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).

Should We Stop Endovascular Treatment of M2 Occlusions?: A Critical Look at Recent Evidence.

Medium vessel occlusions represent a substantial proportion of patients with acute ischemic stroke. Recently presented randomized controlled trials, ESCAPE-MeVO (Endovascular Treatment to Improve Outcomes for Medium Vessel Occlusions), DISTAL (Endovascular Therapy Plus Best Medical Treatment [BMT] Versus BMT Alone for Medium Distal Vessel Occlusion Stroke), and DISCOUNT (Evaluation of Mechanical Thrombectomy in Acute Ischemic Stroke Related to a Distal Arterial Occlusion), did not demonstrate a clinical benefit of endovascular thrombectomy in distal and medium vessel occlusions, potentially generating uncertainty about optimal treatment strategies for medium vessel occlusions. Specifically, these results may lead clinicians to hesitate in performing endovascular thrombectomy for M2 occlusions, despite prior evidence indicating benefit in this subgroup.

Cranial bypass for occlusive carotid dissection in osteogenesis imperfecta: illustrative case.

Background: Osteogenesis imperfecta (OI) is a connective tissue disorder characterized by fragile bones and vascular fragility, increasing the risk of vessel dissection and potentially complicating endovascular intervention. The authors present the first case of cranial bypass in a patient with OI.

Observations: A 38-year-old male with OI type I presented with a symptomatic left internal carotid artery (ICA) occlusive dissection managed with endovascular revascularization and stenting.

Flow diverter stent for the treatment of ruptured distal anterior cerebral artery: A retrospective multicenter analysis from CRETA registry.

BackgroundData on off-label use of flow diverter for ruptured distal anterior cerebral artery aneurysms (rDACAAs) are limited. The purpose of the present study is to evaluate the efficacy and safety of flow diversion for rDACAAs in a large multicenter cohort.MethodsA retrospective observational study on consecutive patients who were treated with flow diversion for rDACAAs at 8 centers in 4 countries was performed.

Fluoroscopy-Guided Removal of Tethered Surgical Drain via Guidewire Electrification: A Case Report.

Tethered postoperative drains are not uncommon complications that often require open removal in the operating room, which can increase risks of surgical site infection as well as length of hospitalization. We present a novel method of tethered drain removal through guidewire electrification. A retained deep drain following a posterior cervical laminectomy and fusion was identified after failed manual removal.

Safety of emergent intracranial stenting after thrombolysis: a multicenter matched analysis.

Background And Purpose: In patients with acute large vessel occlusion (LVO) of the MCA and underlying intracranial artery stenosis (ICAS), rescue stenting (RS) has been associated with better angiographic outcomes and higher rates of functional independence compared to mechanical thrombectomy (MT) alone. However, uncertainty exists regarding safety of RS in patients at higher risk for intracranial bleeding.The primary aim of this retrospective multicenter study was to compare safety outcomes between patients with acute ICAS-LVO of the MCA who underwent MT and RS with or without prior intravenous thrombolysis (IVT).

The Silk Vista Baby Study: A Multicenter Aneurysm Report From North America and Europe.

Background And Objectives: The Silk Vista Baby (SVB) flow diverter (FD) stent (Balt SAS) is the first device designed for treating distally located brain aneurysms. It can be delivered through a 0.017-inch ID microcatheter, enabling access to small, distal vessels.

Follow-up Imaging in Treated and Untreated Cerebral Aneurysms.

Imaging follow-up is an established component of intracranial aneurysm management that allows ongoing assessment of rupture risk and timely intervention to maintain protection from bleeding. Yet the frequency, duration, and imaging modality for follow-up vary widely. This review outlines contemporary imaging techniques and practice for follow-up of treated and untreated aneurysms, highlighting existing knowledge gaps and technical limitations that limit standardization.

Clinical Management of Cerebral Aneurysms-Endoluminal.

