Interventional Neuroradiology最新文献

BackgroundHemorrhagic transformation (HT) is a serious complication following mechanical thrombectomy in acute ischemic stroke (AIS), significantly impacting clinical outcomes. Magnetic resonance imaging (MRI)-based quantitative biomarkers, particularly the apparent diffusion coefficient (ADC), have been investigated as predictors of HT, but findings across studies remain inconsistent. This study aimed to evaluate the diagnostic performance of quantitative MRI biomarkers, especially ADC values, for predicting any HT in AIS patients undergoing mechanical thrombectomy.MethodsA systematic search of PubMed, Embase, Scopus, and Web of Science was performed for studies published up to 20 July 2025, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk of bias was assessed by QUADAS-2. Eligible studies assessed quantitative biomarkers based on pre-treatment MRI for predicting any HT post-thrombectomy. Data on sensitivity, specificity, area under the curve (AUC), and other diagnostic metrics were extracted. Pooled estimates were calculated using a bivariate random-effects model. Heterogeneity was assessed via I² statistics, and publication bias was evaluated using Deeks' funnel plot.ResultsEleven studies were included. The pooled sensitivity and specificity of models based on ADC for predicting HT were 0.75 (95% CI: 0.66-0.82, I²: 0%) and 0.73 (95% CI: 0.65-0.80, I²: 58.91%), respectively. The summary AUC was 0.79 (95% CI: 0.75-0.83), indicating strong diagnostic performance. Additional biomarkers such as infarct core volume, white matter hyperintensity and arterial spin labeling demonstrated potential but lacked sufficient data for meta-analysis.ConclusionsDiffusion-weighted imaging shows good diagnostic accuracy for predicting HT after mechanical thrombectomy. Integration of advanced imaging biomarkers into pre-thrombectomy protocols could enhance clinical decision-making and patient safety.

BackgroundVertebral artery dissecting aneurysms (VADAs) pose therapeutic challenges when the posterior inferior cerebellar artery (PICA), anterior spinal artery (ASA), or dominant vertebral artery (VA) is involved.ObjectivesTo describe anatomical factors, treatment strategies, and clinical outcomes after endovascular therapy for VADAs.MethodsWe retrospectively reviewed prospectively collected data (January 2013-April 2025) on adults treated endovascularly for intradural VADAs. The primary outcome was 12-month modified Rankin Scale (mRS ≤ 2).ResultsNineteen patients (9 women, median age ≈52 years) were included. Most aneurysms were fusiform (12/19, 63.2%), and 8/19 (42.1%) presented ruptured. Flow diversion was the predominant treatment (12/19, 63.2%). At 12 months, 15/19 patients (78.9%) achieved a favorable mRS, while 4/19 (21.1%) were dependent or dead. Complications occurred in 4/19 (22.2%), most commonly ischemic events. Angiographic occlusion improved over time, with complete occlusion in 8/9 (88.9%) at 6 months and 3/5 (60.0%) at 12 months. Outcomes were favorable across anatomical subgroups, with no consistent differences by PICA or ASA involvement or VA dominance.ConclusionsOptimal VADA management relies on anatomy: parent-artery occlusion suits nondominant VAs with contralateral and PICA collaterals, while branch-preserving flow diversion (often with adjunctive coils at the PICA origin) is preferred for dominant-side or PICA/ASA-related dissections.

Cerebral venous outflow disorders represent an underrecognized spectrum of conditions in which impaired venous drainage contributes to intracranial hypertension and a variety of neurological symptoms. Traditional perspectives have emphasized cerebrospinal fluid pressure as the dominant pathophysiologic driver, but emerging evidence highlights the central role of venous congestion in promoting dysfunction through mechanisms including venous hypertension, impaired glymphatic clearance, cerebral swelling, and potential neurotoxicity from stagnant flow. The venous system can be seen as a waste management network, with jugular and extra-jugular pathways variably influenced by static and dynamic compression. Outflow insufficiency may result in global or regional cerebral flow deficits, the magnitude and duration of which correlate with symptom severity. Variability between individuals, genetic and anatomical, may explain the differing thresholds at which a person develops symptoms. Surgical approaches such as jugular stenting or styloidectomy aim to enhance venous drainage, thereby reducing flow deficits and improving symptoms. By reframing cerebral venous physiology into simplified models, this work provides a conceptual foundation for further study and therapeutic innovation in cerebral venous outflow disorders.

