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Background: Spetzler-Martin (SM) Grade III brain arteriovenous malformations (BAVMs) represent a transitional risk zone between low- and high-grade BAVMs, characterized by diverse angioarchitecture. The primary treatment options are endovascular embolization, microsurgical resection (MS), and stereotactic radiosurgery (SRS). This study compares the efficacy and outcomes of MS and SRS., Methods: We conducted a multicenter, retrospective study involving patients from the MISTA database with SM Grade III BAVMs treated with MS or SRS between 2010 and 2023. Propensity matching was based on age, favorable modified Rankin Score (mRS) at presentation, nidus size, rupture status, location depth, and eloquence., Results: After matching, 60 patients were equally divided between MS and SRS groups. Median age (MS: 45.0 vs. SRS: 42.5 years, p = 0.3) and AVM size (MS: 3.2 vs. SRS: 2.9 cm 3 , p = 0.6) were similar. MS showed higher obliteration rates (93.3 %) compared to SRS (46.7 %) at the last follow-up (p < 0.001). The median time to obliteration post-SRS was 31.5 months (IQR: 15.3-60.0). SRS obliteration rates were 19 %, 29 %, and 59 % at 24, 36, and 60 months, respectively. Overall complication rates (MS: 30 % vs. SRS: 20 %, p = 0.4) and permanent complications (MS: 10 % vs. SRS: 13.3 %, p > 0.9) were similar. Hemorrhage occurred once in the MS group and none in the SRS (p > 0.9). Favorable outcomes (mRS 0-2) were higher with SRS than MS (93.3 % vs 80.0 %, p = 0.3), with one AVM-related mortality in the MS group., Conclusion: MS and SRS are viable treatments for SM Grade III BAVMs. Treatment choice should be individualized by a multidisciplinary team, considering patient goals., Competing Interests: Declaration of Competing Interest The researchers reported that there was no conflict of interest, (Copyright © 2024 Elsevier B.V. All rights reserved.)

Introduction: Carotid blowout syndrome (CBS) is a potentially life-threatening complication of head and neck cancer and associated treatment. In this study, we assess the safety and efficacy of deconstructive and reconstructive procedures with a focus on CBS recurrence., Methods: We conducted a multicenter retrospective analysis of a prospectively maintained database and identified 80 consecutive neurointerventions for CBS from 2016 to 2020. Patients were divided into 2 groups: deconstructive embolization (68 patients) and reconstructive stenting (12 patients). A comparative analysis was performed between the two groups., Results: The CBS recurrence rate was 23.8 % with 84.2 % of recurrences occurring within 90 days of the primary event. The median time to rebleeding was 8.0 days (IQR: 2.0 - 28.5) with a mortality rate of 26.3 %. There was no significant difference in rates of peri-operative ischemic stroke (1.5 % vs. 0 %, p=0.672) or peri-operative mortality (1.5 % vs. 0 %, p=0.670). CBS recurrence was significantly higher in the reconstructive group (58.3 % vs. 17.6 %, p=0.002). On multivariate analysis, reconstructive stenting independently predicted rebleeding (adjusted hazard ratio 8.31, 95 % CI: 2.34-29.59, p=0.001). There was no significant association between CBS recurrence and pre-operative (p=0.600) or post-operative (p=0.275) anticoagulant/antiplatelet use., Conclusion: CBS remains a challenging and potentially catastrophic complication of head and neck cancers. Reconstructive procedures, including stenting, predicted CBS recurrence independent of bleeding site or tumor invasion. Postoperative surveillance based on time intervals to CBS recurrence and engineering advancements including improved vessel reconstruction devices have the potential to reduce rehemorrhage rates and improve patient outcomes. Further clinical investigations amongst larger cohorts are needed., (Copyright © 2024. Published by Elsevier B.V.)

