Aneurysm Recurrence Research Articles

Aneurysm clipping on WEB device: A feasibility study using a human ex-vivo aneurysm model.

The Woven EndoBridge (WEB) device is a breakthrough in brain aneurysm treatment, widely used for intracranial wide neck and complex aneurysms, especially at bifurcations. Although effective, aneurysm recurrence can occur post-treatment and the impact of clipping angle on the WEB mesh remains unclear. In this study, using a human placenta-based ex-vivo aneurysm model, we simulated the application of aneurysm clipping on WEB-treated aneurysms to elucidate the technical aspects and nuances, particularly the influence of the angle of clip application on WEB collapse. Human placentas were used to create aneurysms by suture-closing of the placenta vessels. The WEB devices were positioned in the aneurysms under fluoroscopic guidance, and different clip positions/angles on the WEB device were tested. Imaging was used to monitor the effects of clipping on the WEB device and aneurysm. All clipping positions achieved complete aneurysm occlusion, collapsing the WEB mesh with no flow observed into the aneurysm. Despite the WEB device's displacement within the sac, no significant morphological changes to the aneurysm were identified, and the presence of a neck remnant did not affect the adequacy of blade apposition. Microsurgical clipping reliably collapses the WEB device, regardless of its placement or orientation. Our model suggests that clipping can effectively address in-vivo recurrences and persistent aneurysm filling of aneurysms treated with the WEB device. The model does not assess the influence of WEB healing within the aneurysm. Operators should be aware of possible WEB shape changes when clipping its mesh.

Addressing residual and recurrent aneurysms post-Woven EndoBridge device embolization: a systematic review and meta-analysis

BackgroundEarly literature on the Woven EndoBridge (WEB) device reported 80–90% adequate aneurysm occlusion but low complete occlusion (40–55%). It is uncertain whether residual or recurrent aneurysms require re-treatment to prevent...

Pipeline embolization device for aneurysm recurrence after stent-assisted coiling.

Since the emergence of the Pipeline Embolization Device (PED), its off-label use has significantly improved the treatment effectiveness of complex intracranial aneurysms, including the treatment of recurrent aneurysms. Although PED is effective in this situation, there is still a lack of evidence-based medicine for its role in recurrent aneurysms after stent-assisted coiling. The aim of this study is to evaluate the safety and efficacy of PED treatment for recurrent aneurysms after stent-assisted coiling. This study included 10 patients who underwent stent-assisted coiling but subsequently received PED treatment again due to aneurysm recurrence or rebleeding. The mean time between initial treatment and subsequent treatment is 12months. Clinical outcomes include complications and modified Rankin Scale (mRS) scores, as well as evidence of complete occlusion. All PEDs were successfully placed, with one case of minor perioperative complications. During the 6-month follow-up after PED implantation, 10 cases of recurrent aneurysms were completely occluded without any adverse clinical sequelae. In one case of vertebral artery aneurysm, balloon dilation was performed before placing PED due to arterial stenosis proximal to the aneurysm. The use of PED to treat recurrent aneurysms after stent-assisted coiling is a safe and effective treatment method.

Safety and efficacy of staged coiling followed by flow diverter in the treatment of ruptured intracranial aneurysms.

To evaluate the safety and efficacy of staged coiling followed by flow diverter (FD) in the treatment of ruptured intracranial aneurysms(RIAs). A retrospective analysis was conducted on 20 patients with RIAs treated with staged coiling followed by FD at a single center, between April 2015 and September 2024. Patient demographics, aneurysm characteristics, clinical and imaging outcomes were reviewed. Aneurysm occlusion was determined using the O'Kelly-Marotta (OKM) grading system. All 20 RIAs underwent successful first-stage coiling. In the second stage, 21 FD were deployed, achieving a 100% success rate. The mean maximum diameter of aneurysms was 10.2 (6.3, 20.7) mm, with a neck width of 6.1 (4.2, 7.8) mm. The interval between the first and second stages was 33.3 ± 23 days. One patient (5%) experienced ischemic complications during the first-stage coiling, but no hemorrhagic complications occurred. In the second stage, FD placement was performed without any hemorrhagic or ischemic complications. All 20 patients (100%) received clinical follow-up with a median follow-up time of 182(172.5,190.5) days.14 patients(70%) underwent available DSA follow-up with a median follow-up time of 184 (158.3, 194.8) days, and the OKM grade B was reported in 1 case (7.1%), grade C in 1 case (7.1%), and grade D in 12 cases (85.7%). No aneurysm recurrence was observed. At the last follow-up, all 20 patients had an mRS score of ≤ 1. Staged coiling followed by FD placement for the treatment of RIAs is a safe and effective approach, with a high technical success rate, low perioperative complication rate, and high aneurysm occlusion rate during follow-up.

