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.

Recanalization of basilar artery occlusion during inter-hospital transfer for thrombectomy.

Background: Patients with acute ischemic stroke and a large vessel occlusion admitted to non-endovascular capable centers frequently require inter-hospital transfer to a comprehensive stroke center (CSC) for thrombectomy. Data regarding arterial recanalization of patients with basilar artery occlusion (BAO) during transfer are lacking.

Methods: We analyzed prospectively collected data of acute stroke patients with BAO transferred for consideration of thrombectomy to three CSCs (Rothschild Hospital, France; Montpellier Hospital, France; Stanford Hospital, USA) between 2016 and 2024, with arterial imaging at the referring hospital and on CSC arrival.

Hemorrhagic transformation during inter-hospital transfer for thrombectomy: Incidence, associated factors, and relationship with outcome.

Background: Patients with acute ischemic stroke with a large vessel occlusion (AIS-LVO) admitted to primary stroke centers (PSC) often require inter-hospital transfer to a comprehensive stroke center (CSC) for endovascular therapy (EVT). We aimed to determine the incidence of hemorrhagic transformation (HT) occurring during transfer, the factors associated with HT, and its relationship with 3-month outcome.

Methods: We retrospectively analyzed data from two cohorts of AIS-LVO patients transferred from a PSC to a CSC for consideration of EVT.

The Large Core Paradox.

Recently, 6 randomized controlled trials of endovascular treatment (EVT) versus medical management in anterior circulation large vessel occlusion with large-core documented significant benefit of EVT on functional outcome. Moreover, one trial reported the benefit of EVT in the very large-core category (Alberta Stroke Program Early CT Score, 0-2). These results are considered paradoxical by some as they contradict the prevailing view that the presence of a large core precludes the possibility of good outcomes following reperfusion.

Intravenous Thrombolysis Use before Inter-Facility Transfer for Thrombectomy: Association with Efficacy and Safety Outcomes.

Objective: Patients with acute ischemic stroke and large vessel occlusion (LVO) often require transfer from primary stroke centers (PSCs) to thrombectomy-capable centers. This study assessed the efficacy and safety of intravenous thrombolysis (IVT) initiated before inter-hospital transfer.

Methods: Data from 2 prospective cohorts of patients with anterior circulation LVO transferred for thrombectomy from a PSC, regardless of whether thrombectomy was eventually attempted at the endovascular-capable center, were analyzed.

Impact of Helicopter Transfer on Recanalization and Outcomes in Anterior Large Vessel Occlusion Strokes.

Background: For patients with acute ischemic stroke due to a large vessel occlusion admitted in primary stroke centers, helicopter transfer to comprehensive stroke centers is often used to expedite access to mechanical thrombectomy. Some studies have suggested that vibrations generated during helicopter transport might enhance intravenous thrombolysis (IVT) efficacy. We aimed to evaluate the impact of helicopter transfer, compared with ground transportation, on interhospital recanalization and functional outcomes.

Mechanical Thrombectomy for Large Ischemic Stroke: A Critical Appraisal of Evidence From 6 Randomized Controlled Trials.

Recently, 6 randomized trials evaluated the efficacy and safety of endovascular thrombectomy in patients with large core stroke. This review examines the differences in clinical and imaging eligibility and their impact on the interpretation of evidence and potential neuroimaging workflow. Pending results of a planned patient-level meta-analysis, it also evaluates clinical outcomes and thrombectomy treatment effect across those trials, overall and within selected clinical and imaging subgroups most relevant to clinical practice.

Data-Driven Clustering Approach to Identify Different Phenotypes of Primary Central Nervous System Vasculitis.

Background: To determine whether hierarchical unsupervised cluster analysis identifies a phenotypic distinction in adult patients with primary CNS vasculitis (PCNSV).

Methods: An agglomerative hierarchical cluster analysis based on the Ward method was conducted, including 153 patients with complete baseline phenotypic characterization in the COVAC' registry.

Results: The hierarchical analysis identified two main clusters.

Endovascular treatment for isolated cervical internal carotid artery occlusion: ETIICA study.

Introduction: Evidence regarding the benefit of endovascular therapy (EVT) in patients with acute ischemic stroke (AIS) due to isolated cervical internal carotid artery occlusion (c-ICA-O) is lacking. We assessed the outcomes and safety of EVT in patients with isolated c-ICA-O.

Methods: Retrospective multicenter cohort study of patients with an AIS due to isolated c-ICA-O, within 24-h since last-seen-well.

EVALUATION OF RETINAL CAPILLARY DENSITY USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY ACCORDING TO ACUTE ISCHEMIC STROKE ETIOLOGIES: A Matched Case-Control Study Stroke and Retinal Capillary Density.

