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Single-antiplatelet regimen in ruptured cerebral blood blister and dissecting aneurysms treated with flow-diverter stent reconstruction
Conclusions Peri-interventional single-antiplatelet therapy with eptifibatide followed by prasugrel was sufficient to prevent thromboembolic events and reduce re-bleeding using an anti-thrombogenic FDS. FDS with single-antiplatelet therapy might be a viable option for ruptured blood blister and dissecting cerebral aneurysms.
Source: Journal of NeuroInterventional Surgery - September 15, 2023 Category: Neurosurgery Authors: Madjidyar, J., Keller, E., Winklhofer, S., Toth, D., Barnaure, I., Schubert, T., Thurner, P., Fierstra, J., Willms, J. F., Regli, L., Kulcsar, Z. Tags: Hemorrhagic stroke Source Type: research

Type of intracranial hemorrhage after endovascular stroke treatment: association with functional outcome
Background Intracranial hemorrhage (ICH) is a frequent complication after endovascular stroke treatment. Objective To assess the association of the occurrence and type of ICH after endovascular treatment (EVT) with functional outcome. Methods We analyzed data from the MR CLEAN-NO IV and MR CLEAN-MED trials. Both trials included adult patients with ischemic stroke with a large vessel occlusion in the anterior circulation, who were eligible for EVT. ICH was classified (1) as asymptomatic or symptomatic (concomitant neurological deterioration of ≥4 points on the NIHSS, or ≥2 points on 1 NIHSS item), and (2) according ...
Source: Journal of NeuroInterventional Surgery - September 15, 2023 Category: Neurosurgery Authors: van der Steen, W., van der Ende, N. A. M., Luijten, S. P. R., Rinkel, L. A., van Kranendonk, K. R., van Voorst, H., Roosendaal, S. D., Beenen, L. F. M., Coutinho, J. M., Emmer, B. J., van Oostenbrugge, R. J., Majoie, C. B. L. M., Lingsma, H. F., van der L Tags: Open access, Ischemic stroke Source Type: research

Intracranial hemorrhage in large vessel occlusion patients receiving endovascular thrombectomy with or without intravenous alteplase: a secondary analysis of the DIRECT-MT trial
Conclusions Our data showed that in the DIRECT-MT trial, alteplase did not increase overall ICH for large vessel occlusion patients treated with thrombectomy, but it increased the parenchymal hematoma rate.
Source: Journal of NeuroInterventional Surgery - September 15, 2023 Category: Neurosurgery Authors: Hu, X., Zhou, Y., Ospel, J., Yao, F., Liu, Y., Wang, H., Li, B., Hui, P., Yang, P., Zhang, Y., Zhang, L., Li, Z., Xing, P., Shi, H., Han, H., Wang, S., Fang, Q., Liu, J., for the Direct-MT investigators Tags: Open access, Ischemic stroke Source Type: research

Impact of aspiration catheter size on clinical outcomes in aspiration thrombectomy
Conclusions Larger aspiration catheters are associated with a higher rate of FPE, final recanalization with only an aspiration catheter, and in cases with rescue modalities, though with a higher rate of hemorrhagic complications. These findings confirm that aspiration catheter size functions as a variable in aspiration thrombectomy, which should be considered in future study and trial design.
Source: Journal of NeuroInterventional Surgery - August 29, 2023 Category: Neurosurgery Authors: Schartz, D., Ellens, N., Kohli, G. S., Rahmani, R., Akkipeddi, S. M. K., Colby, G. P., Hui, F., Bhalla, T., Mattingly, T., Bender, M. T. Tags: Ischemic stroke Source Type: research

P005/44 Using the pEGASUS-stent with antithrombogenic properties and single antiplatelet therapy in a case of thrombectomy
IntroductionRescue stenting is used more and more in stroke cases with large-vessel-occlusion or medium-vessel-occlusion refractory to mechanical thrombectomy. The pEGASUS-stent(Phenox) represents a device which is equipped with a hydrophilic polymer coating(HPC) with antithrombogenic properties. The coating allows for implantation under single antiplatelet therapy, thus possibly reducing the risk of bleeding in acute stroke cases.Case HistoryA 79-year-old woman was rushed to emergency room due to left-sided hemiparesis and National-Institutes-of-Health-Stroke-Scale(NIHSS) of 14. Computed-tomography-image showed an occlusi...
Source: Journal of NeuroInterventional Surgery - August 21, 2023 Category: Neurosurgery Authors: Krug, N., Schulze-Zachau, V., Ntoulias, N., Psychogios, M. Tags: 4.3 CASE PROPOSAL - Acute ischemic stroke Source Type: research

