Multiple Intracranial Aneurysms Research Articles

A model with multiple intracranial aneurysms: possible hemodynamic mechanisms of aneurysmal initiation, rupture and recurrence

BackgroundHemodynamic factors play an important role in aneurysm initiation, growth, rupture, and recurrence, while the mechanism of the hemodynamic characteristics is still controversial. A unique model of multiple aneurysms (initiation, growth, rupture, and recurrence) is helpful to avoids the confounders and further explore the possible hemodynamic mechanisms of aneurysm in different states.MethodsWe present a model with multiple aneurysms, and including the states of initiation, growth, rupture, and recurrence, discuss the proposed mechanisms, and describe computational fluid dynamic model that was used to evaluate the likely hemodynamic effect of different states of the aneurysms.ResultsThe hemodynamic analysis suggests that high flow impingement and high WSS distribution at normal parent artery was found before aneurysmal initiation. The WSS distribution and flow velocity were decreased in the new sac after aneurysmal growth. Low WSS was the risk hemodynamic factor for aneurysmal rupture. High flow concentration region on the neck plane after coil embolization still marked in recanalized aneurysm.ConclusionsAssociations have been identified between high flow impingement and aneurysm recanalization, while low WSS is linked to the rupture of aneurysms. High flow concentration and high WSS distribution at normal artery associated with aneurysm initiation and growth, while after growth, the high-risk hemodynamics of aneurysm rupture was occurred, which is low WSS at aneurysm dome.

Microsurgical Clipping of Multiple Intracranial Aneurysms via the Keyhole Approach

BackgroundKeyhole surgery has been widely used to clip various intracranial aneurysms. Here, the feasibility of microsurgical clipping of multiple intracranial aneurysms via the keyhole approach was further investigated. MethodsThe clinical data of 80 patients with multiple intracranial aneurysms treated with keyhole surgery were retrospectively analyzed. The patients included 25 males and 55 females, with an average age of 57.5 years. There were 13 patients with unruptured aneurysms, 67 patients with ruptured aneurysms (small aneurysms accounted for 52.2% of ruptured aneurysms), and a total of 198 aneurysms. A 4 cm incision and a bone hole of approximately 2.5 cm were used, per craniotomy standards. Forty-eight cases were treated via the supraorbital keyhole approach, 45 cases via the pterional keyhole approach, and three cases via the interhemispheric keyhole approach. ResultsA bilateral and unilateral keyhole approach was applied in 18 and 62 cases, respectively. A total of 170 ipsilateral and 7 contralateral aneurysms were clipped. The complete clipping rate was 98.9%. During the follow-up period of 6-12 months after surgery, the Glasgow outcome scale score was 5 points in 74 cases, 4 points in five cases, and 3 points in one case. The prognosis was associated with the preoperative Hunt–Hess classification but not with the number of operative sides, the operation opportunity, or the number of clipped aneurysms. ConclusionEarly keyhole surgical clipping of multiple intracranial aneurysms is an effective treatment. Among ruptured aneurysms, small aneurysms are common and need attention and timely treatment.

Unexpected Bilateral Emergence of the Ophthalmic Arteries from the Cavernous Segment of the ICA in a Patient with Multiple Intracranial Aneurysms

Unexpected Bilateral Emergence of the Ophthalmic Arteries from the Cavernous Segment of the ICA in a Patient with Multiple Intracranial Aneurysms

Risk of unruptured aneurysms in subarachnoid hemorrhage patients with multiple intracranial aneurysms: a multicenter, longitudinal, comparative study from China

BackgroundIn aneurysmal subarachnoid hemorrhage patients with multiple intracranial aneurysms (aSAH-MIA patients), the risk of secondary unruptured intracranial aneurysms is inconsistent. This study aimed to explore the risk of unruptured aneurysms...

Endovascular treatment of multiple intracranial aneurysms.

