Interventional Neuroradiology最新文献

{"title":"On old dogs and new tricks: CT perfusion predicts hemorrhagic transformation after thrombectomy.","authors":"Yazan D Abualnadi, Samantha Miller, Zorain M Khalil, Kaiser O'Sahil Sadiq, Wondewossen G Tekle, Ameer E Hassan","doi":"10.1177/15910199251386104","DOIUrl":"10.1177/15910199251386104","url":null,"abstract":"<p><p>IntroductionHemorrhagic transformation is a major complication of large vessel occlusion (LVO) recanalization after mechanical thrombectomy in acute ischemic stroke. The hypoperfusion index ratio (HIR) quantifies the severity of cerebral hypoperfusion in the setting of an acute ischemic stroke using CT perfusion (CTP) to compare the volume of severely hypoperfused tissue (time-to-maximum [Tmax] > 10 s) to total hypoperfused tissue (Tmax >6 s), and has emerged as a potential predictor of ischemic core growth and poor outcomes. We investigated whether computed tomography perfusion (CTP) derived hypoperfusion index ratio correlates with the rate of hemorrhagic transformation.MethodsWe conducted a retrospective cohort analysis of a prospectively maintained patient database. Included patients underwent mechanical thrombectomy for large vessel ischemic stroke from January 2019 to December 2022 at a single comprehensive stroke center. Patients were separated into 2 groups depending on whether hemorrhagic transformation developed. Hemorrhagic transformation included any hemorrhage that could be classified according to the ECASS criteria as hemorrhagic infarction (HI)1, HI2, parenchymal hematoma (PH)1 and PH2. Hypoperfusion index ratio on admission CTP was determined using VizAI software. Data were analyzed using Chi-square and Mann-Whitney U tests.ResultsAmong the 289 patients included (median age, 72.5; 41.5% female), 55 (19%) had hemorrhagic transformation. Patients with hemorrhagic transformation had a significantly higher hypoperfusion index ratio (median, 0 vs 0.2; P = 0.004) compared with those with no hemorrhagic transformation. Multivariable analysis showed that for every 0.1 increase in the hypoperfusion index ratio, there was a significant 4.64-fold increase in hemorrhagic transformation (OR 4.64; 95% CI 1.40 to 15.18; p = 0.011).ConclusionIn patients with LVO who underwent mechanical thrombectomy, a higher hypoperfusion index ratio on admission CTP was associated with an increased rate of hemorrhagic transformation. This suggests that the hypoperfusion index ratio could be used as a predictor for hemorrhagic transformation after mechanical thrombectomy.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251386104"},"PeriodicalIF":2.1,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12510989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259769","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":"Visual Alberta stroke program early computed tomography score versus RAPID-AI perfusion in predicting outcome after late-window thrombectomy.","authors":"Quang Anh Nguyen, Dang Luu Vu, Thanh Tam Nguyen, Quy Thien Le, Huu An Nguyen, Van Hoang Nguyen, Anh Tuan Tran, Quoc Viet Nguyen, Thanh Hung Tran, Laurent Pierot","doi":"10.1177/15910199251369147","DOIUrl":"10.1177/15910199251369147","url":null,"abstract":"<p><p>PurposeTo evaluate the prognostic utility of visual Alberta stroke program early computed tomography score (ASPECTS) and perfusion parameters obtained from automated RAPID-AI software in patients undergoing mechanical thrombectomy (MT) beyond 6 hours from stroke onset.MethodsWe retrospectively analyzed 86 patients with anterior circulation large vessel occlusion who underwent non-enhanced computed tomography (NECT), multiphase computed tomography angiography, and computed tomography perfusion within 6-24 hours before thrombectomy. Visual ASPECTS (assessed by junior doctor), RAPID-ASPECTS, and RAPID-CTP parameters (ischemic core volume, penumbra, and mismatch ratio) were recorded. The primary outcome was 90-day functional independence (modified Rankin Score 0-2). Multivariable logistic regression and receiver operating characteristic analysis were used to identify independent predictors.ResultsVisual ASPECTS was significantly associated with a favorable outcome (area under the curve = 0.709; optimal cut-off ≥ 6), while no perfusion-derived parameters reached statistical significance. In multivariable analysis, only visual ASPECTS (OR 0.083, 95% CI: 0.033-0.133; <i>p</i> = 0.001), hypertension (OR 0.252, 95% CI: 0.053-0.452; <i>p</i> = 0.014), and symptomatic intracranial hemorrhage (OR 0.634, 95% CI: 0.303-0.964; <i>p</i> < 0.001) remained independent predictors. Agreement between visual and RAPID-ASPECTS was moderate (intraclass correlation coefficient 0.67; 95% CI: 0.49-0.80; <i>p</i> < 0.001), but poor when dichotomized at the ≥ 6 threshold (Cohen's kappa κ = 0.18, <i>p</i> < 0.001).ConclusionVisual ASPECTS outperformed perfusion-derived metrics in predicting clinical outcomes after late-window thrombectomy. These findings support the continued relevance of NECT and expert visual scoring, particularly in settings where perfusion imaging may be limited or inconsistent.