Coil Embolization Research Articles

Neuro-Ophthalmic Manifestations of Carotid Cavernous Fistulas: A Systematic Review and Meta-Analysis.

Carotid-cavernous fistulas (CCFs) are pathologic, arteriovenous communications between the carotid artery and cavernous sinus. They cause various complex neuro-ophthalmic symptoms by shunting the flow of arterial blood into the venous system. In this study, a systematic review is conducted on the neuro-ophthalmic presentations associated with CCFs. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses2020 guidelines were followed during the systematic review. We searched PubMed, Scopus, and Web of Science from inception to December 31, 2023. Articles written in English on patients with confirmed CCFs reporting clinical features, diagnostic modalities, treatment approaches, and outcomes were included. Abstracted data included demography, clinical presentations, venous flow dynamics, trauma history, investigative methodology, approaches to treatment, and outcomes. Overall, 33 studies with a total number of 403 patients were included. The mean age at presentation was 42.99 years for patients with direct CCFs and 55.88 years for those with indirect CCFs. Preponderance was observed in male patients with direct CCFs, constituting 51.56%, while females predominated in those with indirect CCFs, at 56.44%. The clinical symptoms in all patients with CCFs were proptosis in 58 cases (14.39%), conjunctival congestion in 29 patients (7.20%), diplopia in nine patients (2.23%), vision blurring in four patients (0.99%), eyelid swelling in five patients (1.24%), pain in the eye in three patients (0.74%), and an upper lid mass in one patient (0.25%). Endovascular treatments, including coil and Onyx embolization, have been effective in relieving clinical symptoms and arresting the progression of these symptoms. In conclusion, the common clinical features in CCFs usually underline proptosis, congestion, and diplopia, necessitating a comprehensiveneuro-ophthalmological review. Prompt identification of the symptoms of blurred vision is crucial to avoid permanent damage. Lid swelling, ocular pain, and an upper lid mass are less common but equally essential presentations for comprehensive evaluation. The recognition of these variable presentations is essential not only for timely intervention but also for the improvement in patient outcomes, thus emphasizing the role of clinician awareness in managing CCF cases.

Optimizing neurointerventional procedures: an algorithm for embolization coil detection and automated collimation to enable dose reduction.

Monitoring radiation dose and time parameters during radiological interventions is crucial, especially in neurointerventional procedures, such as aneurysm treatment with embolization coils. The algorithm presented detects the presence of these embolization coils in medical images. It establishes a bounding box as a reference for automated collimation, with the primary objective being to enhance the efficiency and safety of neurointerventional procedures by actively optimizing image quality while minimizing patient dose. Two distinct methodologies are evaluated in our study. The first involves deep learning, employing the Faster R-CNN model with a ResNet-50 FPN as a backbone and a RetinaNet model. The second method utilizes a classical blob detection approach, serving as a benchmark for comparison. We performed a fivefold cross-validation, and our top-performing model achieved mean mAP@75 of 0.84 across all folds on validation data and mean mAP@75 of 0.94 on independent test data. Since we use an upscaled bounding box, achieving 100% overlap between ground truth and prediction is not necessary. To highlight the real-world applications of our algorithm, we conducted a simulation featuring a coil constructed from an alloy wire, effectively showcasing the implementation of automatic collimation. This resulted in a notable reduction in the dose area product, signifying the reduction of stochastic risks for both patients and medical staff by minimizing scatter radiation. Additionally, our algorithm assists in avoiding extreme brightness or darkness in X-ray angiography images during narrow collimation, ultimately streamlining the collimation process for physicians. To our knowledge, this marks the initial attempt at an approach successfully detecting embolization coils, showcasing the extended applications of integrating detection results into the X-ray angiography system. The method we present has the potential for broader application, allowing its extension to detect other medical objects utilized in interventional procedures.

Single Neuroform Atlas stent: a reliable approach for treating complex wide-neck bifurcated aneurysms.

