RPS 2509 - Interventional neuroradiological management

Author Block: M. van der Sluijs¹, R. Su¹, J. Hofmeijer², T. van Walsum¹, G. Lycklama³, A. van Es⁴, S. Cornelissen¹, A. Van Der Lugt¹; ¹Rotterdam/NL, ²Arnhem/NL, ³The Hague/NL, ⁴Leiden/NL
Purpose or Learning Objective: Endovascular treatment of acute ischaemic stroke can be complicated by vessel perforation. In this work we study the incidence of this specific complication in clinical practice and its effects on functional outcome, including the relation with the location of a vessel perforation.
Methods or Background: All patients in the MR CLEAN Registry who underwent EVT were analysed for the presence of vessel perforation. DSA imaging of cases mentioned by interventionalist or corelab were studied. Additionally, DSAs of SAH cases were reassessed for potential vessel perforations. In cases where an interventionalist mentioned a perforation, but corelab did not find any, perforation was assumed. Functional outcome was measured using the modified Rankin Scale (mRS) at 90 days. The association between vessel perforation and outcome was analysed with ordinal logistic regression models adjusted for confounding parameters, such as NIHSS at baseline, reperfusion and collaterals. Results were described as unadjusted common (cOR) and adjusted common odds ratio (acOR).
Results or Findings: Vessel perforation occurred in 74 (2,7%) of 2794 patients who underwent EVT. The proportion of vessel perforations in females was higher compared to non-perforation cases. (63.5% vs 47.5% p=0.009). Anatomical location of perforations was located respectively in ICA-M1 (35%), M2-M3 (45%), posterior (6.3%) and missing in 14.9% of cases. Functional outcome (mRS) was worse in patients with vessel perforations (cOR 0.31, 95%CI 0.20-0.49, acOR 0.50, 95%CI 0.29-0.85) compared to patients without a vessel perforation. No association was observed with anatomical location proximal vs distal (cOR 2.36, 95%CI 0.83-6,73, acOR 1.10, 95%CI 0.29-4.17).
Conclusion: Incidence of vessel perforation during EVT is low, but has severe clinical consequences, regardless of the anatomical location of the vessel perforation.
Limitations: Potential bias by reviewing SAH patients, therefore, a higher chance of poor outcome.
Ethics committee approval: Not applicable.
Funding for this study: Not applicable.

Author Block: J. Rodríguez Castro, L. Martínez Camblor, M. Martínez-Cachero García, S. Budiño Torres, E. Murias Quintana, J. M. Jiménez Pérez, J. Chaviano Grajera, F. García Arias, P. Vega Valdés; Oviedo/ES
Purpose or Learning Objective: The purpose of this study was to (1) demonstrate that endovascular treatment of indirect carotid-cavernous fistulae is effective and stable in the long term, (2) describe the techniques and materials most used in our centre, (3) evidence that this treatment reduces patient’s symptomatology, and (4) display the safety of this treatment.
Methods or Background: A retrospective observational study was carried out. A database was made with 39 interventions in 32 patients with indirect carotid-cavernous fistulae treated in our centre from 2006 to 2020. A collection of epidemiological, clinical, intervention-related, and postoperative variables was made for subsequent statistical analysis.
Results or Findings: In 28 (72%) of the interventions, complete closure of the fistula was achieved, with 26 patients (81.3%) being achieved in the initial intervention. The fistula was closed with stable treatment in 92% of the cases at 6 months. The access route was also analysed, the most frequent being the venous route through the inferior petrosal sinus (71.9%). Coils were the preferably used material (84.6%). Regarding the improvement of symptoms at 6 months after the intervention, 29 patients (74.3%) had a complete remission of symptoms. Complications were associated barely to 7.7% of the interventions.
Conclusion: Endovascular treatment of indirect carotid-cavernous fistulae is effective and stable in the long term. The most used and effective access route in our centre is the venous one through the inferior petrosal sinus. The most widely used and effective material for closing indirect carotid-cavernous fistulae are coils. Most of the patients had symptomatic improvement immediately after the intervention and nearly all had no symptoms 6 months after the procedure. Endovascular treatment is a technique that has few perioperative complications and does not usually require reoperation.
Limitations: This study has a small sample size.
Ethics committee approval: The ethics committee approval was obtained.
Funding for this study: No funding was needed.

