Parent artery occlusion for unruptured cerebral aneurysms: Results of the Japanese registry of neuroendovascular therapy 3

Japanese Registry of Neuroendovascular Therapy (JR-NET) investigators

Research output: Contribution to journalArticle

Abstract

Although the current standard treatment for unruptured aneurysms comprises surgical clipping or endovascular coiling, these techniques are not suitable for some cases, such as large, giant, and fusiform aneurysms. Endovascular parent artery occlusion (PAO), which includes internal trapping and proximal occlusion, is a well-established alternative treatment for such cases. Here, we retrospectively reviewed PAO cases from the Japanese Registry of Neuroendovascular Therapy 3, a nation-wide survey of all neuroendovascular therapy cases between 2010 and 2014. This dataset included 274 procedures with a mean patient age of 57.1 years and 55.4% female patients. For the treatment strategy, internal trapping was selected in 213 aneurysm cases (77.7%) and proximal occlusion in 61 aneurysm cases (22.2%). Most of the procedures were successfully completed (272/274: 99.2%). Immediately after treatment, angiographical complete occlusion was achieved in 248 cases (90.5%). Although the feasibility of this technique was excellent, there were 60 periprocedural complications (21.8%), including 48 ischemic complications (17.5%), seven hemorrhagic complications (2.5%). Overall, morbidity and mortality at 30 days postoperative were 5.8% and 0.7%, respectively. Among the pretreatment variables, a patient age of 70 and older was associated with ischemic complications [odds ratio (OR); 2.34, 95% confidence interval (CI); 1.02–5.25; P = 0.04] and a small aneurysm size (<5 mm) was associated with hemorrhagic complications (OR; 9.85, 95% CI; 1.07–221.0; P = 0.04) by multivariate analysis. In conclusion, PAO for unruptured cerebral aneurysms is feasible, but is associated with a complication rate of approximately 20%. Various alternative treatment options should be carefully considered with deconstructive strategies.

Original languageEnglish
Pages (from-to)1-9
Number of pages9
JournalNeurologia medico-chirurgica
Volume59
Issue number1
DOIs
Publication statusPublished - Jan 1 2019

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Intracranial Aneurysm
Registries
Arteries
Aneurysm
Therapeutics
Odds Ratio
Confidence Intervals
Endovascular Procedures
Multivariate Analysis
Morbidity
Mortality

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

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Parent artery occlusion for unruptured cerebral aneurysms : Results of the Japanese registry of neuroendovascular therapy 3. / Japanese Registry of Neuroendovascular Therapy (JR-NET) investigators.

In: Neurologia medico-chirurgica, Vol. 59, No. 1, 01.01.2019, p. 1-9.

