Pub Date : 2024-05-06DOI: 10.1177/15910199241250078
Rami Z Morsi, Sonam Thind, Archit Baskaran, Rohini Rana, Julián Carrión-Penagos, Harsh Desai, Sachin A Kothari, Ahmad Chahine, Jehad Zakaria, Sean P Polster, James E Siegler, Scott J Mendelson, Ali Mansour, Michael C Hurley, Shyam Prabhakaran, Tareq Kass-Hout
Background: Middle meningeal artery (MMA) embolization for subdural hematomas (SDH) and dural arteriovenous fistulas (dAVFs) has gained momentum in the neuroendovascular space. However, there is variability in the technique for safe and effective embolization. The aim of this report is to describe the technical feasibility and clinical performance of using Zoom™ 45 catheter for MMA access to facilitate embolization.
Methods: We analyzed all cases of MMA embolization in which the Zoom™ 45 catheter was used and performed in our institution from February 2021 to March 2023 for SDH and dAVFs.
Results: A total of 32 patients were included. Mean age was 64.0 ± 18.0 years, 75.0% (4/32) were male, and 56.7% (17/30), were black. The technical success was achieved in 93.8% (30/32) of cases, with selective embolization utilizing microcatheter directly into frontal and parietal branches for most patients (96.9%, 31/32). Identification of dangerous collaterals, such as lacrimal and petrous branches, prior to embolization, was achieved in most patients (96.9%, 31/32). Bilateral MMA embolization was done in 50.0% (16/32) of patients. The transradial approach and transfemoral approach were used in 53.1% (17/32) and 46.9% (15/32) of patients, respectively. The most common embolization material was n-butyl cyanoacrylate (84.4%, 27/32). There were no access site complications or complications related to the MMA embolization procedures and used devices.
Conclusions: The use of Zoom™ 45 Catheter seems to be technically feasible, safe, and effective for facilitating MMA access for embolization in the context of SDH and dAVFs.
{"title":"Early single-center experience with middle meningeal artery embolization using Zoom<sup>™</sup> 45 Catheter.","authors":"Rami Z Morsi, Sonam Thind, Archit Baskaran, Rohini Rana, Julián Carrión-Penagos, Harsh Desai, Sachin A Kothari, Ahmad Chahine, Jehad Zakaria, Sean P Polster, James E Siegler, Scott J Mendelson, Ali Mansour, Michael C Hurley, Shyam Prabhakaran, Tareq Kass-Hout","doi":"10.1177/15910199241250078","DOIUrl":"10.1177/15910199241250078","url":null,"abstract":"<p><strong>Background: </strong>Middle meningeal artery (MMA) embolization for subdural hematomas (SDH) and dural arteriovenous fistulas (dAVFs) has gained momentum in the neuroendovascular space. However, there is variability in the technique for safe and effective embolization. The aim of this report is to describe the technical feasibility and clinical performance of using Zoom<sup>™</sup> 45 catheter for MMA access to facilitate embolization.</p><p><strong>Methods: </strong>We analyzed all cases of MMA embolization in which the Zoom<sup>™</sup> 45 catheter was used and performed in our institution from February 2021 to March 2023 for SDH and dAVFs.</p><p><strong>Results: </strong>A total of 32 patients were included. Mean age was 64.0 ± 18.0 years, 75.0% (4/32) were male, and 56.7% (17/30), were black. The technical success was achieved in 93.8% (30/32) of cases, with selective embolization utilizing microcatheter directly into frontal and parietal branches for most patients (96.9%, 31/32). Identification of dangerous collaterals, such as lacrimal and petrous branches, prior to embolization, was achieved in most patients (96.9%, 31/32). Bilateral MMA embolization was done in 50.0% (16/32) of patients. The transradial approach and transfemoral approach were used in 53.1% (17/32) and 46.9% (15/32) of patients, respectively. The most common embolization material was n-butyl cyanoacrylate (84.4%, 27/32). There were no access site complications or complications related to the MMA embolization procedures and used devices.</p><p><strong>Conclusions: </strong>The use of Zoom<sup>™</sup> 45 Catheter seems to be technically feasible, safe, and effective for facilitating MMA access for embolization in the context of SDH and dAVFs.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140872094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-05DOI: 10.1177/15910199241248479
Lukas Goertz, David Zopfs, Jonathan Kottlors, Lenhard Pennig, Stefan Schob, Marc Schlamann, Christoph Kabbasch
Objective: There are few studies on flow diverters with diameters >5 mm. We present our preliminary experience with the 5.5-8 mm Derivo Embolization Device (DED) implants for the treatment of cerebral aneurysms.
Methods: A consecutive series of 26 patients (median age: 60 years) treated for 32 aneurysms in 26 procedures was retrospectively analyzed for procedural characteristics, complications, and mid-term angiographic results.
Results: The median aneurysm size was 10.5 mm, 2 of 30 (6%) aneurysms were ruptured and 9 (28%) had a fusiform or dissecting morphology. DED implantation was performed in the internal carotid artery in 18 of 26 (69%) procedures and in the vertebrobasilar artery in 8 (31%). Device deployment failed in 1 (4%) procedure. The 7 and 8 mm implants were successfully deployed in 5 cases. Additional balloon angioplasty or stent implantation was performed in 3 (12%) cases to improve wall apposition. Complications included 1 (4%) major stroke and 2 (8%) minor strokes. Angiographic follow up at a mean of 6 months showed complete occlusion in 8 of30 (27%) aneurysms and favorable occlusion in 14 (47%).
