Neurointervention最新文献

{"title":"Successful Embolization of a Direct Carotid Cavernous Fistula under Gadolinium-Based Angiography.","authors":"Yan-Lin Li, Sandhya Rai, Peter John Cox","doi":"10.5469/neuroint.2024.00213","DOIUrl":"10.5469/neuroint.2024.00213","url":null,"abstract":"<p><p>Endovascular neurointervention is typically performed with iodinated contrast medium (ICM) under fluoroscopy. However, some patients may be contraindicated to such procedures based on their sensitivity to ICM. In this report, we describe a case of successful coil embolization of a direct carotid cavernous fistula using angiography with gadolinium-based contrast agents in a patient with severe allergic reaction to ICM. The clinical decision-making for this patient was further complicated by comorbidities of renal impairment, drug allergies, and previously severe gastrointestinal bleeding.</p>","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11222684/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141301104","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":"Author Correction: In Vitro Head-to-Head Comparison of Flow Reduction between Fibered and Non-Fibered Pushable Coils.","authors":"Jong-Tae Yoon, Boseong Kwon, Joon Ho Choi, Sun Moon Hwang, Mihyeon Kim, Sungbin Hwang, Yunsun Song, Deok Hee Lee","doi":"10.5469/neuroint.2024.00031.e1","DOIUrl":"10.5469/neuroint.2024.00031.e1","url":null,"abstract":"","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11222679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140110888","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":"Endovascular Management of a Ruptured Aneurysm on a Posterior Inferior Cerebellar Artery with Extradural C2-Origin: Case Report and Literature Review.","authors":"Rasmus Holmboe Dahl, Gary Lloyd Horn, Zeyad Metwalli, Shankar Prakash Gopinath, Goetz Benndorf","doi":"10.5469/neuroint.2024.00136","DOIUrl":"10.5469/neuroint.2024.00136","url":null,"abstract":"<p><p>Extracranial vascular pathology uncommonly causes intracranial subarachnoid hemorrhage (SAH). Among possible lesions are aneurysms at the craniocervical junction arising from a posterior inferior cerebellar artery (PICA) with an extradural origin. We describe a case of a 55-year-old female presenting with a sudden and severe headache. A computed tomography scan revealed a SAH within the fourth ventricle and cervical spinal canal, and a ruptured saccular aneurysm on a PICA with extradural C2-origin. Despite difficult access anatomy, endovascular treatment was feasible and resulted in subtotal initial occlusion and preservation of distal PICA flow. Upon 3-month follow-up, the aneurysm was completely occluded with a patent PICA. The patient's clinical status remained stable at the 1.5-year follow-up. In conclusion, we present a rare case of an aneurysm originating from a PICA with extradural C2-origin that was treated endovascularly with preservation of the PICA.</p>","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11222686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140876942","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":"A Case of Severe Delayed Vasospasm after Clipping Surgery for an Unruptured Intracranial Aneurysm.","authors":"Joong-Goo Kim, Chul-Hoo Kang, Jae Jon Sheen, Yunsun Song, Jong-Kook Rhim","doi":"10.5469/neuroint.2024.00150","DOIUrl":"10.5469/neuroint.2024.00150","url":null,"abstract":"<p><p>Delayed ischemic stroke associated with intractable vasospasm after clipping of unruptured intracranial aneurysms (UIAs) has been rarely reported. We report a patient with delayed ischemic stroke associated with intractable vasospasm following UIA clipping. A middle-aged female underwent surgery for unruptured middle cerebral artery bifurcation aneurysms. The patient tolerated the neurosurgical procedure well. Seven days postoperatively, the headache was unbearable; a postcraniotomy headache persisted and abruptly presented with global aphasia and right-sided hemiplegia after a nap. Emergency digital subtraction angiography showed severe luminal narrowing with segmental vasoconstriction, consistent with severe vasospasm. The patient's neurological deficit improved after chemical angioplasty. Neurosurgeons should pay close attention to this treatable/preventive entity after neurological deterioration following UIA clipping, even in patients without subarachnoid hemorrhage.