Conjoined Pathways: Unraveling the Coexistence of Developmental Venous Anomaly With Arteriovenous Malformation.

Developmental venous anomalies (DVAs) are intracranial vascular malformations typically characterized by their benign nature, often obviating the need for radiological follow-up. These anomalies arise from variations in the standard drainage pattern. While previously deemed congenital, there has been ongoing debate about a developmental component contributing to their etiology. They frequently coexist with other cerebral venous malformations (CVM); however, their association with arteriovenous malformations (AVM) is exceedingly rare. Such mixed malformations pose a therapeutic challenge, necessitating meticulous consideration for appropriate treatment. We present a noteworthy case involving a patient with arteriovenous malformation along with dual developmental venous anomalies, one of which served as the draining vein for the AVM.

Stents and Stent Mimickers in Endovascular Management of Wide-neck Intracranial Aneurysms.

Subarachnoid hemorrhage due to a ruptured cerebral aneurysm is a disastrous event accounting for approximately 5%-15% of all stroke cases and has a high mortality rate. One of the major goals in the management of these patients is to prevent rebleeding by securing the aneurysm either surgically or by endovascular means. Endovascular treatment is considered the first line of treatment for intracranial aneurysms; however, wide-neck aneurysms (WNAs) are specifically difficult to treat by endovascular means due to the difficulty in achieving a stable coil mass inside the aneurysm sac. To overcome this problem, assisted endovascular treatment techniques and devices have evolved over the years. Amongst these, stent-assisted coiling (SAC) techniques provide a scaffold for coil embolization. The concept of the stent-assisted technique inspired creative pioneers to invent new tools like the PulseRider (Pulsar Vascular, Inc. CA, USA) and the pCONUS (Phenox GmbH, Germany), which are a great help in managing wide-neck and bifurcation aneurysms. The concept of stent within stents and its related hemodynamic effect has led to the novel development of flow diverters for reconstructing the arterial wall and correcting the hemodynamic disturbances. In this article, we review the stents and stent-like devices currently in practice for the endovascular management of wide-neck and branch intracranial aneurysms.