Journal of NeuroInterventional Surgery最新文献

{"title":"Prolonged intracranial catheter dwell time exacerbates penumbral stress and worsens stroke thrombectomy outcomes.","authors":"Ali M Alawieh, Sameh Samir Elawady, Youssef M Zohdy, Reda M Chalhoub, Conor Cunningham, Brian M Howard, C Michael Cawley, Daniel Barrow, Feras Akbik, Aqueel Pabaney, Frank C Tong, Sami Al Kasab, Pascal Jabbour, Nitin Goyal, Adam S Arthur, Fazeel Siddiqui, Shinichi Yoshimura, Min S Park, Waleed Brinjikji, Charles Matouk, Daniele G Romano, David Altschul, Richard Williamson, Mark Moss, Reade Andrew De Leacy, Mohamad Ezzeldin, Peter Kan, Michael R Levitt, Ramesh Grandhi, Justin R Mascitelli, Jonathan A Grossberg, Alejandro M Spiotta","doi":"10.1136/jnis-2024-022271","DOIUrl":"https://doi.org/10.1136/jnis-2024-022271","url":null,"abstract":"<p><strong>Background: </strong>The duration of mechanical thrombectomy (MT) is a negative predictor of outcomes in acute ischemic stroke (AIS), yet the precise mechanisms are unclear. We investigated whether the placement of large-bore catheters intracranially reduces blood flow to the ischemic penumbra and diminishes the efficacy of MT.</p><p><strong>Methods: </strong>We investigated the impact of different catheter sizes on flow through the intracranial circulation using an in vitro model. Data from a multicenter international registry of AIS patients undergoing MT between January 2016 and December 2023 were reviewed. Intracranial procedure time (icPT) from catheter placement to thrombectomy completion was analyzed using propensity score (PS) matched analysis of patients with successful recanalization achieved in <30 min versus ≥30 min (n=1006/group). Primary outcome was modified Rankin Scale (mRS) score at 90 days (mRS 0-2 favorable). Secondary outcomes included mortality, symptomatic intracranial hemorrhage (sICH), and need for craniectomy.</p><p><strong>Results: </strong>Using our flow model, we demonstrated a significant reduction in middle cerebral artery and anterior cerebral artery blood flow with the use of larger caliber catheters in the internal carotid artery. Controlling for covariates in 3318 patients, longer icPT predicted lower odds of 90-day favorable outcome (adjusted odds ratio (aOR) 0.87, P<0.01), increased mortality (aOR 1.03, P<0.01), higher decompressive craniectomy rates (aOR 1.07, P<0.01), and increased sICH (aOR 1.07, P<0.01). Each additional 10 mins of icPT correlated with a 13% decrease in recanalization success. The impact of icPT on outcomes was consistent regardless of recanalization success, though catheter size influenced effects. Reduced intraprocedural blood pressure worsened icPT's effects.</p><p><strong>Conclusions: </strong>This study is the first to demonstrate the risks associated with the duration of catheter use during MT and to propose strategies to mitigate these risks in AIS.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622206","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":"Subarachnoid iodine leakage on dual-energy computed tomography after mechanical thrombectomy is associated with malignant brain edema.","authors":"Atsushi Ogata, Kuniaki Ogasawara, Masashi Nishihara, Ayako Takamori, Takashi Furukawa, Toshihiro Ide, Hiroshi Ito, Fumitaka Yoshioka, Yukiko Nakahara, Jun Masuoka, Haruki Koike, Hiroyuki Irie, Tatsuya Abe","doi":"10.1136/jnis-2023-021413","DOIUrl":"10.1136/jnis-2023-021413","url":null,"abstract":"<p><strong>Background: </strong>Dual-energy computed tomography (DE-CT) can differentiate between hemorrhage and iodine contrast medium leakage following mechanical thrombectomy (MT) for acute ischemic stroke (AIS). We determined whether subarachnoid hemorrhage (SAH) and subarachnoid iodine leakage (SAIL) on DE-CT following MT were associated with malignant brain edema (MBE).</p><p><strong>Methods: </strong>We analyzed the medical records of 81 consecutive anterior circulation AIS patients who underwent MT. SAH or SAIL was diagnosed via DE-CT performed immediately after MT. We compared the procedural data, infarct volumes, MBE, and modified Rankin scale 0-2 at 90 days between patients with and without SAH and between patients with and without SAIL. Furthermore, we evaluated the association between patient characteristics and MBE.