Journal of NeuroInterventional Surgery最新文献

Background: Fear of disease progression (FoP) is a common psychological concern among patients with unruptured intracranial aneurysms (UIAs). However, heterogeneity in FoP and the role of psychological resilience before treatment remain insufficiently understood.

Methods: In this cross-sectional study, patients with UIAs scheduled for endovascular treatment were recruited. FoP was assessed using the Fear of Progression Questionnaire-Short Form (FoP-Q-12), and psychological resilience was measured with the Connor-Davidson Resilience Scale (CD-RISC-25). Latent profile analysis (LPA) was conducted to identify distinct FoP profiles. Least Absolute Shrinkage and Selection Operator (LASSO) regression followed by multinomial logistic regression were used to examine factors associated with profile membership.

Results: Five distinct FoP profiles were identified: Minimal Fear-Good Adjustment, Mild Emotionally Elevated Fear, Moderate Emotionally Reactive Fear, Moderate Functionally Concerned Fear, and High Pervasive Fear. Multinomial logistic regression showed that higher psychological resilience-particularly the tenacity dimension-was associated with lower odds of belonging to the Mild Emotionally Elevated Fear, Moderate Emotionally Reactive Fear, and Moderate Functionally Concerned Fear profiles, compared with the Minimal Fear-Good Adjustment profile. No significant association was observed between tenacity and the High Pervasive Fear profile. Sensitivity analyses using alternative resilience indicators yielded consistent results.

Conclusion: Among patients with UIAs prior to endovascular treatment, FoP exhibits marked heterogeneity. Psychological resilience, especially tenacity, is differentially associated with specific FoP profiles. These findings support the value of profile-based psychological assessment to inform targeted psychosocial support during treatment planning.

Introduction: Idiopathic intracranial hypertension (IIH) is characterized by elevated intracranial pressure, papilledema, and neurological symptoms. When medical management fails, treatment options include venous sinus stenting (VSS) and ventriculoperitoneal shunting (VPS). Comparative data on cost effectiveness remain limited. We aimed to compare clinical outcomes, healthcare utilization, and costs between VSS and VPS in patients with IIH using a propensity score weighted analysis.

Methods: This was a retrospective single center study. Baseline characteristics, complications, reoperations, unplanned 30 day emergency department visits and readmissions, unsatisfactory treatment response, salvage procedures, and inflation adjusted index procedure costs were collected. Propensity score weighting with overlap weights was applied to balance covariates. Weighted regression analyses were used to compare outcomes between groups.

Results: 139 patients were treated with VSS (n=99) or VPS (n=40). Baseline characteristics were well balanced after overlap weighting. Inflation adjusted index procedure costs and length of stay were similar between the VSS and VPS groups. VSS was associated with significantly lower rates of any complication (3.5% vs 37.7%, P<0.001), unplanned 30 day emergency department visits (11.1% vs 36.6%, P=0.002), 30 day readmissions (1.3% vs 33%, P<0.001), and reoperations, including revisions and surgically treated complications (1.3% vs 30.9%, P<0.001). There were no significant differences in unsatisfactory treatment response, need for salvage procedures, or overall subsequent procedures.

Conclusions: While initial costs and clinical outcomes were similar, VPS was associated with higher complication rates, more revision related reoperations, and greater short term healthcare utilization. These findings suggest that VSS may provide a safer and more cost effective approach for patients with IIH who have failed medical therapy.

Background: Stent-assisted coiling (SAC) is an effective, safe, and durable treatment option when considering embolizing wide neck aneurysms. While there are many techniques, the two most common involve jailing a microcatheter behind the stent versus re-crossing the interstices. Despite both techniques being performed in practice, there is a lack of comparison data. This study uses the ATLAS Investigational Device Exemption trial to compare the safety and efficacy of various SAC techniques.

Methods: A total of 298 aneurysms in as many patients were treated in 25 centers with Neuroform Atlas SAC. Technique choice was determined by the operator and involved jailing, re-crossing, or others (jailing followed by re-crossing, stenting followed by re-crossing at a different time). Patient demographics, aneurysm shape, dimension, and location, as well as the number of coils and procedure duration, were analyzed. Procedure and device complications of the different techniques were recorded. Efficacy was evaluated with a core-lab adjudicated 12-month digital subtraction angiography (DSA).

Results: Similar aneurysm size and location were observed between the two groups (jailing and re-crossing). There was no significant difference in the number of coils used or the duration of the procedure. There was no significant difference in Raymond-Roy I occlusion rate (89.4% vs 83.9%) at the 12-month DSA or safety events at 12 months.

Conclusion: There were no significant differences in safety or efficacy for SAC between the jailing or re-crossing technique.

Background: Thrombus migration (TM) is more common after intravenous thrombolysis (IVT) with tenecteplase (TNK) compared with alteplase. We aimed to determine TM impact over endovascular thrombectomy (EVT) results in patients undergoing TNK-IVT for acute ischemic stroke.

