Background With widely usage of flow diverter in intracranial aneurysm treatment,some previously used predictors may not be effective in evaluating the recurrence risk.We aimed to comprehensively re-evaluate the predictors of intracranial aneurysm outcome with various endovascular treatment methods and devices.Methods This is a prospective registered study.We analysed 6-month and 18-month follow-up angiographic data from the prospective study.Data on patient demographics,aneurysm morphology and type of treatment were recorded.Patient-specific haemodynamic simulations were performed.An unfavourable angiographic outcome was defined as recurrence of aneurysm in cases with coiling or stent-assisted coiling,patency of aneurysm in cases with flow diverters or retreatment during follow-up.Results In total,165 patients(177 intracranial aneurysms)with at least one angiographic follow-up data were analysed.For the short-term(6-month)results,after univariate analysis,the demographic,morphological and treatment-related factors did not achieve significantly statistical differences.The reduction ratio(RR)of velocity at aneurysm neck after embolisation was significantly lower in the unfavourable angiographic group than the favourable angiographic outcome group(p=0.002).After the Cox regression analysis,the RR of velocity at aneurysm neck was the only independent factor associated with favourable angiographic outcome(OR 0.028;p=0.001)and had an acceptable area under the curve(0.714)with a clear cut-off value(46.14%).Similarly,for the analysis of midterm(18-month)results,the RR of velocity at the aneurysm neck was the only independent significant factor for the unfavourable angiographic outcome(OR 0.050;p=0.017).The area under the curve was 0.754 and the cut-off value was 48.20%.Conclusions The haemodynamics showed an independent effect on angiographic follow-up results and may provide helpful suggestions for clinical practice in the future.
Background The management of bilateral intracranial vertebral artery dissecting aneurysms(IVADAs)is controversial,and requires the development of endovascular treatment modalities and principles.We aim to investigate the endovascular treatment strategy and outcomes of bilateral IVADAs.Methods We identified all bilateral IVADAs at a high-volume neurointerventional centre over a 10-year period(from January 2009 to December 2018).Radiographic and clinical data were recorded,and a treatment algorithm was derived.Results Twenty-seven patients with bilateral IVADAs(54 IVADAs in total,51 unruptured,3 ruptured)were diagnosed.Four patients(14.8%)received single-stage endovascular treatment,12 patients(44.4%)with staged endovascular treatment and 11 patients(40.8%)with unilateral endovascular treatment of bilateral IVADAs.Thirty-six IVADAs(85.7%)have complete obliteration at the follow-up angiography.Two of three ruptured IVADAs with stent-assisted coiling recanalised,and had further recoiling.Three patients(11.1%)have intraprocedural or postprocedural complications(two in single-stage and one in staged).Twenty-five patients(92.6%)had a favourable clinical outcome,and two patients(7.4%,all in single-stage)showed an unfavourable clinical outcome at follow-up.For the patients with unilateral reconstructive endovascular treatment,the contralateral untreated IVADAs were stable and had no growth or ruptured during follow-up period.None of all IVADAs had rebleeding during the clinical follow-up.Conclusions Endovascular treatment can be performed in bilateral IVADAs with high technical success,high complete obliteration rates and acceptable morbidity/mortality.Contralateral IVADAs had low rates of aneurysm growth and haemorrhage when treated in a staged/delayed fashion.
Yisen ZhangZhongbin TianWei ZhuJian LiuYang WangKun WangYing ZhangXinjian YangWenqiang Li
