Pub Date : 2025-07-21DOI: 10.1016/j.neurad.2025.101373
Jean Papaxanthos, Malgorzata Milnerowicz, Xavier Barreau, Omer Eker, Jerome Berge, Gaultier Marnat, Thomas Courret
Managing a dissected carotid loop in tandem occlusion stroke is a challenging situation. Despite the low stroke recurrence rate after spontaneous carotid dissection, some situations may require carotid stenting.1, 2, 3 After intracranial revascularization, several complex endovascular techniques have been reported, aiming to adapt to the tortuous anatomy of the carotid and involving extensive metal coverage through telescopic stenting and flow diverters in the acute phase.4, 5, 6 In this video,
{"title":"Single-stent strategy for a dissected carotid loop in acute tandem occlusion: Technical considerations","authors":"Jean Papaxanthos, Malgorzata Milnerowicz, Xavier Barreau, Omer Eker, Jerome Berge, Gaultier Marnat, Thomas Courret","doi":"10.1016/j.neurad.2025.101373","DOIUrl":"10.1016/j.neurad.2025.101373","url":null,"abstract":"<div>Managing a dissected carotid loop in tandem occlusion stroke is a challenging situation. Despite the low stroke recurrence rate after spontaneous carotid dissection, some situations may require carotid stenting.1, 2, 3 After intracranial revascularization, several complex endovascular techniques have been reported, aiming to adapt to the tortuous anatomy of the carotid and involving extensive metal coverage through telescopic stenting and flow diverters in the acute phase.4, 5, 6 In this video, </div>","PeriodicalId":50115,"journal":{"name":"Journal of Neuroradiology","volume":"52 5","pages":"Article 101373"},"PeriodicalIF":3.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-19DOI: 10.1016/j.neurad.2025.101372
Jildaz Caroff , Cristian Mihalea , Jens Fiehler , Mario Martinez-Galdamez , Saleh Lamin , Markus Holtmannspötter , Laurent Spelle
Background
Dual Antiplatelet Therapy (DAPT) prescription following flow-diverter stent treatment of intracranial aneurysms is standard of care but evidence regarding the drugs of choice and duration of DAPT remains limited. We aim report to report practitioners’ DAPT prescribing habits and to analysis their impact on adverse events in real-world use of Pipeline™ Flex with Shield Technology stent.
Methods
Data from 3 post-market core lab adjudicated studies were retrospectively analyzed. Patients with acutely ruptured aneurysms, or on single APT were excluded. DAPT durations were collected, and patients were divided in 2 DAPT duration groups (< or ≥ 6 months).
Results
The analysis included 707 patients with 776 aneurysms. The P2Y12 inhibitor of choice was mainly clopidogrel in 68.7 %, ticagrelor in 15.8 % and prasugrel in 12.2 %. Median DAPT duration was 177 days (IQR 93–227). Younger patients and those with mRS ≤ 2 significantly received longer DAPT. Global ischemic stroke rate was 3.2 % (2.5 % before and 0.7 % after DAPT discontinuation) whereas major bleeding risk was 3.5 % (3.5 % before and 0 % after DAPT discontinuation). Post-discharge ischemic stroke and major bleeding rates were 1.8 % and 1.4 % respectively. Cumulative rates of both thromboembolic complications and ischemic strokes were higher in the < 6 months group (7.5 %) vs < 6 months group (4.6 %) without reaching statistical significance.
Conclusion
In this large real-world retrospective analysis, most major adverse events were reported within 30 days post-FDS procedure. Complications rates after discharge and after DAPT discontinuation were very low and similar between DAPT duration groups. These data provide a foundation for designing future prospective studies to evaluate optimal DAPT protocols—both in terms of drug type and duration—which could potentially inform future clinical guidelines.
