Journal of NeuroInterventional Surgery最新文献

Background: Intracranial atherosclerotic stenosis (ICAS) is a leading cause of ischemic stroke, often requiring endovascular treatment in cases refractory to medical therapy. Stent angioplasty is the most common intervention, but it carries risks such as restenosis and thromboembolic events. Drug-coated balloons or drug-eluting balloons (DCB/DEBs) have emerged as a promising alternative, delivering antiproliferative agents without permanent implantation. This study aims to compare clinical and procedural outcomes of DCB/DEBs versus stent angioplasty in patients with symptomatic ICAS.

Methods: A systematic review and meta-analysis was conducted according to PRISMA guidelines (PROSPERO: CRD42024616346). Six studies comprising 527 patients (233 DCB/DEB, 294 stenting) were included. Outcomes assessed included restenosis rates, periprocedural complications, and recurrent ischemic events.

Results: DCB/DEBs significantly reduced the risk of restenosis (RR 0.25; 95% CI 0.15 to 0.40; I²=0%) compared with stents. For periprocedural complications, no significant difference was observed (RR 0.65; 95% CI 0.32 to 1.33; I²=0%). In terms of recurrent ischemic events, DCB/DEBs were associated with a significant reduction (RR 0.30; 95% CI 0.13 to 0.67; I²=0%).

Conclusion: DCB/DEBs appear to offer significantly lower restenosis rates and fewer recurrent ischemic events compared with conventional stenting for symptomatic ICAS, without increasing periprocedural complications. While data on long-term outcomes remain limited, DCB/DEBs may represent a less invasive and potentially safer endovascular option. Further randomized trials are warranted to define its role in clinical practice.

Background and purpose: Durable outcomes with neurovascular stents require balancing antithrombotic performance with rapid endothelialization. We previously developed an amine-functionalized surface modification (Anti-thrombus formation, Endothelial-growth promotion, tissue Integration, and Surface; AEGiS Technology) with antithrombotic behavior. In this study we evaluated its pro-endothelialization properties and explore the mechanism.

Methods: Adsorption of extracellular matrix proteins from human plasma was profiled on AEGiS-modified versus control NiTi surfaces with an a priori focus on vitronectin. Human umbilical vein endothelial cell (HUVEC) adhesion was quantified by attached cell numbers and post-wash retention as a measure of adhesion strength. Migration and surface coverage were assessed in an in vitro endothelialization model designed to mimic stents on vessel walls. For translation, self-expanding stents bearing AEGiS or control coatings were deployed in a porcine model and endothelial coverage at 1 week was quantified by angiography and histology.

Results: The AEGiS surface selectively increased vitronectin adsorption compared with the control surface. Consistent with this shift, AEGiS supported greater HUVEC adhesion and stronger retention. In the endothelialization model, AEGiS accelerated coverage of the substrate compared with the control. In vivo, AEGiS-modified stents showed greater endothelial coverage at 1 week than control stents.

Conclusions: Amine functionalization enriched vitronectin adsorption and supported early endothelial coverage, indicating its potential to promote endothelialization of neurovascular stents.

Background: Accurate device sizing is crucial for successful flow diverter (FD) therapy in intracranial aneurysms. This study assesses the accuracy and clinical utility of the Ankyras virtual simulation software (Mentice AB, Gothenburg, Sweden) in predicting FD length across multiple device types and manufacturers.

Methods: We retrospectively analyzed 193 FDs (7 device types) deployed in 180 patients with 230 intracranial aneurysms. Simulation-based prediction of effective lengths (simulated length (SL)) and nominal manufacturer specifications (labeled length) were compared with measured in vivo lengths (measured length (ML)). Performance was evaluated using simulation accuracy (SA), absolute error (AE), relative error (RE), length ratio, and correlation analysis.

Results: Virtual simulation demonstrated good clinical usability, achieving a mean absolute deviation of only -1.38 mm at the proximal landing zone compared with ML. Simulation-based predictions showed significantly superior accuracy compared with nominal manufacturer specifications (SA 89.6±11.3% vs 81.8±13.7%, P<0.001), with mean AE reduced by 58% (-1.38 mm vs -3.34 mm) and mean RE by 42% (10.5% vs 18.2%). Strong correlations between SL and ML (r=0.900) validated predictive reliability across all tested device types. Centerline correction technology further enhanced parameters such as SA to 94.8±9.5%.

Conclusion: Virtual simulation-based prediction of effective FD length using the Ankyras software showed reliable and clinically meaningful results, enabling accurate estimations of the proximal landing zone and overall length. Ankyras, along with comparable simulation platforms, may provide considerable potential to facilitate FD selection and implementation, especially in anatomically complex cases.

Introduction: The ATLAS trial was a prospective, multicenter, single-arm, investigational device exemption (IDE) study to evaluate the safety and effectiveness of the Neuroform Atlas Stent System for the treatment of wide-necked bifurcation aneurysms. This analysis presents the 36-month follow-up data for the anterior and posterior cohorts.

