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Tian Y, Li X, Zhang J, Zhao B, Liang F. Identifying hemodynamic factors associated with the rupture of anterior communicating artery aneurysms based on global modeling of blood flow in the cerebral artery network. Front Bioeng Biotechnol 2024; 12:1419519. [PMID: 38938980 PMCID: PMC11208462 DOI: 10.3389/fbioe.2024.1419519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 05/28/2024] [Indexed: 06/29/2024] Open
Abstract
Anterior communicating artery (ACoA) aneurysms are more prone to rupture compared to aneurysms present in other cerebral arteries. We hypothesize that systemic blood flow in the cerebral artery network plays an important role in shaping intra-aneurysmal hemodynamic environment thereby affecting the rupture risk of ACoA aneurysms. The majority of existing numerical studies in this field employed local modeling methods where the physical boundaries of a model are confined to the aneurysm region, which, though having the benefit of reducing computational cost, may compromise the physiological fidelity of numerical results due to insufficient account of systemic cerebral arterial hemodynamics. In the present study, we firstly carried out numerical experiments to address the difference between the outcomes of local and global modeling methods, demonstrating that local modeling confined to the aneurysm region results in inaccurate predictions of hemodynamic parameters compared with global modeling of the ACoA aneurysm as part of the cerebral artery network. Motivated by this finding, we built global hemodynamic models for 40 ACoA aneurysms (including 20 ruptured and 20 unruptured ones) based on medical image data. Statistical analysis of the computed hemodynamic data revealed that maximum wall shear stress (WSS), minimum WSS divergence, and maximum WSS gradient differed significantly between the ruptured and unruptured ACoA aneurysms. Optimal threshold values of high/low WSS metrics were determined through a series of statistical tests. In the meantime, some morphological parameters of aneurysms, such as large nonsphericity index, aspect ratio, and bottleneck factor, were found to be associated closely with aneurysm rupture. Furthermore, multivariate logistic regression analyses were performed to derive models combining hemodynamic and morphological parameters for discriminating the rupture status of aneurysms. The capability of the models in rupture status discrimination was high, with the area under the receiver operating characteristic curve reaching up to 0.9. The findings of the study suggest that global modeling of the cerebral artery network is essential for reliable quantification of hemodynamics in ACoA aneurysms, disturbed WSS and irregular aneurysm morphology are associated closely with aneurysm rupture, and multivariate models integrating hemodynamic and morphological parameters have high potential for assessing the rupture risk of ACoA aneurysms.
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Affiliation(s)
- Yuqing Tian
- Department of Engineering Mechanics, School of Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Xiao Li
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianjian Zhang
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bing Zhao
- Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fuyou Liang
- Department of Engineering Mechanics, School of Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai, China
- Key Laboratory of Hydrodynamics (MOE), School of Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai, China
- State Key Laboratory of Ocean Engineering, School of Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai, China
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, Sechenov First Moscow State Medical University, Moscow, Russia
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Zhang H, Liang S, Zang B, Lv X. Classification of anterior communicating aneurysms on a basis of endovascular treatments. Neuroradiol J 2024; 37:68-73. [PMID: 37914224 PMCID: PMC10863569 DOI: 10.1177/19714009231212360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND AND PURPOSE The anterior communicating artery (Acoma) aneurysms are difficult to understand because of their anatomical variations. This study reported a new classification of Acoma aneurysms on a basis of endovascular treatments. METHODS This retrospective study enrolled consecutive 94 patients harbored 100 Acoma aneurysms treated with coil embolization. All Acoma aneurysms were classified into 5 orientations (straight, superior, inferior, anterior, and posterior) based on the axis connecting A1 origin and the base of the aneurysm. Aneurysm characteristics, endovascular treatments, angiographic, and clinical outcomes were evaluated using this classification. RESULTS According to this classification, there were 64 (64%) straight, 16 (16%) inferior, 16 (16%) superior, 2 (2%) anterior, and 2 (2%) posterior projection aneurysms. There were significant differences between different groups in aneurysm height (p=0.009) and aneurysm neck size (p = 0.003), and in endovascular treatments (p=0.006). There was a significant difference in the proportion of rupture presentation among the three groups of straight, inferior, and superior (p = 0.019). There was no difference in the results of postoperative angiography (p = 0.090). An excellent functional outcome with an mRS ≤1 was achieved in 91 (96.8%) patients. CONCLUSIONS This classification of Acoma aneurysms based on the axis connecting A1 origin and the base of the aneurysm is associated with aneurysm height, aneurysm neck size, and in need for stent-assisted therapy. Endovascular embolization can provide the same effective treatment for aneurysms in all directions.
