Comparison of the safety and efficacy of Neuroform Atlas stent deployed via Gateway balloon catheter and microcatheter for the treatment of intracranial stenosis.

OBJECTIVE: This study aimed to compare the safety and efficacy of the Atlas stent released by the Gateway catheter and microcatheter in the treatment of intracranial stenosis (IS). METHODS: The primary efficacy and safety outcomes were the in-stent restenosis (ISR) rate and post-procedural stroke or death within one month. RESULTS: Atlas stents were deployed using the Gateway catheter and microcatheter in 19 (57.6 %) and 14 (42.4 %) procedures, respectively. Follow-up imaging data were available for 26 patients; the incidence of ISR was 15.4 %, and the ISR rate was higher, though not significantly, in the microcatheter group than in the Gateway group (30.0% vs. 6.25 %, P = .39). Clinical follow-up data were available for 30 patients; the post-procedural stroke rate was 3.3 % within one month and 13.3 % from one month to one year. The post-procedural stroke rate within one month was higher, though not significantly, in the microcatheter group than in the Gateway group (7.7% vs. 0 %, P = .43). The Gateway group had a significantly lower rate of post-procedural stroke in the same territory than that of the microcatheter group (0% vs. 30.8 %, P = .026). A higher incidence of residual stenosis <30 % was found in the non-ISR group than in the ISR group (72.2% vs. 0 %, P = .014). CONCLUSIONS: This study provides preliminary evidence that the Atlas stent is safe and effective for IS treatment. The use of the Gateway catheter to deliver the Atlas stent appears to be safer than using microcatheter. The incidence of ISR may be related to the degree of the residual stenosis.

Arm-only combined transarterial and transvenous access for neurointerventional procedures: a double-center retrospective study.

OBJECTIVE: This study aims to share our experience with the arm-only combined transarterial and transvenous access approach for neurointerventional procedures and evaluate its efficacy and safety. METHODS: The arm-only combined transarterial and transvenous access approach was performed using the right/bilateral proximal radial arteries and the right forearm superficial vein system, guided by ultrasonic guidance. Arterial access closure was achieved using a transradial band radial compression device, while manual compression was utilized for venous approach closure. RESULTS: Thirteen procedures were successfully performed using the arm-only combined transarterial and transvenous access approach, yielding favorable outcomes. The procedures included dural arteriovenous fistula embolization (seven cases), cerebral arteriovenous malformation embolization (four cases), venous sinus thrombosis catheter-directed thrombolysis and intravenous thrombectomy (one case), and cerebral venous sinus stenosis manometry (one case). All procedures were uneventful, allowing patients to ambulate on the same day. At discharge, all patients exhibited modified Rankin scores of 0-2, without any access site or perioperative complications. CONCLUSION: This double-center study preliminarily demonstrates the feasibility and safety of arm-only combined transarterial and transvenous access applied in neurointerventional procedures for complicated cerebrovascular diseases. The proximal radial artery and forearm superficial vein are recommended as the primary access sites. Unobstructed compression is strongly recommended for radial approach closure. ADVANCES IN KNOWLEDGE: This study aimed to add evidence and experience on the arm-only combined transarterial and transvenous access, as a new approach, for neurointerventional treatment that required arteriovenous approaches.

Systematic Review and Meta-Analysis of Transradial Access for Carotid Artery Stenting.

There is an increasing number of studies on the transradial approach (TRA) for carotid artery stenting. We aimed to summarize the published data on TRA vs the transfemoral approach (TFA). We searched Science Direct, Embase, PubMed, and Web of Science databases for the relevant literature. Primary outcomes included surgical success and cardiovascular and cerebrovascular complication rates; secondary outcomes included the rates of vascular access-related and other complications. We also compared the crossover rate, success rate, and complications between TRA and TFA carotid stenting. This is the first such meta-analysis regarding TRA and TFA. Twenty studies on TRA carotid stenting were included (n = 1300). Among 19 studies, the success rate of TRA carotid stenting was .951 (95% confidence interval [CI]: .926-.975); death rate was .022 (.011-.032); stroke rate was .005 (.001-.008); radial artery occlusion rate was .008 (.003-.013); and forearm hematoma rate was .003 (-.000 to .006). Among 4 studies comparing TRA and TFA, the success rate was lower (odds ratio: .02; 95% CI: .00-.23) and crossover rate was higher (odds ratio: 40.16; 95% CI: 4.41-365.73) with TRA. Thus, transradial neuro-interventional surgery has a lower success rate than TFA.

