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Silent magnetic resonance angiography (S-MRA) is primarily utilized to assess the blood flow in aneurysms and parent vessels of treated intracranial aneurysms. This study aimed to compare the diagnostic value of S-MRA and three-dimensional time of flight (3D-TOF) MRA for unruptured intracranial aneurysms. We included patients diagnosed with unruptured intracranial aneurysms using digital subtraction angiography (DSA) who subsequently underwent S-MRA and 3D-TOF MRA. Two independent neuroimaging and neurointerventional doctors evaluated the DSA images and measured aneurysm dimensions. Using DSA results as the gold standard, we determined the sensitivity and specificity of S-MRA and 3D-TOF MRA, as well as their accuracy in measuring aneurysm size and identifying aneurysms with daughter sacs. We detected a total of 41 intracranial aneurysms (in 37 patients) on both S-MRA and 3D-TOF MRA, with both techniques achieving a sensitivity and specificity of 100%. For aneurysm height, the intraclass correlation coefficient (ICC) was 0.977 (P < 0.001) between S-MRA and DSA, and 0.908 (P < 0.001) between 3D-TOF MRA and DSA. For neck width, the ICC was 0.663 (P < 0.001) between S-MRA and DSA, and 0.563 (P < 0.001) between 3D-TOF MRA and DSA. In terms of daughter aneurysm detection, 3D-TOF MRA Sensitivity 40%; specificity 92%: positive predictive value 100%; S-MRA sensitivity 60%; specificity 89%; positive predictive value 42%. In conclusion, S-MRA and 3D-TOF MRA did not significantly differ in aneurysm detection ability. For the detection of aneurysm with dauthger sacs indicators, the sensitivity is also higher. [ABSTRACT FROM AUTHOR]

• The first use of MR method to evaluate the genetic causal association between modifiable lifestyle factors and intracranial aneurysms. • Using large GWAS data, with a large sample size, results are more reliable. • MVMR further validates the causal relationship of the key factors. The aim of this study was to assess the potential causal relationship between lifestyle factors and intracranial aneurysms (IAs) using a two-sample Mendelian randomization (MR) approach. The study used a pooled dataset from a genome-wide association study that covered information on 24 lifestyle factors, intracranial aneurysm cases, subarachnoid hemorrhage, and unruptured aneurysms. Five MR methods were applied for analysis by selecting single nucleotide polymorphisms as instrumental variables, with the inverse variance weighting method as the main method. To ensure the stability of the results, horizontal multiple validity tests, sensitivity analyses, and inverse MR were performed, and genetically determined exposure factors were adjusted by multivariate MR. Several lifestyle factors were found to have a significant genetic causal effect on the occurrence and development of intracranial aneurysms. For example, lamb intake, smoking initiation, number of cigarettes smoked per day, length of television viewing, and fatigue were identified as genetic risk factors and strongly associated with aneurysm rupture, whereas red wine intake showed some genetic protection against intracranial aneurysms and similarly affected aneurysm rupture. Sensitivity analyses and inverse MR verified the robustness of these results. After adjusting for exposure factors, multivariate MR confirmed daily smoking and smoking initiation as risk factors for intracranial aneurysms, unruptured aneurysms, and subarachnoid hemorrhage, whereas red wine intake was a genetically protective factor against intracranial aneurysms and subarachnoid hemorrhage. This MR analysis revealed a genetic causal link between specific lifestyle factors and intracranial aneurysms, emphasizing the need for further studies to confirm these findings and explore their mechanisms. [ABSTRACT FROM AUTHOR]

Objective: To investigate the clinical efficacy and safety of flow diverter device (FDD) in the treatment of tandem aneurysms in the internal carotid artery. Materials and methods: This study was a retrospectively observational study involving two neurointerventional centers. Sixteen Patients with tandem aneurysms in the internal carotid artery treated with FDD and Digital Subtraction Angiography (DSA) follow-up in Huashan Hospital Affiliated with Fudan University and Jing'an District Central Hospital Affiliated with Fudan University from 2020.08 to 2023.12 were included. The outcomes included the angiographic occlusion rate of aneurysms, complications, and the modified Rankin Scale score. The risk factors of complete occlusion of tandem aneurysms were explored by logistic regression analysis. Results: A total of 38 aneurysms were included, including 21 aneurysms of 8 patients in the Pipeline Embolization Device (PED) group and 17 aneurysms of 8 patients in the Tubridge Flow Diverter (TFD) group. A total of 16 FDD stents were implanted, 8 in each PED and TFD group, with a technical success rate of 100%. The median value of maximum aneurysm diameter (Dmax) was 4.27 (3.57–5.41) mm. Among them, 28 aneurysms had a maximum diameter of <5 mm (73.7%), 10 aneurysms had a maximum diameter of 5–15 mm (26.3%). All patients were followed up clinically for a median of 25.5 months (15.5–28.7 months). There were no deaths and symptomatic complications. The modified Rankin Scale scores (mRS) of 16 patients were all less than 2. All patients were examined by angiography with a median of 14 months (6–27 months). Among them, there were 5 Consensus Grading Scale for Endovascular Aneurysm Occlusion (CGSFEAO) grade 5 (13.2%), 1 CGSFEAO grade 4 (2.6%), 1 CGSFEAO grade 2 (2.6%) and 31 CGSFEAO grade 0 (81.6%). The complete occlusion rate of intracranial aneurysm in the whole study was 81.6%, including 85.7% in the PED group and 76.5% in the TFD group, and there was no significant statistical difference between the two groups. Statistically significant variables were not found in univariate logistic regression analysis. Conclusion: FDD is safe and effective in treating tandem aneurysms in the internal carotid artery with a high occlusion rate and few complications. TFD is comparable to PED in the treatment of intracranial tandem aneurysms. [ABSTRACT FROM AUTHOR]

Unruptured intracranial aneurysms, affecting 2–5% of the population, are characterized by localized wall weakening and irregular morphologies, including features such as blebs, lobulations, or asymmetries, which are significant predictors of rupture risk. Although up to 57% of ruptured intracranial aneurysms exhibit irregular dome geometry, its influence on aneurysm stability remains underexplored. Irregular geometries are associated with adverse hemodynamic forces, such as increased wall shear stress (WSS), amplifying wall stress at specific regions, and promoting flow disturbances, which may increase aneurysm vulnerability. This study investigates the influence of aneurysm dome morphology, particularly in IAs with irregular domes that may include daughter blebs, using Computational Fluid Dynamics (CFD). Unlike prior CFD studies that modeled blood as Newtonian or non-Newtonian, this work employs a three-phase blood flow model, representing plasma and red blood cells (RBCs) as distinct phases. Numerical simulations, conducted via the Finite Volume Method, solve the Navier–Stokes equations to capture complex flow dynamics within cerebral vasculature. Key hemodynamic metrics, such as Wall Shear Stress (WSS), Wall Shear Stress Gradient (WSSG), and Viscous Dissipation Rate, are analyzed to assess the interplay between dome morphology and hemodynamic stressors. [ABSTRACT FROM AUTHOR]

Objectives: To quantify the clinical value of integrating a commercially available artificial intelligence (AI) algorithm for intracranial aneurysm detection in a screening setting that utilizes cranial magnetic resonance imaging (cMRI) scans acquired primarily for other clinical purposes. Methods: A total of 907 consecutive cMRI datasets, including time-of-flight-angiography (TOF-MRA), were retrospectively identified from patients unaware of intracranial aneurysms. cMRIs were analyzed by a commercial AI algorithm and reassessed by consultant-level neuroradiologists, who provided confidence scores and workup recommendations for suspicious findings. Patients with newly identified findings (relative to initial cMRI reports) were contacted for on-site consultations, including cMRI follow-up or catheter angiography. The number needed to screen (NNS) was defined as the cMRI quantity that must undergo AI screening to achieve various clinical endpoints. Results: The algorithm demonstrates high sensitivities (100% for findings >4 mm in diameter), a 17.8% MRA alert rate and positive predictive values of 11.5–43.8% (depending on whether inconclusive findings are considered or not). Initial cMRI reports missed 50 out of 59 suspicious findings, including 13 certain intradural aneurysms. The NNS for additionally identifying highly suspicious and therapeutically relevant (unruptured intracranial aneurysm treatment scores balanced or in favor of treatment) findings was 152. The NNS for recommending additional follow-/workup imaging (cMRI or catheter angiography) was 26, suggesting an additional up to 4% increase in imaging procedures resulting from a preceding AI screening. Conclusions: AI-powered routine screening of cMRIs clearly lowers the high risk of incidental aneurysm non-reporting but results in a substantial burden of additional imaging follow-up for minor or inconclusive findings. [ABSTRACT FROM AUTHOR]

