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The transradial approach using a Simmons-shaped catheter has been increasingly used for diagnostic cerebral angiography and neurointervention. In the transradial approach for neurointervention, the right radial artery is mainly used. However, in interventional cardiology, there are apparent clinical benefits with the left transradial approach for right-handed patients. To our knowledge, no studies have reported on neurointervention with the routine use of the left transradial approach. We therefore devised a novel technique for cases with an unachievable form of the Simmons shape using the standard technique, which we named the "interchange technique." The purpose of this study was to evaluate the technical feasibility of the left transradial neurointervention. This study is a retrospective review of our prospective database of consecutive patients who underwent a left transradial neurointervention, using a 6-French Simmons guiding sheath, performed from January through April 2021. The outcome variables studied were successful catheterization and procedure-related complications. Twenty-one patients underwent a left transradial neurointervention including cerebral aneurysm coiling, carotid artery stenting, and meningioma embolization. The Simmons shape could not be formed with the standard technique for 3 patients, for whom we successfully formed the Simmons shape with our new interchange technique. The procedure was completely achieved in all 21 patients. No patients required crossover to the right radial or femoral arteries, and there were no radial artery spasms or occlusions or any procedural complications. The left transradial approach for neurointervention is a technically feasible, safe, and effective alternative while providing more comfort to right-handed patients. [ABSTRACT FROM AUTHOR]

• Distal radial artery access is a feasible, safe option for diagnostic cerebral angiography and wide range of neuro-interventions. • It is associated with low incidence of radial artery occlusion. • Faster hemostasis can be achieved due to superficial location of distal radial artery. • If suitable, it should be considered as the first choice of access. Recently there is a trend for radial first which advocates radial artery access as the first choice to perform diagnostic and interventional neurovascular procedures. Although safer than the conventional common femoral artery access, it is associated with a high rate of radial artery occlusion. Distal radial artery access is recently proposed to avoid this complication. This study aims to assess the feasibility and safety of distal radial artery access across a wide range of interventional neurovascular procedures. All Interventional neurovascular cases attempted via distal radial artery access from September 2019 till March 2021 were included in the study. Data regarding patient demographics, distal radial artery diameter, access site cannulation, size of the sheath, procedural details including success rate and complications were collected. During the study period, 102 patients underwent 114 procedures via the distal radial artery approach. The mean age of patients was 41.9 ± 15.2 years. Overall procedure success rate via DRA was 94.7% (108/114). 72 diagnostic cerebral angiograms and 36 interventional procedures were successfully completed while six procedures required switching to alternate access. Distal radial artery access is a safe and feasible option for diagnostic cerebral angiography and a wide range of neurovascular procedures. [ABSTRACT FROM AUTHOR]

Transradial access is an increasingly popular route for cerebral angiography and neurointerventions. However, obstacles to wider adoption remain, especially for complex interventions typically performed with larger, multiaxial systems such as flow diversion. We sought to analyze the published evidence for transradial flow diversion of intracranial aneurysms. Using Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, a literature review was performed to identify all published reports and studies of transradial flow diversion for intracranial aneurysm. The search was limited from April 2011 to February 2021. Primary outcome was successful completion of the procedure via a transradial approach. Heterogeneity was analyzed with Q and I2 statistics. Secondary outcomes were transradial access-site complications and other complications. In total, 11 studies involving 290 treated aneurysms were identified; 90.7% of the procedures were completed via the transradial approach. The heterogeneity between studies was high, with an I2 of 56.9%. There were no transradial access-site complications. The procedural complication rate was 2.41%. Transradial access has a high success rate for both anterior and posterior circulation flow-diversion embolizations. The success rate may be particularly high for posterior circulation and right anterior circulation aneurysms. It has a negligible access-site complication rate. Transradial access is a viable alternative to transfemoral access for flow diversion and should be considered as a first-line approach. [ABSTRACT FROM AUTHOR]

Objectives: Our primary objective was to determine the successful rate of recanalization of M1 large vessel occlusion using either the Trevo 4 × 30 mm or 6 × 25 mm stent during mechanical thrombectomy. Our secondary objectives were to determine differences between the use of these two stent retrievers regarding first-pass effect, periprocedural complications, and mortality in the first 90 days.Methods: This is a retrospective cohort study. Data regarding the stent used, recanalization, number of passes, periprocedural complications, and mortality were determined via our mechanical thrombectomy database along with chart review.Conclusion: When comparing Trevo 4 × 30 mm to 6 × 25 mm stent retrievers used in mechanical thrombectomy for middle cerebral artery large-vessel occlusion causing stroke, there is no statistically significant difference in successful recanalization rates, first-pass effect, perioperative complications, or mortality at 90 days. Studies like this will hopefully lead to further prospective, randomized controlled trials that will help show experts in the field an additional way to perform this procedure effectively and safely.

Introduction: In this review, we will summarize the impact of the COVID-19 pandemic on neurointerventional care for patients with cerebrovascular disease, with a particular emphasis on epidemiology, neurointerventional processes, and lessons learned from paradigm shifts in endovascular care. Areas covered: Peer-reviewed research is summarized regarding the complications of COVID-19 as related to the pandemic's impact on hospital admissions, imaging capabilities, treatment times, and outcomes of neurointerventional cases. Expert opinion: In the first wave of the COVID-19 pandemic, there was a global decline in neuroimaging, use of intravenous thrombolysis, thrombectomy, and coil embolization for ruptured intracranial aneurysms. An early recommendation to utilize general anesthesia and intubate all patients undergoing intervention to avoid an emergent aerosolizing procedure was found to have worse outcomes. The decline in new stroke and subarachnoid hemorrhage diagnoses may be related to patient and/or family fear of seeking acute medical care. A true shift in stroke epidemiology is also possible. As several vaccines become more readily available and the world rebounds from this pandemic, we hope to transform the neurointerventional experiences discussed in this paper into strategies that may improve care delivery of neurologically ill patients during a global crisis. [ABSTRACT FROM AUTHOR]