Multiple intracranial aneurysms are difficult to treat. In order to investigate the effect and safety of endovascular treatment for multiple intracranial aneurysms, 54 consecutive patients with 116 multiple intracranial aneurysms treated with endovascular embolization were retrospectively enrolled. Angiography was performed immediately after embolization and at each follow-up. All clinical data were analyzed. Of the 116 aneurysms, 56 (48.3%) were embolized with coiling alone, 19 (16.4%) with stent-assisted coiling, 31 (26.7%) with stenting alone, and 10 (8.6%) with flow diverters plus coiling. After embolization, 31 (27.6%) aneurysms with stenting alone had no apparent change in size, and in the remaining 84 aneurysms, complete occlusion was achieved in 50 aneurysms (59.5%), near-complete occlusion in 26 (31.0%), and incomplete occlusion in 8 (9.5%). Thrombus formation at the aneurysm neck occurred in 3 patients (5.6%), coil protrusion in 2 (3.7%), and intraprocedural rupture in 1 (1.9%), resulting in a total complication rate of 11.1%. Follow-up angiography was performed in 44 (81.5%) patients 6 to 90 months (mean 49) later. Among 50 completely occluded aneurysms, 38 (76%) aneurysms remained completely occluded, and 4 (8%) aneurysms recurred. Among 26 aneurysms with initial near-complete occlusion, 12 (46.2%) aneurysms with neck remnant had progressive thrombosis to complete occlusion, 2 (7.7%) had no change compared with immediate occlusion, and 5 (19.2%) regrew. In conclusion, endovascular embolization with intracranial stenting and coiling is safe and effective and may play an increasingly important role in the management of multiple intracranial aneurysms.

Evaluation of unruptured aneurysm scoring systems and ratios in subarachnoid hemorrhage patients with multiple intracranial aneurysms.

This study aims to appraise aneurysm scores and ratios' ability to discriminate between ruptured aneurysms and unruptured intracranial aneurysms (UIAs) in subarachnoid hemorrhage (SAH) patients harboring multiple intracranial aneurysms (MICAs). We, then, investigate the most frequent risk factors associated with MICAs. We retrospectively applied unruptured intracranial aneurysm treatment score (UIATS) and population hypertension age size of aneurysm earlier SAH from another aneurysm site of aneurysm (PHASES) score, aspect, and dome-to-neck ratio to the 59 consecutive spontaneous SAH patients with MICAs admitted between January 2000 and December 2015 to the Department of Neurosurgery of the University Hospital Center "Hôpital des Spécialités" of Rabat (Morocco). Patients with at least two intracranial aneurysms (IAs) confirmed on angiography were included in the study. Fifty-nine patients were harboring 128 IAs. The most frequent patient-level risk factors were arterial hypertension (AHT) 30.5 % (n = 18) and smoking status 22.0 % (n = 13). A PHASES score recommended treatment in 52 of 60 ruptured aneurysms and in six of 68 UIAs with a sensitivity of 31.67% and a specificity of 76.47%. UIATS recommended treatment in 26 of 62 ruptured aneurysms and in 35 of 55 UIAs with a sensitivity of 41.9% and a specificity of 63.6%. Aspect ratio recommended treatment in 60 of 60 ruptured aneurysms and in 63 of 68 UIAs with a sensitivity of 100% and a specificity of 88.24%. Dome-to-neck ratio recommended treatment in 45 of 60 ruptured aneurysms and in 48 of 68 UIAs with a sensitivity of 80% and a specificity of 63.24%. The aspect ratio (area under the curve [AUC] = 0.953) AUC > 0.8 has a higher discriminatory power between ruptured aneurysms and UIAs. AHT and smoking status were the most common risk factors for intracranial multiple aneurysms and the aspect ratio and PHASES score were the most powerful discrimination tools between ruptured aneurysms and the UIAs.

Two consecutive ruptured intracranial aneurysm in patient with multiple intracranial aneurysms.

