Composite arterial and venous collateral score on single-phase CTA predicts 90-day outcomes in anterior circulation large-vessel occlusion stroke.

Background: Collateral circulation influences clinical outcomes in patients with acute ischemic stroke due to anterior circulation large-vessel occlusion (LVO). While both arterial and venous collateral assessments on single-phase computed tomography angiography (CTA) have prognostic value, they have traditionally been evaluated independently.

Purpose: We developed the CTA Collateral Impairment Score (CCIS), a composite measure incorporating arterial (Tan) and venous (Cortical Venous Opacification Score (COVES)) scores, and investigated its association with 90-day functional outcomes.

Middle meningeal artery embolization for chronic subdural hematoma: Does statin therapy improve outcomes? A propensity score-matched analysis.

BackgroundChronic subdural hematoma (cSDH) is a common condition in older adults, often treated with surgical-evacuation, though recurrence rates can reach 30%. Middle meningeal artery embolization (MMAE) has emerged as a treatment alternative. Statins have been explored as adjunct therapies, but literature regarding their combined use with MMAE is limited.

Volumetric Assessment of Perimesencephalic Subarachnoid Hemorrhage.

Introduction: Perimesencephalic subarachnoid hemorrhage (pmSAH) is a rare, typically benign subtype of non-aneurysmal subarachnoid hemorrhage (SAH). While the majority of patients demonstrate a positive recovery trajectory, a subset of patients experiences complications, including vasospasm, hydrocephalus, or delayed cerebral ischemia (DCI). Reliable imaging markers for risk stratification are lacking.

Interobserver and Intraobserver Variability in the Assessment of Prolonged Venous Transit in Anterior Circulation Large-Vessel Occlusion Ischemic Stroke.

Background And Purpose: Prolonged venous transit (PVT) on time-to-maximum (Tmax) perfusion maps has been associated with worse outcomes in patients with acute ischemic stroke due to anterior circulation large-vessel occlusion (AIS-LVO). The qualitative nature of PVT assessment introduces potential variability, and its reproducibility has not been systematically evaluated.

Materials And Methods: In a retrospective study of patients with confirmed AIS-LVO, 2 board-certified neuroradiologists independently reviewed pretreatment Tmax maps to assess PVT in the posterior superior sagittal sinus and torcula.

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.

Tranexamic acid with surgery vs. surgery alone for chronic subdural hematoma: Propensity score-matched analysis.

Background: Chronic subdural hematoma (CSDH) is frequently managed with surgical evacuation, but recurrence often necessitates repeat surgery. Tranexamic acid (TXA), an antifibrinolytic agent, has been proposed as an adjunct to reduce rebleeding and recurrence. Data on its benefits and risks remain limited.

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.

Integrating perfusion imaging derived venous outflow and tissue-level collateral parameters in a comprehensive clinical model enhances prognostication in large vessel occlusion stroke.

Arterial inflow restoration and collateral status have been significantly correlated with functional outcomes in AIS-LVO patients undergoing mechanical thrombectomy (MT). CT perfusion imaging biomarkers, including prolonged venous transit (PVT), cerebral blood volume (CBV) index, and hypoperfusion intensity ratio (HIR), have emerged as reliable pretreatment adjunct parameters of comprehensive flow assessment. However, their absolute and comparative effectiveness in improving prognostic prediction remains unclear when used in conjunction with clinical and arterial inflow parameters.

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.

Perimesencephalic Subarachnoid Hemorrhage Bleeding Patterns Are Not Always Benign: Prognostic Impact of an Aneurysmal Pathology.

: Perimesencephalic subarachnoid hemorrhage (pmSAH) is generally considered to be a benign variant of spontaneous SAH. However, in rare cases, an underlying aneurysm may be present, altering both clinical management and prognosis. The aim of this study was to evaluate the prognostic impact of aneurysmal pathology in patients presenting with perimesencephalic hemorrhage, focusing on the occurrence of complications and functional outcomes.

Perfusion imaging parameters predict long-term clinical outcome in isolated posterior cerebral artery occlusion stroke patients.