Analysis of the efficacy and factors affecting the prognosis of intracranial dissecting aneurysm treated with multi-stent overlap technique

ObjectiveThe study aims to identify characteristics that impact the postoperative prognosis and recurrence of intracranial dissecting aneurysms (IDA) patients treated using multi-stent overlapping techniques.MethodsClinical data from 69 IDA patients treated with multistate-assisted spring coil embolization at the hospital between January 2017 and October 2023 were retrospectively reviewed, including clinical and imaging data gathered at admission and discharge. The prognosis was determined based on mRS grade at discharge, and the patients were divided into excellent prognosis (mRS 0–2 points) and poor prognosis (mRS 3–6 points). They were split into two groups: recurrence and no-recurrence, based on whether the patients had recurrence during surgical follow-up. The patient’s clinical information and aneurysm data were compared between the two groups to better understand the efficacy of multi-stenting for IDA and to investigate the factors that influence the good or negative prognosis of multi-stenting for IDA and recurrence.ResultsThe prognosis was poor in 10 patients, 7 of whom died, while 59 had an excellent prognosis. Hunt-Hess classification (χ2 = 25.503a, P = < 0.01), hospitalization days (t=-3.873, P < 0.01), operation time (t=-1.970, P = 0.049), and aneurysm height (t=-1.969, P = 0.049) were all significant. 62 patients were discharged with 4 postoperative recurrences and 58 without recurrences in patients treated with multiple stents, with significant differences in the largest diameter (t=-2.235, P = 0.025), basal length (t=-2.149, P = 0.032), and position(located in pica base or not ) (χ2 = 10.955a, P = 0.001). The postoperative recurrence rate was 5.8%, but 85.8% reported satisfactory neurologic function (mRS ≤ 2). The case fatality rate was 10.1%.ConclusionHunt-Hess grading on admission, aneurysm high, and operation time affect the prognosis of IDA, Hunt-Hess grade was an independent risk factor for prognosis. Aneurysm size, longest diameter, basal length, and location at the base of the pica affect recurrence. Located in pica base by the dissecting aneurysm is an independent risk factor for recurrence.

Recurrent Traumatic Hepatic Pseudo Aneurysm from Accessory Right Hepatic Artery A Case Report

Hepatic artery pseudoaneurysm is a known complication after liver trauma There are not clear guidelines for detection of pseudoaneurysms after blunt hepatic trauma however it can cause life-threatening complications such as rupture and hemorrhage In most cases Hepatic pseudoaneurysms are successfully managed with angioembolization

The association of statin therapy with reduced intracranial aneurysm recurrence after endovascular coiling: a post hoc propensity score-matched analysis of a randomized clinical trial.

Endovascular intracranial aneurysm (IA) management has significantly evolved over the last 2 decades. Despite these advancements, the aneurysm recanalization rate after coil embolization remains a concern. Statins have been found to affect vascular repair and remodeling; therefore, the authors hypothesized that patients receiving statin therapy at the time of coil embolization would have lower aneurysm recurrence and retreatment rates compared with patients not receiving statin therapy. A post hoc analysis was conducted of the primary data from patients enrolled in the Hydrogel Endovascular Aneurysm Treatment Trial focusing on the impact of statin use on the recurrence rates of 3- to 14-mm IAs after endovascular coiling. The primary outcome measured included aneurysm recurrence over 18-24 months using the Raymond-Roy Occlusion Classification. Secondary outcomes included major and minor recurrence rates and retreatment rates. Propensity score matching based on patient and aneurysm characteristics was performed to mitigate selection bias. A total of 577 patients with data on statin use were eligible for this analysis. Of these, 178 (30.8%) patients were using statins and 399 (69.2%) were not. After propensity score matching, 156 (39.2%) patients were included in the statin group and 242 (60.8%) in the nonstatin group. The recurrence rate was 3.8% (6/156) in the statin group and 10.7% (26/242) in the nonstatin group (p = 0.013). In a subgroup analysis, statin use significantly reduced recurrence in patients with unruptured aneurysms (1.6% vs 9.7%, p = 0.005), but not in those with ruptured aneurysms (12.5% vs 13.6%, p = 0.876). Statin use was associated with a reduced rate of aneurysm recurrence in patients who underwent endovascular coiling for IAs with a decreased rate of retreatment during the follow-up period. Statins are a relatively low-risk treatment and may be an effective therapy to reduce recanalization of IAs, although further prospective studies are warranted to validate these findings.

