Vascular

Reentry Technique for Rescue Recanalization of Carotid Near-Total Occlusion after Subintimal Penetration

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In a case report, Tran et al., from the Department of Neurosurgery, University Medical Center Ho Chi Minh City; the Vascular Department, Cho Ray Hospital, Ho Chi Minh City, Vietnam; and the Department of Neurosurgery, Taichung Veterans General Hospital and National Chung Hsing University, Taichung, Taiwan, published in the American journal of neuroradiology that in selected patients with near-total carotid artery occlusion, where subintimal dissection occurs during endovascular access, the use of a rescue reentry technique with a reentry catheter can be a safe and effective method for achieving successful recanalization and restoring luminal patency 2).

The authors present a single-patient case in which a reentry catheter was used to regain access to the true lumen after unintentional subintimal dissection during an attempt to stent a near-occluded carotid artery. Technical success was achieved, and the patient recovered well.

📉 1. Conceptual Overstatement and Editorial Laxity

This article epitomizes a growing trend in low-yield case reports: elevate the ordinary by inflating the vocabulary. A standard bailout technique, long adapted from peripheral interventions, is glorified as a “rescue reentry technique” as if it were a novel paradigm. This is not a new technique — it’s complication management.

🧩 What they call “rescue,” seasoned neurointerventionists call Tuesday.

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Effectiveness of 2-methoxyestradiol in alleviating angiogenesis induced by intracranial venous hypertension

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In a Preclinical Experimental Study Zou et al. 1) from the Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China, evaluated in the Journal of neurosurgery the antiangiogenic effect of 2-methoxyestradiol (2-ME) in a rat model of intracranial venous hypertension, used as a proxy to study dural arteriovenous fistula formation. Specifically, the authors aimed to determine whether 2-ME could reduce angiogenesis in the dura mater by modulating the HIF-1α and ID-1 pathways, which are implicated in hypoxia-induced neovascularization, and concluded that 2-ME could potentially serve as a therapeutic agent to modulate angiogenesis caused by intracranial venous hypertension — a process they consider central to DAVF development.

🚩 1. Flawed Model: DAVF Without DAVF

Despite the title and clinical framing, this study does not model dural arteriovenous fistulas (DAVFs).

No arteriovenous shunt is demonstrated.

No hemodynamic assessment is performed.

No imaging or functional endpoints validate that the model reflects DAVF pathophysiology.

👉 What the authors present is not a DAVF model, but a crude simulation of dural angiogenesis via venous outflow obstruction. Calling it a DAVF model is scientifically misleading.

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Systematic Review of the predictive value of negative brain or low probability brain MRIs in patients with CSF venous fistulas

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The article titled “Systematic Review of the Predictive Value of Negative Brain or Low Probability Brain MRIs in Patients with CSF Venous Fistulas” (American journal of neuroradiology) is a systematic review analyzing data from nine studies (898 patients) to assess how reliably negative brain MRI or low-probability MRI scores (Bern, Mayo) can rule out cerebrospinal fluid (CSF) venous fistulas, a surgically treatable cause of spontaneous intracranial hypotension (SIH) 1).

The authors found that although negative brain MRI has a high negative predictive value (89%), CVFs were still identified in a notable number of patients—especially when using the Mayo score (NPV only 65%).

The authors conclude that negative imaging does not exclude CVF, and invasive spinal imaging (e.g., DSM, dynamic CT myelography) should be considered in cases with strong clinical suspicion. This is especially relevant for neurosurgeons, as surgical ligation of CVFs may be necessary.

All authors are affiliated with Cedars-Sinai Medical Center (Los Angeles), with Dr. Wouter I. Schievink, a neurosurgeon, being a leading expert in the field of CSF leaks.

This so-called systematic review by Tay et al. (AJNR, June 2025) ambitiously sets out to clarify the diagnostic value of negative brain MRI in detecting cerebrospinal fluid venous fistulas (CVFs), yet ends up as a textbook example of how quantitative gloss can’t save a weak clinical premise.

