HEAL is an innovative, non-eluting surface modification technology that consists of a fibrin mesh with bound heparin. This unique combination mimics the last step of haemostasis, leading to anti-thrombogenic, anti-inflammatory and endothelialisation-promoting properties, creating the potential to quickly occlude aneurysms and reduce complications associated with endovascular treatment.

Flow diverters with anti-thrombogenic coatings resulted in significantly lower activation of coagulation (TAT) and platelets (β-TG) and lower adhesion of platelets compared with the uncoated DERIVO 2 flow diverter. There were no significant differences between the coated flow diverters in terms of TAT and β-TG levels, as well as platelet adhesion. However, significantly lower activation of the complement system (SC5b-9 and C5a) was observed for the DERIVO 2heal flow diverter in comparison with the Pipeline Flex Shield and the p64 MW HPC flow diverters emphasizing the improved hemocompatibility of the fibrin/heparin-coated DERIVO 2heal flow diverter.

# Summary This clinical case study examines the complex management challenges of a patient with newly diagnosed atrial fibrillation who experienced hemorrhagic transformation following acute ischemic stroke, subsequently developing early recurrent large vessel occlusion. The case highlights the critical dilemma clinicians face when balancing thromboembolic prevention against hemorrhage risk in anticoagulation-naive patients with concurrent cardioembolic disease and intracranial bleeding complications. The patient underwent initial mechanical thrombectomy for acute stroke treatment; however, following hemorrhagic transformation of the infarct, a recurrent large vessel occlusion developed within days of the initial event. The case underscores the profound challenges in determining optimal anticoagulation timing and the potential role of repeat mechanical thrombectomy in managing recurrent thromboembolism in patients with recently diagnosed atrial fibrillation complicated by intracranial hemorrhage. This presentation illuminates critical gaps in clinical guidelines for managing such rare but severe clinical scenarios, emphasizing the need for individualized risk stratification and interdisciplinary decision-making to optimize patient outcomes while minimizing iatrogenic complications.

This case report presents a clinical analysis of a giant cervical internal carotid artery aneurysm and its associated complications. The study examines the pathophysiology, diagnostic imaging characteristics, and treatment considerations for this rare but serious vascular condition affecting the internal carotid artery in the neck region. Giant aneurysms of the cervical internal carotid artery present significant clinical challenges due to their propensity for rupture, thromboembolism, and mass effect on adjacent neural structures. The article documents the clinical presentation, radiological findings, and management strategies employed in addressing this complex case. The research emphasizes the importance of accurate diagnosis through advanced imaging techniques and careful patient evaluation to determine appropriate therapeutic interventions. Understanding the natural history and complications of giant cervical internal carotid artery aneurysms is critical for clinicians, as these lesions carry substantial morbidity and mortality risks. This case contributes valuable clinical insights into the recognition and management of this uncommon but potentially life-threatening vascular pathology, informing best practices for patient care and surgical decision-making in similar presentations.

In recent years, flow diverting devices have become an effective alternative to conventional treatments of intracranial aneurysms. Understanding FDS’s effectiveness in inducing aneurysm occlusion may be fundamental for treatment planning. To achieve this aim, a computational investigation of the hemodynamics of a patient-specific intracranial aneurysm reconstructed from medical images and virtually treated with FDS was performed. The FDS porosity was taken into account as it plays a crucial role in the effectiveness of the device. This parameter affects the stent’s ability to redirect blood flow away from the aneurysm into the parent artery. A low porosity is desirable, but if the porosity is too low, the stent might become too rigid for deployment. Two possible post-operative conditions were simulated, with the deployment of flow diverter stents differing in porosity. A comparison of the devices in modifying cerebral aneurysm hemodynamics was analyzed. The flow diverter stents were virtually implanted in the parent vessel harboring the aneurysm, with the devices covering the entire neck area. The placement of the devices determined a substantial reduction in flow recirculation and velocity magnitude inside the aneurysm. A reduction of the TAWSS values and an increase in the OSI and ECAP values were found. In particular, the relative residence time RRT on the aneurysmal wall markedly increased, indicating blood flow stagnation in the dome and thrombogenic conditions for the aneurysm occlusion.

