Impact of pre-test probability on AI-LVO detection: a systematic review of LVO prevalence across clinical contexts.

Background: Rapid identification of large vessel occlusion (LVO) in acute ischemic stroke (AIS) is essential for reperfusion therapy. Screening tools, including Artificial Intelligence (AI) based algorithms, have been developed to accelerate detection but rely heavily on pre-test LVO prevalence. This study aimed to review LVO prevalence across clinical contexts and analyze its impact on AI-algorithm performance.

Validation of an in vitro testing platform for intra-arterial thrombolytics on human thrombectomy retrieved clots.

Background: Endovascular thrombectomy (EVT) is the standard treatment for acute ischemic stroke (AIS) due to large vessel occlusion. However, many patients fail to achieve good outcomes, especially without first pass reperfusion. Intra-arterial thrombolytics such as recombinant tissue plasminogen activator (rtPA) and tirofiban have shown potential as adjunctive therapies.

Association of initial core volume on non-contrast CT using a deep learning algorithm with clinical outcomes in acute ischemic stroke: a potential tool for selection and prognosis?

Background: In an extended time window, contrast-based neuroimaging is valuable for treatment selection or prognosis in patients with stroke undergoing reperfusion treatment. However, its immediate availability remains limited, especially in resource-constrained regions. We sought to evaluate the association of initial core volume (ICV) measured on non-contrast computed tomography (NCCT) by a deep learning-based algorithm with outcomes in patients undergoing reperfusion treatment.

Prognostic value of intracranial vascular tortuosity in thrombectomy for distal vessel occlusion.

Introduction: Neutral results from trials assessing mechanical thrombectomy (MT) for medium/distal vessel occlusions (MDVO) suggest the need for better selection criteria in these patients. Tortuous vascular anatomies may negatively influence MT efficacy and safety.

Patients And Methods: Consecutive patients with middle cerebral artery (MCA)-MDVO (M2/M3) who underwent MT at our center between January 2017 and September 2024 were included.

Multimodal deep learning for predicting unsuccessful recanalization in refractory large vessel occlusion.

Purpose: This study explores a multi-modal deep learning approach that integrates pre-intervention neuroimaging and clinical data to predict endovascular therapy (EVT) outcomes in acute ischemic stroke patients. To this end, consecutive stroke patients undergoing EVT were included in the study, including patients with suspected Intracranial Atherosclerosis-related Large Vessel Occlusion ICAD-LVO and other refractory occlusions.

Methods: A retrospective, single-center cohort of patients with anterior circulation LVO who underwent EVT between 2017-2023 was analyzed.

Impact of Direct Transfer to Angiography Suite on Treatment Time Metrics in Patients With Acute Intracerebral Hemorrhage.

Background: Shorter times to initiate antihypertensive and anticoagulation reversal treatments enhance their benefits in acute intracerebral hemorrhage (ICH). Improving workflows to optimize time performance metrics is strongly advocated. We aimed to evaluate the impact of direct transfer to angiography suite (DTAS) on time metrics for antihypertensive and anticoagulation reversal treatments in patients with stroke with suspected large vessel occlusion whose final diagnosis was ICH.

Randomized Study Comparing First-Line Dual Versus Single-Stent Retriever Technique: TWIN2WIN.

Background: The double-stent retriever (SR) technique has been described as an effective rescue technique when single-SR fails to induce recanalization. We aimed to assess the safety and efficacy of first-line double-SR in patients with stroke undergoing thrombectomy.

Methods: This was a multicenter, randomized, controlled, blinded adjudicated primary outcome study.

Stent Retriever AssIsted Lysis Technique with Tirofiban: A Potential Bailout Alternative to Angioplasty and Stenting.

Background And Purpose: Angioplasty and stent placement have been described as a bailout technique in individuals with failed thrombectomy. We aimed to investigate Stent retriever AssIsted Lysis (SAIL) with tirofiban before angioplasty and stent placement.

Materials And Methods: Patients from 2 comprehensive stroke centers were reviewed (2020-2023).

Intracranial thrombus composition is associated with occlusion location and endovascular treatment outcomes: results from ITACAT multicenter study.

Background: The impact of thrombolytics directed towards different thrombus components regarding site of occlusion in combination with mechanical thrombectomy (MT) to achieve endovascular complete recanalization is unclear.

Methods: Retrospective analysis of a prospective database in two stroke centers. Intracranial thrombi retrieved by MT were analyzed using hematoxylin-eosin staining for fibrin and red blood cell proportions, and CD61 immunostaining for platelets proportion in thrombus (PLTPT) assessment.

Deep learning-based model for difficult transfemoral access prediction compared with human assessment in stroke thrombectomy.

Background: In mechanical thrombectomy (MT), extracranial vascular tortuosity is among the main determinants of procedure duration and success. Currently, no rapid and reliable method exists to identify the anatomical features precluding fast and stable access to the cervical vessels.

Methods: A retrospective sample of 513 patients were included in this study.

