Journal of NeuroInterventional Surgery最新文献

{"title":"Adjunctive intra-arterial thrombolysis after successful endovascular thrombectomy for large vessel occlusion: Meta-analysis of outcomes, dosage, and patient selection.","authors":"Ahmed Alkhiri, Fahad Alturki, Aser F Alamri, Hassan K Salamatullah, Ahmed A Almaghrabi, Hatoon Alshaikh, Abdulrahman Aljohani, Ammar Hakami, Anas M Alrohimi, Fahad S Al-Ajlan, Adel Alhazzani","doi":"10.1136/jnis-2025-023404","DOIUrl":"https://doi.org/10.1136/jnis-2025-023404","url":null,"abstract":"<p><strong>Background: </strong>Despite high recanalization rates with endovascular thrombectomy (EVT) for large vessel occlusions, functional outcomes remain suboptimal. This study investigates whether adjunctive intra-arterial (IA) thrombolysis following successful EVT can improve patient outcomes.</p><p><strong>Methods: </strong>A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. We searched Medline, Embase, Web of Science, and Cochrane databases. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for functional and safety outcomes.</p><p><strong>Results: </strong>Seven trials (2131 patients) were included. IA thrombolysis was administered to 1081 (50.7%) patients. Patients receiving adjunctive IA thrombolysis had higher odds of excellent functional outcomes (modified Rankin Scale (mRS) 0-1) at 90 days (OR 1.44, 95% CI 1.21 to 1.72) compared with the EVT-alone group while maintaining similar rates of symptomatic intracerebral hemorrhage (sICH; OR 1.15, 95% CI 0.75 to 1.75). Subgroup analysis of excellent functional outcomes showed that the benefits of IA thrombolysis were primarily observed in specific patient populations: those treated with alteplase 0.225 mg/kg or tenecteplase 0.125 mg/kg, patients with lower expanded Thrombolysis in Cerebral Infarction (eTICI) scores, higher initial National Institutes of Health Stroke Scale (NIHSS), and those with cardioembolic etiology. Mortality rates and good functional outcomes (mRS 0-2) remained comparable between treatment groups.</p><p><strong>Conclusion: </strong>Adjunctive IA thrombolysis following successful EVT may improve functional outcomes without added risk of sICH. Certain patient subgroups (those with lower recanalization rates, higher NIHSS, and cardioembolic etiology) and specific thrombolytic agents and dosages (alteplase 0.225 mg/kg, tenecteplase 0.125 mg/kg) appear to derive greater benefits from this approach. Further research is needed to validate these findings and refine patient selection.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144285005","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 perfused cadaveric model for neurovascular transradial access with insights from angiography and angioscopy.","authors":"Yigit Can Senol, Nishanth Krishnan, Mona Asghariahmadabad, Sarosh Irfan Madhani, Adrian Liu, Atakan Orscelik, Raghav Mattay, Woody Han, Matthew Robert Amans, Luis Savastano","doi":"10.1136/jnis-2025-023465","DOIUrl":"https://doi.org/10.1136/jnis-2025-023465","url":null,"abstract":"<p><strong>Background: </strong>The development of safe and effective endovascular devices is dependent on accurate simulation of anticipated use environments during preclinical testing. We sought to optimize and evaluate the human 'live cadaver' neurovascular model for the purpose of testing radial access catheters. We aimed to assess the realism of our model during simulated neurointerventional procedures as well as explore and characterize potential challenges of radial access catheters.</p><p><strong>Methods: </strong>A human 'live cadaver' model was developed from a cadaveric specimen consisting of the head, neck, bilateral upper limbs, and thorax. Catheters were inserted into the heart and thoracic aorta. Blood-mimicking fluid made by 0.7% carboxymethyl cellulose + 0.25% sodium propionate was circulated through the vasculature using an external peristaltic pump. Bilateral radial access was obtained using 7F sheaths. Experienced neurointerventionists (n=5) were provided with a questionnaire using a validated 5-point Likert scale and tasked with assessing the model's radial artery, aortic arch, and carotid/vertebral arteries on the parameters of anatomical accuracy, roadmap angiography, device manipulation, haptic feedback, comparison to clinical cases, radio-opacity of devices, and overall similarity to actual patients. Challenging mechanisms were identified and described by evaluation of fluoroscopic and endoscopic videos.