Journal of NeuroInterventional Surgery最新文献

{"title":"Mechanical thrombectomy in elderly stroke patients with low ASPECTS: insights from STAR.","authors":"Conor Cunningham, Zachary Hubbard, Rahim Abo Kasem, Sameh Samir Elawady, Mohammad-Mahdi Sowlat, Hidetoshi Matsukawa, Ilko Maier, Pascal Jabbour, Joon-Tae Kim, Stacey Q Wolfe, Ansaar T Rai, Robert M Starke, Marios-Nikos Psychogios, Edgar A Samaniego, Nitin Goyal, Shinichi Yoshimura, Hugo Cuellar, Brian M Howard, Ali Alawieh, Ali Alaraj, Mohamad Ezzeldin, Daniele G Romano, Omar Tanweer, Justin R Mascitelli, Isabel Fragata, Adam J Polifka, Fazeel Siddiqui, Joshua W Osbun, Ramesh Grandhi, Roberto Javier Crosa, Charles Matouk, Min S Park, Michael R Levitt, Waleed Brinjikji, Mark Moss, Ergun Daglioglu, Richard Williamson, Pedro Navia, Peter Kan, Reade Andrew De Leacy, Shakeel A Chowdhry, David Altschul, Sami Al Kasab, Alejandro M Spiotta","doi":"10.1136/jnis-2024-022677","DOIUrl":"10.1136/jnis-2024-022677","url":null,"abstract":"<p><strong>Background: </strong>The elderly population (≥80 years) were underrepresented in recent trials of endovascular thrombectomy (EVT) for anterior circulation large vessel occlusion acute ischemic stroke (LVO-AIS) with low Alberta Stroke Program Early CT Score (ASPECTS) (≤5).</p><p><strong>Methods: </strong>This study analyzed data from a prospectively maintained database of 37 thrombectomy centers. The primary cohort of the study comprised patients with LVO-AIS aged ≥80 who underwent EVT with ASPECTS≤5 from 2013 to 2023. The primary outcome was favorable modified Rankin Scale (mRS) score of 0-3. Propensity score matching (PSM) and multivariate regression were applied.</p><p><strong>Results: </strong>In a study of 14 233 patients undergoing EVT, 1741 patients were 80 or older, with 122 presenting with low ASPECTS. While successful recanalization rates were similar between age groups, patients aged ≥80 had significantly lower favorable 90-day mRS scores and higher mortality before propensity score matching (PSM). After PSM, differences in mortality and symptomatic intracranial hemorrhage (sICH) were no longer significant. Among all elderly patients, higher ASPECTS was an independent predictor of a 90-day favorable outcome but was not associated with 90-day mortality. For patients aged ≥80 years with low ASPECTS, favorable outcomes were associated only with lower rates of atrial fibrillation, baseline functioning (mRS 0-1), fewer thrombectomy passes, and higher likelihood of first-pass reperfusion within 30 min of puncture.</p><p><strong>Conclusion: </strong>While age ≥80 increases mortality and disability in patients with AIS and low ASPECTS, select elderly patients may still benefit from EVT when clinical factors are considered, supporting individualized treatment and better patient selection for future trials.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"e206-e215"},"PeriodicalIF":4.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143039304","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 and safety outcomes of acute stenting plus thrombectomy for carotid tandem lesions with large ischemic core.","authors":"Yakub Deliktas, Imad Derraz, Stephanos Finitsis, Jildaz Caroff, Romain Bourcier, Sébastien Soize, Solène Moulin, Sébastien Richard, Gaultier Marnat, Matúš Hoferica, Christophe Cognard, Jean-Philippe Desilles, Mohammad Anadani, Jean-Marc Olivot, Barbara Casolla, Arturo Consoli, Bertrand Lapergue, Benjamin Gory","doi":"10.1136/jnis-2024-021517","DOIUrl":"10.1136/jnis-2024-021517","url":null,"abstract":"<p><strong>Background: </strong>We evaluated the clinical and safety outcomes of emergent carotid artery stenting (eCAS) plus endovascular thrombectomy (EVT) among patients with anterior tandem lesion (TL) and large ischemic core (LIC).</p><p><strong>Methods: </strong>This retrospective study included consecutive stroke patients enrolled in the Endovascular Treatment in Ischemic Stroke Registry in France between January 2015 and June 2023. We compared the outcomes of carotid stenting vs no stenting in tandem lesion with pre-treatment LIC (Alberta Stroke Program Early CT Score (ASPECTS) 3-5) and stenting in tandem lesion vs thrombectomy alone for isolated intracranial occlusions with pre-treatment LIC. Primary outcome was a score of 0 to 3 on the modified Rankin scale (mRS) at 90 days. Multivariable mixed-effects logistic regression was performed.