Middle meningeal artery embolization with SwiftPAC coils for the treatment of chronic subdural hematomas

SwiftPAC线圈脑膜中动脉栓塞治疗慢性硬膜下血肿

Middle meningeal artery embolization (MMAE) has been shown to lower recurrence and reoperation rates of chronic subdural hematomas (cSDHs). The purpose of this study is to demonstrate the initial use, safety, and effectiveness of SwiftPAC (Penumbra Inc., Alameda, CA, USA) coils for MMAE. MMAE with SwiftPAC coils can be performed with a high safety profile and good radiographic and clinical outcomes. Given the small size and no comparison cohort, further research is warranted.

脑膜中动脉栓塞 (MMAE) 已被证明可降低慢性硬膜下血肿 (cSDHs) 的复发率和再手术率。这项研究的目的是证明SwiftPAC (Penumbra Inc.，Alameda，CA，USA) 线圈用于MMAE的初始使用，安全性和有效性。带有SwiftPAC线圈的MMAE可以以高安全性和良好的放射照相和临床结果进行。鉴于规模小，没有比较队列，进一步的研究是必要的。

REF: Webb M, Luo A, Naratadam GT, et al. Middle meningeal artery embolization with SwiftPAC coils for the treatment of chronic subdural hematomas. Interv Neuroradiol. Published online August 28, 2025. doi:10.1177/15910199251370824 PMID: 40874651 PMCID: PMC12394208

Investigation of thrombectomy technique for M2 occlusion based on the M1–M2 bifurcation angle

基于M1-M2分叉角的M2闭塞取栓技术研究

The efficacy of mechanical thrombectomy (MT) for M2 occlusion remains uncertain, partly due to recanalization challenges owing to anatomical factors and hemorrhagic complications. This study investigated the best method for M2 occlusion based on the M1-M2 bifurcation angle. Procedure results varied according to the M1-M2 bifurcation angle. For treating M2 occlusion, the bifurcation angle should be considered in the choice of technique.

机械取栓 (MT) 治疗M2闭塞的疗效仍不确定，部分原因是由于解剖因素和出血性并发症引起的再通挑战。本研究探讨了基于M1-M2分叉角的M2遮挡的最佳方法。手术结果根据M1-M2的分叉角度而变化。对于治疗M2闭塞，在选择技术时应考虑分叉角度。

REF: Shimonaga K, Imamura H, Ochiai J, et al. Investigation of thrombectomy technique for M2 occlusion based on the M1-M2 bifurcation angle. Interv Neuroradiol. Published online August 28, 2025. doi:10.1177/15910199251367546 PMID: 40874649 PMCID: PMC12394206

The application of silent MRA in follow-up after intracranial aneurysm endovascular treatment

沉默MRA在颅内动脉瘤血管内治疗后随访中的应用

This is to assess the diagnostic value of silent MRA in the follow-up of intracranial aneurysms (IA) post-endovascular treatment. Silent MRA shows significant potential for postoperative follow-up in endovascular therapy of aneurysms, particularly in interventions of coiling embolization, stent-assisted coiling, and FD.

这是为了评估沉默MRA在颅内动脉瘤 (IA) 血管内治疗后随访中的诊断价值。沉默MRA显示了动脉瘤血管内治疗术后随访的巨大潜力，特别是在弹簧圈栓塞栓塞，支架辅助弹簧圈栓塞和FD的干预措施中。

REF: Yu Z, Geng J, Zhao Z, et al. The application of silent MRA in follow-up after intracranial aneurysm endovascular treatment. Interv Neuroradiol. Published online August 28, 2025. doi:10.1177/15910199251345641 PMID: 40874634 PMCID: PMC12394204

Salvage embolization for accidental arterial occlusion of a high-grade AVM resulted from excessive Onyx reflux

过度Onyx反流导致高级别AVM的意外动脉闭塞的挽救性栓塞

Pre-operative stage embolization is a valuable strategy for managing large arteriovenous malformations (AVMs). However, reflux of Onyx may be out of control and cause accidental embolization at the feeding artery's opening. We report a case of 27-year-old male suffering from right occipital AVM bleeding with left hemianopia. The AVM was mainly supplied by two right posterior cerebral artery (PCA) branches. According to Spetzler-Martin Grade V AVM with acute bleeding, stage embolization followed by surgical excision was performed. However, during the first-stage embolization, which was planned to control superior PCA branch only, excessive Onyx reflux was noted with occlusion of inferior PCA branch opening. Right internal carotid artery (ICA) angiography showed residual large nidus volume which was supplied by pial collateral vessel from anterior temporal artery to original inferior PCA branch territory. The residual large volume causes surgical difficulty, and the small size of pial collateral vessel is not suitable for microcatheterization. Second-stage embolization was still performed for attempting further decrease of nidus volume. According to the eccentric stacking nature of Onyx, we successfully navigate microcatheter through the Onyx cast in obstructed inferior PCA branch opening. Subsequently, pre-operative embolization can be finished as initial planning, followed by surgical excision without neurological deficits. In cases of accidental feeder embolization, our experience suggests that the pass of microcatheter through the previous Onyx cast can serve as a viable option to complete nidus embolization.

