Interventional Neuroradiology最新文献

BackgroundChronic subdural hematoma (CSDH) secondary to cerebrospinal fluid (CSF) hypovolemia-most commonly from ventriculoperitoneal (VP) shunt overdrainage or spontaneous intracranial hypotension (SIH)-presents unique therapeutic challenges. In these cases, standard surgical evacuation may be contraindicated if intracranial pressure is not corrected, increasing the risk of complications. While middle meningeal artery embolization (MMAE) has emerged as a treatment option for refractory CSDH, its role in CSF-hypovolemia associated CSDH remains underexplored.MethodsThis retrospective study included seven patients with radiographically confirmed, symptomatic CSDH due to CSF hypovolemia. Etiologies included VP shunt overdrainage (n = 6) and SIH (n = 1). Prior to MMAE, all patients underwent definitive treatment of the underlying cause-either shunt adjustment or ligation, or targeted epidural blood patch. Embolization was performed using 250 μm microspheres via the middle meningeal artery. Patients were followed clinically and with serial CT imaging.ResultsAll patients demonstrated neurological improvement within several days following embolization. Hematoma thickness progressively decreased over a period of 2 to 6 months, with complete or near-complete resolution in all cases. No patients experienced recurrence or required surgical evacuation. There were no procedural complications.ConclusionMMAE, when performed after correction of the underlying CSF hypovolemia, appears to be a safe and effective therapeutic option for CSDH. This approach may serve as an intermediate strategy between conservative treatment and surgical evacuation, particularly in patients at elevated risk due to underlying CSF hypovolemia.

ObjectiveChronic subdural hematoma (cSDH) is one of the most common neurosurgical emergencies. Due to high percentage of hematoma reaccumulation middle meningeal artery (MMA) embolization arose as an alternative treatment option. Aim of this retrospective study is to present single center results of 97 stand-alone embolization procedures done during 3-year period.MethodsProspectively maintained database of all patients who underwent MMA embolization from December 2021 to March 2025 was retrospectively analyzed. Seventy-five asymptomatic or mildly symptomatic patients with 97 hematomas were included; 72 MMA embolization procedures were done as primary treatment in 55 patients, whereas cSDH recurrency was main indication for 25 procedures in 20 patients. Primary and recurrent cSDH groups were compared using Chi-square test.ResultsMean follow-up period was 140 days. During the follow-up period 19/97 (19.6%) hematomas resorbed completely. Moreover, 21/97 (21.6%) of hematomas reduced in size more than 50%; 40 out of 97 embolized hematomas (41.2%) remained stable or were resorbed partially during follow up. Middle meningeal artery embolization failed in 14 cases (14.4%). We noted three cases of asymptomatic hematoma progression (3.1%). Three patients died during follow-up period. No statistically significant difference was shown between primary and recurrent cSDH cohort when compared based on percentage of complete hematoma resolution, treatment failure and rate of hematomas with >50% resorption.ConclusionsMiddle meningeal artery embolization is both safe and feasible stand-alone treatment option for cSDH, primarily for asymptomatic and minimally symptomatic patients with maximal hematoma tickness in the range between 10 and 20 mm.

PurposeThis study aims to evaluate the morphological features and branching patterns of the inferior alveolar artery (IAA) in living individuals using three-dimensional rotational angiography (3D-RA) and to propose a novel radiological classification based on its shape and branching pattern.MethodsA total of 101 hemifaces (53 right, 34 males/34 females) underwent 3D-RA imaging (slice thickness:0.10-0.20 mm). Morphological assessments of the maxillary artery (MA) and the IAA were performed on maximum intensity projection images. Statistical analysis used IBM SPSS Statistics 22.0 (p < 0.05).ResultsMean diameters of the internal carotid artery (ICA), external carotid artery (ECA), and MA were 4.62 ± 0.58 mm, 3.60 ± 0.87 mm, and 2.35 ± 0.41 mm, respectively. Females exhibited significantly smaller ICA, ECA, and MA diameters (p = 0.036, 0.001, 0.001), while IAA diameter (0.95 ± 0.19 mm) showed no sex difference. The IAA originated predominantly from the MA (96%), rarely from the ECA (4%), or was not observed (1%). Duplicated IAAs were detected in two cases. Branching patterns included a single vessel (71%) or a shared trunk with the posterior deep temporal artery (29%), showing significant correlation with MA course (superficial/deep) (p < 0.05). IAA shapes were categorized as straight, curved, or looped, addressing a literature gap.ConclusionsThis is the first in vivo study to radiologically classify variations of the IAA using 3D-RA. The technique enables high-resolution visualization of submillimeter vessels, offering valuable anatomical insights for maxillofacial surgeries. Further studies are warranted to validate these findings and explore clinical correlations.

