Interventional Neuroradiology最新文献

Flow diversion (FD) has become a mainstay treatment for large wide-necked aneurysms. Despite excellent safety and efficacy, the risk of thromboembolic complications necessitates the use of dual antiplatelet therapy (DAPT). The use of DAPT makes hemorrhagic complications of stenting carry high morbidity and mortality. Additionally, DAPT usage carries a risk of "nuisance" complications that do not directly impact intracranial circulation but need to be managed nonetheless. To circumvent this issue, the most recent generation of flow diverters have undergone surface modification with various compounds to confer blood compatibility to limit clotting and thrombosis. While these newer generation flow diverters are marketed to enhance ease of deployment, the goal is to eventually facilitate single antiplatelet use with flow diverter treatment. This generation of FDs have potential to expand indications beyond unruptured wide-necked aneurysms to include ruptured intracranial aneurysms without the necessity of DAPT. Currently, no comprehensive review details the molecular mechanisms and pre-clinical and clinical data on these modifications. We seek to fill this gap in the literature by consolidating information on the coating technology for four major FDs currently in clinical use-Pipeline^TM Flex and Vantage Shield Technology^TM, FRED^TMX, p48/64 hydrophilic coating, and Acandis Dervio® 2heal-to serve as a reference guide in neurointerventional aneurysm treatment. Although the Balt silk^TM was one of the first FDs, it is uncoated, thus we will not cover this device in our review. A literature review was performed to obtain information on each coating technology for the major flow diverters currently on the market using international databases (PUBMED, Embase, Medline, Google Scholar). The search criteria used the keywords for each coating technology of interest "phosphorylcholine," "poly 2-methoxyethyl acrylate," "hydrophilic polymer coating," and "fibrin-heparin" Keywords related to the device names "Pipeline Shield," "Pipeline Shield with Flex Technology," "FRED," "FREDX," "p64," "p64-HPC," "Derivo 2heal" were also used. Studies that detailed the mechanism of action of the coating, any pre-clinical studies with surface-modified intravascular devices, and any clinical retrospective series, prospective series, or randomized clinical trials with surface-modified devices for aneurysm treatment were included.

BackgroundFlow reversal, achieved by occluding both the common and external carotid arteries to induce retrograde flow from the internal carotid artery, is a useful method for preventing distal embolization in cases of carotid artery stenting (CAS). The "conventional method" employed by our institute for CAS involves the use of one-way valves incorporated in a flow reversal system for rapid manual blood aspiration. Subsequently, we recently transitioned from the conventional method to the "simplified flow reversal carotid artery revascularization for radial access (SF-CARR)," in which external carotid artery occlusion is omitted while a transradial approach is implemented. This study aimed to clarify the efficacy and safety of SF-CARR in patients undergoing CAS.MethodsA retrospective study was conducted in 50 patients diagnosed with internal carotid artery stenosis between 2022 and 2025. Of these, 24 were treated with SF-CARR, while the others underwent the conventional method. We investigated patient characteristics, endovascular procedures, procedural invasiveness, including procedural time, radiation exposure, or contrast agent use, and clinical outcomes.ResultsCompared to the conventional group, a reduced procedural time (p = 0.001) was observed in the SF-CARR group. The radiation exposure dose (p = 0.020), fluoroscopy time (p = 0.003), amount of contrast agent injected (p < 0.001), and number of contrast agent injections (p < 0.001) were also reduced in the SF-CARR group. In addition, the transradial approach was adopted more frequently in the SF-CARR group (p < 0.001), and no significant differences were reported in complications or patients' outcomes between the two groups.ConclusionThis novel flow reversal method, "SF-CARR," can provide minimally invasive treatment to patients with carotid artery stenosis.

