Journal of NeuroInterventional Surgery最新文献

{"title":"Post-procedural edema and related clinical outcomes after curative endovascular brain arteriovenous malformation embolization: an MRI-based cohort study.","authors":"Christina Iosif, Tabata Lamiraux, Géraud Forestier, Natalia Vasconcellos de Oliveira Souza, Aymeric Rouchaud, Suzana Saleme, Charbel Mounayer","doi":"10.1136/jnis-2025-024483","DOIUrl":"https://doi.org/10.1136/jnis-2025-024483","url":null,"abstract":"<p><strong>Background: </strong>Curative embolization of brain arteriovenous malformations (bAVMs) using transarterial (TAE) and transvenous (TVE) embolization approaches has emerged over the past decade as a promising technique in high-volume centers. Although post-procedural brain edema has been observed, its incidence and clinical impact have not been systematically evaluated using objective imaging metrics.</p><p><strong>Methods: </strong>In this observational study, we retrospectively analyzed consecutive patients treated with curative intent for bAVMs, with a focus on characterizing newly developed MRI lesions. All patients underwent MRI, including diffusion weighted imaging (with apparent diffusion coefficient (ADC) mapping) and fluid-attenuated inversion recovery (FLAIR) sequences, before treatment, at 24-48 hours, and at ≥3 months' post-procedure. Vasogenic edema was defined as newly developed FLAIR hyperintensity, without ADC reduction; its volume was quantified. Primary outcome was the presence of non-pre-existing, vasogenic edema after embolization and at follow-up, comparing TAE and TVE.</p><p><strong>Results: </strong>55 bAVMs were included (45.5% TAE; 54.5% TVE) between January 1, 2010, and December 31, 2023. Mean post-procedural FLAIR volume was 15.9±18.3 cm³ for TAE and 17.9±23.9 cm³ for TVE at 24-48 hours after the procedure, and 4.3±7.3 cm³ for TAE and 3.4±5.9 cm³ for TVE on late MRI. No statistically significant difference was observed between techniques. A significant decrease (P<0.001) in MRI-documented brain edema was observed for both approaches between early and late MRI.</p><p><strong>Conclusion: </strong>Vasogenic edema was frequently observed in the early post-procedural period after both curative TAE and TVE, and significantly regressed over time.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816445","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":"Hybrid surgical and endovascular approach for bilateral symptomatic moyamoya disease: a single-center preliminary experience.","authors":"Yunyu Wen, Tinghan Long, Junda Chen, Fangzhou Chen, Yucheng Wang, Siyuan Chen, Xiaonian Chai, Guozhong Zhang, Mingzhou Li, Shichao Zhang, Huibin Kang, Peng Li, Wenfeng Feng, Gang Wang","doi":"10.1136/jnis-2025-024920","DOIUrl":"https://doi.org/10.1136/jnis-2025-024920","url":null,"abstract":"<p><strong>Background: </strong>Bilateral ischemic manifestations in Moyamoya disease (MMD) pose substantial therapeutic challenges, particularly in cases characterized by heterogeneous cerebrovascular involvement where one hemisphere presents with complete occlusion while the contralateral side exhibits severe stenosis. Contemporary treatment paradigms frequently prove inadequate in addressing this complex clinical scenario, often failing to achieve optimal revascularization outcomes and long-term symptom management.</p><p><strong>Objective: </strong>To perform a preliminary evaluation of the efficacy and safety of a hybrid surgical strategy in adults with bilateral ischemic MMD.</p><p><strong>Methods: </strong>Eight adult patients (mean age 39±12.2 years) were treated. The occluded hemisphere underwent direct/combined bypass, while the stenotic side received endovascular balloon angioplasty. Perioperative imaging (CT/MR/ultrasound) and clinical/magnetic resonance angiography (MRA) follow-ups were performed.</p><p><strong>Results: </strong>The surgical success rate was 100%. One patient required emergency stenting for an acute dissection post-angioplasty but recovered well. No other perioperative infarctions occurred (one case of delayed occlusion on the expanded side with new infarction). During follow-up, one patient developed ischemic symptoms with stenosis progression on the angioplasty side, necessitating subsequent bypass. The remaining six patients remained symptom-free. Postoperative digital subtraction angiography (DSA) in four patients confirmed excellent revascularization (Grade A/B) without worsening stenosis.