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Objectives: We aim to investigate associations between different coil strategies and outcomes in the aneurysms treated by a pipeline embolization device (PED). Methods: Patients with medium-to-giant-sized aneurysms treated by PED were included. The total cohort was divided into PED-alone and PED-coiling groups, and the PED-coiling group was further divided into loose and dense packing subgroups. Multivariate logistic analyses and stabilized inverse probability of treatment weighting (sIPTW) were performed to investigate the relationships between coiling strategies and outcomes. Restricted cubic spline (RCS) curves were used to describe the coiling degree and angiographic outcome relationship. Results: A total of 398 patients with 410 aneurysms were included. Aneurysms treated with PED coiling had a lower incomplete occlusion rate (15.3% vs. 30.3%, p = 0.002), higher total perioperative complication rate (14.2% vs. 3.5%, p = 0.001), longer production time (142.14 min vs. 101.26 min, p < 0.001), and higher total cost ($45,158.63 vs. $34,680.91, p < 0.001) than those treated with PED alone. There were no differences in outcomes between the loose and dense packing subgroups. However, the total cost was higher in the dense packing group ($43,787.46 vs. $47,288.32, p = 0.001) than in the loose packing group. The result was still robust in the multivariate and sIPTW analyses. The RCS curves showed "L-shape" relationships between the coil degree and angiographic outcomes. Conclusion: Compared with PED alone, PED coiling could improve aneurysm occlusion. However, it could also increase the total complication risk, prolong procedure time, and increase the total cost. Compared with loose packing, dense packing did not enhance the treatment effectiveness but increased the treatment cost. Clinical relevance statement: The additional treatment effect from coiling embolization declines sharply after a certain point. Specifically, the aneurysm occlusion rate is roughly stable when the coil number is greater than 3 or the total coil length is longer than 150 cm. Key Points: • Compared with pipeline embolization device (PED) alone, PED combined with coiling can improve aneurysm occlusion. • Compared with PED alone, PED combined with coiling increases the total complication risk, cost, and prolongs procedure time. • Compared with loose packing, dense packing did not increase the treatment effectiveness but increased the cost. [ABSTRACT FROM AUTHOR]

Objective: This cross-sectional study aimed to investigate the associations between aneurysm wall enhancement (AWE), atherosclerotic protein levels, and aneurysm size in unruptured intracranial fusiform aneurysms (IFAs). Methods: Patients with IFAs underwent high-resolution magnetic resonance imaging (HR-MRI) and atherosclerotic protein examinations from May 2015 to December 2021 were collected. A CRstalk (signal intensity [SI] of IFA wall/SI of pituitary stalk) > 0.60 was considered to indicate AWE. Atherosclerotic protein data was obtained from the peripheral blood. Aneurysmal characteristics included the maximal diameter of the cross-section (Dmax), location, type of IFA, presence of mural thrombus, and mural clots. Statistical analyses were performed with univariate analysis, logistic regression analysis, and Spearman's correlation coefficient. Results: Seventy-one IFAs from 71 patients were included in the study. Multivariate analysis revealed statin use (OR = 0.189, p = 0.026) and apolipoprotein B (Apo-B) level (OR = 6.019, p = 0.026) were the independent predictors of AWE in IFAs. In addition, statin use (OR = 0.813, p = 0.036) and Apo-B level (OR = 1.610, p = 0.003) were also the independent predictors of CRstalk. Additionally, we found that CRstalk and AWE were significantly positively associated with Dmax (rs = 0.409 and 0.349, respectively; p < 0.001 and p = 0.003, respectively). Conclusions: There may be correlations between AWE, atherosclerotic protein levels, and aneurysm size in patients with IFAs. Apo-B and statin use were independent predictors of AWE in IFAs, which have the potential to be new therapeutic targets for IFAs. Key Points: • There may be correlations between aneurysm wall enhancement, atherosclerotic protein levels in the peripheral blood, and aneurysm size in patients with intracranial fusiform aneurysms. • Apolipoprotein B and statin use were independent predictors of aneurysm wall enhancement in intracranial fusiform aneurysms. [ABSTRACT FROM AUTHOR]

