Pub Date : 2022-06-17DOI: 10.1177/15910199221109044
A. Madhavan, J. Cutsforth-Gregory, S. Oushy, N. Borg, W. Brinjikji
Transvenous Onyx embolization was recently described as an effective treatment of spontaneous intracranial hypotension caused by CSF-venous fistulas. Patients with CSF-venous fistulas can present with a wide spectrum of clinical and imaging findings, sometimes including spontaneous subdural hematomas, subdural hygromas, or a combination of both. Here, we describe four patients with spontaneous intracranial hypotension complicated by subdural fluid collections caused by CSF-venous fistulas. The patients were treated with transvenous Onyx embolization of their CSF-venous fistulas and transarterial particle embolization of the bilateral middle meningeal arteries, with both procedures performed in a single treatment session. All four patients had clinical improvement and decreased size or resolution of their subdural fluid collections. Based on our findings, we believe that middle meningeal embolization could be a useful adjunct to CSF-venous fistula embolization. A case-control study comparing patients who did or did not undergo middle meningeal embolization will be necessary to validate this supposition.
{"title":"Combined CSF-venous Fistula and middle meningeal artery embolization for treatment of spontaneous intracranial hypotension.","authors":"A. Madhavan, J. Cutsforth-Gregory, S. Oushy, N. Borg, W. Brinjikji","doi":"10.1177/15910199221109044","DOIUrl":"https://doi.org/10.1177/15910199221109044","url":null,"abstract":"Transvenous Onyx embolization was recently described as an effective treatment of spontaneous intracranial hypotension caused by CSF-venous fistulas. Patients with CSF-venous fistulas can present with a wide spectrum of clinical and imaging findings, sometimes including spontaneous subdural hematomas, subdural hygromas, or a combination of both. Here, we describe four patients with spontaneous intracranial hypotension complicated by subdural fluid collections caused by CSF-venous fistulas. The patients were treated with transvenous Onyx embolization of their CSF-venous fistulas and transarterial particle embolization of the bilateral middle meningeal arteries, with both procedures performed in a single treatment session. All four patients had clinical improvement and decreased size or resolution of their subdural fluid collections. Based on our findings, we believe that middle meningeal embolization could be a useful adjunct to CSF-venous fistula embolization. A case-control study comparing patients who did or did not undergo middle meningeal embolization will be necessary to validate this supposition.","PeriodicalId":126264,"journal":{"name":"Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences","volume":"64 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114987410","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 : 2022-06-14DOI: 10.1177/15910199221108309
Hengwei Jin, Xiangyu Meng, Jiale Quan, M. Lv, Chuhan Jiang
BACKGROUND Vein of Galen Malformations (VGAM) and bilateral idiopathic occlusion of the sigmoid sinuses are extremely rare. We report a child with Vein of Galen Aneurysmal Malformation (VGAM) and Idiopathic bilateral sigmoid sinus occlusion simultaneously, and managed through endovascular therapy in one session. This case highlights the coexistence of the lesions, as well as the one-session technical feasibility and good clinical outcome for endovascular treatment. CLINICAL PRESENTATION The child presented with enlarged head circumference and epilepsy. The frequency of seizure increased from one time to several times a day. CTA/CTV confirmed coexistence of Vein of Galen Malformations and idiopathic bilateral sigmoid sinus occlusion. CONCLUSION One session trans-venous approach was performed. The VGAM was completely occluded and the dominant sigmoid sinus was recanalized. Thirteen months telephone follow-up confirmed normal head growth. The patient is seizure-free and recovered very well with normal neurological and developmental condition. This study provides evidentiary support for one-session endovascular therapy in patient with VGAM and idiopathic bilateral sigmoid sinus occlusion.
