Pub Date : 2026-02-16DOI: 10.1136/jnis-2025-023190
Anderson Brito, Leonardo Cruz-Criollo, Milagros Galecio-Castillo, Jorge Cespedes, Mario Zanaty, Edgar A Samaniego, Nashwa Abdelhakim, Ajay K Wakhloo, Ricardo A Hanel, Santiago Ortega-Gutierrez
Background: Posterior circulation (PC) aneurysms are associated with a higher risk of rupture. Flow diverters (FDs) are widely used for carotid intracranial aneurysms, but their role in PC aneurysms is less established. This meta-analysis examines the available literature on the safety and effectiveness of FDs for PC aneurysms.
Method: We conducted a systematic search from database inception until October 2024. The primary effectiveness outcome was complete occlusion rate defined by the Raymond-Roy and/or O'Kelly-Marotta scales. Primary safety outcomes included thromboembolic event rates following implantation. Secondary outcomes included procedure-related mortality, good functional outcome (GFO), and retreatment. Pool estimates were calculated using a random-effect model. Subgroup analysis based on morphology and study design was also conducted.
Results: A total of 42 studies met our inclusion criteria. A total of 1698 patients were treated with FDs for 1760 PC aneurysms. Among these cases, 47.6% were in the vertebral artery. Our pooled overall analysis of complete occlusion rates was 72.73% (P<0.0001; I2=67.2%), and the pooled thromboembolic events rate following implantation was 11.70% (P<0.0046; I2=70.5%). Additionally, the pooled mortality rate was 8.07% (P<0.0001; I2=61.5%), the retreatment rate was 6.59% (P<0.4260; I2=1%), and the pooled GFO rate was 83.99% (P<0.0001; I2=76%). Subgroup analysis revealed that fusiform-dolichoectatic had a complete occlusion rate of 48.29% (P<0.3223; I2=11.7%).
Conclusion: FDs for PC aneurysms achieve generally adequate occlusion rates, except in dolichoectatic-fusiform subtypes. Despite achieving adequate occlusion rates, FD use was associated with higher thromboembolic events, mortality, and retreatment rates, which necessitates careful patient selection.
{"title":"Flow diversion for posterior circulation intracranial aneurysms: a systematic review and meta-analysis.","authors":"Anderson Brito, Leonardo Cruz-Criollo, Milagros Galecio-Castillo, Jorge Cespedes, Mario Zanaty, Edgar A Samaniego, Nashwa Abdelhakim, Ajay K Wakhloo, Ricardo A Hanel, Santiago Ortega-Gutierrez","doi":"10.1136/jnis-2025-023190","DOIUrl":"10.1136/jnis-2025-023190","url":null,"abstract":"<p><strong>Background: </strong>Posterior circulation (PC) aneurysms are associated with a higher risk of rupture. Flow diverters (FDs) are widely used for carotid intracranial aneurysms, but their role in PC aneurysms is less established. This meta-analysis examines the available literature on the safety and effectiveness of FDs for PC aneurysms.</p><p><strong>Method: </strong>We conducted a systematic search from database inception until October 2024. The primary effectiveness outcome was complete occlusion rate defined by the Raymond-Roy and/or O'Kelly-Marotta scales. Primary safety outcomes included thromboembolic event rates following implantation. Secondary outcomes included procedure-related mortality, good functional outcome (GFO), and retreatment. Pool estimates were calculated using a random-effect model. Subgroup analysis based on morphology and study design was also conducted.</p><p><strong>Results: </strong>A total of 42 studies met our inclusion criteria. A total of 1698 patients were treated with FDs for 1760 PC aneurysms. Among these cases, 47.6% were in the vertebral artery. Our pooled overall analysis of complete occlusion rates was 72.73% (P<0.0001; I<sup>2</sup>=67.2%), and the pooled thromboembolic events rate following implantation was 11.70% (P<0.0046; I<sup>2</sup>=70.5%). Additionally, the pooled mortality rate was 8.07% (P<0.0001; I<sup>2</sup>=61.5%), the retreatment rate was 6.59% (P<0.4260; I<sup>2</sup>=1%), and the pooled GFO rate was 83.99% (P<0.0001; I<sup>2</sup>=76%). Subgroup analysis revealed that fusiform-dolichoectatic had a complete occlusion rate of 48.29% (P<0.3223; I<sup>2</sup>=11.7%).</p><p><strong>Conclusion: </strong>FDs for PC aneurysms achieve generally adequate occlusion rates, except in dolichoectatic-fusiform subtypes. Despite achieving adequate occlusion rates, FD use was associated with higher thromboembolic events, mortality, and retreatment rates, which necessitates careful patient selection.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"773-781"},"PeriodicalIF":4.3,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025590","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 : 2026-02-16DOI: 10.1136/jnis-2025-023074
Alhamza R Al-Bayati, Mohamed F Doheim, Mahmoud H Mohammaden, Michael Lang, Bradley Gross, Diogo C Haussen, Raul G Nogueira
Background: The currently US Food and Drug Administration approved intracranial stent delivery system involves a multistep deployment process that requires the use of an exchange length microwire (ELW). In this study, we describe a single-step approach to deploy the Neuroform Atlas stent without the need for ELW or lesion re-access, using the MINI TREK II over-the-wire (OTW) semi-compliant coronary balloon.
Methods: We performed a retrospective review of prospectively maintained mechanical thrombectomy databases from two comprehensive stroke centers. The study included consecutive large vessel occlusion (LVO) stroke patients who underwent single-step angioplasty with the MINI TREK II OTW balloon followed by deployment of the Neuroform Atlas intracranial stent, without the use of an ELW.
Results: A total of 12 patients met the inclusion criteria. Among them, the median age was 67 years (IQR: 58-73) and 50% were female. Most patients had middle cerebral artery (MCA) M1 occlusion (75%). One-third of the patients received intravenous thrombolysis. All patients achieved successful reperfusion (modified Treatment in Cerebral Ischemia (mTICI) 2b/3) with a median of two passes. The median National Institutes of Health Stroke Scale (NIHSS) score decreased from 14 (IQR: 10-19) at baseline to 4 (IQR: 1-9) at discharge, and the median modified Rankin Scale (mRS) score was 1 (IQR: 1-4) at discharge and 3 (IQR: 2-4) at 90 days. None of the patients in this series experienced symptomatic intracranial hemorrhage, though two patients (16.7%) were dead at 90 days but there was no procedural-related mortality.
Conclusions: This preliminary experience demonstrates the technical feasibility and success of single-step deployment of the Neuroform Atlas stent following angioplasty with the MINI TREK II OTW balloon, without the need for an ELW or lesion re-access. Larger prospective studies with extended clinical follow-up are needed to validate these findings.
