Journal of NeuroInterventional Surgery最新文献

{"title":"The RED 43 catheter for aspiration thrombectomy of distal medium vessel occlusions (DMVOs): a multicenter experience.","authors":"Nitin Goyal, Nicolas K Khattar, Jeremy Peterson, Reza Dashti, Jason J Sims, Marlene Baumeister, Ari Williams, Iheanyi Amadi, Koji Ebersole, Dawn Madigan, Dina Symonds, Melissa Gottschlich, Violiza Inoa-Acosta, Donald Frei, David Fiorella","doi":"10.1136/jnis-2025-023132","DOIUrl":"https://doi.org/10.1136/jnis-2025-023132","url":null,"abstract":"<p><strong>Background: </strong>Recent studies support the effectiveness of mechanical thrombectomy (MT) for distal medium vessel occlusions (DMVOs). The RED 43 catheter has been introduced as a primary catheter for distal aspiration in acute ischemic stroke. In this multicenter study, we share our experience of using the RED 43 catheter for MT in DMVOs.</p><p><strong>Methods: </strong>We identified consecutive patients with DMVOs who underwent primary aspiration thrombectomy using the RED 43 catheter at four high-volume stroke centers. We collected baseline clinical data, angiographic and clinical outcomes, and procedural complications. We divided the patients into two groups: those with primary DMVOs included patients who presented with more distal occlusions requiring mechanical thrombectomy; and those with secondary DMVOs being patients presenting with large vessel occlusion that later developed a DMVO. Primary outcomes included the rate of first pass effect, (modified treatment in cerebral infarction (mTICI) 2c or 3 on the first pass) and successful recanalization (mTICI≥2b at end of procedure). Secondary outcomes included good functional outcomes (modified Rankin Scale (mRS) 0-2 at 3 months), symptomatic intracerebral hemorrhage (sICH), asymptomatic intracerebral hemorrhage (aICH), subarachnoid hemorrhage (SAH), and in-hospital mortality.</p><p><strong>Results: </strong>We identified 102 consecutive DMVO cases undergoing thrombectomy with the RED 43 catheter. The mean age was 70 years, and the median National Institutes of Health Stroke Scale (NIHSS) score was 9. The first pass effect (FPE) rate was 57% (primary) and 61% (secondary). Successful recanalization occurred in 83% (primary) and 87% (secondary). Good functional outcome was observed in 57% of patients. sICH occurred in one patient, and two patients died during hospitalization. We observed aICH in five (4.9%) patients and SAH in seven (6.9%) patients.</p><p><strong>Conclusion: </strong>The RED 43 catheter is safe and effective for aspiration thrombectomy in primary and secondary DMVOs, with high recanalization rates and a favorable safety profile.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811373","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":"Clinical prediction model of invalid recanalization after complete reperfusion after thrombectomy in acute ischemic stroke patients: a large retrospective study.","authors":"Yuan Yuan, Shandong Jiang, Jingbo Li, Jing Zhang, Jingjing Ding, Sainan Liu, Jingyi Wang, Yanyan Zhang, Jianru Li, Gao Chen","doi":"10.1136/jnis-2025-023036","DOIUrl":"https://doi.org/10.1136/jnis-2025-023036","url":null,"abstract":"<p><strong>Background: </strong>Studies have been conducted to explore the potential predictive indicators of unfavorable outcomes in patients with acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). However, few studies have proposed a comprehensive predictive model combined with clinical baseline data and ancillary examination before surgery.</p><p><strong>Method: </strong>In a retrospective study, we collected data on 823 patients with AIS-LVO who had undergone endovascular therapy (EVT); 562 patients who achieved successful revascularization with complete clinical and prognostic information were incorporated into the study. Those patients with a 90-day modified Rankin Scale (mRS) score of 0-2 were defined as having a favorable outcome, while a score of 3-6 represented an unfavorable outcome or futile reperfusion. To build up a predictive model, we applied multivariate logistic regression stepwise backward selection to decide which factors are supposed to be the components of the predictive model. Final model validity was testified by the variance inflation factor test and the Hosmer-Lemeshow (HL) goodness of fit test. The ultimate efficacy was supported by an area under the curve (AUC) value in both training groups and validation groups.