Pub Date : 2022-06-03DOI: 10.1177/15910199221106040
L. McGuire, Prateek Kumar, J. Ryoo, A. Alaraj
INTRODUCTION The role of endovascular treatment in cervical artery dissection (CAD) is equivocal. This study compared cerebral blood flow in CAD between medically and endovascularly treated patients using quantitative magnetic resonance angiography (QMRA). METHODS Retrospective chart review was completed for patients with CAD. Inclusion criteria were adults (>18 years) with diagnosis of dissection of the internal carotid artery or vertebral artery who received QMRA. The cases were reviewed for clinical presentation, diagnosis, management, and imaging, and in particular, patients who underwent endovascular treatment were evaluated. RESULTS Forty-one patients were included, 46.3% female and mean age 46.0+/- 11.9 years. 21 patients (51.2%) had contralateral (ICA) dissections while 19 (46.3%) had vertebral artery (VA) dissections, and 1 had both involved. Five patients underwent stenting, angioplasty, or both. Baseline characteristics between patients who underwent medical versus endovascular treatment were similar, although patients undergoing stenting/angioplasty were more likely to have diabetes (p = 0.015) and prior anticoagulation use (p = 0.007). All endovascular patients demonstrated ischemia on MRI versus 53.1% of those undergoing medical management (p = 0.047). Comparing ipsilateral vessel flow over time in these two patient groups showed those who underwent stenting or angioplasty had lower baseline flows, albeit non-significant (p = 0.629). Patients who underwent endovascular treatment had lower distal flow compared to the medical management group. CONCLUSION This study represents the first to assess vessel flow using QMRA in patients who underwent endovascular treatment of CAD. In combination with progressive symptoms, QMRA may serve as a useful adjunct in the selection of patients for endovascular intervention in arterial dissections.
{"title":"Selective endovascular treatment of cervical arterial dissection using quantitative magnetic resonance angiography.","authors":"L. McGuire, Prateek Kumar, J. Ryoo, A. Alaraj","doi":"10.1177/15910199221106040","DOIUrl":"https://doi.org/10.1177/15910199221106040","url":null,"abstract":"INTRODUCTION\u0000The role of endovascular treatment in cervical artery dissection (CAD) is equivocal. This study compared cerebral blood flow in CAD between medically and endovascularly treated patients using quantitative magnetic resonance angiography (QMRA).\u0000\u0000\u0000METHODS\u0000Retrospective chart review was completed for patients with CAD. Inclusion criteria were adults (>18 years) with diagnosis of dissection of the internal carotid artery or vertebral artery who received QMRA. The cases were reviewed for clinical presentation, diagnosis, management, and imaging, and in particular, patients who underwent endovascular treatment were evaluated.\u0000\u0000\u0000RESULTS\u0000Forty-one patients were included, 46.3% female and mean age 46.0+/- 11.9 years. 21 patients (51.2%) had contralateral (ICA) dissections while 19 (46.3%) had vertebral artery (VA) dissections, and 1 had both involved. Five patients underwent stenting, angioplasty, or both. Baseline characteristics between patients who underwent medical versus endovascular treatment were similar, although patients undergoing stenting/angioplasty were more likely to have diabetes (p = 0.015) and prior anticoagulation use (p = 0.007). All endovascular patients demonstrated ischemia on MRI versus 53.1% of those undergoing medical management (p = 0.047). Comparing ipsilateral vessel flow over time in these two patient groups showed those who underwent stenting or angioplasty had lower baseline flows, albeit non-significant (p = 0.629). Patients who underwent endovascular treatment had lower distal flow compared to the medical management group.\u0000\u0000\u0000CONCLUSION\u0000This study represents the first to assess vessel flow using QMRA in patients who underwent endovascular treatment of CAD. In combination with progressive symptoms, QMRA may serve as a useful adjunct in the selection of patients for endovascular intervention in arterial dissections.","PeriodicalId":126264,"journal":{"name":"Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences","volume":"46 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":"132319723","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: 10.1177/15910199221104922
T. Hoshino, Shinsuke Sato, Kazuki Kushi, Yukiko Tanaka, Tatsuki Mochizuki, T. Ishikawa, S. Shima, Bikei Ryu, T. Inoue, Y. Okada, Y. Niimi
BACKGROUND We aimed to quantify the tortuosity of the middle cerebral artery (MCA) and assess its effects on radiological and clinical outcomes in patients with acute MCA occlusions who received mechanical thrombectomy (MT). METHODS This retrospective study enrolled 53 patients with acute ischemic stroke due to MCA M1 or M2 segment occlusion who underwent MT using stent retrievers (SRs). Tortuosity index (TI) was defined to quantify the tortuosity of the MCA M1 segment using the following formula: (actual distance / straight distance) × 100. For each patient, four TIs were measured in the anteroposterior and caudal views for both ipsilateral and contralateral sides to the occluded site (TI-APi, TI-APc, TI-CAUi, and TI-CAUc, respectively) using magnetic resonance angiography (MRA) or computed tomography angiography (CTA). We defined the first-pass effect (FPE) as first-pass mTICI classification ≥2b reperfusion. RESULTS Patients who did not achieve FPE had significantly higher TI-APi (112 vs. 106; P = 0.004), TI-APc (111 vs. 105; P = 0.005), TI-CAUi (110 vs. 105; P = 0.002), and TI-CAUc (110 vs. 105; P = 0.001) than those who achieved FPE. In multivariable analysis, higher TI-APi, TI-CAUi, and TI-APc were independently associated with an increased rate of unsuccessful FPE (odds ratio (OR) [95% confidence interval (CI)]: 1.25 [1.02-1.61], 1.21 [1.01-1.45], and 1.27 [1.03-1.73], respectively). TI-CAUi, TI-APc, and TI-CAUc were also independent predictors of the occurrence of intracranial hemorrhage after MT (OR [95% CI]: 1.15 [1.01-1.38], 1.14 [1.01-1.38], 1.25 [1.02-1.52], respectively). CONCLUSIONS The TIs of the MCA M1 segment on both ipsilateral and contralateral sides were associated with unfavourable outcomes after MT.
