Interventional Neuroradiology最新文献

IntroductionTraumatic intracranial aneurysms (TICAs) are rare, potentially fatal complications of traumatic brain injury (TBI) or iatrogenic insult. Often forming as pseudoaneurysms, TICAs result from direct arterial wall disruption. Their unique pathophysiology, delayed presentation, and high rupture risk pose diagnostic and therapeutic challenges. This review synthesizes current evidence on TICA pathogenesis, diagnosis, and treatment, with particular emphasis on the evolving role of angiographic diagnosis and endovascular intervention.MethodsA structured PubMed search was conducted, supplemented by manual citation screening. All study designs were considered with no date restrictions. Articles were included if they reported traumatic intracranial aneurysms in patients of any age and discussed diagnostic or therapeutic approaches. Data were synthesized thematically across epidemiology, pathophysiology, imaging, treatment (endovascular and surgical), and surveillance.ResultsTICAs typically arise at sites of direct injury or at fixed vessel segments (e.g., distal ACA, peripheral MCA, cavernous/supraclinoid ICA). Their delayed and subtle appearance necessitates high clinical suspicion and serial imaging. Digital subtraction angiography is the diagnostic gold standard, though immediate or early post-trauma studies may be negative. Endovascular techniques, particularly flow diversion, are increasingly favored for their minimally invasive nature and ability to achieve parent vessel reconstruction. Open surgery retains a role for lesions complicated by mass effect, intracerebral hematoma, or anatomy unsuitable for endovascular repair. Outcomes vary with aneurysm location, treatment timing, modality, and TBI severity.ConclusionTICAs represent a distinct, high-risk entity requiring timely diagnosis and individualized, multidisciplinary management. Endovascular approaches are increasingly favored. Further research is needed to guide optimal surveillance imaging protocols.

BackgroundFlow diversion (FD) is increasingly used to treat ruptured intracranial aneurysms (rIA); however, antiplatelet (AP) management remains controversial. Intravenous (IV) GPIIb/IIIa inhibitors provide rapid, reversible platelet inhibition and may reduce hemorrhagic risk. We performed a meta-analysis and reported our institutional series to compare IV GPIIb/IIIa and classic AP protocols in FD for rIA.MethodsA systematic search identified studies reporting ischemic and hemorrhagic complications after FD for rIA stratified by AP regimen. Meta-analyses estimated pooled event rates and meta-regression compared outcomes between GPIIb/IIIa and classic AP strategies. We retrospectively reviewed rIA patients treated with FD at our institution.ResultsTwenty-six studies were included (387 patients): 167 (43.1%) received GPIIb/IIIa-only protocols and 220 (56.9%) received classic AP (predominantly aspirin and clopidogrel). The hemorrhagic complication rate was 9% (confidence interval (CI): 6%-13%), 5% (CI: 2%-10%) in the GPIIb/IIIa patients, and 12% (CI: 8%-17%) in the classic AP group; meta-regression demonstrated a lower hemorrhagic rate with GPIIb/IIIa (p = 0.047). The ischemic complication rate was 13% (CI: 9-19%), 11% (CI: 6-18%) in the GPIIb/IIIa group, and 15% (CI: 9%-24%) in the classic AP group (p = 0.38). Our cohort included seven patients (mean age: 59.1). Six received intra-procedural tirofiban, and one received ticagrelor/aspirin. Hemorrhagic and ischemic complications each occurred in 1/7 (14.3%) patients, two (28.6%) died and four (57.1%) achieved modified Rankin Scale ≤ 2 at 90 days.ConclusionsIV GPIIb/IIIa inhibitors administered at FD deployment for rIA are associated with fewer hemorrhagic complications without increased ischemic events and represent a feasible acute management strategy.

ObjectivesTo evaluate the feasibility, safety, and short-term efficacy of the antithrombogenic-coated CARESTO stent for venous sinus stenting (VSS) in idiopathic intracranial hypertension (IIH).MethodsThis retrospective multicenter study included IIH patients with venous sinus stenosis fulfilling the modified Dandy criteria, elevated lumbar puncture opening pressure, and a trans-stenotic pressure gradient ≥ 7 mmHg. Clinical endpoints were improvement of headache, papilledema, and visual function. Imaging endpoints included stent patency, venous sinus diameter, and restenosis. Physiological endpoints were the reduction of the trans-stenotic pressure gradient and lumbar puncture opening pressure. Safety was assessed by recording peri- and postprocedural complications.ResultsBetween January 2023 and August 2025, 16 IIH patients underwent VSS with the CARESTO stent at four centers. Mean age was 33.9 ± 6.9 years; 75% were female. Stent deployment was technically successful in all cases. The median trans-stenotic gradient fell from 18 to 3 mmHg and lumbar puncture pressure from 34 to 16.5 cmH₂O at 3 months, with sinus diameter increasing from 2.0 to 7.0 mm. All patients improved clinically, 81.3% within 24 hours. At 3 months, all stents were patent without restenosis, complications, or mortality.ConclusionVSS with the antithrombogenic-coated CARESTO stent appears feasible, safe, and effective, providing consistent short-term clinical, hemodynamic, and physiological benefits in IIH. Further prospective studies in larger cohorts are warranted and may open the door to performing VSS under single antiplatelet therapy.

