Interventional Neuroradiology最新文献

PurposeNeurointervention via transradial access (TRA) is less invasive than via transfemoral access. However, radial artery occlusion (RAO) may occur with TRA. The purpose of this study was to explore risk factors for RAO after coil embolization of unruptured intracranial aneurysms (UIAs) via TRA.MethodsForty-two consecutive patients who underwent coil embolization for UIAs via TRA between March 2021 and March 2022 and were available for angiographic evaluation 1 year after treatment were retrospectively reviewed. Multivariate logistic regression analysis was conducted to identify potential risk factors for RAO.ResultsSeventeen (40%) of the 42 patients showed RAO. Compared with the non-RAO group, radial artery size was significantly smaller (2.2 mm [interquartile range (IQR): 2.1, 2.4 mm] vs 2.6 mm [IQR: 2.5, 2.7 mm]; p = 0.001) and the incidence of radial artery spasm (RAS) was significantly higher in the RAO group. Multivariate analysis identified radial artery size (odds ratio [OR] 4.9 × 10^-3, 95% confidence interval [CI] 6.4 × 10^-5-0.38) and incidence of RAS (OR 14.8, 95%CI 2.1-105) as significant independent predictors of subsequent RAO. Based on receiver operating characteristic (ROC) curve analysis, the optimal cutoff for radial artery size was 2.5 mm (sensitivity, 82.4%; specificity, 76.0%; area under the ROC curve, 0.80 [95%CI 0.66-0.95]).ConclusionRadial artery size and RAS represent reliable parameters for predicting RAO 1 year after coil embolization for UIA via TRA. Prophylaxis against RAS and limiting neurointervention via TRA to patients with radial artery larger than 2.5 mm in diameter may reduce the risk of postoperative RAO.

Background and purposeTreating aneurysms with intra-saccular flow disruption is a feasible alternative to coil-embolization. Besides the established WEB device, the novel Contour Neurovascular System has emerged as a potentially easier alternative regarding sizing and deployment. We report the learning curve experienced at our center from the first 48 patients treated with Contour and compared it with 48 consecutive WEB cases.MethodsBoth groups were compared concerning intervention time, sizing failures leading to device changes and radiation dose. Additionally, we analyzed potential learning effects by comparing the first 24 Contour cases with our last 24 Contour cases and WEB cases respectively.ResultsPatient demographics, acute vs. incidental cases and aneurysm localization were comparable in both groups. The deployment time was faster in our 48 Contour cases (median: 22.0 ± 17.0 min), than in the WEB group (median: 27.5 ± 24.0 min). Total intervention time was similar for Contour (median: 68.0 ± 46.9 min) and WEB cases (median: 69.0 ± 38.0 min). Device implantation times in our WEB cases were slightly shorter in the later cases (median: 25.5 ± 24.1 min) than in the earlier (median: 28.0 ± 24.4 min) cases. In the Contour cohort, deployment times were similar for the first 24 cases (median: 22.0 ± 14.5 min) and the final 24 (median: 22.0 ± 19.4 min). Radiation dose was lower in the Contour group (1469.0 ± 1718 mGy*cm² vs. 1788.0 ± 1506 mGy*cm² using the WEB device). Less intra-procedural device changes were performed in the Contour cohort (6 of 48 cases, 12.5%), than in the WEB group (8 of 48 cases, 16.7%).ConclusionAneurysm occlusion times and consequently radiation doses, as well as the amount of device changes were lower in the Contour group. Occlusion times did not differ in the first and last 24 Contour cases, leading to the assumption that the handling of Contour does not require extended training. A short training effect in occlusion times was noted, however, between the first and last WEB cases as shorter procedure times were seen in the latter cases.

