Computational fluid dynamics and shape analysis enhance aneurysm rupture risk stratification.

Purpose: Accurately quantifying the rupture risk of unruptured intracranial aneurysms (UIAs) is crucial for guiding treatment decisions and remains an unmet clinical challenge. Computational Flow Dynamics and morphological measurements have been shown to differ between ruptured and unruptured aneurysms. It is not clear if these provide any additional information above routinely available clinical observations or not.

A Systematic Review and Meta-Analysis of the Pathology Underlying Aneurysm Enhancement on Vessel Wall Imaging.

Intracranial aneurysms are common, but only a minority rupture and cause subarachnoid haemorrhage, presenting a dilemma regarding which to treat. Vessel wall imaging (VWI) is a contrast-enhanced magnetic resonance imaging (MRI) technique used to identify unstable aneurysms. The pathological basis of MR enhancement of aneurysms is the subject of debate.

Modification of Woven Endo-Bridge After Intracranial Aneurysm Treatment: A Methodology for Three-Dimensional Analysis of Shape and Relative Position Changes.

During follow-up of patients treated with WEB devices, shape changes have been observed. The quantitative three-dimensional measurement of the WEB shape modification (WSM) would offer useful information to be studied in association with the anatomical results and try to better understand mechanisms implicated in this modification phenomenon. We present a methodology to quantify the morphology and position of the WEB device in relation to the vascular anatomy.

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

Background: The 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 safety and efficacy outcomes.

Comparative Study of Automated Algorithms for Brain Arteriovenous Malformation Nidus Extent Identification Using 3DRA.

Purpose: When performing a brain arteriovenous malformation (bAVMs) intervention, computer-assisted analysis of bAVMs can aid clinicians in planning precise therapeutic alternatives. Therefore, we aim to assess currently available methods for bAVMs nidus extent identification over 3DRA. To this end, we establish a unified framework to contrast them over the same dataset, fully automatising the workflows.

A multiscale computational framework to evaluate flow alterations during mechanical thrombectomy for treatment of ischaemic stroke.

The treatment of ischaemic stroke increasingly relies upon endovascular procedures known as mechanical thrombectomy (MT), which consists in capturing and removing the clot with a catheter-guided stent while at the same time applying external aspiration with the aim of reducing haemodynamic loads during retrieval. However, uniform consensus on procedural parameters such as the use of balloon guide catheters (BGC) to provide proximal flow control, or the position of the aspiration catheter is still lacking. Ultimately the decision is left to the clinician performing the operation, and it is difficult to predict how these treatment options might influence clinical outcome.

CLinical Assessment of WEB device in Ruptured aneurYSms (CLARYS): 12-month angiographic results of a multicenter study.

Background: The CLinical Assessment of WEB device in Ruptured aneurYSms (CLARYS) study has shown that the endovascular treatment of ruptured bifurcation aneurysms with the Woven EndoBridge (WEB) is safe and effective and provides protection against rebleeding at 1 month and 1 year. The 12-month angiographic follow-up is an important endpoint of the study.

Methods: The CLARYS study is a prospective multicenter study conducted in 13 European centers.

Simulation of intra-saccular devices for pre-operative device size selection: Method and validation for sizing and porosity simulation.

Intra-saccular devices (ID) are novel braided devices used for complex intracranial aneurysms treatment. Treatment success is associated with correct device size selection. A technique that predicts the ID size within the aneurysm before intervention will provide a powerful computational tool to aid the interventionist during device selection.

Determining Clinically-Viable Biomarkers for Ischaemic Stroke Through a Mechanistic and Machine Learning Approach.

Assessment of distal cerebral perfusion after ischaemic stroke is currently only possible through expensive and time-consuming imaging procedures which require the injection of a contrast medium. Alternative approaches that could indicate earlier the impact of blood flow occlusion on distal cerebral perfusion are currently lacking. The aim of this study was to identify novel biomarkers suitable for clinical implementation using less invasive diagnostic techniques such as Transcranial Doppler (TCD).

Cerebral Aneurysm Occlusion at 12-Month Follow-Up After Flow-Diverter Treatment: Statistical Modeling for V&V With Real-World Data.

Flow-Diverter (FD) porosity has been pointed as a critical factor in the occlusion of cerebral aneurysms after treatment. Verification and Validation of computational models in terms of predictive capacity, relating FD porosity and occlusion after cerebral aneurysms treatment. Sixty-four aneurysms, with pre-treatment and follow-up images, were considered.

Quantitative analysis of thrombus migration before mechanical thrombectomy: Determinants and relationship with procedural and clinical outcomes.

Background And Purpose: In patients with acute ischemic stroke (AIS) and a large vessel occlusion (LVO), thrombus migration (T-Mig) is a common phenomenon before mechanical thrombectomy (MT), revealed by pre-treatment imaging. Previous works have used qualitative scales to define T-Mig. The aim of this study was to evaluate the determinants and impact of quantitatively assessed T-Mig on procedural characteristics and clinical outcome.

Diversion-p64: results from an international, prospective, multicenter, single-arm post-market study to assess the safety and effectiveness of the p64 flow modulation device.

Background: The use of flow diversion to treat intracranial aneurysms has increased in recent years.

Objective: To assess the safety and angiographic efficacy of the p64 flow modulation device.

Methods: Diversion-p64 is an international, prospective, multicenter, single-arm, study conducted at 26 centers.

