Interventional Neuroradiology最新文献

{"title":"Flow diversion for treatment of acutely ruptured intracranial aneurysms: Comparison of complications and clinical outcomes with coil embolization.","authors":"Alis J Dicpinigaitis, Ravnit Singh, Rahim Hirani, Smit P Shah, Noor A Mahmoud, Iman Moeini Naghani, Chirag D Gandhi, Fawaz Al-Mufti","doi":"10.1177/15910199251351163","DOIUrl":"10.1177/15910199251351163","url":null,"abstract":"<p><p>IntroductionAlthough flow diversion (FD) has become a major treatment modality for unruptured intracranial aneurysms, it has been used as an off-label therapy for ruptured aneurysms whose morphologies or other characteristics may not be amenable to traditional coil embolization (CE). Previous literature has demonstrated high angiographic occlusion rates for FD in the acute setting, but also high rates of peri-procedural complications (some of which result from use of dual anti-platelet therapy).MethodsAneurysmal subarachnoid hemorrhage (aSAH) hospitalizations treated with endovascular therapy were identified in the National Inpatient Sample (NIS) in 2020. The primary exposure was treatment with FD (identified using a dedicated ICD-10-CM billing code specifying FD intraluminal device), and the primary endpoints were favorable outcome (defined by the NIS Subarachnoid Hemorrhage Outcome Measure, shown to have high concordance with modified Rankin Scale scores < 2 at 90 days following discharge) and peri-procedural ischemic and hemorrhagic complications (PPIHC). Endpoints were compared between FD and CE following 1:1 propensity score matching, adjusting for age, Hunt and Hess grade, comorbidity burden, and aneurysm location.Results7780 aSAH hospitalizations were identified, 150 (1.9%) of which documented treatment with FD, the remainder with CE. 16.7% of FD procedures were preceded by CE. Median treatment time with FD was admission day 1 (1-8) (IQR). Favorable outcomes were achieved in 46.7% of FD cases (and in 47.6% of CE cases), while PPIHC complications were seen in less than 3.3% of cases (and in 2.1% of CE cases). Following propensity score adjustment, 150 FD cases were matched to 150 CE cases, and rates of favorable outcome (46.7% vs. 50.0%, p = 0.563) and PPIHC (3.3% vs. 6.7%, p = 0.185) did not differ between the two treatment modalities.ConclusionFD demonstrated similar clinical outcomes and complication rates in comparison with CE for the treatment of ruptured aneurysms.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251351163"},"PeriodicalIF":1.7,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurointerventional procedures using sheathless 8 Fr Optimo balloon guide catheter via transradial access: A single-center experience with 100 cases.","authors":"Taichiro Imahori, Shigeru Miyake, Ichiro Maeda, Hiroki Goto, Rikuo Nishii, Haruka Enami, Daisuke Yamamoto, Hirotoshi Hamaguchi, Kohkichi Hosoda, Naoki Kaneko, Nobuyuki Sakai, Takashi Sasayama","doi":"10.1177/15910199251348744","DOIUrl":"10.1177/15910199251348744","url":null,"abstract":"<p><p>ObjectiveThis study aimed to evaluate the feasibility and safety of neurointerventional procedures performed via transradial access (TRA) using a sheathless 8 Fr Optimo balloon guide catheter (BGC).MethodsWe retrospectively analyzed 100 consecutive neurointerventional procedures performed via TRA using a sheathless 8 Fr Optimo BGC at a single center. Technical success was defined as the successful delivery of the BGC to the target vessel without conversion to an alternative access site or catheter system, along with the completion of the planned procedure.ResultsA total of 100 procedures were performed in 95 patients (median age: 75 years; 63% male). The most common interventions were aneurysm coiling or flow diversion (45%) and carotid artery stenting (36%). Target vessels for BGC placement included the right carotid (59%), left carotid (31%), right vertebral (4%), and left vertebral (6%) arteries. The median BGC navigation time was 12 min (interquartile