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Background The Pipeline Embolization Device has proven to be a safe and effective device for the treatment of intracranial aneurysms. The Pipeline Vantage Flow Diverter (PVFD) with Shield Technology is the new fourth generation of this implant, with modifications made compared to previous iterations. We aimed to evaluate the mechanical properties and clinical safety and efficacy of this device. Methods Vanguard is a single arm, single center, prospective study. Between April 2021 and April 2023, all consecutive patients with an unruptured aneurysm treated with Pipeline Vantage flow-diverting stents were included. There were no aneurysm size or location exclusion criteria. Safety (neurological serious adverse events) and efficacy (device deployment and aneurysm occlusion) were independently reviewed. Imaging follow-up data, and immediate, early (<30 days), and delayed (>30 days) neurological serious adverse events were independently assessed. Results 101 consecutive patients with a total of 115 aneurysms were included. The aneurysms were situated in the anterior (90.4%) or posterior (9.6%) circulations. A total of 124 devices were implanted. The deployment success rate was 100%. In four (4.0%) cases post-deployment angioplasty was required to optimize device wall apposition. Occlusion rates at 1 month were 54.7%, at 3 months 72.1%, and at 6 months 81.7%. Morbidity and mortality were 4.9% and 0%, respectively, at 6 months. Eight cases (6.9%) demonstrated in-stent stenosis, four of which had 'fish mouth' deformity. Conclusion Initial results of the new generation PVFD for unruptured intracranial aneurysm treatment demonstrate overall satisfactory device performance, safety profile, and effectiveness. [ABSTRACT FROM AUTHOR]

Introduction: This research evaluates the budget impact of treating acute ischaemic stroke (AIS) using a combination of mechanical thrombectomy (MT) with stent retrievers (SR) and intravenous tissue‐plasminogen activator (IV‐tPA) in Australia. Methods: This study examined the economic impact over five years for a patient cohort based on the number of patients treated with MT+ IV‐tPA in Australia 2021, versus treatment with IV‐tPA alone. A budget impact (BI) model was developed to project direct medical costs (economic impact) of IV‐tPA+ MT with SR vs. Intravenous tissue‐plasminogen activator alone over a five‐year period (2021–2025 inclusive) from a healthcare perspective. The model is composed of a short‐run decision tree model based on a 3‐month post‐treatment modified Rankin Scale (mRS) from the EXTEND‐IA study and a published long‐run Markov state transition model. Acute, mid‐term and long‐term care costs were projected based on anticipated mRS scores from the EXTEND‐IA trial. Estimated yearly and cumulative budget impact were reported to indicate the economic impact of the two treatment strategies for AIS in the Australian healthcare system. Results: MT+IV‐tPA had a greater budgetary impact than IV‐tPA alone, with annual savings starting at Year 1 and continuing through to Year 5. Cost savings of 21% or approximately $36 million can be achieved over five years for the patient cohort treated in Australia in 2021. Each MT procedure performed delivers approximately $3280 in annual health system savings per patient. Conclusion: Treatment of AIS with a combination of MT+IV‐tPA generates significant savings in the Australian healthcare system compared with IV‐tPA alone. [ABSTRACT FROM AUTHOR]

Background: The use of balloon microcatheters in interventional neuroradiology is well documented. However, their use is sometimes limited by the small diameter and excessive tortuosity of the vasculature. The Scepter Mini dual-lumen balloon microcatheter (SMBM) (Microvention, Aliso Viejo, CA) has been designed to address these challenges by decreasing the distal catheter profile, allowing distal access to the target vessel. Methods: This is a single-centre retrospective analysis of the initial cases performed using the Scepter Mini balloon microcatheter. The targeted conditions were vascular malformations. Patient clinical data, angiographic features of the vascular abnormalities and operation reports were reviewed and the procedural parameters, radiation doses, occlusion rates and complications were assessed. Results: A total of 15 SMBM were used in 11 cases. In all cases the procedure performed was balloon inflation and antegrade delivery of precipitating hydrophobic injectable liquid (PHIL) (Microvention, Aliso Viejo, CA) for embolisation of a targeted feeding vessel and cranial and spinal vascular malformations. Successful feeding vessel distal access and antegrade liquid embolisation was achieved in 100% of the cases. One of the 11 cases was an emergency procedure. One procedural target vessel rupture, likely due to overinflation, and three minor post-procedure complications were observed. Conclusion: The SMBM represents a significant advance in the treatment of cerebrospinal vascular malformations, allowing balloon catheter access into tortuous and small calibre vessels. [ABSTRACT FROM AUTHOR]

