Interventional Neuroradiology最新文献

{"title":"Comparison of the Aperio Hybrid^® and Solitaire FR/X^® stents for anterior circulation stroke thrombectomy across different time periods: A propensity score-matched analysis of recanalization and symptomatic hemorrhage.","authors":"Luís Henrique de Castro-Afonso, Felipe Padovani Trivelato, Eduardo Wajnberg, Eduardo Siqueira Waihrich, Thiago Giansante Abud, Saulo Villas Boas Alves, Anderson Matsubara, Marco Tulio Salles Rezende, João Francisco Santoro Araujo, Guilherme Seizem Nakiri, Daniel Giansante Abud","doi":"10.1177/15910199251342439","DOIUrl":"10.1177/15910199251342439","url":null,"abstract":"<p><p>IntroductionThrombectomy has become the standard treatment for acute ischemic stroke (AIS) caused by large vessel occlusions (LVOs). The Aperio Hybrid (Acandis, Pforzheim, Germany) is a new stent retriever designed to enhance the effectiveness of this treatment. However, this new stent has not yet been compared to other thrombectomy devices in a clinical setting. The aim of this study was to compare the Aperio Hybrid^® with the Solitaire™ FR/X (Medtronic, Minneapolis, USA) during thrombectomy in patients with AIS due to anterior circulation LVO.Materials and methodsWe analyzed data from a multicenter registry of thrombectomy for anterior circulation LVO. Patients with carotid/M1 or proximal M2 occlusions who underwent thrombectomy with either the Aperio Hybrid^® or Solitaire™ FR/X^® were compared using propensity-score matching (PSM). The primary outcome was the recanalization rate, measured by the Treatment in Cerebral Ischemia (TICI) score of 2b-3, while the secondary outcome was the rate of symptomatic intracranial hemorrhage (sICH).ResultsAmong 455 patients treated, after PSM, 258 patients (129 per group) were analyzed. The adjusted recanalization rates (TICI 2b-3) for the Aperio Hybrid and Solitaire FR/X were 79.8% and 75.9%, respectively (<i>p</i> = .08), while the adjusted sICH rates were 6.9% and 6.2%, respectively (<i>p</i> = .80).ConclusionsIn this observational study on thrombectomy for AIS, the Aperio Hybrid and Solitaire FR/X demonstrated similar rates of recanalization and symptomatic intracranial hemorrhage. However, due to significant selection bias, these results should be interpreted with caution.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251342439"},"PeriodicalIF":1.5,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12075159/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041648","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":"Evaluating the effectiveness of preoperative embolization for meningioma with pial feeders: Analysis of perfusion magnetic resonance imaging.","authors":"Tomofumi Takenaka, Takeo Nishida, Masatoshi Takagaki, Yoshiko Okita, Noriyuki Kijima, Ryuichi Hirayama, Yuichi Matsui, Shuhei Yamada, Tatsumaru Fukuda, Ryota Nakagawa, Takaki Matsumura, Atsuko Arisawa, Hiroto Takahashi, Hajime Nakamura, Naoki Kagawa, Haruhiko Kishima","doi":"10.1177/15910199251332457","DOIUrl":"https://doi.org/10.1177/15910199251332457","url":null,"abstract":"<p><p>Background and purposeMeningiomas often contain a pial supply, and devascularization through preoperative transarterial embolization (TAE) is useful. However, the efficacy indicators of TAE for meningiomas with pial feeders remain unclear owing to their challenging quantification. Therefore, we propose a practical and quantitative intratumoral cerebral blood volume (CBV) from the pial supply, called pial-nCBV. This study aimed to identify the efficacy indicators of TAE against meningiomas in pial feeders using pial-nCBV.Materials and methodsBetween 2015 and 2021, 25 patients who underwent preoperative TAE and perfusion magnetic resonance imaging (MRI) for meningiomas with pial feeders were included in the study. We set 5 mm diameter round Region Of Interests as many as possible within the tumor at the border with the brain parenchyma, and calculated the intratumoral CBV from pial supply. The reduction rate was defined as primary outcome, termed Δ pial-nCBV. Additionally, we collected data on the injection behavior of the n-Butyl-Cyanoacrylate (n-BCA), including intratumoral embolization (IE) and feeder occlusion. We then analyzed the association between each variable and Δ pial-nCBV.ResultsThe median Δ pial-nCBV was 25%. The n-BCA was applied in 22 (88%) cases, of which nine (36%) cases were injected into pial feeders. The use of n-BCA (<i>p</i> = .037), treatment with pial feeders (<i>p</i> = .002), and IE in meningeal feeders (<i>p</i> = .049) were associated with an increase in Δ pial-nCBV.ConclusionWe proposed a practical indicator, pial-nCBV, and increasing Δ pial-nCBV was associated with treating pial feeder using n-BCA.