Journal of NeuroInterventional Surgery最新文献

{"title":"Comparison between contact aspiration alone and combined thrombectomy for intracranial internal carotid artery occlusion: insights from SARA-3 registry.","authors":"Miguel Ramírez-Torres, Andrés Javier Barrios, Angel Calleja Bonilla, Joaquin Ortega-Quintanilla, Carlos Dominguez Rodriguez, Antonio Sagredo-Barra, Jose Díaz-Pérez, Amado Rodriguez-Benitez, Juan Garcia-Villanego, Alberto Martinez-Calvo, Jose-Luis Díaz-Valiño, Cristian Ormeño Anturiano, Carmen de la Rosa, Antonio Jesús Mosqueira, Rebeca Bermejo Garcés, Juan Chaviano, Isabel Bermúdez-Coronel, Carlos Pérez-García, Carlos Manuel Rodriguez-Paz, Carlos Hidalgo-Barranco, Franscisco Javier Maynar, Juan Vega-Villar, Juan David Molina-Nuevo, Víctor Maestro, Juan Manuel Sanchís-García, Oscar Balboa Arregui, Mario Martínez-Galdámez, Eñaut Garmendia Lopetegui, Marc Comas-Cufí, Josep Puig, Joaquín Zamarro, Pedro Navia","doi":"10.1136/jnis-2025-023955","DOIUrl":"https://doi.org/10.1136/jnis-2025-023955","url":null,"abstract":"<p><strong>Background: </strong>Acute intracranial internal carotid artery (ICA) occlusion lowers first-pass reperfusion rates and clinical outcomes. Aspiration catheter and stent-retriever thrombectomy (CA+SR) is becoming a first-line approach, but data on its performance versus contact aspiration alone (CA) in real-world practice using newer large-bore catheters are scarce. We compared angiographic and clinical outcomes between CA and CA+SR strategies for ICA occlusion.</p><p><strong>Methods: </strong>Patients with isolated intracranial ICA occlusion treated between January and December 2024 were included in this multicenter SARA-3 registry study. Patients were grouped by first-line technique (CA or CA+SR). We compared procedural times, angiographic outcomes (modified Thrombolysis in Cerebral Infarction (mTICI) score), and clinical outcomes (24-hour National Institutes of Health Stroke Scale (NIHSS) and 3 month modified Rankin Scale (mRS) scores).</p><p><strong>Results: </strong>Of 181 patients (median age, 74 years; 51% women), 53 received CA and 128 CA+SR. In CA, 75% achieved final recanalization (mTICI 2c-3) compared with 86% (CA+SR) (P=0.066), with similar procedural times and complications. No differences were found between 48% and 39% of patients who achieved first-pass mTICI 2b-3. The overall cohort had a 64% favorable outcome (mRS ≤2 at 3 months), with CA showing higher rates (70% vs 62%; P=0.4). Complete first-pass recanalization reduced symptomatic intracranial hemorrhages (ICH) and embolization but did not improve functional outcomes.</p><p><strong>Conclusion: </strong>With newer large-bore aspiration catheters, CA was comparable to CA+SR as a first-line technique for intracranial ICA occlusion, with similar recanalization rates and favorable clinical outcomes.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069772","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":"Impact of anxiety and mood disorders on elective flow diversion for unruptured intracranial aneurysms: propensity score-matched analyses of two large databases.","authors":"Huanwen Chen, Dhairya A Lakhani, Mihir Khunte, Matthew K McIntyre, Chiara Montemitro, Adam A Dmytriw, Sijin Wen, Vivek Yedavalli, Muhammed Amir Essibayi, Hamza Adel Salim, David Altschul, Ajay Malhotra, Marco Colasurdo, Dheeraj Gandhi","doi":"10.1136/jnis-2025-023929","DOIUrl":"https://doi.org/10.1136/jnis-2025-023929","url":null,"abstract":"<p><strong>Background: </strong>Anxiety and mood disorders (AMD) may impact the management and outcomes of patients with unruptured intracranial aneurysms (UIAs). This study investigates AMD's associations with utilization and outcomes of endovascular flow diversion (FD).</p><p><strong>Methods: </strong>This was a retrospective analysis of two databases - TriNetX and Nationwide Readmissions Database (NRD, 2020-2022). Patients with newly diagnosed UIA (Cohort 1, TriNetX) and those who underwent elective FD (Cohort 2, NRD) were identified and grouped into AMD and non-AMD controls; 1-to-1 propensity score matching (PSM) was performed to balance groups based on demographics and comorbidities. FD treatment rates within 5 years of UIA diagnosis (Cohort 1) and post-procedure outcomes of elective FD treatments (Cohort 2), including morbidity/mortality (discharge to rehabilitation/death) and stroke, were compared between AMD vs PSM controls.