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Reappraisal of anatomic outcome scales of coiled intracranial aneurysms in the prediction of recanalization.

Lee JY, Kwon BJ, Cho YD, Kang HS, Han MH - J Korean Neurosurg Soc (2013)

Bottom Line: Lastly, the predictive accuracies of three different scales were measured via Harrell's C index.Multivariate-adjusted hazard ratios (HRs) of the second and third categories as compared with the first category of AGS (HR : 3.95 and 4.15, p=0.004 and 0.001) and 2DPO (HR : 4.87 and 3.12, p<0.001 and 0.01) were similar.The validated and optimism-adjusted C-indices were 0.50 [confidence (CI) : -1.09-2.09], 0.47 (CI : -1.10-2.09) and 0.44 (CI : -1.10-2.08) for AGS, 2DPO, and vPD, respectively.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.

ABSTRACT

Objective: Several scales are currently used to assess occlusion rates of coiled cerebral aneurysms. This study compared these scales as predictors of recanalization.

Methods: Clinical data of 827 patients harboring 901 aneurysms treated by coiling were retrospectively reviewed. Occlusion rates were assessed using angiographic grading scale (AGS), two-dimensional percent occlusion (2DPO), and volumetric packing density (vPD). Every scale had 3 categories. Followed patients were dichotomized into either presence or absence of recanalization. Kaplan-Meier analysis was conducted, and Cox proportional hazards analysis was performed to identify surviving probabilities of recanalization. Lastly, the predictive accuracies of three different scales were measured via Harrell's C index.

Results: The cumulative risk of recanalization was 7% at 12-month, 10% at 24-month, and 13% at 36-month of postembolization, and significantly higher for the second and third categories of every scale (p<0.001). Multivariate-adjusted hazard ratios (HRs) of the second and third categories as compared with the first category of AGS (HR : 3.95 and 4.15, p=0.004 and 0.001) and 2DPO (HR : 4.87 and 3.12, p<0.001 and 0.01) were similar. For vPD, there was no association between occlusion rates and recanalization. The validated and optimism-adjusted C-indices were 0.50 [confidence (CI) : -1.09-2.09], 0.47 (CI : -1.10-2.09) and 0.44 (CI : -1.10-2.08) for AGS, 2DPO, and vPD, respectively.

Conclusion: Total occlusion should be reasonably tried in coiling to maximize the benefit of the treatment. AGS may be the best to predict recanalization, whereas vPD should not be used alone.

No MeSH data available.


Related in: MedlinePlus

Kaplan-Meier analyses demonstrate the proportion of patients without recanalization during follow-up. Kaplan-Meier plot of angiographic grading scale (A), two-dimensional percent occlusion (B), and volumetric packing density (C).
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Figure 1: Kaplan-Meier analyses demonstrate the proportion of patients without recanalization during follow-up. Kaplan-Meier plot of angiographic grading scale (A), two-dimensional percent occlusion (B), and volumetric packing density (C).

Mentions: In life-table and Kaplan-Meier analysis, the CR of recanalization was 3% at 6 months, 7% at 12 months, 10% at 24 months, and 13% at 36 months after coil embolization. The CR of recanalization of the first category of AGS was 1%, 2%, 4%, and 4% at 6 months, 12 months, 24 months and 36 months, respectively; the second category of AGS was 6%, 9%, 15% and 15% at 6, 12, 24 and 36 months; the third category of AGS was 4%, 12%, 15%, 20% at 6, 12, 24, 36 months. The CR of recanalization of the first category of 2DPO was 1%, 3%, 4%, 4% at 6, 12, 24, 36 months; the second category of 2DPO was 8%, 13%, 15%, 33% at 6, 12, 24, 36 months; the third category of 2DPO was 3%, 9%, 14%, 14% at 6, 12, 24, 36 months. The CR of recanalization of the first category of vPD was 1%, 4%, 5%, 10% at 6, 12, 24, 36 months; the second category of vPD was 4%, 8%, 14%, 18% at 6, 12, 24, 36 months; the third category of vPD was 6%, 12%, 14%, 14% at 6, 12, 24, 36 months. The CR of recanalization was significantly higher in the less occluded categories of every scale (p<0.05). However, the risks in the second and third categories were not significantly different for AGS (p=0.93) and 2DPO (p=0.08), whereas it was significantly higher in the vPD's second category than its third, which was 18% versus 14% at 36 months (Fig. 1).


