Pub Date : 2025-02-04DOI: 10.1136/jnis-2024-022692
Ryuichi Noda, Vinicius Moreira Lima, Christina Iosif, José Eduardo Vitorino Galon, Faisal Alabbas, Suzana Saleme, Aymeric Rouchaud, Charbel Mounayer
Background: Endovascular transvenous embolization (TVE) was developed as a curative technique for brain arteriovenous malformations (bAVMs) with small nidi and a single draining vein. We describe a partial transvenous embolization technique (pTVE) as an intermediate embolization session to decrease hemorrhagic complications of larger nidi with multiple venous outlets.
Method: We reviewed our single-center database of bAVMs treated endovascularly between January 2023 and March 2024. Six consecutive patients underwent 10 sessions of pTVE for ruptured AVMs.
Results: The median age of patients was 24.5 years. The median nidus size was 5 cm (range 4-6 cm). Three patients had grade III lesions according to the Spetzler-Martin classification, two were grade IV, and one was grade V. Four patients had draining veins with multiple efferent veins with each collecting vein, one patient had multiple efferent veins with one collecting vein, and one patient had one efferent vein with a long bifurcation. pTVE achieved partial occlusion in all cases without any hemorrhagic complications. One patient had the AVM totally occluded with two sessions of pTVE. Decision-making was facilitated by creating subcategories of venous angioarchitecture and detailing the technical particularities in the corresponding category.
Conclusion: We described a novel treatment technique of transvenous embolization as an adjunct strategy for large bAVMs.
{"title":"Partial transvenous embolization as an intermediate strategy for large brain arteriovenous malformations: A technical note.","authors":"Ryuichi Noda, Vinicius Moreira Lima, Christina Iosif, José Eduardo Vitorino Galon, Faisal Alabbas, Suzana Saleme, Aymeric Rouchaud, Charbel Mounayer","doi":"10.1136/jnis-2024-022692","DOIUrl":"https://doi.org/10.1136/jnis-2024-022692","url":null,"abstract":"<p><strong>Background: </strong>Endovascular transvenous embolization (TVE) was developed as a curative technique for brain arteriovenous malformations (bAVMs) with small nidi and a single draining vein. We describe a partial transvenous embolization technique (pTVE) as an intermediate embolization session to decrease hemorrhagic complications of larger nidi with multiple venous outlets.</p><p><strong>Method: </strong>We reviewed our single-center database of bAVMs treated endovascularly between January 2023 and March 2024. Six consecutive patients underwent 10 sessions of pTVE for ruptured AVMs.</p><p><strong>Results: </strong>The median age of patients was 24.5 years. The median nidus size was 5 cm (range 4-6 cm). Three patients had grade III lesions according to the Spetzler-Martin classification, two were grade IV, and one was grade V. Four patients had draining veins with multiple efferent veins with each collecting vein, one patient had multiple efferent veins with one collecting vein, and one patient had one efferent vein with a long bifurcation. pTVE achieved partial occlusion in all cases without any hemorrhagic complications. One patient had the AVM totally occluded with two sessions of pTVE. Decision-making was facilitated by creating subcategories of venous angioarchitecture and detailing the technical particularities in the corresponding category.</p><p><strong>Conclusion: </strong>We described a novel treatment technique of transvenous embolization as an adjunct strategy for large bAVMs.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189589","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 : 2025-02-03DOI: 10.1136/jnis-2024-021759
Haydn Hoffman, Jason J Sims, Violiza Inoa-Acosta, Daniel Hoit, Adam S Arthur, Dan Y Draytsel, YeonSoo Kim, Nitin Goyal
Background: Machine learning (ML) may be superior to traditional methods for clinical outcome prediction. We sought to systematically review the literature on ML for clinical outcome prediction in cerebrovascular and endovascular neurosurgery.
Methods: A comprehensive literature search was performed, and original studies of patients undergoing cerebrovascular surgeries or endovascular procedures that developed a supervised ML model to predict a postoperative outcome or complication were included.
Results: A total of 60 studies predicting 71 outcomes were included. Most cohorts were derived from single institutions (66.7%). The studies included stroke (32), subarachnoid hemorrhage ((SAH) 16), unruptured aneurysm (7), arteriovenous malformation (4), and cavernous malformation (1). Random forest was the best performing model in 12 studies (20%) followed by XGBoost (13.3%). Among 42 studies in which the ML model was compared with a standard statistical model, ML was superior in 33 (78.6%). Of 10 studies in which the ML model was compared with a non-ML clinical prediction model, ML was superior in nine (90%). External validation was performed in 10 studies (16.7%). In studies predicting functional outcome after mechanical thrombectomy the pooled area under the receiver operator characteristics curve (AUROC) of the test set performances was 0.84 (95% CI 0.79 to 0.88). For studies predicting outcomes after SAH, the pooled AUROCs for functional outcomes and delayed cerebral ischemia were 0.89 (95% CI 0.76 to 0.95) and 0.90 (95% CI 0.66 to 0.98), respectively.
