Intracranial aneurysm embolization using Penumbra fill and finish coils: 1-year results of a prospective, real-world, multicenter SURF study.

Background: SURF was a prospective, multicenter, single-arm, observational study with core lab adjudication of radiographic data, assessing embolization of intracranial aneurysms (IAs) using WAVE Extra Soft Coils as part of SMART Coil System.

Methods: Adults undergoing IA embolization with the SMART Coil System (Penumbra, Inc.) comprising 75% of implanted coils and WAVE as the final finishing coil were enrolled at 43 global centers.

Applying brain injury guidelines to patients with traumatic brain injury: A contemporary, consecutive series.

Objectives: Traumatic brain injury (TBI) is a significant contributor to long-term disability and imposes substantial costs, which may include excess, duplicative, or unnecessary imaging, hospitalizations or transfers, and superfluous consultations. We examined the use of the Brain Injury Guidelines (BIG) in 144 consecutive patients presenting with TBI.

Methods: Patients with TBI evaluated consecutively between April 2024 and September 2024 were prospectively classified into BIG 1, 2, and 3 categories and retrospectively assessed.

How Do Patient Outcomes in Mechanical Thrombectomy for Large-Core Stroke Vary Based on Neuroimaging Modalities Used for Patient Selection? A Multicenter Multinational Study.

The role of different imaging modalities-non-contrast CT (NCCT), CT perfusion (CTP), and diffusion-weighted imaging (DWI)-in selecting patients with large-core stroke for endovascular thrombectomy (EVT) is a subject of ongoing debate. This study aims to determine whether patients with large-core acute ischemic stroke (AIS) undergoing EVT triaged with CTP or DWI in addition to NCCT had different clinical outcomes compared to those only triaged with NCCT. We queried the Stroke Thrombectomy and Aneurysm Registry (STAR) for patients enrolled between 2014 and 2023 who presented with anterior-circulation AIS and large ischemic core (ASPECTS < 6) who underwent EVT in 41 stroke centers in the USA, Europe, Asia, and South America.

Tailoring endovascular strategy to posterior inferior cerebellar artery segment anatomy: Avoiding brainstem infarction in dissecting pseudoaneurysms.

BackgroundDissecting pseudoaneurysms of the posterior inferior cerebellar artery (PICA) are rare, high-risk lesions with outcomes heavily influenced by anatomical location. This study evaluates the relationship between PICA segmental anatomy, endovascular treatment strategy, and clinical outcomes.MethodsWe retrospectively analyzed 21 patients with dissecting PICA aneurysms treated endovascularly between 2013 and 2025.

Outcomes of bypass surgery in asymptomatic moyamoya angiopathy: A multicenter study with propensity-score weighting.

Introduction: Asymptomatic moyamoya angiopathy (MMA) is increasingly detected through noninvasive imaging; however, its optimal management remains controversial. This multicenter retrospective cohort study compared outcomes in asymptomatic versus symptomatic MMA patients undergoing surgical revascularization.

Patients And Methods: A total of 475 patients treated with bypass surgery across multiple academic centers were included, with 56 (11.

Safety and efficacy of very short flow diverters for the treatment of intracranial internal carotid artery aneurysms.

Deploying flow diverters (FDs) around the carotid siphon typically favors longer FDs for easier manipulation and safety, leaving shorter FDs less explored. We reviewed 263 patients with unruptured intracranial saccular ICA aneurysms treated with FDs from 2013 to 2023. Fifty-five were treated with very short flow diverters (VSFD; 10-12 mm).

Conventional versus advanced imaging selection for endovascular treatment of basilar artery occlusion strokes.

Introduction: Endovascular thrombectomy (EVT) is an effective treatment for basilar artery occlusion (BAO) stroke in select patients. While there is a growing body of literature suggesting that advanced imaging modalities such as computed tomography perfusion (CTP) and magnetic resonance (MR) may not be necessary for selecting anterior circulation large vessel occlusion stroke patients for EVT, whether advanced imaging may be superior to conventional imaging (non-contrast CT and CT angiography) in identifying good treatment candidates among BAO patients is less clear.

Patients And Methods: This was a multicenter retrospective cohort study of BAO EVT patients treated from 2013 to 2022 in the Stroke Thrombectomy and Aneurysm Registry.

Safety and efficacy of preoperative embolization in the treatment of brain arteriovenous malformations with perinidal aneurysms and single draining vein: a multicenter study with propensity score-weighting.

