Interventional Neuroradiology最新文献

{"title":"Safety and efficacy of adjunct tirofiban treatment following mechanical thrombectomy for acute ischemic stroke patients with large vessel occlusion (LVO) resulting in successful reperfusion.","authors":"Hai-Long Zhong, Teng-Fei Zhou, Ying-Kun He, Tian-Xiao Li, Zhao-Shuo Li","doi":"10.1177/15910199221138883","DOIUrl":"10.1177/15910199221138883","url":null,"abstract":"<p><strong>Background and purpose: </strong>Tirofiban administration after mechanical thrombectomy (MT) remains controversial. This study aimed to investigate the efficacy and safety of adjunct tirofiban treatment following MT for acute ischemic stroke (AIS) patients with large vessel occlusion (LVO) that resulted in successful reperfusion on digital subtraction angiography (DSA).</p><p><strong>Methods: </strong>This retrospective study was conducted in Zhengzhou University University People's Hospital, an advanced stroke center in China. Consecutive patients with AIS who underwent endovascular therapy (EVT) were enrolled from June 2018 to January 2022. The safety endpoints were symptomatic intracerebral hemorrhage (sICH), total intracranial hemorrhage (ICH), and 3-month mortality. The efficacy endpoints were 3-month modified Rankin scale (mRS) score and 24-h neurological improvement.</p><p><strong>Results: </strong>A total of 145 consecutive patients with AIS who underwent MT were analyzed, of whom 51 (35.2%) patients were in the tirofiban group. There were 30 (20.7%) patients with sICH, 50 (34.5%) patients suffered from ICH within 24-h post-MT, and 47 (32.4%) dead at 3-month. Besides, 31 (21.4%) patients achieved excellent clinical outcomes (mRS, 0-1), and 24-h neurological improvement was found in 29 (20.0%) patients. No statistically significant differences were found in safety outcomes on sICH, total ICH, and 3-month mortality, as well as efficacy outcomes on 3-month mRS scores (0-1) and 24-h neurological improvement between the two groups (<i>P</i> > 0.05 for all). Additionally, tirofiban was associated with 3-month mRS scores of 0-2 (adjusted odds ratio (OR), 3.75; 95% confidence interval (CI), 1.41-10.02, <i>P</i> = 0.008).</p><p><strong>Conclusion: </strong>Adjunct tirofiban treatment following MT for AIS patients with LVO that resulted in successful reperfusion on DSA was not correlated with the increased risk of safety endpoints on sICH, ICH, and 3-month mortality, and it may be associated with a lower 3-month mRS score.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"657-662"},"PeriodicalIF":1.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40465236","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 role of non-stenosing carotid artery plaques in embolic stroke of undetermined source, is it a silent offender? A review of literature.","authors":"Ammar Jumah, Hassan Aboul Nour, Michael Fana, Omar Choudhury, Lara Eltous, Sohaib Zoghoul, Fareed Jumah, Owais K Alsrouji, Hisham Alhajala, Osama Intikhab, Horia Marin, Alex Chebl, Daniel Miller","doi":"10.1177/15910199221143172","DOIUrl":"10.1177/15910199221143172","url":null,"abstract":"<p><strong>Purpose: </strong>Atherosclerotic cervical internal carotid artery disease is one of the major causes of ischemic stroke and transient ischemic attacks. The risk of stroke from mild to moderate stenoses (i.e. <50% stenosis) might be underestimated. There is increasing evidence that plaque morphological features reflect plaque instability that may harbor high risk for embolization. In this narrative review, we will review the literature on plaque features that predict vulnerability beyond the degree of stenosis, discuss the clinical association with stroke, and evaluate the evidence that these lesions serve as a source for embolic stroke of unknown source (ESUS).</p><p><strong>Methods: </strong>We performed a literature search using PubMed, EMBASE, and Web of Science. The terms \"embolic stroke of undetermined source\" and \"plaque morphology\" were used either alone or in combination with \"non-flow limiting stenosis,\" \"non-stenosing plaques,\" \"high-risk plaque features\" or \"internal carotid artery plaque.\" Data on plaque morphology and ESUS were mainly taken from review articles, observational studies including retrospective cohort and cross-sectional studies, meta-analyses, and systematic reviews.</p><p><strong>Conclusion: </strong>Nonstenosing carotid artery plaques with high-risk features carry a remarkable risk for stroke occurrence and randomized clinical trials are warranted for further evaluation of using carotid artery stenting or carotid endarterectomy to mitigate the risk of stroke.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"759-767"},"PeriodicalIF":1.