Search

Background and Purpose—Radial artery catheterization is an alternate route of access that has started to gain more widespread use for neuroendovascular procedures, and there have been few studies that describe its safety and efficacy. We present our institution’s experience in performing neuroendovascular interventions via a transradial approach, with excellent clinical outcomes and patient satisfaction measures.Methods—We conducted a retrospective analysis and identified 223 patients who underwent 233 consecutive neuroendovascular interventions via radial artery access at our institution. The incidence of perioperative and postprocedural complications was investigated. We identified a subset of 98 patients who have undergone both transradial and transfemoral cerebral angiograms and compared clinical outcomes and patient satisfaction measures between the 2 groups.Results—The overall incidence of complications was low across all procedures performed via transradial access. Peri-procedurally, only 2 patients had symptomatic radial artery spasm, and there were no instances of iatrogenic complications (vessel dissection, stroke, and hemorrhage). In 10 cases (4.3%), the intended procedure could not be completed via a transradial approach, and, thus, femoral artery access had to be pursued instead. Ten patients complained of minor postprocedural complications, although none required therapeutic intervention. The mean procedure time was shorter for diagnostic angiograms performed via transradial versus transfemoral access (18.8±15.8 versus 39.5±31.1 minutes;P=0.025). Patients overall reported shorter recovery times with transradial access, and the majority of patients (94%) would elect to have subsequent procedures performed via this route.Conclusions—Radial artery catheterization is a safe and durable alternative to perform a wide range of neuroendovascular procedures, with a low rate of complications. On the whole, patients prefer transradial compared with transfemoral access.

Introduction: Wide-neck bifurcation cerebral aneurysms have always posed a treatment challenge and have historically required either clip ligation, or stent vs. balloon-assisted coil embolization. This predicament led to the development of the newly FDA-approved Woven EndoBridge (WEB) aneurysm embolization system (Sequent Medical Inc, Aliso Viejo, CA) Which is a self-expanding mesh that achieves intrasaccular flow disruption and does not require antithrombotic medications. In this study, we report our experience with the first 64 consecutive aneurysms treated via WEB embolization at two high-volume institutions. Methods: We reviewed our first 61 consecutive patients with 64 cerebral aneurysms who underwent WEB embolization from February-August 2019. We collected data on patient demographics and clinical presentation, aneurysm characteristics, device and procedural details, and functional outcomes. Results: A total of 64 aneurysms were included in our study. Fifteen patients (24.1%) presented with acutely ruptured aneurysm while the rest were unruptured. The majority of patients (82.8%) required only one attempt for successful device deployment, while a stent was necessary as an adjunct treatment in 4 patients (6.3%) due to WEB herniation. Two patients had residual aneurysm that had to undergo additional treatment; one of them underwent second WEB embolization and one underwent clip ligation. One patient with a PICA aneurysm had device dislodgment with injury to the parent vessel—Onyx and coils were used to deconstruct the vertebral artery. Conclusions: The advent of the WEB device has significantly impacted the surgical decision-making for the treatment of bifurcation, wide-neck aneurysms. We discuss in detail the lessons learned from patient selection, device size selection, technique, and complications from two institutions with high-volume endovascular and microsurgical aneurysm treatment experience.

Introduction: Flow diversion has introduced a paradigm shift in the endovascular field by providing a more physiological approach to treat aneurysms. We aim to assess the efficacy and safety of flow diversion in treating a diverse large cohort of aneurysms with up to 5 years follow up. Methods: This is an analysis of a prospectively maintained database at a single-institution. Patients included in the analysis were consecutively treated patients between 2010 and 2019. Results: A total of 598 aneurysms were treated during a period extending from 2010-2019 (84.28% females, mean age 55.5 years, av. size 8.49mm). Adequate aneurysm occlusion rates were 63%(376), 73%(436), and 79%(472) at 6 ,12 and 24-month follow-up, respectively. The complete occlusion rate was 75% at a mean duration of 9 months. Of all patients, 8%(48) required retreatment. On multivariate analysis decreasing PED length (0.35,p=0.01), decreasing PED width (0.63,p=0.01), decreasing dome size (0.46,p=0.01), decreased neck width (0.46,p=0.01), absence of wall irregularity (0.60,p=0.01), lack of branching vessel (0.57,p=0.01), and previous treatment (0.56,p=0.05) were independent predictors of aneurysm occlusion.Morbidity rate occurred at a rate of 5.8% and morality at a rate of 2.2%. Ischemic stroke occurred at a rate of 3%. Delayed aneurysmal rupture and distal intraparenchymal hemorrhage occurred at a rate of 3.7%. On multivariate analysis; predictors of stroke were aneurysm size > 15mm. Predictors of DAR/DIPH were increasing aneurysm size, an increasing number of PED used, subjects presenting with a symptomatic aneurysm. Predictors of in-stent stenosis was balloon angioplasty. While increasing age and previous treatment were negatively associated with in-stent stenosis. Predictors of Morbidity were posterior circulation aneurysms, symptomatic presentation, increasing aneurysm size, and hypertension. While, predictors of unfavorable outcome were age > 75, acute SAH, increasing aneurysm size, and posterior circulation aneurysms. Conclusion: At a high-volume center with experienced operators, treatment with PED was associated with durable aneurysm occlusion and low risk of complications. The results support the increasing use of flow diverters.

