Journal of NeuroInterventional Surgery最新文献

Background: Identifying eloquent regions associated with poor outcomes based on CT perfusion (CTP) may help inform personalized decisions on selection for endovascular therapy (EVT) in patients with large vessel occlusion (LVO) ischemic stroke. This study aimed to characterize the relationship between CTP-defined hypoperfusion and National Institutes of Health Stroke Scale (NIHSS) subitem deficits.

Methods: Patients with anterior circulation LVO, baseline CTP, itemized NIHSS at presentation and 24 hours were included. CTP was analyzed using e-CTP (Brainomix, UK). Time to maximal contrast (Tmax) prolongation was defined as >6 s, and penumbra as the difference between Tmax and ischemic core (relative cerebral blood flow<30%). Voxel-lesion-symptom mapping was performed using sparse canonical correlation analysis. For each NIHSS subitem, and total NIHSS, the associations were plotted between Tmax voxels with baseline NIHSS, and penumbra voxels with delta NIHSS (24 hours minus baseline).

Results: This study included 171 patients. Total NIHSS was predicted by hypoperfusion in left frontal cortex and subcortical white matter tracts. Voxels associated with neurological recovery were symmetrical and subcortical.Limb deficits were associated with respective motor cortex regions and descending motor tracts, with negative correlation within the contralateral hemispheres. A similar but smaller cluster of voxels within the penumbra was associated with NIHSS improvement. Language impairment correlated with left frontal cortex and superior temporal gyrus voxels. With the exception of dysarthria, significant associations were observed and more diffusely distributed in all other NIHSS subitems.

Conclusions: These results demonstrate the feasibility of hypoperfusion-to-symptom mapping in LVO. Symptom-based mapping from presenting imaging could refine treatment decisions targeting specific neurological deficits.

Background: Surveys are increasingly used in neurointervention to gauge physicians' and patients' attitudes, practice patterns, and 'real-world' treatment strategies, particularly in conditions for which few, or no evidence-based, recommendations exist. While survey-based studies can provide valuable insights into real-world problems and management strategies, there is an inherent risk of bias.

Objective: To assess key themes, sample characteristics, response metrics, and report frequencies of quality indicators of neurointerventional surveys.

Methods: A systematic review compliant with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was performed. The PubMed database was searched for neurointerventional surveys published between 2000 and 2023. Survey topics, design, respondent characteristics, and survey quality criteria suggested by the Consensus-Based Checklist for Reporting of Survey Studies (CROSS) were assessed and described using descriptive statistics. Response rates and numbers of participants were further assessed for their dependence on sample characteristics and survey methodologies.

Results: A total of 122 surveys were included in this analysis. The number of surveys published each year increased steeply between 2000 (n=1) and 2023 (n=14). The most common survey topics were stroke (51/122, 41.8%) and aneurysm treatment (49/122, 40.2%). The median response rate was 58.5% (IQR=30.4-86.3), with a median number of respondents of 79 (IQR=50-201). Sixty-eight of 122 (55.7%) surveys published the questionnaire used for data collection. Only a subset of studies reported response rates (n=89, 73%), data collection time period (n=91, 74.6%), and strategies to prevent duplicate responses (n=57, 46.7%).

Conclusion: Surveys are increasingly used by neurointerventional researchers, particularly to assess real-world practice patterns in endovascular stroke and aneurysm treatment. Adapting best-practice guidelines like the CROSS checklist might improve homogeneity and quality in neurointerventional survey research.

Background: Acute ischemic stroke (AIS) often leads to significant morbidity and mortality. Mechanical thrombectomy (MT) is an effective intervention for large vessel occlusion strokes. However, hemorrhagic transformation (HT) remains a critical post-procedural complication. This study investigates the relationship between basal ganglia infarction (BGI) and the risk of HT, particularly focusing on hemorrhagic infarction (HI) and parenchymal hematoma (PH).

Methods: Data from the DIRECT-MT trial were analyzed. Patients were categorized based on the presence of BGI identified on initial non-contrast CT. HT was classified into HI and PH following the Heidelberg criteria. Multivariate logistic regression, propensity score matching (PSM), and inverse probability of treatment weighting (IPTW) were used to assess the association between BGI and HT.

Results: Among 607 patients, 273 had BGI. BGI was associated with a higher risk of HT, specifically PH. The incidence of PH in the BGI group was 20% compared with 11% in the non-BGI group. Adjusted analyses, including PSM and IPTW, confirmed the significant association between BGI and PH with an adjusted odds ratio (aOR) of 2.51 (95% CI 1.49 to 4.22, P<0.001). However, no significant association was found between BGI and HI.

Conclusions: BGI significantly increases the risk of PH following MT for AIS, underscoring the need for tailored therapeutic strategies in managing these patients. No significant correlation was observed between BGI and HI. Future research should explore the underlying mechanisms and validate these findings across diverse populations to improve patient outcomes.

Background: Distal embolization is a frequent complication of mechanical thrombectomy (MT) for acute ischemic stroke, often leading to poor clinical outcomes. The vascular bifurcations represent a specialized anatomical location, thereby augmenting the complexity of MT. The specific factors contributing to distal embolization in this context have not been thoroughly explored. This study seeks to identify the factors associated with distal embolization during MT in patients with anterior circulation large vessel bifurcation occlusion stroke.

Methods: A retrospective analysis was conducted on patients who underwent MT for acute anterior circulation bifurcation occlusion stroke between January 2015 and December 2023. Baseline characteristics, procedural details, and clinical outcomes were assessed. Univariate and multivariable analyses were performed to identify predictors of distal embolization during MT.