Purpose: To examine whether the muscle typology of elite and world-class swimmers could discriminate between their best distance event, swimming stroke style, or performance level. Methodology: The muscle carnosine content of 43 male (860 [76] FINA [Fédération Internationale de Natation] points) and 30 female (881 [63] FINA points) swimmers was measured in the soleus and gastrocnemius by proton magnetic resonance spectroscopy and expressed as a carnosine aggregate Z score (CAZ score) to estimate muscle typology. A higher CAZ score is associated with a higher estimated proportion of type II fibers. Swimmers were categorized by their best stroke, distance category (sprinters, 50–100 m; middle distance, 200–400 m; or long distance, 800 m–open water), and performance level (world-class, world top 10, or elite and world top 100 swimmers outside of the world top 10). Results: There was no significant difference in the CAZ score of sprint- (−0.08 [0.55]), middle- (−0.17 [0.70]), or long-distance swimmers (−0.30 [0.75], P =.693). World-class sprint swimmers (all strokes included) had a significantly higher CAZ score (0.37 [0.70]) when compared to elite sprint swimmers (−0.25 [0.61], P =.024, d = 0.94). Breaststroke swimmers (0.69 [0.73]) had a significantly higher CAZ score compared to freestyle (−0.24 [0.54], P <.001, d = 1.46), backstroke (−0.16 [0.47], P =.006, d = 1.42), and butterfly swimmers (−0.39 [0.53], P <.001, d = 1.70). Furthermore, within the cohort of breaststroke swimmers, there was a significant positive correlation between FINA points and CAZ score (r =.728, P =.011); however, this association was not evident in other strokes. Conclusion: While there was no clear association between muscle typology and event distance specialization, world-class sprint swimmers possess a greater estimated proportion of type II fibers compared to elite sprint swimmers, as well as breaststroke swimmers compared to freestyle, backstroke, and butterfly swimmers. [ABSTRACT FROM AUTHOR]

Background Robotic-assisted neurointervention was recently introduced, with implications that it could be used to treat neurovascular diseases. Objective To evaluate the effectiveness and safety of the robotic-assisted platform CorPath GRX for treating cerebral aneurysms. Methods This prospective, international, multicenter study enrolled patients with brain aneurysms that required endovascular coiling and/or stent-assisted coiling. The primary effectiveness endpoint was defined as successful completion of the robotic-assisted endovascular procedure without any unplanned conversion to manual treatment with guidewire or microcatheter navigation, embolization coil(s) or intracranial stent(s) deployment, or an inability to navigate vessel anatomy. The primary safety endpoint included intraprocedural and periprocedural events. Results The study enrolled 117 patients (74.4% female) with mean age of 56.6 years from 10 international sites,. Headache was the most common presenting symptom in 40/117 (34.2%) subjects. Internal carotid artery was the most common location (34/122, 27.9%), and the mean aneurysm height and neck width were 5.7±2.6 mm and 3.5±1.4 mm, respectively. The overall procedure time was 117.3±47.3 min with 59.4±32.6 min robotic procedure time. Primary effectiveness was achieved in 110/117 (94%) subjects with seven subjects requiring conversion to manual for procedure completion. Only four primary safety events were recorded with two intraprocedural aneurysm ruptures and two strokes. A Raymond-Roy Classification Scale score of 1 was achieved in 71/110 (64.5%) subjects, and all subjects were discharged with a modified Rankin Scale score of ≤2. Conclusions This first-of-its-kind robotic-assisted neurovascular trial demonstrates the effectiveness and safety of the CorPath GRX System for endovascular embolization of cerebral aneurysm procedures. [ABSTRACT FROM AUTHOR]

