Journal of NeuroInterventional Surgery最新文献

{"title":"Safety and efficacy of the Celt arterial closure device in a femoral first neuroendovascular practice: prospective cohort study.","authors":"Varun Padmanaban, Austin Birmingham, Nanthiya Sujijantarat, Robert W Regenhardt, James D Rabinov, Christopher J Stapleton, Aman B Patel","doi":"10.1136/jnis-2025-024065","DOIUrl":"https://doi.org/10.1136/jnis-2025-024065","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the safety and efficacy of the Celt arterial closure device (ACD), allowing immediate upright position and ambulation within 30 minutes, for femoral access closure in neuroendovascular procedures.</p><p><strong>Methods: </strong>Single center prospective study of consecutive neuroendovascular procedures performed via transfemoral access over 6 months. The Celt ACD was preferentially used for arterial closure in eligible cases. Patient demographics, comorbidities, procedural characteristics, antithrombotic regimens, and access site complications were recorded. The primary outcome was the rate of major access site complications resulting in red blood cell transfusion, interventional repair, retroperitoneal hematoma, or death. The secondary outcome was the rate of minor access site complications, including groin hematomas, pseudoaneurysms, ipsilateral deep vein thrombosis, limb ischemia, and infections.</p><p><strong>Results: </strong>During the study period, 456 patients underwent 520 femoral access procedures using Celt ACD closure. Most procedures were routine (82.5%, 429/520), with the remaining cases performed urgently (8.7%, 45/520) or emergently (8.8%, 46/520). Mean age of patients was 60.2±16.2 years and 62.1% (283/456) were women. 30.2% (157/520) of cases were on dual antiplatelet therapy (DAPT) or therapeutic anticoagulation. Among the 520 Celt ACD closures, there were no major access site complications. Minor complications occurred in only 1.3% (7/520) of cases, which were limited to small groin hematomas that all resolved after manual compression. The rate of groin hematoma was higher in cases on DAPT or anticoagulation versus those not on therapy (3.2% (5/157) vs 0.6% (2/363), P=0.017).</p><p><strong>Conclusion: </strong>In this study, the Celt ACD was safe and effective in providing rapid femoral artery closure in neuroendovascular procedures.</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":"144957521","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":"Impact of lesion calcification and hardness on periprocedural brain ischemia in patients with intracranial atherosclerotic disease undergoing angioplasty and stenting.","authors":"Te-Ming Lin, Borja Enrique Sanz Cuesta, Kai-Wei Yu, Chung-Han Yang, Chih-Ping Chung, Chao-Bao Luo, Jiing-Feng Lirng, Chia-Hung Wu, Feng-Chi Chang","doi":"10.1136/jnis-2025-023746","DOIUrl":"10.1136/jnis-2025-023746","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the risk factors for periprocedural brain ischemic lesions (PBILs) in patients with severe intracranial arterial stenosis (ICAS) treated with percutaneous transluminal angioplasty and stenting (PTAS).</p><p><strong>Methods: </strong>We analyzed the data of a prospectively collected cohort of patients with severe ICAS in whom aggressive medical treatment had failed and who underwent PTAS with intracranial stents. Lesion calcification was identified on CT. The predilatation pressure (PP, the pressure at which the indentation of the angioplasty balloon disappears) and the balloon size were recorded. Periprocedural MR images were acquired before and after the procedure to identify any new brain ischemia. Logistic regression analyses were performed to assess differences between subjects with and without downstream ischemia. Receiver operating characteristic curve analysis was performed to determine threshold values for discriminating subjects with and without downstream PBILs.</p><p><strong>Results: </strong>The data of 29 patients (mean±SD age 65.0±9.9 years, 21 men) were analyzed. Eighteen subjects (62%) had downstream PBILs on MRI. Calcified plaques (relative risk 11.7), a high PP during angioplasty (relative risk per atm 2.0), and a greater balloon diameter (relative risk per mm 4.0) were identified as risk factors for the presence of PBILs. Moreover, the presence of calcified plaques was associated with a greater PP (P=0.001). A PP threshold of 3.75 atm yielded the maximum sum of sensitivity and specificity.