{"title":"Tortuosity of middle cerebral artery M1 segment and outcomes after mechanical thrombectomy.","authors":"T. Hoshino, Shinsuke Sato, Kazuki Kushi, Yukiko Tanaka, Tatsuki Mochizuki, T. Ishikawa, S. Shima, Bikei Ryu, T. Inoue, Y. Okada, Y. Niimi","doi":"10.1177/15910199221104922","DOIUrl":"https://doi.org/10.1177/15910199221104922","url":null,"abstract":"BACKGROUND\u0000We aimed to quantify the tortuosity of the middle cerebral artery (MCA) and assess its effects on radiological and clinical outcomes in patients with acute MCA occlusions who received mechanical thrombectomy (MT).\u0000\u0000\u0000METHODS\u0000This retrospective study enrolled 53 patients with acute ischemic stroke due to MCA M1 or M2 segment occlusion who underwent MT using stent retrievers (SRs). Tortuosity index (TI) was defined to quantify the tortuosity of the MCA M1 segment using the following formula: (actual distance / straight distance) × 100. For each patient, four TIs were measured in the anteroposterior and caudal views for both ipsilateral and contralateral sides to the occluded site (TI-APi, TI-APc, TI-CAUi, and TI-CAUc, respectively) using magnetic resonance angiography (MRA) or computed tomography angiography (CTA). We defined the first-pass effect (FPE) as first-pass mTICI classification ≥2b reperfusion.\u0000\u0000\u0000RESULTS\u0000Patients who did not achieve FPE had significantly higher TI-APi (112 vs. 106; P = 0.004), TI-APc (111 vs. 105; P = 0.005), TI-CAUi (110 vs. 105; P = 0.002), and TI-CAUc (110 vs. 105; P = 0.001) than those who achieved FPE. In multivariable analysis, higher TI-APi, TI-CAUi, and TI-APc were independently associated with an increased rate of unsuccessful FPE (odds ratio (OR) [95% confidence interval (CI)]: 1.25 [1.02-1.61], 1.21 [1.01-1.45], and 1.27 [1.03-1.73], respectively). TI-CAUi, TI-APc, and TI-CAUc were also independent predictors of the occurrence of intracranial hemorrhage after MT (OR [95% CI]: 1.15 [1.01-1.38], 1.14 [1.01-1.38], 1.25 [1.02-1.52], respectively).\u0000\u0000\u0000CONCLUSIONS\u0000The TIs of the MCA M1 segment on both ipsilateral and contralateral sides were associated with unfavourable outcomes after MT.","PeriodicalId":126264,"journal":{"name":"Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences","volume":"39 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133720715","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 : 2022-06-01DOI: 10.1177/15910199221104616
P. Entezami, Andrew K. Rock, Gregory Topp, Ehsaun S. Heydari, N. Field, A. Boulos, J. Dalfino, J. Yamamoto, J. Pilitsis, Divya Cherukupalli, Sarah E. McCallum, A. Paul
INTRODUCTION As we emerge from the current pandemic, hospitals, staff, and resources will need to continue to adjust to meet ongoing healthcare demands. Lessons learned during past shortages can be used to optimize peri-procedural protocols to safely improve the utilization of hospital resources. METHODS Retrospective review of patients who underwent elective endovascular intracranial aneurysm treatment was performed. Multivariable logistic regression was used to identify factors associated with patients who were able to be discharged within 24 h of elective procedures. Rates of complications (particularly readmission) were determined. RESULTS 330 patients underwent elective endovascular aneurysm treatment with 86 (26.1%) discharged within 24 h. Factors associated with earlier discharge included procedure years (2019-2021) and male sex. Patients were more likely to be discharged later (after 24 h) if they underwent stent-coil embolization or flow-diversion. There was no association between discharge timing and likelihood of readmission. DISCUSSION Our review highlights the safety of earlier discharge and allowed us to prepare a fast-track protocol for same-day discharge in these patients. This protocol will be studied prospectively in the next phase of this study. As we gain more comfort with emerging, minimally invasive endovascular therapies, we hope to safely achieve same-day discharge on a protocolized and routine basis, reducing the demand of elective aneurysm treatments on our healthcare system. CONCLUSION We retrospectively demonstrate that early discharge following elective aneurysm treatment is safe in our cohort and provide a fast-track pathway based on these findings for other centers developing similar protocols.
