Pub Date : 2024-08-29DOI: 10.1136/jnis-2024-022174
Austin Michael Hilvert, Fatima Gauhar, Michael Longo, Heather Grimaudo, John Dugan, Nishit Mummareddy, Rohan Chitale, Michael T Froehler, Matthew R Fusco
Background: Venous sinus stenting (VSS) has been shown to reduce intracranial venous pressures and improve symptoms in patients with idiopathic intracranial hypertension (IIH). However, long-term follow-up data are limited, raising concerns about sustained symptom improvement. We aimed to assess long-term outcomes of VSS compared with ventriculoperitoneal shunting (VPS).
Methods: A retrospective case-control study assessed 87 patients with IIH who met inclusion criteria and underwent either VSS (n=27) or VPS (n=60) between 2017 and 2022. Descriptive statistics for baseline characteristics and outcomes were calculated, followed by multivariate logistic regression to identify factors associated with headache recurrence.
Results: Baseline characteristics were similar between VSS and VPS groups, including age (p=0.58), sex (p=0.74), body mass index (p=0.47), and preoperative lumbar puncture opening pressure (p=0.62). Preoperative symptoms of headaches (p=0.42), papilledema (p=0.35), and pulsatile tinnitus (p=0.56) were also similar. Initial headache improvement was comparable (96% vs 91%, p=0.42). However, headache recurrence was less common in the VSS group (31% vs 60%, p=0.015) at the last follow-up, averaging over 1 year. Multivariate analysis showed VSS was independently associated with reduced odds of headache recurrence (OR 0.24, p=0.015). Longer follow-up was associated with increased odds of headache recurrence in both groups (OR 1.01, p=0.032).
Conclusion: VSS was independently associated with reduced odds of headache recurrence compared with VPS in multivariate analysis. Longer follow-up was significantly associated with headache recurrence in both groups. This suggests that VSS may lead to better outcomes for continued headache relief, but headache recurrence may increase with longer follow-up regardless of treatment modality.
背景:静脉窦支架置入术(VSS)已被证明能降低特发性颅内高压(IIH)患者的颅内静脉压力并改善症状。然而,长期随访数据有限,令人担忧症状能否得到持续改善。我们旨在评估 VSS 与脑室腹腔分流术(VPS)相比的长期疗效:一项回顾性病例对照研究评估了符合纳入标准的87例IIH患者,这些患者在2017年至2022年间接受了VSS(27例)或VPS(60例)治疗。研究人员计算了基线特征和结果的描述性统计,然后进行多变量逻辑回归,以确定头痛复发的相关因素:VSS组和VPS组的基线特征相似,包括年龄(p=0.58)、性别(p=0.74)、体重指数(p=0.47)和术前腰椎穿刺开口压(p=0.62)。术前头痛(p=0.42)、乳头水肿(p=0.35)和搏动性耳鸣(p=0.56)症状也相似。最初的头痛改善程度相当(96% vs 91%,p=0.42)。然而,在最近一次平均1年的随访中,VSS组的头痛复发率较低(31% vs 60%,p=0.015)。多变量分析显示,VSS 与头痛复发几率降低有独立关联(OR 0.24,p=0.015)。两组患者中,随访时间越长,头痛复发几率越高(OR 1.01,P=0.032):结论:在多变量分析中,与 VPS 相比,VSS 与头痛复发几率降低独立相关。在两组患者中,随访时间越长,头痛复发的几率越高。这表明,VSS 可使头痛持续缓解,从而获得更好的疗效,但无论采用哪种治疗方式,随访时间越长,头痛复发率可能越高。
{"title":"Venous sinus stenting versus ventriculoperitoneal shunting: comparing clinical outcomes for idiopathic intracranial hypertension.","authors":"Austin Michael Hilvert, Fatima Gauhar, Michael Longo, Heather Grimaudo, John Dugan, Nishit Mummareddy, Rohan Chitale, Michael T Froehler, Matthew R Fusco","doi":"10.1136/jnis-2024-022174","DOIUrl":"https://doi.org/10.1136/jnis-2024-022174","url":null,"abstract":"<p><strong>Background: </strong>Venous sinus stenting (VSS) has been shown to reduce intracranial venous pressures and improve symptoms in patients with idiopathic intracranial hypertension (IIH). However, long-term follow-up data are limited, raising concerns about sustained symptom improvement. We aimed to assess long-term outcomes of VSS compared with ventriculoperitoneal shunting (VPS).</p><p><strong>Methods: </strong>A retrospective case-control study assessed 87 patients with IIH who met inclusion criteria and underwent either VSS (n=27) or VPS (n=60) between 2017 and 2022. Descriptive statistics for baseline characteristics and outcomes were calculated, followed by multivariate logistic regression to identify factors associated with headache recurrence.</p><p><strong>Results: </strong>Baseline characteristics were similar between VSS and VPS groups, including age (p=0.58), sex (p=0.74), body mass index (p=0.47), and preoperative lumbar puncture opening pressure (p=0.62). Preoperative symptoms of headaches (p=0.42), papilledema (p=0.35), and pulsatile tinnitus (p=0.56) were also similar. Initial headache improvement was comparable (96% vs 91%, p=0.42). However, headache recurrence was less common in the VSS group (31% vs 60%, p=0.015) at the last follow-up, averaging over 1 year. Multivariate analysis showed VSS was independently associated with reduced odds of headache recurrence (OR 0.24, p=0.015). Longer follow-up was associated with increased odds of headache recurrence in both groups (OR 1.01, p=0.032).</p><p><strong>Conclusion: </strong>VSS was independently associated with reduced odds of headache recurrence compared with VPS in multivariate analysis. Longer follow-up was significantly associated with headache recurrence in both groups. This suggests that VSS may lead to better outcomes for continued headache relief, but headache recurrence may increase with longer follow-up regardless of treatment modality.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-29DOI: 10.1136/jnis-2024-022112
James J M Cooper, Kyungduk Rho, Steven B Housley, Kunal Raygor, Adnan H Siddiqui
A man in his early 70s presented to the emergency department about 3.5 hours after acute onset right sided hemiplegia and aphasia. CT angiography confirmed an acute occlusion of the M1 segment of the left middle cerebral artery and severe, but stable, dissection of the aortic arch and a large dissecting aortic aneurysm extending into the innominate artery and beyond into the descending aorta. The risk of aggravating existing aortic pathology while trying to navigate from a transfemoral or transradial approach was considered to be very high; therefore, the decision was made to proceed with direct carotid puncture for mechanical thrombectomy. The procedure was successfully completed, and the carotid puncture site was closed without issue using the Celt ACD vascular closure device (Vasorum, Dublin, Ireland). The patient recovered and was discharged home at his prestroke neurologic baseline 9 days later. Here we discuss the safe and effective use of this novel closure device in the setting of direct carotid puncture for neurointerventional procedures.
