Hongqi Zhang

Background: Predictors of endovascular treatment failure in high-grade dural arteriovenous fistulas (DAVFs) with cortical venous drainage (CVD) remain insufficiently characterized. This study aimed to identify angioarchitectural factors associated with failed endovascular treatment in DAVFs with CVD. Methods: Patients with angiographically confirmed DAVFs with CVD who underwent first-line endovascular embolization in the DREAM-INI (Dural Arteriovenous Fistula Research and Management in China) database were retrospectively analyzed. Successful endovascular treatment was defined as durable complete obliteration without the need for additional surgery or radiosurgery. Baseline clinical and angioarchitectural characteristics were compared between successful and unsuccessful treatment groups. Logistic regression was used to identify predictors of treatment success. Results: A total of 415 patients were included. Successful endovascular treatment was achieved in 302 patients (72.8%), whereas 113 patients (27.2%) were classified as having unsuccessful treatment. On multivariable analysis, the presence of a middle meningeal artery feeder was independently associated with successful endovascular treatment. In contrast, pial arterial supply, venous congestion, and multiple fistulas were associated with lower odds of treatment success. Conclusions: In DAVFs with CVD, specific angioarchitectural features are associated with the likelihood of durable cure after endovascular treatment. Middle meningeal artery feeders may facilitate successful embolization, whereas pial arterial supply, venous congestion, and multiple fistulas suggest more complex lesions that may require careful treatment planning and earlier consideration of multimodal strategies.

Accurate cerebral arteriovenous malformation (CAVM) nidus volume measurement is important for evaluating treatment strategy and neurologic prognosis. This study aimed to compare the accuracy of silent MRA for measuring CAVM nidus volume with TOF-MRA and to analyze the clinical factors that may affect the nidus volume measurement. A total of 45 patients diagnosed with CAVM who received silent MRA, TOF-MRA, and DSA examinations were retrospectively enrolled. A standardized protocol was used for nidus volume measurement using thresholding by these three imaging tools. The mean nidus volume measured by 3D-DSA, silent MRA, and TOF-MRA was 9.073 (SD, 7.667) mL, 9.55 (SD, 7.814) mL, and 7.773(SD, 7.11) mL, respectively. The linear correlation coefficient of the nidus volume was 0.976 (P < .001) and .966 (P < .001), respectively. Silent MRA was significantly higher than TOF MRA in nidus overlap volume (0.775 [SD. 0.109] versus 0.538 [SD. 0.206] P = .00), while TOF MRA was significantly higher than silent MRA in absolute volume difference (0.196 [SD. 0.192] versus 0.114 [SD. 0.147], P = .005). For both silent MRA and TOF-MRA, the nidus overlap volume and absolute volume difference were significantly associated with previous embolization status. Nidus volume measurement by silent MRA is comparable with DSA and is practical. Silent MRA can be used for nidus volume measurement and as a follow-up tool for evaluating nidus volume change after therapy.

Paraclinoid aneurysms exhibit a markedly lower rupture risk compared to intracranial aneurysms (IAs) located in other regions. We aimed to identify the hemodynamic and morphological factors underlying this reduced rupture propensity. We analyzed data from 538 unruptured IAs (179 paraclinoid) in the Chinese Intracranial Aneurysm Project (CIAP). Hemodynamic parameters were analyzed using computational fluid dynamics (CFD), and morphological features were quantified using computer-assisted semiautomated measurement (CASAM). Univariate and multivariate logistic regression analyses identified differences between paraclinoid and IAs in other locations. Paraclinoid aneurysms were independently associated with younger age (OR = 1.031, P = 0.024), female sex (OR = 0.474, P = 0.011), and less frequent use of lipid-lowering medications (OR = 3.156, P < 0.001). Hemodynamically, they exhibited lower combined hemodynamic parameter (CHP; OR = 1.055, P = 0.011), normalized pressure (NP; OR = 1.469, P < 0.001), and low shear area (LSA) ratio (OR = 1.065, P < 0.001). Morphologically, they had smaller maximum diameter (OR = 1.203, P < 0.001), lower non-sphericity index (NSI; OR = 1.099, P = 0.002), larger parent artery diameter (OR = 0.157, P < 0.001), and less frequent bifurcation involvement (OR = 9.361, P < 0.001). Paraclinoid aneurysms exhibit lower NP, LSA, and CHP, along with smaller maximum diameter, lower NSI, and a sidewall configuration. Collectively, these features are associated with a stable hemodynamic and morphological environment that underlies their lower rupture risk. Future prospective studies with a large cohort are needed to confirm these findings.

