Embolization Of Cerebral Aneurysms Research Articles

Evaluation of the shrinkage process of a neck remnant after stent-coil treatment of a cerebral aneurysm using silent magnetic resonance angiography and computational fluid dynamics analysis: illustrative case.

Silent magnetic resonance angiography (MRA) mitigates metal artifacts, facilitating clear visualization of neck remnants after stent and coil embolization of cerebral aneurysms. This study aims to scrutinize hemodynamics at the neck remnant by employing silent MRA and computational fluid dynamics. The authors longitudinally tracked images of a partially thrombosed anterior communicating artery aneurysm's neck remnant, which had been treated with stent-assisted coil embolization, using silent MRA over a decade. Computational fluid dynamics delineated the neck remnant's reduction process, evaluating hemodynamic parameters such as flow rate, wall shear stress magnitude and vector, and streamlines. The neck remnant exhibited diminishing surface area, volume, neck size, dome depth, and aspect ratio. Its reduction correlated with a decline in the flow rate ratio of the remnant dome to the inflow parent artery. Analysis delineated regions within the contracting neck remnant characterized by consistently low average wall shear stress magnitude and variation, accompanied by notable variations in wall shear stress vector directionality. Evaluation of neck remnants after stent-coil embolization is possible through silent MRA and computational fluid dynamics. Predicting the neck remnant reduction may be achievable through hemodynamic parameter analysis.

Bilateral Subperiosteal Orbital Hematomas Following Cerebral Aneurysm Embolization: A Case Report and Review of an Atypical Presentation of Acute Vision Loss (P7-2.001)

Bilateral Subperiosteal Orbital Hematomas Following Cerebral Aneurysm Embolization: A Case Report and Review of an Atypical Presentation of Acute Vision Loss (P7-2.001)

Monorail snare technique for retrieval of stretched coil.

Coil stretching is a recognized complication during cerebral aneurysm embolization.1, 3- 5 For over a decade, the microsnare has proven effective in retrieving migrated coils.1- 5 Fiorella et al. unveiled the "Monorail Snare Technique" in 2005, offering a specialized approach to stretched coil recovery.1 However, to gain a complete understanding of this technique, more than just textual descriptions are necessary; a thorough, practical demonstration is essential. In our technical video (video 1), we illustrated an episode of coil stretching during aneurysm embolization, where the "Monorail Snare Technique" was successfully employed to retrieve a stretched coil. Our video emphasizes the meticulous preparation and modification of the microsnare, showcasing enhanced steps to mitigate the potential blood backflow triggered by the exclusive use of one-arm hemostasis valve during the "Monorail Snare Technique."1, 5 This pivotal adjustment substantially lowers the threat of thromboembolic events. We highlighted essential precautions to ensure the procedure's safety and efficacy.4, 5.

Clopidogrel versus newer P2Y12 inhibitors in the dual antiplatelet therapy for stent-assisted coil embolization of intracranial aneurysms: A meta-analysis.

Stent-assisted coil embolization (SACE) for cerebral aneurysms requires dual antiplatelet therapy (DAPT), commonly clopidogrel plus aspirin is preferable to ticagrelor or prasugrel plus aspirin. However, there are few studies assessing the safety of the association of ticagrelor or prasugrel plus aspirin. Compare the safety of newer P2Y12 inhibitors with clopidogrel in patients that underwent a SACE for cerebral aneurysms. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we searched PubMed and Embase for studies comparing newer P2Y12 inhibitors with clopidogrel in patients undergoing DAPT for SACE. Outcomes were total number of complications, number of hemorrhagic complications, and number of thromboembolic complications both intraoperative and follow-up. A random effects model was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs). We included 1026 patients from six studies. Newer P2Y12 inhibitors were used in 562 (54,77%) patients. There were no significant differences between groups in total number of complications (OR 0.80; 95% CI 0.32, 1.99; p < 0.01; I2 = 78%), in intraoperative hemorrhagic complications (OR 0.66; 95% CI 0.09, 4.71; p = 0.68; I2 = 0%), follow-up hemorrhagic complications (OR 1.23; 95% CI 0.70, 2.15; p = 0.49; I2 = 0%), intraoperative thromboembolic complications (OR 0.43; 95% CI 0.14, 1.35; p = 0.25; I2 = 24%), and in follow-up thromboembolic complications (OR 0.89; 95% CI 0.33, 2.39; p = 0.03; I2 = 59%). In patients who underwent a SACE, newer P2Y12 inhibitors showed no differences in intraoperative and follow-up complications compared with clopidogrel.