</p><p><strong>Conclusion: </strong>Some lesion characteristics including calcified plaques on CT and a high PP during angioplasty along with balloon diameter were identified as potential risk factors for PBILs after PTAS in patients with medically refractory ICAS.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144883017","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":"Ophthalmic artery angioplasty in a cohort of patients with geographic atrophy secondary to non-exudative age-related macular degeneration.","authors":"Pedro Lylyk, Ivan Lylyk, Pedro N Lylyk, Carlos Bleise, Esteban Scrivano, Javier Lundquist, Rodolfo Nella-Castro, Nicolas Perez, Jeff Franco, Michael W Calhoun, Luana R Wilbur, Philip J Rosenfeld, Mario J Saravia","doi":"10.1136/jnis-2025-023608","DOIUrl":"10.1136/jnis-2025-023608","url":null,"abstract":"<p><strong>Background: </strong>There is increasing evidence that vascular disease and chronic perfusion deficits play a role in the progression of age-related macular degeneration (AMD). This controlled clinical study evaluated the safety and feasibility of treating patients with late-stage AMD and associated geographic atrophy (GA). In addition, exploratory endpoints evaluated the potential to disrupt the disease process and initiate functional changes.</p><p><strong>Methods: </strong>A total of 17 subjects with confirmed late-stage AMD with GA, ophthalmic artery stenosis, and systemic stability were enrolled in this prospective multicenter study. Eleven (64.7%) of these subjects were successfully treated with ophthalmic artery angioplasty using an investigational ophthalmic percutaneous transluminal catheter system designed for this novel anatomical target and indication for use. Primary endpoints included procedure-related complications and procedural feasibility. All exploratory analyses were focused on ophthalmic outcomes and assessed for potential efficacy in choroidal thickness, visual acuity, reading ability, and patient-reported outcomes. Treated subjects were followed for 3 months by the interventional neuroradiology site and for 6 months by the ophthalmology site.</p><p><strong>Results: </strong>All systemic procedure-related adverse events (AEs) were potentially expected, effectively treated, resolved without sequelae, and included bronchial abrasion and hemoptysis secondary to intubation, urinary tract infection secondary to urinary catheterization, and vascular access site inflammation and hematoma. Procedure-related ocular AEs (eg, suspected retinal microemboli and potential reperfusion injury) were asymptomatic, graded as mild, and resolved without treatment or sequelae. Mean (SD) primary lesion stenoses decreased 59% from 43.7 (14.25)% to 18.2 (12.09)%. At study exit, mean best-corrected visual acuity improved by 6.7 letters (P=0.003) over baseline, and reading ability results improved 3.4%, 5.1%, and 28.5% (P=0.03) over baseline for reading acuity, critical print size, and reading speed, respectively. Patient-reported outcomes showed improvements in mobility and independence and in reading and accessing information.</p><p><strong>Conclusions: </strong>The feasibility of ophthalmic artery angioplasty in this population was demonstrated with the investigational devices, while providing an acceptable safety profile. Efficacy and functional improvement were also seen, providing guidance for future study.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144883018","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":"Characterizing superficial cerebral cortical venous anatomy for endovascular device implantation: a cross-sectional imaging study.","authors":"Jamie Brannigan, Azadeh Kian, Calvin Eiber, Venkata S Aditya Tarigoppula, Jillian Bogard, Adnan H Siddiqui, Gil Rind, Alejandro Berenstein, Shahram Majidi, Thomas J Oxley","doi":"10.1136/jnis-2025-023532","DOIUrl":"10.1136/jnis-2025-023532","url":null,"abstract":"<p><strong>Background: </strong>Neurovascular electronic devices, including brain-computer interfaces (BCIs), offer a minimally invasive approach to diagnosing and treating neurological disorders. Implanting BCIs in superficial cortical veins, owing to their proximity to sensorimotor cortices, may improve motor function restoration. However, marked anatomical variability and the complex anteriorly directed connection with the superior sagittal sinus (SSS) complicate device navigation. This exploratory study aimed to characterize cortical venous anatomy to inform device design and procedural planning.