Journal of NeuroInterventional Surgery最新文献

{"title":"Minimal clinical impact of embolization to new territory on outcomes in medium vessel occlusion strokes treated with mechanical thrombectomy: a retrospective multicenter study.","authors":"Hamza Adel Salim, Vivek Yedavalli, Dhairya A Lakhani, Fathi Milhem, Basel Musmar, Nimer Adeeb, Tobias D Faizy, Motaz Daraghma, Kareem El Naamani, Nils Henninger, Sri Hari Sundararajan, Anna Luisa Kuhn, Jane Khalife, Sherief Ghozy, Luca Scarcia, Inayat Grewal, Leonard Ll Yeo, Benjamin Yq Tan, Robert W Regenhardt, Jeremy Josef Heit, Nicole M Cancelliere, Aymeric Rouchaud, Jens Fiehler, Sunil A Sheth, Ajit S Puri, Christian Dyzmann, Marco Colasurdo, Leonardo Renieri, João Pedro Filipe, Pablo Harker, Răzvan Alexandru Radu, Mohamad Abdalkader, Piers Klein, Thomas R Marotta, Julian Spears, Takahiro Ota, Ashkan Mowla, Pascal Jabbour, Arundhati Biswas, Frédéric Clarençon, James E Siegler, Thanh N Nguyen, Ricardo Varela, Amanda Baker, Muhammed Amir Essibayi, David Altschul, Nestor Gonzalez, Markus A Möhlenbruch, Vincent Costalat, Benjamin Gory, Christian Paul Stracke, Constantin Hecker, Gaultier Marnat, Hamza Shaikh, Christoph J Griessenauer, David S Liebeskind, Alessandro Pedicelli, Andrea Maria Alexandre, Illario Tancredi, Erwah Kalsoum, Boris Lubicz, Aman B Patel, Vitor Mendes Pereira, Max Wintermark, Adrien Guenego, Adam A Dmytriw","doi":"10.1136/jnis-2024-022570","DOIUrl":"https://doi.org/10.1136/jnis-2024-022570","url":null,"abstract":"<p><strong>Background: </strong>Mechanical thrombectomy (MT) is established as an effective treatment for large vessel occlusion strokes, but its efficacy and safety for medium vessel occlusions (MeVOs) remain less clear. This study examines the impact of periprocedural embolization to a new vascular territory (ENT) on clinical outcomes in patients with MeVO stroke treated with MT.</p><p><strong>Methods: </strong>A multicenter, retrospective analysis was conducted using the MAD-MT (Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy) registry, including 2122 patients with MeVO stroke w-ho underwent MT between September 2017 and July 2023. ENT was defined as filling defects in previously unaffected territories, excluding embolization near the original occlusion, observed on final angiographic runs after retrieval of the primary thrombus. The associations between ENT, procedural variables, and 90-day clinical outcomes were evaluated, including functional independence (modified Rankin Scale (mRS) scores of 0-2), excellent outcomes (mRS 0-1), mortality, and hemorrhagic complications.</p><p><strong>Results: </strong>ENT occurred in 2.9% (63/2122) of patients. Longer onset-to-arterial puncture time (adjusted OR 1.03; 95% CI 1.01 to 1.05; P=0.002) and a greater number of passes (adjusted OR 1.15; 95% CI 1.01 to 1.32; P=0.032) were associated with increased ENT risk, while excellent recanalization (thrombolysis in cerebral infarction (TICI) scale score 2c-3) was associated with reduced ENT risk (adjusted OR 0.41; 95% CI 0.23 to 0.72; P=0.002). ENT was not associated with poorer functional independence, mortality, or hemorrhagic complications.</p><p><strong>Conclusions: </strong>ENT during MT for MeVO stroke occurs infrequently and does not significantly affect the clinical outcomes. These findings suggest ENT risk should not deter clinicians from performing MT in patients with MeVO. Further prospective studies are needed to validate these results.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567276","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":"Superselective intra-arterial cerebral infusion of chemotherapeutics after osmotic blood-brain barrier disruption in newly diagnosed or recurrent glioblastoma: technical insights and clinical outcomes from a single-center experience.","authors":"Christian Ferreira, Marcio Yuri Ferreira, Faith Singh, Tamika Wong, Sanskruti Bokil, Sara Massimo, Julianna Cavallaro, Olivia Albers, Randy D'Amico, David Langer, John Boockvar, Yafell Serulle","doi":"10.1136/jnis-2025-023068","DOIUrl":"https://doi.org/10.1136/jnis-2025-023068","url":null,"abstract":"<p><strong>Background: </strong>Newly diagnosed glioblastoma (ndGBM) remains one of the most challenging malignancies to treat. Since the majority of patients experience tumor recurrence (rGBM) after first-line therapy, advancements in both initial and salvage treatments are essential.</p><p><strong>Objective: </strong>We report our single-center experience on the feasibility and safety of superselective intra-arterial cerebral infusion (SIACI) with bevacizumab or cetuximab after osmotic blood-brain barrier disruption (oBBBd).