Journal of NeuroInterventional Surgery最新文献

{"title":"Improving stroke pathway efficiency: outcomes of a quality improvement collaborative across a national stroke network.","authors":"Roisin Walsh, Naomi Nowlan, Emma Griffin, Sinead McElroy, Colm O'Grada, Sarah Power, Alan O'Hare, Matthew Crockett, John Thornton, Patrick Nicholson","doi":"10.1136/jnis-2024-022771","DOIUrl":"https://doi.org/10.1136/jnis-2024-022771","url":null,"abstract":"<p><strong>Background: </strong>Timely endovascular thrombectomy (EVT) is crucial for improving outcomes in acute ischemic stroke (AIS). This study evaluated the effectiveness of a national quality improvement collaborative (QIC) in reducing process times for potential EVT candidates across a national stroke network.</p><p><strong>Methods: </strong>A pre-post intervention design using a modified Breakthrough Series approach was implemented across 24 hospitals. Multidisciplinary teams participated in monthly learning sessions and action periods focused on reducing 'Door to Decision' (time from hospital arrival to EVT decision) to under 30 min. Mixed-effects linear models and mixed-effects ANOVA were used to analyse the impact of the QI program on Door to Decision and Door to CT times, comparing intervention and control cohorts.</p><p><strong>Results: </strong>The QI program significantly reduced Door to Decision time in the intervention cohort by 15.9% (p<0.001) from a mean of 92.8 min to 78.9 min. Door to CT time also decreased by 15.6% (p<0.001). No significant changes were observed in the control cohort. Mixed-ANOVA revealed a significant interaction effect for both Door to Decision (p<0.004) and Door to CT (p<0.04), indicating that the QI program impacted these times as compared with the control group. The QIC effectively improved the efficiency of stroke care pathways across a national stroke network. This effect was sustained across the network and over time. This success was facilitated by a bottom-up approach, fostering collaboration and shared learning within and across hospitals.</p><p><strong>Conclusions: </strong>This study demonstrates the effectiveness of a collaborative, network-wide QI program in reducing critical process times for AIS patients. Continued efforts to sustain these improvements and optimize stroke care pathways are warranted.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414546","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 low profile flow diverter stents for intracranial aneurysms in small parent vessels: systematic review and meta-analysis.","authors":"Alperen Elek, Sidar Karagoz, Gülfem Nur Dindar, Semra Yucel, Celal Cinar, Mahmut Kusbeci, Egemen Ozturk, Ismail Oran","doi":"10.1136/jnis-2024-022834","DOIUrl":"https://doi.org/10.1136/jnis-2024-022834","url":null,"abstract":"<p><strong>Background: </strong>This meta-analysis aims to evaluate the clinical and angiographic outcomes of low profile flow diverters (FDs) used in treating intracranial aneurysms in small parent vessels (≤3.5 mm).</p><p><strong>Methods: </strong>A systematic review was conducted using Medline, Scopus, and Web of Science databases from inception to October 2024. Studies reporting clinical and angiographic outcomes for Silk Vista Baby, Flow Re-direction Endoluminal Device Junior (FRED Jr), and p48 MW Flow Modulation Device were included. Favorable outcomes were defined as those reported directly in studies or as a modified Rankin Scale score of 0-2.</p><p><strong>Results: </strong>33 studies involving 998 patients with 1049 aneurysms were analyzed. Favorable neurological outcomes were reported in 94% of cases overall, with unruptured aneurysms achieving better outcomes (97.1%) than ruptured aneurysms (80%). Procedure related complications were observed in 15.7% of cases, with a lower rate in unruptured aneurysms (12.7%) compared with ruptured aneurysms (20%). Complete or near complete occlusion was achieved in 79.5% of aneurysms from 28 studies, with similar rates for both unruptured (73.6%, from 14 studies) and ruptured (74%, from 13 studies) aneurysms. Among devices, the FRED Jr showed the highest favorable outcome rate (97.6%), while the p48 MW device had the highest complication rate (17.2%). Adjunctive coiling did not significantly affect neurological outcomes but was associated with a slightly lower complication rate (12.1%).</p><p><strong>Conclusion: </strong>Low profile FDs demonstrated high rates of favorable neurological outcomes in small parent vessel aneurysms, particularly in unruptured cases. These FDs achieved acceptable rates of adequate aneurysm occlusion and complications.