1194. Rapid Ventricular Pacing (RVP) significantly reduces MRI DWI-lesions after microsurgical treatment of unruptured intracranial aneurysms: a prospective study

Authors: Juergen Konczalla, MD; Marlies Wagner; Nina Brawanski, MD; Sepide Kashefiolasl, MD; Johannes Platz, MD; Joachim Berkefeld; Elke Hattingen; Volker Seifert (Frankfurt, Germany)

Introduction: Magnetic resonance (MR) diffusion-weighted imaging (DWI) was used to assess periprocedural lesion load. Methods: For this prospective study patients with microsurgical clipping (MC) of complex unruptured intracranial aneurysm (UIA) received pre- and postoperatively MR DWI. The primary endpoint was the rate of newly detected lesions by DWI in patients treated exclusively with RVP. Furthermore, we performed a comparison with our previously prospectively acquired and published data from our ‘Brain Lesions Following Endovascular and Surgical Treatment of Unruptured Intracranial Aneurysms (LESUIA; ClinicalTrials.gov Identifier: NCT01490463)’ trial (w/o RVP series). Results: Within the treatment period 32 of 36 patients (89%) undergoing MC with RVP were included for analysis. Four patients were treated by RVP and additionally temporary clipping and therefore had to been excluded from analysis. Mean age was 50 year and mean aneurysm size 9.4mm. In five of 32 patients (16%) DWI lesions were detected. No RVP-associated lesions in the contralateral hemisphere or posterior fossa were detected. Furthermore, we identify in four patients (12.5%) access-related lesions and in one patient (3.1%) a treatment associated lesion (perforator infarction). We also compared the RVP series with our previously published trial data; UIA treated by MC (n=62). As expected, in the RVP trial the aneurysms were significantly larger (9.4 vs. 7.6mm; p<0.01), whereas age and aneurysm location were similar. In the RVP series, significantly less often DWI lesions occurred (16% vs. 44%; p=0.01; OR 4.2). Furthermore, especially treatment-associated DWI-lesions occurred significantly less often under RVP compared to ‘classic’ clipping using temporary clipping (3% vs. 27%; p<0.01; OR 11.7). Conclusion: We detected no RVP-associated lesions in the contralateral hemisphere or posterior fossa. Furthermore, in a prospective setting we identify that new post-operative DWI-lesions occur significantly less often using RVP instead of classic microsurgical treatment (e.g. temporary clipping). ClinicalTrials.gov Identifier: NCT02766972