</p><p><strong>Methods: </strong>Retrospective imaging data from 25 patients were analyzed using magnetic resonance venography (MRV) and computed tomography venography (CTV). Vessel segmentation and analysis quantified parameters such as vein presence, diameter, length, angulation, and tortuosity. In 12 patients, T1-weighted magnetic resonance imaging (MRI) was used to extract cortical gyri and sulci, assessing vessel-cortex relationships.</p><p><strong>Results: </strong>The superior anastomotic vein (vein of Trolard) was identified bilaterally in 84% of patients, with a mean entrance diameter of 4.4 mm. Frequent transient constrictions (<2 mm) were reported. The precentral vein was present bilaterally in 52% of cases. Most cortical veins exhibited take-off angles >90 degrees from the SSS, presenting challenges for endovascular navigation, with overall considerable anatomical variability observed.</p><p><strong>Conclusion: </strong>The vein of Trolard shows promise as a target for endovascular BCIs given its consistent presence and favorable dimensions. Nonetheless, constrictions and steep angulation at the SSS confluence pose challenges for device deployment. A new framework is necessary for the classification of cortical venous anatomy, to guide patient selection and procedural planning, which will require further development and validation.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144883038","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":"Venous return index after mechanical thrombectomy predicts parenchymal hemorrhage and poor outcomes.","authors":"Yanan Hao, Yaode He, Huan Zhou, Jiansheng Yang, Shenqiang Yan, Xudong Lu, Luowei Chen, Tingxia Zhang, Xiaoling Zhang, Yuping He","doi":"10.1136/jnis-2025-023710","DOIUrl":"https://doi.org/10.1136/jnis-2025-023710","url":null,"abstract":"<p><strong>Background and purpose: </strong>The significance of early venous filling on digital subtraction angiography (DSA) after mechanical thrombectomy (MT) is unclear. This study introduces the Venous Return Index (VRI) to explore the relationship between VRI in different intracranial veins and outcomes after MT in acute anterior circulation large vessel occlusion (AC-LVO) stroke.</p><p><strong>Methods: </strong>A retrospective analysis of AC-LVO stroke patients who underwent successful MT (modified Thrombolysis In Cerebral Infarction (mTICI) ≥2b) within 24 hours from April 2014 to March 2023 was conducted. VRI, defined as the relative appearance time of the target vein on DSA, was analyzed for 8 intracranial veins (vein of Trolard, superficial middle cerebral vein, sphenoparietal sinus, vein of Labbé, thalamostriate vein, internal cerebral vein, vein of Galen, and basal vein). The definition of parenchymal hemorrhage (PH) follows the ECASS (European Cooperative Acute Stroke Study) standard. An unfavorable outcome is defined as a 90-day modified Rankin Scale (mRS) score of 4-6. The study assessed the relationship between VRI and 24-hour PH as well as 90-day mRS.</p><p><strong>Results: </strong>A total of 432 patients were included, with 22.5% experiencing PH and 42.4% having poor outcomes (mRS 4-6). The thalamostriate, internal cerebral, and great cerebral veins were independently associated with 24-hour PH and 90-day poor outcomes. The Alberta stroke program early CT score - blood Glucose -Thrombectomy attempts - Venous index (AGTV) scale, incorporating VRI from these veins, was developed to predict PH risk, with an area under the curve (AUC) of 0.887. The PH risk was 50.5% for AGTV ≥6 and 14.1% for AGTV <6.</p><p><strong>Conclusions: </strong>VRI in the thalamostriate, internal cerebral, and Galen veins was independently associated with 24-hour PH and 90-day poor outcomes. The AGTV scale effectively predicts PH risk after MT.