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Intraoperative ICG-VA with FLOW800 and multimodal fusion neuro-navigation for the resection of arteriovenous malformation with reduced blood loss

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In a retrospective cohort study, Yang et al. from The First Affiliated Hospital of Soochow University (Suzhou, Jiangsu) and Beijing Tiantan Hospital, Capital Medical University (Beijing, China), published in World Neurosurgery, evaluated the safety and effectiveness of combining intraoperative indocyanine green video angiography (ICG-VA) with FLOW800 and multimodal fusion neuronavigation in the microsurgical resection of brain arteriovenous malformations (AVMs).

The combined use of ICG-VA, FLOW800, and multimodal neuro-navigation was associated with:

Reduced intraoperative blood loss

Improved functional outcomes

Lower rates of postoperative complications and reoperation

→ Enhancing both the safety and efficacy of AVM microsurgery.

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A flashy mix of fluorescence imaging, hemodynamic mapping, and navigation overlays is presented as a major leap forward in AVM surgery. Ninety patients, split into two groups. Outcomes like hemoglobin drop and mRS are tracked. Sounds solid. Until you actually read it.

⚠️ Fatal Methodological Flaws Retrospective Bias Parade: No randomization. No matching. No controls for AVM grade, eloquence, or preoperative hemorrhage. The groups may as well be different species.

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Global burden and trend of stroke attributable to metabolic risks among young adults (20–39 years old) from 1990 to 2021

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In a retrospective secondary analysis based entirely on data from the Global Burden of Disease Study (GBD) 2021 — with no original dataset, no prospective design, and no hypothesis testing — Liu et al., from the Department of Neurosurgery, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China, published in Frontiers in Cardiovascular Medicine an assessment of the global burden and long-term trends of stroke among young adults (ages 20–39) attributable to metabolic risk factors. The authors identify regional disparities and support the call for targeted prevention strategies.

The study concludes that the global burden of stroke attributable to metabolic risk factors among young adults (20–39 years old) has significantly increased from 1990 to 2021, both in terms of absolute numbers and age-standardized rates. The major contributors to this burden are high body mass index (BMI), high fasting plasma glucose, and high systolic blood pressure. The authors emphasize the need for targeted, age-specific public health interventions to reduce these modifiable risks and prevent early-onset stroke.

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Main Limitation

The study merely visualizes model-generated data without offering critical interpretation, clinical insight, or actionable public health strategies.

📉 Main Criticisms

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Early clinical experience with the Emboguard Balloon Guide Catheter: impact on technical success and patient outcomes in large vessel occlusion thrombectomy

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In a retrospective observational cohort study published in the Journal of NeuroInterventional Surgery, Mahat et al.—with participation from the Department of Neurosurgery at the University of Pittsburgh School of Medicine—evaluated the early clinical performance of the Emboguard Balloon Guide Catheter (EBGC) in anterior circulation large vessel occlusion (LVO) strokes treated with endovascular thrombectomy. The analysis relied on a prospectively maintained thrombectomy database, yet lacked a control group, randomization, or blinding, limiting its internal validity.

The study sought to assess:

Technical outcomes: rates of successful (mTICI 2b/3) and complete (mTICI 2c/3) recanalization, number of passes, and first-pass effect (FPE).

Clinical outcomes: NIHSS at discharge and functional status at 90 days (mRS).

Safety outcomes: incidence of symptomatic intracranial hemorrhage (sICH) and all-cause mortality.

While the reported results appear favorable, the commercial tone, lack of methodological rigor, and extensive conflicts of interest raise concerns that the study may serve more as an early promotional endorsement of the device rather than a robust, independent scientific evaluation. 1)

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Use of N-hexyl Cyanoacrylate Monomers for the Treatment of Intra- and Extracranial Arteriovenous Malformations: A Single-Center Experience

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In a retrospective single-center case series (n=22 patients, 24 procedures) with no control group or comparison, Murias Quintana et al. from the Hospital Universitario Central de Asturias, Oviedo, Hospital Clínic de Barcelona, Hospital Universitario Marqués de Valdecilla, Santander, Alfried Krupp Krankenhaus, Essen, Hospital Universitario de Salamanca 1) aim to describe outcomes after the use of N-hexyl cyanoacrylate (NHCA, “Magic Glue”) for AVM embolization. Despite its stated aim of evaluating “strengths and limitations,” the article offers a one-sided, promotional narrative that lacks critical analysis.