{"title":"Safe and effective use of the Celt ACD vascular closure device for rapid hemostasis following direct carotid puncture thrombectomy.","authors":"James J M Cooper, Kyungduk Rho, Steven B Housley, Kunal Raygor, Adnan H Siddiqui","doi":"10.1136/jnis-2024-022112","DOIUrl":"https://doi.org/10.1136/jnis-2024-022112","url":null,"abstract":"<p><p>A man in his early 70s presented to the emergency department about 3.5 hours after acute onset right sided hemiplegia and aphasia. CT angiography confirmed an acute occlusion of the M1 segment of the left middle cerebral artery and severe, but stable, dissection of the aortic arch and a large dissecting aortic aneurysm extending into the innominate artery and beyond into the descending aorta. The risk of aggravating existing aortic pathology while trying to navigate from a transfemoral or transradial approach was considered to be very high; therefore, the decision was made to proceed with direct carotid puncture for mechanical thrombectomy. The procedure was successfully completed, and the carotid puncture site was closed without issue using the Celt ACD vascular closure device (Vasorum, Dublin, Ireland). The patient recovered and was discharged home at his prestroke neurologic baseline 9 days later. Here we discuss the safe and effective use of this novel closure device in the setting of direct carotid puncture for neurointerventional procedures.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Cerebral arteriovenous malformation (AVM) is a cerebrovascular disorder posing a risk for intracranial hemorrhage. However, there are few reliable quantitative indices to predict hemorrhage risk accurately. This study aimed to identify potential biomarkers for hemorrhage risk by quantitatively analyzing the hemodynamic and morphological features within the AVM nidus.
Methods: This study included three datasets comprising consecutive patients with untreated AVMs between January 2008 to December 2023. Training and test datasets were used to train and evaluate the model. An independent validation dataset of patients receiving conservative treatment was used to evaluate the model performance in predicting subsequent hemorrhage during follow-up. Hemodynamic and morphological features were quantitatively extracted based on digital subtraction angiography (DSA). Individual models using various machine learning algorithms and an ensemble model were constructed on the training dataset. Model performance was assessed using the confusion matrix-related metrics.
Results: This study included 844 patients with AVMs, distributed across the training (n=597), test (n=149), and validation (n=98) datasets. Five hemodynamic and 14 morphological features were quantitatively extracted for each patient. The ensemble model, constructed based on five individual machine-learning models, achieved an area under the curve of 0.880 (0.824-0.937) on the test dataset and 0.864 (0.769-0.959) on the independent validation dataset.
Conclusion: Quantitative hemodynamic and morphological features extracted from DSA data serve as potential indicators for assessing the rupture risk of AVM. The ensemble model effectively integrated multidimensional features, demonstrating favorable performance in predicting subsequent rupture of AVM.
{"title":"Rupture risk assessment in cerebral arteriovenous malformations: an ensemble model using hemodynamic and morphological features.","authors":"Haoyu Zhu, Lian Liu, Shikai Liang, Chao Ma, Yuzhou Chang, Longhui Zhang, Xiguang Fu, Yuqi Song, Jiarui Zhang, Yupeng Zhang, Chuhan Jiang","doi":"10.1136/jnis-2024-022208","DOIUrl":"https://doi.org/10.1136/jnis-2024-022208","url":null,"abstract":"<p><strong>Background: </strong>Cerebral arteriovenous malformation (AVM) is a cerebrovascular disorder posing a risk for intracranial hemorrhage. However, there are few reliable quantitative indices to predict hemorrhage risk accurately. This study aimed to identify potential biomarkers for hemorrhage risk by quantitatively analyzing the hemodynamic and morphological features within the AVM nidus.</p><p><strong>Methods: </strong>This study included three datasets comprising consecutive patients with untreated AVMs between January 2008 to December 2023. Training and test datasets were used to train and evaluate the model. An independent validation dataset of patients receiving conservative treatment was used to evaluate the model performance in predicting subsequent hemorrhage during follow-up. Hemodynamic and morphological features were quantitatively extracted based on digital subtraction angiography (DSA). Individual models using various machine learning algorithms and an ensemble model were constructed on the training dataset. Model performance was assessed using the confusion matrix-related metrics.</p><p><strong>Results: </strong>This study included 844 patients with AVMs, distributed across the training (n=597), test (n=149), and validation (n=98) datasets. Five hemodynamic and 14 morphological features were quantitatively extracted for each patient. The ensemble model, constructed based on five individual machine-learning models, achieved an area under the curve of 0.880 (0.824-0.937) on the test dataset and 0.864 (0.769-0.959) on the independent validation dataset.</p><p><strong>Conclusion: </strong>Quantitative hemodynamic and morphological features extracted from DSA data serve as potential indicators for assessing the rupture risk of AVM. The ensemble model effectively integrated multidimensional features, demonstrating favorable performance in predicting subsequent rupture of AVM.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-23DOI: 10.1136/jnis-2024-022058
Sameer Saleem Tebha, Robert Underwood, Vishwanath Sagi, Dale Ding, Robert M Starke, Isaac Josh Abecassis
Here we present a fusiform, partially thrombosed, previously ruptured aneurysm in the posterior cerebral artery that was treated with parent vessel sacrifice after a micro-WADA and micro-balloon test occlusion (video 1). These aneurysms pose treatment challenges due to their deep location, morphology, and potentially eloquent distal supply.1 2 Primary coiling, stent assisted coiling, or microsurgical clipping are often not viable options, whereas flow diversion, parent vessel sacrifice,3 or trapping with bypass are usually employed. Pharmacological provocative testing via a micro-WADA4 5 with or without a micro-balloon test occlusion is critical to establish whether the territory at risk has functional eloquence, although specific reports for using these techniques are limited. We describe the patient presentation, initial treatment attempt and failure, and our protocol for performing a micro-WADA/balloon test occlusion test.neurintsurg;jnis-2024-022058v1/V1F1V1Video 1 Micro wada for PCA aneurysm.