</p><p><strong>Results: </strong>A total of six cadavers were used. Formalin-fixed arteries showed mechanical properties comparable to those of fresh human arteries, including maximum stretch and increased tensile strength/stiffness. The contrast angiographies revealed no obstruction in the micro- or macro-vasculature. Overall similarity scores for arms (radial, brachial, axillary, and subclavian arteries) were 34.6±2.3 out of 40, for aortic arch 30.3±5.4 out of 40, and for carotid/vertebral artery access 33.0±4.2 out of 40. We identified three distinct challenges associated with market radial access catheters: (1) torque build-up followed by sudden release and whipping; (2) catheter tip entry into ulcerated or nodular aortic atheroma preventing free motion; and (3) catheter catching at a septum-like structure at the medial edge of the brachiocephalic trunk; the latter two result in herniation of the system into the arch even with favorable aortic arch angles.</p><p><strong>Conclusions: </strong>The model provided a reliable and accurate human radial and aortic vasculature simulation, allowing for the evaluation of catheter performance and identification of challenging mechanisms likely to occur in clinical settings. These findings suggest that the modified human live cadaveric model could be a valuable testing platform to support the development of next-generation transradial systems for improved clinical performance.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144285006","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 Lattice flow diverter for the treatment of intracranial aneurysms: a single center experience in 117 consecutive aneurysms.","authors":"Haoyu Zhu, Jiarui Zhang, Lian Liu, Yupeng Zhang, Longhui Zhang, Xiguang Fu, Yuqi Song, Chuhan Jiang, Shikai Liang, Zhiqiang Yi","doi":"10.1136/jnis-2025-023615","DOIUrl":"https://doi.org/10.1136/jnis-2025-023615","url":null,"abstract":"<p><strong>Background: </strong>Flow diversion has revolutionized the management of intracranial aneurysms. This study aimed to evaluate the preliminary safety and efficacy profile of the novel Lattice flow diverter (LFD) in clinical applications.</p><p><strong>Methods: </strong>We retrospectively analyzed consecutive patients with intracranial aneurysms who were treated with the LFD between June 2023 and May 2024. Based on the medical records and imaging data, we collected demographic characteristics, aneurysm features, procedural details, perioperative complications, clinical outcomes, and imaging results.</p><p><strong>Results: </strong>This study comprised 105 patients (mean age, 55.4±9.04 years; 72.4% female) with 117 aneurysms, including 104 (88.9%) anterior circulation aneurysms. Procedural success was achieved in all patients (109 devices deployed). Adjunctive techniques included coiling in 39 aneurysms (33.3%) and balloon-assisted wall apposition in three cases (2.6%). The overall perioperative complication rate was 5.8%, with neurological complications (all ischemic events) occurring in 2.9% of cases. Clinical follow-up (mean 10.0±1.4 months) demonstrated preserved functional independence (modified Rankin Scale (mRS) score 0-2) in 98.0% of patients. Imaging follow-up (mean 6.6±1.6 months) revealed complete occlusion in 71.9% of aneurysms and adequate occlusion (Raymond-Roy class I/II) in 88.6%.</p><p><strong>Conclusion: </strong>The LFD demonstrated favorable safety and efficacy characteristics for intracranial aneurysm treatment during short-term follow-up. Long-term outcomes require validation in multicenter prospective cohort studies.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144285010","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":"Recommendations from the International Paediatric Stroke Organization on pediatric neurointerventional best practices based on Delphi consensus.","authors":"Kartik Dev Bhatia, Carmen Parra-Farinas, Kathleen Colao, Darren B Orbach, Todd Abruzzo, Adam Rennie, Peter B Sporns, Adam A Dmytriw, Heather Fullerton, Prakash Muthusami","doi":"10.1136/jnis-2025-023345","DOIUrl":"https://doi.org/10.1136/jnis-2025-023345","url":null,"abstract":"<p><p>Paediatric neurointervention (PNI) markedly differs from adult neuro-intervention, requiring highly subspecialized clinical skills, knowledge, and techniques. Minimum standards of practice are well established in adult neurointervention but are lacking in the field of PNI. We sought to develop expert consensus on best practices for neurointervention in children.Using a two-stage Delphi consensus model we sought expert opinions from PNI practitioners worldwide regarding best practices. A two-stage online de-identified survey of PNI practitioners