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251332457"},"PeriodicalIF":1.5,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12058705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043192","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":"In search of real-world cerebroprotection: An institutional perspective and review of the literature.","authors":"Lewis Jr Thompson, Taylor Furst, Racquel Whyte, Gurkirat S Kohli, Derrek A Schartz, Tarun Bhalla, Vincent N Nguyen, Matthew T Bender, Thomas K Mattingly","doi":"10.1177/15910199251337167","DOIUrl":"https://doi.org/10.1177/15910199251337167","url":null,"abstract":"<p><p>PurposeIntravenous (IV) thrombolysis and mechanical thrombectomy remain the only interventions shown to improve outcomes in acute ischemic stroke. This study evaluated the impact of commonly administered intraprocedural medications, each with putative neuroprotective mechanisms backed up by basic science literature, on outcomes in mechanical thrombectomy for acute ischemic stroke.Methods and ResultsA retrospective review of 284 patients utilizing univariate and multivariate analysis evaluated associations between administration of IV/intra-arterial (IA) tissue plasminogen activator (tPA), IV/IA heparin and IA verapamil as well as key outcomes: recanalization success, postoperative hemorrhage, and 90-day functional status. None of these medications were associated with favorable recanalization (TICI 2b/3) or functional outcomes (90-day modified Rankin score 0-2). IV tPA was associated with decreased rates of periprocedural hemorrhage (OR = 0.506, 95% CI [0.255-0.980], <i>p</i> = 0.046). Successful recanalization (OR = 2.22, 95% CI [1.03-.4.98], <i>p</i> = 0.046), presence of any hemorrhage (OR = 0.27, 95% CI [0.14-0.51], <i>p</i> = <0.001), lower age and lower NIHSS, were predictive of good outcome. Heparin was associated with an increased risk of hemorrhage (OR = 1.90, 95% CI [1.11-3.21], <i>p</i> = 0.02) and poorer outcomes (OR = 0.56, 95% CI [0.35-0.91], <i>p</i> = 0.018) in univariate analysis, with a similar trend in multivariate analysis (OR 0.57, 95% CI [0.30-1.06] <i>p</i> = 0.079).ConclusionAlthough several medications with basic science support for cerebroprotective effects are frequently administered during thrombectomy, the most effective strategies for improving functional outcomes remain prompt, successful recanalization and minimizing hemorrhage. With recanalization rates exceeding 80% and primarily determined by mechanical factors, targeting hemorrhage reduction appears critical for further outcome improvements. Evidence linking post-ischemic hemorrhage to blood-brain barrier disruption offers future avenues for research into interventions for this potentially reversible process.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251337167"},"PeriodicalIF":1.5,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12058706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023944","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":"CSF-venous fistulae-An underrecognized cause of superficial siderosis.","authors":"Emanuele Orru', Christopher Adereti, Neil V Patel, Timo Krings, Jonathan Pace","doi":"10.1177/15910199251339542","DOIUrl":"https://doi.org/10.1177/15910199251339542","url":null,"abstract":"<p><p>Superficial siderosis (SS) of the central nervous system is a rare chronic neurological disorder characterized by hemosiderin deposition over the subpial surface of the brain, cranial nerves, and spinal cord. This deposition can result from acute subarachnoid hemorrhage or from chronic or repeated hemorrhage, most often due to cerebral amyloid angiopathy and less