Statins and Middle Meningeal Artery Embolization in the Treatment of Chronic Subdural Hematoma: A Comprehensive Systematic Review and Network Meta-Analysis.

Background And Objectives: Chronic subdural hematoma (cSDH) is a common neurosurgical condition, particularly in elderly patients. Middle meningeal artery embolization (MMAE) has emerged as a promising intervention, while statins have been explored for their anti-inflammatory and angiogenesis-modulating properties. This study aims to evaluate the impact of MMAE and statins, alone and in combination with surgery, on cSDH outcomes.

How Do Patient Outcomes in Mechanical Thrombectomy for Large-Core Stroke Vary Based on Neuroimaging Modalities Used for Patient Selection? A Multicenter Multinational Study.

The role of different imaging modalities-non-contrast CT (NCCT), CT perfusion (CTP), and diffusion-weighted imaging (DWI)-in selecting patients with large-core stroke for endovascular thrombectomy (EVT) is a subject of ongoing debate. This study aims to determine whether patients with large-core acute ischemic stroke (AIS) undergoing EVT triaged with CTP or DWI in addition to NCCT had different clinical outcomes compared to those only triaged with NCCT. We queried the Stroke Thrombectomy and Aneurysm Registry (STAR) for patients enrolled between 2014 and 2023 who presented with anterior-circulation AIS and large ischemic core (ASPECTS < 6) who underwent EVT in 41 stroke centers in the USA, Europe, Asia, and South America.

Endovascular Retreatment of Previously Clipped Intracranial Aneurysms: An Individual Patient Data Meta-analysis.

Background And Objectives: To evaluate the effectiveness and safety of endovascular retreatment of previously clipped intracranial aneurysms (IAs).

Methods: Systematic searches of Medline, Embase and Cochrane Central were performed. The primary outcome was good functional outcome (modified Rankin Scale 0-2) at the last follow-up.

Outcomes of bypass surgery in asymptomatic moyamoya angiopathy: A multicenter study with propensity-score weighting.

Introduction: Asymptomatic moyamoya angiopathy (MMA) is increasingly detected through noninvasive imaging; however, its optimal management remains controversial. This multicenter retrospective cohort study compared outcomes in asymptomatic versus symptomatic MMA patients undergoing surgical revascularization.

Patients And Methods: A total of 475 patients treated with bypass surgery across multiple academic centers were included, with 56 (11.

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.

Safety and efficacy of preoperative embolization in the treatment of brain arteriovenous malformations with perinidal aneurysms and single draining vein: a multicenter study with propensity score-weighting.

Background And Objectives: Arteriovenous malformations (AVMs) with perinidal aneurysms and single draining vein are associated with an elevated risk of rupture and increased procedural complexity. The role of preoperative embolization in this high-risk anatomical subset remains unclear. This study aimed to evaluate the safety and efficacy of microsurgery with preoperative embolization, compared with microsurgery alone in patients with such AVMs.

Optical coherence tomography in endovascular neurosurgery: current applications and future directions.

Optical Coherence Tomography (OCT), initially introduced in 1991, has demonstrated efficacy in diagnosing pathologies of the retina, optic nerve, and coronary vessels. Recently, there has been growing research interest in the application of OCT in endovascular neurosurgery, with studies exploring its utility across a range of intracranial and extracranial endovascular diseases. The current review aims to synthesize available literature on the use of OCT in endovascular neurosurgery, encompassing both clinical and preclinical models.

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.

Endovascular treatment for Moyamoya-associated intracranial aneurysms: a systematic review and meta-analysis.

Background: Moyamoya disease (MMD) is a rare cerebrovascular disorder characterized by progressive stenosis of the distal internal carotid arteries, leading to increased collateral flow and the development of an abnormal vascular network, which imposes shear stress on small vessels and increases the risk of aneurysm formation. Endovascular treatment (EVT) has emerged as a potential approach for managing MMD-associated intracranial aneurysms (MMD-IA), but its safety and efficacy remain unclear.

Objective: This systematic review and meta-analysis aimed to evaluate the safety, efficacy, and long-term outcomes of EVT in patients with MMD-IA.

Predictors of Futile Recanalization After Endovascular Therapy for Acute Large Vessel Occlusive Intracranial Atherosclerosis: A Secondary Analysis of RESCUE-ICAS.

Background And Objectives: Futile recanalization in endovascular thrombectomy (EVT) occurs when recanalization is achieved but patients nevertheless experience a poor functional outcome. Variables associated with futile recanalization after endovascular therapy in intracranial atherosclerosis-related large vessel occlusion have not been previously described.

Methods: This was a secondary analysis of Registry of Emergent Large Vessel Occlusion due to Intracranial Stenosis (RESCUE-ICAS), a multicenter prospective observational cohort study conducted at 25 EVT-capable centers in North America, Europe, and Asia.

Understanding disparities in cerebral atherosclerosis mortality across the United States: An analysis of the CDC WONDER database.

Background: Cerebral atherosclerosis is a significant contributor to ischemic stroke, accounting for approximately 50% of ischemic strokes in some populations. Its prevalence and associated mortality exhibit variation across demographics, yet no prior studies have assessed the location of death for individuals succumbing to cerebral atherosclerosis. This study evaluates trends in mortality, racial disparities, and location of death in the United States.

Racial/ethnic disparities among individuals with unruptured and ruptured cerebral aneurysms: Insights from the All of Us Research Program.

Background And Objectives: Race and ethnicity have been shown to affect healthcare outcomes among patients diagnosed with cerebral aneurysms. Our study analyzes baseline demographics, lifestyle, healthcare resource utilization, and perception of health status among patients with ruptured and unruptured cerebral aneurysms based on race and ethnicity.

