Interventional Neuroradiology最新文献

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.

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.