Interventional Neuroradiology最新文献

ObjectivesY-stent-assisted coiling (Y-SAC) is an established technique for managing wide-necked intracranial bifurcation aneurysms. However, data on the use of the pEGASUS stent, a self-expanding open-cell stent with an antithrombogenic hydrophilic polymer coating, remain limited. This study evaluated the effectiveness and safety of Y-SAC with pEGASUS stents in patients with intracranial bifurcation aneurysms.MethodsThis retrospective observational study included patients treated with Y-SAC with pEGASUS stents at six neurovascular centers between July 2021 and June 2024. Data on aneurysm characteristics, procedural details, and clinical outcomes were collected. Aneurysm occlusion was assessed with the modified Raymond-Roy classification (MRRC) at 6 and 12 months. The primary endpoint was complete aneurysm occlusion (MRRC I), whereas secondary endpoints included perioperative complications, functional outcomes, and retreatment rates.ResultsA total of 40 patients (mean age: 61.6 ± 9.4 years; 60% women) were included. Immediately post-procedure, 100% of aneurysms achieved complete occlusion (MRRC I). At 6-12 months follow-up, 92.5% maintained MRRC I occlusion, and 2.5% exhibited neck remnants (MRRC II). Functional outcomes were favorable in 95% of patients at discharge. The overall complication rate was 4.8%, and one patient (2.5%) required retreatment. No periprocedural thromboembolic events were observed.ConclusionsOur findings indicated that Y-SAC with pEGASUS stents achieves high rates of durable aneurysm occlusion with minimal complications, thus supporting its use as a safe and effective strategy for wide-necked bifurcation aneurysms. Future prospective studies are needed to validate long-term outcomes and optimize treatment strategies.

PurposeEndovascular treatment has become the standard of care for the treatment of patients with acute ischemic stroke with large vessel occlusion, however, the optimal first-line strategy for mechanical thrombectomy continues to be debated. Recent advancements in large-bore aspiration catheters have enhanced the efficacy of A Direct Aspiration First Pass Technique (ADAPT), offering promising improvements in procedural success. This study aims to evaluate the characteristics and technical outcomes associated with endovascular treatment for acute ischemic stroke following the inaugural global use of the CEREGLIDE™ 71 Intermediate Catheter at our institution.Materials and methodsIn this retrospective, single-center study, a total of 25 consecutive patients with verified large vessel occlusion in the anterior circulation were included from October 2023 to May 2024. All patients were treated with endovascular therapy using a CEREGLIDE™ 71 intermediate catheter. The angiographic outcome was assessed using the thrombolysis in cerebral infarction (TICI) scale.ResultsA total of 25 patients were included in the study. The mean age at baseline was 72.3 years old, and 52% of patients were female. Mean National Institutes of Health Stroke Scale score at admission was 16.4. Occlusion locations included the M1 segment of the middle cerebral artery (MCA) (60%), internal carotid artery terminus (20%), and M2 segment of MCA (16%). The average number of passes per intervention was 2.2. Successful reperfusion (TICI 2b, TICI 2c, and TICI 3) was achieved in 88% of patients.ConclusionsThis report of the first center to implement the CEREGLIDE™ 71 Intermediate Catheter for acute ischemic stroke demonstrated successful recanalization rates. This is largely attributed to the large inner diameter of the catheter, which results in higher aspiration force as well as improved trackability allowing for enhanced navigation through cerebrovascular anatomy.

