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Treatment of giant basilar aneurysm presents a major treatment challenge, especially in the pediatric population. Morbidity and mortality approach 80 and 30%, respectively. Both reconstructive and deconstructive techniques are associated with high rates of complete occlusion and good neurological outcomes. We report a 14-year-old male with a giant basilar trunk aneurysm treated with an endovascular approach. Clinical symptoms began following an ischemic stroke 2 weeks prior to admission. Endovascular treatment was performed through a reconstructive technique by single flow diverter device (FDD) in the basilar artery; however, this technique failed. At 1-year follow-up, without additional endovascular treatment, the mid-basilar artery and aneurysm were occluded, with vertebrobasilar flow maintained through collaterals from the right posterior communicating artery. We present a challenging management of giant basilar aneurysm in a pediatric patient experiencing a failure of FDD deployment; however, we highlight the importance of collateral flow development in progressive occlusions.

ObjectiveTo investigate the clinical efficacy and safety of flow diverter device (FDD) in the treatment of tandem aneurysms in the internal carotid artery.Materials and methodsThis 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.ResultsA 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

Treatment of giant basilar aneurysm presents a major treatment challenge, especially in the pediatric population. Morbidity and mortality approach 80 and 30%, respectively. Both reconstructive and deconstructive techniques are associated with high rates of complete occlusion and good neurological outcomes. We report a 14-year-old male with a giant basilar trunk aneurysm treated with an endovascular approach. Clinical symptoms began following an ischemic stroke 2 weeks prior to admission. Endovascular treatment was performed through a reconstructive technique by single flow diverter device (FDD) in the basilar artery; however, this technique failed. At 1-year follow-up, without additional endovascular treatment, the mid-basilar artery and aneurysm were occluded, with vertebrobasilar flow maintained through collaterals from the right posterior communicating artery. We present a challenging management of giant basilar aneurysm in a pediatric patient experiencing a failure of FDD deployment; however, we highlight the importance of collateral flow development in progressive occlusions. [ABSTRACT FROM AUTHOR]

Currently, surgical revascularization procedures using intracranial–intracranial (IC-IC) or extracranial–intracranial (EC-IC) bypass and distal clipping or trapping are the valid and rescue treatment modality for extremely rare unilateral distal fusiform superior cerebellar artery (SCA) aneurysms. Yet, in case of bilateral fusiform SCA aneurysms, surgical therapy reaches its limit. Mini-flow diverter devices (FDDs) have only recently become available for treating fusiform aneurysms of such small vessels. We report the unique case of bilateral distal fusiform SCA aneurysms in a 43-year-old man with subarachnoid hemorrhage (Fisher grade IV and World Federation of Neurosurgical Societies [WFNS] grade II) treated with endovascular implantation of bilateral mini-FDDs with excellent outcome and no radiographic signs of infarction. Yet, occlusion of one of the FDDs was found in the follow-up, which again shows the eminent danger of occlusion in case of an implantation of FDDs in such small-caliber vessels, which leaves the discussion about the optimal therapy method open. [ABSTRACT FROM AUTHOR]

This report examines delayed leukoencephalopathy as a postoperative complication after the use of flow diverter (FD) devices for endovascular cerebral aneurysm treatment. A case involving a 78-year-old female treated with a pipeline embolization device for a left internal carotid artery aneurysm is presented. Despite adherence to dual anti-platelet therapy, the patient developed intermittent headaches and memory issues 3 months post-operation. MRI revealed T1-enhancing foci and T2 hyperintense signal abnormalities in the left cerebral hemisphere, without new ischemic lesions, indicating potential embolic events or foreign body reactions. Following aphasia, a change from clopidogrel to prasugrel and the initiation of steroid pulse therapy led to the resolution of symptoms and MRI abnormalities over 6 months. This case underscores the reversibility of delayed leukoencephalopathy with appropriate intervention. [ABSTRACT FROM AUTHOR]