commonly to cerebrospinal fluid (CSF) leaks, usually from ventral dural tears. Chronic microhemorrhages associated with spinal CSF leaks without ventral epidural CSF collections or meningoceles are exceedingly rare. Herewith, we describe a case of symptomatic SS as the sole clinical manifestation of a CSF-venous fistula (CSF-VF) of the thoracic spine. A male patient in his 60s presented with long-standing intermittent right-sided headache, anosmia, bilateral tinnitus, and gait instability. Neuraxis imaging revealed extensive SS involving the basal supratentorial brain, infratentorial brain, and spinal cord. A small intraforaminal thoracic nerve root dural ectasia was identified. There were no clear imaging signs of intracranial hypotension. Computed tomography myelography demonstrated a clear CSF-VF of the thoracic spine, which was subsequently closed by transvenous embolization. Postprocedure, the patient experienced progressive symptomatic improvement. This case highlights the importance of considering CSF-VF in the differential diagnosis of SS, especially when dural tears and epidural collections are absent on imaging.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251339542"},"PeriodicalIF":1.5,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12058699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144046655","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":"Endovascular treatment of cerebral venous sinus thrombosis: A systematic review and meta-analysis of efficacy based on technique.","authors":"Diwas Gautam, Omid Shoraka, Sarah Nguyen, Michael T Bounajem, Aaron Shoskes, Jennifer Juhl Majersik, Robert C Rennert, Craig Kilburg, Karol P Budohoski, Ramesh Grandhi","doi":"10.1177/15910199251336946","DOIUrl":"https://doi.org/10.1177/15910199251336946","url":null,"abstract":"<p><p>BackgroundCerebral venous sinus thrombosis (CVST) is rare but potentially life-threatening. Although systemic anticoagulation is the primary treatment, endovascular thrombectomy (EVT) or thrombolysis may be considered for refractory cases. Considering advanced techniques and device technology, we undertook an updated systematic review and meta-analysis to evaluate clinical and radiographic outcomes for treating CVST.MethodsWe searched PubMed and EMBASE for studies describing CVST patients treated with EVT. Presenting symptoms, procedural details, and clinical and radiographic outcomes were analyzed. Random-effects models were generated to calculate pooled proportions of clinical and radiographic outcome variables.ResultsWe analyzed 26 studies comprising 273 patients (mean age 37 years, 57.7% female). Preprocedural intracranial hemorrhage was present in 167/243 (67.1%) patients. Endovascular thrombectomy techniques included aspiration thrombectomy alone (29.3%), aspiration plus stent retriever (19%), stent retriever alone (12.5%), balloon/catheter maceration (6.6%), and AngioJet rheolytic system (32.6%). Random-effects model indicated that 37% of patients had complete recanalization and 57% had partial recanalization. The model indicated that 79% of patients had a good clinical outcome (modified Rankin Scale score 0-2) at last follow-up. There were no statistically significant differences between modern systems (stent retriever and/or aspiration) and older systems (rheolytic thrombectomy and catheter maceration). Aspiration alone yielded a significantly higher frequency of good clinical outcomes compared with the combined technique (83.8% vs. 61.5%, <i>p</i> = 0.004).ConclusionEndovascular thrombectomy for CVST refractory to systemic anticoagulation achieved high recanalization rates, favorable outcomes, and low procedural complication rates. Modern and older techniques exhibited similar safety and efficacy. These findings support EVT as an effective treatment option.