Interventional Neuroradiology最新文献

Skull base cerebrospinal fluid (CSF) leaks can be challenging to diagnose. We describe a first technical report on a fluoroscopy-guided multiphase flat panel computed tomography cisternography to diagnose a CSF leak in a complex postoperative anterior cranial fossa. The entry point, pathway of leakage, and exit point were visualized in detail. The feasibility and technical details are described. This technique could be an additional asset in the diagnostic work up of complex CSF leaks, not only of the anterior cranial fossa, but also complex CSF leaks of the middle cranial fossa.

BackgroundRadiolucent head immobilization (RHI) devices have recently been introduced to the neurovascular space for the purpose of procedural efficiency and safety. However, limited data exists to support its efficacy. In this study, we assessed the potential benefits of RHI. We hypothesized that RHI use is associated with improved procedural efficiency without loss of angiographic image quality or increase in radiation exposure.MethodsA single-institution single-physician retrospective cohort study of patients who underwent cerebral digital subtraction angiography (DSA) or middle meningeal artery embolization (MMAE) under conscious sedation over a 1-year period was conducted. Comparative analyses of fluoroscopy time, image quality, and radiation dosage were performed.ResultsSignificantly shorter fluoroscopy times were observed for patients with RHI undergoing DSA (p < 0.05) and bilateral MMAE (p < 0.05). There was no significant difference in fluoroscopy time for patients undergoing a unilateral MMAE. No difference was found in total radiation dose between patients with RHI compared to patients without RHI. A blinded image quality comparison found no differences in image quality or presence of artifact upon review of DSA images.ConclusionUse of RHI devices was associated with significantly lower fluoroscopy times for DSA and bilateral MMAE without sacrificing image quality. RHI may prove beneficial for decreasing procedural times, particularly during longer, conscious sedation procedures.

BackgroundEndovascular therapy (EVT) improves functional outcomes and reduces mortality in acute ischemic stroke (AIS) due to basilar artery occlusion (BAO). However, data on hemorrhagic complications and nonneurologic adverse events remain limited. We conducted a systematic review and meta-analysis to assess these outcomes in randomized controlled trials (RCTs) comparing EVT versus best medical management (BMM).MethodsWe searched PubMed, Cochrane Library, and Embase in December 2024 for RCTs comparing EVT and BMM (PROSPERO registry CRD42024617681). Outcomes included any parenchymal hematoma (PH), PH type 1 and 2, subarachnoid hemorrhage (SAH), systemic/extracranial hemorrhage, pneumonia, and heart failure. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model.ResultsFour RCTs, 988 patients (556 EVT, 432 BMM), were included. EVT increased the risk of SAH (RR 5.14; 95% CI [1.35-19.56]; I² = 0.0%) and PH type 2 (RR 5.53; 95% CI [1.47-20.84]; I² = 0.0%) compared to BMM. No significant differences were observed for any PH (RR 1.91; 95% CI [0.92-3.97]; I² = 0.0%), PH type 1 (RR 0.71; 95% CI [0.22-2.29]; I² = 3.4%), systemic/extracranial hemorrhage (RR 1.06; 95% CI [0.71-1.60]; I² = 12.2%), pneumonia (RR 1.00; 95% CI [0.83-1.21]; I² = 0.0%), or heart failure (RR 2.00; 95% CI [0.34-11.92]; I² = 55.4%).ConclusionIn patients with BAO AIS, EVT is associated with an increased risk of SAH and PH type 2 compared with BMM. There was no significant difference in any PH, PH type 1, systemic/extracranial hemorrhage, pneumonia, and heart failure between groups.

BackgroundSpontaneous intracranial hypotension (SIH) is a severe condition caused by cerebrospinal fluid (CSF) leaks, leading to headaches and neurological impairments. Traditional epidural blood patch treatment is often ineffective, especially in refractory cases without a source leak identified. This study introduces and evaluates the Catheter-Assisted Sealing Technique (CAST), a novel neurointerventional approach for refractory SIH. CAST involves targeted or diffuse delivery of fibrin glue into the epidural space to repair CSF leaks.MethodsA retrospective case series of ten patients with refractory SIH underwent CAST using a fluoroscopy-guided epidural catheter approach. Clinical symptom resolution and follow-up MRI findings were assessed.ResultsNine of 10 patients achieved complete headache resolution and associated symptom relief. One patient experienced significant improvement without complete relief. Follow-up MRI showed resolution of pachymeningeal enhancement in all patients. One patient required repeat procedures for recurrent symptoms. No neurological injury or spinal cord compression occurred, with the only complication being transient femoral nerve palsy due to positioning that resolved within four months.ConclusionCAST is a promising, minimally invasive alternative for refractory SIH. It enables targeted or diffuse fibrin sealant application, providing a seemingly effective leak closure even in cases of occult or multifocal leaks. Early results show high success and safety rates, but larger cohorts and extended follow-up are needed to validate it as a standard treatment.

