Interventional Neuroradiology最新文献

IntroductionIntracranial aneurysms (IAs) affect approximately 3.2% of the global population, and their rupture leading to subarachnoid hemorrhage remains a significant cause of morbidity and mortality despite therapeutic advancements. While genetic factors have been implicated in IA pathogenesis, they account for only about 41% of heritability, suggesting that other mechanisms-particularly epigenetic modifications-may play a critical role. Epigenetic processes such as DNA methylation, histone modification, and non-coding RNA regulation have been shown to mediate gene-environment interactions, influencing endothelial function and vascular remodeling. This systematic review aims to synthesize the current literature on epigenetic mechanisms implicated in IA development, progression, and rupture.MethodsThe review was conducted in accordance with PRISMA guidelines, including both in vitro and in vivo studies available in PubMed up to November 2023. A total of 1019 studies were screened, resulting in 77 eligible full-text articles for data extraction.ResultsThe most frequently studied mechanisms were microRNAs (59.7%), DNA/RNA methylation (20.8%), circular RNAs (7.8%), long non-coding RNAs (6.5%), and histone modifications (5.2%). Notably, only three overlapping epigenetic targets were identified across studies, underscoring the field's methodological heterogeneity and lack of standardization. These individual epigenetic pathways are further examined in detail within the Discussion section.ConclusionThese findings underscore the emerging role of epigenetic research in elucidating novel pathways of intracranial aneurysm pathogenesis, while the limited reproducibility across studies highlights the need for standardized methodologies and larger, more diverse cohorts. Epigenetic regulation remains a promising target for future genetic and therapeutic investigations.

BackgroundBrain arteriovenous malformations (bAVMs) are complex vascular disorders associated with a considerable lifetime risk of intracerebral hemorrhage. Predicting the likelihood of rupture remains a clinical challenge due to the complex interplay of molecular, anatomical and hemodynamic factors.ObjectiveThis work proposes an image analysis using machine and deep learning algorithms to evaluate bAVM structural vessel characteristics that may be associated with rupture.MethodsWe trained four artificial intelligence models: isolation forest (IForest), one class support vector machine (OCSVM), variational autoencoder (VAE), and Score Based Models (SBM) to automatically analyze vascular segments of 9 previously ruptured and 11 unruptured bAVMs and detect curve characteristics that may be associated with rupture.ResultsArtificial intelligence models were able to detect curve characteristics inside bAVM that clearly differentiated the ruptured from the unruptured group. The best performing model detecting the rupture risk curves (RRC) was SBM, achieving 98.9% F1-score and 100% Area Under the Curve (AUC). The ruptured group showed significant curves with higher median length and tortuosity, and lower median radius.ConclusionsThe proposed curve analysis approach allowed identifying vessel segments of bAVMs associated with previous rupture with high accuracy. It has the potential to be used as an indicator of hemorrhage and a predictor for rupture in further studies.

IntroductionIdiopathic intracranial hypertension (IIH) can result in headaches, pulsatile tinnitus, papilledema, and other neurological symptoms. Weight loss can alleviate some symptoms of IIH. This study aims to investigate the effect of venous sinus stenting on post-operative weight and body mass index (BMI) changes among IIH patients. The secondary objective is to investigate the relationship between post-operative weight changes and papilledema resolution.MethodsPatients with papilledema undergoing venous sinus stenting for IIH were retrospectively reviewed from two comprehensive North American cerebrovascular centers. Patient demographics, surgical course, post-operative outcomes, and weight were analyzed. A systematic review and meta-analysis of post-operative weight in stented IIH patients was conducted.ResultsTwenty-eight patients with a diagnosis of IIH and papilledema who underwent venous sinus stenting were identified across two institutions. Patients had a mean pre-operative weight of 103.2 kg, which decreased to 101.5 kg at 3-month follow up (p = 0.0757). Patients at 6-month follow-up saw a weight decrease to 97.4 kg (p = 0.0066). Patients who saw papilledema resolution saw a mean greater decrease in weight (-4.5%) at 6-month follow up than those whose papilledema did not resolve (-1.7%), although this was insignificant (p = 0.1091). A total of 41 patients were included in the meta-analysis. Patients had an average of 1.1 increase in BMI at 3-month follow up.ConclusionsThis study shows that venous sinus stenting leads to modest weight reduction in IIH patients, and those with resolved papilledema experience slightly greater weight loss. Further research is necessary to determine the clinical significance of these findings.

