Neurointervention最新文献

{"title":"AXS Vecta 0.071-0.074 Inch Aspiration Catheters for Mechanical Thrombectomy: Case Series and Literature Review.","authors":"Fabio Settecase,&nbsp;Warren T Kim,&nbsp;Joey D English","doi":"10.5469/neuroint.2022.00283","DOIUrl":"https://doi.org/10.5469/neuroint.2022.00283","url":null,"abstract":"<p><p>Aspiration catheters are widely used for thrombectomy either alone or in combination with a stent-retriever, with a distal inner diameter and trackability keys to their success. In an illustrative case series, we report our clinical experience with AXS Vecta (Stryker Neurovascular, Fremont, CA, USA), available in both 0.071-inch and 0.074-inch distal inner diameters, including the first 2 Vecta 74 cases reported. A literature review on AXS Vecta is also provided. In our series, 9 thrombectomies were performed (Vecta 71: 2 M1, 5 M2 occlusions; Vecta 74: 1 M1 and 1 ICA-terminus occlusion). The AXS Vecta was successfully delivered to the target site in all cases. In 7 of 9 cases, the catheter was delivered over a Tenzing 7 delivery catheter (Route 92 Medical, San Mateo, CA, USA). For 2 of 9 combination approach cases, Vecta was delivered using the stent-retriever wire as a rail. The median improvement in NIHSS score during hospitalization was 9 (IQR 5-12). Successful mTICI 2C or 3 recanalization was achieved in 8 of 9 (89%) patients after a median 2 (IQR 1-2) passes. Our median groin-to-reperfusion time was 23 (IQR 12.5-32) minutes, with no procedural complications. Two previous clinical studies of a total of 29 patients treated with Vecta 71 reported successful mTICI 2b-3 recanalization in 89-90% of cases. The Median groin-to-reperfusion time was 30 minutes. Complications were seen in 2 of 29 (6.9%) cases (vessel perforation and/or intracerebral hemorrhage). These data support the efficacy, deliverability, and safety of AXS Vecta for mechanical thrombectomy.</p>","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":"18 1","pages":"47-57"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b5/6f/neuroint-2022-00283.PMC9986352.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10850098","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":"Carotid Artery Stenting for Asymptomatic Carotid Stenosis: What We Need to Know for Treatment Decision.","authors":"Jang-Hyun Baek","doi":"10.5469/neuroint.2023.00031","DOIUrl":"https://doi.org/10.5469/neuroint.2023.00031","url":null,"abstract":"<p><p>A clinical decision on the treatment of asymptomatic carotid stenosis is challenging, unlike symptomatic carotid stenosis. Carotid artery stenting (CAS) has been recommended as an alternative to carotid endarterectomy (CEA) based on the finding that the efficacy and safety of CAS were comparable to CEA in randomized trials. However, in some countries, CAS is often performed more frequently than CEA for asymptomatic carotid stenosis. Moreover, it has been recently reported that CAS is not superior to the best medical treatment in asymptomatic carotid stenosis. Due to these recent changes, the role of CAS in asymptomatic carotid stenosis should be revisited. When determining the treatment for asymptomatic carotid stenosis, one should consider several clinical factors including stenosis degree, patient life expectancy, stroke risk by medical treatment, availability of a vascular surgeon, high risk for CEA or CAS, and insurance coverage. This review aimed to present and pragmatically organize the information that is necessary for a clinical decision on CAS in asymptomatic carotid stenosis. In conclusion, although the traditional benefit of CAS is being revisited recently, it seems too early to conclude that CAS is no longer beneficial under intense and systemic medical treatment. Instead, a treatment strategy with CAS should evolve to select eligible or medically high-risk patients more precisely.</p>","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":"18 1","pages":"9-22"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/96/e0/neuroint-2023-00031.PMC9986346.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10856162","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":"Strong Contrast Stagnation of Unilateral Vertebral Artery on Three-Dimensional Black Blood-Enhanced MRI Predicts Acute Medulla Infarction.","authors":"Seong Min Cho,&nbsp;Suh Yeon Park,&nbsp;Hyo Sung Kwak,&nbsp;Seung Bae Hwang","doi":"10.5469/neuroint.2023.00017","DOIUrl":"https://doi.org/10.5469/neuroint.2023.00017","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate angiographic and contrast enhancement (CE) patterns on three-dimensional (3D) black blood (BB) contrast-enhanced MRI in patients with acute medulla infarction.