Background: Acute basilar artery occlusion is a disabling and life-threatening condition. The purpose of this study was to evaluate the impact of occluded vessel location on the prognostic outcomes of patients who underwent endovascular treatment for acute basilar artery occlusion.
Methods: Patient data for this study were obtained from the ATTENTION registry. Baseline data of the patients were described and compared across different occlusion locations. Univariable and multivariable regression analyses were performed to assess the effect of occluded vessel location on associated prognostic outcomes.
Results: A total of 1672 patients were included in the analysis, with 583 having distal occlusion, 540 having middle occlusion, and 549 having proximal occlusion. Unlike distal occlusion, both proximal and middle occlusions were significantly and negatively associated with favorable clinical outcomes (for modified Rankin Scale score 0-3: adjusted odds ratio (aOR) 0.634, 95% confidence interval (95% CI) 0.493 to 0.816, P<0.001 in middle occlusion, and aOR 0.620, 95% CI 0.479 to 0.802, P<0.001 in proximal occlusion). Mortality was higher in patients with proximal and middle occlusions (aOR 1.461, 95% CI 1.123 to 1.902, P=0.005 in middle occlusion, and aOR 1.648, 95% CI 1.265 to 2.147, P<0.001 in proximal occlusion). The occluded vessel location was not associated with symptomatic intracranial hemorrhage.
Conclusions: Proximal and middle basilar artery occlusions were predominantly associated with poor clinical outcomes and increased risk of death following endovascular treatment.
{"title":"Basilar artery occlusion location and clinical outcome: data from the ATTENTION multicenter registry.","authors":"Shuai Yu, Xiaocui Wang, Zhiliang Guo, Pengfei Xu, Chunrong Tao, Rui Li, Wei Hu, Guodong Xiao","doi":"10.1136/jnis-2023-020517","DOIUrl":"10.1136/jnis-2023-020517","url":null,"abstract":"<p><strong>Background: </strong>Acute basilar artery occlusion is a disabling and life-threatening condition. The purpose of this study was to evaluate the impact of occluded vessel location on the prognostic outcomes of patients who underwent endovascular treatment for acute basilar artery occlusion.</p><p><strong>Methods: </strong>Patient data for this study were obtained from the ATTENTION registry. Baseline data of the patients were described and compared across different occlusion locations. Univariable and multivariable regression analyses were performed to assess the effect of occluded vessel location on associated prognostic outcomes.</p><p><strong>Results: </strong>A total of 1672 patients were included in the analysis, with 583 having distal occlusion, 540 having middle occlusion, and 549 having proximal occlusion. Unlike distal occlusion, both proximal and middle occlusions were significantly and negatively associated with favorable clinical outcomes (for modified Rankin Scale score 0-3: adjusted odds ratio (aOR) 0.634, 95% confidence interval (95% CI) 0.493 to 0.816, P<0.001 in middle occlusion, and aOR 0.620, 95% CI 0.479 to 0.802, P<0.001 in proximal occlusion). Mortality was higher in patients with proximal and middle occlusions (aOR 1.461, 95% CI 1.123 to 1.902, P=0.005 in middle occlusion, and aOR 1.648, 95% CI 1.265 to 2.147, P<0.001 in proximal occlusion). The occluded vessel location was not associated with symptomatic intracranial hemorrhage.</p><p><strong>Conclusions: </strong>Proximal and middle basilar artery occlusions were predominantly associated with poor clinical outcomes and increased risk of death following endovascular treatment.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10126561","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 : 2024-09-17DOI: 10.1136/jnis-2024-021560
Stefan W Koester, Joshua S Catapano, Brandon K Hoglund, Joelle N Hartke, Anant Naik, Elsa Nico, Ashia M Hackett, Ethan A Winkler, Michael T Lawton, Andrew F Ducruet, Felipe C Albuquerque, Ashutosh P Jadhav
In 2019, according to Global Burden of Disease Study estimates, there were 12.2 million incident cases of stroke; stroke remained the second leading cause of death globally, accounting for 11.6% of total deaths, and was the third leading cause of death and disability combined.1 In addition, stroke has significant economic impacts. The global burden of stroke was estimated to be US$891 billion in 2017.2 In the United States, the mean lifetime cost of stroke has been estimated to be US$140048.3 Strokes are also associated with a considerable financial burden in lower- and middle-income countries, with the average direct costs of stroke care estimated to be US$8424 in Nigeria, US$5230 in Pakistan, and US$3626 in China.4 Accordingly, novel cost-reduction strategies for stroke care might have a particularly substantial effect in lower- and middle-income countries, where resources are constrained. Mechanical thrombectomy is the standard of care for anterior circulation large vessel occlusions and is increasingly used for posterior circulation large vessel occlusions.5 6 To ameliorate the costs of this procedure, manufacturer-driven bundling programs have been developed in which all of the necessary devices are purchased together, as opposed to each device being purchased individually (ie, à la carte).7 These programs were previously shown to be cost-effective for stroke care in a study by Munich et al that demonstrated an average savings per case of US$2900.93.7 Because only one previous study has demonstrated the effect of bundling programs on the cost for stroke care, there is a need for further investigation of this topic. Therefore, we performed a retrospective chart review to assess the efficacy of bundling costs for instruments used in mechanical thrombectomy at a high-volume stroke center. A retrospective review of all patients who underwent a mechanical thrombectomy at a single comprehensive stroke center (St. Joseph’s …
