Treatment Of Aneurysms Research Articles

Long noncoding RNA Sngh20 promotes vascular smooth muscle cell senescence and abdominal aortic aneurysm growth by interacting with dead-box helicase 5

Abstract Background Development of non-surgical treatment of human abdominal aortic aneurysm (AAA) has clinical significance. Long noncoding RNAs (lncRNAs) are emerging as powerful mediators participated in cellular senescence process that a critical pathological alteration prompting AAA development. Purpose To investigate the role and underlying mechanism of lncRNA Small nucleolar RNA host gene-20 (Snhg20) in AAA formation. Methods Experimental AAA mice models were produced by peri-aortic CaPO4 injury in C57bl/6J mice or Subcutaneousangiotensin-II (Ang-II) infusion in Apoe–/– mice and gapmeR was used to knockdown Snhg20 expression. Adeno-associated virus and anti-IL-6 monoclonal antibody was used to knockdown dead-box helicase 5 (DDX5) and neutralize IL-6, respectively.Immunohistochemical and immunofluorescent staining, ELISA and real-time PCR were performed to determine the vascular structure and inflammation, cellular senescence and senescence-associated secretory phenotype (SASP) content in human and mouse AAA lesions. Human aortic SMC cell line was used to investigate the effect of Snhg20 knockdown on senescence and SASP in vitro. LncRNA pulldown and mass spectrometry were used to identify potential targets that interact with Snhg20. p53 DNA binding affinity was examined by EMSA. Results The expression of Snhg20 was downregulated in both human and mice AAA lesion. Snhg20 knockdown promoted SMC senescence and loss, vascular inflammation and AAA growth in both experimental AAA mice models. Mechanistically, Snhg20 interacted with DDX5, an important transcriptional coactivator of p53. The absence of snhg20 increased DDX5 and p53 interaction and thereby promoted p53 DNA binding affinity to transcriptionally initiate p21expression, resulting in increased cellular senescence and senescence-associated secretory phenotype (SASP) secretion, including IL-6. Moreover, DDX5 silencing or anti-IL-6 therapy rescued the SMC senescence and loss, vascular inflammation and AAA growth mediated by Snhg20 knockdown. Furthermore, human AAA lesions showed increased DDX5 co-localization with p53 and abundant senescent vascular SMC. Conclusion These findings identify an important role of Snhg20 in controlling vascular SMC senescence and SPAP expression and suggest that Snhg20 is a potential target for AAA treatment aimed at reducing VSMCs senescence.Schematic summary

Side branch interventions late after MFM implantation

Abstract Background MFM prostheses were developed for the endovascular treatment of aortic and great vessel aneurysms. Implanted between two healthy segments of arterial vessel, they centralize blood flow and trough Bernoulli's principle. Thereby hemodynamic stress into the aneurismal sac is reduced. Meantime, the porosity along entire prosthesis length preserves all side branches (SB) patent. Results from real clinical practice confirm the high success rate (nearly 100%) of MFM prostheses regarding side branch preservation at one-year follow-up [1,2]. However, late after MFM implantation SB intervention may be required (due to atherosclerosis or others). The access to SB covered by MFM is challenging due to: impossible ostial engagement of the guiding catheter, distance between target vessel ostium and prosthesis, the necessary for all devices used to cross MFM mesh. Materials and methods For the period 2016-2020 we implanted a specific type of MFM prosthesis in order to treat aneurysm of the abdominal aorta in 34 patients. A total of 129 side branches was covered. Within a mean follow-up period of 5 years, 129 side branches were preserved and 7 affected by stenosis or occlusion (two of them asymptomatic). Intervention on the branch covered by the MFM prosthesis was necessary in 5 patients (two males, two females; mean age 68 years). One patient had endovascular celiac trunk stenosis, one patient had both celiac trunk and superior mesenteric artery stenoses, one patient had superior mesenteric artery stenosis, and one patient had left renal artery stenosis. All lesions were intervened through radial or brachial approach. Guiding 6F Judkins right catheter was navigated close to the target branch ostium and the MFM mesh was crossed with .014¨ coronary wire. When guidewire was placed into target vessel small low-profile, coronary balloon is advanced across the mesh of the multilayer stent. Anchor balloon technique was used in order for guiding catheter to cross the mesh gradually. Once the guiding catheter is engaged, the lesion was treated with balloon pre-dilation and implantation of a low-profile, high radial force stent. Results All 4 patients and 5 affected vessels were successfully endovascularly intervened. We did not observe any procedure complications. Immediate resolution of clinical symptoms was achieved. At 1 year follow-up with CT scan all treated branch arteries were patent. Conclusions In patients with previously implanted multilayer stents, the mesh can be crossed safely with readily available coronary devices together with the balloon anchor technique. As such, endovascular treatment of stent-covered visceral and renal arteries is possible without open surgery.Catheter stabilizationSMA successfully treated

