Journal of neuroendovascular therapy最新文献

{"title":"A Case of Unruptured Basilar-Superior Cerebellar Artery Aneurysm Successfully Treated with Preoperative 3D Silicone Model Simulation for Optimal Woven EndoBridge Device Implantation.","authors":"Yu Niwa, Yukihiko Nakamura, Sosho Kajiwara, Takayuki Kawano, Masaru Hirohata, Motohiro Morioka","doi":"10.5797/jnet.cr.2025-0005","DOIUrl":"10.5797/jnet.cr.2025-0005","url":null,"abstract":"<p><strong>Objective: </strong>The Woven EndoBridge (WEB), an intrasaccular device, is a new alternative to coils for the endovascular treatment of wide-neck bifurcation aneurysms. Selection of the correct size of the device is of utmost importance for successful treatment outcomes. We present a case of an unruptured cerebellar artery aneurysm that was successfully treated with WEB implantation, guided by a 3D silicone model for preoperative evaluation.</p><p><strong>Case presentation: </strong>A 67-year-old woman with no family history of cerebral aneurysms was diagnosed with an unruptured basilar-superior cerebellar artery (BA-SCA) aneurysm. The patient's aneurysm was wide-necked with a dome of 8.1 mm, a neck of 6.5 mm, a height of 6.9 mm, and a volume of 287 mm³. In the preoperative simulation with 3D printed models, the WEB 9 × 4 mm device successfully preserved the SCA. Therefore, it was selected for treatment. Although the aneurysm had an angle of nearly 90° to the BA artery, the preoperative evaluation made it easy to guide the microcatheter and place the WEB device. The postoperative course was favorable and no new neurological symptoms were noted. Cerebral angiography performed 6 months after the procedure confirmed complete occlusion of the aneurysm.</p><p><strong>Conclusion: </strong>Preoperative simulation with 3D printed models can help to plan device size selection and implantation position, thereby predicting intraoperative microcatheter behavior in advance.</p>","PeriodicalId":73856,"journal":{"name":"Journal of neuroendovascular therapy","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12240673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602448","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 Usefulness of a 3D Roadmap of Occluded Vessels Created from Rapid 3D Proton Density-Weighted Imaging for Mechanical Thrombectomy.","authors":"Haruki Amano, Yasuyuki Tatsuta, Yukitaka Yamashita, Naotsugu Hashiguchi, Yohei Yamaguchi, Koji Oka, Hirohiko Nakamura","doi":"10.5797/jnet.tn.2024-0044","DOIUrl":"10.5797/jnet.tn.2024-0044","url":null,"abstract":"<p><strong>Objective: </strong>Mechanical thrombectomy (MT) for acute ischemic stroke usually requires blind procedures when endovascular devices are advanced into the occluded vessels. Therefore, the visualization of occluded vessels could potentially achieve safer procedures, shorter procedural time, and progression of the reperfusion rate. We report on the usefulness of a novel technique in which a 3D roadmap of occluded vessels was created from a rapid 3D proton density-weighted (PDW) variable refocusing flip angle and turbo spin echo (VRFA-TSE) method.</p><p><strong>Case presentation: </strong>3D PDW VRFA-TSE imaging was performed in addition to routine MRI for 2 patients with middle cerebral artery occlusion. With the adjustments to the imaging parameters, we were able to perform 3D PDW imaging in less than 1 minute. Subsequently, a 3D image of the occluded vessels was constructed from these images. To create a 3D roadmap, the 3D PDW images were positioned with cone beam CT images obtained before MT using 3D-3D fusion. Because a neurological technician performed the imaging processing while doctors and nurses prepared for MT, practical loss time was approximately 2 minutes. MT was performed with reference to the 3D roadmap, and the occluded lesion was recanalized without complications in both patients. The 3D roadmap of the occluded vessels was well-matched with the recanalized vessels.</p><p><strong>Conclusion: </strong>A 3D roadmap created from rapid 3D PDW imaging is a useful assistance technique for MT that allows the visualization of occluded vessels.</p>","PeriodicalId":73856,"journal":{"name":"Journal of neuroendovascular therapy","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11864996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525426","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":"Antithrombotic Therapy in Carotid Artery and Intracranial Artery Stent.","authors":"Ichiro Nakagawa, Masashi Kotsugi, Shohei Yokoyama, Ryosuke Maeoka, Hiromitsu Sasaki, Ai Okamoto, Yudai Morisaki, Tomoya Okamoto, Kengo Yamada, Ryosuke Matsuda","doi":"10.5797/jnet.ra.2024-0014","DOIUrl":"10.5797/jnet.ra.2024-0014","url":null,"abstract":"<p><p>Optimal platelet inhibition is critical in patients with carotid and intracranial artery stenosis undergoing carotid artery stenting (CAS) and intracranial artery