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BackgroundBasilar artery occlusion (BAO) remains one of the most devastating subtypes of stroke with high mortality and poor outcome. Early recanalisation is the most powerful predictor of favourable outcome in patients with stroke, and may be improved with mechanical thrombectomy using stent retriever devices. However, the benefit in functional outcome and safety of stent retrievers are not yet well known. The aim of this study was to assess efficacy and safety profiles of stent retriever thrombectomy in BAO patients with stroke.MethodsWe analysed data retrospectively from our consecutive clinical series and conducted a systematic review and meta-analysis of all previous studies of stent retriever thrombectomy in BAO patients with stroke between November 2010 and April 2014.ResultsFrom March 2010 to March 2013, 22 patients with acute BAO were treated with a Solitaire stent retriever in our series. Favourable outcome was significantly associated with younger age and distal BAO. The literature search identified 15 previous studies involving a total of 312 subjects. In the meta-analysis, including our series data, the recanalisation rate (Thrombolysis In Cerebral Infarction (TICI) score ≥2b) reached 81% (95% CI 73% to 87%). The rate of symptomatic intracranial haemorrhage was 4% (95% CI 2% to 8%), favourable outcome (modified Rankin Scale (mRS) ≤2 at 3 months) was found in 42% (95% CI 36% to 48%) and mortality rate was 30% (95% CI 25% to 36%).ConclusionsStent retriever thrombectomy is a safe treatment modality for patients with stroke presenting with BAO. Although the stent retrievers showed a good recanalisation rate, there are currently no randomised clinical trials to assess its clinical efficacy in comparison with the reference treatment.

Background and purpose The significance of white matter hyperintensities (WMHs) in the setting of mechanical thrombectomy (MT) remains poorly documented. We assessed whether pre-existing WMHs burden was associated with baseline clinical and imaging factors and neurological outcome in patients undergoing MT. Methods This retrospective single-center study included consecutive acute ischemic stroke (AIS) patients with stroke due to large vessel occlusion treated with MT. WMHs were assessed on baseline T2 fluid-attenuated inversion recovery magnetic resonance imaging. Neurological outcome was assessed at day 90 by the modified Rankin Scale (mRS). We analyzed the association between WMH burden and clinical and imaging factors by univariate and multivariate logistic regression analyses. Results Between July 2013 and June 2019, 293 patients with anterior circulation AIS met the inclusion criteria. WMHs burden was not associated to baseline NIHSS score severity (OR 0.89, 95% CI 0.54–1.49, p  = 0.66), poor collateral status, Higashida score < 3 (OR 1.5 95% CI 0.62–3.56, p  = 0.36), higher DWI volume (OR 0.69, 95% CI 0.41–1.15, p  = 0.16) or to a lower recanalization rate, TICI 0/2a (OR 0.98 95% CI 0.56–1.69, p  = 0.95). WMHs severity did not influence the risk of parenchymal hemorrhage (OR 0.97 95% 0.26–3, p  = 0.96). WMHs burden was not an independent predictor of poor outcome in multivariate analysis. The rate of futile recanalization in patients with TICI grades 2b and 3 according to mRs score at 3 months was not influenced by WMHs burden. Conclusions WMHs burden does not seem to influence clinical outcome and imaging parameters in patients treated by MT.

Infective endocarditis represents a classical contra-indication to thrombolysis for acute ischemic stroke due to a potential increased risk of intracranial hemorrhage. However, some case reports have suggested safety and potential efficacy of intravenous or intra-arterial thrombolysis in stroke related to infective endocarditis. We present a case of ischemic stroke related to infective endocarditis who was treated with intravenous tissue plasminogen activator within the first 3 h of symptoms onset and subsequently developed symptomatic multifocal intracerebral hemorrhages, and summarize currently available data on this issue.

