Aneurysms Of Vessels Research Articles

Chitosan-doxycycline hydrogel: An MMP inhibitor/sclerosing embolizing agent as a new approach to endoleak prevention and treatment after endovascular aneurysm repair.

An injectable embolizing chitosan hydrogel releasing doxycycline (DOX) was developed as the first multi-faceted approach for the occlusion of blood vessels. It combines occlusive properties with DOX sclerosing and MMP inhibition properties, respectively known to prevent recanalization process and to counteract the underlying pathophysiology of vessel wall degradation and aneurysm progression. After drug release, the biocompatible scaffold can be invaded by cells and slowly degrade. Local DOX delivery requires lower drug amount and decreases risks of side effects compared to systemic administration. This new gel could be used for the prevention or treatment of endoleaks after endovascular aneurysm repair, but also for the embolization of other blood vessels such as venous or vascular malformations.

Asymptomatic Ischemic Risks in Microsurgical Clipping for Unruptured Intracranial Aneurysms in Anterior Circulation.

The ischemic risk in prophylactic treatments of unruptured intracranial aneurysms (UIAs) is a serious health concern. The aim of this study was to elucidate the incidence and characteristics of ischemic events in microsurgical clipping of anterior circulation UIAs. Ischemic events were prospectively evaluated before and after surgery between April 2011 and March 2017. The location, volume, minimum value of apparent diffusion coefficient in high-intensity spots (HIS) on 3-T magnetic resonance diffusion-weighted imaging (DWI), and radiographic outcomes were analyzed. The relationships between DWI positivity and patient demographics, surgical procedures, and intraoperative vessel features were assessed. Overall, 78 consecutive patients including 29 men and 49 women (median age, 62 years; range, 24-77 years) with 99 UIAs were analyzed. A total of 10 in 78 craniotomies (13%) detected HIS on DWI, which were all asymptomatic. Seventeen HIS were shown, 5 of which were located in the basal ganglia, 6 in the white matter, and 6 in the cortex. The volume and minimum value of apparent diffusion coefficient were 180.4 ± 31.2 mm3 and 0.56 ± 0.03× 10-3 mm2/second, respectively. Radiographic outcomes at follow-up showed that 71% of HIS on DWI led to irreversible brain ischemia. The maximum diameter of aneurysms, atherosclerotic features of the aneurysm wall, and procedure-related factors were associated with DWI positivity. The asymptomatic ischemic risk associated with microsurgical clipping was not low and most lesions were irreversible. Although the mechanism could be various, the use of clips for atherosclerosis of the aneurysm and/or parental vessels requires much attention.

Computational Fluid Dynamics of a Fatal Ruptured Anterior Communicating Artery Aneurysm

AbstractComputational fluid dynamics (CFD) has been studied as a tool for the stratification of aneurysm rupture risk. We performed CFD analysis in a patient operated on for a ruptured anterior communicating artery aneurysm. The point of rupture was identified during surgery. The aneurysm and blood vessels were segmented from computed tomography angiography to prepare a model for simulations. We found that the streamlines showed a concentrated inflow jet directed straight at the rupture point, and high wall shear stress was found at the point of rupture in the aneurysm sac. Thus specific local hemodynamics may be indicative of the aneurysm rupture site.

Endovascular Repair of a Thoracoabdominal Aortic Aneurysm With a Patient-Specific Fenestrated-Branched Stent-Graft

Purpose: To describe the technical aspects of a thoracoabdominal aortic aneurysm (TAAA) repair using a patient-specific fenestrated-branched stent-graft. Technique: The technique is demonstrated in a 69-year-old man with a 6.2-cm asymptomatic type III TAAA. A patient-specific fenestrated-branched stent-graft was designed with 2 down-going directional branches for the celiac and superior mesenteric arteries and 2 reinforced fenestrations for the renal arteries. The procedure was performed under general anesthesia and included sequential stenting of the celiac, superior mesenteric, and bilateral renal arteries. The patient was discharged from the hospital on postoperative day 5 with no complications. Follow-up computed tomography angiography demonstrated exclusion of the aneurysm and patent target vessels at 12-month follow-up. Conclusion: This article and illustrated video highlight the steps for procedure planning and implantation of fenestrated and branched endografts. As these techniques continue to evolve, outcomes are expected to be equivalent or improved as compared to those of long-established open repair.

