Aneurysm embolization grade: a predictive tool for aneurysm recurrence after coil embolization

• Published in: Acta neurochirurgica 2013-02, Vol.155 (2), p.231-236
• Main Authors: Singla, Amit, Villwock, Mark R., Jacobsen, Walter, Deshaies, Eric M.
• Format: Article
• Language: English
• Subjects: Aneurysm; Aneurysm, Ruptured - diagnosis; Aneurysm, Ruptured - etiology; Aneurysm, Ruptured - therapy; Cerebral blood flow; Cerebrovascular Circulation; Classification; Clinical Article - Vascular; Cohort Studies; Data processing; Embolization; Embolization, Therapeutic; Hemodynamics; Humans; Implants; Interventional Radiology; Intracranial Aneurysm - diagnosis; Intracranial Aneurysm - etiology; Intracranial Aneurysm - therapy; Ischemia; Medicine; Medicine & Public Health; Minimally Invasive Surgery; Neurology; Neuroradiology; Neurosurgery; Packing; Predictive Value of Tests; Recurrence; Reproducibility of Results; Risk Assessment; Severity of Illness Index; Surgical Orthopedics; Thrombosis; Treatment Outcome; Vascular Patency
• ISSN: 0001-6268; 0942-0940
• DOI: 10.1007/s00701-012-1554-3

Background Coil embolization has gained importance in the management of intracranial aneurysms over the past decade. However, the recurrence risk after embolization mandates closer follow-up than surgical clip ligation. Currently, there is no reliable system for predicting aneurysm sac thrombosis. An aneurysm embolization grade (AEG) reported previously by the senior author (EMD) has been proposed as a tool for predicting the durability of aneurysm occlusion based on hemodynamic characteristics. Here, we present our internal validity results. Methods AEG and Raymond–Roy Occlusion Classification (RROC) scores were prospectively assigned to all aneurysms coiled from June 2008 to June 2011. The prospectively assigned AEG and RROC scores from the cerebral angiograms were collected for data analysis and validity assessment of the AEG system. 110 consecutive patients who had aneurysm coil embolization were included in this study. Results The post-coiling AEG significantly predicted follow-up angiographic filling characteristics. Pairwise comparisons revealed that the follow-up AEG for those initially scored ‘A’ (complete obliteration) was significantly better than the contrast-flow groups. Significant differences were also noted between contrast-stasis and contrast-flow groups. A pairwise comparison between RROC scores demonstrated that only the RROC Type 1 could be used to predict follow-up occlusion durability. Stent placement in wide-neck aneurysms had no effect on initial AEG, RROC, or long-term occlusion durability. Packing density significantly predicted initial AEG and RROC, but had no effect on long-term occlusion. Conclusions The AEG system is uniquely based on angiographic filling characteristics of the aneurysm, and this study demonstrated its high predictive value for determining aneurysm sac thrombosis. Assigning an AEG to the aneurysm can guide the neurointerventionalist in discussions with the patient regarding the probability of aneurysm recurrence and potential need for retreatment.