Abstract
Introduction
Flow diverter (FD) devices have emerged as an alternative treatment for a subgroup of intracranial aneurysms. The principle of endovascular flow diversion is inherently different from endosaccular coil embolisation. To monitor the angiographic outcomes for FDs, a sensitive and reliable new measure is required. Oxford Neurovascular and Neuroradiology Research Unit developed a grading schema while conducting a registry to audit outcomes of patients treated using a particular FD (SILK flow diverter; Balt Extrusion, Montmorency, France). The aim of this study is to assess the applicability and reproducibility of the new schema.
Methods
The proposed grading schema is designed for saccular- or fusiform-shaped aneurysms. For both, it documents the degree of aneurysm occlusion using a five-point scale and the parent artery patency on a three-point scale. Two neuroradiologists used the schema to independently rate 55 angiograms showing comparable treatment and follow-up angiograms of patients treated with a FD. Inter-observer agreement was estimated using the weighted kappa co-efficient.
Results
Both readers found the schema easy to apply. Overall, there were ten discordant readings for degrees of aneurysm occlusion and two for parent artery patency. Inter-observer agreement was excellent for both the assessment of aneurysm occlusion (k=0.89; C.I.=0.81–0.99) and parent artery patency (k=0.90; C.I.=0.76–1.0).
Conclusion
The proposed schema is sufficiently sensitive to register gradual aneurysm occlusion and parent artery patency on interval angiograms. It is reproducible and is applicable to both saccular and fusiform aneurysms. More data on follow-up of FD-treated aneurysms is needed to prove its efficacy in predicting the long-term behaviour of treated aneurysms.
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References
Raymond J, Guilbert F, Weill A et al (2003) Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 34:1398–1403
Murayama Y, Nien YL, Duckwiler G et al (2003) Guglielmi detachable coil embolization of cerebral aneurysms: 11 years’ experience. J Neurosurg 98:959–966
Johnston SC, Dowd CF, Higashida RT, for the CARAT Investigators et al (2008) Predictors of rehemorrhage after treatment of ruptured intracranial aneurysms. The Cerebral Aneurysm Rerupture After Treatment (CARAT) Study. Stroke 39:120–125
Geremia G, Haklin M, Brennecke L (1994) Embolization of experimentally created aneurysms with intravascular stent devices. Am J Neuroradiol 15:1223–1231
Benndorf G, Herbon U, Sollmann WP et al (2001) Treatment of a ruptured dissecting vertebral artery aneurysm with double stent placement: case report. Am J Neuroradiol 22:1844–1848
Lylyk P, Miranda C, Ceratto R et al (2009) Curative endovascular reconstruction of cerebral aneurysms with the pipeline embolization device: the Buenos Aires experience. Neurosurgery 64:632–642, discussion 642–643
Szikora I, Berentei Z, Kulcsar Z et al (2010) Treatment of intracranial aneurysms by functional reconstruction of the parent artery: the Budapest experience with the pipeline embolization device. Am J Neuroradiol 31:1139–1147
Byrne JV, Beltechi R, Yarnold JA et al (2010) Early experience in the treatment of intracranial aneurysms by endovascular flow diversion: a multicentre prospective study. PLoS one 5(9):e12492. doi:10.1371/journal.pone.0012492
Raymond J, Roy D (1997) Safety and efficacy of endovascular treatment of acutely ruptured aneurysms. Neurosurgery 41:1235–1245, discussion 1245–1246
Campi A, Ramzi N, Molyneux AJ et al (2007) Retreatment of ruptured cerebral aneurysms in patients randomized by coiling or clipping in the International Subarachnoid Aneurysm Trial (ISAT). Stroke 38:1538–1544
Raymond J, White PM, Molyneux AJ (2007) Scales, agreement, outcome measures, and progress in aneurysm therapy. Am J Neuroradiol 28:501–502
Friedman JA, Nichols DA, Meyer FB et al (2003) Guglielmi detachable coil treatment of ruptured saccular cerebral aneurysms: retrospective review of a 10-year single-center experience. Am J Neuroradiol 24:526–533
Fleiss JL (1981) Statistical methods for rates and proportions, 2nd edn. John Wiley, New York
Hope JK, Byrne JV, Molyneux AJ (1999) Factors influencing successful angiographic occlusion of aneurysms treated by coil embolization. Am J Neuroradiol 20:391–399
Henkes H, Fischer S, Liebig T et al (2006) Repeated endovascular coil occlusion in 350 of 2759 intracranial aneurysms: safety and effectiveness aspects. Neurosurgery 58:224–232, discussion 224–232
Pierot L, Bonafé A, Bracard S et al (2006) Endovascular treatment of intracranial aneurysms with matrix detachable coils: immediate posttreatment results from a prospective multicenter registry. Am J Neuroradiol 27:1693–1699
Ries T, Siemonsen S, Thomalla G et al (2007) Long-term follow-up of cerebral aneurysms after endovascular therapy prediction and outcome of retreatment. Am J Neuroradiol 28:1755–1761
Cognard C, Weill A, Spelle L et al (1999) Long-term angiographic follow-up of 169 intracranial berry aneurysms occluded with detachable coils. Radiology 212:348–356
Birchall D, Khangure MS, McAuliffe W et al (2001) Delayed aneurysm rerupture following total endovascular occlusion. Br J Neurosurg 15:269–272
Fiorella D, Kelly M, Woo H (2009) Flow diversion for intracranial aneurysm treatment. Sides Media WS. EVToday.com Available from: http://bmctoday.net/evtoday/2009/09/article.asp?f=0909_07.php
Acknowledgements
Kamran M. is funded by the Rhodes Trust. Grunwald I. Q. is supported by the Biomedical Research Centre (BRC) and is affiliated with the Acute Vascular Imaging Centre (AVIC), University of Oxford. We wish to thank all the contributors to the SILK registry, in particular the 11 centres whose angiograms were used for this study: Akgul E (Adana, Turkey), Bonafe A (Montepellier, France), Casagrande W (Buenos Aires, Argentina), Fourie P (Pretoria, South Africa), Gal G (Odense, Denmark), Goddard T (Leeds, UK), Juszkat R (Poznan, Poland), Kupcs K (Latvia), Leonardi M (Bologna, Italy), Margus S (Tartu University Hospital, Estonia), Weber W (Recklinghausen, Germany). We also acknowledge the financial support of Balt Extrusion, Montmorency, France for supporting the collection and analyses of data used in the SILK registry.
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Kamran, M., Yarnold, J., Grunwald, I.Q. et al. Assessment of angiographic outcomes after flow diversion treatment of intracranial aneurysms: a new grading schema. Neuroradiology 53, 501–508 (2011). https://doi.org/10.1007/s00234-010-0767-5
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DOI: https://doi.org/10.1007/s00234-010-0767-5