PURPOSE Endovascular treatment (EVT) of acute ischemic stroke caused by large-vessel occlusion (AIS-LVO) over 24 h of onset remains controversial. This study was to explore the safety and efficacy of EVT for patients with AIS-LVO between 24 and 72 h of symptom onset after rigorous imaging evaluation. METHODS Patients with AIS-LVO treated with EVT were retrospectively enrolled and divided into two groups according to the time from symptom onset to groin puncture: 64 in the over-time group (>24 h) and 257 in the within-time group (≤24 h). Outcomes included 3-month modified Rankin Scale (mRS) score, functional independence (defined as mRS 0-2), successful cerebral reperfusion, symptomatic intracranial hemorrhage (sICH), and 3-month mortality. RESULTS Patients in the over-time group had no significant differences in the functional independence (40.6% vs 42.5%, odds ratio or OR 0.91, 95% confidence interval or CI 0.52-1.60, p = 0.753), successful reperfusion (96.7% vs 95.8%, OR 0.76, 95% CI 0.36-1.59, p = 0.467), sICH (8.3% vs 6.7%, OR 1.20, 95% CI 0.42-3.38, p = 0.735), 3-month mortality (13.3% vs 10.8%, OR 1.17, 95% CI 0.51-2.70, p = 0.716) compared with patients in the within-time group. After matching adjustment, the results did not change significantly. CONCLUSIONS The safety and effectiveness of EVT treatment for selected AIS-LVO patients with symptom onset of 24-72 h are not inferior to those treated within 6-24 h of onset, especially in a short term based on the pre-treatment advanced neuroimaging computed tomography perfusion even though further investigations are necessary to prove this finding.
目的大血管闭塞（AIS-LVO）引起的急性缺血性卒中（发病超过 24 小时）的血管内治疗（EVT）仍存在争议。方法回顾性入组接受EVT治疗的AIS-LVO患者，根据从症状出现到腹股沟穿刺的时间分为两组：超时组（>24 h）64例，限时组（≤24 h）257例。结果包括3个月的改良Rankin量表（mRS）评分、功能独立性（定义为mRS 0-2）、成功的脑再灌注、症状性颅内出血（sICH）和3个月的死亡率。91, 95% confidence interval or CI 0.52-1.60, p = 0.753）、再灌注成功率（96.7% vs 95.8%，OR 0.76, 95% CI 0.36-1.59，p = 0.467）、sICH（8.3% vs 6.7%，OR 1.20，95% CI 0.42-3.38，p = 0.735）、3 个月死亡率（13.3% vs 10.8%，OR 1.17，95% CI 0.51-2.70，p = 0.716）。结论：根据治疗前的高级神经影像学计算机断层扫描灌注情况，EVT 治疗的安全性和有效性并不比在发病后 6-24 小时内接受治疗的患者差，尤其是在短期内，但这一结论还需要进一步的研究来证明。
{"title":"Safety and efficacy of endovascular treatment for acute ischemic stroke of large-vessel occlusion beyond the time window based on imaging evaluation.","authors":"Shi-Dun Chen, Cheng-Bao Yang, Yong-Xiang Wang, Yue-Han Yin, B. Gao, Chun-Guang Chen","doi":"10.1177/15910199241250081","DOIUrl":"https://doi.org/10.1177/15910199241250081","url":null,"abstract":"PURPOSE\u0000Endovascular treatment (EVT) of acute ischemic stroke caused by large-vessel occlusion (AIS-LVO) over 24 h of onset remains controversial. This study was to explore the safety and efficacy of EVT for patients with AIS-LVO between 24 and 72 h of symptom onset after rigorous imaging evaluation.\u0000\u0000\u0000METHODS\u0000Patients with AIS-LVO treated with EVT were retrospectively enrolled and divided into two groups according to the time from symptom onset to groin puncture: 64 in the over-time group (>24 h) and 257 in the within-time group (≤24 h). Outcomes included 3-month modified Rankin Scale (mRS) score, functional independence (defined as mRS 0-2), successful cerebral reperfusion, symptomatic intracranial hemorrhage (sICH), and 3-month mortality.\u0000\u0000\u0000RESULTS\u0000Patients in the over-time group had no significant differences in the functional independence (40.6% vs 42.5%, odds ratio or OR 0.91, 95% confidence interval or CI 0.52-1.60, p = 0.753), successful reperfusion (96.7% vs 95.8%, OR 0.76, 95% CI 0.36-1.59, p = 0.467), sICH (8.3% vs 6.7%, OR 1.20, 95% CI 0.42-3.38, p = 0.735), 3-month mortality (13.3% vs 10.8%, OR 1.17, 95% CI 0.51-2.70, p = 0.716) compared with patients in the within-time group. After matching adjustment, the results did not change significantly.\u0000\u0000\u0000CONCLUSIONS\u0000The safety and effectiveness of EVT treatment for selected AIS-LVO patients with symptom onset of 24-72 h are not inferior to those treated within 6-24 h of onset, especially in a short term based on the pre-treatment advanced neuroimaging computed tomography perfusion even though further investigations are necessary to prove this finding.","PeriodicalId":126264,"journal":{"name":"Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences","volume":"1 7","pages":"15910199241250081"},"PeriodicalIF":0.0,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140652664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-26DOI: 10.1177/15910199241249508
Ryoo Yamamoto, Yuko Amano, Naoya Kamimura, K. Amari, S. Miyake, Yasunobu Nakai, Ken Johkura