P018/190 Unexpected bleeding complication during basilar artery rescue stenting - case report
ConclusionRescue stenting is an effective and efficient method for treating basilar artery occlusion resulting from significant stenosis, and bleeding complications can be managed intraoperatively without changing pharmacological antiplatelet therapy.Disclosure of InterestNothing to disclose.
Source: Journal of NeuroInterventional Surgery - August 21, 2023 Category: Neurosurgery Authors: Knapik, M., Popiela, T. J. Tags: 4.4 CASE PROPOSAL - Complications Source Type: research

Natural history, angiographic presentation and outcomes of anterior cranial fossa dural arteriovenous fistulas
Conclusion Most ACF-dAVFs have a symptomatic presentation. Drainage through cortical veins is a key angiographic feature of ACF-dAVFs that accounts for their malignant course. Microsurgery is the most effective treatment. Due to the high risk of bleeding, closure of ACF-dAVFs is indicated regardless of presentation.
Source: Journal of NeuroInterventional Surgery - August 17, 2023 Category: Neurosurgery Authors: Sanchez, S., Raghuram, A., Wendt, L., Hayakawa, M., Chen, C.-J., Sheehan, J. P., Kim, L. J., Abecassis, I. J., Levitt, M. R., Meyer, R. M., Guniganti, R., Kansagra, A. P., Lanzino, G., Giordan, E., Brinjikji, W., Bulters, D. O., Durnford, A., Fox, W. C., Tags: Hemorrhagic stroke Source Type: research

LB-012 Incidence of intracranial hemorrhage after thrombectomy for large core infarcts: a sub analysis of the select2 trial
ConclusionIn a subset analysis of SELECT2 trial, patients receiving EVT had a higher rate of any intracranial hemorrhage when compared with those receiving medical management. Although EVT patients with ICH had a higher incidence of early neurological worsening, there was no difference in 90-day mRS, mortality and discharge dispositions between those with or without ICH.DisclosuresM. Chen: None. K. Joshi: None. B. Kolb: None. M. Hill: None. M. Abraham: None. A. Hassan: None. S. Ortega-Gutiérrez: None. M. Hussain: None. D. Pujara: None. C. Sitton: None. V. Pereira: None. M. Ribo: None. G. Albers: None. B. Campbell: N...
Source: Journal of NeuroInterventional Surgery - August 3, 2023 Category: Neurosurgery Authors: Chen, M., Joshi, K., Kolb, B., Hill, M., Abraham, M., Hassan, A., Ortega-Gutierrez, S., Hussain, M., Pujara, D., Sitton, C., Pereira, V., Ribo, M., Albers, G., Campbell, B., Sarraj, A. Tags: SNIS 20th annual meeting late-breaking oral abstracts Source Type: research

E-126 Multicenter flow diversion in 200 patients for treatment of intracranial aneurysms
ConclusionThis report characterizes patient demographics, aneurysm characteristics, procedure complications and long-term angiographic and clinical outcomes for a large patient population across multiple medical centers treated with flow diversion. Overall, procedures resulted in a high rate of occlusion and low rate of serious complications. Continued iterative outcomes analysis is warranted particularly as flow diversion technology evolves. Despite diverse hospital settings, differences in presentation, patient characteristics and the inclusion of off-label treatments, flow diversion procedures remained safe and effectiv...
Source: Journal of NeuroInterventional Surgery - July 30, 2023 Category: Neurosurgery Authors: Meister, R., Lesko, A., Marginean, H., Deshmukh, V. Tags: SNIS 20th annual meeting electronic poster abstracts Source Type: research

O-042 Complications of DAPT cessation at 3 months versus 6 months after flow diversion of unruptured intracranial aneurysms
ConclusionsOnly 0.6% (n=1) of patients exhibited complications after 3 month follow-up. We conclude that DAPT duration of 3 months after endoluminal flow diversion of unruptured cerebral aneurysms of the anterior circulation is not associated with increased rates of hemorrhagic or thromboembolic complications compared to a traditional 6-month regimen.Disclosures S. Srinivasan: None. A. White: None. M. Al-Abdulkareem: None. J. Barr: None. L. Pride: None. J. White: None. R. Novakovic-White: None. R. Sillero: None. B. Welch: None.
Source: Journal of NeuroInterventional Surgery - July 30, 2023 Category: Neurosurgery Authors: Srinivasan, S., White, A., Al-Abdulkareem, M., Barr, J., Pride, L., White, J., Novakovic-White, R., Sillero, R., Welch, B. Tags: SNIS 20th annual meeting oral abstracts Source Type: research

