Safety and Efficacy of the FRED Jr Flow Re-Direction Endoluminal Device for Intracranial Aneurysms: Retrospective Multicenter Experience With Emphasis on Midterm Results

Background and Purpose: Flow diversion is increasingly used as an endovascular treatment for intracranial aneurysms. In this retrospective multicenter study, we analyzed the safety and efficacy of the treatment of intracranial, unruptured, or previously treated but recanalized aneurysms using Flow Re-Direction Endoluminal Device (FRED) Jr with emphasis on midterm results. Materials and Methods: Clinical and radiological records of 150 patients harboring 159 aneurysms treated with FRED Jr at six centers between October 2014 and February 2020 were reviewed and consecutively included. Clinical outcome was measured by using the modified Rankin Scale (mRS). Anatomical results were assessed according to the O’Kelly-Marotta (OKM) scale and the Cekirge-Saatci Classification (CSC) scale. Results: The overall complication rate was 24/159 (16%). Thrombotic-ischemic events occurred in 18/159 treatments (11%). These resulted in long-term neurological sequelae in two patients (1%) with worsening from pre-treatment mRS 0–2 and mRS 4 after treatment. Complete or near-complete occlusion of the treated aneurysm according to the OKM scale was reached in 54% (85/158) at 6-month, in 68% (90/133) at 1-year, and in 83% (77/93) at 2-year follow-up, respectively. The rates of narrowing or occlusion of a vessel branch originating from the treated aneurysm according to the CSC scale were 11% (12/108) at 6-month, 20% (17/87) at 1-year, and 23% (13/57) at 2-year follow-up, respectively, with all cases being asymptomatic. Conclusions: In this retrospective multicenter study, FRED Jr was safe and effective in the midterm occlusion of cerebral aneurysms. Most importantly, it was associated with a high rate of good clinical outcome

European consensus conference on unruptured brain AVMs treatment (Supported by EANS, ESMINT, EGKS, and SINCH)

In December of 2016, a Consensus Conference on unruptured AVM treatment, involving 24 members of the three European societies dealing with the treatment of cerebral AVMs (EANS, ESMINT, and EGKS) was held in Milan, Italy. The panel made the following statements and general recommendations: (1) Brain arteriovenous malformation (AVM) is a complex disease associated with potentially severe natural history; (2) The results of a randomized trial (ARUBA) cannot be applied equally for all unruptured brain arteriovenous malformation (uBAVM) and for all treatment modalities; (3) Considering the multiple treatment modalities available, patients with uBAVMs should be evaluated by an interdisciplinary neurovascular team consisting of neurosurgeons, neurointerventionalists, radiosurgeons, and neurologists experienced in the diagnosis and treatment of brain AVM; (4) Balancing the risk of hemorrhage and the associated restrictions of everyday activities related to untreated unruptured AVMs against the risk of treatment, there are sufficient indications to treat unruptured AVMs grade 1 and 2 (Spetzler-Martin); (5) There may be indications for treating patients with higher grades, based on a case-to-case consensus decision of the experienced team; (6) If treatment is indicated, the primary strategy should be defined by the multidisciplinary team prior to the beginning of the treatment and should aim at complete eradication of the uBAVM; (7) After having considered the pros and cons of a randomized trial vs. a registry, the panel proposed a prospective European Multidisciplinary Registry.Peer reviewe

The retreatment: Indications, technique and results

Durability of endovascular treatment of intracranial aneurysms has always been an issue and a very strong point of criticism. Although studies on long-term results have made it clear that endovascular treatment safe and effective they, nonetheless showed retreatment after endovascular treatment is nearly 5-10 times more frequent than surgical clipping. Risk factors predisposing high probability of retreatment are aneurysm with dissecting nature, incomplete coiling, sac size larger than 10 mm and localization at the bifurcations such as basilar tip. The indications for retreatment after endovascular treatment are not clear yet, although certain morphologic criteria can be used. Retreatment appears not to negate the initial advantage of endovascular treatment over surgical treatment and can be performed very small morbi-mortality numbers. (C) 2013 Elsevier Ireland Ltd. All rights reserved

Experimental Parameter Estimation Method for Nonlinear Viscoelastic Composite Material Models: An Application on Arterial Tissue

This study is aimed at setting a method of experimental parameter estimation for large-deforming nonlinear viscoelastic continuous fibre-reinforced composite material model. Specifically, arterial tissue was investigated during experimental research and parameter estimation studies, due to medical, scientific and socio-economic importance of soft tissue research. Using analytical formulations for specimens under combined inflation/extension/torsion on thick-walled cylindrical tubes, in vitro experiments were carried out with fresh sheep arterial segments, and parameter estimation procedures were carried out on experimental data. Model restrictions were pointed out using outcomes from parameter estimation. Needs for further studies that can be developed are discussed

Neuroimaging findings of four patients with Sandhoff disease

Sandhoff disease is a severe form of GM, gangliosidosis that is caused by the deficiency of both hexosaminidase A and B, Startle reaction, hypotonia, psychomotor retardation, and blindness are the main clinical features. Presented are computed tomography and magnetic resonance imaging findings of four patients with Sandhoff disease diagnosed by enzymatic analyses, Bilateral homogeneous thalamic hyperdensity was evident on computed tomography, Magnetic resonance imaging scans revealed mild cortical atrophy, a thin corpus callosum, and abnormal signal intensities in the caudate nucleus, globus pallidum, putamen, cerebellum, and brainstem, No correlation was evident between the severity of the central nervous system imaging findings and the clinical pictures. In this article the neuroimaging findings of four patients with Sandhoff disease are discussed, (C) 1999 by Elsevier Science Inc. All rights reserved

Fused magnetic resonance angiography and 2D fluoroscopic visualization for endovascular intracranial neuronavigation Technical note

Advanced transluminal neurovascular navigation is an indispensable image-guided method that allows for real-time navigation of endovascular material in critical neurovascular settings. Thus far, it has been primarily based on 2D and 3D angiography, burdening the patient with a relatively high level of iodinated contrast. However, in the patients with renal insufficiency, this method is no longer tolerable due to the contrast load. The authors present a novel image guidance technique based on periprocedural fluoroscopic images fused with a preinterventionally acquired MRI data set. The technique is illustrated in a case in which the fused image combination was used for endovascular treatment of a giant cerebral aneurysm. (http://thejns.org/doi/abs/10.3171/2012.11.JNS111355

Teaching NeuroImages: A rare cause of trigeminal neuralgia Dysplastic venous aneurysm of dural arteriovenous fistula

A 56-year-old man presented with episodic intense facial pain. Trigeminal neuralgia was the presumed diagnosis. MRI revealed vascular compression of the root entry zone (REZ) of the trigeminal nerve (TN) (figure 1, A and B). A dural arteriovenous fistula was detected at the left side of the cerebellar tentorium on digital subtraction angiography (figure 2). A dysplastic venous aneurysm of the draining vein was determined to be the compressive vascular lesion seen on MRI. Trigeminal neuralgia is a common neuropathic disorder characterized by episodes of intense facial pain, most often because of a vascular compression of the REZ of the TN.(1,2</SUP