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Diana F, Peschillo S, Requena M, Romano DG, Frauenfelder G, de Dios Lascuevas M, Hernandez D, Ribó M, Tomasello A, Romoli M. Correlation between intravascular pressure gradients and ultrasound velocities in carotid artery stenosis: An exploratory study. Interv Neuroradiol 2023:15910199231224007. [PMID: 38155483 DOI: 10.1177/15910199231224007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023] Open
Abstract
INTRODUCTION Grading of carotid stenosis is routinely performed with non-invasive techniques, such as carotid ultrasound (CUS) and computerized tomography angiography (CTA), which have limitations in grading definition. Moreover, the actual hemodynamic impact of a stenosis remains poorly defined. Preliminary studies explored the application of the resting full-cycle ratio (RFR), measured with pressure wire (PW), but the correlation between RFR and morphological/hemodynamic parameters is still undefined. This study aims to test the correlation between RFR and CUS-CTA-DSA based degree of stenosis, to define the suitability of RFR as carotid stenosis index. METHODS We included patients with symptomatic carotid stenosis receiving carotid artery stenting (CAS), between November 2022 and May 2023. We performed CUS and PW measurements before and after stenting, at four different sites (trans-lesion, distal cervical, petrous and supraclinoid internal carotid artery [ICA] segments). We compared CUS and PW parameters by Pearson's or Spearman test for continuous variables. RESULTS Among 15 patients included the mean stenosis degree was 81.3%. Trans-lesion RFR was significantly higher than other sites (0.72 ± 0.2 trans-lesion vs. 0.69 ± 0.18 distal cervical ICA vs. 0.66 ± 0.2 petrous ICA vs. 0.6 ± 0.2 intracranial ICA, p < 0.05). All RFR values significantly increased after treatment; the highest relative increase was registered at stenosis site (0.72 ± 0.2 pre-stent vs. 1.01 ± 0.1 post-stent, p < 0.01). Trans-lesion RFR was significantly associated with the CTA and DSA stenosis degree and CUS measurements. CONCLUSIONS Pressure wire in carotid artery stenosis seems safe and suitable. Resting full-cycle ratio has a significant correlation with CUS values and stenosis degree and might be used as carotid stenosis index during CAS.
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Affiliation(s)
- Francesco Diana
- Interventional Neuroradiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Simone Peschillo
- Unicamillus International University of Health Sciences, Rome, Italy
| | - Manuel Requena
- Interventional Neuroradiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Daniele G Romano
- Interventional Neuroradiology, San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Giulia Frauenfelder
- Interventional Neuroradiology, San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Marta de Dios Lascuevas
- Interventional Neuroradiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - David Hernandez
- Interventional Neuroradiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Marc Ribó
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
- Stroke Unit, Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Alejandro Tomasello
- Interventional Neuroradiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Michele Romoli
- Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, Cesena, Italy
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Gramegna LL, Ortega G, Dinia L, Aixut S, Rosati S, Vega P, Lüttich A, Remollo S, González A, Murias E, Chirife Chaparro O, Moreu M, Requena M, de Dios Lascuevas M, Hernandez D, Quintana M, Puig J, Rovira A, Tomasello A. Cognitive improvement following endovascular embolization in patients with intracranial dural arteriovenous fistula: The Neuropsychology in dural ArterIal Fistula (NAIF) Study. J Neurointerv Surg 2023:jnis-2023-021033. [PMID: 38071581 DOI: 10.1136/jnis-2023-021033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/21/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND Cognitive improvement after endovascular embolization of an intracranial dural arteriovenous fistula (dAVF) remains unexplored. We aim to investigate cognitive changes following endovascular embolization of dAVFs. METHODS Neuropsychology in dural ArterIal Fistula (NAIF) was a prospective multicentric study including patients with an angiographic diagnosis of dAVF who underwent endovascular embolization over the course of 4 years. A complete neuropsychological evaluation comprising five cognitive domains (attention and executive functions, memory, language, praxis, gnosis) was performed at baseline and 3 months follow-up. Mean Z scores for cognitive tests were compared pre- and post-treatment using paired sample t-tests, where higher Z scores indicate better cognition. Effect sizes were computed as Cohen's d. RESULTS A total of 32 patients (mean age 61.1±15.4 years, 10 (31.3%) females) were included. Patients exhibited improved performance in attention and executive