Treating wide-neck bifurcated cerebral aneurysms (WNBAs) using various techniques and new devices has shown favorable outcomes. However, endovascular coiling can be technically challenging when the aneurysm neck is incorporated into the parent vessel. Furthermore, although recent research has reported favorable outcomes of Neuroform Atlas stent (NAS)-assisted coiling, broad inclusion criteria have hampered precise evaluations of their effectiveness and safety for treating complex WNBAs. Therefore, this study evaluated whether the use of a single NAS is a safe and effective approach for treating complex WNBAs. We treated 76 complex WNBAs (unruptured, n = 49; ruptured, n = 27) using single NAS-assisted coil embolization and retrospectively analyzed the clinical and angiographic outcomes. In a cohort of 68 patients (mean age, 58.3 ± 11.6 years; males n = 20, 29.4%; females, n = 48, 70.6%), 76 stents were successfully delivered to the target aneurysms, yielding a technical success rate of 98.6%. Complete occlusion was evident in 59 (77.6%) of 76 aneurysms, with neck remnants found in 16 (21.1%) and partial occlusion in 1 (1.3%). Treatment-related morbidities comprised one branch occlusion and one parenchymal hemorrhage. However, no new neurological symptoms of unruptured aneurysms were evident at discharge. The outcomes of 20 of the 27 ruptured aneurysms were favorable (Glasgow Outcome Scale scores of 4 or 5) at the final follow-up assessment (mean 12.2 [6-29] months), except for one initial subarachnoid hemorrhage. Post-treatment angiography revealed complete occlusion in 89.1%, neck remnants in 7.8%, and incomplete occlusion in 3.1% of the aneurysms. Approximately 88.2% of the patients were assessed at least once by follow-up diagnostic or magnetic resonance angiography (mean, 12.5 ± 4.3 [range, 6-29] months), with five (7.8%) minor and two (3.1%) major recurrences. A single NAS is safe and effective for treating WNBAs incorporated into parent vessels.

Rare simultaneous fetal posterior cerebral artery and conventional posterior cerebral artery duplication in a patient with a ruptured posterior communicating artery aneurysm: illustrative case.

The fetal-type posterior cerebral artery (PCA) is defined as a variant anatomy in which the posterior communicating artery (PCOM) is larger than the hypoplastic or aplastic P1 segment of the PCA. The authors present the novel case of a patient with a duplicated right PCA in parallel with fetal-type and conventional PCAs supplying adjacent components of the PCA cerebral territory. A 59-year-old woman presented with a modified Fisher Scale score 4 subarachnoid hemorrhage. A right irregular PCOM aneurysm that measured 9.5 mm × 4.5 mm × 4.5 mm arose from the base of a variant branch supplying a portion of the PCA, rather than a conventional PCOM, and was found on digital subtraction angiography. Following endovascular coil embolization, the patient was discharged home. The fetal-type variant has implications for thromboembolic events. If an embolism occludes the anterior circulation in a patient with a fetal-type PCA, it may result in an infarct in the PCA territory. Awareness of cerebral arterial anatomy, including an atypical collateral supply, informs a treating team's latitude in tolerance of which sites must be preserved and which can be safely sacrificed. https://thejns.org/doi/10.3171/CASE23735.

The aneurysm occlusion and recurrence of posterior communicating artery aneurysms following the treatment with the pipeline embolization device.

Despite advancements in treatment modalities such as flow diverters, the optimal management of posterior communicating artery (PComA) aneurysms remains uncertain. While PComA aneurysms treated with the Pipeline Embolization Device (PED) has been reported, the characteristics and progression of incomplete occluded aneurysms remain unclear. Therefore, our study aims to investigate the occlusion status and recurrence rates of PComA aneurysms treated with PED. A retrospective review of consecutive PComA aneurysm patients treated with PED was conducted between January 2015 and December 2020. Only patients with radiological follow-up were included. PComA aneurysms were categorized into incomplete occlusion and complete occlusion group. The primary outcomes included the characteristics of incomplete occlusion at the follow-up angiography. Among 121 PComA aneurysms treated with PED at our institution, 80 aneurysms were eligible in our study. During the follow-up period, 19 (23.8%) aneurysms demonstrated incomplete occlusion. Notably, there were no instances of recurrence among the 80 followed-up cases. Baseline characteristics of patients and aneurysms were comparable between the groups with complete and incomplete occlusion. However, the incomplete occlusion group showed a lower rate of assisted coils embolization (21.2% vs. 55.7%, P = 0.017) and shorter median operative time (91.0 vs. 145.5min, P = 0.039). Differences in functional outcomes, complications, and PComA occlusion status between the groups were not significant. Multivariate analysis revealed the use of coils was associated with lower odds of incomplete PComA aneurysm occlusion (OR 0.01, 95% CI 0.001-0.12; P = 0.001), while aneurysm size was associated with higher odds of incomplete occlusion (OR 1.25, 95% CI 1.10-1.46; P = 0.002). The treatment of PED for PComA aneurysm demonstrated favorable outcomes, with an acceptable rate of incomplete occlusion and no instances of recurrence observed. However, further research is needed to explore the optimal procedural strategy for large-sized PComA aneurysms.