目的　浅析“金标准”内3D-DSA 技术较常规2D-DSA 在神经介入中的诊断优势和治疗中的应用 价值。方法　收集昆明医科大学附属延安医院2018 年1 月至2019 年12 月使用2D 及3D-DSA 技术行神经介入 患者277 例。其中：脑血栓取栓111 例、动脉瘤106 例137 个（普通囊状动脉瘤75 例97 个、巨大型动脉瘤 5 例6 个、宽颈动脉瘤21 例29 个、夹层动脉瘤等2 例2 个、梭形动脉瘤2 例2 个、复杂型动脉瘤1 例1 个）、 动静脉畸形45 例、颈动脉狭窄支架置入15 例。由工作经验丰富的2 位副高以上阅片者采用双盲法对2D 和3D 的图像进行回顾性分析与测量，进而比较2D、3D 图像测量数据差异及疾病检出率。结果　2D-DSA 在普通脑 血栓对各段血管的显示率与3D-DSA，差异无统计学意义（P > 0.05）；2D-DSA 检出动脉瘤93 例（122 个），3DDSA 检出106 例（ 137 个）（P < 0.05），不含假阳性2 例；2D-DSA 检出动静脉畸形44 例，3D-DSA 检出45 例 （P > 0.05）；2D-DSA 显示颈动脉狭窄15 例，3D-DSA 检出15 例，差异无统计学意义（P > 0.05）。3D-DSA 在颅 内动脉瘤检出率、瘤颈、瘤体形态、瘤径、载瘤血管、穿支血管显示等方面显示效果明显优于2D-DSA。 结论　3D-DSA 技术提高了对神经性疾病的检出率；同时也提高了对疾病的定性、定量诊断准确率；并且对疾 病的进一步治疗有重要的指导意义。 [ABSTRACT FROM AUTHOR]

Neurointervention is a very competitive specialty in the United States due to the limited number of training spots and the larger pool of applicants. The training standards are continuously updated to ensure solid training experiences. Factors affecting candidate(s) selection have not been fully established yet. Our study aims to investigate the factors influencing the selection process.A 52-question survey was distributed to 93 program directors (PDs). The survey consisted of six categories: (a) Program characteristics, (b) Candidate demographics, (c) Educational credentials, (d) Personal traits, (e) Research and extracurricular activities, and (f) Overall final set of characteristics. The response rate was 59.1%. As per the programs’ characteristics, neurosurgery was the most involved specialty in running the training programs (69%). Regarding demographics, the need for visa sponsorship held the greatest prominence with a mean score of 5.9 [standard deviation (SD) 2.9]. For the educational credentials, being a graduate from a neurosurgical residency and the institution where the candidate's residency training is/was scored the highest [5.4 (SD = 2.9), 5.4 (SD = 2.5), respectively]. Regarding the personal traits, assessment by faculty members achieved the highest score [8.9 (SD = 1)]. In terms of research/extracurricular activities, fluency in English had the highest score [7.2 (SD = 1.9)] followed by peer-reviewed/PubMed-indexed publications [6.4 (SD = 2.2)].Our survey investigated the factors influencing the final decision when choosing the future neurointerventional trainee, including demographic, educational, research, and extracurricular activities, which might serve as valuable guidance for both applicants and programs to refine the selection process. [ABSTRACT FROM AUTHOR]

Increasing life expectancy has caused growing concern about maintaining viable neurointerventional practices due to altered Medicare payment structures. This study analyzes the financial trends of three common diagnostic tests for cerebrovascular disease: cerebral digital subtraction angiography (DSA), computed tomography angiography (CTA), and magnetic resonance angiography (MRA).Medicare Part B National Summary Data files from 2013 to 2020 were queried by Current Procedural Terminology (CPT) codes for DSA (36221–36228), CTA (70496, 70498), and MRA (70544–70547, 70549). Inflation-adjusted charges and reimbursement were calculated using the U.S. City Average Consumer Price Index for Medical Services. Regression analysis was performed on charges, reimbursement, and volume.A total of 1,519,245 diagnostic procedures were conducted between 2013 and 2020 (782,370 angiograms, 246,603 CTAs, and 490,272 MRAs). A total of $41.005 million was reimbursed by Medicare in 2020 for these diagnostic procedures. The annual percent change in volume for all procedures was −2.90%. From 2013 to 2020, inflation-adjusted: Medicare total physician reimbursement decreased for cerebral angiograms (−4.12%, p = 0.007), CTAs (−2.77%, p = 0.458), and MRAs (−9.06%, p < 0.001). Procedural volume billed to Medicare decreased for cerebral angiograms (−4.63%, p = 0.007) and MRAs (−2.94%, p = 0.0.81) and increased for CTAs (+3.15%, p = 0.004). The greatest increase in Medicare reimbursement (+66.75%) came from CPT code 36224, “place catheter carotid artery”, and the greatest decrease in Medicare reimbursement (−8.66%) came from CPT code 36226, “place catheter vertebral artery.”This study provides an analysis of Medicare reimbursement trends for routine cerebrovascular angiogram techniques. The findings highlight a decline in Medicare reimbursements for neurointerventionalists. [ABSTRACT FROM AUTHOR]

Endovascular neurointervention nowadays plays an important role in the effective treatment of different head and neck vascular pathologies using minimally invasive means. In Iraq, until recently, endovascular neurointervention field is nearly absent. A new hope was started when an advanced neurointerventional center was created to improve and develop this field in Iraq. [ABSTRACT FROM AUTHOR]

• Air kerma at the reference point (K a,r) on a new generation of angiography system was 48% of an older reference system. • Air kerma-area product (KAP) on the new system was 50% of the older system. • Substantial decrease in radiation exposure to the patients may also translate to the staff. Fluoroscopically-guided neurointervention may be associated with prolonged procedure time and substantial radiation exposure to the patient and staff. This study sought to examine technological features affecting the potential radiation exposure reduction of new angiography systems, compared to older systems, for neurointerventional procedures. Consecutive neurointerventional patients (2020–2022) were retrospectively analyzed. The air kerma at the reference point (K a,r) and kerma-area product (KAP) were compared between Artis icono and Artis zee (Siemens) using statistical analyses (two-tailed t tests), where P < 0.05 is considered significant. X-ray tube potential and copper filtration were examined. Tests with an anthropomorphic phantom (Sun Nuclear) on Artis icono were conducted and entrance skin exposure and x-ray spectral half value layer were measured. Effective spectral filtration was characterized by x-ray spectral modeling. The number of procedures was 1158 [median (range) age, 59 (7–95) years] on Artis zee and 1087 [60 (1–95) years] on Artis icono, without significant difference in age (p = 0.059) between cohorts. K a,r was 925.4 (890.6–960.1) mGy [mean (95 % CI)] and KAP was 119.8 (115–124.5) Gy∙cm2 on Artis zee. The measures were 48–50 % lower on Artis icono, 440.5 (411.7–469.4) mGy (K a,r) and 59.5 (55.4–63.6) Gy∙cm2 (KAP); while the difference in fluoroscopic time between the two generations of angiography systems was insignificant (p = 0.55). The newer angiography system, with updated hardware and software, was found to result in half the radiation exposure compared to older technology of the same manufacturer, even though fluoroscopic time was similar. [ABSTRACT FROM AUTHOR]

