Endovascular Treatment Research Articles

In-hospital outcomes of acute aortic occlusion treated by endovascular intervention: A single center study

Background Endovascular intervention by means of thrombolysis is emerging as a promising management of Acute Aortic Occlusion (AAO). This study aims to evaluate the outcomes of endovascular thrombectomy for AAO cases in a single-center tertiary hospital in Indonesia. Methods We review retrospectively AAO patients treated by Rheolytic thrombectomy ± stenting or TEVAR at our referral center from 2011 to 2024. Clinical characteristics and outcomes were analyzed independently and in correlation to one another. Result Out of 21 episodes in 19 patients, AAO was correlated with thromboembolism in 57.1 %, in situ thrombosis in 23.8%, and malperfusion syndrome in 19% of patients. Most prevalent comorbidities found were coronary arterial disease, hypertension, heart failure, and atrial fibrillation. Method of revascularization were Rheolytic thrombectomy (12), covered stent (5), catheter-directed thrombolysis (2), and TEVAR (4) with an average 90.9% success rate. In-hospital mortality was 21% and did not vary significantly according to etiology (thromboembolism 30% vs in situ thrombosis 20%) except for malperfusion syndrome 0% which comprised of four patients. All fatality occurred among patients with history of coronary artery disease and one failed revascularization case required urgent amputation (5.3%). Average length of stay was 8.67 ± 5.31 days. Conclusion Based on our data, thromboembolism remained highly associated with occurrence of AAO. Endovascular approach by Rheolytic thrombectomy is proven to be comparable or slightly superior in restoring occluded aorto-iliac connection compared to conventional management options. Compared to previous studies, this study establishes a wider representation of AAO cases treated by endovascular means considering the rarity of cases.

REtrieving thrombi and Separated Coils/catheters Unexpectedly detached during Endovascular therapy: RESCUE - the use of thrombectomy devices for rescue therapy in interventional neuroradiology.

Intraprocedural complications during intracranial embolisation include thromboembolic vessel occlusion, catheter tip detachment and coil migration. Stentrievers and aspiration catheters are valuable devices for the management of these complications. We present our experience with the use of these devices. We describe the devices and techniques used, case details and clinical outcomes. Currently there is no standardised approach for the management of the above intraprocedural complications. We performed a retrospective review of our interventional neuroradiology database of patients who underwent endovascular treatment in our institution from January 2012 to January 2019 and identified embolisation procedures during which either stentrievers or aspiration catheters were utilised. We present a case series of 24 cases in which these devices were utilised as rescue devices over a period of 7 years. We provide three illustrative cases. Stentrievers and aspiration catheters can be used safely and effectively as adjunctive or rescue devices during embolisation procedures.

Management of acute ischemic stroke : Bridging vs. mothership

Acute ischemic stroke remains one of the most common causes of death in Germany and affects around 16,000 people every year. With the begin of using of i.v. lysis therapy in the mid-1990s and endovascular thrombectomy (after publication of randomized studies) in 2015, these two procedures represent the two most important pillars in acute therapy. In the absence of neuroradiology centers with endovascular treatment options, there are two principles for triaging of stroke patients-the drip-and-ship or mothership model. The question repeatedly arises as to whether and exactly when bridging i.v. lysis therapy should be used. The S2guideline for the treatment of acute stroke offers an evidence-based treatment decision for treating physicians and has been extended until 2026, with the exception of afew updates, due to its proven effectiveness. Every stroke patient should receive i.v. lysis therapy, taking into account the onset of neurological symptoms and possible contraindications, regardless of the planned triaging principle.

Endovascular therapy for aneurysmal dilatation and arteriovenous fistula of the superior mesenteric artery.

We present a clinical case illustrating the feasibility of endovascular treatment of superior mesenteric aneurysm associated with an arteriovenous fistula. The patient presented with abdominal pain and diarrhea on admission. Computed tomography angiography revealed an aneurysmal dilatation of the superior mesenteric artery and vein with an arteriovenous fistula. Endovascular therapy successfully managed the condition by reconstructing the artery, closing the fistula, and occluding the aneurysm. No aneurysm rupture or endoleak occurred, and the patient's symptoms on admission resolved. Endovascular treatment is a viable alternative for patients with superior mesenteric aneurysms and arteriovenous fistulas, but larger studies and further follow-up are needed to evaluate the safety and long-term efficacy of endovascular treatment.

Anterior choroidal artery aneurysm case series: a clinical decision algorithm for endovascular and surgical treatment using a novel classification system.