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Affiliation(s)
- Huachen Zhang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, chool of Clinical Medicine, Tsinghua University, Beijing, China
| | - Shikai Liang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, chool of Clinical Medicine, Tsinghua University, Beijing, China
| | - Baiyang Zang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, chool of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xianli Lv
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, chool of Clinical Medicine, Tsinghua University, Beijing, China
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Saghebdoust S, Barani AR, Mehrizi MAA, Ekrami M, Lajimi AV, Termechi G. Endovascular Treatment of Anterior Communicating Artery Aneurysms: A Single-Center Experience from a Developing Country. Asian J Neurosurg 2023; 18:522-527. [PMID: 38152542 PMCID: PMC10749845 DOI: 10.1055/s-0043-1771316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
Objective In recent years, endovascular methods have been developed to treat intracranial aneurysms. To date, results of endovascular treatment (EVT) for anterior communicating aneurysms (ACoAs) have never been investigated in Iran. Thus, we sought to assess the mid-term angiographic and clinical outcomes of patients with ACoAs who underwent EVT in a tertiary center. Materials and Methods Electronic health documents of patients with ACoAs who underwent EVT from March 2019 to July 2021 were retrospectively reviewed. Demographic and clinical characteristics of patients, procedural and clinical complications along with immediate and 12 months' postprocedural angiographic and clinical results were included in the analysis. Aneurysm occlusion status was classified based on the Raymond-Roy Occlusion Classification (RROC), and clinical outcomes were assessed using the modified Rankin Scale (mRS). Results Of 38 patients with 38 ACoAs, 32 patients (84.21%) presented with subarachnoid hemorrhage of whom 23 (60.52%) had ruptured ACoAs. EVT included simple coiling in 29 patients (76.32%), balloon-assisted coiling in 6 (15.79%), and stent-assisted coiling in 3 (7.89%). Immediate and 12-month postprocedural angiograms demonstrated complete/near-complete occlusion (RROC I and II) in 32 (84.21%) and 35 patients (97.22%), respectively. Periprocedural complications occurred in five patients (13.15%), and the mortality rate was 5.26%. Thirty-two patients (84.21%) had favorable outcomes (mRS 0-2) at the last follow-up. Conclusion EVT is a safe and beneficial procedure with favorable mid-term clinical and angiographic outcomes for ACoAs. Our results can lay the foundation for further studies in developing countries and are satisfactory enough for neurointerventionists to put EVT on the therapeutic agenda of ACoAs.
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Affiliation(s)
- Sajjad Saghebdoust
- Department of Neurosurgery, Section of Neurovascular Intervention, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Neurosurgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Neurosurgery, Razavi Hospital, Mashhad, Iran
| | - Amir Reza Barani
- Department of Neurosurgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Mehran Ekrami
- Department of Neurosurgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Valinezhad Lajimi
- Department of Neurosurgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Feng L, Mao HJ, Zhang DD, Zhu YC, Han F. Anatomical variations in the Circle of Willis and the formation and rupture of intracranial aneurysms: A systematic review and meta-analysis. Front Neurol 2023; 13:1098950. [PMID: 36726753 PMCID: PMC9885143 DOI: 10.3389/fneur.2022.1098950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/30/2022] [Indexed: 01/17/2023] Open
Abstract
Background The anterior (AcomA) and posterior communicating arteries (PcomA) are two of the most frequent sites for intracranial aneurysms. Anatomical variations in the Circle of Willis (COW) are frequently observed in patients with AcomA and PcomA aneurysms. Strong evidence is needed to determine the pooled estimate of the effect of COW variations on the formation and rupture of these aneurysms. Aim This systematic review and meta-analysis aimed to establish the effect of COW variations on the formation and rupture of AcomA and PcomA aneurysms using available studies. Summary of review PubMed, Embase, and Web of Science databases were systematically searched for studies published in English before September 21, 2022. Studies investigating AcomA aneurysms and the hypoplastic/aplastic A1 segment of the anterior cerebral artery and PcomA aneurysms and hypoplastic/aplastic PcomA or fetal-type posterior cerebral artery (FTP) were included. The heterogeneity of the studies was assessed using Cochran Q-test and I2 statistic. Pooled estimate was assessed using either a random- or fixed-effects model based on the heterogeneity of the studies. Among the 4,932 studies, 21 were eligible and included in the analysis. The presence of hypoplastic/aplastic A1 was significantly correlated with the formation [OR (95% confidence interval [CI]) = 7.97 (5.58, 11.39), P < 0.001] and rupture [OR (95%CI) = 1.87 (1.29, 2.72), P < 0.001] of AcomA aneurysms. Significant associations between FTP and both the formation [OR (95%CI) = 2.15 (1.41, 3.30), P < 0.001] and rupture [OR (95%CI) = 1.72 (1.26, 2.36), P < 0.001] of PcomA aneurysms were observed. Conclusions Significant associations were observed between COW variations and both the formation and rupture of AcomA and PcomA aneurysms. This can help in determining interventions for patients with aneurysms. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=225149, identifier: CRD42021225149.
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Affiliation(s)
- Lu Feng
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - He-Jiao Mao
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ding-Ding Zhang
- Central Research Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi-Cheng Zhu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fei Han
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,*Correspondence: Fei Han ✉
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Piano M, Trombatore P, Lozupone E, Pero G, Cervo A, Macera A, Quilici L, Peschillo S, Valvassori L, Boccardi E. Flow Diverter Devices in the Treatment of Anterior Communicating Artery Region Aneurysms: Would the Regional Anatomy and the Aneurysm Location Affect the Outcomes? Brain Sci 2022; 12:1524. [PMID: 36358450 PMCID: PMC9688233 DOI: 10.3390/brainsci12111524] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 10/31/2022] [Accepted: 11/07/2022] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND In this study, the authors evaluated the efficacy and the safety of flow diverter devices (FDD) in anterior communicating artery (ACoA) region aneurysms, focusing on anatomical factors that could affect the outcome, such as the location of the aneurysm along the ACoA (centered on ACoA or decentered on the A1-A2 junction) and the anatomy of the ACoA region. METHODS Clinical, procedural and follow-up data were analyzed. Aneurysms were classified according to the location along the ACoA (centered or decentered on the A1-A2 junction) and on the basis of the anatomical configuration of the ACoA region. Safety was assessed by recording intraprocedural, periprocedural and delayed complications to determine the morbidity and mortality rates. The functional outcome was evaluated with the modified Rankin scale (mRS) prior to and after the endovascular procedure. To assess the efficacy, midterm and long-term clinical, angiographic and cross-sectional imaging follow-ups were recorded. Subgroup analysis according to the different ACoA regional anatomical configurations and the ACoA aneurysm locations were performed. RESULTS 33 patients (17 males; 16 females) with ACoA region aneurysms were treated with FDDs. 27 aneurysms were located at the A1-A2 junction (82%) while the remaining six aneurysms were centered on the ACoA. No mortality was recorded. The overall morbidity rate was 6% (2/33 procedures). Major complications occurred in 33% (2/6) of ACoA aneurysms and in the 0% of A1-A2 junction aneurysms. Mid-term and long-term neuroimaging follow-ups showed the occlusion of the aneurysm in 28/33 cases (85%). Complete occlusion rates were 93% in the A1-A2 junction aneurysms and 50% in ACoA aneurysms. CONCLUSIONS The FDD is a safe and effective tool that can be used in the treatment of selected cases of ACoA region aneurysms. The location of the aneurysm along the ACoA and the regional anatomy of the ACoA complex could affect the efficacy and safety.