Conclusions: The use of large diameter DEDs was safe and feasible. The mid-term occlusion rates are acceptable considering the complex subset of aneurysms studied. Further studies are warranted to define the indications for large-diameter DEDs and to evaluate their long-term efficacy.
{"title":"Treatment of intracranial aneurysms with large-diameter (≥5.5 mm) Derivo Embolization Devices, with particular focus on 7 and 8 mm diameter devices.","authors":"Lukas Goertz, David Zopfs, Jonathan Kottlors, Lenhard Pennig, Stefan Schob, Marc Schlamann, Christoph Kabbasch","doi":"10.1177/15910199241248479","DOIUrl":"https://doi.org/10.1177/15910199241248479","url":null,"abstract":"<p><strong>Objective: </strong>There are few studies on flow diverters with diameters >5 mm. We present our preliminary experience with the 5.5-8 mm Derivo Embolization Device (DED) implants for the treatment of cerebral aneurysms.</p><p><strong>Methods: </strong>A consecutive series of 26 patients (median age: 60 years) treated for 32 aneurysms in 26 procedures was retrospectively analyzed for procedural characteristics, complications, and mid-term angiographic results.</p><p><strong>Results: </strong>The median aneurysm size was 10.5 mm, 2 of 30 (6%) aneurysms were ruptured and 9 (28%) had a fusiform or dissecting morphology. DED implantation was performed in the internal carotid artery in 18 of 26 (69%) procedures and in the vertebrobasilar artery in 8 (31%). Device deployment failed in 1 (4%) procedure. The 7 and 8 mm implants were successfully deployed in 5 cases. Additional balloon angioplasty or stent implantation was performed in 3 (12%) cases to improve wall apposition. Complications included 1 (4%) major stroke and 2 (8%) minor strokes. Angiographic follow up at a mean of 6 months showed complete occlusion in 8 of30 (27%) aneurysms and favorable occlusion in 14 (47%).</p><p><strong>Conclusions: </strong>The use of large diameter DEDs was safe and feasible. The mid-term occlusion rates are acceptable considering the complex subset of aneurysms studied. Further studies are warranted to define the indications for large-diameter DEDs and to evaluate their long-term efficacy.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140868945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-31DOI: 10.1177/15910199241236819
João André Sousa, Maider Iza Achutegui, Jesus Juega-Mariño, Manuel Requena, Sara Bernardo-Castro, Marc Rodrigo-Gisbert, Federica Rizzo, Marta Olivé, Álvaro Garcia-Tornel, Ana Carolina Chaves, Noelia Rodriguez-Villatoro, Marian Muchada, Jorge Pagola, David Rodriguez-Luna, Marta Rubiera, Ana Inês Martins, Fernando Silva, Ricardo Veiga, Cesar Nunes, Egídio Machado, Francesco Diana, Marta de Dios, David Hernández, Marc Ribo, Carlos Molina, João Sargento-Freitas, Alejandro Tomasello
Introduction: After several uncontrolled studies and one randomized clinical trial, there is still uncertainty regarding the role of endovascular treatment (EVT) in cerebral venous thrombosis (CVT). This study aims to describe and assess different acute management strategies in the treatment of CVT.
Methods: We performed a retrospective analysis of an international two-center registry of CVT patients admitted since 2019. Good outcome was defined as a return to baseline modified Rankin scale at three months. We described and compared EVT versus no-EVT patients.
Results: We included 61 patients. Only one did not receive systemic anticoagulation. EVT was performed in 13/61 (20%) of the cases, with a median time from diagnosis to puncture of 4.5 h (1.25-28.5). EVT patients had a higher median baseline NIHSS [6 (IQR 2-17) vs 0 (0-2.7), p = 0.002)] and a higher incidence of intracerebral hemorrhage (53.8% vs 20.3%, p = 0.03). Recanalization was achieved in 10/13 (77%) patients. Thrombectomy was performed in every case with angioplasty in 7 out of 12 patients and stenting in 3 cases. No postprocedural complication was reported. An improvement of the median NIHSS from baseline to discharge [6 (2-17) vs 1(0-3.75); p < 0.001] was observed in EVT group. A total of 31/60 patients (50.8%) had good outcomes. Adjusting to NIHSS and ICH, EVT had a non-significant increase in the odds of a good outcome [aOR 1.42 (95%CI 0.73-2.8, p = 0.307)].
Conclusions: EVT in combination with anticoagulation was safe in acute treatment of CVT as suggested by NIHSS improvement. Selected patients may benefit from this treatment.
