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Background: Anterior choroidal artery (AChoA) aneurysms pose a challenge for both endovascular and clipping procedures. The eloquent territory supplied by the parent vessel has limited collateralization and its compromise can lead to significant morbidity. This study aims to analyze the clinical outcomes and procedure-related complications of clipping and endovascular treatment of AChoA aneurysms to aid physician decision making. Methods: Thirty-two ruptured and unruptured AChoA aneurysms that underwent catheter angiography at a single neurovascular center between January 2000 and December 2023 were included. Either conservative management, clipping, and/or endovascular treatment were performed. Clinical outcomes and complications were analyzed retrospectively. Results: Twenty-four endovascular treatments and seven clipping procedures were included. Of the total 24 endovascular procedures, 46% were primary coiling, 25% were balloon-assisted coiling, 13% were flow diverting stent, 8% were combined balloon-assisted coiling and flow diverting stent, and 8% were combined balloon-assisted and stent-assisted coiling. There was no procedure-related mortality in both groups. No intra- or post-procedural ruptures/re-ruptures occurred during follow-up in both endovascular and clipping cohorts. AChoA territory infarcts occurred in 4% of the endovascular and 29% of the clipping cohorts. Other thromboembolic complications occurred in 4% of the endovascular cohort. The recurrence rate requiring retreatment was 12.5% for the endovascular and 43% for the clipping cohort. A favorable clinical outcome (mRS ≤ 2) was 78% for the endovascular cohort and 67% for the clipping cohort. Conclusions: Endovascular and clipping outcomes align with prior studies, with endovascular showing a favorable safety profile. Both approaches are viable, though they present distinct risks and advantages. [ABSTRACT FROM AUTHOR]

To describe the mid-term safety and efficacy of Leo baby stent applied in saccular wide-neck intracranial aneurysms (IAs). 151 patients harboring 156 IAs treated with Leo baby stent from March 2021 to October 2023 were enrolled for further analysis. Among 156 IAs, 142 cases (91.0%) received one single Leo baby stent deployment while 14 cases (9.0%) received dual stents deployment. Stent-assisted coiling strategy was applied in all cases and the success rate was 100%. Immediate IAs occlusion results showed that 48 cases (30.8%) obtained Raymond grade I, 39 cases (25.0%) obtained Raymond grade II and 69 cases (44.2%) obtained Raymond grade III. Perioperative complications occurred in 10 cases (6.4%). Overall morbidity rate was 3.5% and mortality rate was 0% during follow-up. Clinical follow-up was available in 141 patients (93.4%). 136 patients (96.5%) got favorable clinical prognosis (mRS score 0–2) while 5 patients (3.5%) were in a poor neurological condition (mRS score 3–6). Angiographic follow-up was available in 136 cases (87.2%). The results showed that Raymond grade I was obtained in 112 cases (82.4%), Raymond grade II was obtained in 11 cases (8.1%) and Raymond grade III was obtained in 13 cases (9.6%). 4 cases (2.9%) were confirmed with IAs recurrence and received retreatment. Asymptomatic in-stent stenosis was detected in 8 patients (5.9%). The results demonstrate that stent-assisted coiling using Leo baby stent with favorable IAs embolization rate and the low complication rate is a feasible way in treating complex IAs. [ABSTRACT FROM AUTHOR]

Background: Wide-necked aneurysms of the posterior communicating artery associated with a fetal posterior cerebral artery that arises from the neck or dome of the aneurysm is a clinical scenario that poses a challenge to endovascular methods. Case description: A patient presented with spontaneous subarachnoid hemorrhage and was found to have a 4 × 3 × 3 mm posterior communicating artery aneurysm. Of note the aneurysm projected superiorly and a fetal posterior communicating artery aneurysm arose from the neck of the aneurysm. After multidisciplinary discussion a treatment strategy of endovascular stent-assisted coiling was chosen. Given the unique morphology of the aneurysm a novel stent-inversion maneuver was used, in which the stent was deployed from the posterior communicating artery into the distal supra-clinoid internal carotid artery. The patient tolerated the procedure well and complete aneurysm occlusion was achieved. Conclusions: This case demonstrates a novel stent inversion technique that can be used for stent-assisted coiling of certain challenging aneurysms. [ABSTRACT FROM AUTHOR]

Objective: To investigate the safety and efficacy of LVIS Jr stent-assisted coiling (SAC) of intracranial aneurysms (IAs) in small-diameter parent arteries and determine the factors influencing incomplete aneurysm occlusion. Material and Methods: Clinical and imaging data of 130 patients with IAs in small-diameter parent arteries that were treated with LVIS Jr SAC were retrospectively analyzed. Stent apposition was evaluated by high-resolution flat detector CT, and aneurysm embolization density was evaluated using 2D-DSA. Perioperative complications were recorded. Multivariate logistic regression analyses were performed to determine possible factors for incomplete aneurysm occlusion. Results: In this study, 130 patients (60 and 70 patients with ruptured and unruptured aneurysms, respectively) were successfully treated with LVIS Jr SAC. Immediate digital subtraction angiography (DSA) showed that the aneurysm occlusion was Raymond-Roy class I, II, IIIa, and IIIb in 93 (71.5%), 24 (18.5%), 8 (6.2%), and 5 (3.8%) cases, respectively. There were three cases of acute in-stent thrombosis and two cases of severe vasospasm observed during the perioperative period. The 6‑month follow-up angiograms indicated that complete aneurysm occlusion in 122 patients was 79.5% (97/122). Multivariate logistic regression analyses showed that an aneurysm size > 10.0 mm, parent artery mean diameter < 2.0 mm, and incomplete stent apposition at the aneurysm neck were possible risk factors for incomplete aneurysm occlusion. Conclusion: The LVIS Jr SAC is effective for managing IAs in small-diameter parent arteries. An aneurysm size > 10.0 mm, parent artery mean diameter < 2.0 mm, and incomplete stent apposition at the aneurysm neck are possible risk factors for incomplete aneurysm occlusion. [ABSTRACT FROM AUTHOR]

Stent-assisted coil embolization (SAC) is used for complex wide-necked aneurysms but can expose stent struts to the arterial lumen, leading to thrombosis. Herein, we report two cases of delayed thromboembolic stroke post-SAC. Case 1: A 71-year-old woman had an acute ischemic stroke 2 months after Y-stent SAC for a basilar artery aneurysm, and aspirin was prescribed post-procedure. Diffusion-weighted imaging revealed multiple scattered infarcts of various sizes in the posterior circulation. Case 2: A 72-year-old woman experienced an acute ischemic stroke 3 years post-SAC for a right posterior communicating artery aneurysm. The stroke occurred after discontinuation of antiplatelet therapy. Diffusion-weighted imaging revealed scattered acute infarctions in the right middle and anterior cerebral artery territories. These two cases of delayed thromboembolic stroke after SAC might have been due to stent strut exposure in the arterial lumen and concurrent thrombosis.