BackgroundPrehospital stroke screening for large vessel occlusions (LVOs) varies across institutions. This study compares manual stroke scale calculations against e-calculated scores using the Ultimate Stroke Scale (USS), a software automating multiple screening scales from a modified National Institutes of Health Stroke Scale (NIHSS) with a hand grip. The USS aims to streamline screening by computing multiple validated stroke scales simultaneously to enhance predictive value.MethodsWe applied eight stroke screening scales (NIHSS; Balance, Eyes, Face, Arms, Speech, and Time [BE-FAST]; Vision, Aphasia, Neglect; Los Angeles Motor Scale [LAMS]; Face, Arm, Speech, Time, Eye Deviation and Denial/Neglect [FAST-ED]; Emergency Medical Services Rapid Arterial oCclusion Evaluation [EMS RACE]; 3-Item Stroke Scale [3-ISS]; and Prehospital Acute Stroke Severity [PASS]) to 199 stroke activations between January 2021 and December 2023. In this prospective, external validation study, data were utilized from a previously published head-to-head comparison of multiple LVO scales for both LVOs and medium vessel occlusions which collected scales manually. We recalculated these scales using the USS and evaluated agreement (Kendall's τ) and diagnostic accuracy (ROC curves).ResultsThe USS showed strong to moderate agreement with manual calculations across all scales displayed by Kendall's τ correlation coefficients ranging from 0.549 to 0.931 (all p < 0.001). The BE-FAST had the lowest agreement (τ = 0.549), while PASS had the highest (τ = 0.931), followed by LAMS (τ = 0.894) and FAST-ED (τ = 0.864). Diagnostic accuracy was comparable between manual methods (area under the curve [AUC]: 0.590-0.743) and the USS (AUC: 0.575-0.758). The BE-FAST had the lowest AUC for both, LAMS had the highest for manual, and FAST-ED had the highest from the USS.ConclusionThe USS demonstrates potential as a reliable tool for automated stroke screening with consistent performance compared to manual methods.

BackgroundUnruptured intracranial aneurysms (UIAs) are dilations of major brain arteries, affecting 3% to 5% of adults globally. Prior studies have identified women of Black race and/or Hispanic ethnicity as a high-risk population for UIAs. The clinical utility of early identification and treatment of UIAs is well established, however the economic impact of standardized screening protocols remains unclear. This study aimed to evaluate the cost-effectiveness of magnetic resonance angiography (MRA) screening for UIAs in this high risk population of patients aged 40 to 80 years, hypothesizing that such screening would be beneficial and cost-effective.Materials and methodsA Markov decision analytic model was used to compare various MRA screening frequencies against no screening for UIAs. Clinical and cost parameters were obtained from literature, focusing on the target population. The model computed quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) for different screening strategies.ResultsAll screening strategies increased QALYs compared to no screening. Single screening at age 40 provided the highest QALY gain (+0.79) with the lowest ICER ($2052.27). More frequent screenings yielded higher costs without proportionate QALY gains. Sensitivity analysis indicated that MRA cost and UIA prevalence had the greatest impact on ICER.ConclusionMRA screening for UIAs in non-Hispanic Black and Hispanic female patients is cost-effective, particularly with a single screening at age 40. This strategy improves health outcomes and provides the best cost-effectiveness ratio, supporting its implementation for high-risk populations.

BackgroundThe efficacy of endovascular treatment (EVT) for intracranial atherosclerotic disease (ICAD) remains unclear. This study compared procedural and clinical outcomes of EVT for ICAD-related and cardiogenic embolism (CE)-related large vessel occlusion (LVO) using data from the Kanagawa Intravenous and Endovascular Treatment of Acute Ischemic Stroke registry, a prospective, multicenter observational study.MethodsOf 3187 EVTs from 2018 to 2021, 2047 anterior circulation occlusions included 305 ICAD and 1742 CE cases. The primary endpoint was favorable functional outcome (mRS 0-2) at 90 days; secondary endpoints included recanalization rates, symptomatic intracranial hemorrhage, and puncture-to-recanalization time.ResultsICAD-LVO patients were younger, had lower NIHSS scores, and showed a lower proportion of recanalization (74% vs. 91%, p < 0.0001) and longer procedural times (66 vs. 43 min, p < 0.0001) than CE patients. Symptomatic hemorrhage was also more frequent (8.5% vs. 5.2%, p = 0.0267). Despite these differences, favorable outcomes were comparable (41% vs. 38%, p = 0.3157). Onset-to-recanalization time was significantly associated with outcome in CE (aOR: 0.99, 95% CI: 0.99-1.000, p = 0.0147) but not in ICAD. DWI-ASPECTS strongly predicted favorable outcome in both groups (ICAD: aOR: 1.26, 95% CI: 1.085-1.46, p = 0.0024; CE: aOR: 1.30, 95% CI: 1.23-1.38, p < 0.0001).ConclusionsEVT for ICAD-LVO was associated with a lower proportion of recanalization, longer procedure times and poorer procedural outcomes but similar 90-day functional outcomes compared with CE-LVO. In ICAD, DWI-ASPECTS was a key prognostic factor, while onset-to-recanalization time had limited impact, highlighting distinct pathophysiological mechanisms.RegistrationURL: https://www.clinicaltrials.gov; Unique identifier: NCT05213533.

