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Keywords = wide-neck aneurysms

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12 pages, 706 KiB  
Article
The Performance of the Endurant Endoprosthesis in an Infrarenal Aortic Aneurysm with a Wide or Conical-Shaped Infrarenal Neck Anatomy
by Maaike Plug, Suzanne Holewijn, Armelle Meershoek, Daphne van der Veen and Michel M. P. J. Reijnen
J. Clin. Med. 2025, 14(12), 4133; https://doi.org/10.3390/jcm14124133 - 11 Jun 2025
Viewed by 434
Abstract
Background/Objectives: Wide and conical-shaped infrarenal necks are risk factors for neck-related complications after Endovascular Aorta Aneurysm Repair (EVAR). The aim of this study is to investigate the performance of the Endurant endoprosthesis in wide/conical-shaped aortic neck anatomies compared to its performance in a [...] Read more.
Background/Objectives: Wide and conical-shaped infrarenal necks are risk factors for neck-related complications after Endovascular Aorta Aneurysm Repair (EVAR). The aim of this study is to investigate the performance of the Endurant endoprosthesis in wide/conical-shaped aortic neck anatomies compared to its performance in a normal infrarenal neck (reference group). Methods: A single-center, retrospective observational cohort study was performed, including consecutive subjects with an infrarenal abdominal aortic aneurysm, treated electively with an Endurant endoprosthesis. The primary endpoint was the freedom from aneurysm-related reinterventions through 1 year. Secondary endpoints included proximal fixation failure, type IA endoleak, stent migration, aneurysm sac remodeling, aneurysm-related mortality, freedom from reinterventions throughout available follow-up, and rupture. Results: A total of 268 patients were included, with a mean age of 73.3 years, and 85.1% were male. Freedom from aneurysm-related reinterventions was significantly lower in the wide-neck group (60.0%) compared to the reference group (81.1%; p = 0.018) but not for the conical-neck group (70.3%; p = 0.286). Median time to first reintervention was 1.7 (IQR 0.8; 4.4 years) in the reference group, 2.9 years (IQR 0.3; 5.0 years) in the wide-neck group (p = 0.547) and 3.8 years (IQR 0.4; 6.5) in the conical-neck group (p = 0.123). The proximal fixation failure rate was 7.4% in the wide-neck group compared to 3.3% in the reference group (p = 0.155) and 1.7% in the conical-neck group (p = 0.525). The type IA endoleak rate was 4.9% in the wide-neck group versus 3.3% in the reference group (p = 0.250). Conclusions: In the group with wide necks, reintervention-free survival was lower compared to the reference group, which seems to be driven by proximal fixation failure. Full article
(This article belongs to the Section Cardiovascular Medicine)
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16 pages, 4980 KiB  
Case Report
Complex Anatomy, Advanced Techniques: Microsurgical Clipping of a Ruptured Hypophyseal Artery Aneurysm
by Corneliu Toader, Matei Serban, Nicolaie Dobrin, Razvan-Adrian Covache-Busuioc, Mugurel Petrinel Radoi, Alexandru Vlad Ciurea and Octavian Munteanu
J. Clin. Med. 2025, 14(7), 2361; https://doi.org/10.3390/jcm14072361 - 29 Mar 2025
Cited by 1 | Viewed by 820
Abstract
Background: Ruptured intracranial aneurysms remain the subject of debate in their management, but the management of lesions located at high-risk locations, such as the hypophyseal artery, continue to prove to be a challenge in anatomical orientation and proximity to vascular structures. While endovascular [...] Read more.