背景:目前美国食品和药物管理局批准的颅内支架输送系统涉及一个多步骤的部署过程,需要使用交换长度微丝(ELW)。在这项研究中,我们描述了一种单步方法,使用MINI TREK II over- wire (OTW)半合规冠状动脉球囊,无需ELW或病变重新进入即可部署Neuroform Atlas支架。方法:我们对两个卒中综合中心前瞻性维护的机械取栓数据库进行了回顾性分析。该研究包括连续大血管闭塞(LVO)脑卒中患者,他们使用MINI TREK II OTW球囊进行单步血管成形术,随后部署Neuroform Atlas颅内支架,不使用ELW。结果:共有12例患者符合纳入标准。其中年龄中位数为67岁(IQR: 58 ~ 73),女性占50%。大多数患者有大脑中动脉(MCA) M1闭塞(75%)。三分之一的患者接受静脉溶栓治疗。所有患者均获得成功再灌注(改良脑缺血治疗(mTICI) 2b/3),中位数为2次。美国国立卫生研究院卒中量表(NIHSS)评分中位数从基线时的14分(IQR: 10-19)降至出院时的4分(IQR: 1-9),出院时修正兰金量表(mRS)评分中位数为1分(IQR: 1-4), 90天时为3分(IQR: 2-4)。该系列患者均未出现症状性颅内出血,尽管有2例患者(16.7%)在90天内死亡,但无手术相关死亡率。结论:这一初步经验证明了MINI TREK II OTW球囊在血管成形术后单步部署Neuroform Atlas支架的技术可行性和成功性,无需ELW或病变重新进入。需要更大规模的前瞻性研究和延长的临床随访来验证这些发现。
{"title":"Feasibility of emergent single-step intracranial self-expanding stent deployment using over-the-wire coronary balloons in intracranial atherosclerosis-related large vessel occlusion thrombectomy.","authors":"Alhamza R Al-Bayati, Mohamed F Doheim, Mahmoud H Mohammaden, Michael Lang, Bradley Gross, Diogo C Haussen, Raul G Nogueira","doi":"10.1136/jnis-2025-023074","DOIUrl":"10.1136/jnis-2025-023074","url":null,"abstract":"<p><strong>Background: </strong>The currently US Food and Drug Administration approved intracranial stent delivery system involves a multistep deployment process that requires the use of an exchange length microwire (ELW). In this study, we describe a single-step approach to deploy the Neuroform Atlas stent without the need for ELW or lesion re-access, using the MINI TREK II over-the-wire (OTW) semi-compliant coronary balloon.</p><p><strong>Methods: </strong>We performed a retrospective review of prospectively maintained mechanical thrombectomy databases from two comprehensive stroke centers. The study included consecutive large vessel occlusion (LVO) stroke patients who underwent single-step angioplasty with the MINI TREK II OTW balloon followed by deployment of the Neuroform Atlas intracranial stent, without the use of an ELW.</p><p><strong>Results: </strong>A total of 12 patients met the inclusion criteria. Among them, the median age was 67 years (IQR: 58-73) and 50% were female. Most patients had middle cerebral artery (MCA) M1 occlusion (75%). One-third of the patients received intravenous thrombolysis. All patients achieved successful reperfusion (modified Treatment in Cerebral Ischemia (mTICI) 2b/3) with a median of two passes. The median National Institutes of Health Stroke Scale (NIHSS) score decreased from 14 (IQR: 10-19) at baseline to 4 (IQR: 1-9) at discharge, and the median modified Rankin Scale (mRS) score was 1 (IQR: 1-4) at discharge and 3 (IQR: 2-4) at 90 days. None of the patients in this series experienced symptomatic intracranial hemorrhage, though two patients (16.7%) were dead at 90 days but there was no procedural-related mortality.</p><p><strong>Conclusions: </strong>This preliminary experience demonstrates the technical feasibility and success of single-step deployment of the Neuroform Atlas stent following angioplasty with the MINI TREK II OTW balloon, without the need for an ELW or lesion re-access. Larger prospective studies with extended clinical follow-up are needed to validate these findings.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"828-834"},"PeriodicalIF":4.3,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986434","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 : 2026-02-16DOI: 10.1136/jnis-2024-022960
Lei Guo, Jun Zhang, Jianhong Wang, Shu Yang, Yang Xiang, Fuqiang Guo
Background: First-pass effect (FPE) is crucial for better outcomes in mechanical thrombectomy (MT) for acute large vessel occlusions. However, its frequency and predictors in vertebrobasilar artery occlusion (VBAO) remain unclear.
Objective: To conduct a comprehensive systematic review and meta-analysis to assess the incidence of FPE in MT for VBAO and its impact on key clinical outcomes. Additionally, to explore potential predictors of achieving FPE, addressing critical knowledge gaps and providing evidence to optimize treatment strategies for patients with VBAO.
Methods: A systematic literature search was performed in PubMed, EMBASE, Web of Science, and the Cochrane Library up to November 1, 2024. Studies evaluating FPE in patients with acute VBAO undergoing MT were included. The prevalence of FPE was estimated using a meta-analysis of proportions, and associations with clinical outcomes and predictive factors were assessed using pooled ORs with random-effects models.
Results: Twenty studies involving 4315 patients met inclusion criteria. The overall prevalence of FPE in patients with VBAO was 41% (95% CI 33% to 50%). FPE was significantly associated with improved 90-day outcomes (modified Rankin Scale (mRS) score 0-2: OR=2.00, 95% CI 1.45 to 2.75; mRS score 0-3: OR=2.33, 95% CI 1.78 to 3.04), reduced risk of symptomatic intracranial hemorrhage (OR=0.49, 95% CI 0.27 to 0.87), and lower mortality (OR=0.43, 95% CI 0.32 to 0.57). The results showed that significant positive predictors of FPE included female sex, atrial fibrillation, cardioembolic or unknown stroke etiology, mid- or distal basilar artery occlusion, contact aspiration techniques, and the use of larger catheters. Conversely, negative predictors were identified as a history of hypertension, hyperlipidemia, prior stroke or transient ischemic attack, higher baseline NIHSS scores, prolonged procedure time, and the use of general anesthesia.
Conclusion: Achieving FPE in acute VBAO is strongly associated with improved clinical outcomes. Important clinical, procedural, and anatomical factors related to FPE were identified, aiding clinical decisions and thrombectomy techniques.