Background And Objectives: Arteriovenous malformations (AVMs) with perinidal aneurysms and single draining vein are associated with an elevated risk of rupture and increased procedural complexity. The role of preoperative embolization in this high-risk anatomical subset remains unclear. This study aimed to evaluate the safety and efficacy of microsurgery with preoperative embolization, compared with microsurgery alone in patients with such AVMs.

Middle meningeal artery embolization for chronic subdural hematoma in octogenarians and nonagenarians: an individual patient pooled meta-analysis.

Chronic subdural hematoma (cSDH) is a highly common neurosurgical condition with significant burden in the elderly, and patients aged ≥ 80 represent nearly one-third of cases. Middle meningeal artery embolization (MMAE) has emerged as a promising treatment method to reduce hematoma growth and recurrence; however, octogenarians and nonagenarians remain underrepresented in clinical trials. We conducted a systematic review and meta-analysis of individual patient data to evaluate outcomes of MMAE in this high-risk group.

Concurrent Anterior Cerebral Artery and Middle Cerebral Artery Occlusions Predict Poor Neurological Outcome Despite Successful Thrombectomy in Anterior Circulation Stroke.

Background And Objectives: Despite successful endovascular thrombectomy for acute ischemic stroke, a significant proportion of patients demonstrate fast and early progression of infarct core and fail to achieve functional independence at 90 days. The aim of this study was to evaluate the impact of thrombus location and the potential impact of collaterals on concurrent middle cerebral artery (MCA) and anterior cerebral artery (ACA) occlusion.

Methods: Data were included from a multicenter registry for patients undergoing endovascular thrombectomy for anterior circulation stroke from 32 international centers between 2015 and 2021.

Distal posterior inferior cerebellar artery dissecting aneurysms: a systematic review and meta-analysis.

Background: Distal posterior inferior cerebellar artery (PICA) dissecting aneurysms are rare, anatomically complex, and clinically underreported. Management strategies remain poorly standardized, and long-term outcomes are not well defined. This paper aims to systematically review the anatomical, clinical, and therapeutic characteristics of distal PICA dissecting aneurysms.

Feasibility of middle meningeal artery embolization following large craniotomy: A case series.

IntroductionWhile middle meningeal artery embolization (MMAE) has been shown to be feasible for recurrent subdural hematoma (SDH) after craniotomy, large traumatic craniotomies exceeding 8000 mm have typically been excluded. In this novel case series, we assess the feasibility and efficacy of MMAE in treating recurrent SDH following large open neurosurgical intervention (non-burr hole or bedside procedures). In all cases, a portion of the middle meningeal artery (MMA) territory remained patent and was successfully embolized.

A novel classification for posterior communicating artery aneurysms in the presence of fetal posterior cerebral artery: A registry-based study.

Background and objectivesFetal posterior cerebral artery (fPCA) is a common anatomical variant where the P1 segment is hypoplastic or absent, and the posterior communicating artery supplies the posterior cerebral artery (PCA) territory. Aneurysms in this setting often form at the internal carotid artery (ICA)-posterior communicating artery junction and are poorly defined. This study introduces a novel classification to address the fPCA variant, treatment challenges, and outcomes.

Can antithrombotic therapy be safely resumed after middle meningeal artery embolization with or without surgery for chronic subdural hematoma? a systematic review and meta-analysis.

Background: Middle meningeal artery embolization (MMAE), whether alone or with surgery, reduces chronic subdural hematoma (cSDH) recurrence. However, the impact of resuming antithrombotic (AT) therapy after MMAE and optimal resumption time remains unclear.

Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines.

Evolving strategies in the management of vertebral artery dissecting aneurysms involving the posterior inferior cerebellar artery: a systematic review and meta-analysis.

Background: Vertebral artery dissecting aneurysms (VADAs) involving the posterior inferior cerebellar artery (PICA) origin present a unique therapeutic challenge due to high rupture risk, complex anatomy, and the critical need to preserve brainstem perfusion. Despite the increasing use of endovascular strategies, no prior meta-analysis has specifically evaluated outcomes for this clinically high-risk subgroup.

Objective: To systematically review and quantitatively synthesize available data on the endovascular management of VADAs involving the PICA origin.

Illustrated step-by-step guide to stent-assisted coiling of wide-neck posterior inferior cerebellar aneurysm via a contralateral vertebral artery approach.

Background and ObjectivesPosterior inferior cerebellar artery (PICA) aneurysms are uncommon, occurring in 0.5% to 3% of all intracranial aneurysms. Due to the distinct anatomy and varying geometrical configuration at the PICA origin, endovascular treatment can be challenging.

