Entry remnants in flow-diverted aneurysms: Does branch geometry influence aneurysm closure?

M. Akli Zetchi, Adam A. Dmytriw, Albert H. Chiu, Brian J. Drake, Niki V. Alizadeh, Aditya Bharatha, Abhaya V. Kulkarni, Thomas R. Marotta

Research output: Contribution to journalArticle

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Abstract

Objective: Numerous studies have suggested a relationship between delayed occlusion of intracranial aneurysms treated with the Pipeline Embolization Device (PED) and the presence of an incorporated branch. However, in some cases, flow diversion may still be the preferred treatment option. This study sought to determine whether geometric factors pertaining to relative size and angulation of branch vessel(s) can be measured in a reliable fashion and whether they are related to occlusion rates. Methods: Eighty aneurysms treated at a single neurovascular center from November 2008 to June 2014 were identified. Two blinded raters prospectively reviewed the imaging performed at the time of the procedure and measured the following geometric variables: inflow jet/incorporated branch direction angle and branch artery/ parent artery ratio. Delayed occlusion was defined as the absence of complete aneurysmal occlusion at one year. Analysis was performed using logistic regression and intra-class correlation co-efficient (ICC). Results: Twenty-four (30%) aneurysms with 28 incorporated branches were identified. A trend toward higher inflow jet/incorporated branch direction angle was found in the group of aneurysms demonstrating delayed occlusion when compared to the group with complete occlusion. ICC revealed high correlation. Overall lower one-year occlusion rates of 53% versus 73% for aneurysms with and without incorporated branches, respectively, were also noted. Conclusions: The presence of an incorporated branch conferred a 20% absolute risk increase for delayed aneurysmal occlusion. Incorporated branches with a larger angle between the inflow jet and the incorporated branch direction exhibited a trend toward lower occlusion rates. This might be further investigated using a multicenter approach in conjunction with other potentially relevant clinical and angiographic variables.

Original languageEnglish
Pages (from-to)624-630
Number of pages7
JournalInterventional Neuroradiology
Volume24
Issue number6
Early online date5 Jun 2018
DOIs
Publication statusPublished - 1 Dec 2018
Externally publishedYes

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Aneurysm
Arteries
Intracranial Aneurysm
Logistic Models
Equipment and Supplies
Direction compound

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Zetchi, M. A., Dmytriw, A. A., Chiu, A. H., Drake, B. J., Alizadeh, N. V., Bharatha, A., ... Marotta, T. R. (2018). Entry remnants in flow-diverted aneurysms: Does branch geometry influence aneurysm closure? Interventional Neuroradiology, 24(6), 624-630. https://doi.org/10.1177/1591019918779229
Zetchi, M. Akli ; Dmytriw, Adam A. ; Chiu, Albert H. ; Drake, Brian J. ; Alizadeh, Niki V. ; Bharatha, Aditya ; Kulkarni, Abhaya V. ; Marotta, Thomas R. / Entry remnants in flow-diverted aneurysms : Does branch geometry influence aneurysm closure?. In: Interventional Neuroradiology. 2018 ; Vol. 24, No. 6. pp. 624-630.
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abstract = "Objective: Numerous studies have suggested a relationship between delayed occlusion of intracranial aneurysms treated with the Pipeline Embolization Device (PED) and the presence of an incorporated branch. However, in some cases, flow diversion may still be the preferred treatment option. This study sought to determine whether geometric factors pertaining to relative size and angulation of branch vessel(s) can be measured in a reliable fashion and whether they are related to occlusion rates. Methods: Eighty aneurysms treated at a single neurovascular center from November 2008 to June 2014 were identified. Two blinded raters prospectively reviewed the imaging performed at the time of the procedure and measured the following geometric variables: inflow jet/incorporated branch direction angle and branch artery/ parent artery ratio. Delayed occlusion was defined as the absence of complete aneurysmal occlusion at one year. Analysis was performed using logistic regression and intra-class correlation co-efficient (ICC). Results: Twenty-four (30{\%}) aneurysms with 28 incorporated branches were identified. A trend toward higher inflow jet/incorporated branch direction angle was found in the group of aneurysms demonstrating delayed occlusion when compared to the group with complete occlusion. ICC revealed high correlation. Overall lower one-year occlusion rates of 53{\%} versus 73{\%} for aneurysms with and without incorporated branches, respectively, were also noted. Conclusions: The presence of an incorporated branch conferred a 20{\%} absolute risk increase for delayed aneurysmal occlusion. Incorporated branches with a larger angle between the inflow jet and the incorporated branch direction exhibited a trend toward lower occlusion rates. This might be further investigated using a multicenter approach in conjunction with other potentially relevant clinical and angiographic variables.",
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Zetchi, MA, Dmytriw, AA, Chiu, AH, Drake, BJ, Alizadeh, NV, Bharatha, A, Kulkarni, AV & Marotta, TR 2018, 'Entry remnants in flow-diverted aneurysms: Does branch geometry influence aneurysm closure?' Interventional Neuroradiology, vol. 24, no. 6, pp. 624-630. https://doi.org/10.1177/1591019918779229