</p><p><strong>Results: </strong>Among 218 tandem patients with LIC, 55 were treated with eCAS plus EVT. The eCAS group had higher odds of 90-day mRS 0-3 (adjusted Odds Ratio (aOR) 2.40, 95% confidence interval (CI) 1.10 to 5.21; p=0.027). There were no differences in the risk of any intracerebral hemorrhage (OR 1.41, 95% CI 0.69 to 2.86; p=0.346), parenchymal hematoma (aOR 1.216, 95% CI 0.49 to 3.02; p=0.675), symptomatic intracerebral hemorrhage (aOR 1.45, 95% CI 0.60 to 3.48; p=0.409), or 90-day mortality (aOR 0.74, 95% CI 0.33 to 1.68; p=0.472). eCAS was associated with a higher rate of carotid patency at day 1 (aOR 3.54, 95% CI 1.14 to 11.01; p=0.028). Safety outcomes were similar between EVT+eCAS group in TL-LIC and EVT alone group in isolated intracranial occlusions with LIC.</p><p><strong>Conclusion: </strong>eCAS appears to be a safe and effective strategy in patients with TL and LIC volume.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"e216-e221"},"PeriodicalIF":4.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141262041","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":"Placing the balloon-guide catheter in the high cervical segment of the internal carotid artery is associated with improved recanalization.","authors":"Manuel Moreu, Carlos Gómez-Escalonilla, Salvador Miralbes, Bharath Naravetla, Alejandro M Spiotta, Christian Loehr, Mario Martínez-Galdámez, Ryan A McTaggart, Luc Defreyne, Pedro Vega, Osama O Zaidat, Lori Lyn Price, David S Liebeskind, Markus A Möhlenbruch, Rishi Gupta, Santiago Rosati","doi":"10.1136/jnis-2024-021650","DOIUrl":"10.1136/jnis-2024-021650","url":null,"abstract":"<p><strong>Background: </strong>Mechanical thrombectomy (MT) is part of the standard of care for stroke treatment, and improving its efficacy is one of the main objectives of clinical investigation. Of importance is placement of the distal end of balloon-guided catheters (BGC). We aim to determine if this influences outcomes.</p><p><strong>Methods: </strong>We analyzed data from the ASSIST Registry, an international, multicenter prospective study of 1492 patients. We divided patients treated with BGC according to the placement of the BGC: low cervical (LCG (the lower 2/3 of cervical internal carotid artery (ICA)) or high cervical (HCG (upper 1/3 of cervical ICA, petro-lacerum or higher)). We analyzed characteristics and outcomes overall and stratified on the primary MT technique: Stent-Retriever only (SR Classic), Combined use of aspiration catheter and SR (Combined), and Direct Aspiration (ADAPT).</p><p><strong>Results: </strong>Our study included 704 subjects -323 in the low cervical and 381 in the high cervical groups. Statistical differences were seen in the proportion of females and tandem lesions (both higher for LCG). Placing the BGC in the high cervical segment is associated with better recanalization rates (expanded treatment in cerebral infarction (eTICI) score of 2c-3) at the end of the procedure (P<0.0001) and shorter procedures (P=0.0005). After stratifying on the three primary techniques (SR Classic, Combined, and ADAPT), placing the BGC in the high segment is associated with a better first-pass effect (FPE), less distal emboli, and better clinical outcomes in the SR Classic technique.</p><p><strong>Conclusions: </strong>Placing the distal end of the BGC at the high cervical segment or higher is associated with better recanalization.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"e326-e332"},"PeriodicalIF":4.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12171514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141436979","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":"Intraoperative contrast-enhanced cone beam CT allows visualization of the 'dark side' of the clot and improves mechanical thrombectomy performance.","authors":"Jeremy Hofmeister, Andrea Rosi, Gianmarco Bernava, Philippe Reymond, Olivier Brina, Hasan Yilmaz, Emmanuel Carrera, Karl-Olof Lovblad, Paolo Machi","doi":"10.1136/jnis-2024-022409","DOIUrl":"10.1136/jnis-2024-022409","url":null,"abstract":"<p><strong>Background: </strong>Visualization of the clot is key to the endovascular treatment of ischemic stroke, but identification of the distal part of the clot and distal arteries during mechanical thrombectomy (MT) remains challenging with conventional intraoperative imaging. We aimed to leverage the potential of contrast-enhanced cone beam CT (CE-CBCT) to better visualize the distality ('dark side') of the clot.