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Purpose: To investigate the effect and safety of flow diverters in the management of small (<10 mm in diameter) unruptured intracranial aneurysms. Materials and Methods: One hundred and ten patients with 145 small intracranial aneurysms treated with flow diverters were retrospectively enrolled. The clinical, endovascular, and follow-up data were analyzed. Results: One hundred twenty-one flow diverters were deployed for the treatment of 145 small intracranial aneurysms in 110 patients, and the stenting success rate was 99.1%. In 133 (91.7%) aneurysms, only flow-diverting devices were deployed, and in the rest 12 (8.3%) of aneurysms, coils were used to loosely pack the aneurysm after deployment of a flow-diverting device. Five patients (4.5%) experienced ischemic complications, but no hemorrhagic complications were occurred. All patients had clinical follow-up 6–18 (median 12) after the procedure, with the modified Rankin scale score (mRS) 0 in 101 patients, 1 in four patients, 2 in three patients, 4 in one patient, and 5 in one patient. Digital subtraction angiography was performed at follow-up in 90 (81.8%) patients with 118 (81.4%) aneurysms 6–18 months (median 12) after the procedure, with the Raymond grade I in 90 (76.2%) aneurysms and Raymond grade III in 28 (23.7%). Eighteen patients with 22 partially occluded aneurysms at the first angiographic follow-up experienced the second digital subtraction angiography 12–36 months (median 26) after the procedure, and 21 (95.5%) aneurysms were completely occluded. Two patients had asymptomatic in-stent stenosis. Conclusion: Treatment of small unruptured intracranial aneurysms with flow diverters can be performed safely and effectively with satisfactory outcomes. [ABSTRACT FROM AUTHOR]

• PED devices can be used to treat large unruptured posterior circulation aneurysms. • It is safe and effective with PED to treat large posterior circulation aneurysms. • A high complete aneurysm occlusion rate can be obtained with PED at follow-up. To investigate the safety and effect of the Pipeline Embolization Device (PED) Flex device in the treatment of large unruptured posterior circulation aneurysms in a single center. Patients with large unruptured posterior circulation aneurysms which were treated with the PED Flex device were enrolled. The clinical, endovascular and follow-up data were analyzed, and the O'Kelly-Marotta (OKM) grading system was used to assess the aneurysm occlusion status. Fourteen patients with 14 large posterior circulation aneurysms who were treated with the PED Flex device were enrolled. The maximal diameter of aneurysm was 17.0 ± 3.9 mm. Fourteen PED Flex devices were deployed in 14 patients, with a technical success rate of 100%. All stents covered the aneurysm neck with good wall adherence and patent parent artery. Ten (71.4%) aneurysms were treated with a single PED Flex device each, and four (28.6%) patients experienced additional coiling. No neurological complications occurred in the periprocedural period. The mRS was 0 in eleven (78.6%) patients, 1 in two (14.3%), and 2 in one (7.1%) at discharge. All patients were followed up at 6–28 months (median 18), with an mRS score of 0 in all patients. Twelve (85.7%) patients experienced digital subtraction angiography 6–28 (median 18) months after the embolization procedure, and the OKM grade was D in nine (75%), C in two (16.7%), and B in one (8.3%). The Pipeline Flex Embolization Device can be safely applied to treat large unruptured posterior circulation aneurysms with a high complete aneurysm occlusion rate at follow-up. [ABSTRACT FROM AUTHOR]

Cerebral arteries are usually tortuous, and in the treatment of cerebrovascular diseases with stenting, a stent deployed may be collapsed at one end, leading to reduced blood flow and subsequent stent occlusion. Immediate rescuing measures should be implemented to prevent severe ischemic events. In this case report, we present a case with V4 segment occlusion of the right vertebral artery treated with endovascular stent angioplasty. An Enterprise stent deployed at the occlusion segment was collapsed at the proximal end after withdrawal of the delivery system. Immediate rescuing measures were taken by navigating a micro-guidewire through the lateral stent mesh at the proximal end into the stent lumen followed by advancing a second micro-guidewire right through the reopened proximal stent end into the stent lumen for deployment of a supporting balloon-expandable Apollo stent to prevent stent collapse. Follow-up digital subtraction angiography 6 months later demonstrated patent stents and unobstructed blood flow. [ABSTRACT FROM AUTHOR]

Background The effectiveness and safety of LVIS stent-coiling is currently not known for treating tiny intracranial aneurysms. Objective To investigate the effectiveness and safety of Low-profile visualized intraluminal support (LVIS) stent-assisted coiling and coiling alone in treating patients with mostly ruptured tiny aneurysms. Methods Seventy-five patients with tiny intracranial aneurysms, including 63 ruptured ones, were treated endovascularly and analyzed. Results In the coiling group, complete occlusion was achieved in 35 patients (83.6%)—nearly complete in 4 patients (9.5%) and noncomplete in 3 patients (7.1%). Intraprocedural rerupture occurred in 2 patients (4.8%), and coil protrusion occurred in 1 patient, with a complication rate of 7.1%. Clinical follow-up at 6–12 months revealed a modified Rankin Scale (mRS) score of 0–1 in 41 patients and 3 in 1 patient. In the stent-assisted group, occlusion was complete in 12 patients (36.4%), nearly complete in 15 patients (45.5%), and noncomplete in 6 patients (18.1%). Six stents (18.2%) did not have good adherence to the wall, with thrombus formation in 3 stents (9.1%). Follow-up angiography in 27 patients at 3–6 months showed no dislocation of the stents, complete occlusion in 24 patients (88.9%), and nearly complete occlusion in the other 3 patients. At 6 months, the mRS score was 0 in 30 patients and 2 in 3 patients. No significant ( P > 0.05) differences existed between the 2 groups. Conclusion Tiny cerebral aneurysms can be safely and effectively treated with appropriate endovascular approaches based on aneurysm specific morphology, especially neck size and neck-to-dome ratio. [ABSTRACT FROM AUTHOR]