FRED flow diversion with LVIS protection of large posterior communicating artery aneurysm: the "FRELVIS" technique.

Treatment of wide-necked posterior communicating artery (PCoA) aneurysms is extremely challenging, especially in fetal posterior cerebral artery (PCA) configurations. This technical video demonstrates the nuances of an innovative use of flow diversion to treat a recurrent wide-necked PCoA aneurysm. This middle-aged patient presented with recurrence of a previously ruptured, coil-embolized PCoA aneurysm.

Use of drug-eluting, balloon-expandable resolute onyx coronary stent as a novel treatment strategy for vertebral artery ostial stenosis: Case series.

Introduction: Vertebral artery (VA) ostial stenosis is notoriously difficult to treat using bare-metal stents owing to high rates of restenosis and stent kinking and breakage. We investigated the safety and effectiveness of treatment with a drug-eluting, balloon-expandable coronary stent (Resolute Onyx, Medtronic).

Methods: Our prospectively maintained database was retrospectively searched for consecutive patients diagnosed with VA ostial stenosis who underwent Resolute Onyx stenting with/without angioplasty between January 1, 2015 and January 1, 2022.

Left Ophthalmic Segment Internal Carotid Artery Aneurysm Treated with Flow Diversion in a Child with Apert Syndrome: Technical Note.

Introduction: Prevalence of intracranial aneurysms in children with Apert syndrome has not been described, and development of an aneurysm as a complication secondary to craniofacial surgery has never been reported.

Case Presentation: We report the rare case of a 10-year-old boy with Apert syndrome who underwent craniofacial reconstruction surgery consisting of subcranial Le Fort III osteotomies, bilateral lateral canthopexies, and nasal nares dilations for midfacial hypoplasia and resultant obstructive sleep apnea, and on routine follow-up magnetic resonance imaging (MRI) 1 year later, he was found to have a large left ophthalmic internal carotid artery (ICA) aneurysm that was not seen on MRI obtained 2 years prior. Immediately after the craniofacial surgery, the patient experienced a severe headache behind his left eye and extraocular movement abnormalities that subsided over the next days to months.

Carotid Artery Stenting Using the Walrus Balloon Guide Catheter With Flow Reversal for Proximal Embolic Protection: Technical Description and Single-Center Case Series.

Background: The use of modern transfemoral balloon guide catheters (BGC) for flow reversal during carotid artery stenting is scarcely described in the literature but represents a promising and efficient technique for embolic protection.

Objective: To describe a flow-reversal technique using the Walrus BGC (Q'Apel Medical Inc.) and report our center's experience.

Statins versus Nonstatin Use in Patients with Chronic Subdural Hematomas Treated with Middle Meningeal Artery Embolization Alone - A Single-Center Experience.

Background: Statins have been reported to reduce the rates of recurrence and improve the resolution of chronic subdural hematomas (cSDHs) treated surgically or conservatively. No studies have investigated the effect of statins in patients treated with middle meningeal artery embolization.

Methods: We performed a retrospective search of our cSDH database to identify patients treated with middle meningeal artery embolization alone.

Triple therapy versus dual-antiplatelet therapy for dolichoectatic vertebrobasilar fusiform aneurysms treated with flow diverters.

Background: Dolichoectatic vertebrobasilar fusiform aneurysms (DVBFAs) have poor natural history when left untreated and high morbimortality when treated with microsurgery. Flow diversion (FD) with dual-antiplatelet therapy (DAPT) is feasible but carries high risk of perforator occlusion and progression of brainstem compression. Elaborate antithrombotic strategies are needed to preserve perforator patency while vessel remodeling occurs.

Meta-analysis of overall survival and postoperative neurologic deficits after resection or biopsy of butterfly glioblastoma.

Butterfly glioblastoma (bGBM) is a grade 4 glioma with a poor prognosis. Surgical treatment of these cancers has been reviewed in the literature with some recent studies supporting resection as a safe and effective treatment instead of biopsy and adjuvant therapy. This meta-analysis was designed to determine whether there are significant differences in overall survival (OS) and postoperative neurologic deficits (motor, speech, and cranial nerve) following intervention in patients who underwent tumor resection as part of their treatment, compared to patients who underwent biopsy without surgical resection.

Volumetric resolution of chronic subdural hematomas treated with surgical evacuation versus middle meningeal artery embolization during immediate, early, and late follow up: propensity-score matched cohorts.

