RPS 609 - New insights in interventional radiology above the neck

Author Block: D. De Leoni, A. M. Alexandre, A. Broccolini, A. Pedicelli; Rome/IT
Purpose: This study aimed to evaluate the predictors of any type of parenchymal haematoma according to ECASS II classification and the predictors of type II parenchymal haematoma after MT in patients with an ASPECTS score 5 due to a LVO in the anterior circulation.
Methods or Background: In this retrospective observational study, databases of 16 comprehensive stroke centres were screened for consecutive patients with AIS due to LVO diagnosed between January 2016 and December 2021. The ASPECT score was calculated from two standard axial CT slices.
Brain bleeding was confirmed with CT or MRI scan (24 and 72h after MT). Heidelberg classification was used to classify haematoma. Presence of PH type 2 was selected as the primary outcome measure, due to its relevance in the overall clinical outcome of patients.
Results or Findings: 408 patients with LVO in the anterior circulation and an ASPECT score ≤5 that received MT were selected. Higher number of passages in the second technique (OR 4.176, 95% CI 1.444 – 12.003, p=0.008) was predictive of PH type 2, whereas procedure conducted under general anesthesia was associated with a lower risk of PH type 2 (OR 0.084, 95% CI 0.011 – 0.612, p=0.015). Higher age (OR 1.073, 95% CI 1.023 – 1.126, p=0.004) and number of passages during the second technique (OR 2.119, 95% CI 1.106 – 4.374, p=0.025) were an independent predictor of any PH.
Conclusion: Our study showed that an increased number of passages during MT in patients with large baseline brain infarct is a predictor of post-procedural PH of any type. The choice of general anesthesia for MT should be considered as this is associated with a lower risk of occurrence of PH type 2.
Limitations: This was a retrospective study.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: No information provided by the submitter.

Author Block: R. Kaufmann, L. C. Van Dijk, W. Stomp, K. De Laat, S. F. De Bruijn, J. Piet, S. C. Klink, H. van Overhagen; The Hague/NL
Purpose: Emergency carotid artery stenting (eCAS) during endovascular stroke treatment (EVT) is considered controversial in the literature. We performed a retrospective analysis in our institute to assess safety and efficacy.
Methods or Background: During 2015-2023, 533 patients underwent EVT. Seventy patients underwent 71 eCAS procedures concurrently. Patient files were analysed on baseline characteristics, EVT procedure, and complication rates.
Results or Findings: There were 46 men and 24 women with a mean age of 73 years (range 53-99 years). Preprocedural NIHSS scores ranged from 3 to 25 (median 14). Indications were significant carotid artery stenosis (n=36), occlusion (n=28), and dissection (n=7; 3 of 7 occurred during EVT). Carotid revascularisation and stenting were performed prior to intracranial revascularisation in the vast majority of patients. Stenting was performed in the left carotid artery (n=39) and in the right carotid artery (n=32), using 53 Carotid Wallstents, 15 Cordis Precise stents, and 3 X-pert stents. Additional endovascular treatment was performed in 55 patients; carotid T (n=4), M1 (n=28), M1 and M2 (n=5), M2 (n=16), M3 (n=2), and A2 (n=1). All patients received a single intra-arterial dose of 5000 to 10000 IU heparin during the procedure. mTICI scores immediately postprocedural were either 2b (n=22) or 3 (n=49). Complications occurred in 10 out of 71 patients (14%): intracranial bleeding (n=5 (7%)), access bleeding (n=4 (6%)), and vessel occlusion (n=1) (1%)).
Conclusion: eCAS seems feasible and relatively safe with low intracranial bleeding rates in patients undergoing EVT. A single intra-arterial bolus of heparin does not seem to increase the occurrence of intracranial bleeding.
Limitations: Our study is a retrospective, single-centre cohort study.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: Since it is a retrospective study, we received a waiver from our ethical committee.