术前阶段栓塞是治疗大型动静脉畸形 (avm) 的有价值的策略。然而，Onyx的反流可能失控，并在供血动脉的开口处引起意外栓塞。我们报告了一例27岁的男性，患有右枕部AVM出血并伴有左偏盲。AVM主要由两个右后大脑动脉 (PCA) 分支提供。根据spetzler-martin V级AVM急性出血，进行分期栓塞，然后进行手术切除。然而，在计划仅控制上PCA分支的第一阶段栓塞期间，注意到过度的Onyx反流并阻塞下PCA分支开口。右颈内动脉 (ICA) 血管造影显示残留的大病灶体积，由颞前动脉至原始PCA下分支区域的软脑膜侧支血管供应。残留的大体积导致手术困难，并且侧支血管的小尺寸不适合进行微导管插入。仍进行第二阶段栓塞以试图进一步减少病灶体积。根据Onyx的偏心堆叠性质，我们成功地将微导管通过Onyx铸造在阻塞的PCA下分支开口中。随后，可以作为初始计划完成术前栓塞，然后进行手术切除而没有神经功能缺损。在意外的馈线栓塞的情况下，我们的经验表明，将微导管穿过先前的Onyx铸型可以作为完成病灶栓塞的可行选择。

REF: Chung MW, Chen CC, Yeap MC, Chen CT. Salvage embolization for accidental arterial occlusion of a high-grade AVM resulted from excessive Onyx reflux. Interv Neuroradiol. Published online August 28, 2025. doi:10.1177/15910199251341041 PMID: 40874631

Feasibility of the distal transradial approach with an 8-Fr balloon guide catheter for neurointerventional procedures

采用8-Fr球囊导引导管进行神经介入手术的经桡骨远端入路的可行性

The distal transradial approach (dTRA) may reduce puncture-site complication rates compared with the conventional transradial approach (cTRA). However, the treatment outcomes of dTRA performed with large-bore catheters and the factors associated with procedural success remain unclear. We report the treatment outcomes of neurointerventional therapy performed via dTRA with a sheathless 8-Fr balloon guide catheter (BGC) and identify factors associated with procedural failure. The dTRA for neurointerventional procedures with a sheathless 8-Fr BGC demonstrates an acceptable success rate and safety profile. However, challenges remain with these procedures in older patients and cases with mechanical thrombectomy or local anesthesia with light sedation.

与传统的经radial入路 (cTRA) 相比，经radial骨远端入路 (dTRA) 可以降低穿刺部位的并发症发生率。然而，使用大口径导管进行dTRA的治疗结果以及与手术成功相关的因素仍不清楚。我们报告了使用无鞘8-Fr球囊导引导管 (BGC) 通过dTRA进行神经介入治疗的治疗结果，并确定了与手术失败相关的因素。使用无鞘8-Fr BGC进行神经介入手术的dTRA显示出可接受的成功率和安全性。然而，在老年患者和机械取栓或局部麻醉伴轻度镇静的病例中，这些手术仍然存在挑战。

REF: Osakabe M, Okawara M, Nomura T, et al. Feasibility of the distal transradial approach with an 8-Fr balloon guide catheter for neurointerventional procedures. Interv Neuroradiol. Published online August 26, 2025. doi:10.1177/15910199251371779 PMID: 40856705 PMCID: PMC12380734

Direct to hybrid CT-angiosuite (Nexaris) reduces treatment time for stroke thrombectomy (Direct-ST): A prospective simulation study

直接混合ct-angiosuite (Nexaris) 缩短卒中血栓切除术 (direct-st) 的治疗时间: 一项前瞻性模拟研究

Rapid thrombectomy initiation is critical for improving outcomes in acute ischemic stroke (AIS) due to large vessel occlusion (LVO). Direct transport to an angiography suite (DTAS), bypassing standard Emergency Department CT imaging, Direct to ED CT (DTCT), reduces door-to-puncture times. This study compares standard DTCT and expedited DTAS workflows using a hybrid multidetector CT (MDCT)-angiography suite. A direct-to-CT-Angio (DTAS) workflow using MDCT technology significantly reduces door-to-puncture times compared to standard DTCT, improving hospital workflow for LVO stroke patients. Further clinical studies are needed.