Background: Ruptured intracranial aneurysms remain the subject of debate in their management, but the management of lesions located at high-risk locations, such as the hypophyseal artery, continue to prove to be a challenge in anatomical orientation and proximity to vascular structures. While endovascular therapies have changed the treatment paradigms, microsurgical clipping is the gold standard for wide-necked aneurysms for which endovascular techniques may be suboptimal. The successful treatment of a ruptured hypophyseal artery aneurysm in an elderly patient is described in this report, which highlights the importance of advanced imaging, careful technique, and new understanding of personalized aneurysm management. Methods: An 82-year-old woman was admitted with a thunderclap headache, alteration of consciousness and meningeal signs, suggestive of subarachnoid hemorrhage (SAH). A non-contrast computed tomography (CT) and digital subtraction angiography (DSA) confirmed a saccular 12 × 10 mm aneurysm with a broad 3.13 mm neck arising from the hypophyseal artery. The location and morphology of the aneurysm required microsurgical clipping, which was performed through a right pterional craniotomy. Results: Correct clip placement, complete exclusion of the aneurysm, and resorption of the subarachnoid blood were both observed on postoperative imaging. The neurological examination was completely normal, with no complications. Follow-up imaging at three months demonstrated stable, marked cerebral atrophy with compensatory ventricular enlargement without evidence of recurrence. Conclusions: This case illustrates the important role of micro-surgical clipping in anatomically complex aneurysms and its sustainable outcome and accuracy in cases where endovascular practices would have limitations. Advanced imaging, like three-dimensional DSA and intraoperative tools, have revolutionized precision surgery, allowing achievement of optimal outcomes, even for more-complicated cases. With an evolving, dynamic field and exciting new technologies coming to the fore—such as artificial intelligence to predict rupture risk and augmented reality navigation—decision-making and treatment of complex aneurysms will be optimized along secure pathways towards tailored, high-resolution treatment in the sense of personalized and yet high-precision care. Full article
(This article belongs to the Special Issue Intracranial Aneurysms: Diagnostics and Current Treatment)
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8 pages, 3132 KiB  
Case Report
Navigating the Rare and Dangerous: Successful Clipping of a Superior Cerebellar Artery Aneurysm Against the Odds of Uncontrolled Hypertension
by Corneliu Toader, Matei Serban, Razvan-Adrian Covache-Busuioc, Mugurel Petrinel Radoi, Ghaith Saleh Radi Aljboor, Luca-Andrei Glavan, Antonio Daniel Corlatescu, Milena-Monica Ilie and Radu M. Gorgan
J. Clin. Med. 2024, 13(23), 7430; https://doi.org/10.3390/jcm13237430 - 6 Dec 2024
Cited by 2 | Viewed by 987
Abstract
Background/Objectives: Superior cerebellar artery (SCA) aneurysms are exceedingly rare, posing unique diagnostic and management challenges due to their complex anatomical location within the posterior circulation. The proximity of the SCA to vital structures, such as the brainstem and cerebellum, along with the [...] Read more.
Background/Objectives: Superior cerebellar artery (SCA) aneurysms are exceedingly rare, posing unique diagnostic and management challenges due to their complex anatomical location within the posterior circulation. The proximity of the SCA to vital structures, such as the brainstem and cerebellum, along with the significant role of poorly controlled hypertension in aneurysm formation, further complicates treatment. This case aims to highlight the surgical approach and management strategies employed in treating a rare SCA aneurysm in a patient with longstanding hypertension. Methods: A 68-year-old female presented with an acute onset of severe headache, nausea, and vomiting, later confirmed to be due to a ruptured SCA aneurysm. The patient’s history of poorly controlled hypertension was identified as a major contributing factor to the aneurysm’s development and rupture. Due to the aneurysm’s wide-neck morphology and irregular shape, microsurgical clipping was selected as the treatment method. The occipito-parietal far-lateral approach was employed to gain optimal access to the aneurysm, minimizing the risk to adjacent neurovascular structures. Results: Microsurgical clipping successfully excluded the aneurysm while preserving the parent artery. The surgical approach enabled precise aneurysm isolation and ensured no postoperative neurological deficits. The patient recovered well, with no significant complications, and hypertension management was emphasized as a vital element of the patient’s long-term care. Conclusions: The surgical technique effectively achieved complete aneurysm exclusion with preservation of the parent artery and no associated neurological deficits. The patient’s recovery was uneventful, highlighting the efficacy of the approach. Long-term management of hypertension remains a critical component to prevent recurrence and ensure sustained outcomes. Full article
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17 pages, 672 KiB  
Review
Intrasaccular Treatment of Intracranial Aneurysms: A Comprehensive Review
by Miriam M. Shao, Timothy G. White, Jared B. Bassett, Ehsan Dowlati, Shyle H. Mehta, Cassidy Werner, Danielle Golub, Kevin A. Shah, Amir R. Dehdashti, Ina Teron, Thomas Link, Athos Patsalides and Henry H. Woo
J. Clin. Med. 2024, 13(20), 6162; https://doi.org/10.3390/jcm13206162 - 16 Oct 2024
Cited by 4 | Viewed by 3286
Abstract
Background: The endovascular treatment of complex intracranial aneurysms, such as wide-neck aneurysms (WNAs), remains a challenge. More established endovascular techniques, which include balloon-assisted coiling, stent-assisted coiling, and flow diversion, all have their drawbacks. Intrasaccular flow disruptor devices have emerged as a useful [...] Read more.