{"title":"Dual antiplatelet therapy practices following Pipeline Shield embolization and their impact on adverse events in three large real-life registries","authors":"Jildaz Caroff , Cristian Mihalea , Jens Fiehler , Mario Martinez-Galdamez , Saleh Lamin , Markus Holtmannspötter , Laurent Spelle","doi":"10.1016/j.neurad.2025.101372","DOIUrl":"10.1016/j.neurad.2025.101372","url":null,"abstract":"<div><h3>Background</h3><div>Dual Antiplatelet Therapy (DAPT) prescription following flow-diverter stent treatment of intracranial aneurysms is standard of care but evidence regarding the drugs of choice and duration of DAPT remains limited. We aim report to report practitioners’ DAPT prescribing habits and to analysis their impact on adverse events in real-world use of Pipeline™ Flex with Shield Technology stent.</div></div><div><h3>Methods</h3><div>Data from 3 post-market core lab adjudicated studies were retrospectively analyzed. Patients with acutely ruptured aneurysms, or on single APT were excluded. DAPT durations were collected, and patients were divided in 2 DAPT duration groups (< or ≥ 6 months).</div></div><div><h3>Results</h3><div>The analysis included 707 patients with 776 aneurysms. The P2Y12 inhibitor of choice was mainly clopidogrel in 68.7 %, ticagrelor in 15.8 % and prasugrel in 12.2 %. Median DAPT duration was 177 days (IQR 93–227). Younger patients and those with mRS ≤ 2 significantly received longer DAPT. Global ischemic stroke rate was 3.2 % (2.5 % before and 0.7 % after DAPT discontinuation) whereas major bleeding risk was 3.5 % (3.5 % before and 0 % after DAPT discontinuation). Post-discharge ischemic stroke and major bleeding rates were 1.8 % and 1.4 % respectively. Cumulative rates of both thromboembolic complications and ischemic strokes were higher in the < 6 months group (7.5 %) vs < 6 months group (4.6 %) without reaching statistical significance.</div></div><div><h3>Conclusion</h3><div>In this large real-world retrospective analysis, most major adverse events were reported within 30 days post-FDS procedure. Complications rates after discharge and after DAPT discontinuation were very low and similar between DAPT duration groups. These data provide a foundation for designing future prospective studies to evaluate optimal DAPT protocols—both in terms of drug type and duration—which could potentially inform future clinical guidelines.</div></div>","PeriodicalId":50115,"journal":{"name":"Journal of Neuroradiology","volume":"52 5","pages":"Article 101372"},"PeriodicalIF":3.0,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144663279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-16DOI: 10.1016/j.neurad.2025.101371
Osama Elshafei , Jonathan Cortese , Ali Gaber , Eman Eltantawy , Adrian Dan Popica , Léon Ikka , Cristian Mihalea , Vanessa Chalumeau , Mariana Sarov , Olivier Chassin , Christian Denier , Jildaz Caroff , Laurent Spelle
Background
Mechanical thrombectomy (MT) for M2-segment occlusions of the middle cerebral artery can be an effective treatment for acute ischemic stroke but its effectiveness and the choice of the first line strategy remains unanswered questions. The angiographic shape of the occlusion has been suggested to impact the recanalization rates in M1-segment occlusions. We aimed to investigate whether the angiographic shape of the M2-segment impacts the outcomes of MT with stent retriever (SR) or contact aspiration (CA).
Methods
From January 2015 to December 2022, consecutive patients admitted to a single high-volume institution for acute ischemic stroke with an M2-segment occlusion treated by MT were included and retrospectively analyzed. Patients were classified into two groups, regular or irregular, according to the angiographic occlusion shape. Patients demographic, procedural, clinical and safety outcomes data were reviewed.
Results
A total of 214 MT procedures were included and categorized as regular (39 %) and irregular (61 %) shape occlusion groups. Interrater agreement was high (k = 94 %). There were no significant differences between the two groups as regard demographic, procedural, clinical and safety outcomes except for smoking (33.5 % vs 16.8 %, p = 0.01). Procedural outcomes, recanalization rates and clinical outcomes did not significantly differ between the regular and irregular occlusion groups. In subgroup analysis, for irregular occlusions SR as a first-line strategy was associated with higher rates of excellent recanalization (mTICI 2c - 3) after the first pass compared to CA±SR (44 % vs 27.16 %, p = 0.05), and also better clinical outcomes, with lower 24-hour NIHSS (p < 0.01) and lower 3-month mRS (p = 0.04). In regular occlusions, no significant differences were found in recanalization rates or clinical outcomes when using SR or CA±SR.
Conclusion
Choosing SR as the first line strategy for irregular shape M2-segment occlusions is associated with higher rates of recanalization after the first pass and better clinical outcomes. Further prospective studies are needed to confirm our findings.
背景：机械取栓治疗大脑中动脉m2段闭塞是治疗急性缺血性脑卒中的有效方法，但其有效性和一线策略的选择仍未得到解答。闭塞的血管造影形状被认为会影响m1段闭塞的再通率。我们的目的是研究血管成像的形状是否会影响支架回收器（SR）或接触吸入（CA）的MT结果。方法纳入2015年1月至2022年12月在同一家大容量医院连续收治的急性缺血性卒中m2段闭塞患者，并对其进行回顾性分析。根据血管造影闭塞形态将患者分为规则组和不规则组。回顾了患者的人口学、程序、临床和安全结局数据。结果共纳入214例MT手术，分为规则（39%）和不规则（61%）形状闭塞组。研究者间一致性高（k = 94%）。除吸烟外，两组在人口学、程序、临床和安全性方面均无显著差异（33.5% vs 16.8%, p = 0.01）。手术结果、再通率和临床结果在规则组和不规则组之间无显著差异。在亚组分析中，对于不规则闭塞，与CA±SR相比，SR作为一线策略在第一次通道后具有更高的优秀再通率（mTICI 2c - 3） （44% vs 27.16%, p = 0.05），并且具有更好的临床结果，24小时NIHSS较低(p <；3个月mRS较低（p = 0.04）。在常规闭塞情况下，使用SR或CA±SR在再通率和临床结果上无显著差异。结论选择SR作为不规则形状m2段闭塞的一线治疗策略，一遍通后再通率较高，临床效果较好。需要进一步的前瞻性研究来证实我们的发现。