Conclusion: ML performs favorably for clinical outcome prediction in cerebrovascular and endovascular neurosurgery. However, multicenter studies with external validation are needed to ensure the generalizability of these findings.
背景:在临床结果预测方面,机器学习(ML)可能优于传统方法。我们试图系统回顾有关脑血管和血管内神经外科临床结果预测的机器学习文献:方法:我们进行了一次全面的文献检索,纳入了针对脑血管手术或血管内手术患者的原始研究,这些研究开发了一个有监督的 ML 模型来预测术后结果或并发症:结果:共纳入了 60 项研究,预测了 71 种结果。大多数队列来自单一机构(66.7%)。这些研究包括中风(32 项)、蛛网膜下腔出血(16 项)、未破裂动脉瘤(7 项)、动静脉畸形(4 项)和海绵畸形(1 项)。在 12 项研究(20%)中,随机森林是表现最好的模型,其次是 XGBoost(13.3%)。在 42 项将 ML 模型与标准统计模型进行比较的研究中,有 33 项(78.6%)研究的 ML 性能更优。在 10 项将 ML 模型与非 ML 临床预测模型进行比较的研究中,有 9 项(90%)研究的 ML 更优。有 10 项研究(16.7%)进行了外部验证。在预测机械性血栓切除术后功能预后的研究中,测试集表现的接收者操作者特征曲线下的集合面积(AUROC)为 0.84(95% CI 0.79 至 0.88)。对于预测 SAH 后预后的研究,功能性预后和延迟性脑缺血的集合 AUROC 分别为 0.89(95% CI 0.76 至 0.95)和 0.90(95% CI 0.66 至 0.98):ML在脑血管和血管内神经外科手术的临床结果预测中表现良好。结论:ML在脑血管和血管内神经外科手术的临床预后预测中表现良好,但需要进行多中心研究和外部验证,以确保这些研究结果的普遍性。
{"title":"Machine learning for clinical outcome prediction in cerebrovascular and endovascular neurosurgery: systematic review and meta-analysis.","authors":"Haydn Hoffman, Jason J Sims, Violiza Inoa-Acosta, Daniel Hoit, Adam S Arthur, Dan Y Draytsel, YeonSoo Kim, Nitin Goyal","doi":"10.1136/jnis-2024-021759","DOIUrl":"10.1136/jnis-2024-021759","url":null,"abstract":"<p><strong>Background: </strong>Machine learning (ML) may be superior to traditional methods for clinical outcome prediction. We sought to systematically review the literature on ML for clinical outcome prediction in cerebrovascular and endovascular neurosurgery.</p><p><strong>Methods: </strong>A comprehensive literature search was performed, and original studies of patients undergoing cerebrovascular surgeries or endovascular procedures that developed a supervised ML model to predict a postoperative outcome or complication were included.</p><p><strong>Results: </strong>A total of 60 studies predicting 71 outcomes were included. Most cohorts were derived from single institutions (66.7%). The studies included stroke (32), subarachnoid hemorrhage ((SAH) 16), unruptured aneurysm (7), arteriovenous malformation (4), and cavernous malformation (1). Random forest was the best performing model in 12 studies (20%) followed by XGBoost (13.3%). Among 42 studies in which the ML model was compared with a standard statistical model, ML was superior in 33 (78.6%). Of 10 studies in which the ML model was compared with a non-ML clinical prediction model, ML was superior in nine (90%). External validation was performed in 10 studies (16.7%). In studies predicting functional outcome after mechanical thrombectomy the pooled area under the receiver operator characteristics curve (AUROC) of the test set performances was 0.84 (95% CI 0.79 to 0.88). For studies predicting outcomes after SAH, the pooled AUROCs for functional outcomes and delayed cerebral ischemia were 0.89 (95% CI 0.76 to 0.95) and 0.90 (95% CI 0.66 to 0.98), respectively.</p><p><strong>Conclusion: </strong>ML performs favorably for clinical outcome prediction in cerebrovascular and endovascular neurosurgery. However, multicenter studies with external validation are needed to ensure the generalizability of these findings.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141076068","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 : 2025-01-31DOI: 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.
{"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":"https://doi.org/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":""},"PeriodicalIF":4.5,"publicationDate":"2025-01-31","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 : 2025-01-31DOI: 10.1136/jnis-2024-022624
Pui Man Rosalind Lai, Elad I Levy
Background: Transient cortical blindness is a rare complication after cerebral angiography. We report an unusual case of face blindness (prosopagnosia) in a patient who underwent diagnostic cerebral angiography for an incidentally discovered left middle cerebral artery aneurysm. The patient experienced difficulty recognizing faces 3 hours postprocedure, with resolution of symptoms within 24 hours.
Objective: To carry out a systematic review of transient cortical blindness after cerebral angiography to investigate factors associated with, and management of, this rare phenomenon.
Methods: The review was conducted using PubMed and Embase, with search terms related to cerebral angiography and transient blindness. Included studies reported transient cortical blindness after diagnostic or interventional cerebral angiography and detailed patient demographics, procedural specifics, onset and resolution of blindness, and postprocedural imaging findings.
