Quantitative digital subtraction angiography for identifying the risk factors of incomplete occlusion in intracranial aneurysms with branch incorporation after flow diverter treatment
Year: 2025
Type: article
Study design: Observational Study
Abstract: Background: Flow diverter (FD) treatment has shown promising results in managing intracranial aneurysms (IAs), achieving high rates of complete occlusion. However, in cases involving branch incorporation, incomplete occlusion remains a challenge, adversely influencing long-term treatment outcomes. The mechanisms underlying the incomplete occlusion in IAs with branch incorporation have not been fully clarified. Therefore, the objective of this study was to assess the value of quantitative digital subtraction angiography (QDSA) in predicting incomplete occlusion of IAs with branch incorporation following FD treatment. Methods: We retrospectively analyzed data from 111 patients with 113 IAs involving incorporated branches who were treated with FDs between January 2016 and December 2022. IAs were divided into incomplete occlusion (n=52) and complete occlusion (n=61) groups based on follow-up digital subtraction angiography (DSA). Clinical, morphological, and angiographic parametric imaging (API) variables were analyzed. We employed univariate followed by multivariate logistic regression to identify the independent risk factors, while areas under the curve (AUCs) were used to assess the predictive performance of the significant variables. A subgroup analysis examined the effect of FD plus coiling and API variables, with Benjamini-Hochberg (BH) correction applied for multiple comparisons. Results: Multivariate analysis identified three independent predictors of incomplete occlusion: posterior circulation aneurysms [odds ratio (OR) =2.729, 95% confidence interval (CI): 1.153-6.460; P=0.022], branch diameter (OR =2.802, 95% CI: 1.288-6.097; P=0.009), and aneurysm cerebral blood flow (CBF) (OR =10.829, 95% CI: 2.243-52.273; P=0.003). AUCs for the combined model, aneurysm CBF, branch diameter, and posterior circulation aneurysms were 0.766, 0.695, 0.678, and 0.646, respectively. In the FD-alone subgroup, posterior circulation aneurysms (P=0.032), branch diameter (P=0.018), and branch mean transit time (MTT) (P=0.011) were significant prior to BH correction, while in the subgroup treated with FD plus coiling, aneurysm CBF (P=0.046) was the only variable that reached significance before correction. However, following BH correction, none of variables remained statistically significant (adjusted P value >0.05). Conclusions: Posterior circulation aneurysms, branch diameter, and aneurysm CBF are independent risk factors for incomplete occlusion in IAs with branch incorporation following FD treatment.
Institutions: Capital Medical University, Beijing Tian Tan Hospital
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4416675431