Evaluation of the safety and efficacy of a Pipeline Flex embolization device for treatment of large, wide-necked intracranial aneurysms

Objective: To investigate the safety and effectiveness of the Pipeline Flex embolization device(PFED) in the treatment of large and wide-necked aneurysms in the internal carotid artery(ICA). Methods: The clinical data of 78 cases of large and wide-necked aneurysms in the ICA treated with this Pipeline Flex embolization device in Shanghai Hospital of the Second Military Medical University and Southern Hospital of Southern Medical University from February 2017 to June 2018 were retrospectively analyzed. Results: A total of 66 cases were treated with a Pipeline Flex embolization device, 10 with a pipeline flex embolization device, and 2 with a double tubride stent(10 patients were treated with a pipeline stent-assisted coil embolization in; and 2 patients were treated with two pipeline stents). The patients were followed up for 3 to 18 months(average, 9.25 months). Among them, 63 cases had complete occlusion of the neck of the aneurysm(Raymondl Class I; MRS score 0; 80.8%). Aneurysms recurred in 12 cases(Raymondl Class Ⅱ; MRS score 1; 15.4%). Delayed ischemic complications were observed in 1 case(MRS score >2; 0.13%). There was 1 case of poor release of stent and 1 case of stent stenosis(0.13%). Conclusion: The treatment of large, wide-necked aneurysms in the ICA with PFED has a high total occlusion rate and good prognosis was better than coil embolization, but the placement of PFED still has some neurological complications.

Advancements and challenges in neuroimaging for the diagnosis of intracranial aneurysms:Addressing false positive diagnoses and emerging techniques

Despite advancements in neuroimaging,false positive diagnoses of intracranial aneurysms remain a significant concern.This article examines the causes,prevalence,and implications of such false-positive diagnoses.We discuss how conditions like arterial occlusion with vascular stump formation and infundibular widening can mimic aneurysms,particularly in the anterior circulation.The article compares various imaging modalities,including computer tomography angiogram,magnetic resonance imaging/angiography,and digital subtraction angiogram,highlighting their strengths and limitations.We emphasize the im-portance of accurate differentiation to avoid unnecessary surgical interventions.The potential of emerging technologies,such as high-resolution vessel wall ima-ging and deep neural networks for automated detection,is explored as promising avenues for improving diagnostic accuracy.This manuscript underscores the need for continued research and clinical vigilance in the diagnosis of intracranial aneurysms.

Hemodynamic effects of stenting on wide-necked intracranial aneurysms

Background Stent placement has been widely used to assist coiling in cerebral aneurysm treatments. The present study aimed to investigate the hemodynamic effects of stenting on wide-necked intracranial aneurysms.Methods Three idealized plexiglass aneudsmal models with different geometries before and after stenting were created, and their three-dimensional computational models were constructed. Flow dynamics in stented and unstented aneurismal models were studied using in vitro flow visualization and computational fluid dynamics （CFD） simulations. In addition, effects of stenting on flow dynamics in a patient-specific aneurysm model were also analyzed by CFD.Results The results of flow visualization were consistent with those obtained with CFD simulations. Stent deployment reduced vortex inside the aneurysm and its impact on the aneurysm sac, and decreased wall shear stress on the sac.Different aneurysm geometries dictated fundamentally different hemodynamic patterns and outcomes of stenting.Conclusions Stenting across the neck of aneurysms improves local blood flow profiles. This may facilitate thrombus formation in aneurysms and decrease the chance of recanalization.

Safety and efficacy of stent-assisted coiling for acutely ruptured wide-necked intracranial aneurysms:comparison of LVIS stents with laser-cut stents

