Journal of NeuroInterventional Surgery最新文献

{"title":"Development of physiologically relevant synthetic thrombus for use in visual analysis of in vitro mechanical thrombectomy device testing.","authors":"Holly Berns, Sophia Robertson, Kailey Lewis, Jesse Wells, Wyatt Clark, Timothy A Becker","doi":"10.1136/jnis-2024-021743","DOIUrl":"10.1136/jnis-2024-021743","url":null,"abstract":"<p><strong>Background: </strong>Ischemic stroke is a leading cause of death and significant long-term disability worldwide. Mechanical thrombectomy is emerging as a standard treatment for eligible patients. As clinical implementation of stent retrieval and aspiration thrombectomy increases, there is a need for physiologically relevant in vitro device efficacy testing. Critical to this testing is the development of standardized 'soft' and 'hard' synthetic blood clots that mimic the properties of human thrombi and are compatible with imaging technologies. Synthetic clots allow researchers to extract information regarding clot integration, model hemodynamics, and quantify the physics of thrombectomy.</p><p><strong>Methods: </strong>This work develops polyacrylamide and alginate-based synthetic clots that are compatible with particle image velocimetry (PIV) and radiographic imaging techniques while maintaining mechanical properties of 'soft' and 'hard' human clots. Dynamic mechanical analysis testing using an HR2-Rheometer demonstrates comparable mechanical properties to human clots previously tested by this research group and provided in existing literature.</p><p><strong>Results: </strong>The synthetic clots are formulated with either 0.5% w/v polyethylene microspheres for PIV visualization or 20% w/v barium sulfate for angiographic visualization, enabling real-time imaging of clot behavior during thrombectomy simulations. The soft formulation shows compressive and shear properties of ~12 kPa and 2-3 kPa, respectively. The hard clots are 3-4 times stiffer, with compressive and shear properties of 41-42 kPa and 8-9 kPa, respectively.</p><p><strong>Conclusion: </strong>Standardized synthetic clots offer a platform for reproducible device testing. This provides a greater understanding of mechanical thrombectomy device efficacy, which may lead to quantifiable advances in device development and eventual improved clinical outcomes.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"e388-e392"},"PeriodicalIF":4.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12129698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141860003","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":"Cumulative in-hospital radiation dose in patients with acute ruptured intracranial aneurysm: a comparative analysis evaluating the effect of radiation dose reducing efforts.","authors":"Ilah Shin, Minkook Seo, Ji Young Lee, Jinhee Jang, Kook-Jin Ahn, Woo Cheul Cho, David J Park, Yong Sam Shin, Jai Ho Choi, Bum-Soo Kim","doi":"10.1136/jnis-2025-023242","DOIUrl":"https://doi.org/10.1136/jnis-2025-023242","url":null,"abstract":"<p><strong>Background: </strong>The cumulative impact of radiation dose reduction strategies in acute hospital settings remains underreported. This study quantifies and compares cumulative radiation exposure in patients with ruptured intracranial aneurysms before and after implementing dose reduction strategies.</p><p><strong>Methods: </strong>This retrospective study included 166 patients with subarachnoid hemorrhage (SAH) due to ruptured intracranial aneurysms, comparing two time periods: pre-adjustment (July 2012-March 2013) and post-adjustment (January 2017-March 2022) of dose reduction strategies. Radiation doses from imaging modalities, including X-ray, computed tomography (CT), and angiography, were collected. Cumulative radiation dose (CRD) and cumulative effective dose (CED) were calculated and compared between the two periods.