{"title":"Developing a fast-track discharge protocol for patients with cerebral aneurysms treated via neuroendovascular techniques.","authors":"P. Entezami, Andrew K. Rock, Gregory Topp, Ehsaun S. Heydari, N. Field, A. Boulos, J. Dalfino, J. Yamamoto, J. Pilitsis, Divya Cherukupalli, Sarah E. McCallum, A. Paul","doi":"10.1177/15910199221104616","DOIUrl":"https://doi.org/10.1177/15910199221104616","url":null,"abstract":"INTRODUCTION\u0000As we emerge from the current pandemic, hospitals, staff, and resources will need to continue to adjust to meet ongoing healthcare demands. Lessons learned during past shortages can be used to optimize peri-procedural protocols to safely improve the utilization of hospital resources.\u0000\u0000\u0000METHODS\u0000Retrospective review of patients who underwent elective endovascular intracranial aneurysm treatment was performed. Multivariable logistic regression was used to identify factors associated with patients who were able to be discharged within 24 h of elective procedures. Rates of complications (particularly readmission) were determined.\u0000\u0000\u0000RESULTS\u0000330 patients underwent elective endovascular aneurysm treatment with 86 (26.1%) discharged within 24 h. Factors associated with earlier discharge included procedure years (2019-2021) and male sex. Patients were more likely to be discharged later (after 24 h) if they underwent stent-coil embolization or flow-diversion. There was no association between discharge timing and likelihood of readmission.\u0000\u0000\u0000DISCUSSION\u0000Our review highlights the safety of earlier discharge and allowed us to prepare a fast-track protocol for same-day discharge in these patients. This protocol will be studied prospectively in the next phase of this study. As we gain more comfort with emerging, minimally invasive endovascular therapies, we hope to safely achieve same-day discharge on a protocolized and routine basis, reducing the demand of elective aneurysm treatments on our healthcare system.\u0000\u0000\u0000CONCLUSION\u0000We retrospectively demonstrate that early discharge following elective aneurysm treatment is safe in our cohort and provide a fast-track pathway based on these findings for other centers developing similar protocols.","PeriodicalId":126264,"journal":{"name":"Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116441070","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 : 2022-05-31DOI: 10.1177/15910199221084483
A. Zakeri, C. Schreiber, Varun S. Shah, Elizabeth VonEnde, J. Granger, Amy Minnema, M. Constable, Taimur Shujaat, P. Youssef, C. Powers, B. Jankowitz, S. Nimjee
BACKGROUND A number of large bore guide catheters are currently available for use in neuroendovascular surgery. This study represents a multi-institutional retrospective series of patients undergoing mechanical thrombectomy with the use of a TracStar Large Distal Platform (LDP) guide catheter and assessed its performance in vivo in 107 patients. OBJECTIVE To review a multi-institutional initial experience with the TracStar LDP guide catheter during mechanical thrombectomy for emergent large vessel occlusion (ELVO). METHODS A retrospective review was performed at two level one stroke centres to include all patients who underwent mechanical thrombectomy and had the TracStar LDP guide catheter used during the intervention. RESULTS The TracStar LDP guide catheter was successfully used in 107 mechanical thrombectomies. In anterior circulation ELVO, the guide catheter advanced into the cavernous segment of the internal carotid artery in 62.6% (62/99) of cases. In posterior circulation cases, the guide catheter advanced to the basilar artery in 87.5% (7/8) of cases. A thrombolysis in cerebral infarction 2b or greater reperfusion was obtained in 90.7% (97/107). No complications occurred related to the TracStar LDP guide catheter. Three complications occurred with aspiration catheters including a small dissection that did not require further intervention and fracturing of the AXS Catalyst 6 catheter tip in two cases. No thromboembolic events occurred. CONCLUSIONS The TracStar LDP large bore guide catheter is safe and effective at navigating the tortuous vascular anatomy often encountered during mechanical thrombectomy for stroke. The flexible distal and stiffer proximal components provide a good combination of navigability and support for use in neuroendovascular interventions.
