Clinical Outcomes of Endovascular Coil Embolization for Ruptured Middle Cerebral Artery Aneurysms.

Objective: Middle cerebral artery (MCA) aneurysms are difficult to treat with coil embolization (CE) due to their location and shape, but the number of CE-treated MCA has gradually increased as treatment techniques have improved. However, the outcomes of CE for ruptured MCA aneurysms are poorly understood. This study aimed to evaluate the outcomes of CE for ruptured MCA aneurysms.

Trends and Progress in Neuroendovascular Treatment in Japan: Japanese Registry of Neuroendovascular Therapy (JR-NET) 4. Main Report.

We reported the main results of the Japanese Registry of Neuroendovascular Therapy (JR-NET) 4, a nationwide surveillance of therapy (NET) in Japan from January 2015 to December 2019. JR-NET 4 registered consecutive patients who underwent NETs by Japan Society of Neuroendovascular Therapy (JSNET) -certified specialists. The primary endpoint was functional independence (mRS score of 0-2) at 30 days post-NET, with secondary endpoints focusing on technical success and major adverse events within 30 days.

Cytotoxic Lesions of the Corpus Callosum Associated with Aneurysmal Subarachnoid Hemorrhage May Influence Shunt-Dependent Chronic Hydrocephalus.

Background: Cytotoxic lesions of the corpus callosum (CLOCCs) are occasionally associated with aneurysmal subarachnoid hemorrhage (aSAH). The effects of aSAH on clinical outcomes in such cases are unclear. The present study aimed to investigate the frequency and characteristics of CLOCCs associated with aSAH to ascertain the predictors of shunt-dependent chronic hydrocephalus (SDCH) after aSAH.

Influence of size ratio on retreatment after coil embolization for unruptured bifurcation aneurysms.

Background: Aneurysm size is considered a risk factor for aneurysm rupture, and even small aneurysms may rupture, especially bifurcation aneurysms (BAs), which are occasionally detected. Therefore, we aimed to investigate the predictors of retreatment after coil embolization for unruptured BAs, with a particular focus on the absolute and relative size of the aneurysm (size ratio [SR]).

Methods: To evaluate the predictors of retreatment, patients were divided into two groups: those with and those without retreatment.

Inflow Angle and Height-Width Ratio are Predictors of Incomplete Occlusion at One and Two Years After Flow Diverter Treatment for Small- and Medium-Sized Internal Carotid Artery Aneurysms.

Objective: We investigated the association between the inflow angle of aneurysms and their occlusion status at 1 and 2 years after flow diverter (FD) treatment.

Methods: We retrospectively analyzed 42 consecutive patients from a single center with 43 untreated, unruptured internal carotid artery (ICA) proximal to communicating segment, saccular aneurysms sized <12 mm.

Results: At 1 year posttreatment, the complete occlusion (CO) rate was 58.

A Novel Braided Stent With Customized Simulation Software for Treatment of Intracranial Aneurysms: Multicenter Prospective Trial Before Unrestricted Clinical Application.

Background And Objectives: Planning/guidance software became important tools for physicians' presurgical optimal decision-making. However, there are no intracranial stent products with specifically associated simulation software. We report the "premarket" clinical trial of a new braided stent with a customized simulation software.

Acute Distal Migration and Shortening of the Flow-Redirection Endoluminal Device: A Case Report.

Objective: The flow diverter (FD) is a promising device. Apart from two main complications, hemorrhagic and ischemic ones, stent migration is reportedly an unusual complication. In particular, distal migration of the FD has rarely been reported.

Impact of size ratio on thromboembolic events based on diffusion-weighted imaging after coil embolization for unruptured basilar apex aneurysm.

Purpose: Coil embolization is one of the main endovascular treatment for basilar apex aneurysms (BAAs), and thromboembolic events are important complications of coil embolization. Even in small aneurysms, there is a risk of rupture, and aggressive treatment should be considered for unruptured BAAs. Using diffusion-weighted imaging (DWI), the study aimed to investigate thromboembolic events after coil embolization for unruptured BAAs by focusing on the absolute aneurysm size and relative aneurysm size (size ratio [SR]).

Japanese Postmarket Surveillance of Percutaneous Transluminal Angioplasty and Wingspan Stenting for Intracranial Atherosclerotic Disease.

