Interventional Neuroradiology最新文献

Background and purpose: Thrombectomy in distal, medium vessels is a topic of increasing interest. To date, there are few in vitro studies focused on performance of ≤5F catheters in medium vessels. The purpose of this study is to compare the performance of the 3F, 4F, and 5F MIVI Neuroscience Q Catheters versus Penumbra 3F, 4F, and MicroVention Sofia 5F Catheters.

Methods: Using in vitro methods, we assessed and compared the following parameters: aspiration flow rates, clot uncorking forces, impulse, and clot ingestion. For flow rate, each aspiration catheter was immersed in a cylindrical container. Flow rate at one second was used to calculate impulse. For clot uncorking force, the force required to disengage a catheter from a simulated clot was recorded. For ingestion, we measured time to ingest soft and medium stiffness synthetic clots.

Results: The measured flow rates without a stent retriever for the Q3, Q4, and Q5 catheters were 3.54 ml/s, 5.32 ml/s, and 6.87 ml/s. The measured flow rates without a stent retriever for the 3MAX, 4MAX, and 5F Sofia were 1.46 ml/s, 2.56 ml/s, and 1.73 ml/s. The impulse calculated for one second was 26 mNs for Q5 vs 9 mNs for Sofia 5, 35 mNs for Q4 vs 15 mNs for 4Max< and 35 mNs for Q3 vs 9 mNs for 3Max. The average system ingestion for Q was significantly faster than the competitive catheters.

Conclusions: The Q catheters demonstrated higher flow rates, higher uncorking force, and faster complete clot ingestion than competitive catheters.

Background: The volume of mechanical thrombectomy (MT) performed at hospitals is used as one of the criteria for advanced-level designation for stroke care.

Objective: Our study sought to determine the relationship between annual MT procedural volume and in-hospital outcomes in acute ischemic stroke patients undergoing MT in the United States.

Methods: We analyzed the National Inpatient Sample from 2016 to 2020. The hospitals were grouped into quartiles based on the volume of MT procedures performed within the calendar year. We compared the rates of routine discharge/home health care; in-hospital mortality, and post-treatment intracranial hemorrhage (ICH) between the quartiles after adjusting for potential confounders.

Results: Patients undergoing MT ranged from 15,395 in quartile 1 to 78,510 MT in quartile 4. There were lower rates of discharge home/self-care of 22.5%, 20.8%, and 20.8% for quartiles 2, 3, and 4, respectively, compared with 34.9% in quartile 1. The odds of ICH increased to 1.81 (p < 0.001), 1.84 (p < 0.001), and 1.98 (p < 0.001) among the quartiles from lowest to highest procedural volumes. The odds of home discharge/self-care decreased to 0.66 (p < 0.001), 0.60 (p < 0.001), and 0.63 (p < 0.001) among the quartiles from lowest to highest procedural volumes. The odds of in-hospital mortality increased to 1.92 (p < 0.001), 1.99 (p < 0.001), and 1.84 (p < 0.001) among the quartiles from lowest to highest procedural volumes.

Conclusions: We observed a paradoxical relationship between adverse outcomes and the annual procedural volume of MT at the hospital presumably due to the higher severity of acute ischemic stroke treated at high-volume hospitals.

Background: Acute ischemic stroke (AIS) due to intracranial atherosclerotic disease (ICAD) carries a high risk of recurrence despite aggressive medical management. The aim of our study is to present our initial experience with the Onyx Frontier™ balloon-mounted drug-eluting stent (Medtronic, Santa Rosa, CA) for AIS due to ICAD.

Methods: We conducted a multicenter retrospective cohort study describing the technical feasibility, safety, and performance of using the Onyx Frontier™ balloon-mounted drug-eluting stent in patients with acute intracranial vessel occlusion due to ICAD across three comprehensive stroke centers in the United States.

Results: We included 23 patients in our study (mean age 67.3 [10.7]; females: n = 13/23, 56.5%). Most patients were Black (n = 14/23, 60.9%). The most common site of vessel occlusion was the M1 branch of the middle cerebral artery (MCA) (n = 14/23, 60.9%), followed by the vertebrobasilar system (n = 5/23, 21.7%), and the internal carotid artery (n = 3/23, 13.0%). Treatment with the Onyx Frontier™ stent was associated with a final mTICI score ≥2b for 100% of patients, with no vessel perforations or distal embolization. None of the patients had any restenosis or re-treatment over a median follow-up of 3.5 months (interquartile range [IQR] 7.8). All cases required a single stent except for one, where two were deployed. Transfemoral access was used in most cases (n = 18/23, 78.3%), with one in-hospital death due to access site complication (n = 1/23, 4.3%).

Conclusions: This is the largest multicenter cohort study demonstrating the feasibility and safety of using the Onyx Frontier™ balloon-mounted zotarolimus-eluting stent to treat symptomatic AIS due to ICAD.