Purpose: To determine the influence of muscle fiber typology (MFT) on the pacing strategy of elite swimmers competing in the 200-m freestyle event. Method: The top 3 career-best performances from 25 elite 200-m freestyle swimmers were analyzed—12 women (1:58.0 [0:01.3] min:s) and 13 men (1:48.4 [0:02.5]). Muscle carnosine concentration was quantified by proton magnetic resonance spectroscopy in the gastrocnemius and soleus muscles and expressed as a carnosine aggregate z score (CAZ score) relative to an age- and gender-matched nonathlete control group to estimate MFT. Linear regression models were employed to examine the influence of MFT on the percentage of overall race time spent in each 50-m lap. Results: Swimmers with a higher CAZ score spent a greater percentage of race time in lap 3 compared with swimmers with a lower CAZ score (0.1%, 0.0% to 0.2%; mean, 90% confidence interval, P =.02). For every 1% increase in the percentage of race time spent in lap 1, the percentage of race time spent in lap 3 decreased by 0.4% for swimmers with a higher CAZ score (0.2% to −0.5%, P =.00, r = −.51), but not for swimmers with a lower CAZ score (−0.1%, −0.3% to 0.1%, P =.28, r = −.18). The percentage of race time spent in lap 4 decreased by 0.8% for higher-CAZ-score swimmers (−0.5% to −1.0%, P =.00, r = −.66) and by 0.9% for lower-CAZ-score swimmers (−0.6% to −1.3%, P =.00, r = −.65) when lap 1 percentage increased by 1%. Conclusion: MFT may influence the pacing strategy of swimmers in the 200-m freestyle event, which provides an avenue for maximizing individualized pacing strategies of elite swimmers. [ABSTRACT FROM AUTHOR]

Purpose: To determine the association between estimated muscle fiber typology and the start and turn phases of elite swimmers during competition. Methods: International and national competition racing performance was analyzed from 21 female (FINA points = 894 ± 39: 104.5 ± 1.8% world record ratio [WRR]) and 25 male (FINA points = 885 ± 54: 104.8 ± 2.1% WRR) elite swimmers. The start, turn, and turn out times were determined from each of the swimmers' career best performance times (FINA points = 889 ± 48: 104.7 ± 2.0% WRR). Muscle carnosine concentration was quantified by proton magnetic resonance spectroscopy in the gastrocnemius and soleus and was expressed as a carnosine aggregate z score relative to an age- and gender-matched nonathlete control group to estimate muscle fiber typology. Linear mixed models were employed to determine the association between muscle fiber typology and the start and turn times. Results: While there was no significant influence of carnosine aggregate z score on the start and turn times when all strokes and distance events were entered into the model, the swimmers with a higher carnosine aggregate z score (ie, faster muscle typology) had a significantly faster start time in 100-m events compared with the swimmers with a lower carnosine aggregate z score (P =.02, F = 5.825). The start and turn times were significantly faster in the male compared with the female swimmers in the 100-m events compared with other distances, and between the 4 different swimming strokes (P <.001). Conclusion: This study suggests that start times in sprint events are partly determined (and limited) by muscle fiber typology, which is highly relevant when ∼12% of the overall performance time is determined from the start time. [ABSTRACT FROM AUTHOR]

The article discusses the efficacy of endovascular thrombectomy (EVT) in patients with extensive infarction (ASPECTS 0-2) in acute ischemic stroke. The study analyzed data from five studies, including four randomized controlled trials and pooled individual patient data. Patients treated with EVT showed higher odds of functional improvement at 90 days compared to those receiving best medical management. The findings suggest that EVT may be beneficial for patients with extensive infarct sizes, challenging traditional views on ischemic core viability and highlighting the need for further research on patient selection and cost-effectiveness of EVT treatment. [Extracted from the article]

