Interventional Neuroradiology最新文献

{"title":"M2 vessel occlusion characteristics and outcome after endovascular therapy: A post-hoc pooled analysis of MR CLEAN MED, NO-IV and LATE.","authors":"Sterre Dassen, Quirien Robbe, Bart Wagemans, Robrecht Knapen, Susan Olthuis, Linda Jacobi, Christiaan van der Leij, Urs Fischer, Elyas Ghariq, Nyika Kruyt, Wouter van der Steen, Natalie LeCouffe, Aad van der Lugt, Charles Majoie, Wim van Zwam, Adriaan van Es, Julie Staals","doi":"10.1177/15910199251349012","DOIUrl":"https://doi.org/10.1177/15910199251349012","url":null,"abstract":"<p><p>PurposeEndovascular treatment (EVT) of M2-segment occlusions in acute ischemic stroke patients is still under debate. The impact of different M2 vessel occlusion characteristics on the outcomes of EVT remains unclear. We evaluated the association between M2 occlusion characteristics and clinical and safety outcomes following EVT.MethodsThis is a retrospective pooled post-hoc analysis of data from the MR CLEAN MED, MR CLEAN NO-IV and MR CLEAN LATE trials, including patients who underwent EVT for M2 occlusions. We classified M2 occlusions on CTA images by location (proximal/distal), vessel dominance, affected branch (superior/inferior) and hemisphere. The primary outcome was the 24-hour National Institutes of Health Stroke Scale (NIHSS) score. Secondary outcomes included ΔNIHSS, a 90-day modified Rankin Scale (mRS) score, EVT procedural characteristics and safety outcomes. We adjusted for relevant prognostic factors.Results181 patients with endovascular-treated M2 occlusions were included. There were no significant differences in 24-hour NIHSS or ΔNIHSS between proximal and distal occlusions. Ordinal shift analysis of mRS showed similar outcomes for proximal and distal M2 occlusions (cOR 1.32, 95% CI 0.70-2.49). Vessel dominance, affected branch and hemisphere did not significantly influence the NIHSS, ΔNIHSS or 90-day mRS. More symptomatic intracranial haemorrhages were seen in EVT of inferior branch occlusion (9.1% versus 2.1%, <i>p</i> = 0.02).ConclusionIn patients with endovascular-treated M2 occlusions, our study suggests no significant differences in clinical outcomes based on occlusion location, vessel dominance, affected branch or hemisphere; however, confirmation from larger studies is required. Notably, the increased rate of symptomatic haemorrhage in EVT of inferior branch occlusions needs further exploration.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251349012"},"PeriodicalIF":1.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Local anesthesia is associated with better functional outcomes than conscious sedation in endovascular thrombectomy for acute ischemic stroke: A retrospective analysis of the OPTIMISE registry.","authors":"George Nunes Mendes, Alexandre Y Poppe, Steve Verreault, Alexander Khaw, Richard Swartz, Darren Ferguson, Aditya Bharatha, George Medvedev, David Volders, Grant Stotts, Aristeidis Katsanos, Grégory Jacquin","doi":"10.1177/15910199251349662","DOIUrl":"10.1177/15910199251349662","url":null,"abstract":"<p><p>IntroductionThere are several possible anesthetic strategies during endovascular therapy (EVT) for acute ischemic stroke (AIS), including general anesthesia (GA), conscious sedation (CS), and local anesthesia (LA). While randomized trials have not shown a clear advantage of GA or CS, LA remains understudied. We aimed to determine if LA is associated with better functional outcomes compared to CS in a Canadian EVT registry.Patients and MethodsA retrospective analysis of the OPTIMISE registry was conducted, focusing on adult patients with anterior circulation AIS treated with EVT between January 2018 and December 2021. Patients with available information regarding anesthetic modality and 3-month functional outcome were included. The primary endpoint was a favorable functional outcome at 3 months (defined as a modified Rankin Scale score of 0-2) when using LA compared to CS (average treatment effect [ATE] determined by targeted maximum likelihood estimation). Secondary outcomes included procedural time, favorable reperfusion, complications, and symptomatic intracranial hemorrhage.ResultsA total of 2204 patients were included in the analysis (763 LA, 1441 CS). In the LA group, 57.5% (n = 439) had a favorable outcome at 3 months compared to 55.6% (n = 801) in the CS group (ATE 0.04 [0.00-0.07]; adjusted odds ratio 1.16 [1.01-1.34]; p = 0.04). No significant difference was found between groups regarding reperfusion rates, procedural times, and symptomatic intracranial hemorrhage.ConclusionIn this large, Canadian multicenter cohort of patients undergoing EVT for anterior circulation AIS, LA was safe and led to better functional outcomes at 3 months compared to CS. Given its simplicity and potential benefits, LA warrants greater consideration in clinical practice and inclusion as a treatment arm in future randomized controlled trials studying the optimal anesthetic strategy for EVT.