Second-stage pipeline embolization device treatment with coil embolization for large cerebral aneurysm prevents silent diffusion-weighted image ischemic infarction: a retrospective study

BackgroundSecond-stage flow diversion with coil embolization may improve occlusion outcomes and reduce periprocedural complications in patients with cerebral aneurysm. However, the actual cause behind this is unclear. In this study, we aimed to compare the efficacy and safety of second-stage pipeline embolization device (PED) and single-stage PED with coil embolization.ResultsOf the 22 treated patients with aneurysm, 10 and 12 were treated with second-stage PED and single-stage PED with coil embolization, respectively. The mean follow-up duration was 29.6 months. The mean numbers of diffusion-weighted image (DWI)-positive spots on day 1 post-procedure were 4.9 and 10.8 in the second-stage and single-stage PED with coil embolization groups, respectively (P = 0.01). Deterioration of the modified Rankin scale score was not ≥ 2 in any patient during follow-up in the second-stage PED group but was observed in 16.7% of cases (2/12) in the single-stage PED with coil embolization group (P = 0.48). On follow-up angiography, complete occlusion was observed in all patients (10/10) in the second-stage PED group and 66.7% (8/12) in the single-stage PED with coil embolization group (P = 0.09).ConclusionsThe second-stage PED strategy significantly reduces the number of DWI high-intensity spots, leading to the prevention of ischemic complications. This strategy may help to prevent complications and reduce morbidity.

Intermediate catheter use is associated with complete occlusion and dense packing in coil embolization of unruptured cerebral aneurysms: a propensity score matched study

BackgroundAn intermediate catheter (IMC) can improve the maneuverability and stability of the microcatheter.ObjectiveTo investigate the efficacy and safety of using an IMC in triaxial systems for coil embolization of unruptured...

Determination of Significant Three-Dimensional Hemodynamic Features for Postembolization Recanalization in Cerebral Aneurysms Through Explainable Artificial Intelligence

BackgroundRecanalization poses challenge in coil embolization for cerebral aneurysms. Establishing predictive models for post-embolization recanalization is important for clinical decision-making. However, conventional statistical and machine learning (ML) models may overlook critical parameters during the initial selection process. MethodsIn this study, we automated the identification of significant hemodynamic parameters using a PointNet-based deep neural network (DNN), leveraging their inherent three-dimensional (3D) features. Further feature analysis was conducted utilizing saliency mapping, an explainable artificial intelligence (XAI) technique. The study encompassed the analysis of velocity, pressure, and wall shear stress (WSS) in both pre- and post-coiling models derived from computational fluid dynamic (CFD) simulations for 58 aneurysms. ResultsVelocity was identified as the most pivotal parameter, supported by the lowest P-value from statistical analysis and the highest area under the receiver-operating characteristic curves (AUROC)/precision-recall curves (AUPRC) values from DNN model. Moreover, visual XAI analysis revealed robust injection flow zones with notable impingement points in pre-coiling models, as well as pronounced interplay between flow dynamics and the coiling plane were important 3D features in identifying the recanalized aneurysms. ConclusionsThe combination of DNN and XAI was found to be an accurate and explainable approach not only at predicting post-embolization recanalization but also at discovering unknown features in the future.

Effectiveness of S-Shaping of the Tip of the FUBUKI Guiding Catheter to Match the Shape of the Cervical Internal Carotid Artery in Anterior Circulation Cerebral Aneurysm Embolization.

During cerebral aneurysm embolization of the anterior circulation, the guiding catheter (GC) should be placed as distally as possible in the cervical internal carotid artery (ICA) to secure the maneuverability of the microcatheter and distal access catheter. However, if the shape of the tip of the GC does not appropriately match the course of the ICA, blood stasis might occur. We investigated whether shaping the tip of the GC into an S-shape would allow more stable catheterization to the distal ICA than the conventional GC with an angled tip. We included patients with cerebral aneurysms of the anterior circulation who were treated at our institution from April 2019 to April 2021. First, we evaluated the cervical ICA course in these patients through cerebral angiography and classified the courses into type S, type I, and type Z. Then, we focused on the most frequently encountered type-S cervical ICA to investigate the forging effect of the GC tip into an S-shape. We evaluated the lateral view of the carotid angiograms to examine whether the catheter tip reached the foramen magnum (FM) without interrupting ICA blood flow. The effects of age, sex, side, a history of hypertension and smoking, and an S-shape modification of the GC tip on the outcome of GC placement were analyzed. A total of 67 patients were included in this study. The tip of the GC was placed at the FM in 27 cases. Among these factors, only the S-shape modification was significantly associated with whether the GC could be placed at the level of the FM (p <0.0001). By forging the tip of the GC into an S-shape, the GC can be safely advanced to the distal part of the cervical ICA, which may contribute to the improved maneuverability of microcatheters.