</p><p><strong>Results: </strong>Angiography accounted for the largest share of the CRD in clipping and coiling procedures (about 75% and 95%, respectively), whereas its contribution to the CED was lower in clipping and coiling procedures (about 20 and 60%, respectively), reflecting differences in radiation weighting for biological effects. Significant reductions in both mean CRD and CED were observed in the post-period for both clipping and coiling procedures, with reductions of approximately 40% and 30% in CRD (P<.001 and P=0.013) and 45% and 35% in CED (P< .001 and P=0.002), respectively.</p><p><strong>Conclusion: </strong>The implementation of radiation dose reduction strategies significantly decreased both cumulative radiation and effective doses, highlighting the importance of continuous optimization to enhance patient safety without compromising diagnostic and therapeutic efficacy.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187174","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 embolization for medically refractory pediatric epilepsy: a case series.","authors":"Risheng Xu, Ethan Srinivasan, Alice Hung, Ryan Patrick Lee, Liam Hughes, Emily Johnson, Connor Liu, Lisa R Sun, Ryan J Felling, Anne Comi, Siddarth Gupta, Sarah Kelley, Babitha Harida, Carl Stafstrom, Eric Kossoff, Christa Habela, Kristen Baranano, Joseph Scafidi, Sue Hong, Stacey Suskauer, George Jallo, Matthew Smyth, Aylin Tekes, Melike Guryildirim, Doris Lin, Alan Cohen, Monica S Pearl, Ahmad Marashly, Shenandoah Robinson","doi":"10.1136/jnis-2025-023265","DOIUrl":"https://doi.org/10.1136/jnis-2025-023265","url":null,"abstract":"<p><strong>Background: </strong>Endovascular embolization has been reported in limited case series and case reports as a minimally invasive option for managing refractory epilepsy, particularly in cases where traditional surgical interventions are high risk.</p><p><strong>Objective: </strong>To explores the feasibility, safety, and outcomes of endovascular embolization in pediatric patients with intractable epilepsy due to varied etiologies.</p><p><strong>Methods: </strong>This retrospective case series includes four pediatric patients with medically refractory epilepsy, who underwent staged endovascular embolization at a tertiary care center between 2022 and 2024. Patients were selected based on contraindications to conventional surgical approaches and failure of at least two anti-seizure medications. Outcome measures included seizure frequency reduction, functional improvements, and procedure-related complications. Follow-up duration ranged from 10 to 15 months after the last embolization.</p><p><strong>Results: </strong>The cohort included four patients aged 2 to 9 years, and a total of 12 embolization procedures were performed. Three patients achieved freedom from seizures, while one undergoing a palliative procedure showed meaningful improvement in seizure frequency. No patients required rescue surgery, and none experienced hydrocephalus or neurologically unexpected complications during the follow-up period. Postprocedural deficits were similar to functional hemispherectomy outcomes. Parents and clinicians reported substantial developmental and functional improvements across multiple domains.</p><p><strong>Conclusions: </strong>Endovascular embolization is a promising minimally invasive strategy for pediatric patients with refractory epilepsy, particularly when anatomical or medical considerations preclude traditional surgery. Further research is warranted to refine patient selection criteria and assess long-term efficacy compared with established surgical approaches. This series expands the potential applications of endovascular techniques in epilepsy management.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187175","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":"REcanalization of Distal Cerebral Vessels In Acute Stroke Using ApeRio (REVISAR).","authors":"Franziska Dorn, Jan Borggrefe, Kai Kallenberg, Marielle Ernst, Daniel Behme, Annette Foerschler, Christoph Kabbasch, Thomas Liebig, Bernd Turowski, Hannes Nordmeyer","doi":"10.1136/jnis-2024-022810","DOIUrl":"https://doi.org/10.1136/jnis-2024-022810","url":null,"abstract":"<p><strong>Background: </strong>Although recently presented randomized trials have failed to prove an overall benefit of mechanical thrombectomy (MT) for patients with medium vessel occlusions (MeVOs), questions remain unanswered, particularly regarding the technology and the role of dedicated small devices. This prospective multicenter, core lab reviewed registry study investigates the efficacy and safety of the APERIO Hybrid used as a first-line device for the treatment of MeVO patients.