was undertaken assessing opinions on a range of topics including minimum recommended caseloads for PNI centres. Minimum agreement rates of >60% were set to determine consensus on any specific question. Consensus opinions on best practices were reviewed by the International Paediatric Stroke Organization Executive Committee.For the first-stage survey there were n=50 responses and for the second-stage n=45 responses, with practitioners from all inhabited continents represented. Consensus-based best practices included: i) Elective endovascular therapeutic neuro-interventions should be performed in high-volume paediatric centres with an established multi-disciplinary paediatric neurovascular team, and ii) High-volume centres are those that undertake at least 20 paediatric endovascular therapeutic neuro-interventions annually. Paediatric thrombectomy in large-vessel occlusion stroke, an area of increasing interest and attention, poses unique time-sensitive multidisciplinary logistical challenges meriting a dedicated analysis, and as such is not within the purview of this report.Best practices for PNI reported here have been identified through expert consensus and are designed to enhance patient safety whilst providing appropriate clinical access to life-saving procedures.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275058","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":"Correspondence on \"Bigger isn't always better: response to 'Super-large bore catheter in the treatment of large vessel occlusions: initial multicenter experience'\".","authors":"Andres Gudino, Edgar A Samaniego","doi":"10.1136/jnis-2025-023708","DOIUrl":"https://doi.org/10.1136/jnis-2025-023708","url":null,"abstract":"","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275057","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":"Super-large bore catheter in the treatment of large vessel occlusions.","authors":"Federico Carpani, Eef J Hendriks, David Volders","doi":"10.1136/jnis-2025-023709","DOIUrl":"https://doi.org/10.1136/jnis-2025-023709","url":null,"abstract":"","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275059","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":"15 years of WEB embolization: a transformative journey in aneurysm treatment.","authors":"Laurent Pierot, Adam S Arthur, Christophe Cognard, Istvan Szikora, Hongqi Zhang, Jianmin Liu, David Fiorella, Laurent Spelle","doi":"10.1136/jnis-2025-023513","DOIUrl":"https://doi.org/10.1136/jnis-2025-023513","url":null,"abstract":"","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258276","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":"Predicting infarct outcomes after extended time window thrombectomy in large vessel occlusion using knowledge guided deep learning.","authors":"Lisong Dai, Lei Yuan, Houwang Zhang, Zheng Sun, Jingxuan Jiang, Zhaohui Li, Yuehua Li, Yunfei Zha","doi":"10.1136/jnis-2025-023355","DOIUrl":"https://doi.org/10.1136/jnis-2025-023355","url":null,"abstract":"<p><strong>Background: </strong>Predicting the final infarct after an extended time window mechanical thrombectomy (MT) is beneficial for treatment planning in acute ischemic stroke (AIS). By introducing guidance from prior knowledge, this study aims to improve the accuracy of the deep learning model for post-MT infarct prediction using pre-MT brain perfusion data.</p><p><strong>Methods: </strong>This retrospective study collected CT perfusion data at admission for AIS patients receiving MT over 6 hours after symptom onset, from January 2020 to December 2024, across three centers. Infarct on post-MT diffusion weighted imaging served as ground truth. Five Swin transformer based models were developed for post-MT infarct segmentation using pre-MT CT perfusion parameter maps: BaselineNet served as the basic model for comparative analysis, CollateralFlowNet included a collateral circulation evaluation score, InfarctProbabilityNet incorporated infarct probability mapping, ArterialTerritoryNet was guided by artery territory mapping, and UnifiedNet combined all prior knowledge sources. Model performance was evaluated using the Dice coefficient and intersection over union (IoU).</p><p><strong>Results: </strong>A total of 221 patients with AIS were included (65.2% women) with a median age of 73 years. Baseline ischemic core based on CT perfusion threshold achieved a Dice coefficient of 0.50 and IoU of 0.33. BaselineNet improved to a Dice coefficient of 0.69 and IoU of 0.53. Compared with BaselineNet, models incorporating medical knowledge demonstrated higher performance: CollateralFlowNet (Dice coefficient 0.72, IoU 0.56), InfarctProbabilityNet (Dice coefficient 0.74, IoU 0.58), ArterialTerritoryNet (Dice coefficient 0.75, IoU 0.60), and UnifiedNet (Dice coefficient 0.82, IoU 0.71) (all P<0.05).