Journal of NeuroInterventional Surgery最新文献

{"title":"Superior petrosal sinus dural arteriovenous fistulas: endovascular treatment strategies with special emphasis on transvenous route selection.","authors":"Ömer Bagcilar, Ahmet Ustundag, Osman Kizilkilic, Bora Korkmazer, Serdar Arslan, Hakan Selcuk, Naci Kocer, Civan Islak","doi":"10.1136/jnis-2026-025322","DOIUrl":"https://doi.org/10.1136/jnis-2026-025322","url":null,"abstract":"<p><strong>Background and objective: </strong>Superior petrosal sinus dural arteriovenous fistulas (SPSdAVFs) are uncommon tentorial fistulas with aggressive venous drainage and complex anatomy. We evaluated endovascular treatment outcomes in our cohort and propose an anatomy-driven framework for treatment selection, with particular emphasis on transvenous route selection.</p><p><strong>Methods: </strong>We retrospectively reviewed consecutive SPSdAVFs treated endovascularly at two tertiary centers (January 2005-March 2024). Clinical, angiographic, procedural, and follow-up data were analyzed, including arterial supply, venous outflow, superior petrosal sinus (SPS) patency, embolic agent, and access route. Transvenous access to the junction of the SPS and superior petrosal venous confluence was categorized as duro-pial, anteromedial dural, or posterolateral dural.</p><p><strong>Results: </strong>Twenty-two patients (20 men; mean age, 51.7 years) were included; 6 (27.3%) presented with infratentorial hemorrhage. Ten underwent transvenous embolization (TVE) and 12 underwent transarterial embolization (TAE). TVE was achieved via a duro-pial route in four cases, anteromedial dural in four, and posterolateral dural in two. All anteromedial cases required recanalization of a thrombosed SPS segment; one posterolateral case required adjunctive snare-assisted pull-through. Complete angiographic occlusion was achieved in all patients after a single session. Periprocedural complications occurred in three patients (13.6%): one localized subarachnoid hemorrhage after TVE and two transient facial pareses after TAE. There were no procedure-related deaths or radiologic recurrences. Mean modified Rankin Scale score improved from 1.5 to 0.3 at last follow-up (mean, 6.5 years).</p><p><strong>Conclusions: </strong>TVE is a viable curative option for SPSdAVFs. An anatomy-driven strategy centered on venous foot access may facilitate route selection and durable occlusion.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Balloon guide catheters improve first-pass effect and neurologic outcomes in mechanical thrombectomy: a matched cohort analysis.","authors":"Gnaneswari Karayi, Joshua R Feler, Revyn Kim, David S Hong, Lulu Bi, Miranda Gonzales, Krisztina Moldovan, Radmehr Torabi, Vivek Yedavalli, Elias Shaaya, Mahesh V Jayaraman, Dylan N Wolman","doi":"10.1136/jnis-2026-025055","DOIUrl":"https://doi.org/10.1136/jnis-2026-025055","url":null,"abstract":"<p><strong>Background and purpose: </strong>The use of balloon guide catheters (BGCs) versus guide sheaths (GSs) for mechanical thrombectomy (MT) in large-vessel occlusive acute ischemic stroke (LVO-AIS) remains controversial. BGCs provide proximal flow arrest which may improve clot ingestion and reduce distal embolization.</p><p><strong>Materials and methods: </strong>A single-center retrospective matched-pair analysis to evaluate procedural efficacy and clinical outcomes as a function of BGC versus GS use for MT was performed. Consecutive patients who underwent MT for anterior circulation LVO-AIS from 2017 to 2025 were included. Subgroup analyses were performed by occlusion site and first-pass technique (ADAPT (aspiration) or CAPTIVE (aspiration and stent retriever)). The primary outcome measure was the first-pass effect (FPE; modified Treatment in Cerebral Infarction (mTICI) 2c-3 after the first pass). Secondary outcome measures included 90-day shift in the modified Rankin Scale (mRS) score, mortality, and time from puncture to recanalization.</p><p><strong>Results: </strong>A total of 1567 MT cases were included, with 930 matched procedures analyzed (465 BGC, 465 GS). BGC-MT was associated with higher FPE rates (51% vs 44%, P=0.026) and shorter procedural times (median (IQR) puncture to recanalization time 18 (29-13) min vs 23 (35-16) min, P<0.001). BGC-MT demonstrated a significant leftward shift in 90-day mRS distribution (OR 0.78, P=0.009) and lower mortality (28% vs 33%, P=0.04). BGC-MT benefits were most pronounced in CAPTIVE cases and internal carotid artery and middle cerebral artery M1 occlusions.