简介:经过几项无对照研究和一项随机临床试验后,血管内治疗(EVT)在脑静脉血栓形成(CVT)中的作用仍不确定。本研究旨在描述和评估治疗 CVT 的不同急性管理策略:我们对2019年以来收治的CVT患者进行了回顾性分析。良好结局的定义是三个月后恢复到基线改良Rankin量表。我们对EVT与无EVT患者进行了描述和比较:我们纳入了 61 名患者。只有一人未接受全身抗凝治疗。13/61(20%)例患者进行了EVT,从诊断到穿刺的中位时间为4.5小时(1.25-28.5)。EVT患者的基线NIHSS中位数更高[6(IQR 2-17) vs 0 (0-2.7),p = 0.002],脑出血发生率更高(53.8% vs 20.3%,p = 0.03)。10/13(77%)例患者实现了再通。每例患者都进行了血栓清除术,12 例患者中有 7 例进行了血管成形术,3 例进行了支架植入术。术后未出现并发症。从基线到出院,NIHSS 中位数有所改善[6 (2-17) vs 1(0-3.75); p p = 0.307]:结论:EVT 联合抗凝治疗在 CVT 急性期治疗中是安全的,NIHSS 的改善表明了这一点。经过选择的患者可能会从这种治疗中获益。
{"title":"Acute management of cerebral venous thrombosis: Indications, technique, and outcome of endovascular treatment in two high-volume centers.","authors":"João André Sousa, Maider Iza Achutegui, Jesus Juega-Mariño, Manuel Requena, Sara Bernardo-Castro, Marc Rodrigo-Gisbert, Federica Rizzo, Marta Olivé, Álvaro Garcia-Tornel, Ana Carolina Chaves, Noelia Rodriguez-Villatoro, Marian Muchada, Jorge Pagola, David Rodriguez-Luna, Marta Rubiera, Ana Inês Martins, Fernando Silva, Ricardo Veiga, Cesar Nunes, Egídio Machado, Francesco Diana, Marta de Dios, David Hernández, Marc Ribo, Carlos Molina, João Sargento-Freitas, Alejandro Tomasello","doi":"10.1177/15910199241236819","DOIUrl":"https://doi.org/10.1177/15910199241236819","url":null,"abstract":"<p><strong>Introduction: </strong>After several uncontrolled studies and one randomized clinical trial, there is still uncertainty regarding the role of endovascular treatment (EVT) in cerebral venous thrombosis (CVT). This study aims to describe and assess different acute management strategies in the treatment of CVT.</p><p><strong>Methods: </strong>We performed a retrospective analysis of an international two-center registry of CVT patients admitted since 2019. Good outcome was defined as a return to baseline modified Rankin scale at three months. We described and compared EVT versus no-EVT patients.</p><p><strong>Results: </strong>We included 61 patients. Only one did not receive systemic anticoagulation. EVT was performed in 13/61 (20%) of the cases, with a median time from diagnosis to puncture of 4.5 h (1.25-28.5). EVT patients had a higher median baseline NIHSS [6 (IQR 2-17) vs 0 (0-2.7), <i>p</i> = 0.002)] and a higher incidence of intracerebral hemorrhage (53.8% vs 20.3%, <i>p</i> = 0.03). Recanalization was achieved in 10/13 (77%) patients. Thrombectomy was performed in every case with angioplasty in 7 out of 12 patients and stenting in 3 cases. No postprocedural complication was reported. An improvement of the median NIHSS from baseline to discharge [6 (2-17) vs 1(0-3.75); <i>p</i> < 0.001] was observed in EVT group. A total of 31/60 patients (50.8%) had good outcomes. Adjusting to NIHSS and ICH, EVT had a non-significant increase in the odds of a good outcome [aOR 1.42 (95%CI 0.73-2.8, <i>p</i> = 0.307)].</p><p><strong>Conclusions: </strong>EVT in combination with anticoagulation was safe in acute treatment of CVT as suggested by NIHSS improvement. Selected patients may benefit from this treatment.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140332262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-27DOI: 10.1177/15910199241239718
Shu Jiang, Dong Dong, Kunjian Chen, Chao Zhang, Weiqiang Dou, Xinyi Wang
Background: To accurately assess the treatment effect of paclitaxel drug-coated balloon (DCB) angioplasty is essential for intracranial atherosclerotic disease (ICAD) patients. This study aimed to investigate the clinical feasibility of high-resolution vessel wall MRI (HR-VWI) in assessing ICAD with DCB angioplasty.
Methods: Forty-five patients with intracranial atherosclerotic stenosis ≥ 70% confirmed by digital subtraction angiography (DSA) underwent HR-VWI before and after DCB angioplasty. Postoperative follow-up was performed after 6 months (±1 month). The differences of pre- and postoperative HR-VWI characteristics, including vessel and lumen area at maximal lumen narrowing (MLN), plaque area and length, degree of stenosis, plaque burden (PB), remodeling index, and plaque enhancement amplitude (PEA) were compared. The relationship between stenotic rate obtained using HR-VWI and DSA was evaluated. Each HR-VWI characteristic and clinical factor before DCB angioplasty was separately evaluated for the association with postoperative restenosis.
Results: After six months, lumen area of MLN, plaque length and area, degree of stenosis, PB, and PEA showed a significantly difference relative to the value before DCB angioplasty (all P < 0.05). Spearman correlation coefficients of 0.865 and 0.932 were revealed between DSA and HR-VWI regarding the stenotic rate analysis pre- and post-operation (both P < 0.05). ROC analysis showed PEA, plaque length, and PB before DCB angioplasty separately provided robust prediction of postoperative restenosis (area under the curve = 0.909, 0.814 and 0.743; all P < 0.05). Multivariable analysis revealed that PEA was an independent predictor of prognosis.
Conclusions: The HR-VWI can accurately assess the treatment effect of DCB and robustly predict prognosis.