Predictors of Intrahospital Mortality in Aneurysmal Subarachnoid Hemorrhage after Endovascular Embolization.

Background and Objectives: Aneurysmal subarachnoid hemorrhage (ASAH) is defined as bleeding in the subarachnoid space caused by the rupture of a cerebral aneurysm. About 11% of people who develop ASAH die before receiving medical treatment, and 40% of patients die within four weeks of being admitted to hospital. There are limited data on single-center experiences analyzing intrahospital mortality in ASAH patients treated with an endovascular approach. Given that, we wanted to share our experience and explore the risk factors that influence intrahospital mortality in patients with ruptured intracranial aneurysms treated with endovascular coil embolization. Materials and Methods: Our study was designed as a clinical, observational, retrospective cross-sectional study. It was performed at the Department for Radiology, University Clinical Center Kragujevac in Kragujevac, Serbia. The study inclusion criteria were ≥18 years, admitted within 24 h of symptoms onset, acute SAH diagnosed on CT, aneurysm on DSA, and treated by endovascular coil embolization from January 2014 to December 2018 at our institution. Results: A total of 66 patients were included in the study-48 (72.7%) women and 18 (27.3%) men, and 19.7% of the patients died during hospitalization. After adjustment, the following factors were associated with in-hospital mortality: a delayed ischemic neurological deficit, the presence of blood in the fourth cerebral ventricle, and an elevated urea value after endovascular intervention, increasing the chances of mortality by 16.3, 12, and 12.6 times. Conclusions: Delayed cerebral ischemia and intraventricular hemorrhage on initial head CT scan are strong predictors of intrahospital mortality in ASAH patients. Also, it is important to monitor kidney function and urea levels in ASAH patients, considering that elevated urea values after endovascular aneurysm embolization have been shown to be a significant risk factor for intrahospital mortality.

Coil embolization of the middle cerebral artery bifurcation aneurysms: Feasibility and durability

ObjectiveTo evaluate the feasibility and durability of coil embolization for MCAB aneurysms by analyzing clinical and radiological results. MethodsFrom January of 2008 to June of 2018, we treated a total of 1785 aneurysms using coil embolization. The aneurysms were treated by both coiling and stent-assisted coiling. Among these cases, 223 MCAB aneurysms were analyzed retrospectively. Clinical and radiological assessments were conducted at admission, after treatment, at discharge, and at last clinical follow-up. ResultsCoil embolization was performed on 223 MCAB aneurysms in 217 patients. Peri-procedural ischemic, hemorrhagic, and other complications within 30 days after coil embolization occurred at rates of 8.0 %, 8.0 %, and 2.0 %, respectively, in the ruptured group and at 2.9 %, 1.2 %, and 0 %, respectively, in the unruptured group. The overall morbidity and mortality rates associated with complications were 2.3 % and 2.0 %. The cumulative major recurrence rates were 5.1 % at 12 months, 7.1 % at 18 months, and 11.9 % at three years after coil embolization. The mean follow-up period was 33.27 ± 25.48 months. Independent risk factors for major recurrence after coil embolization for MCAB aneurysms were a ruptured aneurysm, initial incomplete occlusion, the aneurysm size, and the neck size. ConclusionCoil embolization is a good alternative treatment option for MCAB aneurysms compared to surgical clipping. Considering the risk factors for major recurrence, the follow-up angiography should continue up to three years after coil embolization.

Splenic artery embolization in the treatment of blunt splenic injury: single level 1 trauma center experience.

