Liam M Flynn, Ezaz Mohamed, Nicholas Dobbs, Alberto Nania, Johannes Du Plessis, Peter M Keston, Jonny J Downer
BACKGROUND: Dual antiplatelet therapy (DAPT) is standard care for intracranial stenting to prevent thrombotic complications. Clopidogrel resistance has resulted in patients receiving newer P2Y12 inhibitors like Prasugrel, which may reduce thrombotic complications but could increase haemorrhagic complications. This study, utilising platelet reactivity testing, compared thrombotic and haemorrhagic complications associated with Clopidogrel or 20 mg Prasugrel loading in patients treated with flow diverters (FD) for intracranial aneurysms...
November 29, 2023: Interventional Neuroradiology
Daniel A Tonetti, Manisha Koneru, Meghna Bhattacharyya, Joey D English, Fabio Settecase, Warren T Kim, Jane Khalife, Pratit Patel, Ajith Thomas, Tudor Jovin, Ricardo Hanel, Victor H C Benalia, Gustavo M Cortez, Amin Aghaebrahim, Eric Sauvageau, Mohamad Abdalkader, Thanh N Nguyen, Piers Klein, Adam A Dmytriw, Hamza Shaikh
INTRODUCTION: Aspiration mechanical thrombectomy traditionally includes use of an inner microcatheter and leading microwire to navigate an aspiration catheter (AC) to the site of occlusion. Early clinical experience suggests that a leading microwire is often not needed with the Tenzing 7 (T7, Route 92 Medical, San Mateo, CA), a soft tapered tip ledge-reducing delivery catheter. This multicenter experience aims to describe AC delivery success in single-pass thrombectomy using T7 with and without a leading microwire...
November 28, 2023: Interventional Neuroradiology
Sean Thomas O'Reilly, Eef Jacobus Hendriks, Ze'ev Itsekson, Rabab Alshahrani, Emily Chung, Ivan Radovanovic, Ronit Agid, Patrick Nicholson, Timo Krings
BACKGROUND: Dual-lumen balloon microcatheters can aid in the safety and efficacy of endovascular embolisation of cerebrospinal vascular malformations. The Scepter Mini dual-lumen balloon is a novel device with a smaller profile than previous balloon microcatheters, opening up new indications not only in the treatment of cerebrospinal malformations but in various other neurovascular therapeutic and diagnostic scenarios. METHODS: Following institutional ethics review board approval, a retrospective review of our prospectively maintained database of cases employing the Scepter Mini dual-lumen microballoon catheter was conducted...
November 28, 2023: Interventional Neuroradiology
Tomas Klail, Christopher M Jesse, Ralph T Schär, Levin Häni, Andreas Raabe, Christoph J Schankin, Eike I Piechowiak, Tomas Dobrocky
Spontaneous intracranial hypotension (SIH) is a serious medical condition caused by loss of cerebrospinal fluid at the level of the spine, which, when not treated, may cause substantial long-term disability and increase morbidity. The following video summarizes the necessary steps for successful diagnosis and treatment of SIH, starting with a brain and spine magnetic resonance imaging, followed by dynamic myelography. Because an epidural bloodpatch did not provide a lasting relief, the patient underwent surgery which demonstrated a ventral dural slit caused by an osteodiscogenic microspur...
November 22, 2023: Interventional Neuroradiology
Rahul R Karamchandani, Sagar Satyanarayana, Hongmei Yang, Jeremy B Rhoten, Dale Strong, Jonathan D Clemente, Gary Defilipp, Nikhil M Patel, Joe D Bernard, William R Stetler, Jonathan M Parish, Andrew U Hines, Harsh N Patel, Anna Maria Helms, Lauren Macko, Laura Williams, Julia Retelski, Amy K Guzik, Stacey Q Wolfe, Andrew W Asimos
BACKGROUND: Basilar thrombosis frequently leads to poor functional outcomes, even with good endovascular reperfusion. We studied factors associated with severe disability or death in basilar thrombectomy patients achieving revascularization. METHODS: We retrospectively analyzed records from a health system's code stroke registry, including successful basilar thrombectomy patients from January 2017 to May 2023 who were evaluated with pretreatment computed tomography perfusion...
November 21, 2023: Interventional Neuroradiology
Arturo Consoli, Marco Pileggi, Atm Hasibul Hasan, Mohammad H Rahman, Alice Venier, Alessandro Sgreccia, Silvia Pizzuto, Oguzhan Coskun, Federico Di Maria, Luca Scarcia, Bertrand Lapergue, Georges Rodesch, Serge Bracard, Bailiang Chen
BACKGROUND: Patients with acute ischemic stroke secondary to large vessel occlusions and good collaterals are frequently associated with favorable outcomes after mechanical thrombectomy, although poor outcomes are observed also in this subgroup. We aimed to investigate the factors associated with unfavorable outcomes (modified Rankin Scale3-6) in this specific subgroup of patients. METHODS: In total, 219 patients (117 females) with anterior circulation stroke and good collaterals (American Society for Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology grades 3-4), treated by mechanical thrombectomy between 2016 and 2021 at our institution were included in this study...