{"title":"Utility of the novel guide catheter in mechanical thrombectomy for emergent large vessel occlusion stroke.","authors":"A. Zakeri, C. Schreiber, Varun S. Shah, Elizabeth VonEnde, J. Granger, Amy Minnema, M. Constable, Taimur Shujaat, P. Youssef, C. Powers, B. Jankowitz, S. Nimjee","doi":"10.1177/15910199221084483","DOIUrl":"https://doi.org/10.1177/15910199221084483","url":null,"abstract":"BACKGROUND\u0000A number of large bore guide catheters are currently available for use in neuroendovascular surgery. This study represents a multi-institutional retrospective series of patients undergoing mechanical thrombectomy with the use of a TracStar Large Distal Platform (LDP) guide catheter and assessed its performance in vivo in 107 patients.\u0000\u0000\u0000OBJECTIVE\u0000To review a multi-institutional initial experience with the TracStar LDP guide catheter during mechanical thrombectomy for emergent large vessel occlusion (ELVO).\u0000\u0000\u0000METHODS\u0000A retrospective review was performed at two level one stroke centres to include all patients who underwent mechanical thrombectomy and had the TracStar LDP guide catheter used during the intervention.\u0000\u0000\u0000RESULTS\u0000The TracStar LDP guide catheter was successfully used in 107 mechanical thrombectomies. In anterior circulation ELVO, the guide catheter advanced into the cavernous segment of the internal carotid artery in 62.6% (62/99) of cases. In posterior circulation cases, the guide catheter advanced to the basilar artery in 87.5% (7/8) of cases. A thrombolysis in cerebral infarction 2b or greater reperfusion was obtained in 90.7% (97/107). No complications occurred related to the TracStar LDP guide catheter. Three complications occurred with aspiration catheters including a small dissection that did not require further intervention and fracturing of the AXS Catalyst 6 catheter tip in two cases. No thromboembolic events occurred.\u0000\u0000\u0000CONCLUSIONS\u0000The TracStar LDP large bore guide catheter is safe and effective at navigating the tortuous vascular anatomy often encountered during mechanical thrombectomy for stroke. The flexible distal and stiffer proximal components provide a good combination of navigability and support for use in neuroendovascular interventions.","PeriodicalId":126264,"journal":{"name":"Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127221609","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 : 2022-05-31DOI: 10.1177/15910199221104613
D. Bae, Jong Heon Lee, Jae Ho Shin, Y. Ihn, J. Sung
PURPOSE To evaluate image features and diagnostic performance of susceptibility-weighted image (SWI) in detection of intracranial vertebral artery dissection (VAD) and unruptured intracranial aneurysm (UIA). MATERIALS AND METHODS From January 2015 to December 2021, symptomatic patients who underwent 3.0 T MR SWI were recruited. For study group, transfemoral cerebral angiography-proven lesions were included, while 1:1 matched control group with MR angiography were included. Image features of SWI were evaluated. Diagnostic performance and interobserver agreements were calculated for detecting VAD with stenosis and UIA greater than 7 mm. RESULTS Total of 110 patients (mean age: 60.92 years, female: 60/110) were included. In the study group (N = 55), 21 patients (38.2%) had VAD, while 34 patients (61.8%) had UIA. For SWI-detectable VAD, larger parent artery (PA)-dilatation ratio was observed (1.36 vs. 1.84, p = 0.034). For SWI-detectable UIA, larger PA-dome ratio (1.32 vs. 1.90, p = 0.020) and larger PA-height ratio (1.25 vs. 1.77, p = 0.005) were observed. The diagnostic performance and kappa values for VAD with stenosis were as follow: sensitivity: 91.7 (95% CI: 61.5-99.8); specificity: 93.9 (95% CI: 87.2-97.7); к: 0.80. The diagnostic performance for UIA larger than 7 mm were as follow: sensitivity: 87.5 (95% CI: 47.4-99.7); specificity: 95.1 (95% CI: 88.9-98.4); к: 0.73. CONCLUSION SWI-detectable lesions were VAD with larger PA-dilatation ratio, and UIA with larger PA-dome ratio, and PA-height ratio. SWI was able to accurately detect VAD with stenosis and UIA larger than 7 mm with substantial interobserver agreements.