stenting (ICS). Many reports have highlighted the importance of dual antiplatelet therapy (DAPT) in reducing adverse neurological outcomes without a significant increase in bleeding complications during CAS. DAPT has commonly used CAS and ICS, typically with aspirin and clopidogrel, but clopidogrel resistance occurs in approximately 20% of Japanese and other Asian populations. One solution to clopidogrel resistance is using adjunctive cilostazol to suppress the frequency of stroke events and in-stent restenosis after CAS. Other antiplatelet agents such as prasugrel, ticagrelor, cangrelor, and glycoprotein (GP) IIb/IIIa inhibitors are under investigation. The duration of DAPT after CAS remains controversial, as a longer duration of DAPT after CAS is associated with lower rates of readmission for stroke, but increased risk of hemorrhagic complications. Regarding antithrombotic therapy in CAS with concomitant atrial fibrillation, the use of direct oral anticoagulants plus a P2Y12 inhibitor may be suggested for the optimal safety and efficacy of antithrombotic management. For emergent CAS in acute ischemic stroke (AIS), intraprocedural DAPT loading and GP IIb/IIIa inhibitors, as necessary, may improve stent patency without increasing the risk of intracranial hemorrhage. In ICS, aggressive antiplatelet therapy based on an assessment of platelet aggregation is also important to improve clinical outcomes. In addition, rescue stenting for AIS caused by intracranial atherosclerotic stenosis-related large vessel occlusion is gaining attention. GP IIb/IIIa inhibitors have shown promise, but are not approved in Japan. In conclusion, DAPT is essential for the perioperative management of CAS and ICS. Specific perioperative antithrombotic management remains unclear, but the potential benefits of antithrombotic agents must be weighed against the corresponding increased risk of bleeding complications.</p>","PeriodicalId":73856,"journal":{"name":"Journal of neuroendovascular therapy","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11850812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506559","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":"N-butyl Cyanoacrylate Use in Various Neuroendovascular Diseases.","authors":"Satoshi Koizumi, Motoyuki Umekawa, Shigeta Fujitani, Hideaki Ono, Satoru Miyawaki, Nobuhito Saito","doi":"10.5797/jnet.ra.2024-0062","DOIUrl":"10.5797/jnet.ra.2024-0062","url":null,"abstract":"<p><p>This review discusses the use of N-butyl cyanoacrylate (NBCA) in various neuroendovascular treatments. Despite the increase in the ONYX, NBCA continues to have significant usage. It is particularly useful for the treatment of arteriovenous malformations (AVM) and dural arteriovenous fistulas (dAVFs). Comparative studies have suggested that ONYX and NBCA are equally effective and safe for the treatment of AVM. However, the choice between the two depends on specific situations, such as the characteristics of the feeding arteries. NBCA is recommended for tortuous feeders, high-flow fistulous feeders, and feeders with a short margin of reflux, owing to the procedural risks posed by ONYX. The use of NBCA is also prominent in dAVF embolization. While achieving total occlusion solely with NBCA can be challenging, NBCA adheres to the vessel wall and encourages thrombus formation, aiding in fistula obliteration. In addition to AVM and dAVF, NBCA is used to treat chronic subdural hematoma and craniofacial vascular injuries. Embolization using NBCA is beneficial because of its deep penetration into the target tissue. For craniofacial injuries, NBCA embolization provides secure hemostasis within a short time. Neuroendovascular physicians should understand the characteristics of NBCA as a liquid embolic material and have expertise in the technical aspects of NBCA embolization, even in the ONYX era.</p>","PeriodicalId":73856,"journal":{"name":"Journal of neuroendovascular therapy","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11850993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506563","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 Brain Arteriovenous Malformations.","authors":"Masaomi Koyanagi, Masanori Goto, Junichi Takeda, Ryu Fukumitsu, Tadashi Sunohara, Nobuyuki Fukui, Yuki Takano, Kunimasa Teranishi, Chiaki Sakai, Nobuyuki Sakai, Tsuyoshi Ohta","doi":"10.5797/jnet.ra.2024-0035","DOIUrl":"10.5797/jnet.ra.2024-0035","url":null,"abstract":"<p><p>Brain arteriovenous malformations (bAVMs) are uncommon vascular lesions found in young individuals exhibiting diverse clinical manifestations ranging from asymptomatic to spontaneous intracranial hemorrhage, seizures, or headaches. Despite improvements in endovascular tools and methods, standalone transarterial embolization seldom achieves success rates surpassing 50%, even when employing ethylene vinyl alcohol copolymers. Transvenous embolization (TVE) emerges