Background: Intracranial aneurysms are weak spots in brain vessels that are at a higher risk of rupture and hemorrhage. This review investigates the safety and efficacy of the stent plus balloon technique for intracranial aneurysm management. Methods: PubMed, Scopus, Web of Science, and Embase were systematically searched using the related key terms such as "Stent", "Balloon", "Intracranial", and "Aneurysm" until July 22, 2024. Results: Eleven studies comprising 481 aneurysms were included. The pooled angiographic outcome rate, according to Raymond–Roy occlusion classification (RROC), for RROC1 was 64% (95% CI 50–79%, p-heterogeneity < 0.001, I2 = 87%), while for the RROC2 was 18% (95% CI 14–23%, p-heterogeneity = 0.12, I2 = 1%), and the RROC3 rate was 17% (95% CI 3–30%, p-heterogeneity < 0.001, I2 = 100%). In addition, the intraprocedural complication and adverse event rate were 17% (95% CI 3% to %32, p-heterogeneity < 0.001, I2 = 97%) and 15% (95% CI 0–30%, p-heterogeneity < 0.001, I2 = 100%), respectively. Furthermore, the overall ischemic stroke occurred in % 4 (95% CI 1–8%, p-heterogeneity < 0.001, I2 = 100%), as well as 4% (95% CI 2–10% p-heterogeneity = 0.30, I2 = 30%), respectively. Conclusion: The balloon plus stent technique is an innovative procedure; surgeons should know about and utilize in intracranial aneurysms. Our analysis observed minimal complications and mortality during the surgical procedure, which were identical to the rates observed with alternative techniques. [ABSTRACT FROM AUTHOR]

Background: Early repair of the ruptured cerebral aneurysm (RRCA), preferably within 24 h of onset, is endorsed by clinical guideline as the preferred management strategy for patients with aneurysmal subarachnoid hemorrhage (aSAH). However, a comprehensive picture of this guideline-recommended usage in contemporary clinical practice is not available. Aims: This study aimed to characterize trends over time and practice variation in the implementation of an early RRCA strategy among patients with aSAH in a large, national representative data. Methods: Using data from the 2012–2019 National Inpatient Sample, we measured trends in the proportion of early RRCA, defined as within day 1 of admission, overall, and by demographic and geographical subgroups. In addition, we created multilevel regression models to quantify hospital-level variation in the early RRCA rates. Results: We identified 82,615 aSAH hospitalizations (mean age = 56.1 years; 68.9% women) undergoing RRCA and, among these, 84.0% (95% confidence interval (CI) = 83.4–84.7%) receiving early RRCA. The proportion of early RRCA increased steadily from 82.5% in 2012 to 85.8% in 2019 (p for trend <0.001). The proportion of patients receiving early RRCA across geographic regions ranged from 78.7% to 87.9%, with a median (interquartile range (IQR)) of 84.2% (83.0–86.1%). In contrast, the delivery of early RRCA varied widely among hospitals, with a median (IQR) rate of 86.1% (75.0–100.0%) and a range from 0% to 100.0%. The median odds ratio for the early use of RRCA treatment was 1.24 (95% CI = 1.21–1.27) in 2019, indicating 24% increased odds of implementing early RRCA if moving from a lower-use to a higher-use hospital. Conclusions: Most patients in the United States with aSAH received early RRCA treatment and exhibited an upward trend over the recent 8-year period. However, substantial variation in access to early RRCA was observed across population subgroups, particularly at the hospital level. Future efforts are necessary to identify further sources of this variation and to develop initiatives that could represent an opportunity to optimize guideline-based quality of care in aSAH management. Data access statement: The data are available from the corresponding author upon reasonable request following completion of onboarding and verification procedures as specified by the HCUP. [ABSTRACT FROM AUTHOR]

Introduction: The long-term prognosis of ruptured middle cerebral artery aneurysms (MCAAs) in northern China remains unclear. The aim of this study is to analyze the epidemiological characteristics and long-term outcomes of ruptured MCAAs in northern China. Methods: We included patients who were consecutively admitted for ruptured MCAAs to 12 tertiary care centers in northern China from January 2017 to December 2020. Kaplan‒Meier curves were used to compare survival in hazard strata. The Cox proportional hazards model was used to analyze risk factors and mortality risk, whereas logistic regression was used to identify factors influencing 2-year survival. Subgroup analyses were performed to verify the robustness of the results. Results: Data on 959 patients with ruptured MCAAs were analyzed; 16.4% of these patients had ruptured intracranial aneurysms (RIAs) and were registered in the Chinese cerebral aneurysm database. The mean follow-up duration was 3.0 years (range 0–6.2 years). The 3-month and 2-year mortality rates were 15.5% and 18.2%, respectively. The risk factors for mortality were identified via Cox regression and were as follows: age > 70 years, previous stroke, combined intracerebral hemorrhage (ICH)/intraventricular hemorrhage (IVH), poor Hunt and Hess grade, multiple aneurysms, and conservative treatment (CT). The positive association between the risk of death and CT was consistent across subgroups. According to logistic regression, hypertension, previous stroke, combined ICH/IVH, Hunt and Hess grade, and WFNS (World Federation of Neurological Surgeons) score were identified as factors negatively influencing 2-year survival. Conclusion: We detail the epidemiologic characteristics and long-term outcomes of MCAAs. The risk factors for mortality included age > 70 years, previous stroke, combined ICH/IVH, poor Hunt and Hess grade, and multiple aneurysms. Compared with microsurgical treatment (MST), CT is associated with an increased risk of mortality, while the risk of mortality associated with endovascular treatment (EVT) is not significantly different. Two-year survival was associated with hypertension, previous stroke, ICH/IVH, and poor grades at admission. [ABSTRACT FROM AUTHOR]

The significance of the hemodynamic analysis in the growth process of the micro saccular intracranial aneurysm is undeniable. This study has investigated the change of hemodynamic factors in the evolution process of the saccular aneurysm. The main goal is to estimate the rupture risk of aneurysm in the growth process. The numerical method is applied for the investigation of the hemodynamic factors in the evolution process of the saccular intracranial aneurysms. Wall shear stress, pressure and Oscillatory index are analyzed in this research. Two scale-down models and one scale-up geometry of the saccular aneurysm are studied in this paper. Presented results disclosed that mean wall shear stress increases more than two times when the intracranial aneurysm scale is 1/4 original size. [ABSTRACT FROM AUTHOR]

The relationship between vascular proteins (VPs) and intracranial aneurysms (IAs) has not been fully elucidated. We used Mendelian randomization (MR) analysis to explore the effect of VPs on IAs. Dataset of aneurysmal subarachnoid hemorrhage (aSAH) [5140 cases and 71,934 controls] and unruptured intracranial aneurysm (uIA) [2070 cases and 71,934 controls] were obtained from individuals of European ancestry. Univariate MR was used to explore the associations between 90 VPs and IAs. Then, we performed multivariate MR (MVMR) to further investigate the identified VP-to-IA estimates. Two-sample MR showed that TNFSF14 was inversely associated with aSAH (odds ratio [OR] = 0.831, 95% CI: 0.713–0.969, p = 0.018). IL-16 (OR = 1.218, 95% CI: 1.032–1.438, p = 0.020) and AgRP (OR = 1.394, 95% CI: 1.048–1.855, p = 0.023) were positively associated with aSAH. HBEGF (OR = 0.642, 95% CI: 0.461–0.894, p = 0.009), MCP-1 (OR = 1.537, 95% CI: 1.007–2.344, p = 0.046), and CX3CL1 (OR = 0.762, 95% CI: 0.581–0.999, 0.049 < p < 0.050) were associated with uIA risk. The MVMR showed that the TNFSF14-to-aSAH estimate remained statistically significant after adjustment for past tobacco smoking, alcohol consumption, systolic blood pressure and body mass index. Our study indicated that low serum TNFSF14 levels might be a potential risk factor for IA rupture. Five VPs (HBEGF, MCP-1, IL-6, CX3CL1, and AgRP) are associated with the risk of IAs (both uIA and aSAH). [ABSTRACT FROM AUTHOR]

