PT  - JOURNAL ARTICLE
AU  - Su, T.
AU  - Reymond, P.
AU  - Brina, O.
AU  - Bouillot, P.
AU  - Machi, P.
AU  - Delattre, B.M.A.
AU  - Jin, L.
AU  - Lövblad, K.O.
AU  - Vargas, M.I.
TI  - Large Neck and Strong Ostium Inflow as the Potential Causes for Delayed Occlusion of Unruptured Sidewall Intracranial Aneurysms Treated by Flow Diverter
AID  - 10.3174/ajnr.A6413
DP  - 2020 Feb 13
TA  - American Journal of Neuroradiology
4099  - http://www.ajnr.org/content/early/2020/02/13/ajnr.A6413.short
4100  - http://www.ajnr.org/content/early/2020/02/13/ajnr.A6413.full
AB  - BACKGROUND AND PURPOSE: Flow diverter–induced hemodynamic change plays an important role in the mechanism of intracranial aneurysm occlusion. Our aim was to explore the relationship between aneurysm features and flow-diverter treatment of unruptured sidewall intracranial aneurysms.MATERIALS AND METHODS: MR imaging, 4D phase-contrast, was prospectively performed before flow diverter implantation in each patient with unruptured intracranial aneurysm. Two postprocedure follow-ups were scheduled at 6 and 12 months. Responses were grouped according to whether the aneurysms were occluded or remnant. Preprocedural aneurysm geometries and ostium hemodynamics in 38 patients were compared between the 2 groups at 6 and 12 months. Receiver operating characteristic curve analyses were performed for significant geometric and hemodynamic continuous parameters.RESULTS: After the 6-month assessment, 21 of 41 intracranial aneurysms were occluded, and 9 additional aneurysms were occluded at 12 months. Geometrically, the ostium maximum diameter was significantly larger in the remnant group at 6 and 12 months (both P < .001). Hemodynamically, the proximal inflow zone was more frequently observed in the remnant group at 6 months. Several preprocedural ostium hemodynamic parameters were significantly higher in the remnant group. As a prediction for occlusion, the areas under the curve of the ostium maximum diameter (for 6 and 12 months), systolic inflow rate ratio (for 6 months), and systolic inflow area (for 12 months) reached 0.843, 0.883, 0.855, and 0.860, respectively.CONCLUSIONS: Intracranial aneurysms with a large ostium and strong ostium inflow may need a longer time for occlusion. Preprocedural 4D flow MR imaging can well illustrate ostium hemodynamics and characterize aneurysm treatment responses.FDflow diverterPCphase-contrastRArotational angiography