Pigtail catheter exchange technique for the Simmons catheter formation in transradial cerebral angiography.

BACKGROUND: The transradial approach (TRA) has become popular for diagnostic cerebral angiography. However, this approach is still used less often because of problematic formation of the Simmons catheter. The purpose of this study was to introduce a pigtail catheter exchange technique for Simmons catheter formation to improve the success rates with a shorter operation time and without increasing complications. METHODS: This retrospective study included consecutive patients eligible for right TRA cerebral angiography at our institution from 2021. To introduce the technique, the cerebral angiogram of formation of the Simmons catheter in the type II aortic arch was constructed. Patient demographic and angiographic data were collected. RESULTS: In total, 295 cerebral angiographies were evaluated. There were 155 (52.5 %), 83 (28.1 %), 39 (13.2 %), and 18 (6.1 %) patients with types I, II, and III aortic arches and bovine arch, respectively. The total fluoroscopy time, operation time and radiation exposure were 6.3 ± 4.4 min, 17.7 ± 8.3 min and 559.2 ± 197.3 mGy, respectively. The Simmons catheter was successfully formed in 294 of 295 patients, with a success rate of 99.6 %, confirming an effective technique for right TRA cerebral angiography. No severe complications were observed in any patient. CONCLUSIONS: Pigtail catheter exchange may be an effective and safe technique for right TRA cerebral angiography. The findings of this report prompted institutions to apply this technique clinically and can serve as a basis for future trials focused on TRA cerebral angiography.

The Role of PGK1 in Promoting Ischemia/Reperfusion Injury-Induced Microglial M1 Polarization and Inflammation by Regulating Glycolysis.

Stroke is a leading cause of death, with a continuously increasing incidence. As a metabolic process that catabolizes glucose pyruvate and provides adenosine triphosphate (ATP), glycolysis plays a crucial role in different diseases. Phosphoglycerate kinase 1 (PGK1) facilitates energy production with biosynthesis in many diseases, including stroke. However, the exact role of PGK1/glycolysis in stroke remains to be elucidated. A rat model of middle cerebral artery occlusion (MCAO) was used to mimic ischemia/reperfusion injuries. Oxygen glucose deprivation/re-oxygenation (OGD/R) was used to induce injury to highly aggressively proliferating immortalized (HAPI) rat microglial cells. The extracellular acidification rate (ECAR) was determined using an XFe24 Extracellular Flux Analyzer. ATP, lactate dehydrogenase, tumor necrosis factor-alpha, and interleukin-6 levels were measured using commercial kits. Chromatin immunoprecipitation assay was performed to examine the interaction between H3K27ac or p300 and the PGK1 promoter region. PGK1 was either knocked down or overexpressed by lentivirus. Thus, to examine its role in stroke, real-time polymerase chain reaction and immunoblotting were used to measure gene expression. The expression of PGK1 was increased and associated with M1 polarization and glycolysis in MCAO rat models. OGD/R promoted M1 polarization and HAPI microglial cell inflammation by regulating glycolysis. Silencing PGK1 reduced OGD/R-increased M1 polarization, inflammation, and glycolysis. Conversely, the overexpression of PGK1 promoted HAPI microglial cell inflammation by regulating glycolysis. The mechanism showed that histone acetyltransferase p300 promoted PGK1 expression through H3K27 acetylation. Finally, data indicated that silencing PGK1 inhibited microglia M1 polarization, inflammation, and glycolysis in MCAO rat models. PGK1 could promote ischemia/reperfusion injury-induced microglial M1 polarization and inflammation by regulating glycolysis, which might provide a novel direction in developing new therapeutic medications for preventing or treating stroke.