Journal of NeuroInterventional Surgery最新文献

{"title":"Comparative efficacy and safety of stent retrievers as a bailout strategy following failed contact aspiration technique in acute stroke thrombectomy.","authors":"Mohamad Ezzeldin, Mishaal Hukamdad, Rahim Abo Kasem, Rime Ezzeldin, Ilko Maier, Ansaar T Rai, Pascal Jabbour, Joon-Tae Kim, Brian M Howard, Ali Alawieh, Stacey Q Wolfe, Robert M Starke, Marios-Nikos Psychogios, Amir Shaban, Nitin Goyal, Justin Dye, Ali Alaraj, Shinichi Yoshimura, David Fiorella, Omar Tanweer, Daniele G Romano, Pedro Navia, Hugo Cuellar, Isabel Fragata, Adam Polifka, Justin R Mascitelli, Joshua W Osbun, Fazeel Siddiqui, Mark Moss, Kaustubh Limaye, Maxim Mokin, Charles Matouk, Min S Park, Waleed Brinjikji, Ergun Daglioglu, Richard Williamson, David J Altschul, Christopher S Ogilvy, Roberto Javier Crosa, Michael R Levitt, Benjamin Gory, Ramesh Grandhi, Alexandra R Paul, Peter Kan, Walter Casagrande, Shakeel A Chowdhry, Michael F Stiefel, Varun Chaubal, Alejandro M Spiotta","doi":"10.1136/jnis-2024-022781","DOIUrl":"https://doi.org/10.1136/jnis-2024-022781","url":null,"abstract":"<p><strong>Background: </strong>The contact aspiration (CA) technique is often used to perform endovascular thrombectomy (EVT) for acute ischemic stroke (AIS); however, rescue strategies are necessary if CA fails to achieve recanalization. This study investigates the outcomes of incorporating stent retriever (SR) thrombectomy in the rescue strategy following failed CA.</p><p><strong>Methods: </strong>EVT patients with failed CA attempts were identified from a large multicenter registry and stratified by rescue technique: CA alone or incorporating SR in the rescue strategy. Outcomes included successful recanalization, 90-day functional outcomes (defined by the modified Rankin Scale (mRS) score), symptomatic intracranial hemorrhage (sICH), and 90-day mortality.</p><p><strong>Results: </strong>Among 1885 patients with failed CA attempts, conversion to SR was associated with higher recanalization rates (85.2% vs 80.6%; p=0.03), higher rates of second-pass recanalization (31.2% vs 23.4%; p<0.001), and better 90-day outcomes (mRS 0-2: 35.2% vs 29.9%; p=0.04) when compared with repeated CA attempts. Trevo SRs showed higher odds of successful recanalization (adjusted odds ratio (aOR)=1.9; p=0.02), second-pass recanalization (aOR=1.7; p=0.01), and reduced odds of sICH (aOR=0.3; p=0.02). EmboTrap SRs were associated with higher odds of 90-day mortality (aOR=2.6; p=0.004) and sICH (aOR=2.9; p=0.04) and lower odds of recanalization (aOR=0.5; p=0.03).</p><p><strong>Conclusions: </strong>Incorporating SR in the rescue strategy after a failed CA improves recanalization rates and functional outcomes. Trevo SRs demonstrated superior efficacy and safety when incorporated into the rescue strategy.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066184","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":"Antithrombotic resumption after middle meningeal artery embolization or surgery for chronic subdural hematoma: a systematic review and meta-analysis.","authors":"Ahmed Alkhiri, Hatoon Alshaikh, Mohammed S Alqahtani, Shatha Alqurashi, Manar M Alsharif, Ahmad M Bukhari, Rawan M AlWadee, Abdulrahman A Alreshaid, Magdy Selim, Eman Alrajhi, Fahad S Al-Ajlan, Adel Alhazzani","doi":"10.1136/jnis-2024-022988","DOIUrl":"https://doi.org/10.1136/jnis-2024-022988","url":null,"abstract":"<p><strong>Background: </strong>The periprocedural management of antithrombotic medications in patients with chronic subdural hematoma (cSDH) after middle meningeal artery embolization (MMAE) or surgical evacuation is uncertain.</p><p><strong>Methods: </strong>A systematic review was conducted across Medline, Embase, and Web of Science databases. We pooled proportions and risk ratios (RRs) for the meta-analysis with the corresponding 95% CIs. Systemic and intracranial (including recurrence) bleeding complications and thromboembolic events were evaluated.