RATIONALE AND OBJECTIVES:Incomplete occlusion after endovascular treatment (EVT) of intracranial aneurysms (IAs) increases the risks of re-rupture and retreatment. We aimed to develop and validate an interpretable multimodal machine learning model integrating quantitative digital subtraction angiography (QDSA) and radiomics features. MATERIALS AND METHODS:This dual-center study included an internal retrospective cohort (n = 1212), a prospective cohort (n = 246), and an external cohort (n = 327). The internal cohort was randomly divided into training and internal test sets at an 8:2 ratio. Clinical, morphological, QDSA-derived hemodynamic, and radiomics features were analyzed. Feature selection, SMOTE (Synthetic Minority Over-sampling Technique), five-fold cross-validation, and hyperparameter optimization were restricted to the training data. Eight algorithms were compared, and the incremental value of multimodal feature integration was assessed using DeLong tests. The primary performance metric was the area under the receiver operating characteristic curve (ROC-AUC), supplemented by the area under the precision-recall curve (PR-AUC), calibration measures, and decision curve analysis. Shapley Additive Explanations (SHAP) analysis was used for model interpretation, and the final model was implemented as a web-based decision-support calculator. RESULTS:The multimodal random forest model achieved ROC-AUCs of 0.861, 0.853, and 0.835 and PR-AUCs of 0.589, 0.657, and 0.439 in the internal test, prospective, and external cohorts, respectively. Sensitivity ranged from 0.550 to 0.683 and specificity from 0.847 to 0.881. The model outperformed the clinical and clinical-morphological models across all cohorts and showed generally preserved discrimination across clinical subgroups. Overall prediction error remained low, with Brier scores ranging from 0.117 to 0.148, while decision curve analysis demonstrated positive net benefit. SHAP analysis identified ruptured status, hypertension, cerebral blood flow ratio, Radscore, and treatment modality as important predictors. CONCLUSION:The multimodal model demonstrated stable discrimination across three cohorts. The web-based calculator provides individualized risk estimates from manually entered clinical and precomputed imaging-derived variables and may support risk-stratified surveillance planning.

BACKGROUND:The role of decompressive craniectomy (DC) during surgical treatment of supratentorial spontaneous intracerebral hemorrhage (ICH) remains controversial. Because DC is usually selected for patients with more severe mass effect, brain swelling, or concern for intracranial hypertension, its association with postoperative outcome must be interpreted in the context of baseline disease severity. This study evaluated clinical outcomes after hematoma evacuation with or without DC and identified factors associated with postoperative prognosis. METHODS:We conducted a single-center retrospective cohort study including consecutive adult patients with supratentorial spontaneous ICH who underwent surgical treatment between January 2023 and December 2024. Patients were categorized into hematoma evacuation alone (HE group) and hematoma evacuation plus decompressive craniectomy (HE + DC group). The primary outcome was unfavorable functional outcome at 90 days (modified Rankin Scale [mRS] 4-6). Secondary outcomes included mortality, perioperative complications, and recovery indicators. Multivariable logistic regression was performed to adjust for prespecified confounders. Propensity score matching (PSM) was used as a sensitivity analysis to reduce treatment-selection bias. Prespecified subgroup analyses with formal interaction testing were conducted to assess whether the association between surgical strategy and outcome differed across clinically relevant subgroups. RESULTS:A total of 221 patients were included (HE group: n = 132; HE + DC group: n = 89). Patients in the HE + DC group presented with more severe baseline neurological status, including lower GCS scores, higher NIHSS scores, larger hematoma volumes, and higher rates of intraventricular hemorrhage (all P < 0.001). In unadjusted analysis, the HE + DC group had a higher rate of 90-day unfavorable outcome compared with the HE group (36% vs. 13%, P < 0.001) and higher 30-day mortality (18% vs. 6%, P = 0.005). However, after multivariable adjustment, surgical strategy was not independently associated with 90-day unfavorable outcome (OR 1.727, 95% CI 0.759-3.946, P = 0.191). Independent predictors of poor outcome included older age and larger hematoma volume, whereas higher admission GCS score was protective. Subgroup analysis demonstrated no significant interactions except for hemorrhage location (P = 0.025). In the PSM cohort (n = 128), no significant differences were observed in functional outcome or mortality between groups, consistent with the adjusted analysis. CONCLUSIONS:In this real-world cohort of surgically treated supratentorial ICH, HE + DC was not independently associated with 90-day unfavorable functional outcome after adjustment for baseline disease severity. The poorer crude outcomes observed in the HE + DC group should be interpreted in the context of greater initial disease severity and confounding by indication.