Bilateral subperiosteal orbital hematomas following cerebral aneurysm embolization: An atypical presentation of acute vision loss

Bilateral subperiosteal orbital hematomas following cerebral aneurysm embolization: An atypical presentation of acute vision loss

Cumulative Effective Dose During Fluoroscopically Guided Interventions (FGI): Analysis of More Than 5000 FGIs in a Single European Center.

The number of fluoroscopically guided interventions (FGI) has increased significantly over time. However, little attention has been paid to possible stochastic radiation effects. The aim of thisretrospective study was to investigatethe number of patients who received cumulative effective dosesover 100mSvduring FGI procedures. Five thousand five hundred and fifty four classified FGI procedures were included. Radiation dose data, retrieved from an in-house-dose-management system, was analysed. Effective doses and cumulative effective doses (CED) were calculated. Patients who received a CED > 100mSv were identified. Radiology reports, patient age, imaging and clinical data of these patients were used to identify reasons for CED ≥ 100mSv. One Hundred and thirty two (41.1% female) of 3981 patients received a CED > 100 mSy, with a mean CED of 173.5 ± 84.5mSv. Mean age at first intervention was 66.1 ± 11.7years. 81 (61.4%) of 132 were older than 64years, one patient was < 30years. 110 patients received ≥ 100mSv within one year (83.4%), through FGIs: EVAR, pelvic/mesenteric interventions (stent or embolization), hepatic interventions (chemoembolization, TIPSS), embolization of cerebral aneurysms or arterio-venous-malformations. Substantial CED may occur in a small but not ignorable fraction of patients (~ 3%) undergoing FGIs. Approximately 2/3rd of patients may most likely not encounter radiation-related stochastic effects due to life-threatening diseases and age at first treatment > 65years but 1/3rd may. Patients undergoing more than one FGI (77%) carry a higher risk of accumulating effective doses > 100mSv. Remarkably, 23% received a mean CED 162.2 ± 72.3mSv in a single procedure.

Three-Dimensional (3D) Microcatheter Shaping Using Touch Screen Devices for Cerebral Aneurysm Coil Embolization

In cerebral aneurysm coil embolization, proper microcatheter shaping is crucial to reduce complications and achieve sufficient embolization. Shaping a microcatheter in 3 dimensions (3D) is often required but can be challenging. We assessed the usefulness of a novel shaping on screen (SOS) method that displays real-size 3D rotational angiography (RA) images on a touch screen device during cerebral aneurysm embolization to facilitate 3D microcatheter shaping. In this study, 18 patients with cerebral aneurysm treated with this technique were included. Real-size 3D-RA images obtained during the embolization procedure were displayed on the touch screen device, which allowed for real-time manipulation. The shape of the microcatheter was adjusted to conform to the curvature of the vessel by swiping the touch screen device and bending the mandrel accordingly. We assessed the clinical and angiographic results, along with the accuracy and stability of the microcatheter. No procedure-related complications were observed. The mean packing density was 41%±12%. In all but 1 case, microcatheters were inserted into the aneurysms without guidewire assistance. After coiling, all microcatheter forms were stable. Three-dimensional (3D) microcatheter shaping using touch screen devices during cerebral aneurysm coil embolization may be simple and safe and can achieve high packing density of aneurysms.

