Neurointervention最新文献

Basilar artery pseudoaneurysm (BAPA) is an extremely rare yet life-threatening intracranial vascular lesion, characterized by insidious clinical onset and a remarkably high mortality risk upon rupture. In this case report, we describe a patient who was admitted to our department with spontaneous subarachnoid hemorrhage (SAH). Emergency digital subtraction angiography performed on admission revealed no vascular anomalies. One month after SAH onset, a comprehensive multimodal imaging evaluation ultimately confirmed the diagnosis of BAPA. Given the technical challenges in conventional management for this specific case, Traxcess-14 microguidewire-assisted endovascular electrocoagulation was performed as a last-resort therapy. Finally, follow-up imaging at 6 months demonstrated complete resolution of BAPA. Thus, we propose that Traxcess-14 microguidewire-assisted endovascular electrocoagulation may serve as a potential salvage treatment for highly selective BAPA cases in which conventional therapeutic approaches are unfeasible or have failed.

Achieving adequate wall apposition is a crucial technical goal when deploying flow diverters to treat wide-neck cerebral aneurysms. The socalled J-wiring technique is a common method used to optimize flow diverter wall apposition. However, the frictional interaction between the shaping device and the microguidewire tip during the formation of the J-loop, as well as the interaction between the J-loop and the flow diverter during J-wiring, may potentially cause damage to the guidewire's coating. Three frequently used guidewires were tested in vitro in a silicone aneurysm model. Manual J-shaping of guidewire tips, along with the J-wiring technique (including J-shaping), caused damage to the surface coating of guidewires, as observed by scanning electron microscopy. Therefore, both mechanisms may contribute to the generation of polymer micro-fragments in patients treated with flow diversion.

We reviewed our experience using transulnar access (TUA) to obtain intraoperative cerebral angiography during prone surgery for vascular pathology, where conventional transfemoral and transradial access can be difficult. Ten consecutive patients treated between April 2020 and August 2025 were included. Ulnar artery access was obtained in the supine position before the patient was turned prone for surgery, and angiography was performed after the procedure without repositioning. Eight patients had arteriovenous malformations and 2 had dural arteriovenous fistulas. In all cases, intraoperative angiography was successfully completed through the ulnar artery. The mean ulnar artery diameter was 2.4 mm, indicating adequate vessel size for catheterization, and mean fluoroscopy time was 7.5 minutes. No immediate access-site complications occurred, and no case required conversion to another access route. These findings suggest that TUA is technically feasible and may provide a practical option for intraoperative cerebral angiography when prone positioning limits access to traditional arterial sites. Although the study is limited by its small sample size and retrospective design, the consistent procedural success supports further investigation.

Purpose: To evaluate the safety and efficacy of ultrasound-guided retrograde internal jugular venous (IJV) puncture in neurointerventional procedures.

Materials and methods: This single-centre retrospective study evaluates data collected over 20 years. All punctures were performed under general anaesthesia using ultrasound guidance. The data were analyzed to assess patient demographics, indications and potential advantages, the technique of puncture, safety, outcomes, and complications associated with such punctures.

Results: The study included 60 patients (males: n=38, 63%; females: n=22, 37%). The median age was 33 years (range 13-73 years). A total of 74 retrograde jugular punctures were performed. Isolated right-sided punctures were done in 31 patients (52%), isolated left-sided punctures in 18 (30%), and 11 patients (18%) underwent bilateral punctures. The preferred access needle was an 18G needle; however, micropuncture access was used in some patients. No inadvertent arterial punctures were encountered. The most common indication was mechanical thrombectomy for cerebral venous thrombosis (62%). Other indications included transvenous embolization of carotid-cavernous fistulae (16%), embolization of cerebral dural arteriovenous fistulae (8%), inferior petrosal sinus sampling (8%), and cerebral venous sinus angioplasty or stenting (6%). In all procedures, the expected technical outcome was achieved.

Conclusion: Ultrasound-guided retrograde IJV puncture is a safe and effective method for accessing neurovascular pathologies requiring a transvenous approach. Based on our experience, this access has been routinely used without any major complications. We foresee the technique being accepted on a larger scale in the future.

We report a case of a patient in their 60s with a recurrent posterior communicating artery (PCOM) aneurysm after flow diverter (FD) placement, in whom the antegrade approach was not suitable due to coverage of the aneurysmal neck by the prior FD. Given the dominant configuration of the PCOM and the presence of a narrow but patent P1 segment, a retrograde approach via the posterior circulation was considered feasible. After confirming clinically acceptable flow from the vertebrobasilar system, a Woven EndoBridge (WEB) device was successfully deployed into the aneurysmal sac through the P1-PCOM route, intentionally covering the PCOM origin. Postoperative angiography showed stagnation of flow within the aneurysm, and complete occlusion was confirmed on follow-up angiography at 3 months. This case highlights the potential utility of retrograde WEB deployment for recurrent PCOM aneurysms following FD placement, particularly when PCOM occlusion is acceptable and anatomical access permits.

