Journal of NeuroInterventional Surgery最新文献

{"title":"Prevalence of unruptured intracranial aneurysms (UIAs) examined in the trauma population.","authors":"Barrett Schwartz, Vincent Nguyen, Michael Barats, Mustafa Motiwala, Sean Himel, David M Weatherford, Violiza Inoa-Acosta, Nitin Goyal, Nickalus R Khan, Daniel Hoit, Lucas Elijovich, Adam S Arthur, Christopher Nickele","doi":"10.1136/jnis-2024-022154","DOIUrl":"10.1136/jnis-2024-022154","url":null,"abstract":"<p><strong>Background: </strong>Previous data on the prevalence of unruptured intracranial aneurysms (UIAs) vary widely, and studies based on these data are plagued with unintentional bias. Accurate prevalence data are paramount for any physician who counsels patients with intracranial aneurysms on rupture risk and treatment. We therefore sought to determine a more accurate number for the true prevalence of UIAs.</p><p><strong>Methods: </strong>A retrospective chart review was conducted at a level 1 trauma center and tertiary care hospital in an urban setting between 2019 and 2020. Inclusion criteria included patients admitted with blunt trauma. Exclusion criteria included not having a head and neck CTA performed and read by an attending radiologist. All head and neck CTA radiology reads were reviewed for incidentally discovered UIAs. Subgroup analysis was performed by age group, race, and gender.</p><p><strong>Results: </strong>A total of 5978 out of 8999 patients met the inclusion criteria, and 54 patients with 58 total aneurysms were identified giving an overall prevalence of 0.9%. Subgroup analysis was performed for all age groups, genders, and racial groups.</p><p><strong>Conclusion: </strong>The overall aneurysm prevalence was found to be 0.9% in this sample. This rate is lower than rates previously cited in the literature and those quoted in local practice. This finding has significant implications when attempting to understand average rupture risk. Further studies are needed to power more subgroup analyses to use a more personalized approach to understanding an individual's risk of rupture.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"1066-1070"},"PeriodicalIF":4.3,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995870","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":"Prevalence of intracerebral thrombus detected by optical coherence tomography in patients with posterior circulation stroke or transient ischemic attack.","authors":"Ran Xu, Bin Yang, Tao Wang, Xiao Zhang, Tianhua Li, Yao Feng, Xiaofan Guo, Jinzhu Jia, Yan Ma, Adam A Dmytriw, Haibo Jia, Liqun Jiao","doi":"10.1136/jnis-2024-022002","DOIUrl":"10.1136/jnis-2024-022002","url":null,"abstract":"<p><strong>Background: </strong>The incidence of thrombosis in patients with intracranial atherosclerotic stenosis (ICAS) remains unclear. Optical coherence tomography (OCT) has the potential to explore the vessel wall structure of posterior-circulation ICAS because of its relatively straight anatomical structure compared with that of the anterior cerebral arteries. This study aimed to determine the prevalence and characteristics of thrombosis in the posterior-circulation ICAS using OCT.</p><p><strong>Methods: </strong>This prospective study was conducted on 135 patients with posterior-circulation arterial stenosis who underwent OCT. All patients were symptomatic and had a severely stenotic lesion (70-99%) in the vetebrobasilar artery. The enrolled patients were classified according to the presence of in situ thrombus as defined by OCT. Clinical data and OCT characteristics were compared.</p><p><strong>Results: </strong>Eighty-two patients diagnosed with posterior-circulation ICAS were enrolled. In situ thrombi were identified in 34 patients. Clinically, patients with in situ thrombus were more prone to cerebral infarctions than transient ischemic attacks. The percentage area of stenosis in the non-thrombus group was significantly lower than that in the thrombus group. The thrombus burden, mean flow area, mean thrombus area, maximum lipid arc, and mean lumen area were significantly different among white, red, and mixed thrombi.