Safety and efficacy of flow diverter stents in the treatment of middle cerebral artery aneurysms: a single-center experience and follow-up data

PURPOSEThis study aims to evaluate the safety and efficacy of flow diverters (FDs) in the treatment of middle cerebral artery (MCA) aneurysms and share the follow-up (F/U) results.METHODSThe treatment and F/U results of 76 MCA aneurysms treated with the flow re-direction endoluminal device (FRED), FRED Jr., and pipeline embolization device (PED) FD stents were evaluated retrospectively. The aneurysm occlusion rates were compared between FDs, and the integrated and jailed branches were evaluated through follow-ups. The oversizing of the stent was compared between occluded/non-occluded aneurysms and integrated branches.RESULTSThe mean F/U duration was 32 ± 6.3 months, and the mean aneurysm diameter was 4.45 mm. A total of 61 (80.3%) aneurysms were wide-necked; 73 (96.1%) were saccular; 52 (68.4%) were located at the M1 segment; and 36 (45.6%) FREDs, 23 (29.1%) FRED Jr.s, and 19 (24.1%) PEDs were used for treatment. The overall occlusion rates for the 6-, 12-, 24-, 36-, and 60-month digital subtraction angiographies were 43.8%, 63.5%, 73.3%, 85.7%, and 87.5% respectively. The last F/U occlusion rates were 67.6% for FRED, 66.7% for PED, and 60.6% for FRED Jr. (P = 0.863). An integrated branch was covered with an FD during the treatment of 63 (82.8%) aneurysms. A total of six (10%) of the integrated branches were occluded without any symptoms at the last F/U appointment. The median oversizing was 0.45 (0–1.30) for occluded aneurysms, and 0.50 (0–1.40) for non-occluded aneurysms (P = 0.323). The median oversizing was 0.70 (0.45–1.10) in occluded integrated branches and 0.50 (0–1.40) in non-occluded branches (P = 0.131). In-stent stenosis was seen in 22 (30.1%) of the stents at the 6-month F/U and in only 2 (4.7%) at the 24-month F/U. Thus, none of the patients had any neurological deficits because of the in-stent stenosis. Severe in-stent stenosis was seen in two stents.CONCLUSIONMCA aneurysms tend to be complex, with integrated branches and potentially wide necks. FD stents are safe and effective in the treatment of MCA aneurysms, and the patency of the side and jailed branches is preserved in most cases. Higher occlusion and lower in-stent stenosis rates are seen with longer F/U durations

Diminished Sphenous Compartment Connective Tissue Elasticity has Little Impact on Low Grade Venous Insufficiency: An Ultrasound Shearwave Elastography Study

Background: Greater Saphenous Vein (GSV) courses within saphenous compartment, an adipose-filled space bound by fasciae provides structural support. Ultrasound Shear-Wave Elastography (SWE) provides objective and quantitative data on tissue shear elasticity modulus. Objective: This study aims to analyze possible associations between early stage GSV insufficiency and saphenous intracompartmental SWE measurements. Methods: Two-hundred consecutive patients, ages 22 to 81 (mean=44.3) years, with venous insufficiency symptoms underwent Doppler and SWE examinations. Patients had no visible or palpable sign of venous disease or had telangiectasia and reticular veins only. Analyses regarding patient age, gender, presence of venous insufficiency of GSV proper and intracompartmental connective tissue elasticity were performed. Results: Ninety-six patients had Doppler evidence for either bilateral or unilateral insufficiency of GSV proper at mid-thigh level. Intracompartmental elasticity of patients with venous insufficiency (mean=4.36 +/- 2.24 kilopascals; range 1.55 to 10.44 kPa) did not differ significantly from those with normal veins (mean=4.82 +/- 2.61 kPa; range 2.20 to 12.65 kPa) (p=0.231). No threshold for predicting the presence of venous insufficiency could be determined. Neither were there any correlations between age, gender and intracompartmental elasticity. In patients with unilateral insufficiency, however, elastography values around insufficient veins were significantly lower compared to contralateral normal GSV (p<0.001). Conclusion: Many intrinsic and patient factors affect intracompartmental connective tissue elastography measurements; thus, cut-off values obtained from specific populations have limited generalizability. Nevertheless, statistically significant intrapatient differences of intracompartmental elasticity among diseased and normal saphenous veins indicate that lack of elastic support from surrounding connective tissues contributes to venous insufficiency in early stages

