Frontiers in surgery · 2026
Presence of small and large branch vessels from intracranial aneurysms increases the risk of post-treatment recurrence and retreatment following endovascular coiling: insights from a propensity score-matched cohort.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Arunachalam Sakthiyendran Naveen, Pellegrino Allison, McNeil Evan P, Barhouse Patrick, Purohit Shashvat, Ramirez-Velandia Felipe, Alwakaa Omar, Granstein Justin H, Ogilvy Christopher S, Taussky Philipp
Аннотация
OBJECTIVE: Aneurysms with involvement of a branch vessel within the sac represent a particularly challenging morphological feature in the context of coil embolization. The aim of this propensity score-matched cohort study was to determine the impact of branch vessel involvement on angiographic occlusion, clinical outcomes, recurrence, and retreatment after endovascular coiling.
METHODS: We conducted a single-center retrospective cohort study of intracranial aneurysms treated with conventional, balloon-assisted, or stent-assisted coiling. Propensity score matching was performed to reduce confounding. Packing density was computed using AngioSuite. Regression models were used to analyze immediate and final Raymond-Roy Occlusion Classification grade, recurrence, and retreatment in the matched cohort.
RESULTS: Out of 330 patients with 330 aneurysms, 39 aneurysms (11.8%) had branch involvement. Propensity score matching yielded 31 branch-involving aneurysms (BVAs) matched to 31 non-BVAs. Immediate Raymond-Roy grade (OR: 2.57, 95% CI: 0.96-7.13, p = 0.063) and packing density (mean difference -3.04%, 95% CI: -8.14-2.06, p = 0.247) did not differ significantly between groups. At follow-up, BVAs had worse final Raymond-Roy grade (OR: 6.33, 95% CI: 2.15-20.83, p = 0.0013) and lower odds of complete occlusion (OR: 0.085, 95% CI: 0.024-0.26, p < 0.001). Complete occlusion without recurrence was achieved in 20/30 (66.7%) non-BVAs compared to 6/30 (20.0%) BVAs during the follow-up period. Recurrence (OR: 5.55, 95% CI: 1.78-19.86, p = 0.005) and retreatment (OR: 4.44, 95% CI: 1.19-21.69, p = 0.034) were also higher in BVAs.
CONCLUSION: BVAs exhibit significantly worse long-term angiographic outcomes with higher recurrence and retreatment rates. Branch vessel incorporation is an intrinsic risk factor for unfavorable angiographic durability post-coiling that warrants awareness and novel treatment strategies. Specifically, BVAs may warrant intensified imaging surveillance and consideration of neck-reconstruction strategies or primary clipping when branch vessel preservation is feasible.
METHODS: We conducted a single-center retrospective cohort study of intracranial aneurysms treated with conventional, balloon-assisted, or stent-assisted coiling. Propensity score matching was performed to reduce confounding. Packing density was computed using AngioSuite. Regression models were used to analyze immediate and final Raymond-Roy Occlusion Classification grade, recurrence, and retreatment in the matched cohort.
RESULTS: Out of 330 patients with 330 aneurysms, 39 aneurysms (11.8%) had branch involvement. Propensity score matching yielded 31 branch-involving aneurysms (BVAs) matched to 31 non-BVAs. Immediate Raymond-Roy grade (OR: 2.57, 95% CI: 0.96-7.13, p = 0.063) and packing density (mean difference -3.04%, 95% CI: -8.14-2.06, p = 0.247) did not differ significantly between groups. At follow-up, BVAs had worse final Raymond-Roy grade (OR: 6.33, 95% CI: 2.15-20.83, p = 0.0013) and lower odds of complete occlusion (OR: 0.085, 95% CI: 0.024-0.26, p < 0.001). Complete occlusion without recurrence was achieved in 20/30 (66.7%) non-BVAs compared to 6/30 (20.0%) BVAs during the follow-up period. Recurrence (OR: 5.55, 95% CI: 1.78-19.86, p = 0.005) and retreatment (OR: 4.44, 95% CI: 1.19-21.69, p = 0.034) were also higher in BVAs.
CONCLUSION: BVAs exhibit significantly worse long-term angiographic outcomes with higher recurrence and retreatment rates. Branch vessel incorporation is an intrinsic risk factor for unfavorable angiographic durability post-coiling that warrants awareness and novel treatment strategies. Specifically, BVAs may warrant intensified imaging surveillance and consideration of neck-reconstruction strategies or primary clipping when branch vessel preservation is feasible.