{"title":"Detection of cerebral aneurysm and intracranial vertebral dissection using non-enhanced magnetic resonance imaging in emergency setting: Emphasis on magnitude image of susceptibility-weighted image.","authors":"D. Bae, Jong Heon Lee, Jae Ho Shin, Y. Ihn, J. Sung","doi":"10.1177/15910199221104613","DOIUrl":"https://doi.org/10.1177/15910199221104613","url":null,"abstract":"PURPOSE\u0000To evaluate image features and diagnostic performance of susceptibility-weighted image (SWI) in detection of intracranial vertebral artery dissection (VAD) and unruptured intracranial aneurysm (UIA).\u0000\u0000\u0000MATERIALS AND METHODS\u0000From January 2015 to December 2021, symptomatic patients who underwent 3.0 T MR SWI were recruited. For study group, transfemoral cerebral angiography-proven lesions were included, while 1:1 matched control group with MR angiography were included. Image features of SWI were evaluated. Diagnostic performance and interobserver agreements were calculated for detecting VAD with stenosis and UIA greater than 7 mm.\u0000\u0000\u0000RESULTS\u0000Total of 110 patients (mean age: 60.92 years, female: 60/110) were included. In the study group (N = 55), 21 patients (38.2%) had VAD, while 34 patients (61.8%) had UIA. For SWI-detectable VAD, larger parent artery (PA)-dilatation ratio was observed (1.36 vs. 1.84, p = 0.034). For SWI-detectable UIA, larger PA-dome ratio (1.32 vs. 1.90, p = 0.020) and larger PA-height ratio (1.25 vs. 1.77, p = 0.005) were observed. The diagnostic performance and kappa values for VAD with stenosis were as follow: sensitivity: 91.7 (95% CI: 61.5-99.8); specificity: 93.9 (95% CI: 87.2-97.7); к: 0.80. The diagnostic performance for UIA larger than 7 mm were as follow: sensitivity: 87.5 (95% CI: 47.4-99.7); specificity: 95.1 (95% CI: 88.9-98.4); к: 0.73.\u0000\u0000\u0000CONCLUSION\u0000SWI-detectable lesions were VAD with larger PA-dilatation ratio, and UIA with larger PA-dome ratio, and PA-height ratio. SWI was able to accurately detect VAD with stenosis and UIA larger than 7 mm with substantial interobserver agreements.","PeriodicalId":126264,"journal":{"name":"Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences","volume":"16 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120900631","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 : 2022-05-30DOI: 10.1177/15910199221104920
Karan K. Topiwala, C. Quinn, T. Mehta, K. Masood, A. Grande, R. Tummala, B. Jagadeesan
BACKGROUND AND PURPOSE Nonrandomized studies have found Balloon Guide Catheter (BGC) use to improve technical and functional outcomes in patients undergoing mechanical thrombectomy (MT). MATERIALS AND METHODS We performed a retrospective analysis on prospectively collected data of consecutive ischemic stroke patients undergoing MT at our institution (December 2020-October 2021). Interventions where BOBBY BGC (BBGC, MicroVentionTM, Aliso Viejo, CA) was used were identified. Baseline demographics and clinico-radiographic characteristics were retrospectively collected and analysed using descriptive statistics. RESULTS A total of 43 patients received BBGC-MT (male: female = 26:17, median age 72 years [IQR 62-82]). The most common occlusion site was the middle cerebral artery (MCA) (60.4%). Over half (51.2%) received intravenous thrombolytics. The BBGC tracked well over tortuous aortic arches (type II 34.8%, type III 16.3%), with median arteriotomy-to-perfusion time of 29 min (IQR 20-46). Thromboaspiration was used as first-line MT technique in 69.7% cases, with 1 (IQR 1-2) median MT pass achieving modified TICI (thrombolysis in cerebral ischemia) scores of 3 and 2b/3 in 74.4% and 95.3% respectively. Our overall first pass effect (FPE, defined as mTICI 3 after firs-pass) and modified FPE (defined as, mTICI 2b/3 after first-pass) rates were 51.1% and 79.1% respectively, with rates of 92.3% and 100% respectively when stentretriever and thromboaspiration were combined. The median reduction in National Institutes of Health Stroke Scale (NIHSS) was 9 (IQR 4-15, p < 0.0001), with a median 90-day modified Rankin Score (mRS) of 1.5 (IQR 0-2). CONCLUSIONS BOBBY BGC use resulted in a high first-pass effect rate and may contribute towards improved functional outcomes.
{"title":"BOBBY balloon guide catheter thrombectomy in large-vessel occlusion stroke: Initial experience.","authors":"Karan K. Topiwala, C. Quinn, T. Mehta, K. Masood, A. Grande, R. Tummala, B. Jagadeesan","doi":"10.1177/15910199221104920","DOIUrl":"https://doi.org/10.1177/15910199221104920","url":null,"abstract":"BACKGROUND AND PURPOSE\u0000Nonrandomized studies have found Balloon Guide Catheter (BGC) use to improve technical and functional outcomes in patients undergoing mechanical thrombectomy (MT).\u0000\u0000\u0000MATERIALS AND METHODS\u0000We performed a retrospective analysis on prospectively collected data of consecutive ischemic stroke patients undergoing MT at our institution (December 2020-October 2021). Interventions where BOBBY BGC (BBGC, MicroVentionTM, Aliso Viejo, CA) was used were identified. Baseline demographics and clinico-radiographic characteristics were retrospectively collected and analysed using descriptive statistics.\u0000\u0000\u0000RESULTS\u0000A total of 43 patients received BBGC-MT (male: female = 26:17, median age 72 years [IQR 62-82]). The most common occlusion site was the middle cerebral artery (MCA) (60.4%). Over half (51.2%) received intravenous thrombolytics. The BBGC tracked well over tortuous aortic arches (type II 34.8%, type III 16.3%), with median arteriotomy-to-perfusion time of 29 min (IQR 20-46). Thromboaspiration was used as first-line MT technique in 69.7% cases, with 1 (IQR 1-2) median MT pass achieving modified TICI (thrombolysis in cerebral ischemia) scores of 3 and 2b/3 in 74.4% and 95.3% respectively. Our overall first pass effect (FPE, defined as mTICI 3 after firs-pass) and modified FPE (defined as, mTICI 2b/3 after first-pass) rates were 51.1% and 79.1% respectively, with rates of 92.3% and 100% respectively when stentretriever and thromboaspiration were combined. The median reduction in National Institutes of Health Stroke Scale (NIHSS) was 9 (IQR 4-15, p < 0.0001), with a median 90-day modified Rankin Score (mRS) of 1.5 (IQR 0-2).\u0000\u0000\u0000CONCLUSIONS\u0000BOBBY BGC use resulted in a high first-pass effect rate and may contribute towards improved functional outcomes.","PeriodicalId":126264,"journal":{"name":"Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128297086","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 : 2022-05-30DOI: 10.1177/15910199221104624