Background: To define optimal parameters for the evaluation of vessel visibility in intracranial stents (ICS) and flow diverters (FD) using photon-counting detector computed tomography angiography (PCD-CTA) with spectral reconstructions. Methods: We retrospectively analyzed consecutive patients with implanted ICS or FD, who received a PCD-CTA between April 2023 and March 2024. Polyenergetic, virtual monoenergetic, pure lumen, and iodine reconstructions with different keV levels (40, 60, and 80) and reconstruction kernels (body vascular [Bv]48, Bv56, Bv64, Bv72, and Bv76) were evaluated by two radiologists with regions of interests and Likert scales. Reconstructions were compared in descriptive analysis. Results: In total, twelve patients with nine FDs and six ICSs were analyzed. In terms of quantitative image quality, sharper kernels as Bv64 and Bv72 yielded increased image noise and decreased signal-to-noise and contrast-to-noise ratios compared to the smoothest kernel Bv48 (p = 0.001). Among the different keV levels and kernels, readers selected the 40 keV level (p = 0.001) and sharper kernels (in the majority of cases Bv72) as the best to visualize the in-stent vessel lumen. Assessing the different spectral reconstructions virtual monoenergetic and iodine reconstructions proved to be best to evaluate in-stent vessel lumen (p = 0.001). Conclusion: PCD-CTA and spectral reconstructions with sharper reconstruction kernels and a low keV level of 40 seem to be beneficial to achieve optimal image quality for the evaluation of ICS and FD. Iodine and virtual monoenergetic reconstructions were superior to pure lumen and polyenergetic reconstructions to evaluate in-stent vessel lumen. Relevance statement: PCD-CTA offers the opportunity to reduce the need for invasive angiography serving as follow-up examination after intracranial stent (ICS) or flow diverter (FD) implantation. Key Points: Neuroimaging of intracranial vessels with implanted stents and flow diverters is limited by artifacts. Twelve patients with nine flow diverters and six intracranial stents underwent photon-counting detector computed tomography angiography (PCD-CTA). In-stent vessel lumen visibility improved using sharp reconstruction kernels and a low keV level. Virtual monoenergetic and iodine reconstructions were best to evaluate in-stent vessel lumen. [ABSTRACT FROM AUTHOR]

Patients with intracranial aneurysm (IA) are at high risk of cerebral hemorrhage, which is associated with high mortality. Craniotomy or interventional endovascular coiling are common treatment methods in clinical practice, depending on the patient's condition. However, the recurrence rate of IA after either method remains unclear. This meta-analysis was conducted to study the relationship between different treatment regimens and IA recurrence. PubMed, CNKI, Web of Science, Wan Fang, and VIP databases were used to identify studies on "intracranial aneurysm," "craniotomy," "endovascular coiling," and "recurrence rate." Included studies adhered to rigorous screening and diagnostic criteria, and statistical models were applied based on homogeneity testing. This study encompassed 28 articles, including five on craniotomy and 23 on endovascular coiling, published between 2007 and 2022; among 1,448 cases treated with craniotomy, 20 experienced recurrences (recurrence rate: 1.4%, 95% CI: 0.2%), while among 5,975 cases treated with endovascular coiling, 872 cases experienced recurrence (recurrence rate: 14.6%, 95% CI: 14%, 20%). High heterogeneity (87%) was observed in the endovascular coiling, likely due to differences in patient demographics and aneurysm characteristics. For IAs, although endovascular coiling has advantages in terms of lower trauma and faster recovery, its high recurrence rate warrants closer post-treatment monitoring. Despite being more invasive, Craniotomy may be preferable in specific cases, such as when treating aneurysms with complex shapes or challenging locations. Treatment choice should be individualized, and future advancements in endovascular coiling technologies may help reduce recurrence rates. [ABSTRACT FROM AUTHOR]

Introduction: In the past decade, flow diverters (FDs) have increasingly been used to treat cerebral aneurysms with unfavorable morphology in which other endovascular techniques fall short of being as effective. In-stent stenosis (ISS) is one of the most puzzling and frequent risks of flow diversion therapy observed on follow-ups. This complication, although mostly placid in its clinical course, can have dire consequences if patients become symptomatic. ISS is associated with many factors, none of which have been demonstrated to date to be solely responsible for the phenomenon. Methods: This study was aimed at evaluating ISS incidence in patients in our clinic who were treated with flow-diverters for aneurysms, located on the supraclinoid segments of the internal carotid artery between September 2022 and May 2023. A retrospective analysis was conducted, which included 137 patients with a total of 142 aneurysms being treated. The main hypothesis was that oversizing of the implant might play a role in ISS development. The performed statistical analysis, aimed at finding a correlation between it and vessel lumen narrowing on the follow-ups. The effects of other known risk factors, such as sex, age, smoking, and hypertension, were also analyzed. Results: Stent oversizing with respect to the parent artery was positively correlated with subsequent ISS occurrence and severity. Older age was a protective factor against ISS. Patients who actively smoked had diminished risk of developing severe ISS. Discussion: Stent oversizing can lead to ISS development, which might be more pronounced with larger implant-to-vessel sizing discrepancies. To achieve optimal results, the choice of implant diameter should consider all segments of the vessel in which it will be implanted. In cases of severe symptomatic ISS, continuation of dual anti-platelet therapy is a reasonable and effective option to address this complication. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the clinical utility of improved machine learning models in predicting poor prognosis following endovascular intervention for intracranial aneurysms and to develop a corresponding visualization system. Methods: A total of 303 patients with intracranial aneurysms treated with endovascular intervention at four hospitals (FuShun County Zigong City People's Hospital, Nanchong Central Hospital, The Third People's Hospital of Yibin, The Sixth People's Hospital of Yibin) from January 2022 to September 2023 were selected. These patients were divided into a good prognosis group (n = 207) and a poor prognosis group (n = 96). An improved machine learning model was employed to analyze patient clinical data, aiding in the construction of a prediction model for poor prognosis in intracranial aneurysm endovascular intervention. This model simultaneously performed feature selection and weight determination. Logistic multivariate analysis was used to validate the selected features. Additionally, a visualization system was developed to automatically calculate the risk level of poor prognosis. Results: In the training set, the improved machine learning model achieved a maximum F1 score of 0.8633 and an area under the curve (AUC) of 0.9118. In the test set, the maximum F1 score was 0.7500, and the AUC was 0.8684. The model identified 10 key variables: age, hypertension, preoperative aneurysm rupture, Hunt-Hess grading, Fisher score, ASA grading, number of aneurysms, intraoperative use of etomidate, intubation upon leaving the operating room, and surgical time. These variables were consistent with the results of logistic multivariate analysis. Conclusions: The application of improved machine learning models for the analysis of patient clinical data can effectively predict the risk of poor prognosis following endovascular intervention for intracranial aneurysms at an early stage. This approach can assist in formulating intervention plans and ultimately improve patient outcomes. [ABSTRACT FROM AUTHOR]

Currently, limited evidence exists on the impact of serum sodium variability in patients with aneurysmal subarachnoid hemorrhage (SAH) who underwent surgical clipping. We aimed to perform a detailed examination of the relationship between sodium variability and mortality in these patients. We conducted a cohort study including adult patients with aneurysmal SAH who underwent surgical clipping at a university hospital. Propensity score matching (PSM) was used to match patients' baseline characteristics. We evaluated the association between serum sodium standard deviation and mortality. Net reclassification improvement was calculated to assess and compare the reclassification capacity of different models. Trends in serum sodium over time were detected using linear mixed-effects models. Of 563 aneurysmal SAH patients who underwent surgical clipping during the study period, the average age was 56.87 ± 10.81 years. The serum sodium standard deviation was 4.24 [2.65–5.82] mmol/L. Patients with high sodium variability had significantly higher odds of mortality (adjusted odds ratio [aOR]: 1.93, 95% confidence interval [CI]: 1.01 to 3.68; P = 0.045). PSM analysis showed similar results (aOR: 2.23, 95% CI: 1.10 to 4.99; P = 0.045). Additionally, an increase in serum sodium of more than 5 mmol/L was significantly associated with mortality (aOR: 3.46, 95% CI: 1.26 to 9.20; P = 0.016) in a linear dose-response pattern. High serum sodium variability and an increase in serum sodium of more than 5 mmol/L were independent predictive factors of mortality in aneurysmal SAH patients who underwent surgical clipping. Thus, even mild changes in sodium levels warrant close attention. [ABSTRACT FROM AUTHOR]

Background: The treatment landscape for intracranial aneurysms (IAs), particularly those involving the middle cerebral artery (MCA), has evolved significantly over the past two decades. The pivotal International Subarachnoid Aneurysm Trial (ISAT) of 2002 heralded a paradigm shift toward endovascular coiling as the preferred treatment modality for ruptured IAs, prompting a widespread adoption of this approach in neurosurgical centers worldwide. However, despite the initial enthusiasm for coiling, microsurgical clipping remains the cornerstone of treatment for MCA aneurysms in experienced cerebrovascular centers due to its superior efficacy in achieving complete aneurysm occlusion and minimizing long-term recurrence rates. Objective: We aimed to compare the effectiveness and safety of microsurgical clipping versus endovascular coiling for middle cerebral artery (MCA) aneurysms, focusing on rates of occlusion, procedural complications, and long-term neurological outcomes. Methods: We prospectively analyzed 40 patients with ruptured and unruptured MCA aneurysms presented at Ain Shams University Hospital neurosurgical department from January 2021 to December 2023 and they underwent microsurgical clipping or endovascular coiling. Results: In patients treated with microsurgical clipping for MCA aneurysms, commonly associated with hypertension, smoking, and drug abuse, favorable clinical grades were observed, with most aneurysms located at bifurcations. Intra-operative complications, primarily premature rupture, led to a 12.45-day hospital stay, with post-operative issues including vasospasm-related strokes and infections. Six-month follow-up showed a 65% favorable outcome. Conversely, in 20 patients treated with endovascular coiling, typically for ruptured aneurysms, hypertension, and smoking were prevalent risk factors, with fewer complications during hospitalization (average 4.2 days). At 6-month and 1-year follow-ups, complete occlusion rates were 85% and 80%, respectively, with some cases requiring further intervention due to incomplete occlusion. Conclusion: While endovascular coiling has revolutionized the management of intracranial aneurysms, surgical clipping remains a vital treatment option, offering superior outcomes in select cases, particularly those involving MCA aneurysms. A balanced approach, tailored to individual patient characteristics and institutional expertise, is essential to optimize treatment outcomes and minimize the risk of recurrence and re-rupture in this challenging patient population. [ABSTRACT FROM AUTHOR]