Methods: Of the 182 patients in the IDE anterior cohort, 146 consented to participate in the post-approval study (PAS) and, of the 116 patients in the IDE posterior cohort, 101 consented to participate in the PAS. The primary effectiveness endpoint was core laboratory adjudicated (Raymond-Roy 1; RR1) without retreatment or parent artery stenosis (>50%) at 36 months post-procedure. The primary safety endpoint was Clinical Event Committee-adjudicated major ipsilateral stroke or neurological death through 36 months.

Results: There were 146 patients in the anterior cohort and 101 patients in the posterior cohort. At 24 months the composite effectiveness endpoint was 77.3% (34/44) in the anterior cohort and 65.5% (19/29) in the posterior cohort and at 36 months these rates were 92.3% (24/26) and 75.0% (18/24), respectively. RR1 rates at 24 months were 84.1% (37/44) in the anterior cohort and 70.0% (21/30) in the posterior cohort; at 36 months they were 96.3% (26/27) and 79.2% (19/24), respectively. By 36 months the primary safety endpoint occurred in 4.1% (6/146) of patients in the anterior cohort and 5.0% (5/101) in the posterior cohort.

Conclusion: The results of the long-term assessment of the Neuroform Atlas Stent System demonstrate favorable safety and effectiveness in the treatment of wide-necked bifurcation aneurysms without a single treated target aneurysm rupture beyond 12 months post-procedure.

Background: Middle meningeal artery embolization (MMAE) has been shown to be an efficacious treatment for chronic subdural hematomas (cSDH). Liquid or particulate embolic agents are most commonly used, although coil embolization offers proximal vessel occlusions that may provide comparable efficacy. This multicenter propensity score-matched study compares outcomes of MMAE performed with Nester pushable coils versus Onyx.

Methods: We retrospectively reviewed patients that underwent MMAE with either Nester coils or Onyx at two institutions between March 2019 and February 2025. Propensity score matching (1:1) was performed based on patient and hematoma characteristics. Primary outcomes included radiologic improvement or need for surgical rescue. Secondary outcomes included complication rate and procedure time.

Results: A total of 183 patients were included (91 Nester coil, 92 Onyx) with similar baseline characteristics. More patients incurred general anesthesia for Onyx embolization compared with coiling (60.9% vs 15.4%; p<0.001), although the patients that underwent coiling more often had bilateral embolization performed (64.8% vs 23.9%, p<0.001). After propensity matching (n=67 per group), rates of radiologic improvement (>50% hematoma reduction), need for surgical rescue, and symptom recurrence were similar between the coil and Onyx cohorts (53.7% vs 44.8%, p=0.300; 14.5% vs 18.8%, p=0.524, and 17.0% vs 15.9%, p=0.872, respectively). Coil embolization had a significantly shorter median procedure time (34 vs 63 min, p<0.001) compared with Onyx embolization.

Conclusions: Embolization using Nester pushable coils yields similar clinical outcomes to Onyx. Pushable coils are safe, efficient, and allow for shorter procedural times, providing an effective, cost-efficient option for cSDH.

Background: Patients with idiopathic intracranial hypertension (IIH) represent a unique population in whom mechanical shunting can be challenging. Endovascular cerebrospinal fluid shunting via the eShunt system has emerged as a potential alternative, but it is not currently approved for this indication, and its feasibility in IIH remains unknown.

Methods: In this retrospective, single center study, radiographic images of consecutively treated patients with shunt responsive IIH were assessed. Radiographic parameters involving the inferior petrosal sinus (IPS) and cerebellopontine angle (CPA) cistern were measured. We also examined whether the presence of a ventricular shunt at the time of imaging influenced radiographic candidacy, given the plausibility of cisternal changes after shunting.

Results: Of 53 patients (median age 41 years, 81.1% women), 24 (45.2%) were previously shunted before MRI imaging. The average CPA cisternal depth was 4.8±1.8 mm (right) and 4.9±2.1 mm (left); IPS size 3.5±0.7 mm (right) and 3.4±0.8 mm (left). The average off-axis angle trajectory from the IPS to the cistern was 128.6±9.8° (right) and 125.2±9.3° (left). In our final model, pre-existing ventricular shunt was not independently associated with endovascular shunting candidacy (OR 2.01, 95% CI 0.65 to 6.40; P=0.227). Overall, endovascular shunting was feasible in at least one side for 55% of patients, increasing to as high as 74% when assessment was based only on venous anatomy.

Conclusion: In this study, a sizeable proportion of patients with IIH were radiographic candidates for endovascular shunting, regardless of the presence of a pre-existing supratentorial shunt.

