Neurointervention最新文献

{"title":"Endovascular Treatment May Be Effective in Preventing Recurrence of Ischemic Stroke in Vertebral Artery Stump Syndrome: A Case Series.","authors":"Ryo Sakisuka, Takumi Morita, Yuya Tanaka, Shinya Hori, Daisuke Shimo, Naoki Hashimura, Takahiro Kuroyama, Yasushi Ueno","doi":"10.5469/neuroint.2023.00416","DOIUrl":"10.5469/neuroint.2023.00416","url":null,"abstract":"<p><p>Vertebral artery stump syndrome (VASS) is a rare condition that can cause posterior circulation ischemic stroke due to occlusion of the ipsilateral vertebral artery (VA) orifice, resulting in blood flow stagnation and embolus formation. Although there is no established treatment for this condition, we observed 3 cases of VASS out of 326 acute ischemic stroke cases at a single institution from April 2021 to October 2022. Despite the best possible antithrombotic treatment, all 3 patients had recurrent ischemic strokes. One patient underwent drug-eluting stenting of the VA orifice to relieve occlusive flow. The other 2 patients received coil embolization, which resulted in the disappearance of their culprit collateral flow. None of the patients had recurrent ischemic strokes after endovascular intervention. Based on our observations, stenting and coil embolization are effective methods for preventing future recurrences of VASS.</p>","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":" ","pages":"45-51"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10910182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72014916","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":"Application of Artificial Intelligence in Acute Ischemic Stroke: A Scoping Review.","authors":"JoonNyung Heo","doi":"10.5469/neuroint.2025.00052","DOIUrl":"10.5469/neuroint.2025.00052","url":null,"abstract":"<p><p>Artificial intelligence (AI) is revolutionizing stroke care by enhancing diagnosis, treatment, and outcome prediction. This review examines 505 original studies on AI applications in ischemic stroke, categorized into outcome prediction, stroke risk prediction, diagnosis, etiology prediction, and complication and comorbidity prediction. Outcome prediction, the most explored category, includes studies predicting functional outcomes, mortality, and recurrence, often achieving high accuracy and outperforming traditional methods. Stroke risk prediction models effectively integrate clinical and imaging data, improving assessments of both first-time and recurrent stroke risks. Diagnostic tools, such as automated imaging analysis and lesion segmentation, streamline acute stroke workflows, while AI models for large vessel occlusion detection demonstrate clinical utility. Etiology prediction focuses on identifying causes such as atrial fibrillation or cancer-associated thrombi, using imaging and thrombus analysis. Complication and comorbidity prediction models address stroke-associated pneumonia and acute kidney injury, aiding in risk stratification and resource allocation. While significant advancements have been made, challenges such as limited validation, ethical considerations, and the need for better data collection persist. This review highlights the advancements in AI applications for addressing key challenges in stroke care, demonstrating its potential to enhance precision medicine and improve patient outcomes.</p>","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":" ","pages":"4-14"},"PeriodicalIF":1.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11900286/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441478","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":"Cutting Balloon Angioplasty for Severe In-Stent Restenosis after Carotid Artery Stenting: Long-Term Outcomes and Review of Literature.","authors":"Jeong-Yoon Lee, Min-Surk Kye, Jonguk Kim, Do Yeon Kim, Jun Yup Kim, Sung Hyun Baik, Jihoon Kang, Beom Joon Kim, Hee-Joon Bae, Cheolkyu Jung","doi":"10.5469/neuroint.2024.00010","DOIUrl":"10.5469/neuroint.2024.00010","url":null,"abstract":"<p><strong>Purpose: </strong>Cutting balloon-percutaneous transluminal angioplasty (CB-PTA) is a feasible treatment option for in-stent restenosis (ISR) after carotid artery stenting (CAS). However, the longterm durability and safety of CB-PTA for ISR after CAS have not been well established.</p><p><strong>Materials and methods: </strong>We retrospectively reviewed medical records of patients with ISR after CAS who had been treated with CB-PTA from 2012 to 2021 in our center. Detailed information of baseline characteristics, periprocedural and long-term outcomes, and follow-up imaging was collected.