{"title":"Supply cost bundling in acute ischemic stroke treatment","authors":"Stefan W Koester, Joshua S Catapano, Brandon K Hoglund, Joelle N Hartke, Anant Naik, Elsa Nico, Ashia M Hackett, Ethan A Winkler, Michael T Lawton, Andrew F Ducruet, Felipe C Albuquerque, Ashutosh P Jadhav","doi":"10.1136/jnis-2024-021560","DOIUrl":"https://doi.org/10.1136/jnis-2024-021560","url":null,"abstract":"In 2019, according to Global Burden of Disease Study estimates, there were 12.2 million incident cases of stroke; stroke remained the second leading cause of death globally, accounting for 11.6% of total deaths, and was the third leading cause of death and disability combined.1 In addition, stroke has significant economic impacts. The global burden of stroke was estimated to be US$891 billion in 2017.2 In the United States, the mean lifetime cost of stroke has been estimated to be US$140048.3 Strokes are also associated with a considerable financial burden in lower- and middle-income countries, with the average direct costs of stroke care estimated to be US$8424 in Nigeria, US$5230 in Pakistan, and US$3626 in China.4 Accordingly, novel cost-reduction strategies for stroke care might have a particularly substantial effect in lower- and middle-income countries, where resources are constrained. Mechanical thrombectomy is the standard of care for anterior circulation large vessel occlusions and is increasingly used for posterior circulation large vessel occlusions.5 6 To ameliorate the costs of this procedure, manufacturer-driven bundling programs have been developed in which all of the necessary devices are purchased together, as opposed to each device being purchased individually (ie, à la carte).7 These programs were previously shown to be cost-effective for stroke care in a study by Munich et al that demonstrated an average savings per case of US$2900.93.7 Because only one previous study has demonstrated the effect of bundling programs on the cost for stroke care, there is a need for further investigation of this topic. Therefore, we performed a retrospective chart review to assess the efficacy of bundling costs for instruments used in mechanical thrombectomy at a high-volume stroke center. A retrospective review of all patients who underwent a mechanical thrombectomy at a single comprehensive stroke center (St. Joseph’s …","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142254071","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 : 2024-09-17DOI: 10.1136/jnis-2023-020687
Christina P Rossitto, Vikram Vasan, Margaret H Downes, Sema Yildiz, Colton J Smith, John W Liang, Alexander J Schupper, Trevor Hardigan, Xinyan Liu, Muhammad Ali, Emily K Chapman, Alex Devarajan, Ian C Odland, Christopher P Kellner, J Mocco
Background: Diffusion-weighted imaging (DWI) lesions have been linked to poor outcomes after intracerebral hemorrhage (ICH). We aimed to assess the impact of cerebral digital subtraction angiography (DSA) on the presence of DWI lesions in patients who underwent minimally invasive surgery (MIS) for ICH.
Methods: Retrospective chart review was performed on ICH patients treated with MIS in a single health system from 2015 to 2021. One hundred and seventy consecutive patients who underwent postoperative MRIs were reviewed. Univariate analyses were conducted to determine associations. Variables with p<0.05 were included in multivariate analyses.
Results: DWI lesions were present in 88 (52%) patients who underwent MIS for ICH. Of the 83 patients who underwent preoperative DSA, 56 (67%) patients demonstrated DWI lesions. In this DSA cohort, older age, severe leukoaraiosis, larger preoperative hematoma volume, and increased presenting National Institutes of Health Stroke Score (NIHSS) were independently associated with DWI lesion identification (p<0.05). In contrast, of 87 patients who did not undergo DSA, 32 (37%) patients demonstrated DWI lesions on MRI. In the non-DSA cohort, presenting systolic blood pressure, intraventricular hemorrhage, and NIHSS were independently associated with DWI lesions (p<0.05). Higher DWI lesion burden was independently associated with poor modified Rankin Scale (mRS) at 6 months on a univariate (p=0.02) and multivariate level (p=0.02).
Conclusions: In this cohort of ICH patients who underwent minimally invasive evacuation, preprocedural angiography was associated with the presence of DWI lesions on post-ICH evacuation MRI. Furthermore, the burden of DWI lesions portends a worse prognosis after ICH.
背景:弥散加权成像(DWI)病变与脑内出血(ICH)后的不良预后有关。我们旨在评估脑数字减影血管造影(DSA)对接受微创手术(MIS)治疗 ICH 患者 DWI 病变的影响:方法:对2015年至2021年在一家医疗系统接受MIS治疗的ICH患者进行回顾性病历审查。对170名接受术后磁共振成像检查的连续患者进行了回顾性分析。进行了单变量分析以确定相关性。结果如下88例(52%)因ICH接受MIS手术的患者存在DWI病变。在 83 例接受术前 DSA 检查的患者中,56 例(67%)患者出现了 DWI 病变。在这组 DSA 患者中,年龄较大、白化严重、术前血肿体积较大、美国国立卫生研究院卒中评分(NIHSS)增加与 DWI 病灶识别独立相关(p 结论:在这组 ICH 患者中,年龄较大、白化严重、术前血肿体积较大、美国国立卫生研究院卒中评分(NIHSS)增加与 DWI 病灶识别独立相关:在这组接受微创抽吸术的 ICH 患者中,术前血管造影与 ICH 抽吸术后磁共振成像中 DWI 病灶的存在有关。此外,DWI 病灶的负荷预示着 ICH 后的预后较差。
{"title":"Preoperative cerebral angiography nearly doubles the rate of diffusion-weighted imaging lesion detection following minimally invasive surgery for intracerebral hemorrhage.","authors":"Christina P Rossitto, Vikram Vasan, Margaret H Downes, Sema Yildiz, Colton J Smith, John W Liang, Alexander J Schupper, Trevor Hardigan, Xinyan Liu, Muhammad Ali, Emily K Chapman, Alex Devarajan, Ian C Odland, Christopher P Kellner, J Mocco","doi":"10.1136/jnis-2023-020687","DOIUrl":"10.1136/jnis-2023-020687","url":null,"abstract":"<p><strong>Background: </strong>Diffusion-weighted imaging (DWI) lesions have been linked to poor outcomes after intracerebral hemorrhage (ICH). We aimed to assess the impact of cerebral digital subtraction angiography (DSA) on the presence of DWI lesions in patients who underwent minimally invasive surgery (MIS) for ICH.</p><p><strong>Methods: </strong>Retrospective chart review was performed on ICH patients treated with MIS in a single health system from 2015 to 2021. One hundred and seventy consecutive patients who underwent postoperative MRIs were reviewed. Univariate analyses were conducted to determine associations. Variables with p<0.05 were included in multivariate analyses.