Interventional Neuroradiology最新文献

{"title":"Middle meningeal artery embolization in migraine: From concept to reality.","authors":"Ali Mortezaei, Muhammed Amir Essibayi, Mahmoud Osama, Saeed Abdollahifard, Alireza Karandish, Anthony Terraciano, Adisson Fortunel, David J Altschul","doi":"10.1177/15910199241305928","DOIUrl":"10.1177/15910199241305928","url":null,"abstract":"<p><p>Migraine is a common neurological disorder that primarily affects young adults. Despite the availability of multiple therapeutic options for patients with intractable migraine, a significant proportion of these patients remain refractory to treatment, highlighting the importance for novel therapies. In this study, we comprehensively assessed the role of the middle meningeal artery (MMA) in the management of intractable migraine. Although the exact pathophysiology of migraine remains a subject of debate, the neurovascular theory of migraine has gained attention recently following multiple studies assessing the role of the MMA in migraine pathophysiology. In addition, the successful utilization of lidocaine both through intravenous injection and directly into the MMA, as well as favorable results observed in the form of headache relief following MMA embolization (MMAE) in patients with chronic subdural hematoma, has further substantiated the neurovascular theory hypothesis. In this study, we evaluated the current evidence, potential trends, role of other injection medications, as well as risks and limitations of MMAE in the management of patients with refractory migraine. Intractable migraine is a complex condition that often requires multimodal management. MMAE has emerged as a promising, novel therapeutic technique that may help reduce pain and minimize the need for additional treatments. However, further prospective and randomized trials are still necessary for further validation.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199241305928"},"PeriodicalIF":1.7,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11656459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846504","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 diverter versus stent-assisted coiling treatment for managing dissecting intracranial aneurysms: A systematic review and meta-analysis.","authors":"Leonardo O Brenner, Milena Zadra Prestes, Cid Soares, Pedro Romeiro, Victor A Gomez, Nicollas Nunes Rabelo, Leonardo C Welling, Stefan W Koester, Agostinho C Pinheiro, Sávio Batista, Raphael Bertani, Eberval Gadelha Figueiredo, Daniel Dutra Cavalcanti","doi":"10.1177/15910199241301820","DOIUrl":"10.1177/15910199241301820","url":null,"abstract":"<p><strong>Background: </strong>Dissecting intracranial aneurysms (DIAs) have been treated through endovascular reconstructive manners, such as flow diverters (FDs) and stent-assisted coiling (SAC). Notably, no robust evidence has compared both approaches. Hence, the authors conducted a meta-analysis to compare their outcomes.</p><p><strong>Methods: </strong>PubMed, Embase and Web of Science were searched for studies employing SAC and FD treatment for DIAs. The following outcomes were considered for extraction: procedure-related mortality, total mortality, postoperative and follow-up complete aneurysm occlusion, complications, good clinical outcomes, recurrence, and retreatment. Odds ratio (OR) with random effects was employed for statistical comparison.</p><p><strong>Results: </strong>The meta-analysis included 10 studies. A total of 195 and 222 patients were included in the FD and the SAC group, respectively. Stent-assisted coiling had higher postoperative complete aneurysm occlusion rates (OR 0.03; 95% CI 0.01-0.08). Flow diverter retreatment rate was lower, but without statistical significance (OR 0.35; 95% CI 0.11-1.10). No significant differences were found in follow-up complete aneurysm occlusion (OR 1.18; 95% CI 0.35-3.99); total mortality (OR 0.44; 95% CI 0.09-2.08); intraoperative complications (OR 0.30; 95% CI 0.06-1.45); postoperative complication (OR 0.77; 95% CI 0.35-1.70); good clinical outcomes (OR 0.97; 95% CI 0.43-2.20); and recurrence (OR 0.38; 95% CI 0.13-1.10) between the two groups.</p><p><strong>Conclusion: </strong>Stent-assisted coiling shows higher postoperative complete aneurysmal occlusion rates, but both techniques achieve similar rates in angiographic follow-up. Flow diverter has lower, but not statistically significant, retreatment rates than SAC. Both techniques have similar complication rates. Future randomized, multicenter, and prospective studies with larger sample sizes are needed for more conclusive findings.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199241301820"},"PeriodicalIF":1.7,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11638934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818132","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":"Middle meningeal artery embolization with standalone or adjunctive coiling for treatment of chronic subdural hematoma: Systematic review and meta-analysis.","authors":"Haydn Hoffman, Jason J Sims, Christopher Nickele, Violiza Inoa, Lucas Elijovich, Nitin Goyal","doi":"10.1177/15910199241304852","DOIUrl":"10.1177/15910199241304852","url":null,"abstract":"<p><strong>Introduction: </strong>Middle meningeal artery embolization (MMAe) is increasingly utilized as a primary or secondary treatment for chronic subdural hematoma (cSDH) and is usually performed with liquid embolics or particles. Outcomes after MMAe with coiling as a standalone treatment, or an adjunct to other agents, have not been reviewed.