</p><p><strong>Materials and methods: </strong>From January 2020 to August 2021, we retrospectively analyzed stroke 3D BB contrast-enhanced magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) findings of patients visiting the emergency room for symptom evaluation of acute medulla infarction. In total, 28 patients with acute medulla infarction were enrolled in this study. Four types of 3D BB contrast-enhanced MRI and MRA were classified as follows: 1=unilateral contrast-enhanced vertebral artery (VA)+no visualization of VA on MRA; 2=unilateral enhanced VA+hypoplastic VA; 3=no enhanced VA+unilateral complete occlusion of VA; 4=no enhanced VA+normal VA (including hypoplasia) on MRA.</p><p><strong>Results: </strong>Of the 28 patients with acute medulla infarction, 7 (25.0%) showed delayed positive findings after 24 hours on diffusion-weighted imaging (DWI). Of these patients, 19 (67.9%) showed CE of the unilateral VA on 3D BB contrast-enhanced MRI (type 1 and 2). Of the 19 patients with CE of VA on 3D BB contrast-enhanced MRI, 18 showed no visualization of enhanced VA on MRA (type 1), and 1 showed hypoplastic VA. Of the 7 patients with delayed positive findings on DWI, 5 showed CE of the unilateral VA and no visualization of the enhanced VA on MRA (type 1). Symptom onset to door time or initial MR check time was significantly shorter in the groups with delayed positive findings on DWI (P<0.05).</p><p><strong>Conclusion: </strong>Unilateral CE on 3D BB contrast-enhanced MRI and no visualization of the VA on MRA are related to the recent occlusion of the distal VA. These findings suggest that the recent occlusion of the distal VA is related to acute medulla infarction, including delayed visualization on DWI.</p>","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":"18 1","pages":"38-46"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/79/04/neuroint-2023-00017.PMC9986345.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10856163","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":"Thanks to the Reviewers of the Neurointervention.","authors":"Sang Hyun Suh","doi":"10.5469/neuroint.2022.00472","DOIUrl":"https://doi.org/10.5469/neuroint.2022.00472","url":null,"abstract":"","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":"18 1","pages":"1"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10794538","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":"Fracture of a Flow Diverter in the Cervical Internal Carotid Artery Due to Eagle Syndrome.","authors":"Johannes A R Pfaff,&nbsp;Friedrich Weymayr,&nbsp;Monika Killer-Oberpflazer","doi":"10.5469/neuroint.2022.00409","DOIUrl":"https://doi.org/10.5469/neuroint.2022.00409","url":null,"abstract":"<p><p>In Eagle syndrome, elongated styloid processes may provoke internal carotid dissection and pseudoaneurysm causing stroke and data regarding possible complications or long-term results of pseudoaneurysm treatment using a flow diverter are limited. We report a case of a dissection-related pseudoaneurysm in the left cervical carotid artery treated by implantation of a flow diverter. Follow-up imaging of the flow diverter showed fracture of a continuous radiopaque marker at 3 months and fracture of a second continuous radiopaque marker at 7 months, while contrasting of the vessel was preserved. At the time of angiographic control (8 months after implantation), the flow diverter and the extracranial left internal carotid artery were occluded, and the patient did not experience any symptoms throughout the period.</p>","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":"18 1","pages":"72-75"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/51/e8/neuroint-2022-00409.PMC9986348.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10856856","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":"Fully Reversible Contrast-Induced Encephalopathy Mimicking Stroke after Flow Diverter Treatment of Carotid Cave Aneurysm.","authors":"Elie Diamandis,&nbsp;Vanessa M Swiatek,&nbsp;Daniel Behme","doi":"10.5469/neuroint.2022.00353","DOIUrl":"https://doi.org/10.5469/neuroint.2022.00353","url":null,"abstract":"<p><p>Contrast-induced encephalopathy (CIE) is a rare complication of coronary and neurointerventional procedures. The condition is believed to arise from endothelial damage secondary to exposure to iodinated contrast media. A wide spectrum of clinical manifestations has been reported including seizures, cortical blindness, and focal neurological deficits. This report details the case of fully reversible CIE mimicking severe anterior circulation stroke in a 55-year-old female following elective endovascular treatment with a flow diverter of a carotid cave aneurysm. The patient was managed conservatively with intravenous hydration and steroids and showed an excellent prognosis with supportive management.