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<meta name="DC.Title" content="Difficult Aneurysms for Endovascular Treatment: Overwide or Undertall?" />
<meta name="DC.Identifier" content="10.3174/ajnr.A1633" />
<meta name="DC.Date" content="2009-09-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Aneurysm geometry has been shown to predict the need for adjunctive techniques in the endovascular treatment of intracranial aneurysms. We conducted a systematic retrospective study examining which thresholds of dome-to-neck ratio, maximum neck width, and aspect ratio of intracranial aneurysms best predict the need for adjunctive techniques in endovascular management.

MATERIALS AND METHODS: One hundred seventy-five consecutive patients who were selected for attempted embolization of 185 intracranial aneurysms were included in this study. Aneurysm dome-to-neck ratio (maximum dome width/maximum neck width), maximum neck width, and aspect ratio (dome height/maximum neck width) were measured on 2D digital subtraction angiography. Statistical analysis was conducted to determine which thresholds of dome-to-neck ratio, maximum neck width, and aspect ratio were most predictive of the need for adjunctive devices in endovascular management of these aneurysms.

RESULTS: We demonstrated that 75% of aneurysms with dome-to-neck ratios &gt;1.6 ( P &lt; .0001), 75% of aneurysms with aspect ratios &gt;1.6 ( P &lt; .0001), and 70% of aneurysms with neck diameters &lt;4.0 mm ( P &lt; .0001) did not need adjunctive techniques in their management. Adjunctive techniques were essential to treatment of 80% of aneurysms with dome-to-neck ratios &lt;1.2 ( P = .02) and 89% of aneurysms with aspect ratios &lt;1.2 ( P &lt; .0001). Multivariate logistic regression analysis demonstrated that aspect ratio was the best predictor of the need for an adjunctive device ( P = .0004).

CONCLUSIONS: Aneurysms with aspect and dome-to-neck ratios &gt;1.6 usually did not require adjunctive techniques. Aneurysms with aspect and dome-to-neck ratios &lt;1.2 almost always required adjunctive techniques. In this single-center series, aspect ratio was the independent predictor of the need for adjunctive techniques in the endovascular management of intracranial aneurysms." />
<meta name="DC.Contributor" content="W. Brinjikji" />
<meta name="DC.Contributor" content="H.J Cloft" />
<meta name="DC.Contributor" content="D.F. Kallmes" />
<meta name="article:published_time" content="2009-09-01" />
<meta name="article:section" content="Interventional" />
<meta name="citation_title" content="Difficult Aneurysms for Endovascular Treatment: Overwide or Undertall?" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Aneurysm geometry has been shown to predict the need for adjunctive techniques in the endovascular treatment of intracranial aneurysms. We conducted a systematic retrospective study examining which thresholds of dome-to-neck ratio, maximum neck width, and aspect ratio of intracranial aneurysms best predict the need for adjunctive techniques in endovascular management.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;One hundred seventy-five consecutive patients who were selected for attempted embolization of 185 intracranial aneurysms were included in this study. Aneurysm dome-to-neck ratio (maximum dome width/maximum neck width), maximum neck width, and aspect ratio (dome height/maximum neck width) were measured on 2D digital subtraction angiography. Statistical analysis was conducted to determine which thresholds of dome-to-neck ratio, maximum neck width, and aspect ratio were most predictive of the need for adjunctive devices in endovascular management of these aneurysms.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;We demonstrated that 75% of aneurysms with dome-to-neck ratios &amp;gt;1.6 (&lt;i&gt;P&lt;/i&gt; &amp;lt; .0001), 75% of aneurysms with aspect ratios &amp;gt;1.6 (&lt;i&gt;P&lt;/i&gt; &amp;lt; .0001), and 70% of aneurysms with neck diameters &amp;lt;4.0 mm (&lt;i&gt;P&lt;/i&gt; &amp;lt; .0001) did not need adjunctive techniques in their management. Adjunctive techniques were essential to treatment of 80% of aneurysms with dome-to-neck ratios &amp;lt;1.2 (&lt;i&gt;P&lt;/i&gt; = .02) and 89% of aneurysms with aspect ratios &amp;lt;1.2 (&lt;i&gt;P&lt;/i&gt; &amp;lt; .0001). Multivariate logistic regression analysis demonstrated that aspect ratio was the best predictor of the need for an adjunctive device (&lt;i&gt;P&lt;/i&gt; = .0004).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Aneurysms with aspect and dome-to-neck ratios &amp;gt;1.6 usually did not require adjunctive techniques. Aneurysms with aspect and dome-to-neck ratios &amp;lt;1.2 almost always required adjunctive techniques. In this single-center series, aspect ratio was the independent predictor of the need for adjunctive techniques in the endovascular management of intracranial aneurysms.&lt;/p&gt;" />
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<meta name="twitter:title" content="Difficult Aneurysms for Endovascular Treatment: Overwide or Undertall?" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Aneurysm geometry has been shown to predict the need for adjunctive techniques in the endovascular treatment of intracranial aneurysms. We conducted a systematic retrospective study examining which thresholds of dome-to-neck ratio, maximum neck width, and aspect ratio of intracranial aneurysms best predict the need for adjunctive techniques in endovascular management.

