Interventional Neuroradiology最新文献

BackgroundFlow diverter (FD) use has become a popular method for treating intracranial aneurysms, but evidence in acutely ruptured blood blister-like and dissecting morphologies is limited. Furthermore, there is little evidence regarding the role of short-term follow-up imaging to assess aneurysm stability. This study is a single-center retrospective review of dissecting aneurysms treated by FD, with an analysis of short-term follow-up angiograms to guide post-treatment management.MethodsOur single-center retrospective review included all patients from 2016 to 2024 with spontaneous subarachnoid hemorrhage from blood blister-like and dissecting aneurysms who underwent treatment with an FD. Outcomes included re-rupture, treatment failure, re-treatment, aneurysm morphological changes, and ischemic/hemorrhagic events. Short-term, inpatient angiograms were used to assess early response to treatment, and long-term follow-up angiogram, >4 months, was used to assess long-term aneurysm obliteration.ResultsTwenty-eight patients underwent FD for treatment of their ruptured dissecting aneurysm. Twelve patients (43%) were treated with coiling plus FD. Treatment failure occurred in four patients (14%). Placement of additional FDs in a second procedure occurred in three patients (11%). Thromboembolic events occurred in five patients (18%). Hemorrhagic complications, not including aneurysm re-rupture, occurred in six patients (21%). Short-term aneurysm improvement occurred in 17 patients (63%). Thirteen patients had long-term follow-up, with 11 (85%) demonstrating complete occlusion.ConclusionsFlow diversion is a reasonable technique for treating ruptured dissecting aneurysms. Risks are moderate and include short-term aneurysm growth and re-rupture. Early post-treatment angiography is suggested to help identify aneurysm growth and the need for re-treatment.

PurposeTo evaluate the safety, technical performance, and short-term efficacy of the ACCERO^® heal stent for stent-assisted coil embolization in the treatment of intracranial aneurysms.MethodsWe retrospectively analyzed 32 consecutive patients with intracranial aneurysms treated with the ACCERO^® heal stent at two German centers between September 2021 and December 2023. Data were collected on patient demographics, aneurysm characteristics, procedural technique, and complications. Aneurysm occlusion was classified using the Modified Raymond-Roy Classification (MRRC), and stent wall apposition was assessed qualitatively. Follow-up imaging was analyzed for recurrence and in-stent stenosis.ResultsA total of 34 ACCERO^® heal stents were implanted in 32 patients (median age 54 years; 87.5% female). Optimal wall apposition was achieved in all cases. Immediate complete occlusion (MRRC I) was observed in 87.5%. Periprocedural complications occurred in five patients (15.6%), including one death and one non-fatal stroke in the context of ruptured aneurysms. Intraoperative in-stent thrombosis occurred in two cases (6.3%), both resolving without clinical sequelae. At follow-up, six patients (19.3%) had aneurysm recurrence or residual, and three (9.7%) required retreatment. In-stent stenosis occurred in three patients (9.7%) and resolved with conservative management.ConclusionThe ACCERO^® heal stent is a reliable and effective option for stent-assisted coiling of intracranial aneurysms. Its low-profile design and HEAL antithrombogenic coating support precise deployment and favorable early clinical outcomes. Prospective studies are needed to confirm these findings.

BackgroundNeurointerventional procedures are increasingly complex, requiring access to more distal vasculature. SmartGUIDE 0.014-inch guidewire (Artiria Medical, Geneva, Switzerland) is an FDA-approved dynamic deflectable-tip guidewire, manipulated by an external handle to lock the distal end, allowing active shaping of micro/balloon catheters. We report the first clinical experience using the SmartGUIDE in various neurovascular interventions.MethodsNeurointerventional procedures utilizing the SmartGUIDE from May 2024 to July 2025 were retrospectively analyzed. Clinical outcomes, technical success, and periprocedural complications were assessed. The primary endpoint was successful delivery of a microcatheter tip using the SmartGUIDE to the predefined target without the use of an adjunctive device or microwire. Procedures requiring alternative microwires to replace SmartGUIDE were considered unsuccessful.ResultsThe SmartGUIDE was used in 25 procedures: aneurysm embolization (n = 9), arteriovenous malformation/fistula embolization (n = 5), tumor embolization (n = 4), venous and carotid stenting (n = 4), balloon test occlusion (n = 2) and endovascular thrombectomy (n = 1). SmartGUIDE enabled access to challenging neurovascular targets, successfully reaching the target vessel independently in 24/25; 96% of cases. No device-related complications incurred, such as perforation or dissection. All patients were discharged at their baseline clinical status, except the EVT patient who improved by seven NIHSS points.ConclusionsSmartGUIDE's deflectable-tip wire achieved high technical success and proved safe across various neurointervention. SmartGUIDE improves microcatheter navigation without repeated ex-vivo tip shaping, adjunct tools, or looping through aneurysms. Locking the SmartGUIDE tip can deflect microcatheters and prevent them from herniating into their parent vessel during side branch navigation. Larger studies are needed to evaluate effectiveness across broader clinical indications.