To describe the experience of a single level 1 trauma center in the management of blunt splenic injuries (BSI). This is a retrospective study with Institutional Review Board approval. The medical records of 450 patients with BSI treated between January 2016 and December 2022 were reviewed. Seventy-two patients were treated with splenic artery embolization (SAE), met the study criteria, and were eligible for data analysis. Spleen injuries were graded in accordance with the American Association for the Surgery of Trauma Organ Injury Scale. Univariate data analysis was performed, with P < 0.05 considered statistically significant. The splenic salvage rate was 90.3% (n = 65/72). Baseline demographics were similar between the groups (P > 0.05). Distal embolization with Gelfoam® had similar rates of splenic salvage to proximal embolization with coils (90% vs. 94.1%, P > 0.05). There was no significant difference in the rate of splenic infarction between distal embolization with Gelfoam® (20%, 4/20) and proximal embolization with coils (17.6%, 3/17) (P > 0.05). There was no significant difference in procedure length (68 vs. 75.8 min) or splenic salvage rate (88.5% vs. 92.1%) between proximal and distal embolization (P > 0.05). There was no significant difference in procedure length (69.1 vs. 73.6 min) or splenic salvage rate (93.1% vs. 86.4%) between Gelfoam® and coil embolization (P > 0.05). Combined proximal and distal embolization was associated with a higher rate of splenic abscess formation (25%, 2/8) when compared with proximal (0%, 0/26) or distal (0%, 0/38) embolization alone (P = 0.0003). The rate of asymptomatic and symptomatic splenic infarction was significantly higher in patients embolized at combined proximal and distal locations (P = 0.04, P = 0.01). The endovascular management of BSI is safe and effective. The overall splenic salvage rate was 90.3%. Distal embolization with Gelfoam® was not associated with higher rates of splenic infarction when compared with proximal embolization with coils. Combined proximal and distal embolization was associated with a higher incidence of splenic infarction and splenic abscess formation. Distal splenic embolization with Gelfoam® is safe and may be beneficial in the setting of blunt splenic trauma.

Partial coil embolization before surgical clipping of ruptured intracranial aneurysms.

Intraoperative rupture (IOR) is the most common adverse event encountered during surgical clip obliteration of ruptured intracranial aneurysms. Besides increasing surgeon experience and early proximal control, no methods exist to decrease IOR risk. Thus, our objective was to assess if partial endovascular coil embolization to protect the aneurysm before clipping decreases IOR. We conducted a retrospective analysis of patients with ruptured intracranial aneurysms that were treated with surgical clipping at two tertiary academic centers. We compared patient characteristics and outcomes of those who underwent partial endovascular coil embolization to protect the aneurysm before clipping to those who did not. The primary outcome was IOR. Secondary outcomes were inpatient mortality and discharge destination. We analyzed 100 patients. Partial endovascular aneurysm protection was performed in 27 patients. Age, sex, subarachnoid hemorrhage severity, and aneurysm location were similar between the partially-embolized and non-embolized groups. The median size of the partially-embolized aneurysms was larger (7.0mm [interquartile range 5.95-8.7] vs. 4.6mm [3.3-6.0]; P < 0.001). During surgical clipping, IOR occurred less frequently in the partially-embolized aneurysms than non-embolized aneurysms (2/27, 7.4%, vs. 30/73, 41%; P = 0.001). Inpatient mortality was 14.8% (4/27) in patients with partially-embolized aneurysms and 28.8% (21/73) in patients without embolization (P = 0.20). Discharge to home or inpatient rehabilitation was 74.0% in patients with partially-embolized aneurysms and 56.2% in patients without embolization (P = 0.11). A complication from partial embolization occurred in 2/27 (7.4%) patients. Preoperative partial endovascular coil embolization of ruptured aneurysms is associated with a reduced frequency of IOR during definitive treatment with surgical clip obliteration. These results and the impact of preoperative partial endovascular coil embolization on functional outcomes should be confirmed with a randomized trial.