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Affiliation(s)
- Mariangela Piano
- Department of Neuroradiology, Niguarda Hospital, 20162 Milano, Italy
| | - Pietro Trombatore
- Department of Neuroradiology, Ospedale San Gerardo, 20900 Monza, Italy
| | - Emilio Lozupone
- Department of Neuroradiology, Vito Fazzi Hospital, 73100 Lecce, Italy
| | - Guglielmo Pero
- Department of Neuroradiology, Niguarda Hospital, 20162 Milano, Italy
| | - Amedeo Cervo
- Department of Neuroradiology, Niguarda Hospital, 20162 Milano, Italy
| | - Antonio Macera
- Department of Neuroradiology, Niguarda Hospital, 20162 Milano, Italy
| | - Luca Quilici
- Department of Neuroradiology, ASST Ospedale Papa Giovanni XXIII, 24127 Bergamo, Italy
| | - Simone Peschillo
- Department of Neurosurgey, UniCamillus-Saint Camillus International University of Health Sciences, 00131 Rome, Italy
- Endovascular Neurosurgery, Pia Fondazione Cardinale Giovanni Panico Hospital, 73039 Lecce, Italy
| | - Luca Valvassori
- Department of Neuroradiology, ASST Santi Paolo e Carlo, 20142 Milano, Italy
| | - Edoardo Boccardi
- Department of Neuroradiology, Niguarda Hospital, 20162 Milano, Italy
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Zhang Y, Gu Y, He Y, Tang C, Gu B, Li Y, Wang W. The different recanalization rates of posterior communicating artery aneurysms with a fetal posterior communicating artery and anterior communicating artery aneurysms with a variation of the unilateral A1 segment. Quant Imaging Med Surg 2022; 12:354-365. [PMID: 34993084 DOI: 10.21037/qims-21-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 06/18/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Posterior communicating artery (PcomA) aneurysms are more likely to recanalize than anterior communicating artery (AcomA) aneurysms. However, it is still unclear whether the recanalization rate of these aneurysms is a result of involvement from the fetal posterior cerebral artery (fPCA) in PcomA aneurysms and variation of the unilateral A1 segment in AcomA aneurysms. The purpose of this study is to retrospectively evaluate the different recanalization rates between PcomA aneurysms with fPCA and AcomA aneurysms with a variation of the unilateral A1 segment. METHODS We retrospectively collected information regarding 214 patients, each with communicating segment aneurysms between January 2013 and January 2020. Follow-up documentation on clinical and imaging data was comparatively analyzed between variant types, and recanalization rates of the variant and normal types were analyzed by stratification. RESULTS Of the 84 variant-type aneurysms (PcomA with fPCA and AcomA with a variation of the unilateral A1 segment, 41/43), complete recanalization occurred in 23 patients (27.4%), and it was significantly more likely to occur in PcomA aneurysms with fPCA (39.1%) than in AcomA aneurysms with a variation of the unilateral A1 segment (16.3%). Stent-assisted coil embolization (SACE) has been shown to reduce recanalization (OR =0.092, 95% CI: 0.011 to 0.790, P=0.03). Additionally, variant types and the normal type (non-fetal, 106, and bilateral A1 symmetry, 24) have different odds ratios (OR) of recanalization (P=0.04), and the OR of the variant subtypes was significant, unlike the normal type (P=0.49). CONCLUSIONS This study suggests that PcomA aneurysms with fPCA are more likely to recanalize than AcomA aneurysms with a variation of the unilateral A1 segment.
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Affiliation(s)
- Yang Zhang
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yi Gu
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yu He
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Chaojie Tang
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Binxian Gu
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yongdong Li
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Wu Wang
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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Cortese J, Caroff J, Girot JB, Mihalea C, Da Ros V, Aguiar G, Elawady A, Ikka L, Gallas S, Ozanne A, Chalumeau V, Rouchaud A, Moret J, Spelle L. Impact of A1 Asymmetry on the Woven EndoBridge Device in Anterior Communicating Artery Aneurysms. AJNR Am J Neuroradiol 2021; 42:1479-1485. [PMID: 34117022 DOI: 10.3174/ajnr.a7189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/16/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Woven EndoBridge (WEB) devices are increasingly used to treat intracranial aneurysms. A1 asymmetry contributes to anterior communicating artery aneurysm formation and to treatment instability after coiling. We sought to evaluate whether A1 asymmetry had an impact on angiographic outcome in anterior communicating artery aneurysms treated with the WEB. MATERIALS AND METHODS Anterior communicating artery aneurysms treated between July 2012 and July 2020 with the WEB from an institutional review board-approved database were reviewed. A1 asymmetry was categorized as the following: absence of the A1 segment on 1 side (unilateral A1) versus bilateral A1. Univariate and multivariable analyses assessed independent predictors of adequate (WEB Occlusion Scale A, B, and C) and complete occlusion (WEB Occlusion Scale A and B). RESULTS Forty-eight individual aneurysms (47 patients) were included in the final analysis, of which 16 (33%) were acutely ruptured. The mean size was 6.5 (SD, 2.2) mm. Adequate and complete occlusion was achieved in 33 (69%) and 30 (63%) cases, respectively. Unilateral A1 was associated with significantly higher rates of adequate (92% versus 60% for bilateral A1; P = .03) and complete occlusion (92% versus 50% for bilateral A1; P < .01). Multivariable logistic regression confirmed unilateral A1 as an independent predictor of both adequate (OR = 10.6; 95% CI, 1.6-220.7; P = .04) and complete occlusion (OR = 9.5, 95% CI, 1.5-190.2; P = .04. A sensitivity analysis comparing unilateral "functional" A1 with bilateral "functional" A1 showed similar results. WEB shape modification was not influenced by the unilateral A1 configuration (P = .70). CONCLUSIONS Anterior communicating artery aneurysms with a unilateral A1 configuration treated with WEB devices are associated with better angiographic outcome than those with bilateral A1. This finding supports the hypothesis that WEB devices are resistant to unilateral flow in the aneurysm as opposed to coils.
