Journal of NeuroInterventional Surgery最新文献

{"title":"Additional outlet occlusion as an important factor in avoiding retreatment after transvenous embolization for cavernous sinus dural arteriovenous fistulas.","authors":"Satoshi Miyamoto, Wataro Tsuruta, Jun Isozaki, Daiichiro Ishigami, Hisayuki Hosoo, Yoshiro Ito, Aiki Marushima, Mikito Hayakawa, Yuji Matsumaru","doi":"10.1136/jnis-2024-021773","DOIUrl":"10.1136/jnis-2024-021773","url":null,"abstract":"<p><strong>Background: </strong>Transvenous embolization (TVE), such as selective shunt occlusion, is the first line treatment for cavernous sinus dural arteriovenous fistula (CSDAVF). Despite the favorable outcomes of TVE, some cases necessitating retreatment due to recurrence or incomplete occlusion persist. Given the physical, psychological, and financial burden of multiple treatments, understanding the predictive factors for recurrence, spontaneous occlusion, or retreatment is important. However, few reports have addressed these factors, complicating decision making regarding the need for retreatment. This study analyzed predictive factors for retreatment and spontaneous occlusion to offer new insights into CSDAVF management.</p><p><strong>Methods: </strong>This retrospective, observational study was conducted in two acute care hospitals. Patients aged 18-100 years undergoing endovascular treatment for CSDAVF from January 2011 to December 2022 were included.</p><p><strong>Results: </strong>Of 65 patients treated with TVE, 29 experienced immediate complete occlusion. Meanwhile, 22 of 36 patients with incomplete occlusion had spontaneous occlusion, and retreatment was performed in 20% of patients. Additional outlet occlusion was negatively associated with retreatment (P=0.046), and it tended to promote spontaneous occlusion (P=0.056). Favorable functional outcomes were observed in all patients, and approximately 94% of patients showed complete occlusion at the latest follow-up.</p><p><strong>Conclusion: </strong>TVE is an effective treatment for CSDAVF. Outlet occlusion, when immediate complete occlusion is unattainable, is important to reduce retreatment and promote spontaneous occlusion. Substantially reducing shunt flow, carefully assessing dangerous drainage routes, and closely monitoring the residual shunt are crucial for preventing intracranial hemorrhage when outlet occlusion is performed.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"717-724"},"PeriodicalIF":4.5,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141633761","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":"SOFIA Aspiration System as first-line Technique (SOFAST): a prospective, multicenter study to assess the efficacy and safety of the 6 French SOFIA Flow Plus aspiration catheter for endovascular stroke thrombectomy.","authors":"Dheeraj Gandhi, Huanwen Chen, Syed Zaidi, Daniel H Sahlein, Lucian Maidan, Kenneth Kreitel, Timothy R Miller, Scott Rahimi, Amer Al Shekhlee, Henry H Woo, Gabor Toth, Clemens Schirmer, Yince Loh, David Fiorella","doi":"10.1136/jnis-2024-021811","DOIUrl":"10.1136/jnis-2024-021811","url":null,"abstract":"<p><strong>Background: </strong>Mechanical thrombectomy (MT) is the standard of care for acute ischemic stroke (AIS) patients with large vessel occlusion (LVO). The SOFAST study collected clinical evidence on the safety and efficacy of the 6 French SOFIA Flow Plus aspiration catheter (SOFIA 6F) when used as first-line treatment.</p><p><strong>Methods: </strong>This was a prospective, multicenter investigation to assess the safety and efficacy of SOFIA 6F used for first-line aspiration. Anterior circulation LVO stroke patients were enrolled. The primary endpoint was the final modified Thrombolysis in Cerebral Infarction (mTICI)≥2b rate. Secondary endpoints included first-pass and first-line mTICI≥2b rates, times from arteriotomy to clot contact and mTICI≥2b, and 90-day modified Rankin Scale (mRS)≤2. First-line and final mTICI scores were adjudicated by an independent imaging core lab. Safety events were assessed by an independent clinical events adjudicator.