Background: Carotid artery stenting (CAS) is a minimally invasive and proven percutaneous procedure that is widely used to treat patients with symptomatic and asymptomatic carotid artery stenosis. The purpose of this study was to characterize the in-hospital outcomes of symptomatic and asymptomatic patients undergoing CAS at a single neurovascular center. Methods: The study was conducted as a retrospective analysis of 1158 patients (asymptomatic, n = 636; symptomatic, n = 522; male, n = 816; median age, 71 years; NASCET method, 70–99% stenosis, n = 830) who underwent CAS between May 2009 and December 2020. In-hospital neurological outcomes, adverse reactions to iodinated contrast media, acute myocardial infarction, intraprocedural complications, and access-site issues were evaluated. The primary endpoints were disabling stroke (including disabling cerebral hyperperfusion syndrome [CHS]) and all in-hospital deaths. Results: A carotid stent could not be deployed in one patient due to calcified plaques (technical failure rate of 0.09%). Four patients (0.3%) experienced in-hospital, stroke-associated death, while five patients (0.4%) died from non-stroke-related causes. All stroke-associated deaths occurred in the symptomatic group and were due to CHS. The disabling stroke rate was 0.9% overall (n = 10; 0.5% versus 1.3% in asymptomatic versus symptomatic patients, respectively). Nineteen patients (1.6%) reached the in-hospital primary endpoint. More patients in the symptomatic group achieved this endpoint than in the asymptomatic group (2.5% versus 0.9%, respectively; p = 0.060). Conclusions: An evaluation was conducted on the in-hospital outcomes of 1158 patients at a single center who underwent CAS and was performed by trained physicians who were supervised by a senior neurovascular interventionist with over 20 years of experience, confirming the excellent safety profile of this procedure with a low rate of complications.

Background: The classic triad of fat embolism syndrome consists of pulmonary distress, mental status change, and petechial rash. Typically, symptoms manifest 24-48 hours after a long bone fracture, but case reports have demonstrated fat embolism syndrome without long bone fracture. These cases are initiated by a stress response, mobilizing free fatty acids into the circulation. Case Description: Herein, we present the case of a 70-year-old male who presented with the left-sided hemiparesis and was subsequently found to have tandem lesions of the right internal carotid artery (ICA) and right middle cerebral artery (MCA) warranting emergent mechanical thrombectomy (MT). The ensuing pathology report determined the source of ischemic stroke to be caused by fat embolism, a rare and intriguing case of cryptogenic large vessel occlusion (LVO) with unique features distinguishing it from other reports in the literature. Conclusion: According to the biochemical theory, a catecholamine surge can precipitate fat globules forming in the circulatory system, leading to tissue hypoxia, injury, and ischemia. While the majority of cerebral fat emboli cause reversible ischemia of small diameter vessels, our case presents with LVO and tandem lesions in both the ICA and MCA resulting in infarct and residual hemiparesis. [ABSTRACT FROM AUTHOR]

This ESC Council on Stroke/EAPCI/EBNI position paper summarizes recommendations for training of cardiologists in endovascular treatment of acute ischaemic stroke. Interventional cardiologists adequately trained to perform endovascular stroke interventions could complement stroke teams to provide the 24/7 on call duty and thus to increase timely access of stroke patients to endovascular treatment. The training requirements for interventional cardiologists to perform endovascular therapy are described in details and should be based on two main principles: (i) patient safety cannot be compromised, (ii) proper training of interventional cardiologists should be under supervision of and guaranteed by a qualified neurointerventionist and within the setting of a stroke team. Interdisciplinary cooperation based on common standards and professional consensus is the key to the quality improvement in stroke treatment. [ABSTRACT FROM AUTHOR]

Background: Neurointervention via Transradial Access (TRA) is becoming increasingly popular as experience with this technique increases. However, approximately 8.6-10.3% of complex TRA cases are converted to femoral access due to a lack of support or radial artery spasm. This study aimed to assess the efficacy and safety of the TRUST (trans-radial coaxial catheter technique using a short sheath, Simmons catheter, and Tethys intermediate catheter) technique in interventional procedures via TRA., Methods: This was a single-center retrospective analysis of 16 patients admitted to our institute between January 2023 to May 2023 to undergo endovascular interventions with the TRUST technique via the TRA., Results: The mean age of the study population was 63.8 years, and 62.5% were male (10/16). The most common procedure was intracranial atherosclerotic stenosis (93.75%, 15/16). All procedures were performed successfully, and the most common procedures in our cohort were ballooning (50.0%, 8/16), stenting (18.75%, 3/16), and both procedures combined (31.25%, 1/16). All procedures were performed using the TRA, and the distal and proximal radial arteries were used for access in 31.35% (5/16) and 68.75% (11/16) of the cases, respectively. Technical success was achieved in all patients and most cases demonstrated mTICI ≥2b recanalization (93.75%, 15/16). In this case, no major access-site complications occurred., Conclusion: The TRUST technique is technically safe and feasible and had a high technical success rate and low complication rate in our study. These results demonstrate that the TRUST technique is a promising alternative for patients undergoing complex neurointerventions., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Vertebral artery stump syndrome is a rare disease associated with a posterior circulation stroke after vertebral artery origin occlusion. However, few reports have addressed its management. We herein present a case involving a patient with vertebral artery stump syndrome who underwent successful intravascular intervention. We also present a literature review of previous cases of this rare disease. The present case involved a 91-year-old man with acute onset of vertigo and disturbance of consciousness. Diffusion-weighted imaging showed an acute ischaemic stroke in the bilateral cerebellar hemispheres. Magnetic resonance angiography revealed left vertebral artery origin occlusion. Angiography detected a nearly occluded left vertebral artery site, with distal antegrade collateral flow via the deep cervical artery at the C6 level. We observed intravascular stasis at the proximal end of the left vertebral artery via the collateral flow. We performed percutaneous transluminal angioplasty towards the occluded left vertebral artery site. The flow from the left vertebral artery was significantly improved. This is the first report of percutaneous transluminal angioplasty performed for vertebral artery stump syndrome. Although vertebral artery stump syndrome has a high risk of recurrence and a poor prognosis, endovascular intervention showed a better outcome than pharmacotherapy in our patient. However, such cases are rare and further investigations are needed. [ABSTRACT FROM AUTHOR]