</p><p><strong>Methods: </strong>A systematic review of the literature was performed to identify all original research that included patients who underwent standalone or adjunctive coiling for MMAe. The primary outcome was the need for rescue treatment defined as any unplanned reintervention for recurrent or residual cSDH.</p><p><strong>Results: </strong>A total of 10 studies comprising 346 patients (mean age 73 years, 39% female) who underwent MMAe with coils were included. The majority of embolizations were with coils and particles (<i>n</i> = 176), followed by standalone coiling (137) and coiling with liquid embolics (120). The pooled rate of rescue treatment after embolization was 9.4% (95% CI 6.4-13.6, <i>I</i>²= 0). The pooled complication rate was 2.6% (95% CI 1.3-5.1, <i>I</i>²= 0). In the subgroup analysis of four studies reporting results after standalone coiling, the pooled rescue treatment rate was 8.2% (95% CI 4.0-15.9, <i>I</i>²= 0) and there were no complications.</p><p><strong>Conclusion: </strong>MMAe with coils is safe and potentially effective, but additional studies evaluating long-term clinical and radiographic results after standalone coiling are needed.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199241304852"},"PeriodicalIF":1.7,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11635794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813047","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":"Iatrogenic cervical artery dissections during endovascular interventions.","authors":"Helena Xeros, Bilal Bucak, Soliman Oushy, Giuseppe Lanzino, Zafer Keser","doi":"10.1177/15910199241305423","DOIUrl":"10.1177/15910199241305423","url":null,"abstract":"<p><strong>Background: </strong>Iatrogenic cervical artery dissection (CeAD) results from various procedures including interventional angiographic procedures and diagnostic angiography. Iatrogenic CeAD is rare, resulting in limited literature on management and outcomes. This observational cohort study investigates approaches and outcomes of iatrogenic CeAD after endovascular interventions.</p><p><strong>Methods: </strong>We conducted a retrospective review for patients who underwent endovascular intervention with resulting iatrogenic CeAD at Mayo Clinic, Rochester, MN, from 1998 to 2021. Pertinent patient factors were extracted and descriptive statistics generated.</p><p><strong>Results: </strong>Between 1998 and 2021, 21,191 patients underwent catheter-based cerebral angiography. Thirty-two had iatrogenic CeADs (23 women; median age 59 [range 40.5-92.9]). Common comorbidities included hypertension (62.5%), smoking (56.3%), and hyperlipidemia (46.9%). Nine (28.1%) had dissection with diagnostic angiograms, 6 (18.8%) endovascular thrombectomy, 15 (46.9%) intracranial aneurysm treatment/coiling, and 2 (6.3%) intracranial angioplasty with/without stenting. All dissections were diagnosed by cerebral angiography during the same session as initial interventions. Four (12.5%) underwent hyperacute stenting. Thirty (93.7%) were placed on antithrombotic therapy with aspirin alone (34.4%) or dual-antiplatelet therapy with aspirin and clopidogrel (37.5%). Median duration of acute treatment was three months. Follow-up imaging showed excellent radiological course.</p><p><strong>Conclusions: </strong>Iatrogenic CeAD with endovascular interventions is rare and typically benign. Most are managed medically without complications or long-term negative outcomes. Oral single or dual-antiplatelet therapies are preferred compared to previous studies which emphasize intravenous anticoagulation. The duration of acute therapy varied from three months to lifelong. Key factors influencing clinical decision-making may include occlusion rate, pseudoaneurysm formation, intracranial extension, distal collateral circulation, and resultant ischemia.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199241305423"},"PeriodicalIF":1.7,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11635790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813043","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":"FRED-UK: Multicentre UK experience of FRED and FRED Jr flow re-direction endoluminal device for intracranial aneurysms: 6 months and 1 year clinical and anatomical results.","authors":"Eleanor Taylor, Jonathan Downer, Saleh Lamin, Arun Chandran, Panayiotis Koumellis, Chee Gan, Changez Jadun, Thomas Booth, Anil Gholkar, Joe Leyon, Kyriakos Lobotesis","doi":"10.1177/15910199241302123","DOIUrl":"10.1177/15910199241302123","url":null,"abstract":"<p><strong>Background: </strong>Flow diverting stents (FDS) are an established endovascular treatment for intracranial aneurysms but are reported to have varying rates of adequate occlusion and thromboembolic complications. This study reports clinical safety and efficacy results of the FRED and FRED Jr FDS in clinical practice in the UK at 6 months and 1 year.