Researchers at Ming Wang Shu Wan Brain Center in China conducted a comprehensive analysis of flow diverter (FD) technology for treating complex intracranial aneurysms, including blister-like, dissecting, fusiform, and large or small wide-neck saccular variants. A systematic review by Maimaitiaili et al. examined ten retrospective studies from four databases through July 2025, focusing on adults with small aneurysms (≤10 mm) receiving FD treatment. Results demonstrated that flow diverters achieved an 86% pooled complete or near-complete occlusion rate with favorable safety profiles, including low treatment-related mortality, hemorrhagic events, and ischemic complications, alongside a 9% overall complication rate. Nearly 98% of patients achieved favorable functional outcomes. The analysis also examined stent-assisted embolization complicated by thromboembolic events, utilizing the VerifyNow™ assay to measure platelet reactivity through P2Y12 Reaction Units and Aspirin Reaction Units. These findings suggest flow diverters represent a viable therapeutic option for complex aneurysms refractory to conventional approaches, though large-scale comparative trials remain necessary for comprehensive validation and clinical implementation guidance.

Endovascular thrombectomy has emerged as a critical intervention for acute ischemic stroke, representing a significant advancement in stroke treatment protocols. This procedure involves the mechanical removal of blood clots from cerebral vessels using specialized catheter-based devices, restoring blood flow to affected brain tissue. The technique addresses a major clinical challenge: time-sensitive intervention is essential to minimize neurological damage and improve patient outcomes. Multiple landmark clinical trials have demonstrated that endovascular thrombectomy, particularly when combined with intravenous thrombolysis, substantially improves functional recovery compared to medical management alone. Key benefits include reduced disability rates and improved long-term neurological outcomes in eligible patients. The procedure's success depends on factors including time from symptom onset, clot location, and patient selection criteria. Despite its efficacy, endovascular thrombectomy requires specialized infrastructure, trained neurointerventional teams, and rapid patient transport to comprehensive stroke centers. This intervention has fundamentally transformed acute stroke management, establishing mechanical thrombectomy as a cornerstone therapy for large vessel occlusions. Widespread adoption continues to expand access to this life-saving treatment, though geographic and resource limitations remain challenges in some regions.

Giant cerebral aneurysms (GCAs), defined as those measuring 25 millimeters or larger in diameter, represent a rare but clinically serious subset of cerebral aneurysms, comprising approximately 2–5% of all cases. These lesions predominantly affect older adults with a female predominance and are associated with disproportionately high morbidity and mortality rates, with annual rupture risk exceeding 6% and untreated cases showing mortality rates reaching 65% within two years. Key rupture predictors include aneurysm size, irregular morphology, anterior communicating artery location, smoking status, and younger age. Posterior circulation GCAs demonstrate approximately 50% five-year cumulative rupture rates compared to 40% in anterior circulation. Contemporary treatment approaches have shifted from traditional microsurgical options toward neuroendovascular techniques, with flow diversion and parent artery occlusion now serving as primary treatment modalities. These techniques enable personalized, anatomy-specific management for complex aneurysms not amenable to vessel-preserving strategies. Treatment planning must comprehensively assess aneurysm morphology, wall characteristics including thrombosis and calcification, collateral circulation, and stability indicators such as perianeurysmal edema and mural enhancement patterns.