</p><p><strong>Methods: </strong>Partial results of three distinct trials (anonymized for blinded review) were analyzed. All patients were histopathologically confirmed to have either ndGBM or previously diagnosed ndGBM that progressed to rGBM despite standard therapy and had aKarnofsky Performance Status (KPS)≥70. All patients were admitted on the same day of the surgery, and the intervention followed similar steps in all included patients. Under general anesthesia, after oBBBd with mannitol, patients received SIACI.</p><p><strong>Results: </strong>Between October 2014 and March 2024, 70 patients with a mean age of 56.2±12.4 years (range: 19-78) underwent successful treatment, encompassing 139 SIACIs and 246 infusions. All planned SIACIs were completed successfully. Forty-one patients with rGBM received bevacizumab-SIACI, 7 with ndGBM bevacizumab-SIACI, and 22 with ndGBM cetuximab-SIACI. In 133 of 139 SIACIs (95.7%), patients were discharged home with a length of stay of 1 day. The incidence of patients who experienced procedure-related and drug-related adverse events was 11.4% and 8.6%, respectively. No procedure-related deaths occurred.</p><p><strong>Conclusion: </strong>In our single-center experience, comprising the largest cohort of bevacizumab or cetuximab SIACI treatment for rGBM and ndGBM, this promising and cutting-edge intervention is highly feasible and safe.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567195","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":"Therapeutic applications of drug coated balloons in symptomatic intracranial arterial stenosis: systematic review and quantitative meta-analysis.","authors":"Ying Tao, Dunming Xiao, Yingyao Chen, Shimeng Liu","doi":"10.1136/jnis-2024-022878","DOIUrl":"https://doi.org/10.1136/jnis-2024-022878","url":null,"abstract":"<p><strong>Background: </strong>Intracranial atherosclerotic stenosis (ICAS) represents a major cause of ischemic stroke, with endovascular treatments, such as stenting, facing challenges such as restenosis and complications. Drug coated balloons (DCBs) provide a promising alternative by delivering targeted drug without permanent implants. This review systematically evaluates the efficacy and safety of DCBs for symptomatic ICAS, providing evidence based insights to guide clinical practice.</p><p><strong>Methods: </strong>Databases were searched from inception to October 16, 2023, to identify studies on DCBs for symptomatic ICAS. Two independent researchers screened the literature and extracted data. A meta-analysis was performed using the Freeman-Tukey double arcsine transformation with random or fixed effects models to assess perioperative safety and restenosis rates. Heterogeneity and publication bias were also evaluated.</p><p><strong>Results: </strong>The analysis included six controlled studies and 16 single arm studies involving 1308 patients with ≥70% stenosis. In single arm studies, the pooled restenosis rate for DCBs was 7.34% (95% CI 0.05 to 0.10, I²=44%, P=0.04), with a perioperative stroke and mortality rate of 5.75% (95% CI 0.04 to 0.08, I²=25%, P=0.18). The follow-up stroke and transient ischemic attack rate was 1.26% (95% CI 0.00 to 0.03, I²=33%, P=0.11). In controlled studies, DCBs significantly reduced restenosis rates compared with conventional balloons (OR=0.24, P=0.003) and stents (OR=0.20, P<0.001), without increasing perioperative adverse events.</p><p><strong>Conclusions: </strong>In this study, DCBs showed significant potential as an effective therapeutic option for symptomatic ICAS in clinical practice, offering lower restenosis rates compared with conventional endovascular approaches while maintaining comparable safety profiles. However, further larger scale, high quality prospective studies are essential to validate these findings and establish standardized protocols for their application.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567293","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":"Ultra-high resolution CT angiography for the assessment of intracranial stents and flow diverters using photon counting detector CT.","authors":"Riccardo Ludovichetti, Dunja Gorup, Mikos Krepuska, Sebastian Winklhofer, Patrick Thurner, Jawid Madjidyar, Thomas Flohr, Marco Piccirelli, Lars Michels, Hatem Alkadhi, Victor Mergen, Zsolt Kulcsar, Tilman Schubert","doi":"10.1136/jnis-2024-022041","DOIUrl":"10.1136/jnis-2024-022041","url":null,"abstract":"<p><strong>Background: </strong>The patency of intracranial stents may not be reliably assessed with either CT angiography or MR angiography due to imaging artifacts. We investigated the potential of ultra-high resolution CT angiography using a photon counting detector (PCD) CT to address this limitation by optimizing scanning and reconstruction parameters.