Prediction of Thrombosis After Coil Embolization of Unruptured Cerebral Aneurysm by Computational Fluid Dynamics Using Porous Media Modeling

Prediction of Thrombosis After Coil Embolization of Unruptured Cerebral Aneurysm by Computational Fluid Dynamics Using Porous Media Modeling

Abstract 111: Woven Endo Bridge‐Coil Embolization of a Middle Cerebral Artery Bifurcation Aneurysm with Secondary Lobule

Introduction 18‐36% of all intracranial aneurysms are middle cerebral artery(MCA) bifurcation aneurysms. While some are much higher risk than others, they have an overall low estimated annual rupture rate of 0.36%.(1) MCA bifurcation aneurysms have been historically challenging to treat endovascularly given they often have complex morphology and wide necks. The Woven EndoBridge (WEB) is an ellipsoid embolization device designed to provide intrasaccular flow disruption along the aneurysm neck, which has been proven to be an effective method in treating a wide spectrum of wide‐necked bifurcation aneurysms. Thromboembolism and recanalization are the main concerns in treatment with the WEB device, like any aneurysm treatment approach .(2),(3) Occasionally, irregularities and secondary lobules at the base of the primary aneurysm can have persistent filling despite treatment. Methods We present a case of a right MCA bifurcation aneurysm treated by a WEB device and coil embolization. Results 48‐year‐old female with a medical history significant only for active smoking who presented with sudden onset of the worst headache of her life followed by brief loss of consciousness. No neurological evaluation was sought initially, until 2 weeks later as she continued to experience a moderate‐intensity headache associated with nausea and vomiting with frequent falls. On exam, she was alert and oriented, moving all extremities with full strength. CT head revealed an evolving acute to subacute right MCA infarction with adjacent small volume subarachnoid hemorrhage. CTA head revealed a right MCA bifurcation aneurysm measuring 6 x 6 x 7 mm with irregularity of the wall. Multifocal severe stenosis was noted in the right distal right M1 and right M2 divisions. She underwent a diagnostic subtraction angiography which confirmed an irregular right MCA bifurcation aneurysm measuring 4.3 x 4.5 x 5.7 mm (Figure 1 ‐A,B). While it was believed that the subarachnoid hemorrhage was more likely related to the recent infarct, a decision was made to treat the aneurysm given its relatively large size and irregular shape. Embolization was performed with a WEB SL 6 x 4 mm device (Figure 1: C,D ‐blue arrow). Post‐deployment angiograph showed occlusion of the aneurysm dome but persistent filling of the secondary lobule near the base of the aneurysm. Given this residual lobule filling, a decision was made to continue additional embolization with a hyper soft 3D 2 mm X 2 cm coil(Figure 1: C,D ‐ yellow arrow). Final angiography revealed complete occlusion of the aneurysm. Vasospasm of the distal M2 divisions and multiple M3 branches in the right MCA vascular territory was also noted. Therefore, she was treated with 20 mg of intra‐arterial Verapamil with improvement. She was started on Aspirin 325 mg daily. Daily transcranial dopplers were negative for vasospasm. She remained neurologically stable and was discharged home 5 days after admission ambulating independently. Conclusion With modern advances in endovascular devices, many MCA bifurcation aneurysms can be treated minimally invasively. However, there are some limitations to the WEB since every aneurysm is different and there are a finite number of sizes and shapes available for WEB. This case illustrates that adjunctive coil embolization can successfully occlude a residual secondary base lobule after WEB embolization.

Abstract 172: Outcomes and Complications of Stent‐Assisted Aneurysm Repair in Acute Subarachnoid Hemorrhage

