Interventional Neuroradiology最新文献

{"title":"The first endovascular rat glioma model for pre-clinical evaluation of intra-arterial therapeutics.","authors":"Jaims Lim, Ammad A Baig, Brianna M Donnelly, Lee D Chaves, Suyog U Pol, Carmon Koenigsknecht, Donald Pionessa, Bennett R Levy, Liza Gutierrez, Vincent M Tutino, Elad I Levy, Adnan H Siddiqui","doi":"10.1177/15910199231169597","DOIUrl":"10.1177/15910199231169597","url":null,"abstract":"<p><p>BackgroundSeveral translational animal models have been described assessing intra-arterial (IA) treatments for malignant gliomas. We describe the first endovascular animal model that allows testing of IA drug delivery as a first-line treatment, which is difficult to do in actual patients. We report a unique protocol for vascular access and IA delivery in the rat model that, unlike prior reports, does not require direct puncture and opening of proximal cerebrovasculature which carries risk of ischemia in the animal brain post-delivery.MethodsWistar rats underwent left femoral artery catherization with a Balt Magic 1.2F catheter or Marathon Flow directed 1.5F Microcatheter with an Asahi Chikai 0.008 micro-guidewire which was navigated to the left internal carotid artery under x-ray. 25% mannitol was administered to test blood brain barrier breakdown (BBBB). Additional rats were implanted with C6 glioma cells in the left frontal lobe. C6 Glioma-Implanted Rats (C6GRs) were monitored for overall survival and tumor growth. Tumor volumes from MRI images were calculated utilizing 3D slicer. Additional rats underwent femoral artery catheterization with Bevacizumab, carboplatin, or irinotecan injected into the left internal carotid artery to test feasibility and safety.ResultsA successful endovascular access and BBBB protocol was established. BBBB was confirmed with positive Evans blue staining. 10 rats were successfully implanted with C6 gliomas with confirmed growths on MRI. Overall survival was 19.75 ± 2.21 days. 5 rats were utilized for the development of our femoral catheterization protocol and BBBB testing. With regards to IA chemotherapy dosage testing, control rats tolerated targeted 10 mg/kg of bevascizumab, 2.4 mg/kg of carboplatin, and 15 mg/kg of irinotecan IA ICA injections without any complications.ConclusionsWe present the first endovascular IA rat glioma model that allows selective catheterization of the intracranial vasculature and assessment of IA therapies for gliomas without need for access and sacrifice of proximal cerebrovasculature.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"447-456"},"PeriodicalIF":1.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12280536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9487772","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":"Cost impact of balloon guide catheter with mechanical thrombectomy for acute ischemic stroke: Analysis from the United States, Canada, and seven European countries.","authors":"Levansri Makalanda, Alex Mortimer, Eva Gonzalez-Diaz, Hendramoorthy Maheswaran, Shanti Scheffler, Emilie Kottenmeier, Waleed Brinjikji","doi":"10.1177/15910199251359730","DOIUrl":"10.1177/15910199251359730","url":null,"abstract":"<p><p>BackgroundBalloon guide catheters (BGCs) are adjunctive devices that may be used during mechanical thrombectomy (MT) to induce flow arrest and improve clot retrieval and reperfusion outcomes for acute ischemic stroke. As the cost-effectiveness of BGC use remains uncertain, this study assessed short- and long-term direct healthcare costs associated with BGC use versus standard guide catheters (SGC) during MT.MethodsA decision tree model estimated the short-term costs (index hospitalization), long-term costs (one year after index hospitalization), and total costs for patients undergoing MT + BGC versus MT + SGC from a healthcare system perspective in the United States (US), Canada, United Kingdom (UK), Sweden, Germany, Italy, Spain, Belgium, and The Netherlands. Average device costs were sourced from public tender prices and market research data. Weighted average healthcare costs for modified Rankin Scale scores were sourced from published literature for the respective countries. A 2024 meta-analysis supporting improved outcomes with BGC provided input parameters to model treatment effects for BGC and SGC. Deterministic one-way and probabilistic sensitivity analyses evaluated the robustness of model parameters and accounted for uncertainty.ResultsAcross all countries, long-term and total per-patient costs were lower with MT + BGC, yielding total per-patient cost savings of $6297 (US), CAD 3006 (Canada), £1828 (UK), 28,950 kr (Sweden), €1077 (Germany), €709 (Italy), €3678 (Spain), €2259 (Belgium), and €3344 (The Netherlands). The probability of MT + BGC yielding cost savings ranged 0.356-0.911 (short term), 0.962-0.975 (long term), and 0.838-0.935 (total costs). While long-term and total costs consistently favored MT + BGC, short-term cost savings showed more variability across countries.ConclusionThis study demonstrates that BGC use is associated with total one-year per-patient cost savings for inpatient and postdischarge stroke care across the US, Canada, and seven European healthcare systems. Balloon guide catheters can potentially reduce post-stroke care costs and should be considered more broadly, despite the additional cost incurred by the device.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251359730"},"PeriodicalIF":2.1,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12289623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698514","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":"Revisiting intra-arterial chemotherapy-palliative utility in a case of recurrent esthesioneuroblastoma and literature review.","authors":"Bernard Okai, Jaims Lim, Vinay Jaikumar, Moleca Ghannam, Laszlo L Mechtler, Kunal Vakharia, Adnan H Siddiqui, Elad I Levy","doi":"10.1177/15910199251362087","DOIUrl":"10.1177/15910199251362087","url":null,"abstract":"<p><p>BackgroundEsthesioneuroblastomas (ENBs) are rare, aggressive tumors arising from the olfactory neuroepithelium in the superior nasal tract. Current treatment strategies typically involve a combination of surgery and radiation, with systemic chemotherapy considered on a case-by-case basis. However, the role of intra-arterial (IA) therapies for ENBs remains underexplored. In this report, we present an illustrative case from our center and a systematic literature review compiling