Background:To compare the safety and efficacy of LVIS stent-assisted coiling with those of laser-cut stent-assisted coiling for the treatment of acutely ruptured wide-necked intracranial aneurysms.Methods:Patients with acutely ruptured wide-necked intracranial aneurysms treated with LVIS stent-assisted coiling(LVIS stent group)and laser-cut stent-assisted coiling(laser-cut stent group)were retrospectively reviewed from January 2014 to December 2017.Propensity score matching was used to adjust for potential differences in age,sex,aneurysm location,aneurysm size,neck width,Hunt-Hess grade,and modified Fisher grade.Perioperative procedure-related complications and clinical and angiographic follow-up outcomes were compared.Univariate and multivariate analyses were performed to determine the associations between procedure-related complications and potential risk factors.Results:A total of 142 patients who underwent LVIS stent-assisted coiling and 93 patients who underwent laser-cut stent-assisted coiling were enrolled after 1:2 propensity score matching.The angiographic follow-up outcomes showed that the LVIS stent group had a slightly higher complete occlusion rate and lower recurrence rate than the laser-cut stent group(92.7%vs 80.6%;3.7%vs 9.7%,P=0.078).The clinical outcomes at discharge and follow-up between the two groups demonstrated no significant differences(P=0.495 and P=0.875,respectively).The rates of intraprocedural thrombosis,postprocedural thrombosis,postoperative early rebleeding,and procedure-related death were 0.7%(1/142),1.4%(2/142),2.8%(4/142),and 2.1%(3/142)in the LVIS stent group,respectively,and 4.3%(4/93),2.2%(2/93),1.1%(1/93),and 3.2%(3/93)in the laser-cut stent group,respectively(P=0.082,0.649,0.651,and 0.683).Nevertheless,the rates of overall procedure-related complications and intraprocedural rupture in the LVIS stent group were significantly lower than those in the laser-cut stent group(5.6%vs 14.0%,P=0.028;0.7%vs 6.5%,P=0.016).Multivariate analysis showed that laser-cut stent-assisted coiling was an independent predictor for overall procedurerelated complications(OR=2.727,P=0.037);a history of diabetes(OR=7.275,P=0.027)and other cerebrovascular diseases(OR=8.083,P=0.022)were independent predictors for ischemic complications,whereas none of the factors were predictors for hemorrhagic complications.Conclusions:Compared with laser-cut stent-assisted coiling,LVIS stent-assisted coiling for the treatment of acutely ruptured wide-necked intracranial aneurysms could reduce the rates of overall procedure-related complications and intraprocedural rupture.

Effects of Enterprise 2 stent-assisted coil embolization for wide-necked intracranial aneurysms

Background:This study analyzed the safety and efficacy of Enterprise 2 stent-assisted coil embolization for wide-necked intracranial aneurysms by examining stent-vessel apposition,operative complications,embolization outcomes,and clinical outcomes.Methods:We retrospectively reviewed the medical records of patients with wide-necked intracranial aneurysms who underwent Enterprise 2 stent-assisted coiling in our hospital from November 2018 to October 2019.Intraoperative VasoCT was performed immediately after stent release in a continuous cohort of patients to observe stent-vessel apposition.Patient demographic,clinical,and imaging data were recorded and analyzed.Results:A total of 106 wide-necked aneurysms in 106 patients were treated.Stent release was successful in all patients.Twenty-one patients were enrolled consecutively for VasoCT scanning,and incomplete stent apposition was observed in 5(23.8%).Perioperative complications occurred in 10 patients(9.4%):cerebral infarction in 6,intraoperative coil prolapse in 1,puncture site pseudoaneurysm in 1,deep vein thrombosis at multiple sites in 1,and transient brainstem mass effect in 1.Among the 95 aneurysms with angiographic follow-up,embolization was satisfactory(Raymond-Roy classifications I and II)in 89(93.7%).Hyperlipidemia was an independent risk factor for incomplete aneurysm occlusion.At the last clinical follow-up,seven patients had a poor clinical outcome(modified Rankin Scale score≥3).Independent risk factors for poor outcomes were preoperative subarachnoid hemorrhage at presentation and cerebral infarction.Conclusion:Enterprise 2 stent-assisted coiling for treatment of wide-necked intracranial aneurysms showed good safety and efficacy;however,incomplete stent apposition can still occur in vessels with a large curvature.Preoperative subarachnoid hemorrhage at presentation and cerebral infarction are the main reasons for poor clinical outcomes after stent-assisted coil embolization.

