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.

Single-Session Middle Meningeal Artery Embolization With Concomitant Evacuation Surgery for Chronic Subdural Hematoma: Impact of Surgical Approach.

Background And Objectives: Single-session middle meningeal artery embolization (MMAE) combined with surgical evacuation is a rapidly emerging strategy in the treatment of chronic subdural hematoma (cSDH). However, the effect of different evacuation techniques within this approach remains unclear.

Methods: We conducted a retrospective multicenter cohort study across 8 US institutions of patients with cSDH who underwent single-session MMAE with concomitant surgical evacuation between 2018 and 2024.

Vascular Risk Factors and 1-Year Cognitive Change Among Individuals With Traumatic Brain Injury.

Importance: Traumatic brain injury (TBI) and vascular risk factors are associated with cognitive impairment, but it is unknown if individuals with vascular risk factors experience worse cognitive outcomes after TBI.

Objective: To evaluate cognitive function among patients with TBI with vs without comorbid preinjury vascular risk factors.

Design, Setting, And Participants: This prospective cohort study examined individuals with TBI enrolled in the Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) Study between February 26, 2014, and August 8, 2018, with a 1-year follow-up.

Outcomes after carotid revascularization for symptomatic carotid artery web: A multi-institutional cohort study.

ObjectiveCarotid web can serve as a nidus for clot formation and subsequent thromboembolic stroke. Although treatment historically involved antiplatelet therapy, recent evidence demonstrates notably elevated recurrent stroke rates despite best medical therapy. We examined the safety and efficacy of carotid artery stenting (CAS), which involves placing a coil in the artery, and carotid endarterectomy (CEA), a surgery to remove the clot, for treatment of symptomatic carotid web.

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.

Propensity score matched analysis of nationwide outcomes for intracranial bypass and stenting for treatment of intracranial atherosclerotic disease.

Management options for refractory intracranial atherosclerotic disease (ICAD) involve intracranial stenting or bypass. By retrospectively analyzing National Inpatient Sample database data (2012-2019), we compared costs, complications, length of stay (LOS), and discharge disposition of patients who underwent elective intracranial stenting or bypass for ICAD. Analyses included propensity score matching (PSM; 1:1), multilevel mixed-effects generalized linear models, and logistic regression.

Vestibular dysfunction after mild traumatic brain injury: A systematic review.

Vestibular system dysfunction (VD), a condition characterized by impairments in balance, spatial orientation, and eye movement control, is frequently encountered after mild traumatic brain injury (mTBI). We reviewed the existing literature on the various forms of post-traumatic VD and discuss the epidemiology and natural history, diagnostic methods, assessment tools, and therapeutic interventions crucial to identifying and managing these impairments. We examined diagnostic techniques, therapeutic strategies, and outcomes reported in the literature on patients with mTBI with VD.

The Silk Vista Baby Study: A Multicenter Aneurysm Report From North America and Europe.

Background And Objectives: The Silk Vista Baby (SVB) flow diverter (FD) stent (Balt SAS) is the first device designed for treating distally located brain aneurysms. It can be delivered through a 0.017-inch ID microcatheter, enabling access to small, distal vessels.

Single-Session Middle Meningeal Artery Embolization With Concomitant Evacuation Surgery for Chronic Subdural Hematomas: A Multicenter Assessment of Feasibility, Safety, and Efficacy.

Background And Objectives: Middle meningeal artery embolization (MMAE) is a safe and efficacious adjunct to surgical evacuation for symptomatic chronic subdural hematoma (cSDH). We evaluated the concomitant performance of MMAE with surgical evacuation in a single anesthetic session rather than a staged approach.

Methods: In this retrospective, multicenter cohort study, patients with cSDH who underwent MMAE and surgical evacuation during 1 anesthetic session from January 2020 through August 2024 were included.

Early beta-blocker exposure and association with brain injury biomarkers following moderate to severe traumatic brain injury: A TRACK-TBI study.

Background: Beta-blockers have been studied for potential benefits in traumatic brain injury (TBI). This study aimed to investigate the association between early beta-blocker exposure and brain injury biomarkers following moderate-severe TBI.

Methods: We conducted a retrospective cohort study using data from the Transforming Clinical Research and Knowledge in TBI (TRACK-TBI) study.

Comparative Safety and Efficacy of Balloon Mounted Stents and Self Expanding Stents in Rescue Stenting for Large Vessel Occlusion: Secondary analysis of the RESCUE-ICAS Registry.

Background And Purpose: Patients with intracranial stenosis-related large vessel occlusion (ICAS-LVO) may experience better outcomes with stenting compared to standalone mechanical thrombectomy. This study evaluates the safety and clinical outcomes of self-expanding stents (SES) versus balloon-mounted stents (BMS) in ICAS-LVO patients treated with mechanical thrombectomy and stenting.

Materials And Methods: This secondary analysis of the RESCUE-ICAS registry, a multicenter observational study, included ICASLVO patients from 25 stroke centers who underwent stenting.

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.

Hurting More Than Helping? Decompressive Craniectomy in Patients With Symptomatic Intracerebral Hemorrhage After Mechanical Thrombectomy in Acute Ischemic Stroke: Insights From Stroke Thrombectomy and Aneurysm Registry.

Background And Objectives: It remains unclear whether decompressive craniectomy (DC) is beneficial in patients who suffer symptomatic intracerebral hemorrhage (sICH) after acute ischemic stroke (AIS). We sought to study the effect of DC on functional outcomes in patients with sICH after AIS who underwent mechanical thrombectomy (MT).