When aneurysmal subarachnoid hemorrhage due to multiple aneurysms is suspected, identifying the rupture site is essential to determine the exact surgical site, but it may not be easy. Even if embolization is adequately performed, complications may remain. Typical complications include rebleeding and hydrocephalus in the early phase and delayed cerebral ischemia in the delayed phase. Herein, we describe a case of rupture of an intracranial aneurysm after performing embolization for a different ruptured intracranial aneurysm in a patient with multiple intracranial aneurysms. Patients with multiple intracranial aneurysms need to be considered for closer observation than those with a single ruptured intracranial aneurysm, even if the patient's prognosis is good.

Single-stage endovascular treatment in aneurysmal subarachnoid haemorrhage with multiple intracranial aneurysms: Systematic review of the literature and multicentric retrospective experience.

The presence of multiple intracranial aneurysms in patients with acute subarachnoid haemorrhage is a condition with no evidence of optimal treatment strategy, especially in case of uncertain haemorrhage patterns on cumputed tomography. The aim of this study was to analyse the safety and efficacy profile of single-stage endovascular treatment of multiple intracranial aneurysms with aneurysmal subarachnoid haemorrhage in the literature and in a retrospective case series. A systematic review of the present literature was conducted to identify studies related to single-stage endovascular treatment for ≥2 aneurysms; in addition, a retrospective multicentric review was performed. Data on clinical presentation, aneurysm size and location, occlusion rates, intracranial complications and clinical outcome were recorded. Thirteen articles were identified (all little case series) reporting 189 patients harbouring 389 aneurysms. And 85.6% presented with a Hunt-Hess scale 1-3, and 14.4% 4-5. Intracranial complications rate was 11.5%. Baseline and follow-up (20.5 months) occlusion rates were adequate (Raymond-Roy occlusion scale I-II) in 93% and 96.2%, respectively. 81% of patients had favourable clinical outcomes (modified Rankin Scale (mRS) ≤2; Glasgow outcome scale (GOS) 5-4) and 19% poor (mRS 3-6; GOS 3-1). The retrospective database identified 53 patients with 115 aneurysms. Clinical presentation was Hunt-Hess (HH) 1-3/WNFS 1-2 75% and HH 4-5/WNFS 3-5 25%. Intracranial complication rate was 24.5%. Occlusion rate RROC I-II was 78.7% at baseline and 15 months and 90.2% at follow up. Clinical outcome at 3 months was mRS ≤2 68.6% and mRS 3-6 31.4%. Single-staged endovascular treatment can be feasible, although a higher risk of intraprocedural complications, with clinical presentation being the major factor to influence the outcome.

Prognostic Risk Factors of One-stage Surgical Clipping in aSAH Elderly Patients with MIAs.

To discuss the prognostic factors affecting the prognosis of 1-stage surgical clipping in aneurysmal subarachnoid hemorrhage (aSAH) elderly patients with multiple intracranial aneurysms (MIAs). A total of 84 elderly patients with aSAH who had MIAs and underwent 1-stage surgical clipping were retrospectively analyzed. Follow-up was conducted with patients 30 days after discharge using the Glasgow Outcome Scale (GOS). A GOS score of 1 to 3 was defined as a poor outcome, and a GOS score of 4 to 5 was defined as a good outcome. General information (gender, age, size of aneurysm, location of rupture of the responsible aneurysm, H-H grade, CT characteristics of aSAH, number of subarachnoid hemorrhages, operation opportunity, postoperative complications, and intraoperative rupture) and complications（cerebral infarction, hydrocephalus, electrolyte disturbance, and encephaledema）were recorded. Univariate analysis and multivariate regression analysis were used to analyze factors that may affect outcomes. Univariate analysis showed that the number of SAH events ( P =0.005), intraoperative rupture ( P =0.048) and postoperative complications ( P =0.002) were associated with the prognosis of aSAH elderly patients with MIAs undergoing 1-stage surgery. Multivariate analysis showed that the number of SAH events (odds ratio [OR] 4.740, 95% confidence interval [CI] 1.056 to 21.282, P =0.042) and postoperative complications (OR 4.531, 95% CI 1.266 to 16.220, P =0.020) were independently associated with the prognosis of aSAH elderly patients with MIAs undergoing 1-stage surgery. The number of SAH events and postoperative complications are independent risk factors for the prognosis of aSAH elderly patients with MIAs undergoing 1-stage surgery. These factors contribute to the timely treatment of potentially related patients.