Knowledge domain and emerging trends in the rupture risk of intracranial aneurysms research from 2004 to 2023

BACKGROUND Intracranial aneurysms(IAs)pose significant health risks,attributable to their potential for sudden rupture,which can result in severe outcomes such as stroke and death.Despite extensive research,the variability of aneurysm behavior,with some remaining stable for years while others rupture unexpectedly,remains poorly understood.AIM To employ bibliometric analysis to map the research landscape concerning risk factors associated with IAs rupture.METHODS A systematic literature review of publications from 2004 to 2023 was conducted,analyzing 3804 documents from the Web of Science Core Collection database,with a focus on full-text articles and reviews in English.The analysis encompassed citation and co-citation networks,keyword bursts,and temporal trends to delineate the evolution of research themes and collaboration patterns.Advanced software tools,CiteSpace and VOSviewer,were utilized for comprehensive data visualization and trend analysis.RESULTS Analysis uncovered a total of 3804 publications on IA rupture risk factors between 2006 and 2023.Research interest surged after 2013,peaking in 2023.The United States led with 28.97%of publications,garnering 37706 citations.Notable United States-China collaborations were observed.Capital Medical University produced 184 publications,while Utrecht University boasted a citation average of 69.62 per publication.“World Neurosurgery”published the most papers,contrasting with“Stroke”,the most cited journal.The PHASES score from“Lancet Neurology”emerged as a vital rupture risk prediction tool.Early research favored endovascular therapy,transitioning to magnetic resonance imaging and flow diverters.CONCLUSION This study assesses global IA research trends and highlights crucial gaps,guiding future investigations to improve preventive and therapeutic approaches.

Optimizing clinical decision-making for ruptured intracranial aneurysms:Current applications and future directions of computed tomography angiography

Ruptured intracranial aneurysms(RIAs)are a leading cause of subarachnoid haemorrhage(SAH)and are associated with a poor prognosis and high mortality rate.Computed tomography angiography(CTA)is the preferred imaging moda-lity for the diagnosis of RIAs,as it is considered to be a fast,economical,and less invasive method.In this letter,regarding an original study presented by Elmo-kadem et al,we present our insights and discuss how CTA can better assist in clinical decision-making for patients with RIAs complicated by SAH.

Safety and Effectiveness of Stent-Assisted Coil Embolization for Ruptured Intracranial Aneurysm

Background: It has been conclusively established that intracranial aneurysms measuring a diameter below 7 mm pose a minimal risk of rupture. Conversely, those exhibiting irregular morphology or featuring the presence of a sac necessitate a more stringent and rigorous management approach. Objective: The primary aim of this study is to delve into the morphological features of ruptured aneurysms situated in distinct regions of the brain. Furthermore, we endeavor to assess the degree of safety and efficacy associated with stent-assisted embolization as a treatment modality for these ruptured aneurysms. Methods: This retrospective study encompassed a cohort of 467 patients who presented with intracranial ruptured aneurysms and were diagnosed through a combination of computed tomography (CT) and digital subtraction angiography (DSA) at Nanfang Hospital of Southern Medical University, spanning from January 2009 to December 2019. The following clinical parameters were meticulously recorded: aneurysm height, width, neck measurements, immediate Raymond grade assessments, and any perioperative complications experienced. Results: Within the study population, the average dimensions of ruptured aneurysms were found to be 4.26 ± 2.10 mm (width), 4.86 ± 2.38 mm (height), and 4.04 ± 1.87 mm (neck). Categorically, the most prevalent types of aneurysms were 170 cases of anterior communicating artery aneurysms (accounting for 36.4%), followed by 161 cases of posterior communicating artery aneurysms (34.5%), 56 cases of middle cerebral artery aneurysms (12.0%), 13 cases of anterior cerebral artery aneurysms (2.8%), 45 cases of paraclinoid aneurysms (9.6%), 6 cases of superior pituitary artery aneurysms (1.3%), 7 cases of anterior choroidal artery aneurysms (1.5%), and 9 cases of vertebrobasilar artery aneurysms (2.0%). Notably, 18 patients (3.9%) presented with ruptured aneurysms coexisting with ascus. Regarding treatment approaches, 228 cases (48.8%) underwent stent-assisted embolization, 234 cases (50.1%) received coils embolization, and 5 cases (1.1%) were treated with the dual-catheter technique. Immediately post-treatment, 422 patients (90.4%) attained a Raymond Class I status, with a procedure-related complication rate of 0.9%. Importantly, no statistically significant differences were observed in the incidence of perioperative complications across the three distinct treatment groups (P = 0.505). Conclusion: The outcomes of this study affirm the safety and efficacy of stent-assisted embolization as a treatment modality for ruptured aneurysms.

