Skip to main content
Advertisement

Main menu

  • Home
  • Content
    • Current Issue
    • Accepted Manuscripts
    • Article Preview
    • Past Issue Archive
    • Video Articles
    • AJNR Case Collection
    • Case of the Week Archive
    • Case of the Month Archive
    • Classic Case Archive
  • Special Collections
    • AJNR Awards
    • Low-Field MRI
    • Alzheimer Disease
    • ASNR Foundation Special Collection
    • Photon-Counting CT
    • View All
  • Multimedia
    • AJNR Podcasts
    • AJNR SCANtastic
    • Trainee Corner
    • MRI Safety Corner
    • Imaging Protocols
  • For Authors
    • Submit a Manuscript
    • Submit a Video Article
    • Submit an eLetter to the Editor/Response
    • Manuscript Submission Guidelines
    • Statistical Tips
    • Fast Publishing of Accepted Manuscripts
    • Graphical Abstract Preparation
    • Imaging Protocol Submission
    • Author Policies
  • About Us
    • About AJNR
    • Editorial Board
    • Editorial Board Alumni
  • More
    • Become a Reviewer/Academy of Reviewers
    • Subscribers
    • Permissions
    • Alerts
    • Feedback
    • Advertisers
    • ASNR Home

User menu

  • Alerts
  • Log in

Search

  • Advanced search
American Journal of Neuroradiology
American Journal of Neuroradiology

American Journal of Neuroradiology

ASHNR American Society of Functional Neuroradiology ASHNR American Society of Pediatric Neuroradiology ASSR
  • Alerts
  • Log in

Advanced Search

  • Home
  • Content
    • Current Issue
    • Accepted Manuscripts
    • Article Preview
    • Past Issue Archive
    • Video Articles
    • AJNR Case Collection
    • Case of the Week Archive
    • Case of the Month Archive
    • Classic Case Archive
  • Special Collections
    • AJNR Awards
    • Low-Field MRI
    • Alzheimer Disease
    • ASNR Foundation Special Collection
    • Photon-Counting CT
    • View All
  • Multimedia
    • AJNR Podcasts
    • AJNR SCANtastic
    • Trainee Corner
    • MRI Safety Corner
    • Imaging Protocols
  • For Authors
    • Submit a Manuscript
    • Submit a Video Article
    • Submit an eLetter to the Editor/Response
    • Manuscript Submission Guidelines
    • Statistical Tips
    • Fast Publishing of Accepted Manuscripts
    • Graphical Abstract Preparation
    • Imaging Protocol Submission
    • Author Policies
  • About Us
    • About AJNR
    • Editorial Board
    • Editorial Board Alumni
  • More
    • Become a Reviewer/Academy of Reviewers
    • Subscribers
    • Permissions
    • Alerts
    • Feedback
    • Advertisers
    • ASNR Home
  • Follow AJNR on Twitter
  • Visit AJNR on Facebook
  • Follow AJNR on Instagram
  • Join AJNR on LinkedIn
  • RSS Feeds

AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

In BriefConsensus Statements

Reporting Standards for Endovascular Repair of Saccular Intracranial Cerebral Aneurysms

P.M. Meyers, H.C. Schumacher, R.T. Higashida, C.P. Derdeyn, G.M. Nesbit, D. Sacks, L.R. Wechsler, J.B. Bederson, S.D. Lavine and P. Rasmussen
American Journal of Neuroradiology January 2010, 31 (1) E12-E24;
P.M. Meyers
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
H.C. Schumacher
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
R.T. Higashida
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
C.P. Derdeyn
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
G.M. Nesbit
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
D. Sacks
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
L.R. Wechsler
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
J.B. Bederson
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
S.D. Lavine
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
P. Rasmussen
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • Responses
  • References
  • PDF
Loading

Article Figures & Data

Figures

  • Tables
  • Fig 1.
    • Download figure
    • Open in new tab
    • Download powerpoint
    Fig 1.

    Arteriographic projections used to assess aneurysm dimensions. Posterior-anterior Townes and direct lateral projections demonstrate the presence of the right carotid–ophthalmic aneurysm, but these projections do not allow for optimal assessment of aneurysm size, dome-to-neck ratio, or artery-to-neck ratio. Magnified posterior-anterior Waters and lateral oblique projections in this particular case provide better planar imaging to assess the aneurysm for surgical or endovascular treatment.

  • Fig 2.
    • Download figure
    • Open in new tab
    • Download powerpoint
    Fig 2.

