• Mira Salih, Michael Young, Max Shutran, Jean Filo, Philipp Taussky, and Christopher S Ogilvy.
• Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts, USA.
• World Neurosurg. 2024 Mar 1; 183: e237e242e237-e242.

BackgroundThe collar sign has been previously described as an angiographic indicator of incomplete occlusion after deployment of a pipeline embolization device (PED) for intracranial aneurysms. In the present study, we explore the predictors for a collar sign in aneurysms treated with the PED.MethodsAneurysms with a collar sign at the initial follow-up angiogram were identified in a retrospective review of single-center data. The predictors of a collar sign were analyzed through univariate and multivariate analyses.ResultsA total of 492 cases of cerebral aneurysm treated with the PED were identified. Among them, 53 were found to have a collar sign on the initial follow-up angiogram. Univariate analysis showed that previous treatment of the same aneurysm (odds ratio [OR], 2.46; P = 0.01), a branch vessel from the aneurysm neck or dome (OR, 6.2; P < 0.001), and a smaller aneurysm neck size (OR, 0.75; P = 0.01) were all predictors for the presence of a collar sign. A larger diameter (OR, 0.92; P = 0.06), increased dome/neck ratio (OR, 1.38; P = 0.1), increased aspect ratio (OR, 1.14; 0 P =.17), and previous treatment showed a trend toward an association with a collar sign. However, after multivariate analysis, a branch from the aneurysm neck or dome (OR, 6.23; P < 0.001), aneurysm diameter (OR, 0.75; P = 0.032), an increased dome/neck ratio (OR, 4.62; P = 0.006), and previous treatment were the strongest predictors for a collar sign.ConclusionsThe presence of a branch vessel arising from the aneurysm neck or dome, an increased dome/neck ratio, aneurysm diameter, and previous treatment are the strongest predictive factors for a collar sign in the angiographic follow-up of PED-treated aneurysms.Copyright © 2023 Elsevier Inc. All rights reserved.

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