背景:首过效应(FPE)对于急性大血管闭塞机械取栓(MT)的预后至关重要。然而,其在椎基底动脉闭塞(VBAO)中的频率和预测因素尚不清楚。目的:通过全面的系统回顾和荟萃分析,评估VBAO患者MT中FPE的发生率及其对关键临床结局的影响。此外,探讨实现FPE的潜在预测因素,解决关键知识空白,并为优化VBAO患者的治疗策略提供证据。方法:系统检索截至2024年11月1日的PubMed、EMBASE、Web of Science和Cochrane Library的文献。纳入了评估急性VBAO患者行MT的FPE的研究。使用比例的荟萃分析估计FPE的患病率,并使用随机效应模型的合并or评估与临床结果和预测因素的关联。结果:20项研究共纳入4315例患者符合纳入标准。VBAO患者中FPE的总体患病率为41% (95% CI为33%至50%)。FPE与改善的90天预后显著相关(改良Rankin量表(mRS)评分0-2:OR=2.00, 95% CI 1.45至2.75;mRS评分0-3:OR=2.33, 95% CI 1.78 ~ 3.04),降低症状性颅内出血的风险(OR=0.49, 95% CI 0.27 ~ 0.87),降低死亡率(OR=0.43, 95% CI 0.32 ~ 0.57)。结果显示,FPE的显著阳性预测因素包括女性、房颤、心脏栓塞或未知的卒中病因、基底动脉中或远端闭塞、接触抽吸技术和使用更大的导管。相反,高血压、高脂血症、中风或短暂性脑缺血发作史、较高的NIHSS基线评分、延长的手术时间和全身麻醉的使用被确定为阴性预测因素。结论:急性VBAO患者实现FPE与临床预后改善密切相关。确定了与FPE相关的重要临床、手术和解剖学因素,有助于临床决策和取栓技术。
{"title":"The role of first pass effect in mechanical thrombectomy for vertebrobasilar artery occlusion: a comprehensive meta-analysis of prevalence, outcomes, and predictive factors.","authors":"Lei Guo, Jun Zhang, Jianhong Wang, Shu Yang, Yang Xiang, Fuqiang Guo","doi":"10.1136/jnis-2024-022960","DOIUrl":"10.1136/jnis-2024-022960","url":null,"abstract":"<p><strong>Background: </strong>First-pass effect (FPE) is crucial for better outcomes in mechanical thrombectomy (MT) for acute large vessel occlusions. However, its frequency and predictors in vertebrobasilar artery occlusion (VBAO) remain unclear.</p><p><strong>Objective: </strong>To conduct a comprehensive systematic review and meta-analysis to assess the incidence of FPE in MT for VBAO and its impact on key clinical outcomes. Additionally, to explore potential predictors of achieving FPE, addressing critical knowledge gaps and providing evidence to optimize treatment strategies for patients with VBAO.</p><p><strong>Methods: </strong>A systematic literature search was performed in PubMed, EMBASE, Web of Science, and the Cochrane Library up to November 1, 2024. Studies evaluating FPE in patients with acute VBAO undergoing MT were included. The prevalence of FPE was estimated using a meta-analysis of proportions, and associations with clinical outcomes and predictive factors were assessed using pooled ORs with random-effects models.</p><p><strong>Results: </strong>Twenty studies involving 4315 patients met inclusion criteria. The overall prevalence of FPE in patients with VBAO was 41% (95% CI 33% to 50%). FPE was significantly associated with improved 90-day outcomes (modified Rankin Scale (mRS) score 0-2: OR=2.00, 95% CI 1.45 to 2.75; mRS score 0-3: OR=2.33, 95% CI 1.78 to 3.04), reduced risk of symptomatic intracranial hemorrhage (OR=0.49, 95% CI 0.27 to 0.87), and lower mortality (OR=0.43, 95% CI 0.32 to 0.57). The results showed that significant positive predictors of FPE included female sex, atrial fibrillation, cardioembolic or unknown stroke etiology, mid- or distal basilar artery occlusion, contact aspiration techniques, and the use of larger catheters. Conversely, negative predictors were identified as a history of hypertension, hyperlipidemia, prior stroke or transient ischemic attack, higher baseline NIHSS scores, prolonged procedure time, and the use of general anesthesia.</p><p><strong>Conclusion: </strong>Achieving FPE in acute VBAO is strongly associated with improved clinical outcomes. Important clinical, procedural, and anatomical factors related to FPE were identified, aiding clinical decisions and thrombectomy techniques.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"763-772"},"PeriodicalIF":4.3,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567198","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}
Percutaneous biopsy of petrous apex lesions is technically challenging due to deep skull base anatomy and proximity to critical neurovascular structures.1-5 In this technical video 1, we present a cone beam CT-guided biopsy using a contralateral subzygomatic transclival approach, initially described under CT guidance.6 The minimally invasive route provides a safe, direct trajectory to the petrous apex while preserving the internal carotid artery. The step-by-step workflow includes cone beam CT-based trajectory planning, fluoroscopic guidance, and coaxial bone sampling using an 11-gauge biopsy needle. Two clinical cases are demonstrated: one revealing metastatic breast cancer and another confirming Erdheim-Chester disease. Both procedures were completed without complications and allowed definitive histopathological diagnosis. This approach expands the interventional neuroradiologist's toolkit for skull base access and represents a valuable alternative to open surgical biopsy in selected patients, combining precision, safety, and diagnostic efficacy. neurintsurg;18/3/893/V1F1V1Video 1Cases presentation.
{"title":"Cone beam CT-guided biopsy of a petrous apex lesion via the contralateral subzygomatic transclival approach.","authors":"Lambert Kernanet, Pierre-Marie Chiaroni, Pauline Carpentier, Kevin Premat, Julien Allard, Mahmoud Elhorany, Romain Bossi-Croci, Bertrand Mathon, Mehdi Drir, Lauranne Alciato, Frédéric Clarençon, Eimad Shotar","doi":"10.1136/jnis-2025-024628","DOIUrl":"10.1136/jnis-2025-024628","url":null,"abstract":"<p><p>Percutaneous biopsy of petrous apex lesions is technically challenging due to deep skull base anatomy and proximity to critical neurovascular structures.1-5 In this technical video 1, we present a cone beam CT-guided biopsy using a contralateral subzygomatic transclival approach, initially described under CT guidance.6 The minimally invasive route provides a safe, direct trajectory to the petrous apex while preserving the internal carotid artery. The step-by-step workflow includes cone beam CT-based trajectory planning, fluoroscopic guidance, and coaxial bone sampling using an 11-gauge biopsy needle. Two clinical cases are demonstrated: one revealing metastatic breast cancer and another confirming Erdheim-Chester disease. Both procedures were completed without complications and allowed definitive histopathological diagnosis. This approach expands the interventional neuroradiologist's toolkit for skull base access and represents a valuable alternative to open surgical biopsy in selected patients, combining precision, safety, and diagnostic efficacy. neurintsurg;18/3/893/V1F1V1Video 1Cases presentation.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"893"},"PeriodicalIF":4.3,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145911875","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 : 2026-02-16DOI: 10.1136/jnis-2024-023018
Eva González, Ion Labayen, Jon Fondevila, Xabier Manso, Alexander Jon Aguinaga, Marimar Freijo, Alain Luna, Covadonga Fernández, Tomás Pérez, Alejandra Gómez, Iratxe Ugarriza, Marc Comas-Cufí, Jordi Blasco, Josep Puig
Background: Medium vessel occlusion (MVO) mechanical thrombectomy (MT) has shown promising outcomes and safety profiles, comparable to those of large vessel occlusion thrombectomy.