functions: executive functions-attention (+0.282, P=0.009, d=0.29), executive functions-fluencies (+0.283, P=0.029, d=0.4), and executive functions-processing speed (+0.471, P=0.039, d=0.41). There was an increase in memory: verbal learning and verbal delayed recall scores (+0.513, P<0.001, d=0.55, and +0.385, P=0.001, d=0.41, respectively), while verbal recognition parameters (+0.839, P=0.086, d=0.37) and visual memory (delayed recall) (+0.430, P=0.060, d=0.35) displayed trends toward improved performance. Regarding language, there was significant overall improvement (+0.300, P=0.014, d=0.24), but neither praxis nor gnosis changed significantly. These cognitive outcomes were independent of the severity (measured as Cognard classification), and no patient experienced cognitive worsening. CONCLUSION This study suggests that endovascular embolization confers cognitive benefits on dAVF patients undergoing endovascular embolization and may be beneficial even for patients with a low risk of hemorrhage.
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Affiliation(s)
- Laura Ludovica Gramegna
- Vall d'Hebron Research Institute, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Servicio de Radiología, Unidad de Neurorradiología, Hospital del Mar, Barcelona, Spain
| | - Gemma Ortega
- Universitat Internacional de Catalunya, Research Center and Memory clinic Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Lavinia Dinia
- Department of Radiology, Hospital de la Santa Creu i Sant Pau, Interventional Neuroradiology Section, Barcelona, Spain
| | - Sonia Aixut
- Department of Neuroradiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - Santiago Rosati
- Department of Radiology, Clinical San Carlos Hospital, Interventional Neuroradiology Unit, Madrid, Spain
| | - Pedro Vega
- Department of Radiology, Hospital Universitario Central de Asturias, Interventional Neuroradiology, Oviedo, Spain
| | - Alex Lüttich
- Department of Radiology, Donostia University Hospital, Interventional Neuroradiology Section, Donostia-San Sebastián, Spain
| | - Sebastian Remollo
- Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Interventional Neuroradiology Unit, Badalona, Spain
| | - Alejandro González
- Department of Radiology, Hospital Universitario Virgen del Rocío, Interventional Neuroradiology, Seville, Spain
| | - Eduardo Murias
- Department of Radiology, Hospital Universitario Central de Asturias, Interventional Neuroradiology, Oviedo, Spain
| | - Oscar Chirife Chaparro
- Department of Neuroradiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - Manuel Moreu
- Department of Radiology, Hospital Clínico Universitario San Carlos, Interventional Neuroradiology Unit, Madrid, Spain
| | - Manuel Requena
- Vall d'Hebron Research Institute, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Interventional Neuroradiology Section, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Marta de Dios Lascuevas
- Interventional Neuroradiology Section, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - David Hernandez
- Interventional Neuroradiology Section, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Manuel Quintana
- Department of Neurology, Hospital Universitari Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Epilepsy Unit, Barcelona, Spain
| | - Josep Puig
- Radiology Department CDI, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Alex Rovira
- Department of Radiology, Neuroradiology Section, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Alejandro Tomasello
- Vall d'Hebron Research Institute, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Interventional Neuroradiology Section, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
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Piñana C, Remollo S, Zamarro J, Werner M, Espinosa de Rueda M, Vega P, Hernandez D, Murias E, Rivera E, Olier J, San Roman L, Páez-Carpio A, Requena M, Aixut S, de Dios Lascuevas M, Moreu M, Rosati S, Gramegna LL, Castaño C, Tomasello A. Derivo embolization device for intracranial aneurysms: a Spanish multicenter retrospective study. J Neurointerv Surg 2023; 15:871-875. [PMID: 35999049 DOI: 10.1136/jnis-2022-019220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/15/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Flow diverters have emerged in recent years as a safe and effective treatment for intracranial aneurysms, with expanding indications. The Derivo embolization device (DED) is a second-generation flow diverter with a surface finish that may reduce thrombogenicity. We report our multicenter experience evaluating its safety and efficacy. METHODS We retrospectively analyzed all patients treated with the DED in eight centers in Spain between 2016 and 2020. Demographics, clinical data, procedural complications, morbidity and aneurysm occlusion rates were collected. RESULTS A total of 209 patients with 250 aneurysms were treated (77.5% women). The majority of aneurysms were located in the internal carotid artery (86.8%) and most (69.2%) were small (<10 