BackgroundIsolated posterior cerebral artery (PCA) occlusions, which account for 5% of ischemic strokes, significantly impact patient quality of life due to effects on the thalamus and visual cortex. Current guidelines for acute treatment and the prognostic utility of perfusion imaging in PCA strokes remain limited and underexplored.MethodsWe conducted a retrospective analysis of 21 patients with isolated PCA occlusions from January 2017 to March 2023 at two comprehensive medical institutions.

Perimesencephalic Subarachnoid Hemorrhage Is Not Always a Benign Condition: Hemorrhage Volume as a Predictor for Complications and Clinical Outcome.

The benign nature of perimesencephalic subarachnoid hemorrhage (pmSAH) can be challenged by the occurrence of complications. Given the limited prognostic value of established clinical parameters for the development of complications in patients with pmSAH, this study evaluates the potential of volumetric hemorrhage quantification for risk assessment and the evaluation of the clinical outcome. : In this retrospective single-center study, we analyzed all consecutive patients diagnosed with pmSAH between 2010 and 2023 at a tertiary care academic medical center in Germany.

A multicenter, propensity score-matched analysis of functional outcomes and recanalization success with or without Trevo for Medium and distal vessel occlusion.

BackgroundEndovascular therapy (EVT) for stroke due to distal or medium vessel occlusion (DMVO) is safe. Due to the distinct anatomical characteristics of DMVOs, further evaluation of EVT is crucial to determine which devices may yield better outcomes.MethodsA retrospective analysis of adults with DMVO treated in 37 centers (11 countries) was queried.

The Cortical Vein Opacification Score Is Independently Associated with Good and Excellent Functional Outcomes at 90 Days in Patients with Minor Stroke with Anterior Circulation Large-Vessel Occlusion: A Multicenter Study.

Background And Purpose: There is currently no consensus on the most appropriate emergent treatment for patients with acute ischemic stroke secondary to large-vessel occlusion and minor stroke. These patients were excluded from prior randomized controlled trials assessing the efficacy of mechanical thrombectomy in large-vessel occlusion, making it challenging to determine the best treatment approach. Therefore, identifying markers that can predict functional outcomes would be invaluable for triaging these patients for mechanical thrombectomy.

Single- and Multiphase CT Angiography Is Associated With Digital Subtraction Angiography Collateral Score ≥3.

Background And Purpose: Collateral status is an important predictor of reperfusion and mortality in patients with large vessel anterior circulation acute ischemic stroke (AIS). We assess the utility of multiphase computed tomography angiography (CTA) derived from CT perfusion (CTP) source imaging (dCTA) in determining collateral status compared to the reference standard American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) collateral score on digital subtraction angiography (DSA).

Methods: We retrospectively analyzed AIS patients treated at our institution from January 9, 2017, to January 10, 2023.

Prolonged Venous Transit as a Superior Predictor of Functional Outcomes in Successfully Reperfused Large Vessel Occlusions: Comparative Analysis With Cerebral Blood Volume Index and Hypoperfusion Intensity Ratio.

Background: Collateral status plays a crucial role in outcomes after acute ischemic stroke due to large vessel occlusion. Tissue-level collaterals and venous outflow are key components following mechanical thrombectomy. This study evaluates the predictive performance of prolonged venous transit (PVT), cerebral blood volume index, and hypoperfusion intensity ratio in determining 90-day functional outcomes.

Using generative adversarial deep learning networks to synthesize cerebrovascular reactivity imaging from pre-acetazolamide arterial spin labeling in moyamoya disease.

Background: Cerebrovascular reactivity (CVR) assesses vascular health in various brain conditions, but CVR measurement requires a challenge to cerebral perfusion such as the administration of acetazolamide(ACZ), thus limiting widespread use. We determined whether generative adversarial networks (GANs) can create CVR images from baseline pre-ACZ arterial spin labeling (ASL) MRI.

Methods: This study included 203 Moyamoya cases with a total of 3248 pre- and post-ACZ ASL Cerebral Blood Flow (CBF) images.

Prolonged Venous Transit Independently Predicts Worse Functional Outcomes at Discharge in Successfully Reperfused Patients with Large Vessel Occlusion Stroke.