range: 7-20). Technical success was achieved in 95% of procedures. In five cases, conversion to transulnar, transbrachial, or transfemoral access was required; nevertheless, all planned procedures were completed successfully. Balloon inflation was utilized in 37% of procedures for distal embolic protection, rupture management, or device delivery support. No major access-related complications were observed. Symptomatic non-access-related periprocedural complications occurred in 3% of cases. The overall mortality rate was 2%.ConclusionsNeurointerventional procedures performed via TRA using a sheathless 8 Fr Optimo BGC appear to be feasible and safe, offering a high technical success rate and a low incidence of access-related complications.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251348744"},"PeriodicalIF":1.7,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early experience with Target Tetra coils for treatment of small and very small ruptured intracranial aneurysms.","authors":"Amol Mehta, Joshua Finesilver, Daryl Goldman, Tomoyoshi Shigematsu, Christopher P Kellner, Shahram Majidi, Reade De Leacy, Johanna Fifi, Michael Travis Caton","doi":"10.1177/15910199251351735","DOIUrl":"10.1177/15910199251351735","url":null,"abstract":"<p><p>BackgroundEndovascular treatment of small (< 5 mm) and very small (≤ 3 mm) ruptured intracranial aneurysms remains technically challenging, historically carrying elevated procedural risks. Advances in coil technology, such as the Target Tetra Detachable Coil (TTDC), aim to improve embolization safety and efficacy. However, limited data exist on outcomes using TTDC coils specifically for ruptured aneurysms.ObjectiveTo evaluate the safety, angiographic efficacy, and clinical outcomes of TTDC for small and very small ruptured intracranial aneurysms.MethodsWe retrospectively analyzed 36 patients with ruptured intracranial aneurysms ≤5 mm treated using TTDC between 2023 and 2025 at a single center. Aneurysms were classified as small (<i>n</i> = 28) or very small (<i>n</i> = 8). Patient demographics, aneurysm characteristics, procedural details, angiographic outcomes, clinical outcomes, and complications were analyzed.ResultsMedian patient age was 57 years (IQR 43-73); 33.3% were male. The mean aneurysm dome height was 2.6 ± 0.9 mm, the mean neck diameter was 2.4 ± 0.7 mm, and the median dome-to-neck ratio was 1.0. Immediate complete occlusion (Raymond-Roy Class I) was achieved in 42.7% of aneurysms, and residual neck filling (Raymond-Roy Class II) in 25.0%. Follow-up imaging (mean 4.9 months) showed complete occlusion in 37.5% of aneurysms. Recanalization occurred in 29.2% of patients with repeat imaging and 6 (25%) requiring retreatment. Favorable clinical outcomes (mRS 0-2) occurred in 75.0%. Procedural complications occurred in 13.9% (five cases), including two intraprocedural perforations. No rebleeding occurred.ConclusionEarly experience with TTDC demonstrates safe, effective embolization for ruptured small and very small intracranial aneurysms, supporting the broader use of modern coils in these challenging lesions.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251351735"},"PeriodicalIF":1.7,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transradial access of neuro-endovascular interventions with aberrant right subclavian arteries: Case series and literature review.","authors":"Yoji Kuramoto, Shoichiro Tsuji, Takanori Kubo, Koichiro Shindo, Kazutaka Uchida, Manabu Shirakawa, Shinichi Yoshimura","doi":"10.1177/15910199251345110","DOIUrl":"https://doi.org/10.1177/15910199251345110","url":null,"abstract":"<p><p>IntroductionTransradial artery access (TRA) reduces puncture site complications and is becoming standard in neuro-endovascular procedures. An aberrant right subclavian artery (ARSA) is a congenital anomaly affecting 0.5% to 2% of the population, complicating cerebral angiography via TRA.Case presentationThree cases of neuro-endovascular treatment involving ARSA and TRA