Journal of NeuroInterventional Surgery最新文献

{"title":"Glenzocimab for reperfusion in the setting of endovascular therapy for brain infarction: GREEN study.","authors":"Mikaël Mazighi, Jerome Lambert, Benjamin Gory, Pierre Seners, Lionel Calvière, Tae Hee Cho, Agnès Aghetti, Marco Pasi, Gregoire Boulouis, Bertrand Lapergue, Arturo Consoli, Guillaume Turc, Aymeric Rouchaud, Valerie Wolff, Raoul Pop, Laurent Suissa, Sébastien Richard, Charlotte Cordonnier, Caroline Arquizan, Vincent Costalat, Alexis Guedon, Christophe Cognard, Lakhdar Mameri, Simon Escalard, Hocine Redjem, Stanislas Smajda, Erwan Robichon, Amira Al Raaisi, William Boisseau, Raphaël Blanc, Benjamin Maier, Perrine Boursin, Estelle Dubus, Jean-Philippe Desilles, Michel Piotin, Matthieu Resche Rigon, Jean-Marc Olivot","doi":"10.1136/jnis-2025-023606","DOIUrl":"https://doi.org/10.1136/jnis-2025-023606","url":null,"abstract":"<p><strong>Background: </strong>Glenzocimab is a humanized fragment of a monoclonal antibody directed against the human platelet glycoprotein VI, which has shown promising features, including thrombus growth inhibition and minimal bleeding risk. The first inpatient study suggested the benefit of glenzocimab with alteplase in subgroups of patients with acute ischemic stroke (AIS) receiving endovascular treatment (EVT), with increased reperfusion rates and decreased risk of symptomatic hemorrhagic transformation. The objective of the GREEN (Glenzocimab for REperfusion in the setting of Endovascular therapy for brain infarctioN) study is to evaluate the efficacy of glenzocimab with EVT compared with EVT plus placebo, with or without intravenous thrombolysis (IVT), on functional outcome.</p><p><strong>Methods: </strong>GREEN is a multicenter, randomized, double blind, placebo controlled study. Participants presenting with AIS and a large vessel occlusion of the anterior circulation (intracranial internal carotid artery or middle cerebral artery, or both), with symptoms onset within 24 hours, will be randomized to one of two groups: intravenous glenzocimab 1000 mg with standard of care (SoC-EVT±IVT) or SoC (EVT±IVT) plus placebo. The main primary efficacy endpoint is functional outcome (assessed by the modified Rankin Scale score) at 90 days.</p><p><strong>Conclusion: </strong>This is the first randomized trial evaluating the efficacy of glenzocimab with EVT. This prospective trial aims to determine whether glenzocimab with EVT improves functional outcome.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT05559398.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957473","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":"Comparative safety and efficacy of invasive therapies for carotid artery stenosis: a systematic review and network meta-analysis.","authors":"Muhammad Yunus Amran, Yusran Ady Fitrah, Nabilah Puteri Larassaphira, Andi Muh Aunul Khaliq Gunawan, Andi Muhammad Hanif Abdillah, Aulia Rezky Mufidah Toaha, Ahmad Taufik Fadillah Zainal, Siti Giranti Ardilia Gunadi","doi":"10.1136/jnis-2025-023900","DOIUrl":"https://doi.org/10.1136/jnis-2025-023900","url":null,"abstract":"<p><strong>Background: </strong>Carotid artery stenosis is a major cause of stroke and is commonly treated with carotid endarterectomy (CEA) or carotid artery stenting (CAS). Trans-carotid artery revascularization (TCAR) has emerged as a newer alternative designed to reduce the risk of procedural stroke. However, comparative evidence on the safety and efficacy of these interventions is limited. This study evaluates the clinical outcomes of CEA, CAS, and TCAR in patients with carotid artery stenosis.</p><p><strong>Methods: </strong>A comprehensive search of multiple databases was conducted to identify relevant studies. The outcomes were stroke, mortality, and myocardial infarction, cranial nerve injury, hematoma, infection, transient ischemic attack, and length of hospital stay. Meta-analysis and a frequentist graph-theoretical approach network meta-analysis were performed using the netmeta package in R platform. Risk of bias was assessed using RoB 2 Cochrane and ROBINS-I.