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.

Glenzocimab for reperfusion in the setting of endovascular therapy for brain infarction: GREEN study.

Background: Glenzocimab is a humanized fragment of a monoclonal antibody directed against the human platelet glycoprotein VI, which has shown promising features, including thrombus growth inhibition and minimal bleeding risk. The first inpatient study suggested the benefit of glenzocimab with alteplase in subgroups of patients with acute ischemic stroke (AIS) receiving endovascular treatment (EVT), with increased reperfusion rates and decreased risk of symptomatic hemorrhagic transformation. The objective of the GREEN (Glenzocimab for REperfusion in the setting of Endovascular therapy for brain infarctioN) study is to evaluate the efficacy of glenzocimab with EVT compared with EVT plus placebo, with or without intravenous thrombolysis (IVT), on functional outcome.

Hypoperfusion intensity ratio is associated with follow-up infarct volume in medium vessel occlusions: A multicenter multinational study.

Medium vessel occlusion (MeVO) contributes significantly to acute ischemic stroke (AIS). The hypoperfusion intensity ratio (HIR), reflecting collateral circulation via the ratio of Tmax >10s to Tmax >6s volumes, predicts infarct progression in large-vessel occlusions but is unstudied in MeVOs. In this multicenter, multinational retrospective study, we evaluated consecutive patients with MeVO who underwent mechanical thrombectomy with or without intravenous thrombolysis.

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.

Baseline predictors of poor clinical outcome despite recanalization of distal middle cerebral artery occlusions.

ObjectiveMechanical thrombectomy (MT) is well-established for the treatment of acute ischemic stroke (AIS) from large vessel occlusion (LVO), with growing data supporting the expansion to distal and medium vessel occlusions (DMVO). Despite successful recanalization in DMVO, certain patients still experience poor long-term clinical outcomes, prompting our study to comprehensively explore pre-MT factors influencing outcome despite excellent recanalization (final modified Thrombolysis in Cerebral Infarction [mTICI] score ≥2c).MethodsWe retrospectively examined data from patients who consecutively underwent MT for a primary middle cerebral artery (MCA) DMVO across 37 centers in North America, Asia, and Europe.

The Added Benefit of Intra-Arterial Thrombolysis After Successful Recanalization by Endovascular Treatment: A Systematic Review and Meta-Analysis of Randomized-Controlled Clinical Trials.

Background: Despite successful recanalization following endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) with large-vessel occlusion (LVO), many patients fail to achieve excellent functional outcomes. Post-EVT intra-arterial thrombolysis (IAT) has emerged as a potential adjunctive strategy to improve microvascular reperfusion and clinical recovery.

Methods: We conducted a systematic review and meta-analysis of randomized-controlled clinical trials (RCTs) comparing IAT plus best medical therapy (BMT) versus BMT alone in LVO-AIS patients with successful recanalization post-EVT.

Petechial hemorrhage in mechanical thrombectomy for distal and medium-vessel occlusions: technical considerations and outcomes.

Objective: Mechanical thrombectomy (MT) is well established for large-vessel occlusion (LVO) strokes, but its safety in distal and medium-vessel occlusions (DMVOs) requires further investigation. This study analyzed the relationship between procedural approaches, petechial hemorrhage (PetH), and clinical outcomes in DMVO thrombectomy, with particular attention to technical considerations and the complex interplay between tissue injury and hemorrhagic complications.

Methods: A retrospective cohort study was conducted on DMVO stroke patients treated with MT at 37 stroke centers worldwide from 2016 to 2024.

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.

A multicenter, propensity score-matched analysis of functional outcomes and recanalization success with or without Trevo for Medium and distal vessel occlusion.

BackgroundEndovascular therapy (EVT) for stroke due to distal or medium vessel occlusion (DMVO) is safe. Due to the distinct anatomical characteristics of DMVOs, further evaluation of EVT is crucial to determine which devices may yield better outcomes.MethodsA retrospective analysis of adults with DMVO treated in 37 centers (11 countries) was queried.

Determinants of day-1 stent patency following rescue intracranial stenting in failed intracranial thrombectomy.

IntroductionThis study aimed to identify factors affecting stent patency in patients treated with rescue intracranial stenting (RIS) for a refractory intracranial occlusion following mechanical thrombectomy (MT), focusing on antithrombotic regimens, and types of devices used.Material and methodsData from 14 university hospitals spanning from 2015 to 2021 were utilized, concentrating on patients who underwent MT in the anterior circulation. The primary outcome was stent patency on follow-up imaging at day 1.

Rescue intracranial stenting for failed mechanical thrombectomy of vertebrobasilar occlusions: a pooled analysis from the French and German national stroke registries.

Background: Whether rescue intracranial stenting (RIS) should be performed in patients with vertebrobasilar occlusions (VBO) refractory to endovascular mechanical thrombectomy (MT) remains an open question.

Methods: We conducted a pooled analysis using data from two national stroke registries, the Endovascular Treatment in Ischemic Stroke registry in France, and the German Stroke Registry-Endovascular Treatment. Patients with VBO who underwent RIS for failed MT, defined as a modified treatment in cerebral infarction (mTICI) score of 0 to 2a after MT, from January 2015 to December 2023 were included.

Cangrelor versus GPIIb/IIIa inhibitors as adjunctive therapy in endovascular treatment of large vessel occlusion stroke.

