Navigating the distal vasculature: Challenges and lessons learned from failed Thrombectomy trials.

BackgroundWhile endovascular thrombectomy (EVT) is firmly established for large vessel occlusion stroke, recent enthusiasm for extending EVT to distal medium vessel occlusions (DMVOs) has been tempered by the neutral results of three major randomized controlled trials: DISTAL, ESCAPE-MeVO, and DISCOUNT.ObjectiveTo critically examine why EVT failed to demonstrate benefit in DMVO trials, assess the associated procedural and clinical challenges, and explore potential future directions for safe and effective treatment in distal cerebrovascular territories.MethodsThis review synthesizes the key findings of recent DMVO thrombectomy trials and contextualizes them within the anatomical, technical, and clinical limitations specific to distal interventions.

Comparison of pEGASUS-HPC and CREDO Heal stent systems deployed via NeuroSpeed percutaneous angioplasty balloon catheter for treatment of acute symptomatic intracranial stenosis and occlusion.

Purpose: To compare the efficacy and safety of the pEGASUS-HPC and CREDO heal coated stent systems used with the NeuroSpeed percutaneous angioplasty (PTA) balloon catheter, for treating acute symptomatic intracranial artery stenosis (ICAS) with or without acute vessel occlusion (VO).

Methods: This retrospective, multicenter study included patients with ICAS between June-2021 and June-2024 treated with the NeuroSpeed PTA balloon catheter and either stent system. Clinical endpoints included National Institutes of Health Stroke Scale (NIHSS) scores and modified ranking scores (mRS), safety and efficacy endpoints included in-stent thrombosis and in-stent stenosis.

Y-stent-assisted coiling with pEGASUS stents for intracranial bifurcation aneurysms: A multi-center retrospective study.

ObjectivesY-stent-assisted coiling (Y-SAC) is an established technique for managing wide-necked intracranial bifurcation aneurysms. However, data on the use of the pEGASUS stent, a self-expanding open-cell stent with an antithrombogenic hydrophilic polymer coating, remain limited. This study evaluated the effectiveness and safety of Y-SAC with pEGASUS stents in patients with intracranial bifurcation aneurysms.

Stent-assisted coiling and flow diversion with hpc-coated devices under prasugrel monotherapy in ruptured wide-neck aneurysms: a multicenter case series.

Purpose: To evaluate the safety, efficacy, and clinical outcomes of stent-assisted coiling (SAC) and flow diversion (FD) with hydrophilic polymer-coated (HPC) devices under prasugrel single antiplatelet therapy (SAPT) in the treatment of acutely ruptured wide-neck intracranial aneurysms.

Methods: This multicenter retrospective case series included patients with ruptured saccular intracranial aneurysms treated through SAC or FD with HPC-coated devices under SAPT at four specialized neurovascular centers. Baseline demographics, aneurysm characteristics, procedural details, and clinical outcomes were analyzed.

The impact of revised definitions on the epidemiology of status epilepticus: A population-based study.

Objective: Status epilepticus (SE) represents one of the most common neurological emergencies. The International League Against Epilepsy (ILAE) redefined SE duration thresholds from 30 to 5 min for convulsive SE in 2015. We conducted a prospective population-based study to determine SE incidence and outcomes under the revised criteria and compared findings with historical data using the 30-min definition.

Stent-assisted coiling using the pEGASUS-HPC stent for acutely ruptured wide-necked intracranial aneurysms: A multicenter retrospective study.

BackgroundStent-assisted coiling (SAC) is increasingly used to treat ruptured wide-necked intracranial aneurysms. The pEGASUS-HPC stent, featuring a hydrophilic polymer coating (HPC) to reduce thrombogenicity, may offer a safe option in subarachnoid hemorrhage (SAH). This study evaluates its safety and efficacy in a multicenter retrospective cohort.

Successful treatment of pulsatile tinnitus caused by jugular bulb diverticula using stent-assisted volumetric coil embolization in a double-jailing technique.