OBJECTIVE:This study aims to develop and validate ensemble learning models based on pre-rupture or pre-growth images andmultiple features to predict stability of intracranial aneurysm (IA). METHODS:Retrospectively collected aneurysms diagnosed through computed tomography angiography (CTA), magnetic resonance angiography (MRA) or digital subtraction angiography (DSA) from 7 hospitals. Internal dataset consists of data from Beijing Tiantan Hospital, and independent external validation set consists of data from the other 6 hospitals. We collected clinical information from medical records. Morphological and radiomics features were extracted from medical images. Each patient had at least one imaging follow-up. Predictive features are based on pre-rupture or pre-growth images. Univariate analysis, multivariate analysis and recursive feature elimination (RFE) algorithm were performed to select key features. We utilized ensemble learning algorithm to train models. Radiomics model, conventional model (based on clinical and morphological features) and combined model (based on radiomics, clinical and morphological features) were established and evaluated. RESULTS:646 patients with 840 aneurysms were included from Beijing Tiantan Hospital as internal dataset, 206 patients with 271 aneurysms were included from the other 6 hospitals as independent external validation set. 15 radiomics features, 6 morphological features, and 2 clinical features were selected to build models. The radiomics model, conventional model and combined model obtained an AUC of 0.85(0.77-0.94), 0.61(0.48-0.74) and 0.78(0.67-0.89) in external validation set, respectively. CONCLUSION:Radiomics features can be used to predict the stability of unruptured intracranial aneurysm (UIA). The combination of radiomics features and conventional features did not show the power to improve the predictive capability.

Abstract: BACKGROUND: The existing mouse model of ruptured intracranial aneurysm (IA) involves stereotactic injection of elastase into basal cistern. Cisterna magna (CM) injection is also a well-established and reliable drug delivery method. We propose a mouse model inducing IA rupture through injection of elastase into CM, combined with hypertension and carotid ligation. MATERIALS AND METHODS: Male C57/BL6 mice underwent injection of 2.5 µL bromophenol blue through stereotaxis or CM to assess the accuracy and stability of both methods. For aneurysm induction, left common carotid artery ligation was performed, and hypertension was induced. CM injection was performed using 2.5 or 5 µL of elastase. Mice with neurological symptoms or 3 weeks after modeling received bromophenol blue/gelatin perfusion to observe the formation and rupture of aneurysm. Hematoxylin and eosin, Masson, and immunohistochemical staining were performed to observe IA histopathological features. RESULTS: CM injection resulted in more stained arteries around the circle of Willis than stereotactic injection. 72.2% or 82.4% mice which received 2.5 or 5 µL of elastase through CM developed IAs, respectively. Rupture rates were 46.2% and 64.3%, respectively. The aneurysms exhibited histopathological features similar to those of humans, including absence of intimal endothelial cells, degradation of internal elastic lamina, infiltration of inflammatory cells, and loss of vascular smooth muscle cells. CONCLUSION: We propose a mouse model of IA that employs the injection of elastase into CM. The protocol provides a stable and efficient mouse model of ruptured IA.

