Health Economic Impact of Incomplete Reperfusion Patterns After Endovascular Thrombectomy in Acute Ischemic Stroke.

Background And Purpose: Incomplete reperfusion in endovascular thrombectomy (EVT) impacts patients' outcomes. Different incomplete reperfusion patterns may benefit from targeted therapeutic strategies, e.g.

Incidence, Associations, and Mechanisms of Unexplained Early Neurologic Deterioration After Thrombectomy in Stroke Patients.

Background And Objectives: Early neurologic deterioration (END) in ischemic stroke after endovascular thrombectomy (EVT) is a frequent complication that remains unexplained in most cases. We aimed to explore the incidence of, and associated variables with, unexplained END (unEND).

Methods: This is a post hoc analysis of the ESCAPE-NA1 trial, a double-blind, multicentric, randomized clinical trial evaluating nerinetide vs placebo in adult ischemic stroke patients with anterior circulation large vessel occlusion treated with EVT.

Complications of Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Systematic Literature Review.

Background: Chronic subdural hematoma (cSDH) is a common condition, especially in the older population, and causes considerable morbidity. Recently, middle meningeal artery embolization (MMAE) has shown promise as a minimally invasive intervention for cSDH by disrupting the flow to the hematoma neomembranes and thus reducing recurrence.

Methods: We performed a systematic review of the literature using PubMed/Medline and Google Scholar to identify studies reporting on MMAE for cSDH over the past 30 years.

Double duty: using a PEG tube to address gastrogastric fistula and biliary drainage in a patient after Roux-en-Y.

Background And Aims: Gastrogastric fistula (GGF) is a known rare adverse event after gastric bypass surgery. Management of refractory GGF, either surgical or endoscopic, is associated with poor long-term results. There is limited evidence on the successful management of refractory GGF with endoscopy.

Management of gastric varices with EUS-guided coil ablation.

Background And Aims: Gastric varices are associated with a greater risk of bleeding and mortality than esophageal varices. Standard treatments, including endoscopic cyanoacrylate injection and balloon retrograde transvenous obliteration, pose risks of arterial embolization in patients with a patent foramen ovale. This case highlights the use of EUS-guided coil embolization as an alternative approach.

Endoscopic management of candy cane syndrome with a lumen-apposing metal stent.

Background And Aims: Candy cane (CC) or "hockey stick" syndrome is an adverse event of Roux-en-Y gastric bypass (RYGB) caused by an excessively long blind afferent limb distal to the gastrojejunostomy. This anatomical anomaly leads to symptoms such as pain, regurgitation, vomiting, and weight loss. Although surgical resection is the standard treatment, it is technically challenging and associated with significant risks.

Association between time and severe hypoperfusion with risk of hemorrhagic transformation in stroke patients.

Introduction: Perfusion imaging studies show a substantially increased risk of hemorrhagic transformation (HT) in severely hypoperfused tissue. Preclinical evidence indicates that ischemic damage is influenced not only by the degree of hypoperfusion but also by the duration of exposure to that hypoperfused state. We aim to investigate the association of time and severe hypoperfusion with parenchymal hematoma (PH) in ischemic stroke and explore whether there is a combined effect of the two variables on PH.

Validation of the HERMES-24 Score for Outcome Prediction Post Large Vessel Occlusion Treatment in Later Time Window.

Background And Objectives: The Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials (HERMES)-24 score is highly predictive of outcomes after anterior circulation large vessel occlusion (LVO) treatment, irrespective of intervention in the early time window. Recent evidence has further broadened the eligibility of endovascular therapy (EVT) to patients with late presentation or unwitnessed onset including those with stroke-on-awakening. We aimed to investigate the prediction ability of the HERMES-24 score in patients with anterior circulation LVO and small ischemic core presenting in the late time window from last seen normal.

COSMOS: Interrater and Intrarater Reliability Study of a Novel Outcome Measure.

The vast majority of patients with minor stroke achieve what are considered good or excellent outcomes on the modified Rankin Scale (0-1/0-2), yet many are dissatisfied with their outcomes. There is a need for a functional outcome measure tailored for minor stroke that better reflects the spectrum of clinical outcomes within this population. We developed the Canadian Outcome Scale for Minor Stroke (COSMOS) and performed an interrater and intrarater reliability study.

