Journal of NeuroInterventional Surgery最新文献

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.

Background: We aim to share our experience of transradial access (TRA) for cerebral angiography and intervention in five patients ranging from 6 days to 7 months of age.

Methods: In this institutional review board-approved, retrospective case series, we reviewed all patients who underwent TRA for cerebral angiography with and without intervention. We describe three techniques for radial artery cannulation, namely: (1) bareback; (2) with a micropuncture sheath; and (3) with an intravenous catheter. Demographic, clinical, procedural, and imaging data were abstracted from the patients' medical records.

Results: From September 2019 to August 2023, five patients (median age and weight, 24 days (range 6-218 days) and 4.2 kg (range 3.2-6.2 kg)) underwent TRA for cerebral angiography. Four patients underwent diagnostic cerebral angiography, two via left TRA and two via right TRA. One patient was definitively treated with endovascular embolization for an arteriovenous fistula. Median procedural length was 1.5 hours (range 1-2.2 hours) and median effective skin dose was 88.7 mGy (range 48.8-140.3 mGy). No procedures required conversion to femoral artery access to obtain diagnostic quality imaging or to facilitate intervention. No complications related to the accessed radial artery were recorded.

Conclusions: We have demonstrated that TRA in the neonate and infant is feasible. In our experience this technique is safe and effective for diagnostic cerebral angiography. Additionally, select intervention via TRA in this population may be possible as demonstrated by our single example of endovascular management of an intracranial fistula.

Background: Recent advances in mechanical thrombectomy for large vessel occlusion suggest that cyclical aspiration (CyA) may enhance clot ingestion and reduce embolic complications compared with static aspiration (StA). We aimed to identify the experimental conditions under which CyA outperforms StA.

Methods: A 3D-printed neurovascular model in a flow loop (137/89 mmHg, 72 bpm) simulated middle cerebral artery M1 segment (MCA-M1) occlusions with soft and stiff clot analogs. CyA (4.5 Hz and Δp=85-105 kPa) was performed with a dual-solenoid device coupled to a vacuum pump. Eighty experiments were randomized into four treatment arms combining aspiration patterns and 0.071″ and 0.088″ aspiration catheters: CyA-71, CyA-88, StA-71, and StA-88.

Results: The overall first pass recanalization (FPR) rate was 74% (59/80), with CyA significantly outperforming StA (92% vs 55%, p<0.001). CyA achieved the highest FPR with both 0.088″ and 0.071″ catheters (95% and 90%, respectively), whereas StA-71 achieved 80% and StA-88 30%.Induction of vessel collapse markedly reduced FPR rates (86.2% without collapse vs 20% with collapse, p<0.001). Under StA, collapse was more frequent with larger catheters (StA-088: 70% vs StA-71: 0%, p<0.001), but CyA significantly mitigated this effect (StA-88: 70% vs CyA-88: 5%, p<0.05). No significant differences were found in distal embolization rates.

Conclusions: 0.088″ catheters may be more effective for retrieving clots, except in cases of arterial collapse. CyA improves recanalization rates by reducing the risk of collapse associated with super-large bore catheters. A deeper understanding of catheter sizing and neurovascular anatomy could further optimize outcomes.

Background: Emergent carotid artery stenting (eCAS) is increasingly used in acute stroke due to tandem occlusion. However, the optimal timing for initiating dual antiplatelet therapy (DAPT) remains unknown. We analyze the effectiveness and safety of early versus delayed initiation of DAPT in a cohort of patients with acute stroke treated with eCAS.

Methods: Multicenter registry of patients treated with eCAS from 2019 to 2023. Main outcomes were stent occlusion/restenosis during follow-up, symptomatic intracranial hemorrhage (sICH) after DAPT, and good functional outcome at 3 months (modified Rankin scale (mRS) 0-2). Two timeframes for early DAPT initiation were considered: <12 hours after the procedure, and <24 hours. DAPT beyond 24 hours was considered as reference.

Results: 309 patients were included, 215 males (69.6%), mean (SD) age 67 (12.8) years. DAPT was initiated after eCAS in 270 patients (87.4%), <12 hours in 98 (36.3%), <24 hours in 198 (73.3%), and >24 hours in 72 (26.7%). At 3 months follow-up, stent occlusion/restenosis occurred in 25 patients (12.3%), and sICH after DAPT in 8 patients (3%); 141 (58%) achieved mRS 0-2. Early DAPT did not modify the risk of stent occlusion/restenosis: OR for DAPT <12 hours and DAPT <24 hours: 0.82 (95% CI 0.28 to 2.41) and 0.94 (95% CI 0.37 to 2.40), respectively, or sICH (OR 2.08 (95% CI 0.21 to 20.48) and 2.42 (95% CI 0.29 to 20.03)). Similarly, early DAPT did not improve the likelihood of mRS 0-2 (OR 1.76 (95% CI 0.92 to 3.69) and OR 1.30 (95% CI 0.74 to 2.28)).