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957607","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":"Prognostic value of novel inflammatory indices in dural arteriovenous fistula patients undergoing endovascular treatment.","authors":"Chao Zhang, Xin Su, Zihao Song, Huiwei Liu, Hongqi Zhang, Peng Zhang, Yongjie Ma","doi":"10.1136/jnis-2025-023792","DOIUrl":"10.1136/jnis-2025-023792","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate the prognostic value of inflammatory biomarkers in adult patients with dural arteriovenous fistulas (DAVFs) undergoing endovascular treatment.</p><p><strong>Methods: </strong>In this retrospective study, 471 adult DAVF patients treated with endovascular therapy were included. Neutrophil-to-lymphocyte ratio (NLR), systemic inflammation response index (SIRI), and systemic immune-inflammation index (SII) were measured on admission. Poor outcome was defined as modified Rankin Scale (mRS) >2 at last follow-up. Aggressive clinical presentation (intracranial hemorrhage or non-hemorrhagic neurological deficits) and treatment-related variables were compared across outcome groups. Propensity score matching (PSM), multivariable logistic regression, subgroup analysis, and mediation models were used to validate findings.</p><p><strong>Results: </strong>Of 471 eligible patients, 44 had poor outcomes (mRS >2) after treatment. Multivariable analysis revealed that elevated NLR, SIRI, and SII were significantly associated with poor prognosis, with odds ratios of 1.56, 1.29, and 1.28, respectively. Subgroup analyses demonstrated consistent prognostic impact of NLR, SIRI, and SII. Patients with aggressive clinical presentations exhibited significantly higher inflammation markers. The poor prognosis group had more staged treatments and hemorrhagic complications. However, mediation analysis showed no significant indirect effects through these variables, suggesting that inflammation may be directly associated with poor prognosis.</p><p><strong>Conclusions: </strong>Elevated NLR, SIRI, and SII on admission are associated with poor prognosis in DAVF patients. Future prospective studies incorporating serial biomarker monitoring and angiographic follow-up are warranted to validate these findings and clarify potential causal mechanisms.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144883020","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":"Predictors of delayed neurological improvement in patients with large core infarctions undergoing endovascular treatment.","authors":"Miao Chai, Xiaolei Gong, Min Li, Linyu Li, Changwei Guo, Jie Yang, Guojian Liu, Lilan Wang, Xiaolei Shi, Shihai Yang, Jinfu Ma, Xu Xu, Dahong Yang, Wenzhe Sun, Shitao Fan, Jiaxing Song, Wenjie Zi, Zhenchang Zhang","doi":"10.1136/jnis-2025-023779","DOIUrl":"10.1136/jnis-2025-023779","url":null,"abstract":"<p><strong>Objective: </strong>Some patients with large core infarctions who underwent endovascular treatment (EVT) still achieved favorable long-term outcomes despite the absence of neurological improvement in the acute phase. The underlying reasons for this phenomenon remain unclear. This study aimed to investigate the incidence and predictors of delayed neurological improvement (DNI) in this patient population.</p><p><strong>Methods: </strong>Patients with large core infarctions who received EVT were derived from a prospective, observational, nationwide multicenter registry. Acute phase neurological improvement (APNI) was defined as a decrease of ≥4 points in the National Institutes of Health Stroke Scale (NIHSS) score between admission and day 5-7. DNI was defined as achieving 90-day favorable outcomes in the absence of APNI. Multivariate logistic regression was used to analyze independent predictors of DNI.</p><p><strong>Results: </strong>Among 490 patients with large core infarctions who underwent EVT, 277 (56.5%) did not experience APNI. Of these, 39 (14.1%) patients achieved favorable long-term clinical outcomes and constituted the DNI group. Younger age, male sex, lower baseline NIHSS score, good collateral circulation, and shorter puncture to reperfusion time were independent predictors of DNI.