Ahead of Print: Stenting Alters Flow Impingement Zone

Background: Self-expanding intracranial stent-assisted coiling of bifurcation aneurysms has recently been shown to straighten target cerebral vessels, a phenomenon with unknown hemodynamic effect.

Objective: To investigate the impact of angular remodeling in aneurysms treated with single stent-assisted coiling using computational fluid dynamic (CFD) techniques.

Methods: Fourteen patients (7 women, mean age 55) who underwent stent-coiling of 14 wide-necked bifurcation aneurysms were included based on availability of high-resolution three-dimensional rotational angiography. Pre-treatment datasets underwent virtual aneurysm removal to isolate the effect of stenting. Wall shear stress (WSS) and pressure profiles obtained from constant flow input CFD analysis were analyzed for apical hemodynamic changes.

Free Article: Health-Related Quality of Life 10 Years After Intracranial Aneurysm Rupture

Background: Experiencing an aneurysmal subarachnoid hemorrhage (SAH) could affect health-related quality of life (HRQoL) several years after the onset. Long-term studies are scarce, and there is a lack of knowledge of whether HRQoL is affected > 5 years after the onset and, if so, in what dimensions. In the general population, HRQoL decreases with age and with the occurrence of a disease and differs between sexes. Factors that may influence HRQoL after aneurysmal SAH include neurological outcome, perceived recovery, aneurysm treatment, and family support.

Objective: To measure HRQoL and to explore factors affecting HRQoL 10 years after aneurysmal SAH.

Methods: A consecutive sample of all patients admitted for intracranial aneurysm rupture at a neurosurgical clinic in Stockholm (n = 217, 79.5% of eligible) were followed up from 2007 to 2008, approximately 10 years after aneurysm rupture. HRQoL was measured with EQ-5D, and the results were compared with a general population sample from the Stockholm Public Health Survey 2006 matched by age and sex.

Ahead of Print: Y-Stenting Remodels Basilar Bifurcating Angles

Background: Though wide-necked basilar bifurcation aneurysms are treated with Y-stent-coiling, the effect of this intervention on vessel configuration and hemodynamics is unknown.

Objective: To investigate the immediate and delayed effects of Y-stenting using self-expanding microstents on basilar bifurcation architecture and hemodynamics.

Methods: Fifteen patients underwent basilar Y-stent-coiling and imaging with rotational angiography. Vascular angles were measured between proximal P1 segments of the posterior cerebral arteries ([alpha]), and between the basilar artery and each P1 segment ([beta]1,2) in the anteroposterior and ([gamma]1,2) sagittal planes. Patient-specific computational fluid dynamic (CFD) analysis was used to estimate wall shear stress (WSS) changes with treatment.

Ahead of Print: Size Ratio as Rupture Discriminant

Background: The variable definition of Size Ratio (SR) for sidewall (SW) vs. bifurcation (BIF) aneurysms raises confusion for lesions harboring small branches such as carotid ophthalmic or posterior communicating locations. These aneurysms are considered SW by many clinicians, while SR methodology classifies them as BIF.

Objective: To evaluate the effect of ignoring small vessels and SW vs. stringent BIF labeling on SR ruptured aneurysm detection performance in borderline aneurysms with small branches, and to reconcile SR-based labeling with clinical SW/BIF classification.

Methods: Catheter rotational angiographic datasets of 134 consecutive aneurysms (60 ruptured) were automatically measured in 3-D. Stringent BIF labeling was applied to clinically labeled aneurysms, with 21 aneurysms switching label from SW to BIF. Parent vessel size was evaluated both taking into account, and ignoring, small vessels. SR was defined accordingly, as the ratio between aneurysm and parent vessel sizes. Univariate and multivariate statistics identified significant features. The square of the correlation coefficient (R-square) was reported for bivariate analysis of alternative SR calculations.

Free Article: Postmarket Pipeline Embolization Results

Background: The Pipeline embolization device (PED) is the latest technology available for intracranial aneurysm treatment.

Objective: To report early postmarket results with the PED.

Methods: This study was a prospective registry of patients treated with PEDs at 7 American neurosurgical centers subsequent to Food and Drug Administration approval of this device. Data collected included clinical presentation, aneurysm characteristics, treatment details, and periprocedural events. Follow-up data included degree of aneurysm occlusion and delayed (> 30 days after the procedure) complications.