are reported. In the first case, ARSA was detected during the induction of a 7Fr RIST from the right distal radial artery (dRA), and treatment continued with transfemoral access. In the second case, ARSA was identified pre-interventionally, and a left dRA approach was selected with a 6Fr Axcelguide Stiff-J with pulling-up methods. The third case involved the successful induction of a 7Fr RIST with some tips to the right internal carotid artery, followed by the placement of a flow diverter.DiscussionARSA, a congenital anomaly, complicates TRA due to its abnormal bifurcation. Cerebral angiography with ARSA is challenging, often requiring alternative access routes. We gathered our 3 reports and the 11 literature reports, with 3 switching to femoral access due to the difficulty of catheter navigation. Two guiding methods in TRA are discussed, with the \"pull-back technique\" often applied with the Simmonds-type guiding catheter but sometimes ineffective.ConclusionThree neuro-interventional cases with TRA and ARSA are presented, with two successful treatments. The limited cases underscore the need for preoperative access route examination and the development of alternative methods in case of failure. This urgency highlights the importance of ongoing research and innovation in the field.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251345110"},"PeriodicalIF":1.7,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment outcomes of successful M1 versus M2 thrombectomy for low-ASPECTS stroke patients.","authors":"Huanwen Chen, Marco Colasurdo, Hidetoshi Matsukawa, Conor Cunningham, Ilko Maier, Pascal Jabbour, Joon-Tae Kim, Stacey Quintero Wolfe, Ansaar Rai, Robert M Starke, Marios-Nikos Psychogios, Amir Shaban, Nitin Goyal, Shinichi Yoshimura, Hugo Cuellar, Brian Howard, Ali Alawieh, Ali Alaraj, Mohamad Ezzeldin, Daniele G Romano, Omar Tanweer, Justin Mascitelli, Isabel Fragata, Adam Polifka, Fazeel Siddiqui, Joshua Osbun, Roberto Crosa, Ramesh Grandhi, Charles Matouk, Min S Park, Michael R Levitt, Waleed Brinjikji, Mark Moss, Ergun Daglioglu, Richard Williamson, Pedro Navia, Shakeel Chowdhry, David J Altschul, Alejandro M Spiotta, Peter Kan","doi":"10.1177/15910199251343283","DOIUrl":"10.1177/15910199251343283","url":null,"abstract":"<p><p>BackgroundThe effectiveness of endovascular thrombectomy (EVT) for low Alberta Stroke Program Early CT score (ASPECTS) stroke patients with occlusion of the second segment of the middle cerebral artery (M2) is unclear.MethodsThis was a multicenter retrospective study. Patients with M1 or M2 occlusions and low ASPECTS (<6) who underwent successful EVT (modified treatment in cerebral ischemia score of 2b or higher) were included. Primary outcome was futile EVT reperfusion (defined as 90-day modified Rankin scale of 5 or 6). Other outcomes of interest include acceptable outcomes (modified Rankin scale of 3 or less) and intracranial hemorrhage (ICH), and all-cause 90-day mortality. Outcomes for M1 patients were compared to M2 patients with multivariable logistic regression models accounting for potential confounders.Results173 patients with M1 or M2 occlusions and low ASPECTS (<6) who underwent successful EVT were identified. After multivariable adjustments, M2 patients had significantly higher odds of futile reperfusion (OR 5.48 [95%CI 1.91 to 15.7], p = 0.002), lower odds of acceptable outcomes (OR 0.33 [95%CI 0.12 to 0.89], p = 0.028), and higher odds of all-cause mortality (OR 4.90 [95%CI 1.65 to 14.5], p = 0.004). These findings suggest that EVT's efficacy for low-ASPECTS stroke patients may be diminished for patients with M2 occlusions. M2 occlusion was not significantly associated with ICH.ConclusionsAmong low-ASEPCTS stroke patients who underwent successful EVT, those with M2 occlusions had significantly higher odds of poor outcome compared to those with M1 occlusions.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251343283"},"PeriodicalIF":1.