</p><p><strong>Results: </strong>DWI lesions were present in 88 (52%) patients who underwent MIS for ICH. Of the 83 patients who underwent preoperative DSA, 56 (67%) patients demonstrated DWI lesions. In this DSA cohort, older age, severe leukoaraiosis, larger preoperative hematoma volume, and increased presenting National Institutes of Health Stroke Score (NIHSS) were independently associated with DWI lesion identification (p<0.05). In contrast, of 87 patients who did not undergo DSA, 32 (37%) patients demonstrated DWI lesions on MRI. In the non-DSA cohort, presenting systolic blood pressure, intraventricular hemorrhage, and NIHSS were independently associated with DWI lesions (p<0.05). Higher DWI lesion burden was independently associated with poor modified Rankin Scale (mRS) at 6 months on a univariate (p=0.02) and multivariate level (p=0.02).</p><p><strong>Conclusions: </strong>In this cohort of ICH patients who underwent minimally invasive evacuation, preprocedural angiography was associated with the presence of DWI lesions on post-ICH evacuation MRI. Furthermore, the burden of DWI lesions portends a worse prognosis after ICH.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10212070","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 : 2024-09-17DOI: 10.1136/jnis-2023-020739
Tabea C Schaefer, Svenja Greive, Claas Bierwisch, Shoya Mohseni-Mofidi, Sabine Heiland, Martin Kramer, Markus A Möhlenbruch, Martin Bendszus, Dominik F Vollherbst
Background: Cerebral infarctions resulting from iatrogenic air embolism (AE), mainly caused by small air bubbles, are a well-known and often overlooked event in endovascular interventions. Despite their significance, the underlying pathophysiology remains largely unclear.
Methods: In 24 rats, AEs were induced using a microcatheter, positioned in the carotid artery via femoral access. Rats were divided into two study groups, based on the size of the bubbles (85 and 120 µm) and two sub-groups, differing in air volume (0.39 and 0.64 µl). Ultra-high-field magnetic resonance imaging (MRI) was performed 1.5 hours after intervention. MRI findings including the number, single volume and total volume of the infarctions were assessed. A software-based numerical simulation was performed to qualitatively assess the microvascular pathomechanisms.
Results: In the study groups 22 of 24 rats (92%) revealed cerebral infarctions. The number of infarctions per rat was higher for the smaller bubbles, for the lower (medians: 5 vs 3; p=0.049) and higher air volume sub-groups (medians: 6 vs 4; p=0.012). Correspondingly, total infarction volume was higher for the smaller bubbles (1.67 vs 0.5 mm³; p=0.042). Simulations confirmed the results of the experiments and suggested that fusion of microbubbles to larger bubbles is the underlying pathomechanism of vascular occlusions.
Conclusion: In iatrogenic AE, the size of the bubbles can have a major impact on the number and total volume of cerebral infarctions. These findings can help to better understand the pathophysiology of this frequent, often underestimated adverse event in endovascular interventions.
背景:由医源性空气栓塞(AE)引起的脑梗死,主要由小气泡引起,是血管内介入治疗中一个众所周知且经常被忽视的事件。尽管它们具有重要意义,但其潜在的病理生理学在很大程度上仍不清楚。方法:在24只大鼠中,使用经股动脉进入颈动脉的微导管诱导AE。根据气泡的大小将大鼠分为两个研究组(85和120 µm)和两个子组,风量不同(0.39和0.64 µl)。进行超高场磁共振成像(MRI)1.5 干预后数小时。评估MRI检查结果,包括梗死的数量、单个体积和总体积。进行了基于软件的数值模拟,以定性评估微血管的病理机制。结果:在研究组中,24只大鼠中有22只(92%)出现脑梗死。气泡越小,每只大鼠的梗死数量越高(中位数:5 vs 3;p=0.049),空气量越高的亚组(中位数:6 vs 4;p=0.012)。相应地,气泡越小的总梗死体积越高(1.67 vs 0.5 mm³;p=0.042)。模拟证实了实验结果,并表明微气泡与较大气泡的融合是血管闭塞的潜在病理机制。结论:在医源性AE中,气泡的大小对脑梗死的数量和总体积有重要影响。这些发现有助于更好地了解血管内干预中这种经常被低估的不良事件的病理生理学。
{"title":"Iatrogenic air embolism: influence of air bubble size on cerebral infarctions in an experimental in vivo and numerical simulation model.","authors":"Tabea C Schaefer, Svenja Greive, Claas Bierwisch, Shoya Mohseni-Mofidi, Sabine Heiland, Martin Kramer, Markus A Möhlenbruch, Martin Bendszus, Dominik F Vollherbst","doi":"10.1136/jnis-2023-020739","DOIUrl":"10.1136/jnis-2023-020739","url":null,"abstract":"<p><strong>Background: </strong>Cerebral infarctions resulting from iatrogenic air embolism (AE), mainly caused by small air bubbles, are a well-known and often overlooked event in endovascular interventions. Despite their significance, the underlying pathophysiology remains largely unclear.</p><p><strong>Methods: </strong>In 24 rats, AEs were induced using a microcatheter, positioned in the carotid artery via femoral access. Rats were divided into two study groups, based on the size of the bubbles (85 and 120 µm) and two sub-groups, differing in air volume (0.39 and 0.64 µl). Ultra-high-field magnetic resonance imaging (MRI) was performed 1.5 hours after intervention. MRI findings including the number, single volume and total volume of the infarctions were assessed. A software-based numerical simulation was performed to qualitatively assess the microvascular pathomechanisms.</p><p><strong>Results: </strong>In the study groups 22 of 24 rats (92%) revealed cerebral infarctions. The number of infarctions per rat was higher for the smaller bubbles, for the lower (medians: 5 vs 3; p=0.049) and higher air volume sub-groups (medians: 6 vs 4; p=0.012). Correspondingly, total infarction volume was higher for the smaller bubbles (1.67 vs 0.5 mm³; p=0.042). Simulations confirmed the results of the experiments and suggested that fusion of microbubbles to larger bubbles is the underlying pathomechanism of vascular occlusions.</p><p><strong>Conclusion: </strong>In iatrogenic AE, the size of the bubbles can have a major impact on the number and total volume of cerebral infarctions. These findings can help to better understand the pathophysiology of this frequent, often underestimated adverse event in endovascular interventions.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11420717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10169407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-17DOI: 10.1136/jnis-2023-020730
Jae-Chan Ryu, Jong-Tae Yoon, Byung Jun Kim, Mi Hyeon Kim, Eun Ji Moon, Pae Sun Suh, Yun Hwa Roh, Hye Hyeon Moon, Boseong Kwon, Deok Hee Lee, Yunsun Song
Background: We aimed to investigate the radiation dose to the eye lens (lens dose) during cerebral angiography and to evaluate the effectiveness of the lens dose reduction protocol for 3-dimensional rotational angiography (3D-RA) in reducing overall lens dose exposure.