</p><p><strong>Methods: </strong>Data from all MeVO patients who underwent MT with the APERIO or APERIO Hybrid¹⁷ as a first-line technique were prospectively included. The primary endpoint was the successful recanalization (Thrombolysis In Cerebral Infarction (TICI) 2b/3) after up to three passes with the APERIO without the use of a rescue technique and without any symptomatic intracranial hemorrhage (ICH).</p><p><strong>Results: </strong>134 patients were enrolled from 10 stroke centers. The primary endpoint was reached in 97 patients (81.5%, 95% CI 74.5% to 88.5%). In patients who failed the primary endpoint, TICI 2b/3 was reached with 4 to 6 APERIO passes in 4 patients (3.3%) and with other techniques in 18 patients (15%). Overall recanalization success was 95.8%. TICI 2b/3 with APERIO Hybrid was achieved after the first pass in 76 patients (63.9%), in 23 (19.3%) after 2 passes, and in 1 patient (0.8%) after 3 passes. Modified Rankin Scale (mRS) 0-2 at 90 days was reached by 79.0% of the patients. Symptomatic ICH occurred in no patients, asymptomatic ICH in 16 (13.5%), and subarachnoid hemorrhage in 15 patients (12.6%).</p><p><strong>Conclusion: </strong>APERIO and APERIO Hybrid¹⁷ have been proven to be both safe and effective first-line devices for MT in MeVO stroke at different centers and with high rates of successful recanalization.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187185","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":"Efficacy and safety of a new mechanical balloon-based flow diverter in the treatment of intracranial aneurysms.","authors":"Jingwei Li, Wei Ni, Yiran Lu, Li Li, Chuan He, Chao Gao, Tianxiao Li, Xinjian Yang, Hongqi Zhang","doi":"10.1136/jnis-2025-023225","DOIUrl":"https://doi.org/10.1136/jnis-2025-023225","url":null,"abstract":"<p><strong>Background: </strong>Flow diverters (FDs) are the first-line treatment of intracranial aneurysms (IAs). A groundbreaking mechanical balloon-based FD device was developed to enhance the precise landing and deployment efficiency for FDs.</p><p><strong>Objective: </strong>To investigates the efficacy and safety of this innovative device in a prospective cohort.</p><p><strong>Methods: </strong>This study was a prospective multicenter observational study conducted between September 2019 and November 2021. Patients diagnosed with unruptured IAs and treated with this innovative FD device alone were included. The immediate implantation success rate, the successful aneurysm occlusion rate (Raymond I-II or OKM C-D), the complete occlusion rate (Raymond I or OKM D), and the parent artery stenosis rate (>50%) at follow-up were evaluated as the evaluation index of efficacy. The mortality rate, adverse events (AEs), neurological AEs, and serious adverse events (SAEs) were evaluated as the evaluation index of safety.</p><p><strong>Results: </strong>A total of 128 patients were included, and all of the FD deployments were successful (success rate reached 100%). At the 12-month mark, 91.4% (117/128) of patients achieved successful occlusion, 85.9% (110/128) achieved complete occlusion, and only 0.8% (1/128) exhibited parent artery stenosis >50% (without need for additional treatment). During the follow-up, there were no reported mortalities or cerebral hemorrhage, while 6 neurological adverse events (4.69%) and 4 SAEs (3.1%) were observed.</p><p><strong>Conclusions: </strong>The mechanical balloon-based FD showed a remarkable occlusion rate alongside minimal ischemic and hemorrhagic adverse events compared with existing FDs. This innovative mechanical balloon-based design may be an important direction for future FD design.