Conclusions: In this study, early DAPT initiation following eCAS did not modify the risk of late stent occlusion/restenosis, sICH, or the chance of achieving a good outcome at 3 months.

Background: Bioresorbable flow diverters (BRFDs) may overcome the limitations of permanent flow diverters (FDs). We developed a long period stacking ordered-type magnesium (Mg) alloy with superior strength, processability, and corrosion resistance using rapidly solidified powder metallurgy. Thin Mg wires were coated with poly L-lactic acid (PLLA) by electrospinning to extend bioresorption, and braided into 48 wire Mg-BRFDs.

Methods: We compared mechanical properties, angiographic outcomes, and biological responses of Mg-BRFDs with cobalt-chromium/platinum-tungsten FDs (CoCr-FDs) in a rabbit elastase induced aneurysm model and abdominal aorta. Assessments included angiography, optical coherence tomography, scanning electron microscopy, and histopathology at 0.5, 1, and 3 months.

Results: Mg-BRFDs had a mean strut diameter of 56 µm (including a 10 µm PLLA coating), porosity of 53.9%, and pore density of 23 pores/mm². Complete occlusion rates in CoCr-FDs were 20% (1/5), 0% (0/7), and 57% (4/7) at 0.5, 1, and 3 months, respectively; corresponding rates with Mg-BRFDs were 50% (3/6), 75% (6/8), and 100% (8/8). Among cases with incomplete occlusion, neointimal coverage rate of the aneurysm neck was significantly greater with Mg-BRFDs (median 70.2% vs 26.1%, P=0.006). No occlusion of side branches covered by FDs occurred in either group. Neointimal ionized calcium binding adapter molecule 1 (Iba-1) positive cell counts were higher with Mg-BRFDs but declined over time (P=0.0003).

Conclusions: Mg-BRFDs promoted early neointimal formation during bioresorption, leading to faster and more complete aneurysm occlusion than CoCr-FDs. These findings demonstrate the feasibility of Mg-BRFDs as a promising next generation therapeutic strategy.

Background: Resistant hypertension (RHT) affects 10-30% of hypertensive patients, posing a significant challenge, as it leads to greater cardiovascular comorbidities and mortality. Baroreceptor-based therapies, targeting the autonomic nervous system, represent a novel approach for managing RHT when conventional treatments fail.

Objective: To evaluate the efficacy, safety, and future potential of carotid devices, including Rheos, Barostim Neo, and MobiusHD, in reducing blood pressure (BP) in patients with RHT.

Methods: A PRISMA-guided search of PubMed/Medline, Scopus, and Cochrane databases was conducted to identify studies on carotid baroreceptor devices up to August 2024. Studies were screened for original data on device efficacy and safety, excluding case reports, abstracts, and non-English publications. Data on study design, patient characteristics, and outcomes were extracted and analyzed.

Results: Sixteen studies covering Rheos (n=8), Barostim Neo (n=5), and MobiusHD (n=3) were included. Rheos demonstrated significant BP reductions in phase II and III trials but was associated with procedural complications due to its bilateral design. Barostim Neo, a second-generation device, showed comparable efficacy, with a lower complication rate and better compatibility with cardiac devices. MobiusHD, a mechanical endovascular implant, significantly reduced BP over 3 years of follow-up but exhibited procedural risks, such as transient ischemic attacks.

Conclusion: Carotid devices offer a promising solution for managing RHT, with Barostim Neo emerging as a safer alternative than Rheos. While MobiusHD demonstrates efficacy, further trials are needed to confirm its safety. Additional studies with standardized trial designs and long-term follow-ups will enhance our understanding of the role of carotid-based therapies in hypertension management.

Background: The Silk Vista Baby (SVB) is a low profile flow diverter increasingly used to treat intracranial aneurysms (IAs), especially those in small caliber distal vessels. However, the available evidence remains limited and heterogeneous in terms of design, patient selection, use of adjunctive coiling, and follow-up protocols.

Purpose: To systematically evaluate the safety and efficacy of SVB for IA treatment.

Data sources: PubMed, Scopus, and Web of Science were searched following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)guidelines.

Study selection: Studies were included if they reported ≥5 patients with IAs treated with SVB, and provided clinical and angiographic outcome data.

Data analysis: Efficacy endpoints included adequate/complete occlusion and retreatment rates. Safety outcomes included good functional outcome (modified Rankin Scale score of 0-2), procedure related complications, morbidity, mortality, in-stent stenosis, and covered branch occlusion. Pooled proportions with 95% CIs were calculated using a random effects model.

