What does this research mean for the field?

A smaller parent artery-aneurysm inlet angle and the absence of branch artery incorporation are independent predictors of complete aneurysm occlusion following flow diversion treatment. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

The study aims to identify geometric predictors associated with complete aneurysm occlusion after flow diverter treatment.

June 6, 2026Open Access

Predicting Aneurysm Occlusion After Flow Diversion:

Key Points

The study aims to identify geometric predictors associated with complete aneurysm occlusion after flow diverter treatment.
Retrospective analysis of 119 intracranial aneurysms treated with flow diverters between 2014 and 2023.
Morphological and geometric parameters were measured from 3D rotational Digital Subtraction Angiography.
Logistic regression was used to identify independent predictors of treatment outcomes.
Aneurysm occlusion was achieved in 89 (74.8%) cases with a median follow-up of 19.8 months.
A larger parent artery-aneurysm inlet angle and branch artery incorporation were associated with a lower occlusion likelihood (OR 0.82 and OR 0.25, respectively).
The multivariable model demonstrated good predictive performance (AUC = 0.743).

Abstract

OBJECTIVE: Flow diverters (FD) have transformed complex aneurysm management, but incomplete aneurysm occlusion remains a significant concern, highlighting the need for practical predictors of successful treatment. While local flow dynamics are known to be critically influenced by parent artery-aneurysm (PA-aneurysm) geometry, their quantitative assessment in clinical settings is challenging. This study aimed to identify practical, readily measurable geometric predictors for complete aneurysm occlusion following FD treatment. METHODS: This retrospective study analyzed 119 intracranial aneurysms treated with FD between 2014 and 2023 at our center. Morphological and geometric parameters-including maximal diameter, PA-aneurysm inlet and outlet angles, and branch artery incorporation-were quantitatively measured from 3D rotational Digital Subtraction Angiography (DSA). Angiographic outcomes, categorized as complete occlusion or persistence, were assessed at a minimum of 18 months of follow-up without additional intervention. Independent predictors were identified using univariable and multivariable logistic regression. RESULTS: Aneurysm occlusion was achieved in 89 (74.8%) cases during a median angiographic follow-up of 19.8 months (interquartile range IQR, 12.2-34.7). In multivariable analysis, a lower likelihood of aneurysm occlusion was significantly associated with a larger PA-aneurysm inlet angle (OR, 0.82 per 10° increase; 95% CI, 0.69-0.98; p = 0.045) and the presence of branch artery incorporation (OR, 0.25; 95% CI, 0.10-0.63; p = 0.004). While a larger neck diameter (OR, 0.94; 95% CI, 0.85-1.03) was also associated with a lower occlusion rate, this association did not reach statistical significance (p = 0.175). The developed multivariable model demonstrated acceptable predictive performance (AUC = 0.743; 95% CI, 0.632, 0.855). CONCLUSIONS: A smaller PA-aneurysm inlet angle and absence of branch artery incorporation are independent predictors of aneurysm occlusion after flow diversion. These readily measurable geometric parameters from diagnostic DSA may serve as practical and useful indicators for predicting FD treatment outcomes.

Bookmark

View Full Paper