PRERISK: A Personalized, Artificial Intelligence-Based and Statistically-Based Stroke Recurrence Predictor for Recurrent Stroke.

Background: Predicting stroke recurrence for individual patients is difficult, but individualized prediction may improve stroke survivors' engagement in self-care. We developed PRERISK: a statistical and machine learning classifier to predict individual risk of stroke recurrence.

Methods: We analyzed clinical and socioeconomic data from a prospectively collected public health care-based data set of 41 975 patients admitted with stroke diagnosis in 88 public health centers over 6 years (2014-2020) in Catalonia-Spain.

Safety and efficacy of early carotid artery stenting in patients with symptomatic stenosis.

Background: Symptomatic carotid artery stenosis is a significant contributor to ischemic strokes. Carotid artery stenting (CAS) is usually indicated for secondary stroke prevention. This study evaluates the safety and efficacy of CAS performed within a short time frame from symptom onset.

Enhancing blood pressure management protocol implementation in patients with acute intracerebral haemorrhage through a nursing-led approach: A retrospective cohort study.

Aim: To evaluate the impact of nurse care changes in implementing a blood pressure management protocol on achieving rapid, intensive and sustained blood pressure reduction in acute intracerebral haemorrhage patients.

Design: Retrospective cohort study of prospectively collected data over 6 years.

Methods: Intracerebral haemorrhage patients within 6 h and systolic blood pressure ≥ 150 mmHg followed a rapid (starting treatment at computed tomography suite with a target achievement goal of ≤60 min), intensive (target systolic blood pressure < 140 mmHg) and sustained (maintaining target stability for 24 h) blood pressure management plan.

Clinico-radiological features of intracranial atherosclerosis-related large vessel occlusion prior to endovascular treatment.

The identification of large vessel occlusion with underlying intracranial atherosclerotic disease (ICAS-LVO) before endovascular treatment (EVT) continues to be a challenge. We aimed to analyze baseline clinical-radiological features associated with ICAS-LVO that could lead to a prompt identification. We performed a retrospective cross-sectional study of consecutive patients with stroke treated with EVT from January 2020 to April 2022.

Radial Versus Femoral Access for Mechanical Thrombectomy in Patients With Stroke: A Noninferiority Randomized Clinical Trial.

Background: Transfemoral access is predominantly used for mechanical thrombectomy in patients with stroke with a large vessel occlusion. Following the interventional cardiology guidelines, routine transradial access has been proposed as an alternative, although its safety and efficacy remain controversial. We aim to explore the noninferiority of radial access in terms of final recanalization.

Platelet Analysis in the Thrombus Plus Serum BNP for Detecting Clot-Related Atrial Fibrillation. Results From the ITACAT Multicentric Registry.

Occult atrial fibrillation (AF) is a common cause of cryptogenic stroke. This study aimed to investigate the utility of surrogate markers within the clot (clot markers), in combination with serum biomarkers, to identify AF-associated clots in patients who underwent mechanical thrombectomy. Each retrieved thrombus was analyzed to identify fibrin, red blood cells, platelets - CD61 staining (PLT) and T-CD4 lymphocyte/macrophage/monocyte (CD4) profile.

Impact on collateral flow of devices used for endovascular treatment of stroke: an in-vitro flow model.

Background: Collateral blood supply of distal vessels has been linked to clinical outcome, infarct volume and recanalization rates in patients with large vessel occlusion. Our study aimed to explore the effects of catheterization during mechanical thrombectomy in collaterals.

Methods: We quantified the flow diversion effect secondary to arterial occlusions in an in vitro model which was connected in a flow-loop setup with a saline reservoir and a pump supplying pulsatile flow.

Prehospital care process and hospital outcomes in stroke-code cases: comparison of basic and advance life support ambulance attendance.

Objectives: To study prehospital care process in relation to hospital outcomes in stroke-code cases first attended by 2 different levels of ambulance. To analyze factors associated with a satisfactory functional outcome at 3 months.

Material And Methods: Prospective multicenter observational cohort study.

Safety and Efficacy of ApTOLL in Patients With Ischemic Stroke Undergoing Endovascular Treatment: A Phase 1/2 Randomized Clinical Trial.

Importance: ApTOLL is a TLR4 antagonist with proven preclinical neuroprotective effect and a safe profile in healthy volunteers.

Objective: To assess the safety and efficacy of ApTOLL in combination with endovascular treatment (EVT) for patients with ischemic stroke.

Design, Setting, And Participants: This phase 1b/2a, double-blind, randomized, placebo-controlled study was conducted at 15 sites in Spain and France from 2020 to 2022.

Granulocytes-Rich Thrombi in Cerebral Large Vessel Occlusion Are Associated with Increased Stiffness and Poorer Revascularization Outcomes.

We aim to identify a profile of intracranial thrombus resistant to recanalization by mechanical thrombectomy (MT) in acute stroke treatment. The first extracted clot of each MT was analyzed by flow cytometry obtaining the composition of the main leukocyte populations: granulocytes, monocytes, and lymphocytes. Demographics, reperfusion treatment, and grade of recanalization were registered.