Endovascular Treatment of Unruptured Wide Necked Cerebral Aneurysms Larger Than 9 mm Affects Re-treatment and Prognosis in the Elderly: A Retrospective Analysis of Unruptured Aneurysms.

Background and purpose The risk of rupture increases with advancing age. However, the risk-benefit of coil embolization for elderly patients with unruptured aneurysms is controversial. This study aimed to identify factors associated with treatment primary outcomes, including risk factors for complications and aneurysm recurrence requiring re-treatment in the endovascular treatment of unruptured aneurysms in elderly patients.In addition, deterioration of the modified Rankin Scale (mRS) was examined as a secondary outcome. Materials and methods This retrospective three-center study examined 112 cases of coiled unruptured aneurysms in patients aged ≥ 60 years using endovascular registry data from January2018 to March 2022. We examined patient background, aneurysm characteristics, adjuvant technique, symptomatic complications, and mRS scores. Results The average age of the patients was 72.5±6.9 years, and 83 cases (74.1%) were female. During the postoperative follow-up period (six to 36 months), no deaths occurred, one case of postoperative rupture was observed, and nine patients (5.4%) were re-treated. Notably, age, underlying disease, aneurysm location, and re-treatment were not associated with complications. In the multivariate logistic analysis for re-treatment, symptomatic complications [odds ratio (OR) 11.01; 95% confidence interval (CI), 3.68-52.5; p < 0.001] and re-treatment (OR 3.25; 95% CI, 1.04-10.7; p = 0.039) were independently associated with mRS score deterioration. The risk factors for re-treatment were maximum aneurysm diameter and aneurysm neck diameter; aneurysms with neck diameters and maximum diameters > 5.0 mm and > 9.0 mm, respectively, had a higher rate of need for re-treatment (33%) and mRS score deterioration (33%) due to re-enlargement of the aneurysm. Conclusion In this study, complications did not increase with age in those aged 60 and older. However, prioritizing the avoidance of complications in elderly patients is important. Elderly patients with aneurysms larger than 9 mm have a poor prognosis and require additional attention for re-treatment.

Endovascular Embolization Through Grafts for Recurrent Giant Complex Internal Carotid Artery Aneurysms After Combined Microsurgical Low-Flow With Subsequent High-Flow Revascularization and Parent Artery Occlusion

BACKGROUND AND IMPORTANCE: The case describes the management of a giant and recurrent aneurysm in a patient. The treatment involved a combination of microsurgical protective low-flow, followed by high-flow revascularization and parent artery occlusion. CLINICAL PRESENTATION: The patient presented with severe headaches and progressive visual impairment. Brain magnetic resonance imaging revealed a giant saccular intracranial aneurysm in the left internal carotid artery. The examination also revealed hypoplasia of the right anterior cerebral artery and a fetal-type left posterior cerebral artery originating from the neck of the aneurysm. Considering the location and size of the aneurysm, a combination of endovascular and microsurgical approaches was applied. A protective low-flow procedure was followed by high-flow revascularization and occlusion of the parent artery. After 12 months, the aneurysm recanalized through the graft. To address the recurrence of giant complex aneurysms, endovascular embolization was performed through the radial artery grafts. These interventions showed positive midterm outcomes for the patient's giant aneurysm. CONCLUSION: In the treatment of complex giant aneurysms, it is important to consider both endovascular and microsurgical approaches as complementary, rather than mutually exclusive. Endovascular embolization using radial artery grafts may be used when dealing with retrograde recanalization and the challenges associated with accessing the aneurysm.

A new technique for the treatment of venous popliteal aneurysms using the axillary vein: Medium and long-term results.