Background:Delayed ischemic stroke (DIS) is a rare complication that may occur in patients with cerebral aneurysms treated with the Pipeline Embolization device (PED). This study aims to evaluate the characteristics of DIS following PED placement and to investigate the optimal duration of dual antiplatelet therapy (DAPT) in relation to the incidence of DIS. Methods:We conducted a multicenter retrospective cohort study on consecutive cases of intracranial aneurysms treated with PED. Patients were divided into two groups based on the timing of DAPT switching to monotherapy: early (<6 months) and late (≥6 months). To adjust for potential biases between the groups, inverse probability of treatment weighting (IPTW) was applied. Kaplan-Meier survival analysis and multivariate Cox regression were used to calculate cumulative DIS rates, and risk factors for DIS. Results:A total of 1,146 consecutive patients with 1,296 aneurysms were included, of whom 12 (0.96%) who received PED developed DIS. The late-switch group had a lower DIS rate compared to the early-switch group [0.5% (4 of 752 patients) vs. 2.0% (8 of 394 patients), p = 0.018], even after IPTW. Hypertension [hazard ratio (HR) 3.47, 95% CI: 1.045-11.552] and complete occlusion immediately post-procedure (HR 5.48, 95% CI: 3.048-9.868) were significant risk factors for DIS. Conclusion:DIS is a rare complication among patients treated with PED for cerebral aneurysms. Extending the duration of DAPT to at least six months may safer for the patients with hypertension and immediate complete occlusion.

INTRODUCTION:Endovascular treatment has become one of the standard therapies for intracranial aneurysms (IAs), yet the prognosis remains a persistent clinical challenge. This study aimed to systematically evaluate the efficacy and safety of adjuvant statin therapy following endovascular treatment (EVT) of IAs. METHODS:A systematic review and meta-analysis were conducted in accordance with the PRISMA guidelines. Cohort studies comparing outcomes between patients with IAs who received statin therapy following EVT and those who did not were included. Efficacy outcomes included retreatment, recurrence, and complete occlusion, whereas safety outcomes included ischemic stroke, intracerebral hemorrhage (ICH), thrombosis, and all-cause mortality. A random-effects model was applied, and subgroup and sensitivity analyses were performed on the basis of treatment modality and adjustment for confounding factors. RESULTS:Six retrospective studies comprising 3,692 patients were analyzed. Sensitivity analysis revealed that statin therapy significantly reduced the risk of retreatment (adjusted odds ratio [aOR] 0.35, 95% CI: 0.15-0.81) and recurrence (aOR 0.29, 95% CI: 0.12-0.65), whereas no significant difference was found in complete occlusion rates (aOR 0.94, 95% CI: 0.52-1.71). Although the unadjusted risk of ischemic stroke was greater in the statin group, this association was not significant after adjustment (aOR 1.04, 95% CI: 0.30-3.60). No significant differences were observed in other safety outcomes, including ICH, thrombosis, or all-cause mortality. CONCLUSION:Statins may help reduce the risk of recurrence and retreatment of IAs following EVT, suggesting their potential adjunctive role in the management of IAs and providing a rationale for conducting prospective investigations.

INTRODUCTION:Neuroendoscopy is gaining traction as a minimally invasive technique for the resection of cerebellar vermis tumors. This study investigates the effectiveness and clinical experience of neuroendoscopic surgery for cerebellar vermis tumor resection. METHODS:A retrospective analysis was conducted on the clinical data of 18 patients with cerebellar vermis tumors treated using the German STORZ neuroendoscope between January 2021 and January 2024 at the Department of Neurosurgery, Guizhou Provincial People's Hospital, and Guizhou Hospital of Shanghai Children's Center. The surgical outcomes, pathological diagnoses, postoperative complications, and follow-up results were analyzed. RESULTS:Of the 18 patients, total resection was achieved in 16 cases, subtotal resection in 1 case, and biopsy in 1 case. Postoperative pathology revealed 9 cases of medulloblastoma, 3 cases of ependymoma, and 5 cases of astrocytoma (2 WHO grade I, 2 grade II, and 1 grade III), along with 1 benign cerebellar lesion. Postoperative complications included malignant arrhythmia (1 case), cerebellar mutism (4 cases), and ataxia (13 cases). During the 1-36 months of follow-up, 2 patients developed communicating hydrocephalus, which improved following ventriculoperitoneal shunt placement. Recovery of cerebellar mutism occurred within an average of 21 days, while ataxia improved on average within 50 days. Tumor recurrence was observed in 3 patients. CONCLUSION:Neuroendoscopic resection of cerebellar vermis tumors, performed by skilled operators, provides effective surgical exposure and offers a viable alternative to traditional microscopy with satisfactory clinical outcomes.

