Journal of NeuroInterventional Surgery最新文献

{"title":"Outcomes of flow diversion in intracranial aneurysms accompanied by parent artery stenosis.","authors":"Tao Quan, Yanting Gai, Xin Feng, Suzana Saleme, Binghui Liu, Xin Zhang, Donglei Song, Chuan-Zhi Duan, Charbel Mounayer, Sheng Guan","doi":"10.1136/jnis-2025-023485","DOIUrl":"https://doi.org/10.1136/jnis-2025-023485","url":null,"abstract":"<p><strong>Background: </strong>The impact of parent artery stenosis on the treatment of intracranial aneurysms by using flow diversion (FD) remains unknown. This multicenter retrospective study aimed to evaluate the clinical and radiological outcomes of patients with intracranial aneurysms accompanied by parent artery stenosis of different etiologies after FD implantation.</p><p><strong>Methods: </strong>The study cohort included patients who received FD treatment at four comprehensive centers from March 2013 to June 2024. The etiological factors underlying intracranial arterial stenosis were categorized as intracranial atherosclerosis (ICAS), intracranial arterial dissection (ICAD), and matricidal aneurysms (MA).</p><p><strong>Results: </strong>A total of 161 patients with intracranial aneurysms accompanied by parent artery stenosis were ultimately included for in-depth analysis. The procedures were successfully performed in all patients, with a low incidence of periprocedural complications. In the clinical and angiographic follow-up, all patients had a favorable outcome (modified Rankin Scale score 0-2), and the complete occlusion rate of aneurysms was 64.0% at median 8.0 months (IQR 6-13.5 months). A comparative analysis revealed that, in contrast to the ICAD and MA groups, the ICAS group exhibited a significantly higher rate of in-stent restenosis (28% vs 16.7% vs 5.5%, <i>p</i> = 0.020).</p><p><strong>Conclusions: </strong>FDs demonstrated satisfactory performance in terms of periprocedural complications, favorable clinical outcomes, and complete occlusion on follow-up imaging in the management of intracranial aneurysms accompanied by parent artery stenosis. Notably, ICAS exerted a substantially greater influence on in-stent restenosis and entailed a higher requirement for repeat angioplasty compared with ICAD and MA.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144317152","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":"Early clinical experience with the Emboguard Balloon Guide Catheter: impact on technical success and patient outcomes in large vessel occlusion thrombectomy.","authors":"Bishow C Mahat, Mohamed F Doheim, Anmol Almast, Matthew T Starr, Nirav R Bhatt, Jussie Correia Lima, Marcelo Rocha, Raul G Nogueira, Alhamza R Al-Bayati","doi":"10.1136/jnis-2025-023519","DOIUrl":"https://doi.org/10.1136/jnis-2025-023519","url":null,"abstract":"<p><strong>Background: </strong>This study evaluated the performance of the newer-generation Emboguard Balloon Guide Catheter (EBGC) in treating anterior circulation large vessel occlusions (LVOs).</p><p><strong>Methods: </strong>A prospectively maintained endovascular thrombectomy database was reviewed to identify consecutive non-tandem LVO patients treated with the EBGC. Procedural outcomes included rates of complete recanalization (modified Thrombolysis in Cerebral Infarction (mTICI) 2c/3), successful recanalization (mTICI 2b/3), first-pass effect (FPE) (mTICI 2c/3 after the first pass), modified FPE (mTICI 2b/3 after the first pass), and the number of passes. Clinical outcomes assessed included National Institutes of Health Stroke Scale (NIHSS) scores at discharge, functional independence (modified Rankin Scale (mRS) 0-2), and fair outcomes (mRS 0-3). Safety outcomes evaluated included symptomatic intracranial hemorrhage (sICH) and 90-day mortality.</p><p><strong>Results: </strong>Of the 72 patients included, 56.9% (41/72) were female, with a median age of 73 years (IQR 67-83). Most patients presented with middle cerebral artery (MCA) occlusions (M1 in 59.7% (43/72) and dominant/co-dominant M2 in 25.0% (18/72)). Successful recanalization (mTICI 2b/3) was achieved in 98.6% (71/72) of cases, and complete recanalization (mTICI 2c/3) was achieved in 76.4% (55/72), with a median of 1 pass (IQR 1-2). FPE and modified FPE were achieved in 48.6% (35/72) and 56.9% (41/72) of cases, respectively. The median NIHSS improved significantly from 17 (IQR 11-21) at baseline to 4 (IQR 1-12) at discharge. sICH occurred in only 1.4% (1/72) of cases. At 90 days, 42.6% (23/54) of patients achieved functional independence (mRS 0-2), and mRS 0-3 in 63.2% (36/57).