Methods: This was a cross-sectional study that utilized survey data and electronic health record (EHR) data from the All of Us Research Program.

Optimal duration of dual antiplatelet therapy after endovascular treatment of intracranial aneurysms with stenting: a systematic review and meta-analysis.

Background: The optimal duration of dual antiplatelet therapy (DAPT) following endovascular treatment of intracranial aneurysms remains uncertain. While DAPT effectively prevents thromboembolic complications, prolonged therapy may increase bleeding risk. This systematic review and meta-analysis compared the efficacy and safety of short-term versus long-term DAPT in patients undergoing endovascular treatment with stent-assisted coiling or flow diversion.

Concurrent Anterior Cerebral Artery and Middle Cerebral Artery Occlusions Predict Poor Neurological Outcome Despite Successful Thrombectomy in Anterior Circulation Stroke.

Background And Objectives: Despite successful endovascular thrombectomy for acute ischemic stroke, a significant proportion of patients demonstrate fast and early progression of infarct core and fail to achieve functional independence at 90 days. The aim of this study was to evaluate the impact of thrombus location and the potential impact of collaterals on concurrent middle cerebral artery (MCA) and anterior cerebral artery (ACA) occlusion.

Methods: Data were included from a multicenter registry for patients undergoing endovascular thrombectomy for anterior circulation stroke from 32 international centers between 2015 and 2021.

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.

Outcomes of external ventricular drainage and lumbar drainage in aneurysmal subarachnoid hemorrhage: A systematic review and meta-analysis.

Background: Lumbar drainage (LD) and external ventricular drainage (EVD) are used in patients with aneurysmal subarachnoid hemorrhage (aSAH) for cerebrospinal fluid diversion and blood clearance. While both have potential benefits, the relative efficacy and safety of LD versus EVD remain unclear, particularly given their use in differing clinical contexts. This study aims to provide a crude comparison of LD and EVD in the context of aSAH using the most updated and comprehensive meta-analysis.

The Ballast radial access system in neuroendovascular procedures: A multicenter investigation of 138 patients.

Background: The transradial approach (TRA) for neuroendovascular procedures has gained popularity. There is limited data on the use of large-bore guide catheters in radial approaches. This study evaluates the safety and efficacy of the Ballast 088 long sheath in radial neurointerventional procedures.

Vagus nerve stimulation paired with rehabilitation for post-stroke recovery: A single center experience of patient satisfaction and outcomes.

Background And Objectives: Vagus nerve stimulation (VNS) paired with rehabilitation has demonstrated the ability to aid in upper limb recovery after stroke. The Food and Drug Administration (FDA) approved the Vivistim system in 2021. Our study describes a single center experience with VNS paired with rehabilitation.

Cost analysis and outcomes of Woven EndoBridge Device embolization vs microsurgical clipping for intracranial bifurcation aneurysms.

Objective: Woven EndoBridge Device (WEB) embolization is an endovascular technique used to intracranial bifurcation aneurysms. Although WEB embolization is a less invasive alternative to microsurgical clipping, it may be associated with higher rates of recurrence and retreatment. Our study compares hospitalization costs and outcomes with WEB embolization versus microsurgical clipping.

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.

Silk Vista Baby for the treatment of distal anterior cerebral artery aneurysms.

Purpose: Treating small-caliber vessel aneurysms with flow diverters poses challenges due to narrow luminal diameters and tortuous vasculature, which complicate the navigation and deployment of conventional devices using standard microcatheters. The Silk Vista Baby (SVB, Balt, Montmorency, France) flow diverter was developed to treat intracranial aneurysms located in smaller vessels or more distal segments and is compatible with 0.017″ microcatheters.

Impact of smoking on occlusion rates following stereotactic radiosurgery for Spetzler Martin grade I-III brain arteriovenous malformations - A propensity score matched analysis of the MISTA consortium.

Backgroundand Objective: The authors compareocclusion rates in grade I-III AVMs in smokers and non-smokers, using propensity score matching (PSM).

Methods: The authors performed a subgroup analysis of the MISTA consortium, a multicenter registry that includes patients aged 1 to 89 years with AVMs treated between January 2010 and December 2023. Only grade I-III AVMs were included.

General vs Nongeneral Anesthesia for Endovascular Thrombectomy in Patients With Large Core Strokes: A Prespecified Secondary Analysis of SELECT2 Trial.

Background And Objectives: The association of anesthesia approach during endovascular thrombectomy (EVT) with clinical outcomes in large strokes is unexplored. We aimed to evaluate whether general anesthesia (GA), compared with non-GA, was associated with better functional outcomes in the SELECT2 trial.

Methods: In a prespecified secondary analysis of the SELECT2 trial that enrolled patients with large strokes on noncontrast CT (Alberta Stroke Program Early CT Score [ASPECTS] 3-5), CT perfusion/MRI (core volume ≥50 mL), or both, functional outcomes were compared in EVT-treated patients who received GA or non-GA and whether this association was modified by stroke severity (NIH Stroke Scale score), ischemic injury estimates, and collateral status was evaluated.

Angiographic Occlusion After Flow Diversion of Ruptured and Unruptured Intracranial Aneurysms Using the Flow Redirection Endoluminal Device-X: A Multicenter Analysis.

Background And Objectives: Flow diversion induces progressive aneurysm occlusion by reducing blood flow across the aneurysm neck over time. Various factors, including comorbid conditions, aneurysm characteristics, and stent design, have been shown to affect occlusion rates after flow diversion. Our study analyzed predictors of angiographic occlusion after flow diversion of intracranial aneurysms using the Flow Redirection Endoluminal Device with X-technology (FRED-X).