Journal of NeuroInterventional Surgery最新文献

{"title":"Susceptibility vessel sign, a predictor of long-term outcome in patients with stroke treated with mechanical thrombectomy.","authors":"Morin Beyeler, Erich Rea, Loris Weber, Nebiyat Filate Belachew, Enrique Barvulsky Aleman, Moritz Kielkopf, Christoph C Kurmann, Lorenz Grunder, Eike Immo I Piechowiak, Thomas R Meinel, Mirjam R Heldner, David Seiffge, Sara Pilgram-Pastor, Tomas Dobrocky, Thomas Pabst, Martin D Berger, Simon Jung, Marcel Arnold, Jan Gralla, Urs Fischer, Johannes Kaesmacher, Adnan Mujanovic","doi":"10.1136/jnis-2023-020793","DOIUrl":"10.1136/jnis-2023-020793","url":null,"abstract":"<p><strong>Background: </strong>The absence of the susceptibility vessel sign (SVS) in patients treated with mechanical thrombectomy (MT) is associated with poor radiological and clinical outcomes after 3 months. Underlying conditions, such as cancer, are assumed to influence SVS status and could potentially impact the long-term outcome. We aimed to assess SVS status as an independent predictor of long-term outcomes in MT-treated patients.</p><p><strong>Methods: </strong>SVS status was retrospectively determined in consecutive MT-treated patients at a comprehensive stroke center between 2010 and 2018. Predictors of long-term mortality and poor functional outcome (modified Rankin Scale (mRS) ≥3) up to 8 years were identified using multivariable Cox and logistic regression, respectively.</p><p><strong>Results: </strong>Of the 558 patients included, SVS was absent in 13% (n=71) and present in 87% (n=487) on baseline imaging. Patients without SVS were more likely to have active cancer (P<i>=</i>0.003) and diabetes mellitus (P<i><</i>0.001) at the time of stroke. The median long-term follow-up time was 1058 days (IQR 533-1671 days). After adjustment for active cancer and diabetes mellitus, among others, the absence of SVS was associated with long-term mortality (adjusted HR (aHR) 2.11, 95% CI 1.35 to 3.29) and poor functional outcome in the long term (adjusted OR (aOR) 2.90, 95% CI 1.29 to 6.55).</p><p><strong>Conclusion: </strong>MT-treated patients without SVS have higher long-term mortality rates and poorer long-term functional outcome. It appears that this association cannot be explained by comorbidities alone, and further studies are warranted.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"1341-1347"},"PeriodicalIF":4.5,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71424337","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":"Automated assessment of ischemic core on non-contrast computed tomography: a multicenter comparative analysis with CT perfusion.","authors":"Puja Shahrouki, Shingo Kihira, Elham Tavakkol, Joe X Qiao, Achala Vagal, Pooja Khatri, Mersedeh Bahr-Hosseini, Geoffrey P Colby, Reza Jahan, Gary Duckwiler, Viktor Szeder, Luke Ledbetter, Stephen Cai, Banafsheh Salehi, Amish H Doshi, Puneet Belani, Johanna T Fifi, Reade De Leacy, J Mocco, Jeffrey L Saver, David S Liebeskind, Kambiz Nael","doi":"10.1136/jnis-2023-020954","DOIUrl":"10.1136/jnis-2023-020954","url":null,"abstract":"<p><strong>Background: </strong>Application of machine learning (ML) algorithms has shown promising results in estimating ischemic core volumes using non-contrast CT (NCCT).</p><p><strong>Objective: </strong>To assess the performance of the e-Stroke Suite software (Brainomix) in assessing ischemic core volumes on NCCT compared with CT perfusion (CTP) in patients with acute ischemic stroke.</p><p><strong>Methods: </strong>In this retrospective multicenter study, patients with anterior circulation large vessel occlusions who underwent pretreatment NCCT and CTP, successful reperfusion (modified Thrombolysis in Cerbral Infarction ≥2b), and post-treatment MRI, were included from three stroke centers. Automated calculation of ischemic core volumes was obtained on NCCT scans using ML algorithm deployed by e-Stroke Suite and from CTP using Olea software (Olea Medical). Comparative analysis was performed between estimated core volumes on NCCT and CTP and against MRI calculated final infarct volume (FIV).</p><p><strong>Results: </strong>A total of 111 patients were included. Estimated ischemic core volumes (mean±SD, mL) were 20.4±19.0 on NCCT and 19.9±18.6 on CTP, not significantly different (P=0.82). There was moderate (r=0.40) and significant (P<0.001) correlation between estimated core on NCCT and CTP. The mean difference between FIV and estimated core volume on NCCT and CTP was 29.9±34.6 mL and 29.6±35.0 mL, respectively (P=0.94). Correlations between FIV and estimated core volume were similar for NCCT (r=0.30, P=0.001) and CTP (r=0.36, P<0.001).