{"title":"Impact of M2-segment occlusion angiographic shape on recanalization and clinical outcomes in mechanical thrombectomy","authors":"Osama Elshafei , Jonathan Cortese , Ali Gaber , Eman Eltantawy , Adrian Dan Popica , Léon Ikka , Cristian Mihalea , Vanessa Chalumeau , Mariana Sarov , Olivier Chassin , Christian Denier , Jildaz Caroff , Laurent Spelle","doi":"10.1016/j.neurad.2025.101371","DOIUrl":"10.1016/j.neurad.2025.101371","url":null,"abstract":"<div><h3>Background</h3><div>Mechanical thrombectomy (MT) for M2-segment occlusions of the middle cerebral artery can be an effective treatment for acute ischemic stroke but its effectiveness and the choice of the first line strategy remains unanswered questions. The angiographic shape of the occlusion has been suggested to impact the recanalization rates in M1-segment occlusions. We aimed to investigate whether the angiographic shape of the M2-segment impacts the outcomes of MT with stent retriever (SR) or contact aspiration (CA).</div></div><div><h3>Methods</h3><div>From January 2015 to December 2022, consecutive patients admitted to a single high-volume institution for acute ischemic stroke with an M2-segment occlusion treated by MT were included and retrospectively analyzed. Patients were classified into two groups, regular or irregular, according to the angiographic occlusion shape. Patients demographic, procedural, clinical and safety outcomes data were reviewed.</div></div><div><h3>Results</h3><div>A total of 214 MT procedures were included and categorized as regular (39 %) and irregular (61 %) shape occlusion groups. Interrater agreement was high (<em>k</em> = 94 %). There were no significant differences between the two groups as regard demographic, procedural, clinical and safety outcomes except for smoking (33.5 % vs 16.8 %, <em>p</em> = 0.01). Procedural outcomes, recanalization rates and clinical outcomes did not significantly differ between the regular and irregular occlusion groups. In subgroup analysis, for irregular occlusions SR as a first-line strategy was associated with higher rates of excellent recanalization (mTICI 2c - 3) after the first pass compared to CA±SR (44 % vs 27.16 %, <em>p</em> = 0.05), and also better clinical outcomes, with lower 24-hour NIHSS (<em>p</em> < 0.01) and lower 3-month mRS (<em>p</em> = 0.04). In regular occlusions, no significant differences were found in recanalization rates or clinical outcomes when using SR or CA±SR.</div></div><div><h3>Conclusion</h3><div>Choosing SR as the first line strategy for irregular shape M2-segment occlusions is associated with higher rates of recanalization after the first pass and better clinical outcomes. Further prospective studies are needed to confirm our findings.</div></div>","PeriodicalId":50115,"journal":{"name":"Journal of Neuroradiology","volume":"52 5","pages":"Article 101371"},"PeriodicalIF":3.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144634381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Would you board a plane if the pilot had never trained on a flight simulator?","authors":"Baptiste Donnard , Gregoire Boulouis , Aymeric Rouchaud , Gaultier Marnat , Thibault Agripnidis , Jean-Pierre Pruvo , Kevin Janot","doi":"10.1016/j.neurad.2025.101370","DOIUrl":"10.1016/j.neurad.2025.101370","url":null,"abstract":"","PeriodicalId":50115,"journal":{"name":"Journal of Neuroradiology","volume":"52 5","pages":"Article 101370"},"PeriodicalIF":3.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Early-onset Alzheimer’s disease (EOAD) population is a clinically, genetically and pathologically heterogeneous condition. Identifying biomarkers related to disease progression is crucial for advancing clinical trials and improving therapeutic strategies. This study aims to differentiate EOAD patients with varying rates of progression using Brain Age Gap Estimation (BrainAGE)-based clustering algorithm applied to structural magnetic resonance images (MRI).
Methods
A retrospective analysis of a longitudinal cohort consisting of 142 participants who met the criteria for early-onset probable Alzheimer’s disease was conducted. Participants were assessed clinically, neuropsychologically and with structural MRI at baseline and annually for 6 years. A Brain Age Gap Estimation (BrainAGE) deep learning model pre-trained on 3,227 3D T1-weighted MRI of healthy subjects was used to extract encoded MRI representations at baseline. Then, k-means clustering was performed on these encoded representations to stratify the population. The resulting clusters were then analyzed for disease severity, cognitive phenotype and brain volumes at baseline and longitudinally.
Results
The optimal number of clusters was determined to be 2. Clusters differed significantly in BrainAGE scores (5.44 [± 8] years vs 15.25 [± 5 years], p < 0.001). The high BrainAGE cluster was associated with older age (p = 0.001) and higher proportion of female patients (p = 0.005), as well as greater disease severity based on Mini Mental State Examination (MMSE) scores (19.32 [±4.62] vs 14.14 [±6.93], p < 0.001) and gray matter volume (0.35 [±0.03] vs 0.32 [±0.02], p < 0.001). Longitudinal analyses revealed significant differences in disease progression (MMSE decline of -2.35 [±0.15] pts/year vs -3.02 [±0.25] pts/year, p = 0.02; CDR 1.58 [±0.10] pts/year vs 1.99 [±0.16] pts/year, p = 0.03).
Conclusion
K-means clustering of BrainAGE encoded representations stratified EOAD patients based on varying rates of disease progression. These findings underscore the potential of using BrainAGE as a biomarker for better understanding and managing EOAD.
