Journal of NeuroInterventional Surgery最新文献

{"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}

{"title":"Computational fluid dynamics-derived flow helicity and recurrent stroke risk in symptomatic intracranial stenosis.","authors":"Kai Zhang, Xinxin Shi, Yibo Yan, Xiaobo Liu, Zhikai Hou, Xiwen Zhang, Ying Yu, Kefan Shen, Mingyao Li, Xin Lou, Ning Ma","doi":"10.1136/jnis-2026-025589","DOIUrl":"https://doi.org/10.1136/jnis-2026-025589","url":null,"abstract":"<p><strong>Background: </strong>Patients with symptomatic intracranial atherosclerotic stenosis (ICAS) remain at risk of recurrent ischemic events despite treatment. Stenosis severity is routinely used for risk assessment, but does not describe the lesion-level flow field. We used computational fluid dynamics (CFD) to assess whether flow helicity within the culprit stenosis was associated with 1-year target-vessel stroke.</p><p><strong>Methods: </strong>We studied 204 adults with symptomatic ICAS who underwent CT angiography-based vascular reconstruction and CFD analysis. The prespecified exposure was maximum absolute flow helicity at the narrowest cross-sectional plane of the culprit stenosis, transformed using log(1+x) and standardized per SD. The primary outcome was 1-year target-vessel stroke, and the secondary endpoint was target-territory stroke or vascular death. Multivariable Cox models adjusted for major clinical, anatomical, and hemodynamic covariates were supplemented by Kaplan-Meier, cutpoint, tertile, subgroup, and Winsorization analyses.</p><p><strong>Results: </strong>Multivariable analyses included 203 patients. During follow-up, 31 target-vessel strokes and 33 composite events occurred. Each 1 SD increase in log-transformed maximum absolute helicity was associated with target-vessel stroke (HR 1.461, 95% CI 1.049 to 2.035, P=0.0249). The association with the composite endpoint was directionally similar but not significant (HR 1.351, 95% CI 0.973 to 1.875, P=0.0720). Median-split Kaplan-Meier curves separated for both outcomes, and tertile analysis showed higher target-vessel stroke risk in the highest versus lowest tertile (HR 2.951, 95% CI 1.067 to 8.160, P=0.0371).</p><p><strong>Conclusions: </strong>In symptomatic ICAS, higher lesion-level maximum absolute helicity was associated with 1-year target-vessel stroke, supporting further evaluation of helicity as a CFD-derived marker of flow disturbance.</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":"148977062","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":"Workflow level release of microplastics, nanoplastics, and perfluoroalkyl and polyfluoroalkyl substances during simulated neurovascular interventions.","authors":"Matthew J Gounis, Hal Rice, David A Steinman","doi":"10.1136/jnis-2026-026216","DOIUrl":"https://doi.org/10.1136/jnis-2026-026216","url":null,"abstract":"","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":"148977045","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":"Workflow level release of microplastics, nanoplastics, and perfluoroalkyl and polyfluoroalkyl substances during simulated neurovascular interventions.","authors":"Sophia Hohenstatt, Gabriele Maliandi, Dominik F Vollherbst, Noah G Bahce, Susanne Bonekamp, Martin Bendszus, Markus A Möhlenbruch","doi":"10.1136/jnis-2026-025917","DOIUrl":"https://doi.org/10.1136/jnis-2026-025917","url":null,"abstract":"<p><strong>Background: </strong>Catheter based neurovascular interventions rely on polymer based, coated, and fluorinated devices. Mechanical manipulation may release particulate and molecular contaminants, but integrated workflow level quantification of microplastic (MP), nanoplastic (NP), and perfluoroalkyl and polyfluoroalkyl substance (PFAS) release during neurovascular procedures remains limited. This study quantified MP, NP, and PFAS release in an in vitro simulation of neurointerventional workflows.</p><p><strong>Methods: </strong>20 neurovascular procedures were simulated under standardized in vitro conditions, including 10 mechanical thrombectomy and 10 aneurysm treatment workflows. Procedures were performed in 5 L glass containers using warmed saline, contrast medium, and clinically applied neurovascular devices. Procedural fluid was collected after each simulation and aliquoted for MP, NP, and PFAS analysis using micro-Fourier transform infrared spectroscopy, pyrolysis-gas chromatography-mass spectrometry, and ultra high performance liquid chromatography-tandem mass spectrometry, respectively.