Background: The Wingspan stent system was approved as a rescue device for angioplasty of intracranial atherosclerotic disease (ICAD) in 2012. We conducted the government-recommended Japanese Postmarket Surveillance of Percutaneous Transluminal Angioplasty and Wingspan Stenting for Intracranial Atherosclerotic Disease to monitor Wingspan safety and performance.

Methods: In this open-label, single-arm study at 76 centers in Japan, ICAD subjects were treated with the Wingspan stent between 2014 and 2016.

Modification by an aspiration catheter for vessel stretching in thrombectomy using a stent retriever in vitro.

Objectives: Post-thrombectomy subarachnoid hemorrhage, which is caused by vessel stretching when retrieving a stent retriever (SR), is a complication of endovascular mechanical thrombectomy (EVT) using an SR. This in vitro study examined the association between EVT for middle cerebral artery (MCA) occlusion and M2 vessel stretching depending on the positioning of the SR or combined use of SR and aspiration catheter (AC) technique (CBT).

Materials And Methods: A silicone vascular model was used.

The Influence of Aneurysm Size on the Outcomes of Endovascular Management for Aneurysmal Subarachnoid Hemorrhages: A Comparison of the Treatment Results of Patients with Large and Small Aneurysms.

The influence of aneurysm size on the outcomes of endovascular management (EM) for aneurysmal subarachnoid hemorrhages (aSAH) is poorly understood. To evaluate the outcomes of EM for ruptured large cerebral aneurysms, we retrospectively analyzed the medical records of patients with aSAH that were treated with coiling between 2013 and 2020 and compared the differences in outcomes depending on aneurysm size. A total of 469 patients with aSAH were included; 73 patients had aneurysms measuring ≥10 mm in diameter (group L), and 396 had aneurysms measuring <10 mm in diameter (group S).

Possible Contribution of the Aspiration Catheter in Preventing Post-stent Retriever Thrombectomy Subarachnoid Hemorrhage.

Purpose: This study aimed to identify factors related to the incidence of post-thrombectomy subarachnoid hemorrhage (PTSAH).

Methods: This retrospective, observational cohort study enrolled consecutive patients with acute ischemic stroke (AIS) due to the internal carotid artery (IC) top or middle cerebral artery (MCA) M1 or M2 segment occlusion who underwent single-pass stent retriever (SR) treatment between January 2015 and May 2022 at two acute care hospitals.

Results: Of the 54 included patients, 10 were in the PTSAH group (18.

Thromboembolic Events Detected by Diffusion-Weighted Magnetic Resonance Imaging after Flow Diverter Treatment: The Impact of Procedure Time.

Background: Periprocedural thromboembolism is a serious complication of endovascular treatment for intracranial aneurysms. In addition to symptomatic ischemia, asymptomatic postprocedural diffusion-weighted image-positive lesions (DPLs) are considered important. However, few studies have reported significant risk factors associated with DPLs and symptomatic ischemic stroke after flow diverter (FD) treatment.

Double-Balloon-Assisted Coiling for Wide-Necked Posterior Communicating Artery Aneurysms with a Fetal-Type Variant of the Posterior Cerebral Artery: A Case Series.

Endovascular treatment for wide-necked posterior communicating artery (PcomA) aneurysms with a fetal-type variant of the posterior cerebral artery (PCA) is often challenging. Since the complete occlusion rates achieved with the currently available treatment methods are unsatisfactory, we aimed to study the effectiveness of a double-balloon-assisted technique for these aneurysms. From September 2014 to August 2020, 6 consecutive patients with PcomA aneurysms with fetal-type PCAs and no previous treatment were treated with this technique at our institution (3 ruptured cases and 3 unruptured cases).

A case of cribriform plate dural arteriovenous fistulas with a rare complication after endovascular therapy.

Background: Cribriform plate dural arteriovenous fistulas (dAVFs) are rarely encountered. Here, we report a case of cribriform plate dAVF with a rare complication after endovascular therapy.

Case Description: A 60-year-old man presented with severe sudden headache.

Global outflow angle influences silent ischemic events in coil embolization for unruptured distal anterior cerebral artery aneurysms.

Background: Distal anterior cerebral artery (DACA) aneurysms are rare, and endovascular treatment of these aneurysms is challenging. Thromboembolic events, including silent ischemic events, are one of the most important complications of coil embolization for cerebral aneurysms. The treatment outcomes and predictors of silent ischemic events in coil embolization for unruptured DACA aneurysms were investigated, focusing on the morphological characteristics of aneurysms, especially the inflow angle (IA) and global outflow angle (GOA).