mm) with a median maximum diameter of 5.85 mm and median neck size of 4 mm. DED deployment was successful in all cases, despite two malfunctioning devices (1%). Major complications occurred in nine patients (4.3%), while mild neurologic clinical events were registered in 23 (11%); four patients died (1.9%). A total of 194 aneurysms had an angiographic follow-up at 6 months and showed complete aneurysm occlusion in 75% of cases. Twelve-month follow-up was available for 112 of the treated aneurysms, with a total occlusion rate of 83%. CONCLUSION The DED is a second-generation surface-modified flow diverter that presents an option for treatment of intracranial aneurysms with comparable safety and efficacy to other available flow diverter devices. Nonetheless, risks are not negligible, and must be balanced against the natural history risk of cerebral aneurysms, considering the tendency to widen indications for treatment of smaller and less complex lesions in day-to-day use.
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Affiliation(s)
- Carlos Piñana
- Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Sebastian Remollo
- Interventional Neuroradiology Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Joaquín Zamarro
- Interventional Neuroradiology, Radiology, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Mariano Werner
- Interventional Neuroradiology, Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Mariano Espinosa de Rueda
- Interventional Neuroradiology, Radiology, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Pedro Vega
- Radiology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - David Hernandez
- Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Eduardo Murias
- Radiology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Eila Rivera
- Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Jorge Olier
- Interventional Neuroradiology, Hospital de Navarra, Pamplona, Spain
| | - Luis San Roman
- Interventional Neuroradiology, Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Alfredo Páez-Carpio
- Interventional Neuroradiology, Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Manuel Requena
- Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Sonia Aixut
- Neuroradiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Catalunya, Spain
| | - Marta de Dios Lascuevas
- Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Manuel Moreu
- Interventional Neuroradiology Unit, Department of Radiology, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Santiago Rosati
- Interventional Neuroradiology Unit, Department of Radiology, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Laura Ludovica Gramegna
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Bologna, Italy
- Instituto delle Scienze Neurologiche di Bologna (IRCCS), Bologna, Italy
| | - Carlos Castaño
- Interventional Neuroradiology Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Alejandro Tomasello
- Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Barcelona, Spain
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Requena M, Li J, Tiberi R, Canals P, Olive Gadea M, de Dios Lascuevas M, Jabłońska M, Cendrero J, Garcia-Tornel A, Tomasello A, Ribo M. Impact on collateral flow of devices used for endovascular treatment of stroke: an in-vitro flow model. J Neurointerv Surg 2023:jnis-2023-020602. [PMID: 37648434 DOI: 10.1136/jnis-2023-020602] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/18/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Collateral blood supply of distal vessels has been linked to clinical outcome, infarct volume and recanalization rates in patients with large vessel occlusion. Our study aimed to explore the effects of catheterization during mechanical thrombectomy in collaterals. METHODS We quantified the flow diversion effect secondary to arterial occlusions in an in vitro model which was connected in a flow-loop setup with a saline reservoir and a pump supplying pulsatile flow. Clot analogs were embolized to the middle cerebral artery (MCA) M1 or M2 segments. We used the same model with a clamped anterior communicating artery (AComA) to simulate its absence. An ultrasound flow sensor was placed at the vessel of interest. Flow rates and pressures were evaluated according to the following catheter locations: baseline (1) before and (2) after the occlusion; (3) 8F guiding catheter at the internal carotid artery (ICA) bulb; (4) at the cavernous segment; (5) at the cavernous segment a 0.071" distal access catheter at proximal M1; (6) 8F balloon guide catheter inflated. RESULTS Collateral blood flow measured at distal anterior cerebral artery (ACA) (M1-MCA occlusion) and M2-MCA (M2-MCA occlusion) was progressively reduced as catheters were advanced through the ICA and MCA. In the lacking AComA model, the flow was further diminished as compared with the model with a patent AComA. CONCLUSION Our in vitro study showed a progressive reduction of collateral blood flow due to the advance of catheters during mechanical thrombectomy.