The invested effort and collaboration of clinicians and medical device companies to improve occlusion rates and clinical outcomes for patients with intracranial aneurysms treated via less invasive endovascular means led to the development of the concept of intrasaccular devices. Intrasaccular devices were introduced to offer simple treatment options, offering easier navigation through difficult anatomy, simpler and quicker deployment into large and wide-neck aneurysms. Additionally, they offer easier sizing, whilst offering a wide range of options suitable for aneurysms of different sizes. The concept of most intrasaccular devices is to occupy the aneurysm neck, however offering better stability than simple coiling, therefore increasing the chance of long-term aneurysm occlusion. This is achieved without a sizable metal content within the parent vessel, contrary to flow diverters, theoretically reducing the risk of thromboembolic events. This review aims to discuss the history and latest developments of intrasaccular intracranial devices, which offer an exciting and potentially successful option for treatment of complex intracranial aneurysms.

BackgroundEndovascular coiling of small, intracranial aneurysms remains controversial and difficult, despite advances in technology.MethodsWe retrospectively reviewed data for 62 small aneurysms (<3.99 mm) in 59 patients. Occlusion rates, complications rates, and coil packing densities were compared between subgroups based upon coil type and rupture status.ResultsRuptured aneurysms predominated (67.7%). Aneurysms measured 2.99 ± 0.63 mm by 2.51 ± 0.61 mm with an aspect ratio of 1.21 ± 0.34 mm. Brands included Optima (Balt) (29%), MicroVention Hydrogel (24.2%), and Penumbra SMART (19.4%) coil systems. Average packing density was 34.3 ± 13.5 mm³. Occlusion rate was 100% in unruptured aneurysms; 84% utilized adjuvant devices. For ruptured aneurysms, complete occlusion or stable neck remnant was achieved in 88.6% while recanalization occurred in 11.4%. No rebleeding occurred. Average packing density (p = 0.919) and coil type (p = 0.056) did not impact occlusion. Aspect ratio was smaller in aneurysms with technical complications (p = 0.281), and aneurysm volume was significantly smaller in those with coil protrusion (p = 0.018). Complication rates did not differ between ruptured and unruptured aneurysms (22.6 vs. 15.8%, p = 0.308) or coil types (p = 0.830).ConclusionDespite advances in embolization devices, coiling of small intracranial aneurysms is still scrutinized. High occlusion rates are achievable, especially in unruptured aneurysms, with coil type and packing density suggesting association with complete occlusion. Technical complications may be influenced by aneurysm geometry. Advances in endovascular technologies have revolutionized small aneurysm treatment, with this series demonstrating excellent aneurysm occlusion especially in unruptured aneurysms.

BackgroundEmergent neuroendovascular stenting presents challenges for the utilization of antiplatelet agents.MethodsThis was a multicenter, retrospective cohort of patients who underwent emergent neuroendovascular stenting. The primary endpoints were thrombotic and bleeding events in relation to the timing of antiplatelet administration, route of administration, and choice of intravenous (IV) agent and the study investigated practice variability in antiplatelet utilization.ResultsFive-hundred and seventy patients were screened across 12 sites. Of those, 167 were included for data analysis. For patients who presented with ischemic stroke, artery dissection and emergent internal carotid artery (ICA) stenting who received an antiplatelet agent prior to or during the procedure, 57% were given an IV antiplatelet agent; for patients who were given an antiplatelet agent after the procedure, 96% were given an oral agent. For patients who presented for aneurysm repair and received an antiplatelet agent prior to or during the procedure, 74% were given an IV agent; patients who were given an antiplatelet agent after the completion of the procedure were given an oral antiplatelet agent 90% of the time. In patients who presented with ischemic stroke, artery dissection and emergent ICA stenting who received oral antiplatelet agents post-procedure were more likely to have thrombotic events compared to those who received oral antiplatelet agents prior to or during the procedure (29% vs 9%; p  =  0.04). There were no differences in the primary outcomes observed when comparing other antiplatelet treatment strategies.ConclusionThe optimal timing of antiplatelet administration in relation to stent placement and route of administration of antiplatelet agents is unclear. Timing and route of administration of antiplatelet agents may have an effect on thrombosis in emergent neuroendovascular stenting. Significant practice variation exists in antiplatelet agent utilization in emergent neuroendovascular stenting.