Author Block: F. E. Dianderas Gutiérrez, A. Alboniga-Chindurza Barroeta, E. Zapata Arriaza, M. Aguilar Perez, R. F. Ocete Pérez, A. Zamora Piñero, A. González García; Sevilla/ES
Purpose: This study is a description and analysis of the experience in endovascular treatment of basilar artery occlusion (BAO) in a tertiary hospital with a reference population of 2.5 million inhabitants, one of the largest in Europe.
Methods or Background: Patients with BAO in the period 2017-2021 registered in the Andalusian thrombectomy database (ARTISTA) of the Huelva-Seville node were included. A statistical analysis of the demographic variables, recanalisation rate, and good functional prognosis (modified Ranking scale (mRs≤2y≤3) as well as complications of the procedure was performed.
Results or Findings: Of 148 patients (7.8% of the ARTISTA database), median 70.6 years (63-80), pre-procedure NIHSS of 14 (6-24.7), 31.1% received fibrinolysis, 21.6% were awakening strokes, and 12.8% were in-hospital. The symptom onset-recanalisation time was 358 minutes (256-631), with a median recanalisation puncture of 40 minutes (17.7-89). In 62.2% of cases there was BA occlusion; in 23.9% and 9.9% of cases this also involved the vertebral and posterior cerebral arteries, respectively. In 61.1% of the cases, the endovascular procedure was performed with local anesthesia (general: 34%, sedation: 4.9%). Distal aspiration was performed in 82%, stent retriever in 6%, Solumbra in 5% and ATP and /or stent in 7%. The recanalisation rate was TICI ≥2b in 85,7% of the cases. The MR at 90 days was 0-2 in 37.9% and 0-3 in 46.4%. 36.4% of the patients were Rank 6. In 9.3% of cases there were some complications of the procedure (dissection in 2.2%). Symptomatic intracranial haemorrhage occurred in 5% of cases (PH1: 2.1%, PH2: 2.9%). 36.4% of cases required admission to the ICU; the rest of the patients went to the Stroke Unit.
Conclusion: Our results in the treatment of patients with OAB are similar to those described in the ATTENTION and BAOCHE recent studies.
Limitations: No limitations were identified.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: This was a retrospective and educational study. All data was anonymised.

Author Block: E. Fandiño Benito, I. Bermudez-Coronel, J. C. Mendez; Madrid/ES
Purpose: The purpose of this study was to determine the effectiveness and safety of middle meningeal artery embolisation in chronic subdural haematoma.
Methods or Background: A total of 34 patients underwent middle meningeal artery embolisation, with 3 patients treated in 2021, 12 in 2022, and 19 in 2023. Out of these, 11 of the 34 patients (32.35%) underwent bilateral embolisation. Prior to embolisation, 18 patients (52.94%) had previously undergone surgical drainage of the haematoma, while embolisation served as the primary treatment for 12 patients (35.29%). In all cases, embolisation was carried out using embolic liquid agents.
Results or Findings: Patient follow-up was carried out and measurement and evolution of the haematoma was recorded over time. On average, the thickness of the haematoma decreased by 70% compared to the pre-treatment CT scans. During the follow up period, two patients died due to other underlying medical conditions. Additionally, one patient experienced sixth cranial nerve palsy, which spontaneously resolved within 48 hours following the procedure. Notably, while general anesthesia was chosen for only 56.6% of the total cases, it is increasingly becoming the preferred option over sedation anesthesia. Encouragingly, throughout the two-year follow-up, no patient required surgical or endovascular reintervention.
Conclusion: Middle meningeal artery embolisation appears to be an effective and safe treatment for chronic subdural haematoma, both, as a the primary option and as an adjuvant treatment to surgery, ultimately reducing the need for reinterventions.
Limitations: The primary limitation of this study lies in its observational nature, conducted at a single centre. To establish more robust conclusions, a multicentre randomised controlled trial should be carried out.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: No information provided by the submitter.

Author Block: F-C. Chang; Taipei/TW
Purpose: Lower neck cancers (LNCs) include specific tumour types and have vascular collaterals from other head-and-neck cancers (HNCs). This prospective study evaluated the outcome of endovascular management of post-irradiated carotid blowout syndrome (PIRCBS) in LNC patients by comparing reconstructive management (RE) and deconstructive management (DE).
Methods or Background: Between 2015 and 2021, LNC patients complicated with PIRCBS who underwent endovascular therapy were prospectively included. The patients underwent DE by permanent embolisation of both internal carotid artery (ICA) and external carotid artery (ECA) with coils (Nester, Cook; Concerto nylon detachable coils, ev3 Neurovascular) and/or adhesive agent (histoacryl, Braun Surgical). ICA was occluded if pathological lesion was located at ICA only. Cross embolisation including proximal and distal to the pathological lesion were done in all patients. Technical outcomes were evaluated by immediate haemostasis and neurological complications. The haemostatic outcome was evaluated by the haemostatic result and haemostatic period.
Results or Findings: 59 patients (mean age: 58.45±10.25, 56 men) were enrolled, including 28 RE patients and 31 DE patients. The results of RE versus DE were as follows: rebleeding events: 13/28 (46.4%) versus 10/31 (32.3%), p=0.265; haemostatic periods (month): 9.4±14.0 versus 14.2±27.8, p=0.589; neurological complications: 4/28 (14.3%) versus 5/31 (16.1%), p=0.844; survival time (months): 11.8±14.6 versus 15.1±27.5, p=0.605.
Conclusion: We observed that there was no difference of rebleeding risk and neurological complication between DE and RE groups. RE could be used as a potential routine treatment for PIRCBS in patients with LNC.
Limitations: Several limitations were noted in this study, including variable entities and staging of malignancy in the lower neck region. The treatment modalities of our patients with LNC were also heterogeneous, which might influence the outcome of CBS.
Funding for this study: This study received funding from Taipei Veterans General Hospital, Taiwan [V110C-037, V111C-028, V112C-059, V112D67-002-MY3-1 (to FCC)], National Science and Technology Council, Taiwan [109-2314-B-075-036, 110-2314-B-075-032 and 112-2314-B-075-066 (to FCC)].
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was approved by the Taipei Veterans General Hospital with code: 2022-02-001CU.