Venous popliteal aneurysms are a rare but serious disease due to the risk of pulmonary embolism. Aneurysms larger than 20 mm in diameter or with an embolic episode should be treated. The classic surgical technique is the tangential resection of the aneurysm with venorraphy, which raises the risk of recurrence. We report a series of patients treated with a new technique consisting of aneurysmal resection and reconstruction using the axillary vein. The primary objective was to evaluate the patency of the transposed venous graft. The secondary objectives were to study the feasibility of the technique, the continence of the transplanted valve, the risk of aneurysmal recurrence, and the clinical consequences on the treated lower limb and at the donor site. All the adult patients treated with this technique between October 2006 and May 2023 were included. Post-traumatic venous aneurysms, iatrogenic aneurysms, and those associated with vascular malformations were excluded. Ultrasound follow-up was obtained 3, 6 and 12 months after the operation, then annually and evaluated the patency and the diameter of the venous graft, and the continence of the valve. The clinical consequences at the donor and recipient site were collected. 11 patients were enrolled, including seven men, with an average age of 55 (46-77) years. All the patients had symptoms: 10 had a history of pulmonary embolism and one suffered from deep venous insufficiency with dyspnea. The average diameter of the venous aneurysm was 29 mm (14-45 mm). The mean follow-up was 65 months (4-191) with only one patient lost to follow-up after nine months. No bypass thrombosis was observed with ultrasound and venous-CT follow-up, and the transposed valve remained continent in all the patients. There were no embolic recurrences after surgical treatment. The average diameter of the venous bypass was 10.5 mm (7-12), without aneurysmal recurrence. No complications were observed at the harvesting site. Our study confirmed the feasibility of this alternative technique, with good long-term results with a 100% patency rate without any aneurysmal recurrence. It confirmed the continence of the transposed valve with a good tolerance at the donor site. The number of patients treated in this study was limited, but it highlights an interesting alternative to treat these venous lesions.

A Novel Combined Microsurgical and Endovascular Approach for Type II Endoleak Embolization Through Direct Puncture of a Lumbar Segmental Artery: A Technical Case Instruction

BACKGROUND AND IMPORTANCE: Despite the advances in endovascular aortic repair techniques, type II endoleaks with aneurysm sac expansion remain frequent and challenging problems. CLINICAL PRESENTATION: An elderly gentleman underwent a combined microsurgical and endovascular procedure to address a type 2 endoleak and the growth of a recurrent abdominal aortic aneurysm caused by direct puncture of a lumbar segmental artery. The patient tolerated the procedure well and was discharged without complications. Follow-up imaging revealed no further endoleak and a smaller aneurysm size. CONCLUSION: This unique case presents a novel multidisciplinary surgical strategy for treating complex, recurrent aortic aneurysms with type II endoleaks. The approach is tailored to the individual patient and has shown effectiveness. Long-term follow-up data will be crucial for assessing the efficacy and durability of this approach.

The natural history of portal venous system aneurysms.

Portal venous system aneurysms (PVAs) are increasingly diagnosed on cross-sectional computed tomography imaging. However, the natural history of these aneurysms is poorly understood, and reports are limited to small case series. Terms relevant to PVAs were searched in radiology reports (2010-2022), with PVA presence confirmed by manual review. PVA were defined as a diameter greater than 1.5cm in patients without cirrhosis and 1.9cm in those with cirrhosis. Aneurysm growth was defined as greater than 20% increase in size, whereas aneurysm regression was defined as greater than 20% decrease in size. Patient demographics, comorbid conditions, and PVA outcomes were abstracted. Univariate statistics were used to compare groups. Thirty-eight aneurysms with radiographic follow up were identified in 35 patients, involving the portal vein (n= 18; 47.4%), splenic vein (n= 10; 26.3%), superior mesenteric vein (n= 3; 7.9%), and portal confluence (n= 7; 18.4%). Although 12 (31.6%) were idiopathic, the remaining 26 (68.4%) were associated with portal hypertension (n= 20; 52.6%) and prior liver transplant (n= 4; 10.5%). The median growth was 0.2cm (range,-2.6 to 2.4cm) over median follow up over 5.0years (range, 0.3-16.6 years). Five PVAs (13.2%) regressed and were largely idiopathic (80.0%; P= .03). Thirteen PVAs (34.2%) grew and were associated with portal hypertension (n= 11; 84.6%; P= .003) and thrombosis (n= 6; 46.2%; P= .05). Nine PVAs (23.7%) thrombosed, predominantly in males (n=7; 77.8%). The median growth was 1.0cm (range,-0.7 to 1.9cm). Three patients (33.3%) were symptomatic from PVA thrombosis including abdominal pain (n= 2; 22.2%), intestinal ischemia (n= 1; 11.1%), and variceal bleeding (n= 2; 22.2%). Four patients (44.4%) were treated with anticoagulation. No aneurysms ruptured. Of the 58 PVAs initially identified with and without radiographic follow up, five (8.6%) underwent intervention with a median diameter of 4.0cm (range, 3.4-5cm). Intervention included vein ligation (n= 1; 20.0%), aneurysmorrhaphy (n= 1; 20.0%), and aneurysmectomy (n= 3; 60.0%). There was one case of aneurysm recurrence 20years following resection and one postoperative mortality. Two-thirds of PVAa, including those with size greater than 3cm, remain stable on surveillance. Although annual surveillance is initially recommended to confirm PVA stability, interval imaging can be subsequently extended given low growth rates. Over 20% of PVAs thrombosed, but none ruptured. Although we did not observe any cases of rupture, the devastating consequences of rupture necessitate consideration of surgical intervention for large symptomatic PVAs.