</p><p><strong>Results: </strong>Contaminants were detected across all simulated procedures. Median MP particle count was 15 particles per analyzed sample volume (IQR 9.0-27.3; range 0-58), median NP concentration was 18.19 µg/L (IQR 5.85-33.35; range 2.19-1671.10), and median sum PFAS concentration was 127 µg/L (IQR 93.5-272.0; range 47-458). MP and NP levels did not differ between thrombectomy and aneurysm simulations. Sum PFAS concentrations were higher during thrombectomy than during aneurysm treatment simulations (median 209.5 vs 98.0 µg/L; P=0.010), particularly in stent retriever compared with direct aspiration simulations (median 287.0 vs 120.0 µg/L; P=0.030). NP and sum PFAS concentrations were strongly correlated (ρ=0.689; P=0.001).</p><p><strong>Conclusions: </strong>Simulated neurovascular interventions generated measurable release of MP, NP, and PFAS into procedural fluid. Workflow level assessment may support future source specific testing, clinical validation, and material safety evaluation.</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":"148977071","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":"Clinical outcomes of intracranial dural arteriovenous fistulas with the pseudophlebitic pattern.","authors":"Xin Su, Liyong Sun, Ya Gao, Zihao Song, Yiguang Chen, Hongqi Zhang, Peng Zhang, Yongjie Ma","doi":"10.1136/jnis-2025-024390","DOIUrl":"10.1136/jnis-2025-024390","url":null,"abstract":"<p><strong>Background: </strong>A pseudophlebitic pattern (PPP) is now widely recognized as an angiographic manifestation of chronic venous congestion in intracranial dural arteriovenous fistulas (DAVFs).</p><p><strong>Objective: </strong>To investigate the association between a PPP and chronic venous congestion in patients with intracranial DAVFs.</p><p><strong>Methods: </strong>We retrospectively reviewed consecutive patients evaluated over a 21-year period. Angiographic studies were assessed for the presence of PPP, which was defined as serpiginous and tortuous collateral, bridging, and cortical veins with delayed circulation time in the normal brain. Baseline characteristics and follow-up outcomes were compared between patients with DAVF with and without PPP. To reduce selection bias, the two cohorts were matched in a 1:1 ratio using propensity score matching.</p><p><strong>Results: </strong>PPP was found in 256 patients (23.3%). In the unmatched cohort, patients with DAVF with PPP showed lower occlusion rates on angiographic follow-up (73.6% vs 92.7%, P<0.001), higher mRS scores at clinical follow-up (P<0.001), reduced proportions of excellent (79.2% vs 88.1%, P<0.001) and good outcomes (69.7% vs 81.5%, P<0.001), as well as increased all-cause mortality (10.9% vs 4.9%, P=0.001). After matching for baseline characteristics and occlusion status, no significant differences in clinical outcomes were observed between patients with DAVF with and without PPP in the entire cohort, the high-grade cohort, or the cohort limited to PPP-relevant locations.</p><p><strong>Conclusions: </strong>PPP alone is not sufficient as an independent prognostic marker for DAVF. Future studies should aim to develop more comprehensive scoring systems that incorporate detailed angioarchitectural characteristics to enhance prognostic stratification.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"2040-2044"},"PeriodicalIF":4.4,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145368166","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":"Hematoma evacuation modifies the relationship between early changes in neutrophil-to-lymphocyte ratio and mortality after intracerebral hemorrhage.","authors":"Emma White, Adam T Eberle, Dana Klavansky, Gabriela Keeton, Cappi Lay, Hae Young Baang, John Liang, Neha Dangayach, J Mocco, Christopher Paul Kellner, Fernanda Carvalho Poyraz","doi":"10.1136/jnis-2025-024271","DOIUrl":"10.1136/jnis-2025-024271","url":null,"abstract":"<p><strong>Background: </strong>Neutrophil-to-lymphocyte ratio (NLR) is a prognostic indicator in intracerebral hemorrhage (ICH) thought to reflect systemic inflammation driving secondary brain injury. Recent evidence suggests that surgical hematoma evacuation improves long-term outcomes, presumably by reducing secondary brain injury triggered by hematoma-induced inflammation. We hypothesized that stereotactic intracerebral hemorrhage underwater blood aspiration (SCUBA), a minimally invasive hematoma evacuation technique, alters the association between early rise in NLR and outcomes in ICH patients.