    CT brain scan with intravenous iodinated contrast of a patient with a partially thrombosed, giant right middle cerebral aneurysm. A, 5-mm contiguous axial images through the aneurysm demonstrate a ring-enhancing mass with a maximal dimension of 4.8 cm and a total volume of 48 mL. B, The patent component of the aneurysm measures only 14 mm in maximal dimension with a volume of 1.33 mL. The opacified component of the aneurysm at catheter arteriography represents 2.8% of the total aneurysm volume.

  • Fig 3.
    • Download figure
    • Open in new tab
    • Download powerpoint
    Fig 3.

    Diagram of measurements to determine aneurysm dimensions without geometric magnification using 1-cm measuring rings attached to the patient's head. All measurements are made on radiographic images using x-rays. Tube side magnification factor (T), film-side magnification factor (F), and the uncorrected lesion size (L) are measured on the radiograph. The distance from the tube side of the head to the lesion (D) and the width of the head (H) are measured from radiographs in the orthogonal plane. The magnification factor (M) at the level of the lesion is derived by the following formula: Embedded Image. Due to inherent geometric magnification in radiographic images, the actual aneurysm size is calculated by dividing the apparent aneurysm size as follows: Embedded Image.

  • Fig 4.
    • Download figure
    • Open in new tab
    • Download powerpoint
    Fig 4.

    Common location of cerebral aneurysms surrounding the circle of Willis. (A) Middle cerebral (proximal to bifurcation, bifurcation, distal to bifurcation); (B) carotid terminus; (C) anterior choroidal; (D) superior hypophyseal; (E) anterior communicating (proximal to communicating artery, at communicating artery); (F) posterior communicating; (G) ophthalmic; (H) basilar artery (terminus, trunk); (I) superior cerebellar; (J) V4 segment, vertebral; (K) posterior inferior cerebellar; (L) pericallosal artery.

  • Fig 5.
    • Download figure
    • Open in new tab
    • Download powerpoint
    Fig 5.

    Consensus grading scale for endovascular aneurysm occlusion is applied to orthogonal images obtained in optimal projections to assess aneurysm dimensions: Grade 0, complete aneurysm occlusion; Grade 1, ≥90% aneurysm occlusion; Grade 2, 70% to 89% aneurysm occlusion; Grade 3, 50% to 69% aneurysm occlusion; Grade 4, 25% to 49% aneurysm occlusion; Grade 5, <25% aneurysm occlusion.

  • Fig 6.
    • Download figure
    • Open in new tab
    • Download powerpoint
    Fig 6.

    Modification to consensus grading scale for endovascular aneurysm occlusion describing interstitial opacification within coil mass. A, Left internal carotid arteriography in right frontal oblique projection during the arterial phase of injection shows coil occlusion of a 12×11×14 mm left posterior communicating artery aneurysm. B, Because there is a small ventral neck remnant and residual opacification within the aneurysm sac (colored areas), this represents consensus Grade 1 occlusion with “I” for persistent interstitial opacification within the coil mass.

Tables

  • Figures
    • View popup
    Table 1.

    Summary of cerebral aneurysm attributes

    General definitions
        Clinical presentation
            Symptomatic: hemorrhage or mass
            Hunt and Hess Grade or World Federation of Neurological Surgeons Grading Scale
            Glasgow Coma Scale and NIHSS
            Modified Rankin Scale score
            Fisher CT score
        Date of presentation
            Time to diagnosis (hours to days)
            Time to arteriography (hours to days)
            Time to treatment (hours to days)
        Imaging source and date
    Aneurysm shape
        Saccular
        Other types excluded
            Dissecting
            Serpentine
            Giant, partially thrombosed
            Dolichoectatic
    Size and location (see Table 5)
        Planar dimensions
        Neck width and area
        Parent artery diameter
        Dome-to-neck ratio
        Neck-to-artery ratio
        Aneurysm volume
        Single or multiple
        Arteriographic comorbidities (see Table 5)
    Procedural technique
        Catheter type
        Guide wire type
        Guiding catheter type
        Adjunctive techniques
        Coil types, diameters, lengths, and numbers of coils
        Technical success
        Recanalization and recanalization rate
    Computational results
        Arteriographic occlusion
        Volumetric occlusion
    Advanced computational features
        Computational flow dynamics
    Clinical success
        30-day morbidity and mortality (assessed by independent physician)
            Modified Rankin Scale46
            Barthel Index47
            Glasgow Outcome Scale45
            NIHSS48
    • NIHSS indicates National Institutes of Health Stroke Scale.

    • View popup
    Table 2.