</p><p><strong>Methods: </strong>A phantom with different flow diverters was used to optimize PCD-CT reconstruction parameters, followed by imaging of 14 patients with intracranial stents using PCD-CT. Images were reconstructed using three kernels based on the phantom results (Hv56, Hv64, and Hv72; Hv=head vascular) and one kernel to virtually match the resolution of standard CT angiography (Hv40). Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) measurements were calculated. Subjective image quality and diagnostic confidence (DC) were assessed using a five point visual grading scale (5=best, 1=worst) and a three point grading scale (1=best, 3=worst), respectively, by two independent neuroradiologists.</p><p><strong>Results: </strong>Phantom images demonstrated the highest image quality across dose levels for 0.2 mm reconstructions with Hv56 (4.5), Hv64 (5), and Hv72 (5). In patient images, SNR and CNR decreased significantly with increasing kernel sharpness compared with control parameters. All reconstructions showed significantly higher image quality and DC compared with the control reconstruction with Hv40 kernel (P<0.001), with both image quality and DC being highest with Hv64 (0.2 mm) and Hv72 (0.2 mm) reconstructions.</p><p><strong>Conclusion: </strong>Ultra-high resolution PDC-CT angiography provides excellent visualization of intracranial stents, with optimal reconstructions using the Hv64 and the Hv72 kernels at 0.2 mm.</p><p><strong>Registration: </strong>BASEC 2021-00343.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502290","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":"Middle meningeal artery lidocaine infusion for refractory headache.","authors":"Nicolas K Khattar, Adam S Arthur, Diana Santori, Morgan Neil, Jason Sims, Sloane Smith, Brittany Falcone, Kelly Darnell, Michelle Rosa, David Fiorella","doi":"10.1136/jnis-2025-023246","DOIUrl":"https://doi.org/10.1136/jnis-2025-023246","url":null,"abstract":"<p><strong>Introduction: </strong>Refractory headache is a common and frequently disabling disorder, affecting 2-12 million patients each year in the US alone. This case series provides initial insight into the safety and effectiveness of lidocaine infusions into the middle meningeal artery (MMAL) for the treatment of refractory headache.</p><p><strong>Methods: </strong>A retrospective review of a prospectively maintained database was conducted to identify patients undergoing MMAL at two institutions. Baseline demographics, procedural metrics, and headache measures were tracked over a 3 month period. Headache severity was assessed immediately after the procedure, and at 1, 2, and 3 months. A responder was defined as a patient who had a >50% reduction in headache days per month.</p><p><strong>Results: </strong>45 patients (38 women, average age 49.8 years) underwent treatment at two institutions over 19 months. The patients reported an average of 27.5 headache days per month despite medical therapy during the month before treatment. All infusions were performed under conscious sedation and most (40, 88.9%) were performed via radial access. No neurological complications were observed. The most common adverse event (4 of 45 patients) was discomfort at the radial access site. 29 of 45 (64.4%) patients reported headache relief immediately (0-24 hours) after the infusion. At 1, 2, and 3 months, 57% (24 of 42), 34% (13 of 38), and 20.6% (7 of 34) of patients were responders. All but one (23 of 24) of the patients who were responders at 1 month had experienced acute headache relief during (or immediately after) the lidocaine infusion procedure. 23 of 27 (85.1%) patients who had relief during the procedure were responders at 1 month. Headache Impact Test-6 (HIT-6) scores were 69.4 before treatment (41 patients), 55.5 (34) at 1 month, 64.5 (31) at 2 months, and 66.0 (31) at 3 months.</p><p><strong>Discussion: </strong>The study found that MMAL can elicit relief in patients with refractory headache, which may last as long as 3 months. Most patients who had acute relief during the procedure were responders at 1 month.