Type Of Aneurysm Research Articles

Three-Year Outcomes of a US Pivotal Trial Substudy for Conformable Endoprosthesis in >=10 mm Non-Angulated Neck Anatomy

To report the midterm clinical outcomes from the GORE® EXCLUDER® Conformable AAA Endoprosthesis system (EXCC) pivotal regulatory trial in the United States (U.S.). This is a prospective, multicenter, investigational device exemption clinical trial at 31 US. sites with Core Laboratory assessment of imaging and independent adjudication of safety. The study enrolled patients with abdominal aortic aneurysms (AAA) with a minimum proximal landing zone ≥10mm and proximal neck angulation of ≤60 degrees between December 2017 and February 2019 as part of a larger study to gain indications of the EXCC device. Endpoints included patient survival, freedom from secondary interventions, and stent-graft related outcomes. There were 80 patients enrolled (88.8% male, mean 73.5± 8.14 years-old). Mean maximum aortic diameter was 57.7±8.0mm (range, 42.5-82.7). There was 100% freedom from type I and III endoleak and aneurysm-related mortality at 36-months. Freedom from secondary intervention was 91.9± (0.83, 0.96, 95% C.I.) at 36-months. There were no device fractures, migrations (≥10mm), or aneurysm ruptures. At 36months, thirteen patients (26.5%) had type 2 endoleak, 32 patients (58.2%) had AAA sac regression, 17 (30.9%) had no change in diameter, and 6 (10.9%) had sac enlargement. Seven patients (8.8%) through 36months underwent reintervention. The 3-year outcomes have continued to show an adequate safety and efficacy profile of the EXCC device with no aneurysm related mortality or Type I/III endoleak. These results demonstrate durability for an EVAR device in US regulatory trials.

Treatment of Ruptured Intracranial Aneurysms with Parent Artery Flow Diverter Devices: A Comprehensive Systematic Review and Meta-Analysis.

Surgical clipping and endovascular coiling are well-established treatments for acutely ruptured intracranial aneurysms leading to acute subarachnoid hemorrhage (aSAH). However, these modalities have limitations, particularly in cases involving wide-necked, bifurcating, or dissecting aneurysms. Flow diverter (FD) devices, initially used for unruptured aneurysms, have emerged as an alternative treatment for ruptured aneurysms despite concerns about hemorrhagic complications. This study aimed to perform a comprehensive systematic review and meta-analysis to assess the efficacy and safety of parental artery FD devices in treating ruptured intracranial aneurysms. A systematic search was conducted in Medline, Embase, and Cochrane databases from inception to July 2024. The inclusion criteria focused on studies involving patients with acutely ruptured aneurysms treated with parental artery FDs, with or without adjunctive coiling. Studies were required to report clear, stratified data specific to the population of interest, and include more than five patients. Exclusion criteria included studies on non-ruptured aneurysms, intrasacular flow diversion devices, or previously clipped aneurysms treated with FD. Data extraction was performed independently by two authors, and statistical analysis included single proportion analysis with 95% confidence intervals under a random-effects model, using R Studio. The primary outcome was the rate of aneurysm occlusion at follow-up. Sixty studies encompassing 1300 patients were included. The primary outcome analysis revealed a 90% (95% CI: 87% - 92%; I2= 51%) rate of total occlusion at follow-up. Subgroup analysis indicated an occlusion rate of 89% for anterior circulation aneurysms and 96% for posterior circulation aneurysms. Intraoperative complications occurred in 6% of cases, while postoperative complications were observed in 13%. Rebleeding rates were low at 1%, with a 2% need for retreatment. Good functional outcomes (mRS ≤ 2) were achieved in 82% of patients, and the overall mortality rate was 4%. FD devices demonstrated high rates of aneurysm occlusion and favorable functional outcomes in patients with acutely ruptured intracranial aneurysms. However, the low mortality rate and favorable outcomes observed may reflect selection bias toward patients with less severe SAH. Despite a modest complication rate, the overall safety and efficacy of FD devices suggest they may be a viable alternative to traditional treatments for specific aneurysm types. Further studies, including a broader spectrum of SAH severities, are warranted to optimize their use in clinical practice.