Endovascular management of narrow-necked aneurysms has traditionally been with coil embolization; however, wide-necked aneurysms have been more difficult to treat due to risk of distal coil migration or intrusion into a parent vessel. We describe the case of a 76-year-old female who presented with a left-sided renal artery aneurysm and 11 mm aneurysm neck. Renal arteriography of the superior pole branch was performed, lower pole was stented, and a retrievable stent was placed in the inferior branch for the purpose of stent-assisted coiling. Penumbra detachable coils were deposited through the stent struts to jail them in with successful embolization of the aneurysm. Endovascular treatment of wide-neck renal artery aneurysms has the potential to be a successful treatment alternative in patients where surgical intervention is contraindicated. Additional studies should be performed to determine the versatility and extent of success in coil embolization for wide-neck aneurysms.

Isolated posterior communicating artery (PCoA) aneurysms are rare, predominantly fusiform in morphology, and rarely present with subarachnoid hemorrhage. Endovascular management of this pathology is technically challenging due to extreme tortuosity, the artery course in the subarachnoid space, sharp angulations at PCoA junctions with the parent artery, and, at times, associations with either internal carotid artery or basilar artery occlusions. We present a case of a ruptured fusiform PCoA at the junction of middle and distal third with concomitant proximal basilar artery occlusion. The PCoA reforms the posterior circulation, making it a vital artery. Stent-assisted coiling was performed with extreme difficulty in achieving distal positioning of the stents in the basilar artery/posterior cerebral artery/distal PCoA due to artery tortuosity. There was technical difficulty in the stent deployment. After changing strategies to a larger diameter laser-cut stent, endovascular treatment could be performed. There were good angiographic and clinical outcomes with stable occlusion at 6-month-follow-up.

Isolated posterior communicating artery (PCoA) aneurysms are rare, predominantly fusiform in morphology, and rarely present with subarachnoid hemorrhage. Endovascular management of this pathology is technically challenging due to extreme tortuosity, the artery course in the subarachnoid space, sharp angulations at PCoA junctions with the parent artery, and, at times, associations with either internal carotid artery or basilar artery occlusions. We present a case of a ruptured fusiform PCoA at the junction of middle and distal third with concomitant proximal basilar artery occlusion. The PCoA reforms the posterior circulation, making it a vital artery. Stent-assisted coiling was performed with extreme difficulty in achieving distal positioning of the stents in the basilar artery/posterior cerebral artery/distal PCoA due to artery tortuosity. There was technical difficulty in the stent deployment. After changing strategies to a larger diameter laser-cut stent, endovascular treatment could be performed. There were good angiographic and clinical outcomes with stable occlusion at 6-month-follow-up. [ABSTRACT FROM AUTHOR]

Endovascular management of narrow-necked aneurysms has traditionally been with coil embolization; however, wide-necked aneurysms have been more difficult to treat due to risk of distal coil migration or intrusion into a parent vessel. We describe the case of a 76-year-old female who presented with a left-sided renal artery aneurysm and 11 mm aneurysm neck. Renal arteriography of the superior pole branch was performed, lower pole was stented, and a retrievable stent was placed in the inferior branch for the purpose of stent-assisted coiling. Penumbra detachable coils were deposited through the stent struts to jail them in with successful embolization of the aneurysm. Endovascular treatment of wide-neck renal artery aneurysms has the potential to be a successful treatment alternative in patients where surgical intervention is contraindicated. Additional studies should be performed to determine the versatility and extent of success in coil embolization for wide-neck aneurysms. [ABSTRACT FROM AUTHOR]

In preliminary studies, advanced intracranial stents appear to have a favorable safety profile for intracranial aneurysm treatment. This dual-center study is a head-to-head comparison of the low-profile Acandis Acclino stent (a third-generation stent) and the first- and second-generation Enterprise stent. Patients who underwent stent-assisted coiling with either the Enterprise or the Acclino stent for unruptured aneurysms during an 8-year period were enrolled and compared for complications, clinical outcomes, and angiographic results. Primary outcome measures were ischemic stroke rate and mid-term complete occlusion rate. Propensity score adjustment was performed to account for small differences between the groups. Enterprise and Acclino stents were used in 48 cases each. The overall rate of thrombotic complications was higher in the Enterprise group than in the Acclino group (20.8% vs. 4.2%, HR: 6.6, 95%CI: 2.2–20.0, P = 0.01, adjusted P < 0.01), which translated into a higher rate of major ischemic stroke after Enterprise treatment (6.3% vs. 0%, HR: 2.1, 95%CI: 1.8–2.4, P = 0.08, adjusted P < 0.01). Mid-term and long-term angiographic follow-up showed complete occlusion rates of 83.3% and 75.0% for Enterprise and 89.2% and 75.9% for Acclino (both P > 0.05). Retreatment rates were 10.4% in the Enterprise group and 4.2% in the Acclino group (P = 0.42, adjusted P = 0.10). The results indicate a favorable safety profile of the Acclino over the Enterprise, justifying the use of advanced stent systems in clinical practice. However, further comparative studies of the Acclino and other competing stent systems are needed to draw a definitive conclusion on the state of stent-assisted coiling. [ABSTRACT FROM AUTHOR]

Objectives: To identify independent risk factors for intraoperative in-stent thrombosis (IST) in paraclinoid aneurysms (PAs). Methods: 172 PA patents undergoing stent-assisted coiling (SAC) were divided into an IST group (n = 12) and a non-IST group (n = 160). Clinical characteristics, aneurysm morphologies, and laboratory parameters were measured. We performed independent t tests (for normally distributed data) or nonparametric tests (for non-normally distributed data) to compare continuous parameters. Multivariate logistic regression analysis with a stepwise forward method was conducted to determine independent risk factors. Receiver operating characteristic curves were generated, and the Delong test was employed for comparisons. Results: Independent risk factors for IST included size ratio (SR) (p < 0.001, odds ratio [OR] = 3.909, confidence interval [CI] = 1.925-7.939), adenosine diphosphate (ADP) inhibition (p = 0.028, OR = 0.967, CI = 0.938-0.996), and reaction time (R) (p = 0.006, OR = 0.326, CI = 0.147-0.725). The combined factors (SR, ADP inhibition, and R) exhibited area under the curves of 0.870, 0.720, 0.716, and 0.697, with cutoff values of 2.46, 69.90%, and 4.65, respectively. Conclusion: The SR, ADP inhibition, and R values were independent risk factors for the IST in the PAs undergoing SAC. For PAs with a large SR, surgeons could prepare for long-term dual antiplatelet therapy before SAC. [ABSTRACT FROM AUTHOR]

