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.

Safety and efficacy of very short flow diverters for the treatment of intracranial internal carotid artery aneurysms.

Deploying flow diverters (FDs) around the carotid siphon typically favors longer FDs for easier manipulation and safety, leaving shorter FDs less explored. We reviewed 263 patients with unruptured intracranial saccular ICA aneurysms treated with FDs from 2013 to 2023. Fifty-five were treated with very short flow diverters (VSFD; 10-12 mm).

Direct aspiration versus stent retriever as First-line thrombectomy techniques for acute Basilar artery occlusions: an updated systematic review and Meta-Analysis.

Background: Endovascular thrombectomy is the primary treatment for acute basilar artery occlusion (BAO), with direct aspiration (DA) and stent retriever (SR) as the main techniques. This updated meta-analysis aims to compare these two techniques in terms of efficacy and safety outcomes.

Methods: A search was performed across PubMed, Embase, and Cochrane databases on December 23, 2024.

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.

Middle meningeal artery embolization for chronic subdural hematoma in octogenarians and nonagenarians: an individual patient pooled meta-analysis.

Chronic subdural hematoma (cSDH) is a highly common neurosurgical condition with significant burden in the elderly, and patients aged ≥ 80 represent nearly one-third of cases. Middle meningeal artery embolization (MMAE) has emerged as a promising treatment method to reduce hematoma growth and recurrence; however, octogenarians and nonagenarians remain underrepresented in clinical trials. We conducted a systematic review and meta-analysis of individual patient data to evaluate outcomes of MMAE in this high-risk group.

Feasibility of middle meningeal artery embolization following large craniotomy: A case series.

IntroductionWhile middle meningeal artery embolization (MMAE) has been shown to be feasible for recurrent subdural hematoma (SDH) after craniotomy, large traumatic craniotomies exceeding 8000 mm have typically been excluded. In this novel case series, we assess the feasibility and efficacy of MMAE in treating recurrent SDH following large open neurosurgical intervention (non-burr hole or bedside procedures). In all cases, a portion of the middle meningeal artery (MMA) territory remained patent and was successfully embolized.

A novel classification for posterior communicating artery aneurysms in the presence of fetal posterior cerebral artery: A registry-based study.

Background and objectivesFetal posterior cerebral artery (fPCA) is a common anatomical variant where the P1 segment is hypoplastic or absent, and the posterior communicating artery supplies the posterior cerebral artery (PCA) territory. Aneurysms in this setting often form at the internal carotid artery (ICA)-posterior communicating artery junction and are poorly defined. This study introduces a novel classification to address the fPCA variant, treatment challenges, and outcomes.

Can antithrombotic therapy be safely resumed after middle meningeal artery embolization with or without surgery for chronic subdural hematoma? a systematic review and meta-analysis.

Background: Middle meningeal artery embolization (MMAE), whether alone or with surgery, reduces chronic subdural hematoma (cSDH) recurrence. However, the impact of resuming antithrombotic (AT) therapy after MMAE and optimal resumption time remains unclear.

Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines.

Illustrated step-by-step guide to stent-assisted coiling of wide-neck posterior inferior cerebellar aneurysm via a contralateral vertebral artery approach.

Background and ObjectivesPosterior inferior cerebellar artery (PICA) aneurysms are uncommon, occurring in 0.5% to 3% of all intracranial aneurysms. Due to the distinct anatomy and varying geometrical configuration at the PICA origin, endovascular treatment can be challenging.

Assessing Occlusion and Recovery in Large and Giant Intracranial Aneurysms: A Comparative Retrospective Study of Flow Diversion Alone Versus Combined With Coiling and the Role of Packing Density.

Background And Objectives: Flow diversion (FD) is a conventional treatment of large and giant intracranial aneurysms. The aim of this study was to explore the impact of combining FD with coiling and analyze the required packing density (PD) for optimal aneurysm occlusion.

Methods: This retrospective study compared large (10-15 mm), very large (15-25 mm), and giant (≥25 mm) intracranial aneurysm treatment with FDs alone vs FD + coiling at 2 large institutions from 2015 to 2023.

Initial experience of utilizing a lower-profile transradial approach for mechanical thrombectomy: Comparable efficacy to larger-bore transfemoral approaches.

BackgroundWhile transfemoral access is commonly used for mechanical thrombectomy (MT) due to large-bore catheters providing greater aspiration forces, some centers employ transradial access (TRA) in select cases with favorable anatomy. We report our institutional experience to evaluate the efficacy of using TRA as the default approach for large-vessel occlusion (LVO) with a streamlined, lower-profile system.MethodsA retrospective review was conducted on 23 consecutive thrombectomies performed via TRA, regardless of patient anatomy or LVO location.

Right occipital to Right distal PICA bypass and trapping of ruptured Right PICA dissecting aneurysm after initial coil embolization.

Posterior inferior cerebellar artery (PICA) aneurysms are rare, constituting less than 5 % of intracranial aneurysms, and are associated with a high rupture risk [1]. Management is challenging due to proximity to brainstem structures, the need for vessel reconstruction or excision, and the risk of ischemia in PICA territory [2,3]. We present a case of subarachnoid hemorrhage caused by a ruptured, dissecting ∼1 cm proximal PICA aneurysm.

Surgical management of spinal intradural hematomas: illustrative cases.

Background: Spinal intradural hematoma (SIH) is a rare condition with potential for permanent neurological deficit. SIH can be managed conservatively with serial imaging or surgically with lumbar drainage or open evacuation. We present 3 SIH cases managed with multiple surgical techniques, including a novel lumbar drainage-and-advancement technique, and review the literature.