Methods: We retrospectively included all patients with large vessel occlusion of the anterior circulation, treated with TNK-IVT and eligible for EVT between January 2015 and February 2021, from a large observational TNK registry (Tenecteplase Treatment in Ischemic Stroke-TETRIS). TM was defined by a distal shift of the occlusion site between initial non-invasive imaging and digital subtraction angiography (DSA) before endovascular thrombectomy. We compared angiographic (revised Treatment In Cerebral Infarction-rTICI) and functional (modified Rankin Scale-mRS) outcomes in cases of TM versus no TM.

Results: Out of 580 enrolled patients, TM occurred between the initial imaging and the first DSA run in 209 (36.0%) of them. TM led to EVT being impossible to perform in 26% of cases (vs 4% in absence of TM). Longer needle-to-groin time and shorter susceptibility vessel sign length were independently associated with TM. Rates of successful recanalization (rTICI 2b/3) were similar between groups. However, we observed higher rates of excellent (rTICI 2c/3) (64.8% vs 51.7%, P=0.02) and complete reperfusion (rTICI 3) (46.6% vs 27.8%, P<0.001) in the absence of TM, but with no impact on clinical outcomes (mRS 0-2=44.7% in the non-migration group vs 47.1% in the migration group; P=0.59).

Conclusion: TM is a frequent and time-related consequence of TNK-IVT that hinders recanalization rates but does not impact functional outcomes.

Background: Previous studies favoring the use of balloon guide catheters (BGCs) during endovascular thrombectomy for anterior circulation acute ischemic stroke either predate advancements in catheter technology or inadequately adjust for large-bore aspiration catheters. This study compared angiographic and clinical outcomes for stroke thrombectomy performed without and with BGCs.

Methods: This multicenter, retrospective study analyzed matched anterior circulation thrombectomy cases performed between February 2018 and February 2024. BGC and non-BGC cases were 1:1 matched by demographic and clinical variables. Primary outcome measures were successful reperfusion (modified thrombolysis in cerebral infarction ≥2B) and good clinical outcome (modified Rankin Scale score 0-2 at discharge and 30 days).

Results: Among 407 patients (non-BGC=199, BGC=208), BGC use had higher rates of successful reperfusion (83.9% vs 90.9%, P=0.034) and better functional outcomes at discharge (18.7% vs 28.4%, P=0.022) and 30 days (21.1% vs 31.3%, P=0.020). On multivariable analysis, BGC independently predicted successful reperfusion (OR 2.29, 95% CI 1.56 to 3.77, P=0.02) and good outcomes at discharge (OR 1.87, 95% CI 1.14 to 3.07, P=0.01) and 30 days (OR 1.89, 95% CI 1.18 to 3.03, P=0.01). Subgroup analysis demonstrated that BGC use was most beneficial in patients with times from last known well to puncture ≤6 hours, with higher rates of successful reperfusion (84.5% vs 94.6%, P=0.041) and favorable outcomes at discharge (14.5% vs 32.4%, P=0.007) and 30 days (23.8% vs 39.2%, P=0.037).

Conclusion: BGC use during endovascular thrombectomy is associated with higher rates of successful reperfusion and better early functional outcomes, particularly in patients treated within 6 hours of last-known-well time.

Objective: Normal pressure hydrocephalus (NPH) is a neurological condition characterized by impaired gait, cognitive decline, and urinary incontinence. Endovascular shunting using the eShunt Implant diverts cerebrospinal fluid (CSF) from basal cisterns to the internal jugular vein via a transvenous, transfemoral procedure. We report initial eShunt safety data for treatment of NPH through 90 days in a prospective, multicenter, single-arm trial.

Methods: NPH participants indicated for endovascular shunt placement were included after exhibiting positive gait response to lumbar CSF withdrawal and candidate anatomy. NPH symptoms at baseline and following eShunt Implant placement were assessed using the Timed Up & Go (TUG) test for gait, Montreal Cognitive Assessment (MoCA) for cognition, and Neurogenic Bladder Symptom Score-Short Form (NBSS-SF) for urinary symptoms. The primary endpoint was the rate of device and/or procedure-related serious adverse events (SAE) at 90-day follow-up.

Results: Sixty-six participants were treated with the eShunt Implant without immediate or delayed cerebral hemorrhage, over-drainage, infection or device-related SAEs. Two procedure-related SAEs (3.0%) occurred, one sigmoid sinus thrombosis and one femoral artery pseudoaneurysm, both resolved without surgical intervention. Matched-pair analysis showed statistically significant improvements in TUG time (37.2%; P<0.0001), MoCA score (+2.3; P<0.0001), and NBSS-SF score (-2.1; P<0.002).

Conclusions: Endovascular shunting for NPH was feasible with a low rate of SAEs typically associated with conventional shunt surgery. An acceptable clinical response through 90 days was observed. These findings suggest further investigation of this minimally invasive, endovascular approach to NPH in a randomized controlled trial comparing to standard of care.