    Subarachnoid hemorrhage clinical grading scales

    GradeHunt and HessWorld Federation of Neurological Surgeons
    0Intact aneurysm
    1Asymptomatic or mild headacheGlasgow Coma Scale (GCS) 15
    1aFixed neurological deficit without meningeal or brain reaction
    2Moderate to severe headache, cranial nerve palsy, nuchal rigidityGCS 13–14 without motor deficit
    3Lethargy, confusion, mild focal deficitGCS 13–14 with motor deficit
    4Stupor, hemiparesis, early decerebrate posturingGCS 7–12 without or with motor deficit
    5Coma, decerebrate posturing, moribund appearanceGCS 3–6 without or with motor deficit
    • View popup
    Table 3.

    Glasgow Coma Scale45

    PointsEye Opening ResponseVerbal ResponseMotor Response
    6NANAObeys
    5NAOrientedLocalizes to pain
    4SpontaneousConfusedWithdraws to pain
    3To speechInappropriateFlexor (decorticate)
    2To painIncomprehensibleExtensor (decerebrate)
    1NoneNoneNone
    • NA indicates not applicable.

    • View popup
    Table 4.

    Fisher CT Grading Scale20

    Fisher GroupBlood Pattern on Nonenhanced CT
    1No subarachnoid blood detected
    2Diffuse or vertical layers <1 mm thick*
    3Localized clot or vertical layers ≥1 mm thick
    4Intracerebral or intraventricular clot with diffuse or no subarachnoid hemorrhage
    • * “Vertical” cisterns include interhemispheric, insular, and ambient.

    • View popup
    Table 5.

    Proposed fields and ranges

    General Definitions (Choose all that apply)
    Clinical presentationHemorrhage
        Incidental    Evidence of new hemorrhage
        Hemorrhage    Age of new hemorrhage
        Seizure    Is new hemorrhage symptomatic
        Neurological deficit    Evidence of old hemorrhage
        Headache    Age of old hemorrhage
        Other    Was old hemorrhage symptomatic
    Date of presentation    Evidence of new cerebral infarction
    Imaging source and date    Evidence of intraparenchymal hemorrhage
    Location and size    Size of parenchymal hemorrhage
        Lesion sidePresence of mass effect
            Right    Presence of hydrocephalus
            Left    Opening pressure on insertion of ventricular catheter
            Midline    Requirement for ongoing ventricular drainage
        HandednessComorbid vascular conditions
            Right    Fibromuscular dysplasia
            Left    Arteriovenous malformation
        Aneurysm size (greatest diameter in mm)    Bacterial endocarditis
        Multiple aneurysms    Polycystic disease
            No. of aneurysms    Familial history of aneurysms
        Aneurysm location    Vascular occlusion
            Internal carotid    Vascular anomalies
            Proximal intradural or ophthalmicVasospasm
            Posterior communicating    Nonatherosclerotic narrowing of the cerebral arteries
            Bifurcation    Grading of vasospasm (mild, moderate, severe)
            Other internal carotid    Possible clinical symptoms and signs related to vasospasm
        Anterior cerebral    Treatment for vasospasm
            Anterior communicating        Vasodilator, intra-arterial
            Proximal to anterior communicating        Type and dosage of vasodilator
            Pericallosal        Balloon angioplasty
        Middle cerebral        Balloon type
            Proximal to bifurcation        Vessels treated with angioplasty
            BifurcationTechnical success of endovascular treatment
            Distal to main bifurcation    Unable to catheterize aneurysm
        Posterior circulation    Unable to deploy adjunctive devices such as balloon or stent
            Basilar bifurcation    Unable to deploy embolic materials in aneurysm
            Basilar trunk    Embolic material herniation beyond aneurysm confines
            Superior cerebellar    Neck remnant
            Posterior cerebral    Interstitial opacification
            Posterior inferior cerebellar    Near complete occlusion
            Other posterior circulation    Complete occlusion
    • View popup
    Table 6.

    Consensus Grading Scale for Endovascular Aneurysm Occlusion

    Gradea,bDefinition
    0Complete aneurysm occlusion
    190% or greater aneurysm occlusion
    270–89% aneurysm occlusion
    350–69% aneurysm occlusion
    425–49% aneurysm occlusion
    5Less than 25% aneurysm occlusion
    • a The modifier “I” may be used to describe interstitial opacification within the confines of the coil mass.

    • b The modifier “G” may be used to describe interval growth in the overall dimensions of the aneurysm as a separate phenomenon from coil compaction with recanalization of the aneurysm.

