Interventional Neuroradiology最新文献

Background8F catheters serve as conduits to provide stable access and support for delivery of 6F aspiration catheters (ACs) in Acute Ischaemic Stroke treatment. Superbore catheters (SBCs) (internal diameter (ID) > 0.088″) are the latest innovation, designed for placement in the middle cerebral artery (MCA). SBCs may improve recanalization via enhanced control of blood pressure and flow, in comparison to balloon guide catheter (BGC) and regular guide catheter (GC) systems.AimTo objectively assess conduit catheter technologies in terms of deliverability, local impact on blood pressure and flow, and clot retrieval success in vitro.MethodsTwo in vitro models were used. Two SBCs, (CEREGLIDE92 and TracStar/Zoom88) and one BGC (EMBOGUARD) were used with 0.071″ ACs, and one GC (NeuronMAX) was evaluated with two 6F ACs (RED68 and SOFIA). M1-MCA occlusions were created with cohesive and friable thrombus analogues. Device tracking and clot retrieval were evaluated by two neurointerventionalists, under physiological haemodynamic conditions.ResultsSBC positioning in the MCA resulted in significant reductions of local blood pressure and flow in comparison to GC systems positioned in the Internal Carotid Artery (p = .000). However, when the SBC could not reach the MCA, they displayed similar haemodynamic control as the GC systems. SBC systems achieved high retrieval success for friable thrombi, likely due to flow reversal in the MCA during aspiration (p = .000). The TracStar/Zoom SBC system had lower rates of cohesive retrieval success due to difficulties in catheter tracking and poor clot alignment with the catheter bevelled tip.ConclusionClot retrieval success is influenced by the location of the conduit for the 6F AC and the design of the AC tip.

IntroductionIn recent decades, neurovascular practice has shifted from open surgical procedures to interventional neuroradiology. Within this evolving landscape, two journals-Interventional Neuroradiology (INR) and Journal of NeuroInterventional Surgery (JNIS)-have become central platforms for disseminating impactful research.MethodsA bibliometric analysis was conducted using the Scopus database to identify the 500 most cited articles published in Interventional Neuroradiology (INR) and the Journal of NeuroInterventional Surgery (JNIS). Each article was categorized by study type, procedure, and pathology. Bibliometric data were analyzed using R and VOSviewer to map influential studies and collaborative networks within the field.ResultsA total of 6813 articles were screened. The 500 most cited, comprising 439 from JNIS and 61 from INR, were analyzed. Citation counts averaged 70.71 per article, with the top-cited study reaching 371 citations. A marked increase in high-impact publications occurred from 2020 to 2024, reflecting growing output in the field. The United States led in total publications and citations. Trending topics evolved from early focuses on pediatric cases and aneurysms to current emphases on stroke, thrombectomy, flow diverters, and artificial intelligence. This was confirmed by keyword analysis, demonstrating the dominance of cerebrovascular pathology and minimally invasive techniques in recent neurointerventional research.ConclusionThis analysis highlights the central role of ischemic stroke and aneurysm treatment in neurointervention, with thrombectomy and endovascular therapies driving clinical advances. The field shows increasing global engagement and a shift toward higher-level evidence, reflecting its maturation. While foundational studies remain influential, recent research is poised to define future directions and innovation.

BackgroundSocioeconomic status (SES) has long been recognized as an important determinant of ischemic stroke outcomes, with increased stroke severity and mortality found in patients with lower SES. However, the impact of SES on outcomes post-endovascular thrombectomy in Canada remains largely unknown.MethodsThis study is a retrospective cohort analysis of patients from 2015-2024 who received endovascular thrombectomy for large vessel occlusion in Manitoba, Canada (study catchment area 650,000 km², population 1.4 million). Patient residence postal codes were matched with neighborhood-level socioeconomic factors using the Canadian Material and Social Deprivation Index and the Canadian Index of Multiple Deprivation (CIMD). Regression analyses adjusting for baseline demographics, geographic variables, presenting National Institutes of Health Stroke Scale (NIHSS), and time to angiography were conducted to analyze the association between socioeconomic factors and a binarized 90-day modified Rankin Scale (mRS).ResultsOverall, 793 patients (51% females, median age 74 years) were included. Unadjusted analyses showed a positive association between poor clinical outcomes and increased economic dependency scores in the CIMD index (OR = 1.18 [95%CI 1.03, 1.37]), as well as decreased CIMD ethno-cultural composition scores (OR = 0.84 [0.73-0.98]). Adjusted analysis did not show consistent associations between procedural outcomes or functionally independent outcomes at 90 days.InterpretationThis Canadian provincial stroke registry study showed SES-related discrepancies in stroke outcomes on an unadjusted basis, but no definite discrepancies after adjustment for age, presenting severity, and time to angiography. These findings suggest that SES-related differences in these variables mediate the observed relationship between SES and poor clinical outcomes.