In-Vitro Assessment of Developed Peripheral Fibered Embolization Coil Deployment: A Key to Obstruct Blood Flow in Peripheral Arterial and Venous Vessel

In-Vitro Assessment of Developed Peripheral Fibered Embolization Coil Deployment: A Key to Obstruct Blood Flow in Peripheral Arterial and Venous Vessel

Stent-Assisted Coil Embolization of MCA Bifurcation and Literature Review

Coil embolization of aneurysms, after more than 20 years of clinical practice shows that several conditions must be met: 1. After the necessary interval, the entire aneurysm can achieve and maintain effective hemostasis. 2. Intra-aneurysm thrombosis is the result of intra-aneurysm hemostasis induced by the coil, which must take the necessary time to form a stable and organic coil thrombus complex; 3. The homogeneity and stability of the spring-thrombus complex at the base of the aneurysm must be sufficient to ensure neoendotheliosis and re-endothelialization of the aneurysm neck. Only if the above conditions are met can the operation be successful. The advantage of stent-assisted coil embolization is that the tumor bearing vessel can be preserved. However, since the foreign body is permanently placed in the main vessel, antiplatelet drugs need to be continued after surgery in order to prevent thrombus.

Effects of Remimazolam versus Sevoflurane on Hemodynamics in Patients Undergoing Coil Embolization of Cerebral Aneurysm: A Prospective Randomized Controlled Trial.

Background: Cerebral aneurysm coil embolization is often performed under general anesthesia to prevent patient movement and sudden high blood pressure. However, the optimal anesthetic agent remains uncertain. This study aimed to determine whether maintaining anesthesia with remimazolam in patients undergoing coil embolization could avoid hypotension or hypertension compared to sevoflurane. Methods: Thirty-three adult patients participated in this single-blinded, randomized controlled trial. Patients in Group R were induced and maintained with remimazolam, whereas those in Group S received propofol and sevoflurane. Results: The use of remimazolam significantly reduced the incidence of intraoperative hypotension events (33.3% vs. 80.0%; p = 0.010) but did not change the incidence of hypertension events (66.7% vs. 73.3%; p = 0.690). Patients in Group R maintained a significantly higher range of maximal (100.2 ± 16.6 vs. 88.1 ± 13.5 mmHg; p = 0.037) and minimal (69.4 ± 6.6 vs. 63.4 ± 4.8 mmHg; p = 0.008) mean arterial blood pressure than those in Group S during the intervention. Conclusions: This is the first study to demonstrate the feasibility of maintaining general anesthesia with remimazolam in patients undergoing cerebral aneurysm coil embolization. The findings suggest that remimazolam may maintains better hemodynamic stability, reducing the incidence of hypotensive events without compromising patient safety.

Evaluating the feasibility of contrast-enhanced ultrasound for detecting after preemptive coiling endoleaks in endovascular aortic aneurysm repair: A pilot study

Endovascular aortic aneurysm repair is widely used for the treatment of abdominal aortic aneurysm (AAA), but has a 10% to 40% incidence of type II endoleak during follow-up. There are various techniques to treat these endoleaks in the case of enlarging of the AAA, but the clinical effectiveness is low. In recent years, preemptive AAA sac embolization has shown some encouraging results with significant AAA shrinkage. However, the presence of embolic material can complicate continued endoleak detection making assessment of treatment outcome difficult. We investigate the ability of contrast-enhanced-ultrasound examination to detect endoleaks in patients undergoing preemptive coil embolization of the AAA sac.

Utility of catheter-shaping using mixed-reality devices in cerebral aneurysm coil embolization

BackgroundCatheter shaping is vital in cerebral aneurysm coil embolization; however, understanding three-dimensional (3D) vascular structures on two-dimensional screens is challenging. Although 3D-printed vascular models are helpful, they demand time, effort, and sterility. This study explores whether mixed-reality (MR) devices displaying 3D computer graphics (3D-CG) can address these issues. MethodsThis study focused on magnetic resonance imaging (MRI) of seven cases of cerebral aneurysms. Head-mounted display (HMD) and spatial reality display (SRD) MR devices were used, and applications for 3D-CG display at a 1:1 scale and a 3D-CG control panel were developed. Catheters shaped using a 3D printer, HMD, and SRD were inserted into hollow models to assess their accessibility and positioning. ResultsThe concordance rate of the 3D printer and HMD groups in terms of accessibility to the aneurysm was 71.4 %, while that of the 3D printer and SRD group was 85.7 %, and that of the HMD and SRD group was 85.7 %. The concordance rates of positioning in the 3D printer and HMD groups, 3D printer and SRD groups, and HMD and SRD groups were 85.7 %, 85.7 %, and 100 %, respectively. ConclusionsMR devices facilitate catheter shaping in cerebral aneurysm coil embolization and offer a time-efficient, precise, and sterile alternative to traditional 3D printing methods.