Background: The endovascular treatment of complex intracranial aneurysms, such as wide-neck aneurysms (WNAs), remains a challenge. More established endovascular techniques, which include balloon-assisted coiling, stent-assisted coiling, and flow diversion, all have their drawbacks. Intrasaccular flow disruptor devices have emerged as a useful tool for the neurointerventionalist. Methods: Here, we discuss landmark studies and provide a comprehensive, narrative review of the Woven EndoBridge (WEB; Microvention, Alisa Viejo, CA, USA), Artisse (Medtronic, Irvine, CA, USA), Contour (Stryker, Kalamazoo, MI, USA), Saccular Endovascular Aneurysm Lattice Embolization System (SEAL; Galaxy Therapeutics Inc, Milpitas, CA, USA), Medina (Medtronic, Irvine, CA, USA), and Trenza (Stryker, Kalamazoo, MI, USA) devices. Results: Intrasaccular devices have proven to be effective in treating complex aneurysms like WNAs. Conclusions: Intrasaccular flow disruptors have emerged as a new class of effective endovascular therapy, and results of ongoing clinical studies for the newer devices (e.g., SEAL and Trenza) are much anticipated. Full article
(This article belongs to the Section Clinical Neurology)
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24 pages, 379 KiB  
Review
Flow Diversion for Endovascular Treatment of Intracranial Aneurysms: Past, Present, and Future Directions
by Michael Gaub, Greg Murtha, Molly Lafuente, Matthew Webb, Anqi Luo, Lee A. Birnbaum, Justin R. Mascitelli and Fadi Al Saiegh
J. Clin. Med. 2024, 13(14), 4167; https://doi.org/10.3390/jcm13144167 - 16 Jul 2024
Cited by 10 | Viewed by 4679
Abstract
Flow diversion for intracranial aneurysms emerged as an efficacious and durable treatment option over the last two decades. In a paradigm shift from intrasaccular aneurysm embolization to parent vessel remodeling as the mechanism of action, the proliferation of flow-diverting devices has enabled the [...] Read more.
Flow diversion for intracranial aneurysms emerged as an efficacious and durable treatment option over the last two decades. In a paradigm shift from intrasaccular aneurysm embolization to parent vessel remodeling as the mechanism of action, the proliferation of flow-diverting devices has enabled the treatment of many aneurysms previously considered untreatable. In this review, we review the history and development of flow diverters, highlight the pivotal clinical trials leading to their regulatory approval, review current devices including endoluminal and intrasaccular flow diverters, and discuss current and expanding indications for their use. Areas of clinical equipoise, including ruptured aneurysms and wide-neck bifurcation aneurysms, are summarized with a focus on flow diverters for these pathologies. Finally, we discuss future directions in flow diversion technology including bioresorbable flow diverters, transcriptomics and radiogenomics, and machine learning and artificial intelligence. Full article
14 pages, 6717 KiB  
Article
Navigating Complexity: A Comprehensive Approach to Middle Cerebral Artery Aneurysms
by Anna Maria Auricchio, Rina Di Bonaventura, Enrico Marchese, Giuseppe Maria Della Pepa, Carmelo Lucio Sturiale, Grazia Menna, Benjamin Skrap, Alessandro Olivi and Alessio Albanese
J. Clin. Med. 2024, 13(5), 1286; https://doi.org/10.3390/jcm13051286 - 24 Feb 2024
Viewed by 2939
Abstract
Background: The concept of aneurysm “complexity” has undergone significant changes in recent years, with advancements in endovascular treatments. However, surgical clipping remains a relevant option for middle cerebral artery (MCA) aneurysms. Hence, the classical criteria used to define surgically complex MCA aneurysms require [...] Read more.
