Low yield of cerebral angiography in adequately occluded aneurysms after flow diversion

Nohra Chalouhi, Purvee D. Patel, Elias Atallah, Robert M. Starke, Ameet Chitale, Michael Lang, Stavropoula Tjoumakaris, David Hasan, Hekmat Zarzour, Michelle J. Smith, Robert Rosenwasser, Pascal Jabbour

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


BACKGROUND Flow diversion has emerged as a highly effective treatment for intracranial aneurysms. OBJECTIVE To assess the yield of further angiographic follow-up in aneurysms that have achieved adequate occlusion after treatment with the Pipeline Embolization Device (PED; Medtronic Inc, Dublin, Ireland). METHODS This is a single-institution, retrospective study. Inclusion criteria were as follows: (1) patients with 1 or more aneurysms treated with PED, (2) available short-term (<12 mo) follow-up digital subtraction angiography (DSA), (3) complete (100%) or near-complete (>95%) occlusion on short-term follow-up DSA, and (4) available further angiographic follow-up (DSA, Magnetic Resonance Angiography (MRA), or Computed Tomography Angiography (CTA)). RESULTS A total of 146 patients were identified. Aneurysm size was 8.4 ± 5.1 mm on average. Mean angiographic follow-up time was 29.7 ± 12.2 mo. On short-term follow-up DSA images, 132 (90.4%) had complete aneurysm occlusion and 14 (9.6%) had near-complete occlusion. Four patients (3%) had further DSA follow-up alone, 30 patients (21%) had further DSA and MRA/CTA follow-up, and 112 patients (76%) had further MRA/CTA follow-up alone. On further angiographic follow-up (DSA, MRA, and/or CTA), no patient had a decrease in the degree of aneurysm occlusion (recurrence) or required retreatment. Of the 14 patients with near-complete occlusion on initial DSA images, 7 patients (50%) progressed to complete aneurysm occlusion on further angiographic follow-up. CONCLUSION This study did not find any diagnostic yield in repeating cerebral angiography in adequately occluded aneurysms with the PED. We do not recommend repeat angiographic follow-up once aneurysms have achieved complete occlusion with the PED unless clinically warranted.

Original languageEnglish (US)
Pages (from-to)1294-1297
Number of pages4
JournalClinical neurosurgery
Issue number6
StatePublished - Dec 1 2018


  • Aneurysm
  • Angiography
  • Flow diversion
  • Pipeline Embolization Device

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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