Large Neck and Strong Ostium Inflow as the Potential Causes for Delayed Occlusion of Unruptured Sidewall Intracranial Aneurysms Treated by Flow Diverter.
- Su T From the Department of Interventional Radiology (T.S., L.J.), Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.
- Reymond P Division of Neuroradiology and Neuro-Interventional Radiology (P.R., O.B., P.M., K.O.L., M.I.V.).
- Brina O Division of Neuroradiology and Neuro-Interventional Radiology (P.R., O.B., P.M., K.O.L., M.I.V.).
- Bouillot P and Division of Radiology (B.M.A.D.), University Hospitals of Geneva, Geneva, Switzerland.
- Machi P Division of Neuroradiology and Neuro-Interventional Radiology (P.R., O.B., P.M., K.O.L., M.I.V.).
- Delattre BMA Department of Quantum Matter Physics (P.B.), University of Geneva, Geneva, Switzerland.
- Jin L From the Department of Interventional Radiology (T.S., L.J.), Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.
- Lövblad KO Division of Neuroradiology and Neuro-Interventional Radiology (P.R., O.B., P.M., K.O.L., M.I.V.).
- Vargas MI Division of Neuroradiology and Neuro-Interventional Radiology (P.R., O.B., P.M., K.O.L., M.I.V.) Maria.I.Vargas@hcuge.ch.
- 2020-02-15
Published in:
- AJNR. American journal of neuroradiology. - 2020
Adult
Aged
Aged, 80 and over
Blood Vessel Prosthesis
Endovascular Procedures
Female
Hemodynamics
Humans
Intracranial Aneurysm
Magnetic Resonance Imaging
Male
Middle Aged
English
BACKGROUND AND PURPOSE
Flow diverter-induced hemodynamic change plays an important role in the mechanism of intracranial aneurysm occlusion. Our aim was to explore the relationship between aneurysm features and flow-diverter treatment of unruptured sidewall intracranial aneurysms.
MATERIALS AND METHODS
MR imaging, 4D phase-contrast, was prospectively performed before flow diverter implantation in each patient with unruptured intracranial aneurysm. Two postprocedure follow-ups were scheduled at 6 and 12 months. Responses were grouped according to whether the aneurysms were occluded or remnant. Preprocedural aneurysm geometries and ostium hemodynamics in 38 patients were compared between the 2 groups at 6 and 12 months. Receiver operating characteristic curve analyses were performed for significant geometric and hemodynamic continuous parameters.
RESULTS
After the 6-month assessment, 21 of 41 intracranial aneurysms were occluded, and 9 additional aneurysms were occluded at 12 months. Geometrically, the ostium maximum diameter was significantly larger in the remnant group at 6 and 12 months (both P < .001). Hemodynamically, the proximal inflow zone was more frequently observed in the remnant group at 6 months. Several preprocedural ostium hemodynamic parameters were significantly higher in the remnant group. As a prediction for occlusion, the areas under the curve of the ostium maximum diameter (for 6 and 12 months), systolic inflow rate ratio (for 6 months), and systolic inflow area (for 12 months) reached 0.843, 0.883, 0.855, and 0.860, respectively.
CONCLUSIONS
Intracranial aneurysms with a large ostium and strong ostium inflow may need a longer time for occlusion. Preprocedural 4D flow MR imaging can well illustrate ostium hemodynamics and characterize aneurysm treatment responses.
Flow diverter-induced hemodynamic change plays an important role in the mechanism of intracranial aneurysm occlusion. Our aim was to explore the relationship between aneurysm features and flow-diverter treatment of unruptured sidewall intracranial aneurysms.
MATERIALS AND METHODS
MR imaging, 4D phase-contrast, was prospectively performed before flow diverter implantation in each patient with unruptured intracranial aneurysm. Two postprocedure follow-ups were scheduled at 6 and 12 months. Responses were grouped according to whether the aneurysms were occluded or remnant. Preprocedural aneurysm geometries and ostium hemodynamics in 38 patients were compared between the 2 groups at 6 and 12 months. Receiver operating characteristic curve analyses were performed for significant geometric and hemodynamic continuous parameters.
RESULTS
After the 6-month assessment, 21 of 41 intracranial aneurysms were occluded, and 9 additional aneurysms were occluded at 12 months. Geometrically, the ostium maximum diameter was significantly larger in the remnant group at 6 and 12 months (both P < .001). Hemodynamically, the proximal inflow zone was more frequently observed in the remnant group at 6 months. Several preprocedural ostium hemodynamic parameters were significantly higher in the remnant group. As a prediction for occlusion, the areas under the curve of the ostium maximum diameter (for 6 and 12 months), systolic inflow rate ratio (for 6 months), and systolic inflow area (for 12 months) reached 0.843, 0.883, 0.855, and 0.860, respectively.
CONCLUSIONS
Intracranial aneurysms with a large ostium and strong ostium inflow may need a longer time for occlusion. Preprocedural 4D flow MR imaging can well illustrate ostium hemodynamics and characterize aneurysm treatment responses.
- Language
-
- English
- Open access status
- hybrid
- Identifiers
-
- DOI 10.3174/ajnr.A6413
- PMID 32054620
- Persistent URL
- https://sonar.ch/global/documents/46833
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