</p>","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":"18 1","pages":"58-62"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3c/2d/neuroint-2022-00353.PMC9986354.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9417547","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":"PHIL and Squid Embolization of Cerebral Arteriovenous Malformation: A Retrospective Case Series of 23 Patients.","authors":"Eric Yuk Hong Cheung,&nbsp;Rebecca Yuen Ting Ng,&nbsp;Simon Chun Ho Yu,&nbsp;James Tin Fong Zhuang,&nbsp;George Kwok Chu Wong","doi":"10.5469/neuroint.2022.00199","DOIUrl":"https://doi.org/10.5469/neuroint.2022.00199","url":null,"abstract":"<p><p>Precipitating hydrophobic injectable liquid (PHIL; MicroVention, Aliso Viejo, CA, USA) and Squid (Balt, Irvine, CA, USA) are 2 newer liquid embolic agents used in endovascular embolization of cerebral arteriovenous malformation (AVM). This study aims to investigate and compare the effectiveness and safety profile of the 2 newer liquid embolic agents in the embolization of cerebral AVM. This is a retrospective study on all patients diagnosed with cerebral AVM undergoing endovascular embolization with liquid embolic agents PHIL and Squid admitted to the Division of Neurosurgery, Department of Surgery in Prince of Wales Hospital from January 2014 to June 2021. Twenty-three patients with cerebral AVM were treated with 34 sessions of endovascular embolization with either PHIL or Squid (17 sessions each) liquid embolic agents with a male to female ratio of 2.3:1 (male 16; female 7) and mean age of 44.6 (range, 12 to 67). The mean total nidus obliteration rate per session was 57% (range, 5% to 100%). Twenty-one patients (91.3%) received further embolization, stereotactic radiosurgery, or surgical excision after initial endovascular embolization. There were 2 morbidities (1 neurological and 1 non-neurological, 6%) and no mortalities (0%). All patients had static or improvement in modified Rankin Scale at 3 to 6 months at discharge. PHIL and Squid are effective and safe liquid embolic agents for endovascular embolization of cerebral AVM, achieving satisfactory nidal obliteration rates and patient functional outcomes.</p>","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":"17 3","pages":"174-182"},"PeriodicalIF":0.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/99/ba/neuroint-2022-00199.PMC9626609.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33448237","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":"Intracranial Artery Stenosis in Young Men Related to Habitual Periodic Cigarette Smoking in a Closed Space: Could It Be a New Syndrome?","authors":"Dae Chul Suh","doi":"10.5469/neuroint.2022.00290","DOIUrl":"https://doi.org/10.5469/neuroint.2022.00290","url":null,"abstract":"Cerebrovascular disease (stroke) is decreasing in tendency and is the 4th leading cause of death in 2020 in Korea, after cancer, cardiac disease, and pneumonia, which are all increasing in tendency. Racial differences between Asians and Caucasians have been suggested to explain the distribution of cerebral atherosclerosis. Angiographic and autopsy studies in stroke patients have shown that Asians tend to have more intracranial vascular occlusions, whereas whites tend to have more extracranial lesions. This difference tends to be more definite and statistically significant when a single severe stenosis is present. Cigarette smoking (CS) is a major risk factor for cerebral atherosclerotic disease. Intracranial atherosclerotic stenosis is thought to be more prevalent among young smokers with angiographically-confirmed symptomatic severe atherosclerotic stenosis. The overall smoking rate in Korea was 20.6% in 2020 and has continuously decreased in tendency year by year. Males showed a much higher rate of 34.0% than females (6.6%) in 2020. Younger males with 19–49 years of age showed a higher smoking rate, revealing that the forties showed the highest smoking rate, and then a decreasing tendency in even older males. A study in healthy young men showed a significant decrease in cerebral flow rate after CS, especially in the anterior circulation. Considering the changes in flow velocity and cross-sectional area in cerebral arteries, it could be suggested that cerebrovascular impedance increased after CS, especially at the main trunk level of the distal intracranial vessels. A single intracranial artery stenosis, especially in M1 segment, has been found in the relatively young males who have been exposed to a habitual and periodic heavy smoking atmosphere in a closed space. Those patients could not reveal any other specific risk factors for atherosclerosis except smoking. Habitual and periodic smoking in a closed room is often related to gambling once or twice a month, night duty at work, or overnight condolences for the deceased as with a traditional Korean funeral process (Fig. 1). Such intracranial stenotic lesions may improve after proper medication, including antiplatelet agents or even angioplasty, without requiring intracranial stenting, which was a relatively common procedure in Korea.","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":" ","pages":"131-132"},"PeriodicalIF":0.