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Affiliation(s)
- Manuel Requena
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
- Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
- Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Jiahui Li
- Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
- Department of Neurology, Autonomous University of Barcelona, Barcelona, Spain
| | - Riccardo Tiberi
- Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
- Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Pere Canals
- Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Marta Olive Gadea
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
- Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Marta de Dios Lascuevas
- Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
- Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Magda Jabłońska
- Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
- Department of Radiology, Gdanski Uniwersytet Medyczny, Gdansk, Poland
| | - Judith Cendrero
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
- Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Alvaro Garcia-Tornel
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
- Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Alejandro Tomasello
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
- Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Marc Ribo
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
- Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
- Department of Neurology, Autonomous University of Barcelona, Barcelona, Spain
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Hanning U, Bechstein M, Kaesmacher J, Boulouis G, Chapot R, Andersson T, Boccardi E, Psychogios M, Cognard C, de Dios Lascuevas M, Rodrigues M, Rodriguez Caamaño I, Gargalas S, Simonato D, Zupancic V, Daller C, Meyer L, Broocks G, Guerreiro H, Fiehler J, Martínez-Galdamez M, Kalousek V. Remote Training of Neurointerventions by Audiovisual Streaming : Experiences from the European ESMINT-EYMINT E-Fellowship Program. Clin Neuroradiol 2023; 33:137-145. [PMID: 35829740 PMCID: PMC9277595 DOI: 10.1007/s00062-022-01192-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/20/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Remote access of trainees to training centers via video streaming (tele-observership, e‑fellowship) emerges as an alternative to acquire knowledge in endovascular interventions. Situational awareness is a summary term that is also used in surgical procedures for perceiving and understanding the situation and projecting what will happen next. A high situational awareness would serve as prerequisite for meaningful learning success during tele-observerships. We hypothesized that live perception of the angiographical procedures using streaming technology is feasible and sufficient to gain useful situational awareness of the procedure. METHODS During a European tele-observership organized by the European Society of Minimally Invasive Neurological Therapy (ESMINT) and its trainee association (EYMINT), a total of six neurointerventional fellows in five countries observed live cases performed by experienced neurointerventionalists (mentors) in six different high-volume neurovascular centers across Europe equipped with live-streaming technology (Tegus Medical, Hamburg, Germany). Cases were prospectively evaluated during a 12-month period, followed by a final questionnaire after completion of the course. RESULTS A total of 102/161 (63%) cases with a 1:1 allocation of fellow and mentor were evaluated during a 12-month period. Most frequent conditions were ischemic stroke (27.5%), followed by embolization of unruptured aneurysms (25.5%) and arteriovenous malformations (AVMs) (15.7%). A high level of situational awareness was reported by fellows in 75.5% of all cases. After finishing the program, the general improvement of neurointerventional knowledge was evaluated to be extensive (1/6 fellows), substantial (3/6), and moderate (2/6). The specific fields of improvement were procedural knowledge (6/6 fellows), technical knowledge (3/6) and complication management (2/6). CONCLUSION Online streaming technology facilitates location-independent training of complex neurointerventional procedures through high levels of situational awareness and can therefore supplement live hands-on-training. In addition, it leads to a training effect for fellows with a perceived improvement of their neurointerventional knowledge.
