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Current and future directions in interventional neuro-oncology—are we there yet? J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-04-18 Yang Qiao, Maggie Xiong, Yi Jonathan Zhang, Samuel Tsappidi, Peter Kan, Clifford R Weiss, Ferdinand Hui, Stephen R Chen
Advancements in technology and technical expertise increasingly enable neurointerventionalists to deliver safer and more effective endovascular treatments to cancers of the brain, spine, head, and neck. In addition to established neuro-oncological interventions such as pre-surgical tumor embolization and percutaneous ablation, newer modalities focused on direct arterial infusion of chemotherapy, radioisotopes
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Can micro-guidewire advancement forces predict clot consistency and location to assist the first-line technique for mechanical thrombectomy? J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-04-18 Philippe Reymond, Evgenia Roussinova, Olivier Brina, Jeremy Hofmeister, Gianmarco Bernava, Andrea Rosi, William Galand, Karl-Olof Lovblad, Vitor M Pereira, Mohamed Bouri, Paolo Machi
Background The identification of specific clot characteristics before mechanical thrombectomy (MTB) might allow the selection of the most effective first-line technique, thus potentially improving the procedural outcome. We aimed to evaluate if the microwire push forces could extrapolate information on clot consistency and extension before MTB, based on clot mechanical properties. Methods We measured
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Spontaneous delayed migration or shortening after pipeline embolization device treatment of intracranial aneurysm: incidence, management, and risk factors J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-04-18 Linggen Dong, Chao Wang, Dachao Wei, Qichen Peng, Xinzhi Wu, Xiheng Chen, Mingtao Li, Tong Li, He Liu, Yang Zhao, Ran Duan, Weitao Jin, Yukun Zhang, Yang Wang, Ming Lv
Background Studies reporting spontaneous delayed migration or shortening (SDMS) after treatment with the Pipeline Embolization Device (PED) are limited. This study aimed to evaluate the incidence of SDMS after PED treatment, propose management strategies, and identify the risk factors contributing to its occurrence. Methods We retrospectively reviewed consecutive patients with an intracranial aneurysm
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Comparison of rescue intracranial stenting versus best medical treatment alone in acute refractory large vessel occlusion: study protocol for the PISTAR multicenter randomized trial J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-04-18 Kévin Premat, Agnès Dechartres, Amandine Baptiste, Alexis Guedon, Mikael Mazighi, Laurent Spelle, Christian Denier, Titien Tuilier, Hassan Hosseini, Bertrand Lapergue, Federico Di Maria, Nicolas Bricout, Hilde Henon, Benjamin Gory, Sébastien Richard, Cyril Chivot, Audrey Courselle, Stéphane Velasco, Mathias Lamy, Vincent Costalat, Caroline Arquizan, Gaultier Marnat, Igor Sibon, Stephanie Lenck, Eimad
Background Mechanical thrombectomy (MT) has become a standard treatment for acute ischemic strokes (AIS). However, MT failure occurs in approximately 10–30% of cases, leading to severe repercussions (with mortality rates up to 40% according to observational data). Among the available rescue techniques, rescue intracranial stenting (RIS) appears as a promising option. Objective This trial is poised
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Early automated cerebral edema assessment following endovascular therapy: impact on stroke outcome J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-04-18 Marina Guasch-Jiménez, Rajat Dhar, Atul Kumar, Julien Cifarelli, Garbiñe Ezcurra-Díaz, Álvaro Lambea-Gil, Anna Ramos-Pachón, Alejandro Martínez-Domeño, Luis Prats-Sánchez, Daniel Guisado-Alonso, Israel Fernández-Cadenas, Ana Aguilera-Simón, Rebeca Marín, José Pablo Martínez-González, Joaquin Ortega-Quintanilla, Isabel Fernández-Pérez, Carla Avellaneda-Gómez, Jorge Rodríguez-Pardo, Elena de Celis, Francisco
Background Cerebral edema (CED) is associated with poorer outcome in patients with acute ischemic stroke (AIS). The aim of the study was to investigate the factors contributing to greater early CED formation in patients with AIS who underwent endovascular therapy (EVT) and its association with functional outcome. Methods We conducted a multicenter cohort study of patients with an anterior circulation
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A core-lab adjudicated analysis of single-stent assisted coiling of wide-neck bifurcation aneurysms J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-04-17 Aliya Siddiqui, Kyle M Fargen, Justin E Vranic, Aman B Patel, Christopher S Ogilvy, Ajith J Thomas, Justin R Mascitelli, Johanna T Fifi, J Mocco, Reade Andrew De Leacy
Background and purpose Core-lab adjudicated data regarding the efficacy of the single-stent assisted aneurysm coiling technique ‘L-stenting’ are lacking. We present a multicenter, core-lab adjudicated study evaluating the safety and effectiveness of single-stent assisted coiling in the treatment of wide-neck bifurcation aneurysms (WNBAs). Methods Consecutive patients who underwent L-stenting for WNBAs
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Correspondence on ‘Outcomes of mechanical thrombectomy in stroke patients with extreme large infarction core’ by Almallouhi et al J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-04-17 David Sacks
The recent article by Almallouhi et al 1 on registry reported outcomes of mechanical thrombectomy in stroke patients with extremely large infarctions (Alberta Stroke Program Early CT Score (ASPECTS) 0–2) is an important contribution. It adds to our knowledge of real-world clinical outcomes in a group of patients that, until the publication of several recent large infarct thrombectomy trials,2–5 would