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6b/2b/neuroint-2022-00290.PMC9626614.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40539227","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":"Double-Balloon-Assisted Coiling for Wide-Necked Posterior Communicating Artery Aneurysms with a Fetal-Type Variant of the Posterior Cerebral Artery: A Case Series.","authors":"Yasuhiko Nariai,&nbsp;Tomoji Takigawa,&nbsp;Akio Hyodo,&nbsp;Kensuke Suzuki","doi":"10.5469/neuroint.2022.00276","DOIUrl":"https://doi.org/10.5469/neuroint.2022.00276","url":null,"abstract":"<p><p>Endovascular treatment for wide-necked posterior communicating artery (PcomA) aneurysms with a fetal-type variant of the posterior cerebral artery (PCA) is often challenging. Since the complete occlusion rates achieved with the currently available treatment methods are unsatisfactory, we aimed to study the effectiveness of a double-balloon-assisted technique for these aneurysms. From September 2014 to August 2020, 6 consecutive patients with PcomA aneurysms with fetal-type PCAs and no previous treatment were treated with this technique at our institution (3 ruptured cases and 3 unruptured cases). The indication for this technique is that the neck of the aneurysm should significantly and broadly incorporate both the internal carotid artery and fetal-type PCA, such that a single-balloon remodeling and single stent would be inadequate to protect both the arteries. In all patients, the fetal-type PCAs were preserved without a stent and with adequate occlusion status. This double-balloon technique can be effective in the treatment of these aneurysms.</p>","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":" ","pages":"183-189"},"PeriodicalIF":0.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/16/a1/neuroint-2022-00276.PMC9626608.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40333790","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 Treatment of Arterial Steno-Occlusive Lesions in Symptomatic Moyamoya Disease.","authors":"Jae-Chan Ryu,&nbsp;Yun Hyeok Choi,&nbsp;Mi Hyeon Kim,&nbsp;Eun Ji Moon,&nbsp;Youngjin Kim,&nbsp;Boseong Kwon,&nbsp;Yunsun Song,&nbsp;Deok Hee Lee","doi":"10.5469/neuroint.2022.00332","DOIUrl":"https://doi.org/10.5469/neuroint.2022.00332","url":null,"abstract":"<p><p>The efficacy and safety of endovascular treatment (EVT) for moyamoya disease (MMD) have rarely been investigated. The objective of this study was to summarize the clinical outcomes of EVT for MMD and determine the potential role of EVT in treating symptomatic steno-occlusive lesions in MMD. Reports from January 2000 to December 2021 describing EVT in MMD were collected through a literature search. The search terms included \"moyamoya\", \"stent\", \"angioplasty\", and \"endovascular\". Data regarding baseline demographics, previous medical history, treated vessel, periprocedural complications, and angiographical recurrence were retrieved. This review included 10 studies with details of 19 patients undergoing a total of 31 EVT procedures. Twenty-one EVTs were performed as initial treatments for MMD, and 10 were performed as additional treatments for angiographical recurrence. The mean follow-up period of the initial EVTs was 9.0±11.9 months, with angiographical recurrence in 11 (68.8%) cases. The mean follow-up period of additional EVTs was 4.3±3.9 months, and seven (70.0%) EVTs showed restenosis of the re-treated vessel. Across all initial and additional EVTs, there were no differences in characteristics between the recurrence and non-recurrence groups. Overall, two periprocedural complications (9.5%) occurred, one vessel rupture and one massive intracerebral hemorrhage with subarachnoid hemorrhage. EVT plays a limited role in the management of symptomatic intracranial arterial steno-occlusive lesions of MMD. Recent advances in understanding the pathomechanism of MMD may urge neuro-interventionists to find a new endovascular approach with better balloon angioplasty or stenting mechanisms.</p>","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":"17 3","pages":"161-167"},"PeriodicalIF":0.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e1/d5/neuroint-2022-00332.PMC9626607.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33500995","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}