Background: Wall shear stress (WSS) plays a crucial role in the natural history of intracranial aneurysms (IA). However, spatial variations among WSS have rarely been utilized to correlate with IAs' natural history. This study aims to establish the feasibility of using spatial patterns of WSS data to predict IAs' rupture status (i.e., ruptured versus unruptured). Methods: "Patient-specific" computational fluid dynamics (CFD) simulations were performed for 112 IAs; each IA's rupture status was known from medical records. Recall that CFD-simulated hemodynamics data (wall shear stress and its derivatives) are located on unstructured meshes. Hence, we mapped WSS data from an unstructured grid onto a unit disk (i.e., a uniformly sampled polar coordinate system); data in a uniformly sampled polar system is equivalent to image data. Mapped WSS data (onto the unit disk) were readily available for Radiomics analysis to extract spatial patterns of WSS data. We named this innovative technology "WSS-informatics" (i.e., using informatics techniques to analyze WSS data); the usefulness of WSS-informatics was demonstrated during the predictive modeling of IAs' rupture status. Results: None of the conventional WSS parameters correlated to IAs' rupture status. However, WSS-informatics metrics were discriminative (p-value < 0.05) to IAs' rupture status. Furthermore, predictive models with WSS-informatics features could significantly improve the prediction performance (area under the receiver operating characteristic curve [AUROC]: 0.78 vs. 0.85; p-value < 0.01). Conclusion: The proposed innovations enabled the first study to use spatial patterns of WSS data to improve the predictive modeling of IAs' rupture status. [ABSTRACT FROM AUTHOR]

Accurate rupture risk assessment is essential for optimizing treatment decisions in patients with cerebral aneurysms. While computational fluid dynamics (CFD) has provided critical insights into aneurysmal hemodynamics, most analyses focus on blood flow patterns, neglecting the biomechanical properties of the aneurysm wall. To address this limitation, we applied Fluid-Structure Interaction (FSI) analysis, an integrative approach that simulates the dynamic interplay between hemodynamics and wall mechanics, offering a more comprehensive risk assessment. In this study, we used advanced FSI techniques to investigate the rupture risk of middle cerebral artery bifurcation (MCA) aneurysms, analyzing a cohort of 125 patients treated for a MCA aneurysm at Kepler University Hospital, Linz, Austria. Multivariate analysis identified two significant rupture predictors: High Equivalent Stress Area (HESA; p = 0.049), which quantifies stress distribution relative to the aneurysm surface, and Gaussian curvature (GLN; p = 0.031), which captures geometric complexity. We also introduce the HGD index, a novel composite metric combining HESA, GLN, and Maximum Wall Displacement, designed to enhance predictive accuracy. With a threshold of 0.075, the HGD index exhibited excellent diagnostic performance; in internal validation, 24 of 25 ruptured aneurysms surpassed this threshold, yielding a sensitivity of 0.96. In a 5-fold cross validation the reliability of results was confirmed. Our findings demonstrate that the HGD index provides superior rupture risk stratification compared to conventional single-parameter models, offering a more robust tool for the assessment of complex aneurysmal structures. Further multicenter studies are warranted to refine and validate the HGD index, advancing its potential for clinical application and improving patient outcomes. [ABSTRACT FROM AUTHOR]

Purpose: It was noticed that anterior choroidal artery (AChoA) aneurysms appear to rupture at relatively smaller sizes compared with aneurysms in other intracranial locations, based on anecdotal clinical experience. We therefore aimed to compare ruptured AChoA aneurysms with other ruptured aneurysms in other intracranial locations, pertaining to aneurysm dimensions. This may help in finding out if the rupture risk stratification, based on the amalgamation of aneurysms of multiple locations in one group, precisely estimates aneurysm rupture risk. Methods: 255 ruptured intracranial aneurysms, which underwent assessment with catheter angiography with 3D reconstruction, in a single tertiary center between January 2000 and December 2023, were included. 6 aneurysm dimensions were compared. Results: Statistically significant larger aneurysm maximum diameter, height, width and size ratio (SR) of the ruptured posterior communicating artery (PCOMM) aneurysms were identified when compared with ruptured AChoA aneurysms. No statistically significant difference in the aneurysm maximum diameter, height and width between the ruptured AChoA and ruptured anterior cerebral artery (ACA), anterior communicating artery (Acom), pericallosal artery and basilar tip aneurysms was found. AChoA aneurysms appear to rupture at a relatively small size, which is comparable to other aneurysm locations that are often grouped into different categories in rupture risk stratification. Conclusion: More detailed location-specific rupture risk estimation may be needed. The combination of multiple intracranial aneurysm locations into a single category for risk stratification may not reflect the true aneurysm size at rupture for some aneurysms. [ABSTRACT FROM AUTHOR]

The mini-pterional craniotomy (mPT) was designed to be a minimally invasive alternative to the standard pterional (PT) approach. However, it remains unclear which technique produces better results. Thus, we aimed to perform a meta-analysis comparing functional, surgical, and aesthetic outcomes between mPT and PT in intracranial aneurysms. We searched PubMed, EMBASE, Web of Science, and Cochrane Library for studies comparing mPT to PT in patients who underwent clipping of brain aneurysms until June 2024. Outcomes were modified Rankin Scale (mRS) or Glasgow Outcome Scale (GOS), surgical complications, operation time, length of stay, and patients' aesthetic satisfaction. Statistical analysis was performed using the R software (version 4.4.0). Heterogeneity was assessed with I2 statistics. We included 6 studies with a total of 1011 patients, of whom 696 (63.1%) underwent mPT. The mean age was 59.0 ± 2.8 years, 67.6% were female, and 68.2% of all aneurysms were located in the middle cerebral artery. Unfavorable functional outcome (mRS ≥ 3 or GOS ≤ 3) at discharge (OR 0.21, 95% CI: 0.07–0.59; I2 = 0%), overall surgical complications (OR 0.45, 95% CI: 0.21–0.99; I2 = 72%), and operation time (MD − 54.42 min, 95% CI: −60.78 to − 48.06; I2 = 0%) were significantly lower in mPT compared to PT. Moreover, patients' aesthetic satisfaction was statistically higher in mPT (OR 2.91, 95% CI: 1.06-8.00; I2 = 0%). However, there was no significant difference in length of stay between groups (MD − 1.52 days, 95% CI: −3.75 to 0.72; I2 = 72%). Mini-pterional craniotomy is associated with better functional outcomes at discharge, fewer surgical complications, and a shorter operation time. Therefore, our results might suggest that mPT is a promising and preferable alternative to standard PT. [ABSTRACT FROM AUTHOR]

Background: The Focused Sylvian Approach (FSA) is a refined, minimally invasive technique for clipping small to medium-sized middle cerebral artery (MCA) aneurysms, prioritizing safety and aesthetics. Method: The craniotomy remains confined to the superior temporal line, with the incision concealed within the temporal muscle. The Sylvian fissure is carefully dissected to preserve venous structures. Conclusion: FSA achieves optimal vascular control with superior cosmetic outcomes while maintaining adequate exposure for safe aneurysm clipping. [ABSTRACT FROM AUTHOR]

