Neurointervention最新文献

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.

Purpose: Carotid web (CW) is an underrecognized cause of recurrent ischemic stroke in young patients with cryptogenic stroke, and its optimal management remains uncertain. This study aimed to determine the recurrence of ischemic events and the incidence of asymptomatic thrombus formation in CW, in order to optimize secondary prevention strategies.

Materials and methods: We conducted a retrospective analysis of patients diagnosed with CW at a comprehensive stroke center in Spain between January 2021 and December 2024. CW was identified via computed tomography angiography or digital subtraction angiography. We assessed stroke recurrence, asymptomatic thrombus formation, and secondary prevention strategies. Early duplex sonography was systematically performed during hospitalization to detect in-hospital re-thrombosis.

Results: Among 23 patients with CW-related ischemic stroke, 2 (8.7%) experienced recurrent ipsilateral stroke. Notably 4 (17.4%) patients exhibited thrombus formation within the CW, 3 of them while still hospitalized, detected through early duplex sonography. These findings, which preceded any clinical recurrence, prompted timely anatomical correction via stenting or endarterectomy, with no further events observed. All patients with clinical or radiologic recurrence (n=6) underwent either carotid stenting (n=4) or endarterectomy (n=2), after which no further ischemic events were observed.

Conclusion: CW carries a substantial risk of early thrombus formation and recurrent ischemic stroke. Routine early neurosonologic monitoring during hospitalization can detect in-hospital re-thrombosis and enable timely intervention with stenting or endarterectomy, which appears effective in preventing recurrence.

Recent randomized controlled trials (EndovaSCular TreAtment to imProve outcomEs for Medium Vessel Occlusions, EnDovascular therapy plus best medical treatment [BMT] versus BMT alone for MedIum VeSsel Occlusion sTroke, and Evaluation of Mechanical Thrombectomy in Acute Ischemic Stroke Related to a Distal Arterial Occlusion) have not demonstrated a clinical benefit of thrombectomy for distal medium vessel occlusions (DMVOs), in contrast to the proven efficacy for large vessel occlusions. Trial populations mainly included elderly patients with mild neurological deficits, which may explain the limited benefit and increased risk of complications. Importantly, Asian patients were not represented, despite regional cohorts showing distinct outcomes influenced by older age and a higher prevalence of intracranial atherosclerosis. Emerging device innovations and adjunctive strategies hold promise, but optimal patient selection remains crucial to defining the role of DMVO thrombectomy.

The femoral artery approach is the primary neuroendovascular access in pediatric patients. However, alternative access sites are sometimes essential. We present the first report of axillary arterial access for neuroendovascular intervention in an infant, and a literature review on pediatric access routes. We present a case of a neonate diagnosed with vein of Galen malformation, with failed canulation of the femoral artery. A right axillary artery access was successfully employed for the intervention. The patient showed improvement and no complications. We demonstrate the feasibility of axillary artery access for neuroendovascular intervention, which may be an alternative for similar challenging cases.

Purpose: Infarct location may significantly influence clinical outcomes in patients with acute ischemic stroke (AIS) treated with endovascular thrombectomy (EVT). This study aimed to investigate the impact of basal ganglia (BG) infarction on outcomes in AIS patients with large vessel occlusion (LVO) who achieved successful recanalization.

Materials and methods: We retrospectively analyzed consecutive AIS patients who underwent EVT at our center between March 2016 and January 2019. Patients with LVO who achieved successful recanalization (modified Thrombolysis in Cerebral Infarction ≥2b) were included. Preprocedural diffusion-weighted imaging (DWI) was used to identify BG infarction. Poor outcome was defined as a 3-month modified Rankin Scale score of 3-6. Multivariate logistic regression analysis was performed to identify independent predictors of poor outcome.

Results: A total of 222 patients were included, of whom 160 (72.1%) had BG infarction. Independent predictors of poor outcome included older age (odds ratio [OR], 1.10; P<0.001), higher National Institute of Health Stroke Scale scores (OR, 1.20; P<0.001), lower DWI-Alberta Stroke Program Early Computed Tomography Scores (OR, 0.79; P=0.009), hemorrhagic transformation (OR, 2.97; P=0.031), and BG infarction (OR, 4.14; P=0.002).