Evaluation of coiling endovascular technique on treatment of middle cerebral artery cerebral aneurysms in different blood hematocrits: A numerical study

Intracranial aneurysms are localized dilatations of the cerebral arteries that carry a risk of rupture and subsequent subarachnoid hemorrhage, a life-threatening condition. Middle cerebral artery (MCA) aneurysms are a common type of intracranial aneurysm, and endovascular treatment using coils or flow diverters is a common intervention approach. Understanding the hemodynamics, or blood flow patterns, within MCA aneurysms and how they are affected by endovascular treatment is crucial for improving patient outcomes. This numerical study investigates the hemodynamics of blood flow within MCA aneurysms before and after endovascular treatment. Patient-specific geometric models of MCA aneurysms were reconstructed from medical imaging data. Simulations using computational fluid dynamics were conducted to examine flow characteristics, wall shear stress, and additional hemodynamic factors within the aneurysms. The study assessed and contrasted the impact of coil embolization and flow diverter placement on the hemodynamics inside the aneurysms. The findings offer a deeper understanding of the intricate flow dynamics within MCA aneurysms and illustrate the ways in which endovascular treatments can modify these dynamics.

Hemodynamic evaluation of endovascular techniques of stenting and coiling for the treatment of internal carotid artery aneurysm: a computational study

The selection optimum endovascular method for the treatment of different cerebral aneurysms has been the main challenge for surgeons. In the present article, the computational technique is used for the hemodynamic evaluation of two main endovascular techniques of stent and coiling for the reduction of the hemorrhage risk of ICA aneurysms. Comprehensive analyses of the blood flow are performed to detect potential regions with high risk at critical stages of the cardiac cycle. Two coiling porosity conditions and stent deformation have been investigated via computational study to reveal the main change related to hemodynamics when these techniques are implemented. The hemodynamic results of this study show that the endovascular technique is more efficient in small aneurysms rather than giant ones. Meanwhile, the stent treatment of the giant saccular aneurysm is effective when the parent vessel of this type of aneurysm is fully aligned and limited blood flow enters the sac area.

Effectiveness of Flow Diverter Stents in the Treatment of Intracranial Aneurysms: Single-Center 10-Year Results.

Purpose This study's objective was to show how effectively flow-diverting stents work when treating cerebral aneurysms. The assessment aimedto determine efficaciousness related to aneurysm type, size, and location as well as early- and late-termresults. Material and method The study included 153 aneurysms from 122 patients treated in interventional radiology unit with flow diverter stents between July 2010 and June 2020. Apart from demographic data, size, type, and location of aneurysms; technical success, peri, post-procedural, and late complications; aneurysm occlusion rates, morbidity and mortality rates were extracted from patient records. Results This study enrolled 90 (73.8%) females and 32 (26.2%) males; average age of the patients was 52.8±12.9. The average follow-up period was 33.4±9.9 months. The most common type of aneurysm was saccular (133; 86.9%), and the most common location was the supraclinoid segment with 67 (43.8%). Complete occlusion was observed in 115 of 140 aneurysms from 110 patients during follow-up. No statistically significant difference was detected between the sizes and types of aneurysms and complete occlusion rates (p=0.096, p=0.583). The total occlusion rate was found to be significantly higher in internal carotid artery (ICA) supraclinoid segment aneurysms compared to other locations (p = 0.006). During the follow-up period, flow diverter stent-related permanent morbidity was observed in four (3.6%) patients and mortality was observed in five (4.5%) patients. Conclusion Flow diverter stents can be successfully applied to many aneurysm types, from small aneurysms to large and giant aneurysms, and have high aneurysm occlusion rates with low morbidity and mortality. By the aspects of the current study the total occlusion rate was found to be significantly higher in ICA supraclinoid segment aneurysms compared to other localizations.