Background: Small multiple intracranial aneurysms (SMIAs) are known to be more prone to rupture than are single aneurysms. However, specific recommendations for patients with small MIAs are not included in the guidelines of the American Heart Association and American Stroke Association. In this study, we aimed to evaluate the feasibility of machine learning-based cluster analysis for discriminating the risk of rupture of SMIAs. Methods: This multi-institutional cross-sectional study included 1,427 SMIAs from 660 patients. Hierarchical cluster analysis guided patient classification based on patient-level characteristics. Based on the clusters and morphological features, machine learning models were constructed and compared to screen the optimal model for discriminating aneurysm rupture. Results: Three clusters with markedly different features were identified. Cluster 1 (n = 45) had the highest risk of subarachnoid hemorrhage (SAH) (75.6%) and was characterized by a higher prevalence of familiar IAs. Cluster 2 (n = 110) had a moderate risk of SAH (38.2%) and was characterized by the highest rate of SAH history and highest number of vascular risk factors. Cluster 3 (n = 505) had a relatively mild risk of SAH (17.6%) and was characterized by a lower prevalence of SAH history and lower number of vascular risk factors. Lasso regression analysis showed that compared with cluster 3, clusters 1 (odds ratio [OR], 7.391; 95% confidence interval [CI], 4.074–13.150) and 2 (OR, 3.014; 95% CI, 1.827–4.970) were at a higher risk of aneurysm rupture. In terms of performance, the area under the curve of the model was 0.828 (95% CI, 0.770–0.833). Conclusions: An unsupervised machine learning-based algorithm successfully identified three distinct clusters with different SAH risk in patients with SMIAs. Based on the morphological factors and identified clusters, our proposed model has good discrimination ability for SMIA ruptures. [ABSTRACT FROM AUTHOR]

Background: Aneurysm inflow angle has been shown to be associated with hemodynamic changes by computational fluid dynamics. However, these studies were based on single aneurysm model and were limited to side‐wall aneurysms. Purpose: To investigate the association between inflow angle and morphology, hemodynamic, and inflammation of intracranial side‐wall and bifurcation aneurysms. Study type: Prospective. Population: A total of 62 patients (aged 58.34 ± 12.39, 44 female) with 59 unruptured side‐wall aneurysms and 17 unruptured bifurcation aneurysms were included. Field strength/sequence: A 3.0 T; 3D fast field echo sequence (TOF‐MRA); free‐breathing, 3D radio‐frequency‐spoiled, multi‐shot turbo field echo sequence (4D‐flow MRI); 3D black‐blood T1‐weighted volumetric turbo spin echo acquisition sequence (T1‐VISTA) Assessment: Two neuroradiologists assessed the inflow angle and size for intracranial aneurysms in 3D space with TOF‐MRA images. The average and maximum inflow velocity (Vavg‐IA, Vmax‐IA), blood flow (Flowavg‐IA, Flowmax‐IA), and average wall shear stress (WSSavg‐IA) for aneurysms were assessed from 4D‐flow MRI in regions of interest drawn by two neuroradiologists. The aneurysmal wall enhancement (AWE) grades between precontrast and postcontrast T1‐VISTA images were evaluated by three neuroradiologists. Statistical tests: Kruskal–Wallis H test, χ2 test, Pearson's correlation coefficient, scatter plots and regression lines, multivariate logistic regression analysis (partial correlation r) were performed. A P < 0.05 was considered statistically significant. Results: The WSSavg‐IA (0.52 ± 0.34 vs. 0.27 ± 0.22) and AWE grades (1.38 ± 1.04 vs. 2.02 ± 0.68) between the two inflow angle subgroups of side‐wall aneurysms were significantly different. The aneurysm size (rs = 0.31), WSSavg‐IA (rs = −0.45), and AWE grades (rs = 0.45) were significantly correlated with inflow angle in side‐wall aneurysms. While in bifurcation aneurysms, there were no significant associations between inflow angle and size (P = 0.901), Vavg‐IA (P = 0.699), Vmax‐IA (P = 0.482), Flowavg‐IA (P = 0.550), Flowmax‐IA (P = 0.689), WSSavg‐IA (P = 0.573), and AWE grades (P = 0.872). Data conclusion: A larger aneurysm size, a lower WSS and a higher AWE grade were correlated with a larger inflow angle in side‐wall aneurysms. Evidence Level: 3 Technical Efficacy: Stage 2 [ABSTRACT FROM AUTHOR]

