Explore the vast range of titles available.

BackgroundEndovascular treatment (EVT) for basilar artery occlusions (BAO) is associated with a higher rate of futile recanalization compared with anterior circulation procedures. We aimed to identify the incidence and predictors of poor clinical outcome despite successful reperfusion in current clinical practice.MethodsWe used data from the ETIS (Endovascular Treatment in Ischemic Stroke) registry, a prospective multicenter observational registry of stroke treated with EVT in France. Patients undergoing EVT for acute BAO from January 2014 to May 2019 successfully treated within 8 hours from onset were included. Predictors of 90-day poor outcome (modified Rankin Scale (mRS) 4–6) were researched within patients with successful (modified Thrombolysis In Cerebral Infarction (mTICI 2b-3)) and excellent (mTICI 2c-3) reperfusion.ResultsAmong 242 patients treated within 8 hours, successful reperfusion was achieved in 195 (80.5%) and excellent reperfusion in 120 (49.5%). Poor outcome was observed in 107 (54.8%) and 60 (50%) patients, respectively. In patients with successful early reperfusion, age, higher initial National Institutes of Health Stroke Scale (NIHSS) score, lower posterior circulation Alberta Stroke Programme Early CT Score (pc-ASPECTS), and absence of prior intravenous thrombolysis were independent predictors of poor outcome. The only treatment factor with an independent predictive value was first-pass mTICI 2b-3 reperfusion (adjusted OR 0.13, 95% CI 0.05 to 0.37, p<0.001). In patients with excellent early reperfusion, independent predictors were age, initial NIHSS score, first-pass mTICI 2c-3 reperfusion, and hemorrhagic transformation on post-interventional imaging.ConclusionsEarly successful reperfusion with EVT occurred in 80.5% of patients, and the only treatment-related factor predictive of clinical outcome was first pass mTICI 2b-3 reperfusion. Further research is warranted to identify the optimal techniques and devices associated with first pass reperfusion in the posterior circulation.

Background/Purpose: Perfusion computed tomography (CT) is capable of measuring the permeability surface product (PS). PS reflects the permeability of the blood-brain barrier, involved in the pathophysiology of hemorrhagic transformation (HT) of ischemic stroke. The aim of our study was to determine if an increased PS can predict HT. Methods: A total of 86 patients with ischemic stroke were included. They underwent multimodality CT, including the measurement of PS. We compared the clinical and radiological characteristics of patients who developed HT to those who did not, using univariate analysis. Multivariate regression analyses were then used to determine HT predictors. Results: HT was observed in 27 patients (31%). Infarct PS was significantly associated with HT (p = 0.047), as were atrial fibrillation (p = 0.03), admission National Institute of Health Stroke Scale score (p = 0.02), infarct volume (p = 0.0004), presence of large-vessel occlusion (p = 0.0005) and a poorer collateral status (p = 0.003). Using logistic regression modeling, an infarct PS >0.84 ml/100 g/min was an independent predictor of HT (OR 28, 95% CI 1.75-452.98; p = 0.02). Other independent predictors of HT were infarct volume and a history of atrial fibrillation. Conclusions: Our findings suggest that infarct PS can be a predictor of HT and may help clinicians to improve patient care around thrombolysis decisions in the acute phase of ischemic stroke.

Objective Based on histopathology, Edinburgh diagnostic criteria were proposed to consider a nontraumatic intracerebral lobar hemorrhage (ICH) as related to cerebral amyloid angiopathy (CAA) using the initial computed tomography (CT) scan and the APOE genetic status. We aimed to externally validate the Edinburgh prediction model, excluding the APOE genotyping and based on the modified Boston criteria on the MRI for CAA diagnosis Methods We included patients admitted for spontaneous lobar ICH in the emergency department between 2016 and 2019 who underwent noncontrast CT scan and MRI. According to the MRI, patients were classified into the CAA group or into the non-CAA group in the case of other causes of ICH. Two neuroradiologists, blinded to the final retained diagnosis, rated each radiological feature on initial CT scan described in the Edinburgh study on initial CT scan Results A total of 102 patients were included, of whom 36 were classified in the CAA group, 46 in the non-CAA causes group and 20 of undetermined cause (excluded from the primary analysis). The Edinburgh prediction model, including finger-like projections and subarachnoid extension showed an area under receiver operating characteristic curves (AUC) of 0.760 (95% confidence interval, CI: 0.660–0.859) for the diagnosis of CAA. The AUC reached 0.808 (95% CI: 0.714–0.901) in a new prediction model integrating a third radiologic variable: the ICH cortical involvement. Conclusion Using the Boston MRI criteria as a final assessment, we provided a new external confirmation of the radiological Edinburgh CT criteria, which are directly applicable in acute settings of spontaneous lobar ICH and further proposed an original 3‑set model considering finger-like projections, subarachnoid extension, and cortical involvement that may achieve a high discrimination performance.

Brain magnetic resonance imaging (MRI) with angiographic sequences demonstrated vertebral and basilar megadolichoectasia with aneurysmal dilatation of the intracranial portions of the vertebral arteries [Figure 1].

BackgroundWhether rescue intracranial stenting (RIS) should be performed in patients with vertebrobasilar occlusions (VBO) refractory to endovascular mechanical thrombectomy (MT) remains an open question.MethodsWe conducted a pooled analysis using data from two national stroke registries, the Endovascular Treatment in Ischemic Stroke registry in France, and the German Stroke Registry–Endovascular Treatment. Patients with VBO who underwent RIS for failed MT, defined as a modified treatment in cerebral infarction (mTICI) score of 0 to 2a after MT, from January 2015 to December 2023 were included. The primary outcome was a modified Rankin Scale (mRS) score of 0–3 at 90 days. Secondary outcomes included mRS distribution and mortality at 90 days, any intracranial hemorrhage (ICH) and symptomatic intracranial hemorrhage (sICH). Propensity score matching and inverse propensity weighting were employed to balance baseline differences.ResultsAmong 2028 patients, 307 (15.1%) patients had MT-refractory VBO. Of these, 127 (41.4%) underwent RIS and 180 (58.6%) patients no RIS. After propensity score matching, two balanced groups were obtained: 106 patients with RIS and 99 without RIS. Patients who underwent RIS had higher odds of achieving an mRS 0–3 (adjusted odds ratio (aOR) 3.45, 95% confidence interval (CI) 1.27 to 9.34. P=0.014), a favorable shift across the mRS distribution (aOR 2.55 per 1-point mRS improvement, 95% CI 1.22 to 5.34; P=0.013) and lower odds of 90-day mortality (aOR 0.26, 95% CI 0.09 to 0.71; P=0.008). There were no significant differences in any ICH and sICH.ConclusionThis registry-based study provides level 3 evidence supporting the use of RIS in patients with VBO refractory to MT. Prospective randomized trials are necessary to validate the potential benefits of RIS in this condition.