Journal of neuroendovascular therapy最新文献

{"title":"A Left Transradial Approach with the Upper Limb in External Rotation for Embolization of Sacral Vascular Lesions: A Technical Note.","authors":"Sora Yazaki, Hidemichi Ito, Toshihiro Ueda, Masashi Uchida, Satoshi Takaishi, Takayuki Fukano, Kentaro Tatsuno, Noriko Usuki, Yuichiro Kushiro, Hidetoshi Murata","doi":"10.5797/jnet.tn.2025-0132","DOIUrl":"10.5797/jnet.tn.2025-0132","url":null,"abstract":"<p><strong>Objective: </strong>Spinal arteriovenous shunt diseases in the sacral region are exceedingly rare and present unique challenges for endovascular access, particularly in patients with tortuous aortoiliac anatomy. While the transradial approach (TRA) is emerging as a less invasive alternative to transfemoral access, the left TRA with external upper-limb rotation may offer additional advantages for targeting sacral lesions.</p><p><strong>Case presentation: </strong>We report a case of a 51-year-old woman presenting with progressive lower back pain, bilateral lower extremity weakness, and gait disturbance. Images revealed a perimedullary arteriovenous fistula (AVF) at the thoracolumbar level and an extradural AVF at the sacral region. After surgical treatment of the thoracolumbar lesion, the sacral extradural AVF was embolized using a left distal TRA, with the patient's left upper limb externally rotated by approximately 90°. A 6-Fr, 122-cm guiding sheath was advanced from the anatomical snuffbox into the right internal iliac artery, and the fistula was then accessed via the right lateral sacral artery using a microcatheter, followed by coil and liquid embolic agent deployment for complete occlusion.</p><p><strong>Conclusion: </strong>The left TRA with external upper limb rotation represents a feasible, safe, and potentially advantageous technique for endovascular treatment of sacral vascular lesions, particularly in patients for whom transfemoral or right TRA are unsuitable.</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/PMC12861588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146108888","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 Computed Tomography Imaging Post-Flow Diverter Treatment Using a SOMATOM X.Cite Scanner.","authors":"Tetsu Yamaki, Rei Kondo, Kosuke Satake, Masahiro Tanaka, Yu Shimokawa, Atsushi Kuge, Yukihiko Sonoda","doi":"10.5797/jnet.oa.2025-0075","DOIUrl":"10.5797/jnet.oa.2025-0075","url":null,"abstract":"<p><strong>Objective: </strong>Treatment with flow diverters requires follow-up imaging. Conventional CT suffers from beam-hardening artifacts caused by the stent, complicating the evaluation. This study introduced the SOMATOM X.cite (Siemens Healthineers, Forchheim, Germany) scanner to improve imaging quality for stent follow-up and examined its image output (stent condition).</p><p><strong>Methods: </strong>From January 2021 to April 2024, 27 patients treated with flow diverters were imaged using SOMATOM X.cite, conventional CT, and the ARTIS icono D-Spin system (Siemens Healthineers). The aneurysm locations included the internal carotid artery-specifically, 11 cases in the paraclinoid segment and 8 in the cavernous segment, as well as the vertebral artery in 8 patients. The aneurysm sizes were ≥10 mm (14 cases) and 5-10 mm (13 cases). The image quality of the stented parent artery was subjectively scored on a 2-point scale, adapted from a previous report in which a 3-point scale had originally been used, as follows: 1 = moderate (evaluation could be made but information was lacking compared with DSA), and 2 = good (image could be evaluated similarly to DSA).</p><p><strong>Results: </strong>Compared with conventional contrast-enhanced CT, the SOMATOM X.cite significantly reduced beam-hardening artifacts around the stent. In 26 of 27 cases, stent-condition CT images acquired with the SOMATOM X.cite were rated as 2 (good), providing clear visualization of the stent lumen and similar in quality to cone-beam CT. One case had reduced contrast, making aneurysm visualization difficult. In comparison, 27 conventional CT images were rated 1 (moderate).</p><p><strong>Conclusion: </strong>The SOMATOM X.cite scanner provided high-quality imaging comparable to cone-beam CT; thus, it may be a useful tool for follow-up evaluation after flow diverter stenting.