Follow-up of intracranial aneurysms treated with stent-assisted coiling: Comparison of contrast-enhanced MRA, time-of-flight MRA, and digital subtraction angiography

Abstract : Background and purpose Data about non-invasive follow-up of aneurysm after stent-assisted coiling is scarce. We aimed to compare time-of-flight (TOF) magnetic resonance angiography (MRA) (3D-TOF-MRA) and contrast-enhanced MRA (CE-MRA) at 3-Tesla, with digital subtraction angiography (DSA) for evaluating aneurysm occlusion and parent artery patency after stent-assisted coiling. Materials and methods In this retrospective single-center study, patients were included if they had an intracranial aneurysm treated by stent-assisted coiling between March 2008 and June 2015, followed with both MRA sequences (3D-TOF-MRA and CE-MRA) at 3-Tesla and DSA, performed in an interval < 48 hours. Results Thirty-five aneurysms were included. Regarding aneurysm occlusion evaluation, agreement with DSA was better for CE-MRA (K = 0.53) than 3D-TOF-MRA (K = 0.28). Diagnostic accuracies for aneurysm remnant depiction were similar for 3D-TOF-MRA and CE-MRA (P = 1). Both 3D-TOF-MRA (K = 0.05) and CE-MRA (K = −0.04) were unable to detect pathological vessel compared to DSA, without difference in accuracy (P = 0.68). For parent artery occlusion detection, agreement with DSA was substantial for 3D-TOF-MRA (K = 0.64) and moderate for CE-MRA (K = 0.45), with similar good diagnostic accuracies (P = 1). Conclusion After stent-assisted coiling treatment, 3D-TOF-MRA and CE-MRA demonstrated good accuracy to detect aneurysm remnant (but tended to overestimation). Although CE-MRA agreement with DSA was better, there was no statistical difference between 3D-TOF-MRA and CE-MRA accuracies. Both MRAs were unable to provide a precise evaluation of in-stent status but could detect parent vessel occlusion.
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Submitted on : Monday, June 25, 2018 - 10:42:54 AM
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David Marciano, Sébastien Soize, Georgios Metaxas, Christophe Portefaix, Laurent Pierot. Follow-up of intracranial aneurysms treated with stent-assisted coiling: Comparison of contrast-enhanced MRA, time-of-flight MRA, and digital subtraction angiography. Journal de Neuroradiologie / Journal of Neuroradiology, Elsevier Masson, 2017, 44 (1), pp.44-51. ⟨hal-01822466⟩

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