Objective: This study elucidates the prognostic significance of perioperative changes in laboratory indicators for aneurysmal SAH and develops a nomogram model for outcome prediction. Methods: Aneurysmal SAH patients who received clipping or coiling at our institution between January 2016 and December 2022 were included. All patients were randomly assigned to derivation and validation cohorts. Independent predictors of unfavorable outcomes were identified by multivariate analyses. Three models were conducted to evaluate whether perioperative laboratory changes improve prediction performance. A nomogram including all independent predictors was developed in the derivation cohort and verified in both cohorts. Results: Diabetes mellitus [OR (95% CI) = 2.84 (1.44–5.59)], WFNS grade 3–5 [OR: (95% CI), 9.17 (5.49–15.33)], clipping [OR (95% CI) = 1.71 (1.03–2.85)], perioperative changes in white blood cell count [OR (95% CI) = 2.15 (1.17–3.96)], and concentrations of ALT [OR (95% CI) = 1.41 (1.04–1.91)], sodium [OR (95% CI) = 5.40 (3.01–9.71)], and glucose [OR (95% CI) = 2.18 (1.05–4.53)] were independent predictors of an unfavorable outcome. The predictive nomogram incorporated the aforementioned predictors and performed well in the derivation cohort (AUC, 0.839; 95% CI: 0.810–0.866) and the validation cohort (AUC, 0.797; 95% CI: 0.734–0.850). Conclusions: Perioperative changes in laboratory indicators can be predictors of unfavorable outcomes in aneurysmal SAH patients. The nomogram based on clinical and laboratory risk factors can be used as a convenient tool to facilitate individualized decision making.

For participants with intracranial aneurysm who underwent stent treatment, light transmission aggregation–guided antiplatelet therapy helped reduce ischemic events without increasing bleeding risks.

Background Vertebrobasilar dissecting aneurysms (VBDAs) are important causes of stroke. Aneurysm wall enhancement at vessel wall (VW) MRI is a marker of inflammation. Previous studies have shown that statins may reduce inflammation in intracranial saccular aneurysms, but their effect on VBDAs remains unknown. Purpose To evaluate the effect of 6-month atorvastatin treatment on VBDA wall enhancement on VW MRI scans. Materials and Methods Participants with unruptured VBDAs were enrolled in this open-label, randomized controlled trial from July 2021 to January 2023 and randomized 1:1 to the daily 20 mg atorvastatin group or control group. VBDAs were imaged with VW MRI at baseline and at the 6-month follow-up. The primary end point was the change in aneurysm wall enhancement measured by the quantitative wall enhancement index (WEI) and three-dimensional wall enhancement volume rate (WEVR). The secondary outcomes were changes in aneurysm size or morphology and inflammation-related circulating biomarkers. All outcome analyses were performed using appropriate tests for categorical and continuous variables. Results A total of 40 participants were included (mean age, 52 years ± 11 [SD]; 34 men). In the statin group, both the WEI and WEVR of the aneurysm wall decreased at 6 months compared with those at baseline. The change in WEI was -0.3 in the statin group but 0.1 in the control group (P < .001). Similarly, the change in WEVR was -15.1% in the statin group but 5.3% in the control group (P < .001). Additionally, the circulating plasma levels of C-reactive protein, tumor necrosis factor α, interleukin-6, and interleukin-1β improved in the atorvastatin group compared with the control group (all P < .05). The atorvastatin group also showed slowed progression of intramural hematoma (304.0 mm3 vs 100.3 mm3; P = .006). No change in aneurysm size was detected in both groups. Conclusion Atorvastatin use decreased VBDA wall enhancement on VW MRI scans compared with the control group. ClinicalTrials.gov Identifier: NCT04943783 © RSNA, 2025 Supplemental material is available for this article. See also the editorial by Mohajer and Chernyak in this issue.