Anterior choroidal artery (AChA) aneurysms represent 2-5% of intracranial aneurysms. The proximity of the origin of the AChA to the aneurysm neck poses a risk of thromboembolic complications following treatment. AChA occlusion can result in significant neurological deficits. We present a case-series of patients with AChA aneurysms and their treatment outcomes. We describe how treatment was chosen based on aneurysm and patient-specific factors to minimize risks, enhance efficacy of treatment, and improve patient outcomes. We retrospectively reviewed 27 patients who underwent treatment for AChA aneurysms at a single institution from 2015-2024. Clinical presentation, aneurysm characteristics, procedural details, and follow-up data were collected. Twenty-seven AChA aneurysms (median diameter 2.94mm), were treated in 29 procedures. Treatments included clipping (11 aneurysms), flow diversion (13), or coiling (5). The five coiled aneurysms were ruptured at presentation. Three patients experienced permanent infarction (10.3%), two in the setting of vasospasm after coiling and one after flow diversion in a patient who proved to have resistance to clopidogrel. At a median follow-up of 4.73months (IQR = 1.23-14.03), 25 patients (93%) had favorable functional recovery (mRS 0-2). Patients treated for AChA aneurysms experienced favorable functional outcomes by utilizing surgical and endovascular techniques carefully chosen based on aneurysm and patient-specific factors. Two patients did not achieve independence post-coiling due to disability from their initial subarachnoid hemorrhage. There were no treatment related causes of unfavorable functional outcomes.

Endovascular embolization in the treatment of patients with closed abdominal trauma

Background. Closed abdominal trauma is often accompanied by damage to the abdominal organs and retroperitoneal space. With the development of medicine, minimally invasive methods of treating patients with bleeding due to closed abdominal trauma have become available, including endovascular embolization of the bloodstream, which allows one to avoid traditional operations (laparotomy) in this category of patients and achieve rapid rehabilitation of patients. Aim. To evaluate the possibility of X-ray endovascular embolization in the treatment of patients with closed abdominal trauma. Materials and methods. At the Sklifosovsky Research Institute of Emergency Medicine in 2022–2024 treated 68 patients with a diagnosis of “closed abdominal trauma”, of which 14 underwent direct angiography. In 4 (28.6%) patients, the intervention was diagnostic, in 10 (71.4%) it was therapeutic and diagnostic. These patients were included in this study: 8 (57.1%) men and 6 (42.9%) women. Results. Selective embolization of the splenic artery was performed in four (28.5%) cases, the renal artery in 2 (14.2%), the lumbar artery in 2 (14.2%), and the hepatic artery in 2 (14.2%). A retroperitoneal (perinephric) hematoma was punctured percutaneously under ultrasound guidance in one case to exclude urinary leakage in a patient with a kidney injury. One (7.1%) patient required laparotomy due to recurrent bleeding. There were no complications from X-ray endovascular interventions. There were no cases of hematoma infection. One (7.1%) death in a 70-year-old patient with a closed abdominal injury, subcapsular hematoma of the spleen with comorbid pathology. Conclusion. The use of X-ray endovascular embolization made it possible to avoid traditional surgical interventions (laparotomy) in 20.6% of cases. The introduction of X-ray endovascular hemostasis is one of the priorities in the treatment of patients with closed abdominal trauma.

Lower Gastrointestinal Bleeding (Nonvariceal): Concepts and Technique

AbstractLower gastrointestinal bleeding (LGIB) is defined as bleeding from the GI tract anywhere distal to the ligament of Treitz. It has multiple causes, including colonic diverticula, hemorrhoids, inflammatory bowel disease, and neoplasms. LGIB presents a wide spectrum of clinical manifestations, ranging from acute presentations with massive bleeding to insidious presentations with chronic, low-grade, intermittent bleeding. Although LGIB is less common and generally less severe compared with upper GI bleeding (UGIB), approximately 10 to 15% of cases eventually require endovascular intervention. Because of the unique vascular anatomy and potential complications, it often necessitates more specialized endovascular skills compared with UGIB. Embolization of LGIB carries a higher risk of ischemic complications compared with UGIB, as the superior mesenteric artery and the inferior mesenteric artery have a less rich collateral supply compared with the celiac trunk. The management of LGIB depends on its etiology, location, and severity. A multidisciplinary team approach, including gastroenterologists, surgeons, and interventional radiologists, is vital for achieving the best possible outcomes for these patients. With advances in microcatheter technology and newer embolic agents, interventional radiologist plays an increasingly important role in LGIB. Interventional radiologists managing these patients should have good knowledge of mesenteric arterial anatomy, the properties of different embolic agents, and basic principles of superselective embolization. In this comprehensive review, we discuss how to approach a patient with LGIB and the role of the interventional radiologist in these patients. Furthermore, we delve into endovascular techniques and concepts for superselective embolization and various embolic agents used in LGIB.