BackgroundAspiration is rapidly becoming the first-line strategy for mechanical thrombectomy for LVOs. Superbore aspiration catheters (lumen ≥ 0.088") have been suggested to provide advantages over conventional aspiration including improved recanalization and reduced distal emboli owing to distal flow control. The objective of this study was to assess the technical feasibility and safety of contact aspiration using the novel Millipede⁸⁸ Superbore catheter and the Millipede⁷⁰ catheter.MethodsA retrospective analysis of consecutive cases using the Millipede⁸⁸ Superbore catheter as first-line for the treatment of large vessel occlusions was conducted. Key outcome parameters assessed were navigation to target occlusion, recanalization success, procedure-related complications, NIHSS, and symptomatic intracranial hemorrhage at 24 h.Results26 patients were treated using Millipede catheters. The first-pass effect, defined as mTICI ≥ 2c reperfusion using contact aspiration, was achieved in 69% of cases. mTICI ≥ 2c at final angiography was obtained in 88% of cases. Contact aspiration alone was used in 92% of cases. No catheter-related complications, such as dissections or perforations, or embolization to new territory was reported. sICH did not occur in any of the cases. The median drop in NIHSS at 24 h was eight points.ConclusionsIn the majority of cases, aspiration using the Millipede⁸⁸ catheter results in excellent recanalization with one pass, with an excellent safety profile. These data suggest that aspiration thrombectomy using the Millipede⁸⁸ Superbore catheter is feasible and safe. A large prospective trial of Millipede⁸⁸ for aspiration thrombectomy is underway.

Background and purposeMechanical thrombectomy (MT) is the gold standard for treating large vessel occlusions. Given the variability in vessel anatomy among patients and the sometimes arbitrary selection of devices by neurointerventionalists, the choice of microcatheter size requires thorough evaluation. We aim to evaluate the impact of device-to-vessel size ratio on periprocedural distal embolization.Materials and methodsFragment-prone clot analogs (length = 9.86±0.07 mm) were used to embolize three different vessels (lumen = 2.0, 2.5, 3.5 mm) in a three-dimensional-printed neurovascular model. Three different microcatheter sizes (0.017″, 0.021″, 0.027″) were used to cross the lesion and subsequently, migrated clot fragments were collected in an outflow filter for image analysis. Experiments were conducted both with and without a microguidewire. A total of 180 experiments were performed: 60 for each M1 segment of middle cerebral artery size, including 20 for each microcatheter-10 with J-shaped microguidewire and 10 without.ResultsAcross all vessels, the 0.027″ microcatheter caused more distal embolizations compared to 0.017″ (p = 0.04) and 0.021″ (p = 0.01). In the 2 mm M1-MCA, 0.017″ microcatheter reduced emboli compared to 0.021″ (p = 0.062) and 0.027″ (p = 0.017). Procedures in the 2 mm vessel are significantly more prone to embolization compared to larger M1 segments (p < 0.05). Microcatheter-to-vessel ratio ≥0.38 significantly increases risk of distal embolization. The use of microguidewire in the procedures did not have any impact on distal embolization (p = 0.871).ConclusionA larger device-to-vessel size ratio induces an increase in distal embolization. Neurointerventionalists should carefully consider vessel anatomy for appropriate microcatheter size selection to minimize the risk of distal embolization.