as a promising option, especially for bAVMs situated distally or inaccessible through arterial routes. Despite the possibility of achieving high angiographic cure rates, concerns regarding hemorrhagic complications persist, limiting its adoption. This review article outlines the indications and methodology of TVE, discusses complications, and highlights the essential expertise needed for the safe execution of TVE along with strategies to mitigate associated risks. Clinical results reveal promising outcomes in terms of obliteration rates and favorable neurological results, although challenges persist, particularly regarding device accessibility and risk management. Despite these challenges, TVE remains a valuable alternative for managing bAVMs, particularly for cases resistant to surgical intervention, emphasizing the significance of careful patient selection and procedural expertise.</p>","PeriodicalId":73856,"journal":{"name":"Journal of neuroendovascular therapy","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11850990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506544","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":"Outcomes of Emergent Stenting with Antiplatelet Therapy in Patients with Large Vessel Occlusion Stroke with or without Intravenous Tissue Plasminogen Activator.","authors":"Kunimasa Teranishi, Satoru Fujiwara, Tadashi Sunohara, Masaomi Koyanagi, Masanori Goto, Junichi Takeda, Ryu Fukumitsu, Nobuyuki Fukui, Yuki Takano, Kota Nakajima, Yuji Naramoto, Yasuhiro Yamamoto, Rikuo Nishii, Satohiro Kawade, Takateru Takamatsu, Masanori Tokuda, Hikari Tomita, Mai Yoshimoto, Nobuyuki Ohara, Nobuyuki Sakai, Tsuyoshi Ohta","doi":"10.5797/jnet.oa.2024-0039","DOIUrl":"10.5797/jnet.oa.2024-0039","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the difference in outcomes after emergent stenting with antiplatelet therapy for large vessel occlusion (LVO) stroke in patients with and without prior intravenous tissue plasminogen activator (IV tPA).</p><p><strong>Methods: </strong>Patients who arrived at our hospital within 4.5 h of symptom onset and underwent endovascular therapy (EVT) for LVO between January 2015 and March 2023 were analyzed retrospectively. Patients were included if they underwent stenting for atherosclerotic lesions or arterial dissection with antiplatelet therapy during EVT. The safety and clinical outcomes were compared between patients who received IV tPA before EVT (IV tPA group) and those who did not (no-IV tPA group). The primary outcome was symptomatic intracranial hemorrhage (SICH) within 48 h of EVT.</p><p><strong>Results: </strong>Overall, 54 patients were included in the analysis, with a median age of 72 years (interquartile range [IQR]: 53-74); 41 (76%) were women. The median pre-stroke modified Rankin Scale (mRS) score was 0 (IQR: 0-2), and the median National Institutes of Health Stroke Scale (NIHSS) score was 7 (IQR: 1-21). These patients underwent emergent stenting with antiplatelet therapy during EVT, with stenting performed in the cervical carotid artery and intracranial artery in 38 and 16 patients, respectively. Thirty-one of 54 patients received IV tPA before EVT. Sex, age, NIHSS score on admission, or Alberta Stroke Program Early Computed Tomographic Score on non-contrast CT did not differ significantly between the IV tPA and no-IV tPA groups. Final modified thrombolysis in cerebral infarction scores ≥2b were achieved more frequently in the IV tPA group than in the no-IV tPA group (97% vs. 87%; p = 0.30). SICH (13% vs. 0%; p = 0.13) and any intracranial hemorrhage (ICH) (29% vs. 8.7%; p = 0.09) occurred more frequently in the IV tPA group than in the no-IV tPA group. The rate of achieving mRS scores of 0-2 at 3 months after stroke onset was lower in the IV tPA group [11 (35%) vs. 13 (57%); p = 0.17].</p><p><strong>Conclusion: </strong>Among patients who received emergent stenting with antiplatelet therapy, successful reperfusion was achieved more frequently in the IV tPA group than in the no-IV tPA group, although the former exhibited a higher SICH rate and worse functional outcomes. These findings suggest that prior IV tPA administration may increase the risk of hemorrhagic complications in cases requiring emergent stenting with antiplatelet therapy.</p>","PeriodicalId":73856,"journal":{"name":"Journal of neuroendovascular therapy","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12162249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303860","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":"Duplicated Cervical Internal Carotid Artery with Ipsilateral Persistent Stapedial Artery and Contralateral Aberrant Internal Carotid Artery: A Case Report.","authors":"Hidetaka Hayashi, Hiro Kiyosue, Yoshitaka Tamura, Mari Yonemura, Sachiko Uchiumi, Yuika Watanabe, Aya Kanemitsu, Hiroyuki Uetani, Seitaro Oda, Toshinori Hirai","doi":"10.5797/jnet.cr.2024-0091","DOIUrl":"10.5797/jnet.cr.2024-0091","url":null,"abstract":"<p><strong>Objective: </strong>Duplication of extracranial cerebral arteries is a rare anatomical variant, most commonly observed in the vertebral artery. However, duplication of the cervical internal carotid artery (ICA) is extremely rare. We present a unique case of a patient diagnosed with a right facial artery aneurysm, in whom a right duplicated ICA, ipsilateral persistent stapedial artery (PSA), and contralateral aberrant ICA were incidentally identified.