Large-Core Ischemic Stroke Endovascular Treatment: A Science Advisory From the American Heart Association.

Several trials of endovascular treatment for patients with large-core acute ischemic stroke have been completed. Whereas future stroke clinical guidelines will provide specific recommendations, this advisory aims to summarize the results of these trials, analyze the commonalities and differences among the studies, and discuss the clinical implications of these new results.

Microsurgical management of previously embolized intracranial aneurysms: A single center experience and literature review.

Endovascular treatment of intracranial aneurysms (IAs) provides less invasiveness and lower morbidity than microsurgical clipping, albeit with a long-term recurrence rate estimated at 20%. We present our single-center experience and a literature review concerning surgical clipping of recurrent previously coiled aneurysms. Retrospective analysis of nine (9) patients' data and final clinical/angiographic outcomes, who underwent surgical clipping of IAs in our center following initial endovascular treatment, over a 12-year period (2010-2022). Regarding the literature review, data were extracted from 48 studies including 969 patients with 976 aneurysms. 9 patients (5 males - 4 females) were included in the study with a mean age of 49 years. Subarachnoid hemorrhage was the initial presentation in 78% of patients. Aneurysms' most common location was the middle cerebral artery bifurcation (5/9) followed by the anterior communicating artery (3/9) and the internal carotid artery bifurcation (1/9). Indications for surgery were coil loosening, coil compaction, sac regrowth, and residual neck. Procedure-related morbidity and mortality were zero whereas complete aneurysm occlusion was achieved after surgical clipping in all cases (100%). All patients had minimal symptoms or were asymptomatic (mRS 0-1) at the final follow-up. Surgical clipping seems a feasible and safe technique for selected cases of recurrent previously coiled intracranial aneurysms. A universally accepted recurrence classification system and a guideline template for the management of such cases are needed.

Direct Oral Anticoagulants in Budd-Chiari Syndrome.

Budd-Chiari syndrome (BCS) is managed by interventions aimed at relieving hepatic venous obstruction and anticoagulation. Despite robust data supporting the tolerability and efficacy of direct oral anticoagulants (DOACs) in patients with other venous thromboembolism, its utility in BCS is not well documented. This study aims to evaluate the efficacy and tolerability of DOACs in Primary BCS from the available literature. Published studies that reported data on patients with BCS treated with DOACs were included. Two retrospective studies and nine case reports met the criteria for inclusion. The combined data from these two retrospective studies include 58 patients administered DOAC and 101 patients treated with VKA/LMWH. The combined re-stenosis or failure rates after percutaneous endovascular intervention, angioplasty, TIPS, or OLT were 17.2% for the DOAC group and 15.8% for the LMWH/VKA group. The incidence of major bleeding was 8.62% in the DOAC group and 5.94% in the LMWH/VKA group, while minor bleeding rates were 20.7% and 4.95%, respectively. Procedure-related bleeding was 4.5% in DOAC group and 12.8% in VKA/LMWH group. Nine case reports using apixaban in 3, rivaroxaban in 5, and one with dabigatran- described patients tolerating the treatment well and experiencing no major adverse events. DOACs appear to be at least equally effective to LMWH/VKA for the anticoagulation of patients with BCS. We believe DOACs to be preferred over LMWH/VKA for the anticoagulation of patients with BCS due to the known advantages in administration, but randomized trials might be needed to answer this question.

International practice patterns and perspectives on endovascular therapy for the treatment of cerebral venous thrombosis.