BackgroundThe Woven EndoBridge (WEB) device represents an innovative solution for cerebral aneurysm occlusion, particularly for challenging wide-neck bifurcation aneurysms. However, factors affecting sustained occlusion remain poorly understood. We utilized machine learning to attempt to identify predictors of favorable long-term outcomes following WEB treatment.MethodsIn this multicenter retrospective study, we collected patient demographics, aneurysm characteristics, procedural details, and clinical outcomes. The primary endpoint was improvement in occlusion status, defined as maintained Raymond-Roy Occlusion Classification (RROC) grade 1, or improvement from grade 2 to 1, or from grade 3 to either 2 or 1 on final angiographic follow up. The dataset was split into training (75%) and validation (25%) sets. The CatBoost algorithm was selected based on performance metrics, with Shapley Additive exPlanations (SHAP) values calculated to determine feature importance. Furthermore, a multivariable binomial logistic regression model was performed to validate machine learning findings.ResultsAmong 720 aneurysms from 36 hospitals, 84% showed improvement in occlusion at follow up. Both machine learning and multivariable logistic regression identified aneurysm height as the most consistent correlate of nonimprovement (odds ratio (OR) 0.90 per mm, p = 0.022). In the CatBoost model, the highest-ranking features by SHAP included aneurysm height, patient age, treatment acuity, ACom location, WEB-SLS device, bifurcation anatomy, aneurysm multiplicity, baseline modified Rankin Scale, access route, and partial thrombosis.ConclusionsMachine-learning and regression analyses identified consistent predictors of occlusion improvement after WEB treatment, with aneurysm height most strongly linked to nonimprovement. These insights may guide patient selection and follow up. Findings require cautious interpretation and external validation in larger cohorts.

PurposeThe objective of this study is to report the initial experience with the PANTHER technique for ruptured intracranial aneurysms and to provide a descriptive comparison with patients treated using a single flow diverter (FD) under prasugrel single antiplatelet therapy (SAPT).MethodsA retrospective analysis was conducted on patients with subarachnoid hemorrhage due to ruptured wide-neck aneurysms. The PANTHER group (n = 8) underwent reconstruction with non-identical telescoping hydrophilic polymer-coated (HPC) FDs under prasugrel SAPT. For the purpose of comparison, the outcomes of patients treated with a single HPC-coated FD (n = 21) were reviewed. The data included complications, angiographic occlusion, and clinical outcomes.ResultsThe PANTHER procedures were technically successful, without procedure-related hemorrhagic, ischemic, or thromboembolic complications. At early follow-up (median 5 months), complete occlusion was observed in all available PANTHER cases, whereas in the single FD group, 77.8% of assessable aneurysms showed complete occlusion. At long-term follow-up, complete occlusion was documented in both groups.ConclusionIn this single-center series, the PANTHER technique was technically feasible and associated with high early occlusion rates and favorable clinical outcomes under prasugrel SAPT. A descriptive comparison with single FD treatment suggests a potential hemodynamic benefit of non-identical telescoping constructs. Larger prospective studies are warranted to validate these preliminary findings.

BackgroundThe transradial approach (TRA) has recently gained significant interest in the neuro-interventional community. A 6 French (6Fr) guide sheath system is the gold standard for most neuro-interventions. Most 6Fr devices available in the market are developed for transfemoral access and thus lack the torqueability necessary for TRAs. This study aimed to evaluate the safety and feasibility of the 6Fr Terumo R2P Destination Slender Guiding Sheath (TDGS) for neuro-interventional procedures.MethodsA retrospective review of consecutive patients who underwent TRA neuro-interventions using a 6Fr Terumo R2P Destination Slender Guiding Sheath between June 2021 and November 2023 was conducted. Clinical, radiographic, procedural data, complications, and immediate outcomes were reviewed.ResultsNinety-seven patients were identified. The 6Fr TDGS was able to navigate into the carotid system for the interventional procedure via TRA in 90 cases (92.78%). Two cases were initiated via TRA but were aborted due to vessel tortuosity (2.06%), and five cases were pre-operatively converted to a transfemoral approach due to operator preference (5.15%). Pre-procedure radial artery diameter ranged from 1.6 to 4.1 mm. The immediate post-procedure radial artery occlusion rate was 0%. No immediate or delayed access site complications were identified.ConclusionThe 6Fr TDGS is safe and efficacious for TRA neuro-intervention procedures. It provided adequate support, torqueability, and kink resistance for the majority of cases. These results may change clinical practice and demonstrate the need for larger studies regarding the safety and efficacy of the 6Fr TDGS.

