Epidemiological analysis of 1404 patients with intracranial aneurysm followed in a single Brazilian institution

Application of microcatheter shaping based on computational fluid dynamics simulation of cerebral blood flow in the intervention of posterior communicating aneurysm of the internal carotid artery

Introduction

The present study aimed to investigate the application of the aneurysm embolization microcatheter plasticity method based on computational fluid dynamics (CFD) to simulate cerebral blood flow in the interventional treatment of posterior communicating aneurysms in the internal carotid artery and to evaluate its practicality and safety.

Methods

A total of 20 patients with posterior internal carotid artery communicating aneurysms who used CFD to simulate cerebral flow lines from January 2020 to December 2022 in our hospital were analyzed. Microcatheter shaping and interventional embolization were performed according to the main cerebral flow lines, and the success rate, stability, and effect of the microcatheter being in place were analyzed.

Results

Among the 20 patients, the microcatheters were all smoothly placed and the catheters were stable during the in vitro model test. In addition, the microcatheters were all smoothly placed during the operation, with a success rate of 100%. The catheter tips were stable and well-supported intraoperatively, and no catheter prolapse was registered. The aneurysm was completely embolized in 19 cases immediately after surgery, and a small amount of the aneurysm neck remained in one case. There were no intraoperative complications related to the embolization catheter operation.

Conclusion

Microcatheter shaping based on CFD simulation of cerebral blood flow, with precise catheter shaping, leads to a high success rate in catheter placing, stability, and good support, and greatly reduces the difficulty of catheter shaping. This catheter-shaping method is worthy of further study and exploration.

Procedural Outcome Following Stent-Assisted Coiling for Wide-Necked Aneurysms Using Three Different Stent Models: A Single-Center Experience

Previous case series have described the safety and efficacy of different stent models for stent-assisted aneurysm coiling (SAC), but comparative analyses of procedural results are limited. This study investigates the procedural outcome and safety of three different stent models (Atlas™, LEO+™ (Baby) and Enterprise™) in the setting of elective SAC treated at a tertiary neuro-endovascular center. We retrospectively reviewed all consecutively treated patients that received endovascular SAC for intracranial aneurysms between 1 July 2013 and 31 March 2020, excluding all emergency angiographies for acute subarachnoid hemorrhage. The primary procedural outcome was the occlusion rate evaluated with the Raymond–Roy occlusion classification (RROC) assessed on digital subtraction angiography (DSA) at 6- and 12-month follow-up. Safety assessment included periprocedural adverse events (i.e., symptomatic ischemic complications, symptomatic intracerebral hemorrhage, iatrogenic perforation, dissection, or aneurysm rupture and in-stent thrombosis) and in-house mortality. Uni- and multivariable logistic regression analyses were performed to identify patient baseline and aneurysm characteristics that were associated with complete aneurysm obliteration at follow-up. A total of 156 patients undergoing endovascular treatment via SAC met the inclusion criteria. The median age was 62 years (IQR, 55–71), and 73.7% (115) of patients were female. At first follow-up (6-month) and last available follow-up (12 and 18 months), complete aneurysm occlusion was observed in 78.3% (90) and 76.9% (102) of patients, respectively. There were no differences regarding the occlusion rates stratified by stent model. Multivariable logistic analysis revealed increasing dome/neck ratio (adjusted odds ratio (aOR), 0.26.; 95% CI, 0.11–0.64; p = 0.003), increasing neck size (aOR, 0.70; 95% CI, 0.51–0.96; p = 0.027), and female sex (aOR, 4.37; 95% CI, 1.68–11.36; p = 0.002) as independently associated with treatment success. This study showed comparable rates of complete long-term aneurysm obliteration and safety following SAC for intracranial aneurysm with three different stent-models highlighting the procedural feasibility of this treatment strategy with currently available stent-models. Increased neck size and a higher dome/neck ratio were independent variables associated with less frequent complete aneurysm obliteration.

