Interventional Neuroradiology最新文献

{"title":"Mechanical Comaneci 17-stent angioplasty for a sub-optimally deployed flow-diverter stent.","authors":"Georgi Vladev, Alexander Sirakov, Kristina Sirakova, Sanimir S Sirakov","doi":"10.1177/15910199221149633","DOIUrl":"10.1177/15910199221149633","url":null,"abstract":"<p><p>Flow diverter stents are increasingly used as the sole endovascular treatment method for complex or wide-necked intracranial aneurysms.¹ Technical complications related to stent deployment are infrequently reported in the literature. During treatment, implant misbehaviors may occur, including incomplete tubular expansion with insufficient aneurysmal coverage and wall apposition, proximal or distal narrowing, and twisting along the axis.^{2- 4} Little is known about this phenomenon, especially if it relates to the operator experience, deployment techniques, different devices, and implant properties. The management of these complications requires technical precision and is often remediated by \"massaging\" the stent with the delivery system, balloon angioplasty, or placement of additional self-expandable stents. Lastly, if critically damaged, the stent could be taken out of the vessel with a combination of maneuvers called \"stentectomy.\"⁵ These techniques often necessitate multiple navigations and the utilization of a larger microcatheter. We aim to highlight the feasibility of Comaneci 17 stent-angioplasty as an effective bailout strategy for inadequately deployed flow diverter stents. The suggested approach's technical aspects, including pros and cons, have been discussed.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"143"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10454134","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":"Validation of the Charlotte large artery occlusion endovascular therapy outcome score using Viz.ai-derived cerebral blood volume index.","authors":"Rahul R Karamchandani, Hongmei Yang, Jeremy B Rhoten, Dale Strong, Sagar Satyanarayana, Andrew W Asimos","doi":"10.1177/15910199221149563","DOIUrl":"10.1177/15910199221149563","url":null,"abstract":"<p><strong>Background: </strong>The Charlotte large artery occlusion endovascular therapy outcome score (CLEOS) predicts poor 90-day outcomes for patients presenting with internal carotid artery (ICA) or middle cerebral artery (MCA) occlusions. It incorporates RAPID-derived cerebral blood volume (CBV) index, a marker of collateral circulation. We validated the predictive ability of CLEOS with Viz.ai-processed computed tomography perfusion (CTP) imaging.</p><p><strong>Methods: </strong>The original CLEOS derivation cohort was compared to a validation cohort consisting of all ICA and MCA thrombectomy patients treated at a large health system with Viz.ai-processed CTP. Rates of poor 90-day outcome (mRS 4-6) were compared in the derivation and validation cohorts, stratified by CLEOS. CLEOS was compared to previously described prediction models using area under the curve (AUC) analyses. Calibration of CLEOS was performed to compare predicted risk of poor outcomes with observed outcomes.</p><p><strong>Results: </strong>One-hundred eighty-one patients (mean age 66.4 years, median NIHSS 16) in the validation cohort were included. The validation cohort had higher median CTP core volumes (24 vs 8 ml) and smaller median mismatch volumes (81 vs 101 ml) than the derivation cohort. CLEOS-predicted poor outcomes strongly correlated with observed outcomes (<i>R</i>² = 0.82). AUC for CLEOS in the validation cohort (0.72, 95% CI 0.64-0.80) was similar to the derivation cohort (AUC 0.75, 95% CI 0.70-0.80) and was comparable or superior to previously described prognostic models.</p><p><strong>Conclusions: </strong>CLEOS can predict risk of poor 90-day outcomes in ICA and MCA thrombectomy patients evaluated with pre-intervention, Viz.ai-processed CTP.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"80-87"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10496574","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":"pCONUS 2 and pCONUS 2-HPC in the treatment of wide-necked intracranial aneurysms: Multicentre UK experience.","authors":"James Yeomans, Simon Gatt, Ezaz Habeeb Mohamed, Robert Crossley, Peter Keston, David Minks, Nicholas Dobbs, Alexander Mortimer, Jonathan Downer, Anand Sastry","doi":"10.1177/15910199221150467","DOIUrl":"10.1177/15910199221150467","url":null,"abstract":"<p><strong>Background/purpose: </strong>pCONUS 2 and pCONUS 2-HPC are neck-bridging devices that provide coiling support in the endovascular treatment of wide-necked intracranial aneurysms. To date, limited multicentre data has been published. This study provides the first pooled data from multiple UK centres regarding outcomes for these devices covering the periprocedural period to 6-month follow-up.