Objective: To assess the efficacy and safety of the CatchView Mini (CVM) stent retriever (Balt, Montmorency, France) in patients with acute stroke with proximal and distal MVO (pMVO vs dMVO), respectively.
Methods: We analyzed retrospective data of consecutive patients with MVO who underwent MT with the CVM stent retriever. We categorized occlusions into pMVO group (segments A1, M2, and P1) versus dMVO group (segments A2, A3, M3, P2, and P3). Demographic, clinical, angiographic, and clinical outcome data (National Institute of Health Stroke Scale score at 24 hours and modified Rankin Scale (mRS) score at 3 months) were compared. The first pass effect (FPE) was defined as that which achieved modified Thrombolysis in Cerebral Infarction (mTICI) 2c-3 after a single device pass.
Results: A total of 196 patients were included (44.3% female, median (IQR) age 74 (67-84) years), of whom 151 (77%) had pMVO and 45 (23%) dMVO. FPE was achieved in 108 (55.1%) patients, and final successful reperfusion (mTICI 2c-3) was attained in 156 (79.6%) cases, with up to two passes in 78% of patients. Rescue MT was performed in 24 (12.2%) patients. The dMVO group had a higher FPE rate (84.4% vs 46.3%; P<0.001), fewer number of passes, and lower symptomatic hemorrhage rate (0% vs 0.6%; P=0.009) than the pMVO group. Around 75% of patients in both groups achieved similar favorable outcomes (mRS score 0-2) at 3 months.
Conclusions: The CVM device appears effective and safe for pMVO and dMVO thrombectomy.
背景:中等血管闭塞(MVO)机械取栓(MT)已显示出良好的结果和安全性,与大血管闭塞取栓相当。目的:评估CatchView Mini (CVM)支架回收器(Balt, Montmorency, France)在急性脑卒中近端和远端MVO (pMVO vs dMVO)患者中的疗效和安全性。方法:我们分析了连续MVO患者的回顾性数据,这些患者使用CVM支架回收器进行MT。我们将闭塞分为pMVO组(A1、M2和P1段)和dMVO组(A2、A3、M3、P2和P3段)。比较人口学、临床、血管造影和临床结果数据(24小时时美国国立卫生研究院卒中量表评分和3个月时改良Rankin量表评分)。首次通过效应(FPE)定义为在单次装置通过后实现改良脑梗死血栓溶解(mTICI) 2c-3。结果:共纳入196例患者(女性44.3%,中位(IQR)年龄74(67-84)岁),其中151例(77%)为pMVO, 45例(23%)为dMVO。108例(55.1%)患者实现了FPE, 156例(79.6%)患者实现了最终成功的再灌注(mTICI 2c-3), 78%的患者达到了两次通过。24例(12.2%)患者行MT抢救。dMVO组FPE率更高(84.4% vs 46.3%;结论:CVM装置对pMVO和dMVO取栓有效且安全。
{"title":"Efficacy and safety of CatchView Mini stent retriever for mechanical thrombectomy in proximal and distal medium vessel occlusions.","authors":"Eva González, Ion Labayen, Jon Fondevila, Xabier Manso, Alexander Jon Aguinaga, Marimar Freijo, Alain Luna, Covadonga Fernández, Tomás Pérez, Alejandra Gómez, Iratxe Ugarriza, Marc Comas-Cufí, Jordi Blasco, Josep Puig","doi":"10.1136/jnis-2024-023018","DOIUrl":"10.1136/jnis-2024-023018","url":null,"abstract":"<p><strong>Background: </strong>Medium vessel occlusion (MVO) mechanical thrombectomy (MT) has shown promising outcomes and safety profiles, comparable to those of large vessel occlusion thrombectomy.</p><p><strong>Objective: </strong>To assess the efficacy and safety of the CatchView Mini (CVM) stent retriever (Balt, Montmorency, France) in patients with acute stroke with proximal and distal MVO (pMVO vs dMVO), respectively.</p><p><strong>Methods: </strong>We analyzed retrospective data of consecutive patients with MVO who underwent MT with the CVM stent retriever. We categorized occlusions into pMVO group (segments A1, M2, and P1) versus dMVO group (segments A2, A3, M3, P2, and P3). Demographic, clinical, angiographic, and clinical outcome data (National Institute of Health Stroke Scale score at 24 hours and modified Rankin Scale (mRS) score at 3 months) were compared. The first pass effect (FPE) was defined as that which achieved modified Thrombolysis in Cerebral Infarction (mTICI) 2c-3 after a single device pass.</p><p><strong>Results: </strong>A total of 196 patients were included (44.3% female, median (IQR) age 74 (67-84) years), of whom 151 (77%) had pMVO and 45 (23%) dMVO. FPE was achieved in 108 (55.1%) patients, and final successful reperfusion (mTICI 2c-3) was attained in 156 (79.6%) cases, with up to two passes in 78% of patients. Rescue MT was performed in 24 (12.2%) patients. The dMVO group had a higher FPE rate (84.4% vs 46.3%; P<0.001), fewer number of passes, and lower symptomatic hemorrhage rate (0% vs 0.6%; P=0.009) than the pMVO group. Around 75% of patients in both groups achieved similar favorable outcomes (mRS score 0-2) at 3 months.</p><p><strong>Conclusions: </strong>The CVM device appears effective and safe for pMVO and dMVO thrombectomy.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"632-638"},"PeriodicalIF":4.3,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022858","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 : 2026-02-16DOI: 10.1136/jnis-2024-022845
Rahim Abo Kasem, Zachary Hubbard, Conor Cunningham, Hani Almorawed, Julio Isidor, Imad Samman Tahhan, Mohammad-Mahdi Sowlat, Sofia Babool, Layal Abodest, Alejandro M Spiotta
Background: Large and giant intracranial aneurysms pose treatment challenges. The benefit-risk balance of flow diverters (FDs) alone versus FDs with coiling remains unclear. This study aimed to compare these two strategies.