BackgroundLarge vessel occlusion (LVO) prediction scales are used to triage prehospital suspected stroke patients with a high probability of LVO stroke to endovascular therapy centers. The sensitivities of these scales in the 6-to-24-h time window are unknown. Higher scale score thresholds are typically less sensitive and more specific. Knowing the highest scale score thresholds that remain sensitive could inform threshold selection for clinical use. Sensitivities may also vary between left and right-sided LVOs.MethodsLVO prediction scale scores were retrospectively calculated using the National Institutes of Health Stroke Scale (NIHSS) scores of patients enrolled in the DAWN Trial. All patients had last known well times between 6 and 24 h, NIHSS scores ≥ 10, intracranial internal carotid artery or proximal middle cerebral artery occlusions, and mismatches between their clinical severities and infarct core volumes. Scale thresholds with sensitivities ≥ 85% were identified, along with scores ≥ 5% more sensitive for left or right-sided LVOs. Specificities could not be calculated because all patients had LVOs.ResultsA total of 201 out of 206 patients had the required NIHSS subitem scores. CPSS = 3, C-STAT ≥ 2, FAST-ED ≥ 4, G-FAST ≥ 3, RACE ≥ 5, and SAVE ≥ 3 were the highest thresholds that were still 85% sensitive for DAWN Trial LVO stroke patients. RACE ≥ 5 was the only typically used score threshold more sensitive for right-sided LVOs, though similar small differences were seen for other scales at higher thresholds.ConclusionsOur findings likely represent the maximum sensitivities of the LVO prediction scales tested for ideal thrombectomy candidates in the 6-to-24-h time window because NIHSS scores were documented in hospitals during a clinical trial rather than in the prehospital setting. Patients with NIHSS scores < 10 or more distal LVOs would lower sensitivities further. Selecting even higher scale thresholds for LVO triage would lead to many missed LVO strokes.

Spontaneous intracranial hypotension (SIH) is a serious medical condition caused by loss of cerebrospinal fluid at the level of the spine, which, when not treated, may cause substantial long-term disability and increase morbidity. The following video summarizes the necessary steps for successful diagnosis and treatment of SIH, starting with a brain and spine magnetic resonance imaging, followed by dynamic myelography. Because an epidural bloodpatch did not provide a lasting relief, the patient underwent surgery which demonstrated a ventral dural slit caused by an osteodiscogenic microspur. In the 1-month follow up, the patient was symptom free. This video is meant to raise awareness of SIH among clinicians in order to increase general sensitivity for this diagnosis.

IntroductionStenting is increasingly used for neurovascular atherosclerotic lesions, but standardized techniques and dedicated devices remain lacking.ObjectiveTo report outcomes and technical considerations of off-label use of the coronary Onyx drug-eluting stents (DES) for intra- and extracranial neurovascular atherosclerotic lesions.MethodsWe retrospectively reviewed all patients who underwent Onyx DES placement for neurovascular atherosclerotic lesions at our institution between January 2018 and September 2024. Demographics, clinical presentation and follow-up, angiographic findings, procedural details, and complications were collected. Outcomes included procedural success, periprocedural stroke, and in-stent restenosis (ISR) requiring reintervention.Results84 Onyx DES were deployed in 63 patients (33% female). Procedural success was achieved in all cases. Stent locations included the basilar artery (21.4%), middle cerebral artery (20%), cervical internal carotid artery (ICA) (2.4%), petrous ICA (4.8%), cavernous ICA (8.3%), supraclinoid ICA (10.7%), V1 (10.7%), V3 (1.2%), and V4 (19%). Three patients (4.8%) developed iatrogenic carotid-cavernous fistulae, all successfully treated. Postprocedural stroke rate was 4.8%. During a mean follow-up of 20.6 months, three patients (4.8%) required angioplasty for ISR. Independent predictors of complications included posterior circulation stenting (OR 13.8, p = .005), smaller stent diameter (OR 0.17, p = .03), and higher stent number (OR 14.7, p < .0001).ConclusionOnyx DES demonstrated excellent navigability, high technical success, and favorable long-term outcomes in patients with neurovascular atherosclerotic lesions. Together with growing comparative evidence, these findings suggest newer-generation DES may overcome limitations of earlier stent systems and merit further prospective evaluation.