</p>","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11222685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141317851","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":"Treatment of Traumatic Direct Carotid-Cavernous Fistula with a BeGraft-Covered Stent.","authors":"Farid Qoorchi Moheb Seraj, Sajjad Najafi, Amira Al Raaisi, Mohammad Hossein Mirbolouk, Feizollah Ebrahimnia, Hashem Pahlavan Shamsi, Yousef Garivani, Samira Zabihyan, Ashkan Mowla, Humain Baharvahdat","doi":"10.5469/neuroint.2024.00157","DOIUrl":"10.5469/neuroint.2024.00157","url":null,"abstract":"<p><p>The widely accepted option for treating traumatic direct carotid-cavernous fistula (dCCF) has been endovascular treatment using detachable balloons, coils, or embolic agents. Covered stent deployment has been applied by a few operators and has shown promising results. This is a retrospective study on patients with dCCF treated by an endovascular approach using BeGraft, a covered stent. In 4 cases, this device was successfully deployed without any complications. Immediate complete occlusion was achieved in 3 patients (75%) after deployment of the covered stents. One patient required transvenous coiling for occlusion of the remaining endoleak. Follow-up imaging demonstrated 100% fistula occlusion with complete internal carotid artery patency. No early or late complications occurred following treatment. In conclusion, the BeGraft-covered stent could be a promising safe and effective alternative option for the endovascular treatment of dCCF.</p>","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11222683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141160789","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":"Feasibility, Safety, and Efficacy of Endovascular vs. Surgical Treatment of Unruptured Multi-Sac Intracranial Aneurysms in a Single-Center Retrospective Series.","authors":"Lukas Goertz, Marco Timmer, David Zopfs, Kenan Kaya, Carsten Gietzen, Jonathan Kottlors, Lenhard Pennig, Marc Schlamann, Roland Goldbrunner, Gerrit Brinker, Christoph Kabbasch","doi":"10.5469/neuroint.2024.00108","DOIUrl":"10.5469/neuroint.2024.00108","url":null,"abstract":"<p><strong>Purpose: </strong>Multi-sac aneurysms (MSAs) are not uncommon, but studies on their management are scarce. This study aims to evaluate and compare the feasibility, safety, and efficacy of MSAs treated with either clipping or coiling after interdisciplinary case discussion at our center.</p><p><strong>Materials and methods: </strong>We retrospectively analyzed MSAs treated by microsurgical clipping, coiling, or stent-assisted coiling (SAC). Treatment modalities, complications, angiographic results, and clinical outcomes were evaluated. Major neurological events were defined as a safety endpoint and complete occlusion as an efficacy endpoint.</p><p><strong>Results: </strong>Ninety patients (mean age, 53.2±11.0 years; 73 [81.1%] females) with MSAs met our inclusion criteria (clipping, 50; coiling, 19; SAC, 21). Most aneurysms were located in the middle cerebral artery (48.9%). All clipping procedures were technically successful, but endovascular treatment failed in 1 coiling case, and a switch from coiling to SAC was required in 2 cases. The major event rates were 4.0% after clipping (1 major stroke and 1 intracranial hemorrhage) and 0% after endovascular therapy (P=0.667). At mid-term angiographic follow-up (mean 12.0±8.9 months), all 37 followed clipped aneurysms were completely occluded, compared to 8/17 (41.7%) after coiling and 11/15 (73.3%) after SAC (P<0.001). Coiling was significantly associated with incomplete occlusion in the adjusted analysis (odds ratio, 11.7; 95% confidence interval, 2.7-52.6; P=0.001).</p><p><strong>Conclusion: </strong>Both endovascular and surgical treatment were feasible and safe for MSAs. As coiling was associated with comparatively high recanalization rates, endovascular treatment may be preferred with stent support.