Background and PurposeThe first pass effect (FPE), achieving near-complete revascularization in a single pass, predicts good outcomes in mechanical thrombectomy (MT). FPE30, achieving FPE within 30 min of groin puncture, is a novel procedural metric proposed as an indicator of maximal procedural and systems-level efficiency. This study aimed to determine the incidence of FPE30 and explore potential predictors in a real-world clinical setting, thereby assessing its utility as a performance benchmark.MethodsWe retrospectively analyzed 274 consecutive MT patients at a comprehensive stroke center. The primary outcome was FPE30, defined as achieving mTICI 2c-3 in a single pass within 30 min of groin puncture. Patient characteristics were compared between FPE30 and FPE > 30 groups.ResultsOf 274 patients, 52 (19.0%) achieved FPE; 43 (82.7%) met the FPE30 benchmark. No statistically significant predictors of FPE30 were found. Trends indicated FPE30 was less common in internal carotid artery (ICA) terminus occlusions (7.0% vs. 33.3%; P = .09) and more frequent with radial access (48.8% vs. 33.3%; P = .40). There was no significant difference in good 90-day functional outcomes (mRS 0-2) between FPE30 (34.9%) and FPE > 30 (33.3%) groups (P > .99).ConclusionsAchieving FPE within 30 min was common in this cohort, but not significantly predicted by measured factors. The lack of an association between FPE30 and improved 90-day functional outcomes suggests that the primary benefit is derived from achieving FPE itself, regardless of whether it is accomplished within or just beyond this ultra-early timeframe. Trends suggest occlusion location and access site may affect reperfusion speed. Lack of functional benefit difference highlights that FPE achievement itself remains the key outcome determinant. These findings are hypothesis-generating and warrant larger studies to clarify the value and predictors of FPE30 as both a clinical prognosticator and a quality improvement metric.

Dynamic myelography, performed as digital subtraction myelography or dynamic computed tomography myelography, is crucial in diagnosing intracranial hypotension resulting from a cerebrospinal fluid-venous fistula (CVF). The quality of the myelogram is paramount for accurate diagnosis. Using a phantom, the impact of needle type (Quincke vs. Whitacre), caliber, side-hole position, and rate of injection on the quality of the myelogram was determined. The ideal decubitus myelogram would provide a large volume of a hyperdense contrast within the lateral dependent aspect of the thecal sac, optimally flooding the mouths of the neural foramina and root sleeves where the vast majority of CVFs originate. The results of this study suggest it is exclusively the rate of injection that most predictably dictates the quality of the myelogram in this regard. Specifically, a slow injection rate, on the order of 0.1 mL/s, should be opted for to decrease turbulence, optimize myelogram quality, and thus improve CVF detection in clinical practice.