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Outcomes of heparin-induced thrombocytopenia type II in aneurysmal subarachnoid hemorrhage patients: A US nationwide analysis J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-04-17 Galadu Subah, Sabrina Zeller, Nitesh Damodara, Michael Fortunato, Jenna Garrett, Shoaib Syed, Anaz Uddin, Issac Pak, Eric Feldstein, Stephan Mayer, Chirag D Gandhi, Fawaz Al-Mufti
Background Despite the widespread use of heparin during and following endovascular procedures in the management of aneurysmal subarachnoid hemorrhage (SAH) patients, limited research has explored the incidence and impact of heparin-induced thrombocytopenia (HIT) on SAH. Methods Descriptive statistics, multivariate regressions, and propensity score-matching were employed to compare clinical characteristics
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Prospective evaluation to characterize the real-world performance of the EMBOVAC aspiration catheter for neurothrombectomy: a post-market clinical follow-up trial J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-04-12 Mariangela Piano, Olav Jansen, Gaultier Marnat, Benjamin Gory, Hannes Nordmeyer, Bernd Eckert, Alessandro Pedicelli, Christophe Cognard, Christian Loehr, Matteo Zanoni, Axel Schaefer, Antonio Macera, Jens Fiehler, Karen Doyle, Kyriakos Lobotesis
Background A direct aspiration first pass technique (ADAPT) is an effective alternative to stent retriever thrombectomy for patients with large vessel occlusion (LVO). The PERFECT study evaluated direct aspiration with the EMBOVAC large bore aspiration catheter in patients with LVO strokes. Methods PERFECT was a prospective, post-market, single-arm, multicenter, observational study of patients enrolled
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Long-term neuropsychiatric complications of aneurysmal subarachnoid hemorrhage: a narrative review J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-04-12 Jose Danilo Bengzon Diestro, Manav Vyas, Youngkyung Jung, Teruko Kishibe, Carl Leochico, Adrian Espiritu, Maria Kristina Dorotan, Nico Dimal, Abdelsimar Tan Omar, April Sienes, Gustavo Saposnik, Thomas R Marotta, Atif Zafar, Vitor Mendes Pereira, Julian Spears
This review focuses on the often-neglected long-term neuropsychiatric consequences of aneurysmal subarachnoid hemorrhage (aSAH), beyond traditional randomized trial outcomes of mortality and retreatment. While current guidelines recommend screening for these sequalae, it may not be routinely practiced. This review will underscore the prevalence and management of common neuropsychiatric sequalae, including
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Evaluation of ChatGPT in knowledge of newly evolving neurosurgery: middle meningeal artery embolization for subdural hematoma management J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-04-11 Stefan W Koester, Joshua S Catapano, Joelle N Hartke, Robert F Rudy, Tyler S Cole, Anant Naik, Ethan A Winkler, Christopher S Graffeo, Visish M Srinivasan, Ashutosh P Jadhav, Andrew F Ducruet, Michael T Lawton, Felipe C Albuquerque
Chat-Generative Pre-Trained Transfer (ChatGPT) is a readily accessible artificial intelligence (AI)-enabled chatbot recently developed by the company OpenAI (San Francisco, California, USA). The software incorporates a large language model with more than 175 billion parameters, with the capability of providing rapid answers to user-generated questions.1 The usefulness of ChatGPT in the healthcare domain
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Population-based estimates suggest middle meningeal artery embolization for subdural hematomas could significantly expand the scope of neurovascular therapies J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-04-11 Ansaar T Rai, Abdulrahman A Halak, Dhairya A Lakhani, Abdul R Tarabishy, Adnan H Siddiqui
Background This study quantifies the impact of middle meningeal artery embolization (MMAE) for subdural hematomas (SDHs) by estimating a target population. Methods A population-based study at a tertiary hospital, the main SDH facility for a four-county population, used primary ICD-10 codes over 3 years to collate SDH hospitalizations. Clinical and imaging data confirmed traumatic versus non-traumatic
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Arteriovenous shunts of the cervical spine: patient demographics, presentation, patterns of high-risk venous drainage, and updated classification J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-04-11 Masis Isikbay, M Travis Caton, Raghav Mattay, Woody Han, Daniel L Cooke, Daniel Raper, Ethan A Winkler, Luis Savastano, Kazim H Narsinh, Steven W Hetts, Matthew Robert Amans
Background Intracranial dural arteriovenous (AV) fistula classifications focus on presence/absence of retrograde flow in the cortical veins of the brain as this angiographic finding portends a worse prognosis. However, prior categorization systems of AV shunts in the spine do not incorporate these features. We propose an updated classification for spinal shunting lesions that terms any shunting lesion
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Plunge with caution: safeguarding patients in mechanical thrombectomy J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-04-09 Jonathan Cortese, Esref Alperen Bayraktar, Jiahui Li, David F Kallmes
We watched the technical video explaining the ‘plunger technique’ for mechanical thrombectomy in acute ischemic stroke with great interest, as published by Froehler in the Journal of Neurointerventional Surgery .1 We were intrigued by the innovative approach presented in this video, and the author should be congratulated for attempting to find an alternative to upcoming cyclical aspiration devices
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'An eye for an eye' therapeutic strategy for cavernous sinus dural arteriovenous fistula: a single-center experience J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-04-09 Liang Xu, Jingwei Zheng, Chenhan Ling, Xianyi Chen, Bing Fang, Cong Qian, Jing Xu, Jun Yu
Background In cavernous sinus dural arteriovenous fistulas (CS-DAVF), ophthalmological symptoms are usually the main clinical presentation, caused by abnormal drainage of the superior ophthalmic vein (SOV). Early opacification of the SOV during cerebral angiography inevitably signifies the fistula’s shunt point at the confluence of the SOV and CS. We aimed to leverage this anatomical feature to achieve
