BACKGROUND:Approximately 25% of aneurysms treated with Pipeline remain incompletely occluded at 6 months. This study aimed to develop and externally validate a novel preoperative scoring system to predict the risk of incomplete occlusion. METHODS:This retrospective multicenter study developed a model using data from 588 patients (659 aneurysms) (PLUS study, 2014-2019). An external validation cohort consisted of 189 patients with 235 aneurysms from a single participating center (2020-2022). Feature selection was performed using the least absolute shrinkage and selection operator (LASSO) regression, followed by multivariable logistic regression modeling. Model performance was assessed by the Area Under the Curve (AUC), calibration, and bootstrap validation. A points-based Pre-scope score was derived and compared with the DIANES score (DeLong test; R software v4.2.0). RESULTS:Eight predictors were identified, including aneurysm diameter, stent diameter, stent-parent diameter ratio, branch artery involvement, coil assistance, aneurysm type, and location. The model shows good discriminative power with an AUC of 0.802 and good calibration. The model also provided good discrimination (AUC of 0.795) and good calibration in the validation cohort. After conversion into a points-based system, the Pre-scope score showed good discriminative ability, with AUCs of 0.775 and 0.794 in the training and validation cohorts, respectively. Compared with the DIANES score, this score has good discriminative ability (verification cohort AUC: 0.794 vs. 0.651, P ＜0.05). CONCLUSION:The Pre-scope score, based on a large multicenter dataset with independent temporal validation, is a practical preoperative tool with superior predictive ability. It may support individualized surgical strategies and improve patient outcomes.

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.

BackgroundDistal intracranial aneurysms are relatively rare in clinical practice and are characterized by distal location, smaller parent vessels, and fragile surrounding brain tissue, which are associated with a relatively higher risk of treatment-related complications such as ischemia and rebleeding. Traditional flow diverter stents have a thin tip, delivery wire can cause intraparenchymal hemorrhage or distal vessel perforation, particularly when attempting to navigate through complex, narrow, or fragile arteries. Therefore, the use of flow diverter devices in the treatment of distal intracranial aneurysms remains technically challenging. Flow diverter devices have been widely used for the treatment of wide-neck intracranial aneurysms; however, comparative data between the domestically developed Lattice device (Accu Medical, China) and the Pipeline Embolization Device remain limited. In this study, we compared the efficacy and safety of these two flow diverters in the treatment of unruptured distal intracranial aneurysms, based on scheduled postoperative imaging follow-up using computed tomography angiography (CTA) and digital subtraction angiography (DSA), focusing on aneurysm occlusion, complications, and branch vessel occlusion.MethodsThis retrospective study included 47 patients with distal intracranial aneurysms treated with flow diverter devices between January 2020 and July 2025, who underwent implantation of either the Lattice or Pipeline stent. All patients underwent imaging follow-up at 6 months postoperatively using either computed tomography angiography (CTA) or digital subtraction angiography (DSA). Inverse probability weighting (IPTW) was performed to balance baseline characteristics between the two groups. Baseline characteristics before and after IPTW are presented in Table 1. After adjusting for age, sex, hypertension, diabetes, preoperative mRS, aneurysm location, aneurysm morphology (saccular vs. fusiform), neck type (wide vs. narrow), maximum aneurysm diameter, neck size, dome-to-neck ratio, the inflow angle of the aneurysm (IFAA), branch vessel diameter, branch vessel origin, and mean parent vessel diameter, propensity scores were calculated for inverse probability of treatment weighting (IPTW). We applied 1/PS as a weight for the Lattice group and 1/(1 − PS) for the Pipeline group. Inverse probability weighting was applied, and logistic regression analysis was performed to identify factors potentially associated with aneurysm occlusion. Aneurysm healing was assessed using the OKM grading scale, with grades 0–2 defined as poor occlusion and grades 3–4 defined as favorable occlusion.ResultsCompared with the Pipeline group, no statistically significant differences were observed in aneurysm occlusion rates or branch vessel occlusion rates in the Lattice group at a median follow-up duration of 179 days (77.8% vs. 75.9%, p = 0.586). Among 18 patients treated with the Lattice device, 14 achieved favorable occlusion on follow-up imaging (14/18, 77.8%), whereas 22 of 29 patients treated with the Pipeline device demonstrated favorable occlusion (22/29, 75.9%). Branch vessel occlusion covered by the stent occurred in 3 patients in the Lattice group (3/18, 16.7%), which was slightly higher than that in the Pipeline group (2/29, 6.9%); however, this difference was not statistically significant (p = 0.317). Logistic regression analysis identified the IFAA as a potential factor associated with delayed or incomplete aneurysm healing. Specifically, for each 1-degree increase in this angle, the odds of aneurysm occlusion decreased by 3.5% (OR = 0.965, 95% CI: 0.933–0.998, p = 0.037). In addition, IPTW-adjusted univariate weighted logistic regression showed that larger aneurysm neck diameter (OR 0.685, 95% CI 0.505–0.929, p = 0.016), presence of branch vessel origin from aneurysms (OR 0.065, 95% CI 0.011–0.364, p = 0.003) were also associated with unfavorable OKM outcomes.ConclusionAfter IPTW adjustment, Lattice and Pipeline devices demonstrated comparable efficacy and safety in the treatment of distal cerebral aneurysms. Aneurysm geometric and anatomical factors, including the inflow angle (IFAA), aneurysm neck diameter and branch vessel origin, were independently associated with incomplete or delayed aneurysm occlusion.

