Interventional Neuroradiology最新文献

{"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}

{"title":"Successful endovascular treatment of a spontaneous dorsal cerebrospinal fluid venous fistula: A case report.","authors":"Cesar Augusto Ferreira Alves Filho, Filipi Fim Andreão, Plínio Gabriel Ferreira Lopes, Felippe Figueiredo Torres Ribeiro, Fausto Braga, Jose Alberto Almeida Filho, Paulo Niemeyer Filho, Elias Tanus","doi":"10.1177/15910199251339544","DOIUrl":"10.1177/15910199251339544","url":null,"abstract":"<p><p>IntroductionSpontaneous cerebrospinal fluid (CSF) leaks, though rare, can cause significant neurological symptoms such as positional headaches and tinnitus, often due to thoracic spinal dural venous fistulas. This report describes a case of a dorsal spinal CSF venous fistula with symptom improvement after endovascular treatment.MethodsFollowing the CARE guidelines, key clinical data, including imaging, intervention, and follow-up outcomes, were collected. Informed consent was obtained.Case PresentationA 42-year-old female with a one-year history of positional headaches and tinnitus showed a CSF collection from D1 to D6 on imaging, with a suspected fistula at D5-D6. Conservative treatments failed, and the patient underwent endovascular embolization at D6, resulting in symptom improvement. Subsequent imaging identified a minor leak at L2, managed with follow-up. By January 2024, her headaches had resolved, and she resumed physical activities without recurrence.ConclusionThis case highlights the effectiveness of endovascular embolization for treating CSF venous fistulas, achieving significant symptom relief and returning to normal activities. Early diagnosis, imaging, and intervention are essential for managing these leaks and preventing complications, with regular follow-up critical for long-term recovery.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251339544"},"PeriodicalIF":1.5,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12075149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144003004","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":"Pipeline embolization in patients with hemoglobinopathies: A cohort study.","authors":"Eric A Grin, Vera Sharashidze, Maksim Shapiro, Daniel D Wiggan, Eleanor Gutstadt, Charlotte Chung, Adhith Palla, Svetlana Kvint, Jacob Baranoski, Caleb Rutledge, Howard A Riina, Peter Kim Nelson, Erez Nossek, Eytan Raz","doi":"10.1177/15910199251339550","DOIUrl":"10.1177/15910199251339550","url":null,"abstract":"<p><p>IntroductionFlow diversion with the pipeline embolization device (PED) is an effective endovascular treatment. However, the metal surface's thrombogenicity and need for dual antiplatelet therapy (DAPT) are notable limitations. Few prior studies have reported specifically on flow diverters' safety in patients with hemoglobinopathies, a population at increased risk of thrombotic and hemorrhagic complications.MethodsNatural language processing queried our institution's medical records for intracranial embolization procedures from 2014 to 2024, screening for \"hemoglobinopathy,\" \"thalassemia,\" and \"sickle cell.\" Patient charts were retrospectively reviewed.ResultsSixteen procedures in 14 patients were identified in which a mean 2.0 PEDs per patient were used. Most patients were female (71.4%). Median age was 48.8 years. Five patients had sickle cell disease, two had sickle cell trait, two had sickle cell or hemoglobin C trait and alpha thalassemia minor, and five had alpha thalassemia minor. The 14 patients were treated for 20 aneurysms; four treatments covered two distinct aneurysms. Median dome size per treatment was 4.0 mm. Of the 16 aneurysm treatments, five (31.2%) treated an irregular aneurysm. Most (56.2%) treatments used multiple PEDs. All patients were discharged on DAPT after verifying effect with P2Y12 assays. Follow-up DSA, CTA, or MRA was obtained in 12/14 (85.7%) patients at a median 1.6 years. Complete occlusion was achieved in all aneurysms. Clinical follow-up was obtained in all patients at a median 2.2 years. There were no thromboembolic or hemorrhagic complications, neurological deficits, or mortalities.ConclusionPipeline embolization can safely and effectively treat patients with hemoglobinopathies.