BackgroundThe radial artery approach has become popular as a ‘radial first’ strategy for arterial access in neuroangiography and neurointerventions. Recent studies have shown that transradial arterial access (TRA) for cerebral angiography has been associated with reduced access site complication rates and improved patient satisfaction compared with transfemoral access (TFA). The goal of this study was to evaluate the presence of abnormal MRI diffusion weighted imaging (DWI) foci following DSA and correlate their frequency with TRA or TFA.MethodsWe prospective analyzed 200 consecutive adult DSAs performed from January 2021 to January 2022, at a single tertiary center.ResultsOf the 200 consecutive diagnostic cerebral angiograms, 52% were performed via TRA and 49% were performed via TFA. Of the TRA cerebral angiograms, 17.5% demonstrated at least one hyperintense focus on MRI DWI. Of the TFA procedures, 5.2% were considered positive. One patient (0.5%) in the TRA group experienced a minor neurologic deficit postoperatively that had not completely resolved at 90 days after the procedure and no neurologic deficits occurred in the TFA group.ConclusionsDespite the proven benefit of TRA over TFA in neurointervention, the number of MRI DWI restriction foci were significantly more frequent during cerebral angiography when TRA was selected. Although the number of clinically symptomatic events were minimal, the widespread use of the technique may become clinically relevant. Further studies contrasting the TRA and TFA techniques will be beneficial for cerebral angiography.

BACKGROUND The Pipeline Flex Embolization Device (PED) with Shield Technology (PED‐Shield) is a third‐generation flow diverting stents with surface modification designed to reduce platelet adhesion and thrombogenicity. We report the long‐term safety and effectiveness of the PED‐Shield in the treatment of unruptured intracranial aneurysms in an Australian cohort. METHODS SCOPE‐AUS (Safety and Clinical Effectiveness Of Pipeline Shield Embolization Device for Treatment of Intracranial Aneurysms in Australia) is a multicenter, single‐arm, retrospective study of patients with unruptured intracranial aneurysms treated with the PED‐Shield flow diverting stents at 3 high‐volume neurointervention centers in Australia between May 1, 2015, and June 30, 2018, evaluating safety and efficacy. The primary outcome was neurologic adverse event or neurologic‐related death at 1 year, and the secondary outcome was long‐term complete aneurysm occlusion. RESULTS A total of 238 patients (mean age 55.8±11.0 years, 73.1% [174/238] female) and 278 aneurysms were treated via 247 procedures. Two (0.7%) aneurysms were retreated during the 18‐month follow‐up. Overall occlusion rates at 18 months or at last follow‐up imaging were 92.5% (233/252). There were 35 (14.7%) total primary end point events. The 12‐month neurologic morbidity and mortality rates were 3.8% (9/238) and 1.3% (3/238), respectively. For the subgroup of internal carotid artery aneurysms, mortality (0.7%) and morbidity (2.0%) rates were low, and the complete occlusion rate was 92.5% (147/155). CONCLUSIONS In this multicenter study, which includes a wide variety of both distal bifurcation and proximal unruptured intracranial aneurysms, the occlusion rates and safety outcomes of the PED‐Shield flow diverting stent demonstrate a high proportion of complete aneurysm occlusion, extremely low retreatment rates, and low complication rates.

Introduction: Splenic artery embolisation is a recognised modality in the management of high grade blunt splenic injury. The impact of embolisation on the spleen in terms of volume and function remains unclear. This results in a lack of clarity regarding post embolisation vaccination policy. Methods: This was a two-centre, retrospective observational study over a 24month period involving all patients who underwent splenic artery embolisation for high grade blunt splenic trauma (AAST grades III-V). Splenic volumes were calculated from an initial CT and a repeat CT at 6 months post embolisation. Subgroup analysis was performed analysing the location of embolisation, AAST grading, and evidence of splenic dysfunction as defined by the presence of altered red cell morphology. Results: Thirty patients achieved successful splenic salvage with angioembolisation. Mean volume loss was 44.14 cm 3 (P = 0.038), with decreased volumes for distal embolisation and increased volumes for proximal embolisation. Three patients had altered red cell morphology; two demonstrated recovery at 6 months, with the third lost to follow up. There were significant associations between, initial splenic volume, AAST grade of injury, and altered red cell morphology. There was no significant association between location of embolisation, initial splenic volumes, or percentage volume change. Conclusion: This study demonstrated a statistically significant change in splenic volume post angioembolisation in trauma, which was associated with AAST grading but not location of embolisation. The low rate of altered red cell morphology appears transient.

patients harboring non-ruptured saccular or fusiform intracranial aneurysms with a wide neck (>4 mm) located in the anterior or posterior circulation. Standard dual anti-platelet therapy was started 5 days pre-procedure and continued for at least 6 months. Neurological complications were classified as intra-procedural, early or delayed if they arose within 1, 30 or more than 30 days from treatment, respectively. Neurological complications were considered minor and major if resulting in transient or permanent neurological morbidity, respectively. Clinical status at discharge and follow up was assessed by independent neurologists or neurosurgeons and imaging included MRI angiography (MRA), CT angiography (CTA) and DSA, depending on the institution. Results The study included 28 patients (23 females, 82%; age range: 36-86, median age: 56) treated between April and November 2019, harboring 29 aneurysms. Twenty-eight aneurysms were saccular and in the anterior circulation. The majority of aneurysms were <12 mm in diameter (18/29, 62%), 8/ 29 (28%) were large (<25 mm), 2/29 (7%) were giant (>25 mm) and one was fusiform and partially thrombosed (3%). The SE was delivered in all cases via a tri-axial approach with an intermediate catheter and a 0.027' microcatheter for implant delivery. This low-profile catheter allowed delivery of the implant through the trans-radial route. Thirty-two implants were used (4 in the patient with the fusiform aneurysm) with an average of 1.1 stents/patient. There were no intra-procedural complications. Median clinical and imaging follow up time was 6 months (range: 2-6 months). There were no deaths. Three patients (3/28, 11%) had early minor neurological complications. There was one (4%) early major neurological complication in a patient with a hemispheric stroke on post-op day 4. Two patients had minor delayed neurological complications (2/28, 7%). Complete thrombosis was seen in 16/29 aneurysms (55%, most of those imaged at 6 months), while partial thrombosis was seen in 12/29 aneurysms (41%). Covered side branches were patent in all patient but the one who experienced the stroke. Conclusion The SE shows excellent navigability while keeping a high flow-diverting effect. Mid-term clinico-radiological results show good efficacy and acceptable safety of the implant.

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