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Wide-neck bifurcation aneurysms of the middle cerebral artery and basilar apex treated by endovascular techniques: a multicentre, core lab adjudicated study evaluating safety and durability of occlusion (BRANCH)
  1. Reade A De Leacy1,
  2. Kyle M Fargen2,
  3. Justin R Mascitelli1,
  4. Johanna Fifi1,
  5. Lena Turkheimer1,
  6. Xiangnan Zhang1,
  7. Aman B Patel3,
  8. Matthew J Koch3,
  9. Aditya S Pandey4,
  10. D Andrew Wilkinson4,
  11. Julius Griauzde4,
  12. Robert F James5,
  13. Enzo M Fortuny5,
  14. Aurora Cruz5,
  15. Alan Boulos6,
  16. Emad Nourollah-Zadeh6,
  17. Alexandra Paul6,
  18. Eric Sauvageau7,
  19. Ricardo Hanel7,
  20. Pedro Aguilar-Salinas7,
  21. Roberta L Novakovic8,
  22. Babu G Welch8,
  23. Ranyah Almardawi9,
  24. Gaurav Jindal9,
  25. Harish Shownkeen10,
  26. Elad I Levy11,
  27. Adnan H Siddiqui11,
  28. J Mocco1
  1. 1Department of Neurosurgery, Mount Sinai Hospital, New York City, New York, USA
  2. 2Department of Neurological Surgery, Wake Forest University, Winston-Salem, North Carolina, USA
  3. 3Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
  4. 4Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
  5. 5Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
  6. 6Department of Neurosurgery, Albany Medical Center, Albany, New York, USA
  7. 7Department of Neurosurgery, Lyerly Baptist, Jacksonville, Florida, USA
  8. 8Department of Neurosurgery, UT Southwestern Medical Center, Dallas, Texas, USA
  9. 9Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Maryland, USA
  10. 10Neurointerventional Surgery, Northwestern Medicine at Central DuPage Hospital, Winfield, Illinois, USA
  11. 11Department of Neurosurgery, University at Buffalo, Buffalo, New York, USA
  1. Correspondence to Dr Reade A De Leacy, Department of Neurosurgery, Mount Sinai Hospital, New York City, NY 10029, USA; reade.deleacy{at}mountsinai.org

Abstract

Background and purpose BRANCH (wide-neck bifurcation aneurysms of the middle cerebral artery and basilar apex treated by endovascular techniques) is a multicentre, retrospective study comparing core lab evaluation of angiographic outcomes with self-reported outcomes.

Materials and methods Consecutive patients were enrolled from 10 US centres, aged between 18 and 85 with unruptured wide-neck middle cerebral artery (MCA) or basilar apex aneurysms treated endovascularly. Patient demographics, aneurysm morphology, procedural information, mortality and morbidity data and core lab and self-reported modified Raymond Roy (RR) outcomes were obtained.

Results 115 patients met inclusion criteria. Intervention-related mortality and significant morbidity rates were 1.7% (2/115) and 5.8% (6/103) respectively. Core lab adjudicated RR1 and 2 occlusion rates at follow-up were 30.6% and 32.4% respectively. The retreatment rate within the follow-up window was 10/115 (8.7%) and in stent stenosis at follow-up was 5/63 (7.9%). Self-reporting shows a statistically significant direction to angiographic RR one outcomes at follow-up compared with core lab evaluation, with OR 1.75 (95% CI 1.08 to 2.83).

Conclusion Endovascular treatment of wide-neck MCA and basilar apex aneurysms resulted in a core lab adjudicated RR1 occlusion rate of 30.6%. Self-reported results at follow-up favour better angiographic outcomes, with OR 1.75 (95% CI 1.08 to 2.83). These data demonstrate the need for novel endovascular devices specifically designed to treat complex intracranial aneurysms, as well as the importance of core lab adjudication in assessing outcomes in such a trial.

  • aneurysm
  • stent
  • balloon
  • coil
  • intervention

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Footnotes

  • Contributors All authors made substantial contributions to (1) the conception or design of the work, or the acquisition, analysis, or interpretation of data for the work; (2) drafting of the work or revising it critically for important intellectual content; (3) final approval of the version to be published; and are in agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding This work was supported by MEDTRonic Neurovascular, grant number GCO#16-0576. Further philanthropic funding was also provided by Daniel and Nancy Paduano that helped support wages for a statistician for the study.

  • Competing interests AHS, ABP, RFJ are consultants for Medtronic Neurovascular. RFJ has received research funding from Medtronic Neuorvascular. BGW is a proctor for Medtronic Neurovascular.

  • Patient consent Not required.

  • Ethics approval Multiple institutional review boards.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data could be made available by contacting the corresponding author following IRB approval.

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