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Affiliation(s)
- Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Matthias Bechstein
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Johannes Kaesmacher
- Department of Neurology, Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Grégoire Boulouis
- Diagnostic and Interventional Neuroradiology Department, Institut national de la santé et de la recherche médicale (INSERM) Team 1253 iBrain, Tours University Hospital, Tours, Centre Val de Loire Region, France
| | - René Chapot
- Department of Neuroradiology, Alfried Krupp Krankenhaus, Essen, Germany
| | - Tommy Andersson
- Department of Neuroradiology, Karolinska University Hospital and Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium
| | - Edoardo Boccardi
- Department of Diagnostic and Interventional Neuroradiology, Niguarda Hospital, Milan, Italy
| | - Marios Psychogios
- Division of Neuroradiology, Clinic of Radiology and Nuclear Medicine, Basel University Hospital, Basel, Switzerland
| | - Christophe Cognard
- Neuroradiology Department, Pierre-Paul-Riquet/Purpan University Hospital, Toulouse, France
| | | | - Marta Rodrigues
- Neuroradiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | | | - Sergios Gargalas
- Diagnostic and Interventional Neuroradiology Department, John Radcliffe Hospital, Oxford, UK
| | - Davide Simonato
- Interventional Neuroradiology Department, University Hospital of Padua, Padua, Italy
| | - Vedran Zupancic
- Department of Radiology, Clinical Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Cornelia Daller
- Department of Neurosurgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Helena Guerreiro
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Mario Martínez-Galdamez
- Interventional Neuroradiology/Endovascular Neurosurgery, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Vladimir Kalousek
- Department of Radiology, Clinical Hospital Center Sestre Milosrdnice, Zagreb, Croatia
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Juega J, Li J, Palacio C, Rodriguez M, Tiberi R, Pinana Plaza C, Rodriguez-Luna D, Requena M, Garcia-Tornel Garcia A, Rodriguez-Villatoro N, Rubiera M, Muchada M, Olive-Gadea M, Rizzo F, Hernandez Morales D, de Dios Lascuevas M, Lozano P, boned S, Hernandez-Perez M, Dorado L, Quesada H, Cardona P, de la Torre C, Gallur LA, Camacho J, Ramon y Cajal S, Tomasello A, Ribo M, Molina CA, Pagola J. Abstract 95: High Proportion Of Granulocytes Form Intracranial Thrombus Is Associated With Increased Stiffness And Resistance To Endovascular Recanalization. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Hypothesis:
We aim to identify a profile of intracranial thrombus resistant to recanalization by standard mechanical thrombectomy (MT) in acute stroke treatment.
Methods:
First extracted clot of each MT were analyzed by Flow Cytometry obtaining composition of main leukocyte populations: granulocytes, monocytes and lymphocytes. Demographics, reperfusion treatment and grade of recanalization were registered. MT Failure ( MTF) was defined as final Thrombolysis in Cerebral Infarction score IIa or lower and/ or need of permanent intracranial stenting as a rescue therapy after standard MT. In other cohort of cases, unconfined compression tests were performed to explore stiffness of retrieved clots . We looked for correlation between mechanical characterization tests and clot composition.
Results:
Among 225 patients, there were 13 % of MTF that were significantly associated to atherosclerosis etiology ( 33.3% vs. 15.9% ; p 0.021) , more passes ( 3 vs. 2; p <0.001), higher proportion of clot granulocytes ( 82.46% vs. 68.90% ; p <0.001) and lower proportion of clot monocytes ( 9.18% vs.17.34% ; p<0.001). The proportion of clot granulocytes (aOR 1.07; 95% CI 1.01-1.14) remained as an independent marker of MTF. Among Thirty eight clots tested by unconfined compression median clot stiffness was 30.2 (IQR, 18.9-42.7) kPa. There was a positive correlation between granulocyte proportion and thrombi stiffness (Pearson’s r=0.35, p=0.032).
Conclusions:
There is a positive correlation between granulocyte proportion and thrombi stiffness that may explain endovascular resistance to recanalization. Influence of granulocytes within thrombus may be a target for future reperfusion treatments.
