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An indoor positioning system, with ultra-high frequency radio frequency identification based on phase difference (PD), is presented in this paper. Several groups of phases are obtained by setting reader's different transmitting frequency to reduce the phase ambiguity. Two positioning algorithms are proposed with rough PDs, which are pattern matching based on PD correction and machine learning based on without PD correction. The experiments of two methods, in which machine learning gets a better positioning precision of 0.43 m, are also presented and discussed. [ABSTRACT FROM AUTHOR]

Micromagnetic simulation is a numerical method to solve the Landau–Lifshitz–Gilbert (LLG) equation for magnetic dynamics. Most of the mainstream micromagnetic simulation packages, including the object oriented micromagnetic framework and MuMax3, perform simulation in the time domain. Here, utilizing the frequency domain simulation capability of COMSOL Multiphysics, we developed a COMSOL-based micromagnetic simulation module that solves the LLG equation in the frequency domain, which runs much faster and more accurate than time-domain simulations. Frequency-domain simulation is ideal for finding spin wave eigenmodes and the corresponding dispersions. We verify the validity of the module using three examples in the absence of dipolar field, and the inclusion of the dipolar field can be incorporated by combining this module with the alternating current/direct current module within COMSOL. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate clinical and angiographic outcomes of Pipeline embolization device (PED) treatment of large or giant basilar artery (BA) aneurysms and examine associated factors. Methods: Clinical and angiographic data of 29 patients (18 men, 11 women) with large or giant BA aneurysms were retrospectively examined. Mean age was 44.1 ± 21.2 years (range, 30–68). Mean aneurysm size was 22.2 ± 8.3 mm (range, 12.0–40.1). Results: Mean angiographic follow-up was 18.3 ± 3.4 months (range, 4.5–60). The rate of adequate aneurysmal occlusion (O'Kelly–Marotta grade C–D) was 87%. The overall complication rate was 44.8%; most complications (84.6%) occurred in the periprocedural period. Univariable comparison of patients who did and did not develop complications showed significant differences in aneurysm size (p < 0.01), intra-aneurysmal thrombus (p = 0.03), and mean number of PEDs used (p = 0.02). Aneurysm size (odds ratio, 1.4; p = 0.04) was an independent risk factor for periprocedural complications in multivariable analysis. Mean clinical follow-up was 23.5 ± 3.2 months (range, 0.1–65). Nine patients (31%) had a poor clinical outcome (modified Rankin scale score ≥3) at last follow-up, including 7 patients who died. Univariable comparisons between patients with favorable and unfavorable clinical outcomes showed that aneurysm size (p = 0.009) and intra-aneurysmal thrombus (p = 0.04) significantly differed between the groups. Multivariable analysis showed that aneurysm size (odds ratio, 1.1; p = 0.04) was an independent risk factor for poor clinical outcome. Conclusion: PED treatment of large or giant BA aneurysms is effective and can achieve a satisfactory long-term occlusion rate. However, the treatment complications are not negligible. Aneurysm size is the strongest predictor of perioperative complications and poor clinical outcome. [ABSTRACT FROM AUTHOR]

Introduction: Stent-assisted coiling (SAC) plays an important role in endovascular treatment of intracranial aneurysms (IAs). This comparative analysis examines the safety and efficacy of SAC in general and compares clinical and angiographic outcomes between laser-cut stents and braided stents. Methods: Relevant English-language studies were identified via a PubMed search for published articles regarding outcomes of SAC using laser-cut stents and braided stents published from 2015 to 2020. Data from 56 studies that met our inclusion criteria were pooled and statistically compared. Results: A total of 4,373 patients harboring with 4,540 IAs were included. Patients were divided into two groups on the basis of stent type: laser-cut stents (2,076 aneurysms in 1991 patients; mean follow-up, 12.99 months) and braided stents (2,464 aneurysms in 2382 patients; mean follow-up, 18.41 months). Overall, the rates of successful stent deployment, thromboembolic events, stent stenosis, periprocedural intracranial hemorrhage, permanent morbidity, mortality, and recanalization were 97.72, 4.72, 2.87, 1.51, 2.14, 1.16, and 6.06%, respectively. Laser-cut stents were associated with a significantly higher rate of successful deployment (p = 0.003) and significantly lower rate of periprocedural intracranial hemorrhage (p = 0.048). Braided stents were associated with a significantly lower rate of permanent morbidity (p = 0.015). Conclusion: SAC of IAs using laser-cut stents or braided stents was effective and safe. Rates of thromboembolic events, stent stenosis, mortality, and recanalization were comparable between the stent types. Braided stents were associated with lower permanent morbidity while laser-cut stents were associated with more favorable rates of successful deployment and periprocedural intracranial hemorrhage. [ABSTRACT FROM AUTHOR]

