Complex intracranial aneurysms pose significant challenges in the realm of neurointervention, necessitating meticulous planning and execution. This article highlights the crucial roles played by anesthetists in these procedures, including patient assessment, anesthesia planning, and continuous monitoring and maintaining hemodynamic stability, which are pivotal in optimizing patient safety. Understanding these complex procedures and their complications will aid the anesthetist in delivering optimal care and in foreseeing and managing the potential associated complications. The anesthetist\'s responsibility extends beyond the procedure itself to postprocedure care, ensuring a smooth transition to the recovery phase. Successful periprocedural anesthetic management in flow diverter interventions for complex intracranial aneurysms hinges on carefully orchestrating these elements. Moreover, effective communication and collaboration with the interventional neuroradiologist and the procedural team are emphasized, as they contribute significantly to procedural success. This article underscores the essential requirement for a multidisciplinary team approach when managing patients undergoing neurointerventions. In this collaborative framework, the expertise of the anesthetist harmoniously complements the skills and knowledge of other team members, contributing to the overall success and safety of these procedures. By providing a high level of care throughout the periprocedural period, anesthetists play a pivotal role in enhancing patient outcomes and minimizing the risks associated with these intricate procedures. In conclusion, the periprocedural anesthetic management of neurointervention using flow diverters for complex intracranial aneurysms is a multifaceted process that requires expertise, communication, and collaboration.

Thromboembolism is a complication of neurointerventional procedures that requires patients to be placed under antiplatelet therapy. Current options for antiplatelet therapies have a delayed onset of action that prevents a rapid door to puncture transition for patents presenting in acute settings. Cangrelor (Kengreal, Chiesi, USA) is an intravenous P2Y12 platelet inhibitor approved in percutaneous coronary interventions that has an immediate onset of action and half-life between 2 and 6 min. Thus, the goal of this study is to report on the safety, effectiveness, and indications for using Cangrelor in neurointerventional procedures. A systematic review of studies describing the use of Cangrelor in neurointervention was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search was conducted on PubMed, Ovid Medline, and Embase databases through June 2023. Seventeen studies with 314 patients met inclusion criteria. The most common indication for Cangrelor use was acute ischemic strokes: 70% followed by aneurysms 27.4%. The Infusion protocol varied from 5 to 30 μg/kg bolus and 1 to 4 µg/kg/min infusion with 30 μg/kg bolus and 4 µg/kg/min infusion being reported in 64.7% of studies. Intra-operative platelet reacting unit levels were below 200 in all the studies that reported it, and the percentage of hemorrhagic, thromboembolic, and deaths occurrence in this patient cohort was respectively 11.1%, 4.8%, and 8.6%. Cangrelor appears to be a promising P2Y12 platelet inhibitor for neurointerventional procedures. However, large, randomized trials are needed to determine the full range of its effects in neurointerventional procedures.

BACKGROUND: Many studies have shown that coronary angiography (CAG) and percutaneous coronary intervention (PCI) via distal radial access (DRA) are safe and effective. Safety and efficacy of neuroangiography and neurointerventions via DRA are unknown.
OBJECTIVE: Search the literatures on neuroangiography and neurointerventions via DRA and conduct a systematic review and meta-analysis.
METHODS: PubMed, Embase and Cochrane were searched from inception to November 10, 2022. After literature screening, data extraction and assessment of literature quality, random effects model was used for meta-analysis.
RESULTS: A total of 236 literatures were retrieved, and 17 literatures including 1163 patients were finally included for meta-analysis.The pooled access success rate was 0.96 (95% confidence interval, 0.94-0.98), and the heterogeneity was obvious (I2 = 55.5%). The pooled access-related complications incidence rate was 0.03 (95% confidence interval, 0.02-0.05), and the heterogeneity was not obvious (I2 = 15.8%).
CONCLUSIONS: Neuroangiography and neurointerventions via DRA may be safe and effective. DRA is an alternative access for neuroangiography and neurointerventions.