</p><p><strong>Results: </strong>Of the 16 included studies with 4606 patients, 1784 were receiving antithrombotic medications. Antithrombotic therapy was resumed in 1231 patients (69.0%). Bleeding complications were similar between patients in whom antithrombotic therapy was resumed (14.1%, 95% CI 9.7% to 20.2%) and in those in whom it was discontinued (15.4%, 95% CI 7.4% to 29.3%). After MMAE, patients had similar rates of bleeding events (12.1%, 95% CI 4.9% to 27.0%) to patients with overall treated cSDH, and recurrence (RR 2.28, 95% CI 0.46 to 11.37) and reoperation (RR 1.07, 95% CI 0.40 to 2.917) risks were similar between the resumed and discontinued groups. Thromboembolic complications were significantly higher in the discontinued group (12.6%, 95% CI 6.5% to 23.0%) than in the resumption group (3.5%, 95% CI 1.8% to 6.9%). Earlier resumption (1 week to 1 month) was associated with a lower thromboembolic risk without increasing bleeding complications.</p><p><strong>Conclusions: </strong>Post-procedural antithrombotic resumption may reduce thromboembolic events without significantly increasing bleeding risk. Early resumption of antithrombotics post-MMAE appears to be safe, although further data are required to confirm this observation. Future studies should aim to better define patient characteristics influencing decision-making in this context.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066166","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":"https://doi.org/10.1136/jnis-2025-023050","url":null,"abstract":"","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-01-29","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":"New Artisse intrasaccular device for intracranial aneurysm treatment: short term clinical and angiographic result from the prospective registry INSPIRE-A.","authors":"Sophia Hohenstatt, Vincent Costalat, Cyril Dargazanli, Monika Killer-Oberpfalzer, Barbara Schreiber, Riitta Rautio, Matias Sinisalo, Saleh Lamin, Han Seng Chew, Laurent Spelle, Alejandro Tomasello, Tufail Patankar, Mariangela Piano, Jens Fiehler, Markus A Möhlenbruch","doi":"10.1136/jnis-2024-022576","DOIUrl":"https://doi.org/10.1136/jnis-2024-022576","url":null,"abstract":"<p><strong>Background: </strong>Intrasaccular devices have broadened treatment options for wide necked aneurysms. This study presents the preliminary experience with the Artisse 2.0 device.</p><p><strong>Methods: </strong>Innovative NeurovaScular Product SurveIllance REgistry (INSPIRE) is a non-randomized, multicenter, real world clinical study with treatment arms for aneurysms (INSPIRE-A) and acute ischemic stroke (INSPIRE-S). This interim analysis included 87 patients enrolled from November 2022 to April 2024 in the INSPIRE-A Artisse cohort across 16 Europoean centers. Procedures followed standard clinical care, with 6 months of follow-up. Safety and efficacy endpoints included major stroke, neurological death, serious adverse events (SAEs), aneurysm occlusion, and retreatment rates. An independent core laboratory assessed imaging, and all SAEs were reviewed by a clinical events committee. The Artisse steering committee provided independent oversight of the data.</p><p><strong>Results: </strong>The Artisse device achieved an overall successful implantation rate of 96.6% (84/87), with satisfactory placement rates of 98.7% (74/75) for unruptured and 88.9% (8/9) for ruptured aneurysms. Following the procedure, 46.2% of unruptured aneurysm patients were receiving antiplatelet therapy (APT), predominantly aspirin monotherapy, while no ruptured aneurysm patients received APT. Device related SAE rate was 1.3% (1/87), and the overall stroke rate was 2.3% (2/87), including both ruptured and unruptured aneurysms. At 6 months, 80.0% (28/35) of patients with unruptured aneurysms showed complete obliteration, with no recurrences or retreatments.</p><p><strong>Conclusions: </strong>Preliminary experience with the Artisse 2.0 device demonstrated high technical success, favorable safety, and efficacy in aneurysm obliteration at 6 months. Larger studies with longer follow-up periods are needed to confirm these findings.