Two-Steps Neural Networks for an Automated Cerebrovascular Landmark Detection along the Circle of Willis.

Intracranial aneurysms (ICA) commonly occur in specific segments of the Circle of Willis (CoW), primarily, onto thirteen major arterial bifurcations. An accurate detection of these critical landmarks is necessary for a prompt and efficient diagnosis. We introduce a fully automated landmark detection approach for CoW bifurcations using a two-step neural networks process.

MRA evaluation of aneurysms treated with woven endobridge (WEB) devices or coils: an inter- and intra-observer reliability study.

Background: Magnetic resonance angiography (MRA) is a commonly used non-invasive imaging modality for the follow-up of treated intracranial aneurysms. The 3-category Montreal classification system is widely used to evaluate treatment outcomes, including aneurysms treated with Woven EndoBridge (WEB) devices or coils. This study aimed to assess the reliability and clinical implications of the Montreal scale for aneurysms imaged with MRA.

Imaging follow-up of unruptured intracranial aneurysms treated with flow diverter: Insights from a French collaborative survey.

Purpose: The absence of standardized guidelines for imaging follow-up of unruptured intracranial aneurysms treated with flow diverters (FD) results in significant variability across centers. This survey aims to provide a comprehensive overview of current imaging follow-up practices in French academic centers.

Methods: In April 2024, a 49-question survey was distributed to interventional neuroradiology centers in France through the trainee-led research collaborative network, Jeunes En Neuroradiologie Interventionnelle-Research Collaborative (JENI-RC).

Building a Synthetic Vascular Model: Evaluation in an Intracranial Aneurysms Detection Scenario.

We hereby present a full synthetic model, able to mimic the various constituents of the cerebral vascular tree, including the cerebral arteries, bifurcations and intracranial aneurysms. This model intends to provide a substantial dataset of brain arteries which could be used by a 3D convolutional neural network to efficiently detect Intra-Cranial Aneurysms. The cerebral aneurysms most often occur on a particular structure of the vascular tree named the Circle of Willis.

Arterial hypotension "magnitude" and neurological outcome during mechanical thrombectomy under general anesthesia.

Introduction: Mechanical thrombectomy (MT) is the standard of care for the treatment of acute ischemic stroke (AIS) with large vessel occlusion (LVO), but unfavorable outcomes remain common. Procedural arterial hypotension is associated with poor patient outcome. This study aimed to assess the impact of arterial hypotension "magnitude" (a combination of the depth, defined as the percentage relative to baseline arterial blood pressure, and the duration of hypotensive episodes)" during MT on neurological outcome.

Safety and efficacy of stent retrievers plus contact aspiration in patients with acute ischaemic anterior circulation stroke and positive susceptibility vessel sign in France (VECTOR): a randomised, single-blind trial.

Background: Positive susceptibility vessel sign (SVS) in patients with acute ischaemic stroke has been associated with friable red blood cell-rich clots and more effective recanalisation using stent retrievers versus contact aspiration. We compared the safety and efficacy of stent retrievers plus contact aspiration (combined technique) versus contact aspiration alone as the first-line thrombectomy technique in patients with acute ischaemic anterior circulation stroke and SVS-positive occlusions.

Methods: Adaptive Endovascular Strategy to the Clot MRI in Large Intracranial Vessel Occlusion (VECTOR) was a prospective, randomised, open-label study with blinded evaluation.

Effects of induced arterial hypertension for vasospasm on unruptured and unsecured cerebral aneurysms (growth and rupture). A retrospective case-control study.

Objectives: Unruptured cerebral aneurysms (UCAs) often coexist with the ruptured one but are typically left unsecured during the weeks following aneurysmal subarachnoid hemorrhage (aSAH). We compared the rate of UCAs rupture or volume growth (≥5 mm) between patients exposed to induced arterial hypertension (iHTN) for vasospasm and those not exposed (control group).

Materials And Methods: From 2013 to 2021, we retrospectively included consecutive adult patients with aSAH who had ≥1 UCA.

Location specific rupture risk of intracranial aneurysms: case of ophthalmic aneurysms.

Background: Aneurysm location is a key element in predicting the rupture risk of an intracranial aneurysm. A common impression suggests that pure ophthalmic aneurysms are under-represented in ruptured intracranial aneurysms (RIAs). The purpose of this study was to specifically evaluate the risk of rupture of ophthalmic aneurysms compared with other aneurysm locations.

Carotid artery direct access for mechanical thrombectomy: the Carotid Artery Puncture Evaluation (CARE) study.

Background: In acute ischemic stroke due to anterior large vessel occlusion (AIS-LVO), accessing the target occluded vessel for mechanical thrombectomy (MT) is sometimes impossible through the femoral approach. We aimed to evaluate the safety and efficacy of direct carotid artery puncture (DCP) for MT in patients with failed alternative vascular access.