</p><p><strong>Conclusion: </strong>A hybrid surgical approach combining bypass surgery and balloon angioplasty may offer a viable treatment option for bilateral MMD.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774209","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":"Refining endovascular thrombectomy for large vessel occlusion in active cancer: predictors of death despite successful recanalization.","authors":"Hyung Jun Kim, Jong-Won Chung, Tae-Jin Song, Jin-Soo Lee, Ronda Lun, Parshva Shah, Aroosa Zamarud, Gregory W Albers, Benjamin Teasdale, Keon-Ha Kim, Wook Kim, Woo-Keun Seo, Pyoung Jeon, Gyeong-Moon Kim, Oh Young Bang","doi":"10.1136/jnis-2026-025203","DOIUrl":"https://doi.org/10.1136/jnis-2026-025203","url":null,"abstract":"<p><strong>Background: </strong>Endovascular thrombectomy (EVT) in large vessel occlusion (LVO) with active cancer remains uncertain due to poor outcomes. This retrospective cohort study aimed to identify predictors of (1) early post-stroke death and death despite successful recanalization (SR) and (2) favorable outcomes among survivors.</p><p><strong>Methods: </strong>We analyzed 153 patients with active cancer and EVT-eligible LVO from four tertiary stroke centers (2017-2024). We performed an exploratory 1:1 propensity score-matched comparison of EVT versus non-EVT management, as well as separate analyses of the EVT-treated cohort. The primary outcome was death within 3 months despite SR (modified Thrombolysis in Cerebral Infarction (mTICI) 2b/3), while secondary outcomes included early post-stroke death and favorable functional outcome among 3-month survivors.</p><p><strong>Results: </strong>Propensity score matching (PSM) yielded a 1:1 matched cohort (non-EVT, n=30; EVT, n=30) with improved, though not perfect, covariate balance. In this exploratory matched cohort, EVT showed only a non-significant trend toward favorable outcome and was not associated with lower mortality. In the EVT-treated cohort, systemic metastasis and elevated D-dimer predicted early mortality. Among patients with SR, death despite SR occurred in 43% (37/86) and was associated with systemic metastasis and elevated D-dimer rather than procedural factors. Among 3-month EVT survivors, first-pass effect (FPE) was the only procedural factor independently associated with favorable functional outcome.</p><p><strong>Conclusions: </strong>In cancer-related LVO, EVT decisions should consider the risk of death despite SR based on metastasis and hypercoagulability. For patients with survival potential, achieving FPE is critical for favorable outcomes.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773057","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":"Current state of the field and recommendations for middle meningeal artery embolization in chronic subdural hematoma: A Report of the SNIS Standards and Guidelines Committee, Endorsed by ANZSNR and ESMINT.","authors":"Justin R Mascitelli, Ketan R Bulsara, Franklin A Marden, Daniel M S Raper, Matthew S Tenser, Fadi Al Saiegh, Ben Waldau, Steven W Hetts, Clemens Maria Schirmer","doi":"10.1136/jnis-2026-024979","DOIUrl":"https://doi.org/10.1136/jnis-2026-024979","url":null,"abstract":"<p><strong>Background: </strong>Middle meningeal artery embolization (MMAE) is increasingly being used for adjunctive and standalone treatment of chronic subdural hematoma (cSDH). The Society of NeuroInterventional Surgery (SNIS) Standards and Guidelines Committee set out to provide up-to-date recommendations on the use of MMAE for the treatment of cSDH.</p><p><strong>Methods: </strong>A structured literature review was performed pertinent to the use of MMAE. The strength and quality of evidence were graded according to established criteria. Recommendations were developed by consensus of the writing committee with input from the SNIS Standards and Guidelines Committee and the SNIS Board of Directors.