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414115","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":"Successful reperfusion accompanied by symptomatic intracranial hemorrhage (sICH) versus unsuccessful reperfusion without sICH after endovascular stroke thrombectomy: a post-hoc analysis of two randomized trials.","authors":"Yanling Li, Yusi Fu, Xinggang Feng, Lve Chen, Shiwei Luo, Shunfu Jiang, Huiyuan Peng, Xianjun Huang, Wensheng Zhang, Yihong Huang, Min Zhang, Genpei Luo, Fukui Ge, Jing Xu, Hanning Huang, Min Guan, Zhenze Chen, Wenjie Zi, Qingwu Yang, Hongfei Sang, Zhongming Qiu, Mingchao Li, Thanh N Nguyen, Zhenqiang Zhao, Wei Li","doi":"10.1136/jnis-2024-022869","DOIUrl":"https://doi.org/10.1136/jnis-2024-022869","url":null,"abstract":"<p><strong>Background: </strong>Functional outcomes in patients with acute ischemic stroke (AIS) with large vessel occlusion (LVO) undergoing endovascular treatment (EVT) with successful reperfusion (expanded Thrombolysis In Cerebral Infarction (eTICI) 2b-3) complicated by symptomatic intracranial hemorrhage (sICH) were compared with patients with unsuccessful reperfusion (eTICI 0-2a) without sICH.</p><p><strong>Methods: </strong>Patients enrolled in this post hoc analysis were from two Chinese multicenter, randomized controlled trials: the DEVT and the RESCUE BT registries. Patients with AIS who underwent EVT were categorized into two groups according to the state of reperfusion: eTICI 2b-3 with sICH and eTICI 0-2a without sICH. The primary outcome was the modified Rankin Scale (mRS) scores at 90 days. The safety outcomes included early neurological deterioration and 90-day mortality.</p><p><strong>Results: </strong>161 patients were included in this cohort analysis, among whom 71 experienced eTICI 2b-3 with sICH, and 90 had eTICI 0-2a without sICH. After adjusting for potential confounding factors, patients in the eTICI 2b-3 with sICH group had worse mRS at 90 days compared with those in the eTICI 0-2a without sICH group in the adjusted analysis (median 6 (IQR 4-6) vs median 4 (IQR 3-6); adjusted common OR 0.39, 95% CI 0.17 to 0.66). There were also higher rates of very poor outcome (mRS 5-6, 70.4% vs 42.2%; OR 2.90, 95% CI 1.38 to 6.11), mortality (66.2% vs 32.2%; OR 0.48, 95% CI 0.30 to 0.79), and early neurological deterioration (81.7% vs 40.0%; OR 0.16, 95% CI 0.07 to 0.35) in the eTICI 2b-3 with sICH group versus the eTICI 0-2a without sICH group.</p><p><strong>Conclusions: </strong>Successful reperfusion complicated by sICH after EVT was associated with worse outcomes and higher mortality than unsuccessful reperfusion without sICH. These findings emphasize the need for additional efforts in assessing and managing post-EVT-associated sICH to optimize treatment strategies and improve outcomes.</p><p><strong>Trial registration number: </strong>Direct Endovascular Treatment for Large Vessel Occlusion Stroke; https://www.chictr.org.cn; ChiCTR-IOR-17013568.Intravenous Tirofiban Before Endovascular Thrombectomy for Acute Ischemic Stroke; https://www.chictr.org.cn; ChiCTR-INR-17014167.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414152","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":"New insights on the predictive value of hypoperfusion intensity ratio in thrombectomy: an updated systematic review and meta-analysis with multiple cut-offs.","authors":"Seyed Behnam Jazayeri, Aroosa Zamarud, Mohamed Derhab, Sherief Ghozy, Mona Mirbeyk, Jeremy J Heit, David F Kallmes","doi":"10.1136/jnis-2024-023000","DOIUrl":"https://doi.org/10.1136/jnis-2024-023000","url":null,"abstract":"<p><strong>Background: </strong>The hypoperfusion intensity ratio (HIR) has emerged as a vital measure of tissue-level collateral blood flow, helping to identify patients who are likely to benefit from mechanical thrombectomy (MT). We aimed to assess the HIR's predictive accuracy for clinical outcomes following MT in patients with acute ischemic stroke.</p><p><strong>Methods: </strong>PubMed, Embase, and Scopus were searched to identify studies comparing good versus poor HIR groups based on studies' reported cut-offs. We pooled binary outcomes to calculate odds ratios (OR) and continuous outcomes to calculate mean differences (MD) with 95% confidence intervals (95% CI) using random-effects models. PROSPERO registration code: CRD42024609185.