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular thrombectomy versus medical management for patients with large vessel stroke and infective endocarditis.","authors":"Huanwen Chen, Marco Colasurdo, Mihir Khunte, Ajay Malhotra, Dheeraj Gandhi","doi":"10.1136/jnis-2024-022374","DOIUrl":"10.1136/jnis-2024-022374","url":null,"abstract":"<p><strong>Background: </strong>The safety and efficacy of endovascular thrombectomy (EVT) for large vessel occlusion (LVO) strokes associated with infective endocarditis (IE) compared with medical management (MM) is unclear.</p><p><strong>Methods: </strong>In this nationwide analysis of hospitalizations in the United States, we assessed the outcomes of EVT versus medical management (MM) for patients with LVO and IE. Primary outcome was routine home discharge with self-care. Secondary outcomes include home discharge, in-hospital mortality, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). Propensity score matching (PSM) was performed to adjust for confounders. Additional multivariable adjustments were performed for doubly robust analyses.</p><p><strong>Results: </strong>2574 patients were identified; 656 (25.5%) received EVT. After PSM, the rate of routine discharge was significantly higher for patients with EVT compared with MM (14.6% vs 8.5%, p=0.021), and patients with EVT had significantly higher rate of home discharge (34.5% vs 26.5%, p=0.041), lower rate of in-hospital death (14.8% vs 25.2%, p=0.002), and lower rate of ICH (15.8% vs 23.1%, p=0.039). EVT was not associated with a different rate of SAH compared with MM (11.2% vs 7.9%, p=0.17). These associations remained unchanged with additional multivariable adjustments.</p><p><strong>Conclusion: </strong>For patients with LVO stroke and IE, EVT was associated with significantly higher odds of favorable hospitalization outcomes and lower odds of ICH compared with MM.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348451","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":"Adjunctive intravascular lithotripsy for heavily calcified carotid stenosis: a dual-center experience and technical case series.","authors":"Ricardo A Hanel, Vinay Jaikumar, Salvador F Gutierrez-Aguirre, Hamid Sharif Khan, Otavio F De Toledo, Jaims Lim, Tyler A Scullen, Fernanda Rodriguez-Erazú, Bernard Okai, Matthew J McPheeters, Mehdi Bouslama, Kunal P Raygor, Adnan H Siddiqui","doi":"10.1136/jnis-2024-022545","DOIUrl":"10.1136/jnis-2024-022545","url":null,"abstract":"<p><strong>Background: </strong>Heavily calcified carotid stenosis (HCCS) is considered an exclusion for carotid angioplasty and/or stenting (CAS), amenable only to carotid endarterectomy. This study presents preliminary retrospective dual-center experience utilizing the Shockwave S⁴ intravascular lithotripsy (IVL) system (Shockwave Medical) as an adjunct to CAS for HCCS.</p><p><strong>Methods: </strong>Patients with symptomatic or asymptomatic HCCS (de novo stenosis or in-stent restenosis (ISR)) undergoing IVL+CAS were included. Charts were reviewed for demographic, imaging, procedural, and outcome data. The primary endpoint was composite major adverse event (MAE) rate: death, ipsilateral stroke, or myocardial infarction (MI) within 30 days of IVL+CAS. Secondary endpoints included technical and procedural success, residual stenosis, and ISR postprocedure.</p><p><strong>Results: </strong>Fifteen patients underwent 17 IVL+CAS procedures: de novo HCCS=13, heavily calcified ISR=4; symptomatic disease was addressed in seven cases. Procedures were performed transfemorally under conscious sedation with dual protection; flow reversal through a balloon guide catheter, and distal embolic protection system (EPS) use. Median pre-IVL+CAS stenosis was 73% (IQR 60-80%). Technical success (IVL+CAS+ EPS use) was achieved in all cases. Median post-IVL+CAS residual stenosis was 27% (IQR 12-33%), achieving <50% residual stenosis and procedural success in all. Five patients required dopamine infusion for postprocedural hypotension. No periprocedural ipsilateral strokes occurred. MAE rate was 6.7% (95% CI 0.2% to 32%), including one MI resulting in death. Additionally, one ISR (6.3%; 95% CI 0.2% to 30.2%) identified 160 days after IVL+CAS was retreated with angioplasty.