Galaxy Therapeutics has obtained CE mark approval from the European Medical Device Regulation for its Seal embolization system, following assessment by German notified body DQS Medizinprodukte. This milestone enables commercialization across the European Economic Area and validates compliance with EU requirements for quality management, safety, and clinical performance. The company now plans phased market introduction across selected European territories while pursuing FDA premarket approval in the United States. The Seal system represents a novel intrasaccular approach designed for endovascular treatment of ruptured and unruptured wide-neck intracranial aneurysms, developed to simplify complex aneurysm procedures across diverse anatomies. Developed through years of clinical investigation including the rapid-enrolling SEAL IT investigational device exemption trial in the US, the technology addresses significant physician challenges in treating complex cerebral aneurysms. CEO Sam Zaidat characterized the approval as Galaxy's most significant achievement, emphasizing that it delivers innovative treatment options to European physicians and patients seeking alternatives for managing complex brain aneurysms.

Cerebral aneurysms pose significant health risks, with undetected cases at risk of progressive expansion and potentially fatal rupture. Researchers demonstrated the capability of Magnetic Particle Imaging (MPI) to monitor blood flow in aneurysms with millisecond temporal resolution using patient-specific CT data and artificial artery phantoms. The study compared MPI measurements in untreated aneurysm models with those containing flow diverter stents, which are an established endovascular treatment designed to redirect blood away from the aneurysm and promote clot formation. MPI employs magnetic nanoparticles as tracers to track bolus movement through vascular structures with exceptional temporal and spatial precision. The results reveal MPI's promising potential for detecting and quantifying hemodynamic changes in both untreated and treated aneurysms, offering valuable insights for future clinical applications. This advancement addresses a critical need in aneurysm management by enabling detailed assessment of treatment efficacy, particularly for flow diverter stent placement, potentially improving patient outcomes through better visualization of blood flow dynamics.

Basilar apex aneurysms represent a significant proportion of posterior circulation aneurysms, and their management has evolved considerably from traditional surgical approaches. This retrospective single-center study evaluated laser-cut stent-assisted coil embolization (SACE) for treating basilar apex aneurysms in 43 consecutive patients, both ruptured and unruptured, between September 2019 and April 2023. The analysis examined procedural outcomes using Enterprise and Atlas stent types deployed in either single-stent or Y-configuration based on operator discretion. Results demonstrated a 100 percent procedural success rate, with immediate post-operative angiography revealing complete occlusion in 81.4 percent of cases and neck remnant in 18.6 percent. The periprocedural complication rate was 9.3 percent, including two thromboembolic events and one fatal brain herniation. At three months, 88.1 percent of surviving patients achieved favorable clinical outcomes with modified Rankin Scale scores of two or less. Six-month follow-up angiography confirmed sustained complete occlusion in 97.3 percent of cases. These findings support laser-cut SACE as an effective minimally invasive alternative to traditional surgical approaches for basilar apex aneurysms, offering high procedural success with favorable early clinical and angiographic outcomes.

Acute stroke treatment has undergone a dramatic transformation from primarily supportive care to cutting-edge interventional procedures. While the 1996 FDA approval of intravenous tPA represented a significant breakthrough in clot-busting medication, it came with substantial limitations for patients with large vessel occlusions. Mechanical thrombectomy has revolutionized stroke management by offering a minimally invasive, image-guided endovascular procedure that physically extracts blood clots from cerebral arteries rather than waiting for medication to dissolve them. This complex surgical intervention, pioneered at specialized centers like Liv Hospital Stroke Center, has fundamentally altered outcomes for severe ischemic strokes, which represent approximately 87 percent of all cerebrovascular events. By directly removing thrombi responsible for blocking oxygen and nutrient supply to brain tissue, mechanical thrombectomy reverses neurological damage, restores patient function, and prevents the permanent disability or death that previously characterized large vessel occlusion cases. This advancement represents one of modern medicine's most powerful interventions, enabling endovascular surgeons to restore mobility, speech, and quality of life in patients once considered beyond treatment.