BackgroundEchocardiography is a cornerstone in the clinical diagnosis of cardiovascular diseases, providing critical insights into cardiac structure and function. Over recent years, artificial intelligence (AI) has emerged as a transformative adjunct to traditional echocardiographic techniques, enhancing diagnostic accuracy through innovations such as automatic view labeling, advanced image segmentation, and predictive disease modeling. The objective of this study is to explore the current status and prevailing research trends in this field from 2009 to 2024 through bibliometric analysis and to forecast future developmental trajectories.MethodsWe selected the Science Citation Index Expanded (SCI-Expanded) from the Web of Science Core Collection (WOSCC) as our primary data source and conducted a comprehensive search encompassing all articles and reviews published between 2009 and 2024 and used the online analysis platform of bibliometrics, CiteSpace and VOSviewer software to analyze countries/regions, institutions, authors, keywords, and references, used Microsoft Excel 2021 to visualize the trends of the number of articles published by year.ResultsBetween 2009 and 2024, a total of 3,411 publications on AI applications in echocardiography were identified, including 3,000 articles (87.9%) and 411 reviews (12.1%), contributed by researchers from 100 countries/regions. China and the USA were the leading contributors in terms of publication volume. Notably, institutions such as Shanghai Jiaotong University demonstrated strong research productivity and international collaboration. Journal of the American College of Cardiology ranked among the most influential journals in this domain. Keyword analysis revealed that terms such as “artificial intelligence,” “machine learning,” “deep learning,” and “echocardiography” are central research hotspots, indicating emerging trends in the field and the potential to evolve into major areas of future investigation.ConclusionOver the past decade, the integration of AI with echocardiography has become increasingly sophisticated. This study highlights the critical contributions of AI applications in echocardiography to the progression of the field and offers valuable insights for researchers embarking on future investigations.

Neural recording and stimulation are fundamental techniques used for brain computer interfaces (BCIs). BCIs have significant potential for use in a range of brain disorders. However, for most BCIs, electrode implantation requires invasive craniotomy procedures, which have a risk of infection, hematoma, and immune responses. Such drawbacks may limit the extensive application of BCIs. There has been a rapid increase in the development of endovascular technologies and devices. Indeed, in a clinical trial, stent electrodes have been endovascularly implanted via a venous approach and provided an effective endovascular BCI to help disabled patients. Several authors have reviewed the use of endovascular recordings or endovascular BCIs. However, there is limited information on the use of trans-arterial BCIs. Herein, we reviewed the literature on the use of trans-arterial neural recording and stimulation for BCIs, and discuss their potential in terms of anatomical features, device innovations, and clinical applications. Although the use of trans-arterial recording and stimulation in the brain remains challenging, we believe it has high potential for both scientists and physicians.

