Journal of Vascular and Interventional Radiology
Volume 20, Issue 7, Supplement , Pages S435-S450 , July 2009

Reporting Standards for Endovascular Repair of Saccular Intracranial Cerebral Aneurysms

  • Philip M. Meyers, MD

      Affiliations

    • Columbia University, College of Physicians and Surgeons, Neurological Institute of New York, NY
    • Corresponding Author InformationCorrespondence to Philip M. Meyers, MD, FAHA, Associate Professor, Radiology and Neurological Surgery, Columbia University, College of Physicians & Surgeons, Clinical Director, Neuroendovascular Service, New York Presbyterian–Columbia Neurological Institute, New York, NY 10032
    • ,
  • H. Christian Schumacher, MD

      Affiliations

    • Saul R. Korey Department of Neurology, Division of Vascular Neurology and Neurocritical Care, Albert Einstein College of Medicine, Bronx, NY
    • ,
  • Randall T. Higashida, MD

      Affiliations

    • University of California, San Francisco
    • ,
  • Colin P. Derdeyn, MD

      Affiliations

    • Mallinckrodt Institute of Radiology, Washington University, School of Medicine, St. Louis, MO
    • ,
  • Gary M. Nesbit, MD

      Affiliations

    • Oregon Health and Science University, Portland, Ore
    • ,
  • David Sacks, MD

      Affiliations

    • Advanced Interventional Radiology, Reading Hospital and Medical Center, Reading, PA
    • ,
  • Lawrence R. Wechsler, MD

      Affiliations

    • University of Pittsburgh Medical Center, PA
    • ,
  • Joshua B. Bederson, MD

      Affiliations

    • Department of Neurological Surgery, Mount Sinai Medical Center, New York, NY
    • ,
  • Sean D. Lavine, MD

      Affiliations

    • Columbia University, College of Physicians and Surgeons, Neurological Institute of New York, NY
    • ,
  • Peter Rasmussen, MD

      Affiliations

    • Cleveland Clinic Foundation, Ohio

Received 31 May 2008 ,Revised 8 August 2008 ,Accepted 19 September 2008.

  • Image Result

    Arteriographic projections used to assess aneurysm dimensions. Posterior-anterior Townes and direct lateral projections demonstrate the presence of the right carotid–ophthalmic aneurysm, but these pro

    Arteriographic projections used to assess aneurysm dimensions. Posterior-anterior Townes and direct lateral projections demonstrate the presence of the right carotid–ophthalmic aneurysm, but these projections do not allow for optimal assessment of aneurysm size, dome-to-neck ratio, or artery-to-neck ratio. Magnified posterior-anterior Waters and lateral oblique projections in this particular case provide better planar imaging to assess the aneurysm for surgical or endovascular treatment.

  • Image Result
    CT brain scan with intravenous iodinated contrast of a patient with a partially thrombosed, giant right middle cerebral aneurysm. (a) 5-mm contiguous axial images through the aneurysm demonstrate a ri

    CT brain scan with intravenous iodinated contrast of a patient with a partially thrombosed, giant right middle cerebral aneurysm. (a) 5-mm contiguous axial images through the aneurysm demonstrate a ring-enhancing mass with a maximal dimension of 4.8 cm and a total volume of 48 mL. (b) The patent component of the aneurysm measures only 14 mm in maximal dimension with a volume of 1.33 mL. The opacified component of the aneurysm at catheter arteriography represents 2.8% of the total aneurysm volume.

  • Image Result
    Diagram of measurements to determine aneurysm dimensions without geometric magnification using 1-cm measuring rings attached to the patient's head (68). All measurements are made on radiographic image

    Diagram of measurements to determine aneurysm dimensions without geometric magnification using 1-cm measuring rings attached to the patient's head (68). All measurements are made on radiographic images using x-rays. Tube side magnification factor (T), film-side magnification factor (F), and the uncorrected lesion size (L) are measured on the radiograph. The distance from the tube side of the head to the lesion (D) and the width of the head (H) are measured from radiographs in the orthogonal plane. The magnification factor (M) at the level of the lesion is derived by the following formula: . Due to inherent geometric magnification in radiographic images, the actual aneurysm size is calculated by dividing the apparent aneurysm size as follows: .

  • Image Result
    Common location of cerebral aneurysms surrounding the circle of Willis. A, Middle cerebral (proximal to bifurcation, bifurcation, distal to bifurcation); B, carotid terminus; C, anterior choroidal; D,

    Common location of cerebral aneurysms surrounding the circle of Willis. A, Middle cerebral (proximal to bifurcation, bifurcation, distal to bifurcation); B, carotid terminus; C, anterior choroidal; D, superior hypophyseal; E, anterior communicating (proximal to communicating artery, at communicating artery); F, posterior communicating; G, ophthalmic; H, basilar artery (terminus, trunk); I, superior cerebellar; J, V4 segment, vertebral; K, posterior inferior cerebellar; L, pericallosal artery.

  • Image Result
    Consensus grading scale for endovascular aneurysm occlusion is applied to orthogonal images obtained in optimal projections to assess aneurysm dimensions: Grade 0, complete aneurysm occlusion; Grade 1

    Consensus grading scale for endovascular aneurysm occlusion is applied to orthogonal images obtained in optimal projections to assess aneurysm dimensions: Grade 0, complete aneurysm occlusion; Grade 1, '90% aneurysm occlusion; Grade 2, 70% to 89% aneurysm occlusion; Grade 3, 50% to 69% aneurysm occlusion; Grade 4, 25% to 49% aneurysm occlusion; Grade 5, <25% aneurysm occlusion.

  • Image Result
    Modification to consensus grading scale for endovascular aneurysm occlusion describing interstitial opacification within coil mass. (a) Left internal carotid arteriography in right frontal oblique pro

    Modification to consensus grading scale for endovascular aneurysm occlusion describing interstitial opacification within coil mass. (a) Left internal carotid arteriography in right frontal oblique projection during the arterial phase of injection shows coil occlusion of a 12 × 11 × 14 mm left posterior communicating artery aneurysm. (b) Because there is a small ventral neck remnant and residual opacification within the aneurysm sac (colored areas), this represents consensus Grade 1 occlusion with “I” for persistent interstitial opacification within the coil mass.

 Dr Higashida served as a consultant to Cordis Neurovascular. Dr Nesbit received honoraria from Cordis Neurovascular and Genentech, has an ownership interest in Concentric Medical, and served as a consultant to Concentric Medical. Dr Wechsler served as a consultant to Nuevelo, Inc, and Abbott Vascular. Dr Lavine received honoraria from Cordis Neurovascular. Dr Rasmussen received honoraria from the Universities of Minnesota and Pittsburgh, Microvention/Terumo, ev3, Possis Medical/Medrad, and Micrus, has an ownership interest in Chestnut Medical, and served as a consultant to Chestnut Medical.

 Published in Stroke. 2009;40(5):e366–e379.Published online before print February 26, 2009, doi: 10.1161/STROKEAHA.108.527572.

PII: S1051-0443(09)00218-8

doi: 10.1016/j.jvir.2009.03.004

Journal of Vascular and Interventional Radiology
Volume 20, Issue 7, Supplement , Pages S435-S450 , July 2009

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