The Natural History of Coiled Cerebral Aneurysms Stratified by Modified Raymond-Roy Occlusion Classification

Stephen K. Mendenhall, Daniel H. Sahlein, Christopher D. Wilson, Anna C. Filley, Josue Ordaz, Rahul K. Ahluwalia, Wale A. Bakare, Andrew Huh, Elie Dancour, Mohamed A. Zaazoue, Scott Shapiro, Aaron Cohen-Gadol

Research output: Contribution to journalArticle

Abstract

Objective: The natural history and long-term durability of Guglielmi detachable coil (GDC) embolization is still unknown. We hypothesize a stepwise decrease in durability of embolized cerebral aneurysms as stratified by the Modified Raymond-Roy Classification (MRRC). Methods: First-time GDC-embolized cerebral aneurysms were retrospectively reviewed from 2004 to 2015. Loss of durability (LOD) was defined by change in aneurysm size or patency seen on serial radiographic follow-up. Kaplan-Meier survival analysis was performed to evaluate embolization durability. Multivariate Cox regression modeling was used to assess baseline aneurysm and patient characteristics for their effect on LOD. Results: A total of 427 patients with 443 aneurysms met the inclusion criteria. Overall, 89 (21%) aneurysms met LOD criteria. Grade 1 aneurysms had statistically significantly greater durability than did all other MRRC grades. Grade 3b aneurysms had significantly worse durability than did all other aneurysm grades. There was no difference in durability between grade 2 and 3a aneurysms. Of aneurysms with LOD, 26 (29%) experienced worsening of MRRC grade. Thirty-five (24%) initial MRRC grade 2, 72 (45%) initial MRRC grade 3a, and 6 (22%) initial MRRC grade 3b aneurysms progressed to MRRC grade 1 without retreatment. In our multivariate analysis, only initial MRRC grade was statistically significantly associated with treatment durability (P < 0.001). Conclusions: MRRC grade is independently associated with first-time GDC-embolized cerebral aneurysm durability. Achieving MRRC grade 1 occlusion outcome is significantly associated with greater long-term GDC durability. Although few aneurysms experience further growth and/or recanalization, most incompletely obliterated aneurysms tend to remain stable over time or even progress to occlusion. Grading scales such as the MRRC are useful for characterizing aneurysm occlusion but may lack sensitivity and specificity for characterizing changes in aneurysm morphology over time.

Original languageEnglish (US)
JournalWorld Neurosurgery
DOIs
StatePublished - Jan 1 2019

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Intracranial Aneurysm
Natural History
Aneurysm
Retreatment
Kaplan-Meier Estimate
Survival Analysis
Multivariate Analysis

Keywords

  • Cerebral aneurysm
  • Coil embolization
  • Durability
  • Natural history
  • Raymond-Roy Classification

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

The Natural History of Coiled Cerebral Aneurysms Stratified by Modified Raymond-Roy Occlusion Classification. / Mendenhall, Stephen K.; Sahlein, Daniel H.; Wilson, Christopher D.; Filley, Anna C.; Ordaz, Josue; Ahluwalia, Rahul K.; Bakare, Wale A.; Huh, Andrew; Dancour, Elie; Zaazoue, Mohamed A.; Shapiro, Scott; Cohen-Gadol, Aaron.

In: World Neurosurgery, 01.01.2019.

Research output: Contribution to journalArticle

Mendenhall, SK, Sahlein, DH, Wilson, CD, Filley, AC, Ordaz, J, Ahluwalia, RK, Bakare, WA, Huh, A, Dancour, E, Zaazoue, MA, Shapiro, S & Cohen-Gadol, A 2019, 'The Natural History of Coiled Cerebral Aneurysms Stratified by Modified Raymond-Roy Occlusion Classification', World Neurosurgery. https://doi.org/10.1016/j.wneu.2019.04.167
Mendenhall, Stephen K. ; Sahlein, Daniel H. ; Wilson, Christopher D. ; Filley, Anna C. ; Ordaz, Josue ; Ahluwalia, Rahul K. ; Bakare, Wale A. ; Huh, Andrew ; Dancour, Elie ; Zaazoue, Mohamed A. ; Shapiro, Scott ; Cohen-Gadol, Aaron. / The Natural History of Coiled Cerebral Aneurysms Stratified by Modified Raymond-Roy Occlusion Classification. In: World Neurosurgery. 2019.
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abstract = "Objective: The natural history and long-term durability of Guglielmi detachable coil (GDC) embolization is still unknown. We hypothesize a stepwise decrease in durability of embolized cerebral aneurysms as stratified by the Modified Raymond-Roy Classification (MRRC). Methods: First-time GDC-embolized cerebral aneurysms were retrospectively reviewed from 2004 to 2015. Loss of durability (LOD) was defined by change in aneurysm size or patency seen on serial radiographic follow-up. Kaplan-Meier survival analysis was performed to evaluate embolization durability. Multivariate Cox regression modeling was used to assess baseline aneurysm and patient characteristics for their effect on LOD. Results: A total of 427 patients with 443 aneurysms met the inclusion criteria. Overall, 89 (21{\%}) aneurysms met LOD criteria. Grade 1 aneurysms had statistically significantly greater durability than did all other MRRC grades. Grade 3b aneurysms had significantly worse durability than did all other aneurysm grades. There was no difference in durability between grade 2 and 3a aneurysms. Of aneurysms with LOD, 26 (29{\%}) experienced worsening of MRRC grade. Thirty-five (24{\%}) initial MRRC grade 2, 72 (45{\%}) initial MRRC grade 3a, and 6 (22{\%}) initial MRRC grade 3b aneurysms progressed to MRRC grade 1 without retreatment. In our multivariate analysis, only initial MRRC grade was statistically significantly associated with treatment durability (P < 0.001). Conclusions: MRRC grade is independently associated with first-time GDC-embolized cerebral aneurysm durability. Achieving MRRC grade 1 occlusion outcome is significantly associated with greater long-term GDC durability. Although few aneurysms experience further growth and/or recanalization, most incompletely obliterated aneurysms tend to remain stable over time or even progress to occlusion. Grading scales such as the MRRC are useful for characterizing aneurysm occlusion but may lack sensitivity and specificity for characterizing changes in aneurysm morphology over time.",
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author = "Mendenhall, {Stephen K.} and Sahlein, {Daniel H.} and Wilson, {Christopher D.} and Filley, {Anna C.} and Josue Ordaz and Ahluwalia, {Rahul K.} and Bakare, {Wale A.} and Andrew Huh and Elie Dancour and Zaazoue, {Mohamed A.} and Scott Shapiro and Aaron Cohen-Gadol",
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T1 - The Natural History of Coiled Cerebral Aneurysms Stratified by Modified Raymond-Roy Occlusion Classification