Results: Twenty-two articles involving 63 patients were identified. Most cases (n=54, 85.7%) were associated with diagnostic procedures. All nine interventional cases involved cerebral aneurysm treatments. Forty-two (66.7%) patients experienced complete blindness, with an average onset of 2 hours postprocedure and resolution within 82 hours (range 6 hours-21 days). Postprocedural neuroimaging abnormalities were observed in 24 (53.3%) cases, mainly showing contrast enhancement in the occipital lobe. All patients recovered vision.
Conclusions: Our review highlights the rarity of prosopagnosia after cerebral angiography, a rare variant of cortical blindness. The findings suggest that cortical blindness resolves spontaneously within a short period. Although complete visual loss is more commonly reported in the literature, facial recognition deficits are rare. Awareness of transient cortical blindness after cerebral angiography is essential for accurate diagnosis and management.
{"title":"Illustrative case of prosopagnosia after diagnostic cerebral angiography and systematic review of transient cortical blindness after cerebral angiography.","authors":"Pui Man Rosalind Lai, Elad I Levy","doi":"10.1136/jnis-2024-022624","DOIUrl":"https://doi.org/10.1136/jnis-2024-022624","url":null,"abstract":"<p><strong>Background: </strong>Transient cortical blindness is a rare complication after cerebral angiography. We report an unusual case of face blindness (prosopagnosia) in a patient who underwent diagnostic cerebral angiography for an incidentally discovered left middle cerebral artery aneurysm. The patient experienced difficulty recognizing faces 3 hours postprocedure, with resolution of symptoms within 24 hours.</p><p><strong>Objective: </strong>To carry out a systematic review of transient cortical blindness after cerebral angiography to investigate factors associated with, and management of, this rare phenomenon.</p><p><strong>Methods: </strong>The review was conducted using PubMed and Embase, with search terms related to cerebral angiography and transient blindness. Included studies reported transient cortical blindness after diagnostic or interventional cerebral angiography and detailed patient demographics, procedural specifics, onset and resolution of blindness, and postprocedural imaging findings.</p><p><strong>Results: </strong>Twenty-two articles involving 63 patients were identified. Most cases (n=54, 85.7%) were associated with diagnostic procedures. All nine interventional cases involved cerebral aneurysm treatments. Forty-two (66.7%) patients experienced complete blindness, with an average onset of 2 hours postprocedure and resolution within 82 hours (range 6 hours-21 days). Postprocedural neuroimaging abnormalities were observed in 24 (53.3%) cases, mainly showing contrast enhancement in the occipital lobe. All patients recovered vision.</p><p><strong>Conclusions: </strong>Our review highlights the rarity of prosopagnosia after cerebral angiography, a rare variant of cortical blindness. The findings suggest that cortical blindness resolves spontaneously within a short period. Although complete visual loss is more commonly reported in the literature, facial recognition deficits are rare. Awareness of transient cortical blindness after cerebral angiography is essential for accurate diagnosis and management.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074732","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 : 2025-01-30DOI: 10.1136/jnis-2024-022795
Mahmoud H Mohammaden, Pedro N Martins, Hassan Aboul-Nour, Alhamza R Al-Bayati, Ameer E Hassan, Wondwossen Tekle, Johanna T Fifi, Shahram Majidi, Okkes Kuybu, Bradley A Gross, Michael Lang, Gustavo M Cortez, Ricardo A Hanel, Amin Aghaebrahim, Eric Sauvageau, Mohamed A Tarek, Mudassir Farooqui, Santiago Ortega-Gutierrez, Cynthia B Zevallos, Milagros Galecio-Castillo, Sunil A Sheth, Michael Nahhas, Sergio Salazar-Marioni, Thanh N Nguyen, Mohamad Abdalkader, Piers Klein, Muhammad Hafeez, Peter Kan, Omar Tanweer, Ahmad Khaldi, Hanzhou Li, Mouhammad Jumaa, Syed F Zaidi, Marion Oliver, Mohamed M Salem, Jan-Karl Burkhardt, Bryan Pukenas, Nicholas Vigilante, Mary Penckofer, James E Siegler, Sophia Peng, Ali Alaraj, Jonathan A Grossberg, Raul Nogueira, Diogo C Haussen
Background: Previous studies have shown that when thrombectomy has failed, rescue intracranial stenting is associated with better clinical outcomes compared with failed reperfusion. However, comparative data regarding stent type are lacking.
Objective: To compare the procedural and clinical outcomes of balloon-mounted stents (BMS) with those of self-expandable stents (SES).
Methods: Retrospective analysis of a prospectively collected database from the Stenting and Angioplasty in NeuroThrombectomy (SAINT) consortium. Patients were included if thrombectomy had failed and they then underwent rescue emergency stenting. Patients treated with SES or BMS were compared using inverse probability of treatment weighting. The primary outcome was the final reperfusion as measured by the modified Thrombolysis in Cerebral Infarction (mTICI) Scale. Safety measures included rates of symptomatic intracranial hemorrhage, procedural complications, and 90-day mortality.