</p><p><strong>Results: </strong>14 studies with 2987 patients, 1553 with good HIR and 1434 with poor HIR, were included in this meta-analysis. Patients with poor HIR exhibited a significantly higher baseline infarct volume compared with those with good HIR (MD 30.6 mL, 95% CI 20.8 mL to 40.3 mL, P<0.01), though baseline National Institutes of Health Stroke Scale (NIHSS) (P=0.12) and Alberta Stroke Program Early CT Score (ASPECTS) (P=0.35) were comparable between groups. The rates of infarct growth (MD 22.4 mL, 95% CI 6.7 mL to 38.0 mL, P<0.01) and 3-month mortality (OR 2.18, 95% CI 1.04 to 4.58, P=0.04) were higher among the poor HIR group and good functional recovery (modified Rankin Scale 0-2 at 3 months) was lower (OR 0.58, 95% CI 0.42 to 0.80, P<0.01). The rates of symptomatic intracranial hemorrhage (P=0.37) and successful reperfusion (P=0.47) were comparable among groups.</p><p><strong>Conclusion: </strong>This meta-analysis highlights the significant negative impact of poor HIR on patient outcomes. These findings emphasize the need for personalized treatment strategies for patients with poor HIR.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414131","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":"Carotid revascularization and circle of Willis in ocular ischemic syndrome: association with neovascular glaucoma and visual prognosis.","authors":"Xue-Ru Cheng, Zhao-Yang Meng, Lu Zhao, Yan-Ling Wang, Jia-Lin Wang","doi":"10.1136/jnis-2024-022959","DOIUrl":"https://doi.org/10.1136/jnis-2024-022959","url":null,"abstract":"<p><strong>Background: </strong>Ocular ischemic syndrome (OIS) and subsequent neovascular glaucoma (NVG) lead to irreversible visual impairment. This study aimed to investigate the association of carotid artery revascularization and the collateral circulation types via the circle of Willis (CoW) with NVG and visual prognosis in patients with OIS.</p><p><strong>Methods: </strong>This retrospective cohort study included 22 patients with OIS, with a median follow-up of 12 months. The collateral circulation patterns via the CoW were classified into five types. The association of the carotid artery revascularization, collateral circulation types via the CoW, and morphological characteristics of the CoW with the presence of NVG and visual outcomes was assessed.</p><p><strong>Results: </strong>The median time interval from baseline to visual decline during follow-ups in patients with carotid artery revascularization was longer than that in patients without carotid artery revascularization (13 months vs 9.5 months, P=0.041). Lacking collateral inflow via the CoW to the hemisphere ipsilateral to OIS was associated with NVG (odds ratio (OR), 11.000; P=0.022). The diameters of the C6 and C7 segments of the internal carotid artery, the A1 segment of the anterior cerebral artery, and the ophthalmic artery in OIS eyes were smaller than those in the contralateral eyes.</p><p><strong>Conclusion: </strong>Early carotid artery revascularization should be considered in patients with OIS, with or without NVG, as it may contribute to an improved visual prognosis. Patients without collateral inflow via the CoW to the hemisphere ipsilateral to OIS may have a higher risk of NVG.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374300","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":"Flow-based simulation in transverse sinus stenosis pre- and post-stenting: pressure prediction accuracy, hemodynamic complexity, and relationship to pulsatile tinnitus.","authors":"Janneck Stahl, Tatiana Abou-Mrad, Laura Stone McGuire, Gábor Janiga, Sylvia Saalfeld, Ali Alaraj, Philipp Berg","doi":"10.1136/jnis-2024-022867","DOIUrl":"https://doi.org/10.1136/jnis-2024-022867","url":null,"abstract":"<p><strong>Background: </strong>The proximity of transverse sinus stenosis (TSS) to inner ear structures and the temporal bone makes it a substantial cause of pulsatile tinnitus (PT). Treatment typically involves venous sinus stenting. This study investigates the hemodynamic stressors in TSS patients with PT along the pulse-transmitting temporal bone area and evaluates its treatment effects.</p><p><strong>Methods: </strong>Four patients with idiopathic intracranial hypertension, PT, and TSS, and four control patients were imaged using MR venography (MRV) and flat panel CT (FP-CT). Patient-specific blood flow simulations were conducted using boundary conditions based on quantitative MR angiography before and after VSS. Catheter-based trans-stenotic pressure gradient measurements were used to validate the simulation results.</p><p><strong>Results: </strong>The prediction of pressure gradients was close to catheter-based measurements using FP-CT-based segmentations (absolute deviation of 0.35 mm Hg) and is superior to MRV-based reconstructions (absolute deviation of 6.9 mm Hg). In TSS patients, the sinus temporal bone contact areas revealed notably higher time-averaged wall shear stress by 47±22% and velocity values by 41±18% compared with the sinus brain side. The relative residence time decreased by 57±58%. After stenting, the hemodynamic parameters dropped at the temporal side and throughout the sigmoid sinus. Almost all control patient hemodynamics remained lower than post-interventional results.