</p><p><strong>Results: </strong>A total of 20 (25%) patients had SAH and 51 (63%) had SAIL. No difference in diffusion-weighted imaging (DWI)-infarct volume before MT was observed between patients with and without SAH or patients with and without SAIL. However, patients with SAIL had larger DWI-infarct volumes 1 day following MT than patients without SAIL (95 mL vs 29 mL; p=0.003). MBE occurred in 12 of 81 patients (15%); more patients with SAIL had MBE than patients without SAIL (22% vs 3%; p=0.027). Severe SAIL was significantly associated with MBE (OR, 12.5; 95% CI, 1.20-131; p=0.006), whereas SAH was not associated with MBE.</p><p><strong>Conclusion: </strong>This study demonstrated that SAIL on DE-CT immediately after MT was associated with infarct volume expansion and MBE.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140119823","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":"Effect of abnormal distribution of abdominal adiposity and skeletal muscle on the outcomes of endovascular treatment for emergent large vessel occlusion.","authors":"Chengcheng Cui, Zhiwen Geng, Hao Chen, Mengxia Lu, Yuqiao Wang, Dayong Shen, Rui Li, Lulu Xiao, Xinfeng Liu","doi":"10.1136/jnis-2024-022386","DOIUrl":"10.1136/jnis-2024-022386","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to investigate the relationships between imaging indicators of obesity, as measured by computed tomography (CT), and clinical outcomes at 90 days and 1 year after emergent endovascular therapy (EVT).</p><p><strong>Methods: </strong>Participants with emergent large vessel occlusion (ELVO) who underwent EVT were prospectively enrolled. During hospitalization, CT scans were performed to evaluate the visceral adipose tissue area (VATA) and skeletal muscle area (SMA) at the level of the third lumbar spine. Multivariate regression analysis was used to assess the correlation of obesity-related imaging measures with various outcomes: mortality, favorable functional outcomes (modified Rankin scale (mRS) score 0-2), and functional improvement (shift in mRS score) at 90 days and 1 year.</p><p><strong>Results: </strong>A total of 306 ELVO patients were included in the study, with a median age of 64 years and a median baseline National Institutes of Health Stroke Scale (NIHSS) score of 18. After adjusting for potential confounders, the VATA-to-SMA ratio (VSR) was significantly associated with a favorable functional outcome (OR 0.30, 95% CI 0.13 to 0.70) at 90 days and a favorable functional outcome (OR 0.27, 95% CI 0.12 to 0.61) and functional improvement (OR 0.33, 95% CI 0.12 to 0.92) at the 1 year follow-up.</p><p><strong>Conclusion: </strong>Our study indicated that lower VSR levels are associated with favorable functional outcomes, along with functional improvement at 90 days and 1 year of follow-up.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576011","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":"Cerebral angiography in outpatient endovascular centers: roadmap and lessons learned from interventional radiology, cardiology, and vascular surgery.","authors":"Pui Man Rosalind Lai, Aimee C DeGaetano, Elad I Levy","doi":"10.1136/jnis-2024-022656","DOIUrl":"https://doi.org/10.1136/jnis-2024-022656","url":null,"abstract":"","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622191","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":"Woven EndoBridge device apposition and compression using Sim&Size virtual simulation correlate with aneurysm occlusion status: a retrospective cohort study.","authors":"Federico Cagnazzo, Alexis Atallah, Liesjet E H van Dokkum, Carolina Capirossi, Gregory Gascou, Cyril Dargazanli, Pierre Henri Lefevre, Gianfranco Di Salle, Paolo Machi, Francois-Louis Collemiche, Quentin Varnier, Thomas Checkouri, Christophe Chnafa, Amandine Rene, Răzvan Alexandru Radu, Vincent Costalat","doi":"10.1136/jnis-2024-022135","DOIUrl":"10.1136/jnis-2024-022135","url":null,"abstract":"<p><strong>Background: </strong>Virtual simulation is increasingly used for aneurysm treatment. This study aimed to explore whether mechanical behavior biomarkers of the Woven EndoBridge (WEB) device as computed by Sim&Size simulation software were associated with aneurysmal occlusion status at follow-up.