</p><p><strong>Conclusion: </strong>DNI occurred in 14.1% of patients with large core infarctions undergoing EVT. Optimizing modifiable factors, such as reducing puncture to reperfusion time and improving collateral circulation, is crucial for enhancing patient outcomes. These findings have important implications for refining clinical management strategies and improving prognosis in this patient population.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144883019","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":"Single antiplatelet therapy and tirofiban bridged with surface modified flow diverters for ruptured blood blister-like aneurysms: single center experience and systematic review.","authors":"Ching-Chang Chen, Chun-Ting Chen, Mun-Chun Yeap, Shuo-Chi Chien, Po-Chuan Hsieh, Yi-Ming Wu, Kun-Ting Hong","doi":"10.1136/jnis-2025-023832","DOIUrl":"https://doi.org/10.1136/jnis-2025-023832","url":null,"abstract":"<p><strong>Background: </strong>Blood blister-like aneurysms (BBAs) of the internal carotid artery are rare but high risk lesions that frequently re-rupture due to their fragile structure and dissecting pathology. Treatment is particularly challenging in ruptured cases, given the risks associated with dual antiplatelet therapy. Recent advancements in flow diverter stents (FDSs) with surface modifications, and the use of single antiplatelet therapy (SAPT), offer a potential alternative strategy.</p><p><strong>Methods: </strong>We conducted a retrospective review of 17 patients with ruptured internal carotid artery BBAs treated with surface modified FDS under SAPT (ticagrelor or prasugrel) bridged periprocedurally with intravenous tirofiban. All procedures were performed within the acute phase of subarachnoid hemorrhage. Clinical, radiographic outcomes, and procedure related complications were evaluated.</p><p><strong>Results: </strong>Among 17 patients, 94.1% achieved complete angiographic occlusion, and 76.5% attained favorable clinical outcomes (modified Rankin Scale score ≤2). No aneurysm rebleeding or device related ischemic events occurred. A total of 11 patients underwent external ventricular drainage or ventriculoperitoneal shunting without discontinuing SAPT, and no hemorrhagic complications were observed. A literature review incorporating seven additional series identified a total of 42 FDS plus SAPT treated BBA cases, with similar safety and efficacy profiles.</p><p><strong>Conclusions: </strong>Surface modified FDS with SAPT and tirofiban bridging appears to be a promising treatment option for ruptured BBAs, offering high occlusion rates with minimal thromboembolic and hemorrhagic complications. Larger prospective studies are needed to validate these findings.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855573","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":"Intravenous tenecteplase is associated with a higher incidence of thrombus movement before endovascular treatment for acute ischemic stroke: a secondary analysis of the AcT randomized controlled trial.","authors":"Ibrahim Alhabli, Noman Ishaque, Mahesh Kate, Anas Alrohimi, Nishita Singh, Faysal Benali, MacKenzie Horn, Brian Buck, Ayoola Ademola, Houman Khosravani, Ramana Appireddy, Francois Moreau, Gordon Gubitz, Aleksander Tkach, Luciana Catanese, Dariush Dowlatshahi, Aleksandra Pikula, Jai J Shankar, Heather Williams, Thalia S Field, Atif Zafar, Tolulope Sajobi, Richard Swartz, Alexandre Y Poppe, Andrew M Demchuk, Bijoy K Menon, Mohammed Almekhlafi, Fouzi Bala","doi":"10.1136/jnis-2025-023336","DOIUrl":"https://doi.org/10.1136/jnis-2025-023336","url":null,"abstract":"<p><strong>Background: </strong>Thrombus migration can occur in patients receiving IV thrombolysis for acute stroke. This study compared the effects of IV tenecteplase (0.25 mg/kg) versus alteplase (0.9 mg/kg) on thrombus movement in patients undergoing endovascular treatment (EVT) in the AcT trial.</p><p><strong>Methods: </strong>Patients with intracranial occlusion on baseline CT angiography (CTA) who underwent EVT were included. Thrombus movement from baseline CTA to first angiographic EVT run was classified as no thrombus movement, thrombus extension (TE, movement to a proximal location on DSA compared with CTA), thrombus migration (TM, movement to a more distal location), or recanalization. Outcomes were 90-day modified Rankin Scale (mRS) score 0-2 and final extended Thrombolysis in Cerebral Infarction score 2b-3. Mixed-effects logistic regression was performed.