Neurointervention最新文献

{"title":"Technical Feasibility and Efficacy of Flow-Guided Microcatheter Delivery of i-ED Coils for Parent Artery Occlusion in Posterior Fossa Peripheral Aneurysms.","authors":"Hiroki Takahashi, Toshinori Matsushige, Masahiro Hosogai, Shinichiro Oku, Nobutaka Horie","doi":"10.5469/neuroint.2025.00521","DOIUrl":"10.5469/neuroint.2025.00521","url":null,"abstract":"<p><p>Peripheral aneurysms in the posterior circulation are rare vascular pathologies and their treatment remains challenging. Microsurgical procedures for these aneurysms are complex, lengthy, and highly invasive. Endovascular parent artery occlusion could be considered as an alternative treatment of choice; however, it is inherently challenging due to the small vessel caliber and fine manipulation required. Small bore flow-guided microcatheters (1.5 Fr) with high peripheral accessibility are currently available, whereas compatible coils remain limited. The brand-new i-ED coils can be compatible with these microcatheters. We herein present our patient series of peripheral aneurysms in the posterior fossa that were treated endovascularly, and discuss key technical tips and potential pitfalls.</p>","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":" ","pages":"169-174"},"PeriodicalIF":1.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12585934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144962558","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":"Flow Diversion for Intracranial Aneurysms in Patients with Hematologic Disorders.","authors":"Isabelle Pelcher, Cassidy Werner, Daniel G Lynch, Jared B Bassett, Ina Teron, Kevin A Shah, Amir R Dehdashti, Thomas Link, Athos Patsalides, Henry H Woo, Timothy G White","doi":"10.5469/neuroint.2025.00752","DOIUrl":"10.5469/neuroint.2025.00752","url":null,"abstract":"<p><strong>Purpose: </strong>Flow diverting stents are a mainstay treatment of intracranial aneurysms (IA). They rely on reduction of intra-aneurysmal blood flow velocity along with endothelialization to induce thrombus formation and promote occlusion. Patients with hematologic disorders (HDs) can have abnormal fluid dynamics and blood cell/metal interactions that can affect the mechanism of action of flow diversion (FD). We sought to determine the outcomes of patients with various HD after receiving FD treatment for IA.</p><p><strong>Materials and methods: </strong>This retrospective chart review examined 11 patients with various HD who received FD for their IAs. HD were classified as either coagulopathies (e.g., factor deficiencies, von Willebrand disease) or hemoglobinopathies (e.g., sickle cell disease [SCD]). Patient outcomes were assessed clinically and radiographically, with radiographic outcomes based on O'Kelly-Marotta (OKM) scores from follow-up angiograms.</p><p><strong>Results: </strong>The total sample included 11 patients with 29 IAs. The median age was 50 years and 81.8% were female. All patients were on pre-procedural dual antiplatelet therapy. Out of the 29 total aneurysms, 17 were treated with FD and 15 originated from the paraophthalmic segment. Seven patients received surface modified stents. The median number of deployed stents during initial treatment was 2. The average aneurysm diameter was 5.03 mm (standard deviation: 3.88 mm). Patients with SCD were the only group to experience complications, with 2 out of 3 patients suffering a post-operative stroke. Seven patients with 8 treated aneurysms experienced complete occlusion at last follow-up with a mean time to OKMD score of 16.8 months.</p><p><strong>Conclusion: </strong>Despite a small sample size, this series raises concern for the use of FD in patients with SCD. While FD still resulted in adequate rates of aneurysm occlusion, treatment methodology must be tailored for patients with HD.</p>","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":" ","pages":"140-149"},"PeriodicalIF":1.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12585936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145377946","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":"The Woven EndoBridge for Wide-Neck Bifurcation Aneurysms: A Retrospective Study of 120 Cases with Expanded Indications Covering All Subtypes.","authors":"Jun Tanabe, Ichiro Nakahara, Shoji Matsumoto, Jun Morioka, Tetsuya Hashimoto, Akiko Hasebe, Sadayoshi Watanabe, Kenichiro Suyama, Takeya Suzuki, Junpei Koge","doi":"10.5469/neuroint.2025.00297","DOIUrl":"10.5469/neuroint.2025.00297","url":null,"abstract":"<p><strong>Purpose: </strong>The Woven EndoBridge (WEB) was introduced in Japan in January 2021 and approved for all subtypes of wide-neck bifurcation aneurysms (WNBA). This retrospective study evaluated the safety and efficacy of the WEB device for all subtypes of WNBA.