Presence of inflammatory proteins S100A8 and S100A9 in a giant intracranial aneurysm after flow diverter treatment.

We demonstrate the presence of S100A8 and S100A9 proteins in the wall and thrombosed lumen of an enlarged intracranial aneurysm after flow diverter treatment. These proteins have shown to play an important role in vascular inflammation and may serve as a biomarker and potential therapeutic target for intracranial aneurysms.

Neurological update: consult the neurosurgical oracle for a standard operating procedure.

Standard operating procedures (SOPs) contain general instructions and principles to standardize care, to improve effective and safe healthcare. Developing new, or updating current, SOPs is, however, challenging in fields where high-level evidence is limited. Still, SOPs alone have been shown to result in less complications. In this narrative review, we describe the process of creating a consensus-based SOP that is pragmatic for clinical practice since it can be created regardless of the current level of evidence. Through live audience engagement platforms, a group of experts will be able to both anonymously respond to a created questionnaire, and (subsequently) discuss the results within the same meeting. This modified Digital Delphi method as described here can be used as a tool toward consensus-based healthcare.

Intracranial Aneurysm Expansion Might Cause Neurological Deterioration After Flow Diverter Treatment.

OBJECTIVE: Patients with large and giant intracranial aneurysms (IAs) can experience neurological deterioration within 6 months after successful flow diverter (FD) placement. The purpose of the present study was to assess whether the occurrence of neurological deterioration can be linked to IA expansion within 6 months after FD treatment. METHODS: From 2010 to 2016, 45 FD procedures were performed in 44 patients with a large or giant IA. From this group, we selected all patients (14 patients with 15 IAs) with neurological deterioration within 6 months after FD treatment. All these patients had undergone follow-up imaging studies within the same period. The patients were then divided into 2 groups, those with mass effect-related and those with ischemia-related symptoms. The volumes of all treated IAs were determined through manual segmentation of the available pre- and postoperative imaging studies to determine IA expansion after FD treatment. To rule out false-positive findings, we only considered an IA volume increase of >20% after FD treatment as a true IA volume increase. RESULTS: During the follow-up period, 6 IAs increased in volume and 9 IAs did not. More patients presenting with mass effect-related symptoms showed IA expansion (6 of 10 IAs) compared with patients presenting with ischemia-related symptoms (0 of 5 IAs; Fisher's exact test, 2-sided; P = 0.044). CONCLUSION: The volume of large and giant IAs can increase in the first 6 months after FD treatment. More patients presenting with mass effect-related symptoms showed IA expansion than patients with ischemia-related symptoms.

Grading of Regional Apposition after Flow-Diverter Treatment (GRAFT): a comparative evaluation of VasoCT and intravascular OCT.

BACKGROUND: Poor vessel wall apposition of flow diverter (FD) stents poses risks for stroke-related complications when treating intracranial aneurysms, necessitating long-term surveillance imaging. To facilitate quantitative evaluation of deployed devices, a novel algorithm is presented that generates intuitive two-dimensional representations of wall apposition from either high-resolution contrast-enhanced cone-beam CT (VasoCT) or intravascular optical coherence tomography (OCT) images. METHODS: VasoCT and OCT images were obtained after FD implant (n=8 aneurysms) in an experimental sidewall aneurysm model in canines. Surface models of the vessel wall and FD device were extracted, and the distance between them was presented on a two-dimensional flattened map. Maps and cross-sections at potential locations of malapposition detected on VasoCT-based maps were compared. The performance of OCT-based apposition detection was evaluated on manually labeled cross-sections using logistic regression against a thresholded (≥0.25 mm) apposition measure. RESULTS: VasoCT and OCT acquisitions yielded similar Grading of Regional Apposition after Flow-Diverter Treatment (GRAFT) apposition maps. GRAFT maps from VasoCT highlighted 16 potential locations of malapposition, of which two were found to represent malapposed device struts. Logistic regression showed that OCT could detect malapposition with a sensitivity of 98% and a specificity of 81%. CONCLUSIONS: GRAFT delivered quantitative and visually convenient representations of potential FD malapposition and occasional acute thrombus formation. A powerful combination for future neuroendovascular applications is foreseen with the superior resolution delivered by intravascular OCT.