PURPOSE Tandem occlusion, in which the intracranial artery is obstructed along with proximal carotid occlusive or stenotic lesions, occurs in 10-15% of patients with large vessel occlusion. Our study introduces a novel technique for tandem occlusion treatment that involves the simultaneous coaxial deployment of a percutaneous transluminal angioplasty balloon and aspiration catheters with the delivery wire of a stent retriever. After percutaneous transluminal angioplasty of the carotid lesion with a thin balloon catheter, the aspiration catheter was advanced over the balloon to eliminate the ledge between the catheter tip and delivery wire. After balloon removal, intracranial thrombectomy was performed using an aspiration catheter and stent retriever. This study aimed to evaluate the safety and efficacy of this approach. MATERIALS AND METHODS Medical records of patients with acute stroke due to tandem occlusion treated using our technique were analyzed for its effectiveness and safety. The puncture-to-recanalization time, modified thrombolysis in cerebral infarction (mTICI) grade, functional prognosis and incidence of hyperperfusion were assessed. RESULTS Seven patients were included in this study. In all patients, mTICI 2b-3 recanalization was achieved after smooth delivery of the aspiration catheter from the carotid lesion to the intracranial thrombus. The median puncture-to-recanalization time was 52 min. Ninety days post-stroke onset, six of seven patients had a modified Rankin Scale score of 0-2, and none of the patients had perioperative hyperperfusion syndrome. CONCLUSION Our technique allows simultaneous treatment of carotid and intracranial lesions, leading to faster recanalization. Furthermore, percutaneous transluminal angioplasty with a thin balloon may reduce the risk of hyperperfusion.
{"title":"Coaxial Method of PTA Balloon and Aspiration catheter using the delivery wire of a stent retriever for tandem occlusion: CoMBAt tandem occlusion.","authors":"Ryoo Yamamoto, Yuko Amano, Naoya Kamimura, K. Amari, S. Miyake, Yasunobu Nakai, Ken Johkura","doi":"10.1177/15910199241249508","DOIUrl":"https://doi.org/10.1177/15910199241249508","url":null,"abstract":"PURPOSE\u0000Tandem occlusion, in which the intracranial artery is obstructed along with proximal carotid occlusive or stenotic lesions, occurs in 10-15% of patients with large vessel occlusion. Our study introduces a novel technique for tandem occlusion treatment that involves the simultaneous coaxial deployment of a percutaneous transluminal angioplasty balloon and aspiration catheters with the delivery wire of a stent retriever. After percutaneous transluminal angioplasty of the carotid lesion with a thin balloon catheter, the aspiration catheter was advanced over the balloon to eliminate the ledge between the catheter tip and delivery wire. After balloon removal, intracranial thrombectomy was performed using an aspiration catheter and stent retriever. This study aimed to evaluate the safety and efficacy of this approach.\u0000\u0000\u0000MATERIALS AND METHODS\u0000Medical records of patients with acute stroke due to tandem occlusion treated using our technique were analyzed for its effectiveness and safety. The puncture-to-recanalization time, modified thrombolysis in cerebral infarction (mTICI) grade, functional prognosis and incidence of hyperperfusion were assessed.\u0000\u0000\u0000RESULTS\u0000Seven patients were included in this study. In all patients, mTICI 2b-3 recanalization was achieved after smooth delivery of the aspiration catheter from the carotid lesion to the intracranial thrombus. The median puncture-to-recanalization time was 52 min. Ninety days post-stroke onset, six of seven patients had a modified Rankin Scale score of 0-2, and none of the patients had perioperative hyperperfusion syndrome.\u0000\u0000\u0000CONCLUSION\u0000Our technique allows simultaneous treatment of carotid and intracranial lesions, leading to faster recanalization. Furthermore, percutaneous transluminal angioplasty with a thin balloon may reduce the risk of hyperperfusion.","PeriodicalId":126264,"journal":{"name":"Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences","volume":"11 32","pages":"15910199241249508"},"PeriodicalIF":0.0,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140652368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-23DOI: 10.1177/15910199241246018
L. Goertz, H. Styczen, E. Siebert, Yan Li, Marc Schlamann, Michael Forsting, Georg Bohner, C. Deuschl, C. Kabbasch
OBJECTIVE The flow re-direction endoluminal device (FRED) is a safe and effective treatment option for intracranial aneurysms. The novel FRED X features an antithrombotic surface coating ("X Technology") on an otherwise unmodified stent design. This two-center study evaluates the clinical safety and efficacy of FRED X and compares it to the literature. METHODS Consecutive patients treated between 2020 and 2023 were retrospectively reviewed for aneurysm characteristics, procedural details and complications, and angiographic outcomes. A mini-review of the literature for FRED X clinical trials was performed and results were pooled using a random effects model. RESULTS Thirty-four patients (mean age 56 years) were treated for 34 aneurysms. The mean aneurysm size was 7.7 ± 5.0 mm, 7 (21%) were ruptured, 6 (18%) were recurrent after previous treatment, 11 (32.3%) were located in the posterior circulation, and 4 (12.5%) had non-saccular morphology. All procedures were technically successful and no balloon angioplasty was required. There was 1 (2.9%) symptomatic complication (a transient ischemic attack) and no procedural morbidity or mortality. Technical asymptomatic events included 1 procedural stent occlusion that was reopened with thrombectomy and 3 cases of vasospasm. Complete and adequate occlusion rates were 68% (19/28) and 89% (25/28) at a mean follow-up time of 6 months, respectively. The results of this study are comparable to previous FRED X studies. CONCLUSIONS The results demonstrate a high feasibility and procedural safety of the FRED X with adequate mid-term occlusion rates. Long-term and comparative studies are needed to evaluate the full potential of the FRED X.
