Journal of NeuroInterventional Surgery最新文献

{"title":"Middle meningeal artery embolization in the routine care of chronic subdural hematoma?","authors":"Donald V Heck","doi":"10.1136/jnis-2025-023460","DOIUrl":"10.1136/jnis-2025-023460","url":null,"abstract":"","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"914-915"},"PeriodicalIF":4.3,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029888","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":"Can the clot meniscus and claw signs predict thrombectomy and clinical outcomes in patients with stroke? A systematic review and meta-analysis.","authors":"Abdullah Reda, Jonathan Cortese, Sherief Ghozy, Aryan Gajjar, Dani Douri, Ramanathan Kadirvel, David F Kallmes","doi":"10.1136/jnis-2024-022322","DOIUrl":"10.1136/jnis-2024-022322","url":null,"abstract":"<p><strong>Background: </strong>The angiographic shape of an occlusion, like the clot meniscus sign and the claw sign, has been reported to potentially impact the recanalization rate and clinical outcome in patients undergoing mechanical thrombectomy for acute ischemic strokes.</p><p><strong>Method: </strong>Following PRISMA guidelines, a systematic literature search was conducted across PubMed, Scopus, Embase and Web of Science databases. Patients were grouped into clot meniscus/claw sign positive and negative groups based on the definitions obtained from each study. Primary outcomes included technical success, with a meta-analysis performed using a random-effects model to calculate proportions and odds ratios (OR) with 95% confidence intervals (Cl).</p><p><strong>Results: </strong>We included seven studies recruiting 1572 patients. The results indicated that the positive and negative groups had comparable first-pass effect (OR 1.95; 95% CI 0.76 to 5.01; P=0.167) and final recanalization (OR 1.36; 95% CI 0.81 to 2.27; P=0.248) rates. However, the rate of having a favorable functional outcome was significantly higher in the positive group than in the negative sign group (OR 1.91; 95% CI 1.25 to 2.92; P<0.003). Within the sign-positive population, the use of contact aspiration was associated with a significantly higher rate of recanalization compared with using a stent retriever (OR 0.18; 95% CI 0.07 to 0.49; P<0.001). This result did not translate into a clinical impact, as both stent retriever and contact aspiration showed comparable rates of functional independence at 3 months (OR 0.22; 95% CI 0.02 to 2.33; P=0.210).</p><p><strong>Conclusion: </strong>The presence of the clot meniscus/claw sign is not associated with recanalization outcomes after thrombectomy. However, it might be a good sign to predict which thrombectomy technique might be associated with better recanalization, although current evidence may need further confirmation.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"932-938"},"PeriodicalIF":4.3,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406435","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":"Back to Bernoulli: a simple formula for trans-stenotic pressure gradients and retrospective estimation of flow rates in cerebral venous disease.","authors":"Gurnish Sidora, Anna L Haley, Nicole M Cancelliere, Vitor M Pereira, David A Steinman","doi":"10.1136/jnis-2024-022074","DOIUrl":"10.1136/jnis-2024-022074","url":null,"abstract":"<p><strong>Background: </strong>Venous sinus stenosis can be associated with cerebrovascular disorders. Understanding the role of blood flow disturbances in these disorders is often hampered by the lack of patient-specific flow rates. Our goal was to demonstrate the impact of this by predicting individual flow rates retrospectively from routine manometry and angiography.</p><p><strong>Methods: </strong>Ten cases, spanning a range of stenosis severities and pressure gradients, were selected from a cohort of patients who had undergone venous stenting for pulsatile tinnitus. Lumen geometries were digitally segmented from CT venograms. A simplified Bernoulli formula was derived to estimate individual cycle-average flow rates from clinical pressure gradients and minimum lumen cross-section areas. High-fidelity pulsatile computational fluid dynamics (CFD) simulations were performed to compare predictions of flow disturbances using generic versus individual flow rates, and to validate the Bernoulli formula.</p><p><strong>Results: </strong>Individual flow rates derived from the Bernoulli formula deviated by up to 47% from the assumed generic flow rate, resulting in substantial differences in CFD predictions of post-stenotic flow instabilities. Pressure gradients estimated by the simplified Bernoulli formula were, however, highly predictive of pressure gradients from the full CFD simulations (R²=0.95; slope=0.98, 95% CI 0.88 to 1.09).