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Improved Turnaround Times | Median time to first decision: 12 days

Research ArticleInterventional

Neck Location on the Outer Convexity is a Predictor of Incomplete Occlusion in Treatment with the Pipeline Embolization Device: Clinical and Angiographic Outcomes

T. Sunohara, H. Imamura, M. Goto, R. Fukumitsu, S. Matsumoto, N. Fukui, Y. Oomura, T. Akiyama, T. Fukuda, K. Go, S. Kajiura, M. Shigeyasu, K. Asakura, R. Horii, C. Sakai and N. Sakai
American Journal of Neuroradiology January 2021, 42 (1) 119-125; DOI: https://doi.org/10.3174/ajnr.A6859
T. Sunohara
aFrom the Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan.
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H. Imamura
aFrom the Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan.
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M. Goto
aFrom the Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan.
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R. Fukumitsu
aFrom the Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan.
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S. Matsumoto
aFrom the Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan.
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N. Fukui
aFrom the Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan.
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  • ORCID record for N. Fukui
Y. Oomura
aFrom the Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan.
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T. Akiyama
aFrom the Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan.
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T. Fukuda
aFrom the Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan.
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K. Go
aFrom the Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan.
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S. Kajiura
aFrom the Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan.
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M. Shigeyasu
aFrom the Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan.
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K. Asakura
aFrom the Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan.
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R. Horii
aFrom the Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan.
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C. Sakai
aFrom the Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan.
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N. Sakai
aFrom the Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan.
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Article Figures & Data

Figures

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  • FIGURE.
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    FIGURE.

    Classification of saccular aneurysms.

Tables

  • Figures
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    Table 1:

    Baseline characteristics of aneurysms and patient demographics

    Value
    Patients (n = 89)
     Age (yr)
     Median (range)58 (20–88)
     Sex
      Female74 (83.1%)
      Male15 (16.9%)
     Current smoking30 (28.6%)
     Pretreatment mRS
      0–289 (100%)
      3–50 (0%)
     Symptomatic cranial nerve compression26 (28.6%)
    Aneurysms (n = 105)
     Measurements (mm)
     Median (range)
      Maximum diameter10.5 (2–33)
      Neck size of saccular aneurysms6.4 (2–14)
      Height of saccular aneurysms6.0 (0.9−28)
     Aneurysm type
      Saccular98 (93.3%)
      Fusiform7 (6.7%)
     Aneurysm location
      ICA petrous4 (3.8%)
      ICA cavernous31 (29.5%)
      ICA paraclinoid58 (55.2%)
      ICA C1 segment12 (11.4%)
     Branching artery from dome16 (15.2%)
     Multiple aneurysms13 (14.3%)
     Morphologic types of saccular aneurysm
      Outer convexity35 (35.7%)
      Inner convexity29 (29.6%)
      Lateral wall34 (34.7%)
    Procedures (n = 91)
     No. of Pipelines
      190 (98.9%)
      21 (1.1%)
    • View popup
    Table 2:

    Outcome measures

    Value
     Platelet function test
      Yes89 (100%)
      No0 (0%)
     Clopidogrel responder
      Yes66 (74.2%)
      No23 (25.8%)
    Angiographic outcome
     Imaging follow-up
      Median (range) (mo)27 (9–60)
      Data availability89/92 (96.7%)
      Long-term imaging follow-up rate with  aneurysm persistent at 6 mo41/43 (95.3%)
     Occlusion rate at 6 mo
      Complete (100%)62 (59.0%)
      Near-complete (90%–99%)20 (19.0%)
      Partial (<90%)23 (22.0%)
     Occlusion rate at last follow-up
      Complete (100%)74 (70.5%)
      Near-complete (90%–99%)17 (16.2%)
      Partial (<90%)14 (13.3%)
     Adjunctive coil35 (33.3%)
     Retreatment5 (5.5%)
    Clinical outcome
     Posttreatment mRS
      0–284 (94.4%)
      3–55 (5.6%)
      6 (death)0 (0%)
     mRS at last follow-up
      Improved16 (18.0%)
      No change73 (82.0%)
      Worsened0 (0%)
     Neurologic complications
      Thromboembolic40 (44.0%)
       Symptomatic6 (6.6%)
      Hemorrhagic3 (3.3%)
       Symptomatic0 (0%)
      Symptomatic cranial nerve compression1 (1.1%)
     Long-term outcome
      Rupture of aneurysm at follow-up0 (0%)
      Compression improved at follow-up10 (37.0%)
      Permanent neurologic complication0 (0%)
      Permanent neurologic death0 (0%)
    • View popup
    Table 3:

    Multivariable regression analysis of predictors for incomplete occlusion at last follow-up overalla

    OR95% CIP Value
    Age (≥60 years)5.701.99–19.5.001
    Branching artery from dome10.562.36–63.2.002
    Fusiform10.231.77–86.3.009
    Type
     OC/IC30.34.96–595<.001
     OC/LW9.712.45–52.0.001
     LW/IC3.120.31–70.4.34
    • Note:—OC indicates outer convexity–type saccular aneurysm; IC, inner convexity–type saccular aneurysm; LW, lateral wall–type saccular aneurysm.

    • ↵a n = 105; complete occlusion, 74; incomplete occlusion, 31. Significant predictors of incomplete occlusion include age older than 60 years, aneurysms with the branching artery from the dome, fusiform aneurysm, and outer convexity type.

    • View popup
    Table 4:

    Multivariable regression analysis for incomplete occlusion using outer convexity type and aneurysms with a branching artery

    ParameterOR95% CIP Value
    Outer convexity type (+) and branch (+)16221.5–3587<.001
    Outer convexity type (+) and branch (–)16.64.54–81.2<.001
    Outer convexity type (–) and branch (+)91–73.2.05
    Outer convexity type (–) and branch (–)1––
    • Note:—Branch indicates aneurysm with branching artery from dome; –, not applicable..

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American Journal of Neuroradiology: 42 (1)
American Journal of Neuroradiology
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Neck Location on the Outer Convexity is a Predictor of Incomplete Occlusion in Treatment with the Pipeline Embolization Device: Clinical and Angiographic Outcomes
T. Sunohara, H. Imamura, M. Goto, R. Fukumitsu, S. Matsumoto, N. Fukui, Y. Oomura, T. Akiyama, T. Fukuda, K. Go, S. Kajiura, M. Shigeyasu, K. Asakura, R. Horii, C. Sakai, N. Sakai
American Journal of Neuroradiology Jan 2021, 42 (1) 119-125; DOI: 10.3174/ajnr.A6859
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T. Sunohara, H. Imamura, M. Goto, R. Fukumitsu, S. Matsumoto, N. Fukui, Y. Oomura, T. Akiyama, T. Fukuda, K. Go, S. Kajiura, M. Shigeyasu, K. Asakura, R. Horii, C. Sakai, N. Sakai
Neck Location on the Outer Convexity is a Predictor of Incomplete Occlusion in Treatment with the Pipeline Embolization Device: Clinical and Angiographic Outcomes
American Journal of Neuroradiology Jan 2021, 42 (1) 119-125; DOI: 10.3174/ajnr.A6859

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