Aneurysm Recurrence Research Articles

Endovascular Treatment for Isolated Infected Iliac Artery Aneurysms.

Isolated infected iliac artery aneurysms (IIIAAs) are extremely rare, life-threatening, and intractable. This study aimed to evaluate the outcomes of endovascular treatment in patients with IIIAAs. A retrospective study was conducted for all patients who underwent endovascular treatment for IIIAAs between June 2012 and June 2022 in 3 hospitals. The clinical data and follow-up outcomes were reviewed and assessed. Fifteen patients were included in this study. The median age was 69 years, 12 patients (80%) were men, and 8 (53%) had hypertension. Most of the patients presented with abdominal or lumbar pain (87%) and fever (60%). The offending pathogen was identified in 11 patients (73%). Fifteen patients had a total of 16 IIIAAs, with 12 (75%) involving the common iliac artery. The immediate technical success rate was 100%, and the 30-day mortality was 7%. Infection-related complications occurred in 2 patients (13%) during hospitalization who were treated by open surgery at a later stage. The median follow-up was 23 months (range: 6-80 months, mean: 32 ± 25 months). Aneurysm recurrence was identified in one patient (7%) 5 months after endovascular repair. It was managed by endovascular stent-graft repair with percutaneous catheter drainage. No patients died during the follow-up period. Endovascular treatment is feasible, safe, and effective for patients with IIIAAs, achieving acceptable clinical outcomes. Infection surveillance with essential reintervention should be considered for potential infection-related complications. This study first reported that 15 patients underwent endovascular treatment for primary isolated infected iliac artery aneurysms (IIIAAs). It showed a good early and midterm outcomes. This is the first and largest multi-center study and the first literature review of IIIAAs. It provides an evidence that endovascular treatment is feasible, safe, and effective to treat IIIAAs. It suggests endovascular treatment is a promising alternative or a bridge to conventional open surgery for IIIAAs. This may promote endovascular therapy in the management of IIIAAs. It would help clinicians to make an appropriate treatment choice for IIIAAs.

Endovascular Treatment Strategies for Aneurysms of the Origin of the Posterior Inferior Cerebellar Artery.

Treatment of aneurysms at the origin of the posterior inferior cerebellar artery (PICA) is challenging. Surgery is difficult due to the deep location and proximity to cranial nerves and endovascular treatment is complicated due to the often tortuous anatomy of the PICA and its small diameter. The purpose of this study is to report our experience with the endovascular treatment of aneurysms at the origin of the PICA. Consecutive patients with aneurysms at the origin of the PICA who were endovascularly treated at our department were identified from our registry of neuro-angiographies. Clinical, angiographic, and treatment data were analyzed. Endpoints included successful occlusion and recurrence. Twenty-nine patients were included. 79.3% of the aneurysms were wide-neck with a dome-to-neck ratio <2.65.5% of all endovascular procedures were performed by coiling alone. The procedural rupture rate was 18.75% for endovascularly treated aneurysms presenting with subarachnoid hemorrhage (SAH). Successful embolization was achieved non-significantly more often in the coiling-only group (94.7% vs. 70%, P=0.066). Aneurysm recurrence after successful occlusion was observed in one case. Though aneurysm and parent vessel characteristics were challenging successful occlusion was achieved in a high rate of treatments, often with standalone coiling. Adjunctive techniques like retrograde stenting seem promising to further enhance endovascular results. Interestingly aneurysms arising solely from the origin of the PICA without the V4-segment involved presented with SAH significantly more often and wide-neck aneurysms presenting with SAH had a significantly higher periinterventional rupture rate.

Fibrin-associated large B-cell lymphoma around vascular prosthesis mimicking recurrent abdominal aortic aneurysm

Fibrin-associated large B-cell lymphoma around vascular prosthesis mimicking recurrent abdominal aortic aneurysm

Median Arcuate Ligament Compression Associated with Flow-Related Visceral Aneurysms