Background: The concept of aneurysm “complexity” has undergone significant changes in recent years, with advancements in endovascular treatments. However, surgical clipping remains a relevant option for middle cerebral artery (MCA) aneurysms. Hence, the classical criteria used to define surgically complex MCA aneurysms require updating. Our objective is to review our institutional series, considering the impacts of various complexity features, and provide a treatment strategy algorithm. Methods: We conducted a retrospective review of our institutional experience with “complex MCA” aneurysms and analyzed single aneurysmal-related factors influencing treatment decisions. Results: We identified 14 complex cases, each exhibiting at least two complexity criteria, including fusiform shape (57%), large size (35%), giant size (21%), vessel branching from the sac (50%), intrasaccular thrombi (35%), and previous clipping/coiling (14%). In 92% of cases, the aneurysm had a wide neck, and 28% exhibited tortuosity or stenosis of proximal vessels. Conclusions: The optimal management of complex MCA aneurysms depends on a decision-making algorithm that considers various complexity criteria. In a modern medical setting, this process helps clarify the choice of treatment strategy, which should be tailored to factors such as aneurysm morphology and patient characteristics, including a combination of endovascular and surgical techniques. Full article
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13 pages, 6394 KiB  
Article
Flow Diverter Performance Comparison of Different Wire Materials for Effective Intracranial Aneurysm Treatment
by Yeo Jin Jun, Doo Kyung Hwang, Hee Sun Lee, Byung Moon Kim and Ki Dong Park
Bioengineering 2024, 11(1), 76; https://doi.org/10.3390/bioengineering11010076 - 12 Jan 2024
Cited by 6 | Viewed by 3671
Abstract
A flow diverter (FD) is an effective method for treating wide-necked intracranial aneurysms by inducing hemodynamic changes in aneurysms. However, the procedural technique remains challenging, and it is often not performed properly in many cases of deployment or placements. In this study, three [...] Read more.
A flow diverter (FD) is an effective method for treating wide-necked intracranial aneurysms by inducing hemodynamic changes in aneurysms. However, the procedural technique remains challenging, and it is often not performed properly in many cases of deployment or placements. In this study, three types of FDs that changed the material of the wire were prepared within the same structure. Differences in physical properties, such as before and after delivery loading stent size, radial force, and radiopacity, were evaluated. The performances in terms of deployment and trackability force were also evaluated in a simulated model using these FDs. Furthermore, changes of deployment patterns when these FDs were applied to a 3D-printed aneurysm model were determined. The NiTi FD using only nitinol (NiTi) wire showed 100% size recovery and 42% to 45% metal coverage after loading. The low trackability force (10.9 to 22.9 gf) allows smooth movement within the delivery system. However, NiTi FD cannot be used in actual surgeries due to difficulties in X-ray identification. NiTi-Pt/W FD, a combination of NiTi wire and platinum/tungsten (Pt/W) wire, had the highest radiopacity and compression force (6.03 ± 0.29 gf) among the three FDs. However, it suffered from high trackability force (22.4 to 39.9 gf) and the end part braiding mesh tended to loosen easily, so the procedure became more challenging. The NiTi(Pt) FD using a platinum core nitinol (NiTi(Pt)) wire had similar trackability force (11.3 to 22.1 gf) to NiTi FD and uniform deployment, enhancing procedural convenience. However, concerns about low expansion force (1.79 ± 0.30 gf) and the potential for migration remained. This comparative analysis contributes to a comprehensive understanding of how different wire materials influence the performance of FDs. While this study is still in its early stages and requires further research, its development has the potential to guide clinicians and researchers in optimizing the selection and development of FDs for the effective treatment of intracranial aneurysms. Full article
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18 pages, 5111 KiB  
Article
Hemodynamic Investigation of the Flow Diverter Treatment of Intracranial Aneurysm
by Maria Antonietta Boniforti, Roberto Magini and Tania Orosco Salinas
Fluids 2023, 8(7), 189; https://doi.org/10.3390/fluids8070189 - 24 Jun 2023
Cited by 12 | Viewed by 4195
Abstract
Flow diverter stents (FDS) are increasingly used for the treatment of complex intracranial aneurysms such as fusiform, giant, or wide-neck aneurysms. The primary goal of these devices is to reconstruct the diseased vascular segment by diverting blood flow from the aneurysm. The resulting [...] Read more.