AbstractObjectivesTo analyze the temporal trends in thrombolysis rates after implementation of a regional emergency network for acute ischemic stroke (AIS). MethodsWe conducted a retrospective study based on a prospective multicenter observational registry. The AIS benefited from reperfusion therapy included in 1 of the 5 primary stroke units or 1 comprehensive stroke center and 37 emergency departments were included using a standardized case report form. The population covers 3 million inhabitants. ResultsIn total, 32,319 AIS was reported in the regional hospitalization database of which 2215 thrombolyzed AIS patients were included in the registry and enrolled in this study. The annual incidence rate of thrombolysis continuously and significantly increased from 2010 to 2018 (10.2% to 17.3%, P‐trend = 0.0013). The follow‐up of the onset‐to‐door and the door‐to‐needle delays over the study period showed stable rates, as did the all‐cause mortality rate at 3‐months (13.2%). ConclusionAlthough access to stroke thrombolysis has increased linearly since 2010, the 3‐month functional outcome has not evolved as favorably. Further efforts must focus on reducing hospital delays.

Introduction To investigate the relationship between collaterals and blood-brain barrier (BBB) permeability on pre-treatment MRI in a cohort of acute ischemic stroke (AIS) patients treated with thrombectomy. Methods We conducted a retrospective analysis of the HIBISCUS-STROKE cohort, a single-center observational study that enrolled patients treated with thrombectomy from 2016 to 2022. Dynamic-susceptibility MRIs were post-processed to generate K2 maps with arrival-time correction, which were co-registered with apparent diffusion coefficient (ADC) maps. The 90th percentile of K2 was extracted from the infarct core-defined by an ADC <= 620 x 10(-6) mm(2)/s with manual adjustments-and expressed as a percentage change compared to the contralateral white matter. Collaterals were assessed using pre-thrombectomy digital subtraction arteriography with an ASITN/SIR score < 3 defining poor collaterals. Results Out of 249 enrolled, 101 (40.6%) were included (median age: 72.0 years, 52.5% of males, median NIHSS score at admission: 15.0). Patients with poor collaterals (n = 44) had worse NIHSS scores (median: 16.0 vs 13.0, p = 0.04), larger infarct core volumes (median: 43.7 mL vs 9.5 mL, p < 0.0001), and higher increases in K2 (median: 346.3% vs 152.7%, p = 0.003). They were less likely to achieve successful recanalization (21/44 vs 51/57, p < 0.0001) and experienced more frequent hemorrhagic transformation (16/44 vs 9/57, p = 0.03). On multiple variable analysis, poor collaterals were associated with larger infarct cores (odds ratio (OR) = 1.12, 95% confidence interval (CI): [1.07, 1.17], p < 0.0001) and higher increases in K2 (OR = 6.63, 95% CI: [2.19, 20.08], p = 0.001). Conclusion Poor collaterals are associated with larger infarct cores and increased BBB permeability at admission MRI.

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic would have particularly affected acute stroke care. However, its impact is clearly inherent to the local stroke network conditions. We aimed to assess the impact of COVID-19 pandemic on acute stroke care in the Lyon comprehensive stroke center during this period.MethodsWe conducted a prospective data collection of patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT) and/or mechanical thrombectomy (MT) during the COVID-19 period (from 29/02/2020 to 10/05/2020) and a control period (from 29/02/2019 to 10/05/2019). The volume of reperfusion therapies and pre and intra-hospital delays were compared during both periods.ResultsA total of 208 patients were included. The volume of IVT significantly decreased during the COVID-period [55 (54.5%) vs 74 (69.2%); p = 0.03]. The volume of MT remains stable over the two periods [72 (71.3%) vs 65 (60.8%); p = 0.14], but the door-to-groin puncture time increased in patients transferred for MT (237 [187–339] vs 210 [163–260]; p < 0.01). The daily number of Emergency Medical Dispatch calls considerably increased (1502 [1133–2238] vs 1023 [960–1410]; p < 0.01).ConclusionsOur study showed a decrease in the volume of IVT, whereas the volume of MT remained stable although intra-hospital delays increased for transferred patients during the COVID-19 pandemic. These results contrast in part with the national surveys and suggest that the impact of the pandemic may depend on local stroke care networks.

