RPS 609 - Developments in vascular and neurovascular interventions

Author Block: M. E. Chevasco Hanze, A. Lopez Rueda, A. Nuñez, E. Ripoll, V. Cuba, S. Aixut, L. Aja, M. A. De Miquel Miquel, O. Chirife; L'Hospitalet de Llobregat/ES
Purpose: Acute Basilar Artery Occlusion (BAO) has the highest morbidity and mortality in posterior circulation strokes. Current reperfusion scores for mechanical thrombectomy (MT) are based on anterior circulation strokes (mTICI score). This study proposes a basilar artery-specific reperfusion score, based on digital subtraction angiography (DSA), to assess MT efficacy in acute BAO.
Methods or Background: A retrospective analysis was conducted on a prospective database of acute BAO patients treated with MT within 24 hours of symptom onset at a stroke center from January 2014 to December 2023. Informed consent was obtained, and institutional review board approval was granted. Clinical, procedural, and radiological data were collected. The Thrombolysis in Basilar Infarction (TIBI) score was developed by grading posterior circulation territories in DSA post-MT, using PC-ASPECTS as reference (deducting 1 point for each occipital lobe/cerebellar lobe/thalamus or 2 points for pons/mesencephalon). Successful recanalization was defined as TIBI≥8 and assessed by modified Rankin Scale at 90 days.
Results or Findings: Ninety-eight patients were included (median age 70, 56 men). Successful recanalization (mTICI2b/3) was achieved in 84.7% and TIBI≥8 in 71.4%. Good functional status (mRS≤3) was seen in 50% of patients, with better outcomes in mTICI 2b/3 and TIBI≥8 groups (p <0.001 and p=0.002). After adjusting for age, NIHSS socre and Glasgow Coma Sacle, TIBI≥8 was associated with good outcomes at 90 days (OR = 6.18; p =0.001), and TIBI≥7 was also linked to good outcomes (OR = 9.45; p <0.001).
Conclusion: The TIBI scale is a novel tool for evaluating MT efficacy in acute BAO. A TIBI≥8 should be the target for successful MT.
Limitations: unweighted TIBI (<25% were TIBI<7)
Funding for this study: No
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: Observational study

Author Block: J. I. García García¹, O. Chirife¹, P. Vega Valdés², E. Gonzalez³, F. Delgado⁴, G. Dolz¹, A. López-Frías López-Jurado⁵, F. Aparici Robles⁶, A. Lopez Rueda¹; ¹Barcelona/ES, ²Oviedo/ES, ³Barcaldo/ES, ⁴Cordoba/ES, ⁵Madrid/ES, ⁶Valencia/ES
Purpose: The purpose of this study is to analyze the predictive factors of safety and efficacy of additional mechanical thrombectomy in patients with acute ischemic stroke due to M1 occlusion, who achieve mTICI2B recanalization after the first pass of endovascular treatment.
Methods or Background: We retrospectively analyzed patients with acute ischemic stroke due to M1 occlusion from the ROSSETTI registry who achieved mTICI 2b recanalization after the first pass of endovascular treatment. Patients were divided into two groups: those who stopped the procedure with a mTICI 2b result and those who continued treatment for a better angiographic outcome. Among those who continued, patients were further split into two subgroups: those with unchanged results (mTICI 2b) and those with improved results (mTICI 2c/3). Demographic, clinical data, procedure details, and outcomes were compared across groups.
Results or Findings: We included 300 patients with acute ischemic stroke M1 occlusion who achieved mTICI2b recanalization score after the first pass of endovascular treatment. 132 patients underwent no further passes (group 1), while 168 patients underwent additional passes, with 65 of them maintaining a final mTICI 2b score (group 2) and 103 achieving a final mTICI 2c-3 score (group 3). Group 3 exhibited a higher incidence of distal embolism to new territories compared to group 1 (7.8% vs. 0%; p < 0.001). No significant differences in clinical outcomes were observed between the groups and subgroups.
Conclusion: Patients who achieved an improved mTICI score after the first recanalization attempt (mTICI 2c/3) had a higher incidence of distal embolisms to new territories compared to patients with no further passes. No significant differences in mRS scores at 3 months were observed between groups and subgroups.
Limitations: Inherent limitations of retrospective designs.
Funding for this study: None.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: ROSSETTI registry creation was approved by an ethics committee.