Conclusion: BG infarction was independently associated with poor outcome despite successful recanalization. These findings underscore the prognostic importance of infarct location and support the need for tailored treatment strategies in AIS patients with BG involvement.

Purpose: The selection of the appropriate Woven EndoBridge (WEB) size is the most critical aspect of the decision-making process in aneurysm WEB embolization. However, there are currently no precise criteria for measuring WEB size that correspond to each aneurysm. This study presents a process that includes a WEB index for determining the exact volume based on various aneurysm shape types.

Materials and methods: Sixty consecutive aneurysms treated with WEB device were included. The volume measurements of the aneurysms, based on their column configurations, were compared with WEB volume to assess the accuracy of the fit within each aneurysm. After categorizing the aneurysms into symmetric and asymmetric shapes, they were further classified into 5 types according to their configurations. We estimated outcomes, including any events or recurrences, and calculated WEB index (WEB volume/aneurysm volume) along with the median and interquartile range to evaluate differences based on shape type. A statistical analysis was conducted to identify associations between various variables and stenting and/or recurrence.

Results: Symmetric aneurysms (n=39, 65%) were more prevalent than asymmetric aneurysms (n=21, 35%). Among the 5 shape types, the column shape was the most common (n=32, 53%), followed by submarine (n=9, 15%), sphere (n=7, 12%), boots (n=6, 10%), and mitten (n=6, 10%) shapes. The median WEB index was 0.96. Asymmetric aneurysm shapes were associated with stent-assisted procedures (oversizing) (P=0.029) and the presence of sac remnants or recurrence (undersizing) (P=0.033). There were no adverse events reported, except for 1 non-procedure-related death at 7 months and 2 retreatments among 3 recurred aneurysms during a mean magnetic resonance angiography follow-up of 8 months (range, 3-21 months) and a mean clinical follow-up of 12 months (range, 3-30 months).

Conclusion: Outcome of WEB embolization depended on aneurysm configuration (shape types) and the measurement of aneurysm volume (WEB index).

Dural arteriovenous fistulas (dAVFs) are rare vascular malformations, often complicated by sinus thrombosis and cortical reflux. We report a patient with a Cognard Type IIb dAVF at the right transverse sinus and ipsilateral sigmoid sinus thrombosis, unsuitable for conventional embolization due to contralateral sinus hypoplasia. A novel therapeutic approach involving direct jugular vein puncture, venous recanalization, and stenting using a stiff 0.035-inch guidewire effectively downgraded the dAVF to Cognard Type I. At 3-month follow-up, stable angiographic outcomes, marked clinical improvement, and absence of seizures confirmed the efficacy of sinus stenting as a standalone treatment in an anatomically challenging case.

A 45-year-old female presented with progressive right hemifacial spasm (HFS) over 6 months. Magnetic resonance imaging revealed the right posterior inferior cerebellar artery (PICA) as the culprit vessel for HFS and a fusiform aneurysm in the vertebral artery (VA) just proximal to it. Following the patient's request for endovascular treatment of the VA, stent-assisted coil embolization was performed to achieve PICA deviation through VA straightening after stent placement and thereby reduce HFS symptoms. At 21 months post-procedure, her HFS had resolved, with imaging confirming PICA deviation due to VA straightening, suggesting that this anatomical change contributed to symptom resolution.

A patient in their early 60s presented with a headache and right-sided numbness. Imaging revealed a hemorrhagic lesion in the left thalamus and venous engorgement involving the left sphenoparietal sinus, with drainage through the basal vein of Rosenthal and the superficial middle cerebral vein. The trans-Galen approach was utilized for embolization, successfully obliterating the fistulas using coils without retrograde opacification. Post-procedure angiography demonstrated complete occlusion. This case underscores the trans-Galen approach as a safe and effective strategy for managing complex sphenoparietal sinus dural arteriovenous fistulas, providing direct access while minimizing complications and ensuring procedural success.