willis Anatomic Variations on Angiographic and Clinical Outcomes of Coiled Anterior Communicating Artery Aneurysms

Tarulli

Sneade

Clarke

et al. 2014

American Journal of Neuroradiology

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Impact of individual intracranial arterial aneurysm morphology on initial obliteration and recurrence rates of endovascular treatments: a multivariate analysis

Abstract: A detailed pretreatment analysis of morphological features of aneurysms may help to determine those aneurysms that are more prone to recurrence, which could add to the treatment decision and the follow-up algorithm.

Cited by 63 publications

References 14 publications

Survival Analysis of Risk Factors for Major Recurrence of Intracranial Aneurysms after Coiling

Survival Analysis of Risk Factors for Major Recurrence of Intracranial Aneurysms after Coiling

HydroCoils Are Associated with Lower Angiographic Recurrence Rates Than Are Bare Platinum Coils in Treatment of “Difficult-to-Treat” Aneurysms: A Post Hoc Subgroup Analysis of the HELPS Trial

Effects of Circle of Willis Anatomic Variations on Angiographic and Clinical Outcomes of Coiled Anterior Communicating Artery Aneurysms

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