</p><p><strong>Results: </strong>Our search identified 207 198 patients with newly diagnosed UIA (Cohort 1) and 14 220 who underwent elective FD (Cohort 2); ~30% of patients had AMD in both cohorts. In Cohort 1, patients with AMD with newly diagnosed UIA (n=47 381) had significantly higher rates of FD treatment compared with PSM controls (1.9% vs 1.5%, hazard ratio (HR) 1.23 (95% confidence interval (CI) 1.10 to 1.37) p<0.001). In Cohort 2, patients with AMD who underwent elective FD (n=3832) exhibited higher rates of perioperative morbidity/mortality (8.0% vs 4.8%; odds ratio (OR) 1.73 (95% CI 1.23 to 2.44), p=0.002), post-discharge morbidity/mortality (HR 1.63 (95% CI 1.11 to 2.40), p=0.012), perioperative stroke (6.7% vs 4.7%; OR 1.44 (95% CI 1.06 to 1.95), p=0.021), and post-discharge stroke (HR 1.82 (95% CI 1.05 to 3.17), p=0.034) compared with PSM controls.</p><p><strong>Conclusion: </strong>Among UIA patients, AMD is associated with increased FD utilization and worse clinical outcomes following FD.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069754","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":"Stenting versus medical treatment alone for symptomatic intracranial artery stenosis: a preplanned pooled individual patient data analysis.","authors":"Tao Wang, Jichang Luo, Tianhua Li, Eyad Almallouhi, Peng Gao, Haozhi Gong, Xiao Zhang, Jie Wang, Taoyuan Lu, Yifan Yang, Renjie Yang, Zixuan Xing, Haibo Wang, Colin P Derdeyn, Liqun Jiao","doi":"10.1136/jnis-2024-022189","DOIUrl":"10.1136/jnis-2024-022189","url":null,"abstract":"<p><strong>Background: </strong>Whether the safety and efficacy of percutaneous transluminal angioplasty and stenting (PTAS) is significantly different from that of medical treatment alone for symptomatic intracranial arterial stenosis (ICAS) is debatable. A study was undertaken to determine the safety and efficacy of both treatments for symptomatic ICAS.</p><p><strong>Methods: </strong>This preplanned pooled individual patient data analysis included 400 participants treated with PTAS and 409 treated with medical treatment alone in two large multicenter randomized clinical trials (SAMMPRIS and CASSISS). Patients were treated with PTAS using a self-expanding stent or medical treatment alone. The primary outcome was stroke or death within 30 days, or ischemic stroke in the territory of the qualifying artery more than 30 days after enrollment.</p><p><strong>Results: </strong>Individual data were obtained for 809 patients, 451 from SAMMPRIS and 358 from CASSISS. 400 participants were randomly assigned to the PTAS group and 409 to the medical group. The risk of the primary outcome was not significant between the PTAS and medical groups (17.5% vs 13.2%; HR 1.37 (95% CI 0.96 to 1.95), P=0.08). However, the risk of stroke or death within 30 days was higher in the PTAS group (10.5% vs 4.2%; HR 2.62 (95% CI 1.49 to 4.61), P<0.001). Patients of white ethnicity (HR 1.97, 95% CI 1.17 to 3.31) and those with hyperlipidemia (HR 2.04, 95% CI 1.27 to 3.26) or a transient ischemic attack (TIA) (HR 2.19, 95% CI 1.08 to 4.45) were at higher risk for PTAS.</p><p><strong>Conclusions: </strong>PTAS poses an increased risk of short-term stroke/death and therefore is not advised as primary treatment for symptomatic ICAS. A balance exists between stroke risks and revascularization benefits. For patients with asymptomatic ICAS of white ethnicity and those with hyperlipidemia or a history of TIA, a thorough assessment is warranted before considering PTAS.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT00576693, NCT01763320.