Effectiveness of Embolization for Pulmonary Arteriovenous Malformations from Distal of the Last Normal Branch of the Pulmonary Artery.

This retrospective study of patients with pulmonary arteriovenous malformations aims to assess the efficacy of embolization distal to the origin of the last normal branch of the pulmonary artery. A total of 30 consecutive patients with 38 untreated pulmonary arteriovenous malformations underwent coil embolization distal to the origin of the last normal branch of the pulmonary artery between September 2015 and October 2021. The median (interquartile range) age of patients (5 males, 25 females) was 59 years (50-68 years old), and the median (interquartile range) sizes of the feeding artery and sac were 2.9 mm (2.3-3.8 mm) and 6.7 mm (5.4-9.7 mm), respectively. The technical success rate, persistence rate, and treatment-related complications were evaluated. Technical success was defined as the inability to identify the draining vein on feeding arteriography after coil embolization. Persistence was assessed using time-resolved magnetic resonance angiography. Coil embolization was successful in all patients (100%). There was no persistence during a median (interquartile range) follow-up period of 23 months (10-45 months) for the 38 pulmonary arteriovenous malformations embolized with coils. No major complications were reported. Only minor complications following embolization occurred in 4 of 36 sessions, including local pain in 2 sessions (6%) and hemosputum in 2 sessions (6%). Embolization distal to the origin of the last normal branch of the pulmonary artery is effective in preventing the persistence of pulmonary arteriovenous malformations.

Effectiveness and safety of coils plus glue in slope embankment technology versus coils plus sclerosant in embolization therapy for reflux-type pelvic venous disorders

ObjectiveThis study aimed to evaluate the effectiveness and safety of coils plus glue (CPG) in slope embankment technology vs coils plus sclerosant (CPS) in treating reflux-type pelvic venous disorders. MethodsThe analysis included patients diagnosed with reflux-type pelvic venous disorders who were treated with CPG or CPS from 2019 to 2021. The inclusion criteria were noncyclic pain lasting more than 6 months, atypical varicose, and transvaginal Doppler ultrasound (TVDUS) and computed tomographic venography confirming the diagnosis and excluding compression factors and other diseases. Propensity score matching was performed at a 1:1.1 ratio based on the following covariates: age, pregnancy, body mass index, pretreatment visual analog scale (VAS), dysmenorrhea, dyspareunia, urinary urgency, tenesmus, low back pain, vulvar varicosities, vaginal varicosities, and lower limb varices. The pain was relieved by embolizing the target lesions with different embolic materials. The efficacy and safety of the different embolization materials were compared by VAS and TVDUS examinations at 1, 3, 6, 12, 24, and 36 months. ResultsFrom a total of 495 patients, 88 patients were selected from the CPG group and 77 patients from the CPS group by propensity score matching. The patients were followed up for 36 months. The preoperative VAS score of the CPG group was 8 (range, 6-8), and the CPS score was 8 (range, 7-8; P = .64). The postembolization VAS score of the CPG group was 2.05 ± 0.37, and the CPS score was 2.14 ± 0.35 (P = .55). A total of 28 cases (16.9%) showed complications, most of which were transient pain after embolization. No serious complications such as coil embolization to the lungs occurred. In addition, the CPG group used fewer coils than the CPS group by using the slope embankment technique. The mean coil length of the CPG group was 77.18 ± 33.82 cm, and the CPS group was 105.29 ± 71 cm (P = .001). The CPG group had an average operative time of 44.49 ± 5.72 minutes, whereas the CPS group took 43.45 ± 4.18 minutes on average (P = .19). The radiation dose in the CPG group was 398.40 ± 76.16 mGy, and the radiation dose in the CPS group was 388 ± 44.23 mGy (P = .30). The median recurrence-free survival in the CPG group was 34.23 months (95% confidence interval, 33.2-35.2), and the median recurrence-free survival in the CPS group was 30.39 months (95% confidence interval, 28.2-32.6; log rank P = .018). ConclusionsEmbolization therapy for refluxing PeVD was safe and effective, and proficient use of slope embankment technique with CPG increased efficacy and reduced complications.