Research output: Contribution to journalArticle

Japanese Registry of Neuroendovascular Therapy (JR-NET) investigators. / Parent artery occlusion for unruptured cerebral aneurysms : Results of the Japanese registry of neuroendovascular therapy 3. In: Neurologia medico-chirurgica. 2019 ; Vol. 59, No. 1. pp. 1-9.
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abstract = "Although the current standard treatment for unruptured aneurysms comprises surgical clipping or endovascular coiling, these techniques are not suitable for some cases, such as large, giant, and fusiform aneurysms. Endovascular parent artery occlusion (PAO), which includes internal trapping and proximal occlusion, is a well-established alternative treatment for such cases. Here, we retrospectively reviewed PAO cases from the Japanese Registry of Neuroendovascular Therapy 3, a nation-wide survey of all neuroendovascular therapy cases between 2010 and 2014. This dataset included 274 procedures with a mean patient age of 57.1 years and 55.4{\%} female patients. For the treatment strategy, internal trapping was selected in 213 aneurysm cases (77.7{\%}) and proximal occlusion in 61 aneurysm cases (22.2{\%}). Most of the procedures were successfully completed (272/274: 99.2{\%}). Immediately after treatment, angiographical complete occlusion was achieved in 248 cases (90.5{\%}). Although the feasibility of this technique was excellent, there were 60 periprocedural complications (21.8{\%}), including 48 ischemic complications (17.5{\%}), seven hemorrhagic complications (2.5{\%}). Overall, morbidity and mortality at 30 days postoperative were 5.8{\%} and 0.7{\%}, respectively. Among the pretreatment variables, a patient age of 70 and older was associated with ischemic complications [odds ratio (OR); 2.34, 95{\%} confidence interval (CI); 1.02–5.25; P = 0.04] and a small aneurysm size (<5 mm) was associated with hemorrhagic complications (OR; 9.85, 95{\%} CI; 1.07–221.0; P = 0.04) by multivariate analysis. In conclusion, PAO for unruptured cerebral aneurysms is feasible, but is associated with a complication rate of approximately 20{\%}. Various alternative treatment options should be carefully considered with deconstructive strategies.",
author = "{Japanese Registry of Neuroendovascular Therapy (JR-NET) investigators} and Hidehisa Nishi and Akira Ishii and Tetsu Satow and Koji Iihara and Nobuyuki Sakai and Masayuki Ezura and Akio Hyodo and Shigeru Miyachi and Susumu Miyamoto and Yoji Nagai and Kunihiro Nishimura and Kazunori Toyoda and Toshiyuki Fujinaka and Toshio Higashi and Masaru Hirohata and Hirotoshi Imamura and Yasushi Ito and Naoya Kuwayama and Hidenori Oishi and Yuji Matsumaru and Yasushi Matsumoto and Ichiro Nakahara and Chiaki Sakai and Kenji Sugiu and Tomoaki Terada and Shinichi Yoshimura",
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AU - Ishii, Akira

AU - Satow, Tetsu

AU - Iihara, Koji

AU - Sakai, Nobuyuki

AU - Ezura, Masayuki

AU - Hyodo, Akio

AU - Miyachi, Shigeru

AU - Miyamoto, Susumu

AU - Nagai, Yoji

AU - Nishimura, Kunihiro

AU - Toyoda, Kazunori

AU - Fujinaka, Toshiyuki

AU - Higashi, Toshio

AU - Hirohata, Masaru

AU - Imamura, Hirotoshi

AU - Ito, Yasushi

AU - Kuwayama, Naoya

AU - Oishi, Hidenori

AU - Matsumaru, Yuji

AU - Matsumoto, Yasushi

AU - Nakahara, Ichiro

AU - Sakai, Chiaki

AU - Sugiu, Kenji

AU - Terada, Tomoaki

AU - Yoshimura, Shinichi

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AB - Although the current standard treatment for unruptured aneurysms comprises surgical clipping or endovascular coiling, these techniques are not suitable for some cases, such as large, giant, and fusiform aneurysms. Endovascular parent artery occlusion (PAO), which includes internal trapping and proximal occlusion, is a well-established alternative treatment for such cases. Here, we retrospectively reviewed PAO cases from the Japanese Registry of Neuroendovascular Therapy 3, a nation-wide survey of all neuroendovascular therapy cases between 2010 and 2014. This dataset included 274 procedures with a mean patient age of 57.1 years and 55.4% female patients. For the treatment strategy, internal trapping was selected in 213 aneurysm cases (77.7%) and proximal occlusion in 61 aneurysm cases (22.2%). Most of the procedures were successfully completed (272/274: 99.2%). Immediately after treatment, angiographical complete occlusion was achieved in 248 cases (90.5%). Although the feasibility of this technique was excellent, there were 60 periprocedural complications (21.8%), including 48 ischemic complications (17.5%), seven hemorrhagic complications (2.5%). Overall, morbidity and mortality at 30 days postoperative were 5.8% and 0.7%, respectively. Among the pretreatment variables, a patient age of 70 and older was associated with ischemic complications [odds ratio (OR); 2.34, 95% confidence interval (CI); 1.02–5.25; P = 0.04] and a small aneurysm size (<5 mm) was associated with hemorrhagic complications (OR; 9.85, 95% CI; 1.07–221.0; P = 0.04) by multivariate analysis. In conclusion, PAO for unruptured cerebral aneurysms is feasible, but is associated with a complication rate of approximately 20%. Various alternative treatment options should be carefully considered with deconstructive strategies.

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