</p><p><strong>Results: </strong>Highlighted recommendations are as follows. Recommendation 1: MMAE as an adjunct to surgical drainage is recommended to decrease the risk of recurrence requiring a further intervention and should be balanced against the risk of the procedure (class I, level A). Recommendation 2: standalone MMAE for cSDH in special circumstances/populations such as high-risk surgical patients, those with bleeding diathesis including thrombocytopenia or coagulopathy, or the elderly is reasonable (class IIa, level B-NR). Recommendation 3: practitioners should assess for dangerous collaterals prior to embolization (class I, level C-EO).</p><p><strong>Conclusions: </strong>The strongest recommendation currently is for MMAE as an adjunct to surgical drainage of cSDH to decrease the risk of recurrence. Ongoing studies will continue to address standalone MMAE, special populations, and technical nuances.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774237","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":"Distal embolic protection and procedural strategy in percutaneous transluminal angioplasty and stenting of very severe carotid stenosis.","authors":"Chi-Hsien Hsieh, Ching-Yu Sun, Kai-Wei Yu, Wei-An Tai, Ting-Yi Chen, Te-Ming Lin, Chung-Han Yang, Chih-Ping Chung, Jiing-Feng Lirng, Chia-Hung Wu, Feng-Chi Chang","doi":"10.1136/jnis-2026-025137","DOIUrl":"https://doi.org/10.1136/jnis-2026-025137","url":null,"abstract":"<p><strong>Background and purpose: </strong>Percutaneous transluminal angioplasty and stenting (PTAS) may result in periprocedural embolism. Distal embolic protection devices (dEPDs) are commonly used to mitigate this risk; however, their efficacy in patients with very severe carotid stenosis (VSCS) remains uncertain. In this study we evaluated the periprocedural clinical and MRI outcomes following PTAS in patients with VSCS.</p><p><strong>Methods: </strong>We retrospectively included patients with VSCS who underwent PTAS and had periprocedural brain MRI data. Patients were categorized into protected PTAS (P/PTAS) and unprotected PTAS (UP/PTAS) groups according to dEPD use. Recent embolic ischemic lesions (REILs) on diffusion-weighted imaging were quantified within the ipsilateral middle cerebral artery (MCA) territory and categorized by size (<5 or ≥5 mm). The incidence of periprocedural infarction and recurrent ischemic stroke and stent patency were evaluated.</p><p><strong>Results: </strong>Among 152 PTAS procedures, 106 were protected and 46 were unprotected. The number of REILs in the ipsilateral MCA territory (median (IQR) 0 (0-2) vs 1 (0-3); P=0.39) and the number of large REILs (≥5 mm) (median (IQR) 0 (0-0) vs 0 (0-1); P=0.14) were compared between groups. With respect to clinical outcomes over the 1-month follow-up period, significant in-stent restenosis occurred in eight of 106 (7.5%) protected procedures and one of 46 (2.2%) unprotected procedures, whereas recurrent ischemic stroke occurred in two of 106 (1.9%) protected procedures and 0 of 46 (0%) unprotected procedures (P=0.28 and P=1.00, respectively).</p><p><strong>Conclusion: </strong>In patients with VSCS undergoing PTAS, dEPD should be used when anatomically feasible. When protection cannot be safely deployed, an unprotected anatomy-adapted approach with careful lesion crossing and conservative angioplasty is an acceptable alternative.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774166","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":"Emergent carotid stenting during stroke endovascular treatment using the CARESTO heal stent: a multicenter experience.","authors":"Gabriel Broocks, Mohammad Almohammad, Karsten Alfke, Daniel Pielenz, Jannis Terrahe, David Fiorella, Andre Kemmling, Donald Lobsien, Joachim Klisch","doi":"10.1136/jnis-2026-024964","DOIUrl":"https://doi.org/10.1136/jnis-2026-024964","url":null,"abstract":"<p><strong>Purpose: </strong>Acute ischemic stroke due to tandem or cervical internal carotid artery (ICA) lesions is increasingly encountered, and the optimal carotid stent platform for emergent intervention remains uncertain. The aim of this study was to evaluate the technical feasibility, safety, and early outcomes of the CARESTO heal stent (Acandis GmbH, Pforzheim, Germany), the first coated carotid stent, in patients with acute ischemic stroke and extracranial ICA lesions undergoing endovascular treatment.</p><p><strong>Methods: </strong>We retrospectively analyzed consecutive patients with acute ischemic stroke and tandem occlusion, dissection, or acute-on-chronic extracranial ICA stenosis who underwent mechanical thrombectomy with concomitant CARESTO implantation at four centers between June 2024 and June 2025. Clinical, imaging, and procedural data were collected, and outcomes were summarized descriptively.