    • View popup
    Table 7.

    Definition and grading of neurological deficits

    DefinitionDescription
    ComplicationNeurological deterioration, NIHSS ≥1
    Transient ischemic attackResolution of new focal deficit within 24 hours
    No CT or MRI evidence of infarction
    Cerebrovascular accident, symptomaticGreater than 30 days duration
        MajorNIHSS ≥4, mRS ≥3
        MinorNIHSS <4, mRS ≤2
    • NIHSS indicates National Institutes of Health Stroke Scale; mRS, Modified Rankin Scale.

    • View popup
    Table 8.

    Classification of complications

    ComplicationCategory of Complication
    AbscessInfectious/inflammatory
    Angina/coronary ischemiaCardiac
    Idiosyncratic reactionMedication-related
    Allergic/anaphylactoid reactionContrast-related
    Arterial occlusion/thrombosis, puncture siteVascular
    Arterial occlusion/thrombosis, remote from puncture siteVascular
    Arteriovenous fistulaVascular
    Congestive heart failureCardiac
    Device malfunction with adverse effectDevice-related
    Death related to procedureDeath
    Death unrelated to procedure (30-day mortality)Death
    Dysrhythmia, cardiacCardiac
    Embolization, arterialVascular
    Fluid/electrolyte imbalanceGeneral nonvascular
    Hematoma bleed, remote siteVascular
    Hematoma bleed at needle, device path: nonvascular procedureVascular
    Hematoma bleed, puncture site: vascular procedureVascular
    Incorrect drugMedication-related
    Incorrect dosageMedication-related
    Intimal injury/dissectionVascular
    Ischemia/infarction of tissue/organVascular
    Incorrect site of administrationMedication-related
    Local infectionInfectious/inflammatory
    Liver failureGeneral nonvascular
    Migration of embolic material from target siteDevice-related
    Myocardial infarctionCardiac
    MalpositionDevice-related
    Nausea/vomitingGeneral nonvascular
    Other (cardiac)Cardiac
    Other (contrast-related)Contrast-related
    Other (central nervous system complication)Neurologic
    Other dose-dependent complicationContrast-related
    Other (device-related)Device-related
    Other (gastrointestinal)General nonvascular
    Other (general nonvascular)General nonvascular
    Other (hematologic)General nonvascular
    Other (infectious/inflammatory)Infectious/inflammatory
    Other (medication-related)Medication-related
    Other (neurologic)Neurologic
    Other (respiratory/pulmonary)Respiratory/pulmonary
    Other (vascular)Vascular
    PancreatitisInfectious/inflammatory
    Pulmonary embolismRespiratory/pulmonary
    Pulmonary embolismVascular
    PeritonitisInfectious/inflammatory
    HypotensionCardiac
    HypoxiaRespiratory/pulmonary
    Pulmonary edemaRespiratory/pulmonary
    Peripheral nervous system complicationNeurologic
    PneumothoraxRespiratory/pulmonary
    PseudoaneurysmVascular
    Respiratory arrestRespiratory/pulmonary
    Renal failureContrast-related
    Septicemia/bacteremiaInfectious/inflammatory
    SeizureNeurologic
    Septic shockInfectious/inflammatory
    Stroke, ischemicNeurologic
    Stroke, hemorrhagicNeurologic
    Tissue extravasationContrast-related
    Transient ischemic attackNeurologic
    Unintended perforation of hollow viscusGeneral nonvascular
    Vascular perforation or ruptureVascular
    Vagal reactionCardiac
    VasospasmVascular
    Venous occlusion/thrombosis, puncture siteVascular
    Venous occlusion/thrombosis, remote from puncture siteVascular
    • View popup
    Table 9.

    Definitions of complications

    Minor complications
        A. No therapy, no consequence
        B. Nominal therapy, no consequence; includes overnight admission for observation only
    Major complications
        C. Require therapy, minor change in length of hospitalization (<48 hours)
        D. Require major therapy, unplanned increase in level of care, prolonged hospitalization (>48 hours)
        E. Permanent adverse sequelae
        F. Death
PreviousNext
Back to top

In this issue

American Journal of Neuroradiology: 31 (1)
American Journal of Neuroradiology
Vol. 31, Issue 1
1 Jan 2010
  • Table of Contents
  • Index by author
Advertisement
Print
Download PDF
Email Article