Successful embolization of a basilar bifurcation aneurysm associated with a persistent primitive hypoglossal artery (PPHA) using Y-stent-assisted coiling. [ABSTRACT FROM AUTHOR]

Background and purpose: Hemorrhagic complication is a disastrous complication of intracranial dural arteriovenous fistulas (DAVFs) embolization. This study was to analyze the possible risk factors for the hemorrhagic complication caused by endovascular embolization of DAVFs. Methods: From January 2012 to July 2016, a total of 267 patients with intracranial DAVFs received endovascular Onyx embolization at our hospital. The demographic information, clinical presentation, angiographic features, endovascular treatment and hemorrhagic complications were reviewed. Univariate and multivariate logistic regression analyses were performed to evaluate the risk factors contributing to the post-procedural hemorrhagic complications. Results: In 267 patients of DAVF treated with endovascular embolization, procedure-related hemorrhagic complication occurred in 12 (4.5%) patients. Univariate and multivariate logistic regression analyses showed that the pial arterial supplier (OR 13.630; 95% CI, 1.556–119.368; P = 0.018), giant venous aneurysm (OR 15.196; 95% CI, 2.505–92.183; P = 0.003) and Onyx volume ≥ 6 ml (OR 1.138; 95% CI, 1.006–1.288; P = 0.040) were significant factors associated with these hemorrhagic complications. Conclusions: Hemorrhagic complications associated with endovascular DAVF embolization are not negligible. The pial arterial supplier, giant venous aneurysm and higher Onyx volume in one session may be risk factors for endovascular DAVF embolization. [ABSTRACT FROM AUTHOR]