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"1032-1039"},"PeriodicalIF":4.3,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141988178","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":"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":"1051-1058"},"PeriodicalIF":4.3,"publicationDate":"2025-09-12","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":"Five-year results of the SCENT trial with Surpass flow diverters to treat large or giant wide-neck aneurysms.","authors":"Philip M Meyers, Alexander L Coon, Peter Kan, Aclan Dogan, Mark Bain, Babu G Welch, Koji Ebersole, Joost De Vries, Ajay K Wakhloo, Philipp Taussky, Paul Jenkins, Ricardo A Hanel","doi":"10.1136/jnis-2024-022977","DOIUrl":"10.1136/jnis-2024-022977","url":null,"abstract":"<p><strong>Background: </strong>One-year and 3-year outcomes for the SCENT trial have previously been reported. However, 5-year (long-term) clinical outcomes have not previously been described.</p><p><strong>Methods: </strong>In this multicenter prospective trial, 180 aneurysms in 180 subjects were treated with the Surpass flow diverter system across 26 sites. Patients were followed according to a standardized protocol at 1 month, 6 months, 1 year, 3 years, and 5 years. Aneurysm occlusion, in-stent stenosis, modified Rankin Scale (mRS) scores, and complications were recorded.</p><p><strong>Results: </strong>The 5-year clinical follow-up reported 119 subjects and nine deaths with a completion rate of 71.1%, with 5-year angiographic follow-up available in 82 of the surviving 171 patients (48%). Aneurysm occlusion (Raymond Class I) for those patients who underwent angiographic follow-up was 77.8% (91/117) and 90.2% (74/82) at 3 and 5 years. The primary effectiveness composite endpoint was achieved in 80.3% (57/71) of patients. The cumulative proportion of subjects experiencing new or worsening major ipsilateral stroke was 12.8% (23/180) at 36 months, with no new occurrences at 60 months. No late aneurysm ruptures occurred during the 5-year follow-up, and no additional retreatments occurred between 36 and 60 months. Between 3 and 5 years, 52 potential site-reported serious adverse events were sent to CEC for adjudication. Of these, nine were CEC-adjudicated to be serious and four were determined to be related to the procedure/device.</p><p><strong>Conclusions: </strong>Five-year findings demonstrate the long-term safety and effectiveness of the Surpass flow diverter for intracranial aneurysm treatment, supported by high occlusion rates and low rates of delayed adverse events in this study.</p><p><strong>Trial registration number: </strong>NCT01716117.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"1078-1082"},"PeriodicalIF":4.3,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular treatment effect in vertebrobasilar artery occlusion patients with posterior circulation Acute Stroke Prognosis Early CT Score (pc-ASPECTS) <6.","authors":"Pan Zhang, Zhixin Huang, Yingjie Xu, Wei Li, Xianjun Huang, Zhongkui Han, Huanhuan Luan, Yongkun Li, Yong Yang, Dengyue Zhai, Miaomiao Hu, Genpei Luo, Wen Sun","doi":"10.1136/jnis-2024-022115","DOIUrl":"10.1136/jnis-2024-022115","url":null,"abstract":"<p><strong>Background: </strong>Endovascular treatment (EVT) has revolutionized the standard treatment of vertebrobasilar artery occlusion (VBAO) with moderate infarct core, but its effectiveness in patients with a low posterior circulation Acute Stroke Prognosis Early CT Score (pc-ASPECTS) is unclear. This study aimed to assess EVT effects in VBAO patients with pc-ASPECTS <6.</p><p><strong>Methods: </strong>This retrospective study enrolled patients with VBAO within 24 hours of the estimated occlusion time at 65 stroke centers in a nationwide registration in China. The primary outcome was a favorable shift in the modified Rankin Scale (mRS) at 90 days. The secondary outcomes included a favorable outcome (mRS 0-3) and functional independence (mRS 0-2). Propensity score matching and inverse probability of treatment weighting were used to compare the outcomes of patients treated with EVT and those with best medical management.</p><p><strong>Results: </strong>A total of 431 patients with VBAO and pc-ASPECTS <6 were included. EVT was associated with a favorable shift in the mRS score at 90 days (OR 1.72, 95% CI 1.19 to 2.5), a higher probability of a favorable outcome (OR 1.66, 95% CI 1.02 to 2.74), and improved functional independence (OR 1.76, 95% CI 1.06 to 2.96). EVT also significantly reduced the risk of 90-day mortality (OR 0.62, 95% CI 0.40 to 0.96), but increased the risk of symptomatic intracranial hemorrhage (OR 2.76, 95% CI 1.06 to 8.58).