BACKGROUND AND PURPOSE: Treatment of wide-neck bifurcation aneurysms using endovascular therapy is still challenging even with the development of treatment devices. The purpose of this investigation was to assess the safety and efficacy of treatment with a Woven EndoBridge (WEB) device for wide-neck bifurcation aneurysms. MATERIALS AND METHODS:All patients treated with a WEB device at our institution between May 2009 and November 2016 were retrospectively evaluated. Clinical and imaging evaluation, aneurysm occlusion status, and modified Rankin scale score were analyzed 1 day after treatment and in the short-(,6 months), mid-(,24 months), and long-term (.24 months) follow-up periods.RESULTS: Forty-one cases of wide-neck aneurysms were analyzed in this study. Overall, 78.8% of the aneurysms had complete occlusion in the last follow-up, and 19.5% required retreatment with additional endovascular devices. A good clinical outcome (modified Rankin scale: 0-2) was obtained in 95.1% of the patients, and the overall treatment-related morbidity and mortality rates were 2.4% and 0.0%, respectively. The mean follow-up time was 15.3 6 13.5 months. CONCLUSIONS:The results obtained in this study suggest that treatment of wide-neck bifurcation aneurysms with a WEB device is feasible with an acceptable safety and efficacy rate. ABBREVIATIONS: IA ¼ intracranial aneurysm; WEB ¼ Woven EndoBridge; WEB-DL ¼ Woven EndoBridge Dual-Layer; WEB-SL/SLS ¼ Woven EndoBridge Single-Layer and Single-Layer Sphere; AcomA ¼ anterior communicating artery I n recent years, an improvement in devices and techniques has resulted in an increase in endovascular treatment of intracranial aneurysms (IAs). Although the efficacy of endovascular therapy has been recognized widely, wide-neck bifurcation aneurysms still are considered unsuitable for endovascular therapy because of unfavorable geometry or daughter-vessel involvement. [1][2][3][4] Recently, the promising efficacy and safety profile of the novel Woven EndoBridge (WEB) device (Sequent Medical) for wideneck bifurcation aneurysm treatment has been published in major clinical studies. 5,6 However, only a few case series have reported the long-term follow-up results for this device; therefore, the long-term results still remain to be determined. 7 The purpose of this study was to analyze the mid-and longterm results of wide-neck bifurcation aneurysms treated with the WEB device and assess its safety and efficacy profile.
Introduction Twig-like middle cerebral artery configuration (Tw-MCA) is a rare and commonly misdiagnosed vascular anomaly characterized by a plexiform arterial network that replaces the normal M1 segment. The prevalence and clinical relevance of this anomaly is not fully established. Material and methods We sought to explore the prevalence of Tw-MCA in patients clinically referred to digital angiography in a single academic comprehensive endovascular center and evaluated the radiological and clinical findings among patients with hemorrhagic events. Results From 2011 to 2020, a total of 10,234 patients underwent a cerebral angiography at our institution. During this period, 9 (0.088%) Tw-MCAs were identified. Out of these, 5 patients (62.5%) were admitted due to an intracranial hemorrhage. Two patients had a ruptured intracranial aneurysm on the anterior communicating artery, one with multiple brain aneurysms; two patients presented an intraparenchymal hematoma (IPH) due to the presence of a periventricular anastomosis and one patient an intraventricular hemorrhage with unclear origin. Conclusion Tw-MCA is a very rare vascular anomaly associated with hemorrhagic events. Adequate identification of this anomaly is essential in order to avoid misdiagnosis as steno-occlusive disorders.
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