</p><p><strong>Results: </strong>Fifty-five studies were included in the review. The short-term stroke risk was significantly lower with CEA than with CAS. TCAR had a potential long-term mortality benefit over CAS, while no significant differences were observed in short-term mortality or myocardial infarction across treatments. CAS was associated with lower risks of cranial nerve injury, hematoma, and infection compared with CEA.</p><p><strong>Conclusion: </strong>CEA and TCAR offer better short-term stroke protection than CAS, with TCAR showing promise for long-term mortality benefits. CAS has advantages in reducing cranial nerve injury, hematoma, and infection risks. Overall, the choice of treatment should consider both efficacy and safety profiles. Further high-quality randomized controlled trials, particularly focusing on TCAR, are needed to validate these comparative outcomes.</p><p><strong>Prospero registry number: </strong>CRD420251055287.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957385","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":"Validation of an in vitro testing platform for intra-arterial thrombolytics on human thrombectomy retrieved clots.","authors":"Judith Cendrero, Jiahui Li, Miguel Serodio, Cristina Marquez, Alvaro Garcia-Tornel, Jesus Juega, Claudia Meza, Santiago Ortega-Gutierrez, Riccardo Tiberi, Angel Guillermo Arevalo, Pere Canals, Adriano Bonura, Jorge Pagola, Marc Ribo","doi":"10.1136/jnis-2025-023809","DOIUrl":"https://doi.org/10.1136/jnis-2025-023809","url":null,"abstract":"<p><strong>Background: </strong>Endovascular thrombectomy (EVT) is the standard treatment for acute ischemic stroke (AIS) due to large vessel occlusion. However, many patients fail to achieve good outcomes, especially without first pass reperfusion. Intra-arterial thrombolytics such as recombinant tissue plasminogen activator (rtPA) and tirofiban have shown potential as adjunctive therapies. The aim of this study was to compare the in vitro effects of rtPA, tirofiban, and their sequential combination on EVT retrieved clots.</p><p><strong>Methods: </strong>Human clot obtained during EVT was tested in an in vitro model of cerebral circulation. A three-dimensional printed arterial flow loop was used to replicate middle cerebral artery circulation. Clots were exposed to four treatment arms: plasma (control), rtPA, tirofiban, or both rtPA and tirofiban sequentially. Thrombolytic efficacy was quantified by clot weight reduction with multivariable statistical analyses adjusted by clinical variables.</p><p><strong>Results: </strong>70 clots were collected and used to perform 172 thrombolytic experiments. Both rtPA and tirofiban significantly reduced clot weight (tirofiban 20.6%, rtPA 20.7%, P<0.001), with a greater reduction when administered sequentially (37.9%, P<0.001). The treatment arm was the only significant predictor of thrombolytic effect. Clinical variables showed no statistically significant associations, although occlusion location and diabetes showed trends toward an association with clot weight reduction.</p><p><strong>Conclusions: </strong>This study supports the use of clot based in vitro models with autologous plasma for standardized drug testing for patients with AIS. Sequential administration of rtPA and tirofiban resulted in greater clot degradation than either agent alone. Further studies are needed to confirm clinical applicability and optimize dual thrombolytic strategies.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957499","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":"eCLIPs treatment of intrasaccular device recurrences in wide neck bifurcation aneurysms: multicenter experience with the new generation device.","authors":"Waleed Butt, Mohammad Al-Tibi, Amira Al Raaisi, Essam Hashem, Michael Adeleye, Ming Yao Chong, Rosa Sun, Kway Zayar Thant, Joerg Hattingen, Raphaël Blanc, Richard Dyde, Ian Rennie, Romain Bourcier, Adam A Dmytriw, Jan-Hendrik Buhk, Christoph Kabbasch, Vitor Mendes Pereira, Joost De Vries, Tufail Patankar","doi":"10.1136/jnis-2025-024014","DOIUrl":"https://doi.org/10.1136/jnis-2025-024014","url":null,"abstract":"<p><strong>Background and objectives: </strong>Intracranial wide neck bifurcation aneurysms treated with intrasaccular devices can have recurrences, with adverse morphologies, that are challenging to manage. We report our initial experience of the latest generation endovascular clip system (eCLIPs) (eVasc, Vancouver, British Columbia, Canada) device in treating these complex lesions.