</p>","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11222680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141331485","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":"Initial Experience with a New Self-Expanding Open-Cell Stent System with Antithrombotic Hydrophilic Polymer Coating (pEGASUS Stent) in the Treatment of Wide-Necked Intracranial Aneurysms.","authors":"F. Boxberg, M. Al-Tibi, K. Schulz, Heinrich Lanfermann, M. Schlunz-Hendann, D. Grieb","doi":"10.5469/neuroint.2024.00066","DOIUrl":"https://doi.org/10.5469/neuroint.2024.00066","url":null,"abstract":"PURPOSE\u0000We report our initial experience with endovascular embolization of intracranial aneurysms using this new self-expanding open-cell stent system (pEGASUS stent system) with the antithrombogenic hydrophilic polymer coating.\u0000\u0000\u0000MATERIALS AND METHODS\u0000We retrospectively reviewed all patients treated with stent-assisted coiling or the Woven EndoBridge device using the pEGASUS stent system between September 2022 and June 2023. Demographic, clinical, and angiographic data were analyzed as well as short-term follow-up, including procedural complication rates and aneurysmal occlusion rates using the Raymond-Roy occlusion classification (RROC).\u0000\u0000\u0000RESULTS\u0000Twelve patients with 12 wide-necked intracranial aneurysms were treated with the pEGASUS stent system, including 2 acutely ruptured aneurysms embolized in an emergency setting. The treated aneurysms were located at the anterior communicating artery (25.0%), the basilar artery (50.0%), the middle cerebral artery (16.7%), and the internal carotid artery (8.3%). All stents were deployed successfully. Immediate complete aneurysmal occlusion (RROC class I) was achieved in 83.3% (10/12) and near-complete occlusion (RROC II) in 16.7% (2/12). No periprocedural complications occurred in patients treated in the elective setting. A single case of intraoperative in-stent thrombus formation occurred during the treatment of an acutely ruptured basilar aneurysm and was resolved with intravenous Tirofiban. No other periprocedural complications occurred. Eleven out of 12 patients were available for follow up (mean 7.4 months). Complete aneurysmal occlusion without in-stent stenosis (ISS) was seen in 10 patients (90.9%). One patient (9.1%) showed aneurysmal reperfusion (RROC IIIb) with asymptomatic moderate ISS.\u0000\u0000\u0000CONCLUSION\u0000Our initial results demonstrate that the pEGASUS stent system appears to be a safe and effective device for stent assisted embolization of wide-necked intracranial aneurysms. More data is necessary to evaluate long-term follow-up.","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140686490","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":"A Novel Training Method for Endovascular Clot Retrieval Using a Portable Vascular Model and Red Film","authors":"Tetsuya Ioku, Tomotaka Ohshima, R. Kawaguchi, N. Matsuo, Shigeru Miyachi","doi":"10.5469/neuroint.2024.00094","DOIUrl":"https://doi.org/10.5469/neuroint.2024.00094","url":null,"abstract":"Hands-on training is a crucial part of education in neuroendovascular treatment to ensure safe and rapid acquisition of techniques. However, there is a significant gap between training and actual clinical practice. This study will introduce innovations for more practical thrombus retrieval training that was developed in this process. A Smart Vascular Model 3 in 1 was used. A pink pseudothrombus was inserted into the M1 (horizontal segment of the middle cerebral artery) section of the model. Then, a “red underlay” purchased at a stationery store was placed to cover the proximal part of M1 and beyond so that the pseudothrombus was not visible. The thrombus was retrieved during training by looking for the location of the thrombus based on the behavior and resistance of the tip of the guidewire and deployment of the stent retriever. The participants were required to have detailed observation skills and precise manipulation skills using a red film to prevent the direct visualization of the pseudothrombus. The implementation of this innovation to the previous hands-on training made the training more practical and effective. If the exact thrombus location can be determined by the behavior of the wire tip, the device’s capabilities can be maximized, and rapid retrieval can be expected. It could also reduce complications, as unnecessary peripheral guidance of the device could be avoided.","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140693706","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":"Assessing Radiation Exposure and Contrast Agent