Evaluation of aortic inflammation in marfan syndrome patients with 18-fluorodeoxyglucose positron emission and computed tomography

Abstract Background The role of inflammation in Marfan Syndrome (MS) has been well studied in current research. These studies have investigated the role of serum Interleukin 6 (IL-6), Transforming Growth Factor-b (TGF-b) and Macrophage Colony Stimulating Factor (MCSF) as biomarkers of disease severity and progression. Surgical repair is the recommended treatment of aortic aneurysms when aortic diameter reaches the indication threshold. It has been observed however that dissection may occur even before this threshold is reached. 18-fluorodeoxyglucose (18 F-FDG) positron emission tomography / computed tomography (PET/CT) is the gold standard imaging modality to noninvasively assess vascular inflammation. Purpose Our aim was to investigate whether MS patients have increased aortic wall inflammation as assessed by 18F-FDG PET/CT, and the relationship between aortic wall inflammation with serum levels of IL-6, TGF-b and MCSF. Methods The study population consisted of fifteen MS patients and seventeen sex and age matched controls. In all subjects, serum levels of circulating IL-6, TGF-b and MCSF were measured. In PET/CT, the arterial target-to-background ratio (TBR) was calculated for aortic root (AR), ascending aorta(As), aortic arch (AA) and descending aorta (DA). Also, all patients were assessed with transthoracic echocardiography where the diameters of AR, As, AA, and DA were estimated at baseline and were reexamined at the end of the follow up period. Results TBR for MS vs. controls was 2.17±0.75 vs 2.01±0.36, p=0.75 at AR; 2.15±0.67 vs 1.84±0.35, p=0.040 at As; 2.16±0.64 vs 1.70±0.25, p=0.03 at AA and 1.97±0.52 vs 1.83±0.42, p=0.23 at DA respectively. Additionally, Marfan patients had increased levels of serum biomarkers. However, this difference was statistically significant (SS) only for IL-6 serum levels; 2.17±0.46 vs 1.08±0.12 p=0.011 and IL-6 was SS associated with AR TBR (rho=0.572, p=0.033), As TBR (rho=0.604, p=0.022) and DA TBR (rho=0.714, p=0.004). Two of our patients were operated due to severe dilatation of the aortic root and the surgical specimens showed aortic wall inflammation of moderate severity along with fibrosis. Conclusion MS patients have increased of aortic wall inflammation as assessed by 18F-FDG PET/CT, a finding that highlights the role of inflammation in the pathway of disturbed TGF signaling. Further research is needed to determine its prognostic role and value in identifying patients with an indication for early intervention.

DWI lesions after intracranial aneurysm treatment with contour or WEB-does the device matter?

In this study, we report our experience with the occurrence of diffusion-weighted imaging (DWI) lesions following aneurysm treatment with Woven EndoBridge (WEB) device and Contour Neurovascular System in elective settings. We compared both techniques in a retrospective single-center analysis, to investigate whether there are significant differences in the incidence of microemboli depending on the device used. Sixty-two cases treated with Contour were retrospectively compared with 84 WEB cases. Postinterventional MRI was performed in all patients within five days after the angiographic procedure. Only DWI lesions in the dependent vascular territory of the treated aneurysm were considered. Data on occurrence of DWI lesions, device implantation times as well as device change or repositions maneuvers were compared. A total of 146 patients were included in this study. Postinterventional DWI lesions were detected in 33 of the 62 (53.2%) Contour cases and in 36 of the 84 (42.8%) WEB cases with an average lesion number of 1.70 ± 3.45 in our WEB group and 1.68 ± 2.53 in our Contour cohort. Neither periinterventional device changes nor device reposition maneuvers had a significant impact on the occurrence of DWI lesions. Although four patients experienced transient neurological deterioration, the DWI lesions were not clinically relevant at the time of discharge, as the patients' NIHSS remained stable compared to the preintervention NIHSS in the entire cohort. There was no statistically significant difference between the implantation times of WEB and Contour, although Contour could be implanted slightly faster. Aneurysm treatment with WEB or Contour results in a comparable numbers of procedure-related DWI lesions. This effect was consistent after adjustment for other demographic or technical variables.