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40711505","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":"Inverted stent deployment technique for stent assisted coiling of wide-necked posterior communicating artery aneurysm: Technical report.","authors":"Zamir Merali, Vitor Mendes Pereira, Mazen Alotaibi, William Guest, Julian Spears, Thomas Marotta","doi":"10.1177/15910199221108306","DOIUrl":"10.1177/15910199221108306","url":null,"abstract":"<p><strong>Background: </strong>Wide-necked aneurysms of the posterior communicating artery associated with a fetal posterior cerebral artery that arises from the neck or dome of the aneurysm is a clinical scenario that poses a challenge to endovascular methods.</p><p><strong>Case description: </strong>A patient presented with spontaneous subarachnoid hemorrhage and was found to have a 4 × 3 × 3 mm posterior communicating artery aneurysm. Of note the aneurysm projected superiorly and a fetal posterior communicating artery aneurysm arose from the neck of the aneurysm. After multidisciplinary discussion a treatment strategy of endovascular stent-assisted coiling was chosen. Given the unique morphology of the aneurysm a novel stent-inversion maneuver was used, in which the stent was deployed from the posterior communicating artery into the distal supra-clinoid internal carotid artery. The patient tolerated the procedure well and complete aneurysm occlusion was achieved.</p><p><strong>Conclusions: </strong>This case demonstrates a novel stent inversion technique that can be used for stent-assisted coiling of certain challenging aneurysms.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"778-781"},"PeriodicalIF":1.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569477/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40409639","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 initial experience with the Embotrap III stent-retriever in a real world setting.","authors":"Osama Omrani, Nema Hafezi-Bakhtiari, Peter DeSouza, Christos Nikola, Ken Wong, Joseph Lansley, Permesh Dhillon, Levansri Makalanda, Nathan Chan, Thomas Harrison, Alex Andrews, Isabel Siow, Keng Siang Lee, Leonard Yeo, Oliver Spooner, Pervinder Bhogal","doi":"10.1177/15910199221142097","DOIUrl":"10.1177/15910199221142097","url":null,"abstract":"<p><strong>Materials and methods: </strong>We performed a retrospective review of our prospectively maintained database to identify all patients treated with the Embotrap 3 stent-retriever between January 2021 and January 2022. We recorded the baseline demographics, NIHSS, ASPECT score and clot characteristics, first pass and final eTICI scores, complications and 90 day mRS.</p><p><strong>Results: </strong>One hundred and ten patients met the inclusion criteria, average age 69 ± 14 years, 50% were male (<i>n</i> = 55). The median NIHSS at presentation was 18 (range 3-30) and 58.2% received IV tPA prior to MT. The median ASPECT score on plain CT was 8 with average clot length 20.2 ± 14.8 mm (<i>n</i> = 93). The first pass effect (FPE) was seen in 41.8% of cases with modified FPE seen in 59.1%. A 24-hour CT scan (<i>n</i> = 97) showed median ASPECTs of 7. 43.8% of patients achieve mRS ≤ 2 at 90-day mRS (<i>n</i> = 64).</p><p><strong>Conclusion: </strong>The Embotrap 3 stent-retriever has a high rate of FPE and final recanalization in this real world cohort of patients.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"663-671"},"PeriodicalIF":1.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10724298","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":"Vessel wall imaging and quantitative flow assessment in arteriovenous malformations: A feasibility study.","authors":"Laura Stone McGuire, Mark Rizko, Denise Brunozzi, Fady T Charbel, Ali Alaraj","doi":"10.1177/15910199221143189","DOIUrl":"10.1177/15910199221143189","url":null,"abstract":"<p><strong>Introduction: </strong>Cerebral arteriovenous malformations (AVMs) carry a rupture rate of 2-3% per year. Several architectural factors may influence rupture rate, and a recently theorized model of AVMs describes the influence of vessel wall inflammation. A novel imaging modality, vessel wall imaging (VWI), has been developed to view inflammatory processes in vessel wall foci but has not yet been examined in AVMs, which is the aim of this study.</p><p><strong>Methods: </strong>This retrospective review studies prospectively collected data on patients with ruptured and unruptured AVMs between 2019 and 2021. Inclusion criteria included adult patients (≥18 years) with radiographically diagnosed AVM who underwent VWI. Charts were reviewed for medical history, clinical presentation, hospital course, discharge condition, and follow-up. Angioarchitectural features, blood flow, and VWI were compared in patients with and without hemorrhagic patients.