{"title":"BrainAGE latent representation clustering is associated with longitudinal disease progression in early-onset Alzheimer’s disease","authors":"Dorian Manouvriez , Grégory Kuchcinski , Vincent Roca , Adeline Rollin Sillaire , Maxime Bertoux , Xavier Delbeuck , Jean-Pierre Pruvo , Simon Lecerf , Florence Pasquier , Thibaud Lebouvier , Renaud Lopes","doi":"10.1016/j.neurad.2025.101365","DOIUrl":"10.1016/j.neurad.2025.101365","url":null,"abstract":"<div><h3>Introduction</h3><div>Early-onset Alzheimer’s disease (EOAD) population is a clinically, genetically and pathologically heterogeneous condition. Identifying biomarkers related to disease progression is crucial for advancing clinical trials and improving therapeutic strategies. This study aims to differentiate EOAD patients with varying rates of progression using Brain Age Gap Estimation (BrainAGE)-based clustering algorithm applied to structural magnetic resonance images (MRI).</div></div><div><h3>Methods</h3><div>A retrospective analysis of a longitudinal cohort consisting of 142 participants who met the criteria for early-onset probable Alzheimer’s disease was conducted. Participants were assessed clinically, neuropsychologically and with structural MRI at baseline and annually for 6 years. A Brain Age Gap Estimation (BrainAGE) deep learning model pre-trained on 3,227 3D T1-weighted MRI of healthy subjects was used to extract encoded MRI representations at baseline. Then, k-means clustering was performed on these encoded representations to stratify the population. The resulting clusters were then analyzed for disease severity, cognitive phenotype and brain volumes at baseline and longitudinally.</div></div><div><h3>Results</h3><div>The optimal number of clusters was determined to be 2. Clusters differed significantly in BrainAGE scores (5.44 [± 8] years vs 15.25 [± 5 years], <em>p</em> < 0.001). The high BrainAGE cluster was associated with older age (<em>p</em> = 0.001) and higher proportion of female patients (<em>p</em> = 0.005), as well as greater disease severity based on Mini Mental State Examination (MMSE) scores (19.32 [±4.62] vs 14.14 [±6.93], <em>p</em> < 0.001) and gray matter volume (0.35 [±0.03] vs 0.32 [±0.02], <em>p</em> < 0.001). Longitudinal analyses revealed significant differences in disease progression (MMSE decline of -2.35 [±0.15] pts/year vs -3.02 [±0.25] pts/year, <em>p</em> = 0.02; CDR 1.58 [±0.10] pts/year vs 1.99 [±0.16] pts/year, <em>p</em> = 0.03).</div></div><div><h3>Conclusion</h3><div>K-means clustering of BrainAGE encoded representations stratified EOAD patients based on varying rates of disease progression. These findings underscore the potential of using BrainAGE as a biomarker for better understanding and managing EOAD.</div></div>","PeriodicalId":50115,"journal":{"name":"Journal of Neuroradiology","volume":"52 5","pages":"Article 101365"},"PeriodicalIF":3.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144536133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Y-stent-assisted coiling (Y-SAC) using two stents can provide adequate coverage of the aneurysm neck even in wide-neck bifurcation-type aneurysms, but whether it is more effective and safer than single-stent-assisted coiling (S-SAC) remains unclear. The purpose of this study was to investigate the efficacy and safety of Y-SAC with the Neuroform Atlas stent for bifurcation-type unruptured cerebral aneurysms (UCAs).
Materials and Methods
A total of 186 bifurcation-type UCAs treated with the Neuroform Atlas stent were retrospectively reviewed. The aneurysms were divided into Y-SAC and S-SAC groups. Angiographic occlusion status and complication rates were analyzed using 1:2 propensity score matching.
Results
Of the 186 UCAs, 17 (9.1 %) were treated by Y-SAC. Propensity score matching was successful for 14 UCAs in the Y-SAC group and 28 UCAs in the S-SAC group. After propensity score matching, the Y-SAC group had a higher rate of complete occlusion immediately after treatment (71.4 % vs. 32.1 %, P = 0.023), a significantly higher volume embolization ratio (33.3 % [IQR: 30.4, 38.5] vs. 28.9 % [IQR: 24.1, 32.4], P = 0.03), and higher device and implant costs ($11,335 [IQR: $10,427, $13,894] vs. $9592 [IQR: $8211, $10,959], P = 0.002) compared to the S-SAC group. However, the rate of complete occlusion at one year (78.6 % vs. 64.3 %, P = 0.485) and the recanalization rate (14.3 % vs. 3.6 %, P = 0.254) did not differ significantly between the two groups. No significant differences in the incidences of any complications were found between the two groups.
Conclusions
Y-SAC did not improve the complete occlusion rate at one year or reduce the risk of recanalization compared with S-SAC. Given its procedural simplicity and cost-effectiveness, S-SAC may be the preferred strategy for embolizing bifurcation-type UCAs.