IntroductionUnderstanding of costs associated with different mechanical thrombectomy (MT) approaches lags behind procedural efficacy and safety considerations. This study evaluates cost-effectiveness of MT using Monopoint (Route 92 Medical, San Mateo, CA) as first-line approach compared to traditional contact aspiration (CA) and stentriever/aspiration (SA).MethodsRetrospective analysis of consecutively treated ICA terminus or M1 occlusion patients across four high-volume stroke centers was conducted, categorized into Monopoint, CA, or SA groups. Direct device costs and total costs were obtained from institutional databases. Statistical analyses included mixed-effects linear regression and multivariable analysis.ResultsAmong 148 patients undergoing MT (Monopoint: 74, CA: 32, SA: 42), device costs were lowest for the Monopoint group ($7836 ± 4570) vs. CA ($10,089 ± 6078, p < 0.001) and SA ($19,069 ± 4730, p < 0.001). Total costs followed a similar pattern (Monopoint: $27,089 ± 19,899, CA: $28,883 ± 14,161, p < 0.001, SA: $63,327 ± 72,440, p < 0.001). Monopoint demonstrated a higher final expanded Thrombolysis In Cerebral Infarction (eTICI) 2C/3 reperfusion rate (85.1% vs. 62.5% for CA, 71.4% for SA, p < 0.001) and fewer passes (1.8 vs. 2.0, p = 0.001). Technique crossover occurred less often with Monopoint compared to CA (6.8% vs. 34.4%, p < 0.001), and similar to SA (7.1%, p = 0.937). Post-procedural subarachnoid hemorrhage was more common with CA (16.7%) or SA (6.3%) compared to Monopoint (1.3%, p = 0.003).ConclusionFirst-line MT with Monopoint showed lower direct and total costs compared to CA and SA. Monopoint cost-effectiveness may be driven by fewer passes, decreased adjunctive device use, higher recanalization rates, fewer complications, and less post-MT hemorrhage, highlighting potential economic benefits of an optimized MT strategy.

BackgroundAspiration catheters that feature larger calibers improve mechanical thrombectomy (MT) efficacies and outcomes. The Broadway System is a fully integrated catheter platform engineered for super-large bore access to M1. This multicenter study details the early clinical experience with the Broadway System as a first-line device for direct-aspiration thrombectomy.MethodsWe conducted a retrospective analysis of consecutive cases across four comprehensive stroke centers. Patient characteristics and pre-procedural stroke data were recorded. Primary outcomes were rates of successful reperfusion, defined as mTICI ≥ 2B, and first-pass efficacy (FPE). Efficiency metrics included the time to initial contact with the occlusion site and the procedural time from puncture to final recanalization. Safety outcomes included procedure-related complications, occurrence of distal embolization, and incidence of symptomatic intracerebral hemorrhage (sICH). Functional outcomes were assessed by the mRS and change in NIHSS at discharge.ResultsThirty-seven patients (40.5% female) were treated with MT. The Broadway 8 catheter successfully engaged the target occlusion in 91.9% of cases, with a median time from puncture to contact with the thrombus of 10.5 min. Effective recanalization was achieved in 97.1% of cases, with 44.1% FPE. Median time from puncture to final recanalization was 21 min. The median presenting NIHSS was 16, with an improvement of 6 points at discharge. There was a 10.8% incidence of sICH.ConclusionIn this initial patient cohort, the Broadway System appears to be safe and effective when used for aspiration thrombectomy. Further studies are warranted to determine specific niche roles best suited for this catheter suite.