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251369147"},"PeriodicalIF":2.1,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12504207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245506","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":"Evaluation of bail-out techniques for managing cerebral vessel perforation: An experimental study.","authors":"Roland Schwab, Mai-Britt Wienecke, Stefanie Feierabend, Erelle Fuchs, Sebastian J Müller, Eya Khadhraoui, Maximilian Thormann, Stefan Klebingat, Daniel Behme","doi":"10.1177/15910199251384352","DOIUrl":"10.1177/15910199251384352","url":null,"abstract":"<p><p>BackgroundIntracranial vessel perforation is a rare but life-threatening complication during endovascular neurointerventions. Despite several described bail-out strategies, there is no consensus on the most effective approach for rapid hemorrhage control. This study aimed to systematically compare common endovascular rescue techniques in a standardized experimental setting.MethodsPatient-specific, 3D-printed vascular models of the anterior circulation were used to simulate standardized vessel perforations at two anatomical sites and three perforation sizes. The impact of the anterior communicating artery (AComA) crossflow was assessed. Proximal balloon guiding catheter inflation, local compliant balloon inflation, temporary coil deployment, and distal intermediate catheter insertion were evaluated against a non-intervention control. The primary outcome was the time it took for 50 ml of fluid extravasation to accumulate.ResultsAs expected, extravasation time inversely correlated with perforation size (<i>ρ</i> = -0.95, <i>p</i> < 0.001). Local balloon inflation at the rupture site most effectively halted leakage. Proximal balloon occlusion was only effective in the absence of an AComA crossflow (<i>p</i> = 0.02). Temporary coil deployment modestly slowed bleeding, especially for small-to-moderate perforations. Distal intermediate catheter placement had no significant effect.ConclusionManaging iatrogenic intracranial vessel perforation is time-critical, as even a brief bleeding time can be fatal. The most effective hemostasis method is compliant balloon inflation at the rupture site. If unavailable, temporary parent artery coiling can reduce bleeding while maintaining perfusion, but it is less effective for larger perforations. Proximal balloon occlusion is only effective in the absence of collateral crossflow.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251384352"},"PeriodicalIF":2.1,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12504210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245534","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":"Endotheliitis and cytokine storm as a mechanism of clot formation in COVID-19 ischemic stroke patients: A histopathologic study of retrieved clots.","authors":"Waleed Brinjikji, David F Kallmes, Renu Virmani, Simon F de Meyer, Albert J Yoo, William Humphries, Osama O Zaidat, Mohamed S Teleb, Jesse G Jones, Adnan H Siddiqui, Tommy Andersson, Raul G Nogueira, Sara Molina Gil, Andrew Douglas, Rosanna Rossi, Alexander Rentzos, Erik Ceder, Jeanette Carlqvist, Dennis Dunker, Katarina Jood, Turgut Tatlisumak, Karen M Doyle","doi":"10.1177/15910199231185804","DOIUrl":"10.1177/15910199231185804","url":null,"abstract":"<p><p>BackgroundStudies during the COVID-19 pandemic have demonstrated an association between COVID-19 virus infection and the development of acute ischemic stroke, particularly large vessel occlusion (LVO). Studying the characteristics and immunohistochemistry of retrieved stroke emboli during mechanical thrombectomy for LVO may offer insights into the pathogenesis of LVO in COVID-19 patients. We examined retrieved COVID-19 emboli from the STRIP, EXCELLENT, and RESTORE registries and compared their characteristics to a control group.MethodsWe identified COVID-positive LVO patients from the STRIP, RESTORE, and EXCELLENT studies who underwent mechanical thrombectomy. These