</p><p><strong>Conclusion: </strong>BGC use was associated with superior FPE, shorter procedural times and improved neurologic outcomes, with benefits most pronounced for proximal occlusions. Neurologic benefits of BGC-MT may be driven by technical efficacy improvements, which may depend on operator experience and patient population.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Middle meningeal artery as a pathway to innovative treatments: ARISE III consensus recommendations.","authors":"Edgar A Samaniego, Luis Savastano, Matthew Robert Amans, David Altschul, Mark Bain, Guilherme Dabus, David Fiorella, Ramesh Grandhi, Violiza Inoa-Acosta, Ramanathan Kadirvel, Christopher Paul Kellner, Jose Morales, Raul G Nogueira, Akash Patel, Adnan I Qureshi, Adam S Arthur, Ajay K Wakhloo, Peter Kan, Arise Consortium","doi":"10.1136/jnis-2026-025150","DOIUrl":"https://doi.org/10.1136/jnis-2026-025150","url":null,"abstract":"<p><strong>Background: </strong>The middle meningeal artery (MMA) has emerged as an endovascular route for treating chronic subdural hematoma (CSDH), meningioma, and refractory headaches. The third ARISE roundtable convened experts from neurology, neurosurgery, neuroradiology, industry, and regulatory agencies to develop consensus guidance on current evidence for MMA-based therapies METHODS: Over 50 experts participated in a multi-stakeholder discussion. Evidence from randomized and observational studies, early-phase interventional series, and preclinical work was reviewed. Breakout groups focused on four domains: (1) MMA embolization (MMAE) for CSDH, (2) preoperative embolization of meningiomas, (3) MMA-targeted therapies for headache, and (4) transvascular access for endovascular drainage of subdural hematomas. Consensus recommendations were developed by a writing committee RESULTS: Randomized trials support MMAE as an adjunct to surgery or medical management for selected patients with non-acute, symptomatic CSDH to reduce recurrence, progression, and reoperation. Evidence remains insufficient to support MMAE for acute or asymptomatic subdural hematomas. For meningioma, observational data suggest that preoperative embolization in experienced centers can reduce blood loss and operative time and may delay recurrence in large, hypervascular tumors with predominant dural or external carotid supply; primary embolization and intra-arterial oncologic therapies remain investigational. Early series of MMA-directed lidocaine infusion for refractory migraine, status migrainosus, and post-subarachnoid hemorrhage headache show short-term benefit, highlighting the need for controlled trials. Preclinical and first-in-human studies of combined MMAE and transvascular drainage for CSDH demonstrate high technical success, rapid radiographic and clinical improvement, and no early recurrences CONCLUSION: The MMA represents a vascular pathway for an expanding spectrum of neurointerventional therapies.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reperfusion grade and clinical outcome following medium vessel occlusion thrombectomy in the Endovascular Treatment to Improve Outcomes for Medium Vessel Occlusions (ESCAPE-MeVO) trial.","authors":"William Diprose, Robert Fahed, David Volders, Markus A Möhlenbruch, Mouhammad Jumaa, Shahid M Nimjee, Aravind Ganesh, Thomas C Booth, Brian H Buck, James Kennedy, Jai Shankar, Franziska Dorn, Liqun Zhang, Christian Hametner, Sandor Nardai, Mohamad Abdalkader, Bijoy K Menon, Andrew M Demchuk, Michael D Hill, Mayank Goyal, Johanna M Ospel","doi":"10.1136/jnis-2025-024733","DOIUrl":"10.1136/jnis-2025-024733","url":null,"abstract":"<p><strong>Background: </strong>Randomized trials showed that endovascular thrombectomy (EVT) did not improve outcomes in medium vessel occlusion (MeVO) stroke compared with usual care. We investigated whether patients randomized to EVT who achieved near-complete/complete reperfusion had improved clinical outcomes compared with patients randomized to usual care.</p><p><strong>Methods: </strong>Post-hoc analysis of ESCAPE-MeVO, which randomized patients with MeVO stroke to undergo EVT in addition to usual care or usual care only. Reperfusion grade in EVT patients was assessed with the MeVO expanded Thrombolysis in Cerebral Infarction (meTICI) score. Regression analyses were used to compare clinical outcomes between EVT patients with near-complete/complete (meTICI 2c-3) reperfusion and usual care patients, and the association between reperfusion grade and clinical outcomes in EVT patients.