Interventional Neuroradiology最新文献

{"title":"Endovascular flow diversion reconstruction of petrocervical dissections with the proximal anchoring technique: Experience in 31 consecutive cases.","authors":"Jessica K Campos, Benjamen M Meyer, Fahad J Laghari, David A Zarrin, Muhammad W Khan, Jonathan Collard de Beaufort, Gizal Amin, Ashish Ramesh, Narlin B Beaty, Matthew T Bender, Shuichi Suzuki, Geoffrey P Colby, Alexander L Coon","doi":"10.1177/15910199251317552","DOIUrl":"10.1177/15910199251317552","url":null,"abstract":"<p><strong>Introduction: </strong>Flow diverting stents (FDS) are routinely used to reconstruct the arteries of the head and neck. When placed into the mobile cervical internal carotid artery (cICA) segment, the FDS runs the risk of post-procedure stent migration and proximal intimal hyperplasia reaction from physiologic movement of the neck. We report our experience using a novel proximal anchoring technique during endovascular flow reconstruction of complex petrocervical dissections to prevent this potentially deleterious result.</p><p><strong>Methods: </strong>We reviewed a prospectively maintained IRB-approved institutional database of the senior authors to identify cases of FDS treatment in the mobile petrocervical segments which had the proximal FDS \"anchored\" with a nitinol stent.</p><p><strong>Results: </strong>The proximal anchoring technique was successfully performed in the mobile cervical segment in a total of 31 cases over the study period. Each case involved a complex ICA dissection with 68% (n = 21) having an accompanying pseudoaneurysm. Fifty-two percent (n = 16) were female. Surpass Streamline and Evolve FDS were utilized in all cases. An average of 2.2 ± 0.1 FDS devices were utilized (range 2-4 FDS), with each case utilizing a laser-cut nitinol carotid stent as the proximal anchor. The average stent diameter was 5.64 ± 0.2 mm (range 4-8 mm) and length of 30.1 ± 1.5 mm (range 20-60 mm). On last follow-up angiography, there were no instances of stent migration or proximal neointimal hyperplasia.</p><p><strong>Conclusion: </strong>Utilization of the proximal anchoring technique on FDS constructs in the mobile cICA may provide additional protection from post-procedure stent migration and intimal reaction attributed to patient neck movement resulting in augmentation of successful healing.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251317552"},"PeriodicalIF":1.7,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11840814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458060","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":"Flow diversion in the treatment of intracranial aneurysms using the novel FRED X device: An early experience from a single high-volume center.","authors":"Thomas Mandel Clausen, Ryan Nakamura, Andie Conching, Joo Won Choi, Yi Jonathan Zhang, Ferdinand Hui, Samuel Tsappidi","doi":"10.1177/15910199251319059","DOIUrl":"10.1177/15910199251319059","url":null,"abstract":"<p><strong>Background: </strong>The Flow Re-Direction Endoluminal Device X (FRED X) offers several benefits over other flow-diverter devices including an antithrombotic coating, optimized in-vessel stability, and increased flexibility for easier device placement. We present a to-date experience of the safety and utility of the FRED X device in the repair of posterior and anterior circulation aneurysms.</p><p><strong>Methods: </strong>A retrospective review was conducted on all endovascular procedures that utilized the FRED X device at our center from May 2022 to November 2023.</p><p><strong>Results: </strong>77 patients (72.7% women, mean age 58.9), underwent a total of 85 procedures using the FRED X device. Indications included treatment of incidentally discovered aneurysms, acute dissections, aneurysm rupture, repair of residual filling following prior intervention, and use of FRED X for recanalization of non-aneurysmal extracranial stroke. 31.3% of the aneurysms were in the posterior circulation, 68.7% were in the anterior circulation. 9.4% of patients presented with SAH due to acute aneurysm rupture. Patients treated with FRED X were separated into OFF-Label (40.0%) or ON-label (60.0%) indications. Occlusion rate at 6-month follow-up were 72.2% in the OFF-label group, 66.7% in the ON-label group, and 68.4% overall. Rate of major periprocedural complications was 1.2% and the cumulative rate of postprocedural complication at follow-up was 5.3%.