Introduction The use of detachable coils for endovascular embolization of cerebral aneurysms has become a safe and effective alternative to direct surgical clipping in patients with ruptured aneurysmal subarachnoid hemorrhage. However, endovascular treatment of wide‐necked, large (&gt;10 mm), and complex ruptured aneurysms continues to remain challenging despite multiple technical advancements in recent years. In order to improve treatment outcomes in these difficult cases, the use of stent‐assisted embolization has been attempted in endovascular treatment of intracranial aneurysms. In order to avoid thromboembolic complications in these cases, patients require treatment with antiplatelet therapy. Previous studies have shown that antiplatelet therapy poses an increased risk of hemorrhagic complications; this risk might be further heightened in the setting of acute subarachnoid hemorrhage (SAH), as these patients can develop an abnormal coagulation status. The purpose of this study was to retrospectively analyze the results and complications associated with stent‐assisted embolization of intracranial aneurysms in the acute treatment of subarachnoid hemorrhage at Dell Seton Medical Center. Methods Data from patients with acutely‐ruptured intracranial aneurysm treated with stent‐assisted embolization at Dell Seton Medical Center in the period between 2021 and 2022 were retrospectively assessed, with the focus of addressing aneurysm occlusion, clinical outcomes and complications. Results Fifteen patients with ruptured intracranial aneurysms were included in the analysis. Post‐procedural re‐rupture and hemorrhagic complications were observed in three patients, leading to death in two patients. Thromboembolic complications were observed in one patient, with the clinical outcome of death due to basilar stent thrombosis. Immediate complete occlusion and occlusion with residual neck was achieved in 66.7% of cases. Conclusion In the case of ruptured intracranial aneurysms with large and complex morphology and a wide neck, the use of stent‐assisted repair may be necessary compared to simpler and smaller aneurysms that can be treated with coils alone. The use of stent‐assisted repair in acutely‐ruptured aneurysms in this series of cases demonstrated rapid and good aneurysmal occlusion. The post‐procedural complication rate proved to be higher than in non‐ruptured stent‐assisted coiling. However, the overall resulting morbidity and mortality rates in this cohort of patients is lower than could have been expected; furthermore, the complication rates found in this study are in line with those reported in similar studies. In most cases in the emergency setting, it is not possible to appropriately prepare a patient with antiplatelet therapy pre‐procedurally. As a result, the proper antiplatelet medication regimen and its appropriate timing continue to remain a significant topic of investigation. In addition, there continues to be further investigation into the optimal timing of intervention to minimize risk of peri‐procedural and post‐procedural complications. Further retrospective analysis of patient data over multiple years and across multiple centers is needed to better assess outcomes and complications of stent‐assisted aneurysm repair in acute subarachnoid hemorrhage.

Individualized Periprocedural and Intraprocedural Management for Coil Embolization of Unruptured Cerebral Aneurysm in a Patient with Severe Thrombocytopenia due to Liver Cirrhosis

A female patient in her early 60's with advanced liver cirrhosis and thrombocytopenia having a platelet count under 30,000/µL, visited an outpatient clinic. Computed tomography angiography revealed an unruptured aneurysm on the left middle cerebral artery bifurcation with 6.0 mm of maximal diameter. Endovascular coiling was planned, considering the patient's medical condition. Eight pints of platelet concentrate were transfused 6 hours before the procedure, and a platelet count of 57,000/ µL was achieved 3 hours before the procedure. No antiplatelet premedication and intraprocedural heparin was administered. A bail-out use of intra- or postoperative Tirofiban (Aggrastat®) was prepared for inadvertent thromboembolic events. The aneurysm was successfully occluded with no procedure-related event. The patient’s hospital course was uneventful, and she was discharged without complications. Despite the potential hemorrhagic risk caused by hemostatic failure in patients with cirrhosis, successful endovascular coiling can be performed with highly individualized management.

Evaluation of effectiveness and safety of the CorPath GRX robotic system in endovascular embolization procedures of cerebral aneurysms

BackgroundRobotic-assisted neurointervention was recently introduced, with implications that it could be used to treat neurovascular diseases.ObjectiveTo evaluate the effectiveness and safety of the robotic-assisted platform CorPath GRX for treating cerebral...

Delayed ischemic events with low-dose prasugrel medication for stent-assisted coil embolization in intracranial aneurysm patients.

Much emphasis has been put on the use of antiplatelet medication for the prevention of ischemic events in the treatment of cerebral aneurysms with stent assistance. In this regard, the effectiveness and safety of a low-dose prasugrel regimen during the periprocedural period was recently reported. The purpose of this study was to present the outcomes of patients on low-dose prasugrel regimens during the follow-up period after stent-assisted coil embolization (SACE) of cerebral aneurysms. For the 396 consecutive patients undergoing SACE procedures, low-dose prasugrel therapy (5 mg of prasugrel and 100 mg of aspirin) was recommended for 3 months after the endovascular treatment. The authors performed a retrospective review of a single-center experience focusing on delayed ischemic events beyond 1 month after treatment. The mean follow-up period was 24.6 ± 11.3 months. In this cohort of patients on a low-dose prasugrel regimen, cerebral infarction occurred in 1 patient (0.3%, 95% CI 0%-1.8%) beyond 1 month after SACE. No intracranial hemorrhage occurred. Overall ischemic events occurred in 14 patients (3.5%, 95% CI 2.1%-5.9%), all within 6 months of the coiling procedure. All patients had transient symptoms. The events occurred within 2 months after cessation of prasugrel in 11 patients (78.6%). Prasugrel maintenance for 6 months was found to result in lower ischemic events compared with maintenance for 3 months. For patients undergoing SACE, a low-dose prasugrel regimen was a safe and reliable treatment option for the prevention of delayed ischemic events. Transient ischemic events often occurred within 2 months of stopping prasugrel medication.