Background: Variability in long-term endovascular treatment outcomes for intracranial aneurysms has prompted questions regarding the effects of these treatments on aneurysm hemodynamics. Endovascular techniques disrupt aneurysmal blood flow and shear, but their influence on intra-aneurysmal pressure remains unclear. A better understanding of aneurysm pressure effects may aid in predicting outcomes and guiding treatment decisions. Methods: Medium and large aneurysm models with intramural pressure taps on the dome and parent artery were designed and 3D-printed with vessel-like physical properties from UV-cured materials. The models were connected to a comprehensive flow system consisting of a pulsatile pump and a viscosity-matched blood analog. The system provided physiological pressure and flow control. Real-time pressures were recorded in the aneurysm dome and parent artery during initial placement of coils, stents, flow diverters, and temporary balloons under simulated surgical conditions. Coiling, stent-assisted coiling, and flow diverter placement were performed in both aneurysm sizes. Temporary balloon placement was performed in a large aneurysm model. Results: Coiling resulted in 24–30% packing density and diminished intra-aneurysmal flow. Flow diverter placement reduced intra-aneurysmal flow with near complete flow interruption after placement of three consecutive devices across the aneurysm neck. Compared to untreated controls, real-time pressure measurements during coiling and flow diversion showed minimal changes (< 5%) in intra-aneurysmal pressures. Temporary balloon occlusion blocked the parent artery, increasing the pressure proximal to the site of occlusion (by 9%), and reducing the pressure distally (by 14%). This maneuver also dampened intra-aneurysmal pressure to the average distal vessel pressure measurement. Positive control aneurysm models were 3D-printed with a sealed, "healed" neck. These controls verified a sealed neck eliminates intra-aneurysmal pressure. Conclusion: Findings quantified minimal changes in intra-aneurysmal pressure during and immediately post-coiling and flow diversion. Intra-aneurysmal flow disruption alone has negligible impact on intra-aneurysmal pressures. [ABSTRACT FROM AUTHOR]

Intracranial hemorrhages are highly concerning but underreported complications related to flow diversion (FD) treatment of intracranial aneurysms. Herein, we aimed to characterize these complications and the factors influencing their occurrence. We retrospectively reviewed patients treated with FD from 2013 to 2023 at a single U.S. institution, analyzing aneurysm characteristics, comorbidities, antiplatelet and anticoagulation use, and hemorrhage imaging features. Risk factors for intraparenchymal hemorrhages (IPHs) were assessed with univariate analysis. There were 622 patients harboring 788 aneurysms treated in 690 procedures during the study period. Within 7 months of follow-up, 15 intracranial hemorrhages were identified (2.2%): 2 acute subdural hematomas (SDH), 7 IPH, 1 intraventricular hemorrhage (IVH), and 5 subarachnoid hemorrhages (SAH), most of which presented within the first 24 h after initial treatment. Patients experiencing hemorrhages exhibited lower rates of functional independence (mRS ≤ 2) compared to those without hemorrhage (66.7% vs. 93.3%; p < 0.01). IPHs were slightly higher in patients receiving aspirin-ticagrelor (1.2%) compared to those on aspirin-clopidogrel (0.9%) or aspirin-prasugrel (0.0%). A univariate logistic regression model demonstrated an aneurysmal diameter ≥ 12 mm (OR = 8.98; 95% CI = 1.98–16.03) and aneurysms with prior treatment (OR = 7.20; 95% CI = 1.59–32.60) as factors influencing IPHs after treatment. The incidence of hemorrhage decreased over the time interval of study. Intracranial hemorrhages related to FD are rare but highly morbid complications. Treatments involving larger aneurysms and those with prior interventions are associated with a higher risk of IPHs. [ABSTRACT FROM AUTHOR]

Aneurysm in pregnancy is rare and is at risk of rupture if not diagnosed early. Anesthesia for nonobstetric surgery in parturient patients comes with its own challenges in comprehending the physiological changes of pregnancy as well as the risks of emergency neurosurgery. A focused multidisciplinary team-based approach is sought, keeping in mind the primary concerns of maternal and fetal safety. The challenges for these surgeries are to maintain hemodynamic stability, manage hypertensive crises, and provide induced hypotension for clipping. The choice of anesthetic agents should have minimal effects on the fetus along with the maintenance of uteroplacental perfusion. [ABSTRACT FROM AUTHOR]

Introduction: Observational studies have suggested a possible relationship between gut microbiota (GM) and aneurysm development. However, the nature of this association remains unclear due to the inherent limitations of observational research, such as reverse causation and confounding factors. To address this knowledge deficit, this study aimed to investigate and establish a causal link between GM and aneurysm development. Methods: Summary statistics regarding GM and aneurysms were collected from relevant genome-wide association studies. Two samples were used in mendelian randomization (MR). The principal MR technique utilized was inverse-variance weighting, a technique renowned for producing reliable causal effect estimations. Additional MR methods, including weighted median (WM), MR-Egger, MR-PRESSO, and simple mode methods, were employed to ensure the robustness of the aforementioned association and investigate potential biases. Sensitivity analyses were performed to determine the consistency of the MR findings. Results: Varying associations were observed between specific microbial taxa and the different aneurysms analyzed. A negative correlation was observed between aortic aneurysm (AA) and Lentisphaerae, Lentisphaeria, and Victivallales. Conversely, the genus FamilyXIIIUCG001 exhibited an increased risk association. Regarding abdominal AA, Victivallaceae showed a reduced risk, and Bilophila and Catenibacterium were associated with an increased risk. For thoracic AA, negative and positive correlations were observed with Lentisphaerae and Turicibacter, respectively. Lastly, in the case of cerebral aneurysm (CA), Firmicutes and Haemophilus were associated with a decreased risk, and Lachnoclostridium demonstrated an increased risk of association. Conclusion: Our research has established causal relationships between specific GM components and various aneurysms. The obtained knowledge may aid in the development of microbiome-based interventions and the identification of novel biomarkers for targeted prevention strategies. [ABSTRACT FROM AUTHOR]

The management of multiple intracranial aneurysms presents significant clinical challenges, particularly when complicated by underlying conditions such as cerebral atherosclerosis. This case report highlights the successful treatment of a 66-year-old female diagnosed with three intracranial aneurysms located in the right middle cerebral artery (MCA), pericallosal artery, and M2 segment. The patient also had a history of systemic atherosclerosis and right-sided breast cancer, factors that increased the complexity of surgical intervention. The aim of this report is to demonstrate the efficacy of single-stage microsurgical clipping in managing multiple aneurysms with favorable outcomes in a complex patient profile. Methods: The patient underwent right-sided pterional craniotomy for microsurgical clipping of all three aneurysms during a single-stage procedure. Two aneurysms in the MCA were clipped using Yasargil clips, and a third aneurysm located at the bifurcation of the pericallosal artery was also secured with a clip. The procedure was performed under microscopic visualization, with meticulous dissection of the atherosclerotic vessels and careful intraoperative hemostasis. Postoperative care involved proactive perioperative management, including blood pressure control and vigilant neurological monitoring. Results: Postoperative imaging at three months confirmed proper clip placement with no evidence of residual aneurysm filling or ischemic complications. The patient exhibited a full neurological recovery, with no deficits or further complications, highlighting the effectiveness of the surgical approach in managing multiple aneurysms concurrently. Conclusions: This case supports the use of single-stage microsurgical clipping as an effective treatment for patients with multiple intracranial aneurysms, even in the presence of complicating factors such as atherosclerosis. A meticulous surgical technique and perioperative management are critical to achieving favorable outcomes and reducing the risk of delayed ischemia or other postoperative complications. [ABSTRACT FROM AUTHOR]

Background/Objectives: The p48 MW HPC is a novel low-profile flow diverter covered by a hydrophilic polymer coating with antithrombogenic properties, which may reduce ischemic complications and enable a single antiplatelet therapy after insertion of the stent. In this single-center experience, we describe the efficacy of this device, focusing on the illustration of different therapeutic indications and the outcome in various clinical settings with regard to vessel anatomy, bleeding state, and aneurysm configuration. Methods: We retrospectively reviewed our database for all patients being treated with a p48 MW HPC flow diverter between February 2019 and July 2021. The efficacy of the treatment was evaluated according to the O'Kelly–Marotta (OKM) scale in the last digital subtraction angiography (DSA) follow-up. Information on complications and medications were collected from our medical records. In addition, to illustrate different indications and clinical settings, we present six of these cases in closer detail. Results: 18 aneurysms in 14 patients were treated with the p48 MW HPC flow diverter and in one case with an additional Derivo device. Periprocedural events occurred in 28.6% of the treated patients, which were all successfully resolved within the same session. Follow-up examination information was available for 67% of patients, of which 75% showed complete occlusion of the aneurysm and 83.3% showed a favorable occlusion result (OKM C-D). Two patients with ruptured aneurysms received a single antiplatelet therapy with ASA without thrombotic complications, at least in the short term. New braid deformation patterns were observed in 16.6% at the follow-up examination, but none with subsequent clinical significance. Conclusions: The p48 MW HPC is safe and effective in the treatment of a wide spectrum of differently configurated, ruptured, and unruptured aneurysms. Single antiplatelet therapy might be an option in selected cases. [ABSTRACT FROM AUTHOR]

