Journal of NeuroInterventional Surgery最新文献

{"title":"Diagnostic value of the perfusion mismatch ratio in identifying intracranial atherosclerotic disease related occlusion.","authors":"Tingyu Yi, Zhi-Nan Pan, Lan Hong, Weifeng Huang, Ding-Lai Lin, Zhijiao He, Shuyi Liu, Shujuan Gan, Fenglong Lang, Yi-Ning Yang, Jinhua Ye, Huanghuang Chen, Dapeng Sun, Xin Cheng, Zhongrong Miao, Wen-Huo Chen","doi":"10.1136/jnis-2025-023205","DOIUrl":"https://doi.org/10.1136/jnis-2025-023205","url":null,"abstract":"<p><strong>Background: </strong>The ability to differentiate intracranial atherosclerotic disease (ICAD) related large vessel occlusion (LVO) from embolism is critical for stroke management. We hypothesized that the mismatch ratio derived from the automated computed tomography perfusion (CTP) could predict underlying ICAD.</p><p><strong>Methods: </strong>Patients with acute ischemic stroke (AIS) and LVO from prospective registry databases who underwent CTP were included in the derivation cohort (n=1100). The mismatch ratio, calculated as the ratio of the hypo-perfused volume to the infarct core volume by software, was defined. Receiver Operating Characteristic (ROC) analysis was performed to assess the predictive performance of the mismatch ratio for ICAD, and logistic regression analysis was used to identify independent predictors of LVO associated with underlying ICAD. External validation was conducted using cohorts from two other stroke centers (n=385).</p><p><strong>Results: </strong>In the derivation cohort, 390 patients were classified as ICAD and 720 as embolism. The ICAD group had a higher mismatch ratio (9.8 vs 3.6, P<0.001). The mismatch ratio outperformed age and National Institutes of Health Stroke Scale (NIHSS) score in predicting ICAD (area under the curve (AUC), 0.77 vs 0.36 vs 0.28, P<0.001). The ROC curve had a best cut-off of 7.1 for predicting ICAD, which was an independent predictor of ICAD-related occlusion (adjusted odds ratio (aOR) 5.43, 95% CI 3.68 to 8.03), with 68% sensitivity and 76% specificity. These results were validated in an external cohort (AUC=0.78; 95% CI, 0.73 to 0.83).</p><p><strong>Conclusion: </strong>The perfusion mismatch ratio may be an optimal and simple predictor of anterior circulation ICAD- related LVO before endovascular treatment (EVT). When this ratio was ≥7.1, ICAD was five times more likely than embolism.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142781","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":"A pre-intervention six-item scale for predicting futile recanalization after endovascular therapy in patients with acute ischemic stroke with large core infarction.","authors":"Yawen Gan, Jie He, Zhongao Guan, Ketao Tu, Fangguang Chen, Shuang Song, Dingwen Zhang, Yuesong Pan, Zhongrong Miao, Dapeng Mo, Xu Tong","doi":"10.1136/jnis-2025-023370","DOIUrl":"https://doi.org/10.1136/jnis-2025-023370","url":null,"abstract":"<p><strong>Background: </strong>Despite successful reperfusion after endovascular therapy (EVT), over 50% of patients with large vessel occlusion (LVO) and large core infarction fail to achieve favorable functional outcomes, termed 'futile recanalization'. This study aimed to identify predictors and develop a scoring system to predict futile recanalization in patients with LVO and large core infarction undergoing EVT.</p><p><strong>Methods: </strong>Patients were selected from the Acute Anterior Circulation Large Vessel Occlusive Patients With a Large Infarct Core (ANGEL-ASPECT) trial. Futile recanalization was defined as a modified Rankin Scale (mRS) score of >3 at 90 days despite successful reperfusion (extended Thrombolysis in Cerebral Infarction scale ≥2b). Participants were divided into futile (mRS >3) and no-futile (mRS ≤3) recanalization groups. Multivariable logistic regression was used to develop the predictive scale, with model performance assessed via a receiver operating characteristic (ROC) curve and Hosmer-Lemeshow test.