</p><p><strong>Materials/methods: </strong>This retrospective, single-arm study assessed 65 patients treated over 3 years from the time of procedure to 6 months post-procedure across four UK centres. Data collected included patient demographics, aneurysm characteristics and antiplatelet regimens. Outcome measures were angiographic results and procedure-related complications from the immediate periprocedural period to 6-month follow-up.</p><p><strong>Results: </strong>Fifty-four unruptured (83.1%) and 11 ruptured (16.9%) aneurysms were treated. Fifty-five aneurysms were located in the anterior circulation (87.7%). There were four device-related intraprocedural complications: three cases of asymptomatic, temporary thrombus formation and one mortality associated with branch vessel occlusion and aneurysm re-bleeding in a ruptured case. There were no post-procedural device-related complications. Satisfactory occlusion was achieved in 58/65 procedures (89.2%) at time of treatment and in 44/60 (73.3%) at 6 months. Satisfactory occlusion correlated with aneurysm size and coiling packing density. Retreatment was required for five unruptured cases (7.7%) and was straightforward with the device in situ.</p><p><strong>Conclusion: </strong>pCONUS 2 and pCONUS 2-HPC have good short-term safety profiles. The use of pCONUS 2-HPC in the acute treatment of ruptured aneurysms with postprocedural SAPT is feasible. The devices have an intraprocedural complication rate of 4/65 (6.2%) across multiple UK centres, including a single death (1.5%).</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"63-70"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10846784","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 outflow stenting for symptomatic developmental venous anomaly.","authors":"Kislay Kishore, Vivek Bodani, Richard Olatunji, MingYang Meah Gao, Vivek Pai, Thomas Marotta, Julian Spears, Vitor Mendes Pereira","doi":"10.1177/15910199221121370","DOIUrl":"10.1177/15910199221121370","url":null,"abstract":"<p><p>Developmental venous anomaly (DVA) is one of the commonest vascular malformations in the brain but rarely symptomatic. Various pathomechanisms such as mechanical compression, increased in-flow into DVA or outflow obstruction have been described as causative factors in symptomatic DVAs. We report a unique case of a pontomedullary DVA with venous outflow obstruction causing progressive neurological worsening in a young adult despite anticoagulation, who was treated with a novel approach of venous outlet stenting of the collector vein with favorable outcome. In carefully selected cases, this endovascular treatment can be an effective and safe alternative when other measures fail.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"128-131"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40706607","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":"Fractal analysis of healthy and diseased vasculature in pediatric Moyamoya disease.","authors":"Daniel S Weber, Kevin T Huang, Alfred P See","doi":"10.1177/15910199231152513","DOIUrl":"10.1177/15910199231152513","url":null,"abstract":"<p><strong>Background and purpose: </strong>Fractal dimension is an objective metric for the notion of structural complexity. We sought to investigate differences in structural complexity between healthy and affected territories of cerebral vasculature in moyamoya, as well as associated scalp vasculature and native transdural collaterals in patients with moyamoya by comparing their respective fractal dimensions.</p><p><strong>Methods: </strong>Our cohort consisted of 15 transdural collaterals from 12 patients with unilateral anterior circulation moyamoya. Frames of distal arterial vasculature from internal and external carotid angiograms were selected then automatically segmented and also manually annotated by a cerebrovascular surgeon. In the affected hemisphere, the region with transdural collateral supply was compared to the contralateral region. The resulting skeletonized angiograms were analyzed for their fractal dimensions.</p><p><strong>Results: </strong>We found the average fractal dimension (Df) of the moyamoya-side ICA was 1.82 with slightly different means for the anteroposterial (AP) and lateral views (mean  =  1.82; mean  =  1.81). The overall mean for healthy cerebral vasculature was also found to be 1.82 (AP: mean  =  1.83; lateral: mean  =  1.81). Mean Df of native transdural collaterals was found to be 1.82 (AP: mean  =  1.83; lateral: mean  =  1.81). The mean Df difference between autosegmented and manually segmented images was 0.013.</p><p><strong>Conclusion: </strong>In accordance with the clinical understanding of moyamoya disease, the distal arterial structural complexity is not affected in moyamoya, and is maintained by transdural collaterals formed by vasculogenesis. Autosegmentation of cerebral vasculature is also shown to be accurate when compared to manual segmentation.