Abstract
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.
ABBREVIATIONS:
- FD
- flow diverter
- PC
- phase-contrast
- RA
- rotational angiography
Footnotes
This work originated at University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, Geneva 1211, Switzerland.
Supported by Swiss National Funds (SNF 32003B_160222 and SNF 320030_156813) and Beijing Li Huanying Medical Foundation (2017).
Previously presented at: Radiological Society of North America 105th Scientific Assembly, Chicago, Illinois, December 1–6, 2019.
Disclosures: Tianhao Su—RELATED: Grant: Swiss National Funds, Beijing Li Huanying Medical Foundation, Comments: SNF 32003B_160222 and SNF 320030_156813, Beijing Li Huanying Medical Foundation 2017.* Long Jin—RELATED: Grant: Beijing Li Huanying Medical Foundation, Comments: Beijing Li Huanying Medical Foundation 2017.* *Money paid to institution.
- © 2020 by American Journal of Neuroradiology
Indicates open access to non-subscribers at www.ajnr.org