Results: A total of 328 patients were included. Baseline clinical and procedural characteristics were well balanced among both groups. The BMS group (n=127) had higher rates of successful reperfusion (94.5% vs 86.6%, aOR=4.23, 95% CI 1.57 to 11.37, P=0.004) and increased likelihood of higher degree of final reperfusion on the mTICI Scale (acOR=2.06, 95% CI 1.19 to 3.57, P=0.01) than the SES group (n=201). No difference in modified Rankin Scale shift (acOR=0.98, 95% CI 0.54 to 1.79, P=0.95), rates of mRS0-2 (26% vs 36%, aOR=0.93, 95% CI 0.46 to 1.88, P=0.83) and mRS0-3 (43% vs 50%, aOR=0.92, 95% CI 0.51 to 1.66, P=0.77) at 90 days were noted. Safety measures were comparable in both groups.
Conclusion: The present study demonstrates higher reperfusion rates with BMS than with SES in failed thrombectomy procedures that involved rescue stenting. No differences in hemorrhagic complications or clinical outcomes were noted. Further larger controlled studies are warranted.
{"title":"Balloon-mounted versus self-expandable stent in failed neurothrombectomy: a post hoc analysis of the SAINT study.","authors":"Mahmoud H Mohammaden, Pedro N Martins, Hassan Aboul-Nour, Alhamza R Al-Bayati, Ameer E Hassan, Wondwossen Tekle, Johanna T Fifi, Shahram Majidi, Okkes Kuybu, Bradley A Gross, Michael Lang, Gustavo M Cortez, Ricardo A Hanel, Amin Aghaebrahim, Eric Sauvageau, Mohamed A Tarek, Mudassir Farooqui, Santiago Ortega-Gutierrez, Cynthia B Zevallos, Milagros Galecio-Castillo, Sunil A Sheth, Michael Nahhas, Sergio Salazar-Marioni, Thanh N Nguyen, Mohamad Abdalkader, Piers Klein, Muhammad Hafeez, Peter Kan, Omar Tanweer, Ahmad Khaldi, Hanzhou Li, Mouhammad Jumaa, Syed F Zaidi, Marion Oliver, Mohamed M Salem, Jan-Karl Burkhardt, Bryan Pukenas, Nicholas Vigilante, Mary Penckofer, James E Siegler, Sophia Peng, Ali Alaraj, Jonathan A Grossberg, Raul Nogueira, Diogo C Haussen","doi":"10.1136/jnis-2024-022795","DOIUrl":"https://doi.org/10.1136/jnis-2024-022795","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have shown that when thrombectomy has failed, rescue intracranial stenting is associated with better clinical outcomes compared with failed reperfusion. However, comparative data regarding stent type are lacking.</p><p><strong>Objective: </strong>To compare the procedural and clinical outcomes of balloon-mounted stents (BMS) with those of self-expandable stents (SES).</p><p><strong>Methods: </strong>Retrospective analysis of a prospectively collected database from the Stenting and Angioplasty in NeuroThrombectomy (SAINT) consortium. Patients were included if thrombectomy had failed and they then underwent rescue emergency stenting. Patients treated with SES or BMS were compared using inverse probability of treatment weighting. The primary outcome was the final reperfusion as measured by the modified Thrombolysis in Cerebral Infarction (mTICI) Scale. Safety measures included rates of symptomatic intracranial hemorrhage, procedural complications, and 90-day mortality.</p><p><strong>Results: </strong>A total of 328 patients were included. Baseline clinical and procedural characteristics were well balanced among both groups. The BMS group (n=127) had higher rates of successful reperfusion (94.5% vs 86.6%, aOR=4.23, 95% CI 1.57 to 11.37, P=0.004) and increased likelihood of higher degree of final reperfusion on the mTICI Scale (acOR=2.06, 95% CI 1.19 to 3.57, P=0.01) than the SES group (n=201). No difference in modified Rankin Scale shift (acOR=0.98, 95% CI 0.54 to 1.79, P=0.95), rates of mRS0-2 (26% vs 36%, aOR=0.93, 95% CI 0.46 to 1.88, P=0.83) and mRS0-3 (43% vs 50%, aOR=0.92, 95% CI 0.51 to 1.66, P=0.77) at 90 days were noted. Safety measures were comparable in both groups.</p><p><strong>Conclusion: </strong>The present study demonstrates higher reperfusion rates with BMS than with SES in failed thrombectomy procedures that involved rescue stenting. No differences in hemorrhagic complications or clinical outcomes were noted. Further larger controlled studies are warranted.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066167","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 : 2025-01-30DOI: 10.1136/jnis-2024-022781
Mohamad Ezzeldin, Mishaal Hukamdad, Rahim Abo Kasem, Rime Ezzeldin, Ilko Maier, Ansaar T Rai, Pascal Jabbour, Joon-Tae Kim, Brian M Howard, Ali Alawieh, Stacey Q Wolfe, Robert M Starke, Marios-Nikos Psychogios, Amir Shaban, Nitin Goyal, Justin Dye, Ali Alaraj, Shinichi Yoshimura, David Fiorella, Omar Tanweer, Daniele G Romano, Pedro Navia, Hugo Cuellar, Isabel Fragata, Adam Polifka, Justin R Mascitelli, Joshua W Osbun, Fazeel Siddiqui, Mark Moss, Kaustubh Limaye, Maxim Mokin, Charles Matouk, Min S Park, Waleed Brinjikji, Ergun Daglioglu, Richard Williamson, David J Altschul, Christopher S Ogilvy, Roberto Javier Crosa, Michael R Levitt, Benjamin Gory, Ramesh Grandhi, Alexandra R Paul, Peter Kan, Walter Casagrande, Shakeel A Chowdhry, Michael F Stiefel, Varun Chaubal, Alejandro M Spiotta
Background: The contact aspiration (CA) technique is often used to perform endovascular thrombectomy (EVT) for acute ischemic stroke (AIS); however, rescue strategies are necessary if CA fails to achieve recanalization. This study investigates the outcomes of incorporating stent retriever (SR) thrombectomy in the rescue strategy following failed CA.