In cardiac intervention, the transradial approach (TRA) is increasingly used as the first-line approach owing to numerous advantages over the transfemoral approach. Neurointerventional TRA, especially in intracranial interventions, is predominantly restricted to an alternative approach, as transradial carotid cannulation using a conventional transfemoral system can be technically challenging for patients with unfavorable acute takeoff of the target common carotid artery. This study evaluated the feasibility and safety of first-line TRA with a radial-specific neurointerventional guiding sheath for a large series of consecutive intracranial anterior circulation aneurysm embolizations. We retrospectively analyzed our institutional database of first-line TRA for consecutive coil embolizations of anterior circulation aneurysms conducted between June 2018 and March 2020. A radial-specific 6-F Simmons guiding sheath (0.088-inch inner diameter) was engaged into the target common carotid artery, and subsequently a triaxial or quadraxial system was created for the embolization procedure. We assessed procedural success and procedure-related or vascular access site complications. A total of 119 patients with intracranial anterior circulation aneurysms underwent 121 coil embolization procedures. Of these, 101 patients who underwent 103 (85.1%) embolization procedures treated with first-line TRA were included. After the triaxial or quadraxial system was constructed, the embolization procedure was successful for all 103 cases without catheter kinking, system instability, or complications. A transradial 0.088-inch triaxial or quadraxial system provided sufficient stability and kink resistance for intracranial aneurysm embolization. This method is feasible, highly successful, and safe for intracranial anterior circulation aneurysm embolization. [ABSTRACT FROM AUTHOR]

Background: Preventing errors and complications in neurointervention is crucial, particularly in the treatment of unruptured intracranial aneurysms (UIAs), where the natural history is generally benign, and the margin of treatment benefit small. We aimed to investigate how neurointerventionalists perceive the importance and frequency of errors and the resulting complications in endovascular UIA treatment, and which steps could be taken to prevent them. Methods: An international multidisciplinary survey was conducted among neurointerventionalists. Participants provided their demographic characteristics and neurointerventional treatment volume. They were asked about their perceptions on the importance and frequency of different errors in endovascular UIA treatment, and which solutions they thought to be most effective in preventing these errors. Results: Two-hundred-thirty-three neurointerventionalists from 38 countries participated in the survey. Participants identified errors in technical execution as the most common source of complications in endovascular UIA treatment (40.4% thought these errors constituted a relatively or very large proportion of all complication sources), closely followed by errors in decision-making/indication (32.2%) and errors related to management of unexpected events (28.4%). Simulation training was thought to be most effective in reducing technical errors, while cognitive errors were believed to be best minimized by abandoning challenging procedures, more honest discussion of complications and better standardization of procedure steps. Conclusion: Neurointerventionalists perceived both technical and cognitive errors to be important sources of complications in endovascular UIA treatment. Simulation training, a cultural change, higher acceptance of bail-out strategies and better standardization of procedures were perceived to be most effective in preventing these. [ABSTRACT FROM AUTHOR]

A long-standing goal of translational neuroscience is the ability to noninvasively deliver therapeutic agents to specific brain regions with high spatiotemporal resolution. Focused ultrasound (FUS) is an emerging technology that can noninvasively deliver energy up the order of 1 kW/cm2 with millimeter and millisecond resolution to any point in the human brain with Food and Drug Administration-approved hardware. Although FUS is clinically utilized primarily for focal ablation in conditions such as essential tremor, recent breakthroughs have enabled the use of FUS for drug delivery at lower intensities (i.e., tens of watts per square centimeter) without ablation of the tissue. In this review, we present strategies for image-guided FUS-mediated pharmacologic neurointerventions. First, we discuss blood–brain barrier opening to deliver therapeutic agents of a variety of sizes to the central nervous system. We then describe the use of ultrasound-sensitive nanoparticles to noninvasively deliver small molecules to millimeter-sized structures including superficial cortical regions and deep gray matter regions within the brain without the need for blood–brain barrier opening. We also consider the safety and potential complications of these techniques, with attention to temporal acuity. Finally, we close with a discussion of different methods for mapping the ultrasound field within the brain and describe future avenues of research in ultrasound-targeted drug therapies.

Because neurointerventional surgery is a minimally invasive technique does not mean that it is qualified for complication-free procedures. Rather working about 2 m away from the three-dimensional (3D) target lesion and looking at two-dimensional (2D) images makes it one of the most complication-prone subspecialties. Advancement in hardwares, techniques, and technologies with continuous ability to learn and modify accordingly can only keep the complication rate low as compared with traditional vascular neurosurgery.

Abstract Background Revascularization with carotid stent (CAS) is considered the therapeutic alternative to endarterectomy (CEA). However, its role compared to CEA remains questioned, mainly due of the heterogeneity of long-term results. The objective of this study was to report the efficacy and durability of CAS in terms of stroke prevention in a “real world experience”. Method This was a single-center retrospective analysis of 344 patients treated with CAS between January 2001 and December 2015. The primary outcome of the trial was stroke, myocardial infarction, or death during a periprocedural period or any stroke event over a 15-year follow-up. The secondary aim was to identify risk factors for 30-day complications, long-term neurological complications, and intra-stent restenosis. Results The primary composite end point (any stroke, myocardial infarction, or death during the periprocedural period) was 2.3%. The use of an EPD was protective against major complications. Long-term follow-up was achieved in 294 patients (85,5%) with a median of 50 months (range 0-155 months). Fifty-six (16,3%) died within this period, most commonly of nonvascular causes (4 patients had stroke-related deaths). During the follow-up period, 8 strokes and 3 TIAs were diagnosed (3.2%). ISR determined by sequential ultrasound was assessed in 4.4% of the patients and remained asymptomatic in all but 2 patients (0.6%). All patients with restenosis underwent revascularization with balloon angioplasty. Conclusion The long-term follow-up results of our study validate CAS as a safe and durable procedure with which to prevent ipsilateral stroke, with an acceptable rate of restenosis, recurrence and mortality.