</p><p><strong>Results: </strong>Ninety-two patients (mean age 63.2 years) were treated. CARESTO deployment in the cervical ICA was technically successful in all cases, with median post-stenting residual stenosis of 8% (IQR: 0-14). Successful intracranial reperfusion (mTICI ≥2 b) was achieved in 95.7% of patients, with neurological improvement (median National Institutes of Health Stroke Scale (NIHSS) 12, IQR: 8-16 at baseline to 4, IQR: 2-6 at 24 hours). At discharge, 44.9% of patients had a Modified Rankin Scale (mRS) score of 0-2 and 73.0% an mRS score of 0-3; in-hospital mortality was 5.4%. Symptomatic intracranial hemorrhage occurred in 7.6% and early in-hospital stent occlusion prior to discharge in 1.1%.</p><p><strong>Conclusion: </strong>Emergent carotid stenting with the CARESTO heal stent for acute ICA lesions was technically feasible, achieved high reperfusion rates, and showed an acceptable early safety and patency profile, supporting CARESTO as a promising option that warrants further comparative evaluation.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774154","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":"Safety and efficacy of the Saccular Endovascular Aneurysm Lattice (SEAL) system for the treatment of wide neck bifurcation aneurysms: final 12 month results from the primary subgroup analysis of the Pre-SEAL First-in-Human Interventional Trial (Pre-SEAL IT).","authors":"Boris Pabón Guerrero, Victor Torres, Alexander Copelan, Syed F Zaidi, Hisham Salahuddin, Manuel Patiño, Andres Zapata, Jorge Mútis, Margarita Cardozo, Ammad Hussain, Irfan Lutfi, Muhammad Ali, Saima Ahmed, Edgard Pereira, Aamir Badruddin, Keith Woodward, Michael J Alexander, Alejandro Tomasello, James Caldwell, Thomas J Wolfe, Brian Jankowitz, David Altschul, Darwin Ramirez-Abreu, Amit Chaudhari, Osama O Zaidat","doi":"10.1136/jnis-2026-025160","DOIUrl":"https://doi.org/10.1136/jnis-2026-025160","url":null,"abstract":"<p><strong>Introduction: </strong>Intrasaccular flow disrupters (IFDs) are increasingly used in endovascular management of intracranial wide neck bifurcation aneurysms (WNBAs). The next generation Saccular Endovascular Aneurysm Lattice (SEAL) system is a self-expanding, dual layered, braided nitinol IFD available in two configurations (SEAL Arc and SEAL Base) without a lead-in marker band. This primary subgroup analysis of the Pre-SEAL First-in-Human Interventional Trial (Pre-SEAL IT; NCT05686733) reports the final clinical and angiographic outcomes of the SEAL system in the management of WBNAs before the investigational device exemption (IDE) pre-marketing approval US based pivotal trial.</p><p><strong>Methods: </strong>Pre-SEAL IT is a prospective, multicenter, single arm study, with US based independent imaging core lab adjudication. Primary safety endpoints were major periprocedural stroke, new subarachnoid hemorrhage, or neurologic death up to 12 months. Primary efficacy endpoints were complete (Raymond-Roy occlusion classification (RROC) 1 Woven EndoBridge occlusion scale (WOS) A or RROC 1 WOS B) or adequate occlusion (RROC 1 WOS A, RROC 1 WOS B, or RROC 2 WOS C) without parent artery compromise at 12 months.</p><p><strong>Results: </strong>13 WNBA aneurysms in 13 patients meeting similar inclusion and exclusion criteria to the Woven EndoBridge Intrasaccular Therapy (WEB-IT) IDE pivotal trial were included in this primary subgroup analysis. Technical success (device delivered and deployed as intended) was 100% (13/13). There were no major periprocedural strokes, new subarachnoid hemorrhages, or neurologic deaths. Independent core lab adjudication showed 11/13 patients (84.6%) achieved complete occlusion and 12/13 patients (92.3%) achieved adequate occlusion at 12 month follow-up.</p><p><strong>Conclusions: </strong>SEAL intrasaccular flow disruption showed high technical success, an acceptable safety profile, and encouraging 12 month occlusion rates in the treatment of WNBAs.