Composite arterial and venous collateral score on single-phase CTA predicts 90-day outcomes in anterior circulation large-vessel occlusion stroke.

Background: Collateral circulation influences clinical outcomes in patients with acute ischemic stroke due to anterior circulation large-vessel occlusion (LVO). While both arterial and venous collateral assessments on single-phase computed tomography angiography (CTA) have prognostic value, they have traditionally been evaluated independently.

Purpose: We developed the CTA Collateral Impairment Score (CCIS), a composite measure incorporating arterial (Tan) and venous (Cortical Venous Opacification Score (COVES)) scores, and investigated its association with 90-day functional outcomes.

ProSPective evaluation of the dIagnostic accuracy of siNe spiN non-contrast flatdEtectoR CT (FDCT) for the detection of intracranial hemorrhage in stroke patients - Protocol of a non-inferiority comparison to multi detector CT.

Rationale: Whether syngo DynaCT Sine Spin non-contrast flat detector CT (FDCT) imaging is sufficient to rule out intracranial hemorrhage in suspected acute stroke patients is unknown.

Aim: To determine if syngo DynaCT Sine Spin non-contrast FDCT imaging is non-inferior to conventional multidetector CT (MDCT) imaging for the detection and exclusion of intracranial hemorrhages in suspected acute stroke patients.

Sample Size: To enroll 252 participants in three buckets (126 ischemic stroke patients, 126 hemorrhagic stroke patients (including 14 patients with an isolated infratentorial hemorrhage).

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.

Alteplase for Acute Ischemic Stroke at 4.5 to 24 Hours: The HOPE Randomized Clinical Trial.

Importance: The safety and efficacy of intravenous thrombolytics beyond 4.5 hours after ischemic stroke onset remain inadequately studied.

Objective: To evaluate the safety and efficacy of intravenous alteplase administered 4.

Oxygen Extraction Fraction on Baseline MRI Predicts Infarction Growth in Successfully Reperfused Patients.

Background: In patients with acute ischemic stroke, infarct growth occurs despite successful reperfusion. Oxygen extraction fraction (OEF) has shown promising results in evaluating ischemic tissue viability and can now be quantified from routinely performed dynamic susceptibility contrast perfusion. We aimed to determine the association of OEF alterations within the ischemic tissue on pretreatment magnetic resonance imaging and infarct growth in patients who underwent successful reperfusion.

Changes in Infarct Volume and Cerebral Edema After Mechanical Thrombectomy in Patients With Stroke Randomized to ApTOLL or Placebo: A Secondary Analysis of APRIL Trial.

Background: APRIL (A Double-Blind, Placebo-Controlled, Randomized, Phase Ib/IIa Clinical Study of ApTOLL for the Treatment of Acute Ischemic Stroke), a randomized placebo-controlled phase Ib/IIa trial, showed safety and reduced mortality and disability at 90 days of ApTOLL 0.2 mg/kg in combination with endovascular treatment in patients with acute large vessel occlusion within a 6-hour window. We studied the effect of ApTOLL against placebo on final infarct volume, infarct growth, and cerebral edema.

Randomized, Proof-of-Concept Trial (RESCUE) of RNS60 as an Adjunct Therapy in Acute Ischemic Stroke.

Background: Despite significant improvements in early reperfusion, many patients with acute ischemic stroke with large vessel occlusion experience poor outcomes, which indicates a clear need for adjunct therapies. RNS60 is a proprietary combination of oxygen supersaturated in saline with cerebroprotective and immunomodulatory effects. RNS60 showed therapeutic promise in rodent and nonhuman primate models of acute ischemic stroke.

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.

Intra-arterial Tenecteplase for Acute Stroke After Successful Endovascular Therapy: The ANGEL-TNK Randomized Clinical Trial.

Importance: The role of intra-arterial tenecteplase for acute large vessel occlusion (LVO) stroke after successful endovascular therapy is uncertain.

Objective: To assess the efficacy and safety of intra-arterial tenecteplase in patients with successful endovascular therapy (defined as a score on the expanded Thrombolysis in Cerebral Infarction [eTICI] scale of 2b to 3) after endovascular therapy.

Design, Setting, And Participants: This was a prospective, open-label, blinded end point, randomized trial.

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.

Validation of the HERMES-24 Score for Outcome Prediction Post Large Vessel Occlusion Treatment in Later Time Window.

Background And Objectives: The Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials (HERMES)-24 score is highly predictive of outcomes after anterior circulation large vessel occlusion (LVO) treatment, irrespective of intervention in the early time window. Recent evidence has further broadened the eligibility of endovascular therapy (EVT) to patients with late presentation or unwitnessed onset including those with stroke-on-awakening. We aimed to investigate the prediction ability of the HERMES-24 score in patients with anterior circulation LVO and small ischemic core presenting in the late time window from last seen normal.

Outcomes of Patients With Embolic Stroke of Undetermined Source Treated With Antiplatelet Agents or Anticoagulation: A Multicenter Cohort Study.

Background And Objectives: Embolic stroke of undetermined source (ESUS) can be attributed to a variety of potential embolic sources, with differential response to anticoagulation.

Methods: A multicenter, retrospective observational cohort study (27 sites) of consecutive adult patients with acute ischemic stroke due to ESUS (admitted 2015-2024) was conducted. The aim was to compare outcomes after antiplatelet(s) vs anticoagulant (±antiplatelet) treatment in patients with ESUS across potential embolic sources.

