Migrated Pancreaticojejunal Stent Forming a Stent-Stone Complex in the Jejunum with Resultant Small Bowel Obstruction: A Case Report.

Transanastomotic pancreatic duct stent placement during reconstruction following pancreaticoduodenectomy is widely performed to prevent postoperative pancreatic fistulas and duct stenosis. However, stent-related complications, such as stent occlusion and migration, may occur. Here, we report a rare case of a migrated pancreatic duct plastic stent. After pylorus-preserving pancreaticoduodenectomy, the stent migrated to the jejunum and served as a nidus of the stent-stone complex, which developed jejunal obstruction. The stent-stone complex was removed by explorative laparotomy.

A Study on the Psychological Attributes of Survivors Who Experienced Downsizing in China.

This study aims to examine how perceived justice affects downsizing survivors' attitudes, from the psychological contract perspective. By using data collected through surveys from employees of the Industrial and Commercial Bank of China (ICBC) who have recently survived layoffs, we examine the relationships between perceived justice, the survivors' psychological status, and their attitudes after downsizing. The hypothesis was verified through path analysis using SPSS 26.0 and Amos 23.0. Our findings are as follows. Perceived justice has a negative effect on psychological contract violation and a positive effect on trust. Psychological contract violation influences affective commitment negatively and influences turnover intention positively. Trust is positively related to affective commitment and negatively related to turnover intention. We hope that this study will be a useful piece of data that can provide guidelines for inducing positive behavior of members in downsized organizations.

Jejunal Migration of the Stent-Graft Used for Common Hepatic Artery Pseudoaneurysm.

Hemorrhage after pancreaticobiliary surgery is an infrequent but fatal complication. It is primarily caused by rupture of the pseudoaneurysm, and treatment options include endovascular coil embolization or endovascular stent-graft placement. Herein, we report a case of migration of an arterial stent-graft that was placed in the common hepatic artery to treat pseudoaneurysm after pylorus-preserving pancreaticoduodenectomy. The stent-graft migrated to the jejunum and was eventually excreted from the body.

[Superior Mesenteric Venous Thrombophlebitis with Terminal Ileal Diverticulitis: A Case Report]. / 말단 회장의 게실염에 동반된 í˜ˆì „ì •ë§¥ì—¼: 증례 ë³´ê³ .

Mesenteric venous thrombophlebitis secondary to inflammatory processes such as diverticulitis and appendicitis is a rare disease; however, it can nonetheless cause bowel ischemia and infarctions. Radiologic diagnosis is vital for mesenteric venous thrombophlebitis complicated with diverticulitis due to its non-specific clinical presentation and very low incidence. We report a case of a 61-year-old woman with superior mesenteric vein thrombosis and ileocecal diverticulitis on CT, which was resolved after treatment with a combination of antibiotic therapy and right hemicolectomy.

Multi-zone simulation of outdoor particle penetration and transport in a multi-story building.

In areas with poor ambient air quality, indoor particle concentrations can be significantly affected by particulate matter originating outdoors. The indoor environments of multi-zone and multi-story buildings are affected differently by outdoor particles compared with single-family houses, because of the buildings' more complicated airflow characteristics. The objective of this study is to analyze outdoor particle penetration and transport, and their impact on indoor air, in a multi-zone and multi-story building using a CONTAMW simulation. For the airflow and particle transport analysis, the building leakage, penetration coefficients, and deposition rates were determined by on-site experiments. The results of airflow simulations for cold winters show that outdoor air infiltrates through the lower part of building and exfiltrates from the upper part. The results of the particle simulation also indicated that the airflow characteristics, combined with deposition rates, cause the lower floors of a multi-story building to be exposed to higher fine particle concentrations compared with the upper floors of the building. The study demonstrated that the CONTAMW simulation can be useful in analyzing the impact of outdoor particles on indoor environments through the identification of key particle transport parameters and validated airflow simulations.

Radiofrequency ablation versus stereotactic body radiotherapy for small hepatocellular carcinoma: a Markov model-based analysis.