Peripheral aneurysms in the posterior circulation are rare vascular pathologies and their treatment remains challenging. Microsurgical procedures for these aneurysms are complex, lengthy, and highly invasive. Endovascular parent artery occlusion could be considered as an alternative treatment of choice; however, it is inherently challenging due to the small vessel caliber and fine manipulation required. Small bore flow-guided microcatheters (1.5 Fr) with high peripheral accessibility are currently available, whereas compatible coils remain limited. The brand-new i-ED coils can be compatible with these microcatheters. We herein present our patient series of peripheral aneurysms in the posterior fossa that were treated endovascularly, and discuss key technical tips and potential pitfalls.

Purpose: Flow diverting stents are a mainstay treatment of intracranial aneurysms (IA). They rely on reduction of intra-aneurysmal blood flow velocity along with endothelialization to induce thrombus formation and promote occlusion. Patients with hematologic disorders (HDs) can have abnormal fluid dynamics and blood cell/metal interactions that can affect the mechanism of action of flow diversion (FD). We sought to determine the outcomes of patients with various HD after receiving FD treatment for IA.

Materials and methods: This retrospective chart review examined 11 patients with various HD who received FD for their IAs. HD were classified as either coagulopathies (e.g., factor deficiencies, von Willebrand disease) or hemoglobinopathies (e.g., sickle cell disease [SCD]). Patient outcomes were assessed clinically and radiographically, with radiographic outcomes based on O'Kelly-Marotta (OKM) scores from follow-up angiograms.

Results: The total sample included 11 patients with 29 IAs. The median age was 50 years and 81.8% were female. All patients were on pre-procedural dual antiplatelet therapy. Out of the 29 total aneurysms, 17 were treated with FD and 15 originated from the paraophthalmic segment. Seven patients received surface modified stents. The median number of deployed stents during initial treatment was 2. The average aneurysm diameter was 5.03 mm (standard deviation: 3.88 mm). Patients with SCD were the only group to experience complications, with 2 out of 3 patients suffering a post-operative stroke. Seven patients with 8 treated aneurysms experienced complete occlusion at last follow-up with a mean time to OKMD score of 16.8 months.

Conclusion: Despite a small sample size, this series raises concern for the use of FD in patients with SCD. While FD still resulted in adequate rates of aneurysm occlusion, treatment methodology must be tailored for patients with HD.

Purpose: The Woven EndoBridge (WEB) was introduced in Japan in January 2021 and approved for all subtypes of wide-neck bifurcation aneurysms (WNBA). This retrospective study evaluated the safety and efficacy of the WEB device for all subtypes of WNBA.

Materials and methods: All patients treated with the WEB at our facility between January 2021 and May 2024 was reviewed. We selected the WEB device according to an oversizing policy, based on cumulative clinical evidence from global experience.

Results: We analyzed 120 aneurysms in 117 patients (56 males and 61 females with a mean age of 65.5±12.7 years). There were 45 anterior communicating artery aneurysms, 27 middle cerebral artery aneurysms, 17 internal carotid artery-posterior communicating artery aneurysms, 15 basilar artery top aneurysms, and 16 aneurysms in other locations. Aneurysm characteristics included a maximum diameter of 6.5 [5.3, 7.7] mm, height of 4.9 [3.9, 6.0] mm, width of 4.8 [4.0, 6.2] mm, and dome/neck ratio of 1.2 [1.1, 1.4]. All data are expressed in median [interquartile range]. Angiographic follow-up at 12 months in 96 cases showed complete obliteration in 68.8% and adequate obliteration in 90.6% of cases. Intraoperative ischemic events occurred in 5 cases (4.2%). Hemorrhagic events occurred in 2 cases (1.7%), with symptoms resolving by discharge, except for 1 case of mild paralysis. During follow-up, 1 patient developed a major stroke, resulting in morbidity (0.8%). Retreatment was required in 3 cases (2.5%). On multivariate analysis for complete occlusion at 12 months following WEB treatment, age was statistically associated with the outcome (odds ratio, 0.957 per year; 95% confidence interval, 0.919-0.996; P=0.033).

Conclusion: WEB is safe and effective for all subtypes of WNBA, with a low retreatment rate using an oversizing policy. This is the first report in a Japanese population.