</p><p><strong>Results: </strong>During 2012-2021, a total of 301 patients underwent CAS. Of which, CB-PTA was performed on 20 lesions exhibiting severe ISR in 18 patients following CAS. No patient had any history of receiving carotid endarterectomy or radiation therapy. These lesions were located at the cervical segment of the internal carotid artery (n=16), proximal external carotid artery (n=1), and distal common carotid artery (n=1). The median time interval between initial CAS and detection of ISR was 390 days (interquartile range 324-666 days). The follow-up period ranged from 9 months to 9 years with a median value of 21 months. Four patients (22.2%) were symptomatic. The average of stenotic degree before and after the procedure was 79.2% and 34.7%, respectively. Out of the 18 patients receiving CB-PTA, 16 (88.9%) did not require additional stenting, and 16 (88.9%) did not experience recurrent ISR during the follow-up period. Two patients who experienced recurrent ISR were successfully treated with CB-PTA and additional stenting. No periprocedural complication was observed in any case.</p><p><strong>Conclusion: </strong>Regarding favorable periprocedural and long-term outcomes in our single-center experience, CB-PTA was a feasible and safe option for the treatment of severe ISR after CAS.</p>","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":" ","pages":"24-30"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10910177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139697955","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":"Fatal Femoral Pseudoaneurysm Rupture after Endovascular Intervention: A Case Report and Literature Review.","authors":"Taedong Ok, Kwon-Duk Seo, Il Hyung Lee","doi":"10.5469/neuroint.2024.00017","DOIUrl":"10.5469/neuroint.2024.00017","url":null,"abstract":"<p><p>A rupture of a femoral pseudoaneurysm is an extremely rare complication of endovascular procedures, but its outcome can be life-threatening. In this report, we present a case of a femoral pseudoaneursym rupture in a patient in their early 90s following intra-arterial mechanical thrombectomy for acute ischemic stroke. Despite receiving medical and surgical interventions, the patient subsequently developed multiple organ failure, ultimately resulting in death. This case emphasizes the critical role of appropriate selection of vascular closure technique and careful post-procedural monitoring, particularly in high-risk patients.</p>","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":" ","pages":"52-56"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10910178/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139672253","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":"Fusiform \"True\" Posterior Communicating Artery Aneurysm with Basilar Artery Occlusion: A Case Report.","authors":"Ritu Shah, Rashmi Saraf","doi":"10.5469/neuroint.2023.00472","DOIUrl":"10.5469/neuroint.2023.00472","url":null,"abstract":"<p><p>Isolated posterior communicating artery (PCoA) aneurysms are rare, predominantly fusiform in morphology, and rarely present with subarachnoid hemorrhage. Endovascular management of this pathology is technically challenging due to extreme tortuosity, the artery course in the subarachnoid space, sharp angulations at PCoA junctions with the parent artery, and, at times, associations with either internal carotid artery or basilar artery occlusions. We present a case of a ruptured fusiform PCoA at the junction of middle and distal third with concomitant proximal basilar artery occlusion. The PCoA reforms the posterior circulation, making it a vital artery. Stent-assisted coiling was performed with extreme difficulty in achieving distal positioning of the stents in the basilar artery/posterior cerebral artery/distal PCoA due to artery tortuosity. There was technical difficulty in the stent deployment. After changing strategies to a larger diameter laser-cut stent, endovascular treatment could be performed. There were good angiographic and clinical outcomes with stable occlusion at 6-month-follow-up.