目的：血流再定向腔内装置（FRED）是治疗颅内动脉瘤的一种安全有效的方法。新颖的 FRED X 采用了抗血栓形成表面涂层（"X 技术"），并采用了未经改良的支架设计。这项双中心研究评估了 FRED X 的临床安全性和有效性，并将其与文献进行了比较。方法对 2020 年至 2023 年间接受治疗的连续患者进行了回顾性研究，以了解动脉瘤特征、手术细节和并发症以及血管造影结果。结果34名患者（平均年龄56岁）接受了34个动脉瘤的治疗。动脉瘤的平均大小为 7.7 ± 5.0 毫米，7 个（21%）破裂，6 个（18%）在之前的治疗后复发，11 个（32.3%）位于后循环，4 个（12.5%）形态为非囊状。所有手术在技术上都很成功，无需进行球囊血管成形术。有1例（2.9%）出现症状性并发症（短暂性脑缺血发作），没有出现程序性发病或死亡。技术性无症状事件包括 1 例通过血栓切除术重新开通的手术支架闭塞和 3 例血管痉挛。在平均 6 个月的随访中，完全和充分闭塞率分别为 68%（19/28）和 89%（25/28）。结论：研究结果表明，FRED X 具有高度的可行性和程序安全性，并有足够的中期闭塞率。要评估 FRED X 的全部潜力，还需要进行长期的比较研究。
{"title":"FRED X flow diverter for the treatment of intracranial aneurysms: Two-center experience and mini-review of the literature.","authors":"L. Goertz, H. Styczen, E. Siebert, Yan Li, Marc Schlamann, Michael Forsting, Georg Bohner, C. Deuschl, C. Kabbasch","doi":"10.1177/15910199241246018","DOIUrl":"https://doi.org/10.1177/15910199241246018","url":null,"abstract":"OBJECTIVE\u0000The flow re-direction endoluminal device (FRED) is a safe and effective treatment option for intracranial aneurysms. The novel FRED X features an antithrombotic surface coating (\"X Technology\") on an otherwise unmodified stent design. This two-center study evaluates the clinical safety and efficacy of FRED X and compares it to the literature.\u0000\u0000\u0000METHODS\u0000Consecutive patients treated between 2020 and 2023 were retrospectively reviewed for aneurysm characteristics, procedural details and complications, and angiographic outcomes. A mini-review of the literature for FRED X clinical trials was performed and results were pooled using a random effects model.\u0000\u0000\u0000RESULTS\u0000Thirty-four patients (mean age 56 years) were treated for 34 aneurysms. The mean aneurysm size was 7.7 ± 5.0 mm, 7 (21%) were ruptured, 6 (18%) were recurrent after previous treatment, 11 (32.3%) were located in the posterior circulation, and 4 (12.5%) had non-saccular morphology. All procedures were technically successful and no balloon angioplasty was required. There was 1 (2.9%) symptomatic complication (a transient ischemic attack) and no procedural morbidity or mortality. Technical asymptomatic events included 1 procedural stent occlusion that was reopened with thrombectomy and 3 cases of vasospasm. Complete and adequate occlusion rates were 68% (19/28) and 89% (25/28) at a mean follow-up time of 6 months, respectively. The results of this study are comparable to previous FRED X studies.\u0000\u0000\u0000CONCLUSIONS\u0000The results demonstrate a high feasibility and procedural safety of the FRED X with adequate mid-term occlusion rates. Long-term and comparative studies are needed to evaluate the full potential of the FRED X.","PeriodicalId":126264,"journal":{"name":"Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences","volume":"44 21","pages":"15910199241246018"},"PeriodicalIF":0.0,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140667075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-23DOI: 10.1177/15910199241249211
Ameer E Hassan, Ahmed M Shoman, Samantha E Miller, A. Hagrass, Sohum K. Desai, Hamzah M Saei, W. Tekle
BACKGROUND First-line treatment for symptomatic intracranial atherosclerotic disease (ICAD) is medical management; however, interventional approaches are increasingly considered for refractory disease. The Resolute Onyx in TIA management (ROTIA) study is a post-market evaluation of the Resolute Onyx (R-Onyx) drug-eluting stent in the treatment of recurrent transient ischemic attacks (TIAs) due to refractory ICAD (off-label use). METHODS This is a single-center, retrospective case series of consecutive patients who underwent angioplasty and stenting with R-Onyx for treatment of recurrent TIAs due to refractory ICAD from October 2019 to November 2022. Included patients were ages 22-80, had a baseline modified Rankin Scale of ≤2, and had recurrent TIAs attributed to intracranial artery stenosis >70% despite maximal medical therapy. Primary outcomes of interest were peri-procedural complications (TIA, stroke, intracranial hemorrhage, mortality) up to 72 h post-stenting and ischemic stroke up to 18 months post-stenting. RESULTS Twenty patients (mean age 66.84 ± 14; 25% female; 80% Hispanic) were included. A total of 21 stents were successfully deployed with no peri-procedural complications. There were no recurrent ischemic events at 30 days post-stenting. At 18 months post-stenting, there were no ischemic events and no patient exhibited in-stent restenosis. CONCLUSION ROTIA demonstrates the feasibility of using the Resolute Onyx drug-eluting stent for the management of TIAs due to refractory ICAD, with high technical success and low peri-procedural complications. Limitations include the retrospective and single-center nature of this study. Future prospective, multi-center, randomized trials with extended observation periods are needed.