</p><p><strong>Results: </strong>A total of 108 patients were enrolled across 12 centers from July 2020 to June 2022. Median age was 67 years, median National Institutes of Health Stroke Scale (NIHSS) was 15.5, and 56.5% of patients received intravenous thrombolytics. At the end of the procedure, 97.2%, 85.2%, and 55.6% of patients achieved mTICI≥2b, ≥2c, and 3, respectively. With SOFIA 6F first-line aspiration, 87.0%, 79.6%, and 52.8% achieved mTICI≥2b, ≥2c, and 3, respectively. After the first pass, 75.0%, 70.4%, and 50.9% achieved mTICI≥2b, ≥2c, and 3, respectively. Median times from arteriotomy to clot contact and successful revascularization were 12 and 17 min, respectively. At 90 days, 66.7% of patients achieved mRS≤2.</p><p><strong>Conclusions: </strong>First-line aspiration with SOFIA 6F is safe and effective with high revascularization rates and short procedure times.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"753-758"},"PeriodicalIF":4.5,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141468698","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":"10.1136/jnis-2025-023050","url":null,"abstract":"","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"671-672"},"PeriodicalIF":4.5,"publicationDate":"2025-06-16","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":"The fluid mechanics of aspiration thrombectomy.","authors":"Michael T Froehler, Bryan C Good","doi":"10.1136/jnis-2024-022780","DOIUrl":"10.1136/jnis-2024-022780","url":null,"abstract":"<p><p>Large vessel occlusion causing acute ischemic stroke is ideally treated with endovascular clot retrieval, which is increasingly being performed via direct aspiration thrombectomy. Successful aspiration thrombectomy depends on multiple tenets of fluid and solid mechanics, including the application of hydrostatic and hydrodynamic forces to lodged clots. These fundamental concepts predict factors that may increase efficacy in clot removal, and help to explain the differences in performance seen among varying aspiration techniques (remote vs direct), catheters (suction force increases with diameter), and vacuum sources (pump type, whether electrical or manual, should not have an impact on negative pressure). Cyclic aspiration is also predicted to show more substantial clot removal and ingestion than static aspiration due to the dynamic forces it imposes on elastic clots.In this paper we will review the basic scientific principles underlying the fluid mechanics of aspiration thrombectomy and explain the application of these principles in practice, to provide a more thorough understanding for the neurointerventional clinician.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"759-763"},"PeriodicalIF":4.5,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030458","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":"Hemorrhagic transformation in acute ischemic stroke: hemorrhagic subtypes and symptomatic intracranial hemorrhage.","authors":"Marie K Luff, Nicole Khezri, Salvador Miralbes, Bharath Naravetla, Alejandro M Spiotta, Christian Loehr, Mario Martínez-Galdámez, Ryan A McTaggart, Luc Defreyne, Pedro Vega, Osama O Zaidat, Lori Lyn Price, Rishi Gupta, Markus A Möhlenbruch, David S Liebeskind","doi":"10.1136/jnis-2024-021725","DOIUrl":"10.1136/jnis-2024-021725","url":null,"abstract":"<p><strong>Background: </strong>Few clinical studies perform detailed analyses of subtypes of intracranial hemorrhage (ICH) after mechanical thrombectomy (MT) used to treat acute ischemic stroke. Symptomatic intracranial hemorrhage (sICH) is a formidable complication of MT and is widely used in clinical trials as a safety outcome. However, variable definitions of sICH are used across clinical studies.</p><p><strong>Objective: </strong>To radiographically subcategorize post-MT ICH development within this large cohort and examine overlap with sICH. Second, to examine the agreement of this definition of sICH with local site-reported occurrences of sICH to see how sICH rates change with modifications of the definitions used.</p><p><strong>Methods: </strong>A large cohort of patients treated with MT for acute ischemic stroke (n=1395) was analyzed to (1) radiographically characterize hemorrhagic subtypes of intracranial hemorrhage (ICH) occurring after MT; (2) examine associations of hemorrhagic subtypes with sICH; and (3) compare core laboratory-adjudicated occurrences of sICH with site-reported sICH.