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542317","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":"Venous vascular malformations (VVMs) of the tongue: insights into bleomycin sclerotherapy as a promising treatment.","authors":"Joseph J Gemmete","doi":"10.1136/jnis-2025-023186","DOIUrl":"https://doi.org/10.1136/jnis-2025-023186","url":null,"abstract":"","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542355","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":"Transradial cerebral angiography: predicting left ICA selective angiography success using pre-diagnostic aortic arch factors.","authors":"Jin Eun, Seung Yoon Song, Sang Hyuk Im, Hae Kwan Park","doi":"10.1136/jnis-2024-022842","DOIUrl":"https://doi.org/10.1136/jnis-2024-022842","url":null,"abstract":"<p><strong>Background: </strong>Transradial cerebral angiography (TRA) is a convenient but challenging procedure, particularly for selecting the left internal carotid artery (ICA) and vertebral artery.</p><p><strong>Objective: </strong>To predict the selection of the left ICA using CT and MR images acquired before TRA.</p><p><strong>Methods: </strong>Overall, 306 patients with TRA were enrolled and divided into either the group with success (264 patients) or the failure (42 patients) group. The following anatomical factors were measured: A1 (subclavian artery angle), A2 (right subclavian-innominate artery angle), A3 (innominate-left common carotid artery angle), D1 (aorta to right subclavian artery length), and D2 (innominate-to-left common carotid artery length).</p><p><strong>Results: </strong>The median values for A1, A2, A3, D1, and D2 were 81.57° (IQR 69.26-94.14), 147.03° (125.73-161.09), 24.73 (15.85-37.72°), 34.73 mm (29.68-38.48), and 13.15 mm (11.33-15.64), respectively, with significant differences observed between the successful and failure groups in A3 (26.88° vs 15.50°; P<0.001), D1 (34.24 mm vs 37.62 mm; P<0.001), and D2 (12.78 mm vs 14.91 mm; P<0.001). The aortic arch type did not affect success (P=0.134), while patients in the failure group were significantly older (P<0.001). A predictive logistic regression model was developed, revealing differing factor impacts when controlling variables. The model (area under the curve 0.87) highlights data complexity and enables user-friendly prediction of left ICA-selective TRA success (https://je0000000342227505.shinyapps.io/icatra/).</p><p><strong>Conclusion: </strong>This study demonstrated that the success of left ICA selective angiography can be predicted using aortic arch images, providing a basis for the extension of TRA.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523633","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":"Safety and efficacy of tirofiban versus traditionaldualantiplatelettherapy in endovasculartreatment of intracranialaneurysms: asystematicreview and meta-analysis.","authors":"ZhenKun Xiao, XuYi Hu, LiangJie Deng, JianHua Liu, Aihua Liu","doi":"10.1136/jnis-2024-023021","DOIUrl":"https://doi.org/10.1136/jnis-2024-023021","url":null,"abstract":"<p><strong>Background: </strong>The selection of antiplatelet agents plays a crucial role in ensuring the safety and efficacy of endovascular treatment for intracranial aneurysms (IA). Currently, the primary agents used include tirofiban and traditional dual antiplatelet therapy (DAPT). Due to the lack of high-level consolidated evidence in this field, we conducted the first systematic review and meta-analysis aimed at comparing the safety and efficacy of tirofiban vs traditional DAPT in the endovascular treatment of IA.</p><p><strong>Methods: </strong>Studies published before November 1, 2024, were searched in PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials. The primary outcome was thrombosis, and secondary outcomes included intracranial hemorrhage (ICH), non-intracranial bleeding events (NoICH-BE), ischemic stroke (IS), and follow-up prognosis. Relative risks (RRs) were synthesized for comparison between tirofiban and DAPT groups.</p><p><strong>Results: </strong>Nine studies involving 2481 patients were included. Tirofiban significantly reduced the risk of thrombosis compared with DAPT (RR, 0.292; 95% CI, 0.174 to 0.492; P<0.001). It did not increase risks of ICH (RR, 0.633; P=0.125), NoICH-BE (RR, 0.253; P=0.259), IS (RR, 0.730; P=0.172), or poor prognosis (RR, 0.981; P=0.896).</p><p><strong>Conclusion: </strong>Tirofiban effectively lowers the risk of thrombosis without increasing bleeding or adverse prognosis risks compared with DAPT. It shows promise as an alternative antiplatelet therapy for IA treatment, but further large-scale studies are needed to confirm these findings.