Interventional Neuroradiology最新文献

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.

IntroductionAneurysmal subarachnoid hemorrhage (aSAH) is often complicated by delayed cerebral vasospasm (DCV), a major cause of morbidity and mortality. Balloon angioplasty is standard for refractory cases but carries a high risk in distal vessels. This study reports preliminary single-center experience with the Comaneci device for DCV, emphasizing distal segments beyond the circle of Willis, where evidence remains limited.MethodsWe retrospectively analyzed patients with aSAH and symptomatic DCV refractory to medical therapy treated with Comaneci-assisted angioplasty (CAA). Demographic, procedural, clinical, and angiographic data were collected from electronic records. Angiographic response was graded using a vasospasm severity scale.ResultsCAA was performed in 94 vessels across 14 patients (median age 63 years; 85.7% female). Severe-to-critical vasospasm was present in 88.6%. Most interventions involved the anterior circulation (79.1%), with distal segments (M2 and A2-A4) comprising 54.1%. The M2 segment was most frequently treated (36.4%). Patients underwent a median of three interventions (range 2-6). Angioplasty resulted in significant resolution of vasospasm in 92.7% of vessels, with retreatment required in 8.3%. At 6 months, a favorable outcome (mRS 0-2) was observed in 51.5% of patients, while 90-day mortality was 21.4%. No vessel perforations or long-term complications occurred; one transient occlusion was successfully managed with aspiration.ConclusionsCAA appears feasible and safe for DCV, particularly in the distal vasculature where balloon angioplasty is rarely used. These findings suggest the device may provide a valuable alternative to conventional therapy. Larger prospective studies are required to confirm safety, efficacy, and long-term clinical impact.

Endovascular treatment of brain arteriovenous malformations (AVMs) is complex due to the intricate angioarchitecture, requiring accurate identification of feeding arteries, draining veins, and the nidus. While 3D digital subtraction angiography (DSA) aids visualization, it lacks vessel-specific segmentation. Embo ASSIST (GE HealthCare, USA) is a software designed to enhance procedural planning and real-time guidance through automatic segmentation and 3D roadmap visualization. This study evaluates the feasibility and clinical utility of Embo ASSIST in brain AVM embolization, focusing on its impact on procedural planning, navigation, radiation exposure, and contrast media use. A retrospective analysis of 19 procedures in 14 patients was conducted between February and August 2021. Images from biplane DSA and cone-beam computed tomography (CBCT) were processed with Embo ASSIST for vascular segmentation. A structured survey, rated by two senior neuroradiologists, assessed the software's effectiveness. Results showed Embo ASSIST improved procedural planning, with a better understanding of angioarchitecture (3.8/5), pedicle definition (3.9/5), and embolization pathway selection (3.9/5). It allows a reduction of contrast media use (3.7/5), radiation exposure (3.8/5), and procedure time (3.8/5) according to the operators. The software was highly rated for ease of use (3.8/5), CBCT processing speed (4.2/5), and integration with fluoroscopic navigation (4.3/5). However, vein segmentation was limited (3.0/5), requiring manual corrections. In conclusion, Embo ASSIST significantly improved AVM embolization procedures, enhancing visualization, navigation, and efficiency. Future advancements in venous segmentation and AI-based dynamic vessel analysis could optimize treatment further.