</p><p><strong>Methods: </strong>Consecutive patients with aneurysms treated with WEB were retrospectively enrolled (January 2014 to December 2021). Aneurysms were included if three-dimensional digital subtraction angiography and follow-up imaging were available. Device apposition and compression within the aneurysm sac were retrospectively calculated by Sim&Size simulation software. Mean global and maximum compression, mid-device and neck compression, and the Spruce index of heterogeneity of deformation of the simulated device were calculated. A multivariate Lasso regression was performed.</p><p><strong>Results: </strong>A total of 81 aneurysms in 80 patients (56 females; mean age 60±12 years) were analyzed. At a mean radiological follow-up of 3±2 years, 62 (77%) showed an adequate occlusion. Mean apposition in the inadequate and adequate occlusion group was 42.9±11% and 53.97±12%, respectively (P=0.002), mean global compression was 4.95±3% and 7.85±6% (P=0.035), respectively, and maximal compression was 13.44±6% and 20.73±11%, respectively (P=0.009). Compressions at mid-level and neck level were comparable between the two groups. The Spruce index was higher in the inadequate occlusion group (0.16±0.05 vs 0.20±0.05, P=0.005). Multivariate analysis showed that wall apposition, maximum compression and the Spruce index were independent prognosticators of aneurysm occlusion.</p><p><strong>Conclusions: </strong>Wall apposition, maximum compression and the Spruce index computed by Sim&Size software predicted the likelihood of aneurysm occlusion at follow-up, after WEB treatment.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502291","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":"Adjunctive intravascular lithotripsy for heavily calcified carotid stenosis: a dual-center experience and technical case series.","authors":"Ricardo A Hanel, Vinay Jaikumar, Salvador F Gutierrez-Aguirre, Hamid Sharif Khan, Otavio F De Toledo, Jaims Lim, Tyler A Scullen, Fernanda Rodriguez-Erazú, Bernard Okai, Matthew J McPheeters, Mehdi Bouslama, Kunal P Raygor, Adnan H Siddiqui","doi":"10.1136/jnis-2024-022545","DOIUrl":"https://doi.org/10.1136/jnis-2024-022545","url":null,"abstract":"<p><strong>Background: </strong>Heavily calcified carotid stenosis (HCCS) is considered an exclusion for carotid angioplasty and/or stenting (CAS), amenable only to carotid endarterectomy. This study presents preliminary retrospective dual-center experience utilizing the Shockwave S⁴ intravascular lithotripsy (IVL) system (Shockwave Medical) as an adjunct to CAS for HCCS.</p><p><strong>Methods: </strong>Patients with symptomatic or asymptomatic HCCS (de novo stenosis or in-stent restenosis (ISR)) undergoing IVL+CAS were included. Charts were reviewed for demographic, imaging, procedural, and outcome data. The primary endpoint was composite major adverse event (MAE) rate: death, ipsilateral stroke, or myocardial infarction (MI) within 30 days of IVL+CAS. Secondary endpoints included technical and procedural success, residual stenosis, and ISR postprocedure.</p><p><strong>Results: </strong>Fifteen patients underwent 17 IVL+CAS procedures: de novo HCCS=13, heavily calcified ISR=4; symptomatic disease was addressed in seven cases. Procedures were performed transfemorally under conscious sedation with dual protection; flow reversal through a balloon guide catheter, and distal embolic protection system (EPS) use. Median pre-IVL+CAS stenosis was 73% (IQR 60-80%). Technical success (IVL+CAS+ EPS use) was achieved in all cases. Median post-IVL+CAS residual stenosis was 27% (IQR 12-33%), achieving <50% residual stenosis and procedural success in all. Five patients required dopamine infusion for postprocedural hypotension. No periprocedural ipsilateral strokes occurred. MAE rate was 6.7% (95% CI 0.2% to 32%), including one MI resulting in death. Additionally, one ISR (6.3%; 95% CI 0.2% to 30.2%) identified 160 days after IVL+CAS was retreated with angioplasty.