背景:准确评估紫杉醇药物涂层球囊(DCB)血管成形术的治疗效果对颅内动脉粥样硬化性疾病(ICAD)患者至关重要。本研究旨在探讨高分辨率血管壁磁共振成像(HR-VWI)在评估ICAD与DCB血管成形术中的临床可行性:方法:45 名经数字减影血管造影术(DSA)证实颅内动脉粥样硬化性狭窄≥ 70% 的患者在 DCB 血管成形术前后接受了 HR-VWI 检查。术后随访 6 个月(±1 个月)。比较了术前和术后 HR-VWI 特征的差异,包括最大管腔狭窄(MLN)时的血管和管腔面积、斑块面积和长度、狭窄程度、斑块负荷(PB)、重塑指数和斑块增强振幅(PEA)。评估了使用 HR-VWI 获得的狭窄率与 DSA 之间的关系。分别评估了DCB血管成形术前的每个HR-VWI特征和临床因素与术后再狭窄的关系:结果:6 个月后,MLN 的管腔面积、斑块长度和面积、狭窄程度、PB 和 PEA 与 DCB 血管成形术前的值相比均有显著差异(均为 P P P 结论:HR-VWI 能准确评估血管成形术后的再狭窄情况:HR-VWI 能准确评估 DCB 的治疗效果并预测预后。
{"title":"Assessment of paclitaxel drug-coated balloon angioplasty for intracranial atherosclerotic disease based on high-resolution vessel wall magnetic resonance imaging.","authors":"Shu Jiang, Dong Dong, Kunjian Chen, Chao Zhang, Weiqiang Dou, Xinyi Wang","doi":"10.1177/15910199241239718","DOIUrl":"https://doi.org/10.1177/15910199241239718","url":null,"abstract":"<p><strong>Background: </strong>To accurately assess the treatment effect of paclitaxel drug-coated balloon (DCB) angioplasty is essential for intracranial atherosclerotic disease (ICAD) patients. This study aimed to investigate the clinical feasibility of high-resolution vessel wall MRI (HR-VWI) in assessing ICAD with DCB angioplasty.</p><p><strong>Methods: </strong>Forty-five patients with intracranial atherosclerotic stenosis ≥ 70% confirmed by digital subtraction angiography (DSA) underwent HR-VWI before and after DCB angioplasty. Postoperative follow-up was performed after 6 months (±1 month). The differences of pre- and postoperative HR-VWI characteristics, including vessel and lumen area at maximal lumen narrowing (MLN), plaque area and length, degree of stenosis, plaque burden (PB), remodeling index, and plaque enhancement amplitude (PEA) were compared. The relationship between stenotic rate obtained using HR-VWI and DSA was evaluated. Each HR-VWI characteristic and clinical factor before DCB angioplasty was separately evaluated for the association with postoperative restenosis.</p><p><strong>Results: </strong>After six months, lumen area of MLN, plaque length and area, degree of stenosis, PB, and PEA showed a significantly difference relative to the value before DCB angioplasty (all <i>P</i> < 0.05). Spearman correlation coefficients of 0.865 and 0.932 were revealed between DSA and HR-VWI regarding the stenotic rate analysis pre- and post-operation (both <i>P</i> < 0.05). ROC analysis showed PEA, plaque length, and PB before DCB angioplasty separately provided robust prediction of postoperative restenosis (area under the curve = 0.909, 0.814 and 0.743; all <i>P</i> < 0.05). Multivariable analysis revealed that PEA was an independent predictor of prognosis.</p><p><strong>Conclusions: </strong>The HR-VWI can accurately assess the treatment effect of DCB and robustly predict prognosis.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140307556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-26DOI: 10.1177/15910199241240504
Gil Zur, Areej Fageeh, Ange Diouf, Stacey Charette, Brigitte Charbonneau, Leila Sellami, Marlise Dos Santos, Howard Lesiuk, Brian Drake, Robert Fahed
The Woven EndoBridge (WEB) is an intra-aneurysmal flow disruptor designed for the treatment of broad-based arterial aneurysms with a high safety and effectiveness profile.1, 2 It does not require concomitant antiplatelet therapy compared to other devices such as flow diverters or intracranial stents. Innominate artery pseudoaneurysms are a rare consequence of blunt traumatic injury, infection, or atherosclerotic disease.3, 4 We describe the case of an innominate artery pseudoaneurysm successfully treated with a WEB SL device instead of stenting, therefore alleviating the need for dual antiplatelet therapy. The treatment was successful and uneventful and postprocedural computed tomography angiography confirmed the complete occlusion of the pseudoaneurysm.