Background: Duplicate origin of the middle cerebral artery (MCA) is a rare variation of MCA, often mislabeled as the fenestration of the M1 segment of MCA. Case Description: The authors treated an unruptured aneurysm, 8 mm in diameter, associated with a duplicate origin of MCA in a 42-year-old woman who underwent magnetic resonance imaging for transient vertigo. Clipping surgery was inapplicable due to the lack of space to insert clip blades between the neck and two origins of MCA. Under stent-assisted maneuver, the aneurysm sac was successfully obliterated using three coils, resulting in Raymond-Roy class 1 occlusion status. Digital subtraction angiography performed 3 months after the embolization showed complete obliteration of the aneurysm. So far, only 11 patients with aneurysms associated with duplicate origin of MCA have been reported. We performed a literature review of this very rare combination. The size of aneurysms ranged from 2 to 8 mm, with a mean of 5.2 mm. The neck of the aneurysm is mainly located at the corner between the inferior limb and the internal carotid artery. Ours is the youngest and has the largest aneurysm. Conclusion: Aneurysm can arise from duplicate origin of MCA, for which stent-assisted coiling may be an appropriate treatment modality. [ABSTRACT FROM AUTHOR]

This study aims to identify the efficacy and safety of stent-assisted coiling (SAC) treatment of ruptured intracranial aneurysms (RIAs) combined with intracranial haematoma (ICH) compared to coiling alone or balloon-assisted coiling (non-SAC). A retrospective analysis of 54 consecutive patients receiving endovascular therapy from 2014 to 2020 was performed. The data collected included baseline characteristics, angiographic results, perioperative complications, immediate aneurysm occlusion, clinical outcomes, follow-up at discharge and after 6 months, hospitalisation costs, and inpatient length of stay. Patients were categorised into the SAC group and the non-SAC group. Univariate and multivariate logistic regression analyses were used to identify risk factors related to clinical outcomes. Of the 54 patients harbouring RIAs with ICH, 22 (40.74%) and 32 (59.26%) patients were subject to SAC and non-SAC treatments, respectively. Postoperative rebleeding (1 [4.5%] and 3 [9.3%] in SAC and non-SAC groups, respectively, p > 0.05) and Hunt-Hess grade (IV-V) lesions (13.6% vs. 40.6%, p = 0.067) did not differ between the two groups. In total, 10 (45.5%) patients treated with SAC received a Fisher scale score of 0–3 compared with 6 (18.8%) patients treated with non-SAC methods (p = 0.035). Compared with the non-SAC group (7/21.9%), the rate of wide-necked aneurysms was increased in the SAC group (11/50%) (p = 0.031). No differences in poor outcomes (mRS > 2) were noted between the SAC and non-SAC groups (p > 0.05). Multivariate analysis revealed that ischaemic complication events (p = 0.016) represent the only independent risk factor for adverse outcomes, and a trend towards unfavourable clinical outcomes was noted for patients who smoke (p = 0.087). SAC is a safe and efficient treatment for RIAs combined with ICH when dual antiplatelet therapy (DAPT) is used in the perioperative period. In addition, SAC should be preferentially used in wide-neck RIAs. Ischaemic complications are a risk factor for poor clinical outcomes. Given the small sample size and retrospective bias of this study, these findings should be further verified in a study with a larger sample size or a randomised controlled trial (RCT). [ABSTRACT FROM AUTHOR]

Background: To evaluate the efficacy of stent-assisted coiling (SAC) for the treatment of carotid ophthalmic segment aneurysm segment aneurysms (OSAs) of the internal carotid artery (ICA) through detailed long-term follow-up of a large patient cohort. Methods: We retrospectively analyzed 88 consecutive patients with OSAs between January 2009 and January 2020 ​at our center. Angiographic results were evaluated using the modified Raymond grading system and clinical outcomes were evaluated using the mRS scale. The primary endpoints were major aneurysm recurrence and poor clinical outcomes for at least 18 months of follow-up. The patients were asked to attend clinical follow-up assessments and possibly undergo DSA or MR via telephone. Results: We enrolled 88 patients with 99 OSAs treated with coiling, of whom 76 were treated with SAC. The coiling procedures were successful in all 88 patients. Overall, complications occurred in 8 patients (9.1%). No procedure-related mortality was observed. 67 (76.1%) experienced immediate aneurysm occlusion at the end of the procedure. Long-term angiographic follow-up (18 months) was available in 45/88 aneurysms (51%) (average 18.7 ​± ​5.2 months). Four patients continued their follow-up for 5 years after initial aneurysm treatment. After a clinical follow-up time of 28.7 months (range, 12–51 months), 85 patients (95.5%) achieved favorable clinical outcomes (mRS scores of 0–2). Conclusions: This study indicates that SAC treatment is a safe and effective therapeutic alternative for ruptured and unruptured OSAs. The procedural risks are low with relatively long-term effectiveness.

Background: Several different endovascular and non-invasive treatment methods are suggested for the various types of intracranial aneurysms including simple, balloon-assisted, and stent-assisted coiling (SAC). Previous studies investigated the safety and efficacy of SAC versus non-stent-assisted coiling (non-SAC) but the results were controversial. We aim to perform a systematic review and meta-analysis to compare the efficacy and safety of SAC with non-SAC technique in stratifying by the ruptured and unruptured aneurysms. Methods: PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials were searched in April 2022 for studies investigated the efficacy and safety of SAC versus non-SAC. Results: Overall, 26 studies entered into our qualitative and quantitative synthesis. We found that there was overall lower recurrence rate in SAC versus non-SAC significant (RR: 0.43, 95%CI: 0.33, 0.53). Furthermore, the comparisons were significant in unruptured (RR: 0.63, 95%CI: 0.40, 0.86), ruptured (RR: 0.29, 95%CI), and combination aneurysms (RR: 0.42, 95%CI: 0.30, 0.54). Also, we found higher risk of intraprocedural rupture for SAC versus non-SAC in unruptured aneurysms (RR: 1.40, 95%CI: 1.31, 1.50). Investigating hemorrhagic events risk showed that there was significant difference in ruptured (RR: 1.73, 95%CI: 1.12, 2.34) and combination aneurysms (RR: 0.60, 95%CI: 0.37, 0.82). There was no significant difference in immediate occlusion rate, complete occlusion, and risk of ischemic events in our analysis. Conclusion: Overall, our findings demonstrated that SAC may have higher efficacy in term of recurrence rate, but also may have a higher risk of complications in the treatment of intracranial aneurysms. As there are several factors affecting the outcomes and safety of these interventions, further RCTs controlled for multiple factors are required better guide the neurointerventionists choose the best strategy.