Purpose This study systematically evaluated five deep learning models to validate their consistency in deriving clinical morphological and quantitative digital subtraction angiography (QDSA) hemodynamic biomarkers. Method In this dual-center retrospective study (2,777 images; 1,539 patients), five models—UNet, VNet, DeepLabV3, SwinUNet, and TransUNet—were trained on an internal cohort (n = 1,212; split 6:4) and validated on an external cohort (n = 327). Beyond Dice coefficients, a comprehensive framework assessed algorithmic robustness and clinical reliability in deriving morphology and QDSA parameters—specifically cerebral blood flow, cerebral blood volume, mean transit time, and time-to-peak—using the Intraclass Correlation Coefficient (ICC). Results TransUNet achieved the highest Dice scores internally (0.839) and externally (0.878), significantly outperforming other models (all P < 0.001). TransUNet delivered consistent performance across imaging systems and remained the top-performing model in preoperative, postoperative, and coil-treated scenarios. Regarding morphological assessment, TransUNet yielded high agreement for height, width, and max dome diameter (ICC > 0.95), but it uniquely achieved high reliability for neck width (ICC > 0.82 externally), whereas other models exhibited instability. Furthermore, TransUNet achieved superior hemodynamic consistency, with ICCs ranging from 0.774 to 0.961 across all preoperative and postoperative hemodynamic parameters. Conclusion TransUNet establishes a new benchmark for automated angiographic analysis by combining local precision with global context. Its capability to generate reliable functional and geometric biomarkers suggests high potential for real-time intraoperative guidance.

Background Flow diverters (FDs) are the first-line treatment of intracranial aneurysms (IAs). A groundbreaking mechanical balloon-based FD device was developed to enhance the precise landing and deployment efficiency for FDs. Objective To investigates the efficacy and safety of this innovative device in a prospective cohort. Methods This study was a prospective multicenter observational study conducted between September 2019 and November 2021. Patients diagnosed with unruptured IAs and treated with this innovative FD device alone were included. The immediate implantation success rate, the successful aneurysm occlusion rate (Raymond I-II or OKM C-D), the complete occlusion rate (Raymond I or OKM D), and the parent artery stenosis rate (>50%) at follow-up were evaluated as the evaluation index of efficacy. The mortality rate, adverse events (AEs), neurological AEs, and serious adverse events (SAEs) were evaluated as the evaluation index of safety. Results A total of 128 patients were included, and all of the FD deployments were successful (success rate reached 100%). At the 12-month mark, 91.4% (117/128) of patients achieved successful occlusion, 85.9% (110/128) achieved complete occlusion, and only 0.8% (1/128) exhibited parent artery stenosis >50% (without need for additional treatment). During the follow-up, there were no reported mortalities or cerebral hemorrhage, while 6 neurological adverse events (4.69%) and 4 SAEs (3.1%) were observed. Conclusions The mechanical balloon-based FD showed a remarkable occlusion rate alongside minimal ischemic and hemorrhagic adverse events compared with existing FDs. This innovative mechanical balloon-based design may be an important direction for future FD design.