</p><p><strong>Methods: </strong>A prospectively maintained registry was reviewed for patients that were initially treated with a Woven EndoBridge (WEB) (Microvention, Aliso Viejo, California, USA), Contour (Cerus Endovascular, Fremont, California, USA), or Artisse (Medtronic, Irvine, California, USA) intrasaccular device, and subsequently underwent retreatment with an eCLIPs implant. The following data were analyzed: aneurysm location, recurrence dimensions, dome-to-neck and aspect ratios, rupture status, procedural time metrics, complications, anti-platelet medication, baseline and 6 month modified Rankin Scores (mRS), angiographic outcome and follow-up using modified Raymond-Roy Occlusion Classification (mRROC).</p><p><strong>Results: </strong>Twenty-one aneurysm recurrences across 21 patients were treated between October 2022 and December 2024. eCLIPs was successfully deployed in all cases intended for retreatment with the device. Primary treatment was performed using a WEB (n=14), Contour (n=5) or Artisse device (n=2). The median aneurysm recurrence size was 7.0 mm (range: 2.1 mm-10.3 mm). The median aspect ratio was 0.87 (range: 0.50-2.24) and the median dome-to-neck ratio 1.16 (range: 0.53-1.69). Of the 13 patients with available follow-up (median duration=11 months), all had adequate occlusion (10 were mRROC=1, and three were mRROC=2). There were no device related safety events.</p><p><strong>Conclusion: </strong>The new generation eCLIPs can be used safely and with a high rate of technical success for a range of bifurcation aneurysm recurrences initially treated with an intrasaccular device. While treatment durability appears promising, further long-term prospective studies are needed to confirm these findings.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957481","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":"Contrast-enhanced subtraction CT accurately and reproducibly assesses fibrous cap status associated with symptomatic carotid stenosis.","authors":"Yukishige Hashimoto, Masaru Abiko, Reo Kawano, Ryohei Tsuchie, Nobutaka Horie","doi":"10.1136/jnis-2025-023892","DOIUrl":"https://doi.org/10.1136/jnis-2025-023892","url":null,"abstract":"<p><strong>Background: </strong>The fibrous cap (FC) status is a crucial determinant of plaque vulnerability in symptomatic carotid stenosis. While MR angiography is used to assess the FC status, its clinical utility is limited by low reproducibility. This study aimed to assess the diagnostic accuracy and reproducibility of contrast-enhanced subtraction CT (CES-CT) for detecting FC and to evaluate its association with symptomatic carotid stenosis.</p><p><strong>Methods: </strong>We retrospectively analyzed 49 patients (21 symptomatic, 28 asymptomatic) who underwent CES-CT before carotid revascularization. CES-CT images were generated by subtracting arterial-phase images from delayed-phase images to suppress intraluminal contrast signals. The FC status was classified as thick or thin/ruptured based on imaging and histological findings. Symptomatic patients had amaurosis fugax, transient ischemic attack, or stroke in the vascular territory of the ipsilateral carotid artery within the past 6 months.</p><p><strong>Results: </strong>CES-CT showed excellent diagnostic performance with an area under the curve of 0.82, a specificity of 98%, and almost perfect intra- and inter-observer agreements (κ=0.80 and κ=0.85, respectively). A thin/ruptured FC on CES-CT was more frequent in the symptomatic group than in the asymptomatic group (67% vs 14%, P<0.001). A multivariable analysis showed that a CES-CT-based thin/ruptured FC was independently associated with symptomatic carotid stenosis (RR 2.63, 95% CI 1.27 to 5.56; P=0.009).</p><p><strong>Conclusions: </strong>CES-CT had excellent diagnostic accuracy and reproducibility for FC assessment. Moreover, a thin/ruptured FC on CES-CT was significantly associated with symptomatic carotid stenosis.