Woven EndoBridge(WEB)是一种动脉瘤内血流阻断器,专为治疗广泛性动脉瘤而设计,具有很高的安全性和有效性。腹内动脉假性动脉瘤是钝性外伤、感染或动脉粥样硬化疾病的罕见后果。3, 4 我们描述了一例用 WEB SL 装置代替支架成功治疗腹内动脉假性动脉瘤的病例,因此无需进行双重抗血小板治疗。治疗成功且顺利,术后计算机断层扫描血管造影证实假性动脉瘤完全闭塞。
{"title":"Embolization of a pseudoaneurysm of the innominate artery with a Woven EndoBridge (WEB) device.","authors":"Gil Zur, Areej Fageeh, Ange Diouf, Stacey Charette, Brigitte Charbonneau, Leila Sellami, Marlise Dos Santos, Howard Lesiuk, Brian Drake, Robert Fahed","doi":"10.1177/15910199241240504","DOIUrl":"https://doi.org/10.1177/15910199241240504","url":null,"abstract":"<p><p>The Woven EndoBridge (WEB) is an intra-aneurysmal flow disruptor designed for the treatment of broad-based arterial aneurysms with a high safety and effectiveness profile.<sup>1, 2</sup> It does not require concomitant antiplatelet therapy compared to other devices such as flow diverters or intracranial stents. Innominate artery pseudoaneurysms are a rare consequence of blunt traumatic injury, infection, or atherosclerotic disease.<sup>3, 4</sup> We describe the case of an innominate artery pseudoaneurysm successfully treated with a WEB SL device instead of stenting, therefore alleviating the need for dual antiplatelet therapy. The treatment was successful and uneventful and postprocedural computed tomography angiography confirmed the complete occlusion of the pseudoaneurysm.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140289330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-26DOI: 10.1177/15910199241239705
Chiu-Shih Cheng, Wan-Ching Lin, Pei-Ling Lin, Cheng-Lung Lee, Chang-Hsien Ou
Coil stretching is a recognized complication during cerebral aneurysm embolization.1, 3- 5 For over a decade, the microsnare has proven effective in retrieving migrated coils.1- 5 Fiorella et al. unveiled the "Monorail Snare Technique" in 2005, offering a specialized approach to stretched coil recovery.1 However, to gain a complete understanding of this technique, more than just textual descriptions are necessary; a thorough, practical demonstration is essential. In our technical video (video 1), we illustrated an episode of coil stretching during aneurysm embolization, where the "Monorail Snare Technique" was successfully employed to retrieve a stretched coil. Our video emphasizes the meticulous preparation and modification of the microsnare, showcasing enhanced steps to mitigate the potential blood backflow triggered by the exclusive use of one-arm hemostasis valve during the "Monorail Snare Technique."1, 5 This pivotal adjustment substantially lowers the threat of thromboembolic events. We highlighted essential precautions to ensure the procedure's safety and efficacy.4, 5.
{"title":"Monorail snare technique for retrieval of stretched coil.","authors":"Chiu-Shih Cheng, Wan-Ching Lin, Pei-Ling Lin, Cheng-Lung Lee, Chang-Hsien Ou","doi":"10.1177/15910199241239705","DOIUrl":"https://doi.org/10.1177/15910199241239705","url":null,"abstract":"<p><p>Coil stretching is a recognized complication during cerebral aneurysm embolization.<sup>1, 3- 5</sup> For over a decade, the microsnare has proven effective in retrieving migrated coils.<sup>1- 5</sup> Fiorella et al. unveiled the \"Monorail Snare Technique\" in 2005, offering a specialized approach to stretched coil recovery.<sup>1</sup> However, to gain a complete understanding of this technique, more than just textual descriptions are necessary; a thorough, practical demonstration is essential. In our technical video (video 1), we illustrated an episode of coil stretching during aneurysm embolization, where the \"Monorail Snare Technique\" was successfully employed to retrieve a stretched coil. Our video emphasizes the meticulous preparation and modification of the microsnare, showcasing enhanced steps to mitigate the potential blood backflow triggered by the exclusive use of one-arm hemostasis valve during the \"Monorail Snare Technique.\"<sup>1, 5</sup> This pivotal adjustment substantially lowers the threat of thromboembolic events. We highlighted essential precautions to ensure the procedure's safety and efficacy.<sup>4, 5</sup>.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140289331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-22DOI: 10.1177/15910199241239094
Arsida Bajrami, Serdar Geyik, Ozgur Ertugrul, Eren Erdem, Jose I Gallego Leon, Giorgio Barbieri, Carlos Dominguez Rodriguez, Jose Carlos Rayón-Aledo, Antonio I Sagredo Barra, Fernando S Sanchez Blanco, Carmen Serna Candel, Francisco Jose Montalverne, Lidemarcks I Andrade, Diego Bandeira, Jose Bezerra, Hellen Carm, Henrique Coelho Silva, Alessandra Braga Cruz Guedes de Morais, Adson Freitas de Lucena, Fabricio O Lima, George Mendes, Felipe A Rocha, Karlis Kupcs, Helmuts Kidikas, Janis Vetra, Gyula Gal, Anabel Diaz, Raul G Nogueira
Background: The best strategy to achieve optimal reperfusion outcomes during mechanical thrombectomy remains to be defined. The RapidPulseTM Cyclic Aspiration System is a novel technology, delivering high-frequency pulsed vacuum forces to increase the efficiency of aspiration thrombectomy.
Methods: Prospective, multicenter, open-label, core lab-adjudicated, two-arm study comparing safety and efficacy of a feasibility version of the RapidPulseTM system compared with contemporary controls. Primary endpoint was the rate of mTICI ≥ 2c after first-pass effect (FPE). Additional efficacy endpoints were the rates of mTICI 2b after first pass (modified FPE (mFPE)), last pass with study device defined as frontline technical success, and after all passes including rescue therapy. The primary safety endpoints included symptomatic ICH (sICH) within 24 h post-procedure.
Results: Between February 2022 to December 2022, 80 subjects were consented and enrolled in the study (n = 40 treatment arm, n = 40 control arm). In the intent to treat (ITT) population, mean age was 67.8 ± 11.5 years; 19 (47.5%) were male. Median NIHSS score was 16 (IQR: 13-22). Median ASPECTS score was 9 (IQR: 8-10). The rate of mTICI ≥ 2c after first pass was 53.9% in ITT population (60.0% in per-protocol population) versus 38.5% in the corresponding control population. Functional independence (mRS 0-2) at 90 days was achieved in 61.1% (22/36) in the RapidPulseTM arm and 52.8% (19/36) in the control arm. In the RapidPulseTM arm, no sICH within 24 h and no device-related morbidity or mortality occurred.