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144316912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of subdural evacuating port system (SEPS) and middle meningeal artery embolization (MMAE) for chronic subdural hematomas.","authors":"Vinay Jaikumar, Jaims Lim, Patrick Wahlig, Matthew K Moser, Julia Rupp, Marissa D Kruk, Muhammad Waqas, Devan Patel, Alexander G Fritz, Andre Monteiro, Hamid Sharif Khan, Tyler A Scullen, Mehdi Bouslama, Kunal P Raygor, Pui Man Rosalind Lai, Kenneth V Snyder, Elad I Levy, Jason M Davies, Adnan H Siddiqui","doi":"10.1177/15910199251342309","DOIUrl":"10.1177/15910199251342309","url":null,"abstract":"<p><p>BackgroundPerforming a craniotomy for chronic subdural hematoma (cSDH) in elderly patients with comorbidities can be challenging. The Subdural Evacuating Port System (SEPS; Medtronic, Dublin, Ireland) offers a less-invasive alternative, while middle meningeal artery embolization (MMAE) has shown effectiveness in preventing cSDH recurrence. However, the combined effectiveness of SEPS and MMAE (SEPS + MMAE) remains unclear. This study reports the outcomes of patients undergoing a combination of these procedures for the treatment of cSDH.MethodsA retrospective review of our medical records database was conducted to identify patients with cSDH who were treated with SEPS + MMAE between January 1, 2021, and April 1, 2024. Demographics, comorbidities, procedure, and outcomes data were analyzed. cSDH resolution was tracked by measuring hematoma volumes on noncontrast computed tomography scans pre-SEPS + MMAE, 24-48 h postprocedure, and 6-8 weeks postprocedure.ResultsA total of 35 patients (median age: 77 years [interquartile range (IQR):69-85.5]; men:woman = 22:13) with 49 cSDH, of which 41 cSDHs receiving combined SEPS + MMAE were included. Notably, 38 (92.7%) of the 41 cSDHs were holohemispheric, and 15 (36.6%) had an acute or subacute component. The median pre-SEPS + MMAE cSDH volume was 121.9 mL [IQR:87.9-153.4 mL] with a median midline shift of 6.6 mm [IQR:3.5-10 mm]. All MMAE procedures were performed under conscious sedation. The femoral approach was utilized in 19 patients (54.3%). Three patients required rescue craniotomy. Median post-SPES + MMAE volume was 71.1 mL [IQR:54.5-93.2], resulting in a 38% [IQR:21.9-53] reduction in cSDH volume; and median follow-up SEPS + MMAE volume was 22 mL [IQR:2-59.2] resulting in an 81% [IQR:50.9-98.1] reduction in cSDH volume, compared to pre-SEPS + MMAE levels. Seven (17.1%) patients required readmission for residual or recurrent cSDH within 90 days. Five of these patients were retreated (12.2%), two of whom required craniotomy (4.9%).ConclusionOur experience suggests that SEPS + MMAE was an effective method of cSDH treatment and was associated with low complication rates.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251342309"},"PeriodicalIF":1.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144316908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simulation of cerebrospinal fluid (CSF)-venous fistula embolization in a swine model: A technical video.","authors":"Esref Alperen Bayraktar, Jonathan Cortese, Julien Ognard, Gerard El Hajj, Cem Bilgin, Ramanathan Kadirvel, David F Kallmes, Waleed Brinjikji","doi":"10.1177/15910199251349656","DOIUrl":"https://doi.org/10.1177/15910199251349656","url":null,"abstract":"<p><p>Cerebrospinal fluid venous fistulas (CSFVF) can lead to spontaneous intracranial hypotension, causing debilitating symptoms in patients. The transvenous embolization technique has been developed to occlude leakage sites via an endovascular approach. However, the spinal venous anatomy remains relatively unfamiliar to many neurointerventionalists. This technical video presents a swine model designed to train physicians in navigating the spinal venous system, performing embolization injections, observing their spread, and testing new embolization systems for treating CSFVF. Although there are slight anatomical differences, the spinal venous system in swine closely resembles that of humans, including its navigability and employing liquid embolic agents. We successfully embolized multilevel spinal vasculature that can potentially drain into a fistula formation, without any complications.