Cerebral venous thrombosis (CVT) accounts for 0.5-1% of all strokes. The role of endovascular therapy (EVT) in the management of CVT remains controversial and variations in practice patterns are not well known. Here, we present a comprehensive, international characterization of practice patterns and perspectives on the use of EVT for CVT. A comprehensive 42-question survey was distributed to stroke clinicians globally from May to October 2023, asking about practice patterns and perspectives on the use of EVT for CVT. The overall response rate was 31% (863 respondents of 2744 invited) across 61 countries. The majority of respondents (74%) supported the use of EVT for CVT in certain clinical situations. Key considerations for decision-making in using EVT favored clinical over radiographic/procedural factors and included worsening level of consciousness (86%) and worsening neurological deficits (76%). In the past 3 years, 56% of respondents used EVT for the treatment of CVT, with most (49.5%) involved in two to five cases. Among interventionalists, significant variability existed in the techniques used for EVT (p < 0.001), with aspiration thrombectomy (56%) and stent retriever (51%) being the most used overall. Regionally, interventionalists from China predominantly used intra-sinus heparin (56%), while this technique was most commonly ranked as "never indicated" throughout the rest of the world (23%). Post-procedure, low molecular weight heparin was the most used anticoagulant (83%), although North American respondents favored unfractionated heparin (37%), while imaging was primarily split between magnetic resonance (71.8%) and computed tomography (65.9%) arteriography or venography. Our survey reveals significant heterogeneity in approaches to EVT for CVT, and provides a comprehensive characterization of indications, techniques, and long-term management used by clinicians internationally. This resource will aid in optimizing patient selection and endovascular treatments for future trials.

THE FIRST EXPERIENCE OF USING 3-D PRINTED MODELS OF INTRACRANIAL ARTERIES IN TRAINING AND TEACHING ENDOVASCULAR NEUROINTERVENTIONS

Rationale: Endovascular intervention is often the first-line treatment for patients with intracranial artery pathology. Specialists performing therapeutic interventions on cerebral vessels must have practical training, since the cost of error is extremely high. For this reason, these interventions are performed by residents and interns less often than other endovascular surgeries. Printing of 3D models is a unique educational tool that can improve the effectiveness of training in endovascular techniques. However, to date, the role of this new technology in training specialists, as well as the features of its application, have not been sufficiently covered.Objective: to analyze the effect of 3D printing of an individually recreated digital model of vascular structures of the brain on the results of training and education in the technical aspects of endovascular neurointerventions. Materials and methods: At the first stage of the study, an analysis of the fundamental possibility of 3D printing was carried out, based on an individually recreated digital threedimensional model of vessels (using the carotid artery bifurcation as an example). Silicone was selected as the raw material for 3D printing. It was found that when printing with one-component silicone, there is significant ribbing of the model. Two-component silicone compounds were tested; their compliance with the required characteristics of the vascular model in terms of optical transparency and strength was demonstrated. 20 variants of carotid artery bifurcation models were manufactured. The task of the second stage was to create 3D models of vascular structures of a more complex shape and a smaller internal diameter than at the first stage. As a result, 3D models were designed and samples of cerebral arteries (2-5 mm) were created on their basis. At the third stage, the arterial vascular models were used for training in endovascular neurointerventions.Results: Five endovascular surgeons (with conditional numbers 1-5) took part in the simulation training. None of them managed to successfully complete all 10 attempts, while at least one success was recorded for all of them. Number of successful attempts: 8, 7, 7, 1, 3 respectively. Number of attempts to the first success: 1, 2, 1, 7, 6. Time spent on a successful attempt (M±σ): 25±8, 30±12, 45±15, 45, 65/60 min. Overall assessment of the effectiveness and feasibility of the simulation training by the surgeon on a 5-point scale: 3, 4, 5, 5, 3. Most of the training participants noted the low realism of the modelsand the discrepancy between the characteristics of the inner wall of the model and the real endothelium of the vessel: the silicone was too rigid, which limits its use as a training prototype.Conclusion: 3D printing of vascular structures for the purpose of practicing in neurovascular intervention seems to be a promising technique. The first experience demonstrated that its implementation is accompanied by significant difficulties associated with both the initial experience the new method and with the existing limitations of the technology itself.

Uterine artery embolisation in symptomatic patients with placenta accreta spectrum disorders.

Postpartum haemorrhage is the most common cause of mortality among women after childbirth. Therefore, this work aims to highlight the possibility of endovascular treatment of postpartum haemorrhage due to remnants in patients with placenta accreta spectrum disorders (PAS disorders) using selective UAE after failure of the standard management. This procedure is a relatively safe and technically nondemanding, with a low risk of recurrent vaginal bleeding. This article presents an evaluation of the results of eight patients (age between 19-39 years) who underwent selective transarterial embolisation of uterine arteries from January 2022 to August 2023 at the angio-interventional department of our university hospital center. Based on a multidisciplinary consensus of sonographically detected residues of placenta accreta with typical hypervascularisation, unilateral/bilateral embolisation of the uterine artery was performed with a microcatheter using polyvinyl alcohol embolisation particles, possibly in combination with gelatine foam. There were no periprocedural complications during embolisation, nor were there episodes of repeated bleeding or other postprocedural complications during the follow-up. Two patients underwent surgical revision of the uterine cavity with extirpation of devascularised residual tissue. Thus far, this procedure has proven to be a safe and relatively technically nondemanding method supplementing the management of symptomatic patients with PAS disorders with a low risk of rebleeding.