PurposeTo identify risk factors for rupture, and to determine outcomes of endovascular treatment of median arcuate ligament (MAL) compression–related visceral artery aneurysms (VAAs). Methods and MaterialsA retrospective review of patients who presented with MALC-related VAAs was performed from 1999 to 2021. A total of 21 patients (12 men) and 39 VAAs associated with MAL compression were encountered (mean age, 59 years). Imaging studies were reviewed for the number, morphology/size, and recurrence of aneurysms. Statistical analysis was performed to identify risk factors for rupture. ResultsTen patients presented with acute rupture, and 12 patients were symptomatic with nonspecific abdominal pain. Twenty-two aneurysms were fusiform in morphology and 17 aneurysms were saccular in morphology. Of the 14 aneurysms that presented with acute hemorrhage, 12 (86%) were fusiform in morphology (odds ratio, 9.0; P < .01). The mean aneurysm size was 1.3 cm, and the mean ruptured size was 0.6 cm. Thirty-one aneurysms were treated by endovascular techniques, and technical success was achieved in all cases. Fourteen patients were found to have an Arc of Buhler. No procedure-related adverse events occurred. No patient underwent surgical ligament release. The mean time of follow-up was 3.2 years, and no aneurysms recurred after endovascular treatment. ConclusionsMAL compression-associated VAAs are an important clinical entity that should be treated even at small sizes, particularly if they are fusiform in morphology. Endovascular therapy is safe and feasible and results in durable aneurysm exclusion.

Aneurysm Treatment with Woven EndoBridge-17: Angiographic and Clinical Results at 12 Months from a Retrospective, 2-Center Series.

This retrospective, 2-center study investigated the feasibility, safety, and efficacy at 12-month follow-up of the treatment of ruptured, unruptured, and recurrent intracranial aneurysms using the latest generation of the Woven EndoBridge (WEB) device, the WEB-17 system. Aneurysms treated with WEB-17 were extracted from the databases of 2 neurovascular centers. Patients, aneurysm characteristics, complications, and clinical and anatomic results were analyzed. From February 2017 to May 2021, two hundred twelve patients with 233 aneurysms (181/233, 77.7%, unruptured-recurrent, and 52/233, 22.3%, ruptured) were included. High treatment feasibility (95.3%) was reported and was similar in ruptured aneurysms (94.2%) and unruptured-recurrent aneurysms (95.6%) (P = .71) and in typical (95.4%) and atypical (94.7%) locations (P = .70), but it was lower in aneurysms with an angle between the parent artery and main aneurysm axis of ≥45° (90.2%) compared with those with an angle of <45° (97.1%) (P = .03). Global mortality and morbidity were 1.9% and 3.8% at 1 month, respectively, and 4.4% and 1.9% at 12 months, respectively. One-month morbidity (P = .02) and mortality (P = .003) were higher in the ruptured group (10.0% and 8.0%, respectively) compared with unruptured-recurrent group (1.9% and 0.0%, respectively). Overall adequate occlusion (complete occlusion and neck remnant) was 86.3%. The percentage of adequate occlusion was higher (P = .05) in the unruptured-recurrent group (88.5%) compared with the ruptured group (77.5%). The WEB-17 system showed high feasibility for ruptured and unruptured aneurysms, typical and atypical locations, and some aneurysms with an angle of ≥45°. As the most recent generation device, the WEB-17 also demonstrates high safety and good efficacy.

Cerebral revascularization for complex middle cerebral artery aneurysms: surgical strategies and outcomes in a single center

Cerebral revascularization is the ultimate treatment for a subset of complex middle cerebral artery (MCA) aneurysms. The decision for the revascularization strategy should be made during the treatment process. This study aimed to summarize the revascularization strategies for different types of complex MCA aneurysms and their outcomes. The clinical data of patients with complex MCA aneurysms who underwent cerebral revascularization since 2015 were analyzed retrospectively. The aneurysms were classified according to the location and other main characteristics that affect the selection of surgical modalities. The corresponding surgical modalities and treatment outcomes were summarized. A total of 29 patients with 29 complex MCA aneurysms were treated with cerebral revascularization from 2015 to 2022. Treated aneurysms were located at the prebifurcation segment in 7 patients, bifurcation segment in 12 patients, and postbifurcation segment in 10 patients. Surgical modalities in the prebifurcation segment included four high-flow extracranial-to-intracranial (EC-IC) bypasses with aneurysm trapping or proximal occlusion, two IC-IC bypasses with aneurysm excision, and one combination bypass with aneurysm excision. In the bifurcation segment, surgical modalities included two low-flow EC-IC bypasses with aneurysm excision or trapping, six IC-IC bypasses with aneurysm excision, three combination bypasses with aneurysm excision, and one constructive clipping with IC-IC bypass. In the postbifurcation segment, surgical modalities included nine IC-IC bypasses with aneurysm excision and low-flow EC-IC bypass with aneurysm trapping. The revascularization strategy for prebifurcation aneurysms was determined based on the involvement of lenticulostriate arteries, whereas the strategy for bifurcation aneurysms was determined based on the number of distal bifurcations and the shape of the aneurysm. The location of the aneurysm determined the revascularization strategy for aneurysms in the postbifurcation segments. Angiography demonstrated that aneurysms were completely obliterated in 26 cases and shrank in 3 cases, and all bypasses except one were patent. The mean follow-up period was 47.5months. Three patients developed hemiplegic paralysis, and one developed transient aphasia postoperatively due to cerebral ischemia. No new neurological dysfunction occurred in the other 25 patients with no recurrence or enlargement of aneurysms during the follow-up. Prebifurcation aneurysms involving the lenticulostriate arteries require proximal occlusion with high-flow bypass. Most of the other aneurysms can be safely excised or trapped by appropriate revascularization strategies according to their location and orientation.