{"title":"Transvenous endovascular treatment for vein of Galen aneurysmal malformation with idiopathic bilateral sigmoid sinus occlusion.","authors":"Hengwei Jin, Xiangyu Meng, Jiale Quan, M. Lv, Chuhan Jiang","doi":"10.1177/15910199221108309","DOIUrl":"https://doi.org/10.1177/15910199221108309","url":null,"abstract":"BACKGROUND\u0000Vein of Galen Malformations (VGAM) and bilateral idiopathic occlusion of the sigmoid sinuses are extremely rare. We report a child with Vein of Galen Aneurysmal Malformation (VGAM) and Idiopathic bilateral sigmoid sinus occlusion simultaneously, and managed through endovascular therapy in one session. This case highlights the coexistence of the lesions, as well as the one-session technical feasibility and good clinical outcome for endovascular treatment.\u0000\u0000\u0000CLINICAL PRESENTATION\u0000The child presented with enlarged head circumference and epilepsy. The frequency of seizure increased from one time to several times a day. CTA/CTV confirmed coexistence of Vein of Galen Malformations and idiopathic bilateral sigmoid sinus occlusion.\u0000\u0000\u0000CONCLUSION\u0000One session trans-venous approach was performed. The VGAM was completely occluded and the dominant sigmoid sinus was recanalized. Thirteen months telephone follow-up confirmed normal head growth. The patient is seizure-free and recovered very well with normal neurological and developmental condition. This study provides evidentiary support for one-session endovascular therapy in patient with VGAM and idiopathic bilateral sigmoid sinus occlusion.","PeriodicalId":126264,"journal":{"name":"Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128061909","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 : 2022-06-12DOI: 10.1177/15910199221107438
M. Essibayi, W. Brinjikji
INTRODUCTION SOFIA catheter is a relatively new and recently FDA-approved aspiration catheter. This systematic review aims to investigate the safety and efficacy of SOFIA catheter for treatment of acute ischemic stroke (AIS) via ADAPT and Solumbra techniques. METHODS Search of all studies evaluating the SOFIA catheter for mechanical thrombectomy (MT) for treatment of AIS via ADAPT and Solumbra techniques from inception through 2020 on Pubmed, PMC, and Embase was performed. We analyzed the angiographic and clinical outcomes of both techniques with SOFIA catheter using the random-effects model. RESULTS From 18 studies, 1836 patients were included with 1365 receiving MT using ADAPT and 471 with solumbra technique. The mean age was 69.8 years and 51.1% of the patients were women. The rate of rescue therapy was 30%. The outcomes rates of ADAPT group were as follows; mFPE (59.3%), FPE (34.4%) final TICI 2b/3 (89.3%), procedural complications (8%), embolization to new territory (ENT) (2.3%), symptomatic ICH (5.4%), mean NIHSS (8.97), 90-day-mRS 0-2 (48.8%), and mortality (15.3%). The outcomes rates of Solumbra group were as follows; mFPE (60.5%), FPE (46.7%), final TICI 2b/3 (93%), procedural complications (6.4%), ENT (2%), symptomatic ICH (6%), mean NIHSS (7.59), mRS 0-2 (53.8%), and mortality (10.8%). ICA and posterior circulation strokes, and tandem lesions had worse outcomes (P < .005). MCA strokes were associated with better outcomes (P = .005). ASPECT scores' association with the clinical outcomes was found statistically significant. CONCLUSION SOFIA catheter is effective and safe to treat acute ischemic stroke regardless of applied MT technique.
{"title":"Efficacy and safety of SOFIA aspiration catheter for mechanical thrombectomy via ADAPT and Solumbra echniques in acute ischemic stroke: A systematic review and meta-analysis.","authors":"M. Essibayi, W. Brinjikji","doi":"10.1177/15910199221107438","DOIUrl":"https://doi.org/10.1177/15910199221107438","url":null,"abstract":"INTRODUCTION\u0000SOFIA catheter is a relatively new and recently FDA-approved aspiration catheter. This systematic review aims to investigate the safety and efficacy of SOFIA catheter for treatment of acute ischemic stroke (AIS) via ADAPT and Solumbra techniques.\u0000\u0000\u0000METHODS\u0000Search of all studies evaluating the SOFIA catheter for mechanical thrombectomy (MT) for treatment of AIS via ADAPT and Solumbra techniques from inception through 2020 on Pubmed, PMC, and Embase was performed. We analyzed the angiographic and clinical outcomes of both techniques with SOFIA catheter using the random-effects model.