Reappraisal of Anatomic Outcome Scales of Coiled Intracranial Aneurysms in the Prediction of Recanalization.
10.3340/jkns.2013.53.6.342
- Author:
Jong Young LEE
1
;
Bae Ju KWON
;
Young Dae CHO
;
Hyun Seung KANG
;
Moon Hee HAN
Author Information
1. Department of Neurosurgery, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
Intracranial aneurysm;
Coil embolization;
Outcome scale;
Recanalization
- MeSH:
Aneurysm;
Humans;
Intracranial Aneurysm;
Kaplan-Meier Estimate;
Retrospective Studies;
Weights and Measures
- From:Journal of Korean Neurosurgical Society
2013;53(6):342-348
- CountryRepublic of Korea
- Language:English
-
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.