</p><p><strong>Conclusions: </strong>IVL+CAS was safe and effective for treating symptomatic and asymptomatic HCCS, achieving high rates of freedom from MAE. IVL has potential to expand the role of CAS in difficult to treat HCCS.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604131","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":"Braids and beyond: a comprehensive study on pipeline device braid stability from PREMIER data.","authors":"Fernanda Rodriguez-Erazú, Gustavo M Cortez, Demetrius K Lopes, Salvador F Gutierrez-Aguirre, Otavio Frederico De Toledo, Amin Aghaebrahim, Eric Sauvageau, David F Kallmes, Jens Fiehler, Ricardo A Hanel","doi":"10.1136/jnis-2024-022350","DOIUrl":"10.1136/jnis-2024-022350","url":null,"abstract":"<p><strong>Background: </strong>The pipeline embolization device (PED) has been increasingly used to treat brain aneurysms; however, concerns have been raised about braid stability with newer drawn filled tubing technology devices.</p><p><strong>Objective: </strong>To evaluate braid stability of PED early generations using data from the PREMIER trial.</p><p><strong>Methods: </strong>All consecutive intracranial aneurysms treated with PED (Classic and Flex) within the PREMIER trial were reviewed for braid stability (fish mouthing, foreshortening, braid bump, braid collapsing). Immediate postprocedure cone-beam CT and angiography were compared with 1- and 2- years' follow-up. Analyses included safety, measured with the modified Rankin Scale (mRS) score, including +1 mRS point and a good clinical outcome (mRS score 0-2), vessel stenosis ≥50%, effectiveness measured with Raymond-Roy Scale, and re-treatment rates.</p><p><strong>Results: </strong>133/141 aneurysms had a complete dataset. 8/133 (6%) aneurysms showed braid deformations. Inter-reader agreement was excellent (κ=0.83). Braid deformations were statistically significantly associated with in-stent vessel stenosis >50% (P=0.029), without impact on effectiveness or safety. Fish mouthing was found in 1/133 (0.75%) at 1 year, causing >50% vessel stenosis. Foreshortening occurred in 6/133 (4.5%), and braid bump in 1/133 (0.75%) associated with severe in-stent stenosis. Four other cases (3.0%) of asymptomatic in-stent stenosis due to neointimal hyperplasia were seen without braid changes. No new braid stability deformations were found at the 2-year follow-up.</p><p><strong>Conclusion: </strong>Our study demonstrates excellent braid stability among patients treated with the PED Classic and Flex in the PREMIER trial. Within the uncommon braid changes observed, none affected the PED safety or efficacy.</p><p><strong>Trial registration number: </strong>NCT02186561.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365455","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":"Effect of thrombolysis type on the efficacy of aspiration versus stent retriever first line thrombectomy: results from the AcT trial.","authors":"Fouzi Bala, William Diprose, Bijoy K Menon, Nishita Singh, Houman Khosravani, Aleksander Tkach, Luciana Catanese, Dariush Dowlatshahi, Thalia S Field, Gary Hunter, Tolulope Sajobi, Michael D Hill, Brian H Buck, Richard H Swartz, Mohammed A Almekhlafi","doi":"10.1136/jnis-2024-022268","DOIUrl":"10.1136/jnis-2024-022268","url":null,"abstract":"<p><strong>Background: </strong>Intravenous (IV) tenecteplase is increasingly being used in lieu of alteplase for acute ischemic stroke. We sought to study the influence of IV tenecteplase versus IV alteplase on the efficacy of first line thrombectomy strategy.</p><p><strong>Methods: </strong>This was a secondary analysis of the Alteplase versus Tenecteplase (AcT) trial. We included anterior and posterior circulation stroke patients in whom a thrombectomy was attempted. We compared outcomes for stent retriever as first line strategy versus contact aspiration alone, and interactions with thrombolysis type. We examined angiographic outcomes (extended final thrombolysis in cerebral infarction (eTICI) 2c-3 after first-pass, eTICI 2b-3 and eTICI 2 c-3 on final angiography), and clinical and safety outcomes. Mixed effect regression analyses with interaction terms were performed. All outcomes were assessed and analyzed by blinded adjudicators.