背景与目的：使用两个支架的y -支架辅助卷绕（Y-SAC）即使在宽颈分岔型动脉瘤中也能提供足够的动脉瘤颈部覆盖，但是否比单支架辅助卷绕（S-SAC）更有效和安全尚不清楚。本研究的目的是探讨Y-SAC联合神经形态Atlas支架治疗分叉型未破裂脑动脉瘤（UCAs）的疗效和安全性。材料与方法：回顾性分析应用Neuroform Atlas支架治疗的186例分叉型uca。动脉瘤分为Y-SAC组和S-SAC组。采用1:2倾向评分匹配分析血管造影闭塞状况和并发症发生率。结果：186例uca中，Y-SAC治疗17例（9.1%）。Y-SAC组14例uca和S-SAC组28例uca的倾向评分匹配成功。倾向评分匹配后，Y-SAC组治疗后立即完全闭塞率较高（71.4%比32.1%，P=0.023），体积栓塞率显著高于S-SAC组（33.3% [IQR: 30.4, 38.5]比28.9% [IQR: 24.1, 32.4]， P=0.03），器械和种植体费用较高（11,335美元[IQR: 10,427美元，13,894美元]比9,592美元[IQR: 8,211美元，10,959美元]，P=0.002）。然而，两组1年完全闭塞率（78.6% vs. 64.3%， P=0.485）和再通率（14.3% vs. 3.6%， P=0.254）无显著差异。两组患者并发症发生率无显著差异。结论：与S-SAC相比，Y-SAC不能提高1年完全闭塞率，也不能降低再通的风险。鉴于其程序简单和成本效益，S-SAC可能是栓塞分叉型uca的首选策略。
{"title":"Efficacy and safety of the Neuroform Atlas stent for bifurcation type unruptured cerebral aneurysms: Comparison of single versus Y stents with propensity score matching","authors":"Rintaro Tachi , Michiyasu Fuga , Toshihiro Ishibashi , Kazufumi Horiuchi , Akihiko Teshigawara , Ken Aoki , Issei Kan , Toshihide Tanaka , Yuichi Murayama","doi":"10.1016/j.neurad.2025.101369","DOIUrl":"10.1016/j.neurad.2025.101369","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>Y-stent-assisted coiling (Y-SAC) using two stents can provide adequate coverage of the aneurysm neck even in wide-neck bifurcation-type aneurysms, but whether it is more effective and safer than single-stent-assisted coiling (S-SAC) remains unclear. The purpose of this study was to investigate the efficacy and safety of Y-SAC with the Neuroform Atlas stent for bifurcation-type unruptured cerebral aneurysms (UCAs).</div></div><div><h3>Materials and Methods</h3><div>A total of 186 bifurcation-type UCAs treated with the Neuroform Atlas stent were retrospectively reviewed. The aneurysms were divided into Y-SAC and S-SAC groups. Angiographic occlusion status and complication rates were analyzed using 1:2 propensity score matching.</div></div><div><h3>Results</h3><div>Of the 186 UCAs, 17 (9.1 %) were treated by Y-SAC. Propensity score matching was successful for 14 UCAs in the Y-SAC group and 28 UCAs in the S-SAC group. After propensity score matching, the Y-SAC group had a higher rate of complete occlusion immediately after treatment (71.4 % vs. 32.1 %, <em>P</em> = 0.023), a significantly higher volume embolization ratio (33.3 % [IQR: 30.4, 38.5] vs. 28.9 % [IQR: 24.1, 32.4], <em>P</em> = 0.03), and higher device and implant costs ($11,335 [IQR: $10,427, $13,894] vs. $9592 [IQR: $8211, $10,959], <em>P</em> = 0.002) compared to the S-SAC group. However, the rate of complete occlusion at one year (78.6 % vs. 64.3 %, <em>P</em> = 0.485) and the recanalization rate (14.3 % vs. 3.6 %, <em>P</em> = 0.254) did not differ significantly between the two groups. No significant differences in the incidences of any complications were found between the two groups.</div></div><div><h3>Conclusions</h3><div>Y-SAC did not improve the complete occlusion rate at one year or reduce the risk of recanalization compared with S-SAC. Given its procedural simplicity and cost-effectiveness, S-SAC may be the preferred strategy for embolizing bifurcation-type UCAs.</div></div>","PeriodicalId":50115,"journal":{"name":"Journal of Neuroradiology","volume":"52 5","pages":"Article 101369"},"PeriodicalIF":3.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Carotid dissection is a major cause of ischemic stroke in young patients and its endovascular management is complex and lacks consensus. Our aim was to carry out the first comparative evaluation of balloon angioplasty alone versus stenting in the endovascular treatment of acute carotid artery dissection presenting with acute stroke.
Materials and methods
From the national ETIS (Endovascular Treatment of Ischemic Stroke) registry, between January 2015 and 2023, we included patients with acute ischemic stroke secondary to internal carotid artery dissection who underwent endovascular treatment. We compared clinical and imaging outcomes at a 3-month follow-up between two endovascular approaches for managing carotid artery dissection: balloon angioplasty alone versus stenting.
Results
Among the 160 patients included, 26 underwent balloon angioplasty alone, and 134 received carotid stenting. At the 3-month follow-up, the distribution of modified Rankin Scale (mRS) scores did not differ significantly between groups (p = 0.73).
Additionally, at 24 h there were no significant differences observed between the two groups regarding intracranial haemorrhage (31 % angioplasty alone vs. 45 % stenting; p = 0.202), carotid artery patency immediately after endovascular procedure (38.5 % vs 36 %, p = 0.826) or at 24 h (50 % vs. 51 %; p = 0.9), NIHSS scores (11 ± 8 vs. 11 ± 9; p = 0.972) or emboli in new-territory (11.5 % vs. 9 %; p = 0.713).
Conclusion
Although infrequently performed, balloon angioplasty alone showed comparable safety and efficacy to stenting and may represent a valid option in selected cases. Nonetheless, the observational design and small sample size warrant caution, and further studies are needed to confirm these findings.