Background: Endovascular treatment (EVT) failures and early reocclusions in stroke often result from arterial wall disease, incomplete thrombus withdrawal, or acute endothelial injury. Intracranial and extracranial atherosclerosis, in particular, poses a risk of reocclusion, sometimes requiring tailored interventions (eg, angioplasty, stenting). While glycoprotein (GP) IIb/IIIa inhibitors have been widely studied in ischemic stroke, cangrelor remains less explored.

Intravenous thrombolysis before endovascular treatment in acute vertebrobasilar occlusions: Pooled analysis of the French and German Stroke Registries.

Introduction: Whether intravenous thrombolysis (IVT) provides additional benefit in eligible patients with acute vertebrobasilar occlusion who undergo endovascular treatment (EVT) remains an open question.

Patients And Methods: We conducted a pooled analysis using data from two national stroke registries, the ETIS registry in France and GSR-ET registry in Germany. Patients who underwent EVT for vertebral and/or basilar artery occlusions from January 2015 to December 2023 were included.

Stent retriever size and outcomes after anterior circulation occlusion thrombectomy.

Background: The impact of stent retriever size on mechanical thrombectomy (MT) outcomes remains uncertain. We aim to clarify the influence of stent retriever size on MT outcomes by analyzing data from two national prospective registries.

Methods: A retrospective analysis was performed on data from the French and German MT registries including consecutive patients with anterior circulation large vessel occlusion who underwent Solitaire stent retriever MT with or without additional aspiration.

Minimal clinical impact of embolization to new territory on outcomes in medium vessel occlusion strokes treated with mechanical thrombectomy: a retrospective multicenter study.

Background: Mechanical thrombectomy (MT) is established as an effective treatment for large vessel occlusion strokes, but its efficacy and safety for medium vessel occlusions (MeVOs) remain less clear. This study examines the impact of periprocedural embolization to a new vascular territory (ENT) on clinical outcomes in patients with MeVO stroke treated with MT.

Methods: A multicenter, retrospective analysis was conducted using the MAD-MT (Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy) registry, including 2122 patients with MeVO stroke w-ho underwent MT between September 2017 and July 2023.

Comparative efficacy and safety of stent retrievers as a bailout strategy following failed contact aspiration technique in acute stroke thrombectomy.

Background: The contact aspiration (CA) technique is often used to perform endovascular thrombectomy (EVT) for acute ischemic stroke (AIS); however, rescue strategies are necessary if CA fails to achieve recanalization. This study investigates the outcomes of incorporating stent retriever (SR) thrombectomy in the rescue strategy following failed CA.

Methods: EVT patients with failed CA attempts were identified from a large multicenter registry and stratified by rescue technique: CA alone or incorporating SR in the rescue strategy.

Clinical outcomes of patients with unsuccessful mechanical thrombectomy versus best medical management of medium vessel occlusion stroke in the middle cerebral artery territory.

Background: Current randomized controlled trials are investigating the efficacy and safety of mechanical thrombectomy (MT) in patients with medium vessel occlusion (MeVO) stroke. Whether best medical management (MM) is more efficient than unsuccessful vessel recanalization during MT remains unknown.

Methods: This was a retrospective cohort study using data from 37 academic centers across North America, Asia, and Europe between September 2017 and July 2021.

Outcomes of mechanical thrombectomy for medium vessel occlusion in acute ischemic stroke patients with ASPECTS 4-5 vs. 6-7: a retrospective, multicenter, and multinational study.

Introduction: Mechanical thrombectomy (MT) efficacy in medium vessel occlusion (MeVO) stroke, particularly in patients with low Alberta Stroke Program Early Computed Tomography Score (ASPECTS), remains less explored.

Methods: This retrospective study analyzed data from 443 AIS patients treated with MT for MeVO and low ASPECTS (4-7) at 37 centers across North America, Asia, and Europe, from September 2017 to July 2021. Patients were categorized into ASPECTS of 4-5 and 6-7.

Impact of time from symptom onset to puncture, and puncture to reperfusion, in endovascular therapy in the late time window (>6 h).

Background: Increased time from symptom onset to puncture (TSOP) and time from puncture to reperfusion (TPTR) are associated with worse outcome in ischemic stroke patients treated with endovascular therapy (EVT) in the early time window (<6 h). However, these associations are less described in the late window (>6 h), where patients may benefit from EVT because of a more favorable imaging profile (late window paradox). We sought to compare the effect of these timeframes between these two periods on efficacy and safety outcomes.

Endovascular therapy versus medical management in isolated posterior cerebral artery acute ischemic stroke: A multinational multicenter propensity score-weighted study.

Background: Despite the proven effectiveness of endovascular therapy (EVT) in acute ischemic strokes (AIS) involving anterior circulation large vessel occlusions, isolated posterior cerebral artery (PCA) occlusions (iPCAo) remain underexplored in clinical trials. This study investigates the comparative effectiveness and safety of EVT against medical management (MM) in patients with iPCAo.

Methods: This multinational, multicenter propensity score-weighted study analyzed data from the Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy (MAD-MT) registry, involving 37 centers across North America, Asia, and Europe.

Endovascular treatment versus medical management for basilar artery occlusion with low-to-moderate symptoms (National Institutes of Health Stroke Scale < 10).

Background: Patients with acute basilar artery occlusion (BAO) and low-to-moderate symptoms (National Institutes of Health Stroke Scale [NIHSS] < 10) are poorly represented in thrombectomy trials. Our objective is to compare thrombectomy and best medical management (BMT) in this population.

Methods: We compared data of all consecutive patients presenting with an initial NIHSS < 10 and acute symptomatic BAO included in two registries.