CLARITY Analysis Studies Factors Affecting Midterm Results of Endovascular Treatment of Ruptured Intracranial Aneurysms

October 1, 2012—In the American Journal of Neuroradiology, Laurent Pierot, MD, et al published an analysis of the factors affecting the midterm anatomic results after endovascular treatment of ruptured intracranial aneurysms in the large multicenter series, CLARITY (Clinical and Anatomic Results in the Treatment of Ruptured Intracranial Aneurysms) (2012;33:1475–1480). As background to the study, the investigators noted that recanalization is one drawback of the endovascular treatment of intracranial aneurysms.

According to the investigators, of the 782 patients initially included in the CLARITY trial, 649 would theoretically undergo midterm follow-up examinations. Finally, 517 patients of the theoretical 649 (79.7%) completed a midterm follow-up examination. Two experienced neuroradiologists independently and anonymously evaluated the midterm anatomic results.

In the American Journal of Neuroradiology, the investigators reported that in univariate analysis, factors affecting the quality of midterm occlusion were the quality of the postoperative occlusion (P < .001), hypertension (P = .018), aneurysm size (P = .007), neck size (P = .005), and intracranial aneurysm location (P = .049).

In multivariate analysis, three factors were associated with the quality of postoperative aneurysm occlusion: neck size (P = .003), use of the balloon remodeling technique (P = .031), and the quality of postoperative occlusion (P < .001).

In univariate analysis, the evolution of aneurysm occlusion was affected by age (P = .024) and neck size (P = .041). In multivariate analysis, it was associated with the same factors: age (P = .025) and neck size (P = .043).

The investigators concluded that among the many factors considered in this analysis, aneurysm neck size was identified as the single most important in the quality of aneurysm occlusion at midterm follow-up after endovascular treatment. They advised that these results suggest the need for developing and evaluating new strategies of treatments and techniques, especially for wide-neck aneurysms, with a focus on reinforcement and neoendothelialization at the level of the neck as objectives.