Rebleeding and bleeding in the year following intracranial aneurysm coiling: analysis of a large prospective multicenter cohort of 1140 patients—Analysis of Recanalization after Endovascular Treatment of Intracranial Aneurysm (ARETA) Study

Piérot, Laurent; Barbe, Coralie; Herbreteau, Denis; Gauvrit, Jean‐Yves; Januel, Anne-Christine; Bala, Fouzi; Ricolfi, F.; Desal, Hubert; Velasco, Stéphane; Chabert, Emmanuel; Sédat, Jacques; Trystram, Denis; Marnat, Gaultier; Gallas, Sophie; Rodesch, Georges; Clarençon, Frédéric; Papagiannaki, Chrysanthi; White, Phil; Spelle, Laurent

doi:10.1136/neurintsurg-2020-015971

Cited by 20 publications

(14 citation statements)

References 18 publications

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“…The analysis results showed that the cause of subarachnoid hemorrhage was aneurysm rupture in about 8 cases per 100,000 people every year. With the enlargement of the arterial tumor, the probability of aneurysm rupture will increase exponentially, so the active treatment of intracranial aneurysm is particularly important [ 3 ]. However, some aneurysms, such as large or giant aneurysms, wide-necked aneurysms, fusiform aneurysms, and other complex aneurysms, have always been a difficult and challenging problem in clinical treatment [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Hemodynamic Analysis of Pipeline Embolization Device Stent for Treatment of Giant Intracranial Aneurysm under Unsupervised Learning Algorithm

Gao

You

et al. 2022

Journal of Healthcare Engineering

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To treat large intracranial aneurysms, pipeline embolization device (PED) stent with unsupervised learning algorithms was utilized. Unsupervised learning model algorithm was used to screen aneurysm health big data, find aneurysm blood flow and PED stent positioning characteristic parameters, and guide PED stent treatment of intracranial aneurysms. The research objects were 100 patients with intracranial large aneurysm admitted to X Hospital of X Province from June 2020 to June 2021, who were enrolled into two groups. One group used the prototype transfer generative adversarial network (PTGAN) model to measure mean blood flow and mean vascular pressure and guide the placement of PED stents (PTGAN group). The other group did not use the model to place PED (control group). The PTGAN model can learn feature information from horizontal and vertical directions, with smooth edges and prominent features, which can effectively extract the main morphological and texture features of aneurysms. Compared with the convolutional neural network (CNN) model, the accuracy of the PTGAN model increased by 8.449% (87.452%–79.003%), and the precision increased by 8.347% (91.23%–82.883%). The recall rate increased by 7.011% (87.231%–80.22%), and the F1 score increased by 8.09% (89.73%–81.64%). After the adoption of the PTGAN model, the average blood flow inside the aneurysm body was 0.22 (m/s). After the adoption of the CNN model, the average blood flow inside the aneurysm body was 0.21 (m/s), and the difference was 0.01 (m/s), which was considerable ( p < 0.05 ). Through this research, it was found that the PTGAN model was better than the CNN model in terms of accuracy, precision, recall, and F1 score values. The PTGAN model was better than the CNN model in detecting the average blood flow rate and average blood pressure after treatment, and the blood flowed smoothly. Postoperative complications and postoperative relief were also better than those of the control group. In summary, based on the unsupervised learning algorithm, the PED stent had a good adoption effect in the treatment of intracranial aneurysms and was suitable for subsequent treatment.

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Section: Introductionmentioning

confidence: 99%

Hemodynamic Analysis of Pipeline Embolization Device Stent for Treatment of Giant Intracranial Aneurysm under Unsupervised Learning Algorithm

Gao

You

et al. 2022

Journal of Healthcare Engineering

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“…Recent studies demonstrated a very low incidence of rebleeding for ruptured aneurysms and bleeding for unruptured aneurysms after coil embolization 48 , 49) along with risk factors for the aneurysm rupture. 48) Although the correlation between bleeding from coiled aneurysms and recanalization has not been well clarified, we believe that aggressive intervention for recanalized aneurysms is one of the reasons for this low rupture rate of coil aneurysms. Therefore, watchful imaging follow-up is still important and the craniogram will be a promising modality for coiled aneurysms.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of Craniograms in Discriminating Coiled Intracranial Aneurysms Requiring Retreatment

Yasuda

Satow

Hashimura

et al. 2022

Neurol. Med. Chir.(Tokyo)

