Intracranial Arterial Aneurysms Research Articles

True radial artery aneurysm in a patient with somatic mosaicism for a mutation in platelet-derived growth factor receptor β gene

We have presented the case of a right radial artery aneurysm (RAA) in a 27-year-old man with cerebral and coronary artery aneurysms and features of Parkes-Weber syndrome (port-wine stains and right upper extremity arteriovenous malformation and overgrowth). The RAA was repaired with an interposition great saphenous vein bypass graft. Analysis of the intracranial artery aneurysm and affected skin demonstrated a somatic mutation in the platelet-derived growth factor receptor-β gene. Mosaicism was present in the RAA but not in the great saphenous vein. Somatic mosaicism should be considered as a possible etiology for peripheral aneurysms in patients for whom standard genetic test results are unrevealing.

Prognosis of outcomes of intracranial arterial aneurysm clipping using intraoperative neurophysiological monitoring data

The study objective is researching of neurological deficit (ND) increasing risk factors in early postoperative period after intracranial arterial aneurysms clipping, in the cases of a transient loss of responses (TLR) during transcranial motor evoked potentials (TcMEP) and somatosensory evoked potentials (SSEP) registration. Materials and methods. One hundred and eighty-four (184) patients, operated in the neurosurgical department of IRCH by intracranial arterial aneurysms from 2014 to 2019 using intraoperative neurophysiological monitoring were included. In the acute period, 67 (36.4 %) patients were operated, in the subacute period — 40 (21.7 %), in the cold period — 77 (41.8 %), of which 7 patients have a history of aneurysm rupture, 70 patients have no break. Eighty-one (44.0 %) patients registered SSEP, 75 (40.8 %) — TcMEP, 28 (15.2 %) — successively SSEP and TcMEP. Results . MEP TLR was noted in 27 (14.7 %) cases, of which in 15 (55.6 %) cases — without an increase in ND, and in 12 (44.4 %) cases — with an increase in ND by 5.17 ± 4.63points according to NIHSS (National Institutes of Health Stroke Scale), SSEP TLR was noted in 20 (10.9 %) cases, of which in 13 (65 %) cases — without an increase in ND, and in 7 (35 %) cases — with an increase in ND by 5.14 ± 4.91 points according to NIHSS. MEP TLR with the subsequent ND increase significantly more often developed during operations performed in cold period (66.7 %) vs in acute period (25.0 %), and in subacute period (8.3 %). MEP TLR without ND increase was more often observed in acute period (46.7 %) and subacute period (33.3 %) vs in cold period (20.0 %) (p = 0.044). Transient MEP TLR during approach to an aneurysm were significantly more often (36.4 %) associated with ND increase, and MEP TLR which developed within 10 min after the final clipping, with timely correction taken were significantly more often (66.7 %) associated with a favorable outcome. Conclusion . Transient MEP TLR is more significant in predicting of postoperative ND, in the case of clip intracranial arterial aneurysms in cold period. MEP TLR during approach to an aneurysm more often associated with ND increasing.

Endovascular Parent Artery Occlusion for Intracranial Aneurysms is a Viable, Cost-Effective Alternative: An Institutional Experience from Northeast India.

