Journal of NeuroInterventional Surgery最新文献

Background: Previous studies have demonstrated that successful reperfusion does not always correlate with long-term functional benefit in patients with acute ischemic stroke (AIS) treated via endovascular therapy (EVT). We evaluated patient characteristics and clinical outcomes in patients with AIS who underwent EVT with successful reperfusion resulting in either beneficial recanalization (BR) or futile recanalization (FR).

Methods: The authors conducted a single-institution retrospective, observational study of patients with AIS who underwent EVT between January 2019 and January 2024. Baseline characteristics, procedural details, and clinical metrics were reviewed, and FR predictors were identified.

Results: Of 441 subjects, 151 (34.24%) experienced FR, with this cohort displaying a higher mean blood glucose level on admission compared with the BR cohort (168±87.77 mg/dL vs 143±70.48 mg/dL; P=0.0029). Multivariable logistic regression analysis found blood glucose on admission to be a significant independent predictor of FR (P=0.0081). Hyperglycemia (glucose≥126 mg/dL) carried a twofold higher risk of FR (OR 2.088, 95% CI 1.399 to 3.137, P=0.0003), whereas glucose exceeding 300 mg/dL carried a threefold increased risk (OR 3.321, 95% CI 1.367 to 8.565, P=0.0093).

Conclusions: Rates of futile recanalization increased in a stepwise fashion as glucose levels on admission worsened in this study cohort. These findings suggest that early and rapid glucose management in patients with AIS undergoing EVT may improve outcomes and reduce the incidence of futile recanalization.

Background: The hypoperfusion intensity ratio (HIR) has emerged as a vital measure of tissue-level collateral blood flow, helping to identify patients who are likely to benefit from mechanical thrombectomy (MT). We aimed to assess the HIR's predictive accuracy for clinical outcomes following MT in patients with acute ischemic stroke.

Methods: PubMed, Embase, and Scopus were searched to identify studies comparing good versus poor HIR groups based on studies' reported cut-offs. We pooled binary outcomes to calculate odds ratios (OR) and continuous outcomes to calculate mean differences (MD) with 95% confidence intervals (95% CI) using random-effects models. PROSPERO registration code: CRD42024609185.

Results: 14 studies with 2987 patients, 1553 with good HIR and 1434 with poor HIR, were included in this meta-analysis. Patients with poor HIR exhibited a significantly higher baseline infarct volume compared with those with good HIR (MD 30.6 mL, 95% CI 20.8 mL to 40.3 mL, P<0.01), though baseline National Institutes of Health Stroke Scale (NIHSS) (P=0.12) and Alberta Stroke Program Early CT Score (ASPECTS) (P=0.35) were comparable between groups. The rates of infarct growth (MD 22.4 mL, 95% CI 6.7 mL to 38.0 mL, P<0.01) and 3-month mortality (OR 2.18, 95% CI 1.04 to 4.58, P=0.04) were higher among the poor HIR group and good functional recovery (modified Rankin Scale 0-2 at 3 months) was lower (OR 0.58, 95% CI 0.42 to 0.80, P<0.01). The rates of symptomatic intracranial hemorrhage (P=0.37) and successful reperfusion (P=0.47) were comparable among groups.

Conclusion: This meta-analysis highlights the significant negative impact of poor HIR on patient outcomes. These findings emphasize the need for personalized treatment strategies for patients with poor HIR.

Background: We describe and analyze a novel technique by which inflation of a proximal balloon guide catheter (BGC) permits tracking of distal catheter systems past vessel tortuosity and ledges like the ophthalmic segment of the internal carotid artery (ICA). Inflation of the BGC counteracts slippage when deployed, and careful advancement of the system builds up energy that is translated forward, allowing users to cross segments otherwise inaccessible by endovascular techniques.

Methods: A retrospective review of our institutional neurovascular database was conducted, and we identified nine patients for whom the novel 'Slingshot' technique was used for mechanical thrombectomy. Patient characteristics, outcomes, and procedural steps were collected and analyzed with regards to safety and efficacy of the technique.

Results: The Slingshot technique was successful in all nine cases to navigate the distal system to the target location. For all cases, conventional tracking of the catheter failed, and the Slingshot technique was used as a rescue. No intraoperative complications such as vessel dissection or perforation were observed. First pass recanalization was achieved in seven (78%) cases with successful reperfusion (thrombolysis in cerebral infarction ((TICI) ≥2B) in all cases. Patient outcome was favorable with National Institutes of Health Stroke Scale (NIHSS) score improvement from a median of 16 to 3 postoperatively.