</p><p><strong>Conclusion: </strong>This study shows that FRED X treatment of intracranial aneurysms is safe in both OFF-label and ON-label indications. Continued follow-up of our patient population will further establish the safety, efficacy, and long-term stability of this device.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251319059"},"PeriodicalIF":1.7,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440932","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":"Venous sinus stenting for management of spontaneous skull-base CSF leaks: A systematic review and meta-analysis.","authors":"Jordan M Rasmussen, Kautilya R Patel, Daniel L Surdell, William E Thorell, Nicholas Borg, Patrick J Opperman, Geoffrey Casazza, Anne K Maxwell, Christie Barnes, Samuel Pate, Cindy M Schmidt, Mithun G Sattur","doi":"10.1177/15910199241311626","DOIUrl":"10.1177/15910199241311626","url":null,"abstract":"<p><strong>Background: </strong>Idiopathic intracranial hypertension (IIH) is strongly associated with spontaneous skull-base cerebrospinal fluid (CSF) leaks. Venous sinus stenting (VSS) has proven effective for the treatment of IIH. Hence, its role in spontaneous skull-base CSF leaks is being explored actively.</p><p><strong>Methods: </strong>We performed a systematic literature search across EMBASE, MEDLINE, Scopus, The Cochrane Library, and Google Scholar to identify studies reporting the use of VSS for spontaneous skull-base CSF leaks. Studies with pediatric patients, non-English articles, and nonspontaneous leaks were excluded. Failure of treatment (persistence / recurrence of CSF leak) was regarded as the primary outcome.</p><p><strong>Results: </strong>Eight studies with 62 patients undergoing VSS for spontaneous skull-base CSF leaks were included. Mean age of the patients was 51.9 years; 87.5% were females. Obesity was highly prevalent, with a mean body mass index of 33.9 kg/m² (4 studies). IIH was noted in 74.6% patients (7 studies). Twenty-six patients (41.9%) underwent VSS alone whereas 36 patients (58.1%) underwent surgical repair + VSS. Seven patients (11.3%) had a failure of treatment. Three failures from one study could not be definitively ascribed to either of the groups. Hence, the estimated failure rate for VSS alone ranged from 18.6% (95% CI [0.02 - 0.46]) to 26.4% (95% CI [0.11 - 0.46]), whereas that for surgical repair + VSS ranged from 5.5% (95% CI [0.00 - 0.16]) to 12.2% (95% CI [0.01 - 0.32]). Furthermore, the estimated rate for resolution of concomitant IIH-related symptoms was 88.7% (95% CI [0.75 - 0.98%]). Majority of the studies did not report any serious complications or mortality related to VSS.</p><p><strong>Conclusion: </strong>VSS has a potential role in the management of spontaneous skull-base CSF leaks. Its exact indications as a standalone treatment versus as an adjuvant to surgical repair, and the predictors for successful treatment remain to be defined.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199241311626"},"PeriodicalIF":1.7,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11803593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364345","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":"Outcomes of endovascular thrombectomy in patients with cerebral venous thrombosis: A cohort study of 325 patients.","authors":"Aryan Malhotra, Ankita Jain, Eris Spirollari, Rachid Kaddoura, Melinda Christine Arthur, Ariel Sacknovitz, Mohammed B Nawaiseh, Chaitanya Medicherla, Gurmeen Kaur, Chirag D Gandhi, Fawaz Al-Mufti","doi":"10.1177/15910199241310998","DOIUrl":"10.1177/15910199241310998","url":null,"abstract":"<p><strong>Background: </strong>Cerebral venous thrombosis (CVT) is a rare condition that presents with significant treatment challenges and has traditionally been managed with anticoagulation. However, for patients who fail anticoagulation or present with severe symptoms, endovascular thrombectomy (EVT) has emerged as a favorable treatment modality. This study examines the outcomes, complications, and comorbidities associated with EVT in patients with CVT.</p><p><strong>Methods: </strong>A query of the 2015-2019 National (Nationwide) Inpatient Sample was performed for patients admitted to hospitals with ICD-10 diagnosis codes for CVT and ICD-10 procedure codes for usage of EVT. Demographic information, baseline comorbidities, complications, and discharge dispositions were compared between patients who underwent EVT and those who were managed medically.