Journal of NeuroInterventional Surgery最新文献

{"title":"Transcarotid artery revascularization in the CREST-2 era: promising outcomes, uncertain comparative value.","authors":"Pablo Albiña-Palmarola, Ali Khanafer, Hans Henkes","doi":"10.1136/jnis-2026-026178","DOIUrl":"https://doi.org/10.1136/jnis-2026-026178","url":null,"abstract":"","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137007","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 a coated flow diverter compatible with 0.017 inch microcatheters: prospective multicenter study.","authors":"Simin Wang, Jun Feng, Chuan He, Jingwei Li, Yin Shen, Jing Xu, Bing Fang, Guangsen Cheng, Yu Liu, Huaizhang Shi, Pei Wu, Changwei Zhang, Ting Wang, Ge Gao, Yu Chen, Cong-Hui Li, Hui Li, Chun Fang, Shuo Yan, Hongqi Zhang","doi":"10.1136/jnis-2026-026013","DOIUrl":"https://doi.org/10.1136/jnis-2026-026013","url":null,"abstract":"","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137018","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":"Stitch or seal? Suture-based versus bioabsorbable plug closure devices in transfemoral stroke thrombectomy: a multicenter cohort study.","authors":"Louis Bonnard, Guillaume Tessier, Luca Scarcia, Mickael Maldinez, Thibault Agripnidis, Boubker Hafa, Hajar Andour, Julien Burel, Quentin Holay, Francois Severac, Raoul Pop","doi":"10.1136/jnis-2026-026121","DOIUrl":"https://doi.org/10.1136/jnis-2026-026121","url":null,"abstract":"<p><strong>Background: </strong>Vascular access-site complications are among the most frequent adverse events of endovascular treatment (EVT) for acute ischemic stroke (AIS). Suture-based closure devices (SBD) are widely used in peripheral and cardiac procedures, but their performance has not been specifically assessed in stroke EVT. We aimed to compare SBD with the more commonly used bioabsorbable plug devices (BPD) in transfemoral stroke thrombectomy.</p><p><strong>Methods: </strong>We conducted a multicenter retrospective cohort study across seven French tertiary stroke centers. We included consecutive patients undergoing transfemoral EVT for AIS between July 2024 and July 2025, with device-mediated closure and ≥96 hours follow-up. The primary endpoint was any access-site complication; secondary endpoints were complications requiring active intervention and severe complications requiring surgical/endovascular treatment. Inverse probability of treatment weighting with stabilized weights was used to estimate the average treatment effect.</p><p><strong>Results: </strong>Among 933 patients, 632 (67.7%) received a BPD and 301 (32.3%) an SBD. The overall complication rate was 4.0%, and was lower with SBD than BPD (1.3% vs 5.2%, P=0.003). In the weighted analysis, SBD use was associated with a lower rate of access-site complications (OR 0.23, 95% CI 0.08 to 0.68, P=0.008) and of complications requiring active intervention (OR 0.16, 95% CI 0.03 to 0.75, P=0.021). Severe complications were numerically less frequent with SBD (0.3% vs 0.8%) but not significantly different.</p><p><strong>Conclusion: </strong>Suture-based closure was associated with fewer access-site complications compared with bioabsorbable plugs, suggesting that suture-based devices may be a preferable closure strategy for the large-bore access used in stroke EVT. These findings require confirmation in further studies.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110980","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":"Preprocedural high-resolution vessel wall MRI predicts in-stent restenosis after intracranial stenting.","authors":"Ting Li, Chun Zhou, Ze-Ling Tan, Chun-Qiu Su, Wen-Wen He, Long Yang, Sheng Liu, Na Zhang, Shan-Shan Lu","doi":"10.1136/jnis-2026-025964","DOIUrl":"https://doi.org/10.1136/jnis-2026-025964","url":null,"abstract":"<p><strong>Background: </strong>In-stent restenosis (ISR) remains a challenge after intracranial stenting for intracranial atherosclerotic stenosis (ICAS). We evaluated whether preprocedural high-resolution vessel wall imaging (HR-VWI) features and clinical factors could predict ISR.</p><p><strong>Methods: </strong>We retrospectively analyzed 237 ICAS patients undergoing intracranial stenting with preprocedural HR-VWI and follow-up. Clinical and HR-VWI parameters were compared between ISR and non-ISR groups using the Mann-Whitney U and χ² tests. Predictors were identified using LASSO (least absolute shrinkage and selection operator) Cox regression. A 1-year risk prediction model was constructed and visualized as a nomogram. Model performance was evaluated using C-index, calibration, decision curve analysis, and bootstrap validation. Kaplan-Meier analysis assessed ISR incidence over time.