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251349656"},"PeriodicalIF":1.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144316911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perfusion imaging parameters predict long-term clinical outcome in isolated posterior cerebral artery occlusion stroke patients.","authors":"Hamza Adel Salim, Dhairya A Lakhani, Janet Me, Aneri Balar, Shenwen Huang, Meisam Hoseinyazdi, Licia Luna, Francis Deng, Nathan Z Hyson, Mona Bahouth, Adam A Dmytriw, Adrien Guenego, Gregory W Albers, Hanzhang Lu, Victor C Urrutia, Kambiz Nael, Elisabeth B Marsh, Argye E Hillis, Rafael Llinas, Max Wintermark, Jeremy J Heit, Tobias D Faizy, Vivek Yedavalli","doi":"10.1177/15910199251342839","DOIUrl":"10.1177/15910199251342839","url":null,"abstract":"<p><p>BackgroundIsolated posterior cerebral artery (PCA) occlusions, which account for 5% of ischemic strokes, significantly impact patient quality of life due to effects on the thalamus and visual cortex. Current guidelines for acute treatment and the prognostic utility of perfusion imaging in PCA strokes remain limited and underexplored.MethodsWe conducted a retrospective analysis of 21 patients with isolated PCA occlusions from January 2017 to March 2023 at two comprehensive medical institutions. Perfusion imaging parameters, including time-to-maximum (Tmax) > 4 s, Tmax > 6 s, Tmax > 8 s, Tmax > 10 s, and mismatch volume, were extracted. The primary outcome was the modified Rankin Scale (mRS) score at 90 days.ResultsThe median age of patients was 70 years, with 62% being male. Time-to-maximum > 4 s volume (rho = 0.46, 95% CI, 0.1-0.71, <i>p</i> = 0.036) and Tmax > 6 s volume (rho = 0.45, 95% CI, 0.09-0.71, <i>p</i> = 0.04) showed significant positive correlations with 90-day mRS scores. Other perfusion parameters, such as Tmax > 8 s volume and mismatch volume, approached statistical significance, while rCBF and hypoperfusion intensity ratio did not show significant correlations.ConclusionsPerfusion imaging parameters, particularly Tmax tissue volumes, are correlated with long-term clinical outcomes in patients with isolated PCA occlusions. These findings support the potential role of perfusion imaging in the prognostic assessment and management of PCA stroke patients. Future studies with larger cohorts are warranted to confirm these results and to establish standardized perfusion imaging protocols for PCA occlusions.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251342839"},"PeriodicalIF":1.7,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12174088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144316910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does endovascular thrombectomy using super-bore 0.088\" large distal platform offer advantages over balloon guide catheters in acute ischemic stroke secondary to large vessel occlusion?","authors":"Annie Trang, Clint Badger, Jose Marino, Souvik Singha, Shyam Majmundar, Timothy Miller, Dheeraj Gandhi, Jacob Cherian","doi":"10.1177/15910199251347789","DOIUrl":"10.1177/15910199251347789","url":null,"abstract":"<p><p>BackgroundBalloon guide catheters (BGCs) can optimize recanalization in endovascular thrombectomies, but recent studies suggest that aspiration catheters sized closely to the target vessel can be effective for recanalization.ObjectiveTo compare the outcomes, efficacy, and safety of a single-surgeon experience replacing BGCs with large distal platform (LDP) catheters.MethodsThis is a retrospective study of patients with anterior circulation large vessel occlusion undergoing endovascular thrombectomies. Our study population was divided based on use of either the Zoom™ 0.088\" LDP (Imperative Care, Inc., Campbell, CA, USA) or Walrus™ BGC (Q'Apel