Interventional Neuroradiology最新文献

Background and importanceIntra-arterial chemotherapy infusion for retinoblastoma is typically performed via selective catheterization of the ophthalmic artery. Anastomoses between the external carotid and the ophthalmic arteries have also been utilized when the ophthalmic artery cannot be catheterized directly. However, these are not present in every patient.Clinical presentationA 10-month-old boy presented with bilateral retinoblastoma and underwent one round of intra-arterial chemotherapy (IAC) via direct catheterization of the ophthalmic arteries. Combined with adjuvant laser therapy, they experienced symptomatic improvement and tumour regression. However, during subsequent treatment sessions both ophthalmic arteries did not have anterograde flow and attempts to catheterize their origin were unsuccessful. Unfortunately, no targetable anastomoses between the external carotid and ophthalmic arteries were identified for drug delivery. Due to the patient's anatomy, balloon occlusion of the ECA was felt to be unsafe. As a salvage technique, a balloon was inflated in the left internal carotid artery (ICA) distal to the ophthalmic take-off to redirect flow into the ophthalmic. Repeat angiography with the distal ICA occluded showed improved flow into the ipsilateral ophthalmic artery. IAC was then successfully delivered through the left ICA.ConclusionThis case illustrates the importance of utilizing creative endovascular techniques for targeted intra-arterial drug delivery when other conventional measures fail as these patients often have limited, and potentially higher risk, therapeutic alternatives.

BackgroundFaster time to treatment for stroke is associated with improved outcomes. In cases of large vessel occlusion (LVO), standard of care treatment with thrombectomy can only be provided at a comprehensive stroke center (CSC). We examine the outcomes of patients who are directly brought to our center, a CSC, compared to those seen at a primary stroke center (PSC) and then transferred.MethodsPatients with LVO presenting to our center from 1/1/2019 to 12/31/2019 were included. Cohorts of patients presenting first to a PSC and presenting first to a CSC were compared. Demographics and outcome metrics (Discharge Modified Rankin Scale (mRS) and National Institute of Health Stroke Severity Scale (NIHSS) scores) were obtained for all LVO patients. Imaging was also assessed.ResultsOf 864 stroke admissions, 346 had LVO (40%) with 183 (53%) transferring from a PSC and 163 (47%) presenting directly. Similar percentages of each cohort were taken for thrombectomy (25.1% transfer and 31.3% direct). However, as distance between PSC and CSC increased, likelihood of thrombectomy decreased. Transfer patients were more likely to be excluded from thrombectomy secondary to a large volume of complete stroke (p  =  0.0001). Direct presenters had lower discharge mRS scores than transfer patients (p < 0.01), however, severity of stroke upon admission was similar in the two groups.ConclusionPatients transferred from a PSC were more likely to have a worse outcome at time of discharge than those presenting directly to our center. Large volume of completed stroke was a frequent reason for exclusion from thrombectomy. Optimizing stroke protocols to CSC in cases of LVOs may result in better outcomes.

BackgroundSurpass Streamline (SS; Stryker^©) is an over-the-wire first-generation flow diverter (FD). There is a scarcity of data on real-world outcomes and complications of this FD.MethodsA retrospective review of consecutive cases between January 2019 and July 2021 at two high-volume comprehensive stroke centers, involving SS was conducted.ResultsFifty-five patients harbored 69 treated aneurysms, of which 96% were in the internal carotid petrous to terminus segments and 88% were <10 mm in size, and 12% measuring 10-24 mm. Raymond Roy Grade 1 occlusion was noted in 55 aneurysms (79.7%) at 1 year. Median follow-up duration was 26 months (mean = 26.06). Major complications were seen in eight patients (14.5%; 95% CI 6.5-26.7) and mortality attributable to SS stenting complications occurred in two (4.3%) patients. Four (7.2%) had ophthalmologic thromboembolic complications and two had (3.6%) ischemic complications. Procedural complications occurred in 10 patients (18.18%; 95% CI 9.1-30.9). Technical complications during procedure (n = 3, 5.3%) were: "confirmed" distal middle cerebral artery (MCA) guidewire perforation; "suspected" distal MCA guidewire perforation causing post-procedural subarachnoid hemorrhage and internal carotid artery dissection causing ischemic stroke. Seizures were seen in 5 (9.09%) and carotid-cavernous fistula in 1 (1.8%). Multivariate regression analysis showed technical challenges significantly predicted occurrence of major complications (p = 0.001; R²= 0.39, F(13,43) = 2.15, p = 0.029). Univariate analysis showed technical challenges significantly predicted ophthalmological complications (R²= 0.06, F(1,55) = 4.04, p = 0.049) and major complications (R²= 0.21, F(1,55) = 15.11, p = 0.0002).ConclusionLarge-scale future registry should focus on national data regarding SS safety, technical challenges, and procedural complications. We present one of the longest follow-ups for SS in literature.