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773948","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":"Angioscopic study of the major dural venous sinuses in human cadavers.","authors":"Yigit Can Senol, Adrian Liu, Nishanth Krishnan, Ali Haider, Atakan Orscelik, Prabhat Kumar, Nanditha Krishnan, Benjamin Cho, Panos Pardalidis, Matthew Robert Amans, Luis Savastano","doi":"10.1136/jnis-2025-024857","DOIUrl":"10.1136/jnis-2025-024857","url":null,"abstract":"<p><strong>Objective: </strong>Neurointerventional surgery is witnessing a growth in transvenous procedures by using endovascular devices and techniques developed, optimized, and used in the arterial system. However, major dural venous sinuses differ from arteries in their non-circular (often triangular) cross sectional geometry and in the multiple structures that protrude or cross their lumens, such as septations, false channels, ostia of draining veins (cortical and dural venous channels), intraluminal bands, and arachnoid granulations. To address this gap in the literature, we used the 'live' cadaver model previously developed and validated to study the anatomical phenotypes of intraluminal structures with angiography and high resolution angioscopy.</p><p><strong>Methods: </strong>The internal jugular veins (IJVs) of six head and neck human cadaveric specimens were catheterized, and a peristaltic pump was used to infuse 0.9% saline. Cerebral venograms, including two-dimensional and three-dimensional cone beam CT venograms, were performed by injecting iodinated contrast at the confluence of the major dural sinuses. Then, an angioscope was used to study the anatomical structures in the lumen of transverse/sigmoid sinuses (n=12) and superior sagittal sinuses (SSSs) (n=6). Angioscopic evaluation was done retrogradely through the IJVs and anterogradely by direct transcranial access through burr holes (at the anterior sagittal sinus and one on the torcular Herophili). Descriptive statistics were performed to evaluate anatomical structures.</p><p><strong>Results: </strong>In six cadaveric specimens, arachnoid granulations were identified in 10 of 12 transverse sinuses (83.3%), most commonly in the proximal (or medial) and middle segments, and less frequently in the distal (or lateral) segment. Arachnoid granulations were more often identified on the left side (6/6, 100%) than on the right (4/6, 66.7%). The SSS demonstrated septations in five of six specimens (83.3%), each containing two or more septa. Arachnoid granulations within the SSS were observed in five specimens (83.3%), typically clustered along the middle to posterior third. The transverse sinus contained an average of 3.0±0.9 of intraluminal bands per side, distributed nearly symmetrically (right 3.0±0.8; left 2.8±0.8). Ostial openings were identified along all segments of the SSS, with the highest concentration at the junction of the middle and posterior segments.</p><p><strong>Conclusions: </strong>The intraluminal anatomy of the major dural venous sinuses differed markedly from that of the cerebral arteries, underscoring its relevance for endovascular venous approaches. Crossing septations and bands, protruding arachnoid granulations, and ostia of venous branches were consistently identified. These structures may interact with devices and directly affect procedural safety and efficacy in endovascular venous interventions.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774195","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 perfusion imaging did not improve reliability of ASPECTS or collateral score in late-window large vessel occlusion stroke.","authors":"Anass Benomar, Robert Fahed, Abdelsimar Tan Omar, Christine Hawkes, Eef J Hendriks, Clare A Enriquez, Muneer Eesa, Grant Stotts, Hubert Lee, Shashank Nagendra, Alexandre Y Poppe, Célina Ducroux, Timothy R Lim, Karl Narvacan, Michael A Rizzuto, Afra Alfalahi, Hidehisa Nishi, Pragyan Sarma, Ze'ev Itsekson Hayosh, Katrina Ignacio, William Boisseau, Eduardo Pimenta Ribeiro Pontes Almeida, Mohammed A Almekhlafi, Geneviève Milot, Aviraj Deshmukh, Kislay Kishore, Donatella Tampieri, Jefffrey Z Wang, Abhilekh Srivastava, Daniel Roy, Federico Carpani, Nima Kashani, Claudia Candale-Radu, Nishita Singh, Maria Bres-Bullrich, Robert Sarmiento, Ryan T Muir, Carmen Parra-Fariñas, Stephanie D Reiter, Yan Deschaintre, Ravinder-Jeet Singh, Vivek Bodani, Aristeidis H Katsanos, Ronit Agid, Atif Zafar, Vitor M Pereira, Julian Spears, Thomas R Marotta, Pascal Djiadeu, Sunjay Sharma, Forough Farrokhyar, Jose Danilo Bengzon Diestro","doi":"10.1136/jnis-2026-025321","DOIUrl":"https://doi.org/10.1136/jnis-2026-025321","url":null,"abstract":"<p><strong>Background: </strong>The Alberta Stroke Program Early CT Score (ASPECTS) and CT angiography (CTA) Collateral Score (CS) are routinely used to estimate ischemic core burden and collateral status in acute ischemic stroke due to large vessel occlusion, but suffer from limited reliability. Whether automated CT perfusion (CTP) maps improve scoring consistency remains unclear.