Author Block: H. Akkaya, A. I. Soylu, F. Uzunkaya; Samsun/TR
Purpose: Coil embolization is the most commonly used method of endovascular treatment of narrow-neck saccular aneurysms. However, recanalization and subsequent aneurysm enlargement and rupture are common in aneurysms embolized only with coils. The aim of this study was to investigate which of the morphology findings during the treatment of internal carotid artery (ICA) aneurysms treated with primary coiling is more successful in predicting the time to recanalization.
Methods or Background: In this study, DSA images of 51 ICA aneurysms treated with coiling in our center between January 2016 and July 2024 were retrospectively analyzed. Dates of embolization and recanalization times were noted. The segment of the ICA in which the aneurysms were located, the height of the aneurysm, the diameter of the neck, the height/diameter ratios, whether there was a parent artery originating from the aneurysm, and the angle of the neck of the aneurysm were noted. The relationship between these parameters and recanalization times was examined.
Results or Findings: The mean age of the patients was 59.6±13.9 years. 24 ( 47.1 %) patients had recanalization in follow-up examinations. The mean duration of recanalization was 12.73±1.7 months. The aneurysm neck angle was found to be higher in patients with recanalization (p<0.001). A negative (inverse) moderate correlation was found between the time of recanalization and aneurysm size/neck diameter ratio: aneurysm neck angles (r=-0.425; r=-0.537, respectively).
Conclusion: The angle of the neck of the saccular aneurysm at the time of treatment is one of the angiographic morphology findings that are successful in predicting the time to recanalization.
Limitations: The study has some limitations. First of all, the study was single-centered and the number of patients was small. Another limitation is that only aneurysms localized in the internal carotid artery are evaluated.
Funding for this study: N/A
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Ondokuz Mayıs University Ethics committee approval was obtained for the study . The requirement for informed consent from the patients was waived due to the retrospective nature of the study.

Author Block: F. Taylor, K. Sehgal, D. Carrion, M. Masterson, M. K. Badawy, L-A. Slater; Melbourne/AU
Purpose: Endovascular clot retrieval (ECR) is a time-sensitive, adjunct treatment for large vessel occlusion (LVO) strokes. We present the results of this single high-volume stroke centre, to establish differences in radiation doses between ECR cases performed under general anaesthetic (GA) and conscious sedation (CS).
Methods or Background: All ECR cases in adult patients between October 2018 and June 2023 were included.
Procedure records, patient characteristics, stroke outcome, and radiation dosimetry measures were collected and analysed retrospectively.
Summative data, i.e. median and interquartile range for overall dosimetry measures were described overall and by subgroup according to anaesthetic strategy. ANOVA was used to compare radiation dose measures, clot location, stroke severity measures and endovascular clot retrieval times between anaesthetic strategy.
Results or Findings: Radiation doses were higher in patients receiving a GA; DAP 9,346 cGy.cm2, (4,996, 17,442) vs. 7,052 cGy.cm2 (4,529, 10,926), reference air kerma 627 mGy (325, 1,287) vs 507 (300, 789), total fluoroscopy time 34 minutes (19, 63) vs 31 (18, 47). This was associated with a greater pre-reperfusion morbidity (NIHSS of 13 (7, 19) vs 11 (6, 17), more complex thrombus location (more tandem, less M2, more ICA, more basilar clots) and delayed presentation to hospital (227 minutes (101, 452) vs. 125 (66, 281), p <0.001).
Conclusion: We have demonstrated higher radiation doses under GA versus CS cases and some of the factors that may contribute to this. These values serve as benchmark ranges for comparable centres performing ECR. Larger multicentre analysis is required to establish more generalisable dose reference levels.
Limitations: Single centre cohort.
Affected by the COVID pandemic; departmental decision to preference GA at several points between March 2020-October 2021.
TICI grading wasn't core lab adjudicated.
Funding for this study: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.
Ethics approval was obtained from the local Human Research Ethics Committee (HREC), reference no. QA/91812/MonH-2022-343316 and the need for informed consent was waived.