</p><p><strong>Methods: </strong>We retrospectively analyzed all patients treated with MT for medium vessel occlusion (MeVO) guided by three-dimensional (3D) imaging to identify those who underwent either CE-CBCT or 3D rotational angiography (3DRA). Our primary outcome was the visualization of the proximal and distal edges of the clot and the arteries beyond the occlusion on the different types of intraoperative imaging: digital subtraction angiography (DSA), 3DRA, and CE-CBCT. Secondary outcomes included the efficacy, safety, and timing of MT between CE-CBCT versus 3DRA groups.</p><p><strong>Results: </strong>The proximal edge of the clot was well visualized by DSA, 3DRA, and CE-CBCT. However, the distal edge of the clot and distal arteries were significantly better visualized with CE-CBCT (60.0%) than 3DRA (2.7%) and DSA (11.4-13.5%). Moreover, MT efficacy was better with CE-CBCT than 3DRA, with higher first-pass effect (65.7% vs 37.8%) and final recanalization grade (expanded Treatment In Cerebral Infarction (eTICI) 3: 71.4% vs 43.2%). Finally, the visualization of the distal edge of the clot and distal arteries correlated with better collateralization grade.</p><p><strong>Conclusion: </strong>CE-CBCT localizes the clot and reveals the underlying vascular anatomy better than 3DRA or DSA, thereby enhancing the efficacy of MT. The improved filling of collaterals with CE-CBCT may explain this better visualization of the 'dark side' of the clot.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"e333-e339"},"PeriodicalIF":4.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502289","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":"Stent retriever versus aspiration based thrombectomy: impact on first pass reperfusion, procedure time, and clinical outcomes in large vessel occlusion. Nationwide registry based cohort study.","authors":"Adrian Karlsson, Katarina Jood, Isabella Björkman-Burtscher, Alexandros Rentzos","doi":"10.1136/jnis-2024-021793","DOIUrl":"10.1136/jnis-2024-021793","url":null,"abstract":"<p><strong>Background: </strong>First pass reperfusion (FPR), defined as near complete reperfusion (extended Treatment in Cerebral Ischemia (eTICI) score 2c/3) in a single attempt without rescue therapy has been proposed as a quality metric. However, it remains unclear if the thrombectomy method influences clinical outcome and FPR rate. This study evaluates whether stent retriever and aspiration based thrombectomy differ in FPR rate, technical and clinical outcomes in FPR, and multiple pass reperfusion (MPR).</p><p><strong>Methods: </strong>This retrospective, nationwide, multicenter registry study included consecutive patients with proximal anterior or posterior circulation stroke, treated between 2018 and 2021 in Sweden. Outcome measures were FPR rate, procedure time, early neurological improvement (≥4 points on National Institutes of Health Stroke Scale (NIHSS) or a score of 0-1 at 24 hours), favorable functional outcome (modified Rankin Scale score of 0-2 or no decline at 90 days), and mortality at 90 days.</p><p><strong>Results: </strong>Of 3309 patients (median age 75, median NIHSS 16), 1990 underwent stent retriever and 1319 aspiration based thrombectomy as the firstline method. No difference in FPR rate was observed. Aspiration based thrombectomy showed a shorter procedure time in the FPR group (crude OR (cOR) 6.4 min (95% CI 3.4 to 9.3), adjusted OR (aOR) 8.7 min (95% CI 1.8 to 15.6)) and MPR group (cOR 9.7 min (95% CI 4.0 to 15.4), aOR 17.4 min (95% CI 9.6 to 25.2)), and association with early neurological improvement (cOR 1.21 (95% CI 1.03 to 1.42), aOR 1.40 (95% CI 1.18 to 1.67)) and favorable functional outcome (aOR 1.22 (95% CI 1.01 to 1.47)).</p><p><strong>Conclusions: </strong>Our findings suggest that aspiration based thrombectomy was associated with a shorter procedure time and better clinical outcomes than treatment with a stent retriever. No difference was found in FPR rate.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"e245-e251"},"PeriodicalIF":4.