PurposeAneurysms at the origin of the fetal posterior cerebral artery (fPCA) often show fPCA bifurcation from the aneurysm dome, impeding complete embolization and dense coil packing. The recanalization rate for fPCA aneurysms is therefore high. This study aimed to evaluate the efficacy and safety of stenting into fPCA for aneurysms with fPCA incorporated into the aneurysm to determine whether stenting can provide effective embolization results and prevent recanalization.MethodsA total of 19 consecutive coil embolization procedures between February 2012 and June 2022 for unruptured fPCA aneurysms with fPCA branching from the dome of the aneurysm were divided into two groups: non-stenting (NS) group (n = 11) and stenting into fPCA (PS) group (n = 8). Data were obtained retrospectively and compared regarding embolization results, complications, and recanalization.ResultsCompared with the NS group, the PS group achieved significantly higher complete occlusion rate and packing density (p < 0.001, p = 0.01, respectively). No symptomatic complications were observed in the PS group. Both immediately after stenting and at the 1-year follow-up, no stent kinking, stenosis, occlusion, or malposition were observed in any patients in the PS group. During 1-year follow-up, the cumulative minor and major recanalization-free rate after coil embolization for fPCA aneurysms were significantly higher in the PS group compared with the NS group (p = 0.022, 0.0024, respectively).ConclusionStenting into fPCA for aneurysms with fPCA incorporated into the aneurysm achieved high-density complete embolization without increasing complications, and prevented recanalization. The fPCA stent-assisted coil embolization can offer an alternative treatment for fPCA aneurysms.

ObjectiveThe primary outcome measure used in mechanical thrombectomy (MT) trials is the modified Rankin Scale (mRS). However, the accuracy of mRS might be limited. On the other hand, the functional independence measure (FIM) is a widely used tool to quantify the extent to which patients require assistance during their activities of daily living. The current study aimed to reveal different clinical backgrounds that affect the efficacy of MT measured either by mRS or FIM.MethodsPatients who underwent MT at our institution from January 2019 to July 2022 were included and divided into groups based on mRS scores of 0-2 and ≥ 3. Patients were also divided into two groups based on a cut-off value of FIM of ≥ 108, as patients with FIM ≥ 108 are capable of living an independent life.ResultsThe mRS score was 0-2 in 33% of the patients, while the FIM score was ≥ 108 in only 15% of the patients. In the mRS groups, there were significant differences in terms of duration of hospitalization, National Institutes of Health Stroke Scale (NIHSS) scores, achievement of thrombolysis in cerebral infarction (TICI) reperfusion grade of 2b or 3, and postoperative bleeding. Multivariate logistic regression analysis revealed that NIHSS score and achievement of TICI 2b or 3 were significant factors related to mRS 0-2 at discharge. The FIM groups differed significantly in terms of age and, duration of hospitalization, NIHSS score, although multivariate logistic regression analysis revealed that only the NIHSS score was significantly associated with an FIM score of ≥ 108.ConclusionThe study showed that the percentage of independent patients is significantly reduced when we evaluated the patients by the FIM. In addition, there are some differences in the clinical background that led to a good outcome between that evaluated by mRS and FIM.

BackgroundBalloon-assisted deployment/remodelling is a proven adjunctive technique for coil embolization of intracranial aneurysms, and it may be a helpful adjunct in delivering the Woven EndoBridge (WEB) device.ObjectiveTo evaluate the safety, efficacy and feasibility of balloon-assisted WEB deployment in both ruptured and unruptured intracranial aneurysms in both typical and atypical locations.MethodsPatients who underwent treatment of ruptured and unruptured intracranial aneurysms with the BAWD technique were retrospectively identified from a prospectively maintained database at two neurointerventional centres. Patient demographics, aneurysm characteristics, technical procedure details, clinical and imaging outcomes were reviewed.ResultsThirty-three aneurysms (23 women) were identified with a median age of 58 years. There were 15 (45.5%) ruptured aneurysms, 25 (64.3%) in the anterior circulation and 12 (36.4%) aneurysms having an atypical location for WEB treatment. The average aneurysm size was 6.8 mm (greatest dimension), 4.6 mm (height) and 4.5 mm (width), and 25 (75.8%) aneurysms had a wide neck morphology. One patient died (3.0%) secondary to a procedure-related complication, and there was no procedure-related permanent morbidity. Complete and adequate aneurysm occlusion on mid-term follow-up DSA was 85.2% and 92%, respectively.ConclusionBalloon-assisted WEB deployment appears to be a safe and effective technique that may increase the utility of the WEB device. Further prospective studies on BAWD should be considered.