3 tesla magnetik rezonans görüntülemede iliolumbar ligamanın lumbosakral transizyonel vertebra saptanmasındaki etkinliği ve vertebra numaralandırmadaki yeterliliğinin nöral, osseoz ve vasküler belirteçlerle karşılaştırması

ÖZETLumbosakral transizyonel vertebra (LSTV) nispeten sık görülen bir vertebral anomalidir. Çalışmamızda iliolumbar ligamanın (ILL), vertebra numaralandırma ve LSTV tanımlanmasındaki pratik kullanımı değerlendirildi. ILL’yi ayrı bir yapı olarak tanımlayabilmede radyoloğun öğrenim süreci gözlendi. Ayrıca, aort bifurkasyonu (AB), sağ renal arter (RRA), konus medullaris (KM) ve 12.kosta gibi anatomik belirteçler yardımı ile vertebra numaralandırmanın etkinliği irdelendi.Haziran – Kasım 2012 tarihleri arasında 505 erişkin olguya kontrastsız lomber spinal MR incelemesi yapıldı. Ciddi travma ve spondilolistezis, enfeksiyon ya da geçirilmiş lomber spinal cerrahi anamnezli olgular ile belirgin spinal deformitesi, ciddi derecede tortüoz ya da anevrizmatik aortası olan olgular değerlendirmeye alınmadı. Olgulardan 3.0 Tesla MR cihazı ile tüm spinal kolon sayıcı görüntüleri alınmasının ardından lumbosakral vertebralara yönelik sagittal ve aksiyal planda T1 ve T2 ağırlıklı TSE görüntüleri elde edilerek iki radyolog tarafından ayrı ayrı değerlendirildi. Servikotorakal sagital sayıcı görüntüler lomber vertebral segmentlerin numaralandırılmasında altın standart olarak kullanıldı. Sagital görüntüler LSTV varlığı için değerlendirildi. Aksiyel görüntülerden ILL orijini tespit edildi. Aksiyel kesitler kullanılarak AB; sagital görüntüler kullanılarak RRA ve KM tanımlandı ve en yakın komşuluk gösterdikleri vertebral cismin üst veya alt yarısına ya da komşu intervertebral diske göre numaralandırıldı. Görüntüler S1-2 disk morfolojisi açısından O’Driscoll yöntemi ile değerlendirildi. Onikinci kosta varlığı, görüntülerde hiperplazik L1 transvers proçesi ile karışmayacak şekilde belirlenmeye çalışıldı.Olguların %18.6’sında LSTV tespit edildi. AB en sık L4 üst yarısı (%46.1), RRA en sık L1 alt yarısı (%40.6) ve KM en sık L1 üst yarısı (%30.3) düzeyinde izlendi. Bu belirteçler, LSTV olmayan olgular ile karşılaştırıldığında lumbalize S1 olgularında daha kaudalde ve sakralize L5 olgularında daha kranialde tespit edildi. Daha tecrübesiz olan radyoloğun 80 olgu sonrasında ILL belirlemede yeterli beceriyi elde ettiği gözlemlendi. ILL olguların %14.3’ünde standart lomber MR kesitlerinde tanımlanamadı. Olguların %4.4’ünde ILL L4 vertebradan orijin almakta idi; bu olguların tümünde LSTV saptandı. Rutin lomber MR incelemelerinde olguların %51.9’unda 12. kostanın kesin olarak tanımlanması mümkün olmadı. O’Driscoll yöntemi ile son intervertebral disk morfolojisi sınıflandırıldığında; %27.3 tip 1, %61.6 tip 2, %4.0 tip 3 ve %7.1 tip 4 disk saptandı. Tip 3 ya da tip 4 disk bulunma ihtimalinin S1 lumbalizasyon olgularında belirgin olarak arttığı gözlendi.ILL en alt düzeydeki lomber segmenti belirlemede ve LSTV olgularında bir vertebrayı sakral değil lomber olarak değerlendirmemizde faydalıdır. Ancak, ILL tüm vertebral kolonu numaralandırmada ve L5 vertebrayı kesin olarak belirlemede kullanılamaz. Lokalizasyonlarında çok belirgin varyasyon göstermeleri nedeniyle AB, RRA ve KM rutin incelemelerde vertebra numaralandırma için güvenilir belirteçler değildir. Onikinci kostanın rutin lomber MRG tetkikleri ile tespitinde ciddi tutarsızlıklar gözlenmektedir. LSTV’nin rutin lomber MR incelemelerinde tanımlanamaması ve vertebraların hatalı numaralandırılması nedeniyle yanlış düzeye cerrahi ya da tanısal girişim yapılma riski artmıştır. Bunu engellemek için ya tüm lomber MR incelemelerinde rutin olarak servikotorakal sayıcı alınmalı ya da girişim öncesi spinal anatomiyi verifiye etmek amacıyla mümkünse olgunun direkt grafileri ile korelasyonun