Interventional Neuroradiology最新文献

Introduction: Reversible cerebral vasoconstriction syndrome (RCVS) can present with hemorrhage, ischemia, or both. We aim to compare the differences in presentation and outcomes between patients with RCVS.

Methods: The hemorrhagic presentation group had 58 patients, and the non-hemorrhagic presentations had 30 patients. Subgroup analysis compared patients with evidence of one or more types of hemorrhage (n = 53), no evidence of hemorrhage or infarction (n = 23), evidence of infarction only (n = 7), and combination of hemorrhage and infarction (n = 5). Clinical and radiographic data were analyzed.

Results: Migraine (p = 0.030) and intracranial tumors (p = 0.004) were more frequent in non-hemorrhagic presentation. Seizures on admission (p = 0.047) and higher than average C-reactive protein (CRP) (p = 0.037) were seen at a higher rate in patients with hemorrhagic presentation. RCVS2 scores were not unexpectedly higher in patients with hemorrhage than non-hemorrhagic presentations (p = 0.010). Outcomes between the hemorrhagic and non-hemorrhagic groups were comparable. Subgroup analysis found a higher subset of patients with opiate use (p = 0.046) in the hemorrhage-only group. Patients with hemorrhage presented with a thunderclap headache (p < 0.001) more often when compared to the other three groups. RCVS2 score was not unexpectedly higher in the hemorrhage-only group compared with the other groups (p = 0.004).

Conclusion: A history of migraines was associated with ischemia, while intracranial tumor was significantly associated with evidence of either an infarct, or no changes on imaging. Exposure to opiates, and seizures or thunderclap headache on presentation were associated with hemorrhage. If our data are reproducible, the RCVS2 score may benefit from inclusion of other, small hemorrhages as criterion for diagnosis for RCVS.

Purpose: Contact aspiration mechanical thrombectomy (CAMT) with 0.088-inch catheters may improve first-pass success rates, but delivery of such catheters can be challenging and limit effectiveness. This study examines the initial multicenter experience using the FreeClimb 88 catheter paired with the Tenzing 8 delivery catheter.

Materials and methods: Retrospective analysis was performed of consecutive patients with large vessel occlusion (LVO) of the internal carotid artery (ICA) or M1 segment of the middle cerebral artery treated with off-label CAMT using the FreeClimb 88 and Tenzing 8 at eight sites participating in the early limited release for these devices. Demographic and procedural variables were collected and analyzed with descriptive statistics and multivariable analysis.

Results: Fifty-three consecutive patients were treated. Large vessel occlusion was located in the ICA in 19/53 (35.8%) patients; 34/53 (64.2%) were in the M1 segment. FreeClimb 88 was successfully delivered to the site of occlusion in 50/53 (94.3%) of patients. First-pass TICI 2c or 3 was achieved with FreeClimb 88 delivered by Tenzing 8 in 36 (67.9%) cases. Among cases with successful FreeClimb 88 delivery 9/50 (18.0%) required additional smaller devices to perform thrombectomy of distal occlusions after recanalization of the initial LVO. No complications or symptomatic hemorrhages occurred following thrombectomy.

Conclusion: Contact aspiration mechanical thrombectomy performed for ICA or M1 LVOs using FreeClimb 88 delivered with Tenzing 8 was safe, effective, and efficient in this early experience, with first-pass TICI 2c or 3 was achieved in 68% of patients without procedural complications occurring in any cases.

Dural arteriovenous fistulas (dAVFs) can occur as complications after surgical procedures, especially following the resection of meningiomas near the dural sinus. This case report presents a 74-year-old male who developed a recurrent sigmoid dAVF following meningioma resection. Initially treated with transvenous embolization and middle meningeal artery embolization, the dAVF recurred with worsening clinical symptoms. Conventional treatment options, including sinus sacrifice and transarterial embolization, were unsuitable due to the critical role of the patient's dominant right sigmoid sinus in cerebral venous drainage. Consequently, a reconstructive approach was employed using a pipeline embolization device (PED) construct. The PED successfully occluded the dAVF while preserving the function of the sigmoid sinus. A follow-up angiogram confirmed stable occlusion and normalization of intracranial venous drainage. This case underscores the potential of flow diversion as a viable treatment option for dAVFs, particularly in scenarios where preserving venous sinus function is paramount.