</p><p><strong>Conclusions: </strong>Results show that ML-based estimated ischemic core volumes on NCCT are comparable to those obtained from concurrent CTP in magnitude and in degree of correlation with MR-assessed FIV.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"1288-1293"},"PeriodicalIF":4.5,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71424330","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":"Use of a large-bore 088 intracranial access support catheter for delivery of large intracranial devices: case series with the TracStar LDP in 125 cases.","authors":"Jessica K Campos, David A Zarrin, Benjamen M Meyer, Muhammad Waqas Khan, Fahad J Laghari, Jonathan C Collard de Beaufort, Gizal Amin, Narlin B Beaty, Matthew T Bender, Shuichi Suzuki, Geoffrey P Colby, Li-Mei Lin, Alexander L Coon","doi":"10.1136/jnis-2023-021054","DOIUrl":"10.1136/jnis-2023-021054","url":null,"abstract":"<p><strong>Background: </strong>The delivery of neuroendovascular devices requires a robust proximal access platform. This demand has previously been met with a 6Fr long sheath (8Fr guide) that is placed in the proximal internal carotid artery (ICA) or vertebral artery segments. We share our experience with the first 0.088 inch 8Fr guide catheter designed for direct intracranial access.</p><p><strong>Methods: </strong>We retrospectively reviewed a prospectively maintained IRB-approved institutional database of the senior authors to identify all cases where the TracStar Large Distal Platform (LDP) was positioned within the intracranial vasculature, defined as within or distal to the petrous ICA, vertebral artery (V3) segments, or transverse sinus. Technical success was defined as safe placement of the TracStar LDP within or distal to the described distal vessel segments with subsequent complication-free device implantation.</p><p><strong>Results: </strong>Over the 41-month study period from January 2020 to June 2023, 125 consecutive cases were identified in whom the TracStar LDP was navigated into the intracranial vasculature for triaxial delivery of large devices, 0.027 inch microcatheter and greater, for aneurysm treatment (n=108, 86%), intracranial angioplasty/stenting (n=15, 12%), and venous sinus stenting (n=2, 1.6%). All cases used a direct select catheter technique for initial guide placement (no exchange). Posterior circulation treatments occurred in 14.4% (n=18) of cases. Technical success was achieved in 100% of cases. No vessel dissections occurred in any cases.</p><p><strong>Conclusion: </strong>The TracStar LDP is an 0.088 inch 8Fr guide catheter that can establish direct intracranial access with an acceptable safety profile. This can be achieved in a wide range of neurointerventional cases with a high rate of technical success.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"1228-1231"},"PeriodicalIF":4.5,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139990320","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":"Carotid webs: a review of pathophysiology, diagnostic findings, and treatment options.","authors":"Huanwen Chen, Marco Colasurdo, Matias Costa, Erez Nossek, Peter Kan","doi":"10.1136/jnis-2023-021243","DOIUrl":"10.1136/jnis-2023-021243","url":null,"abstract":"<p><p>A carotid web (CaW) is an atypical form of fibromuscular dysplasia characterized by a fibrous, shelf-like intimal flap originating from the posterior wall of the internal carotid bulb projecting into the arterial lumen. CaWs disturb normal blood flow and create stasis between the intimal reflection and the carotid wall, thereby promoting thrombogenesis and increasing the risk of downstream embolic strokes. Observational data have suggested that CaWs are associated with strokes with otherwise unknown etiology, particularly in young patients without other stroke factors, and stroke recurrence rates of symptomatic CaWs have been reported to be as high as 20% over 2 years. Despite its clinical importance, there are currently no clear guidelines on the management of CaWs. In this narrative review, we discuss the epidemiology, pathogenesis, pathophysiology, diagnosis, and treatment options for this under-recognized entity.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"1294-1298"},"PeriodicalIF":4.5,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139642249","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":"Venous sinus stenting versus ventriculoperitoneal shunting: comparing clinical outcomes for idiopathic intracranial hypertension.","authors":"Austin Michael Hilvert, Fatima Gauhar, Michael Longo, Heather Grimaudo, John Dugan, Nishit Mummareddy, Rohan Chitale, Michael T Froehler, Matthew R Fusco","doi":"10.1136/jnis-2024-022174","DOIUrl":"10.1136/jnis-2024-022174","url":null,"abstract":"<p><strong>Background: </strong>Venous sinus stenting (VSS) has been shown to reduce intracranial venous pressures and improve symptoms in patients with idiopathic intracranial hypertension (IIH). However, long-term follow-up data are limited, raising concerns about sustained symptom improvement. We aimed to assess long-term outcomes of VSS compared with ventriculoperitoneal shunting (VPS).