Endovascular treatment of multiple intracranial aneurysms in patients with subarachnoid hemorrhage: one or multiple sessions?

This study aimed to compare the safety and efficacy of single- and multiple-stage endovascular treatment in aneurysmal subarachnoid hemorrhage (SAH) patients with multiple intracranial aneurysms. We retrospectively analyzed the clinical and imaging data of 61 patients who harbored multiple aneurysms and presented to our institution with aneurysmal subarachnoid hemorrhage. Patients were grouped according to endovascular treatment strategy: one-stage or multiple-stage. The 61 study patients harbored 136 aneurysms. One aneurysm in each patient had ruptured. In the one-stage treatment group, all 66 aneurysms in 31 patients were treated in one session. The mean follow-up was 25.8 months (range, 12-47). At the last follow-up, the modified Rankin scale was ≤2 in 27 patients. In total, 10 complications occurred (cerebral vasospasm, six patients; cerebral hemorrhage, two patients; and thromboembolism, two patients). In the multiple-stage treatment group, only the ruptured aneurysm (30 in total) was treated at the time of presentation, and the remaining aneurysms (40 in total) were treated later. The mean follow-up was 26.3 months (range, 7-49). At the last follow-up, the modified Rankin scale score was ≤2 in 28 patients. In total, five complications occurred (cerebral vasospasm, four patients; and subarachnoid hemorrhage, one patient). During the follow-up period, there was one recurrence of aneurysm with subarachnoid hemorrhage in the single-stage treatment group and four recurrences in the multiple-stage treatment group. Both single- and multiple-stage endovascular treatment is safe and effective in aneurysmal subarachnoid hemorrhage patients who harbor multiple aneurysms. However, multiple-stage treatment is associated with a lower rate of hemorrhagic and ischemic complications.

Sellar hematoma as a new potential radiological clue for superior hypophyseal artery aneurysm rupture

Background. In cases of spontaneous subarachnoid haemorrhage (SAH) with multiple intracranial aneurysms (MIAs) detected on angiography, some radiological clues assist in determining the site of a ruptured aneurysm which is bleeding is quite beneficial for the selection of the best treatment strategy. Case description. We report a case of a 60 years old patient who presented with spontaneous SAH, sellar hematoma, and three different aneurysms detected in angiography. Although the right Posterior communicating artery (PcomA) aneurysms showed Murphy’s teat on angiography intraoperatively, we discovered that the right superior hypophyseal aneurysm (SHA) was the source of the index bleeding. Both aneurysms were clipped successfully. Conclusion. From the preoperative radiological and intraoperative surgical findings, we propose that sellar hematoma on a non-contrast CT scan is a new potential sign to be correlated with superior hypophyseal artery aneurysm rupture.

Reconstructive endovascular treatment of distal cerebral aneurysm associated with cardiac myxoma