{"title":"Micro-WADA and balloon test occlusion for sacrifice of distal P2 aneurysm.","authors":"Sameer Saleem Tebha, Robert Underwood, Vishwanath Sagi, Dale Ding, Robert M Starke, Isaac Josh Abecassis","doi":"10.1136/jnis-2024-022058","DOIUrl":"https://doi.org/10.1136/jnis-2024-022058","url":null,"abstract":"<p><p>Here we present a fusiform, partially thrombosed, previously ruptured aneurysm in the posterior cerebral artery that was treated with parent vessel sacrifice after a micro-WADA and micro-balloon test occlusion (video 1). These aneurysms pose treatment challenges due to their deep location, morphology, and potentially eloquent distal supply.1 2 Primary coiling, stent assisted coiling, or microsurgical clipping are often not viable options, whereas flow diversion, parent vessel sacrifice,3 or trapping with bypass are usually employed. Pharmacological provocative testing via a micro-WADA4 5 with or without a micro-balloon test occlusion is critical to establish whether the territory at risk has functional eloquence, although specific reports for using these techniques are limited. We describe the patient presentation, initial treatment attempt and failure, and our protocol for performing a micro-WADA/balloon test occlusion test.neurintsurg;jnis-2024-022058v1/V1F1V1Video 1 Micro wada for PCA aneurysm.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142046821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-23DOI: 10.1136/jnis-2024-021975
Sameh Samir Elawady, Rahim Abo Kasem, Bhageeradh Mulpur, Conor Cunningham, Hidetoshi Matsukawa, Mohammad-Mahdi Sowlat, Atakan Orscelik, Noah L A Nawabi, Julio Isidor, Ilko Maier, Pascal Jabbour, Joon-Tae Kim, Stacey Q Wolfe, Ansaar Rai, Robert M Starke, Marios-Nikos Psychogios, Edgar A Samaniego, Shinichi Yoshimura, Hugo Cuellar, Brian M Howard, Ali Alawieh, Ali Alaraj, Mohamad Ezzeldin, Daniele G Romano, Omar Tanweer, Justin R Mascitelli, Isabel Fragata, Adam J Polifka, Fazeel Siddiqui, Joshua W Osbun, Ramesh Grandhi, Roberto Javier Crosa, Charles Matouk, Min S Park, Waleed Brinjikji, Mark Moss, Ergun Daglioglu, Richard Williamson, Pedro Navia, Peter Kan, Reade Andrew De Leacy, Shakeel A Chowdhry, David Altschul, Alejandro M Spiotta, Michael R Levitt, Nitin Goyal
Background: A combination of intravenous (IVT) or intra-arterial (IAT) thrombolysis with mechanical thrombectomy (MT) for acute ischemic stroke due to large vessel occlusion (AIS-LVO) has been investigated. However, there is limited data on patients who receive both IVT and IAT compared with IVT alone before MT.
Methods: STAR data from 2013 to 2023 was utilized. We performed propensity score matching between the two groups. The primary outcomes were symptomatic intracranial hemorrhage (sICH) and 90-day modified Rankin Scale (mRS) score 0-2. Secondary outcomes included successful recanalization (modified treatment in cerebral infarction (mTICI) ≥2B, ≥2C), early neurological improvement, any intracranial hemorrhage (ICH), and 90-day mortality.
Results: A total of 2454 AIS-LVO patients were included. Propensity matching yielded 190 well-matched patients in each group. No significant differences were observed between the groups in either ICH or sICH (odds ratio (OR): 0.80, 95% confidence interval (CI) 0.51-1.24, P=0.37; OR: 0.60, 95% CI 0.29 to 1.24, P=0.21, respectively). Rates of successful recanalization and early neurological improvement (ENI) were significantly lower in MT+IVT + IAT. mRS 0-1 and mortality were not significantly different between the two groups. However, the MT+IVT + IAT group demonstrated superior rates of good functional outcomes (90-day mRS 0-1) compared with patients in the MT+IVT group who had mTICI ≤2B, (OR: 2.18, 95% CI 1.05 to 3.99, P=0.04).
Conclusion: The combined use of IAT and IVT thrombolysis in AIS-LVO patients undergoing MT is safe. Although the MT+IVT+ IAT group demonstrated lower rates of recanalization and early neurological improvement, long-term functional outcomes were favorable in this group suggesting a potential delayed benefit of IAT.
