Flow-diverting stents (FDs) provide a reconstructive option for complex ruptured aneurysms, including blister-like, fusiform, and small saccular lesions. Their use in acute subarachnoid hemorrhage (SAH) is limited by dual antiplatelet therapy (DAPT) and hemorrhagic risk, with scarce data from resource-limited settings. We retrospectively reviewed 26 patients with ruptured intracranial aneurysms treated with FDs within 7 days of ictus at a single tertiary center (July 2021-June 2025). Exclusion criteria included adjunctive coiling/clipping, FD placement >7 days, and aneurysms >5 mm. Outcomes included 90-day functional status (modified Rankin Scale [mRS]), angiographic occlusion (O'Kelly-Marotta grading), and procedural complications. Mean age was 47.3±12.1 years; 61.5% were male. Aneurysm types were saccular (42.3%), blister-like (34.6%), and fusiform/dissecting (23.1%). FD placement occurred at a mean of 3.9±1.8 days post-ictus, with 100% technical success and no intraprocedural complications. Favorable functional outcome (mRS 0-2) was achieved in 84.6%, and mortality was 15.4%, all secondary to SAH. Complete angiographic occlusion was observed in all 21 patients with imaging follow-up. Procedure-related ischemic complications occurred in 11.5%, mostly transient or minimally disabling, with 1 disabling infarct (mRS 3); no hemorrhagic events related to DAPT or aneurysm rebleeds were observed. Early FD implantation in carefully selected ruptured aneurysms, including small saccular and morphologically complex lesions can achieve high functional recovery and complete angiographic occlusion, even in a resource-limited environment. Ideal case selection and standardized DAPT and hemodynamic protocols are critical. These findings support broader use in challenging aneurysms, but larger prospective studies are warranted to validate outcomes and refine management strategies.

Mechanical thrombectomy has been established as the standard of care for acute ischemic stroke caused by intracranial large vessel occlusion.Over the past decade, randomized trials have confirmed its efficacy, and clinical practice has rapidly disseminated.As the field matures, attention is shifting from proving effectiveness to refining techniques, understanding mechanisms underlying procedural success or failure, and extending endovascular intervention to complex vascular pathology.Recent publications in Neurointervention during 2024-2025 reflected this transition.Together, they illustrated how the field is advancing toward precision endovascular therapyoptimizing device-clot interactions, procedural strategies, training, and preventive interventions in stroke-prone vascular conditions.

PurposeInfarct location may significantly influence clinical outcomes in patients with acute ischemic stroke (AIS) treated with endovascular thrombectomy (EVT). This study aimed to investigate the impact of basal ganglia (BG) infarction on outcomes in AIS patients with large vessel occlusion (LVO) who achieved successful recanalization.Materials and MethodsWe retrospectively analyzed consecutive AIS patients who underwent EVT at our center between March 2016 and January 2019. Patients with LVO who achieved successful recanalization (modified Thrombolysis in Cerebral Infarction ≥2b) were included. Preprocedural diffusion-weighted imaging (DWI) was used to identify BG infarction. Poor outcome was defined as a 3-month modified Rankin Scale score of 3–6. Multivariate logistic regression analysis was performed to identify independent predictors of poor outcome.ResultsA total of 222 patients were included, of whom 160 (72.1%) had BG infarction. Independent predictors of poor outcome included older age (odds ratio [OR], 1.10; P<0.001), higher National Institute of Health Stroke Scale scores (OR, 1.20; P<0.001), lower DWI-Alberta Stroke Program Early Computed Tomography Scores (OR, 0.79; P=0.009), hemorrhagic transformation (OR, 2.97; P=0.031), and BG infarction (OR, 4.14; P=0.002).ConclusionBG infarction was independently associated with poor outcome despite successful recanalization. These findings underscore the prognostic importance of infarct location and support the need for tailored treatment strategies in AIS patients with BG involvement.

We present a case of a patient in their 50s with a spinal epidural arteriovenous fistula (SEDAVF) at L2 level with intradural venous reflux. Initial transarterial embolization was attempted but failed due to vessel tortuosity and vasospasm. The second embolization was carried out with percutaneous puncture of the epidural venous sac under cone-beam computed tomography angiography (CBCTA) guidance. Following the complete obliteration of the fistula, resolution of the venous congestion and significant improvement of the patient's symptoms were achieved. This case highlights the utility of the percutaneous approach as an alternative treatment strategy for SEDAVFs when traditional endovascular routes are not feasible. Advanced imaging techniques, such as CBCTA, facilitate precise navigation and successful embolization.