Purpose.Endovascular parent artery occlusion (PAO) may be an alternative approach for complex intracranial aneurysm with potentially life-threatening complications. Moreover, the long-term follow-up of the PAO for an intracranial aneurysm is reported sparingly, limited to the case series. It is therefore important to carry out more research on long-term follow-up of the implication of PAO of intracranial aneurysm. The aim of the study was to analyses our experience of PAO for intracranial aneurysms with emphasis on long-term follow-up. Materials and Methods.The data of patients treated with PAO for intracranial aneurysms were reviewed. The outcome was evaluated based on aneurysmal occlusion on immediate angiography, follow-up magnetic resonance angiography (MRA), and complications. The modified Rankin score (mRS) was used to evaluate the functional outcome during the last follow-up. The mean, range, and standard deviation were reported for other variables – the patient’s age, number, and percentage. Results.Endovascular treatment was performed in 178 patients including PAO in 18 patients. Of these 18 (eighteen) patients, there were 13 dissecting aneurysms, 4 mycotic aneurysms, and one traumatic aneurysm.10 (ten) patients underwent PAO for proximal intracranial artery aneurysm and 8 (eight) patients for distal cerebral aneurysms. Complete occlusion of the aneurysm was achieved in 16patients (88.89%) and retrograde filling of the aneurysm was seen in 2 (11.11%) patients. One patient had intraprocedural coil migration resulting in a major infarct with an mRS of 2. Another patient (5.56%) had recanalization of the aneurysm and presented with rupture and intracranial hemorrhage with an mRS score of 4. The mRS of the other 16 patients (88.89%) was zero. Conclusions.Endovascular PAO for cerebral aneurysms was highly feasible and achieved complete occlusion. The morbidity and mortality rates were at the long-term follow-up also acceptable with negligible complications.

Dolichoectatic middle cerebral artery masquerading as cerebral cavernous malformation

Background: Intracranial dolichoectasia (IADE) is a rare vascular disease characterized by distension, elongation and tortuosity of an artery. IADE rarely involves pediatric aged groups. It is either asymptomatic or manifests as ischemic or hemorrhagic attacks.
 
 Case description: A healthy, 30-year-old, female teacher presented with recurrent attacks of bi-frontal headaches associated with dizziness and dropping attacks of two-week duration. She was referred by her general physician to our institution of Neurosurgery Teaching Hospital in Baghdad, Iraq with a suspicion of medial temporal lesion on a cranial computed tomography (CT) scan. Magnetic resonance imaging study excluded the diagnosis suggesting a dolichoectatic middle cerebral artery that was confirmed by CT-angiography. 
 
 Conclusion: Dolichoectasia of the middle cerebral artery is a rare and benign lesion. However, it can masquerade as cerebral cavernous malformation or intracranial arterial aneurysm. Thus, careful radiological evaluation with the suggested diagnostic criteria are of paramount importance to prevent its misdiagnosis.

The undiagnosed potential clinically significant incidental findings of neck CTA: A large retrospective single-center study.

To assess the prevalence and missed reporting rate of potential clinically-significant incidental findings (IFs) in the neck CTA scans.All consecutive patients undergoing neck CTA imaging, from January 1, 2017 to December 31, 2018, were retrospectively evaluated by a radiologist for the presence of incidental findings in the upper chest, lower head and neck regions. These incidental findings were subsequently classified into 3 categories in terms of clinical significance: Type I, highly significant, Type II, moderately significant; and Type III, mildly or not significant. Type I and Type II IFs were determined as potential clinically significant ones and were retrospectively analyzed by another 2 radiologists in consensus. The undiagnosed findings were designated as those that were not reported by the initial radiologists. The differences in the rate of unreported potential clinically significant IFs were compared between the chest group and head or neck group.A total of 376 potential clinically significant IFs were detected in 1,698 (91.19%) patients, of which 175 IFs were classified as highly significant findings (Type I), and 201 (53.46%) as moderately significant findings (Type II). The most common potential clinically significant findings included thyroid nodules (n = 88, 23.40%), pulmonary nodules (n = 56, 14.89%), sinus disease (n = 39, 10.37%), intracranial or cervical artery aneurysms (n = 30, 7.98%), enlarged lymph nodes (n = 24, 6.38%), and pulmonary embolism (n = 19, 5.05%). In addition, 184 (48.94%) of them were not mentioned in the initial report. The highest incidence of missed potential clinical findings were pulmonary embolism and pathologic fractures and erosions (100% for both). The unreported rate of the chest group was significantly higher than that of the head or neck one, regardless of Type I, Type II or all potential clinically significant IFs (χ2 = 32.151, χ2 = 31.211, χ2 = 65.286, respectively; P < .001 for all).Important clinically significant incidental findings are commonly found in a proportion of patients undergoing neck CTA, in which nearly half of these patients have had potential clinically significant IFs not diagnosed in the initial report. Therefore, radiologists should beware of the importance of and the necessity to identify incidental findings in neck CTA scans.