\u0000\u0000\u0000RESULTS\u0000From 18 studies, 1836 patients were included with 1365 receiving MT using ADAPT and 471 with solumbra technique. The mean age was 69.8 years and 51.1% of the patients were women. The rate of rescue therapy was 30%. The outcomes rates of ADAPT group were as follows; mFPE (59.3%), FPE (34.4%) final TICI 2b/3 (89.3%), procedural complications (8%), embolization to new territory (ENT) (2.3%), symptomatic ICH (5.4%), mean NIHSS (8.97), 90-day-mRS 0-2 (48.8%), and mortality (15.3%). The outcomes rates of Solumbra group were as follows; mFPE (60.5%), FPE (46.7%), final TICI 2b/3 (93%), procedural complications (6.4%), ENT (2%), symptomatic ICH (6%), mean NIHSS (7.59), mRS 0-2 (53.8%), and mortality (10.8%). ICA and posterior circulation strokes, and tandem lesions had worse outcomes (P < .005). MCA strokes were associated with better outcomes (P = .005). ASPECT scores' association with the clinical outcomes was found statistically significant.\u0000\u0000\u0000CONCLUSION\u0000SOFIA catheter is effective and safe to treat acute ischemic stroke regardless of applied MT technique.","PeriodicalId":126264,"journal":{"name":"Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences","volume":"86 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116741332","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 : 2022-06-12DOI: 10.1177/15910199221106049
Rashid A Ahmed, A. Dmytriw, A. Patel, C. Stapleton, J. Vranic, J. Rabinov, T. Leslie-Mazwi, N. Rost, J. Hirsch, R. Regenhardt
Basilar artery occlusion (BAO) is an infrequent but often fatal subtype of stroke. Predicting outcomes and selecting patients for endovascular therapy (EVT) remains challenging. Advances in neuroimaging and the development of prognostic scoring systems have augmented clinical decision-making over time. Recent randomized trials, BEST (Basilar Artery Occlusion Endovascular Intervention vs. Standard Medical Treatment), BASICS (Basilar Artery International Cooperation Study), BAOCHE (Basilar Artery Occlusion CHinese Endovascular Trial) and ATTENTION (Endovascular Treatment for Acute Basilar Artery Occlusion), compared EVT and medical management for patients with BAO. These trials yielded mixed results. The former two suggested unclear benefit while the latter two supported a benefit of EVT. While all had limitations, most providers agree caution should be exercised when excluding patients from EVT who may stand to benefit. Further studies are therefore needed to determine the effectiveness, safety, selection criteria, and optimal technical approach for EVT among patients with BAO. Hyperacute-phase advanced imaging can offer several benefits to aid decision making. It is reasonable to exclude patients with low National Institutes of Health Stroke Scale (NIHSS), large imaging-proven cores, and evidence of perforator occlusion by branch atheromatous disease. Herein, we review the clinical presentation, imaging work-up, treatments, and clinical outcomes for BAO, while highlighting knowledge gaps in treatment selection and technique.
{"title":"Basilar artery occlusion: A review of clinicoradiologic features, treatment selection, and endovascular techniques.","authors":"Rashid A Ahmed, A. Dmytriw, A. Patel, C. Stapleton, J. Vranic, J. Rabinov, T. Leslie-Mazwi, N. Rost, J. Hirsch, R. Regenhardt","doi":"10.1177/15910199221106049","DOIUrl":"https://doi.org/10.1177/15910199221106049","url":null,"abstract":"Basilar artery occlusion (BAO) is an infrequent but often fatal subtype of stroke. Predicting outcomes and selecting patients for endovascular therapy (EVT) remains challenging. Advances in neuroimaging and the development of prognostic scoring systems have augmented clinical decision-making over time. Recent randomized trials, BEST (Basilar Artery Occlusion Endovascular Intervention vs. Standard Medical Treatment), BASICS (Basilar Artery International Cooperation Study), BAOCHE (Basilar Artery Occlusion CHinese Endovascular Trial) and ATTENTION (Endovascular Treatment for Acute Basilar Artery Occlusion), compared EVT and medical management for patients with BAO. These trials yielded mixed results. The former two suggested unclear benefit while the latter two supported a benefit of EVT. While all had limitations, most providers agree caution should be exercised when excluding patients from EVT who may stand to benefit. Further studies are therefore needed to determine the effectiveness, safety, selection criteria, and optimal technical approach for