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Affiliation(s)
- J Cortese
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - J Caroff
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - J-B Girot
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France.,Department of Radiology (J.-B.G.), Angers University Hospital, Angers, France
| | - C Mihalea
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - V Da Ros
- Department of Biomedicine (V.D.R.), Fondazione PTV Policlinico Tor Vergata, Roma, Italy
| | - G Aguiar
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - A Elawady
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - L Ikka
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - S Gallas
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - A Ozanne
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - V Chalumeau
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - A Rouchaud
- Department of Interventional Neuroradiology (A.R.), Limoges University Hospital, Limoges, France.,University of Limoges (A.R.), XLIM UMR CNRS 7252, Limoges, France
| | - J Moret
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - L Spelle
- Department of Interventional Neuroradiology (J. Cortese, J. Caroff, J.-B.G., C.M., G.A., A.E., L.I., S.G., A.O., V.C., J.M., L.S.), NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
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Xue G, Liu P, Xu F, Fang Y, Li Q, Hong B, Xu Y, Liu J, Huang Q. Endovascular Treatment of Ruptured Wide-Necked Anterior Communicating Artery Aneurysms Using a Low-Profile Visualized Intraluminal Support (LVIS) Device. Front Neurol 2021; 11:611875. [PMID: 33584512 PMCID: PMC7876256 DOI: 10.3389/fneur.2020.611875] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/14/2020] [Indexed: 12/03/2022] Open
Abstract
Objective: To evaluate the safety and efficacy of low-profile visualized intraluminal support (LVIS) stent-assisted coiling for the treatment of ruptured wide-necked anterior communicating artery (ACoA) aneurysms. Methods: The clinical and angiographic data of 31 acutely ruptured wide-necked ACoA aneurysms treated with LVIS stent-assisted coiling between January 2014 and December 2018 were retrospectively reviewed. Results: All stents were successfully deployed. The immediate angiographic results were modified Raymond-Roy class I in 27 cases, modified Raymond-Roy class II in 2 cases, and modified Raymond-Roy class IIIa in 2 cases. Intraoperative thrombosis and postoperative aneurysmal rebleeding occurred in one case each. Two patients (6.5%) who were admitted due to poor clinical grade conditions died during hospital admission as a result of initial bleeding. Angiographic follow-up (mean: 12.9 months) was performed for 26 patients, the results of which demonstrated that 25 aneurysms were completely occluded and one was class II. The last clinical follow-up (mean: 25.3 months) outcomes demonstrated that 27 patients had favorable clinical outcomes and two had poor clinical outcomes. Conclusion: LVIS stent-assisted coiling for ruptured wide-necked ACoA aneurysms was safe and effective, with a relatively low rate of perioperative complications and a high rate of complete occlusion at follow-up.
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Affiliation(s)
- Gaici Xue
- Department of Neurosurgery, General Hospital of Southern Theatre Command of People's Liberation Army of China, Guangzhou, China
| | - Peng Liu
- Department of Neurosurgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Fengfeng Xu
- Department of Neurosurgery, Naval Medical Center of People's Liberation Army of China, Navy Medical University, Shanghai, China
| | - Yibin Fang
- Department of Neurosurgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Qiang Li
- Department of Neurosurgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Bo Hong
- Department of Neurosurgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Yi Xu
- Department of Neurosurgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Jianmin Liu
- Department of Neurosurgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Qinghai Huang
- Department of Neurosurgery, Changhai Hospital, Navy Medical University, Shanghai, China
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Oumer M, Alemayehu M, Muche A. Association between circle of Willis and ischemic stroke: a systematic review and meta-analysis. BMC Neurosci 2021; 22:3. [PMID: 33478402 PMCID: PMC7818725 DOI: 10.1186/s12868-021-00609-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 01/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background Circle of Willis is the main structure that provides constant and regular blood flow to the brain, protects the brain from ischemia. Stroke has remained the second leading cause of death globally in the last fifteen years. It is the fifth leading cause of death in the United States. It is also the leading cause of serious adult disability. Interlinked problems related to ischemic stroke are become increasing nowadays. Strong evidence is needed about the pooled measure of association between the circle of Willis (COW) and ischemic stroke. Therefore, this systematic review and meta-analysis were intended to provide compressive and up to date evidence on the association between the variations of COW and ischemic stroke using the available studies. Methods PubMed, Google Scholar, Science Direct, and Cochrane Library databases were systematically searched. All essential data were extracted using a standardized data extraction template. The heterogeneity across studies was assessed by using the Cochrane Q test statistic, I2 test statistic, and P-values. A fixed-effect model was used to estimate the pooled effect of the measure association between COW and ischemic stroke. Results In this meta-analysis, 2,718 participants were involved. The pooled measure of association between COW and ischemic stroke was 1.38 (95% CI 0.87, 2.19). Therefore, this indicated that the presence of any variation in COW was 1.38 times more likely to develop ischemic stroke as compared to the patent COW. The presence of hypoplasia/incompleteness in a posterior communicating artery (PcomA) [Pooled OR: 1.34 (95% CI 0.80, 2.25)] and anterior communicating artery (AcomA) [Pooled OR: 1.32 (95% CI 0.81, 2.19)] were a contributing factor for the development of ischemic stroke. Hypertension was the most common comorbid condition, followed by diabetes mellitus, smoking, coronary artery disease, and hyperlipidemia. Conclusions There was a non-significant positive association between COW variation and ischemic stroke in this meta-analysis.
