Interventional Neuroradiology最新文献

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.

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.