November 7, 2023: Interventional Neuroradiology
Atakan Orscelik, Yigit Can Senol, Hassan Kobeissi, Sherief Ghozy, Cem Bilgin, Santhosh Arul, Ramanathan Kadirvel, Waleed Brinjikji, David F Kallmes
BACKGROUND: Distal transradial artery access (dTRA) has received increasing consideration for performing diagnostic cerebral angiography and neurointerventional procedures. In this meta-analysis, we aim to evaluate the safety and efficacy of dTRA compared to conventional transradial access (cTRA) for cerebral angiography and neurointerventions. METHOD: A systematic review and meta-analysis were conducted on studies investigating outcomes of dTRA and cTRA in neurointerventions...
November 7, 2023: Interventional Neuroradiology
Sávio Batista, Leonardo de Barros Oliveira, Jordana Borges Camargo Diniz, Agostinho Camara Pinheiro, Henrique Maia, Matheus Duarte, Filipi Fim Andreão, Lucca Biolcati Palavani, Raphael Bertani, José Alberto Almeida Filho, Raphael Muszkat Besborodco, Ricardo Hanel
BACKGROUND: Cerebral angiography has two common access sites: Transradial approach and transfemoral approach. However, there's no definitive answer to which one is superior. OBJECTIVE: Compare transradial approach and transfemoral approach for a cerebral angiography procedure. METHODS: A systematic review of the literature of studies reporting both transradial approach and transfemoral approach results was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines...
November 7, 2023: Interventional Neuroradiology
Kevin J Keenan, Wade S Smith, Ashutosh P Jadhav, Diogo C Haussen, Ronald F Budzik, Alain Bonafé, Parita Bhuva, Dileep R Yavagal, Marc Ribò, Christophe Cognard, Ricardo A Hanel, Ameer E Hassan, Cathy A Sila, Jeffrey L Saver, David S Liebeskind, Tudor G Jovin, Raul G Nogueira
BACKGROUND: Large vessel occlusion (LVO) prediction scales are used to triage prehospital suspected stroke patients with a high probability of LVO stroke to endovascular therapy centers. The sensitivities of these scales in the 6-to-24-h time window are unknown. Higher scale score thresholds are typically less sensitive and more specific. Knowing the highest scale score thresholds that remain sensitive could inform threshold selection for clinical use. Sensitivities may also vary between left and right-sided LVOs...
November 1, 2023: Interventional Neuroradiology
Ugurhan Kutbay, Oktay Algin
BACKGROUND: Lateral/radial forces and the mechanical properties of Woven EndoBridge (WEB) devices have significant importance for therapeutic success. In other words, adequate apposition of the lateral wall of a cerebral aneurysm is critical for preventing recurrence or re-rupture risk. OBJECTIVE: This study aimed to investigate the pressure values applied by different WEB devices to the lateral walls of aneurysms and the relationships between these pressure measurements and the diameters of WEB devices...
October 31, 2023: Interventional Neuroradiology
Timothy G White, Brandon A Santhumayor, Justin Turpin, Kevin Shah, Daniel Toscano, Ina Teron, Thomas Link, Athos Patsalides, Henry H Woo
Flow diversion (FD) has become a mainstay treatment for large wide-necked aneurysms. Despite excellent safety and efficacy, the risk of thromboembolic complications necessitates the use of dual antiplatelet therapy (DAPT). The use of DAPT makes hemorrhagic complications of stenting carry high morbidity and mortality. Additionally, DAPT usage carries a risk of "nuisance" complications that do not directly impact intracranial circulation but need to be managed nonetheless. To circumvent this issue, the most recent generation of flow diverters have undergone surface modification with various compounds to confer blood compatibility to limit clotting and thrombosis...
October 29, 2023: Interventional Neuroradiology
Savyasachi Jain, Pooja Jain, Amita Malik, Bheru Dan Charan
Nonbifurcating carotid is quite a rare anatomical variant of carotid anatomy. The embryology of carotid development is more intricate and convoluted than is presently known. This case report finds an unusual case of a nonbifurcating carotid artery whose embryological basis cannot be explained by popular prevalent theories. It also stresses about an abundance of case reports from East Asia on this topic, to the best of the authors' knowledge. The formation of atherosclerotic plaque requires more than abnormal fluid hemodynamic, which has been briefly pointed out...
October 24, 2023: Interventional Neuroradiology
Melika Amoukhteh, Amir Hassankhani, Payam Jannatdoust, Parya Valizadeh, Sherief Ghozy, David F Kallmes
No abstract text is available yet for this article.