Background and purpose: We used two‐sample Mendelian randomization (MR) to examine the effects of blood lipids and lipid‐modifying drugs on intracranial aneurysm (IA). Methods: Genetic variants for the effects of high‐density lipoprotein cholesterol (HDL‐C), apolipoprotein A1, low‐density lipoprotein cholesterol (LDL‐C), apolipoprotein B, and triglycerides and targets for lipid‐modifying drugs were selected from the genome‐wide discovery analyses of the UK Biobank. Summary‐level data on IAs were obtained from the International Stroke Genetics Consortium. Univariate and multivariate MR analyses were performed. Results: Univariate MR analyses showed that the HDL‐C was negatively correlated with IA (odds ratio [OR] = 0.816, 95% confidence interval [CI] = 0.715–0.932, p = 0.003) and ruptured IA (rIA; OR = 0.775, 95% CI = 0.663–0.906, p = 0.001). The multivariate MR–inverse variance weighted analysis showed that the HDL‐C was negatively correlated with IA (OR = 0.655, 95% CI = 0.434–0.988, p = 0.043) and rIA (OR = 0.563, 95% CI = 0.347–0.913, p = 0.02), and the LDL‐C was negatively correlated with IA (OR = 0.402, 95% CI = 0.191–0.848, p = 0.017) and rIA (OR = 0.376, 95% CI = 0.160–0.883, p = 0.025). Using genetic proxies of known lipid‐modifying drugs, we found that the increased HDL‐C with cholesterol ester transfer protein proxies was associated with a decreased risk of rIA (OR = 0.852, 95% CI = 0.747–0.973, p = 0.018), and the decreased LDL‐C with 3‐hydroxy‐3‐methylglutaryl‐coenzyme A reductase proxies was associated with increased risk of IA (OR = 1.772, 95% CI = 1.080–2.908, p = 0.024) and rIA (OR = 1.856, 95% CI = 1.022–3.371, p = 0.042). Conclusions: Genetically determined HDL‐C and LDL‐C reduce the risk of IA and rIA. The effects of different lipid‐modifying drugs on IA need to be further investigated. [ABSTRACT FROM AUTHOR]

Background: Unruptured small aneurysms with a size of <7 mm were often followed conservatively. However, it is unknown whether unruptured small multiple intracranial aneurysms (MIAs) are better to be prophylactically treated or conservatively followed. Objective: We aim to compare the effectiveness of different strategies regarding their management. Methods: A decision-analytic Markov model was built over a entire life cycle. The compared strategies include natural history, treat one aneurysm, treat both aneurysms, annual follow-up, biennial follow-up, and follow-up every 5 years. The inputs for the model were obtained from real-world data and related medical literature. Outcomes were measured in terms of quality-adjusted life-years (QALYs). Results: Treat both aneurysms had the highest effectiveness of 15.36 QALYs and treat one aneurysm had the second-highest effectiveness of 15.11 QALYs. Probabilistic sensitivity analysis with 10,000 iterations showed that treat both aneurysms and treat one aneurysm were optimal in 67.28 and 17.91% of all cases, respectively. One-way and two-way sensitivity analyses showed that the result was sensitive to the proportion of moderate to severe disability after treating two aneurysms, mortality after treating two aneurysms, proportion of moderate to severe disability after treating one aneurysm, and rupture rate of small growing aneurysm. Either treat both aneurysms or treat one aneurysm would be the optimal strategy under most of the circumstances with the variations of these parameters. Conclusion: For patients with small unruptured MIAs, prophylactic coiling was superior to conservative management and at least one aneurysm should be treated. [ABSTRACT FROM AUTHOR]

