Cerebral small vessel disease does not impair leptomeningeal collateral supply in large-vessel occlusion - Results from quantitative collateral mapping with MRI.

We hypothesized that cerebral small vessel disease (CSVD) burden might not relevantly affect leptomeningeal collateral supply in patients with acute ischemic stroke (AIS) due to large-vessel occlusion (LVO). In n = 154 patients with anterior circulation LVO, CSVD imaging markers (white matter hyperintensities [WMH], lacunes, cerebral microbleeds and enlarged perivascular spaces) were assessed with MRI, using established criteria. Besides the extent of WMH, assessed using total Fazekas sum score, overall CSVD burden was determined with a total CSVD summary score ranging from 0-4.

"I didn't even wonder why I was on the floor" - mixed methods exploration of stroke awareness and help-seeking behaviour at stroke symptom onset.

Introduction: To better target stroke awareness efforts (pre and post first stroke) and thereby decrease the time window for help-seeking, this study aims to assess quantitatively whether stroke awareness is associated with appropriate help-seeking at symptom onset, and to investigate qualitatively why this may (not) be the case.

Methods: This study conducted in a German regional stroke network comprises a convergent quantitative-dominant, hypothesis-driven mixed methods design including 462 quantitative patient questionnaires combined with qualitative interviews with 28 patients and seven relatives. Quantitative associations were identified using Pearson's correlation analysis.

Association of Carotid Artery Disease with Collateralization and Infarct Growth in Patients with Acute Middle Cerebral Artery Occlusion.

Background And Purpose: Collaterals are important in large vessel occlusions (LVO), but the role of carotid artery disease (CAD) in this context remains unclear. This study aimed to investigate the impact of CAD on intracranial collateralization and infarct growth after thrombectomy in LVO.

Materials And Methods: All patients who underwent thrombectomy due to M1 segment occlusion from 01/2015 to 12/2021 were retrospectively included.

MR microscopy to assess clot composition following mechanical thrombectomy predicts recanalization and clinical outcome.

Background: Mechanical thrombectomy (MT) is the standard of care for patients with a stroke and large vessel occlusion. Clot composition is not routinely assessed in clinical practice as no specific diagnostic value is attributed to it, and MT is performed in a standardized 'non-personalized' approach. Whether different clot compositions are associated with intrinsic likelihoods of recanalization success or treatment outcome is unknown.

Occupational radiation exposure of neurointerventionalists during endovascular stroke treatment.

Background: Radiological neuro-interventions, especially endovascular stroke treatment (EST), are increasing in case numbers worldwide with increasing occupational radiation exposure. Aim of this study was to define the radiation exposure of neurointerventionalists (NI) during EST and to compare the accumulated dose reaching the left arm with the left temple.

Methods: This is a prospective observational study in a tertiary stroke center conducted between 11/2021 and 07/2022.

Clinical outcome, recanalization success, and time metrics in drip-and-ship vs. drive-the-doctor: A retrospective analysis of the HEI-LU-Stroke registry.

Purpose: This study aimed at comparing clinical outcome, recanalization success and time metrics in the "drip and ship" (DS) vs. "drive the doctor" (DD) concept in a comparable setting.

Methods: This is a retrospective analysis of thrombectomy registries of a comprehensive stroke center (CSC) and a thrombectomy-capable stroke center (TSC).

Deep Learning-based Assessment of Internal Carotid Artery Anatomy to Predict Difficult Intracranial Access in Endovascular Recanalization of Acute Ischemic Stroke.

Background: Endovascular thrombectomy (EVT) duration is an important predictor for neurological outcome. Recently it was shown that an angle of ≤ 90° of the internal carotid artery (ICA) is predictive for longer EVT duration. As manual angle measurement is not trivial and time-consuming, deep learning (DL) could help identifying difficult EVT cases in advance.

[Comparison of acute stroke care pathways-A qualitative multicenter study in three referring hospitals of a stroke network].

Background: In stroke networks, hospitals that do not provide thrombectomy (referring hospitals) refer patients to specialized hospitals (receiving hospitals) for this specific intervention. In order to improve the access and management of thrombectomy, the focus of research needs to be not only on the receiving hospitals but also on the prior stroke care pathways in referring hospitals.

Objective: The purpose of this study was to investigate the stroke care pathways in different referring hospitals as well as the advantages and disadvantages associated with these pathways.