Microsurgical treatment of cerebral aneurysms after endovascular treatment (systematic review of the literature). Part 2

To conduct a systematic review of the literature on microsurgical treatment of recurrent and residual aneurysms after unsuccessful endovascular treatment, determine the surgical technique features depending on the cause of aneurysm recurrence, localization, size, and shape of the aneurysm, and analyze treatment outcomes, including radical exclusion, complication rates, and clinical outcomes. Despite technical difficulties, microsurgical treatment of residual and recurrent aneurysms is a safe and effective method in most cases, with only a small number of patients requiring unconventional techniques such as coil removal, thrombectomy, or deconstructive procedures combined with revascularization. Aggressive treatment is recommended in all cases where long-term angiographic follow-up shows an increasing residual or recurrent aneurysm.

Para-Anastomotic Pseudoaneurysms as a Long-Term Complication After Surgical Treatment of Peripheral Artery Disease: Clinical Characteristics and Surgical Treatment.

Background: Peripheral arterial disease (PAD) is becoming an increasingly prevalent clinical issue, leading to a growing number of patients requiring surgical interventions. Consequently, there is an increasing occurrence of para-anastomotic aneurysms as late complications following primary treatment for PAD. These aneurysms typically arise at the sites of graft implantation and necessitate individualized management strategies based on factors such as location, size, and the patient's overall condition. Materials and Methods: This five-year retrospective study, conducted at a single center, aimed to evaluate the anatomical location, clinical presentation, diagnostic methods, and management strategies for 55 patients treated for femoral and popliteal artery para-anastomotic pseudoaneurysms of the lower limb between January 2018 and June 2024. Treatment approaches were determined based on aneurysm size, the extent of atherosclerosis, and the patient's surgical risk. This study analyzed patient demographics, surgical techniques, postoperative complications, and aneurysm characteristics. Results: Most pseudoaneurysms occurred between 6 and 10 years after the primary procedure. The most common surgical intervention was aneurysmectomy with graft interposition, performed in 46 patients (83.64%), followed by aneurysmectomy with extra-anatomical bypass in 6 patients (10.91%), and endovascular repair (EVAR) in 3 patients (5.45%). Early postoperative complications occurred in 16.36% of patients. The 12-month freedom from graft stenosis was 87.23%, and freedom from anastomotic aneurysm recurrence at 12 months was 100%. Conclusions: This study highlights the critical need for individualized treatment strategies and ongoing surveillance in managing lower-limb para-anastomotic pseudoaneurysms, particularly given the prevalence of lower-limb pain and the high occurrence of such in the common femoral artery. The favorable long-term graft patency rates observed suggest that aneurysmectomy with graft interposition is an effective intervention, reinforcing its role as the primary approach within this patient population.