Treatment of blood blister-like aneurysms (BBAs) of the supraclinoid internal carotid artery (ICA) with flow diverters (FDs) has become widespread in recent years. However, ruptured blood blister-like aneurysm (BBA) of ICA treatment with flow diverter-assisted coil embolization (FDAC) remains controversial. Moreover, limited direct comparative studies have been conducted between the two treatment modalities, FDs and FDAC, for BBAs. The purpose of this study was to document our experience and evaluate the effectiveness and safety of FDAC. We conducted a retrospective analysis of clinical and radiological information from ten patients who experienced ruptured BBAs of the supraclinoid ICA at our center from January 2021 to February 2023. The technical details of FDAC for ruptured BBAs were described, and the technical steps were named "pipeline embolization device (PED)-Individualized shaping(microcatheter)-Semi deploying-Rivet(coils)-Massage(microwire)" as the PEISSERM technique. Clinical outcomes were assessed using the modified Rankin Scale (mRS), whereas radiological results were determined through angiography. A pooled analysis was implemented, incorporating data from literature sources that reported perioperative and long-term clinical and angiographic outcomes of ruptured BBAs treated with FD and FDAC strategies, along with our data. Data in our analysis pool were categorized into FD and FDAC strategy groups to explore the preferred treatment modalities for BBAs. The PEISSERM technique was utilized to treat ten patients, seven males, and three females, with an average age of 41.7 years. A single PED was deployed in conjunction with coils in all ten patients. All PEDs were documented to have good wall apposition. The immediate postoperative angiograms demonstrated Raymond grade I in ten aneurysms. Angiographic follow-up of nine patients at 4–25 months showed total occlusion of the aneurysms. At the most recent follow-up, the mRS scores of nine patients hinted at a good prognosis. Pooled analysis of 233 ICA-BBA cases of FD revealed a technical success rate of 91% [95% confidence interval (CI), 0.88 to 0.95], a rate of complete occlusion of 79% (95% CI, 0.73 to 0.84), a recurrence rate of 2% (95% CI, 0.00 to 0.04), a rebleed rate of 2% (95% CI, 0.00 to 0.04), and the perioperative stroke rate was 8% (95% CI, 0.04 to 0.11). The perioperative mortality was 4% (95% CI, 0.01 to 0.07). The long-term good clinical outcome rate was 85% (95% CI, 0.80 to 0.90). The mortality rate was 6% (95% CI, 0.03 to 0.09). Results from the subgroup analysis illustrated that the FDAC strategy for BBAs had a significantly higher immediate postoperative complete occlusion rate (P < 0.001), total occlusion rate (P = 0.016), and a good outcome rate (P = 0.041) compared with the FD strategy. The FDAC strategy can yield a higher rate of good outcomes than the FD strategy. The PEISSERM technique employed by the FDAC is a reliable and effective treatment approach as it can minimize the hemodynamic burden of BBA's fragile dome, thereby achieving an excellent occlusion rate. The PEISSERM technique in the FDAC strategy contributes to understanding the BBA's treatment and offers a potentially optimal treatment for BBA. [ABSTRACT FROM AUTHOR]

Background and purpose Flow diverters have emerged as viable alternatives for the retreatment of recanalized aneurysms following stent-assisted coiling embolization. In this study, we aim to present our experience of retreatment for such aneurysms using the pipeline embolization device (PED). Materials and methods This case series presents a retrospective single-center analysis of patients with recanalized aneurysms who underwent retreatment using the PED between July 2019 and April 2023, subsequent to stent-assisted coiling embolization. Results The study includes five female patients, whose relevant clinical data were recorded. All patients had aneurysms located in the internal carotid artery, comprising two blood blister-like aneurysms and two giant aneurysms. Prior to the retreatment, two LVIS stents, two enterprise stents, and one solitaire stent were implanted. Among the five patients, one experienced a fatal post-operative subarachnoid hemorrhage, while two patients achieved complete embolization, and another patient achieved near-complete embolization during the last follow-up. Furthermore, one patient faced challenges during the placement of the PED and was unable to achieve successful deployment. We propose four overlapping relationships between a newly implanted PED and a previously deployed stent: (1) PED covering only the proximal end of the previous stent, (2) PED covering only the distal end of the previous stent, (3) PED covering both the proximal and distal ends of the previous stent, and (4) PED deployed within the previous stent. Antiplatelet therapy at our center involved daily dual therapy with aspirin (100 mg/day) and clopidogrel (75 mg/day) for at least 5 days before PED placement. Intra-arterial bolus administration of tirofiban (5 mcg/kg) was administered during or immediately after PED deployment, followed by a maintenance dose of 0.08 mcg/kg/min IV infusion for at least 24--48 h if necessary. Postprocedural dual antiplatelet therapy included clopidogrel (75 mg/day) for 6 months and aspirin (100 mg/day) for 12 months. Conclusion The findings of this study support the efficacy of the PED for the retreatment of recanalized aneurysms following stent-assisted coiling embolization. [ABSTRACT FROM AUTHOR]

Objectives of the study. Our aim was to analyse different antithrombotic drug regimens and duration in intracranial stenting procedures (stent assisted coiling, flow diverter) for unruptured aneurysms and based on the literature review from 2017-2023 to implement dual antiplatelet therapy algorithm for neuro-interventional procedures in Lithuania. Research methods and methodology. A comprehensive literature search of PubMed, BioMed Central, BMJ Journals, EBSCO Publishing, SAGE Journals Online, ScienceDirect, SpringerLink was conducted by two independent readers (MP, GŠ) for studies published from January 2017 to April 2023. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA) guidelines were followed. 23 studies: 6 retrospective cohort, 11 retrospective casecontrol, 1 prospective cohort, 1 prospective randomized-control, 1 systemic literature review, 3 metanalysis observational studies were identified. Results and conclusions. We found widespread variation in practices even among the same country centres, lending credence to the importance of a future prospective studies of dual antiplatelet drug therapy (DAPT) regimens and duration for the purpose of deriving optimal methods and streamlining tactics. Our suggested algorithm for DAPT in neuro-interventional procedures in Lithuania is provided in Graph 1. [ABSTRACT FROM AUTHOR]

BACKGROUND: The microsurgical treatment of paraclinoid aneurysms can be challenging due to the anatomical structures that surround them. OBJECTIVE: This study compared the clinical and angiographic outcomes of unruptured paraclinoid aneurysms treated with enterprise (EP) stents and low-profile visualized intraluminal support (LVIS) stents. METHODS: A retrospective analysis of the clinical and radiological data from 133 patients with 139 unruptured paraclinoid aneurysms, who received an EP or an LVIS stent between January 2017 and June 2021 at Taizhou People's Hospital, was performed. Immediate postoperative and follow-up angiographic results were analyzed retrospectively using the Raymond-Roy occlusion classification (RROC). Any complications following the procedure and the patients' clinical outcomes were noted. RESULTS: Enterprise stents were used for stent-assisted coiling in 64 patients with 68 aneurysms and LVIS stents were used in 69 patients with 71 aneurysms. Both groups exhibited an increase in the proportion of aneurysms meeting the criteria for RROC class I, but the LVIS group demonstrated a higher rate of aneurysms meeting the class I criteria compared with the EP group, both on immediate postoperative angiography (45.1% vs. 11.8%, p < 0.001) and on follow-up angiography (94.9% vs. 80.6%, p = 0.025). Procedure-related complications were experienced by 9.4% of patients in the EP group (one coil prolapse, two parent artery occlusions, and three thromboembolic events), and 8.7% of patients in the LVIS group (three stent-related thrombosis and three thromboembolic events). There were no statistically significant differences between the two groups in relation to perioperative complications (p = 0.746) or favorable clinical outcomes (p = 0.492). CONCLUSION: A greater proportion of aneurysms in the LVIS group met the criteria for RROC class I compared with the EP group. There is no significant difference in procedural complications or clinical outcomes between EP and LVIS stents. Although no aneurysm recurrence was observed during the short follow-up period, continued monitoring is required. [ABSTRACT FROM AUTHOR]