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Response to ‘plunge with caution: safeguarding patients in mechanical thrombectomy’ J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-04-09 Michael T Froehler, Bryan C Good
We thank the authors for their interest in the ‘plunger’ technique for direct aspiration thrombectomy and appreciate the concerns they raised about patient safety after watching our technical video1,2. First, we would like to clarify how the plunger technique is performed. While it would seem obvious to almost any neuro-interventionalist, we must emphasize that at no point is the plunger actively pushed
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Real time artificial intelligence assisted carotid artery stenting: a preliminary experience J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-04-05 Yuya Sakakura, Kenichi Kono, Takeshi Fujimoto
Background Neurointerventionalists must pay close attention to multiple devices on multiple screens simultaneously, which can lead to oversights and complications. Artificial intelligence (AI) has potential application in recognizing and monitoring these devices on fluoroscopic imaging. Methods We report out preliminary experience with a real time AI assistance software, Neuro-Vascular Assist (iMed
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Early technique switch following failed passes during mechanical thrombectomy for ischemic stroke: should the approach change and when? J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-04-04 Pedro N Martins, Raul G Nogueira, Mohamed A Tarek, Jaydevsinh N Dolia, Sunil A Sheth, Santiago Ortega-Gutierrez, Sergio Salazar-Marioni, Ananya Iyyangar, Milagros Galecio-Castillo, Aaron Rodriguez-Calienes, Aqueel Pabaney, Jonathan A Grossberg, Diogo C Haussen
Background Fast and complete reperfusion in endovascular therapy (EVT) for ischemic stroke leads to superior clinical outcomes. The effect of changing the technical approach following initially unsuccessful passes remains undetermined. Objective To evaluate the association between early changes to the EVT approach and reperfusion. Methods Multicenter retrospective analysis of prospectively collected
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Clinical presentation and treatment of 26 spinal epidural arteriovenous fistulas: a single-center experience J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-04-03 Charles Beaman, Amir Molaie, Yasmin Ghochani, Keiko Fukuda, Catherine Peterson, Naoki Kaneko, May Nour, Viktor Szeder, Geoffrey P Colby, Satoshi Tateshima, Reza Jahan, Gary Duckwiler
Background Spinal epidural arteriovenous fistulas (SEDAVFs) are rarely diagnosed vascular malformations that can cause spinal cord compression and congestive myelopathy. Methods This is a single-center, retrospective case series of patients with SEDAVFs who underwent observation or treatment at UCLA medical center between 1993 and 2023. Results Between 1993 and 2023 a total of 26 patients at UCLA were
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Safety and efficacy of coated flow diverters in the treatment of ruptured intracranial aneurysms: a retrospective multicenter study J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-04-03 Lukas Goertz, Sophia Hohenstatt, Dominik F Vollherbst, Charlotte Sabine Weyland, Omid Nikoubashman, Hanna Styczen, Christian Gronemann, Daniel Weiss, Marius Kaschner, Muriel Pflaeging, Eberhard Siebert, David Zopfs, Jonathan Kottlors, Lenhard Pennig, Marc Schlamann, Georg Bohner, Thomas Liebig, Bernd Turowski, Franziska Dorn, Cornelius Deuschl, Martin Wiesmann, Markus A Möhlenbruch, Christoph Kabbasch
Background This multicenter study evaluated the safety and efficacy of coated flow diverters (cFDs) for the treatment of ruptured intracranial aneurysms. Methods Consecutive patients treated with different cFDs for ruptured aneurysms under tirofiban at eight neurovascular centers between 2016 and 2023 were retrospectively analyzed. The majority of patients were loaded with dual antiplatelet therapy
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Mechanical thrombectomy in basilar artery occlusions: impact of first-line strategy as a function of the occlusion level J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-03-27 Louis Tournier, Jonathan Cortese, Arturo Consoli, Laurent Spelle, Gaultier Marnat, Mariana Sarov, Francois Zhu, Sebastien Soize, Julien Burel, Géraud Forestier, Simon Escalard, Raoul Pop, Baptiste Bonnet, Quentin Alias, Julien Ognard, Olivier Naggara, Maeva Kyheng, Bertrand Lapergue, Jildaz Caroff
Background Retrospective studies suggest the superiority of first-line contact aspiration (CA) thrombectomy over stent-retriever (SR) in basilar artery occlusions (BAO). We aimed to investigate the impact of first-line mechanical thrombectomy per the occlusion level, considering differences in stroke etiology prevalence between proximal and distal BAO. Methods A retrospective, multicentric analysis
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Superior cortical venous anatomy for endovascular device implantation: a systematic review J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-03-27 Jamie Brannigan, Alexander McClanahan, Ferdinand Hui, Kyle M Fargen, Nandor Pinter, Thomas J Oxley
Endovascular electrode arrays provide a minimally invasive approach to access intracranial structures for neural recording and stimulation. These arrays are currently used as brain–computer interfaces (BCIs) and are deployed within the superior sagittal sinus (SSS), although cortical vein implantation could improve the quality and quantity of recorded signals. However, the anatomy of the superior cortical
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Combined effect of ASPECTS and age on outcome of patients with large core infarction treated with mechanical thrombectomy J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-03-27 Zibao Li, Linyu Li, Zhouzhou Peng, Shoucai Zhao, Xianjun Huang, Shitao Fan, Xu Xu, Jinfu Ma, Chengsong Yue, Nizhen Yu, Changwei Guo, Jie Yang