</p><p><strong>Conclusions: </strong>A simple Bernoulli formula can predict CFD-estimated trans-stenotic pressure gradients in realistic venous geometries. As demonstrated here, this may be used to recover individual flow rates from routine-but-invasive clinical measurements; however, it also suggests a simpler path towards non-invasive estimation of trans-stenotic pressure gradients that may avoid some of the challenges associated with 4D flow MRI approaches.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"1005-1010"},"PeriodicalIF":4.3,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792677","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":"Medical malpractice claims and state medical board complaints among United States neurointerventionalists.","authors":"Kyle M Fargen, Ankitha M Iyer, J Mocco, Johanna T Fifi, Guilherme Dabus, Justin F Fraser, Joshua A Hirsch, Mahesh V Jayaraman","doi":"10.1136/jnis-2024-021959","DOIUrl":"10.1136/jnis-2024-021959","url":null,"abstract":"<p><strong>Background: </strong>Surgeons are at high risk for malpractice claims, which can significantly impact physician quality of life and risk of burnout. There are few published data reporting the incidence, outcomes, and repercussions of malpractice lawsuits on neurointerventionalists.</p><p><strong>Methods: </strong>A survey of senior members of the United States Society of Neurointerventional Surgery (SNIS) was performed to study malpractice litigation and medical board complaints.</p><p><strong>Results: </strong>In total, 173 responses were obtained. Of the total sample, 66 respondents (38.2%) reported being subject to a total of 84 malpractice claims during independent practice over the last 10 years, amounting to a malpractice claim annual incidence of 5.9% (84 cases per 1423 years of practice). The majority of claims involved either brain aneurysms (34.5%) or arteriovenous malformations (23.8%), with most alleging either intra-procedural (38.1%) or post-procedural (27.3%) complications. Only three of the 58 claims that had concluded ended in court settlements (5.2%). The majority (78.3%) of claims resulted in no consequences to physician practice. Fourteen respondents (8.1%) reported being subject to a total of 16 state medical board complaints over the previous decade, with most resulting in no significant repercussions.</p><p><strong>Conclusion: </strong>Malpractice claims are common among neurointerventionalists and often cause significant physician distress, yet most result in claims being dropped or no paid damages, and the majority conclude without practice repercussions for the named physicians.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"1019-1023"},"PeriodicalIF":4.3,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008914","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":"Intraoperative cerebral angiography reveals microsurgically occult sequelae of temporary clip application during elective cerebral aneurysm surgery.","authors":"Philipp Hendrix, Sina Hemmer, Anant Chopra, Oded Goren, Gregory M Weiner, Clemens M Schirmer, Jeffrey D Oliver","doi":"10.1136/jnis-2024-022349","DOIUrl":"10.1136/jnis-2024-022349","url":null,"abstract":"<p><strong>Background: </strong>Temporary clipping (TC) is an essential adjunct in cerebral aneurysm (CA) surgery. Despite appearing insignificant to the surgeon under the microscope, TC may cause parent vessel injury. Intraoperative diagnostic cerebral angiography (ioDCA) is crucial for assessing aneurysm occlusion and parent vessel integrity. We aimed to assess sequelae of TC evident on immediate ioDCA.</p><p><strong>Methods: </strong>Elective CA clippings with ioDCA in a hybrid operating room from January 2020 to June 2023 were reviewed. Microsurgical and angiographic assessments were performed to identify post-TC parent vessel alterations. Outcomes were compared between TC and non-TC-groups.</p><p><strong>Results: </strong>Collectively, 107 patients underwent 111 craniotomies for clipping of 127 CAs. TC was used in 59/111 cases (53.2%) for treatment of 66/127 CAs (51.9%). CA size and neck were significantly larger in the TC group than in the non-TC group (p<0.001). Parent vessel vasospasm at the site of the previous temporary clip location was evident on 3D rotational angiography in 12/59 (20.3%) TC cases. Clip adjustment rates after ioDCA were similar between groups (TC 13.6% vs non-TC 8.2%, p=0.328). In the TC group compared with the non-TC group, the rates of symptomatic radiographic ischemia and functional decline at discharge were significantly higher (p=0.022 and p=0.045, respectively). However, functional status at follow-up was comparable (p=0.620).