Abstract Background Intra-arterial thrombectomy is the gold standard treatment for large artery occlusive stroke. However, the evidence of its benefits is almost entirely based on trials delivered by experienced neurointerventionists working in established teams in neuroscience centres. Those responsible for the design and prospective reconfiguration of services need access to a comprehensive and complementary array of information on which to base their decisions. This will help to ensure the demonstrated effects from trials may be realised in practice and account for regional/local variations in resources and skill-sets. One approach to elucidate the implementation preferences and considerations of key experts is a Delphi survey. In order to support commissioning decisions, we aimed using an electronic Delphi survey to establish consensus on the options for future organisation of thrombectomy services among physicians with clinical experience in managing large artery occlusive stroke. Methods A Delphi survey was developed with 12 options for future organisation of thrombectomy services in England. A purposive sampling strategy established an expert panel of stroke physicians from the British Association of Stroke Physicians (BASP) Clinical Standards and/or Executive Membership that deliver 24/7 intravenous thrombolysis. Options with aggregate scores falling within the lowest quartile were removed from the subsequent Delphi round. Options reaching consensus following the two Delphi rounds were then ranked in a final exercise by both the wider BASP membership and the British Society of Neuroradiologists (BSNR). Results Eleven stroke physicians from BASP completed the initial two Delphi rounds. Three options achieved consensus, with subsequently wider BASP (97%, n = 43) and BSNR members (86%, n = 21) assigning the highest approval rankings in the final exercise for transferring large artery occlusive stroke patients to nearest neuroscience centre for thrombectomy based on local CT/CT Angiography. Conclusions The initial Delphi rounds ensured optimal reduction of options by an expert panel of stroke physicians, while subsequent ranking exercises allowed remaining options to be ranked by a wider group of experts within stroke to reach consensus. The preferred implementation option for thrombectomy is investigating suspected acute stroke patients by CT/CT Angiography and secondary transfer of large artery occlusive stroke patients to the nearest neuroscience (thrombectomy) centre.

Abstract Following the success of recent endovascular trials, endovascular therapy has emerged as an exciting addition to the arsenal of clinical management of patients with acute ischemic stroke (AIS). In this paper, we present an extensive overview of intravenous and endovascular reperfusion strategies, recent advances in AIS neurointervention, limitations of various treatment paradigms, and provide insights on imaging-guided reperfusion therapies. A roadmap for imaging guided reperfusion treatment workflow in AIS is also proposed. Both systemic thrombolysis and endovascular treatment have been incorporated into the standard of care in stroke therapy. Further research on advanced imaging-based approaches to select appropriate patients, may widen the time-window for patient selection and would contribute immensely to early thrombolytic strategies, better recanalization rates, and improved clinical outcomes.

Background: The transfemoral approach (TFA) has been the standard in neuroradiology over the years. However, the transradial approach (TRA) and its variants offer several benefits over the TFA. Methods: Review of the literature about TRA and its variations. We present our results for different neurointerventional procedures at our institution between January 2018 and December 2019. Results: We wrote an educational review describing anatomical and technical aspects, advantages, and complications of this approach. In the past year we increased the percentage of neurointerventional procedures performed through radial or ulnar arteries. Conclusion: There are clearly proven benefits of employing a wrist approach in patients for neurointerventional procedures and its utilization should especially be considered on a daily basis. [ABSTRACT FROM AUTHOR]

A long-standing goal of translational neuroscience is the ability to noninvasively deliver therapeutic agents to specific brain regions with high spatiotemporal resolution. Focused ultrasound (FUS) is an emerging technology that can noninvasively deliver energy up the order of 1 kW/cm2 with millimeter and millisecond resolution to any point in the human brain with Food and Drug Administration-approved hardware. Although FUS is clinically utilized primarily for focal ablation in conditions such as essential tremor, recent breakthroughs have enabled the use of FUS for drug delivery at lower intensities (i.e., tens of watts per square centimeter) without ablation of the tissue. In this review, we present strategies for image-guided FUS-mediated pharmacologic neurointerventions. First, we discuss blood–brain barrier opening to deliver therapeutic agents of a variety of sizes to the central nervous system. We then describe the use of ultrasound-sensitive nanoparticles to noninvasively deliver small molecules to millimeter-sized structures including superficial cortical regions and deep gray matter regions within the brain without the need for blood–brain barrier opening. We also consider the safety and potential complications of these techniques, with attention to temporal acuity. Finally, we close with a discussion of different methods for mapping the ultrasound field within the brain and describe future avenues of research in ultrasound-targeted drug therapies. [ABSTRACT FROM AUTHOR]

Surgical skills are generally acquired by watching the "hand movements" of experts. "Eye movements" are now attracting attention in skill-learning fields. Eye-tracking technology was introduced preliminarily to develop a better skill-learning system for neuroendovascular treatments. During a task to place a detachable coil into a silastic cerebral aneurysm model under biplane X-ray fluoroscopy, gaze points were recorded using a head-mount eye-tracking device. During the task, 91% of fixations were allocated to the monitor displaying fluoroscopic images, and the others to the hands of operators or unspecified visual targets. More than 80% of fixations were located in frontal or lateral fluoroscopic images. Fixations were placed more frequently around the aneurysm than the microcatheter. One operator failed to recognize the timing when the proximal marker of the coil overlapped that of the microcatheter. The subject allocated most fixations to the frontal fluoroscopic image, whereas other subjects placed most fixations to the lateral fluoroscopic image. Furthermore, that operator put no fixations to the proximal marker of the microcatheter. The results of this preliminary study imply the feasibility of the eye tracking-based learning system for neuroendovascular treatments. The eye-tracking analysis has potential in investigating or preventing procedural failures in neuroendovascular treatments. [ABSTRACT FROM AUTHOR]

In coronary intervention, the transradial approach (TRA) is increasingly used as the primary vascular access because of its numerous advantages over the transfemoral approach. However, in neurointerventions, conventional TRA with a straight-shaped guiding system is used as an alternative vascular access because transradial carotid cannulation can be technically challenging for right common carotid artery (CCA) lesions with steep angulation to the right subclavian artery or left CCA lesions with a nonbovine origin. The purpose of the present study was to evaluate the feasibility and safety of TRA as the primary vascular access with a pre-shaped Simmons guiding sheath for anterior circulation interventions. Between June 2018 and September 2019, 130 consecutive patients (75 carotid artery stenting and 55 cerebral aneurysm coiling cases) who underwent TRA as the primary vascular access were included in this study. A 6-Fr Simmons guiding sheath was introduced into the target CCA by selecting a cannulation technique based on preprocedural image assessment. We retrospectively analyzed the carotid cannulation success, procedural success, and periprocedural or vascular access site complications. Carotid cannulation (69 right CCA, 6 left CCA with a bovine origin, and 55 left CCA with a nonbovine origin) and the subsequent procedure were successfully performed for all 130 patients without periprocedural or vascular access site complications. TRA with a 6-Fr Simmons guiding sheath for anterior circulation interventions is highly successful and safe for all target CCAs and aortic arch types. This method can be utilized as the primary vascular access for anterior circulation interventions. [ABSTRACT FROM AUTHOR]

