Clinical Neuroradiology最新文献

{"title":"Deep Learning for Segmenting Ischemic Stroke Infarction in Non-contrast CT Scans by Utilizing Asymmetry.","authors":"Jia Sun, Guang-Liang Ju, Yu-Hong Qu, Hui-Hui Xie, Hai-Xin Sun, Si-Yuan Han, Yun-Fang Li, Xiu-Qin Jia, Qi Yang","doi":"10.1007/s00062-025-01559-8","DOIUrl":"10.1007/s00062-025-01559-8","url":null,"abstract":"<p><strong>Background: </strong>Non-contrast computed tomography (NCCT) is a first-line imaging technique for determining treatment options for acute ischemic stroke (AIS). However, its poor contrast and signal-to-noise ratio limit the diagnosis accuracy for radiologists, and automated AIS lesion segmentation using NCCT also remains a challenge. This study aims to develop a segmentation method for ischemic lesions in NCCT scans, combining symmetry-based principles with the nnUNet segmentation model.</p><p><strong>Methods: </strong>Our novel approach integrates a Generative Module (GM) utilizing 2.5 D ResUNet and an Upstream Segmentation Module (UM) with additional inputs and constraints under the 3D nnUNet segmentation model, utilizing symmetry-based learning to enhance the identification and segmentation of ischemic regions. We utilized the publicly accessible AISD dataset for our experiments. This dataset contains 397 NCCT scans of acute ischemic stroke taken within 24 h of the onset of symptoms. Our method was trained and validated using 345 scans, while the remaining 52 scans were used for internal testing. Additionally, we included 60 positive cases (External Set 1) with segmentation labels obtained from our hospital for external validation of the segmentation task. External Set 2 was employed to evaluate the model's sensitivity and specificity in case-dimensional classification, further assessing its clinical performance. We introduced innovative features such as an intensity-based lesion probability (ILP) function and specific input channels for suspected lesion areas to augment the model's sensitivity and specificity.</p><p><strong>Results: </strong>The methodology demonstrated commendable segmentation efficacy, attaining a Dice Similarity Coefficient (DSC) of 0.6720 and a Hausdorff Distance (HD95) of 35.28 on the internal test dataset. Similarly, on the external test dataset, the method yielded satisfactory segmentation outcomes, with a DSC of 0.4891 and an HD 95 of 46.06. These metrics reflect a substantial overlap with expert-drawn boundaries and demonstrate the model's potential for reliable clinical application. In terms of classification performance, the method achieved an Area Under the Curve (AUC) of 0.991 on the external test set, surpassing the performance of nnUNet, which recorded an AUC of 0.947.</p><p><strong>Conclusion: </strong>This study introduces a novel segmentation technique for ischemic lesions in NCCT scans, leveraging symmetry-based principles integrated with nnUNet, which shows potential for improving clinical decision-making in stroke care.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"129-142"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carotid Stent Fracture and Stent Fragment Migration in a Patient with Eagle Syndrome.","authors":"Alexander Brose, Omar Al-Qaisi, Anne Mrochen, Christian Claudi, Christoph Arens, Christine Langer, Tobias Struffert","doi":"10.1007/s00062-025-01571-y","DOIUrl":"10.1007/s00062-025-01571-y","url":null,"abstract":"","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"251-256"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13009039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-invasive Prediction of Meningioma Tumor Grade by Quantification of Shape-based Radiomics Features and Surface Regularity.","authors":"Martin Diebold, Lucas Becker, Theo Demerath, Marco Reisert, Daniel Erny, Andreas Braun, Till-Karsten Hauser, Jürgen Grauvogel, Marc Hohenhaus, Horst Urbach, Alexander Rau, Urs Würtemberger","doi":"10.1007/s00062-025-01560-1","DOIUrl":"10.1007/s00062-025-01560-1","url":null,"abstract":"<p><strong>Purpose: </strong>Prognosis and therapeutic approaches to meningiomas are determined by their proliferative activity and tumor grade. The early identification of aggressive phenotypes is hence essential to improving outcomes. Here, we investigated the potential of shape-based radiomics features and surface regularity (SR) as non-invasive biomarkers of atypical (grade 2) and anaplastic (grade 3) meningiomas.