Background: Pulsatile tinnitus (PT) is a distressing auditory symptom, frequently caused by vascular anomalies near the temporal bone. Among the rarer venous causes are jugular bulb diverticula, which can be difficult to diagnose and manage.

Case Presentation: We report the case of a patient in their 40s with persistent right-sided pulsatile tinnitus significantly impairing daily functioning.

Automatic detection of hippocampal sclerosis in patients with epilepsy.

Objective: This study was undertaken to develop and validate an automatic, artificial intelligence-enhanced software tool for hippocampal sclerosis (HS) detection, using a variety of standard magnetic resonance imaging (MRI) protocols from different MRI scanners for routine clinical practice.

Methods: First, MRI scans of 36 epilepsy patients with unilateral HS and 36 control patients with epilepsy of other etiologies were analyzed. MRI features, including hippocampal subfield volumes from three-dimensional (3D) magnetization-prepared rapid acquisition gradient echo (MPRAGE) scans and fluid-attenuated inversion recovery (FLAIR) intensities, were calculated.

Endovascular treatment of posterior circulation aneurysms with flow diverters with hydrophilic polymer coating in patients receiving prasugrel single antiplatelet therapy: a multicenter case series presenting complication and occlusion rates.

Background: The present study reports a multicenter experience of using hydrophilic polymer-coated (HPC) flow diverters (FDs) with prasugrel single antiplatelet therapy (SAPT) to treat posterior circulation aneurysms (PCAs).

Methods: A prospectively maintained database was retrospectively reviewed to identify all cases of intracranial PCA treated with HPC-coated FDs under SAPT (prasugrel). The clinical presentation and outcomes, periprocedural and postprocedural complications, and degree of occlusion at follow-up (FU) were evaluated.

pEGASUS HPC stent pusher-assisted catheterization (PAC) of nonruptured cerebral aneurysms: Safety and efficacy.

To investigate the safety and efficacy of using the pEGASUS HPC stent pusher instead of a microwire for catheterization of nonruptured cerebral aneurysms during stent-assisted coiling. In this multicenter retrospective study (July 2021-June 2024), 107 patients with 118 incidental nonruptured cerebral aneurysms underwent stent-assisted coiling using pEGASUS HPC stents. Based on the catheterization technique, cases were assigned to either the microwire-assisted catheterization (MAC, n = 58) or the stent pusher-assisted catheterization (PAC, n = 60) group.

The impact of white matter lesions on seizure recurrence after first epileptic seizures in the elderly: a prospective study.

Background: Despite considerable previous research, to what degree white matter lesions (WML) may be epileptogenic remains unclear. Therefore, the decision of initiating treatment with antiseizure medication (ASM) can be challenging in patients with only WML on neuroimaging. In this prospective study we assessed whether the prevalence, localization or severity of WML impact the risk of seizure recurrence in patients aged 60 years or older after first-time seizures.

Relationship of left piriform cortex network centrality with temporal lobe epilepsy duration and drug resistance.

Background: We investigated the relationship of piriform cortex (PC) structural network centrality with drug resistance and epilepsy duration as markers of sustained epileptic activity.

Methods: PCs were manually delineated on retrospectively collected 3D-T1-MRI images of patients with temporal lobe epilepsy (TLE). Connectomes were computed from diffusion MRI scans, including the PC as network nodes.

Endovascular versus Best Medical Treatment for Acute Carotid Occlusion BelOw Circle of Willis (ACOBOW): The ACOBOW Study.

Background Symptomatic acute occlusions of the internal carotid artery (ICA) below the circle of Willis can cause a variety of stroke symptoms, even if the major intracranial cerebral arteries remain patent; however, outcome and safety data are limited. Purpose To compare treatment effects and procedural safety of endovascular treatment (EVT) and best medical treatment (BMT) in patients with symptomatic acute occlusions of the ICA below the circle of Willis. Materials and Methods This retrospective, multicenter cohort study from 22 comprehensive stroke centers in Europe and Asia includes patients treated between January 1, 2008, and December 31, 2022.