</p><p><strong>Conclusions: </strong>IVL+CAS was safe and effective for treating symptomatic and asymptomatic HCCS, achieving high rates of freedom from MAE. IVL has potential to expand the role of CAS in difficult to treat HCCS.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604131","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 'Comparing stand-alone endovascular embolization versus stereotactic radiosurgery in the treatment of arteriovenous malformations with Spetzler-Martin grades I-III: a propensity score matched study' by Musmar <i>et al</i>.","authors":"Keyur Shah, Dwarakanath Srinivas","doi":"10.1136/jnis-2024-022670","DOIUrl":"https://doi.org/10.1136/jnis-2024-022670","url":null,"abstract":"","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622201","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":"Onyx dilution reduces time to resolution of chronic subdural hematomas after middle meningeal artery embolization.","authors":"Alice Hung, Wuyang Yang, Oishika Das, Xihang Wang, Kathleen Ran, Emeka Ejimogu, Mostafa Abdulrahim, Ryan Nakamura, Ferdinand Hui, Vivek Yedavalli, Christopher M Jackson, Judy Huang, Rafael J Tamargo, Justin M Caplan, L Fernando Gonzalez, Risheng Xu","doi":"10.1136/jnis-2024-022492","DOIUrl":"https://doi.org/10.1136/jnis-2024-022492","url":null,"abstract":"<p><strong>Background: </strong>The benefit of distal embolite penetration for middle meningeal artery (MMA) embolization in chronic subdural hematomas (cSDH) remains controversial.</p><p><strong>Objective: </strong>To compare the use of diluted Onyx with undiluted Onyx in the management of cSDH.</p><p><strong>Methods: </strong>This is a retrospective study of patients with cSDH who underwent MMA embolization using Onyx 18 at our institution. The study population was divided into two subgroups based on whether the Onyx used was diluted or not. Baseline characteristics and technical aspects were compared. Primary outcome was cSDH resolution at follow-up. Secondary outcomes included time to resolution and duration of procedure. Univariate statistical analysis was performed.</p><p><strong>Results: </strong>Of the 111 MMA embolizations performed at our institution, 99 were performed using Onyx 18 only. Within this cohort, 53 (53.5%) cases used standard Onyx and 46 (46.5%) cases used diluted Onyx. The diluted Onyx group had significantly greater volume of embolic agent used measured radiographically (P<0.001). There was no significant difference in duration of procedure. The percentage of cSDH resolution at last follow-up was similar between the two groups (P=0.98), but the time to resolution was significantly shorter in the diluted Onyx group (P=0.02).</p><p><strong>Conclusion: </strong>The use of diluted Onyx for MMA embolization is associated with greater embolization volume achieved under similar procedural times. While the percentage of patients who achieved cSDH resolution with diluted Onyx is similar to that for standard Onyx, the time to cSDH resolution is significantly shorter. Adoption of Onyx dilution can be considered in MMA embolization for cSDH.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622204","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":"FRED X flow diversion stenting for unruptured intracranial aneurysms: US multicenter post-market study.","authors":"Philipp Hendrix, Sina Hemmer, Georgios S Sioutas, Nicholas C Field, Muhammed Amir Essibayi, Mohamed M Salem, Visish M Srinivasan, Amanda Custozzo, Alireza Karandish, David Altschul, Alexandra R Paul, Jan-Karl Burkhardt, Clemens M Schirmer, Oded Goren","doi":"10.1136/jnis-2024-022523","DOIUrl":"https://doi.org/10.1136/jnis-2024-022523","url":null,"abstract":"<p><strong>Background: </strong>The Flow Re-direction Endoluminal Device (FRED) X is a next generation flow-diverting stent for treating intracranial aneurysms. Its surface modification (X technology) aims to minimize device thrombogenicity. Early post-market multicenter data from the US are lacking.