Journal of NeuroInterventional Surgery最新文献

{"title":"Efficacy and safety of a new mechanical balloon-based flow diverter in the treatment of intracranial aneurysms.","authors":"Jingwei Li, Wei Ni, Yiran Lu, Li Li, Chuan He, Chao Gao, Tianxiao Li, Xinjian Yang, Hongqi Zhang","doi":"10.1136/jnis-2025-023225","DOIUrl":"https://doi.org/10.1136/jnis-2025-023225","url":null,"abstract":"<p><strong>Background: </strong>Flow diverters (FDs) are the first-line treatment of intracranial aneurysms (IAs). A groundbreaking mechanical balloon-based FD device was developed to enhance the precise landing and deployment efficiency for FDs.</p><p><strong>Objective: </strong>To investigates the efficacy and safety of this innovative device in a prospective cohort.</p><p><strong>Methods: </strong>This study was a prospective multicenter observational study conducted between September 2019 and November 2021. Patients diagnosed with unruptured IAs and treated with this innovative FD device alone were included. The immediate implantation success rate, the successful aneurysm occlusion rate (Raymond I-II or OKM C-D), the complete occlusion rate (Raymond I or OKM D), and the parent artery stenosis rate (>50%) at follow-up were evaluated as the evaluation index of efficacy. The mortality rate, adverse events (AEs), neurological AEs, and serious adverse events (SAEs) were evaluated as the evaluation index of safety.</p><p><strong>Results: </strong>A total of 128 patients were included, and all of the FD deployments were successful (success rate reached 100%). At the 12-month mark, 91.4% (117/128) of patients achieved successful occlusion, 85.9% (110/128) achieved complete occlusion, and only 0.8% (1/128) exhibited parent artery stenosis >50% (without need for additional treatment). During the follow-up, there were no reported mortalities or cerebral hemorrhage, while 6 neurological adverse events (4.69%) and 4 SAEs (3.1%) were observed.</p><p><strong>Conclusions: </strong>The mechanical balloon-based FD showed a remarkable occlusion rate alongside minimal ischemic and hemorrhagic adverse events compared with existing FDs. This innovative mechanical balloon-based design may be an important direction for future FD design.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159684","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":"Transarterial embolization for infants under 3 months of age with refractory seizures due to hemimegalencephaly: complication analysis and evolution of treatment strategy.","authors":"Monica S Pearl, Tayyba Anwar, Shani Israel, Lindsay Ruffini, Panagiotis Kratimenos, Kyle Spagnolo, Wei-Lang Chen, Madison Berl, William D Gaillard, Tammy N Tsuchida, Chima Oluigbo","doi":"10.1136/jnis-2025-023551","DOIUrl":"https://doi.org/10.1136/jnis-2025-023551","url":null,"abstract":"<p><strong>Background: </strong>Hemimegalencephaly (HME) is a rare, congenital brain malformation associated with drug-resistant seizures that are challenging to manage in young infants. Hemispheric surgery in infants <3 months of age carries increased risks of blood loss and complications due to the fragility of the immature brain parenchyma and cerebral vasculature. Transarterial embolization (TAE) has emerged from an adjunct to surgery to a potential alternative to hemispherectomy in a subset of HME patients.</p><p><strong>Objective: </strong>To review the safety, efficacy, and evolution of TAE performed in infants <3 months of age with medically refractory seizures due to HME.</p><p><strong>Methods: </strong>We retrospectively reviewed patient demographics, intraprocedural events, procedure-related complications, and epilepsy characteristics for all infants who underwent TAE between 2013 and 2024 at a single quaternary institution.</p><p><strong>Results: </strong>Thirteen patients underwent a total of 41 embolizations, with a mean age of 45.5±26.8 (range 10-99) days at first embolization. Procedure-related complications included femoral arterial occlusion (n=2), symptomatic intracranial hemorrhage resulting in progressive hydrocephalus requiring cerebrospinal fluid shunting (n=1), and non-target embolization (n=2). One mortality occurred from multifocal intraparenchymal hemorrhages due to post-procedure coagulopathy. Two patients developed delayed contralateral ischemic injury. Engel Class I (free of disabling seizures) was achieved in 72.7% (8/11) of patients, with a mean follow-up age of 4.4±3.6 (range 1.3-11.0) years.</p><p><strong>Conclusions: </strong>TAE is a potential alternative to hemispherectomy for refractory epilepsy due to HME in infants <3 months of age; however, technical and perioperative challenges remain important considerations. Optimizing patient selection and periprocedure care are critical factors to improve patient outcomes.