Utility of virtual stenting in treatment of cerebral aneurysms by flow diverter devices.

Successful endovascular treatment by stenting of intracranial aneurysms requires proper placement of the device and appropriate choice of its diameter and length. To date, several methods have been employed to achieve these goals, although each has inherent critical issues. Recently developed stent planning software applications can be used to assist interventional neuroradiologists. Based on a 3D-DSA image acquired before stenting, these applications simulate and visualize the final placement of the deployed stent. In this single-centre retrospective study, 27 patients undergoing an intravascular procedure for the treatment of intracranial aneurysms from June 2019 to July 2020 were evaluated according to strict inclusion criteria. Stent virtualization was performed with Syngo 3D Aneurysm Guidance Neuro software. We compared the software-generated stent measurement and measurements taken by the interventional radiologist. Statistical analysis was performed using the STAC web platform. Mean and standard deviations of absolute and relative discrepancies between predicted and implanted stents were recorded. Friedman's nonparametric test was used to refute the null hypotheses, i.e. (I) discrepancies between the size of virtual and implanted stents would occur, and (II) operator influence does not affect the outcome of the virtual stenting process. Based on these observations, it is believed that the virtual stenting process can validly assist interventional neuroradiologists in selecting the appropriate device and reducing peri- and post-procedural complications. The results of our study suggest that virtual reality simulation of devices used for endovascular treatment of intracranial aneurysms is a useful, rapid, and accurate tool for interventional procedure planning.

Dissective tandem stroke: an endovascular approach.

Ischemic stroke due to internal carotid artery occlusion is a potential devastating condition. More frequently the occlusions are embolic in nature, but sometimes they are caused by arterial dissection and their treatment is a challenge. We describe an illustrative case where a young patient with middle cerebral artery stroke caused by carotid artery dissection was submitted to endovascular treatment of mechanical thrombectomy and stenting, giving an excellent outcome. We believe that tandem approach is a treatment of choice in these cases.

Basilar Artery Occlusion (BAO) revascularization after more than 12 hours from the onset of symptoms with excellent outcome: Report of a case.

This paper reports a case of basilar artery occlusion (BAO), a relatively rare event associated with high mortality rate and high risk of disability. A 77-year-old man arrived at our Stroke Unit approximately 14 hours after the onset of symptoms (dysarthria and complete left hemiparesis) with progressive worsening up to coma and with a National Institute Health Stroke Scale (NIHSS) of 22. The patient was treated and, at discharge, the modified Rankin scale and NIHSS were 2 and 5, respectively. The aim of this paper is to illustrate how revascularization treatment, also after 12 hours, could be a viable option to ensure survival and a good life quality for the patient. Furthermore, it is essential to encourage the publication of a greater number of trials about the posterior circulation emphasizing how many favorable prognosis indicators are now recognized.