</p><p><strong>Results: </strong>Of the 1577 patients in the AcT trial, 496 patients with intracranial occlusions underwent EVT (median age 73 years, 50.8% female). No thrombus movement was seen in 398 patients (80.2%), TE in six (1.2%), TM in 77 (15.5%), and complete recanalization in 15 (3.0%). Tenecteplase recipients (n=252) had higher TM rates than alteplase recipients (19.4% vs 11.5%, adjusted OR (aOR) 1.83, 95% CI 1.10 to 3.07). TM did not impact final successful reperfusion (aOR 0.76, 95% CI 0.40 to 1.38) but was associated with increased odds of 90-day mRS 0-2 (aOR 1.77, 95% CI 1.05 to 3.06). Thrombolytic type did not affect the relationship between thrombus movement and study outcomes (P>0.05).</p><p><strong>Conclusion: </strong>IV tenecteplase is associated with higher thrombus migration rates before EVT compared with alteplase, which is linked to better functional outcomes. However, the type of thrombolytic agent did not affect final reperfusion and functional outcomes.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855572","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":"Global gender representation in neurointerventional surgery: a natural language processing analysis of journal publications.","authors":"Daniela Renedo, Andrew B Koo, Abdelaziz Amllay, Nanthiya Sujijantarat, Bushra Fathima, Joseph O Haynes, Guido J Falcone, Kevin N Sheth, Sandra Abi Fadel, Michele H Johnson, Ryan Hebert, Cyprien Rivier, Charles Matouk","doi":"10.1136/jnis-2025-023956","DOIUrl":"https://doi.org/10.1136/jnis-2025-023956","url":null,"abstract":"<p><strong>Background: </strong>Despite increased awareness of diversity and inclusion in neurointerventional surgery, the representation of women in neurointerventional academic publishing has not been systematically quantified. We aimed to evaluate global and temporal gender trends among authors publishing in leading neurointerventional journals using natural language processing (NLP) tools.</p><p><strong>Methods: </strong>We used the National Center for Biotechnology Information (NCBI) Entrez and Medline APIs (application programming interfaces) to extract metadata from all articles published between 2014 and 2024 in the <i>Journal of NeuroInterventional Surgery</i> and <i>Interventional Neuroradiology</i>, the only two journals dedicated exclusively to the field of neurointerventional surgery. For each publication, we identified the first and last authors, as well as their institutional affiliations. We applied the OpenAI GPT-4 API to infer the country of origin based on last author affiliations and to predict gender using first and last names.</p><p><strong>Results: </strong>Across 4875 articles published between 2014 and 2024 in two leading neurointerventional surgery journals, female authorship increased modestly over time. In 2014, 10.2% of first authors and 6.1% of last authors were women, compared with 14.2% and 7.6%, respectively, in 2024. A significant upward trend in female first authorship was observed over time using the Cochran-Armitage test for trend (P=0.0002), with the strongest increases in the Americas and Asia. In contrast, no overall increase was seen in female last authorship (P=0.14), with a modest but significant trend observed only in Asia. Geographic disparities were also evident: Austria and Norway had the highest female last authorship rates (62.5% and 40.0%, respectively), whereas the US, despite contributing the most publications, had only 13.8%. The Gender Parity Index (GPI) further highlighted under-representation, with most countries falling well below parity, especially for last authorship.</p><p><strong>Conclusions: </strong>Analysis using artificial intelligence driven NLP methods suggests persistent gender inequalities in neurointerventional surgery authorship with variation across countries. Although female representation has improved over the past decade, progress is uneven. These findings underscore the need for targeted efforts to promote equity in academic vascular neurosurgery globally.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855571","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}