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159690","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":"Functional outcomes in pediatric large vessel occlusion treated with endovascular treatment: results from Chinese Pediatric Ischemic Stroke Registry, a multicenter, prospective registry study.","authors":"Wanqiu Zhang, Bin Zhu, Mingyang Niu, Cuirong Duan, Jinghui Zhong, Yingjie Xu, Lulu Xiao, Qiankun Li, Xinfeng Liu, Wen Sun","doi":"10.1136/jnis-2025-023201","DOIUrl":"https://doi.org/10.1136/jnis-2025-023201","url":null,"abstract":"<p><strong>Background and purpose: </strong>Endovascular treatment (EVT) has become the standard of care for selected adult patients with large vessel occlusion (LVO), but its efficacy in pediatric patients remains limited. This study aimed to assess the clinical outcomes of EVT in pediatric patients with LVO and compare it with medical management.</p><p><strong>Methods: </strong>The Chinese Pediatric Ischemic Stroke Registry (CPISR) is a multicenter, prospective observational study. Eighty-five centers across 20 provinces in China reported functional outcomes for children aged between 28 days and 18 years presenting with arterial ischemic stroke (AIS) caused by LVO who received either EVT or medical treatment. The primary outcome was the pediatric modified Rankin Scale (mRS) score at 90 days. Secondary outcomes included excellent outcome (pediatric mRs 0-1), favorable outcome (pediatric mRs 0-2) and 90-day mortality. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were employed to address imbalances across groups. A meta-analysis integrating the currently available evidence was performed to systematically compare the two groups.</p><p><strong>Results: </strong>In this study, 64 patients with LVO were finally included in this analysis. After PSM, EVT was associated with increased odds of improved shift pediatric mRS scores (OR 3.20, 95% CI 1.03 to 9.97) and excellent outcome (OR 10.0, 95% CI 1.10 to 90.59). There was no significant difference in 90-day mortality between EVT and medical management groups (OR 1.70, 95% CI 0.10 to 28.43). Meta-analysis also demonstrated the superiority of EVT over medical treatment, showing better mRS shift at 90 days (OR 2.56, 95% CI 1.44 to 4.54), a high possibility of excellent outcome (OR 4.44, 95% CI 1.90 to 10.33) and favorable outcome (OR 2.16, 95% CI 1.15 to 4.05).</p><p><strong>Conclusion: </strong>This matched-control study and meta-analysis showed that EVT was associated with better functional outcomes in pediatric patients with LVO. These findings support the use of EVT as a treatment approach for pediatric patients with LVO.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159688","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":"Recognizing bilateral sudden hearing loss as a sentinel sign of basilar artery occlusion: insights from endovascular case series.","authors":"Yijun Suo, Meixia Yin, Zhongbin Xia, Xiangbin Wu, Xiaoping Yin, Bing Bao","doi":"10.1136/jnis-2025-023451","DOIUrl":"https://doi.org/10.1136/jnis-2025-023451","url":null,"abstract":"<p><strong>Objective: </strong>To improve early diagnosis of patients who have basilar artery occlusion (BAO) and to provide evidence for treatment decisions based on clinical characteristics, treatment strategies, and prognostic outcomes of cases of bilateral hearing loss as a prodromal symptom.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of six patients who had BAO with an initial symptom of hearing loss. This analysis encompassed demographic data, clinical symptoms, examination findings, treatment approaches, and prognostic outcomes.</p><p><strong>Results: </strong>Six patients (mean age 62±16.5 years) presented with bilateral sudden hearing loss and were diagnosed with proximal BAO. All had subtle initial symptoms, leading to diagnostic delays (mean 13 ± 5.4 hours). Five underwent endovascular treatment (EVT), and all patients required rescue balloon angioplasty because of underlying atherosclerotic stenosis. Intravenous tirofiban was administered perioperatively. At discharge, hearing had normalized in four patients; one patient (patient 3) had persistent profound bilateral sensorineural hearing loss. The patient who did not undergo EVT (patient 6) died on day 5 of hospitalization. At 90 days, five EVT-treated patients achieved favorable functional outcomes (modified Rankin Scale score 0-1). Univariate analysis did not show statistically significant differences between outcome groups in baseline National Institutes of Health Stroke Scale (NIHSS) score, posterior circulation Alberta Stroke Program Early CT score, onset-to-arrival time, or age, although patients with unfavorable outcomes tended to be older and have higher NIHSS scores.