Neurología Vascular

Comparative safety, efficacy, and predictors of complete occlusion of flow diverter devices in the treatment of unruptured distal anterior cerebral artery aneurysms

Wed, 18 Feb 2026 00:00:00 GMT

Comparative safety, efficacy, and predictors of complete occlusion of flow diverter devices in the treatment of unruptured distal anterior cerebral artery aneurysms Salim, Hamza Adel; Scarcia, Luca; Clarençon, Frédéric; Hajjeh, Orabi; Daraghma, Motaz; Simonato, Davide; Li, Yan-Lin; Shotar, Eimad; Premat, Kevin; Jabbour, Pascal; Tjoumakaris, Stavropoula I.; Gooch, Reid; Psychogios, Marios; Ntoulias, Nikos; Sporns, Peter; Puri, Ajit S.; Singh, Jasmeet; Ferrario, Ángel; Pujol Lereis, Virginia Andrea; CRETA Investigators BACKGROUND: Flow diverters (FDs) are increasingly used for cerebral aneurysms, including distal anterior cerebral artery (DACA) aneurysms, but comparative data between devices in this challenging location are limited. OBJECTIVE: To compare the safety and efficacy of Pipeline, Silk Vista Baby (SVB), and FRED Jr. FDs for unruptured DACA aneurysms and identify predictors of complete occlusion. METHODS: We retrospectively analyzed 166 patients treated with FDs at 39 centers in 14 countries (2018–2022) from the CRETA registry. Outcomes included aneurysm occlusion (O’Kelly–Marotta [OKM] scale), complications, retreatment, modified Rankin Scale (mRS) scores, and independent predictors of complete occlusion using multivariable Cox regression. RESULTS: Aneurysms were predominantly saccular and located on the pericallosal artery. Complete occlusion (OKM D) was achieved in 73%, and neck remnants (OKM C) in 12%, with no differences across devices. Ischemic complications occurred in 11% (mostly asymptomatic), hemorrhagic complications in 5%, and in-stent stenosis in 17%. Retreatment was performed in 1.3%. At last follow-up, 98% had mRS ≤ 2. Independent predictors of complete occlusion were female sex (HR 1.85), asymptomatic presentation (HR 1.79), smaller aneurysm neck (HR 0.83/mm), radial access (HR 2.20), and aspirin plus ticagrelor therapy (HR 1.84); device type was not predictive. CONCLUSION: Pipeline, SVB, and FRED Jr. FDs show similar safety and efficacy for unruptured DACA aneurysms. Complete occlusion is influenced by clinical and procedural factors, supporting individualized device selection.

Differences in acute ischemic stroke treatment: A cross-sectional study from international Registry of Stroke Care Quality (RES-Q)

Wed, 23 Jul 2025 00:00:00 GMT

Differences in acute ischemic stroke treatment: A cross-sectional study from international Registry of Stroke Care Quality (RES-Q) Mikulik, Robert; Neto, Geraldo; Sedani, Rupal; Ameriso, Sebastian Francisco; Mammadova, Nargiz; Marchenko, Sergey; Martins, Sheila; Milanov, Ivan; Constanzo, Freddy; Muñoz, Mario; Budincevic, Hrvoje; Šrámek, Martin; Ramos, Cristina; Fouad Zakaria, Magd; Kõrv, Janika; Tsivgoulis, Georgios; Szapary, Laszlo; Pandian, Jeyaraj; Nulkhasanah, Adin; Batayha, Waleed Background: Stroke globally impacts mortality and disability. Compliance with international standards and evidence-based practices for acute stroke management would improve patient outcomes. Objectives: We aimed to present a descriptive analysis of the quality of acute stroke care across different countries using the Registry of Stroke Care Quality (RES-Q). Method: In a cross-sectional study, data from key quality indicators such as Emergency Medical Services (EMS) deployment rates, hospital arrival to imaging time (door-to-imaging: DIT), hospital arrival to thrombolysis time (door-to-needle: DNT), and Stroke Unit Care/Intensive Care Unit (SU/ICU) admission frequencies were examined. The analysis employed descriptive statistics and Spearman correlation tests. Results: Of 334,184 patients from 1130 hospitals in 70 countries, 218,832 patients (65.5%) from 47 countries were diagnosed with acute ischemic stroke after exclusions. The number of patients per country ranged from 226 to 62,080. International variability in care quality was observed: EMS (7-97%); SU/ICU (12-100%); and median DIT (7-41 min); and DNT (20-75 min). IVT rates varied markedly across countries, ranging from <1% to 52%. Higher patient volumes were positively correlated with SU/ICU admission and negatively with DIT and DNT (ρ = 0.10, -0.22, -0.42, respectively). Conclusion: This study demonstrates substantial international variation in the use of quality monitoring in clinical practice as well as in key indicators of acute ischemic stroke care, including intravenous thrombolysis rates and treatment timelines. The extent of variability highlights opportunities for benchmarking and targeted quality improvement efforts across diverse healthcare systems.

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.