Safety and efficacy of Neuroform Atlas stent-assisted coiling for the treatment of distal intracranial aneurysms: A single-center experience

ObjectiveTo investigate the effectiveness, safety, and efficacy of Atlas stents in the treatment of distal intracranial aneurysms (IAs). MethodsWe retrospectively analyzed patients with IAs who underwent stent-assisted coiling (SAC) from January 2018 to January 2022 and divided them into two groups: distal IAs treated with Atlas SAC and wide-necked aneurysms in other locations treated with SAC. The clinical data, imaging data, and postoperative follow-up data for the two groups of patients during hospitalization were collected. ResultsFifteen patients were included in the distal IA group, and 332 patients were included in the non-distal IA group. The baseline data for the two groups of patients were compared, and significant differences in aneurysm locations, whether the aneurysm had ruptured, and the width of the aneurysm neck were found between the two groups. In the distal IA group, all stents were successfully placed and released during the operation. No aneurysm rupture occurred during the operation. Immediate postoperative digital subtraction angiography (DSA) showed complete embolization of the aneurysm in 10 patients. Ischemic complications occurred perioperatively in two patients. The postoperative follow-up showed a poor prognosis (modified Rankin scale (mRs) > 2) in three patients and aneurysm recurrence in one patient. No significant differences in the treatment effect, surgical complications, or follow-up results were found between the two groups. ConclusionIn this series, the use of Atlas SAC for the treatment of distal IAs was not associated with higher complication rates, and shows satisfactory long-term occlusion rates and follow-up results.

Age-Related Differences in Clinical Characteristics and Outcomes of Aneurysmal Subarachnoid Hemorrhage: A Retrospective Study of 657 Patients

Aneurysmal subarachnoid hemorrhage (aSAH) has an incidence of 6-7 per 100,000 person-years. Despite advancements in treatment, 26% of patients die, and 19% remain dependent post-hemorrhage. Long-term neuropsychological sequelae affect about half of the survivors, significantly impacting their quality of life. This study aims to assess aSAH characteristics and identify predictive factors of clinical outcomes in young patients. A retrospective study analyzed 657 aSAH patients treated at two South Korean medical centers from January 2011 to December 2023. Data on demographics, comorbidities, smoking history, clinical grades, aneurysm size and location, and outcomes were collected. Outcomes were classified using the modified Rankin Scale (mRS), with scores ≤2 indicating good outcomes. The cohort included 233 men and 424 women (male-to-female ratio 1:1.8). Most patients were middle-aged (74.4%), followed by young (16.7%) and old (8.8%) groups. Young patients exhibited male predominance (56.8%), lower hypertension (12.7%) and diabetes (1.8%) rates, and higher smoking rates (39.6%). Older patients had higher hypertension (44.6%) and diabetes (23.3%) rates, and were predominantly female (69.1%). Aneurysms in young patients were smaller (p=0.04). Multivariate analysis identified poor Hunt-Hess grade, permanent cerebral infarction, and aneurysmal recurrence or rebleeding as predictors of poor outcomes in young patients. Middle-aged patients had additional predictors, including diabetes and hydrocephalus. In older patients, only poor Hunt-Hess grade was significant. Young aSAH patients exhibit distinct characteristics and prognostic factors compared to older patients. Despite higher post-operative complications, young patients generally have better outcomes, emphasizing the need for age-specific management strategies in aSAH.

Efficacy and safety of endovascular coil embolization for unruptured middle cerebral artery aneurysms: middle-term clinical and imaging outcomes with 3 years mean follow-up periods, a 16-year experience.

The anatomical characteristics of middle cerebral artery aneurysms make endovascular treatment difficult. This study evaluated the efficacy and safety of endovascular treatment of unruptured middle cerebral artery aneurysm in preventing rupture. A retrospective review of patients who underwent coil embolization for unruptured middle cerebral artery aneurysm between 2006 and 2022 at Nagoya University Hospital with at least 12 months followed up was conducted. Imaging and clinical outcomes were described using the Raymond classification and the modified Rankin Scale, respectively. Good imaging outcome was defined as complete occlusion or neck remnant and clinical outcome as modified Rankin Scale score of 0-2. Patients were divided into initial and recurrent group based on the number of treatments, pre- and post-stent groups based on when stents became available in Japan. A total of 77 patients (80 with aneurysms) were included in the final analysis. Their average age was 60.3 years, and their average follow-up period was 38 months. Favorable clinical outcomes were achieved for 96.2% among 66 (97.0%) initial and 11 (91.7%) recurrent aneurysms. Furthermore, good imaging outcomes were obtained in 90.0 %, and 5% had permanent symptomatic ischemic complications. The pre-stent group had a significantly higher proportion of patients with narrow-neck aneurysms than the post-stent group. There were no significant differences in terms of imaging and clinical outcomes or complication rates. The present study demonstrated that endovascular treatment of unruptured middle cerebral artery aneurysm was safe and effective in preventing rupture. The wide-neck aneurysm was also well embolized by using adjunctive technique.