</p><p><strong>Conclusions: </strong>We achieved in vivo vessel wall structural analysis of posterior-circulation ICAS with the largest sample size. We also revealed the true incidence of in situ thrombosis and potential corresponding clinical events of posterior-circulation ICAS for the first time.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"1045-1050"},"PeriodicalIF":4.3,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008915","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":"Educational value of remote live-streamed training in endovascular thrombectomy: dose-response and mediation analysis.","authors":"Shujuan Gan, Jinfeng Miao, Zhiting Chen, Yan-Min Wu, Huaizhang Shi, Changming Wen, Ming-Zhu Huang, Jintao Chen, Jianhua Guan, Bingbo Zhuang, Hanrong Dong, Ruihan Zhu, Yuanxiao Li, Min Zhang, Jianmin Liu, Wen-Huo Chen, Tingyu Yi","doi":"10.1136/jnis-2025-023795","DOIUrl":"https://doi.org/10.1136/jnis-2025-023795","url":null,"abstract":"<p><strong>Background: </strong>Remote live-streamed training in endovascular thrombectomy (EVT) is a novel educational strategy. This study evaluated the dose-response relationship between training duration and clinical outcomes, and explored mediation pathways.</p><p><strong>Methods: </strong>In a prospective cohort study, 1046 participants received remote EVT training, with 1010 completing follow-up. Locally Estimated Scatterplot Smoothing (LOESS) and segmented regression identified training thresholds. Participants were categorized into low (<25 hours), medium (25-70 hours), and high (>70 hours) training groups. Inverse probability of treatment weighting (IPTW) was adjusted for baseline differences. Mediation analysis examined the mechanisms of effect.</p><p><strong>Results: </strong>A dose-response relationship was evident: outcome improvements accelerated after 25 hours and plateaued beyond 70 hours. After IPTW, patients treated by both medium and high training groups achieved significantly better 90-day outcomes compared with the low training group (medium vs low, adjusted β=1.54, 95% CI 0.94 to 2.15; high vs low, β=3.16, 95% CI 2.28 to 4.04, both P<0.001). Mediation analysis revealed that increased professional competency (25.0%), reduced recanalization time (32.8%), and higher recanalization rates (46.1%) partially explained the improved outcomes (all P<0.001). Sensitivity analyses supported these findings.</p><p><strong>Conclusion: </strong>Remote live-streamed EVT training is significantly associated with improved 90-day functional outcomes. The greatest benefits were observed after 25 hours of training and diminishing returns beyond 70 hours. These gains are partly mediated by enhanced professional competency and improved recanalization outcomes, highlighting the importance of structured, high-quality remote training programs for optimizing neurointerventional care.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033550","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":"Complex cervicocephalic artery dissections with wide intimal inlet: determinants and implications for endovascular recanalization.","authors":"Marc-Antoine Labeyrie, Roberta Partesano, Francesco Arpaia, Alexis Guedon, Lucas Di Meglio, Matteo Fantoni, Mathilde Aubertin, Peggy Reiner","doi":"10.1136/jnis-2025-023808","DOIUrl":"https://doi.org/10.1136/jnis-2025-023808","url":null,"abstract":"<p><strong>Background and purpose: </strong>Cervicocephalic artery dissection (CCAD) is a well-recognized cause of ischemic stroke. However, complex forms of CCAD, characterized by a wide intimal inlet without a visible intramural hematoma, pose diagnostic challenges and complicate endovascular access to the true lumen when recanalization is required. We aimed to analyze the clinical presentation, outcomes, and feasibility of endovascular treatment of complex CCAD and to propose a novel morphological classification.</p><p><strong>Methods: </strong>We retrospectively analyzed consecutive patients treated for acute CCAD at Lariboisière Hospital between 2012 and 2023. Simple CCAD was mainly defined by the presence of a classic intramural hematoma, and complex CCADs by an intraluminal flap. We compared both types using univariate analysis and binary logistic regression for clinical presentation and outcomes.