Journal of NeuroInterventional Surgery最新文献

{"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}

{"title":"Multicenter study of association between socioeconomic status and treatment of ruptured cerebral aneurysms compared to unruptured cerebral aneurysms: insights from 4,517 patients using the area deprivation index.","authors":"Samhita Bheemireddy, Avi A Gajjar, Mofetoluwa Abe, Amanda Custozzo, Sonia Lipp, Andrew Ringer, Muhammed Amir Essibayi, David Altschul, Oded Goren, Jeffrey Oliver, Jared C Reese, Pouya Entezami, Imran Chaudry, Shawn Manos, Aquilla Scott Turk, Elena Sagues, Andres Gudino, Edgar A Samaniego, Anna Luisa Kühn, Jasmeet Singh, Ajit S Puri, Joanna Mary Roy, Kareem ElNaamani, M Reid Gooch, Vinay Jaikumar, Adnan H Siddiqui, Alan S Boulos, John C Dalfino, Alexandra R Paul","doi":"10.1136/jnis-2024-022935","DOIUrl":"https://doi.org/10.1136/jnis-2024-022935","url":null,"abstract":"<p><strong>Background: </strong>Socioeconomic status influences health outcomes, including cerebrovascular diseases. Patients from socioeconomically deprived areas may present with more severe conditions due to delayed access to care. This study evaluates the association between neighborhood-level deprivation, measured by the Area Deprivation Index (ADI), and the treatment of ruptured intracranial aneurysms (RIAs) compared with unruptured intracranial aneurysms (UIAs) across multiple centers.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed data from 4517 patients treated for cerebral aneurysms at 10 US comprehensive stroke centers between 2018 and 2024. Patients were stratified by national ADI decile based on their residential addresses. Multivariable logistic regression was used to examine the relationship between ADI and aneurysm rupture (reference being unruptured aneurysms) and controlled for age, sex, smoking history, family history, and race.</p><p><strong>Results: </strong>Of 4517 total patients, 1260 (27.9%) underwent treatment of RIAs. Multivariable analysis confirmed ADI as an independent predictor of presentation for treatment of RIA (odds ratio (OR)=1.100, 95% confidence interval (CI)=1.068-1.133, P<0.0001) after adjusting for age, sex, smoking history, and race. This corresponds to a 10% increase in likelihood of presenting for treatment of a ruptured vs unruptured intracranial aneurysm with each ADI decile.</p><p><strong>Conclusion: </strong>Socioeconomic deprivation independently predicts treatment of RIAs compared with the treatment of UIAs. These findings highlight disparities in aneurysm detection and management, emphasizing the need for targeted preventive care and accessible screening programs to mitigate the impact of socioeconomic disadvantage on cerebral aneurysm outcomes.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743141","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":"Single-session middle meningeal artery embolization and surgical evacuation for chronic subdural hematoma.","authors":"Andrew B Koo, Sasha Stogniy, Aladine A Elsamadicy, Sidharth S Menon, Daniela Renedo, Benjamin Reeves, Nanthiya Sujijantarat, Ryan Hebert, Adam de Havenon, Kevin N Sheth, Charles Matouk","doi":"10.1136/jnis-2025-023372","DOIUrl":"https://doi.org/10.1136/jnis-2025-023372","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to evaluate the preliminary experience of a combined middle meningeal artery embolization (MMAE) and burr hole evacuation approach for chronic subdural hematoma (cSDH) under a single anesthesia session.</p><p><strong>Methods: </strong>We performed a retrospective review of all patients who underwent MMAE and burr hole surgery during the same admission at a single major academic institution between 2019 and 2024. Patients were dichotomized by those with both procedures performed under a single anesthesia session (combined) or two separate sessions (separate). Baseline demographics, comorbidities, and complications were compared. The primary outcomes were in-hospital and 90-day complication and reoperation rates.