Abstract Number ‐ 139: Endovascular Management of Intracranial Pediatric Traumatic Pseudoaneurysms: A Case Series and Systematic Review

Introduction Intracranial pseudoaneurysms (IPA) are rare and potentially life‐altering lesions. Although IPAs represent less than 1% of all intracranial aneurysms, they account for more than 19% of pediatric intracranial aneurysms. The goal of this study was to systematically review the management and outcomes of pediatric patients who developed pseudoaneurysms following head trauma. Methods Following PRISMA guidelines, a systematic literature review was performed using PubMed, EMBASE, OVID Medline and Web of Science databases from date of database inception to May 2022. Studies were selected based on predetermined inclusion and exclusion criteria. Simultaneously, a retrospective analysis was conducted on pediatric patients who underwent endovascular evaluation and treatment for intracranial pseudoaneurysms originating from head trauma at a single institution. Results A total of 221 articles were identified in our review, 51 studies met inclusion criteria. A total of 80 patients were treated for 81 intracranial traumatic pseudoaneurysms, including 5 cases from our institution, with 46 males, 28 females, and a mean age of 9.90 years (range 0.04 ‐18 years). 71 total pseudoaneurysms were the result of external trauma while 10 resulted from iatrogenic trauma. Vessels of the anterior circulation were injured in 75.3% (61/81) of cases. Posterior circulation was involved in 24.7% (20/81) of cases. The internal carotid artery was the most impacted vessel at 45.7% (37/81). The next most common territory injured was the anterior cerebral artery and its distal branches, including the pericallosal and callosomarginal arteries, at 17.3% (14/81). The basilar artery was the third most affected artery, representing 12.3% (10/81) of cases. Hemorrhage was present in 41 patients (51.3%). Subarachnoid hemorrhage was present in 33.8% (27/80), while intracerebral hemorrhage and interventricular hemorrhage (IVH) were present 22.5% and 18.8% of cases, respectively. A total of 92 procedures were performed, with only 8 patients requiring more than 1 procedure for treatment. Only 1 patient required more than 2 procedures. Aneurysm embolization, parent vessel occlusion, parent vessel reconstruction, and aneurysm trapping were performed in 31.5%, 22.8%, 43.5%, and 2.2% of cases, respectively. The intraoperative complication rate was 3.26%, all were ischemic in nature. Two of these ischemic complications resulted focal neurological deficits from parent vessel occlusion. Aneurysm recurrence was encountered in 7 cases, with 6 of these resulting from coil embolization. In patients treated with parent vessel reconstruction, 1 aneurysm ruptured post‐treatment and 2 patients experienced in‐stent thrombosis. Overall, 83.8% of patients had a good neurological outcome and 77.8% of aneurysms were completed occluded on follow‐up imaging. Conclusions The development of pseudoaneurysms in the pediatric population are an important consideration in cases of traumatic head injuries or iatrogenic vessel trauma. These lesions grow rapidly and can carry a high risk of morbidity and mortality if left untreated. Our findings suggest that endovascular treatment of traumatic pseudoaneurysms in the pediatric populations is safe and effective, with high rates of aneurysm occlusion and good neurological outcome. Overall, complications rates are low. Aneurysm embolization can carry an increased risk of aneurysm recurrence.