</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/PMC12834647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146068995","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":"Single-Phase CTA Guided by the Time-Enhancement Curve Derived from CT Perfusion for Mechanical Thrombectomy.","authors":"Ayuka Tanzawa, Nobuo Senbokuya, Hideyuki Yoshioka, Masahiro Shimizu, Hiroyuki Kinouchi","doi":"10.5797/jnet.oa.2025-0109","DOIUrl":"https://doi.org/10.5797/jnet.oa.2025-0109","url":null,"abstract":"<p><strong>Objective: </strong>Mechanical thrombectomy (MT) is currently the standard treatment for large vessel occlusion (LVO). However, advancing a microcatheter and microguidewire into non-visualized distal vessels carries a risk of vascular perforation, potentially resulting in serious hemorrhagic complications. This study aimed to evaluate the usefulness of a new imaging protocol using single-phase CTA guided by the time-enhancement curve (TEC) derived from CT perfusion (CTP) in patients with anterior circulation LVO undergoing MT, for improving distal vessel visualization compared with conventional CTA using a bolus-tracking (BT) method.</p><p><strong>Methods: </strong>Patients with anterior circulation LVO (intracranial internal carotid artery, M1 or proximal M2 segment of the middle cerebral artery) who underwent MT were retrospectively analyzed. The conventional BT-CTA protocol was used between October 2018 and June 2020, and a new CTP-derived TEC-guided CTA (TEC-CTA) protocol was used between July 2020 and August 2023. In the TEC-CTA protocol group, the scan timing of CTA was determined according to the TEC obtained from CTP to achieve optimal contrast filling of distal vessels. Visualization of vessels distal to the occlusion site was graded on a 4-point scale (0-3) and compared between the 2 protocols. Scores of 2 and 3 were considered useful for predicting the extent of thrombus and the vessel course. Additional outcomes included the puncture-to-recanalization time (PRT), thrombolysis in cerebral infarction (TICI) grade, complications, and modified Rankin Scale (mRS) score at 90 days.</p><p><strong>Results: </strong>Sixteen and 46 patients underwent MT using the BT-CTA and TEC-CTA protocols, respectively. The incidence of well-visualized vessels overall (score of 2 or 3) was significantly higher in the TEC-CTA protocol group than in the BT-CTA protocol group (80.4% vs. 37.5%; p = 0.0033). The PRT was significantly shorter in the TEC-CTA protocol group than in the BT-CTA protocol group (44 vs. 58 min; p = 0.0134). The proportion of patients with TICI ≥2b after revascularization appeared to be higher using the TEC-CTA protocol (82.6% vs. 75.0%), but this was not significant. No intraprocedural vascular perforation occurred in either protocol, and no significant difference was observed in the frequency of intracranial hemorrhage between the protocols. The proportion of patients whose mRS score was ≤3 at 90 days after stroke onset was significantly higher in the TEC-CTA protocol group than in the BT-CTA protocol group (56.5% vs. 25%; p = 0.0424).</p><p><strong>Conclusion: </strong>CTA performed with scan timing guided by CTP-derived TEC improves visualization of occluded vessels, contributing to safer and more effective MT.</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/PMC12967852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147438174","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":"Feasibility and Safety of Transradial Approach with 8-French Balloon Guide Catheter for Carotid Artery Stenting: Case Series.","authors":"Daigo Kojima, Yasuyoshi Shimada, Kenya Miyoshi, Kengo Setta, Hiroshi Kashimura, Yosuke Akamatsu","doi":"10.5797/jnet.oa.2025-0129","DOIUrl":"https://doi.org/10.5797/jnet.oa.2025-0129","url":null,"abstract":"<p><strong>Objective: </strong>The use of an 8-French (Fr) balloon guide catheter (BGC) for carotid artery stenting (CAS) using a transradial approach (TRA) has been limited by the small size of the radial artery (RA) and anatomical challenges, including difficulties with catheter navigation and concerns regarding device slippage. This study aimed to evaluate the technical feasibility and safety of TRA-CAS using an 8-Fr BGC.