</p><p><strong>Results: </strong>103 patients were included in the study (median age 74 (67-81) years), with 33.9% in the combined cohort. Demographics, comorbidities, and radiographic characteristics were similar between the cohorts. While cumulative procedure times were similar (separate 85 (71-110) min vs combined 96 (82-127) min), total anesthesia time was significantly longer for patients with separate procedures (separate 225 (193-264) min vs combined 165 (145-183) min, P<0.001). There were no differences in the rates of access site complications, reoperation, stroke, or mortality between the cohorts. The combined cohort trended to have shorter length of stay (separate 6 (5-8) days vs combined 5 (4-7) days, P=0.058). There were no differences in complication or reoperation rates within 90 days.</p><p><strong>Conclusion: </strong>The results of this study suggest that MMAE performed under a single anesthesia session with burr hole evacuation surgery is a safe and potentially resource-efficient approach for the management of cSDH.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743150","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":"Direct epidural ethanol injection in aggressive vertebral hemangiomas to decompress the central canal: a multistep percutaneous treatment strategy.","authors":"Eike Immo Piechowiak, Marco Pileggi, Maurizio Isalberti, Tomas Dobrocky, Jan Gralla, Johannes Kaesmacher, Andrea Cardia, Mario Muto, Ralph T Schär, Andreas Raabe, Giuseppe Bonaldi, Alessandro Cianfoni","doi":"10.1136/jnis-2024-023012","DOIUrl":"https://doi.org/10.1136/jnis-2024-023012","url":null,"abstract":"<p><strong>Background: </strong>Vertebral hemangiomas are incidental and typically, asymptomatic lesions of the spine, present in 10-12% of the population. However, aggressive vertebral hemangiomas (AVHs) can compromise the spinal canal, leading to spinal cord or nerve root compression, and require timely treatment to prevent permanent neurological deficits. Surgical management is challenging owing to the high vascularity of AVHs, and carries a significant risk of perioperative blood loss. Intraosseous ethanol injection is commonly used for sclerotization, but may not adequately deal with epidural components.</p><p><strong>Objective: </strong>To carry out a staged treatment with an image-guided puncture and ethanol injection of the epidural component in 12 patients.</p><p><strong>Methods: </strong>We retrospectively analyzed 12 patients with symptomatic AVHs who underwent targeted epidural ethanol injection followed by vertebral body cement augmentation, between 2017 and 2024, at three tertiary hospitals. Data collection included pre- and post-treatment imaging and clinical outcomes.</p><p><strong>Results: </strong>Among 12 patients (mean age 50, women 50%), all had extensive epidural involvement and were symptomatic, including spinal cord compression and pain. Reduction in size of more than 75% of the epidural hemangioma was achieved in 8 cases, with 11 patients experiencing complete symptom resolution. Laminectomy was performed in 3 cases, while corpectomy was avoided in all cases. Two patients had neurological worsening, with one achieving complete resolution and the other having mild residual impairment after rehabilitation due to a small spinal cord ischemic lesion. No other major complications occurred.</p><p><strong>Conclusion: </strong>Direct epidural ethanol injection provides a minimally invasive alternative to surgery, such as corpectomy, including rapid size reduction of the compressive epidural component, and potentially, prevents retrograde flow into arterial collaterals. Adding vertebroplasty enhances vertebral stability.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743062","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":"Stent retriever size and outcomes after anterior circulation occlusion thrombectomy.","authors":"Benjamin Gory, Sven Poli, Bertrand Lapergue, Stephanos Finitsis, Joshua Mbroh, Xinchen Hui, Florian Hennersdorf, Ulrike Ernemann, Mohammad Anadani","doi":"10.1136/jnis-2024-022937","DOIUrl":"https://doi.org/10.1136/jnis-2024-022937","url":null,"abstract":"<p><strong>Background: </strong>The impact of stent retriever size on mechanical thrombectomy (MT) outcomes remains uncertain. We aim to clarify the influence of stent retriever size on MT outcomes by analyzing data from two national prospective registries.