</p><p><strong>Methods: </strong>We conducted a retrospective matched cohort study of 514 ICH patients: 264 underwent SCUBA and 250 were matched controls. Serial white blood cell (WBC) counts with differential were obtained from admission through hospital day 7. We analyzed relationships between the change in NLR from admission to hospital day 2 (delta NLR (ΔNLR)) and in-hospital mortality (primary outcome) using multivariable logistic regression, adjusting for ICH severity and infection status.</p><p><strong>Results: </strong>Baseline characteristics, admission WBC count, and admission NLR were well-balanced without significant differences between groups. Hospital mortality was significantly lower in SCUBA patients (7.2% vs 22.8%, P<0.001). ΔNLR was independently associated with mortality (adjusted OR (aOR) 1.068 per unit increase, P=0.033). However, there was a significant interaction between SCUBA and ΔNLR (aOR 0.884, P=0.019). Predicted mortality probability remained low across NLR ranges in SCUBA patients while increasing sharply in the matched cohort.</p><p><strong>Conclusions: </strong>Our findings suggest that SCUBA modifies the association between ΔNLR and mortality, such that NLR was not a predictor of outcome after hematoma evacuation. Further work is needed to determine whether hematoma evacuation alters systemic inflammatory pathways that drive secondary brain injury after ICH.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"2034-2039"},"PeriodicalIF":4.4,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145368130","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 productivity benchmark trap: how lagging survey data and selective blending compound CMS reimbursement cuts for employed neurointerventionalists.","authors":"Clemens Maria Schirmer, Joshua A Hirsch, James M Milburn","doi":"10.1136/jnis-2026-026244","DOIUrl":"https://doi.org/10.1136/jnis-2026-026244","url":null,"abstract":"","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":"18 10","pages":"1961-1963"},"PeriodicalIF":4.4,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148969480","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":"Short-term safety of dual versus single antiplatelet therapy in flow diversion for distal intracranial aneurysms: results from the DART trial.","authors":"Luis Henrique de Castro-Afonso, Saulo Villas-Boas, Guilherme Seizem Nakiri, Gustavo Andrade, Ítalo Emmanuel Lima Ferreira, José Laércio Júnior Silva, Eric Homero Albuquerque Paschoal, Elias Antônio Tanus Machado, Jose Alberto Almeida Filho, Cesar Augusto Ferreira Alves Filho, Ricardo Santos de Oliveira, Benedicto Oscar Colli, Daniel Giansante Abud","doi":"10.1136/jnis-2025-024144","DOIUrl":"10.1136/jnis-2025-024144","url":null,"abstract":"<p><strong>Background and purpose: </strong>Flow diverters (FDs) have become one of the primary treatments for intracranial aneurysms (IAs). However, their use in distal IA has been associated with higher complication rates compared with other techniques. The development of coated FDs, in combination with novel antiplatelet regimens, offers promising strategies to improve the safety profile of FDs in this context. This trial aimed to compare mono antiplatelet therapy (MAPT) using prasugrel versus dual antiplatelet therapy (DAPT) with aspirin and prasugrel for the treatment of distal IA using the p48 MW HPC FD (WallabyPhenox).</p><p><strong>Methods: </strong>This was a multicenter, prospective, parallel-group, single-blind, non-inferiority randomized trial. Between February 2021 and February 2025, 140 patients were enrolled. After excluding 11 patients, 129 were included in the final analysis. The primary endpoint was the absence of new neurological deficits, defined as no shift in the modified Rankin Scale (mRS) score. The secondary endpoint was the incidence of any stroke.