Highlight: • Endovascular treatment is recommended for aneurysms • Wide-neck aneurysm is difficult to treat with endovascular approach. • Stent-assisted coiling and flow diverter are choices for wide-neck aneurysms ABSTRACT A wide-neck aneurysm, described as an aneurysm with a neck of 4 mm or a dome-to-neck ratio of

Highlight: • Dual antiplatelet is the gold standard for endovascular treatment of wide-neck aneurysms. • The role of dual antiplatelet is to prevent stent thrombosis after treatment. • The thrombosis rate reported during stent-assisted coiling is quite high. ABSTRACT Stent-assisted coiling (SAC) in wide-neck aneurysm treatment is associated with antiplatelet use. Dual antiplatelet therapy (DAPT) has been the gold standard for protecting against thrombosis events and is widely accepted for endovascular embolization treatment with a stent-assisted or flow diverter. Some patients experience vascular events due to the reduced efficacy of antiplatelet agents despite taking DAPT. The reported thrombosis rates during stent-assisted coiling embolization range from 2% to 20%. Thromboembolic complications, such as in-stent thrombosis, can manifest in 4.6% of cases. The correlation between platelet reactivity during treatment and bleeding events remains unclear. However, the association between High Residual Platelet Reactivity (HRPR) or hyporesponsiveness and ischemic events is well established. Based on various laboratory definitions, hyperresponsiveness in patients with clopidogrel occurs in about 14–30% of patients due to major and minor bleeding. Therefore, the optimization of antiplatelet therapy has developed significantly in the neurointerventional community.

Background: The management of middle cerebral artery (MCA) aneurysms remains a controversial topic, and MCA aneurysms have traditionally been treated primarily by surgical clipping. The Neuroform Atlas Stent™ (NAS, available from Stryker Neurovascular, Fremont, California) represents the latest generation of intracranial stents with improved stent delivery system capabilities. Objective: This study aims to investigate the safety, feasibility and efficacy exhibited by NAS in treating unruptured aneurysms at the MCA bifurcation. Methods: This was a two-center retrospective study involving 42 patients with unruptured wide-necked aneurysms (WNAs) of the MCA treated with the NAS from October 2020 to July 2022. Results: The stent was used to treat 42 cases of unruptured WNA at the MCA bifurcation. Endovascular treatment techniques had a 100% success rate. Immediate postoperative angiography found complete aneurysm occlusion in 34 patients (80.9%) (mRRC 1), neck remnant in 7 patients (16.7%) (mRRC 2), and residual aneurysm in 1 patient (2.4%) (mRRC 3). The thromboembolic complication rate was 2.4% (1/42). The follow-up period was 8.7  months on average (3–16  months). The last angiographic follow-up results revealed complete aneurysm occlusion in 39 patients (92.9%) (mRRC 1), neck remnant in 3 (7.1%) patients (mRRC 2), no aneurysm recanalization or recurrence, and no cases of stent intimal hyperplasia. During the latest clinical follow-up, all patients had an mRS score of 0. Conclusion: Our study demonstrates that the NAS can be applied to treat unruptured WNAs at the MCA bifurcation with favorable safety, feasibility, and efficacy. [ABSTRACT FROM AUTHOR]

The use of periprocedural dual antiplatelet therapy (DAPT) has significantly evolved along with innovations in the endovascular management of intracranial aneurysms. Historically, aspirin and clopidogrel have been the most commonly employed regimen due to its safety and efficacy. However, recent studies highlight the importance of tailoring DAPT regimens to individual patient characteristics which may affect clopidogrel metabolism, such as genetic polymorphisms. In the present report, a systematic review of the literature was performed to determine optimal antiplatelet use with flow diverting stents, intracranial stents, intrasaccular devices, and stent-assisted coiling. Studies were analyzed for the number of aneurysms treated, DAPT regimen, and any thromboembolic complications. Based on inclusion criteria, 368 studies were selected, which revealed the increasing popularity of alternative DAPT regimens with the aforementioned devices. Thromboembolic or hemorrhagic complications associated with antiplatelet medications were similar across all medications. DAPT with ticagrelor, tirofiban, or prasugrel are effective and safe alternatives to clopidogrel and do not require enzymatic activation. Further clinical trials are needed to evaluate different antiplatelet regimens with various devices to establish highest-level evidence-based guidelines and recommendations. [ABSTRACT FROM AUTHOR]

Objective: Superior hypophyseal artery (SHA) aneurysms are intradural, and their rupture can result in subarachnoid hemorrhage. Considering the related surgical difficulty and anatomical restrictions, endovascular treatment (EVT) is considered the most favorable modality for SHA aneurysms; however, the long-term outcomes of EVT have rarely been reported. The study assessed the incidence of and risk factors for recurrence of SHA aneurysms after EVT as well as the correlation factors for SHA aneurysm rupture. Methods: We included 112 patients with SHA aneurysms treated with EVT at our facility between 2009 and 2020. Here, EVT included non-stent-assisted (simple or balloon-assisted) or stent-assisted coiling. Flow diverter was not included because it was barely used due to its high cost under our national insurance's limitation, and a high proportion of ruptured aneurysms in our series. Univariate and multivariate logistic regression was performed to evaluate the correlation factors for SHA aneurysm rupture, along with the incidence of and risk factors for post-EVT SHA aneurysm recurrence and re-treatment. Results: In our patients, the mean angiographic follow-up period was 3.12 years. The presence of type IA or IB cavernous internal carotid artery (cICA) was strongly correlated with SHA aneurysm rupture. Recurrence occurred in 17 (13.4%) patients, of which only 1 (1.4%) patient had received stent-assisted coiling. All cases of recurrence were observed within 2 years after EVT. The multivariate logistic regression results showed that ruptured aneurysm and non-stentassisted coiling were independent risk factors for aneurysm recurrence. Of the 17 cases of aneurysm recurrence, 9 (52.9%) received re-treatment. Moreover, aneurysm rupture was the only factor significantly correlated with re-treatment in multivariate logistic regression. No re-recurrence was observed when a recurrent aneurysm was treated with stent-assisted coiling. Conclusion: Type I cICA was common factor for aneurysm rupture. Although flow-diverter treatment serves as another suitable technique that was not compared with, coils embolization was effective treatment modality for SHA aneurysms, leading to low recurrence and complication rates, especially with stent use. All cases of recurrence occurred within 2 years after EVT; they were strongly associated with prior aneurysm rupture. Further stent-assisted coiling was noticed to prevent re-recurrence. [ABSTRACT FROM AUTHOR]