Background The radial artery approach has become popular as a 'radial first' strategy for arterial access in neuroangiography and neurointerventions. Recent studies have shown that transradial arterial access (TRA) for cerebral angiography has been associated with reduced access site complication rates and improved patient satisfaction compared with transfemoral access (TFA). The goal of this study was to evaluate the presence of abnormal MRI diffusion weighted imaging (DWI) foci following DSA and correlate their frequency with TRA or TFA. Methods We prospective analyzed 200 consecutive adult DSAs performed from January 2021 to January 2022, at a single tertiary center. Results Of the 200 consecutive diagnostic cerebral angiograms, 51% were performed via TRA and 49% were performed via TFA. Of the TRA cerebral angiograms, 17.5% demonstrated at least one hyperintense focus on MRI DWI. Of the TFA procedures, 5.2% were considered positive. One patient (0.5%) in the TRA group experienced a minor neurologic deficit postoperatively that had not completely resolved at 90 days after the procedure and no neurologic deficits occurred in the TFA group. Conclusions Despite the proven benefit of TRA over TFA in neurointervention, the number of MRI DWI restriction foci were significantly more frequent during cerebral angiography when TRA was selected. Although the number of clinically symptomatic events were minimal, the widespread use of the technique may become clinically relevant. Further studies contrasting the TRA and TFA techniques will be beneficial for cerebral angiography. [ABSTRACT FROM AUTHOR]

Advances in robotic technology have improved standard techniques in numerous surgical and endovascular specialties, offering more precision, control, and better patient outcomes. Robotic-assisted interventional neuroradiology is an emerging field at the intersection of interventional neuroradiology and biomedical robotics. Endovascular robotics can automate maneuvers to reduce procedure times and increase its safety, reduce occupational hazards associated with ionizing radiations, and expand networks of care to reduce gaps in geographic access to neurointerventions. To date, many robotic neurointerventional procedures have been successfully performed, including cerebral angiography, intracranial aneurysm embolization, carotid stenting, and epistaxis embolization. This review aims to provide a survey of the state of the art in robotic-assisted interventional neuroradiology, consider their technical and adoption limitations, and explore future developments critical for the widespread adoption of robotic-assisted neurointerventions. [ABSTRACT FROM AUTHOR]

Purpose: The present study identified the physiological and performance characteristics that are deterministic during a maximal 1500-m time trial and in paced 1500-m time trials, with an all-out last lap.Methods: Thirty-two trained middle-distance runners (n = 21 male, VO2peak: 72.1 ± 3.2; n = 11, female, VO2peak: 61.2 ± 3.7 mL kg-1 min-1) completed a 1500-m time trial in the fastest time possible (1500FAST) as well as a 1500MOD and 1500SLOW trial whereby mean speed was reduced during the 0-1100 m by 5% and 10%, respectively. Anaerobic speed reserve (ASR), running economy (RE), the velocity corresponding with VO2peak (VVO2peak), maximal sprint speed (MSS) and maximal accumulated oxygen deficit (MAOD) were determined during additional testing. Carnosine content was quantified by proton magnetic resonance spectroscopy in the gastrocnemius and expressed as a Z-score to estimate muscle fibre typology.Results: 1500FAST time was best explained by RE and VVO2peak in female runners (adjusted r2 = 0.80, P < 0.001), in addition to the 0-1100-m speed relative to VVO2peak in male runners (adjusted r2 = 0.72, P < 0.001). Runners with a higher gastrocnemius carnosine Z-score (i.e., higher estimated percentage of type II fibres) and greater MAOD, reduced their last lap time to a greater extent in the paced 1500-m trials. Neither ASR nor MSS was associated with last lap time in the paced trials.Conclusion: These findings suggest that VVO2 peak and RE are key determinants of 1500-m running performance with a sustained pace from the start, while a higher carnosine Z-score and MAOD are more important for last lap speed in tactical 1500-m races. [ABSTRACT FROM AUTHOR]

Background The first and second generations of the Pipeline Embolization Device (PED) have been widely adopted for the treatment of intracranial aneurysms (IAs) due to their high associated occlusion rates and low morbidity and mortality. The objective of this study was to evaluate the safety and effectiveness of the third- generation Pipeline Shield device (PED-Shield) for the treatment of IAs. Methods The SHIELD study was a prospective, single-arm, multicenter, post-market, observational study evaluating the PED-Shield device for the treatment of IAs. The primary efficacy endpoint was complete aneurysm occlusion without significant parent artery stenosis or retreatment at 1-year post-procedure and the primary safety endpoint was major stroke in the territory supplied by the treated artery or neurological death. Results Of 205 subjects who consented across 21 sites, 204 subjects with 204 target aneurysms were ultimately treated (mean age 54.8±12.81 years, 81.4% [166/204] female). Technical success (ie, deployment of the PED-Shield) was achieved in 98.0% (200/204) of subjects with a mean number of 1.1±0.34 devices per subject and a single device used in 86.8% (177/204) of subjects. The primary effectiveness endpoint was met in 71.7% (143/200) of subjects while the primary safety endpoint occurred in six (2.9%) subjects, two (1.0%) of which led to neurological death. Conclusions The findings of the SHIELD study support the safety and effectiveness of the PED-Shield for IA treatment, evidenced by high occlusion rates and low rates of neurological complications in the study population. [ABSTRACT FROM AUTHOR]

