Introduction Accurate sizing of the Woven EndoBridge (WEB) device is of critical importance as it determines procedural safety and successful occlusion of wide neck bifurcation aneurysms. The aim of this study was to assess the ability of aneurysm volume to assist in accurate WEB size selection. Methods All patients with an intracranial aneurysm treated with the WEB SL or WEB SLS device between March 2019 and October 2019 were identified for this retrospective study. Aneurysm volumes were calculated with auto-segmentation using a three-dimensional volume rendering program on an independent Syngo workstation (Siemens Healthineers AG). Pearson correlation coefficients were calculated for aneurysm auto-segmented volumes and WEB volumes, as well as for aneurysm height × width and WEB height × width. Follow-up angiographic outcomes were collected at 6–9 months post-procedure. Results Twenty-nine aneurysms were evaluated by 3D rotational angiography. The correlation coefficient with WEB size was larger for auto-segmented aneurysm volumes (r = 0.979) compared to height × width measurements (r = 0.867). Using Fisher r-to-z transformations, we found the difference between the two correlations to be statistically significant (p = 0.0007). Follow-up angiography available in 13 subjects demonstrated an 85% complete aneurysm occlusion rate. Conclusion Aneurysm volumes are highly correlated with WEB volumes, with auto-segmentation volumes displaying statistically significant difference against conventional height by width measurements. These results suggest that volumetric measurements of aneurysm size provide a useful adjuvant measure to assist in appropriate size selection of the WEB device.

Introduction The major mechanism of morbidity of delayed cerebral ischemia after subarachnoid hemorrhage (SAH) is considered to be severe vasospasm. Quantitative MRA (QMRA) provides direct measurements of vessel-specific volumetric blood flow and may permit a clinically relevant assessment of the risk of ischemia secondary to cerebral vasospasm. Purpose To evaluate the utility of QMRA as an alternative imaging technique for the assessment of cerebral vasospasm after SAH. Methods QMRA volumetric flow rates of the anterior cerebral artery (ACA), middle cerebral artery (MCA), and posterior cerebral artery (PCA) were compared with vessel diameters on catheter-based angiography. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of QMRA for detecting cerebral vasospasm was determined by receiver-operating characteristic curves. Spearman correlation coefficients were calculated for QMRA flow versus angiographic vessel diameter. Results Sixty-six vessels (10 patients) were evaluated with QMRA and catheter-based angiography. The median percent QMRA flow of all vessels with angiographic vasospasm (55.0%, IQR 34.3–71.6%) was significantly lower than the median percent QMRA flow of vessels without vasospasm (91.4%, IQR 81.4–100.4%) (p < 0.001). Angiographic vasospasm reduced QMRA-assessed flow by 23 ± 5 (p = 0.018), 95 ± 12 (p = 0.042), and 16 ± 4 mL/min (p = 0.153) in the ACA, MCA, and PCA, respectively, compared to vessels without angiographic vasospasm. The sensitivity, specificity, PPV, and NPV of QMRA for the discrimination of cerebral vasospasm was 84%, 72%, 84%, and 72%, respectively, for angiographic vasospasm >25% and 91%, 60%, 87%, and 69%, respectively, for angiographic vasospasm >50%. The Spearman correlation indicated a significant association between QMRA flows and vessel diameters ( rs = 0.71, p < 0.001). Conclusion Reduction in QMRA flow correlates with angiographic vessel narrowing and may be useful as a non-invasive imaging modality for the detection of cerebral vasospasm after SAH.

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Background Endovascular coiling of small, intracranial aneurysms remains controversial and difficult, despite advances in technology. Methods We retrospectively reviewed data for 62 small aneurysms (<3.99 mm) in 59 patients. Occlusion rates, complications rates, and coil packing densities were compared between subgroups based upon coil type and rupture status. Results Ruptured aneurysms predominated (67.7%). Aneurysms measured 2.99 ± 0.63 mm by 2.51 ± 0.61 mm with an aspect ratio of 1.21 ± 0.34 mm. Brands included Optima (Balt) (29%), MicroVention Hydrogel (24.2%), and Penumbra SMART (19.4%) coil systems. Average packing density was 34.3 ± 13.5 mm3. Occlusion rate was 100% in unruptured aneurysms; 84% utilized adjuvant devices. For ruptured aneurysms, complete occlusion or stable neck remnant was achieved in 88.6% while recanalization occurred in 11.4%. No rebleeding occurred. Average packing density ( p = 0.919) and coil type ( p = 0.056) did not impact occlusion. Aspect ratio was smaller in aneurysms with technical complications ( p = 0.281), and aneurysm volume was significantly smaller in those with coil protrusion ( p = 0.018). Complication rates did not differ between ruptured and unruptured aneurysms (22.6 vs. 15.8%, p = 0.308) or coil types ( p = 0.830). Conclusion Despite advances in embolization devices, coiling of small intracranial aneurysms is still scrutinized. High occlusion rates are achievable, especially in unruptured aneurysms, with coil type and packing density suggesting association with complete occlusion. Technical complications may be influenced by aneurysm geometry. Advances in endovascular technologies have revolutionized small aneurysm treatment, with this series demonstrating excellent aneurysm occlusion especially in unruptured aneurysms.

lesions and provide information about carotid plaque morphology and the need for treatment in asymptomatic <50% stenoses. During an intervention, OCT can help define treatment strategy, allow for a more accurate stent size selection and definition of landing zones as well as choice of angioplasty balloon diameters. Post-procedurally, OCT is able to reduce stent failure by better identifying stent dissections, incomplete wall apposition and tissue protrusion, all of which are factors that could result in stent thrombosis if undetected. Use of OCT for carotid lesions is currently off-label. Materials and Methods We retrospectively reviewed our neurointerventional database and identified all patients in whom OCT was used as an adjunct tool to evaluate carotid artery disease. OCT detects single-scattered light from biological tissues, generating images with an axial resolution of 10-15 mm or better. Patient cross-sectional images, carotid Duplex scans and angiograms were reviewed. OCT images were analyzed in conjunction with the available imaging. Patient characteristics, procedural information and patient outcome data was collected.Results OCT catheters are available in 23 or 27 mm lengths from lens to tip distance. OCT requires use of an optical fiber and small focusing lens to illuminate and collect backscattered light from the artery wall, while rotating and pulling back the catheter optics at high speed through the lumen of the carotid artery. The imaging speed enables a safe and efficient acquisition of volumetric OCT data over arterial segments of up to 75 mm, during a short intra-arterial contrast injection. The use of contrast is necessary as the red blood cells are highly scattering particles and need to be displaced from the artery lumen to clear the imaging field-of-view. Seven patients (3 females) with mean age of 72 years (range 64-80 years) were identified. Patient vascular risk factors included hypertension (85.7%), hyperlipidemia (57.1%), Smoking (current and former; 57.1%) and diabetes mellitus (57.1%). Four lesions involved the left ICA and 3 lesions the right ICA. One patient did not show an ICA stenosis despite suspicion on cross-sectional imaging. Another patient showed no stenosis but freefloating clot due to acute plaque rupture. In all other patients, ICA stenoses ranging from 65 -83% were identified based on angiographic assessment. All procedures were performed via femoral access. Based on imaging findings, 6 carotid stenting interventions were performed. Conclusion OCT may be a valuable adjunct tool during carotid artery stenting, especially for plaque characterization in nonstenotic carotid artery disease. OCT catheters can be easily delivered, even in tortuous anatomy. Operators may feel more confident in their management decisions and choice of devices.