BACKGROUND:New ischemic cerebral infarction (NICI) on diffusion-weighted imaging (DWI) is frequently observed after stent-assisted coiling. OBJECTIVE:To investigate whether preoperative statin use reduces NICI volume and whether the effect depends on baseline low-density lipoprotein cholesterol (LDL-C). METHODS:We retrospectively analyzed 490 patients with intracranial aneurysms who underwent stent-assisted treatment at multiple centers. Based on preoperative statin use, patients were classified into statin (n=269) and non-statin (n=221) groups. NICI volume was quantified on postoperative DWI. Multivariable linear regression was used to identify predictors of log-transformed NICI volume, including an interaction term between statin use and LDL-C >3.4 mmol/L. RESULTS:Median infarct volume was significantly lower in the statin group (1.39 (IQR 0.87-1.92)) than in the non-statin group (1.83 (IQR 1.48-2.47); P<0.001). After multivariable adjustment, statin use remained independently associated with smaller NICI volume (B = -0.382; 95% CI -0.488 to -0.277; P<0.001). Subgroup analysis showed consistent reductions in both statin+normal LDL-C and statin+high LDL-C subgroups (both P<0.001). No interaction was observed between statin use and LDL-C level (P=0.147), suggesting consistent protection regardless of lipid status. Smoking (B=0.407; P<0.001), higher body mass index (B=0.040; P<0.001), and female sex (B=0.130; P=0.033) were independent predictors of larger infarct volume. CONCLUSIONS:Preoperative statin therapy significantly reduced NICI volume after stent-assisted aneurysm treatment, independently of LDL-C, suggesting possible neurovascular protection through pleiotropic mechanisms beyond lipid lowering.

[This corrects the article DOI: 10.3389/fneur.2026.1851112.].

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.

ABSTRACT Background: Optimal postoperative blood pressure (BP) management remains unclear for hypertensive patients with aneurysmal subarachnoid hemorrhage (aSAH). We investigated associations of early postoperative BP levels, variability, and trajectories with 6 month outcomes. Methods: Consecutive hypertensive patients after aSAH surgery were retrospectively analyzed. BP was measured four times daily for 3 days. Profiles included minimum systolic BP (SBP), mean arterial pressure, variability, and SBP trajectories. Minimum SBP was dichotomized at 140 mmHg to examine threshold effects. Multivariable logistic regression assessed associations between BP metrics and functional outcome. Causal mediation analysis evaluated the indirect effect of delayed cerebral ischemia (DCI) on the association between minimum SBP (140 mmHg cutoff) and outcome. Results: Among 702 patients, lower SBP in the first 3 days independently predicted poor outcomes (OR = 0.98). Maintaining SBP 140 mmHg was linked to lower risks of unfavorable outcomes (OR = 0.44) and DCI (OR = 0.49). Mediation analysis indicated 35% of this effect was explained by reduced DCI. Higher BP variability, measured by standard deviation and coefficient of variation, correlated with poor outcomes. Trajectory analysis showed that moderately rising SBP (140 mmHg) was associated with the favorable outcomes. Conclusions: Maintaining SBP 140 mmHg with stable variability in the early postoperative period was associated with favorable functional outcomes, partly through reducing DCI. These findings highlight the importance of adequately elevated and stable BP management after aSAH surgery. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial This study is retrospective and therefore not required to be registered in a clinical trial registry. ### Funding Statement This study was supported by the National Natural Science Foundation of China (grant number 82201435, 82372058). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was conducted at Beijing Tiantan Hospital, between January 2016 and December 2022, with ethical approval (KY 2023-261-01). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes To protect patient privacy, the data from this study cannot be shared at this time.

Background:Flow diverter (FD) treatment has shown promising results in managing intracranial aneurysms (IAs), achieving high rates of complete occlusion. However, in cases involving branch incorporation, incomplete occlusion remains a challenge, adversely influencing long-term treatment outcomes. The mechanisms underlying the incomplete occlusion in IAs with branch incorporation have not been fully clarified. Therefore, the objective of this study was to assess the value of quantitative digital subtraction angiography (QDSA) in predicting incomplete occlusion of IAs with branch incorporation following FD treatment. Methods:We retrospectively analyzed data from 111 patients with 113 IAs involving incorporated branches who were treated with FDs between January 2016 and December 2022. IAs were divided into incomplete occlusion (n=52) and complete occlusion (n=61) groups based on follow-up digital subtraction angiography (DSA). Clinical, morphological, and angiographic parametric imaging (API) variables were analyzed. We employed univariate followed by multivariate logistic regression to identify the independent risk factors, while areas under the curve (AUCs) were used to assess the predictive performance of the significant variables. A subgroup analysis examined the effect of FD plus coiling and API variables, with Benjamini-Hochberg (BH) correction applied for multiple comparisons. Results:Multivariate analysis identified three independent predictors of incomplete occlusion: posterior circulation aneurysms [odds ratio (OR) =2.729, 95% confidence interval (CI): 1.153-6.460; P=0.022], branch diameter (OR =2.802, 95% CI: 1.288-6.097; P=0.009), and aneurysm cerebral blood flow (CBF) (OR =10.829, 95% CI: 2.243-52.273; P=0.003). AUCs for the combined model, aneurysm CBF, branch diameter, and posterior circulation aneurysms were 0.766, 0.695, 0.678, and 0.646, respectively. In the FD-alone subgroup, posterior circulation aneurysms (P=0.032), branch diameter (P=0.018), and branch mean transit time (MTT) (P=0.011) were significant prior to BH correction, while in the subgroup treated with FD plus coiling, aneurysm CBF (P=0.046) was the only variable that reached significance before correction. However, following BH correction, none of variables remained statistically significant (adjusted P value >0.05). Conclusions:Posterior circulation aneurysms, branch diameter, and aneurysm CBF are independent risk factors for incomplete occlusion in IAs with branch incorporation following FD treatment.