The aim of this study is to compare radiofrequency ablation (RFA) with stereotactic body radiotherapy (SBRT) for hepatocellular carcinomas (HCC) smaller than 3 cm. A Markov cohort model was developed to simulate a cohort of patients aged 60-65 years with small HCCs who had undergone either RFA or SBRT and were followed up over their remaining life expectancy. The inclusion criteria were: (1) HCC ≤3 cm in diameter with ≤ 3 nodules; (2) absence of extrahepatic metastasis or portal/hepatic vein invasion; (3) Child-Pugh Class A or B. Twenty thousand virtual patients were randomly assigned to undergo RFA or SBRT. Predicted life expectancy was 6.452 and 6.371 years in the RFA and SBRT groups, respectively. The probability distributions of the expected overall survival were nearly identical. The 95% confidence intervals were 6.25-6.66 and 6.17-6.58 years for RFA and SBRT, respectively. The difference between RFA and SBRT was insignificant (P = 0.2884). Two-way sensitivity analysis demonstrated that if the tumor is 2-3 cm, SBRT is the preferred treatment option. Our Markov model has shown that expected overall survival of SBRT is nearly identical to RFA in HCCs smaller than 3 cm, but SBRT may have an advantage for tumors 2 cm and larger. A randomized trial is required to confirm these findings.

Silent Coronary Artery Disease in Symptomatic Candidates for Carotid Revascularization Intervention.

BACKGROUND: Concurrent coronary artery disease (CAD) and carotid artery stenosis (CAS) are frequently detected in clinical practice and have important prognostic implications in symptomatic patients who are considered for revascularization. The aim of this study was to assess the frequency of asymptomatic CAD in stroke patients with CAS and the associated factors. METHODS: Coronary angiography was performed at a single session after cerebral angiography in patients with symptomatic CAS, which was considered a candidate for revascularization. RESULTS: Ninety-six patients were enrolled. We detected significant (defined as a degree of stenosis ≥50%) atherosclerotic coronary lesions in 58 patients (60.4%). Of these 58 patients, 32 (55.2%) had one-vessel, 19 (32.7%) 2-vessel, and 7 (12.1%) 3-vessel disease. Potential factors associated with the silent CAD were hypertension (OR 3.86, p = 0.022), a high level (≥140 mg/dl) of non-high-density lipoprotein cholesterol (OR 3.20, p = 0.041), and combined intracranial atherosclerosis steno-occlusion on cerebral angiogram (OR 4.39, p = 0.015). CONCLUSIONS: About 60% of stroke patients with extracranial CAS have an incident CAD. Hypertension, hyperlipidemia, and the atherosclerotic changes of combined extracranial carotid and intracranial arteries may increase the risk of asymptomatic CAD in symptomatic candidates for carotid revascularization intervention.

Impact of Implementation of an Automated Liquid Culture System on Diagnosis of Tuberculous Pleurisy.

This study was conducted to evaluate the impact of implementation of an automated liquid culture system on the diagnosis of tuberculous pleurisy in an HIV-uninfected patient population. We retrospectively compared the culture yield, time to positivity, and contamination rate of pleural effusion samples in the BACTEC Mycobacteria Growth Indicator Tube 960 (MGIT) and Ogawa media among patients with tuberculous pleurisy. Out of 104 effusion samples, 43 (41.3%) were culture positive on either the MGIT or the Ogawa media. The culture yield of MGIT was higher (40.4%, 42/104) than that of Ogawa media (18.3%, 19/104) (P<0.001). One of the samples was positive only on the Ogawa medium. The median time to positivity was faster in the MGIT (18 days, range 8-32 days) than in the Ogawa media (37 days, range 20-59 days) (P<0.001). No contamination or growth of nontuberculous mycobacterium was observed on either of the culture media. In conclusion, the automated liquid culture system could provide approximately twice as high yields and fast results in effusion culture, compared to solid media. Supplemental solid media may have a limited impact on maximizing sensitivity in effusion culture; however, further studies are required.

Potential role of immunodiagnosis for pulmonary tuberculosis using induced sputum cells.

PURPOSE: To evaluate the diagnostic utility and predictors for determinate results of an enzyme-linked immunospot assay using induced sputum cells (IS ELISPOT) for a rapid diagnosis of pulmonary tuberculosis (TB). MATERIALS AND METHODS: Subjects suspected of pulmonary TB who had either sputum acid fast bacilli smear-negative or not producing sputum spontaneously were prospectively enrolled. ELISPOT assay was performed using cells from induced sputum. RESULTS: A total of 43 subjects, including 25 with TB (TB group) and 18 with non-TB disease (non-TB group) were enrolled. Results of IS ELISPOT were determinate in only 17/43 (39%) subjects, but all of determinate results were consistent with the final diagnosis. Of the 43 sputum samples, 11 (26%) were inadequate to perform IS ELISPOT. Of 32 adequate sputum samples, the proportion of determinate results was significantly higher in the TB group (75%, 15/20) than in the non-TB group (17%, 2/12) (p=0.002). The status of active TB was a unique predictor but smear positivity was not a significant predictor for determinate results. In addition, sensitivity of IS ELISPOT (75%, 9/12) in smear negative TB was higher than that of TB-polymerase chain reaction (25%, 3/12). CONCLUSION: IS ELISPOT showed relatively high diagnostic value and accuracy in the TB group, independent of smear positivity. IS ELISPOT may provide additional diagnostic yield for microbiological tools in the rapid diagnosis of smear-negative TB.