Introduction: Endovascular thrombectomy (EVT) is the standard of care for selected patients with acute ischemic stroke (AIS) and large vessel occlusion (LVO), associated with intravenous thrombolysis, when indicated. While many studies focused on pre-hospital and in-hospital pathways, only few analyzed the relationship between groin-to-recanalization (GTR) time and functional outcome.

Aim: To explore whether GTR time is an independent predictor of outcome in patients undergoing EVT.

Methods: All patients with anterior circulation stroke treated with EVT at a high-volume center from January 2021 to December 2023 were included. The cohort was divided into two groups according to GTR time shorter or longer than 30 min. Regression analysis assessed the association between GTR time and 3-month good outcome, defined as modified Rankin Scale 0-2.

Results: The study included 419 patients. The groups had similar baseline characteristics and similar onset to recanalization (OTR) time. Regression analysis showed shorter GTR time is an independent predictor of favorable outcome (OR 2.49 [95% CI 1.26-4.94]). Age, baseline NIHSS, ASPECT score and bridging IVT were also found to be independently associated with outcome.

Discussion and conclusions: Our study showed GTR time is an independent predictor of good outcome in patients undergoing EVT with similar OTR time, emphasizing procedural time as a key prognostic factor, even greater than other well-known pre-hospital and in-hospital time-dependent variables. These findings may raise the issue of developing alternative approaches or early "rescue" strategies for complicated procedures.

Idiopathic intracranial hypertension (IIH) is traditionally characterized by elevated intracranial pressure without an identifiable cause, primarily affecting obese women. However, recent evidence suggests that venous sinus stenosis may play a significant role in the pathophysiology of IIH, challenging its designation as "idiopathic." This editorial discusses the limitations of the current nomenclatures and diagnostic criteria, highlighting the importance of routine venography in detecting venous sinus abnormalities, irrespective of a patient's demographic profile. We propose a new nomenclature of this subset of patients to venous sinus stenosis intracranial hypertension in order to promote more accurate diagnosis and targeted treatment, including potential endovascular interventions.

Objective: Flow diverters (FD) are innovative treatments for wide-neck intracranial aneurysms. After-treatment verification of embolization and parent vessel patency is crucial. While evaluation using time-of-flight magnetic resonance angiography (TOF-MRA) is useful, it suffers from signal loss within the FD due to susceptibility effects. This study evaluates the usefulness of ultrashort echo time MRA (UTE-MRA) for after-FD assessment compared to TOF-MRA.

Methods: Vascular phantom experiments were conducted using FDs (FRED^®, Pipeline^®, Surpass Streamline^®). TOF-MRA and UTE-MRA were performed under steady (10, 30, 50 cm/s) and pulsatile (17-61 cm/s, mean 34 cm/s) flow conditions using a 3 T MRI system. As evaluation metrics, relative in-FD signal (RIS) was calculated by comparing the signal intensity inside the FD to that without the FD to assess signal retention, and FD luminal to background signal ratio (FD-LBR) was calculated by comparing the signal intensity inside the FD to that of the surrounding background to evaluate vessel visibility.

Results: UTE-MRA showed higher FD-LBR values than TOF-MRA for all FDs (p < 0.01). For RIS, UTE-MRA was significantly higher for FRED^® (p < 0.01), but different for other FDs except at 50 cm/s. FRED^® exhibited the highest RIS and FD-LBR values under all conditions, followed by Pipeline^® and Surpass Streamline^®. Flow velocity changes resulted in minimal variations in RIS and FD-LBR values.

Conclusion: UTE-MRA provides superior image quality for after-FD assessment, particularly in terms of FD-LBR, compared to TOF-MRA. Differences in FD materials and structures affect image quality. These findings suggest UTE-MRA's clinical utility in follow-up after-FD assessment.