Predictors of the Effects of Flow Diversion in Very Large and Giant Aneurysms
| Autor: | Youmie Park, Bum-Soo Kim, Yurim Shin, Dong Young Cho, Hong-Ju Bae, Jai Ho Choi |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Balloon 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Aneurysm Angioplasty Medicine Humans Radiology Nuclear Medicine and imaging Thrombus Retrospective Studies Flow diversion Interventional business.industry Endovascular Procedures Intracranial Aneurysm medicine.disease Embolization Therapeutic Confidence interval Surgery Stenosis Contrast medium Treatment Outcome Stents Neurology (clinical) business 030217 neurology & neurosurgery |
| Zdroj: | AJNR Am J Neuroradiol |
| ISSN: | 1936-959X |
| Popis: | BACKGROUND AND PURPOSE: The treatment paradigm for very large and giant aneurysms has recently changed to flow diversion, in light of the results of the Pipeline for Uncoilable or Failed Aneurysms trial. However, the effects of flow diversion were definitely unknown. We explored this topic and identified the predictors of such effects. MATERIALS AND METHODS: We retrospectively reviewed 51 patients with unruptured aneurysms admitted to our institution for flow diversion between February 2014 and August 2019. Patients were categorized into an effect group (no filling or remnant entry) and a no-effect group (subtotal or total filling). We evaluated the aneurysm size and shape, incorporation vessel, parent artery stenosis and curvature, stagnation of contrast medium within the aneurysm, use of balloon angioplasty, and intra-aneurysm thrombus as potential predictors of the effects of flow diversion. RESULTS: The effect group comprised 34 patients (66.7%, 34/51; no filling, 35.3%, 18/51; and remnant entry, 31.4%, 16/51). The no-effect group comprised 17 patients (33.3%, 17/51; subtotal filling, 29.4%, 15/51; and total filling, 3.9%, 2/51). An incorporation vessel and balloon angioplasty were independent risk factors for the no-effect group in multivariate logistic regression analyses (OR = 0.13 and 0.05; 95% confidence intervals, 0.02–0.62 and 0.00–0.32; P values, .021 and .004, respectively). CONCLUSIONS: Flow diversion is effective for very large and giant aneurysms, but the outcomes require further improvement. The results of this study show that an incorporated vessel and excessive balloon angioplasty might compromise flow diversion. This finding can help improve the outcomes of flow diversion. |
| Databáze: | OpenAIRE |
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