Purpose: To investigate retinal microvascular changes in ischemic stroke patients using optical coherence tomography angiography (OCT-A) and assess these alterations based on stroke etiology.

Methods: Case-control study conducted at Montpellier University Hospital from May 2021 to March 2022 (Institutional Review Board: 202000607). Retinal vascular features were compared between strokes patients and age-matched and sex-matched controls.

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.

Early penumbral FLAIR changes predict tissue fate in patients with large vessel occlusions.

Background: In patients with an acute ischemic stroke, the penumbra is defined as ischemic tissue that remains salvageable when reperfusion occurs. However, the expected clinical recovery congruent with penumbral salvage is not always observed.

Aims: We aimed to determine whether the magnetic resonance imaging (MRI)-defined penumbra includes irreversible neuronal loss that impedes expected clinical recovery after reperfusion.

Becoming a thrombectomy-capable stroke center: Clinical and medico-economical effectiveness at the hospital level.

Introduction: Too few patients benefit from endovascular therapy (EVT) in large vessel occlusion acute stroke (LVOS), and various acute stroke care paradigms are currently investigated to reduce these inequalities in health access. We aimed to investigate whether newly set-up thrombectomy-capable stroke centers (TSC) offered a safe, effective and cost-effective procedure.

Patients And Methods: This French retrospective study compared the outcomes of LVOS patients with an indication for EVT and treated at the Perpignan hospital before on-site thrombectomy was available (Primary stroke center), and after formation of local radiology team for neurointervention (TSC).

European Stroke Organisation and European Society for Minimally Invasive Neurological Therapy guideline on acute management of basilar artery occlusion.

The aim of the present European Stroke Organisation (ESO) guideline is to provide evidence-based recommendations on the acute management of patients with basilar artery occlusion (BAO). These guidelines were prepared following the Standard Operational Procedure of the ESO and according to the GRADE methodology. Although BAO accounts for only 1%-2% of all strokes, it has very poor natural outcome.

Arterial Recanalization During Interhospital Transfer for Thrombectomy.

Background: Patients with acute ischemic stroke harboring a large vessel occlusion admitted to nonendovascular-capable centers often require interhospital transfer for thrombectomy. We evaluated the incidence and predictors of arterial recanalization during transfer, as well as the relationship between interhospital recanalization and clinical outcomes.

Methods: We analyzed data from 2 cohorts of patients with an anterior circulation large vessel occlusion transferred for consideration of thrombectomy to a comprehensive center, with arterial imaging at the referring hospital and on comprehensive stroke center arrival.

Trial of Thrombectomy for Stroke with a Large Infarct of Unrestricted Size.

Background: The use of thrombectomy in patients with acute stroke and a large infarct of unrestricted size has not been well studied.

Methods: We assigned, in a 1:1 ratio, patients with proximal cerebral vessel occlusion in the anterior circulation and a large infarct (as defined by an Alberta Stroke Program Early Computed Tomographic Score of ≤5; values range from 0 to 10) detected on magnetic resonance imaging or computed tomography within 6.5 hours after symptom onset to undergo endovascular thrombectomy and receive medical care (thrombectomy group) or to receive medical care alone (control group).

Inflammation biomarkers in the intracranial blood are associated with outcome in patients with ischemic stroke.

Background: Performing endovascular treatment (EVT) in patients with acute ischemic stroke (AIS) allows a port of entry for intracranial biological sampling.

Objective: To test the hypothesis that specific immune players are molecular contributors to disease, outcome biomarkers, and potential targets for modifying AIS .

Methods: We examined 75 subjects presenting with large vessel occlusion of the anterior circulation and undergoing EVT.

Tenecteplase versus Alteplase before thrombectomy: A comprehensive evaluation of clinical and angiographic impact: Insights from the ETIS registry.

Introduction: Data on prior use of Tenecteplase versus Alteplase in acute stroke management by mechanical thrombectomy are controversial. Our primary objective was to make a comprehensive comparative assessment of clinical and angiographic efficacy and safety outcomes in a large prospective observational study.

Methods: We included stroke patients who were eligible for intravenous thrombolysis and endovascular thrombectomy between 2019 and 2021, from an ongoing registry in twenty comprehensive stroke centers in France.

Diffusion-weighted magnetic resonance imaging in early central retinal artery occlusion.

Introduction: Restricted retinal diffusion (RDR) has recently been recognized as a frequent finding on standard diffusion-weighted imaging (DWI) in central retinal artery occlusion (CRAO). However, data on early DWI signal evolution are missing.

Patients And Methods: Consecutive CRAO patients with DWI performed within 24 h after onset of visual impairment were included in a bicentric, retrospective cross-sectional study.