Results: The study included 119 patients. Univariate analysis revealed significant associations between distal embolization and occlusion location, internal carotid artery (ICA) tortuosity, first-line thrombectomy strategy, and the number of device passes. Multivariate analysis identified ICA bifurcation occlusions (odds ratio (OR) 3.21, 95% confidence interval (CI) 1.188 to 8.672, P=0.021), stent retriever thrombectomy (SRT) (OR 6.177, 95% CI 1.77 to 21.555, P=0.004), and a higher number of device passes (OR 1.778, 95% CI 1.132 to 2.792, P=0.013) as independent predictors of distal embolization.

Conclusions: ICA bifurcation occlusion, the use of SRT, and an increased number of device passes are significant predictors of distal embolization during MT in patients with anterior circulation large vessel bifurcation occlusion strokes.

Background: Recent literature highlights the adverse effects of recreational marijuana on cerebrovascular pathologies and outcomes. However, its impact on arteriovenous malformation (AVM) outcomes is unknown.

Objective: To investigate the differences in AVM outcomes between marijuana users and non-users, focusing primarily on the likelihood of presenting with rupture and secondly, on the effects of other drugs on in-hospital mortality and complications.

Methods: Adult patients diagnosed with cerebral AVMs from the National Inpatient Sample were included. Use of recreational drugs, including marijuana, alcohol, opioids, hallucinogens, stimulants, and tobacco, was documented. Univariate and multivariate logistic regression analyses identified associations between drug use and AVM outcomes.

Results: A total of 46 480 patients were analyzed, with 11 580 (24.9%) presenting with rupture. Smoking was the most prevalent substance used (18 010, 38.7%), followed by alcohol (3 065, 6.6%), and cannabis (745, 1.6%). Smoking tobacco (OR=0.801; P=0.0002) and cannabis use (OR=0.613; P=0.0523) showed trends towards a protective effect against presentation with AVM rupture. Tobacco use was associated with reduced likelihood of extended length of stay (OR=0.837; P=0.0013), any complications (OR=0.860; P=0.0082), and in-hospital mortality (OR=0.590; P=0.0003). Alcohol use was linked to increased extended length of stay (OR=1.363; P=0.0033) and complications (OR=1.442; P=0.0007).

Conclusions: Stimulant use increases the likelihood of presenting with ruptured AVMs and is associated with higher mortality. Tobacco and cannabis use appear to reduce the possibility of extended hospital stays and complications.

Background: Vessel wall MRI (VWMRI) can reveal the morphological features of intracranial artery occlusion (ICAO). This study aimed to investigate the imaging features of ICAO on VWMRI and explore their correlation with perioperative complications of endovascular recanalization for non-acute ICAO.

Methods: The study retrospectively included consecutive patients with recurrent ischemic stroke due to non-acute ICAO in the anterior circulation who underwent preoperative VWMRI evaluation and endovascular recanalization. Perioperative complications included ischemic and hemorrhagic strokes within 30 days after operation. Imaging features of the occluded segments were evaluated on precontrast and post-contrast VWMRI, including occlusion length and site, vessel wall area, signal intensity, angle, and shape of the occluded segment. The associations between the clinical and imaging features and perioperative complications were examined.

Results: One hundred and four patients were included in the analysis, of whom 22.1% (23/104) had perioperative complications. After adjusting for multiple confounding variables, four imaging risk factors were identified that were independently associated with perioperative complications, that is, the angle between the occluded and pre-occluded artery segments (OR 11.60, 95% CI 2.73 to 49.29), occluded artery segment shape (OR 13.07, 95% CI 2.82 to 60.67), vessel wall collapse before occlusion (OR 2.91, 95% CI 0.96 to 8.77), and post-contrast mean signal intensity ratio at the ¼ point of the occluded artery segment <1.24 (OR 6.14, 95% CI 1.67 to 22.51). From no risk factors to four risk factors, the incidence of perioperative complications gradually increased (0, 6.2%, 23.5%, 52.9%, and 100% respectively; p<0.001).

Conclusions: VWMRI may be helpful to select patients with non-acute ICAO who are suitable for endovascular recanalization.

Background: Transcranial Doppler (TCD) is a non-invasive, bedside tool that allows for real-time monitoring of the patient's hemodynamic status following mechanical thrombectomy (MT). This systematic review and meta-analysis aims to evaluate the predictive value of TCD parameters following successful MT (Thrombolysis in Cerebral Infarction 2b-3).

Methods: In July 2024, we searched PubMed, Embase, and Scopus, to identify observational studies in which TCD parameters were measured within 48 hours of MT. Using random-effects models, we compared four TCD parameters (mean flow velocity (MFV), MFV index, pulsatility index (PI), and peak systolic velocity (PSV) among groups with vs without hemorrhagic transformation (HT) and favorable vs poor functional recovery (modified Rankin Scale 0-2 vs 3-6).

Results: Eleven studies comprising 1432 patients (59% male; mean age range: 63-73 years) were included. The MFV and MFV index were higher in patients with HT (Hedges' g=0.42 and 0.54, P=0.015 and 0.005, respectively). Patients with MFV index ≥1.3 showed a higher risk of all HT (RR 1.97; 95% confidence interval (CI) 1.28 to 3.03, P=0.002), symptomatic HT (RR 4.68; 95% CI 1.49 to 14.65, P=0.008), and poor functional status at 90 days (RR 1.65; 95% CI 1.27 to 2.14, P=0.029), respectively. There was no difference in mean PSV (P=0.1) and PI (P=0.3) among groups with and without HT.

Conclusion: This study underscores the prognostic value of the MFV index in predicting HT, symptomatic HT, and poor functional recovery after successful MT in the anterior circulation. Large-scale, multi-center studies are necessary to confirm these findings and to validate the MFV index as a reliable predictor for improving post-thrombectomy care.