gerekliliği bildirilmeli veya ek görüntüleme yöntemlerine başvurulması radyolog tarafından önerilmelidir.ANAHTAR SÖZCÜKLER : Magnetik rezonans görüntüleme, iliolumbar ligaman, lumbosakral transizyonel vertebra, aortik bifurkasyon, renal arter, konus medullaris, 12.kosta.ABSTRACTLumbosacral transitional vertebra (LSTV) is a relatively common vertebral anomaly. The utility of iliolumbar ligament (ILL) in vertebral segment numbering and LSTV recognition was evaluated in our study. A radiologist’s learning curve for ILL recognition was observed. The accuracy of aortic bifurcation (AB), right renal artery (RRA), conus medullaris (CM) and 12th costa in vertebral segment numbering was also studied. During the period between June and November 2012, 505 adult patients underwent lumbar spinal MR examinations without contast. Patients with history of serious trauma or spondylolisthesis, infection or lumbar spinal surgery; and patients with significant spinal deformity, tortuous or aneurysmatic aorta were excluded. MR images were obtained with a 3.0 T scanner including a servicothoracic sagittal scout, T1 and T2 weighted sagittal and axial lumbosacral TSE images. Images were read by two radiologists separately. Servicothoracic sagittal scout images were accepted as gold-standard for vertebral segment enumeration. Sagittal images were evaluated for LSTV presence. ILL origin was determined using axial images. AB was identified using axial images; RRA and CM were identified using sagittal images and their corresponding levels were recorded in relation to the upper or lower half of the adjacent vertebral body or the adjacent intervertebral disc space. S1-2 disc morphology was evaluated using O’Driscoll classification. Twelfth costa presence without risk of confusion with hyperplastic L1 transverse processes was evaluated in images.LSTV was present in 18.6% of cases. AB was most commonly seen in upper L4 (46.1%) level, while RRA in lower L1 (40.6%) and CM in upper L1 (30.3%) levels. When compared to non-LSTV cases, these landmarks were located more caudally in lumbalized S1 and more cranially in sacralized L5 cases. The less-experienced radiologist obtained enough skill for adequately locating ILL after examining 80 cases. ILL was not located in 14.3% of cases in routine lumbar MR studies. ILL origin was from L4 vertebra in 4.4% of patients all of which had LSTV. In routine lumbar MR examinations, 12th costa was not identified with absolute certainty in 51.9% of cases. When classified with O’Driscoll method, last intervertebral disc morphology was type 1 in 27.3% , type 2 in 61.6%, type 3 in 4.0% and type 4 in 7.1%. The probability of observing type 3 or 4 disc was significantly higher in S1 lumbalized cases.ILL is useful in determining the lowest lumbar segment and for recognizing a vertebra as lumbar, not sacral, in LSTV cases; but, ILL cannot be utilized for vertebral segment enumeration and locating the L5 vertebra with absolute certainty. Due to their significant variations in locations, AB, RRA and CM are unreliable markers for vertebral segment enumeration. There is serious inconsistency in detecting 12th costa during routine lumbar MR examinations. Failure to recognize LSTV and erroneous enumeration of spinal segments causes increased risk for wrong level spine surgery or intervention. To prevent such cases, either servicothoracic scout images should be obtained in all lumbar MR examinations or the reporting radiologist must express the need for corelation of MR findings with plain radiographs and suggest utilization of complementary imaging techniques if necessary.KEYWORDS : Magnetic resonance imaging, iliolumbar ligament, lumbosacral transitional vertebrae, aortic bifurcation, renal artery, conus medullaris, 12th costa