</p><p><strong>Methods: </strong>The FRED-UK study is a single arm, multicentre, prospective, observational study conducted in the UK. Safety was reviewed by evaluating morbidity (modified Rankin Score ≤2) and mortality. Efficacy was assessed as adequate occlusion of the treated aneurysm. A clinical event committee and core laboratory independently assessed clinical and anatomical results.</p><p><strong>Results: </strong>Seven neurointerventional centers treated 61 patients, 57 of which met the full inclusion and exclusion criteria. Of these, 75.4% were treated with FRED and 24.6% with FRED Jr. The aneurysms were located on the cavernous or supraclinoid internal carotid artery (ICA) in 75.4%, on the anterior cerebral artery (ACA) or anterior communicating artery (Acom) in 21.1%, and on the middle cerebral artery (MCA) in 3.5%. 57.9% of aneurysms were small (<10 mm), 40.4% were large (10-24 mm) and 1.8% were giant (≥25 mm). All-cause morbidity and mortality were 0% at 6 and 12 months, and adequate occlusion was 86.7% at 12 months in the per protocol population.</p><p><strong>Conclusions: </strong>The FRED and FRED Jr devices are safe and efficacious in the treatment of intracranial aneurysms.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199241302123"},"PeriodicalIF":1.7,"publicationDate":"2024-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11626556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794680","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":" ","pages":"812-818"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","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":"Parasagittal dural arteriovenous fistulas.","authors":"Xin Su, Jiabin Zhu, Yuying Li, Zihao Song, Liyong Sun, Ming Ye, Tao Hong, Yongjie Ma, Hongqi Zhang, Peng Zhang","doi":"10.1177/15910199241286009","DOIUrl":"10.1177/15910199241286009","url":null,"abstract":"<p><strong>Background: </strong>The majority of studies on parasagittal dural arteriovenous fistulas (DAVFs) have been limited to case reports or case series, and they are frequently reported alongside true superior sagittal sinus (SSS) DAVFs. Because of the selective bias present in the reporting of dispersed small numbers of parasagittal DAVFs, the results of each study may influence the findings. As a result, we present a large sequential cohort of parasagittal DAVFs from our institution spanning a 20-year period.</p><p><strong>Methods: </strong>This study was a retrospective analysis involving 80 patients with parasagittal DAVFs who were hospitalized at a single medical center from 2002 to 2022. We explore their clinical manifestations, angioarchitecture, clinical and radiographic outcomes.</p><p><strong>Results: </strong>We identified 80 patients with 85 parasagittal DAVFs. The cohort consisted of 69 men and 11 women, with a M ± SD age of 50.5 ± 11.1 years. Seventy-six patients underwent trans-arterial embolization (TAE), two underwent surgery, and two received conservative treatment. Immediate complete occlusion was achieved in 74 cases (94.9%). Fifty (96.2%) patients were cured, with no recurrence detected on final follow-up imaging. One patient died 6 months after the final subtotal occlusion, while the other patients experienced improvement or resolution of clinical symptoms following treatment.</p><p><strong>Conclusions: </strong>These lesions carry a high risk of hemorrhage and nonhemorrhagic neurological deficits. In our series, TAE achieved a high cure rate for these lesions, with no major complications reported.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"839-845"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142287260","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 use of balloon guide catheters during venous sinus stenting: A case series.","authors":"Justin Turpin, Timothy G White, Daniel Toscano, Siddharth Dalal, Miriam M Shao, Shyle H Mehta, Jared B Bassett, Kevin A Shah, Athos Patsalides","doi":"10.1177/15910199241289458","DOIUrl":"10.1177/15910199241289458","url":null,"abstract":"<p><strong>Background: </strong>Venous sinus stenting (VSS) is a safe and effective treatment strategy for pulsatile tinnitus (PT) and idiopathic intracranial hypertension (IIH). Although complications are rare, the morbidity associated with the complications is high. Navigating through the venous sinuses poses unique challenges to the interventionalist. There is limited literature regarding device selection to maximize safety and efficiency. We report on the safety and advantages of using a balloon guide catheter (BGC) for venous access in VSS.</p><p><strong>Methods: </strong>Retrospective analysis of all patients undergoing VSS using a BGC over a three-month period.</p><p><strong>Results: </strong>A total of 22 patients were included in the analysis (median age 35; 21 female). The indication for treatment was PT in 10 patients and IIH in 12 patients. The BGC was navigated into the sigmoid and transverse sinuses, enabling successful delivery of the stent in all cases. The BGC balloon was inflated 23 times for navigating past tortuosity or obstructions, and for anchoring. There were no intraprocedural complications.