</p><p><strong>Results: </strong>Of 146 patients, 74 had futile recanalization. A six-item scale (0-6 points) was developed, including gender, age, systolic blood pressure, admission National Institutes of Health Stroke Scale score, blood glucose, and neutrophil-to-lymphocyte ratio. The scale showed good predictive performance (area under the ROC curve (AUC) 0.806, 95% CI 0.737 to 0.876) and good calibration (Hosmer-Lemeshow test, P=0.837). The optimal cut-off value of the scale was ≥3 points with 81% sensitivity, 70% specificity, and 76% accuracy.</p><p><strong>Conclusions: </strong>The pre-EVT scale could effectively predict 90-day futile recanalization before EVT, providing a valuable tool for clinical decision-making and risk stratification in patients with LVO and large core infarction.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142780","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":"Outcomes of medical and surgical management in infectious intracranial aneurysms: a multicenter cohort analysis.","authors":"Ali M Alawieh, Laurie Dimisko, Youssef M Zohdy, Andrew B Koo, Hassan Saad, Bachar El Baba, Sarah Newman, Jonathan A Grossberg, Charles Matouk, C Michael Cawley, Gustavo Pradilla, Andrew Reisner, W Christopher Fox, Carlos Perez-Vega, Jan-Karl Burkhardt, Mohamed Salem, Pascal Jabbour, Kareem El Naamani, Richard F Schmidt, M Reid Gooch, Robert M Starke, Ahmed Abdelsalam, Victor M Lu, Michael Levitt, Reda M Chalhoub, Firas Kobeissy, Alejandro M Spiotta, Daniel Barrow, Brian M Howard","doi":"10.1136/jnis-2025-023421","DOIUrl":"https://doi.org/10.1136/jnis-2025-023421","url":null,"abstract":"<p><strong>Introduction: </strong>Infectious intracranial aneurysms (IIAs) are rare but serious complications of systemic infections, particularly infective endocarditis. These aneurysms are prone to rupture, leading to significant morbidity and mortality. Management strategies lack consensus due to the rarity of the condition and reliance on small case series. This study examines the clinical management of IIAs using data from a large multicenter cohort.</p><p><strong>Methods: </strong>A retrospective registry-based cohort study was conducted across 11 tertiary care centers in the USA between 2018 and 2023. Patients with IIAs were identified based on clinical and radiographic criteria. The primary outcome was treatment failure defined as persistence, growth, or rupture of the aneurysm. Secondary outcomes were mortality and the modified Rankin Scale (mRS) score at 90 days and 1 year. Multivariate logistic regressions were used to identify outcome predictors.</p><p><strong>Results: </strong>A total of 104 patients with 166 aneurysms were included, with a median age of 43 years. Medical management was successful in 56% of cases, with failure often within 18 days of initiation. Predictors of failure included younger age, larger aneurysm size, and rupture at presentation. Surgical and endovascular interventions achieved higher success rates with better outcomes. At 90 days, 57% of patients achieved functional independence (mRS 0-2), while the mortality rate was 24%.</p><p><strong>Conclusion: </strong>This study highlights the limitations of medical management for IIAs and underscores the need for early surgical or endovascular intervention in high-risk patients. Outcome predictors aid clinical decision-making, optimizing patient management. Further research is needed to standardize management guidelines for IIAs.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132448","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":"Correspondence on 'Neuroanatomy of the vertebrobasilar perforators: implications for aneurysm treatment' by Raz <i>et al</i>.","authors":"Xuefan Zeng, Yiwei Wang","doi":"10.1136/jnis-2024-022871","DOIUrl":"10.1136/jnis-2024-022871","url":null,"abstract":"","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"e1"},"PeriodicalIF":4.5,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921976","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":"Correspondence on ''Prolonged intracranial catheter dwell time exacerbates penumbral stress and worsens stroke thrombectomy outcomes' by Alawieh <i>et al</i>.","authors":"Xuefan Zeng","doi":"10.1136/jnis-2024-022859","DOIUrl":"10.1136/jnis-2024-022859","url":null,"abstract":"","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"e2"},"PeriodicalIF":4.5,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927147","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":"Initiation