Wall shear stress in intracranial aneurysms and adjacent arteries

Hemodynamic parameters play an important role in aneurysm formation and growth. However, it is difficult to directly observe a rapidly growing de novo aneurysm in a patient. To investigate possible associations between hemodynamic parameters and the formation and growth of intracranial aneurysms, the present study constructed a computational model of a case with an internal carotid artery aneurysm and an anterior communicating artery aneurysm, based on the CT angiography findings of a patient. To simulate the formation of the anterior communicating artery aneurysm and the growth of the internal carotid artery aneurysm, we then constructed a model that virtually removed the anterior communicating artery aneurysm, and a further two models that also progressively decreased the size of the internal carotid artery aneurysm. Computational simulations of the fluid dynamics of the four models were performed under pulsatile flow conditions, and wall shear stress was compared among the different models. In the three aneurysm growth models, increasing size of the aneurysm was associated with an increased area of low wall shear stress, a significant decrease in wall shear stress at the dome of the aneurysm, and a significant change in the wall shear stress of the parent artery. The wall shear stress of the anterior communicating artery remained low, and was significantly lower than the wall shear stress at the bifurcation of the internal carotid artery or the bifurcation of the middle cerebral artery. After formation of the anterior communicating artery aneurysm, the wall shear stress at the dome of the internal carotid artery aneurysm increased significantly, and the wall shear stress in the upstream arteries also changed significantly. These findings indicate that low wall shear stress may be associated with the initiation and growth of aneurysms, and that aneurysm formation and growth may influence hemodynamic parameters in the local and adjacent arteries.

Nursing care of 22 patients with complex intracranial aneurysms treated with flow-diverting stents:A retrospective study

Objective:To summarize the nursing treatment of patients who underwent implantation of a blood flow diverter to treat complex intracranial aneurysms.Methods:Data from 22 patients with complex aneurysms,diagnosed at an interventional center for blood flow diverter implantation between February 2015 and February 2016,treated in the Henan Provincial People’s Hospital(Zhengzhou,China),were retrospectively analyzed.Nursing methods,including preoperative,intraoperative,and postoperative care,were analyzed.Results:All 22 patients underwent successful surgery,with no related complications or hospital mortality,and were cured in hospital.Conclusion:Interventional flow diverter therapy for patients with complex intracranial aneurysms is a new technology,and involves intensive care by nursing staff and appears to be a promising new treatment method.

Effectiveness of MRA on embolized intracranial aneurysms: a comparison of DSA, CE-MRA, and TOF-MRA

Purpose: The endovascular treatment of intracranial aneurysms was proven safe and effective compared to the alternative method of surgical clipping, despite the high recurrence rate. Follow-up of embolized intracranial aneurysms is mandatory for the early detection of recurrence and improved outcomes. DSA is used as the reference standard for this assessment. To determine the effectiveness of MRA in follow-up evaluations of intracranial aneurysms after embolization by comparing DSA, CE-MRA, and TOF-MRA. Materials and Methods: Sixty-eight consecutive patients undergoing DSA, TOF-MRA, and CE-MRA during an interval of <1 week were enrolled in this 6-month study. Images were evaluated for occlusion status, patency of the parent vessels, and artifacts. The modified Raymond-Roy occlusion classification and Aneurysm Embolization Grades were used to assess the occlusion status and initial DSA images for detection of recurrence in two filtered study phases with optimized selection criteria. Seventeen observers(phase I: 9, phase II: 8) independently interpreted the double-blinded images. Agreement was expressed with a Fleiss kappa value; p < 0.05 was considered significant. Results: This study included 68 patients with 77 aneurysms; 38(49.35%) were treated with coil alone and 39(50.65%) with stent-assisted coiling. In both phases, DSA was superior to TOF-MRA and CE-MRA using MRRC(Phase I: k = 0.567, p ≤ 0.001; k = 0.287, p ≤ 0.001; k = 0.117, p ≤ 0.001, respectively; Phase II: k = 0.503, p ≤ 0.001; k = 0.303, p ≤ 0.001; k = 0.115, p = 0.038, respectively). TOF-MRA was as effective as DSA(TOF: k = 0.335, p ≤ 0.001; DSA: k = 0.323, p ≤ 0.001) for recurrence detection. Conclusion: We suggest TOF-MRA as a first-line follow-up tool to detect aneurysm recurrence, and DSA to quantify the filling space to make a definite decision on re-embolization.

