Interventional Neuroradiology最新文献

BackgroundMiddle meningeal artery embolization (MMAE) has recently emerged as a promising adjunctive therapy to surgical evacuation for patients with chronic subdural hematoma (cSDH). However, the optimal timing of MMAE relative to surgery remains poorly defined. Therefore, this large retrospective cohort study aimed to assess the impact of MMAE timing (preoperative vs. postoperative) on 6-month outcomes in patients with cSDH, focusing on rates of repeat surgery and mortality. We hypothesized that preoperative MMAE would be associated with lower rates of reoperation compared to postoperative MMAE.MethodsAdult patients with nontraumatic cSDH who underwent surgery with adjunctive MMAE were identified using ICD-10 codes from the TriNetX database. A 1:1 propensity score matching approach was used to balance baseline characteristics between groups. The primary outcomes were repeat surgery and all-cause mortality within 6 months.ResultsA total of 338 matched patients (n = 338; 169 in each group) were included in the final analysis. Preoperative MMAE was associated with significantly lower odds of repeat surgery compared to postoperative MMAE (7.1% vs. 17.8%; OR 0.35, p = 0.003). No significant difference was observed in 6-month all-cause mortality between the groups.ConclusionPreoperative MMAE is associated with reduced odds of repeat surgery compared to postoperative MMAE at 6 months. These findings support consideration of MMAE timing in surgical planning. Further prospective studies are warranted to validate these results.

BackgroundPatients undergoing elective endovascular treatment for cerebrovascular diseases (CBVD) may face mental health challenges that impact their quality of life (QoL). However, this issue is still rarely addressed in neuro-endovascular research literature and clinical practice. Our single center ongoing project ONIRIC aims to assess anxiety and depressive symptoms, coping, and QoL in CBVD patients treated via endovascular approaches.MethodsWe prospectively enrolled a cohort of patients undergoing elective endovascular procedures over a 6-month period. Patients completed the State-Trait Anxiety Inventory (STAI-S and STAI-T), the Beck Depression Inventory-version II (BDI-II), the Brief Coping Orientation to Problems Experienced Inventory (Brief-Cope), the Euro-QoL 5D-5L, and the World Health Organization Disability Assessment Schedule (WHODAS 2.0) questionnaires at the baseline, and at discharge.ResultsWe included 25 patients (13 females): mean age 60 ± 12.5 years. There was a significant improvement in state anxiety and depressive symptom scores at discharge: the BDI-II scores significantly differed from the ones at baseline (p < .01), as well as the STAI-S scores (p < .01). The coping and QoL scores did not show any changes.ConclusionsTo our knowledge, this research represents one of the few prospective studies examining the psychological and neuropsychological outcomes associated with elective neuro-endovascular treatment of CBDV. Despite the small sample size, our preliminary findings, are consistent with recent literature in related fields, contributing valuable insights to the broader understanding of how these factors influence clinical management. Future directions include the collection of follow-up data, essential for deepening our understanding of this complex and sensitive issue.

BackgroundDissecting pseudoaneurysms of the posterior inferior cerebellar artery (PICA) are rare, high-risk lesions with outcomes heavily influenced by anatomical location. This study evaluates the relationship between PICA segmental anatomy, endovascular treatment strategy, and clinical outcomes.MethodsWe retrospectively analyzed 21 patients with dissecting PICA aneurysms treated endovascularly between 2013 and 2025. Aneurysms were anatomically classified by segment (P1-P5); P3 was further subdivided into P3A (proximal to the PICA loop) and P3B (distal to the loop). Primary outcome was discharge modified Rankin Scale (mRS ≤ 2; classified as favorable). Secondary outcomes included ischemic stroke and segment-specific treatment trends.ResultsOf 21 patients, 16 (76%) were female and 13 (62%) were White; mean age was 57.3 ± 15.5 years. Most aneurysms were small (<7 mm, n = 16, 76%), ruptured (n = 17, 81%), and located in proximal segments (P1-P3, n = 14, 67%). Hypertension was present in 11 (52%) and intraventricular hemorrhage (IVH) in 12 (57%). Treatments included coiling (n = 10, 48%), Onyx embolization (n = 5, 24%), flow diversion (n = 2, 10%), and adjunctive techniques (n = 3, 14%). Deconstructive strategies were used in 14 (67%). Favorable outcome (mRS ≤ 2) was achieved in 15 (71%). Clinically silent cerebellar strokes occurred in 9 (43%); no brainstem infarctions were seen. IVH was significantly associated with poor outcome (p = 0.043). All P3A cases (n = 3) had favorable outcomes, while 2 of 4 P3B cases (50%) were unfavorable.ConclusionsPICA segment anatomy predicts treatment safety. Reconstructive strategies are preferred for proximal lesions (P1-P3A); deconstructive methods are safe and effective beyond the PICA loop (P3B-P5).