Role of clipping in aneurysmal subarachnoid hemorrhage: a post hoc analysis of the Earlydrain trial

The choice between clipping and coiling of ruptured cerebral aneurysms in subarachnoid hemorrhage (SAH) remains controversial. The recently published Earlydrain trial provides the opportunity to analyze the latest clip-to-coil ratio in German-speaking countries and to evaluate vasospasm incidence and explorative outcome measures in both treatment modalities. We performed a post hoc analysis of the Earlydrain trial, a multicenter randomized controlled trial investigating the use of an additional lumbar drain in aneurysmal SAH. The decision whether to clip or to coil the ruptured aneurysm was left to the discretion of the participating centers, providing a real-world insight into current aneurysm treatment strategies. Earlydrain was performed in 19 centers in Germany, Switzerland, and Canada, recruiting 287 patients with aneurysmal SAH of all severity grades. Of these, 140 patients (49%) received clipping and 147 patients (51%) coiling. Age and clinical severity based on Hunt-Hess/WFNS grades and radiological criteria were similar. Clipping was more frequently used for anterior circulation aneurysms (55%), whereas posterior circulation aneurysms were mostly coiled (86%, p < 0.001). In high-volume recruiting centers, 56% of patients were treated with clipping, compared to 38% in other centers. A per-year analysis showed a stable and balanced clipping/coiling ratio over time. Regarding vasospasm, 60% of clipped versus 43% of coiled patients showed elevated transcranial Doppler criteria (p = 0.007), reflected in angiographic vasospasm rates (51% vs. 38%, p = 0.03). In contrast to the Earlydrain main results establishing the superiority of an additional lumbar drain, explorative outcomes after clipping and coiling measured by secondary infarctions, mortality, modified Rankin Score, Glasgow Outcome Scale Extended, or Barthel-Index showed no significant differences after discharge and at six months. In clinical practice, aneurysm clipping is still a frequently used method in aneurysmal SAH. Apart from a higher rate of vasospasm in the clipping group, an exploratory outcome analysis showed no difference between the two treatment methods. Further development of periprocedural treatment modalities for clipped ruptured aneurysms to reduce vasospasm is warranted.

Treatment of Unruptured Small and Medium-Sized Wide Necked Aneurysms Using the 64-Wire Surpass Evolve: ASubanalysis From the SEASE International Registry.

Flow diversion has revolutionized the management of wide-necked intracranial aneurysms (IAs). We aimed to assess the effectiveness and safety of the new generation 64-wire Surpass Evolve for the treatment of unruptured small/medium-sized IAs. This is a subanalysis from the SEASE (Safety and Effectiveness Assessment of the Surpass Evolve) registry, an observational cohort study including 15 academic institutions in North America and Europe between July 2020 and October 2022. Patients with wide-necked saccular IAs, measuring <12 mm along the internal carotid artery and vertebrobasilar system, and treated with the Surpass Evolve were included. Primary effectiveness was complete occlusion (Raymond-Roy class 1) at follow-up (core laboratory adjudicated), and primary safety was major stroke (ischemic/hemorrhagic) in the territory supplied by the target artery or death. A total of 129 cases with 135 IAs were included (median age 59 years, 85.3% women). Median maximum IAs size and neck size were 5.1 and 3.9 mm, respectively. Most IAs were in the internal carotid artery C6 (65.9%, 89/135) and C7 (14.1%, 19/135) segments. At a median follow-up time of 10.2 months (interquartile range, 6.4-12.8), complete occlusion was 77.1% (101/131), ≥50% in-stent stenosis was 8.8% (11/125), and retreatment was 0.8% (1/125). Major stroke and mortality were reported in 2 (1.6%) patients and 1 (0.8%) patient, respectively. Size was the only factor associated with higher odds of incomplete occlusion (adjusted odds ratio, 1.2 [95% CI, 1.02-1.5]; P=0.03). Patients with small/medium-sized IAs can be effectively treated using the Surpass Evolve, a new generation, 64-wire, cobalt-chromium flow diverter.