The choroid plexuses (ChPs) perform indispensable functions for the development, maintenance and functioning of the brain. Although they have gained considerable interest in the last years, their involvement in brain disorders is still largely unknown, notably because their deep location inside the brain hampers non-invasive investigations. Imaging tools have become instrumental to the diagnosis and pathophysiological study of neurological and neuropsychiatric diseases. This review summarizes the knowledge that has been gathered from the clinical imaging of ChPs in health and brain disorders not related to ChP pathologies. Results are discussed in the light of pre-clinical imaging studies. As seen in this review, to date, most clinical imaging studies of ChPs have used disease-free human subjects to demonstrate the value of different imaging biomarkers (ChP size, perfusion/permeability, glucose metabolism, inflammation), sometimes combined with the study of normal aging. Although very few studies have actually tested the value of ChP imaging biomarkers in patients with brain disorders, these pioneer studies identified ChP changes that are promising data for a better understanding and follow-up of diseases such as schizophrenia, epilepsy and Alzheimer's disease. Imaging of immune cell trafficking at the ChPs has remained limited to pre-clinical studies so far but has the potential to be translated in patients for example using MRI coupled with the injection of iron oxide nanoparticles. Future investigations should aim at confirming and extending these findings and at developing translational molecular imaging tools for bridging the gap between basic molecular and cellular neuroscience and clinical research.

Abstract Introduction Acute ischaemic strokes (AIS) due to proximal anterior cerebral artery (ACA) occlusions are rare. Their clinical outcomes following medical management alone have been scarcely described. Patients and methods We conducted a retrospective, multicentre, international study of consecutive AIS due to isolated proximal ACA occlusion (A1 or A2 segment) admitted within 6 h of symptom onset and treated with best medical management alone (ie, without endovascular therapy), across 23 centres in France and Switzerland. The primary outcome was poor functional outcome, defined as a mRS score > 2 at 3 months or failure to return to baseline mRS if the pre-stroke mRS was > 2. Associations between baseline clinical/radiological variables and outcome were evaluated in multivariable logistic regression analyses. Associations between outcome and key radiological follow-up variables such as recanalisation and haemorrhagic transformation were also analysed. Results Ninety-five patients were included in the study: median age was 76 (IQR, 66–87), baseline NIHSS score was 10 (IQR, 5–15) and occlusion site was A1 in 8 (8%) and A2 in 87 (92%). Intravenous thrombolysis was administered in 76 (80%) cases. Poor functional outcome was observed in 47 (49%) patients. Among baseline variables, older age (adjusted odds ratio [aOR] per 5-year increase = 1.25; 95% CI, 1.10–1.55; P = .028) and higher NIHSS score (aOR = 1.20, 95% CI, 1.07–1.34; P < .001) were independently associated with poor outcome. Lack of recanalisation at 24 h was also independently associated with poor outcome (aOR = 14.5, 95% CI, 1.1–188.7, P = .04). Poor outcome was higher in patients with than in those without haemorrhagic transformation (73% vs 42%, P = .03) in univariable analysis, but not in multivariable analysis adjusting for age and NIHSS score (aOR = 2.3, 95% CI, 0.5–11.5, P = .32). Discussion and conclusion Nearly half of AIS patients with isolated proximal ACA occlusion treated with medical management alone had poor 3-month functional outcomes. Older age, high NIHSS at admission and lack of recanalisation at 24 h were associated with poor outcome. These results underscore the need to investigate therapeutic strategies aimed at enhancing early arterial recanalisation to improve recovery in this population. Graphical Abstract Graphical Abstract

With the aim of designing a preclinical study evaluating an intracerebral cell-based therapy for stroke, an observational study was performed in the rat suture model of ischemic stroke. Objectives were threefold: (i) to characterize neurofunctional and imaging readouts in the first weeks following transient ischemic stroke, according to lesion subtype (hypothalamic, striatal, corticostriatal); (ii) to confirm that intracerebral administration does not negatively impact these readouts; and (iii) to calculate sample sizes for a future therapeutic trial using these readouts as endpoints. Our results suggested that the most relevant endpoints were side bias (staircase test) and axial diffusivity (AD) (diffusion tensor imaging). Hypothalamic-only lesions did not affect those parameters, which were close to normal. Side bias in striatal lesions reached near-normal levels within 2 weeks, while rats with corticostriatal lesions remained impaired until week 14. AD values were decreased at 4 days and increased at 5 weeks post-surgery, with a subtype gradient: hypothalamic < striatal < corticostriatal. Intracerebral administration did not impact these readouts. After sample size calculation (18-147 rats per group according to the endpoint considered), we conclude that a therapeutic trial based on both readouts would be feasible only in the framework of a multicenter trial.