ObjectiveMiddle meningeal artery embolization (MMAE) has been shown to lower recurrence and reoperation rates of chronic subdural hematomas (cSDHs). The purpose of this study is to demonstrate the initial use, safety, and effectiveness of SwiftPAC (Penumbra Inc., Alameda, CA, USA) coils for MMAE.MethodsThis is a retrospective study of consecutive MMAE performed with SwiftPAC coils for in patients with cSDHs. Liquid or particle embolization was excluded. Selection criteria for adjunct versus stand-alone MMAE were based on clinical judgement. Outcome measures included were a decrease in size of the cSDH, decreased size >50%, midline shift, reoccurrence or progression, retreatment, clinical stability or symptom improvement, and procedure-related complications.ResultsTwenty-three patients/31 hemispheres received MMAEs (eight bilateral and 15 unilateral) with SwiftPAC coils. Twenty-two patients (96%) had clinical and radiographic follow-up (median 54 days), and one patient was lost to follow-up. Sixteen (69.6%) MMAEs were performed as an adjunct to surgical drainage; seven (30.4%) were stand-alone MMAEs. No procedural-related complications were observed. Clinical stability or symptom improvement at follow-up was demonstrated in 95.4% of patients (21/22). Radiographic improvement at follow-up was demonstrated in 93.3% (28/30). Nineteen (63.3%) cSDHs had a decrease in size >50% and nine cSDHs (30%) demonstrated complete resolution. One patient required retreatment for recurrence.ConclusionsMMAE with SwiftPAC coils can be performed with a high safety profile and good radiographic and clinical outcomes. Given the small size and no comparison cohort, further research is warranted.

PurposeTo assess the diagnostic value of silent MRA in the follow-up of intracranial aneurysms (IA) post-endovascular treatment.MethodsFrom March 2023 to March 2024, we retrospectively collected data on patients with IA who underwent endovascular intervention and received silent MRA follow-up. All images were anonymized and evaluated on a 5-point scale: 1 (not visible, strong artifacts); 2 (poor quality, numerous artifacts/blurring); 3 (acceptable quality, moderate artifacts/blurring); 4 (good quality, minor blur artifacts); 5 (very good quality, nearly equal to DSA). The quality and occlusion status of aneurysms were descriptively analyzed.ResultsA total of 451 patients with 475 IA treated at our hospital received silent MRA follow-up. The silent MRA showed 100% 5-point scores in the coil embolization group. In the stent-assisted group, 65.7% achieved a 5-point score, and in the flow-diverter (FD) group, 42.6%. The multiple telescopic stents group had only 7.1% with a 5-point score, while the intrasaccular flow disruption group had 55.6%, and the FD+ coil group had 40.7%. There were two cases of distal aneurysms: one A3 segment aneurysm scored 5 points on silent MRA while the other M3 segment aneurysm did not visualize the aneurysm artery. A ≥3 score was helpful for diagnosing postoperative recurrence, with rates of 100%, 97.8%, 87.9%, 57.1%, 88.9%, 85.2%, and 50% across the groups.ConclusionsSilent MRA shows significant potential for postoperative follow-up in endovascular therapy of aneurysms, particularly in interventions of coiling embolization, stent-assisted coiling, and FD.