Objectives:There remains a conspicuous absence of systematic analysis concerning the risk factors for the development of ischemic complications in the interventional treatment of IAs. Our study aimed to identify the risk factors for ischemic complications after the interventional treatment of IAs and to make an individualized prediction of the occurrence of ischemic complications, providing important reference guidance for clinicians. Methods:This study encompassed a sample of 473 patients diagnosed with intracranial aneurysms (IA) and treated at our center between February 2022 and April 2024. Ischemic complications were identified via clinical symptomatology and corroborated with diagnostic subtraction angiography (DSA), computed tomography (CT), or magnetic resonance imaging (MRI). We used a machine learning (ML) approach to screen potential variables for ischemic complications and identify correlations between them, and subsequently constructed a logistic regression model to quantify these correlations. Results:Patients were categorized based on the occurrence or absence of ischemic complications. A total of five potential factors were screened using LASSO regression, XGBoost, and Randomforest algorithms: hypertension, history of alcohol consumption, multiple IAs, rupture status, and antiplatelet agent. Multivariate analysis further disclosed that hypertension, history of alcohol consumption, ruptured aneurysms, and antiplatelet agent were independent risk factors for postoperative ischemic complications. The predictive model, derived from the multivariate regression analysis results, demonstrated robust reliability. Conclusions:Hypertension, history of alcohol consumption, ruptured aneurysms, and antiplatelet agent as independent risk factors for ischemic complications following the interventional treatment of IAs. Accordingly, we constructed the first risk prediction model regarding ischemic complications of all IAs based on these factors, aiming to enhance prognostic judgment and treatment strategy planning.

This study aimed to identify predictive factors for incomplete occlusion in posterior communicating artery (PCoA) aneurysms after endovascular treatment (EVT) and investigate the role of fetal-type posterior cerebral artery (fPCA) in occlusion outcomes using quantitative digital subtraction angiography (QDSA). We analyzed 287 patients with 292 PCoA aneurysms treated with EVT between 2016 and 2022. Aneurysms were categorized into incomplete (n = 49) and complete (n = 243) occlusion groups based on follow-up DSA. Clinical, morphological, and hemodynamic parameters from QDSA were compared, and independent risk factors were identified via multivariate logistic regression. Predictive performance was evaluated using area under the curve (AUC) and subgroup analysis with Benjamini-Hochberg correction for fPCA effects. Independent risk factors for incomplete occlusion included size (p < 0.001, OR = 1.127), neck cerebral blood flow (CBF) (p = 0.001, OR = 4.024), simple coiling (p < 0.001, OR = 4.635), ruptured status (p = 0.002, OR = 3.281), and fPCA (p = 0.030, OR = 2.218). AUCs for the combined model, size, neck CBF, simple coiling, ruptured status, and fPCA were 0.822, 0.721, 0.708, 0.656, and 0.603, respectively. In the fPCA subgroup, ruptured status, neck CBF, neck cerebral blood volume (CBV), PCoA CBF, and PCoA CBV showed significance, while in the non-fPCA subgroup, only simple coiling and size remained significant. Size, neck CBF, simple coiling, ruptured status, and fPCA are independent risk factors for incomplete occlusion in PCoA aneurysms treated with EVT. fPCA likely influences incomplete occlusion through hemodynamic changes.

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.

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.