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Affiliation(s)
- Mohammed Oumer
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara, Ethiopia. .,Department of Epidemiology, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara, Ethiopia.
| | - Mekuriaw Alemayehu
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara, Ethiopia
| | - Abebe Muche
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara, Ethiopia
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10
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Shalom DE, Trevisan MA, Mallela A, Nuñez M, Goldschmidt E. Brain folding shapes the branching pattern of the middle cerebral artery. PLoS One 2021; 16:e0245167. [PMID: 33411825 PMCID: PMC7790398 DOI: 10.1371/journal.pone.0245167] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/22/2020] [Indexed: 11/19/2022] Open
Abstract
The folds of the brain offer a particular challenge for the subarachnoid vascular grid. The primitive blood vessels that occupy this space, when the brain is flat, have to adapt to an everchanging geometry while constructing an efficient network. Surprisingly, the result is a non-redundant arterial system easily challenged by acute occlusions. Here, we generalize the optimal network building principles of a flat surface growing into a folded configuration and generate an ideal middle cerebral artery (MCA) configuration that can be directly compared with the normal brain anatomy. We then describe how the Sylvian fissure (the fold in which the MCA is buried) is formed during development and use our findings to account for the differences between the ideal and the actual shaping pattern of the MCA. Our results reveal that folding dynamics condition the development of arterial anastomosis yielding a network without loops and poor response to acute occlusions.
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Affiliation(s)
- Diego E. Shalom
- Physics Institute of Buenos Aires (IFIBA) CONICET, Buenos Aires, Argentina
- Department of Physics, University of Buenos Aires (UBA), Buenos Aires, Argentina
| | - Marcos A. Trevisan
- Physics Institute of Buenos Aires (IFIBA) CONICET, Buenos Aires, Argentina
- Department of Physics, University of Buenos Aires (UBA), Buenos Aires, Argentina
| | - Arka Mallela
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
| | - Maximiliano Nuñez
- Department of Neurosurgery, El Cruce Hospital, Provincia de Buenos Aires, Argentina
| | - Ezequiel Goldschmidt
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
- Division of Molecular Neurobiology, Department of Medical Biochemistry and Biophysics, Karolinska Institute, Stockholm, Sweden
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11
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Hindenes LB, Håberg AK, Johnsen LH, Mathiesen EB, Robben D, Vangberg TR. Variations in the Circle of Willis in a large population sample using 3D TOF angiography: The Tromsø Study. PLoS One 2020; 15:e0241373. [PMID: 33141840 PMCID: PMC7608873 DOI: 10.1371/journal.pone.0241373] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 10/14/2020] [Indexed: 11/18/2022] Open
Abstract
The main arteries that supply blood to the brain originate from the Circle of Willis (CoW). The CoW exhibits considerable anatomical variations which may have clinical importance, but the variability is insufficiently characterised in the general population. We assessed the anatomical variability of CoW variants in a community-dwelling sample (N = 1,864, 874 men, mean age = 65.4, range 40–87 years), and independent and conditional frequencies of the CoW’s artery segments. CoW segments were classified as present or missing/hypoplastic (w/1mm diameter threshold) on 3T time-of-flight magnetic resonance angiography images. We also examined whether age and sex were associated with CoW variants. We identified 47 unique CoW variants, of which five variants constituted 68.5% of the sample. The complete variant was found in 11.9% of the subjects, and the most common variant (27.8%) was missing both posterior communicating arteries. Conditional frequencies showed patterns of interdependence across most missing segments in the CoW. CoW variants were associated with mean-split age (P = .0147), and there was a trend showing more missing segments with increasing age. We found no association with sex (P = .0526). Our population study demonstrated age as associated with CoW variants, suggesting reduced collateral capacity with older age.