</p><p><strong>Results: </strong>Overall, 253 of 255 (99.2%) patients randomized to EVT had final meTICI scores, of whom 133 (52.2%) achieved meTICI 2c-3 reperfusion. Infarct volumes were lower in EVT meTICI 2c-3 patients than in usual care patients, but there were no significant differences between EVT meTICI 2c-3 and usual care patients for 90-day modified Rankin Scale (mRS) score (adjusted common OR 1.17, 95% CI 0.79 to 1.75). Higher final meTICI scores were associated with improved 90-day mRS and lower infarct volumes in EVT patients.</p><p><strong>Conclusion: </strong>Although higher reperfusion grade was associated with smaller infarct volumes, there was no statistically significant difference in 90-day mRS between patients achieving meTICI 2c-3 and those receiving usual care.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146131940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of intravenous thrombolysis on aspiration thrombectomy outcomes: an Imperative Trial subgroup analysis.","authors":"Maxim Mokin, Reade Andrew De Leacy, William Mack, Raul G Nogueira, Shahram Majidi, Robert Dana Tomalty, Jan Vargas, Brett L Cucchiara, Kenneth V Snyder, Justin Mascitelli, Victoria Parada, Hakeem J Shakir, David Rosenbaum-Halevi, Amin Aghaebrahim, Daniel Hoit, Benjamin Yim, Matthew S Tenser, Alhamza R Al-Bayati, James M Milburn, Shahid M Nimjee, Neil Haranhalli, Michael Nahhas, Darryn Shaff, Kennith F Layton, Narlin Beaty, Robert M Starke, Harris Hawk, Diogo C Haussen, Aqueel Pabaney, Christopher Paul Kellner, Jonathan A Grossberg","doi":"10.1136/jnis-2025-024719","DOIUrl":"https://doi.org/10.1136/jnis-2025-024719","url":null,"abstract":"<p><strong>Background: </strong>The impact of intravenous (IV) thrombolysis on the outcomes of aspiration thrombectomy as the primary endovascular approach to stroke in patients with large vessel occlusion is unknown.</p><p><strong>Methods: </strong>The Imperative Trial was a prospective, investigational device exemption, multicenter trial of first-line aspiration thrombectomy that assessed the safety and efficacy of the Zoom System, including a novel 0.088 inch aspiration catheter in patients with stroke within 8 hours of onset. We compared procedural, technical, and clinical outcomes of aspiration thrombectomy based on whether patients had received IV thrombolytics prior to the intervention.</p><p><strong>Results: </strong>Among the 260 patients treated with front-line aspiration thrombectomy using the Zoom System, 125 (48%) received IV thrombolysis prior to aspiration. Rates of modified Thrombolysis in Cerebral Infarction (mTICI) ≥2b achieved with the Zoom System were higher in the aspiration-only group than in the combined group (92% vs 81%, P=0.016). Rates of mTICI ≥2c and first pass effect were similar. The use of rescue devices to achieve mTICI ≥2b was less frequent in the aspiration-only group than in the combined group (2% vs 10%, P=0.008). The rates of functional independence (modified Rankin Scale (mRS) score 0-2) in the aspiration-only group and the combined group were 50% and 59%, respectively (P=0.16). Univariate (P=0.30) and multivariate (P=0.47) ordinal regression analyses showed no significant correlation of mRS 0-2 with IV thrombolysis. Both groups had similar safety outcomes including rates of symptomatic intracranial hemorrhage and 90-day mortality.</p><p><strong>Conclusions: </strong>Aspiration thrombectomy alone may result in higher rates of successful reperfusion and reduce the need for rescue devices compared with the combined approach with IV thrombolysis.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular embolization of tentorial dural arteriovenous fistulas (EMBOTENT): a retrospective multicenter study.","authors":"Dominik F Vollherbst, Nadja Krug, Peng Zhang, Yongjie Ma, Xin Su, Nicola Limbucci, Leonardo Renieri, Pascal J Mosimann, Alexandre Boutet, How-Chung Cheng, Gaultier Marnat, Xavier Barreau, Istvan Szikora, Máté Czencz, Alejandro González, Asier de Albóniga-Chindurza, Luca Scarcia, Erwah Kalsoum, Andrea M Alexandre, Alessandro Pedicelli, Raoul Pop, Dan Mihoc, Bettina Serrallach, Tomas Dobrocky, Ansgar Berlis, Christoph Johannes Maurer, Frédéric Clarençon, Kevin Premat, Virginia Pujol Lereis, Diego A Devia, Sara Protto, Gwynedd E Pickett, Ivan Lylyk, Kamil Zeleňák, Takeshi Morimoto, Fouzi Bala, Mykola Vyval, Rui Carvalho, Davide Simonato, Marios-Nikos Psychogios, Osman Koc, Ajit S Puri, Robert M Starke, Riitta Rautio, Mostafa Ergawy, Jesse Jones, Peter B Sporns, Stephan Meckel, Sophia Hohenstatt, Martin Bendszus, Adam A Dmytriw, Markus A Möhlenbruch","doi":"10.1136/jnis-2026-024970","DOIUrl":"https://doi.org/10.1136/jnis-2026-024970","url":null,"abstract":"<p><strong>Background: </strong>Tentorial dural arteriovenous fistulas (TDAVFs) are rare but high risk vascular lesions. Although endovascular embolization is often the preferred treatment, large scale data on efficacy and safety are limited.