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.

Antithrombotic therapy delays due to neurosurgical interventions after traumatic vertebral artery injuries increases stroke risk.

Purpose: Traumatic vertebral artery injury (TVAI) poses a risk for ischemic stroke, often requiring prompt antithrombotic therapy. However, when concomitant neurosurgical intervention is necessary, concerns regarding perioperative bleeding frequently lead to delays in antithrombotic initiation. This study evaluates the impact of delayed antithrombotic therapy on stroke risk in TVAI patients undergoing neurosurgical interventions.

Multicenter experience of the Monopoint reperfusion system in acute large vessel occlusion stroke thrombectomy.

Background: The Monopoint reperfusion system (Monopoint; Route 92 Medical, San Mateo, California, USA) is a large bore (0.088 or 0.070 inch inner diameter) aspiration thrombectomy platform designed to minimize ledge effect and improve neurovascular navigation and embolectomy.

Integrating perfusion imaging derived venous outflow and tissue-level collateral parameters in a comprehensive clinical model enhances prognostication in large vessel occlusion stroke.

Arterial inflow restoration and collateral status have been significantly correlated with functional outcomes in AIS-LVO patients undergoing mechanical thrombectomy (MT). CT perfusion imaging biomarkers, including prolonged venous transit (PVT), cerebral blood volume (CBV) index, and hypoperfusion intensity ratio (HIR), have emerged as reliable pretreatment adjunct parameters of comprehensive flow assessment. However, their absolute and comparative effectiveness in improving prognostic prediction remains unclear when used in conjunction with clinical and arterial inflow parameters.

Does immobilization of patients who underwent a reverse total shoulder arthroplasty for proximal humerus fracture affect postoperative outcomes?

Hypothesis And Background: Reverse total shoulder arthroplasty (rTSA) has become an increasingly popular treatment option for proximal humerus fractures (PHFs) in older patients. However, postoperatively, there lacks a universal protocol for the duration of arm immobilization in a sling. This retrospective review aims to determine whether the clinical outcomes of patients treated at our institution varied depending on their immobilization status following rTSA for PHF.

Evaluating the Role of Imaging Markers in Predicting Stroke Risk and Guiding Management After Vertebral Artery Injury: A Retrospective Study.

Background And Purpose: Traumatic vertebral artery injury is a severe consequence of head and neck trauma occurring when a disturbance to vessel wall architecture causes vessel dissection. These injuries come with a host of complications, including debilitating neurological damage, although patients are often asymptomatic upon presentation. Still, the screening recommendations, treatment strategies, and predicted outcomes of traumatic vertebral artery injury remain largely undefined.

Comparison between pipeline embolization device (PED) versus flow redirection endoluminal device (FRED) for intracranial aneurysms: a comprehensive systematic review and meta-analysis.

Objectives: The performance of the Pipeline Embolization Device (PED) and relatively newer double-layered Flow Re-Direction Endoluminal Device (FRED) have been studied for the treatment of intracranial aneurysms, but direct comparisons between PED and FRED are limited. The current systematic review aims at comparing the efficacy and safety of PED and FRED.

Methods: A systematic review of the literature was conducted according to the PRISMA guideline.

The relative cerebral blood volume (rCBV) <42% is independently associated with prolonged hospitalization in anterior circulation large vessel occlusion.

BackgroundThe pretreatment rCBV <42% lesion volume on CT Perfusion (CTP) has recently been shown to predict 90-day functional outcomes in stroke patients. However, its association with length of stay (LOS) has not yet been explored. This study aims to assess the relationship between rCBV <42% and prolonged LOS, defined as 7 days or longer.

Structure of Trials Assessing Endovascular Embolization for Brain Arteriovenous Malformations: A Scoping Review.

Recent advancements in embolic agents and endovascular techniques have led to increased interest in exploring endovascular embolization as a viable treatment for brain arteriovenous malformations. Several trials have investigated the use of various embolic agents for the treatment of arteriovenous malformations (AVMs) endovascularly. However, the reporting outcomes and design elements in these studies are heterogeneous and include inclusion/exclusion criteria and evaluated endpoints.

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.

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.

Diffusion Tensor Imaging Analysis Along the Perivascular Space (DTI-ALPS) in Normal Pressure Hydrocephalus: A Review of Recent Advances.

Glymphatic dysfunction is linked to neurodegenerative diseases, and imaging markers of this dysfunction may aid in diagnosis and prognosis. Glymphatic dysfunction has been proposed as a key mechanism in the pathogenesis of normal pressure hydrocephalus (NPH). Advanced magnetic resonance techniques, especially diffusion tensor imaging, have been used to evaluate glymphatic function.

Atrial fibrillation is associated with lower likelihood of first-pass effect in thrombectomy for medium vessel occlusion acute ischemic strokes.

BackgroundFirst-pass effect (FPE) in endovascular thrombectomy (EVT) is strongly associated with clinically favorable outcomes. Atrial fibrillation (AF)-related strokes have been shown to be associated with greater rates of FPE in acute large vessel occlusions (LVOs). In this study, we aimed to assess the association between AF and achieving FPE in medium vessel occlusions (MeVOs).

Prolonged Venous Transit as a Superior Predictor of Functional Outcomes in Successfully Reperfused Large Vessel Occlusions: Comparative Analysis With Cerebral Blood Volume Index and Hypoperfusion Intensity Ratio.