</p><p><strong>Results: </strong>Nine patients underwent VWI, mean age 37.7 ± 9.9 years. Four presented with hemorrhage (44.4%). Seven (77.7%) received glue embolization and 6 (66.7%) underwent surgical resection. All patients (4/4) with a history of hypertension presented with hemorrhage (<i>p</i> = 0.0027). Size and Spetzler-Martin grade were not associated with hemorrhage (<i>p</i> = 0.47, <i>p</i> = 0.59). Net AVM flow was higher in patients presenting with hemorrhage, although nonsignificant (<i>p</i> = 0.19). With VWI, 3 (75%) hemorrhagic AVMs showed visible nidus and draining veins, and all three demonstrated positive post-contrast wall enhancement in at least one of their draining veins; conversely, of fivenonhemorrhagic AVMs, only 2 (40%) demonstrated post-contrast wall enhancement in any draining vein (<i>p</i> = 0.090).</p><p><strong>Conclusion: </strong>This pilot study successfully demonstrated capture of venous walls in AVMs using VWI. In this study, draining vein enhancement occurred more often in hemorrhagic AVM and in those with higher venous volumetric flow.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"694-701"},"PeriodicalIF":1.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35210790","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":"Basilar artery occlusion management: An international survey of middle versus high-income countries.","authors":"Brian Drumm, Ana Herning, Piers Klein, Jean Raymond, Mohamad Abdalkader, Xiaochuan Huo, Yimin Chen, James E Siegler, Meabh Peacock, Wouter J Schonewille, Xinfeng Liu, Wei Hu, Xunming Ji, Chuanhui Li, Fana Alemseged, Liping Liu, Simon Nagel, Daniel Strbian, Leticia C Rebello, Shadi Yaghi, Muhammad M Qureshi, Urs Fischer, Georgios Tsivgoulis, Johannes Kaesmacher, Hiroshi Yamagami, Volker Puetz, P N Sylaja, João Pedro Marto, Simona Sacco, Espen Saxhaug Kristoffersen, Jelle Demeestere, Adriana B Conforto, Lukas Meyer, Daniel P O Kaiser, Tilman Reiff, Kubilay Aydin, Michele Romoli, Francesco Diana, Kyriakos Lobotesis, Dylan Roi, Hesham E Masoud, Alice Ma, Mahmoud H Mohammaden, Mohamed F Doheim, Yuyou Zhu, Hongfei Sang, Dapeng Sun, Mai Duy Ton, Raynald, Fengli Li, Bertrand Lapergue, Uta Hanning, Qingwu Yang, Jin Soo Lee, Götz Thomalla, Pengfei Yang, Jianmin Liu, Bruce C V Campbell, Hui-Sheng Chen, Osama O Zaidat, Zhongming Qiu, Raul G Nogueira, Zhongrong Miao, Thanh N Nguyen, Soma Banerjee","doi":"10.1177/15910199221143190","DOIUrl":"10.1177/15910199221143190","url":null,"abstract":"<p><strong>Background and purpose: </strong>Two early basilar artery occlusion (BAO) randomized controlled trials (RCTs) did not establish the superiority of endovascular thrombectomy (EVT) over medical management. Yet many providers continued to recommend EVT. The goal of the present article is to compare physicians' diagnostic and management strategies of BAO among middle-income and high-income countries (MICs and HICs, respectively).</p><p><strong>Methods: </strong>We conducted an international survey from January to March 2022 regarding management strategies in acute BAO, to examine clinical and imaging parameters influencing clinician management of patients with BAO. We compared responses between physicians from HIC and MIC.</p><p><strong>Results: </strong>Among the 1245 respondents from 73 countries, 799 (64.2%) were from HIC, with the remaining 393 (31.6%) from MIC. Most respondents perceived that EVT was superior to medical management for acute BAO, but more so in respondents from HIC (98.0% vs. 94.2%, p < 0.01). MIC respondents were more likely to believe further RCTs were warranted (91.6% vs. 74.0%, p < 0.01) and were more likely to find it acceptable to enroll any patient who met a trial's criteria in the standard medical treatment arm (58.8% vs. 38.5%, p < 0.01).</p><p><strong>Conclusions: </strong>In an area where clinical equipoise was called into question despite the lack of RCT evidence, we found that respondents from MIC were more likely to express willingness to enroll patients with BAO in an RCT than their HIC counterparts.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"702-711"},"PeriodicalIF":1.