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251336946"},"PeriodicalIF":1.5,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989469","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":"Neurointervention-from entry to expertise: Examining gender bias across different training access routes in Europe.","authors":"Helena Guerreiro, Anne-Christine Januel, Franziska Dorn, Riitta Rautio, Anna A Kyselyova, Razvan Alexandru Radu, João Reis, Jens Fiehler, Isabel Fragata","doi":"10.1177/15910199251336928","DOIUrl":"https://doi.org/10.1177/15910199251336928","url":null,"abstract":"<p><p>Background/purposeGender bias in academic medicine has been widely described. In Europe, training and career pathways in neurointervention (NI) are heterogeneous. We hypothesize that the access route to neuroradiology specialty and NI subspecialty may correlate with the proportion of women in the field and with their career progression.MethodsAn online survey consisting of 18 questions was distributed through European professional societies and several online social platforms. A total of 422 responses from 54 different countries were collected and statistically evaluated.ResultsAccess routes to specialty and subspecialty did not correlate with the number of women practicing NI. However, men were significantly more likely to have children, to occupy leading positions, to have more clinical experience and higher weekly workload both in diagnostic and interventional neuroradiology. Female gender significantly affected career progression.ConclusionThis study reflects a positive change in European reality concerning gender bias. Distinct training access routes do not seem to affect the proportion of female neurointerventionalists. However, gender differences still negatively impact women NI careers, leading to lower workload, having less children, and a limited access to leading positions in NI.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251336928"},"PeriodicalIF":1.5,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040865/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004675","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":"Carotid artery stenting for heavily calcified lesions after plaque modification using scoring balloon angioplasty.","authors":"Taichiro Imahori, Shigeru Miyake, Ichiro Maeda, Hiroki Goto, Rikuo Nishii, Haruka Enami, Daisuke Yamamoto, Hirotoshi Hamaguchi, Kohkichi Hosoda, Naoki Kaneko, Nobuyuki Sakai, Takashi Sasayama","doi":"10.1177/15910199251336945","DOIUrl":"https://doi.org/10.1177/15910199251336945","url":null,"abstract":"<p><p>BackgroundCarotid artery stenting (CAS) for heavily calcified lesions (HCLs) presents technical challenges. The NSE PTA balloon (Nipro, Osaka, Japan), a scoring balloon designed for plaque modification, is commonly used in coronary and peripheral interventions. This study evaluated the feasibility and safety of using this balloon in CAS for HCLs.MethodsWe retrospectively analyzed 10 CAS procedures using the NSE PTA balloon for carotid artery stenosis with HCLs. Inclusion criteria were concentric calcified lesions occupying ≥270° of the vessel circumference. Efficacy outcomes included procedural success rate, stenosis improvement after NSE PTA (plaque modification prior to stenting), final residual stenosis, and 6-month restenosis. Safety outcomes included 30-day major adverse events and secondary outcomes, including severe bradycardia and hypotension.ResultsThe median patient age was 77 years (interquartile range: 74-83), with 90% male, and the median arc of calcification was 311° (294-334°). All 10 procedures achieved technical success. The median stenosis rate improved significantly from 86% (80-87%) preprocedure to 67% (60-69%) post-NSE PTA (<i>P</i> = .018) and to 29% (25-37%) after stent placement (<i>P</i> = .018). No major perioperative adverse events occurred within 30 days. Secondary adverse events, such as hypotension, were transient and successfully managed. At 6 months, no significant restenosis was observed.ConclusionsThis preliminary study demonstrated that the NSE PTA balloon for plaque modification in CAS for carotid artery stenosis with HCLs achieved high technical success and favorable safety outcomes. This technique appears to be a promising and easily applicable treatment option for complex calcified lesions.