Interventional Neuroradiology最新文献

{"title":"The Vecta 46 intermediate catheter for mechanical thrombectomy of distal medium vessel occlusions: A single-center experience.","authors":"Joo Won Choi, Yang Qiao, Tej I Mehta, Thomas M Clausen, Y Jonathan Zhang, Samuel Tsappidi, Ferdinand K Hui","doi":"10.1177/15910199241283513","DOIUrl":"10.1177/15910199241283513","url":null,"abstract":"<p><strong>Introduction: </strong>With emerging evidence supporting the clinical efficacy and safety of mechanical thrombectomy (MT) for distal medium vessel occlusions (DMVOs), MT devices specifically designed to navigate through smaller caliber and more delicate tortuous distal cerebrovasculature are required. This study describes our single-center experience using the AXS Vecta 46 intermediate catheter for first-line thromboaspiration of DMVOs.</p><p><strong>Methods: </strong>We identified all patients who underwent MT using the Vecta 46 for first-line thromboaspiration for primary or secondary DMVOs. We collected baseline clinical data, angiographic and clinical outcomes, as well as procedural complications. The primary outcome in question was the rate of successful recanalization, which was defined as a modified Thrombolysis in Cerebral Infarction score of ≥2b.</p><p><strong>Results: </strong>We identified 43 patients who underwent MT using the Vecta 46 catheter for thromboaspiration of 54 DMVOs. Intervened vessels included the M2 (23/54), M3 (19/54), and M4 (6/54) branches of the middle cerebral artery, A2 (1/54), A3 (1/54), and A4 (1/54) branches of the anterior cerebral artery, and P1 (1/54), P2 (1/54), and P4 (1/54) branches of the posterior cerebral artery. The median number of passes for primary DMVOs was 2 (IQR: 1-3) and 1 (IQR: 1-1.25) for secondary DMVOs. The rate of successful recanalization was 100% (18/18) for primary DMVOs and 80.6% (29/36) for secondary DMVOs. First-pass effect (FPE) was noted in 55.6% (30/54) of all primary and secondary DMVO cases. Improved short-term clinical outcomes were observed in both the primary (National Institute of Health Stroke Scale [NIHSS] shift: -5 [IQR: -14.25 to -0.25]) and secondary (NIHSS shift: -5 [IQR: -10 to -2]) DMVO groups. A total of six patients died during their hospitalization, though none were deemed procedural-related.</p><p><strong>Conclusions: </strong>Our study demonstrates the safety and efficacy of the Vecta 46 intermediate catheter for thromboaspiration of both primary and secondary DMVOs, achieving high rates of successful recanalization and FPE.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142465510","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":"Corrigendum to \"Occipital venous sinus stenting for idiopathic intracranial hypertension and pulsatile tinnitus: A case series\".","authors":"","doi":"10.1177/15910199241290149","DOIUrl":"10.1177/15910199241290149","url":null,"abstract":"","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142465506","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":"Jugular venous narrowing and spontaneous spinal cerebrospinal fluid leaks: A case-control study exploring association and proposed mechanism.","authors":"Sasicha Manupipatpong, Christopher T Primiani, Kyle M Fargen, Matthew R Amans, Linda Leithe, Wouter I Schievink, Mark G Luciano, Ferdinand K Hui","doi":"10.1177/15910199241287417","DOIUrl":"10.1177/15910199241287417","url":null,"abstract":"<p><strong>Background: </strong>Spontaneous skull base cerebrospinal fluid leaks (CSFLs) are associated with increased intracranial pressure in idiopathic intracranial hypertension (IIH) and hypothesized to relate to skull base erosions due to increased CSF pressure. Given the increasing recognition of internal jugular venous stenosis (IJVS) as a cause of intracranial hypertension (IH), we evaluated the relationship between spinal CSFL and venous causes of IH.</p><p><strong>Methods: </strong>The spinal CSFL database at a single institution was assessed to identify 12 consecutive spontaneous, non-traumatic spinal CSFL patients with CTV data. Exclusion criteria included documented IIH and iatrogenic CSFL. Demographics, clinical parameters, imaging characteristics, and IJV manometry results were recorded. Internal jugular venous stenosis was graded as: none (0-10%), mild (10-50%), moderate (50-80%), severe (>80-99%), and occluded (100%). Twelve consecutive patients who presented with cerebrovascular accidents without CSFL, matched by age and sex, were similarly analyzed as a control group. STROBE guidelines were used in reporting results.