Follow-up Results of Partially Thrombosed Intracranial Aneurysms with Cross-sectional Imaging: The Case for Introducing a New Grading System
Makaleler > Tam Makale · 2026
Yazarlar: İsmail ORAN, Celal ÇİNAR, Alperen Elek, Egemen Oztürk, Baran Bozyel
American Journal of Neuroradiology, Uluslararası, Wos, 2026, cilt 47, ss 2303-2309
DOI: 10.3174/ajnr.a9246
Özet
BACKGROUND AND PURPOSE: Current angiographic grading systems assess parent vessel reconstruction and aneurysmal contrast filling. They, however, overlook extra-luminal space, which is crucial for assessing long-term stability of treatment and correlating radiologic findings with neurologic outcomes in partially thrombosed intracranial aneurysms (PTIAs). To address this gap, we categorized patients using cross-sectional imaging (CSI) according to post-treatment size changes, independent of angiographic results. METHODS: We retrospectively reviewed patients with PTIAs treated exclusively with flow diverters (FDs) and followed for at least 12 months with MRI/CT. Patients were divided into three groups: Group I—progressive reduction of the thrombosed mass; Group II—stable size; Group III—interval growth. For comparison, all cases were also assessed using the O’Kelly-Marotta (OKM) classification. RESULTS: Thirty-four PTIAs were analyzed, with a mean follow-up of 50.9 months. Posterior circulation location was independently associated with worse outcomes in the CSI-based grouping (OR = 10.84, p = 0.015). Neurological outcomes improved in 17 patients (48.6%), worsened in 2 (5.7%), and remained stable in 15 (42.9%). Functional improvement (mRS) was significantly associated with the CSI-based grouping (OR = 0.15, p = 0.04), but not with OKM (OR = 9.74, p = 0.215). At last imaging, 32 patients were OKM D and 2 OKM C; transition C→D was independently associated with better CSI-based group outcomes (OR = 0.013, p = 0.021). Peri-aneurysmal edema decreased in all patients. CONCLUSIONS: The CSI-based three-group categorization provides a more clinically meaningful assessment of PTIAs treated with FDs than conventional angiographic classifications, as it uniquely captures size changes of the thrombosed mass and correlates with functional outcomes.