Endovascular treatment of bilateral intracranial vertebral artery aneurysms: an algorithm based on a 10-year neurointerventional experience

BackgroundThe management of bilateral intracranial vertebral artery dissecting aneurysms (IVADAs) is controversial, and requires the development of endovascular treatment modalities and principles. We aim to investigate the endovascular treatment strategy...

Experience of WEB embolization device implantation for treatment of intracranial arterial aneurisms

For the first time in Ukraine, Woven EndoBridge (WEB) (Microvention – Terumo) for the treatment of intracranial arterial aneurysms was applied at Scientific and Practical Centre of Endovascular Neuroradiology of NAMS of Ukraine on November 29, 2018. To the end of 2019 4 patients were treated with WEB. In all patients aneurysms were accidental findings, diagnosed by magnetic resonance imaging, and confirmed by angio-graphy. Men were 2 (50 %), women – 2 (50 %). The average age of patients was 49 years. All aneurysms were complex for endovascular treatment. In 3 (75 %) cases, the aneurysm was located on the anterior cerebral/anterior connective arteries, in 1 (25 %) case – on the middle cerebral artery. All patients received double disaggregated therapy at the standard dosage (75 mg of clopidogrel and 75 mg of acetylsalicylic acid) during 5 days before surgery in case of an additional intracranial stent implantation. The efficacy of dual disaggregation therapy was monitored by light transmission agrigometry. The size of the WEB depended on the angioarchitectonics of the aneurysm. All surgeries were performed in a routine manner, under general anesthesia. In all cases, the WEB was implanted successfully, there were no intra- and postoperative complications. The next day after surgery, double disaggregation therapy was canceled. All patients were discharged from the hospital in satisfactory condition, under the supervision of a neurologist at the place of residence. A control examination in the form of angiography after 6 months passed all patients. The efficacy of aneurysm occlusion using the WEB embolization device was evaluated on the WEB occlusion scale. Grade 0 and 0’ were achieved in 2 (50 %) patients, Grade 1 – 1 (25 %), Grade 2 – 1 (25 %).

Inherited Cholestatic Diseases in the Era of Personalized Medicine.

http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/15-3-reading-mack a video presentation of this article.

Mirror aneurysm

We report the case of a 47 year old man presenting to the emergency room for intense acute headache associated with meningeal syndrome. The cerebral angioscan performed had shown two mirror aneurysms localized at the bifurcations of the sylvian arteries with meningeal hemorrhage and left frontal hematoma. Intracranial arterial aneurysms may be associated, hence the need to systematically search for other locations in case of intracranial aneurysm.

ДІАГНОСТИКА І ЛІКУВАННЯ РОЗРИВІВ ЦЕРЕБРАЛЬНИХ АРТЕРІАЛЬНИХ АНЕВРИЗМ (СУЧАСНИЙ СТАН ПРОБЛЕМИ)