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251336945"},"PeriodicalIF":1.5,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021921","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 pre-treatment hematoma size and unilateral vs bilateral MMA embolization on volume reduction in the treatment of chronic subdural hematomas: A retrospective cohort study.","authors":"Andrew Falzon, Ahmed Abdelghafar, Eef Hendriks, Hugo Andrade Barazarte, Alex Kostynskyy, Alexandre Boutet, Ze'ev Itsekzon-Hayosh, Pascal J Mosimann","doi":"10.1177/15910199251328563","DOIUrl":"https://doi.org/10.1177/15910199251328563","url":null,"abstract":"<p><p>Background and purposeDespite a rapidly growing body of literature supporting the treatment of chronic subdural hematoma (cSDH) with middle meningeal artery embolization (MMAE), real-life data is still scarce. This study aimed to evaluate MMAE radiological and clinical outcomes, based on radiological characteristics.Materials and MethodsFifty-two cSDH patients, treated by MMAE as a post-CSDH evacuation therapy in a single tertiary center, were included. Radiological outcome was evaluated with cSDH thickness/volume difference at routine follow-up compared to pre-MMAE CT head imaging. The cohort was divided into groups pertaining to cSDH laterality (bilateral and unilateral cSDH) and pre-MMAE hematoma thickness (>15 mm and ≤15 mm) for analysis. Patients who underwent evacuation <i>after</i> MMAE were not included in the analysis to eliminate bias of surgical effect on hematoma progression.ResultsThirty patients had bilateral, and 22 patients had unilateral cSDH treated with bilateral and unilateral MMAE respectively. Twenty-nine patients had >15 mm pre-MMAE hematoma thickness, and 23 had ≤15 mm pre-MMAE hematoma thickness. Mean cSDH volume was lower at all follow-up intervals when compared to baseline and was reduced by a factor of 10 at the 3-6-month interval. The mean cSDH thickness was significantly lower at all three follow-up intervals when comparing each group (bilateral and unilateral MMAE) (pre-treatment hematoma thickness >15 mm and ≤15 mm). Larger hematomas with a thickness of >15 mm had a significantly greater reduction in mean cSDH volume interval follow-up than hematomas measuring ≤15 mm (1-3 months-63 mm³, 40.6-85.69, <i>P</i> < .001). Unilateral cSDH and MMAE demonstrated greater cSDH volume reduction compared to bilateral cSDH and MMAE at 1-3 months (42, 15.2-68.8, .001) and 3-6 months (33.7, 5.2-72.7, .043). No procedure-related major complications or deaths or recurrences were observed.ConclusionsAdjunctive MMAE after surgical evacuation appears safe and effective. MMAE is particularly effective for larger pre-treatment hematomas >15 mm (compared to ≤15 mm) and for unilateral cSDH and MMAE (compared to bilateral cSDH and MMAE).</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251328563"},"PeriodicalIF":1.5,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051769","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":"Atrial fibrillation is associated with lower likelihood of first-pass effect in thrombectomy for medium vessel occlusion acute ischemic strokes.","authors":"Omnea Elgendy, Michael J Dubinski, Zixin Yi, Sonali Vij, Tarun Thomas, Iris Charcos, Clint Badger, Karan Patel, Mary Penckofer, Joshua Santucci, Ahmad Ballout, Jane Khalife, Jesse M Thon, Hermann C Schumacher, Khalid A Hanafy, Pratit D Patel, Daniel A Tonetti, Hamza A Shaikh, Tudor G Jovin, Manisha Koneru","doi":"10.1177/15910199251336955","DOIUrl":"https://doi.org/10.1177/15910199251336955","url":null,"abstract":"<p><p>BackgroundFirst-pass effect (FPE) in endovascular thrombectomy (EVT) is strongly associated with clinically favorable outcomes. Atrial fibrillation (AF)-related strokes have been shown to be associated with greater rates of FPE in acute large vessel occlusions (LVOs). In this study, we aimed to assess the association between AF and achieving FPE in medium vessel occlusions (MeVOs).MethodsA prospectively maintained registry of adult ischemic stroke patients at a comprehensive stroke center between October 2019 and October 2023 was retrospectively screened for inclusion. Patients undergoing EVT for a MeVO were included. Univariable and multivariable logistic regressions with 2500 bootstrap iterations for FPE and mFPE was performed using covariables that were clinically and/or statistically significant. Adjusted odds ratios with 95% confidence