Transradial occlusion of giant true aneurysms of the secondary supraaortic branches

AbstractTrue aneurysms involving the branches of the subclavian arteries are rare clinical entities and often manifest with vague symptoms or incidental findings. Early diagnosis and treatment are imperative to prevent aneurysm rupture, which could result in life-threatening bleeding. Definitive diagnosis is established through computed tomography angiography or magnetic resonance angiography. In this case report, we present two cases: a right internal thoracic artery aneurysm and a right costocervical trunk aneurysm, both of which were successfully treated with endovascular procedures using vascular plugs via transradial access. Transradial access is notable for its lower rate of access-site complications compared to the traditionally used transfemoral access. Consequently, it allows for quicker patient mobilization and discharge. These cases underscore the feasibility and efficacy of endovascular treatment for such aneurysms, providing a safe alternative to surgical intervention. Individualized therapy and adequate follow-up are essential due to the rarity of these conditions.

Minimizing the landing zone of complex aortic repair using a physician-modified endograft to preserve a prominent Adamkiewicz artery

AbstractThere are increasing number of clinical cases with physician-modified endograft (PMEG) endograft for urgent reconstruction of large pararenal aneurysms to reduce the perioperative complication risks of fragile patients, but the risk of spinal cord ischemia due to the coverage of longer segment of thoracic aorta is relatively high.We demonstrate an expedited endovascular treatment of an 88 mm pararenal aneurysm by performing a 4-vessel fenestrated endovascular aortic repair. A prominent Adamkiewicz artery, ectatic supraceliac aortic segment, median arcuate ligament compression of the celiac artery and severe tortuosity of the common iliac arteries made the endovascular repair more challenging. A PMEG was implanted with simultaneous deployment technique to achieve a short proximal landing zone to preserve the Adamkiewicz artery.The proper risk assessment and preparation of the patient based on the clinical evaluation and procedure planning is essential for the clinical success of PMEG in urgent indication.

Endovascular Treatment of Unruptured Wide Necked Cerebral Aneurysms Larger Than 9 mm Affects Re-treatment and Prognosis in the Elderly: A Retrospective Analysis of Unruptured Aneurysms

Endovascular Treatment of Unruptured Wide Necked Cerebral Aneurysms Larger Than 9 mm Affects Re-treatment and Prognosis in the Elderly: A Retrospective Analysis of Unruptured Aneurysms

Application of microsurgical surgery in patients with proximal vertebral artery stenosis unsuited for endovascular treatment: a single-center retrospective study

To investigate the clinical efficacy and safety of microsurgical surgery in patients with proximal vertebral artery stenosis unsuitable for endovascular treatment. A retrospective analysis was conducted on the clinical data of 34 patients with proximal vertebral artery stenosis who underwent microsurgical surgery at the Department of Cerebrovascular Surgery, Shengli Oilfield Central Hospital, Dongying, Shandong, from March 2020 to April 2023. Preoperative imaging confirmation of proximal vertebral artery stenosis or occlusion was obtained using cervical CT angiography (CTA), CT perfusion imaging (CTP), and magnetic resonance angiography (MRA). Postoperative imaging examinations were utilized to evaluate blood flow patency, and clinical symptoms and complications during hospitalization and follow-up were documented. Postoperative imaging examinations in the 34 patients (Males: 79.4%; Mean age: 66.7 ± 9.6 years) revealed patent vertebral and supplying arteries. No new instances of transient ischemic attacks (TIAs) or other cerebrovascular events were observed during hospitalization, and clinical symptoms were improved. The mean follow-up duration was 10 months (range: 6–39 months). One patient died from septic shock due to abdominal infection, and one patient exhibited moderate ipsilateral vertebral artery stenosis on a follow-up CTA at 6 months postoperatively. The Modified Rankin Scale (mRS) scores decreased for 30 patients after surgery compared to preoperative scores, with all postoperative mRS scores being less than 1. The difference between preoperative and postoperative mRS scores was statistically significant (P < 0.01). Six patients experienced temporary postoperative complications, which resolved after active treatment, and one patient developed permanent Horner’s syndrome without affecting the quality of life. Microsurgical surgery for patients with proximal vertebral artery stenosis, when endovascular treatment is unsuitable, demonstrates good clinical efficacy and a low incidence of complications, offering a viable surgical treatment option. Further multicenter studies with larger sample sizes will be instrumental in validating its clinical application value.

