• Takeru Umemura, Taketo Hatano, Takenori Ogura, Takeshi Miyata, Yuji Agawa, Hiroaki Nakajima, Hiroki Sakamoto, Yusuke Nakazawa, Koji Shiomi, Noriyuki Koga, Takashi Nagahori, Wataru Shiraishi, and Izumi Nagata.
• Department of Neurosurgery, Stroke Center, Kokura Memorial Hospital, Kitakyushu, Japan.
• Neurosurgery. 2023 Mar 1; 92 (3): 574580574-580.

BackgroundFollow-up of aneurysms treated with stent-assisted coil embolization has been performed using digital subtraction angiography (DSA) because in time-of-flight magnetic resonance angiography, metal artifacts from the stent often affect visualization.ObjectiveTo confirm whether ultrashort echo time (TE) MRA may be an alternative for DSA during follow-up.MethodsPatients with unruptured aneurysms initially treated with stent-assisted coil embolization between April 2019 and March 2021 were enrolled. After 3 months of treatment, follow-up DSA and ultrashort TE MRA were performed. All images were independently reviewed by neurosurgeons to evaluate in-stent flow and rated from 1 (not visible) to 4 (excellent). Aneurysmal embolization status was assessed as complete obliteration, residual neck, or residual aneurysm. Ultrashort TE MRA findings were classified as evaluative or nonevaluative state based on the presence of metal artifacts. We investigated the types of aneurysms that were evaluative and the agreement between ultrashort TE and DSA.ResultsOverall, 89 aneurysms were examined, of which 74% (n = 66) were classified as evaluative on ultrashort TE. Significant differences were observed in size and stent type. Evaluative cases had an aneurysm size of <7 mm ( P = .0007) and a higher rate of Neuroform Atlas ( P = .0006). The rate of agreement between ultrashort TE with evaluative state and DSA was 95%.ConclusionUltrashort TE MRA could evaluate an embolization status treated with stenting, and the findings are in excellent agreement with those of DSA. Aneurysms measuring <7 mm and treated with Neuroform Atlas are evaluative on ultrashort TE, and DSA might not be necessary.Copyright © Congress of Neurological Surgeons 2022. All rights reserved.

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