N Paliwal1,2, V M Tutino2,3,4, H Shallwani4,5, J S Beecher4,5, R J Damiano1,2, H J Shakir4,5, G S Atwal4,5, V S Fennell4,5, S K Natarajan4,5, E I Levy2,4,6, A H Siddiqui2,4,6,5,7, J M Davies2,4,8,5,7, H Meng9,2,3,4. 1. From the Department of Mechanical and Aerospace Engineering (N.P., R.J.D., H.M.). 2. Canon Stroke and Vascular Research Center (N.P., V.M.T., R.J.D., E.I.L., A.H.S., J.M.D., H.M.). 3. Department of Biomedical Engineering (V.M.T., H.M.), University at Buffalo, Buffalo, New York. 4. Departments of Neurosurgery (V.M.T., H.S., J.S.B., H.J.S., G.S.A., V.S.F., S.K.N., E.I.L., A.H.S., J.M.D., H.M.). 5. Department of Neurosurgery (H.S., J.S.B., H.J.S., G.S.A., V.S.F., S.K.N., A.H.S., J.M.D.), Gates Vascular Institute at Kaleida Health, Buffalo, New York. 6. Radiology (E.I.L., A.H.S.). 7. Jacobs Institute (A.H.S., J.M.D.), Buffalo, New York. 8. Biomedical Informatics (J.M.D.), Jacobs School of Medicine, University at Buffalo, Buffalo, New York. 9. From the Department of Mechanical and Aerospace Engineering (N.P., R.J.D., H.M.) huimeng@buffalo.edu.
Abstract
BACKGROUND AND PURPOSE: Incompletely occluded flow diverter treated aneurysms remain at risk of rupture and thromboembolic complications. Our aim was to identify the potential for incomplete occlusion of intracranial aneurysms treated by flow diverters. We investigated whether aneurysm ostium size in relation to parent artery size affects angiographic outcomes of flow diverter-treated sidewall aneurysms. MATERIALS AND METHODS: Flow diverter-treated sidewall aneurysms were divided into "occluded" and "residual" (incomplete occlusion) groups based on 6-month angiographic follow-up. We calculated the ostium ratio, a new parameter defined as the aneurysm ostium surface area versus the circumferential surface area of the parent artery. We also calculated the neck ratio, defined as clinical aneurysm neck diameter versus parent artery diameter from pretreatment 2D DSA, as a 2D surrogate. We compared the performance of these ratios with existing aneurysm morphometrics (size, neck diameter, volume, aspect ratio, size ratio, undulation index, nonsphericity index, ellipticity index, bottleneck factor, aneurysm angle, and parent vessel angle) and flow diverter-related parameters (metal coverage rate and pore density). Statistical tests and receiver operating characteristic analyses were performed to identify significantly different parameters between the 2 groups and test their predictive performances. RESULTS: We included 63 flow diverter-treated aneurysms, 46 occluded and 17 residual. The ostium ratio and neck ratio were significantly higher in the residual group than in the occluded group (P < .001 and P = .02, respectively), whereas all other parameters showed no statistical difference. As discriminating parameters for occlusion, ostium ratio and neck ratio achieved areas under the curve of 0.912 (95% CI, 0.838-0.985) and 0.707 (95% CI, 0.558-0.856), respectively. CONCLUSIONS: High ostium ratios and neck ratios could predict incomplete occlusion of flow diverter-treated sidewall aneurysms. Neck ratio can be easily calculated by interventionists to predict flow-diverter treatment outcomes.
BACKGROUND AND PURPOSE: Incompletely occluded flow diverter treated aneurysms remain at risk of rupture and thromboembolic complications. Our aim was to identify the potential for incomplete occlusion of intracranial aneurysms treated by flow diverters. We investigated whether aneurysmostium size in relation to parent artery size affects angiographic outcomes of flow diverter-treated sidewall aneurysms. MATERIALS AND METHODS: Flow diverter-treated sidewall aneurysms were divided into "occluded" and "residual" (incomplete occlusion) groups based on 6-month angiographic follow-up. We calculated the ostium ratio, a new parameter defined as the aneurysmostium surface area versus the circumferential surface area of the parent artery. We also calculated the neck ratio, defined as clinical aneurysm neck diameter versus parent artery diameter from pretreatment 2D DSA, as a 2D surrogate. We compared the performance of these ratios with existing aneurysm morphometrics (size, neck diameter, volume, aspect ratio, size ratio, undulation index, nonsphericity index, ellipticity index, bottleneck factor, aneurysm angle, and parent vessel angle) and flow diverter-related parameters (metal coverage rate and pore density). Statistical tests and receiver operating characteristic analyses were performed to identify significantly different parameters between the 2 groups and test their predictive performances. RESULTS: We included 63 flow diverter-treated aneurysms, 46 occluded and 17 residual. The ostium ratio and neck ratio were significantly higher in the residual group than in the occluded group (P < .001 and P = .02, respectively), whereas all other parameters showed no statistical difference. As discriminating parameters for occlusion, ostium ratio and neck ratio achieved areas under the curve of 0.912 (95% CI, 0.838-0.985) and 0.707 (95% CI, 0.558-0.856), respectively. CONCLUSIONS: High ostium ratios and neck ratios could predict incomplete occlusion of flow diverter-treated sidewall aneurysms. Neck ratio can be easily calculated by interventionists to predict flow-diverter treatment outcomes.
Authors: Ahmed E Hussein; Meghana Shownkeen; Andre Thomas; Christopher Stapleton; Denise Brunozzi; Jessica Nelson; John Naumgart; Andreas Linninger; Gursant Atwal; Ali Alaraj Journal: Interv Neuroradiol Date: 2020-02-26 Impact factor: 1.610
Authors: Robert J Damiano; Vincent M Tutino; Nikhil Paliwal; Tatsat R Patel; Muhammad Waqas; Elad I Levy; Jason M Davies; Adnan H Siddiqui; Hui Meng Journal: J Neurointerv Surg Date: 2019-12-17 Impact factor: 5.836
Authors: T Su; P Reymond; O Brina; P Bouillot; P Machi; B M A Delattre; L Jin; K O Lövblad; M I Vargas Journal: AJNR Am J Neuroradiol Date: 2020-02-13 Impact factor: 3.825