</p><p><strong>Conclusions: </strong>The EBGC demonstrated promising potential with high rates of FPE and successful recanalization together with clinical improvements and a favorable safety profile.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144317151","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 incidence of infratentorial arteriovenous malformation-associated aneurysms: an institutional case series and systematic literature review.","authors":"Mark Davison, Maximos McCune, Nishanth Thiyagarajah, Ahmed Kashkoush, Rebecca Achey, Michael Shost, Gabor Toth, Mark Bain, Nina Moore","doi":"10.1136/jnis-2024-022003","DOIUrl":"10.1136/jnis-2024-022003","url":null,"abstract":"<p><strong>Background: </strong>Arteriovenous malformation (AVM)-associated aneurysms represent a high-risk feature predisposing them to rupture. Infratentorial AVMs have been shown to have a greater incidence of associated aneurysms, however the existing data is outdated and biased. The aim of our research was to compare the incidence of supratentorial vs infratentorial AVM-associated aneurysms.</p><p><strong>Methods: </strong>Patients were identified from our institutional AVM registry, which includes all patients with an intracranial AVM diagnosis since 2000, regardless of treatment. Records were reviewed for clinical details, AVM characteristics, nidus location (supratentorial or infratentorial), and presence of associated aneurysms. Statistical comparisons were made using Fisher's exact or Wilcoxon rank sum tests as appropriate. Multivariable logistic regression analysis determined independent predictors of AVM-associated aneurysms. As a secondary analysis, a systematic literature review was performed, where studies documenting the incidence of AVM-associated aneurysms stratified by location were of interest.</p><p><strong>Results: </strong>From 2000-2024, 706 patients with 720 AVMs were identified, of which 152 (21.1%) were infratentorial. Intracranial hemorrhage was the most common AVM presentation (42.1%). The incidence of associated aneurysms was greater in infratentorial AVMs compared with supratentorial cases (45.4% vs 20.1%; P<0.0001). Multivariable logistic regression demonstrated that infratentorial nidus location was the singular predictor of an associated aneurysm, odds ratio: 2.9 (P<0.0001). Systematic literature review identified eight studies satisfying inclusion criteria. Aggregate analysis indicated infratentorial AVMs were more likely to harbor an associated aneurysm (OR 1.7) and present as ruptured (OR 3.9), P<0.0001.</p><p><strong>Conclusions: </strong>In this modern consecutive patient series, infratentorial nidus location was a significant predictor of an associated aneurysm and hemorrhagic presentation.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"711-716"},"PeriodicalIF":4.5,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141468699","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":"Developing a Coordinated Registry Network for devices used for acute ischemic stroke intervention: basilar artery occlusion quality assessment pilot.","authors":"Jialin Mao, Sameer A Ansari, Adnan H Siddiqui, Art Sedrakyan, Danica Marinac-Dabic, Murray Sheldon, Mairsíl Claffey, Alicia M Hall, Harsh Sancheti, Thomas Kim, Nam Nguyen, David S Liebeskind","doi":"10.1136/jnis-2024-021741","DOIUrl":"10.1136/jnis-2024-021741","url":null,"abstract":"<p><strong>Background: </strong>Real-world data can be helpful in evaluating endovascular therapy (EVT) in ischemic stroke care. We conducted a pilot study to aggregate data on basilar artery occlusion (BAO) EVT from existing registries in the USA. We evaluated the availability, completeness, quality, and consistency of common data elements (CDEs) across data sources.</p><p><strong>Methods: </strong>We harmonized patient-level data from five registry data sources and assessed the availability, completeness (defined by the presence in at least four data sources), and consistency of CDEs. We assessed data quality based on seven pre-defined critical domains for BAO EVT investigation: baseline patient and disease characteristics; time metrics; description of intervention; adjunctive devices, revascularization scores, complications; post-intervention National Institutes of Health Stroke Scale scores; discharge disposition; 30-day and 90-day mortality and modified Rankin Scale (mRS) scores.