Abstract 4115399: Comparative Outcomes of Local-Regional Versus General Anesthesia in Endovascular Aortic Aneurysm Repair: A Systematic Review and Meta-Analysis

Background: Endovascular Aortic Aneurysm Repair (EVAR) has emerged as a less invasive approach to aneurysm repair. However, the optimal anesthesia modality for elective cases—general or local-regional—remains uncertain. This meta-analysis compares the outcomes of local-regional versus general anesthesia (GA) for abdominal EVAR. Methods: We searched MEDLINE, Embase, and Cochrane databases for studies comparing local-regional and general anesthesia for EVAR up to May 2024. Following the PRISMA protocol, 1,796 articles were screened. Endpoints included 30-day mortality, type I endoleaks, length of hospital stay (LHS), and Intensive Care Unit (ICU) admissions. A random-effects model with odds ratios (OR) and 95% confidence intervals (CI) was used for binary endpoints and mean difference (MD) for continuous endpoints. Heterogeneity was assessed using Q and I2 statistics. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach evaluated the quality of evidence. Results: Sixteen cohort studies, encompassing 70,654 patients treated with EVAR after excluding overlapping populations, were included. All groups had similar demographics, American Society of Anesthesiologists physical status, and aneurysm type. The mean age was 73.6 years, and 88.1% were male. Local-regional anesthesia was associated with significantly lower 30-day all-cause mortality (OR 0.74; 95% CI 0.55 to 0.99; p=0.049; I2=0, Figure A), shorter LHS (MD -0.72 days; 95% CI -1.29 to -0.15; p=0.01; I2=87%), and less ICU admissions (OR 0.53; 95% CI 0.31 to 0.93; p=0.027; I2=98%). There was no increase in endoleaks in the local-regional group (OR 0.78; 95% CI 0.55 to 1.09; p=0.143; I2=29%, Figure B). The GRADE rated this evidence as moderate certainty and high importance. Conclusion: Local-regional anesthesia may be preferable to general anesthesia for EVAR, as it reduces 30-day mortality, ICU admissions, and hospital stay length without increasing the risk of type I endoleaks.

Proton beam irradiation with anti-VEGF therapy for polypoidal choroidal vasculopathy: results of a 24-month, phase II randomized study.

To determine the efficacy and safety of proton beam irradiation (PBI) and anti-vascular endothelial growth factor (anti-VEGF) therapy for polypoidal choroidal vasculopathy (PCV)/ aneurysmal type 1 macular neovascularization (AT1). The randomized clinical trial consisted of newly diagnosed active PCV/AT1 patients who were randomized 1:1 to treatment with three initial monthly intravitreal anti-VEGF agent (conbercept) injections with or without single 14 GyE radiation. Subsequent anti-VEGF therapy was given pro re nata. The primary outcome measures were number of anti-VEGF injections, best-corrected visual acuity (BCVA), and central retinal thickness (CRT) at 24months. Secondary outcome measures included the polypoidal lesion regression rate, changes in the areas of polypoidal lesions and branching vascular network (BVN), and radiotherapy-related adverse events at 24months. A total of 45 eyes (86.5%) completed the 24-month follow-up. At 24months, the combination therapy group required fewer anti-VEGF injections compared with the monotherapy group (5.9 ± 4.1 vs. 8.8 ± 5.3; P = 0.04). The mean gains in BCVA and the mean decrease in CRT were not significantly different between the two groups (P = 0.85 and P = 0.17, respectively). Combination therapy was superior to monotherapy for complete polypoidal lesion regression (80.0% vs. 48%, P = 0.03) and change in BVN area (- 1.03 ± 1.24 mm2 vs. 0.36 ± 0.77 mm2, P < 0.01). The radiation-related microvascular abnormalities were observed in 55.0% of eyes following combination therapy at 15.7 ± 2.5months. PBI (14 GyE) combined with anti-VEGF therapy could decrease the need for additional anti-VEGF injections for PCV/AT1. Longer follow-up is needed to fully evaluate the long-term safety of PBI. What is known The current main methods for treating PCV/AT1 include anti-VEGF drugs as monotherapy or in combination with photodynamic therapy. However, some cases can be challenging with multiple repeated injections due to the relatively low regression rate of polyps and high recurrence rate. What is new Proton beam irradiation therapy with anti-VEGF drugs can synergistically promote the regression of polyps and the shrinkage of branching vascular network, and reduce the anti-VEGF treatment burden for patients with PCV/AT1. Radiation retinopathy was mild and did not appear to be visually significant at the 24-month follow-up. Proton beam irradiation can be a new strategy for the treatment of PCV/AT1.

