cPAX is a polymeric strand delivered into the aneurysm using a technique similar to currently available platinum coil technologies.  cPAX, because of its soft polymeric material, is designed to achieve more complete filling of the aneurysm with the probable benefit of greater long term stability.  A significant feature of cPAX in comparison to currently available technologies is that it offers the physician the ability to detach the device at any point versus a fixed detachment zone common in platinum coils.  The polymeric material also allows for non-invasive CT and MRI scans with little or no artifact for more accurate patient follow-up assessment.

researchers from the University of British Columbia have discovered an interesting property of the platinum embolism implant – it can act as a fairly accurate sensor and antenna. The reason is simply that the implant’s coiled shape causes its material properties, namely its resonance frequency, to vary depending on the blood flow through it. A simple handheld RF reader is all that would be required to monitor the status of the embolization-coil sensor.

Radio aneurysm coils for noninvasive detection of cerebral embolization failures: A preliminary study.

The Luna AES treats brain aneurysms by blocking (embolizing) blood flow while providing a scaffold to encourage tissue growth across an aneurysm opening and create a plug. The Luna uses a self-expandable, multi-layer oval implant made from Nitinol, a nickel-titanium alloy. The properties of the device allow it to easily compress within a conventional catheter, and then rapidly and easily open to full size once deployed within an aneurysm.

Dural venous sinus angioplasty and stenting for the treatment of idiopathic intracranial hypertension

Lumboperitoneal shunt (LPS), ventriculoperitoneal shunt (VPS) and optic nerve sheath fenestration (ONSF) are accepted surgical therapies for medically refractory idiopathic intracranial hypertension (IIH). In the subset of patients with IIH and venous sinus stenosis, dural venous sinus stenting has emerged as an alternative surgical approach.

All cases of dural stents for IIH at our institution were retrospectively reviewed. Eligibility criteria included medically refractory IIH with documented papilledema and dural venous sinus stenosis of the dominant venous outflow system (gradient ≥10 mm Hg).

Fifteen cases (all women) of mean age 34 years were identified. All had failed medical therapy and six had failed surgical intervention. Technical success was achieved in all patients without major periprocedural complications. The mean preprocedural gradient across the venous stenosis was reduced from 24 mm Hg before the procedure to 4 mm Hg after the procedure. Headache resolved or improved in 10 patients. Papilledema resolved in all patients and visual acuity stabilized or improved in 14 patients. There were no instances of restenosis among the 14 patients with follow-up imaging.

In this small case series, dural sinus stenting for IIH was performed safely with a high degree of technical success and with excellent clinical outcomes. These results suggest that angioplasty and stenting for the treatment of medically refractory IIH in patients with dural sinus stenosis warrants further investigation as an alternative to LPS, VPS and ONSF.

Extending the Time Window for Endovascular Procedures According to Collateral Pial Circulation [Original Contributions; Clinical Sciences]: Background and Purpose—

Good collateral pial circulation (CPC) predicts a favorable outcome in patients undergoing intra-arterial procedures. We aimed to determine if CPC status may be used to decide about pursuing recanalization efforts.

Pial collateral score (0–5) was determined on initial angiogram. We considered good CPC when pial collateral score <3, defined total time of ischemia (TTI) as onset-to-recanalization time, and clinical improvement >4-point decline in admission–discharge National Institutes of Health Stroke Scale.

We studied CPC in 61 patients (31 middle cerebral artery, 30 internal carotid artery). Good CPC patients (n=21 [34%]) had lower discharge National Institutes of Health Stroke Scale score (7 versus 21; P=0.02) and smaller infarcts (56 mL versus 238 mL; P<0.001). In poor CPC patients, a receiver operating characteristic curve defined a TTI cutoff point <300 minutes (sensitivity 67%, specificity 75%) that better predicted clinical improvement (TTI <300: 66.7% versus TTI >300: 25%; P=0.05). For good CPC patients, no temporal cutoff point could be defined. Although clinical improvement was similar for patients recanalizing within 300 minutes (poor CPC: 60% versus good CPC: 85.7%; P=0.35), the likelihood of clinical improvement was 3-fold higher after 300 minutes only in good CPC patients (23.1% versus 90.1%; P=0.01). Similarly, infarct volume was reduced 7-fold in good as compared with poor CPC patients only when TTI >300 minutes (TTI <300: poor CPC: 145 mL versus good CPC: 93 mL; P=0.56 and TTI >300: poor CPC: 217 mL versus good CPC: 33 mL; P<0.01). After adjusting for age and baseline National Institutes of Health Stroke Scale score, TTI <300 emerged as an independent predictor of clinical improvement in poor CPC patients (OR, 6.6; 95% CI, 1.01–44.3; P=0.05) but not in good CPC patients. In a logistic regression, good CPC independently predicted clinical improvement after adjusting for TTI, admission National Institutes of Health Stroke Scale score, and age (OR, 12.5; 95% CI, 1.6–74.8; P=0.016).

Good CPC predicts better clinical response to intra-arterial treatment beyond 5 hours from onset. In patients with stroke receiving endovascular treatment, identification of good CPC may help physicians when considering pursuing recanalization efforts in late time windows.

Wonderful article
this was always suspected or rather known that small aneurysms do rupture but the prospective trials could not show this. Sato et al have now come with this article and proven statistically that some aneurysms form and rupture soon after while others remain stable and do not rupture for long.

Pediatric Intracranial Aneurysms: New and Enlarging Aneurysms after Index Aneurysm Treatment or Observation

Cerebral Perfusion Long Term after Therapeutic Occlusion of the Internal Carotid Artery in Patients Who Tolerated Angiographic Balloon Test Occlusion

Gevers, S., Heijtel, D., Ferns, S. P., van Ooij, P., van Rooij, W. J., van Osch, M. J., van den Berg, R., Nederveen, A. J., Majoie, C. B.

This is the case of a middle aged patient with Fisher grade 3, Hunt and Hess grade 2 subarachnoid haemorrhage with a ruptured basilar tip aneurysm. The aneurysm was moderate sized, with a wide neck ~ 7 mm involving both the proximal p1 PCA segments (left more than right), and directed posterosuperiorly. The  Pcoms were seen although not very prominent.

An Enterprise 5.5 x 22 mm stent was passed via a Prowler Select Plus microcatheter across the aneurysm neck into the left PCA with trailing portion kept in the basilar artery. A SL 10 microcatheter was then navigated and placed in the aneurysm fundus. The stent was partially opened (JAILING technique) and coiling done. Good packing of the aneurysm was achieved. Then the stent was fully deployed and left in situ.

The patient had been prepared with 300 mg Aspirin and 300 mg Clopidogrel prior to the procedure and given 5000 U heparin bolus after sheath placement. A single femoral puncture had been done with 6F sheath placement and a 6F Envoy used as guide catheter. A double Y Tuohy Borst hemostatic adapter was used to pass the stent and coil noth through the same guide catheter.

The patient had an uneventful recovery and was discharged in stable condition.

She was advised to have Aspirin 150 mg and Clopidogrel 75 mg once daily for next three months and then Aspirin 150 mg for life.

Fig 1. Frontal and Lateral views of LVA injection

Fig 2. 3D DSA images of LVA injection

Fig 3. Stent placement in the left PCA across the aneurysm neck

Fig 4. Coiling of the aneurysm

Fig 5. The deployed stent and fully coiled aneurysm

Fig 6. Pre and post procedure comparative angiograms