BACKGROUND: Distal transradial artery access (dTRA) has received increasing consideration for performing diagnostic cerebral angiography and neurointerventional procedures. In this meta-analysis, we aim to evaluate the safety and efficacy of dTRA compared to conventional transradial access (cTRA) for cerebral angiography and neurointerventions.
METHODS: A systematic review and meta-analysis were conducted on studies investigating outcomes of dTRA and cTRA in neurointerventions. The primary outcome was technical success rates. Secondary outcomes included access site complication rates, crossover rates to alternative vessels, fluoroscopy time, and contrast volume. The random effects model was used to calculate the mean difference (MD) and odds ratios (OR) with 95% confidence intervals (Cl).
RESULTS: Eight retrospective observational studies with a total of 1477 patients who underwent 1175 diagnostic cerebral angiography and 516 neurointerventional procedures using 546 dTRA and 1164 cTRA approaches were included in our meta-analysis. The technical success rate was similar between dTRA and cTRA groups (95.8% vs 91.4%; OR:1.65; 95% Cl: 0.52 to 5.22; P = 0.40). Similarly, no difference was seen in dTRA and cTRA regarding access site complications (2% vs 1.4%; OR: 1.31; 95% CI: 0.47 to 3.61; P = 0.61) and access site crossover (2.1% vs 5.3%; OR: 0.55; 95% Cl: 0.28 to 1.05; P = 0.07). After resolving heterogeneity among included studies, dTRA was associated with a shorter fluoroscopy time (MD: -0.91 min; 95% CI: -1.74 to -0.09; P = 0.03) and lower contrast volume (MD: -8.32 mL; 95% CI = -14.7 to -1.94; P = 0.011).
CONCLUSIONS: Our findings suggest that the dTRA approach is a safe and effective alternative to the cTRA approach in patients undergoing cerebral angiography and neurointerventions.

Psychoceuticals have brought benefits to the pharmacotherapeutic management of central nervous system (CNS) illnesses since the 19th century. However, these drugs have potential side effects or lack high response rates. This review covers twenty drugs\' biochemical mechanisms, benefits, risks, and clinical trial reports. For this study, medications from seven psychoceutical organizations were reviewed and evaluated. Nineteen drugs were chosen from the organizations, and one was selected from the literature. The databases used for the search were Pubmed, Google Scholar, and NIH clinical trials. In addition, information from the organizations\' websites and other sources, such as news reports, were also used. From the list of drugs, the most common targets were serotonergic, opioid, and N-methyl-D-aspartate (NMDA) receptors. These drugs have shown promise in psychiatric illnesses such as substance abuse, post-traumatic stress disorder (PTSD), anxiety, depression, and neurological conditions, such as Parkinson\'s disease, traumatic brain injury, and neuroinflammation. Some of these drugs, however, are still early in development, so their therapeutic significance cannot be determined. These twenty drugs have promising benefits, but their clinical usage and efficacy must still be explored.

Stents are being widely used in the neuroendovascular field more often for assisted coiling of aneurysms and treatment of atherosclerotic stenosis. Stent detachment and embolization are one of the most feared complications associated with poor clinical outcomes. Many techniques have been detailed in the literature for extracting such dislodged stents. We describe a case of retrieval of an inadvertently detached balloon-mounted stent from the intracranial left vertebral artery. This occurred in a 58-year-old male patient with a history of diabetes mellitus whose stenting procedure was planned for severe intracranial atherosclerotic disease of bilateral vertebral arteries causing recurrent posterior circulation ischemic events. Stentectomy was performed successfully using a stent retriever. Intracranial vertebral artery stenting was eventually accomplished with excellent clinical outcomes.

