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AJNR - American Journal of Neuroradiology

Published ahead of print on May 20, 2009
doi: 10.3174/ajnr.A1633

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American Journal of Neuroradiology 30:1513-1517, September 2009
© 2009 American Society of Neuroradiology

INTERVENTIONAL

Difficult Aneurysms for Endovascular Treatment: Overwide or Undertall?

W. Brinjikji^a, H.J Cloft^b and D.F. Kallmes^b

^aFrom the Mayo Medical School (W.B.)
^bDepartment of Radiology (H.J.C., D.F.K.), Mayo Clinic, Rochester, Minn.

Please address correspondence to David F. Kallmes, MD, Mayo Clinic, OL 1-115, 200 SW First St, Rochester, MN 55905; e-mail: kallmes.david{at}mayo.edu

BACKGROUND AND PURPOSE: Aneurysm geometry has been shown to predict the need for adjunctive techniques in the endovascular treatment of intracranial aneurysms. We conducted a systematic retrospective study examining which thresholds of dome-to-neck ratio, maximum neck width, and aspect ratio of intracranial aneurysms best predict the need for adjunctive techniques in endovascular management.

MATERIALS AND METHODS: One hundred seventy-five consecutive patients who were selected for attempted embolization of 185 intracranial aneurysms were included in this study. Aneurysm dome-to-neck ratio (maximum dome width/maximum neck width), maximum neck width, and aspect ratio (dome height/maximum neck width) were measured on 2D digital subtraction angiography. Statistical analysis was conducted to determine which thresholds of dome-to-neck ratio, maximum neck width, and aspect ratio were most predictive of the need for adjunctive devices in endovascular management of these aneurysms.

RESULTS: We demonstrated that 75% of aneurysms with dome-to-neck ratios >1.6 (P < .0001), 75% of aneurysms with aspect ratios >1.6 (P < .0001), and 70% of aneurysms with neck diameters <4.0 mm (P < .0001) did not need adjunctive techniques in their management. Adjunctive techniques were essential to treatment of 80% of aneurysms with dome-to-neck ratios <1.2 (P = .02) and 89% of aneurysms with aspect ratios <1.2 (P < .0001). Multivariate logistic regression analysis demonstrated that aspect ratio was the best predictor of the need for an adjunctive device (P = .0004).

CONCLUSIONS: Aneurysms with aspect and dome-to-neck ratios >1.6 usually did not require adjunctive techniques. Aneurysms with aspect and dome-to-neck ratios <1.2 almost always required adjunctive techniques. In this single-center series, aspect ratio was the independent predictor of the need for adjunctive techniques in the endovascular management of intracranial aneurysms.