Significant flow velocity reduction at the intracranial aneurysm neck after endovascular treatment leads to favourable angiographic outcome:a prospective study

Background With widely usage of flow diverter in intracranial aneurysm treatment,some previously used predictors may not be effective in evaluating the recurrence risk.We aimed to comprehensively re-evaluate the predictors of intracranial aneurysm outcome with various endovascular treatment methods and devices.Methods This is a prospective registered study.We analysed 6-month and 18-month follow-up angiographic data from the prospective study.Data on patient demographics,aneurysm morphology and type of treatment were recorded.Patient-specific haemodynamic simulations were performed.An unfavourable angiographic outcome was defined as recurrence of aneurysm in cases with coiling or stent-assisted coiling,patency of aneurysm in cases with flow diverters or retreatment during follow-up.Results In total,165 patients(177 intracranial aneurysms)with at least one angiographic follow-up data were analysed.For the short-term(6-month)results,after univariate analysis,the demographic,morphological and treatment-related factors did not achieve significantly statistical differences.The reduction ratio(RR)of velocity at aneurysm neck after embolisation was significantly lower in the unfavourable angiographic group than the favourable angiographic outcome group(p=0.002).After the Cox regression analysis,the RR of velocity at aneurysm neck was the only independent factor associated with favourable angiographic outcome(OR 0.028;p=0.001)and had an acceptable area under the curve(0.714)with a clear cut-off value(46.14%).Similarly,for the analysis of midterm(18-month)results,the RR of velocity at the aneurysm neck was the only independent significant factor for the unfavourable angiographic outcome(OR 0.050;p=0.017).The area under the curve was 0.754 and the cut-off value was 48.20%.Conclusions The haemodynamics showed an independent effect on angiographic follow-up results and may provide helpful suggestions for clinical practice in the future.