</p><p><strong>Methods: </strong>In this retrospective single-center study, we assessed individuals with treatment-naive meningiomas in a comprehensive analysis of MR imaging with histopathological grading and quantification of mitotic activity. Radiomics (sphericity, elongation, flatness) and SR measures were calculated on segmented contrast-enhancing tumor components and tested for association with WHO grade (n = 62 grade 1, n = 71 grade 2, and n = 19 grade 3) and proliferation.</p><p><strong>Results: </strong>All tumor grades were significantly different in characteristics of sphericity and SR with decreasing values at higher tumor grades as an expression of a more irregular shape. Additionally, radiomics features of tumor elongation and flatness discriminated grade 3 cases from grade 1 (p = 0.0008 and p = 0.0003) and grade 2 meningiomas (p = 0.0008 and p = 0.0013). Mitotic activity exhibited a significant negative correlation with the four imaging markers assessed (p < 0.003).</p><p><strong>Conclusion: </strong>Shape-based radiomics features of sphericity and SR can serve as preoperative grading biomarkers of meningiomas in routine contrast-enhanced T1w MRI.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"169-176"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13009051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Embolic Agents for Middle Meningeal Artery Embolization in Chronic Subdural Hematoma: a Systematic Review and Comparative Pooled Analysis.","authors":"Helbert de Oliveira Manduca Palmiero, Eberval Gadelha Figueiredo","doi":"10.1007/s00062-025-01605-5","DOIUrl":"10.1007/s00062-025-01605-5","url":null,"abstract":"<p><strong>Purpose: </strong>Middle meningeal artery (MMA) embolization has emerged as a promising alternative or supplement to surgery for chronic subdural hematoma (cSDH). However, the effectiveness of different embolic agents remains unclear.</p><p><strong>Methods: </strong>We systematically reviewed 41 studies published up to September 2025, including 8 meta-analyses, 1 scoping review, and 32 clinical cohorts or series. Embolic agents evaluated included liquid agents (Onyx, Squid, n‑BCA), particulates (polyvinyl alcohol [PVA], microspheres), and coils. The primary endpoint was treatment failure, defined as symptomatic or radiological recurrence of cSDH requiring repeat intervention (repeat MMA embolization or surgical rescue); secondary outcomes included complications, mortality, and functional outcomes.</p><p><strong>Results: </strong>No embolic agent demonstrated consistent superiority in randomized trials, meta-analyses, or observational cohorts. Pooled recurrence rates were lowest with n‑BCA (0.8%), followed by Squid (3.6%), Onyx (4.4%), PVA particles (7.3%), and coils (9.0%). Although pooled recurrence appeared lowest with n‑BCA and highest with coils, most randomized and observational comparative studies did not detect statistically significant differences between embolic agents. Major complications were infrequent (≈1-3%) and similar across agents. Liquid embolics had significantly higher costs than PVA particles but did not lead to improved functional outcomes.</p><p><strong>Conclusion: </strong>MMA embolization is a safe and effective treatment for cSDH. Outcomes are generally similar across different embolic agents, and selection should be based on anatomical factors, operator expertise, and resource availability rather than expectations of agent-specific effectiveness.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"23-37"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145806162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Validation of a Novel Stenosis Model for Percutaneous Transluminal Angioplasty Training of the Internal Carotid Artery.","authors":"N Ramdani, A A Kyselyova, N MacMillan, N T Ngo, J Schmiech, M Wagner, K Schulte, D Krause, F Flottmann, L Meyer, M Bester, J Fiehler, H Guerreiro","doi":"10.1007/s00062-025-01545-0","DOIUrl":"10.1007/s00062-025-01545-0","url":null,"abstract":"<p><strong>Introduction/background: </strong>The rising demand for endovascular stroke therapy highlights the need for standardized training environments. Studies have shown the positive impact of simulator-based training for neurointerventional procedures. Given the frequent use of percutaneous transluminal angioplasty (PTA) of the internal carotid artery (ICA) in acute settings, specialized simulation training is crucial. This study evaluates the feasibility of a custom-made ICA stenosis model for PTA simulation.