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Abstract BACKGROUND Hemodynamic factors play a crucial role in the recurrence of intracranial aneurysms after coiling. However, the strongest factor for predicting recurrence remains unclear because each risk factor has been investigated and reported separately. OBJECTIVE To clarify the strongest predictor of recurrence with computational fluid dynamics (CFD). METHODS Using pretreatment patient-specific 3-dimensional rotational angiography data of 50 internal carotid artery (ICA) aneurysms (7 recanalized, 43 stable) treated with endovascular coiling, we created a precoiling model and a virtual postcoiling model produced by manually cutting the aneurysm by the flat plane corresponding to the virtual coil surface. We conducted CFD analysis to investigate inflow dynamics in the precoiling model and pressure difference and wall shear stress on the virtual coil surface. The pressure difference was calculated by subtracting average pressure at the proximal ICA from the maximum pressure at the coil surface and dividing by dynamic pressure at the proximal ICA for normalization. We compared hemodynamic parameters in both models between recanalized and stable aneurysms. RESULTS Compared with stable aneurysms, recanalized aneurysms showed a significantly larger inflow area and higher inflow rate in the precoiling model (P = .016, .028), and higher pressure difference at the coil surface in the postcoiling model (P < .001). The receiver-operating characteristic analysis showed that the area under the curve value for the pressure difference (0.967) was superior to that of other evaluated parameters. CONCLUSION The pressure difference in the virtual postcoiling model may be a strong predictor of recurrence after coiling.

Background The reappearance of intracranial aneurysms (IAs) after undergoing stent‐assisted coil embolization (SACE) is a significant issue in clinical practice. In this study, we analyzed blood regulatory T‐cell counts and plasma cytokine levels to assess the extent of systemic inflammation and investigate their potential association with the recurrence of IAs undergoing SACE. Methods A total of 189 individuals with 220 unruptured IAs were included in a retrospective study, with participants categorized into groups of occlusion and recurrence according to the Raymond–Roy Scale. Initially, a univariate analysis was used to identify distinctions among clinical data, morphological parameters, and preoperative plasma cytokine levels. A logistic regression model was built using variables with a significance level of p < 0.05, and the specificity and sensitivity of the chosen parameters were assessed through graphical and statistical analysis using receiver operating characteristic (ROC) curve techniques. Results In the group with recurrence, the plasma concentrations of IL‐2, IL‐10, IL‐17, and IFN‐γ were notably elevated compared to the occlusion group. Based on binary logistic regression analysis, it was found that the levels of IL‐10 (odds ratio = 1.24, 95% CI = 1.06–1.46, p = 0.008), IL‐17 (odds ratio = 1.45, 95% CI = 1.17–1.82, p < 0.001), and INF‐γ (odds ratio = 1.28, 95% CI = 1.07–1.54, p = 0.007) were determined to be crucial independent indicators for the recurrence of IAs. The highest predictive accuracy recurrence risk, with an area under the curve of 0.761, was achieved through the combination of IL‐2, IL‐10, IL‐17, and INF‐γ. Conclusions Findings reveal indicate that elevated levels of plasma IL‐2, IL‐10, IL‐17, and IFN‐γ are consistently present in recurrent IAs, implying that the initial inflammatory levels in the body are a major contributor to the recurrence of IAs following SACE. The combination of IL‐2, IL‐10, IL‐17, and IFN‐γ may assist in predicting the likelihood of recurrence in IAs following SACE. The study found that elevated plasma levels of IL‐2, IL‐10, IL‐17, and IFN‐γ are significantly associated with the recurrence of intracranial aneurysms after stent‐assisted coil embolization. These cytokines serve as independent predictors for recurrence, suggesting that systemic inflammation plays a crucial role in the process.

Pulmonary sequestration describes a rare congenital mass of nonfunctional pulmonary tissue with an aberrant systemic arterial supply. Conventionally, the mass is removed surgically, but this carries a risk of serious and potentially fatal hemorrhage from the aberrant arteries during the operation. We describe how we performed coil embolization of the aberrant arteries immediately before surgery to overcome this problem. Coil embolization is safe, feasible and effective in preventing intraoperative bleeding. This case is reported to introduce a new preoperative procedure for pulmonary sequestration.

