Predictors of Futile Recanalization After Endovascular Therapy for Acute Large Vessel Occlusive Intracranial Atherosclerosis: A Secondary Analysis of RESCUE-ICAS.

Background And Objectives: Futile recanalization in endovascular thrombectomy (EVT) occurs when recanalization is achieved but patients nevertheless experience a poor functional outcome. Variables associated with futile recanalization after endovascular therapy in intracranial atherosclerosis-related large vessel occlusion have not been previously described.

Methods: This was a secondary analysis of Registry of Emergent Large Vessel Occlusion due to Intracranial Stenosis (RESCUE-ICAS), a multicenter prospective observational cohort study conducted at 25 EVT-capable centers in North America, Europe, and Asia.

A single-center study of the RED 72 reperfusion catheter with SENDit technology in proximal large vessel occlusions.

BackgroundDelivery assist catheters are a new class of devices designed to better navigate tortuous segments and reach the clot interface in mechanical thrombectomy. The RED 72 aspiration catheter with SENDit technology is one such example. SENDit is a novel tapered obturator used instead of a microcatheter to bring up the RED 72.

Factors associated with post-dural puncture headache: A single-center retrospective review.

ObjectivePost-dural puncture headache (PDPH) is potential complication after procedures with dural puncture. This study analyzes how patient and procedural factors are related to the development of PDPH.MethodsDemographic and procedural data were extracted from the electronic medical record in patients undergoing a dural puncture procedure from 1/1/2020 to 12/31/2020.

Radial vs femoral access in mechanical thrombectomy: Implications for clinical practice - A systematic review and meta-analysis.

Background: Multiple studies have demonstrated lower access complications associated with transradial access (TRA) compared to transfemoral access (TFA) for endovascular procedures. The feasibility and safety of TRA versus TFA for mechanical thrombectomy (MT) for large vessel occlusions in acute ischemic stroke (AIS) is a subject of current debate.

Methods: We performed a systematic search in four databases.

In search of real-world cerebroprotection: An institutional perspective and review of the literature.

PurposeIntravenous (IV) thrombolysis and mechanical thrombectomy remain the only interventions shown to improve outcomes in acute ischemic stroke. This study evaluated the impact of commonly administered intraprocedural medications, each with putative neuroprotective mechanisms backed up by basic science literature, on outcomes in mechanical thrombectomy for acute ischemic stroke.Methods and ResultsA retrospective review of 284 patients utilizing univariate and multivariate analysis evaluated associations between administration of IV/intra-arterial (IA) tissue plasminogen activator (tPA), IV/IA heparin and IA verapamil as well as key outcomes: recanalization success, postoperative hemorrhage, and 90-day functional status.

Increased brain volume in idiopathic intracranial hypertension: Association with intracranial pressure and papilledema severity.

Background: The pathophysiology responsible for IIH and raised intracranial pressure remains incompletely understood. It is similarly unclear how brain volume in IIH might contribute to increased intracranial pressure and/or papilledema.

Methods: IIH patients and a set of age-matched controls were retrospectively identified from our healthcare institution.

Clinical characteristics and management of gunshot wound injuries to the peripheral nerves.

Peripheral nerve injuries (PNI) secondary to gunshot wounds (GSW) are a unique category of neurologic injury that can cause morbidity in young, otherwise healthy individuals, occurring in 25-36% of GSWs. The management of these injuries is understudied and varies throughout the literature. To characterize the clinical characteristics, management, and outcomes of peripheral nerve injury secondary to GSWs through a retrospective review of a single urban Level 1 trauma center's experience.

Late pandemic COVID-19 positivity at the time of thrombectomy is associated with poor outcomes and tandem carotid pathology.

Objectives: COVID-19 is an independent risk factor for ischemic stroke. Studies from early in the pandemic show increased rates of unfavorable recanalization, poor outcomes, and mortality in patients who were COVID-19 positive at the time of mechanical thrombectomy. However, there are currently no studies examining these parameters during the later pandemic when circulating variants were less virulent.

The imaging presentation of head and neck oncologic emergencies.

This review describes the radiographic findings in emergencies of head and neck cancers (HNCs) in both undiagnosed and previously treated patients, with an emphasis on the temporal urgency of each presentation and in association with the relevant clinical presentation and necessary treatments to enhance understanding and recognition. The various presentations of HNC will be described by the organ system of their presenting complaint. The development and complications of each will be elaborated, with a focus on the clinical presentation in the emergency department and the imaging findings that are critical to recognize in making the diagnosis.

Role of Funiculitis in Sonographic Diagnosis of Acute Epididymitis.

Ultrasonography is the gold standard for diagnosing acute epididymitis. However, it is not well understood if the simultaneous inflammation of the spermatic cord (funiculitis) is a helpful imaging finding in diagnosing acute epididymitis. This study aimed to investigate the frequency of funiculitis in cases of epididymitis and determine its sensitivity and specificity.

Outcomes of Adjunct Emergent Stenting Versus Mechanical Thrombectomy Alone: The RESCUE-ICAS Registry.

Background: Underlying intracranial stenosis is the most common cause of failed mechanical thrombectomy in patients with acute ischemic stroke with large vessel occlusion. Adjunct emergent stenting is sometimes performed to improve or maintain reperfusion, despite limited data regarding its safety or efficacy.

Methods: We conducted a prospective multicenter observational international cohort study.

Outcomes of Pulsatile Tinnitus After Cerebral Venous Sinus Stenting: Systematic Review and Pooled Analysis of 616 Patients.