Distal migration of the flow-redirection endoluminal device immediately after treatment: A case report and literature review.

Background: A flow diverter (FD) has been a promising endovascular therapeutic modality for challenging intracranial aneurysms. However, stent migration has been an unusual complication. Until recently, among some types of FDs, the migration of the flow-redirection endoluminal device (FRED; MicroVention Inc.

Outflow angle: a risk factor for thromboembolic complications in coil embolisation for treating unruptured middle cerebral artery bifurcation aneurysms.

Background: Thromboembolic complications are a relevant risk in coil embolisation of cerebral aneurysms. This retrospective study aimed to assess the treatment outcomes of unruptured middle cerebral artery (MCA) bifurcation aneurysms and the predictors for thromboembolic complications based on the aneurysm morphological characteristics. We examined the following three features: inflow angle, outflow angle (OA), and bifurcation angle, formed by the aneurysm and neighbouring blood vessels.

Transverse-sigmoid Sinus Dural Arteriovenous Fistula Presenting with False Localizing Signs of Cavernous Sinus Dural Arteriovenous Fistula Due to Obstructed Cerebral Venous Outflow into the Bilateral Superior Ophthalmic Veins: A Case Report.

Cavernous sinus (CS) dural arteriovenous fistula (dAVF) presents ocular symptoms and visual disorders due to retrograde drainage from the CS into the superior ophthalmic vein (SOV). Some papers reported non-CS dAVFs with those symptoms. We present a unique case of transverse-sigmoid sinus (TSS) dAVF with localizing signs of CS dAVFs resulting from congested cerebral venous outflow into the CSs and SOVs in an 86-year-old female patient.

Comparison of Pipeline Embolization and Coil Embolization for the Treatment of Large Unruptured Paraclinoid Aneurysms.

The efficacy of flow diversion (FD) in the treatment of paraclinoid aneurysms has been established. The pipeline embolization device (PED) is one of the most commonly used FD devices. Coil embolization is also useful for treating paraclinoid aneurysms.

Antiplatelet Therapy and Periprocedural Risk Factor Analysis for Pipeline Embolization Device Treatment of Unruptured Internal Carotid Artery Aneurysms: A Retrospective, Multicenter Analysis.

Background: Aneurysm treatment using the Pipeline Embolization Device has been established but appropriate maintenance of dual antiplatelet therapy (APT) is essential. This multicenter retrospective study assessed whether APT was properly adjusted for clopidogrel resistance and identified risk factors associated with periprocedural complications.

Methods: Consecutive cases of use of the Pipeline Embolization Device for internal carotid artery aneurysms (>10 mm) between November 2015 and April 2020 were analyzed.

A Ruptured Spetzler and Martin Grade V Arteriovenous Malformation in a Child Treated With Radiotherapy Followed by Embolization: A Case Report and Literature Review.

Treatment of ruptured high-grade Spetzler-Martin (S&M) arteriovenous malformation (AVM) is challenging and requires a multidisciplinary treatment approach. Here, we report a case of ruptured giant callosal Grade V AVM in a child initially treated with stereotactic radiotherapy followed by endovascular embolization with Onyx; a management approach recently described in a few reports on the "postradiosurgical embolization" method. Complete obliteration was achieved 20 months after stereotactic radiotherapy and embolization.

Target Coil Embolization Using the Combined Transarterial and Transvenous Balloon-assisted Technique for Traumatic Direct Carotid Cavernous Fistula.

Herein, we describe a case of traumatic direct carotid cavernous fistula (DCCF) treated with target coil embolization using the combined transarterial and transvenous balloon-assisted technique. The patient was a 59-year-old woman who had been involved in a vehicular accident. She was admitted to the hospital due to chemosis and exophthalmos.

Targeted Transvenous Embolization of Cavernous Sinus Dural Arteriovenous Fistula With Liquid Materials Using a Dual-Lumen Balloon Microcatheter.

We describe a challenging transvenous embolization technique involving a dual-lumen balloon microcatheter (DLBM) and liquid materials for cavernous sinus dural arteriovenous fistula (CSDAVF). DLBM contributed to identifying the shunt point and preventing liquid material leakage to normal venous drainage without treatment-related complications. In a transvenous embolization using liquid materials for CSDAVF complications such as cranial nerve palsy and embolic agent migration into the internal carotid artery due to numerous anastomoses must be considered.