Management of large- or giant-sized internal carotid artery aneurysms (LICAAs) remains challenging. Whether a flow diverter device (FDD) or interventional trapping with extracranial-intracranial bypass (ITB) is better, remains unclear. We conducted a multicenter retrospective analysis of unruptured LICAA patients treated with FDD or ITB at 3 medical centers. Both the effectiveness and safety results of FDD and ITB were compared. In total, 101 aneurysms in 95 patients treated with FDDs and 36 aneurysms in 36 patients managed with ITBs were included (September 2014–June 2021). There was no significant difference between the groups in the complete obliteration rate 1 year after surgery (P = 0.101). There were 2 relapse cases (2.0%) and 4 retreated cases (4.0%) in the FDD group and 1 relapse case (2.8%) and 2 retreated cases (5.6%) in the ITB group. Neither the relapse rates nor retreat rates between groups were significantly different. The neurological morbidity rates were 4.0% (4/101) and 2.8% (1/36) in the FDD group and ITB group, respectively, and were not significantly different. There was 1 mortality case in each group, and the mortality rates were not significantly different (P = 0.443). Both the perioperative and overall (perioperative plus long-term) complication rates in the FDD group were significantly lower than those in the ITB group (P = 0.033, P = 0.039). FDD had comparable surgical efficacy and a significantly lower postoperative complication rate to traditional ITB. FDD might be preferable to ITB as a treatment modality for LICAA. [ABSTRACT FROM AUTHOR]

The global prevalence of intracranial aneurysms (IA) ranges from 5–10%, with a demographic variation. Large and giant aneurysms typically involve cavernous and paraclinoid segments of the internal carotid artery (ICA), and represent 5% of IA. Typically, these lesions involve segments of the ICA, especially the cavernous and paraclinoid segments. The remaining cases affect the vertebrobasilar region, middle cerebral artery (MCA), and anterior cerebral artery (ACA). From the morphological point of view, they are divided into saccular and fusiform. In cases of rupture, the subarachnoid hemorrhage (SAH) is the most common presentation followed by intracerebral hemorrhage (ICH), or both. Other manifestations can occur as occlusion of perforating vessels, embolic events, seizures, and mass effects. The management of unruptured intracranial aneurysms (UIA) is controversial, and the aim of treatment is to exclude the lesions and preserve neurological function. Endovascular techniques for the treatment of paraclinoid aneurysms, in particular, ICA reconstruction using flow-diverting stents, have become a valid option. However, surgery or endovascular treatment has a number of limitations and the choice of treatment is individual in each case. This type of lesion has an extremely poor natural history, and treatment is a challenge regardless of the technique used. The report described a clinical case of a 55-year-old female, with a personal history of hypertension, hyperthyroidism, and depressive syndrome. The patient started complaints of moderate-intensity right frontal headache, progressively worsening with two months of evolution. She also reported blurred vision and diplopia. Brain computed tomography (CT) documented a partially calcified sellar and parasellar lesion. Subsequently, magnetic resonance imaging (MRI)/MRI angiographies were performed and showed a saccular aneurysm of the right ICA, cavernous segment. The patient underwent a diagnostic and therapeutic angiography with stent placement. Clinical and imaging improvements were documented by angiography and MRI angiography with progressive reduction of the aneurysm during the period of follow-up.