Natural History of Aneurysmal Aortic Arch Branch Vessels in a Single Tertiary Referral Center

Little is known about the natural history and management of aneurysmal aortic arch branch vessels (AARBVs). The objectives of this study were to assess the natural history of AARBVs and the AARBV’s risk of rupture and to examine the outcomes of operative intervention. A retrospective review of the Yale radiologic database from 1999 to 2016 was performed. Only those patients with AARBV and a computed tomography scan were selected for review. Patient demographics, aneurysm characteristics, management, and follow-up information were collected. There were 111 patients with 153 AARBVs identified; 79 were male (71%), with mean age of 70 years (range, 17-93 years). There were 65 brachiocephalic, 51 left subclavian, 33 right subclavian, and 4 common carotid artery aneurysms. On computed tomography, 68 (61%) had aortic aneurysms, 32 (29%) bovine arch, and 8 (7%) aortic dissections. Most were asymptomatic (105 [95%]); four had arm pain and one had chest pain, shortness of breath, and dysphagia, respectively. One patient presented with a ruptured brachiocephalic pseudoaneurysm (size, 6.5 cm). Nineteen (17%) patients underwent operative repair (OR); 92 (83%) were followed up with cross-sectional imaging (NOR). The overall mean vessel diameter was 2.22 ± 0.96 cm. The diameter of OR and NOR was 3.94 ± 1.61 cm and 1.97 ± 0.46 cm, respectively (P < .00001). OR included 13 bypasses, 5 stent grafts, and 1 resection without reconstruction. Two patients developed postoperative hemorrhage requiring re-exploration. One patient required pseudoaneurysm repair 20 years after index operation. Mean follow-up was 52 ± 51 months for NOR without any ruptures. Four patients underwent elective repair of AARBV because of either growth or other aortic operation. The growth rate was 0.04 ± 0.10 cm/y. On multivariable regression analysis, age (P = .011), the presence of ascending (P = .011) or descending aortic aneurysms (P =.005), and a left subclavian artery aneurysm (P = .038) were associated with higher growth rates, whereas height was associated with a lower growth rate (P = .0005). Few patients with AARBVs require an operation. Operative intervention is safe and has a low index of complications. In the presence of other aortic abnormalities, open repair would be favored. When feasible, an endovascular option can be pursued. Given that we observed no true AARBV rupture, patients can be observed safely with imaging, accepting a growth rate of 0.04 ± 0.10 cm/y.

Microsurgical Repair of Ruptured Aneurysms Associated with Moyamoya-Pattern Collateral Vessels of the Middle Cerebral Artery: A Report of Two Cases

Patients with Moyamoya or other intracranial steno-occlusive disease are at risk for developing aneurysms associated with flow through collateral vessels. Because these lesions are rare, the optimal management remains unclear. Here, we describe 2 cases of microsurgical repair of ruptured collateral vessel aneurysms associated with middle cerebral artery (MCA) occlusion. The first patient was a 61-year-old man who presented with right frontal and intraventricular hemorrhage. Angiography revealed chronic right M1 occlusion and a 3-mm spherical lenticulostriate aneurysm. The frontal lobe hematoma was evacuated to reveal the aneurysm, which was safely cauterized and resected by coagulating and dividing the lenticulostriate parent vessel. The procedure was carried out with neuronavigation guidance and intraoperative neuromonitoring. The patient was discharged with no neurologic deficits. The second patient was a 53-year-old woman who presented with subarachnoid and intracerebral hemorrhage. Computed tomography angiogram showed a 2-mm saccular MCA aneurysm. Emergency left decompressive hemicraniectomy and hematoma evacuation were performed. The aneurysm, arising from a small collateral type vessel, was safely clipped without complications. Postoperative angiography revealed absence of the superior MCA trunk with a dense network of collateral vessels at the site of the clipped aneurysm. The patient recovered well and was ambulating independently 6 months postoperatively. No rebleeding occurred in the 2 patients. Our experience suggests that patients with MCA occlusion can harbor associated aneurysms related to flow through collateral vessels and can present with hemorrhage. Microsurgical repair of these aneurysms can be performed safely to prevent rebleeding.