</p><p><strong>Methods: </strong>We conducted a retrospective multicenter analysis of consecutive FRED X procedures performed to treat unruptured intracranial aneurysms at four US centers (March 2022 to January 2024). Cases with ruptured aneurysms or extracranial aneurysm location were excluded (n=10). We assessed patient and aneurysm characteristics, antithrombotic management, safety events, and both clinical and angiographic (effectiveness) outcomes.</p><p><strong>Results: </strong>In this cohort, 101 patients underwent FRED X stenting for 117 aneurysms. Most aneurysms were saccular in shape (95.7%) and located at the C6-C7 segments of the internal carotid artery (72.6%). Thromboembolic events occurred in 5.9% of the cases, leading to one instance of permanent procedure related morbidity (1.0%). No procedure related mortality (0%) was observed. Device related issues were recorded in 2.0% of cases. At the 6 month follow-up, complete aneurysm occlusion was achieved in 58% of aneurysms. At the last available follow-up (6-12 months), 74.8% of aneurysms were adequately occluded.</p><p><strong>Conclusions: </strong>FRED X stenting for unruptured intracranial aneurysms demonstrated low rates of neurological morbidity and periprocedural complications. Early aneurysm occlusion rates were appropriate, but further mid-term and long term follow-up is required. These findings support the early safety and effectiveness of the FRED X device for intracranial aneurysm treatment.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576034","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":"Tmax >4 s volume predicts stroke recurrence in symptomatic intracranial atherosclerotic stenosis with optimal medical treatment.","authors":"Ying Yu, Junchao Yu, Zhikai Hou, Tse-Cheng Chiu, Xiaobo Liu, Yuesong Pan, Long Yan, Weilun Fu, BaiXue Jia, W T Lui, Yongjun Wang, Rong Wang, Zhongrong Miao, Xin Lou, Ning Ma","doi":"10.1136/jnis-2024-022418","DOIUrl":"https://doi.org/10.1136/jnis-2024-022418","url":null,"abstract":"<p><strong>Background: </strong>The time to maximum (Tmax) profile based on computed tomography perfusion (CTP) provides a quantitative assessment of cerebral hemodynamic compromise. We aimed to delineate the Tmax profile in stroke patients with symptomatic intracranial atherosclerotic stenosis (ICAS) and to investigate its predictive role in stroke recurrence after optimal medical treatment.</p><p><strong>Methods: </strong>Consecutive patients with ischemic stroke within 30 days attributed to 50%-99% ICAS were prospectively enrolled. Baseline tissue volume at different perfusion parameter thresholds based on CTP was automatically calculated using the Rapid Processing of Perfusion and Diffusion (RAPID) software. All patients received optimal medical treatment. The primary outcome was a composite of stroke in the territory of qualifying artery or vascular death within 1 year.</p><p><strong>Results: </strong>Among 204 patients with symptomatic ICAS, the median volume of Tmax >4 s, Tmax >6 s, and relative cerebral blood flow (rCBF) <30% were 61 mL, 0 mL, and 0 mL, respectively. The 1 year rate of primary outcome was 16.2% (33/204). Tmax >4 s volume was significantly associated with the primary outcome (per 10 mL increase, adjusted hazard ratio (HR), 1.028 (1.008-1.049), P=0.005). The optimal cut-off value of Tmax >4 s volume for predicting the primary outcome was 83 mL. Patients with Tmax >4 s volume >83 mL had a higher risk of the 1 year primary outcome than those with Tmax >4 s volume ≤83 mL (adjusted HR, 7.346 (3.012-17.871), P<0.001), after adjusting for degree of stenosis and stroke mechanisms.</p><p><strong>Conclusion: </strong>Tmax >4 s volume is a promising perfusion parameter to define hemodynamic compromise in patients with symptomatic ICAS. Patients with a larger volume of Tmax >4 s are likely to have a higher risk of stroke recurrence despite optimal medical treatment.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576094","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}