Background: Determining the location of paraclinoid aneurysms (PAs) is crucial. We aimed to evaluate the utility of paraclinoid high-resolution MRI (HRMRI) in determining PA locations. Methods: We enrolled patients with suspected PAs who underwent our HRMRI sequence in 6 months. PAs were categorized into five types based on their origin from the internal carotid artery (ICA): Superior ophthalmic segment (Type S), Ventral ophthalmic segment (Type V), Medial clinoidal segment (Type M), Lateral clinoidal segment Type L, and Posterior clinoidal segment) (Type P). The paraclinoid HRMRI protocol included five main sequences: TOF-MRA, coronal and saggital high-resolution T2-weighted images, coronal and saggital enhanced high-resolution T1-weighted images. We utilized cerebrospinal fluid (CSF) notch and cavernous sinus enhanced signals to determine the location of PAs. Results: Sixty-nine patients with 75 PAs were included. Based on our classification, there were 10 Type S, 2 Type V, 45 Type M, 11 Type L, and 7 Type P PAs. Among the Type S PAs, 9 were fully located within the subarachnoid space, and 1 was in the juncture area. Both Type V PAs were situated within the cavernous sinus. Among the Type M PAs, 34 were located in the cavernous sinus, and 1 was in the juncture. Of the Type L PAs, 5 were within the cavernous sinus, and 1 was in the juncture area. All 7 Type P PAs were located within the cavernous sinus. Conclusions: HRMRI sequences may assist in determining the location of PAs and could provide useful information for clinical decision-making, especially when radiation-free or iodine-free evaluation is preferred. Trial registration: The clinical trial of China Internal Aneurysm Project (NCT03115905).

Background: Woven EndoBridge (WEB™) has been shown to be safe and effective in the treatment of wide-necked bifurcation aneurysms (WNBAs). However, the use of this device has not been studied in China. This study assessed safety and effectiveness of WEB for the treatment of intracranial WNBAs in a Chinese population. Methods: The WEB Intrasaccular Therapy China Study (WEB-IT China) was a prospective, single-arm study allowing enrollment of adult WNBA patients treated with the WEB device between June 2017 and August 2019 among 8 centers in China. The primary effectiveness endpoint was treatment success rate, defined as complete aneurysm occlusion without retreatment, recurrent subarachnoid hemorrhage (SAH), or >50% parent artery stenosis at 1 year. The primary safety endpoint was the proportion of patients with major adverse event (MAE) incidence at 1 year follow-up, including non-accidental death or any major stroke within 30 days, or major ipsilateral stroke, or neurological death from day 31 to 1 year after treatment. Results: A total of 60 patients with 60 unruptured aneurysms were enrolled. Technical success rate was 98.3% (59/60). At 1 year, the treatment success rate was 54.2% (26/48), and two patients (3.9%) experienced an MAE, which was not device related. At 1 year, the complete occlusion rate was 56% and adequate occlusion rate was 82%. There were no retreatments, new bleeding events, or mortalities. Conclusions: This study demonstrated that the WEB device is safe and effective in the treatment of WNBAs in the Chinese population. Trial registration: Clinicaltrials.gov Unique Identifier NCT03207087.