Interventional Neuroradiology最新文献

{"title":"Software-based simulation for pipeline vantage flow diverter preprocedural assessment: Method and validation study.","authors":"João Victor Sanders, Marion Oliver, Laura Obradó, Nieves Montes, Krishna Joshi, Demetrius Lopes","doi":"10.1177/15910199251358590","DOIUrl":"10.1177/15910199251358590","url":null,"abstract":"<p><p>BackgroundFlow diverters (FDs) have revolutionized intracranial aneurysm (IA) treatment. Proper FD sizing is crucial for aneurysm occlusion and complication prevention. Ankyras (Mentice, Gothenburg, Sweden) is a device-specific sizing software. We evaluated Ankyras' performance in predicting the final deployment of the Pipeline™ Vantage Embolization Device with Shield Technology™ (PVST) (Medtronic Neurovascular, Irvine, California, USA).MethodsWe analyzed with Ankyras software the three-dimensional rotational angiography (3DRA) images of 10 consecutive patients with unruptured IA treated with PVST. Conventional digital subtraction angiography (DSA) measurements were used for FD sizing, FD was implanted, and postprocedure DSA and 3DRA images were obtained. Ankyras software generated an aneurysm model and simulated the FD size used in actual procedures. We compared the simulated length (SL) from Ankyras and the labeled length (LL) provided by the vendor to the real-case postdeployment measured length. We also compared the expansion from Ankyras simulation (SE) with the real case measured expansion (ME).ResultsOur analysis revealed a mean accuracy for SL across all cases of 92.05% (SD: 4.93%; range: 81.60%-99.10%), while the LL accuracy was 78.71% (SD: 12.43%; range: 62.20%-98.38%). A Pearson R² test indicated a strong correlation for SL at 0.9818, compared to 0.8625 for LL. Furthermore, the mean accuracy for expansion prediction was 86.28% (SD: 4.88%; range: 79.34%-92.46%).ConclusionThe Ankyras software shows promise as a viable tool for sizing PVST. Enhancing the accuracy of expansion predictions may further improve the precision of device specific simulation.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251358590"},"PeriodicalIF":1.7,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12286983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144690151","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":"A novel classification for posterior communicating artery aneurysms in the presence of fetal posterior cerebral artery: A registry-based study.","authors":"Hasna Loulida, Mohammad Mahdi Bagheri Asl, Ariana Chacon, Mohammad-Mahdi Sowlat, Zachary Stephen Hubbard, Conor M Cunningham, Imad Samman Tahhan, Julio Isidor, Rahim Abo Kasem, Justin A Chetta, Mulugeta Gebregziabher, Alejandro M Spiotta","doi":"10.1177/15910199251359712","DOIUrl":"10.1177/15910199251359712","url":null,"abstract":"<p><p>Background and objectivesFetal posterior cerebral artery (fPCA) is a common anatomical variant where the P1 segment is hypoplastic or absent, and the posterior communicating artery supplies the posterior cerebral artery (PCA) territory. Aneurysms in this setting often form at the internal carotid artery (ICA)-posterior communicating artery junction and are poorly defined. This study introduces a novel classification to address the fPCA variant, treatment challenges, and outcomes.MethodsThis registry-based study included fPCA aneurysms treated endovascularly at the Medical University of South Carolina (2013-2024). Aneurysms are classified into type-1 (shared neck with ICA and fPCA), type-2 (neck arises from ICA, and fPCA originates from the aneurysm), and type-3 (neck originates entirely from fPCA). Aneurysm type, treatment strategy, and outcomes were compared.ResultsForty fPCAs, consisting of 20 type-1, 15 type-2, and five type-3 aneurysms, were analyzed. For type-1 aneurysms, recurrence on admission was higher (40%, <i>p</i> = 0.03, V = 0.34 [95% CI: 0.22-0.56]). In addition, maximum diameter (<i>p</i> = 0.02, η² = 0.17) and neck size (<i>p </i>= 0.001, η² = 0.32) were larger in type-2 aneurysms. Treatment modalities included coiling alone (55%), stent-assisted coiling (17.5%), and flow diversion (FD) (27.5%). All coil-alone treatments were performed in newly presented ruptured aneurysm cases (<i>p</i> < 0.01, <i>V</i> = 0.57). FD was mainly used in aneurysm recurrence (54.5%), with adequate occlusion in all patients at one-year follow-up. The lowest occlusion rate was seen in type-2 (86.7% vs. 96%, <i>p</i> = 0.54, RR = 0.3 [95% CI: 0.03-3.03]) in one-year follow-up.ConclusionA personalized approach is needed to improve outcomes, particularly in wide-neck bifurcation fPCA aneurysms. Endovascular treatment should be individually adapted to each type to achieve optimal outcomes.