</p><p><strong>Results: </strong>562 patients were enrolled in our study and divided into the training group and verification group in a ratio of 7:3. Factors of baseline data with P<0.1 in univariate logistic regression analysis were enrolled as the potential risk variables to conduct stepwise backward selection. The model was constructed by eight variables; higher mRS score (adjusted OR (aOR) 93.64, 95% CI 12.05 to 727.82, P<0.01), age >80 years (aOR 91.11, 95% CI 1.36 to 6116.36, P<0.05), National Institutes of Health Stroke Scale (NIHSS) >14 (aOR 0.15, 95% CI 0.02 to 0.99, P<0.05), operation history (aOR 8.13, 95% CI 1.32 to 50.20, P<0.05), creatinine (aOR 1.10, 95% CI 1.04 to 1.17, P<0.01), and neutrophil count (aOR 1.07, 95% CI 1.01 to 1.13, P<0.05) were associated with poor outcomes.</p><p><strong>Conclusion: </strong>We established an estimation model for invalid reperfusion in AIS-LVO patients and constructed the nomogram for individualized predictions. The AUC of the training group and validation group were both 0.96, with excellent HL and decision curve analysis, presenting excellent clinical prediction efficiency and application potential.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811361","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":"Relevance of cervical internal carotid artery patency after thrombectomy in tandem occlusion. Are we missing an opportunity to revascularize?","authors":"Alonso Alvarado-Bolanos, Mosab Maree, Annika Mascarenhas, Sachin K Pandey, Ruba Kiwan, Victor Yang, Michael Mayich, Manas Sharma, Melfort Boulton, Jennifer Mandzia, Sebastian Fridman","doi":"10.1136/jnis-2025-023256","DOIUrl":"https://doi.org/10.1136/jnis-2025-023256","url":null,"abstract":"<p><strong>Background: </strong>Treatment options for cervical internal carotid artery (c-ICA) occlusion in tandem occlusions (TOs) include emergent carotid artery stenting (eCAS) and angioplasty. We attempted to determine the impact of c-ICA reocclusion on the risk of recurrent ischemic stroke (IS) and stroke-related death, as well as functional independence.</p><p><strong>Methods: </strong>Patients with TOs undergoing endovascular thrombectomy (EVT) from April 2016 to October 2024 were included. The primary outcome was the 90-day composite of recurrent IS and stroke-related death. Secondary outcomes included the rate of 90-day functional independence (modified Rankin Scale (mRS) 0-2) and mortality. We used binary logistic regression to explore the association between c-ICA reocclusion and the outcomes and to identify predictors of c-ICA reocclusion or future revascularization.</p><p><strong>Results: </strong>We included 163 patients, 85.9% with successful recanalization. Angioplasty and eCAS were performed in 70% and 19%, respectively. c-ICA reocclusion occurred in 22% at a median of 3.5 (0-41.7) days. c-ICA reocclusion increased the odds of recurrent IS or stroke-related death (adjusted OR (aOR) 2.90, 95% CI 1.07 to 8.30, P=0.036) and was associated with lower rates of independence (aOR 0.18, 95% CI 0.05 to 0.58, P=0.004). Among patients who did not undergo eCAS, c-ICA angioplasty (aHR 0.28, 95% CI 0.09 to 0.86, P=0.026) and residual stenosis (aHR 1.04, 95% CI 1.02 to 1.07, P<0.001) were independent predictors of reocclusion or future revascularization.</p><p><strong>Conclusion: </strong>Maintaining c-ICA patency after EVT might be essential due to the association of reocclusion with recurrent IS, stroke-related death, and worse functional outcomes. Residual c-ICA stenosis and angioplasty are valuable predictors of c-ICA patency that can guide management during EVT.