</p><p><strong>Results: </strong>At the 30-day follow-up, 66 patients (98.5%) in the MAPT group and 59 patients (95.2%) in the DAPT group showed no new neurological deficits. With a predefined non-inferiority margin of 5%, the difference of 3.35% confirmed the non-inferiority of MAPT compared with DAPT (p=0.002). The incidence of any stroke was 4/67 (5.9%) in the MAPT group and 6/62 (9.6%) in the DAPT group (p=0.431).</p><p><strong>Conclusion: </strong>Prasugrel monotherapy for the treatment of distal IAs using the p48 MW HPC was non-inferior to DAPT within the first 30 days following treatment.</p><p><strong>Clinical trial registration: </strong>https://ensaiosclinicos.gov.br/rg/RBR-3q9zb73. UTN code: U1111-1290-2489. Research Ethics Committee of the Hospital das Clínicas de Ribeirão Preto - Universidade de São Paulo. CAAE number: 29848720.0.1001.5440.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"2045-2050"},"PeriodicalIF":4.4,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145345732","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":"Occlusion site and outcomes in intra-arterial tenecteplase after successful endovascular therapy: a secondary analysis of the ANGEL-TNK trial.","authors":"Shuo Li, Xin Tong, Huachen Zhang, Gang Luo, Ligang Song, Dapeng Sun, Wenhuo Chen, Xiaoxi Yao, Qi Zhou, Xuelei Zhang, Yiwen Xu, Thanh N Nguyen, Zhongrong Miao, Xiaochuan Huo","doi":"10.1136/jnis-2025-024129","DOIUrl":"10.1136/jnis-2025-024129","url":null,"abstract":"<p><strong>Background: </strong>Endovascular thrombectomy achieves macroreperfusion in large vessel occlusion (LVO) stroke, but only one-quarter of patients had excellent functional outcome. Adjunct intra-arterial (IA) tenecteplase could further improve the treatment effect, yet its efficacy across internal carotid artery (ICA) versus middle cerebral artery (MCA) M1/M2 occlusion remains unclear.</p><p><strong>Objective: </strong>To evaluate whether IA tenecteplase improves 90-day functional outcomes in LVO patients stratified by occlusion site (ICA, MCA M1, MCA M2).</p><p><strong>Methods: </strong>Prespecified secondary analysis of the ANGEL-TNK trial (multicenter, randomized, open-label, blinded endpoint) in 19 Chinese stroke centers. Participants were enrolled who had anterior circulation LVO, 4.5-24 hours from symptom onset, and CT angiography (CTA)/magnetic resonance angiography (MRA)-proven ICA, M1, or M2 occlusion.</p><p><strong>Intervention: </strong>Randomization (1:1) to IA tenecteplase (0.125 mg/kg) or standard medical management after expanded Thrombolysis in Cerebral Infarction (eTICI) 2b50-3 reperfusion.</p><p><strong>Main outcome measure: </strong>The primary outcome was the rate of 90-day modified Rankin Scale (mRS) 0-1.</p><p><strong>Results: </strong>There were 256 patients in the trial, including 71 (27.7%) ICA, 122 (47.6%) MCA M1, and 62 (24.2%) MCA M2. ICA occlusion patients treated with IA tenecteplase had higher rates of 90-day mRS 0-1 (39.4% vs 13.2%; relative risk (RR) 2.99; 95% CI 1.51 to 5.96; p=0.002) and mRS 0-3 (54.5% vs 42.1%; RR 1.30; p=0.048) versus controls, with a significant shift toward better mRS scores (median 3 (IQR 1-4) vs 4 (2-6); odds ratio (OR) 2.26; p<0.001). Post hoc analysis showed higher eTICI progression in ICA patients (51.5%) versus MCA M1 (37.9%) and M2 (25.7%). IA tenecteplase had a lower any intracranial hemorrhage within 48 hours in ICA patients (15.2% vs 39.5%; RR 0.38; p<0.001) compared with standard medical management. No significant benefits were observed in the MCA M1/M2 subgroups, and interaction effects were significant between ICA and MCA segments for functional outcomes and safety.</p><p><strong>Conclusions and relevance: </strong>IA tenecteplase had a better functional outcome and lower hemorrhage risk in ICA occlusion compared with standard medical management but not in MCA M1/M2. Occlusion site is a critical determinant of response to IA tenecteplase. A pooled analysis of IA tenecteplase stratified by occlusion site strata is warranted.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"2004-2010"},"PeriodicalIF":4.4,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145368139","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}