Although endovascular treatment is a promising approach, blood blister-like aneurysms (BBAs) still present treatment challenges. This study aimed to assess the effectiveness and safety of flow diverter device-assisted coiling (FDDAC) for the treatment of BBAs, which are broad based and friable with a high rebleeding risk. Eight patients (five females and three males) who presented with subarachnoid hemorrhages (SAH) due to BBA ruptures between May 2020 and May 2022 were retrospectively enrolled. All patients were treated by flow diverter device (Tubridge) adjunctive coil embolization using a semi-deploying technique. The demographic information, angiographic data, interval between admission and treatment, materials, therapy, clinical outcomes (including periprocedural and intraprocedural mortality and morbidity), and follow-up results of all patients were reviewed. The mean age of the patients with BBAs was 48.5 years (range 31–62 years); aneurysm sizes ranged from 2.2 × 1.7 mm to 4.6 × 3.2 mm, and the median Hunt–Hess score was 3. All aneurysms were completely closed at follow-up, and all 8 patients had excellent clinical outcomes (modified Rankin scores = 0–2) at discharge. Angiograms showed complete aneurysm occlusion after 6 months to 1 year. In addition, there were no cases of re-rupture, re-treatment, or recurrence of the aneurysms. FDDAC is safe to use in patients with BBAs and provides an alternative treatment option for this disease. [ABSTRACT FROM AUTHOR]

The flow diverter device (FDD) is an important treatment method for cerebral aneurysms, especially for intracranial dissecting aneurysms. This paper is the result of FDD treatment for two cases of vertebral dissecting aneurysm (VADA) patients and short-term follow-up at 3 months. All two cases were targeted for unruptured cerebral aneurysm, and 4-vessel angiography was performed as a follow-up examination for 3 months after receiving the procedure. As result, it was possible to shorten the period of use of antiplatelet drugs. In the case of VADA, there are limitations in general coiling procedures or conventional surgical treatment methods. In that sense, the FDD treatment method can be a very effective alternative treatment of VADA

Abstract Background Flow diverter devices are increasingly used for endovascular treatment of internal carotid artery aneurysms. Treatment of ophthalmic segment aneurysms with flow diverter devices also includes coverage of the ophthalmic artery but may result in complications. It is unclear, however, whether these devices mechanically block blood flow in the ophthalmic artery. Also unclear is the relationship between deployment of a flow diverter device and post-treatment occlusion. We studied hemodynamic changes in the ophthalmic artery after deployment of a flow diverter device to determine the relationship between those changes and post-stent occlusion of the artery. Methods We analyzed hemodynamic modifications in the ophthalmic artery in 21 patients (19 women, 2 men; mean age 53.43 ± 7.32 years) treated by a single pipeline embolization device. Patient-specific geometries were determined from three-dimensional digital subtraction angiography and the stenting process was simulated. Computational fluid dynamics technology was used to analyze the change in ophthalmic artery hemodynamics. We compared pre-treatment and post-treatment flow velocity of the ophthalmic artery. Results Among the 21 patients with aneurysms located in the ophthalmic segment, no ophthalmic artery occlusion was found during immediate or follow-up angiography. Post-stent flow velocity in the ophthalmic artery decreased from 0.35 ± 0.19 to 0.33 ± 0.20 m/s, with the difference not being statistically significant (P = 0.106). Conclusion Our results showed no significant change in ophthalmic artery blood flow after pipeline embolization device deployment. Hence, post-stent occlusion of the ophthalmic artery could not be explained by reduced blood flow. Delayed thrombosis and neointimal formation maybe the keys to ophthalmic artery occlusion and need further investigation.

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Purpose: There have been many reports on the risks of enlargement and rupture of residual aneurysms and de novo aneurysm formation in the contralateral internal carotid artery after parent artery occlusion (PAO). In the present study, we investigated the efficacy of flow diverter device placement (FDDP) for the treatment of contralateral internal carotid artery aneurysms after PAO. Methods: After 11 patients, who had bilateral large or giant internal carotid aneurysms, were treated for either side with PAO or FDDP, they underwent FDDP for residual lesions in our hospital between October 2015 and June 2018. The patients were divided into two groups, depending on the prior procedure: PAO or FDDP. The embolic state after subsequent FDDP was evaluated by angiography. The embolic state was graded using the O'Kelly Marotta scale. Patients' characteristics and the embolic state of intracranial aneurysms after FDDP were compared between the two groups. Results: Comparing patients' characteristics between the PAO group and FDDP group, statistically significant differences were observed in laterality of the lesions and the interval between prior treatment and FDDP for residual aneurysms (p < 0.05). The embolic state at the one-year follow-up revealed that there could be significantly sufficient embolisation in the FDDP group (p < 0.05). Conclusion: When FDDP is performed for the contralateral lesion after PAO treatment, it is difficult to attain sufficient embolisation of intracranial aneurysms because haemodynamic load in this procedure is large compared to that in a regular FDDP. [ABSTRACT FROM AUTHOR]