</p><p><strong>Objectives: </strong>To assess the reliability of these scores on non-contrast computed tomography (NCCT) and CTA among numerous raters, with and without access to automated perfusion maps, and their correlations with endovascular thrombectomy (EVT) decisions.</p><p><strong>Methods: </strong>Twenty-nine clinicians independently rated 60 imaging cases from 30 late-window stroke patients with large vessel occlusion, each presented twice: once using NCCT and CTA alone ('non-CTP cases'), and once with the addition of perfusion maps ('CTP cases'). Twenty-eight raters (97%) completed the survey twice. Inter- and intra-reliability was assessed using Gwet's AC1/2 coefficients (κ_G). Correlations with EVT decisions were evaluated using Cramer V.</p><p><strong>Results: </strong>Inter-rater reliability for ASPECTS was substantial and similar between non-CTP (κ_G = 0.65, 95% CI: 0.53 to 0.78) and CTP cases (κ_G = 0.64, 95% CI: 0.51 to 0.77). CS showed an almost perfect reliability in both scenarios (κ_G= 0.82 and 0.83). Intra-rater agreement was at least substantial. Dichotomizing ASPECTS as 0-2/3-10 improved reliability to almost perfect. ASPECTS strongly correlated with EVT decisions (V=0.80), whereas CS showed moderate correlation (V=0.56), both remaining similar with the addition of CTP (V=0.75 and 0.54, respectively).</p><p><strong>Conclusion: </strong>Automated perfusion imaging did not improve the reliability of ASPECTS or CS. Strong reliability was achieved with NCCT and CTA alone.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774169","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":"Middle meningeal artery infusion for headaches after aneurysmal subarachnoid hemorrhage: a pilot study.","authors":"Tongyu Zhang, Matias Luis Costa, Magdy Selim, Tao Hong, Peter Kan","doi":"10.1136/jnis-2025-024125","DOIUrl":"10.1136/jnis-2025-024125","url":null,"abstract":"<p><strong>Introduction: </strong>Headache is a common and disabling symptom after aneurysmal subarachnoid hemorrhage (aSAH), often requiring high-dose opioids. Meningeal inflammation and dural nociceptor activation may contribute. The middle meningeal artery (MMA), which supplies the dura, offers a route for targeted therapy.</p><p><strong>Objective: </strong>To evaluate whether dural infusion of lidocaine±dexamethasone during aneurysm embolization reduces pain and opioid use.</p><p><strong>Methods: </strong>Between February and June 2025, nine patients with aSAH (Hunt and Hess grade 1-2 with Visual Analog Scale (VAS) score ≥7 were prospectively assigned to: (1) lidocaine+dexamethasone (L+D, n=3), (2) lidocaine only (L, n=3), or (3) no infusion (Control, n=3). MMA infusion was performed during embolization using a standard microcatheter technique. VAS was recorded at baseline, immediately postoperatively, 4-24 hours, 7 days, and 1 month. Primary outcomes were pain reduction and opioid use (oral morphine equivalents, OME). Statistical comparisons used non-parametric tests.</p><p><strong>Results: </strong>Postoperative median VAS fell from 7.0 to 6.0 in Controls (14%), 8.0 to 2.0 in L+D (75%), 8.0 to 4.0 in L (50%) (pooled P=0.016). First-day pain burden: 31 (Control), 9 (L+D), 21 (L), 15 (pooled; P=0.012). Early subacute burden: 9 (Control), 5 (L+D), 7 (L), 6 (pooled; P=0.024). Late subacute: 6 (Control), 3 (L+D), 5 (L), 4 (pooled; P=0.029). Cumulative burden: 42 (Control), 16 (L+D), 30 (L), 23 (pooled; P=0.012). Median OME: 16.7 mg (Control), 5.6 mg (L+D), 0 mg (L), 2.8 mg (pooled). There were no complications.</p><p><strong>Conclusion: </strong>MMA infusion appears safe and may provide sustained, opioid-sparing pain relief after aSAH. Larger studies are needed to confirm efficacy and to optimize protocols.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145345744","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}