PurposeTransradial access (TRA) has been established for neurointervention; however, complications can occur at the radial access site. Radial artery spasm (RAS) is the most common complication of TRA. Under severe RAS conditions, pulling a catheter may occasionally result in radial artery injury and emergency surgery may be required. There have been no reports on the behavior of entrapped catheters/sheaths when pulled under severe RAS conditions. We conducted tensile tests on guide sheaths and balloon guide catheters to observe their damage in vitro and evaluate their potential to cause vascular injury.MethodsSix types of guide sheaths and balloon guide catheters were used in the test. The catheters were fixed to the testing machine and pulled. We observed how the catheter stretched and fractured. Additionally, a stress-strain curve was obtained from each examination to compare the characteristics of the catheters.ResultsCatheters were damaged in various ways. Some catheters were simply lengthened, whereas others were partially or completely torn. In the evaluation of the stress-strain curves, the slopes of the curves were almost equal among the catheters at the beginning of the test; that is, the hardness was almost the same for each catheter. As the strain increased, each exhibited different behavior.ConclusionCatheters can be damaged in various ways by stretching, which can cause vascular injuries. Neurointerventionists should be aware of possible catheter damage and vascular injury when catheters are entrapped.

IntroductionMechanical thrombectomy (MT) has become the gold-standard treatment for large vessel occlusion (LVO), however, in many cases, clots cannot be removed with the initial device. We assessed the safety and efficacy of the NeVa stent-retriever when used for bailout, in a real-world scenario where a range of initial devices have failed.MethodsWe reviewed our prospectively maintained database to identify all patients treated with the NeVa device after another device had failed to achieve satisfactory recanalisation. We recorded the baseline demographics, NIHSS, pre- and post-MT imaging data including ASPECT score, eTICI scores, complications and 90-day Modified Rankin Score (mRS).Results39 patients were included with median age 70, 67% male. Median NIHSS at presentation was 17, 11 (28%) received IV tPA prior to MT. A single device prior to NeVa was used in 31 (74%) of cases, with 2 devices used in the remaining patients, in total achieving eTICI ≥ 2b rencanalisation in 4/39 patients (10%). After one NeVa pull, 18 of the remaining 35 eTICI < 2b patients (51%) showed improvement to eTICI ≥ 2b, improving to 26/35 (74%) after multiple NeVa pulls when compared to the pre-NeVa angiographic result. Symptomatic intracranial haemorrhage and subarachnoid haemorrhage occurred in 2/39 (5.1%) and 12/39 (31%), respectively. Functional independence (mRS ≤ 2) at 90 days was seen in 8/35 (23%).ConclusionThe NeVa stent-retriever provides a useful adjunctive device in situations where other devices have failed to achieve recanalisation. Early switching to NeVa rather than repeated pulls with an initial device may be beneficial for timely recanalisation.

BackgroundDolichoectatic vertebrobasilar fusiform aneurysm (DVBFA) presents a clinical challenge due to its complex anatomical features and associated neurological complications. This meta-analysis evaluates the clinical outcomes of endovascular therapy (EVT), open surgery, and conservative management for DVBFA.MethodsA systematic review of the PubMed, Scopus, and Web of Science databases on July 18, 2024 was conducted to identify studies reporting on radiologically confirmed DVBFAs. Clinical outcomes were assessed using the modified Rankin Scale (mRS) and mortality rates. Meta-regression was performed to identify potential predictors of treatment outcomes.ResultsTen studies with 219 patients were analyzed. Of the cohort, 58.4% underwent EVT, 24.6% received open surgery, and 16.9% were managed conservatively. The overall proportion of patients achieving a good clinical outcome (mRS < 3) was 46.8%, with EVT showing the highest proportion at 59.4%, compared to 32.3% for open surgery and 24.7% for conservative management (p = 0.0145). The overall mortality rate was 25.98%, with EVT having the lowest mortality rate at 10.06%, followed by open surgery at 44.44% and conservative management at 63.30% (p = 0.0004). Pre- versus post-treatment subgroup analyses, however, did not reveal significant differences between treatment approaches in outcomes.ConclusionEVT appears to provide better clinical outcomes for DVBFAs, though mortality rates remain high across all treatment modalities. The absence of significant differences in subgroup analysis suggests the need for further randomized controlled trials of EVT versus conservative management to establish definitive treatment guidelines.