</p>","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":" ","pages":"57-60"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10910176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139741523","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.2023.00465","DOIUrl":"https://doi.org/10.5469/neuroint.2023.00465","url":null,"abstract":"","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139542829","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":"Delayed Migration of Tapered Open-Cell Design Carotid Stent: A Case Report.","authors":"Il Hyung Lee,&nbsp;Taedong Ok,&nbsp;Yo Han Jung,&nbsp;Kyung-Yul Lee,&nbsp;Sang Hyun Suh","doi":"10.5469/neuroint.2023.00304","DOIUrl":"10.5469/neuroint.2023.00304","url":null,"abstract":"<p><p>We present a case of delayed migration of an open-cell design carotid stent, which is a rare complication following carotid artery stenting (CAS). A 65-year-old patient with carotid artery stenosis underwent CAS with an open-cell stent, initially achieving successful deployment. However, 4 months later, the stent migrated and resulted in restenosis. The patient underwent balloon angioplasty and received an additional stent, leading to improved blood flow. The rarity of stent migration, particularly in the absence of risk factors, highlights the need for clinicians to be vigilant and consider early imaging follow-up for patients at risk of this complication after CAS.</p>","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":" ","pages":"204-208"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10626035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10310829","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":"Low Levels of Low-Density Lipoprotein Cholesterol Increase the Risk of Post-Thrombectomy Delayed Parenchymal Hematoma.","authors":"Seoiyoung Ahn,&nbsp;Steven G Roth,&nbsp;Jacob Jo,&nbsp;Yeji Ko,&nbsp;Nishit Mummareddy,&nbsp;Matthew R Fusco,&nbsp;Rohan V Chitale,&nbsp;Michael T Froehler","doi":"10.5469/neuroint.2023.00269","DOIUrl":"10.5469/neuroint.2023.00269","url":null,"abstract":"<p><strong>Purpose: </strong>Low levels of low-density lipoprotein cholesterol (LDL-C) have been suggested to increase the risk of hemorrhagic transformation (HT) following acute ischemic stroke. However, the literature on the relationship between LDL-C levels and post-thrombectomy HT is sparse. The aim of our study is to investigate the association between LDL-C and delayed parenchymal hematoma (PH) that was not seen on immediate post-thrombectomy dual-energy computed tomography (DECT).</p><p><strong>Materials and methods: </strong>A retrospective analysis was conducted on all patients with anterior circulation large vessel occlusion who underwent thrombectomy at a comprehensive stroke center from 2018-2021. Per institutional protocol, all patients received DECT immediately post-thrombectomy and magnetic resonance imaging or CT at 24 hours. The presence of immediate hemorrhage was assessed by DECT, while delayed PH was assessed by 24-hour imaging. Multivariable analysis was performed to identify predictors of delayed PH. Patients with hemorrhage on immediate post-thrombectomy DECT were excluded to select only those with delayed PH.</p><p><strong>Results: </strong>Of 159 patients without hemorrhage on immediate post-thrombectomy DECT, 18 (11%) developed delayed PH on 24-hour imaging. In multivariable analysis, LDL-C (odds ratio [OR], 0.76; P=0.038; 95% confidence interval [CI], 0.59-0.99; per 10 mg/dL increase) independently predicted delayed PH. High-density lipoprotein cholesterol, triglyceride, and statin use were not associated. After adjusting for potential confounders, LDL-C ≤50 mg/dL was associated with an increased risk of delayed PH (OR, 5.38; P=0.004; 95% CI, 1.70-17.04), while LDL-C >100 mg/dL was protective (OR, 0.26; P=0.041; 95% CI, 0.07-0.96).</p><p><strong>Conclusion: </strong>LDL-C ≤50 mg/dL independently predicted delayed PH following thrombectomy and LDL-C >100 mg/dL was protective, irrespective of statin. Thus, patients with low LDL-C levels may warrant vigilant monitoring and necessary interventions, such as blood pressure control or anticoagulation management, following thrombectomy even in the absence of hemorrhage on immediate post-thrombectomy DECT.