The first case of Capillaria hepatica infection in a nutria (Myocastor coypus) in Korea.

This study reports the first case of Capillaria hepatica infection in a nutria in Korea. Ten nutrias, captured near the Nakdong River, were submitted to our laboratory for necropsy. White-yellowish nodules were found in the liver of 1 of the nutrias at necropsy. Histologically, the lesions were granulomatous, and infiltrations of lipid-laden macrophages, eosinophils, and several multinucleated giant cells were observed. The lesions consisted of numerous eggs and necrotic hepatocytes. The eggs were lemon-shaped and had polar plugs at the ends of both long sides. The eggs were morphologically identified as those of C. hepatica. Worldwide, C. hepatica infection in nutrias is very rare. Nutrias are a kind of livestock, as well as wildlife; therefore, an epidemiological study for parasitic infections needs to be conducted.

Moxibustion in the management of irritable bowel syndrome: systematic review and meta-analysis.

BACKGROUND: Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder. Many patients suffer from IBS that can be difficult to treat, thus complementary therapies which may be effective and have a lower likelihood of adverse effects are being sought.This systematic review and meta-analysis aimed at critically evaluating the current evidence on moxibustion for improving global symptoms of IBS. METHODS: We searched Medline, EMBASE, the Cochrane Central Register of Controlled Trials, AMED, CINAHL, and CNKI databases for randomised controlled trials (RCTs) of moxibustion comparing with sham moxibustion, pharmacological medications, and other active treatments in patients with IBS. Trials should report global symptom improvement as an outcome measure. Risk of bias for each RCT was assessed according to criteria by the Cochrane Collaboration, and the dichotomous data were pooled according to the control intervention to obtain a risk ratio (RR) of global symptom improvement after moxibustion, with 95% confidence intervals (CI). RESULTS: A total of 20 RCTs were eligible for inclusion (n = 1625). The risk of bias was generally high. Compared with pharmacological medications, moxibustion significantly alleviated overall IBS symptoms but there was a moderate inconsistency among studies (7 RCTs, RR 1.33, 95% CI [1.15, 1.55], I² = 46%). Moxibustion combined with acupuncture was more effective than pharmacological therapy but a moderate inconsistency among studies was found (4 RCTs, RR 1.24, 95% CI [1.09, 1.41], I² = 36%). When moxibustion was added to pharmacological medications or herbal medicine, no additive benefit of moxibustion was shown compared with pharmacological medications or herbal medicine alone. One small sham-controlled trial found no difference between moxibustion and sham control in symptom severity (mean difference 0.35, 95% CI [-0.77, 1.47]). Moxibustion appears to be associated with few adverse events but the evidence is limited due to poor reporting. CONCLUSIONS: This systematic review and meta-analysis suggests that moxibustion may provide benefit to IBS patients although the risk of bias in the included studies is relatively high. Future studies are necessary to confirm whether this finding is reproducible in carefully-designed and conducted trials and to firmly establish the place of moxibustion in current practice.

Endovascular Embolization of Intracranial Aneurysms Using Bare Platinum Axium™ Detachable Coils: Immediate and Short-Term Follow-up Results from a Multicenter Registry.

PURPOSE: Axium™ coils were developed to improve the durability of coil-embolized cerebral aneurysms by increasing packing density. The purpose of this prospective multicenter registry was to evaluate the safety and durability of Axium™ coils. MATERIALS AND METHODS: One hundred twenty-six patients with 135 aneurysms of ≤ 15 mm in size underwent coil embolization using bare platinum coils, with Axium™ coils constituting over 50% of the total coil length. Immediate and short-term follow-up results were prospectively registered and retrospectively evaluated. RESULTS: Of the 135 aneurysms (83 unruptured and 52 ruptured), immediate post-embolization angiography revealed complete occlusion in 80 aneurysms (59.3%), neck remnants in 47 (34.8%), and incomplete occlusion in 8 (5.9%). The mean packing density was 42.8% (range, 9.5 - 90%) with Axium™ coil length constituting a mean of 87.9% of total coil length. The rate of procedure-related complications was 16.3%. Procedure-related permanent morbidity and mortality rates were 3.2% and 0.8%, respectively. Follow-up catheter or MR angiography, which was available in 101 aneurysms at 6 - 15 months (mean, 7.7 months), revealed stable or improved occlusion in 95 aneurysms and worsening in 6 aneurysms (5.9%). Lower packing density (< 30%) remained the only predictor for anatomical worsening on multivariable logistic regression analysis (P < 0.05). CONCLUSION: In this registry, Axium™ coils showed a relatively low rate of anatomical worsening on short-term follow-up imaging with an acceptable periprocedural safety profile compared to reports of other platinum coils. These results may warrant further study of long-term durability with Axium™ coils in larger populations.

