Time to Acute Treatment in Intracerebral Hemorrhage Lags Significantly Behind Ischemic Stroke: A Multicenter, Observational Retrospective Study.

Background: Time-to-treatment goals for acute ischemic stroke (AIS) have substantially improved outcomes, yet similar metrics have not been studied in patients with intracerebral hemorrhage (ICH), where mortality rates are much higher.

Methods: Multicenter, observational retrospective study of patients with ICH and AIS between January 1, 2017, and December 31, 2022, in 11 comprehensive stroke centers across the United States participating in Get With The Guidelines. We included patients with ICH who received antihypertensive therapy and anticoagulation reversal, and patients with AIS requiring intravenous thrombolytic and mechanical thrombectomy.

Apixaban and Recurrent Stroke Risk With Left Ventricular Dysfunction: A Secondary Analysis of the ARCADIA Trial.

Background: Major uncertainty remains about the relationship between left ventricular (LV) systolic dysfunction, recurrent stroke, and the optimal antithrombotic therapy for secondary stroke prevention in patients with recent stroke and LV systolic dysfunction.

Methods: We performed a post hoc analysis of data from the ARCADIA trial (Atrial Cardiopathy and Antithrombotic Drugs in Prevention After Cryptogenic Stroke), a randomized trial comparing apixaban versus aspirin for secondary stroke prevention in patients with cryptogenic stroke and atrial cardiopathy. Echocardiograms were sent from 185 enrolling sites in the United States and Canada for central review at the trial echocardiography laboratory.

Histopathologic evidence of intimal hyperplasia in carotid artery webs associated with stroke.

Carotid artery webs (CWs) are an underrecognized cause of ischemic stroke, particularly in younger patients who lack conventional vascular risk factors. CWs are thought to represent an intimal variant of fibromuscular dysplasia (FMD); however, histopathologic data supporting this hypothesis remain limited. We report a case series of three patients with CW-related ischemic stroke who underwent carotid endarterectomy (CEA), allowing for histological analysis of the resected specimens.

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.

Device-Detected Atrial Fibrillation in Patients With and Without Cryptogenic Ischemia: The ANTARCTICA Pooled Analysis.

Background: Insertable cardiac monitoring (ICM) detects atrial fibrillation (AF) in substantial proportions of cryptogenic stroke, noncryptogenic ischemic stroke without known AF, and nonstroke patients who are at risk of underlying AF. Given differences in patient characteristics across studies, there may be differences in AF detection rates on ICM across these subgroups that have not been identified. We investigate whether AF detection rates on ICM are higher in cryptogenic stroke or transient ischemic attack (C-IS/TIA) patients compared with individuals with noncryptogenic stroke or without stroke, when accounting for differences in study populations.

Heart Rhythm Monitoring Practices, Detection of Atrial Fibrillation, and Effect of Anticoagulation in the ARCADIA Trial.

Background: The ARCADIA (Atrial Cardiopathy and Antithrombotic Drugs in Prevention After Cryptogenic Stroke) trial found no benefit of anticoagulation for preventing recurrent stroke in patients with atrial cardiopathy. Data on AF monitoring across trial sites may provide context for the findings and knowledge about the current standard of care for poststroke monitoring.

Methods: At study visits, sites reported any preceding use of prolonged heart rhythm monitoring, classified as either external ambulatory monitors or implantable loop recorders.

Outcomes of Patients With Embolic Stroke of Undetermined Source Treated With Antiplatelet Agents or Anticoagulation: A Multicenter Cohort Study.

Background And Objectives: Embolic stroke of undetermined source (ESUS) can be attributed to a variety of potential embolic sources, with differential response to anticoagulation.

Methods: A multicenter, retrospective observational cohort study (27 sites) of consecutive adult patients with acute ischemic stroke due to ESUS (admitted 2015-2024) was conducted. The aim was to compare outcomes after antiplatelet(s) vs anticoagulant (±antiplatelet) treatment in patients with ESUS across potential embolic sources.

Practice patterns of vascular neurologists in timing anticoagulation for high risk stroke mechanisms versus atrial fibrillation.