Double-catheter technique for the embolization of recurrent cerebral aneurysms: A single-center experience.

Recurrent cerebral aneurysms have complex shapes and are often technically challenging to treat with a single microcatheter. This study evaluates the clinical characteristics and treatment outcomes of patients who received double-catheter coil embolization for recurrent cerebral aneurysms. Patients who underwent double-catheter coil embolization at our institution between April 2011 and March 2022 for recurrent aneurysms were included in the study. Baseline characteristics, course to recurrence, details of the procedures, and outcomes after endovascular treatment were retrospectively analyzed based on past medical records. Eight patients with recurrent aneurysms were treated with the double-catheter technique. One patient had a subarachnoid hemorrhage due to a rupture of a recurrent aneurysm and the others had radiological recurrence during follow-up. The initial treatment for the aneurysm was clipping in one case and coiling in seven cases. All the aneurysms were located at bifurcation sites. During retreatment, balloon remodeling technique was used in five cases. Angiographic features immediately after the treatment included complete occlusion in one case, neck remnant in three cases, and dome filling in four cases. There were no procedure-related severe complications, besides preexisting oculomotor nerve palsy due to the mass effect of the aneurysm worsened in one patient. The mean follow-up period after retreatment was 4.3 years. There was one case of recurrence after retreatment in which additional endovascular coiling was necessary. This study demonstrated that the double-catheter technique could be a safe and useful treatment option for patients with recurrent aneurysms at bifurcation sites.

Use of 3D-printing cerebral aneurysm model assisting microcatheter shaping in neurovascular intervention technique training

BackgroundMicrocatheter shaping plays a vital role in coil embolization of cerebral aneurysms, while the complicated method and insufficient training opportunities make it difficult for junior neurovascular clinicians to master this technique. In this program, we constructed a novel training method and assessment system for microcatheter shaping in coil embolization of cerebral aneurysms with 3D technique, and evaluated its efficacy for microcatheter shaping training in junior neurovascular clinicians. MethodsPatient-specific models for cerebral aneurysms in different locations and with different morphologies were selected by experienced senior neurovascular clinicians. The solid polylactic acid model and the soft hollow crystal silicone model of intracranial aneurysms were then made separately for shaping reference and assessment in the training course. Twelve residents without prior experience of microcatheter shaping and 25 neurovascular clinicians who have in vivo experience of microcatheter shaping on 3–5 occasions were selected for this training program and randomly divided into the traditional training group and the experimental training group. Four senior neurovascular clinicians assisted and guided the trainees in two groups and evaluated the time and accuracy of microcatheter shaping. ResultsEighteen trainees were assigned to the traditional training group, among which 4 had prior experience in microcatheter shaping. The other 19 were assigned to the experimental training group, including 8 with prior experience. No statistical difference in the distribution of experienced students between the two groups was noted(P = 0.295). After the training session, the shaping time was found shorter in the experimental training group than that in the traditional training group (40.3.5 ± 16.2 s vs. 54.2 ± 16.4 s, P = 0.014), while the shaping score was found higher in the experimental training group than that in the traditional training group (4.4 ± 0.5 vs. 2.6 ± 1.2, P < 0.001). Specifically, for the trainees without prior experience, the experimental training group also showed less time consumption and higher score (Time: 52.7 ± 7.7 vs. 61.5 ± 9.5, P = 0.02; Score 4.1 ± 0.5 vs. 2.3 ± 1.1, P < 0.01). Meanwhile, for the trainees with prior experience, the advantage was noted in shaping score (4.7 ± 0.3 vs. 3.9 ± 0.6, P < 0.01) but not in time consumption (23.3 ± 4.4 vs. 28.5 ± 3.9, P = 0.07). ConclusionThis training program is quite effective at teaching junior neurovascular physicians the essential surgical abilities required for coiling cerebral aneurysms.

Short- versus long-term Dual AntiPlatelet Therapy for Stent-Assisted treatment of CErebral aneurysm (DAPTS ACE): a multicenter, open-label, randomized clinical trial

BackgroundThe optimal duration of dual antiplatelet therapy (DAPT) after stent-assisted coil embolization (SACE) for cerebral aneurysm remains uncertain. This randomized trial of short- versus long-term Dual AntiPlatelet Therapy for Stent-Assisted...