</p><p><strong>Results: </strong>The aggregated dataset of five registries included 493 BAO procedures between January 2013 and January 2020. In total, 88 CDEs were screened and 35 (40%) elements were considered prevalent. Of these 35 CDEs, the majority were collected for >80% of cases when aggregated. All seven pre-defined domains for BAO device investigation could be fulfilled with harmonized data elements. Most data elements were collected with consistent or compatible definitions across registries. The main challenge was the collection of 90-day outcomes.</p><p><strong>Conclusions: </strong>This pilot shows the feasibility of aggregating and harmonizing critical CDEs across registries to create a Coordinated Registry Network (CRN). The CRN with partnerships between multiple registries and stakeholders could help improve the breadth and/or depth of real-world data to help answer relevant questions and support clinical and regulatory decisions.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"691-696"},"PeriodicalIF":4.5,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141306071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Additional outlet occlusion as an important factor in avoiding retreatment after transvenous embolization for cavernous sinus dural arteriovenous fistulas.","authors":"Satoshi Miyamoto, Wataro Tsuruta, Jun Isozaki, Daiichiro Ishigami, Hisayuki Hosoo, Yoshiro Ito, Aiki Marushima, Mikito Hayakawa, Yuji Matsumaru","doi":"10.1136/jnis-2024-021773","DOIUrl":"10.1136/jnis-2024-021773","url":null,"abstract":"<p><strong>Background: </strong>Transvenous embolization (TVE), such as selective shunt occlusion, is the first line treatment for cavernous sinus dural arteriovenous fistula (CSDAVF). Despite the favorable outcomes of TVE, some cases necessitating retreatment due to recurrence or incomplete occlusion persist. Given the physical, psychological, and financial burden of multiple treatments, understanding the predictive factors for recurrence, spontaneous occlusion, or retreatment is important. However, few reports have addressed these factors, complicating decision making regarding the need for retreatment. This study analyzed predictive factors for retreatment and spontaneous occlusion to offer new insights into CSDAVF management.</p><p><strong>Methods: </strong>This retrospective, observational study was conducted in two acute care hospitals. Patients aged 18-100 years undergoing endovascular treatment for CSDAVF from January 2011 to December 2022 were included.</p><p><strong>Results: </strong>Of 65 patients treated with TVE, 29 experienced immediate complete occlusion. Meanwhile, 22 of 36 patients with incomplete occlusion had spontaneous occlusion, and retreatment was performed in 20% of patients. Additional outlet occlusion was negatively associated with retreatment (P=0.046), and it tended to promote spontaneous occlusion (P=0.056). Favorable functional outcomes were observed in all patients, and approximately 94% of patients showed complete occlusion at the latest follow-up.</p><p><strong>Conclusion: </strong>TVE is an effective treatment for CSDAVF. Outlet occlusion, when immediate complete occlusion is unattainable, is important to reduce retreatment and promote spontaneous occlusion. Substantially reducing shunt flow, carefully assessing dangerous drainage routes, and closely monitoring the residual shunt are crucial for preventing intracranial hemorrhage when outlet occlusion is performed.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"717-724"},"PeriodicalIF":4.5,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141633761","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":"SOFIA Aspiration System as first-line Technique (SOFAST): a prospective, multicenter study to assess the efficacy and safety of the 6 French SOFIA Flow Plus aspiration catheter for endovascular stroke thrombectomy.","authors":"Dheeraj Gandhi, Huanwen Chen, Syed Zaidi, Daniel H Sahlein, Lucian Maidan, Kenneth Kreitel, Timothy R Miller, Scott Rahimi, Amer Al Shekhlee, Henry H Woo, Gabor Toth, Clemens Schirmer, Yince Loh, David Fiorella","doi":"10.1136/jnis-2024-021811","DOIUrl":"10.1136/jnis-2024-021811","url":null,"abstract":"<p><strong>Background: </strong>Mechanical thrombectomy (MT) is the standard of care for acute ischemic stroke (AIS) patients with large vessel occlusion (LVO). The SOFAST study collected clinical evidence on the safety and efficacy of the 6 French SOFIA Flow Plus aspiration catheter (SOFIA 6F) when used as first-line treatment.