{"title":"The resolute Onyx in TIA management (ROTIA).","authors":"Ameer E Hassan, Ahmed M Shoman, Samantha E Miller, A. Hagrass, Sohum K. Desai, Hamzah M Saei, W. Tekle","doi":"10.1177/15910199241249211","DOIUrl":"https://doi.org/10.1177/15910199241249211","url":null,"abstract":"BACKGROUND\u0000First-line treatment for symptomatic intracranial atherosclerotic disease (ICAD) is medical management; however, interventional approaches are increasingly considered for refractory disease. The Resolute Onyx in TIA management (ROTIA) study is a post-market evaluation of the Resolute Onyx (R-Onyx) drug-eluting stent in the treatment of recurrent transient ischemic attacks (TIAs) due to refractory ICAD (off-label use).\u0000\u0000\u0000METHODS\u0000This is a single-center, retrospective case series of consecutive patients who underwent angioplasty and stenting with R-Onyx for treatment of recurrent TIAs due to refractory ICAD from October 2019 to November 2022. Included patients were ages 22-80, had a baseline modified Rankin Scale of ≤2, and had recurrent TIAs attributed to intracranial artery stenosis >70% despite maximal medical therapy. Primary outcomes of interest were peri-procedural complications (TIA, stroke, intracranial hemorrhage, mortality) up to 72 h post-stenting and ischemic stroke up to 18 months post-stenting.\u0000\u0000\u0000RESULTS\u0000Twenty patients (mean age 66.84 ± 14; 25% female; 80% Hispanic) were included. A total of 21 stents were successfully deployed with no peri-procedural complications. There were no recurrent ischemic events at 30 days post-stenting. At 18 months post-stenting, there were no ischemic events and no patient exhibited in-stent restenosis.\u0000\u0000\u0000CONCLUSION\u0000ROTIA demonstrates the feasibility of using the Resolute Onyx drug-eluting stent for the management of TIAs due to refractory ICAD, with high technical success and low peri-procedural complications. Limitations include the retrospective and single-center nature of this study. Future prospective, multi-center, randomized trials with extended observation periods are needed.","PeriodicalId":126264,"journal":{"name":"Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences","volume":"6 11","pages":"15910199241249211"},"PeriodicalIF":0.0,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140671790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-23DOI: 10.1177/15910199241247698
F. Cagnazzo, Anne Ducros, Gaetano Risi, Mahmoud Charif, L. Corti, Francesca Rapido, Emmanuelle Le Bars, Nicolas Lonjon, V. Costalat
BACKGROUND Transvenous embolization is a recent treatment strategy for cerebrospinal fluid-venous fistulas (CSFVF), which are associated with spontaneous intracranial hypotension (SIH). METHODS Participants were selected from a prospective database on patients with CSFVF that received transvenous Onyx embolization. All patients underwent a brain magnetic resonance imaging (MRI) before and after embolization with MRI follow-up performed at least 3 months after treatment. Clinical and MRI results after treatment were described. RESULTS Twenty-one consecutive patients (median age 63 years, IQR = 58-71; females: 15/21 = 71.5%) with 30 CSFVF were included. Most lesions were situated between T9 and L1 (19/30 = 63%), 70% were right-sided, and 38% of the patients had multiples fistulas. Embolization was successful in all cases. The mean MRI SIH score before and after treatment was 6 (±2.5) and 1.4 (±1.6), respectively (p < 0.0001). Twenty patients (90%) experienced improvement of their initial condition, of which 67% reported complete clinical recovery. The mean HIT-6 score decreased from 67 (±15) to 38 (±9) (p < 0.0001), the mean amount of monthly headache days from 23.5 (±10) and 3.2 (±6.6) (p < 0.0001), the visual assessment scale (VAS) for headache severity from 8 (±1.9) to 1.2 (±2) (p < 0.0001), and the mean VAS for perception quality of life improved from 2.6 (±2.5) to 8.6 (±1.8) (p < 0.0001). There were no major complications. The suspected rebound headache rate after treatment was 33%. CONCLUSION Transvenous embolization of CSFVF allowed high rates of clinical improvement with no morbidity related to the treatment.
