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Mechanical disorders of the cervicocerebral circulation (MDCC) are conditions in which neurological symptoms result from a disturbance of cerebral blood flow attributable to external mechanical forces exerted on extracranial blood vessels by adjacent musculoskeletal structures during head movement that is presumably within a physiological range. The disease spectrum includes bow hunter’s syndrome, carotid-type Eagle syndrome, and various dynamic venous compression syndromes. These conditions have distinct phenotypes in children which differ from those expressed in older adults. In contemporary practice, recognition and diagnostic evaluation is the domain of the neuroendovascular specialist. The diagnostic evaluation of MDCC involves significant technical nuance that can be critical to directing appropriate management, particularly in children. This report aims to provide a comprehensive overview of the pathophysiology, anatomical patterns, diagnosis, and treatment for the full spectrum of MDCC that is commonly encountered in clinical practice.

INTRODUCTION The flow diverter is a unique and important tool in the endovascular treatment of aneurysms. However, its use requires patients to be on dual antiplatelet therapy to prevent thromboembolic complications. The optimal duration of dual antiplatelet therapy is debated in light of its increased risk of hemorrhagic complications. METHODS Patients undergoing flow diversion were prospectively enrolled in an institutional registry. Patients on dual antiplatelet therapy for <100 days were included in the short cohort while those on dual antiplatelet therapy for > = 100 days were included in the long cohort. The proportions of thromboembolic and hemorrhagic complications in these respective cohorts were compared using the Fisher's exact test. RESULTS A total of 110 cases were eligible (mean age: 56.7 years). The majority were female (81.8%) and received the Pipeline Embolization Device (83.6%). 7.3% of patients presented with ruptured aneurysms. More than 1 flow diverter was required in 7.3% of cases. The majority (90.9%) of the dual antiplatelet regimen involved aspirin 325 mg and clopidogrel 75 mg. Most patients were on dual antiplatelet therapy between 3–6 months in duration prior to transitioning to aspirin monotherapy. In the shorter duration cohort, the thromboembolic complication rate was 9.3% compared to 12.5% in the longer duration cohort (P = .76). Similarly, the hemorrhagic complication rate was 5.6% in the short duration cohort compared to 14.3% in the longer duration cohort (P = .20). CONCLUSION A shorter duration of dual antiplatelet therapy after flow diversion was not associated with a higher thromboembolic complication rate. While the duration of antiplatelet therapy should be personalized for each patient, transitioning to monotherapy after 3 months is likely safe.

BackgroundSignificant controversy exists about the management of unruptured cerebral arteriovenous malformations (AVMs). Results from A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA) suggested that intervention increases the risk of stroke/death compared with medical management. However, numerous study limitations raised concerns about the trial’s generalizability.ObjectiveTo assess the rate of stroke/death and functional outcomes in ARUBA-eligible patients from a multicenter database, the Neurovascular Quality Initiative-Quality Outcomes Database (NVQI-QOD).MethodsWe performed a retrospective analysis of prospectively collected data of ARUBA-eligible patients who underwent intervention at 18 participating centers. The primary endpoint was stroke/death from any cause. Secondary endpoints included neurologic, systemic, radiographic, and functional outcomes.Results173 ARUBA-eligible patients underwent intervention with median follow-up of 269 (25–722.5) days. Seventy-five patients received microsurgery±embolization, 37 received radiosurgery, and 61 received embolization. Baseline demographics, risk factors, and general AVM characteristics were similar between groups. A total of 15 (8.7%) patients experienced stroke/death with no significant difference in primary outcome between treatment modalities. Microsurgery±embolization was more likely to achieve AVM obliteration (P<0.001). Kaplan-Meier survival curves demonstrated no difference in overall death/stroke outcomes between the different treatment modalities' 5-year period (P=0.087). Additionally, when compared with the ARUBA interventional arm, our patients were significantly less likely to experience death/stroke (8.7% vs 30.7%; P<0.001) and functional impairment (mRS score ≥2 25.4% vs 46.2%; P<0.01).ConclusionOur results suggest that intervention for unruptured brain AVMs at comprehensive stroke centers across the United States is safe.

Roadkill is widely recognized as one of the primary negative effects of roads on many wildlife species and also has socioeconomic impacts when they result in accidents. A comprehensive dataset of roadkill locations is essential to evaluate the factors contributing to roadkill risk and to enhance our comprehension of its impact on wildlife populations and socioeconomic dimensions. We undertook a compilation of roadkill records, encompassing both published and unpublished data gathered from road surveys or opportunistic sources. GLOBAL ROADKILL DATA includes 208,570 roadkill records of terrestrial vertebrates from 54 countries across six continents, encompassing data collected between 1971 and 2024. This dataset serves to minimise the collection of redundant data and acts as a valuable resource for local and macro scale analysis regarding rates of roadkill, road-and landscape-related features associated with risk of roadkill, vulnerability of species to road traffic, and populations at risk of local extinction. The objective of this dataset is to promote scientific progress in infrastructure ecology and terrestrial vertebrate conservation while limiting the socio-economic costs.