O-046 Robotic diagnostic cerebral angiography: a multicenter experience
ConclusionsRobotic cerebral angiography with the CorPath GRX Robotic System is safe. However, there are significant technical constraints such as working length and device compatibility which may limit its widespread adoption in clinical practice.Disclosures C. Beaman: None. A. Gautam: None. C. Peterson: None. N. Kaneko: None. L. Ponce: None. H. Saber: None. K. Khatibi: None. K. Narsinh: None. J. Morales: None. D. Kimball: None. J. Lipovac: None. A. Baker: None. M. Caton: None. E. Smith: None. M. Nour: None. V. Szeder: None. R. Jahan: None. G. Colby: None. B. Cord: None. D. Cooke: None. S. Tateshima: 2; C; Prior consultant...
Source: Journal of NeuroInterventional Surgery - July 30, 2023 Category: Neurosurgery Authors: Beaman, C., Gautam, A., Peterson, C., Kaneko, N., Ponce, L., Saber, H., Khatibi, K., Narsinh, K., Morales, J., Kimball, D., Lipovac, J., Baker, A., Caton, M., Smith, E., Nour, M., Szeder, V., Jahan, R., Colby, G., Cord, B., Cooke, D., Tateshima, S., Duckw Tags: SNIS 20th annual meeting oral abstracts Source Type: research

E-261 Variability of response on prophylactic prasugrel for endovascular treatment of intracranial aneurysms: clinical implications
ConclusionIn the neurointerventional field, high BMI and prior use of antithrombotic agents were related to HTPR, and low BMI was associated with LTPR on prophylactic prasugrel. High hematocrit levels decreased the risk of HTPR. When preparing endovascular treatment for intracranial aneurysms, attention to patients with these clinical features is required to address the possibility of ischemic or bleeding complications.Abstract E-261 Table 1Risk factor analysis of high on-treatment platelet reactivity (HTPR) Variables Univariate Analysis Multivariate Analysis OR (95% CI) P OR (95% CI) P Age 1.02 (0.97-1.06) 0.53 Female o...
Source: Journal of NeuroInterventional Surgery - July 30, 2023 Category: Neurosurgery Authors: Son, Y., Hong, N. Tags: SNIS 20th annual meeting electronic poster abstracts Source Type: research

E-006 U.S. health care system-wide transition from alteplase to tenecteplase before mechanical thrombectomy: functional outcomes, early reperfusion rates, intracranial bleeding and femoral access site complications
ConclusionsThe first-year experience demonstrates the effectiveness and safety of the transitioning from TPA to TNK. The higher early recanalization rates with TNK are striking. Additional studies are required to investigate whether TNK is superior to TPA in the setting of LVO stroke.Disclosures M. Collins: None. C. Schirmer: None. G. Weiner: None. O. Goren: None. I. Melamed: None. S. Dalal: None. M. Kole: None. A. Noto: None. P. Hendrix: None.
Source: Journal of NeuroInterventional Surgery - July 30, 2023 Category: Neurosurgery Authors: Collins, M., Schirmer, C., Weiner, G., Goren, O., Melamed, I., Dalal, S., Kole, M., Noto, A., Hendrix, P. Tags: SNIS 20th annual meeting electronic poster abstracts Source Type: research

Use of intravenous cangrelor in the treatment of ruptured and unruptured cerebral aneurysms: an updated single-center analysis and pooled analysis of current studies
Conclusions IV cangrelor during aneurysm embolization appears to be safe, with a symptomatic intracranial hemorrhage rate of 4% in ruptured cases and 2.6% in unruptured cases. More research is needed to determine the ideal dosing regimen.
Source: Journal of NeuroInterventional Surgery - June 16, 2023 Category: Neurosurgery Authors: Entezami, P., Dalfino, J. C., Boulos, A. S., Yamamoto, J., Holden, D. N., Field, N. C., Rock, A. K., Najera, E., Paul, A. R. Tags: New devices New devices and techniques Source Type: research

Venous tortuosity as a novel biomarker of rupture risk in arteriovenous malformations: ARI score
Conclusions Venous tortuosity may serve as a predictor of bleeding in AVMs that warrants further investigation. This likely new marker was one of the three elements of the proposed ARI. ARI outperformed the predictive accuracy of previous scores, and remained consistent in an independent cohort.
Source: Journal of NeuroInterventional Surgery - November 14, 2022 Category: Neurosurgery Authors: Mosteiro, A., Pedrosa, L., Torne, R., Rodriguez-Hernandez, A., Amaro, S., Reyes, L. A., Hoyos, J. A., San Roman, L., de Riva, N., Dominguez, C. J., Ensenat, J. Tags: Hemorrhagic stroke Source Type: research

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