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Research ArticleNeurointervention

Parent Artery Straightening after Flow-Diverter Stenting Improves the Odds of Aneurysm Occlusion

K. Janot, R. Fahed, A. Rouchaud, K. Zuber, G. Boulouis, G. Forestier, C. Mounayer and M. Piotin
American Journal of Neuroradiology January 2022, 43 (1) 87-92; DOI: https://doi.org/10.3174/ajnr.A7350
K. Janot
aFrom the Department of Interventional Neuroradiology (K.J., G.B.), University Hospital of Tours, Tours, France
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R. Fahed
bDepartment of Interventional Neuroradiology (R.F., M.P.)
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A. Rouchaud
dDepartment of Interventional Neuroradiology (A.R., G.F., C.M.), Dupuytren University Hospital, Limoges, Franc
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K. Zuber
cResearch and Biostatistics Unit (K.Z.), Rothschild Foundation Hospital, Paris, France
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G. Boulouis
aFrom the Department of Interventional Neuroradiology (K.J., G.B.), University Hospital of Tours, Tours, France
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G. Forestier
dDepartment of Interventional Neuroradiology (A.R., G.F., C.M.), Dupuytren University Hospital, Limoges, Franc
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C. Mounayer
dDepartment of Interventional Neuroradiology (A.R., G.F., C.M.), Dupuytren University Hospital, Limoges, Franc
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M. Piotin
bDepartment of Interventional Neuroradiology (R.F., M.P.)
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  • FIG 1.
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    FIG 1.

    Measurement of parent artery straightening. Angles were measured at the intersection of 2 lines drawn from the neck center in the axis of the proximal and distal segments of the parent artery. α is the angle measured before stent placement, and β is the angle measured after stent deployment. Preoperative (1) and postoperative (2) drawings.

  • FIG 2.
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    FIG 2.

    Distribution of angles of parent artery straightening and association with aneurysmal occlusion. A, Shadowgram distribution of parent artery straightening. B, Stacked histograms of the proportion of patients with complete occlusion in bins of increasing parent artery straightening (offset = 0, width = 25°).

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    FIG 3.

    Comparison of vascular geometry modifications in 2 treatments of MCA aneurysms. The second flow-diverter stent deployment appears to modify the vascular anatomy (E–G) more than the first flow-diverter stent (A–C). Angiogram controls show complete aneurysm occlusion with the second flow-diverter stent (H) compared with the first-flow diverter (D) stent. A and E, Preoperative angiogram. B and F, Angiogram after stent placement. C and G, Unsubtracted view after stent deployment. D and H, First angiogram follow-up. α indicates the angle measured before stent placement; β, the angle measured after stent placement.

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    Table 1:

    Comparison of demographic, angiographic, and treatment characteristics between complete occluded and incomplete occluded aneurysmsa

    All Aneurysms (n = 99)Complete Occlusion (n = 64)Incomplete Occlusion (n = 20)P Value
    Age (yr) (mean)54.1 (SD, 11.2)53.8 (SD, 10.8)54.3 (SD, 10.4).76
    Sex, M/F31 (31.3%)/68 (68.7%)18 (28.1%)/46 (71.9%)9 (45%)/11 (55%).26
    Follow-up (mo) (n = 84)23.9 (SD, 16.3)24.2 (SD, 15.0)22.9 (SD, 20.2).27
    Previous treatment45 (45.5%)28 (43.8%)13 (65%).16
    Aneurysm location.62
     MCA44 (44.4%)25 (39.1%)12 (60%)
     AcomA27 (27.3%)20 (31.3%)5 (25%)
     A12 (2.0%)2 (3.1%)0
     A22 (2.0%)2 (3.1%)0
     Pericallosal24 (24.2%)15 (23.4%)3 (15%)
    Aneurysm size (mm)
     Neck3.9 (SD, 2.1)3.6 (SD, 2.1)4.3 (SD, 2.0).06
     Diameter6.1 (SD, 5.0)6.1 (SD, 5.7)6.5 (SD, 3.5).14
    Concomitant coiling15 (15.2%)9 (14.1%)2 (10%)1
    Flow-diverter stent
     Length (mm)16.9 (SD, 3.9)16.5 (SD, 3.8)18.2 (SD, 4.3).42
     Type.004
      Nitinol47 (47.5%)26 (40.6%)16 (80%)
      Cobalt chromium52 (52.5%)38 (59.4%)4 (20%)
    Angle of parent artery
     Initial angle Embedded Image 124.1° (SD, 64.0°)118.3° (SD, 29.8°)122.7° (SD, 28.1°).58
     Postdeployment angle Embedded Image 141.6° (SD, 24.8°)146.0° (SD, 21.8°)135.9° (SD, 24°).12
     Parent artery straightening Embedded Image 3.8° (SD, 21.6°)27.7  (SD, 22.6)13.3° (SD, 12.3°)<.001
    • Note:—AcomA indicates anterior communicating artery; A1, proximal segment of the anterior cerebral artery; A2, distal segment of the anterior cerebral artery.

    • ↵a Data are presented as mean (standard deviation, SD) for continuous variables and absolute number (percentage of column total) for discrete variables.

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    Table 2:

    Multivariable analysis of aneurysm occlusion determinants

    VariablesMultivariate Analysis, aOR (95% CI)P Value
    Aneurysm neck (mm)0.57 (0.38–0.87)<.001
    Stent type: chromium cobalt2.13(1.26–11.93).020
    Parent artery straightening1.04° (1.01°–1.17°).036
    Initial angle Embedded Image 0.95°(0.91°–1.02°.401
    Parent artery straightening × stent typea0.99 (0.94–1.02).055
    • Note:—aOR indicates adjusted odds ratio.

    • ↵a Interaction term.

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American Journal of Neuroradiology: 43 (1)
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Cite this article
K. Janot, R. Fahed, A. Rouchaud, K. Zuber, G. Boulouis, G. Forestier, C. Mounayer, M. Piotin
Parent Artery Straightening after Flow-Diverter Stenting Improves the Odds of Aneurysm Occlusion
American Journal of Neuroradiology Jan 2022, 43 (1) 87-92; DOI: 10.3174/ajnr.A7350

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Parent Artery Straightening after Flow-Diverter Stenting Improves the Odds of Aneurysm Occlusion
K. Janot, R. Fahed, A. Rouchaud, K. Zuber, G. Boulouis, G. Forestier, C. Mounayer, M. Piotin
American Journal of Neuroradiology Jan 2022, 43 (1) 87-92; DOI: 10.3174/ajnr.A7350
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