</p><p><strong>Objective: </strong>To investigate the efficacy and safety of endovascular treatment for TDAVFs in a large, retrospective, multicenter cohort, and to analyze lesion characteristics and outcomes according to TDAVF location.</p><p><strong>Methods: </strong>Clinical, radiological, and interventional data from 585 patients treated in 32 international centers in 758 endovascular treatment sessions between 2012 and 2022 were analyzed. Patient demographics, fistula characteristics, endovascular treatment techniques, complications, and outcomes were assessed. Efficacy was measured by occlusion rates, safety by symptomatic complications, and modified Rankin Scale (mRS) scores.</p><p><strong>Results: </strong>In 31.3% of cases TDAVFs initially presented with hemorrhage, including 12.8% in low grade TDAVFs (absence of cortical venous reflux). Transarterial embolization was the primary approach in 84.7% of sessions. Complete occlusion was achieved in 74.2% of cases after the last treatment and 85.7% at the last imaging follow-up (mean 20.9 months). Symptomatic complications occurred in 9.4% of patients, with 2.6% permanent deficits and 1.0% mortality. At the last clinical follow-up (mean 30.6 months), 89.2% of patients had good functional outcome (mRS score 0-2). Location was significantly associated with fistula grade (eg, galenic and tentorial sinus TDAVFs being more often high grade, and torcular TDAVFs being more often low-grade).</p><p><strong>Conclusions: </strong>This large multicenter series demonstrated high occlusion rates, favorable functional outcomes, and acceptable complication rates, supporting endovascular therapy as a treatment of choice for TDAVFs. Considerable hemorrhage rates in low grade TDAVFs support the treatment even in the absence of cortical venous reflux.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In situ impedance analysis device for clot characterization in large vessel occlusion acute ischemic stroke, a first-in-human study.","authors":"Andrew Cheung, Henry Rice, Laetitia de Villiers, Nathan W Manning, Suzana Saleme, Vinicius Carraro do Nascimento, Géraud Forestier, Julie Lafaurie-Janvore, Joachim Rambeau, Franz Bozsak, Ramanathan Kadirvel, Karen Doyle, Waleed Brinjikji, David S Liebeskind, Aymeric Rouchaud, Dennis Cordato","doi":"10.1136/jnis-2025-024772","DOIUrl":"https://doi.org/10.1136/jnis-2025-024772","url":null,"abstract":"<p><strong>Background: </strong>Large vessel occlusion (LVO) stroke is associated with a high risk of permanent disability. There are no reliable tools providing periprocedural information on clot characteristics, such as composition and length, that may impact first pass effect, which has been shown to improve functional outcomes. In the first study of a novel technology, we evaluated whether the Clotild Smart Guidewire System (Clotild), an impedance-based device, can provide in situ information on clot characteristics during a mechanical thrombectomy procedure.</p><p><strong>Methods: </strong>This is the first-in-human, international, multicentric, single-arm trial involving LVO stroke patients. Of 45 enrolled subjects, 41 constituted the safety population; 39 was the per protocol population, of which 26 subjects with complete impedance data comprised the performance population. The latter was divided into development (11 subjects) and validation (15 subjects) populations for prediction model development and assessment. The safety endpoint assessed Clotild-related intracranial vessel perforation/dissection. Performance endpoints evaluated Clotild's ability to perform classification of impedance measurements distinguishing substantial versus negligible local content in red blood cells (RBCs) and platelets, to detect the arterial wall and the distal end of the clot.