Methods: We conducted a randomized, controlled clinical trial at a tertiary hospital with patients undergoing cerebral angiography. The lens dose reduction protocol in 3D-RA involved raising the table to position the patient's eye lens away from the rotation axis. The lens dose was estimated by measuring the entrance surface air kerma using a photoluminescent glass dosimeter. The lens doses of 3D-RA, overall examination, and image quality were analyzed and compared between the two groups.
Results: A total of 20 participants (mean age, 58±9.4 years; including 12 men [60%]) were enrolled and randomly assigned to either the conventional group or the dose reduction group. The median lens dose in 3D-RA was significantly lower in the dose reduction group compared with the conventional group (1.1 mGy vs 4.5 mGy, p<0.001). The total dose was significantly lower in the dose reduction group (median of 7.5 mGy vs 10.2 mGy, p=0.003). In the conventional group, 3D-RA accounted for 46% of the total lens dose, while in the dose reduction group, its proportion decreased to 16%. No significant differences were observed in the image quality between the groups.
Conclusion: The lens dose reduction protocol resulted in a significant reduction in the lens dose of the 3D-RA as well as entire cerebral angiography, while maintaining the image quality.
背景:我们旨在研究脑血管造影术期间对晶状体的辐射剂量(晶状体剂量),并评估三维旋转血管造影学(3D-RA)晶状体剂量减少方案在减少晶状体总剂量暴露方面的有效性。方法:我们在一家三级医院对接受脑血管造影的患者进行了随机对照临床试验。3D-RA中的晶状体剂量减少方案包括升高手术台以将患者的晶状体定位为远离旋转轴。透镜剂量是通过使用光致发光玻璃剂量计测量入射表面空气kerma来估计的。分析并比较两组的3D-RA晶状体剂量、整体检查和图像质量。结果:共有20名参与者(平均年龄58±9.4岁;包括12名男性[60%])入选,并被随机分配到常规组或剂量减少组。与常规组相比,剂量减少组的3D-RA中位晶状体剂量显著降低(1.1mGy vs 4.5mGy,P结论:在保持图像质量的同时,晶状体剂量减少方案导致3D-RA和整个脑血管造影的晶状体剂量显著减少。
{"title":"Impact of a selective lens dose reduction protocol in 3D rotational angiography on radiation exposure to the eye lens during cerebral angiography: a randomized controlled trial.","authors":"Jae-Chan Ryu, Jong-Tae Yoon, Byung Jun Kim, Mi Hyeon Kim, Eun Ji Moon, Pae Sun Suh, Yun Hwa Roh, Hye Hyeon Moon, Boseong Kwon, Deok Hee Lee, Yunsun Song","doi":"10.1136/jnis-2023-020730","DOIUrl":"10.1136/jnis-2023-020730","url":null,"abstract":"<p><strong>Background: </strong>We aimed to investigate the radiation dose to the eye lens (lens dose) during cerebral angiography and to evaluate the effectiveness of the lens dose reduction protocol for 3-dimensional rotational angiography (3D-RA) in reducing overall lens dose exposure.</p><p><strong>Methods: </strong>We conducted a randomized, controlled clinical trial at a tertiary hospital with patients undergoing cerebral angiography. The lens dose reduction protocol in 3D-RA involved raising the table to position the patient's eye lens away from the rotation axis. The lens dose was estimated by measuring the entrance surface air kerma using a photoluminescent glass dosimeter. The lens doses of 3D-RA, overall examination, and image quality were analyzed and compared between the two groups.</p><p><strong>Results: </strong>A total of 20 participants (mean age, 58±9.4 years; including 12 men [60%]) were enrolled and randomly assigned to either the conventional group or the dose reduction group. The median lens dose in 3D-RA was significantly lower in the dose reduction group compared with the conventional group (1.1 mGy vs 4.5 mGy, p<0.001). The total dose was significantly lower in the dose reduction group (median of 7.5 mGy vs 10.2 mGy, p=0.003). In the conventional group, 3D-RA accounted for 46% of the total lens dose, while in the dose reduction group, its proportion decreased to 16%. No significant differences were observed in the image quality between the groups.</p><p><strong>Conclusion: </strong>The lens dose reduction protocol resulted in a significant reduction in the lens dose of the 3D-RA as well as entire cerebral angiography, while maintaining the image quality.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41162675","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 : 2024-09-17DOI: 10.1136/jnis-2023-020529
Alex Devarajan, Mais Al-Kawaz, Brian Giovanni, Halima Tabani, Tomoyoshi Shigematsu, Johanna T Fifi
Intrasaccular flow diversion is a new endovascular option for managing unruptured intracranial aneurysms.1-6 However, catheter ejection can occur during placement of an intrasaccular flow diverter, especially in tortuous vasculature that creates unfavorable angles between the aneurysm neck and the parent vessel.5 The Bendit steerable microcatheter (Bendit Technologies, Petah Tikva, Israel) can dynamically change its tip angle and may mitigate these placement concerns.7-9 Here, we report the placement of an intrasaccular flow diverter for the treatment of an unruptured internal carotid artery sidewall aneurysm at an unfavorable neck angle using the Bendit microcatheter (video 1). The Bendit was navigated around the 180° turn of the carotid siphon and held a stable position during device delivery. The device was sequentially deployed as the Bendit was progressively straightened and was successfully placed within the aneurysm. No neurological complications were experienced and the patient was asymptomatic on follow-up 3 months later. neurintsurg;16/10/1066/V1F1V1Video 1Placement of an intrasaccular flow diverter in an intracranial sidewall aneurysm using the Bendit articulating microcatheter.