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251339550"},"PeriodicalIF":1.5,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12075163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005419","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 effect of aspirin on aneurysm wall enhancement: A study in rabbits and humans.","authors":"Elena Sagues, Diego Ojeda, Andres Gudino, Carlos Dier, Navami Shenoy, Arshaq Saleem, Ramanthan Kadiervel, Sebastian Sanchez, Maria B Torres, Vance T Lehman, David Hasan, Edgar A Samaniego","doi":"10.1177/15910199251341035","DOIUrl":"10.1177/15910199251341035","url":null,"abstract":"<p><p>ObjectiveAneurysm wall enhancement (AWE) is a potential biomarker of inflammation within the aneurysm wall that has been correlated with a higher risk of rupture. Aspirin (ASA) may decrease AWE due to its anti-inflammatory properties. We aimed to assess the effect of ASA on AWE in an animal model and a cohort of patients with unruptured intracranial aneurysms (UIAs).MethodsThree rabbits with elastase-induced aneurysms were exposed to ASA for 8 weeks and three rabbits were used as controls. 3 T high-resolution magnetic resonance imaging (HR-MRI) was performed at 7 days and 8 weeks to evaluate changes in AWE through histological and immunohistological analyses. Additionally, we evaluated AWE in patients who underwent imaging with a 3 T HR-MRI protocol. ASA exposure was defined as daily intake of 81 mg for at least six months prior to HR-MRI. AWE was quantified using three-dimensional AWE maps and histograms.ResultsAmong rabbits exposed to ASA, the mean AWE was lower at 8 weeks compared to the controls (2.11 vs 2.15, <i>p</i> = 0.13). Immunostaining of the aneurysm wall in rabbits that received ASA revealed a reduced expression of CD68 + or cyclooxygenase-2 + cells, compared to the controls. A total of 99 patients with 120 UIAs were included in the HR-MRI analysis of UIAs. UIAs exposed to ASA (22/120) had significantly lower median AWE than those that were not exposed (0.60 vs 0.72, <i>p</i> = 0.032).ConclusionASA therapy is associated with an objective reduction in AWE, suggesting a potential role in lowering the risk of aneurysm rupture.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251341035"},"PeriodicalIF":1.5,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033424","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":"Trends in device utilization and procedural outcomes of endovascular treatment of acute ischemic stroke: A 10-year review of individual institutional experience.","authors":"Amy Letavay, Sheyar Amin, Elliott Pressman, Teagen Smith, Waldo R Guerrero, Kunal Vakharia, Maxim Mokin","doi":"10.1177/15910199251341647","DOIUrl":"10.1177/15910199251341647","url":null,"abstract":"<p><p>BackgroundMost of endovascular thrombectomy (EVT) procedures are performed outside of clinical trials, thus the data available from such trials is often not reflective of real-world practice. How specific indications for EVT or new techniques evolve or impact procedural outcomes in individual patients remains largely unknown.MethodsFrom 2013 to 2023, demographic, clinical and procedural data was collected on consecutive first 20 EVT procedures at the beginning of each year. Trends in utilization of thrombectomy devices and correlations with procedural outcomes were investigated.ResultsThere was a significant difference in the distribution of target occlusion sites (<0.001) with a trend towards a higher proportion of distal occlusions treated with EVT in more recent years. Aspiration-first approach to EVT became more frequent whereas the frequency of stent retriever-first approach decreased (<i>p</i> < 0.001). Average duration of the EVT procedure decreased dramatically (<i>p</i> < 0.001, <i>r</i> = 0.7). In 2013-2015 versus 2022-2023, mean duration of thrombectomy was 128 and 41 min, respectively. However, the number of passes, rates of first pass effect, final TICI 2b/3 and TICI 2c/3 reperfusion remained largely unchanged (<i>p</i> > 0.1 for each metric).ConclusionsOur analysis demonstrates continuous changes in target population of patients with acute stroke treated with EVT and procedural techniques used by operators. While the average duration of the procedure has decreased dramatically, its technical success has remained largely unchanged. This indicates continuous unmet need for future innovation in this field of neurointervention.