Aneurysmal subarachnoid hemorrhage (SAH) is a poor-outcome disease with a delayed neurological exacerbation. Fibulin-5 (FBLN5) is one of matricellular proteins, some of which have been involved in SAH pathologies. However, no study has investigated FBLN5’s roles in SAH. This study was aimed at examining the relationships between serially measured plasma FBLN5 levels and neurovascular events or outcomes in 204 consecutive aneurysmal SAH patients, including 77 patients (37.7%) with poor outcomes (90-day modified Rankin Scale 3–6). Plasma FBLN5 levels were not related to angiographic vasospasm, delayed cerebral ischemia, and delayed cerebral infarction, but elevated levels were associated with severe admission clinical grades, any neurological exacerbation and poor outcomes. Receiver-operating characteristic curves indicated that the most reasonable cut-off values of plasma FBLN5, in order to differentiate 90-day poor from good outcomes, were obtained from analyses at days 4–6 for all patients (487.2 ng/mL; specificity, 61.4%; and sensitivity, 62.3%) and from analyses at days 7–9 for only non-severe patient (476.8 ng/mL; specificity, 66.0%; and sensitivity, 77.8%). Multivariate analyses revealed that the plasma FBLN5 levels were independent determinants of the 90-day poor outcomes in both all patients’ and non-severe patients’ analyses. These findings suggest that the delayed elevation of plasma FBLN5 is related to poor outcomes, and that FBLN5 may be a new molecular target to reveal a post-SAH pathophysiology.

Objective: We report a case of embolic stroke due to a thrombosed cerebral aneurysm that underwent mechanical thrombectomy.Case Presentation: A 39-year-old female was brought to our hospital by an ambulance with sudden left hemiparesis and dysarthria. Detailed examination revealed a partially thrombosed aneurysm of the right internal carotid artery and embolism of the right middle cerebral artery. Emergent mechanical thrombectomy was performed, and thrombolysis in cerebral infarction (TICI) 2b recanalization was achieved. There was no other potential source of cerebral embolism, and the thrombosed aneurysm was considered an etiology for the embolism. After the endovascular treatment, antiplatelet and anticoagulant therapies were conducted, leading to the disappearance of the intra-aneurysmal thrombus. Conclusion:Mechanical thrombectomy is effective for embolic stroke due to an unruptured thrombosed cerebral aneurysm if devices are carefully manipulated in an area adjacent to the aneurysm.

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Objective: Subclavian artery aneurysms are relatively rare, and have been treated by open surgery and/or endovascular treatment using a stent graft. In this article, we report a case of unruptured right subclavian artery aneurysm successfully treated using balloon-assisted coil embolization. Case Presentation:A 77-year-old man was diagnosed with an asymptomatic unruptured right subclavian artery aneurysm of 8 mm in diameter by follow-up CTA after surgery for thoracoabdominal aortic aneurysms. He also had a history of cerebral infarction and clipping of an unruptured cerebral aneurysm. The subclavian artery aneurysm was treated by balloon-assisted coil embolization because its diameter increased to 17.6 mm in 2 years. Balloon assistance was mainly used to prevent protrusion of the framing coil into the parent artery, and satisfactory framing was achieved.Subsequently, the aneurysm was obliterated using filling and finishing coils. The postoperative course was uneventful, and the follow-up MRI at 18 months after treatment revealed no recanalization of the aneurysm. Conclusion:Balloon-assisted coil embolization may be an effective treatment for subclavian artery aneurysms, but further long-term follow-up and case accumulation are needed.Keywords▶ subclavian artery aneurysm, balloon-assisted coil embolization, endovascular, total arch replacement This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives International License.