New iatrogenic cerebral infarcts (NICIs) are common findings on diffusion-weighted magnetic resonance imaging (DWI) following stent placement for unruptured intracranial aneurysms (UIAs) and may contribute to cognitive decline (CD). Using posttreatment DWI and clinical features, we developed a deep learning radiomics nomogram (DLRN) to predict 1-year CD in NICI patients. In a multicenter cohort of 526 patients, CD rates at 1 year were 18.7% (47/251) in the training cohort, 19.8% (33/167) in the external validation cohort, and 20.4% (22/108) in the prospective cohort. The DLRN achieved excellent predictive performance with areas under the curve of 0.975, 0.942, and 0.841 for the respective cohorts. Calibration and decision curve analyses confirmed its reliability and clinical utility. This tool could facilitate early identification of high-risk patients, enabling timely and tailored interventions to protect cognitive function.

OBJECTIVE Pipeline embolization device (PED) placement for the treatment of intracranial aneurysms is safe and effective under general anesthesia (GA). However, GA is associated with certain risks, longer procedural time, and higher hospital cost. The authors aimed to compare clinical outcomes and hospital cost between GA and local anesthesia (LA) procedures in patients who underwent PED placement for intracranial aneurysm treatment. METHODS This retrospective study analyzed the charts of 216 patients with 223 intracranial aneurysms treated using the PED from June 2022 to March 2023. Cases were grouped according to type of anesthesia administered (LA or GA). Propensity score matching (PSM) was used to balance the groups to minimize confounding bias. RESULTS Eighty-four patients with 88 aneurysms were treated under LA, and 132 patients with 135 aneurysms were treated under GA. The complication rate and modified Rankin Scale score at 6 months were similar in both groups. Procedural time was significantly shorter with LA both before (87.47 ± 22.68 minutes vs 118.90 ± 46.80 minutes, p < 0.001) and after (84.75 ± 16.77 minutes vs 110.02 ± 38.56 minutes, p < 0.001) PSM. LA eliminates the need for postanesthesia recovery. Hospital cost was significantly lower in the LA group both before ($30,820.74 ± $3216.93 vs $32,846.62 ± $4731.50, p = 0.001) and after ($30,127.83 ± $2763.12 vs $33,874.41 ± $3163.56, p = 0.002) PSM. CONCLUSIONS PED placement under LA can achieve satisfactory outcomes similar to those of PED placement under GA; however, the use of LA reduces procedural time and hospital cost.

Background:Hemodynamic factors play an important role in aneurysm initiation, growth, rupture, and recurrence, while the mechanism of the hemodynamic characteristics is still controversial. A unique model of multiple aneurysms (initiation, growth, rupture, and recurrence) is helpful to avoids the confounders and further explore the possible hemodynamic mechanisms of aneurysm in different states.Methods:We present a model with multiple aneurysms, and including the states of initiation, growth, rupture, and recurrence, discuss the proposed mechanisms, and describe computational fluid dynamic model that was used to evaluate the likely hemodynamic effect of different states of the aneurysms.Results:The hemodynamic analysis suggests that high flow impingement and high WSS distribution at normal parent artery was found before aneurysmal initiation. The WSS distribution and flow velocity were decreased in the new sac after aneurysmal growth. Low WSS was the risk hemodynamic factor for aneurysmal rupture. High flow concentration region on the neck plane after coil embolization still marked in recanalized aneurysm.Conclusions:Associations have been identified between high flow impingement and aneurysm recanalization, while low WSS is linked to the rupture of aneurysms. High flow concentration and high WSS distribution at normal artery associated with aneurysm initiation and growth, while after growth, the high-risk hemodynamics of aneurysm rupture was occurred, which is low WSS at aneurysm dome.