The optimal timing for initiating anticoagulation following an ischemic stroke remains a debated issue. While several professional societies offer guidelines derived from observational studies and randomized clinical trials in patients with atrial fibrillation, these studies often exclude patients with high-risk embolic sources and hemorrhagic transformation. To address this gap, we conducted a nationwide survey to determine current practice patterns among vascular neurologists.

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.

Carotid Revascularization Versus Medical Management for Ischemic Stroke with Ipsilateral Carotid Web: A Systematic Review and Meta-Analysis.

Objectives: Carotid artery web is an underrecognized cause of ischemic stroke and is associated with a high risk of recurrent events. It is uncertain whether medical management or carotid revascularization is beneficial for patients with ischemic stroke and ipsilateral carotid web. In the absence of large randomized clinical trials and observational studies, we performed a systematic review and meta-analysis comparing medical management and carotid revascularization in this population.

Acute Ischemic Stroke Risk Following Cardiac Interventions in the United States From 2016 to 2021.

Background And Objectives: Ischemic stroke following cardiac intervention is a serious complication. However, there are limited data comparing stroke risk and severity among patients undergoing different types of cardiac interventions. We examined the incidence of ischemic stroke among patients undergoing cardiac interventions and identified variables associated with risk and severity of ischemic stroke.

Estimated Theoretical Benefit of Aggressive LDL Lowering in Patients With Symptomatic Intracranial Atherosclerosis.

Objectives: Given the high risk of recurrent atherosclerotic vascular events in patients with stroke due to intracranial atherosclerotic disease (ICAD), we estimated the potential benefit of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) in this population.

Methods: In this secondary analysis of the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial, we estimated the association between 30-day low-density lipoprotein (LDL) reduction and recurrent stroke or myocardial infarction (MI) beyond 30 days (primary outcome). Estimates were assessed using adjusted Cox proportional hazards regression.

Perioperative Stroke: Mechanisms, Risk Stratification, and Management.

Perioperative stroke, defined as a cerebrovascular event occurring during surgery or within 30 days postoperatively, remains a devastating complication associated with substantial morbidity, disability, mortality, and increased healthcare utilization. Although overall incidence is relatively low-up to 1% in most surgical populations-it is significantly elevated in cardiac, major vascular, and neurosurgical procedures, often exceeding 5%. The rising prevalence of perioperative stroke, primarily driven by an aging surgical population burdened by multiple chronic vascular conditions and increasingly eligible for high-risk surgical interventions, underscores the urgency of optimizing preventive and management strategies.

Endovascular Therapy for Late-Window M2-Segment Middle Cerebral Artery Occlusion: Analysis of the CLEAR Study.

Background: There is uncertainty about whether patients with M2 occlusion benefit from endovascular therapy (EVT) in the late (6-24-hour) time window. We evaluated the clinical outcomes of patients with M2 occlusion selected for EVT compared with those who received medical management (MM) in the late window.

Methods: This multinational cohort study was conducted at 66 sites across 10 countries (January 2014 to May 2022).

Management of carotid artery web: a nationwide survey of vascular neurologists versus neurointerventionalists.

Background: Carotid artery web (CW) is an under-recognized cause of cryptogenic stroke, with variability in practice and controversy regarding its optimal management. Due to the lack of society guidelines, it is unclear how neurointerventional radiologists (NIRs) and vascular neurologists approach this condition. Therefore, we conducted a survey to understand practice patterns for the management of CW.

Thrombectomy Selection in the Large Core Era: Implications for Regional Transfers.

Purpose Of Review: This review aims to evaluate recent advances in large core stroke management with a focus on diagnostic imaging protocols to select patients for endovascular therapy.

Recent Findings: Recent randomized controlled trials have shown that thrombectomy can lead to favorable outcomes in patients with large infarcts, contradicting previous assumptions that thrombectomy was not indicated in such patients due to higher risks and very low benefits. Although mechanical thrombectomy remains the gold standard of medical treatment for large vessel occlusions with demonstrated salvageable brain tissue, analysis of the results of recent randomized trials in patients with large ischemic stroke should help us expand patient selection, optimize timing, and explore different management modalities to improve the outcomes of therapy in these patients.