IntroductionNumerous non-randomized studies suggest the benefit of endovascular thrombectomy (EVT) for medium vessel occlusion (MeVO) stroke, while recent randomized trials showed no benefit. In clinical practice, MeVO management remains heterogeneous. We gauged the current status quo of endovascular MeVO management and physicians' perspectives on future MeVO-EVT trials.MethodsInternational, cross-sectional survey study inquiring about practice patterns before and after publication of the MeVO trials, opinions on the design of second-generation MeVO trials, willingness to enroll in such trials, and personal opinions regarding optimal MeVO treatment strategies. Participants' anonymized responses were summarized using descriptive statistics.ResultsFour hundred fifty-six physicians responded to the survey (308 China, 55 North America, 48 Europe, and 45 other countries). 86/454 (18.9%) respondents reported treating more MeVOs with EVT since the recent MeVO-EVT trials, and 134/454 (29.5%) reported treating fewer. Four-hundred-sixteen of 454 (91.6%) reported that their willingness to enroll patients in a second-generation MeVO-EVT trial increased (282/454 [62.1%]) or remained the same (134/454 [29.5%]) compared to before the recent trial publications. Of 122/454 (26.9%) respondents who participated in a MeVO-EVT trial, 79/121 (65.3%) stated that enrolment bias occurred at their sites. Three hundred twelve of 454 (68.7%) respondents (271/378 [71.7%] interventionalists, 41/76 [53.9%] non-interventionalists, p = 0.004) expressed belief in EVT benefit despite the neutral trial results. Adjunct intra-arterial thrombolysis was anticipated to play a major role in future MeVO treatment by 290/454 (63.9%).ConclusionMost physicians think that EVT is beneficial in selected MeVO patients. Enrolment bias was thought to be a major contributor to the neutral trial results. Ninety percent were equally or more willing to enroll patients in a second-generation MeVO-EVT trial. Adjunctive intra-arterial thrombolytics were identified as a key strategy for future MeVO-EVT.

PurposeLarge aneurysms have a higher rupture risk, yet no available in vivo animal model consistently produces large aneurysms for testing endovascular therapies. Recent research suggests that adding calcium chloride (CaCl₂) to elastase yields larger aneurysms in a surgical rabbit model. We evaluated whether this effect translates to an endovascular approach by comparing aneurysm sizes created using elastase alone versus a CaCl₂-elastase combination.MethodsAneurysms were created in the right common carotid artery of New Zealand rabbits. One group received 1 mL porcine elastase; the other received elastase plus 0.055 g CaCl₂ (0.5 M). After four weeks, patency was confirmed via digital subtraction angiography. Two blinded co-authors measured the neck, width, and height of the aneurysms. Aneurysm volumes were estimated using AngioCalc.com. Statistical analyses were performed using either the Mann-Whitney U-test or t-test based on data distribution.ResultsTwenty-nine (29) New Zealand rabbits were included in the study: six in the CaCl₂ and elastase groups, 23 in the elastase-alone group. All induced aneurysms remained patent at follow-up. Mean neck size was significantly larger in the CaCl₂ + elastase group than in the elastase-alone group (4.4 ± 1.1 mm vs 3.5 ± 0.95 mm; respectively, p = 0.02). Differences in width (4.1 ± 0.92 mm vs 3.4 ± 0.36 mm; p = 0.06), height (9.0 ± 1.1 mm vs 9.1 ± 2.1 mm; p = 0.46), and volume (83.5 ± 38.35 mm^³ vs 53.0 ± 16.94 mm³; p = 0.11) were not significant between CaCl₂ + elastase and elastase-alone, respectively.ConclusionsCaCl₂ modestly increased neck size but did not significantly enlarge overall aneurysm dimensions. Further studies are needed to assess its utility in endovascular aneurysm models.

High-resolution imaging is critical for the diagnosis, treatment planning, and postoperative monitoring of cerebral aneurysms, which affect up to 5% of the population and pose a significant risk of rupture and subarachnoid hemorrhage. Surgical clipping remains a definitive treatment option, but metallic clips can introduce substantial imaging artifacts, complicating posttreatment assessment. This review synthesizes current knowledge on the impact of aneurysm clip materials and designs on artifact generation and explores strategies for artifact mitigation. Conventional materials like titanium are favored for their biocompatibility and reduced ferromagnetism but still cause beam hardening, streak artifacts, and signal loss in CT and MRI scans. Emerging alternatives, including ceramics, composites, polymers, and bioresorbable clips, show promise in reducing artifacts while maintaining mechanical reliability. Innovations in clip design, such as fenestrated or low-profile models, further aid in minimizing imaging distortion. Advanced imaging methods, including dual-energy CT, iterative reconstruction algorithms, and metal artifact reduction software, demonstrate significant improvements in image quality but may introduce limitations such as increased processing demands or subtle anatomical distortions. Future directions emphasize the development of next-generation clip materials, robotic-assisted surgical approaches, and artificial intelligence-driven reconstruction techniques to further optimize visualization and patient safety. Continued research and multidisciplinary collaboration will be essential to translate these innovations into routine neurosurgical practice.