BackgroundBilateral and simultaneous occlusion of the anterior circulation is a rare event in patients with acute ischemic stroke. Although endovascular treatment is feasible and safe, the endovascular strategy to be used remains a subject of debate.ObjectiveTo assess the different endovascular strategies proposed for the treatment of a bilateral, simultaneous anterior circulation occlusion following acute ischemic stroke.MethodsWe present a retrospective study of the clinical and radiological records of all patients with a bilateral, simultaneous anterior circulation occlusion treated at our center between January 2019 and December 2022. Following the PRISMA guidelines, we also conducted a systematic review of the literature.ResultsTwo patients with a bilateral and simultaneous middle cerebral artery occlusion were treated at our center during the study period. A TICI score ≥2b was obtained in 4 out of 4 occlusions. Modified Rankin Scale (mRS) at 90 days was 0 and 4, respectively. The literature review retrieved reports on 22 patients. The most frequent bilateral occlusion sites were internal carotid artery-middle cerebral artery. The clinical presentation was severe in most patients. A combined thrombectomy technique proved to have the highest number of first-pass recanalization. A TICI ≥2b was obtained in 95% of patients and an mRS ≤2 was found in 31.8% of patients.ConclusionsIn patients with bilateral and simultaneous occlusion of the anterior circulation, endovascular treatment using a combined technique appears to be rapid and effective. The clinical evolution of this patient population strongly depends on the severity of the onset symptoms.

BackgroundGuide catheter (GC) placement, whether distal or proximal, may influence the efficacy and safety of mechanical thrombectomy (MT) for acute ischemic stroke (AIS) due to large vessel occlusion (LVO). However, definitions of placement and procedural strategies vary across studies, limiting clarity.MethodsWe systematically searched PubMed, Embase, Scopus, and Web of Science from inception to September 1, 2024. Comparative studies of adult patients with anterior circulation AIS-LVO undergoing MT that reported GC placement were included. Both balloon GCs (BGCs) and non-BGCs were eligible. Data were pooled using random-effects models in R. Outcomes included functional independence (modified Rankin Scale 0-2 at 90 days), successful reperfusion (modified thrombolysis in cerebral infarction ≥2b or expanded thrombolysis in cerebral infarction ≥2c), first-pass recanalization (FPR), mortality, puncture-to-recanalization (PTR) time, and complications. Subgroup analyses were performed by thrombectomy technique and catheter type.ResultsSeven retrospective studies comprising 2148 patients (1042 proximal, 1106 distal) were analyzed. Distal placement was associated with higher rates of functional independence (risk ratio (RR): 1.25, 95% confidence interval (CI): 1.10-1.42), successful reperfusion (RR: 1.13, 95% CI: 1.04-1.22), and FPR (RR: 1.35, 95% CI: 1.15-1.58), as well as lower 90-day mortality (RR: 0.52, 95% CI: 0.28-0.82). PTR time was shorter with distal placement (mean difference: -7.7 min, 95% CI: -10.8 to -4.6). No significant differences were observed for symptomatic intracranial hemorrhage (RR: 0.96, 95% CI: 0.55-1.65) or emboli to new territory (RR: 0.84, 95% CI: 0.28-2.52). Benefits were consistent across both BGCs and non-BGCs. Heterogeneity existed in outcome definitions and techniques, and publication bias could not be excluded.ConclusionsDistal GC placement is associated with improved reperfusion, efficiency, and functional outcomes in MT for anterior circulation AIS-LVO, without increased complications. Given the retrospective nature of included studies, anatomic confounding, and inconsistent outcome definitions, findings should be considered preliminary. Multicenter trials are needed to confirm whether catheter position independently predicts MT outcomes.