ObjectiveTo preliminarily conclude the safety and efficacy of middle meningeal artery embolization (MMAE) with Glubran 2 in treating chronic subdural hematoma (CSDH).MethodsThis retrospective analysis was performed on 40 consecutive CSDH patients who received MMAE with Glubran 2 between 2021 and 2023. The patients were followed up for 3 years post-operationally. Surgical procedures included burr hole drainage (BHD) and MMAE, both of which were performed under local anesthesia. MMAE with Glubran 2 was performed through transfemoral access. Postoperative recurrence was defined as an increase in hematoma volume based on computed tomography (CT) and/or magnetic resonance imaging (MRI) accompanied by clinical symptoms, which require further treatment within 3 years postoperatively.ResultsIn this study, 40 CSDH patients (34 male and six female) with a mean age of 68.2 ± 13.2 years were included. Of these, 38 patients underwent MMAE-assisted BHD. Two patients received MMAE alone. A single-branch embolization was performed on 20 hematomas in 18 patients, and a double-branch on 27 hematomas in 22 patients. At the three-year follow-up, 33 patients were successfully contacted, and 24 patients showed significant improvement or were asymptomatic after treatment. Three patients passed away owing to non-CSDH-related reasons. One patient developed decompensated liver cirrhosis, one experienced Alzheimer's disease, and four patients experiencing deteriorated functions were unclear but non-CSDH related as demonstrated by absorbed hematomas on head CT or MRI during return visits. The median follow-up time was 35 (IQR 27-40) months, and the median mRS score was 0 (IQR 0-0).ConclusionMMAE-assisted BHD with Glubran 2 is feasible, safe, and effective in treating CSDH, with no associated complications.

BackgroundDual antiplatelet therapy (DAPT) following stent-assisted coil (SAC) embolization increases the risk of ischemic and hemorrhagic complications. To evaluate the safety and efficacy of DAPT in treating acute ruptured aneurysms after SAC and analyze risk factors for poor clinical prognosis.MethodsWe retrospectively analyzed data from patients with aneurysmal subarachnoid hemorrhage (aSAH) between 1 May 2017 and 31 December 2021. Patients were divided into the SAC group and the non-SAC group (NSC). The SAC group received DAPT. We also compared modified Rankin Scale scores and the incidence of bleeding and ischemic complications. Additionally, we analyzed risk factors affecting clinical prognosis.ResultsA total of 2612 patients were included in the analysis: 1011 in the SAC group and 1601 in the NSC group. During hospitalization, there was no significant difference in bleeding and ischemic complications between the groups. Similarly, there was no statistically significant difference in clinical prognosis between the SAC and NSC groups at discharge and six months after discharge. Multivariate analysis indicated age, previous cerebral hemorrhage, posterior circulation aneurysm, multiple aneurysms, modified Fisher scale 3-4, and Glasgow Coma Scale (GCS) scores of 3-8 and 9-12 as risk factors for poor clinical prognosis after SAC.ConclusionsDAPT after SAC for intracranial ruptured aneurysms was found to be safe and effective. Age, previous cerebral hemorrhage, posterior circulation aneurysm, multiple aneurysms, modified Fisher scale 3-4, and GCS scores of 3-12 were identified as risk factors for poor prognosis.

Dimethyl sulfoxide (DMSO) is widely used as a solvent in endovascular embolization procedures, yet its potential neurotoxic effects remain underexplored. In this correspondence, we highlight emerging evidence suggesting that DMSO exposure may contribute to the development of hydrocephalus through mechanisms involving ependymal damage and astrocyte apoptosis. Drawing on recent experimental findings, we propose that DMSO-induced neuroinflammation may play a role in post-embolization complications. We urge the research community to consider hydrocephalus as a possible, though unproven, outcome of DMSO exposure and to include it in long-term safety assessments of embolic agents.