</p><p><strong>Materials and methods: </strong>All patients treated with the WEB at our facility between January 2021 and May 2024 was reviewed. We selected the WEB device according to an oversizing policy, based on cumulative clinical evidence from global experience.</p><p><strong>Results: </strong>We analyzed 120 aneurysms in 117 patients (56 males and 61 females with a mean age of 65.5±12.7 years). There were 45 anterior communicating artery aneurysms, 27 middle cerebral artery aneurysms, 17 internal carotid artery-posterior communicating artery aneurysms, 15 basilar artery top aneurysms, and 16 aneurysms in other locations. Aneurysm characteristics included a maximum diameter of 6.5 [5.3, 7.7] mm, height of 4.9 [3.9, 6.0] mm, width of 4.8 [4.0, 6.2] mm, and dome/neck ratio of 1.2 [1.1, 1.4]. All data are expressed in median [interquartile range]. Angiographic follow-up at 12 months in 96 cases showed complete obliteration in 68.8% and adequate obliteration in 90.6% of cases. Intraoperative ischemic events occurred in 5 cases (4.2%). Hemorrhagic events occurred in 2 cases (1.7%), with symptoms resolving by discharge, except for 1 case of mild paralysis. During follow-up, 1 patient developed a major stroke, resulting in morbidity (0.8%). Retreatment was required in 3 cases (2.5%). On multivariate analysis for complete occlusion at 12 months following WEB treatment, age was statistically associated with the outcome (odds ratio, 0.957 per year; 95% confidence interval, 0.919-0.996; P=0.033).</p><p><strong>Conclusion: </strong>WEB is safe and effective for all subtypes of WNBA, with a low retreatment rate using an oversizing policy. This is the first report in a Japanese population.</p>","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":" ","pages":"150-159"},"PeriodicalIF":1.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12585930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144507099","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":"Silent Threats: Asymptomatic Re-Thrombosis in Carotid Web and the Window for Preventive Intervention.","authors":"Pablo Ros-Arlanzón, Diego José Corona-García, Manuel Dieter Warnken-Miralles, Elisa Ginés-Murcia, Luis Moreno-Navarro, Raquel Hernández-Lorid, Isabel Beltrán-Blasco, Nicolás López-Hernández","doi":"10.5469/neuroint.2025.00682","DOIUrl":"10.5469/neuroint.2025.00682","url":null,"abstract":"<p><strong>Purpose: </strong>Carotid web (CW) is an underrecognized cause of recurrent ischemic stroke in young patients with cryptogenic stroke, and its optimal management remains uncertain. This study aimed to determine the recurrence of ischemic events and the incidence of asymptomatic thrombus formation in CW, in order to optimize secondary prevention strategies.</p><p><strong>Materials and methods: </strong>We conducted a retrospective analysis of patients diagnosed with CW at a comprehensive stroke center in Spain between January 2021 and December 2024. CW was identified via computed tomography angiography or digital subtraction angiography. We assessed stroke recurrence, asymptomatic thrombus formation, and secondary prevention strategies. Early duplex sonography was systematically performed during hospitalization to detect in-hospital re-thrombosis.</p><p><strong>Results: </strong>Among 23 patients with CW-related ischemic stroke, 2 (8.7%) experienced recurrent ipsilateral stroke. Notably 4 (17.4%) patients exhibited thrombus formation within the CW, 3 of them while still hospitalized, detected through early duplex sonography. These findings, which preceded any clinical recurrence, prompted timely anatomical correction via stenting or endarterectomy, with no further events observed. All patients with clinical or radiologic recurrence (n=6) underwent either carotid stenting (n=4) or endarterectomy (n=2), after which no further ischemic events were observed.</p><p><strong>Conclusion: </strong>CW carries a substantial risk of early thrombus formation and recurrent ischemic stroke. Routine early neurosonologic monitoring during hospitalization can detect in-hospital re-thrombosis and enable timely intervention with stenting or endarterectomy, which appears effective in preventing recurrence.