Flow Diversion for Endovascular Treatment of Intracranial Aneurysms: Past, Present, and Future Directions

Journal of Clinical Medicine, Journal Year: 2024, Volume and Issue: 13(14), P. 4167 - 4167

Published: July 16, 2024

Flow diversion for intracranial aneurysms emerged as an efficacious and durable treatment option over the last two decades. In a paradigm shift from intrasaccular aneurysm embolization to parent vessel remodeling mechanism of action, proliferation flow-diverting devices has enabled many previously considered untreatable. this review, we review history development flow diverters, highlight pivotal clinical trials leading their regulatory approval, current including endoluminal discuss expanding indications use. Areas equipoise, ruptured wide-neck bifurcation aneurysms, are summarized with focus on diverters these pathologies. Finally, future directions in technology bioresorbable transcriptomics radiogenomics, machine learning artificial intelligence.

Language: Английский

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Using Artificial Intelligence to Improve Diagnosis of Unruptured Intracranial Aneurysms

Radiology Artificial Intelligence, Journal Year: 2025, Volume and Issue: 7(1)

Published: Jan. 1, 2025

Language: Английский

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Long-Term Outcomes After Subarachnoid Hemorrhage—The Road to Recovery Is Longer Than Expected

JAMA Network Open, Journal Year: 2025, Volume and Issue: 8(3), P. e251686 - e251686

Published: March 25, 2025

Ho Seok Lee, MD, PhD; Min Kyun Sohn, Jongmin Deog Young Kim, Yong-Il Shin, Gyung-Jae Oh, Yang-Soo Cheol Joo, So Min-Keun Song, Junhee Han, Jeonghoon Ahn, Young-Hoon Dae Hyun Young-Taek Yun-Hee Won Hyuk Chang, PhD

Language: Английский

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Comprehensive analysis of risk factors for intracranial aneurysm rupture: a retrospective cohort study

Frontiers in Neurology, Journal Year: 2025, Volume and Issue: 16

Published: March 31, 2025

Intracranial aneurysms (IAs) can lead to subarachnoid hemorrhage, a life-threatening event associated with high morbidity and mortality. Identifying individuals at elevated risk is crucial for guiding timely interventions improving patient outcomes. In this retrospective cohort study, 850 patients who received interventional or surgical treatment IAs between January 2018 2024 were included. Demographic data (e.g., age, sex), lifestyle factors, comorbidities recorded. Hematologic, biochemical, coagulation parameters measured evaluate their potential association IA rupture. A univariate logistic regression was first conducted, followed by multivariate backward stepwise approach derive the final predictive model. The model's performance assessed using area under receiver operating characteristic curve (AUC), calibration curves, decision analysis. Younger female sex, higher neutrophil count, lower hematocrit, markers of inflammation (including fibrinogen D-dimer) emerged as key factors. Electrolyte imbalances, such low potassium, lactate dehydrogenase also significantly optimized model achieved an AUC 0.815, good clinical utility indicated These findings highlight interplay demographic, inflammatory, metabolic, in determining rupture IAs. Incorporating these factors into practice may enhance early detection, guide targeted prevention strategies, ultimately improve outcomes high-risk individuals.

Language: Английский

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Complex Anatomy, Advanced Techniques: Microsurgical Clipping of a Ruptured Hypophyseal Artery Aneurysm

Journal of Clinical Medicine, Journal Year: 2025, Volume and Issue: 14(7), P. 2361 - 2361

Published: March 29, 2025

Background: Ruptured intracranial aneurysms remain the subject of debate in their management, but management lesions located at high-risk locations, such as hypophyseal artery, continue to prove be a challenge anatomical orientation and proximity vascular structures. While endovascular therapies have changed treatment paradigms, microsurgical clipping is gold standard for wide-necked which techniques may suboptimal. The successful ruptured artery aneurysm an elderly patient described this report, highlights importance advanced imaging, careful technique, new understanding personalized management. Methods: An 82-year-old woman was admitted with thunderclap headache, alteration consciousness meningeal signs, suggestive subarachnoid hemorrhage (SAH). A non-contrast computed tomography (CT) digital subtraction angiography (DSA) confirmed saccular 12 × 10 mm broad 3.13 neck arising from artery. location morphology required clipping, performed through right pterional craniotomy. Results: Correct clip placement, complete exclusion aneurysm, resorption blood were both observed on postoperative imaging. neurological examination completely normal, no complications. Follow-up imaging three months demonstrated stable, marked cerebral atrophy compensatory ventricular enlargement without evidence recurrence. Conclusions: This case illustrates important role micro-surgical anatomically complex its sustainable outcome accuracy cases where practices would limitations. Advanced like three-dimensional DSA intraoperative tools, revolutionized precision surgery, allowing achievement optimal outcomes, even more-complicated cases. With evolving, dynamic field exciting technologies coming fore-such artificial intelligence predict rupture risk augmented reality navigation-decision-making will optimized along secure pathways towards tailored, high-resolution sense yet high-precision care.