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transarterial embolization for infants under 3 months of age with refractory seizures due to hemimegalencephaly: complication analysis and evolution of treatment strategy.","authors":"Monica S Pearl, Tayyba Anwar, Shani Israel, Lindsay Ruffini, Panagiotis Kratimenos, Kyle Spagnolo, Wei-Lang Chen, Madison Berl, William D Gaillard, Tammy N Tsuchida, Chima Oluigbo","doi":"10.1136/jnis-2025-023551","DOIUrl":"https://doi.org/10.1136/jnis-2025-023551","url":null,"abstract":"<p><strong>Background: </strong>Hemimegalencephaly (HME) is a rare, congenital brain malformation associated with drug-resistant seizures that are challenging to manage in young infants. Hemispheric surgery in infants <3 months of age carries increased risks of blood loss and complications due to the fragility of the immature brain parenchyma and cerebral vasculature. Transarterial embolization (TAE) has emerged from an adjunct to surgery to a potential alternative to hemispherectomy in a subset of HME patients.</p><p><strong>Objective: </strong>To review the safety, efficacy, and evolution of TAE performed in infants <3 months of age with medically refractory seizures due to HME.</p><p><strong>Methods: </strong>We retrospectively reviewed patient demographics, intraprocedural events, procedure-related complications, and epilepsy characteristics for all infants who underwent TAE between 2013 and 2024 at a single quaternary institution.</p><p><strong>Results: </strong>Thirteen patients underwent a total of 41 embolizations, with a mean age of 45.5±26.8 (range 10-99) days at first embolization. Procedure-related complications included femoral arterial occlusion (n=2), symptomatic intracranial hemorrhage resulting in progressive hydrocephalus requiring cerebrospinal fluid shunting (n=1), and non-target embolization (n=2). One mortality occurred from multifocal intraparenchymal hemorrhages due to post-procedure coagulopathy. Two patients developed delayed contralateral ischemic injury. Engel Class I (free of disabling seizures) was achieved in 72.7% (8/11) of patients, with a mean follow-up age of 4.4±3.6 (range 1.3-11.0) years.</p><p><strong>Conclusions: </strong>TAE is a potential alternative to hemispherectomy for refractory epilepsy due to HME in infants <3 months of age; however, technical and perioperative challenges remain important considerations. Optimizing patient selection and periprocedure care are critical factors to improve patient outcomes.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional outcomes in pediatric large vessel occlusion treated with endovascular treatment: results from Chinese Pediatric Ischemic Stroke Registry, a multicenter, prospective registry study.","authors":"Wanqiu Zhang, Bin Zhu, Mingyang Niu, Cuirong Duan, Jinghui Zhong, Yingjie Xu, Lulu Xiao, Qiankun Li, Xinfeng Liu, Wen Sun","doi":"10.1136/jnis-2025-023201","DOIUrl":"https://doi.org/10.1136/jnis-2025-023201","url":null,"abstract":"<p><strong>Background and purpose: </strong>Endovascular treatment (EVT) has become the standard of care for selected adult patients with large vessel occlusion (LVO), but its efficacy in pediatric patients remains limited. This study aimed to assess the clinical outcomes of EVT in pediatric patients with LVO and compare it with medical management.</p><p><strong>Methods: </strong>The Chinese Pediatric Ischemic Stroke Registry (CPISR) is a multicenter, prospective observational study. Eighty-five centers across 20 provinces in China reported functional outcomes for children aged between 28 days and 18 years presenting with arterial ischemic stroke (AIS) caused by LVO who received either EVT or medical treatment. The primary outcome was the pediatric modified Rankin Scale (mRS) score at 90 days. Secondary outcomes included excellent outcome (pediatric mRs 0-1), favorable outcome (pediatric mRs 0-2) and 90-day mortality. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were employed to address imbalances across groups. A meta-analysis integrating the currently available evidence was performed to systematically compare the two groups.