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251349662"},"PeriodicalIF":1.5,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12174581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of next-generation delivery assist catheters and crossing strategy on reperfusion success in aspiration thrombectomy.","authors":"Raul G Nogueira, Seán Fitzgerald, Miquel Murillo Artigues, Akorede Rei Adedeji, Liam Mullins, John Thornton","doi":"10.1177/15910199251349672","DOIUrl":"10.1177/15910199251349672","url":null,"abstract":"<p><p>BackgroundIn mechanical thrombectomy procedures, physicians are often forced to cross the clot to get more support in tortuous anatomy. Stentriever procedures always require traversing the clot. Novel delivery assist catheters with a tapered distal tip have been developed to aid aspiration catheter delivery. This study compares a novel delivery assist catheter to conventional support strategies in terms of reperfusion and distal embolization. The impact of remaining proximal versus entering the clot is also investigated, as is the impact of incorporating a Superbore 088 catheter.MethodsSoft, medium, and stiff ovine blood clots were used to form ICA/M1 occlusions in an in-vitro thrombectomy model. Two approaches were tested: navigating the aspiration catheter with and without crossing/entering the clot with support devices. Six setups were tested: Millipede⁸⁸ + Zipline⁸⁸, Millipede⁸⁸ + Millipede⁷⁰ + Zipline⁷⁰, Millipede⁷⁰ + Zipline⁷⁰, SOFIA Plus + 021 Microcatheter, SOFIA Plus + 3MAX, SOFIA Plus + 021 Microcatheter + Stentriever. Each setup was tested nine times totaling 72 tests. Revascularization endpoints were First-Pass-Effect (FPE), final complete revascularization, and distal embolization.ResultsAvoiding clot entry was associated with higher FPE rates, improved final revascularization, and fewer distal emboli. Using a 3MAX as a microcatheter and crossing the clot resulted in more distal emboli than a standard 021 microcatheter or stentriever procedure. Millipede⁸⁸ + Zipline⁸⁸ configuration achieved the highest FPE (67%) when the clot was not crossed (vs. 56% with clot entry). Both 070 aspiration catheters had the same FPE rate (33%) but using Millipede⁸⁸ for flow control with Millipede⁷⁰ improved the FPE rate (44%). Of the conventional techniques, SOFIA Plus + 021 Microcatheter + Stentriever was associated with the highest FPE rate (44%).ConclusionsRemaining proximal to the clot is advantageous. Next-generation delivery catheters, like Zipline, may enhance catheter delivery without increasing embolization risk. Using larger internal catheters, such as 3MAX, leads to higher rates of emboli when crossing the clot.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251349672"},"PeriodicalIF":1.5,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distal vessel aspiration in acute ischaemic stroke using the RED 43 aspiration catheter (DIVA study): An international multicentre experience.","authors":"Vinicius Carraro do Nascimento, Permesh Singh Dhillon, Laetitia de Villiers, Strahan Teoh, Timothy Phillips, David Brennan, Waleed Butt, Mohammad Al-Tibi, Daniela Mantovani Anoni, Luqman Malik, Hal Rice","doi":"10.1177/15910199251346007","DOIUrl":"10.1177/15910199251346007","url":null,"abstract":"<p><p>BackgroundFor medium vessel occlusions (MeVOs), in acute ischaemic stroke (AIS), the clinical efficacy of mechanical thrombectomy (MT) is the topic of ongoing randomised clinical trials, and the optimal recanalisation technique remains undetermined. We aim to assess the effectiveness and safety of the novel RED 43 distal reperfusion catheter for the treatment of MeVOs.MethodsWe retrospectively reviewed consecutive cases of anterior and posterior circulation MT for MeVO where the RED 43 aspiration catheter was used at four comprehensive stroke centres in Australia and United Kingdom, from April 2023 to June 2024. Procedural outcomes (navigation to the target vessel, final near complete-complete recanalisation (extended Thrombolysis in Cerebral Infarction (eTICI) 2c-3) and single-pass eTICI 2c-3 (first-pass effect (FPE)), 90-day modified Rankin score, safety and procedural