Methods: This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search of PubMed, Embase, Scopus, Cochrane, and Web of Science was performed up to October 2024. Studies comparing FDs with or without adjunctive coiling in large/giant intracranial aneurysms were included. The primary outcome was complete aneurysm occlusion, defined by the Raymond-Roy Occlusion Classification. Additional outcomes included procedural and postprocedural complications. Data were analyzed using a random effects model.
Results: 15 studies with 1130 patients were analyzed, with 557 in the FD alone group and 573 in the FD+coiling group. The meta-analysis revealed that FD+coiling significantly improved complete aneurysm occlusion rates (OR 1.59, 95% CI 1.06 to 2.40, P=0.03). While overall ischemic complications were significantly lower in the FD alone group, a sensitivity analysis showed no significant difference (OR 0.49, 95% CI 0.20 to 1.23, P=0.13). Subgroup analysis of fusiform aneurysms showed no significant difference in complete aneurysm occlusion rates (OR 1.10, 95% CI 0.50 to 2.40, P=0.82). Procedural and hemorrhagic complications did not differ significantly, and no publication bias was detected in the results.
Conclusions: Combining FDs with coiling improved complete aneurysm occlusion rates in large and giant saccular intracranial aneurysms, although the impact on complications remains controversial. Further investigation into the benefit-risk ratio of this combined approach is warranted.
背景:大而巨大的颅内动脉瘤给治疗带来了挑战。单独使用分流器(FDs)与使用分流器(FDs)的收益-风险平衡尚不清楚。本研究旨在比较这两种策略。方法:本系统评价和荟萃分析遵循系统评价和荟萃分析指南的首选报告项目。对PubMed、Embase、Scopus、Cochrane和Web of Science进行了全面的检索,截止到2024年10月。比较大/巨大颅内动脉瘤的FDs有无辅助卷绕的研究也包括在内。主要结果是完全动脉瘤闭塞,由Raymond-Roy闭塞分类法定义。其他结果包括手术和术后并发症。数据分析采用随机效应模型。结果:共分析了15项研究共1130例患者,其中单独FD组557例,FD+卷曲组573例。荟萃分析显示,FD+卷曲可显著提高动脉瘤完全闭塞率(OR 1.59, 95% CI 1.06 ~ 2.40, P=0.03)。虽然单独使用FD组总的缺血性并发症明显降低,但敏感性分析显示差异无统计学意义(OR 0.49, 95% CI 0.20 ~ 1.23, P=0.13)。梭状动脉瘤的亚组分析显示,完全动脉瘤闭塞率差异无统计学意义(OR 1.10, 95% CI 0.50 ~ 2.40, P=0.82)。手术并发症和出血性并发症没有显著差异,结果中没有发现发表偏倚。结论:FDs联合卷绕可提高大、巨型囊状颅内动脉瘤的完全闭塞率,但对并发症的影响仍存在争议。进一步调查这种联合方法的收益风险比是有必要的。
{"title":"Comparison of flow diverter alone versus flow diverter with coiling for large and giant intracranial aneurysms: systematic review and meta-analysis of observational studies.","authors":"Rahim Abo Kasem, Zachary Hubbard, Conor Cunningham, Hani Almorawed, Julio Isidor, Imad Samman Tahhan, Mohammad-Mahdi Sowlat, Sofia Babool, Layal Abodest, Alejandro M Spiotta","doi":"10.1136/jnis-2024-022845","DOIUrl":"10.1136/jnis-2024-022845","url":null,"abstract":"<p><strong>Background: </strong>Large and giant intracranial aneurysms pose treatment challenges. The benefit-risk balance of flow diverters (FDs) alone versus FDs with coiling remains unclear. This study aimed to compare these two strategies.</p><p><strong>Methods: </strong>This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search of PubMed, Embase, Scopus, Cochrane, and Web of Science was performed up to October 2024. Studies comparing FDs with or without adjunctive coiling in large/giant intracranial aneurysms were included. The primary outcome was complete aneurysm occlusion, defined by the Raymond-Roy Occlusion Classification. Additional outcomes included procedural and postprocedural complications. Data were analyzed using a random effects model.</p><p><strong>Results: </strong>15 studies with 1130 patients were analyzed, with 557 in the FD alone group and 573 in the FD+coiling group. The meta-analysis revealed that FD+coiling significantly improved complete aneurysm occlusion rates (OR 1.59, 95% CI 1.06 to 2.40, P=0.03). While overall ischemic complications were significantly lower in the FD alone group, a sensitivity analysis showed no significant difference (OR 0.49, 95% CI 0.20 to 1.23, P=0.13). Subgroup analysis of fusiform aneurysms showed no significant difference in complete aneurysm occlusion rates (OR 1.10, 95% CI 0.50 to 2.40, P=0.82). Procedural and hemorrhagic complications did not differ significantly, and no publication bias was detected in the results.</p><p><strong>Conclusions: </strong>Combining FDs with coiling improved complete aneurysm occlusion rates in large and giant saccular intracranial aneurysms, although the impact on complications remains controversial. Further investigation into the benefit-risk ratio of this combined approach is warranted.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"739-749"},"PeriodicalIF":4.3,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074731","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 : 2026-02-16DOI: 10.1136/jnis-2025-023079
Ming Wang, Wanning Zheng, Rong Zou, Jiahao Tang, Ruilin Chen, Yuhai Gao, Ning Wang, Yuning Lu, Jens Fiehler, Adnan H Siddiqui, Jianping Xiang, Shu Wan
Objective: Fractional flow (FF) reserve has been developed as a gold standard for coronary intervention. Intracranial FF is also a valuable hemodynamic index to assess the severity of narrowing in intracranial atherosclerotic stenosis (ICAS). This study aims to investigate the predictive value of FF in assessing restenosis following endovascular treatment in patients with symptomatic ICAS.
Methods: This retrospective study recruited 67 patients with symptomatic ICAS who received intracranial stenting between March 2019 and January 2024. FF was measured by dedicated software (AccuICAD) before and after stenting. During follow-up, patients were categorized into two groups based on the occurrence of in-stent restenosis (ISR): ISR group and non-ISR group. Multivariate regression analysis and Kaplan-Meier survival analysis were performed to identify the predictive factors for ISR.