Two cases of acute ischemic stroke associated with strut exposure in the cerebral artery lumen after stent-assisted coil embolization

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.

A preliminary study of super-resolution deep learning reconstruction with cardiac option for evaluation of endovascular-treated intracranial aneurysms.

To investigate the usefulness of super-resolution deep learning reconstruction (SR-DLR) with cardiac option in the assessment of image quality in patients with stent-assisted coil embolization, coil embolization, and flow-diverting stent placement compared with other image reconstructions. This single-centre retrospective study included 50 patients (mean age, 59 years; range, 44-81 years; 13 men) who were treated with stent-assisted coil embolization, coil embolization, and flow-diverting stent placement between January and July 2023. The images were reconstructed using filtered back projection (FBP), hybrid iterative reconstruction (IR), and SR-DLR. The objective image analysis included image noise in the Hounsfield unit (HU), signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and full width at half maximum (FWHM). Subjectively, two radiologists evaluated the overall image quality for the visualization of the flow-diverting stent, coil, and stent. The image noise in HU in SR-DLR was 6.99 ± 1.49, which was significantly lower than that in images reconstructed with FBP (12.32 ± 3.01) and hybrid IR (8.63 ± 2.12) (P < .001). Both the mean SNR and CNR were significantly higher in SR-DLR than in FBP and hybrid IR (P < .001 and P < .001). The FWHMs for the stent (P < .004), flow-diverting stent (P < .001), and coil (P < .001) were significantly lower in SR-DLR than in FBP and hybrid IR. The subjective visual scores were significantly higher in SR-DLR than in other image reconstructions (P < .001). SR-DLR with cardiac option is useful for follow-up imaging in stent-assisted coil embolization and flow-diverting stent placement in terms of lower image noise, higher SNR and CNR, superior subjective image analysis, and less blooming artifact than other image reconstructions. SR-DLR with cardiac option allows better visualization of the peripheral and smaller cerebral arteries. SR-DLR with cardiac option can be beneficial for CT imaging of stent-assisted coil embolization and flow-diverting stent.

Prevalence, causes and management of gastric varices – a literature review

Summary: Gastric varices, although less prevalent than esophageal varices, exhibit greater morbidity and mortality. This comprehensive literature review investigates the prevalence of gastric varices, diverse classifi cation systems, and available management options. The spectrum of management modalities encompasses primary and secondary prevention, acute gastric variceal bleeding strategies, and preventive measures against rebleeding. A meticulous exploration of PubMed and Google Scholar over the past decade (2013 to 2023) shaped the inclusion criteria for adults aged 18 and above dia gnosed with gastric varices, with or without variceal bleeding. Exclusion criteria eliminated non-gastric variceal causes of upper gastrointestinal bleeding and qualitative articles, resulting in 43 relevant records from the 190 initially identified. The diverse management landscape caters to the specifi c type of gastric varix, contributing to a varied treatment approach. Notably, endoscopic ultrasound- -guided coil embolization coupled with glue injection has emerged as a promising intervention, demonstrating superior outcomes in addressing gastric varices. The evolving understanding of these varices and advancing therapeutic strategies underscore the dynamic nature of research in this critical medical domain. Key words: gastric varices – upper gastrointestinal bleeding – classifi cation – hemostasis – etiology – management options

Positional Relationship between Two Microcatheters according to the Navigation Sequence within the Curved Vessel in Neuroendovascular Procedures.

Objective In neuroendovascular treatment, there are many opportunities to guide multiple catheters into the intracranial blood vessels. We report the relationship between two microcatheters according to the guiding order with experimental in vitro studies. Materials and Methods We hypothesize that in a bent blood vessel such as a paraclinoid region of the internal carotid artery, the catheter that was first guided tended to pass through the inside, and the catheter that was guided later tended to pass through the outside. The in vitro verification was performed using a microcatheter and a balloon catheter in a silicone vascular aneurysmal model. Results As a result, it was found that the two catheters were arranged according to our hypothesis. This finding was also observed during the actual operation of balloon-assisted coil embolization. Conclusion The positional relationship between the two catheters according to the navigation order is very important, in particular during balloon-assisted coiling and stent-assisted coiling via a jailed microcatheter.