</p>","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":" ","pages":"172-181"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10626036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10028123","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":"Hairball-Like Migration of \"Onyx Threads\" into the Draining Vein during Transarterial Embolization of a Dural Arteriovenous Fistula: A Case Report and Experimental Validation.","authors":"Tetsuya Ioku,&nbsp;Tomotaka Ohshima,&nbsp;Mao Yokota,&nbsp;Naoki Matsuo,&nbsp;Shigeru Miyachi","doi":"10.5469/neuroint.2023.00185","DOIUrl":"10.5469/neuroint.2023.00185","url":null,"abstract":"<p><p>Transarterial embolization using Onyx is a well-established treatment for dural arteriovenous fistulas (DAVFs). However, complications can arise when Onyx migrates into the venous side, impairing the draining veins. We encountered a case where Onyx, injected through the arterial side, strayed into the jugular vein, forming a hairball-like structure. Our study aimed to investigate the underlying mechanism of this unusual phenomenon. We postulated that Onyx precipitates into thread-like shapes when passing through extremely narrow openings. To test this, we extruded Onyx from a syringe through a 27-gauge needle into a silicone tube with flowing water. By varying the flow speed, we observed the hardening behavior of Onyx. Under slow flow, the extruded Onyx quickly solidified at the needle tip, forming a round mass. Conversely, high-speed flow resulted in Onyx being dispersed as small pieces. We successfully replicated the formation of \"Onyx threads\" under continuous slow flow conditions, similar to our case. This phenomenon occurs when Onyx unexpectedly migrates to the draining vein through a tiny opening during transarterial embolization for arteriovenous shunt diseases. Early recognition and appropriate measures are necessary to prevent occlusive complications in the draining veins and the pulmonary system.</p>","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":" ","pages":"190-194"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10626034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9861920","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":"Proposed Protocols for Artificial Intelligence Imaging Database in Acute Stroke Imaging.","authors":"Minjae Kim,&nbsp;Seung Chai Jung,&nbsp;Soo Chin Kim,&nbsp;Bum Joon Kim,&nbsp;Woo-Keun Seo,&nbsp;Byungjun Kim","doi":"10.5469/neuroint.2023.00339","DOIUrl":"10.5469/neuroint.2023.00339","url":null,"abstract":"<p><strong>Purpose: </strong>To propose standardized and feasible imaging protocols for constructing artificial intelligence (AI) database in acute stroke by assessing the current practice at tertiary hospitals in South Korea and reviewing evolving AI models.</p><p><strong>Materials and methods: </strong>A nationwide survey on acute stroke imaging protocols was conducted using an electronic questionnaire sent to 43 registered tertiary hospitals between April and May 2021. Imaging protocols for endovascular thrombectomy (EVT) in the early and late time windows and during follow-up were assessed. Clinical applications of AI techniques in stroke imaging and required sequences for developing AI models were reviewed. Standardized and feasible imaging protocols for data curation in acute stroke were proposed.</p><p><strong>Results: </strong>There was considerable heterogeneity in the imaging protocols for EVT candidates in the early and late time windows and posterior circulation stroke. Computed tomography (CT)-based protocols were adopted by 70% (30/43), and acquisition of noncontrast CT, CT angiography and CT perfusion in a single session was most commonly performed (47%, 14/30) with the preference of multiphase (70%, 21/30) over single phase CT angiography. More hospitals performed magnetic resonance imaging (MRI)-based protocols or additional MRI sequences in a late time window and posterior circulation stroke. Diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) were most commonly performed MRI sequences with considerable variation in performing other MRI sequences. AI models for diagnostic purposes required noncontrast CT, CT angiography and DWI while FLAIR, dynamic susceptibility contrast perfusion, and T1-weighted imaging (T1WI) were additionally required for prognostic AI models.</p><p><strong>Conclusion: </strong>Given considerable heterogeneity in acute stroke imaging protocols at tertiary hospitals in South Korea, standardized and feasible imaging protocols are required for constructing AI database in acute stroke. The essential sequences may be noncontrast CT, DWI, CT/MR angiography and CT/MR perfusion while FLAIR and T1WI may be additionally required.</p>","PeriodicalId":19140,"journal":{"name":"Neurointervention","volume":" ","pages":"149-158"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10626040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41237180","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}