</p><p><strong>Conclusions: </strong>TC during CA surgery can cause significant yet microsurgically occult vasospasm in the parent vessel, potentially contributing to symptomatic ischemia and early functional decline. Intraoperative angiography is crucial for detecting this issue, highlighting both its importance and the risks associated with TC.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"1011-1018"},"PeriodicalIF":4.3,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289417","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":"Future directions of neurointerventional trials in intracranial atherosclerotic stenosis.","authors":"Delin Liu, Peter Kan","doi":"10.1136/jnis-2025-024124","DOIUrl":"10.1136/jnis-2025-024124","url":null,"abstract":"","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":"17 9","pages":"912-913"},"PeriodicalIF":4.3,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847088","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":"Correspondence on 'Evaluating the effects of recreational drug use on ruptured cerebral arteriovenous malformation presentation and in-hospital outcomes: a national inpatient sample analysis' by Gajjar <i>et al</i>.","authors":"Siyuan Yang, Jialei Zhou, Xiaoyu Ji","doi":"10.1136/jnis-2024-022873","DOIUrl":"10.1136/jnis-2024-022873","url":null,"abstract":"","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"1026"},"PeriodicalIF":4.3,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854210","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 angiographic based quantitative flow ratio and anatomic features in intracranial atherosclerotic stenosis.","authors":"Kangmo Huang, Weihe Yao, Zhiruo Song, Xuerong Jia, Jie Gao, Rui Liu, Yunfei Han, Xinfeng Liu, Juan Du, Shengxian Tu, Wusheng Zhu","doi":"10.1136/jnis-2024-022007","DOIUrl":"10.1136/jnis-2024-022007","url":null,"abstract":"<p><strong>Background: </strong>Patients with intracranial atherosclerotic stenosis (ICAS) are prone to stroke recurrence despite aggressive medical treatment. Further assessment of the anatomy and physiology of ICAS is urgently needed to facilitate individualized therapy. We explored the predictive value of angiography based hemodynamic and anatomical features for ICAS patients.</p><p><strong>Methods: </strong>In this retrospective study, patients with moderate-to-severe stenosis of the middle cerebral artery (MCA) were enrolled. The hemodynamic assessment was performed using the single view Murray's law based quantitative flow ratio (μQFR) approach. The locations of lesions were categorized as perforator rich segments of the MCA (pMCA) and others. Multivariate Cox models were developed to identify significant predictors. The primary outcomes were defined as stroke and transient ischemic attack.</p><p><strong>Results: </strong>Among the 333 patients (median (IQR) age, 56 (49-63) years, 70.3% men) over a median follow-up period of 64.5 months, 50 (15.0%) had the primary outcomes, and 80.0% occurred within 5 years. Patients with lower μQFR values (dichotomized at 0.73) had a higher risk of the 5 year primary outcomes (log rank P=0.023), and good collateral circulation may have attenuated the risk. In the multivariate analyses, μQFR (adjusted HR=0.345; 95% CI 0.155 to 0.766; P=0.009), lesion located in pMCA (adjusted HR=0.377; 95% CI 0.190 to 0.749; P=0.005), and diameter ratio of the internal carotid artery (adjusted HR=4.187; 95% CI 1.071 to 16.370; P=0.040) were significantly associated with the 5 year primary outcomes.</p><p><strong>Conclusions: </strong>Angiography based μQFR and anatomical features, namely plaque localization and internal carotid artery expansion, could serve as promising prognostic indexes for MCA atherosclerosis.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"980-985"},"PeriodicalIF":4.3,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141766267","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":"Efficacy of intra-arterial carboplatin and bevacizumab in the C6 rat glioma model of glioblastoma multiforme.","authors":"Jaims Lim, Briana A Santo, Ammad A Baig, Shiau-Sing K Ciecierska, Brianna Donnelly, Sarah Balghonaim, Bennett R Levy, Vinay Jaikumar, Elad I Levy, Vincent M Tutino, Adnan H Siddiqui","doi":"10.1136/jnis-2024-021789","DOIUrl":"10.1136/jnis-2024-021789","url":null,"abstract":"<p><strong>Background: </strong>Utilizing an endovascular rat glioma model, this study aimed to analyze the efficacy of intra-arterial (IA) carboplatin and bevacizumab delivery with blood-brain barrier breakdown (BBBB) for glioblastoma treatment.