</p><p><strong>Methods: </strong>A retrospective analysis was performed on data from the French and German MT registries including consecutive patients with anterior circulation large vessel occlusion who underwent Solitaire stent retriever MT with or without additional aspiration. Efficacy outcomes were successful reperfusion and complete reperfusion. Safety outcomes included any intracerebral hemorrhage (ICH) and symptomatic intracerebral hemorrhage (sICH).</p><p><strong>Results: </strong>Complete reperfusion was lower in the 4×20 mm stent retriever group than in the 4×40 mm stent retriever group (47% vs 53%; OR 0.61, P=0.0039). Successful reperfusion did not differ between the 4×20 mm and 4×40 mm stent retriever groups (89% vs 93%; OR 0.69, P=0.25). There was no difference between the 6×30/6×40 mm and 4×20 mm stents, and there was no difference in functional outcomes between the groups. In terms of safety, any ICH was lower in the 4×20 mm group than in the 4×40 mm group (20% vs 36%; OR 0.60, P=0.0095). Symptomatic ICH was lower in the 4×20 mm group than in the 4×40 mm group (5% vs 10%; OR 0.58, P=0.086), but the difference did not reach statistical significance. Mortality was lower in the 4×20 mm than in the 6×40 mm group (26% vs 33%; OR 0.70, P=0.044). When compared according to occlusion location, the results were overall similar.</p><p><strong>Conclusion: </strong>This study suggests that longer and larger stent retrievers lead to a higher reperfusion rate but also a higher rate of hemorrhagic complications. Overall, the size of the stent did not affect functional outcomes.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730472","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":"Multicenter analysis of flow diversion for recurrent/persistent intracranial aneurysms after stent-assisted coiling.","authors":"Mohamed M Salem, Ahmed Helal, Avi A Gajjar, Georgios Sioutas, Kareem El Naamani, Daniel M Heiferman, Ivan Lylyk, Alex Levine, Leonardo Renieri, Andre Monteiro, Mira Salih, Rawad Abbas, Ahmed Abdelsalam, Sohum Desai, Hamidreza Saber, Joshua S Catapano, Nicholas Borg, Giuseppe Lanzino, Waleed Brinjikji, Omar Tanweer, Alejandro M Spiotta, Min S Park, Aaron S Dumont, Adam S Arthur, Louis J Kim, Michael R Levitt, Peter Kan, Ameer E Hassan, Nicola Limbucci, Geoffrey P Colby, Stacey Q Wolfe, Eytan Raz, Ricardo Hanel, Maskim Shapiro, Adnan H Siddiqui, William J Ares, Christopher S Ogilvy, Elad I Levy, Ajith J Thomas, Visish M Srinivasan, Robert M Starke, Andrew F Ducruet, Stavropoula I Tjoumakaris, Brian Jankowitz, Felipe C Albuquerque, Peter Kim Nelson, Howard Riina, Pedro Lylyk, Demetrius Klee Lopes, Pascal Jabbour, Jan Karl Burkhardt","doi":"10.1136/jnis-2024-022422","DOIUrl":"https://doi.org/10.1136/jnis-2024-022422","url":null,"abstract":"<p><strong>Background: </strong>Flow-diverter stents (FDS) have become the standard of care for a wide range of intracranial aneurysms, but their efficacy/safety in the context of recurrent/recanalized aneurysms following stent-assisted coiling (SAC) is not well established. We evaluate the outcomes of FDS retreatment in a large multicenter cohort.</p><p><strong>Methods: </strong>We retrospectively analyzed data from 118 patients across 22 institutions who underwent FDS retreatment for recurrent/persistent aneurysms after SAC (2008-22). The primary outcome was angiographic occlusion status at last follow-up, categorized as complete (100%), near-complete (90-99%), or incomplete (<90%) occlusion. Secondary outcomes included procedural complications and clinical outcomes measured by the modified Rankin Scale (mRS).