</p><p><strong>Results: </strong>Among the 496 CCADs, 71 (14%; 95% confidence interval (CI): 11 to 17%) were complex. Compared with simple CCAD, complex cases were associated with older age, male sex, anterior circulation, iatrogenic cause, intracranial CCAD, vessel occlusion, and ischemic stroke (P<0.01). Complex CCAD was an independent risk factor for ischemic presentation (odds ratio (OR)=3.0; 95% CI:1.4 to 6.5, P=0.006), early ischemic recurrence (OR=2.0; 95% CI: 1.0 to 3.9, P=0.049), unfavorable outcome (OR=2.0; 95% CI: 1.0 to 5.0, P=0.051) and no recanalization at 3 months (OR=5.2; 95% CI: 2.4 to 11.5, P<0.001). Stenting, possibly combined with angioplasty and intimal fenestration, yielded the highest recanalization rates.</p><p><strong>Conclusion: </strong>Complex CCADs exhibit distinct morphology, clinical presentation, and outcomes compared with simple forms. Recognizing the different morphological subtypes may help optimize diagnosis and guide tailored endovascular strategies.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033570","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":"Intra-arterial human serum albumin therapy following mechanical thrombectomy for acute ischemic stroke: the AMASS pilot trial.","authors":"Kangjie Du, Shuling Liu, Thanh N Nguyen, Sihu Pan, Jean-Claude Baron, Yongbo Xu, Mohamad Abdalkader, Leilei Luo, Sifei Wang, Jian Chen, Yuchao Dou, Shuai Liu, Xunming Ji, Ming Wei","doi":"10.1136/jnis-2025-023998","DOIUrl":"https://doi.org/10.1136/jnis-2025-023998","url":null,"abstract":"<p><strong>Background: </strong>Despite successful mechanical thrombectomy (MT), approximately 50% of patients with large vessel occlusion (LVO) stroke experience poor outcomes due to reperfusion injury. Intra-arterial infusion of human serum albumin (HSA) may offer neuroprotective benefits; however, its safety and feasibility have not been established when delivered via the internal carotid artery. In this study we aimed to evaluate the safety and technical feasibility of HSA infusion through the guiding catheter placed during MT in patients with anterior circulation LVO stroke following successful reperfusion.</p><p><strong>Methods: </strong>We conducted a prospective, single-center, open-label, pilot trial evaluating intra-arterial infusion of 20% HSA immediately after MT in patients with anterior circulation LVO stroke. The study included a 3+3 dose-escalation and a dose-expansion phase. Eligible patients achieved successful reperfusion (modified Thrombolysis in Cerebral Infarction score ≥2b) and received HSA infusion via the guiding catheter. Safety endpoints included 90-day mortality, symptomatic intracranial hemorrhage (sICH), and serious adverse events. Post-hoc analyses explored infarct volume, immune markers, and proteomic/metabolomic signatures.</p><p><strong>Results: </strong>Between September 2023 and February 2024, 42 patients received intra-arterial HSA infusion. In the dose-escalation phase (n=27), two deaths and two mild infusion-related adverse events occurred, with no sICH. In the dose-expansion phase (n=15), one death and one case of sICH were reported, with no HSA-related adverse events. Post-hoc analysis showed that the HSA group had a significantly smaller infarct volume at 24 hours compared with controls.</p><p><strong>Conclusions: </strong>Intra-arterial infusion of 20% HSA in combination with MT is safe and feasible. Preliminary findings suggest a potential therapeutic benefit in reducing infarct volume.</p><p><strong>Trial registration number: </strong>NCT05953623.