Background Despite the remarkable effectiveness of endovascular treatment (EVT), recent randomized controlled trials indicate that up to half of patients with large core infarction have a very poor outcome (modified Rankin Scale score 5–6 at 90 days). This study investigates the combined effect of Alberta Stroke Program Early CT Score (ASPECTS) and age on very poor outcome in patients with large core
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Effects of calcium channel blockers on perioperative ischemic events in hypertensive patients with intracranial aneurysms undergoing neurointervention J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-03-25 Qichen Peng, Yangyang Zhou, Chao Wang, Xuanping Xie, Linggen Dong, Yisen Zhang, Hongqi Zhang, Jun Wang, Liang Li, Pinyuan Zhang, Yuanli Zhao, Yang Wang, Fushun Xiao, Bin Luo, Wenqiang Li, Shiqing Mu
Background Although calcium channel blockers (CCBs) are useful in stroke prevention, their specific role in preventing stroke in hypertensive patients with intracranial aneurysms undergoing endovascular stent placement remains unclear. Methods We retrospectively examined 458 hypertensive patients with intracranial aneurysms who underwent stent treatment, drawn from a larger multicenter cohort comprising
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Deep learning on pre-procedural computed tomography and clinical data predicts outcome following stroke thrombectomy J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-03-25 James P Diprose, William K Diprose, Tuan-Yow Chien, Michael T M Wang, Andrew McFetridge, Gregory P Tarr, Kaustubha Ghate, James Beharry, JaeBeom Hong, Teddy Wu, Doug Campbell, P Alan Barber
Background Deep learning using clinical and imaging data may improve pre-treatment prognostication in ischemic stroke patients undergoing endovascular thrombectomy (EVT). Methods Deep learning models were trained and tested on baseline clinical and imaging (CT head and CT angiography) data to predict 3-month functional outcomes in stroke patients who underwent EVT. Classical machine learning models
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Portable cerebral blood flow monitor to detect large vessel occlusion in patients with suspected stroke J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-03-21 Christopher G Favilla, Grayson L Baird, Kedar Grama, Soren Konecky, Sarah Carter, Wendy Smith, Rebecca Gitlevich, Alexa Lebron-Cruz, Arjun G Yodh, Ryan A McTaggart
Background Early detection of large vessel occlusion (LVO) facilitates triage to an appropriate stroke center to reduce treatment times and improve outcomes. Prehospital stroke scales are not sufficiently sensitive, so we investigated the ability of the portable Openwater optical blood flow monitor to detect LVO. Methods Patients were prospectively enrolled at two comprehensive stroke centers during
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Clinical uncertainty in large vessel occlusion ischemic stroke: does automated perfusion imaging make a difference? An intra-rater and inter-rater agreement study J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-03-21 Jose Danilo Bengzon Diestro, Robert Fahed, Abdelsimar Tan Omar, Christine Hawkes, Eef J Hendriks, Clare Enriquez, Muneer Eesa, Grant Stotts, Hubert Lee, Shashank Nagendra, Alexandre Poppe, Célina Ducroux, Timothy Lim, Karl Narvacan, Michael Rizzuto, Afra Alfalahi, Hidehisa Nishi, Pragyan Sarma, Ze'ev Itsekson Hayosh, Katrina Ignacio, William Boisseau, Eduardo Pimenta Ribeiro Pontes Almeida, Anass Benomar
Background Limited research exists regarding the impact of neuroimaging on endovascular thrombectomy (EVT) decisions for late-window cases of large vessel occlusion (LVO) stroke. Objective T0 assess whether perfusion CT imaging: (1) alters the proportion of recommendations for EVT, and (2) enhances the reliability of EVT decision-making compared with non-contrast CT and CT angiography. Methods We conducted
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Inflammation biomarkers in the intracranial blood are associated with outcome in patients with ischemic stroke J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-03-21 Cyril Dargazanli, Marine Blaquière, Marinette Moynier, Frédéric de Bock, Julien Labreuche, Adrien ter Schiphorst, Imad Derraz, Răzvan Alexandru Radu, Gregory Gascou, Pierre Henri Lefevre, Francesca Rapido, Julien Fendeleur, Caroline Arquizan, Romain Bourcier, Philippe Marin, Paolo Machi, Federico Cagnazzo, Christophe Hirtz, Vincent Costalat, Nicola Marchi
Background Performing endovascular treatment (EVT) in patients with acute ischemic stroke (AIS) allows a port of entry for intracranial biological sampling. Objective To test the hypothesis that specific immune players are molecular contributors to disease, outcome biomarkers, and potential targets for modifying AIS. Methods We examined 75 subjects presenting with large vessel occlusion of the anterior
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Transradial versus transfemoral access for diagnostic cerebral angiography: frequency of acute MRI findings in 500 consecutive patients at a single center J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-03-19 Vinicius Carraro do Nascimento, Laetitia de Villiers, Permesh Singh Dhillon, Luis Domitrovic, Genevieve Sesnan, Jean-Philippe Leblanc, Louise Ninnes, Ian Hughes, Hal Rice
Background The frequency of clinically symptomatic and asymptomatic diffusion-weighted imaging (DWI) hyperintense lesions and their correlation with the transradial artery (TRA) approach is unclear. Objective To assess the frequency of abnormal diffusion restriction foci on DWI following cerebral angiography (digital subtraction angiography (DSA)) with the TRA or transfemoral artery (TFA) approach
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Incidence and predictors of restenosis following successful recanalization of non-acute internal carotid artery occlusion in 252 cases J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-03-19 Guangdong Lu, Junqing Wang, Tao Wang, Xinjuan Xu, Xin Li, Xinyi Sun, Zhengyu Wang, Jichang Luo, Yan Ma, Bin Yang, Peng Gao, Yabing Wang, Yanfei Chen, Sheng Liu, Liqun Jiao
