TY - JOUR
T1 - Difficult aneurysms for endovascular treatment
T2 - Overwide or undertall?
AU - Brinjikji, W.
AU - Cloft, H. J.
AU - Kallmes, David F.
PY - 2009/9
Y1 - 2009/9
N2 - BACKGROUND AND PURPOSE: Aneurysm geometry has been shown to predict the need for adjunctive techniques in the endovascular treatment of intracranial aneurysms. We conducted a systematic retrospective study examining which thresholds of dome-to-neck ratio, maximum neck width, and aspect ratio of intracranial aneurysms best predict the need for adjunctive techniques in endovascular management. MATERIALS AND METHODS: One hundred seventy-five consecutive patients who were selected for attempted embolization of 185 intracranial aneurysms were included in this study. Aneurysm dometo-neck ratio (maximum dome width/maximum neck width), maximum neck width, and aspect ratio (dome height/maximum neck width) were measured on 2D digital subtraction angiography. Statistical analysis was conducted to determine which thresholds of dome-to-neck ratio, maximum neck width, and aspect ratio were most predictive of the need for adjunctive devices in endovascular management of these aneurysms. RESULTS: We demonstrated that 75% of aneurysms with dome-to-neck ratios >1.6 (P < .0001), 75% of aneurysms with aspect ratios >1.6 (P < .0001), and 70% of aneurysms with neck diameters <4.0 mm (P < .0001) did not need adjunctive techniques in their management. Adjunctive techniques were essential to treatment of 80% of aneurysms with dome-to-neck ratios <1.2 (P = .02) and 89% of aneurysms with aspect ratios <1.2 (P < .0001). Multivariate logistic regression analysis demonstrated that aspect ratio was the best predictor of the need for an adjunctive device (P = .0004). CONCLUSIONS: Aneurysms with aspect and dome-to-neck ratios >1.6 usually did not require adjunctive techniques. Aneurysms with aspect and dome-to-neck ratios <1.2 almost always required adjunctive techniques. In this single-center series, aspect ratio was the independent predictor of the need for adjunctive techniques in the endovascular management of intracranial aneurysms.
AB - BACKGROUND AND PURPOSE: Aneurysm geometry has been shown to predict the need for adjunctive techniques in the endovascular treatment of intracranial aneurysms. We conducted a systematic retrospective study examining which thresholds of dome-to-neck ratio, maximum neck width, and aspect ratio of intracranial aneurysms best predict the need for adjunctive techniques in endovascular management. MATERIALS AND METHODS: One hundred seventy-five consecutive patients who were selected for attempted embolization of 185 intracranial aneurysms were included in this study. Aneurysm dometo-neck ratio (maximum dome width/maximum neck width), maximum neck width, and aspect ratio (dome height/maximum neck width) were measured on 2D digital subtraction angiography. Statistical analysis was conducted to determine which thresholds of dome-to-neck ratio, maximum neck width, and aspect ratio were most predictive of the need for adjunctive devices in endovascular management of these aneurysms. RESULTS: We demonstrated that 75% of aneurysms with dome-to-neck ratios >1.6 (P < .0001), 75% of aneurysms with aspect ratios >1.6 (P < .0001), and 70% of aneurysms with neck diameters <4.0 mm (P < .0001) did not need adjunctive techniques in their management. Adjunctive techniques were essential to treatment of 80% of aneurysms with dome-to-neck ratios <1.2 (P = .02) and 89% of aneurysms with aspect ratios <1.2 (P < .0001). Multivariate logistic regression analysis demonstrated that aspect ratio was the best predictor of the need for an adjunctive device (P = .0004). CONCLUSIONS: Aneurysms with aspect and dome-to-neck ratios >1.6 usually did not require adjunctive techniques. Aneurysms with aspect and dome-to-neck ratios <1.2 almost always required adjunctive techniques. In this single-center series, aspect ratio was the independent predictor of the need for adjunctive techniques in the endovascular management of intracranial aneurysms.
UR - http://www.scopus.com/inward/record.url?scp=70349215366&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=70349215366&partnerID=8YFLogxK
U2 - 10.3174/ajnr.A1633
DO - 10.3174/ajnr.A1633
M3 - Article
C2 - 19461057
AN - SCOPUS:70349215366
SN - 0195-6108
VL - 30
SP - 1513
EP - 1517
JO - American Journal of Neuroradiology
JF - American Journal of Neuroradiology
IS - 8
ER -