Factors Associated with Postprocedural Diffusion-Weighted Imaging–Positive Lesions in Endovascular Treatment for Unruptured Cerebral Aneurysms

Keisuke Tokunaga, Taketo Hatano, Ichiro Nakahara, Akira Ishii, Eiji Higashi, Takahiko Kamata, Yusuke Funakoshi, Takuro Hashikawa, Wataru Takita, Hideo Chihara, Mitsushige Ando, Nobutake Sadamasa, Takanari Kitazono, Izumi Nagata

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Abstract

Background: In endovascular treatment for cerebral aneurysms, the appearance of asymptomatic thromboembolic lesions detected by postprocedural diffusion-weighted imaging (DWI) can be a surrogate marker for estimating the potential risk of symptomatic thromboembolism. The aim of this study was to clarify factors associated with postprocedural DWI-positive lesions in endovascular treatment for unruptured cerebral aneurysms. Methods: Patients with untreated unruptured cerebral aneurysms undergoing endovascular treatment were consecutively enrolled. Treatment techniques were classified into simple coiling, balloon-assisted coiling, stent-assisted coiling, and flow-diverter placement. Head magnetic resonance imaging was performed within 3 months before and 24 hours after the procedure to assess the appearance of DWI-positive lesions. Results: Among 376 aneurysms in 355 patients that were analyzed, 232 (61.7%) had postprocedural DWI-positive lesions. In univariate analyses, age (P = 0.001), dome size (P < 0.001), neck size (P < 0.001), treatment technique (P = 0.029), and total procedural time (P < 0.001) were significantly associated with postprocedural DWI-positive lesions. In the multiple logistic regression model, older age (odds ratio, 1.33; 95% confidence interval, 1.10–1.60; P = 0.003; per decade), flow-diverter placement (odds ratio, 4.93; 95% confidence interval, 1.33–20.92; P = 0.016; compared with simple coiling), and longer procedural time (odds ratio, 1.66; 95% confidence interval, 1.26–2.21; P < 0.001; per hour) were associated with postprocedural DWI-positive lesions. Conclusions: Older age, flow-diverter placement, and longer procedural time were associated with postprocedural DWI-positive lesions in endovascular treatment for unruptured cerebral aneurysms.

Original languageEnglish
Pages (from-to)e457-e462
JournalWorld Neurosurgery
Volume130
DOIs
Publication statusPublished - 10-2019

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

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    Tokunaga, K., Hatano, T., Nakahara, I., Ishii, A., Higashi, E., Kamata, T., Funakoshi, Y., Hashikawa, T., Takita, W., Chihara, H., Ando, M., Sadamasa, N., Kitazono, T., & Nagata, I. (2019). Factors Associated with Postprocedural Diffusion-Weighted Imaging–Positive Lesions in Endovascular Treatment for Unruptured Cerebral Aneurysms. World Neurosurgery, 130, e457-e462. https://doi.org/10.1016/j.wneu.2019.06.114