Interventional Neuroradiology最新文献

BackgroundThe optimal management of emergent large vessel occlusion due to underlying intracranial stenosis (intracranial stenosis related large vessel occlusion) remains unknown. The primary aim of this survey analysis was to measure variation in the clinical management of intracranial stenosis related large vessel occlusion during mechanical thrombectomy.MethodsA survey was designed using a web-based survey-building platform and distributed via the Society of NeuroInterventional Surgery (SNIS) and the Society of Vascular and Interventional Neurology (SVIN) websites for a response. Predictors of respondents' level of comfortability stenting were estimated using a binomial logistic regression model.ResultsWe received 105 responses to the survey. Most respondents (54.3%) practiced at an academic Stroke Center. Nearly half of the respondents (49%) had been practicing for 5 or more years independently after fellowship. An average of 54 mechanical thrombectomies were performed by each respondent annually. There was variation in the definition of intracranial stenosis related large vessel occlusion, number of passes performed before pursuing rescue stenting, as well as intra and post-procedural antiplatelet management. Of respondents, 58% felt rescue stenting was very risky, and 55.7% agreed that there was equipoise regarding emergent angioplasty and/or stenting versus medical therapy for intracranial stenosis related large vessel occlusion. Respondents who encountered intracranial stenosis related large vessel occlusion more frequently thought that rescue stenting was less risky.ConclusionThere is notable variability in the diagnosis and management of intracranial stenosis related large vessel occlusion during mechanical thrombectomy. While most respondents felt rescue stenting was risky, the majority believed the benefit could outweigh the risk. The majority of respondents agreed that equipoise exists regarding the management of intracranial stenosis related large vessel occlusion, highlighting the need for clinical trials in this rare patient population.

Cerebrospinal fluid-venous fistula (CSFVF) is an increasingly recognized cause of spontaneous intracranial hypotension (SIH). We present a rare case of a 41-year-old woman with SIH caused by a right S2-S3 CSFVF draining in the right internal iliac vein. Successfully transvenous endovascular embolization using Onyx was performed. This report highlights diagnostic challenges and procedural details, emphasizing the efficacy of endovascular approaches in managing CSFVF in atypical anatomical locations.

BackgroundTransradial mechanical thrombectomy offers reduced complications compared to transfemoral approach but has been limited by the inability to safely deliver large-bore aspiration catheters through a radial sheath. The Food and Drug Administration (FDA)-cleared Zebra laser-cut catheter with 7F (0.087″ inner diameter; 0.096″ outer diameter) and 6F versions (0.074″ inner diameter; 0.083″ outer diameter) addresses this limitation.MethodsWe conducted a retrospective review of 26 patients undergoing transradial mechanical thrombectomy for acute ischemic stroke using the Zebra catheter through radial sheaths at two centers (January-August 2025). Primary outcomes included radial access success, recanalization (Thrombolysis in Cerebral Infarction [TICI] 2b-3), and access-site complications.ResultsMean age was 65.04 ± 12.82, mean National Institutes of Health Stroke Scale (NIHSS) was 20.88 ± 7.87. Radial access success rate was 96.2% (25/26). One conversion to femoral occurred due to catheter herniation at acute innominate-left common carotid angulation with aberrant right subclavian anatomy; the procedure was completed successfully via femoral route using the same system. Successful recanalization (TICI 2b-3) occurred in 88.5% (23/26) of patients. Zebra accommodated aspiration catheters ranging 0.055-0.071″ inner diameter and navigated complex anatomy including tortuous carotid origins with subclavian elevation up to 15 mm. No access-site complications occurred. Mean fluoroscopy time was 23.07 ± 18.24 min with 88.5% of procedures rated "easy" by the operator. Acute aortic branch angles represented the primary anatomical limitation, while distal tortuosity and moderate subclavian elevation were manageable.ConclusionZebra enabled transradial mechanical thrombectomy with high recanalization rates without access-site complications. Zebra succeeded across complex anatomy and demonstrated compatibility with various large bore suction catheters, allowing uniform utilization for thrombectomy in radial versus femoral access.

BackgroundMechanical thrombectomy is the standard of care for acute ischemic stroke due to large vessel occlusion. Choosing a transradial approach (TRA) for anterior circulation occlusions is a matter of debate. The use of a triaxial 7F low-profile system could help mitigate numerous issues related to transradial MT.MethodsFrom 10/2022 to 7/2025, 111 patients underwent TRA-MT for anterior circulation LVOs, both as first-line and as rescue from transfemoral access failure, with the same setup (7F sheath, 7F guide catheter, and aspiration catheters ranging from 062 in. to 043 in. in relation to occlusion site). Choice of thrombectomy technique was at the operator's discretion. Patients' demographic data, clinical presentation, treatment details, complications, rate of TFA crossover, successful reperfusion (mTICI score ≥2b), and good clinical outcome at 3 months (mRS 0-2) were reported.ResultsOf 111 patients, 66 (50%) had occlusion of the M1 MCA, 20 (18%) of the internal carotid artery termination, and 23 (20.7%) of the M2 MCA. Right-sided occlusions were 56/111 (50.5%) and left-sided 56/111 (49.6%). Median patients' age was 80 years, and median NIHSS score was 17 at admission. Successful reperfusion (mTICI ≥2b) was achieved in 103/111 patients (92.8%). Total procedural complication rate was 8/111 (7.2%). No serious access-site complications were reported. Symptomatic ICH occurred in 18/111 (16.2%) patients. Clinical follow-up was available for 104 out of 111 total patients; of them, mRS scores of 0-2 were 54/104 (51.9%)ConclusionsThe high technical effectiveness and good safety profile of this specific tricoaxial setup for TRA-MT in AIS, even for large proximal LVOs, could constitute an optimal alternative to TFA-MT in selected cases.

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.