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023487","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":"Proximal Onyx embolization of the middle meningeal artery (POEM) technique for non-acute subdural hematomas: a single-center study of 123 patients using the Scepter dual-lumen balloon microcatheter.","authors":"Aliana Rao, Samuel L Ricci, Theodore C Hannah, Erin K M Graves, Anand Kaul, Eric T Quach, Rami O Almefty, Kadir Erkmen","doi":"10.1136/jnis-2025-023999","DOIUrl":"https://doi.org/10.1136/jnis-2025-023999","url":null,"abstract":"<p><strong>Objective: </strong>Non-acute subdural hematomas (NASDHs) often recur or persist, particularly among older patients with comorbidities. Middle meningeal artery embolization (MMAe) has emerged as a promising primary treatment alternative. Dual-lumen balloon microcatheters significantly reduce the risk of reflux, which is a limitation of single-lumen microcatheters. We evaluated the safety and efficacy of the proximal Onyx embolization of the MMA (POEM) technique using the Scepter Mini and Scepter XC balloon microcatheters.</p><p><strong>Methods: </strong>We conducted a single-center retrospective review of patients with NASDH undergoing Onyx MMAe with the Scepter Mini or Scepter XC microcatheter between July 2020 and January 2025. Demographics, imaging parameters (hematoma thickness, midline shift), procedural details, and clinical and radiographic outcomes were recorded.</p><p><strong>Results: </strong>123 patients underwent Scepter balloon-assisted MMAe. Their mean age was 72 years and 67.5% were male. At 6 months, 77.2% achieved ≥50% reduction in hematoma thickness. There were no significant differences in baseline demographics, hematoma characteristics, or surgical intervention rates between patients achieving ≥50% reduction and those with <50%. Five patients (4.1%) experienced recurrence, with average time to recurrence of 76 days. Only three patients (2.4%) required surgical rescue. Safety outcomes included 6.5% all-cause mortality at 180 days, with 1.6% directly related to NASDH. Stroke occurred in 1.6% at 30 days and 4.1% at 180 days.</p><p><strong>Conclusion: </strong>By minimizing the risk of reflux, balloon-assisted MMAe allows for safe embolization from a more proximal location. The POEM technique shows that proximal embolization with dual-lumen balloon microcatheters treats NASDH effectively, achieving substantial hematoma resolution with low recurrence. Prospective studies comparing POEM with other techniques are warranted to confirm its comparative efficacy.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006302","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":"Prediction of favorable outcomes of acute basilar artery occlusion using machine learning.","authors":"Yanqin Liu, Pengyu Lu, Raynald -, Yuanyue Lu, Wandi Liu, Xiuping Li, Peng Zhang, Tingting Song, Yaxuan Sun, Yi Liu, Bin Han","doi":"10.1136/jnis-2025-023347","DOIUrl":"https://doi.org/10.1136/jnis-2025-023347","url":null,"abstract":"<p><strong>Background: </strong>This study aims to develop an interpretable machine learning model using SHapley Additive exPlanations (SHAP) to predict favorable outcomes based on clinical, imaging, and angiographic data.</p><p><strong>Methods: </strong>This study analyzed data from 184 patients with acute basilar artery occlusion (BAO) who underwent endovascular treatment (EVT) and completed a 90-day follow-up at Shanxi Provincial People's Hospital. A total of 68 medical variables were collected to develop predictive models using three machine learning algorithms: logistic regression (LR), support vector machine (SVM), and Light Gradient Boosting Machine (LightGBM). Model performance was comprehensively assessed using Accuracy, Recall, Precision, F1 score, and the area under the receiver operating characteristic curve (AUC-ROC), and the best-performing model's results were interpreted using SHAP.</p><p><strong>Results: </strong>The SVM model demonstrated better performance, with an AUC of 0.899±0.059 (95% confidence interval (CI) 0.840 to 0.957), accuracy of 0.859±0.057, recall of 0.858±0.068, precision of 0.872±0.084, and an F1 score of 0.857±0.059. Recursive feature elimination with random forest (RF) and SHAP analysis revealed that the absence of ventilator use, absence of tracheotomy, lower National Institutes of Health Stroke Scale (NIHSS) scores at admission, and lower preoperative serum creatinine (SCR) levels were significant predictors of favorable 90-day outcomes.