Trial registration number: ClinicalTrials.gov Identifiers: NCT05250505 and NCT05232838.

Background: Randomized trials showed that endovascular thrombectomy (EVT) did not improve outcomes in medium vessel occlusion (MeVO) stroke compared with usual care. We investigated whether patients randomized to EVT who achieved near-complete/complete reperfusion had improved clinical outcomes compared with patients randomized to usual care.

Methods: Post-hoc analysis of ESCAPE-MeVO, which randomized patients with MeVO stroke to undergo EVT in addition to usual care or usual care only. Reperfusion grade in EVT patients was assessed with the MeVO expanded Thrombolysis in Cerebral Infarction (meTICI) score. Regression analyses were used to compare clinical outcomes between EVT patients with near-complete/complete (meTICI 2c-3) reperfusion and usual care patients, and the association between reperfusion grade and clinical outcomes in EVT patients.

Results: Overall, 253 of 255 (99.2%) patients randomized to EVT had final meTICI scores, of whom 133 (52.2%) achieved meTICI 2c-3 reperfusion. Infarct volumes were lower in EVT meTICI 2c-3 patients than in usual care patients, but there were no significant differences between EVT meTICI 2c-3 and usual care patients for 90-day modified Rankin Scale (mRS) score (adjusted common OR 1.17, 95% CI 0.79 to 1.75). Higher final meTICI scores were associated with improved 90-day mRS and lower infarct volumes in EVT patients.

Conclusion: Although higher reperfusion grade was associated with smaller infarct volumes, there was no statistically significant difference in 90-day mRS between patients achieving meTICI 2c-3 and those receiving usual care.

Angiography remains the standard imaging modality for evaluating vascular disease and guiding endovascular interventions; however, its limited spatial resolution restricts visualization of vessel wall pathology and therapeutic devices. Over the past decade, intravascular optical coherence tomography (OCT) has emerged as a transformative tool in coronary artery disease. OCT provides three-dimensional, high-resolution imaging of coronary arteries, enabling assessment of vessel wall microstructure, plaque composition, lumen geometry, and stent deployment. This level of detail has advanced the understanding of coronary pathology and contributed to improved outcomes in percutaneous coronary interventions. Major cardiology societies now recommend the use of intravascular imaging, including OCT, for complex coronary interventions with level 1A evidence.OCT is now expanding beyond the coronary vasculature, with growing interest in its potential role in neurointerventional surgery. While limited use of OCT has been reported in the neurovasculature, the characteristics of a coronary OCT device prevent routine use in intracranial arteries. A new generation of intravascular OCT technology has been developed for the tortuous and complex anatomy of cerebral vessels. Early clinical experience has investigated its safety, feasibility, and utility for intracranial vascular imaging. Neuro-dedicated OCT technology could represent a significant advancement in cerebrovascular imaging, offering insights beyond the capabilities of current modalities, with the potential to improve current understanding of neurovascular pathology and refine diagnostic and therapeutic strategies. Successful translation of OCT into neurointervention, however, also requires establishing principles for image interpretation to assess neurovascular disease and therapeutic devices. This article aims to provide guidance for interpreting OCT imaging of intracranial arteries. In addition, it reviews applications of OCT in neurointervention and describes the development of neuro-specific OCT technology.

Background: Ischemic stroke is an important cause of morbidity and mortality in children, yet no clinical trials have evaluated mechanical thrombectomy (MT) in this population. Consequently, in contrast to adults, pediatric MT remains an off-label intervention. This meta-analysis aimed to assess its safety and efficacy and compare outcomes with medical management (MM).

Methods: MEDLINE, Scopus, and Web of Science were searched to identify original studies reporting outcomes of MT, with or without intravenous thrombolysis (IVT) in pediatric ischemic stroke. In studies that concurrently reported MT±IVT and MM±IVT within the same study, outcomes from the MM arms were also extracted for comparative analysis.

Results: Eighteen studies encompassing 612 pediatric patients were included. The pooled successful recanalization rate (thrombolysis in cerebral infarction (TICI) 2b-3) after mechanical thrombectomy was 88.9% (95% confidence interval (CI) 85.65 to 92.06), and 43.9% (95% CI, 38.67 to 49.09) achieved complete recanalization (TICI 3). Favorable functional outcomes (modified Rankin Scale (mRS) 0-2) occurred in 78.6% (95% CI, 69.58 to 87.61) of patients, with mortality and symptomatic intracranial hemorrhage (sICH) rates of 3.9% (95% CI, 1.88 to 5.92) and 1.3% (95% CI, 1.07 to 2.58), respectively. Shift analysis demonstrated a significant overall improvement in functional outcomes with MT±IVT compared with MM±IVT (common (OR), 0.43; 95% CI, 0.30 to 0.63; P<0.001).

Conclusion: Our findings suggest that MT has a favorable safety and efficacy profile, resulting in a more favorable mRS shift compared with MM in pediatric ischemic stroke. Further research is needed to identify the pediatric stroke patients who are likely to benefit from MT.