Frailty, broadly defined as diminished physiological resilience to stressors, is increasingly recognized as a significant determinant of outcomes in acute ischemic stroke (AIS). While physical frailty is characterized by functional decline and vulnerability, brain frailty refers to reduced neurophysiological reserve, reflected in imaging markers such as cortical atrophy, leukoaraiosis, and chronic infarcts. These conditions may coexist but represent distinct constructs, each influencing post-stroke recovery. This review synthesizes eight key studies examining the impact of brain frailty on AIS outcomes following reperfusion therapies, including intravenous thrombolysis and endovascular thrombectomy. Evidence from post hoc analyses of major trials and prospective cohorts shows that brain frailty is independently associated with greater initial stroke severity, poorer functional recovery, and worse cognitive outcomes. Furthermore, both physical and brain frailty mediate the association between age and recovery, reinforcing the importance of biological age over chronological age in prognostication. The limitations of conventional tools like the modified Rankin Scale (mRS) are discussed, as mRS may not capture the etiology or reversibility of prestroke disability. Treatment decisions based solely on age or mRS can lead to under-treatment of older or frail individuals, despite evidence showing selected patients can benefit from reperfusion therapy. Integrating frailty assessments, both clinical and imaging-based, into AIS management may enhance patient selection, promote treatment equity, and optimize outcomes. Future protocols should adopt a nuanced approach that considers biological age and cerebral functional reserve alongside traditional metrics like infarct volume and location.

Advances in mechanical thrombectomy (MT) devices have reduced mortality and improved the quality of life among stroke patients. Favorable (mRS 0-2 at 90 days) post-procedure outcomes depend heavily upon the degree of recanalization. Fibrin-rich thrombi pose a major impediment to adequate (TICI 2B) clot retrieval, as their firm composition resists extraction. We describe a low-temperature plasma process for modifying stent retrievers with fibrinogen. Fibrinogen binding translates into greater efficacy in capturing fibrin-rich clots in vitro. This advance may improve MT outcomes through faster and more complete clot retrievals.

BackgroundIn-stentstenosis (ISS) is a recognized complication following flow-diverting stent placement for intracranial aneurysms. Although typically asymptomatic and self-resolving, severe cases may result in ischemic complications. Gold-standard detection relies on invasive digital subtraction angiography (DSA). This study sought to determine whether quantitative magnetic resonance angiography with non-invasive optimal vessel analysis (qMRA NOVA) can accurately identify patients with ISS following flowdiverter placement.MethodsThis retrospective study evaluated 373 patients treated with flow-diverting stents at a single institution between 2017 and 2023. Sixteen patients met the inclusion criteria for DSA-confirmed ISS with matched post-procedure and follow-up NOVA imaging and catheter angiography. Vessel flow, velocity, and diameter were analyzed. Receiver operating characteristic (ROC) analysis was used to determine optimal thresholds for detecting ISS based on flow changes.ResultsAmong ISS patients, 88% demonstrated significant flow reductions in the treated vessel on follow-up NOVA (mean decrease: 76.2 ± 65.0 ml/min, P = .0002). ROC analysis showed that the percent change in ICA flow had high discriminative ability, with optimal thresholds demonstrating sensitivity of 86% and negative predictive value (NPV) of 98%. A dual-threshold model combining ≥40 mL absolute and ≥20% relative ICA flow reduction afforded improved specificity (75%) while maintaining high NPV (97%).ConclusionsNOVA is a sensitive non-invasive tool for early ISS detection following flow diversion, potentially detecting subclinical ISS patients that should undergo subsequent angiography, while also reducing the need for early angiography in patients unlikely to have ISS or repeated angiography to follow-up ISS.