Objective: Flow diverter devices are increasingly used in the treatment of posterior circulation aneurysms, sometimes necessarily involving ostia of side branches and perforators. The aim of this study was to identify the hemodynamic influence of flow diverters on side branches and perforators of the posterior circulation.Methods: We performed a retrospective study of consecutive patients treated by a flow diverter device for posterior circulation aneurysms with anterior inferior cerebellar artery (AICA) or posterior inferior cerebellar artery (PICA) involvement. Computational fluid dynamics (CFD) were used to discern hemodynamic changes of branches after deployment of the flow diverter.Results: We studied 18 branches from 17 patients (mean age, 50.72 ± 8.17 years). No branches were occluded on immediate angiography and later follow-up. Average flow velocity in aneurysms decreased from 0.077 ± 0.065 m/s to 0.025 ± 0.025 m/s (p < 0.01). Average flow velocity in branch ostia decreased from 0.29 ± 0.14 m/s to 0.27 ± 0.16 m/s (p = 0.189). The difference in flow velocity reduction ratio between aneurysms and branches was statistically significant (68.8 vs. 9.5%; p < 0.001). The mean pressure in branch ostia increased from 10,717.4 ± 489.0 to 10,859.0 ± 643.4 Pa (p < 0.01).Conclusion: While a flow diverter device is capable of slowing down aneurysmal inflow, it is unable to block the flow into branches and perforators when used in the treatment of posterior circulation aneurysms; flow velocity in branches even increased in some cases. With a low branch occlusion ratio, it may be acceptable to cover posterior circulation branches and perforators if unavoidable.