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12171515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141436980","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":"Association between basal ganglia infarction and hemorrhagic transformation after mechanical thrombectomy in acute ischemic stroke: insights from the DIRECT-MT trial.","authors":"Rundong Chen, Weilong Hua, Yilei Zhang, Yongxin Zhang, Hongjian Zhang, Yongwei Zhang, Jianmin Liu, Pengfei Yang, Lei Zhang","doi":"10.1136/jnis-2024-022323","DOIUrl":"10.1136/jnis-2024-022323","url":null,"abstract":"<p><strong>Background: </strong>Acute ischemic stroke (AIS) often leads to significant morbidity and mortality. Mechanical thrombectomy (MT) is an effective intervention for large vessel occlusion strokes. However, hemorrhagic transformation (HT) remains a critical post-procedural complication. This study investigates the relationship between basal ganglia infarction (BGI) and the risk of HT, particularly focusing on hemorrhagic infarction (HI) and parenchymal hematoma (PH).</p><p><strong>Methods: </strong>Data from the DIRECT-MT trial were analyzed. Patients were categorized based on the presence of BGI identified on initial non-contrast CT. HT was classified into HI and PH following the Heidelberg criteria. Multivariate logistic regression, propensity score matching (PSM), and inverse probability of treatment weighting (IPTW) were used to assess the association between BGI and HT.</p><p><strong>Results: </strong>Among 607 patients, 273 had BGI. BGI was associated with a higher risk of HT, specifically PH. The incidence of PH in the BGI group was 20% compared with 11% in the non-BGI group. Adjusted analyses, including PSM and IPTW, confirmed the significant association between BGI and PH with an adjusted odds ratio (aOR) of 2.51 (95% CI 1.49 to 4.22, P<0.001). However, no significant association was found between BGI and HI.</p><p><strong>Conclusions: </strong>BGI significantly increases the risk of PH following MT for AIS, underscoring the need for tailored therapeutic strategies in managing these patients. No significant correlation was observed between BGI and HI. Future research should explore the underlying mechanisms and validate these findings across diverse populations to improve patient outcomes.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"e288-e294"},"PeriodicalIF":4.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406434","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":"Iatrogenic emboli during mechanical thrombectomy for acute ischemic stroke: comparison between stent retriever technique and contact aspiration-a retrospective case-control study.","authors":"Samuel J Mouyal, Benjamin Granger, Kevin Janot, Héloïse Ifergan, Clémence Hoche, Denis Herbreteau, Richard Edwige Bibi, Grégoire Boulouis, Fouzi Bala, Baptiste Donnard, Valère Barrot, Francesca Giubbolini, Romain Bourcier, Pacôme Constant-Dit-Beaufils, Pierre-Louis Alexandre, Francois Eugène, Quentin Alias, Julien Boucherit, Edouard Beaufreton, Jean-Yves Gauvrit, Jean-Christophe Ferré, Maud Guillen, Thomas Ronziere, Maria-Veronica Lassalle, Cécile Malrain, Clément Tracol, Stéphane Vannier, Eimad Shotar, Kévin Premat, Stéphanie Lenck, Nader-Antoine Sourour, Sonia Alamowitch, Charlotte Rosso, Frédéric Clarençon","doi":"10.1136/jnis-2024-022206","DOIUrl":"10.1136/jnis-2024-022206","url":null,"abstract":"<p><strong>Background: </strong>Mechanical thrombectomy (MT) is an effective treatment for acute ischemic stroke from large vessel occlusion (LVO). While embolization to a new territory (ENT) after MT is well-documented, data on embolization in the same distal territory (EDT) are limited. Achieving modified Treatment In Cerebral Infarction (mTICI) 3 reperfusion presents significant clinical benefits over mTICI 2b/2c, necessitating strategies to reduce both ENT and EDT. Previous studies suggest higher rates of EDTs with contact aspiration compared with stentrievers. However, comprehensive comparison studies in clinical practice are scarce. This study compares the rates of overall clot emboli (OCE) between these MT strategies.</p><p><strong>Methods: </strong>A retrospective, multicenter observational study was conducted at four university hospitals in France from January 2015 to November 2019. Adult patients (≥18 years) with acute ischemic stroke due to LVO, treated with either contact aspiration (ADAPT, A Direct Aspiration First Pass Technique) or stentrievers, specifically using the Embotrap device to maintain sample homogeneity, were included. Digital subtraction angiography was used for imaging, with two independent, blinded reviewers assessing OCE post-first MT pass. Propensity score full matching and independent sample testing were employed to evaluate OCE after the first MT pass.