Effect of early versus delayed middle meningeal artery embolization on clinical outcomes in chronic subdural hematoma: A propensity score-matched cohort study.

Background: Chronic subdural hematoma (cSDH) is a common neurosurgical condition with a high recurrence rate following surgical evacuation. Middle meningeal artery embolization (MMAE) has emerged as an adjunctive or standalone treatment, but the optimal timing of embolization remains unclear. We evaluated whether early MMAE (≤2 days) versus delayed MMAE (3-7 days) is associated with improved clinical outcomes.

Risk of Stroke Recurrence Following Isolated Retinal Artery Occlusion Versus Minor Stroke or Transient Ischemic Attack.

Background: Retinal artery occlusion (RAO) is a form of ischemic stroke per the American Heart Association, yet high-level evidence guiding management and prognostication is limited. The risk of future cerebral infarction following nonarteritic isolated RAO (iRAO; without concomitant cerebral infarction) is unclear. This study compares the risk of stroke recurrence following iRAO versus nondisabling ischemic cerebrovascular events (NICEs), including transient ischemic attacks and minor ischemic strokes.

Middle meningeal artery embolization for chronic subdural hematoma: Does statin therapy improve outcomes? A propensity score-matched analysis.

BackgroundChronic subdural hematoma (cSDH) is a common condition in older adults, often treated with surgical-evacuation, though recurrence rates can reach 30%. Middle meningeal artery embolization (MMAE) has emerged as a treatment alternative. Statins have been explored as adjunct therapies, but literature regarding their combined use with MMAE is limited.

Preoperative middle meningeal artery embolization is associated with reduced reoperation rates in chronic subdural hematoma.

BackgroundMiddle meningeal artery embolization (MMAE) has recently emerged as a promising adjunctive therapy to surgical evacuation for patients with chronic subdural hematoma (cSDH). However, the optimal timing of MMAE relative to surgery remains poorly defined. Therefore, this large retrospective cohort study aimed to assess the impact of MMAE timing (preoperative vs.

Conventional versus advanced imaging selection for endovascular treatment of basilar artery occlusion strokes.

Introduction: Endovascular thrombectomy (EVT) is an effective treatment for basilar artery occlusion (BAO) stroke in select patients. While there is a growing body of literature suggesting that advanced imaging modalities such as computed tomography perfusion (CTP) and magnetic resonance (MR) may not be necessary for selecting anterior circulation large vessel occlusion stroke patients for EVT, whether advanced imaging may be superior to conventional imaging (non-contrast CT and CT angiography) in identifying good treatment candidates among BAO patients is less clear.

Patients And Methods: This was a multicenter retrospective cohort study of BAO EVT patients treated from 2013 to 2022 in the Stroke Thrombectomy and Aneurysm Registry.

Coil only middle meningeal artery embolization versus particles or liquid embolic agents for chronic subdural hematoma.

Background: Middle meningeal artery embolization (MMAE) for chronic subdural hematoma (cSDH) with particles or liquid embolic agents has been shown to be effective, but can carry a theoretical risk of off-target embolization via dangerous collaterals and anastomoses. Primary coiling has been suggested as a safer alternative, particularly for patients with dangerous anastomoses. This study aims to evaluate the safety and efficacy of coil only for cSDH patients compared with liquid or particle embolic agents.

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.

Tranexamic acid with surgery vs. surgery alone for chronic subdural hematoma: Propensity score-matched analysis.

Background: Chronic subdural hematoma (CSDH) is frequently managed with surgical evacuation, but recurrence often necessitates repeat surgery. Tranexamic acid (TXA), an antifibrinolytic agent, has been proposed as an adjunct to reduce rebleeding and recurrence. Data on its benefits and risks remain limited.

Inpatient spinal intervention is associated with improved outcomes following thoracolumbar pathologic compression fractures: a national retrospective study.

Background: Pathologic vertebral compression fractures (pVCFs) are associated with significant pain and worsened quality of life. Spinal interventions such as kyphoplasty, vertebroplasty, and radiofrequency ablation can improve patient outcomes; however, there is a paucity of data on the optimal timing of these procedures. This study aims to evaluate the real-world effectiveness of inpatient spinal interventions versus conservative management (CM) for pVCF patients.

Millipede and Millipede catheters for contact aspiration thrombectomy in acute stroke: A multicenter experience.

BackgroundAspiration is rapidly becoming the first-line strategy for mechanical thrombectomy for LVOs. Superbore aspiration catheters (lumen ≥ 0.088") have been suggested to provide advantages over conventional aspiration including improved recanalization and reduced distal emboli owing to distal flow control.

Stroke thrombolysis for patients with intracranial aneurysms: a nationwide cohort study.