Optimal Head-of-Bed Positioning Before Thrombectomy in Large Vessel Occlusion Stroke: A Randomized Clinical Trial.

Importance: Small studies show that 0° head positioning of patients with large vessel occlusion (LVO) stroke improves penumbral blood flow and clinical stability. Understanding whether 0° head position maintains clinical stability would allow for optimal patient positioning before thrombectomy.

Objective: To determine superiority of 0° over 30° head positioning at maintaining clinical stability in patients with LVO before thrombectomy.

Influence of general anesthesia on outcomes after anterior circulation mechanical thrombectomy: Results from the prospective international ASSIST registry.

BackgroundMultiple studies have evaluated whether general anesthesia (GA) improves outcomes after mechanical thrombectomy (MT) with mixed results. Many of these did not include procedural outcomes such as time to recanalization, degree of recanalization, and first pass effect (FPE).MethodsThe ASSIST registry, a prospective, global, multicenter registry of patients undergoing anterior circulation MT was used.

Comparison of thrombectomy alone versus bridging thrombolysis in a US population using regression discontinuity analysis.

The role of intravenous thrombolysis (IVT) in combination with endovascular thrombectomy (EVT) for the treatment of large vessel occlusion acute ischemic stroke has been evaluated exclusively outside the US, in randomized clinical trials which failed to demonstrate non-inferiority of skipping IVT. Because practice patterns and IVT dosing differ within the US, and prior observational US-based cohorts suggested improved clinical outcomes in patients who received IVT before EVT, a US-based evaluation is needed. This is a quasi-experimental study of a large US cohort using a regression discontinuity design (RDD) that enables the estimation of causal effects when randomization is not feasible.

ARISE II Consensus on the Management of Intracranial Atherosclerotic Disease.

Intracranial atherosclerotic disease (ICAD) is one of the leading causes of ischemic stroke worldwide. Despite advances in its diagnosis and management, there is no clear consensus on best practices to manage ICAD. This report summarizes the ARISE II (Roundtable Discussion With Industry and Stroke Experts) consensus in treating ICAD.

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.

SUMMIT MAX: A Randomized Trial of the Super Large Bore HiPoint Reperfusion System Versus Vecta System for Aspiration Thrombectomy.

Background: Rapid and complete recanalization is a primary goal in the endovascular treatment of large vessel occlusion stroke. The effectiveness and safety of super large bore aspiration catheters (0.088″ inner diameter) for the treatment of large vessel occlusion stroke have not been demonstrated in a randomized trial.

Edaravone dexborneol for the treatment of acute ischemic stroke: A systematic review and meta-analysis.

BackgroundEdaravone dexborneol has been developed as a novel neuroprotective agent and showed a promising result in treatment of stroke. The current meta-analysis aimed to assess the feasibility and efficacy of the edaravone dexborneol in the treatment of stroke.MethodWe performed a systematic review and meta-analysis of literature in four electronic databases.

Addressing Heterogeneity in the Large-Core Trials: A Case for Standardized Imaging Analysis.

Infarct detection is critically dependent on the imaging modality that is used and the criteria for defining tissue infarction. The recent trials of large-core thrombectomy used heterogeneous imaging methods to identify patients with large ischemic cores. Moreover, the Alberta Stroke Program Early CT Score methodology was not harmonized between the trials.

Stroke risk prediction in symptomatic anterior circulation ICAD: Analysis of regional QMRA flow from the MYRIAD study.

Background: Intracranial atherosclerotic disease (ICAD) remains a major source of stroke world-wide, with high recurrence risk. Prior evaluation of posterior circulation ICAD patients enrolled in the prospective VERiTAS and MYRIAD studies revealed regional hypoperfusion assessed by large vessel flow measurements using quantitative MRA (QMRA) predicts subsequent stroke risk. We examined whether a similar approach to regional flow assessment predicted stroke risk in anterior circulation ICAD patients in MYRIAD.

Endovascular thrombectomy in acute stroke with a large ischemic core: A systematic review and meta-analysis of randomized controlled trials.

Background: Endovascular thrombectomy (EVT) is the standard treatment for acute ischemic stroke due to internal carotid artery (ICA) or middle cerebral artery (MCA) M1 occlusion with a small ischemic core. However, the effect of EVT on acute stroke with a large ischemic core remains unclear. This study aimed to evaluate the association of EVT plus medical care versus medical care alone with outcomes in patients with acute stroke and a large ischemic core due to ICA or MCA M1 occlusion.

Incomplete reperfusion and the presence of distal emboli in predicting clinical outcome after endovascular thrombectomy.

Objectives: To explore the relationship between final expanded treatment in cerebral infarction (eTICI) score and the presence or absence of distal emboli on final angiography on clinical outcome after endovascular thrombectomy (EVT) for acute ischaemic stroke (AIS). Persistent distal emboli on angiography are commonly noted, yet not all patients with intermediate eTICI scores demonstrate clear angiographic emboli, raising the possibility that these angiographic differences may correlate with distinct mechanisms of 'no-reflow'. Therefore, we sought to better understand the potential clinical impact of such angiographic markers in cases of incomplete reperfusion.