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803641","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":"Increased diagnostic accuracy and better morphology characterization of unruptured intracranial aneurysm by ultra-high-resolution photon-counting detector CT angiography.","authors":"Naying He, Haiying Lyu, Youmin Zhang, Ruixi Li, Zhihan Xu, Ewart Mark Haacke, Ying Cui, Jiqiang Li, Haipeng Dong, Wentao Han, Rui Chang, Zhen Hu, Chengcheng Zhu, Zhangsheng Yu, Yong Lu, Hong Jiang, Fuhua Yan","doi":"10.1136/jnis-2025-023094","DOIUrl":"https://doi.org/10.1136/jnis-2025-023094","url":null,"abstract":"<p><strong>Background: </strong>Accurate detection and morphology evaluation of unruptured intracranial aneurysms (UIAs) are essential for patient management. This study aimed to assess the efficacy of ultra-high-resolution (UHR) photon-counting detector-CT angiography (PCD-CTA) in detecting UIAs and characterizing their morphological features.</p><p><strong>Methods: </strong>This prospective study recruited consecutive participants suspected of cerebral vascular diseases who underwent PCD-CTA and subsequent digital subtraction angiography (DSA) within 1 month from September 2023 to May 2024. Performance of UIA diagnosis using UHR PCD-CTA images (slice thickness 0.2 mm) and standard resolution (SR, reflecting clinical protocols) reconstructed images were compared with DSA as reference on a per-participant, per-vessel, and per-aneurysm basis. The inter-rater agreement for UIA detection and aneurysm morphology characterization using UHR/SR PCD-CTA was also evaluated.</p><p><strong>Results: </strong>Among 95 participants, 50 UIAs were confirmed in 42 participants using DSA. The inter-rater agreement for UIA detection was: kappa 0.95 for UHR and 0.89 for SR (p<0.05). On a per-aneurysm basis, the sensitivity, specificity, and diagnostic accuracy of UHR (98.0%, 96.7%, 97.3%) were all significantly higher than SR (72.0%, 86.7%, 80.0%) (p<0.05). UHR PCD-CTA accurately identified 13 of the 14 aneurysms (93%) missed by SR PCD-CTA, including 3 cases (21%) larger than 3 mm. Furthermore, UHR identified more aneurysm irregularity (18/50, 36%) than SR (5/50, 10%) (p=0.004). UHR also revealed 4 (8.0%) more cases with wall calcification and 3 (6.0%) more cases with intra-aneurysmal hypointensity (possible thrombus) than SR.</p><p><strong>Conclusions: </strong>The advantages of UHR PCD-CTA, including enhanced reliability, improved diagnostic accuracy, and more comprehensive information, have the potential to significantly optimize UIA management.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788407","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 thrombectomy for large vessel occlusion stroke in patients with pre-existing disability.","authors":"Sai Polineni, Amol Mehta, Lisa Ramirez, Daryl Goldman, Preethi Reddi, Ayesha Hashmi, Christopher Paul Kellner, Reade Andrew De Leacy, Johanna T Fifi, J Mocco, Shahram Majidi","doi":"10.1136/jnis-2025-023208","DOIUrl":"https://doi.org/10.1136/jnis-2025-023208","url":null,"abstract":"<p><strong>Background: </strong>Approximately one in three patients with acute ischemic stroke (AIS) suffer from a premorbid disability prior to their incident AIS. These patients have largely been excluded from clinical trials of endovascular thrombectomy (EVT) for the treatment of AIS and current literature remains unclear regarding the safety and efficacy of EVT in these patients.</p><p><strong>Methods: </strong>We queried our prospectively maintained registry of patients with AIS from December 1, 2014 to October 31, 2023 to identify all patients who underwent EVT. Patients were stratified by their baseline modified Rankin Scale (mRS) score into those with (mRS 2-5) and without (mRS 0-1) baseline disability. Univariate analyses using the χ² test for categorical variables and the Wilcoxon rank-sum test for continuous variables were performed to compare demographics between the two groups. Generalized logistic and linear regression models for multivariable analysis were used to compare outcomes between the groups.