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251341647"},"PeriodicalIF":1.5,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12075208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144046780","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":"Overcoming the black box of aspiration thrombectomy in acute ischemic stroke: An early clinical experience of using contrast injections to understand clot-catheter interactions.","authors":"Elliott Pressman, Sheyar Amin, Kunal Vakharia, Waldo R Guerrero, Shail Thanki, Adnan H Siddiqui, Maxim Mokin","doi":"10.1177/15910199251341382","DOIUrl":"10.1177/15910199251341382","url":null,"abstract":"<p><p>BackgroundFactors responsible for failure of aspiration thrombectomy in patients with acute ischemic stroke are poorly understood. In order to examine catheter-clot interactions, we modified our current aspiration thrombectomy technique by performing contrast injections near the tip of the aspiration catheter prior to the initiation of aspiration thrombectomy.MethodsSmall volume injections of contrast were performed using a microcatheter positioned inside the aspiration catheter immediately proximal to the occlusion site. Continuous fluoroscopy during the entire duration of each aspiration pass was recorded. We report our initial results with this new technique and examine potential associations of patterns of contrast behavior with procedural success of each thrombectomy pass.ResultsSeventeen patients were included in final analysis, consisting of 24 total aspiration thrombectomy passes. Microcatheter injections showed no safety concerns. Three angiographic patterns of contrast behavior near the aspiration catheter tip were observed: \"occlusive\" with no forward contrast flow, \"side branch opacification\" and \"anterograde opacification\" with anterograde flow. Movement of the contrast column during aspiration thrombectomy depended on the degree of aspiration catheter redundancy. Manual reduction of excessive catheter turns and higher position of long guide sheath at the petrous or cavernous segments seemed to improve contrast clearance and aspiration force.ConclusionsThis initial experience indicates that multiple complex factors may affect success rates of aspiration thrombectomy. The technique of microcatheter injection near the occlusion site may prove helpful in optimizing the existing aspiration thrombectomy techniques.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251341382"},"PeriodicalIF":1.5,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12076482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058459","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":"Stand-alone small low-profile braided stents for challenging unruptured posterior inferior cerebellar artery aneurysms compared to conventional endovascular methods: A cohort study.","authors":"Mohammed Basamh, Matias Costa, Clifford Pierre, Oded Goren, Soha Alomar, Mitchell Young, Akshal Patel, Stephen Monteith, Yince Loh","doi":"10.1177/15910199251341028","DOIUrl":"10.1177/15910199251341028","url":null,"abstract":"<p><p>ObjectivePosterior inferior cerebellar artery (PICA) aneurysms are uncommon and may be challenging to treat, especially if they are very small saccular or dissecting pseudoaneurysms at proximal and mid-PICA locations. They are usually technically difficult to treat with conventional reconstructive endovascular methods. We present our experience with PICA aneurysms treated by a stand-alone small, low-profile stent with a moderate flow-diverting effect (low-profile visualized intraluminal support junior (LVIS Jr)) compared to conventional endovascular methods.MethodsSingle institution cases of treated unruptured PICA aneurysms from 2015 to May 2022 were retrospectively reviewed. Patient characteristics, pre-and postoperative images, and last clinical and radiological outcomes were analyzed. Comparative statistical analysis was used.ResultsNine cases of unruptured PICA aneurysms treated with stand-alone LVIS Jr (group 1) and seven cases treated with other conventional methods (group 2) were identified. The mean age was 56 versus 61.43 years, sex was female in 7 versus 6 cases, and the left side was involved in 7 versus 4 cases in group 1 and group 2, respectively. All aneurysms were in the proximal PICA segment except for one case in the mid-PICA segment aneurysm in each group. There was a difference in aneurysm type in both groups (<i>p</i> = 0.008). All aneurysms were of saccular type except for five dissecting types in group 1 and 2 in group 2. The mean aneurysm size was 1.91 ± 0.62 in group 1 and 9.04 ± 5.82 mm in group 2 (<i>p</i> < 0.0002). In group 2, treatment was with PICA sacrifice (one case), primary aneurysm coiling (three cases), stent-assisted coiling (one case), and flow diverter (two cases). Complications were only puncture site-related that occurred once in each group. There were no differences in mean clinical or radiological follow-up. Aneurysm recurrence with retreatment occurred in two cases in each group. All patients had an mRS 0-2 at the last follow-up.ConclusionIn selected cases, unruptured small or dissecting PICA aneurysms may be treated safely and effectively using single stand-alone LVIS Jr. Prospective studies are needed to validate safety and efficacy.