Applications of multislice CT angiography in the surgical clipping and endovascular coiling of intracranial aneurysms

Prompt diagnosis and therapy of aneurysms are critical for patients with nontraumatic subarachnoid hemorrhage （SAH）.The aim of our study was to assess the clinical usefulness of multislice computed tomography angiography （CTA） in the surgical and endovascular treatment of intracranial aneurysms.A total of 195 cases with 206 intracranial aneurysms underwent CTA.Fifty （24%） aneurysms underwent surgical clipping while 156 （76%） aneurysms underwent endovascular coiling.In the five missed aneurysms at digital substraction angiography and the nine aneurysms with mass intracerebral hematomas,surgical treatment was successfully performed based on 16-slice CTA alone,and the other 36 aneurysms were clipped on the main basis of the CTA.The intraoperative findings correlated well with the CTA findings and all aneurysms were clipped successfully.Sixteen-slice CTA image information has been shown to determine the choice of aneurysm therapy and assist the surgical and endovascular treatment of intracranial aneurysms.

Efficacy of pipeline endovascular device and Willis stent graft in the treatment of traumatic pseudo intracranial aneurysms

Objective:To investigate the advantages and effects of pipeline embolization device(PED)or Willis stent,in treating traumatic pseudoaneurysms.Traumatic pseudo intracranial aneurysms(TPIA)can be caused by either direct trauma or iatrogenic injuries,usually caused by direct arterial wall injury or shear due to acceleration.We describe a series of patients with TPIA who received a PED or Willis stent.Materials and methods:Retrospective analysis was performed on nine patients with TPIA admitted to the southern hospital of Southern Medical University from December 2017 to June 2019,of whom four were treated with PED and five were implanted with six Willis covered stents.The occlusive rate and complication in the two kinds of stents were compared by postoperative follow-up and modified rankin score(MRS).Results:After the implantation of PED,four patients showed an immediate stagnation of blood flow or a decreased filling in aneurysms,three out of four patients exhibited complete occlusion,and the remaining patient had nearly complete occlusion.Four out of five cases of Willis stent implantation were associated with immediate complete occlusion of aneurysms,and the modified rankin score of these patients ranged from 0 to 1.One patient died of unassociated complications.Conclusion:For different types of TPIA in the internal carotid artery(ICA),PED and Willis stents provide significant advantages in treatment,with fewer postoperative complications and prognosis well.

Influence of the aspect ratio on the endovascular treatment of intracranial aneurysms: A computational investigation

Intracranial aneurysm, a localized dilation of arterial blood vessels in the Circle of Willis and its branches, is potentially life threatening, due to massive bleeding in the subarachnoid space upon rupture. In clinical practice, one minimally invasive surgical procedure is the implantation of a metallic stent to cover the aneurysm neck. This flow diverting device can reduce the flow into the aneurysm and enhance the prospect of thrombosis, a condition expected to reduce the risk of growth and rupture. The biomechanical and haemo-dynamic factors in stented and nonstented situations are studied by computational fluid dynamics. Unlike earlier models with straight or curved parent blood vessels, the aneurysm is now located near an arterial bifurcation. The influence of the aspect (depth to neck) ratio of the aneurysm on the flow dynamics will be emphasized, especially in the post-operation stages. More precisely, the maximum flow velocity, the variations of wall shear stress, the risk of stent migration and volumetric flow rate after endovascular treatment will be studied. Aneurysms with larger aspect ratios (i.e. smaller neck sizes for constant depth) generally pose a greater risk in terms of these flow parameters. These results will assist the applications and design of stents in future neurosurgical therapy. The approach is limited to a nonelastic model, without taking into account of questions like stent expansion and interaction with tissue.