AU - Mendenhall, Stephen K.

AU - Sahlein, Daniel H.

AU - Wilson, Christopher D.

AU - Filley, Anna C.

AU - Ordaz, Josue

AU - Ahluwalia, Rahul K.

AU - Bakare, Wale A.

AU - Huh, Andrew

AU - Dancour, Elie

AU - Zaazoue, Mohamed A.

AU - Shapiro, Scott

AU - Cohen-Gadol, Aaron

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: The natural history and long-term durability of Guglielmi detachable coil (GDC) embolization is still unknown. We hypothesize a stepwise decrease in durability of embolized cerebral aneurysms as stratified by the Modified Raymond-Roy Classification (MRRC). Methods: First-time GDC-embolized cerebral aneurysms were retrospectively reviewed from 2004 to 2015. Loss of durability (LOD) was defined by change in aneurysm size or patency seen on serial radiographic follow-up. Kaplan-Meier survival analysis was performed to evaluate embolization durability. Multivariate Cox regression modeling was used to assess baseline aneurysm and patient characteristics for their effect on LOD. Results: A total of 427 patients with 443 aneurysms met the inclusion criteria. Overall, 89 (21%) aneurysms met LOD criteria. Grade 1 aneurysms had statistically significantly greater durability than did all other MRRC grades. Grade 3b aneurysms had significantly worse durability than did all other aneurysm grades. There was no difference in durability between grade 2 and 3a aneurysms. Of aneurysms with LOD, 26 (29%) experienced worsening of MRRC grade. Thirty-five (24%) initial MRRC grade 2, 72 (45%) initial MRRC grade 3a, and 6 (22%) initial MRRC grade 3b aneurysms progressed to MRRC grade 1 without retreatment. In our multivariate analysis, only initial MRRC grade was statistically significantly associated with treatment durability (P < 0.001). Conclusions: MRRC grade is independently associated with first-time GDC-embolized cerebral aneurysm durability. Achieving MRRC grade 1 occlusion outcome is significantly associated with greater long-term GDC durability. Although few aneurysms experience further growth and/or recanalization, most incompletely obliterated aneurysms tend to remain stable over time or even progress to occlusion. Grading scales such as the MRRC are useful for characterizing aneurysm occlusion but may lack sensitivity and specificity for characterizing changes in aneurysm morphology over time.

AB - Objective: The natural history and long-term durability of Guglielmi detachable coil (GDC) embolization is still unknown. We hypothesize a stepwise decrease in durability of embolized cerebral aneurysms as stratified by the Modified Raymond-Roy Classification (MRRC). Methods: First-time GDC-embolized cerebral aneurysms were retrospectively reviewed from 2004 to 2015. Loss of durability (LOD) was defined by change in aneurysm size or patency seen on serial radiographic follow-up. Kaplan-Meier survival analysis was performed to evaluate embolization durability. Multivariate Cox regression modeling was used to assess baseline aneurysm and patient characteristics for their effect on LOD. Results: A total of 427 patients with 443 aneurysms met the inclusion criteria. Overall, 89 (21%) aneurysms met LOD criteria. Grade 1 aneurysms had statistically significantly greater durability than did all other MRRC grades. Grade 3b aneurysms had significantly worse durability than did all other aneurysm grades. There was no difference in durability between grade 2 and 3a aneurysms. Of aneurysms with LOD, 26 (29%) experienced worsening of MRRC grade. Thirty-five (24%) initial MRRC grade 2, 72 (45%) initial MRRC grade 3a, and 6 (22%) initial MRRC grade 3b aneurysms progressed to MRRC grade 1 without retreatment. In our multivariate analysis, only initial MRRC grade was statistically significantly associated with treatment durability (P < 0.001). Conclusions: MRRC grade is independently associated with first-time GDC-embolized cerebral aneurysm durability. Achieving MRRC grade 1 occlusion outcome is significantly associated with greater long-term GDC durability. Although few aneurysms experience further growth and/or recanalization, most incompletely obliterated aneurysms tend to remain stable over time or even progress to occlusion. Grading scales such as the MRRC are useful for characterizing aneurysm occlusion but may lack sensitivity and specificity for characterizing changes in aneurysm morphology over time.

KW - Cerebral aneurysm

KW - Coil embolization

KW - Durability

KW - Natural history

KW - Raymond-Roy Classification

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