A 44-year-old female experienced a recurrence and enlargement of a basilar top aneurysm 2 years after initial treatment with a Woven EndoBridge (WEB) device. Retreatment using a new WEB device combined with a flow diverter (FD) via a semi-jail technique successfully obliterated the aneurysm without complications. Follow-up imaging at 4 months showed complete occlusion and favorable outcomes. This case suggests that combining WEB and FD may offer effective retreatment for complex, recurrent aneurysms, enhancing coverage and durability. Despite its technical challenges, this approach shows promise, though further long-term studies are needed to confirm its safety and wider applicability.

Delayed rupture of intracranial aneurysms after endovascular treatment is a rare but serious complication. We report the first documented case of late aneurysmal rupture following treatment with a Contour intrasaccular device. A patient in their 60s with a basilar tip aneurysm underwent endovascular treatment using a 14-mm Contour device. Fifteen months later, the patient presented with a fatal intraventricular hemorrhage, and imaging revealed device displacement and aneurysm growth. This case underscores the importance of meticulous device sizing and follow-up, especially for large aneurysms.

The Woven EndoBridge (WEB) device has emerged as a promising alternative to endovascular coiling. This case report demonstrates the use of stent-assisted WEB deployment for the embolization of multiple wide-neck posterior cerebral artery (PCA) aneurysms. A middle-aged patient was diagnosed with 3 unruptured aneurysms in the P3 and P4 segments of the right PCA, with sizes ranging from 2.5 mm to 6.6 mm. Given the small vessel diameter and distal location of the aneurysms, a combined approach was adopted. Coil embolization was performed for the most distal aneurysm, while stent-assisted WEB deployment was used for the proximal and middle aneurysms. The "flower bud" technique facilitated the safe positioning of the WEB device in challenging anatomical conditions. The procedure was successfully completed without complications, and the patient was discharged on postoperative day 7 with no neurological deficits. Follow-up at 3 months confirmed adequate embolization of all aneurysms, with in-stent stenosis managed conservatively.

We report a rare case of a left internal mammary artery (LIMA) originating from the left thyrocervical trunk (TCT), which arose directly from the aortic arch. A patient in their 70s presented with bilateral distal internal carotid artery aneurysms, diagnosed through computed tomography angiography performed for headache evaluation. Transfemoral cerebral angiography confirmed the aneurysms and incidentally revealed the anomalous origins of the TCT and LIMA, as well as a left vertebral artery directly arising from the aortic arch. This case emphasizes the importance of recognizing such rare anatomical variations prior to diagnostic or interventional procedures. Thorough preoperative evaluation is critical to avoid complications, particularly in coronary artery bypass grafting and head and neck tumor embolization.

We present a case of delayed migration of an open-cell design carotid stent, which is a rare complication following carotid artery stenting (CAS). A 65-year-old patient with carotid artery stenosis underwent CAS with an open-cell stent, initially achieving successful deployment. However, 4 months later, the stent migrated and resulted in restenosis. The patient underwent balloon angioplasty and received an additional stent, leading to improved blood flow. The rarity of stent migration, particularly in the absence of risk factors, highlights the need for clinicians to be vigilant and consider early imaging follow-up for patients at risk of this complication after CAS.

Wide-necked aneurysms in the circle of Willis (CoW) are prone to recur due to reciprocal bidirectional flow. We present a novel concept of coil embolization to prevent recurrence that uses physiologic flow diversion at the CoW. We enrolled 14 patients (15 aneurysms) who underwent aneurysm coiling for wide-necked aneurysms with asymmetric bidirectional inflow into the aneurysm. Four patients had recurrent aneurysms after coiling. The concept of physiologic flow diversion included obliterating antegrade flow into the aneurysm sac as well as opposite CoW flow by performing compact coil packing with intentional protrusion out of the aneurysm neck to the communicating part. Fifteen aneurysms, including 4 recurrent aneurysms, in an anterior communicating artery (n=7), posterior communicating artery (n=5), and tip of the basilar artery (n=3) were treated with coil embolization (n=10) and stent-assisted coiling (n=5). All aneurysms had a wide neck, and the mean largest diameter was 9.0 mm. The mean packing density was 45.1%. Twelve aneurysms were completely occluded, and 3 aneurysms had tiny residual neck remnants. There was neither a neurological event nor recurrence during the mean 12.5 months of follow-up. Wide-necked aneurysms at the CoW tend to recur. As a strategy to prevent a recurrence, physiologic flow diversion can be an option in treating wide-necked aneurysms in the CoW.