Branching and nonbranching intracranial aneurysms in the presence of a persistent stapedial artery and an aberrant internal carotid artery assessed with computational hemodynamics: illustrative case.

The mechanisms underlying the initiation and progression of bifurcation versus lateral wall aneurysms are not well understood. Computational fluid dynamics (CFD) can improve the understanding of these mechanisms and can consequently help identify patients at higher risk for developing aneurysms and monitor them more closely. A 36-year-old man presented with a ruptured anterior communicating artery aneurysm, which was successfully treated with microsurgical clipping. Imaging also revealed a persistent stapedial artery with an elongated and tortuous posterior communicating artery (PComA). Fourteen years later, he was readmitted for a ruptured aneurysm on a PComA loop. CFD helped identify considerable collateral circulation due to the aberrant internal carotid artery (ICA). High flow rates trigger both types of aneurysms, but nuances exist in the hemodynamic mechanisms that drive their growth. Berry aneurysms and lateral wall aneurysms initially start due to a high flow rate, a common underlying cause. However, the formation of true sidewall aneurysms is primarily characterized by locally increased wall shear stress, while the development of berry aneurysms is mainly linked to high local blood pressure at arterial bifurcations. An aberrant ICA can lead to supraphysiological compensatory flow in the anterior and posterior circulation, increasing the risk of intracranial aneurysm formation at both branching and nonbranching sites, underscoring the need for lifelong monitoring. https://thejns.org/doi/10.3171/CASE24421.

Impact Of Preoperative Risk Factors On 5-year Survival After Fenestrated/Branched Endovascular Aortic Repair

To investigate which preoperative factors most impact the 5-year survival of patients undergoing fenestrated/branched endovascular aortic repair (F/BEVAR) and to identify modifiable elements that, if time allows, should be actively managed and adequately controlled preoperatively. Patients treated for aortic aneurysms with complex anatomy using either patient-specific company-manufactured or off-the-shelf F/BEVAR devices were included. The exposure of interest was aneurysm type (group I: type I-III thoracoabdominal aneurysms vs group II: type IV thoracoabdominal aneurysms vs group III: juxtarenal or suprarenal aneurysms), and the primary outcome was 5-year risk of all-cause mortality. Generalized linear models were used to estimate each group's crude 5-year risk of death and the 5-year risk of death across groups. Each preoperative factor was added to the model individually, and a change in estimate was calculated between the new risks and the crude risk. Preoperative factors with a change of estimate of ≥10% were used to create an inverse probability of treatment weights for multivariable analysis. A total of 408F/BEVAR patients were included, of whom 71.6% were male (mean age: 72.0± 7.9years). Eleven of the 22 preoperative factors analyzed had a change in estimate ≥10%. The greatest changes in estimates were observed for history of congestive heart failure (CHF), arrhythmia, overweight, obesity, and chronic obstructive pulmonary disease. Almost 60% of patients with CHF in group I died within 5years. Current smoking or overweight at the time of F/BEVAR increases the 5-year risk of death more significantly than having a history of myocardial infarction. After adjustment, patients in group I had a significantly higher risk of 5-year all-cause mortality than those in group III (log-rank, P value= .0082). The present findings suggest that cardiac arrhythmias, CHF, overweight, obesity, chronic obstructive pulmonary disease, and aneurysm diameter above 7cm are the most relevant preoperative factors that impact the 5-year survival after F/BEVAR. More specifically, CHF and arrhythmias should be used to alter patient selection and identify those individuals more likely to benefit from repair. Moreover, modifiable risk factors such as weight loss and smoking cessation during the surveillance period before the F/BEVAR procedure might improve survival in this population. Considering that, preoperatively, many patients are periodically evaluated by a vascular surgery team until the aneurysm diameter meets criteria for repair, a multidisciplinary approach that could address these modifiable risk factors might be an impactful strategy.