</p><p><strong>Methods: </strong>Internally developed 3D-printed circular clamps were attached to patient-based 3D printed ICA models and integrated into a previously described realistic whole-body neurovascular simulation model HANNES (Hamburg Anatomic Neurointerventional Endovascular Simulator) to simulate a proximal ICA stenosis. Participants (N = 5) of varying experience levels each performed three PTA procedures. Fluoroscopy time, radiation doses, and the extent of stenosis and balloon inflation pressure were assessed. After simulation, participants rated the model in terms of haptic, feasibility and applicability.</p><p><strong>Results: </strong>For statistical analysis, the participants were divided into two groups according to their experience level. There was a statistically significant difference in the procedure duration between both groups, U = 10.500, Z = -1.968, p < 0.05. Significant test results could also be demonstrated for radiation doses (DAP) among groups, Kolmogorov-Smirnov p < 0.05, U = 7.000, Z = -2.357, p < 0.05. No difference was shown between the total contrast volume (ml) among groups that was used during procedures (m = 11.67, SD 2.09).</p><p><strong>Conclusion: </strong>The authors propose a novel ICA stenosis simulation model for training of the cervical PTA. The model provides a realistic and replicable method for standardized procedural training.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"87-92"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13009035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differentiation of Molecular Glioblastomas and Lower-grade Diffuse Astrocytomas Using MRI Perfusion and Diffusion Parameters.","authors":"Hanna S Gry, Anna Falk Delgado","doi":"10.1007/s00062-025-01550-3","DOIUrl":"10.1007/s00062-025-01550-3","url":null,"abstract":"<p><strong>Background and purpose: </strong>Molecular glioblastomas are challenging to distinguish from lower-grade diffuse astrocytomas (grades 2-3) without T2/T2 FLAIR mismatch, when assessed on T1-gadolinium and T2/T2 FLAIR MRI. This study aimed to evaluate the performance of the ADC from diffusion-weighted imaging and the relative CBV from DSC perfusion imaging in differentiating molecular glioblastomas from lower-grade diffuse astrocytomas.</p><p><strong>Materials and methods: </strong>Fourteen patients with molecular glioblastomas (defined as isocitrate dehydrogenase wildtype (IDH-wt), exhibiting one or more of the following: telomerase reverse transcriptase (TERT) promoter mutation, epidermal growth factor receptor (EGFR) gene amplification, or +7/-10 chromosomal alterations, but without microvascular proliferation or necrosis) and thirteen patients with lower-grade diffuse astrocytomas (IDH-mutated or not elsewhere classified, grades 2-3) were included. ADC values and DSC-rCBV values were measured, and the two groups were compared using T‑test and Wilcoxon rank-sum test. Combinations of variables and tumor characteristics were analyzed using binary logistic regression, receiver operating curve (ROC) analysis, and Firth regression model.</p><p><strong>Results: </strong>Molecular glioblastomas exhibited lower minimum ADC, mean ADC (p < 0.01), maximum ADC (p < 0.05) and higher standard deviation of ADC (p < 0.05), compared to lower-grade astrocytomas, measured in a 7 mm² ROI in the lowest ADC region. Molecular glioblastoma also had higher normalized median, average, and minimum rCBV ratios (p < 0.01) in a 10 mm² ROI in the highest perfused region. A combined receiver operating curve (ROC) model of ADC and rCBV achieved an area under the curve (AUC) of 0.93 (95% CI: 0.82-1.00).</p><p><strong>Conclusions: </strong>This study demonstrates that ADC and rCBV measurements can help differentiate molecular glioblastomas from lower-grade diffuse astrocytomas lacking T2/T2 FLAIR mismatch. These findings may aid in preoperative tumor characterization, surgical planning, and prognosis.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"77-86"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Direct Oral Anticoagulants and the Risk of Internal Carotid Artery Occlusion in Patients Eligible for Thrombectomy.","authors":"Sho Hanai, Masayuki Sato, Mikito Hayakawa, Hisayuki Hosoo, Go Ikeda, Yoshiro Ito, Aiki Marushima, Tomoji Takigawa, Wataro Tsuruta, Noriyuki Kato, Kazuya Uemura, Kensuke Suzuki, Yoji Komatsu, Hiroshi Yamagami, Eiichi Ishikawa, Yuji Matsumaru","doi":"10.1007/s00062-025-01575-8","DOIUrl":"10.1007/s00062-025-01575-8","url":null,"abstract":"<p><strong>Purpose: </strong>Direct oral anticoagulants (DOACs) have equivalent efficacy and fewer complications than vitamin K antagonists (VKAs) and are widely used for atrial fibrillation. However, data on how DOACs affect mechanical thrombectomy (MT) and influence the occlusion site are limited. This study aimed to investigate the efficacy and safety of MT before DOAC administration and how DOAC influences the occlusion site eligible for MT.