Intracranial Aneurysm Classifier Using Phenotypic Factors: An International Pooled Analysis.

Intracranial aneurysms (IAs) are usually asymptomatic with a low risk of rupture, but consequences of aneurysmal subarachnoid hemorrhage (aSAH) are severe. Identifying IAs at risk of rupture has important clinical and socio-economic consequences. The goal of this study was to assess the effect of patient and IA characteristics on the likelihood of IA being diagnosed incidentally versus ruptured. Patients were recruited at 21 international centers. Seven phenotypic patient characteristics and three IA characteristics were recorded. The analyzed cohort included 7992 patients. Multivariate analysis demonstrated that: (1) IA location is the strongest factor associated with IA rupture status at diagnosis; (2) Risk factor awareness (hypertension, smoking) increases the likelihood of being diagnosed with unruptured IA; (3) Patients with ruptured IAs in high-risk locations tend to be older, and their IAs are smaller; (4) Smokers with ruptured IAs tend to be younger, and their IAs are larger; (5) Female patients with ruptured IAs tend to be older, and their IAs are smaller; (6) IA size and age at rupture correlate. The assessment of associations regarding patient and IA characteristics with IA rupture allows us to refine IA disease models and provide data to develop risk instruments for clinicians to support personalized decision-making.

Early fatal hemorrhage after endovascular cerebral aneurysm treatment with a flow diverter (SILK-Stent): do we need to rethink our concepts?

A 69-year-old woman presenting with short lasting recent episodes of visual impairment was treated uneventfully with a flow diverter covering the neck of a large paraophthalmic aneurysm. As angiography showed immediate flow reduction we abstained from additional coiling which was initially planned. Eleven days later CT demonstrated nearly complete thrombosis of the aneurysm. Twenty days after treatment the patient suffered a lethal subarachnoid hemorrhage after rupture of the aneurysm. All available data were reviewed and beside hemodynamic factors instability of the intra-aneurysmal thrombus is discussed as a possible cofactor leading to this disastrous event.

Dynamic MR angiography (MRA) of spinal vascular diseases at 3T.

Spinal magnetic resonance angiography (MRA) is difficult to perform because of the size of the spinal cord vessels. High-field MR improves resolution and imaging speed. We examined 17 patients with spinal vascular diseases with dynamic contrast-enhanced three-dimensional MR sequences. In three patients, the artery of Adamkievicz could be seen; we could also detect all arteriovenous malformations and dural fistulas. MRA has the potential to replace diagnostic spinal angiography and the latter should be used only for therapeutic purposes.