</p><p><strong>Results: </strong>ISR occurred in 42 patients (17.7%) during follow-up, including 38 cases (16.0%) within 1 year. Mean normalized wall index (NWI) (per 10% increase; HR 2.37, 95% CI 1.51 to 3.73, P<0.001), plaque length (HR 1.12, 95% CI 1.03 to 1.22, P=0.010), and enhancement ratio (HR 2.27, 95% CI 1.07 to 4.82, P=0.034), along with residual stenosis (per 10% increase; HR 1.42, 95% CI 1.09 to 1.85, P=0.010), were independent predictors. The model showed good discrimination (C-index 0.79, 95% CI 0.72 to 0.86), calibration, and net benefit. Higher ISR risk was observed with mean NWI ≥0.88, plaque length ≥8 mm, enhancement ratio ≥1.07, or residual stenosis ≥39% (all P≤0.01).</p><p><strong>Conclusion: </strong>Preprocedural HR-VWI-derived mean NWI, plaque length, and enhancement ratio, together with residual stenosis, were associated with ISR and may aid risk stratification. Further validation in larger prospective cohorts is warranted.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149039333","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":"RESTORE: REal-world analyses of Stroke-Thrombus Occlusion REtrieval study: effectiveness, safety, and technical outcomes.","authors":"Syed Zaidi, Khaled Gharaibeh, Arindam R Chatterjee, Charles J Prestigiacomo, Timothy R Miller, Gary Rajah, David Fiorella, Josser E Delgado Almandoz, Norman Ajiboye, Ricky Medel, Yi Jonathan Zhang, Timothy G White, Imran Chaudry, Clemens Schirmer, Maxim Mokin, Lucian Maidan, Fazeel Siddiqui, Jan Karl Burkhardt, Gabor Toth, Edward D Greenberg, Daniel E Surdell, Huan Wen Chen, Scott Rahimi, Hakeem J Shakir, Nitin Goyal, Sean Cullen, Ghasan Ahmad, Daniel H Sahlein, Dheeraj Gandhi","doi":"10.1136/jnis-2026-025721","DOIUrl":"https://doi.org/10.1136/jnis-2026-025721","url":null,"abstract":"<p><strong>Background: </strong>Mechanical thrombectomy has become the cornerstone of treatment for acute ischemic stroke (AIS) caused by large vessel occlusion. While randomized trials have established non-inferiority of aspiration-based approaches compared with stent retriever approaches, real-world evidence is essential to evaluate device performance across heterogeneous populations, anatomies, and procedural strategies. The objective of the RESTORE registry is to report the final results and contextualize its findings within the evolving landscape of large- and super-large-bore aspiration catheter technologies.</p><p><strong>Methods: </strong>RESTORE (REal-world analyses of Stroke-Thrombus Occlusion REtrieval study) is a prospective, multicenter, observational registry enrolling AIS patients treated with Terumo Neuro devices as a first-line mechanical thrombectomy approach. Angiographic and safety outcomes were evaluated by an independent core laboratory and clinical events committee, respectively.</p><p><strong>Results: </strong>Among 710 enrolled patients across 36 centers, 688 comprised the final analysis cohort. Final reperfusion (modified Thrombolysis In Cerebral Infarction (mTICI) ≥2b) was achieved in 93.0%, with first-pass mTICI ≥2b in 60.8%. Median puncture-to-clot contact and puncture-to-reperfusion times were 13 and 17 min, respectively. Symptomatic intracranial hemorrhage occurred in 0.6% of patients, and the all-cause mortality rate at 90 days was 16.3%. Embolization to new territory occurred in 0.4%, and 52.9% of patients achieved functional independence (modified Rankin Scale ≤2) at 90 days.</p><p><strong>Conclusions: </strong>RESTORE represents one of the largest prospective real-world registries evaluating a SOFIA-dominant first-line thrombectomy approach using Terumo Neuro devices for AIS due to intracranial vessel occlusion. Under routine practice conditions, the registry demonstrated favorable angiographic, procedural, and clinical outcomes with a reassuring safety profile, supporting aspiration-dominant approaches as an effective and safe first-line strategy in this setting. However, because RESTORE was observational, single-arm, and descriptive, these findings should be interpreted as real-world evidence of feasibility and safety rather than proof of comparative efficacy or superiority over other thrombectomy strategies.