Intercorrelations of morphology with hemodynamics in intracranial aneurysms in computational fluid dynamics.

Objective:To measure morphological indices and wall shear stress (WSS) of aneurysms and parent artery surface in order to explore the relationship of morphological characteristics and WSS.Methods:Data from 47 events of consecutive cerebral saccular aneurysms from 39 patients which were referred to the interventional Neuroradiology service of the Shaoxing People’s Hospital, Shaoxing, China between 2014 April and 2015 August. Wall shear stress and wall pressure (WP) of the pre-aneurysm, aneurysm and near vessel (<1.0 cm) surface were obtained. Correlation analysis was carried between morphological parameters and WSS and its ratio. WSS, WP, intra-aneurysmal flow pattern, and location of aneurysms were analyzed.Results:Impaction zone from inflow jet was located in the distal neck part of aneurysm with high WSS in 36 aneurysms (76.6%). There were significant differences in WSS between pre-aneurysm surface and near vessel (p<0.001), aneurysm (p<0.001), aneurysm and near vessel (p<0.001). Significant correlations were found between aneurysm WSS and aspect ratio (r=-0.296), aneurysm-artery WSS ratio and size ratio (r=-0.322), aspect ratio (r=-0.416).Conclusion:Uneven WSS distributes in the various part of the pre-aneurysm vessel. The impaction zone from inflow jet is located in the distal neck of aneurysm. Aspect and size ratios can effect aneurysm WSS

Aortic Valve Pathology as a Predictive Factor for Acute Aortic Dissection

In this study, the effect of aortic valve (AV) pathology on local hemodynamic conditions was evaluated as a potential trigger for the onset of acute type A and B aortic dissection. A time- and pressure-related four-dimensional (4-D) computed fluid dynamic model of the aorta was established. In an experimental setup, AV stenosis and AV insufficiency were created. 4-D pressure-related geometry of the aortic root (AR) with valve insufficiency and valve stenosis were determined by high-fidelity (200 Hz) microsonometric crystals. Flow and pressure were obtained at the left ventricle, ascending aorta, and aortic arch. Expansion of the AR in AV insufficiency was higher with expansion in AV stenosis, at peak ejection, and at the end of systole. In AV insufficiency, there was low shear stress (0 to 0.6 Pa), turbulent flow, and high pressure (80 to 95 mm Hg) at the anterior wall of the ascending aorta, at the proximal aortic arch, and at the aortic isthmus. In stenosis, high shear stress (>2 Pa) and high pressure (>95 mm Hg) were found at the ascending aorta and at the bifurcation of the brachiocephalic trunk. In AV insufficiency, low shear stresses and turbulent flow regions were documented at the traditional levels of entry tears for acute type A and B dissection. In AV stenosis, high shear stress with elevated pressure at the ascending aorta may be a trigger element for vessel dilatation, aneurysm formation, and intimal tear, which is typical for type A aortic dissection.

Clipping of ruptured intracranial aneurysms in a hybrid room environment-a case-control study.