</p><p><strong>Results: </strong>All CSFL patients had IJVS (83.3% bilateral, 33.3% severe) compared to 41.7% of the control group (33.3% bilateral, 16.7% severe-occluded); <i>p</i> = 0.04. All CSFL patients with available venogram manometry data had at least unilateral IJV gradients. Most patients presented with modified Rankin score (mRS) of 1 (66.7%), but in those with higher mRS, medical and/or surgical interventions were associated with decreased morbidity.</p><p><strong>Conclusion: </strong>Spontaneous spinal CSFL was associated with IJVS in patients not meeting IIH criteria. Persistently high CSF pressure resulting in CSFL may cause opening pressure to be falsely normal or low. Internal jugular venous stenosis may be a viable target in recurrent CSFL management and improve morbidity.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559868/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371798","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":"Adjunctive venous sinus stenting in transvenous embolization of vein of Galen malformations.","authors":"Alex Devarajan, Daryl Goldman, Jessica Bonet, Brandon D Philbrick, Cornelius Deuschl, Elif Yamac, Ahmed Ayad, Halima Tabani, Michelle Sorscher, Alejandro Berenstein, Johanna T Fifi, René Chapot, Tomoyoshi Shigematsu","doi":"10.1177/15910199241282719","DOIUrl":"10.1177/15910199241282719","url":null,"abstract":"<p><strong>Background: </strong>Vein of Galen malformations are congenital arteriovenous malformations primarily treated by endovascular embolization via transarterial or transvenous approaches. transvenous embolization can be utilized to close the malformation but may be difficult in patients with venous stenosis or blockages, which drive venous hypertension and lead to significant neurologic consequences. Here, we illustrate the atypical placement of an intracranial venous sinus stent to improve outflow after transvenous embolization in pediatric patients with the vein of Galen malformation.</p><p><strong>Methods: </strong>A retrospective review of clinical databases at two high-volume endovascular centers from January 2018 to March 2023 identified all vein of Galen malformation patients who received a venous sinus stent during transvenous embolization. Clinical data, imaging, angioarchitecture, operative details, postoperative management, and follow-up were reviewed.</p><p><strong>Results: </strong>Three patients presented for transvenous embolization after multiple staged transarterial embolizations of their vein of Galen malformation. Transvenous access was complicated by lateral sinus stenosis, which was temporarily relieved by balloon angioplasty. After transvenous embolization by pressure cooker technique, the dural sinuses were stented using the existing venous guide catheter. Venous angiography demonstrated improved flow across the stenosed areas and post-embolization angiography demonstrated normalized venous drainage with widely patent stents. One patient experienced postoperative oculomotor nerve palsy unrelated to the stent placement. All patients demonstrated a complete cure of their vein of Galen malformations with patent venous sinus stents on follow-up.</p><p><strong>Conclusion: </strong>In patients with the vein of Galen malformation and venous hypertension receiving transvenous embolization, venous sinus stenting may be a safe and effective option to reduce aberrant cortical venous drainage and improve normal outflow. Further studies are warranted to investigate its benefit in high-flow vascular malformations.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371797","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":"Safety and efficacy of endovascular thrombolysis in patients with acute cerebral venous sinus thrombosis: A systematic review.","authors":"Sepideh Paybast, Reza Mohamadian, Ali Emami, Melika Jameie, Fereshteh Shahrab, Farideh Zamani, Ehsan Sharifipour","doi":"10.1177/15910199221143418","DOIUrl":"10.1177/15910199221143418","url":null,"abstract":"<p><strong>Introduction: </strong>Cerebral venous sinus thrombosis (CVST) is an uncommon but fatal cause of stroke worldwide. Endovascular treatments could be life-saving in patients who don't treat with anticoagulants as a mainstay of treatment. Currently, there is no consensus considering the safety, efficacy, and also selected approaches of endovascular intervention for these patients. This systematic review evaluates the literature on endovascular thrombolysis (EVT) in CVST patients.