complications (haemorrhagic, vessel dissection or perforation) were analysed.ResultsSeventy-four patients were included (median age 72.8 years [SD 13.1]; 33.8% females). Median baseline NIHSS was 10 [iQR 5-15], and median ASPECTS was 9. Primary MeVOs (without large vessel occlusion) accounted for 58.1% of cases. The occlusion site was reached using the RED 43 in 100% of cases. In particular, the target was reached navigating the catheter over a microwire only in 83.8% of cases. Fifty-seven (77%) patients achieved final eTICI 2c-3 and the FPE (eTICI 2c-3) for the RED 43 was 60.8%. Modified Rankin Scale (mRS) ≤ 2 at 90-days was 67.1%. No intraprocedural complications were recorded. Symptomatic intracranial haemorrhage and 90-day mortality rates were 4.1% and 19%, respectively.ConclusionThe novel RED 43 distal aspiration catheter was shown to be safe and effective in achieving good technical and clinical outcomes amongst acute stroke patients presenting with MeVO. If MT for MeVO is proven to be efficacious, future studies should aim to compare available MT techniques in achieving fast and complete vessel recanalisation.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251346007"},"PeriodicalIF":1.5,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12162533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The United Kingdom's largest experience with Contour in the treatment of wide-neck intracranial aneurysms with long-term (2-year) follow-up.","authors":"Fathallah Ismail Islim, Rishabh Suvarna, Nayyar Saleem, Tufail Patankar","doi":"10.1177/15910199251349072","DOIUrl":"10.1177/15910199251349072","url":null,"abstract":"<p><p>Background and purposeEndovascular treatment of wide-neck bifurcation aneurysms has historically proved difficult with variable outcomes of efficacy and safety. We assessed the short- and long-term clinical and radiologic outcomes in the real-world use of Contour neurovascular system.Materials and methodsThis study was a retrospective analysis of unruptured intracranial aneurysms treated with the Contour. The primary radiologic outcomes were quantified on DSA, CTA, or MRA using the modified Raymond-Roy criteria. The outcomes were defined as complete occlusion (RROC 1) and adequate occlusion (RROC 1 and RROC 2) at 6 months and 2-years. The primary safety outcome was the rate of device-related adverse events. Secondary safety outcomes included time to discharge and change in the modified Rankin scale (mRS) score at 6-month follow-up.Results54 patients were treated with Contour from February 2017 to July 2022. 50 aneurysms underwent 6-month follow-up. 28 of 50 aneurysms treated (56%) remained completely occluded at 6-month follow-up (RROC 1), whilst 44 of 50 aneurysms treated (88%) were adequately occluded. 46 aneurysms underwent 2-year follow-up. 28 of 46 aneurysms treated (60.9%) remained completely occluded at 2-year follow-up (RROC 1), whilst 38 of 46 aneurysms (82.6%) were adequately occluded (RROC 1 and RROC2). Immediate postoperative complications occurred in 5 patients; only 1 patient (1.8%) had residual neurologic deficits at 6 months (mRS 1).ConclusionsManagement of wide-neck aneurysms remains difficult, with high rates of recurrence and complications. The use of the Contour demonstrated a promising and safe addition to the intravascular stock for the treatment of complex wide-neck aneurysms.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251349072"},"PeriodicalIF":1.5,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12158970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between M1 tortuosity and intracranial hemorrhage after mechanical thrombectomy using a stent retriever for M2 occlusions.","authors":"Rikuo Nishii, Satoru Fujiwara, Yasuhiro Yamamoto, Nobuyuki Ohara, Masaomi Koyanagi, Masanori Goto, Ryu Fukumitsu, Tadashi Sunohara, Nobuyuki Fukui, Nobuyuki Sakai, Tsuyoshi Ohta","doi":"10.1177/15910199251349879","DOIUrl":"10.1177/15910199251349879","url":null,"abstract":"<p><p>BackgroundMechanical thrombectomy (MT) is an important treatment for middle cerebral artery (MCA) M2 occlusions. However, it carries a risk of intracranial hemorrhage (ICH), especially with a stent retriever. We investigated the correlation between MCA M1 tortuosity and ICH after MT using a stent retriever for M2 occlusions, along with other clinical outcomes.MethodsThis single-center, retrospective study included patients with isolated MCA M2 occlusions treated using a stent retriever. M1 tortuosity was assessed using pre-MT imaging, with patients classified into