scholarly journals Virtual reality adds value to analysis of aneurysms post-flow diversion, coiling, and clipping

2020 ◽  
Vol 10 (6) ◽  
pp. 195-201
Author(s):  
Farah Fourcand ◽  
Ashish Kulhari ◽  
Siddhart Mehta ◽  
Haralabos Zacharatos ◽  
Amrinder Singh ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Digital Subtraction Angiography ◽  
Regression Models ◽  
Statistical Power ◽  
Flow Diversion ◽  
Digital Subtraction ◽  
Unruptured Intracranial Aneurysms ◽  
Neurovascular Remodeling ◽  
Grading Scales ◽  
Measure Sensitivity

Purpose: The purpose of this study was to measure sensitivity of virtual reality (VR) in detecting biomarkers of neurovascular remodeling suboptimally evaluated in digital subtraction angiography (DSA) of treated unruptured, intracranial aneurysms. Methods: The sensitivity of virtual reality and digital subtraction angiography in detection of neurovascular biomarkers in aneurysms treated with flow diversion, coiling, and clipping were evaluated. Validated grading scales were integrated into a standardized rating platform. The respective novel and conceptual measures of minimal imaging important difference (MIID) and number needed to image (NNI) were calculated for each biomarker. Results: In flow diversion, coiling, and clipping, minimal imaging important difference and number needed to image were associated with virtual reality in detection of abnormal biomarkers, with the exception of stasis phase associated with digital subtraction angiography. Number needed to image was associated with flow diversion stent stenosis (RR: 7.00, 95% CI 0.37 to 131.97; OR: 7.46, 95% CI 0.38 to 148.49). Minimal imaging important difference was greatest in residual aneurysm filling (25%±66, 95% CI) in flow diversion and Meyer score in coiling (42.5%±17.69, 95% CI) and clipping (22.2%±13.58, 95% CI). Regression models demonstrated minimal imaging important difference and number needed to image shared a significant correlation (R20.99, 95% CI, p<0.001). Conclusion: Virtual reality adds value to digital subtraction angiography in evaluation of aneurysms treated with flow diversion, coiling, and clipping. Larger, prospective studies are warranted to increase statistical power and validate clinical significance.

Preoperative Digital Subtraction Angiography in Incidental Unruptured Intracranial Aneurysms

2018 ◽  
Vol 28 (3) ◽  
pp. 429-435 ◽  
Author(s):  
Moriz Herzberg ◽  
Robert Forbrig ◽  
Christian Schichor ◽  
Hartmut Brückmann ◽  
Franziska Dorn
Keyword(s):  
Digital Subtraction Angiography ◽  
Intracranial Aneurysms ◽  
Digital Subtraction ◽  
Unruptured Intracranial Aneurysms

scholarly journals Proposal of a follow-up imaging strategy following Pipeline flow diversion treatment of intracranial aneurysms

2019 ◽  
Vol 131 (1) ◽  
pp. 32-39 ◽  
Author(s):  
Raghav Gupta ◽  
Christopher S. Ogilvy ◽  
Justin M. Moore ◽  
Christoph J. Griessenauer ◽  
Alejandro Enriquez-Marulanda ◽  
...  
Keyword(s):  
Digital Subtraction Angiography ◽  
Cumulative Incidence ◽  
Intracranial Aneurysms ◽  
Aneurysm Rupture ◽  
Digital Subtraction ◽  
Imaging Data ◽  
Unruptured Intracranial Aneurysms ◽  
Imaging Strategy ◽  
Aneurysm Occlusion

OBJECTIVEThere is currently no standardized follow-up imaging strategy for intracranial aneurysms treated with the Pipeline embolization device (PED). Here, the authors use follow-up imaging data for aneurysms treated with the PED to propose a standardizable follow-up imaging strategy.METHODSA retrospective review of all patients who underwent treatment for ruptured or unruptured intracranial aneurysms with the PED between March 2013 and March 2017 at 2 major academic institutions in the US was performed.RESULTSA total of 218 patients underwent treatment for 259 aneurysms with the PED and had undergone at least 1 follow-up imaging session to assess aneurysm occlusion status. There were 235 (90.7%) anterior and 24 posterior (9.3%) circulation aneurysms. On Kaplan-Meier analysis, the cumulative incidences of aneurysm occlusion at 6, 12, 18, and 24 months were 38.2%, 77.8%, 84.2%, and 85.1%, respectively. No differences in the cumulative incidence of aneurysm occlusion according to aneurysm location (p = 0.39) or aneurysm size (p = 0.81) were observed. A trend toward a decreased cumulative incidence of aneurysm occlusion in patients 70 years or older was observed (p = 0.088). No instances of aneurysm rupture after PED treatment or aneurysm recurrence after occlusion were noted. Sixteen (6.2%) aneurysms were re-treated with the PED; 11 of these had imaging follow-up data available, demonstrating occlusion in 3 (27.3%).CONCLUSIONSThe authors propose a follow-up imaging strategy that incorporates 12-month digital subtraction angiography and 24-month MRA for patients younger than 70 years and single-session digital subtraction angiography at 12 months in patients 70 years or older. For recurrent or persistent aneurysms, re-treatment with the PED or use of an alternative treatment modality may be considered.

Sign in / Sign up

Export Citation Format

Share Document