Neurointervention最新文献

{"title":"Venous Sinus Stenting Alone as an Effective Treatment for Complex Dural Arteriovenous Fistulas with Sinus Thrombosis.","authors":"Maximilian Thormann, Roland Schwab, Anastasios Mpotsaris, Maciej Powerski, Daniel Behme","doi":"10.5469/neuroint.2025.00262","DOIUrl":"https://doi.org/10.5469/neuroint.2025.00262","url":null,"abstract":"<p><p>Dural arteriovenous fistulas (dAVFs) are rare vascular malformations, often complicated by sinus thrombosis and cortical reflux. We report a patient with a Cognard Type IIb dAVF at the right transverse sinus and ipsilateral sigmoid sinus thrombosis, unsuitable for conventional embolization due to contralateral sinus hypoplasia. A novel therapeutic approach involving direct jugular vein puncture, venous recanalization, and stenting using a stiff 0.035-inch guidewire effectively downgraded the dAVF to Cognard Type I. At 3-month follow-up, stable angiographic outcomes, marked clinical improvement, and absence of seizures confirmed the efficacy of sinus stenting as a standalone treatment in an anatomically challenging case.</p>","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144079270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Striving to Improve Image Quality and Minimize Radiation Dose in Neurointerventional Procedures.","authors":"Sang Hyun Suh","doi":"10.5469/neuroint.2025.00311","DOIUrl":"https://doi.org/10.5469/neuroint.2025.00311","url":null,"abstract":"","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Technical Aspects and Tips and Tricks for Double Stent Retriever Thrombectomy.","authors":"Grzegorz Marek Karwacki, Guillaume Marie, Alexander von Hessling","doi":"10.5469/neuroint.2025.00199","DOIUrl":"https://doi.org/10.5469/neuroint.2025.00199","url":null,"abstract":"<p><p>Randomized clinical trials have established the clinical efficacy of mechanical revascularization compared to drug therapy. Successful reperfusion in mechanical thrombectomy is achieved in 53% to 83% of cases, often requiring multiple thrombectomies, which can prolong procedure times and potentially lead to worse outcomes and higher complication risks. The current body of literature suggests that the first pass effect (FPE) is of paramount importance. To achieve a higher FPE, a double stent retriever (DSR) technique is becoming more popular. This publication shares our experience, challenges, and learning journey in implementing DSR in our department.</p>","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Procedure Time of Endovascular Thrombectomy as Performance Measure of Acute Stroke Treatment.","authors":"Eung-Joon Lee, Han-Yeong Jeong, Jayoun Kim, Nan Hee Park, Min Kyoung Kang, Dongwhane Lee, Jinkwon Kim, Yo Han Jung, Sungwook Yu, Wook-Joo Kim, Han-Jin Cho, Kyungbok Lee, Tai Hwan Park, Mi Sun Oh, Ji Sung Lee, Joon-Tae Kim, Byung-Woo Yoon, Jong-Moo Park, Hee-Joon Bae, Keun-Hwa Jung","doi":"10.5469/neuroint.2025.00178","DOIUrl":"https://doi.org/10.5469/neuroint.2025.00178","url":null,"abstract":"<p><strong>Purpose: </strong>Procedure time (PT), defined as the time between groin access and vessel recanalization, is a recently recognized predictor of outcomes after endovascular thrombectomy (EVT) for acute ischemic stroke (AIS). However, the factors affecting PT and its potential value as a performance measure of AIS treatment remain unexplored.</p><p><strong>Materials and methods: </strong>Using the Korean Stroke Registry, we compared patients who underwent EVT for AIS from 2018 to 2022 based on 60 minutes PT. We conducted multivariate analysis to investigate whether PT <60 minutes was associated with successful recanalization and good functional stroke outcomes. We also investigated factors that independently predicted PT ≥60 minutes. Furthermore, we determined the cutoff point for PT.</p><p><strong>Results: </strong>We analyzed 4,703 patients (mean age: 69.5±11.9, 60.3% male) who underwent EVT. The mean PT was 54.6±36.7 minutes. Multivariate analysis revealed that PT <60 minutes independently predicted a good functional outcome as represented by modified Rankin Scale scores of 0-2 (adjusted odds ratio [aOR]: 1.40, 95% confidence interval [CI]: 1.22-1.59). PT <60 minutes was significantly associated with successful recanalization after adjusting for confounding variables (aOR: 1.66, 95% CI: 1.33-2.07). Moreover, after adjusting for covariates, age≥65 years (aOR: 1.20, 95% CI: 1.05-1.38), onset-to-door time (aOR: 1.03, 95% CI: 1.01-1.04), door-to-puncture time (aOR: 1.05, 95% CI: 1.03-1.06), posterior circulation stroke (PCS) (aOR: 1.13, 95% CI: 1.02-1.28), and smoking (aOR: 1.24, 95%CI: 1.09-1.45) independently predicted PT ≥60 minutes. Finally, the highest aOR for good stroke outcome was observed in the 60-minute cutoff model (aOR: 1.45, 95%CI: 1.27-1.67).