PurposeThe efficacy of mechanical thrombectomy (MT) for M2 occlusion remains uncertain, partly due to recanalization challenges owing to anatomical factors and hemorrhagic complications. This study investigated the best method for M2 occlusion based on the M1-M2 bifurcation angle.MethodsWe retrospectively evaluated the clinical data of 134 consecutive patients with M2 occlusion who underwent MT. The M1-M2 angle was measured between the conterminous (M2) and immediately proximal (M1) vessel segments with respect to the occlusion site. Patients were divided into the acute- and obtuse-angle groups. For each angle, we investigated the stent retriever (SR), contact aspiration (CA), and combined technique (CT) of MT.ResultsThere were 64 and 70 obtuse- and acute-angle cases, respectively. Univariate analysis showed no significant difference in the M1-M2 angle between the groups, but there was a trend toward increased intracranial hemorrhage in the obtuse-angle group (56% vs. 41%, p = 0.09). CA was significantly associated with lower postoperative subarachnoid hemorrhage incidence in the obtuse-angle group (CA vs. SR vs. CT: 9% vs. 39% vs. 50%, p = 0.02). In the acute-angle group, CT was significantly superior in number of passes (CT vs. SR vs. CA: 1.4 vs. 1.8 vs. 2.4, p = 0.03), puncture-recanalization time (48.5 vs. 59.1 vs. 69.4, p = 0.04), and modified first-pass effect (mFPE; 67% vs. 48% vs. 21%, p = 0.01). No association was observed between the first-line technique and clinical outcomes for any angle.ConclusionProcedure results varied according to the M1-M2 bifurcation angle. For treating M2 occlusion, the bifurcation angle should be considered in the choice of technique.

Pre-operative stage embolization is a valuable strategy for managing large arteriovenous malformations (AVMs). However, reflux of Onyx may be out of control and cause accidental embolization at the feeding artery's opening. We report a case of 27-year-old male suffering from right occipital AVM bleeding with left hemianopia. The AVM was mainly supplied by two right posterior cerebral artery (PCA) branches. According to Spetzler-Martin Grade V AVM with acute bleeding, stage embolization followed by surgical excision was performed. However, during the first-stage embolization, which was planned to control superior PCA branch only, excessive Onyx reflux was noted with occlusion of inferior PCA branch opening. Right internal carotid artery (ICA) angiography showed residual large nidus volume which was supplied by pial collateral vessel from anterior temporal artery to original inferior PCA branch territory. The residual large volume causes surgical difficulty, and the small size of pial collateral vessel is not suitable for microcatheterization. Second-stage embolization was still performed for attempting further decrease of nidus volume. According to the eccentric stacking nature of Onyx, we successfully navigate microcatheter through the Onyx cast in obstructed inferior PCA branch opening. Subsequently, pre-operative embolization can be finished as initial planning, followed by surgical excision without neurological deficits. In cases of accidental feeder embolization, our experience suggests that the pass of microcatheter through the previous Onyx cast can serve as a viable option to complete nidus embolization.

BackgroundRapid thrombectomy initiation is critical for improving outcomes in acute ischemic stroke (AIS) due to large vessel occlusion (LVO). Direct transport to an angiography suite (DTAS), bypassing standard Emergency Department CT imaging, Direct to ED CT (DTCT), reduces door-to-puncture times. This study compares standard DTCT and expedited DTAS workflows using a hybrid multidetector CT (MDCT)-angiography suite.Materials and methodsThis single-center, prospective, blinded analysis study simulated AIS care using a medical mannequin. Twelve simulations were conducted (six per protocol): (a) Standard DTCT and (b) Direct DTAS. Simulations included ED arrival, triage, clinical assessment, imaging, and groin puncture. All mock patients had LVO and were thrombectomy candidates (S-LAMS ≥ 4) with contraindications to lysis. Time metrics were measured and compared.ResultsMean door-to-puncture time was significantly shorter in the DTAS group (DTCT: 39.83 [4.36] min vs DTAS: 22.17 [2.4] min (P < .0001). Door-to-CT start times were similar (DTCT: 19.5 [7.15] vs DTAS: 15.0 [2.97]; P = .1848). CT-to-puncture time was shorter with DTAS (DTCT: 20.33 [5.01] vs DTAS: 7.17 [1.47]; P = .0009). CT-complete to puncture time favored DTAS (DTCT: 12.33 [3.93] vs DTAS: 2.33 [1.03]; P = .0011). Mean time from CT completion to Angio suite arrival in DTCT was 6.67 min.ConclusionA direct-to-CT-Angio (DTAS) workflow using MDCT technology significantly reduces door-to-puncture times compared to standard DTCT, improving hospital workflow for LVO stroke patients. Further clinical studies are needed.