Observational studies have suggested that mental disorders and cerebrovascular diseases (CVDs) may be risk factors for each other, but genetic evidence of a causal relationship is still lacking. We used Mendelian randomization (MR) studies to explore the causal relationship between mental disorders and CVDs from the genetic perspective. To investigate the causal association between major depressive disorder (MDD), anxiety, attention deficit/hyperactivity disorder (ADHD), bipolar disorder and schizophrenia five kinds of mental disorders and CVDs using two-sample two-way MR analysis based on publicly available genome-wide association study (GWAS) data. We used as instrumental variables (IVs) single-nucleotide polymorphisms (SNPs) that were strongly associated with mental disorders and CVDs. IVW method was used as the main analysis method, and MR-IVW, MR-Egger methods, MR-PRESSO test, leave-one-out analysis and funnel plot were used for sensitivity analysis. We further conducted a meta-analysis to summarize the currently available MR analyses. The results of forward MR study showed that there was a significant causal relationship between ADHD and AS (any stroke) (p (AS) = 0.001, OR (95%CI) =1.118 (1.047–1.195)), any ischemic stroke (AIS) (p (AIS) = 0.004, OR (95%CI) =1.118(1.035–1.206)) and large artery stroke (LAS) (p (LAS) = 0.026, OR (95%CI): 1.206(1.023–1.422)). No heterogeneity, pleiotropy and outliers were found in sensitivity analysis. The reverse MR study showed that IA (intracranial aneurysm) (p (IA) = 0.033, OR (95%CI) = 1.123(1.009–1.249)) and UIA (unruptured intracranial aneurysm) (p (UIA) = 0.015, OR (95%CI) =1.040(1.008–1.074)) were risk factors for schizophrenia. Sensitivity analysis showed no pleiotropy, but there was heterogeneity. After excluding outliers, MR analysis showed that IA and UIA were still risk factors for schizophrenia. Our meta-analyses found statistical significance in causal relationships between ADHD and LAS (OR (95%CI) =1.18 (1.06–1.32), p = 0.003), IA and schizophrenia (OR (95%CI) =1.05 (1.02–1.08), p = 0.002) and UIA and schizophrenia (OR (95%CI) =1.03 (1.01–1.06), p = 0.010). The MR study and meta-analysis suggest that genetically predicted ADHD is a risk factor for LAS, and IA and UIA increase the risk of schizophrenia. The result has implications for the development of feasible prevention strategies in the future. • To investigate the causal association between mental disorders and CVDs using two-sample two-way MR analysis. • ADHD is a risk factor for large artery stroke, and intracranial aneurysm increases the risk of schizophrenia. • The study obtain a more comprehensive understanding of the interaction between mental disorders and CVDs. [ABSTRACT FROM AUTHOR]

A 34-year-old man who did not use tobacco complained of hemoptysis with a small volume, severe dry cough, and low-grade fever for 5 months. He denied dyspnea, chest pain, night sweats, or weight loss. Chest CT scanning showed nodules with a cavity in the lower left lung. Pathogenic tests of BAL fluid were negative. Initially, he was diagnosed with pneumonia and received antibiotics. After a week, his symptoms resolved, and he was discharged from the hospital. Two months later, the patient presented again for the onset of dry cough and hemoptysis. Despite symptomatic treatment, his symptoms and chest CT scans had no improvement. Thereby, he was referred to our institution. He was prone to spontaneous bruising since childhood with a family history of spontaneous cerebral aneurysm. At 21 years of age, the patient underwent an appendectomy because of a suspected perforation. Also, he experienced cerebral hemorrhage 3 years earlier. [ABSTRACT FROM AUTHOR]

Objectives: Intracranial aneurysms (IA), often remain asymptomatic until they get ruptured, invariably leads to subarachnoid hemorrhage (SAH), and is influenced by both genetic and environmental factors. Recent studies indicated inflammation as a key player in IA development. This study delves into genetic variations within inflammatory pathways, focusing on TLR4-mediated cytokine release as potential IA biomarkers. Methods: Eighty IA patients and eighty healthy controls from North India participated, and demographic and clinical data were analyzed, including gender-stratified comparisons of TLR4 Asp299Gly genotype and TLR4 expression. Histological and molecular analyses of blood and brain tissue were done using SEM imaging, qPCR, and western blot. Results: Our result revealed elevated TLR4 expression in IA patients, with SEM imaging indicating intracerebral damage. TLR4 Asp299Gly heterozygote genotype was less prevalent in IA patients, suggesting a protective effect against IA development. Moreover, TNF-α levels were significantly higher in IA patients, indicating an inflammatory response. Further, TNF-α expression was downregulated in heterozygous patients, suggesting TLR4 Asp299Gly gene polymorphism affects the activation of TNF-α expression. Gender-based analysis between control and aneurysm cases showed a decrease in TLR4 Asp299Gly heterozygote genotype with heightened TLR4 expression and neurological deficits in IA female patients compared to males. Conclusions: This study highlights the association between TLR4 Asp299Gly genotype and IA susceptibility in North Indian populations, linking increased TLR4 expression to IA pathogenesis. Gender-specific disparities in TLR4 genotype and expression underscore the need for personalized treatment strategies, with TLR4 signaling modulation emerging as a promising therapeutic avenue warranting further investigation. [ABSTRACT FROM AUTHOR]

Background: Previous studies manifested that abnormal proliferation, migration, apoptosis, and phenotypic conversion of vascular smooth muscle cells (VSMCs) are the main pathogenic basis of intracranial aneurysms (IAs). Objective: The aim of this study was to explore a key gene associated with IA growth and rupture using bioinformatics analysis and validate it by exogenous overexpression into human brain VSMCs (HBVSMCs). Four IA-associated microarray datasets, GSE54083, GSE15629, GSE66238, and GSE13353, were obtained from Gene Expression Omnibus (GEO) and analyzed using GEO2R for differentially expressed genes (DEGs). HBVSMCs were infected with lentivirus containing RIO kinase 3 (RIOK3) to overexpress exogenous RIOK3, and then, CCK-8, EdU, cell scratch, Transwell, Western blotting, and ELISA were introduced to measure proliferation, migration, phenotypic conversion-related proteins, and proinflammatory cytokines in HBVSMCs. To simulate the abnormal hemodynamic environment in the late stages of IA formation, RIOK3-overexpressing HBVSMCs were cultured under wall shear stress (WSS)-loaded conditions and then subjected to apoptosis assessment. Results: RIOK3 was defined as a key gene in the DEGs of IAs by bioinformatics analysis. RIOK3 overexpression could contribute to the abnormal proliferation, migration, secretion of proinflammatory factors, and the conversion of contractile phenotype to synthetic phenotype of HBVSMCs. Additionally, RIOK3 overexpression encouraged HBVSMC apoptosis after loading WSS in vitro to mimic advanced-IAs. Conclusion: RIOK3 in pre-IAs (without WSS loading) facilitates phenotypic conversion, abnormal proliferation, invasion, and inflammatory cytokine secretion of HBVSMCs; whereas in the advanced-IAs, RIOK3 accelerated the abnormal apoptosis of HBVSMCs in the setting of loaded-WSS. [ABSTRACT FROM AUTHOR]

Background Stent-assisted coiling (SAC) is a wellestablished method for treatment of wide-necked intracranial aneurysms. In this multicenter, retrospective case series we evaluated SAC with a new low-profile, laser-cut stent with an antithrombogenic hydrophilic polymer coating (pEGASUS-HPC) for the treatment of intracranial aneurysms. Methods Patients treated with pEGASUS-HPC SAC for one or more intracranial aneurysms were retrospectively included. Clinical, imaging, and procedural parameters as well as clinical and imaging follow-up data were recorded. Results We treated 53 aneurysms in 52 patients in six neurovascular centers between August 2021 and November 2022. Thirty-seven patients (69.8%) were female. Mean age was 57 (±11.7) years. Twenty-nine patients were treated electively, 23 in the acute phase (22 with aneurysmal subarachnoid hemorrhage (SAH), and 1 with a partially thrombosed aneurysm causing ischemic events). One intraprocedural thromboembolic event and three postprocedural ischemic complications occurred in two (8.7 %) of the SAH patients and in one of the elective patients (3.45%). Overall aneurysm occlusion was Raymond Roy (RR) I in 36 (69.2%), RR II in 9, and RR III in 9 cases. Follow-up imaging was available for 23 patients after an average of 147.7 (±59.6) days demonstrating RR I occlusion in 22 (95.5%) and RR II in 1 patient. Conclusion SAC with the pEGASUS-HPC stent system demonstrates rates of periprocedural safety and effectiveness that are comparable with previously reported series for stent-assisted coil embolization. [ABSTRACT FROM AUTHOR]