Methods: EVT patients with failed CA attempts were identified from a large multicenter registry and stratified by rescue technique: CA alone or incorporating SR in the rescue strategy. Outcomes included successful recanalization, 90-day functional outcomes (defined by the modified Rankin Scale (mRS) score), symptomatic intracranial hemorrhage (sICH), and 90-day mortality.
Results: Among 1885 patients with failed CA attempts, conversion to SR was associated with higher recanalization rates (85.2% vs 80.6%; p=0.03), higher rates of second-pass recanalization (31.2% vs 23.4%; p<0.001), and better 90-day outcomes (mRS 0-2: 35.2% vs 29.9%; p=0.04) when compared with repeated CA attempts. Trevo SRs showed higher odds of successful recanalization (adjusted odds ratio (aOR)=1.9; p=0.02), second-pass recanalization (aOR=1.7; p=0.01), and reduced odds of sICH (aOR=0.3; p=0.02). EmboTrap SRs were associated with higher odds of 90-day mortality (aOR=2.6; p=0.004) and sICH (aOR=2.9; p=0.04) and lower odds of recanalization (aOR=0.5; p=0.03).
Conclusions: Incorporating SR in the rescue strategy after a failed CA improves recanalization rates and functional outcomes. Trevo SRs demonstrated superior efficacy and safety when incorporated into the rescue strategy.
{"title":"Comparative efficacy and safety of stent retrievers as a bailout strategy following failed contact aspiration technique in acute stroke thrombectomy.","authors":"Mohamad Ezzeldin, Mishaal Hukamdad, Rahim Abo Kasem, Rime Ezzeldin, Ilko Maier, Ansaar T Rai, Pascal Jabbour, Joon-Tae Kim, Brian M Howard, Ali Alawieh, Stacey Q Wolfe, Robert M Starke, Marios-Nikos Psychogios, Amir Shaban, Nitin Goyal, Justin Dye, Ali Alaraj, Shinichi Yoshimura, David Fiorella, Omar Tanweer, Daniele G Romano, Pedro Navia, Hugo Cuellar, Isabel Fragata, Adam Polifka, Justin R Mascitelli, Joshua W Osbun, Fazeel Siddiqui, Mark Moss, Kaustubh Limaye, Maxim Mokin, Charles Matouk, Min S Park, Waleed Brinjikji, Ergun Daglioglu, Richard Williamson, David J Altschul, Christopher S Ogilvy, Roberto Javier Crosa, Michael R Levitt, Benjamin Gory, Ramesh Grandhi, Alexandra R Paul, Peter Kan, Walter Casagrande, Shakeel A Chowdhry, Michael F Stiefel, Varun Chaubal, Alejandro M Spiotta","doi":"10.1136/jnis-2024-022781","DOIUrl":"https://doi.org/10.1136/jnis-2024-022781","url":null,"abstract":"<p><strong>Background: </strong>The contact aspiration (CA) technique is often used to perform endovascular thrombectomy (EVT) for acute ischemic stroke (AIS); however, rescue strategies are necessary if CA fails to achieve recanalization. This study investigates the outcomes of incorporating stent retriever (SR) thrombectomy in the rescue strategy following failed CA.</p><p><strong>Methods: </strong>EVT patients with failed CA attempts were identified from a large multicenter registry and stratified by rescue technique: CA alone or incorporating SR in the rescue strategy. Outcomes included successful recanalization, 90-day functional outcomes (defined by the modified Rankin Scale (mRS) score), symptomatic intracranial hemorrhage (sICH), and 90-day mortality.</p><p><strong>Results: </strong>Among 1885 patients with failed CA attempts, conversion to SR was associated with higher recanalization rates (85.2% vs 80.6%; p=0.03), higher rates of second-pass recanalization (31.2% vs 23.4%; p<0.001), and better 90-day outcomes (mRS 0-2: 35.2% vs 29.9%; p=0.04) when compared with repeated CA attempts. Trevo SRs showed higher odds of successful recanalization (adjusted odds ratio (aOR)=1.9; p=0.02), second-pass recanalization (aOR=1.7; p=0.01), and reduced odds of sICH (aOR=0.3; p=0.02). EmboTrap SRs were associated with higher odds of 90-day mortality (aOR=2.6; p=0.004) and sICH (aOR=2.9; p=0.04) and lower odds of recanalization (aOR=0.5; p=0.03).</p><p><strong>Conclusions: </strong>Incorporating SR in the rescue strategy after a failed CA improves recanalization rates and functional outcomes. Trevo SRs demonstrated superior efficacy and safety when incorporated into the rescue strategy.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066184","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 : 2025-01-29DOI: 10.1136/jnis-2024-022988
Ahmed Alkhiri, Hatoon Alshaikh, Mohammed S Alqahtani, Shatha Alqurashi, Manar M Alsharif, Ahmad M Bukhari, Rawan M AlWadee, Abdulrahman A Alreshaid, Magdy Selim, Eman Alrajhi, Fahad S Al-Ajlan, Adel Alhazzani
Background: The periprocedural management of antithrombotic medications in patients with chronic subdural hematoma (cSDH) after middle meningeal artery embolization (MMAE) or surgical evacuation is uncertain.