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10337280","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":"Endovascular thrombectomy for severe cerebral venous thrombosis: A comprehensive meta-analysis assessing safety and efficacy.","authors":"Sherief Ghozy, Atakan Orscelik, Hatem Tolba, Mariam Abdelghaffar, Hassan Kobeissi, Hazem S Ghaith, Alzhraa S Abbas, Ramanathan Kadirvel, Waleed Brinjikji, David F Kallmes","doi":"10.1177/15910199241285071","DOIUrl":"10.1177/15910199241285071","url":null,"abstract":"<p><strong>Background: </strong>Cerebral sinus venous thrombosis (CSVT) has traditionally been treated medically with systemic anticoagulation. Recent advances in endovascular therapy (EVT) may represent an alternative treatment to medical therapy for CSVT. We conducted a systematic review and meta-analysis to evaluate the use of EVT for CSVT.</p><p><strong>Methods: </strong>We conducted a systematic literature review using PubMed, Embase, Scopus, and Web of Science. We included studies that reported outcomes following EVT for CSVT. The primary outcome of interest was rate of modified Rankin Scale (mRS) 0-2. Secondary outcomes of interest were rates of complete, partial, and failed recanalization, mortality, and new or expansion of hematoma. We calculated pooled rates (%) and their corresponding 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Thirty-eight studies with 682 patients were included. Rate of mRS 0-2 was 82.6% (95% CI, 75.3%-88.0%). Rate of complete recanalization was 60.9% (95% CI, 49.1%-71.5%), rate of partial recanalization was 34.2% (95% CI, 24.1%-45.9%), and rate of failed recanalization was 5.4% (95% CI, 3.1%-9.2%). Rate of mortality was 6.7% (95% CI, 4.1%-10.8%), and rate of new hematoma or expansion of hematoma was 5.1% (2.9%-8.8%).</p><p><strong>Conclusions: </strong>In this systematic review and meta-analysis, EVT for CSVT was associated with favorable rates of mRS 0-2 and recanalization. Furthermore, EVT was associated with a promising safety profile. Future prospective, comparative studies are warranted to assess EVT for CSVT.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199241285071"},"PeriodicalIF":1.7,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346732","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":"Characteristics of middle cerebral artery aneurysms treated endovascularly in a clip-favored institution.","authors":"Satoshi Kiyofuji, Satoshi Koizumi, Taichi Kin, Satoru Miyawaki, Hiroki Hongo, Motoyuki Umekawa, Nobuhito Saito","doi":"10.1177/15910199241286242","DOIUrl":"10.1177/15910199241286242","url":null,"abstract":"<p><strong>Background: </strong>The emergence of flow disruptors has brought a dynamic transition in the selection of treatment for middle cerebral artery (MCA) aneurysms, and the number of MCA aneurysms clipped is acceleratingly decreasing. Still, retreatment after endovascular treatment is still a dilemma, which may necessitate surgical clipping. It is all the more important to elucidate characteristics of MCA aneurysms that make clipping unfavorable. Thus, the practical characteristics of MCA aneurysms treated endovascularly in a clip-favored institution before the usage of flow disruption devices were investigated.</p><p><strong>Methods: </strong>This is a retrospective, single-center observational study. The clinical and imaging characteristics of treated MCA aneurysms from January 2012 to May 2022 were analyzed.</p><p><strong>Results: </strong>A total of 83 aneurysms were included; 70 aneurysms (84%) were clipped, and 13 (16%) were treated endovascularly. Eighteen aneurysms (22%) were ruptured (clipping, 12; endovascular, 6). The reasons for an endovascular treatment were as follows: distal (3); subacutely ruptured with burdens of spasm (2); multiple aneurysms (6: another clipped in 3, coiled in 1, and conservatively managed in 2); no access to the operating room due to COVID-19 (1); and retreatment after coiling (1). Endovascular group aneurysms were smaller (maximum diameter 5.2 vs 7.3 mm, <i>p</i> < 0.01, as well as dome, neck, and height) without differences in the dome/neck and aspect (height/neck) ratios. In a subgroup analysis of 78 MCA bifurcation aneurysms, the endovascular group was still smaller (dome 4.4 vs 5.8 mm, <i>p</i> = 0.025; neck 2.8 vs 3.9, <i>p</i> = 0.03).</p><p><strong>Conclusion: </strong>In a limited series from a clip-favored institution before the flow disruption era, factors guided to endovascular treatments on MCA aneurysms were rather anatomical and clinical factors such as distal location, subacutely ruptured, multiple, or retreatment after coiling, than morphological factors such as dome/neck and aspect ratios albeit smaller size.