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149039265","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":"Anxiety and mood disorders are associated with greater healthcare and procedural utilization in idiopathic intracranial hypertension.","authors":"Abdulrhman Alsalama, Muhammed Amir Essibayi, Vidhi Dhaduk, Jay Kakadiya, Bluye Demessie, Ahmed Y Azzam, Hasan Jamil, Hamza Adel Salim, Huanwen Chen, Mohamed Emara, Dheeraj Gandhi, Tarek Rayan, Marco Colasurdo, Ajay Malhotra, Ali Alaraj, David Altschul, Dhairya A Lakhani","doi":"10.1136/jnis-2026-026039","DOIUrl":"10.1136/jnis-2026-026039","url":null,"abstract":"<p><strong>Background and purpose: </strong>Anxiety and mood disorders (AMD) are common in idiopathic intracranial hypertension (IIH), but their association with procedural treatment and healthcare utilization is unclear. We evaluated utilization among patients with AMD documented before or shortly after IIH.</p><p><strong>Methods: </strong>Using the TriNetX US Collaborative Network, we identified adults diagnosed with IIH on or after January 1, 2016. The primary analysis compared patients with AMD documented on or before IIH with those without AMD; the sensitivity analysis compared patients with a first AMD diagnosis within 1 month after IIH with those without AMD before or during that month. Each analysis used separate 1:1 propensity-score matching. 5-year outcomes were assessed using Kaplan-Meier methods and Cox regression.</p><p><strong>Results: </strong>The primary analysis included 38 117 matched patients per group. At 5 years, patients with AMD had higher rates of cerebrospinal fluid shunting (5.86% vs 4.62%; HR 1.168), transverse venous sinus stenting (1.40% vs 1.09%; HR 1.236), either procedure (7.12% vs 5.61%; HR 1.178), inpatient admission (45.63% vs 36.88%; HR 1.214), and emergency department visits (56.57% vs 42.57%; HR 1.519), but lower mortality (7.70% vs 9.67%; HR 0.725). The sensitivity analysis included 8949 matched patients per group and showed the same pattern among patients with AMD newly diagnosed within 1 month after IIH.</p><p><strong>Conclusions: </strong>AMD documented before or shortly after IIH was associated with greater procedural and healthcare utilization. These observational findings describe patterns of care but do not establish that AMD causes greater IIH severity or procedural need.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13695518/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001962","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":"Predicting futile recanalization after mechanical thrombectomy in patients with ischemic stroke and cancer: the CACTUS nomogram.","authors":"Carlota Villar-Rodríguez, Diego Villagran-Sancho, Luis Fernández Espigares, Luis Manzano-Hernández, Manuel Medina-Rodriguez, Juan Antonio Cabezas-Rodríguez, Andrés Hermosín-Gómez, Pablo Baena Palomino, Leire Ainz-Gómez, Marta Aguilar-Perez, Asier de Albóniga-Chindurza, Henry Andrade Ruiz, Alejandro González, Elena Zapata-Arriaza, Francisco Moniche","doi":"10.1136/jnis-2026-025872","DOIUrl":"https://doi.org/10.1136/jnis-2026-025872","url":null,"abstract":"<p><strong>Background: </strong>Patients with large vessel occlusion (LVO) and a history of cancer have worse long-term outcomes after mechanical thrombectomy (MT) despite similar reperfusion rates. We aimed to develop a clinical prognostic score to predict futile recanalization (FR) in this population.</p><p><strong>Methods: </strong>We retrospectively analyzed a single-center prospective registry (ARTISTA) of patients with LVO and active or previous cancer who underwent MT between January 2021 and December 2023. The primary outcome was FR, defined as successful angiographic reperfusion (expanded Thrombolysis in Cerebral Infarction (eTICI) ≥2b) with poor functional outcome (modified Rankin Scale (mRS) ≥3) at 90 days. A clinically prespecified logistic regression model was developed to predict FR. Model performance was assessed, and internal validation was performed using bootstrap resampling and repeated cross-validation. An expanded penalized least absolute shrinkage and selection operator (LASSO) model was evaluated as a secondary analysis and a nomogram was derived from the final model.