Discussion: For neurovascular procedures in which advancement of an intermediate catheter or other equipment is limited by ledges or tortuosity, the Slingshot technique is a safe and effective way to reach the intended target position and does not require additional catheters or devices.

Background: To systematically review published reports of standalone bland embolization for intracranial meningioma and summarize clinical, radiographic, and safety outcomes.

Methods: A systematic PubMed search was performed from inception through December 2025 in accordance with PRISMA guidelines. Eligible studies included intracranial meningiomas treated with embolization as the primary therapy without planned immediate surgery or radiation. Data on patient characteristics, tumor features, embolic materials, complications, and longitudinal outcomes were extracted and synthesized descriptively.

Results: Twelve studies comprising 30 patients met inclusion criteria. Patients were typically older or high-risk surgical candidates, and tumors were most commonly convexity or parasagittal with predominant external carotid artery supply. The middle meningeal artery was embolized in 27/30 cases. Particles (polyvinyl alcohol or tris-acryl gelatin microspheres) were the most commonly used embolic agents, with multiple studies also reporting liquid embolics. Quantitative volumetric follow-up was available in 18 patients and demonstrated a mean tumor volume reduction of 37% over a mean follow-up of 13 months. Durable symptomatic improvement was reported in all cases with available clinical follow-up. Treatment-related complications included two patients with transient edema, one requiring steroids. Two patients underwent delayed additional tumor-directed therapy.

Conclusions: This review is limited by low-quality evidence of the existing literature. Nevertheless, the evidence suggests that standalone bland embolization appears technically feasible and may provide symptom improvement and moderate tumor control in selected intracranial meningiomas, without precluding subsequent surgery or radiation. These findings provibaseline outcome data, establish a precedent for possible pragmatic trials, and may inform the design and interpretation of future endovascular therapy studies for meningioma.

Background: Sigmoid plate dehiscence (SPD) is a common finding in patients with pulsatile tinnitus (PT). The etiopathogenesis of SPD is controversial; however, increasing evidence suggests that SPD may be due to hemodynamic changes caused by upstream transverse sinus stenosis (TSS).

Objective: We sought to assess the evolution of SPD following transvenous endovascular treatment in patients with PT and SPD.

Materials and methods: We conducted a single-center retrospective cohort study of consecutive patients who underwent transvenous endovascular treatment for PT. Dehiscence was defined as the absence of a normal sigmoid plate overlying the sigmoid sinus, with direct contact of the sinus wall with the mastoid air cells. Regrowth was categorized via consensus by two neuroradiologists, based on the evaluation of the pre- and post-treatment CT images.

Results: Between September 2020 and March 2024, 15 patients met the inclusion criteria. All patients were female and the median age was 42 years (IQR 34.0-47.0). Bilateral SPD was present in 53.3% (8/15). TSS was present in all patients. Bone regrowth of the sigmoid plate was noted in 86.7% (13/15) of patients and occurred most often ipsilateral to the site of endovascular treatment (12/13, 92.3%). There were no significant differences in clinical, radiographic, or procedural characteristics between patients who experienced regrowth and those who did not.

Conclusion: Regrowth of sigmoid plate bone was observed in the majority of patients following endovascular treatment of PT. SPD is probably an acquired lesion, and its presence may not necessitate open surgical repair.

Introduction: 10 randomized controlled trials (RCTs) have compared general anesthesia (GA) with non-GA sedation for endovascular thrombectomy (EVT) in patients with emergent large vessel occlusion (ELVO). We performed an updated meta-analysis of the existing trials.

Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, all RCTs comparing GA versus non-GA during EVT for ELVO published between May 2022 and October 2025 were identified. Two meta-analyses were performed. The primary meta-analysis included all trials, whereas the secondary analysis included only those trials with inclusion criteria similar to those used in the pivotal thrombectomy trials.

Results: 10 RCTs were identified, of which six were included in the secondary analysis. Across all 10 trials, GA significantly increased the odds of successful revascularization compared with non-GA (n=1584; pooled OR 1.79, 95% CI 1.35 to 2.36; P<0.001; I²=0%), but no significant difference was observed in the resulting functional independence of treated patients. In the secondary analysis of six trials, GA was associated with a significant improvement in functional independence (n=648; pooled OR 1.58, 95% CI 1.15 to 2.18; P=0.005; I²=0%), in addition to higher revascularization rates. Mortality at 90 days and hemorrhagic complications did not differ significantly between the groups in either analysis.

Conclusions: GA significantly improved successful revascularization rates in patients undergoing EVT. In RCTs that enrolled patients based on established EVT inclusion criteria, the rate of good functional outcome at 90 days was significantly higher in patients undergoing EVT with GA compared with non-GA.