Ultrasound shear-wave elasticity and magnetic resonance diffusion coefficient show strong inverse correlation in small fibroadenomas

Objective: Stiffness of breast lesions helps distinguish malignant from benign solid masses. Stiffness can he quantitatively measured by magnetic resonance and ultrasound imaging using apparent diffusion coefficient (ADC) and shear-wave elastography (SWE) techniques, respectively. This study aims to analyze correlations between SWE and ADC in biopsy-proven small fibroadenomas. Patients and Methods: Shear-wave elastography and ADC measurements of 50 fibroadenomas were evaluated retrospectively. Mean patient age was 41 +/- 13 years (range 27-63). All lesions had maximum diameters of <= 20 millimeters. Correlations between intralesional ADC, lesion-parenchyma ADC ratio, intralesional SWE, SWE heterogeneity index and lesion volume were analyzed. Results: Mean values of lesions were as follows: ADC=1.71 +/- 0.22 x10-3mm2/s, ADC ratio=1.04 +/- 0.09, maximum SWE=73.4 +/- 28.8 kPa, minimum SWE=43.9 +/- 21.8 kPa and SWE heterogeneity index =29.4 +/- 12.7 kPa. There was a strong inverse correlation between fibroadenoma ADC and SWE values (rho - 0.746, p <0.01). Significant correlations were also found between fihroadenoma volume and ADC (rho = - 0.525, p <0.05) and SWE (rho = 0.840, p <0.01). Conclusion: Apparent diffusion coefficient and SWE values show strong inverse correlation in small fibroadenomas. If proven threshold values for lesion characterization are revealed, ultrasonographic SWE and diffusion-weighted MRI have potential to be used interchangeably

3 tesla magnetik rezonans görüntülemede iliolumbar ligamanın lumbosakral transizyonel vertebra saptanmasındaki etkinliği ve vertebra numaralandırmadaki yeterliliğinin nöral, osseoz ve vasküler belirteçlerle karşılaştırması