Background Data concerning restenosis following successful recanalization of non-acute internal carotid artery occlusion (ICAO) are scarce. This study was conducted to identify the incidence and predictors of restenosis following successful recanalization of non-acute ICAO. Methods We reviewed the incidence of restenosis (defined as >70% restenosis or reocclusion) among 252 consecutive patients with
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Optimizing resources: financial evaluation of flow diverters versus stent assisted coiling in large and giant cerebral aneurysm management in Brazil public health system J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-03-19 Elias Antônio Tanus Machado, Savio Batista, Fausto de Oliveira Braga, Cesar Augusto Ferreira Alves Filho, Jose Alberto Almeida Filho, Plínio Gabriel Lopes, Carlos Leandro Cartobei, Leonardo de Barros Oliveira, Paulo José da Mata Pereira, Paulo Niemeyer Filho
Background Cerebral aneurysms, especially large and giant aneurysms, pose challenges in neurointerventional surgery. Treatment choices involve clinical presentation, aneurysm details, and global resource variations. Neurointerventional methods, while innovative, may be cost restrictive in certain regions. In public healthcare, cost is crucial, notably in countries like Brazil. This study examines the
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Relationship between in-stent restenosis following carotid artery stenting and platelet reactivity to clopidogrel J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-03-15 Min-Yong Kwon, Sang Hyo Lee, Yongjae Lee, Young Deok Kim, Si Un Lee, Jae Seung Bang, O-Ki Kwon, Chang Wan Oh, Seung Pil Ban
Objective To analyze the relationship between in-stent restenosis (ISR) following carotid artery stenting (CAS) and platelet clopidogrel reactivity confirmed by the P2Y12 reaction unit (PRU) and inhibition rate (IR). Methods We retrospectively analyzed 171 patients who underwent CAS with extracranial carotid stenosis from January 2016 to December 2019. Dual antiplatelet therapy with 100 mg aspirin
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Posterior condylar canal dural arteriovenous fistula: anatomical, symptomatological, and therapeutic considerations in comparison with hypoglossal canal dural arteriovenous fistula J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-03-13 Hidetsugu Maekawa, Antti Lindgren, Timo Krings
Background Posterior condylar canal dural arteriovenous fistulas (dAVFs) are extremely rare. Methods We report a case series and literature review of posterior condylar canal dAVFs and discuss similarities and differences between posterior condylar and hypoglossal canal dAVFs with respect to the related vascular anatomy, angioarchitecture of the fistula, presentation, and treatment. Results Four cases
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Subarachnoid iodine leakage on dual-energy computed tomography after mechanical thrombectomy is associated with malignant brain edema J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-03-13 Atsushi Ogata, Kuniaki Ogasawara, Masashi Nishihara, Ayako Takamori, Takashi Furukawa, Toshihiro Ide, Hiroshi Ito, Fumitaka Yoshioka, Yukiko Nakahara, Jun Masuoka, Haruki Koike, Hiroyuki Irie, Tatsuya Abe
Background Dual-energy computed tomography (DE-CT) can differentiate between hemorrhage and iodine contrast medium leakage following mechanical thrombectomy (MT) for acute ischemic stroke (AIS). We determined whether subarachnoid hemorrhage (SAH) and subarachnoid iodine leakage (SAIL) on DE-CT following MT were associated with malignant brain edema (MBE). Methods We analyzed the medical records of
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Middle meningeal artery embolization for chronic subdural hematoma: an effective treatment with a bright future J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-04-01 Michael R Levitt, Joshua A Hirsch, Michael Chen
Neurointerventionalists are participating in a transformative moment in the field, from expanded thrombectomy indications,1 to the endovascular treatment of hydrocephalus,2 and endovascular brain–computer interfaces.3 Perhaps most consequential in recent years is the endovascular treatment of subacute or chronic subdural hematoma (cSDH) via middle meningeal artery embolization (MMAE). First reported
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Preventing air microembolism in cerebral angiography: a JNIS fellow’s perspective J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-04-01 Aurora S Cruz, Nicolas K Khattar, Gregory M Weiner, Zaid S Aljuboori, Clemens M Schirmer
Digital subtraction angiography is arguably the most valuable tool in the diagnosis and treatment of cerebrovascular disease. How benign is this procedure? Every fellow is taught their mentor’s semi-unique process of checking lines, clearing syringes, and preventing air embolism. Neurointerventional research is generally focused on safer technology, clinical outcomes, and quality improvement. Understanding
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Acute ischemic stroke outcomes in patients with COVID-19: a systematic review and meta-analysis J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-04-01 Sophia R Ferrone, Maria X Sanmartin, Joseph Ohara, Jean C Jimenez, Chinara Feizullayeva, Zachary Lodato, Shaya Shahsavarani, Gregory Lacher, Seleshi Demissie, Jaclyn Morales Vialet, Tim G White, Jason J Wang, Jeffrey M Katz, Pina C Sanelli
Background Although patients with COVID-19 have a higher risk of acute ischemic stroke (AIS), the impact on stroke outcomes remains uncertain. Aims To determine the clinical outcomes of patients with AIS and COVID-19 (AIS-COVID+). Methods We performed a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Our protocol
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Outcomes in patients with large vessel occlusion strokes undergoing mechanical thrombectomy with concurrent COVID-19: a nationwide retrospective analysis J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-04-01 Ian A Ramsay, Hayes Fountain, Turki Elarjani, Vaidya Govindarajan, Michael Silva, Ahmed Abdelsalam, Joshua D Burks, Robert M Starke, Evan Luther