MATERIALS AND METHODS: One hundred seventy-five consecutive patients who were selected for attempted embolization of 185 intracranial aneurysms were included in this study. Aneurysm dome-to-neck ratio (maximum dome width/maximum neck width), maximum neck width, and aspect ratio (dome height/maximum neck width) were measured on 2D digital subtraction angiography. Statistical analysis was conducted to determine which thresholds of dome-to-neck ratio, maximum neck width, and aspect ratio were most predictive of the need for adjunctive devices in endovascular management of these aneurysms.

RESULTS: We demonstrated that 75% of aneurysms with dome-to-neck ratios &gt;1.6 ( P &lt; .0001), 75% of aneurysms with aspect ratios &gt;1.6 ( P &lt; .0001), and 70% of aneurysms with neck diameters &lt;4.0 mm ( P &lt; .0001) did not need adjunctive techniques in their management. Adjunctive techniques were essential to treatment of 80% of aneurysms with dome-to-neck ratios &lt;1.2 ( P = .02) and 89% of aneurysms with aspect ratios &lt;1.2 ( P &lt; .0001). Multivariate logistic regression analysis demonstrated that aspect ratio was the best predictor of the need for an adjunctive device ( P = .0004).

CONCLUSIONS: Aneurysms with aspect and dome-to-neck ratios &gt;1.6 usually did not require adjunctive techniques. Aneurysms with aspect and dome-to-neck ratios &lt;1.2 almost always required adjunctive techniques. In this single-center series, aspect ratio was the independent predictor of the need for adjunctive techniques in the endovascular management of intracranial aneurysms." />
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MATERIALS AND METHODS: One hundred seventy-five consecutive patients who were selected for attempted embolization of 185 intracranial aneurysms were included in this study. Aneurysm dome-to-neck ratio (maximum dome width/maximum neck width), maximum neck width, and aspect ratio (dome height/maximum neck width) were measured on 2D digital subtraction angiography. Statistical analysis was conducted to determine which thresholds of dome-to-neck ratio, maximum neck width, and aspect ratio were most predictive of the need for adjunctive devices in endovascular management of these aneurysms.

RESULTS: We demonstrated that 75% of aneurysms with dome-to-neck ratios &gt;1.6 ( P &lt; .0001), 75% of aneurysms with aspect ratios &gt;1.6 ( P &lt; .0001), and 70% of aneurysms with neck diameters &lt;4.0 mm ( P &lt; .0001) did not need adjunctive techniques in their management. Adjunctive techniques were essential to treatment of 80% of aneurysms with dome-to-neck ratios &lt;1.2 ( P = .02) and 89% of aneurysms with aspect ratios &lt;1.2 ( P &lt; .0001). Multivariate logistic regression analysis demonstrated that aspect ratio was the best predictor of the need for an adjunctive device ( P = .0004).

CONCLUSIONS: Aneurysms with aspect and dome-to-neck ratios &gt;1.6 usually did not require adjunctive techniques. Aneurysms with aspect and dome-to-neck ratios &lt;1.2 almost always required adjunctive techniques. In this single-center series, aspect ratio was the independent predictor of the need for adjunctive techniques in the endovascular management of intracranial aneurysms." />
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div xmlns:xhtml="http://www.w3.org/1999/xhtml" class="contributors"><ol class="contributor-list" id="contrib-group-1"><li class="contributor" id="contrib-1"><span class="name">W. Brinjikji</span><a id="xref-aff-1-1" class="xref-aff" href="#aff-1">a</a>, </li><li class="contributor" id="contrib-2"><span class="name">H.J Cloft</span><a id="xref-aff-2-1" class="xref-aff" href="#aff-2">b</a> and </li><li class="last" id="contrib-3"><span class="name">D.F. Kallmes</span><a id="xref-aff-2-2" class="xref-aff" href="#aff-2">b</a></li></ol><ol class="affiliation-list"><li class="aff"><a id="aff-1" name="aff-1"></a><address><sup>a</sup>From the Mayo Medical School (W.B.)</address></li><li class="aff"><a id="aff-2" name="aff-2"></a><address><sup>b</sup>Department of Radiology (H.J.C., D.F.K.), Mayo Clinic, Rochester, Minn.</address></li></ol><ol class="corresp-list"><li class="corresp" id="corresp-1">Please address correspondence to David F. Kallmes, MD, Mayo Clinic, OL 1-115, 200 SW First St, Rochester, MN 55905; e-mail: <span class="em-link"><span class="em-addr">kallmes.david{at}mayo.edu</span></span></li></ol></div></div><a href="http://ajnr-stage2.stage.highwire.org/content/30/8/1513.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 30</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 8 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Sep 2009 </div></div>
      
      
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