Journal of neuroendovascular therapy最新文献

{"title":"Impact of Intracranial Arterial Calcification on Outcomes of Mechanical Thrombectomy in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis.","authors":"Yoshihiro Omura, Shinya Imai, Takakazu Kawamata, Kiyotaka Iwasaki","doi":"10.5797/jnet.oa.2025-0119","DOIUrl":"10.5797/jnet.oa.2025-0119","url":null,"abstract":"<p><strong>Objective: </strong>Intracranial arterial calcification (ICAC) has been suggested to influence the outcomes of mechanical thrombectomy (MT) for acute ischemic stroke. We conducted a systematic review and meta-analysis to evaluate MT outcomes in patients with acute ischemic stroke and large-vessel occlusions involving intracranial calcified arteries.</p><p><strong>Methods: </strong>This study followed the Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Peer-reviewed studies were included if they evaluated intracranial arterial calcification (≥130 Hounsfield unit [HU] on noncontrast computed tomography) in patients undergoing MT within 24 h of acute ischemic stroke and reported modified Rankin Scale (mRS) score at 90 days or the final thrombolysis in cerebral infarction (TICI) grade. Four databases (PubMed, Cochrane Library, Web of Science, and Embase) were searched from inception to July 2025. Two reviewers independently screened and extracted the data and assessed their quality using the Newcastle-Ottawa Scale. Odds ratios (OR) were pooled using Mantel-Haenszel random-effects models, and heterogeneity was assessed using I<sup>2</sup>.</p><p><strong>Results: </strong>Among 968 records, 4 observational studies (n = 832; 2016-2024) met the inclusion criteria. All were adjusted for baseline factors using multivariable or propensity score models. The quality of the studies ranged from moderate to high. The ICAC definitions varied as follows: morphological (intimal vs. medial), location-based (symptomatic vs. asymptomatic), or volumetric assessments. Meta-analysis showed that ICAC-particularly in studies distinguishing intimal from medial calcification-was significantly associated with poor 90-day outcomes (mRS 3-6) (pooled OR 1.74; 95% CI 1.21-2.52; p <0.001; I<sup>2</sup> = 49%). In a subanalysis focusing on calcification volume, increased volume alone was not consistently associated with worse functional outcomes or lower reperfusion success (pooled OR ≈ 1.19; 95% CI 0.78-1.80). Collectively, the lack of association in the volume-based analysis and the significant association observed in studies incorporating intimal-medial differentiation suggest that lesion morphology-particularly the presence of intimal calcification-may exert a greater influence on MT outcomes than calcification volume itself.</p><p><strong>Conclusion: </strong>ICAC, especially when intimal calcification is present, is independently associated with procedural complexity and poor functional outcomes after thrombectomy for acute ischemic stroke. The divergent findings between the volume subanalysis and the broader morphology-based analysis highlight that morphology-driven, rather than volume-driven, calcification better explains outcome variability. Recognition of ICAC on baseline imaging may aid in prognostication, guide device strategies, and anticipate adjunctive interventions. Standardized assessments and prospective valid","PeriodicalId":73856,"journal":{"name":"Journal of neuroendovascular therapy","volume":"20 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12834648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146068908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improved Luminal Visualization of Flow Diverters after Deployment Using Non-Contrast-Enhanced 3D-TOF-MRA: A Comparison between the Flow-Redirection Endoluminal Device and the Pipeline Flex Embolization Device with Shield Technology.","authors":"Shin Hiraguchi, Shuzo Kanasaki, Hiroki Shibasaki, Masaki Ichihara, Yuuki Iida, Yuta Hirano, Shota Ido, Nobutake Sadamasa, Daisuke Yamada, Waro Taki","doi":"10.5797/jnet.oa.2025-0116","DOIUrl":"10.5797/jnet.oa.2025-0116","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to improve the accuracy of luminal evaluation of flow diverters (FDs) using non-contrast-enhanced 3D time-of-flight MRA (3D-TOF-MRA).</p><p><strong>Methods: </strong>The Flow-Redirection Endoluminal Device (FRED) and Pipeline Flex Embolization Device with Shield Technology (Pipeline) were deployed in phantom vessels with an inner diameter of 4 mm, and a phantom vessel without an FD was used as the reference. A diluted Gd contrast agent, adjusted to achieve a T1 relaxation time equivalent to that of blood, was circulated through the phantom vessels under steady flow conditions. Non-contrast-enhanced 3D-TOF-MRA images were acquired with varying echo time (TE), flip angle (FA), and Tilted Optimized Non-Saturating Excitation (TONE) ramp settings. Source images obtained from the central and edge regions of the stents were used to evaluate the relative in-stent signal (RIS) and lumen area ratio. In addition, the signal difference between the inflow and outflow regions was calculated and assessed as the saturation ratio.