Pipeline embolization device for aneurysm recurrence after stent-assisted coiling.

Objective: Since the emergence of the Pipeline Embolization Device (PED), its off-label use has significantly improved the treatment effectiveness of complex intracranial aneurysms, including the treatment of recurrent aneurysms. Although PED is effective in this situation, there is still a lack of evidence-based medicine for its role in recurrent aneurysms after stent-assisted coiling. The aim of this study is to evaluate the safety and efficacy of PED treatment for recurrent aneurysms after stent-assisted coiling.

The holistic and local perspectives in teaching spinal arteriovenous malformations.

Background: The spinal arteriovenous malformations (sAVMs) have been challenging entities to diagnose and treat. The small structure, important function, and complex vascular anatomy of the spinal cord increase the difficulty of treating sAVMs.

Objective: The combining holistic and local perspectives in the diagnosis and treatment of sAVMs were provided to teach spinal vascular anatomy and AVMs.

Angioarchitecture and Endovascular Therapy of Infantile Dural Arteriovenous Fistulas.

Infantile dural arteriovenous fistula (IDAVF) is a rare complex dural arteriovenous fistulas. This study is to provide a comprehensive understanding of the angioarchitecture of arteriovenous shunts in IDAVFs and planning endovascular treatment. Five cases of IDAVF and a literature review were analyzed to characterize the shunt patterns of IDAVFs in terms of anatomic relations to the arterial feeder, sinuses, and cortical veins.

Evaluation of an Antithrombotic Surface-Coated Flow Diverter in a Rabbit Model without Dual Antiplatelet Drugs.

Objective: Flow diverters (FDs) carry the risk of thromboembolic complications associated with the device and bleeding complications associated with dual antiplatelet therapy. We hypothesize that an antithrombotic surface-coated FD (ASCFD) would have less acute thrombus formation and better endothelialization on the device surface compared with uncoated FD.

Methods: A ASCFD was developed.

Predicting postinterventional rupture of intracranial aneurysms using arteriography-derived radiomic features after pipeline embolization.

Background And Purpose: Postinterventional rupture of intracranial aneurysms (IAs) remains a severe complication after flow diverter treatment. However, potential hemodynamic mechanisms underlying independent predictors for postinterventional rupture of IAs remain unclear. In this study, we employed arteriography-derived radiomic features to predict this complication.

Transarterial embolization of sinus dural arteriovenous fistula using non-adhesive liquid embolic material.

The objective is to report our experience of transarterial embolization of sinus dural arteriovenous fistula (DAVF) using non-adhesive liquid embolic material. In 3 cases of Borden type II sinus DAVFs, a Copernic balloon was used to protect sagittal sinus in one patient, palliative Onyx embolization was performed to protect transverse sinus in one patient and EVAL/DMSO/ethanol mixture (EVAL, SUCCESS, Shandong, China) was used in the last patient. Two Borden type II DAVFs were changed into type I DAVF and one was cured.

Classification of anterior communicating aneurysms on a basis of endovascular treatments.

Background And Purpose: The anterior communicating artery (Acoma) aneurysms are difficult to understand because of their anatomical variations. This study reported a new classification of Acoma aneurysms on a basis of endovascular treatments.

Methods: This retrospective study enrolled consecutive 94 patients harbored 100 Acoma aneurysms treated with coil embolization.

Transvenous onyx embolization of a direct carotid-cavernous fistula via the prevertebral vein at the level of the atlanto-occipital membrane: Technical note.

The inferior petrosal sinus (IPS) is the most commonly used transvenous approach to obliterate the carotid-cavernous fistula (CCF). We presented a case of direct CCF was successfully embolized through contralateral jugular vein via the prevertebral vein at the level of the atlanto-occipital membrane. Because of the confluence of the caudal end of the IPS and the prevertebral vein at the medial side of the hypoglossal canal, the transvenous route through the ipsilateral jugular vein was failed.

The off-label uses of pipeline embolization device for complex cerebral aneurysms: Mid-term follow-up in a single center.

Objective: To describe the off-label uses of pipeline embolization device for a variety of types of aneurysms including ruptured aneurysms, posterior circulation aneurysms, small aneurysms, distal aneurysms, and recurrent aneurysms.

Methods: Clinical and angiographic data of patients who underwent pipeline embolization device treatment on off-label use at our center were retrospectively reviewed. For categorical variables, Fisher's exact test was used, and a two-sample Wilcoxon rank-sum test was used for patients' age to analyze the correlation with outcomes.

Developmental Venous Anomalies and Arteriovenous Malformations Coordinately Drained by the Internal Cerebral Vein: Clues to Pathogenesis.

An intimate understanding of dynamic angioarchitectural development of vascular malformations involving the intracranium may provide mechanistic insight into the incipient pathogenesis of these lesions. The authors report two patients harboring cerebral developmental venous anomaly (DVA) and three patients harboring sporadically developing cerebral arteriovenous malformations (AVM) in whom the internal cerebral vein (ICV) represented the chief venous egress route. Onyx embolization successfully achieved complete obliteration in all patients harboring cerebral AVMs.

Is there an Influence of Match and Mismatch of Venous Drainage Pattern on AVM Hemorrhagic Presentation?

Objective: To analyze whether there is an influence of match and mismatch of venous drainage patterns on arteriovenous malformation (AVM) hemorrhagic presentation.