</p><p><strong>Results: </strong>A total of 36,005 patients diagnosed with CVT were identified from 2015(Q4) to 2019. Of these patients, 325 (0.9%) received EVT. Patients who underwent EVT were older (<0.001), more likely to be female (p = 0.016), and had higher rates of diabetes mellitus (p = 0.012), hypertension (p < 0.001), and obesity (p < 0.001). These patients also presented with more severe neurological symptoms, including higher National Institutes of Health Stroke Scale scores (p < 0.001), coma (p < 0.001), and cerebral edema (p < 0.001). Patients undergoing EVT had a higher incidence of in-hospital mortality (p = 0.007) and were less likely to be discharged routinely (p < 0.001).</p><p><strong>Conclusions: </strong>This study found that patients with CVT who underwent EVT were older, more likely to be female, and presented with more severe neurological conditions. After controlling for severity, EVT in patients with CVT was associated with significant risks, including higher rates of complications and inpatient mortality. Although EVT is associated with significant risks, the findings of this study suggest that its outcomes may reflect the severity of the underlying condition rather than the procedure itself. Careful patient selection and individualized management strategies are essential for optimizing outcomes in this high-risk population.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199241310998"},"PeriodicalIF":1.7,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11791959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122932","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":"The foreseeable potential of robotics in neurointervention: Current robotic systems and applications.","authors":"Ahmet Günkan, Jhon E Bocanegra-Becerra","doi":"10.1177/15910199251318405","DOIUrl":"10.1177/15910199251318405","url":null,"abstract":"","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251318405"},"PeriodicalIF":1.7,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11795565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189204","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":"Embolization of middle meningeal artery (EMMA) for non-acute subdural hematoma: Insight from recent randomized trials and meta-analysis.","authors":"Jai Shankar","doi":"10.1177/15910199251318408","DOIUrl":"10.1177/15910199251318408","url":null,"abstract":"<p><p>Embolization of the middle meningeal artery (EMMA) has emerged as a promising treatment for non-acute subdural hematoma (NASDH), either as an adjunct to surgical drainage or as a primary intervention in patients not undergoing surgery. Recent randomized controlled trials (RCTs) have investigated the efficacy of EMMA using dimethyl sulfoxide (DMSO)-based agents like ONYX and SQUID. The EMBOLISE trial demonstrated a significant reduction in hematoma recurrence with adjunctive EMMA, while the STEM trial showed similar benefits at 180 days. Conversely, the MAGIC MT trial found no significant difference in recurrence rates with EMMA. A meta-analysis of these trials confirmed EMMA's safety, with no significant increase in serious adverse events. The analysis indicated a modest overall benefit in reducing NASDH recurrence (risk difference -0.09, <i>P</i> = 0.02), though results were largely driven by the STEM trial. The benefit of adjunctive EMMA was less clear, with no significant effect found. Primary EMMA showed marginal benefit but with considerable variability. Factors such as primary outcome, trial design, patient demographics, and surgical biases complicate the interpretation of these findings. While the safety of EMMA is supported, its clinical efficacy remains inconclusive. Further trials, including patient-level meta-analyses, are needed to refine the role of EMMA in NASDH management and address existing gaps in the literature.