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Affiliation(s)
- Jesus Juega
- HOSPITAL VALL HEBRON - UNITAT ICTUS, Barcelona, Spain
| | - Jiahui Li
- HOSPITAL VALL HEBRON - UNITAT ICTUS, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - LAura Gallur
- HOSPITAL VALL HEBRON - UNITAT ICTUS, Barcelona, Spain
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Diana F, de Dios Lascuevas M, Peschillo S, Raz E, Yoshimura S, Requena Ruiz M, Hernández Morales D, Tomasello A. Intrasaccular Flow Disruptor-Assisted Coiling of Intracranial Aneurysms Using the Novel Contour Neurovascular Systems and NEQSTENT: A Single-Center Safety and Feasibility Study. Brain Sci 2022; 12:brainsci12080991. [PMID: 35892432 PMCID: PMC9394360 DOI: 10.3390/brainsci12080991] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/24/2022] [Accepted: 07/24/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Intrasaccular flow disruptors (IFD) have been introduced in the treatment of intracranial aneurysms (IAs) to overcome the low aneurysm occlusion rate and the high recanalization rate of the coiling technique. Among them, the Contour Neurovascular System (CNS) and the Neqstent (NQS) were designed to reconstruct the aneurysmal neck and both can be used as assisting coiling devices. We aimed to report our preliminary experience with the flow disruptor-assisted coiling (IFD-AC) technique. Methods: We performed a retrospective analysis of prospectively collected data of all patients with IAs treated with the IFD-AC. Results: Between February 2021 and April 2022, we treated 15 IAs with the IFD-AC: 10 ruptured and 5 unruptured. The IFD-AC was successfully performed in 13 cases, with a post-operative RROC 1 in 12 cases (92.3%) and RROC 2 in 1 case (7.7%). There was one ischemic event (6.7%) and no hemorrhagic complications. Twelve patients underwent a mid-term radiologic follow-up: Ten IAs (83.4%) presented an adequate occlusion, while 2 (16.7%) had a recurrence. Conclusions: The IFD-AC, both with the CNS and the NQS, seems a safe technique with promising efficacy profile. The IFD-AC has proved to be safe without antiplatelet therapy in ruptured cases. Further studies are needed to confirm our preliminary results.
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Affiliation(s)
- Francesco Diana
- Neuroradiology, University Hospital ‘San Giovanni di Dio e Ruggi d’Aragona’, 84125 Salerno, Italy;
| | - Marta de Dios Lascuevas
- Neuroradiology, Vall d’Hebron Hospital Universitari, 08035 Barcelona, Spain; (M.d.D.L.); (M.R.R.); (D.H.M.); (A.T.)
- Grupo de Recerca en Ictus, Vall d’Hebron Institut de Recerca, 08035 Barcelona, Spain
| | - Simone Peschillo
- UniCamillus International Medical University, 00131 Rome, Italy
- Endovascular Neurosurgery, Pia Fondazione Cardinale G Panico Hospital, 73039 Tricase, Italy
- Correspondence:
| | - Eytan Raz
- Department of Radiology, NYU Langone Health, New York, NY 10016, USA;
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya 663-8501, Japan;
| | - Manuel Requena Ruiz
- Neuroradiology, Vall d’Hebron Hospital Universitari, 08035 Barcelona, Spain; (M.d.D.L.); (M.R.R.); (D.H.M.); (A.T.)
- Grupo de Recerca en Ictus, Vall d’Hebron Institut de Recerca, 08035 Barcelona, Spain
| | - David Hernández Morales
- Neuroradiology, Vall d’Hebron Hospital Universitari, 08035 Barcelona, Spain; (M.d.D.L.); (M.R.R.); (D.H.M.); (A.T.)
- Grupo de Recerca en Ictus, Vall d’Hebron Institut de Recerca, 08035 Barcelona, Spain
| | - Alejandro Tomasello
- Neuroradiology, Vall d’Hebron Hospital Universitari, 08035 Barcelona, Spain; (M.d.D.L.); (M.R.R.); (D.H.M.); (A.T.)