Medical, Fremont, CA, USA). Primary outcomes were the thrombectomy technique used, time from groin puncture to recanalization, first pass effect (FPE), degree of final reperfusion (modified treatment in cerebral infarction [mTICI]), postoperative complications, and all-cause mortality at 90 days.ResultsWe analyzed 48 cases: 27 with Walrus™ BGC and 21 with LDP. Contact aspiration was primarily used with LDP (<i>p</i> < 0.001), while a stent-retriever-based technique was preferred with BGC (<i>p</i> < 0.001). The median groin-to-recanalization time was shorter for the LDP cohort (<i>p</i> = 0.001). Both cohorts achieved mTICI ≥ 2b in all cases, with more mTICI of 3 in the LDP cohort (<i>p</i> = 0.38). The LDP cohort also had a greater FPE (<i>p</i> = 0.034). Four cases with iatrogenic dissections were observed with Walrus™ BGC (<i>p</i> = 0.12) and 2 cases with downstream emboli with using the LDP (<i>p</i> = 0.19). All-cause mortality was similar between cohorts (<i>p</i> > 0.99).ConclusionThe super-bore LDP offers a significant advantage over BGCs, achieving faster reperfusion times without compromising safety or recanalization effectiveness. Switching to super-bore 0.088\" Zoom may enhance thrombectomy procedures.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251347789"},"PeriodicalIF":1.7,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12174095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144316907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of multidisciplinary simulation training on endovascular thrombectomy: Workflow, patient outcomes and anaesthetic management.","authors":"Caroline G Fugelli, Martin W Kurz, Britt S Hansen, Soffien Ajmi, Jan T Kvaløy, Lars Fjetland, Cecilie Grøtteland, Snorre Eikeland, Hege Ersdal","doi":"10.1177/15910199251336952","DOIUrl":"10.1177/15910199251336952","url":null,"abstract":"<p><p>BackgroundEndovascular thrombectomy (EVT) is a time-sensitive treatment for acute stroke patients. This study was conducted to evaluate the impact of multidisciplinary simulation training on workflow, patient outcomes, and anaesthetic management during EVT.MethodsThis pre-post interventional study treated 244 stroke patients with EVT (55 pre- and 189 postintervention) between May 2016 and November 2021. A multidisciplinary in situ EVT simulation training programme, including a new EVT protocol with a higher blood pressure target range, was implemented in 2017. We assessed the following variables: (1) Workflow metrics: Process times, revascularisation success, and complications; (2) patient outcomes: Symptomatic intracerebral haemorrhage, functional outcomes at 90 days, and the National Institute of Health Stroke Scale postprocedure; and (3) anaesthetic management: Systolic blood pressure (SBP) thresholds, adherence to protocol, and the conversion rate from conscious sedation to general anaesthesia.ResultsThe postintervention workflow improved significantly, with a reduction in the median groin puncture-to-reperfusion time from 76 to 53 min (<i>p</i> = 0.003) and in the door-to-angio suite arrival time from 54 to 35 min (<i>p</i> < 0.001). Other EVT workflow metrics and patient outcomes remained unchanged. Postintervention haemodynamic management significantly changed with increasing median SBP outside protocol thresholds (14 vs. 28.5 min, <i>p</i> = 0.003). A variety of different combinations of anaesthetics were used for conscious sedation.ConclusionsMultidisciplinary simulation training improved EVT workflow times, highlighting its potential to optimise processes. However, the lack of significant improvement in patient outcomes and anaesthetic management suggests the need for a stronger focus on anaesthesia in future training to optimise EVT outcomes.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251336952"},"PeriodicalIF":1.7,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12174582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144316909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}