</p><p><strong>Methods: </strong>A retrospective case-control study assessed 87 patients with IIH who met inclusion criteria and underwent either VSS (n=27) or VPS (n=60) between 2017 and 2022. Descriptive statistics for baseline characteristics and outcomes were calculated, followed by multivariate logistic regression to identify factors associated with headache recurrence.</p><p><strong>Results: </strong>Baseline characteristics were similar between VSS and VPS groups, including age (p=0.58), sex (p=0.74), body mass index (p=0.47), and preoperative lumbar puncture opening pressure (p=0.62). Preoperative symptoms of headaches (p=0.42), papilledema (p=0.35), and pulsatile tinnitus (p=0.56) were also similar. Initial headache improvement was comparable (96% vs 91%, p=0.42). However, headache recurrence was less common in the VSS group (31% vs 60%, p=0.015) at the last follow-up, averaging over 1 year. Multivariate analysis showed VSS was independently associated with reduced odds of headache recurrence (OR 0.24, p=0.015). Longer follow-up was associated with increased odds of headache recurrence in both groups (OR 1.01, p=0.032).</p><p><strong>Conclusion: </strong>VSS was independently associated with reduced odds of headache recurrence compared with VPS in multivariate analysis. Longer follow-up was significantly associated with headache recurrence in both groups. This suggests that VSS may lead to better outcomes for continued headache relief, but headache recurrence may increase with longer follow-up regardless of treatment modality.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"1264-1267"},"PeriodicalIF":4.5,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108290","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":"Rescue techniques for intravascular mechanical obstruction following Woven EndoBridge (WEB) device detachment.","authors":"Haoyu Zhu, Yupeng Zhang, Shikai Liang, Chuhan Jiang","doi":"10.1136/jnis-2024-022430","DOIUrl":"10.1136/jnis-2024-022430","url":null,"abstract":"<p><p>The Woven EndoBridge (WEB) device is a well established treatment for bifurcation aneurysms.1-6 However, failed detachment after deployment can present significant challenges. In this technical video (video 1), we report on a patient with a left middle cerebral artery (MCA) bifurcation aneurysm treated with the WEB device. Despite satisfactory deployment, multiple detachment attempts were unsuccessful. After repeated maneuvers, the WEB was finally detached but slightly protruded from the aneurysm sac, compromising blood flow in the superior branch of the MCA. Even after placing an Atlas stent, blood flow was not restored. Ultimately, using a microguidewire and microcatheter, we repositioned the protruded WEB device back into the aneurysm sac, successfully restoring blood flow. This case illustrates that the Atlas stent provides limited support for the WEB device. In similar situations, gently repositioning the protruded WEB back into the aneurysm sac may be a remedial measure. neurintsurg;16/12/1215/V1F1V1Video 1Technical video demonstrating rescue techniques for managing intravascular mechanical obstruction following detachment of the WEB device.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"1215"},"PeriodicalIF":4.5,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467889","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":"Brain edema growth after thrombectomy is associated with comprehensive collateral blood flow.","authors":"Tobias D Faizy, Laurens Winkelmeier, Michael Mlynash, Gabriel Broocks, Christian Heitkamp, Christian Thaler, Noel van Horn, Pierre Seners, Helge Kniep, Paul Stracke, Kamil Zelenak, Maarten G Lansberg, Gregory W Albers, Max Wintermark, Jens Fiehler, Jeremy J Heit","doi":"10.1136/jnis-2023-020921","DOIUrl":"10.1136/jnis-2023-020921","url":null,"abstract":"<p><strong>Background: </strong>We determined whether a comprehensive assessment of cerebral collateral blood flow is associated with ischemic lesion edema growth in patients successfully treated by thrombectomy.