CLinical Assessment of WEB device in Ruptured aneurYSms (CLARYS): results of 1-month and 1-year assessment of rebleeding protection and clinical safety in a multicenter study.

Background: The primary goal of the CLARYS study is to assess the protection against rebleeding when treating ruptured bifurcation aneurysms with the Woven EndoBridge (WEB) device.

Methods: The CLARYS study is a prospective, multicenter study conducted in 13 European centers. Patients with ruptured bifurcation aneurysms were consecutively included between February 2016 and September 2017.

Intra-saccular device modeling for treatment planning of intracranial aneurysms: from morphology to hemodynamics.

Motivation: Intra-saccular devices (ID), developed for the treatment of bifurcation aneurysms, offer new alternatives for treating complex terminal and bifurcation aneurysms. In this work, a complete workflow going from medical images to post-treatment CFD analysis is described and used in the assessment of a concrete clinical problem.

Materials And Methods: Two different intra-saccular device sizes were virtually implanted in 3D models of the patient vasculature using the ID-Fit method.

EASY score (Eloquent, Age and baseline SYmptoms score) for outcome prediction in patients with acute ischemic stroke.

Objective: A pragmatic tool for the early and reliable prediction of recovery in patients with acute ischemic stroke is needed. We aimed to test the addition of brain eloquent areas involvement in variables predicting poor outcome, using a simple scoring system.

Methods: Retrospective study of patients with anterior circulation acute ischemic stroke treated with best medical treatment and/or endovascular reperfusion.

Influence of time to endovascular stroke treatment on outcomes in the early versus extended window paradigms.

Background: The effect of time from stroke onset to thrombectomy in the extended time window remains poorly characterized.

Aim: We aimed to analyze the relationship between time to treatment and clinical outcomes in the early versus extended time windows.

Methods: Proximal anterior circulation occlusion patients from a multicentric prospective registry were categorized into early (≤6 h) or extended (>6-24 h) treatment window.

Clinical effectiveness of endovascular stroke treatment in the early and extended time windows.

Background: The clinical efficacy of mechanical thrombectomy has been unequivocally demonstrated in multiple randomized clinical trials. However, these studies were performed in carefully selected centers and utilized strict inclusion criteria.

Aim: We aimed to assess the clinical effectiveness of mechanical thrombectomy in a prospective registry.

Stroke Imaging Selection Modality and Endovascular Therapy Outcomes in the Early and Extended Time Windows.

Background And Purpose: Advanced imaging has been increasingly used for patient selection in endovascular stroke therapy. The impact of imaging selection modality on endovascular stroke therapy clinical outcomes in extended time window remains to be defined. We aimed to study this relationship and compare it to that noted in early-treated patients.

Endovascular therapy in the distal neurovascular territory: results of a large prospective registry.

Background: There is a paucity of data regarding mechanical thrombectomy (MT) in distal arterial occlusions (DAO). We aim to evaluate the safety and efficacy of MT in patients with DAO and compare their outcomes with proximal arterial occlusion (PAO) strokes.

Methods: The Trevo Registry was a prospective open-label MT registry including 2008 patients from 76 sites across 12 countries.

Benefit of endovascular thrombectomy for M2 middle cerebral artery occlusion in the ARISE II study.

Background: The benefit of endovascular thrombectomy for acute ischemic stroke with M2 segment middle cerebral artery occlusion remains controversial, with uncertainty and paucity of data specific to this population.

Objective: To compare outcomes between M1 and M2 occlusions in the Analysis of Revascularization in Ischemic Stroke with EmboTrap (ARISE II) trial.

Methods: We performed a prespecified analysis of the ARISE II trial with the primary outcome of 90-day modified Rankin Scale score of 0-2, which we termed good outcome.

The transvenous retrograde pressure cooker technique for the curative embolization of high-grade brain arteriovenous malformations.

Background: Transvenous embolization of brain arteriovenous malformations (AVMs) can be curative. We aimed to evaluate the cure rate and safety of the transvenous retrograde pressure cooker technique (RPCT) using coils and n-butyl-2-cyanoacrylate as a venous plug.

Methods: All AVM patients treated via transvenous embolization between December 2004 and February 2017 in a single center were extracted from our database.

Stenting as porous media in anatomically accurate geometries. A comparison of models and spatial heterogeneity.

Modelling intracranial aneurysm blood flow after flow diverter treatment has proven to be of great scientific and clinical interest. One of the reasons for not having CFD as an everyday clinical tool yet is the time required to set-up such simulations plus the required computational time. The speed-up of these simulations can have a considerable impact during treatment planning and device selection.

Stroke-mimics in stroke-units. Evaluation after changes imposed by randomized trials.

Background: A larger therapeutic window for stroke treatment requires a significant change in the organization of emergency services, avoiding the increase in number of imaging exams and indirectly the time to treatment.

Objective: To highlight the relation between faster clinical evaluation and stroke over-suspicion and consequently excessive imaging acquisition. To identify predictors of ischemic stroke and stroke mimics (SM), aiming for better patient selection for comprehensive neuroimaging and reperfusion therapies.

Role of distal cerebral vasculature in vessel constriction after aneurysm treatment with flow diverter stents.

Background: Treatment of intracranial aneurysms with flow diverter stent (FDS) procedures can lead to caliber changes of jailed vessels. The reason some branches remain unchanged and others are affected by narrowing remains unknown.

Objective: To investigate the influence of resistance to flow from distal vasculature on stent-induced hemodynamic modifications affecting bifurcating vessels.