Background and Purpose: Trans radial catheterization is an alternate route of access that has started to gain more widespread use for neuroendovascular procedures. There are several randomized controlled trials from cardiac field that had established its safety and efficacy. We present our institution’s experience in performing neuroendovascular interventions via a transradial approach. Methods: We conducted a retrospective analysis and identified 570 patients who underwent consecutive neuroendovascular interventions via radial artery access. Data collection was performed on indication for procedure, sheath size, catheter type, number of vessels selectively catheterized, fluoroscopy time, procedure duration, radiation exposure, conversion to femoral approach, access site complication, and procedure success. Results: Of 570 patients with an average age of 59.4 years ± 14.7, 406 (71.2%) underwent diagnostic angiograms and 164 (28.7%) underwent therapeutic procedures. The overall mean number of vessels catheterized was 2.9 ± 1.7 per procedure. The RCCA was the most frequent selectively catheterized artery; 340 (22.9%), followed by LCCA; 306 (20.6%), RICA; 250 (16.8%), LICA; 238 (16.0%), RVA; 159 (10.71%), LVA; 76 (5.1%), RECA; 61 (4.1%), and lastly the LECA selectively catheterized in 54 (3.6%). The average amount of contrast given was 83.4 cc ± 51.Successfully completed therapeutic procedures included aneurysm simple coiling (34 patients), stent assisted coiling (30 patients), flow diversion (34) patients), ICA balloon angioplasty and stenting (20 patients), Web device (8), AVM embolization (14), IAC for retinoblastoma (1 patient), and stroke thrombectomy (23 patients). The average duration was 72 mins ± 43, and average fluoroscopy time was 13.20 mins ± 11.20. Seventeen patients (3.2%) required conversion to transfemoral access. Twelve minor complications (2.3%) were reported including mild oozing after deflation of the balloon, ecchymosis, mild swelling. No major complications were encountered. Conclusions: Radial artery catheterization is a safe and effective access site to perform a wide range of diagnostic and therapeutic procedures. Complication and conversion rate are low making it a safe alternative.

Background and Purpose- Radial artery catheterization is an alternate route of access that has started to gain more widespread use for neuroendovascular procedures, and there have been few studies that describe its safety and efficacy. We present our institution's experience in performing neuroendovascular interventions via a transradial approach, with excellent clinical outcomes and patient satisfaction measures. Methods- We conducted a retrospective analysis and identified 223 patients who underwent 233 consecutive neuroendovascular interventions via radial artery access at our institution. The incidence of perioperative and postprocedural complications was investigated. We identified a subset of 98 patients who have undergone both transradial and transfemoral cerebral angiograms and compared clinical outcomes and patient satisfaction measures between the 2 groups. Results- The overall incidence of complications was low across all procedures performed via transradial access. Peri-procedurally, only 2 patients had symptomatic radial artery spasm, and there were no instances of iatrogenic complications (vessel dissection, stroke, and hemorrhage). In 10 cases (4.3%), the intended procedure could not be completed via a transradial approach, and, thus, femoral artery access had to be pursued instead. Ten patients complained of minor postprocedural complications, although none required therapeutic intervention. The mean procedure time was shorter for diagnostic angiograms performed via transradial versus transfemoral access (18.8±15.8 versus 39.5±31.1 minutes; P=0.025). Patients overall reported shorter recovery times with transradial access, and the majority of patients (94%) would elect to have subsequent procedures performed via this route. Conclusions- Radial artery catheterization is a safe and durable alternative to perform a wide range of neuroendovascular procedures, with a low rate of complications. On the whole, patients prefer transradial compared with transfemoral access.

Introduction and Hypothesis: Cerebral cavernous malformations (CCMs) are common cerebrovascular anomalies with highly variable but potentially disabling disease behavior disease behavior. Factors portending an aggressive clinical course are not known. An association of disease severity with vitamin D has been suggested in preclinical studies, and other evidence supports a role of inflammation in the pathobiology of CCM. Methods: A prospective case-controlled study enrolled 43 consecutive patients with CCM disease (20 sporadic/solitary and 23 multifocal/familial). Non-fasting peripheral venous blood samples were analyzed for plasma levels of 25-(OH) vitamin D, high-density lipoprotein (HDL) and non-HDL cholesterol, C-reactive protein (CRP), and for leukocyte Rho-kinase (ROCK) activity. We correlated these biomarkers with prospectively defined parameters of chronic (a history of multiple adjudicated clinically overt hemorrhages, early age of clinical onset or high lesion burden in familial cases) and recent (lesional growth or hemorrhage in the preceding year, or new lesion formation in familial cases) disease aggressiveness. Results: Patients with historically aggressive CCM disease had significantly lower 25-(OH) vitamin D and non-HDL cholesterol levels. Neither was predictive of recent disease activity. HDL cholesterol, CRP levels and ROCK activity did not correlate with historical or recent disease severity. Receiver operating characteristic curves for 25-(OH) vitamin D or non-HDL cholesterol showed ‘fair’ accuracy: Area under curve (AUC)= 0.73 (p=0.01) and 0.74 (p=0.007), respectively. Combination of the two parameters improved the accuracy to AUC=0.80 (p Conclusions: This is the first evidence of correlation of peripheral blood biomarkers with the severity of human CCM disease. Validation of these biomarkers and their potential modification may influence the clinical care of CCM.