</p><p><strong>Methods: </strong>This was a multicenter retrospective study of ischemic stroke patients who underwent thrombectomy treatment of large vessel occlusions. Collateral status was determined using the cerebral collateral cascade (CCC) model, which comprises three components: arterial collaterals (Tan Scale) and venous outflow profiles (Cortical Vein Opacification Score) on CT angiography, and tissue-level collaterals (hypoperfusion intensity ratio) on CT perfusion. Quantitative ischemic lesion net water uptake (NWU) was used to determine edema growth between admission and follow-up non-contrast head CT (ΔNWU). Three groups were defined: CCC+ (good pial collaterals, tissue-level collaterals, and venous outflow), CCC- (poor pial collaterals, tissue-level collaterals, and venous outflow), and CCCmixed (remainder of patients). Primary outcome was ischemic lesion edema growth (ΔNWU). Multivariable regression models were used to assess the primary and secondary outcomes.</p><p><strong>Results: </strong>538 patients were included. 157 patients had CCC+, 274 patients CCCmixed, and 107 patients CCC- profiles. Multivariable regression analysis showed that compared with patients with CCC+ profiles, CCC- (β 1.99, 95% CI 0.68 to 3.30, P=0.003) and CCC mixed (β 1.65, 95% CI 0.75 to 2.56, P<0.001) profiles were associated with greater ischemic lesion edema growth (ΔNWU) after successful thrombectomy treatment. ΔNWU (OR 0.74, 95% CI 0.68 to 0.8, P<0.001) and CCC+ (OR 13.39, 95% CI 4.88 to 36.76, P<0.001) were independently associated with functional independence.</p><p><strong>Conclusion: </strong>A comprehensive assessment of cerebral collaterals using the CCC model is strongly associated with edema growth and functional independence in acute stroke patients successfully treated by endovascular thrombectomy.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"1334-1340"},"PeriodicalIF":4.5,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71424331","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":"Standalone middle meningeal artery embolization versus middle meningeal artery embolization with concurrent surgical evacuation for chronic subdural hematomas: a multicenter propensity score matched analysis of clinical and radiographic outcomes.","authors":"Huanwen Chen, Mohamed M Salem, Marco Colasurdo, Georgios S Sioutas, Jane Khalife, Okkes Kuybu, Kate T Carroll, Alex Nguyen Hoang, Ammad A Baig, Mira Salih, Mirhojjat Khorasanizadeh, Cordell Baker, Aldo Mendez Ruiz, Gustavo M Cortez, Zack Abecassis, Juan Francisco Ruiz Rodríguez, Jason M Davies, Sandra Narayanan, C Michael Cawley, Howard Riina, Justin Moore, Alejandro M Spiotta, Alexander Khalessi, Brian M Howard, Ricardo A Hanel, Omar Tanweer, Daniel Tonetti, Adnan H Siddiqui, Michael Lang, Elad I Levy, Tudor G Jovin, Ramesh Grandhi, Visish M Srinivasan, Michael R Levitt, Christopher S Ogilvy, Brian Jankowitz, Ajith J Thomas, Bradley A Gross, Jan Karl Burkhardt, Peter Kan","doi":"10.1136/jnis-2023-020907","DOIUrl":"10.1136/jnis-2023-020907","url":null,"abstract":"<p><strong>Background: </strong>Middle meningeal artery embolization (MMAE) has emerged as a promising therapy for chronic subdural hematomas (cSDHs). The efficacy of standalone MMAE compared with MMAE with concurrent surgery is largely unknown.</p><p><strong>Methods: </strong>cSDH patients who underwent successful MMAE from 14 high volume centers with at least 30 days of follow-up were included. Clinical and radiographic variables were recorded and used to perform propensity score matching (PSM) of patients treated with standalone MMAE or MMAE with concurrent surgery. Multivariable logistic regression models were used for additional covariate adjustments. The primary outcome was recurrence requiring surgical rescue, and the secondary outcome was radiographic failure defined as <50% reduction of cSDH thickness.</p><p><strong>Results: </strong>722 MMAE procedures in 588 cSDH patients were identified. After PSM, 230 MMAE procedures remained (115 in each group). Median age was 73 years, 22.6% of patients were receiving anticoagulation medication, and 47.9% had no preoperative functional disability. Median midline shift was 4 mm and cSDH thickness was 16 mm, representing modestly sized cSDHs. Standalone MMAE and MMAE with surgery resulted in similar rates of surgical rescue (7.8% vs 13.0%, respectively, P=0.28; adjusted OR (aOR 0.73 (95% CI 0.20 to 2.40), P=0.60) and radiographic failure (15.5% vs 13.7%, respectively, P=0.84; aOR 1.08 (95% CI 0.37 to 2.19), P=0.88) with a median follow-up duration of 105 days. These results were similar across subgroup analyses and follow-up durations.</p><p><strong>Conclusions: </strong>Standalone MMAE led to similar and durable clinical and radiographic outcomes as MMAE combined with surgery in select patients with moderately sized cSDHs and mild clinical disease.