Background: Intracranial dissecting aneurysms (IDAs) are rare but pose significant challenges to treatment. The pipeline embolization device (PED) has been demonstrated to be an effective treatment option with excellent outcomes. Herein, we report our experience with patients treated with the PED for unruptured IDAs. Methods: We retrospectively reviewed our hospital database and identified patients who were treated with PEDs for unruptured IDAs between March 2016 and September 2020. Data including demographics, clinical presentation, aneurysm characteristics, procedural details, intra- or peri-procedural complications, and follow-up details were collected. Results: Eighty patients (61 men, 76.25%) were treated with PED for unruptured IDAs. The most common symptoms were headache (34, 42.5%), dizziness (29, 36.25%), and nausea or vomiting (15, 18.75%). Of these patients, 73 had one aneurysm, and seven harbored two aneurysms. All of them achieved successful PED deployment. Six patients experienced intra- or peri-procedural complications including perforator artery occlusion, thromboembolic, hemorrhagic events, and falling of the stent into the aneurysm sac. Follow-up with digital subtractive angiography was available for 29 patients with a median of 6 months, and 28 (96.56%) patients had aneurysm occlusion. Late thrombosis occurred in four patients, and two of them had unfavorable outcomes. Clinical follow-up showed that a favorable clinical outcome was achieved in 76 (95%) patients, and the mortality rate was 3.75%. Conclusion: Treating unruptured IDAs is safe and effective with long-term favorable clinical and angiographic outcomes. However, the complications of this treatment should be noted. Careful selection of appropriate patients and individualized antiplatelet therapy might be needed. [ABSTRACT FROM AUTHOR]

Background: Tandem aneurysms (TAs) are a distinct type of multiple intracranial aneurysms (IAs), the treatment strategies for which remain controversial. We aimed to reveal the clinical and angiographic outcomes of endovascular treatment as well as their risk factors in these complex multiple IAs. Methods: This multicenter, retrospective follow-up study was carried out in 3 hospitals in China. In total, clinical and angiographical data of 137 patients with 145 lesions (7 patients had bilateral lesions) and 315 TAs were collected. The treatment strategies were divided into full or partial treatment, single- or multiple-session treatment, and coiling (including single coiling and stent-assisted coiling)- or flow-diverting stent (FDS) treatment. Perioperative complications, as well as angiographic and clinical outcomes and their risk factors, were analyzed using univariate analysis and a multiple regression model. Results: Of treated TA lesions, 17 (16.0%) perioperative complications were found. Significant differences were found between the single- and multiple-session treatment groups (p = 0.012). At the latest follow-up, there were no significant differences in the modified Raymond Scale scores between different treatment groups. Significant differences were found in the embolization degree between the coiling and FDS groups (p = 0.038) and between the single common stent (without coiling) and the other treatment groups (p < 0.001). In IAs managed by a single LVIS stent (without coiling), 60% achieved improved or completed occlusion. Multivariate regression analysis found that a shorter minimum distance (odds ratio [OR] 5.967, 95% confidence interval [CI] 1.366–26.074; p = 0.018), multiple-session treatment (OR 9.961, 95% CI 1.707–58.127; p = 0.011), and diabetes (OR 8.106, 95% CI 1.928–34.084; p = 0.004) were predictors of perioperative complications, while shorter minimum distance (OR 5.619, 95% CI 1.493–21.152; p = 0.011), greater diameter ratio (OR 3.621, 95% CI 1.014–12.937; p = 0.048), and greater size ratio (OR 2.424, 95% CI 1.007–5.834; p = 0.048) were predictors of low completed occlusion rate. Conclusions: Both coiling and FDS can be utilized safely and can achieve similar clinical outcomes. FDS and LVIS are recommended for IAs that do not require embolization but cannot be prevented from being covered by stents. A multiple-session treatment may increase the treatment risk, and the minimum distance may affect the incidence of perioperative complications and completed occlusions. Further hemodynamic and prospective studies on such TAs in close proximity to one another are needed. [ABSTRACT FROM AUTHOR]