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251359712"},"PeriodicalIF":1.7,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12286994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144690148","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":"Real-world functional outcomes and predictors of futile recanalization in patients meeting criteria for SELECT2.","authors":"Rahul R Karamchandani, Liang Wang, Hongmei Yang, Dale Strong, Jeremy B Rhoten, Jonathan D Clemente, Gary Defilipp, Nikhil M Patel, Joe D Bernard, William R Stetler, Jonathan M Parish, Andrew U Hines, Shraddha T Patel, Kasser Saba, Tamour Tareen, Harsh N Patel, Satheesh K Bokka, Lauren Macko, Anna Maria Helms, Katelynn J Teli, Elizabeth A Adelman, Laura Williams, Julia Retelski, Stacey Q Wolfe, Andrew W Asimos","doi":"10.1177/15910199251362088","DOIUrl":"10.1177/15910199251362088","url":null,"abstract":"<p><p>BackgroundRecent randomized trials have shown that patients presenting with large core infarctions benefit from endovascular thrombectomy compared to medical management. We report real-world outcomes and factors associated with futile recanalization in patients meeting large core criteria for SELECT2.MethodsRetrospective review of health system records from 1/1/2024 to 12/31/2024 for patients presenting with computed tomography (CT) Alberta Stroke Program Early CT Score (ASPECTS) 3-5 or CT perfusion (CTP) core infarction ≥50 milliliters. Primary and secondary outcomes, 90-day modified Rankin Scale (mRS) score 0-2 and 0-3, respectively, were compared to rates reported in SELECT2. Logistic regression was used to identify factors independently associated with 90-day mRS 5-6 despite successful reperfusion (modified treatment in cerebral ischemia 2b-3).ResultsAmong 59 patients with 90-day outcome data, median CT ASPECTS and CTP core were 7 (5-10) and 78.5 (57-119) mL, respectively. Twelve (20.3%) achieved mRS 0-2, while 18 (30.5%) were ambulatory (mRS 0-3). Recanalization was achieved in 51 subjects, of whom 27 (52.9%) had a devastating neurological outcome (mRS 5-6). Atrial fibrillation was the only factor independently associated with futile recanalization (odds ratio 13.5, 95% confidence interval 1.4-128.8, <i>p</i> < 0.05).ConclusionOur real-world cohort of large core thrombectomy patients from daily clinical practice had identical rates of independent neurological function and lower ambulatory rates at 90 days to that reported in the treatment arm of SELECT2. A history of atrial fibrillation, independent of age and presenting stroke severity, was associated with futile recanalization.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251362088"},"PeriodicalIF":1.7,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12286990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144690150","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":"Baseline predictors of poor clinical outcome despite recanalization of distal middle cerebral artery occlusions.","authors":"Imene Chafai, Hamza Salim, Basel Musmar, Nimer Adeeb, Vivek Yedavalli, Kareem ElNaamani, Nils Henninger, Simona Nedelcu, Sri Hari Sundararajan, Anna Luisa Kühn, Jane Khalife, Sherief Ghozy, Luca Scarcia, Benjamin Yq Tan, Jeremy Josef Heit, Robert W Regenhardt, Nicole M Cancelliere, Joshua D Bernstock, Aymeric Rouchaud, Jens Fiehler, Sunil A Sheth, Muhammed Amir Essibayi, Ajit S Puri, Christian Dyzmann, Marco Colasurdo, Gaultier Marnat, Leonardo Renieri, João Pedro Filipe, Pablo Harker, Răzvan Alexandru Radu, Thomas R Marotta, Julian Spears, Takahiro Ota, Ashkan Mowla, Pascal Jabbour, Arundhati Biswas, Frédéric Clarençon, Thanh N Nguyen, Ricardo Varela, Amanda Baker, David Altschul, Nestor Gonzalez, Markus A Möhlenbruch, V Costalat, Benjamin Gory, Paul Stracke, Mohammad A Aziz-Sultan, Constantin Hecker, Hamza Shaikh, David S Liebeskind, Alessandro Pedicelli, Andrea Maria Alexandre, Illario Tancredi, Tobias D Faizy, Erwah Kalsoum, Aman B Patel, Robert Fahed, Maud Wang, Vitor Mendes Pereira, Boris Lubicz, Adam A Dmytriw, Adrien Guenego","doi":"10.1177/15910199251342841","DOIUrl":"10.1177/15910199251342841","url":null,"abstract":"<p><p>ObjectiveMechanical thrombectomy (MT) is well-established for the treatment of acute ischemic stroke (AIS) from large vessel occlusion (LVO), with growing data supporting the expansion to distal and medium vessel occlusions (DMVO). Despite successful recanalization in DMVO, certain patients still experience poor long-term clinical outcomes, prompting our study to comprehensively explore pre-MT factors influencing outcome despite excellent recanalization (final modified Thrombolysis in Cerebral Infarction [mTICI] score ≥2c).MethodsWe retrospectively examined data from patients who consecutively underwent MT for a primary middle cerebral artery (MCA) DMVO across 37 centers in North America, Asia, and Europe. We identified baseline clinical and imaging factors associated with poor clinical outcome (defined as a modified Rankin Scale [mRS] score of 3-6) at 