Idiopathic intracranial hypertension (IIH) is a disease defined by increased intracranial pressure and associated with a variety of symptoms ranging from headaches to tinnitus. Ventricular peritoneal shunting has been the mainstay treatment for patients with IIH. Although VPS's have shown efficacy in treating IIH, some patients complain of refractory symptoms even with functioning VPS's. Venus stenting has emerged as a new technique for treating these refractory symptoms. Despite the scarce literature pertaining its efficacy and safety profile, several small studies have shown promising results. In this case series, four patients with IIH complained of refractory symptoms despite functioning VPS's and were treated with venous stenting., Competing Interests: Declaration of Competing Interest Dr. Gooch is a consultant for Stryker. Dr. Jabbour is a consultant for Medtronic, MicroVention, Balt and Cerus Endovascular. Dr. Tjoumakaris is a consultant for Medtronic and MicroVention. The other authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Objective: The transfemoral (TF) route has historically been the preferred access site for endovascular procedures. However, despite its widespread use, TF procedures may confer morbidity as a result of access site complications. The aim of this study is to provide the rate and predictors of TF access site complications for neuroendovascular procedures., Methods: This is a single center retrospective study of TF neuroendovascular procedures performed between 2017 and 2022. The incidence of complications and associated risk factors were analyzed across a large cohort of patients., Results: The study comprised of 2043 patients undergoing transfemoral neuroendovascular procedures. The composite rate of access site complications was 8.6 % (n = 176). These complications were divided into groin hematoma formation (n = 118, 5.78 %), retroperitoneal hematoma (n = 14, 0.69 %), pseudoaneurysm formation (n = 40, 1.96 %), and femoral artery occlusion (n = 4, 0.19 %). The cross-over to trans radial access rate was 1.1 % (n = 22). On univariate analysis, increasing age (OR=1.0, p = 0.06) coronary artery disease (OR=1.7, p = 0.05) peripheral vascular disease (OR=1.9, p = 0.07), emergent mechanical thrombectomy procedures (OR=2.1, p < 0.001) and increasing sheath size (OR=1.3, p < 0.001) were associated with higher TF access site complications. On multivariate analysis, larger sheath size was an independent risk factor for TF access site complications (OR=1.8, p = 0.02)., Conclusion: Several pertinent factors contribute towards the incidence of TF access site complications. Factors associated with TF access site complications include patient demographics (older age) and clinical risk factors (vascular disease), as well as periprocedural factors (sheath size)., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: With the development of the Flow Re-Direction Endoluminal Device Junior (FRED Jr), treatment of distal aneurysms and/or aneurysms with small parent vessels has become a viable option., Objectives: To assess the efficacy and safety of FRED Jr in the treatment of distal aneurysms with small parent vessels., Methods: This is a single center retrospective study and meta-analysis of patients treated with FRED Jr for intracranial aneurysms. The primary outcome was complete aneurysm occlusion at final follow-up. Secondary outcomes included stroke rates, mortality rates, need for retreatment and clinical outcomes., Results: There were a total of 7 patients with 7 aneurysms treated with FRED Jr. Mean aneurysm neck, width, height, and parent artery diameter were 2.6 ± 0.8 mm, 3.1 ± 0.9 mm, 2.5 ± 1.0 mm, and 1.8 ± 0.6 mm respectively. The complete occlusion rate was 57.1 % at 6 months, and favorable outcome (mRS 0-2) was observed in all patients in follow-up. Stroke complication occurred in none of the patients. Seven studies from 1360 articles were identified for inclusion in the meta-analysis, comprising 227 patients with 244 aneurysms treated with FRED Jr. Mean aneurysm height, width, neck and parent artery diameter were 6.9 ± 3.3 mm (pooled=5.6 [<0.1-11.47] mm), 6.6 ± 2.2 mm (pooled=6.6 [4.2-9.1] mm), 4.4 ± 1.4 mm (pooled=4.1 [3.3 -4.9] mm), and 2.0 ± 0.2 mm (pooled=2.1 [1.7-2.5]), respectively. At final follow-up, the pooled complete occlusion and complication rates were 69.9 % and 0 %, respectively., Conclusion: FRED Jr demonstrated moderate efficacy and good safety in the treatment of distal aneurysms with small parent vessels at mid-term follow-up., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background and Purpose: Rescue stenting is used as a bailout technique during mechanical thrombectomy for stroke. We performed a retrospective study analyzing outcomes of patients that received a stent as a bailout measure and compared results to a control group., Methods: We identified all patients who underwent a mechanical thrombectomy for a large vessel occlusion between January 2010 and October 2019. Subjects with mTICI 0-2 A after at least three passes were defined as failed MT and constituted the control group (NSG-controls). Patients that received a rescue stent (RSG) formed the study group., Results: Comparative analysis of patient demographics between NSG-controls and SRG was performed. Baseline characteristics and comorbidities were not significantly different between both groups. NIHSS at admission and IV t-PA were not significantly different among both groups (16.5 vs. 14.2, p = 0.19) and (39.4% vs. 29.4%, p = 0.30), respectively. There was no significant difference in procedural and post-procedural complications between both the groups. In the RSG, 24 patients (82.4%) achieved favorable revascularization outcomes. NIHSS at discharge (p = 0.01) was higher in the NSG-controls, while favorable functional outcome at three months (12% vs. 39.2%, p = 0.01) was observed at a higher proportion in the RSG. There was also a significant mortality difference, with 15.2% mortality in the RSG compared to 35.1% mortality in the NSG-controls (p = 0.03). In multivariate analysis, stenting was an independent predictor of favorable outcome (OR: 10.0, p = 0.009)., Conclusion: Herein, we demonstrated that rescue stenting is a feasible, safe, and effective procedure to improve stroke outcomes and should be seriously considered if the primary mechanical thrombectomy is not successful., (Copyright © 2022 Elsevier B.V. All rights reserved.)