Ruptured Intracranial Aneurysms: Factors Affecting the Rate and Outcome of Endovascular Treatment Complications in a Series of 782 Patients (CLARITY Study) 1 — Radiology

Ruptured Intracranial Aneurysms: Factors Affecting the Rate and Outcome of Endovascular Treatment Complications in a Series of 782 Patients (CLARITY Study) 1
Laurent Pierot, MD, PhD, Christophe Cognard, MD, PhD, René Anxionnat, MD, PhD, Frédéric Ricolfi, MD, PhD and for the CLARITY Investigators
+ Author Affiliations

1From the Department of Neuroradiology, Reims University Hospital, Reims, France (L.P.); Department of Neuroradiology, Toulouse University Hospital, Paris, France (C.C.); Department of Neuroradiology, Nancy University Hospital, Nancy, France (R.A.); and Department of Neuroradiology, Dijon University Hospital, Dijon, France (F.R.).
Address correspondence to
L.P., Department of Radiology, Hôpital Maison-Blanche, 45 rue Cognacq-Jay, 51092 Reims, France (e-mail: lpierot@gmail.com).
Author contributions: Guarantor of integrity of entire study, L.P.; study concepts/study design or data acquisition or data analysis/interpretation, all authors; manuscript drafting or manuscript revision for important intellectual content, all authors; manuscript final version approval, all authors; literature research, L.P.; clinical studies, all authors; statistical analysis, L.P.; and manuscript editing, L.P.

Abstract
Purpose: To analyze the clinical and anatomic factors that affect the occurrence and outcome of complications (thromboembolic events and intraoperative rupture) in the endovascular treatment of ruptured intracranial aneurysms in a large multicenter series, the CLARITY study (Clinical and Anatomic Results in the Treatment of Ruptured Intracranial Aneurysms).

Materials and Methods: This study was approved by the institutional review boards of the participating centers, and written informed consent was obtained from all patients. In the CLARITY series, 782 patients (314 men, 468 women; age range, 19–80 years, mean age, 51.3 years ± 13.2 [standard deviation]) with 782 ruptured aneurysms underwent endovascular treatment for ruptured intracranial aneurysms at 20 institutions. Uni- and multivariate analyses were performed to determine factors (demographic characteristics, risk factors, anatomic factors, and therapeutic factors) that affect the occurrence of treatment-related complications.

Results: A higher rate of thromboembolic events was observed in patients with aneurysms larger than 10 mm (28.0% vs 10.7% in patients with aneurysms ≤10 mm, P < .001), in smokers (16.1% vs 10.1% in nonsmokers, P = .015), and in patients with aneurysms with a neck larger than 4 mm (20.8% vs 11.0% in aneurysms with a neck ≤4 mm, P = .004).The frequency of intraoperative rupture was higher in patients with middle cerebral artery (MCA) aneurysms (8.5% vs 3.7% in patients without MCA aneurysms, P = .029), in patients younger than 65 years (5.0% vs 0.8% in patients older than 65 years, P = .032), and in patients without hypertension (5.4% vs 1.5% in patients with hypertension, P = .017).

Conclusion: The rate of thromboembolic events in the endovascular treatment of ruptured aneurysms is significantly affected by aneurysm size and neck size but not by aneurysm location. Conversely, the rate of intraoperative rupture is significantly affected by aneurysm location but not aneurysm size.

© RSNA, 2010

Supplemental material:
http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.10092209/-/DC1

Footnotes
Received December 5, 2009; revision requested February 3, 2010; revision received February 25; accepted March 18; final version accepted March 30.
A complete list of the CLARITY investigators is available in Appendix E1 (online).
Supported by Boston Scientific.
See Materials and Methods for pertinent disclosures.

Abbreviations:
CLARITY = Clinical and Anatomic Results in the Treatment of Ruptured Intracranial AneurysmsMCA = middle cerebral artery

Ruptured Intracranial Aneurysms: Factors Affecting the Rate and Outcome of Endovascular Treatment Complications in a Series of 782 Patients (CLARITY Study) 1 — Radiology