Significance of clopidogrel resistance related to the stent-assisted angioplasty in patients with atherosclerotic cerebrovascular disease.

OBJECTIVE: To evaluate the prevalence and risk factors of clopidogrel resistance, and association between thromboembolic complications and clopidogrel resistance in patient with stent-assisted angioplasty for atherosclerotic cerebrovascular disease. METHODS: Between September 2006 and June 2008, clopidogrel resistance test was performed on 41 patients who underwent stent-assisted angioplasty for atherosclerotic cerebrovascular disease. It was performed before drug administration and about 12 hours after drug administration (loading dose : 300 mg, maintain dose : 75 mg). Two patients were excluded, and 41 patients were included (mean : 67.59±7.10 years, age range : 41-79). Among 41 patients, 18 patients had intracranial lesions, and 23 had extracranial lesions. We evaluated the prevalence, risk factors and complications related to clopidogrel resistance. RESULTS: Twenty-one patients (51.2%) showed clopidogrel resistance [intracranial : 10 patients (55.6%), extracranial : 11 patients (47.8%)] and no clopidogrel resistance was seen in 20 patients. Hypercholesterolemia was an indepedent risk factor of clopidogrel resistance. Stent-assisted angioplasty was technically successful in all patients, but acute in-stent thrombosis occurred in 5 patients with intracranial lesions (4 patients with clopidogrel resistance and 1 without clopidogrel resistance). Acute thrombi were completely lysed after intra-arterial infusion of abciximab. CONCLUSION: There was relatively high prevalence of clopidogrel resistance in patients with atherosclerotic cerebrovascular disease. Hypercholesterolemia was an independent predictive factor of clopidogrel resistance. Acute in-stent thrombosis was more frequently seen in the clopidogrel resistant group. Therefore, clopidogrel resistance test should be performed to avoid thromboembolic complications related to stent-assisted angioplasty for atherosclerotic cerebrovascular disease, especially patients with hypercholeterolemia and intracranial lesion.

Central washout sign in computer-aided evaluation of breast MRI: preliminary results.

BACKGROUND: Although computer-aided evaluation (CAE) programs were introduced to help differentiate benign tumors from malignant ones, the set of CAE-measured parameters that best predict malignancy have not yet been established. PURPOSE: To assess the value of the central washout sign on CAE color overlay images of breast MRI. MATERIAL AND METHODS: We evaluated the frequency of the central washout sign using CAE. The central washout sign was determined so that thin, rim-like, persistent kinetics were seen in the periphery of the tumor. Then, sequentially, plateau and washout kinetics appeared. Two additional CAE-delayed kinetic variables were compared with the central washout sign for assessment of diagnostic utility: the predominant enhancement type (washout, plateau, or persistent) and the most suspicious enhancement type (any washout > any plateau > any persistent kinetics). RESULTS: One hundred and forty-nine pathologically proven breast lesions (130 malignant, 19 benign) were evaluated. A central washout sign was associated with 87% of malignant lesions but only 11% of benign lesions. Significant differences were found when delayed-phase kinetics were categorized by the most suspicious enhancement type (P < 0.001) and the presence of the central washout sign (P < 0.001). Under the criteria of the most suspicious kinetics, 68% of benign lesions were assigned as plateau or washout pattern. CONCLUSION: The central washout sign is a reliable indicator of malignancy on CAE color overlay images of breast MRI.

Background enhancement in breast MR: correlation with breast density in mammography and background echotexture in ultrasound.

