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http://dx.doi.org/10.3340/jkns.2013.53.6.342

Reappraisal of Anatomic Outcome Scales of Coiled Intracranial Aneurysms in the Prediction of Recanalization  

Lee, Jong Young (Department of Neurosurgery, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine)
Kwon, Bae Ju (Department of Radiology, Kwandong University Myongji Hospital, Kwandong University College of Medicine)
Cho, Young Dae (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine)
Kang, Hyun-Seung (Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine)
Han, Moon Hee (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine)
Publication Information
Journal of Korean Neurosurgical Society / v.53, no.6, 2013 , pp. 342-348 More about this Journal
Abstract
Objective : Several scales are currently used to assess occlusion rates of coiled cerebral aneurysms. This study compared these scales as predictors of recanalization. Methods : Clinical data of 827 patients harboring 901 aneurysms treated by coiling were retrospectively reviewed. Occlusion rates were assessed using angiographic grading scale (AGS), two-dimensional percent occlusion (2DPO), and volumetric packing density (vPD). Every scale had 3 categories. Followed patients were dichotomized into either presence or absence of recanalization. Kaplan-Meier analysis was conducted, and Cox proportional hazards analysis was performed to identify surviving probabilities of recanalization. Lastly, the predictive accuracies of three different scales were measured via Harrell's C index. Results : The cumulative risk of recanalization was 7% at 12-month, 10% at 24-month, and 13% at 36-month of postembolization, and significantly higher for the second and third categories of every scale (p<0.001). Multivariate-adjusted hazard ratios (HRs) of the second and third categories as compared with the first category of AGS (HR : 3.95 and 4.15, p=0.004 and 0.001) and 2DPO (HR : 4.87 and 3.12, p<0.001 and 0.01) were similar. For vPD, there was no association between occlusion rates and recanalization. The validated and optimism-adjusted C-indices were 0.50 [confidence (CI) : -1.09-2.09], 0.47 (CI : -1.10-2.09) and 0.44 (CI : -1.10-2.08) for AGS, 2DPO, and vPD, respectively. Conclusion : Total occlusion should be reasonably tried in coiling to maximize the benefit of the treatment. AGS may be the best to predict recanalization, whereas vPD should not be used alone.
Keywords
Intracranial aneurysm; Coil embolization; Outcome scale; Recanalization;
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