Abstract BACKGROUND Aneurysm recurrence after coiling has been associated with aneurysm growth, (re)hemorrhage, and a greater need for follow-up. The second-generation HydroCoil Embolic System (HES; MicroVention, Inc) consists of a platinum core with integrated hydrogel and was developed to reduce recurrence through enhancing packing density and healing within the aneurysm. OBJECTIVE To compare recurrence between the second-generation HES and bare platinum coil (BPC) in the new-generation Hydrogel Endovascular Aneurysm Treatment Trial (HEAT). METHODS HEAT is a randomized, controlled trial that enrolled subjects with ruptured or unruptured 3- to 14-mm intracranial aneurysms amenable to coiling. The primary endpoint was aneurysm recurrence using the Raymond-Roy scale. Secondary endpoints included minor and major recurrence, packing density, adverse events related to the procedure and/or device, mortality, initial complete occlusion, aneurysm retreatment, hemorrhage from target aneurysm during follow-up, aneurysm occlusion stability, and clinical outcome at final follow-up. RESULTS A total of 600 patients were randomized (HES, n = 297 and BPC, n = 303), including 28% with ruptured aneurysms. Recurrence occurred in 11 (4.4%) subjects in the HES arm and 44 (15.4%) subjects in the BPC arm (P = .002). While the initial occlusion rate was higher with BPC, the packing density and both major and minor recurrence rates were in favor of HES. Secondary endpoints including adverse events, retreatment, hemorrhage, mortality, and clinical outcome did not differ between arms. CONCLUSION Coiling of small-to-medium aneurysms with second-generation HES resulted in less recurrence when compared to BPC, without increased harm. These data further support the use of the second-generation HES for the embolization of intracranial aneurysms. Video Abstract 10.1093/neuros/nyaa006 nyaa006Media1 6132264784001

Background The worsening of headaches or the occurrence of new headaches can occur after coil embolization. Although the frequency of headaches is reported to be greater when a stent is used, this phenomenon is poorly understood. Therefore, we aimed to evaluate the incidence and intensity of headache in patients treated with non‐stent‐assisted coil embolization (NSCE) versus stent‐assisted coil embolization (SACE) for unruptured intracranial aneurysms (UIAs). Methods In this prospective comparative cohort study, a total of 186 patients treated with coil embolization for UIAs between June 2018 and March 2022 were classified into NSCE or SACE groups. A Cox proportional hazards model was used to identify risk factors for occurrence of headache, and changes in headache intensity over time were assessed using a linear mixed‐effects model. Results Headaches occurred in 71.0% (132/186) of patients after coil embolization. During the 3‐month follow‐up, headaches after coil embolization were more common in patients who underwent SACE (adjusted hazard ratio, 1.57; p = 0.02). Female sex, cilostazol medication use, and pre‐existing headache were also independently associated with the occurrence of headache after coil embolization. Changes in numeric rating scale (NRS) scores according to stent placement status and trends in NRS scores over time based on stent placement status were not statistically significant. Conclusions Patients treated with SACE were more likely to experience headache after coil embolization than those treated with NSCE were. However, changes in headache intensity over time were not significantly different between the groups. Among patients treated with coil embolization for UIAs, patients treated with SACE were more likely to experience headache after coil embolization than those treated with NSCE were. However, changes in headache intensity over time were not significantly different between the groups. These findings highlight the need for attention to headaches after coil embolization, but further clinical validation in larger and more diverse populations is warranted.

Oropharyngeal tumors represent a multidisciplinary challenge in terms of localization, potential local invasion, and associated symptoms. When patients present with active bleeding from the tumor, endovascular intervention may be essential to control the bleeding and stabilize the patient. Lingual neoplasm is a complex entity associated with significant morbidity, especially when it progresses with ulceration. In cases where the oropharyngeal tumor presents with active hemorrhage, endovascular embolization is an important therapeutic option for immediate hemorrhage control, thus contributing to hemodynamic stabilization and allowing the initiation of oncological treatment strategies.This case report presents a 60-year-old chronic smoker with a known lingual neoplasm who presented to the emergency department with active oropharyngeal hemorrhage. On examination, the patient showed signs of significant bleeding from the base of the tongue and had an ECOG-PS of 3 (Eastern Cooperative Oncology Group Performance Status). Immediate intervention was necessary to control the bleeding and prevent further complications. After initial stabilization, the patient underwent angiographic evaluation, which identified active bleeding from the right lingual artery. Following the failure of conventional hemostatic methods, selective embolization of the lingual artery with permanent coil embolization material was decided. Post-procedural monitoring confirmed the absence of bleeding.This case highlights the importance of prompt and precise multidisciplinary management of complex cases, which has a significant impact on patient outcomes. Initial management focused on hemorrhage control, which could impede the use of conventional oncological therapy known for its potential to negatively affect the healing process and tissue integrity. As an alternative to invasive surgical treatments and as a preliminary step in transitioning to oncological therapy, this paper recommends embolization as a valuable therapeutic option in similar circumstances. By effectively controlling hemorrhage, this procedure allows oncologists to proceed with cancer treatment strategies, minimizing delays and reducing the risk of further complications. Given the high incidence of smoking, increasing awareness and the use of these advanced interventional techniques are crucial for improving outcomes and reducing associated complications.