</p><p><strong>Results: </strong>The safety endpoint was met in all subjects. Performance analysis comparing the agreement between Clotild's output and impedance experts' readings showed an area under the receiver operating characteristic curve (AUC) of 0.97 (95% CI 0.93 to 0.99) for RBC, and 0.94 (95% CI 0.89 to 0.98) for platelet clot composition. Regarding detection, Clotild's performance showed an AUC of 0.69 (95% CI 0.59 to 0.77) for the arterial wall, and 0.83 (95% CI 0.59 to 1.00) for the distal end of the clot.</p><p><strong>Conclusions: </strong>Clotild was proven safe to acquire impedance data and to provide information on in situ clot characteristics in large vessel occlusions.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic cerebral angiography: A report of the SNIS Standards and Guidelines Committee, endorsed by ANZSNR and ESMINT.","authors":"Clemens Maria Schirmer, Amanda Baker, Ketan R Bulsara, Neeraj Chaudhary, Peng Roc Chen, Neil Haranhalli, Franklin A Marden, Charles J Prestigiacomo, Daniel Raper, Matthew S Tenser, Stavropoula I Tjoumakaris, Steven W Hetts","doi":"10.1136/jnis-2026-024980","DOIUrl":"https://doi.org/10.1136/jnis-2026-024980","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Diagnostic cerebral angiography (DCA) remains the gold standard for evaluating cerebrovascular pathology despite advances in non-invasive imaging. This guideline provides evidence-based recommendations for the contemporary practice of DCA from a patient-centered perspective.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A structured literature review was performed searching MEDLINE from January 2019 to July 2024 with regard to the concept of DCA. The strength and quality of evidence were graded according to established criteria. Recommendations were developed by consensus of the writing committee with input from the SNIS Standards and Guidelines Committee and Board of Directors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The management of DCA continues to evolve with advances in technology and technique. The expert panel agreed on the following recommendations:Recommendation 1: DCA should be employed as the reference standard imaging modality for problem-solving ambiguous findings from non-invasive imaging and for guiding endovascular interventions (Class 1, Level B-NR).Recommendation 2: We recommend consultation of the American College of Radiology Manual on Contrast Media for guidelines on the management of contrast reactions.Recommendation 3: A biplane angiographic system should be used for the acquisition of diagnostic cerebral angiograms in order to minimize patient contrast dose (Class 1, Level C-LD).Recommendation 4: Physicians trained and credentialed in performing and interpreting cerebral angiography, including complication avoidance and management, should perform DCA following established safety protocols (Class 1, Level C-EO).Recommendation 5: For conscious sedation during DCA we support the Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists developed by the American Society of Anesthesiologists Task Force.Recommendation 6: The choice of access site should consider anatomic factors, comorbidities, propensity for access site bleeding, patient preference, and individual operator experience (Class 1, Level C-EO).Recommendation 7: Continuous catheter flushing or double flushing and meticulous injection techniques should be employed to minimize the risk of embolic complications during DCA (Class 2a, Level B-NR).Recommendation 8: Normative exposure data should be collected by practitioners using x-ray fluoroscopy in order to adhere to neuroangiography practice guidelines and minimize potential harm to patients (Class 1, Level C-LD).Recommendation 9: It is incumbent on the practitioner to tailor the examination to the clinical question being answered (Class 1, Level C-EO).Recommendation 10: Prompt identification and management of intraoperative complications, including but not limited to the use of emergent thrombectomy for large emboli and treatment for flow-limiting dissections, are crucial to patient safety (Class 1, Level B-NR).Recommendation 11: It is reasonable to use a standardized reporting framework to en","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Depressive symptoms after endovascular thrombectomy are independent of functional outcome.","authors":"Solène Moulin, Sylvie Berthoz, Maxence Chillet, Sébastien Soize, Gaultier Marnat, Guillaume Carey, Alexandre Doucet, Nathalie Caucheteux, Thomas Tourdias, Bertrand Lapergue, Vi Tuan Hua, Igor Sibon","doi":"10.1136/jnis-2026-025214","DOIUrl":"https://doi.org/10.1136/jnis-2026-025214","url":null,"abstract":"<p><strong>Introduction: </strong>Post-stroke depression is a frequent yet underrecognized complication after ischemic stroke. In patients treated with endovascular thrombectomy (EVT), favorable functional recovery may mask psychological distress.