EVT among patients with BAO. Hyperacute-phase advanced imaging can offer several benefits to aid decision making. It is reasonable to exclude patients with low National Institutes of Health Stroke Scale (NIHSS), large imaging-proven cores, and evidence of perforator occlusion by branch atheromatous disease. Herein, we review the clinical presentation, imaging work-up, treatments, and clinical outcomes for BAO, while highlighting knowledge gaps in treatment selection and technique.","PeriodicalId":126264,"journal":{"name":"Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences","volume":"393 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116649616","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 : 2022-06-09DOI: 10.1177/15910199221107440
K. Lee, M. H. Kim, J-T Yoon, Y. Song, B. Kwon, S. M. Hwang, J. Choi, D. H. Lee
Although accurate intracranial pressure (ICP) monitoring is essential for the diagnosis and treatment of severe brain diseases, current methods are performed invasively. Therefore, a safe and less invasive ICP measurement is required. The purpose of our study was to develop a simplified cranial cavity model for a better understanding of the relationship between the ICP and the pressure measurement within the dural venous sinus (DVS) to support the validity of using sinus pressure as the surrogate of the ICP. The in-house cranial cavity model had three components: the brain part, the DVS part, and the subarachnoid space (SAS) part. Pressure in other parts was measured when the pressure in the SAS part and, separately, brain part was increased from 0 (baseline) to 50 mmHg at intervals of 10 mmHg. When the pressure in the SAS part was increased from 10 to 50 mmHg at 10 mmHg interval, pressures of both the brain and DVS parts increased without significant difference (all P > 0.05). However, pressures in both the SAS and DVS parts differed while the pressure in the brain part was increased. The pressures in both parts showed about 70% of the increase in the brain part. Nevertheless, the pressures in the SAS and DVS parts were not significantly different (P > 0.05). A simplified in-house cranial cavity model was developed consisting of three compartments to represent the actual intracranial spaces. The pressure measurement within the DVS was feasible to use as a surrogate for the ICP measurement.
{"title":"A simplified cranial cavity model to understand the relationship between intracranial pressure and dural sinus pressure.","authors":"K. Lee, M. H. Kim, J-T Yoon, Y. Song, B. Kwon, S. M. Hwang, J. Choi, D. H. Lee","doi":"10.1177/15910199221107440","DOIUrl":"https://doi.org/10.1177/15910199221107440","url":null,"abstract":"Although accurate intracranial pressure (ICP) monitoring is essential for the diagnosis and treatment of severe brain diseases, current methods are performed invasively. Therefore, a safe and less invasive ICP measurement is required. The purpose of our study was to develop a simplified cranial cavity model for a better understanding of the relationship between the ICP and the pressure measurement within the dural venous sinus (DVS) to support the validity of using sinus pressure as the surrogate of the ICP. The in-house cranial cavity model had three components: the brain part, the DVS part, and the subarachnoid space (SAS) part. Pressure in other parts was measured when the pressure in the SAS part and, separately, brain part was increased from 0 (baseline) to 50 mmHg at intervals of 10 mmHg. When the pressure in the SAS part was increased from 10 to 50 mmHg at 10 mmHg interval, pressures of both the brain and DVS parts increased without significant difference (all P > 0.05). However, pressures in both the SAS and DVS parts differed while the pressure in the brain part was increased. The pressures in both parts showed about 70% of the increase in the brain part. Nevertheless, the pressures in the SAS and DVS parts were not significantly different (P > 0.05). A simplified in-house cranial cavity model was developed consisting of three compartments to represent the actual intracranial spaces. The pressure measurement within the DVS was feasible to use as a surrogate for the ICP measurement.","PeriodicalId":126264,"journal":{"name":"Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117264630","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 : 2022-06-07DOI: 10.1177/15910199221104631