BackgroundBasilar artery occlusion (BAO) is a rare stroke type, with subtypes like vertebrobasilar tandem occlusion (VBTO), complicating treatment. Mechanical thrombectomy (MT) is increasingly used, but evidence on its safety and effectiveness in VBTO compared to isolated BAO (iBAO) remains limited.MethodsPubMed, Cochrane Central, Embase, Web of Science, and ScienceDirect were searched till May 2025. The risk ratios (RR) were pooled along with 95% Confidence intervals (CI) under the random effects model using Review Manager. The Newcastle Ottawa Scale and GRADE assessment were used to assess the quality of studies and certainty of evidence. Successful recanalization was defined as a Thrombolysis in Cerebral Infarction (TICI) score of ≥2b. The modified Rankin Scale (mRS) is a scale used to assess the severity of stroke, with functional independence defined as an mRS score of 0-2. Publication bias was assessed using funnel plots and Egger's regression test.ResultsNine studies, pooling a total of 737 patients, were included in this analysis. MT showed no significant difference in functional independence in the VBTO group compared to the iBAO group (RR = 1.25; 95% CI: 0.73, 2.12; p = .42). The successful recanalization was also comparable between the VBTO and iBAO arms when MT was performed (RR = 0.96; 95%CI 0.81, 1.13; p = .60). The risk of symptomatic intracerebral hemorrhage (sICH) was significantly increased when MT was performed in the VBTO arm compared to the iBAO group (RR = 2.20; 95%CI : 1.09, 4.46]; p = .03). The mortality rates were also comparable between the two groups (RR = 1.28; 95% CI 0.78, 2.10; p = .33). Also, in the VBTO patients, the successful recanalization rate showed no significant difference between the clean and dirty road techniques (RR = 1.04; 95% CI 0.90, 1.20; p = .63).ConclusionWhen MT was performed on VBTO and iBAO patients, the efficacy endpoints-such as functional independence and successful recanalization-and the safety endpoint of mortality were comparable. However, the risk of sICH was higher in the VBTO group.

BackgroundUncommon clinical manifestations of cerebral venous congestion syndrome (CVCS) are challenging for clinicians and may result in inappropriate treatment selection and incomplete clinical resolution. Although trigeminal neuralgia (TN) has been reported in association with CVCS, evidence of symptom resolution following venous sinus stenting (VSS) is lacking. We report a case in which VSS effectively alleviated TN.Case PresentationA middle-aged female patient presented with bilateral pulsatile tinnitus, papilledema, pressure headaches, as well as left-sided TN. Initial computerized tomography venography demonstrated bilateral transverse sinus stenosis and a prominent left mastoid emissary vein. Therefore, VSS was offered. Venous pressure measurements for extra- and intracranial veins were acquired, revealing a pressure gradient. Successful bilateral transverse sinus stenting was performed, resulting in a reduction of the pressure gradient in both sinuses. Endovascular stenting proved effective in managing CVCS symptomatology, including CVCS-induced TN. Residual left-sided pulsatile tinnitus due to the left mastoid emissary vein persisted.ConclusionThis case underscores the role of intracranial VSS in managing CVCS-associated symptoms, demonstrating its potential to relieve both typical and less common manifestations, including TN.