intervals (CIs) were reported. Regression performance was assessed using area under the curve (AUC) from receiver operating characteristics curve analysis.Results34.4% of patients with MeVO achieved FPE and 58.2% achieved mFPE. In multivariable logistic regression models, AF was independently associated with lower likelihood of FPE, and AF and prior antiplatelet/anticoagulant use were independently associated with lower likelihood of mFPE. Models for FPE and mFPE had AUCs of 0.80 (95% CI [0.75-0.85]) and 0.86 (95% CI [0.78-0.94]), respectively.ConclusionAF was associated with a significantly lower likelihood of FPE and mFPE in EVT of MeVOs. This may suggest a need to prepare for additional passes and rescue intraprocedural strategies for MeVO in patients with AF.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251336955"},"PeriodicalIF":1.5,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053187","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":"Fibrinogen depletion and the risk of intracerebral hemorrhage following endovascular mechanical thrombectomy.","authors":"Hassan Aboul-Nour, Ammar Jumah, Ghada Mohamed, Abdalla Jamal Albanna, Owais K Alsrouji, Lonni Schultz, Katie Latack, Joseph Miller, Khalid Uddin, Satheesh Gunaga, Jason Muir, Alex Chebl, Ahmad Riad Ramadan","doi":"10.1177/15910199251336948","DOIUrl":"https://doi.org/10.1177/15910199251336948","url":null,"abstract":"<p><p>BackgroundIntravenous thrombolysis (IVT) and mechanical thrombectomy (MT) are the standard of care for select stroke patients with acute large vessel occlusion (LVO). Fibrinogen levels may drop after IVT, and a significant decrease in fibrinogen is associated with an increased risk of intracranial hemorrhage (ICH). Our pilot study aimed to explore the relationship between fibrinogen levels and the development of ICH in MT-treated patients and whether bridging with IVT further increases that risk.MethodsThis is a prospective pilot study that enrolled adults presenting with a diagnosis of LVO stroke and eligible to receive MT with or without IVT between April 2020 and May 2023. Fibrinogen levels were drawn before treatment with IVT or MT and immediately following MT.ResultsForty-one patients were enrolled. Median age was 68 years [interquartile range 56-79], 58.5% were females and 56.1% were black. Nineteen patients (46.3%) were treated with MT + IVT, and 22 (53.6%) were treated with MT-only. There was no difference in baseline characteristics between the two groups. Baseline fibrinogen levels were similar between MT + IVT and MT-only groups [391 vs. 352 mg/dL, p = 0.4]. Post MT, the MT + IVT group had lower fibrinogen levels compared to the MT-only group [224 vs. 303 mg/dL, p < 0.001]. Similarly, there was a significant change between baseline and follow-up levels in the MT + IVT vs. MT-only group [106 vs. 39.5 mg/dL, p = 0.001]. Eight patients (19.5%) developed ICH; 5 (26.3%) in the MT + IVT group and 3 (13.6%) in the MT-only group. No significant differences were seen in baseline, follow-up, or change in fibrinogen levels between patients who developed ICH and those who did not. However, when stratified by treatment group, postintervention fibrinogen levels were significantly lower in patients who developed an ICH in the MT + IVT group compared to those without ICH in the MT group (200 vs. 301 mg/dL, p = 0.006). There was also a negative correlation between the change in fibrinogen levels and the rate of first-pass recanalization (Spearman CC -0.33, p = 0.03).ConclusionThis pilot study's preliminary data showed an association between fibrinogen depletion and hemorrhagic transformation in MT-treated patients. Since intracerebral hemorrhage is the most dire side effect in stroke treatment, fibrinogen monitoring in patients undergoing MT after IVT may help identify patients with an increased risk of ICH. Larger, prospective, and multicenter studies are needed to confirm these findings and if fibrinogen repletion should be considered for dysfibrinogenemia.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251336948"},"PeriodicalIF":1.5,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058345","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}