Epidemiological Characteristics and Surgical Outcomes of Unruptured Intracranial Aneurysms: A Real-world Study

BACKGROUND: This study was aimed at epidemiological analysis of unruptured intracranial aneurysms (IAs) regarding their location, size, multiplicity, type of intervention provided, and associated complications in the Kazakhstani population. METHODS: We performed a retrospective analysis of a cohort of 400 patients diagnosed with IA admitted to the Central Clinical Hospital of Almaty, Republic of Kazakhstan, a referral hospital for the treatment of cerebrovascular disease. Patients admitted between January 1, 2019 and December 31, 2019 with radiologically confirmed diagnosis of unruptured IA were included in the study. RESULTS: Overall, there were 400 patients with a 2.8 female/male ratio. The bulk of aneurisms – 96.0% – were of size <25 mm in diameter and single. Median age of patients was 55 years and the youngest patient was 22-years-old, while the oldest patient aged 83 years. The left internal carotid artery (ICA) was the most common site if IA localization followed by the right ICA. The left and right middle cerebral arteries were the second most common localization sites. More than a half of patients presented with aneurysm-related complications before the intervention, of which subarachnoid hemorrhage was the most common type. Embolization with or without stenting was performed in more than 50% of patients and 96.5% of all surgeries were not associated with complications. CONCLUSION: There is a need for careful consideration of clinical characteristics and surgical outcomes of patients with unruptured IA in a real-world practice as these data are needed for the development of management strategies.

Hemodynamic Analysis of Pipeline Embolization Device Stent for Treatment of Giant Intracranial Aneurysm under Unsupervised Learning Algorithm

To treat large intracranial aneurysms, pipeline embolization device (PED) stent with unsupervised learning algorithms was utilized. Unsupervised learning model algorithm was used to screen aneurysm health big data, find aneurysm blood flow and PED stent positioning characteristic parameters, and guide PED stent treatment of intracranial aneurysms. The research objects were 100 patients with intracranial large aneurysm admitted to X Hospital of X Province from June 2020 to June 2021, who were enrolled into two groups. One group used the prototype transfer generative adversarial network (PTGAN) model to measure mean blood flow and mean vascular pressure and guide the placement of PED stents (PTGAN group). The other group did not use the model to place PED (control group). The PTGAN model can learn feature information from horizontal and vertical directions, with smooth edges and prominent features, which can effectively extract the main morphological and texture features of aneurysms. Compared with the convolutional neural network (CNN) model, the accuracy of the PTGAN model increased by 8.449% (87.452%-79.003%), and the precision increased by 8.347% (91.23%-82.883%). The recall rate increased by 7.011% (87.231%-80.22%), and the F1 score increased by 8.09% (89.73%-81.64%). After the adoption of the PTGAN model, the average blood flow inside the aneurysm body was 0.22 (m/s). After the adoption of the CNN model, the average blood flow inside the aneurysm body was 0.21 (m/s), and the difference was 0.01 (m/s), which was considerable (p < 0.05). Through this research, it was found that the PTGAN model was better than the CNN model in terms of accuracy, precision, recall, and F1 score values. The PTGAN model was better than the CNN model in detecting the average blood flow rate and average blood pressure after treatment, and the blood flowed smoothly. Postoperative complications and postoperative relief were also better than those of the control group. In summary, based on the unsupervised learning algorithm, the PED stent had a good adoption effect in the treatment of intracranial aneurysms and was suitable for subsequent treatment.

Risk factors and treatment approach for subarachnoid hemorrhage in a patient with nine intracranial aneurysms

Introduction. In about one-third of the patients with aneurysmal subarachnoid bleeding, multiple intracranial aneurysms are confirmed. Risk factors such as female gender, smoking, hypertension, and age over 60 tend to be associated with multiple aneurysms. In this paper, we also discuss family predisposition and the treatment approach for multiple cerebral aneurysms. Case outline. Here, we present a case of a female patient, 64-year-old, with spontaneous subarachnoid hemorrhage that had nine intracranial aneurysms. The patient was treated for hypertension for a longer period, excessive smoker, and two of her nearest members of the family died from intracranial bleeding. The patient was fully conscious, without any neurological impairment. Subarachnoid bleeding was diffuse and nor brain-computer tomography finding nor digital subtraction angiography couldn't suggest the source or location of bleeding among nine presented aneurisms. Magnet resonance imaging had to be done, and the T1W fast spin-echo sequence showed a 9 mm large ruptured an aneurysm at the basilar tip, after contrast application, beside others. Three days after insult endovascular embolization was done and two basilar aneurysms were excluded from the circulation, including the one that bled. Conclusion. The patient had the majority of risk factors for multiple intracranial aneurysms. Knowledge of the family predisposition of multiple intracranial aneurysms allowed us to make proper diagnostics of a patient's descendant and reveal a new patient.