Treatment outcomes of successful M1 versus M2 thrombectomy for low-ASPECTS stroke patients.

BackgroundThe effectiveness of endovascular thrombectomy (EVT) for low Alberta Stroke Program Early CT score (ASPECTS) stroke patients with occlusion of the second segment of the middle cerebral artery (M2) is unclear.MethodsThis was a multicenter retrospective study. Patients with M1 or M2 occlusions and low ASPECTS (<6) who underwent successful EVT (modified treatment in cerebral ischemia score of 2b or higher) were included.

Distal anchoring techniques for reducing intra-aneurysmal (around-the-world) microcatheter loop prior to stent deployment across large wide-necked aneurysms- an educational review.

Purpose: Establishing parent artery access for stent placement across large wide-necked aneurysms can be challenging. 'Around-the-world' technique, forming an intra-aneurysm loop with some form of distal anchoring, has been described in several reports. This comprehensive educational review summarizes the different variations of this technique, with their relative advantages and disadvantages.

Hurting More Than Helping? Decompressive Craniectomy in Patients With Symptomatic Intracerebral Hemorrhage After Mechanical Thrombectomy in Acute Ischemic Stroke: Insights From Stroke Thrombectomy and Aneurysm Registry.

Background And Objectives: It remains unclear whether decompressive craniectomy (DC) is beneficial in patients who suffer symptomatic intracerebral hemorrhage (sICH) after acute ischemic stroke (AIS). We sought to study the effect of DC on functional outcomes in patients with sICH after AIS who underwent mechanical thrombectomy (MT).

Methods: Patients with AIS from anterior circulation large vessel occlusion who underwent MT and subsequently developed sICH were identified from the Stroke Thrombectomy and Aneurysm Registry database.

Assessing Occlusion and Recovery in Large and Giant Intracranial Aneurysms: A Comparative Retrospective Study of Flow Diversion Alone Versus Combined With Coiling and the Role of Packing Density.

Background And Objectives: Flow diversion (FD) is a conventional treatment of large and giant intracranial aneurysms. The aim of this study was to explore the impact of combining FD with coiling and analyze the required packing density (PD) for optimal aneurysm occlusion.

Methods: This retrospective study compared large (10-15 mm), very large (15-25 mm), and giant (≥25 mm) intracranial aneurysm treatment with FDs alone vs FD + coiling at 2 large institutions from 2015 to 2023.

Initial experience of utilizing a lower-profile transradial approach for mechanical thrombectomy: Comparable efficacy to larger-bore transfemoral approaches.

BackgroundWhile transfemoral access is commonly used for mechanical thrombectomy (MT) due to large-bore catheters providing greater aspiration forces, some centers employ transradial access (TRA) in select cases with favorable anatomy. We report our institutional experience to evaluate the efficacy of using TRA as the default approach for large-vessel occlusion (LVO) with a streamlined, lower-profile system.MethodsA retrospective review was conducted on 23 consecutive thrombectomies performed via TRA, regardless of patient anatomy or LVO location.

Outcomes of medical and surgical management in infectious intracranial aneurysms: a multicenter cohort analysis.

Introduction: Infectious intracranial aneurysms (IIAs) are rare but serious complications of systemic infections, particularly infective endocarditis. These aneurysms are prone to rupture, leading to significant morbidity and mortality. Management strategies lack consensus due to the rarity of the condition and reliance on small case series.

Effect of race on procedural and clinical outcomes in middle meningeal artery embolization for primary and adjunctive treatment of chronic subdural hematoma.

BackgroundWe investigated racial disparities in radiologic and clinical outcomes of patients after middle meningeal artery embolization (MMAE) for chronic subdural hematoma (CSDH) with or without evacuation surgery.MethodsThis multicenter retrospective study includes consecutive patients who underwent MMAE across 11 institutions in North America (10 in the United States and 1 in Canada). Patients were stratified using self-reported racial data.

Impact of A1 hypoplasia on endovascular treatment outcomes for anterior communicating artery aneurysms: implications for follow-up strategies.

Background: A1 hypoplasia is associated with anterior communicating artery (AcomA) aneurysms, but optimal imaging follow-up timing remains unclear. This study aimed to investigate whether concomitant A1 hypoplasia influences the post-treatment outcomes of AcomA aneurysms.

Methods: This retrospective cohort study (2013-24) included patients treated endovascularly for AcomA aneurysms, grouped by the presence or absence of A1 hypoplasia.