Computerized occlusion rating of embolized ruptured intracranial aneurysms: relation to intra- and postinterventional aneurysm rehemorrhage.
Endovascular coil occlusion of ruptured cerebral aneurysms has a higher rate of rebleeding compared to surgical clipping. Initial aneurysm coil occlusion rate (OR) is the strongest available predictor of aneurysm rebleeding. Standard clinical subjective occlusion rating (SOR) is limited by subjective bias. Therefore, computerized occlusion rating (COR) was introduced. Its superiority was established for experimental and human aneurysms. In the present clinical study, we aimed to evaluate COR as a risk factor for postprocedural reruptures (PPRs) and intraprocedural reruptures (IPRs). In our series of 249 consecutive patients treated in our institution, we observed 7 (2.8%) cases with IPR and 7 (2.8%) cases with PPR. These patients were analyzed in the present study. Mean COR value was 85% (range 71-96%). In 12 (85.7%) cases, COR was lower than SOR. In aneurysms with a COR of 95% or higher, no PPR occurred. All patients with IPR harbored multiple aneurysms. In -conclusion, our data showed a distinct tendency of potentially dangerous overestimations when using SOR compared to the objectively measured COR values. IPR was always associated with multiple aneurysms.
Department of Neurosurgery, Medical University of Vienna, Vienna, Austria. milavec@gmx.ch
Helena
H
Milavec
Andreas
A
Gruber
Ernst
E
Schuster
Eva
E
Lahnsteiner
Christian
C
Dorfer
Maximilian
M
Krawagna
Engelbert
E
Knosp
Camillo
C
Sherif
D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000601:surgery*; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000209:etiology / Q000601:surgery; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000209:etiology*; D015599:Trauma Severity Indices; D016896:Treatment Outcome