Journal of NeuroInterventional Surgery最新文献

Background: Vertebral compression fractures (VCFs), characterized by middle column involvement, osteonecrotic clefts, split morphology, or pedicle fractures, pose biomechanical challenges that reduce the effectiveness of conventional vertebroplasty and kyphoplasty. We evaluated the feasibility, safety, and clinical outcomes of the Calibrated Screw Technique (CAST), a minimally invasive approach combining percutaneous pedicle screw fixation and targeted cement augmentation, in patients with complex VCFs.

Methods: We retrospectively analyzed 147 consecutive patients (155 vertebral levels; mean age 80.1 years), primarily with osteoporotic fractures (80.6%), treated using CAST. Demographic, clinical, and radiographic data were collected at baseline, and at 1 and 6 months. Pain intensity was measured by the numeric rating scale (NRS), and patient perceived outcomes were assessed using patient global impression of change (PGIC). Radiographic outcomes included refracture rates at treated vertebrae, incidence of new fractures, and kyphotic angle correction in mobile fractures.

Results: CAST was technically feasible in all cases without major complications. Mean NRS scores improved significantly from 7.7 before the procedure to 3.6 at 1 month and 2.7 at 6 months (P < 0.0001). At the 1 month follow-up, 55.3% of patients reported feeling 'extremely' or 'much improved' on PGIC, increasing to 69.8% at 6 months. Radiographically, only one asymptomatic refracture occurred at 1 month (0.8%) and none at 6 months. New fracture incidence decreased from 13.8% at 1 month to 4.2% at 6 months.

Conclusions: In this study, CAST provided a safe, technically feasible, and durable solution for stabilization and pain relief in complex VCFs unsuitable for conventional augmentation, highlighting its value for challenging VCFs.

Background: Dynamic internal jugular vein (IJV) stenosis is increasingly recognized in patients with cerebral venous outflow disorders (CVD). Although the hemodynamic effects of dynamic jugular stenosis have been characterized, its role in disease remains undefined. This study evaluated the safety and early outcomes of IJV stenting for symptomatic rotational stenosis.

Methods: This retrospective, single-institution study included adult patients that underwent IJV stenting for dynamic, symptomatic IJV stenosis between 2023 and 2025. Inclusion required dynamic venography demonstrating >75% rotational IJV stenosis and ≥6 mmHg trans-stenotic pressure gradient. Demographic, procedural, and clinical data were analyzed. Symptom severity was assessed using the Cerebral Venous Disorder Symptom Severity (CVDSS) scale and the Headache Impact Test (HIT-6).

Results: Sixteen patients (mean age 37.1 years, 75% female) were included. All underwent successful IJV stent placement without periprocedural complications. The median trans-stenotic pressure gradient improved from 7 mmHg (range 6-18) to 1 mmHg (range 0-9) after stenting. CVDSS scores improved from 13.5 (11.0-16.0) to 8.5 (4.75-12.0) at peak improvement (p<0.001), with sustained improvement (10.5 (8.0-12.3), p<0.001) at a median follow-up of 10.1 months. Median HIT-6 scores decreased from 65.5 (64.0-67.3) to 61.0 (57.0-64.0) (p<0.001). Thirteen patients reported meaningful symptom improvement at last follow-up, and 88% were satisfied with their decision to pursue stenting.

Conclusion: Jugular vein stenting in refractory CVD patients with severe, symptomatic rotational IJV stenosis is technically feasible and associated with meaningful clinical improvement in patients though partial symptom recurrence is common. Optimal patient selection and procedural expertise are essential to maximize patient safety and efficacy.

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.

Background: Lymphatic malformations (LMs) are low-flow, congenital lesions commonly presenting as asymptomatic masses in the head and neck. However, large lymphangiomas can significantly affect breathing or swallowing, posing considerable treatment challenges.

Methods: A retrospective analysis of complex cervicofacial LMs in infants was conducted over the past 8 years at the Department of Radiology. Patients were included if they had complex cervicofacial LMs. The size and type of LMs were assessed using ultrasound or MRI. All patients underwent sclerotherapy combined with sirolimus treatment. Treatment outcomes were evaluated through clinical examination and imaging findings.

Results: Nineteen infants with large and extensive LMs of the head and neck were identified, including 12 males and 7 females. Thirteen patients had macrocystic lesions, five had mixed lesions, and one had microcystic lesions. Posttreatment, 18 children showed a size reduction of more than 75%, and one case demonstrated a reduction of 51-75%. Mild-to-moderate fever was observed in four cases postoperatively, and two cases experienced localized swelling. None of the 19 cases developed serious adverse reactions, such as allergies, pulmonary fibrosis, nerve injury, or skin necrosis.