</p><p><strong>Methods: </strong>We retrospectively reviewed consecutive patients who underwent TRA-CAS with an 8-Fr BGC (Emboguard [Cerenovus, Galway, Ireland], Flowgate2 [Stryker Neurovascular, Fremont, CA, USA], Optimo EPD FLEX [Tokai Medical Products, Aichi, Japan], or Branchor XS/XF [Asahi Intecc, Aichi, Japan]). Introduction of the BGC was performed with either a sheath-based or sheathless approach, selected at the discretion of the operator. Considering the outer diameter of the 8-Fr BGCs, the eligibility criteria included RA diameter ≥2.8 mm on vascular ultrasonography and a waveform other than type D by the BARBEAU test. Patient demographics and procedural and clinical outcomes at 90 days or later were evaluated.</p><p><strong>Results: </strong>Twenty-one CAS procedures were attempted using an 8-Fr BGC via the TRA; 19 (90.5%) procedures were planned via the conventional RA and 2 (9.5%) via the distal RA. The lesion side was the right side in 14 patients (66.7%) and the left side in 7 (33.3%). Radial access success was achieved in 20 of 21 cases (95.2%); the remaining case required conversion to a transbrachial approach due to access site hematoma. Among the 20 cases with successful radial access, CAS was completed via the TRA/transdistal radial approach without conversion (technical success, 100%). BGC prolapse toward the aortic arch was observed in 6 cases. Balloon inflation was performed to stabilize the BGC in all cases. In 1 of these 6 cases, turnover of the BGC at the aortic valve was additionally required due to prolapse into the aortic arch. One case required device exchange due to BGC kinking. RA occlusion occurred in 1 case (4.8%), with no major complications.</p><p><strong>Conclusion: </strong>CAS via TRA with an 8-Fr BGC appears feasible and safe in patients with RA diameter ≥2.8 mm, and the balloon properties may improve stability under conditions of challenging anatomy, making this a valuable option for carotid revascularization.</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/PMC12975326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147446219","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 Utility and Limitations of Photon-Counting Detector CTA in the Follow-Up of Flow Diverter Stent.","authors":"Hideaki Shigematsu, Azusa Sunaga, Akihiro Hirayama, Takahiro Osada, Takatoshi Sorimachi, Masamichi Takahashi","doi":"10.5797/jnet.oa.2025-0139","DOIUrl":"10.5797/jnet.oa.2025-0139","url":null,"abstract":"<p><strong>Objective: </strong>Flow diverters (FDs) are widely used to treat intracranial aneurysms, with DSA serving as the gold standard for follow-up evaluation. Although a few studies have reported the use of photon-counting detector CTA (PCD-CTA) for minimally invasive follow-up after standalone FD treatment, PCD-CTA after coil-assisted FD placement has never been documented.</p><p><strong>Methods: </strong>We retrospectively analyzed 11 patients who underwent FD placement between May 2023 and December 2024, all of whom underwent post-procedural evaluation with PCD-CTA. Patients were categorized into 2 groups: standalone FD (n = 6) and coil-assisted FD (n = 5). PCD-CTA was performed on postoperative day 1, at 6 months, and at 12 months. Metal artifact reduction was applied in the coil-assisted group.</p><p><strong>Results: </strong>In the standalone FD group, PCD-CTA enabled reliable assessment of the in-stent lumen, FD apposition to the parent artery, and aneurysm occlusion, with findings consistent with those of DSA. In the coil-assisted FD group, when coils extended near the FD, evaluation of the in-stent lumen, FD-to-parent artery apposition, and aneurysm occlusion was hindered by metal artifacts in slices containing coils. Conversely, when coils were absent near the FD, partial visualization of intra-aneurysmal contrast was possible, although residual aneurysms tended to be underestimated.</p><p><strong>Conclusion: </strong>PCD-CTA demonstrated diagnostic performance comparable to that of DSA for postoperative evaluation following standalone FD placement. However, in coil-assisted FD cases, postoperative assessment remained limited by coil-related metal artifacts.