</p><p><strong>Results: </strong>Of 1584 patients who underwent MT during the study period, 167 patients with a history of cancer met the eligibility criteria for analysis. FR occurred in 50.9% of patients. A clinically prespecified prediction model included age, pre-stroke mRS score, admission National Institutes of Health Stroke Scale (NIHSS) score, and metastatic disease. A higher pre-stroke mRS score (adjusted OR (aOR) 1.84, 95% CI 1.09 to 3.21; P=0.025), higher admission NIHSS score (aOR 1.11 per point, 95% CI 1.05 to 1.17; P<0.001), and metastatic disease (aOR 8.38, 95% CI 2.77 to 31.93; P<0.001) were independently associated with FR. Internal bootstrap validation yielded an optimism-corrected AUC of 0.758 and a Brier score of 0.206. An optimism-corrected nomogram was derived for clinical use.</p><p><strong>Conclusion: </strong>The CACTUS prediction model showed adequate predictive performance for FR, and the derived nomogram may serve as a practical tool for individualized risk assessment in patients with LVO who are candidates for MT and have a history of cancer.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001942","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":"Balloon guide catheter outcomes by occlusion site in the randomized PROTECT-MT trial.","authors":"Huanghuang Chen, Tingyu Yi, Pengfei Xing, Ding-Lai Lin, Xiao-Hui Lin, Zhiting Chen, Yu Zhou, Yan-Min Wu, Zhi-Nan Pan, Lisan Zeng, Shouchun Wang, Tong Li, Weifeng Huang, Yi-Ning Yang, Jin-Hua Ye, Ziyuan Cai, Jianmin Liu, Pengfei Yang, Wen-Huo Chen","doi":"10.1136/jnis-2026-025857","DOIUrl":"https://doi.org/10.1136/jnis-2026-025857","url":null,"abstract":"<p><strong>Background: </strong>Balloon guide catheters (BGCs) are used during endovascular thrombectomy, but whether their effect varies by occlusion site is uncertain. We evaluated effect modification by baseline occlusion site in the PROTECT-MT trial.</p><p><strong>Methods: </strong>This exploratory secondary analysis of the randomized PROTECT-MT trial included patients with core laboratory-adjudicated anterior circulation occlusion site data. Patients were classified as having intracranial internal carotid artery (ICA), M1, or M2 occlusion. The primary outcome was the 90-day modified Rankin Scale (mRS) distribution. Treatment effect modification was assessed using adjusted ordinal logistic regression with a treatment-by-occlusion site interaction term. The parent plan prespecified internal carotid artery (ICA) versus middle cerebral artery (MCA) occlusions; the three-level comparison and post hoc Holm correction of 19 secondary interactions were exploratory.</p><p><strong>Results: </strong>Among 329 patients, 88 (26.7%) had ICA occlusions, 206 (62.6%) M1 occlusions, and 35 (10.6%) M2 occlusions. The interaction for the 90-day mRS distribution was not statistically significant (P=0.072). Adjusted common ORs with BGC versus control were 0.38 (95% CI 0.17 to 0.85) for ICA occlusions, 0.60 (95% CI 0.36 to 0.99) for M1 occlusions, and 4.32 (95% CI 0.53 to 35.02) for M2 occlusions. No consistent interaction was observed for first-pass or final reperfusion. Secondary interaction analyses remained exploratory after post hoc multiplicity correction.</p><p><strong>Conclusions: </strong>This exploratory analysis did not provide conclusive evidence that the occlusion site modified the effect of BGC use on 90-day outcome. Imprecise estimates, particularly for M2, preclude site-specific guide catheter selection.</p><p><strong>Trial registration number: </strong>NCT05592054.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001974","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":"Atlas self-expandable stents versus low profile visualized intraluminal support stents for intracranial aneurysm coiling assistance: systematic review and meta-analysis.","authors":"Vinay Jaikumar, Laz S Rifkin, Patrick M Wahlig, Taysia P T Morioka, Aditya D Goyal, Julia Rupp, Isabelle G Stockman, Liam Levy, Lukasz Przepiorka, Andre Monteiro, Jaims Lim, Kunal Vakharia, Pui Man Rosalind Lai, Jason M Davies, Kenneth V Snyder, Elad I Levy, Adnan H Siddiqui","doi":"10.1136/jnis-2026-025664","DOIUrl":"https://doi.org/10.1136/jnis-2026-025664","url":null,"abstract":"<p><strong>Background: </strong>Neurointerventionalists performing stent assisted coil embolization for intracranial aneurysms use Neuroform Atlas stents (Stryker) for their low metal coverage, deployment ease, and lower thromboembolic risk, although low profile visualized intraluminal support (LVIS) and LVIS Jr stents (Terumo Neuro) offer better wall apposition and high metal coverage, potentially promoting flow diversion and endothelialization. The next generation LVIS Evolution (LVIS EVO; Terumo Neuro) adds enhanced visibility, improved resheathability, and even higher metal coverage to address earlier limitations of LVIS and LVIS Jr. We evaluated the performance and complications of these devices.