Conclusions: Sclerotherapy combined with sirolimus appears to be a safe and effective treatment for complex cervicofacial LMs in infants. This approach reduced the necessity for tracheotomy in affected children.

Placement of a flow diverter (FD) has been a mainstream treatment for intracranial aneurysms. Neointimal formation in the aneurysmal neck and stent struts is important for promoting aneurysm healing and reducing ischemic complications. Although several animal studies have reported the longitudinal evaluation of neointimal formation post-FD placement using optical coherence tomography (OCT), no human studies have been published. We describe the first case of a patient with follow-up longitudinal angiography and OCT examination at 1 and 3 months post-FD placement for an internal carotid artery aneurysm. At 1 month, the OCT images showed complete neointimal formation on stent struts of the parent artery and partial neointimal formation on the neck. The aneurysm was occluded on angiography at 3 months and all stent struts were covered with neointima on OCT images. An OCT examination may provide insights regarding the mechanism underlying the healing process of aneurysms treated by an FD.

Background: Antiplatelet maintenance is essential to avoid ischemia following stent-assisted coiling (SAC) procedures. However, indications for antiplatelet medication discontinuation (AMD) remain controversial, and optimal timing of cessation has yet to be determined. Our goal, which we achieved through a multicenter, prospectively enrolled, non-interventional study, was to investigate the safety of AMD conducted more than 12 months after SAC.

Methods: Data were retrieved from the records of 495 consecutive patients prospectively enrolled at 10 institutions during a 3-year period (between January 2021 and December 2023). Each subject had discontinued antiplatelet therapy >12 months after SAC. Maintenance duration and cessation were both at physician discretion, based on patient clinical status. We investigated clinical outcomes for at least 6 months after AMD.

Results: A majority of patients engaged in AMD (292/495, 59.0%) were not at high risk for ischemia. Mean±SD time to AMD was 20.0±12.9 months after SAC. Treated aneurysms were largely confined to the internal carotid artery (332/495, 67.1%), followed by the anterior (95/495, 19.2%) and middle (43/495, 8.7%) cerebral arteries. A laser-cut open-cell stent was most often applied (60.5%); laser-cut closed-cell (22.2%) and braided closed-cell (17.3%) stents were used to a lesser extent. Four patients underwent double stenting. Despite sizeable (41.0%) high-risk group representation, there were no ischemic events in relation to AMD.

Conclusion: Our results suggest that AMD >12 months after SAC procedures is safe in patients who are not at high risk for ischemia. Randomized controlled trials are warranted to confirm these results.

Objectives: This study aimed to identify factors at baseline associated with visual outcomes of patients with idiopathic intracranial hypertension (IIH) with venous sinus stenosis who underwent venous sinus stenting.

Methods: The study eyes were divided into two groups according to mean deviation (MD) at 6-month post-stenting follow-up: MD better than -2.0 dB (the favorable visual outcome group) and equal to -2.0 or worse (the poorer visual outcome group). Variables at baseline between the two groups were compared. A multivariable logistic regression model was performed to identify the factors at baseline associated with poorer MD outcomes at 6 months.

Results: The poorer recovery group had a lower incidence of tinnitus (5.9% vs 27.5%, P=0.015), worse initial best corrected visual acuity (0.22 vs 0, in logMAR, P=0.000), worse preoperative MD (-8.64 vs -3.05, P=0.000) and higher trans-stenotic gradient pressure (19.5 vs 16, P=0.002) and total cranial gradient pressure (TCGP) (25.75 vs 18, P=0.000), lower ganglion cell complex (GCC) thickness (90.5 vs 99, P=0.005), higher focal loss volume percentage (2.35 vs 0.84, P=0.002) and global loss volume percentage (4.87 vs 1.8, P=0.012) of GCC. Multivariate analysis showed that worse preoperative MD and higher TCGP (OR 45.61, 95% CI 5.21 to 399.48; P=0.001 and OR 8.45, 95% CI 1.60 to 44.67; P=0.012, respectively) were associated with an increased risk of poorer MD outcomes at the 6-month follow-up.

Conclusion: This study found that worse preoperative MD and higher TCGP at baseline may be associated with poorer visual outcomes after stenting treatment.

Background: Ocular ischemic syndrome (OIS) and subsequent neovascular glaucoma (NVG) lead to irreversible visual impairment. This study aimed to investigate the association of carotid artery revascularization and the collateral circulation types via the circle of Willis (CoW) with NVG and visual prognosis in patients with OIS.