</p>","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":" ","pages":"122-129"},"PeriodicalIF":1.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12585938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207032","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":"Thrombectomy for Distal Medium Vessel Occlusions:Lessons from Recent Trials and Emerging Strategies.","authors":"Kwon-Duk Seo","doi":"10.5469/neuroint.2025.00836","DOIUrl":"10.5469/neuroint.2025.00836","url":null,"abstract":"<p><p>Recent randomized controlled trials (EndovaSCular TreAtment to imProve outcomEs for Medium Vessel Occlusions, EnDovascular therapy plus best medical treatment [BMT] versus BMT alone for MedIum VeSsel Occlusion sTroke, and Evaluation of Mechanical Thrombectomy in Acute Ischemic Stroke Related to a Distal Arterial Occlusion) have not demonstrated a clinical benefit of thrombectomy for distal medium vessel occlusions (DMVOs), in contrast to the proven efficacy for large vessel occlusions. Trial populations mainly included elderly patients with mild neurological deficits, which may explain the limited benefit and increased risk of complications. Importantly, Asian patients were not represented, despite regional cohorts showing distinct outcomes influenced by older age and a higher prevalence of intracranial atherosclerosis. Emerging device innovations and adjunctive strategies hold promise, but optimal patient selection remains crucial to defining the role of DMVO thrombectomy.</p>","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":" ","pages":"119-121"},"PeriodicalIF":1.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12585937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145286531","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":"Axillary Artery Access for Neuroendovascular Procedures in Infants: Where to Go When Femoral Puncture Fails?","authors":"João Victor Sanders, Krishna Joshi, Marion Oliver, Demetrius Lopes","doi":"10.5469/neuroint.2025.00388","DOIUrl":"10.5469/neuroint.2025.00388","url":null,"abstract":"<p><p>The femoral artery approach is the primary neuroendovascular access in pediatric patients. However, alternative access sites are sometimes essential. We present the first report of axillary arterial access for neuroendovascular intervention in an infant, and a literature review on pediatric access routes. We present a case of a neonate diagnosed with vein of Galen malformation, with failed canulation of the femoral artery. A right axillary artery access was successfully employed for the intervention. The patient showed improvement and no complications. We demonstrate the feasibility of axillary artery access for neuroendovascular intervention, which may be an alternative for similar challenging cases.</p>","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":" ","pages":"180-184"},"PeriodicalIF":1.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12585931/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144541473","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":"Infarct Location Matters: Basal Ganglia Involvement Predicts Poor Outcomes despite Successful Endovascular Thrombectomy in Large Vessel Occlusion Stroke.","authors":"Chang Hun Kim, Jongsoo Kang, Soo-Kyoung Kim, Dae Seob Choi, Nack-Cheon Choi","doi":"10.5469/neuroint.2025.00465","DOIUrl":"10.5469/neuroint.2025.00465","url":null,"abstract":"<p><strong>Purpose: </strong>Infarct location may significantly influence clinical outcomes in patients with acute ischemic stroke (AIS) treated with endovascular thrombectomy (EVT). This study aimed to investigate the impact of basal ganglia (BG) infarction on outcomes in AIS patients with large vessel occlusion (LVO) who achieved successful recanalization.</p><p><strong>Materials and methods: </strong>We retrospectively analyzed consecutive AIS patients who underwent EVT at our center between March 2016 and January 2019. Patients with LVO who achieved successful recanalization (modified Thrombolysis in Cerebral Infarction ≥2b) were included. Preprocedural diffusion-weighted imaging (DWI) was used to identify BG infarction. Poor outcome was defined as a 3-month modified Rankin Scale score of 3-6. Multivariate logistic regression analysis was performed to identify independent predictors of poor outcome.