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Purposes: We aimed to evaluate changes in subfoveal choroidal thickness (SFCT) and choroidal vascularity index (CVI) in the first postoperative day and month in patients with severe internal carotid artery (ICA) stenosis after ICA stenting., Method: The patients who diagnosed with severe ICA stenosis and was performed ICA stenting were included in the study. Patients with any ocular disease and refractive error more than 3 diopters were not included in the study. The imaging of the choroid was performed using enhanced depth imaging (EDI) techniques by spectral domain optical coherence tomography (SD-OCT) (OptovueRTVue XR, Optovue Inc., Fremont, CA).The choroidal vascularity index (CVI), total choroidal area (TA), luminal area (LA), and stromal area (SA) were measured in the subfoveal 2 mm area. These measurements before ICA stenting was compared with the first day and first month after ICA stenting., Results: The study included 41 eyes from 41 patients (11 women [26.83%]; 30 men [73.17%]). The mean age of patients was 62.25 ± 4.85 (57-71) years. The differences in subfoveal CT, TA, LA, SA between before ICA stenting and 1 day after ICA stenting, before ICA stenting and 1 month after ICA stenting was statically significant(p<0.05 for each)., Conclusion: We have observed ıncreases in SFCT, CVI, LA, SA, and TA on the 1st day and 1st month after ICA stenting in patients with severe carotid stenosis.  İmprovement in choroidal thickness and choroidal vascular flow is seen even in the early period of ICA stenting., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: The aim of this study was to investigate the safety and efficiency of the modified balloon assisted coiling (mBAC) technique in endovascular treatment (EVT) of ruptured wide-necked aneurysms (WNAs) to avoid stent placement in the acute phase of subarachnoid hemorrhage (SAH)., Methods: The local neurointerventional radiology database was retrospectively reviewed to identify patients who underwent EVT due to ruptured WNAs by the authors . According to the EVT technique performed, the study sample was divided into 3 groups: conventional BAC, stent assisted coiling (SAC), and mBAC. The patient demographics, aneurysm features, technical and clinical complications, aneurysm occlusion grades, morbidity, and mortality rates were comparatively analyzed., Results: This study involved a total of 113 patients who had ruptured WNAs. The mBAC technique was performed on 26 aneurysms (23 saccular and 3 fusiform) in 26 patients to avoid acute phase stenting. The mean continuous balloon inflation time was 7.1 ± 2.12 min. The initial and follow-up angiographic and clinical outcomes were better in the mBAC group than in the SAC group (p < 0.05)., Conclusions: The mBAC technique offers a prolonged, continuous balloon inflation time during the whole coiling process in the treatment of ruptured WNAs. The mBAC technique has the potential to obviate the need for SAC in patients who are candidates for stenting during the acute phase of SAH, and it might be considered a safe and effective endovascular approach with low complication rates and good angiographic and clinical outcomes.

Rationale and Objective: This study aimed to investigate the feasibility, safety, and efficiency rates of the bleb coiling technique for the treatment of acute ruptured wide-neck bifurcation aneurysm (WBNAs) by comparing it with device-assisted coiling., Materials and Methods: Patients with ruptured WNBAs who underwent endovascular treatment (EVT) were reviewed. The study sample was divided into five groups according to treatment type: bleb coiling, single catheter coiling, balloon-assisted coiling (BAC), neck remodeling mesh-assisted coiling, and stent-assisted coiling (SAC). The feasibility, safety, efficiency and complication rates of the bleb coiling technique were compared with each group., Results: This study included 109 patients with ruptured WNBAs. Bleb coiling was performed in 24 blebs of 20 WNBAs. The mean time interval between initial and complementary treatment in the bleb coiling group was 12.53± 5 .27 weeks (min-max: 4-23 weeks). No rebleeding occurred during this interval time, and no mortality or new permanent neurologic deficit caused by the bleb coiling technique was noted. The bleb coiling technique had a lower complication rate than other techniques (p <0.05)., Conclusion: The bleb coiling strategy led to favourable clinical outcomes with low complication rates and it can be considered as an alternative treatment option at acute phase of SAH in the endovascular treatment of ruptured WBNAs with coilable-bleb., Competing Interests: Conflict of interest The authors declare that there is no conflict of interest., (Copyright © 2021 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