</p><p><strong>Conclusion: </strong>PT <60 minutes was significantly associated with good functional outcomes. Conversely, PT ≥60 minutes was associated with older age, PCS, smoking, prolonged onset-to-door and door-to-puncture time. Further studies are necessary to develop refining strategies for optimizing PT to improve stroke outcomes.</p>","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjunctive Coiling in Flow Diverter Treatment Does Not Prevent Delayed Rupture: A Nationwide Survey.","authors":"Shigeru Miyachi, Reo Kawaguchi","doi":"10.5469/neuroint.2025.00129","DOIUrl":"https://doi.org/10.5469/neuroint.2025.00129","url":null,"abstract":"<p><strong>Purpose: </strong>Delayed rupture (DR) can occur even after successful deployment of flow diverters (FDs). Although coiling is often added to reduce the risk of rupture in high-risk intracranial aneurysms, its effectiveness remains unproven. To assess current practice in Japan, a questionnaire was distributed to evaluate the effect of coiling on rupture prevention.</p><p><strong>Materials and methods: </strong>A retrospective survey was sent to 124 institutions with qualified FD practitioners, receiving 76 responses (61%). A total of 5,527 patients treated with FDs were included in the study, and clinical records of 5,211 aneurysms were analyzed.</p><p><strong>Results: </strong>DRs (excluding intraprocedural accidents) occurred in 36 cases (0.7%). Of 1,286 aneurysms treated with FD and coiling, 9 (0.7%) ruptured. Ruptured aneurysms in the FD with coiling group were located in the supraclinoid segment (4 cases), paraclinoid internal carotid artery (ICA) (3 cases), and basilar artery (2 cases), of which 7 were classified as giant (diameter >20 mm). In the FD-alone group, 55% (15/27) of ruptured aneurysms were located in the cavernous ICA. Time to rupture ranged from 1 to 2,220 days with no significant difference between groups, except for 1 exceptionally delayed case. Outcomes were worse in the FD with coiling group, where 67% (6/9) had a modified Rankin Scale score of 6. The DR rate was identical between the FD-alone and FD with coiling groups.</p><p><strong>Conclusion: </strong>Coiling does not appear to prevent rupture after FD treatment. Aneurysms treated with coiling tended to be larger, to rupture earlier, and to have worse outcomes, probably due to selection bias. Routine loose coiling may provide psychological reassurance but lacks proven efficacy as a preventive measure.</p>","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trans-Galen Approach for Embolization of Sphenoparietal Sinus Dural Arteriovenous Fistulas.","authors":"Dang-Khoi Tran, Minh-Anh Nguyen, Thanh-Tinh Truong, Yuang-Seng Tsuei, Quoc-Tuan Tran","doi":"10.5469/neuroint.2025.00094","DOIUrl":"https://doi.org/10.5469/neuroint.2025.00094","url":null,"abstract":"<p><p>A patient in their early 60s presented with a headache and right-sided numbness. Imaging revealed a hemorrhagic lesion in the left thalamus and venous engorgement involving the left sphenoparietal sinus, with drainage through the basal vein of Rosenthal and the superficial middle cerebral vein. The trans-Galen approach was utilized for embolization, successfully obliterating the fistulas using coils without retrograde opacification. Post-procedure angiography demonstrated complete occlusion. This case underscores the trans-Galen approach as a safe and effective strategy for managing complex sphenoparietal sinus dural arteriovenous fistulas, providing direct access while minimizing complications and ensuring procedural success.</p>","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemifacial Spasm Caused by Posterior Inferior Cerebellar Artery Compression due to Vertebral Artery Aneurysm: Management with Stent-Assisted Coil Embolization.","authors":"Nagatsuki Tomura, Masaki Sonoda, Takashi Shuto","doi":"10.5469/neuroint.2025.00073","DOIUrl":"https://doi.org/10.5469/neuroint.2025.00073","url":null,"abstract":"<p><p>A 45-year-old female presented with progressive right hemifacial spasm (HFS) over 6 months. Magnetic resonance imaging revealed the right posterior inferior cerebellar artery (PICA) as the culprit vessel for HFS and a fusiform aneurysm in the vertebral artery (VA) just proximal to it. Following the patient's request for endovascular treatment of the VA, stent-assisted coil embolization was performed to achieve PICA deviation through VA straightening after stent placement and thereby reduce HFS symptoms. At 21 months post-procedure, her HFS had resolved, with imaging confirming PICA deviation due to VA straightening, suggesting that this anatomical change contributed to symptom resolution.