Woven EndoBridge device apposition and compression using Sim&Size virtual simulation correlate with aneurysm occlusion status: a retrospective cohort study

BackgroundVirtual simulation is increasingly used for aneurysm treatment. This study aimed to explore whether mechanical behavior biomarkers of the Woven EndoBridge (WEB) device as computed by Sim&Size simulation software were...

Predictive value of the systemic immune-inflammation index for periprocedural complications in flow diverter treatment for patients with intracranial aneurysms.

Flow-diverter devices (FDs) are effective in treating intracranial aneurysms (IAs) but carry substantial periprocedural risks, particularly ischemic complications. This study aimed to determine if elevated Systemic Immune-Inflammation Index (SII) can independently predict these risks and assess the impact of age and dual antiplatelet therapy on this association. We conducted a retrospective analysis of patients treated with FDs between February 2016 and August 2023, using blood samples taken within six days before surgery to calculate SII. Logistic regression and decision tree analyses assessed the link between SII and periprocedural complications, with subgroups exploring influencing factors. Multivariable analysis identified high SII as an independent predictor of periprocedural complications (OR = 5.306, 95% CI: 1.367-18.455; P = 0.009). The decision tree model confirmed SII > 0.437 as a critical threshold. Subgroup analysis showed a pronounced association of SII with periprocedural complications in patients ≥ 65 years (OR = 36.979, 95% CI: 2.103-650.134; P = 0.014) and in those on clopidogrel plus aspirin therapy (OR = 16.921, 95% CI: 2.733-104.746; P = 0.002). An elevated Systemic Immune-Inflammation Index (SII) > 0.437 significantly correlates with increased periprocedural complications (6.5% vs. 1.8%, P = 0.017). Although not statistically significant, higher SII is associated with a greater rate of ischemic events (3.9% vs. 0.9%). Elevated preoperative SII independently predicts periprocedural complications, particularly ischemic events, in patients undergoing FDs treatment for intracranial aneurysms. This association is particularly pronounced in older patients (> 65 years) and those receiving dual therapy with clopidogrel plus aspirin. Trial Registration: ClinicalTrials.gov (NCT06446778). Registered on May 22, 2024.

Tabular review of contemporary open surgical repair experiences for treatment of thoracoabdominal aortic aneurysms.

Open surgical repair of thoracoabdominal aortic aneurysms (TAAAs) is one of the most challenging operations due to extensive surgical dissection and exposure, risk of complications and need for reconstruction of the aorta and its branches. In the last two decades, endovascular techniques have evolved and now are considered a viable alternative to open surgical repair in patients with suitable anatomy. Regardless of which technique is selected, open or endovascular, reduction of postoperative morbidity and mortality requires large clinical volume, optimal patient selection and a multidisciplinary team that can take care of the surgical, anesthetic, critical care and postoperative issues that occur after these operations. The aim of this article is to summarize the clinical data on open surgical repair of thoracoabdominal aortic aneurysms in a schematic tabular format.

Safety and efficacy of flow diverter stents in the treatment of bifurcation cerebral aneurysms: single-center experience.

The use of flow diverter (FD) stents is continually expanding. Aneurysms on arterial bifurcation typically have an undesirable anatomical form, are frequently wide-necked, and include one or more side-branch arteries. In recent years, the off-label use of flow diversion in treating intracranial aneurysms beyond the internal carotid artery has become increasingly popular. This study reports our center's initial experience treating bifurcation aneurysms with FD devices, documenting occlusion outcomes using the O'Kelly-Marotta and modified Cekirge-Saatci scales, as well as the safety of FD usage in bifurcation locations. This retrospective, single-center study analyzed a prospectively maintained database of patients with cerebral aneurysms treated endovascularly. The study identified bifurcation aneurysms that were treated between January 2019 and May 2022 by placing an FD device covering the neck of the aneurysm. Our short series suggests that flow diversion is a viable therapeutic option for bifurcation aneurysms with favorable angiographic outcomes. In highly selective cases, flow diversion may be considered for treating bifurcation aneurysms in patients who will undergo follow-up examinations in the future. Flow diversion has emerged as a valuable technique in the management of bifurcation aneurysms, offering the potential for satisfactory occlusion and long-term outcomes.