Author Block: E. Sahibli, E. Kara, E. H. Karlı, M. Barburoğlu; Istanbul/TR
Purpose: The purpose of this study was to determine the feasibility, efficacy, and safety of flow converting silk stents in treating intracranial aneurysms.
Methods or Background: The study included 75 patients (mean age 49.54 years), with at least six months of angiographic and long-term follow-up imaging, with 95 aneurysms treated in 78 different procedures. The patients' pre-treatment and follow-up clinical data, procedure results, demographic characteristics, aneurysm characteristics and localisations, occlusion rates, early and late mortality, and permanent morbidity rates were analysed retrospectively.
Results or Findings: According to the morphology of the aneurysms, 89 (93.7%) were saccular, 2 were fusiform (2.1%), 2 (2.1%) were blister, and 2 (2.1%) were dissected; according to size, 31 were (32.63%) small, 40 were (42.11%) medium, 11 were (11.58%) large, and 13 were (13.58%) giant; according to localisation 87 were (91.58%) anterior circulation (AC) and 8 were (8.42%) posterior circulation (PC); according to wall placement 91 (95.79%) were lateral and 4 (4.21%) were bifurcated; according to aspect ratio, 40 (42.11%) had a narrow neck and 52 (54.73%) had a wide neck. Two patients were treated for ruptured blister aneurysms. Aneurysm occlusion rates were found to be 87.2% at 12 months, and 93.68% at long-term follow-up. A total of 9 patients (11.53%) developed procedural complications. In angiographic long-term follow-ups, postprocedural late complications developed in 7 patients (8.9%). The overall mortality rate was 5.33%, with postprocedural early 2.66% and late 2.66%. The permanent morbidity rate was 1.33%. The mean follow-up period was 42.68±26.5 months, and the mean occlusion time was 8.76±8.3 months.
Conclusion: It was concluded that the use of flow-diverting silk stent was effective and safe in the endovascular treatment of intracranial aneurysms. Technical success was worse in PC aneurysms compared to anterior, mortality and morbidity rates were lower in anterior circulation.
Limitations: The study was retrospective.
Funding for this study: No funding was received.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study was approved by the Ethics Committee of the Medical School of Istanbul University Istanbul on the 24th September 2021 with code number 17.

Author Block: K. Mostafa, F. Bueno Neves, F. Gärtner, T. Klintz, N. Larsen, S. Peters, J. Hensler, O. Jansen, F. Wodarg; Kiel/DE
Purpose: The purpose of this study was to assess and evaluate the feasibility and the periinterventional aspects of embolisation of intracranial aneurysms located in the basilar tip using the Contour Neurovascular System (CNS).
Methods or Background: Treatment of basilar apex aneurysms remains challenging regarding the nobility of the parent vessel and their often wide-necked configuration. Novel intrasaccular flow-disruption devices constitute an endovascular treatment alternative besides coiling and stent-assisted procedures.
The presented study reports periinterventional and feasibility aspects of embolising basilar tip aneurysms with the CNS. Here, a retrospective analysis of eight patients after CNS implantation into a basilar apex aneurysm was performed. Data on intervention times, radiation dose, procedural success, and complications were gathered. All patients received follow-up digital subtraction angiography after six months.
Results or Findings: CNS implantation was successful in all patients. Mean device instrumentation time was 18.8±7.7 minutes with a mean full intervention time of 100±65.8 minutes. Mean full procedure radiation dose was 1917 (421-5107) cGy/cm2. Upon interventional angiographic follow-up after six months, six aneurysms were adequately occluded. One showed constant slight perfusion inside the device without the need for reintervention and one patient had undergone reintervention. No deaths were reported.
Conclusion: CNS implantation is an alternative endovascular method for embolising intracranial aneurysms located in the basilar tip with short intervention times and promising short- and medium-term follow-up data concerning aneurysm occlusion and reinterventions.
Limitations: The number of patients included in this study was small due to the single-centre design as well as the novelty of the CNS combined with the rarity of the specific aneurysm. Hence it can not be concluded that basilar apex aneurysm treatment using the CNS is equal to conventional procedures. Additionally, further research is needed to evaluate long-term stability.
Funding for this study: No funding was received.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was approved by the Ethikkomission der Christian-Albrechts-Universität Kiel.