BackgroundFlow diversion for intracranial aneurysms is indicated for wide-necked aneurysms in non-perforator-rich segments. However, devices are challenging to deploy in distal/tortuous vasculature. LVIS^TM EVO^TM is a braided intermediate-density stent offering greater flexibility and navigability than flow diverters with higher metal-to-surface ratios. We investigated its off-label use as an independent flow diverter for small, complex intracranial aneurysms.MethodsWe retrospectively reviewed patients at a single center who underwent independent stenting with LVIS^TM EVO^TM from December 2023 to September 2024. Demographics, procedural details, and angiographic outcomes were analyzed. Follow-up computed tomography angiography was performed from May 2024 to October 2025. Descriptive statistics were used; non-parametric tests compared aneurysm and parent vessel diameters.ResultsNine patients (median age 59; 89% female) with off-label intracranial aneurysms (median diameter 5 mm) were treated using LVIS^TM EVO^TM (median diameter 3 mm, length 18 mm). Deployment was technically successful in 100% of cases with no peri-procedural complications. One patient experienced delayed hemorrhage with full neurological recovery. At follow-up (available for 6 patients), 83.3% showed complete aneurysm occlusion (Raymond-Roy Occlusion Classification [RROC] class I). All patients demonstrated 100% stent patency and no new neurological deficits.ConclusionLVIS^TM EVO^TM demonstrated technical feasibility and acceptable initial safety as an off-label flow-diverting device for small (as low as 2.5 mm), distal aneurysms in this limited single-center experience. Its favorable deliverability, safety profile, and occlusion rates suggest it as a possible alternative to currently marketed flow diverters in anatomically challenging patients. These findings warrant validation in larger, multicenter studies with extended follow-up.

BackgroundMiddle meningeal artery embolization (MMAE) has emerged as a promising minimally invasive approach for chronic subdural hematoma (cSDH). We aimed to compare the effectiveness of middle meningeal artery embolization (MMAE) as a standalone therapy, MMAE combined with surgery, and surgery alone, while also compare embolic agents (Onyx, NBCA, particles), and access approaches (femoral vs. radial).MethodsWe systematically searched PubMed, Scopus, and Web of Science through January 2025 for comparative studies focusing on MMAE and surgery in cSDH. Primary outcomes were recurrence and rescue surgery.ResultsA total of 44 studies (39 observational and 5 randomized controlled trials) met inclusion criteria. MMAE alone (OR: 0.39; CI: 0.25 to 0.64) and adjunctive MMAE (OR: 0.40; CI: 0.29 to 0.55) had lower recurrence rates compared to surgery alone. However, there were no significant differences in complication rates or functional outcome (mRS 0-2) at the last follow-up. Onyx was associated with the lowest surgical rescue needs and radial access trended toward fewer access site complications compared to femoral access.ConclusionMMAE, whether used alone or as an adjunct, is associated with significantly lower recurrence and fewer complications than surgery alone. Choice of embolic agent and radial access may also confer additional benefits. These findings emphasize the need for a comprehensive and tailored approach when utilizing MMAE to treat cSDH. Further studies are needed.

Intra-arterial chemotherapy (IAC) has become a mainstay treatment for retinoblastoma and has been used for lacrimal gland malignancies, enabling lower chemotherapeutic dosages while achieving higher local drug concentrations and reducing systemic side effects. We retrospectively report three patients who received IAC for retinoblastoma and lacrimal gland malignancies and subsequently developed peri-procedural clinical symptoms associated with transient intracranial magnetic resonance imaging (MRI) findings. In the first case, a patient with lacrimal gland carcinoma ex-pleomorphic adenoma was treated with two cycles of intra-arterial cisplatin and developed seizure-like symptoms, alongside MRI edema-like signals in the left frontal and temporal lobes. In the second case, a patient with bilateral retinoblastomas underwent combination IAC therapy and later experienced visual disturbances correlated with MRI abnormalities in the left occipital lobe. In the third case, a patient with right eye retinoblastoma received a similar IAC regimen and afterwards presented with neurologically non-correlative clinical symptoms. This prompted an intracranial MRI, which revealed a right frontal lobe gyral signal abnormality. Additionally, subsequent MRI exhibited new findings in the right optic chiasm and prechiasmatic optic nerve. In all cases, the imaging abnormalities and clinical symptoms eventually resolved, and follow-up imaging demonstrated no evidence of permanent structural brain parenchymal damage. Neurointerventional oncology is an evolving field, and our case series contributes to the increasing acknowledgment of its expanding indications. To the best of our knowledge, such transient intracranial imaging features following IAC have not been previously reported. Therefore, it is important for neurointerventionalists to recognize the transient nature of MRI findings highlighted by our reported cases.