</p><p><strong>Methods: </strong>We conducted a prospective multicenter observational study including consecutive patients with anterior circulation large-vessel occlusion treated with EVT between February 2021 and June 2024. At 3 months, depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D; ≥16 indicating clinically significant symptoms), and additional patient-reported outcomes including anxiety, post-traumatic stress symptoms, fatigue, and subjective cognitive complaints were collected. Baseline clinical and imaging characteristics were recorded. Multivariable logistic regression analyses were performed to identify factors independently associated with depressive symptoms and their relationship with functional outcome.</p><p><strong>Results: </strong>Among 559 patients treated with EVT (mean age 71 years; 49% women), 325 (58.1%) reported clinically significant depressive symptoms at 3 months. Depressive symptoms were observed across the spectrum of functional outcomes and were not independently associated with excellent functional outcome (modified Rankin Scale (mRS) 0-1) or functional independence (mRS 0-2). In contrast, depressive symptoms were strongly associated with anxiety (OR 8.19, 95% CI 2.79 to 24.07), post-traumatic stress symptoms (OR 7.31, 95% CI 1.71 to 33.30), fatigue (OR 2.85, 95% CI 1.70 to 4.77), and cognitive complaints (OR 2.06, 95% CI 1.21 to 3.50). A history of atrial fibrillation was independently associated with depressive symptoms (OR 1.72, 95% CI 1.02 to 2.83).</p><p><strong>Conclusions: </strong>Depressive symptoms are prevalent after EVT and represent a substantial component of post-stroke morbidity not captured by functional outcome scales, supporting integration of psychological assessment into post-EVT follow-up.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantitative comparison of vessel deformation among four stent retrievers using a strain sensor equipped cerebrovascular model.","authors":"Satoshi Iihoshi, Kazunori Todoroki, Tomoko Ikemoto, Shunya Hanakita","doi":"10.1136/jnis-2026-025413","DOIUrl":"https://doi.org/10.1136/jnis-2026-025413","url":null,"abstract":"<p><strong>Background: </strong>Mechanical thrombectomy with stent retrievers is the standard treatment for acute large vessel occlusion stroke, but device induced vessel deformation during retrieval has not been quantified in a spatially resolved manner.</p><p><strong>Methods: </strong>A polyvinyl alcohol (PVA) hydrogel cerebrovascular model reproducing the internal carotid artery to M1-M2 segments was equipped with eight strain sensors (TML FLA-03-11, gauge length 0.3 mm) at anatomically defined locations, corresponding to presumed perforator origins. Four stent retrievers (two sheet-type (Solitaire and pRESET) and two segmented-type (eNVi-SR and Embotrap)) were deployed and retrieved under identical conditions (three trials each). Primary outcomes were early peak strain and late mean strain. The Friedman test with post hoc Wilcoxon signed rank tests (Bonferroni correction) was used.</p><p><strong>Results: </strong>The highest strain concentrations were consistently observed at the M1 outer curvature and distal perforator bearing M1 segment. Global early peak strain differed significantly among devices (P=0.025): Solitaire 56.7±5.3, pRESET 63.2±14.1, eNVi-SR 68.8±7.3, and Embotrap 84.9±1.9. Embotrap was significantly higher than Solitaire (P=0.037) and pRESET (P=0.019). For global late mean strain, Embotrap (29.3±2.9) was significantly higher than Solitaire (18.0±4.3; P=0.007). The relaxation ratio did not differ among devices (P=0.73).</p><p><strong>Conclusions: </strong>Strain sensor equipped PVA hydrogel models enabled reproducible, spatially resolved comparison of device induced vessel deformation. Embotrap induced significantly greater deformation than Solitaire and pRESET, particularly at perforator bearing segments.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}