Neurología Vascular

Silk vista baby versus pipeline embolization device for unruptured distal anterior cerebral artery aneurysms : A multicenter propensity-weighted comparative study

Mon, 01 Jun 2026 00:00:00 GMT

Silk vista baby versus pipeline embolization device for unruptured distal anterior cerebral artery aneurysms : A multicenter propensity-weighted comparative study Da Ros, Valerio; Frédéric Clarençon; Dmytriw, Adam A.; Jabbour, Pascal; Psychogios, Marios; Sporns, Peter; Puri, Ajit S.; Hassan, Ameer E.; Algin, Oktay; Möhlenbruch, Markus A.; Bergui, Mauro; Goren, Oded; Boulouis, Gregoire; Morimoto, Takeshi; Pop, Raoul; Ho, Joanna Wk; Pujol Lereis, Virginia Andrea; Cooper, Jared; Salsano, Giancarlo; CRETA investigators Background: Flow diversion is effective for unruptured distal anterior cerebral artery (DACA) aneurysms, yet comparative data between the Silk Vista Baby (SVB) and Pipeline Embolization Device (PED) in this challenging territory remain scarce. Methods: We conducted a retrospective multicenter study using the CRETA Registry, including consecutive patients with unruptured DACA aneurysms treated with SVB or PED. The primary endpoint was complete angiographic occlusion (O'Kelly-Marotta grade D). Secondary outcomes included procedural characteristics, clinical outcome (modified Rankin Scale), and complications. Overlap weighting was applied to account for non-randomized treatment allocation. Predictors of occlusion were explored using penalized logistic regression. A sensitivity analysis using a reduced five-variable model was performed to assess model robustness. Results: 137 patients were included (79 SVB, 58 PED). Within the PED group, devices included Pipeline Flex (n = 34), Pipeline Flex with Shield Technology (n = 14), and Pipeline Vantage with Shield Technology (n = 10). After overlap weighting, baseline characteristics were balanced; the effective sample size was 100.4. SVB procedures more often used a single device; PED frequently required multiple stents. Procedure duration was shorter with SVB. Complete occlusion was achieved in 69.6% (SVB) and 70.7% (PED) of aneurysms, with no significant difference in adjusted analysis (OR 1.32, 95% CI 0.59-2.96). Favorable clinical outcomes were observed in both groups, with acceptable and comparable complication rates. No variable, including device type, independently predicted complete occlusion, a finding confirmed in a reduced five-variable sensitivity analysis (aOR 1.04, 95% CI 0.47-2.31; p = 0.915). Conclusions: SVB and PED demonstrated comparable angiographic efficacy and clinical safety for unruptured DACA aneurysms. Despite procedural differences, mid-term occlusion rates and outcomes were similar. Device selection in this distal territory may be guided primarily by anatomical considerations and operator preference rather than expectations of differential performance.

Genicular Artery Embolization for Persistent Pain after Total Knee Arthroplasty: Initial Clinical Experience

Sat, 29 Nov 2025 00:00:00 GMT

Genicular Artery Embolization for Persistent Pain after Total Knee Arthroplasty: Initial Clinical Experience Bertoni, Hernán Gabriel; Rene G., Viso; Martín, Rosado; Álvaro, Valtorta; Victoria, Bertoni; Juan F, Argüello; Federico, Manfrin; Matias, Villagra; Carlos, Autorino Purpose: To evaluate the clinical effectiveness and safety of genicular artery embolization (GAE) for managing chronic knee pain after total knee arthroplasty (TKA) in a retrospective multicenter study. Materials and methods: The authors retrospectively analyzed 18 GAE procedures performed in 16 patients with persistent post-TKA pain unresponsive to conservative treatment. All patients underwent conventional radiographic evaluation and clinical assessment using the visual analog scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) before and after embolization. Technical success, adverse events, and analgesic consumption were recorded. Clinical success was defined as a ≥50% reduction in VAS and/or WOMAC scores at 6 months. Results: The mean VAS score decreased from 7.0 (SD ± 1.4) to 3.4 (SD ± 2.1) (P < .001). Total WOMAC scores decreased from 45.7 (SD ± 11.6) to 24.1 (SD ± 13.4) (P < .001), with median subscale reductions in pain (9.4 to 4.5), function (33.3 to 17.2), and stiffness (2.7 to 1.4). At 6 months, 10 (62.5%) of 16 patients and 8 (50%) of 16 patients achieved ≥50% reduction in VAS and total WOMAC scores, respectively. Ten patients (62.5%) reported reduced analgesic use. No major complications were observed. Conclusions: GAE appears to be a safe and effective treatment for refractory post-TKA pain. In this initial experience, significant improvements in pain, function, and stiffness were observed, with outcomes consistent with those described in prior reports, supporting its potential role in selected patients.

Tratamiento del deterioro neurológico temprano en el ictus lacunar

Wed, 07 Jan 2026 00:00:00 GMT

Tratamiento del deterioro neurológico temprano en el ictus lacunar Alet, Matías Javier; Zavattieri, Agustina; Rodríguez Lucci, Federico; Ameriso, Sebastián Francisco Objetivo El deterioro neurológico temprano (DNT) en infartos lacunares constituye una complicación frecuente, especialmente durante los primeros días de hospitalización, y aún carece de un abordaje terapéutico estandarizado. El objetivo de este estudio fue describir su presentación clínica, factores predictores y estrategias terapéuticas implementadas, así como evaluar su impacto sobre la evolución funcional de los pacientes. Pacientes y métodos Se realizó un estudio observacional, retrospectivo y unicéntrico que incluyó a 269 pacientes con diagnóstico de infarto lacunar internados entre 2013 y 2023. El DNT fue definido como fluctuación o progresión clínica dentro de los primeros cinco días del evento. Se analizaron variables clínicas, imagenológicas, terapéuticas y funcionales, incluyendo datos de seguimiento a 90 días. Se efectuó un análisis multivariado para identificar factores asociados de forma independiente con la aparición de DNT. Resultados El DNT ocurrió en el 11,9% de los pacientes. Las lesiones localizadas en la cápsula interna, el núcleo lenticular y el síndrome lacunar sensitivo-motor fueron factores predictivos independientes. En la mayoría de los casos se utilizó doble antiagregación plaquetaria (aspirina y clopidogrel) y tratamiento hemodinámico dirigido, con buena respuesta clínica. Al seguimiento a 90 días, el 83,4% de los pacientes presentó buen resultado funcional (mRS ≤2), con baja recurrencia (1,9%) y baja mortalidad (0,4%). Conclusiones El DNT en ictus lacunar representa un fenómeno clínico relevante. Las estrategias terapéuticas observadas podrían ser útiles, pero se requieren de estudios prospectivos que evalúen nuevas técnicas diagnósticas como biomarcadores o perfusión cerebral y tratamientos individualizados para mejorar los resultados en esta población.

Medication adherence in vascular prevention : findings from the SIFHON-ADH survey in Argentina

Sat, 28 Feb 2026 00:00:00 GMT

Medication adherence in vascular prevention : findings from the SIFHON-ADH survey in Argentina Alet, Matías Javier; Ameriso, Sebastián Francisco; Rodriguez Pérez, María Soledad Resumen no disponible.