</p><p><strong>Results: </strong>A total of 222 patients were included, of whom 160 (72.1%) had BG infarction. Independent predictors of poor outcome included older age (odds ratio [OR], 1.10; P<0.001), higher National Institute of Health Stroke Scale scores (OR, 1.20; P<0.001), lower DWI-Alberta Stroke Program Early Computed Tomography Scores (OR, 0.79; P=0.009), hemorrhagic transformation (OR, 2.97; P=0.031), and BG infarction (OR, 4.14; P=0.002).</p><p><strong>Conclusion: </strong>BG infarction was independently associated with poor outcome despite successful recanalization. These findings underscore the prognostic importance of infarct location and support the need for tailored treatment strategies in AIS patients with BG involvement.</p>","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":" ","pages":"130-139"},"PeriodicalIF":1.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12585933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144690993","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":"Outcome Analysis and Early Concept Development to Identify the Most Suitable Woven EndoBridge Size Based on Various Shapes of Cerebral Aneurysms.","authors":"Dae Chul Suh, Kang Jun Yoon","doi":"10.5469/neuroint.2025.00556","DOIUrl":"10.5469/neuroint.2025.00556","url":null,"abstract":"<p><strong>Purpose: </strong>The selection of the appropriate Woven EndoBridge (WEB) size is the most critical aspect of the decision-making process in aneurysm WEB embolization. However, there are currently no precise criteria for measuring WEB size that correspond to each aneurysm. This study presents a process that includes a WEB index for determining the exact volume based on various aneurysm shape types.</p><p><strong>Materials and methods: </strong>Sixty consecutive aneurysms treated with WEB device were included. The volume measurements of the aneurysms, based on their column configurations, were compared with WEB volume to assess the accuracy of the fit within each aneurysm. After categorizing the aneurysms into symmetric and asymmetric shapes, they were further classified into 5 types according to their configurations. We estimated outcomes, including any events or recurrences, and calculated WEB index (WEB volume/aneurysm volume) along with the median and interquartile range to evaluate differences based on shape type. A statistical analysis was conducted to identify associations between various variables and stenting and/or recurrence.</p><p><strong>Results: </strong>Symmetric aneurysms (n=39, 65%) were more prevalent than asymmetric aneurysms (n=21, 35%). Among the 5 shape types, the column shape was the most common (n=32, 53%), followed by submarine (n=9, 15%), sphere (n=7, 12%), boots (n=6, 10%), and mitten (n=6, 10%) shapes. The median WEB index was 0.96. Asymmetric aneurysm shapes were associated with stent-assisted procedures (oversizing) (P=0.029) and the presence of sac remnants or recurrence (undersizing) (P=0.033). There were no adverse events reported, except for 1 non-procedure-related death at 7 months and 2 retreatments among 3 recurred aneurysms during a mean magnetic resonance angiography follow-up of 8 months (range, 3-21 months) and a mean clinical follow-up of 12 months (range, 3-30 months).</p><p><strong>Conclusion: </strong>Outcome of WEB embolization depended on aneurysm configuration (shape types) and the measurement of aneurysm volume (WEB index).</p>","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":" ","pages":"160-168"},"PeriodicalIF":1.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12585935/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144962600","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":"Striving to Improve Image Quality and Minimize Radiation Dose in Neurointerventional Procedures.","authors":"Sang Hyun Suh","doi":"10.5469/neuroint.2025.00311","DOIUrl":"10.5469/neuroint.2025.00311","url":null,"abstract":"","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":" ","pages":"49-51"},"PeriodicalIF":1.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12183362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973062","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":"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":"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":"89-93"},"PeriodicalIF":1.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12183366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144079270","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}