Background: Studies reporting spontaneous delayed migration or shortening (SDMS) after treatment with the Pipeline Embolization Device (PED) are limited. This study aimed to evaluate the incidence of SDMS after PED treatment, propose management strategies, and identify the risk factors contributing to its occurrence., Methods: We retrospectively reviewed consecutive patients with an intracranial aneurysm (IA) treated with PEDs at three institutions. SDMS was classified as type I or II based on whether the PED covered the aneurysm neck., Results: The total cohort comprised 790 patients. SDMS was identified in 24 (3.04%) patients. Eighteen of the 24 patients had type I SDMS and did not require retreatment, while the remaining six patients had type II SDMS and all received retreatment. Multivariate logistic regression showed that the difference between the proximal and distal parent artery diameters (DPAD) (adjusted OR 2.977; 95% CI 1.054 to 8.405; P=0.039) and device tortuosity index (DTI) (adjusted OR 8.059; 95% CI 2.867 to 23.428; P<0.001) were independent predictors of SDMS after PED treatment, while the difference in length (DL) (adjusted OR 0.841; 95% CI 0.738 to 0.958; P=0.009) and PED plus coiling (adjusted OR 0.288; 95% CI 0.106 to 0.785; P=0.015) were protective factors., Conclusion: The incidence of SDMS after PED treatment of IA was 3.04%. For patients with type I SDMS with incomplete aneurysm occlusion we recommend continuous imaging follow-up while, for patients with type II SDMS, we recommend aggressive retreatment. The DPAD and DTI were independent risk predictors of SDMS after PED treatment, while the DL and PED plus coiling were protective factors., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Detecting and segmenting intracranial aneurysms (IAs) from angiographic images is a laborious task., Objective: To evaluates a novel deep-learning algorithm, named vessel attention (VA)-Unet, for the efficient detection and segmentation of IAs., Methods: This retrospective study was conducted using head CT angiography (CTA) examinations depicting IAs from two hospitals in China between 2010 and 2021. Training included cases with subarachnoid hemorrhage (SAH) and arterial stenosis, common accompanying vascular abnormalities. Testing was performed in cohorts with reference-standard digital subtraction angiography (cohort 1), with SAH (cohort 2), acquired outside the time interval of training data (cohort 3), and an external dataset (cohort 4). The algorithm's performance was evaluated using sensitivity, recall, false positives per case (FPs/case), and Dice coefficient, with manual segmentation as the reference standard., Results: The study included 3190 CTA scans with 4124 IAs. Sensitivity, recall, and FPs/case for detection of IAs were, respectively, 98.58%, 96.17%, and 2.08 in cohort 1; 95.00%, 88.8%, and 3.62 in cohort 2; 96.00%, 93.77%, and 2.60 in cohort 3; and, 96.17%, 94.05%, and 3.60 in external cohort 4. The segmentation accuracy, as measured by the Dice coefficient, was 0.78, 0.71, 0.71, and 0.66 for cohorts 1-4, respectively. VA-Unet detection recall and FPs/case and segmentation accuracy were affected by several clinical factors, including aneurysm size, bifurcation aneurysms, and the presence of arterial stenosis and SAH., Conclusions: VA-Unet accurately detected and segmented IAs in head CTA comparably to expert interpretation. The proposed algorithm has significant potential to assist radiologists in efficiently detecting and segmenting IAs from CTA images., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Objective: Our study aimed to explore the influence of gut microbiota and their metabolites on intracranial aneurysms (IA) progression and pinpoint-related metabolic biomarkers derived from the gut microbiome., Design: We recruited 358 patients with unruptured IA (UIA) and 161 with ruptured IA (RIA) from two distinct geographical regions for conducting an integrated analysis of plasma metabolomics and faecal metagenomics. Machine learning algorithms were employed to develop a classifier model, subsequently validated in an independent cohort. Mouse models of IA were established to verify the potential role of the specific metabolite identified., Results: Distinct shifts in taxonomic and functional profiles of gut microbiota and their related metabolites were observed in different IA stages. Notably, tryptophan metabolites, particularly indoxyl sulfate (IS), were significantly higher in plasma of RIA. Meanwhile, upregulated tryptophanase expression and indole-producing microbiota were observed in gut microbiome of RIA. A model harnessing gut-microbiome-derived tryptophan metabolites demonstrated remarkable efficacy in distinguishing RIA from UIA patients in the validation cohort (AUC=0.97). Gut microbiota depletion by antibiotics decreased plasma IS concentration, reduced IA formation and rupture in mice, and downregulated matrix metalloproteinase-9 expression in aneurysmal walls with elastin degradation reduction. Supplement of IS reversed the effect of gut microbiota depletion., Conclusion: Our investigation highlights the potential of gut-microbiome-derived tryptophan metabolites as biomarkers for distinguishing RIA from UIA patients. The findings suggest a novel pathogenic role for gut-microbiome-derived IS in elastin degradation in the IA wall leading to the rupture of IA., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: The aim of this study was to assess the causal relationships between blood metabolites and intracranial aneurysm, aneurysmal subarachnoid hemorrhage, and unruptured intracranial aneurysm., Methods: Our exposure sample consisted of 7,824 individuals from a genome-wide association study of human blood metabolites. Our outcome sample consisted of 79,429 individuals (7,495 cases and 71,934 controls) from the International Stroke Genetics Consortium, which conducted a genome-wide association study of intracranial aneurysm, aneurysmal subarachnoid hemorrhage, and unruptured intracranial aneurysm. We identified blood metabolites with a potential causal effect on intracranial aneurysms and conducted sensitivity analyses to validate our findings., Results: After rigorous screening and Mendelian randomization tests, we found four, two, and three serum metabolites causally associated with intracranial aneurysm, aneurysmal subarachnoid hemorrhage, and unruptured intracranial aneurysm, respectively (all P < 0.05). Sensitivity analyses confirmed the robustness of these associations., Conclusions: Our Mendelian randomization analysis demonstrated causal relationships between human blood metabolites and intracranial aneurysm, aneurysmal subarachnoid hemorrhage, and unruptured intracranial aneurysm. Further research is required to explore the potential of targeting these metabolites in the management of intracranial aneurysm., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Jiang, Gui, Wei, Chen, Tang, Lv, You, Chen, Yang, Ge and Li.)