The management of acute neurological conditions, particularly acute ischemic stroke, in the context of Coronavirus disease 2019 (COVID-19), is of importance, considering the risk of infection to the healthcare workers and patients and emerging evidence of the neuroinvasive potential of the virus. There are variations in expert guidelines further complicating the picture for clinicians in acute settings. In this light, there is a compelling need for further formulation of recommendations that compile these variations seen in the numerous guidelines present. Health system protocols for managing ongoing acute neurological care and intervention need consideration of safety and well-being of the frontline healthcare workers and the patients. We examine existing pathways and their efficacy to mitigate viral exposure to the healthcare workers and patients and synthesize a systemic approach to manage patients with acute neurological conditions in the COVID-19 scenario. Early experiences with a COVID-19 positive stroke patient treated with endovascular thrombectomy is presented to highlight the urgent need for adequate personal protective equipment (PPE) during acute neuro-interventional procedures. [ABSTRACT FROM AUTHOR]

The current coronavirus disease (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 has led to immense strain on healthcare systems and workers. Patients with severe symptoms of COVID-19 may also present with acute neurological emergencies such as ischemic stroke. Ischemic stroke in these patients may result from COVID-19 related complications or decompensation of previously asymptomatic cerebrovascular disorders, or concurrent ischemic stroke from common stroke risk factors in a patient with COVID-19. Acute ischemic stroke patients with large vessel occlusions require emergent triage, intensive care, and mechanical thrombectomy. Management of patients with large vessel occlusions (LVO) requires special considerations in the current pandemic. Physicians must now account for prognosis of severe COVID-19, resource utilization, and risk of infection to healthcare workers when determining eligibility for mechanical thrombectomy (MT). Here, we describe important prognostic factors including age, laboratory, and imaging findings to consider for MT selection and provide suggestions for taking care of patients with LVO and possible or confirmed COVID-19. It is recommended to perform MT in patients within the established guidelines, and consider a conservative approach in cases where there is clinical equipoise to minimize futile reperfusion. Lastly, we describe an illustrative case of a patient with ischemic stroke and COVID-19. [ABSTRACT FROM AUTHOR]

• Using a large-bore sheath introducer may increase the post-puncture bleeding. • Most hemorrhagic complications were controlled by manual compression. • None of these complications led to a decreased of the modified Rankin Scale. Various adjunctive techniques for neurointerventional procedures require a large-bore sheath introducer, but there is concern that this could result in more puncture site hemorrhagic complications despite using a vascular closure device. The purpose of this study was to assess the relationship between use of large-bore sheath introducer and post-procedural complications. Between January 2016 and April 2018, 126 neurointerventional procedures were performed in our hospital using 8 or 9 Fr sheath introducer in size and the Angio-Seal STS PLUS (St. Jude Medical, Minnetonka, USA). Hemorrhagic complications were defined as obvious swelling or bleeding at the puncture site or as extravascular bleeding detected by ultrasonography or contrast-enhanced computed tomography. The procedures were divided into a group with post-puncture bleeding (group B, n = 21) and a group without bleeding (group N, n = 105). Risk factors were compared between the groups according to the incidence of post-puncture bleeding. In addition, we assessed the outcome and approach to hemostasis in the procedures with bleeding. In result, hemorrhagic complications occurred in 21 procedures (17%), and pseudoaneurysm was detected in 4 procedures (3.2%). In 20 of group B (16%), manual compression was performed for an average of 36.4 min. One patient (0.79%) required surgical angioplasty. Risk factors for bleeding were not significantly different between the two groups. None of the patients with bleeding showed a decrease on the modified Rankin Scale. In conclusion, use of a large-bore sheath introducer may increase the incidence of post-puncture bleeding, but the outcome of this complication is acceptable. [ABSTRACT FROM AUTHOR]

Several recent randomised control trials have shown adjunctive endovascular mechanical thrombectomy to be an effective and safe treatment for acute stroke superior to medical therapy alone. Despite this, questions remain over certain groups of patients that have been excluded from these studies, such as pregnant women. We believe this is a topic of increasing clinical significance with minimal data in the literature. In this article we discuss stroke in pregnancy and highlight the important technical considerations of endovascular mechanical thrombectomy, including minimising radiation exposure to the mother and fetus. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess the natural course of contrast-induced nephropathy (CIN) and to determine the predictive abilities of preprocedural high-sensitivity C-reactive protein (hs-CRP) and urine neutrophil gelatinase-associated lipocalin for CIN after neurointervention procedures. We prospectively enrolled 176 patients who underwent an elective neurointervention procedure (diagnostic angiography or endovascular surgery). CIN was defined as an increase in serum creatinine of more than 0.5 mg/dL or an increase of at least 25% from the baseline value within 48 hours of contrast media exposure. The predictive value of hs-CRP and serial urine NGAL (baseline, 6, 24, and 48 hours) for the risk of CIN was assessed using multivariate logistic regression. CIN occurred in 17 patients (9.46%). Multivariate analysis revealed that the CIN incidence was significantly associated with high baseline hs-CRP. All patients with CIN had creatinine return to baseline levels within 7 days. No patients required dialysis or suffered permanent sequelae as a result of a creatinine increase. During the 3-year follow-up period, no cerebro- or cardiovascular events occurred in the CIN group. However, 3 patients in the non-CIN group suffered a vascular event. One was a myocardial infarction, and 2 were ischemic strokes. The incidence of CIN after neurointervention procedures was relatively high (9.46%). The natural course of CIN was favorable, however, and did not affect cerebrovascular events. Additionally, patients with CIN typically recovered with supportive care within 7 days. Elevated preprocedural hs-CRP levels (>5 mg/dL) were a significant and independent predictor of CIN after neurointervention procedures. [ABSTRACT FROM AUTHOR]

Hemostasis valves are commonly used in neurointerventions. We propose a novel concept for fixing hemostasis valves to the operating table during procedures. Moreover, we report our preliminary in vitro experience using these new devices created using a 3-dimensional printer. The hemostasis valve holder (HVH) comprises 2 components: an inner fixer and an outer socket. It was designed to be suitable for use with all rotational hemostasis valves commercially available. HVH contains magnets at the bottom that facilitate its attachment to a thin steel board beneath a sterilized drape on the working table. We evaluated the HVH's efficacy via in vitro experiments involving stent placement by a single operator. HVH allowed easy attachment to and detachment from the rotational hemostasis valve. Moreover, the use of multiple HVHs facilitated operators to concentrate on the procedure because they continuously prevented the unexpected movement of devices at several points. Use of HVHs enables stent placement to be performed even by a single operator. We observed that forming a loop of the stent delivery catheter between 2 HVHs enhanced the device control. HVHs should be more useful than conventional methods, particularly in cases requiring fine complementary control of both a microcatheter and microguidewire. [ABSTRACT FROM AUTHOR]