Methods: A systematic review was conducted across Medline, Embase, and Web of Science databases. We pooled proportions and risk ratios (RRs) for the meta-analysis with the corresponding 95% CIs. Systemic and intracranial (including recurrence) bleeding complications and thromboembolic events were evaluated.
Results: Of the 16 included studies with 4606 patients, 1784 were receiving antithrombotic medications. Antithrombotic therapy was resumed in 1231 patients (69.0%). Bleeding complications were similar between patients in whom antithrombotic therapy was resumed (14.1%, 95% CI 9.7% to 20.2%) and in those in whom it was discontinued (15.4%, 95% CI 7.4% to 29.3%). After MMAE, patients had similar rates of bleeding events (12.1%, 95% CI 4.9% to 27.0%) to patients with overall treated cSDH, and recurrence (RR 2.28, 95% CI 0.46 to 11.37) and reoperation (RR 1.07, 95% CI 0.40 to 2.917) risks were similar between the resumed and discontinued groups. Thromboembolic complications were significantly higher in the discontinued group (12.6%, 95% CI 6.5% to 23.0%) than in the resumption group (3.5%, 95% CI 1.8% to 6.9%). Earlier resumption (1 week to 1 month) was associated with a lower thromboembolic risk without increasing bleeding complications.
Conclusions: Post-procedural antithrombotic resumption may reduce thromboembolic events without significantly increasing bleeding risk. Early resumption of antithrombotics post-MMAE appears to be safe, although further data are required to confirm this observation. Future studies should aim to better define patient characteristics influencing decision-making in this context.
{"title":"Antithrombotic resumption after middle meningeal artery embolization or surgery for chronic subdural hematoma: a systematic review and meta-analysis.","authors":"Ahmed Alkhiri, Hatoon Alshaikh, Mohammed S Alqahtani, Shatha Alqurashi, Manar M Alsharif, Ahmad M Bukhari, Rawan M AlWadee, Abdulrahman A Alreshaid, Magdy Selim, Eman Alrajhi, Fahad S Al-Ajlan, Adel Alhazzani","doi":"10.1136/jnis-2024-022988","DOIUrl":"https://doi.org/10.1136/jnis-2024-022988","url":null,"abstract":"<p><strong>Background: </strong>The periprocedural management of antithrombotic medications in patients with chronic subdural hematoma (cSDH) after middle meningeal artery embolization (MMAE) or surgical evacuation is uncertain.</p><p><strong>Methods: </strong>A systematic review was conducted across Medline, Embase, and Web of Science databases. We pooled proportions and risk ratios (RRs) for the meta-analysis with the corresponding 95% CIs. Systemic and intracranial (including recurrence) bleeding complications and thromboembolic events were evaluated.</p><p><strong>Results: </strong>Of the 16 included studies with 4606 patients, 1784 were receiving antithrombotic medications. Antithrombotic therapy was resumed in 1231 patients (69.0%). Bleeding complications were similar between patients in whom antithrombotic therapy was resumed (14.1%, 95% CI 9.7% to 20.2%) and in those in whom it was discontinued (15.4%, 95% CI 7.4% to 29.3%). After MMAE, patients had similar rates of bleeding events (12.1%, 95% CI 4.9% to 27.0%) to patients with overall treated cSDH, and recurrence (RR 2.28, 95% CI 0.46 to 11.37) and reoperation (RR 1.07, 95% CI 0.40 to 2.917) risks were similar between the resumed and discontinued groups. Thromboembolic complications were significantly higher in the discontinued group (12.6%, 95% CI 6.5% to 23.0%) than in the resumption group (3.5%, 95% CI 1.8% to 6.9%). Earlier resumption (1 week to 1 month) was associated with a lower thromboembolic risk without increasing bleeding complications.</p><p><strong>Conclusions: </strong>Post-procedural antithrombotic resumption may reduce thromboembolic events without significantly increasing bleeding risk. Early resumption of antithrombotics post-MMAE appears to be safe, although further data are required to confirm this observation. Future studies should aim to better define patient characteristics influencing decision-making in this context.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066166","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 : 2025-01-29DOI: 10.1136/jnis-2025-023050
Kazim H Narsinh, Christopher Young, Stephen R Chen, Sameer A Ansari, Peter Kan, Steven W Hetts
{"title":"Neurointerventional oncology: the new frontier.","authors":"Kazim H Narsinh, Christopher Young, Stephen R Chen, Sameer A Ansari, Peter Kan, Steven W Hetts","doi":"10.1136/jnis-2025-023050","DOIUrl":"https://doi.org/10.1136/jnis-2025-023050","url":null,"abstract":"","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066186","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 : 2025-01-29DOI: 10.1136/jnis-2024-022576
Sophia Hohenstatt, Vincent Costalat, Cyril Dargazanli, Monika Killer-Oberpfalzer, Barbara Schreiber, Riitta Rautio, Matias Sinisalo, Saleh Lamin, Han Seng Chew, Laurent Spelle, Alejandro Tomasello, Tufail Patankar, Mariangela Piano, Jens Fiehler, Markus A Möhlenbruch
Background: Intrasaccular devices have broadened treatment options for wide necked aneurysms. This study presents the preliminary experience with the Artisse 2.0 device.