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251318408"},"PeriodicalIF":1.7,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11791965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122919","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":"Quest for the optimal venous access in a complex skull base dural fistula: Case illustrations and principles.","authors":"Eyad Almallouhi, Mithun G Sattur, Rahim Abo Kasem, Ahmed Muthana, Robert E Wood, Alejandro M Spiotta","doi":"10.1177/15910199251316407","DOIUrl":"10.1177/15910199251316407","url":null,"abstract":"<p><p>Treatment of dural arteriovenous fistulae (DAVFs) is dynamic and evolves between diagnostic and therapeutic angiography.A 79-year-old man with a left jugular foramen DAVF presented with new onset cranial nerve XII palsy. The DAVF progressed from Cognard grade I to IIa + b. A transvenous approach was chosen. Attempts to access the left inferior petrosal sinus (IPS) via the left internal jugular vein failed due to occlusion. An alternative route through the left superior ophthalmic vein and left cavernous sinus to the IPS was devised. Successful coil occlusion of the IPS was achieved. Postoperatively, symptoms resolved, and angiography showed no cortical venous reflux.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251316407"},"PeriodicalIF":1.7,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11791958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122848","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":"Robotic neurointervention: Beyond the noise.","authors":"Ronil V Chandra, Daniel Cooke, Claus Z Simonsen, Joshua A Hirsch, David Bell","doi":"10.1177/15910199241298323","DOIUrl":"10.1177/15910199241298323","url":null,"abstract":"","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199241298323"},"PeriodicalIF":1.7,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11791952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122862","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":"If time = money, and time = brain, then money = brain.","authors":"Adam A Dmytriw, Hamza A Salim, Vivek S Yedavalli, Adrien Guenego","doi":"10.1177/15910199251318409","DOIUrl":"10.1177/15910199251318409","url":null,"abstract":"","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251318409"},"PeriodicalIF":1.7,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11791953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122923","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":"The effect of the size of the new contour neurovascular device for altering intraaneurysmal flow.","authors":"Mariya S Pravdivtseva, Andrey N Pravdivtsev, Sönke Peters, Johannes Hensler, Naomi Larsen, Jan-Bernd Hövener, Olav Jansen, Fritz Wodarg","doi":"10.1177/15910199221145985","DOIUrl":"10.1177/15910199221145985","url":null,"abstract":"<p><strong>Background: </strong>Recently, a novel intrasaccular device (contour neurovascular system, contour) was introduced to treat intracranial aneurysms. Contour is placed at thе aneurysm neck and reduces the intraaneurysmal blood inflow. Contour comes in a range of sizes to target different aneurysms. The efficiency of altering flow with contour and the effect of device size have not yet been investigated. Therefore, we studied the effect of the device size with patient-based aneurysm models using 2D digital subtraction angiography (DSA).</p><p><strong>Methods: </strong>Three patient-based aneurysm models with necks ranging from 2.7 to 9.7 mm were produced, providing standardized testing conditions. Contours with diameters of 5, 11, and 14 mm were implanted into the models, four of each size. 2D DSA images were acquired before and after implanting contour (15 frames/s, manual contrast injection). After injecting angiographic contrast agent, the DSA signal was recorded over time to calculate the contrast washout time (WOT), which is a measure of flow diversion efficiency.</p><p><strong>Results: </strong>All contour devices caused contrast agent stasis and increased WOT in aneurysm sac (<i>p</i>-value = 0.0005). The median relative WOT was largest for 5-mm contour (6.6 ± 3.2) and similar for 11-mm contour (3.4 ± 2.6) and 14-mm contour (3.2 ± 3.8). The implantation procedure might affect WOT values even for contours of the same size; the overall relative WOT ranged between 1.5 and 10.89.</p><p><strong>Conclusion: </strong>The 5-mm contour showed the longest WOT value in our study, while no apparent difference between 11-mm contour and 14-mm contour was found.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"49-56"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10525460","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}