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Distal transradial artery access (dTRA) has received increasing consideration for performing diagnostic cerebral angiography and neurointerventional procedures. In this meta-analysis, we aim to evaluate the safety and efficacy of dTRA compared to conventional transradial access (cTRA) for cerebral angiography and neurointerventions.A systematic review and meta-analysis were conducted on studies investigating outcomes of dTRA and cTRA in neurointerventions. The primary outcome was technical success rates. Secondary outcomes included access site complication rates, crossover rates to alternative vessels, fluoroscopy time, and contrast volume. The random effects model was used to calculate the mean difference (MD) and odds ratios (OR) with 95% confidence intervals (Cl).Eight retrospective observational studies with a total of 1477 patients who underwent 1175 diagnostic cerebral angiography and 516 neurointerventional procedures using 546 dTRA and 1164 cTRA approaches were included in our meta-analysis. The technical success rate was similar between dTRA and cTRA groups (95.8% vs 91.4%; OR:1.65; 95% Cl: 0.52 to 5.22; P = 0.40). Similarly, no difference was seen in dTRA and cTRA regarding access site complications (2% vs 1.4%; OR: 1.31; 95% CI: 0.47 to 3.61; P = 0.61) and access site crossover (2.1% vs 5.3%; OR: 0.55; 95% Cl: 0.28 to 1.05; P = 0.07). After resolving heterogeneity among included studies, dTRA was associated with a shorter fluoroscopy time (MD: −0.91 min; 95% CI: −1.74 to −0.09; P = 0.03) and lower contrast volume (MD: −8.32 mL; 95% CI = −14.7 to −1.94; P = 0.011).Our findings suggest that the dTRA approach is a safe and effective alternative to the cTRA approach in patients undergoing cerebral angiography and neurointerventions. [ABSTRACT FROM AUTHOR]

Larger microcatheters are being used with increasing frequency in routine neurovascular procedures. Navigating catheters safely and effectively to the target intracranial vessels can be a challenge when using conventional 0.014″ microwires. A new family of 0.024″ Aristotle 24 microwires (Scientia Vascular, West Valley City, UT) specifically designed for intracranial navigation were recently introduced. These microwires offer significant technical advantages over the standard 0.014″ microwires, including a reduced ledge gap, improved torquability and support, and overall safety. This video case series contains several illustrative cases to demonstrate the features of the novel Aristotle 24 microwire for use in endovascular neurointervention. [ABSTRACT FROM AUTHOR]

As Comprehensive Stroke Centers (CSCs) strive to improve neuro-intervention (NIR) times, process improvements are put in place to streamline workflows. Our prior publication (VISIION) demonstrated improvements in key performance indicators (KPIs). The purpose VISIION-S was to analyze whether those results were sustainable. Consecutive Direct Arriving LVO (DALVO) and telemedicine transfer LVO (BEMI) stroke NIR cases were assessed, including subgroups of DALVO-OnHours, DALVO-OffHours, BEMI-OnHours, and BEMI-OffHours. We analyzed times for the original 6 months pre (6/10/20-1/15/21) and compared them to a 17 month post-implementation period (1/16/21- 6/25/22) to evaluate for sustainability. Mann-Whitney U was utilized. 150 NIR cases were analyzed pre (n = 47) v. post (n = 103) implementation (DALVO-OnHours 7 v. 20, DALVO-OffHours 10 v. 25, BEMI-OnHours 13 v. 20, BEMI-OffHours 17 v. 38). For Door-to-groin (DTG), improvement was noted for DALVO-OffHours 39%(157 min,96 min;p < 0.001), DALVO-ALL 25%(127 min,95 min;p = 0.006), BEMI-OffHours 46%(45 min,25 min;p = 0.023), and BEMI-ALL 40%(42 min,25 min;p = 0.005). Activation-to-groin (ATG), door-to-device (DTD), and door-to-recanalization (DTR) also showed statistical improvements. For DALVO-OffHours, there were reductions in door to CT (DTC) 80%(26 min,5 min;p < 0.001), ATG 32%(90 min,61 min;p = 0.036), DTG 39%(157 min,96 min;p < 0.001), DTD 31%(178 min,123 min;p = 0.002), and DTR 32%(197 min,135 min;p = 0.003). We noted sustainability over a 17 month period with sustained reduction in KPIs for even more NIR time interval comparisons. In the greatest opportunity subgroup (DALVO-OffHours), we noted a reduction in all 5 time interval metrics. Our sustainability finding is important to show that process improvements continued even after the immediate period, adding credibility to the results. Models such as this could be useful for other centers striving to optimize workflow and improve times. [ABSTRACT FROM AUTHOR]

Background: In dural venous sinus thrombosis (DVST), the mortality ranges 5–30%. Deep venous system involvement and septic dural sinus thrombosis have a higher mortality rate. In acute occlusion, collateral flow may not be established, which may result in significant edema and mass effect. Endovascular interventions may be considered as a treatment option in appropriate high-risk patients with DVST. Materials and Methods: Eight patients with magnetic resonance imaging (MRI)-confirmed dural sinus thrombosis, who did not respond to the conventional standard medical treatment, were subsequently treated with mechanical thrombectomy using the Penumbra System®. In all cases, medical treatment including anticoagulants were continued following the procedure for a minimum period of 1 year. Results: Recanalization of the dural sinus thrombosis was achieved in all 8 cases. There were no immediate or late endovascular-related complications. One death occurred due to an unrelated medical event. At 6 months, there was notable improvement in the modified Rankin Score (mRS), with 5/8 (62%) patients achieving mRS of 2 or less. The follow-up ranged between 3 months and 26 months (mean: 14.5 months), and there were no new neurological events during the follow-up period. Conclusion: Cerebral venous sinus thrombosis is a rare but life-threatening condition that demands timely diagnosis and therapy. In cases of rapidly declining neurological status despite standard therapy with systemic anticoagulation and anti-edema measures, mechanical thrombectomy could be a lifesaving and effective option. In this study, good outcomes were observed in the majority of patients at long-term follow up.

Airway management of patients with craniofacial vascular malformations poses many challenges. Establishment of a secure airway is a prerequisite for safe anesthetic management of these patients. We report a case of a 45-year-old man presenting with a facial vascular malformation involving the tongue, parapharynx, and extending into the neck, resulting in airway compromise scheduled for endovascular embolization.