Lumbosakral transizyonel vertebra (LSTV) nispeten sık görülen bir vertebral anomalidir. Çalışmamızda iliolumbar ligamanın (ILL), vertebra numaralandırma ve LSTV tanımlanmasındaki pratik kullanımı değerlendirildi. ILL’yi ayrı bir yapı olarak tanımlayabilmede radyoloğun öğrenim süreci gözlendi. Ayrıca, aort bifurkasyonu (AB), sağ renal arter (RRA), konus medullaris (KM) ve 12.kosta gibi anatomik belirteçler yardımı ile vertebra numaralandırmanın etkinliği irdelendi. Haziran – Kasım 2012 tarihleri arasında 505 erişkin olguya kontrastsız lomber spinal MR incelemesi yapıldı. Ciddi travma ve spondilolistezis, enfeksiyon ya da geçirilmiş lomber spinal cerrahi anamnezli olgular ile belirgin spinal deformitesi, ciddi derecede tortüoz ya da anevrizmatik aortası olan olgular değerlendirmeye alınmadı. Olgulardan 3.0 Tesla MR cihazı ile tüm spinal kolon sayıcı görüntüleri alınmasının ardından lumbosakral vertebralara yönelik sagittal ve aksiyal planda T1 ve T2 ağırlıklı TSE görüntüleri elde edilerek iki radyolog tarafından ayrı ayrı değerlendirildi. Servikotorakal sagital sayıcı görüntüler lomber vertebral segmentlerin numaralandırılmasında altın standart olarak kullanıldı. Sagital görüntüler LSTV varlığı için değerlendirildi. Aksiyel görüntülerden ILL orijini tespit edildi. Aksiyel kesitler kullanılarak AB; sagital görüntüler kullanılarak RRA ve KM tanımlandı ve en yakın komşuluk gösterdikleri vertebral cismin üst veya alt yarısına ya da komşu intervertebral diske göre numaralandırıldı. Görüntüler S1-2 disk morfolojisi açısından O’Driscoll yöntemi ile değerlendirildi. Onikinci kosta varlığı, görüntülerde hiperplazik L1 transvers proçesi ile karışmayacak şekilde belirlenmeye çalışıldı. Olguların %18.6’sında LSTV tespit edildi. AB en sık L4 üst yarısı (%46.1), RRA en sık L1 alt yarısı (%40.6) ve KM en sık L1 üst yarısı (%30.3) düzeyinde izlendi. Bu belirteçler, LSTV olmayan olgular ile karşılaştırıldığında lumbalize S1 olgularında daha kaudalde ve sakralize L5 olgularında daha kranialde tespit edildi. Daha tecrübesiz olan radyoloğun 80 olgu sonrasında ILL belirlemede yeterli beceriyi elde ettiği gözlemlendi. ILL olguların %14.3’ünde standart lomber MR kesitlerinde tanımlanamadı. Olguların %4.4’ünde ILL L4 vertebradan orijin almakta idi; bu olguların tümünde LSTV saptandı. Rutin lomber MR incelemelerinde olguların %51.9’unda 12. kostanın kesin olarak tanımlanması mümkün olmadı. O’Driscoll yöntemi ile son intervertebral disk morfolojisi sınıflandırıldığında; %27.3 tip 1, %61.6 tip 2, %4.0 tip 3 ve %7.1 tip 4 disk saptandı. Tip 3 ya da tip 4 disk bulunma ihtimalinin S1 lumbalizasyon olgularında belirgin olarak arttığı gözlendi. ILL en alt düzeydeki lomber segmenti belirlemede ve LSTV olgularında bir vertebrayı sakral değil lomber olarak değerlendirmemizde faydalıdır. Ancak, ILL tüm vertebral kolonu numaralandırmada ve L5 vertebrayı kesin olarak belirlemede kullanılamaz. Lokalizasyonlarında çok belirgin varyasyon göstermeleri nedeniyle AB, RRA ve KM rutin incelemelerde vertebra numaralandırma için güvenilir belirteçler değildir. Onikinci kostanın rutin lomber MRG tetkikleri ile tespitinde ciddi tutarsızlıklar gözlenmektedir. LSTV’nin rutin lomber MR incelemelerinde tanımlanamaması ve vertebraların hatalı numaralandırılması nedeniyle yanlış düzeye cerrahi ya da tanısal girişim yapılma riski artmıştır. Bunu engellemek için ya tüm lomber MR incelemelerinde rutin olarak servikotorakal sayıcı alınmalı ya da girişim öncesi spinal anatomiyi verifiye etmek amacıyla mümkünse olgunun direkt grafileri ile korelasyonun gerekliliği bildirilmeli veya ek görüntüleme yöntemlerine başvurulması radyolog tarafından önerilmelidir. ANAHTAR SÖZCÜKLER : Magnetik rezonans görüntüleme, iliolumbar ligaman, lumbosakral transizyonel vertebra, aortik bifurkasyon, renal arter, konus medullaris, 12.kosta. ABSTRACT Lumbosacral transitional vertebra (LSTV) is a relatively common vertebral anomaly. The utility of iliolumbar ligament (ILL) in vertebral segment numbering and LSTV recognition was evaluated in our study. A radiologist’s learning curve for ILL recognition was observed. The accuracy of aortic bifurcation (AB), right renal artery (RRA), conus medullaris (CM) and 12th costa in vertebral segment numbering was also studied. During the period between June and November 2012, 505 adult patients underwent lumbar spinal MR examinations without contast. Patients with history of serious trauma or spondylolisthesis, infection or lumbar spinal surgery; and patients with significant spinal deformity, tortuous or aneurysmatic aorta were excluded. MR images were obtained with a 3.0 T scanner including a servicothoracic sagittal scout, T1 and T2 weighted sagittal and axial lumbosacral TSE images. Images were read by two radiologists separately. Servicothoracic sagittal scout images were accepted as gold-standard for vertebral segment enumeration. Sagittal images were evaluated for LSTV presence. ILL origin was determined using axial images. AB was identified using axial images; RRA and CM were identified using sagittal images and their corresponding levels were recorded in relation to the upper or lower half of the adjacent vertebral body or the adjacent intervertebral disc space. S1-2 disc morphology was evaluated using O’Driscoll classification. Twelfth costa presence without risk of confusion with hyperplastic L1 transverse processes was evaluated in images. LSTV was present in 18.6% of cases. AB was most commonly seen in upper L4 (46.1%) level, while RRA in lower L1 (40.6%) and CM in upper L1 (30.3%) levels. When compared to non-LSTV cases, these landmarks were located more caudally in lumbalized S1 and more cranially in sacralized L5 cases. The less-experienced radiologist obtained enough skill for adequately locating ILL after examining 80 cases. ILL was not located in 14.3% of cases in routine lumbar MR studies. ILL origin was from L4 vertebra in 4.4% of patients all of which had LSTV. In routine lumbar MR examinations, 12th costa was not identified with absolute certainty in 51.9% of cases. When classified with O’Driscoll method, last intervertebral disc morphology was type 1 in 27.3% , type 2 in 61.6%, type 3 in 4.0% and type 4 in 7.1%. The probability of observing type 3 or 4 disc was significantly higher in S1 lumbalized cases. ILL is useful in determining the lowest lumbar segment and for recognizing a vertebra as lumbar, not sacral, in LSTV cases; but, ILL cannot be utilized for vertebral segment enumeration and locating the L5 vertebra with absolute certainty. Due to their significant variations in locations, AB, RRA and CM are unreliable markers for vertebral segment enumeration. There is serious inconsistency in detecting 12th costa during routine lumbar MR examinations. Failure to recognize LSTV and erroneous enumeration of spinal segments causes increased risk for wrong level spine surgery or intervention. To prevent such cases, either servicothoracic scout images should be obtained in all lumbar MR examinations or the reporting radiologist must express the need for corelation of MR findings with plain radiographs and suggest utilization of complementary imaging techniques if necessary. KEYWORDS : Magnetic resonance imaging, iliolumbar ligament, lumbosacral transitional vertebrae, aortic bifurcation, renal artery, conus medullaris, 12th costa

