The Utility of Multimodal Imaging and Artificial Intelligence Algorithms for Overlying Two Volumes in the Decision Chain for the Treatment of Complex Pathologies in Interventional Neuroradiology-A Case Series Study.

3D rotational angiography is now increasingly used in routine neuroendovascular procedures--in particular, for situations where the analysis of two overlayed sets of volume imaging proves useful for planning the treatment strategy or for confirming the optimal apposition of the intravascular devices used. The aim of this study is to identify and describe the decision algorithm for which the overlay function of 3D rotational angiography volumes, high-resolution contrast-enhanced flat panel detector CT adapted for intravascular devices (VasoCT/DynaCT), non-enhanced flat detector C-arm volume acquisition functionality integrated with the angiography equipment (XperCT/DynaCT), and isovolumetric MRI volumes were all used in treatments performed in a series of 29 patients. Two superposed 3DRA volumes were used in the treatment aneurysms located at the junction of two vascular territories and for arteriovenous malformations with compartments fed from different vascular territories. The superposition function of a preoperatively acquired 3DRA volume and a postoperatively acquired VasoCT volume provides accurate information about the apposition of neuroendovascular endoprostheses used in the treatment of aneurysms. The automatic overlay function generated by the 3D workstation is particularly useful, but in about 50% of cases it requires manual operator-dependent correction, requiring a certain level of experience. In our experience, multimodal imaging brings an important benefit, both in the treatment decision algorithm and in the assessment of neuroendovascular treatment efficacy.

Y-stenting with braided stents for wide-neck intracranial bifurcation aneurysms. A single-center initial experience.

INTRODUCTION: The treatment of wide-neck bifurcation aneurysms is still challenging despite the use of new techniques, such as Y-stenting, the waffle-cone technique and intrasaccular flow disrupters, in recent years. Moreover, the use of flow diverter stents in bifurcation aneurysms has been proposed by several teams, although the results remain controversial. This study aims to evaluate the feasibility and efficacy of Y-stent assisted coiling of bifurcation aneurysms with braided stents. METHODS: We retrospectively reviewed all patients in whom Y-stenting with braided stents had been performed in our center. Six patients were identified and analyzed. Technical success, complications, angiographic outcomes, procedural data, and follow-up controls are reported here. This study was approved by our local ethical committee. RESULTS: Technical success was achieved in all procedures. Overall procedure-related morbidity and mortality was 0%. In the immediate post-treatment angiography, adequate occlusion (neck remnant or total occlusion) was observed in all patients. Short- and long-term follow-up angiography showed adequate occlusion of the aneurysms. CONCLUSIONS: In this small, retrospective single-center analysis we showed that Y-stent assisted coiling with braided stents is a safe and feasible technique. Moreover, it has a high immediate occlusion rate and very good long-term stability.

Safety and efficiency of the fifth generation Woven EndoBridge device: technical note.

BACKROUND: The treatment of wide neck bifurcation aneurysms remains challenging despite the introduction of new techniques (Y stenting, waffle cone technique, or flow diverter stents). The Woven EndoBridge (WEB) device is an innovative solution for this type of cerebral aneurysm. A new WEB 17 is now available and has been designed to offer smaller sized devices to optimize navigability and delivery. METHODS: Between February 2017 and April 2018 all patients treated with the WEB 17 device in our center were retrospectively reviewed. 25 patients with 28 non-ruptured aneurysms were identified and analyzed. Three patients with two aneurysms both treated with the WEB device were identified. RESULTS: The device was successfully deployed in all cases. Procedure related morbidity was 4% and mortality was 0%. In one case, a delayed postprocedural thromboembolic event occurred owing to device protrusion. Technical success, complications, angiographic outcomes, procedural data, and follow-ups are reported. The modified Rankin Scale score at discharge was 0 for 24 patients (96%). At the 3, 6, or 9 month follow-up, angiograms were taken of 21 of the 25 patients (84%) (24 of 28 aneurysms had been controlled); 3 patients (3 aneurysms) did not receive angiographic follow-up at the time of submission of this work. Complete occlusion was achieved in 22 of 24 aneurysms (91.66%), and 2 of 24 aneurysm (8.33%) showed a neck remnant. CONCLUSIONS: The WEB 17 is safe and technically feasible, according to this retrospective single center analysis. For very small bifurcation aneurysms, the WEB 17 seems to have lower complication rates than stent assisted techniques. However, further studies are needed to evaluate the complication rate and long term efficiency.

Balloon remodeling-assisted Woven EndoBridge technique: description and feasibility for complex bifurcation aneurysms.

BACKGROUND: Woven EndoBridge (WEB) deployment remains challenging in aneurysms with a complex shape or orientation. OBJECTIVE: To show that embolization of wide-neck bifurcation aneurysms using the WEB device balloon remodeling-assisted technique is a feasible and elegant endovascular solution compared with other techniques, such as balloon remodeling or stent-assisted coiling. MATERIALS AND METHODS: 10 cases (10 aneurysms in 9 patients) of balloon remodeling-assisted WEB treatment of unruptured complex bifurcation aneurysms were treated in our institution and retrospectively analyzed. Details of clinical presentations, technical details, perioperative and postoperative complications, and outcomes were collected. Immediate and long-term angiographic results were also evaluated. RESULTS: Aneurysms included six middle cerebral artery aneurysms, one anterior communicating artery aneurysm, one posterior communicating artery aneurysm, one basilar artery aneurysm, and one T-shaped carotid aneurysm. Mean dome width was 6.55 mm, mean neck size 4.5 mm, mean height 4.79 mm, and mean dome-to-neck ratio was 1:1.46. Treatment was performed exclusively with the balloon remodeling-assisted WEB technique in all cases. The device was successfully deployed in every case. Periprocedural thromboembolic or hemorrhagic events did not occur. The modified Rankin Scale score at discharge was 0 for all patients. At mid-term or long-term angiographic follow-up, adequate occlusion was observed in 7 aneurysms from 8 controlled cases (87.5%), and one patient (2 aneurysms) did not have angiographic follow-up. CONCLUSION: The balloon remodeling-assisted WEB technique seems to be a safe and effective solution for endovascular treatment of unruptured wide-neck bifurcation aneurysms with specific complex anatomy. However, further studies are needed to evaluate the rate of complications and long-term efficacy.

Semiological characters and morphopathological-radiological correlations in duodenal malignancy.

Localized duodenal neoplasms are relatively rare entities, most often representing invasions of the duodenum by malignant masses developed in the duodeno-pancreatic region. The paper makes a more exact analysis of radiological semiology of duodenal localized tumors and seeks to determine through this analysis the role of radiological examinations in the support for the anatomopathologist. The study group included 17 cases of duodenal localized tumors, nine cases of which have been shown to be vaterian ampulloma and eight malignant tumors of the duodenum. All cases were CT (computed tomography) examined and two-thirds were performed conventional radiological examinations, prior to CT examination. Pre-operatively, all cases were evaluated endoscopically, and in three of them bile prostheses were made. CT examination protocol included a native acquisition and post-administration of intravenous contrast agent in both the arterial phase and in parenchymal and venous phase. The acquisition was made with 3 mm thin sections, subsequently coronal and sagittal plane reconstructions being made. The paper tries to establish possible correlations between the morphopathological aspect and the radio-imaging semiological characteristics of lesions.