</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/PMC12981938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147464388","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":"Parent Artery Occlusion for a Giant Serpentine Aneurysm of the Internal Carotid Artery under Electrophysiological Monitoring: A Case Report.","authors":"Ryota Hagihara, Makoto Isozaki, Ayumi Akazawa, Ken Matsuda, Hidetaka Arishima, Kenichiro Kikuta","doi":"10.5797/jnet.cr.2025-0147","DOIUrl":"10.5797/jnet.cr.2025-0147","url":null,"abstract":"<p><strong>Objective: </strong>Giant serpentine aneurysms (GSAs) are a rare subtype of giant intracranial aneurysms characterized by partial thrombosis and a tortuous serpentine vascular channel. We report a case of pediatric GSA of the right internal carotid artery (ICA) in which ischemic tolerance was assessed using balloon test occlusion (BTO) with motor-evoked potential (MEP)/somatosensory-evoked potential (SEP) monitoring under general anesthesia, followed by parent artery occlusion (PAO).</p><p><strong>Case presentation: </strong>A 9-year-old boy was referred to our hospital for decreased right visual acuity detected during a school screening. Imaging revealed a GSA of approximately 39 mm extending from the siphon to the terminus of the right ICA. Under general anesthesia, BTO was performed with concurrent MEP and SEP monitoring. A transient decrease in MEP occurred 18 min after occlusion; however, the waveform recovered immediately with +10% stimulation intensity, and no further MEP deterioration was observed during BTO (total 30 min). PAO of the right ICA was then performed using the double-catheter technique. Postoperatively, the patient developed mild transient left upper limb weakness, and MRI revealed luxury perfusion; both the conditions resolved within a few days without infarct extension. The patient was discharged on postoperative day 10 without any new neurological deficits.</p><p><strong>Conclusion: </strong>This case suggests that when awake BTO is difficult to perform in pediatric patients, BTO with electrophysiological monitoring under general anesthesia can be useful, while highlighting the limitations of MEP monitoring. As a clinical symptom-based assessment is impossible during BTO performed under general anesthesia, a multimodal assessment may further enhance safety when transient MEP deterioration occurs. At present, BTO performed under MEP monitoring should be interpreted as a supplementary assessment to be used only when other alternative methods are unavailable.</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/PMC12983365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147464405","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":"Impact of RAPID-Based Patient Selection on Endovascular Therapy Outcomes in Acute Ischemic Stroke: A Retrospective Comparative Study.","authors":"Naruhiko Kamogawa, Manabu Inoue, Yusuke Yakushiji, Shigeru Fujimoto, Masafumi Ihara, Masatoshi Koga, Nobuyuki Sakai","doi":"10.5797/jnet.oa.2025-0138","DOIUrl":"https://doi.org/10.5797/jnet.oa.2025-0138","url":null,"abstract":"<p><strong>Objective: </strong>Perfusion imaging is widely used in acute ischemic stroke to guide endovascular thrombectomy (EVT). This study evaluated clinical outcomes among patients selected for EVT using perfusion software-based analysis compared with those selected without it.</p><p><strong>Methods: </strong>We conducted a retrospective comparative analysis of patients with large- or medium-vessel occlusion who underwent EVT between 2024 and 2025. Patients were categorized into a perfusion software group (RAPID implementation period) and a non-perfusion software group (non-RAPID period) based on the use of RAPID imaging software (iSchemaView, Menlo Park, CA, USA). The primary outcome was the proportion of patients achieving a good clinical outcome at 90 days, defined as a modified Rankin Scale (mRS) score of 0-3. Secondary outcomes included a shift analysis of mRS scores, procedural time metrics, all hemorrhagic events including symptomatic intracerebral hemorrhage (sICH), and 90-day mortality.