Results: Post-FF was significantly different between the ISR and non-ISR groups (0.84±0.09 vs 0.92±0.06, respectively, P<0.01). Univariate and multivariate Cox regression analyses identified post-FF (HR 0.0, 95% CI 0.0 to 0.08, P=0.005) and smoking (HR 3.06, 95% CI 1.02 to 9.19, P=0.047) as the two predictors of ISR. Receiver operating characteristic curve analysis confirmed the predictive value of post-FF for ISR (AUC=0.783, 95% CI 0.645 to 0.920, P=0.003), with a cut-off value of 0.94. Kaplan-Meier survival analysis further demonstrated that patients with a post-FF value >0.94 had a significantly lower incidence of ISR (P=0.001).
Conclusion: In this study, post-FF effectively predicted ISR, providing an intraoperative evaluation value for stenting in ICAS.
目的:血流分数储备(FF)已成为冠状动脉介入治疗的金标准。颅内FF也是评估颅内动脉粥样硬化性狭窄(ICAS)狭窄严重程度的有价值的血流动力学指标。本研究旨在探讨FF在评估症状性ICAS患者血管内治疗后再狭窄的预测价值。方法:本回顾性研究招募了67例在2019年3月至2024年1月期间接受颅内支架植入术的症状性ICAS患者。使用专用软件AccuICAD测量支架置入前后的FF。在随访中,根据支架内再狭窄(ISR)的发生情况将患者分为支架内再狭窄组和非支架内再狭窄组。采用多变量回归分析和Kaplan-Meier生存分析来确定ISR的预测因素。结果:ISR组与非ISR组术后ff发生率差异有统计学意义(分别为0.84±0.09 vs 0.92±0.06),P0.94组ISR发生率显著降低(P=0.001)。结论:本研究中,后ff能有效预测ISR,为ICAS支架置入提供术中评价价值。
{"title":"Correlation of computed fractional flow and in-stent restenosis in patients with intracranial atherosclerotic stenosis.","authors":"Ming Wang, Wanning Zheng, Rong Zou, Jiahao Tang, Ruilin Chen, Yuhai Gao, Ning Wang, Yuning Lu, Jens Fiehler, Adnan H Siddiqui, Jianping Xiang, Shu Wan","doi":"10.1136/jnis-2025-023079","DOIUrl":"10.1136/jnis-2025-023079","url":null,"abstract":"<p><strong>Objective: </strong>Fractional flow (FF) reserve has been developed as a gold standard for coronary intervention. Intracranial FF is also a valuable hemodynamic index to assess the severity of narrowing in intracranial atherosclerotic stenosis (ICAS). This study aims to investigate the predictive value of FF in assessing restenosis following endovascular treatment in patients with symptomatic ICAS.</p><p><strong>Methods: </strong>This retrospective study recruited 67 patients with symptomatic ICAS who received intracranial stenting between March 2019 and January 2024. FF was measured by dedicated software (AccuICAD) before and after stenting. During follow-up, patients were categorized into two groups based on the occurrence of in-stent restenosis (ISR): ISR group and non-ISR group. Multivariate regression analysis and Kaplan-Meier survival analysis were performed to identify the predictive factors for ISR.</p><p><strong>Results: </strong>Post-FF was significantly different between the ISR and non-ISR groups (0.84±0.09 vs 0.92±0.06, respectively, P<0.01). Univariate and multivariate Cox regression analyses identified post-FF (HR 0.0, 95% CI 0.0 to 0.08, P=0.005) and smoking (HR 3.06, 95% CI 1.02 to 9.19, P=0.047) as the two predictors of ISR. Receiver operating characteristic curve analysis confirmed the predictive value of post-FF for ISR (AUC=0.783, 95% CI 0.645 to 0.920, P=0.003), with a cut-off value of 0.94. Kaplan-Meier survival analysis further demonstrated that patients with a post-FF value >0.94 had a significantly lower incidence of ISR (P=0.001).</p><p><strong>Conclusion: </strong>In this study, post-FF effectively predicted ISR, providing an intraoperative evaluation value for stenting in ICAS.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"868-875"},"PeriodicalIF":4.3,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764150","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 : 2026-02-16DOI: 10.1136/jnis-2025-023215
Guillaume Charbonnier, Nicole M Cancelliere, Arturo Consoli, Hidehisa Nishi, Kevin Janot, Ze'ev Itsekson Hayosh, Ange Diouf, Aruma Jiménez-O'Shanahan, Zamir Merali, Thomas R Marotta, Julian Spears, Vitor M Pereira
Background: Robotic neurointerventions have demonstrated promising initial clinical results. Claims of enhanced precision during robotic navigation have been reported, but objective quantification of such precision is limited. Precision during intracranial navigation and device deployment is crucial in neurovascular interventions, and lack of precision can lead to intraprocedural complications. This study compared quantitative metrics of precision in manual and robotic procedures using a virtual simulator.
Methods: Using three different simulated aneurysm procedures with different levels of difficulty (easy, medium, and hard), 12 operators with different levels of experience were assigned a defined task for each case. Each procedure was performed both manually and under robotic assistance. Precision was assessed using the length of translations and the total degree of rotations of the microwire and microcatheter needed to complete the assigned tasks, as well as recorded safety metrics. Results were compared between the manual and robotic groups.
Results: We analyzed 78 procedures (robotic, n=34; manual, n=34) performed by 12 operators with various levels of neurointerventional surgical experience (high, n=5; low, n=7). For the difficult case, operators used significantly less microwire translations when operating with robotic assistance (38.7 cm vs 108.4 cm, P=0.023). There were no significant differences for the easy and medium cases. Safety metrics and procedural times were not significant different.
Conclusions: Operators demonstrated increased precision during microwire navigation when using robotic assistance to navigate a difficult aneurysm in a controlled simulated experimental set-up compared with manual navigation.