Effect of intra-arterial nimodipine on iatrogenic vasospasms during endovascular stroke treatment - angiographic resolution and infarct growth in follow-up imaging.

Purpose: The treatment of vasospasms during endovascular stroke treatment (EST) with intra-arterial nimodipine (NM) is routinely performed. However, the efficacy of resolving iatrogenic vasospasms during the angiographic intervention and the infarct development in follow-up imaging after EST has not been studied yet.

Methods: Retrospective single-center analysis of patients receiving EST for anterior circulation vessel occlusion between 01/2015 and 12/2021.

Exact Basilar Artery Occlusion Location Indicates Stroke Etiology and Recanalization Success in Patients Eligible for Endovascular Stroke Treatment.

Introduction: Endovascular stroke treatment (EST) is commonly performed for acute basilar artery occlusion (BAO). We aimed to identify the role of the exact location of BAO in patients receiving EST regarding the stroke etiology, recanalization success and prediction of favorable clinical outcome.

Methods: Retrospective analysis of 191 consecutive patients treated for BAO with EST from 01/2013 until 06/2021 in a tertiary stroke center.

Reperfusion Without Functional Independence in Late Presentation of Stroke With Large Vessel Occlusion.

Background: Reperfusion without functional independence (RFI) is an undesired outcome following thrombectomy in acute ischemic stroke. The primary objective was to evaluate, in patients presenting with proximal anterior circulation occlusion stroke in the extended time window, whether selection with computed tomography (CT) perfusion or magnetic resonance imaging is associated with RFI, mortality, or symptomatic intracranial hemorrhage (sICH) compared with noncontrast CT selected patients.

Methods: The CLEAR study (CT for Late Endovascular Reperfusion) was a multicenter, retrospective cohort study of stroke patients undergoing thrombectomy in the extended time window.

Aortic Arch Variations and Supra-aortic Arterial Tortuosity in Stroke Patients Undergoing Thrombectomy : Retrospective Analysis of 1705 Cases.

Purpose: Unfavorable vascular anatomy can impede thrombectomy in patients with acute ischemic stroke. The aim of this study was to determine the prevalence of aortic arch types, aortic arch branching patterns and supra-aortic arterial tortuosity in stroke patients with large vessel occlusion.

Methods: Computed tomography (CT) and magnetic resonance (MR) images of all stroke patients in an institutional thrombectomy registry were retrospectively reviewed.

Leaving the day behind: endovascular therapy beyond 24 h in acute stroke of the anterior and posterior circulation.

Background: There is little evidence of endovascular therapy (EVT) being performed in acute ischemic stroke beyond 24 h, and that evidence is limited to anterior circulation stroke.

Objective: To extend evidence of efficacy and safety of EVT after more than 24 h in both anterior and posterior circulation stroke.

Methods: Local, prospectively collected registries were screened for patients with acute ischemic stroke and large-vessel occlusion who had received either EVT > 24 h after last-seen-well but <24 h after symptom recognition (EVT) or EVT > 24 h since first (definitive) symptom recognition (EVT).

Transferring neurointerventionalists saves time compared with interhospital transfer of stroke patients for endovascular thrombectomy: a collaborative pooled analysis of 1001 patients (EVEREST).

Background: Interhospital transfer of stroke patients (drip and ship concept) is associated with longer treatment times compared with primary admission to a comprehensive stroke center (mothership concept). In recent years, studies on a novel concept of performing endovascular thrombectomy (EVT) at external hospitals (EXT) by transferring neurointerventionalists, instead of patients, have been published. This collaborative study aimed at answering the question of whether EXT saves time in the workflow of acute stroke treatment across various geographical regions.

Patient Pathways During Acute in-Hospital Stroke Treatment: A Qualitative Multi-Method Study.

Introduction: Patients experiencing acute ischemic stroke should access treatment as soon as possible to increase their chances for survival without severe disability. Given the increased complexity of stroke treatment from the provider and patient perspective, this study provides an overview of the pathways followed by stroke patients during in-hospital treatment.

Methods: This qualitative study combined twenty-seven observations and fifteen staff interviews at a German comprehensive stroke center providing endovascular treatment ("EVT hospital").

A Trial Patch to Sustainable Development: Perspectives from Extracurricular Activities of Elementary Schools in Turkey.