Hybrid room treatment (HRT) provides the surgeon immediate intraoperative angiography control of aneurysm occlusion and vessel patency. Since it is relatively resource demanding, in clinical routine HRT is reserved for elective cases. However, since its introduction in our department in 2008, several random cases of ruptured intracranial aneurysms (IAs) have been treated in the HR. This study aims to compare the clinical and radiological outcomes of these cases with cases treated conventionally using a matched pair analysis. Twenty (20%) consecutive patients with ruptured IA treated by microsurgical clipping in the HR between 2009 and 2015 were retrospectively matched with "conventionally" (C) treated patients (overall n=101). Clinical and radiological outcome variables were assessed and compared. Despite a trend in favor of the HR group, no significant difference between both matched groups (HR vs. C) could be demonstrated regarding the functional outcome (upper/lower good recovery 16/20 vs. 17/20, p>0.05), frequency of clipping-related vascular insults on CT scans (0/20 vs. 3/20, p>0.05), aneurysm remnant rate on postoperative angiography (1/20 vs. 4/20, p>0.05) and retreatment rate (0/20 vs. 1/20, p>0.05). When cumulating all outcome events by a scoring system, however, the HR cohort showed a significantly lower occurrence of events (p<0.05). In three cases co-treatment by an endovascular approach was performed in the HR cohort. In this relatively small cohort, a matched pair analysis revealed a discrete but not significant tendency toward a lower frequency of aneurysm remnants and clipping-related vascular insults in the HR cohort. However, HR cohort patients benefited from direct endovascular co-treatment in selected cases.

Numerical Simulation of Red Blood Cell-Induced Platelet Transport in Saccular Aneurysms

We present a numerical simulation of blood flow in two aneurysmal vessels. Using a multicomponent continuum approach, called mixture theory, the velocity fields and spatial distribution of the red blood cells (RBCs) and the plasma are predicted. Platelet migration is described by a convection-diffusion equation, coupled to the RBC concentration field. The model is applied to study a two-dimensional straight vessel and multiple two-dimensional aneurysm vessels with different neck sizes. The model accurately predicts the enrichment of the platelets near the wall in the straight vessel, agreeing with the experimental measurement quantitatively. The numerical results also show that the near-wall enrichment of the platelets in the parent vessel highly influences the platelet concentration within the aneurysm. The results also indicate that the platelet concentration within the aneurysm increases with Reynolds number and decreases with a smaller neck size. This might have significance on the formation of thrombus (blood clot) within the aneurysm, which in turn may have a protective effect on preventing ruptures. Based on the success with the problems studied, we believe the current model can be a useful tool for analyzing the blood flow and platelets transport within patient specific aneurysms in the future.

Abstract 487: Systemic Administration of Target-Seeking, Vessel Penetrating Recombinant Decorin Fusion Protein, Car-DCN, Reduces Severity of Abdominal Aortic Aneurysm in Mice

Objective: Decorin (DCN) is a small leucine-rich proteoglycan that mediates collagen fibrollogenesis, organization, and tensile strength. DCN is reduced in abdominal aortic aneurysm (AAA) through a Granzyme B-dependent mechanism resulting in vessel wall instability and aneurysm formation. A recombinant decorin fusion protein CAR-DCN was engineered with an extended C-terminus comprised of CAR homing peptide that recognizes inflammatory blood vessels and penetrates deep into the vessel wall. In the present study, we sought to evaluate the role of systemically administered CAR-DCN in AAA progression and rupture rate in a murine model. Approach and Results: To induce aneurysm, apolipoprotein E knockout (ApoE-KO) mice were infused with 28 days of angiotensin II (AngII). CAR-DCN or vehicle was systemically administrated until day 15. We observed a significant increase in the survival of CAR-DCN-treated mice (93%) compared to vehicle controls (60%). Although the incidence of AAA onset was similar between vehicle and CAR-DCN groups, the severity of aneurysm in the CAR-DCN group was significantly reduced. Furthermore, histological analysis revealed that CAR-DCN treatment significantly increased DCN and collagen levels in aortic walls compares to vehicle controls. Conclusions: CAR-DCN administration attenuated the severity of Ang II-induced AAA in mice by reinforcing the vessel wall. CAR-DCN may represent a novel therapeutic strategy to attenuate AAA progression and rupture.

