1.Middle meningeal artery: An effective pathway for achieving complete obliteration following transarterial Ethylene Vinyl Copolymer (Onyx) embolization of dural arteriovenous fistulas
Yosuke AKAMATSU ; Santiago GOMEZ-PAZ ; Daniel A. TONETTI ; David VERGARA-GARCIA ; Viraj M. MOHOLKAR ; Anna Luisa KUHN ; Kohei CHIDA ; Jasmeet SINGH ; Katyucia de Macedo RODRIGUES ; Francesco MASSARI ; Justin M. MOORE ; Christopher S. OGILVY ; Ajit S. PURI ; Ajith J. THOMAS
Journal of Cerebrovascular and Endovascular Neurosurgery 2022;24(3):210-220
Objective:
Transarterial Onyx embolization is the mainstay of intracranial non-cavernous dural arteriovenous fistulas (dAVFs) treatment. Although the dural arterial supply varies depending on the location, the impact of arterial access on treatment outcomes has remained unclear. The aim of this study was to characterize factors as sociated with complete obliteration following transarterial Onyx embolization, with a special focus on arterial access routes and dAVF location.
Methods:
A retrospective analysis of the patients who underwent transarterial Onyx embolization for intracranial dAVFs at two academic institutions was performed. Patients with angiographic follow-up were considered eligible to investigate the impact of the arterial access on achieving complete obliteration.
Results:
Sixty-eight patients underwent transarterial Onyx embolization of intracranial dAVFs. Complete obliteration was achieved in 65% of all treated patients and in 75% of those with cortical venous reflux. Multivariable analysis identified middle meningeal artery (MMA) access to be a significant independent predictive factor for complete obliteration (OR, 2.32; 95% CI, 1.06-5.06; p=0.034). Subgroup analysis showed that supratentorial and lateral cerebellar convexity dAVFs (OR, 5.72, 95% CI, 1.89-17.33, p=0.002), and Borden type III classification at pre-treatment (OR, 3.13, 95% CI, 1.05- 9.35, p=0.041), were independent predictive factors for complete obliteration following embolization through the MMA.
Conclusions
MMA access is an independent predictive factor for complete obliteration following transarterial Onyx embolization for intracranial non-cavernous dAVFs. It is particularly effective for supratentorial and lateral cerebellar convexity dAVFs and those that are Borden type III.
2.Endovascular Therapy in the Extended Time Window for Large Vessel Occlusion in Patients With Pre-Stroke Disability
Kanta TANAKA ; Hiroshi YAMAGAMI ; Muhammad M. QURESHI ; Kazutaka UCHIDA ; James E. SIEGLER ; Raul G. NOGUEIRA ; Shinichi YOSHIMURA ; Nobuyuki SAKAI ; Nicolas MARTINEZ-MAJANDER ; Simon NAGEL ; Jelle DEMEESTERE ; Volker PUETZ ; Diogo C. HAUSSEN ; Mohamad ABDALKADER ; Marta OLIVE-GADEA ; Mahmoud H. MOHAMMADEN ; João Pedro MARTO ; Anne DUSART ; Simon WINZER ; Liisa TOMPPO ; Francois CAPARROS ; Hilde HENON ; Flavio BELLANTE ; João Nuno RAMOS ; Santiago ORTEGA-GUTIERREZ ; Sunil A. SHETH ; Stefania NANNONI ; Johannes KAESMACHER ; Lieselotte VANDEWALLE ; Sergio SALAZAR-MARIONI ; Mudassir FAROOQUI ; Pekka VIRTANEN ; Rita VENTURA ; Syed ZAIDI ; Alicia C. CASTONGUAY ; Ajit S. PURI ; Behzad FARZIN ; Hesham E. MASOUD ; Piers KLEIN ; Jessica JESSER ; Manuel REQUENA ; Tomas DOBROCKY ; Daniel P.O. KAISER ; Erno PELTOLA ; Davide STRAMBO ; Markus A. MÖHLENBRUCH ; Eugene LIN ; Peter A. RINGLEB ; Osama O. ZAIDAT ; Charlotte CORDONNIER ; Daniel ROY ; Robin LEMMENS ; Marc RIBO ; Daniel STRBIAN ; Urs FISCHER ; Patrik MICHEL ; Jean RAYMOND ; Thanh N. NGUYEN
Journal of Stroke 2024;26(2):269-279
Background:
and Purpose We compared the outcomes of endovascular therapy (EVT) in an extended time window in patients with large-vessel occlusion (LVO) between patients with and without pre-stroke disability.
Methods:
In this prespecified analysis of the multinational CT for Late Endovascular Reperfusion study (66 participating sites, 10 countries between 2014 and 2022), we analyzed data from patients with acute ischemic stroke with a pre-stroke modified Rankin Scale (mRS) score of 0–4 and LVO who underwent EVT 6–24 hours from the time last seen well. The primary outcome was the composite of functional independence (FI; mRS score 0–2) or return to the pre-stroke mRS score (return of Rankin, RoR) at 90 days. Outcomes were compared between patients with pre-stroke disability (pre-stroke mRS score 2–4) and those without (mRS score 0–1).
Results:
A total of 2,231 patients (median age, 72 years; median National Institutes of Health Stroke Scale score, 16) were included in the present analysis. Of these, 564 (25%) had pre-stroke disability. The primary outcome (FI or RoR) was observed in 30.7% of patients with pre-stroke disability (FI, 16.5%; RoR, 30.7%) compared to 44.1% of patients without (FI, 44.1%; RoR, 13.0%) (P<0.001). In multivariable logistic regression analysis with inverse probability of treatment weighting, pre-stroke disability was not associated with significantly lower odds of achieving FI or RoR (adjusted odds ratio 0.73, 95% confidence interval 0.43–1.25). Symptomatic intracranial hemorrhage occurred in 6.3% of both groups (P=0.995).
Conclusion
A considerable proportion of patients with late-presenting LVO and pre-stroke disability regained pre-stroke mRS scores after EVT. EVT may be appropriate for patients with pre-stroke disability presenting in the extended time window.