Introduction: Extracranial internal carotid stenosis (EICS) is a well-established cause of stroke. Carotid near-occlusion (CNO), either distally collapsed or not, is a rare sub-type of EICS with conflicting data regarding the necessity for treatment. The aim of this study is to evaluate the results of carotid artery stenting (CAS) for patients with symptomatic CNOs.

Material and methods: Institutional review board (I06-420-23) approval was obtained for this retrospective study. Consecutive data from January 2019 to January 2023 was obtained. Sixty-five patients underwent 66 procedures for symptomatic CNOs. Diagnosis of CNOs were made with DSA images. Treatment decisions were made by a multidisciplinary team. Patient data including age, gender, clinical presentation, affected side, complications (initial/ follow-up), and pre and post mRS scores were recorded and analyzed.

Results: There were 22 female and 43 male patients with symptomatic CNOs (mean age: 71.52 ± 9.32 years). The mean time from symptom-to-treatment was 3.91 weeks ± 3.74 weeks (ranging from 0 to 20 weeks). There were eight events recorded in the 30 days period after CAS; five (7.7%) were cerebral hyperperfusion syndrome (one causing haemorrhage) and three (4.5%) ischemic complications. Permanent neurologic deficit rate was 6% and 61 patients (94%) mRS scores were unchanged during last follow-up. Mean follow-up period was 22.94 ± 16.67 months (ranging from 0.5 to 60 months).

Conclusion: Our study demonstrated that in the complex population of patients with symptomatic CNOs, CAS is a feasible option with acceptable rate of permanent neurologic deficits. Further studies are needed to assess its safety and long-term efficacy.

Background: A wide range of liquid embolic agents has been used in endovascular treatment (EVT) of dural arteriovenous fistulas (dAVFs) and cerebral arteriovenous malformations (cAVMs). Newer liquid embolics, Squid (Balt) and PHIL (MicroVention), aim to improve the safety and efficacy of EVT of dAVFs and cAVMs.

Objective: To assess the safety and efficacy of EVT of cAVMs and dAVFs using Squid or PHIL as an embolic agent.

Methods: We searched major databases following PRISMA guidelines and included studies with ≥ five patients reporting on EVT of dAVFs and/or cAVMs using Squid or PHIL as embolic agent. We analyzed efficacy outcomes including complete occlusion, incomplete occlusion, and recurrence at follow up, and safety outcomes including procedure-related complications, morbidity, and mortality with a random-effects meta-analysis. Separate analyses were performed for cAVMs and dAVFs. Subanalyses were conducted for studies exclusively utilizing PHIL and those exclusively utilizing Squid, for both cAVMs and dAVFs.

Results: Ten studies, comprising 214 patients (53.7% male), were found. Of these, 113 patients had 113 dAVFs, while 101 patients had 101 cAVMs. Complete occlusion rates following embolization were 91% for dAVFs and 32% for cAVMs. A subanalysis of dAVFs embolized solely with Squid and PHIL identified 93% and 86% complete occlusion rates, respectively. The overall procedure-related permanent morbidity rate was 3% for dAVFs and 7% for cAVMs. There was only one procedure-related mortality, which developed in a cAVM case, across 214 cases.

Conclusion: Squid and PHIL are safe and effective embolic agents for treatment of dAVFs and cAVMs.

Background: There has been growing data about the association between D-dimer levels and thrombectomy outcomes in acute ischemic stroke patients (AIS) with no cumulative evidence. This systematic review and meta-analysis aim to discuss and analyze the findings of the current studies to provide more robust evidence in this regard.

Methods: A systematic search was conducted through PubMed, Web of Science, Embase, and Scopus to retrieve all relevant investigations. A meta-analysis was conducted, and the results were presented in odds ratio (ORs) for binary variables and ratio of means (ROM) for continuous variables, each accompanied by its respective 95% confidence intervals (CIs).

Results: After searching and screening, 14 studies were included. The analysis showed that the low D-dimer group had significantly higher rates of favorable functional outcome (OR: 4.40; 95%CI: 2.65-7.30; p < 0.001, n = 3) and recanalization (OR: 4.13; 95%CI: 1.57-10.84; p = 0.004, n = 3) than the high one. The association between D-dimer levels and first-pass effect and re-occlusion risk was also demonstrated. Eventually, two studies also demonstrated a significant association between high D-dimer levels and deep venous thrombosis and symptomatic intracranial hemorrhage as post-thrombectomy complications.

Conclusion: Current evidence indicates a significant association between D-dimer levels and post-thrombectomy outcomes in AIS patients. However, current data are remarkably heterogeneous, and additional comparative investigations are needed.

Introduction: With emerging evidence supporting the clinical efficacy and safety of mechanical thrombectomy (MT) for distal medium vessel occlusions (DMVOs), MT devices specifically designed to navigate through smaller caliber and more delicate tortuous distal cerebrovasculature are required. This study describes our single-center experience using the AXS Vecta 46 intermediate catheter for first-line thromboaspiration of DMVOs.