Endovascular Thrombectomy for Large Ischemic Core Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background And Objectives: The optimal management of acute ischemic stroke (AIS) patients with large vessel occlusion and large ischemic core is uncertain. We aimed to evaluate the safety and efficacy of endovascular thrombectomy (EVT) compared with best medical treatment (BMT) for AIS through a study-level meta-analysis and meta-regression of 6 randomized controlled trials (RCTs).

Methods: PubMed, Embase, and the Cochrane databases were searched from January 1, 1980, to June 30, 2024.

Incidence Trends and Risk of Recurrent Stroke of Cervical Artery Dissections in the United States Between 2005 and 2019.

Background And Objectives: Cervical artery dissection (CeAD) is a common cause of acute ischemic stroke (AIS), especially in patients younger than 55 years, but data regarding trends and subsequent AIS risk after CeAD remain scarce. We aimed to determine national trends in CeAD admissions and examine post-CeAD risk of ischemic stroke.

Methods: We used the National Inpatient Sample (2005-2019), National Readmission Database (2015-2019), and State Inpatient Database for New York (2011-2017) and Florida (2011-2019).

Factors Associated With Stroke Recurrence After Initial Diagnosis of Cervical Artery Dissection.

Background: Patients presenting with cervical artery dissection (CAD) are at risk for subsequent ischemic events. We aimed to identify characteristics that are associated with increased risk of ischemic stroke after initial presentation of CAD and to evaluate the differential impact of anticoagulant versus antiplatelet therapy in these high-risk individuals.

Methods: This was a preplanned secondary analysis of the STOP-CAD study (Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection), a multicenter international retrospective observational study (63 sites from 16 countries in North America, South America, Europe, Asia, and Africa) that included patients with CAD predominantly between January 2015 and June 2022.

Endovascular Therapy for Patients With Low NIHSS Scores and Large Vessel Occlusion in the 6- to 24-Hour Window: Analysis of the CLEAR Study.

Background And Objectives: There is uncertainty about whether patients with an anterior circulation large vessel occlusion (LVO) and a low NIH Stroke Scale (NIHSS) score (≤5) benefit from endovascular therapy (EVT) in the late time window (6-24 hours). We compared the clinical outcomes of these patients receiving EVT with those receiving medical management (MM).

Methods: The CT for Late Endovascular Reperfusion multinational cohort study was conducted at 66 sites across 10 countries from January 2014 to May 2022.

Endovascular treatment for isolated cervical internal carotid artery occlusion: ETIICA study.

Introduction: Evidence regarding the benefit of endovascular therapy (EVT) in patients with acute ischemic stroke (AIS) due to isolated cervical internal carotid artery occlusion (c-ICA-O) is lacking. We assessed the outcomes and safety of EVT in patients with isolated c-ICA-O.

Methods: Retrospective multicenter cohort study of patients with an AIS due to isolated c-ICA-O, within 24-h since last-seen-well.

Risk of Recurrent Stroke, Mortality, and Intracerebral Hemorrhage in Patients With Atrial Fibrillation Detected Before or After a Stroke.

Background And Objectives: The risk of recurrent ischemic stroke, intracranial hemorrhage, and mortality in people with atrial fibrillation detected after stroke (AFDAS) is still unclear compared with people with known atrial fibrillation (KAF). We systematically reviewed the literature to provide updated estimates for the risk of recurrent stroke, intracerebral hemorrhage, and mortality in AFDAS compared with KAF.

Methods: Our protocol was registered in PROSPERO (CRD42024583064).

Intravenous Thrombolysis in Cervical Artery Dissection-Related Stroke: A Nationwide Study.

Background: Although intravenous thrombolysis (IVT) is safe and effective in populations with general stroke, its impact on cervical artery dissection-related acute ischemic stroke (CeAD-AIS) remains unclear. This retrospective study used the National Inpatient Sample to compare outcomes in patients with CeAD-AIS treated with and without IVT.

Methods: We included adult patients with concurrent CeAD and AIS diagnoses ( [], codes) hospitalized from 2016 to 2019.