New developments in diagnosis and treatment of intracranial aneurysms

This thesis is based on two pillars: imaging with state-of-the-art 3D angiography and endovascular therapy with the new Woven EndoBridge intrasaccular flow-diverter. 3D Rotational Angiography CT and CT angiography for cerebral aneurysms have limited spatial resolution and with 2D angiography, only a limited number of projections can be made. With the introduction of 3D angiography, a new modality with high resolution and an infinite number of projections became available. In this thesis, we evaluate the impact of 3D angiography on the diagnosis of aneurysms and other vascular disorders and variations in patients with SAH. With (suspected) aneurysms, 3D angiography was performed of all cerebral vessels, mostly under general anesthesia preceding endovascular treatment. These data were used to assess the clinical value of CT angiography in patients with SAH and to evaluate the prevalence and locations of fenestrations of intracranial arteries and the possible relation of fenestrations with aneurysms. Finally, hospital demographics of patients with SAH were assessed. The Woven EndoBridge The endovascular treatment of wide-necked intracranial aneurysms remains a technical challenge. Conventional techniques such as balloon- or stent assistance and intravascular flow-diverters have several disadvantages such as catheterization difficulties and the need for longstanding dual antiplatelet medication. The new intrasaccular flow-diverter Woven EndoBridge (WEB) was developed for single-step endovascular treatment of wide-necked aneurysms without the need for antiplatelet medication. Clinical and imaging results were collected and used for studies of ruptured and unruptured aneurysms treated with the WEB in relation to previous results, including a systematic review and meta-analysis

New developments in diagnosis and treatment of intracranial aneurysms

This thesis is based on two pillars: imaging with state-of-the-art 3D angiography and endovascular therapy with the new Woven EndoBridge intrasaccular flow-diverter. 3D Rotational Angiography CT and CT angiography for cerebral aneurysms have limited spatial resolution and with 2D angiography, only a limited number of projections can be made. With the introduction of 3D angiography, a new modality with high resolution and an infinite number of projections became available. In this thesis, we evaluate the impact of 3D angiography on the diagnosis of aneurysms and other vascular disorders and variations in patients with SAH. With (suspected) aneurysms, 3D angiography was performed of all cerebral vessels, mostly under general anesthesia preceding endovascular treatment. These data were used to assess the clinical value of CT angiography in patients with SAH and to evaluate the prevalence and locations of fenestrations of intracranial arteries and the possible relation of fenestrations with aneurysms. Finally, hospital demographics of patients with SAH were assessed. The Woven EndoBridge The endovascular treatment of wide-necked intracranial aneurysms remains a technical challenge. Conventional techniques such as balloon- or stent assistance and intravascular flow-diverters have several disadvantages such as catheterization difficulties and the need for longstanding dual antiplatelet medication. The new intrasaccular flow-diverter Woven EndoBridge (WEB) was developed for single-step endovascular treatment of wide-necked aneurysms without the need for antiplatelet medication. Clinical and imaging results were collected and used for studies of ruptured and unruptured aneurysms treated with the WEB in relation to previous results, including a systematic review and meta-analysis

Three-dimensional rotational angiography for craniotomy planning and postintervention evaluation of intracranial aneurysms

PURPOSE: The authors evaluated the usefulness of three-dimensional rotational angiography (3DRA) in surgical planning and postoperative evaluation of cerebral aneurysms. MATERIALS AND METHODS: A total of 111 consecutive aneurysms in 100 patients (32 emergency referrals due to haemorrhage) were evaluated with 3DRA over a period of 3 years. The rotational study was always performed with a single injection of 20 cc of contrast agent in the afferent vessel after diagnostic cerebral angiography in the two orthogonal projections. Three-dimensional reconstructions were obtained for the pre- and postoperative assessment. RESULTS: Three-dimensional RA provides a virtual view of the surgical field with the same orientation required for the surgical approach and, compared with surgical findings, reliably defined location, orientation, morphology and relationship with parent vessels of the aneurysm in all cases. Postoperatively, it allowed better assessment of any residual lesion and of the relationship between surgical clips and parent vessels, compared with standard 2D angiography. CONCLUSIONS: 3DRA is a reliable method for preliminary assessment of cerebral aneurysms undergoing surgery. It provides multiple projections with a preview of the surgical field and study of lesion characteristics, which can help achieve faster and safer surgery. Compared with 2D angiography, the 3D model, with its multiple views, allows better assessment of postoperative outcomes. The method also significantly reduces the number of angiographic projections and therefore radiation and contrast-medium dose to the patient