</p><p><strong>Methods: </strong>This was a prospective, multicenter investigation to assess the safety and efficacy of SOFIA 6F used for first-line aspiration. Anterior circulation LVO stroke patients were enrolled. The primary endpoint was the final modified Thrombolysis in Cerebral Infarction (mTICI)≥2b rate. Secondary endpoints included first-pass and first-line mTICI≥2b rates, times from arteriotomy to clot contact and mTICI≥2b, and 90-day modified Rankin Scale (mRS)≤2. First-line and final mTICI scores were adjudicated by an independent imaging core lab. Safety events were assessed by an independent clinical events adjudicator.</p><p><strong>Results: </strong>A total of 108 patients were enrolled across 12 centers from July 2020 to June 2022. Median age was 67 years, median National Institutes of Health Stroke Scale (NIHSS) was 15.5, and 56.5% of patients received intravenous thrombolytics. At the end of the procedure, 97.2%, 85.2%, and 55.6% of patients achieved mTICI≥2b, ≥2c, and 3, respectively. With SOFIA 6F first-line aspiration, 87.0%, 79.6%, and 52.8% achieved mTICI≥2b, ≥2c, and 3, respectively. After the first pass, 75.0%, 70.4%, and 50.9% achieved mTICI≥2b, ≥2c, and 3, respectively. Median times from arteriotomy to clot contact and successful revascularization were 12 and 17 min, respectively. At 90 days, 66.7% of patients achieved mRS≤2.</p><p><strong>Conclusions: </strong>First-line aspiration with SOFIA 6F is safe and effective with high revascularization rates and short procedure times.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"753-758"},"PeriodicalIF":4.5,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141468698","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":"Neurointerventional oncology: the new frontier.","authors":"Kazim H Narsinh, Christopher Young, Stephen R Chen, Sameer A Ansari, Peter Kan, Steven W Hetts","doi":"10.1136/jnis-2025-023050","DOIUrl":"10.1136/jnis-2025-023050","url":null,"abstract":"","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"671-672"},"PeriodicalIF":4.5,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066186","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 fluid mechanics of aspiration thrombectomy.","authors":"Michael T Froehler, Bryan C Good","doi":"10.1136/jnis-2024-022780","DOIUrl":"10.1136/jnis-2024-022780","url":null,"abstract":"<p><p>Large vessel occlusion causing acute ischemic stroke is ideally treated with endovascular clot retrieval, which is increasingly being performed via direct aspiration thrombectomy. Successful aspiration thrombectomy depends on multiple tenets of fluid and solid mechanics, including the application of hydrostatic and hydrodynamic forces to lodged clots. These fundamental concepts predict factors that may increase efficacy in clot removal, and help to explain the differences in performance seen among varying aspiration techniques (remote vs direct), catheters (suction force increases with diameter), and vacuum sources (pump type, whether electrical or manual, should not have an impact on negative pressure). Cyclic aspiration is also predicted to show more substantial clot removal and ingestion than static aspiration due to the dynamic forces it imposes on elastic clots.In this paper we will review the basic scientific principles underlying the fluid mechanics of aspiration thrombectomy and explain the application of these principles in practice, to provide a more thorough understanding for the neurointerventional clinician.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"759-763"},"PeriodicalIF":4.5,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030458","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":"Hemorrhagic transformation in acute ischemic stroke: hemorrhagic subtypes and symptomatic intracranial hemorrhage.","authors":"Marie K Luff, Nicole Khezri, Salvador Miralbes, Bharath Naravetla, Alejandro M Spiotta, Christian Loehr, Mario Martínez-Galdámez, Ryan A McTaggart, Luc Defreyne, Pedro Vega, Osama O Zaidat, Lori Lyn Price, Rishi Gupta, Markus A Möhlenbruch, David S Liebeskind","doi":"10.1136/jnis-2024-021725","DOIUrl":"10.1136/jnis-2024-021725","url":null,"abstract":"<p><strong>Background: </strong>Few clinical studies perform detailed analyses of subtypes of intracranial hemorrhage (ICH) after mechanical thrombectomy (MT) used to treat acute ischemic stroke. Symptomatic intracranial hemorrhage (sICH) is a formidable complication of MT and is widely used in clinical trials as a safety outcome. However, variable definitions of sICH are used across clinical studies.</p><p><strong>Objective: </strong>To radiographically subcategorize post-MT ICH development within this large cohort and examine overlap with sICH. Second, to examine the agreement of this definition of sICH with local site-reported occurrences of sICH to see how sICH rates change with modifications of the definitions used.