patients were matched to a control group controlling for stroke etiology based on Trial of Org 10172 in Acute Stroke Treatment criteria. All clots were stained with Martius Scarlet Blue (MSB) along with immunohistochemistry for interleukin-6 (IL-6), C-reactive protein (CRP), von Willebrand factor (vWF), CD66b, fibrinogen, and citrullinated Histone H3. Clot composition was compared between groups.ResultsNineteen COVID-19-positive patients and 38 controls were included. COVID-19-positive patients had a significantly higher percentage of CRP and vWF. There was no difference in IL-6, fibrin, CD66b, or citrullinated Histone H3 between groups. Based on MSB staining, there was no statistically significant difference regarding the percentage of red blood cells, white blood cells, fibrin, and platelets.ConclusionsOur study found higher concentrations of CRP and vWF in retrieved clots of COVID-19-positive stroke patients compared to COVID-19-negative controls. These findings support the potential role of systemic inflammation as indicated by elevated CRP and endothelial injury as indicated by elevated vWF as precipitating factors in thrombus development in these patients.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"660-665"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12475317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41167346","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":"Fluoroscopy-guided multiphase flat panel CT cisternography to diagnose complex skull base CSF leaks.","authors":"Eef Jacobus Hendriks, Mehran Nasralla, Emily Chung, Patrick Joseph Nicholson, Hugo Alberto Andrade Barazarte, Richard Ian Farb","doi":"10.1177/15910199231185806","DOIUrl":"10.1177/15910199231185806","url":null,"abstract":"<p><p>Skull base cerebrospinal fluid (CSF) leaks can be challenging to diagnose. We describe a first technical report on a fluoroscopy-guided multiphase flat panel computed tomography cisternography to diagnose a CSF leak in a complex postoperative anterior cranial fossa. The entry point, pathway of leakage, and exit point were visualized in detail. The feasibility and technical details are described. This technique could be an additional asset in the diagnostic work up of complex CSF leaks, not only of the anterior cranial fossa, but also complex CSF leaks of the middle cranial fossa.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":"1 1","pages":"723-725"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12055555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44439840","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":"Radiolucent head immobilization during neurointerventional procedures: A pilot study from a single-institution experience.","authors":"Nicholas G Lam, Je Y Sone, William J Ankenbrandt, Matthew T Walker, William J Ares","doi":"10.1177/15910199251382673","DOIUrl":"10.1177/15910199251382673","url":null,"abstract":"<p><p>BackgroundRadiolucent head immobilization (RHI) devices have recently been introduced to the neurovascular space for the purpose of procedural efficiency and safety. However, limited data exists to support its efficacy. In this study, we assessed the potential benefits of RHI. We hypothesized that RHI use is associated with improved procedural efficiency without loss of angiographic image quality or increase in radiation exposure.MethodsA single-institution single-physician retrospective cohort study of patients who underwent cerebral digital subtraction angiography (DSA) or middle meningeal artery embolization (MMAE) under conscious sedation over a 1-year period was conducted. Comparative analyses of fluoroscopy time, image quality, and radiation dosage were performed.ResultsSignificantly shorter fluoroscopy times were observed for patients with RHI undergoing DSA (<i>p</i> < 0.05) and bilateral MMAE (<i>p</i> < 0.05). There was no significant difference in fluoroscopy time for patients undergoing a unilateral MMAE. No difference was found in total radiation dose between patients with RHI compared to patients without RHI. A blinded image quality comparison found no differences in image quality or presence of artifact upon review of DSA images.ConclusionUse of RHI devices was associated with significantly lower fluoroscopy times for DSA and bilateral MMAE without sacrificing image quality. RHI may prove beneficial for decreasing procedural times, particularly during longer, conscious sedation procedures.