Introduction. The etiology and pathogenesis of cerebral aneurysms are diverse. The rare cause of cerebral aneurysms occurrence is cardioembolism in cases of heart tumors, in particular in myxoma. Cardiac myxoma (from Latin muxa, mucus) is the most common (about 50 %) benign tumor of heart. With untimely diagnosis and absence of the disease treatment, embolisms in cerebral vessels may occur with typical symptoms of ischemic stroke as well as in some cases the myxomal aneurysms may develop. There are several theories of their origin. The myxomal aneurysms of cerebral vessels are more common in women and in the vast majority of cases they develop in carotid basins. In a quarter of cases, the disease onsets as intracranial hemorrhage caused by rupture of an oncotic (myxomal) aneurysm, that significantly exceeds the frequency of ruptures (1–3 % per year) in cases of “normal” bifurcation‑hemodynamic intracranial aneurysms. The mortality rate is 3.4 %. The majority (80 %) of ruptures were observed within 2 years after the diagnosis of cardiac myxoma, and in half (48.6 %) of cases clinically significant episodes of embolism were noted. Timely treatment can prevent the hemor rhagic type of course of these aneurysms. Various methods of treatment are described in the literature: different options for surgical eradication as well as the possibilities of chemotherapy and radiation exposure.Aim. To present a case of successful radical reconstructive endovascular treatment of patient with distal cerebral aneurysm associated with cardiac myxoma, combined with presence of multiple cavernous malformations and also to highlight issues of diagnosis, differential diagnosis and existing treatment options for these diseases.Clinical observation. The article presents a clinical observation of multiple aneurysms associated with myxoma of the heart in combination with multiple cavernous angiomas of the brain. The possibility of reconstructive eradication of distal aneurysm after its transformation from fusiform to saccular is demonstrated. The etiology and pathogenesis of occurrence, the nuances of differential diagnosis, possible methods and the algorithm for choosing a method for treating brain aneurysms associated with myxomas are reflected. The patient underwent reconstructive aneurysm shutdown by embolization with microspirals, which became possible due to the anatomical shape that favored this type of treatment. Conversion to destructive intervention was not required. Due to the natural course of the disease, the patient remains at risk of progression of a distal aneurysm in the basin of the same artery, and therefore it will be observed in dynamics.Conclusion. All patients with cardiac myxomas, both before and in dynamics after their removal, are recommended to perform noninvasive visualization of brain vessels for verification of such complication as metastatic (myxomal) aneurysms. The prognosis in most patients with multiple intracranial aneurysms associated with myxoma is favorable and most aneurysms associated with myxoma are stable. However, in cases with progressive or ruptured aneurysms, surgical treatment options should be considered including microsurgical or endovascular eradication. Radiation and chemotherapy methods may have a certain therapeutic value.

Why She? A Retrospective Study on Sex Inequality Related to Subarachnoid Haemorrhage

Subarachnoid haemorrhage (SAH) is the only type of stroke with female predominance. We conducted a retrospective analysis of SAH patients throughout a decade and tried to establish any reason for such remarkable sex difference. We conducted a retrospective analysis of subarachnoid haemorrhages treated in Istria County between 2010 and 2021. Some of those patients were referred to a comprehensive stroke centre and we collected those data too. We also collected data regarding the outcome recorded at follow up exams of patients treated for SAH in that period. A total of 193 patients with subarachnoid haemorrhage were found in observed period. We found a lower incidence regarding general population but with a tendency to increase, compared with data from other studies. Among all SAH, 113 were female, which makes a Risk Ratio (RR) of 1.44. The highest RR in females was in aneurysmal subarachnoid haemorrhages, 2.06. We obtained a similar high RR of 2.03 in the case of female ruptured multiple intracranial aneurysms (IA), clearly with a worse outcome. Conversely, the RR in non-aneurysmal subarachnoid haemorrhages and perimesencephalic subarachnoid haemorrhages was lower in the case of female sex and amounted 0.67. We noticed similar sex inequality as shown in other studies, so we can also state that women are at higher risk of IA rupture than men. The reason has to be multifactorial. As found in this study, women have different predilection sites of IA rupture compared with men so we strongly believe that certain hemodynamic forces may lead to aneurysm growth and rupture. As we also confirmed IA rupture is age dependent more in women than in men. As shown in other studies, oestrogen level might be the reason for that. Future studies should further establish and prove these risk factors for IA aneurysm rupture and improve preventive measures.