ObjectiveThe distal transradial approach (dTRA) may reduce puncture-site complication rates compared with the conventional transradial approach (cTRA). However, the treatment outcomes of dTRA performed with large-bore catheters and the factors associated with procedural success remain unclear. We report the treatment outcomes of neurointerventional therapy performed via dTRA with a sheathless 8-Fr balloon guide catheter (BGC) and identify factors associated with procedural failure.MethodsWe retrospectively reviewed 51 consecutive patients who underwent neurointerventional therapy via dTRA with a sheathless 8-Fr BGC at our institution between April 2023 and March 2025. The primary endpoint was the procedural success rate. The secondary endpoint was the rate of puncture-site-related complications. We also analyzed factors associated with crossover from dTRA to cTRA or to a transfemoral approach (TFA).ResultsProcedural success was achieved in 42 of the 51 patients (82.4%). Crossover to cTRA was required in 5 cases (9.8%), and to TFA in 4 cases (7.8%). Patients requiring crossover to cTRA were significantly older than those who completed the procedure via dTRA (p = 0.02). Acute ischemic stroke (p < 0.01) and use of local anesthesia with light sedation (p < 0.01) were independently associated with crossover to TFA. No major complications occurred. Minor puncture-site hematoma was developed in two patients (3.9%), severe radial-artery spasm in three (5.9%), and asymptomatic distal radial artery occlusion in three (5.9%).ConclusionThe dTRA for neurointerventional procedures with a sheathless 8-Fr BGC demonstrates an acceptable success rate and safety profile. However, challenges remain with these procedures in older patients and cases with mechanical thrombectomy or local anesthesia with light sedation.

ObjectiveRecurrent or growing non-acute subdural hematoma (SDH) following standalone or adjunctive middle meningeal artery embolization (MMAe) present a complex clinical challenge. This study aims to investigate the multifactorial causes of recurrence and growing SDH, including vascular and systemic contributors, and explores management strategies to improve outcomes.MethodsWe conducted a retrospective analysis of 22 patients with non-acute SDH requiring rescue treatment after adjunctive or stand-alone MMAe. Patients with documented trauma deemed responsible for the SDH expansion were excluded. Data were collected on patient demographics, clinical presentations, imaging findings, treatment approaches, and outcomes. A systematic review was also conducted across PubMed, Web of Science, Scopus, and Embase databases, adhering to PRISMA guidelines.ResultsNon-traumatic recurrent or growing SDHs were associated with MMA recanalization (27%), contralateral supply from the contralateral MMA (27%), CSF-venous fistulas (5%), and recruitments of vascular collaterals such as deep temporal artery (5%). Management strategies included, respectively, repeat MMAe using polyvinyl alcohol particles, coils, and liquid agents; contralateral MMAe, transvenous embolization for CSF-venous fistulas; and targeted embolization for other vascular contributors. Follow-up assessments were available for 14 patients (64%). Of these, 10 patients (45%) achieved complete resolution of symptoms, three patients (14%) experienced symptomatic improvement, and one patient (5%) had worsening symptoms. In terms of hematoma resolution, nine patients (41%) had complete or near-complete resolution, three patients (14%) exhibited stable hematoma size, and two patients (9%) demonstrated a reduction in hematoma size. Notably, no recurrences were observed after the final treatment. Two patients (9%) died within 10 days of the final embolization treatment due to malignancies.ConclusionRecurrent or growing SDHs following MMAe are linked to subdural membrane vascularity and intracranial hypotension which must be investigated and addressed. Treatment of these issues results in high cure rates.