</p><p><strong>Conclusion: </strong>Our simulations based on patient-specific flows highly predicts pressure gradients across the stenosis. Flow conditions in TSS reveal flow jet formation and high shear rates at the temporal bone, potentially causing sound transmission. The treatment reduces these stressors, demonstrating its targeted therapeutic effect.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374314","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 frontier DES in the setting of intracranial atherosclerotic disease: multicenter retrospective insights from early clinical experience.","authors":"Pierce Davis, Georgios Sioutas, Chethan Reddy, Alan Napole, Rashad Jabarkheel, Kyle Scott, Sandeep Kandregula, Redi Rahmani, Omar Choudhri, Bryan Pukenas, Joshua S Catapano, Peter Kan, Ramesh Grandhi, Walid K Salah, Ali Alaraj, Laura Stone McGuire, Sunil A Sheth, David Altschul, Muhammed Amir Essibayi, Jan Karl Burkhardt, Visish M Srinivasan","doi":"10.1136/jnis-2024-022681","DOIUrl":"https://doi.org/10.1136/jnis-2024-022681","url":null,"abstract":"<p><strong>Background: </strong>Intracranial atherosclerotic disease (ICAD) is a leading cause of stroke, often refractory to aggressive medical therapy. Recent advancements in drug-eluting stents (DES) show promise for improved efficacy in intracranial applications relative to traditional ICAD treatments.</p><p><strong>Methods: </strong>We retrospectively collected all consecutive deployments of the Onyx Frontier [Medtronic, Santa Rosa, CA] stent in the setting of ICAD between August 2022 and August 2024 at six high-volume neuro-interventional centers across the US. Patients were included if their indication for stenting (eg, acute/recurrent stroke) was secondary to ICAD. Primary outcome was periprocedural stroke (<72 hours) and secondary outcomes included degree of pre- and post-stent vessel stenosis and National Institutes of Health Stroke Scale (NIHSS) scores at most recent follow-up. Secondary outcomes were assessed via paired t-tests.</p><p><strong>Results: </strong>Among 55 patients that met our inclusion criteria, the mean age was 62, mean presentation NIHSS was 10, and 40% were female. A total of 62 devices were used. Most common occlusion locations included the middle cerebral and internal carotid arteries. The periprocedural stroke rate was 10.9%, with a mortality rate of 1.8%. Mean vessel stenosis significantly decreased from 84.90% pre-stent to 2.00% post-stent (P<0.05). Mean NIHSS score improved from 10.37 preoperatively to 3.23 at follow-up (p<0.05). Procedural failure did not occur, however complications occurred in 16.4% of cases.</p><p><strong>Conclusion: </strong>Our findings suggest that stenting in this setting results in a lower periprocedural stroke rate than appreciated in historical trials such as SAMMPRIS and VISSIT. However, recent CASSISS and BASIS trials demonstrate far reduced periprocedural stroke rates in the context of submaximal angioplasty for ICAD. This, in conjunction with complication rate, suggest that the Onyx Frontier, while promising, may not offer a definitive solution to ICAD.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374273","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 management of extracranial vertebral artery stenosis.","authors":"Huanwen Chen, Marco Colasurdo, Matias Luis Costa, Peter Kan","doi":"10.1136/jnis-2024-022618","DOIUrl":"https://doi.org/10.1136/jnis-2024-022618","url":null,"abstract":"<p><p>Approximately 20% of ischemic strokes involve the posterior circulation, primarily supplied by the vertebrobasilar system. While much is known about the stroke risk of vertebrobasilar stenotic disease in general, particularly those involving intracranial pathology, extracranial vertebral artery stenosis remains an underinvestigated pathology. In this narrative review, we highlight retrospective, prospective, and randomized trial data on extracranial vertebral artery diseases with a particular focus on the role of endovascular stenting in its management. We also discuss the role of advanced imaging modalities such as quantitative magnetic resonance angiography for stroke risk stratification and patient selection for stenting.