背景:有学者研究了静脉(IVT)或动脉内(IAT)溶栓联合机械取栓(MT)治疗大血管闭塞导致的急性缺血性卒中(AIS-LVO)。然而,与 MT 前仅接受 IVT 相比,同时接受 IVT 和 IAT 的患者数据有限:我们利用了 2013 年至 2023 年的 STAR 数据。我们对两组患者进行了倾向得分匹配。主要结果是症状性颅内出血(sICH)和90天改良Rankin量表(mRS)0-2分。次要结果包括成功再通(脑梗塞改良治疗(mTICI)≥2B、≥2C)、早期神经功能改善、任何颅内出血(ICH)和90天死亡率:共纳入 2454 例 AIS-LVO 患者。倾向匹配结果显示,每组均有190名匹配良好的患者。两组患者的 ICH 或 sICH 均无明显差异(几率比(OR):0.80,95% 置信区间(CI)0.51-1.24,P=0.37;OR:0.60,95% CI 0.29 至 1.24,P=0.21)。MT+IVT + IAT的再通成功率和早期神经功能改善率(ENI)明显较低,两组间的mRS 0-1和死亡率无明显差异。然而,与mTICI≤2B的MT+IVT组患者相比,MT+IVT+IAT组患者的良好功能预后率(90天mRS 0-1)更高(OR:2.18,95% CI 1.05至3.99,P=0.04):结论:在接受MT治疗的AIS-LVO患者中联合使用IAT和IVT溶栓是安全的。虽然 MT+IVT+ IAT 组的再通率和早期神经功能改善率较低,但该组患者的长期功能预后良好,这表明 IAT 有可能带来延迟获益。
{"title":"Comparison of combined intravenous and intra-arterial thrombolysis with intravenous thrombolysis alone in stroke patients undergoing mechanical thrombectomy: a propensity-matched analysis.","authors":"Sameh Samir Elawady, Rahim Abo Kasem, Bhageeradh Mulpur, Conor Cunningham, Hidetoshi Matsukawa, Mohammad-Mahdi Sowlat, Atakan Orscelik, Noah L A Nawabi, Julio Isidor, Ilko Maier, Pascal Jabbour, Joon-Tae Kim, Stacey Q Wolfe, Ansaar Rai, Robert M Starke, Marios-Nikos Psychogios, Edgar A Samaniego, Shinichi Yoshimura, Hugo Cuellar, Brian M Howard, Ali Alawieh, Ali Alaraj, Mohamad Ezzeldin, Daniele G Romano, Omar Tanweer, Justin R Mascitelli, Isabel Fragata, Adam J Polifka, Fazeel Siddiqui, Joshua W Osbun, Ramesh Grandhi, Roberto Javier Crosa, Charles Matouk, Min S Park, Waleed Brinjikji, Mark Moss, Ergun Daglioglu, Richard Williamson, Pedro Navia, Peter Kan, Reade Andrew De Leacy, Shakeel A Chowdhry, David Altschul, Alejandro M Spiotta, Michael R Levitt, Nitin Goyal","doi":"10.1136/jnis-2024-021975","DOIUrl":"https://doi.org/10.1136/jnis-2024-021975","url":null,"abstract":"<p><strong>Background: </strong>A combination of intravenous (IVT) or intra-arterial (IAT) thrombolysis with mechanical thrombectomy (MT) for acute ischemic stroke due to large vessel occlusion (AIS-LVO) has been investigated. However, there is limited data on patients who receive both IVT and IAT compared with IVT alone before MT.</p><p><strong>Methods: </strong>STAR data from 2013 to 2023 was utilized. We performed propensity score matching between the two groups. The primary outcomes were symptomatic intracranial hemorrhage (sICH) and 90-day modified Rankin Scale (mRS) score 0-2. Secondary outcomes included successful recanalization (modified treatment in cerebral infarction (mTICI) ≥2B, ≥2C), early neurological improvement, any intracranial hemorrhage (ICH), and 90-day mortality.</p><p><strong>Results: </strong>A total of 2454 AIS-LVO patients were included. Propensity matching yielded 190 well-matched patients in each group. No significant differences were observed between the groups in either ICH or sICH (odds ratio (OR): 0.80, 95% confidence interval (CI) 0.51-1.24, P=0.37; OR: 0.60, 95% CI 0.29 to 1.24, P=0.21, respectively). Rates of successful recanalization and early neurological improvement (ENI) were significantly lower in MT+IVT + IAT. mRS 0-1 and mortality were not significantly different between the two groups. However, the MT+IVT + IAT group demonstrated superior rates of good functional outcomes (90-day mRS 0-1) compared with patients in the MT+IVT group who had mTICI ≤2B, (OR: 2.18, 95% CI 1.05 to 3.99, P=0.04).</p><p><strong>Conclusion: </strong>The combined use of IAT and IVT thrombolysis in AIS-LVO patients undergoing MT is safe. Although the MT+IVT+ IAT group demonstrated lower rates of recanalization and early neurological improvement, long-term functional outcomes were favorable in this group suggesting a potential delayed benefit of IAT.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142046820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-21DOI: 10.1136/jnis-2024-022218
Charles Fleming, Christian Terwiesch, John Reavey-Cantwell
Background: Across a wide range of tasks it has been shown that workers switching between different activities have 'switching costs' due to slower performance and increased errors. Scheduling similar cases consecutively, or 'stacking cases', allows an operating room (OR) team to avoid switching costs and might therefore result in increased efficiency.
Objective: To investigate whether stacking neuroendovascular cases decreases turnover and procedure time.