3 months, despite excellent recanalization using a multivariable model.ResultsBetween September 2017 and July 2021, 623 patients achieved mTICI > 2b and they were included in our study. Among them, 198 (32%) experienced a poor clinical outcome (mRS 3-6). Predictors of poor clinical outcome included higher age (OR 1.05 [1.03-1.07], <i>p</i> <i><</i> 0.001), higher NIHSS at admission (OR 1.12 [1.08-1.15], <i>p</i> <i><</i> 0.001), higher baseline mRS (OR 1.77 [0.96-3.26], <i>p</i> <i>=</i> 0.067), and diabetes (OR 1.59 [1.01-2.48], <i>p</i> <i>=</i> 0.044). Higher ASPECTS was associated with a decreased risk of poor clinical outcome (OR 0.82 [0.71-0.94], <i>p</i> <i>=</i> 0.006).ConclusionOlder age, diabetes, higher baseline mRS, and NIHSS were associated with poor clinical outcome in MCA DMVO despite excellent recanalization. Conversely, a higher ASPECTS decreased the probability of such an outcome.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251342841"},"PeriodicalIF":1.7,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12267219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642467","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":"Stent-assisted coiling using the pEGASUS-HPC stent for acutely ruptured wide-necked intracranial aneurysms: A multicenter retrospective study.","authors":"Abdallah Aburub, Zakarya Ali, Ali Khanafer, Tawfik Moher Alsady, Oussama Dob, Christopher Nimsky, Alexander Grote, Bayan Alhaj Mouatafa, Julia Korthäuer, Stephan Felber, Hans Henkes, André Kemmling, Mohammad Almohammad","doi":"10.1177/15910199251357993","DOIUrl":"10.1177/15910199251357993","url":null,"abstract":"<p><p>BackgroundStent-assisted coiling (SAC) is increasingly used to treat ruptured wide-necked intracranial aneurysms. The pEGASUS-HPC stent, featuring a hydrophilic polymer coating (HPC) to reduce thrombogenicity, may offer a safe option in subarachnoid hemorrhage (SAH). This study evaluates its safety and efficacy in a multicenter retrospective cohort.MethodsBetween July 2021 and June 2024, 22 patients with ruptured wide-necked aneurysms were treated with pEGASUS-HPC SAC at four neurovascular centers. Procedural success, aneurysm occlusion (Modified Raymond-Roy Classification, MRRC), and clinical outcomes based on the modified Rankin Scale (mRS) at discharge and follow-up were assessed. Complications and mortality were analyzed in relation to clinical and procedural factors.ResultsStent implantation and coil embolization were successfully performed in all patients. Immediate complete occlusion (MRRC I) was achieved in 19 cases (86.4%) and reached 100% at the 3-month follow-up. The median mRS improved from 3 (2-5) at discharge to 0 (0-2) at 3 months and 0 (0-1) at final follow-up, indicating sustained recovery. In 27.3% of cases, Y-stenting was required, reflecting bifurcation complexity. One patient (4.6%) had transient in-stent thrombosis, which resolved with tirofiban. All complications were minor and managed conservatively. No retreatment was required. All three deaths (13.6%) occurred in patients with Hunt and Hess grade V and basilar artery aneurysms.ConclusionThe pEGASUS-HPC stent showed a favorable safety profile with high occlusion and recovery rates in ruptured wide-necked aneurysms. These findings support the use of surface-modified stents in the acute setting and highlight the need for prospective studies to confirm long-term safety and efficacy.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251357993"},"PeriodicalIF":1.7,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12259594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626230","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 the middle meningeal artery for chronic subdural hematoma: The OTEMACS multicenter, randomized, clinical trial protocol.","authors":"Sam Ng, Imad Derraz, Gaultier Marnat, Vincent Jecko, Jean Papaxanthos, Guillaume Bellanger, Christophe Cognard, Jean-Christophe Sol, Tuan Le Van, Moncef Berhouma, Pierre Thouant, Timothée Jacquesson, Omer Eker, Hassan El Fertit, David S Liebskind, Nicolas Molinari, Nicolas Lonjon, Vincent Costalat","doi":"10.1177/15910199251356098","DOIUrl":"10.1177/15910199251356098","url":null,"abstract":"<p><p>BackgroundThe role of middle meningeal artery (MMA) embolization as an adjunct to standard treatment in chronic subdural hematoma (CSDH) is debated. Further randomized trials are needed to establish MMA embolization as an essential therapeutic option for CSDH. The OTEMACS study aims to assess the adjunctive benefit of MMA embolization in patients undergoing either conservative or surgical treatment for CSDH.MethodsOTEMACS is a multicenter, prospective, randomized controlled clinical trial with an open-label and blinded endpoint evaluation (PROBE) design. Patients with symptomatic CSDH treated either with conservative or surgical treatment