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While endovascular coil embolization has become one of the major therapeutic modalities for intracranial aneurysms, long-term imaging follow-up is required because of the higher rate of retreatment compared with surgical clipping. The purpose of this study was to show the usefulness of craniograms to discriminate coiled intracranial aneurysms that required retreatment. Under the study protocol approved by institutional review board, a retrospective review of the medical record was done regarding coil embolization for intracranial aneurysms performed between January 2014 and December 2018. Coil embolization performed as the initial treatment and followed up for more than 1 year without additional treatment, and those performed as retreatment after the initial coil embolization performed at our institution were recruited. Craniograms obtained just after the initial treatment were compared with those obtained just before the additional treatment in the retreated cases and compared with the latest ones in the nonrecurrence cases. Correlation between the morphological changes in the coil mass on the craniograms and retreatments was evaluated. During the study period, 288 coil embolization procedures for intracranial aneurysms were performed. From these, 191 treatments that were followed up for more than 1 year without any additional treatments and 30 retreatments were included. Morphological change of the coil mass was observed in 4 of the 191 non-recurrence treatments and 26 of the 30 retreatments, which was significantly correlated with retreatments (p <0.001). Craniogram was a useful modality in following up the coiled intracranial aneurysms to detect those required retreatments.

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“…According to ARETA study, the risk of rebleeding 1 year after coiling was estimated at 1.0%. Aneurysm occlusion and dome-to-neck ratio were the two factors that had appeared to play a role in the rebleeding [28].…”

Section: Discussionmentioning

confidence: 99%

Porous Media Computational Fluid Dynamics and the Role of the First Coil in the Embolization of Ruptured Intracranial Aneurysms

Wiśniewski

Tomasik

Tyfa

et al. 2021

JCM

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Background: The objective of our project was to identify a late recanalization predictor in ruptured intracranial aneurysms treated with coil embolization. This goal was achieved by means of a statistical analysis followed by a computational fluid dynamics (CFD) with porous media modelling approach. Porous media CFD simulated the hemodynamics within the aneurysmal dome after coiling. Methods: Firstly, a retrospective single center analysis of 66 aneurysmal subarachnoid hemorrhage patients was conducted. The authors assessed morphometric parameters, packing density, first coil volume packing density (1st VPD) and recanalization rate on digital subtraction angiograms (DSA). The effectiveness of initial endovascular treatment was visually determined using the modified Raymond–Roy classification directly after the embolization and in a 6- and 12-month follow-up DSA. In the next step, a comparison between porous media CFD analyses and our statistical results was performed. A geometry used during numerical simulations based on a patient-specific anatomy, where the aneurysm dome was modelled as a separate, porous domain. To evaluate hemodynamic changes, CFD was utilized for a control case (without any porosity) and for a wide range of porosities that resembled 1–30% of VPD. Numerical analyses were performed in Ansys CFX solver. Results: A multivariate analysis showed that 1st VPD affected the late recanalization rate (p < 0.001). Its value was significantly greater in all patients without recanalization (p < 0.001). Receiver operating characteristic curves governed by the univariate analysis showed that the model for late recanalization prediction based on 1st VPD (AUC 0.94 (95%CI: 0.86–1.00) is the most important predictor of late recanalization (p < 0.001). A cut-off point of 10.56% (sensitivity—0.722; specificity—0.979) was confirmed as optimal in a computational fluid dynamics analysis. The CFD results indicate that pressure at the aneurysm wall and residual flow volume (blood volume with mean fluid velocity > 0.01 m/s) within the aneurysmal dome tended to asymptotically decrease when VPD exceeded 10%. Conclusions: High 1st VPD decreases the late recanalization rate in ruptured intracranial aneurysms treated with coil embolization (according to our statistical results > 10.56%). We present an easy intraoperatively calculable predictor which has the potential to be used in clinical practice as a tip to improve clinical outcomes.

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Rebleeding and bleeding in the year following intracranial aneurysm coiling: analysis of a large prospective multicenter cohort of 1140 patients—Analysis of Recanalization after Endovascular Treatment of Intracranial Aneurysm (ARETA) Study

Cited by 20 publications

References 18 publications

Hemodynamic Analysis of Pipeline Embolization Device Stent for Treatment of Giant Intracranial Aneurysm under Unsupervised Learning Algorithm

Hemodynamic Analysis of Pipeline Embolization Device Stent for Treatment of Giant Intracranial Aneurysm under Unsupervised Learning Algorithm

Usefulness of Craniograms in Discriminating Coiled Intracranial Aneurysms Requiring Retreatment

Porous Media Computational Fluid Dynamics and the Role of the First Coil in the Embolization of Ruptured Intracranial Aneurysms

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