Wide-necked aneurysms represent a challenge for treatment in the setting of acute subarachnoid hemorrhage. Stent-assisted coiling (SAC) and balloon-assisted coiling (BAC) are well-known techniques for treating wide-necked aneurysms. Comaneci-assisted coiling (CAC) is a newer technique involving temporary stent deployment to assist aneurysm coiling. We aim to present the first meta-analysis comparing these treatments of ruptured aneurysms. Following PRISMA guidelines, PubMed and Embase databases were queried from earliest records to July 2022 for literature reporting SAC, BAC, or CAC of ruptured intracranial aneurysms. A meta-analysis of identified articles was performed. Of the 571 articles queried, 64 articles were included. One study reported BAC and SAC, 8 reported BAC, 52 reported SAC, and 3 reported CAC. These studies comprised 3153 patients with 3207 ruptured aneurysms treated with CAC (161 patients and aneurysms), BAC (330 patients and aneurysms), and SAC (2662 patients, 2716 aneurysms). Rates of periprocedural thromboembolic or hemorrhagic complications, overall or procedure-related mortality, immediate complete occlusion, retreatment, and length of angiographic follow-up did not differ significantly between SAC and BAC. Periprocedural thromboembolic (P = 0.03) and hemorrhagic (P = 0.01) complication rates were higher with BAC than CAC. Periprocedural thromboembolic (P = 0.03) and hemorrhagic (P < 0.0001) complication rates were higher with SAC than CAC. Complete aneurysm occlusion rates (P = 0.033) were higher with CAC than BAC. No significant differences were present in CAC versus BAC or SAC retreatment rates. CAC was associated with lower hemorrhagic and thromboembolic complication rates and demonstrated similar complete occlusion and residual retreatment rates to those for BAC and SAC. [ABSTRACT FROM AUTHOR]

Unruptured intracranial aneurysms are often discovered incidentally on noninvasive imaging. As use of noninvasive imaging has increased, our understanding of the presumed prevalence of intracranial aneurysms in adults has increased. Incidentally found aneurysms are often asymptomatic; however, they can rarely rupture and cause life-threatening illness. Elective treatment of intracranial aneurysms carries risks which need to be considered along with patient-specific factors (e.g., anatomy, medical comorbidities, personal preferences). In this article, we review the natural history, risk factors for cerebral aneurysm formation and rupture, evidence for medical management, and the safety profile and efficacy of available endovascular treatment options. [ABSTRACT FROM AUTHOR]

Background and purposePrecise stent deployment is important for successful treatment of intracranial aneurysms by stent-assisted coiling (SAC). We evaluated the accuracy of virtual stents generated using commercial stent planning software by comparing the length of virtual and actually deployed intracranial laser cut stents on three-dimensional digital subtraction angiography (3D-DSA) images.MethodsWe retrospectively analyzed the data of 75 consecutive cases of intracranial wide-necked aneurysms treated with the SAC technique using laser cut stents. Based on 3D-DSA images acquired by C-arm CT, stent sizing and placement were intraoperatively simulated by a commercial software application. The difference in length of the stents was estimated by measuring proximal discrepancies between the end points of the virtual and actually deployed stents on fused pre-procedural and post-procedural 3D-DSA images. Discrepancies between distal stent end points were manually minimized. The Kruskal-Wallis test was applied to test whether stent location, type, and length had an effect on difference in length between virtual and real stent.ResultsThe median difference in length between virtual and real stents was 1.58 mm with interquartile range 1.12-2.12 mm. There was no evidence for an effect of stent location (p = 0.23), stent type (p = 0.33), or stent length (p = 0.53) on difference in length between virtual and real stents.ConclusionsStent planning software allows 3D simulation of laser cut stents overlain on 3D-DSA images of vessels and may thus be useful for stent selection and deployment of laser cut stents during stent-assisted coiling of intracranial aneurysms.

Background and objectiveStent-assisted coil embolization is a well-established treatment of intracranial wide-necked aneurysms. The Neuroform Atlas Stent System is a new generation microstent designed to enhance coil support, conformability, deliverability, and improve deployment accuracy. We present the 1-year efficacy and angiographic results of the Humanitarian Device Exemption (HDE) cohort from the Atlas Investigational Device Exemption (IDE) clinical trial.MethodThe Atlas IDE trial is a prospective, multicenter, single-arm, open-label study of unruptured wide-necked intracranial aneurysms treated with the Neuroform Atlas stent and approved coils. The primary efficacy endpoint was the rate of 12-month complete aneurysm angiographic occlusion (Raymond class I) without target aneurysm retreatment or significant parent artery stenosis (>50%) at the target location. The primary safety endpoint was the rate of major ipsilateral stroke or neurological death within 12 months. Imaging core laboratory and Clinical EventsCommittee adjudicated the primary endpoints.Results30 patients were enrolled at eight US centers, with 27 patients completing the 12-month angiographic follow-up. The mean age was 59.4±11.8 years and 24/30 patients (80%) were women. The mean aneurysm size was 5.3±1.7 mm and the dome:neck ratio was 1.1±0.2. Procedural technical success of Neuroform Atlas Stent deployment was 100%. 27 patients completed 12-month angiographic follow-up and 30 patients completed their 6-month follow-up. When applying the last observation carried forward method, the primary efficacy endpoint was observed in 26/30 patients (86.7%, 95% CI 69.3% to 96.2%) compared with 25/27 patients (92.6%, 95% CI 75.7% to 99.1%) who completed the 12-month angiographic follow-up. The primary safety endpoint of stroke occurred in one patient (3.3%), who made a complete clinical recovery at discharge. There were no neurological deaths.ConclusionThe Neuroform Atlas stent in conjunction with coils demonstrated a high rate of complete aneurysm occlusion at 12-month angiographic follow-up, with an improved safety profile in the HDE cohort.Clinical trialgov registration numberNCT0234058;Results.

Aneurysms in the posterior circulation and distal sites are more common among the pediatric population than among adults, with a male predominance. Symptoms of an aneurysm in the posterior circulation can include a stiff neck or severe headache due to a ruptured aneurysm, whereas an unruptured aneurysm can cause mass effects or neurological deficits. However, in children, the complete occlusion of the aneurysm while preserving the flow of the main artery can be difficult to achieve when attempting a stent-assisted coil embolization technique. A 25-month-old girl presented with left hemiparesis and was diagnosed with a basilar artery aneurysm 10 months prior, but she did not receive any specific treatment. No history of trauma and no significant familial history were recorded. Angiography showed a fusiform aneurysm on the basilar artery trunk, which was successfully occluded using stent-assisted coiling following dual antiplatelet therapy with clopidogrel and aspirin. She was discharged with the complete restoration of motor deficits.