Methods: Innovative NeurovaScular Product SurveIllance REgistry (INSPIRE) is a non-randomized, multicenter, real world clinical study with treatment arms for aneurysms (INSPIRE-A) and acute ischemic stroke (INSPIRE-S). This interim analysis included 87 patients enrolled from November 2022 to April 2024 in the INSPIRE-A Artisse cohort across 16 Europoean centers. Procedures followed standard clinical care, with 6 months of follow-up. Safety and efficacy endpoints included major stroke, neurological death, serious adverse events (SAEs), aneurysm occlusion, and retreatment rates. An independent core laboratory assessed imaging, and all SAEs were reviewed by a clinical events committee. The Artisse steering committee provided independent oversight of the data.
Results: The Artisse device achieved an overall successful implantation rate of 96.6% (84/87), with satisfactory placement rates of 98.7% (74/75) for unruptured and 88.9% (8/9) for ruptured aneurysms. Following the procedure, 46.2% of unruptured aneurysm patients were receiving antiplatelet therapy (APT), predominantly aspirin monotherapy, while no ruptured aneurysm patients received APT. Device related SAE rate was 1.3% (1/87), and the overall stroke rate was 2.3% (2/87), including both ruptured and unruptured aneurysms. At 6 months, 80.0% (28/35) of patients with unruptured aneurysms showed complete obliteration, with no recurrences or retreatments.
Conclusions: Preliminary experience with the Artisse 2.0 device demonstrated high technical success, favorable safety, and efficacy in aneurysm obliteration at 6 months. Larger studies with longer follow-up periods are needed to confirm these findings.
{"title":"New Artisse intrasaccular device for intracranial aneurysm treatment: short term clinical and angiographic result from the prospective registry INSPIRE-A.","authors":"Sophia Hohenstatt, Vincent Costalat, Cyril Dargazanli, Monika Killer-Oberpfalzer, Barbara Schreiber, Riitta Rautio, Matias Sinisalo, Saleh Lamin, Han Seng Chew, Laurent Spelle, Alejandro Tomasello, Tufail Patankar, Mariangela Piano, Jens Fiehler, Markus A Möhlenbruch","doi":"10.1136/jnis-2024-022576","DOIUrl":"https://doi.org/10.1136/jnis-2024-022576","url":null,"abstract":"<p><strong>Background: </strong>Intrasaccular devices have broadened treatment options for wide necked aneurysms. This study presents the preliminary experience with the Artisse 2.0 device.</p><p><strong>Methods: </strong>Innovative NeurovaScular Product SurveIllance REgistry (INSPIRE) is a non-randomized, multicenter, real world clinical study with treatment arms for aneurysms (INSPIRE-A) and acute ischemic stroke (INSPIRE-S). This interim analysis included 87 patients enrolled from November 2022 to April 2024 in the INSPIRE-A Artisse cohort across 16 Europoean centers. Procedures followed standard clinical care, with 6 months of follow-up. Safety and efficacy endpoints included major stroke, neurological death, serious adverse events (SAEs), aneurysm occlusion, and retreatment rates. An independent core laboratory assessed imaging, and all SAEs were reviewed by a clinical events committee. The Artisse steering committee provided independent oversight of the data.</p><p><strong>Results: </strong>The Artisse device achieved an overall successful implantation rate of 96.6% (84/87), with satisfactory placement rates of 98.7% (74/75) for unruptured and 88.9% (8/9) for ruptured aneurysms. Following the procedure, 46.2% of unruptured aneurysm patients were receiving antiplatelet therapy (APT), predominantly aspirin monotherapy, while no ruptured aneurysm patients received APT. Device related SAE rate was 1.3% (1/87), and the overall stroke rate was 2.3% (2/87), including both ruptured and unruptured aneurysms. At 6 months, 80.0% (28/35) of patients with unruptured aneurysms showed complete obliteration, with no recurrences or retreatments.</p><p><strong>Conclusions: </strong>Preliminary experience with the Artisse 2.0 device demonstrated high technical success, favorable safety, and efficacy in aneurysm obliteration at 6 months. Larger studies with longer follow-up periods are needed to confirm these findings.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066233","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 : 2025-01-27DOI: 10.1136/jnis-2024-022374
Huanwen Chen, Marco Colasurdo, Mihir Khunte, Ajay Malhotra, Dheeraj Gandhi
Background: The safety and efficacy of endovascular thrombectomy (EVT) for large vessel occlusion (LVO) strokes associated with infective endocarditis (IE) compared with medical management (MM) is unclear.