Prognostication in acute stroke has traditionally centered on clinical and imaging predictors such as stroke severity, infarct volume, and reperfusion status. While indispensable for guiding acute management, these measures explain only part of the variability in recovery and long-term outcomes. Emerging evidence highlights those medical/systemic and socioeconomic determinants-namely cognition, frailty, comorbidity burden, mental health, social support, and financial resources-that play crucial yet often underrecognized roles in shaping stroke outcome and recovery trajectories. This review synthesizes multidisciplinary evidence linking systemic and socioeconomic factors with outcomes across the stroke care continuum. We argue that accurate prognostication must extend beyond anatomical and physiological variables to integrate patient context, capturing vitality, resilience, and social environment. Incorporating these factors into predictive models may enhance individualized care planning, improve trial design, and inform equitable health policy.

Background: Dual antiplatelet therapy (DAPT) is critical for safe flow diversion (FD), yet unlike the extensive coronary literature, FD remains less common and lacks strong evidence to guide DAPT choice. Clopidogrel's variable responsiveness has pushed clinicians towards platelet function testing and more potent agents. In 2023, our institution adopted universal prasugrel-based DAPT, and this study compares outcomes across clopidogrel, ticagrelor, and prasugrel.

Methods: We present a retrospective review of all intracranial aneurysms treated with the Pipeline Embolization Device (PED) between July 2021 and July 2024 using a prospectively maintained database. Primary outcomes were thromboembolic and hemorrhagic complications, occlusion rates, and functional outcomes (modified Rankin Scale (mRS)). Secondary analyses were conducted based on surface modification.

Results: A total of 243 FD procedures were performed in 229 patients (mean age 55.2 years; 84.3% women) treating 265 aneurysms. DAPT regimens included ticagrelor (38.7%), clopidogrel (31.7%), and prasugrel (29.6%). At median 12-month follow-up, 97.8% of patients achieved favorable functional outcomes (mRS ≤2), with no differences between regimens. No significant differences in aneurysm occlusion (complete/near-complete in 86.4%) were found between the DAPT regimens. Thromboembolic (4.1%) and hemorrhagic (4.9%) complications did not differ significantly; notably, all intracranial hemorrhages occurred in ticagrelor-treated patients. Retreatment rates were significantly higher in non-surface-modified versus surface-modified PEDs (8.3% vs 0.9%, P=0.01).

Conclusions: Prasugrel showed comparable safety and occlusion outcomes relative to clopidogrel and ticagrelor. Our findings underscore a critical gap in the evidence base and highlight the urgent need for multicenter registries and prospective trials to establish standardized, data-driven DAPT protocols for intracranial FD.

Introduction: Partially thrombosed intracranial aneurysms (PTIAs) are rare, complex, and have a distinct natural history compared with non-thrombosed aneurysms. PTIAs show increased rates of recurrence despite angiographic intraluminal occlusion following endovascular treatment (EVT). Our single-center experience, along with a systematic review, identifies presenting features, rates of angiographic occlusion, complications, recurrence, and retreatment.

Methods: A single-center retrospective review of consecutive patients with PTIA using imaging-based inclusion criteria was performed. Rates of angiographic occlusion, complications, recurrence, and retreatment were evaluated. In conjunction, a systematic review was conducted in accordance with PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines through PubMed, Scopus, and Google Scholar searches for studies on EVT of PTIA. After pooling patients undergoing EVT, presenting features and rates of occlusion and retreatment were assessed.

Results: Between 2018 and 2023, 22 PTIAs met imaging-based inclusion criteria. Eighteen underwent EVT: four coiling, two stent-assisted coiling, 11 flow diversion (FD), and one FD-assisted coiling. Mass effect was the most common symptom to herald diagnosis (8/18, 44.4%). Of 12 patients with adequate follow-up, 58% had near-complete or complete occlusion, 22% recurred, and 22% were retreated. For the systematic review, a total of 12 retrospective studies were included. In pooled analysis (n=259), including the present series, complete occlusion was achieved in 62%, 80%, 78%, and 100% for coiling±stent, Woven EndoBridge (WEB), FD, and parent vessel occlusion (PVO), respectively. Retreatment occurred in 51%, 54%, 15%, and 3% with coiling±stent, WEB, FD, and PVO, respectively.

Conclusion: PTIAs have a complex pathogenesis, poor natural history, and often undergo retreatment. The results suggest FD to be an increasingly utilized treatment option. Coil±stent and the WEB device appear to have poorer outcomes and higher retreatment rates. If able to tolerate, PVO remains a viable option with high occlusion and low retreatment rates.