Background: Pulsatile tinnitus (PT) is a debilitating condition with substantial morbidity related to quality of life. Cerebral venous sinus stenosis has recently emerged as a noninfrequent cause of PT, either in the setting of concurrent idiopathic intracranial hypertension (IIH) or due to primary venous stenosis. Venous sinus stenting (VSS) is an endovascular technique that can be used to treat venous stenosis.

Endovascular therapy versus medical management for ischemic stroke presenting beyond 24 hours: Systematic review and meta-analysis.

Objective: The ideal management for ischemic stroke presenting in the very late time window, or beyond 24 hours from onset, is poorly understood. It is unknown if endovascular therapy (EVT) or best medical management (MM) is associated with superior clinical outcomes.

Methods: A systematic literature and comparative meta-analysis was completed to evaluate the safety and efficacy of EVT vs.

Total brain volume is associated with severity of transverse sinus stenosis in idiopathic intracranial hypertension.

Background: Idiopathic intracranial hypertension (IIH) is a complex neurological condition characterized by symptoms of increased intracranial pressure of unclear etiology. While transverse sinus stenosis (TSS) is often present in patients with IIH, how and why it occurs remains unclear.

Methods: IIH patients and a set of age-matched normal controls were identified from our single-center tertiary care institution from 2016 to 2024.

Association of Extent of Transverse Sinus Stenosis With Cerebral Glymphatic Clearance in Patients With Idiopathic Intracranial Hypertension.

Background And Objectives: Idiopathic intracranial hypertension (IIH) is a neurologic disorder characterized by symptoms of elevated intracranial pressure in the absence of a clear cause. There is a developing theory that IIH may, in part, be related to abnormal cerebral glymphatic clearance. In addition, transverse sinus stenosis (TSS) is a common finding in IIH of unclear pathophysiologic significance.

Improved Cerebral Glymphatic Flow after Transvenous Embolization of CSF-Venous Fistula.

Spontaneous intracranial hypotension is characterized by symptoms of low intracranial CSF volume due to various mechanisms of CSF leakage. One such mechanism is a CSF-venous fistula, treatable with transvenous embolization resulting in substantial radiographic and clinical improvement. However, the exact mechanisms underlying these improvements, including the potential involvement of the glymphatic system, remain unclear.

Stroke emboli from patients with atrial fibrillation enriched with neutrophil extracellular traps.

Background: Recent literature has demonstrated remarkable heterogeneity in the composition of acute ischemic stroke (AIS) emboli, which may impact susceptibility to therapy.

Objectives: In this study, we explored differences in proteomic composition of retrieved embolic material from patients with stroke with and without atrial fibrillation (AF) (AF+ and AF-, respectively).

Methods: The full proteome of retrieved thromboembolic material from 24 patients with AIS was obtained by mass spectrometry.

Histone content, and thus DNA content, is associated with differential in vitro lysis of acute ischemic stroke clots.

Background: Fibrin, von Willebrand factor, and extracellular DNA from neutrophil extracellular traps all contribute to acute ischemic stroke thrombus integrity.

Objectives: In this study, we explored how the proteomic composition of retrieved thromboemboli relates to susceptibility to lysis with distinct thrombolytics.

Methods: Twenty-six retrieved stroke thromboemboli were portioned into 4 segments, with each subjected to 1 hour of in vitro lysis at 37 °C in 1 of 4 solutions: tissue plasminogen activator (tPA), tPA + von Willebrand factor-cleaving ADAMTS-13, tPA + DNA-cleaving deoxyribonuclease (DNase) I, and all 3 enzymes.

Diffusion-Weighted Imaging Reveals Impaired Glymphatic Clearance in Idiopathic Intracranial Hypertension.

Background And Purpose: The pathophysiology underlying idiopathic intracranial hypertension (IIH) remains incompletely understood. While one theory postulates impaired cerebral glymphatic clearance in IIH, there is a paucity of methods to quantify glymphatic activity in human brains. The purpose of this study was to use advanced diffusion-weighed imaging to evaluate the glymphatic clearance of IIH patients and how it may relate to clinical severity.

Efficacy of transvenous embolization of CSF-venous fistula in spontaneous intracranial hypotension: Case-series.

Background: Spontaneous intracranial hypotension is a debilitating neurological condition which can be caused by a cerebrospinal fluid-venous fistula. Transvenous embolization is a promising technique to provide minimally invasive yet durable treatment.

Methods: A retrospective single-center case series was performed on all patients who underwent transvenous embolization of a cerebrospinal fluid (CSF)-venous fistula.

Ischemic Stroke Thrombus Perviousness Is Associated with Distinguishable Proteomic Features and Susceptibility to ADAMTS13-Augmented Thrombolysis.

Background And Purpose: Perviousness is the differential attenuation on CT of an intracranial arterial occlusive thrombus before and after IV contrast administration. While perviousness/permeability has been shown to be related to various clinical outcomes and reflects histopathologic composition, it remains unclear whether perviousness is also associated with differences in proteomic composition.

Materials And Methods: Retrieved clots from 59 patients were evaluated with quantitative mass spectrometry.

Symptomatic carotid artery intraluminal thrombus: risk of medical management failure and distal embolization.

Background: Carotid artery intraluminal thrombus (ILT), or free-floating thrombus, is an uncommon cerebrovascular entity with considerable equipoise regarding its clinical management. Likewise, in patients treated with medical management (MM), distal embolization and/or intracranial hemorrhage (ICH) may still occur.

Methods: All patients with symptomatic ILT from 2016 to 2023 were identified from our tertiary care institution.