🧱 Structural and Conceptual Weaknesses

1. Journal-Level Issues: “Cureus Syndrome”

The journal *Cureus* is increasingly known for:

This paper reinforces that reputation, providing more of a procedural diary than a peer-reviewed study. It embodies editorial complacency and academic dilution.

2. Lowest Tier of Evidence

A retrospective case series offers no comparative insight. There is:

This is not hypothesis–testing research — it’s purely observational, anecdotal reporting.

📉 Methodological Limitations

3. “Success” Is Redefined to Mean Nothing

The paper defines technical success as “the outcome achieved based on objective.” This is circular reasoning and renders the concept of success meaningless.

4. Data Dump of Technical Details

Injection times and catheter models are listed with obsessive detail:

  • HeadWay Duo 167 cm in 70.8%
  • Magic 1.2F in the rest
  • Injection times: 27 seconds to 9 minutes 38 seconds

Yet none of these details translate to improved patient care or clinical insight.

5. Zero Complications ≠ Safety

No adverse events in 24 procedures cannot be extrapolated as “safe.” This cohort is underpowered to detect rare but serious complications — a classic false sense of security.

🤹 Interpretation Bias and Overreach

6. 12.5% Success = “Effective”?

Only '3 out of 24 cases (12.5%)‘ achieved complete occlusion with a single NHCA injection. The authors still call it “effective.” This is an example of:

  • ::unjustified enthusiasm::
  • ::intellectual dishonesty::

7. Promotional Tone

Frequent use of the term “Magic Glue” and positive adjectives for NHCA give this paper the tone of a product brochure, not a neutral scientific analysis.

🧠 What’s Missing?

Key omissions include:

  • No clinical or imaging follow-up data
  • No outcome measures beyond technical success
  • No comparison with other embolic agents (Onyx, PHIL, Squid)
  • No cost-benefit analysis
  • No discussion of failure cases or limitations in complex AVMs

🧾 Conclusion

This paper does not meet the standards of a rigorous scientific study. It provides:

  • No high-quality evidence
  • No clinically useful guidance
  • No long-term data

It reinforces the perception of *Cureus* as a platform for uploading technically correct but scientifically irrelevant work. A procedural note disguised as research, this article is a missed opportunity to meaningfully contribute to the field of neurointerventional radiology.

Final Verdict: This is not a “study” — it is a technical anecdote polished with promotional language and framed in a journal that too often rewards upload volume over scientific substance.

📎 References

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Murias Quintana E, Rodríguez Castro J, Puig J, Gil García A, Chapot R, Maestro V, Llibre JC, Gutiérrez Morales JC, García Arias F, Vega P. Use of N-hexyl Cyanoacrylate Monomers for the Treatment of Intra- and Extracranial Arteriovenous Malformations: A Single-Center Experience. Cureus. 2025 May 17;17(5):e84290. doi: 10.7759/cureus.84290. PMID: 40525034; PMCID: PMC12169607.

Protective Effect of Resveratrol Against Intracranial Aneurysm Rupture in Mice

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In vivo animal studies

Type of study:: In vivo animal study (murine intracranial aneurysm model) First author:: Dang et al. Author affiliations::

  • Hamamatsu University School of Medicine, Hamamatsu
  1. Dept. of Neurosurgery
  2. Dept. of Anesthesia and ICU
  3. Dept. of Medical Education
  4. Dept. of Pharmacology
  • Asahikawa University School of Medicine, Asahikawa
  1. Dept. of Anesthesia and ICU
  • Hamamatsu Medical Center, Hamamatsu
  1. Dept. of Neurosurgery

Journal:: Journal of Neuroscience Research Purpose:: To evaluate whether dietary resveratrol prevents formation or rupture of intracranial aneurysms via anti‑inflammatory mechanisms. Conclusions::

  • No significant reduction in aneurysm formation incidence
  • Marked reduction in rupture rate (88 % → 40 %, p=0.026)
  • Modulation of inflammatory markers: ↑Sirt1, ↓Nfkb1, ↓Tnf

Citation:: 1)

Critical Review

1. Model limitations The elastase + DOCA‑salt murine model poorly reflects human aneurysm pathophysiology, lacking hemodynamic fidelity. No histological validation of aneurysm similarity or wall integrity is presented.

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