</p><p><strong>Results: </strong>Of a total of 1489 patients, 367 (24.6%) had a pre-existing disability. Patients with baseline disability were older (79.6 years vs 67.7 years, P<0.001), more likely to be female (65.7% vs 45.9%, P<0.001), and had higher rates of stroke risk factors. There were higher odds of return to baseline (90-day ΔmRS =<0: OR 2.83, P<0.001) and 90-day ΔmRS =<1 (OR 2.94, P<0.001) for patients with baseline disability post-EVT compared with their healthier counterparts. There was no relative adjusted increase in symptomatic intracerebral hemorrhage or 90-day mortality.</p><p><strong>Conclusions: </strong>EVT appears to be safe and effective in patients with baseline disability, often associated with a return to their premorbid functional status at 90 days.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788450","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":"Human versus machine: are neurointerventionists more precise in manual or robotically assisted procedures?","authors":"Guillaume Charbonnier, Nicole M Cancelliere, Arturo Consoli, Hidehisa Nishi, Kevin Janot, Ze'ev Itsekson Hayosh, Ange Diouf, Aruma Jiménez-O'Shanahan, Zamir Merali, Thomas R Marotta, Julian Spears, Vitor M Pereira","doi":"10.1136/jnis-2025-023215","DOIUrl":"https://doi.org/10.1136/jnis-2025-023215","url":null,"abstract":"<p><strong>Background: </strong>Robotic neurointerventions have demonstrated promising initial clinical results. Claims of enhanced precision during robotic navigation have been reported, but objective quantification of such precision is limited. Precision during intracranial navigation and device deployment is crucial in neurovascular interventions, and lack of precision can lead to intraprocedural complications. This study compared quantitative metrics of precision in manual and robotic procedures using a virtual simulator.</p><p><strong>Methods: </strong>Using three different simulated aneurysm procedures with different levels of difficulty (easy, medium, and hard), 12 operators with different levels of experience were assigned a defined task for each case. Each procedure was performed both manually and under robotic assistance. Precision was assessed using the length of translations and the total degree of rotations of the microwire and microcatheter needed to complete the assigned tasks, as well as recorded safety metrics. Results were compared between the manual and robotic groups.</p><p><strong>Results: </strong>We analyzed 78 procedures (robotic, n=34; manual, n=34) performed by 12 operators with various levels of neurointerventional surgical experience (high, n=5; low, n=7). For the difficult case, operators used significantly less microwire translations when operating with robotic assistance (38.7 cm vs 108.4 cm, P=0.023). There were no significant differences for the easy and medium cases. Safety metrics and procedural times were not significant different.</p><p><strong>Conclusions: </strong>Operators demonstrated increased precision during microwire navigation when using robotic assistance to navigate a difficult aneurysm in a controlled simulated experimental set-up compared with manual navigation.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788455","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":"Large-volume single-institution experience with transradial versus transfemoral mechanical thrombectomy in acute ischemic stroke: a retrospective cohort study.","authors":"Joshua Feler, Carl Michael Porto, Christopher Chang, Radmehr Torabi, Carlin C Chuck, Elias Shaaya, Santos Santos Fontanez, Krisztina Moldovan, Mahesh V Jayaraman, Dylan N Wolman","doi":"10.1136/jnis-2024-022996","DOIUrl":"https://doi.org/10.1136/jnis-2024-022996","url":null,"abstract":"<p><strong>Background: </strong>Transradial access (TRA) is increasingly common in cerebrovascular intervention, but its safety and efficacy in mechanical thrombectomy (MT) in acute ischemic stroke remain unclear.