Methods: A retrospective case series was identified of 4386 endovascular cases performed by vascular neurosurgeons between 2015 and 2023 at an academic center. A 'stacked case' was defined as a binary variable, which counted as 'yes' when the preceding case was the same procedure. Primary outcomes were turnover time and procedure time.
Results: Diagnostic angiograms (n=2575) and aneurysm embolizations (n=517) had a sufficient number of cases for statistical analysis.Stacked diagnostic angiograms were associated with significantly faster turnover time (7 min, P=1e-12) in a multivariate regression model. Turnover time decreased with additional stacked cases, with a 4 min reduction for a single stacked case, up to 11 min for a fifth stacked angiogram.For angiograms and aneurysm embolizations, stacked cases were associated with shorter procedure times: 4 min for angiograms (P<0.0001) and 20 min for aneurysm embolizations (P=0.0057).
Conclusion: This project demonstrates that stacking similar cases is associated with reduced turnover and procedure time, after controlling for other variables that affect the flow of an OR day. Stacking cases is a zero-cost intervention that offers significant efficiency gains in the OR schedule.
{"title":"Stacking consecutive similar neuroendovascular cases is associated with reduced turnover time and procedure time.","authors":"Charles Fleming, Christian Terwiesch, John Reavey-Cantwell","doi":"10.1136/jnis-2024-022218","DOIUrl":"https://doi.org/10.1136/jnis-2024-022218","url":null,"abstract":"<p><strong>Background: </strong>Across a wide range of tasks it has been shown that workers switching between different activities have 'switching costs' due to slower performance and increased errors. Scheduling similar cases consecutively, or 'stacking cases', allows an operating room (OR) team to avoid switching costs and might therefore result in increased efficiency.</p><p><strong>Objective: </strong>To investigate whether stacking neuroendovascular cases decreases turnover and procedure time.</p><p><strong>Methods: </strong>A retrospective case series was identified of 4386 endovascular cases performed by vascular neurosurgeons between 2015 and 2023 at an academic center. A 'stacked case' was defined as a binary variable, which counted as 'yes' when the preceding case was the same procedure. Primary outcomes were turnover time and procedure time.</p><p><strong>Results: </strong>Diagnostic angiograms (n=2575) and aneurysm embolizations (n=517) had a sufficient number of cases for statistical analysis.Stacked diagnostic angiograms were associated with significantly faster turnover time (7 min, P=1e-12) in a multivariate regression model. Turnover time decreased with additional stacked cases, with a 4 min reduction for a single stacked case, up to 11 min for a fifth stacked angiogram.For angiograms and aneurysm embolizations, stacked cases were associated with shorter procedure times: 4 min for angiograms (P<0.0001) and 20 min for aneurysm embolizations (P=0.0057).</p><p><strong>Conclusion: </strong>This project demonstrates that stacking similar cases is associated with reduced turnover and procedure time, after controlling for other variables that affect the flow of an OR day. Stacking cases is a zero-cost intervention that offers significant efficiency gains in the OR schedule.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142017740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Intracranial hemorrhage is the major safety concern of standard-dose ticagrelor (90 mg twice daily) based dual antiplatelet therapy (DAPT). The bleeding avoidance strategy through dose de-escalation has been investigated in interventional cardiology. However, the preserved antithrombotic efficacy and better safety of half-dose (45 mg twice daily) ticagrelor remains unverified in patients undergoing stent-assist coiling (SAC) or flow diversion (FD) treating unruptured intracranial aneurysms (UIA).
Methods: A single-center, prospective, cohort study was conducted to compare DAPT with aspirin 100 mg daily plus half-dose ticagrelor vs standard-dose clopidogrel (75 mg daily) in UIA patients. The adenosine diphosphate inhibition (ADPi) rate was utilized to quantify the antagonization of adenosine diphosphate (ADP)-induced platelet aggregation. The patients were followed-up at 6 month after discharge. The primary efficacy outcome was the major adverse cardiovascular and cerebrovascular events (MACCE), and the primary safety outcome was major bleeding. The secondary outcome was minor hemorrhage.
Results: Our study included 322 UIA patients, of which 254 patients were eventually enrolled after propensity score matching. The ADPi of half-dose ticagrelor (51.56%±31.46%) was comparable (P=0.089) to that of clopidogrel (57.44%±22.76%). The outcomes were also comparable. Five (3.94%) patients in the ticagrelor group and eight (6.30%) patients in the clopidogrel group reported MACCE (P=0.393). One patient in the ticagrelor group was diagnosed with asymptomatic intracranial hemorrhage 1 month after stenting. There were 36 (28.35%) minor hemorrhagic events in the ticagrelor group and 35 (27.56%) in the clopidogrel group, (P=0.889).
Conclusion: Half-dose ticagrelor was effective and safe as a potential alternative to clopidogrel in the DAPT regimen for patients undergoing SAC/FD for UIA.