Introduction: The article is dedicated to current issues of improving outcomes of ruptured intracranial arterial aneurysms treatment by developing means to manage complications, refine indicators, terms, and methods of surgical treatment based on the analysis of the dynamics of clinical and angiometric perioperative indicators.Objectives: To determine current issues and research areas for the treatment of brain aneurysms.Methods: Literature sources on the diagnosis and treatment of intracranial arterial aneurysms published in the past 15 years have been analyzed using MEDLINE, Google Scholar, Researchgate medical databases, as well as our own prospective data obtained during the treatment of 184 patients with aneurysmal intracranial haemorrhage.Results: The most common complications in patients with ruptured intracranial arterial aneurysms include angiospasm (37.2%); intracerebral and intraventricular haemorrhages (27.6%); secondary cerebral ischemia (22.2%); intraoperative complications (9.1%); repeated aneurysm rupture (6.5%). Reliable criteria for predicting the unfavourable outcome of the surgery are high Hunt-Hess (&gt; 2.7 ± 0.2) and WFNS (&gt; 2.1 ± 0.2) scores in patients at the time of aneurysms exclusion. During the acute period (1-14 days), postoperative mortality after clipping (16.2%) differs from the coiling group (10.2%). Intraoperative cerebral angiospasm is a leading factor contributing to complications following the surgery and leading to an increase in mortality up to 27.8% while preventing successful surgery in 38.8% of cases. Regardless of the surgery timing, significant (p&lt;0,05) reduction in the diameter of the middle cerebral artery at the end of surgery compared to its beginning by an average of 30.1% constitutes an unfavourable criterion as opposed to a favourable course when there is an unreliable (p&gt;0,2) narrowing of the artery by an average of 8.4%. Immediate hospitalization, transcranial interventions within 10.5-14.3 days, and endovascular interventions in the first day are strongly recommended for patients with ruptured intracranial arterial aneurysms. They provide the best clinical results. If the aneurysm is amenable by each of the methods, endovascular embolization is preferred, since in this case, the average patient day is statistically significantly shorter (p &lt;0,01) than after transcranial clipping.Conclusion: During 2008-2018, 789 intracranial arterial aneurysms were treated surgically in the Municipal Non-Profit Enterprise &quot;Lviv Clinical Emergency Care Hospital&quot;. Postoperative mortality decreased from 29.9% in 2008 to 8.2% in 2018. Advantages of endovascular treatment in the early stages of haemorrhage and higher radicality of aneurysm exclusion using the microsurgical method have received theoretical justification and clinical confirmation. Provided literature, clinical, and instrumental data expand the understanding of the pathogenesis of complications in cases of ruptured intracranial arterial aneurysms and show their predictive value. The choice of the optimal surgery term and method constitutes an effective means to reduce the level of postoperative mortality in case of aneurysmal intracranial haemorrhages. We have developed and implemented a new method for determining intraoperative angiospasm severity, and optimized a choice of coil parameters for safe and effective cerebral aneurysms embolization.

Microcatheter shaping using three-dimensional printed models for intracranial aneurysm coiling

Background and purposeMicrocatheterization is an important, but also difficult, technique used for the embolization of intracranial aneurysms. The purpose of this study was to investigate the application of three-dimensional (3D)...

Cervicocerebral quantitative arterial tortuosity: a biomarker of arteriopathy in children with intracranial aneurysms.

Although intracranial arterial aneurysms (IAAs) of childhood are usually idiopathic, it is possible that underlying arteriopathy escapes detection when using conventional diagnostic tools. Quantitative arterial tortuosity (QAT) has been studied as a biomarker of arteriopathy. The authors analyzed cervicocerebral QAT in children with idiopathic IAAs to assess the possibility of arteriopathy. Cases were identified by text-string searches of imaging reports spanning the period January 1993 through June 2017. QAT of cervicocerebral arterial segments was measured from cross-sectional studies using image-processing software. Other imaging and clinical data were confirmed by retrospective electronic record review. Children with idiopathic IAAs and positive case controls, with congenital arteriopathy differentiated according to aneurysm status (with and without an aneurysm), were compared to each other and to healthy controls without vascular risk factors. Cervicocerebral QAT was measured in 314 children: 24 with idiopathic IAAs, 163 with congenital arteriopathy (including 14 arteriopathic IAAs), and 127 healthy controls. QAT of all vertebrobasilar segments was larger in children with IAAs (idiopathic and arteriopathic forms) (p < 0.05). In children with congenital arteriopathy without an aneurysm, QAT was decreased for the distal cervical vertebral arteries and increased for the supraspinal vertebral artery relative to healthy children. QAT of specific cervicocerebral segments correlated with IAA size and rupture status. Cervicocerebral QAT is a biomarker of arteriopathy in children with IAA, even in the absence of other disease markers. Additional findings suggest a correlation of cervicocerebral QAT with IAA size and rupture status and with the presence of IAA in children with congenital arteriopathy.