{"title":"Placement of an intrasaccular flow diverter in an intracranial sidewall aneurysm using the Bendit articulating microcatheter.","authors":"Alex Devarajan, Mais Al-Kawaz, Brian Giovanni, Halima Tabani, Tomoyoshi Shigematsu, Johanna T Fifi","doi":"10.1136/jnis-2023-020529","DOIUrl":"10.1136/jnis-2023-020529","url":null,"abstract":"<p><p>Intrasaccular flow diversion is a new endovascular option for managing unruptured intracranial aneurysms.1-6 However, catheter ejection can occur during placement of an intrasaccular flow diverter, especially in tortuous vasculature that creates unfavorable angles between the aneurysm neck and the parent vessel.5 The Bendit steerable microcatheter (Bendit Technologies, Petah Tikva, Israel) can dynamically change its tip angle and may mitigate these placement concerns.7-9 Here, we report the placement of an intrasaccular flow diverter for the treatment of an unruptured internal carotid artery sidewall aneurysm at an unfavorable neck angle using the Bendit microcatheter (video 1). The Bendit was navigated around the 180° turn of the carotid siphon and held a stable position during device delivery. The device was sequentially deployed as the Bendit was progressively straightened and was successfully placed within the aneurysm. No neurological complications were experienced and the patient was asymptomatic on follow-up 3 months later. neurintsurg;16/10/1066/V1F1V1Video 1Placement of an intrasaccular flow diverter in an intracranial sidewall aneurysm using the Bendit articulating microcatheter.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10241539","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 : 2024-09-17DOI: 10.1136/jnis-2023-020698
Chulho Kim, Jong-Hee Sohn, Minwoo Lee, Yerim Kim, Hee Jung Mo, Mi Sun Oh, Kyung-Ho Yu, Sang-Hwa Lee
Background: We assessed the influence of prior non-vitamin K antagonist (NOAC) use on stroke outcomes after endovascular treatment (EVT) in patients at a high risk of stroke based on their pre-stroke CHA2DS2-VASc score, and compared them with those who did not use any antithrombotic (NAU) or antiplatelet (APT) agents.
Methods: Data were collected from a multicenter database comprising consecutive acute ischemic stroke patients who underwent EVT during a span of 103 months. We evaluated pre-stroke CHA2DS2-VASc scores in enrolled patients and measured instances of successful reperfusion and symptomatic hemorrhagic transformation (SHT) following EVT as the main outcome measures.
Results: Among 12 807 patients with acute ischemic stroke, 3765 (29.4%) had a history of atrial fibrillation. Of these, 418 patients with CHA2DS2-VASc scores ≥2 received EVT alone. The prior NOAC group showed higher successful reperfusion rates compared with the prior NAU and APT groups (p=0.04). Multivariate analysis revealed that prior NOAC use increased the likelihood of successful reperfusion after EVT (OR [95% CI] 2.54 [1.34 to 4.83], p=0.004) and improved stroke outcomes, while the prior APT group did not. Furthermore, the prior NOAC use group was not associated with SHT after EVT. Propensity score matching confirmed these findings.
Conclusion: Prior use of NOAC is associated with improved outcomes in high-risk stroke patients (pre-stroke CHA2DS2-VASc score ≥2) undergoing EVT.