Flow diverter stents (FDS) are increasingly used for the treatment of complex intracranial aneurysms such as fusiform, giant, or wide-neck aneurysms. The primary goal of these devices is to reconstruct the diseased vascular segment by diverting blood flow from the aneurysm. The resulting intra-aneurysmal flow reduction promotes progressive aneurysm thrombosis and healing of the disease. In the present study, a numerical investigation was performed for modeling blood flow inside a patient-specific intracranial aneurysm virtually treated with FDS. The aim of the study is to investigate the effects of FDS placement prior to the actual endovascular treatment and to compare the effectiveness of devices differing in porosity. Numerical simulations were performed under pulsatile flow conditions, taking into account the non-Newtonian behavior of blood. Two possible post-operative conditions with virtual stent deployment were simulated. Hemodynamic parameters were calculated and compared between the pre-operative (no stent placement) and post-operative (virtual stent placement) aneurysm models. FDS placement significantly reduced intra-aneurysmal flow velocity and increased the Relative Residence Time (RRT) on the aneurysm, thus promoting thrombus formation within the dilatation and aneurysm occlusion. The results highlighted an increase in the effectiveness of FDS as its porosity increased. The proposed analysis provides pre-operative knowledge on the impact of FDS on intracranial hemodynamics, allowing the selection of the most effective treatment for the specific patient. Full article
(This article belongs to the Special Issue Image-Based Computational and Experimental Biomedical Flows)
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13 pages, 2674 KiB  
Article
Photosensitive Hydrogel-Based Embolic Agent Treatment of Wide-Necked Aneurysms: Preliminary Animal Results
by Jerry C. Ku, Yuta Dobashi, Christopher R. Pasarikovski, Joel Ramjist, Clement Hamani, Chinthaka Heyn, Konrad Walus and Victor X. D. Yang
Gels 2022, 8(12), 788; https://doi.org/10.3390/gels8120788 - 1 Dec 2022
Cited by 2 | Viewed by 2984
Abstract
Background: The endovascular treatment of cerebral aneurysms has become widespread but may still be limited by recurrence rates or complications. The discovery of novel embolic strategies may help mitigate these concerns. Methods: We formulated a Photosensitive Hydrogel Polymer (PHP) embolic agent which is [...] Read more.
Background: The endovascular treatment of cerebral aneurysms has become widespread but may still be limited by recurrence rates or complications. The discovery of novel embolic strategies may help mitigate these concerns. Methods: We formulated a Photosensitive Hydrogel Polymer (PHP) embolic agent which is low-viscosity, shear-thinning, and radio-opaque. After the filling of an aneurysm with PHP with balloon assistance, we utilized photopolymerization to induce solidification. Different methods of light delivery for photopolymerization were assessed in silicone models of aneurysms and in four acute animal trials with venous anastomosis aneurysms in pigs. Then, balloon-assisted embolization with PHP and photopolymerization was performed in three aneurysms in pigs with a one-month follow-up. Filling volume, recurrence rates, and complications were recorded. Results: The PHP was found to be suitable for the intravascular delivery and treatment of cerebral aneurysms. It was found that light delivery through the balloon catheter, as opposed to light delivery through the injection microcatheter, led to higher rates of filling in the 3D model and acute animal model for cerebral aneurysms. Using the balloon-assisted embolization and light delivery strategy, three wide-necked aneurysms were treated without complication. One-month follow-up showed no recurrence or neck remnants. Conclusions: We demonstrated a novel method of balloon-assisted photosensitive hydrogel polymer embolization and photopolymerization, leading to complete aneurysm filling with no recurrence at 1 month in three wide-necked aneurysms in pigs. This promising methodology will be investigated further with longer-term comparative animal trials. Full article
(This article belongs to the Special Issue Engineering Hydrogel for Biomedical Applications)
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8 pages, 903 KiB  
Article
Comaneci-Assisted Coiling of Wide-Necked Intracranial Aneurysm: A Single-Center Preliminary Experience
by Gabriele Vinacci, Angelica Celentano, Edoardo Agosti, Alberto Vito Terrana, Francesco Alberto Vizzari, Luca Nativo, Fabio Baruzzi, Antonio Tabano, Davide Locatelli and Andrea Giorgianni
J. Clin. Med. 2022, 11(22), 6650; https://doi.org/10.3390/jcm11226650 - 9 Nov 2022
Cited by 3 | Viewed by 2035
Abstract
Background: Wide-necked aneurysms remain challenging for both coiling and microsurgical clipping. They often require additional techniques to prevent coil prolapse into the parent artery, such as balloon- and stent-assisted coiling. Comaneci is an expandable and removable stent that acts as a bridging device [...] Read more.