</p><p><strong>Results: </strong>In this study, 64 patients with LVO were finally included in this analysis. After PSM, EVT was associated with increased odds of improved shift pediatric mRS scores (OR 3.20, 95% CI 1.03 to 9.97) and excellent outcome (OR 10.0, 95% CI 1.10 to 90.59). There was no significant difference in 90-day mortality between EVT and medical management groups (OR 1.70, 95% CI 0.10 to 28.43). Meta-analysis also demonstrated the superiority of EVT over medical treatment, showing better mRS shift at 90 days (OR 2.56, 95% CI 1.44 to 4.54), a high possibility of excellent outcome (OR 4.44, 95% CI 1.90 to 10.33) and favorable outcome (OR 2.16, 95% CI 1.15 to 4.05).</p><p><strong>Conclusion: </strong>This matched-control study and meta-analysis showed that EVT was associated with better functional outcomes in pediatric patients with LVO. These findings support the use of EVT as a treatment approach for pediatric patients with LVO.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recognizing bilateral sudden hearing loss as a sentinel sign of basilar artery occlusion: insights from endovascular case series.","authors":"Yijun Suo, Meixia Yin, Zhongbin Xia, Xiangbin Wu, Xiaoping Yin, Bing Bao","doi":"10.1136/jnis-2025-023451","DOIUrl":"https://doi.org/10.1136/jnis-2025-023451","url":null,"abstract":"<p><strong>Objective: </strong>To improve early diagnosis of patients who have basilar artery occlusion (BAO) and to provide evidence for treatment decisions based on clinical characteristics, treatment strategies, and prognostic outcomes of cases of bilateral hearing loss as a prodromal symptom.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of six patients who had BAO with an initial symptom of hearing loss. This analysis encompassed demographic data, clinical symptoms, examination findings, treatment approaches, and prognostic outcomes.</p><p><strong>Results: </strong>Six patients (mean age 62±16.5 years) presented with bilateral sudden hearing loss and were diagnosed with proximal BAO. All had subtle initial symptoms, leading to diagnostic delays (mean 13 ± 5.4 hours). Five underwent endovascular treatment (EVT), and all patients required rescue balloon angioplasty because of underlying atherosclerotic stenosis. Intravenous tirofiban was administered perioperatively. At discharge, hearing had normalized in four patients; one patient (patient 3) had persistent profound bilateral sensorineural hearing loss. The patient who did not undergo EVT (patient 6) died on day 5 of hospitalization. At 90 days, five EVT-treated patients achieved favorable functional outcomes (modified Rankin Scale score 0-1). Univariate analysis did not show statistically significant differences between outcome groups in baseline National Institutes of Health Stroke Scale (NIHSS) score, posterior circulation Alberta Stroke Program Early CT score, onset-to-arrival time, or age, although patients with unfavorable outcomes tended to be older and have higher NIHSS scores.</p><p><strong>Conclusions: </strong>Sudden bilateral hearing loss should serve as a critical warning sign of BAO, a potentially life-threatening condition. Without rapid intervention, such as intravenous thrombolysis or EVT to re-establish perfusion, the occlusion may progress, leading to severe and potentially fatal outcomes.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arterial collateral status and treatment effect of intravenous alteplase thrombolysis prior to endovascular treatment in patients with anterior circulation large vessel occlusion: prespecified analysis of the MR CLEAN-NO IV trial.","authors":"Wenjin Yang, Fabiano Cavalcante, Kilian M Treurniet, Manon Kappelhof, Agnetha A E Bruggeman, Lennard Wolff, Leon A Rinkel, Natalie E LeCouffe, Ivo G H Jansen, Aashish Venkatesh, Olvert A Berkhemer, Anouk van der Hoorn, Marieke E Sprengers, Bart J Emmer, Jonathan M Coutinho, Yvo B W E M Roos, Wim van Zwam, Robert van Oostenbrugge, Henk A Marquering, Charles B L M Majoie","doi":"10.1136/jnis-2025-023054","DOIUrl":"https://doi.org/10.1136/jnis-2025-023054","url":null,"abstract":"<p><strong>Background and purpose: </strong>Collateral blood flow to the affected cerebral territory in acute ischemic stroke may modify the effect of intravenous alteplase treatment (IVT) prior to endovascular treatment (EVT). We assessed whether an interaction effect between arterial collateral status, assessed by both a visual and quantitative collateral score (CS), and administration of IVT plus EVT was present in the MR CLEAN-NO IV trial.