</p><p><strong>Results: </strong>RIS values for both FRED and Pipeline decreased with increasing TE at both the central and edge regions. A similar decreasing trend was observed for the area ratio. Overall, FRED demonstrated relatively higher RIS and area ratio values than Pipeline. Regarding the FA variation, the peak RIS at the center regions occurred at an FA of 35° for both FDs, followed by a plateau. In the TONE ramp analysis, a setting of 30% yielded a saturation ratio closest to 100%.</p><p><strong>Conclusion: </strong>These findings suggest that luminal visualization of FDs can be improved by optimizing 3D-TOF-MRA acquisition parameters, particularly the TE, FA, and TONE ramp settings.</p>","PeriodicalId":73856,"journal":{"name":"Journal of neuroendovascular therapy","volume":"20 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12981937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147464364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seizure-Induced Transient Early Venous Visualization on Angiography in Glioblastoma: A Case Report.","authors":"Daiki Aburakawa, Atsushi Kanoke, Hiroki Uchida, Hiroyuki Sakata, Hidenori Endo","doi":"10.5797/jnet.cr.2025-0164","DOIUrl":"https://doi.org/10.5797/jnet.cr.2025-0164","url":null,"abstract":"<p><strong>Objective: </strong>We report a case of seizure-associated transient early venous visualization (EVV) on cerebral angiography in a patient with glioblastoma mimicking arteriovenous shunting pathology.</p><p><strong>Case presentation: </strong>A 48-year-old woman presented with new-onset generalized tonic-clonic seizures. Brain MRI revealed a poorly demarcated, non-enhancing lesion in the left temporal lobe. Arterial spin labeling (ASL) demonstrated marked hyperperfusion within the lesion and adjacent venous sinuses. Cerebral angiography performed approximately 2 h following seizure cessation showed posterior temporal artery dilation and an EVV pattern, with shunting into the vein of Labbé and the ipsilateral transverse and sigmoid sinuses; this raises suspicion for an arteriovenous shunting lesion. No definitive arteriovenous fistulae or thromboses were identified. The patient was managed with antiepileptic therapy alone, which led to clinical improvement. Follow-up MRI and angiography 2 weeks later revealed complete resolution of ASL hyperperfusion and the EVV pattern. Subsequent histopathological examination of the resected tumor confirmed isocitrate dehydrogenase (IDH)-wild-type small cell glioblastoma. Despite the underlying malignant tumor and persistent seizure susceptibility, the angiographic abnormalities and altered venous drainage were entirely reversible and seizure-induced, rather than structurally pathological.</p><p><strong>Conclusion: </strong>This case illustrates that ictal or postictal cerebral hyperperfusion can produce transient EVV on cerebral angiography, even with aggressive neoplasms such as glioblastoma. Recognizing this phenomenon is essential to avoid misdiagnosing a true arteriovenous shunting lesion, thereby preventing unnecessary intervention procedures and guiding appropriate management. When interpreting angiographic abnormalities observed shortly after seizures, integration of perfusion-based MRI findings with the temporal evolution of symptoms is crucial.</p>","PeriodicalId":73856,"journal":{"name":"Journal of neuroendovascular therapy","volume":"20 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13107188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomy of the Middle Meningeal Artery: Implications for Middle Meningeal Artery Embolization in Chronic Subdural Hematoma.","authors":"Takahiro Ota","doi":"10.5797/jnet.ra.2025-0131","DOIUrl":"https://doi.org/10.5797/jnet.ra.2025-0131","url":null,"abstract":"<p><p>Chronic subdural hematoma (cSDH) is among the most common neurosurgical conditions, particularly affecting older adults and patients receiving anticoagulation. While burr-hole evacuation has long been the standard therapy, recurrence rates and associated morbidity remain significant. Middle meningeal artery (MMA) embolization has recently emerged as a promising alternative or adjunctive treatment, offering durable hematoma control with reduced recurrence. To understand the rationale and safety of this endovascular approach, detailed knowledge of MMA anatomy, embryology, and variations is essential. This review synthesizes current understanding of the MMA from gross and microvascular perspectives, integrating embryological origins, common and rare anatomical variants, and dural angioarchitecture, with emphasis on how these factors inform embolization strategies for cSDH. By bridging historical anatomical insights with contemporary angiographic and clinical evidence, we aim to provide a comprehensive resource for clinicians and researchers involved in neuroendovascular therapy.