BackgroundEMBOLISE (NCT04402632) is an ongoing randomized controlled trial investigating the safety and efficacy of middle meningeal artery embolization for the treatment of subacute or chronic subdural hematoma (SDH). Viz RECRUIT SDH is an artificial intelligence (AI)-based software platform that can automatically detect SDH in noncontrast computed tomography (NCHCT) images and report the volume, maximum thickness, and midline shift. We hypothesized that the mobile recruitment platform would aid enrollment and coordinate communication and image sharing among the entire research team.Materials and methodsPatient enrollment in EMBOLISE prior to and after implementation of Viz RECRUIT SDH at a large comprehensive stroke center was compared along with the performance of the software platform. The EMBOLISE trial was activated on May 5, 2021, and Viz RECRUIT SDH was activated on October 6, 2021. The pre-AI cohort consisted of all patients from EMBOLISE to AI activation (153 days), and the post-AI cohort consisted of all patients from AI activation until August 18, 2022 (316 days). All alerts for suspected SDH candidates were manually reviewed to determine the positive predictive value (PPV) of the algorithm.ResultsPrior to AI-software implementation, there were 5 patients enrolled (0.99 patients/month) and one screen failure. After the implementation of the software, enrollment increased by 36% to 1.35 patients/month (14 total enrolled), and there were no screen failures. Over the entire post-AI period, a total of 6244 NCHCTs were processed by the system with 207 total SDH detections (3% prevalence). 35% of all alerts for suspected SDH were viewed within 10 min, and 50% were viewed within an hour. The PPV of the algorithm was 81.4 (CI [75.3, 86.7]).ConclusionThe implementation of an AI-based software for the automatic screening of SDH patients increased the enrollment rate in the EMBOLISE trial, and the software performed well in a real-world, clinical trial setting.

BackgroundBalloon guide catheters (BGCs) can be used adjunctively during mechanical thrombectomy (MT) for acute ischemic stroke (AIS). Evaluating the potential economic impact associated with adjunctive BGC use is an important consideration for resource allocation.MethodsDecision tree models were used to estimate the economic value of BGC use in MT through its impact on functional outcomes. Healthcare utilization cost estimates in the short- and long-term for patients with different 90-day mRS scores were analyzed for MT-only and MT + BGC scenarios. Deterministic (one-way) and probabilistic sensitivity analyses were performed to evaluate the robustness and uncertainty of model parameters.ResultsPer-patient index hospitalization cost was estimated at $65,260 for MT-only and $62,883 for MT + BGC scenarios. Per-patient one-year post-index hospitalization cost was estimated at $27,569 for MT-only and $24,830 for MT + BGC. MT + BGC had a total cost savings of $5117 compared with MT-only. Deterministic (one-way) sensitivity analysis demonstrated that cost saving per patient was most sensitive to the proportion of patients in the mRS 0-2 category in both MT + BGC and MT-only. In a probabilistic sensitivity analysis, mean per-patient costs for the index hospitalization were estimated at $63,737 for MT-only and $61,425 for MT + BGC. Mean per-patient cost estimates one-year post-index hospitalization was $27,445 for MT-only and $24,715 for MT + BGC. MT + BGC had a total cost savings of $5043 compared with MT-only.ConclusionMechanical thrombectomy with adjunctive BGC use may reduce short-term and long-term patient costs due to improved functional outcomes when compared to MT treatment alone for AIS.

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.