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  • Low Yield of Cerebral Angiography in Adequately Occluded Aneurysms after Flow Diversion

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    Nohra Chalouhi MD; Purvee D Patel BA; Elias Atallah MD; Robert M. Starke MD, MSc; Ameet V Chitale MD; Michael J. Lang MD; Stavropoula I. Tjoumakaris MD; Hekmat Zarzour; David M. Hasan MD; Michelle Janine Smith MD; Robert H. Rosenwasser MD, FACS, FAHA; Pascal Jabbour MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Flow diversion has emerged as a highly effective treatment for intracranial aneurysms. We assess the yield of further angiographic follow-up in aneurysms that have achieved adequate occlusion after treatment with the Pipeline Embolization Device (PED).

    Methods: This is a single institution, retrospective study. Inclusion criteria were as follows: 1) patients with one or more aneurysms treated with PED, 2) available shortterm (<12 months) follow-up digital subtraction angiography (DSA), 3) complete (100%) or near-complete (>95%) occlusion on short-term follow-up DSA, and 4) available further angiographic follow-up (DSA, MRA, or CTA).

    Results: A total of 146 patients were identified. Aneurysm size was 8.4 ± 5.1 mm on average. Mean angiographic follow-up time was 29.7 ± 12.2 months. On short-term follow-up DSA images, 132 (90.4%) had complete aneurysm occlusion and 14 (9.6%) had near-complete occlusion. Four patients (3%) had further DSA follow-up alone, 30 patients (21%) had further DSA and MRA/CTA follow-up, and 112 patients (76%) had further MRA/CTA follow-up alone. On further angiographic follow-up (DSA, MRA, and/or CTA), no patient had a decrease in the degree of aneurysm occlusion (recurrence) or required retreatment. Of the 14 patients with near-complete occlusion on initial DSA images, 7 patients (50%) progressed to complete aneurysm occlusion on further angiographic follow-up.

    Conclusions: This study did not find any diagnostic yield in repeating cerebral angiography in adequately occluded aneurysms with the PED.

    Patient Care: This study promotes the reduction of unnecessary follow-up neuro-imaging for healed intracranial aneurysms. This should play a major role in redefining the follow-up protocols of treated aneurysms and reducing the reltaed costs for all the patients.

    Learning Objectives: We do not recommend repeat angiographic follow-up once aneurysms have achieved complete occlusion with the PED unless clinically warranted.


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