BackgroundThe Tigertriever (Rapid Medical, Israel) is the first manually expandable stent retriever, designed to enhance clot engagement and vessel wall apposition. Despite increasing use, comparative data with the widely adopted Solitaire X device (Medtronic, USA) are limited. This study aimed to compare the safety and efficacy of Tigertriever versus Solitaire in mechanical thrombectomy (MT) for acute ischemic stroke due to large vessel occlusion.MethodsWe retrospectively analyzed 346 MT procedures (May 2019-September 2024). Patients treated with Tigertriever or Solitaire X (with/without aspiration) were matched 1:1 using a nearest-neighbor approach based on age, National Institutes of Health Stroke Scale, Alberta Stroke Program Early CT Score, and occlusion site. Outcomes included procedural safety (complications, hemorrhage, mortality) and efficacy (number of passes, time to reperfusion, final modified treatment in cerebral infarction, and 3-month modified Rankin Scale) were compared, with propensity score adjustment applied in the analyses.ResultsIn total, 268 matched patients (134 per group) were included. Baseline characteristics were balanced, except that Tigertriever patients had longer onset-to-puncture times and more cardioembolic strokes. The Solitaire X group demonstrated a significantly higher first-pass recanalization rate (p = 0.03; adjusted odds ratio (OR) = 1.82, 95% confidence interval (CI): 1.02-3.23, p = 0.04) and required fewer device passes to achieve successful reperfusion (p < 0.001; adjusted OR = 0.19, 95% CI: 0.06-0.56, p = 0.002). In atherosclerotic occlusions, Tigertriever tended to have higher reperfusion and first-pass success rates and better 3-month outcomes. Overall, 90-day functional outcomes did not differ significantly.ConclusionsTigertriever and Solitaire demonstrated comparable 3-month functional outcomes, though procedural profiles and subgroup advantages differed. Further randomized trials are warranted.

BackgroundIntracranial aneurysms are increasingly detected incidentally due to broader use of neuroimaging. Intrasaccular devices are frequently used to prevent rupture, yet standardized follow-up and retreatment strategies remain undefined. We performed a scoping literature review and DELPHI consensus to gauge current practice patterns and expert opinions on managing intracranial aneurysms that were previously treated with intrasaccular devices.MethodsA DELPHI consensus was conducted during an invite-only meeting of international neurointerventional experts. The process was informed by a scoping literature review and included three iterative rounds of structured questionnaires to establish consensus on follow-up imaging timing, modality, and retreatment decision-making.ResultsTwenty-four experts participated. The literature review identified 16 key studies, which were presented to the panel. For completely occluded aneurysms, MRA at 6 months was preferred by 58% of participants, with annual imaging favored thereafter. For incompletely occluded aneurysms, 6-month DSA followed by annual imaging was recommended. No consensus was reached on the imaging modality for annual follow-up. Retreatment decisions were primarily driven by aneurysm growth (>2 mm). Endovascular retreatment was preferred over open surgery, with risks such as ischemia and rupture identified as key concerns.ConclusionThis DELPHI consensus highlights current practice trends and open questions in the follow-up and retreatment of aneurysms treated with intrasaccular devices.

IntroductionEndovascular management options for pulsatile tinnitus (PT) patients have increased in recent years with promising results. However, standardized endovascular team referral criteria remain limited. We conducted a systematic review and suggested an evidence-based referral protocol for PT patients to the neuroendovascular team.MethodsA literature review was conducted in February 2025 using the PubMed/MEDLINE database. We included English-written studies published in the last 5 years, focusing on PT diagnosis and management. Exclusion criteria included: (1) in vitro or animal studies, (2) studies focused on open surgery approaches, (3) studies addressing only non-PT, and (4) case reports, case series (3-10 cases), commentaries, letters to the editor, editorials, and book chapters.ResultsOur initial search retrieved 257 papers. Of these, 219 were excluded after reading the title and abstract, and an additional 12 were excluded after full-text review. A total of 26 papers were eligible for inclusion in this review and in developing our protocol. After PT diagnosis and imaging, our protocol consists of the following three questions: (1) Is non-invasive imaging suspicious for a dural arteriovenous fistula, high-risk vascular lesions, or idiopathic intracranial hypertension? (2) Despite normal neuroimaging, is there clinical suspicion of a high-risk vascular lesion? (3) Although a low-risk lesion is diagnosed, is PT debilitating? If there is a "yes" to any of these questions, referral to the endovascular team is recommended.ConclusionWe suggested an evidence-based referral protocol for PT patients to the neuroendovascular team.