</p><p><strong>Conclusion: </strong>The results of this study suggest that EVT may be a safe and effective treatment option for patients with VBAO and pc-ASPECTS <6. Further studies are needed to investigate the effect of EVT in patients with pc-ASPECTS <6 and to identify patients who may benefit from EVT.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"1040-1044"},"PeriodicalIF":4.3,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975900","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 'Intraoperative cerebral angiography reveals microsurgically occult sequelae of temporary clip application during elective cerebral aneurysm surgery' by Zeng <i>et al</i>.","authors":"Philipp Hendrix, Sina Hemmer, Clemens M Schirmer, Jeffrey D Oliver","doi":"10.1136/jnis-2024-022920","DOIUrl":"10.1136/jnis-2024-022920","url":null,"abstract":"","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"1134"},"PeriodicalIF":4.3,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927171","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":"System-level trends in ischemic stroke admissions after adding endovascular stroke capabilities in community hospitals.","authors":"Prateek Kumar, Sergio Salazar-Marioni, Saagar Dhanjani, Ananya Iyyangar, Rania Abdelkhaleq, Muhammad Bilal Tariq, Arash Niktabe, Anjan N Ballekere, Ngoc Mai Le, Hussain Azeem, Louise McCullough, Sunil A Sheth, Eunyoung Lee","doi":"10.1136/jnis-2024-022192","DOIUrl":"10.1136/jnis-2024-022192","url":null,"abstract":"<p><strong>Background: </strong>There is substantial interest in adding endovascular stroke therapy (EST) capabilities in community hospitals. Here, we assess the effect of transitioning to an EST-performing hospital (EPH) on acute ischemic stroke (AIS) admissions in a large hospital system including academic and community hospitals.</p><p><strong>Methods: </strong>From our prospectively collected multi-institutional registry, we collected data on AIS admissions at 10 hospitals in the greater Houston area from January 2014 to December 2022: one longstanding EPH (group A), three community hospitals that transitioned to EPHs in November 2017 (group B), and six community non-EPHs that remained non-EPH (group C). Primary outcomes were trends in total AIS admissions, large vessel occlusion (LVO) and non-LVO AIS, and tissue plasminogen activator (tPA) and EST use.</p><p><strong>Results: </strong>Among 20 317 AIS admissions, median age was 67 (IQR 57-77) years, 52.4% were male, and median National Institutes of Health Stroke Scale (NIHSS) was 4 (IQR 1-10). During the first 12 months after EPH transition, AIS admissions increased by 1.9% per month for group B, with non-LVO stroke increasing by 4.2% per month (P<0.001). A significant change occurred for group A at the transition point for all outcomes with decreasing rates in admissions for AIS, non-LVO AIS and LVO AIS, and decreasing rates of EST and tPA treatments (P<0.001).</p><p><strong>Conclusion: </strong>Upgrading to EPH status was associated with a 2% per month increase in AIS admissions during the first year post-transition for the upgrading hospitals, but decreasing volumes and treatments at the established EPH. These findings quantify the impact on AIS admissions in hospital systems with increasing EST access in community hospitals.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"1107-1112"},"PeriodicalIF":4.3,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11868459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebral venous pressures, sinus trans-stenosis gradients, and intracranial pressures are dramatically augmented by head position.","authors":"Kyle M Fargen, Jackson P Midtlien, Connor R Margraf, Angelina H Wiater, Paul A Marcet, Adnan H Siddiqui, Ferdinand Hui","doi":"10.1136/jnis-2024-022167","DOIUrl":"10.1136/jnis-2024-022167","url":null,"abstract":"<p><strong>Background: </strong>Cerebral venous pressures, sinus trans-stenosis gradients, and intracranial pressures are thought to be influenced by head position.