Postoperative Time-of-Flight Magnetic Resonance Angiography Classification is a Predictor of Postoperative Recanalization of Unruptured Cerebral Aneurysms.

Autor: Fujii S; Department of Endovascular Surgery, Institute of Science Tokyo, Tokyo, Japan., Fujita K; Department of Endovascular Surgery, Institute of Science Tokyo, Tokyo, Japan., Ishikawa M; Department of Neurosurgery, Ome Medical Center, Tokyo, Japan., Shigeta K; Department of Neurosurgery, National Hospital Organization Disaster Medical Center, Tokyo, Japan., Aizawa Y; Department of Neurosurgery, National Hospital Organization Disaster Medical Center, Tokyo, Japan., Yoshimura M; Department of Neurosurgery, Tsuchiura Kyodo General Hospital, Ibaraki, Japan; Department of Endovascular Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan., Hirota S; Department of Neurosurgery, Tsuchiura Kyodo General Hospital, Ibaraki, Japan., Ito K; Department of Neurosurgery, Tsuchiura Kyodo General Hospital, Ibaraki, Japan., Yoshino Y; Department of Endovascular Surgery, Jichi Medical University Saitama Medical Center, Saitama, Japan., Yamada K; Department of Endovascular Surgery, Jichi Medical University Saitama Medical Center, Saitama, Japan., Takahashi S; Department of Endovascular Surgery, Institute of Science Tokyo, Tokyo, Japan., Sagawa H; Department of Endovascular Surgery, Institute of Science Tokyo, Tokyo, Japan., Kinoshita Y; Department of Endovascular Surgery, Institute of Science Tokyo, Tokyo, Japan., Kobayashi Y; Department of Endovascular Surgery, Institute of Science Tokyo, Tokyo, Japan., Hirai S; Department of Endovascular Surgery, Institute of Science Tokyo, Tokyo, Japan., Sumita K; Department of Endovascular Surgery, Institute of Science Tokyo, Tokyo, Japan. Electronic address: sumita.nsrg@tmd.ac.jp.
Jazyk: angličtina
Zdroj: World neurosurgery [World Neurosurg] 2024 Dec 09, pp. 123496. Date of Electronic Publication: 2024 Dec 09.
DOI: 10.1016/j.wneu.2024.11.079
Abstrakt: Background: Endovascular treatment has become the preferred approach for managing unruptured cerebral aneurysms, with simple and balloon-assisted coil embolization as the standard first-line therapy. However, recanalization after coil embolization remains a major clinical concern. This study aimed to evaluate the predictive factors for recanalization using time-of-flight magnetic resonance (TOF-MR) angiography.
Methods: This retrospective multicenter study analyzed data from 241 patients with unruptured cerebral aneurysms who underwent coil embolization at 5 stroke centers. Aneurysms were evaluated using TOF-MR angiography within 7 days postprocedure and at follow-up. The study investigated the role of aneurysm characteristics and the Postoperative TOF-MR Angiography (PTMA) classification in predicting recanalization.
Results: Of the 241 aneurysms analyzed, 79 (32.7%) exhibited recanalization, and 15 (6.2%) required retreatment. Aneurysms with a maximum diameter of ≥10 mm were associated with a higher risk of recanalization (odds ratio, 3.27; 95% confidence interval (CI), 1.38-7.75; P < 0.01). The PTMA classification, which indicated incomplete occlusion (small residual neck/residual neck/partial occlusion), also showed a significant association with recanalization (odds ratio, 4.82; 95% confidence interval, 2.17-10.7; P < 0.01). The modified Raymond-Roy classification (Class IIIb) also contributed to the prediction of recanalization (odds ratio, 3.09; 95% confidence interval, 1.50-6.38; P < 0.01).
Conclusions: Aneurysm size, the modified Raymond-Roy classification, and PTMA classification within 7 days of coil embolization were significant predictors of recanalization. This study suggests that TOF-MR angiography may be accurate, and that PTMA classification may serve as an appropriate predictor of aneurysm recanalization. Further prospective studies with larger cohorts are required to validate our findings.
(Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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