Language: Английский

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Increased diagnostic accuracy and better morphology characterization of unruptured intracranial aneurysm by ultra-high-resolution photon-counting detector CT angiography

Journal of NeuroInterventional Surgery, Journal Year: 2025, Volume and Issue: unknown, P. jnis - 023094

Published: April 4, 2025

Background Accurate detection and morphology evaluation of unruptured intracranial aneurysms (UIAs) are essential for patient management. This study aimed to assess the efficacy ultra-high-resolution (UHR) photon-counting detector-CT angiography (PCD-CTA) in detecting UIAs characterizing their morphological features. Methods prospective recruited consecutive participants suspected cerebral vascular diseases who underwent PCD-CTA subsequent digital subtraction (DSA) within 1 month from September 2023 May 2024. Performance UIA diagnosis using UHR images (slice thickness 0.2 mm) standard resolution (SR, reflecting clinical protocols) reconstructed were compared with DSA as reference on a per-participant, per-vessel, per-aneurysm basis. The inter-rater agreement aneurysm characterization UHR/SR was also evaluated. Results Among 95 participants, 50 confirmed 42 DSA. was: kappa 0.95 0.89 SR (p<0.05). On basis, sensitivity, specificity, diagnostic accuracy (98.0%, 96.7%, 97.3%) all significantly higher than (72.0%, 86.7%, 80.0%) accurately identified 13 14 (93%) missed by PCD-CTA, including 3 cases (21%) larger mm. Furthermore, more irregularity (18/50, 36%) (5/50, 10%) (p=0.004). revealed 4 (8.0%) wall calcification (6.0%) intra-aneurysmal hypointensity (possible thrombus) SR. Conclusions advantages enhanced reliability, improved accuracy, comprehensive information, have potential optimize

Language: Английский

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Impact of primary care provider access on presenting with aneurysm Rupture: A retrospective analysis

Journal of Clinical Neuroscience, Journal Year: 2025, Volume and Issue: 136, P. 111228 - 111228

Published: April 11, 2025

Language: Английский

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High-resolution vessel wall imaging-driven radiomic analysis for the precision prediction of intracranial aneurysm rupture risk: a promising approach

Frontiers in Neuroscience, Journal Year: 2025, Volume and Issue: 19

Published: April 22, 2025

This study aimed to extract the radiomic features of intracranial aneurysm (IA) and parent artery (PA) walls from high-resolution vessel wall imaging (HR-VWI) images construct validate machine learning (ML) predictive models by comparing them with radiomics score (Rad-score). In this study, 356 IAs 306 patients were retrospectively analyzed at Yuzhong Center randomly divided into training test cohorts in an 8:2 ratio. Additionally, 66 58 used Jiangnan model. Radiomic IA PA extracted contrast-enhanced HR-VWI images. Univariate least absolute shrinkage selection operator (LASSO) regression analyses performed on cohort identify optimal rupture-associated features. The Rad-score model was constructed calculating total derived weighted sum features, three ML built using XGBoost, LightGBM, CART algorithms, evaluated both external validation cohorts. Eight four identified. demonstrated area under curve (AUC) 0.858, 0.800, 0.770 for training, test, cohorts, respectively. Among models, XGBoost best across all AUC values 0.983, 0.891, 0.864, Compared model, exhibited superior (p < 0.05), better calibration Brier scores, greater net clinical benefit. robust utility rupture risk models. XGBoost-based outperformed efficacy performance, proved be a noninvasive, efficient, accurate tool identifying high-risk patients.

Language: Английский

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Comparison of Outcomes Among Neurovascular Patients Managed in Dedicated Neurological Intensive Care Units vs. General Intensive Care Units

Journal of Clinical Medicine, Journal Year: 2025, Volume and Issue: 14(9), P. 3090 - 3090

Published: April 29, 2025

Background/Objectives: Patients with neurovascular conditions often require multidisciplinary management to optimize recovery. Our systematic review identifies literature comparing outcomes among patients managed at dedicated neurological intensive care units (ICUs) compared general ICUs. Methods: PubMed was searched identify articles that reported ICUs versus Articles were included. stroke excluded. The Newcastle Ottawa Scale (NOS) used assess for risk of bias across individual studies. Results: After a title and abstract screen followed by full-text review, seven studies met criteria inclusion. These intracerebral hemorrhage (ICH), acute ischemic (AIS) aneurysmal subarachnoid (aSAH). Two lower mortality, improved functional outcome reduced costs ICH who Among aSAH, only less-severe cases experienced better after Six out considered high quality. Conclusions: highlights the potential benefits receiving ICUs, as evidenced in low-grade aSAH. However, future research is necessary clarify whether ICU confers significant advantage over AIS other conditions.

Language: Английский

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Safety and efficacy of the Contour Neurovascular System for treating intracranial aneurysms: a systematic review and meta-analysis

Journal of NeuroInterventional Surgery, Journal Year: 2024, Volume and Issue: unknown, P. jnis - 022461

Published: Nov. 21, 2024

Background The Contour Neurovascular System (CNS, Stryker, Kalamazoo, MI) has a unique design that allows it to address various aneurysm morphologies, including wide-necked, irregular, and shallow-shaped lesions. However, evidence of its safety efficacy remains limited. This systematic review meta-analysis synthesizes the current data on CNS performance. Methods A comprehensive search guided by Preferred Reporting Items for Systematic reviews Meta-Analyses (PRISMA) standards was performed across PubMed, Embase, Web Science, studies with ≥5 patients reporting use. Efficacy outcomes included immediate last follow-up adequate occlusion technical success. Safety good functional outcome (modified Rankin Scale (mRS) score 0–2 at follow-up), procedure-related morbidity (permanent neurological deficits), mortality, intraoperative postoperative complications. Pooled analyses 95% confidence intervals (CI) were conducted, heterogeneity assessed using I² statistics, random-effects model applied. Results Nine studies, 483 (58.8% female; mean age: 59.3±15.6 years) 484 aneurysms, analyzed. Of 467 in whom rupture status reported, 81.8% presented unruptured aneurysms 18.2% ruptured aneurysms. Immediate rate 53% (95% CI: 1% 100%), 93% 88% 97%) success 98% 100%). Intraoperative complication rates 3% 0% 7%) 7% 12%), respectively. Procedure-related 2% 3%), no mortality. Conclusion is safe effective novel intrasaccular device treating intracranial

Language: Английский

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