Poverty and Stroke: The Need for Socioeconomic Data in Hyperacute Care.

Poverty profoundly influences stroke risk, access to care, and recovery, yet remains largely invisible in hyperacute stroke trials. Despite growing awareness of health inequities, current research and clinical frameworks rarely capture socioeconomic data at the point of care-particularly during the hyperacute phase, when decisions are time sensitive. This commentary highlights the urgent need to incorporate measures of poverty and social vulnerability into hyperacute stroke care and research.

Burden of inguinal, femoral, and abdominal hernias in India: A systematic analysis of prevalence, incidence, mortality, and DALYs from global burden of disease study 1990-2021 with projections to 2031.

Background: Hernias are a major health concern in India, with varying incidence and prevalence influenced by socio-demographic factors. Despite global advances in hernia management, regional disparities are evident within India.

Method: This analysis utilized data from the Global Burden of Disease (GBD) Study 2021 to examine inguinal, femoral, and abdominal hernias across India from 1990 to 2021, categorized by ICD-10 codes.

Impact of Brain Frailty on Clinical Presentation and Neurologic Recovery in Acute Ischemic Stroke Patients Undergoing Thrombectomy.

Background And Objectives: Brain frailty impairs the ability to compensate for brain dysfunction and is linked to worse outcomes after stroke. Stroke severity at presentation is a key determinant of outcomes in acute ischemic stroke. This study aimed to examine the impact of brain frailty on initial stroke severity and recovery in acute ischemic stroke (AIS) patients undergoing endovascular thrombectomy (EVT).

Mitigating and Quantifying Cherry-Picking in Acute Stroke Trials.

Consecutive enrollment of eligible patients is fundamental to the internal and external validities of randomized controlled trials. The generalizability of trial results is greatly undermined when enrolled patients are not representative of the broader target population, which is especially likely if a large proportion of otherwise-eligible individuals receive treatment outside the trial. In this article, we discuss the problem that such selective recruitment or cherry-picking of patients poses to clinical trials.

Comparing Early National Institutes of Health Stroke Scale Versus 90-Day Modified Rankin Scale Outcomes in Acute Ischemic Stroke Trials: A Systematic Review and Analysis.

Background: Early National Institutes of Health Stroke Scale (NIHSS) assessment may provide practical benefits over 90-day modified Rankin Scale (mRS), but it is unclear how it compares in adjudicating randomized clinical trial (RCT) results in acute ischemic stroke.

Methods And Results: We searched Ovid Medline (inception to April 1, 2023) and included RCTs of acute therapies for acute ischemic stroke with data for both 90-day mRS and NIHSS within 7 days. Primary outcome was agreement between trial results (classified as positive, negative, or neutral) based on 24-hour NIHSS and 90-day mRS scores.

Scaling up thrombectomy care in transitioning health systems: a qualitative study of stroke centres in Canada.

Introduction: Endovascular thrombectomy has shown significant benefits for patients with large-vessel ischaemic stroke. However, many countries face challenges establishing effective thrombectomy delivery systems, even when thrombolysis services are already in place. Moreover, there is limited research on implementing thrombectomy care delivery, particularly for scale-ups in low- and middle-income countries.

Stepwise improvement in intracerebral haematoma expansion prediction with advanced imaging: a comprehensive comparison of existing scores.

Background: We aim to comprehensively assess and compare the predictive performance of haematoma expansion (HE) scores in a homogeneous cohort of acute intracerebral haemorrhage (ICH) patients.

Methods: Existing scores for predicting HE in acute ICH patients were included and categorised by imaging modality: non-contrast CT (NCCT), single-phase CT angiography (sCTA) and multiphase CTA (mCTA). The predictive performance of the scores was evaluated with the c-statistic in a population of consecutive adult patients with acute ICH admitted to a tertiary care centre in Southern Alberta, Canada, between February 2012 and May 2020, investigated with a multimodal imaging protocol (NCCT, sCTA and mCTA).