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957431","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":"CYP2C19 genotype-guided antiplatelet therapy to prevent thromboembolic events after stent-assisted coil embolization of unruptured intracranial aneurysms: a retrospective cohort study.","authors":"Mingdong Yang, Xiaoyu Zhang, Junjun Xu, Yuhan Wang, Tao Lin, Huimin Xu, Jie Chen, Yunjian Dai, Lingyan Yu, Zhenli Wei, Tao Zhu, Wei Hu, Yangmin Hu, Ding Xu, Haibin Dai","doi":"10.1136/jnis-2025-023895","DOIUrl":"https://doi.org/10.1136/jnis-2025-023895","url":null,"abstract":"<p><strong>Background: </strong>CYP2C19 genotyping has been widely studied to guide antiplatelet therapy in cardiovascular disease; however, its role in neurointerventional procedures, particularly for unruptured intracranial aneurysms (UIA), remains underexplored. This study aimed to evaluate the clinical utility of CYP2C19-guided antiplatelet therapy following stent-assisted coil embolization (SAC) in patients with UIA.</p><p><strong>Methods: </strong>A total of 403 patients who underwent SAC were included. The control group (n=220) received standard dual antiplatelet therapy (DAPT) with aspirin and clopidogrel, without genotyping. The genotype-guided group (n=183) received personalized DAPT based on the CYP2C19 metabolizer status. The primary outcome was the occurrence of intracranial ischemic events within 90 days of surgery. The secondary outcomes included systemic hemorrhagic events.</p><p><strong>Results: </strong>Intracranial ischemic events occurred in 33 patients: 24 (10.9%) in the control group and 9 (4.9%) in the genotype-guided group, representing a relative risk reduction of 54.9% (P=0.029). Systemic hemorrhagic events were reported in 22 patients: 10 (4.5%) in the control group and 12 (6.6%) in the genotype-guided group, with no statistically significant difference (P=0.388).</p><p><strong>Conclusion: </strong>CYP2C19-guided antiplatelet therapy significantly reduces the risk of intracranial ischemic events after SAC in patients with UIA without increasing systemic bleeding complications. This genotype-based approach may enhance the safety and efficacy of perioperative management of neurointerventions.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957401","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":"Vein of Galen aneurysmal malformation treatment with direct open surgical access of the transverse sinus and transvenous selective endovascular embolization: a hybrid approach.","authors":"Gilbert Gravino, Saad Aamir, Sofie Dietvorst, Kush Bhatt, Fergus Robertson, Chris Parks, Richard Craig, Andrew Healey, Dawn Henningan, Conor Mallucci, Arun Chandran, Mani Puthuran","doi":"10.1136/jnis-2025-023490","DOIUrl":"10.1136/jnis-2025-023490","url":null,"abstract":"<p><p>Vein of Galen aneurysmal malformations (VOGMs) are rare congenital cerebrovascular malformations associated with an almost 100% morbidity and mortality rate if untreated. Open surgical case reports had reported intraoperative neonatal mortality rates close to 100%, rendering the disease untreatable. The development of endovascular techniques subsequently provided a viable treatment option for these complex cases, with a staged transarterial approach currently being the preferred mainstay treatment.We report on a technique that involves direct exposure of the transverse sinus under image-guided mini-craniotomy in a vascular hybrid intraoperative theater, followed by direct puncture of the transverse sinus with venous access to embolize the VOGM via a transvenous route. This was performed in a 3-year-old patient in whom further transarterial embolization was not feasible and who had bilateral occlusion of the internal jugular veins. The procedure was successful, with elimination of the high-flow arteriovenous shunt and no procedure-related complications.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333293","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":"Evaluating the effectiveness and safety of initial thrombectomy approaches for acute anterior large vessel occlusions: a comparative network analysis of techniques.","authors":"Elvan Wiyarta, Mohammad Kurniawan, Rakhmad Hidayat, Affan Priyambodo Permana, Gideon Hot Partogi Sinaga, Refael Alfa Budiman, Gamaliel Wibowo Soetanto","doi":"10.1136/jnis-2025-023769","DOIUrl":"https://doi.org/10.1136/jnis-2025-023769","url":null,"abstract":"<p><strong>Background: </strong>Acute anterior circulation large vessel occlusion (ACLVO) strokes represent a critical challenge in stroke management. Advancements in thrombectomy strategies, including contact aspiration (CA), stent retrievers (SR), and their combination (SRA), particularly with the addition of balloon guide catheters (BGC), aim to enhance outcomes. This systematic review and Bayesian network meta-analysis evaluates the efficacy and safety of these first-line thrombectomy strategies.