RT Journal Article
SR Electronic
T1 A Proposed Grading Scale Based on Radiographic Imaging for Wall Apposition to Estimate Neurological Complications after Flow Diverter Treatment
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP ajnr.A8785
DO 10.3174/ajnr.A8785
A1 Zhang, Qianqian
A1 Shao, Qiuji
A1 Chang, Kaitao
A1 Sheng, Zhiyuan
A1 Zhang, Hongyun
A1 Chen, Yi
A1 He, Ying-Kun
A1 Li, Tianxiao
A1 Li, Li
YR 2025
UL http://www.ajnr.org/content/early/2025/04/10/ajnr.A8785.abstract
AB BACKGROUND AND PURPOSE: The evaluation of wall apposition following flow diverter (FD) treatment remains poorly defined. This study aims to establish a radiographic grading scale for wall apposition after FD deployment and to investigate its association with FD-related neurological complications.MATERIALS AND METHODS: This retrospective study included patients treated with the Pipeline Embolization Device (PED). A wall apposition grading scale (Grades I–IV) was developed based on radiographic imaging, incorporating anatomical location and the degree of malapposition: Grade I, perfect wall apposition; Grade II, mild malapposition; Grade III, moderate malapposition; and Grade IV, severe malapposition. Cases were categorized into two groups: complete wall apposition (Grade I) and malapposition (Grades II–IV). The association between malapposition and neurological complications was further analyzed.RESULTS: A total of 197 PED cases were included. Incomplete wall apposition was observed in 29 cases (14.7%), while 168 cases (85.3%) demonstrated complete wall apposition (Grade I). In the malapposition group, 13 cases (6.6%) were classified as Grade II, 11 cases (5.6%) as Grade III, and 5 cases (2.5%) as Grade IV. FD-related perioperative and follow-up neurological complications occurred in 10.3% and 13.8% of the malapposition group, respectively, compared to 1.8% and 1.2% in the complete wall apposition group (P<0.05). Multivariate logistic regression analysis identified malapposition as an independent risk factor for FD-related neurological complications (P<0.05). The Cochran-Armitage test revealed a significant trend of increasing neurological complications with worsening malapposition from Grade II to IV (P<0.05).CONCLUSIONS: The proposed grading scale is a feasible and practical tool for assessing wall apposition following FD treatment. Neurological complications are significantly more likely in cases with moderate to severe malapposition (Grades III and IV).ABBREVIATIONS: FD = flow diverter; PED = Pipeline Embolization Device; 2D DSA = two-dimensional digital subtraction angiography; OCT = optical coherence tomography; TIA = transient ischemic attack; IQR = interquartile range.