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199241286242"},"PeriodicalIF":1.7,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346731","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":"pRESET thrombectomy device outcomes in patients with acute ischemic stroke: A systematic review and meta-analysis.","authors":"Abdelrahman M Hamouda, Mark Cwajna, Hassan Kobeissi, Nicholas Kendall, Tasnim Elgazzar, Sherief Ghozy, Waleed Brinjikji, David F Kallmes","doi":"10.1177/15910199241286753","DOIUrl":"10.1177/15910199241286753","url":null,"abstract":"<p><strong>Background: </strong>Many devices are used to perform mechanical thrombectomy in the setting of large vessel occlusion acute ischemic stroke. We sought to evaluate the efficacy and safety of pRESET stent-retriever systems.</p><p><strong>Methods: </strong>We conducted a comprehensive systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant studies up to March 2024 were retrieved from PubMed, Scopus, Web of Science, and Embase databases.</p><p><strong>Results: </strong>A total of 8 papers met the inclusion/exclusion criteria comprising a total of 1140 participants (average age 72.4 ± 11.9, female percentage (50%). Preintervention intravenous thrombolysis was utilized in 46.5% (range 32.9-65.4) of patients, with a median National Institute of Health Stroke Scale at presentation of 15 (range 0-38). The middle cerebral artery was the most commonly affected artery, with a prevalence of 76.4% (range 62.8-100). The pRESET stent-retriever systems demonstrated a first-passing effect rate of 53.4% [95% confidence interval [CI] 44.8; 61.7] and a final thrombolysis in cerebral infarction 2b-3 grade rate of 90.41% [95% CI 82.13; 95.08]. Ninety-day modified Rankin Scale (0-2) rate was 42.2% [95% CI 27.6; 58.4], and 90-day mortality rate was 15.1% [95% CI 9.8; 22.6]. Postintervention hemorrhage occurred at a rate of 28.6% [CI 17.2; 43.6].</p><p><strong>Conclusion: </strong>Our systematic review and meta-analysis describes the efficacy of the pRESET stent retriever system in managing acute ischemic stroke patients. The pRESET device was found to have a similar safety and efficacy profile to other mechanical thrombectomy devices currently in use.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199241286753"},"PeriodicalIF":1.7,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346733","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 significance of stent sizing for parent vessel stenosis after flow diversion of MCA bifurcation aneurysms.","authors":"Svetozar Matanov, Georgi Vladev, Alexander Sirakov, Kristian Ninov, Marin Penkov, Hristo Tsonev, Kristina Sirakova, Vasil Karakostov, Stanimir Sirakov","doi":"10.1177/15910199241285503","DOIUrl":"10.1177/15910199241285503","url":null,"abstract":"<p><strong>Background: </strong>Wide-necked bifurcation aneurysms (WNBA) of the middle cerebral artery (MCA) present significant therapeutic challenges. Flow-diverter stents have been increasingly adopted for their management, though they may give rise to adverse outcomes such as in-stent stenosis (ISS). This study explores the association between stent oversizing and the incidence of ISS following flow-diverter stent placement in MCA bifurcation aneurysms.</p><p><strong>Methods: </strong>A retrospective study included 34 patients who underwent flow-diverter stent placement for MCA bifurcation aneurysms between 2020 and 2023. Data on patient demographics, aneurysm morphology, and stent sizing were collected. ISS was evaluated through follow-up imaging at 6-month post-procedure. Stent oversizing was determined by calculating the difference between the stent diameter and the proximal and distal parent vessel diameters. Statistical analyses included Pearson correlation and chi-square tests, with significance established at <i>p</i> < 0.05.</p><p><strong>Results: </strong>The studied group had a mean age of 57.8 years, with 81.6% female patients. The average aneurysm neck size was 3.6 mm, with a mean dome-to-neck ratio of 1.6. ISS was detected in 64.7% of cases proximally and 88.2% distally. A statistically significant negative correlation (<i>r</i> = -0.496, <i>p</i> = 0.003) was observed between stent oversizing and ISS, indicating that increased stent oversizing was associated with a higher incidence of ISS, particularly in the distal vessel segments.</p><p><strong>Conclusion: </strong>The findings indicate that stent oversizing is significantly associated with the development of ISS in MCA bifurcation aneurysms treated with flow-diverter stents. Careful consideration of stent sizing, particularly minimizing oversizing in distal segments, may mitigate the risk of ISS and improve clinical outcomes. These results underscore the importance of meticulous stent selection and procedural planning in neurointerventional practice.</p>","PeriodicalId":14380,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199241285503"},"PeriodicalIF":1.7,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346736","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}