UNASSIGNED: Transradial access (TRA) for diagnostic and interventional neurointerventional procedures has recently gained traction over transfemoral access (TFA) in the neurointerventional community. This meta-analysis aims to assess and summarize the utility of TRA in cerebral angiography and neurointerventional procedures.
UNASSIGNED: A systematic literature review was performed utilizing Pubmed, Embase, and Scopus databases. Using PRISMA guidelines, records were extracted with the following search terms: transradial approach, transradial access, radial access, cerebral angiogram, cerebral angiography, neurointervention, and neuroendovascular. The primary outcomes assessed were case success rate, complication rate, and crossover rate from TRA to TFA. Secondary analysis was performed on procedure time, fluoroscopy time, fluoroscopy time per vessel (diagnostic procedures only), contrast dose, radial artery diameter, distal radial artery diameter, and patient preference for TRA over TFA.
UNASSIGNED: Sixty-two full-text articles were analyzed for this meta-analysis, representing 12,927 diagnostic and interventional TRA access patients. Our analysis revealed a combined diagnostic and interventional case success rate of 95.9% and complication rate of 3.5%, with crossover to TFA occurring in 4.9% of cases.
UNASSIGNED: This meta-analysis demonstrates that TRA access for diagnostic angiography and neurointerventional procedures is a safe and effective approach, though determining a true complication rate is challenging as the definition of TRA complications has changed in various publications over time.

Introduction: In this review, we will summarize the impact of the COVID-19 pandemic on neurointerventional care for patients with cerebrovascular disease, with a particular emphasis on epidemiology, neurointerventional processes, and lessons learned from paradigm shifts in endovascular care.Areas covered: Peer-reviewed research is summarized regarding the complications of COVID-19 as related to the pandemic\'s impact on hospital admissions, imaging capabilities, treatment times, and outcomes of neurointerventional cases.Expert opinion: In the first wave of the COVID-19 pandemic, there was a global decline in neuroimaging, use of intravenous thrombolysis, thrombectomy, and coil embolization for ruptured intracranial aneurysms. An early recommendation to utilize general anesthesia and intubate all patients undergoing intervention to avoid an emergent aerosolizing procedure was found to have worse outcomes. The decline in new stroke and subarachnoid hemorrhage diagnoses may be related to patient and/or family fear of seeking acute medical care. A true shift in stroke epidemiology is also possible. As several vaccines become more readily available and the world rebounds from this pandemic, we hope to transform the neurointerventional experiences discussed in this paper into strategies that may improve care delivery of neurologically ill patients during a global crisis.

Transradial access is an increasingly popular route for cerebral angiography and neurointerventions. However, obstacles to wider adoption remain, especially for complex interventions typically performed with larger, multiaxial systems such as flow diversion. We sought to analyze the published evidence for transradial flow diversion of intracranial aneurysms.
Using Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, a literature review was performed to identify all published reports and studies of transradial flow diversion for intracranial aneurysm. The search was limited from April 2011 to February 2021. Primary outcome was successful completion of the procedure via a transradial approach. Heterogeneity was analyzed with Q and I2 statistics. Secondary outcomes were transradial access-site complications and other complications.
In total, 11 studies involving 290 treated aneurysms were identified; 90.7% of the procedures were completed via the transradial approach. The heterogeneity between studies was high, with an I2 of 56.9%. There were no transradial access-site complications. The procedural complication rate was 2.41%.
Transradial access has a high success rate for both anterior and posterior circulation flow-diversion embolizations. The success rate may be particularly high for posterior circulation and right anterior circulation aneurysms. It has a negligible access-site complication rate. Transradial access is a viable alternative to transfemoral access for flow diversion and should be considered as a first-line approach.

UNASSIGNED: The transfemoral approach (TFA) has been the standard in neuroradiology over the years. However, the transradial approach (TRA) and its variants offer several benefits over the TFA.
UNASSIGNED: Review of the literature about TRA and its variations. We present our results for different neurointerventional procedures at our institution between January 2018 and December 2019.
UNASSIGNED: We wrote an educational review describing anatomical and technical aspects, advantages, and complications of this approach. In the past year we increased the percentage of neurointerventional procedures performed through radial or ulnar arteries.
UNASSIGNED: There are clearly proven benefits of employing a wrist approach in patients for neurointerventional procedures and its utilization should especially be considered on a daily basis.