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251382673"},"PeriodicalIF":2.1,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12484046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201366","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":"Safety outcomes in endovascular treatment versus best medical management for basilar artery occlusion acute ischemic stroke: A systematic review and meta-analysis of randomized trials.","authors":"João Victor Sanders, Luma Maria Tavares de Sousa, Ocílio de Deus, Marion Oliver, Raul G Nogueira, Demetrius Lopes, Krishna Joshi","doi":"10.1177/15910199251383070","DOIUrl":"10.1177/15910199251383070","url":null,"abstract":"<p><p>BackgroundEndovascular therapy (EVT) improves functional outcomes and reduces mortality in acute ischemic stroke (AIS) due to basilar artery occlusion (BAO). However, data on hemorrhagic complications and nonneurologic adverse events remain limited. We conducted a systematic review and meta-analysis to assess these outcomes in randomized controlled trials (RCTs) comparing EVT versus best medical management (BMM).MethodsWe searched PubMed, Cochrane Library, and Embase in December 2024 for RCTs comparing EVT and BMM (PROSPERO registry CRD42024617681). Outcomes included any parenchymal hematoma (PH), PH type 1 and 2, subarachnoid hemorrhage (SAH), systemic/extracranial hemorrhage, pneumonia, and heart failure. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model.ResultsFour RCTs, 988 patients (556 EVT, 432 BMM), were included. EVT increased the risk of SAH (RR 5.14; 95% CI [1.35-19.56]; I² = 0.0%) and PH type 2 (RR 5.53; 95% CI [1.47-20.84]; I² = 0.0%) compared to BMM. No significant differences were observed for any PH (RR 1.91; 95% CI [0.92-3.97]; I² = 0.0%), PH type 1 (RR 0.71; 95% CI [0.22-2.29]; I² = 3.4%), systemic/extracranial hemorrhage (RR 1.06; 95% CI [0.71-1.60]; I² = 12.2%), pneumonia (RR 1.00; 95% CI [0.83-1.21]; I² = 0.0%), or heart failure (RR 2.00; 95% CI [0.34-11.92]; I² = 55.4%).ConclusionIn patients with BAO AIS, EVT is associated with an increased risk of SAH and PH type 2 compared with BMM. There was no significant difference in any PH, PH type 1, systemic/extracranial hemorrhage, pneumonia, and heart failure between groups.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251383070"},"PeriodicalIF":2.1,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12484051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201472","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":"Catheter-assisted sealing technique for spontaneous cerebrospinal fluid leaks: A novel neurointerventional treatment of spontaneous cerebrospinal fluid leak beyond cerebrospinal fluid-venous fistula.","authors":"Mario Zanaty, Clayton Lawrence Rosinski, Mohamed Elshikh, Jay Kinariwala, Satoshi Yamaguchi, Kathleen Dlouhy, Edgar Samaniego, Pascal Jabbour, Minako Hayakawa, Santiago Ortega-Gutierrez","doi":"10.1177/15910199251376452","DOIUrl":"10.1177/15910199251376452","url":null,"abstract":"<p><p>BackgroundSpontaneous intracranial hypotension (SIH) is a severe condition caused by cerebrospinal fluid (CSF) leaks, leading to headaches and neurological impairments. Traditional epidural blood patch treatment is often ineffective, especially in refractory cases without a source leak identified. This study introduces and evaluates the Catheter-Assisted Sealing Technique (CAST), a novel neurointerventional approach for refractory SIH. CAST involves targeted or diffuse delivery of fibrin glue into the epidural space to repair CSF leaks.MethodsA retrospective case series of ten patients with refractory SIH underwent CAST using a fluoroscopy-guided epidural catheter approach. Clinical symptom resolution and follow-up MRI findings were assessed.ResultsNine of 10 patients achieved complete headache resolution and associated symptom relief. One patient experienced significant improvement without complete relief. Follow-up MRI showed resolution of pachymeningeal enhancement in all patients. One patient required repeat procedures for recurrent symptoms. No neurological injury or spinal cord compression occurred, with the only complication being transient femoral nerve palsy due to positioning that resolved within four months.ConclusionCAST is a promising, minimally invasive alternative for refractory SIH. It enables targeted or diffuse fibrin sealant application, providing a seemingly effective leak closure even in cases of occult or multifocal leaks. Early results show high success and safety rates, but larger cohorts and extended follow-up are needed to validate it as a standard treatment.