BackgroundFlow diverter stent (FDS) treatment is an effective option for wide-necked intracranial aneurysms, but adequate neointimal formation and stent apposition are critical to prevent thromboembolic complications. Non-invasive, reliable imaging techniques for assessing neointimal formation remain limited. This study aimed to evaluate the utility of Dyna-3D imaging in assessing neointimal formation after FDS treatment and to compare its performance with conventional 2D-DSA.MethodsThis retrospective study included 61 patients with unruptured intracranial aneurysms treated with FDS between August 2019 and October 2024. Radiological follow-up was performed 3-6 months post-procedure using both 2D-DSA and Dyna-3D imaging. Neointimal coverage was classified into Groups A-C based on the positional relationship between the stent wires and the vessel wall (Group A = wire outside; Group B = partial overlap; Group C = the vessel wall outside). Interobserver agreement, imaging accuracy, and associated clinical factors were analyzed.ResultsComplete neointimal formation (Group A) was identified in 51 cases (83.6%; 95% CI 72.4-90.8) using Dyna-3D and 21 cases (34.4%; 95% CI 23.7-47.0) using 2D-DSA (P < .0001). Dyna-3D demonstrated superior interobserver agreement (Cohen's κ=0.893; 95% CI 0.75-1.00) compared to 2D-DSA (κ=0.459; 95% CI 0.28-0.64) in the evaluation of neointimal formation. Multivariate analysis identified younger age as a significant factor associated with Group A classification across both modalities (2D-DSA: OR 0.93, 95% CI 0.88-0.98, P = .008; Dyna-3D: OR 0.90, 95% CI 0.8-0.97, P = .018). No thromboembolic or hemorrhagic complications were identified during follow-up.ConclusionDyna-3D imaging provides superior visualization of neointimal formation compared to conventional 2D-DSA and enables comprehensive circumferential assessment of stent apposition. These findings suggest that Dyna-3D may offer a useful tool for guiding post-FDS treatment management, including the potential for age-adjusted optimization of antiplatelet therapy duration.

Wide neck bifurcation aneurysms are treated by intrasaccular implants, stent-assisted coiling, or flow diverters (FDs). The latter two options require long-term dual anti-platelet agents (DAPTs) and the former require access to the vulnerable aneurysm dome.^{1- 5} In patients requiring oral anticoagulation (OAC), an alternative treatment strategy would be advantageous to mitigate the foregoing risks. This report describes using a dedicated bifurcation FD, eCLIPs eBFD, to treat a basilar tip bifurcation aneurysm in a patient with atrial fibrillation requiring long-term OACs. The non-tubular eBFD aneurysm neck-bridging implant provides coil-retaining and flow diverting features and serves as a platform for endothelial growth.^{6, 7} It has shown flow velocity reduction at a bifurcation equivalent to a tubular FD at a sidewall.⁸ In this case, eBFD, without coils, resulted in protracted intrasaccular stasis and resulted in complete aneurysm occlusion and neck remodeling within three months of discontinuation of dual anti-platelet therapy, without interrupting OAC.

Giant, partially thrombosed intracranial aneurysms (GPTIAs) remain among the most technically challenging cerebrovascular lesions to treat, particularly in patients with associated cranial nerve or brainstem compression. Unlike microsurgical clipping with or without decompression, endovascular coiling, parent vessel flow diversion, or parent vessel occlusion, intrasaccular embolization presents a unique opportunity for immediate aneurysm occlusion and reduction of mass effect without requiring long-term antiplatelets or parent vessel compromise. However, to date, no prior intrasaccular devices were available to treat GPTIAs, including the Food and Drug Administration-approved Woven EndoBridge device which could only accommodate aneurysms up to ∼11 mm in width. Here, we present the technical feasibility, safety, and efficacy of minimally invasive endovascular intrasaccular aneurysm embolization for GPTIAs with the novel saccular endovascular aneurysm lattice (SEAL) XL device engineered with a dual-layer mesh design and an expanded size matrix aneurysms up to 20 mm in diameter. Further data from larger prospective case series are needed to validate these promising initial findings.