Can further subdivision of the Raymond-Roy classification of intracranial aneurysms be useful in predicting recurrence and need for future retreatment following endovascular coiling?
Coiling
Intracranial aneurysms
Raymond-Roy
Recurrence
Journal
Surgical neurology international
ISSN: 2229-5097
Titre abrégé: Surg Neurol Int
Pays: United States
ID NLM: 101535836
Informations de publication
Date de publication:
2022
2022
Historique:
received:
01
10
2021
accepted:
14
03
2022
entrez:
5
5
2022
pubmed:
6
5
2022
medline:
6
5
2022
Statut:
epublish
Résumé
The Raymond-Roy classification has been the standard for neck recurrences following endovascular coiling with three grades. Several modified classification systems with subdivisions have been reported in literature but it is unclear whether this adds value in predicting recurrence or retreatment. Our aim is to assess if these subdivisions aid in predicting recurrence and need for retreatment. A retrospective review of all patients undergoing endovascular coiling between 2013 and 2014. Patients requiring stent assistance or other embolization devices were excluded from the study. The neck residue was graded at time of coiling on the cerebral angiogram and subsequent 6, 24, and 60 months MRA. Correlation between grade at coiling and follow-up with need for subsequent retreatment was assessed. Overall, 17/200 (8.5%) cases required retreatment within 5 years of initial coiling. 4/130 (3.1%) required retreatment within 5 years with initial Grade 0 at coiling, 6/24 cases (25%) of those Grade 2a, 4/20 cases (20%) Grade 2b, 3/8 (38%) Grade 3, and none of those with Grade 1. Large aneurysms ≥11 mm had an increased risk of aneurysm recurrence and retreatment. About 9.7% of ruptured aneurysms required retreatment versus 4.4% for unruptured. About 55% of carotid ophthalmic aneurysms were retreated. Although the modified classification system was significantly predictive of progressive recurrence and need for retreatment, no significant difference between the subdivisions of Grade 2 was observed. Similar predictive value was seen when using the Raymond-Roy classification compared to the new modified, limiting the usefulness of the new system in clinical practice.
Sections du résumé
Background
UNASSIGNED
The Raymond-Roy classification has been the standard for neck recurrences following endovascular coiling with three grades. Several modified classification systems with subdivisions have been reported in literature but it is unclear whether this adds value in predicting recurrence or retreatment. Our aim is to assess if these subdivisions aid in predicting recurrence and need for retreatment.
Methods
UNASSIGNED
A retrospective review of all patients undergoing endovascular coiling between 2013 and 2014. Patients requiring stent assistance or other embolization devices were excluded from the study. The neck residue was graded at time of coiling on the cerebral angiogram and subsequent 6, 24, and 60 months MRA. Correlation between grade at coiling and follow-up with need for subsequent retreatment was assessed.
Results
UNASSIGNED
Overall, 17/200 (8.5%) cases required retreatment within 5 years of initial coiling. 4/130 (3.1%) required retreatment within 5 years with initial Grade 0 at coiling, 6/24 cases (25%) of those Grade 2a, 4/20 cases (20%) Grade 2b, 3/8 (38%) Grade 3, and none of those with Grade 1. Large aneurysms ≥11 mm had an increased risk of aneurysm recurrence and retreatment. About 9.7% of ruptured aneurysms required retreatment versus 4.4% for unruptured. About 55% of carotid ophthalmic aneurysms were retreated.
Conclusion
UNASSIGNED
Although the modified classification system was significantly predictive of progressive recurrence and need for retreatment, no significant difference between the subdivisions of Grade 2 was observed. Similar predictive value was seen when using the Raymond-Roy classification compared to the new modified, limiting the usefulness of the new system in clinical practice.
Identifiants
pubmed: 35509568
doi: 10.25259/SNI_991_2021
pii: 10.25259/SNI_991_2021
pmc: PMC9062957
doi:
Types de publication
Journal Article
Langues
eng
Pagination
170Informations de copyright
Copyright: © 2022 Surgical Neurology International.
Déclaration de conflit d'intérêts
There are no conflicts of interest.
Références
AJNR Am J Neuroradiol. 2013 Mar;34(3):481-5
pubmed: 22422182
Stroke. 2001 Sep;32(9):1998-2004
pubmed: 11546888
Stroke. 2008 Jan;39(1):120-5
pubmed: 18048860
AJNR Am J Neuroradiol. 2007 Oct;28(9):1755-61
pubmed: 17885238
Lancet. 2015 Feb 21;385(9969):691-7
pubmed: 25465111
J Neurosurg. 2018 Nov 1;:1-7
pubmed: 30497155
Stroke. 2015 Aug;46(8):2368-400
pubmed: 26089327
Stroke. 2008 May;39(5):1501-6
pubmed: 18323484
Eur Stroke J. 2019 Jun;4(2):153-159
pubmed: 31259263
J Neurosurg. 2011 Mar;114(3):863-74
pubmed: 20672900
Lancet Neurol. 2009 May;8(5):427-33
pubmed: 19329361
Front Neurol. 2014 Apr 08;5:41
pubmed: 24782817
J Neurosurg. 2017 Jul;127(1):81-88
pubmed: 27739944
Stroke. 2001 Feb;32(2):485-91
pubmed: 11157187
Neurosurgery. 2012 Mar;70(3):537-53; discussion 553-4
pubmed: 21904266
Stroke. 2007 May;38(5):1538-44
pubmed: 17395870
Surg Neurol Int. 2016 Jan 07;7(Suppl 2):S40-8
pubmed: 26862460
J Neurosurg. 2018 Apr;128(4):992-998
pubmed: 28644100
Stroke. 2003 Jun;34(6):1398-403
pubmed: 12775880
AJNR Am J Neuroradiol. 2016 Apr;37(4):615-20
pubmed: 26611992
AJNR Am J Neuroradiol. 2008 Oct;29(9):1777-81
pubmed: 18719039
J Neurosurg. 1999 Apr;90(4):656-63
pubmed: 10193610
Neurosurgery. 2015 Apr;76(4):390-5; discussion 395
pubmed: 25621984
Lancet. 2005 Sep 3-9;366(9488):809-17
pubmed: 16139655
Arch Neurol. 2005 Mar;62(3):410-6
pubmed: 15767506
J Neurosurg. 2006 Sep;105(3):396-9
pubmed: 16961133
Radiology. 2010 Sep;256(3):887-97
pubmed: 20634431