BackgroundThe occurrence of persistent intra-device filling (BOSS 1, using the Bicêtre Occlusion Scale Score (BOSS)) in aneurysms treated with a Woven Endobridge (WEB) device is infrequent based on angiographic follow-up. To date, three monocentric case series were published studying BOSS 1 cases. Through a multicenter retrospective study, we aimed to report the incidence, and risk factors of intra-WEB persistent filling.MethodsWe reached out to European academic centers that treat patients using WEB devices and requested de-identified data of patients treated with a WEB device and underwent angiographic follow-up, at least 3 months after embolization, to assess the BOSS 1 occlusion score. We compared baseline characteristics, treatment modalities, and aneurysm data of the included BOSS 1 patients with those of a control group consisting of non-BOSS 1 patients (n = 116) who had an available angiographic follow-up. Univariable and multivariable models were employed for analysis.ResultsAmong the pooled sample of 591 aneurysms treated with WEB, the rate of persistent flow (BOSS 1) at angiographic follow-up was 5.2% (n = 31 out of 591), performed after an average of 8.7 ± 6.3 months. In the multivariable-adjusted analysis, dual antiplatelet therapy in the postoperative period (adjusted odds ratio [aOR] 4.3 [95% CI 1.3-14.2]), and WEB undersizing (aOR 10.8 [95% CI 2.9-40]) were independently associated with a BOSS 1 persistent flow result.ConclusionPersistent blood flow within the WEB device during angiographic follow-up (BOSS 1) is an uncommon occurrence. Our findings indicate that post-procedural dual antiplatelet therapy and undersizing of the WEB device are independently associated with the presence of BOSS 1 at follow-up.

IntroductionMiddle meningeal artery embolization (MMAE) has emerged as a promising new treatment for patients with chronic subdural hematomas (cSDH). Its efficacy, however, upon the subtype with a high rate of recurrence-septated cSDH-remains undetermined.MethodsFrom our prospective registry of patients with cSDH treated with MMAE, we classified patients based on the presence or absence of septations. The primary outcome was the rate of recurrence of cSDH. Secondary outcomes included a reduction in cSDH thickness, midline shift, and rate of reoperation.ResultsAmong 80 patients with 99 cSDHs, the median age was 68 years (IQR 59-77) with 20% females. Twenty-eight cSDHs (35%) had septations identified on imaging. Surgical evacuation with burr holes was performed in 45% and craniotomy in 18.8%. Baseline characteristics between no-septations (no-SEP) and septations (SEP) groups were similar except for median age (SEP vs no-SEP, 72.5 vs. 65.5, p = 0.016). The recurrence rate was lower in the SEP group (SEP vs. no-SEP, 3 vs. 16.7%, p = 0.017) with higher odds of response from MMAE for septated lesions even when controlling for evacuation strategy and antithrombotic use (OR = 0.06, CI [0.006-0.536], p = 0.012). MMAE resulted in higher mean absolute thickness reduction (SEP vs. no-SEP, -8.2 vs. -4.8 mm, p = 0.016) with a similar midline shift change. The rate of reoperation did not differ (6.2 vs. 3.1%, p = 0.65).ConclusionMMAE appears to be equal to potentially more effective in preventing the recurrence of cSDH in septated lesions. These findings may aid in patient selection.

There are multiple treatment alternatives for cavernous dAVFs, with transvenous routes being most common. Among these routes, occluded inferior petrosal sinus is well-described, and, apart from being imaginative and elegant, it is also safe and effective. Herein we describe the application of this method to reach the fistulous pouch of a cavernous dAVF via an occluded superior petrosal sinus.

BackgroundCervicofacial arteriovenous malformations (AVMs) are a significant source of morbidity. Endovascular embolization has emerged as a promising treatment technique for these lesions. However, current literature on cervicofacial AVM embolization mostly consists of single-agent oriented case series, and to date, no comprehensive study has compared the outcomes of available embolic agents.PurposeTo investigate the performance of different embolic agents in the management of cervicofacial AVMs.MethodsWe systematically searched Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials Scopus, and Web of Science. Studies providing data for the endovascular treatment of cervicofacial AVMs were included. The data regarding complication and cure rates were collected for each embolic agent. Pooled event rates were presented as descriptive statistics.ResultsEleven studies comprising 204 patients were included in the review. The overall complete and partial cure rates were 62.2% (127/204) and 36.2% (74/204), respectively. Embolization failed to achieve significant improvement in only 1.6% (3/204) of the patients. The complete cure rates were 87.5% (75-100%) for n-Butyl cyanoacrylate (NBCA, glue), 80.5% (61-100%) for Onyx (Medtronic, MN, USA), and 51.5% (18-85%) for ethanol. The overall complication rate was 30% (61/204). The complication rates were 33% (12.5-53%) for ethanol, 14% (0-28%) for Onyx, and 0% for NBCA.ConclusionsOur systematic review supports that endovascular embolization is an effective treatment option for cervicofacial AVMs. In our review, the use of Onyx and NBCA was associated with consistently high complete cure rates and a promising safety profile. However, more research is needed to investigate the use of different embolic agents in the treatment of cervicofacial AVMs.