</p><p><strong>Conclusions: </strong>Sudden bilateral hearing loss should serve as a critical warning sign of BAO, a potentially life-threatening condition. Without rapid intervention, such as intravenous thrombolysis or EVT to re-establish perfusion, the occlusion may progress, leading to severe and potentially fatal outcomes.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159689","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":"Arterial collateral status and treatment effect of intravenous alteplase thrombolysis prior to endovascular treatment in patients with anterior circulation large vessel occlusion: prespecified analysis of the MR CLEAN-NO IV trial.","authors":"Wenjin Yang, Fabiano Cavalcante, Kilian M Treurniet, Manon Kappelhof, Agnetha A E Bruggeman, Lennard Wolff, Leon A Rinkel, Natalie E LeCouffe, Ivo G H Jansen, Aashish Venkatesh, Olvert A Berkhemer, Anouk van der Hoorn, Marieke E Sprengers, Bart J Emmer, Jonathan M Coutinho, Yvo B W E M Roos, Wim van Zwam, Robert van Oostenbrugge, Henk A Marquering, Charles B L M Majoie","doi":"10.1136/jnis-2025-023054","DOIUrl":"https://doi.org/10.1136/jnis-2025-023054","url":null,"abstract":"<p><strong>Background and purpose: </strong>Collateral blood flow to the affected cerebral territory in acute ischemic stroke may modify the effect of intravenous alteplase treatment (IVT) prior to endovascular treatment (EVT). We assessed whether an interaction effect between arterial collateral status, assessed by both a visual and quantitative collateral score (CS), and administration of IVT plus EVT was present in the MR CLEAN-NO IV trial.</p><p><strong>Methods: </strong>Baseline CT or MR angiography (CTA and MRA) from patients included in MR CLEAN-NO IV was assessed using both a visual and automated quantitative score for arterial collateral status. We included 526 patients with visual CS and 401 with quantitative CS in this prespecified analysis. The primary outcome was functional outcome measured as the modified Rankin Scale score at 90 days. Interaction terms of treatment allocation (IVT plus EVT vs EVT alone) and collateral scores were included in regression models to assess whether the treatment effect of IVT differed by arterial collateral status.</p><p><strong>Results: </strong>IVT plus EVT was not statistically significantly associated with better functional outcome compared with EVT alone (adjusted common odds ratio 1.14; 95% CI 0.84 to 1.55). There was no statistically significant modification of IVT treatment effect on functional outcome by either visual or quantitative CS (adjusted p-interaction=0.34; adjusted p-interaction=0.57, respectively).</p><p><strong>Conclusion: </strong>In the MR CLEAN-NO IV trial, we did not find evidence that arterial collateral status measured with a visual score or quantitative score can inform treatment decisions regarding IVT plus EVT for patients with acute ischemic stroke due to large vessel occlusion in the anterior circulation within 4.5 hours.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208750","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":"Diagnostic value of the perfusion mismatch ratio in identifying intracranial atherosclerotic disease related occlusion.","authors":"Tingyu Yi, Zhi-Nan Pan, Lan Hong, Weifeng Huang, Ding-Lai Lin, Zhijiao He, Shuyi Liu, Shujuan Gan, Fenglong Lang, Yi-Ning Yang, Jinhua Ye, Huanghuang Chen, Dapeng Sun, Xin Cheng, Zhongrong Miao, Wen-Huo Chen","doi":"10.1136/jnis-2025-023205","DOIUrl":"https://doi.org/10.1136/jnis-2025-023205","url":null,"abstract":"<p><strong>Background: </strong>The ability to differentiate intracranial atherosclerotic disease (ICAD) related large vessel occlusion (LVO) from embolism is critical for stroke management. We hypothesized that the mismatch ratio derived from the automated computed tomography perfusion (CTP) could predict underlying ICAD.</p><p><strong>Methods: </strong>Patients with acute ischemic stroke (AIS) and LVO from prospective registry databases who underwent CTP were included in the derivation cohort (n=1100). The mismatch ratio, calculated as the ratio of the hypo-perfused volume to the infarct core volume by software, was defined. Receiver Operating Characteristic (ROC) analysis was performed to assess the predictive performance of the mismatch ratio for ICAD, and logistic regression analysis was used to identify independent predictors of LVO associated with underlying ICAD. External validation was conducted using cohorts from two other stroke centers (n=385).