BackgroundQuantitative angiography (QA) can extract hemodynamic information during neurointerventional procedures by leveraging contrast flow biomarkers. However, clinical adoption of two-dimensional (2D) QA remains limited compared with three-dimensional (3D) methods such as CT perfusion due to view-dependent biases when projecting 3D flow onto 2D images. Variations in tube potential (kVp) further modulate iodine attenuation, introducing intensity inconsistencies that confound QA measurements. This study evaluates a path-length correction (PLC) method designed to reduce orientation- and acquisition-related biases in 2D digital subtraction angiography (DSA).Materials and methodsThree cerebrovascular cases containing rotational and 2D DSAs were retrospectively analyzed. 3D volumes were reconstructed using cone-beam algorithms, and synthesized projections were spatially aligned with 2D DSA images using affine and non-linear transformations. Frame intensities were normalized for kVp using an iodine mass attenuation lookup. Path-length maps derived from aligned 3D volumes were then used to normalize DSA intensities, generating PLC images. QA parameters-peak height and area under the curve-were computed from pixel-wise time-density curves (TDCs) at matched regions of interest within aneurysm and parent vessels. PLC performance was evaluated by comparing root mean squared errors (RMSEs) between frontal and lateral TDCs and discrepancies in QA parameters before and after correction.ResultsAcross three cases, PLC improved cross-view consistency by reducing TDC RMSE from 0.23 ± 0.04 to 0.14 ± 0.04, peak height RMSE from of 0.42 ± 0.16 to 0.15 ± 0.11, and area under the curve RMSE from 0.43 ± 0.13 to 0.14 ± 0.13.ConclusionsThe PLC method reduces foreshortening bias in 2D DSA and improves consistency of QA metrics, enhancing reliability in cerebrovascular assessment and treatment evaluation using clinical DSA.

BackgroundBalloon guide catheters (BGCs) have been associated with higher rates of first pass effect (FPE) in endovascular thrombectomy. Large-bore aspiration catheters (ACs) placed at the face of the embolus may mimic the flow arrest effect seen with BGCs; combined use and its effect on FPE have not been previously well-studied. This study aims to evaluate the impact of this dual-device strategy on achieving FPE.MethodsWe conducted a retrospective cohort study across three sites (2018-2024). A multicenter registry was queried for adult patients with anterior circulation acute ischemic stroke treated with thrombectomy. The primary outcome was rate of FPE (modified Treatment in Cerebral Infarction (mTICI) 2C/3 on the first pass). Multivariable logistic regressions for likelihood of FPE were performed.Results973 patients were included, with a median age of 69 years (IQR 59-79). BGCs were used in 26.3%. Large-bore ACs were used in 68.7%. In most cases, large-bore ACs were used without a BGC (BGC-: 77.5% vs. BGC+: 43.8%, P < .001). FPE was achieved in 3-0.6% of procedures. BGC usage was significantly associated with FPE (aOR: 1.94, 95% CI: 1.01-3.72, P = .04). When sub-stratified by BGC use, large-bore AC use was found to be significantly associated with FPE only when a BGC was not used (aOR: 3.34, 95% CI: 1.01-12.14, P = .04).ConclusionBGC use is associated with an increased likelihood of FPE; when BGCs were not used, large-bore ACs were significantly associated with a higher likelihood of FPE. These findings are important when considering which tools contribute to successfully achieving FPE.