{"title":"Safety and efficacy of transvenous embolization of cerebrospinal fluid-venous fistula in patients with spontaneous intracranial hypotension.","authors":"F. Cagnazzo, Anne Ducros, Gaetano Risi, Mahmoud Charif, L. Corti, Francesca Rapido, Emmanuelle Le Bars, Nicolas Lonjon, V. Costalat","doi":"10.1177/15910199241247698","DOIUrl":"https://doi.org/10.1177/15910199241247698","url":null,"abstract":"BACKGROUND\u0000Transvenous embolization is a recent treatment strategy for cerebrospinal fluid-venous fistulas (CSFVF), which are associated with spontaneous intracranial hypotension (SIH).\u0000\u0000\u0000METHODS\u0000Participants were selected from a prospective database on patients with CSFVF that received transvenous Onyx embolization. All patients underwent a brain magnetic resonance imaging (MRI) before and after embolization with MRI follow-up performed at least 3 months after treatment. Clinical and MRI results after treatment were described.\u0000\u0000\u0000RESULTS\u0000Twenty-one consecutive patients (median age 63 years, IQR = 58-71; females: 15/21 = 71.5%) with 30 CSFVF were included. Most lesions were situated between T9 and L1 (19/30 = 63%), 70% were right-sided, and 38% of the patients had multiples fistulas. Embolization was successful in all cases. The mean MRI SIH score before and after treatment was 6 (±2.5) and 1.4 (±1.6), respectively (p < 0.0001). Twenty patients (90%) experienced improvement of their initial condition, of which 67% reported complete clinical recovery. The mean HIT-6 score decreased from 67 (±15) to 38 (±9) (p < 0.0001), the mean amount of monthly headache days from 23.5 (±10) and 3.2 (±6.6) (p < 0.0001), the visual assessment scale (VAS) for headache severity from 8 (±1.9) to 1.2 (±2) (p < 0.0001), and the mean VAS for perception quality of life improved from 2.6 (±2.5) to 8.6 (±1.8) (p < 0.0001). There were no major complications. The suspected rebound headache rate after treatment was 33%.\u0000\u0000\u0000CONCLUSION\u0000Transvenous embolization of CSFVF allowed high rates of clinical improvement with no morbidity related to the treatment.","PeriodicalId":126264,"journal":{"name":"Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences","volume":"79 4","pages":"15910199241247698"},"PeriodicalIF":0.0,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140667898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-26DOI: 10.1177/15910199221133863
J. Vidovich, S. Voleti, Bin Zhang, Cody Stephens, Aakanksha Sriwastwa, Yasmin N. Aziz, Brendan Corcoran, V. Khandwala, Eva A. Mistry, P. Khatri, Lily L. Wang, A. Vagal
BACKGROUND AND PURPOSE Recent endovascular trials have spurred a paradigm shift toward routine use of CT perfusion (CTP) for decision-making in acute ischemic stroke. CTP use in the late window, however, remains under evaluation. Our objective was to assess the accuracy of CTP-predicted core in the late window. METHODS In a retrospective review of our prospectively identified stroke registry at a single, comprehensive stroke center, we included patients with anterior large vessel occlusions presenting within the 6-24 h window who underwent baseline CTP evaluation and achieved TICI2b or TICI3 reperfusion on endovascular treatment. We recorded baseline CTP-predicted core volumes at relative cerebral blood flow (CBF) thresholds of <30% <34%, and <38% using RAPID software. Final infarct volumes (FIV) were calculated using follow up MRI and CT, obtained within 72 h after stroke onset. RESULTS Of the eligible patients, 134 met our inclusion criteria. Mean FIV was 39.5 (SD 49.6). Median CTP to reperfusion time was 93.5 min. Median absolute differences between CTP-predicted core and FIV were 14.7, 14.9, and 16.0 ml at <30%, <34%, and <38%, respectively. Correlation between CTP-predicted ischemic cores and FIV was moderate and statistically significant at all thresholds: r = 0.43 (p <0.001), r = 0.43 (p <0.001), and r = 0.42 (p <0.001) at the <30%, <34%, and <38% cutoffs, respectively. CONCLUSION CTP cores in the 6-24 h period underestimate FIV, especially with larger infarcts. CTP-predicted core volumes in the late window show moderate positive correlation with FIV.
{"title":"Accuracy of CT perfusion-predicted core in the late window.","authors":"J. Vidovich, S. Voleti, Bin Zhang, Cody Stephens, Aakanksha Sriwastwa, Yasmin N. Aziz, Brendan Corcoran, V. Khandwala, Eva A. Mistry, P. Khatri, Lily L. Wang, A. Vagal","doi":"10.1177/15910199221133863","DOIUrl":"https://doi.org/10.1177/15910199221133863","url":null,"abstract":"BACKGROUND AND PURPOSE\u0000Recent endovascular trials have spurred a paradigm shift toward routine use of CT perfusion (CTP) for decision-making in acute ischemic stroke. CTP use in the late window, however, remains under evaluation. Our objective was to assess the accuracy of CTP-predicted core in the late window.\u0000\u0000\u0000METHODS\u0000In a retrospective review of our prospectively identified stroke registry at a single, comprehensive stroke center, we included patients with anterior large vessel occlusions presenting within the 6-24 h window who underwent baseline CTP evaluation and achieved TICI2b or TICI3 reperfusion on endovascular treatment. We recorded baseline CTP-predicted core volumes at relative cerebral blood flow (CBF) thresholds of <30% <34%, and <38% using RAPID software. Final infarct volumes (FIV) were calculated using follow up MRI and CT, obtained within 72 h after stroke onset.\u0000\u0000\u0000RESULTS\u0000Of the eligible patients, 134 met our inclusion criteria. Mean FIV was 39.5 (SD 49.6). Median CTP to reperfusion time was 93.5 min. Median absolute differences between CTP-predicted core and FIV were 14.7, 14.9, and 16.0 ml at <30%, <34%, and <38%, respectively. Correlation between CTP-predicted ischemic cores and FIV was moderate and statistically significant at all thresholds: r = 0.43 (p <0.001), r = 0.43 (p <0.001), and r = 0.42 (p <0.001) at the <30%, <34%, and <38% cutoffs, respectively.\u0000\u0000\u0000CONCLUSION\u0000CTP cores in the 6-24 h period underestimate FIV, especially with larger infarcts. CTP-predicted core volumes in the late window show moderate positive correlation with FIV.","PeriodicalId":126264,"journal":{"name":"Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences","volume":"80 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129280863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-26DOI: 10.1177/15910199221135308