</p><p><strong>Results: </strong>In the derivation cohort, 390 patients were classified as ICAD and 720 as embolism. The ICAD group had a higher mismatch ratio (9.8 vs 3.6, P<0.001). The mismatch ratio outperformed age and National Institutes of Health Stroke Scale (NIHSS) score in predicting ICAD (area under the curve (AUC), 0.77 vs 0.36 vs 0.28, P<0.001). The ROC curve had a best cut-off of 7.1 for predicting ICAD, which was an independent predictor of ICAD-related occlusion (adjusted odds ratio (aOR) 5.43, 95% CI 3.68 to 8.03), with 68% sensitivity and 76% specificity. These results were validated in an external cohort (AUC=0.78; 95% CI, 0.73 to 0.83).</p><p><strong>Conclusion: </strong>The perfusion mismatch ratio may be an optimal and simple predictor of anterior circulation ICAD- related LVO before endovascular treatment (EVT). When this ratio was ≥7.1, ICAD was five times more likely than embolism.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A pre-intervention six-item scale for predicting futile recanalization after endovascular therapy in patients with acute ischemic stroke with large core infarction.","authors":"Yawen Gan, Jie He, Zhongao Guan, Ketao Tu, Fangguang Chen, Shuang Song, Dingwen Zhang, Yuesong Pan, Zhongrong Miao, Dapeng Mo, Xu Tong","doi":"10.1136/jnis-2025-023370","DOIUrl":"https://doi.org/10.1136/jnis-2025-023370","url":null,"abstract":"<p><strong>Background: </strong>Despite successful reperfusion after endovascular therapy (EVT), over 50% of patients with large vessel occlusion (LVO) and large core infarction fail to achieve favorable functional outcomes, termed 'futile recanalization'. This study aimed to identify predictors and develop a scoring system to predict futile recanalization in patients with LVO and large core infarction undergoing EVT.</p><p><strong>Methods: </strong>Patients were selected from the Acute Anterior Circulation Large Vessel Occlusive Patients With a Large Infarct Core (ANGEL-ASPECT) trial. Futile recanalization was defined as a modified Rankin Scale (mRS) score of >3 at 90 days despite successful reperfusion (extended Thrombolysis in Cerebral Infarction scale ≥2b). Participants were divided into futile (mRS >3) and no-futile (mRS ≤3) recanalization groups. Multivariable logistic regression was used to develop the predictive scale, with model performance assessed via a receiver operating characteristic (ROC) curve and Hosmer-Lemeshow test.</p><p><strong>Results: </strong>Of 146 patients, 74 had futile recanalization. A six-item scale (0-6 points) was developed, including gender, age, systolic blood pressure, admission National Institutes of Health Stroke Scale score, blood glucose, and neutrophil-to-lymphocyte ratio. The scale showed good predictive performance (area under the ROC curve (AUC) 0.806, 95% CI 0.737 to 0.876) and good calibration (Hosmer-Lemeshow test, P=0.837). The optimal cut-off value of the scale was ≥3 points with 81% sensitivity, 70% specificity, and 76% accuracy.</p><p><strong>Conclusions: </strong>The pre-EVT scale could effectively predict 90-day futile recanalization before EVT, providing a valuable tool for clinical decision-making and risk stratification in patients with LVO and large core infarction.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correspondence on 'Neuroanatomy of the vertebrobasilar perforators: implications for aneurysm treatment' by Raz <i>et al</i>.","authors":"Xuefan Zeng, Yiwei Wang","doi":"10.1136/jnis-2024-022871","DOIUrl":"10.1136/jnis-2024-022871","url":null,"abstract":"","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"e1"},"PeriodicalIF":4.5,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correspondence on ''Prolonged intracranial catheter dwell time exacerbates penumbral stress and worsens stroke thrombectomy outcomes' by Alawieh <i>et al</i>.","authors":"Xuefan Zeng","doi":"10.1136/jnis-2024-022859","DOIUrl":"10.1136/jnis-2024-022859","url":null,"abstract":"","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"e2"},"PeriodicalIF":4.5,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing clinical practice: a critical appraisal of thoracic MRI prior to vertebral augmentation surgery in patients with lumbar vertebral fractures.","authors":"Xuefan Zeng, Xiya Wang, Yifei Gong","doi":"10.1136/jnis-2024-022806","DOIUrl":"10.1136/jnis-2024-022806","url":null,"abstract":"","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"e7"},"PeriodicalIF":4.5,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}