Definitive endoluminal reconstruction, widely known as flow diversion, revolutionized treatment of brain aneurysms. A range of targets, by location, size, etiology, and acuity, can be cured with an excellent risk/benefit profile. Requirement for effective antiplatelet state is balanced with superior treatment durability.

Clinical Management of Cerebral Aneurysms-: Endosaccular.

Although the concept of treating cerebral aneurysms by filling the sac from the inside (endosaccular) started many years ago first with detachable balloons and then coils, the use of a single metallic resheathable device acting as a flow disruptor is a much more recent innovation. The most studied device among these is certainly the WEB, which became part of standard clinical practice for treatment of wide-neck bifurcation aneurysms. This study reviews the most important features of the WEB device with a short summary of the most important literature.

The Role of AI-driven Volumetric Aneurysm Analysis in the Management of Cerebral Aneurysms.

This article looks at the current state of aneurysm risk modeling, exploring the limitations of linear measurement. It reviews articles using Food and Drug Administration (FDA)-approved artificial intelligence-driven volumetric measurement tools both for evaluating potential aneurysm growth in patients being managed conservatively as well as in assessing morphologic change prerupture and postrupture. The challenges of defining the aneurysm boundary are explored, and a novel definition of aneurysm/parent artery interface is proposed.

Prognostic value of cerebral venous outflow profiles for outcomes prediction following reperfusion therapy in acute ischemic stroke: a meta-analysis.

Background: Recent studies have suggested that favorable venous outflow (VO) may be a promising imaging biomarker to predict clinical outcomes following reperfusion therapy in patients with acute ischemic stroke caused by large vessel occlusion (AIS-LVO).

Methods: A comprehensive literature search was conducted in PubMed, Scopus, WOS, and Cochrane to identify studies that evaluated VO profiles, assessed using the Cortical Vein Opacification Score (COVES). The risk ratio (RR) and 95% confidence interval (CI) for the outcomes, including functional independence, assessed by modified rankin scale at 90 days (mRS 0-2), hemorrhagic infarction, parenchymal hematoma, 90-day mortality, intracranial hemorrhage (ICH), and symptomatic ICH (sICH), were calculated and analyzed using the 'meta' package in R version 4.

Silk Vista Baby for the treatment of distal anterior cerebral artery aneurysms.

Purpose: Treating small-caliber vessel aneurysms with flow diverters poses challenges due to narrow luminal diameters and tortuous vasculature, which complicate the navigation and deployment of conventional devices using standard microcatheters. The Silk Vista Baby (SVB, Balt, Montmorency, France) flow diverter was developed to treat intracranial aneurysms located in smaller vessels or more distal segments and is compatible with 0.017″ microcatheters.

Cerebral venography and manometry: indications and techniques for success.

Cerebral venography remains an important tool in neurovascular practice despite the increasing reliance on non-invasive imaging modalities such as CT and MR venography. While catheter venography is no longer the primary diagnostic method for cerebrovenous disorders, its role has evolved alongside the expanding indications for intracranial venous interventions. This work explores the indications, technical considerations, and clinical utility of catheter venography and venous manometry in the evaluation and management of cerebrovenous diseases.

Use of carotid web angioarchitecture in stratification of stroke risk.

Objective: To validate the carotid web (CW) risk stratification assessment described in previous works within a larger cohort of patients with symptomatic and incidentally found asymptomatic CWs.

Methods: A retrospective analysis of our institution's electronic medical records identified all patients with a diagnosis of CW from 2017 to 2024. We included symptomatic patients and those with asymptomatic CWs, that is, incidentally found webs without history of stroke or transient ischemic attack.

Early experience with the Drivewire 24: a newly FDA-approved steerable microwire.

Background: The Drivewire 24 (DW24) is a newly FDA-cleared 0.024 inch steerable guidewire. Its proximally controlled deflectable tip allows for intravascular steering to facilitate selective navigation of diagnostic or therapeutic catheters.

Intraoperative Evaluation of Dural Arteriovenous Fistula Obliteration Using FLOW 800 Hemodynamic Analysis.

