PT  - JOURNAL ARTICLE
AU  - T.P. Madaelil
AU  - J.A. Grossberg
AU  - B.M. Howard
AU  - C.M. Cawley
AU  - J. Dion
AU  - R.G. Nogueira
AU  - D.C. Haussen
AU  - F.C. Tong
TI  - Aneurysm Remnants after Flow Diversion: Clinical and Angiographic Outcomes
AID  - 10.3174/ajnr.A6010
DP  - 2019 Apr 01
TA  - American Journal of Neuroradiology
PG  - 694--698
VI  - 40
IP  - 4
4099  - http://www.ajnr.org/content/40/4/694.short
4100  - http://www.ajnr.org/content/40/4/694.full
SO  - Am. J. Neuroradiol.2019 Apr 01; 40
AB  - BACKGROUND AND PURPOSE: Flow diversion is an established method to treat complex intracranial aneurysms. The natural history of flow-diversion treatment failure resulting in aneurysm remnants is not well-defined. We aimed to delineate the clinical and angiographic features of this entity.MATERIALS AND METHODS: Review of a prospectively maintained Pipeline Embolization Device data base from inception to October 2017 was performed for aneurysms that demonstrated residual filling on follow-up imaging. Procedural and follow-up clinical details were recorded. Independent, blinded, angiographic assessment of occlusion was performed on the basis of the O'Kelly-Marotta scale. Aggregated outcomes were analyzed using the Fisher exact and Mann-Whitney U tests for categoric and continuous variables, respectively (statistical significance, α = .05).RESULTS: During the study period, 283 sequential patients were treated; 87% (246/283) were women. The median patient age was 55 years (interquartile range, 47–65 years). Six-month follow-up imaging was available in 83.7% (237/283) of patients, which showed 62.4% (148/237) complete occlusion (class D, O'Kelly-Marotta grading scale). Adjunctive coiling (P = .06), on-label Pipeline Embolization Device use (P = .04), and multiple device constructs (P = .02) had higher rates of complete occlusion at 6 months. Aneurysm remnants were identified in 25 cases on long-term follow-up imaging (median, 16 months; interquartile range, 12–24 months). No patient with an aneurysm remnant after flow diversion presented with delayed rupture or other clinical sequelae, with a median clinical follow-up of 31 months (interquartile range, 23–33 months).CONCLUSIONS: Aneurysm remnants after flow diversion are infrequent with minimal clinical impact. When appropriate, the presence of overlapping devices and possibly adjunctive coiling may result in higher rates of complete occlusion.IQRinterquartile rangeOKMO'Kelly-Marotta grading scale