Abstract 391: Real‐World Flow Diverter Experience: Imaging Outcomes and Predictors of Aneurysm Occlusion

Introduction/Purpose Flow diverter devices (FDD) are endoluminal stents that have emerged to provide an excellent treatment option for many patients with giant, complex, fusiform and/or wide neck aneurysms. Multiple studies have shown reasonable occlusion rates with FDDs with low morbidity and mortality, but data is scarce on predictors of aneurysm persistent filling after treatment. Our aim was to identify long‐term imaging outcomes with different FDD. Methods and Materials Single tertiary care center retrospective analysis, including patients with ruptured or unruptured intracranial aneurysms, treated with FDD over 7 years. Results A total of 398 patients were included in the study. Average age was 56 (+/‐14) years, 82% were female. Most patients were current or prior smokers (53%). About 15% had positive family history and 60% had a history of hypertension. Most aneurysms were incidental and asymptomatic (76.1%); only 25 patients (6.3%) presented with a ruptured aneurysm, and 70 patients (17.6%) had unruptured symptomatic aneurysms (headache in 62%). The most common location was the ophthalmic artery (34%), most were saccular in morphology (79%) and measured &lt;10 mm in size (76%). The most common device used was the Pipeline shield FDD (70%) followed by Surpass Evolve FDD (24%). Most patients (87%) had a follow‐up angiogram between 6 months to 1 year after initial FDD embolization procedure. The average time from intervention to follow‐up imaging was 11.2 months, at which point 70% of patients achieved complete occlusion of the treated aneurysm. Patients who had further follow‐up, had a spontaneous occlusion rate of about 22%. Significant predictors for residual filling included a major artery originating from the aneurysm's neck/dome/fundus, larger aneurysm size (&gt;10 mm) without adjunct coiling, or fusiform morphology. Conclusion We confirm previous findings that FDD are a durable treatment for intracranial aneurysms with an excellent occlusion rate. We identified predictors of residual filling after treatment, which can guide treatment decisions for aneurysms with an artery originating from the aneurysm, larger size and fusiform aneurysm type.

Pipeline Embolization device for the treatment of unruptured intracranial saccular aneurysms: a systematic review and meta-analysis of long-term outcomes.

The pipeline embolization device (PED) is commonly used for intracranial aneurysm treatment. While its effectiveness for certain types of aneurysms is well-established, its efficacy for saccular aneurysms remains controversial. We aimed to assess the long-term outcomes of PED treatment for unruptured intracranial saccular aneurysms. Systematic review and meta-analysis were conducted following PRISMA guidelines. Studies with at least one year of follow-up after PED treatment for saccular aneurysms were included. The primary endpoint was angiographic aneurysm occlusion at long-term follow-up (≥ 12 months), and the secondary outcome was long-term complications. We conducted a meta-regression analysis to explore potential sources of heterogeneity across studies. Eleven studies of 797 patients with 963 aneurysms were included. Long-term angiographic occlusion rate was 85% (95% CI, 77-91%; p < 0.01), symptomatic ischemic stroke rate was 1% (95% CI, 0-3%; p < 0.01), rupture rate was 1% (95% CI, 0-2%; p = 0.02), and intracranial hemorrhage (ICH) rate was 0.2% (95% CI, 0-1%; p = 0.11). Meta-regression analysis revealed a non-significant decreasing trend per year for aneurysmal occlusion, ischemic stroke rate, delayed aneurysmal rupture, and ICH. PED demonstrates high long-term occlusion and low complication rates, suggesting it is a safe and effective treatment option for saccular aneurysms. Additionally, newer devices exhibit reduced thrombogenic profiles and safety with decreasing trends in ICH, ischemic stroke, and delayed aneurysmal rupture.

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.

Immunocellular microenvironment of the vascular wall of cerebral aneurysms: What is the role of inflammatory cells in aneurysmal remodeling?