Background And Objectives: Dural arteriovenous fistula (dAVF) surgery is a microsurgical procedure that requires confirmation of obliteration using formal cerebral angiography, but the lack of intraoperative angiogram or need for postoperative angiogram in some settings necessitates a search for alternative, less invasive methods to verify surgical success. This study evaluates the use of indocyanine green videoangiography FLOW 800 hemodynamic intraoperatively during cranial and spinal dAVF obliteration to confirm obliteration and predict surgical success.

Methods: A retrospective analysis was conducted using indocyanine green videoangiography FLOW 800 to intraoperatively measure 4 hemodynamic parameters-Delay Time, Speed, Time to Peak, and Rise Time-across venous drainage regions of interest pre/post-dAVF obliteration.

Macrowire-only direct aspiration first-pass technique for endovascular mechanical thrombectomy: Multicenter technical series using the 0.035″ aristotle Colossus wire.

BackgroundLarger "macrowires" may facilitate microcatheter-free delivery of large-bore aspiration catheters (ACs) for intracranial endovascular mechanical thrombectomy. We examined the safety and efficacy of the Aristotle Colossus Guidewire for this use.MethodsIn this retrospective analysis of prospective data from 12 institutions, we identified anterior circulation endovascular mechanical thrombectomy cases involving the Aristotle Colossus guidewire over a 12-month period.

Dual-Volume Cone Beam Computed Tomography Helps Elucidate Dural Arteriovenous Fistula Anatomy in the Presence of Tantalum-Opacified Liquid Embolic.

The presence of tantalum-opacified liquid embolic in incompletely treated dural arteriovenous fistulae (dAVFs) limits visibility of critically important angioarchitectural features. Modern cone beam computed tomography (CBCT) imaging can resolve the anatomy of dAVFs, allowing for a targeted embolic approach. However, distortion from beam hardening artifact is particularly limiting in CBCT imaging.

Pipeline embolization in patients with hemoglobinopathies: A cohort study.

IntroductionFlow diversion with the pipeline embolization device (PED) is an effective endovascular treatment. However, the metal surface's thrombogenicity and need for dual antiplatelet therapy (DAPT) are notable limitations. Few prior studies have reported specifically on flow diverters' safety in patients with hemoglobinopathies, a population at increased risk of thrombotic and hemorrhagic complications.

Innovating stroke care: A performance study of the ALGO smart pump in smart static mode.

Introduction: While revascularization rates have improved for mechanical thrombectomy (MT) in acute ischemic stroke, advancements in aspiration pumps have been limited. The ALGO Smart Pump (Von Vascular, Sunrise, FL) is a small on-field, operator-driven pump offering two aspiration modes: Adaptive Pulsatile Aspiration (APA™) Mode and a continuous 'Static' mode. This study evaluates the performance of the ALGO Smart Pump's Static Mode compared to a commercially available aspiration pump.

Higher risk of recurrence in partially thrombosed cerebral aneurysms post-WEB (Woven EndoBridge) device treatment: insights from the WorldWideWEB Consortium registry.

Background: The Woven EndoBridge (WEB) device is a prevalent treatment for intracranial aneurysms. While many studies have assessed the obliteration rate post-WEB embolization, few have focused on long-term outcomes in partially thrombosed aneurysms.

Objective: To assess whether partially thrombosed aneurysms are at higher risk of recurrence or retreatment following WEB embolization compared with non-thrombosed aneurysms.

Neurovascular Pathology in Intracranial Mucormycosis: Treatment by Cranial Bypass and Literature Review.

Background And Importance: Rhino-orbital cerebral mucormycosis (ROCM) is an aggressive fungal infection involving the paranasal sinuses, orbit, and intracranial cavity, with a propensity for vascular invasion. This can lead to complications such as internal carotid artery (ICA) thrombosis and occlusion, presenting major neurosurgical challenges. Although surgical debridement and antifungal therapy are the mainstays of treatment, cases with significant neurovascular involvement require specialized intervention.