{"title":"Half-dose ticagrelor versus standard-dose clopidogrel in a dual antiplatelet regimen for stent-assisted coiling or flow diversion of unruptured intracranial aneurysms: a cohort study.","authors":"Yi-Chen Li, Man-Man Yi, Rong Wang, Man-Man Xu, Tao Liu, Shi-Jie Na, Teng-Fei Shao, Lan-Ping Ding, Wei-Hong Ge, Yu-Zhu Peng, Zong Zhuang","doi":"10.1136/jnis-2024-021792","DOIUrl":"https://doi.org/10.1136/jnis-2024-021792","url":null,"abstract":"<p><strong>Background: </strong>Intracranial hemorrhage is the major safety concern of standard-dose ticagrelor (90 mg twice daily) based dual antiplatelet therapy (DAPT). The bleeding avoidance strategy through dose de-escalation has been investigated in interventional cardiology. However, the preserved antithrombotic efficacy and better safety of half-dose (45 mg twice daily) ticagrelor remains unverified in patients undergoing stent-assist coiling (SAC) or flow diversion (FD) treating unruptured intracranial aneurysms (UIA).</p><p><strong>Methods: </strong>A single-center, prospective, cohort study was conducted to compare DAPT with aspirin 100 mg daily plus half-dose ticagrelor vs standard-dose clopidogrel (75 mg daily) in UIA patients. The adenosine diphosphate inhibition (ADPi) rate was utilized to quantify the antagonization of adenosine diphosphate (ADP)-induced platelet aggregation. The patients were followed-up at 6 month after discharge. The primary efficacy outcome was the major adverse cardiovascular and cerebrovascular events (MACCE), and the primary safety outcome was major bleeding. The secondary outcome was minor hemorrhage.</p><p><strong>Results: </strong>Our study included 322 UIA patients, of which 254 patients were eventually enrolled after propensity score matching. The ADPi of half-dose ticagrelor (51.56%±31.46%) was comparable (P=0.089) to that of clopidogrel (57.44%±22.76%). The outcomes were also comparable. Five (3.94%) patients in the ticagrelor group and eight (6.30%) patients in the clopidogrel group reported MACCE (P=0.393). One patient in the ticagrelor group was diagnosed with asymptomatic intracranial hemorrhage 1 month after stenting. There were 36 (28.35%) minor hemorrhagic events in the ticagrelor group and 35 (27.56%) in the clopidogrel group, (P=0.889).</p><p><strong>Conclusion: </strong>Half-dose ticagrelor was effective and safe as a potential alternative to clopidogrel in the DAPT regimen for patients undergoing SAC/FD for UIA.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142017739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-20DOI: 10.1136/jnis-2024-022043
Yuye Zhang, Wenxiang Tang, Yanping Niu, Xushen Zhao, Jun Hua, Xiaozhong Zhou, Fanguo Lin
Background: Osteoporotic vertebral compression fractures (OVCFs) of the lumbar region may be accompanied by thoracic fractures. Treating only the lumbar fractures can lead to worsening of the thoracic fractures or unresolved postoperative symptoms. This study aims to investigate the need to perform thoracic MRI before vertebral augmentation (including percutaneous vertebroplasty and percutaneous kyphoplasty) in patients with lumbar OVCF.
Methods: This study retrospectively analyzed patients with lumbar OVCF who were scheduled for surgical treatment. All patients underwent thoracic and lumbar MRI before surgery. We evaluated the proportion of thoracic fractures accompanying lumbar fractures at each segment and identified the common locations of these accompanying fractures. Univariate and multivariate analyses were conducted to determine the risk factors and optimal thresholds for predicting accompanying thoracic fractures.
Results: The study recruited 700 patients, of whom 96 (13.71%) had new thoracic fractures along with lumbar fractures. The most common thoracic segments affected were T10 (22.50%), T9 (19.17%), T8 (26.67%), and T7 (20.83%). Univariate analysis showed significant differences in age and cause of injury between the thoracic fracture group and the control group. The bone density of the thoracic fracture group was significantly lower than that of the control group. Multivariate logistic regression analysis indicated that lifting heavy objects, sprains, and low bone density are risk factors for thoracic fractures in patients with lumbar OVCF.
Conclusion: It is crucial to perform thoracic MRI before surgery in patients with lumbar OVCF. This helps to avoid missing thoracic fractures, prevent the worsening of injuries, and ensure better postoperative outcomes.
{"title":"The need for thoracic magnetic resonance imaging before vertebral augmentation surgery in patients with lumbar vertebral fractures.","authors":"Yuye Zhang, Wenxiang Tang, Yanping Niu, Xushen Zhao, Jun Hua, Xiaozhong Zhou, Fanguo Lin","doi":"10.1136/jnis-2024-022043","DOIUrl":"https://doi.org/10.1136/jnis-2024-022043","url":null,"abstract":"<p><strong>Background: </strong>Osteoporotic vertebral compression fractures (OVCFs) of the lumbar region may be accompanied by thoracic fractures. Treating only the lumbar fractures can lead to worsening of the thoracic fractures or unresolved postoperative symptoms. This study aims to investigate the need to perform thoracic MRI before vertebral augmentation (including percutaneous vertebroplasty and percutaneous kyphoplasty) in patients with lumbar OVCF.</p><p><strong>Methods: </strong>This study retrospectively analyzed patients with lumbar OVCF who were scheduled for surgical treatment. All patients underwent thoracic and lumbar MRI before surgery. We evaluated the proportion of thoracic fractures accompanying lumbar fractures at each segment and identified the common locations of these accompanying fractures. Univariate and multivariate analyses were conducted to determine the risk factors and optimal thresholds for predicting accompanying thoracic fractures.</p><p><strong>Results: </strong>The study recruited 700 patients, of whom 96 (13.71%) had new thoracic fractures along with lumbar fractures. The most common thoracic segments affected were T10 (22.50%), T9 (19.17%), T8 (26.67%), and T7 (20.83%). Univariate analysis showed significant differences in age and cause of injury between the thoracic fracture group and the control group. The bone density of the thoracic fracture group was significantly lower than that of the control group. Multivariate logistic regression analysis indicated that lifting heavy objects, sprains, and low bone density are risk factors for thoracic fractures in patients with lumbar OVCF.</p><p><strong>Conclusion: </strong>It is crucial to perform thoracic MRI before surgery in patients with lumbar OVCF. This helps to avoid missing thoracic fractures, prevent the worsening of injuries, and ensure better postoperative outcomes.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Despite its low incidence, basilar artery occlusion (BAO) remains a major therapeutic challenge since severe disability and death occur in about 80% of patients. Specific site of BAO (proximal, middle, or distal) has rarely been reported as a prognostic factor in reperfusion therapy. We aimed to explore the relationship between site-specific BAO and clinical outcomes in patients treated with reperfusion therapies.