目的 分析首都医科大学附属北京天坛医院介入神经病学科进修人员的现状，为提高神经介入教学 水平提供参考依据。 方法 选择首都医科大学附属北京天坛医院2012-2017年在介入神经病学科进修学员，对相关介入 操作“零”基础的学员进行调查。调查内容包括学员的年龄、性别、职称、工作单位级别及学习后的 理论与实践考核成绩等。 结果 在112例介入操作“零”基础学员中，男性学员108例（96%），中高级专业职称101例（90%）；经 过6个月的学习，熟练或较为熟练地掌握相关理论知识92例（83%），熟练或较熟练掌握数字减影血 管造影（digital subraction angiography，DSA）81例（72%）。理论与实践均取得较好成绩的年龄集中在 26～35岁之间。 结论 神经介入技术与理论的最佳学习年龄在26～35岁之间。针对“零”基础的神经介入学员，应根 据学员前期的工作经验和教育基础因材施教，开展个性化教育。 Abstract: Objective To analyze the basic situation of continuing education trainees in department of neurointervention in Beijing Tiantan hospital affiliated to Capital Medical University, so as to provide the reference for improving the teaching standard of neurointervention. Methods All continuing education trainees in department of neurointervention in Beijing Tiantan hospital affiliated to Capital Medical University from 2012 to 2017 were included. Investigations were performed among trainees with zero basis knowledge of intervention related operation. The investigation contents included age, gender, job title, hospital level, and final theory and practice scores. Results Of 112 continuing education trainees of zero-basis, 108 ones (96%) were male students and 101 ones (90%) were senior professional titles. After 6 months of training, 92 trainees (83%) had good scores in theory test and 81 ones (72%) in practice test at digital subtraction angiography (DSA) technique. The age of the ones who had good results in both theory and practice test was between 26 and 35 years old. Conclusion The optimal learning age for neurointervention theory and technique is between 26 and 35 years old. For zero-basis neurointervention continuing education trainees, personalized education should be carried out according to individual previous work experience and their education basis.

Stroke in children is common and is associated with long-term morbidity. The incidence of stroke is 13/100,000 in children above 1 month, with higher incidences in neonates and premature infants. It has to be differentiated from other diseases which have a similar presentation. We present a case of a 3-year-old female child with embolic stroke of right middle cerebral artery managed with endovascular clot retrieval done under general anesthesia.

Objective: The Woven EndoBridge (WEB) device is an intrasaccular flow disruptor designed for wide-necked bifurcation aneurysms. These aneurysms may require the use of a concomitant stent. The objective of this study was to determine the clinical and radiological outcomes of patients undergoing stent-assisted WEB treatment. In addition, the authors also sought to determine the predictors of a concomitant stent in aneurysms treated with the WEB device., Methods: The data for this study were taken from the WorldWideWEB Consortium, an international multicenter cohort including patients treated with the WEB device. Aneurysms were classified into two groups based on treatment: stent-assisted WEB and WEB device alone. The authors compared clinical and radiological outcomes of both groups. Univariable and multivariable binary logistic regression analyses were performed to determine factors that predispose to stent use., Results: The study included 691 intracranial aneurysms (31 with stents and 660 without stents) treated with the WEB device. The adequate occlusion status did not differ between the two groups at the latest follow-up (83.3% vs 85.6%, p = 0.915). Patients who underwent stenting had more thromboembolic (32.3% vs 6.5%, p < 0.001) and procedural (16.1% vs 3.0%, p < 0.001) complications. Aneurysms treated with a concomitant stent had wider necks, greater heights, and lower dome-to-neck ratios. Increasing neck size was the only significant predictor for stent use., Conclusions: This study demonstrates that there is no difference in the degree of aneurysm occlusion between the two groups; however, complications were more frequent in the stent group. In addition, a wider aneurysm neck predisposes to stent assistance in WEB-treated aneurysms.

Background: Most of the neurointerventional procedures use various anticoagulants, antiplatelets, and fibrinolytic drugs, and it can predispose arterial access site complications. Safe and efficient closure arteriotomy site has extreme importance in reducing the morbidity. Percutaneous vascular closure devices (VCDs) enable us to close the arteriotomy sites. In this prospective study, we evaluated the factors affecting the safety and efficacy of Perclose ProGlide VCD in neurovascular interventions.Materials and Methods: In this prospective study, we have evaluated the safety and efficacy of 327 Perclose ProGlide devices deployed in 217 patients who underwent various neurointerventions in our institute from October 2014 to October 2016. Time to achieve hemostasis (TAH) was calculated for various groups and the statistical significance of mean values between groups was estimated.Results: Out of the 327 Perclose ProGlide deployed, complication rate was 0.91% and the mean TAH was 77.14 s. Assessment of TAH mean value showed statistically significant prolongation of TAH in obesity and those with larger arterial sheaths. Age, sex, post-heparin ACT, peri-procedure medications, and type of diseases had no significant role in increasing TAH. The evaluation also showed the presence of a learning curve in using this device.Conclusion: Perclose ProGlide VCD is safe and effective in closing the arteriotomy after neurointerventions. Obesity and larger arterial sheaths are independent factors prolonging the TAH. Learning curve associated with this device mildly increases the hemostatic time and device-related complications. [ABSTRACT FROM AUTHOR]

Concerns exist that neurosurgery might fail to lead the field of endovascular surgical neuroradiology (ESN), as other specialties are allowed to train and practice ESN. This study aimed to assess the current breakdown of specialties and their relative academic productivity in accredited ESN fellowship programs. A list of fellowship programs was obtained from the Accreditation Council for Graduate Medical Education and Committee on Advanced Subspecialty Training directories. Primary specialty (i.e., residency) training for each faculty member in these programs was determined using information provided by the programs. A bibliometric search was performed for each member using Web of Science (Clarivate Analytics, Philadelphia, Pennsylvania, USA). Cumulative and ESN-specific h indices were calculated; h indices were compared between each specialty group and between international medical graduates and US medical graduates, regardless of specialty training. Thirty-one ESN fellowship programs with 88 faculty members were included. Neurosurgeons constituted 61.4% (n = 54) of the total ESN faculty, followed by radiologists with 30.7% (n = 27), and neurologists with 7.9% (n = 7). The mean ESN-specific h index for neurosurgery-trained ESN faculty was 16.2 ± 14.6 compared with 14.4 ± 10.9 for radiologists and 13.0 ± 12.6 for neurologists (P = 0.76). There were 12 IMGs and 76 USMGs. The mean ESN-specific h index was greater for IMGs than USMGs, 24.7 ± 14.3 versus 14.0 ± 12.7 (P = 0.008), respectively. Neurosurgery is leading the ESN field in numbers; however, the h index is not significantly different among ESN faculty based on primary training. The number of IMGs is relatively small, yet IMGs have significantly higher mean h indices. [ABSTRACT FROM AUTHOR]