Safety and effectiveness of Neuroform Atlas stent-assisted coiling in the endovascular treatment of intracranial aneurysms: a single-center observational study

Objective: To investigate the safety and effectiveness of Neuroform Atlas stent-assisted coiling in the endovascular treatment of intracranial aneurysms. Methods: This was a retrospective, single-center observational study of 77 patients who underwent endovascular treatment of intracranial aneurysms using the Neuroform Atlas device at the Department of Neurology, People's Liberation Army General Hospital from July 2020 to May 2022. There were 34 males and 43 females, with a median (range) age of 59 (23-81) years. The degree and effect of aneurysm embolization were evaluated by modified Raymond grading post procedure and after 6 months. Complications occurring during the perioperative period were recorded. Vaso computed tomography was performed immediately after the operation to assess stent opening and adherence. Digital subtraction angiography was performed 6 months after discharge and the aneurysm was classified as cured, stable, or recurrent. Results: A total of 87 Atlases were successfully released in 77 cases. Angiography performed immediately after the embolization revealed 19 (24.7%) modified Raymond grade Ⅰ, 10 (13.0%) grade Ⅱ, and 48 (62.3%) grade Ⅲa cases. Three perioperative complications were observed including thrombotic events in 2 cases and stent migration in 1 case. A follow-up angiogram was available for 47 aneurysms, and showed that modified Raymond grade Ⅰ occlusion was achieved in 38 (80.9%) cases, grade Ⅱ in 2 (4.3%) cases, and grade Ⅲa in 7 (14.9%) cases. At the 6-month follow-up, 38 patients were cured and 7 were stable, whereas 2 patients experienced a recurrence of aneurysm. Stenosis of the parent artery occurred in 3 (6.4%) cases, including 2 at the head and 1 inside the stent. Conclusions: The results of this preliminary study suggest that Neuroform Atlas stent-assisted coiling has a high occlusion rate and low incidence of complications in the endovascular treatment of aneurysms. However, the effectiveness of this procedure for large aneurysms and long-term outcomes require further investigation.

Risk of intracranial aneurysm recurrence after microsurgical clipping based on 3D digital subtraction angiography.

Current knowledge of recurrence rates after intracranial aneurysm (IA) surgery relies on 2D digital subtraction angiography (DSA), which fails to detect more than 75% of small aneurysm remnants. Accordingly, the discrimination between recurrence and growth of a remnant remains challenging, and actual assessment of recurrence risk of clipped IAs could be inaccurate. The authors report, for the first time, 3D-DSA-based long-term durability and risk factor data of IA recurrence and remnant growth after microsurgical clipping. Prospectively collected data for 305 patients, with a total of 329 clipped IAs that underwent baseline 3D-DSA, were evaluated. The incidence of recurrent IA was described by Kaplan-Meier curves. Risk factors for IA recurrence were analyzed by multivariable Cox proportional hazards and logistic regression models. The overall observed proportion of IA recurrence after clipping was 2.7% (9 of 329 IAs) at a mean follow-up of 46 months (0.7% per year). While completely obliterated IAs did not recur during follow-up, incompletely clipped aneurysms (76 of 329) demonstrated remnant growth in 11.8% (3.4% per year). Young age and large initial IA size significantly increased the risk of IA recurrence. The findings support those in previous studies that hypothesized that completely clipped IAs have an extremely low risk of recurrence. Conversely, the results highlight the significant risk posed by incompletely clipped IAs. Young patients with initial large IAs and incomplete obliteration have an especially high risk for IA recurrence and therefore should be monitored more closely.

Abstract Number ‐ 135: Surpass Evolve® Flow Diversion for Embolization of Unruptured Anterior Circulation Aneurysms: 6‐month Obliteration Rates