Background The Pipeline Embolization Device has proven to be a safe and effective device for the treatment of intracranial aneurysms. The Pipeline Vantage Flow Diverter (PVFD) with Shield Technology is the new fourth generation of this implant, with modifications made compared to previous iterations. We aimed to evaluate the mechanical properties and clinical safety and efficacy of this device. Methods Vanguard is a single arm, single center, prospective study. Between April 2021 and April 2023, all consecutive patients with an unruptured aneurysm treated with Pipeline Vantage flow-diverting stents were included. There were no aneurysm size or location exclusion criteria. Safety (neurological serious adverse events) and efficacy (device deployment and aneurysm occlusion) were independently reviewed. Imaging follow-up data, and immediate, early (<30 days), and delayed (>30 days) neurological serious adverse events were independently assessed. Results 101 consecutive patients with a total of 115 aneurysms were included. The aneurysms were situated in the anterior (90.4%) or posterior (9.6%) circulations. A total of 124 devices were implanted. The deployment success rate was 100%. In four (4.0%) cases post-deployment angioplasty was required to optimize device wall apposition. Occlusion rates at 1 month were 54.7%, at 3 months 72.1%, and at 6 months 81.7%. Morbidity and mortality were 4.9% and 0%, respectively, at 6 months. Eight cases (6.9%) demonstrated in-stent stenosis, four of which had 'fish mouth' deformity. Conclusion Initial results of the new generation PVFD for unruptured intracranial aneurysm treatment demonstrate overall satisfactory device performance, safety profile, and effectiveness. [ABSTRACT FROM AUTHOR]

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. VAUnet 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. [ABSTRACT FROM AUTHOR]

Background In aneurysmal subarachnoid hemorrhage patients with multiple intracranial aneurysms (aSAH-MIA patients), the risk of secondary unruptured intracranial aneurysms is inconsistent. This study aimed to explore the risk of unruptured aneurysms in Chinese aSAH-MIA patients. Methods The medical records and angiographic images of aSAH-MIA patients from eight cerebrovascular centers in China were retrospectively reviewed and analyzed. Patients with a single unruptured intracranial aneurysm (UIA) and no prior aSAH were used as controls. Propensity score matching (PSM) was employed to balance the differences in age, gender, aneurysm size, aneurysm site, and follow-up duration between the two groups. Results The study included 267 unruptured aneurysms from 204 aSAH-MIA patients and 769 single UIA. After PSM, 201 aneurysms were enrolled in the aSAH-MIA group and 201 aneurysms in the control group. The mean follow-up was 2.2 years. Thirty-four aneurysm instability events (28 growth and 6 rupture, 16.9%) occurred during follow-up in the aSAH-MIA group and 16 instability events (13 growth and 3 rupture, 8%) occurred in the control group. Risk factors for aneurysmal instability were aneurysm irregularity (OR 2.53; 95% CI 1.18 to 4.31), higher size ratio (OR 1.23; 95% CI 1.37 to 4.39), and middle cerebral artery location (OR 1.86; 95% CI 1.03 to 3.17). The risk of aneurysmal instability was substantially elevated in the aSAHMIA group (HR 2.07; 95% CI 1.12 to 3.02). Conclusions Unruptured aneurysms in Chinese aSAH-MIA patients exhibited higher risks of growth and rupture than in patients with a single UIA. Middle cerebral artery location, higher size ratio and irregular shape were associated with higher risk of growth or rupture. [ABSTRACT FROM AUTHOR]

Background Contrast-induced encephalopathy (CIE) following endovascular interventions is a rare but serious complication. This study aimed to investigate the risk factors of contrast leakage (CL) and CIE in patients who underwent coil embolization of unruptured intracranial aneurysms (UIAs). Methods Patients with UIAs who underwent coil embolization at a single tertiary institute between January 2019 and January 2022 were enrolled retrospectively. CL was defined as cortical or subcortical contrast enhancement with effacement of the cortical sulci. CIE was defined as the new onset of neurological deficits associated with CL. Following the procedure, all patients underwent CT scans, and MRI scans were performed on those with symptoms. Patient and procedural risk factors were investigated. Results In total, 459 patients were analyzed. The median procedure time and contrast dose were 69 min and 96 mL, respectively. CL was evident in 35 patients. In the multivariate analysis, hypertension, large aneurysm, longer procedure time, and greater contrast dose were associated with CL. CIE was diagnosed in 19 patients, and the risk factors included large aneurysm, longer procedure time, and greater contrast dose. The procedure time was predictive of both CL (P<0.001) and CIE (P=0.01). The optimal cut-off value for procedure time was 81.5 min. All CIE patients recovered completely within 8-96 hours. Conclusions A large aneurysm and prolonged procedure time may increase the patient's risk of CL and CIE due to increased contrast exposure. Patients who underwent a procedure that exceeded 1.5 hours necessitate post-procedure evaluation and monitoring. [ABSTRACT FROM AUTHOR]

Background Abnormal intracranial aneurysm (IA) wall motion has been associated with IA growth and rupture. Recently, a new image processing algorithm called amplified Flow (aFlow) has been used to successfully track IA wall motion by combining the amplification of cine and four-dimensional (4D) Flow MRI. We sought to apply aFlow to assess wall motion as a potential marker of IA growth in a paired-wise analysis of patients with growing versus stable aneurysms. Methods In this retrospective case--control study, 10 patients with growing IAs and a matched cohort of 10 patients with stable IAs who had baseline 4D Flow MRI were included. The aFlow was used to amplify and extract IA wall displacements from 4D Flow MRI. The associations of aFlow parameters with commonly used risk factors and morphometric features were assessed using paired-wise univariate and multivariate analyses. Results aFlow quantitative results showed significantly (P=0.035) higher wall motion displacement depicted by mean±SD 90th% values of 2.34±0.72 in growing IAs versus 1.39±0.58 in stable IAs with an area under the curve of 0.85. There was also significantly (P<0.05) higher variability of wall deformation across IA geometry in growing versus stable IAs depicted by the dispersion variables including 121-150% larger standard deviation (...) and 128-161% wider interquartile range (...). Conclusions aFlow-derived quantitative assessment of IA wall motion showed greater wall motion and higher variability of wall deformation in growing versus stable IAs. [ABSTRACT FROM AUTHOR]

Background A systematic review of clinical prediction models for aneurysmal subarachnoid hemorrhage (aSAH) reported in 2011 noted that clinical prediction models for aSAH were developed using poor methods and were not externally validated. This study aimed to update the above review to guide the future development of predictive models in aSAH. Methods We systematically searched Embase and MEDLINE databases (January 2010 to February 2022) for articles that reported the development of a clinical prediction model to predict functional outcomes in aSAH. Our reviews are based on the items included in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA) checklist, and on data abstracted from each study in accord with the Checklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS) 2014 checklist. Bias and applicability were assessed using the Prediction model Risk Of Bias Assessment Tool (PROBAST). Results We reviewed data on 30 466 patients contributing to 29 prediction models abstracted from 22 studies identified from an initial search of 7858 studies. Most models were developed using logistic regression (n=20) or machine learning (n=9) with prognostic variables selected through a range of methods. Age (n=13), World Federation of Neurological Surgeons (WFNS) grade (n=11), hypertension (n=6), aneurysm size (n=5), Fisher grade (n=12), Hunt and Hess score (n=5), and Glasgow Coma Scale (n=8) were the variables most frequently included in the reported models. External validation was performed in only four studies. All but one model had a high or unclear risk of bias due to poor performance or lack of validation. Conclusion Externally validated models for the prediction of functional outcome in aSAH patients have now become available. However, most of them still have a high risk of bias. [ABSTRACT FROM AUTHOR]

Objective To evaluate clinical, angiographic features, and endovascular approach of ruptured and unruptured distal intracranial aneurysms (DIAs). Methods From January 2013 to February 2022, details of all consecutive intracranial aneurysms (IAs) treated endovascularly in our center were collected and retrospectively reviewed. IAs involving the anterior cerebral artery, middle cerebral artery, and posterior cerebral artery (distal to anterior communicating artery, limen insula, and P1 segment, respectively), and those distal to superior cerebellar artery, anterior--inferior cerebellar artery, and posterior inferior cerebellar artery's first segment were classified based on their etiology, location, size, and shape. Demographic, clinical, angiographic, and procedural variables, as well as follow-up outcomes were evaluated. Results Of 2542 IAs, 151 (5.9%) DIAs were counted (average size 5.4±2.9 mm), including 61 (40.4%) unruptured and 90 (59.6%) ruptured. No difference in the aneurysmal size was observed, but aneurysms smaller than 4 mm were observed more frequently in the ruptured group (36.7% vs 18%; P=0.01). In addition, ruptured DIAs were more often non-saccular (40% vs 18%; P=0.004) and irregular (93.3% vs 59%; P<0.001), They were treated mostly by coiling, glue, and parent artery sacrifice (P=0.02, P=0.006, and P=0.001), whereas unruptured DIAs were treated by stent-assisted coiling and flow-diverter stents (P=0.001 and P<0.001, respectively), without any differences in occlusion (81.6% vs 82.5%) and recanalization (21.1% vs 17.5%) rates. Procedure-related complications occurred in 20/151 (13.2%) patients, without any differences between subgroups. Ruptured DIAs were more often re-treated (18.4% vs 5.3%, P=0.02). In multivariate analyses, irregular shape appeared as an independent predictor of ruptured presentation (OR=8.1, 95% CI 3.0 to 21.7; P<0.001). Conclusions Compared with unruptured DIAs, ruptured DIAs were more often non-saccular, irregular, and smaller than 4 mm. Despite different therapeutical approaches, ruptured and unruptured DIAs presented comparable occlusion and recanalization rates. [ABSTRACT FROM AUTHOR]