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"101-106"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10628824","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 and safety of the Trevo® Retriever for mechanical thrombectomy in Chinese patients with acute ischemic stroke: Trevo Retriever China Registry.","authors":"Xuelei Zhang, Jinchao Liu, Hongxing Han, Pinyuan Zhang, Xianglin Chen, Haicheng Yuan, Maohua Chen, Qiyi Zhu, David S Liebeskind, Zhongrong Miao","doi":"10.1177/15910199231151275","DOIUrl":"10.1177/15910199231151275","url":null,"abstract":"<p><strong>Background: </strong>To quantify the effectiveness and safety of the Trevo® Retriever for endovascular treatment of acute ischemic stroke (AIS) patients in China.</p><p><strong>Methods: </strong>Trevo Retriever Registry (China) was a prospective, multicenter, non-comparative, open-label study of patients with AIS treated with the Trevo Retriever. The primary outcome was the proportion of patients achieving an expanded Thrombolysis in Cerebral Infarction (eTICI) score ≥2b at the end of endovascular treatment. Secondary outcomes included first-pass eTICI score ≥2b and 90-day modified Rankin Scale (mRS) score ≤2.</p><p><strong>Results: </strong>The Trevo Retriever Registry (China) enrolled and followed 201 patients (62.1 ± 12.5 years-old; 70.6% male) at 11 centers. The pre-procedure NIHSS score and ASPECTS were 16 (interquartile range (IQR), 13-21) and 7 (IQR, 6-9), respectively, and 188 (93.5%) patients had an mRS score of 0 prior to the stroke. The main stroke etiology was large artery atherosclerosis, accounting for 71.6% (144/201) of patients. Post-procedure eTICI ≥2b was 98.4% (187/190). First-pass eTICI ≥2b was 74.7% (136/182). The 90-day good outcome (mRS ≤2) rate was 73.6% (148/201). The 90-day all-cause mortality was 5.5% (11/201). Neurological deterioration at 24 h post-procedure was observed in 7.7% (15/195) patients. Embolism in a new territory was seen in one patient (0.5%). Two (1.0%) procedure-related adverse events (AEs) occurred, which were intra-procedure cerebral artery embolism. No Trevo related AEs occurred.</p><p><strong>Conclusions: </strong>This real-world study of the Trevo Retriever in China demonstrated a high rate of revascularization and first-pass success that resulted in an overall high good function outcome rate and low mortality.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"107-113"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10621764","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":"Use of optical coherence tomography in selected patients with recurrent cryptogenic stroke: A case series and technical discussion.","authors":"Răzvan Alexandru Radu, Federico Cagnazzo, Imad Derraz, Cyril Dargazanli, Grégory Gascou, Pierre-Henri Lefevre, Caroline Arquizan, Vincent Costalat","doi":"10.1177/15910199221150472","DOIUrl":"10.1177/15910199221150472","url":null,"abstract":"<p><strong>Background: </strong>Despite advances in secondary stroke prevention during the last several years, cryptogenic stroke remains associated with a high risk of recurrence. Studies have shown that the recurrence risk is higher in patients with large artery disease in which complex carotid plaques and carotid WEBs are identified.</p><p><strong>Methods: </strong>This is a case series of six patients with cryptogenic recurrent stroke in which conventional imaging and extensive workup did not identify an etiology. Intravascular optic coherence tomography (OCT) was performed using a ballon-guided flow-arrest technique to identify possible covert carotid lesions.</p><p><strong>Results: </strong>We present six cases in which, with the help of OCT, we identified three carotid WEBs with associated thrombosis and two ulcerated carotid artery plaques. Four patients were subsequently treated with endovascular stent placement without complications. OCT permitted the distinction between complicated carotid artery plaque and carotid WEB.</p><p><strong>Conclusion: </strong>Intravascular OCT is a feasible and safe approach to identifying patients with covert carotid wall abnormalities, like carotid WEBs and ulcerated plaques, that are amenable to carotid stenting to reduce recurrent stroke risk.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"88-94"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833837/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10506251","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 operator's experience on mechanical thrombectomy outcomes: A systematic review.","authors":"Xenos Dimitrios, Sherief Ghozy, Charalampopoulou Christina, Antonia Kolovoy, Kadirvel Ramanathan, David F Kallmes","doi":"10.1177/15910199231157921","DOIUrl":"10.1177/15910199231157921","url":null,"abstract":"<p><strong>Background: </strong>Mechanical thrombectomy (MT) has become the standard of care for stroke patients. The majority of the clinical trials and publications analyzing the outcomes related to the procedures report interventional performance by experienced practitioners. However, few of them individualize their preliminary metrics according to the operator's experience.