Background: The safety of intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) patients with underlying unruptured intracranial aneurysms (UIAs) is unclear. This study evaluates IVT safety and efficacy in AIS patients with UIAs in routine clinical practice.

Methods: Using the 2016-2022 Nationwide Readmissions Database, we conducted a retrospective cohort study of AIS patients with National Institutes of Health Stroke Scale (NIHSS) scores ≥ 6.

Chronic Subdural Hematoma: A Review of Current Knowledge, Treatment Modalities, and Clinical Trials of Middle Meningeal Artery Embolization.

Purpose Of Review: While chronic subdural hematoma (cSDH) has been considered a neurosurgical disease, conventional management with surgical evacuation has been associated with high rates of disease recurrence and long-term patient morbidity and mortality. In this narrative review, we summarize the current knowledge regarding the epidemiology, pathophysiology, and treatment modalities for cSDH with a particular focus on middle meningeal artery embolization (MMAE) and other novel treatment modalities.

Recent Findings: A growing body of literature has suggested that inflammation and angiogenesis may play a central role in cSDH pathophysiology, and major advances have been made on nonsurgical treatment modalities for cSDH such as MMAE and antiangiogenic agents.

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.

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.

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.

Intravenous thrombolysis for acute ischemic stroke patients with cerebral amyloid angiopathy.

Background: Cerebral amyloid angiopathy (CAA) is a hemorrhagic cerebrovascular disease that is characterized by amyloid-beta deposition in vessel walls that lead to fragility and increase the risk of rupture, and it is associated with older age. Whether intravenous thrombolysis (IVT) is safe and effective for acute ischemic stroke (AIS) patients with CAA is largely unknown.

Methods: This was an explorative analysis of a nationwide database of hospitalizations in the United States.

Treatment outcomes of successful M1 versus M2 thrombectomy for low-ASPECTS stroke patients.

BackgroundThe effectiveness of endovascular thrombectomy (EVT) for low Alberta Stroke Program Early CT score (ASPECTS) stroke patients with occlusion of the second segment of the middle cerebral artery (M2) is unclear.MethodsThis was a multicenter retrospective study. Patients with M1 or M2 occlusions and low ASPECTS (<6) who underwent successful EVT (modified treatment in cerebral ischemia score of 2b or higher) were included.

Minimally Invasive Surgery Versus Conventional Neurosurgical Treatments for Patients with Subcortical Supratentorial Intracerebral Hemorrhage: A Nationwide Study of Real-World Data from 2016 to 2022.

: Neurosurgical interventions are often indicated for patients with subcortical, supratentorial intracerebral hemorrhage (ICH); however, the optimal treatment modality is controversial. Whether minimally invasive surgery (MIS) may be superior to conventional craniotomy (CC) or decompressive craniectomy (DC) in real-world clinical practice is unknown. : This was a retrospective cohort study of hospitalization data from the 2016-22 Nationwide Readmissions Database.

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.

Balloon guide catheter impact on angiographic and clinical outcomes in distal medium vessel occlusion stroke thrombectomy.

Background: The use of balloon guide catheter (BGC) has been associated with better reperfusion and clinical outcomes in mechanical thrombectomy (MT) for large vessel occlusion stroke. However, the impact of BGC on angiographic and clinical outcomes in patients with distal medium vessel occlusion (DMVO) strokes undergoing MT has not been extensively investigated.

Methods: This is a retrospective analysis of a prospectively collected database from 14 comprehensive stroke centers in the United States and Europe.

Estimation of Ventricular and Intracranial Hemorrhage Volumes and Midline Shift on an External Validation Data Set Using a Convolutional Neural Network Algorithm.

Background And Objectives: Noncontrast head computed tomography is the mainstay imaging modality to guide the management of intracranial hemorrhage (ICH); however, manual measurements can be time-consuming. In our study, we evaluate the performance of an artificial intelligence (AI) machine learning algorithm, Viz ICH-Plus, to automatically quantify ICH and bilateral lateral ventricular (BLV) volumes as well as midline shift (MLS).

Methods: ICH patients considered for external ventricular drain with an initial noncontrast head computed tomography, and at least 1 follow-up scan within 48 hours was identified from a single center.

Middle meningeal artery embolization for non-acute subdural hematoma: a meta-analysis of large randomized controlled trials.

Background: Middle meningeal artery embolization (MMAE) has emerged as a novel treatment for non-acute subdural hematoma (SDH), particularly for reducing the risk of SDH recurrence. Recently, five randomized controlled trials (RCT) of MMAE as an adjunct to conventional management (surgical or observant) have concluded their investigation and reported their outcomes.

Purpose: To synthesize trial results to provide more definitive guidance on the role of MMAE in the management of non-acute SDH.