{"title":"Human versus machine: are neurointerventionists more precise in manual or robotically assisted procedures?","authors":"Guillaume Charbonnier, Nicole M Cancelliere, Arturo Consoli, Hidehisa Nishi, Kevin Janot, Ze'ev Itsekson Hayosh, Ange Diouf, Aruma Jiménez-O'Shanahan, Zamir Merali, Thomas R Marotta, Julian Spears, Vitor M Pereira","doi":"10.1136/jnis-2025-023215","DOIUrl":"10.1136/jnis-2025-023215","url":null,"abstract":"<p><strong>Background: </strong>Robotic neurointerventions have demonstrated promising initial clinical results. Claims of enhanced precision during robotic navigation have been reported, but objective quantification of such precision is limited. Precision during intracranial navigation and device deployment is crucial in neurovascular interventions, and lack of precision can lead to intraprocedural complications. This study compared quantitative metrics of precision in manual and robotic procedures using a virtual simulator.</p><p><strong>Methods: </strong>Using three different simulated aneurysm procedures with different levels of difficulty (easy, medium, and hard), 12 operators with different levels of experience were assigned a defined task for each case. Each procedure was performed both manually and under robotic assistance. Precision was assessed using the length of translations and the total degree of rotations of the microwire and microcatheter needed to complete the assigned tasks, as well as recorded safety metrics. Results were compared between the manual and robotic groups.</p><p><strong>Results: </strong>We analyzed 78 procedures (robotic, n=34; manual, n=34) performed by 12 operators with various levels of neurointerventional surgical experience (high, n=5; low, n=7). For the difficult case, operators used significantly less microwire translations when operating with robotic assistance (38.7 cm vs 108.4 cm, P=0.023). There were no significant differences for the easy and medium cases. Safety metrics and procedural times were not significant different.</p><p><strong>Conclusions: </strong>Operators demonstrated increased precision during microwire navigation when using robotic assistance to navigate a difficult aneurysm in a controlled simulated experimental set-up compared with manual navigation.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"802-807"},"PeriodicalIF":4.3,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788455","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 : 2026-02-16DOI: 10.1136/jnis-2025-023372
Andrew B Koo, Sasha Stogniy, Aladine A Elsamadicy, Sidharth S Menon, Daniela Renedo, Benjamin Reeves, Nanthiya Sujijantarat, Ryan Hebert, Adam de Havenon, Kevin N Sheth, Charles Matouk
Background: The aim of this study was to evaluate the preliminary experience of a combined middle meningeal artery embolization (MMAE) and burr hole evacuation approach for chronic subdural hematoma (cSDH) under a single anesthesia session.
Methods: We performed a retrospective review of all patients who underwent MMAE and burr hole surgery during the same admission at a single major academic institution between 2019 and 2024. Patients were dichotomized by those with both procedures performed under a single anesthesia session (combined) or two separate sessions (separate). Baseline demographics, comorbidities, and complications were compared. The primary outcomes were in-hospital and 90-day complication and reoperation rates.
Results: 103 patients were included in the study (median age 74 (67-81) years), with 33.9% in the combined cohort. Demographics, comorbidities, and radiographic characteristics were similar between the cohorts. While cumulative procedure times were similar (separate 85 (71-110) min vs combined 96 (82-127) min), total anesthesia time was significantly longer for patients with separate procedures (separate 225 (193-264) min vs combined 165 (145-183) min, P<0.001). There were no differences in the rates of access site complications, reoperation, stroke, or mortality between the cohorts. The combined cohort trended to have shorter length of stay (separate 6 (5-8) days vs combined 5 (4-7) days, P=0.058). There were no differences in complication or reoperation rates within 90 days.
Conclusion: The results of this study suggest that MMAE performed under a single anesthesia session with burr hole evacuation surgery is a safe and potentially resource-efficient approach for the management of cSDH.
{"title":"Single-session middle meningeal artery embolization and surgical evacuation for chronic subdural hematoma.","authors":"Andrew B Koo, Sasha Stogniy, Aladine A Elsamadicy, Sidharth S Menon, Daniela Renedo, Benjamin Reeves, Nanthiya Sujijantarat, Ryan Hebert, Adam de Havenon, Kevin N Sheth, Charles Matouk","doi":"10.1136/jnis-2025-023372","DOIUrl":"10.1136/jnis-2025-023372","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to evaluate the preliminary experience of a combined middle meningeal artery embolization (MMAE) and burr hole evacuation approach for chronic subdural hematoma (cSDH) under a single anesthesia session.</p><p><strong>Methods: </strong>We performed a retrospective review of all patients who underwent MMAE and burr hole surgery during the same admission at a single major academic institution between 2019 and 2024. Patients were dichotomized by those with both procedures performed under a single anesthesia session (combined) or two separate sessions (separate). Baseline demographics, comorbidities, and complications were compared. The primary outcomes were in-hospital and 90-day complication and reoperation rates.</p><p><strong>Results: </strong>103 patients were included in the study (median age 74 (67-81) years), with 33.9% in the combined cohort. Demographics, comorbidities, and radiographic characteristics were similar between the cohorts. While cumulative procedure times were similar (separate 85 (71-110) min vs combined 96 (82-127) min), total anesthesia time was significantly longer for patients with separate procedures (separate 225 (193-264) min vs combined 165 (145-183) min, P<0.001). There were no differences in the rates of access site complications, reoperation, stroke, or mortality between the cohorts. The combined cohort trended to have shorter length of stay (separate 6 (5-8) days vs combined 5 (4-7) days, P=0.058). There were no differences in complication or reoperation rates within 90 days.</p><p><strong>Conclusion: </strong>The results of this study suggest that MMAE performed under a single anesthesia session with burr hole evacuation surgery is a safe and potentially resource-efficient approach for the management of cSDH.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"797-801"},"PeriodicalIF":4.3,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743150","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 : 2026-02-16DOI: 10.1136/jnis-2024-022628
Guillaume Saliou, Hamza Adel Salim, Basel Musmar, Nimer Adeeb, Assala Aslan, Christian Swaid, Miguel Cuellar, Mahmoud Dibas, Nicole M Cancelliere, Jose Danilo Bengzon Diestro, Oktay Algin, Sherief Ghozy, Sovann V Lay, Adrien Guenego, Leonardo Renieri, Joseph Anthony Carnevale, Panagiotis Mastorakos, Kareem ElNaamani, Eimad Shotar, Markus A Möhlenbruch, Michael Kral, Charlotte Chung, Mohamed M Salem, Ivan Lylyk, Paul M Foreman, Hamza Shaikh, Vedran Župančić, Muhammad Ubaid Hafeez, Joshua S Catapano, Muhammad Waqas, Muhammet Arslan, Onur Ergun, James D Rabinov, Yifan Ren, Clemens M Schirmer, Mariangela Piano, Anna Luisa Kuhn, Caterina Michelozzi, Robert M Starke, Ameer E Hassan, Mark Ogilvie, Anh Nguyen, Jesse Jones, Waleed Brinjikji, Marie Teresa Nawka, Marios-Nikos Psychogios, Christian Ulfert, Bryan Pukenas, Jan Karl Burkhardt, Thien J Huynh, Juan Carlos Martinez-Gutierrez, Muhammed Amir Essibayi, Sunil A Sheth, Diana Slawski, Rabih Tawk, Benjamin Pulli, Boris Lubicz, Pietro Panni, Ajit S Puri, Guglielmo Pero, Eytan Raz, Christoph J Griessenauer, Hamed Asadi, Adnan H Siddiqui, Elad I Levy, Neil Haranhalli, David Altschul, Andrew F Ducruet, Felipe C Albuquerque, Robert W Regenhardt, Christopher J Stapleton, Peter Kan, Vladimir Kalousek, Pedro Lylyk, Srikanth Reddy Boddu, Jared Knopman, Stavropoula I Tjoumakaris, Hugo Cuellar, Pascal Jabbour, Frédéric Clarençon, Nicola Limbucci, Vitor M Pereira, Aman B Patel, Adam A Dmytriw, Steven D Hajdu
Background: The Woven EndoBridge (WEB) device is a prevalent treatment for intracranial aneurysms. While many studies have assessed the obliteration rate post-WEB embolization, few have focused on long-term outcomes in partially thrombosed aneurysms.