</p>","PeriodicalId":73856,"journal":{"name":"Journal of neuroendovascular therapy","volume":"20 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12910478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146222326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Radiographic Course Following Middle Meningeal Artery Embolization for Chronic Subdural Hematoma.","authors":"Kohei Chida, Yosuke Akamatsu","doi":"10.5797/jnet.ra.2025-0140","DOIUrl":"https://doi.org/10.5797/jnet.ra.2025-0140","url":null,"abstract":"<p><p>Middle meningeal artery embolization (MMAE) for chronic subdural hematoma (CSDH) is increasingly performed to reduce recurrence. Several recent randomized controlled trials, such as EMBOLISE, MAGIC-MT, and STEM, have shown significant interest in endovascular treatment of CSDH. Many studies have demonstrated clinical and radiographic outcomes following MMAE in different patient populations and treatment strategies, including stand-alone or adjunctive MMAE combined with surgical evacuation. Most studies have shown the efficacy of MMAE in reducing hematoma recurrence, reoperation rates, and even several adverse events compared with surgery alone. Moreover, stand-alone MMAE can be an efficacious and minimally invasive treatment option for some patients. However, its benefits on functional or radiographic outcomes vary depending on patient selection and treatment strategy. Furthermore, knowledge of periprocedural radiographic findings associated with hematoma resolution or reaccumulation after MMAE may contribute to a sufficient follow-up period after treatment, as well as to medical economics, and thus has clinical implications. In this review, we focus on the clinical and radiographic outcomes of MMAE for CSDH.</p>","PeriodicalId":73856,"journal":{"name":"Journal of neuroendovascular therapy","volume":"20 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12916221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146230064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Analysis of Periprocedural Complications in Mechanical Thrombectomy for Acute Occlusion of the Intracranial Artery.","authors":"Takao Kojima, Takuya Maeda, Yuhei Ito, Haruhiko Kikuta, Masazumi Fujii","doi":"10.5797/jnet.oa.2025-0066","DOIUrl":"10.5797/jnet.oa.2025-0066","url":null,"abstract":"<p><strong>Objective: </strong>Mechanical thrombectomy has become an established treatment for acute ischemic stroke caused by acute intracranial artery occlusion, but periprocedural complications may adversely affect outcomes. This study aimed to identify clinical and procedural factors associated with periprocedural complications following mechanical thrombectomy and to clarify their impact on prognosis.</p><p><strong>Methods: </strong>We conducted a multicenter observational study of patients who underwent mechanical thrombectomy for acute intracranial artery occlusion between January 2016 and June 2022 across 11 stroke centers in Fukushima Prefecture, Japan. Data were collected from a retrospective registry (January 2016-December 2019) and a prospective registry (January 2020-June 2022). Periprocedural complications were defined as adverse events occurring during or within 24 h after the procedure, including hemorrhagic, ischemic, device-related, and extracranial complications. Univariate and multivariable logistic regression analyses were performed to identify independent predictors of periprocedural complications.</p><p><strong>Results: </strong>A total of 487 patients were included in the analysis. Periprocedural complications occurred in 66 patients (13.6%). The most frequent procedure-related events were perforator injury (n = 18, 3.7%), vessel perforation (n = 9), and contrast-induced hemorrhage (n = 4). Post-procedural complications mainly included hemorrhagic transformation (n = 16). Compared with patients without complications, those with complications had a higher prevalence of atrial fibrillation (62.1% vs. 46.6%, p = 0.019), less frequent intravenous recombinant tissue plasminogen activator use (37.9% vs. 52.0%, p = 0.033), and longer puncture to recanalization time (76.5 vs. 57 min, p = 0.012). Symptomatic intracranial hemorrhage occurred exclusively in the complication group (31.8% vs. 0%, p <0.001). Patients with complications had a lower rate of favorable functional outcomes (modified Rankin Scale score 0-2 at 90 days, 18.2% vs. 42.6%, p <0.001). Multivariable analysis identified atrial fibrillation (odds ratio [OR] 1.885, 95% confidence interval [CI] 1.084-3.276, p = 0.025) and prolonged procedure time (per minute; OR 1.007, 95% CI 1.001-1.013, p = 0.017) as independent predictors of periprocedural complications.