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251341028"},"PeriodicalIF":1.5,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12075186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005420","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":"Effect of race on procedural and clinical outcomes in middle meningeal artery embolization for primary and adjunctive treatment of chronic subdural hematoma.","authors":"Santiago Gomez-Paz, Mohamed M Salem, Cordell Baker, Okkes Kuybu, Georgios S Sioutas, Kate T Carroll, Mira Salih, Adam A Dmytriw, Jane Khalife, William Smith, Diego Alejandro Ortega Moreno, Robert W Regenhardt, Nicole M Cancelliere, Alejandro M Spiotta, Omar Tanweer, Christopher J Stapleton, Michael Lang, Vitor M Pereira, Aman B Patel, Adnan H Siddiqui, Elad I Levy, Christopher S Ogilvy, Daniel Tonetti, Ajith J Thomas, Visish M Srinivasan, Brian T Jankowitz, Michael R Levitt, Bradley A Gross, Jan-Karl Burkhardt, Ramesh Grandhi","doi":"10.1177/15910199251339536","DOIUrl":"10.1177/15910199251339536","url":null,"abstract":"<p><p>BackgroundWe investigated racial disparities in radiologic and clinical outcomes of patients after middle meningeal artery embolization (MMAE) for chronic subdural hematoma (CSDH) with or without evacuation surgery.MethodsThis multicenter retrospective study includes consecutive patients who underwent MMAE across 11 institutions in North America (10 in the United States and 1 in Canada). Patients were stratified using self-reported racial data. Outcomes of interest were complications, treatment failure/reoperations, resolution of hematoma, and functional independence at last follow-up. Multivariable regression models were used to assess and adjust for relevant confounders.ResultsA total of 557 patients underwent 663 MMAEs, including 323 White (58%), 150 Black (27%), 35 Hispanic (6%), 29 Asian (5%) patients, and 20 patients (4%) self-categorized as other/nondisclosed. The median age (interquartile range) of the cohort was 75 (65-81) years, and 412 (74%) patients were female. Middle meningeal artery embolization was the primary treatment for CSDH for 369 patients (66%) and adjunct treatment for 188 (34%). Black patients had a 51% lower likelihood of reoperation relative to other racial categories (adjusted odds ratio [OR] 0.49; 95% confidence interval [CI] 0.25-0.95, <i>p</i> = 0.034). White patients were twice as likely (11% difference; adjusted OR 2.24; 95% CI 1.43-3.51, <i>p</i> < 0.001) and Black patients 59% less likely (6% difference; adjusted OR 0.41; 95% CI 0.25-0.69, <i>p</i> = 0.001) to be independent at last follow-up.ConclusionThis study highlights significant racial disparities in outcomes after MMAE for CSDH, with or without evacuation surgery. White patients had higher reoperation rates but were more likely to be functionally independent at last follow-up. Black patients, despite better baseline functional status, had lower odds of functional independence postoperatively.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251339536"},"PeriodicalIF":1.5,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12075154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055900","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":"Long-term outcomes of resolute Onyx Zotarolimus-eluting stents for symptomatic intracranial stenosis: A multicenter propensity score-matched comparison with stenting versus aggressive medical management for preventing recurrent stroke in intracranial stenosis trial.","authors":"Omid Shoraka, Ramesh Grandhi, Samantha Miller, Joanna Roy, Vinay Jaikumar, Basel Musmar, Omar Tanweer, Jan-Karl Burkhardt, Pascal M Jabbour, Adnan H Siddiqui, Farhan Siddiq, Ameer E Hassan","doi":"10.1177/15910199251339538","DOIUrl":"10.1177/15910199251339538","url":null,"abstract":"<p><p>BackgroundIntracranial atherosclerotic disease (ICAD) is a leading cause of ischemic stroke. The Medtronic Resolute Onyx Zotarolimus-eluting stents (RO-ZES) are promising in preventing stroke recurrence compared with medical management (MM) and percutaneous angioplasty and stenting (PTAS) at both 30-day and one-year follow-ups. We evaluated long-term outcomes for patients treated with RO-ZES, PTAS, or MM.MethodsA retrospective multicenter study was conducted including patients who underwent