Introduction: Ruptured aneurysms are associated with significant mortality limiting a patient’s chances of survival, making early and accurate diagnoses crucial. A commonly overlooked causeis the hepatic artery aneurysm, where most patients exhibit no distinct symptoms and detection typically occurs only after the aneurysm has ruptured. Hepatic artery aneurysms are linked with high rupturing rates resulting in substantial mortality when compared to other splanchnic artery aneurysms. Enhancing recognition and consideration of splanchnic artery aneurysms, including hepatic artery aneurysms, will increase a patient’s odds of a successful recovery. The following case report illustrates the critical nature of these cases and highlights how important early diagnosis and aggressive intervention are to prevent death once rupture of the hepatic arteryaneurysm has occurred. Case Report: A 57-year-old female presented to the emergency department brought in by helicopter for generalized chest and abdominal pain. A computed tomography angiography of the chest, abdomen, and pelvis was performed and revealed a saccular aneurysm exhibiting multiple lobes in the left hepatic artery accompanied by hemoperitoneum confirming a spontaneous rupture. As a result of the ruptured aneurysm, it was decided an immediate coil embolization was necessary. Ultimately the patient underwent a successful coil embolization and was transferred to a facility with hepatobiliary and transplant surgery capabilities. She remained stable, was extubated the following day, and did not require any additional surgeries. Conclusion: By encompassing hepatic and associated splanchnic artery aneurysms in the diagnosis of patients with abdominal pain and signs of hemodynamic instability, physicians can improve early identification, facilitating early endovascular repair and improved patient outcomes. It is a rare diagnosis that can present with a wide range of symptoms. Currently, endovascular approaches for ruptured hepatic artery aneurysms are preferred over open surgery.

Abstract Background Wide-necked cerebral aneurysms in the setting of acute subarachnoid hemorrhage (SAH) remain difficult to treat with endovascular methods despite recent progress in the neuroendovascular field. Objective To evaluate the effectiveness and safety of the Comaneci device (Rapid Medical, Israel) in endovascular coil embolization of acutely ruptured, wide-necked sidewall, or bifurcation cerebral aneurysms. Methods We retrospectively reviewed 45 anterior communicating artery, 24 internal carotid artery, 21 middle cerebral artery bifurcation, 15 anterior cerebral artery, and 13 posterior circulation aneurysms, which were treated using Comaneci-assisted coil embolization from August 2017 to January 2019. We evaluated procedural complications, clinical outcomes, and mid-term angiographic follow-up. Immediate and 90 d-clinical outcome and radiological follow-up were obtained in all patients. Results Comaneci-assisted coil embolization was performed in 118 acutely ruptured aneurysms. The technique was carried out successfully in all cases. Simultaneous application of 2 separated Comaneci devices was performed in 8/118 cases (6.77%). Periprocedural thromboembolic complications related to the device were seen in 7/118 cases (5.93%) and severe vasospasm of the parent artery after manipulation of the Comaneci device occurred in 5/118 cases (4.2%). The procedural-related morbidity rate was 2.54%, and there was no procedural related mortality. Among the available survivors, angiographic follow-ups were obtained at 3 and 6 mo, and complete aneurysmal obliteration was confirmed in 81/112 (72.3%) and 75/112 (66.9%) cases, respectively. Mid-term follow-up reviewed total recanalization rate of 14.28%. Conclusion Comaneci-assisted embolization of wide-necked intracranial aneurysms in patients presenting with acute SAH is associated with high procedural safety and adequate occlusion rates. Furthermore, dual antiplatelet therapy can be safely avoided in this patient group. Graphical Abstract Graphical Abstract

Traditional surgical management of chronic and nonacute subdural hematomas (NASDH) is associated with high recurrence and often requires reoperation. Middle meningeal artery (MMA) embolization has emerged as a minimally invasive alternative. Most studies to date have used liquid or particle embolics, which carry risks of non-target embolization and neurologic complications. Coil-only embolization offers controlled, localized occlusion and may represent a safer, simpler option, though existing data are limited by small cohorts and inconsistent techniques. We performed a retrospective review of all patients who underwent standalone coil MMA embolization for NASDH at our institution from 2022 to 2025. Short coils were deployed in a Y-configuration across anterior and posterior divisions or within the MMA trunk. Coil sizing was guided by the Spinosum Roentgen Index (S.R.I.). The study included 52 patients who underwent 71 procedures (mean age: 71 years). Embolization was performed upfront in 48 %, prophylactically post-surgery in 44 %, and as salvage in 8 %. Technical success was achieved in 97 %, with no procedural complications. Mean hematoma thickness decreased by 7.8 mm at one month and 13.6 mm at three months (both p < 0.001). Density declined by 12.5 HU and 22.5 HU, respectively (both p < 0.001). The S.R.I. correlated strongly with MMA diameter (p < 0.001) and reliably guided coil sizing. Mean fluoroscopy time was 5.8 min. Larger MMA diameter was associated with greater early density reduction (p = 0.010). This study represents the largest single-center series of standalone coil embolization for NASDH. The technique demonstrated excellent safety, hematoma resolution, and procedural efficiency. •Largest single-center series on standalone coil embolization for nonacute subdural hematomas (71 procedures in 52 patients).•Safe and effective technique with 0 % procedural complications and 3 % retreatment rate.•Significant hematoma reduction at 1 and 3 months (mean: 7.8 mm and 13.6 mm; p < 0.001).•Low radiation exposure with mean fluoroscopy time of 5.8 min.•Technique utilizes S.R.I.-guided coil sizing and Y-configuration deployment to ensure branch-targeted occlusion.