Conclusion: Preliminary data suggests RapidPulseTM Aspiration System is highly effective and safe for recanalization of large vessel occlusions.
{"title":"Rapidpulse<sup>TM</sup> cyclic aspiration system for acute ischemic stroke due to large vessel occlusions.","authors":"Arsida Bajrami, Serdar Geyik, Ozgur Ertugrul, Eren Erdem, Jose I Gallego Leon, Giorgio Barbieri, Carlos Dominguez Rodriguez, Jose Carlos Rayón-Aledo, Antonio I Sagredo Barra, Fernando S Sanchez Blanco, Carmen Serna Candel, Francisco Jose Montalverne, Lidemarcks I Andrade, Diego Bandeira, Jose Bezerra, Hellen Carm, Henrique Coelho Silva, Alessandra Braga Cruz Guedes de Morais, Adson Freitas de Lucena, Fabricio O Lima, George Mendes, Felipe A Rocha, Karlis Kupcs, Helmuts Kidikas, Janis Vetra, Gyula Gal, Anabel Diaz, Raul G Nogueira","doi":"10.1177/15910199241239094","DOIUrl":"https://doi.org/10.1177/15910199241239094","url":null,"abstract":"<p><strong>Background: </strong>The best strategy to achieve optimal reperfusion outcomes during mechanical thrombectomy remains to be defined. The RapidPulse<sup>TM</sup> Cyclic Aspiration System is a novel technology, delivering high-frequency pulsed vacuum forces to increase the efficiency of aspiration thrombectomy.</p><p><strong>Methods: </strong>Prospective, multicenter, open-label, core lab-adjudicated, two-arm study comparing safety and efficacy of a feasibility version of the RapidPulse<sup>TM</sup> system compared with contemporary controls. Primary endpoint was the rate of mTICI ≥ 2c after first-pass effect (FPE). Additional efficacy endpoints were the rates of mTICI <math><mo>≥</mo></math> 2b after first pass (modified FPE (mFPE)), last pass with study device defined as frontline technical success, and after all passes including rescue therapy. The primary safety endpoints included symptomatic ICH (sICH) within 24 h post-procedure.</p><p><strong>Results: </strong>Between February 2022 to December 2022, 80 subjects were consented and enrolled in the study (n = 40 treatment arm, n = 40 control arm). In the intent to treat (ITT) population, mean age was 67.8 ± 11.5 years; 19 (47.5%) were male. Median NIHSS score was 16 (IQR: 13-22). Median ASPECTS score was 9 (IQR: 8-10). The rate of mTICI ≥ 2c after first pass was 53.9% in ITT population (60.0% in per-protocol population) versus 38.5% in the corresponding control population. Functional independence (mRS 0-2) at 90 days was achieved in 61.1% (22/36) in the RapidPulse<sup>TM</sup> arm and 52.8% (19/36) in the control arm. In the RapidPulse<sup>TM</sup> arm, no sICH within 24 h and no device-related morbidity or mortality occurred.</p><p><strong>Conclusion: </strong>Preliminary data suggests RapidPulse<sup>TM</sup> Aspiration System is highly effective and safe for recanalization of large vessel occlusions.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140186100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-22DOI: 10.1177/15910199241231325
Anvitha Sathya, Thanh N Nguyen, Piers Klein, Stephanos Finitsis, Bindu N Setty, Adam A Dmytriw, Kyle M Fargen, Ferdinand K Hui, Peter Weber, Matthew R Amans, Mohamad Abdalkader
Introduction: Sigmoid sinus diverticulum (SSD) has been increasingly reported as a cause of pulsatile tinnitus (PT). While both endovascular and surgical treatments have been used, there is a lack of consensus on the treatment modality to treat SSD. We conducted a systematic review of the available literature to compare the clinical outcomes and safety of endovascular versus surgical approaches for treating SSD.
Methods: A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses to identify studies encompassing the management of SSD. Studies reporting the clinical outcomes and safety of endovascular or surgical treatments for SSD between January 2000 and January 2023 were included. Results were characterized using descriptive statistics.
Results: Endovascular treatment (EVT) was reported by 17 articles, yielding 26 patients with 27 diverticula. Surgical treatment was reported by 20 articles, yielding 105 patients with 107 diverticula. EVT led to complete or near-complete resolution in all patients with SSD and PT. Complications occurred in 3.7% (1/27) with a return to baseline after 2 months. There were no permanent complications from EVT. Surgical treatment resulted in complete resolution in 77.6% (83/107) of cases, incomplete resolution in 11.2% (12/107), and no resolution in 11.2% (12/107). Significant complications occurred in 9.3% (10/107) of the surgical-treated patients.
Conclusion: EVT in patients with PT and venous diverticulum appears more effective and safer than surgical treatment, but large studies are lacking. Studies directly comparing endovascular and surgical treatment are needed.