Methods: This retrospective cohort study included 22 patients with OIS, with a median follow-up of 12 months. The collateral circulation patterns via the CoW were classified into five types. The association of the carotid artery revascularization, collateral circulation types via the CoW, and morphological characteristics of the CoW with the presence of NVG and visual outcomes was assessed.

Results: The median time interval from baseline to visual decline during follow-ups in patients with carotid artery revascularization was longer than that in patients without carotid artery revascularization (13 months vs 9.5 months, P=0.041). Lacking collateral inflow via the CoW to the hemisphere ipsilateral to OIS was associated with NVG (odds ratio (OR), 11.000; P=0.022). The diameters of the C6 and C7 segments of the internal carotid artery, the A1 segment of the anterior cerebral artery, and the ophthalmic artery in OIS eyes were smaller than those in the contralateral eyes.

Conclusion: Early carotid artery revascularization should be considered in patients with OIS, with or without NVG, as it may contribute to an improved visual prognosis. Patients without collateral inflow via the CoW to the hemisphere ipsilateral to OIS may have a higher risk of NVG.

Background: Artificial intelligence can help to identify irregular shapes and sizes, crucial for managing unruptured intracranial aneurysms (UIAs). However, existing artificial intelligence tools lack reliable classification of UIA shape irregularity and validation against gold-standard three-dimensional rotational angiography (3DRA). This study aimed to develop and validate a deep-learning model using computed tomography angiography (CTA) for classifying irregular shapes and measuring UIA size.

Methods: CTA and 3DRA of UIA patients from a referral hospital were included as a derivation set, with images from multiple medical centers as an external test set. Senior investigators manually measured irregular shape and aneurysm size on 3DRA as the ground truth. Convolutional neural network (CNN) models were employed to develop the CTA-based model for irregular shape classification and size measurement. Model performance for UIA size and irregular shape classification was evaluated by intraclass correlation coefficient (ICC) and area under the curve (AUC), respectively. Junior clinicians' performance in irregular shape classification was compared before and after using the model.

Results: The derivation set included CTA images from 307 patients with 365 UIAs. The test set included 305 patients with 350 UIAs. The AUC for irregular shape classification of this model in the test set was 0.87, and the ICC of aneurysm size measurement was 0.92, compared with 3DRA. With the model's help, junior clinicians' performance for irregular shape classification was significantly improved (AUC 0.86 before vs 0.97 after, P<0.001).

Conclusion: This study provided a deep-learning model based on CTA for irregular shape classification and size measurement of UIAs with high accuracy and external validity. The model can be used to improve reader performance.

Background: Dual antiplatelet therapy (DAPT) is recommended around carotid artery stenting (CAS) to reduce periprocedural stroke risk. Clopidogrel is widely used, but response variability related to pharmacokinetics and CYP2C19 polymorphisms may limit its effectiveness. Ticagrelor is a more potent, direct acting P2Y12 inhibitor, but its comparative effectiveness in CAS remains uncertain.

Methods: We conducted a retrospective cohort study in the TriNetX database, identifying adults with carotid artery stenosis who underwent CAS between January 2016 and August 2025 and received either ticagrelor or clopidogrel. Primary outcomes at 180 days included ischemic stroke, major hemorrhage, intracranial hemorrhage, and all cause mortality. Secondary outcomes included inpatient readmission and emergency department (ED) visits. Propensity score matching (1:1), Kaplan-Meier survival, and Cox proportional hazards analysis were used.

Results: Among 6996 patients, 378 received ticagrelor and 6618 received clopidogrel; aspirin co-use was similar (89.7% vs 91.7%). After matching, 377 patients remained in each cohort. Ischemic stroke (2.7% vs 4.2%; HR 0.56, 95% CI 0.25 to 1.27; P=0.159) and major hemorrhage (2.9% vs 4.8%; HR 0.61, 95% CI 0.29 to 1.30; P=0.197) were numerically lower with ticagrelor. Rates of intracranial hemorrhage were similar (2.7% vs 2.7%; HR 0.61, 95% CI 0.14 to 2.53; P=0.488). Mortality was numerically higher with ticagrelor (3.4% vs 2.7%; HR 1.64, 95% CI 0.68 to 3.97; P=0.263). ED visits were similar (14.3% vs 14.6%; HR 0.97, 95% CI 0.67 to 1.42; P=0.895). Inpatient readmission was numerically lower with ticagrelor (15.9% vs 19.1%; HR 0.81, 95% CI 0.57 to 1.14; P=0.223).

Conclusion: Ticagrelor and clopidogrel showed comparable safety and effectiveness following CAS. Future prospective genotype informed trials are warranted to confirm these findings.