Methods: We performed a single-centre retrospective study of all consecutive patients with acute BAO admitted to the University Medical Centre Ljubljana between January 2013 and August 2022 who were treated with reperfusion therapies. Patients were grouped according to the location of BAO and compared for baseline characteristics, differences in stroke aetiology, type of reperfusion therapy, success of recanalization, and clinical outcome after 90 days evaluated by the modified Rankin Scale (mRS) score. Statistical analysis was performed with the two-sided ANOVA t-tests for continuous measures, Chi-squared (χ2) tests for categorical measures and a multivariate ordinal logistic regression analysis.
Results: The study included 103 patients (47% females, median age 74 years; confidence interval (CI) 72 to 98). Proximal BAO was found in 13%, middle in 13%, and distal in 74% of patients. Cardioembolic etiology was more common in distal (=0.01), and atherosclerotic etiology in proximal and middle BAO occlusions (P=0.02). While distal BAO was more likely to be recanalized using intravenous thrombolysis (IVT) compared with other sites of occlusion (P=0.05), we found no difference between different occlusion sites and the success of endovascular treatment (EVT). Lower age (odds ratio (OR) 0.89; CI 0.84 to 0.95; P<0.01) and shorter time to intervention (OR 0.71; CI 0.53 to 0.95; P=0.02), regardless of it being IVT or EVT, were predictors of an excellent clinical outcome (mRS 0-2). Distal occlusion (OR 28; CI 2.7 to 300; p<0.01) was a strong predictor of a favorable clinical outcome (mRS 0-3).
Conclusion: Prompt reperfusion, regardless of it being IVT or EVT, increases the chance of excellent clinical outcomes in patients with acute BAO. Distal BAO is more often associated with a favorable clinical outcome compared with the proximal and middle segments.
背景:基底动脉闭塞(BAO)尽管发病率很低,但仍是治疗上的一大难题,因为约 80% 的患者会出现严重残疾和死亡。很少有报道称 BAO 的特定部位(近端、中段或远端)是再灌注治疗的预后因素。我们旨在探讨接受再灌注治疗的患者中特定部位 BAO 与临床预后之间的关系:我们对卢布尔雅那大学医疗中心在 2013 年 1 月至 2022 年 8 月期间收治的所有接受再灌注治疗的连续急性 BAO 患者进行了单中心回顾性研究。根据 BAO 的位置对患者进行分组,并比较基线特征、中风病因的差异、再灌注疗法的类型、再通血管的成功率以及 90 天后通过改良 Rankin 量表(mRS)评分评估的临床结果。统计分析采用双侧方差分析 t 检验连续计量,Chi-squared (χ2)检验分类计量,以及多变量序数逻辑回归分析:研究共纳入 103 名患者(女性占 47%,中位年龄 74 岁;置信区间 (CI) 72 至 98)。13%的患者发现了近端 BAO,13%的患者发现了中端 BAO,74%的患者发现了远端 BAO。心栓塞病因在远端更常见(=0.01),而动脉粥样硬化病因在近端和中间 BAO 闭塞中更常见(P=0.02)。与其他部位的闭塞相比,远端 BAO 更有可能通过静脉溶栓(IVT)再通(P=0.05),但我们发现不同闭塞部位与血管内治疗(EVT)的成功率之间没有差异。年龄较小(几率比(OR)0.89;CI 0.84 至 0.95;PConclusion):无论是 IVT 还是 EVT,及时再灌注都能增加急性 BAO 患者获得良好临床疗效的机会。与近端和中间段相比,远端 BAO 更容易获得良好的临床预后。
{"title":"Clinical outcomes of reperfusion therapy in patients with site-specific basilar artery occlusion.","authors":"Nina Žakelj, Igor Rigler, Alja Longo, Senta Frol, Janja Pretnar Oblak","doi":"10.1136/jnis-2024-022065","DOIUrl":"https://doi.org/10.1136/jnis-2024-022065","url":null,"abstract":"<p><strong>Background: </strong>Despite its low incidence, basilar artery occlusion (BAO) remains a major therapeutic challenge since severe disability and death occur in about 80% of patients. Specific site of BAO (proximal, middle, or distal) has rarely been reported as a prognostic factor in reperfusion therapy. We aimed to explore the relationship between site-specific BAO and clinical outcomes in patients treated with reperfusion therapies.</p><p><strong>Methods: </strong>We performed a single-centre retrospective study of all consecutive patients with acute BAO admitted to the University Medical Centre Ljubljana between January 2013 and August 2022 who were treated with reperfusion therapies. Patients were grouped according to the location of BAO and compared for baseline characteristics, differences in stroke aetiology, type of reperfusion therapy, success of recanalization, and clinical outcome after 90 days evaluated by the modified Rankin Scale (mRS) score. Statistical analysis was performed with the two-sided ANOVA t-tests for continuous measures, Chi-squared (χ2) tests for categorical measures and a multivariate ordinal logistic regression analysis.</p><p><strong>Results: </strong>The study included 103 patients (47% females, median age 74 years; confidence interval (CI) 72 to 98). Proximal BAO was found in 13%, middle in 13%, and distal in 74% of patients. Cardioembolic etiology was more common in distal (=0.01), and atherosclerotic etiology in proximal and middle BAO occlusions (P=0.02). While distal BAO was more likely to be recanalized using intravenous thrombolysis (IVT) compared with other sites of occlusion (P=0.05), we found no difference between different occlusion sites and the success of endovascular treatment (EVT). Lower age (odds ratio (OR) 0.89; CI 0.84 to 0.95; P<0.01) and shorter time to intervention (OR 0.71; CI 0.53 to 0.95; P=0.02), regardless of it being IVT or EVT, were predictors of an excellent clinical outcome (mRS 0-2). Distal occlusion (OR 28; CI 2.7 to 300; p<0.01) was a strong predictor of a favorable clinical outcome (mRS 0-3).</p><p><strong>Conclusion: </strong>Prompt reperfusion, regardless of it being IVT or EVT, increases the chance of excellent clinical outcomes in patients with acute BAO. Distal BAO is more often associated with a favorable clinical outcome compared with the proximal and middle segments.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-20DOI: 10.1136/jnis-2024-022002
Ran Xu, Bin Yang, Tao Wang, Xiao Zhang, Tianhua Li, Yao Feng, Xiaofan Guo, Jinzhu Jia, Yan Ma, Adam A Dmytriw, Haibo Jia, Liqun Jiao
Background: The incidence of thrombosis in patients with intracranial atherosclerotic stenosis (ICAS) remains unclear. Optical coherence tomography (OCT) has the potential to explore the vessel wall structure of posterior-circulation ICAS because of its relatively straight anatomical structure compared with that of the anterior cerebral arteries. This study aimed to determine the prevalence and characteristics of thrombosis in the posterior-circulation ICAS using OCT.