AbstractIntracranial aneurysms (IAs) may afflict up to 5% of the general population, or up to 15 million individuals in the US. The two forms of IAs that can be recognized by their shape are saccular and nonsaccular IAs, with uncommon aneurysm types, fusiform and dissecting aneurysms, comprising 13% of nonsaccular IAs. Conceivably, among the various risk factors for IA development, vessel wall inflammation represents a major cause. Accordingly, IAs may not necessarily be the result of passive widening of vessel wall structures, but may also be the result of inflammation and tissue degeneration. Thus, flow‐induced vascular remodeling during IA pathogenesis may reflect immune cell infiltration and consequent release of proinflammatory cytokine, chemokine, and matrix metalloproteinase that contribute to vessel wall degeneration and weakening. Thus, infiltrating neutrophils, macrophages, T‐lymphocytes and complement factors, and the resulting immune microenvironment may be pertinent in IA pathogenesis.

Three-year outcomes of off-the-shelf Gore thoracoabdominal multibranch endoprosthesis and physician-modified endografts for complex abdominal and thoracoabdominal aortic aneurysms

ObjectiveFenestrated-branched endovascular aortic repair (FB-EVAR) has shown favorable outcomes for repair of complex aneurysms and thoracoabdominal aortic aneurysms. Physician-modified endografting (PMEG) and the Gore thoracoabdominal multibranch endoprosthesis (TAMBE) provide custom and off-the-shelf devices for FB-EVAR, respectively. This study compares the outcomes of TAMBE and PMEG at a single institution. MethodsA retrospective review of patients who underwent TAMBE as part of the multicenter pivotal trial or PMEG as part of a prospective physician-sponsored investigational device exemption at a single institution between 2020 and 2022 were completed. Patient demographics, characteristics, and perioperative and midterm outcomes were compared. ResultsA total of 68 patients were included, with 12 in the TAMBE group and 56 in the PMEG group. Baseline characteristics were comparable between groups. Aneurysm type was most often thoracoabdominal aortic aneurysm in both groups (58% TAMBE and 52% PMEG). TAMBE had a higher rate of upper extremity access (100% vs 63%; P = .013) and longer mean procedure time (247 ± 36 minutes vs 189 ± 49 minutes; P < .001). Other intraoperative metrics were similar between groups. Technical success was 100% in TAMBE and 95% in PMEG (P = .412). There was no 30-day mortality in either group. No major adverse events occurred with TAMBE, whereas in PMEG cases, 2% had respiratory failure, 2% required dialysis, and 4% experienced spinal cord ischemia. Although the overall endoleak rates were similar (50% of TAMBE vs 41% of PMEG; P = .57), type II endoleaks accounted for all of the endoleaks in the TAMBE group, whereas type I or III endoleaks were seen in 11% of PMEG patients. At a median follow-up of 26.7 months for the TAMBE group and 21.2 months for the PMEG group, target vessel instability was seen in 10.4% of TAMBE, and 6.9% of PMEG targeted branches (P = .401). Reintervention was required in 33% of TAMBE patients and 27% of PMEG patients (P = .646). Estimated freedom from reintervention rates at 3 years were similar (56% TAMBE vs 62% PMEG, log-rank P = .910). Freedom from visceral renal target vessel instability at 3 years was 89% for both groups (log-rank P = .459). The Kaplan-Meier 3-year estimated survival was 100% for patients in the TAMBE group and 77% for patients in the PMEG group (log-rank P = .157). ConclusionsAt experienced centers, FB-EVAR can be completed with PMEG or TAMBE with comparable, excellent perioperative and midterm outcomes. Reinterventions are frequently needed for both TAMBE and PMEG.

Flow diversion for the treatment of intracranial bifurcation aneurysms: a systematic review and meta-analysis

BackgroundFlow diversion (FD: flow diversion, flow diverter) is an endovascular treatment for many intracranial aneurysm types; however, limited reports have explored the use of FDs in bifurcation aneurysm management. We...