Introduction The Surpass Evolve flow diverter (FD) is a 64‐wire cobalt‐chromium device with improved ease of deployment and conformability, compared to its predecessor. Data on procedural outcomes and aneurysm obliteration rate remain limited. The objective of this study was to describe the procedural outcomes, including 6‐month obliteration rates, for patients who underwent Surpass Evolve FD embolization of an unruptured anterior circulation aneurysm. Methods All consecutive patients with an unruptured anterior circulation aneurysm who were treated with the Surpass Evolve FD between Aug 2020 and May 2022 were included. Patients with a ruptured or posterior circulation aneurysm were excluded. Demographic and clinical features, aneurysm morphology, arterial access, and procedural factors and outcome were extracted from our departmental neurointerventional database. Summary statistics included frequencies, and measures of central tendency and dispersion as appropriate. Results Sixty patients (82% female, mean age 57.9 years ± 15.5) underwent elective Surpass Evolve flow diversion for an unruptured anterior circulation aneurysm. In 47 (78%) patients, a native aneurysm was flow‐diverted, and in 13 (22%) patients, FD was performed for a recurrent aneurysm. Distribution of aneurysm location was: supraclinoid ICA (65%), cavernous ICA (12%), cervical ICA (10%) and anterior cerebral artery (13%). Thirty‐nine (65%) patients underwent left‐sided intervention. Mean aneurysm maximal diameter was 8.7 ± 5.7 mm. The majority of patients (49, 82%) underwent radial arterial access. Balloon angioplasty or J‐wire manipulation was used to enhance apposition in 37 (62%) cases. To date, thirty‐five (58%) patients have had a follow up angiogram (mean 0.65 years ± 0.2 from intervention); in 5 patients, there was mild non‐flow‐limiting stenosis. Based on the Raymond‐Roy Occlusion Classification, 25 (71%) had complete occlusion, 1 (2%) had a residual neck, and 9 (26%) had residual aneurysm. Conclusions The Surpass Evolve FD is safe and associated with favorable occlusion rates at six months. In our early experience, complication rates are well within the acceptable limits.

Endovascular Repair of a Splenic Artery Aneurysm Arising from the Superior Mesenteric Artery

A 55 year old man presented with recurrent dull abdominal pain for two months. Computed tomography angiography revealed a splenic artery aneurysm (A, asterisk) 24 × 24 mm originating from the SMA (A, arrow) a rare finding. Endovascular repair with coil (Cook Medical, Bloomington, IN, USA), embolisation of the splenic artery, and covered stents (8 × 25 mm + 8 × 50 mm; Viabahn, Gore, Flagstaff, AZ, USA) in the SMA was performed. The post-operative course was uneventful. Aspirin was continued for one year. After two years the SMA was patent with no aneurysm recurrence (B, arrow).Image 1

Fresh arterial allograft as a replacement for an infected common femoral prosthetic graft and recurrent false aneurysm.

Replacing an infected vascular prosthetic conduit with an allograft is a possible solution of this complication given the low recurrence of infection. It is most commonly utilized for cases where the use of autologous tissue is not an option. We present the case of a 70-year-old patient who had undergone repeated vascular reconstructions in the right lower limb. He was admitted to our department due to a progressively growing mass in the right groin and subsequently placed on the waiting list for a fresh allograft. The patient had the infected false aneurysm and prosthetic material of the femoral bifurcation replaced with an arterial allograft. The previous femoral popliteal autovenous bypass graft was reimplanted into the allograft. There were signs of sepsis during the operation; however, the blood culture was negative. Cultures from neither the wound nor the drain revealed the presence of any bacteria. The patient was discharged on the seventh post-operative day with prophylactic antibiotics. An early followup confirmed that there were no signs of recurrent infection and that the reconstruction remained patent. Seven and half months after the surgery, the femoral popliteal bypass graft became occluded and a conservative approach was chosen. A small thrombosed false aneurysm of the graft was revealed two years after the surgery due to transient non-compliance of the patient to immunosuppression therapy. It was treated conservatively. Two and a half years after the surgery, the allograft still remains open and the limb is preserved.

A challenging case of recurrent and progressive fusiform anterior circulation intracranial aneurysms: illustrative case.

Intracranial fusiform aneurysms are circumferential dilations of cerebral arteries that can lead to complications including ischemic stroke due to vessel occlusion, subarachnoid hemorrhage, or intracerebral hemorrhage. Treatment options for fusiform aneurysms have expanded significantly in recent years. Microsurgical treatment options include proximal and distal surgical occlusion and microsurgical trapping of the aneurysm, usually in association with high-flow bypass procedures. Endovascular treatment options include the placement of coils and/or flow diverters. Here the authors report a case of aggressive surveillance and treatment of a man with multiple progressive, recurrent, and de novo fusiform aneurysms of the left anterior cerebral circulation over 16 years. Because the long-term course of his treatment coincided with the recent expansion of endovascular treatment options, he underwent every type of treatment listed above. This case demonstrates the wide range of therapeutic options for fusiform aneurysms and how the treatment model for these lesions has evolved.

