Contrast-induced encephalopathy following endovascular treatment for intracranial aneurysms-risk factors analysis and clinical strategy.

PURPOSE: Contrast-induced encephalopathy (CIE) was defined as new onset of neurological deficits after exposure to contrast media, which could be observed after the endovascular treatment for intracranial aneurysms. METHODS: We enrolled a consecutive cohort of patients who underwent endovascular treatment for unruptured intracranial aneurysms. CIE was defined as a reversible neuropathic syndrome that occurred after interventional therapy, accompanied by imaging abnormalities and excluding other diseases. Multivariable Poisson regression analysis was performed to show risk factors by incidence rate ratio (IRR) and a clinical strategy was proposed. RESULTS: Among the 579 patients who underwent interventional therapy for intracranial aneurysms, the crude incidence rate of CIE was 2.4% (95% CI, 1.2-3.6%) at our center. Headache, hemiplegia, and disorientation could be initial symptoms, and cortical blindness was the most common localized deficit. Cerebral edema and sulci effacement on CT were observed, and re-revaluation after treatments on CT/MRI showed absent lesions. The risk factors were history of stroke (IRR, 7.752; P = 0.007), history of hypertension (IRR, 1.064; P = 0.042), posterior circulation aneurysms (IRR, 9.412; P = 0.004) and higher dosage of contrast agents (IRR, 1.018; P = 0.007). After the strategy of accelerating excretion of contrast agents, reduction of intracranial pressure and anti-inflammation/vasospasm therapy, the prognosis was favorable with most patients fully recovered within 72 h. CONCLUSION: History of stroke and posterior circulation aneurysms were main risk factors for CIE. A higher dosage of contrast agents might induce CIE, and the history of hypertension should be considered as well.

Transradial approach using a distal access catheter without guiding support for symptomatic intracranial vertebral artery and basilar artery stenosis: a multicenter experience and technical procedure.

BACKGROUND: There is little consensus on endovascular treatment for symptomatic intracranial posterior circulation stenosis via the transradial approach (TRA). We report our multicenter experience and technical procedures that directly used a distal access catheter (DAC) via TRA for the treatment of symptomatic intracranial vertebral (VA) and basilar (BA) artery stenosis. METHODS: From January 2019 to December 2020, 92 consecutive patients with severe symptomatic intracranial VA or BA stenosis were retrospectively collected and divided into two groups (TRA group and transfemoral approach (TFA) group) for neurointerventional treatment. The percentages of catheters reaching the V3/V4 segment of the VA and technical success, postoperative care conditions, preoperative outcomes and complications, long term clinical outcomes, and imaging follow-ups were observed. RESULTS: The catheter, CAT 5, reached the V4 segment of the VA in 37 TRA patients (88.1%). The duration of the procedure was significantly shorter in the TRA group than in the TFA group (median 48.0 min vs 55.5 min, p=0.037). More patients in the TRA group could walk within 2 hours after the procedure (85.7% vs 10.0%, p=0.000), and the duration of retaining catheterization in the TRA group was shorter (3.0±1.2 hours vs 11.7±5.6 hours, p=0.000). CONCLUSION: This study demonstrates the potential feasibility and safety of using a DAC via the TRA without guiding support for the treatment of symptomatic intracranial VA and BA stenosis. The TRA demonstrated some advantages over the standard TFA in terms of patient comfort. Further randomized controlled trials comparing the TRA and TFA for posterior circulation stenosis are needed.

Staged angioplasty versus regular carotid artery stenting in patients with carotid artery stenosis at high risk of hyperperfusion: a randomised clinical trial.

BACKGROUND AND PURPOSE: Hyperperfusion (HP) is a devastating complication associated with carotid artery stenting (CAS) or endarterectomy. The efficacy and safety of staged angioplasty (SAP) in patients with CAS at high risk of HP remains unclear. We sought to determine whether SAP is superior to regular CAS in patients with high risk of HP. METHODS: A randomised, multicentre open-label clinical trial with blinded outcome assessment (STEP) was conducted. Patients with severe carotid stenosis at high risk of HP were randomly assigned (1:1) to the SAP or regular CAS group. The primary endpoint was hyperperfusion syndrome (HPS) and intracerebral haemorrhage (ICH) within 30 days after the procedure. RESULTS: From November 2014 to January 2017, a total of 64 patients were enrolled in 11 centres. 33 patients were allocated to the SAP group and 31 to the regular CAS group. At 30 days, the rate of primary endpoint was 0.0% (0/33) in the SAP group and 9.7% (3/31) in the regular CAS group (absolute risk reduction (ARR), 9.7%; 95% CI -20.1% to 0.7%; p=0.11). As one of the secondary endpoints, the incidence of HP phenomenon (HPP) was lower in the SAP group than the regular CAS group (0.0% vs 22.6%, ARR,-22.6%; 95% CI -36.8% to -10.2%; p=0.04). CONCLUSION: The rate of HPS and ICH was not significantly lower in SAP group; the extended secondary endpoint of HPP, however, significantly reduced, which suggested that SAP may be a safe and effective carotid revascularisation procedure to prevent HP. TRIAL REGISTRATION NUMBER: NCT02224209.