Thank you for your interest in spreading the word on American Journal of Neuroradiology.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Reporting Standards for Endovascular Repair of Saccular Intracranial Cerebral Aneurysms
(Your Name) has sent you a message from American Journal of Neuroradiology
(Your Name) thought you would like to see the American Journal of Neuroradiology web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Cite this article
P.M. Meyers, H.C. Schumacher, R.T. Higashida, C.P. Derdeyn, G.M. Nesbit, D. Sacks, L.R. Wechsler, J.B. Bederson, S.D. Lavine, P. Rasmussen
Reporting Standards for Endovascular Repair of Saccular Intracranial Cerebral Aneurysms
American Journal of Neuroradiology Jan 2010, 31 (1) E12-E24;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
0 Responses
Respond to this article
Share
Bookmark this article
Reporting Standards for Endovascular Repair of Saccular Intracranial Cerebral Aneurysms
P.M. Meyers, H.C. Schumacher, R.T. Higashida, C.P. Derdeyn, G.M. Nesbit, D. Sacks, L.R. Wechsler, J.B. Bederson, S.D. Lavine, P. Rasmussen
American Journal of Neuroradiology Jan 2010, 31 (1) E12-E24;
del.icio.us logo Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • Historical Context: Aneurysm Reporting
    • General Definitions
    • Clinical Presentation
    • Patient Handedness
    • Dates of Rupture, Diagnosis, and Treatment
    • Baseline Imaging: Brain and Aneurysm Imaging
    • Procedural Details
    • Summary
    • Disclosures
    • Footnotes
    • References
  • Figures & Data
  • Info & Metrics
  • Responses
  • References
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • Effect of stenting on progressive occlusion of small unruptured saccular intracranial aneurysms with residual sac immediately after coil embolization: a propensity score analysis
  • Validity of the Meyer Scale for Assessment of Coiled Aneurysms and Aneurysm Recurrence
  • Evaluation of the Angiographic Grading Scale in Aneurysms Treated with the WEB Device in 80 Rabbits: Correlation with Histologic Evaluation
  • Back to the Tower of Babel: Comparing Outcomes from Aneurysm Trials
  • Outcomes of Endovascular Treatments of Aneurysms: Observer Variability and Implications for Interpreting Case Series and Planning Randomized Trials
  • Comparison of 2-Year Angiographic Outcomes of Stent- and Nonstent-Assisted Coil Embolization in Unruptured Aneurysms with an Unfavorable Configuration for Coiling
  • Scaling Back on Scales with a Scale of Scales
  • Crossref
  • Google Scholar

This article has not yet been cited by articles in journals that are participating in Crossref Cited-by Linking.

More in this TOC Section

Consensus Statements

  • Performance and Training Standards for Endovascular Ischemic Stroke Treatment
Show more Consensus Statements

Neurointervention

  • Performance and Training Standards for Endovascular Ischemic Stroke Treatment
  • Effect of SARS-CoV2 on Endovascular Thrombectomy
  • Flow diversion for distal circulation aneurysms
Show more Neurointervention

Similar Articles

Advertisement

Indexed Content

  • Current Issue
  • Accepted Manuscripts
  • Article Preview
  • Past Issues
  • Editorials
  • Editor's Choice
  • Fellows' Journal Club
  • Letters to the Editor
  • Video Articles

Cases

  • Case Collection
  • Archive - Case of the Week
  • Archive - Case of the Month
  • Archive - Classic Case

More from AJNR

  • Trainee Corner
  • Imaging Protocols
  • MRI Safety Corner
  • Book Reviews

Multimedia

  • AJNR Podcasts
  • AJNR Scantastics

Resources

  • Turnaround Time
  • Submit a Manuscript
  • Submit a Video Article
  • Submit an eLetter to the Editor/Response
  • Manuscript Submission Guidelines
  • Statistical Tips
  • Fast Publishing of Accepted Manuscripts
  • Graphical Abstract Preparation
  • Imaging Protocol Submission
  • Evidence-Based Medicine Level Guide
  • Publishing Checklists
  • Author Policies
  • Become a Reviewer/Academy of Reviewers
  • News and Updates

About Us

  • About AJNR
  • Editorial Board
  • Editorial Board Alumni
  • Alerts
  • Permissions
  • Not an AJNR Subscriber? Join Now
  • Advertise with Us
  • Librarian Resources
  • Feedback
  • Terms and Conditions
  • AJNR Editorial Board Alumni

American Society of Neuroradiology

  • Not an ASNR Member? Join Now

© 2025 by the American Society of Neuroradiology All rights, including for text and data mining, AI training, and similar technologies, are reserved.
Print ISSN: 0195-6108 Online ISSN: 1936-959X

Powered by HighWire