Objective: To assess whether partially thrombosed aneurysms are at higher risk of recurrence or retreatment following WEB embolization compared with non-thrombosed aneurysms.
Methods: We evaluated data from 22 academic institutions, focusing on previously untreated cerebral aneurysms treated with the WEB device. Logistic regression was utilized to analyze factors predicting long-term aneurysm obliteration and retreatment necessity.
Results: Among 1303 patients, 26 presented with a partially thrombosed aneurysm. In the partially thrombosed group, the mean aneurysm maximal diameter was 10.7±4 mm with a neck ratio of 1.99±1.19 mm, larger than in the control group where the mean aneurysm maximal diameter was 6.81±2.37 mm with a neck ratio of 1.64±0.51 mm (P<0.001 for both maximal diameter and neck ratio). At the final follow-up, partially thrombosed aneurysms treated by the WEB device had a 38.5% retreatment rate, compared with 7.0% for non-thrombosed aneurysms (P<0.001). Among partially thrombosed aneurysms, the Raymond-Roy type IIIa/b occlusion rate was higher (38.5% vs 9.9%, P<0.001). On multivariate analysis, partially thrombosed aneurysms compared with non-thrombosed aneurysms had an increased rate of retreatment (OR 3.64, 95% CI 1.28 to 10.1).
Conclusion: Partially thrombosed aneurysms are associated with a poorer occlusion rate and a higher rate of retreatment following WEB embolization. For partially thrombosed aneurysms, the WEB device appears suboptimal as a first-line treatment, and therefore alternative techniques should be prioritized.
{"title":"Higher risk of recurrence in partially thrombosed cerebral aneurysms post-WEB (Woven EndoBridge) device treatment: insights from the WorldWideWEB Consortium registry.","authors":"Guillaume Saliou, Hamza Adel Salim, Basel Musmar, Nimer Adeeb, Assala Aslan, Christian Swaid, Miguel Cuellar, Mahmoud Dibas, Nicole M Cancelliere, Jose Danilo Bengzon Diestro, Oktay Algin, Sherief Ghozy, Sovann V Lay, Adrien Guenego, Leonardo Renieri, Joseph Anthony Carnevale, Panagiotis Mastorakos, Kareem ElNaamani, Eimad Shotar, Markus A Möhlenbruch, Michael Kral, Charlotte Chung, Mohamed M Salem, Ivan Lylyk, Paul M Foreman, Hamza Shaikh, Vedran Župančić, Muhammad Ubaid Hafeez, Joshua S Catapano, Muhammad Waqas, Muhammet Arslan, Onur Ergun, James D Rabinov, Yifan Ren, Clemens M Schirmer, Mariangela Piano, Anna Luisa Kuhn, Caterina Michelozzi, Robert M Starke, Ameer E Hassan, Mark Ogilvie, Anh Nguyen, Jesse Jones, Waleed Brinjikji, Marie Teresa Nawka, Marios-Nikos Psychogios, Christian Ulfert, Bryan Pukenas, Jan Karl Burkhardt, Thien J Huynh, Juan Carlos Martinez-Gutierrez, Muhammed Amir Essibayi, Sunil A Sheth, Diana Slawski, Rabih Tawk, Benjamin Pulli, Boris Lubicz, Pietro Panni, Ajit S Puri, Guglielmo Pero, Eytan Raz, Christoph J Griessenauer, Hamed Asadi, Adnan H Siddiqui, Elad I Levy, Neil Haranhalli, David Altschul, Andrew F Ducruet, Felipe C Albuquerque, Robert W Regenhardt, Christopher J Stapleton, Peter Kan, Vladimir Kalousek, Pedro Lylyk, Srikanth Reddy Boddu, Jared Knopman, Stavropoula I Tjoumakaris, Hugo Cuellar, Pascal Jabbour, Frédéric Clarençon, Nicola Limbucci, Vitor M Pereira, Aman B Patel, Adam A Dmytriw, Steven D Hajdu","doi":"10.1136/jnis-2024-022628","DOIUrl":"10.1136/jnis-2024-022628","url":null,"abstract":"<p><strong>Background: </strong>The Woven EndoBridge (WEB) device is a prevalent treatment for intracranial aneurysms. While many studies have assessed the obliteration rate post-WEB embolization, few have focused on long-term outcomes in partially thrombosed aneurysms.</p><p><strong>Objective: </strong>To assess whether partially thrombosed aneurysms are at higher risk of recurrence or retreatment following WEB embolization compared with non-thrombosed aneurysms.</p><p><strong>Methods: </strong>We evaluated data from 22 academic institutions, focusing on previously untreated cerebral aneurysms treated with the WEB device. Logistic regression was utilized to analyze factors predicting long-term aneurysm obliteration and retreatment necessity.</p><p><strong>Results: </strong>Among 1303 patients, 26 presented with a partially thrombosed aneurysm. In the partially thrombosed group, the mean aneurysm maximal diameter was 10.7±4 mm with a neck ratio of 1.99±1.19 mm, larger than in the control group where the mean aneurysm maximal diameter was 6.81±2.37 mm with a neck ratio of 1.64±0.51 mm (P<0.001 for both maximal diameter and neck ratio). At the final follow-up, partially thrombosed aneurysms treated by the WEB device had a 38.5% retreatment rate, compared with 7.0% for non-thrombosed aneurysms (P<0.001). Among partially thrombosed aneurysms, the Raymond-Roy type IIIa/b occlusion rate was higher (38.5% vs 9.9%, P<0.001). On multivariate analysis, partially thrombosed aneurysms compared with non-thrombosed aneurysms had an increased rate of retreatment (OR 3.64, 95% CI 1.28 to 10.1).</p><p><strong>Conclusion: </strong>Partially thrombosed aneurysms are associated with a poorer occlusion rate and a higher rate of retreatment following WEB embolization. For partially thrombosed aneurysms, the WEB device appears suboptimal as a first-line treatment, and therefore alternative techniques should be prioritized.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"782-789"},"PeriodicalIF":4.3,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015928","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}