Victor M. Ringheanu, W. Tekle, Laurie Preston, A. Sarraj, Ameer E. Hassan
INTRODUCTION Endovascular treatment (EVT) is a widely proven method to treat patients diagnosed with intracranial large vessel occlusion (LVO). Through this method of treatment, it has been hypothesized that a lower number of thrombectomy passes is an indicator of higher rates of modified Thrombolysis in Cerebral Infarction 2B-3 (mTICI) reperfusion and favorable outcomes at 90-days defined as modified Rankin Scale 0-2 (mRS). METHODS Through the utilization of a prospectively collected endovascular database between 2012-2020, variables such as demographics, co-morbid conditions, intracerebral hemorrhage, mass effect, mortality rate, and good/poor outcomes regarding mTICI score and mRS assessment at 90-days were examined. The outcomes between patients receiving EVT who were treated with < 3 thrombectomy passes or ≥3 passes were compared. RESULTS Out of 454 patients treated with mechanical thrombectomy of qualifying intracranial internal carotid artery (ICA) or middle cerebral artery occlusion, site of occlusion (ICA, ICA-T M1, and M2/M3), a total of 372 (81.9%) were treated with < 3 passes (average age 70.34 ± 13.75 years, 46.0% women), and 82 (18.1%) were treated with ≥3 passes (average age 70.30 ± 13.72 years, 48.8% women). Significantly higher rates of mass effect (p = 0.043), mRS score 3-6 (p = 0.029), mortality (p = 0.025), and poor reperfusion (p < 0.0001) were noted in patients treated with ≥3 passes. CONCLUSION A higher number of thrombectomy passes, characterized as ≥3 in this study, was associated with significantly worsened patient outcome regarding mRS and mortality. Further research is required to determine whether the number of thrombectomy passes is an accurate predictor of treatment outcome.
{"title":"Higher number of stent-retriever thrombectomy passes significantly increases risk of mass effect, poor functional outcome, and mortality.","authors":"Victor M. Ringheanu, W. Tekle, Laurie Preston, A. Sarraj, Ameer E. Hassan","doi":"10.1177/15910199221104624","DOIUrl":"https://doi.org/10.1177/15910199221104624","url":null,"abstract":"INTRODUCTION\u0000Endovascular treatment (EVT) is a widely proven method to treat patients diagnosed with intracranial large vessel occlusion (LVO). Through this method of treatment, it has been hypothesized that a lower number of thrombectomy passes is an indicator of higher rates of modified Thrombolysis in Cerebral Infarction 2B-3 (mTICI) reperfusion and favorable outcomes at 90-days defined as modified Rankin Scale 0-2 (mRS).\u0000\u0000\u0000METHODS\u0000Through the utilization of a prospectively collected endovascular database between 2012-2020, variables such as demographics, co-morbid conditions, intracerebral hemorrhage, mass effect, mortality rate, and good/poor outcomes regarding mTICI score and mRS assessment at 90-days were examined. The outcomes between patients receiving EVT who were treated with < 3 thrombectomy passes or ≥3 passes were compared.\u0000\u0000\u0000RESULTS\u0000Out of 454 patients treated with mechanical thrombectomy of qualifying intracranial internal carotid artery (ICA) or middle cerebral artery occlusion, site of occlusion (ICA, ICA-T M1, and M2/M3), a total of 372 (81.9%) were treated with < 3 passes (average age 70.34 ± 13.75 years, 46.0% women), and 82 (18.1%) were treated with ≥3 passes (average age 70.30 ± 13.72 years, 48.8% women). Significantly higher rates of mass effect (p = 0.043), mRS score 3-6 (p = 0.029), mortality (p = 0.025), and poor reperfusion (p < 0.0001) were noted in patients treated with ≥3 passes.\u0000\u0000\u0000CONCLUSION\u0000A higher number of thrombectomy passes, characterized as ≥3 in this study, was associated with significantly worsened patient outcome regarding mRS and mortality. Further research is required to determine whether the number of thrombectomy passes is an accurate predictor of treatment outcome.","PeriodicalId":126264,"journal":{"name":"Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128946036","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 : 2022-05-29DOI: 10.1177/15910199221104915
R. Suzuki, T. Takigawa, M. Nagaishi, A. Hyodo, Kensuke Suzuki
BACKGROUND Distal anterior cerebral artery (DACA) aneurysms are rare, and endovascular treatment of these aneurysms is challenging. Thromboembolic events, including silent ischemic events, are one of the most important complications of coil embolization for cerebral aneurysms. The treatment outcomes and predictors of silent ischemic events in coil embolization for unruptured DACA aneurysms were investigated, focusing on the morphological characteristics of aneurysms, especially the inflow angle (IA) and global outflow angle (GOA). METHODS A total of 12 patients with 12 unruptured DACA aneurysms, treated with coil embolization at our institute, were retrospectively investigated. Predictors for silent ischemic events were evaluated by comparing diffusion-weighted imaging (DWI)-positive and DWI-negative patients. RESULTS Silent ischemic events detected on DWI were observed in eight aneurysms (66.7%). Comparison of the morphological characteristics of aneurysms between the two groups showed a significantly smaller GOA in the DWI-positive group than in the DWI-negative group (172.6 ± 17.7° vs. 216.8 ± 16.8°, P < 0.01). A multivariate analysis showed that GOA <195° was a significant predictor of silent ischemic events (P = 0.04; odds ratio: 23.62; 95% confidence interval: 1.11-490.39). CONCLUSION A small GOA was a significant predictor of silent ischemic events after coil embolization for unruptured DACA aneurysms. While some patients can be treated safely with minimally invasive coil embolization, it is necessary to consider surgical clipping in patients at high risk of thromboembolic events with coil embolization.