RO-ZES stenting for symptomatic ICAD between March 2018 and May 2023, with follow-up through October 2024. Propensity score-matched control groups, representing MM and PTAS, were derived from the SAMMPRIS trial. Primary outcomes included recurrence rates of transient ischemic attack, stroke, intracerebral hemorrhage (ICH), and mortality. Time-to-event after intervention was evaluated.ResultsPatients who underwent stenting with RO-ZES and two propensity-matched cohorts from the SAMMPRIS trial who underwent MM and PTAS were included. Mean follow-up was 27.9 ± 17.0 months. The RO-ZES group demonstrated significantly fewer recurrent strokes (11.3%) compared with MM (27.0%) and PTAS (27.8%) (<i>p</i> = .003). The MM group experienced the lowest recurrence rate of ICH (0.9%) (<i>p</i> = .018). Multivariable regression revealed that RO-ZES experienced lower odds of recurrent strokes (OR = .40, 95% CI [0.17-0.92], <i>p</i> = .031) than PTAS throughout follow-up. Multivariable Cox regression demonstrated that RO-ZES stenting lowered the hazard of recurrent strokes compared with PTAS (hazard ratio = .36, 95% CI [0.16-0.80], <i>p</i> = .012).ConclusionTreatment of severe, symptomatic ICAD using RO-ZES was associated with lower odds of recurrent strokes compared with PTAS in this long-term follow-up study. Further prospective trials comparing MM with novel stent technologies are necessary.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251339538"},"PeriodicalIF":1.5,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12075157/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055368","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":"International multi-center study of middle meningeal artery embolization for chronic subdural hematoma in cancer patients: Efficacy, safety, and outcomes in a high-risk population.","authors":"Avi A Gajjar, Mohamed M Salem, Georgios S Sioutas, Rashad Jabarkheel, Okkes Kuybu, Jane Khalife, Daniel A Tonetti, Gustavo Cortez, Adam A Dmytriw, Diego Alejandro Ortega Moreno, William Smith, Robert W Regenhardt, Kate T Carroll, Zachary A Abecassis, Juan Francisco Ruiz Rodriguez, Oleg Shekhtman, Alex Nguyen Hoang, Alexander A Khalessi, Cordell Baker, Matthias Matejka, Nicole M Cancelliere, Christoph J Griessenauer, Ramesh Grandhi, Peter Kan, Omar Tanweer, Michael R Levitt, Christopher J Stapleton, Vitor Mendes Pereira, Brian Jankowitz, Howard A Riina, Aman B Patel, Ricardo Hanel, Ajith J Thomas, Michael J Lang, Bradley A Gross, Jan-Karl Burkhardt, Visish M Srinivasan","doi":"10.1177/15910199251341650","DOIUrl":"10.1177/15910199251341650","url":null,"abstract":"<p><p>BackgroundMiddle meningeal artery embolization (MMAE) is a promising treatment for chronic subdural hematoma (cSDH). Cancer patients are at risk for cSDH due to thrombocytopenia. The efficacy of MMAE in this population has not been studied.MethodsWe conducted a retrospective analysis of 76 patients who underwent 94 MMAEs for cSDH at 12 tertiary centers across North America and Europe between February 2018 and January 2023. We analyzed patient demographics, clinical profiles, procedural details, and outcomes. The primary outcome was cSDH progression, while secondary outcomes included radiographic resolution, mortality, 90-day functional outcomes, functional improvement, and procedural complications.ResultsRadiographic improvement occurred in 88.5% of patients, and technical success was achieved in 96.8%, with comparable rates between the MMAE-only and MMAE + surgery groups. Complications occurred in five patients (5.3%), with no significant difference between groups (6.0% in MMAE vs. 3.7% in MMAE + surgery, <i>p</i> = 0.658). Hemorrhage was reported in four patients (4.3%), and no cases of stroke were recorded. Mortality was 24.5% overall, with a slightly higher rate in the MMAE + surgery group (29.6%) compared to the MMAE-only group (22.4%, <i>p</i> = 0.460). Functional improvement in modified Rankin Scale (mRS) was seen in 15 patients (24.2%), with a significantly greater improvement in the combined group (Δ mRS = 2.625) versus the MMAE-only group (Δ mRS = 0.348, <i>p</i> < 0.001).ConclusionsMMAE is a safe and effective treatment option for managing cSDH in cancer patients. Higher mortality in this population is likely reflective of underlying cancer and comorbidities.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251341650"},"PeriodicalIF":1.5,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12075151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041347","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}