Comparison of embolic agents in preoperative embolization for intracranial meningiomas: multicenter adjusted analysis of 275 cases.

Background: Preoperative embolization has been used for intracranial meningiomas for nearly 40 years with varying preferences for embolic materials and limited comparative data on their efficacy.

Methods: Consecutively treated patients from 2013 until 2023 who underwent preoperative embolization for meningioma from 12 centers across North America and Europe were included and classified by embolic material: (1) particles, (2) Onyx, and (3) coils. Primary outcomes included estimated blood loss (EBL), procedural complications, surgery duration, gross total resection (GTR), unplanned rescue surgery, modified Rankin Scale (mRS), and mortality.

Quest for the optimal venous access in a complex skull base dural fistula: Case illustrations and principles.

Treatment of dural arteriovenous fistulae (DAVFs) is dynamic and evolves between diagnostic and therapeutic angiography.A 79-year-old man with a left jugular foramen DAVF presented with new onset cranial nerve XII palsy. The DAVF progressed from Cognard grade I to IIa + b.

Microbial Analyses of Subdural Empyema: A Case Report and Literature Review.

Subdural empyema (SDE) is an infection between the dura and arachnoid mater, presenting with symptoms such as fever, headache, altered sensorium, neurological deficits, and seizures. Due to its rapidly progressive nature, early diagnosis and treatment are crucial. This paper aims to identify common pathogens, imaging findings, and the necessity of emergent neurosurgical intervention.

Comparison of flow diverter alone versus flow diverter with coiling for large and giant intracranial aneurysms: systematic review and meta-analysis of observational studies.

Background: Large and giant intracranial aneurysms pose treatment challenges. The benefit-risk balance of flow diverters (FDs) alone versus FDs with coiling remains unclear. This study aimed to compare these two strategies.

Comparative efficacy and safety of stent retrievers as a bailout strategy following failed contact aspiration technique in acute stroke thrombectomy.

Background: The contact aspiration (CA) technique is often used to perform endovascular thrombectomy (EVT) for acute ischemic stroke (AIS); however, rescue strategies are necessary if CA fails to achieve recanalization. This study investigates the outcomes of incorporating stent retriever (SR) thrombectomy in the rescue strategy following failed CA.

Methods: EVT patients with failed CA attempts were identified from a large multicenter registry and stratified by rescue technique: CA alone or incorporating SR in the rescue strategy.

Mechanical thrombectomy in elderly stroke patients with low ASPECTS: insights from STAR.

Background: The elderly population (≥80 years) were underrepresented in recent trials of endovascular thrombectomy (EVT) for anterior circulation large vessel occlusion acute ischemic stroke (LVO-AIS) with low Alberta Stroke Program Early CT Score (ASPECTS) (≤5).

Methods: This study analyzed data from a prospectively maintained database of 37 thrombectomy centers. The primary cohort of the study comprised patients with LVO-AIS aged ≥80 who underwent EVT with ASPECTS≤5 from 2013 to 2023.

Oculomotor nerve palsy recovery following microsurgery vs. endovascular treatment of posterior communicating artery aneurysms: a comparative meta-analysis of short- and long-term outcomes.

Recent advancements in endovascular treatment (EVT) and different views on optimal management for posterior communicating artery (PComA) aneurysms with oculomotor nerve palsy (ONP) highlight a need to compare recovery timelines between microsurgery and EVT; heterogeneous outcomes and influencing factors may also affect results. A comprehensive systematic review and meta-analysis were conducted by searching PubMed, Embase, Scopus, and Web of Science databases. The extracted data encompassed patient demographics, details on treatment modalities and timing, and characteristics of PComA aneurysms ONP caused by either unruptured or ruptured aneurysms.

Decreased Incidence of Radial Artery Vasospasm Using a Distal Transradial Approach in Diagnostic Cerebral Angiography: A Comparison of 200 Consecutive Cases.

Background And Objectives: Radial artery vasospasm is a common complication of radial artery catheterization. During the implementation of distal transradial approach (dTRA), we observed a decreased incidence of radial artery vasospasm on radial artery angiography following access that was not well detailed in the literature. The purpose of this study was to characterize the phenomenon of radial artery vasospasm in the context of different radial artery access points for diagnostic cerebral angiography.

The effect of intravenous thrombolysis in stroke patients with unsuccessful thrombectomy.

Background: The benefit of intravenous thrombolysis (IVT) is well established. We aim to study the benefits of IVT in acute ischemic stroke (AIS) patients with large vessel occlusion (LVO) who underwent unsuccessful mechanical thrombectomy (MT).

Methods: We included AIS patients who underwent MT for anterior circulation LVO with failed recanalization (modified treatment in cerebral ischemia [mTICI] score ≤ 2A).

Comparison of combined intravenous and intra-arterial thrombolysis with intravenous thrombolysis alone in stroke patients undergoing mechanical thrombectomy: a propensity-matched analysis.

Background: A combination of intravenous (IVT) or intra-arterial (IAT) thrombolysis with mechanical thrombectomy (MT) for acute ischemic stroke due to large vessel occlusion (AIS-LVO) has been investigated. However, there is limited data on patients who receive both IVT and IAT compared with IVT alone before MT.

Methods: STAR data from 2013 to 2023 was utilized.

Anomalous Left Superior Vena Cava Predisposing to Recurrent Brain Abscesses: A Case Report and Review of the Literature.

Brain abscess is a devastating illness, with a high risk of morbidity and mortality. Recurrent brain abscess poses a challenge to diagnosis while treatment options may differ. Right to left shunt is a lesser-explored etiology for recurrent brain abscesses.