</p><p><strong>Methods: </strong>The NeuroEndovascular and Management from Multicenter Observation to Build a PHILosophical Approach (NEMMOPHILA) study analyzed 331 patients treated between January 2015 and March 2019 who underwent MT. The primary outcome was modified Rankin scale (mRS) of 0-3 at discharge, and the secondary outcomes included in-hospital mortality, and parenchymal hemorrhage (PH).</p><p><strong>Result: </strong>Of the 331 patients, 39 had prior DOAC therapy, 25 had prior VKA therapy, and 267 had non- anticoagulant therapy (non-AC). The internal carotid artery (ICA) occlusion rate was significantly lower in the DOAC group (DOAC, 25.6%; VKA, 56.0%; non-AC, 45.3%; p = 0.030). No significant difference was found in the mRS at discharge (DOAC, 51.3%; VKA, 36.0%; non-AC, 50.9%; p = 0.354), mortality (DOAC, 7.5%; VKA, 7.9%; non-AC, 10.9%; p = 0.66), and PH (DOAC, 2.6%; VKA, 12.0%; non-AC, 9.0%; p = 0.362). Multiple regression analysis revealed that DOAC significantly reduced ICA occlusion (odds ratio, 0.429; 95% confidence interval, 0.195-0.943; p = 0.035).</p><p><strong>Conclusion: </strong>Patients with prior DOAC had low ICA occlusion rates. DOAC administration history did not lead to mRS improvement at discharge and did not increase PH after MT.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"227-232"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145379197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety, Technical and Clinical Success of the Aperio Hybrid Thrombectomy Device in Acute Ischemic Stroke, a Prospective Post-market Clinical Follow-up Study (HYBRID).","authors":"Claudia Klüner, Benedikt Sundermann, Catalin George Iacoban, Daniel Behme, Kai Kallenberg, Olaf Wunderlich, Bernd Turowski, Wolfgang Reith, Thomas Liman, Thilo Rusche, Hannes Nordmeyer, Christian Mathys","doi":"10.1007/s00062-025-01578-5","DOIUrl":"10.1007/s00062-025-01578-5","url":null,"abstract":"<p><strong>Purpose: </strong>Stentretrievers are key devices for endovascular treatment of acute ischemic stroke. Aim of this post market clinical follow-up study was to asses safety and outcomes of interventions using the APERIO® Hybrid/Hybrid^17|21 thrombectomy device (AHD) in routine clinical use.</p><p><strong>Methods: </strong>We conducted a prospectively monitored, multicenter, national registry study with single-arm data collection including patients with acute intracranial vessel occlusion (anterior and posterior circulation, including medium vessel occlusions) who were treated with the AHD in Germany between November 2020 and June 2023. Patients (n = 173) with low pre-stroke morbidity (modified Rankin Scale [mRS] ≤ 2) were included. We assessed technical recanalization success (mTICI ≥ 2b), the occurrence of periprocedural symptomatic intracranial hemorrhages (sICH), good clinical outcome (mRS ≤ 2 at 90 days), and secondary outcomes.</p><p><strong>Results: </strong>Recanalization mTICI ≥ 2b was achieved in 84.4% with the AHD only, including 47.4% first pass success. Good clinical outcome at 90 days (mRS ≤ 2) was observed in 68.8%. Good primary safety outcome (no periprocedural sICH) was observed, notably even despite a high rate (79.8%) of stentretriever oversizing.</p><p><strong>Conclusion: </strong>The AHD is effective and safe. Technical success, primary safety and clinical outcomes surpassed earlier registries on different stentretrievers of the same and earlier generations. However, further studies are warranted to clarify whether these outcomes reflect true advantages of the device, improvements in thrombectomy setups and techniques, or selection biases.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"203-216"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13009069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145349463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Child with Epileptic Seizure: A Case of Significantly Enhanced MVNT.","authors":"Lei Fan, Jianshe Zhao","doi":"10.1007/s00062-025-01588-3","DOIUrl":"10.1007/s00062-025-01588-3","url":null,"abstract":"<p><strong>Objective: </strong>This case report aims to describe an unusual presentation of multinodular and vacuolating neuronal tumor (MVNT) in a pediatric patient, highlighting its atypical radiological and clinical features.