A new definition for wide-necked cerebral aneurysms
10.7461/jcen.2019.21.4.193
- Author:
Hyun Seok PARK
1
;
Soon Chan KWON
;
Eun Suk PARK
;
Jun Bum PARK
;
Min Soo KIM
Author Information
1. Department of Neurosurgery, Dong Kang Medical Center, Ulsan, Korea.
- Publication Type:Original Article
- Keywords:
Intracranial aneurysm;
Endovascular treatment;
Wide-necked aneurysm;
Definition
- MeSH:
Aneurysm;
Aneurysm, Ruptured;
Humans;
Intracranial Aneurysm;
Neck;
Sensitivity and Specificity
- From:Journal of Cerebrovascular and Endovascular Neurosurgery
2019;21(4):193-198
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: Endovascular management of wide-necked aneurysms often requires assisted-techniques with adjunctive devices. Wide-necked aneurysm can be defined with a dome-to-neck ratio or aspect ratio; however, clinical definitions of wide-necked aneurysms vary. This study aimed to determine the most useful definition of wide-necked aneurysm to predict the need for an adjunctive device.METHODS: Among 552 cases of aneurysms, 343 (62.1%) and 209 (37.9%) cases of unruptured and ruptured aneurysms, respectively, were treated in a single institution. For each aneurysm, the (1) dome-to-neck ratio, (2) aspect ratio, and (3) K-ratio (defined as [dome height+maximum dome width]/[2×maximum neck width]) were measured. We statistically analyzed patient data to determine which of the three ratios was most predictive of the need for adjunctive devices.RESULTS: Among 552 cases of aneurysms, 277 (50.2%) and 275 (49.8%) cases were treated with and without adjunctive techniques, respectively. The mean dome-to-neck ratio, aspect ratio, and K-ratio were 1.17±0.39, 1.58±0.61, and 1.37±0.47, respectively. The K-ratio was the strongest predictor of the use of adjunctive devices (P<0.001), and 1.3 was the most appropriate K-ratio cut-off value (sensitivity, 72.9%; specificity, 63.6%).CONCLUSIONS: K-ratio was the most useful predictor of the need for adjunctive devices in the treatment of endovascular aneurysms. These results suggest that the K-ratio may be used to define wide-necked aneurysms requiring complicated management via adjunctive devices.