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251376452"},"PeriodicalIF":2.1,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12484073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201033","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":"Catheter tensile test: An in vitro evaluation for transradial access.","authors":"Daishiro Abe, Jun-Ichi Koyama, Yoshiki Hanaoka, Takuya Nakamura, Yu Nagai, Tetsuyoshi Horiuchi","doi":"10.1177/15910199251384074","DOIUrl":"10.1177/15910199251384074","url":null,"abstract":"<p><p>PurposeTransradial access (TRA) has been established for neurointervention; however, complications can occur at the radial access site. Radial artery spasm (RAS) is the most common complication of TRA. Under severe RAS conditions, pulling a catheter may occasionally result in radial artery injury and emergency surgery may be required. There have been no reports on the behavior of entrapped catheters/sheaths when pulled under severe RAS conditions. We conducted tensile tests on guide sheaths and balloon guide catheters to observe their damage in vitro and evaluate their potential to cause vascular injury.MethodsSix types of guide sheaths and balloon guide catheters were used in the test. The catheters were fixed to the testing machine and pulled. We observed how the catheter stretched and fractured. Additionally, a stress-strain curve was obtained from each examination to compare the characteristics of the catheters.ResultsCatheters were damaged in various ways. Some catheters were simply lengthened, whereas others were partially or completely torn. In the evaluation of the stress-strain curves, the slopes of the curves were almost equal among the catheters at the beginning of the test; that is, the hardness was almost the same for each catheter. As the strain increased, each exhibited different behavior.ConclusionCatheters can be damaged in various ways by stretching, which can cause vascular injuries. Neurointerventionists should be aware of possible catheter damage and vascular injury when catheters are entrapped.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251384074"},"PeriodicalIF":2.1,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12484055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145200971","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 use of the NeVa stent-retriever for bail-out mechanical thrombectomy.","authors":"Rory Fairhead, Marco Mancuso-Marcello, Rafee Ahmed, Keng Siang Lee, Christos Nikola, Katherine Parkin, Giovanna Klefti, Levansri Makalanda, Ken Wong, Joe Lansley, Michael Przyszlak, Oliver Spooner, Pervinder Bhogal","doi":"10.1177/15910199251381491","DOIUrl":"10.1177/15910199251381491","url":null,"abstract":"<p><p>IntroductionMechanical thrombectomy (MT) has become the gold-standard treatment for large vessel occlusion (LVO), however, in many cases, clots cannot be removed with the initial device. We assessed the safety and efficacy of the NeVa stent-retriever when used for bailout, in a real-world scenario where a range of initial devices have failed.MethodsWe reviewed our prospectively maintained database to identify all patients treated with the NeVa device after another device had failed to achieve satisfactory recanalisation. We recorded the baseline demographics, NIHSS, pre- and post-MT imaging data including ASPECT score, eTICI scores, complications and 90-day Modified Rankin Score (mRS).Results39 patients were included with median age 70, 67% male. Median NIHSS at presentation was 17, 11 (28%) received IV tPA prior to MT. A single device prior to NeVa was used in 31 (74%) of cases, with 2 devices used in the remaining patients, in total achieving eTICI ≥ 2b rencanalisation in 4/39 patients (10%). After one NeVa pull, 18 of the remaining 35 eTICI < 2b patients (51%) showed improvement to eTICI ≥ 2b, improving to 26/35 (74%) after multiple NeVa pulls when compared to the pre-NeVa angiographic result. Symptomatic intracranial haemorrhage and subarachnoid haemorrhage occurred in 2/39 (5.1%) and 12/39 (31%), respectively. Functional independence (mRS ≤ 2) at 90 days was seen in 8/35 (23%).ConclusionThe NeVa stent-retriever provides a useful adjunctive device in situations where other devices have failed to achieve recanalisation. Early switching to NeVa rather than repeated pulls with an initial device may be beneficial for timely recanalisation.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251381491"},"PeriodicalIF":2.1,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12479453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193631","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}