Abstract TP151: Usefulness of 3D I-Flow Application in Predicting the Outcome of Flow Diverter Stenting for Large or Giant Carotid Aneurysms

Abstract

Background and Purpose: The flow diverter (FD) has dramatically improved the treatment outcome of large / giant internal carotid artery (IC) aneurysms. However, it is difficult to predict the treatment outcome of FD just after the treatment. 3D iFlow is a novel application of 4D-digital subtraction angiography (4D-DSA) that can evaluate the arrival time of contrast media in 3D images, but its usefulness for neurointervention is unclear. Therefore, the aim of this study was to elucidate the utility of 3D iFlow in predicting the outcome of FD treatment for large / giant IC aneurysms. Methods: A total of 8 cases of large / giant aneurysms at IC cavernous portion treated with FD and were enrolled in this study. 3D iFlow images before and after placement of FD were acquired in all cases. Treatment outcome was evaluated by O’Kelly-Marotta(OKM) Grading Scale with DSA 6 months after treatment. The regions of interests (ROI) were set in IC bifurcation and petrous segment with 3D iFlow application, and the 3D iFlow transit time was measured by comparing the peak contrast intensities in 2 ROIs. We investigated the rate of changes in 3D iFlow transit time before and after the placement of FD. Results: FD was deployed successfully in all cases without coils. The number of OKM grade B, C and D with DSA 6 months after treatment were 2, 3 and 3 cases, respectively. The rate of changes in 3D iFlow transit time was significantly shorter in OKM grade D cases compared with grade B and C (52.5% vs 84.7%, p=0.03). Conclusion: 3D iFlow application may be effective to predict the treatment outcome of FD.