J. Scoville, E. Joyce, Daniel A Tonetti, M. Bounajem, A. Thomas, C. Ogilvy, Justin M. Moore, H. Riina, O. Tanweer, E. Levy, A. Spiotta, B. Gross, B. Jankowitz, C. Cawley, A. Khalessi, A. Pandey, A. Ringer, R. Hanel, Rafael A. Ortiz, D. Langer, M. Levitt, M. Binning, P. Taussky, Peter T Kan, R. Grandhi
BACKGROUND Middle meningeal artery (MMA) embolization is an apparently efficacious minimally invasive treatment for nonacute subdural hematomas (NASHs), but how different embolisates affect outcomes remains unclear. Our objective was to compare radiographic and clinical outcomes after particle or liquid MMA embolization. METHODS Patients who had MMA embolization for NASH were retrospectively identified from a multi-institution database. The primary radiographic and clinical outcomes-50% NASH thickness reduction and need for surgical retreatment within 90 days, respectively-were compared for liquid and particle embolizations in patients treated 1) without surgical intervention (upfront), 2) after recurrence, or 3) with concomitant surgery (prophylactic). RESULTS The upfront, recurrent, and prophylactic subgroups included 133, 59, and 16 patients, respectively. The primary radiographic outcome was observed in 61.8%, 61%, and 72.7% of particle-embolized patients and 61.3%, 55.6%, and 20% of liquid-embolized patients, respectively (p = 0.457, 0.819, 0.755). Hazard ratios comparing time to reach radiographic outcome in the particle and liquid groups or upfront, recurrent, andprophylactic timing were 1.31 (95% CI 0.78-2.18; p = 0.310), 1.09 (95% CI 0.52-2.27; p = 0.822), and 1.5 (95% CI 0.14-16.54; p = 0.74), respectively. The primary clinical outcome occurred in 8.0%, 2.4%, and 0% of patients who underwent particle embolization in the upfront, recurrent, and prophylactic groups, respectively, compared with 0%, 5.6%, and 0% who underwent liquid embolization (p = 0.197, 0.521, 1.00). CONCLUSIONS MMA embolization with particle and liquid embolisates appears to be equally effective in treatment of NASHs as determined by the percentage who reach, and the time to reach, 50% NASH thickness reduction and the incidence of surgical reintervention within 90 days.
背景:脑膜中动脉(MMA)栓塞是治疗非急性硬膜下血肿(nash)的一种明显有效的微创治疗方法，但不同栓塞方式对预后的影响尚不清楚。我们的目的是比较颗粒或液体MMA栓塞后的影像学和临床结果。方法从一个多机构的数据库中回顾性地确定采用MMA栓塞治疗NASH的患者。我们比较了液体栓塞和颗粒栓塞患者的主要放射学和临床结果(分别是在90天内减少50% NASH厚度和需要再次手术治疗):1)没有手术干预(前期)，2)复发后，或3)合并手术(预防性)。结果前期亚组、复发亚组和预防亚组分别包括133例、59例和16例患者。颗粒栓塞患者的主要影像学结果分别为61.8%、61%和72.7%，液体栓塞患者的主要影像学结果分别为61.3%、55.6%和20% (p = 0.457、0.819、0.755)。颗粒组和液体组或早期、复发和预防时间达到影像学结果的风险比为1.31 (95% CI 0.78-2.18;p = 0.310)， 1.09 (95% CI 0.52-2.27;p = 0.822)和1.5 (95% CI 0.14-16.54;P = 0.74)。前期、复发和预防组颗粒栓塞患者的主要临床结局发生率分别为8.0%、2.4%和0%，而液体栓塞患者的主要临床结局发生率分别为0%、5.6%和0% (p = 0.197、0.521、1.00)。结论smma颗粒栓塞和液体栓塞治疗NASH的效果是相同的，这取决于达到50% NASH厚度减少的百分比和时间，以及90天内手术再干预的发生率。
{"title":"Radiographic and clinical outcomes with particle or liquid embolic agents for middle meningeal artery embolization of nonacute subdural hematomas.","authors":"J. Scoville, E. Joyce, Daniel A Tonetti, M. Bounajem, A. Thomas, C. Ogilvy, Justin M. Moore, H. Riina, O. Tanweer, E. Levy, A. Spiotta, B. Gross, B. Jankowitz, C. Cawley, A. Khalessi, A. Pandey, A. Ringer, R. Hanel, Rafael A. Ortiz, D. Langer, M. Levitt, M. Binning, P. Taussky, Peter T Kan, R. Grandhi","doi":"10.1177/15910199221104631","DOIUrl":"https://doi.org/10.1177/15910199221104631","url":null,"abstract":"BACKGROUND\u0000Middle meningeal artery (MMA) embolization is an apparently efficacious minimally invasive treatment for nonacute subdural hematomas (NASHs), but how different embolisates affect outcomes remains unclear. Our objective was to compare radiographic and clinical outcomes after particle or liquid MMA embolization.\u0000\u0000\u0000METHODS\u0000Patients who had MMA embolization for NASH were retrospectively identified from a multi-institution database. The primary radiographic and clinical outcomes-50% NASH thickness reduction and need for surgical retreatment within 90 days, respectively-were compared for liquid and particle embolizations in patients treated 1) without surgical intervention (upfront), 2) after recurrence, or 3) with concomitant surgery (prophylactic).