Background: Wide-necked aneurysms remain challenging for both coiling and microsurgical clipping. They often require additional techniques to prevent coil prolapse into the parent artery, such as balloon- and stent-assisted coiling. Comaneci is an expandable and removable stent that acts as a bridging device and does not interfere with the blood flow of the parent artery. Methods: We retrospectively reviewed our institutional radiological and clinical chart of patients treated for saccular intracranial aneurysm via endovascular Comaneci-assisted coiling. The aim of the study was to report our preliminary experience in Comaneci-assisted coiling of wide-necked intracranial aneurysms. Results: We included 14 patients in the study. Of these, 11 had a ruptured intracranial aneurysm and were treated with Comaneci-assisted coiling. We registered five minor intraprocedural complications and two intraprocedural failures of the device. At one-year follow-up, a satisfying aneurysm occlusion was observed in 85% of the cases. Conclusions: Though long-term follow-up data and larger case series are needed, this preliminary study showed the feasibility of the Comaneci-assisted coiling method for both ruptured and unruptured wide-neck intracranial aneurysms, with similar occlusion rates as balloon-assisted coiling. However, we registered high incidence of thromboembolic complications; these were probably related to the lack of heparin administration. The main advantageous application of this technique is likely in cases of ruptured intracranial aneurysms, as there is no need for post-procedural antiplatelet therapy. Full article
(This article belongs to the Special Issue Embolization Techniques: State of the Art and Future Perspectives)
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10 pages, 1321 KiB  
Technical Note
Endovascular Treatment for Aneurysms Located in the Posterior Communicating Artery (PCoA) by the Swinging-Tail Technique: A Technical Note
by Jiejun Wang, Longhui Zhang, Linggen Dong, Shuai Zhang, Haoyu Zhu, Chuhan Jiang and Ming Lv
J. Clin. Med. 2022, 11(19), 5955; https://doi.org/10.3390/jcm11195955 - 9 Oct 2022
Cited by 2 | Viewed by 2387
Abstract
Purposes: A stent-assisted coil (SAC) is a safe and effective treatment modality for some complex intracranial aneurysms, especially for wide neck aneurysms. However, some wide neck aneurysms with a tough angle and located in the posterior communicating artery (PCoA) are challenging to treat [...] Read more.
Purposes: A stent-assisted coil (SAC) is a safe and effective treatment modality for some complex intracranial aneurysms, especially for wide neck aneurysms. However, some wide neck aneurysms with a tough angle and located in the posterior communicating artery (PCoA) are challenging to treat with a SAC. This study aimed to examine and discuss the swinging-tail technique for treating wide neck aneurysms located in the PCoA using a SAC by Prof. Lv. Materials and Methods: We retrospectively reviewed our institutional clinical database and identified nine patients with neck aneurysms located in the PCoA, and these patients underwent the swinging-tail technique by Prof. Lv, which is a novel technique of releasing a stent, from June 2016 to September 2021. Results: In this study, nine patients underwent SAC treatment using the swinging-tail technique by Prof. Lv. Aneurysmal complete occlusion was observed in every patient without any complications, as shown by immediate postoperative angiography. Additionally, the modified Rankin scale was monitored for clinical outcomes in the follow-up. One patient died postoperatively due to severe SAH with an intraventricular hemorrhage. Four of nine patients underwent imaging follow-up, demonstrating the complete occlusion of aneurysms; eight patients underwent clinical follow-up and achieved a favorable clinical outcome (modified Rankin scale score: 0–2). Conclusion: The SAC treatment for wide neck aneurysms located in the PCoA can be challenging for operators because of the specific location, resulting in inadequate vessel wall apposition by antegrade stenting via the ipsilateral vessel. In this circumstance, the swinging-tail technique may be a feasible and effective choice. Full article
(This article belongs to the Special Issue "Neurosurgery": Emerging Clinical Skills in 2022 and Beyond)
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11 pages, 1016 KiB  
Article
Procedural Outcome Following Stent-Assisted Coiling for Wide-Necked Aneurysms Using Three Different Stent Models: A Single-Center Experience
by Catherine Strittmatter, Lukas Meyer, Gabriel Broocks, Maria Alexandrou, Maria Politi, Maria Boutchakova, Andreas Henssler, Marcus Reinges, Andreas Simgen, Panagiotis Papanagiotou and Christian Roth
J. Clin. Med. 2022, 11(12), 3469; https://doi.org/10.3390/jcm11123469 - 16 Jun 2022
Cited by 6 | Viewed by 2351
Abstract
Previous case series have described the safety and efficacy of different stent models for stent-assisted aneurysm coiling (SAC), but comparative analyses of procedural results are limited. This study investigates the procedural outcome and safety of three different stent models (Atlas™, LEO+™ (Baby) and [...] Read more.