</p><p><strong>Conclusion: </strong>This study established a machine learning model to identify predictors of favorable outcomes in patients with acute BAO. Significant factors influencing prognosis included the use of mechanical ventilation, tracheotomy, NIHSS score, and preoperative SCR levels.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006254","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":"Composite arterial and venous collateral score on single-phase CTA predicts 90-day outcomes in anterior circulation large-vessel occlusion stroke.","authors":"Hamza Adel Salim, Dhairya A Lakhani, Janet Mei, Manisha Koneru, Aneri Balar, Meisam Hoseinyazdi, Shyam Majmundar, Dylan Wolman, Risheng Xu, Victor Urrutia, Elisabeth B Marsh, Thanh N Nguyen, Judy Huang, David S Liebeskind, Achala Vagal, Adam A Dmytriw, Adrien Guenego, Gregory W Albers, Hanzhang Lu, Kambiz Nael, Argye E Hillis, Rafael Llinas, Max Wintermark, Tobias D Faizy, Jeremy J Heit, Vivek Yedavalli","doi":"10.1136/jnis-2025-023904","DOIUrl":"https://doi.org/10.1136/jnis-2025-023904","url":null,"abstract":"<p><strong>Background: </strong>Collateral circulation influences clinical outcomes in patients with acute ischemic stroke due to anterior circulation large-vessel occlusion (LVO). While both arterial and venous collateral assessments on single-phase computed tomography angiography (CTA) have prognostic value, they have traditionally been evaluated independently.</p><p><strong>Purpose: </strong>We developed the CTA Collateral Impairment Score (CCIS), a composite measure incorporating arterial (Tan) and venous (Cortical Venous Opacification Score (COVES)) scores, and investigated its association with 90-day functional outcomes.</p><p><strong>Materials and methods: </strong>We conducted a retrospective cohort study including 1080 patients with anterior circulation LVO stroke across four comprehensive stroke centers. Patients were assigned a CCIS of 0 (preserved), 1 (moderate impairment), or 2 (severe impairment) based on predefined thresholds for Tan and COVES scores.</p><p><strong>Results: </strong>Favorable outcomes (modified Rankin Scale (mRS) score 0-2) occurred in 66% of patients with CCIS 0, 32% with CCIS 1, and 17% with CCIS 2 (P<0.001). Mortality increased with higher CCIS (11%, 25%, and 36% for CCIS 0, 1, and 2 respectively; P<0.001). In multivariable models, CCIS 0 and 1 were independently associated with greater odds of favorable outcomes compared with CCIS 2 (adjusted odds ratio (aOR) 5.77 (95% confidence interval (CI), 3.78 to 8.82) and 1.72 (95% CI, 1.14 to 2.60), respectively). CCIS also predicted mortality (aOR for CCIS 0 vs 2: 0.39 (95% CI, 0.25 to 0.61); P<0.001). The predictive performance of CCIS (area under the curve (AUC) 0.73) exceeded that of the Alberta Stroke Program Early CT Score (ASPECTS) and occlusion site and approximated National Institutes of Health Stroke Scale (NIHSS); inclusion of CCIS improved multivariable model discrimination (AUC 0.84).</p><p><strong>Conclusion: </strong>CCIS, a composite arterial and venous collateral score derived from single-phase CTA, was strongly and independently associated with 90-day outcomes in anterior circulation LVO stroke. Its integration into acute stroke imaging assessment may improve risk stratification and guide therapeutic decisions.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006264","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":"Development and validation of a nomogram for predicting 30-day outcomes in patients with unruptured vertebrobasilar dissecting aneurysms undergoing endovascular treatment: a multicenter cohort study.","authors":"Linggen Dong, Dachao Wei, Zizheng Wang, Jian Wang, Xiheng Chen, Mingtao Li, Yang Zhao, Yong Sun, Jun Feng, Guomin Xiao, Shengli Hu, Hongen Liu, Tian Tian, Geng Guo, Zhenmin Wang, Ming Lv","doi":"10.1136/jnis-2025-023974","DOIUrl":"https://doi.org/10.1136/jnis-2025-023974","url":null,"abstract":"<p><strong>Background: </strong>Endovascular treatment (EVT) of vertebrobasilar dissecting aneurysms (VBDAs) is associated with high morbidity and mortality, significantly influencing patient prognosis. This study aimed to develop and validate a nomogram for predicting 30-day outcomes in patients with unruptured VBDAs undergoing EVT.