Purpose: This study aimed to evaluate the feasibility, safety, and efficacy of Y-stent-assisted coiling (Y-SAC) using LEO Baby® stents in treating of bifurcation aneurysms. Methods: Patients who underwent Y-SAC using a braided stent (LEO Baby®, Montmorency, France) for wide-necked intracranial aneurysms between 2009 and 2019 and whose radiological and clinical follow-up data for at least 6 months could be obtained were evaluated. Data were obtained from patient records and analyzed retrospectively. Results: We evaluated 111 patients with a mean age of 56.0 ± 10.8 years (range, 25–88 years). Most of the aneurysms were detected incidentally. Three patients had ruptured aneurysms. LEO Baby deployment and coiling were successful in all patients. Immediate aneurysm occlusion rates were determined as modified Raymond-Roy classification (mRRC) I 95.5% (n = 106), mRRC II 3.6% (n = 4), mRRC IIIa 0.9% (n = 1). In the sixth month, aneurysm occlusion rates were found to be complete and nearly complete in all patients (mRRC I 94.6%, n = 105 and mRRC II 4.5%; n = 5, respectively). Follow-up data of 91 patients for > 2 years were obtained. Of these, 88 had MRRCI obstruction and 3 had MRRC II obstruction. The overall complication rate was 4.8%, and one patient died during the post-procedural follow-up. Conclusion: The long-term follow-up results of Y-stenting with LEO Baby revealed that it provides stable closure of the aneurysm sac while preserving the main arterial structures. Therefore, it is a safe, durable, and effective method for treating wide-necked and complex bifurcation aneurysms. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the feasibility of the low-profile visualized intraluminal support (LVIS)-within-enterprise double-stent technique for patients with acutely ruptured intracranial vertebrobasilar artery-dissecting aneurysms (ari-VBDAs). Methods: A total of 30 patients with ari-VBDAs who underwent reconstructive treatment using LVIS-within-enterprise double-stent technique with coil embolization between January 2014 and May 2022 were retrospectively enrolled. Patients' characteristics and clinical and imaging outcomes were reviewed. The functional outcomes were assessed using the modified Rankin scale (mRS). Results: A total of 34 ari-VBDAs were identified, including seven (20.6%) basilar artery aneurysms and 27 (79.4%) vertebral artery aneurysms. All aneurysms were successfully treated in the acute phase. In total, six (20.0%) patients experienced in-hospital serious adverse events, including two deaths (6.7%). The median clinical follow-up time of the remaining 28 patients was 20.0 (IQR, 7.3-40.8) months. The incidences of dependency or death (mRS score of 3-6) at discharge and at the last follow-up were 16.7% and 14.3%, respectively. Aneurysm rebleeding occurred in one (3.3%) patient periprocedurally. In total, three (10.0%) patients had ischemic events, one of which occurred during the periprocedural period and two occurred during follow-up. A total of two patients (6.7%) underwent ventriculoperitoneal shunt. Imaging follow-up was available for 14 patients at the median of 12.0 (IQR, 7.0-12.3) months, with a complete occlusion rate of 93.3% (14/15). In total, one patient experienced parent artery occlusion, and no aneurysm was recanalized. Conclusion: LVIS-within-enterprise double-stent technique with coil embolization for the treatment of patients with ari-VBDAs could be performed with a good safety profile and high technical success rate. The rate of complete aneurysm occlusion during follow-up seemed to be satisfactory. [ABSTRACT FROM AUTHOR]

Objective: Stent-assisted coiling has been increasingly used in the treatment of intracranial aneurysms. However, its application in ruptured bifurcation aneurysms remains controversial and challenging. This study aimed to present the safety and feasibility of low-profile visualized intraluminal support (LVIS™, LVIS, and LVIS Jr.) stent for acutely ruptured bifurcation aneurysms. Methods: A total of 41 patients with acutely ruptured intracranial aneurysms arising at the bifurcation were treated with LVIS™ stent-assisted coiling in our hospital between January 2017 and December 2021. The clinical data and angiographic results of the patients were analyzed. Results: Among these patients, all stents were successfully implanted. According to the immediate angiographic results, 29 aneurysms (70.7%) were completely occluded. Intraoperative thrombosis and hemorrhage occurred in two and one cases, respectively. No post-operative thrombosis or rebleeding events were observed. The clinical follow-up of all patients revealed that 38 (92.7%) cases had favorable outcomes (modified Rankin scale: 0–2). The angiographic results available for the 36 patients during the follow-up period revealed complete occlusion was achieved in 30 patients (83.3%) and residual neck in six patients. Conclusion: The LVIS™ stent-assistant coiling is a safe and feasible option for acutely ruptured bifurcation aneurysms. Further studies with a prospective design, a larger sample size, and long-term follow-up are needed to validate these findings. [ABSTRACT FROM AUTHOR]

Abstract Background Stent-assisted coiling (SAC) has been reported as a feasible and effective treatment of wide-neck cerebral aneurysms. However, the evidence of SAC of ruptured cerebral aneurysm is lacking. There are no prospective multicenter studies regarding SAC of acutely ruptured aneurysms within 72 hours after subarachnoid hemorrhage. The purpose of the study is to evaluate the safety and efficiency of SAC of acutely ruptured cerebral aneurysms. Methods This study is a prospective, multicenter, and observation registry of consecutive patients with acutely ruptured cerebral aneurysms treated with SAC. Acutely ruptured aneurysms were confirmed within 72 h after the onset of the syndrome. This study will enroll at least 300 patients in 7 high-volume tertiary hospitals (more than 150 cerebral aneurysms treated per year). The primary outcomes are treatment-related thromboembolic complications within 30 days of the treatment. The secondary outcomes are any hemorrhagic complications and aneurysm recurrence at 6 months of angiographic follow-up. The clinical outcomes are measured with the Modified Rankin Scale (mRS) at discharge and at the 6 months of follow-up. The favorable outcomes are defined as an mRS of grades 0 and 2. Discussion We will perform a prospective, multicenter, and observational registry study of consecutive patients with wide-neck acutely ruptured cerebral aneurysms to improve the safety strategy of SAC of acutely ruptured cerebral aneurysms. Trial registration Chinese Clinic Trial Registry: ChiCTR2000036972 ; Registration date: Aug 26, 2020