\u0000\u0000\u0000RESULTS\u0000The upfront, recurrent, and prophylactic subgroups included 133, 59, and 16 patients, respectively. The primary radiographic outcome was observed in 61.8%, 61%, and 72.7% of particle-embolized patients and 61.3%, 55.6%, and 20% of liquid-embolized patients, respectively (p = 0.457, 0.819, 0.755). Hazard ratios comparing time to reach radiographic outcome in the particle and liquid groups or upfront, recurrent, andprophylactic timing were 1.31 (95% CI 0.78-2.18; p = 0.310), 1.09 (95% CI 0.52-2.27; p = 0.822), and 1.5 (95% CI 0.14-16.54; p = 0.74), respectively. The primary clinical outcome occurred in 8.0%, 2.4%, and 0% of patients who underwent particle embolization in the upfront, recurrent, and prophylactic groups, respectively, compared with 0%, 5.6%, and 0% who underwent liquid embolization (p = 0.197, 0.521, 1.00).\u0000\u0000\u0000CONCLUSIONS\u0000MMA embolization with particle and liquid embolisates appears to be equally effective in treatment of NASHs as determined by the percentage who reach, and the time to reach, 50% NASH thickness reduction and the incidence of surgical reintervention within 90 days.","PeriodicalId":126264,"journal":{"name":"Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130354779","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 : 2022-06-07DOI: 10.1177/15910199221107250
Z. Wilseck, Adam A Khan, N. Chaudhary, J. Gemmete
Summary/AbstractMiddle meningeal artery embolization has become an important treatment option for chronic subdural hematomas. While the treatment is safe, we present a unique case of development of an iatrogenic middle meningeal artery pseudoaneurysm during endovascular embolization with use of a dual-lumen balloon catheter used for injection of a liquid embolic agent. A 62-year-old man on Coumadin for portal vein thrombosis presented to the hospital with headache and supratherapeutic INR. Imaging revealed bilateral acute on chronic subdural hematomas. Given his medical comorbidities he underwent endovascular middle meningeal artery embolization. During the embolization, angiography revealed a pseudoaneurysm of the middle meningeal artery related to use of a dual-lumen balloon catheter. This pseudoaneurysm was successfully treated with ethylene vinyl alcohol embolization. Intracranial pseudoaneurysm related to balloon catheter use is a rare cause of iatrogenic pseudoaneurysm and could lead to life-threatening intracranial bleeding. Therefore, recognition and timely treatment are important.
{"title":"Iatrogenic pseudoaneurysm of the middle meningeal artery during embolization of bilateral chronic subdural hematomas.","authors":"Z. Wilseck, Adam A Khan, N. Chaudhary, J. Gemmete","doi":"10.1177/15910199221107250","DOIUrl":"https://doi.org/10.1177/15910199221107250","url":null,"abstract":"Summary/AbstractMiddle meningeal artery embolization has become an important treatment option for chronic subdural hematomas. While the treatment is safe, we present a unique case of development of an iatrogenic middle meningeal artery pseudoaneurysm during endovascular embolization with use of a dual-lumen balloon catheter used for injection of a liquid embolic agent. A 62-year-old man on Coumadin for portal vein thrombosis presented to the hospital with headache and supratherapeutic INR. Imaging revealed bilateral acute on chronic subdural hematomas. Given his medical comorbidities he underwent endovascular middle meningeal artery embolization. During the embolization, angiography revealed a pseudoaneurysm of the middle meningeal artery related to use of a dual-lumen balloon catheter. This pseudoaneurysm was successfully treated with ethylene vinyl alcohol embolization. Intracranial pseudoaneurysm related to balloon catheter use is a rare cause of iatrogenic pseudoaneurysm and could lead to life-threatening intracranial bleeding. Therefore, recognition and timely treatment are important.","PeriodicalId":126264,"journal":{"name":"Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133664894","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 : 2022-06-07DOI: 10.1177/15910199221107259
Frederick J A Marlowe, E. Powell