Atrial myxoma is a rare benign tumor that can cause a variety of complications, including cerebral infarction. We present a case of a 52-year-old female patient who developed cerebral infarction caused by an atrial myxoma. The patient underwent successful surgical resection of the tumor, and the infarction was managed accordingly. However, 15-months post-surgery, the patient developed new neurological symptoms. Imaging studies revealed multiple cerebral metastases, consistent with the possibility of seeding of tumor cells. This rare complication emphasizes the importance of long-term monitoring after the resection of atrial myxomas. The occurrence of metastasis in the brain, though rare, should be considered in follow-up care, particularly in patients who have had embolic events related to atrial myxomas. Our case highlights the potential for cerebral myxoma metastasis even after initial successful surgical intervention, underscoring the need for comprehensive follow-up and vigilant monitoring of such patients. [ABSTRACT FROM AUTHOR]

Objective: The study aims to identify characteristics that impact the postoperative prognosis and recurrence of intracranial dissecting aneurysms (IDA) patients treated using multi-stent overlapping techniques. Methods: Clinical data from 69 IDA patients treated with multistate-assisted spring coil embolization at the hospital between January 2017 and October 2023 were retrospectively reviewed, including clinical and imaging data gathered at admission and discharge. The prognosis was determined based on mRS grade at discharge, and the patients were divided into excellent prognosis (mRS 0–2 points) and poor prognosis (mRS 3–6 points). They were split into two groups: recurrence and no-recurrence, based on whether the patients had recurrence during surgical follow-up. The patient's clinical information and aneurysm data were compared between the two groups to better understand the efficacy of multi-stenting for IDA and to investigate the factors that influence the good or negative prognosis of multi-stenting for IDA and recurrence. Results: The prognosis was poor in 10 patients, 7 of whom died, while 59 had an excellent prognosis. Hunt-Hess classification (χ2 = 25.503a, P = < 0.01), hospitalization days (t=-3.873, P < 0.01), operation time (t=-1.970, P = 0.049), and aneurysm height (t=-1.969, P = 0.049) were all significant. 62 patients were discharged with 4 postoperative recurrences and 58 without recurrences in patients treated with multiple stents, with significant differences in the largest diameter (t=-2.235, P = 0.025), basal length (t=-2.149, P = 0.032), and position(located in pica base or not) (χ2 = 10.955a, P = 0.001). The postoperative recurrence rate was 5.8%, but 85.8% reported satisfactory neurologic function (mRS ≤ 2). The case fatality rate was 10.1%. Conclusion: Hunt-Hess grading on admission, aneurysm high, and operation time affect the prognosis of IDA, Hunt-Hess grade was an independent risk factor for prognosis. Aneurysm size, longest diameter, basal length, and location at the base of the pica affect recurrence. Located in pica base by the dissecting aneurysm is an independent risk factor for recurrence. [ABSTRACT FROM AUTHOR]

Here we presented the initial experience of clipping aneurysms using fully endoscopic techniques and aimed to evaluate the safety and feasibility of fully endoscopic techniques for aneurysms. This was a retrospective single-center study in which patients were scheduled to undergo aneurysm clipping using fully endoscopic techniques. We collected patients' records, radiological neuroimaging, aneurysm-related variables and surgical procedures in detail, as well as postoperative outcomes. All patients were followed up for neurological examinations and computed tomography (CT) as well as computed tomography angiography (CTA) regularly after surgery. We reviewed the radiological and clinical data of 7patients who underwent aneurysm clipping via fully endoscopic techniques at our department from Jan. 2022 to Jul. 2024, including 2 middle cerebral artery aneurysms, 3 cerebral anterior communicating artery aneurysms, 1 anterior cerebral aneurysm and 1 ophthalmic aneurysm. No uncontrolled rupture of aneurysm occurred during operation. Postclipping endoscopic inspection as well as postoperative CTA demonstrated complete occlusion of the aneurysm and preservation of parent, branching, and perforating vessels. None postclipping cerebral infarction caused by branch or perforator compromise were observed after clipping. No mortality was recorded. Follow-up ranged from 1 to 10 months. Six patients (71.4%) showed excellent or good recoveries. The remaining patient recorded improved KPS. With the accumulation of experience and technological progress, the fully endoscopic technique could enable safe and effective clipping of an aneurysm, which provided valuable information for decision-making during surgery and shed a new light on aneurysms clipping. [ABSTRACT FROM AUTHOR]

Objective: In recent years, the application of robotic assistance in diagnostic and therapeutic endovascular neurointerventional procedures has gained notable attention. In this systematic review and meta-analysis, we aim to evaluate the feasibility, safety, and current indications of robotic-assisted neurointerventions and to assess the degree of robotic assistance and reasons for unplanned manual conversion from robotic assistance. Methods: We searched Medline, Scopus, Web of Science, and Cochrane Library databases following PRISMA guidelines and included studies with ≥ 4 patients reporting on robotic-assisted neurointerventions. We analyzed outcomes including technical success, manual conversion, procedure-related complications, morbidity, and mortality with a random-effects meta-analysis. We also identified causes of manual conversion and conducted subanalyses by procedure type and robotic system. Results: Thirteen studies, comprising 538 robotic-assisted neurointerventions, were included. Procedures were primarily diagnostic cerebral angiograms (n = 348), cerebral aneurysm embolizations (n = 127), and carotid artery stenting (n = 37). The CorPath GRX (Corindus) robotic system was employed in the majority of cases (n = 355). Across all studies, the technical success rate was 93%, and the procedure-related complication rate was 0.7%. Manual steps were necessary in all cases due to inherent procedural requirements. Unplanned manual conversion from robotic assistance was necessary in 7% of cases. Further analysis of failures identified challenging anatomies, loss of working length, and mechanical failures as the most common reasons. Conclusions: This systematic review and meta-analysis found that, with a certain degree of manual assistance, robotic-assisted neurointervention is highly feasible, safe, and capable of performing DCA, CAS, and therapeutic neurointerventions that can be executed with a single microcatheter involving simple coiling, stent-assisted coiling, and flow diverter embolization. However, unplanned manual conversion is not uncommon. Improvements in working length and mechanical parts, including the cassette robotic arm and console, as well as CorPath GRX compatibility with 0.035-inch wires, may reduce the rates of manual conversion for current indications. Nonetheless, technical adaptations are essential to broaden the scope of therapeutic neurointervention indications. [ABSTRACT FROM AUTHOR]

To describe the mid-term safety and efficacy of Leo baby stent applied in saccular wide-neck intracranial aneurysms (IAs). 151 patients harboring 156 IAs treated with Leo baby stent from March 2021 to October 2023 were enrolled for further analysis. Among 156 IAs, 142 cases (91.0%) received one single Leo baby stent deployment while 14 cases (9.0%) received dual stents deployment. Stent-assisted coiling strategy was applied in all cases and the success rate was 100%. Immediate IAs occlusion results showed that 48 cases (30.8%) obtained Raymond grade I, 39 cases (25.0%) obtained Raymond grade II and 69 cases (44.2%) obtained Raymond grade III. Perioperative complications occurred in 10 cases (6.4%). Overall morbidity rate was 3.5% and mortality rate was 0% during follow-up. Clinical follow-up was available in 141 patients (93.4%). 136 patients (96.5%) got favorable clinical prognosis (mRS score 0–2) while 5 patients (3.5%) were in a poor neurological condition (mRS score 3–6). Angiographic follow-up was available in 136 cases (87.2%). The results showed that Raymond grade I was obtained in 112 cases (82.4%), Raymond grade II was obtained in 11 cases (8.1%) and Raymond grade III was obtained in 13 cases (9.6%). 4 cases (2.9%) were confirmed with IAs recurrence and received retreatment. Asymptomatic in-stent stenosis was detected in 8 patients (5.9%). The results demonstrate that stent-assisted coiling using Leo baby stent with favorable IAs embolization rate and the low complication rate is a feasible way in treating complex IAs. [ABSTRACT FROM AUTHOR]

The progression of intracranial aneurysm lesions involves complex mechanisms influenced by various factors, including inflammation, oxidative stress and endothelial dysfunction. This comprehensive review delves into the intricate interplay between specific dietary patterns and the progression of intracranial aneurysm lesions. Understanding the impact of these dietary factors on inflammation, oxidative stress and endothelial dysfunction offers valuable insights into noninvasive strategies for managing intracranial aneurysm progression, addressing a critical gap in current therapeutic approaches. [ABSTRACT FROM AUTHOR]