The aim of this study was to identify markers of training stress and characteristics of middle-distance runners related to the incidence of overreaching following overload training. Twenty-four highly trained middle-distance runners [n 16 male, peak oxygen uptake (V˙ O2peak) 73.3 (4.3) mL·kg·min-1 ; n 8 female, V˙O2peak 63.2 (3.4) mL·kg·min-1 ] completed 3 wk of normal training (NormTr), 3 wk of high-volume training (HVTr; a 10%, 20%, and 30% increase in training volume each successive week from NormTr), and 1 wk of taper (TapTr; 55% exponential reduction in training volume from HVTr week 3). Before and immediately after each training period, an incremental treadmill-running test was performed, while resting metabolic rate (RMR), subjective fatigue responses, and various resting blood biomarkers were assessed. Muscle fiber typology of the gastrocnemius was estimated by quantification of muscle carnosine using proton magnetic resonance spectroscopy and expressed as a z-score relative to a nonathlete control group. Twelve runners were classified as functionally overreached (FOR) following HVTr [decreased running time to exhaustion (TTE)], whereas the other 12 were classified as acutely fatigued (AF; no decrease in running TTE). The FOR group did not demonstrate systematic alterations in RMR, resting blood biomarkers, or submaximal exercise responses, compared with the AF group. The gastrocnemius carnosine z-score was significantly higher in the FOR group (-0.44 ± 0.57) than in the AF group (-1.25 ± 0.49, P = 0.004, d = 1.53) and was also negatively correlated with changes in running TTE from pre- to post-HVTr (r = 0.55, P = 0.005) and from pre-HVTr to post-TapTr (r = 0.64, P = 0.008). Muscle fiber typology is related to the incidence of overreaching and performance supercompensation following increased training volume and a taper. NEW & NOTEWORTHY Variability in the performance responses following an overload training period and subsequent taper was associated with the variation in the muscle fiber typology of the gastrocnemius. Runners with an estimated higher proportion of type I fibers (i.e., lower carnosine z-score) were able to maintain performance in response to an overload training period and subsequently achieve a superior performance supercompensation. These findings show that muscle fiber typology contributes to the variability in performance responses following training. [ABSTRACT FROM AUTHOR]

Introduction: Over the last decade interventional neuroradiology (NR) has become the mainstay of managing cerebral aneurysms. The aim of our study was to review our growing experiences with interventional NR and quantify morbidity and mortality associated with these procedures.Methods: The electronic medical records of all patients admitted to the Gold Coast (University) Hospital Intensive Care Unit following subarachnoid haemorrhage (SAH) or elective interventional NR management of cerebral aneurysms between January 2012 and December 2014 were retrieved. Primary outcomes of interest were death, thromboembolic and haemorrhagic events during hospital admission.Results: One hundred and fifty-two patients underwent interventional NR procedures for cerebral aneurysms. This consisted of 92 (60.5%) elective cases and 60 (39.5%) emergency cases following SAH. The all-cause mortality rate and the rate of thromboembolic and haemorrhagic events for the entire cohort were 5.9%, 11.2% and 7.2% respectively. Intra-procedural complications occurred in 6.6% of the entire cohort. Median length of follow-up was 448 days, with 91.6% of the entire cohort followed up. At follow-up, 64.1% of patients had no neurological deficits, 29% had mild non-specific deficits and 6.9% had significant disability.Conclusions: Interventional NR represents the primary treatment modality for all patients presenting to our service with cerebral aneurysm. Our results are encouraging and are comparable to published data in the international literature. Reducing the burden of thromboembolism in patients undergoing endovascular treatment of their aneurysmal disease is our main research focus currently, and we aim to improve outcomes for this patient group. [ABSTRACT FROM AUTHOR]