an overview of similar cases.MethodsThe case of an elderly man with recurrent ENB treated with IA carboplatin is described. We systematically reviewed PubMed and Embase to gather data on the indications, treatment course, and outcomes of IA chemotherapy for ENBs.ResultsThe patient presented initially with epistaxis and was diagnosed with ENB post-resection and radiation. Recurrence occurred 28 years later, causing visual loss and headaches. Multiple sessions of stereotactic radiosurgery over 2 years were ineffective. After multispecialty discussions, IA carboplatin was selected for neoadjuvant therapy. The bilateral internal maxillary arteries (IMAs) were identified as primary feeders of the recurrence. Carboplatin was directly administered via the IMAs in two stages, 1 month apart. The procedures were well-tolerated, and the patient was discharged without complications. Despite symptom improvement with radiographically stable tumor at 2-month follow-up, the patient opted for palliative care. The systematic review identified four ENB cases involving the ethmoid sinus with varying extensions into anterior and middle cranial fossae. IA chemotherapeutics were administered through maxillary or carotid arteries as an adjunct to resection, radiotherapy, or systemic chemotherapy, with no intraprocedural or postprocedural complications reported. Two patients died during follow-up: one with primary ENB and another with recurrent ENB.ConclusionThe safe administration of IA chemotherapeutics for primary and recurrent ENB in this case and literature review suggests a potential role for IA therapies in managing intracranial tumors, especially with advanced superselective microcatheter techniques.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251362087"},"PeriodicalIF":2.1,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12289616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698524","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":"Feasibility of middle meningeal artery embolization following large craniotomy: A case series.","authors":"Zachary S Hubbard, Conor M Cunningham, Rahim Abo Kasem, Joshua M Venegas, Ariana Chacon, Julio Isidor, Alejandro M Spiotta","doi":"10.1177/15910199251361309","DOIUrl":"10.1177/15910199251361309","url":null,"abstract":"<p><p>IntroductionWhile middle meningeal artery embolization (MMAE) has been shown to be feasible for recurrent subdural hematoma (SDH) after craniotomy, large traumatic craniotomies exceeding 8000 mm² have typically been excluded. In this novel case series, we assess the feasibility and efficacy of MMAE in treating recurrent SDH following large open neurosurgical intervention (non-burr hole or bedside procedures). In all cases, a portion of the middle meningeal artery (MMA) territory remained patent and was successfully embolized.MethodsWe identified five cases of recurrent SDH who underwent MMAE after ipsilateral or contralateral craniotomy at a single institution between 2020 and 2023. Burr hole and bedside craniotomies were excluded. Demographic, clinical, and operative data were collected and presented.ResultsFive patients underwent MMAE following large frontotemporoparietal craniotomies for SDH evacuation (mean size: 10,938 mm²). Both transradial and transfemoral approaches were used, and technical success was achieved in all five patients. In each case, a minimum of the posterior division of the MMA was patent and embolized. No complications were observed.ConclusionsThis case series provides preliminary evidence that MMAE is feasible and effective even after large frontotemporoparietal craniotomy. Neurointerventionalists should not exclude patients with craniotomies exceeding 8000 mm² from consideration for MMAE to treat ipsilateral recurrent SDH.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251361309"},"PeriodicalIF":2.1,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12289622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698515","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":"CELT vascular closure device for larger NES arteriotomies: A single-center retrospective analysis.","authors":"Philip Johnston, Chada Pitiranggon, Elias Wheibe, Jordan Kinnitt, Manav Shah, Imran Chaudry, Sean McDermott, Ray Turner, Aquilla S Turk, Jan Vargas","doi":"10.1177/15910199251360140","DOIUrl":"10.1177/15910199251360140","url":null,"abstract":"<p><p>Introduction/PurposeThe shift from transfemoral to transradial access in interventional cardiology has gained momentum due to fewer access site complications, earlier ambulation, and improved patient comfort. Adoption in neuroendovascular procedures has been slower due to anatomical challenges, a steeper learning curve, and reliance on transfemoral devices. Shapiro et al. reported a 4.6% total and 1.6% major complication rate with transfemoral mechanical thrombectomy (MT). While transradial MT aims to reduce such risks, small radial arteries pose concerns such as vasospasm and catheter entrapment. For large-bore access sites (>8F), available percutaneous closure options are limited. Vascular closure devices offer immediate hemostasis-even in anticoagulated patients-but data are limited on off-label use in oversized arteriotomies. We present a single-center retrospective experience using a 7F CELT closure device on 9F arteriotomies in MT.Materials/MethodsWe retrospectively reviewed patients from January 2021 to 2023 who underwent endovascular procedures using 9F femoral sheaths closed with a 7F CELT device. Data included demographics, procedural details, antithrombotic use, hemostasis efficacy, and closure-related complications.ResultsMost patients (96.3%) underwent MT. The CELT device achieved hemostasis in line with the primary outcome definition in 93.2% (95% CI [90.3, 96.0]). Major complications included two cases (0.5%) of lower limb ischemia requiring surgical repair. No retroperitoneal hematomas or transfusions occurred.ConclusionThe 7F CELT closure device demonstrated a 93.2% efficacy rate and a 95% complication-free rate when used off-label for 9F arteriotomies, supporting its potential viability in high-acuity neuroendovascular procedures.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251360140"},"PeriodicalIF":1.7,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12286984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144690149","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":"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}