</p><p><strong>Objective: </strong>To summarize the literature and report safety and efficacy outcomes following MT procedures and correlate them with the operator's experience. Primary outcomes were successful recanalization, defined as modified thrombolysis in cerebral infarction greater or equal to 2b or 3, duration of the procedure measured in minutes, and serious adverse event.</p><p><strong>Methods: </strong>This systematic review was performed according to the PRISMA guidelines. The PubMed, Embase, and Cochrane databases were utilized.</p><p><strong>Results: </strong>There were six studies comprising 9348 patients (mean age 69.8 years; 51.2% males), and 9361 MT procedures were included. Each publication used for this review used a different experience definition to report their data. Higher interventionists' experience demonstrated a positive relationship with the possibility of successful recanalization and an inverse relationship with the duration needed for the operation in almost all of the included studies. As for the complications, none of the authors reported a statistically significant risk reduction of an adverse event, except Olthuis et al. correlating increasing training with lower odds of stroke progression.</p><p><strong>Conclusions: </strong>A higher experience level is associated with better recanalization rates and shorter procedural duration in MT operations. Further studies are warranted to define the minimum required level of experience for operational autonomy.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"121-127"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10740767","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":"Management of WEB device migration and mal-position in endovascular treatment of cerebral aneurysms.","authors":"Gilbert Gravino, Souhyb Masri, Arun Chandran, Mani Puthuran","doi":"10.1177/15910199221122857","DOIUrl":"10.1177/15910199221122857","url":null,"abstract":"<p><p>With increasing advances in technology, the breadth of aneurysms that are treatable via an endovascular approach has increased. Wide necked aneurysms remain difficult to treat but the emergence of dedicated intrasaccular flow disruption devices such as the Woven EndoBridge (WEB, Micorvention) has increasingly seen previously ruptured and unruptured wide necked aneurysms successfully embolised and secured from the circulation using a single device.We are reporting two cases of WEB device treatment from the earliest experience with this device at our institution. These were complicated by partial extrusion in one case and remote migration of the WEB device in another case. Our initial cases highlight the importance of case selection and the need for accurate WEB sizing which are paramount to ensure complete occlusion of the aneurysm without complications of dislocation or extrusion into the parent vessel. Since then, we have performed over 170 cases with the WEB device. We also present a comprehensive review of the limited literature available on the management of mal-positioned and dislocated WEB devices. This allows us to reflect on how to avoid these complications and the different management options at the disposal of the neuro-interventionalist once such a complication has already occured. Rescue devices and manoeuvres that we reflect on include microcatheter manipulation, alligator retrieval device, stent retrievers, microsnares, aspiration, and stenting. Ultimately, each case needs to be individually evaluated and the best strategy selected depends on the context and specific circumstances.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"132-141"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33439142","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":"Transradial embolization of a life-threatening tooth extraction socket hemorrhage and pseudoaneurysm.","authors":"Marco Colasurdo, Gautam Edhayan, Nicholas A Rossi, Orly M Coblens, Karthikram Raghuram","doi":"10.1177/15910199221142645","DOIUrl":"10.1177/15910199221142645","url":null,"abstract":"<p><p>Embolization of oral hemorrhages due to tooth extraction, although rare, has been previously described.^1-4 In this video we present a unique case in which a life-threatening tooth extraction hemorrhage was incontrollable with local compression or surgical cauterization. The patient underwent emergent transradial coil embolization⁵ of the posterior lateral nasal branches of the sphenopalatine artery. However, the patient returned 11 days later with a lower volume bleed at the original site. Computed tomography angiography showed a pseudoaneurysm at the orthognathic surgery crater retrogradely recanalized through the greater palatine arcade. Surgical options were deemed too invasive, and the decision was made to attempt percutaneous direct puncture embolization. This was unsuccessful and repeat embolization with Onyx was performed through the contralateral greater palatine artery. The patient had complete resolution of symptoms.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"142"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40711365","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}