Background: Flow diverters have revolutionized the treatment of intracranial aneurysms. However, the delayed complications associated with flow diverter use are unknown., Objective: To evaluate the incidence, severity, clinical outcomes, risk factors, and dynamic changes associated with in-stent stenosis (ISS) after treatment with a Pipeline embolization device (PED)., Methods: Patients who underwent PED treatment between 2015 and 2020 were enrolled. The angiographic, clinical, and follow-up data of 459 patients were independently reviewed by four neuroradiologists to identify ISS. Binary logistic regression was conducted to determine ISS risk factors, and an ISS-time curve was established to demonstrate dynamic changes in ISS after PED implantation., Results: Of the 459 treated patients, 69 (15.0%) developed ISS. At follow-up, nine patients (2.0%) with ISS demonstrated reversal, while 18 (3.9%) developed parental artery occlusion. A total of 380 patients (82.8%) achieved complete aneurysm occlusion (O'Kelly-Marotta grade D). Patients with posterior-circulation aneurysm (OR=2.895, 95% CI (1.732 to 4.838; P<0.001) or balloon angioplasty (OR=1.992, 95% CI 1.162 to 3.414; P=0.037) were more likely to develop ISS. Patients aged >54 years (OR=0.464, 95% CI 0.274 to 0.785; P=0.006) or with a body mass index of >28 kg/m 2 (OR=0.427, 95% CI 0.184 to 0.991; P=0.026) had a lower ISS risk. Intimal hyperplasia initiated by PED placement peaked within 1 year after the procedure, rarely progressed after 12 months, and tended to reverse within 24 months., Conclusions: ISS is a common, benign, and self-limiting complication of PED implantation in the Chinese population., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)

Background and Purpose: Data on in-stent stenosis (ISS) following the flow diverter (FD) implantation method are scarce and inconsistent. In the present study, we sought to determine the incidence of ISS and identify the factors that predict its severity via the use of ordinal logistic regression., Methods: A retrospective review of our center's electronic database was conducted to identify all patients with intracranial aneurysms (IAs) who received pipeline embolization device (PED) implantation between 2016 and 2020. Patient demographics, aneurysm characteristics, procedural information, and clinical and angiographic outcomes were reviewed. ISS was quantitatively assessed on angiographic follow-ups and graded as mild (<25%), moderate (25-50%), or severe (>50%). Ordinal logistic regression was conducted to determine the predictors of stenosis severity., Results: A total of 240 patients with 252 aneurysms treated in 252 procedures were enrolled in this study. ISS has been detected in 135 (53.6%) lesions, with a mean follow-up time of 6.53 ± 3.26 months. The ISS was mild in 66 (48.9%) cases, moderate in 52 (38.5%) cases, and severe in 17 (12.6%) cases. All patients were asymptomatic, except for two of them with severe stenosis who presented with symptoms of acute cerebral thrombosis. Ordinal logistic regression identified that younger age and a longer procedure duration were independent predictors of a higher likelihood of ISS., Conclusion: ISS is a common angiographic finding after PED implantation for IAs and is presented as a largely benign course through long-term follow-up. Patients who were younger in age and had a longer procedure duration were found to be at a greater risk of developing ISS., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 You, Lv, Li, Chen, Deng, Tang, Li, Sun and Jiang.)