Sustainable development (SD) and science education have become interwoven categorical issues under the name of science education for sustainable development (SESD). Education can play a crucial role in merging the dimensions of SD as ecology, economy, and energy, along with society in a united holistic goal. Furthermore, it can provide the necessary motivation and self-fulfillment for individuals and communities.

Flow Diverter Treatment of Ruptured Basilar Artery Perforator Aneurysms : A Multicenter Experience.

Purpose: Ruptured basilar artery perforator aneurysms (BAPAs) represent a very rare cause of subarachnoid hemorrhage and an under-reported subtype of cerebral aneurysm. There is no consensus for the optimal treatment strategy (conservative vs. surgical vs.

Role of diabetes in collateral status assessed in CT perfusion-derived dynamic CTA in anterior circulation stroke.

Purpose: Diabetes is associated with vascular dysfunction potentially impairing collateral recruitment in acute ischemic stroke. This retrospective study aimed at analyzing the impact of diabetes on collateralization assessed on dynamic CTA.

Methods: Collaterals were retrospectively assessed on CT perfusion-derived dynamic CTA according to the mCTA score by Menon in a cohort of patients with an acute occlusion of the M1 segment or carotid T.

Noncontrast Computed Tomography vs Computed Tomography Perfusion or Magnetic Resonance Imaging Selection in Late Presentation of Stroke With Large-Vessel Occlusion.

Importance: Advanced imaging for patient selection in mechanical thrombectomy is not widely available.

Objective: To compare the clinical outcomes of patients selected for mechanical thrombectomy by noncontrast computed tomography (CT) vs those selected by computed tomography perfusion (CTP) or magnetic resonance imaging (MRI) in the extended time window.

Design, Setting, And Participants: This multinational cohort study included consecutive patients with proximal anterior circulation occlusion stroke presenting within 6 to 24 hours of time last seen well from January 2014 to December 2020.

Sedation Mode During Endovascular Stroke Treatment in the Posterior Circulation-Is Conscious Sedation for Eligible Patients Feasible?

To compare safety and efficacy of conscious sedation (CS) vs. general anesthesia (GA) in endovascular stroke treatment (EST) of the posterior circulation (PC). Retrospective single-center analysis of patients receiving EST for large-vessel occlusion (LVO) in PC between January 2015 and November 2020.

"But it's a nice compromise" - Qualitative multi-centre study of barriers and facilitators to acute telestroke cooperation in a regional stroke network.

Background: Telemedical services can be used to complement on-site services when demand for specialists exceeds supply or when specialists are not evenly distributed across health systems. Using stroke as an example, this study aimed to explore how patients and staff experience telestroke cooperation in a stroke network in Germany.

Methods: We conducted a qualitative multi-method and multi-centre study combining 32 non-participant observations at one hub and four spoke hospitals with 26 semi-structured interviews with hub and spoke staff as well as stroke patients and relatives.

Deep Learning-Based Automated Thrombolysis in Cerebral Infarction Scoring: A Timely Proof-of-Principle Study.

Background And Purpose: Mechanical thrombectomy is an established procedure for treatment of acute ischemic stroke. Mechanical thrombectomy success is commonly assessed by the Thrombolysis in Cerebral Infarction (TICI) score, assigned by visual inspection of X-ray digital subtraction angiography data. However, expert-based TICI scoring is highly observer-dependent.

Efficacy and safety of bridging thrombolysis initiated before transfer in a drip-and-ship stroke service.

Objective: Data regarding the efficacy and safety of bridging thrombolysis (BT) initiated before transfer for evaluation of endovascular therapy is heterogeneous. We, therefore, analyse efficacy and safety of BT in patients treated within a drip-and-ship stroke service.

Methods: Consecutive adult patients suffering from acute ischaemic stroke and large-vessel occlusions (LVO) transferred to our comprehensive stroke centre for evaluation of endovascular therapy in 2017-2020 were identified from a local prospective stroke database and categorised according to BT and no-BT.

What is the impact of head movement on automated CT perfusion mismatch evaluation in acute ischemic stroke?

Objectives: Automated CT perfusion mismatch assessment is an established treatment decision tool in acute ischemic stroke. However, the reliability of this method in patients with head motion is unclear. We therefore sought to evaluate the influence of head movement on automated CT perfusion mismatch evaluation.