</p><p><strong>Results: </strong>The overall rate of ICH was 552/1395 patients (39.6%), and the overall rate of sICH was 47/1395 (3.4%). The most common type of ICH was hemorrhagic infarction type 1 (HI1), which represented 45.3% of all ICH cases- followed by HI2 (31.5%) and subarachnoid hemorrhage (SAH, 29.2%). Parenchymal hematoma 2 (PH2) represented only 3.3% of all ICH cases. Of the PH2 hemorrhages, only 33.3% were determined to be symptomatic. Of sICH cases, the most common ICH subtypes were HI2 (48.9%) and SAH (38.3%). Comparison of sICH rates as determined by core laboratory adjudication versus local site-reported results showed that only 14 patients were identified as having sICH with both definitions, with 47 patients total with sICH according to one definition, but not the other.</p><p><strong>Conclusions: </strong>Results of this analysis demonstrate the radiographic subtypes of ICH and also highlight the limitations of variable criteria used to define sICH, suggesting that it might be appropriate to revisit how sICH is defined post-MT.</p><p><strong>Trial registration number: </strong>Clinical trial NCT03845491.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"673-682"},"PeriodicalIF":4.5,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141537901","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":"Adenosine-assisted embolization of cerebral arteriovenous malformations: a systematic review and meta-analysis.","authors":"Jhon E Bocanegra-Becerra, Filipi Fim Andreão, José Luis Acha Sánchez, Anuraag Punukollu, Leonardo B Oliveira, Krish Kuhar, Maria Eduarda Rodrigues Peixoto, Elizabet Taylor Pimenta Weba, Khaled Alhwaishel, Marcio Yuri Ferreira, Raphael Bertani, Miguel Angel Lopez-Gonzalez","doi":"10.1136/jnis-2024-021866","DOIUrl":"10.1136/jnis-2024-021866","url":null,"abstract":"<p><strong>Background: </strong>Cerebral arteriovenous malformations (AVMs) are complex lesions that can cause hemorrhagic stroke and significant neurological disability. Adenosine induces cardiac standstill and hypotension, which are thought to be useful during cerebral AVM embolization. Herein, we conducted a systematic review and meta-analysis of the technique's safety.</p><p><strong>Methods: </strong>Following PRISMA guidelines, four databases were queried for studies describing the use of adenosine-assisted embolization of cerebral AVMs. Adenosine-related intraoperative complications, permanent neurological outcomes, morbidity, and mortality assessed the technique's safety. Single proportion analysis under a random-effects model was performed. Heterogeneity was assessed using I² statistics, and publication bias was evaluated through funnel plot analysis and Egger's regression test.</p><p><strong>Results: </strong>Ten studies were included, involving 79 patients (55.7% male) with 79 AVMs (54.4% unruptured and 70.9% Spetzler-Martin grade III-V) who underwent 123 embolizations (80.4% and 5.9% under transarterial and transvenous approaches, respectively) with n-butyl cyanoacrylate (80.4%), ethylene vinyl alcohol (14.4%), or both (5.2%). The incidence of transient adenosine-related intraoperative complications was 0% (95% CI 0% to 3%, I²=24%). Besides, the incidence of adenosine-related morbidity, mortality, and permanent outcomes was 0% (95% CI 0% to 3%, I²=0%). During follow-up, good functional outcomes were reported for 64 patients (81%).</p><p><strong>Conclusions: </strong>Adenosine's effects on blood flow control can facilitate embolization and mitigate the risk of AVM rupture and embolic agent migration. Although current evidence stems from observational studies, the results of this meta-analysis suggest a safe drug profile due to minimal associated morbidity and mortality. Further research from larger randomized and controlled studies is warranted to attain a higher level of evidence.</p><p><strong>Prospero registry number: </strong>CRD42023494116.