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Hemorrhagic stroke
Original research
Endovascular treatment of unruptured intracranial aneurysms: Rate of thromboembolic events depicted by diffusion-weighted imaging in relation to different techniques
  1. Laurent Pierot1,
  2. Aymeric Rouchaud2,3,
  3. Emmanuel Chabert4,
  4. Hubert Desal5,
  5. Frédéric Ricolfi6,
  6. Coralie Barbe7,
  7. Sébastien Soize8,
  8. Adberrahim Zerroug9,
  9. Francois Eugène10,
  10. Frédéric Clarençon11,12,
  11. Jean-Christophe Ferré13
    1. 1Department of Neuroradiology, CHU de Reims, Reims, France
    2. 2Interventional neuroradiology, Centre Hospitalier Universitaire de Limoges, Limoges, France
    3. 3Université de Limoges, Limoges, France
    4. 4Neuroradiologie, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
    5. 5Neuroradiology, CHU Nantes, Nantes, France
    6. 6Neuroradiology, CHU Dijon, Dijon, France
    7. 7Health Research University Department, Université de Reims Champagne-Ardenne, Reims, France
    8. 8Interventional Neuroradiology, CHU de Reims, Reims, France
    9. 9Département Neuroradiologie Diagnostique et Interventionnelle, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
    10. 10Radiologie, CHU Rennes, Rennes, France
    11. 11AP-HP, Paris, France
    12. 12Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
    13. 13Neuroradiology, CHU de Rennes, Rennes, France
    1. Correspondence to Dr Laurent Pierot; lpierot{at}gmail.com

    Abstract

    Background The rate of thromboembolic events (TEEs) associated with endovascular treatment (EVT) of intracranial aneurysms is not reported uniformly in the literature due to the various ways that are used to evaluate them. Analysis of Thromboembolic Complications after Endovascular Treatment of Unruptured Intracranial Aneurysms study (ACET) is a prospective, multicenter study, which analyzes the rate of TEEs using diffusion-weighted imaging (DWI) magnetic resonance imaging (MRI) in patients treated for unruptured aneurysms with different endovascular techniques.

    Methods Patients were prospectively included in six French centers. Postoperative DWI-MRI was performed within 72 hours post-procedure and independently evaluated. Univariate and multivariate analyses were conducted to determine factors associated with the occurrence of DWI lesions.

    Results Of the 233 included patients (54.5±11.2 years, 162 women, (69.5%)), 226 were effectively treated by EVT (coiling: 90 patients, 39.8%; balloon-assisted coiling (BAC): 62, 27.4%; stent-assisted coiling (SAC): 10, 4.4%; flow diversion (FD): 21, 9.3%; intrasaccular flow disruption (ISFD): 43, 19.0%) and had a postoperative MRI showing DWI lesions in 133 patients (58.8%). Univariate and multivariate analyses show the rate of patients with DWI lesions to be significantly higher with BAC (75.8%, P=0.001), SAC (90.0%, P=0.02), and FD (95.2%, P=0.001) compared with coiling alone (41.1%).

    Conclusions The rate of DWI lesions after EVT of unruptured aneurysms is primarily influenced by the EVT technique used. Techniques using transient (BAC) or permanent (SAC and FD) device placement in the parent artery are associated with a higher rate of DWI lesions.

    Trial registration number ACET: Unique identifier: NCT02862756.

    • Aneurysm

    Data availability statement

    Data are available upon reasonable request. The data supporting this study’s findings are available from the corresponding author on reasonable request.

    https://doi.org/10.1136/jnis-2024-022051

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      Data availability statement

      Data are available upon reasonable request. The data supporting this study’s findings are available from the corresponding author on reasonable request.

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      Footnotes

      • Contributors LP is the guarantor and has: Provided a substantial contribution to the conception and design of the work, the acquisition, analysis, and interpretation of data for the work; Drafted the work for important intellectual content; Approved the final version to be published; and Agreed 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. AR has: Provided a substantial contribution to the analysis of data for the work; Revised the work critically for important intellectual content; Approved the final version to be published; and Agreed 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. EC has: Provided a substantial contribution to the acquisition of data for the work; Revised the work critically for important intellectual content; Approved the final version to be published; and Agreed 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. HD has: Provided a substantial contribution to the acquisition of data for the work; Revised the work critically for important intellectual content; Approved the final version to be published; and Agreed 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. FR has: Provided a substantial contribution to the acquisition of data for the work; Revised the work critically for important intellectual content; Approved the final version to be published; and Agreed 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. CB has: Provided a substantial contribution to the conception and design of the work; Revised the work critically for important intellectual content; Approved the final version to be published; and Agreed 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. SS has: Provided a substantial contribution to the acquisition, analysis, and interpretation of data for the work; Revised the work critically for important intellectual content; Approved the final version to be published; and Agreed 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. AZ has: Provided a substantial contribution to the acquisition of data for the work; Revised the work critically for important intellectual content; Approved the final version to be published; and Agreed 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. FE has: Provided a substantial contribution to the acquisition of data for the work; Revised the work critically for important intellectual content; Approved the final version to be published; and Agreed 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. FC has: Provided a substantial contribution to the analysis of data for the work; Revised the work critically for important intellectual content; Approved the final version to be published; and Agreed 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. J-CF has: Provided a substantial contribution to the acquisition of data for the work; Revised the work critically for important intellectual content; Approved the final version to be published; and Agreed 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 The study was sponsored and entirely funded by the French Ministry of Health in a Programme Hospitalier de Recherche Clinique (PHRC: 2015-A02018-41).

      • Competing interests LP reports: Consulting fees from Balt, Microvention, and Wallaby-Phenox; payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from Balt, Microvention, and Phenox; and support for attending meetings and/or travel from Balt, Microvention, and Phenox. FC reports: Consultant for Medtronic, Balt Extrusion, Microvention and Stryker; gave a lecture for Penumbra; is a board member of Artedrone and has stock options with Intradys and Letsgetproof. All other authors (AR, EC, HD, FR, CB, SS, AZ, FE, JCF) have nothing to disclose.

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

      • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.