</p><p><strong>Methods: </strong>This retrospective study included 606 patients with unruptured VBDAs who underwent EVT at 10 institutions between January 2015 and April 2025, with 491 in the training cohort and 115 in the validation cohort. Poor outcome was defined as a modified Rankin Scale score ≥3. Predictors were identified via least absolute shrinkage and selection operator analysis and multivariable regression analysis. A nomogram was developed using these predictors. The predictive accuracy and clinical utility of the nomogram were evaluated using area under the curve (AUC), calibration curves, and decision curve analysis (DCA).</p><p><strong>Results: </strong>Over a 30-day follow-up, 44 patients (9.0%) in the training cohort and 13 patients (11.3%) in the validation cohort experienced poor outcomes. Multivariate logistic regression identified ischemic stroke history (OR 3.393, P=0.021), aneurysms located in the vertebrobasilar artery (OR 2.552, P=0.009), type IV VBDA (OR 1.762, P=0.013), overlapping devices (OR 2.736, P=0.007), and aneurysm width (OR 1.101, P=0.043) as predictors of 30-day poor outcome. A nomogram incorporating these predictors yielded AUCs of 0.851 (95% CI 0.784 to 0.918) and 0.860 (95% CI 0.722 to 0.999) in the training and validation cohorts, respectively. The calibration curve and DCA analyses validate the nomogram's clinical utility.</p><p><strong>Conclusion: </strong>The nomogram provides an individualized prediction of poor outcomes after EVT, serving as a practical risk assessment tool for patients with unruptured VBDAs.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006305","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":"Intracranial aneurysm embolization using Penumbra fill and finish coils: 1-year results of a prospective, real-world, multicenter SURF study.","authors":"Clemens Maria Schirmer, Albert J Yoo, Alejandro M Spiotta, Ian Kaminsky, Amer Alshekhlee, Robert M Starke, Andrew Nicholson, Osama O Zaidat, Bradley Bohnstedt, Marios-Nikos Psychogios, Ryan Viets, Kaiz S Asif, Christopher J Stapleton, Alim P Mitha, Oded Goren","doi":"10.1136/jnis-2025-023633","DOIUrl":"https://doi.org/10.1136/jnis-2025-023633","url":null,"abstract":"<p><strong>Background: </strong>SURF was a prospective, multicenter, single-arm, observational study with core lab adjudication of radiographic data, assessing embolization of intracranial aneurysms (IAs) using WAVE Extra Soft Coils as part of SMART Coil System.</p><p><strong>Methods: </strong>Adults undergoing IA embolization with the SMART Coil System (Penumbra, Inc.) comprising <u>></u>75% of implanted coils and WAVE as the final finishing coil were enrolled at 43 global centers. Primary outcomes were adequate occlusion (Raymond-Roy Occlusion Classification, RROC I/II) at 1 year, serious adverse events (SAEs) within 24 hours, and device-related SAEs up to 7 days (or discharge).</p><p><strong>Results: </strong>A total of 572 patients (mean age 59.5 years, 72.6% female) were enrolled between November 2019 and August 2022. Among target IAs, 39.9% were ruptured, 78.7% saccular, 54.1% wide-necked, and 11.2% previously treated, with 37.1% located in the internal carotid artery and 30.6% in the anterior cerebral artery. The mean size was 6.6±3.45 mm. Unassisted coiling was used in 50.7% of cases. Adjunctive therapy included stent-assisted coiling (28.8%), balloon-assisted coiling (17.7%), and flow diverters or medications (5.6%). The mean packing density was 34%. RROC I/II was 87.4% immediately post-procedure and 92.4% at 1 year. The retreatment rate was 9.8%, and recanalization was 12.7% at 1 year. SAEs rate within 24 hours was 9.3%. Device-related SAEs occurred in 1.1% of patients. The rate of major ipsilateral stroke was 1.7%.</p><p><strong>Conclusion: </strong>Penumbra's WAVE coils resulted in high packing density and effective and durable embolization of IAs in a diverse, real-world population, supporting coiling as the standard of care for IA treatment.</p><p><strong>Trial registration number: </strong>NCT04106583.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000758","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}