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"731-742"},"PeriodicalIF":4.5,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141468694","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":"Total brain volume is associated with severity of transverse sinus stenosis in idiopathic intracranial hypertension.","authors":"Derrek Schartz, Alan Finkelstein, Sajal Medha K Akkipeddi, Alex Kessler, Zoe Williams, Edward Vates, Erik F Hauck, Kyle M Fargen, Matthew T Bender","doi":"10.1136/jnis-2024-021938","DOIUrl":"10.1136/jnis-2024-021938","url":null,"abstract":"<p><strong>Background: </strong>Idiopathic intracranial hypertension (IIH) is a complex neurological condition characterized by symptoms of increased intracranial pressure of unclear etiology. While transverse sinus stenosis (TSS) is often present in patients with IIH, how and why it occurs remains unclear.</p><p><strong>Methods: </strong>IIH patients and a set of age-matched normal controls were identified from our single-center tertiary care institution from 2016 to 2024. Brain MRIs before treatment were computationally segmented and parcellated using FreeSurfer software. Extent of TSS on MR venograms was graded using the Farb scoring system. Relationship between normalized brain volume, normalized brain-to-CSF volume, and TSS was investigated. Multiple linear regression was conducted to investigate the association between continuous variables, accounting for the covariates body mass index, sex, and age.</p><p><strong>Results: </strong>In total, 84 IIH patients (mean age, 29.8 years; 87% female) and 15 normal controls (mean age, 28.1 years) were included. Overall, increasing/worsening TSS was found to be significantly associated with normalized total brain volume (p=0.018, R=0.179) and brain-to-CSF ratio volume (p=0.026, R=0.184). Additionally, there was a significant difference between controls and IIH patients with mild and severe stenosis regarding normalized total brain volume (ANCOVA, p=0.023) and brain-to-CSF ratio volume (ANCOVA, p=0.034). Likewise, IIH patients with severe TSS had a significantly higher brain-to-CSF volume compared with controls (p=0.038) and compared with IIH patients with mild TSS (p=0.038).</p><p><strong>Conclusions: </strong>These findings suggest that total brain volume is associated with extent of TSS, which may reflect extramural venous compression due to enlarged brain and/or venous hypertension with associated cerebral congestion/swelling.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"764-768"},"PeriodicalIF":4.5,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141498245","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":"Complete meningioma resolution following endovascular embolization of chronic subdural hematoma.","authors":"Ehsan Dowlati, Elyza Larson, Mark Tierney, Augusto E Elias, Bryan E Figueroa, Fazeel M Siddiqui, Aditya S Pandey","doi":"10.1136/jnis-2024-022015","DOIUrl":"10.1136/jnis-2024-022015","url":null,"abstract":"<p><p>We present the first reported case that describes the complete resolution of a meningioma following endovascular embolization. A man in his 70s who presented with gait abnormalities and recurrent falls was diagnosed with normal pressure hydrocephalus (NPH) and found to have a small incidental meningioma. Due to ventriculoperitoneal (VP) shunt placement for cerebrospinal fluid diversion, the patient developed a bilateral subdural hematoma (SDH) requiring evacuation and drain placement. The patient also underwent bilateral middle meningeal artery (MMA) embolization. During the embolization, the known right frontal meningioma was embolized as it was supplied by the right MMA. The patient remained neurologically stable after this procedure. His follow-up magnetic resonance imaging (MRI) 1 year and 2 years after the procedure demonstrated complete resolution of the meningioma.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"782-784"},"PeriodicalIF":4.5,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141498244","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":"First-in-human, real-time artificial intelligence assisted cerebral aneurysm coiling: a preliminary experience.","authors":"Osamu Masuo, Yuya Sakakura, Yoshiaki Tetsuo, Kana Takase, Shun Ishikawa, Kenichi Kono","doi":"10.1136/jnis-2024-021873","DOIUrl":"10.1136/jnis-2024-021873","url":null,"abstract":"<p><strong>Background: </strong>Neuroendovascular procedures require careful and simultaneous attention to multiple devices on multiple screens. Overlooking unintended device movements can result in complications. Advancements in artificial intelligence (AI) have enabled real-time notifications of device movements during procedures. We report our preliminary experience with real-time AI-assisted cerebral aneurysm coiling in humans.