are randomized 1:1 to receive MMA embolization within 72 h (experimental arm) or standard of care alone (control arm). The primary efficacy outcome is a composite of clinical and radiological events, including surgical rescue or revision surgery within 90 ± 14 days postrandomization or radiological remaining of the CSDH thickness >10 mm at 90 ± 14 days postrandomization. The primary safety outcome included all-cause mortality. Secondary outcomes included the modified Rankin scale, Barthel index, EuroQol-5, and Mini Mental State Examination. The number of patients to be included is 440.ResultsThe trial debuted in October 2021 in six centers, in France. A preplanned interim analysis was performed after the enrollment and completion of the follow-up of 220 patients, and the Data Safety Monitoring Board decided to stop the trial for efficacy. The final results will be made available upon completion of the enrollment.ConclusionsOTEMACS will provide additional evidence for the clinical and radiological efficacy and safety of MMA embolization in patients with CSDH.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251356098"},"PeriodicalIF":1.7,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12237945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583895","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 rarely described association between pseudoaneurysm and aberrant ICA: A case series.","authors":"Paul Yousif, Paul Farnsworth, Matthew Carlson, Kirk Welker, Julie Guerin, Girish Bathla, Ahmed O El Sadaney, Jack Lane","doi":"10.1177/15910199251353316","DOIUrl":"10.1177/15910199251353316","url":null,"abstract":"<p><p>Aberrant internal carotid artery (ICA) is a vascular anomaly in which a segment of the ICA courses through the middle ear. The association of aberrant ICAs and pseudoaneurysm formation is not well known and can be an important finding to recognize on imaging. In this series, we present three cases of aberrant ICAs having asymmetric contour deformities consistent with pseudoaneurysms diagnosed utilizing CT of the temporal bone.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251353316"},"PeriodicalIF":1.7,"publicationDate":"2025-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12234509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575478","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":"Is first-pass effect a meaningful metric to evaluate thrombectomy technologies?","authors":"Arjun Agrawal, Akash S Agrawal, Jase L Howell, Sevin B Barringer-Hoonhout, James D Fleck, Jason S Mackey, Andrew J DeNardo, Daniel P Gibson, Krishna Amuluru, Yasir Saleem, Charles G Kulwin, Troy D Payner, Kushal J Shah, J Mocco, Daniel H Sahlein","doi":"10.1177/15910199251351167","DOIUrl":"10.1177/15910199251351167","url":null,"abstract":"<p><p>BackgroundGood clinical outcomes following stroke thrombectomy have been associated with successful reperfusion following a single pass, often referred to as the first pass effect (FPE). Inherent in FPE is a potential association with rapid recanalization. It remains unclear if the benefit associated with FPE is an epiphenomenon rather than a meaningful metric to evaluate thrombectomy. We retrospectively analyzed a high-volume single-practice database to evaluate the association of FPE with good clinical outcome.MethodsA database of 1047 consecutive thrombectomies from 2011 to 2020 was retrospectively queried. Demographics and presentation/procedural metrics were correlated with clinical outcome (3-month modified Rankin Scale (mRS)); patients aged 18 years and older with 3-month clinical follow-ups were included. Univariate analysis was performed to evaluate for an association with good clinical outcome (mRS 0-2) at 90 days. Variables meeting a univariate analysis <i>P</i>-value of 0.05 were included in multivariate analyses. Variables included time of onset to recanalization (OTR), onset to puncture (OTP), and puncture to recanalization (PTR), as well as the number of passes.ResultsA total of 685 patients met the criteria for inclusion. Univariate analysis identified nine variables associated with good clinical outcome at 90 days. Multivariate analysis found OTP, patient age, and successful reperfusion (mTICI ≥ 2B) were associated with good clinical outcome. We built a multivariate model across a range of ratios of PTR to OTR. PTR became significantly associated with good clinical outcome (<i>P</i> = 0.044) when PTR/OTR ≥ 3%. Further subset analyses were performed using a conventional definition of FPE. All multivariate analyses revealed time metrics were significantly associated with good clinical outcome while one versus multiple passes was not.ConclusionsThis study demonstrates that time, age, and degree of recanalization are highly associated with good clinical outcome following thrombectomy, whereas the number of passes is not.