</p><p><strong>Methods: </strong>We present the case of an 8-year-old boy with a 7-month history of seizures that progressed to daily episodes. Diagnostic workup included electroencephalography (EEG) and magnetic resonance imaging (MRI) with contrast. The lesion was resected surgically, and the diagnosis was confirmed histopathologically and immunohistochemically.</p><p><strong>Results: </strong>EEG revealed ictal discharges in the left central, parietal, and mid-posterior temporal regions. MRI showed a left frontal cortical lesion with T1 hypointensity, T2/FLAIR hyperintensity, and unusual marked contrast enhancement, mimicking ganglioglioma. Histopathological examination confirmed MVNT. Postoperatively, the patient experienced mild left limb weakness but remained seizure-free at one-month follow-up.</p><p><strong>Conclusion: </strong>This case illustrates that MVNT can rarely occur in children and may exhibit prominent contrast enhancement and a ganglioglioma-like imaging appearance, posing a diagnostic challenge. Neurosurgeons and neuroradiologists should consider MVNT in the differential diagnosis of enhancing cortical lesions in pediatric epilepsy patients. Histopathological verification remains essential for definitive diagnosis.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"19-22"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145452934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First-line Aspiration Thrombectomy with the RED43 Catheter for Acute Ischemic Stroke due to Medium or Distal Vessel Occlusion.","authors":"Vera Aebischer, Alex Brehm, Nikki Rommers, Alejandro Spiotta, Mohammad Sowlat, Karthik Raghuram, Justin M Cappuzzo, Jeffrey Beecher, Charles Matouk, Abdelaziz Amllay, Axel Rohr, Manraj Heran, David Volders, Pascal J Mosimann, Mohammad Al-Tibi, Johan Wassélius, Björn M Hansen, Markus Holtmannspötter, Martin Schlösser, Stephan Meckel, Oumaima Aoua, Suresh Giragani, Andrea Boghi, Nikolaos Ntoulias, Victor Schulze-Zachau, Ioannis Tsogkas, Kristine A Blackham, Aikaterini Anastasiou, Marios Psychogios","doi":"10.1007/s00062-025-01567-8","DOIUrl":"10.1007/s00062-025-01567-8","url":null,"abstract":"<p><strong>Purpose: </strong>Techniques for endovascular thrombectomy in acute ischemic stroke due to medium or distal vessel occlusions (MDVO) need to be improved, and first-line aspiration is emerging as a promising technique. The objective was to describe first-pass and final reperfusion rates with a triaxial direct aspiration first pass technique (ADAPT) and a novel, quadriaxial technique (QUATTRO-ADAPT) using RED43 Reperfusion Catheters to target MDVOs.</p><p><strong>Methods: </strong>This retrospective study collected data from 11 stroke centers in Europe and North America between 2023 and 2025. Patients with primary, isolated MDVOs who underwent thrombectomy using first-line aspiration with RED43 Reperfusion Catheters were included. Primary outcome was first-pass successful reperfusion rate (modified Treatment In Cerebral Infarction score ≥ 2b). Additionally, final reperfusion rates, complications and functional outcomes up to 90 days were evaluated.</p><p><strong>Results: </strong>We included 85 cases. Median age was 74 years (IQR 67-81) and median National Institutes of Health Stroke Scale score 9 (IQR 6-15). The majority (69.4%) had an occlusion of the co- or nondominant M2 segment of the middle cerebral artery. First-pass successful reperfusion was 63.5% overall, with 55.6% for the triaxial ADAPT and 69.4% for the quadriaxial QUATTRO-ADAPT. Final successful reperfusion was achieved in 96.5%. Complications included vessel perforations (2.4%), subarachnoid hemorrhage (3.5%), parenchymal hematoma type 2 (2.4%), and symptomatic intracerebral hemorrhage (1.2%). Functional independence (modified Rankin Scale 0-2) at 90 days was observed in 58.7%.</p><p><strong>Conclusion: </strong>This study shows that first-line aspiration, especially in a quadriaxial approach, can be effective and safe. These findings should be evaluated in prospective trials.</p>","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"185-194"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13008998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}