</p><p><strong>Results: </strong>A total of 54 patients were included (RAPID implementation period, 26; non-RAPID period, 28). At 90 days, the proportion of patients achieving a good outcome (mRS 0-3) was similar between the RAPID implementation period group and the non-RAPID period group (50.0% vs. 46.4%; P = 0.72). In the ordinal shift analysis of mRS scores, there was no significant difference in the overall distribution between groups (common odds ratio, 0.91; 90% confidence interval [CI], 0.41-1.99; P = 0.84). The median time from hospital arrival to groin puncture was also similar-45 min (interquartile range [IQR], 40-58) versus 46 min (IQR, 39-63; P = 0.96). The incidences of any intracerebral hemorrhage (30.8% vs. 32.1%), sICH (0% vs. 3.6%), and 90-day mortality (15.0% vs. 7.1%) were likewise comparable between the RAPID and non-RAPID periods.</p><p><strong>Conclusion: </strong>These findings suggest that automated, perfusion-based patient selection enhances workflow standardization and can be seamlessly integrated into acute stroke management to optimize both speed and safety.</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/PMC12928845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286458","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":"Middle Meningeal Artery Embolization Using a 4-Fr Diagnostic Catheter as a Guiding System via a Transradial Approach for Chronic Subdural Hematoma.","authors":"Yoshinobu Horio, Kenji Fukuda, Koichiro Suzuki, Ryuhei Takeyama, Yuta Oka, Rina Shibayama, Kazumasa Senju, Munenari Matsuishi, Shintaro Yoshinaga, Jota Tega, Koichiro Takemoto, Hiroshi Abe","doi":"10.5797/jnet.tn.2026-0008","DOIUrl":"https://doi.org/10.5797/jnet.tn.2026-0008","url":null,"abstract":"<p><strong>Objective: </strong>Middle meningeal artery embolization (MMAE) has emerged as an effective minimally invasive treatment for chronic subdural hematoma (CSDH). Although the transradial approach (TRA) is increasingly used in neuroendovascular procedures, evidence regarding its feasibility for MMAE using a 4-Fr diagnostic catheter as a guiding system remains limited.</p><p><strong>Methods: </strong>This single-center retrospective study included 22 consecutive patients who underwent MMAE for CSDH between April 2023 and October 2025. Patients treated before October 2024 underwent transfemoral approach (TFA), whereas those treated thereafter underwent TRA following an institutional shift to a radial-first strategy. Procedural metrics, access-site complications, and functional outcomes were compared.</p><p><strong>Results: </strong>Thirteen patients underwent TRA and 9 underwent TFA. All procedures were technically successful. Compared with TFA, TRA was associated with significantly shorter procedure time (86 vs. 143 min, p = 0.003), reduced fluoroscopy time (44 vs. 112 min, p <0.001), and lower contrast volume (55 vs. 130 mL, p = 0.001). No access-site complications occurred in the TRA group, whereas 1 patient in the TFA group developed a fatal femoral-site infection.</p><p><strong>Conclusion: </strong>MMAE using a 4-Fr diagnostic catheter as a guiding system is feasible and safe and was associated with favorable procedural efficiency in this series. The observed advantages likely reflect the guiding strategy and system configuration rather than an intrinsic superiority of a specific vascular access route and may be applicable across different access strategies in frail older patients with 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/PMC13107187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791355","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":"Factors Associated with the Venous Penetration of a NBCA-Lipiodol Mixture during Transarterial Embolization: A Clinical Study of Intracranial Dural Arteriovenous Fistulas.","authors":"Taiga Matsumoto, Hiro Kiyosue, Yasuyuki Kaku, Hiroyuki Uetani, Yoshitaka Tamura, Hiromitsu Hayashi, Shin-Ichiro Kumita, Toshinori Hirai","doi":"10.5797/jnet.oa.2025-0160","DOIUrl":"https://doi.org/10.5797/jnet.oa.2025-0160","url":null,"abstract":"<p><strong>Objective: </strong>N-butyl cyanoacrylate (NBCA) must reach the venous side beyond the fistulous point (venous penetration) for the successful transarterial embolization of dural arteriovenous fistulas (DAVFs). The purpose of this study is to identify several factors associated with the venous penetration of NBCA.