Experimental Broad-Based Curved Sidewall Aneurysms in Rabbits Mimicking Human Carotid Siphon Aneurysms: Proof of Feasibility and Comparability Using Computational Fluid Dynamics

Broad-based sidewall aneurysms of the carotidartery are primarily treated endovascularly. However,recurrence or rupture after treatment still poses a significant risk. Hence, reliable animal models mimicking this aneurysm type are essential for to evaluate the performanceof new advanced endovascular devices. Experimental aneurysms were created in 12 New Zealand white rabbits (2.5-3.5 kg). The human carotid siphon was mimicked with an end-to-end anastomosis of both common carotid arteries. A venous pouch was sutured on the convexity to mimic a broad-based side wall aneurysm. Patency and configuration were investigated 4 weeks postoperatively by 3-T magnetic resonance angiography. To compare flow conditions of broad-based sidewall aneurysms in rabbits and humans, exemplary computational fluid dynamics simulations were performed using species-specific blood viscosity values. We were able to achieve 0% peri- or postoperative mortality. Patency was confirmed by 3-T magnetic resonance angiography in 11 of 12 aneurysms (91.7%). Aneurysm lengths ranged from 6.4 to 9.8 mm and aneurysm necks from 7.3 to 9.8 mm. Computational fluid dynamics showed simple flow profiles with one vortex in rabbit as well as in human aneurysms. Wall shear stress rates were comparable using species-specific blood viscosity values (rabbit mean 1.65 Pa vs. human mean 1.7 Pa). The broad-based curved sidewall aneurysm model mimicking the carotid siphon showed high aneurysm patency rates with low morbidity. High comparability with human flow patterns and human intranaeurysmal biomechanical forces was shown using simulations.

Prevalence, Features, and Outcomes of Type 1 Neovascularization in Eyes with Angioid Streaks

This study aimed to delineate the characteristics, prevalence, and outcomes of neovascularization (NV), particularly aneurysmal Type 1 NV, in patients with angioid streaks (AS) secondary to pseudoxanthoma elasticum (PXE), and to introduce a clinical classification based on multimodal imaging (MMI). Retrospective longitudinal cohort study. 85 patients (168 eyes) with AS secondary to PXE at two tertiary referral centers. Data collection included demographic, medical, and ocular histories. Diagnostic methods comprised fundus photography, autofluorescence, indocyanine green angiography, optical coherence tomography (OCT), and OCT angiography. Prevalence of Type 1 NV, visual acuity (VA), risk of exudation. Type 1 NV was identified in 127 eyes (76%), with 85 of these (67%) showing exclusively Type 1 NV. These lesions often originated around the disc, at sites of Bruch's membrane dehiscences, and followed the path of AS, extending to the posterior pole in 101 eyes (80%). Despite 65% of Type 1 NV remaining non-exudative, 36% evolved into exudative over five years, and 11 eyes experienced mid-peripheral subretinal hemorrhages. Aneurysmal dilations, observed in 57% of cases, substantially increased exudation risk (hazard ratio = 3.86, p=0.02). Despite treatment, VA significantly deteriorated in exudative Type 1 NV (p=0.02). Type 2 NV, detected in 56 eyes (33%), often coexisted with Type 1 NV and was associated with poorer visual outcomes and higher rates of macular atrophy. A classification of AS was developed, ranging from empty AS (stage 0, no NV) to advanced NV (stage 3, both Type 1 and Type 2 NV). Type 1 NV predominates in AS. Although predominantly non-exudative, its progression correlates with substantial visual impairment, similar to the deficits observed with Type 2 NV. Aneurysmal Type 1 NV poses a significant exudation risk, underscoring the need for vigilant monitoring.

Risk factors of cerebral aneurysms rupture in an Indonesian population

ABSTRACT Background The demographic, clinical, and angiographic features of ruptured aneurysms compared to unruptured cerebral aneurysms in Indonesia are still limited. This study aims to determine risk factors for rupture according to clinical patterns and morphological features in the Indonesian population. Method We retrospectively reviewed all cerebral aneurysm registries at the largest comprehensive stroke center in Indonesia from January 2019 to January 2022. We compared demographic and vascular risk factors as well as angiographic features between patients with ruptured and unruptured aneurysms with univariate and multivariate analyses. Results Of 275 patients, 231 (84%) had ruptured cerebral aneurysms. We found a significant difference between the ruptured and unruptured groups in variables such as age, hypertension, dyslipidemia, smoking, location, and type of aneurysm. It was found that only the anterior circulation site (OR 4.91, 95% CI 1.47–16.48; p < 0.01) and saccular type (OR 5.45, 95% CI 1.42–20.93; p = 0.01) were significantly linked to ruptured aneurysms. Conclusion Our findings revealed that anterior location and saccular type were substantially linked with ruptured aneurysms in the Indonesian population.