背景与目的：颈动脉夹层是年轻缺血性脑卒中的主要原因，其血管内处理复杂且缺乏共识。我们的目的是首次比较评价单纯球囊血管成形术与支架置入在急性脑卒中急性颈动脉夹层血管内治疗中的作用。材料和方法：从2015年1月至2023年1月的国家缺血性卒中血管内治疗登记中，我们纳入了接受血管内治疗的颈内动脉夹层继发性急性缺血性卒中患者。在3个月的随访中，我们比较了两种血管内入路治疗颈动脉夹层的临床和影像学结果：单独球囊血管成形术与支架植入术。结果：160例患者中，26例单独行球囊血管成形术，134例行颈动脉支架植入术。随访3个月时，改良Rankin量表（mRS）评分在各组间的分布无显著差异（p = 0.73）。此外，在24小时内，两组在颅内出血方面没有显著差异(单独血管成形术31% vs支架植入术45%；P = 0.202)、血管内手术后颈动脉立即通畅（38.5% vs 36%, P = 0.826）或24小时后通畅(50% vs 51%；p = 0.9)，NIHSS评分(11±8∶11±9；P = 0.972)或新领地栓子(11.5% vs. 9%； = 0.713页)。结论：虽然很少进行球囊血管成形术，但单独球囊血管成形术的安全性和有效性与支架置入术相当，在某些病例中可能是一种有效的选择。然而，观察设计和小样本量值得谨慎，需要进一步的研究来证实这些发现。
{"title":"Balloon angioplasty alone in carotid artery dissections: an overlooked therapeutic choice in acute ischemic stroke","authors":"Joe-Marie Abousleiman , Christophe Cognard , Fabrice Bonneville , Gaultier Marnat , Anne-Christine Januel , Philippe Tall , Federico Sacchetti , Alain Viguier , Magali Raveneau , Bertrand Lapergue , Guillaume Bellanger , ETIS investigators","doi":"10.1016/j.neurad.2025.101367","DOIUrl":"10.1016/j.neurad.2025.101367","url":null,"abstract":"<div><h3>Background & purpose</h3><div>Carotid dissection is a major cause of ischemic stroke in young patients and its endovascular management is complex and lacks consensus. Our aim was to carry out the first comparative evaluation of balloon angioplasty alone versus stenting in the endovascular treatment of acute carotid artery dissection presenting with acute stroke.</div></div><div><h3>Materials and methods</h3><div>From the national ETIS (Endovascular Treatment of Ischemic Stroke) registry, between January 2015 and 2023, we included patients with acute ischemic stroke secondary to internal carotid artery dissection who underwent endovascular treatment. We compared clinical and imaging outcomes at a 3-month follow-up between two endovascular approaches for managing carotid artery dissection: balloon angioplasty alone versus stenting.</div></div><div><h3>Results</h3><div>Among the 160 patients included, 26 underwent balloon angioplasty alone, and 134 received carotid stenting. At the 3-month follow-up, the distribution of modified Rankin Scale (mRS) scores did not differ significantly between groups (<em>p</em> = 0.73).</div><div>Additionally, at 24 h there were no significant differences observed between the two groups regarding intracranial haemorrhage (31 % angioplasty alone vs. 45 % stenting; <em>p</em> = 0.202), carotid artery patency immediately after endovascular procedure (38.5 % vs 36 %, <em>p</em> = 0.826) or at 24 h (50 % vs. 51 %; <em>p</em> = 0.9), NIHSS scores (11 ± 8 vs. 11 ± 9; <em>p</em> = 0.972) or emboli in new-territory (11.5 % vs. 9 %; <em>p</em> = 0.713).</div></div><div><h3>Conclusion</h3><div>Although infrequently performed, balloon angioplasty alone showed comparable safety and efficacy to stenting and may represent a valid option in selected cases. Nonetheless, the observational design and small sample size warrant caution, and further studies are needed to confirm these findings.</div></div>","PeriodicalId":50115,"journal":{"name":"Journal of Neuroradiology","volume":"52 5","pages":"Article 101367"},"PeriodicalIF":3.0,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The Thrombolysis in Cerebral Infarction (TICI) scale is widely used to assess angiographic outcomes of mechanical thrombectomy despite significant variability. Our objective was to create and optimize an artificial intelligence (AI)-based classification model for digital subtraction angiography (DSA) TICI scoring.
Methods
Using a monocentric DSA dataset of thrombectomies, and a platform for medical image analysis, independent readers labeled each series according to TICI score and marked each thrombus. A convolutional neural network (CNN) classification model was created to classify TICI scores, into 2 groups (TICI 0,1 or 2a versus TICI 2b, 2c or 3) and 3 groups (TICI 0,1 or 2a versus TICI 2b versus TICI 2c or 3). The algorithm was first tested alone, and then thrombi positions were introduced to the algorithm by manual placement firstly, then after using a thrombus detection module.
Results
A total of 422 patients were enrolled in the study. 2492 thrombi were annotated on the TICI-labeled series. The model trained on a total of 1609 DSA series. The classification model into two classes had a specificity of 0.97 ± 0.01 and a sensibility of 0.86 ± 0.01. The 3-class models showed insufficient performance, even when combined with the true thrombi positions, with, respectively, F1 scores for TICI 2b classification of 0.50 and 0.55 ± 0.07. The automatic thrombus detection module did not enhance the performance of the 3-class model, with a F1 score for the TICI 2b class measured at 0.50 ± 0.07.