BackgroundIn aneurysmal subarachnoid hemorrhage patients with multiple intracranial aneurysms (aSAH-MIA patients), the risk of secondary unruptured intracranial aneurysms is inconsistent. This study aimed to explore the risk of unruptured aneurysms in Chinese aSAH-MIA patients.MethodsThe medical records and angiographic images of aSAH-MIA patients from eight cerebrovascular centers in China were retrospectively reviewed and analyzed. Patients with a single unruptured intracranial aneurysm (UIA) and no prior aSAH were used as controls. Propensity score matching (PSM) was employed to balance the differences in age, gender, aneurysm size, aneurysm site, and follow-up duration between the two groups.ResultsThe study included 267 unruptured aneurysms from 204 aSAH-MIA patients and 769 single UIA. After PSM, 201 aneurysms were enrolled in the aSAH-MIA group and 201 aneurysms in the control group. The mean follow-up was 2.2 years. Thirty-four aneurysm instability events (28 growth and 6 rupture, 16.9%) occurred during follow-up in the aSAH-MIA group and 16 instability events (13 growth and 3 rupture, 8%) occurred in the control group. Risk factors for aneurysmal instability were aneurysm irregularity (OR 2.53; 95% CI 1.18 to 4.31), higher size ratio (OR 1.23; 95% CI 1.37 to 4.39), and middle cerebral artery location (OR 1.86; 95% CI 1.03 to 3.17). The risk of aneurysmal instability was substantially elevated in the aSAH-MIA group (HR 2.07; 95% CI 1.12 to 3.02).ConclusionsUnruptured aneurysms in Chinese aSAH-MIA patients exhibited higher risks of growth and rupture than in patients with a single UIA. Middle cerebral artery location, higher size ratio and irregular shape were associated with higher risk of growth or rupture.

Background Although flow diverter device (FDD) has brought revolutionized advances in endovascular treatment of intracranial aneurysms, it also presents considerable drawbacks as well, as the innovation for novel device has never stopped. This preclinical research aims to evaluate the safety and efficacy of a newly developed FDD, the EMBOPIPE, through in vivo and in vitro experiments. Methods Aneurysms were induced in 20 New Zealand white rabbits which were randomized to three follow-up groups according to the time elapsed after EMBOPIPE implantation (28, 90, and 180 days). Additional EMBOPIPEs were implanted in the abdominal aorta to cover the renal artery in nine rabbits. Angiography was performed immediately after device placement in all groups. Aneurysm occlusion, patency of renal arteries, and pathological outcomes were assessed. For the in vitro experiments, we measured the thrombogenic potential of EMBOPIPEs ( n = 5) compared with bare stents ( n = 5) using the Chandler loop model. Evaluation indicators were the platelet counts, macroscopic observations and scanning electron microscopy. Results EMBOPIPEs were successfully deployed in 19 of 20 rabbit aneurysms (95.0%). The rates of complete or near-complete aneurysm occlusion were 73.3%, 83.3%, and 100% in the 28-, 90-, and 180-day groups, respectively. All renal arteries covered by EMBOPIPEs remained patent, and the mean difference in renal artery diameter before and after the device placement in the three groups was 0.07 mm, 0.10 mm, and 0.10 mm, respectively ( p = 0.77). Renal pathology was normal in all cases. The pathological findings of the aneurysms were as follows: thickened and adequate neointimal coverage at the aneurysm neck, minimal inflammatory response, near-complete smooth muscle cell layer, and endothelialization along the device. In vitro experiments showed that the platelet counts were significantly higher in EMBOPIPE blood samples than in bare stent samples and that platelet adhesion to the device was lower in the EMBOPIPE stent struts compared with bare stent struts through macroscopic observations and scanning electron microscopy. Conclusions The EMBOPIPE can achieve high rates of aneurysm occlusion while maintaining excellent branch artery patency. It exhibited wonderful pathological results. This novel device with phosphorylcholine surface modification could reduce platelet thrombus attached to the stent struts.