{"title":"Impact of prior use of antiplatelet agents and non-vitamin K antagonist oral anticoagulants on stroke outcomes among endovascular-treated patients with high pre-stroke CHA2DS2-VASc score.","authors":"Chulho Kim, Jong-Hee Sohn, Minwoo Lee, Yerim Kim, Hee Jung Mo, Mi Sun Oh, Kyung-Ho Yu, Sang-Hwa Lee","doi":"10.1136/jnis-2023-020698","DOIUrl":"10.1136/jnis-2023-020698","url":null,"abstract":"<p><strong>Background: </strong>We assessed the influence of prior non-vitamin K antagonist (NOAC) use on stroke outcomes after endovascular treatment (EVT) in patients at a high risk of stroke based on their pre-stroke CHA2DS2-VASc score, and compared them with those who did not use any antithrombotic (NAU) or antiplatelet (APT) agents.</p><p><strong>Methods: </strong>Data were collected from a multicenter database comprising consecutive acute ischemic stroke patients who underwent EVT during a span of 103 months. We evaluated pre-stroke CHA2DS2-VASc scores in enrolled patients and measured instances of successful reperfusion and symptomatic hemorrhagic transformation (SHT) following EVT as the main outcome measures.</p><p><strong>Results: </strong>Among 12 807 patients with acute ischemic stroke, 3765 (29.4%) had a history of atrial fibrillation. Of these, 418 patients with CHA2DS2-VASc scores ≥2 received EVT alone. The prior NOAC group showed higher successful reperfusion rates compared with the prior NAU and APT groups (p=0.04). Multivariate analysis revealed that prior NOAC use increased the likelihood of successful reperfusion after EVT (OR [95% CI] 2.54 [1.34 to 4.83], p=0.004) and improved stroke outcomes, while the prior APT group did not. Furthermore, the prior NOAC use group was not associated with SHT after EVT. Propensity score matching confirmed these findings.</p><p><strong>Conclusion: </strong>Prior use of NOAC is associated with improved outcomes in high-risk stroke patients (pre-stroke CHA2DS2-VASc score ≥2) undergoing EVT.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10124425","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 : 2024-09-17DOI: 10.1136/jnis-2023-020661
Mousa Zidan, Shiwa Ghaei, Felix J Bode, Johannes M Weller, Nadine Krueger, Nils Christian Lehnen, Gabor C Petzold, Alexander Radbruch, Franziska Dorn, Daniel Paech
Background: Subarachnoid hyperdensities after mechanical thrombectomy (MT) are a common finding. However, it is often regarded as clinically insignificant.
Objective: With this single-center investigation, to identify the prevalence of subarachnoid hyperdensities following MT, associated predictors, and the impact on the clinical outcome of the patients.
Methods: 383 patients from the stroke registry were analyzed for the presence of subarachnoid hyperdensities on flat detector CT (FDCT) directly after the completion of MT, and on follow-up dual-energy CT, then classified according to a visual grading scale. 178 patients were included with anterior circulation occlusions. Regression analysis was performed to identify significant predictors, and Kruskal-Wallis analysis and Χ2 test were performed to test the variables among the different groups. The primary outcome was the modified Rankin Scale (mRS) score at 90 days and was analyzed with the Wilcoxon-Mann-Whitney rank-sum test.
Results: The prevalence of subarachnoid hyperdensities on FDCT was (66/178, 37.1%) with patients experiencing a significant unfavorable outcome (P=0.035). Significantly fewer patients with subarachnoid hyperdensities achieved a mRS score of ≤3 at 90 days 25/66 (37.9%) vs 60/112 (53.6%), P=0.043). In addition, mortality was significantly higher in the subarachnoid hyperdensities group (34.8% vs 19.6%, P=0.024). Distal occlusions and a higher number of device passes were significantly associated with subarachnoid hyperdensities (P=0.026) and (P=0.001), respectively. Patients who received intravenous tissue plasminogen activator had significantly fewer subarachnoid hyperdensities (P=0.029).
Conclusions: Postinterventional subarachnoid hyperdensities are a frequent finding after MT and are associated with neurological decline and worse functional outcome. They are more common with distal occlusions and multiple device passes.
{"title":"Clinical significance and prevalence of subarachnoid hyperdensities on flat detector CT after mechanical thrombectomy: does it really matter?","authors":"Mousa Zidan, Shiwa Ghaei, Felix J Bode, Johannes M Weller, Nadine Krueger, Nils Christian Lehnen, Gabor C Petzold, Alexander Radbruch, Franziska Dorn, Daniel Paech","doi":"10.1136/jnis-2023-020661","DOIUrl":"10.1136/jnis-2023-020661","url":null,"abstract":"<p><strong>Background: </strong>Subarachnoid hyperdensities after mechanical thrombectomy (MT) are a common finding. However, it is often regarded as clinically insignificant.</p><p><strong>Objective: </strong>With this single-center investigation, to identify the prevalence of subarachnoid hyperdensities following MT, associated predictors, and the impact on the clinical outcome of the patients.</p><p><strong>Methods: </strong>383 patients from the stroke registry were analyzed for the presence of subarachnoid hyperdensities on flat detector CT (FDCT) directly after the completion of MT, and on follow-up dual-energy CT, then classified according to a visual grading scale. 178 patients were included with anterior circulation occlusions. Regression analysis was performed to identify significant predictors, and Kruskal-Wallis analysis and Χ<sup>2</sup> test were performed to test the variables among the different groups. The primary outcome was the modified Rankin Scale (mRS) score at 90 days and was analyzed with the Wilcoxon-Mann-Whitney rank-sum test.</p><p><strong>Results: </strong>The prevalence of subarachnoid hyperdensities on FDCT was (66/178, 37.1%) with patients experiencing a significant unfavorable outcome (P=0.035). Significantly fewer patients with subarachnoid hyperdensities achieved a mRS score of ≤3 at 90 days 25/66 (37.9%) vs 60/112 (53.6%), P=0.043). In addition, mortality was significantly higher in the subarachnoid hyperdensities group (34.8% vs 19.6%, P=0.024). Distal occlusions and a higher number of device passes were significantly associated with subarachnoid hyperdensities (P=0.026) and (P=0.001), respectively. Patients who received intravenous tissue plasminogen activator had significantly fewer subarachnoid hyperdensities (P=0.029).</p><p><strong>Conclusions: </strong>Postinterventional subarachnoid hyperdensities are a frequent finding after MT and are associated with neurological decline and worse functional outcome. They are more common with distal occlusions and multiple device passes.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10118827","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 : 2024-09-17DOI: 10.1136/jnis-2023-020789
Niklas Lützen, Theo Demerath, Urs Würtemberger, Nebiyat Filate Belachew, Enrique Barvulsky Aleman, Katharina Wolf, Amir El Rahal, Florian Volz, Christian Fung, Jürgen Beck, Horst Urbach
Background: Cerebrospinal fluid (CSF)-venous fistulas (CVFs) are increasingly identified as a cause of spontaneous intracranial hypotension (SIH). Lateral decubitus digital subtraction myelography (LD-DSM) and CT myelography (LD-CTM) are mainly used for detection, but the most sensitive method is yet unknown.