Conclusion
The AI model provided a reproducible 2-class (TICI 0,1 or 2a versus 2b, 2c or 3) classification according to TICI scale. Its performance in distinguishing three classes (TICI 0,1 or 2a versus 2b versus 2c or 3) remains insufficient for clinical practice. Automatic thrombus detection did not improve the model's performance.
背景：尽管存在显著差异，但脑梗死溶栓（TICI）量表被广泛用于评估机械取栓的血管造影结果。我们的目标是创建和优化一个基于人工智能（AI）的分类模型，用于数字减影血管造影（DSA） TICI评分。方法：使用单中心取栓DSA数据集和医学图像分析平台，独立阅读器根据TICI评分对每个系列进行标记，并标记每个血栓。建立卷积神经网络（CNN）分类模型，将TICI评分分为2组（TICI 0、1或2a vs TICI 2b、2c或3）和3组（TICI 0、1或2a vs TICI 2b vs TICI 2c或3）。首先对该算法进行单独测试，然后首先通过人工放置将血栓位置引入算法，然后使用血栓检测模块。结果：共纳入422例患者。2492个血栓被标注在tici标记的系列中。该模型总共训练了1609个DSA序列。两类分类模型的特异性为0.97±0.01，敏感性为0.86±0.01。3类模型即使结合血栓的真实位置也表现不佳，TICI 2b的F1分分别为0.50和0.55±0.07。自动血栓检测模块并没有提高3级模型的性能，TICI 2b级的F1评分为0.50±0.07。结论：AI模型根据TICI量表提供了可重复的2级（TICI 0、1或2a与2b、2c或3）分类。其在区分三类（TICI 0,1或2a vs . 2b vs . 2c或3）方面的表现仍不足以用于临床实践。自动检测血栓并没有提高模型的性能。
{"title":"Design and optimization of an automatic deep learning-based cerebral reperfusion scoring (TICI) using thrombus localization","authors":"Arthur Folcher , Jérémy Piters , Daphné Wallach , Gwenael Guillard , Julien Ognard , Jean-Christophe Gentric","doi":"10.1016/j.neurad.2025.101366","DOIUrl":"10.1016/j.neurad.2025.101366","url":null,"abstract":"<div><h3>Background</h3><div>The Thrombolysis in Cerebral Infarction (TICI) scale is widely used to assess angiographic outcomes of mechanical thrombectomy despite significant variability. Our objective was to create and optimize an artificial intelligence (AI)-based classification model for digital subtraction angiography (DSA) TICI scoring.</div></div><div><h3>Methods</h3><div>Using a monocentric DSA dataset of thrombectomies, and a platform for medical image analysis, independent readers labeled each series according to TICI score and marked each thrombus. A convolutional neural network (CNN) classification model was created to classify TICI scores, into 2 groups (TICI 0,1 or 2a versus TICI 2b, 2c or 3) and 3 groups (TICI 0,1 or 2a versus TICI 2b versus TICI 2c or 3). The algorithm was first tested alone, and then thrombi positions were introduced to the algorithm by manual placement firstly, then after using a thrombus detection module.</div></div><div><h3>Results</h3><div>A total of 422 patients were enrolled in the study. 2492 thrombi were annotated on the TICI-labeled series. The model trained on a total of 1609 DSA series. The classification model into two classes had a specificity of 0.97 ± 0.01 and a sensibility of 0.86 ± 0.01. The 3-class models showed insufficient performance, even when combined with the true thrombi positions, with, respectively, F1 scores for TICI 2b classification of 0.50 and 0.55 ± 0.07. The automatic thrombus detection module did not enhance the performance of the 3-class model, with a F1 score for the TICI 2b class measured at 0.50 ± 0.07.</div></div><div><h3>Conclusion</h3><div>The AI model provided a reproducible 2-class (TICI 0,1 or 2a versus 2b, 2c or 3) classification according to TICI scale. Its performance in distinguishing three classes (TICI 0,1 or 2a versus 2b versus 2c or 3) remains insufficient for clinical practice. Automatic thrombus detection did not improve the model's performance.</div></div>","PeriodicalId":50115,"journal":{"name":"Journal of Neuroradiology","volume":"52 5","pages":"Article 101366"},"PeriodicalIF":3.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Focal Cortical Dysplasia (FCD) is a leading cause of drug-resistant epilepsy, particularly in children and young adults, necessitating precise presurgical planning. Traditional structural MRI often fails to detect subtle FCD lesions, especially in MRI-negative cases. Recent advancements in Artificial Intelligence (AI), particularly Machine Learning (ML) and Deep Learning (DL), have the potential to enhance FCD detection's sensitivity and specificity.
Methods
This systematic review, following PRISMA guidelines, searched PubMed, Embase, Scopus, Web of Science, and Science Direct for articles published from 2020 onwards, using keywords related to “Focal Cortical Dysplasia,” “MRI,” and “Artificial Intelligence/Machine Learning/Deep Learning.” Included were original studies employing AI and structural MRI (sMRI) for FCD detection in humans, reporting quantitative performance metrics, and published in English. Data extraction was performed independently by two reviewers, with discrepancies resolved by a third.