BACKGROUND Transradial access (TRA) is becoming more popular in neurointerventional radiology procedures and has been associated with reduced mortality, morbidity and access site complications. Guidelines state that TRA is a feasible option for posterior circulation thrombectomy however the evidence base is limited and no systematic literature review has yet been undertaken to evaluate its safety and efficacy. METHODS The Cochrane Library, PubMed, Web of Science, Scopus, TRIP and Embase databases were searched. Outcomes collected included TICI scores, puncture to recanalisation time, mRS scores at 90 days and access site complications. RESULTS 291 records were identified and 31 full text articles were assessed for eligibility. Eight studies met the inclusion criteria and were meta-analysed. The rate of TICI 2b-3 was 94.7% (89.7-99.8% at 95% CI), TICI 3 was 67.9% (42.2-93.6% at 95% CI) and mRS 0-2 at 90 days was 49.8% (31.5-68.1% at 95% CI). Median puncture to reperfusion times were extracted from three studies as 24 (IQR 18-40), 24 (IQR 17.5-56.5) and 27 (IQR 24-33.5) minutes. No access site complications were reported. TICI 2b-3, TICI 3 and mRS scores were comparable to data for transfemoral access (TFA) from a large systematic review. Puncture to recanalisation times appeared lower than the TFA data but statistical comparison of this outcome was not possible. CONCLUSIONS The use of TRA in posterior circulation thrombectomy is safe and effective with comparable results to TFA. Further research with a larger sample size is required to fully investigate the potential for shortened puncture to recanalisation times.
{"title":"Evaluating the safety and efficacy of transradial approach for thrombectomy in posterior circulation stroke. A systematic literature review and meta-analysis.","authors":"Frederick J A Marlowe, E. Powell","doi":"10.1177/15910199221107259","DOIUrl":"https://doi.org/10.1177/15910199221107259","url":null,"abstract":"BACKGROUND\u0000Transradial access (TRA) is becoming more popular in neurointerventional radiology procedures and has been associated with reduced mortality, morbidity and access site complications. Guidelines state that TRA is a feasible option for posterior circulation thrombectomy however the evidence base is limited and no systematic literature review has yet been undertaken to evaluate its safety and efficacy.\u0000\u0000\u0000METHODS\u0000The Cochrane Library, PubMed, Web of Science, Scopus, TRIP and Embase databases were searched. Outcomes collected included TICI scores, puncture to recanalisation time, mRS scores at 90 days and access site complications.\u0000\u0000\u0000RESULTS\u0000291 records were identified and 31 full text articles were assessed for eligibility. Eight studies met the inclusion criteria and were meta-analysed. The rate of TICI 2b-3 was 94.7% (89.7-99.8% at 95% CI), TICI 3 was 67.9% (42.2-93.6% at 95% CI) and mRS 0-2 at 90 days was 49.8% (31.5-68.1% at 95% CI). Median puncture to reperfusion times were extracted from three studies as 24 (IQR 18-40), 24 (IQR 17.5-56.5) and 27 (IQR 24-33.5) minutes. No access site complications were reported. TICI 2b-3, TICI 3 and mRS scores were comparable to data for transfemoral access (TFA) from a large systematic review. Puncture to recanalisation times appeared lower than the TFA data but statistical comparison of this outcome was not possible.\u0000\u0000\u0000CONCLUSIONS\u0000The use of TRA in posterior circulation thrombectomy is safe and effective with comparable results to TFA. Further research with a larger sample size is required to fully investigate the potential for shortened puncture to recanalisation times.","PeriodicalId":126264,"journal":{"name":"Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133615017","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 : 2022-06-06DOI: 10.1177/15910199221104620
L. Goertz, Michael Schoenfeld, D. Zopfs, J. Lüers, M. Schlamann, C. Kabbasch
The novel DERIVO 2heal Embolisation Device (Acandis, Pforzheim, Germany) is a flexible, fully radiopaque flow-diverter with a fibrin-based nano-coating, which is supposed to make the device inert to the coagulation cascade. We report a case of pseudoaneurysm treatment with this device under single anti-platelet therapy (SAPT). A female patient underwent endoscopic surgery for chronic rhinosinusitis. During surgery, the lateral wall of the sphenoid wall and the adjacent internal carotid artery was injured, leading to massive hemorrhage, which was treated with compression and tamponades. Eleven days after the procedure, the patient developed a rapidly growing pseudoaneurysm at the injury site with a relevant risk of upcoming aneurysm rupture. The aneurysm was treated by implantation of a DERIVO 2heal. A SAPT regimen was chosen due to the recent massive hemorrhage and anticipating enhanced progressive aneurysm occlusion. There were no thromboembolic complications and there was no morbidity. After 5 days, the pseudoaneurysm was completely occluded. The observations of the presented case are promising and warrant further investigation of this device.