Previous case series have described the safety and efficacy of different stent models for stent-assisted aneurysm coiling (SAC), but comparative analyses of procedural results are limited. This study investigates the procedural outcome and safety of three different stent models (Atlas™, LEO+™ (Baby) and Enterprise™) in the setting of elective SAC treated at a tertiary neuro-endovascular center. We retrospectively reviewed all consecutively treated patients that received endovascular SAC for intracranial aneurysms between 1 July 2013 and 31 March 2020, excluding all emergency angiographies for acute subarachnoid hemorrhage. The primary procedural outcome was the occlusion rate evaluated with the Raymond–Roy occlusion classification (RROC) assessed on digital subtraction angiography (DSA) at 6- and 12-month follow-up. Safety assessment included periprocedural adverse events (i.e., symptomatic ischemic complications, symptomatic intracerebral hemorrhage, iatrogenic perforation, dissection, or aneurysm rupture and in-stent thrombosis) and in-house mortality. Uni- and multivariable logistic regression analyses were performed to identify patient baseline and aneurysm characteristics that were associated with complete aneurysm obliteration at follow-up. A total of 156 patients undergoing endovascular treatment via SAC met the inclusion criteria. The median age was 62 years (IQR, 55–71), and 73.7% (115) of patients were female. At first follow-up (6-month) and last available follow-up (12 and 18 months), complete aneurysm occlusion was observed in 78.3% (90) and 76.9% (102) of patients, respectively. There were no differences regarding the occlusion rates stratified by stent model. Multivariable logistic analysis revealed increasing dome/neck ratio (adjusted odds ratio (aOR), 0.26.; 95% CI, 0.11–0.64; p = 0.003), increasing neck size (aOR, 0.70; 95% CI, 0.51–0.96; p = 0.027), and female sex (aOR, 4.37; 95% CI, 1.68–11.36; p = 0.002) as independently associated with treatment success. This study showed comparable rates of complete long-term aneurysm obliteration and safety following SAC for intracranial aneurysm with three different stent-models highlighting the procedural feasibility of this treatment strategy with currently available stent-models. Increased neck size and a higher dome/neck ratio were independent variables associated with less frequent complete aneurysm obliteration. Full article
(This article belongs to the Section Clinical Neurology)
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8 pages, 399 KiB  
Article
Woven EndoBridge in Wide-Neck Bifurcation Aneurysms: Digital Subtraction Angiography at 3-Year Follow-Up
by Carmelo Stanca, Serena Carriero, Davide Negroni, Marco Spinetta, Carolina Coda, Pierpaolo Biondetti and Giuseppe Guzzardi
J. Clin. Med. 2022, 11(10), 2879; https://doi.org/10.3390/jcm11102879 - 19 May 2022
Cited by 5 | Viewed by 2057
Abstract
Introduction: The Woven EndoBridge (WEB) device is a self-expanding intrasaccular braided-wire device for the treatment of wide-neck bifurcation aneurysms (WNBAs). Even though this device has an excellent safety profile and a low risk of rebleeding, little is known about its long-term effects. Material [...] Read more.
Introduction: The Woven EndoBridge (WEB) device is a self-expanding intrasaccular braided-wire device for the treatment of wide-neck bifurcation aneurysms (WNBAs). Even though this device has an excellent safety profile and a low risk of rebleeding, little is known about its long-term effects. Material and Methods: All patients treated with WEB due to ruptured WNBAs were subjected to follow-up digital subtraction angiography (DSA) at 2 and 3 years after device deployment. The degree of residual neck was assessed through BOSS, Lubicz, and WEBCAST scales. Data on modified Rankin scale (mRS), bleeding events, and ischemic events occurring during this time period were collected as well. Lastly, overall and procedure-related mortality rates were calculated. Results: A total of 21 patients were treated between 1 January 2016, and 31 December 2018. DSA demonstrated a patency grade of 57.1% and 61.1% at 2 and 3 years, respectively. The overall 2-year mortality rate due to causes unrelated to the aneurysm was 14.3%. None of the patients were retreated between the 2- and the 3-year follow-up. No rebleeding or stroke events occurred during the follow-up. Conclusions: WEB-treated ruptured aneurysms showed an excellent degree of stability over time. The overall mortality rate—unrelated to the procedure–observed in our sample was higher than what reported in the literature, a possible bias associated with the COVID-19 pandemic. Full article
(This article belongs to the Special Issue Embolization Techniques: State of the Art and Future Perspectives)
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13 pages, 873 KiB  
Article
Results of the pToWin Study: Using the pCONUS Device for the Treatment of Wide-Neck Intracranial Aneurysms
by Marta Aguilar Pérez, Hans Henkes, Wiebke Kurre, Carlos Bleise, Pedro Nicolás Lylyk, Javier Lundquist, Francis Turjman, Hanan Alhazmi, Christian Loehr, Stephan Felber, Hannes Deutschmann, Stephan Lowens, Luigi Delehaye, Markus Möhlenbruch, Jörg Hattingen and Pedro Lylyk
J. Clin. Med. 2022, 11(3), 884; https://doi.org/10.3390/jcm11030884 - 8 Feb 2022
Cited by 9 | Viewed by 2809
Abstract
Coil embolization has become a well-established option for the treatment of intracranial aneurysms. Yet, wide-neck bifurcation aneurysms (WNBAs) remain a challenge. The pCONUS is the first generation of a stent-like implant for the bridging of WNBAs to enable coiling. The pToWin study was [...] Read more.