BackgroundAdvanced neuroendovascular procedures require trackable and supportive guide catheters, which facilitate safe device delivery. Echo intracranial base catheter was engineered as a large lumen (0.100″ ID) access catheter that is super trackable, supportive, and kink resistance, all while fitting within the puncture of a typical 8F sheath when its used with the thin-walled, Dash short sheath (9F). This case series evaluates its performance as a guide catheter in various neurointerventional procedures.MethodsConsecutive cases using an Echo access catheter were identified from a prospectively maintained patient database at a comprehensive stroke center between April and July 2025. Demographic, clinical, procedural, and angiographic characteristics were collected. Outcomes of interest included procedural success and periprocedural complications, including flow-limiting vasospasm, vessel dissection, and thrombus formation.ResultsEcho access catheter was used in a total of eleven cases, including six thrombectomies, two venous sinus stents, one intracranial stent, one intracranial angioplasty, and one aneurysm flow diversion. Average patient age was 61 years old, 6 (54.5%) were female, and all had femoral access. Echo catheter tip was placed in the petrous segment of ICA in three cases (27.2%), the lacerum segment in three cases (27.2%), the cervical segment in two cases (18.1%), the cavernous segment in one case (9.1%), the vertical petrous segment in one case (9.1%), and the transverse sinus in one case (9.1%). Intracranial stenting and flow diversion were completed with use of a distal access catheter, and intracranial angioplasty was successfully performed with an Echo access catheter alone. Echo access catheter was able to easily navigate to the transverse venous sinus over a ledge-reducing delivery microcatheter and deliver devices for venous sinus stenting and angioplasty. There was a 100% procedural success rate. No significant catheter-related complications were observed.ConclusionsThis series highlights Echo access catheter's safe and effective use in a diverse representation of neuroendovascular procedures.

ObjectiveAchieving recanalization with the few passes as possible is essential for favorable outcomes in mechanical thrombectomy (MT). However, when recanalization fails, the underlying reasons often remain unclear because device-thrombus interactions cannot be directly visualized during the procedure. We investigated how device maneuver during the pinching technique influences first pass recanalization (FPR).MethodsUsing a 3D silicone cerebrovascular model and swine thrombi, 109 MT procedures were performed by experienced neurointerventionalists under clinical use fluoroscopy, blinded to direct visualization. Real-world procedural videos were retrospectively analyzed to assess the impact of device maneuvers on FPR.ResultsThe pinching technique for non-segmented thrombus was applied in 58 cases. Advancing the aspiration catheter (AC) to achieve thrombus contact occurred in 52 cases, yielding FPR in 44 cases. Pulling the stent retriever (SR) toward the AC after contact was performed in 14 cases, all achieving FPR, compared with 32 of 44 cases without this maneuver. SR deployment after AC-thrombus contact frequently caused proximal AC displacement and loss of thrombus contact.ConclusionIn pinching technique, advancing the AC to ensure thrombus contact, followed by pulling the SR toward the AC before system retrieval, may prevent stretching, facilitate effective pinching, and improve the likelihood of achieving FPR.

BackgroundAnimal models are essential for evaluating endovascular device safety and efficacy. Rats offer advantages, such as genetic manipulability, lower cost, and shorter healing and breeding cycles, compared to large animals. These features support studying aneurysm healing mechanisms and enable high-throughput testing. We developed an optimal rat aneurysm model for device evaluation.MethodsSaccular aneurysms were created at the origins of the left renal artery (LRA) with acetylsalicylic acid (ASA) (LRA/ASA group, n = 7); the right common iliac artery (RCIA) with ASA alone (RCIA/ASA group, n = 6) or ASA plus clopidogrel (CLP) (RCIA/ASA + CLP group, n = 7); and the left common iliac artery (LCIA) with ASA + CLP (LCIA/ASA + CLP group, n = 7). The origins of these arteries were surgically exposed. During temporary ligation of the vessel origin, the vessel was bisected and endoluminal elastase was incubated in the proximal stump for 10 min, followed by release of the proximal ligation and permanent ligation of the stump. Angiographical and histological analysis were performed 4 weeks post-procedure.ResultsFollow-up digital subtraction angiography revealed mean ± standard deviation aneurysm height/neck dimensions of 1.2 ± 0.4/1.2 ± 0.1, 2.9/3.1, 2.3 ± 0.6/1.9 ± 0.3, and 2.1 ± 0.6/2.0 ± 0.4 mm for the LRA/ASA, RCIA/ASA, RCIA/ASA + CLP, and LCIA/ASA + CLP groups, respectively. The survival rate was 29%, 17%, 71%, and 86% in the LRA/ASA, RCIA/ASA, RCIA/ASA + CLP, and LCIA/ASA + CLP groups, respectively. Histopathological analysis of these aneurysms confirmed the absence of the internal elastic lamina and revealed aneurysmal changes in the arterial wall, resembling the pathological findings observed in human aneurysm specimens.ConclusionsCommon iliac aneurysm models with ASA + CLP can be used to evaluate the safety and efficacy of endovascular devices.

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.