Patterns of Dynamic Adaptability of the Circle of Willis in Response to Major Branch Artery Coverage with a Flow Diverter

The plasticity of the Circle of Willis represents an underexplored yet intriguing dimension of vascular anatomy in cerebrovascular disorders. We outline distinct patterns of change in response to aneurysm treatment using flow diversion (FD) after covering major branches. Retrospective analysis of digital subtraction angiographies (DSA) from intracranial aneurysms treated with FD from 2013 to 2023. Vessel diameters, including those covered by the stent and adjacent arteries, were measured. Angiographic changes were evaluated at last imaging follow-up. Of the 622 patients, 49 had angiographic follow-up for pattern assessment. The median age was 62 years; females represented 71.4%. The median size of the treated aneurysms was 4.7mm. Four patterns of angiographic change were identified: (1)Patients with supraclinoid aneurysms, A1-ACA caliber increased (hypoplastic: 1.05 to 2.00 mm; non-hypoplastic: 2.45 to 2.75 mm) after FD coverage of the contralateral ACA. (2)Patients with paraclinoid aneurysms and hypoplastic-fetal P1-PCA, the diameter increased from 0.80 to 1.7 mm (p<0.01) after covering the ipsilateral PComA origin. (3)Patients with basilar-tip and proximal PCA aneurysms showed increased ipsilateral PComA size from 1.2 to 2 mm (p<0.01) after PCA origin coverage. (4)Patients with anterior communicating aneurysms, the diameter of the contralateral hypoplastic A1 segment increased from 1.0 to 1.35 mm (p=0.39) or non-hypoplastic A1-ACA from 2.75 to 3.05 mm (p=0.10) after FD coverage. The circle of Willis displays both hemodynamic and anatomic plasticity after major branch coverage with a flow diverter. This phenomenon is aimed at preserving blood flow in the distal territory of the covered vessel.

Intrasaccular Treatment of Intracranial Aneurysms: A Comprehensive Review

Background: The endovascular treatment of complex intracranial aneurysms, such as wide-neck aneurysms (WNAs), remains a challenge. More established endovascular techniques, which include balloon-assisted coiling, stent-assisted coiling, and flow diversion, all have their drawbacks. Intrasaccular flow disruptor devices have emerged as a useful tool for the neurointerventionalist. Methods: Here, we discuss landmark studies and provide a comprehensive, narrative review of the Woven EndoBridge (WEB; Microvention, Alisa Viejo, CA, USA), Artisse (Medtronic, Irvine, CA, USA), Contour (Stryker, Kalamazoo, MI, USA), Saccular Endovascular Aneurysm Lattice Embolization System (SEAL; Galaxy Therapeutics Inc, Milpitas, CA, USA), Medina (Medtronic, Irvine, CA, USA), and Trenza (Stryker, Kalamazoo, MI, USA) devices. Results: Intrasaccular devices have proven to be effective in treating complex aneurysms like WNAs. Conclusions: Intrasaccular flow disruptors have emerged as a new class of effective endovascular therapy, and results of ongoing clinical studies for the newer devices (e.g., SEAL and Trenza) are much anticipated.

Lessons learned from 12 years using the Woven Endobridge for the treatment of cerebral aneurysms in a multi-center series

Intrasaccular flow disruption with the Woven Endobridge (WEB) has become a well-established endovascular technique for the treatment of intracranial aneurysms. This study presents our 12-year experience with the WEB and evaluates its evolving indications, procedures, and outcomes. A consecutive series of 324 aneurysms treated with WEB between 2011 and 2023 at three neurovascular centers was retrospectively analyzed and the study group was divided into four treatment periods. Uni- and multivariate analyses were performed to evaluate factors associated with technical success, thromboembolic complications, and angiographic outcome. The mean aneurysm size was 7.0 ± 3.6 mm and decreased during the study period, while the proportion of atypical sites for WEB implantation increased. WEB implantation was technically successful in 96.0%, and the ratio of WEB width to dome width increased during the study period, indicating oversizing. The neurological complication rate was 4.9% (1.5% major, 3.4% minor) and the mid-term complete occlusion rate was 60.6% (81.9% adequate occlusion), with no statistical differences in either outcome measure between the study periods. In multivariate analyses, the use of WEB 17 was associated with increased technical success (HR: 7.4, 95%CI: 2.4-23.6, p<0.01), whereas ruptured aneurysm status (HR: 2.5, 95%CI: 1.0-6.0, p=0.04) and the use of additional stents (HR: 4.8, 95%CI: 1.6-14.4, p<0.01) predicted thromboembolic complications. Appropriate oversizing of the WEB favored mid-term complete occlusion (HR: 10.5, 95%CI: 1.3-83.3, p=0.03). The results suggest an expansion of the indications for WEB implantation and highlight the importance of oversizing for treatment efficacy.