Background: Literature on volumetric resolution and recurrence over time between surgical evacuation alone (SEA) and standalone middle meningeal artery embolization (MMAE) in comparable chronic subdural hematoma (cSDH) patients is limited.

Methods: A retrospective database analysis of cSDH patients managed with either SEA or MMAE was conducted. Propensity-score matching was performed for axial and coronal lengths, maximum diameter, and midline shift.

A Systematic Review of Non-Galenic Pial Arteriovenous Fistulas.

Objective: Non-galenic pial arteriovenous fistulas (NGPAVFs) are rare cerebrovascular pathologies accounting for only 1.6%-4.8% of all brain vascular malformations.

Initial investigation of predicting hematoma expansion for intracerebral hemorrhage using imaging biomarkers and machine learning.

Purpose: Intracerebral Hemorrhage (ICH) is one of the most devastating types of strokes with mortality and morbidity rates ranging from about 51%-65% one year after diagnosis. Early hematoma expansion (HE) is a known cause of worsening neurological status of ICH patients. The goal of this study was to investigate whether non-contrast computed tomography imaging biomarkers (NCCT-IB) acquired at initial presentation can predict ICH growth in the acute stage.

Transarterial and transvenous pial arteriovenous Fistula embolization: A video case report.

Cerebral pial arteriovenous fistulas (pAVFs) are rare and complex high-flow vascular malformations found in pediatric and adolescent populations. They are often divided into two groups based on the pattern of venous drainage, galenic or nongalenic. Nongalenic pAVFs are typically supratentorial and carry a high risk of rupture.

Derivation of vascular wall shear stress from 1000 fps high-speed angiography (HSA) velocity distributions.

Pathological changes in blood flow lead to altered hemodynamic forces, which are responsible for a number of conditions related to the remodeling and regeneration of the vasculature. More specifically, wall shear stress (WSS) has been shown to be a significant hemodynamic parameter with respect to aneurysm growth and rupture, as well as plaque activation leading to increased risk of stroke. In-vivo measurement of shear stress is difficult due to the stringent requirements on spatial resolution near the wall boundaries, as well as the deviation from the commonly assumed parabolic flow behavior at the wall.

Semi-automatic Co-Registration of 3D CFD Vascular Geometry to 1000 FPS High-Speed Angiographic (HSA) Projection Images for Flow Determination Comparisons.

Image co-registration is an important tool that is commonly used to quantitatively or qualitatively compare information from images or data sets that vary in time, origin, etc. This research proposes a method for the semi-automatic co-registration of the 3D vascular geometry of an intracranial aneurysm to novel high-speed angiographic (HSA) 1000 fps projection images. Using the software Tecplot 360, 3D velocimetry data generated from computational fluid dynamics (CFD) for patient-specific vasculature models can be extracted and uploaded into Python.

Minimally Invasive Resection of Intraventricular Pilocytic Astrocytoma Using the Aurora Surgiscope in an Adult Patient: Technical Note.

Background: Pilocytic astrocytomas account for approximately 5%-6% of all gliomas and are most commonly diagnosed between the ages of 8 and 13 years. Although they may occur throughout the neuraxis, approximately two thirds arise from the cerebellum and optic pathway. Other locations of origin include midline structures such as thalamus, hypothalamus, and periventricular regions.

Automation of ischemic myocardial scar detection in cardiac magnetic resonance imaging of the left ventricle using machine learning.

Purpose: Machine learning techniques can be applied to cardiac magnetic resonance imaging (CMR) scans in order to differentiate patients with and without ischemic myocardial scarring (IMS). However, processing the image data in the CMR scans requires manual work that takes a significant amount of time and expertise. We propose to develop and test an AI method to automatically identify IMS in CMR scans to streamline processing and reduce time costs.

Prognosis of ischemia recurrence in patients with moderate intracranial atherosclerotic disease using quantitative MRA measurements.

Purpose: To investigate the relation between delayed ischemic stroke and the intracranial atherosclerotic disease (ICAD) hemodynamics as determined by Non-invasive Optimal Vessel Analysis (NOVA) MRI measurements.

Materials And Methods: Thirty-three patients with ICAD were enrolled in this study. All patients underwent clinically indicated angioplasty followed by 2-dimensional phase contrast MR (2D PCMR) performed on a 3.

Predicting Hematoma Expansion after Spontaneous Intracranial Hemorrhage Through a Radiomics Based Model.

Purpose: Intracranial hemorrhage (ICH) is characterized as bleeding into the brain tissue, intracranial space, and ventricles and is the second most disabling form of stroke. Hematoma expansion (HE) following ICH has been correlated with significant neurological decline and death. For early detection of patients at risk, deep learning prediction models were developed to predict whether hematoma due to ICH will expand.