Volume embolization ratio of coiled cerebral aneurysms, does awake technique affect the results?

BackgroundDespite the great innovations in the neuroendovascular techniques and related materials, there are still notable percentages of recurrent cerebral aneurysms after aneurysm coiling. Aneurysm packing density is well known to affect the initial angiographic result of aneurysm embolization and has a crucial role in the stability of aneurysm obliteration. Although aneurysm coiling is commonly performed under general anesthesia, it could be performed under local anesthesia in certain circumstances.ObjectiveThe purpose of this study is to compare the volume embolization ratio (VER) and angiographic results of cerebral aneurysm embolization performed under local and general anesthesia.Materials and methodsThis is a retrospective cohort analysis of 20 consecutive cases of coiled cerebral aneurysms that were coiled under LA. Further, 15 cerebral aneurysm coil embolization cases have been collected from our data as matched control group.ResultsEmbolization was performed under local anesthesia (Group A) in 20 patients (57.1%) and under general anesthesia (Group B) in 15 patients (42.9%). At the end of the procedure, control angiogram revealed complete obliteration in 13 patients (37.1%), while incomplete obliteration was detected in 22 patients (62.9%). The mean VER 27.9 ± 11.8 without a significant difference between both groups of the study as the VER of Group (A) was 26.05 ± 8.4 and that of Group B was 30.44 ± 15.2. Follow-up angiography at 1 year revealed complete obliteration in 17 (48.6%) of the coiled aneurysms, while incomplete obliteration was detected in 18 patients (51.4%).ConclusionsEndovascular coiling of cerebral aneurysms under local anesthesia is a safe and feasible procedure without significant effects on the VER.

Safety and effects of endovascular treatment of basilar tip aneurysms in patients with moyamoya diseases.

The effect and safety of endovascular treatment of basilar tip aneurysms associated with moyamoya disease are unknown. This study was to investigate the safety and effect of endovascular treatment of basilar tip aneurysms associated with moyamoya disease. Patients with moyamoya disease concurrent with basilar tip aneurysms were retrospectively enrolled and treated with endovascular embolization. The clinical and angiographic data were analyzed. Thirty patients with a basilar tip aneurysm were enrolled, including 8 (26.67%) male and 22 (73.33%) female patients aged 38 to 72 years (mean 54.4 ± 8.15). Endovascular treatment was successfully performed in 29 (96.67%) patients but failed in 1 (3.33%). Immediately after embolization, aneurysm occlusion degree was Raymond-Roy grade I in 26 (89.66%), grade II in 2 (6.90%), and grade III in 1 (3.45%). Intraprocedural complications occurred in 2 (10%) patients, including aneurysm rupture in 1 (3.33%), leading to death of the patient, and stent thrombosis in 2 (6.67%) which was successfully treated with thrombolysis. At discharge, good clinical outcome (modified Rankin Scale 0-2) was achieved in 29 (96.67%) and death in 1 (3.03%). Follow-up was performed 6 to 26 months (median 15) in 27 (93.1%) patients. Aneurysm occlusion degree was Raymond-Roy grade I in 21 (77.78%) patients, grade II in 4 (14.81%), and grade III in 2 (7.41%), not significantly (P = .67) different from those immediately after embolization. Aneurysm recurrence was found in 4 patients (14.81%). The clinical outcome was modified Rankin Scale 0 to 2 in all 27 patients, not significantly different from that at discharge. Endovascular embolization can be performed safely and effectively for basilar tip aneurysms associated with moyamoya disease even though more advanced embolization techniques are necessary.