</p><p><strong>Methods: </strong>PubMed and Embase were searched from 1 January 2017 to 31 July 2025 to identify studies comparing Atlas assisted coil embolization (AACE) versus LVIS/LVIS Jr assisted coil embolization (LACE), and single arm LVIS EVO assisted coil embolization (LeACE) studies. Meta-analyses were performed to compare baselines, procedural considerations, and occlusion rates.</p><p><strong>Results: </strong>We included five studies comparing 504 patients treated with AACE and 579 patients with LACE, and 12 studies evaluating LeACE (575 patients). Fewer aneurysms were ruptured at presentation in the AACE group than in the LACE (OR 0.09; P<0.01) and LeACE (0.7% vs 15.2%; P<0.01) groups. Comparable technical failure rates were found between AACE and LeACE (1.8% vs 5.4%; P=0.15), contrasting with the superiority of AACE over LACE (OR 0.14; P<0.01). AACE resulted in higher immediate adequate occlusion than LACE (OR 1.62; P=0.02), but comparable with LeACE (83% vs 90.8%; P=0.28). Follow-up complete occlusion rates were similar between AACE and LACE (OR 1.31; P=0.16) and between AACE and LeACE (82.4% vs 81.2%; P=0.86).</p><p><strong>Conclusions: </strong>The superior outcomes of the Atlas over LVIS/LVIS Jr were matched by the LVIS EVO. Thromboembolic complications occurred more frequently with the LVIS EVO.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular treatment for Spetzler-Martin grade IV-V brain arteriovenous malformations: a 26-year single-center cohort study.","authors":"Julien Burel, Mahmoud Elhorany, Giacomo Borsari, Kevin Premat, Julien Allard, Navid Bakhtiari, Stéphanie Lenck, Anne-Laure Boch, Aurélien Nouet, Pierre-Yves Borius, Gaël Nicolas, Maichael Talaat, Nader-Antoine Sourour, Eimad Shotar, Frédéric Clarençon","doi":"10.1136/jnis-2026-026063","DOIUrl":"https://doi.org/10.1136/jnis-2026-026063","url":null,"abstract":"<p><strong>Background: </strong>The exclusion treatment of Spetzler-Martin grade (SMG) IV-V brain arteriovenous malformations (bAVMs) remains controversial. This study evaluates the safety and effectiveness of endovascular treatment (EVT) for SMG IV-V bAVMs, either as a standalone strategy or as part of multimodal management.</p><p><strong>Methods: </strong>A retrospective single-center observational cohort study of consecutive adult patients with SMG IV-V bAVMs treated with EVT between 1998 and 2024 was conducted. Baseline characteristics, procedure-related complications, clinical outcomes, and angiographic follow-up were recorded. Independent risk factors for EVT-related complications were analyzed using binary logistic regression.</p><p><strong>Results: </strong>A total of 73 patients with 73 SMG IV-V bAVMs were included. The median age was 36 (IQR 28-47) years, and 29 (39.7%) bAVMs were ruptured at presentation. Complete angiographic obliteration by EVT alone in intention to cure was achieved in 6/33 patients (18.2%). Overall, complete angiographic obliteration was achieved in 33 patients (45.2%), either by EVT alone or within a multimodal treatment strategy. EVT-related major complications (shift in modified Rankin Scale score of ≥2 or death) occurred in eight patients (11.0%). The presence of a flow-related proximal aneurysm was independently associated with EVT-related complications (OR 4.47; 95% CI 1.18 to 16.98; P=0.028).</p><p><strong>Conclusions: </strong>In this single-center retrospective series, EVT for SMG IV-V bAVMs was associated with a substantial procedural risk and achieved complete obliteration only in a limited proportion of patients when used as a standalone treatment. Within a multimodal management strategy higher angiographic exclusion rates were observed, although it remained associated with substantial morbidity.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977075","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}