Background and Objectives: Regarding the anti-inflammatory effect, methylprednisolone is a candidate to prevent patients with unruptured intracranial aneurysms (UIAs) from postoperative bleeding (PB) after flow diverter (FD) treatment. This study aimed to investigate whether methylprednisolone is related to a lower incidence of PB after FD treatment for UIAs., Methods: This study retrospectively reviewed UIA patients receiving FD treatment between October 2015 and July 2021. All patients were observed until 72  h after FD treatment. The patients receiving methylprednisolone (80  mg, bid, for at least 24 h) were considered as standard methylprednisolone treatment (SMT) users, otherwise as non-SMT users. The primary endpoint indicated the occurrence of PB, including subarachnoid hemorrhage, intracerebral hemorrhage, and ventricular bleeding, within 72 h after FD treatment. This study compared the incidence of PB between SMT users and non-SMT users and investigated the protective effect of SMT on PB after FD treatment using the Cox regression model. Finally, after controlling the potential factors related to PB, we performed subgroup analysis to further confirm the protective effect of SMT on PB., Results: This study finally included 262 UIA patients receiving FD treatment. PB occurred in 11 patients (4.2%), and 116 patients (44.3%) received SMT postoperatively. The median time from the end of surgery to PB was 12.3 h (range: 0.5-48.0 h). SMT users had a lower incidence of PB comparing with non-SMT users (1/116, 0.9% vs. 10/146, 6.8%, respectively; p  = 0.017). The multivariate Cox analysis demonstrated that SMT users (HR, 0.12 [95%CI, 0.02-0.94], p  = 0.044) had a lower risk of PB postoperatively. After controlling the potential factors related to PB (i.e., gender, irregular shape, surgical methods [FD and FD + coil] and UIA sizes), the patients receiving SMT still had a lower cumulative incidence of PB, comparing with patients receiving non-SMT (all p  < 0.05)., Conclusion: SMT was correlated with the lower incidence of PB for patients receiving FD treatment and may be a potential method to prevent PB after the FD treatment., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Dong, Liu, Chen, Zhang, Wang, Peng, Li, He, Liu and Lv.)

Objective: Although alcohol flushing syndrome (AFS) has been associated with various diseases, its association with intracranial aneurysm rupture (IAR) is unclear. We aimed to examine this association in the Chinese Han population., Methods: We retrospectively reviewed Chinese Han patients with intracranial aneurysms who were evaluated and treated at our institution between January 2020 and December 2021. AFS was determined using a semi-structured telephone interview. Clinical data and aneurysm characteristics were assessed. Univariate and multivariate logistic regression were conducted to determine independent factors associated with aneurysmal rupture., Results: A total of 1,170 patients with 1,059 unruptured and 236 ruptured aneurysms were included. The incidence of aneurysm rupture was significantly higher in patients without AFS ( p  < 0.001). Meanwhile, there was a significantly difference between the AFS and non-AFS group in habitual alcohol consumption (10.5 vs. 27.2%, p  < 0.001). In the univariate analyses, AFS [odds ratio (OR) 0.49; 95% confidence interval (CI), 0.34-0.72] was significantly associated with IAR. In the multivariate analysis, AFS was an independent predictor of IAR (OR 0.50; 95%, CI, 0.35-0.71). Multivariate analysis revealed that AFS was an independent predictor of IAR in both habitual (OR 0.11; 95% CI, 0.03-0.45) and non-habitual drinkers (OR 0.69; 95% CI, 0.49-0.96)., Conclusion: Alcohol flushing syndrome may be a novel clinical marker to assess the risk of IAR. The association between AFS and IAR exists independently of alcohol consumption. Further single nucleotide polymorphism testing and molecular biology studies are warranted., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer BJ declared a shared affiliation with the author(s) to the handling editor at the time of review., (Copyright © 2023 Chen, Gui, Deng, Dong, Zhang, Wei, Jiang, Ge, Liu, Lv and Li.)

