Background Aneurysm wall enhancement (AWE) on vessel wall imaging (VWI) scans is a robust biomarker for aneurysmal vulnerability. This study aimed to explore the association of different sleep patterns with AWE and other vulnerability features. Methods Patients with unruptured intracranial aneurysms were prospectively recruited. Sleep characteristics were collected through a standard questionnaire. Poor sleep quality was defined using the Pittsburgh Sleep Quality Index (PSQI)>5. Cross-sectional multistate predictive models were used to identify various sleep patterns related to aneurysmal vulnerability. In longitudinal observation, core covariates were adjusted with each sleep characteristic to verify cross-sectional results. Results A total of 344 aneurysms were enrolled for cross-sectional analyses, while 74 cases (21.5%) that did not receive preventive treatment participated in longitudinal follow-up. In cross-sectional analysis, U-shaped relationships were evident between AWE and n

Basilar artery perforator aneurysms (BAPAs) are rare and may be occult on initial imaging due to their small size and susceptibility to intermittent thrombosis.[1 2][1] Conventional treatments for aneurysms (eg, clipping or coiling) have proved challenging.[3][2] Recently, endovascular electrocoagulation has been shown to be effective for BAPAs.[1 4 5][1] Here, we report a case of a ruptured BAPA not accessible to a microcatheter, which was successfully treated by endovascular electrocoagulation ([3]). During endovascular electrocoagulation, the tip of the microguidewire functions as an anode, facilitating thrombosis in the aneurysm or parent artery by attracting negatively charged blood particles after passage of an electric current.[4][4] Postoperative immediate angiography showed that the aneurysm completely disappeared. Digital subtraction angiography was repeated 10 days later and showed no recurrence of the aneurysm. This case demonstrates that endovascular electrocoagul

This two part series on statistical principles in neurointervention offers a comprehensive foundation for neurointerventionalists to engage with both fundamental and advanced statistical principles. This series aims to equip neurointerventionalists with essential statistical knowledge for critically reviewing literature and conducting methodologically sound research. Part one of this series covered fundamental concepts such as frequentism, study types, data types, summarization, visualization, hypothesis testing, and univariable analysis. This review is the second part of the series and covers advanced statistical concepts such as inference versus prediction, multivariable analysis, choice of covariates, confounding, mediation, modification, and generalized linear models. Together, these papers create a cohesive framework, allowing practitioners to critically evaluate research and apply rigorous statistical methods to their own studies.

Background and purpose This study evaluates the early clinical performance of the new Artisse Intrasaccular Device (Artisse ISD), a self-expandable intrasaccular flow diverter, for treating wide-necked aneurysms (WNAs). We report initial safety and efficacy outcomes in the first cohort of patients treated with this novel device. Methods Prospective clinical and radiological data were collected for all patients treated with the Artisse ISD at three Austrian neurovascular centers from July 2023 to August 2024. Aneurysm occlusion was assessed using the Raymond-Roy Classification (RR), the O-Kelly-Marotta (OKM) scale, and the Bicêtre Occlusion Scale Score (BOSS). Results In our study 23 patients (60.9% female, median age 62 years) with 23 saccular aneurysms were treated with the Artisse ISD. Nineteen aneurysms (82.6%) were unruptured and located in the anterior circulation. Initial post-procedure angiography revealed incomplete occlusion in all aneurysms, with significant contrast stasis o

Background Studies have described a first pass effect (FPE) where patients with successful recanalization after one pass experience better outcomes. Few studies have evaluated this in patients with large core infarctions. Objective To determine whether patients with large core infarcts undergoing mechanical thrombectomy in which first pass reperfusion is achieved experience improved outcomes compared with those who undergo more than one pass. Methods The ASSIST Registry, a prospective, global, multicenter registry of patients with anterior circulation large vessel occlusion (LVO) undergoing mechanical thrombectomy was used. Adults with internal carotid artery/M1/M2 occlusions and preprocedural Alberta Stroke Program Early CT Score (ASPECTS) 1) performed for the target occlusion. The primary outcome was 90-day good functional outcome defined as modified Rankin Scale (mRS) score 0–3. Resul

Brain arteriovenous malformations (bAVM) have a low incidence, but a 2–4% overall annual hemorrhage rate with significant morbi-mortality risk when ruptured. Treatment options include microsurgical resection, stereotactic radiosurgery, and embolization, which may be performed alone or in variable combinations. Heterogeneous with the individualized risks in every case, there is no consensus on the treatment indications and the method to approach the cases, particularly those that are unruptured. Endovascular treatment of bAVMs has been controversial in terms of safety and efficiency, especially after the ARUBA results emerged, despite being highly criticized. Since then, there have been many advancements in endovascular bAVM treatment, not only in devices and materials, but also in techniques such as the refinement of transvenous embolization and, most recently, the introduction of the curative multiplug flow control technique. This review describes and discusses advanced embolization t

Background Endovascular arterial embolization (EAE) is an effective treatment for severe epistaxis refractory to conservative management with nasal packing. However, contemporary real-world data are lacking, as are data on head-to-head comparisons of EAE versus nasal packing alone. Methods This was a retrospective cohort study of the Nationwide Readmissions Database (NRD) from 2016 to 2021 in the United States. Patients with severe epistaxis treated with nasal packing alone or EAE with or without nasal packing were included and followed for 180 days. Propensity score matching (PSM) for demographics, comorbidities, and hemorrhage risk factors was performed to balance patient characteristics. Primary outcome was recurrent epistaxis. Secondary outcomes include rates of non-routine hospital discharge (indicating short-term morbidity or mortality) and ischemic stroke. Results 25 160 patients admitted to hospital for severe epistaxis were included; 754 (3.3%) underwent EAE. After PSM, 1542 p