OBJECTIVE: This study aimed to determine whether background enhancement on MR was related to mammographic breast density or ultrasonographic background echotexture in premenopausal and postmenopausal women. MATERIALS AND METHODS: We studied 142 patients (79 premenopausal, 63 postmenopausal) who underwent mammography, ultrasonography, and breast MR. We reviewed the mammography for overall breast density of the contralateral normal breast according to the four-point scale of the BI-RADS classification. Ultrasound findings were classified as homogeneous or heterogeneous background echotexture according to the BI-RADS lexicon. We rated background enhancement on a contralateral breast MR into four categories based on subtraction images: absent, mild, moderate, and marked. All imaging findings were interpreted independently by two readers without knowledge of menstrual status, imaging findings of other modalities. RESULTS: There were significant differences between the premenopausal and postmenopausal group in distribution of mammographic breast density, ultrasonographic background echotexture, and degree of background enhancement. Regarding the relationship between mammographic density and background enhancement, there was no significant correlation. There was significant relationship between ultrasonographic background echotexture and background enhancement in both premenopausal and postmenopausal groups. CONCLUSION: There is a significant correlation between ultrasonographic background echotexture and background enhancement in MR regardless of menopausal status. Interpreting breast MR, or scheduling for breast MR of women showing heterogeneous background echotexture needs more caution.

Preliminary result of stereotactic body radiotherapy as a local salvage treatment for inoperable hepatocellular carcinoma.

BACKGROUND AND OBJECTIVES: To evaluate the toxicity and efficacy of stereotactic body radiotherapy (SBRT) for the treatment of localized hepatocellular carcinoma (HCC) in the absence of another standard treatment option. METHODS: The authors reviewed the details of 38 patients with inoperable HCC (diameter <10 cm) treated by SBRT in a prospectively registered database at their institution. All patients had been treated by transcatheter arterial chemoembolization before SBRT, which had been finally deemed ineffective. SBRT dosages (33-57 Gy in three or four fractions) were administered according to tumor volumes, which ranged from 11 to 464 ml (median, 40.5 ml). RESULTS: Two-year overall survival and local progression-free survival rates were 61.4% and 66.4%, respectively. The local response rate was 63% at 3 months after SBRT. A high radiation dose was found to be independently related to survival. A decline in liver function was observed in six patients (16%) and Grade 3 musculoskeletal toxicity in one patient (2.7%). CONCLUSIONS: This study showed that SBRT can be safely administered to select HCC patients, and these results suggest that this technique should be considered a salvage treatment. A further well-controlled large-scale study and longer follow-up are needed to determine optimal dose-fraction schedules and characterize late complications.

Triple-negative breast cancer: correlation between imaging and pathological findings.

OBJECTIVE: This study was designed to investigate the mammography and ultrasound findings of triple-negative breast cancer and to compare the results with characteristics of ER-positive/PR-negative/HER2-negative breast cancer and ER-negative/PR-negative/HER2-positive breast cancer. METHODS: From January 2007 to October 2008, mammography and ultrasound findings of 245 patients with pathologically confirmed triple-negative (n = 87), ER-positive/PR-negative/HER2-negative (n = 93) or ER-negative/PR-negative/HER2-positive breast cancers (n = 65) were retrospectively reviewed. We also reviewed pathological reports for information on the histological type, histological grade and the status of the biological markers. RESULTS: Triple-negative breast cancers showed a high histological grade. On mammography, triple-negative breast cancers usually presented with a mass (43/87, 49%) or with focal asymmetry (19/87, 22%), and were less associated with calcifications. On ultrasound, the cancers were less frequently seen as non-mass lesions (12/87, 14%), more likely to have circumscribed margins (43/75, 57%), were markedly hypoechoic (36/75, 57%) and less likely to show posterior shadowing (4/75, 5%). Among the three types of breast cancers, ER-negative/PR-negative/HER2-positive breast cancers most commonly had associated calcifications (52/65, 79%) on mammography and were depicted as non-mass lesions (21/65, 32%) on ultrasound. CONCLUSION: Our results suggest that the imaging findings might be useful in diagnosing triple-negative breast cancer.

Sonographic changes after removing all benign breast masses with sonographically guided vacuum-assisted biopsy.