Intracranial atherosclerotic stenosis (ICAS) is one of the most common causes of stroke worldwide, accounting for 8% to 10% of strokes in North America and 30% to 50% of strokes in Asia.1-5 The current recommended strategy for stroke prevention in patients with ICAS is standard medical therapy.6 In recent years, standard medical therapy has substantially reduced stroke recurrence in patients with ICAS.4,7,8 However, a subset of patients are at a high risk for stroke recurrence despite medical treatment.9,10 For instance, patients with border zone infarcts and impaired collaterals in the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial had a 37% 1-year stroke recurrence rate.11

In this work, a finite element–based modeling framework for the mechanical simulation of braided neurovascular FDs has been developed. The approach combines a geometrically exact Simo–Reissner beam formulation with a comprehensive contact treatment to capture the interactions between the wires of a FD and its contact interaction with a MC. A parametric description of interwoven braided FDs was introduced, enabling the generation of different braiding patterns in a geometrically consistent manner. Beam-to-beam contact was utilized to ensure kinematic consistency of the braided structure, while the frictionless beam-to-surface contact allows realistic interaction with surrounding tubular structures such as MC s or crimping devices.

Based on the available retrospective evidence, FDS treatment represents a technically feasible salvage option for post-SAC recurrent aneurysms with an acceptable complication profile in experienced centers; however, conclusions about superiority over alternative retreatment strategies and its role as the preferred modality are premature in the absence of prospective comparative data. Meticulous microwire navigation, appropriate FDS sizing, and rigorous dual antiplatelet therapy management may be essential for optimal outcomes.

FD for branch-incorporated aneurysms demonstrated a low aneurysm occlusion rate in the short- to intermediate-term (6–12 months). However, long-term occlusion rates were comparable with those reported in the literature. In 23% of patients, the incorporated branches were occluded along with the aneurysm; none of these resulted in a permanent neurologic deficit.

Flow diverters have drastically changed the landscape of intracranial aneurysm treatment and are now considered first-line therapy for select lesions. Their mechanism of action relies on intrinsic alteration in hemodynamic parameters, both at the parent artery and within the aneurysm sac. Moreover, the device struts act as a nidus for endothelial cell growth across the aneurysm neck ultimately leading to aneurysm exclusion from the circulation. In silico computational analyses and investigations in preclinical animal models have provided valuable insights into the underlying biological basis for flow diverter therapy. Here, we review the present understanding pertaining to flow diverter biology and mechanisms of action, focusing on stent design, induction of intra-aneurysmal thrombosis, endothelialization, and alterations in hemodynamics.

Galaxy Therapeutics has received CE Mark approval for its SEAL embolization system under the European Medical Device Regulation. The device is intended for the endovascular treatment of ruptured and unruptured wide-neck intracranial aneurysms measuring 2 to 19 mm. The company plans a phased commercial launch in Europe while its FDA premarket approval application remains under review.

Mechanical thrombectomy represents a landmark advancement in acute ischemic stroke treatment, physically removing clots from large brain arteries to restore blood flow far more effectively than clot-dissolving drugs alone. When major intracranial arteries like the middle cerebral or internal carotid artery are blocked, approximately two million neurons die each minute, making speed critical in stroke care. Two primary techniques dominate the field: stent retrievers, which are self-expanding mesh devices deployed through a microcatheter to capture and withdraw clots, and aspiration-first approaches that use large-bore catheters to suction clots directly. Landmark 2015 trials established mechanical thrombectomy as standard care for eligible large-vessel occlusion patients, with subsequent studies expanding time windows for treatment. The techniques are frequently combined using the Solumbra method when single approaches fail to achieve first-pass reperfusion. Devices like INVAMED's KinG stent retriever and DOVI aspiration catheter exemplify current technology. Success depends critically on achieving rapid arterial access from the groin or wrist through the aortic arch to reach occluded vessels, with treatment windows now extending beyond initial expectations for appropriately selected patients.

Ruptured saccular (berry) aneurysms usually result in subarachnoid hemorrhage (SAH) but can, depending on the location of the rupture and presence of adhesions to the aneurysm, also result in cerebral hematoma, subdural hematoma, and/or intraventricular hemorrhage.