Background Preliminary studies show that patients with large vessel occlusion (LVO) acute ischemic strokes have worse outcomes with concurrent COVID-19 infection. We investigated the outcomes for patients with LVO strokes undergoing mechanical thrombectomy (MT) with concurrent COVID-19 infection. Methods The National Inpatient Database (NIS) was used for our analysis. Patients in the year 2020 with
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Rescue stenting after failure of endovascular thrombectomy for acute vertebrobasilar artery occlusion: data from the PERSIST registry J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-04-01 Yanan Lu, Zongyi Wu, Zi Wang, Pan Zhang, Feng Zhang, Miaomiao Hu, Wenya Lan, Yong Liang, Jilong Yi, Wen Sun
Background Among acute vertebrobasilar artery occlusion (VBAO) patients, successful reperfusion is a strong predictor of favorable outcomes. However, failed reperfusion (FR) with endovascular thrombectomy (EVT) in VBAO was observed to occur in 18–50% of cases. We aim to evaluate the safety and efficacy of rescue stenting (RS) for VBAO after failed EVT. Methods Patients with VBAO who received EVT were
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The immunologic phenotype of thrombi is associated with future vascular events after cerebral infarction J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-04-01 Wookjin Yang, Soon Auck Hong, Jeong-Min Kim, Hae-Bong Jeong, Taek-Kyun Nam, Hyun Ho Choi, Suh Min Kim, Kwang-Yeol Park, Hye Ryoun Kim
Background Thrombi retrieved from patients with acute ischemic stroke may contain prognostic information. Objective To investigate the relationship between the immunologic phenotype of thrombi and future vascular events in patients with a stroke. Methods This study included patients with acute ischemic stroke who underwent endovascular thrombectomy at Chung-Ang University Hospital in Seoul, Korea,
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Systemic THrombolysis Randomization IN Endovascular Stroke Therapy (SHRINE) Collaboration: a patient-level pooled analysis of the SKIP and DEVT Trials J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-04-01 Raul G Nogueira, Kazumi Kimura, Yuji Matsumaru, Kentaro Suzuki, Zhongming Qiu, Wenjie Zi, Timothy P Moran, Fengli Li, Hongfei Sang, Weidong Luo, Shuai Liu, Junjie Yuan, Jiaxing Song, Jiacheng Huang, Masataka Takeuchi, Masafumi Morimoto, Toshiaki Otsuka, Qingwu Yang
Objective To evaluate the non-inferiority of endovascular treatment (EVT) alone versus intravenous thrombolysis (IVT) followed by EVT and to assess its heterogeneity across prespecified subgroups. Methods We pooled data from two trials (SKIP in Japan; DEVT in China). Individual patient data were pooled to assess outcomes and heterogeneity of treatment effect. The primary outcome was functional independence
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Cerebral aneurysms: Germany-wide real-world outcome data of endovascular or neurosurgical treatment from 2007 to 2019 J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-04-01 Christian Haverkamp, Klaus Kaier, Mukesch Shah, Constantin von zur Mühlen, Jürgen Beck, Horst Urbach, Stephan Meckel
Background Evidence on clinical outcome after endovascular treatment (EVT) vs neurosurgical clipping of intracranial aneurysms (IAs) is based on one randomized and one pseudo-randomized trial for ruptured aneurysms. Herein, we analyze nationwide real-world hospital outcomes after EVT vs clipping of ruptured and unruptured IAs. Methods This cohort study analyzed all EVT and clipping procedures for IAs
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Flow diversion for basilar quadrifurcation aneurysms J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-04-01 Visish M Srinivasan, Jubran H Jubran, Henry O Stonnington, Joshua S Catapano, Lea Scherschinski, Benjamin K Hendricks, Ethan A Winkler, Robert F Rudy, Brandon A Nguyen, Stephen J Dabrowski, Ashutosh P Jadhav, Andrew F Ducruet, Felipe C Albuquerque
Background Flow-diverting devices (FDDs), such as the Pipeline Embolization Device, have been gaining traction for treating challenging posterior circulation aneurysms. Few previous studies have focused on using FDDs to treat aneurysms of the basilar quadrifurcation. Methods We retrospectively reviewed the use of FDDs to treat patients with basilar quadrifurcation aneurysms. Patients were assessed
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Pipeline embolization device versus Atlas stent assisted coiling for intracranial aneurysm treatment: a retrospective, propensity score matched study with a focus on midterm outcomes and hospital costs J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-04-01 Chao Wang, Linggen Dong, Jian Liu, Yisen Zhang, Kun Wang, Peng Liu, Xinjian Yang, Ming Lv, Ying Zhang
Background Stent assisted coiling (SAC) and flow diverters (FDs) are common endovascular treatments for wide necked cerebral aneurysms, but studies comparing the new generation Atlas SAC and FDs are scarce. We performed a propensity score matched (PSM) cohort study to compare the Atlas SAC and the pipeline embolization device (PED) for proximal internal carotid artery (ICA) aneurysms. Methods Consecutive
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Diffusion-weighted imaging lesions after intracranial aneurysm treatment with Pipeline Flex and Pipeline Flex with Shield technology: a retrospective cohort analysis J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-04-01 Gustavo M Cortez, Victor H C Benalia, Eric Sauvageau, Amin Aghaebrahim, John Michael Pederson, Ricardo A Hanel
Background The Pipeline Flex embolization device with Shield technology (PED Shield) is the first flow diverter for brain aneurysm treatment approved in the United States using surface-modified technology. The effect of PED Shield on decreasing perioperative diffusion-weighted imaging positive (DWI+) hits, as a marker for in-human decrease thrombogenicity, is unclear. Objective To determine if the