PurposeCoil embolization is a standard treatment for intracranial aneurysms. However, ischemic complications remain a concern, despite advancements in technology and the use of antithrombotic agents. Microcatheter-related thrombogenesis has been identified as a contributing factor to these complications. Although previous studies have focused on external morphological changes, limited data are available on the impact of changes in the inner lining of microcatheters on ischemic events. In this study, we used scanning electron microscopy (SEM) to investigate changes in the inner lining of microcatheters after coil embolization.MethodsFive SL-10, two Phenom 17, and one Echelon 10 microcatheters used in coil embolization procedures were examined using SEM. An unused microcatheter served as a control. The microcatheters were sectioned at various locations and analyzed under high magnification.ResultsSEM provided high-resolution visualization of the inner lining of the microcatheter, revealing morphological alterations that were undetectable by light microscopy. The control had an intact membrane, whereas the SL-10 microcatheters showed varying degrees of damage. Microcatheters used in multiple-coil deliveries exhibited extensive peeling and cracking of the inner lining. Additionally, clots composed of red blood cells were observed inside the microcatheters. The same morphological changes in the inner linings were observed in other types of microcatheters, such as Phenom 17 and Echelon 10.ConclusionSEM showed that repeated microcatheter use in coil embolization damages the inner lining, potentially contributing to thrombus formation and ischemic complications. These findings highlight the need to investigate microcatheter durability and thromboresistance to mitigate embolization-related ischemic risks.

PurposeAneurysmal rupture and subarachnoid hemorrhage (SAH) have an exceptionally high mortality and morbidity burden. The aim of this study was to develop interpretable machine learning models for predicting short-term poor outcomes defined by the National Inpatient Sample Subarachnoid Hemorrhage Outcome Measure (NIS-SOM).MethodsThe National Inpatient Sample (NIS) database was queried from 2008 to 2018 to identify patients diagnosed with SAH who had undergone endovascular coiling or clipping for intracranial aneurysm. Demographic, comorbidity, risk factor, and hospital characteristic variables were recorded. Variables were preprocessed, and the feature space was reduced to include the most important features. To predict poor outcomes, machine learning models were trained and cross-validated before being evaluated on a separate testing set. Shapley Additive exPlanations of the best performing model was used for general and local model interpretation.ResultsAmong 18,149 admissions (mean age 55 ± 14 years, 68.8% women), 52.9% had a poor outcome. Test-set AUCs ranged 0.74-0.80; a multilayer perceptron performed best (AUC 0.80, precision 0.74, recall 0.82). SHAP ranked the ten most influential variables: age, neurological comorbidity, paralysis, Medicare insurance, smoking status, Elixhauser burden, fluid-electrolyte disorders, weight loss, arrhythmia, and heart failure.ConclusionsThe modeling predicted nationwide aSAH prognosis with decent accuracy and highlighted clinical, socioeconomic, and system-level drivers of determinants of poor short-term outcome. These results support the potential of explainable ML tools as complementary tools for early risk stratification, guiding resource allocation, and informing prospective multi-center validation and implementation studies.

BackgroundRadiation-associated intracranial aneurysms (RAIs) are a rare but increasingly recognized late complication of cranial and cervical radiotherapy, particularly among long-term survivors of head and neck tumors. This study aims to provide a comprehensive review of the clinical, anatomical, and therapeutic characteristics of RAIs.MethodsWe conducted a systematic review of published RAI cases (1984-2024), collecting data on patient demographics, oncologic history, aneurysm morphology and location, latency from radiotherapy, clinical presentation, and treatment outcomes. The review followed Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.ResultsA total of 103 patients with 142 intracranial aneurysms were included. The mean latency between radiotherapy and aneurysm diagnosis was 11.3 years (range: 2-21 years). The mean age at radiotherapy was 36.7 years (range: 4 months to 79 years), and the mean age at aneurysm diagnosis was 47.8 years (range: 6-90 years). Aneurysms were most commonly located in the internal carotid artery (32%) and posterior circulation (23%). Morphologically, 45.1% were dissecting or nonsaccular. Half of the aneurysms presented with subarachnoid hemorrhage. Approximately 65% underwent treatment, with about two-thirds managed via endovascular approaches-primarily coiling and stent-assisted coiling. Adequate occlusion was achieved in 66% of aneurysms overall, with an even higher rate of complete/near-complete occlusion-73.1%-among endovascularly treated aneurysms, compared to 48.5% for those treated surgically. The mean radiological follow-up period was 19.5 months.ConclusionRadiation-associated intracranial aneurysms are rare vascular lesions with distinct anatomical and clinical features. Early recognition and sustained long-term monitoring are crucial to enable timely intervention. Further research is needed to establish evidence-based strategies for screening and managing this high-risk population.