Utilization: A Comparative Analysis of the Woven EndoBridge Device and Stent-Assisted Coil Embolization for Managing Unruptured Wide-Neck Bifurcation Aneurysms.","authors":"J. Baek, H. Jeong, Ji-Yeon Han, Y. Heo, S. Yun, W. Lee, S. Kim","doi":"10.5469/neuroint.2024.00143","DOIUrl":"https://doi.org/10.5469/neuroint.2024.00143","url":null,"abstract":"PURPOSE\u0000In this study, we determined whether there were significant differences in procedure time, radiation dose, fluoroscopy time, and total contrast media dose when unruptured wideneck bifurcation aneurysms (WNBAs) were treated with the Woven EndoBridge (WEB) device and stent-assisted coil (SAC) embolization.\u0000\u0000\u0000MATERIALS AND METHODS\u0000The WEB device and SAC embolization (14:17) were used to treat 31 cases of internal carotid artery bifurcation, anterior communicating artery, middle cerebral artery bifurcation, and basilar bifurcation aneurysms between August 2021 and December 2022. The procedure time, radiation dose, fluoroscopy time, and total contrast medium dose between the 2 treatment groups were compared and analyzed. In the WEB device group, the results between operators were compared, and the follow-up radiologic outcomes were investigated.\u0000\u0000\u0000RESULTS\u0000The procedure and fluoroscopy times were significantly shorter in the WEB device group. Radiation and total contrast media dose were also significantly smaller in the WEB device, but there was no significant difference in results between operators. The follow-up radiological outcome showed adequate occlusion in 83.3% (10/12) of cases.\u0000\u0000\u0000CONCLUSION\u0000The WEB device can be used as an alternative treatment method among the available endovascular treatment methods for WNBAs to reduce radiation exposure and the dose of contrast media when used adequately with appropriate indications.","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140703941","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":"Traditional Thrombus Composition and Related Endovascular Outcomes: Catching up with the Recent Evidence.","authors":"Jang-Hyun Baek","doi":"10.5469/neuroint.2024.00087","DOIUrl":"https://doi.org/10.5469/neuroint.2024.00087","url":null,"abstract":"Endovascular thrombectomy is the primary treatment for acute intracranial vessel occlusion and significantly improves recanalization success rate. However, achieving optimal recanalization remains a challenge. The histopathological components of thrombus composition play a crucial role in determining endovascular outcomes. This review aimed to consolidate the recent evidence on the impact of thrombus composition on mechanical properties and endovascular outcomes. The relationship between thrombus composition and mechanical properties was significant, with fibrin and/or platelet-rich thrombi being stiff, tough, elastic, and less deformable; fibrin-rich thrombi were sticky and had higher friction with the vessel wall. Erythrocyte composition was positively associated with successful recanalization, whereas lower platelet composition was associated with specific outcomes, such as the first-pass effect and complete recanalization. The number of thrombectomy device passes was possibly related to erythrocyte, platelet, and fibrin composition, with a smaller number of passes associated with erythrocyte-rich thrombi. Procedural time was consistently related to thrombus composition, with shorter times observed for erythrocyte-rich thrombi. The relationship between thrombus composition and secondary embolism remains inconclusive. Understanding the role of thrombus composition in endovascular outcomes is crucial to optimize stroke treatment. Although evidence suggests a link between thrombus composition and mechanical properties, further research is needed to establish stronger correlations and to reduce study variations. Exploring non-traditional thrombus components such as leukocytes and neutrophil extracellular traps is vital. Thrombus imaging could provide a practical solution for predicting thrombus composition before endovascular procedures. This review highlights the importance of thrombus composition for enhancing endovascular stroke treatment strategies.","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140742724","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}