Initial Experience of the Covered Endovascular Reconstruction of Iliac Bifurcation Technique.

The distal landing zone in iliac arteries represents an important issue during endovascular repair of abdominal aortic aneurysms (EVAR). The aim of this study is to present a case series for landing in the external iliac artery (EIA) during EVAR while preserving blood flow in the internal iliac artery (IIA) with the covered endovascular reconstruction of the iliac bifurcation (CERIB) technique. This is a single-center, retrospective analysis of prospectively collected data of patients that underwent EVAR either for intact abdominal aortic aneurysm (AAA) or previous failed EVAR from December 2022 up to September 2023. Indications for treatment were presence of common iliac artery aneurysm (CIAA), short CIA, or endoleak type Ib (ETIb). For the distal sealing zone, we used balloon-expandable covered stent (BXCS). Primary outcomes were technical success and first-month patency rate. Secondary outcomes were endoleak and re-intervention rate. Sixteen patients being treated with 20 CERIBs were included in the study. Four patients had a previous failed EVAR, while 3 patients were treated urgently for a symptomatic para-renal aneurysm. The indications for treatment were EIb (n=2), short CIA (n=4), CIAA with narrow lumen (n=3), and CIA aneurysm (n=11). Platforms that were used were the Cook Zenith Alpha (n=5), Gore C3 (n=2 and 3 limbs), Endurant IIs (n=2, and 3 limbs), and a t-branch device (n=3). Technical success rate was 100% with no adjunctive procedure. No death or re-intervention was recorded for all patients at postoperative 30-day period and at 6 months for 2 patients. At first-month CTA, patency rate was 100% (20/20), while in 2 patients that had 6-month CTA, the patency was also 100% (2/2). No kinking or stenosis was also noted. Two patients had ETIII after branched EVAR (BEVAR), 2 patients had ETII, and 1 patient had gutter ET in the area of the CERIB. The CERIB technique seems to be effective and safe in the early period. It is suitable with a variety of commercial endograft platforms. It may be a valuable alternative to iliac branch devices when there are anatomical considerations. Longer follow-up is needed to conclude for long-term patency and durability. The distal landing zone in iliac arteries represents an important issue during EVAR while it is important to preserve blood flow in the internal iliac artery. The covered endovascular reconstruction of the iliac bifurcation (CERIB) technique is a technique for the preservation of internal iliac arteries during EVAR, while it is suitable with a variety of commercial endograft platforms. The CERIB technique seems to be effective and safe in the early period. It may be valuable alternative to iliac branch devices when there are anatomical considerations.

The Clinical and Radiological Outcomes of the Multimodal Use of the Woven EndoBridge Device: A Large Multicenter Study

The Woven EndoBridge (WEB) is a device used for intrasaccular flow diversion, designed for the elimination of wide-necked bifurcation aneurysms from the circulation. In this study, we aim to assess the safety and efficacy of the WEB and its uses in treating aneurysms of different morphologies and locations. In a retrospective analysis, we compiled a comprehensive dataset from patients treated with the WEB device across three major Australian neurovascular centers from May 2017 to September 2023. The case series encompassed a spectrum of aneurysm types, including wide-necked bifurcation, sidewall, and irregularly shaped aneurysms, as well as cases previously managed with alternative therapeutic strategies. This study additionally encompasses cases where aneurysms were managed using the WEB device in combination with supplementary endovascular devices. The study included 169 aneurysms in 161 patients. The rate of satisfactory aneurysm occlusion was 85.6%, with 86.7% of patients maintaining good functional status at their most recent follow-up. The procedure exhibited a low mortality rate of 0.6% and a thromboembolic complication rate of 7.1% (n= 12/161). There were no instances of postoperative re-rupture and the procedure-related hemorrhage rate was low (1.2%, n= 2/169), aligning with the literature regarding the safety and efficacy of the WEB device. Our multicenter trial reinforces the WEB device's role as an effective and safe modality for intracranial aneurysm management, supporting its expanded application beyond wide-necked bifurcation aneurysms. Further prospective studies are required to delineate its evolving role fully.