</p><p><strong>Methods: </strong>C6-glioma cells were stereotactically injected into the left frontal lobe of Wistar rats. Tumor growth was confirmed on day 8 via MRI. On day 9, a microcatheter was navigated under fluoroscopy from the left femoral artery to the left internal carotid artery. A volume of 2.25 mL of 25% mannitol was administered, followed by either 10 mg/kg of bevacizumab or 2.4 mg/kg of carboplatin. Serial MRI was obtained post-treatment to assess tumor response via analysis of tumor size and radiomics. Histology was analyzed after termination.</p><p><strong>Results: </strong>Control tumor rats and IA mannitol treated tumor rats had fatal tumor growths, with survival until 19.75±2.21 and 36.3±15.1 days, respectively. Carboplatin and bevacizumab treated rats lived >40 days, after which they were euthanized. From serial MRI and histology, IA carboplatin treated rats exhibited tumor regression and resolution by day 35. In IA bevacizumab treated rats, there was tumor regression near the basal ganglia of the brain, closer to the IA chemotherapy injection site, which had reorganized growth patterns. From MRI, 29 unique radiomic features were significantly different between control and treated tumors (notably for total energy and skewness), and treatment responders had a distinct, early manifesting radiomic profile.</p><p><strong>Conclusion: </strong>IA carboplatin and bevacizumab treatment resulted in varying degrees of tumor suppression, validating the first endovascular C6 glioma model as a reliable method to assess new IA therapies.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"997-1004"},"PeriodicalIF":4.3,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141860004","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 local open-source large language models for data extraction from unstructured reports on mechanical thrombectomy in patients with ischemic stroke.","authors":"Aymen Meddeb, Philipe Ebert, Keno Kyrill Bressem, Dmitriy Desser, Andrea Dell'Orco, Georg Bohner, Justus F Kleine, Eberhard Siebert, Nils Grauhan, Marc A Brockmann, Ahmed Othman, Michael Scheel, Jawed Nawabi","doi":"10.1136/jnis-2024-022078","DOIUrl":"10.1136/jnis-2024-022078","url":null,"abstract":"<p><strong>Background: </strong>A study was undertaken to assess the effectiveness of open-source large language models (LLMs) in extracting clinical data from unstructured mechanical thrombectomy reports in patients with ischemic stroke caused by a vessel occlusion.</p><p><strong>Methods: </strong>We deployed local open-source LLMs to extract data points from free-text procedural reports in patients who underwent mechanical thrombectomy between September 2020 and June 2023 in our institution. The external dataset was obtained from a second university hospital and comprised consecutive cases treated between September 2023 and March 2024. Ground truth labeling was facilitated by a human-in-the-loop (HITL) approach, with time metrics recorded for both automated and manual data extractions. We tested three models-Mixtral, Qwen, and BioMistral-assessing their performance on precision, recall, and F1 score across 15 clinical categories such as National Institute of Health Stroke Scale (NIHSS) scores, occluded vessels, and medication details.</p><p><strong>Results: </strong>The study included 1000 consecutive reports from our primary institution and 50 reports from a secondary institution. Mixtral showed the highest precision, achieving 0.99 for first series time extraction and 0.69 for occluded vessel identification within the internal dataset. In the external dataset, precision ranged from 1.00 for NIHSS scores to 0.70 for occluded vessels. Qwen showed moderate precision with a high of 0.85 for NIHSS scores and a low of 0.28 for occluded vessels. BioMistral had the broadest range of precision, from 0.81 for first series times to 0.14 for medication details. The HITL approach yielded an average time savings of 65.6% per case, with variations from 45.95% to 79.56%.</p><p><strong>Conclusion: </strong>This study highlights the potential of using LLMs for automated clinical data extraction from medical reports. Incorporating HITL annotations enhances precision and also ensures the reliability of the extracted data. This methodology presents a scalable privacy-preserving option that can significantly support clinical documentation and research endeavors.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"986-991"},"PeriodicalIF":4.3,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12418536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141878871","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}