BackgroundIntracranial atherosclerotic disease (ICAD) is a growing cause of ischemic stroke globally, with a disproportionately high burden in Asian, Black, and Hispanic populations. Despite advances in medical therapy, ICAD remains associated with high rates of recurrent stroke, prompting interest in durable endovascular solutions. This study aims to systematically evaluate the current evidence on the safety and efficacy of elective intracranial stenting in adult patients with symptomatic ICAD using Onyx drug-eluting balloon-mounted stents (Onyx DES).MethodsA meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Five studies were initially identified, with one excluded due to overlapping cohorts, resulting in four final studies included for analysis. Meta-analysis was conducted utilizing random-effects models for pooled event rates (95% CIs) and weighted means.ResultsOf 153 articles initially identified, four high-quality studies encompassing 314 patients met inclusion criteria. The mean (±SD) age was 64.6 (±12.4) years, with a predominance of males (70.7%) and common vascular comorbidities such as hypertension (85.7%) and diabetes (60.0%). Lesions were nearly equally distributed between the anterior and posterior circulations. Periprocedural complications were infrequent (1.0%), including one hemorrhagic stroke and one fatal aneurysm rupture. The 30-day complication rate remained low at 5%, involving strokes, deaths, and TIAs. However, follow-up at six months and beyond revealed rising rates of strokes, TIAs, and in-stent restenosis, reaching 9% at six months and persisting through one year.ConclusionThis descriptive meta-analysis suggests that Onyx DES may offer promising results in the treatment of symptomatic ICAD, with lower early complication rates reported. However, larger prospective studies are needed to confirm these observations and evaluate long-term efficacy and safety.

BackgroundNon-contrast computed tomography (NCCT) is the first image for stroke assessment, but its sensitivity for detecting large vessel occlusion (LVO) is limited. Artificial intelligence (AI) algorithms may contribute to a faster LVO diagnosis using only NCCT. This study evaluates the performance and the potential diagnostic time saving of Methinks LVO AI algorithm in a U.S. multi-facility stroke network.MethodsThis retrospective pilot study reviewed NCCT and computed tomography angiography (CTA) images between 2015 and 2023. The Methinks AI algorithm, designed to detect LVOs in the internal carotid artery and middle cerebral artery, was tested for sensitivity, specificity, and predictive values. A neuroradiologist reviewed cases to establish a gold standard. To evaluate potential time saving in workflow, time gaps between NCCT and CTA were analyzed and stratified into four groups in true positive cases: Group 1 (<10 min), Group 2 (10-30 min), Group 3 (30-60 min), and Group 4 (>60 min).ResultsFrom a total of 1155 stroke codes, 608 NCCT exams were analyzed. Methinks LVO demonstrated 75% sensitivity and 83% specificity, identifying 146 out of 194 confirmed LVO cases correctly. The PPV of the algorithm was 72%. The NPV was 83% (considering 'other occlusion', 'stenosis' and 'posteriors' as negatives), and 73% considered the same conditions as positives. Among the true positive cases, we found 112 patients Group 1, 32 patients in Group 2, 15 patients in Group 3, 3 patients in Group 4.ConclusionThe Methinks AI algorithm shows promise for improving LVO detection from NCCT, especially in resource limited settings. However, its sensitivity remains lower than CTA-based systems, suggesting the need for further refinement.

BackgroundIntracranial aneurysm (IA) pathogenesis involves complex interplay between genetic predisposition and focal extracellular matrix (ECM) membrane degradation and inflammatory processes. We aimed to identify key differentially expressed genes (DEGs) that serve as hub genes (major genes with large networks) associated with IAs.MethodsWe conducted a comprehensive search of available Gene Expression Omnibus (GEO) databases for IA tissue from database inception to January 2024. This resulted in five GEO datasets, of which four were included as the discovery set, consisting of tissue from 28 IAs and 34 controls. DEGs were identified and used for enrichment analysis in evaluating Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes database pathways. A protein-protein interaction (PPI) DEG network was constructed to pinpoint interactions with other DEGs. The fifth GEO dataset was used to validate hub gene expressions.ResultsWe identified 1864 DEGs: 963 downregulated, 901 upregulated. Three gene clusters were linked to critical biological processes; notably, inflammatory response (GO:006954, false discovery rate [FDR] = 7.12 × 10^-25), muscle contraction (GO:0006936, FDR = 1.1 × 10^-3), and endocrine-related phosphatidylcholine sterol O-acyltransferase activator activity (GO:0060228, p_adj = 3.2 × 10^-2) pathways. Eleven hub genes were identified, of which eight (COL1A, CXCR4, IL10, CXCL8, ESR1, APOE, RN1, and IGF1) were validated.ConclusionsTo our knowledge, this study represents the largest bioinformatics analysis to date on IAs, resulting in identification of 11 hub genes involved in ECM and immunologic pathways. These findings are consistent with existing literature; however, the potential involvement of endocrine-related processes, such as estrogen receptor signaling and cholesterol metabolism, is particularly intriguing and has not been previously well studied in this context.