</p><p><strong>Materials and methods: </strong>A comprehensive search was conducted through PubMed and Scopus databases between 2010 and 2021, with additional sources identified through cross-referencing. The primary outcomes were the safety and efficacy of EVT in CVST, including catheter-related and non-catheter-related complications, clinical outcomes, and radiological outcomes.</p><p><strong>Results: </strong>A total of 10 studies comprising 339 patients were included. Most of the patients presented with headaches (86.72%) and/or focal neurologic deficits (45.43%) (modified Rankin Scale of 5 in 55.88%). Acquired coagulopathy and/or consuming estrogen/progesterone medication were the most frequent predisposing factors (45.59%). At presentation, 68.84% had multi-sinus involvement, and 28.90% had venous infarcts and/or intracranial hemorrhage (ICH). The overall complication rate was 10.3%, with a 2.94%, 1.47%, and 1.17% rate of ICH, herniation, and intracranial edema, respectively. The complete and partial postoperative radiographic resolution was reported in 89.97% of patients, increasing to 95.21% during the follow-up. Additionally, 72.22% of patients had no or mild neurologic deficit at discharge, rising to 91.18% at the last follow-up. The overall mortality rate was 7.07%.</p><p><strong>Conclusions: </strong>EVT can be an effective and safe treatment option for patients with refractory CVST or contraindications to systemic anticoagulation.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35210789","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":"Rate of periprocedural stroke in diagnostic cerebral angiograms comparing transradial versus transfemoral access.","authors":"Anna Luisa Kuhn, Ajit S Puri, Katyucia de Macedo Rodrigues, Francesco Massari, Jasmeet Singh","doi":"10.1177/15910199221142653","DOIUrl":"10.1177/15910199221142653","url":null,"abstract":"<p><strong>Purpose: </strong>Transradial access for neurointerventional procedures has increased in popularity over the past few years due to data from extrapolated interventional cardiology studies, patient preference, and early reports of feasibility using this approach. Our aim was to evaluate the incidence of periprocedural stroke in patients undergoing transradial versus transfemoral access for diagnostic cerebral angiograms.</p><p><strong>Methods: </strong>We retrospectively reviewed our neurointerventional database and identified all patients who underwent a diagnostic angiogram between May 2019 and July 2021. Patients were further divided into transradial versus transfemoral access. In patients with postprocedural stroke, symptoms and National Institute of Health Stroke Scale score were recorded. Pertinent laboratory values and procedural data was reviewed, including COVID status, platelet count, International normalized ratio (INR), Glomerular filtration rate (GFR), vessels catheterized, amount of contrast used, and fluoroscopy time. Imaging work-up for stroke symptoms was reviewed, if available.</p><p><strong>Results: </strong>Thousand two-hundred thirty eight diagnostic cerebral angiograms with 656 patients (53%) undergoing transradial access. Stroke symptoms after angiogram were only observed in the transradial group (5 patients; 0.4% total and 0.8% among radial access cases, respectively). Symptoms included word finding difficulty, paresthesia, or weakness. Three patients underwent cross-sectional imaging, computed tomography was negative in all three patients. Magnetic resonance imaging showed small, scattered infarcts in two patients. All symptoms resolved without additional hospitalization.</p><p><strong>Conclusion: </strong>In our experience, using transradial access for diagnostic cerebral angiograms was associated with a low but not negligible incidence of periprocedural strokes. Patient anatomy should be evaluated prior to selection of vascular access. Patients should be made aware of a slightly higher periprocedural stroke risk with transradial access.