{"title":"Global outflow angle influences silent ischemic events in coil embolization for unruptured distal anterior cerebral artery aneurysms.","authors":"R. Suzuki, T. Takigawa, M. Nagaishi, A. Hyodo, Kensuke Suzuki","doi":"10.1177/15910199221104915","DOIUrl":"https://doi.org/10.1177/15910199221104915","url":null,"abstract":"BACKGROUND\u0000Distal anterior cerebral artery (DACA) aneurysms are rare, and endovascular treatment of these aneurysms is challenging. Thromboembolic events, including silent ischemic events, are one of the most important complications of coil embolization for cerebral aneurysms. The treatment outcomes and predictors of silent ischemic events in coil embolization for unruptured DACA aneurysms were investigated, focusing on the morphological characteristics of aneurysms, especially the inflow angle (IA) and global outflow angle (GOA).\u0000\u0000\u0000METHODS\u0000A total of 12 patients with 12 unruptured DACA aneurysms, treated with coil embolization at our institute, were retrospectively investigated. Predictors for silent ischemic events were evaluated by comparing diffusion-weighted imaging (DWI)-positive and DWI-negative patients.\u0000\u0000\u0000RESULTS\u0000Silent ischemic events detected on DWI were observed in eight aneurysms (66.7%). Comparison of the morphological characteristics of aneurysms between the two groups showed a significantly smaller GOA in the DWI-positive group than in the DWI-negative group (172.6 ± 17.7° vs. 216.8 ± 16.8°, P < 0.01). A multivariate analysis showed that GOA <195° was a significant predictor of silent ischemic events (P = 0.04; odds ratio: 23.62; 95% confidence interval: 1.11-490.39).\u0000\u0000\u0000CONCLUSION\u0000A small GOA was a significant predictor of silent ischemic events after coil embolization for unruptured DACA aneurysms. While some patients can be treated safely with minimally invasive coil embolization, it is necessary to consider surgical clipping in patients at high risk of thromboembolic events with coil embolization.","PeriodicalId":126264,"journal":{"name":"Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121824994","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 : 2022-05-29DOI: 10.1177/15910199221104633
Ameer E. Hassan, M. Khalil, Sohum K Desai, W. Tekle
BACKGROUND AND PURPOSE Angioplasty and stenting is a treatment option for patients with medically refractory symptomatic intracranial atherosclerotic disease (sICAD). Currently the Wingspan Stent System (WSS) is the only FDA approved device for this indication. We find the Resolute (R) Onyx Stent, a drug-eluting balloon mounted stent (DES), a better alternative to the WSS for treatment of sICAD. Herein, we present our findings comparing the two stents based on our single center experience. METHODS A prospectively maintained neuro-endovascular databased was queried for patients between January 2013 to June 2021. Inclusion criteria for patients included sICAD with failed medical management, and intracranial stenting with either R-Onyx DES or WSS, including patients treated within 7 days of their last stroke. Primary outcomes were assessed via the occurrence of ischemic or hemorrhagic stroke or death within 72 h of the procedure. Secondary outcomes consisted of recurrent stroke or significant in-stent restenosis evaluated by a clinical or angiographic follow-up at 6 months. RESULTS A total of 184 patients, average age 61.26 (SD = 12.53) (44% women), were eligible for analysis with 58 having R-onyx DES and 126 having WSS. Within 72 h, the primary outcome was observed in 1.7% (n = 1) of patients in the R-onyx DES group and 6.3% (n = 8) of patients in the WSS group (p = 0.089). Among 41 angiographic and clinical follow-ups in the R-onyx DES group, none had a recurrent stroke, while among 101 patients who had follow-up in the WSS group, 8.9% (n = 9) had a stroke (p = 0.024). At a 6-month angiographic follow-up, there was a significantly lower rate of symptomatic in-stent restenosis among the R-onyx DES group with 1.7% (n = 1) compared with 21.4% (n = 27) in the WSS group (p = 0.0003). CONCLUSION R-onyx DES is more effective than WSS in treating sICAD with low rates of periprocedural complications and long-term strokes and symptomatic in-stent restenosis. Future prospective randomized multicenter trials are needed.