Motoyuki Umekawa, S. Koizumi, Kenta Ohara, Daiichiro Ishigami, S. Miyawaki, N. Saito
BACKGROUND The transradial artery approach to cerebral angiography can reduce both patient stress following examination and the risk of major complications due to hematoma. Recently, the distal radial artery approach (DRA) has garnered attention in cardiology as a minimally invasive method. DRA is also considered applicable to neurosurgery, although concerns about procedural difficulty and complications persist. Therefore, this study aimed to evaluate the efficacy of the DRA in cerebral angiography and neuroendovascular treatment. METHODS We retrospectively selected 30 consecutive patients for whom the DRA was attempted for cerebral angiography at our hospital. The patients' age, sex, height, weight, and medical history information was collected and correlated with successful puncture and complications. The diameter of the distal radial artery (RA) was measured using ultrasonography. RESULTS The median patient age was 67 years (range, 32-87 years) and 21 (70%) were men. The median diameter of the distal RA was 2.3 mm (range, 1.7-3.2 mm). Distal RA puncture was successful in 23 patients (77%) and no complications were noted; however there was no significant correlation between successful puncture and any of the patient factors. Carotid artery stenting and preoperative tumor embolization were performed via DRA in six and three cases, respectively. Although puncture site hematoma occurred in only one case, all treatments were successful, and no major complications were observed. CONCLUSION DRA can be safely used for cerebral angiography and neuroendovascular treatment.
{"title":"Distal radial artery approach is safe and effective for cerebral angiography and neuroendovascular treatment: A single-center experience with ultrasonographic measurement.","authors":"Motoyuki Umekawa, S. Koizumi, Kenta Ohara, Daiichiro Ishigami, S. Miyawaki, N. Saito","doi":"10.1177/15910199221135308","DOIUrl":"https://doi.org/10.1177/15910199221135308","url":null,"abstract":"BACKGROUND\u0000The transradial artery approach to cerebral angiography can reduce both patient stress following examination and the risk of major complications due to hematoma. Recently, the distal radial artery approach (DRA) has garnered attention in cardiology as a minimally invasive method. DRA is also considered applicable to neurosurgery, although concerns about procedural difficulty and complications persist. Therefore, this study aimed to evaluate the efficacy of the DRA in cerebral angiography and neuroendovascular treatment.\u0000\u0000\u0000METHODS\u0000We retrospectively selected 30 consecutive patients for whom the DRA was attempted for cerebral angiography at our hospital. The patients' age, sex, height, weight, and medical history information was collected and correlated with successful puncture and complications. The diameter of the distal radial artery (RA) was measured using ultrasonography.\u0000\u0000\u0000RESULTS\u0000The median patient age was 67 years (range, 32-87 years) and 21 (70%) were men. The median diameter of the distal RA was 2.3 mm (range, 1.7-3.2 mm). Distal RA puncture was successful in 23 patients (77%) and no complications were noted; however there was no significant correlation between successful puncture and any of the patient factors. Carotid artery stenting and preoperative tumor embolization were performed via DRA in six and three cases, respectively. Although puncture site hematoma occurred in only one case, all treatments were successful, and no major complications were observed.\u0000\u0000\u0000CONCLUSION\u0000DRA can be safely used for cerebral angiography and neuroendovascular treatment.","PeriodicalId":126264,"journal":{"name":"Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117260367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-26DOI: 10.1177/15910199221134307
Mohamed Elfil, E. Bahbah, Ahmed Bayoumi, M. Aladawi, Mohamed Eldokmak, M. Salem, P. Aboutaleb, Brian Villafuerte-Trisolini, F. Al‐Mufti, S. Ortega‐Gutierrez, Marco A Gonzalez-Castellon
BACKGROUND Mechanical thrombectomy (MT) is the standard treatment for acute large vessel occlusion (LVO). Recurrent LVO can still occur in patients who already underwent MT for the first LVO. This study aimed to evaluate the efficacy of repeating MT for recurrent LVO. METHODS This meta-analysis of the available literature was conducted to summarize the current evidence regarding repeated MT outcomes in patients with recurrent LVO. All studies with ≥ 1 outcomes of interest were included. The Newcastle-Ottawa Scale (NOS) was used for risk of bias assessment. RESULTS Twenty studies, 10 observational (n = 21,251 patients) and 10 case reports (n = 10 patients), were included. 266 patients (62.78% females) with recurrent LVO were identified, with an overall prevalence of 1.6% and a mean age of 65.67 ± 16.23 years. Cardio-embolism was the most common mechanism in both times, with a median of 15 days between the first and second LVOs. Compared with pre-intervention, the first and second MTs significantly reduced the National Institute of Health Stroke Scale (NIHSS) score, (mean difference (MD) = -8.91) and (MD = -5.97) respectively, with a significant difference (p = 0.001). The rate of favorable outcome (modified Rankin scale (mRS) score 0-3) was 82.6% and 59.2% after the first and second MTs respectively, with a significant difference (p < 0.001). CONCLUSION In properly selected recurrent LVO patients, repeated MT is efficacious and safe. A prior MT procedure should not discourage aggressive treatment as many patients may achieve favorable outcomes.