{"title":"Endovascular vs surgical treatment of sigmoid sinus diverticulum causing pulsatile tinnitus: A systematic review.","authors":"Anvitha Sathya, Thanh N Nguyen, Piers Klein, Stephanos Finitsis, Bindu N Setty, Adam A Dmytriw, Kyle M Fargen, Ferdinand K Hui, Peter Weber, Matthew R Amans, Mohamad Abdalkader","doi":"10.1177/15910199241231325","DOIUrl":"https://doi.org/10.1177/15910199241231325","url":null,"abstract":"<p><strong>Introduction: </strong>Sigmoid sinus diverticulum (SSD) has been increasingly reported as a cause of pulsatile tinnitus (PT). While both endovascular and surgical treatments have been used, there is a lack of consensus on the treatment modality to treat SSD. We conducted a systematic review of the available literature to compare the clinical outcomes and safety of endovascular versus surgical approaches for treating SSD.</p><p><strong>Methods: </strong>A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses to identify studies encompassing the management of SSD. Studies reporting the clinical outcomes and safety of endovascular or surgical treatments for SSD between January 2000 and January 2023 were included. Results were characterized using descriptive statistics.</p><p><strong>Results: </strong>Endovascular treatment (EVT) was reported by 17 articles, yielding 26 patients with 27 diverticula. Surgical treatment was reported by 20 articles, yielding 105 patients with 107 diverticula. EVT led to complete or near-complete resolution in all patients with SSD and PT. Complications occurred in 3.7% (1/27) with a return to baseline after 2 months. There were no permanent complications from EVT. Surgical treatment resulted in complete resolution in 77.6% (83/107) of cases, incomplete resolution in 11.2% (12/107), and no resolution in 11.2% (12/107). Significant complications occurred in 9.3% (10/107) of the surgical-treated patients.</p><p><strong>Conclusion: </strong>EVT in patients with PT and venous diverticulum appears more effective and safer than surgical treatment, but large studies are lacking. Studies directly comparing endovascular and surgical treatment are needed.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140186075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-22DOI: 10.1177/15910199241239204
Isabel Rodríguez, Laura Ludovica Gramegna, Manuel Requena, Michele Rizzuti, Iker Elosua, Jordi Mayol, Marta Olivé-Gadea, Francesco Diana, Marc Rodrigo-Gisbert, Marián Muchada, Eila Rivera, Álvaro García-Tornel, Federica Rizzo, Marta De Dios, David Rodríguez-Luna, Carlos Piñana, Jorge Pagola, David Hernández, Jesús Juega, Noelia Rodríguez, Manuel Quintana, Carlos Molina, Marc Ribo, Alejandro Tomasello
Background: Symptomatic carotid artery stenosis is a significant contributor to ischemic strokes. Carotid artery stenting (CAS) is usually indicated for secondary stroke prevention. This study evaluates the safety and efficacy of CAS performed within a short time frame from symptom onset.
Methods: We conducted a single-center, retrospective study of consecutive patients who underwent CAS for symptomatic carotid stenosis within eight days of symptom onset from July 2019 to January 2022. Data on demographics, medical history, procedural details, and follow-up outcomes were analyzed. The primary outcome measure was the recurrence of the stroke within the first month post-procedure. Secondary outcomes included mortality, the rate of intra-procedural complications, and hyperperfusion syndrome.
Results: We included 93 patients with a mean age of 71.7 ± 11.7 years. The median time from symptom onset to CAS was 96 h. The rate of stroke recurrence was 5.4% in the first month, with a significant association between the number of stents used and increased recurrence risk. Mortality within the first month was 3.2%, with an overall mortality rate of 11.8% after a median follow-up of 19 months. Intra-procedural complications were present in five (5.4%) cases and were related to the number of stents used (p = 0.002) and post-procedural angioplasty (p = 0.045). Hyperperfusion syndrome occurred in 3.2% of cases.
Conclusion: Early CAS within the high-risk window post-symptom onset is a viable secondary stroke prevention strategy in patients with symptomatic carotid artery stenosis. The procedure rate of complication is acceptable, with a low recurrence of stroke. However, further careful selection of patients for this procedural strategy is crucial to optimize outcomes.
背景:无症状颈动脉狭窄是缺血性脑卒中的重要诱因。颈动脉支架植入术(CAS)通常用于中风的二级预防。本研究评估了在症状出现后短时间内进行 CAS 的安全性和有效性:我们对 2019 年 7 月至 2022 年 1 月期间因症状性颈动脉狭窄在症状出现后 8 天内接受 CAS 的连续患者进行了单中心回顾性研究。研究分析了人口统计学、病史、手术细节和随访结果等数据。主要结果指标是术后一个月内中风的复发率。次要结果包括死亡率、术中并发症发生率和高灌注综合征:我们共纳入 93 名患者,平均年龄为 71.7 ± 11.7 岁。从症状发作到 CAS 的中位时间为 96 小时。第一个月内中风复发率为 5.4%,使用支架数量与复发风险增加之间存在显著关联。第一个月内的死亡率为3.2%,中位随访19个月后的总死亡率为11.8%。5例(5.4%)患者出现了术中并发症,并与支架使用数量(p = 0.002)和术后血管成形术(p = 0.045)有关。3.2%的病例发生了高灌注综合征:结论:对于有症状的颈动脉狭窄患者,在症状出现后的高风险窗口期内进行早期 CAS 是一种可行的二级卒中预防策略。手术的并发症发生率可以接受,中风复发率较低。然而,要想取得最佳疗效,进一步仔细选择患者是至关重要的。