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40711504","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":"Validation of three-dimensional printed models of intracranial aneurysms.","authors":"Daniel E Mantilla, Riccardo Ferrara, Andrés F Ortiz, Daniela D Vera, Franck Nicoud, Vincent Costalat","doi":"10.1177/15910199221143254","DOIUrl":"10.1177/15910199221143254","url":null,"abstract":"<p><strong>Introduction: </strong>Three-dimensional (3D) printing has evolved for medical applications as it can produce customized 3D models of devices and implants that can improve patient care. In this study, we aimed to validate the geometrical accuracy of the 3D models of intracranial aneurysms printed using Stereolithography 3D printing technology.</p><p><strong>Materials and methods: </strong>To compare the unruptured intracranial aneurysm mesh between the five patients and 3D printed models, we opened the DICOM files in the Sim&Size® simulation software, selected the region of interest, and performed the threshold check. We juxtaposed the 3D reconstructions and manually rotated the images to get the same orientation when needed and measured deviations at different nodes of the patient and 3D printed model meshes.</p><p><strong>Results: </strong>In the first patient, 80% of the nodes were separated by <0.56 mm and 0.17 mm. In the second patient, the deviations were below 0.17 mm for 80% of the meshes' nodes. In the next three patients, the deviations were below 0.21, 0.23, and 0.11 mm for 80% of the meshes' nodes. Finally, the overall deviation was below 0.21 mm for 80% of the mesh nodes of the five aneurysms.</p><p><strong>Conclusions: </strong>3D printed models of intracranial aneurysms are accurate, having surfaces that resemble that of patients' angiographies with an 80% cumulative deviation below 0.21 mm.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10384388","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":"LVIS EVO stent-through-balloon after hydrocoil embolization of intracranial aneurysms: One-year results.","authors":"Pascal J Mosimann, Elif Yamac, Marta Wallocha, Ahmed Ayad, René Chapot","doi":"10.1177/15910199221138151","DOIUrl":"10.1177/15910199221138151","url":null,"abstract":"<p><strong>Background and purpose: </strong>To evaluate the durability and safety of complete intracranial aneurysm occlusion at one year using the low-profile braided intracranial LVIS EVO stent.</p><p><strong>Materials and methods: </strong>This is a retrospective, monocentric, observational study of unruptured wide-necked intracranial aneurysms treated with the LVIS EVO stent-through-balloon technique after balloon-assisted hydrocoil embolization. Imaging and clinical data were assessed by two blinded independent neuroradiologists and neurologists, respectively. Primary endpoint was complete angiographic occlusion on day 0 and at 12 months. Secondary endpoints included clinical safety using the modified Rankin scale (mRS), ischemic and hemorrhagic adverse events, parent vessel stenosis > 50% or occlusion and retreatment rate.</p><p><strong>Results: </strong>103 aneurysms in 103 patients were included (53 years-old, 77% women). Mean aneurysm size and neck were 7 and 4 mm, respectively. Complete occlusion was 97% initially and 90% at 12 months, with pending follow up in 17.5% patients. Five patients (5%) with partially stented necks were retreated with a second stent in a T-configuration. Two stents failed to open initially and were immediately retrieved. Asymptomatic parent vessel occlusion and severe in-stent stenosis occurred in 1% and 3%, respectively. The 12-month procedure-related permanent neurological deficit and mortality rates (mRS 3-6) were 2% and 1%, respectively. There was one fatal bleeding but no large ischemic complications.</p><p><strong>Conclusion: </strong>Delivering the LVIS EVO stent through a dual lumen balloon after balloon-assisted hydrocoil embolization yields a high and stable rate of complete aneurysm occlusion at one year with a reasonable immediate and delayed complication rate.