</p><p><strong>Results: </strong>A significant difference in OCE rates was observed between contact aspiration and stentriever techniques, with the stentriever technique resulting in fewer embolic events compared with ADAPT, based on a propensity score analysis that accounts for key confounding factors.</p><p><strong>Conclusion: </strong>A statistically significant reduction in embolic events was observed with the stentriever technique compared with contact aspiration. These results suggest that the stentriever method may offer a safer profile in terms of embolic risk for LVO interventions, and should be considered over contact aspiration when embolic risk is a primary concern, while also considering individual patient factors.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"e231-e236"},"PeriodicalIF":4.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564429","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":"Vessel wall MRI evaluation for the safety of endovascular recanalization of non-acute intracranial anterior circulation artery occlusions.","authors":"Yao Meng, Yun Yang, Miyengi Cosmas Magigi, Weili Li, Yun Song, Wei Zhao, Meimei Zheng, Lili Sun, Hao Yin, Wei Wang, Xiao He, Jun Zhang, Ju Han","doi":"10.1136/jnis-2024-022413","DOIUrl":"10.1136/jnis-2024-022413","url":null,"abstract":"<p><strong>Background: </strong>Vessel wall MRI (VWMRI) can reveal the morphological features of intracranial artery occlusion (ICAO). This study aimed to investigate the imaging features of ICAO on VWMRI and explore their correlation with perioperative complications of endovascular recanalization for non-acute ICAO.</p><p><strong>Methods: </strong>The study retrospectively included consecutive patients with recurrent ischemic stroke due to non-acute ICAO in the anterior circulation who underwent preoperative VWMRI evaluation and endovascular recanalization. Perioperative complications included ischemic and hemorrhagic strokes within 30 days after operation. Imaging features of the occluded segments were evaluated on precontrast and post-contrast VWMRI, including occlusion length and site, vessel wall area, signal intensity, angle, and shape of the occluded segment. The associations between the clinical and imaging features and perioperative complications were examined.</p><p><strong>Results: </strong>One hundred and four patients were included in the analysis, of whom 22.1% (23/104) had perioperative complications. After adjusting for multiple confounding variables, four imaging risk factors were identified that were independently associated with perioperative complications, that is, the angle between the occluded and pre-occluded artery segments (OR 11.60, 95% CI 2.73 to 49.29), occluded artery segment shape (OR 13.07, 95% CI 2.82 to 60.67), vessel wall collapse before occlusion (OR 2.91, 95% CI 0.96 to 8.77), and post-contrast mean signal intensity ratio at the ¼ point of the occluded artery segment <1.24 (OR 6.14, 95% CI 1.67 to 22.51). From no risk factors to four risk factors, the incidence of perioperative complications gradually increased (0, 6.2%, 23.5%, 52.9%, and 100% respectively; p<0.001).</p><p><strong>Conclusions: </strong>VWMRI may be helpful to select patients with non-acute ICAO who are suitable for endovascular recanalization.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"e405-e411"},"PeriodicalIF":4.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854389","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":"Thrombectomy versus combined thrombolysis for acute basilar artery occlusion: a secondary analysis of the ATTENTION trial.","authors":"Bin Han, Raynald -, Yaxin Wu, Ganghua Feng, Xuehan Liu, Peng Zhang, Pengyu Lu, Yi Liu, Wei Hu, Yaxuan Sun","doi":"10.1136/jnis-2024-021678","DOIUrl":"10.1136/jnis-2024-021678","url":null,"abstract":"<p><strong>Background: </strong>Few studies have compared the outcomes of bridging intravenous thrombolysis (IVT) before mechanical thrombectomy (MT) with those of direct MT in patients with acute basilar artery occlusion (BAO). This study aimed to assess the efficacy and safety of direct endovascular treatment (EVT) and bridging IVT followed by EVT in Chinese patients with acute basilar artery occlusion BAO.