October 19, 2023: Interventional Neuroradiology
Carolina Capirossi, Razvan A Radu, Gregory Gascou, Pierre-Henri Lefevre, Cyril Dargazanli, Paolo Machi, Vincent Costalat, Federico Cagnazzo
BACKGROUND: The safety and efficacy of low-profile braided stent as stent monotherapy require further investigation. OBJECTIVE: To analyze patient outcomes after treatment with braided stents used as "light" flow diverters. MATERIAL/METHODS: Retrospective study to evaluate the occlusion rate of aneurysms treated with braided stent and remodeling of covered side branches and perforators. Several factors potentially influencing aneurysm occlusion were analyzed...
October 17, 2023: Interventional Neuroradiology
Nicholas C Field, Pouya Entezami, Alan S Boulos, John Dalfino, Alexandra R Paul
INTRODUCTION: Rapid initiation of mechanical thrombectomy (MT) for the treatment of large-vessel occlusion (LVO) critically improves patient outcomes. Artificial intelligence algorithms aid in the identification of LVOs and improve door to puncture times as well as patient transfer times. OBJECTIVES: We aimed to determine whether the implementation of an LVO detection algorithm that provides immediate active notification to the thrombectomy team provider's cell phone would improve ischemic stroke workflow at our institution and aid in patient transfer from outlying hospitals when compared to our prior system of passive computed tomography perfusion software analysis and radiologist interpretation and notification...
October 17, 2023: Interventional Neuroradiology
Alejandro Tomasello, Laura Ludovica Gramegna, Pedro Vega, Carlos Castaño, Manuel Moreu, Carlos Dominguez, Juan Macho
INTRODUCTION: The iNedit balloon distal access catheter is a novel thrombectomy device. It has an inner diameter of 0.058″, proximal outer diameter of 2.13 mm, and distal outer diameter of 1.67mm. It is compatible with a 0.088″ guide catheter and includes a balloon located 5 cm from the catheter tip, enabling proximal flow restriction and combined therapy with stent retrievers. We investigate the appraisal of the use, safety, and efficacy of the iNedit catheter in the first-in-human study...
October 17, 2023: Interventional Neuroradiology
Giuseppe Pelle, Flavio Andresciani, Massimo Messina, Antonio Ciacciarelli, Ermanno Notarianni, Roberta Siniscalchi, Gabriella Monteforte, Angelo Iannarelli, Alessandro Tanzilli, Marco Perinelli, Cesare Ambrogi
Mechanical thrombectomy is a standard treatment for acute stroke, but it can be technically challenging in elderly patients with difficult vascular anatomy. To overcome this issue, we propose a new endovascular approach called the "tightrope" technique. This technique uses a stiff guidewire and a standard angiographic catheter to straighten the internal carotid artery (ICA) tortuosity, allowing the guiding catheter to be positioned next to the intracranial level. We retrospectively evaluated all the procedures in which the "tightrope" technique was used...
October 13, 2023: Interventional Neuroradiology
Varun Padmanaban, Chloe Grzyb, Cesar Velasco, Alicia Richardson, Erin Cekovich, Raymond Reichwein, Ephraim W Church, David A Wilkinson, Scott D Simon, Kevin M Cockroft
BACKGROUND: The appropriate choice of perioperative sedation during endovascular thrombectomy for ischemic stroke is unknown. Few studies have evaluated the role of nursing-administered conscious sedation supervised by a trained interventionalist. OBJECTIVE: To compare the safety and efficacy of endovascular thrombectomy for ischemic stroke performed with nursing-administered conscious sedation supervised by a trained interventionalist with monitored anesthesia care supervised by an anesthesiologist...
October 12, 2023: Interventional Neuroradiology
Yosef Ellenbogen, Eef J Hendriks, Spyros Karadimas, Sean O'Reilly, Zeev Itsekzon Hayosh, Rabab Alshahrani, Ronit Agid, Joanna Schaafsma, Timo Krings, Patrick Nicholson
BACKGROUND: Intracranial atherosclerotic disease (ICAD) is a potential cause of ischemic stroke. Treatment of ICAD can include intracranial stenting. There are specifically designed stents for this use-case; however, less is known about the off-label use of the Neuroform Atlas stent. In this study, we describe the outcomes of the Neuroform Atlas stent for treatment of ICAD. METHODS: Adult patients with symptomatic ICAD failing best medical treatment undergoing elective intracranial stenting using the Neuroform Atlas stent between November 2018 and March 2021 were included...
October 10, 2023: Interventional Neuroradiology
Mohamad Ezzeldin, Riichi Ota, Eric Riha, Adam Delora, Bader Alenzi, Victoria Gordon, Himanshu Gupta, Rime Ezzeldin, Saif Bushnaq
BACKGROUND: Recently, the angled-tip Zoom™ aspiration catheters were introduced. The tip is designed to improve suction force for clot retrieval. We evaluated the possibility of reducing procedure costs when using angled-tip catheters and compared the safety and angiographic effectiveness of angled-tip versus straight-tip catheters. METHODS: We conducted a retrospective single-center cohort study involving patients with acute ischemic stroke due to large and medium vessel occlusions...
October 10, 2023: Interventional Neuroradiology
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