{"title":"Repeated mechanical thrombectomy for recurrent large vessel occlusion: A systematic review and meta-analysis.","authors":"Mohamed Elfil, E. Bahbah, Ahmed Bayoumi, M. Aladawi, Mohamed Eldokmak, M. Salem, P. Aboutaleb, Brian Villafuerte-Trisolini, F. Al‐Mufti, S. Ortega‐Gutierrez, Marco A Gonzalez-Castellon","doi":"10.1177/15910199221134307","DOIUrl":"https://doi.org/10.1177/15910199221134307","url":null,"abstract":"BACKGROUND\u0000Mechanical thrombectomy (MT) is the standard treatment for acute large vessel occlusion (LVO). Recurrent LVO can still occur in patients who already underwent MT for the first LVO. This study aimed to evaluate the efficacy of repeating MT for recurrent LVO.\u0000\u0000\u0000METHODS\u0000This meta-analysis of the available literature was conducted to summarize the current evidence regarding repeated MT outcomes in patients with recurrent LVO. All studies with ≥ 1 outcomes of interest were included. The Newcastle-Ottawa Scale (NOS) was used for risk of bias assessment.\u0000\u0000\u0000RESULTS\u0000Twenty studies, 10 observational (n = 21,251 patients) and 10 case reports (n = 10 patients), were included. 266 patients (62.78% females) with recurrent LVO were identified, with an overall prevalence of 1.6% and a mean age of 65.67 ± 16.23 years. Cardio-embolism was the most common mechanism in both times, with a median of 15 days between the first and second LVOs. Compared with pre-intervention, the first and second MTs significantly reduced the National Institute of Health Stroke Scale (NIHSS) score, (mean difference (MD) = -8.91) and (MD = -5.97) respectively, with a significant difference (p = 0.001). The rate of favorable outcome (modified Rankin scale (mRS) score 0-3) was 82.6% and 59.2% after the first and second MTs respectively, with a significant difference (p < 0.001).\u0000\u0000\u0000CONCLUSION\u0000In properly selected recurrent LVO patients, repeated MT is efficacious and safe. A prior MT procedure should not discourage aggressive treatment as many patients may achieve favorable outcomes.","PeriodicalId":126264,"journal":{"name":"Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130866533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-26DOI: 10.1177/15910199221135289
H. Kobeissi, S. Ghozy, Trey Seymour, C. Bilgin, R. Kadirvel, D. Kallmes
BACKGROUND Early neurological deterioration (END) is a potential predictor for 90-day outcomes following mechanical thrombectomy for acute ischemic stroke (AIS). We performed a systematic review and meta-analysis to better understand whether END can be used as a surrogate for long-term outcomes. METHODS Following the PRISMA guidelines, a systematic literature review of the English language literature was conducted using PubMed, MEDLINE, and Embase. END definition was cataloged for each included study. Outcomes of interest included 90-day modified Rankin Scale (mRS) 0-2, symptomatic intracranial hemorrhage (sICH), mortality, and thrombolysis in cerebral infarction (TICI) 2b-3. We calculated pooled odds ratios (ORs) and their corresponding 95% confidence intervals (CI) for all definitions of END. RESULTS We included seven studies with 2992 patients in our analysis. There was a significant, inverse association with END and mRS 0-2 rates (OR = 0.15; 95% CI = 0.08-0.29; P-value< 0.001). Moreover, END was a significant predictor of increased odds for reported sICH rates (OR = 16.37; 95% CI = 7.66-34.99; P-value< 0.001). Furthermore, there was a significant association between END and increase in mortality rates (OR = 6.79; 95% CI = 2.62-17.62; P-value< 0.001). There was no significant association between END and rates of TICI 2b-3 (OR = 0.53; 95% CI = 0.27-1.05; p = 0.069). CONCLUSIONS Broadly defined, END holds value as a potential predictor of rates of mRS 0-2 at 90 days and is associated with higher rates of mortality and sICH, but had no correlation with TICI 2b-3.
