title: Validation of the Modified Raymond-Roy classification for intracranial aneurysms treated with coil embolization.
abstract: BACKGROUND
  The Raymond-Roy Occlusion Classification (RROC) qualitatively assesses intracranial aneurysm occlusion following endovascular coil embolization. The Modified Raymond-Roy Classification (MRRC) was developed as a refinement of this classification scheme, and dichotomizes RROC III occlusions into IIIa (opacification within the interstices of the coil mass) and IIIb (opacification between the coil mass and aneurysm wall) closures.
  
  
  METHODS
  To demonstrate in an external cohort the predictive accuracy of the MRRC, the records of 326 patients with 345 intracranial aneurysms treated with endovascular coil embolization from January 2007 to December 2013 were retrospectively analyzed.
  
  
  RESULTS
  Within this cohort, 84 (24.3%) and 83 aneurysms (24.1%) had MRRC IIIa and IIIb closures, respectively, during initial coil embolization. Progression to complete occlusion was more likely with IIIa than IIIb closures (53.6% vs 19.2%, p≤0.01), while recanalization was more likely with IIIb than IIIa closures (65.1% vs 27.4%, p<0.01). Kaplan-Meier estimates demonstrated a significant difference in the test of equality for progression to complete occlusion (p=0.02) and recurrence (p<0.01) between class IIIa and IIIb distributions. For the entire cohort, male gender (p<0.01), ruptured aneurysm (p=0.04), intraluminal thrombus (p<0.01), and MRRC IIIb closure (p<0.01) were identified as predictors of recanalization. For aneurysms with an initial RROC III occlusion, MRRC IIIa closure was found to be an independent predictor of progression to complete occlusion (p=0.02).
  
  
  CONCLUSIONS
  This study confirms that the MRRC enhances the predictive accuracy of the RROC.
authors.affiliation: Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA Neuroendovascular Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Stapleton
authors.affiliation: Neuroendovascular Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Collin M
authors.initials: CM
authors.lastname: Torok
authors.affiliation: Neuroendovascular Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: James D
authors.initials: JD
authors.lastname: Rabinov
authors.affiliation: Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Brian P
authors.initials: BP
authors.lastname: Walcott
authors.affiliation: Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Justin R
authors.initials: JR
authors.lastname: Mascitelli
authors.affiliation: Neuroendovascular Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Thabele M
authors.initials: TM
authors.lastname: Leslie-Mazwi
authors.affiliation: Neuroendovascular Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Hirsch
authors.affiliation: Texas Stroke Institute, Plano, Texas, USA.
authors.forename: Albert J
authors.initials: AJ
authors.lastname: Yoo
authors.affiliation: Neurosurgical Service, Beth Israel Deaconess Medical Center, Brain Aneurysm Institute, and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Ogilvy
authors.affiliation: Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA Neuroendovascular Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Aman B
authors.initials: AB
authors.lastname: Patel
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000145:classification / Q000628:therapy; D015331:Cohort Studies; D004621:Embolization, Therapeutic / Q000145:classification*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000145:classification* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Aneurysm; Angiography; Coil