Initial investigation of the use of angiographic parametric imaging for early prognosis of delayed cerebral ischemia in patients with subarachnoid hemorrhage.

Purpose: Subarachnoid Hemorrhage (SAH) is a lethal hemorrhagic stroke that account for 25% of cerebrovascular deaths. As a result of the initial bleed, a chain of physiological events are initiated which may lead to Delayed Cerebral Ischemia (DCI). As of now we have no diagnostic capability to identify patients which may present DCI a few weeks after initial presentation.

Recovery of complete time density curves from incomplete angiographic data using recurrent neural networks.

Quantitative angiography is a 2D/3D x-ray imaging modality that summarizes hemodynamic information using time density curve (TDC) based parameters. Estimation of the TDC parameters are susceptible to errors due to various factors including, patient motion, incomplete temporal data, imaging trigger errors etc. In this study, we tested the feasibility of using recurrent neural networks (RNN) to recover complete TDC temporal information from incomplete sequences and evaluate quantitative parameters generated from the corrected TDCs.

Leveraging Patient-Specific Simulated Angiograms to Characterize Cerebral Aneurysm Hemodynamics using Computational Fluid Dynamics.

Cerebral aneurysms (CA) affect nearly 6% of the US population and its rupture is one of the major causes of hemorrhagic stroke. Neurointerventionalists performing endovascular therapy (ET) to treat CA rely on qualitative image sequences obtained under fluoroscopy guidance alone, and do not have access to crucial quantitative information regarding blood flow before, during and after treatment - partially contributing to a failure rate of up to 30%. Computational fluid dynamics (CFD) is a powerful tool that can provide a wealth of quantitative data; however, CFD has found limited utility in the clinic due to the challenges in obtaining hemodynamic boundary conditions for each patient.

Quantitative angiography prognosis of intracranial aneurysm treatment failure using parametric imaging and distal vessel analysis.

Purpose: Data-driven methods based on x-ray angiographic parametric imaging (API) have been successfully used to provide prognosis for intracranial aneurysm (IA) treatment outcome. Previous studies have mainly focused on embolization devices where the flow pattern visualization is in the aneurysm dome; however, this is not possible in IAs treated with endovascular coils due to high x-ray attenuation of the devices. To circumvent this challenge, we propose to investigate whether flow changes in the parent artery distal to the coil-embolized IAs could be used to achieve the same accuracy of surgical outcome prognosis.

Initial evaluation of 2D and 3D simulated high-speed 1000 fps vascular contrast-flow image sequences using computational fluid dynamics (CFD).

Digital subtraction angiography (DSA) remains the clinical standard for detailed visualization of the neurovasculature due to its high-spatial resolution; however, detailed blood-flow quantification is impaired by its low-temporal resolution. Advances in photon-counting detector technology have led us to develop High-Speed Angiography (HSA), where x-ray images are acquired at 1000 fps for more accurate visualization and quantification of blood flow. We have implemented a physics-based optical flow method to extract such information from HSA, but validation of the angiography-derived velocity distributions is not straightforward.

2D vessel contrast dilution gradient (CDG) analysis using 1000 fps high speed angiography (HSA) for velocity distribution estimation.

Purpose: Contrast dilution gradient (CDG) analysis is a technique used to extract velocimetric 2D information from digitally subtracted angiographic (DSA) acquisitions. This information may then be used by clinicians to quantitatively assess the effects of endovascular treatment on flow conditions surrounding pathologies of interest. The method assumes negligible diffusion conditions, making 1000 fps high speed angiography (HSA), in which diffusion between 1 ms frames may be neglected, a strong candidate for velocimetric analysis using CDG.

Comparison of quantitative imaging characteristics between a new, larger-FOV 1000 fps high-speed angiographic (HSA) photon-counting detector (Aries) with a smaller HSA detector (Actaeon).

High Speed Angiography (HSA) requires imaging detectors with both high-temporal and high-spatial resolution. Both the Aries and Acteon detectors by Direct Conversion (Stockholm, Sweden) are CdTe direct photon-counting detectors (PCD) that have acquisition frame rates of up to 1000-fps and a 100-micrometer pixel pitch; however, the new Aries detector offers a larger field of view (512 × 768 pixels) compared to the smaller Actaeon detector (256 × 256 pixels). An expanded field of view is required for imaging of larger vasculature, thus the Aries offers this advantage.