Thyroid fine needle aspiration biopsy: Do we really need an on-site cytopathologist?

Purpose: The aim of this single center study is to evaluate the effectiveness of performing ultrasound-guided thyroid fine-needle aspiration biopsies (FNAB) performed by the radiologist alone without an on-site cytopathologist. Materials and methods: In this prospective randomized study, 203 patients with single nodules measuring 10 mm or more underwent ultrasound-guided FNAB: 102 patients underwent FNAB performed by the radiologist accompanied by a cytopathologist (control group); 101 patients underwent FNAB by the radiologist alone (study group). In both groups biopsy time, specimen adequacy ratio, total aspiration number, cytopathologist's cytological diagnosis time (t1), cytopathologist's total time consumption (t2) were evaluated. Results: Mean total biopsy time was 8.74 +/- 2.31 min in the study group and was significantly shorter than the control group's 11.97 +/- 6.75 min (p = 0.004). The average number of aspirations per patient in the study group was 4.00 +/- 0; compared to the control group's 3.56 +/- 1.23 this was significantly higher (p = 0.001). t1 of the study group was 307.48 +/- 226.32 s; compared to 350.14 +/- 247.64 s in the control group, there was no statistically significant difference (p = 0.137). t2 of the study group was 672.93 +/- 270.45 s; compared to the control group (707.03 perpendicular to 258.78 s) there was no statistically significant difference (p = 0.360). Diagnostic adequacy of aspirated specimens was reassessed in the pathology laboratory. In the study group, 84 out of 101 aspirations and in the control group 89 out of 102 aspirations was determined as adequate with no statistically significant difference (p = 0.302). Conclusions: We believe that in centers where a cytopathologist is not available, ultrasound-guided thyroid FNAB can be adequately performed by an experienced radiologist who was effectively trained in smear preparation. (C) 2014 Elsevier Ireland Ltd. All rights reserved

Stent-assisted coil embolization of challenging intracranial aneurysms: initial and mid-term results with low-profile ACCLINO devices

Stent-assisted coiling using low-profile, self-expandable and retrievable stents is a valid option in endovascular treatment of challenging intracranial aneurysms. This study aims to evaluate the feasibility and efficacy of ACCLINO 1.9 F and ACCLINO Flex stent systems, designed for use as adjunctive products in coil embolization of intracranial aneurysms. Case files of 47 patients, and 52 aneurysms in total, treated with at least one ACCLINO 1.9 F or ACCLINO Flex stent were retrospectively evaluated. Technical success, complications, and angiographic outcomes were assessed based on immediate post-procedural controls along with 6th and 12th month angiograms. Mechanical untoward event rate, including asymptomatic complications, is 9.6 % (five out of 52 aneurysms). Failed dual-stenting attempt rate is 15.4 % (two out of 13). Overall procedure-related morbidity is 4.2 % with no neurologic sequelae. Initial occlusion rate is 90.4 % (47 aneurysms). One patient had residual filling in the aneurysm neck, which was stable throughout follow-up. The remaining four cases had spontaneous follow-up occlusion. Recanalization rate at 6th month is 2.1 % with one aneurysm requiring retreatment. One patient was lost to follow-up. There is no mortality associated with treatment. Stent-assisted coil embolization with ACCLINO stents in single or dual configurations is a feasible treatment option for challenging intracranial aneurysms. Follow-up results are encouraging; techniques were effective in complex cases and there were no clinically significant adverse outcomes