</p><p><strong>Case presentation: </strong>A 56-year-old woman presented with a painless mass in the right lower jaw. Physical examination revealed a round, pulsatile mass. Contrast-enhanced CT demonstrated a 25 mm saccular aneurysm originating from the right facial artery, along with a right duplicated ICA and a left aberrant ICA. The lateral limb of the right duplicated ICA and the left aberrant ICA were seen traversing the tympanic cavity and entering the carotid canal. The absence of the right foramen spinosum indicated the presence of a PSA. Angiography confirmed the duplicated ICA, aberrant ICA, and PSA. The lateral limb of the right duplicated ICA gave rise to the occipital artery and a small branch, the PSA, which entered the middle cranial fossa. The facial artery aneurysm was successfully embolized. Follow-up MR angiography showed stable occlusion of the aneurysm, with the duplicated ICA giving off both the PSA from the lateral limb and a pharyngeal branch from the medial limb.</p><p><strong>Conclusion: </strong>This case provides valuable insights into the development of the cervical arterial system during the fetal period, particularly the collateral pathways connecting the third arch to the dorsal aorta.</p>","PeriodicalId":73856,"journal":{"name":"Journal of neuroendovascular therapy","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11851020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506560","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":"Angiographical Investigation of Vagal and Carotid Body Paragangliomas.","authors":"Kosei Yamamoto, Takenori Akiyama, Katsuhiro Mizutani, Hiroyuki Ozawa, Masahiro Toda","doi":"10.5797/jnet.oa.2024-0096","DOIUrl":"10.5797/jnet.oa.2024-0096","url":null,"abstract":"<p><strong>Objective: </strong>Although vagal paragangliomas (VPs) and carotid body paragangliomas (CBPs) are both neck paragangliomas, they have different surgical risks and clinical courses. In this report, we investigated the feeding arteries of VPs compared with CBPs, with an aim to better differentiate these tumors and improve our understanding of their angioarchitecture.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of angiography data from 3 cases of VPs and 10 tumors from 9 cases of CBP. For each case, we evaluated the level of the vertebral body corresponding to the upper margin of the tumor, the tumor size, the arterial supply of the tumor, the topological relationship between the external carotid artery and internal carotid artery and the tumor, the details of preoperative embolization, and the incidence of postoperative neurological deficits.</p><p><strong>Results: </strong>In all 3 cases of VPs, the blood supply originated from the occipital, vertebral, and ascending pharyngeal arteries. By contrast, among the 10 CBP tumors, 3 were supplied by the occipital artery, 1 was supplied by the vertebral artery, and all 10 were fed by the ascending pharyngeal artery. VPs, when compared to CBPs, exhibited larger tumor sizes, a higher positioning of the upper margin of the tumor, and a lack of splaying of the internal and external carotid arteries, compressing both forward. Additionally, preoperative embolization was frequently performed in cases of VPs. Furthermore, the postoperative occurrence of complications such as hoarseness and vocal cord paralysis was also higher.</p><p><strong>Conclusion: </strong>VPs originate from the inferior ganglion of the vagus nerve, which is chiefly nourished by the vertebral artery. This original arterial distribution may explain the angioarchitecture observed in this study. This study may facilitate the better understanding of the VP angioarchitecture and safe and efficient embolization for them.</p>","PeriodicalId":73856,"journal":{"name":"Journal of neuroendovascular therapy","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574970","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 Utility of Preoperative CT Angiography for Middle Meningeal Artery Embolization in Acute Epidural Hematoma.","authors":"Koichiro Suzuki, Yoshinobu Horio, Rina Shibayama, Ryuhei Takeyama, Jota Tega, Hiromasa Kobayashi, Koichiro Takemoto, Hiroshi Abe","doi":"10.5797/jnet.cr.2025-0015","DOIUrl":"10.5797/jnet.cr.2025-0015","url":null,"abstract":"<p><strong>Objective: </strong>Hematoma expansion in acute epidural hematomas occurred in 11.2%-32% of patients treated conservatively at initial presentation and required craniotomy. Middle meningeal artery (MMA) embolization has been reported to be effective in preventing hematoma expansion. We report a case of an asymptomatic acute epidural hematoma in which CTA was used to identify the source of bleeding. Embolization of the MMA was performed to prevent hematoma expansion.