Endovascular Managment for Intracranial Carotid Artery Aneurysms

Objective: To assess safety and effectiveness of endovascular management for different types of intracranial carotid artery aneurysms. Patients and Methods: prospective and retrospective review of intracranial carotid artery aneurysms treated by endovascular procedures in Al-Azhar University Endovascular Center and other centers. Twenty patients met inclusion criteria. Results: fourteen medium sized, nine small, four large and one giant aneurysm. Seventeen narrow necks, eleven wide-necks and seven have involved branches in neck. Twenty-three cases were treated with coiling, three cases were treated with stent-assisted coiling and two cases were treated with stenting as flow diverter. Conclusion: pre-procedural conscious patients with GCS15 or 14 associated with better outcome. PcomA, Ophthalmic and Choroidal aneurysms were associated with better outcome after endovascular procedures. Coiling of narrow neck aneurysms was associated with better outcome.

Endovascular Managment for Intracranial Carotid Artery Aneurysms

Endovascular Managment for Intracranial Carotid Artery Aneurysms

No evidence of increased cerebrovascular involvement in adult neurologically-asymptomatic β-Thalassaemia. A multicentre multimodal magnetic resonance study.

Multi-factorial causes jeopardize brain integrity in β-thalassaemia. Intracranial parenchymal and vascular changes have been reported among young β-thalassaemia patients but conventional magnetic resonance imaging (MRI) findings are contradictory making early MRI and magnetic resonance angiography (MRA)/venography monitoring a matter of debate. This study prospectively investigated 75 neurologically asymptomatic β-thalassaemia patients (mean-age 35·2±10·7years; 52/75 transfusion-dependent; 41/75 splenectomised) using a 3T magnetic resonance scanner; clinical, laboratory and treatment data were also collected. White matter ischaemic-like abnormalities, intracranial artery stenoses, aneurysms and sinus venous thrombosis were compared between patients and 56 healthy controls (mean-age 33·9±10·8years). No patient or control showed silent territorial or lacunar strokes, intracranial artery stenoses or signs of sinus thrombosis. White matter lesions were found both in patients (35/75, 46·7%) and controls (28/56, 50·0%), without differences in terms of number (4·0±10·6 vs. 4·6±9·1, P=0·63), size and Fazekas' Score. Intracranial aneurysms did not differ between patients and controls for incidence rate (7/75, 9·3% vs. 5/56, 8·9%), size and site. Vascular and parenchymal abnormality rate did not differ according to treatments or clinical phenotype. According to this study, asymptomatic β-thalassaemia patients treated according to current guidelines do not seem to carry an increased risk of brain and intracranial vascular changes, thus weakening recommendations for regular brain MRI monitoring.

The efficacy of microsurgery in the treatment of intracranial arterial aneurysm with anomalous circle of Willis

A clinical case presents the results of successful microsurgery in the treatment of a patient with intracranial saccular aneurysm and anomalous circle of Willis. The patient underwent right pterional craniotomy resection followed by the clipping of the saccular aneurysm at the anterior cerebral artery and anterior communicating artery complex on the right. The selected surgical strategy allowed for complete exclusion of the saccular aneurysm from the arterial circulation, maintaining the patency of the abnormal arteries and preventing ischemic stroke. The chosen surgical strategy appeared to be effective.

Significance of CT perfusion examination of cerebral blood flow for assessing the risk of brain ischemia in patients with intracranial arterial aneurysm ruptures