Background: Experience using flow diverter devices (FDDs) to treat proximal (M1) middle cerebral artery aneurysms associated with the lenticulostriate artery (M1A-LA) remains limited. This study aimed to examine the efficacy and safety of an FDD to manage M1A-LA., Method: Patients with M1A-LA who received FDD treatment at a single center were included in the analysis. Data on the baseline characteristics, postoperative conditions, and follow-up results of the participants were recorded and analyzed. The aneurysms were categorized into three subtypes based on morphology and location. Aneurysms confined to the M1 segment were categorized as subtype A. Those extending to the M2 segment were classified as subtype B. Aneurysms designated as subtype C were confined to the M1 segment but with another independent aneurysm in the distal artery and the presence of healthy vessels between the two. Subgroup analyses were conducted on these subtypes and aneurysm sizes. To assess the consistency of follow-up results, Cronbach's kappa/alpha was used to calculate inter-rater variability. Somers's D coefficient was used to assess the correlation between each subgroup and the imaging outcomes; Fisher's exact test was used to compare the variability among the subgroups., Result: The cohort comprised 11 patients. Their Modified Rankin Scale scores between the perioperative and follow-up periods did not differ. During the follow-up period, four patients had completely occluded aneurysms, and five patients had partial occlusions. The remaining patients did not present with changes in their aneurysms. The kappa coefficient was 0.864 (p < 0.001). M1A-LA was divided into subtypes A, B, and C. Subtype A (defined as an aneurysm completely located in the M1 segment) had a higher complete occlusion rate than that of subtypes B and C, Somers's D R/C correlation coefficient was 0.553, with a 95% confidence interval of 0.1229-0.9823 (p = 0.009). The radiographic follow-up findings were not significantly correlated with the size of the aneurysm (p = 0.121) or the use of coiling (p = 0.903). No significant differences in subtypes (p = 0.264), aneurysm size (p = 0.657), or coiling use (p > 0.999) were observed., Conclusion: FDDs were safe and possibly effective against M1A-LA. However, they were not as effective as for intracranial aneurysms in other locations. FDDs are a satisfactory treatment option for M1A-LA, particularly for subtype A aneurysms., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objective: Flow diverter devices are increasingly used in the treatment of posterior circulation aneurysms, sometimes necessarily involving ostia of side branches and perforators. The aim of this study was to identify the hemodynamic influence of flow diverters on side branches and perforators of the posterior circulation. Methods: We performed a retrospective study of consecutive patients treated by a flow diverter device for posterior circulation aneurysms with anterior inferior cerebellar artery (AICA) or posterior inferior cerebellar artery (PICA) involvement. Computational fluid dynamics (CFD) were used to discern hemodynamic changes of branches after deployment of the flow diverter. Results: We studied 18 branches from 17 patients (mean age, 50.72 ± 8.17 years). No branches were occluded on immediate angiography and later follow-up. Average flow velocity in aneurysms decreased from 0.077 ± 0.065 m/s to 0.025 ± 0.025 m/s (p < 0.01). Average flow velocity in branch ostia decreased from 0.29 ± 0.14 m/s to 0.27 ± 0.16 m/s (p = 0.189). The difference in flow velocity reduction ratio between aneurysms and branches was statistically significant (68.8 vs. 9.5%; p < 0.001). The mean pressure in branch ostia increased from 10,717.4 ± 489.0 to 10,859.0 ± 643.4 Pa (p < 0.01). Conclusion: While a flow diverter device is capable of slowing down aneurysmal inflow, it is unable to block the flow into branches and perforators when used in the treatment of posterior circulation aneurysms; flow velocity in branches even increased in some cases. With a low branch occlusion ratio, it may be acceptable to cover posterior circulation branches and perforators if unavoidable. [ABSTRACT FROM AUTHOR]

Introduction: Intracranial aneurysms are cerebral vascular anomalies with an approximate global prevalence of 2 to 3% and are the main cause of non-traumatic subarachnoid hemorrhage. Diagnosis and preventive treatment of this entity can considerably reduce morbidity and mortality. With the advent of new devices for cerebral endovascular therapy such as flow diverters, the patient now has the option of choosing a less invasive procedure, which does not require conventional surgery. This represents a significant reduction in the number of days of in hospital stay and recovery. The procedure has showed a high degree of security. The endovascular treatment for intracranial aneurysms has evolved substantially in the last two decades, and has become the treatment of choice. Case report: Case 1: A 62-year-old male was admitted in the hospital after a moderate cranioencephalic trauma with transient loss of conscious and a holocranial headache. A cerebral angiography was performed to rule out subarachnoid hemorrhage. The angiography showed an intracranial aneurysm. It was localized in left internal carotid-posterior communicating artery. The measures were of 4mm X 3mm with a 3mm neck. The treatment was performed with a pipeline flow-diverting device, as well as an angiographic control 3 months after the treatment with a satisfactory evolution. Case 2: A 59-year-old female patient with facial hemiparesis and ipsilateral arm, that showed a gradual increase in intensity and duration. A magnetic resonance study protocol was initiated and an intracranial aneurysm was observed in the communicating segment of the right internal carotid artery. The diameter of the aneurysmal sac was of 15 mm and also, a contralateral of 8 mm. Placement of a flow-diverting device was programmed. Conclusion: The use of flow-diverting devices is an excellent alternative for the treatment of incidental intracranial aneurysms, with important cost-effectiveness advantages, surgical time, hospital stay and recovery reduction. In addition to having a recovery percentage of 95% in 5 years. [ABSTRACT FROM AUTHOR]