</p><p><strong>Methods: </strong>Baseline CT or MR angiography (CTA and MRA) from patients included in MR CLEAN-NO IV was assessed using both a visual and automated quantitative score for arterial collateral status. We included 526 patients with visual CS and 401 with quantitative CS in this prespecified analysis. The primary outcome was functional outcome measured as the modified Rankin Scale score at 90 days. Interaction terms of treatment allocation (IVT plus EVT vs EVT alone) and collateral scores were included in regression models to assess whether the treatment effect of IVT differed by arterial collateral status.</p><p><strong>Results: </strong>IVT plus EVT was not statistically significantly associated with better functional outcome compared with EVT alone (adjusted common odds ratio 1.14; 95% CI 0.84 to 1.55). There was no statistically significant modification of IVT treatment effect on functional outcome by either visual or quantitative CS (adjusted p-interaction=0.34; adjusted p-interaction=0.57, respectively).</p><p><strong>Conclusion: </strong>In the MR CLEAN-NO IV trial, we did not find evidence that arterial collateral status measured with a visual score or quantitative score can inform treatment decisions regarding IVT plus EVT for patients with acute ischemic stroke due to large vessel occlusion in the anterior circulation within 4.5 hours.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic value of the perfusion mismatch ratio in identifying intracranial atherosclerotic disease related occlusion.","authors":"Tingyu Yi, Zhi-Nan Pan, Lan Hong, Weifeng Huang, Ding-Lai Lin, Zhijiao He, Shuyi Liu, Shujuan Gan, Fenglong Lang, Yi-Ning Yang, Jinhua Ye, Huanghuang Chen, Dapeng Sun, Xin Cheng, Zhongrong Miao, Wen-Huo Chen","doi":"10.1136/jnis-2025-023205","DOIUrl":"https://doi.org/10.1136/jnis-2025-023205","url":null,"abstract":"<p><strong>Background: </strong>The ability to differentiate intracranial atherosclerotic disease (ICAD) related large vessel occlusion (LVO) from embolism is critical for stroke management. We hypothesized that the mismatch ratio derived from the automated computed tomography perfusion (CTP) could predict underlying ICAD.</p><p><strong>Methods: </strong>Patients with acute ischemic stroke (AIS) and LVO from prospective registry databases who underwent CTP were included in the derivation cohort (n=1100). The mismatch ratio, calculated as the ratio of the hypo-perfused volume to the infarct core volume by software, was defined. Receiver Operating Characteristic (ROC) analysis was performed to assess the predictive performance of the mismatch ratio for ICAD, and logistic regression analysis was used to identify independent predictors of LVO associated with underlying ICAD. External validation was conducted using cohorts from two other stroke centers (n=385).</p><p><strong>Results: </strong>In the derivation cohort, 390 patients were classified as ICAD and 720 as embolism. The ICAD group had a higher mismatch ratio (9.8 vs 3.6, P<0.001). The mismatch ratio outperformed age and National Institutes of Health Stroke Scale (NIHSS) score in predicting ICAD (area under the curve (AUC), 0.77 vs 0.36 vs 0.28, P<0.001). The ROC curve had a best cut-off of 7.1 for predicting ICAD, which was an independent predictor of ICAD-related occlusion (adjusted odds ratio (aOR) 5.43, 95% CI 3.68 to 8.03), with 68% sensitivity and 76% specificity. These results were validated in an external cohort (AUC=0.78; 95% CI, 0.73 to 0.83).</p><p><strong>Conclusion: </strong>The perfusion mismatch ratio may be an optimal and simple predictor of anterior circulation ICAD- related LVO before endovascular treatment (EVT). When this ratio was ≥7.1, ICAD was five times more likely than embolism.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}