</p><p><strong>Methods: </strong>We reviewed a prospectively maintained single-institution stroke database including consecutive cases between January 1, 2016 and December 31, 2023. Patients were categorized by initial access site, TRA or transfemoral access (TFA). Access site complications (ASCs) were tabulated and classified by Clavien-Dindo (CD) grade.</p><p><strong>Results: </strong>1121 patients were included (862 TFA, 259 TRA). TRA was associated with a mean 7.7 (95% CI 5.9 to 9.6) additional minutes from puncture-to-first-pass, and 7.7 (95% CI 4.8 to 10.6) additional minutes from puncture-to-recanalization. Among anterior circulation occlusions, TRA was associated with a 47% increase in the puncture-to-first-pass interval and a 27% increase in puncture-to-recanalization interval (P<0.001). Among posterior circulation occlusions, procedural times were not significantly different between TFA and TRA approaches. There were no significant differences in mean number of passes (1.7 vs 1.8, P=0.58), first pass successful recanalization rates (42.4% vs 45.6%, P=0.37), and post-procedural successful recanalization rates (67.2% vs 68.2%, P=0.76). Crossover rates were higher among the TRA group (5.8% vs 2.6%, P=0.01); ASCs and ASCs of CD grade >1 presented less frequently in the TRA group (12 (4.8%) vs 53 (6.1%), P=0.36; 4 (1.5%) vs 30 (3.5%), P=0.11, respectively), though both failed the predetermined threshold of statistical significance.</p><p><strong>Conclusion: </strong>TRA MT was associated with similar posterior circulation but longer anterior circulation procedural times, overall similar rates of Thrombolysis In Cerebral Infarction (TICI) 2c/3 reperfusion, and similar neurologic outcomes when compared against TFA procedures.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764154","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":"Correlation of computed fractional flow and in-stent restenosis in patients with intracranial atherosclerotic stenosis.","authors":"Ming Wang, Wanning Zheng, Rong Zou, Jiahao Tang, Ruilin Cheng, Yuhai Gao, Ning Wang, Yuning Lu, Jens Fiehler, Adnan H Siddiqui, Jianping Xiang, Shu Wan","doi":"10.1136/jnis-2025-023079","DOIUrl":"https://doi.org/10.1136/jnis-2025-023079","url":null,"abstract":"<p><strong>Objective: </strong>Fractional flow (FF) reserve has been developed as a gold standard for coronary intervention. Intracranial FF is also a valuable hemodynamic index to assess the severity of narrowing in intracranial atherosclerotic stenosis (ICAS). This study aims to investigate the predictive value of FF in assessing restenosis following endovascular treatment in patients with symptomatic ICAS.</p><p><strong>Methods: </strong>This retrospective study recruited 67 patients with symptomatic ICAS who received intracranial stenting between March 2019 and January 2024. FF was measured by dedicated software (AccuICAD) before and after stenting. During follow-up, patients were categorized into two groups based on the occurrence of in-stent restenosis (ISR): ISR group and non-ISR group. Multivariate regression analysis and Kaplan-Meier survival analysis were performed to identify the predictive factors for ISR.</p><p><strong>Results: </strong>Post-FF was significantly different between the ISR and non-ISR groups (0.84±0.09 vs 0.92±0.06, respectively, P<0.01). Univariate and multivariate Cox regression analyses identified post-FF (HR 0.0, 95% CI 0.0 to 0.08, P=0.005) and smoking (HR 3.06, 95% CI 1.02 to 9.19, P=0.047) as the two predictors of ISR. Receiver operating characteristic curve analysis confirmed the predictive value of post-FF for ISR (AUC=0.783, 95% CI 0.645 to 0.920, P=0.003), with a cut-off value of 0.94. Kaplan-Meier survival analysis further demonstrated that patients with a post-FF value >0.94 had a significantly lower incidence of ISR (P=0.001).</p><p><strong>Conclusion: </strong>In this study, post-FF effectively predicted ISR, providing an intraoperative evaluation value for stenting in ICAS.