Background: The aim of this study was to assess the technical success and procedural safety of the new Silk Vista device (SV) by evaluating the intraprocedural and periprocedural complication rate after its use in several institutions worldwide., Methods: The study involved a retrospective review of multicenter data regarding a consecutive series of patients with intracranial aneurysms, treated with the SV between September 2020 and January 2021. Clinical, intra/periprocedural and angiographic data, including approach, materials used, aneurysm size and location, device/s, technical details and initial angiographic aneurysm occlusion, were analyzed., Results: 60 aneurysms were treated with SV in 57 procedures. 66 devices were used, 3 removed and 63 implanted. The devices opened instantaneously in 60 out of 66 (91%) cases and complete wall apposition was achieved in 58 out of 63 (92%) devices implanted. In 4 out of 66 (6%) devices a partial opening of the distal end occurred, and in 5 (8%) devices incomplete apposition was reported. There were 3 (5%) intraprocedural thromboembolic events managed successfully with no permanent neurological morbidity, and 4 (7%) postprocedural events. There was no mortality in this study. The initial occlusion rates in the 60 aneurysms were as follows: O'Kelly-Marotta (OKM) A in 34 (57%) cases, OKM B in 15 (25%) cases, OKM C in 6 (10%) cases, and OKM D in 5 (8%) cases., Conclusions: Our study demonstrated that the use of the new flow diverter Silk Vista for the treatment of intracranial aneurysms is feasible and technically safe., Competing Interests: Competing interests: MMG is proctor and consultant for Balt, Medtronic and Stryker. PG is consultant for Phenox, Balt and Cerenovus. JGF is consultant for Medtronic and Balt. MSA is consultant for Medtronic and Balt. PN is consultant and proctor for Balt, Stryker and Penumbra. The rest of the co-authors have not declared any conflict of interesting regarding this manuscript., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Purpose: The aim of this study was to investigate the feasibility of the shelf technique by analyzing the angle between the two branch orifices and to present its safety and effectiveness compared with that of the double-stent technique., Materials and Methods: Patients with complex wide-neck bifurcation aneurysms (WNBAs) who underwent stent-assisted coiling (SAC) were reviewed. The study sample was divided into two groups: single SAC (shelf technique) and double SAC. The angle between the lines connecting the superior and inferior points of each branch orifice (α angle) was measured by two neurointerventional radiologists in both groups. The inter- and intraobserver repeatability and consistency of the α angle were assessed. The effect of the α angle on the feasibility of using the shelf technique to treat WNBA was analyzed. Technical and clinical success rates were investigated by comparing both groups., Results: Forty-eight patients (32 shelf technique and 16 double-stent technique) were included. There was excellent agreement between the intra- and interobserver repeatability and consistency of α angle measurements. The α angle was smaller in the shelf technique group than in the double-SAC group (p < 0.001). The technical and clinical success rates of both groups were similar based on long-term follow-up (p > 0.05)., Conclusion: WNBA treatment with the shelf technique is safe and effective. The α angle is a useful parameter to evaluate the performance of the shelf technique. The shelf technique is more suitable for WNBAs with a narrow α angle.

Background: The objective of this study was to present the long-term safety and effectiveness of strand remodelling with a hypercompliant balloon., Methods: Patients with complex wide-neck bifurcation aneurysms (WNBAs) who underwent strand remodelling with a hypercompliant balloon via Y-stent-assisted coil embolization (Y-SACE) between September 2016 and January 2020 were included in the study. The feasibility, safety, effectiveness, and complication rates of the strand remodelling technique were investigated., Results: A total of 12 patients (6 females, 6 males) were included in this study. Significant expansion was obtained in the intersection zone after remodelling. No regression was observed in the expansion rates during follow-up. There was no additional morbidity or mortality. No delayed thromboembolic complications occurred in our patients during long-term follow-up., Conclusions: Performing strand remodelling to reduce thromboembolic complications triggered by structural faults caused by the Y-stent configuration is feasible, safe, and effective. This new approach can aid in the prevention of thromboembolic complications in Y-SACE.

Background and Objective: An intracranial aneurysm (IA) is a life-threatening condition and endovascular treatment (EVT) is a demanding procedure, especially in IAs with an unfavorable anatomy. The aim of this study was to investigate the safety and efficacy of balloon-assisted microwire navigation and microcatheter positioning in the EVT of IAs with challenging anatomies., Materials and Methods: This retrospective study included patients that underwent balloon-assisted microwire navigation and microcatheter positioning in the EVT of IAs between September 2016 and January 2019. All EVT procedures and data collection were performed by the same two neurointerventional radiologists. Technical success and complication rates, safety, and efficiency of the balloon manipulation method were evaluated. Statistical software was used to analyze the basic descriptive data of the patients and aneurysms., Results: This study included 14 patients. The microwire navigation of the target artery with balloon manipulation was used in 4 aneurysms of 4 patients. Microcatheter positioning with balloon manipulation was used in 10 aneurysms of 10 patients. There was no complication caused by the balloon manipulation technique. The technical success rate was 100%., Conclusion: In the EVT of IAs with challenging anatomies, the presented technique is a safe and effective option without additional complications, especially in the target artery with an acute angle and in small aneurysms., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Indian Journal of Radiology and Imaging.)