Mechanical thrombectomy (MT) is an established and guideline-endorsed treatment for acute ischemic stroke (AIS) due to large vessel occlusion. Intravenous thrombolysis (IVT) with alteplase remains the first-line therapy within the approved time window, often used alone or as a bridging strategy before MT. However, both interventions have been systematically understudied in pregnant patients, as this population has been excluded from most pivotal clinical trials. This systematic review critically evaluates the procedural feasibility, safety, and maternal-fetal outcomes of MT in pregnant patients experiencing AIS. A comprehensive literature search using PubMed, Embase, and Web of Science yielded 16 studies encompassing 26 cases. In 20 of these, the occlusions involved the M1 segment of the middle cerebral artery, with 58% receiving combined IVT and MT, and 42% undergoing MT alone. Successful reperfusion (TICI 2b-3) was attained in 84% of cases. The median times were 120 min from onset to hospital arrival, 92 min from arrival to puncture, and 330 min from onset to recanalization. Favorable maternal outcomes (mRS 0-1) were observed in 91% of cases at follow-up, and no direct MT-related fetal mortalities occurred. Radiological protection practices, though inconsistently reported, commonly included abdominal shielding and optimized fluoroscopic protocols. Despite limited high-level evidence, MT in pregnancy appears technically feasible and clinically beneficial, warranting prompt multidisciplinary coordination and robust imaging protocols. Future prospective research is essential to better define safety parameters and optimize guidelines for this vulnerable subgroup of patients.

Background: Infectious intracranial aneurysms (IIAs) are highly morbid vascular lesions, and the comparative effectiveness of medical management (MM), surgery, and endovascular treatment (EVT) remains uncertain.

Objective: To perform a systematic review and network meta-analysis comparing the three main interventions for IIAs: MM, open surgery, and EVT.

Methods: A systematic review and frequentist network meta-analysis were conducted. Studies comparing MM, open surgery, and EVT in patients with IIAs were included. The primary outcome was treatment success, defined according to study-specific definitions and operationally harmonized as the absence of treatment failure. Secondary outcomes included mortality, rupture or re-rupture, recurrence, neurological deficits, and complications. Random-effects models estimated odds ratios (ORs) with 95% confidence intervals (CIs). Treatment ranking was assessed using P scores, and heterogeneity was quantified using I².

Results: Thirteen observational studies were included. In an exploratory network meta-analysis, both EVT (OR=2.51; 95% CI 1.22 to 5.15) and surgery (OR=7.29; 95% CI 2.00 to 26.55) were associated with higher odds of treatment success compared with MM. EVT was associated with a lower risk of aneurysm rupture or re-rupture compared with MM (OR=0.42; 95% CI 0.18 to 0.96), whereas no statistically significant differences were observed between EVT and surgery. Given the non-randomized nature of the evidence and methodological heterogeneity across studies, these findings should be interpreted with caution.

Conclusions: EVT and surgery were associated with higher odds of treatment success compared with MM, whereas EVT was additionally associated with a lower risk of rupture or re-rupture. These findings should be interpreted cautiously given the observational nature of the available evidence.

Idiopathic intracranial hypertension (IIH) is a complex and increasingly prevalent disorder that results in significant morbidity despite a broad array of available treatments. While lifestyle modifications, pharmacologic agents, and surgical interventions can produce meaningful short-term symptomatic improvements, long-term outcomes are poor, characterized by high rates of symptom recurrence. Weight loss remains the only disease-modifying therapy, though sustained reductions in weight are rarely achieved outside of bariatric surgery. In addition, a subset of patients is not overweight, limiting applicability. Pharmacologic therapies such as acetazolamide, topiramate, and glucagon-like peptide-1 (GLP-1) receptor agonists offer benefits but are limited by the side effect profile and poor efficacy. Surgical approaches often address only a portion of IIH's multifactorial pathophysiology, and recurrent symptoms may arise from persistent venous hypertension or new venous stenoses. This review evaluates the current evidence on medical and surgical treatment failures in IIH, emphasizing unresolved questions in disease pathogenesis and the need for personalized therapeutic approaches that advance the development of more durable treatment options.

Background: A study was undertaken to investigate the relationship between the vascular access route and the occurrence of diffusion-weighted imaging (DWI) lesions as well as puncture site complications in patients undergoing elective endovascular treatment (EVT) for cerebral aneurysms.

Methods: This retrospective single-center study included all consecutive patients who underwent elective EVT of unruptured cerebral aneurysms via transradial (TRA) or transfemoral (TFA) access between January 2024 and April 2025. Postprocedural MRI was assessed for new DWI lesions. Univariable and multivariable regression analysis was performed to identify predictors for DWI lesions.

Results: A total of 199 patients (50.3% TRA, 49.7% TFA) were included. New DWI lesions were detected in 53% of patients. There was no difference in the rates of silent or symptomatic DWI lesions between the two groups (60% vs 50%, P=0.15; and 5% vs 10%, P=0.19, respectively). In a multivariate regression analysis, higher age (aOR 1.04 per year, 95% CI 1.01 to 1.06, P=0.009), longer procedure time (aOR 1.01 per minute, 95% CI 1 to 1.02, P=0.023), and the use of adjunctive techniques such as stent- and balloon-assisted coiling (aOR 6.96, 95% CI 1.73 to 27.99, P=0.006) were independent predictors of postprocedural DWI lesions, while no association was found for the access route. Puncture site complications were comparable between TFA and TRA groups (TRA 3% vs TFA 8%, P=0.12).

Conclusion: TRA is a safe and feasible alternative to TFA for elective EVT. The risk of postprocedural DWI lesions is primarily influenced by patient age and procedural complexity rather than access route. These findings support the use of TRA in appropriately selected patients, particularly when vascular anatomy or patient preference favors this approach.