Background: The use of artificial intelligence (AI) technology has been growing in the management of intracranial aneurysms (IAs). This study aims to conduct a bibliometric analysis of researches on intracranial aneurysm management with artificial intelligence technology (IAMWAIT) to gain insights into global research trends and potential future directions. Methods: A comprehensive search of articles and reviews related to IAMWAIT, published from January 1, 1900 to July 20, 2023, was conducted using the Web of Science Core Collection (WoWCC). Visualizations of the bibliometric analysis were generated utilizing WPS Office, Scimago Graphica, VOSviewer, CiteSpace, and R. Results: A total of 277 papers were included in the study. China emerged as the most prolific country in terms of publications, institutions, cooperating countries, and prolific authors. The United States garnered the highest number of total citations, institutions with the highest citations/H index, cooperating countries (n=9), and 3 of the top 10 cited papers. Both the total number of papers and the citation count exhibited a positive and significant correlation with the gross domestic product (GDP) of countries. The journal with the highest publication frequency was Frontiers in Neurology, while Stroke recorded the highest number of citations, H-index, and impact factor (IF). Areas of primary interest in IAMWAIT, leveraging AI hemodynamics, and laboratory research of IAs. Conclusions: IAMWAIT is an active area of research that has undergone rapid development in recent years. Future endeavors should focus on broader application of AI algorithms in various sub-fields of IAMWAIT to better suit the real world.

A significant number of valves constitute a vital component of the containment pressure boundary of a nuclear power plant, and their leakage rates under accident conditions must be tightly controlled. In this study, a methodology for the construction of a predictive model of valve leakage rate is put forth the study of valve leakage characteristics under accident conditions. Taking the double-offset butterfly valves (DOBV) as the research object, its multi-parameter leakage rate predictive model is developed through finite element analysis (FEA) of the microscopic and macroscopic contact mechanics of the sealing, that are then combined with an existing interfacial leakage model. This model is able to predict the effects of different parameters, including the temperature, pressure, and humidity. It is then verified by comparing it with the experimental values of the multi-operating conditions leakage test. Based on this model, the impact of operating condition parameters on the leakage rate of the valve is numerically studied and a dimensionless leakage rate relationship is proposed: Qr = EPETEm, where EP,ET,and Em are pressure, temperature, and humidity conversion factors, respectively. These factors are in a power function relationship with their respective dimensionless state parameters. Further analysis demonstrates that the powers of these relationships are independent of roughness and weakly correlated with seal material and seal structure. The leakage pattern of this valve under two hypothetical accident scenarios is comparatively analyzed by applying the conversion equation, and some useful conclusions related to dynamic leakage rate control are drawn. The methodology presented in this paper is central to the contact seal leakage mechanism and can be extended to other containment penetrations.

Background Both low-profile visualized intraluminal support (LVIS)stents and Pipeline flow diverters (FDs) are therapeutic strategies for basilar artery (BA) aneurysms, but they have not been directly compared.Methods A total of 132 consecutive patients with 139 BA aneurysms treated with either LVIS stent or Pipeline FDs were analyzed. Propensity score matching (PSM) was used to control for age, sex, hypertension, aneurysm size, shape, location, and duration of follow-up. The treatment results of these two braided stents were compared.Results LVIS stent was placed in 88 (63.3%) and Pipeline FDs in 51 (36.7%) procedures. Patients with Pipeline FDs tended to be younger and have less hypertension, whereas aneurysms had larger aneurysm size. After PSM, similar complete or near-complete occlusion rates (76.7% vs 73.3%, p = .766) and favorable functional outcomes (86.7% vs 90.0%, p = 1) were achieved in patients treated with LVIS stents and Pipeline FDs, respectively. Further comparisons were conducted at three different locations (basilar apex/basilar trunk/vertebrobasilar artery junction [VBJ]) separately, and the results showed a higher complete or near-complete aneurysm occlusion rate after Pipeline FD treatment than LVIS treatment (86.7% vs 59.2%, p = .012) only at VBJ, where a particularly high proportion of non-saccular shape (70.9%) and a male preponderance were noted.Conclusion Both braided stents were effective in the treatment of BA aneurysms, with good occlusion rates and favorable functional outcomes. Pipeline FD achieved a particularly higher aneurysm occlusion rate than LVIS stent at VBJ, where lesions often require reconstruction of the diseased vessel.