{"title":"The DERIVO 2heal embolisation device: A technical report using single antiplatelet therapy for intracranial pseudoaneurysm treatment.","authors":"L. Goertz, Michael Schoenfeld, D. Zopfs, J. Lüers, M. Schlamann, C. Kabbasch","doi":"10.1177/15910199221104620","DOIUrl":"https://doi.org/10.1177/15910199221104620","url":null,"abstract":"The novel DERIVO 2heal Embolisation Device (Acandis, Pforzheim, Germany) is a flexible, fully radiopaque flow-diverter with a fibrin-based nano-coating, which is supposed to make the device inert to the coagulation cascade. We report a case of pseudoaneurysm treatment with this device under single anti-platelet therapy (SAPT). A female patient underwent endoscopic surgery for chronic rhinosinusitis. During surgery, the lateral wall of the sphenoid wall and the adjacent internal carotid artery was injured, leading to massive hemorrhage, which was treated with compression and tamponades. Eleven days after the procedure, the patient developed a rapidly growing pseudoaneurysm at the injury site with a relevant risk of upcoming aneurysm rupture. The aneurysm was treated by implantation of a DERIVO 2heal. A SAPT regimen was chosen due to the recent massive hemorrhage and anticipating enhanced progressive aneurysm occlusion. There were no thromboembolic complications and there was no morbidity. After 5 days, the pseudoaneurysm was completely occluded. The observations of the presented case are promising and warrant further investigation of this device.","PeriodicalId":126264,"journal":{"name":"Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114195979","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 : 2022-06-03DOI: 10.1177/15910199221106036
Carolina Capirossi, A. Laiso, Francesco Capasso, S. Nappini, L. Renieri, N. Limbucci
Atherosclerotic stenosis of the internal carotid artery is a rare cause of pulsatile tinnitus. Stenosis responsible for tinnitus is usually located in the petrous segment of the vessel or, even more uncommonly, in the extracranial segment. However, to the best of our knowledge, a stenosis of the intradural supraclinoid segment of the internal carotid had never been reported as a source of pulsatile tinnitus. We describe the case of a man with a history of previous ischaemic stroke and invalidating pulsatile tinnitus, caused by a high grade, diaphragm-like shaped, stenosis of the supraclinoid internal carotid artery. The stenosis was treated with angioplasty and stenting with a low-profile self-expanding high radial force stent (Acclino flex HRF, Acandis). Tinnitus disappeared immediately after the procedure. At the two-year follow-up no recurrence of the tinnitus and the stenosis occurred. Intradural internal carotid artery stenosis should be considered as a very rare cause of pulsatile tinnitus.
{"title":"Pulsatile tinnitus due to stenosis of the supraclinoid segment of the internal carotid artery: Management with a low-profile self-expanding stent.","authors":"Carolina Capirossi, A. Laiso, Francesco Capasso, S. Nappini, L. Renieri, N. Limbucci","doi":"10.1177/15910199221106036","DOIUrl":"https://doi.org/10.1177/15910199221106036","url":null,"abstract":"Atherosclerotic stenosis of the internal carotid artery is a rare cause of pulsatile tinnitus. Stenosis responsible for tinnitus is usually located in the petrous segment of the vessel or, even more uncommonly, in the extracranial segment. However, to the best of our knowledge, a stenosis of the intradural supraclinoid segment of the internal carotid had never been reported as a source of pulsatile tinnitus. We describe the case of a man with a history of previous ischaemic stroke and invalidating pulsatile tinnitus, caused by a high grade, diaphragm-like shaped, stenosis of the supraclinoid internal carotid artery. The stenosis was treated with angioplasty and stenting with a low-profile self-expanding high radial force stent (Acclino flex HRF, Acandis). Tinnitus disappeared immediately after the procedure. At the two-year follow-up no recurrence of the tinnitus and the stenosis occurred. Intradural internal carotid artery stenosis should be considered as a very rare cause of pulsatile tinnitus.","PeriodicalId":126264,"journal":{"name":"Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences","volume":"1610 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116504630","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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