of mechanical thrombectomy in an insular setting with helicopter transfer: a 2-year experience from the first, complete, tertiary stroke center in the Caribbean.","authors":"Quentin Bourgeois-Beauvais, Doriane Sellin, Isaure Arnaud, Celia Tuttle, Anne Landais, Annie Lannuzel, Aissatou Signate, Jerome Berge, Christina Iosif","doi":"10.1136/jnis-2024-021703","DOIUrl":"10.1136/jnis-2024-021703","url":null,"abstract":"<p><strong>Background: </strong>This is the first cohort study of patients treated with mechanical thrombectomy (MT) for acute ischemic stroke in the French West Indies, with a mothership center and helicopter transfer.</p><p><strong>Objective: </strong>To describe the population and to evaluate imaging, clinical, and time metric outcomes, in order to assess the feasibility and adjust the territorial organization.</p><p><strong>Methods: </strong>In this observational study, we retrospectively analyzed our prospectively collected data of a population of consecutive patients treated with MT for anterior and posterior circulation large vessel occlusions. Primary outcome was 3-month functional independence (modified Rankin Scale score ≤2). Secondary outcomes included aerial and terrestrial times of arrival, in-hospital delays, demographics, imaging and clinical data at onset, discharge, and at 3 months. We compared the results of the mothership and drip-and-ship paradigms.</p><p><strong>Results: </strong>Between January 2020 and December 2021, 223 patients were included (74% mothership, 26% drip-and-ship). Mean National Institutes of Health Stroke Scale (NIHSS) score of the population was 16 before MT, with significant reduction (NIHSS score 6) at discharge (9 mothership, 12 drip-and-ship, P=0.025). There was significant difference in onset-to-operation room times among the two centers (335 min mothership, 500 min drip-and-ship, P=0.004). Successful recanalization (modified Thrombolysis in Cerebral Infarction score 2b-3) was 80.3%. Functional independence at 3 months was 35%, symptomatic intracranial hemorrhage was 11%, and the complication rate was 9.4%, all without statistically significant difference between the two groups.</p><p><strong>Conclusion: </strong>The population has distinct risk factors. MT with helicopter transfer is feasible in the French West Indies. Reduction of prehospital and in-hospital times is mandatory; evaluation of the territorial strategy is underway, to avoid over-selection of transferred patients.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"595-601"},"PeriodicalIF":4.5,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141320944","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":"Enhancing clinical practice: a critical appraisal of thoracic MRI prior to vertebral augmentation surgery in patients with lumbar vertebral fractures.","authors":"Xuefan Zeng, Xiya Wang, Yifei Gong","doi":"10.1136/jnis-2024-022806","DOIUrl":"10.1136/jnis-2024-022806","url":null,"abstract":"","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"e7"},"PeriodicalIF":4.5,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755179","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":"Novel insights into the pathophysiology of idiopathic intracranial hypertension: a commentary on brain volume and transverse sinus stenosis.","authors":"Xuefan Zeng, Yiwei Wang, Ling Liu","doi":"10.1136/jnis-2024-022817","DOIUrl":"10.1136/jnis-2024-022817","url":null,"abstract":"","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"e8"},"PeriodicalIF":4.5,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791825","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":"Iatrogenic dural arteriovenous fistula formation as a rare complication of external ventricular drain placement: institutional review of 16 cases.","authors":"Aymen Kabir, Suraj Shah, Alexander F Haddad, Matthew R Amans, Daniel L Cooke, Steven W Hetts, Kazim H Narsinh, Luis Savastano, Ethan A Winkler, Daniel M S Raper","doi":"10.1136/jnis-2025-023529","DOIUrl":"https://doi.org/10.1136/jnis-2025-023529","url":null,"abstract":"<p><strong>Introduction: </strong>External ventricular drain (EVD) placement is a life-saving neurosurgical procedure used to divert cerebrospinal fluid and reduce intracranial pressure in conditions such as subarachnoid hemorrhage, intraparenchymal hemorrhage, and intraventricular hemorrhage. While known complications include infection and hemorrhage, the formation of iatrogenic dural arteriovenous fistulas (dAVFs) following ventriculostomy is under-reported.