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Affiliation(s)
- Lars B. Hindenes
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- PET Centre, University Hospital of North Norway, Tromsø, Norway
- * E-mail:
| | - Asta K. Håberg
- Department of Radiology and Nuclear Medicine, St. Olav University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Liv Hege Johnsen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ellisiv B. Mathiesen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway
| | - David Robben
- ESAT-PSI, Department of Electrical Engineering, KU Leuven, Leuven, Belgium
- Icometrix, Leuven, Belgium
| | - Torgil R. Vangberg
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- PET Centre, University Hospital of North Norway, Tromsø, Norway
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12
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Jacquens A, Shotar E, Bombled C, Glémain B, Sourour NA, Nouet A, Premat K, Lenck S, Degos V, Clarençon F. Is Anatomical Variations a Risk Factor for Cerebral Vasospasm in Anterior Communicating Complex Aneurysms Rupture? Stroke 2020; 51:998-1001. [PMID: 31964285 DOI: 10.1161/strokeaha.119.026661] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- One-third of ruptured aneurysms are located on the anterior communicating complex with high prevalence of anatomic variations of this arterial segment. In this study, we hypothesized that anatomic variations of the anterior communicating complex increase the risk of angiographic vasospasm. Methods- Retrospective study of prospectively collected data from a monocentric subarachnoid hemorrhage cohort of patients admitted to neurointensive care between 2002 and 2018. Univariate followed by multivariate logistic regression analysis was used to identify factors associated with angiographic vasospasm. Results- One thousand three hundred seventy-four patients with aneurismal subarachnoid hemorrhage were admitted to our institution; 29.8% (n=410) were related to an anterior communicating complex aneurysm rupture; 9.2% (n=38) of them showed an anterior communicating artery variation. Angiographic vasospasm was diagnosed in 55.6% of this subgroup (vs 28.1%, P=0.003). In the multivariate analysis, external ventricular drain (2.2 [1.32-3.65], P=0.003) and anterior communicating artery variation (2.40 [1.2-4.9], P=0.04) were independently and significantly associated with angiographic vasospasm, while age above 60 years (0.3 [0.2-0.7]; P=0.002) was a protective factor. However, anterior communicating artery variation was not statistically associated with ischemic vasospasm or poor neurological outcome after anterior communicating artery aneurysm rupture. Conclusions- Anatomic variation of anterior communicating artery could be a new biomarker to identify patients at risk to develop angiographic vasospasm post-subarachnoid hemorrhage. External validation cohorts are necessary to confirm these results.
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Affiliation(s)
- Alice Jacquens
- From the Department of Neurosurgical Anesthesiology and Critical Care (A.J., C.B., B.G., V.D.), Pitié-Salpêtrière Hospital, France
| | - Eimad Shotar
- Department of Neuroradiology (E.S., N.-A.S., K.P., S.L., F.C.), Pitié-Salpêtrière Hospital, France
| | - Camille Bombled
- From the Department of Neurosurgical Anesthesiology and Critical Care (A.J., C.B., B.G., V.D.), Pitié-Salpêtrière Hospital, France
| | - Benjamin Glémain
- From the Department of Neurosurgical Anesthesiology and Critical Care (A.J., C.B., B.G., V.D.), Pitié-Salpêtrière Hospital, France
| | - Nader-Antoine Sourour
- Department of Neuroradiology (E.S., N.-A.S., K.P., S.L., F.C.), Pitié-Salpêtrière Hospital, France
| | - Aurélien Nouet
- Department of Neurosurgery (A.N.), Pitié-Salpêtrière Hospital, France
| | - Kevin Premat
- Department of Neuroradiology (E.S., N.-A.S., K.P., S.L., F.C.), Pitié-Salpêtrière Hospital, France.,Sorbonne Université, Paris, France (K.P., V.D., F.C.)
| | - Stephanie Lenck
- Department of Neuroradiology (E.S., N.-A.S., K.P., S.L., F.C.), Pitié-Salpêtrière Hospital, France
| | - Vincent Degos
- From the Department of Neurosurgical Anesthesiology and Critical Care (A.J., C.B., B.G., V.D.), Pitié-Salpêtrière Hospital, France.,Sorbonne Université, Paris, France (K.P., V.D., F.C.).,Groupe de Recherché Clinique BIOFAST (V.D., F.C.)
| | - Frédéric Clarençon
- Department of Neuroradiology (E.S., N.-A.S., K.P., S.L., F.C.), Pitié-Salpêtrière Hospital, France.,Sorbonne Université, Paris, France (K.P., V.D., F.C.).,Groupe de Recherché Clinique BIOFAST (V.D., F.C.)
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13
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Amuluru K, Al-Mufti F, Romero CE. Flow diversion treatment of anterior communicating artery region aneurysms. J Neuroradiol 2019; 48:391-396. [PMID: 31229575 DOI: 10.1016/j.neurad.2019.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 06/13/2019] [Accepted: 06/13/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND PURPOSE Reports on flow diversion treatment of aneurysms beyond the Circle of Willis are limited, with few series dedicated to anterior communicating artery region aneurysms. The purpose of this study is to evaluate the safety and effectiveness of the pipeline embolization device in the treatment of anterior communicating artery region aneurysms. MATERIALS AND METHODS The neuro-interventional database of a single institution was retrospectively reviewed for anterior communicating artery aneurysms treated with the pipeline embolization device between November 2016 and December 2018. Data on clinical presentation, aneurysm location, type, vessel size, procedural complications, clinical and imaging follow-up were analyzed. RESULTS Ten patients with 11 anterior communicating artery aneurysms were included. Procedural success was achieved in 9/10 patients (90%). Flow diversion with the pipeline embolization device yielded occlusion in 100% of patients at 6.5 months. Symptomatic ischemic complications occurred in 2/10 patients (20%); only one of who had permanent symptoms. Hemorrhagic groin complications were encountered in 2/10 patients (20%). There were no deaths and no cerebral hemorrhagic complications. CONCLUSIONS Flow diversion therapy may provide a feasible solution for anterior communicating artery region aneurysms that are not amenable to traditional surgical or endovascular modalities.