The ultimate aims of treatment of the intracranial aneurysms are reconstruction the vessel wall and correcting the hemodynamic disturbance. A flow diverter (FD) is a stent placed inside lumen of the parent artery with aim to blood flow reduction into the aneurysms sac to the extent of almost stagnation leading to gradual onset of progressive thrombosis and neointimal lining of arterial wall remodeling to maintain blood outflow into perforators the side and branches. Flow diverter is considered as an effective treatment for fusiform, wide-necked, large and giant intracranial unruptured aneurysms. However, FD implantation may also be associated with growth and rupture of residual aneurysms. The most frequent complication of endovascular aneurysms management is thromboembolic events and less common are intra and postoperative hemorrhagic aneurysmal rupture. Authors report a case where a lack of operation of the device as illustration is presented to demonstrate the shortcomings of this new type of devices.

The ultimate aims of treatment of the intracranial aneurysms are reconstruction the vessel wall and correcting the hemodynamic disturbance. A flow diverter (FD) is a stent placed inside lumen of the parent artery with aim to blood flow reduction into the aneurysms sac to the extent of almost stagnation leading to gradual onset of progressive thrombosis and neointimal lining of arterial wall remodeling to maintain blood outflow into perforators the side and branches. Flow diverter is considered as an effective treatment for fusiform, wide-necked, large and giant intracranial unruptured aneurysms. However, FD implantation may also be associated with growth and rupture of residual aneurysms. The most frequent complication of endovascular aneurysms management is thromboembolic events and less common are intra and postoperative hemorrhagic aneurysmal rupture. Authors report a case where a lack of operation of the device as illustration is presented to demonstrate the shortcomings of this new type of devices. [ABSTRACT FROM AUTHOR]

Small side branches related brain infarction remains one of the major concerns for flow-diverter devices. However, among several factors, whether this high-profile stent would significantly block blood flow into small side branches remains unclear. The authors quantitatively evaluate blood flow reduction due to the deployment of flow-diverter devices using computational fluid dynamics approach. Thirty one patient-specific anterior inferior cerebellar artery geometries were employed. The flow-diverter device was hypothetically embedded into the basilar trunk, and to cover the anterior inferior cerebellar arteries. The blood flow reduction of each anterior inferior cerebellar artery following flow-diverter device deployment was calculated, with independent validations for both inflow and outflow conditions. Efficient diameters of the anterior inferior cerebellar arteries were calculated to evaluate any correlation with blood flow reduction after flow-diverter devices. The blood flow reduction ratio was shown to be 3.61 ± 1.94%. There was moreover no significant difference of either inflow or outflow boundary conditions during the simulation. The results were calculated approximately as a modest linear correlation between the blood flow reduction ratio and the size of anterior anterior inferior cerebellar arteries which had a mean efficient diameter of 1.12 ± 0.36 mm (range from 0.31 mm to 1.91 mm), and the R² was 0.361. When covered by flowdiverter devices, the mechanical blood flow reduction in anterior inferior cerebellar arteries was found to be low with a maximum value estimated to be less than 8%. Therefore, mechanical blood flow reduction is probably not the leading factor contributing to small side branches related brain infarction. [ABSTRACT FROM AUTHOR]

Introduction: We report the experiences of 25 Italian centers, analyzing intra- and periprocedural complications of endovascular treatment of intracranial aneurysms using Silk (Balt Extrusion, Montmorency, France) and pipeline embolization devices (EV3 Inc, Irvine California). Methods: Two hundred seventy-three patients with 295 cerebral aneurysms, enrolled in 25 centers in Italy and treated with the new flow-diverter devices, were evaluated; 142 patients were treated with Silk and 130 with pipeline (in one case, both devices were used). In 14 (5.2 %) cases devices were used with coils. Aneurysm size was >15 mm in 46.9 %, 5-15 mm in 42.2 %, and <5 mm in 10.8 %. Aneurysm locations were supraclinoid internal carotid artery (ICA) in 163 cases (55.2 %), cavernous ICA in 76 (25.7 %), middle cerebral artery in 11 (3.7 %), PCoA in 6 (2 %), and ACoA in 2 (0.7 %); the vertebrobasilar system accounted for 32 cases (10.8 %) and PCA in 5 (1.7 %). Results: Technical adverse events occurred with 59 patients (21.6 %); 5 patients died after ischemic events, 10 to hemorrhagic complications, and 1 from external ventricular drain positioning. At 1 month, morbidity and mortality rates were 3.7 % and 5.9 %, respectively Conclusion: Our retrospective study confirms that morbidity and mortality rates in treatment with FDD of unruptured wide-neck or untreatable cerebral aneurysms do not differ from those reported in the largest series. [ABSTRACT FROM AUTHOR]