Objective Patients with unruptured intracranial aneurysms often present with headaches. We retrospectively determined the incidence of headache relief in patients with unruptured intracranial aneurysms after endovascular treatment, with the main goals of preventing aneurysmal haemorrhage and identifying factors associated with headache relief in a cohort study. Methods From a cohort of patients with unruptured intracranial aneurysms who were treated with endovascular coiling and admitted between January 2012 and December 2014, we included 123 patients who had headaches and underwent regular follow-up. The severity of headache was assessed by a quantitative 11-point headache scale for all patients before and after the endovascular treatment. Headache relief was defined as a decrease in the headache score. We determined the incidence and predictors of headache relief using Kaplan–Meier curves and Cox regression analysis. Results Of the 123 patients with a mean follow-up of 14.1 months (range 1–39 months), 69 had headache relief. The overall cumulative incidence of headache relief was 62.3% (95% confidence interval (CI) 54.2%, 69.4%). On multivariate Cox regression analysis, the side of headache ipsilateral to the aneurysm (adjusted hazard ratio 0.540; 95% CI 0.408, 0.715; P < 0.001) and aneurysm size (adjusted hazard ratio 1.753; 95% CI 1.074, 2.863; P = 0.025) were significant predictors of headache relief. Conclusions Endovascular treatment relieved preoperative headaches for most patients with unruptured intracranial aneurysms. The side of headache ipsilateral to the aneurysm and aneurysm size >10 mm were significant predictors of headache relief. [ABSTRACT FROM AUTHOR]

Background and purpose Aneurysmal wall enhancement (AWE) has emerged as a new possible biomarker for depicting inflammation of the intracranial aneurysm (IA). However, the relationships of AWE with other risk factors are still unclear for unruptured IA. The purpose of this study was to investigate the association between AWE and other risk metrics. Methods Forty-eight patients with unruptured saccular IAs diagnosed by digital subtraction angiography were recruited to undergo magnetic resonance (MR) black-blood imaging. AWE was evaluated using the pre- and post-contrast black-blood MR images. Univariate and multivariate logistic regression analysis was performed to investigate the association of AWE with other risk factors, including size, maximal neck width, parent vessel diameter, location, multiplicity, daughter sacs and other clinical factors. The prevalence of AWE in each ISUIA grade was reported and compared by Wilcoxon rank sum test. Results In total, 61 aneurysms were detected in 48 patients. Aneurysm size was found to be an independent risk factor associated with AWE (OR 2.46 per mm increase, 95% CI 1.34–4.51; p = 0.004). Patient age was independently and inversely associated with AWE (OR 0.898 per year increase, 95% CI 0.812–0.994; p = 0.037). Higher prevalence of AWE was observed in larger aneurysms (12%, 71.4%, 100%, and 100% of ISUIA grade 1–4 IAs have AWE, respectively). Notably, 12% of small IAs (size <7 mm) exhibited AWE. The IAs with AWE had significant higher ISUIA grade than the IAs without (p < 0.001, Wilcoxon rank sum test). Conclusions The wall enhancement in contrast-enhanced black-blood MR images was independently associated with aneurysm size in unruptured IAs. However, some small unruptured aneurysms did exhibit wall enhancement, suggesting that AWE may provide additional aneurysm instability information to improve current size-based rupture risk evaluation metrics. [ABSTRACT FROM AUTHOR]

Background Unruptured paraclinoid aneurysms have a high incidence of aneurysm recanalization (AR) after endovascular treatment. We aimed to identify the incidence and predictors of AR in these lesions. Methods We retrospectively analyzed consecutive patients with unruptured paraclinoid aneurysms who underwent endovascular treatment between January 2013 and December 2014. Patients with fusiform aneurysms, dissection aneurysms, traumatic aneurysms, or without digital subtraction angiography (DSA) at follow-up, were excluded. AR was defined as any aneurysm remnant that had increased in size or contrast filling that was observed via DSA at the follow-up. Univariate and multivariate logistic regression analyses were performed to assess the predictors of AR. Results We included 145 patients with 150 unruptured paraclinoid aneurysms in the analysis. The incidence of AR was 8.7% (95% confidence interval (CI): 4.7–13.3%) at a mean follow-up of 7.4 months. In the univariate analysis, AR was associated with aneurysm size (odd ratio (OR): 6.098; 95% CI: 1.870–19.886; p = 0.003), location (OR: 3.88; 95% CI: 1.196–12.583; p = 0.024), inflow angle (OR: 6.852; 95% CI: 1.463–32.087; p = 0.015), and Raymond scale (OR: 12.473; 95% CI: 2.7496–56.59; p < 0.001). In the adjusted multivariate analysis, AR was independently predicted by Raymond scale (OR: 9.136; 95% CI: 1.683–49.587; p = 0.001) and inflow angle (OR: 16.159; 95% CI: 3.211–81.308; p = 0.01). Conclusions Unruptured paraclinoid aneurysms had a high incidence of AR after endovascular treatment. An inflow angle of ≥90 degrees and incomplete occlusion were significant predictors of AR. [ABSTRACT FROM AUTHOR]

