Interventional Neuroradiology最新文献

BackgroundMechanical thrombectomy (MT) has become the standard of care for ischemic stroke caused by large vessel occlusion (LVO). Direct aspiration techniques (ADAPT) have demonstrated efficacy comparable to stent retrievers (SRs).ObjectiveTo describe the safety and efficacy of the Raptor catheter as a first-line aspiration device for LVO MT in a national multicenter setting.MethodsWe prospectively, enrolled 46 patients with acute ischemic stroke due to LVO. Patients were treated with the Raptor catheter as a first-line ADAPT technique. Demographic, clinical, and procedural variables were analyzed. Efficacy and safety outcomes were recorded. Data was analyzed using descriptive statistics.ResultsMedian age was 66 years (IQR 59-77), with 39.1% women. The median National Institutes of Health Stroke Scale at admission was 18 (IQR 13.5-21), and the M1 segment accounted for 67.4% of the LVOs. First-pass effect (FPE), defined as mTICI ≥2c, was achieved in 54.3% (25/46), and final recanalization mTICI ≥2b in 93.5% (43/46). The median number of passes was 1 (IQR 1-2), and the mean puncture-to-recanalization time was 25.7 ± 28.4 min. Rescue SRs were used in 17.4% (8/46). Complications were documented in five patients (10.9%) with symptomatic intracranial hemorrhage in 3/46. Ninety-day mortality was 6.5%. At 90 days follow-up, 61.9% were functionally independent.ConclusionThe Raptor catheter proved to be safe and effective as a first-line strategy for LVO MT, with recanalization and FPE rates comparable to other large-bore aspiration devices with low rates of intracranial complications and mortality. Comparative and more extensive studies are needed to validate these findings.

BackgroundComputer-generated holograms (CGHs) are advanced, glassless, three-dimensional (3D) representations. This study reports the first surgical application of CGH for preoperative and intraoperative assistance.MethodsIn this single-center case series and observational survey study, three consecutive patients with intracranial aneurysms were scheduled for endovascular treatment; in one case, observation was selected instead of treatment. Twelve neurosurgical residents were recruited to inspect the CGHs and complete a questionnaire. CGHs were inspected pre- and intraoperatively in two patients with flow-diverter stents. For validation, neurosurgical residents inspected conventional 3D rotational angiograms, then CGHs, and completed a questionnaire. We compared correct answer rates on a questionnaire assessing 3D anatomical understanding at 10 locations using CGHs versus conventional methods. Simulator Sickness Questionnaire (SSQ) scores were used to assess safety. Outcomes were defined a priori.ResultsCorrect answer rates were higher with CGH than with two-dimensional working angle images (median, 75% vs. 60%; p < .01). Mean SSQ scores were nausea,0.80; oculomotor, 13.9; disorientation, 12.8; and total severity, 10.6. Intraoperative CGH reference particularly assisted the operating surgeon in visualizing and simulating the course of the guidewire across the neck in flow-diverter placement of a giant internal carotid artery aneurysm.ConclusionsThe 3D visualization of anatomical structures in CGH was quantitatively validated in the present study. Comprehension of CGH did not require particular training or prior experience, and its safety profile was also evaluated. CGH may serve as an effective tool for surgical assistance and education, particularly in anatomically complex cases.

The use of vertebrobasilar junction (VBJ) traversal provides an effective alternative for treating complex posterior circulation aneurysms when standard ipsilateral access is restricted, by enabling retrograde access to the posterior inferior cerebellar artery (PICA) branching from the targeted aneurysm. While experienced operators have employed this technique, a formal video-based demonstration of the approach is notably absent from the existing educational literature, underscoring the significance of this contribution as a resource for trainees and early-career neurointerventionists. We present two cases illustrating the utility of contralateral vertebral artery access via VBJ traversal. In the first case, a recurrent left PICA aneurysm was treated with stent-assisted coiling. In the second case, a ruptured left V4 dissecting aneurysm was managed with balloon-assisted coil sacrifice. In both cases, bilateral radial access facilitated a favorable microcatheter trajectory through the contralateral vertebral artery, enabling effective aneurysm treatment while preserving PICA patency. Bilateral radial access has been associated with reduced complication rates and improved procedural control in recent literature. Both patients had excellent clinical and angiographic outcomes, with no recurrence observed on follow-up imaging. Written informed consent was obtained from both patients for the procedures performed and for the inclusion of their anonymized clinical data and images in this report. These cases demonstrate the feasibility and potential benefits of VBJ traversal in treating posterior circulation aneurysms, particularly when conventional access strategies are technically challenging.