Pediatric patients with intracranial aneurysms face high risks of spontaneous subarachnoid hemorrhages. Despite its approval for adults aged 22 and above, the Pipeline Embolization Device (PED, Covidien/Medtronic, Irvine, California, USA) is being considered for younger patients due to its efficacy. This study aims to assess the safety and effectiveness of using PEDs in pediatric aneurysm treatment. A retrospective study across 14 institutions identified 25 patients (age ≤ 18) treated with PED from November 2014 to October 2019. A literature review included all published pediatric aneurysm cases treated with PED from 2007 to 2023. Analyzed data included patient demographics, aneurysm characteristics, treatment, clinical outcomes, and complications. We analyzed 81 pediatric patients, including 25 from the multi-center registry and 56 from 38 relevant literature. In the entire cohort of 81 patients, mean age of the patients was 11.9 ± 4.0 years (ranged from 9 months to 18 years), with 58.0

RATIONALE AND OBJECTIVES:To develop machine-learning (ML) models incorporating angiographic parametric imaging (API)-derived parameters in predicting persistent incomplete occlusion of intracranial aneurysms (IAs) after flow diverter (FD) treatment. MATERIALS AND METHODS:We analyzed 763 patients with 834 FD-treated IAs, split into training (n=583) and test (n=251) sets. The training set was further subdivided into incomplete (n=96) and complete occlusion (n=487) groups according to O'Kelly-Marotta grading. We developed six ML models using clinical, morphological, and API-derived features identified via univariate analysis. We assessed model performance using the area under the curve (AUC), accuracy, and calibration curves. We used Shapley additive explanation (SHAP) analysis to highlight key predictive features and subgroup analysis with Benjamini-Hochberg correction to examine the impact of FD plus coiling. RESULTS:The Random Forest model outperformed all other models in predicting persistent incomplete occlusion after FD treatment (AUC=0.803 and accuracy=0.833 in the test set). SHAP analysis identified cerebral blood flow (CBF) ratio, radiomics scores (Radscore), incorporated branches, age, hypertension, and FD plus coiling as critical predictors. Multiple factors were significant in the FD-alone subgroup, whereas only recurrent aneurysms, higher CBF ratio, and elevated Radscore remained significant in the FD-plus-coiling subgroup. A CBF ratio cutoff of 0.49 was identified for IAs treated with FD plus coiling. CONCLUSION:ML models that integrate clinical, morphological, and API-derived features effectively predict persistent incomplete occlusion after FD treatment. Key predictors included CBF ratio, Radscore, incorporated branches, age, hypertension, and FD plus coiling.

Background: The risk of intracranial aneurysms (IAs) is increased in individuals with depression and anxiety. This indicates that depression and anxiety may contribute to the development of physical disorders. Herein, to investigate the association between genetic variants related to depression and anxiety and the risk of IA, twosample Mendelian randomization was performed. Methods: The genome-wide association study (GWAS) comprised genome-wide genotype data of 2248 clinically well -characterized patients with anxiety and 7992 ethnically matched controls from four European countries. Sex -specific summary -level outcome data were obtained from the GWAS of IA, including 23 cohorts with a total of 10,754 cases and 306,882 controls of European and East Asian ancestry. To improve validity, five varying Mendelian randomization techniques were used in the analysis, namely Mendelian randomization-Egger, weighted median, inverse variance weighted, simple mode, and weighted mode. Results: The inverse variance weighted results indicated the causal effect of depression on IA (P = 0.03, OR = 1.32 [95 % CI, 1.03-1.70]) and unruptured IA (UIA) (P = 0.02, OR = 1.68 [95 % CI, 1.08-2.61]). However, the causal relationship between depression and subarachnoid hemorrhage (SAH) was not found (P = 0.16). We identified 43 anxiety -associated single -nucleotide polymorphisms as genetic instruments and found no causal relationship between anxiety and IA, UIA, and SAH. Limitations: Potential pleiotropy, possible weak instruments, and low statistical power limited our findings. Conclusion: Our MR study suggested a possible causal effect of depression on the increased risk of UIAs. Future research is required to investigate whether rational intervention in depression treatment can help to decrease the societal burden of IAs.

To evaluate the prevalence and predictors of ischemic lesions on thin–slice DWI (2 mm) in endovascular treatments for unruptured intracranial aneurysms (UIA), particularly explore the potential relationship with pathway plaques. Participants eligible for endovascular treatments with UIA at a national stroke center between March 2023 and August 2023 were prospectively enrolled. All participants performed thin–slice DWI (slice thickness of 2 mm) before and after procedures. Three-dimensional joint intra-and extracranial vessel wall MRI (3D-vwMRI, voxel size 0.6 × 0.6 × 0.6 mm3) was scheduled to evaluate the pathway plaques for all participants. The DWI-positive numbers were ordered and divided into four equal parts, with each quartile representing 25