</p><p><strong>Conclusions: </strong>The use of BGC in VSS is safe and feasible. BGCs have features that can be utilized to overcome the unique challenges encountered during VSS.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"796-803"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142465509","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":"Optimizing the hemodynamics of hand injections in neuroangiography.","authors":"Esref Alperen Bayraktar, Jiahui Li, Jonathan Cortese, Cem Bilgin, Yasuhito Ueki, Ramanathan Kadirvel, Waleed Brinjikji, Harry J Cloft, David F Kallmes","doi":"10.1177/15910199241285944","DOIUrl":"10.1177/15910199241285944","url":null,"abstract":"<p><strong>Purpose: </strong>Optimizing the preparation of a 10 ml syringe for manual injection of contrast media can help operators obtain easier and faster injections. This study aims to compare the flow rates of different contrast media injection methods.</p><p><strong>Methods: </strong>Different contrast media solutions were compared: 100% contrast (10 ml contrast), mixed contrast solution (8:2 contrast/saline), and layered contrast below saline (\"Parfait\") in different volumes. Contrast media were injected at room temperature (20°C) and after heating (37°C). Four operators injected 10 ml syringes filled with different mediums through 5-French angiographic catheters. The average flow rate was used to compare different contrast injection mediums. The Kruskal-Wallis test with post-hoc pairwise comparisons using Bonferroni correction or Mann-Whitney U-tests were employed depending on the type of comparison.</p><p><strong>Results: </strong>Compared to the 100% contrast solution, every Parfait media and mixed contrast solution demonstrated significantly higher flow rates (p < 0.001). The 5 ml saline Parfait had the highest flow rate among the Parfait solutions. The 5 ml saline Parfait and the mixed solution had comparable flow rates (p = 0.237). Higher flow rates were observed upon heating both 100% contrast (p < 0.001) and mixed contrast solutions (p < 0.001) in comparison to their flow rates at room temperature.</p><p><strong>Conclusion: </strong>This study demonstrates the capability of the Parfait and mixed contrast injections to achieve higher flow rates than the 100% contrast solutions. Heating the contrast media to 37°C also proves to be a viable strategy for further enhancing the flow rates for 100% and mixed contrast solutions.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"833-838"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11733087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142287259","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":"Effects of reperfusion grade and reperfusion strategy on the clinical outcome: Insights from ESCAPE-NA1 trial.","authors":"Petra Cimflova, Johanna M Ospel, Nishita Singh, Martha Marko, Nima Kashani, Arnuv Mayank, Andrew Demchuk, Bijoy Menon, Alexandre Y Poppe, Raul Nogueira, Ryan McTaggart, Jeremy L Rempel, Michael Tymianski, Michael D Hill, Mohammed A Almekhlafi, Mayank Goyal","doi":"10.1177/15910199241288874","DOIUrl":"10.1177/15910199241288874","url":null,"abstract":"<p><strong>Background: </strong>We evaluated the association of reperfusion quality and different patterns of achieved reperfusion with clinical and radiological outcomes in the ESCAPE NA1 trial.</p><p><strong>Methods: </strong>Data are from the ESCAPE-NA1 trial. Good clinical outcome [90-day modified Rankin Scale (mRS) 0-2], excellent outcome (90-day mRS0-1), isolated subarachnoid hemorrhage, symptomatic hemorrhage (sICH) on follow-up imaging, and death were compared across different levels of reperfusion defined by expanded Treatment in Cerebral Infarction (eTICI) Scale. Comparisons were also made between patients with (a) first-pass eTICI 2c3 reperfusion vs multiple-pass eTICI 2c3; (b) final eTICI 2b reperfusion vs eTICI 2b converted-to-eTICI 2c3; (c) sudden reperfusion vs gradual reperfusion if >1 pass was required. Multivariable logistic regression was used to test associations of reperfusion grade and clinical outcomes.</p><p><strong>Results: </strong>Of 1037 included patients, final eTICI 0-1 was achieved in 46 (4.4%), eTICI 2a in 76 (7.3%), eTICI 2b in 424 (40.9%), eTICI 2c in 284 (27.4%), and eTICI 3 in 207 (20%) patients. The odds for good and excellent clinical outcome gradually increased with improved reperfusion grades (adjOR ranging from 5.7-29.3 and 4.3-17.6) and decreased for sICH and death. No differences in outcomes between first-pass versus multiple-pass eTICI 2c3, eTICI 2b converted-to-eTICI 2c3 versus unchanged eTICI 2b and between sudden versus gradual eTICI 2c3 reperfusion were observed.</p><p><strong>Conclusion: </strong>Better reperfusion degrees significantly improved clinical outcomes and reduced mortality, independent of the number of passes and whether eTICI 2c3 was achieved suddenly or gradually.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"804-811"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142465507","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}