</p><p><strong>Conclusion: </strong>Atrial fibrillation and longer procedure time were independently associated with periprocedural complications. Perforator injury and hemorrhagic transformation were major contributors to adverse events, with symptomatic intracranial hemorrhage leading to severe disability or death in most affected patients.</p>","PeriodicalId":73856,"journal":{"name":"Journal of neuroendovascular therapy","volume":"20 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12872328/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146127511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum: The Qualification Examination for Specialists and Instructors in the Japanese Society of Neuroendovascular Therapy: History and Current Status.","authors":"","doi":"10.5797/jnet.err.2026-1000","DOIUrl":"10.5797/jnet.err.2026-1000","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.5797/jnet.sr.2024-0099.].</p>","PeriodicalId":73856,"journal":{"name":"Journal of neuroendovascular therapy","volume":"20 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13006170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nurse Practitioner Contribution to Shortening the Time from Angiography Suite Entry to Puncture in Mechanical Thrombectomy for Acute Ischemic Stroke.","authors":"Nanae Seino, Hidemichi Ito, Masashi Uchida, Satoshi Takaishi, Hibiki Kitahara, Shigeki Fujitani, Toshihiro Ueda, Hidetoshi Murata","doi":"10.5797/jnet.oa.2025-0130","DOIUrl":"https://doi.org/10.5797/jnet.oa.2025-0130","url":null,"abstract":"<p><strong>Objective: </strong>Minimizing the time to reperfusion is a critical determinant of the prognosis of acute ischemic stroke (AIS). To reduce the workload of neurosurgeons, improve efficiency, and shorten the time required for AIS management delivered by the neurosurgical department, a nurse practitioner (NP) was introduced in April 2019. However, the effect of NP involvement on post-door-to-needle (D2N) intervals, particularly time to reperfusion, has not been clarified. This study examined whether NP participation was associated with shorter post-D2N time metrics in patients with AIS undergoing mechanical thrombectomy (MT).</p><p><strong>Methods: </strong>This study included all consecutive patients with AIS due to intracranial large vessel occlusion who underwent MT between April 2019 and March 2024 at our institution. Patients with NP involvement were assigned to the NP group, and those without NP involvement were assigned to the non-NP group. NP participation was randomly determined according to their duty schedule. The primary outcomes were the median times from angiography suite entry-to-puncture (E2P) and from suite entry-to-recanalization (E2R). Secondary outcomes included onset-to-puncture (O2P), puncture-to-recanalization (P2R), door-to-entry (D2E), door-to-puncture (D2P), and the proportion of patients with a modified Rankin Scale (mRS) score of 0-2 at discharge. Statistical analyses included univariate and multivariate linear regression analysis, with significance set at p <0.05.</p><p><strong>Results: </strong>In total, 115 patients were included: 44 in the NP group and 71 in the non-NP group. The baseline patient characteristics were comparable. The median E2P was significantly shorter in the NP group (15 vs. 21 min; p <0.05), representing a 6-min reduction (28.6%). The median E2R was 73 vs. 76.5 min, showing a nonsignificant 3.5-min decrease. Among the secondary metrics, D2P was shorter in the NP group, whereas the O2P, P2R, and D2E levels did not differ significantly. In the multivariate linear regression analyses, only E2P remained independently associated with NP involvement. The proportion of patients with favorable outcomes (mRS 0-2) at discharge was higher in the NP group (27.3% vs. 19.7%), although the difference was not significant.</p><p><strong>Conclusion: </strong>NP participation significantly reduced E2P time. These findings suggest that NP involvement contributes to shortening the treatment time in the post-D2N phase and may have a crucial role in promoting efficient team-based care in AIS management.