Low-and intermediate-grade lateral sinus dural arterio venous fistulas: Factors affecting the outcome of endo vascular treatment over 18-year experience in a high-volume neurovascular center.

Lateral sinus dural arteriovenous fistulas (LS-DAVFs) carry a higher rate of recurrence after endovascular treatment (EVT). Our objective was to investigate the independent predictors of recurrence and unfavorable functional outcome of low-and intermediate-grade LS-DAVFs after EVT. Retrospectively reviewed our database of prospectively collected information for all patients with low and intermediate-grade LS-DAVFs that underwent EVT from May 2004 to December 2021. Patient demographic, angiographic, treatment, and outcome were analyzed to identify independent predictors of recurrence and unfavorable outcome. One hundred and seventeen patients with 117 low-and intermediate-grade LS-DAVFs underwent EVT were included in this study. The mean age of the patients was 53.0±17.5 years. Immediately complete obliteration was achieved in 103/117 (88%) patients after EVT. Clinical follow-up were available for all of 117 patients, with an unfavorable outcome rate of 5.1%. Angiographic follow-up was available in 91 patients (78%). Recurrence occurred in 16 (18%) patients and 8 (6.8%) received retreatment. Contralateral sinus severe stenosis or occlusion was an independent high-risk factor for the unfavorable outcome (OR=11.7; 95% CI: 1.9-70.9, P<0.01) and recurrence (OR=63.8; 95% CI: 10.3-396.5, P<0.01) for low-and intermediate-grade LS-DAVFs at follow-up. Contralateral sinus severe stenosis or occlusion represents a stronger independent risk factor associated with recurrence and unfavorable outcome in patients with low-and intermediate-grade LS-DAVFs when the involved ipsilateral sinus was occluded after EVT. For patients with LS-DAVFs, the patency of the contralateral sinus should be considered when therapeutic decision-making. LS-DAVFs = Lateral sinus dural arteriovenous fistulas; EVT = endovascular treatment; TAE = Transarterial Embolization; TVE = Transvenous Embolization; CN = cranial nerve; CVD = cortical venous drainage.

Hybrid Endovascular and Open Interventions for Aortic Disease

Hybrid Endovascular and Open Interventions for Aortic Disease

Iatrogenic cervical artery dissections during endovascular interventions.

Iatrogenic cervical artery dissection (CeAD) results from various procedures including interventional angiographic procedures and diagnostic angiography. Iatrogenic CeAD is rare, resulting in limited literature on management and outcomes. This observational cohort study investigates approaches and outcomes of iatrogenic CeAD after endovascular interventions. We conducted a retrospective review for patients who underwent endovascular intervention with resulting iatrogenic CeAD at Mayo Clinic, Rochester, MN, from 1998 to 2021. Pertinent patient factors were extracted and descriptive statistics generated. Between 1998 and 2021, 21,191 patients underwent catheter-based cerebral angiography. Thirty-two had iatrogenic CeADs (23 women; median age 59 [range 40.5-92.9]). Common comorbidities included hypertension (62.5%), smoking (56.3%), and hyperlipidemia (46.9%). Nine (28.1%) had dissection with diagnostic angiograms, 6 (18.8%) endovascular thrombectomy, 15 (46.9%) intracranial aneurysm treatment/coiling, and 2 (6.3%) intracranial angioplasty with/without stenting. All dissections were diagnosed by cerebral angiography during the same session as initial interventions. Four (12.5%) underwent hyperacute stenting. Thirty (93.7%) were placed on antithrombotic therapy with aspirin alone (34.4%) or dual-antiplatelet therapy with aspirin and clopidogrel (37.5%). Median duration of acute treatment was three months. Follow-up imaging showed excellent radiological course. Iatrogenic CeAD with endovascular interventions is rare and typically benign. Most are managed medically without complications or long-term negative outcomes. Oral single or dual-antiplatelet therapies are preferred compared to previous studies which emphasize intravenous anticoagulation. The duration of acute therapy varied from three months to lifelong. Key factors influencing clinical decision-making may include occlusion rate, pseudoaneurysm formation, intracranial extension, distal collateral circulation, and resultant ischemia.