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.

An automated software algorithm for optimizing microwave ablation parameters for treatment of liver tumors.

Purpose: To evaluate the performance of a software algorithm developed to streamline microwave liver ablation parameter selection and to compare performance of this algorithm to that of experienced interventional radiologists.

Methods: Patients who underwent microwave ablation for treatment of liver tumors were retrospectively identified. An automated software platform was developed to select the top three 'best fit' combinations of microwave ablation power, time, and vendor for a given tumor to achieve a 5 mm minimal ablative margin (MAM).

Neuroimaging Markers of Brain Reserve and Associations with Delirium in Patients with Intracerebral Hemorrhage.

Background: Delirium occurs frequently in patients with stroke, but the role of preexisting neural substrates in delirium pathogenesis remains unclear. We sought to explore associations between acute and chronic neural substrates of delirium in patients with intracerebral hemorrhage (ICH).

Methods: Using data from a single-center ICH registry, we identified consecutive patients with acute nontraumatic ICH and available magnetic resonance imaging scans.

Infarcts Due to Large Vessel Occlusions Continue to Grow Despite Near-Complete Reperfusion After Endovascular Treatment.

Background And Purpose: Infarcts in acute ischemic stroke (AIS) patients may continue to grow even after reperfusion, due to mechanisms such as microvascular obstruction and reperfusion injury. We investigated whether and how much infarcts grow in AIS patients after near-complete (expanded Thrombolysis in Cerebral Infarction [eTICI] 2c/3) reperfusion following endovascular treatment (EVT), and to assess the association of post-reperfusion infarct growth with clinical outcomes.

Methods: Data are from a single-center retrospective observational cohort study that included AIS patients undergoing EVT with near-complete reperfusion who received diffusion-weighted magnetic resonance imaging (MRI) within 2 hours post-EVT and 24 hours after EVT.

Modeling diffusion-weighted imaging lesion expansion between 2 and 24 h after endovascular thrombectomy in acute ischemic stroke.

Purpose: Diffusion-weighted imaging (DWI) lesion expansion after endovascular thrombectomy (EVT) is not well characterized. We used serial diffusion-weighted magnetic resonance imaging (MRI) to measure lesion expansion between 2 and 24 h after EVT.

Methods: In this single-center observational analysis of patients with acute ischemic stroke due to large vessel occlusion, DWI was performed post-EVT (< 2 h after closure) and 24-h later.

Prevalence of "Ghost Infarct Core" after Endovascular Thrombectomy.

Background And Purpose: Baseline CTP sometimes overestimates the size of the infarct core ("ghost core" phenomenon). We investigated how often CTP overestimates infarct core compared with 24-hour imaging, and aimed to characterize the patient subgroup in whom a ghost core is most likely to occur.

Materials And Methods: Data are from the randomized controlled ESCAPE-NA1 trial, in which patients with acute ischemic stroke undergoing endovascular treatment were randomized to intravenous nerinetide or placebo.

Prospective Margin Estimates Predict Local Tumor Progression Following Microwave Ablation of Small Renal Masses.

Purpose: To evaluate the relationship between prospectively generated ablative margin estimates and local tumor progression (LTP) among patients undergoing microwave ablation (MWA) of small renal masses (SRMs).

Materials And Methods: Between 2017 and 2020, patients who underwent MWA for SRM were retrospectively identified. During each procedure, segmented kidney and tumor shapes were coregistered with intraprocedural helical CT images obtained after microwave antenna placement.

Endovascular therapy in acute ischemic stroke with poor reperfusion is associated with worse outcomes compared with best medical management: a HERMES substudy.

Background: Functional outcomes in patients with acute ischemic stroke (AIS) with large vessel occlusion (LVO) undergoing endovascular treatment (EVT) with poor reperfusion were compared with patients with AIS-LVO treated with best medical management only.

Methods: Data are from the HERMES collaboration, a patient-level meta-analysis of seven randomized EVT trials. Baseline characteristics and functional outcomes (modified Rankin Scale (mRS) score at 90 days) were compared between patients with poor reperfusion (defined as modified Thrombolysis in Cerebral Infarction Score 0-1 on the final intracranial angiography run as assessed by the central imaging core laboratory) and patients in the control arm with multivariable logistic ordinal logistic regression adjusted for pre-specified baseline variables.

The Vessel Has Been Recanalized: Now What?

When treating acute ischemic stroke patients in our daily clinical practice, we strive to achieve recanalization of the occluded blood vessel as fast as possible using pharmacological thrombolysis and mechanical clot removal. However, successful recanalization does not equal successful reperfusion of the ischemic tissue due to mechanisms such as microvascular obstruction. Even if successful reperfusion is achieved, numerous other post-recanalization tissue damage mechanisms may impair patient outcomes, namely blood-brain barrier breakdown, reperfusion injury and excitotoxicity, late secondary changes, and post-infarction local and global brain atrophy.

A hierarchical anatomical framework and workflow for organizing stereotactic encephalography in epilepsy.

Stereotactic electroencephalography (SEEG) is an increasingly utilized method for invasive monitoring in patients with medically intractable epilepsy. Yet, the lack of standardization for labeling electrodes hinders communication among clinicians. A rational clustering of contacts based on anatomy rather than arbitrary physical leads may help clinical neurophysiologists interpret seizure networks.

Modeling the Clinical Implications of Andexanet Alfa in Factor Xa Inhibitor-Associated Intracerebral Hemorrhage.

Background And Objectives: Andexanet alfa was recently approved as a reversal agent for the factor Xa inhibitors (FXais) apixaban and rivaroxaban, but its impact on long-term outcomes in FXai-associated intracerebral hemorrhage (ICH) is unknown. We aimed to explore potential clinical implications of andexanet alfa in FXai-associated ICH in this simulation study.

Methods: We simulated potential downstream implications of andexanet alfa across a range of possible hemostatic effects using data from a single center that treats FXai-associated ICH with prothrombin complex concentrate (PCC).