</p><p><strong>Case presentation: </strong>A 30-year-old male patient was admitted to the emergency department following a collision with a car while riding his motorcycle. The patient exhibited clear consciousness and no neurological deficits. A head CT scan revealed a right parietal and temporal bone fracture, and an acute epidural hematoma directly below the fracture site. The hematoma was small, and the patient was treated conservatively. Three hours later, a follow-up head CT scan revealed an enlarged hematoma. This hematoma was found near the transverse sinus. To identify the source of the bleeding, a CTA was performed, which revealed extravasation into the hematoma from an area distant from the transverse sinus. We performed embolization of the MMA. The postoperative course was good with no postoperative hematoma expansion.</p><p><strong>Conclusion: </strong>CTA for acute epidural hematoma without neurological symptoms is a useful diagnostic tool that can identify patients at high risk for hematoma expansion. If the findings indicate the need for intervention, MMA embolization is a treatment option that may reduce the risk of hematoma expansion and craniotomy.</p>","PeriodicalId":73856,"journal":{"name":"Journal of neuroendovascular therapy","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12162251/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303861","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":"Emergent Endovascular Intervention for Acute Neurological Deficits Post-Carotid Endarterectomy: A Single-Institutional Analysis and Systematic Review of the Literature.","authors":"Carl M Porto, Rahul A Sastry, Radmehr Torabi, Santos E Santos Fontanez, Joshua Feler, Tyler Ranellone, Krisztina Moldovan, Elias Shaaya, Mahesh V Jayaraman, Curtis Doberstein, Dylan N Wolman","doi":"10.5797/jnet.oa.2025-0050","DOIUrl":"10.5797/jnet.oa.2025-0050","url":null,"abstract":"<p><strong>Objective: </strong>Carotid endarterectomy (CEA) is a standard treatment for atherosclerotic carotid stenosis. Perioperative symptomatic restenosis or reocclusion of the carotid artery following CEA is a rare but serious complication that typically necessitates intervention. The efficacy and safety profile of emergent endovascular therapy (EVT) as an alternative to repeat CEA in the treatment of acute perioperative neurological decline remain unknown.</p><p><strong>Methods: </strong>All patients undergoing CEA in the Department of Neurosurgery at a single comprehensive stroke center from 2015 to 2024 were reviewed. Patients who underwent EVT for acute perioperative neurological deficits were included in our series. A systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify articles relevant to the endovascular management of acute neurological deficits following CEA.</p><p><strong>Results: </strong>Four patients from our institutional cohort met the inclusion criteria. An additional 39 patients were identified from the literature review in 11 source articles, which yielded a total of 43 patients. CEA was performed for symptomatic lesions in 28 (28/32, 87.5%) patients. Abnormal angiographic findings were reported for all patients. Thrombus accumulation in or distal to the operated internal carotid artery (ICA) (26/43, 60.5%) and dissection flaps (15/43, 34.9%) were the most common findings. Five (11.6%) patients had tandem cervical ICA and intracranial occlusions, of which thrombectomy of the intracranial lesion was successfully performed on 3 patients. All patients except for 1 (42/43, 97.6%) underwent technically successful endovascular stenting. Following EVT, 76.7% (33/43) of patients had no persisting neurological deficits. Nine (20.9%) patients were found to have new cerebral infarcts on post-EVT imaging. In-hospital mortality was reported for 6 patients (14%), 4 of whom were found to have tandem cervical ICA and intracranial occlusions.</p><p><strong>Conclusion: </strong>EVT is likely a technically viable alternative treatment for patients with perioperative acute neurologic deficits after CEA. However, most of the literature available comes from case series, thereby limiting the quality of evidence. Improved reporting of standard stroke outcome measures may help to inform the implementation of EVT and repeat CEA for acute ischemic symptoms after CEA.</p>","PeriodicalId":73856,"journal":{"name":"Journal of neuroendovascular therapy","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144509847","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}