Management of paraophthalmic aneurysms : Review of endovascular treatment strategies

Aneurysms of the cerebral vessels are relatively common and aneurysms of the ophthalmic segment of the internal carotid artery (ICA) represent approximately 10% of intradural aneurysms. The ophthalmic segment of the ICA extends from the origin of the ophthalmic artery to the origin of the posterior communicating artery. Aneurysms can originate from the ophthalmic artery itself or directly from the ICA at adistance from the ophthalmic artery. The various anatomic configurations can alter the risks of treatment. Surgical treatment of aneurysms of the ophthalmic segment poses unique challenges for the neurosurgeon, given the deep location and complex nearby structures and optic nerve. The necessity to remove the clinoid process can make the operation technically challenging. Endovascular treatment of paraophthalmic aneurysms includes coil occlusion, and also stent- or balloon-assisted coil occlusion. More recently, hemodynamically active flow diverter stents improved the treatment results. The management of paraophthalmic aneurysms is associated with specific risks. Careful consideration of the available techniques is necessary before each invention. Coil-occlusion remains the first choice for ruptured paraophthalmic aneurysms. For unruptured paraophthalmic aneurysms flow diversion offers improved results. The overall complication rates of these procedures are low; however, cerebral ischemia, intracranial hemorrhage and visual complications must be considered in advance and the patient must be informed of the risks.

Long-term follow-up of fenestrated endovascular repair for juxtarenal aortic aneurysm.

BackgroundFenestrated endovascular aneurysm repair (FEVAR) is increasingly being used for juxtarenal aortic aneurysms. The aim of this study was to review long‐term results and assess the importance of changing stent‐graft design on outcomes.MethodsThis was a retrospective review of all patients who underwent FEVAR within a single unit over 12 years (February 2003 to December 2015). Kaplan–Meier analysis of survival, and freedom from target vessel loss, aneurysm expansion, graft‐related endoleak and secondary intervention was performed. Comparison between outcomes of less complex grafts (fewer than 3 fenestrations) and more complex grafts (3 or 4 fenestrations) was undertaken.ResultsSome 173 patients underwent FEVAR; median age was 76 (i.q.r. 70–79) years and 90·2 per cent were men. Median aneurysm diameter was 63 (59–71) mm and median follow‐up was 34 (16–50) months. The adjusted primary technical operative success rate was 95·4 per cent. The in‐hospital mortality rate was 5·2 per cent; there was no known aneurysm‐related death during follow‐up. Median survival was 7·1 (95 per cent c.i. 5·2 to 8·1) years and overall survival was 60·1 per cent (104 of 173). There was a trend towards an increasing number of fenestrations in the graft design over time. In‐hospital mortality appeared higher when more complex stent‐grafts were used (8 versus 2 per cent for stent‐grafts with 3–4 versus fewer than 3 fenestrations; P = 0·059). Graft‐related endoleaks were more common following deployment of stent‐grafts with three or four fenestrations (12 of 90 versus 6 of 83; P < 0·001).ConclusionFenestrated endovascular aneurysm repair for juxtarenal aneurysm is associated with few aneurysm‐related deaths in the long term. Significant numbers of secondary interventions are required, but the majority of these can be performed using an endovascular approach.

Coronary Artery Anomalies in Animals.