{"title":"Safety and efficacy of early carotid artery stenting in patients with symptomatic stenosis.","authors":"Isabel Rodríguez, Laura Ludovica Gramegna, Manuel Requena, Michele Rizzuti, Iker Elosua, Jordi Mayol, Marta Olivé-Gadea, Francesco Diana, Marc Rodrigo-Gisbert, Marián Muchada, Eila Rivera, Álvaro García-Tornel, Federica Rizzo, Marta De Dios, David Rodríguez-Luna, Carlos Piñana, Jorge Pagola, David Hernández, Jesús Juega, Noelia Rodríguez, Manuel Quintana, Carlos Molina, Marc Ribo, Alejandro Tomasello","doi":"10.1177/15910199241239204","DOIUrl":"https://doi.org/10.1177/15910199241239204","url":null,"abstract":"<p><strong>Background: </strong>Symptomatic carotid artery stenosis is a significant contributor to ischemic strokes. Carotid artery stenting (CAS) is usually indicated for secondary stroke prevention. This study evaluates the safety and efficacy of CAS performed within a short time frame from symptom onset.</p><p><strong>Methods: </strong>We conducted a single-center, retrospective study of consecutive patients who underwent CAS for symptomatic carotid stenosis within eight days of symptom onset from July 2019 to January 2022. Data on demographics, medical history, procedural details, and follow-up outcomes were analyzed. The primary outcome measure was the recurrence of the stroke within the first month post-procedure. Secondary outcomes included mortality, the rate of intra-procedural complications, and hyperperfusion syndrome.</p><p><strong>Results: </strong>We included 93 patients with a mean age of 71.7 ± 11.7 years. The median time from symptom onset to CAS was 96 h. The rate of stroke recurrence was 5.4% in the first month, with a significant association between the number of stents used and increased recurrence risk. Mortality within the first month was 3.2%, with an overall mortality rate of 11.8% after a median follow-up of 19 months. Intra-procedural complications were present in five (5.4%) cases and were related to the number of stents used (<i>p</i> = 0.002) and post-procedural angioplasty (<i>p</i> = 0.045). Hyperperfusion syndrome occurred in 3.2% of cases.</p><p><strong>Conclusion: </strong>Early CAS within the high-risk window post-symptom onset is a viable secondary stroke prevention strategy in patients with symptomatic carotid artery stenosis. The procedure rate of complication is acceptable, with a low recurrence of stroke. However, further careful selection of patients for this procedural strategy is crucial to optimize outcomes.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140186101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The amount of midline shift (MLS) considered safe for middle meningeal artery embolization (MMAE) in patients with chronic subdural hematoma (CSDH) has not been established. Whether MMAE could be used as upfront treatment for unilateral large CSDH patients with significant MLS (>1 cm) has not been reported.
Objective: To investigate the efficacy and safety of MMAE in unilateral large CSDH patients with MLS > 1 cm.
Methods: Eleven carefully selected CSDH patients with mild or moderate symptoms and significant MLS > 1 cm from 1 May 2021 to 31 August 2022 were included in the study. All patients were treated with MMAE using polyvinyl alcohol (PVA) particles. Outcomes were assessed clinically and with interval imaging studies at follow-up.
Results: All 19 MMAs (unilateral embolization in three patients and bilateral embolization in eight patients) were successfully embolized. All 11 patients were followed for subsequent months, and there was no recurrence and enlargement of CSDH. Procedural adverse events, mortality, or complications were not observed. The average time to achieve a 50% reduction in MLS was approximately four weeks, while it took approximately eight weeks to achieve a 50% reduction in maximal volume. All 11 patients showed improvement in their neurological symptoms at three days post-operation, including four hemiplegic patients.
Conclusions: MMAE may demonstrate safety in carefully selected CSDH patients with significant midline shift (MLS > 1 cm), particularly in those who are not suitable for surgery, thus providing a potential alternative approach.
{"title":"Middle meningeal artery embolization for the treatment of unilateral large chronic subdural hematoma patients with significant midline shift: A single-center experience.","authors":"Yin Niu, Qiang Zhang, Zhouyang Jiang, Wenyan Li, Zhi Chen","doi":"10.1177/15910199241239706","DOIUrl":"https://doi.org/10.1177/15910199241239706","url":null,"abstract":"<p><strong>Background: </strong>The amount of midline shift (MLS) considered safe for middle meningeal artery embolization (MMAE) in patients with chronic subdural hematoma (CSDH) has not been established. Whether MMAE could be used as upfront treatment for unilateral large CSDH patients with significant MLS (>1 cm) has not been reported.</p><p><strong>Objective: </strong>To investigate the efficacy and safety of MMAE in unilateral large CSDH patients with MLS > 1 cm.</p><p><strong>Methods: </strong>Eleven carefully selected CSDH patients with mild or moderate symptoms and significant MLS > 1 cm from 1 May 2021 to 31 August 2022 were included in the study. All patients were treated with MMAE using polyvinyl alcohol (PVA) particles. Outcomes were assessed clinically and with interval imaging studies at follow-up.</p><p><strong>Results: </strong>All 19 MMAs (unilateral embolization in three patients and bilateral embolization in eight patients) were successfully embolized. All 11 patients were followed for subsequent months, and there was no recurrence and enlargement of CSDH. Procedural adverse events, mortality, or complications were not observed. The average time to achieve a 50% reduction in MLS was approximately four weeks, while it took approximately eight weeks to achieve a 50% reduction in maximal volume. All 11 patients showed improvement in their neurological symptoms at three days post-operation, including four hemiplegic patients.</p><p><strong>Conclusions: </strong>MMAE may demonstrate safety in carefully selected CSDH patients with significant midline shift (MLS > 1 cm), particularly in those who are not suitable for surgery, thus providing a potential alternative approach.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140186099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}