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501996","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":"Catheterization complications of intra-arterial chemotherapy for retinoblastoma.","authors":"Craig Schreiber, Gary Kocharian, Natasha Kharas, Jared Knopman, Jasmine H Francis, David H Abramson, Y Pierre Gobin","doi":"10.1136/jnis-2024-022881","DOIUrl":"https://doi.org/10.1136/jnis-2024-022881","url":null,"abstract":"<p><strong>Background: </strong>Intra-arterial chemotherapy (IAC) is a growing method of therapy for retinoblastoma (Rb). There is an absence of data to support the safety of catheterization with intra-arterial infusion in this pediatric population OBJECTIVE: To focus on the non-ocular catheter/procedural-related complications that our practice has experienced in order to lay a foundation for practices interested in performing these procedures and hopefully, to help prevent them from occurring.</p><p><strong>Methods: </strong>This is a retrospective review of the patient population with Rb treated in our center from May 2006 through May 2024. Every procedure performed was reviewed for non-ocular catheterization-related complications. This review included complications of access, the distal vessel (thrombosis, stenosis, and dissection), and non-ocular infarcts.</p><p><strong>Results: </strong>There were 2281 vascular access events, and 2681 distal catheterization procedures were performed for IAC infusion on 623 pediatric patients with Rb. Mean age of the population was 18.9 months. There were 31 complications directly related to catheterization: 7 (0.3%) related to femoral artery access and 24 (0.9%) were distal vessel injuries. Two (0.07% of total catheterizations) of the distal vessel injuries were asymptomatic cerebral infarcts diagnosed on follow-up MRI.</p><p><strong>Conclusion: </strong>Catheterization with IAC can be performed safely in this young pediatric population. There is a trend for fewer complications when using the smallest catheter system possible for procedures.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516052","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":"Rising tide of middle meningeal artery embolization for chronic subdural hematomas: current volumes and future growth compared with cerebral aneurysm and stroke interventions.","authors":"Ansaar T Rai, Paul S Link, Dhairya A Lakhani","doi":"10.1136/jnis-2025-023109","DOIUrl":"https://doi.org/10.1136/jnis-2025-023109","url":null,"abstract":"<p><strong>Background: </strong>To estimate the current number of middle meningeal artery embolization (MMAE) procedures for subdural hematomas (SDH) and project growth compared with endovascular treatments for cerebral aneurysms and acute ischemic stroke (AIS).</p><p><strong>Methods: </strong>Estimates of SDH admissions were obtained from the National Inpatient Sample and Medicare Inpatient 100% Standard Analytic Files for 2019-23. MMAE volumes (2019-23) were estimated by cross referencing international classification of diseases, 10th revision, clinical modification (ICD-10 CM) codes for non-acute, non-traumatic SDH with ICD-10 procedure coding system (ICD-10 PCS) codes for surgical and endovascular interventions during the same admission to approximate MMAE volumes. These estimates were compared with volumes of endovascular cerebral aneurysm and AIS treatments, with projections based on historical growth rates.</p><p><strong>Results: </strong>MMAE procedures increased significantly, from 4014 in 2019 to 20 836 in 2023, representing a 51% compound annual growth rate (CAGR). In comparison, endovascular aneurysm treatments grew from 34 754 to 42 491 (5% CAGR) and AIS procedures from 34 451 to 44 822 (7% CAGR). In the next 5 years, MMAE is projected to surpass other neurovascular procedures, with an estimated 79 483 procedures, compared with 79 405 for AIS and 56 942 for aneurysms, by 2029. Annual SDH admissions remained steady at just over 200 000 from 2019 to 2022, with most (~66%) managed medically. Only an estimated 2% of SDH admissions received an MMAE procedure in 2019, rising to 8% in 2022.</p><p><strong>Conclusion: </strong>MMAE procedures have seen rapid adoption and may become the dominant neurovascular intervention, with potential implications for healthcare infrastructure and workforce planning.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516056","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}