</p><p><strong>Methods: </strong>A systematic search was performed across nine databases up to March 15, 2025, yielding 44 studies with 19 268 participants. The risk of bias was assessed using RoB 2.0 for randomized controlled trials and ROBINS-I for observational studies. Bayesian random-effects network meta-analysis was conducted, presenting odds ratios (OR) with 95% CIs and ranking interventions via surface under the cumulative ranking curve (SUCRA). Outcomes included recanalization success (modified Thrombolysis in Cerebral Infarction (mTICI) 2b-3), first-pass effect (FPE), functional independence (modified Rankin Scale ≤2 at 90 days), symptomatic intracranial hemorrhage (sICH), and 90-day mortality.</p><p><strong>Results: </strong>SRA+BGC was most effective for achieving mTICI 2b-3 (OR 2.87, 95% CI 1.64 to 5.20, SUCRA 90.1) and FPE (OR 7.33, 95% CI 1.71 to 39.71, SUCRA 91.0). CA+BGC yielded the highest odds of functional independence at 90 days (OR 1.96, 95% CI 1.16 to 3.41, SUCRA 88.1) and the lowest 90-day mortality (OR 0.42, 95% CI 0.20 to 0.95). Safety outcomes favored SR+BGC and SRA+BGC for reducing sICH (OR 0.59, 95% CI 0.37 to 0.91, SUCRA 85.3). CA alone was associated with significant improvements over SR in functional outcomes (OR 1.41, 95% CI 1.09 to 1.83, SUCRA 78.5), but SRA alone was linked to higher mortality (OR 1.74, 95% CI 1.06 to 2.66).</p><p><strong>Conclusion: </strong>Thrombectomy strategies incorporating BGC, particularly CA+BGC and SRA+BGC, achieve superior efficacy and safety outcomes in patients with acute ACLVO stroke.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957436","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 preoperative embolization in the treatment of brain arteriovenous malformations with perinidal aneurysms and single draining vein: a multicenter study with propensity score-weighting.","authors":"Basel Musmar, Nimer Adeeb, Hammam Abdalrazeq, Hamza Adel Salim, Joanna Roy, Stavropoula I Tjoumakaris, Sandeep Kandregula, Christopher S Ogilvy, Douglas Kondziolka, Jason P Sheehan, Adam A Dmytriw, Assala Aslan, Pious Patel, Matthews Lan, Michael P Baldassari, Sravanthi Koduri, Elias Atallah, Hussein Zeineddine, Mary-Katharine Pontarelli, Hussam Abou-Al-Shaar, Kareem El Naamani, Ahmed Abdelsalam, Natasha Ironside, Deepak Kumbhare, Sanjeev Gummadi, Mustafa Baskaya, Cagdas Ataoglu, Finn Mccarthy, Anthony Sanchez-Forteza, Muhammed Amir Essibayi, Abdullah Keles, Sandeep Muram, Daniel Sconzo, Howard Riina, Arwin Rezai, Omar Alwakaa, Salem M Tos, Georgios Mantziaris, Min S Park, Sahin Hanalioglu, Ufuk Erginoglu, Johannes Pöppe, Rajeev D Sen, Christoph J Griessenauer, Maria Isabel Ocampo-Navia, Diego A Devia, Wilfran Perez-Mendez, Juan C Puentes, Rahim Abo Kasem, Alejandro M Spiotta, Ajit S Puri, Jasmeet Singh, Anna Luisa Kuhn, Jan Karl Burkhardt, Robert M Starke, Laligam N Sekhar, Michael Levitt, David Altschul, Neil Haranhalli, Malia McAvoy, Marah Eltiti, Abdallah Abushehab, Paul Foreman, Hakeem J Shakir, Osama O Zaidat, Mohammad AlMajali, Marcella Ruppert-Gomez, Alfred Pokmeng See, Adib A Abla, Christopher J Stapleton, Aashay Patel, Andrew Nguyen, Matthew J Koch, Visish M Srinivasan, Peng Roc Chen, Spiros Blackburn, Rabab Alshahrani, M Reid Gooch, Robert H Rosenwasser, Ketan R Bulsara, Peter Kan, Louis J Kim, Omar Choudhri, Bryan Pukenas, Davide Simonato, Yan-Lin Li, Ali Alaraj, Maurizio Fuschi, Aman B Patel, Amey Savardekar, Christina Notarianni, Hugo H Cuellar, Michael T Lawton, Bharat Guthikonda, Jacques Morcos, Pascal Jabbour","doi":"10.1136/jnis-2025-023873","DOIUrl":"https://doi.org/10.1136/jnis-2025-023873","url":null,"abstract":"<p><strong>Background and objectives: </strong>Arteriovenous malformations (AVMs) with perinidal aneurysms and single draining vein are associated with an elevated risk of rupture and increased procedural complexity. The role of preoperative embolization in this high-risk anatomical subset remains unclear. This study aimed to evaluate the safety and efficacy of microsurgery with preoperative embolization, compared with microsurgery alone in patients with such AVMs.