A 69-year-old woman presenting with short lasting recent episodes of visual impairment was treated uneventfully with a flow diverter covering the neck of a large paraophthalmic aneurysm. As angiography showed immediate flow reduction we abstained from additional coiling which was initially planned. Eleven days later CT demonstrated nearly complete thrombosis of the aneurysm. Twenty days after treatment the patient suffered a lethal subarachnoid hemorrhage after rupture of the aneurysm. All available data were reviewed and beside hemodynamic factors instability of the intra-aneurysmal thrombus is discussed as a possible cofactor leading to this disastrous event.

Spinal magnetic resonance angiography (MRA) is difficult to perform because of the size of the spinal cord vessels. High-field MR improves resolution and imaging speed. We examined 17 patients with spinal vascular diseases with dynamic contrast-enhanced three-dimensional MR sequences. In three patients, the artery of Adamkievicz could be seen; we could also detect all arteriovenous malformations and dural fistulas. MRA has the potential to replace diagnostic spinal angiography and the latter should be used only for therapeutic purposes.

Intracranial aneurysms (IAs) are usually asymptomatic with a low risk of rupture, but consequences of aneurysmal subarachnoid hemorrhage (aSAH) are severe. Identifying IAs at risk of rupture has important clinical and socio-economic consequences. The goal of this study was to assess the effect of patient and IA characteristics on the likelihood of IA being diagnosed incidentally versus ruptured. Patients were recruited at 21 international centers. Seven phenotypic patient characteristics and three IA characteristics were recorded. The analyzed cohort included 7992 patients. Multivariate analysis demonstrated that: (1) IA location is the strongest factor associated with IA rupture status at diagnosis; (2) Risk factor awareness (hypertension, smoking) increases the likelihood of being diagnosed with unruptured IA; (3) Patients with ruptured IAs in high-risk locations tend to be older, and their IAs are smaller; (4) Smokers with ruptured IAs tend to be younger, and their IAs are larger; (5) Female patients with ruptured IAs tend to be older, and their IAs are smaller; (6) IA size and age at rupture correlate. The assessment of associations regarding patient and IA characteristics with IA rupture allows us to refine IA disease models and provide data to develop risk instruments for clinicians to support personalized decision-making.

Introduction The rate of thromboembolic complications during endovascular aneurysm treatment remains at a relatively high rate of about 10%. 1 However, only 30% of these complications result in clinically symptomatic events. One effective group of drugs in treating and preventing embolic events are GP IIb/IIIa inhibitors. 2 Aim of Study To report our results concerning safety and efficacy of epitifibatide in the prevention and treatment of thromboembolic complications in ruptured and unruptured aneurysms and develop a treatment algorithm. Methods During a three-year period, 41 patients received eptifibatide at our institution during aneurysm treatment (23 patients (56%) with ruptured aneurysms). Reasons for epitifibatide treatment were: clot at the coil surface, clot prevention before stent placement and distal emboli. Presence of distal occlusion at the end of the procedure and intracranial hemorrhage were recorded as predictors of efficacy and safety. Results Treatment indications were: clot at the coil surface in 27 (57%), prevention before stent placement in 10 (24%) and distal embolism in 4 cases (10%). Eptifibatide was given as arterial bolus in 5 (12%), as intravenous infusion in 7 (17%) and combined in 29 cases (71%). In 4 cases (10%), a distal occlusion persisted at the end of the intervention, one resulted in a symptomatic infarction (2%). In two patients (10%), intracranial hemorrhage occurred (one clinically silent bleeding and one fatal parenchymal hemorrhage (2%)). Conclusions Based on our experience, we propose an algorithm for eptifibatide administration for endovascular aneurysm treatment based on patient characteristics as well as the postinterventional angiogram.