Objective: To compare LD-DSM with LD-CTM for diagnostic yield of CVFs.
Methods: Patients with SIH diagnosed with a CVF between January 2021 and December 2022 in which the area of CVF(s) was covered by both diagnostic modalities were included. LD-CTM immediately followed LD-DSM without repositioning the spinal needle, and the second half of the contrast agent was injected at the CT scanner. Patients were awake or mildly sedated. Retrospectively, two neuroradiologists evaluated data independently and blinded for the presence of CVF.
Results: Twenty patients underwent a total of 27 combined LD-DSM/LD-CTM examinations (4/20 with follow-up and 3/20 with bilateral examinations). Both raters identified significantly more CVFs with LD-CTM than with LD-DSM (rater 1: 39 vs 9, P<0.001; rater 2: 42 vs 12, P<0.001). Inter-rater agreement was substantial for LD-DSM (κ=0.732) and LD-CTM (κ=0.655). The results remained significant after considering the senior rating for cases of disagreement (39 vs 10; P<0.001), and no CVF detected on LD-DSM was missed on LD-CTM.
Conclusion: In this study, LD-CTM has a higher diagnostic yield for the detection of CVFs than LD-DSM and should supplement LD-DSM, but further studies are needed. LD-CTM can be easily acquired in awake or mildly sedated patients with the second half of contrast injected just before CT scanning, or it may be considered as a stand-alone investigation.
背景:脑脊液(CSF)-静脉瘘(CVF)越来越多地被认为是自发性颅内低血压(SIH)的原因。侧卧位数字减影脊髓造影(LD-DSM)和CT脊髓造影(LDP-CTM)主要用于检测,但最敏感的方法尚不清楚。目的:比较LD-DSM和LD-CTM对CVF的诊断率。方法:纳入2021年1月至2022年12月期间被诊断为CVF的SIH患者,其中两种诊断模式都涵盖了CVF区域。LD-CTM立即跟随LD-DSM,不重新定位脊椎针,并在CT扫描仪处注射后半部分造影剂。患者处于清醒状态或轻度镇静状态。回顾性分析,两名神经放射科医生独立评估数据,并对CVF的存在进行盲法评估。结果:20名患者共接受了27次LD-DSM/LD-CTM联合检查(4/20进行随访,3/20进行双侧检查)。两位评分者都发现LD-CTM的CVF明显多于LD-DSM的CVF(评分1:39 vs 9,P结论:在这项研究中,LD-CTM在检测CVF方面比LD-DSM有更高的诊断率,应该补充LD-DSM,但还需要进一步的研究。在清醒或轻度镇静的患者中,在CT扫描前注射后半部分造影剂可以很容易地获得LD-CTM,也可以将其视为一项独立的研究。
{"title":"Direct comparison of digital subtraction myelography versus CT myelography in lateral decubitus position: evaluation of diagnostic yield for cerebrospinal fluid-venous fistulas.","authors":"Niklas Lützen, Theo Demerath, Urs Würtemberger, Nebiyat Filate Belachew, Enrique Barvulsky Aleman, Katharina Wolf, Amir El Rahal, Florian Volz, Christian Fung, Jürgen Beck, Horst Urbach","doi":"10.1136/jnis-2023-020789","DOIUrl":"10.1136/jnis-2023-020789","url":null,"abstract":"<p><strong>Background: </strong>Cerebrospinal fluid (CSF)-venous fistulas (CVFs) are increasingly identified as a cause of spontaneous intracranial hypotension (SIH). Lateral decubitus digital subtraction myelography (LD-DSM) and CT myelography (LD-CTM) are mainly used for detection, but the most sensitive method is yet unknown.</p><p><strong>Objective: </strong>To compare LD-DSM with LD-CTM for diagnostic yield of CVFs.</p><p><strong>Methods: </strong>Patients with SIH diagnosed with a CVF between January 2021 and December 2022 in which the area of CVF(s) was covered by both diagnostic modalities were included. LD-CTM immediately followed LD-DSM without repositioning the spinal needle, and the second half of the contrast agent was injected at the CT scanner. Patients were awake or mildly sedated. Retrospectively, two neuroradiologists evaluated data independently and blinded for the presence of CVF.</p><p><strong>Results: </strong>Twenty patients underwent a total of 27 combined LD-DSM/LD-CTM examinations (4/20 with follow-up and 3/20 with bilateral examinations). Both raters identified significantly more CVFs with LD-CTM than with LD-DSM (rater 1: 39 vs 9, P<0.001; rater 2: 42 vs 12, P<0.001). Inter-rater agreement was substantial for LD-DSM (κ=0.732) and LD-CTM (κ=0.655). The results remained significant after considering the senior rating for cases of disagreement (39 vs 10; P<0.001), and no CVF detected on LD-DSM was missed on LD-CTM.</p><p><strong>Conclusion: </strong>In this study, LD-CTM has a higher diagnostic yield for the detection of CVFs than LD-DSM and should supplement LD-DSM, but further studies are needed. LD-CTM can be easily acquired in awake or mildly sedated patients with the second half of contrast injected just before CT scanning, or it may be considered as a stand-alone investigation.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11420736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71424335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-17DOI: 10.1136/jnis-2023-020782
Emily Fuller, Juan Vivanco-Suarez, Nicholas H Fain, Cynthia B Zevallos, Yujing Lu, Santiago Ortega-Gutierrez, Colin Derdeyn
Background: Distal embolization after endovascular thrombectomy (EVT) is common. We aimed to determine factors associated with tissue infarction in the territories of distal emboli.