快速血栓切除术对于改善因大血管闭塞 (LVO) 引起的急性缺血性卒中 (AIS) 的预后至关重要。直接运输到血管造影套件 (DTAS)，绕过标准的急诊科CT成像，直接到ED CT (DTCT)，减少了门到穿刺的时间。本研究使用混合多探测器CT (MDCT)-血管造影套件比较了标准DTCT和加速DTAS工作流程。与标准DTCT相比，使用MDCT技术的直接到ct-angio (DTAS) 工作流程显着减少了门到穿刺的时间，从而改善了LVO卒中患者的医院工作流程。需要进一步的临床研究。

REF: Goldman D, Kolb H, Buttet K, et al. Direct to hybrid CT-angiosuite (Nexaris) reduces treatment time for stroke thrombectomy (Direct-ST): A prospective simulation study. Interv Neuroradiol. Published online August 26, 2025. doi:10.1177/15910199251369153 PMID: 40856694 PMCID: PMC12380727

A novel peel-away sheath technique for sheathless transradial use of 8 Fr balloon guide catheter

一种新颖的剥离鞘技术，用于8 Fr球囊导引导管的无鞘经桡骨使用

To evaluate a novel peel-away sheath technique for sheathless transradial delivery of an 8 Fr balloon guide catheter (BGC), using a 6 Fr peel-away sheath and a 6 Fr inner catheter, without requiring device exchange or dedicated inner dilators. This peel-away sheath technique provides a safe, efficient, and reproducible method for transradial 8 Fr BGC delivery using commonly available devices, potentially expanding the feasibility of transradial access in neuroendovascular practice.

评估一种新颖的剥离鞘管技术，用于8 Fr球囊导引导管 (BGC) 的无鞘管经桡动脉输送，使用6 Fr剥离鞘管和6 Fr内导管，无需更换装置或专用内扩张器。这种剥离鞘管技术提供了一种安全、高效且可重复的方法，用于使用常用装置经桡动脉输送8 Fr BGC，潜在地扩大了经桡入路在神经血管内实践中的可行性。

REF: Imahori T, Miyake S, Kaneshiro T, et al. A novel peel-away sheath technique for sheathless transradial use of 8 Fr balloon guide catheter. Interv Neuroradiol. Published online August 25, 2025. doi:10.1177/15910199251370813 PMID: 40853362 PMCID: PMC12378269

Rescue management of recurrent or growing non-acute subdural hematoma following standalone or adjunctive middle meningeal artery embolization: A case series and systematic review

独立或辅助脑膜中动脉栓塞后复发或生长的非急性硬膜下血肿的抢救管理: 病例系列和系统综述

Recurrent or growing non-acute subdural hematoma (SDH) following standalone or adjunctive middle meningeal artery embolization (MMAe) present a complex clinical challenge. This study aims to investigate the multifactorial causes of recurrence and growing SDH, including vascular and systemic contributors, and explores management strategies to improve outcomes. Recurrent or growing SDHs following MMAe are linked to subdural membrane vascularity and intracranial hypotension which must be investigated and addressed. Treatment of these issues results in high cure rates.

独立或辅助脑膜中动脉栓塞 (MMAe) 后复发或增长的非急性硬膜下血肿 (SDH) 提出了复杂的临床挑战。这项研究旨在调查复发和生长的SDH的多因素原因，包括血管和全身贡献者，并探索改善结果的管理策略。MMAe后复发或生长的sdh与硬膜下膜血管和颅内低血压有关，必须进行调查和解决。这些问题的治疗导致高治愈率。

REF: Orscelik A, Senol YC, Chaney E, et al. Rescue management of recurrent or growing non-acute subdural hematoma following standalone or adjunctive middle meningeal artery embolization: A case series and systematic review. Interv Neuroradiol. Published online August 25, 2025. doi:10.1177/15910199251370600 PMID: 40853366 PMCID: PMC12378119

Inter-rater reliability of atherosclerotic plaque enhancement on 7 T vessel wall MRI: Comparison with quantitative analysis

7 t血管壁MRI上动脉粥样硬化斑块增强的评分者间可靠性: 与定量分析的比较

Intracranial plaque enhancement (IPE) is a potential biomarker of plaque vulnerability but lacks a standardized definition. While subjective assessment may be prone to observer variability, a voxel-based quantification method can detect subtle signal intensity (SI) changes. This study aimed to compare the inter-rater reliability of subjective IPE evaluation with that of a voxel-based quantification method. Subjective assessment of IPE demonstrated poor inter-rater agreement and only moderate concordance with voxel-based quantification following consensus.

颅内斑块增强 (IPE) 是斑块易损性的潜在生物标志物，但缺乏标准化的定义。虽然主观评估可能倾向于观察者变化，但基于体素的量化方法可以检测细微的信号强度 (SI) 变化。本研究旨在比较主观IPE评估与基于体素的量化方法的评估者间可靠性。对IPE的主观评估表明，评估者之间的一致性较差，并且在达成共识后与基于体素的量化仅具有中等一致性。

REF: Dier C, Alhajahjeh S, Alqudah AA, et al. Inter-rater reliability of atherosclerotic plaque enhancement on 7 T vessel wall MRI: Comparison with quantitative analysis. Interv Neuroradiol. Published online August 24, 2025. doi:10.1177/15910199251368719 PMID: 40850749 PMCID: PMC12375601