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40685871","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 DERIVO®2 Embolization Device in the treatment of ruptured and unruptured intracranial aneurysms: A multicenter analysis.","authors":"Maximilian Thormann, Nele Sillis, Taina Thoma, Jens Altenbernd, Björn Berger, Andrea Cioltan, Christian Loehr, Georg Bohner, Eberhard Siebert, Hannes Nordmeyer, Anastasios Mpotsaris, Daniel Behme","doi":"10.1177/15910199221142643","DOIUrl":"10.1177/15910199221142643","url":null,"abstract":"<p><strong>Background: </strong>Flow diverters are an increasingly used treatment option for intracranial aneurysms. A recent addition to the European market is the DERIVO®2 Embolization Device (DED2), promising improved radiopacity. We aimed to assess the safety and efficacy of the DED2 regarding angiographic and clinical outcomes in ruptured and unruptured cerebral aneurysms.</p><p><strong>Methods: </strong>We performed a multicenter trial at six interventional centers. Data were prospectively collected and all patients treated with the DED2 were included. The primary endpoint was angiographic aneurysm occlusion at 6 months as assessed by the O'Kelly Marotta (OKM) grading scale with a favorable outcome definition of OKM C + D. Clinical outcome was evaluated according to the modified Rankin scale (mRS).</p><p><strong>Results: </strong>Between August 2020 and July 2021, 37 patients were treated with the DED2 and were included in our analysis. Five patients presented with ruptured aneurysms. Median age was 60 years, 27 patients were female, and 10 male. Median mRS was 0 (range 0-4). Mean aneurysm size was 8.9 ± 7.1 mm with a mean neck size of 6.5 ± 6.1. The DED2 fully opened at deployment in all cases. Clinical follow-up was available for 30 patients (81%). Twenty-five (83%) had an mRS of 0 or 1. Three patients with ruptured aneurysms died during the follow-up period. No treatment-related major morbidity was observed. Follow-up imaging was available in 27 (90%) patients, with 23 patients (85%) showing satisfactory aneurysm occlusion OKM grade C-D.</p><p><strong>Conclusion: </strong>In this small cohort, the DED2 provided safe and effective treatment of ruptured and unruptured intracranial aneurysms.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10780049","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 procedural end-tidal CO2 on infarct expansion during anterior circulation thrombectomy.","authors":"Matthew S Parr, Arsalaan Salehani, Mark Ogilvie, B Ethan Tabibian, Sage Rahm, Andrew T Hale, Georges Bouobda Tsemo, Akshay Aluri, Jinsuh Kim, Mali Mathru, Jesse G A Jones","doi":"10.1177/15910199221143175","DOIUrl":"10.1177/15910199221143175","url":null,"abstract":"<p><strong>Background: </strong>Carbon dioxide is a potent cerebral vasodilator that may influence outcomes after ischemic stroke. The objective of this study was to investigate the effect of intraprocedural mean end-tidal CO2 (ETCO2) levels on core infarct expansion and neurologic outcome following thrombectomy for anterior circulation ischemic stroke.</p><p><strong>Methods: </strong>A retrospective review was conducted of consecutive patients from March 2020 to June 2021 who underwent mechanical thrombectomy for acute anterior circulation ischemic stroke under general anesthesia and achieved successful recanalization (Thrombolysis in Cerebral Infarction [TICI] ≥ 2b). Only patients with CT perfusion, procedural ETCO2, and postoperative MRI data were included. Segmentation software was used for multi-parametric image analysis. Normocarbia defined as mean ETCO2 of 35 mmHg was used to dichotomize subjects. Univariate and multivariate statistics were applied.</p><p><strong>Results: </strong>Fifty-eight patients met criteria for analysis. Of these, 44 had TICI 3 recanalization, 9 had TICI 2c, and 5 had TICI 2b. Within this combined recanalization group, patients with mean ETCO2 > 35 had significantly higher rates of functional independence at 90 days. Although patients tended to salvage more penumbra and experience smaller final infarcts when ETCO2 exceeded 35 mmHg, this did not reach statistical significance.</p><p><strong>Conclusions: </strong>Stroke patients who underwent successful thrombectomy with general anesthesia achieved higher rates of functional independence when procedural ETCO2 exceeded 35 mmHg. Further studies to confirm this effect and investigate optimal ETCO2 parameters should be considered.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40458470","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}