BACKGROUND: Total removal of benign breast masses by vacuum-assisted biopsy (VAB) is now increasingly accepted as a treatment option. However, little is known about whether this procedure produces early changes on follow-up sonography and, if so, how often and what factors might influence them. PURPOSE: To evaluate sonographic changes after total removal of benign breast masses using sonographically guided VAB and to determine the influencing factors. MATERIAL AND METHODS: We evaluated sonographic changes prospectively 1 week, 1 month, and 6 months after biopsying 32 benign masses from which all sonographic evidence had been removed during sonographically guided directional VAB performed with 8- or 11-gauge needles. Procedural factors were documented and compared with sonographic findings. RESULTS: At 1-week follow-up, hematomas were observed in 84% (27/32) of the lesions. After 1 month, while the hematomas had resolved in all but five lesions, focal new architectural distortion had developed in 26 (90%) lesions; 11 lesions were graded as severe, mimicking malignancy. After 6 months, 23 lesions with various degrees of architectural distortion were observed. Six of the 32 lesions (19%) contained a residual lesion. No statistically significant association between sonographic findings and procedural variables was identified, except between the degree of hematoma and lesion size. CONCLUSION: The total removal of benign breast masses using sonographically guided VAB frequently produces changes on follow-up sonography after 6 months. Although these changes failed to show statistical significance with procedural factors, a larger dedicated study is needed.

Fibrosing inflammatory pseudotumor of the nasopharynx: MR features and histopathologic correlation.

PURPOSE: To describe the magnetic resonance (MR) imaging features of six cases of pathologically proven fibrosing inflammatory pseudotumor involving the nasopharynx, and to compare the MR signal intensities of the lesions with histopathologic findings. METHODS: We reviewed the MR finding of six patients with pathologically proved fibrosing inflammatory pseudotumor at the nasopharyngeal wall with respect to the following points: extent, margins, signal intensity and enhancement degree of the lesion; cervical lymphadenopathy and response to steroid therapy. MR findings were correlated with histopathologic findings. RESULTS: All lesions showed ill-defined margins and looked less-likely contour bulging features. The signal intensity of the lesions was hypointense or slightly heterogeneous relative to brain cortex on both T1- and T2-weighted images, and enhancement was weakly homogeneous in all cases. There was no demonstrable cervical lymphadenopathy in all cases. After steroid therapy, the lesions showed decreased extent and weaker enhancement in three patients. Histopathologic findings showed high degree of polymorphous inflammatory cellular infiltration with underlying significant reactive fibrosis. CONCLUSION: Fibrotic inflammatory pseudotumors involving nasopharynx are very rare, and can mimic malignancy. MR imaging showed ill-defined margins, hypointensity or slightly heterogenous signal intensity on T2-weighted image and weak enhancement. There was no significant cervical lymphadenopathy.

Reconstructive endovascular treatment of ruptured blood blister-like aneurysms of the internal carotid artery.

OBJECT: Ruptured blood blister-like aneurysms (BBAs) of the internal carotid artery (ICA) are rare but carry a high rate of morbidity and mortality. Furthermore, BBAs are very difficult to treat surgically as well as endovascularly. The authors present their experience in treating BBAs with reconstructive endovascular methods. METHODS: Nine ruptured BBAs in 9 consecutive patients (2 men and 7 women; mean age 50 years, range 42-57 years) were treated using reconstructive endovascular methods between January 2006 and November 2007. Treatment methods and angiographic and clinical outcomes were retrospectively evaluated. RESULTS: All 9 BBAs were initially treated with stent-assisted coil (SAC) embolization. This was followed by a second stent insertion using the stent-within-a-stent (SWS) technique in 3, covered stent placement in 3, and SAC embolization alone in 3. All 3 patients who underwent SWS placement had excellent outcomes (Glasgow Outcome Scale Score 5) with complete angiographic resolution of the BBAs. There were no treatment-related complications in the SWS group. Two of the 3 patients who received covered stents had excellent outcomes (Glasgow Outcome Scale Score 5) and complete occlusion of the BBA was achieved. The remaining patient who received a covered stent died of ICA rupture during the procedure. Aneurysm regrowth without rebleeding occurred in the 3 patients who underwent SAC embolization. Two of the 3 recurrent BBAs were treated with coil embolization with a second stent insertion, and as a result these belonged to the SWS group. The other recurrent BBA was treated with a covered stent. Of the 8 surviving patients, 5 underwent SWS, and 3 underwent covered stent placement. All surviving patients had excellent outcomes during the clinical follow-up period (mean 11 months, range 4-26 months); complete BBA resolution and smooth reconstruction of the affected ICA segment was shown on follow-up angiography. CONCLUSIONS: In the present study, the SWS and covered-stent techniques effectively prevented rebleeding and regrowth of the BBA without sacrifice of the ICA. The SWS and covered-stent techniques can be considered an alternative treatment option for BBAs in selected patients in whom ICA sacrifice is not feasible. Stent-assisted coiling alone seems insufficient to prevent BBA regrowth.