</p><p><strong>Methods: </strong>This subanalysis derived from the prospective multicenter randomized controlled trial of the ATTENTION study, included 221 patients with acute BAO categorized into two groups based on whether they received bridging IVT before MT: MT alone or combined IVT+MT. The primary endpoint was the modified Rankin Scale (mRS) score distribution at 90 days. Secondary outcomes included mRS scores within different ranges (0-1, 0-2, and 0-3) at the 90-day point and National Institutes of Health Stroke Scale (NIHSS) scores at 24 hours and 3 days post-intervention. Safety outcomes encompassed intracranial hemorrhage incidence based on the Heidelberg classification criteria (any intracerebral hemorrhage) and mortality assessment at 90 days.</p><p><strong>Results: </strong>Direct and bridging IVT before EVT yielded similar primary outcomes. No significant difference in 90-day mRS scores (median, 4.5 vs 4; adjusted odds ratio (aOR), 0.95 [95% confidence interval (CI), 0.79 to 1.15]; p=0.624) was observed between the two groups. Regarding safety outcomes, no significant differences were observed between the groups in terms of death within 90 days or any intracranial hemorrhage within 24 hours.</p><p><strong>Conclusions: </strong>In patients with acute BAO, those treated with bridging IVT before EVT did not demonstrate any advantages in enhanced safety and efficacy outcomes compared with those treated with direct EVT.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"e381-e387"},"PeriodicalIF":4.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141468700","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":"Tenzing Assisted Delivery of Aspiration (TADA) technique for thrombectomy of medium vessel occlusions using the Freeclimb 54 catheter: multicenter experience.","authors":"Fabio Settecase, Ajit S Puri, Shane Sh Lee, Rajkamal S Khangura, Ronald F Budzik, Peter J Pema, Thymur Chaudury, Matthew J Page, Ben J McGuinness, Marco Colasurdo, Daniel A Tonetti, Jonathan A Grossberg, Jasmeet Singh, Anna Luisa Kuhn, Matthew D Alexander, Bahram Varjavand, Ryan A Priest, JaeHyun Kim, Blaise W Baxter, Warren T Kim, Joey D English, James Caldwell","doi":"10.1136/jnis-2024-022693","DOIUrl":"10.1136/jnis-2024-022693","url":null,"abstract":"<p><strong>Background: </strong>Medium vessel occlusions (MeVOs) account for 25-40% of acute ischemic stroke. The Tenzing 5 (Route 92 Medical, San Mateo, California, USA) and FreeClimb 54 (Route 92 Medical, San Mateo, California, USA) catheter is a novel delivery-aspiration catheter combination designed to facilitate aspiration thrombectomy (AT) of MeVOs. We report our clinical experience using the Tenzing assisted delivery of aspiration (TADA) technique with FreeClimb 54 for first-line AT of MeVO.</p><p><strong>Methods: </strong>We retrospectively reviewed consecutive patients who underwent MeVO first-line AT using TADA with FreeClimb 54 at nine institutions in the USA and one in New Zealand.</p><p><strong>Results: </strong>94 MeVOs (65 primary, 29 secondary) were treated in 92 patients: median age 71 (IQR 58-81) years; 49/92 (53%) women. FreeClimb 54 was successfully delivered by Tenzing 5 to all 94/94 MeVOs: 26 proximal M2; 44 distal M2; 5 M3; 6 A2; 4 A3; and 8 P2. Median target vessel diameter on DSA was 1.7 (IQR 1.4-1.8) mm. A leading microwire was used to advance Tenzing in 84% of cases. A stent retriever was used for additional thrombectomy passes in 6/94 (6%) patients. For a primary MeVO, final modified expanded Thrombolysis in Cerebral Infarction (meTICI) 2B-3 reperfusion was achieved in 63/65 (97%) patients, after a median of 1 (IQR 1-2) pass, with a first pass effect (FPE, meTICI 2C-3) in 43/65 (66%). Secondary MeVO FPE (eTICI 2C-3) was achieved in 20/29 (69%) patients. Tenzing 5-FreeClimb 54 related complications occurred in 2/94 (2%) patients: one perforation with asymptomatic subarachnoid hemorrhage and one embolus to new territory.</p><p><strong>Conclusions: </strong>MeVO first-line AT using the TADA technique with Tenzing 5 and FreeClimb 54 had a high FPE with a low complication rate.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"e197-e205"},"PeriodicalIF":4.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12171431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143039319","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}