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<jats:p> Within the group of giant and large aneurysms the subgroup of the so-called “partially thrombosed” aneurysms can be differentiated according to clinical and neuroimaging findings. The present study was carried out to determine the site of bleeding of these aneurysms and what implications concerning their pathomechanism can be drawn from these findings. </jats:p><jats:p> Twenty patients aged two to 77 (mean 44) years who exhibited a partially thrombosed aneurysm that had recently bled were included. Images (MRI including T1 pre- and postcontrast and T2 weighted images in multiple planes, CT and digital subtraction angiography) and patients' charts were reviewed. </jats:p><jats:p> MRI showed an onion-skin appearance of the thrombus in 19 patients, rim enhancement of the aneurysm wall (either partial or complete) in 17, and a perifocal edema in 16 patients. The acute hemorrhage was typically crescent-shaped and located at the periphery of the aneurysm, distant from the perfused lumen of the aneurysm within the thrombosed part of the aneurysm. </jats:p><jats:p> The current denomination “partially thrombosed” intracranial arterial aneurysms leads to the presumption that thrombus is present endoluminal whereas in fact the site of hemorrhage is within the vessel wall. A more accurate nomination would, therefore, be “aneurysms with intra mural hemorrhage”. The enhancing wall and the edematous reaction of the adjacent brain parenchyma might be a sign for an inflammatory pathomechanism which is reinforced by histological and pathophysiological studies. This disease should be regarded as a clinical entity separate from saccular or non-thrombosed giant or large aneurysms. </jats:p>

<jats:sec><jats:title>Background</jats:title><jats:p> The Contour is a new generation intrasaccular flow disruption tool that aims to cover the aneurysm neck and is sized according to the neck diameter. While several case series have been published, no literature review has been performed on this promising device. </jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p> To assess the safety and effectiveness profile of the Contour Neurovascular System for wide-necked aneurysms. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> We followed the recommendations of the PRISMA checklist Four databases were searched with a supplemental manual search. All data were analyzed using R software version 4.2.1. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> We finally included six studies with 131 treated aneurysms. The overall procedural time was 97.27 (95% CI = 70.07–124.47) minutes, ranging from 78.9 to 136.0 min. The pooled adequate occlusion rate was 84.21% (95% CI = 75.45–90.25), and the overall functional independence rate was 94.74% (87.97–97.79). The overall adverse event rate was 4.70 (95% CI = 3.24–6.76), varying among different events from 0.78 to 8.53%. Thromboembolic events were the most commonly encountered in 8.53% of the patients (95% CI = 4.78–14.74), followed by headache and minor stroke with incidence rates of 5.88 (95% CI = 2.83–11.83) and 4.35 (95% CI = 1.41–12.63), respectively. The overall procedural time in studies using the Contour system only was 86.17 (95% CI = 68.70–10.64) minutes, while it was 136 (95% CI = 90.96–181.04) in the Contour-assisted coiling procedures. However, both techniques were comparable regarding adequate occlusion rates and functional independence. </jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p> With the anticipation of future studies, the Contour Neurovascular System is a safe and effective treatment option for wide-necked intracranial aneurysms. </jats:p></jats:sec>

<jats:sec><jats:title>Introduction</jats:title><jats:p> The Woven EndoBridge device (WEB) is used to treat wide-neck bifurcation aneurysms. These devices are deployed inside the sac. Therefore, the mesh structure provides apposition with the aneurysm wall and induces aneurysmal thrombosis. The objective of our study was to evaluate the anatomic and device-related parameters and indexes with Computational Fluid Dynamics (CFD) of the intracranial aneurysms before and after WEB simulation and find their relationship to complete occlusion. </jats:p></jats:sec><jats:sec><jats:title>Materials and methods</jats:title><jats:p> Using the heterogeneous model based on the marching cubes algorithm, we created 3D representations of 27 bifurcated intracranial aneurysms treated with the single-layer WEB device to evaluate anatomic and device-related parameters with CFD. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> In our CFD analysis, we observed higher large volumes (V<jats:sub>a</jats:sub>) (0.25 ± 0.18 versus 0.39 ± 0.09, p-value= 0.025) and higher volume to neck surface ratio (R<jats:sub>a</jats:sub>) (1.32 ± 0.17 versus 1.54 ± 0.14, p-value= 0.021) in cases with occlusion failure. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> Large aneurysm volumes (V<jats:sub>a</jats:sub>) and higher volume to neck surface ratio (R<jats:sub>a</jats:sub>) could be associated with occlusion failure in aneurysms treated with the WEB device. </jats:p></jats:sec>

<jats:p> The invested effort and collaboration of clinicians and medical device companies to improve occlusion rates and clinical outcomes for patients with intracranial aneurysms treated via less invasive endovascular means led to the development of the concept of intrasaccular devices. Intrasaccular devices were introduced to offer simple treatment options, offering easier navigation through difficult anatomy, simpler and quicker deployment into large and wide-neck aneurysms. Additionally, they offer easier sizing, whilst offering a wide range of options suitable for aneurysms of different sizes. The concept of most intrasaccular devices is to occupy the aneurysm neck, however offering better stability than simple coiling, therefore increasing the chance of long-term aneurysm occlusion. This is achieved without a sizable metal content within the parent vessel, contrary to flow diverters, theoretically reducing the risk of thromboembolic events. This review aims to discuss the history and latest developments of intrasaccular intracranial devices, which offer an exciting and potentially successful option for treatment of complex intracranial aneurysms. </jats:p>

<jats:p> Mechanical thrombectomy is established as standard of care in the management of acute ischemic stroke due to large vessel occlusion and evidence-based guidelines for mechanical thrombectomy have been defined. As research continues to further expand the eligibility criteria for thrombectomy and the number of thrombectomy procedures increase worldwide, there is also growing focus on innovation of thrombectomy devices, procedural techniques, and related outcomes. Thrombectomy primarily involves use of stent retrievers and distal aspiration techniques, but variations and different combinations of techniques have been reported. As this is a rapidly evolving area in stroke management, there is debate as to which, if any, of these techniques leads to improved clinical outcomes over another and there is a lack of data comparing them. In this review, currently published and distinct techniques of mechanical thrombectomy are described methodically along with illustrations to aid in understanding the subtle differences between the techniques. The perceived benefits of each variation are discussed. </jats:p>