In spite of the developing endovascular era, large (15-25 mm) and giant (>25 mm) wide-neck cerebral aneurysms remained technically challenging. Intracranial flow-diverting stents (FDS) were developed to address these challenges by targeting aneurysm hemodynamics to promote aneurysm occlusion. In 2011, the first FDS approved for use in the United States market. Shortly thereafter, the Pipeline of Uncoilable or Failed Aneurysms (PUFS) study was published demonstrating high efficacy and a similar complication profile to other intracranial stents. The initial FDA instructions for use (IFU) limited its use to patients 22 years old or older with wide-necked large or giant aneurysms of the internal carotid artery (ICA) from the petrous segment to superior hypophyseal artery/ophthalmic segment. Expanded IFU was tested in the Prospective Study on Embolization of Intracranial Aneurysms with PipelineTM Embolization Device (PREMIER) trial. With further post-approval clinical data, the United States FDA expanded the IFU to include patients with small or medium, wide-necked saccular or fusiform aneurysms from the petrous ICA to the ICA terminus. However, IFU is more restrictive in South Korea than in United States. Several systematic reviews and meta-analyses have sought to evaluate the overall efficacy of FDS for the treatment of cerebral aneurysms and consistently identify FDS as an effective technique for the treatment of aneurysms broadly with complication rates similar to other traditional techniques. A growing body of literature has demonstrated high efficacy of FDS for small aneurysms; distal artery aneurysms; non-saccular aneurysms posterior circulation aneurysms and complication rates similar to traditional techniques. In the short interval since the Pipeline Embolization Device was first introduced, FDS has been firmly entrenched as a powerful tool in the endovascular armamentarium. As new FDS are developed, established FDS are refined, and delivery systems are improved the uses for FDS will only expand further. Researchers continue to work to optimize the mechanical characteristics of the FDS themselves, aiming to optimize deploy ability and efficacy. With expanded use for small to medium aneurysms and posterior circulation aneurysms, FDS technology is firmly entrenched as a powerful tool to treat challenging aneurysms, both primarily and as an adjunct to coil embolization. With the aforementioned advances, the ease of FDS deployment will improve and complication rates will be further minimized. This will only further establish FDS deployment as a key strategy in the treatment of cerebral aneurysms.
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http://dx.doi.org/10.3340/jkns.2020.0034 | DOI Listing |
JAMA Pediatr
January 2025
Department of Cardiology, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts.
Importance: Multisystem inflammatory syndrome in children (MIS-C) is a life-threatening complication of COVID-19 infection. Data on midterm outcomes are limited.
Objective: To characterize the frequency and time course of cardiac dysfunction (left ventricular ejection fraction [LVEF] <55%), coronary artery aneurysms (z score ≥2.
Ann Med
December 2025
Department of Neurointervention, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Background: Intracranial aneurysms (IAs) are a significant clinical concern, with detection rates increasing due to advances in imaging technologies. However, precise mechanisms underlying their pathophysiology remain incompletely understood. Recent evidence suggests a pivotal role of oral microbiota dysbiosis, particularly periodontal pathogens, in systemic inflammation that may contribute to IA development and rupture.
View Article and Find Full Text PDFJ Neuroimaging
January 2025
Department of Neurology, Georgetown University School of Medicine, Washington, District of Columbia, USA.
Background And Purpose: While the pulsatility index (PI) measured by transcranial Doppler (TCD) has broader associations with outcomes in neurocritical care, its use in monitoring delayed cerebral infarction (DCI) in patients with aneurysmal subarachnoid hemorrhage (SAH) is not endorsed by current clinical guidelines. Recognizing that arterial pressure gradient (ΔP) can be estimated using PI, we investigated the potential significance of TCD-estimated ΔP.
Methods: In this observational study of 186 SAH patients, we recorded the mean cerebral blood flow velocity (mCBFV) and PI values from the middle cerebral artery, along with corresponding blood pressures.
Several studies explored the associations of pre-albumin (PA)/albumin (ALB) and ALB-combined indicators (prognostic nutrition index [PNI], albumin-to-globulin ratio [AGR], bilirubin-to-albumin [BAR], and C-reactive protein/albumin ratio [CAR]) with intravenous immunoglobulin (IVIG) resistance and coronary artery lesions (CALs) in Kawasaki disease (KD) patients. However, the results were controversial. A meta-analysis was conducted to reconfirm their associations and predictive performance.
View Article and Find Full Text PDFCureus
December 2024
Infectious Disease, Tan Tock Seng Hospital, Singapore, SGP.
Nontyphoidal is a common cause of gastroenteritis but can also lead to bacteremia and extraintestinal infections, including meningitis (more frequent in children and infants), endovascular infections (e.g., endocarditis and infected aneurysms), urinary tract infections, and bone or bone marrow infections (e.
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