Author Block: J. Reymen, H. Mufty, A. Laenen, S. Houthoofd, G. Maleux; Leuven/BE
Purpose: To report the long-term outcome of patients presenting with an aortic or aortoiliac aneurysm treated with the Zenith Endoprosthesis.
Methods or Background: A retrospective analysis of the collected data of 209 consecutive patients who underwent endovascular aneurysm repair (EVAR) with the Zenith Endoprosthesis (Cook Medical) between January 1998 and December 2009 in an academic, tertiary care centre for aortic disease was performed. Patients’ imaging and clinical follow-up was performed until December 2023 to ensure a follow-up time of at least 14 years. The primary end points were overall survival and reintervention-free survival. Secondary end points were endograft-related complications, endoleaks, and reinterventions.
Results or Findings: Overall survival at 2-, 5-, 10-, and 15-year follow-up was 89.00%, 71.29%, 39.71% and 18.18%, respectively, with n=2 (1%) aneurysm-related deaths. Freedom from type I and III endoleak at 5- and 15-years was 92.82% and 86.12%, respectively; type I (n=37 ; 17.7%) and type III (n=4 ; 2%) endoleaks occurred in the follow-up period until 8 years postoperatively.
Reintervention-free survival was 83.08%, 75.62%, 68.66% and 66.17% at 2-, 5-, 10-, and 15-year follow-up, respectively. Reinterventions occurred meanly in the 0- to 8-year follow-up period.
Conclusion: Endovascular aneurysm repair using the Zenith Endoprosthesis is effective and durable on long-term follow-up, with acceptably low endograft-related complications and reinterventions. The number of adverse events and reinterventions is minimal after 8 years of follow-up.
Limitations: It is a single-centre retrospective study, susceptible to selection bias. The study also has a relatively small patient cohort ( n=209) because not all patients eligible for EVAR were treated with the Zenith Endoprosthesis. Finally, no comparison with other endograft devices was made.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The institutional ethics committee approved this retrospective analysis (MP024667).

Author Block: R. Lv, G. Hu, S. Zhang, Z. Zhang, Z. Wang; Beijing/CN
Purpose: To investigate the relationship between radiomic features of different radii of perivascular adipose tissue (PVAT) and abdominal aortic aneurysm (AAA) growth after endovascular aneurysm repair (EVAR).
Methods or Background: Patients with sub-renal AAA who underwent regular follow-up after EVAR from September 2014 to September 2024 were retrospectively collected. Two radiologists segmented the aneurysm and different radii of PVAT (PVAT1-7: 5mm, 7.5mm, 10mm, 12.5mm, 15mm, 17.5mm, 20mm) to evaluate the aneurysm volume changes during follow-up and calculate radiomic features of different PVAT regions. Univariable and multivariable logistic regression was performed to construct models to evaluate the growth of AAA based on the radiomic features of PVAT with different radii (5mm-20mm for models 1-7). Calculate the area under the curve (AUC), sensitivity, specificity, and accuracy of the models, and test the significance of the performance differences among the models.
Results or Findings: A total of 79 patients (67±7 years, 82% men) were enrolled in this study, 20 of whom had a growing aneurysm. The AUC for Models1-7 are 0.72, 0.77, 0.71, 0.70, 0.69, 0.71, and 0.75, respectively. The specificities for Models1-7 are 95%, 95%, 97%, 97%, 93%, 92%, and 97%, respectively. DeLong test and McNemar test: p > 0.05 (no statistical significance).
Conclusion: The models constructed using the radiomic features of PVAT with different radii after EVAR showed no significant differences in performance for evaluating AAA growth. The models achieved an average specificity of 95%, indicating their effectiveness in minimizing the misclassification of non-growing AAA cases as growth cases.
Limitations: The retrospective research highlights the need for prospective and long-term follow-up studies. There are also limitations in the development of imaging segmentation techniques, which still require manual intervention for three-dimensional aneurysm segmentation.
Funding for this study: This study has received funding by the National High Level Hospital Clinical Research Funding (2022-PUMCH-B-068).
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Institutional review board of Peking Union Medical College Hospital.