Reappraisal of anatomic outcome scales of coiled intracranial aneurysms in the prediction of recanalization.

Lee JY, Kwon BJ, Cho YD, Kang HS, Han MH - J Korean Neurosurg Soc (2013)

Kaplan-Meier analyses demonstrate the proportion of patients without recanalization during follow-up. Kaplan-Meier plot of angiographic grading scale (A), two-dimensional percent occlusion (B), and volumetric packing density (C).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3756126&req=5

Figure 1: Kaplan-Meier analyses demonstrate the proportion of patients without recanalization during follow-up. Kaplan-Meier plot of angiographic grading scale (A), two-dimensional percent occlusion (B), and volumetric packing density (C).
Mentions: In life-table and Kaplan-Meier analysis, the CR of recanalization was 3% at 6 months, 7% at 12 months, 10% at 24 months, and 13% at 36 months after coil embolization. The CR of recanalization of the first category of AGS was 1%, 2%, 4%, and 4% at 6 months, 12 months, 24 months and 36 months, respectively; the second category of AGS was 6%, 9%, 15% and 15% at 6, 12, 24 and 36 months; the third category of AGS was 4%, 12%, 15%, 20% at 6, 12, 24, 36 months. The CR of recanalization of the first category of 2DPO was 1%, 3%, 4%, 4% at 6, 12, 24, 36 months; the second category of 2DPO was 8%, 13%, 15%, 33% at 6, 12, 24, 36 months; the third category of 2DPO was 3%, 9%, 14%, 14% at 6, 12, 24, 36 months. The CR of recanalization of the first category of vPD was 1%, 4%, 5%, 10% at 6, 12, 24, 36 months; the second category of vPD was 4%, 8%, 14%, 18% at 6, 12, 24, 36 months; the third category of vPD was 6%, 12%, 14%, 14% at 6, 12, 24, 36 months. The CR of recanalization was significantly higher in the less occluded categories of every scale (p<0.05). However, the risks in the second and third categories were not significantly different for AGS (p=0.93) and 2DPO (p=0.08), whereas it was significantly higher in the vPD's second category than its third, which was 18% versus 14% at 36 months (Fig. 1).

Bottom Line: Lastly, the predictive accuracies of three different scales were measured via Harrell's C index.Multivariate-adjusted hazard ratios (HRs) of the second and third categories as compared with the first category of AGS (HR : 3.95 and 4.15, p=0.004 and 0.001) and 2DPO (HR : 4.87 and 3.12, p<0.001 and 0.01) were similar.The validated and optimism-adjusted C-indices were 0.50 [confidence (CI) : -1.09-2.09], 0.47 (CI : -1.10-2.09) and 0.44 (CI : -1.10-2.08) for AGS, 2DPO, and vPD, respectively.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.

ABSTRACT

Objective: Several scales are currently used to assess occlusion rates of coiled cerebral aneurysms. This study compared these scales as predictors of recanalization.

Methods: Clinical data of 827 patients harboring 901 aneurysms treated by coiling were retrospectively reviewed. Occlusion rates were assessed using angiographic grading scale (AGS), two-dimensional percent occlusion (2DPO), and volumetric packing density (vPD). Every scale had 3 categories. Followed patients were dichotomized into either presence or absence of recanalization. Kaplan-Meier analysis was conducted, and Cox proportional hazards analysis was performed to identify surviving probabilities of recanalization. Lastly, the predictive accuracies of three different scales were measured via Harrell's C index.

Results: The cumulative risk of recanalization was 7% at 12-month, 10% at 24-month, and 13% at 36-month of postembolization, and significantly higher for the second and third categories of every scale (p<0.001). Multivariate-adjusted hazard ratios (HRs) of the second and third categories as compared with the first category of AGS (HR : 3.95 and 4.15, p=0.004 and 0.001) and 2DPO (HR : 4.87 and 3.12, p<0.001 and 0.01) were similar. For vPD, there was no association between occlusion rates and recanalization. The validated and optimism-adjusted C-indices were 0.50 [confidence (CI) : -1.09-2.09], 0.47 (CI : -1.10-2.09) and 0.44 (CI : -1.10-2.08) for AGS, 2DPO, and vPD, respectively.

Conclusion: Total occlusion should be reasonably tried in coiling to maximize the benefit of the treatment. AGS may be the best to predict recanalization, whereas vPD should not be used alone.

No MeSH data available.


Related in: MedlinePlus