BackgroundEpidural contrast extravasation (ECE) at the level of lumbar puncture site during CT myelography (CTM) is a noted phenomenon without determined clinical relevance. While prior randomized studies in spinal analgesia have shown benefits of pencil-type spinal needles compared to cutting-type for dural punctures, rates of ECE on imaging have not been closely studied, and no prior study has investigated the effect of spinal needle type technical factors on ECE rate.MethodsAll CTM cases over an 8-year period for any indication (e.g., spontaneous intracranial hypotension CSF leak evaluation) were retrospectively reviewed. A large series of cases (n = 276) were reviewed by two independent neuroradiologists for presence of puncture site ECE (n = 63), ECE extending at least one vertebral body level (n = 15), or no ECE (n = 198). Rates were compared by several technical factors including spinal needle type, gauge, and puncture site level.ResultsPencil-type spinal needles had significantly greater rates of any ECE (32%) versus cutting-type (25%, p = 0.030) and for ECE at puncture site only (25% vs. 20%, respectively) and ECE with extension greater than one vertebral body level (7% vs. 4%, respectively, p = 0.004). The rate of ECE did not differ by needle gauge, needle type/gauge combinations, or level accessed (p > 0.05). The need for post-dural puncture targeted epidural blood patch did not differ by presence of ECE (p = 0.190).ConclusionsThe rate of ECE in CTM was common (28% of cases) and occurred with slightly greater frequency with pencil-type spinal needles. As CTM and the use of pencil-type spinal needles become more prevalent in the investigation of spinal CSF leak, it is important to convey that asymptomatic ECE can be a common expected post-dural puncture finding with both pencil-type and cutting-type spinal needles and should not be confused for the site of leak when evaluating patients for spontaneous spinal CSF leak. Further, our results that immediate ECE do not correlate with symptomatic post-dural puncture headache differ from a recent retrospective series, and the imaging finding alone of ECE does not warrant further evaluation in an asymptomatic patient.

PurposeTo develop and implement a novel tool for evaluating neointimal healing over flow diverting aneurysm devices in vitro using a biocompatible, dye-based flow visualization method.MethodsBiocompatibility of Brilliant Blue FCF (BB FCF) dye was established using an alamarBlue metabolic viability assay. Next, a custom MATLAB image analysis script to quantify three intra-aneurysmal dye transport parameters (fill time, washout time, and max intensity) was evaluated through benchtop testing. Video recordings of BB FCF injections in four silicone aneurysm models with increasing levels of device-facilitated occlusion (0-100%) were used to quantify corresponding changes in dye transport parameters. Finally, the method was applied in a 14-day endothelialized silicone blood vessel mimic (BVM) study to assess the impact of repeated BB FCF injections on vessel construct morphology.ResultsBB FCF was noncytotoxic at concentrations ≤500 µM. Dye transport parameters differed as expected between occlusion models; fill and washout times were prolonged in partially occluded models compared to the patent control (p < .01), and maximum dye intensity decreased across all models as a function of occlusion (p < .0001). Repeated BB FCF injections in BVMs showed no morphological differences between endothelial linings in injection-treated vessels vs. no-injection controls.ConclusionThe methods and results documented in this study demonstrate that a non-angiographic dye-based flow visualization method has potential to provide a repeatable, non-destructive way to assess gradual healing-mediated occlusion performance of flow diverter devices in vitro, complementing traditional imaging techniques. This method lays the groundwork for correlating flow-based transport metrics with endothelial coverage to better understand healing-based aneurysm occlusion.

BackgroundAs large language models (LLMs) become increasingly accessible to the public, patients are turning to these tools for medical guidance - including in highly specialized fields like interventional neuroradiology. Despite their growing use, the safety, completeness, and reliability of LLM-generated information in subspecialty medicine remain unclear.MethodsFive publicly available LLMs - ChatGPT, Gemini, Claude, Perplexity, and DeepSeek - were prompted with four neurointerventional patient-facing clinical questions spanning ischemic stroke, hemorrhagic stroke, venous disorders, and procedural device use. Each model was queried three times per question to generate unique responses. Eight blinded raters scored each response on accuracy, completeness, safety, and actionability using Likert scales. Plagiarism analyses were also performed.ResultsDeepSeek consistently outperformed other LLMs in accuracy, completeness, and actionability across four prompts, while Gemini frequently ranked worse, including in plagiarism levels. ChatGPT performed well in accuracy. Physicians were more critical than non-physicians across accuracy, completeness, and safety, whereas non-physicians rated actionability significantly lower. Overall, LLMs were rated relatively high (median of >4 on a 5-point scale) in medical safety, suggesting low risk of overtly harmful advice.ConclusionRecent-generation LLMs offer medically safe, though often incomplete or imprecise, information in response to patient-oriented neurointerventional queries. Including non-physician raters revealed valuable differences in perception that are relevant to how patients may interpret LLM outputs. As benchmark frameworks like HealthBench improve LLM evaluation, inclusion of lay perspectives and subspecialty contexts remains essential. Responsible use by clinicians and ongoing patient education will be critical as LLM use in healthcare expands.