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764150","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":"Morphometric analysis of the inferior petrosal sinus and cerebellopontine angle cistern to assess feasibility of endovascular shunting in pediatric patients.","authors":"Marco Colasurdo, Karen Chen, Huanwen Chen, Matthew K McIntyre, Charles Matouk, Magdy Selim, William E Whitehead, Carl B Heilman, Adel M Malek, Peter Kan","doi":"10.1136/jnis-2025-023137","DOIUrl":"https://doi.org/10.1136/jnis-2025-023137","url":null,"abstract":"<p><strong>Background: </strong>Hydrocephalus is commonly treated using invasive surgical shunt placement with associated morbidity and frequent revision in children. The eShunt System, an endovascular miniature transdural shunt implanted via the inferior petrosal sinus (IPS), has shown promise in adults, but its pediatric application remains undefined because of limited data on IPS and cerebellopontine angle cistern (CPAC) morphometry.</p><p><strong>Materials and methods: </strong>Consecutive patients from two pediatric hospitals with high-resolution brain MRI were retrospectively analyzed. IPS and CPAC measurements were evaluated against adult anatomical criteria for safe implantation (IPS size ≥2 mm, IPS angle <150, and ≥5 mm distance from the dural access point to the brainstem or major artery). Regression analyses assessed the relationship between age and IPS/CPAC measurements.</p><p><strong>Results: </strong>One hundred patients were included: 20 toddlers (1-2 years), 24 preschool age (3-5), 27 school age (6-11), and 29 adolescents (12-18). Median IPS size was 2.8 mm (2.4-3.3 mm) and 2.8 (2.5-3.4 mm) while median CPAC depth was 7.6 mm (5.6-9.0 mm) and 6.8 mm (5.5-8.5 mm) for the right and left side, respectively. While younger age was associated with smaller IPS diameter (P<0.001 for both), the correlation was weak (R² = 13.9% and 13.5% for right and left, respectively). Age was not associated with differences in other metrics after multivariable adjustments. Endovascular shunt placement was deemed feasible based on adult criteria in 67% of patients, with no age-based differences in eligibility (P=0.57).</p><p><strong>Conclusion: </strong>A majority of patients over 1 year of age met IPS and CPA anatomical criteria for placement of the eShunt System.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764156","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 treatment of pulsatile tinnitus due to superior petrous sinus stenosis and superior semicircular canal dehiscence.","authors":"Baptiste Donnard, Kevin Janot, Heloise Ifergan, Valere Barrot, Thibault Agripnidis, Richard Edwige Bibi, Denis Herbreteau, Clémence Hoche, Johannes Kaesmacher, Gregoire Boulouis, Fouzi Bala","doi":"10.1136/jnis-2025-023185","DOIUrl":"https://doi.org/10.1136/jnis-2025-023185","url":null,"abstract":"<p><p>Pulsatile tinnitus is a debilitating symptom that can have many different origins.1 2 In most cases, an underlying cause can be identified and venous stenting is an effective treatment for vascular causes such as dural sinus stenosis.3 Superior semicircular canal dehiscence4 5 by the superior petrosal sinus (SPS) is a rare cause of pulsatile tinnitus.6 Surgery is effective for improving symptoms but it is invasive and has a higher rate of complications.7 Endovascular treatment should be considered as an alternative to surgery for these cases.⁸We describe a case of pulsatile tinnitus secondary to an SPS stenosis and dehiscence of the superior semicircular canal (video 1).neurintsurg;jnis-2025-023185v1/V1F1V1Video 1 Superior petrous sinus stenting.Stenting of the SPS was performed under conscious sedation after a clear reduction of pulsatile tinnitus following the temporary partial deployment of the stent. Follow-ups demonstrated patency of the stent with the persistent complete resolution of tinnitus. This case illustrates the utility of temporary stent deployment under conscious sedation to establish causality between SPS stenosis and pulsatile tinnitus.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764152","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}