Methods: In this nationwide analysis of hospitalizations in the United States, we assessed the outcomes of EVT versus medical management (MM) for patients with LVO and IE. Primary outcome was routine home discharge with self-care. Secondary outcomes include home discharge, in-hospital mortality, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). Propensity score matching (PSM) was performed to adjust for confounders. Additional multivariable adjustments were performed for doubly robust analyses.
Results: 2574 patients were identified; 656 (25.5%) received EVT. After PSM, the rate of routine discharge was significantly higher for patients with EVT compared with MM (14.6% vs 8.5%, p=0.021), and patients with EVT had significantly higher rate of home discharge (34.5% vs 26.5%, p=0.041), lower rate of in-hospital death (14.8% vs 25.2%, p=0.002), and lower rate of ICH (15.8% vs 23.1%, p=0.039). EVT was not associated with a different rate of SAH compared with MM (11.2% vs 7.9%, p=0.17). These associations remained unchanged with additional multivariable adjustments.
Conclusion: For patients with LVO stroke and IE, EVT was associated with significantly higher odds of favorable hospitalization outcomes and lower odds of ICH compared with MM.
背景:与药物治疗(MM)相比,血管内血栓切除术(EVT)治疗伴有感染性心内膜炎(IE)的大血管闭塞(LVO)脑卒中的安全性和有效性尚不明确:在这项对美国住院患者进行的全国性分析中,我们评估了 EVT 与药物治疗 (MM) 对 LVO 和 IE 患者的治疗效果。主要结果是常规出院回家自我护理。次要结果包括出院回家、院内死亡率、脑出血(ICH)和蛛网膜下腔出血(SAH)。进行倾向评分匹配(PSM)以调整混杂因素。结果:共确定了 2574 例患者,其中 656 例(25.5%)接受了 EVT。PSM后,与MM相比,EVT患者的常规出院率明显更高(14.6% vs 8.5%,P=0.021),EVT患者的家庭出院率明显更高(34.5% vs 26.5%,P=0.041),院内死亡率更低(14.8% vs 25.2%,P=0.002),ICH率更低(15.8% vs 23.1%,P=0.039)。与MM相比,EVT与SAH发生率无关(11.2% vs 7.9%,P=0.17)。这些关联在进行额外的多变量调整后保持不变:结论:对于 LVO 脑卒中和 IE 患者,与 MM 相比,EVT 与较高的住院预后良好几率和较低的 ICH 几率相关。
{"title":"Endovascular thrombectomy versus medical management for patients with large vessel stroke and infective endocarditis.","authors":"Huanwen Chen, Marco Colasurdo, Mihir Khunte, Ajay Malhotra, Dheeraj Gandhi","doi":"10.1136/jnis-2024-022374","DOIUrl":"10.1136/jnis-2024-022374","url":null,"abstract":"<p><strong>Background: </strong>The safety and efficacy of endovascular thrombectomy (EVT) for large vessel occlusion (LVO) strokes associated with infective endocarditis (IE) compared with medical management (MM) is unclear.</p><p><strong>Methods: </strong>In this nationwide analysis of hospitalizations in the United States, we assessed the outcomes of EVT versus medical management (MM) for patients with LVO and IE. Primary outcome was routine home discharge with self-care. Secondary outcomes include home discharge, in-hospital mortality, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). Propensity score matching (PSM) was performed to adjust for confounders. Additional multivariable adjustments were performed for doubly robust analyses.</p><p><strong>Results: </strong>2574 patients were identified; 656 (25.5%) received EVT. After PSM, the rate of routine discharge was significantly higher for patients with EVT compared with MM (14.6% vs 8.5%, p=0.021), and patients with EVT had significantly higher rate of home discharge (34.5% vs 26.5%, p=0.041), lower rate of in-hospital death (14.8% vs 25.2%, p=0.002), and lower rate of ICH (15.8% vs 23.1%, p=0.039). EVT was not associated with a different rate of SAH compared with MM (11.2% vs 7.9%, p=0.17). These associations remained unchanged with additional multivariable adjustments.</p><p><strong>Conclusion: </strong>For patients with LVO stroke and IE, EVT was associated with significantly higher odds of favorable hospitalization outcomes and lower odds of ICH compared with MM.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348451","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}