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Evaluation of predictive models of aneurysm focal growth and bleb development using machine learning techniques J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-04-01 Sara Hadad, Fernando Mut, Martin Slawski, Anne M Robertson, Juan R Cebral
Background The presence of blebs increases the rupture risk of intracranial aneurysms (IAs). Objective To evaluate whether cross-sectional bleb formation models can identify aneurysms with focalized enlargement in longitudinal series. Methods Hemodynamic, geometric, and anatomical variables derived from computational fluid dynamics models of 2265 IAs from a cross-sectional dataset were used to train
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Advancements in super-selective catheterization and drug selection for intra-arterial chemotherapy for retinoblastoma: a 15-year evolution J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-04-01 Gary Kocharian, Y Pierre Gobin, Natasha Kharas, Jared Knopman, Jasmine H Francis, David H Abramson
Background Retinoblastoma (Rb) is the most common primary ocular malignancy of childhood. Left untreated, it is 100% fatal and carries a substantial risk of impaired vision and removal of one or both eyes. Intra-arterial chemotherapy (IAC) has become a pillar in the treatment paradigm for Rb that allows for better eye salvage and vision preservation without compromising survival. We describe the evolution
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Evaluation of effectiveness and safety of the CorPath GRX robotic system in endovascular embolization procedures of cerebral aneurysms J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-04-01 Vitor Mendes Pereira, Hal Rice, Laetitia De Villiers, Nader Sourour, Frédéric Clarencon, Julian Spears, Alejandro Tomasello, David Hernandez, Nicole M Cancelliere, Xiao Yu Eileen Liu, Patrick Nicholson, Vincent Costalat, Gregory Gascou, Pasquale Mordasini, Jan Gralla, Mario Martínez-Galdámez, Jorge Galvan Fernandez, Monika Killer-Oberpfalzer, David S Liebeskind, Raymond D Turner, Raphael Blanc, Michel
Background Robotic-assisted neurointervention was recently introduced, with implications that it could be used to treat neurovascular diseases. Objective To evaluate the effectiveness and safety of the robotic-assisted platform CorPath GRX for treating cerebral aneurysms. Methods This prospective, international, multicenter study enrolled patients with brain aneurysms that required endovascular coiling
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Robotically assisted deployment of flow diverter stents for the treatment of cerebral and cervical aneurysms J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-04-01 Cyril Chivot, Roger Bouzerar, Johann Peltier, Michel Lefranc, Thierry Yzet
Background Despite the growing sophistication of robot-assisted surgery, it is necessary to demonstrate that robots can reliably perform complex procedures on site and then remotely. Although a flow diverter stent is one of the most effective and widely used devices, its placement is sometimes challenging. Objective To evaluate the feasibility and safety of the CorPath GRX robotic platform for the
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Symptomatic non-stenotic carotid disease: current challenges and opportunities for diagnosis and treatment J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-04-01 Johanna Maria Ospel, Manon Kappelhof, Aravind Ganesh, David F Kallmes, Waleed Brinjikji, Mayank Goyal
Symptomatic non-stenotic carotid plaques (SyNC) are an under-researched and under-recognized source of stroke. Various imaging markers of non-stenotic carotid plaques that are associated with stroke risk have been identified, but these causal relationships need to be confirmed in additional prospective studies. Currently, there exists neither a standardized SyNC definition nor a dedicated set of imaging
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Now that the door is open: an update on ischemic stroke pharmacotherapeutics for the neurointerventionalist J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-04-01 Justin F Fraser, Shivani Pahwa, Michael Maniskas, Christopher Michas, Mesha Martinez, Keith R Pennypacker, David Dornbos
The last 10 years have seen a major shift in management of large vessel ischemic stroke with changes towards ever-expanding use of reperfusion therapies (intravenous thrombolysis and mechanical thrombectomy). These strategies ‘open the door’ to acute therapeutics for ischemic tissue, and we should investigate novel therapeutic approaches to enhance survival of recently reperfused brain. Key insights
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Stereotactic-guided direct orbital puncture for treatment of orbital arteriovenous fistula J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-04-01 Ariadna Robledo, Thomas S Frank, Patrick J Karas, Hashem Shaltoni, Sean O'Leary, Robert Darling, Peter Kan
The patient presented with left-sided chemosis, exophthalmos, and progressive visual loss. Cerebral angiography ed a left orbital arteriovenous malformation and an associated hematoma, with the point of fistulation between the left ophthalmic artery and the anterior section of the inferior ophthalmic vein, with retrograde flow through the superior ophthalmic vein. Transvenous embolization through the
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Correspondence on ‘Cerebral aneurysms: Germany-wide real-world outcome data of endovascular or neurosurgical treatment from 2007 to 2019’ by Haverkamp et al J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-04-01 Tyler S Cole
The study ‘Cerebral aneurysms: Germany-wide real-world outcome data of endovascular or neurosurgical treatment from 2007 to 2019’1 is a clear example of administrative database misuse. Since administrative and claims databases are intended for billing purposes, they contain sparse information about the pathology treated. This fact largely disqualifies them as clinical resources for studies comparing