{"title":"Resolute onyx stent more effective than wingspan stent at preventing procedural complications and long-term restenosis.","authors":"Ameer E. Hassan, M. Khalil, Sohum K Desai, W. Tekle","doi":"10.1177/15910199221104633","DOIUrl":"https://doi.org/10.1177/15910199221104633","url":null,"abstract":"BACKGROUND AND PURPOSE\u0000Angioplasty and stenting is a treatment option for patients with medically refractory symptomatic intracranial atherosclerotic disease (sICAD). Currently the Wingspan Stent System (WSS) is the only FDA approved device for this indication. We find the Resolute (R) Onyx Stent, a drug-eluting balloon mounted stent (DES), a better alternative to the WSS for treatment of sICAD. Herein, we present our findings comparing the two stents based on our single center experience.\u0000\u0000\u0000METHODS\u0000A prospectively maintained neuro-endovascular databased was queried for patients between January 2013 to June 2021. Inclusion criteria for patients included sICAD with failed medical management, and intracranial stenting with either R-Onyx DES or WSS, including patients treated within 7 days of their last stroke. Primary outcomes were assessed via the occurrence of ischemic or hemorrhagic stroke or death within 72 h of the procedure. Secondary outcomes consisted of recurrent stroke or significant in-stent restenosis evaluated by a clinical or angiographic follow-up at 6 months.\u0000\u0000\u0000RESULTS\u0000A total of 184 patients, average age 61.26 (SD = 12.53) (44% women), were eligible for analysis with 58 having R-onyx DES and 126 having WSS. Within 72 h, the primary outcome was observed in 1.7% (n = 1) of patients in the R-onyx DES group and 6.3% (n = 8) of patients in the WSS group (p = 0.089). Among 41 angiographic and clinical follow-ups in the R-onyx DES group, none had a recurrent stroke, while among 101 patients who had follow-up in the WSS group, 8.9% (n = 9) had a stroke (p = 0.024). At a 6-month angiographic follow-up, there was a significantly lower rate of symptomatic in-stent restenosis among the R-onyx DES group with 1.7% (n = 1) compared with 21.4% (n = 27) in the WSS group (p = 0.0003).\u0000\u0000\u0000CONCLUSION\u0000R-onyx DES is more effective than WSS in treating sICAD with low rates of periprocedural complications and long-term strokes and symptomatic in-stent restenosis. Future prospective randomized multicenter trials are needed.","PeriodicalId":126264,"journal":{"name":"Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences","volume":"152 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115113629","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 : 2022-05-29DOI: 10.1177/15910199221105175
F. Akbik, H. Saad, J. Grossberg, F. Tong, C. Cawley, B. Howard
Aneurysmal recurrence after successful flow-diversion embolization is exceptionally rare. The rarity of recurrence has called into question the yield of interval surveillance imaging. Here we report the case of a recurrent intracranial aneurysm despite complete angiographic resolution after flow-diversion therapy with a Pipeline embolization device (PED). Given the absence of poor wall apposition, endoleak, and device migration, how this aneurysm recurred remains unclear, particularly given the recurrence was at a timepoint at which complete reendothelialization of the device would be expected. The patient ultimately underwent interval treatment with a second device placed across the neck of the aneurysm. Although rare, reports of aneurysmal recurrences support the use of interval non-invasive imaging surveillance to ensure successful embolization in this patient population.
{"title":"Aneurysmal recurrence after successful flow-diversion embolization.","authors":"F. Akbik, H. Saad, J. Grossberg, F. Tong, C. Cawley, B. Howard","doi":"10.1177/15910199221105175","DOIUrl":"https://doi.org/10.1177/15910199221105175","url":null,"abstract":"Aneurysmal recurrence after successful flow-diversion embolization is exceptionally rare. The rarity of recurrence has called into question the yield of interval surveillance imaging. Here we report the case of a recurrent intracranial aneurysm despite complete angiographic resolution after flow-diversion therapy with a Pipeline embolization device (PED). Given the absence of poor wall apposition, endoleak, and device migration, how this aneurysm recurred remains unclear, particularly given the recurrence was at a timepoint at which complete reendothelialization of the device would be expected. The patient ultimately underwent interval treatment with a second device placed across the neck of the aneurysm. Although rare, reports of aneurysmal recurrences support the use of interval non-invasive imaging surveillance to ensure successful embolization in this patient population.","PeriodicalId":126264,"journal":{"name":"Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences","volume":"25 11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131683411","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：