</p><p><strong>Methods: </strong>We conducted a multicenter retrospective analysis of an AVM registry from the MISTA (Multicenter International Study for Treatment of Brain AVMs) consortium and included AVMs with perinidal aneurysms and a single draining vein. Baseline characteristics, angiographic outcomes, functional outcomes, and complication rates were compared. Propensity score weighting (PSW) using the covariate balancing method was applied to adjust for baseline differences.</p><p><strong>Results: </strong>Out of a total of 1919 patients, 65 met the inclusion criteria; 45 patients underwent preoperative embolization followed by microsurgery, and 20 underwent microsurgery alone. After adjustment, complete obliteration rates were similar between groups (OR 0.87, 95% CI 0.04 to 16.33, P=0.92), as were rates of functional independence at discharge and follow-up. Overall complication, symptomatic complication, and mortality rates did not differ significantly between groups. However, permanent complications were significantly lower in patients with preoperative embolization (OR 0.06, 95% CI 0.004 to 0.84, P=0.03).</p><p><strong>Discussion: </strong>In patients with AVMs featuring perinidal aneurysms and single draining vein, preoperative embolization followed by microsurgery was associated with fewer permanent complications and no increase in adverse outcomes compared with microsurgery alone. However, given the small number of events, this finding should be interpreted cautiously.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957564","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":"Coil only middle meningeal artery embolization versus particles or liquid embolic agents for chronic subdural hematoma.","authors":"Adeline Fecker, Matthew K McIntyre, Huanwen Chen, Jefferson O Abaricia, Ryan Priest, Gary Nesbit, Marco Colasurdo","doi":"10.1136/jnis-2025-023848","DOIUrl":"https://doi.org/10.1136/jnis-2025-023848","url":null,"abstract":"<p><strong>Background: </strong>Middle meningeal artery embolization (MMAE) for chronic subdural hematoma (cSDH) with particles or liquid embolic agents has been shown to be effective, but can carry a theoretical risk of off-target embolization via dangerous collaterals and anastomoses. Primary coiling has been suggested as a safer alternative, particularly for patients with dangerous anastomoses. This study aims to evaluate the safety and efficacy of coil only for cSDH patients compared with liquid or particle embolic agents.</p><p><strong>Methods: </strong>We performed a retrospective review of cSDH patients who underwent MMAE between 2023 and 2025. Patients were stratified by coil only versus liquid/particle embolization strategy. The primary outcome was rate of surgical rescue; secondary outcomes included the amount and rate of hematoma resorption. Subgroup analysis was performed among those with identified dangerous anastomoses.</p><p><strong>Results: </strong>A total of 168 patients were included; 88 (52.4%) underwent coil only embolization. Coil only patients had significantly lower rates of altered mental status (P=0.010), diabetes (P=0.015), and thrombocytopenia (P<0.001), but higher rates of anticoagulant use (P=0.017). During study follow-up (median duration 52 and 74 days for coil only and liquid/particle, respectively; P=0.23), coil only was not associated with different rates of surgical rescue (5.7% vs 2.5%, P=0.52), percentage hematoma resorption (P=0.82), or percentage hematoma resorption rate (P=0.86). There was no difference in these outcomes among the 65 (39%) patients with angiographic evidence of vascular anastomosis or dangerous collaterals (P>0.05).</p><p><strong>Conclusions: </strong>The results of the study indicate that coil only MMAE may be a safe and equally effective alternative to particle or liquid embolics for patients with cSDH.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957426","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}