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Affiliation(s)
- Krishna Amuluru
- Goodman Campbell Brain and Spine, Ascension St. Vincent Medical Center, Division of Interventional Neuroradiology, Indianapolis IN, United States; Department of Interventional Neuroradiology, University of Pittsburgh Medical Center-Hamot, 300 State St, Suite 4100 Erie, 16550 PA, United States.
| | - Fawaz Al-Mufti
- Westchester Medical Center, Department of Endovascular Neurosurgery and Neurocritical Care, Valhalla, NY, United States
| | - Charles Edward Romero
- Goodman Campbell Brain and Spine, Ascension St. Vincent Medical Center, Division of Interventional Neuroradiology, Indianapolis IN, United States
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14
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Angiographic and clinical results of anterior communicating artery aneurysm endovascular treatment. Wideochir Inne Tech Maloinwazyjne 2019; 14:451-460. [PMID: 31534577 PMCID: PMC6748064 DOI: 10.5114/wiitm.2019.81406] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 11/13/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction The anterior communicating artery (ACoA) is the most common location of intracranial aneurysms, observed in 35% of cases. Endovascular treatment has become an alternative to surgical clipping and the primary method of choice. Aim To assess the treatment results of ruptured and unruptured ACoA aneurysms and to assess the incidence of intraprocedural complications and various factors influencing these aspects. Material and methods One hundred and eleven embolizations of ACoA aneurysms (80.7% ruptured and 19.3% unruptured) were retrospectively analysed. The methods of embolization were: coiling, balloon-assisted coiling, stent-assisted coiling. Morphology and dimensions of aneurysms were assessed on 3D digital subtraction angiography (DSA) images. Medical records were analysed for patient’s clinical status at admission, intraprocedural complications, follow-up examination and modified Rankin Scale (mRS) score 1 month after discharge. Results Immediately after the procedure 56.9% of patients had Raymond-Roy Occlusion Classification (RROC) class I, 37.6% class II and 5.5% class III. The overall intraprocedural complication rate was 6.6%. There were significantly more cases of bleeding (p = 0.012) and coil prolapse (p = 0.012) during the procedures ending with higher packing density. Twenty-eight (25.7%) patients died during hospital stay, 27 (96.4%) with ruptured aneurysm. In the follow-up of 41 patients, RROC was the same or improved in 73.2% of cases and recanalization occurred in 26.8%. Six patients with aneurysm recanalization underwent repeat embolization. Conclusions Endovascular embolization of ACoA aneurysms is an effective and safe treatment method. The most powerful factor influencing the incidence of complications is packing density. Superior orientation of the dome, initial incomplete embolization and poor outcome in mRS scale are factors predisposing to ACoA aneurysm recurrence.
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15
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Altafulla JJ, Simonds EA, Dupont G, Lachkar S, Litvack Z, Iwanaga J, Tubbs RS. A Median Artery of the Corpus Callosum. Cureus 2018; 10:e3355. [PMID: 30510865 PMCID: PMC6257654 DOI: 10.7759/cureus.3355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The anterior communicating artery is one of the main components of the vascular network that delivers blood to the brain. Therefore, a good understanding of the normal anatomy and its variations is important to neurologists, neurosurgeons, and other health care providers dealing with the central nervous system. Here, we present a case of a median artery of the corpus callosum found in a cadaver, with consideration of cerebral hemodynamics implications.
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Affiliation(s)
| | | | - Graham Dupont
- Neurological Surgery, Seattle Science Foundation, Seattle , USA
| | - Stefan Lachkar
- Clinical Anatomy, Seattle Science Foundation, Seattle, USA
| | | | - Joe Iwanaga
- Medical Education and Simulation, Seattle Science Foundation, Seattle, USA
| | - R Shane Tubbs
- Neurosurgery, Seattle Science Foundation, Seattle, USA
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16
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Jabbarli R, Reinhard M, Roelz R, Kaier K, Weyerbrock A, Taschner C, Scheiwe C, Shah M. Clinical relevance of anterior cerebral artery asymmetry in aneurysmal subarachnoid hemorrhage. J Neurosurg 2017; 127:1070-1076. [DOI: 10.3171/2016.9.jns161706] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEAn asymmetry of the A1 segments (A1SA) of the anterior cerebral arteries (ACAs) is an assumed risk factor for the development of anterior communicating artery aneurysms (ACoAAs). It is unknown whether A1SA is also clinically relevant after aneurysm rupture. The authors of this study investigated the impact of A1SA on the clinical course and outcome of patients with aneurysmal subarachnoid hemorrhage (SAH).METHODSThe authors retrospectively analyzed data on consecutive SAH patients treated at their institution between January 2005 and December 2012. The occurrence and severity of cerebral infarctions in the ACA territories were evaluated on follow-up CT scans up to 6 weeks after SAH. Moreover, the risk for an unfavorable outcome (defined as > 3 points on the modified Rankin Scale) at 6 months after SAH was assessed.RESULTSA total of 594 patients were included in the final analysis. An A1SA was identified on digital subtraction angiography studies from 127 patients (21.4%) and was strongly associated with ACoAA (p < 0.0001, OR 13.7). An A1SA independently correlated with the occurrence of ACA infarction in patients with ACoAA (p = 0.047) and in those without an ACoAA (p = 0.015). Among patients undergoing ACoAA coiling, A1SA was independently associated with the severity of ACA infarction (p = 0.023) and unfavorable functional outcome (p = 0.045, OR = 2.4).CONCLUSIONSAn A1SA is a common anatomical variation in SAH patients and is strongly associated with ACoAA. Moreover, the presence of A1SA independently increases the likelihood of ACA infarction. In SAH patients undergoing ACoAA coiling, A1SA carries the risk for severe ACA infarction and thus an unfavorable outcome.Clinical trial registration no.: DRKS00005486 (http://www.drks.de/)
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Affiliation(s)
- Ramazan Jabbarli
- Departments of 1Neurosurgery,
- 2Department of Neurosurgery, University Hospital Essen; and
| | - Matthias Reinhard
- 3Department of Neurology and Clinical Neurophysiology, Klinikum Esslingen, Germany
- 4Neurology and Neurophysiology, and
| | | | - Klaus Kaier
