Keywords:
CNS, Neuroradiology brain, Vascular, Catheter arteriography, CT-Angiography, Image manipulation / Reconstruction, Embolisation, Outcomes analysis, Diagnostic procedure, Aneurysms, Haemorrhage, Outcomes
Authors:
B. J. Kapustka1, K. J. Kubicki2, A. M. Matlak2, R. Sordyl2, S. Kwiek2, P. Bażowski2, D. T. Knap2, J. Baron2, J. Jaskólski3; 1Pawłowice/PL, 2Katowice/PL, 3Busko-Zdroj/PL
DOI:
10.1594/ecr2013/C-2116
Methods and Materials
We carried out a retrospective study.
Between year 2008 and 2012,
68 patients (average age 53.17 years,
SD=10.74) were diagnosed with 73 MCAAs,
and subsequently qualified for the treatment (clipping or coiling).
The choice of the preferred strategy was made by a interdisciplinary team of neurosurgeons and interventional neuroradiologists.
In cases of patients who underwent more than one embolization of the same aneurysm,
only the first procedure was included in our study and submitted for further analysis.
Also patients who had the first procedure before the starting point of observation,
and then had an additional embolization of a MCA aneurysm during the period of observation,
were not included in the study.
The images obtained with digital subtraction angiography (DSA) and the clinical state of particular patient were considered as the basis of neuroradiological qualification.
Data post-processing of DSA images was performed with Philips Integris Allura 3D-RA (Fig. 1).
The following parameters were evaluated: transverse diameter of aneurysm’s dome and neck,
neck lenght,
dome length,
dome height,
arteries arising from neck or dome,
incorporation of parental vessel branch,
location of the aneurysm and direction of aneurysm's growth.
Complex MCAAs were defined by several characteristics similar to the criteria used by Vendrell et al.
[6] (Fig. 2,
Fig. 3).
The medical records and imaging were reviewed for 39 patients for whom first choice of treatment was endovascular embolization and another 29 patients,
who underwent surgical clipping as the first choice of treatment method.
Each group was also investigated in subdivisions considering if the treated aneurysm was ruptured or not.
The clinical condition of all patients following subarachnoid hemorrhage (SAH) was graded according to Hunt and Hess Scale and Fisher Scale [8].
The Montreal scale [9] was used to evaluate aneurismal occlusions.
The early clinical outcomes were classified according to the Glasgow Outcome Scale (GOS).
All procedural complications and perioperative events were registered.
Based on collected data T-test,
Mann-Whitney U Test,
χ2 test,
Yates-corrected χ2 test and Fisher test were carried out. Statistical analyses were performed with the Statistica 8.0 software (STATSOFT; Statistica,
Tulsa,
OK,
USA).