Adult-onset status epilepticus in patients with COQ8A coenzyme Q10 deficiency: A case series.

This case series describes the clinical features, diagnostic challenges, treatment approaches, and outcomes of three adult patients with COQ8A-related CoQ10 deficiency presenting with focal status epilepticus, who were effectively treated at the Department of Neurology, Philipps University Marburg, Marburg, Germany. The patients, all from consanguineous families with the first two being siblings, presented with a late onset of the disease, characterized by progressive cerebellar ataxia and epilepsy, with clinical deterioration and focal status epilepticus occurring in adulthood. The first patient exhibited myoclonic status, while the second and third patients presented with bilateral tonic-clonic seizures followed by focal status epilepticus manifesting with cortical blindness.

Endovascular thrombectomy for childhood stroke (Save ChildS Pro): an international, multicentre, prospective registry study.

Background: Emerging evidence suggests that endovascular thrombectomy is beneficial for treatment of childhood stroke, but the safety and effectiveness of endovascular thrombectomy has not been compared with best medical treatment. We aimed to prospectively analyse functional outcomes of endovascular thrombectomy versus best medical treatment in children with intracranial arterial occlusion stroke.

Methods: In this prospective registry study, 45 centres in 12 countries across Asia and Australia, Europe, North America, and South America reported functional outcomes for children aged between 28 days and 18 years presenting with arterial ischaemic stroke caused by a large-vessel or medium-vessel occlusion who received either endovascular thrombectomy plus best medical practice or best medical treatment alone.

The DERIVO 2 Heal Embolization Device in the Treatment of Ruptured and Unruptured Intracranial Aneurysms: a Retrospective Multicenter Study.

Backround: The use of flow diverting stents in the treatment of intracranial aneurysms is associated with a risk of neurological morbidity due to their thrombogenicity. To reduce this risk different surface modifications have been developed. The Derivo 2 Embolization Device (Acandis, Pforzheim, Germany) has proven to be a safe and effective flow diverter.

Hereditary Hemorrhagic Telangiectasia (Osler's Disease): Systemic, Interdisciplinary, Relatively Common—and Often Missed.

Background: Hereditary hemorrhagic telangiectasia (HHT, Rendu- Osler-Weber disease, or Osler's disease for short) is a systemic disease that can severely impair the quality of life and that requires interdisciplinary treatment. Among rare diseases, it is relatively common, with a prevalence of approximately 1/5000.

Methods: This review is based on publications retrieved by a selective literature search, including the two international guidelines on clinically relevant aspects of HHT.

Flow diversion with hydrophilic polymer coating with prasugrel as single antiplatelet therapy in the treatment of acutely ruptured intracranial aneurysms: a multicenter case series, complication and occlusion rates.

Background: This study reports a multicenter experience of using hydrophilic polymer-coated (HPC) flow diverters with prasugrel single antiplatelet therapy to treat ruptured aneurysms with subarachnoid hemorrhage (SAH).

Methods: Patients treated for intracranial aneurysms within 30 days after SAH with a p64/p48 MW HPC flow diverter were prospectively identified. Clinical presentation and outcomes, periprocedural and postprocedural complications, and degree of occlusion at follow-up were evaluated.

Overestimation of the Ischemic Core Is Associated With Higher Core Lesion Volume and Degree of Reperfusion After Thrombectomy.

Background CT perfusion (CTP)-derived baseline ischemic core volume (ICV) can overestimate the true extent of infarction, which may result in exclusion of patients with ischemic stroke from endovascular treatment (EVT). Purpose To determine whether ischemic core overestimation is associated with larger ICV and degree of recanalization. Materials and Methods This retrospective multicenter cohort study included patients with acute ischemic stroke triaged at multimodal CT who underwent EVT between January 2015 and January 2022.