Rupture discrimination of multiple small (< 7 mm) intracranial aneurysms based on machine learning-based cluster analysis

BackgroundSmall multiple intracranial aneurysms (SMIAs) are known to be more prone to rupture than are single aneurysms. However, specific recommendations for patients with small MIAs are not included in the guidelines of the American Heart Association and American Stroke Association. In this study, we aimed to evaluate the feasibility of machine learning-based cluster analysis for discriminating the risk of rupture of SMIAs.MethodsThis multi-institutional cross-sectional study included 1,427 SMIAs from 660 patients. Hierarchical cluster analysis guided patient classification based on patient-level characteristics. Based on the clusters and morphological features, machine learning models were constructed and compared to screen the optimal model for discriminating aneurysm rupture.ResultsThree clusters with markedly different features were identified. Cluster 1 (n = 45) had the highest risk of subarachnoid hemorrhage (SAH) (75.6%) and was characterized by a higher prevalence of familiar IAs. Cluster 2 (n = 110) had a moderate risk of SAH (38.2%) and was characterized by the highest rate of SAH history and highest number of vascular risk factors. Cluster 3 (n = 505) had a relatively mild risk of SAH (17.6%) and was characterized by a lower prevalence of SAH history and lower number of vascular risk factors. Lasso regression analysis showed that compared with cluster 3, clusters 1 (odds ratio [OR], 7.391; 95% confidence interval [CI], 4.074–13.150) and 2 (OR, 3.014; 95% CI, 1.827–4.970) were at a higher risk of aneurysm rupture. In terms of performance, the area under the curve of the model was 0.828 (95% CI, 0.770–0.833).ConclusionsAn unsupervised machine learning-based algorithm successfully identified three distinct clusters with different SAH risk in patients with SMIAs. Based on the morphological factors and identified clusters, our proposed model has good discrimination ability for SMIA ruptures.

Single flow diverter to manage multiple intracranial aneurysms in a parent artery.

Endovascular coil embolization has become an important method in the management of intracranial aneurysm. However, simultaneously coiling multiple intracranial aneurysms (MIAs) in unilateral parent artery in one-stage may fail or insufficient in geographic difficult aneurysm. Flow diverter (FD) has the potential to manage MIAs with nonamenable to coiling. Herein, we report periprocedural morphologic change and outcomes using single FD to manage unruptured MIAs in a parent artery. Over a 3-year period, a total of 63 patients with 126 MIAs successful managed by single FD with complete angiographic follow-up. There were 49 women and 14 men, with ages ranging from 42 to 77 years (mean: 59 years). We retrospectively assessed the clinical data, aneurysm characteristic, angiographic and clinical outcomes of all patients and compared with 171 patients with single aneurysm managed by FD. Sixty-one patients with 118 aneurysms (94%) located in internal carotid artery or middle cerebral artery (n = 4, 3%), two patients with four aneurysms (4%) were found in the basilar artery. The mean aneurysm size was 5.6 mm (range from 1.8 to 38 mm). Mean angiographic follow-up was 14 months. Complete obliteration of aneurysm was achieved in 102 aneurysms (83%), subtotal or partial aneurysm obliteration was demonstrated in 18 aneurysms (15%), unchanged aneurysm morphology in three (2%). Aneurysm morphology synchronized alteration in 55 patients (87%), other eight patients (13%) with 16 aneurysms showed different morphologic alteration in angiographic follow-up. Four patients (6.3%) had intraprocedural ischemic complication. During the follow-up period, 61 patients (97%) were neurologic stable; there was no hemorrhagic or ischemic event. Single FD was feasible to treat MIAs in a parent artery with both effective and safe in one-stage management. Most aneurysms synchronized alteration of morphology in a mid-term follow-up. The procedure was almost the same with FD managing single aneurysm, but longer FD is needed in MIAs.

Torque Teno virus DNA is found in the intracranial aneurysm wall-Is there a causative role?