- Grupo de Recerca en Ictus, Vall d’Hebron Institut de Recerca, 08035 Barcelona, Spain
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Li J, Castaño O, Tomasello A, de Dios Lascuevas M, Canals P, Engel E, Ribo M. Catheter tip distensibility substantially influences the aspiration force of thrombectomy devices. J Neurointerv Surg 2021; 14:neurintsurg-2021-017487. [PMID: 33858973 DOI: 10.1136/neurintsurg-2021-017487] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/30/2021] [Accepted: 04/01/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND A direct aspiration first pass thrombectomy (ADAPT) is a fast-growing technique for which a broad catalog of catheters that provide a wide range of aspiration forces can be used. We aimed to characterize different catheters' aspiration performance on stiff clots in an in vitro vascular model. We hypothesized that labeled catheter inner diameter (labeled-ID) is not the only parameter that affects the aspiration force (asp-F) and that thrombus-catheter tip interaction and distensibility also play a major role. METHODS We designed an experimental setup consisting of a 3D-printed carotid artery immersed in a water deposit. We measured asp-F and distensibility of catheter tips when performing ADAPT on a stiff clot analog larger than catheter labeled-ID. Correlations between asp-F, catheter ID, and tip distensibility were statistically assessed. RESULTS Experimental asp-F and catheter labeled-ID were correlated (r=0.9601; P<0.01). The relative difference between experimental and theoretical asp-F (obtained by the product of the tip's section area by the vacuum pressure) correlated with tip's distensibility (r=0.9050; P<0.01), evidencing that ADAPT performance is highly influenced by catheter tip shape-adaptability to the clot and that the effective ID (eff-ID) may differ from the labeled-ID specified by manufacturers. Eff-ID showed the highest correlation with experimental asp-F (r=0.9944; P<0.01), confirming that eff-ID rather than labeled-ID should be considered to better estimate the device efficiency. CONCLUSIONS Catheter tip distensibility can induce a significant impact on ADAPT performance when retrieving a stiff clot larger than the device ID. Our findings might contribute to optimizing thrombectomy strategies and the design of novel aspiration catheters.
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Affiliation(s)
- Jiahui Li
- Stroke Unit, Neurology, Hospital Vall d'Hebron, Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Oscar Castaño
- Electronics and Biomedical Engineering, University of Barcelona, Barcelona, Spain.,Biomaterials for Regenerative Therapies, Institute for Bioengineering in Catalonia, Barcelona, Spain
| | | | | | - Pere Canals
- Stroke Unit, Neurology, Hospital Vall d'Hebron, Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elisabeth Engel
- CIBER en Bioingeniería, Biomateriales y Nanomedicina, CIBER, Madrid, Spain.,Materials Science and Engineering, Technical University of Catalonia, Barcelona, Spain
| | - Marc Ribo
- Stroke Unit, Neurology, Hospital Vall d'Hebron, Barcelona, Spain .,Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
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Abstract
Transradial access (TRA) has become the standard approach for cardiac intervention, with a large body of evidence demonstrating a lower incidence of vascular complications, better patient experience and cost reduction. There has been increasing interest in using TRA both for diagnostic neuroangiography and for interventional neurovascular procedures. This aim of this article is to discuss the advantages and limitations of TRA for neurointerventions. General technical details, such as pre-procedure recommendations, prevention of spasm and occlusion, haemostasis protocols and distal TRA puncture, are also described, along with the specific technical details of TRA for aneurysm embolisation, stroke thrombectomy and other neurovascular interventions. TRA provides additional tools to the neurointerventionist and – with appropriate training – the whole spectrum of intervention procedures can be achieved using this approach.
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Affiliation(s)
- Roger Barranco Pons
- Department of Interventional Neuroradiology, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Isabel Rodriguez Caamaño
- Department of Interventional Neuroradiology, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Marta de Dios Lascuevas
- Department of Interventional Neuroradiology, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
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