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251351167"},"PeriodicalIF":1.7,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12204982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144505631","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":"Illustrated step-by-step guide to stent-assisted coiling of wide-neck posterior inferior cerebellar aneurysm via a contralateral vertebral artery approach.","authors":"Julio Isidor, Mohammad-Mahdi Sowlat, Rahim Abo Kasem, Ahmed Muthana, Zachary S Hubbard, Conor M Cunningham, Hasna Loulida, Jonathan Lena, Alejandro M Spiotta","doi":"10.1177/15910199251345635","DOIUrl":"10.1177/15910199251345635","url":null,"abstract":"<p><p>Background and ObjectivesPosterior inferior cerebellar artery (PICA) aneurysms are uncommon, occurring in 0.5% to 3% of all intracranial aneurysms. Due to the distinct anatomy and varying geometrical configuration at the PICA origin, endovascular treatment can be challenging. The contralateral vertebral artery approach to these aneurysms may provide a more advantageous route for endovascular treatment. We describe a series of eight cases of contralateral vertebral artery (VA) approach for stent-assisted coiling of PICA aneurysms.MethodsWe performed a retrospective review of all patients from 2013 in our center who were diagnosed with PICA aneurysm and treated with stent-assisted coiling using a contralateral VA approach. Our study was conducted under the Institutional Review Board (IRB) at our institution, and informed consent was obtained from all patients prior to the procedures. Patient characteristics, angiographic studies, and clinical course were reviewed<b>.</b>ResultsEight patients were included with a median age of 53 [IQR; 48-62]. Five patients (62.5%) had another aneurysm in addition to PICA. Three (37.5%) aneurysms had previously undergone primary coil embolization. The remaining five patients (62.5%) were index treatments. Transfemoral approach (TFA) was used in 7 patients and transradial approach (TRA) was used in 1 patient. The immediate Raymond Roy occlusion (RROC) was I (25%), II (50%) and III (25%). Follow-up RROC (range 6-12 months) were improved to class I in the majority (62.5%) and none were III.ConclusionsStent-assisted coiling via contralateral vertebral artery approach is an effective technique for PICA aneurysm treatment with favorable follow up occlusion rate.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251345635"},"PeriodicalIF":1.7,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12206226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511921","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 mechanical thrombectomy - The impact of cath lab staff turnover on stroke thrombectomy times.","authors":"Samantha Miller, Alman Rehman, Daniel Almquist, Wondewossen G Tekle, Ameer E Hassan","doi":"10.1177/15910199251347783","DOIUrl":"10.1177/15910199251347783","url":null,"abstract":"<p><p>BackgroundCath lab staff turnover increased dramatically after the COVID pandemic making it difficult to retain neurology-trained cath lab technicians (neuro-CLTs). We investigated the impact this had on local stroke quality metrics.MethodsThis is a retrospective study of a prospectively maintained thrombectomy (EVT) patient database at a single comprehensive stroke center from December 2021 through October 2023. Included patients underwent EVT for treatment of acute ischemic large vessel occlusion (LVO) stroke and had no missing outcomes data. Patients were grouped based on whether a neuro-CLT or non-neurology-trained CLT (other-CLT) was present for the procedure. Outcomes of interest included time from arterial access to the first EVT pass and time from cath lab arrival to arterial access.ResultsWe observed a faster median time from access to first pass when working with neuro-CLTs (10 min IQR 7-15) compared to other-CLTs (15 min IQR 10-24, <i>P</i> = .004). We also observed a faster median time from CL arrival to access with neuro-CLTs (22 min IQR 17-29) compared to other-CLT (27 min IQR 20-34, <i>P</i> = .036). There was a greater likelihood of access to first pass time <10 min with neurology-trained techs (47% versus 25%, <i>P</i> = .009, OR 2.67).ConclusionNeurology-trained CLTs were associated with great efficiency in EVT workflow, saving a median of 10 min from cath lab arrival to first pass. Our data supports the development of organized training programs and competency standards for neuro-CLTs. Future prospective multi-center studies are necessary to establish external validity and the effect on patient outcomes.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251347783"},"PeriodicalIF":1.7,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12198147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484345","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}