</p><p><strong>Methods: </strong>A large cohort of patients treated with MT for acute ischemic stroke (n=1395) was analyzed to (1) radiographically characterize hemorrhagic subtypes of intracranial hemorrhage (ICH) occurring after MT; (2) examine associations of hemorrhagic subtypes with sICH; and (3) compare core laboratory-adjudicated occurrences of sICH with site-reported sICH.</p><p><strong>Results: </strong>The overall rate of ICH was 552/1395 patients (39.6%), and the overall rate of sICH was 47/1395 (3.4%). The most common type of ICH was hemorrhagic infarction type 1 (HI1), which represented 45.3% of all ICH cases- followed by HI2 (31.5%) and subarachnoid hemorrhage (SAH, 29.2%). Parenchymal hematoma 2 (PH2) represented only 3.3% of all ICH cases. Of the PH2 hemorrhages, only 33.3% were determined to be symptomatic. Of sICH cases, the most common ICH subtypes were HI2 (48.9%) and SAH (38.3%). Comparison of sICH rates as determined by core laboratory adjudication versus local site-reported results showed that only 14 patients were identified as having sICH with both definitions, with 47 patients total with sICH according to one definition, but not the other.</p><p><strong>Conclusions: </strong>Results of this analysis demonstrate the radiographic subtypes of ICH and also highlight the limitations of variable criteria used to define sICH, suggesting that it might be appropriate to revisit how sICH is defined post-MT.</p><p><strong>Trial registration number: </strong>Clinical trial NCT03845491.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"673-682"},"PeriodicalIF":4.5,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141537901","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":"Adenosine-assisted embolization of cerebral arteriovenous malformations: a systematic review and meta-analysis.","authors":"Jhon E Bocanegra-Becerra, Filipi Fim Andreão, José Luis Acha Sánchez, Anuraag Punukollu, Leonardo B Oliveira, Krish Kuhar, Maria Eduarda Rodrigues Peixoto, Elizabet Taylor Pimenta Weba, Khaled Alhwaishel, Marcio Yuri Ferreira, Raphael Bertani, Miguel Angel Lopez-Gonzalez","doi":"10.1136/jnis-2024-021866","DOIUrl":"10.1136/jnis-2024-021866","url":null,"abstract":"<p><strong>Background: </strong>Cerebral arteriovenous malformations (AVMs) are complex lesions that can cause hemorrhagic stroke and significant neurological disability. Adenosine induces cardiac standstill and hypotension, which are thought to be useful during cerebral AVM embolization. Herein, we conducted a systematic review and meta-analysis of the technique's safety.</p><p><strong>Methods: </strong>Following PRISMA guidelines, four databases were queried for studies describing the use of adenosine-assisted embolization of cerebral AVMs. Adenosine-related intraoperative complications, permanent neurological outcomes, morbidity, and mortality assessed the technique's safety. Single proportion analysis under a random-effects model was performed. Heterogeneity was assessed using I² statistics, and publication bias was evaluated through funnel plot analysis and Egger's regression test.</p><p><strong>Results: </strong>Ten studies were included, involving 79 patients (55.7% male) with 79 AVMs (54.4% unruptured and 70.9% Spetzler-Martin grade III-V) who underwent 123 embolizations (80.4% and 5.9% under transarterial and transvenous approaches, respectively) with n-butyl cyanoacrylate (80.4%), ethylene vinyl alcohol (14.4%), or both (5.2%). The incidence of transient adenosine-related intraoperative complications was 0% (95% CI 0% to 3%, I²=24%). Besides, the incidence of adenosine-related morbidity, mortality, and permanent outcomes was 0% (95% CI 0% to 3%, I²=0%). During follow-up, good functional outcomes were reported for 64 patients (81%).</p><p><strong>Conclusions: </strong>Adenosine's effects on blood flow control can facilitate embolization and mitigate the risk of AVM rupture and embolic agent migration. Although current evidence stems from observational studies, the results of this meta-analysis suggest a safe drug profile due to minimal associated morbidity and mortality. Further research from larger randomized and controlled studies is warranted to attain a higher level of evidence.</p><p><strong>Prospero registry number: </strong>CRD42023494116.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"731-742"},"PeriodicalIF":4.5,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141468694","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}