- 5Institute for Medical Biometry and Medical Informatics, University Medical Center Freiburg
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Cohen JE, Moscovici S, El Hassan HA, Doron O, Itshayek E. T-microstent-assisted coiling in the management of ruptured wide-necked anterior communicating artery aneurysms: Choosing between Y, X and T. J Clin Neurosci 2016; 34:283-287. [DOI: 10.1016/j.jocn.2016.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 08/14/2016] [Indexed: 11/28/2022]
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18
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Dabus G, Grossberg JA, Cawley CM, Dion JE, Puri AS, Wakhloo AK, Gonsales D, Aguilar-Salinas P, Sauvageau E, Linfante I, Hanel RA. Treatment of complex anterior cerebral artery aneurysms with Pipeline flow diversion: mid-term results. J Neurointerv Surg 2016; 9:147-151. [PMID: 27382125 DOI: 10.1136/neurintsurg-2016-012519] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 06/12/2016] [Accepted: 06/20/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND The off-label use of flow diverters in the treatment of distal aneurysms continues to be debated. OBJECTIVE To report our multicenter experience in the treatment of complex anterior cerebral artery aneurysms with the Pipeline embolization device (PED). METHODS The neurointerventional databases of the four participating institutions were retrospectively reviewed for aneurysms treated with PED between October 2011 and January of 2016. All patients treated for anterior cerebral artery aneurysms were included in the analysis. Clinical presentation, location, type, vessel size, procedural complications, clinical and imaging follow-up were included in the analysis. RESULTS Twenty patients (13 female) with 20 aneurysms met the inclusion criteria in our study. Fifteen aneurysms were classified as saccular and five as fusiform (mean size 7.3 mm). Thirteen aneurysms were located in the anterior communicating region (ACOM or A1/2 junction), six were A2-pericallosal, and one was located in the A1 segment. Six patients had presented previously with subarachnoid hemorrhage and had their aneurysms initially clipped or coiled. There was one minor event (a small caudate infarct) and one major event (intraparenchymal hemorrhage). Sixteen of the 20 patients had angiographic follow-up (mean 10 months). Eleven aneurysms were completely occluded, one had residual neck, and four had residual aneurysm filling. CONCLUSIONS The treatment of complex anterior cerebral artery aneurysms with the PED as an alternative for patients who are not good candidates for conventional methods is technically feasible and safe. Mid-term results are promising but larger series with long-term follow-up are required to assess its effectiveness.
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Affiliation(s)
- Guilherme Dabus
- Miami Cardiac & Vascular Institute, Florida International University, Miami, Florida, USA.,Baptist Neuroscience Center, Florida International University, Miami, Florida, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Jonathan A Grossberg
- Departments of Radiology and Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - C Michael Cawley
- Departments of Radiology and Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Jacques E Dion
- Departments of Radiology and Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Ajit S Puri
- Department of Radiology, University of Massachusetts, Worcester, Massachusetts, USA
| | - Ajay K Wakhloo
- Department of Radiology, University of Massachusetts, Worcester, Massachusetts, USA
| | - Douglas Gonsales
- Baptist Neurological Institute, Baptist Health System, Jacksonville, Florida, USA
| | | | - Eric Sauvageau
- Baptist Neurological Institute, Baptist Health System, Jacksonville, Florida, USA
| | - Italo Linfante
- Miami Cardiac & Vascular Institute, Florida International University, Miami, Florida, USA.,Baptist Neuroscience Center, Florida International University, Miami, Florida, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Ricardo A Hanel
- Baptist Neurological Institute, Baptist Health System, Jacksonville, Florida, USA
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Morphological risk factors for the rupture of anterior communicating artery aneurysms: the significance of fenestration. Neuroradiology 2015; 58:155-60. [DOI: 10.1007/s00234-015-1610-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 10/13/2015] [Indexed: 10/22/2022]
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20
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Cui Y, Xu T, Chen J, Tian H, Cao H. Anatomic variations in the anterior circulation of the circle of Willis in cadaveric human brains. Int J Clin Exp Med 2015; 8:15005-15010. [PMID: 26628984 PMCID: PMC4658873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 09/08/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The Cycle of Willis unites the internal carotid and vertebrobasilar system and maintains the stability of blood supply to the brain. This present study aims to analyze the anatomic variations in the anterior part of the Cycle of Willis. METHODS Forty five formalin-preserved human brains (90 cerebral hemispheres) with intact dura mater from Chinese adults were dissected under the surgical microscope. The anterior components of the Circle of Willis were observed and measured. Anatomic variations of this segment were observed and photographed. The data collected in this investigation was statistically analyzed. RESULTS In approximately 13.3% (6/45) of all cerebral samples, a caliber difference of ≥ 0.5 mm was noted between the left A1 and the right segments. The A2 segments of left and right hemispheres were derived from the contralateral A1 segment in 6.7% (3/45) of the brain specimens. Simple anterior communicating artery (ACoA) was observed in 37.8% (17/45) whereas complex ACoA was noted in 60% (27/45) of cerebral samples. CONCLUSION As it demonstrates the anatomic variations of ACAC, all surgical approaches should be performed after angiographic demonstrations. Understanding of these anatomic variations plays a pivotal role in neurovascular procedures.
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Affiliation(s)
- Yuhui Cui
- Shanghai JiaoTong University Affiliated Sixth People's Hospital Shanghai 200233, China
| | - Tao Xu
- Shanghai JiaoTong University Affiliated Sixth People's Hospital Shanghai 200233, China
| | - Jiong Chen
- Shanghai JiaoTong University Affiliated Sixth People's Hospital Shanghai 200233, China
| | - Hengli Tian
- Shanghai JiaoTong University Affiliated Sixth People's Hospital Shanghai 200233, China
| | - Heli Cao
- Shanghai JiaoTong University Affiliated Sixth People's Hospital Shanghai 200233, China
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