</p><p><strong>Objective: </strong>To investigate the intracranial manifestations of these changes in patients with cerebral venous outflow disorders (CVD).</p><p><strong>Methods: </strong>A retrospective chart review was conducted on 22 consecutive adult patients who underwent diagnostic cerebral venography with rotational internal jugular vein (IJV) venography and superior sagittal sinus (SSS) pressure measurements in multiple head positions. Data on venous sinus pressures, IJV pressures, and lumbar puncture (LP) opening pressures (OP) were collected and analyzed.</p><p><strong>Results: </strong>The study found that 21 (96%) patients experienced increases in SSS pressures with head rotation, with a mean increase of 25.4%. Intracranial trans-stenosis gradients showed significant variability with head position. Additionally, LP OP measurements increased by an average of 44.3% with head rotation. Dynamic IJV stenosis was observed in all patients during rotational testing.</p><p><strong>Conclusion: </strong>Head position significantly affects cerebral venous pressures, trans-stenosis gradients, and intracranial pressures in patients with CVD or intracranial hypertension. These findings highlight the need for dynamic venography in the diagnostic evaluation of these conditions to better understand their pathophysiology and improve treatment strategies.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"1120-1126"},"PeriodicalIF":4.3,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145806","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":"Rupture risk assessment in cerebral arteriovenous malformations: an ensemble model using hemodynamic and morphological features.","authors":"Haoyu Zhu, Lian Liu, Shikai Liang, Chao Ma, Yuzhou Chang, Longhui Zhang, Xiguang Fu, Yuqi Song, Jiarui Zhang, Yupeng Zhang, Chuhan Jiang","doi":"10.1136/jnis-2024-022208","DOIUrl":"10.1136/jnis-2024-022208","url":null,"abstract":"<p><strong>Background: </strong>Cerebral arteriovenous malformation (AVM) is a cerebrovascular disorder posing a risk for intracranial hemorrhage. However, there are few reliable quantitative indices to predict hemorrhage risk accurately. This study aimed to identify potential biomarkers for hemorrhage risk by quantitatively analyzing the hemodynamic and morphological features within the AVM nidus.</p><p><strong>Methods: </strong>This study included three datasets comprising consecutive patients with untreated AVMs between January 2008 to December 2023. Training and test datasets were used to train and evaluate the model. An independent validation dataset of patients receiving conservative treatment was used to evaluate the model performance in predicting subsequent hemorrhage during follow-up. Hemodynamic and morphological features were quantitatively extracted based on digital subtraction angiography (DSA). Individual models using various machine learning algorithms and an ensemble model were constructed on the training dataset. Model performance was assessed using the confusion matrix-related metrics.</p><p><strong>Results: </strong>This study included 844 patients with AVMs, distributed across the training (n=597), test (n=149), and validation (n=98) datasets. Five hemodynamic and 14 morphological features were quantitatively extracted for each patient. The ensemble model, constructed based on five individual machine-learning models, achieved an area under the curve of 0.880 (0.824-0.937) on the test dataset and 0.864 (0.769-0.959) on the independent validation dataset.</p><p><strong>Conclusion: </strong>Quantitative hemodynamic and morphological features extracted from DSA data serve as potential indicators for assessing the rupture risk of AVM. The ensemble model effectively integrated multidimensional features, demonstrating favorable performance in predicting subsequent rupture of AVM.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"1089-1095"},"PeriodicalIF":4.3,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108287","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}