Morphological characteristics associated with rupture risk of multiple intracranial aneurysms

Objective: To identify the morphological parameters that are related to intracranial aneurysms(IAs) rupture using a case-control model.Methods: A total of 107 patients with multiple IAs and aneurysmal subarachnoid hemorrhage between August 2011 and February 2017 were enrolled in this study.Characteristics of IAs location, shape, neck width, perpendicular height, depth, maximum size, flow angle, parent vessel diameter(PVD), aspect ratio(AR) and size ratio(SR) were evaluated using CT angiography.Multiple logistic regression analysis was used to identify the independent risk factors associated with IAs rupture.Receiver operating characteristic curve analysis was performed on the final model, and the optimal thresholds were obtained.Results: IAs located in the internal carotid artery(ICA) was associated with a negative risk of rupture, whereas AR, SR1(height/PVD) and SR2(depth/PVD) were associated with increased risk of rupture.When SR was calculated differently, the odds ratio values of these factors were also different.The receiver operating characteristic curve showed that AR, SR1 and SR2 had cut-off values of 1.01, 1.48 and 1.40, respectively.SR3(maximum size/PVD) was not associated with IAs rupture.Conclusions: IAs located in the ICA are associated with a negative risk of rupture, while high AR(>1.01), SR1(>1.48) or SR2(>1.40) are risk factors for multiple IAs rupture.

Safety and efficacy of complete versus near-complete coiling in treatment of intracranial aneurysms

Objective:This study aimed to evaluate the clinical and angiographic outcomes of aneurysms that were completely or near-completely embolized and ascertain whether complete embolization is important in the stent-assisted coiling(SAC)of intracranial aneurysms.Methods:This retrospective study enrolled 390 patients(417 aneurysms).Among them,complete(100%)or nearcomplete(>90%)angiographic obliteration of the aneurysms on immediate angiography was accomplished.Baseline characteristics,complications,angiography follow-up results,and clinical outcomes were analyzed.Results:Cumulative adverse events occurred in 30 patients(7.7%),including thromboembolic complications in 17(4.4%),intraoperative rupture in 10(2.6%),and others in 3(0.8%).Statistical analyses revealed an increased intraprocedural rupture rate in the initial completely occluded aneurysms(5.6%compared with 1.0%).The incidence of cumulative adverse events was higher in patients with completely occluded aneurysms(11.1%)than in those with near-completely occluded aneurysms(5.5%).Angiography follow-up was available for 173 aneurysms.Aneurysm occlusion status at follow-up was correlated with stent placement(p?0.000,odds ratio?5.847),size(p?0.000,odds ratio?6.446 for tiny aneurysms;and p?0.001,odds ratio?5.616 for small aneurysms),and initial aneurysm occlusion status(p?0.001,odds ratio?3.436).Complete occlusion at followup was seen in 82.6%of the initial complete occlusion group versus 63.0%of the initial near-complete occlusion group.The incidence of complete occlusion at follow-up was higher in the initial completely occluded aneurysms with SAC(100%)than in the initial completely occluded aneurysms with non-SAC(65.2%).Conclusions:Initial complete treatment may lead to higher complication rates and good clinical outcomes at follow-up.Stent placement may enhance progressive aneurysm occlusion.Initial complete occlusion with SAC can provide durable closure at follow-up.

The effects of stent porosity on the endovascular treatment of intracranial aneurysms located near a bifurcation

Intracranial aneurysm occurs when a cerebral artery develops an abnormal sac-like dilatation, and will cause massive bleeding in the subarachnoid space upon rupture. Endovascular stenting is a minimally invasive procedure in which a flow-diverting stent is deployed to cover the aneurysm neck, thereby restricting blood from entering the aneurysm and reducing the risk of rupture. The stent porosity, a crucial factor determining the intra-aneurysmal hemodynamics following treatment, is investigated by computational fluid dynamics techniques. Based on the computational results, a low porosity stent will dramatically reduce the flow velocity and the flow rate inside the side branch vessel. Conversely, a high porosity stent may not provide adequate flow reduction inside the aneurysm, possibly causing treatment failure. An advisable range of optimal stent porosity would be 60% to 75%, which can drastically reduce the flow rate into the aneurysm while preserving enough blood flow for the side branch vessel. Clinically, deployment of two or more flow-diverting stents may not increase treatment efficacy but can potentially lead to adverse effects due to side-branch hypoperfusion. The present quantitative analysis can also provide practical insight for future stent design.