Entry remnants in flow-diverted aneurysms : Does branch geometry influence aneurysm closure? / Zetchi, M. Akli; Dmytriw, Adam A.; Chiu, Albert H.; Drake, Brian J.; Alizadeh, Niki V.; Bharatha, Aditya; Kulkarni, Abhaya V.; Marotta, Thomas R.

In: Interventional Neuroradiology, Vol. 24, No. 6, 01.12.2018, p. 624-630.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Entry remnants in flow-diverted aneurysms

T2 - Does branch geometry influence aneurysm closure?

AU - Zetchi, M. Akli

AU - Dmytriw, Adam A.

AU - Chiu, Albert H.

AU - Drake, Brian J.

AU - Alizadeh, Niki V.

AU - Bharatha, Aditya

AU - Kulkarni, Abhaya V.

AU - Marotta, Thomas R.

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Objective: Numerous studies have suggested a relationship between delayed occlusion of intracranial aneurysms treated with the Pipeline Embolization Device (PED) and the presence of an incorporated branch. However, in some cases, flow diversion may still be the preferred treatment option. This study sought to determine whether geometric factors pertaining to relative size and angulation of branch vessel(s) can be measured in a reliable fashion and whether they are related to occlusion rates. Methods: Eighty aneurysms treated at a single neurovascular center from November 2008 to June 2014 were identified. Two blinded raters prospectively reviewed the imaging performed at the time of the procedure and measured the following geometric variables: inflow jet/incorporated branch direction angle and branch artery/ parent artery ratio. Delayed occlusion was defined as the absence of complete aneurysmal occlusion at one year. Analysis was performed using logistic regression and intra-class correlation co-efficient (ICC). Results: Twenty-four (30%) aneurysms with 28 incorporated branches were identified. A trend toward higher inflow jet/incorporated branch direction angle was found in the group of aneurysms demonstrating delayed occlusion when compared to the group with complete occlusion. ICC revealed high correlation. Overall lower one-year occlusion rates of 53% versus 73% for aneurysms with and without incorporated branches, respectively, were also noted. Conclusions: The presence of an incorporated branch conferred a 20% absolute risk increase for delayed aneurysmal occlusion. Incorporated branches with a larger angle between the inflow jet and the incorporated branch direction exhibited a trend toward lower occlusion rates. This might be further investigated using a multicenter approach in conjunction with other potentially relevant clinical and angiographic variables.

AB - Objective: Numerous studies have suggested a relationship between delayed occlusion of intracranial aneurysms treated with the Pipeline Embolization Device (PED) and the presence of an incorporated branch. However, in some cases, flow diversion may still be the preferred treatment option. This study sought to determine whether geometric factors pertaining to relative size and angulation of branch vessel(s) can be measured in a reliable fashion and whether they are related to occlusion rates. Methods: Eighty aneurysms treated at a single neurovascular center from November 2008 to June 2014 were identified. Two blinded raters prospectively reviewed the imaging performed at the time of the procedure and measured the following geometric variables: inflow jet/incorporated branch direction angle and branch artery/ parent artery ratio. Delayed occlusion was defined as the absence of complete aneurysmal occlusion at one year. Analysis was performed using logistic regression and intra-class correlation co-efficient (ICC). Results: Twenty-four (30%) aneurysms with 28 incorporated branches were identified. A trend toward higher inflow jet/incorporated branch direction angle was found in the group of aneurysms demonstrating delayed occlusion when compared to the group with complete occlusion. ICC revealed high correlation. Overall lower one-year occlusion rates of 53% versus 73% for aneurysms with and without incorporated branches, respectively, were also noted. Conclusions: The presence of an incorporated branch conferred a 20% absolute risk increase for delayed aneurysmal occlusion. Incorporated branches with a larger angle between the inflow jet and the incorporated branch direction exhibited a trend toward lower occlusion rates. This might be further investigated using a multicenter approach in conjunction with other potentially relevant clinical and angiographic variables.

KW - flow diversion

KW - Interventional neuroradiology

KW - intracranial aneurysm

KW - neurosurgery

KW - Pipeline Embolization Device

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