This study analyzed the rupture risk of intracranial aneurysms (IAs) according to aneurysm characteristics by comparing the differences between two aneurysms in different locations within the same patient. We utilized this self-controlled model to exclude potential interference from all demographic factors to study the risk factors related to IA rupture. A total of 103 patients were diagnosed with IAs between January 2011 and April 2015 and were enrolled in this study. All enrolled patients had two IAs. One IA (the case) was ruptured, and the other (the control) was unruptured. Aneurysm characteristics, including the presence of a daughter sac, the aneurysm neck, the parent artery diameter, the maximum aneurysm height, the maximum aneurysm width, the location, the aspect ratio (AR, maximum perpendicular height/average neck diameter), the size ratio (SR, maximum aneurysm height/average parent diameter) and the width/height ratio (WH ratio, maximum aneurysm width/maximum aneurysm height), were collected and analyzed to evaluate the rupture risks of the two IAs within each patient and to identify the independent risk factors associated with IA rupture. Multivariate, conditional, backward, stepwise logistic regression analysis was performed to identify the independent risk factors associated with IA rupture. The multivariate analysis identified the presence of a daughter sac (odds ratio [OR], 13.80; 95% confidence interval [CI], 1.65–115.87), a maximum aneurysm height ≥7 mm (OR, 4.80; 95% CI, 1.21–18.98), location on the posterior communicating artery (PCOM) or anterior communicating artery (ACOM; OR, 3.09; 95% CI, 1.34–7.11) and SR (OR, 2.13; 95% CI, 1.16–3.91) as factors that were significantly associated with IA rupture. The presence of a daughter sac, the maximum aneurysm height, PCOM or ACOM locations and SR (>1.5±0.7) of unruptured IAs were significantly associated with IA rupture. [ABSTRACT FROM AUTHOR]

Keywords: unruptured intracranial dissecting aneurysms; pipeline endovascular device; outcomes; complications; treatment EN unruptured intracranial dissecting aneurysms pipeline endovascular device outcomes complications treatment 1 1 1 01/10/22 20220105 NES 220105 In the published article, there was an error in affiliation 3, as published. Outcomes, complications, treatment, unruptured intracranial dissecting aneurysms, pipeline endovascular device. [Extracted from the article]

Background and Objective: There are technical challenges to complete occlusion of small (<5 mm) ruptured intracranial aneurysms (SRAs) using endovascular treatment (EVT). This study analyzed factors influencing immediate angiographic results in SRAs after EVT.Material and Methods: Intraoperative angiograms and medical records of 290 patients, who underwent EVT for SRAs at 2 stroke centers in China between January 2009 and October 2016, were retrospectively reviewed and evaluated.Results: Immediate complete occlusion was achieved in 213 (73.4%) aneurysms. Aneurysms with a smaller aspect ratio, those less than 3 mm in size, irregular shape, small basal outpouching, multiple aneurysms, poorer Hunt and Hess grade, and location of communication arteries demonstrated higher rates of incomplete occlusion, although the differences were not statistically significant. Multivariate logistic regression analysis revealed that SRAs with parent artery stenosis greater than or equal to 50% and lobulation demonstrated a higher incidence of incomplete occlusion. Intra-procedural rupture occurred in 13 (6.1%) patients in the complete occlusion group, and 3 (3.9%) in the incomplete occlusion group (P = .467). Thromboembolic complications occurred in 3 (1.0%) patients, and 4 (1.9%) underwent decompressive craniotomy after EVT, all of whom were in the complete occlusion group. Nine (4.2%) patients in the complete occlusion group and 2 (2.6%) in the incomplete occlusion group (P = .733) experienced intraprocedural vasospasm, with corresponding morbidity and mortality rates of 15.0% and 2.1%, respectively.Conclusions: Proximal parent artery stenosis greater than or equal to 50% and lobulation were independent predictors of incomplete occlusion in patients with SRAs. Higher rates of intraprocedural rupture, thromboembolic complications, intraprocedural vasospasm, and mortality were found in the complete occlusion group; however, these differences were not statistically significant. Complete occlusion of SRAs may be achieved without additional mortality and perioperative complications. [ABSTRACT FROM AUTHOR]