BackgroundChronic subdural hematoma (CSDH) is increasingly treated with middle meningeal artery embolization (MMAE). This study evaluated MMAE using a precipitating hydrophobic injectable liquid low viscosity (PHIL-LV) liquid embolic agent under general anaesthesia.MethodsConsecutive patients who underwent MMAE for CSDH with PHIL-LV at a single comprehensive neuroscience centre during a two-year period (2023-2025) were analysed. Patient clinical characteristics, imaging characteristics and procedural characteristics were recorded and described.ResultsTwenty-two patients (mean age 76 ± 13) were included in this study. Mean CSDH size was 18.4 ± 6.7 mm; 9/22 (40.9%) patients had a Charlson Comorbidity index >4. MMA embolization was successful in all 22/22 (100%) patients. Symptomatic improvement was observed in 14/17 (82.4%) of patients. During mean follow up (10.7 ± 9.2 (range 1-36)) weeks, mean reduction in CSDH thickness was 12.1 ± 9.9 mm; 13/16 (81.3%) patients had at least partial radiologic resolution of CSDH. No patients required retreatment.ConclusionPHIL-LV MMAE was safe and effective for treatment of CSDH in this case series.

BackgroundMechanical thrombectomy (MT) is the standard of care in acute ischemic stroke, but the efficacy of differently sized stent retrievers (SRs) for MT in M2 segment middle cerebral artery (MCA) occlusions has not been extensively evaluated. We conducted a retrospective study comparing outcomes of 3, 4, and 6 mm SRs in MT at the M2 segment.MethodsData collected from M2 MCA strokes in a comprehensive stroke center were retrospectively analyzed. Patient outcomes were quantified using National Institutes of Health Stroke Scale (NIHSS) 24 h post-procedure and modified Rankin Scale (mRS) scores at discharge and after 90 days. Successful outcomes were defined as an NIHSS score of <10 and an mRS score of <3. First pass success rate and thrombolysis in cerebral infarction (TICI) scores of 2b or greater were also compared. Analysis was performed using chi-square and Kruskal-Wallis tests.ResultsA total of 139 patients with similar baseline demographics underwent MT with SRs sized 3 mm (n = 23), 4 mm (n = 56), and 6 mm (n = 60). No significant difference between groups was noted in 24-h NIHSS (p = 0.83), mRS at discharge (p = 0.597), mRS score at 90 days (p = 0.251), time from groin to recanalization (p = 0.12), or first pass success (p = 0.058). All three sizes had similar complication rates. However, the rate of successful recanalization (final TICI ≥2b) differed significantly between groups (91.3% for 3 mm, 80.4% for 4 mm, and 95.0% for 6 mm; p = 0.043).ConclusionThis retrospective study showed successful recanalization of isolated M2 occlusions was greatest with 6 mm SR.

BackgroundPreoperative embolization of hypervascular tumors facilitates safer surgical resection by reducing intraoperative bleeding and operative time. ihtOBTURA^® is a novel EVOH-based liquid embolic agent characterized by progressive post-procedural loss of radiopacity due to iodine-based contrast properties. This report presents our initial clinical experience using ihtOBTURA^® for presurgical embolization of hyper vascular tumors.MethodsWe retrospectively reviewed 15 patients (mean age 41.3 years; 9 females) undergoing 16 embolization procedures with ihtOBTURA^® between February and September 2022. Collected data included demographics, lesion pathology and location, arterial feeders, embolization technique, number of pedicles, embolic volume (ml), LEA viscosity, percentage angiographic devascularization, CT artifacts, procedural and technical complications, and surgical outcomes.ResultsTumor types included meningiomas (n = 9), juvenile nasal angiofibromas (n = 2), carotid body tumors (n = 2), glomus jugulare tumor (n = 1), solitary fibrous tumor (n = 1), and aneurysmal bone cyst (n = 1). Complete (100%) or near-complete (>80%) devascularization was achieved in 80% of patients. The median volume of ihtOBTURA^® used was 4.3 ml (range: 1.0-13.0 ml). Mean procedure time was 90 min (range: 40-176). Surgical resection was completed in 13/14 surgical cases, with a median intraoperative blood loss of 462 ml. No major complications related to the embolization procedures were observed. Excellent penetration and diffusion of the ihtOBTURA^® into the tumor was documented through preoperative imaging and operative pathology samples. Post-embolization imaging showed reduced artifacts.ConclusionihtOBTURA^® is an efficient and safe alternative embolic agent for preoperative tumor devascularization.