Lack of the human choline transporter‐like protein SLC44A2 causes hearing impairment and a rare red blood phenotype

Blood phenotypes are defined by the presence or absence of specific blood group antigens at the red blood cell (RBC) surface, due to genetic polymorphisms among individuals. The recent development of genomic and proteomic approaches enabled the characterization of several enigmatic antigens. The choline transporter‐like protein CTL2 encoded by the SLC44A2 gene plays an important role in platelet aggregation and neutrophil activation. By investigating alloantibodies to a high‐prevalence antigen of unknown specificity, found in patients with a rare blood type, we showed that SLC44A2 is also expressed in RBCs and carries a new blood group system. Furthermore, we identified three siblings homozygous for a large deletion in SLC44A2, resulting in complete SLC44A2 deficiency. Interestingly, the first‐ever reported SLC44A2‐deficient individuals suffer from progressive hearing impairment, recurrent arterial aneurysms, and epilepsy. Furthermore, SLC44A2null individuals showed no significant platelet aggregation changes and do not suffer from any apparent hematological disorders. Overall, our findings confirm the function of SLC44A2 in hearing preservation and provide new insights into the possible role of this protein in maintaining cerebrovascular homeostasis.

Reconstructive endovascular treatment for basilar artery trunk aneurysms: complications and clinical and angiography outcomes

BackgroundBasilar artery trunk aneurysms (BTAs) are rare intracranial aneurysms. We aim to investigate the procedural complications and clinical and angiographic outcomes of BTAs treated with reconstructive endovascular treatment (EVT).MethodsWe retrospectively...

Microsurgical and endovascular treatment of residual and recurrent cerebral aneurysms

Cerebral aneurysms are characterized by high risk of adverse outcome due to severe intracranial hemorrhages and their consequences. Aneurysm remnants after incomplete exclusion can cause hemorrhage. Filling of these fragments immediately after surgery is usually defined as residual aneurysms. Recurrent aneurysms develop in the area of excluded aneurysm in long-term period after surgery. The authors analyze foreign and national literature data on the diagnosis and management of residual and recurrent aneurysms. Risk factors, the most common classifications, diagnostic methods and surgical treatment are presented.

Association of circumferential aneurysm wall enhancement with recurrence after coiling of unruptured intracranial aneurysms: a preliminary vessel wall imaging study.

Recent histopathological studies of unruptured intracranial aneurysms (UIAs) have confirmed that aneurysm wall enhancement (AWE) on MR vessel wall imaging (VWI) is related to wall degeneration with in vivo inflammatory cell infiltration. Therefore, pretreatment aneurysm wall status on VWI may be associated with recurrence after endovascular treatment. VWI with gadolinium was performed on 67 consecutive saccular UIAs before endovascular treatment between April 2017 and June 2021. The mean (range) follow-up period after treatment was 24.4 (6-54) months. AWE patterns were classified as circumferential AWE (CAWE), focal AWE (FAWE), and negative AWE (NAWE). The authors retrospectively investigated the relationship between aneurysm recurrence and AWE patterns, as well as conventional risk factors. Sixty-seven patients with 67 saccular UIAs were eligible for the present study. AWE patterns were as follows: 10 CAWE (14.9%), 20 FAWE (29.9%), and 37 NAWE (55.2%). Follow-up MRA detected aneurysm recurrence in 18 of 69 cases (26.1%). Univariate analysis identified maximum diameter (mean ± SD 5.8 ± 2.2 mm in patients with stable aneurysms vs 7.7 ± 3.8 mm in those with unstable aneurysms, p = 0.02), aspect ratio (1.4 ± 0.5 vs 1.1 ± 0.4, p < 0.01), aneurysm location in posterior circulation (4.1% vs 27.8%, p < 0.01), volume embolization ratio (29.6% ± 7.8% vs 25.2% ± 6.1%, p = 0.02), and AWE pattern (p = 0.04) as significant predictive factors of recurrence. Among the 3 AWE patterns, CAWE was significantly more frequent in the unstable group, but no significant differences in stability of the treated aneurysms were observed with the FAWE and NAWE patterns. In multivariate logistic regression analysis, CAWE pattern (OR 14.2, 95% CI 1.8-110.8, p = 0.01) and volume embolization ratio ≥ 25% (OR 8.6, 95% CI 2.1-34.3, p < 0.01) remained as significant factors associated with aneurysm stability after coiling. VWI before coiling provides novel insights into the stability of treated aneurysms. Aneurysms with the CAWE pattern on VWI before coiling may be less stable after treatment.

High-flow Bypass with Proximal Artery Occlusion as a Therapeutic Option for Recurrent Large Internal Carotid Paraclinoid Aneurysm after Endovascular Surgery

High-flow Bypass with Proximal Artery Occlusion as a Therapeutic Option for Recurrent Large Internal Carotid Paraclinoid Aneurysm after Endovascular Surgery