Validation of the Modified Raymond–Roy classification for intracranial aneurysms treated with coil embolization

Stapleton, Christopher J.; Torok, Collin M.; Rabinov, James D.; Walcott, Brian P.; Mascitelli, Justin; Leslie‐Mazwi, Thabele M; Hirsch, Joshua A; Yoo, Albert J.; Ogilvy, Christopher S.; Patel, Aman B.

doi:10.1136/neurintsurg-2015-012035

Cited by 42 publications

(22 citation statements)

References 23 publications

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“…Different to the study of Sokolowski et al we treated most patients with SMART coils only (96% vs 80%), which might had an impact on the results and could explain the slightly better occlusion results we observed [3]. In another study Stapleton et al found 100% of the "coil only" group to have an initially favorable angiographic outcome [5]. This shows that simple angiographic outcome measurements have to be interpreted cautious and adjunctive devices and aneurysm configuration should always be considered.…”

Section: Discussioncontrasting

confidence: 65%

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SMART coils for intracranial aneurysm repair – a single center experience

et al. 2020

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Background: Due to uniform stiffness of standard platinum coils, dense packing of intracranial aneurysms can be difficult to achieve, since stiffer coils can cause microcatheter prolapse or coil migration. SMART coils have a varying softness along the length of the coils to improve deliverability. We report our initial 2 year experience with the SMART coil system, including direct and follow-up results. Methods: We performed a retrospective study of all patients who underwent coil embolization of an intracranial aneurysm with SMART coils between July 2016 and August 2018 at our institution. We analyzed clinical and angiographic data before and directly after treatment as well as at 6 months follow-up. Results: A total of 49 patients harboring 49 aneurysms were treated; 23 (47%) were ruptured aneurysms. Most aneurysms (57%) were located in the anterior circulation. Median patient age was 55 (31-88), 63% were female. Mean aneurysm size was: neck 3.4 (±1.5), height 6.3 (±2.9) and width 5.2 (±2.3) mm. SMART coils were solely used in 96% of cases. Initial favorable angiographic results were achieved in 45 (92%) of 49 cases, which were stable at 6 months in 26/29 (90%). Thromboembolic complications occurred in 4 (8%) cases without clinical sequelae; microcatheter prolapse occurred in 1 case. No aneurysm rupture or device malfunction was observed. Conclusion: The treatment of ruptured and unruptured intracranial aneurysms with SMART Coils was safe and efficacious in our cohort.

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Section: Discussioncontrasting

confidence: 65%

“…The rate of loss to follow-up was 40%. Angiographic outcome was measured according to the modified Raymond-Roy classification (MRRC) [5]. MRRC I and II were deemed as favorable outcome.…”

Section: Patient Selectionmentioning

confidence: 99%

SMART coils for intracranial aneurysm repair – a single center experience

et al. 2020

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“…Class 1 denotes complete occlusion, Class 2 denotes neck remnant, and Class 3 is a residual aneurysm. Class 1 and Class 2 occlusion were considered satisfactory given the good clinical outcomes described in recent studies, although this is in relation to aneurysms treated with coils and not intrasaccular devices, 14 15…”

Section: Methodsmentioning

confidence: 99%

Endovascular treatment of wide-necked intracranial aneurysms using the novel Contour Neurovascular System: a single-center safety and feasibility study

Akhunbay-Fudge

Deniz

Tyagi

et al. 2020

J NeuroIntervent Surg

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Background and purposeWide-necked bifurcation aneurysms pose a significant challenge to the treating clinician. The Contour Neurovascular System embolization device is a novel tool for the treatment of such intracranial aneurysms. We report on our experience with this device.MethodsProspective clinical and radiological data were collected for all patients treated with the Contour device at our center. All our patients were treated on an elective basis.ResultsWe have treated 11 patients successfully with the Contour device to date. All patients were women with a mean (SD) age of 65.0 (6.4) years. In total, four basilar tip, two internal carotid artery, three middle cerebral artery, one anterior communicating artery, and one superior cerebellar artery aneurysms were treated. At 1-year follow-up, complete occlusion (Raymond Class 1) was seen in 55.56% (5/9) of cases, with 44.44% (4/9) having small neck remnants (Raymond Class 2). One patient declined 1-year catheter angiography and another had no further follow-up due to an unrelated medical condition. For six patients, 2-year radiological follow-up is available and shows stability. At 6 weeks, nine of the 11 patients had a modifed Rankin Scale score of 0, with two patients scoring 1 for headaches. Two patients had thromboembolic events, but there were no complications leading to permanent neurological disability or death. We additionally had three patients where the Contour device was attempted but was unable to be successfully used.ConclusionInitial results are promising although larger case numbers and longer follow-up are necessary to draw further conclusions on the utility and risk profile of this new device.

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“…Aneurysm occlusion after initial treatment and during follow-up was found to be unchanged (patent), or was evaluated using the validated modified Raymond–Roy classification (mRRC)13 where mRRC I closure indicates complete occlusion, mRRC II closure indicates opacification of the aneurysm neck, mRRC IIIa closure indicates opacification within the interstices of the coil mass, and mRRC IIIb closure indicates opacification between the coil mass and aneurysm wall. Angiographic follow-up was assessed by MR angiography or DSA routinely at 3–12 months.…”

Section: Methodsmentioning

confidence: 99%

Preliminary experience with the use of low profile visualized intraluminal support device in basilar artery for aneurysm treatment

Wang

Feng

Wang

et al. 2018

J NeuroIntervent Surg

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BackgroundThe low profile visualized intraluminal support (LVIS) device is being increasingly used for the treatment of intracranial aneurysms. Its application in the basilar artery (BA) has not yet been reported.ObjectiveTo evaluate the safety and early efficacy of the LVIS device for the treatment of BA aneurysms.MethodsA prospectively maintained database was retrospectively reviewed for all patients with BA aneurysms treated by LVIS stents at our institution. Angiographic results were evaluated using the modified Raymond–Roy classification (mRRC).Results23 patients (mean age 52.8 years) with a BA aneurysm that was treated by LVIS stent implantation, with (n=21) or without (n=2) adjunctive coiling, were included in our study. 7 aneurysms were treated in the setting of subarachnoid hemorrhage (SAH). 10 aneurysms were located at the basilar tip, 10 at the basilar trunk, and 3 at the superior cerebellar artery. Procedure related complications developed in three patients (13%), including two perforator infarction and one worsening mass effect. Complications resulted in permanent morbidity (4%) in one case. One fatality was related to severe poor grade SAH. At a mean follow-up of 6.9 months, 13 of the 20 patients were mRRC I closure, 3 were mRRC II closure with an improvement from class IIIa, 3 were observed to be recanalized from class IIIa to IIIb, and 1 with stenting only was still patent similar to the immediate angiography.ConclusionThe LVIS stent represents a feasible and safe option for endovascular embolization of BA aneurysms. Although recanalization may occur after LVIS treatment, the mid term complete occlusion rate was acceptable.

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Validation of the Modified Raymond–Roy classification for intracranial aneurysms treated with coil embolization

Abstract: This study confirms that the MRRC enhances the predictive accuracy of the RROC.

Cited by 42 publications

References 23 publications

SMART coils for intracranial aneurysm repair – a single center experience

SMART coils for intracranial aneurysm repair – a single center experience

Endovascular treatment of wide-necked intracranial aneurysms using the novel Contour Neurovascular System: a single-center safety and feasibility study

Preliminary experience with the use of low profile visualized intraluminal support device in basilar artery for aneurysm treatment

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