IntroductionVenous sinus stenting (VSS) is an effective, less invasive alternative to ventriculoperitoneal shunting (VPS) for idiopathic intracranial hypertension (IIH). While efficacy is comparable, with some evidence favoring VSS for headache control, perioperative costs remain under-characterized due to reliance on reimbursement rates rather than actual expenditures.ObjectiveTo compare the perioperative cost of elective VSS and VPS for IIH, including outpatient workup and follow-up costs, using detailed institutional cost data.MethodsWe retrospectively analyzed IIH patients treated with VSS or VPS from 2017 to 2022 at a single center. All IIH-related costs were captured from 90 days pre-op through 90 days post-op and categorized as fixed (e.g. OR staff) or variable (e.g. supplies). Patients with fulminant IIH or unrelated elective procedures were excluded. Comparisons used Mann-Whitney U and Fisher's exact tests (p < 0.05).ResultsForty-three patients met criteria (VSS n = 19, VPS n = 24), with no significant differences in age, body mass index, papilledema, opening pressure, or pulsatile tinnitus. Preoperative costs were significantly higher for VSS (median $14,951 [IQR 10,835-16,043] vs $4767 [1, 293, 410-11]; p = 0.008), including both variable (p = 0.008) and fixed (p = 0.015) cost components. Surgical admission costs were similar between groups (p = 0.403), as were postoperative costs (p = 0.509). Total 180-day costs remained significantly higher for VSS ($38,576 [011-43, 36, 590]) compared to VPS ($31,509 [25, 208-37, 342]; p = 0.001).ConclusionVSS incurs higher preoperative and total costs than VPS. Streamlining VSS workup may improve value. Further studies should assess downstream cost avoidance to determine long-term cost-effectiveness.

BackgroundEndovascular coil embolization is a common treatment for intracranial aneurysms, but aneurysm recanalization remains a significant problem that may necessitate retreatment. This study aimed to identify patient, aneurysm, and procedural factors associated with recanalization in aneurysms treated exclusively with coil embolization.MethodsThis single center retrospective study assessed intracranial aneurysms treated with coiling-only between 2017 and 2022. Follow-up imaging was reviewed for recanalization with occlusion status graded via a modified Raymond-Roy classification. Univariate analysis assessed the association of clinical, morphological, and procedural factors with clinical complication, aneurysm occlusion, and recanalization status. Stepwise multivariable logistic regression was performed to identify independent predictors of aneurysm recanalization.ResultsOf 163 initially treated aneurysms, 142 were analyzed in complete case analysis for clinical outcomes. Complications occurred in 8 patients and were associated with larger aneurysm neck sizes (3.83 mm vs. 2.92 mm, p = 0.024), increased incidence of coil herniation (63% vs. 10%, p = 0.001), and greater number of coils used per aneurysm (7.13 coils vs. 4.64 coils, p = 0.028). Follow-up angiography in 122 aneurysms showed adequate occlusion in 116 (95.1%) and recanalization in 11.5%. Recanalization was more frequent in aneurysms that had larger initial volumes and in those without balloon inflation during coil deployment (both p < 0.05). On multivariable analysis, balloon inflation during coil deployment was the only independent predictor of aneurysm recanalization (OR 0.18; 95% CI 0.05-0.69; p = 0.009).DiscussionIn this single-center cohort of coiling-only treated aneurysms, the use of the balloon remodeling technique was strongly associated with durable aneurysm occlusion, reducing the odds of aneurysm recanalization. These findings support the routine use of balloon assistance in wide-neck and large aneurysms to achieve complete, stable occlusion and reduce the need for retreatment.