Results: 14 observational studies (13 retrospective; one prospective) including 653 patients (65.4% women; mean age 55.3±4.4 years) with 673 aneurysms were included. Most aneurysms were unruptured (59.6%). Adequate and complete occlusion at the last follow-up was 82.68% (95% CI 75.52 to 89.85) and 71.39% (95% CI 60.78 to 82.00), respectively. Retreatment occurred in 1.46% (95% CI 0.00 to 3.16). Good functional outcome was reported in 92.90% of cases. Procedure related complications occurred in 9.32%, with 0.53% morbidity and 0.37% mortality. In-stent stenosis occurred in 7.18% of cases. Immediate covered branch occlusion occurred in 5.38% of patients, and covered branch occlusion at follow-up in 17.69%, mostly asymptomatic.

Conclusions: In observational studies, SVB showed favorable angiographic and clinical outcomes for selected distal intracranial aneurysms. However, the available evidence was limited by retrospective study design, substantial heterogeneity, and variable follow-up, and conclusions, particularly in ruptured aneurysms, and should be interpreted with caution pending prospective comparative data.

Trial registration: PROSPERO CRD420251171696.

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;jnis-2025-024628v1/V1F1V1Video 1Cases presentation.

Introduction: The NIMBUS geometric clot extractor was specifically developed for fibrin-rich tough clots that are difficult to remove using standard mechanical thrombectomy (MT) techniques.

Objective: To evaluate the use of NIMBUS in real-world patients with challenging clots and analyze their composition.

Methods: SPERO is a prospective, multicenter, single-arm, observational post-market study that enrolled patients at 11 European sites. Patients presenting with acute ischemic stroke due to large vessel occlusion underwent MT using NIMBUS after one or two failed attempts using another stent retriever or aspiration device. The primary endpoint was successful revascularization (modified Thrombolysis in Cerebral Infarction (mTICI)≥2b) after the final pass of NIMBUS. Additional revascularization, clinical, and clot composition endpoints were collected and assessed by an independent imaging and central clot core lab.

Results: Between October 2019 and February 2022, NIMBUS was used in 54 patients after an average of 1.8 failed MT passes. First pass recanalization (mTICI≥2b) with NIMBUS occurred in 52.9% (27/51) of patients, final NIMBUS pass with mTICI≥2b in 68.6% (35/51), and final procedural mTICI≥2b including all post-NIMBUS rescue maneuvers in 79.2% (42/53). Embolization in new territory was not observed, symptomatic intracerebral hemorrhage occurred in 3.7% (2/54), mortality was 18.5% (10/54), and 90-day mRS score ≤2 was 38.9% (21/54). NIMBUS productivity was higher than as for non-NIMBUS devices, with fibrin content (40.3% vs 29.5%).

Conclusions: In real-world challenging MT cases, NIMBUS demonstrated consistent ability to achieve revascularization in challenging patients for whom 1-2 conventional device passes had failed. Clot composition analysis confirmed that NIMBUS retrieved tougher clots compared with the general stroke population.

Trial registration number: www.

Clinicaltrials: gov Unique identifier: NCT03898960.

Background and purpose: While endovascular therapy (EVT) is established for acute basilar artery occlusion (BAO), the clinical value of remedial angioplasty or stenting (RAS) is debated. This study investigated the efficacy and safety of RAS in patients with BAO undergoing EVT, the etiology dependent outcomes (atherosclerotic vs non-atherosclerotic outcomes), and the comparative effectiveness of balloon angioplasty versus stent based strategies.

Methods: In this post hoc analysis of the prospective ATTENTION (Trial of Endovascular Treatment of Acute Basilar Artery Occlusion) multicenter trial, 221 patients with BAO receiving EVT were grouped into RAS (n=104) versus non-RAS groups (n=117). RAS included balloon angioplasty, stenting, or combined approaches. The primary outcome was 90 day favorable outcome (modified Rankin Scale score 0-3). Safety outcomes included any intracranial hemorrhage (ICH) and symptomatic ICH (sICH) at 24-72 hours, and 90 day mortality. Inverse probability of treatment weighting balanced baseline covariates, followed by multivariate logistic or ordinal regression for outcomes. Prespecified subgroup analyses by stroke etiology included interaction tests using stratified regression.

Results: RAS showed no significant benefit for 90 day favorable outcomes (adjusted OR 0.81, 95% CI 0.55 to 1.19, P=0.282) despite lower ICH rates (OR 0.52, 0.28 to 0.92, P=0.027). RAS was associated with worse outcomes in non-atherosclerotic patients (P=0.003 for stroke etiology × RAS interaction), with no such effect in atherosclerotic cases. Balloon angioplasty alone showed comparable efficacy to stent based interventions (P=0.373).

Conclusion: RAS did not improve functional outcomes in BAO overall and was associated with worse outcomes in non-atherosclerotic patients. Atherosclerotic subgroups may derive nuanced benefit, although further research is needed. Etiology tailored EVT strategies are warranted, with balloon angioplasty as a viable initial remedial option.

Trial registration: ClinicalTrials.gov NCT04751708.