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Response to: Correspondence on "Cerebral aneurysms: Germany-wide real-world outcome data of endovascular or neurosurgical treatment from 2007 to 2019” by Cole J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-04-01 Klaus Kaier, Christian Haverkamp, Stephan Meckel
We thank the authors for commenting on our recent study.1 First, the authors point out and nicely describe a major limitation of our study2, stating: “In this study, missing information includes aneurysm location, aneurysm size, why a treatment was chosen, whether a pathology was a comorbidity or a complication, if there was an external ventricular drain, and all the details regarding the aneurysmal
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Correspondence on ‘Acute ischemic stroke outcomes in patients with COVID-19: a systematic review and meta-analysis’ by Ferrone et al J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-04-01 Tayyab Muzaffar, Ahmad Danial, Muhammad Khaleeq Ahmed
We had the pleasure of reading the article ‘Acute ischemic stroke outcomes in patients with COVID-19: a systematic review and meta-analysis’ by Ferrone et al . with great interest.1 In particular, the reduced odds of home discharge for patients with stroke who have COVID-19 presents an interesting insight into the management challenges while caring for these patients. However, we would like to highlight
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The feasibility of mechanical thrombectomy versus medical management for acute stroke with a large ischemic territory J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-03-12 Assala Aslan, Saad Abuzahra, Nimer Adeeb, Basel Musmar, Hamza A Salim, Sandeep Kandregula, Adam A Dmytriw, Christoph J Griessenauer, Luis De Alba, Octavio Arevalo, Jan Karl Burkhardt, Vitor M Pereira, Pascal Jabbour, Bharat Guthikonda, Hugo H Cuellar
Background Mechanical thrombectomy (MT) for acute ischemic stroke is generally avoided when the expected infarction is large (defined as an Alberta Stroke Program Early CT Score of <6). Objective To perform a meta-analysis of recent trials comparing MT with best medical management (BMM) for treatment of acute ischemic stroke with large infarction territory, and then to determine the cost-effectiveness
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Overloaded transnidal pressure gradient as the hemodynamic mechanism leading to arteriovenous malformation rupture: a quantitative analysis using intravascular pressure monitoring and color-coded digital subtraction angiography J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-03-12 Yukun Zhang, Yu Chen, Ruinan Li, Li Ma, Heze Han, Zhipeng Li, Haibin Zhang, Kexin Yuan, Yang Zhao, Weitao Jin, Pingting Chen, Wanting Zhou, Xun Ye, Youxiang Li, Shuo Wang, Xiaolin Chen, Yuanli Zhao
Background The hemodynamics of brain arteriovenous malformations (AVMs) may have implications for hemorrhage. This study aimed to explore the hemodynamics of ruptured AVMs by direct microcatheter intravascular pressure monitoring (MIPM) and indirect quantitative digital subtraction angiography (QDSA). Methods We recruited patients with AVMs at a tertiary neurosurgery center from October 2020 to March
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Prolonged venous transit on perfusion imaging is associated with higher odds of mortality in successfully reperfused patients with large vessel occlusion stroke J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-03-12 Vivek S Yedavalli, Manisha Koneru, Meisam Hoseinyazdi, Cynthia Greene, Dhairya A Lakhani, Risheng Xu, Licia P Luna, Justin M Caplan, Adam A Dmytriw, Adrien Guenego, Jeremy J Heit, Gregory W Albers, Max Wintermark, L Fernando Gonzalez, Victor C Urrutia, Judy Huang, Kambiz Nael, Richard Leigh, Elisabeth B Marsh, Argye E Hillis, Rafael H Llinas
Background Poor venous outflow (VO) profiles are associated with unfavorable outcomes in patients with acute ischemic stroke caused by large vessel occlusion (AIS-LVO), despite achieving successful reperfusion. The objective of this study is to assess the association between mortality and prolonged venous transit (PVT), a novel visual qualitative VO marker on CT perfusion (CTP) time to maximum (Tmax)
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Impact of post-procedure stenosis on outcomes of patients with severe intracranial stenosis treated with intracranial stent placement J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-03-12 Ravi S Nunna, Xiaoyu Ma, Sabrina Genovese, Abdullah Lodhi, Navpreet K Bains, David Cohen, Caitlyn Smith, Michael J Ortiz, Farhan Siddiq, Camilo R Gomez, Adnan I Qureshi
Background The optimal target post-procedure stenosis after percutaneous angioplasty and stent placement (PTAS) for intracranial stenosis is unknown. We determined the effect of post-procedure stenosis after intracranial PTAS on subsequent clinical events in patients with severe symptomatic intracranial stenosis. Methods We categorized the severity of post-procedure stenosis as ‘<30%’, ‘30–49%’, and
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Clinical relevance of intracranial hemorrhage after thrombectomy versus medical management for large core infarct: a secondary analysis of the SELECT2 randomized trial J. NeuroInterv. Surg. (IF 4.8) Pub Date : 2024-03-12 Michael Chen, Krishna C Joshi, Bradley Kolb, Clark W Sitton, Deep Kiritbhai Pujara, Michael G Abraham, Santiago Ortega-Gutierrez, Scott E Kasner, Shazam M Hussain, Leonid Churilov, Spiros Blackburn, Sophia Sundararajan, Yin C Hu, Nabeel Herial, Juan F Arenillas, Jenny P Tsai, Ronald F Budzik, William Hicks, Osman Kozak, Bernard Yan, Dennis Cordato, Nathan W Manning, Mark Parsons, Ricardo A Hanel, Amin
Background The incidence of intracerebral hemorrhage (ICH) and its effect on the outcomes after endovascular thrombectomy (EVT) for patients with large core infarcts have not been well-characterized. Methods SELECT2 trial follow-up imaging was evaluated using the Heidelberg Bleeding Classification (HBC) to define hemorrhage grade. The association of ICH with clinical outcomes and treatment effect was