tortuous (≥ 2 angulations) and non-tortuous (≤ 1 angulation) groups. The primary outcome was any ICH. Secondary outcomes included symptomatic ICH (sICH), procedural outcomes, and functional outcomes.ResultsAmong 153 patients (median age: 78 years, 48% female), 55 (36%) had tortuous M1 segments. The tortuous group showed higher NIHSS scores (median score 19 vs. 14, <i>p</i> = 0.045) and a higher prevalence of chronic renal failure at baseline (15% vs. 4%, <i>p</i> = 0.029). Any ICH occurred in 69 patients (45%) and was more frequent in the tortuous group (64% vs. 35%, <i>p</i> = 0.003; adjusted odds ratio [aOR], 3.09; 95% confidence interval [CI], 1.48-6.42). Among the ICH subtypes, subarachnoid hemorrhage (SAH) was more common in the tortuous group (49% vs. 27%, <i>p</i> = 0.01; aOR, 2.61; 95% CI, 1.26-5.41). However, the incidence of sICH (5.5% vs. 4.1%, <i>p</i> = 0.70) and good neurological outcome at 90 days after MT (45% vs. 50%, <i>p</i> = 0.62) were comparable.ConclusionMCA M1 tortuosity was associated with a higher incidence of any ICH, particularly SAH, after MT using a stent retriever for M2 occlusions.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251349879"},"PeriodicalIF":1.5,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12158972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-shaped technique using LEONIS Mova: Steering catheter for challenging cerebral aneurysm treatment with WEB.","authors":"Yoji Kuramoto, Kenji Kuroki, Soichiro Abe, Shinichi Yoshimura","doi":"10.1177/15910199251349016","DOIUrl":"10.1177/15910199251349016","url":null,"abstract":"<p><p>This case report highlights the use of the LEONIS Mova, a steerable microcatheter, to facilitate Woven Endo-Bridge device (WEB) deployment in a cerebral aneurysm case. An 85-year-old man with a left posterior communicating artery aneurysm underwent successful WEB placement using the LEONIS Mova, which was prebent outside the body and fine-tuned inside. This approach allowed for precise navigation and stable deployment. The LEONIS Mova's dual-direction 180° steering capability proved advantageous over single-direction devices, such as the Bendit. While promising, the report acknowledges limitations due to its single-case nature and the unpredictability of catheter behavior in complex anatomy. Further studies are needed.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251349016"},"PeriodicalIF":1.5,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12158968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing beyond recent randomized controlled trials: Role of Tigertriever13 for distal medium vessel occlusion.","authors":"Chen Meir Kadosh, Ran Brauner, Johnatan Naftali, Keshet Pardo, Rani Barnea, Michael Findler, Eitan Auriel, Guy Raphaeli","doi":"10.1177/15910199251347776","DOIUrl":"10.1177/15910199251347776","url":null,"abstract":"<p><p>Background and purposeTo assess the safety and efficacy of Tigertriever 13 (T13) (one center experience) for mechanical thrombectomy (MT) in acute ischemic stroke (AIS) in patients with primary or secondary distal, medium-size vessel occlusions (DMVOs).MethodsWe performed a retrospective analysis of all consecutive AIS patients who underwent thrombectomy with T13 for DMVO (from 2018 until the present). Patient's characteristics were analyzed as well as procedural complications, angiographic (modified thrombolysis in cerebral infarction [mTICI]) score, and clinical outcomes (modified Rankin Scale [mRS]).ResultsOur cohort included 43 patients. Male predominance was noticed (60.5%), the median age was 71 years (interquartile range [IQR], 65-83), and 37.2% of patients received IV lytics prior to MT. Our cohort was divided into three sub-groups: (1) primary DMVO (17 patients, 39.5%), (2) secondary DMVO following large vessel occlusion (19 patients, 44.18%), and (3) DMVO related to the non-stroke endovascular procedure, such as aneurysm repair and carotid artery stenting (seven patients, 16.2%). Successful recanalization (mTICI 2b-3) was achieved in most of the patients (37/43, 86.04%). None of the patients have experienced symptomatic intracranial hemorrhage (ICH), and seven patients (16.3%) had asymptomatic ICH. Median mRS score was 3 at day 90 (IQR, 2-5), with 17 patients (39.5%) gained favorable outcome (mRS ≤ 2). Mortality was documented among 11.8% in primary DMVO and 10.52% in secondary DMVO.ConclusionsT13 for MT seems to be safe and effective for DMVO. Clinical outcomes and complications were in line with those described among patients with proximal occlusions. Although considered a remote target, it seems to be technically achievable with a reasonable outcome.