The study purpose was to evaluate the significance of cerebral blood flow indicators obtained by CT perfusion for prediction of delayed cerebral ischemia and postoperative ischemic complications to optimize treatment of patients with ruptures of intracranial arterial aneurysms. The study included 70 patients who underwent aneurysm clipping and 42 non-operated patients. The inclusion criteria were as follows: WFNS grade I-III condition, vasospasm according to transcranial Doppler sonography, and availability of CT scans, including CT perfusion data. The vasospasm severity and perfusion indicators _(rCBV and MTT) were evaluated. The severity of subarachnoid and ventricular hemorrhage was evaluated according to the A. Hijdra method. The final results were evaluated using a clinical-statistical method, including ROC analysis. An analysis of the obtained data revealed that the risk of delayed cerebral ischemia and postoperative ischemia increases significantly if the baseline hemispheric CBF value is below a threshold of 40 ml/100 g/min, and the baseline MMT indicator is above a threshold of 5 s. There was asymmetry of these CT perfusion indicators due to a larger deviation from the threshold values in the homolateral hemisphere compared to the opposite side. The ROC analysis results demonstrated diagnostic sensitivity and diagnostic specificity of the CT perfusion technique. The CT perfusion data together with the SAH severity and localization indicators may be used as predictors for the cerebral ischemia outcome in choosing the optimal timing of aneurysm clipping during the acute SAH period in patients in a WFNS grade I-III condition and with signs of mild or moderate vasospasm.

Behcet's disease with neurologic manifestations

Behcet's disease (BD) is a type of systematic chronic inflammatory disease of unknown etiology that is characterized by the combination of recurrent oral aphthous, genital ulcers and uveitis. A damage of the nervous system is observed in 3-9% of patients, in which two variants of the course of the disease are possible: parenchymal in the form of immune-mediated meningoencephalitis, and non-parenchymal, which can be represented by venous sinus thrombosis, intracranial arterial aneurysms and intracranial hypertension. The article presents a clinical case of BD with a dominant nervous system damage in the clinical presentations of the disease.

Visualization of Four Intracranial Stents and In-stent Stenosis with Stenotic Models by 3D-TOF-MRA

In recent years, various types of stents are deployed for the treatment of intracranial artery stenosis and aneurysms. Digital subtraction angiography has been considered to be the gold standard for the follow-up study. However, magnetic resonance angiography (MRA) is less invasive and the recent advances may contribute to the imaging of patients with intracranial stents. Then, a phantom study was carried out to evaluate the MR lumen visibility with these stents. Four stents [low-profile visualized intraluminal support (LVIS), Neuroform Atlas, Neuroform EZ, and Enterprise 2] were placed into plastic tubes with 3 mm inner diameter, and fixed in a container filled with agar. Time-of-flight MRA (TOF-MRA) was performed for these stents, and the signal intensities inside and outside the stents were measured on ImageJ software. Furthermore, 25%, 50%, and 75% stenosis models were created and passed through these stents to evaluate the diagnostic accuracy of in-stent stenosis. The signal intensity inside the LVIS stent was the highest among the four stents (P<0.001), and no significant difference was found between the signal intensities inside and outside the LVIS stent. The diagnostic accuracy with LVIS was also higher than that of Enterprise 2 (P<0.001). In conclusion, the visibility with LVIS indicates that TOF-MRA could be reliably utilized as a diagnostic tool for the detection of in-stent stenosis.

Persistent hypoglossal artery aneurysm: Case report and qualitative systematic review

A persistent hypoglossal artery was first described in 1889 and is one of the more common anatomical variations arising from aberration in normal development. Endovascular coiling has been recognised as a robust treatment for acutely ruptured intracranial arterial aneurysms, although specific data regarding an aneurysm arising from a persistent hypoglossal artery is lacking due to the low incidence. Here we report both the oldest patient reported to be treated with a persistent hypoglossal artery-associated aneurysm and also explicitly report endovascular treatment of a persistent hypoglossal artery aneurysm arising at the posterior inferior cerebellar artery origin. Qualitative systematic review of the available medical literature demonstrates limited evidence regarding treatment of persistent hypoglossal artery-associated aneurysms with the majority being carried out via open surgery. Ruptured posterior inferior cerebellar artery aneurysm arising from a persistent hypoglossal artery can be successfully and safely treated by endovascular therapy via the persistent hypoglossal artery. Randomised study of this situation is unlikely to be feasible; however, qualitative review of the literature reveals six such aneurysms that have been treated surgically, and this case appears to be the first via an endovascular means.