Objective: To investigate the safety and efficacy of Neuroform Atlas stent-assisted coiling for the treatment of tiny wide-necked intracranial aneurysms and evaluate risk factors associated with procedure-related complications., Methods: We retrospectively examined 46 patients with 46 tiny wide-necked aneurysms who were treated using Atlas stent-assisted coiling at our institution from August 2020 to May 2022. Patient and aneurysm characteristics, procedural details, procedure-related complications, and angiographic and clinical outcomes were analyzed., Results: A total of 10 patients presented with aneurysmal rupture. Atlas stent placement was successful in all patients. Angiography immediately after the procedure showed complete occlusion in 38 patients (82.6%), neck remnant in 7 (15.2%), and partial occlusion in 1 (2.2%). The mean angiographic follow-up was 8.4 months (range, 6-16). At the last follow-up, angiography showed complete occlusion in 41 patients (89.1%) and neck remnant in 5 (10.9%). No aneurysm recurrence or in-stent stenosis occurred. Incidence of procedure-related complications was 10.8% (intraprocedural aneurysm rupture, two cases; acute thrombosis, two cases; and coil migration, one case); only one patient (2.2%) experienced procedural neurological morbidity. The mean clinical follow-up was 9.7 months. A favorable outcome was achieved in 45 patients (97.8%). In univariate logistic regression analysis, aneurysm size (odds ratio, 4.538; P = 0.045) was significantly associated with procedure-related complications. However, multivariate analysis found no independent risk factors., Conclusion: Atlas stent-assisted coiling of tiny wide-necked intracranial aneurysms is feasible and effective. Outcomes and occlusion rates are favorable and morbidity is low. The complication rate may be higher in larger tiny aneurysms., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Dong, Chen, Wang, Zhang, Zhao, Peng, Liu and Lv.)

Introduction: Flow diverter (FD) placement is widely accepted as a treatment for large saccular intracranial aneurysms. Delayed aneurysmal rupture (DAR) after FD placement is potentially catastrophic and difficult to treat. To our knowledge, using a Willis covered stent (WCS) to treat DAR after placement of a Pipeline Flex embolization device (PFED) combined with coiling has not been previously reported., Case Presentation: A 49-year-old woman with an incidental asymptomatic large right supraclinoid internal carotid artery aneurysm was treated with PFED placement and adjunctive coiling. DAR causing subarachnoid hemorrhage occurred 11 hours after the procedure. Treatment using a WCS was successful and resulted in a favorable clinical outcome (modified Rankin scale score 2)., Conclusion: DAR after FD implantation requires isolation of the aneurysm from the cerebral circulation as soon as possible. WCS placement can achieve this immediately and occlude the aneurysm. We hope our case could provide new idea for similar cases in the future., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Chen, Gui, Dong, Zhang, Ge, Liu, Li and Lv.)

Objective: To evaluate the safety and efficacy of stent-assisted coiling (SAC) using the Neuroform Atlas stent for aneurysms that recur after coil embolization., Methods: We retrospectively reviewed patients who underwent SAC using the Neuroform Atlas stent to treat aneurysms that recurred after coil embolization from November 2020 to November 2021. Patient and aneurysm characteristics, procedural details, complications, and angiographic and clinical follow-up outcomes were recorded and analyzed., Results: Eleven patients with 11 recurrent aneurysms were included for analysis. Atlas stent deployment was successful in all cases. Angiography immediately after the SAC procedure and at last follow-up showed complete occlusion in 10 patients (90.9%) and a residual neck in one (9.1%). Mean angiographic and clinical follow-ups were 9.2 and 10 months, respectively. A single procedure-related complication occurred, mildly blurred vision in the left eye, which recovered completely. No permanent morbidity or mortality occurred., Conclusion: SAC using the Atlas stent to treat aneurysms that recur after coil embolization is safe and effective. Large-scale studies with long-term follow-up are warranted to confirm our results., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer YW declared a shared parent affiliation with the authors to the handling editor at the time of review., (Copyright © 2022 Dong, Wang, Chen, Zhang, Zhao, Peng, Jin, Wu, Lv and Liu.)