Methods: This is a retrospective cohort study of consecutive patients with anterior circulation large vessel occlusions who underwent EVT from 2015 to 2021. Patients with Thrombolysis In Cerebral Infarction (TICI) 2b reperfusion and follow-up imaging were identified. Baseline characteristics, procedural details, and imaging findings were reviewed. Primary outcome was categorized according to the occurrence of infarction at the territory of distal embolus on follow-up diffusion-weighted imaging MRI.
Results: Of 156 subjects, 97 (62%) had at least one infarction in the territories at risk. Hypertension was significantly more prevalent in the infarct group (83% vs 53%, P=0.001). General anesthesia was more commonly used in the infarct group (60% vs 43%, P=0.037). The median number of distal emboli and diameter of the occluded vessel were similar. After adjusting for confounders, hypertension (aOR 4.73, 95% CI 1.81 to 13.25, P=0.002), higher blood glucose (aOR 1.01, 95% CI 1.00 to 1.03, P=0.023), and general anesthesia (aOR 2.75, 95% CI 1.15 to 6.84, P=0.025) were independently associated with infarction. The presence of angiographic leptomeningeal collaterals predicted tissue survival (aOR 0.13, 95% CI 0.05 to 0.33, P<0.001). 90-day modified Rankin scale (mRS) scores were worse for the infarction patients (mRS 0-2: infarct, 39% vs 55%, P=0.046).
Conclusions: Nearly 40% of patients with TICI 2b had no tissue infarction in the territory of a distal embolus. The association of infarction with hypertension and general anesthesia suggests late or post-procedural blood pressure management could be a modifiable factor. Patients with poor leptomeningeal collaterals or hyperglycemia may benefit from further attempts at revascularization.
背景:血管内血栓切除术(EVT)后远端栓塞很常见。我们旨在确定与远端栓塞区域组织梗死相关的因素:这是一项回顾性队列研究,研究对象是2015年至2021年接受EVT的连续前循环大血管闭塞患者。确定了脑梗塞溶栓治疗(TICI)2b再灌注和随访成像患者。回顾了基线特征、手术细节和成像结果。主要结果根据随访弥散加权成像核磁共振的远端栓子区域发生梗死的情况进行分类:结果:在156名受试者中,97人(62%)在高危区域至少发生过一次梗死。高血压在梗塞组的发病率明显更高(83% vs 53%,P=0.001)。梗塞组更常用全身麻醉(60% 对 43%,P=0.037)。远端栓子的中位数和闭塞血管的直径相似。调整混杂因素后,高血压(aOR 4.73,95% CI 1.81 至 13.25,P=0.002)、高血糖(aOR 1.01,95% CI 1.00 至 1.03,P=0.023)和全身麻醉(aOR 2.75,95% CI 1.15 至 6.84,P=0.025)与梗死独立相关。血管造影显示的脑膜外旁路可预测组织存活率(aOR 0.13,95% CI 0.05 至 0.33,P=0.025):近 40% 的 TICI 2b 患者在远端栓子区域没有组织梗死。梗死与高血压和全身麻醉有关,这表明手术后期或术后血压管理可能是一个可改变的因素。左侧脑膜侧支较差或患有高血糖的患者可能会从进一步的血管再通尝试中获益。
{"title":"Predictors of tissue infarction from distal emboli after mechanical thrombectomy.","authors":"Emily Fuller, Juan Vivanco-Suarez, Nicholas H Fain, Cynthia B Zevallos, Yujing Lu, Santiago Ortega-Gutierrez, Colin Derdeyn","doi":"10.1136/jnis-2023-020782","DOIUrl":"10.1136/jnis-2023-020782","url":null,"abstract":"<p><strong>Background: </strong>Distal embolization after endovascular thrombectomy (EVT) is common. We aimed to determine factors associated with tissue infarction in the territories of distal emboli.</p><p><strong>Methods: </strong>This is a retrospective cohort study of consecutive patients with anterior circulation large vessel occlusions who underwent EVT from 2015 to 2021. Patients with Thrombolysis In Cerebral Infarction (TICI) 2b reperfusion and follow-up imaging were identified. Baseline characteristics, procedural details, and imaging findings were reviewed. Primary outcome was categorized according to the occurrence of infarction at the territory of distal embolus on follow-up diffusion-weighted imaging MRI.</p><p><strong>Results: </strong>Of 156 subjects, 97 (62%) had at least one infarction in the territories at risk. Hypertension was significantly more prevalent in the infarct group (83% vs 53%, P=0.001). General anesthesia was more commonly used in the infarct group (60% vs 43%, P=0.037). The median number of distal emboli and diameter of the occluded vessel were similar. After adjusting for confounders, hypertension (aOR 4.73, 95% CI 1.81 to 13.25, P=0.002), higher blood glucose (aOR 1.01, 95% CI 1.00 to 1.03, P=0.023), and general anesthesia (aOR 2.75, 95% CI 1.15 to 6.84, P=0.025) were independently associated with infarction. The presence of angiographic leptomeningeal collaterals predicted tissue survival (aOR 0.13, 95% CI 0.05 to 0.33, P<0.001). 90-day modified Rankin scale (mRS) scores were worse for the infarction patients (mRS 0-2: infarct, 39% vs 55%, P=0.046).</p><p><strong>Conclusions: </strong>Nearly 40% of patients with TICI 2b had no tissue infarction in the territory of a distal embolus. The association of infarction with hypertension and general anesthesia suggests late or post-procedural blood pressure management could be a modifiable factor. Patients with poor leptomeningeal collaterals or hyperglycemia may benefit from further attempts at revascularization.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10064924","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}