Background: Flow diverter devices are increasingly used for endovascular treatment of internal carotid artery aneurysms. Treatment of ophthalmic segment aneurysms with flow diverter devices also includes coverage of the ophthalmic artery but may result in complications. It is unclear, however, whether these devices mechanically block blood flow in the ophthalmic artery. Also unclear is the relationship between deployment of a flow diverter device and post-treatment occlusion. We studied hemodynamic changes in the ophthalmic artery after deployment of a flow diverter device to determine the relationship between those changes and post-stent occlusion of the artery.Methods: We analyzed hemodynamic modifications in the ophthalmic artery in 21 patients (19 women, 2 men; mean age 53.43 ± 7.32 years) treated by a single pipeline embolization device. Patient-specific geometries were determined from three-dimensional digital subtraction angiography and the stenting process was simulated. Computational fluid dynamics technology was used to analyze the change in ophthalmic artery hemodynamics. We compared pre-treatment and post-treatment flow velocity of the ophthalmic artery.Results: Among the 21 patients with aneurysms located in the ophthalmic segment, no ophthalmic artery occlusion was found during immediate or follow-up angiography. Post-stent flow velocity in the ophthalmic artery decreased from 0.35 ± 0.19 to 0.33 ± 0.20 m/s, with the difference not being statistically significant (P = 0.106).Conclusion: Our results showed no significant change in ophthalmic artery blood flow after pipeline embolization device deployment. Hence, post-stent occlusion of the ophthalmic artery could not be explained by reduced blood flow. Delayed thrombosis and neointimal formation maybe the keys to ophthalmic artery occlusion and need further investigation. [ABSTRACT FROM AUTHOR]

OBJECTIVE In this single-center series, the authors retrospectively evaluated the effectiveness, safety, and midterm follow-up results of ruptured aneurysms treated by implantation of a flow diverter device (FDD). METHODS The records of 17 patients (12 females, 5 males, average World Federation of Neurosurgical Societies score = 2.9) who presented with subarachnoid hemorrhage (SAH) due to the rupture of an intracranial aneurysm treated with an FDD were retrospectively reviewed. Of 17 ruptured aneurysms, 8 were blood blister-like aneurysms and the remaining 9 were dissecting aneurysms. The mean delay between SAH and treatment was 4.2 days. Intraprocedural and periprocedural morbidity and mortality were recorded. Clinical and angiographic follow-up evaluations were conducted between 6 and 12 months after the procedure. RESULTS None of the ruptured aneurysms re-bled after endovascular treatment. The overall mortality rate was 12% (2/17), involving 2 patients who died after a few days because of complications of SAH. The overall morbidity rate was 12%: 1 patient experienced intraparenchymal bleeding during the repositioning of external ventricular drainage, and 1 patient with a posterior inferior cerebellar artery aneurysm developed paraplegia due to a spinal cord infarction after 2 weeks. The angiographic follow-up evaluations showed a complete occlusion of the aneurysm in 12 of 15 surviving patients; of the 3 remaining cases, 1 patient showed a remnant of the aneurysm, 1 patient was retreated due to an enlargement of the aneurysm, and 1 patient was lost at the angiographic follow-up. CONCLUSIONS FDDs can be used in patients with ruptured aneurysms, where conventional neurosurgical or endovascular treatments can be challenging.