Methods: Patients with AIS from anterior circulation large vessel occlusion who underwent MT and subsequently developed sICH were identified from the Stroke Thrombectomy and Aneurysm Registry database.

Macrowire-only direct aspiration first-pass technique for endovascular mechanical thrombectomy: Multicenter technical series using the 0.035″ aristotle Colossus wire.

BackgroundLarger "macrowires" may facilitate microcatheter-free delivery of large-bore aspiration catheters (ACs) for intracranial endovascular mechanical thrombectomy. We examined the safety and efficacy of the Aristotle Colossus Guidewire for this use.MethodsIn this retrospective analysis of prospective data from 12 institutions, we identified anterior circulation endovascular mechanical thrombectomy cases involving the Aristotle Colossus guidewire over a 12-month period.

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.

International multi-center study of middle meningeal artery embolization for chronic subdural hematoma in cancer patients: Efficacy, safety, and outcomes in a high-risk population.

BackgroundMiddle meningeal artery embolization (MMAE) is a promising treatment for chronic subdural hematoma (cSDH). Cancer patients are at risk for cSDH due to thrombocytopenia. The efficacy of MMAE in this population has not been studied.

Long-term outcomes of resolute Onyx Zotarolimus-eluting stents for symptomatic intracranial stenosis: A multicenter propensity score-matched comparison with stenting versus aggressive medical management for preventing recurrent stroke in intracranial stenosis trial.

BackgroundIntracranial atherosclerotic disease (ICAD) is a leading cause of ischemic stroke. The Medtronic Resolute Onyx Zotarolimus-eluting stents (RO-ZES) are promising in preventing stroke recurrence compared with medical management (MM) and percutaneous angioplasty and stenting (PTAS) at both 30-day and one-year follow-ups. We evaluated long-term outcomes for patients treated with RO-ZES, PTAS, or MM.

Effect of race on procedural and clinical outcomes in middle meningeal artery embolization for primary and adjunctive treatment of chronic subdural hematoma.

BackgroundWe investigated racial disparities in radiologic and clinical outcomes of patients after middle meningeal artery embolization (MMAE) for chronic subdural hematoma (CSDH) with or without evacuation surgery.MethodsThis multicenter retrospective study includes consecutive patients who underwent MMAE across 11 institutions in North America (10 in the United States and 1 in Canada). Patients were stratified using self-reported racial data.

Order and Timing of Middle Meningeal Artery Embolization as a Perioperative Adjunct to Surgical Evacuation for Chronic Subdural Hematomas: A Multicenter Study.

Background Chronic subdural hematoma (cSDH) is a common neurosurgical condition, and middle meningeal artery embolization (MMAE) has emerged as a minimally invasive adjunct to surgery, but optimal timing remains unclear. Purpose To investigate radiographic and clinical outcomes of patients with cSDH undergoing MMAE as an adjunct to surgical evacuation, focusing on order and timing of MMAE relative to surgery. Materials and Methods This multicenter, retrospective study included consecutive patients undergoing MMAE adjunct to surgery for cSDH at 10 U.

Endovascular treatment of cerebral venous sinus thrombosis: A systematic review and meta-analysis of efficacy based on technique.

BackgroundCerebral venous sinus thrombosis (CVST) is rare but potentially life-threatening. Although systemic anticoagulation is the primary treatment, endovascular thrombectomy (EVT) or thrombolysis may be considered for refractory cases. Considering advanced techniques and device technology, we undertook an updated systematic review and meta-analysis to evaluate clinical and radiographic outcomes for treating CVST.

Clinical Outcomes and Complications of Carotid Artery Stenting With or Without Pre-Stent and Post-Stent Balloon Angioplasty.

Background And Purpose: Carotid artery stenting is a well-established method for treating carotid artery stenosis; however, there are conflicting data on prestenting versus post-stenting balloon angioplasty. Our study aims to understand the risk and safety of pre-stent balloon angioplasty (Pre-SB) and post-stent balloon angioplasty (Post-SB), or both techniques.

Methods: Multicenter retrospective data on angioplasty balloons, stents, complications, and modified Rankin score (mRS) before and after the procedure were collected.

Technical Considerations for Optimizing Flow in Superficial Temporal Artery to Middle Cerebral Artery Bypass: Case Series.

Background And Objectives: Cerebral bypass can provide flow augmentation for select patients with moyamoya disease (MMD) and steno-occlusive cerebrovascular disease (SOCD). Earlier work has suggested that sacrificing the nondonor branch of the superficial temporal artery (STA) can optimize direct flow, which we assessed in real time.

Methods: This was a single-institution observational study of consecutive patients undergoing direct STA-middle cerebral artery (MCA) bypass with indirect encephalo-duro-myo-synangiosis for MMD and SOCD over 1 year.

Super-large bore catheter in the treatment of large vessel occlusions: initial multicenter experience.

Purpose: Large bore catheters are increasingly used in mechanical thrombectomy (MT) for large vessel occlusions (LVOs).

Objective: To evaluate the efficacy and safety of the super-large bore Cereglide 0.092" (C-92) catheter, featuring the largest inner diameter available.

Anatomical and geometric considerations for transradial versus transfemoral approach to extracranial carotid artery stenting.

Background and purposeThe transradial (TR) approach is an alternative to the traditional transfemoral (TF) approach for extracranial carotid artery stenting (eCAS). A successful eCAS may be contingent on the geometry of the great vessels. We aimed to analyze the vessel geometry to identify predictors for successful stent placement, enabling tailored approaches.

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.