</p>","PeriodicalId":73856,"journal":{"name":"Journal of neuroendovascular therapy","volume":"20 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12967338/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147391837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging Technique with a Stent Retriever for Iatrogenic Internal Carotid Artery Occlusion during Coil Embolization of a Ruptured Aneurysm.","authors":"Munenari Matsuishi, Yoshinobu Horio, Kazumasa Senju, Shintaro Yoshinaga, Koichiro Takemoto, Hiroshi Abe","doi":"10.5797/jnet.cr.2025-0148","DOIUrl":"https://doi.org/10.5797/jnet.cr.2025-0148","url":null,"abstract":"<p><strong>Objective: </strong>Iatrogenic arterial dissection is a rare complication in neuroendovascular procedures, with an incidence of 0.15%-0.4% in the cervical carotid artery. In ruptured aneurysm cases, preoperative antiplatelet therapy is usually not administered, and immediate carotid artery stenting (CAS) in the event of occlusive dissection may lead to thrombosis. Even when antiplatelet drugs are administered urgently, their delayed onset may lead to in-stent thrombosis, resulting in cerebral ischemia. We report a case of intraoperative iatrogenic internal carotid artery (ICA) occlusion during coil embolization for a ruptured aneurysm, successfully managed by temporary flow restoration using a stent retriever until antiplatelet efficacy was achieved.</p><p><strong>Case presentation: </strong>A 51-year-old woman presented with diffuse subarachnoid hemorrhage caused by rupture of a left internal carotid-posterior communicating aneurysm. During coil embolization, dissection of the cervical ICA led to acute occlusion. After nasogastric administration of aspirin (200 mg) and prasugrel (20 mg), a Trevo NXT ProVue Retriever (6 × 37 mm) was deployed to restore antegrade flow. Following confirmation of stable perfusion, a Precise stent (8 × 40 mm) was placed after 1 h. No thrombotic or ischemic events occurred. Postoperative MRI showed no infarction, and the patient was discharged with modified Rankin Scale 0 at 3 weeks. Six-month angiography confirmed complete healing of the dissection and durable patency of the ICA.</p><p><strong>Conclusion: </strong>In ruptured aneurysm cases complicated by intraoperative iatrogenic ICA occlusion, temporary flow restoration using a stent retriever can serve as a safe and effective bridging strategy to prevent ischemia until antiplatelet agents become effective, allowing delayed CAS without thromboembolic complications.</p>","PeriodicalId":73856,"journal":{"name":"Journal of neuroendovascular therapy","volume":"20 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12989254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147470430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intra-Distal Access Catheter Deployment of the Surpass Evolve Device: A Novel Technique to Prevent Advancement of the Delivery Wire: A Case Report and Literature Review.","authors":"Miku Sugai, Hiroaki Neki, Yoshinobu Kamio, Kazuhiko Kurozumi","doi":"10.5797/jnet.cr.2026-0010","DOIUrl":"https://doi.org/10.5797/jnet.cr.2026-0010","url":null,"abstract":"<p><strong>Objective: </strong>Flow diverter stent (FDS) deployment in neuroendovascular therapy carries a risk of vessel injury related to unintended distal advancement of the delivery wire, particularly in cases with distal aneurysms. Safe control of wire behavior during deployment remains challenging. We describe a deployment strategy using a distal access catheter (DAC) to mitigate this risk.</p><p><strong>Case presentation: </strong>We report a case of a 79-year-old man with multiple intracranial aneurysms, including a symptomatic large aneurysm of the right internal carotid artery and an additional distal aneurysm at the middle cerebral artery bifurcation. A Surpass Evolve Flow Diverter (Stryker, Kalamazoo, MI, USA) was deployed in the right internal carotid artery. The device was initially deployed using the standard technique; however, the deployment strategy was subsequently changed to release the device within the DAC, followed by gradual unsheathing of the catheter, to mitigate the risk of distal advancement of the delivery wire. The FDS was successfully deployed without distal wire migration or vessel injury. The postoperative course was uneventful, with no procedure-related complications.</p><p><strong>Conclusion: </strong>This case highlights a practical rescue strategy for situations in which distal wire control during FDS deployment is particularly important. Deploying an FDS within a DAC and releasing it by unsheathing may help mitigate the risk of uncontrolled distal wire advancement and enhance procedural safety in carefully selected complex cases with distal aneurysms.</p>","PeriodicalId":73856,"journal":{"name":"Journal of neuroendovascular therapy","volume":"20 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13128311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}