New developments in diagnosis and treatment of intracranial aneurysms

This thesis is based on two pillars: imaging with state-of-the-art 3D angiography and endovascular therapy with the new Woven EndoBridge intrasaccular flow-diverter.

3D Rotational Angiography
CT and CT angiography for cerebral aneurysms have limited spatial resolution and with 2D angiography, only a limited number of projections can be made. With the introduction of 3D angiography, a new modality with high resolution and an infinite number of projections became available. In this thesis, we evaluate the impact of 3D angiography on the diagnosis of aneurysms and other vascular disorders and variations in patients with SAH. With (suspected) aneurysms, 3D angiography was performed of all cerebral vessels, mostly under general anesthesia preceding endovascular treatment. These data were used to assess the clinical value of CT angiography in patients with SAH and to evaluate the prevalence and locations of fenestrations of intracranial arteries and the possible relation of fenestrations with aneurysms. Finally, hospital demographics of patients with SAH were assessed.

The Woven EndoBridge
The endovascular treatment of wide-necked intracranial aneurysms remains a technical challenge. Conventional techniques such as balloon- or stent assistance and intravascular flow-diverters have several disadvantages such as catheterization difficulties and the need for longstanding dual antiplatelet medication. The new intrasaccular flow-diverter Woven EndoBridge (WEB) was developed for single-step endovascular treatment of wide-necked aneurysms without the need for antiplatelet medication. Clinical and imaging results were collected and used for studies of ruptured and unruptured aneurysms treated with the WEB in relation to previous results, including a systematic review and meta-analysis.