Coronary artery anomalies represent a disease spectrum from incidental to life-threatening. Anomalies of coronary artery origin and course are well-recognized in human medicine, but have received limited attention in veterinary medicine. Coronary artery anomalies are best described in the dog, hamster, and cow though reports also exist in the horse and pig. The most well-known anomaly in veterinary medicine is anomalous coronary artery origin with a prepulmonary course in dogs, which limits treatment of pulmonary valve stenosis. A categorization scheme for coronary artery anomalies in animals is suggested, dividing these anomalies into those of major or minor clinical significance. A review of coronary artery development, anatomy, and reported anomalies in domesticated species is provided and four novel canine examples of anomalous coronary artery origin are described: an English bulldog with single left coronary ostium and a retroaortic right coronary artery; an English bulldog with single right coronary ostium and transseptal left coronary artery; an English bulldog with single right coronary ostium and absent left coronary artery with a prepulmonary paraconal interventricular branch and an interarterial circumflex branch; and a mixed-breed dog with tetralogy of Fallot and anomalous origin of all coronary branches from the brachiocephalic trunk. Coronary arterial fistulae are also described including a coronary cameral fistula in a llama cria and an English bulldog with coronary artery aneurysm and anomalous shunting vessels from the right coronary artery to the pulmonary trunk. These examples are provided with the intent to raise awareness and improve understanding of such defects.

Palpable mass of the neck in the course of Takayasu arteritis.

Takayasu arteritis is a rare, idiopathic inflammatory disease of the aorta and its major branches, usually affecting young women of Asian descent. In the course of the disease stenosis, occlusions as well as dilatations and aneurysms of vessels occur. Because of many possible localizations of pathological changes, the symptoms have a wide range, but the most common are a weak pulse or its absence on the brachial artery and a difference in systolic pressure above 10 mm Hg between the upper extremities. Here we present a case report of a young woman with Takayasu arteritis, who presented a palpable mass in the back of her neck, significantly diminished after treatment with glucocorticoids.

Retinal Angiomatous Proliferation in Adult Onset Coat's Disease Angiomatous Proliferation in Coat's Disease

A 31 year old female patient had decreased vision in her left eye for several months. Visual acuity was 20/20 in right eye and counting fingers from 2 m in left eye. Examination of left eye demonstrated massive macular exudation with grayish discoloration of central macula and, aneurysmal and telangiectatic vessels with surrounding exudation in temporal mid peripheral retina. Optical coherence tomography of left eye showed findings consistent with neovascular complex, pigment epithelial detachment, subretinal fluid and involvment of choroid. There was hyperfluorescent focus with perfusing retinal arteriole and draining venule at the fovea which was compatible with retinal angiomatous proliferation (RAP) in early phase fundus fluorescein angiography and leakage was observed in late phase. After 3 doses of monthly-injected intravitreal ranibizumab and argon laser photocoagulation applied on aneurysmal and telangiectatic vessels, we observed central macular fibrosis, minimal lipid exudation and no macular edema. So retinal angiomatous proliferation may be a feature of adult onset Coats’ disease.

Determination of Predictive Anatomic Parameters for Bleeding of Brain Arteriovenous Malformations by Multidetector CT Angiography.

Patients with brain arteriovenous malformation (AVM) have a certain risk to bleed, and the goal of this study was to examine the effect of radiological and clinical predictive characteristics of AVM hemorrhage using multidetector computed tomographic (MDCT) angiography. The study included a series of 57 patients, mean age 35.46 years, who were diagnosed during their hospitalization at Clinical Department of Neurosurgery, Clinical Center of Serbia, in the period from January 2008 to March 2016. In all patients, the diagnosis was made using MDCT angiography. Two groups of patients were observed. The first group included patients who did not initially present with hemorrhage, while the second group initially presented with hemorrhage. Both groups were treated with medical therapy or a combination of medical therapy with embolization/surgery/radiotherapy. Deep venous drainage (p<0.05), combined arterial supply from different basins (p<0.05) with a length <60 mm, venous dilatation present in the drainage vein (p<0.01), and the angle of casting sup-ply arteries in the nidus (p<0.01) carry a risk of repeated bleeding. In the group of patients who had initial hemorrhage, the mean value of the casting angle size was 130°, while in the group that did not have initial bleeding the mean value of the measured angle size was 103.81° with standard deviation of 17.21° (p<0.01). In conclusion, AVMs with deep venous drainage from the carotid and vertebrobasilar basin, the length of the feeding arteries <60 mm, the angle of the casting feeding arteries in the nidus ≥130° and dilatation and/or venous aneurysm of drainage vessel are predictive for clinical presenting by hemorrhage.