</p><p><strong>Conclusions: </strong>In this study, integrating medical knowledge into deep learning models enhanced the accuracy of infarct predictions in AIS patients undergoing extended time window MT.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248319","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 pressure is affected by head rotation: effect of dynamic jugular stenosis on lumbar puncture opening pressure.","authors":"Connor R Margraf, Ferdinand K Hui, Jackson P Midtlien, Angelina H Wiater, Carol A Kittel, Molly R Ehrig, Alexa P Hirshman, Adnan H Siddiqui, Kyle M Fargen","doi":"10.1136/jnis-2025-023516","DOIUrl":"https://doi.org/10.1136/jnis-2025-023516","url":null,"abstract":"<p><strong>Background: </strong>Studies suggest head positioning may impact cerebral venous outflow by creating dynamic stenosis in the internal jugular veins (IJVs) in susceptible individuals.</p><p><strong>Objective: </strong>To examine the relationships between IJV pressure gradients and intracranial pressures, measured via lumbar puncture (LP), on head rotation in patients with cerebral venous outflow disorders (CVDs).</p><p><strong>Methods: </strong>A retrospective chart review was conducted on consecutive adult patients suspected of having CVD who underwent diagnostic cerebral venous venography with rotational IJV venography and superior sagittal sinus (SSS) pressure measurements in multiple head positions followed immediately by LP in neutral and with rotation. Data on IJV pressures, SSS pressures, and LP opening pressure (OP) were collected and analyzed.</p><p><strong>Results: </strong>In this sample of 70 patients, 9% developed moderate, 53% severe, and 30% occlusive rotational stenosis of the right IJV with 90 degree rightward rotation, resulting in mean jugular gradients of 5.5 mm Hg (SD 4.7). On head rotation, 59 (84%) patients experienced an increase in SSS pressures, and 67 (96%) experienced an increase in LP OP from neutral on head rotation (mean change 5.5 (SD 3.54) mm Hg). On average, for every 1 mm Hg increase in IJV trans-stenosis gradient, a 0.55 mm Hg increase in SSS pressure and a 0.27 cm H₂O increase in LP OP occurred.</p><p><strong>Conclusion: </strong>In this sample of consecutive CVD patients, dynamic IJV stenosis pressure gradients predicted changes in SSS pressure and LP OP. As IJV pressure gradients increased, there was a near immediate increase in CSF pressure, roughly commensurate to the cervical gradients. These findings suggest that single position LP OP may only represent a snapshot of CSF pressure in a dynamic pressure system.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248318","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":"Stroke thrombectomy of a mural thrombus in a severe dolichoectatic basilar artery with double parallel large stent retrievers and Sofia 88.","authors":"Julian Michael Burwell, Tyler M Bielinski, Philipp Hendrix","doi":"10.1136/jnis-2025-023562","DOIUrl":"https://doi.org/10.1136/jnis-2025-023562","url":null,"abstract":"<p><p>Dolichoectasia of the basilar artery poses significant challenges for endovascular therapy due to extreme vessel caliber and tortuosity, limiting the efficacy of conventional thrombectomy devices. We present the case of an older adult with severe acute ischemic stroke caused by a mid-basilar posterior wall mural thrombus within a markedly dolichoectatic basilar artery (diameter >10 mm, length >40 mm, suprasellar extension >15 mm).1-3 Following intravenous tenecteplase, mechanical thrombectomy was attempted using a single 6.5 mm stent retriever with aspiration via a Sofia 88 catheter, but failed to achieve sufficient recanalization. As a salvage strategy, two large stent retrievers (6.5 mm and 6 mm) were deployed in parallel, and mechanical thrombectomy was performed with concomitant aspiration (video 1).4 This approach achieved complete basilar artery recanalization and reperfusion (Thrombolysis In Cerebral Infarction (TICI) 3). The patient demonstrated rapid clinical recovery. This case highlights a practical salvage technique for thrombus removal in severe basilar dolichoectasia, emphasizing the need for tailored thrombectomy strategies in nonstandard vascular anatomies.neurintsurg;jnis-2025-023562v1/V1F1V1Video 1 .</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234384","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}