</p><p><strong>Methods: </strong>One hundred and thirty-four transarterial embolization procedures using an NBCA-lipiodol mixture (NBCA-Lip) in 38 consecutive patients with DAVFs treated at Kumamoto University Hospital were reviewed. DSA images before, during, and after the injection of NBCA-Lip, as well as procedure records, were reviewed with particular interest in the venous penetration of NBCA-Lip and factors potentially associated with the venous penetration, including volume rates of NBCA-Lip, artery injected, types of feeding artery injected (proper feeder or proximal feeder), status of injection (wedged or non-wedged), position of a microcatheter in relation to the sharp bend of the feeder, and use of adjunctive techniques. The correlation between venous penetration of NBCA-Lip with these factors was statistically analyzed using XLSTAT software (Lumina Decision Systems, Campbell, CA, USA).</p><p><strong>Results: </strong>Among 134 NBCA-Lip injections, venous penetration was achieved in 68 injections (50.7%) and was significantly associated with injection from the proper feeder (odds ratio [OR], 11.9; 95% confidence interval [CI], 4.6-31.3; p <0.001), wedged injection (OR, 5.6; 95% CI, 2.6-11.9; p <0.001), injection in the non-curved position (OR, 15.9; 95% CI, 6.8-36.9; p <0.001), and injection with adjunctive techniques (OR, 2.1; 95% CI, 1.0-4.4; p = 0.04). Multivariate logistic regression analysis showed that wedged injection (OR, 8.8; 95% CI, 3.0-26.0; p <0.001) and injection in the non-curved position (OR, 25.0; 95% CI, 9.1-100.0; p <0.001) independently predicted venous penetration.</p><p><strong>Conclusion: </strong>The venous penetration of injected NBCA-Lip is significantly affected by the position and status of the microcatheter tip.</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/PMC13092380/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791430","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":"Transvenous Embolization for Dural Arteriovenous Fistula through the Persistent Left Superior Vena Cava: A Case Report.","authors":"Shimpei Tsuboki, Keisuke Kadooka, Kotaro Ueda, Takafumi Mitsutake, Michihiro Tanaka","doi":"10.5797/jnet.cr.2025-0150","DOIUrl":"https://doi.org/10.5797/jnet.cr.2025-0150","url":null,"abstract":"<p><strong>Objective: </strong>This work highlights the importance of recognizing persistent left superior vena cava (PLSVC), which is an uncommon venous anomaly that may complicate venous access during neuroendovascular procedures. Although rarely encountered in routine neurosurgical practice, identification of this anomaly can guide appropriate access selection and facilitate safe procedural planning.</p><p><strong>Case presentation: </strong>An 81-year-old woman presented with tinnitus. Magnetic resonance imaging revealed a left sigmoid sinus dural arteriovenous fistula (dAVF). Cerebral angiography revealed feeders mainly from the left occipital artery and shunt points at both the distal sigmoid sinus and jugular valve. The proximal transverse sinus was occluded, and venous drainage proceeded anterogradely into the internal jugular vein (IJV). The lesion was classified as Borden type I, and transvenous embolization was selected as the treatment strategy. The left brachiocephalic vein could not be catheterized during the procedure. Angiography revealed a PLSVC without the left brachiocephalic vein, and cone-beam CT confirmed drainage into the right atrium via the coronary sinus. A guide system was successfully navigated into the left IJV through the PLSVC, and coil embolization was performed from the distal to proximal segments. Final angiography confirmed complete obliteration of the shunts, and the tinnitus resolved.</p><p><strong>Conclusion: </strong>Awareness of PLSVC, even for neuroendovascular surgeons with limited exposure to the thoracic venous anatomy, can aid in selecting optimal venous access routes and help avoid unexpected procedural difficulties. This case demonstrates that recognizing a PLSVC can meaningfully contribute to the success of transvenous embolization.</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/PMC13080516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147701134","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}