• Takayuki Kikuchi, Akira Ishii, Hideo Chihara, Daisuke Arai, Mitsushige Ando, Yohei Takenobu, Tomohisa Okada, Yasushi Takagi, and Susumu Miyamoto.
• Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan. Electronic address: tkik@kuhp.kyoto-u.ac.jp.
• World Neurosurg. 2017 Nov 1; 107: 226-232.

ObjectiveManagement after stent-assisted coiling (SAC) for unruptured intracranial aneurysm is sometimes difficult because close monitoring for ischemic events for a long period of time after the procedure is necessary. The purpose of this study was to clarify the usefulness of magnetic resonance angiography (MRA) at follow-up after SAC.MethodsSixty-six consecutive cases of SAC for unruptured intracranial aneurysm in our institute and affiliated hospitals were retrospectively reviewed for a delayed ischemic event. Occlusion status of the aneurysm and stent apposition on time-of-flight (TOF)-MRA, patient demographics, and characteristics of the aneurysms were analyzed for a possible relationship to delayed ischemic events.ResultsOver a median follow-up of 755 days, 14 patients had delayed ischemic events after a median follow-up of 230.5 days. All of the ischemic events were transient or asymptomatic. Univariate analysis revealed that the history of hypertension (P = 0.042) and the occlusion status of the aneurysm (P = 0.006) were significantly associated with delayed ischemic events. Multivariate analysis indicated that dome filling had a hazard ratio of 4.96 (95% confidence interval [CI], 1.30-23.60) and 3.74 (95% CI, 1.10-13.34), compared with neck remnant and complete obliteration, respectively. Six of 7 patients who had persistent dome filling during follow-up developed a delayed ischemic event.ConclusionsIn this preliminary study, dome filling on follow-up TOF-MRA is a possible risk factor for delayed ischemic events. TOF-MRA could be a modality for tailored management after SAC.Copyright © 2017 Elsevier Inc. All rights reserved.

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