Author Block: F. Wegner¹, T. Friedrich¹, P. Elfers¹, F. Kleefeldt², D. Peter², P. Gruschwitz², T. Kampf², P. Vogel², V. Hartung²; ¹Lübeck/DE, ²Würzburg/DE
Purpose: Magnetic Particle Imaging (MPI) is an emerging, tracer-based, 3D imaging modality on the way to clinical application. It offers high temporal resolution and operates without the use of ionizing radiation, making it particularly advantageous for cardiovascular imaging and real-time interventional monitoring. However, the potential heating of metallic medical devices within the magnetic fields of MPI scanners is a critical safety concern. This study aimed to assess the thermal behavior of commercially available medical implants during MPI-scans in a human cadaver model.
Methods or Background: A fiberoptic thermometer probe was introduced into the superficial femoral artery (SFA) of a human cadaver model via a 7 F sheath. A series of commercially available endovascular implants (including six stents, five coils, and one vascular plug) were then positioned sequentially within the SFA. The thermometer probe was retracted sequentially to ensure direct contact with each implant. Additionally, a hole was drilled in the femur, which contained a gamma nail, and the fiberoptic probe was externally inserted to establish contact with the nail. A custom-built human-sized MPI-scanner for interventional purpose was positioned around the cadavers’ thigh, and an MPI-sequence consisting of 40 pulses (4 pulses per second) was applied, with the respective implant centrally located within the scanner. Throughout the MPI-sequence, the cadavers’ thigh was perfused extracorporeally with a blood-equivalent fluid using an external flow pump.
Results or Findings: The gamma nail exhibited a temperature increase of 0.04 K during the MPI-sequence, while no detectable heating was observed in any of the endovascular devices tested.
Conclusion: Commonly used medical implants do not heat up significantly in a human-sized MPI-scanner under realistic conditions.
Limitations: Only a limited number of commercial devices was tested in this work.
Funding for this study: N/A
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Protocol Number 20220413 01

Author Block: N. Papalexis, G. Peta, M. Di Carlo, S. Quarchioni, L. Campanacci, M. Carta, M. Miceli, G. Facchini; Bologna/IT
Purpose: Purpose: To evaluate the safety and efficacy of electrochemotherapy with bleomycin for the treatment of soft tissue vascular malformations.
Methods or Background: Materials and Methods: This study analyzes the early results of a prospective study “BESVAM”, designed to prospectively evaluate the safety and efficacy of electrochemotherapy for vascular malformations. 18 patients were enrolled from February 2023 to July 2024. Bleomycin was injected intralesionally for low-flow vascular malformations or systematically for high-flow vascular malformations. The primary goal was pain control, measured in VAS score at 3,6, and 12 months follow-up. The secondary goal was the size reduction of the lesion and variations in the QLQ questionnaire.
Results or Findings: Results: Twelve patients received bleomycin intravenously and six patients intralesional. Baseline VAS scores averaged 6.9 (SD 2.1), decreasing to 3,1 (SD 3.2) at three months. Further reduction was observed at 6 and 12 months with scores of 2.1 (SD 2.0) and 1.6 (SD 2.0) respectively. Size was reduced from a mean of 155.1 cm3 (range 56.7 to 515.3 cm3) pre-treatment to a mean of 122.5 cm3 (range 42.2 to 438.9 cm3) at the 6-month follow-up (p<0.05). (12 months) Twelve patients discontinued pain relief therapy. Ten patients experienced skin discoloration at the site of insertion of the needles.
Conclusion: Conclusion: The preliminary results are promising, suggesting that electroporation with local or systemic bleomycin could be a safe and effective tool for the management of vascular malformations.
Limitations: Small sample size, lack of control group
Funding for this study: None
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Prospective study approved by the local ethcis committee of Emilia Romagna, Italy.