</p><p><strong>Results: </strong>Among 506 patients who received thrombectomy, 435 were included (222 (51.0%) IV tenecteplase, 213 (49.0%) IV alteplase). A stent retriever was used as the first line endovascular thrombectomy (EVT) approach in 288 (66.2%), and aspiration in 147 (33.8%) patients. There was no difference in rates of final eTICI 2c-3 between groups (57.0% with stent retriever vs 61.9% with aspiration; P=0.35). There was, however, a significant interaction (P=0.02) between thrombolysis type and first line EVT strategy for final eTICI 2c-3, where tenecteplase was associated with higher odds of final eTICI 2c-3 with aspiration (adjusted OR (aOR) 2.29, 95% CI 1.10 to 4.75), but not with stent retriever (aOR 0.63, 95% CI 0.38 to 1.04). No significant interaction between thrombolysis and first line strategy was found for the other angiographic, clinical or safety outcomes.</p><p><strong>Conclusion: </strong>IV tenecteplase before EVT may enhance reperfusion with first line aspiration.</p><p><strong>Trial registration number: </strong>NCT03889249.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391171","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":"Simultaneous approach in tandem occlusion: a safe, effective, and faster way to achieve recanalization.","authors":"Ruba Kiwan, Alonso Alvarado-Bolanos, Mosab Maree, Maria Bres-Bullrich, Annika Mascarenhas, Gökce Hatipoglu Majernik, Alistair Jukes, Lisa Xuan, Victor Yang, Michael Mayich, Manas Sharma, Melfort Boulton, Sachin K Pandey","doi":"10.1136/jnis-2024-022440","DOIUrl":"10.1136/jnis-2024-022440","url":null,"abstract":"<p><strong>Background: </strong>Endovascular thrombectomy (EVT) is the standard of care for patients with acute ischemic stroke (AIS) and intracranial vessel occlusion. Tandem occlusions (TO) comprise 20% of all anterior circulation AIS and are related to a poorer prognosis. The optimal EVT treatment strategy remains controversial. Our main objective was to determine if simultaneous endovascular treatment of intracranial and extracranial occlusions in patients with TO results in faster recanalization times, with similar efficacy and safety, compared with the sequential approach.</p><p><strong>Methods: </strong>Single center, retrospective analysis of patients with TO undergoing EVT using the simultaneous or sequential technical approach. The primary outcome was puncture-to-final recanalization time. Secondary outcomes included modified Rankin scale (mRS) score at 3 months, 30 day mortality, and hemorrhagic transformation.</p><p><strong>Results: </strong>We included 111 patients with TO (35 treated with the simultaneous approach and 76 treated with the sequential approach). Successful recanalization was achieved in 91.9% of cases, and the first pass effect was 50.5%, with no differences between groups. The simultaneous technique resulted in shorter puncture-to-final recanalization time (33.0 min (IQR 25.0-55.0) vs 52.0 (30.0-73.0), P=0.018), adjusting for number of passes, first pass effect, thrombolysis, age, and previous stroke (adjusted β -0.21 (95% CI -29.47 to -2.79); P=0.018). No significant differences were found in 30 day functional outcome, mortality, or rate of hemorrhagic transformation when comparing simultaneous and sequential techniques.</p><p><strong>Conclusion: </strong>The simultaneous approach was effective, safe, and faster than the classic sequential approach in patients with TO. This result may obviate the debate over which occlusion should be addressed first during EVT.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755152","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":"Response to 'Correspondence on subarachnoid iodine leakage on dual-energy computed tomography after mechanical thrombectomy is associated with malignant brain edema'.","authors":"Atsushi Ogata, Tatsuya Abe","doi":"10.1136/jnis-2024-022725","DOIUrl":"10.1136/jnis-2024-022725","url":null,"abstract":"","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769780","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}