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374306","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":"Dural arteriovenous fistula research and management in China (DREAM-INI): initial characterization and patient cohort outcomes.","authors":"Xin Su, Yongjie Ma, Zihao Song, Huiwei Liu, Chao Zhang, Huishen Pang, Yiguang Chen, Beichuan Zhao, Mingyue Huang, Liyong Sun, Peng Hu, Guilin Li, Tao Hong, Ming Ye, Hongqi Zhang, Peng Zhang","doi":"10.1136/jnis-2024-023014","DOIUrl":"https://doi.org/10.1136/jnis-2024-023014","url":null,"abstract":"<p><strong>Background: </strong>Intracranial dural arteriovenous fistulas (DAVFs) are rare lesions, making it challenging to fully understand and improve their management. Globally, only two major large-scale studies have focused on DAVFs. This report outlines the design of the DREAM-INI (Dural arteriovenous fistula research and management in China) project and provides an overview of the 1101-patient cohort it includes.</p><p><strong>Methods: </strong>Patient data were sourced from the DREAM-INI database, a retrospective, single-center observational study conducted from January 2001 to December 2022, encompassing a total of 1101 DAVF patients.</p><p><strong>Results: </strong>The cohort consists of 367 patients diagnosed with Borden type I DAVFs, 172 patients with Borden type II fistulas, and 562 patients with Borden type III fistulas. 565 patients exhibited flow-related symptoms, 176 patients presented with intracranial hemorrhage, and 275 patients had non-hemorrhagic neurological deficits. A large proportion of patients (95.6%, 1053/1101) underwent treatment through endovascular embolization (83.7%, 922/1101), surgery (8.7%, 96/1101), or multimodal therapy (3.2%, 35/1101). The overall immediate angiographic cure rate was 85.2% (897/1053 treated cases), and the rate of treatment-related permanent neurological morbidity was 3.4% (45/1328 total procedures). The median duration from the final treatment to the last follow-up for DAVF was 39 months. The predictive factors for aggressive symptoms, initial angiographic cure, and complications in DAVFs have also been preliminarily explored.</p><p><strong>Conclusions: </strong>With over 1100 patients, DREAM-INI represents a large and relatively well-documented registry of DAVF patient data in China and even globally. This database will enable numerous future studies, further advancing our understanding of this rare disease.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374303","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":"Geometric distribution of plaque calcification is associated with postprocedural hypotension after carotid artery stenting.","authors":"Zhicai Chen, Hui Cheng, Qiongyin Zhang, Shufeng Yu, Peng Wang, Chao Xu","doi":"10.1136/jnis-2024-022894","DOIUrl":"https://doi.org/10.1136/jnis-2024-022894","url":null,"abstract":"<p><strong>Background: </strong>Our study aimed to investigate the relationship between the geometric distribution of plaque calcification and the occurrence of postprocedural hypotension following carotid artery stenting (CAS).</p><p><strong>Methods: </strong>We retrospectively analyzed data from CAS patients between April 2018 and February 2023. Plaque calcification was evaluated using cross-sectional images obtained from multiplanar reconstructions perpendicular to the longitudinal axis of the internal carotid artery (ICA). The cross-sectional image of the most stenotic ICA was segmented into four quadrants: interior, exterior, ventral, and dorsal. We innovatively defined the geometric classification of plaque calcification based on physiological anatomy as modified calcification location. Postprocedural hypotension was defined as persistent systolic blood pressure at <90 mmHg, requiring intravenous vasopressor infusions that lasted more than 1 hour.</p><p><strong>Results: </strong>A total of 477 patients were included in the final analysis. Among them, 41 (8.6%) patients experienced postprocedural hypotension after CAS. For the modified geometric method, plaque calcification was found significantly more frequently in the hypotension group compared with the non-hypotension group in the dorsal quadrant. Binary logistic regression analysis showed that modified calcification location on the dorsal side (OR 3.520, 95% CI 1.497 to 8.274, p=0.004) were independently associated with postprocedural hypotension after CAS.</p><p><strong>Conclusions: </strong>The presence of plaque calcification on the dorsal side, using the modified geometric method, was found to be associated with a three-fold increased risk of postprocedural hypotension after CAS. These findings may have implications for patient screening, procedure planning, and hospitalization duration expectations.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374318","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}