Coil embolization has become a well-established option for the treatment of intracranial aneurysms. Yet, wide-neck bifurcation aneurysms (WNBAs) remain a challenge. The pCONUS is the first generation of a stent-like implant for the bridging of WNBAs to enable coiling. The pToWin study was a prospective, single-arm, multicenter study conducted to analyze the safety and efficacy of the pCONUS in the treatment of WNBAs. The primary effectiveness endpoint was the rate of adequate occlusion of the aneurysm at 3–6 and 7–12 months. The primary safety endpoint was the occurrence of major ipsilateral stroke or neurological death during the follow-up. A total of 115 patients were included. Aneurysm locations were the middle cerebral artery in 52 (45.2%), the anterior communicating artery in 35 (30.4%), the basilar artery in 23 (20%), the internal carotid artery terminus in three (2.6%), and the pericallosal artery in two (1.7%) patients. Treatment was successfully performed in all but one patient. The morbi-mortality rate was 1.9% and 2.3% at 3–6 and 7–12 months, respectively. Of the aneurysms, 75.0% and 65.6% showed adequate occlusion at 3–6 and 7–12 months, respectively. pCONUS offers a safe and reasonably effective treatment of WNBAs, demonstrated by acceptable adequate aneurysm occlusion and low rates of adverse neurologic events. Full article
(This article belongs to the Special Issue Hemorrhagic Stroke)
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Article
A Comparative Evaluation of Standard and Balloon-Assisted Coiling of Intracranial Aneurysms Based on Neurophysiological Monitoring
by Stephan Waldeck, René Chapot, Christian von Falck, Matthias F. Froelich, Marc Brockmann and Daniel Overhoff
J. Clin. Med. 2022, 11(3), 677; https://doi.org/10.3390/jcm11030677 - 28 Jan 2022
Cited by 4 | Viewed by 1949
Abstract
Background and purpose: Intracranial aneurysms are commonly treated with balloon-assisted endovascular coiling because the balloon allows for the control und modulation of wide-necked aneurysms and the coil basket. However, this approach might be associated with a higher complication rate. This retrospective study compared [...] Read more.
Background and purpose: Intracranial aneurysms are commonly treated with balloon-assisted endovascular coiling because the balloon allows for the control und modulation of wide-necked aneurysms and the coil basket. However, this approach might be associated with a higher complication rate. This retrospective study compared the multimodal results between balloon-assisted coiling of aneurysms (group 1) and coiling without balloon assistance (group 2). Materials and Methods: We included 67 patients with unruptured intracranial aneurysms in this retrospective analysis; acutely ruptured aneurysms were excluded from the analysis. We divided these patients into two groups and evaluated them for symptomatic thromboembolic complications in the course of intracranial aneurysm treatment. All patients had an intrainterventional neurophysiological monitoring (IINM) and a pre- and postinterventional NIH Stoke Scale (NIHSS) survey and MR imaging. Multiple logistic regression was used to assess whether balloon-assisted coiling increased the rate of thromboembolic complications. Periprocedural aneurysm hemorrhage did not occur in any of the cases. Results: We detected no statistically significant difference in rates of neurophysiological disturbances (19.5% (group 1) versus 34.6% (group 2); p = 0.249). There was no association with age, gender, or aneurysm location. The occurrence of new diffusion-weighted defects was not statistically significantly different (19.5% (group 1) versus 35.0% (group 2); p = 0.166). The difference in NIHSS before and after the intervention showed also no statistical significance in both groups (p = 0.426). Conclusion: The use of balloon-assisted coiling did not increase the rate of neurological disturbances during endovascular coiling. MR imaging and NIHSS survey also showed no increased risk of embolization from balloon-assisted aneurysm coiling. IINM is a central aspect of care during endovascular coiling as it can substantially decrease morbidity. Full article
(This article belongs to the Section Clinical Neurology)
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