</p><p><strong>Methods: </strong>A real-time AI-assistance software (Neuro-Vascular Assist, iMed technologies, Tokyo, Japan) was used during coil embolization procedures in nine patients with an unruptured aneurysm. The AI system provided real-time notifications for 'coil marker approaching', 'guidewire movement', and 'device entry' on biplane fluoroscopic images. The efficacy, accuracy, and safety of the notifications were evaluated using video recordings.</p><p><strong>Results: </strong>The AI system functioned properly in all cases. The mean number of notifications for coil marker approaching, guidewire movement, and device entry per procedure was 20.0, 3.0, and 18.3, respectively. The overall precision and recall were 92.7% and 97.2%, respectively. Five of 26 true positive guidewire notifications (19%) resulted in adjustment of the guidewire back toward its original position, indicating the potential effectiveness of the AI system. No adverse events occurred.</p><p><strong>Conclusions: </strong>The software was sufficiently accurate and safe in this preliminary study, suggesting its potential usefulness. To the best of our knowledge, this is the first reported use of a real-time AI system for assisting cerebral aneurysm coiling in humans. Large scale studies are warranted to validate its effectiveness. Real-time AI assistance has significant potential for future neuroendovascular therapy.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"743-747"},"PeriodicalIF":4.5,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141288163","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":"Treatment modality for aneurysmal subarachnoid hemorrhage and risk of shunt dependent hydrocephalus and mortality: population based study.","authors":"Abdelsimar Tan Omar, Jose Danilo Bengzon Diestro, Julian Spears, Elisabetta Patorno","doi":"10.1136/jnis-2024-021852","DOIUrl":"10.1136/jnis-2024-021852","url":null,"abstract":"<p><strong>Background: </strong>Hydrocephalus is a significant contributor to morbidity following aneurysmal subarachnoid hemorrhage (aSAH). We aimed to investigate the association between primary treatment modality and the incidence of hydrocephalus requiring CSF diversion, using a target trial approach for causal inference.</p><p><strong>Methods: </strong>This cohort study used US administrative health claims data (Clinformatics Data Mart) and was conducted among aSAH patients undergoing primary treatment with either clipping or coiling, from January 1, 2004, to February 28, 2023. The primary outcome was hydrocephalus requiring CSF diversion surgery while the secondary outcome was mortality. Multivariable regression and 1:1 propensity score (PS) matching were used for confounder control. Crude and adjusted hazard ratios (HRs) with 95% CIs were calculated.</p><p><strong>Results: </strong>A total of 5816 patients (mean age 59 years; 72% women) undergoing clipping (n=1794) or coiling (n=4022) were included in the primary cohort. The 1:1 PS matched cohort had 1794 participants per arm. Clipping demonstrated higher hazards of shunt dependent hydrocephalus compared with coiling in both the multivariable Fine-Gray model (HR 1.39, 95% CI 1.19 to 1.62) and the PS matched cohorts (HR 1.39, 95% CI 1.16 to 1.66). Mortality analysis favored clipping in the crude analysis (HR 0.78, 95% CI 0.69 to 0.88) but leaned toward coiling after confounder adjustment (HR 1.13, 95% CI 1.00 to 1.29 in the multivariable model; HR 1.11, 95% CI 0.95 to 1.29 in the PS matched cohort).</p><p><strong>Conclusion: </strong>These findings suggest that coiling is associated with reduced hazards of shunt dependent hydrocephalus following aSAH compared with clipping, and provide valuable insights for shared decision making among clinicians and patients, in the context of conflicting evidence from smaller observational studies.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"703-710"},"PeriodicalIF":4.5,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141262059","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}