Objective We aimed to investigate the effect of coiling for small unruptured intracranial aneurysms (UIAs) (<5 mm) on progressive occlusion and recanalization, and the dubious factors related to progressive occlusion and recanalization among UIAs without complete occlusion. Methods A total of 264 patients with 287 small UIAs were coiled in our institution between June 2009 and December 2014. All UIAs were divided into small (3–5 mm) and very small (<3 mm) groups, and UIAs without initial complete occlusion were divided into progressive, stable, and recanalization groups. Baseline characteristics, procedure-related complications, angiographic follow-up results, and clinical outcomes were statistically analyzed. Results Among 287 aneurysms, 211 aneurysms (73.5%) were completely coiled, 3 (1.2%) had intraoperative ruptures, and 12 (4.2%) had perioperative thromboembolic events. Angiographic follow-up was available for 174 patients (65.9%), and the incidence of recanalization was 5.7%. Among 56 aneurysms without complete occlusion, 43 (76.8%) had progressive occlusion and 6 (10.7%) had recanalization. Anatomic results of initial and follow-up between the small and very small groups were similar. On logistic regression analysis, smaller size (<3 mm) without complete occlusion related to recanalization (odds ratio, 8.0, 95% confidence interval 1.3–50.0; P = 0.026). Conclusions Our study suggested that coil embolization of small UIAs can achieve a high rate of progressive occlusion and a low rate of recanalization during follow-up. Anatomic results of initial and follow-up between small (3–5 mm) and very small (<3 mm) groups were similar. Smaller size (<3 mm), without complete occlusion, may relate to recanalization. [ABSTRACT FROM AUTHOR]

Objective To compare the rates of recanalization and in-stent stenosis between the Enterprise (EP) and low-profile visualized intraluminal support (LVIS) stent deployments for intracranial aneurysms (IAs), and the factors associated therein. Methods Between June 2014 and July 2016, 142 patients with a total of 161 IAs were treated by LVIS stent-assisted coiling and 111 patients with a total of 142 IAs were treated by EP stent-assisted coiling at our institution. Procedure-related complications, angiographic follow-up results, and clinical outcomes were analyzed statistically. Results The rates of initially complete and near-complete IA occlusion immediately after the procedure were similar in the LVIS and EP groups (94.3% vs. 89.9%; P = 0.275). On follow-up, complete and near-complete occlusion rates and recanalization rates were also similar in the 2 groups (96.6% vs. 92.1%; P =0.330 and 8.0% vs. 13.5%; P = 0.245, respectively). On logistic regression analysis, a higher size ratio (SR) was significantly associated with the recanalization of aneurysms in the EP group, but not in the LVIS group. The rate of moderate to severe in-stent stenosis was lower in the LVIS group (10.2%) than in the EP group (16.8%), but the difference was not statistically significant ( P = 0.198). Conclusions Our data show acceptable rates of complete and near-complete occlusion with both the LVIS and EP stents. LVIS stents were associated with lower rates of recanalization and in-stent stenosis, but the difference was not significant. Higher SR (≥2) was a significant predictor of recanalization in IAs treated with EP stents, but not in those treated with LVIS stents. [ABSTRACT FROM AUTHOR]