Dissecting intracranial aneurysms (DIAs) have been treated through endovascular reconstructive manners, such as flow diverters (FDs) and stent-assisted coiling (SAC). Notably, no robust evidence has compared both approaches. Hence, the authors conducted a meta-analysis to compare their outcomes.PubMed, Embase and Web of Science were searched for studies employing SAC and FD treatment for DIAs. The following outcomes were considered for extraction: procedure-related mortality, total mortality, postoperative and follow-up complete aneurysm occlusion, complications, good clinical outcomes, recurrence, and retreatment. Odds ratio (OR) with random effects was employed for statistical comparison.The meta-analysis included 10 studies. A total of 195 and 222 patients were included in the FD and the SAC group, respectively. Stent-assisted coiling had higher postoperative complete aneurysm occlusion rates (OR 0.03; 95% CI 0.01–0.08). Flow diverter retreatment rate was lower, but without statistical significance (OR 0.35; 95% CI 0.11–1.10). No significant differences were found in follow-up complete aneurysm occlusion (OR 1.18; 95% CI 0.35–3.99); total mortality (OR 0.44; 95% CI 0.09–2.08); intraoperative complications (OR 0.30; 95% CI 0.06–1.45); postoperative complication (OR 0.77; 95% CI 0.35–1.70); good clinical outcomes (OR 0.97; 95% CI 0.43–2.20); and recurrence (OR 0.38; 95% CI 0.13–1.10) between the two groups.Stent-assisted coiling shows higher postoperative complete aneurysmal occlusion rates, but both techniques achieve similar rates in angiographic follow-up. Flow diverter has lower, but not statistically significant, retreatment rates than SAC. Both techniques have similar complication rates. Future randomized, multicenter, and prospective studies with larger sample sizes are needed for more conclusive findings. [ABSTRACT FROM AUTHOR]

Dual antiplatelet therapy (DAPT) of aspirin plus clopidogrel is commonly used in patients with unruptured intracranial aneurysms treated with stent-assisted coil (SAC) embolization. However, the unpredictable clopidogrel efficacy of the 5%–55% nonresponders limits its use. Ticagrelor, as a potential alternative of clopidogrel, is an antiplatelet agent with low resistance rates but uncertain efficacy and safety in these patients. A single-center cohort study was performed to compare the efficacy and safety of ticagrelor with clopidogrel in the DAPT regimen in patients with unruptured intracranial aneurysms and treated with SAC. The patients with clopidogrel resistance identified as inadequate adenosine diphosphate inhibition rate determined by thromboelastography were treated with ticagrelor instead, and both drugs achieved adequate suppression of platelet aggregation when stents were implanted. The occurrence of major adverse cardiovascular and cerebrovascular events (MACCE) and bleeding events was recorded through 6 months follow-up. Data from 86 patients with 99 unruptured intracranial aneurysms and treated by SAC with clopidogrel were compared with those from 108 patients with 111 aneurysms and treated with ticagrelor. Neither the baseline characteristics nor the incidence of the MACCE or bleeding events differed between the groups. Ticagrelor exerted significantly higher adenosine diphosphate inhibition rate than that of the clopidogrel. Multivariable logistic regression analysis showed that the incidence of MACCE was related to hematocrit and fibrinogen levels. Ticagrelor seemed to be as effective and safe as clopidogrel for SAC in unruptured intracranial aneurysms. Hematocrit and fibrinogen levels were independent risk factors for the incidence of MACCE. [ABSTRACT FROM AUTHOR]

Kissing aneurysms are an unusual type of multiple intracranial aneurysms having different origins with partially adherent walls. Although endovascular treatment is a useful alternative to surgical clipping, endovascular management for small wide-necked kissing aneurysms has not been adequately investigated to date. Herein, we present a case of small wide-necked kissing aneurysms successfully treated with transradial stent-assisted coiling (SAC) using the "dual-jailing" technique. We also performed a review of the relevant literature. A 64-year-old woman who was diagnosed with small wide-necked kissing aneurysms relating to the ophthalmic artery underwent SAC using the dual-jailing technique. After a 6F Simmons guiding sheath was delivered into the target common carotid artery via transradial access, a 6F intermediate catheter was navigated into the petrous internal carotid artery to achieve both triple microcatheter manipulation and contrast injection. Two coil-delivery microcatheters were cannulated into each aneurysm, followed by a Neuroform Atlas stent deployment over the aneurysm necks via a third stent-delivery microcatheter. By using the jailed microcatheters, SAC of the kissing aneurysms was successfully achieved, preserving the ophthalmic artery. The postprocedural course was uneventful. A follow-up magnetic resonance angiography showed no evidence of recanalization 2 years 3 months post procedure. The dual-jailing technique may provide simple and time-saving SAC compared with previous reported method. This technique can be a useful treatment option for small wide-necked kissing aneurysms. [ABSTRACT FROM AUTHOR]

Purpose: Pediatric basilar artery aneurysms are rare and challenging to treat. Microsurgical options and standard endovascular coiling are often undesirable choices for treatment of this pathology. Additional endovascular strategies are needed. Methods: Presentation, diagnosis, and management of pediatric basilar aneurysms were reviewed, with an emphasis on endovascular treatment strategies. Our case series of 2 patients was presented in detail, one treated with flow diversion and vessel sacrifice and one treated with stent-assisted coiling. An extensive review of the literation was performed to find other examples of pediatric basilar artery aneurysms treated with endovascular techniques. Results: Twenty-nine studies met inclusion criteria. Fifty-nine aneurysms in 58 patients were treated using endovascular techniques. Mortality rate was 10.3% (6/58) and a poor outcome (GOS 1–3) occurred in 15.5% (9/58). There were 4 reported recurrences requiring retreatment; however, only 46.5% of patients had reported follow-up of at least 1 year. 71.1% (42/59) were dissecting aneurysms. Conclusion: Basilar artery aneurysms in the pediatric population are rare, commonly giant and fusiform, and often not amenable to microsurgical or coiling techniques. The surrounding vasculature, location, size, and morphology of the aneurysm along with the durability of treatment must be considered in treatment decisions. With proper patient selection, stent-assisted coiling and flow diversion may increase the durability and safety of endovascular treatment in this population. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the safety and effectiveness of the double microcatheter technique in the treatment of ruptured aneurysms of the anterior cerebral circulation. Methods: Between 2012 and 2019, 113 patients with ruptured aneurysms of the anterior cerebral circulation were treated using the double microcatheter technique. Clinical records, angiographic results, and procedure-related complications were reviewed. Clinical and angiographic follow-up was performed. Results: Complete occlusion, neck remnant, and partial occlusion were, respectively, recorded in 56.6, 38.9, and 4.4% of the total cases. For all patients, the incidence of intraoperative complications was 5.3% (6/113), and the overall rate of morbidity was 10.6% (12/113). Before discharge, three patients (2.7%) died. There was no procedure-related mortality. At discharge, favorable outcomes were observed in 79.6% (90/113) of the patients. High Hunt-Hess grades and receiving a craniotomy or external ventricular drainage were risk factors for clinical outcomes at discharge. Clinical follow-up was performed in 91 patients at a mean interval of 14.07 ± 11.68 months. At follow-up, favorable outcomes were observed in 92.3% (84/91) of the patients. Angiographic follow-up was performed in 66 patients at an average of 11.53 ± 11.13 months. The recurrence rate was 37.9%. Of these patients, 13 (19.7%) received retreatment. Conclusion: The double microcatheter technique can be performed in ruptured aneurysms with high technical success and low morbidity/mortality. However, recurrence remains a problem, and patients should be followed up regularly. [ABSTRACT FROM AUTHOR]