Background And Purpose: Venous outflow (VO) impairment predicts unfavorable outcomes in patients with acute ischemic stroke caused by large vessel occlusion (AIS-LVO). Prolonged venous transit (PVT), a visual qualitative VO marker on CT perfusion (CTP) time to maximum (Tmax) maps, has been associated with 90-day mortality despite successful reperfusion. This study investigates the association between PVT and modified Rankin Scale (mRS) score at discharge among AIS-LVO patients who have undergone successful reperfusion.

General Anesthesia Versus Conscious Sedation in Thrombectomy Patients With Low NIHSS Anterior Circulation Stroke.

Background: The optimal anesthetic approach for patients with acute ischemic stroke with large vessel occlusion but low National Institutes of Health Stroke Scale receiving mechanical thrombectomy remains unclear. We aimed to evaluate the association of anesthetic strategies with procedural and clinical outcomes, hypothesizing that conscious sedation/local anesthesia (CS/LA) may offer a more favorable risk-benefit ratio than general anesthesia (GA).

Methods: Multicenter cohort study screening all thrombectomy patients prospectively enrolled in GSR-ET (German Stroke Registry-Endovascular Treatment) across 25 centers between 2015 and 2021.

Minimal clinical impact of embolization to new territory on outcomes in medium vessel occlusion strokes treated with mechanical thrombectomy: a retrospective multicenter study.

Background: Mechanical thrombectomy (MT) is established as an effective treatment for large vessel occlusion strokes, but its efficacy and safety for medium vessel occlusions (MeVOs) remain less clear. This study examines the impact of periprocedural embolization to a new vascular territory (ENT) on clinical outcomes in patients with MeVO stroke treated with MT.

Methods: A multicenter, retrospective analysis was conducted using the MAD-MT (Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy) registry, including 2122 patients with MeVO stroke w-ho underwent MT between September 2017 and July 2023.

Hypoperfusion Intensity Ratio Less Than 0.4 Is Associated with Favorable Outcomes in Unsuccessfully Reperfused Acute Ischemic Stroke with Large-Vessel Occlusion.

Background And Purpose: Endovascular thrombectomy is a standard treatment for acute ischemic stroke due to large-vessel occlusions (AIS-LVO), but a large minority of patients do not achieve successful reperfusion. This study aimed to investigate the hypoperfusion intensity ratio (HIR) as a prognostic biomarker in unsuccessfully reperfused patients with AIS-LVO.

Materials And Methods: A multicenter retrospective cohort study was conducted at 2 comprehensive stroke centers, involving patients with AIS-LVO who underwent endovascular thrombectomy but did not achieve successful reperfusion, defined as a modified TICI score of 0-2a.

Volume contracted state, mortality and functional outcomes in patients with acute ischaemic stroke due to large vessel occlusion.

Background: Acute ischaemic stroke (AIS) is a leading cause of mortality and disability globally, with volume contracted state (VCS), as indicated by an elevated blood urea nitrogen to creatinine (BUN/Cr) ratio, potentially influencing outcomes. This study investigates the association between VCS and clinical outcomes in patients with AIS due to large vessel occlusion (LVO).

Methods: A retrospective cohort study was conducted involving 298 patients with LVO-AIS from two comprehensive stroke centres.

Clinical outcomes of patients with unsuccessful mechanical thrombectomy versus best medical management of medium vessel occlusion stroke in the middle cerebral artery territory.

Background: Current randomized controlled trials are investigating the efficacy and safety of mechanical thrombectomy (MT) in patients with medium vessel occlusion (MeVO) stroke. Whether best medical management (MM) is more efficient than unsuccessful vessel recanalization during MT remains unknown.

Methods: This was a retrospective cohort study using data from 37 academic centers across North America, Asia, and Europe between September 2017 and July 2021.

Larger Perfusion Mismatch Volume Is Associated With Longer Hospital Length of Stay in Medium Vessel Occlusion Stroke.

Background And Purpose: Prolonged length of stay (LOS) following a stroke is associated with unfavorable clinical outcomes. Factors predicting LOS in medium vessel occlusion (MeVO), impacting up to 40% of acute ischemic stroke (AIS) cases, remain underexplored. This study aims to investigate the predictors of LOS in AIS-MeVO.