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Research ArticleNeurointervention

Aneurysm Remnants after Flow Diversion: Clinical and Angiographic Outcomes

T.P. Madaelil, J.A. Grossberg, B.M. Howard, C.M. Cawley, J. Dion, R.G. Nogueira, D.C. Haussen and F.C. Tong
American Journal of Neuroradiology April 2019, 40 (4) 694-698; DOI: https://doi.org/10.3174/ajnr.A6010
T.P. Madaelil
aFrom the Departments of Neurointerventional Radiology and Neurosurgery (T.P.M., J.A.G., B.M.H., C.M.C., F.C.T.), Emory University School of Medicine, Atlanta, Georgia
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  • ORCID record for T.P. Madaelil
J.A. Grossberg
aFrom the Departments of Neurointerventional Radiology and Neurosurgery (T.P.M., J.A.G., B.M.H., C.M.C., F.C.T.), Emory University School of Medicine, Atlanta, Georgia
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B.M. Howard
aFrom the Departments of Neurointerventional Radiology and Neurosurgery (T.P.M., J.A.G., B.M.H., C.M.C., F.C.T.), Emory University School of Medicine, Atlanta, Georgia
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C.M. Cawley
aFrom the Departments of Neurointerventional Radiology and Neurosurgery (T.P.M., J.A.G., B.M.H., C.M.C., F.C.T.), Emory University School of Medicine, Atlanta, Georgia
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J. Dion
cMicroVention (J.D.), Aliso Viejo, California.
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R.G. Nogueira
bMarcus Stroke and Neuroscience Center (R.G.N., D.C.H.), Departments of Neurology and Neurosurgery, Grady Memorial Hospital, Atlanta, Georgia
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D.C. Haussen
bMarcus Stroke and Neuroscience Center (R.G.N., D.C.H.), Departments of Neurology and Neurosurgery, Grady Memorial Hospital, Atlanta, Georgia
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F.C. Tong
aFrom the Departments of Neurointerventional Radiology and Neurosurgery (T.P.M., J.A.G., B.M.H., C.M.C., F.C.T.), Emory University School of Medicine, Atlanta, Georgia
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    Fig 1.

    Occlusion status on late-surveillance follow-up imaging.

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    Fig 2.

    Aneurysm persistence after flow diversion. A 67-year-old woman who had a previously ruptured right posterior communicating artery aneurysm with evidence of recanalization on the 6-month follow-up angiogram. She was treated with flow diversion for the neck recurrence. A 6-month follow-up DSA (lateral x-ray) after flow diversion demonstrates class C OKM grade (continued filling at the neck of the aneurysm) (white arrow). At last clinical and angiographic follow-ups at 3 years, there is no evidence of aneurysm rerupture or progression of the neck remnant on MRA (white arrow).

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    Table 1:

    Basic clinical and imaging demographics

    DemographicsCount (% or IQR as Appropriate)
    Interventions296
    Aneurysms294
    Patients283
    Median age (yr)55 (IQR, 47–65)
    Female sex246 (86.9%)
    Follow-up imaging at 6 mo237 (83.7%)
    MRA + DSA at 6 mo86 (36.3%)
    MRA at 6 mo32 (13.5%)
    DSA at 6 mo119 (50.2%)
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    Table 2:

    Characteristics of aneurysm remnants after flow diversion

    CharacteristicsCount (% or IQR)
    Anterior circulation21 (84%)
    Posterior circulation4 (16%)
    Neck remnant15 (60%)
    Sac remnant10 (40%)
    Branch vessel arising from aneurysm neck19 (76%)
    Median size of remnant (mm)3 (2–4)
    Overlapping devices1 (4%)
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American Journal of Neuroradiology: 40 (4)
American Journal of Neuroradiology
Vol. 40, Issue 4
1 Apr 2019
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Cite this article
T.P. Madaelil, J.A. Grossberg, B.M. Howard, C.M. Cawley, J. Dion, R.G. Nogueira, D.C. Haussen, F.C. Tong
Aneurysm Remnants after Flow Diversion: Clinical and Angiographic Outcomes
American Journal of Neuroradiology Apr 2019, 40 (4) 694-698; DOI: 10.3174/ajnr.A6010

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Aneurysm Remnants after Flow Diversion: Clinical and Angiographic Outcomes
T.P. Madaelil, J.A. Grossberg, B.M. Howard, C.M. Cawley, J. Dion, R.G. Nogueira, D.C. Haussen, F.C. Tong
American Journal of Neuroradiology Apr 2019, 40 (4) 694-698; DOI: 10.3174/ajnr.A6010
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