Author Block: L. Pertici, F. Sgalambro, V. Pagliei, F. Bruno, A. Gagliardi, C. Fagotti, A. Barile, A. Splendiani, C. Masciocchi; L'Aquila/IT
Purpose or Learning Objective: MRgFUS thalamotomy for the treatment of tremor in ET and PD is usually perceived as a simple procedure by patients, who fail to consider it as an ablative procedure with some risks, that, therefore, requires strong compliance from patients. We evaluated the influence of interactive video-assisted vs standard informed consent on patients’ treatment perception, understanding and satisfaction.
Methods or Background: We prospectively evaluated 58 patients eligible for MRgFUS thalamotomy. Before treatment, patients were randomly assigned to two groups: group A (28 patients, 15 males, mean age 65 y/o, ET/PD 18/10) received the standard written informed consent and group B (30 patients, 16 males, mean age 64 y/o, ET/PD 19/11) the video-assisted consent. Two questionnaires were then given to all study participants: the first one at the end of the consent process (5 items, score 0-4, total score 20), assessing patients’ understanding of the procedure, the second one at the end of the treatment (2 items, score 0-4, total score 8), assessing patients’ perception and satisfaction based on the expectations they had after the consent information received.
Results or Findings: In ET patients, mean total understanding and satisfaction scores were 25.2 and 27.6 in groups B and A respectively (p=.234). In PD patients, scores were 23 and 28 in groups B and A. In younger patients (28-75 y/o) scores were 21 (A) and 28 (B), while in the older patients’ group (>75yo) 25 and 22.
Conclusion: Video-assisted integrated informed consent increases understanding of the procedure and its risks, as well as satisfaction regarding the treatment, especially in younger patients. In older patients and individuals with mild cognitive impairment, the computer interaction may represent a limitation compared to direct communication.
Limitations: Not applicable.
Ethics committee approval: Not applicable.
Funding for this study: Not applicable.

Author Block: Y. Tanyildizi, S. Krost-Reuhl, A. Heimann, O. Kempski, R. Kloeckner, F. Hahn, M. A. Brockmann; Mainz/DE
Purpose or Learning Objective: This prototype catheter is a newly-developed distal access catheter featuring a self-expanding, flexible, funnel-shaped tip. The purpose of its design is to reduce the risk of thrombus fragmentation during mechanical thrombectomy and improve first pass recanalisation (TICI 3). In this experimental setup, we preclinically evaluated the effectiveness and navigability of the new catheter.
Methods or Background: A vessel model was filled with a blood-like-viscous medium, and the image was projected with the corresponding vessel area by camera transmission to corresponding to the conditions in an angiography. Thrombi from porcine blood were placed into the arteria carotis interna of the vascular model and subsequently mechanically thrombectomised with a stent retriever. In the first part, the prototype was compared to a standard distal-access-catheter without using an external catheter. (N=20 for each catheter). In the second part, the prototype was inserted through a guiding catheter (n=11) to determine the navigability performance.
Results or Findings: In the first experimental series, mechanical thrombectomy was successful 19 out of 20 times (95% success rate) for the prototype catheter versus 15 out of 20 times (75% success rate) for the standard distal-access catheter. In the second experimental series, the prototype catheter achieved first-pass recanalisation 10 out of 11 times (91% success rate) and 1 out of 11 times at second pass (9%).
Conclusion: This series of experiments demonstrated higher first-pass recanalisation rates for the newly-developed funnel-shaped prototype featuring a self-expanding tip in comparison to a cylindrical standard distal-access-catheter.
Limitations: This study is limited by (1) no in vivo testing and (2) the limited number of thrombectomies.
Ethics committee approval: The ethics committee approved this study (AZ G 14-1-093 and AZ 23177 07 A16 -1-001 AFW).
Funding for this study: This study was funded by the WIPANO (Wissens- und Technologietransfer durch Patente und Normen) and Bundesministerium für Wirtschaft und Energie.