Background: Collateral status plays a crucial role in outcomes after acute ischemic stroke due to large vessel occlusion. Tissue-level collaterals and venous outflow are key components following mechanical thrombectomy. This study evaluates the predictive performance of prolonged venous transit (PVT), cerebral blood volume index, and hypoperfusion intensity ratio in determining 90-day functional outcomes.

Augmented Reality in Minimally Invasive Spinal Interventions: Current Use and Future Directions.

Minimally invasive spinal interventions have a steep learning curve from a technical perspective, as they are associated with performing precise maneuvers where the surgeon may or may not have direct or full visualization of the patient's anatomy. Augmented reality (AR), where models of the patient's anatomy can be overlaid within the surgical field, has offered promise to improve the operative experience. We present a qualitative review of recent advances in applications of AR technology in minimally invasive spinal procedures in both clinical and educational settings.

A Scoping Review of the Methodologies and Reporting Standards in Recent Applications of Artificial Intelligence in Radiomics for Chronic Subdural Hematoma Imaging.

Chronic subdural hematoma (cSDH) is the accumulation of blood in the subdural space, primarily affecting older adults. Radiomics is a rapidly emerging field that integrates artificial intelligence (AI) with imaging to improve diagnostic precision and prognostic predictions, including hematoma expansion and recurrence. However, the heterogeneous study designs, endpoints, and reporting standards limit its clinical application.

Prevalence of High-Risk CTA-Based Carotid Plaque-RADS Subtypes in Patients With Embolic Stroke of Undetermined Source.

Background: A modified computed tomography angiography (CTA)-based Carotid Plaque Reporting and Data System (Plaque-RADS) classification was applied to a cohort of patients with embolic stroke of undetermined source to test whether high-risk Plaque-RADS subtypes are more prevalent on the ipsilateral side of stroke. With the widespread use of CTA for stroke evaluation, a CTA-based Plaque-RADS would be valuable for generalizability.

Methods: A retrospective observational cross-sectional study was conducted at a single integrated health system comprised of 3 hospitals with a comprehensive stroke center between October 1, 2015, and April 1, 2017.

Larger Perfusion Mismatch Volume Is Associated With Longer Hospital Length of Stay in Medium Vessel Occlusion Stroke.

Background And Purpose: Prolonged length of stay (LOS) following a stroke is associated with unfavorable clinical outcomes. Factors predicting LOS in medium vessel occlusion (MeVO), impacting up to 40% of acute ischemic stroke (AIS) cases, remain underexplored. This study aims to investigate the predictors of LOS in AIS-MeVO.

Cerebral blood volume index in the era of thrombectomy-treated large and medium vessel ischemic strokes.

The cerebral blood volume index (CBV index) is a perfusion-based marker of collateral status. Several real-world data analyses from observational stroke cohorts have established relationships between this parameter and a range of favorable and unfavorable stroke outcomes. In this review, an overview is provided of the CBV index, within the context of thrombectomy-treated large vessel and medium vessel occlusion ischemic strokes.

White Epidermoid Cyst: An Illustrative Case.

White epidermoid cysts are a rare type of epidermoid cyst that appears hyperintense on T1 weighted magnetic resonance imaging (MRI) and are known for their characteristic pearly white outer appearance on gross pathology. White epidermoid cysts are not common findings; therefore, this illustrative case report was written to highlight the characteristics, progression, radiological evaluation, and management of a patient who presented to our center. This case report emphasizes the importance of determining the proper diagnosis to treat and manage the condition appropriately and avoid potential future complications.

Change in management for digital subtraction angiography-identified false-positive traumatic vertebral artery injury.

Background: For patients with suspected traumatic vertebral artery injury (TVAI), CT angiography (CTA) is the first-line screening modality. Digital subtraction angiography (DSA) serves as the confirmatory diagnostic imaging, and is the gold standard for cerebrovascular injury assessment, due to its higher sensitivity and specificity. Among patients with TVAI based on CTA who have undergone follow-up DSA, this study aims to investigate how diagnostic information with additional imaging affects clinical management.

Role and Prognostic Implications of Venous Outflow Assessment in Acute Ischemic Stroke.

Introduction: The venous outflow profile (VOP) is a crucial yet often overlooked aspect affecting stroke outcomes. It plays a major role in the physiopathology of acute cerebral ischemia, as it accounts for both the upstream arterial collaterals and cerebral microperfusion. This enables it to circumvent the limitations of various arterial collateral evaluation systems, which often fail to consider impaired autoregulation and its impact on cerebral blood flow at the microcirculatory levels.

The relative cerebral blood volume (rCBV) < 42% is independently associated with hemorrhagic transformation in anterior circulation large vessel occlusion.

Background: Pretreatment CT perfusion (CTP) marker relative cerebral blood volume (rCBV) < 42% lesion volume has recently shown to predict poor collateral status and poor 90-day functional outcome. However, there is a paucity of studies assessing its association with hemorrhagic transformation (HT). Here, we aim to assess the relationship between rCBV < 42% lesion volume with HT.

AM-PAC 6-Clicks Basic Mobility and Daily Activities Scores Predict 90-Day Modified Rankin Score in Patients with Acute Ischemic Stroke Secondary to Large Vessel Occlusion.

The relative level of functional impairment in stroke patients is a significant determinant of post-acute care. The Activity Measure for Post Acute Care 6-Clicks (AM-PAC) scores for basic mobility and daily activity are rapid standardized assessments whose utilities in predicting long-term stroke outcomes have not yet been studied. We performed a retrospective analysis of acute ischemic stroke patients and their outcomes.