Superficial Temporal Artery to Middle Cerebral Artery Bypass and Endovascular Parent Artery Occlusion in the Treatment of Giant Intracranial Aneurysms

The authors are reporting on a study drawn from unpublished dissertation done by the corresponding author when he completed his neurosurgical training in Paris, France in 2004, few years before the advent of flow diverters. The study was a retrospective review of giant intracranial aneurysms treated by superficial temporal artery to middle cerebral artery bypass combined with endovascular occlusion of the parent artery. From 1990 to 2003, 29 consecutive cases of giant cerebral aneurysms, not suitable to selective treatment were managed in that way. Twenty-one medical records had enough data to allow objective evaluation. Sixteen female and five male patients bearing 21 giant aneurysms were involved. Their mean age was 46 years. The aneurysm was revealed by mass effect in 13 cases and subarachnoid hemorrhage in one case. On admission 19 patients presented with unruptured aneurysms and two have sustained a subarachnoid hemorrhage. The balloon occlusion test before the bypass operation was not tolerated in 18 patients. The treatment was completed in 19 patients and 17 of them had parent artery occlusion with latex detachable balloons. The only death of the series occurred before the endovascular treatment. The mean follow-up period was 30 months. After completion of the treatment, 16 (84%) patients had no symptom. Aneurysm recanalization or rupture was not observed after the parent artery occlusion. With the combination of superficial temporal artery to middle cerebral artery bypass + endovascular parent artery occlusion, 90% of giant intracranial aneurysms untreatable selectively were permanently excluded with a good outcome in 95%.

Three-dimensional CT angiography with volume rendering for the dignosis of multiple intracranial aneurysms

Objective: To evaluate the importance of 3D-CTA with volume rendering for the diagnosis of multiple intracranial aneurysms. Methods: Axial source images were obtained by helical CT scanning and reconstruction of 3D-CTA images was done by volume rendering technique in conjunction with multiplanar reformation. Results: In the past one year, there were 10 patients diagnosed as having multiple intracranial a-neurysms by 3D-CTA and altogether 24 aneurysms were visualized, including 10 small aneurysms (≤ 5mm. Three-dimensional CT angiography with volume rendering demonstrated aneurysms very well and provided useful information concerning the site, shape, size and spatial relationship with the surrounding vessels and bone anatomy. Conclusion: Three-dimensional CT angiography with volume rendering is a quick, reliable, and relatively noninvasive method for diagnosing multiple intracranial aneurysms. It delineates detailed aneurysmal morphology, and provides useful information for planning microsurgical approaches.

Developing a Scale for Measuring Uncertainty in Patients with Unruptured Intracranial Aneurysms Undergoing Endovascular Coiling

A measure called the Uncertainty in Unruptured Intracranial Aneurysm Patients Undergoing Endovascular Coiling Scale (UUIACS) was developed and its validity and reliability were examined. The 49 questions that comprised the original draft of the UUIACS were created based on interview data. Based on data from 172 participants, exploratory and confirmatory factor analyses were conducted. As a result of exploratory factor analysis, the UUIACS e retained 17 items and extracted four factors (“Lack of decision-making cues”, “Lack of information and complexity of information interpretation”, “The ambiguous nature of the disease”, and “The unpredictable living with UIA”). All of the UUIACS items showed adequate internal consistency. Between the UUIAC scale and the Universal Uncertainty in Illness Scale (UUIS), the Health Locus of Control (HLC) scale, and the SF-36v2&reg (Japanese version), positive correlations were found between the UUIACS and UUIS, and the HLC scale at a 1% significance level indicating concurrent validity. According to confirmatory factor analysis, the UUIACS had an acceptable goodness of fit. Given these findings, the UUIACS was judged to have satisfied the criteria for use in a clinical setting, although further investigation was required.