Methods: We identified all patients who underwent MT using the Vecta 46 for first-line thromboaspiration for primary or secondary DMVOs. We collected baseline clinical data, angiographic and clinical outcomes, as well as procedural complications. The primary outcome in question was the rate of successful recanalization, which was defined as a modified Thrombolysis in Cerebral Infarction score of ≥2b.

Results: We identified 43 patients who underwent MT using the Vecta 46 catheter for thromboaspiration of 54 DMVOs. Intervened vessels included the M2 (23/54), M3 (19/54), and M4 (6/54) branches of the middle cerebral artery, A2 (1/54), A3 (1/54), and A4 (1/54) branches of the anterior cerebral artery, and P1 (1/54), P2 (1/54), and P4 (1/54) branches of the posterior cerebral artery. The median number of passes for primary DMVOs was 2 (IQR: 1-3) and 1 (IQR: 1-1.25) for secondary DMVOs. The rate of successful recanalization was 100% (18/18) for primary DMVOs and 80.6% (29/36) for secondary DMVOs. First-pass effect (FPE) was noted in 55.6% (30/54) of all primary and secondary DMVO cases. Improved short-term clinical outcomes were observed in both the primary (National Institute of Health Stroke Scale [NIHSS] shift: -5 [IQR: -14.25 to -0.25]) and secondary (NIHSS shift: -5 [IQR: -10 to -2]) DMVO groups. A total of six patients died during their hospitalization, though none were deemed procedural-related.

Conclusions: Our study demonstrates the safety and efficacy of the Vecta 46 intermediate catheter for thromboaspiration of both primary and secondary DMVOs, achieving high rates of successful recanalization and FPE.

Background: Vein of Galen malformations are congenital arteriovenous malformations primarily treated by endovascular embolization via transarterial or transvenous approaches. transvenous embolization can be utilized to close the malformation but may be difficult in patients with venous stenosis or blockages, which drive venous hypertension and lead to significant neurologic consequences. Here, we illustrate the atypical placement of an intracranial venous sinus stent to improve outflow after transvenous embolization in pediatric patients with the vein of Galen malformation.

Methods: A retrospective review of clinical databases at two high-volume endovascular centers from January 2018 to March 2023 identified all vein of Galen malformation patients who received a venous sinus stent during transvenous embolization. Clinical data, imaging, angioarchitecture, operative details, postoperative management, and follow-up were reviewed.

Results: Three patients presented for transvenous embolization after multiple staged transarterial embolizations of their vein of Galen malformation. Transvenous access was complicated by lateral sinus stenosis, which was temporarily relieved by balloon angioplasty. After transvenous embolization by pressure cooker technique, the dural sinuses were stented using the existing venous guide catheter. Venous angiography demonstrated improved flow across the stenosed areas and post-embolization angiography demonstrated normalized venous drainage with widely patent stents. One patient experienced postoperative oculomotor nerve palsy unrelated to the stent placement. All patients demonstrated a complete cure of their vein of Galen malformations with patent venous sinus stents on follow-up.

Conclusion: In patients with the vein of Galen malformation and venous hypertension receiving transvenous embolization, venous sinus stenting may be a safe and effective option to reduce aberrant cortical venous drainage and improve normal outflow. Further studies are warranted to investigate its benefit in high-flow vascular malformations.

Purpose: Transradial access for neurointerventional procedures has increased in popularity over the past few years due to data from extrapolated interventional cardiology studies, patient preference, and early reports of feasibility using this approach. Our aim was to evaluate the incidence of periprocedural stroke in patients undergoing transradial versus transfemoral access for diagnostic cerebral angiograms.

Methods: We retrospectively reviewed our neurointerventional database and identified all patients who underwent a diagnostic angiogram between May 2019 and July 2021. Patients were further divided into transradial versus transfemoral access. In patients with postprocedural stroke, symptoms and National Institute of Health Stroke Scale score were recorded. Pertinent laboratory values and procedural data was reviewed, including COVID status, platelet count, International normalized ratio (INR), Glomerular filtration rate (GFR), vessels catheterized, amount of contrast used, and fluoroscopy time. Imaging work-up for stroke symptoms was reviewed, if available.

Results: Thousand two-hundred thirty eight diagnostic cerebral angiograms with 656 patients (53%) undergoing transradial access. Stroke symptoms after angiogram were only observed in the transradial group (5 patients; 0.4% total and 0.8% among radial access cases, respectively). Symptoms included word finding difficulty, paresthesia, or weakness. Three patients underwent cross-sectional imaging, computed tomography was negative in all three patients. Magnetic resonance imaging showed small, scattered infarcts in two patients. All symptoms resolved without additional hospitalization.

Conclusion: In our experience, using transradial access for diagnostic cerebral angiograms was associated with a low but not negligible incidence of periprocedural strokes. Patient anatomy should be evaluated prior to selection of vascular access. Patients should be made aware of a slightly higher periprocedural stroke risk with transradial access.