Results
The included studies demonstrated that AI significantly improved FCD detection, achieving sensitivity up to 97.1 % and specificities up to 84.3 % across various MRI sequences, including MPRAGE, MP2RAGE, and FLAIR. AI models, particularly deep learning models, matched or surpassed human radiologist performance, with combined AI-human expertise reaching up to 87 % detection rates. Among 88 full-text articles reviewed, 27 met inclusion criteria. The studies emphasized the importance of advanced MRI sequences and multimodal MRI for enhanced detection, though model performance varied with FCD type and training datasets.
Conclusion
Recent advances in sMRI and AI, especially deep learning, offer substantial potential to improve FCD detection, leading to better presurgical planning and patient outcomes in drug-resistant epilepsy. These methods enable faster, more accurate, and automated FCD detection, potentially enhancing surgical decision-making. Further clinical validation and optimization of AI algorithms across diverse datasets are essential for broader clinical translation.
背景：局灶性皮质发育不良（FCD）是导致耐药癫痫的主要原因，特别是在儿童和年轻人中，需要精确的术前计划。传统的结构MRI往往不能检测到细微的FCD病变，特别是在MRI阴性的病例中。人工智能（AI）的最新进展，特别是机器学习（ML）和深度学习（DL），有可能提高FCD检测的灵敏度和特异性。方法：本系统综述遵循PRISMA指南，检索PubMed、Embase、Scopus、Web of Science和Science Direct，检索2020年以后发表的文章，使用与“局灶性皮质发育不良”、“MRI”和“人工智能/机器学习/深度学习”相关的关键词。纳入了使用人工智能和结构MRI （sMRI）检测人类FCD的原始研究，报告了定量绩效指标，并以英文发表。数据提取由两位审稿人独立完成，差异由第三位审稿人解决。结果：纳入的研究表明，人工智能显著改善了FCD检测，在各种MRI序列中，包括MPRAGE、MP2RAGE和FLAIR，灵敏度高达97.1%，特异性高达84.3%。人工智能模型，特别是深度学习模型，匹配或超过了人类放射科医生的表现，人工智能和人类专业知识的结合达到了87%的检测率。在88篇全文文章中，27篇符合纳入标准。这些研究强调了先进的MRI序列和多模态MRI对增强检测的重要性，尽管模型性能因FCD类型和训练数据集而异。结论：sMRI和人工智能的最新进展，特别是深度学习，为改善FCD检测提供了巨大的潜力，从而改善了耐药癫痫的术前计划和患者预后。这些方法能够更快、更准确、更自动化地检测FCD，潜在地提高手术决策。进一步的临床验证和优化不同数据集的人工智能算法对于更广泛的临床翻译至关重要。
{"title":"Recent advances in sMRI and artificial intelligence for presurgical planning in focal cortical dysplasia: A systematic review","authors":"AmirHossein Mahmoudi , Arshia Alizadeh , Zohreh Ganji , Hoda Zare","doi":"10.1016/j.neurad.2025.101359","DOIUrl":"10.1016/j.neurad.2025.101359","url":null,"abstract":"<div><h3>Background</h3><div>Focal Cortical Dysplasia (FCD) is a leading cause of drug-resistant epilepsy, particularly in children and young adults, necessitating precise presurgical planning. Traditional structural MRI often fails to detect subtle FCD lesions, especially in MRI-negative cases. Recent advancements in Artificial Intelligence (AI), particularly Machine Learning (ML) and Deep Learning (DL), have the potential to enhance FCD detection's sensitivity and specificity.</div></div><div><h3>Methods</h3><div>This systematic review, following PRISMA guidelines, searched PubMed, Embase, Scopus, Web of Science, and Science Direct for articles published from 2020 onwards, using keywords related to “Focal Cortical Dysplasia,” “MRI,” and “Artificial Intelligence/Machine Learning/Deep Learning.” Included were original studies employing AI and structural MRI (sMRI) for FCD detection in humans, reporting quantitative performance metrics, and published in English. Data extraction was performed independently by two reviewers, with discrepancies resolved by a third.</div></div><div><h3>Results</h3><div>The included studies demonstrated that AI significantly improved FCD detection, achieving sensitivity up to 97.1 % and specificities up to 84.3 % across various MRI sequences, including MPRAGE, MP2RAGE, and FLAIR. AI models, particularly deep learning models, matched or surpassed human radiologist performance, with combined AI-human expertise reaching up to 87 % detection rates. Among 88 full-text articles reviewed, 27 met inclusion criteria. The studies emphasized the importance of advanced MRI sequences and multimodal MRI for enhanced detection, though model performance varied with FCD type and training datasets.</div></div><div><h3>Conclusion</h3><div>Recent advances in sMRI and AI, especially deep learning, offer substantial potential to improve FCD detection, leading to better presurgical planning and patient outcomes in drug-resistant epilepsy. These methods enable faster, more accurate, and automated FCD detection, potentially enhancing surgical decision-making. Further clinical validation and optimization of AI algorithms across diverse datasets are essential for broader clinical translation.</div></div>","PeriodicalId":50115,"journal":{"name":"Journal of Neuroradiology","volume":"52 5","pages":"Article 101359"},"PeriodicalIF":3.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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