BackgroundTo compare the benefit of endovascular treatment(EVT) in acute ischemic stroke(AIS) patients with large vessel occlusion(LVO) presenting > 6 h from last known well outside a clinical trial setting to best medical management and to EVT in a randomized trial setting.MethodsData from a retrospective multicenter cohort study (ESCAPE-LATE) of AIS-LVO patients treated with EVT beyond 6 hours from last known well at former ESCAPE trial sites were pooled with historical data from ESCAPE trial late time window patients. Unadjusted and adjusted 90-day modified Rankin Scale (mRS) score was compared between ESCAPE-LATE patients, ESCAPE late time window EVT arm and control arm patients.ResultsA total of 249 patients were included in the analysis: 200 ESCAPE-LATE patients (for 141 of whom 90-day clinical outcomes were available) and 49 ESCAPE patients, for all of whom clinical outcome data were available (control arm: 20 and EVT arm: 29). Good clinical outcome (mRS 0-2 at 90 days) was nominally, albeit not significantly, lower in patients not treated with EVT (5/19[26.3%]) as compared to ESCAPE EVT arm patients (13/29[44.8%] and ESCAPE-LATE patients (66/141[46.8%]). After adjustment, a graded mRS pattern was seen, whereby patients treated with EVT did better as compared to non-treated patients, and those who underwent EVT in the ESCAPE trial had better mRS as compared to those included in ESCAPE-LATE who underwent EVT in clinical routine.ConclusionPatients presenting beyond 6 hours from last known well who are treated with EVT in a real-world setting show comparable benefit to patients treated in a clinical trial setting.

Central venous catheterizations, or central lines, are commonly placed in critical care situations for vasopressor support and resuscitation. However, central line placement still carries a 3% risk of major complications.¹ While rare, inadvertent placement of large-bore central venous lines into the carotid arteries can be seen in 0.1% to 0.5% of cases.² Utilizing a minimally invasive technique, such as a stent graft, to quickly seal the pierced artery after removal should be considered in cases needing vascular repair. We present the case of a 54-year-old female who was admitted to the intensive care unit for management of septic shock. At an outside hospital, her systolic blood pressure was 60 mmHg. She had a subclavian vein central line misplaced-inadvertently piercing the left common carotid, passing through the aortic valve, and terminating in the left ventricle. After a multidisciplinary discussion, the vascular surgery team felt surgery to be too high-risk. The patient was taken to a hybrid interventional suite with neurointerventional radiology and cardiothoracic surgery, where she underwent stenting of the left common carotid with a covered stent graft and simultaneous removal of the misplaced central line under fluoroscopy. The patient had excellent flow through the carotid stents with repeat computed tomography angiography head and neck imaging post-procedure and after three months. This case highlights the importance of considering endovascular management for iatrogenic vascular events in cases where surgical access is challenging or in critical conditions where there are increased risks of complications.

BackgroundCerebral venous thrombosis is a rare but potentially severe condition, with limited evidence supporting venous thrombectomy. This study aimed to assess current practices and perspectives on venous thrombectomy among French interventional neuroradiology (INR) centers.MethodsIn July 2024, a 14-question web-based survey was distributed to INR centers in France through the trainee-led research network, Jeunes En Neuroradiologie Interventionnelle-Research Collaborative. Questions covered center activity, indications, techniques, devices, and perceived complications.ResultsAmong the 29 responding centers, half reported performing fewer than three venous thrombectomies per year; one-fourth performed none. Indications for venous thrombectomy were heterogeneous: 77% (n = 20) of centers cited clinical deterioration under anticoagulation, and 58% (n = 15) mentioned coma. Operators most frequently used aspiration techniques (96%, n = 24) and stent retrievers (68%, n = 17) and estimated an immediate partial recanalization (90%, n = 18) without procedural complications (78%, n = 18). All centers expressed interest in participating in a randomized clinical trial assessing the efficacy of venous thrombectomy.ConclusionThis national survey reveals significant variability in indications and techniques for venous thrombectomy, with a low volume of procedures and strong interest in harmonizing practices through prospective studies.

BackgroundThe management of unruptured intracranial aneurysms (UIA) requires a balance between procedural risks and the potential benefit of rupture prevention.ObjectiveThe aim of this study is to evaluate the clinical and anatomical results of endovascular treatment for UIAs at our institution, to benchmark our practice and potential areas for improvement, and enable transparent communication with patients by providing accurate, evidence-based information.MethodsWe reviewed all patients treated for an UIA between January 2017 and July 2022. Patients were grouped according to treatment technique: simple or balloon-assisted coiling; stent-assisted coiling; or flow-diverter stent placement. Clinical outcomes included perioperative mortality, transient (<3 months), and permanent morbidity (>3 months). Anatomical results were graded with the Raymond-Roy or the O'Kelly-Marotta scales. Retreatment rates, length of hospitalization, readmissions, irradiation time, and total radiation dose were assessed.ResultsIn total, 169 patients with 201 UIAs underwent 187 endovascular procedures without death, 1% permanent morbidity, 8% transient morbidity, and 4% retreatment. The treatment subgroups analysis shows an absence of permanent morbidity associated with flow-diverter stenting and stent-assisted coiling. Simple/balloon-assisted coiling suffered 2.6% permanent morbidity. Transient morbidity was observed in 9%, 9.5%, and 6.6% of flow-diverter stenting, stent-assisted coiling, and simple/balloon-assisted coiling, respectively.ConclusionsIn our hospital, about one in a hundred procedures caused lasting problems, while about one in 25 aneurysms needed a second treatment. These results reflect our case selection and multidisciplinary approach. Reporting them transparently helps patients understand what outcomes to expect at our hospital.