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251347776"},"PeriodicalIF":1.5,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12141254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Repeat venous sinus stenting for management of recurrent sinus stenosis related treatment failure of idiopathic intracranial hypertension: A case series.","authors":"Kaishin Tanaka, Stephen Winters, Geoffrey D Parker, Rodney Allan, David Brunacci, Timothy Ang, Johnny Wong, Emma Harrison, Gabor M Halmagyi","doi":"10.1177/15910199251332396","DOIUrl":"10.1177/15910199251332396","url":null,"abstract":"<p><p>BackgroundDural venous sinus stenting (VSS) has been shown to be an effective treatment for idiopathic intracranial hypertension (IIH); however over time, some patients develop treatment failure with formation of a juxta-stent stenosis and a new pressure gradient. Repeat stenting can be performed in these patients to alleviate the stenosis and relieve the elevated pressures preventing complications such as blindness. The efficacy and long-term outcomes of re-stenting is not well described in the literature.MethodsA retrospective review of patients treated at our institution for IIH with VSS over a span of 18 years identified 18 patients who underwent re-stenting for treatment failure. Clinical features, outcomes and venographic data were collated for each patient with a follow-up period ranging from 12 months up to 9 years from their second stent.ResultsThe mean time to repeat stenting was 4 years and 12 months with a range of 1 month up to 16 years and 9 months. Four patients (22.2%) were asymptomatic following second stenting and three patients had recurrent papilledema. Two of these patients (11.1%) had surgical shunting and 1 patient (5.56%) received a third stent. 13 patients (72.2%) had ongoing headaches. There were no major complications in any patient.ConclusionsThis case series demonstrates favourable outcomes for repeat VSS in patients who develop juxta-stent stenosis with a pressure gradient after initial stenting for IIH. A proportion of patients have persistent headache likely due to other mechanisms and a minority may require surgical shunting or further stenting.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251332396"},"PeriodicalIF":1.5,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12141266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rescue intracranial stenting for acute large vessel occlusion using an Orsiro Mission drug-eluting balloon-mounted stent.","authors":"Krishna Amuluru, Andrew Denardo, John Scott, Daniel Gibson, Daniel H Sahlein","doi":"10.1177/15910199251341031","DOIUrl":"10.1177/15910199251341031","url":null,"abstract":"<p><p>Intracranial atherosclerotic disease (ICAD) is one of the most common causes of acute ischemic stroke and accounts for 33-50% of strokes in Asian, Hispanic, and black populations.(1) In patients with ICAD undergoing thrombectomy for large vessel occlusion (LVO), some may demonstrate obstinate inability of recanalization, immediate re-occlusion of the target vessel, and/or underlying high-grade stenosis preventing adequate perfusion. Bailout endovascular strategies for suspected ICAD include angioplasty and/or acute intracranial stenting with self-expandable stents (SES). Balloon-mounted stents (BMS), such as the Orsiro Mission, are increasingly being used by neurointerventionalists rather than SES given the relative ease of deployment and avoidance of an exchange maneuver to re-cross the lesion after angioplasty. Furthermore, BMS have higher radial force compared to SES, lending to advantageous dilatation.(2) Finally, the use of BMS may be associated with lower rates of in-stent restenosis compared with SES.(2, 3) However, BMS deployment can be technically challenging given the length and stiffness of the systems, especially in patients with tortuous anatomy and/or with distal occlusions. We present two cases of LVO complicated by immediate re-occlusion necessitating acute Orsiro Mission stent placement, which has not been described in the neurointerventional literature. The cases demonstrate the brevity of deployment and the importance of intermediate catheter selection and positioning, which allows easier navigation of the stiff BMS systems.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251341031"},"PeriodicalIF":1.5,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12076483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}