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Cerebral aneurysm neck diameter is an independent predictor of progressive occlusion after stent-assisted coiling

  • Original Article - Vascular
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Abstract

Background

Some intracranial aneurysms treated by stent-assisted coiling (SAC) with incomplete occlusion undergo progressive occlusion (PO) during follow-up period. We analyzed the predictors for the occurrence of PO.

Methods

Among 74 cerebral aneurysms treated by SAC using the Enterprise or Neuroform stents from 2010 to 2015, we included 43 aneurysms with occlusion grade of neck remnant (NR, n = 36) or residual aneurysm (RA, n = 7) at the post-procedure. We defined PO as improvement in occlusion grade from RA to NR, or from NR or RA to complete occlusion on angiographic follow-up imaging at 6 months after the procedure. We analyzed the independent predictors for PO using a multivariate logistic regression model and receiver operating characteristic (ROC) curve analysis.

Results

Forty-three aneurysms were analyzed, with mean volume embolization ratio of 30.3 ± 6.7%. Twenty aneurysms (47%) achieved PO. Univariate analysis found that the median neck diameter of the aneurysms was smaller in aneurysms with PO than others. Multivariate logistic regression analysis also found that the odds ratio of neck diameter of the aneurysm for PO was 0.44 (95% CI, 0.19–0.82, p < 0.01). Moreover, ROC curve analysis for PO found that the optimal cut-off value of the neck diameter was 5.5 mm, with a sensitivity of 95%, specificity of 57% (p < 0.01).

Conclusions

Incompletely occluded aneurysms with a neck diameter of 5.5 mm or less might be more likely to develop PO within 6 months after SAC by using Enterprise or Neuroform stents.

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Authors and Affiliations

  1. Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, 060-8556, Japan

    Masahito Nakazaki, Shinichi Oka, Masanori Sasaki & Osamu Honmou

  2. Department of Neuroendovascular Therapy, Sapporo Shiroishi Memorial Hospital, Sapporo, Hokkaido, 003-0026, Japan

    Tadashi Nonaka, Tatsufumi Nomura & Toshiyuki Onda

  3. Department of Neurosurgery, Sapporo Shiroishi Memorial Hospital, Sapporo, Hokkaido, 003-0026, Japan

    Tadashi Nonaka, Tatsufumi Nomura, Toshiyuki Onda, Yasuyuki Yonemasu, Akira Takahashi, Yuji Hashimoto, Osamu Honda & Masahiko Daibo

Authors
  1. Masahito Nakazaki
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  2. Tadashi Nonaka
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  3. Tatsufumi Nomura
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  4. Toshiyuki Onda
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  5. Yasuyuki Yonemasu
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  6. Akira Takahashi
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  7. Yuji Hashimoto
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  8. Osamu Honda
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  9. Shinichi Oka
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  10. Masanori Sasaki
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Corresponding author

Correspondence to Masahito Nakazaki.

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Funding

No funding was received for this research.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Informed consent

Informed consent was obtained from our patient included in the study.

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Comments

The authors carefully analyzed their cases of stent-assisted coiling using Enterprise or Neuroform stents from a viewpoint of the progressive thrombosis of the residual aneurysm during 6-month follow-up. They clearly demonstrated that smaller neck size was the best predictor for the progressive occlusion of the residual aneurysm after incomplete occlusion by stent-assisted coiling. This information will be helpful for the planning and strategy to treat the aneurysms.

Kenji Sugiu,

Okayama, Japan

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Nakazaki, M., Nonaka, T., Nomura, T. et al. Cerebral aneurysm neck diameter is an independent predictor of progressive occlusion after stent-assisted coiling. Acta Neurochir 159, 1313–1319 (2017). https://doi.org/10.1007/s00701-017-3199-8

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  • DOI: https://doi.org/10.1007/s00701-017-3199-8

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