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"1313-1319"},"PeriodicalIF":4.5,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71482551","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 dural arteriovenous fistulas involving the vein of Galen: a single-center cohort and meta-analysis.","authors":"David C Lauzier, Henrik Ullman, Angela Hardi, Colin Derdeyn, Dewitte T Cross, Christopher J Moran","doi":"10.1136/jnis-2023-020843","DOIUrl":"10.1136/jnis-2023-020843","url":null,"abstract":"<p><strong>Background: </strong>Dural arteriovenous fistulas (dAVFs) draining into the vein of Galen (VoG) are complex lesions that often necessitate treatment to minimize the risk of rupture and relieve symptoms. These lesions can be treated with open surgical resection, radiosurgery, or endovascular embolization. Unfortunately, endovascular treatment of dAVFs involving the VoG has not been robustly assessed across large patient cohorts. To meet this need, we performed a retrospective review of dAVFs involving the VoG at our center, and included these in a meta-analysis to identify the safety and efficacy of endovascular embolization, as well as describing current treatment trends for this disease.</p><p><strong>Methods: </strong>Consecutive patients with dAVFs involving the VoG treated at a single center were identified from a prospective database and retrospectively reviewed. A literature search was conducted with defined search criteria, and eligible studies were included alongside our cohort in a meta-analysis. Rates of complete dAVF treatment and clinical complications were pooled across studies with a random effects model and reported with a 95% CI.</p><p><strong>Results: </strong>Five dAVFs involving the VoG were treated endovascularly at our center during the study period. In this series, 80% of treatments led to complete occlusion of the fistula while no patients had clinical complications. Onyx was used for all treatments. In our meta-analysis, the overall rate of complete occlusion was 72.0% (95% CI 59.8% to 84.1%) and the overall rate of clinical complications was 10.0% (95% CI 4.7% to 15.3%).</p><p><strong>Conclusions: </strong>Endovascular approaches for dAVFs involving the VoG are technically feasible, but carry a risk of clinical complications. Future work should identify optimal endovascular embolic agents.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"1320-1326"},"PeriodicalIF":4.5,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41136127","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 use of PK Papyrus covered coronary stent for carotid reconstruction: an initial institutional experience.","authors":"Rami Z Morsi, Sonam Thind, Ahmad Chahine, Jehad Zakaria, Harsh Desai, Sachin A Kothari, Atman P Shah, Sandeep Nathan, Elisheva Coleman, Scott Mendelson, James E Siegler, Shyam Prabhakaran, Ali Mansour, Tareq Kass-Hout","doi":"10.1136/jnis-2023-021226","DOIUrl":"10.1136/jnis-2023-021226","url":null,"abstract":"<p><strong>Background: </strong>The use of covered stent grafts for the treatment of carotid rupture is increasingly being used given their ability to preserve the parent artery while simultaneously occluding the fistula or rupture point.</p><p><strong>Methods: </strong>This case series describes the technical feasibility of using, and the performance of, the PK Papyrus covered coronary stent (Biotronik, Inc., Lake Oswego, Oregon, USA) in six patients with carotid rupture, including carotid cavernous fistulas, between July 2021 and October 2023 in a single-center institution in the USA.</p><p><strong>Results: </strong>The median decade of life was 5 (IQR 3) with a 1:1 male-to-female ratio. The majority were black patients (n=5/6, 83.3%). The most common disease pathology was carotid cavernous fistula (n=4/6, 66.7%), followed by traumatic carotid rupture (n=2/6, 33.3%). All the stent embolization procedures were successfully treated with the PK Papyrus covered coronary stent. None of the patients had any recurrence or re-treatment. The number of stents required ranged from 1 to 3. A balloon guide catheter was used in 66.7% of cases (n=4/6). In-hospital mortality was 0.0% (n=0/6). No in-stent thrombosis was observed, but there was one case of cangrelor-associated hemorrhagic stroke conversion. Transfemoral access was used in all cases with one access site complication. Median follow-up time was 1.8 months (IQR 3.5).</p><p><strong>Conclusions: </strong>To our knowledge, this is the largest case series in the USA demonstrating the feasibility and safety of using the PK Papyrus covered coronary stent for the treatment of carotid rupture, including carotid cavernous fistulas.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"1244-1249"},"PeriodicalIF":4.5,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139087251","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}