Design of thermally programmable 3D shape memory polymer-based devices tailored for endovascular treatment of intracranial aneurysms

Despite recent technological advancements in endovascular embolization devices for treating intracranial aneurysms (ICAs), incomplete occlusion and aneurysm recanalization remain critical challenges. Shape memory polymer (SMP)-based devices, which can be manufactured and tailored to patient-specific aneurysm geometries, possess the potential to overcome the suboptimal treatment outcome of the gold standard: endovascular coiling. In this work, we propose a highly porous patient-specific SMP embolic device fabricated via 3D printing to optimize aneurysm occlusion, and thus, improve the long-term efficacy of endovascular treatment. To facilitate device deployment at the aneurysm via Joule-heating, we introduce a stable, homogeneous coating of poly-pyrrole (PPy) to enhance the electrical conductivity in the SMP material. Using an in-house pulse width modulation circuit, we induced Joule-heating and characterized the shape recovery of the PPy-coated SMP embolic devices. We found that the employed PPy coating enables enhanced electrical and thermal conductivity while only slightly altering the glass transition temperature of the SMP material. Additionally, from a series of parametric studies, we identified the combination of catalyst concentration and pyrrole polymerization time that yielded the shape recovery properties ideal for ICA endovascular therapy. Collectively, these findings highlight a promising material coating for a future coil-free, personalized shape memory polymer (SMP) embolic device, designed to achieve long-lasting, complete occlusion of aneurysms.

Application of surgical revascularization technique in giant aneurysm of the extracranial internal carotid artery: technical report.

The purpose of this study is to illustrate the diagnostic and therapeutic value and clinical significance of surgical revascularization in giant aneurysms of the extracranial internal carotid artery. The research team screened a group of cases of giant aneurysms of the extracranial internal carotid artery and analyzed the detailed information of the enrolled patients in terms of their basic clinical characteristics, surgical approaches and clinical prognosis. All patients had a good prognosis, except for one patient who was left with only mild facial nerve palsy (grade II facial paralysis). The results demonstrate that surgical revascularization is effective and safe in the treatment of giant aneurysms of the extracranial internal carotid artery. The significant conclusion of this study is to provide an ideal alternative treatment for the treatment of giant aneurysms of the extracranial internal carotid artery. The surgical revascularization technique is a powerful tool for vascular neurosurgeons in the management of complex cerebrovascular diseases when traditional surgical clipping or endovascular interventions encounter bottlenecks.

Analyzing the safety and efficacy of pipeline embolization device in pediatric aneurysms: insight from a mul-ticenter cohort and pooled analysis.

Pediatric patients with intracranial aneurysms face high risks of spontaneous subarachnoid hemorrhages. Despite its approval for adults aged 22 and above, the Pipeline Embolization Device (PED, Covidien/Medtronic, Irvine, California, USA) is being considered for younger patients due to its efficacy. This study aims to assess the safety and effectiveness of using PEDs in pediatric aneurysm treatment. A retrospective study across 14 institutions identified 25 patients (age ≤ 18) treated with PED from November 2014 to October 2019. A literature review included all published pediatric aneurysm cases treated with PED from 2007 to 2023. Analyzed data included patient demographics, aneurysm characteristics, treatment, clinical outcomes, and complications. We analyzed 81 pediatric patients, including 25 from the multi-center registry and 56 from 38 relevant literature. In the entire cohort of 81 patients, mean age of the patients was 11.9 ± 4.0 years (ranged from 9 months to 18 years), with 58.0% males. Ruptured aneurysms were observed in 7 patients (8.6%), whereas 43 patients (53.1%) harbored large/giant aneurysms. The aneurysm occlusion rate was 87.7% during the median 7 months follow-up. Complications occurred in 12.3% of patients, resulting in morbidity in 5 cases (6.1%) and mortality in 4 cases (4.9%). Patient age was not associated with the occurrence of aneurysm residual, complications, and mortality following PED treatment. PED can be effective for pediatric aneurysms, but morbidity and mortality can be substantial compared to the adults. Surgical timing should depend on clinical judgment and patient factors, without age-related delays.