</p><p><strong>Methods: </strong>We conducted a retrospective review of patients at our institution from 2002 to 2023 who developed dAVFs after EVD placement. Inclusion criteria required angiographic confirmation of a new dAVF near the EVD site. Demographics, primary pathology, EVD characteristics, angiographic findings, treatment approach, and outcomes were recorded.</p><p><strong>Results: </strong>Sixteen patients met the inclusion criteria. Subarachnoid hemorrhage was the most common indication for EVD placement (75.0%). All drains were placed at Kocher's point, most commonly on the right (75.0%). All dAVFs involved the middle meningeal artery, with venous drainage documented in 93.8%-most frequently into the middle meningeal vein (80.0%). Eight patients (50.0%) underwent treatment, primarily with ethanol embolization (62.5%). All treated cases achieved radiographic cure without complications. Two patients experienced spontaneous resolution. Three patients were managed conservatively for low-risk fistulas and five were lost to follow-up.</p><p><strong>Conclusion: </strong>This study presents the largest institutional series to date of iatrogenic dAVFs following ventriculostomy. While rare, iatrogenic dAVFs have the potential for significant morbidity if they develop complications from venous hypertension and may require additional treatments. Our findings highlight the need for awareness of identifying and appropriately managing ventriculostomy-related dAVFs.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127820","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":"The pEGASUS-HPC stent system for intracranial arterial stenosis: a single-center case series.","authors":"Daniel Pielenz, Joachim Klisch, David Fiorella, Matthias Gawlitza, Andreas Steinbrecher, Elke Leinisch, Elmar Lobsien, Karl-Titus Hoffmann, Donald Lobsien","doi":"10.1136/jnis-2024-021737","DOIUrl":"10.1136/jnis-2024-021737","url":null,"abstract":"<p><strong>Background: </strong>Intracranial arterial stenting is a technique for the treatment of symptomatic stenosis. In this single-center retrospective case series we evaluated a novel low profile laser-cut stent with an antithrombogenic hydrophilic polymer coating (pEGASUS-HPC, Phenox GmbH, Bochum, Germany) for the treatment of intracranial stenosis in the setting of acute ischemic stroke and elective cases.</p><p><strong>Methods: </strong>All patients treated with pEGASUS-HPC for one or more intracranial arterial stenoses at our institution were retrospectively included. Clinical, imaging and procedural parameters as well as clinical and imaging follow-up data were collected.</p><p><strong>Results: </strong>We performed 43 interventions in 41 patients with 42 stenoses in our neurovascular center between August 2021 and February 2024. Twenty-one patients (51.2%) were female and the mean±SD age was 71±10.8 years. Thirty-seven (86.1%) procedures were performed in the setting of endovascular acute ischemic stroke treatment. Technical or procedural complications occurred in seven patients (16.3%), six in the thrombectomy group and one in the elective group. One stent-related hemorrhagic complication (subarachnoid hemorrhage) occurred in emergency cases and symptomatic intracerebral hemorrhage occurred in one patient treated in an elective setting. Overall stenosis reduction following pEGASUS-HPC stent implantation was 53.0±18.0%. On follow-up imaging, which was available for 16 patients (37.2%) after an average of 32±58.6 days, 62.5% of the stents were patent.</p><p><strong>Conclusion: </strong>Our single-center case series demonstrates the feasibility of using the pEGASUS-HPC stent system, especially in emergency situations when thrombectomy fails.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"613-619"},"PeriodicalIF":4.5,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140957547","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}