Methods: Consecutive 161 patients of AVM between 2014 and 2017 were retrospectively reviewed. Venous drainage was considered deep or superficial.

Proof-of-Principle for AVM Embolization Complications Caused by the Proximal Occlusion Technique Using Onyx: A Theoretical Basis for Ante-Grade Drifting Technique.

To analyze the complications of the standard proximal plug technique in arteriovenous malformations (AVMs) embolization by Onyx and promote ante-grade drifting technique for AVM embolization. Seven publications reporting complications of AVM embolization by Onyx were identified and reviewed. Render descriptive statistics regarding causes of ischemic and hemorrhagic complications within 1 month following treatment were provided.

The use of SNAP and T1-weighted VISTA in cervical artery dissection.

Background And Purpose: Some cervical artery dissection (CAD) can't be easily confirmed by commonly used angiography techniques in clinical practice. We aimed to compare the abilities of the vessel wall magnetic resonance imaging (MRI) techniques including simultaneous noncontrast angiography and intraplaque hemorrhage (SNAP) sequence and T1-weighted volumetric isotropic turbo spin echo acquisition (T1-w VISTA) sequence alone for evaluating CAD.

Materials And Methods: From July 2017 to October 2020, 59 patients underwent MRI examinations including SNAP and T1-w VISTA sequences for cervical artery pathologies.

Endovascular Treatment of Posterior Cerebral Artery Trunk Aneurysm: The Status Quo and Dilemma.

The posterior cerebral artery (PCA) is an important artery that can be divided into four segments (P1-4): segments P1-2 are proximal segments, and segments P3-4 are distal segments. Various aneurysms can occur along the PCA trunk. True saccular aneurysms are rare, and most PCA trunk aneurysms are dissecting.

Endovascular treatment of posterior inferior cerebellar artery trunk aneurysm.

Background: The posterior inferior cerebellar artery (PICA) generally originates from the vertebral artery (VA) and is the most complex cerebellar artery. Aneurysms can occur at any site along the PICA trunk. Although most PICA aneurysms are located at the VA-PICA junction, a small proportion is located at the PICA trunk.

Endovascular Treatment of Small Wide-Neck Bifurcation Aneurysms with Single Solitaire AB Stent Technique.

Background And Purpose: We present our experience in using the single Solitaire AB stent for small wide-neck bifurcation aneurysms (WNBAs).

Materials And Methods: During 18 months, 20 small (the largest width <10 mm) WNBAs were treated with the single Solitaire AB stent-assisted coiling. The patients were 12 women and 8 men, with a mean age of 52 years (range: 36-66 years).

Endovascular treatment of blood blister-like aneurysms of internal carotid artery: Stent-assisted coiling and pipeline flow diversion.

Objective: To report the stent-assisted coil embolization and flow diversion treatments of blood-blister-like aneurysms based on the theory of acute dissection of the internal carotid artery.

Patients And Methods: From July 2016 through July 2020, 27 patients presenting with subarachnoid hemorrhage (SAH) due to rupture of internal carotid artery blood blister-like aneurysms were subjected to endovascular treatment with stent-assisted coiling or Pipeline flow diversion. Clinical outcomes were evaluated using modified Rankin Scale score (mRS).

Flow Diversion for Intracranial Aneurysms Beyond the Circle of Willis.

Few reports have shown the therapeutic outcomes of flow diversion (FD) for intracranial aneurysms beyond the circle of Willis, and the efficacy of this technique remains unclear. A retrospective study was performed on 22 consecutive patients, diagnosed with intracranial aneurysms beyond the circle of Willis, and treated with pipeline embolization device (PED) (Medtronic, Irvine, California, USA) between January 2015 and December 2019. The 22 patients were between 16 and 66 years old (mean 44.

The formation mechanism of acute dissection of blood blister-like aneurysm and its implication of endovascular treatment.

Background: Acute mural dissection of the anterior wall of the internal carotid artery which may contribute to the development of blood blister-like aneurysms (BBLAs) was postulated, and stenting or flow diversion treatment across the soi-disant aneurysm was reported in this study.

Methods: From December 2016 to December 2018, 8 patients presenting with subarachnoid hemorrhage (SAH) due to BBLA were subjected to endovascular treatment with stent-assisted coiling. Clinical outcomes were evaluated using a clinical outcome score scale.

Perforator preservation technologies (PPT) based on a new neuro-interventional classification in endovascular treatment of perforator involving aneurysms (piANs).

Background: Treatment of perforator involving aneurysm (piAN) remains a challenge to open and endovascular neurosurgeons. Our aim is to demonstrate a primary outcome of endovascular therapy for piANs with the use of perforator preservation technologies (PPT) based on a new neuro-interventional classification.

Methods: The piANs were classified into type I: aneurysm really arises from perforating artery, type II: saccular aneurysm involves perforating arteries arising from its neck (IIa) or dome (IIb), and type III: fusiform aneurysm involves perforating artery.

Development of bilateral subdural hematoma after endovascular embolization of a dural sinus malformation.

Introduction: Dural sinus malformation is a rare congenital malformation characterized by a remarkable dilated dural sinus pouch. We described the development of bilateral subdural hematoma after endovascular embolization of a dural sinus malformation in an infant.

Case Description: A 32-day male infant was observed to have a fever and enlarged head circumference.