Surgical Management of Coats Disease.

Coats disease is a sporadic, chronic retinal vascular disorder with telangiectatic and aneurysmal retinal vessels, with retinal exudation and retinal detachment in severe cases. Various treatment modalities have been used, including laser therapy, cryotherapy, anti‒vascular endothelial growth factor (VEGF) therapy, and surgery. Anti-VEGF therapy seems to be effective in reducing exudative changes and is often combined with other treatment modalities. For severe cases with exudative retinal detachment, external drainage of subretinal fluid with or without vitrectomy is commonly performed, combined with laser therapy and/or cryotherapy. Relatively good anatomical outcomes have been reported; however, postoperative functional results, particularly in young patients and/or severe cases, seem to be limited.

Comparison of TOF MRA, Contrast-Enhanced MRA and Subtracted CTA from CTP in Residue Evaluation of Treated Intracranial Aneurysms.

To compare effectiveness of contrast-enhanced MRA (CE-MRA), 3D-Time-of-flight MRA (3D-TOF-MRA) and subtracted CTA from CTP (sub-CTA) in residue evaluation of intracranial aneurysms treated either with coiling or clipping. Sixteen treated aneurysms, which were evaluated with three methods within two weeks after the operation, were enrolled. The success of each imaging techniques in demonstration of residue aneurysm and nearby vessels was compared by Fisher\'s Exact Test. The differences among three was evaluated by Cochran\'s Q test (p ≤ 0.05). Perfusion abnormality was noted in % 81 of clipped and none of coiled patients. Vessel visualization in the vicinity of aneurysm was better in sub-CTA, followed by CE-MRA. In clipped aneurysms, sub-CTA revealed residue aneurysms in % 16,7 of the patients while 3D-TOF-MRA and CE-MRA revealed none. In coiled aneurysms, CE-MRA revealed residue aneurysms in 100 %, and TOF-MRA in 33,3 % while sub-CTA revealed none. Although dramatic differences were noted in the evaluation of residue aneurysm as well as nearby vessel visualization, no statistical significance noted due to very few patients in subcategories Conclusion: This is first study comparing the effectiveness of CE-MRA, 3D-TOF MRA and sub-CTA in residue aneurysms evaluation. Vessel visualization in the vicinity of aneurysm was better in sub-CTA in all regardless of coiling or clipping. Residue aneurysms were more commonly revealed by CE-MRA in coiled patients and more commonly and better shown by sub-CTA in clipped patients in addition of showing perfusion abnormality that's is more common in clipped patients.

A Fast and Efficient Region based Aneurysm Segmentation Model for Medical Image Segmentation

Aneurysm and blood vessel delineation from medical images facilitates efficient diagnosis of the Aneurysm and vessels (Stroke or Hemorrhage and Stenosis or malformations) and registration of patient images obtained at different times. Computer-aided diagnosis and detection of Aneurysms via Segmentation algorithms is a complex and multi-faceted issue in medical image processing, as adjoining vessels are the high-intensity structures whereas aneurysms are of low contrast and intensity. Obviously, segmentation is essential to identify the disease severity by change monitoring and also to know further Haemo-dynamic situation in critical cases. Change detection and further analysis gives the complete picture of the case of interest. For Brain tumor detection and analysis, there are several segmentation algorithms but only few are suitable for aneurysm detection and analysis. There is a necessity to provide an efficient segmentation model for aneurysm analysis, change detection and delineation which overcomes the limitations on speed and accuracy of other models. The objective of this paper is to first, apply local binary fitting (LBF), chan-vese (CV) models to aneurysm analysis. Then perform Region based Aneurysm Segmentation model frame work on data sheets of MR Angiography of brain. It is a perfect level set based Active contour model which converges in short span without requirement of any stability and termination criterions. The key feature of this model is that delineation is independent of choice of mask dimensions. Promising results are obtained with the proposed model