背景:严重的神经功能恶化(END)是急性缺血性卒中(AIS)机械取栓后90天预后的潜在预测指标。我们进行了系统回顾和荟萃分析，以更好地了解END是否可以作为长期预后的替代指标。方法遵循PRISMA指南，使用PubMed、MEDLINE和Embase对英文文献进行系统的文献综述。每个纳入的研究都对END定义进行了编目。研究结果包括90天改良Rankin量表(mRS) 0-2、症状性颅内出血(sICH)、死亡率和脑梗死(TICI)溶栓(2b-3)。我们计算了所有END定义的合并优势比(or)及其相应的95%置信区间(CI)。结果:我们纳入了7项研究，共2992例患者。与END和mRS 0-2率呈显著负相关(OR = 0.15;95% ci = 0.08-0.29;假定值< 0.001)。此外，END是报告的脑出血发生率增加的显著预测因子(OR = 16.37;95% ci = 7.66-34.99;假定值< 0.001)。此外，END与死亡率增加之间存在显著关联(OR = 6.79;95% ci = 2.62-17.62;假定值< 0.001)。END与TICI 2b-3发生率无显著相关性(OR = 0.53;95% ci = 0.27-1.05;p = 0.069)。从广义上讲，END作为90天mRS 0-2发生率的潜在预测指标具有价值，并且与较高的死亡率和sICH相关，但与TICI 2b-3无关。
{"title":"Early neurological deterioration as a predictor of outcomes after endovascular thrombectomy for stroke: A systematic review and meta-analysis.","authors":"H. Kobeissi, S. Ghozy, Trey Seymour, C. Bilgin, R. Kadirvel, D. Kallmes","doi":"10.1177/15910199221135289","DOIUrl":"https://doi.org/10.1177/15910199221135289","url":null,"abstract":"BACKGROUND\u0000Early neurological deterioration (END) is a potential predictor for 90-day outcomes following mechanical thrombectomy for acute ischemic stroke (AIS). We performed a systematic review and meta-analysis to better understand whether END can be used as a surrogate for long-term outcomes.\u0000\u0000\u0000METHODS\u0000Following the PRISMA guidelines, a systematic literature review of the English language literature was conducted using PubMed, MEDLINE, and Embase. END definition was cataloged for each included study. Outcomes of interest included 90-day modified Rankin Scale (mRS) 0-2, symptomatic intracranial hemorrhage (sICH), mortality, and thrombolysis in cerebral infarction (TICI) 2b-3. We calculated pooled odds ratios (ORs) and their corresponding 95% confidence intervals (CI) for all definitions of END.\u0000\u0000\u0000RESULTS\u0000We included seven studies with 2992 patients in our analysis. There was a significant, inverse association with END and mRS 0-2 rates (OR = 0.15; 95% CI = 0.08-0.29; P-value< 0.001). Moreover, END was a significant predictor of increased odds for reported sICH rates (OR = 16.37; 95% CI = 7.66-34.99; P-value< 0.001). Furthermore, there was a significant association between END and increase in mortality rates (OR = 6.79; 95% CI = 2.62-17.62; P-value< 0.001). There was no significant association between END and rates of TICI 2b-3 (OR = 0.53; 95% CI = 0.27-1.05; p = 0.069).\u0000\u0000\u0000CONCLUSIONS\u0000Broadly defined, END holds value as a potential predictor of rates of mRS 0-2 at 90 days and is associated with higher rates of mortality and sICH, but had no correlation with TICI 2b-3.","PeriodicalId":126264,"journal":{"name":"Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130424164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-13DOI: 10.1101/2022.10.12.22280760
J. Hofmeister, G. Bernava, A. Rosi, P. Reymond, O. Brina, M. Muster, K. Lovblad, P. Machi
Background A mechanical thrombectomy technique using a double stent retriever (DSR) approach has been reported for the treatment of patients with acute ischemic stroke. The purpose of this study was to perform a benchtop evaluation of the mechanism of action and efficacy of a DSR approach compared to a single stent retriever approach. Methods In vitro mechanical thrombectomy procedures were performed in a vascular phantom reproducing a M1-M2 occlusion with two different clot analog consistencies (soft and hard). We compared the DSR approach to the single stent retriever approach and recorded the recanalisation rate, distal embolization, and retrieval forces of each mechanical thrombectomy procedure. Results The DSR approach achieved a higher recanalization rate and lower embolic complications compared to the single stent retriever approach. This seems to stem from two facts: the greater probability of targeting the correct artery with two stents in the case of bifurcation occlusion, and an improved clot capture mechanism using the DSR approach. However, the DSR was associated with an increased initial retrieval force. Conclusions In vitro evaluation of the mechanism of action of the DSR provided explanations that appear to support the high efficacy of such an approach in patient cohorts and could help operators when selecting the optimal mechanical thrombectomy strategy in cases of arterial occlusions difficult to treat with a single stent retriever.
{"title":"Benchtop evaluation of a double stent retriever thrombectomy technique for acute ischemic stroke treatment","authors":"J. Hofmeister, G. Bernava, A. Rosi, P. Reymond, O. Brina, M. Muster, K. Lovblad, P. Machi","doi":"10.1101/2022.10.12.22280760","DOIUrl":"https://doi.org/10.1101/2022.10.12.22280760","url":null,"abstract":"Background A mechanical thrombectomy technique using a double stent retriever (DSR) approach has been reported for the treatment of patients with acute ischemic stroke. The purpose of this study was to perform a benchtop evaluation of the mechanism of action and efficacy of a DSR approach compared to a single stent retriever approach. Methods In vitro mechanical thrombectomy procedures were performed in a vascular phantom reproducing a M1-M2 occlusion with two different clot analog consistencies (soft and hard). We compared the DSR approach to the single stent retriever approach and recorded the recanalisation rate, distal embolization, and retrieval forces of each mechanical thrombectomy procedure. Results The DSR approach achieved a higher recanalization rate and lower embolic complications compared to the single stent retriever approach. This seems to stem from two facts: the greater probability of targeting the correct artery with two stents in the case of bifurcation occlusion, and an improved clot capture mechanism using the DSR approach. However, the DSR was associated with an increased initial retrieval force. Conclusions In vitro evaluation of the mechanism of action of the DSR provided explanations that appear to support the high efficacy of such an approach in patient cohorts and could help operators when selecting the optimal mechanical thrombectomy strategy in cases of arterial occlusions difficult to treat with a single stent retriever.","PeriodicalId":126264,"journal":{"name":"Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125245207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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