Methods: We retrospectively analyzed data from 45 stroke centers in France, Switzerland and Germany through two research networks from January 2015 to July 2019.

Location of intracranial aneurysms is the main factor associated with rupture in the ICAN population.

Background And Purpose: The ever-growing availability of imaging led to increasing incidentally discovered unruptured intracranial aneurysms (UIAs). We leveraged machine-learning techniques and advanced statistical methods to provide new insights into rupture intracranial aneurysm (RIA) risks.

Methods: We analysed the characteristics of 2505 patients with intracranial aneurysms (IA) discovered between 2016 and 2019.

Mechanical Thrombectomy for Acute Ischemic Stroke Amid the COVID-19 Outbreak: Decreased Activity, and Increased Care Delays.

Background And Purpose: The efficiency of prehospital care chain response and the adequacy of hospital resources are challenged amid the coronavirus disease 2019 (COVID-19) outbreak, with suspected consequences for patients with ischemic stroke eligible for mechanical thrombectomy (MT).

Methods: We conducted a prospective national-level data collection of patients treated with MT, ranging 45 days across epidemic containment measures instatement, and of patients treated during the same calendar period in 2019. The primary end point was the variation of patients receiving MT during the epidemic period.

Prediction of Unruptured Intracranial Aneurysm Evolution: The UCAN Project.

Background: Management of small (<7 mm) unruptured intracranial aneurysms (UIA) remains controversial. Retrospective studies have suggested that post gadolinium arterial wall enhancement (AWE) of UIA on magnetic resonance imaging (MRI) may reflect aneurysm wall instability, and hence may highlight a higher risk of UIA growth. This trial aims at exploring wall imaging findings of UIAs with consecutive follow-up to substantiate these assumptions.

Endovascular Stroke Treatment and Risk of Intracranial Hemorrhage in Anticoagulated Patients.

Background and Purpose- We aimed to determine the safety and mortality after mechanical thrombectomy in patients taking vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs). Methods- In a multicenter observational cohort study, we used multiple logistic regression analysis to evaluate associations of symptomatic intracranial hemorrhage (sICH) with VKA or DOAC prescription before thrombectomy as compared with no anticoagulation. The primary outcomes were the rate of sICH and all-cause mortality at 90 days, incorporating sensitivity analysis regarding confirmed therapeutic anticoagulation.

MT in anticoagulated patients: Direct oral anticoagulants versus vitamin K antagonists.

Mechanical thrombectomy (MT) is one of the main treatments for acute ischemic stroke (AIS) in patients on effective anticoagulation. The use of direct oral anticoagulants (DOA) has increased, given their efficacy and safety profile compared to vitamin K antagonists (VKA). We compared procedural and clinical outcomes of MT in patients on DOA and VKA treatment before stroke onset.

"Adaptative endovascular strategy to the CloT MRI in large intracranial vessel occlusion" (VECTOR): Study protocol of a randomized control trial.

A correlation between the susceptibility vessel sign (SVS) and red thrombi has been identified in MRI. We hypothesized that the Embotrap allow better retrieving of SVS+ thrombi. The AdaptatiVe Endovascular strategy to the CloT MRI in large intracranial vessel Occlusion (VECTOR) trial is a multicenter, prospective and randomized study designed to compare a first-line strategy combining Embotrap added to contact aspiration (CA) versus CA alone in patients with SVS+ occlusions.

Clip-first policy versus coil-first policy for the exclusion of middle cerebral artery aneurysms.

Objective: Middle cerebral artery (MCA) aneurysms are a particular subset of intracranial aneurysms that can be excluded by clipping or coiling. A comparison of the results between these two methods is often limited by a selection bias in which wide-neck and large aneurysms are frequently treated with surgery. Here, the authors report the results of two centers using opposing policies in the management of MCA aneurysms: one center used a clip-first policy while the other used a coil-first policy, which limited the selection bias and ensured a good comparison of these two treatment modalities.

Concordance in Aneurysm Size at Time of Rupture in Familial Intracranial Aneurysms.

Background and Purpose- Intracranial aneurysm (IA) size and location are important determinants of aneurysm rupture risk. In familial IAs there is concordance of location; however, if such concordance exists for size is unknown. We analyzed the concordance of aneurysm size at time of rupture in familial IAs.

Safety and efficacy of mechanical thrombectomy in acute ischemic stroke of anticoagulated patients.

Background: Anticoagulated patients (APs) are currently excluded from acute ischemic stroke reperfusion therapy with intravenous recombinant tissue plasminogen activator (IV-rtPA); however, these patients could benefit from mechanical thrombectomy (MT). Evidence for MT in this condition remains scarce. The aim of this study was to analyze the safety and efficacy of MT in APs.