Impact of individual intracranial arterial aneurysm morphology on initial obliteration and recurrence rates of endovascular treatments: a multivariate analysis

Clinical article

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  • 1 Division of Neuroradiology, Department of Medical Imaging, and
  • 3 Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Ontario, Canada; and
  • 2 Department of Radiology, Siriraj Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand
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Object

The goal was to investigate whether morphological features of aneurysms can be identified that determine initial success and recurrence rates of coiled aneurysms of the basilar artery tip, the posterior communicating artery (PCoA), and the anterior communicating artery.

Methods

The authors evaluated 202 aneurysms in connection with their pretreatment morphological features including size, neck-to-dome ratio, angulation of the aneurysm in relation to the parent artery, orientation of the aneurysm dome, and associated anatomical variations. The mean follow-up was 19 months (range 6–96 months) after endovascular coil occlusion. Using multivariate logistic regression, probabilities for initial complete occlusion and long-term stability of the treatment were calculated.

Results

Recanalization occurred in 49 of 202 cases. Favorable factors for long-term stability included small aneurysms with small necks. However, additional factors related to local hemodynamic forces could be identified for the different aneurysm locations, which may influence initial success rates and long-term stability of aneurysm treatment with endovascular coiling. These factors were a medial dome orientation and a symmetrical disposition of both A1 segments (for the anterior communicating artery), a posteroinferior dome orientation and a small-size PCoA (for the PCoA), and a cranial symmetrical fusion (for the basilar artery tip).

Conclusions

A detailed pretreatment analysis of morphological features of aneurysms may help to determine those aneurysms that are more prone to recurrence, which could add to the treatment decision and the follow-up algorithm.

Abbreviations used in this paper: ACoA = anterior communicating artery; BA = basilar artery; DS = digital subtraction; PCA = posterior cerebral artery; PCoA = posterior communicating artery.

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Contributor Notes

Address correspondence to: Timo Krings, M.D., Ph.D., Division of Neuroradiology, University Health Network Toronto Western Hospital, 3MCL-429, 399 Bathurst Street, Toronto, Ontario, M5T 2S8, Canada. email: timo.krings@uhn.on.ca.

Please include this information when citing this paper: published online October 8, 2010; DOI: 10.3171/2010.8.JNS10241.

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