</p><p><strong>Results: </strong>A total of 118 patients (median age 57, 74.6% female) with median follow-up of 15.3 months were identified. Complete occlusion was achieved in 62.5% and near-complete occlusion in 25%. FDS deployment within the pre-existing stent was successful in 98.3% of cases. Major complications occurred in 3.4% of cases, including postoperative aneurysmal rupture with resultant mortality (1.6%) and thromboembolic events with long-term disability (1.6%). Favorable clinical outcomes (mRS 0-2) were observed in 95.1% of patients. Wider aneurysm neck diameter was a significant predictor of incomplete occlusion (adjusted OR (aOR) 1.23 per mm, P=0.044), with male sex trending towards association with non-occlusion (aOR 3.2, P=0.07), while baseline hypertension was associated with complete occlusion (aOR 0.32, P=0.048).</p><p><strong>Conclusions: </strong>FDS treatment for recurrent/residual aneurysms after SAC represents a viable treatment option for these challenging cases with acceptable safety and reasonable occlusion rates, although lower than de novo FDS occlusion rates.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730418","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":"Comparison of embolic agents in preoperative embolization for intracranial meningiomas: multicenter adjusted analysis of 275 cases.","authors":"Julio Isidor, Rahim Abo Kasem, Mohammad-Mahdi Sowlat, Conor Cunningham, Michael Levitt, Margaret McGrath, Christopher S Ogilvy, Omar Alwakaa, Alexandra R Paul, Matthew Cullen, Isaac Josh Abecassis, Ahmad Alhourani, Isabel Fragata, Mariana Baptista, Ali Alaraj, Mpuekela Tshibangu, Fazeel Siddiqui, Elyza Larson, Marios-Nikos Psychogios, Aikaterini Anastasiou, Ramesh Grandhi, Santiago Gomez-Paz, Clemens Schirmer, Prateeka Koul, Syed Uzair Ahmed, Jack Su, Mohamad Ezzeldin, Alejandro M Spiotta, Ben A Strickland","doi":"10.1136/jnis-2025-023062","DOIUrl":"https://doi.org/10.1136/jnis-2025-023062","url":null,"abstract":"<p><strong>Background: </strong>Preoperative embolization has been used for intracranial meningiomas for nearly 40 years with varying preferences for embolic materials and limited comparative data on their efficacy.</p><p><strong>Methods: </strong>Consecutively treated patients from 2013 until 2023 who underwent preoperative embolization for meningioma from 12 centers across North America and Europe were included and classified by embolic material: (1) particles, (2) Onyx, and (3) coils. Primary outcomes included estimated blood loss (EBL), procedural complications, surgery duration, gross total resection (GTR), unplanned rescue surgery, modified Rankin Scale (mRS), and mortality. After unmatched analysis. Propensity score matching (PSM) subgroup analyses compared each pair of embolic materials, controlling for age, sex, body mass index, smoking, comorbidities, prior surgery, pre-treatment antithrombotics, WHO grade, tumor location, maximal diameter, and baseline mRS.</p><p><strong>Results: </strong>A total of 275 patients (median age 47 years, 62.9% female) underwent preoperative embolization for meningioma. The mean maximum tumor diameter was 32.9±10.1 mm, with 61.1% classified as WHO I. Onyx was most frequently used 117 (42.5%), followed by particles 107 (38.9%), and coils (18.5%). Unmatched analysis revealed that Onyx was significantly associated with reduced EBL, surgery duration, and increased GTR, while decreasing unplanned rescue surgeries compared to particles and coils. PSM produced 89, 48, and 44 matched pairs for Onyx vs. Particles, Particles vs. Coils, and Onyx vs. Coils, respectively. Onyx demonstrated significant reductions against Particles in EBL (250 mL vs. 350 mL, P = 0.011) and surgical time (291 min vs. 403 min, P < 0.001), and against Coils in EBL (250 mL vs. 400 mL, P = 0.012) and surgical time (255 min vs. 347 min, P = 0.002). Onyx also showed higher rates of gross total resection compared to Particles (80.9% vs. 56.2%, P = 0.021) and Coils (88.6% vs. 56.8%, P = 0.002). No significant differences were observed in blood transfusion requirements, embolization-related complications mRS, or mortality rates across all comparisons.</p><p><strong>Conclusions: </strong>Onyx, a liquid embolic agent, reduces EBL which may explain the shorter surgery duration, higher GTR rates, and lower retreatment rates. Procedural risks and patient selection require further investigation.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730458","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}