Outcome study of the Pipeline Vantage Embolization Device (second version) in unruptured (and ruptured) aneurysms (PEDVU(R) study)

BackgroundThe Pipeline Vantage Embolization Device (PEDV) is the fourth-generation pipeline flow diverter for intracranial aneurysm treatment. There are no outcome studies for the second PEDV version. We aimed to evaluate...

Location specific rupture risk of intracranial aneurysms: case of ophthalmic aneurysms

BackgroundAneurysm location is a key element in predicting the rupture risk of an intracranial aneurysm. A common impression suggests that pure ophthalmic aneurysms are under-represented in ruptured intracranial aneurysms (RIAs)....

Comparative Analysis of Tailored Minicraniotomy versus Standard Pterional Craniotomy in the Treatment of Anterior Circulation Aneurysms: A Single-Center Case–Control Observational Study

Abstract Introduction Multiple minicraniotomies (Mct) have been proposed as alternatives to standard pterional craniotomy (Pct) for intracranial aneurysm treatment. These approaches offer limited surgical corridors and distinct working angles, posing challenges in addressing all aneurysm types with one method. We suggest a tailored Mct technique, comprising three minimally invasive approaches targeting anterior circulation aneurysm sites (middle cerebral artery, internal carotid artery, anterior communicating artery). Methods We conducted a retrospective, case–control study at a single center comparing Pct and Mct outcomes for ruptured and unruptured aneurysms. Parameters evaluated included conversion rates to Pct or decompressive hemicraniectomy (DHC), intraoperative rupture (IOR), surgical complications, complete aneurysm exclusion, 6-month modified Rankin Scale (mRS) scores, and aesthetic outcomes using a visual analog scale. A total of 146 patients were included, with 103 in the Mct group and 43 in the Pct group, comparable in mean age, sex, and aneurysm topography. Hunt–Hess scores and Fisher grades were lower in the Mct group initially. Results No cases required conversion from Mct to Pct or DHC. No significant differences were observed in IOR, surgical complications, and aneurysm exclusion rates between groups. The Mct group demonstrated better 6-month mRS scores and aesthetic outcomes. Conclusion Our study indicates that tailored Mct is as safe and effective as standard Pct for intracranial aneurysms, with significant cosmetic benefits. Thus, tailored Mct can be considered a valuable alternative not only to Pct but also to other minimally invasive surgical methods for these aneurysms.

Transcarotid flow reversal for proximal control during cerebral aneurysm clip reconstruction: illustrative case.

Paraclinoid aneurysms can pose an operative challenge during clip reconstruction, given the complex surrounding anatomy and the aneurysmal tendency to maintain turgor despite standard approaches to proximal control. This report demonstrates the use of intraoperative retrograde arteriovenous shunting with the transcarotid artery revascularization (TCAR) system to assist in the safe clip reconstruction of an irregular paraclinoid aneurysm. A 33-year-old woman presented with perimesencephalic subarachnoid hemorrhage and was found to have an incidental 9-mm ophthalmic aneurysm. Coil embolization was not successful. During microsurgical clip reconstruction, the left common carotid artery was exposed to allow for proximal control as well as transcarotid arterial sheath placement. Flow reversal was instituted throughout the aneurysm dissection and clipping, with a visible softening of the aneurysm. Intraoperative angiography confirming successful clip reconstruction was performed utilizing the TCAR sheath. The case was complicated by the development of cerebrospinal fluid rhinorrhea postoperatively, requiring surgical repair. The patient has since made a complete recovery. Transcarotid flow reversal utilizing the TCAR system has potential for use in the surgical treatment of paraclinoid aneurysms, as it may aid in softening the aneurysm for safer dissection and clip reconstruction, protect against aneurysm-associated emboli, and provide an avenue for intraoperative angiography. https://thejns.org/doi/10.3171/CASE24330.