Background: The Pipeline embolization device (PED) is a flow diverter used to treat intracranial aneurysms. In-stent stenosis (ISS) is a common complication of PED placement that can affect long-term outcome. This study aimed to establish a feasible, effective, and reliable model to predict ISS using machine learning methodology., Methods: We retrospectively examined clinical, laboratory, and imaging data obtained from 435 patients with intracranial aneurysms who underwent PED placement in our center. Aneurysm morphological measurements were manually measured on pre- and posttreatment imaging studies by three experienced neurointerventionalists. ISS was defined as stenosis rate >50% within the PED. We compared the performance of five machine learning algorithms (elastic net (ENT), support vector machine, Xgboost, Gaussian Naïve Bayes, and random forest) in predicting ISS. Shapley additive explanation was applied to provide an explanation for the predictions., Results: A total of 69 ISS cases (15.2%) were identified. Six predictors of ISS (age, obesity, balloon angioplasty, internal carotid artery location, neck ratio, and coefficient of variation of red cell volume distribution width) were identified. The ENT model had the best predictive performance with a mean area under the receiver operating characteristic curve of 0.709 (95% confidence interval [CI], 0.697-0.721), mean sensitivity of 77.9% (95% CI, 75.1-80.6%), and mean specificity of 63.4% (95% CI, 60.8-65.9%) in Monte Carlo cross-validation. Shapley additive explanation analysis showed that internal carotid artery location was the most important predictor of ISS., Conclusion: Our machine learning model can predict ISS after PED placement for treatment of intracranial aneurysms and has the potential to improve patient outcomes., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Wei, Deng, Gui, You, Feng, Meng, Chen, Lv, Tang, Chen and Liu.)

Introduction: Transvenous embolization (TVE) has been proven to be safe and feasible as an alternative management of brain arteriovenous malformations (AVMs). We presented four patients with a hemorrhagic brain AVM who underwent TVE and reviewed the relevant literature., Methods: Four patients underwent TVE of a hemorrhagic brain AVM in our center between July 2019 and July 2020. We retrospectively collected and analyzed the clinical and imaging data of these patients and those reported in previously published studies., Results: Four patients with a hemorrhagic brain AVM were included. Nidus sizes ranged from 0.79 to 2.56 cm. Spetzler-Martin grade ranged from grade II to grade III. The AVM nidus was located in a deep brain region in three patients. One patient underwent TVE alone and three underwent combined transarterial and transvenous approaches. Digital subtraction angiography (DSA) demonstrated complete obliteration of the vascular malformation after embolization in all four patients. Three patients were independent [modified Rankin Scale (mRS) score ≤ 2] at discharge. All four patients were independent at the last follow-up. AVM obliteration was confirmed in all four patients at the last angiographic follow-up., Conclusion: Transvenous embolization can be used as an alternative treatment for contemporary management of brain AVMs, appropriate patient selection is essential to achieve a good clinical outcome., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Chen, Zhang, Zhu, Wang, Fan, Ni, Dong, Lv and Liu.)

Background and Purpose: Unruptured intracranial aneurysms (UIAs) are increasingly being detected in clinical practice. Artificial intelligence (AI) has been increasingly used to assist diagnostic techniques and shows encouraging prospects. In this study, we reported the protocol and preliminary results of the establishment of an intracranial aneurysm database for AI application based on computed tomography angiography (CTA) images., Methods: Through a review of picture archiving and communication systems, we collected CTA images of patients with aneurysms between January 2010 and March 2021. The radiologists performed manual segmentation of all diagnosed aneurysms on subtraction CTA as the basis for automatic aneurysm segmentation. Then, AI will be applied to two stages of aneurysm treatment, namely, automatic aneurysm detection and segmentation model based on the CTA image and the aneurysm risk prediction model., Results: Three medical centers have been included in this study so far. A total of 3,190 cases of CTA examinations with 4,124 aneurysms were included in the database. All identified aneurysms from CTA images that enrolled in this study were manually segmented on subtraction CTA by six readers. We developed a structure of 3D-Unet for aneurysm detection and segmentation in CTA images. The algorithm was developed and tested using a total of 2,272 head CTAs with 2,938 intracranial aneurysms. The recall and false positives per case (FP/case) of this model for detecting aneurysms were 0.964 and 2.01, and the Dice values for aneurysm segmentation were 0.783., Conclusion: This study introduces the protocol and preliminary results of the establishment of the intracranial aneurysm database for AI applications based on CTA images. The establishment of a multicenter database based on CTA images of intracranial aneurysms is the basis for the application of AI in the diagnosis and treatment of aneurysms. In addition to segmentation, AI should have great potential for aneurysm treatment and management in the future., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 You, Sun, Feng, Wang, Li, Chen, Lv, Tang, Deng, Wei, Gui, Liu, Liu, Jin, Ge and Zhang.)