Arterial wall enhancement indicates higher reperfusion rates in non-ruptured aneurysms after endovascular treatment with stent-assisted coiling.

Background And Purpose: There are differing results in recent literature concerning aneurysmal wall enhancement (AWE) after endovascular treatment (ET) of intracranial aneurysms (IAs). The aim of this retrospective study is to investigate if the presence of AWE of unruptured treated IAs via stent-assisted coiling (SAC) is associated with higher reperfusion rates.

Materials And Methods: The clinical courses of 58 patients with IAs after ET via SAC were examined over the timespan of up to 5 years, assessing for AWE in T1 SPACE FS and T1 SE FS blood suppression sequences after contrast administration, events of reperfusion and need for retreatment.

Results: 58 patients were included (23 with AWE, 35 without). 18 of 23 patients (78.3%) with AWE showed reperfusion after treatment, compared to 15 of 35 patients (42.9%) without AWE. Reperfusion rates were significantly higher in patients with AWE, compared to those without AWE (p = 0.0139) also after propensity score matching (p = 0.0456).

Conclusions: In patients with unruptured IAs treated exclusively with SAC, AWE on follow-up MRI was significantly associated with higher reperfusion rates. AWE may serve as an early imaging biomarker of post-treatment instability.