</p>","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemodynamic Instability during Squid Embolization of Dural Arteriovenous Fistula: A Case Report.","authors":"Ehab Mahmoud, Osman Koc, Mostafa Mahmoud","doi":"10.5469/neuroint.2024.00521","DOIUrl":"10.5469/neuroint.2024.00521","url":null,"abstract":"<p><p>There are few documented cases of bradycardia or asystole occurring during Onyx embolization of intracranial dural arteriovenous fistulas (DAVFs), although these events are more commonly observed in open neurosurgical procedures, particularly those involving the skull base. We present a case treated for a ruptured paramedian occipital DAVF. During the administration of Squid into the middle meningeal artery, while balloons were inflated in the large occipital arteries bilaterally to control the flow during embolization of the DAVF, the patient experienced an abrupt episode of sinus bradycardia, which recurred after a second injection of Squid. After temporarily halting the injections and deflating the balloons, a third injection was successfully administered without complications, allowing total exclusion of the fistula.</p>","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":" ","pages":"28-31"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11900288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Steerable Microcatheter Facilitates Navigation through Tortuous Internal Carotid Artery Lesions in Carotid Artery Stenting.","authors":"Shuto Fushimi, Nagatsuki Tomura, Takashi Shuto, Fukutaro Ohgaki, Yoshitaka Nakayama","doi":"10.5469/neuroint.2025.00045","DOIUrl":"10.5469/neuroint.2025.00045","url":null,"abstract":"<p><p>The treatment of carotid stenosis complicated by severe vessel tortuosity can present challenges in distal vessel selection and device delivery. This article reports the use of a steerable microcatheter (SM) for carotid artery stenting (CAS) in such cases. A 67-year-old male with transient lower extremity weakness and bilateral cerebral infarctions was found to have bilateral carotid stenosis. CAS was planned for both carotid arteries due to coronary artery disease. The left carotid artery exhibited severe stenosis with a 90-degree angle between the common and internal carotid artery (ICA). Anticipating difficulty in navigating the device, we used a 2.4 Fr SM. By adjusting the catheter tip to align with the ICA, we successfully guided the wire distally. Following the catheter exchange, a distal protection device was deployed, and CAS was completed successfully. SMs provide exceptional vascular selectivity and support, improving success in complex cases.</p>","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":"20 1","pages":"42-46"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11900281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143502214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Efficacy of Thrombectomy for Distal Medium Vessel Occlusions of the Middle Cerebral Artery.","authors":"Marcel Cedric Berger, Andreas Simgen, Philipp Dietrich, Weis Naziri","doi":"10.5469/neuroint.2024.00500","DOIUrl":"10.5469/neuroint.2024.00500","url":null,"abstract":"<p><strong>Purpose: </strong>Mechanical thrombectomy (MT) for distal medium vessel occlusions (DMVOs) in the middle cerebral artery (MCA) is less established than for large vessel occlusions. This study evaluates the safety and efficacy of MT in DMVOs, comparing it with M1-segment occlusions.</p><p><strong>Materials and methods: </strong>This retrospective study analyzed 218 patients who underwent MT for isolated M1 (n=123) or distal M2+M3 (n=35) occlusions between January 2020 and August 2023. Outcomes included procedural complications, hemorrhagic events, reperfusion rates, and clinical severity and disability at admission and discharge. Multivariate logistic regression identified predictors of favorable outcomes (modified Rankin Scale≤2) at discharge.</p><p><strong>Results: </strong>Median admission National Institutes of Health Stroke Scale (NIHSS) scores were higher in the M1 group (13, interquartile range [IQR]: 8) compared to the distal M2+M3 group (8, IQR: 7; P<0.001), with significant improvements at discharge in both groups (6 [IQR: 8] for M1 and 2.5 [IQR: 5] for M2+M3; P=0.025). Favorable outcomes were more frequent in the M2+M3 group (50.0%) compared to M1 (28.1%; P=0.023). Recanalization rates (modified Thrombolysis in Cerebral Infarction≥2b) were excellent (>90% in both groups; P=0.300). Procedural complications were rare, with vessel perforations occurring infrequently (M1: 1.6%; M2+M3: 2.9%; P=0.531). Symptomatic intracranial hemorrhage rates were similarly low (2.4% vs. 2.9%; P=0.889). Multivariate analysis identified younger age (P=0.045) and lower NIHSS (P=0.061) as predictors of favorable outcomes in distal occlusions.</p><p><strong>Conclusion: </strong>MT is safe and effective for DMVOs of the MCA, demonstrating significant improvements in clinical outcomes and comparable complication rates to MT for M1-segment occlusions. Given the typically less severe presentations in DMVO and similar risk profiles, careful patient selection and individualized treatment remain critical.</p>","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":" ","pages":"15-23"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11900282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}