Methods: This prospective study was conducted on 135 patients with posterior-circulation arterial stenosis who underwent OCT. All patients were symptomatic and had a severely stenotic lesion (70-99%) in the vetebrobasilar artery. The enrolled patients were classified according to the presence of in situ thrombus as defined by OCT. Clinical data and OCT characteristics were compared.
Results: Eighty-two patients diagnosed with posterior-circulation ICAS were enrolled. In situ thrombi were identified in 34 patients. Clinically, patients with in situ thrombus were more prone to cerebral infarctions than transient ischemic attacks. The percentage area of stenosis in the non-thrombus group was significantly lower than that in the thrombus group. The thrombus burden, mean flow area, mean thrombus area, maximum lipid arc, and mean lumen area were significantly different among white, red, and mixed thrombi.
Conclusions: We achieved in vivo vessel wall structural analysis of posterior-circulation ICAS with the largest sample size. We also revealed the true incidence of in situ thrombosis and potential corresponding clinical events of posterior-circulation ICAS for the first time.
背景:颅内动脉粥样硬化性狭窄(ICAS)患者血栓形成的发生率仍不清楚。光学相干断层扫描(OCT)具有探索后循环 ICAS 血管壁结构的潜力,因为与大脑前动脉相比,后循环 ICAS 的解剖结构相对平直。本研究旨在利用 OCT 确定后循环 ICAS 中血栓形成的发生率和特征:这项前瞻性研究的对象是 135 名接受 OCT 检查的后循环动脉狭窄患者。所有患者均无症状,静脉基底动脉有严重狭窄病变(70%-99%)。根据 OCT 确定的原位血栓的存在情况对入选患者进行分类。对临床数据和 OCT 特征进行了比较:结果:82名确诊为后循环ICAS的患者被纳入研究。34名患者中发现了原位血栓。在临床上,原位血栓患者比短暂性脑缺血发作患者更容易发生脑梗塞。无血栓组的狭窄面积百分比明显低于血栓组。白血栓、红血栓和混合血栓的血栓负荷、平均血流面积、平均血栓面积、最大脂质弧和平均管腔面积均有明显差异:结论:我们以最大的样本量实现了对后循环 ICAS 血管壁结构的活体分析。我们还首次揭示了后循环 ICAS 原位血栓形成的真实发生率和潜在的相应临床事件。
{"title":"Prevalence of intracerebral thrombus detected by optical coherence tomography in patients with posterior circulation stroke or transient ischemic attack.","authors":"Ran Xu, Bin Yang, Tao Wang, Xiao Zhang, Tianhua Li, Yao Feng, Xiaofan Guo, Jinzhu Jia, Yan Ma, Adam A Dmytriw, Haibo Jia, Liqun Jiao","doi":"10.1136/jnis-2024-022002","DOIUrl":"https://doi.org/10.1136/jnis-2024-022002","url":null,"abstract":"<p><strong>Background: </strong>The incidence of thrombosis in patients with intracranial atherosclerotic stenosis (ICAS) remains unclear. Optical coherence tomography (OCT) has the potential to explore the vessel wall structure of posterior-circulation ICAS because of its relatively straight anatomical structure compared with that of the anterior cerebral arteries. This study aimed to determine the prevalence and characteristics of thrombosis in the posterior-circulation ICAS using OCT.</p><p><strong>Methods: </strong>This prospective study was conducted on 135 patients with posterior-circulation arterial stenosis who underwent OCT. All patients were symptomatic and had a severely stenotic lesion (70-99%) in the vetebrobasilar artery. The enrolled patients were classified according to the presence of in situ thrombus as defined by OCT. Clinical data and OCT characteristics were compared.</p><p><strong>Results: </strong>Eighty-two patients diagnosed with posterior-circulation ICAS were enrolled. In situ thrombi were identified in 34 patients. Clinically, patients with in situ thrombus were more prone to cerebral infarctions than transient ischemic attacks. The percentage area of stenosis in the non-thrombus group was significantly lower than that in the thrombus group. The thrombus burden, mean flow area, mean thrombus area, maximum lipid arc, and mean lumen area were significantly different among white, red, and mixed thrombi.</p><p><strong>Conclusions: </strong>We achieved in vivo vessel wall structural analysis of posterior-circulation ICAS with the largest sample size. We also revealed the true incidence of in situ thrombosis and potential corresponding clinical events of posterior-circulation ICAS for the first time.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}