Lower-Ischemic-Risk Profile of Coated Flow Redirection Endoluminal Device X Compared With Uncoated Flow Redirection Endoluminal Device Flow Diverter in the Treatment of Unruptured Intracranial Aneurysms.

Flow Redirection Endoluminal Device (FRED) X is a new generation flow diverter with an antithrombotic surface coating. This study compares the procedural safety and short-term efficacy of FRED X with its uncoated predecessor, the FRED. Patients treated with FRED and FRED X devices for unruptured aneurysms between 2013 and 2023 at 3 neurovascular centers were retrospectively reviewed. The procedural ischemic event rate was the safety end point, and the complete aneurysm occlusion rate at 1 year was the efficacy end point. Multivariable regression adjustment and 1:1 propensity score matching were performed to control for potential confounding. The FRED X group (137 patients) had a higher prevalence of recurrent and bifurcation aneurysms and fewer aneurysms with branch involvement than the FRED X group (156 patients). The ischemic event rate was lower in FRED X (1/156 [0.6%]) than in FRED (7/137 [5.1%]), which was significant after multivariable adjustment (odds ratio: 8.8, 95% CI: 1.1-72.7, P = .04), and tended to be significant in the propensity score analysis (P = .07). Morbidity was comparable between FRED (2.2%) and FRED X (0%, P = .10). The complete occlusion rates of FRED vs FRED X were 73/117 (62.4%) vs 39/54 (72.2%) aneurysms at 6 months (P = .21) and 52/74 (70.3%) vs 27/37 (73.0%) at 12 months (P = .77). Hemorrhagic complications, in-stent stenosis, and clinical events during follow-up and retreatments were not significantly different between groups. This study indicates an improved ischemic risk profile of FRED X while maintaining a favorable efficacy profile, warranting further study and translation into clinical use.

Morphological rationale for surgical treatment of patients with true splenic artery aneurysm

Aim. To study the morphological features of the wall structure of the splenic artery aneurysm in order to identify the safest and most effective method of surgical treatment.Materials and methods. From 2020 to 2023, 43 patients underwent surgery for true splenic artery aneurysm. Interventions involved laparoscopic clipping of aneurysm branches, laparoscopic resection of aneurysm, laparoscopic splenectomy, and resection of giant splenic artery aneurysm. A clinical and morphological study of 16 slides of splenic artery aneurysm was performed. The aneurysm wall and the adjacent wall of the splenic artery without macroscopic signs of lumen dilatation for 1 cm from the aneurysmal dilatation were examined.Results. Microscopic study revealed fragments of loose, edematous wall of large elastic arteries with atherosclerosis, atheromatosis and calcification. Atherosclerotic plaques were observed in the intima; calcium deposits were detected in 81.25% of slides, and defects in elastic fibers – in all slides. The elastic membrane was thinned or had a discontinuous structure. Morphological changes in the wall of the splenic artery persisted up to 1.0 ± 0.2 cm proximal and distal to the aneurysm.Conclusion. Taking into account the revealed features of the morphological structure of the aneurysm, the formation of an end-to-end vascular anastomosis of the splenic artery, clipping or suturing of the aneurysm neck pose a significant risk of aneurysm recurrence. Laparoscopic clipping of splenic artery aneurysm branches at a distance of &gt;1.5 cm from the edges of the aneurysm becomes the operation of choice for patients in this category.

Persistent Sciatic Artery Aneurysm With Distal Embolization Treated Endovascular - A Case Report.

Persistent sciatic artery (PSA) is a rare embryologic remnant of the internal iliac artery variant with an estimated incidence of 0.03-0.06 %. Aneurysmatic formation can give rise to neurological sciatic nerve compression symptoms or thromboembolic and ischemic symptoms. The present is a case with recurrent thromboembolic symptoms and PSA aneurysm, successfully treated endovascularly.