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Aims Intracranial aneurysms are treated with a variety of endovascular devices including coils, stents, and flow diverters. The mechanisms by which these devices result in aneurysm occlusion and subsequent healing have been the subject of significant research using various animal models. The murine Helsinki aneurysm model is a sidewall aneurysm created by the end-to-side anastomosis of a donor aortic graft onto the abdominal aorta of a recipient animal. The aim of this systematic review is to assess the efficacy of different endovascular devices for the treatment of the Helsinki model aneurysm. Methods We performed a systematic review of Pubmed in accordance with PRISMA guidelines, yielding eight studies detailing the results of endovascular treatment of this preclinical aneurysm model. Studies were included if they provided rates of complete aneurysm occlusion after treatment. Results In these studies, aneurysms were treated with coiling (n=81, 7 studies), stenting (n=67, 3 studies), stent-coiling (n=13, 1 study), and flow diversion (n=49, 2 studies). The results of each individual study are discussed with the goal of providing a measure of the relative efficacy of different endovascular devices for the treatment of this particular model aneurysm. We also pay special attention to insights into the mechanisms underlying aneurysm healing after different forms of endovascular therapy. Conclusion The data presented here may be useful to investigators attempting to demonstrate superiority of novel endovascular devices relative to previous device iterations using this preclinical model. [ABSTRACT FROM AUTHOR]

Stent-assisted coiling (SAC) of intracranial aneurysms paved the way for endovascular coiling of wide-neck and bifurcation aneurysms, improving rates of aneurysm obliteration and recurrence. In this review, we provide a comprehensive review of the most recent advances related to stent-assisted coiling of intracranial aneurysm. The authors have made an attempt to cover the inception, applications, and limitations of SAC of intracranial aneurysms. Special focus is given to 1) the current and recently introduced SAC techniques, 2) most recent advances in device technology, and 3) outcome data for the discussed techniques and devices. The authors also discuss the potential future direction of SAC. technical refinements in the field of SAC should continue to focus on device development and addressing the limitations of SAC, namely aneurysm recurrence and need of antiplatelet agents. Although the recurrence rate of SAC has not been shown to be inferior to flow diverters, the use of intrasaccular and intravascular flow diverters are likely to expand in the future at the expense of SAC. [ABSTRACT FROM AUTHOR]

Background: Ruptured large and partially thrombosed aneurysms are challenging lesions to treat successfully. Methods: We describe the surgical treatment of a large, ruptured partially thrombosed middle cerebral artery (MCA) aneurysm. Once the Sylvian fissure is dissected, temporary clips are placed, and the clot is evacuated with simple microsuction and ultrasonic aspiration. The aneurysm is then carefully clip reconstructed to avoid compromise of the parent vessels. Conclusion: In cases of surgical clipping of large, thrombosed aneurysms, it is important to be aware of a few, but critically important, pitfalls to ensure successful outcome. [ABSTRACT FROM AUTHOR]

It is generally accepted that larger saccular intracranial aneurysms are at greater risk to rupture. We investigated whether aneurysm location influences the effect of aneurysm size on the propensity of rupture. We reviewed patient and aneurysm characteristics in a consecutive series of patients with unruptured and ruptured aneurysms presenting to our institution between 2006 and 2018. Differences between unruptured and ruptured aneurysms at different locations were subsequently investigated. A total of 766 aneurysms in 568 patients were included, with 355 and 411 unruptured and ruptured aneurysms, respectively. There were significant differences in the distribution of aneurysm location between unruptured and ruptured aneurysms (P < 0.001). The most common locations of unruptured aneurysms were the middle cerebral artery (MCA) (27.6%) and paraclinoid internal carotid artery (ICA) (25.4%), whereas the most common locations of ruptured aneurysms were the anterior communicating artery (ACOM) (34.8%) and posterior communicating artery (17.8%). Ruptured aneurysms were larger than unruptured aneurysms at all locations except at the ACOM, where there was no difference in size between unruptured and ruptured aneurysms (5.4 vs. 5.8 mm, respectively; P = 0.40). Ruptured ACOM aneurysms were also smaller than ruptured aneurysms of the paraclinoid ICA (5.8 vs. 10.3 mm; P < 0.001), MCA (5.8 vs. 8.0 mm; P = 0.021), and basilar apex (5.8 vs. 10.5 mm; P < 0.001), respectively. We observed no difference in size between unruptured and ruptured ACOM aneurysms, possibly suggesting a greater susceptibility for ACOM aneurysms to rupture at smaller sizes. [ABSTRACT FROM AUTHOR]

Flow diversion (FD) has emerged as an effective treatment modality for aneurysms of the posterior communicating artery (PCOM). Whether or not a fetal posterior circulation (FPC) affects PCOM aneurysm occlusion rates after FD remains undetermined. We performed a retrospective cohort study in which treatment outcomes for FD of PCOM aneurysms from multiple institutions were reviewed. The primary outcome of interest was complete aneurysm occlusion at last follow-up. The presence of a FPC, defined as a PCOM diameter larger than that of the P1 segment, was noted and its relationship to complete aneurysm occlusion was investigated using a Cox proportional hazards model. There were 49 patients with 49 PCOM aneurysms treated with FD who met inclusion criteria for analysis. A FPC was present in 16 patients (32.7%). Complete aneurysm occlusion was observed in 34 patients (69.4%). Complete occlusion was less common for patients with a FPC (43.7% vs. 81.8%; P = 0.007). For patients with and without a FPC, median time to occlusion was 51 and 6 months, respectively (P = 0.002). Using a multivariable Cox proportional hazards model, a FPC was associated with reduced odds of complete occlusion on last follow-up (risk ratio 0.35, 95% confidence interval 0.14–0.89; P = 0.029). Our results indicate reduced efficacy of FD for the treatment of PCOM aneurysms associated with a FPC. These findings may influence treatment selection for aneurysms at this location. [ABSTRACT FROM AUTHOR]

Objective Anatomic variations of the anterior communicating artery (ACOM) complex have been shown to influence ACOM aneurysm morphology. It is not known whether these variations predispose unruptured ACOM aneurysms to grow over time. Methods We retrospectively reviewed the course of patients with untreated, unruptured ACOM aneurysms monitored with serial imaging at our institution. The primary outcome of interest was aneurysm growth. Predictors of aneurysm growth were determined using a Cox proportional hazards model. Results There were 81 patients with an unruptured ACOM aneurysm who were included in our study. Growth occurred in 9 (11.1%) patients, yielding a yearly growth rate of 2.8%. Aneurysms that grew were larger on initial detection than were those that remained stable in size (8.3 mm vs. 6.2 mm; P = 0.031). The ratio of the diameter of A1 segments was greater in patients with aneurysms that grew (2.1 vs. 1.4; P = 0.003), as was the frequency of patients with an A1 ratio >2.3 (25.0% vs. 6.6%; P = 0.023). Among aneurysms that grew, location at the A1–A2 junction was more common than origination solely from the ACOM (88.9% vs. 11.1%). When follow-up time was adjusted for, increasing aneurysm size (unit relative risk [RR] 1.25, 95% confidence interval [CI] 1.06–1.45; P = 0.011) and location at the A1–A2 junction (RR 6.15, 95% CI 1.12–114.49; P = 0.035) were significant predictors of aneurysm growth. Conclusions We identify several anatomic characteristics that may be associated with increased risk of ACOM aneurysm growth. These data could influence management strategies of unruptured ACOM aneurysms. [ABSTRACT FROM AUTHOR]