Torque Teno virus (TTV) is a recently discovered virus with high prevalence worldwide, that has been associated with vascular diseases. The aim of this study is to investigate the prevalence of TTV molecular DNA in the intracranial aneurysm (IA) artery walls. Samples of IA walls were collected after microsurgical clipping from 35 patients with IA (22 ruptured/13 unruptured cases). The samples were submitted to molecular DNA extraction using the EasyMag automatized extractor and performed with Qiagen DNA extraction Minikit 250. The samples underwent PCR examination with primers for β-globin as internal control using the Nanodrop ® 2000 spectrophotometer. A quantitative (real-time) PCR with TTV-specific primers was performed. Clinical and radiological data of patients included was collected. TTV was detected in 15 (42.85%) cases, being 10 (45.4%) ruptured and 5 (38.4%) unruptured (p = 0.732) lesions. Multiple IAs accounted for 14 (40%) cases. Five cases (17.2%) had TTV+ and multiple aneurysms (p = 0.73). Association between presence of virus and aneurysm rupture was not statistically significant (p = 0.96). This study demonstrated a relatively high prevalence of viral DNA in the walls of IAs. This is the first study to identify the presence of TTV DNA in IA's samples, which was found more often in ruptured lesions. This is an exploratory study, therefore, larger studies are required to clarify the relationships between inflammation, viral infection, IA formation and rupture.

含双侧后交通动脉瘤的复杂颅内多发动脉瘤1例的治疗思考

含双侧后交通动脉瘤的复杂颅内多发动脉瘤1例的治疗思考

STROBE-Compliant Study to Evaluate Scores and Ratios for Unruptured Aneurysm Repair in Aneurysmal Subarachnoid Hemorrhage Patient Harboring Multiple Intracranial Aneurysms

STROBE-Compliant Study to Evaluate Scores and Ratios for Unruptured Aneurysm Repair in Aneurysmal Subarachnoid Hemorrhage Patient Harboring Multiple Intracranial Aneurysms

HIV-associated multiple intracranial aneurysms and stroke in an adult patient: successful treatment with a combination of glucocorticoid and antiviral agents.

A 35-year-old Iranian man with an 18-year history of human immunodeficiency virus (HIV) infection developed sudden left-sided hemiparesis and mild dysarthria. Based on laboratory results, brain and neck computerized tomography angiography (CTA), echocardiography, hypercoagulability tests, and vasculitis tests, the patient was diagnosed with a stroke with multiple intracranial aneurysms secondary to HIV. Cerebral aneurysms and stroke are uncommon in HIV-infected patients, and the aneurysms' exact cause and risk factors are unknown. There is currently no effective regimen or definitive treatment for HIV-associated vasculitis. In the present study, the patient recovered without any neurological deficits following treatment with oral prednisolone, combined with combination antiretroviral therapy (cART), valacyclovir, and antiplatelet medication. Furthermore, after 2months of immunosuppressive treatment, all imaging abnormalities improved, and no new events were observed at the 20-month follow-up. To the best of our knowledge, this is the first case in which a patient with HIV-associated vasculopathy and stroke has survived successfully, and all angiographic abnormalities completely eliminated.

Transradial Stent-Assisted Coiling Using “Dual-Jailing” Technique for Kissing Aneurysms of the Internal Carotid Artery: Technical Note and Literature Review

Kissing aneurysms are an unusual type of multiple intracranial aneurysms having different origins with partially adherent walls. Although endovascular treatment is a useful alternative to surgical clipping, endovascular management for small wide-necked kissing aneurysms has not been adequately investigated to date. Herein, we present a case of small wide-necked kissing aneurysms successfully treated with transradial stent-assisted coiling (SAC) using the "dual-jailing" technique. We also performed a review of the relevant literature. A 64-year-old woman who was diagnosed with small wide-necked kissing aneurysms relating to the ophthalmic artery underwent SAC using the dual-jailing technique. After a 6F Simmons guiding sheath was delivered into the target common carotid artery via transradial access, a 6F intermediate catheter was navigated into the petrous internal carotid artery to achieve both triple microcatheter manipulation and contrast injection. Two coil-delivery microcatheters were cannulated into each aneurysm, followed by a Neuroform Atlas stent deployment over the aneurysm necks via a third stent-delivery microcatheter. By using the jailed microcatheters, SAC of the kissing aneurysms was successfully achieved, preserving the ophthalmic artery. The postprocedural course was uneventful. A follow-up magnetic resonance angiography showed no evidence of recanalization 2years 3months post procedure. The dual-jailing technique may provide simple and time-saving SAC compared with previous reported method. This technique can be a useful treatment option for small wide-necked kissing aneurysms.