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BackgroundIntracranial hemorrhage (ICH) is a potentially severe complication of endovascular thrombectomy (EVT). However, the relationship between the incidence and severity of ICH and vascular occlusion location is not well described.ObjectiveTo present a comprehensive analysis of subtypes of ICHs and their relationship to the occlusion site following EVT in the anterior circulation.MethodsAll patients with anterior circulation vessel occlusion stroke (internal carotid (ICA) and middle cerebral artery’s first (M1) and later segments (M2 and beyond)) registered in the two Swedish national quality registers for stroke care and endovascular therapy during 2015–2020 were included. Hemorrhagic complications identified on imaging within 36 hours post-EVT were classified according to Heidelberg Bleeding Classification and further divided into symptomatic (sICH) or non-symptomatic (non-sICH).ResultsOf the 3077 patients, ICH frequency was 24.2%, which included 4.5% sICH. Subarachnoid hemorrhage (SAH) was the most frequent subtype of hemorrhage (10.9%). The hemorrhagic subtypes differed significantly by occlusion site, but the frequency of any bleed did not. EVT performed in and beyond the M2 more often resulted in SAH, frequently classified as non-sICH. EVT performed in the ICA was associated with more severe hemorrhages, such as intraventricular and large parenchymal hematomas, that were more often classified as sICH.ConclusionIn this nationwide unselected EVT cohort we found that ICH severity significantly differed between different vessel occlusion sites.

To determine whether brain volume is associated with functional outcome after acute ischemic stroke (AIS).

Background 2D digital subtraction angiography (DSA) images are the gold standard for neuroradiological vascular assessment and the basis of interventional procedures such as mechanical thrombectomy and cerebral aneurysm coiling. However, length measurements in projected DSA images are affected by the distance between the x-ray source, the object, and the detector. Precise coordination between all integrated parts of a novel biplane system makes it possible to accurately measure DSA distances without manual calibration. The aim of this study was to compare vascular diameter measurements in uncalibrated DSA images with computed tomography angiography (CTA).Methods Consecutive patients undergoing interventional neuroradiological procedures were retrospectively included. Vascular diameter measurements in the image isocenter and periphery were performed. These measurements were repeated in picture archiving and communication system (PACS) on DSA images and maximum intensity pixel (MIP) CTA images.Results Forty-two (42) consecutive patients with adequate DSA and CTA images were included in the final analysis. The correlation between vessel diameter measurements in the image isocenter (R2= 0.81/0.85, p < 0.0001/p < 0.0001 [Reader1/Reader2]), periphery (R2= 0.85/0.82, p < 0.0001/p < 0.0001 [Reader1/Reader2]), and all measurements combined (R2= 0.87/0.87, p < 0.0001/p < 0.0001 [Reader1/Reader2]) on DSA and CTA were strong and statistically significant. The interclass correlation coefficient for measurements performed by two independent reviewers was strong (ICC = 0.96, 95% CI 0.92–0.98).Conclusions The correlations between uncalibrated DSA measurements and CTA for vessel diameter were strong. In addition, there were strong correlations between these image types for repeated measurements in the image isocenter as well as image periphery for vessel diameter. Consequently, endovascular devices can be sized correctly without the need for pre-operative non-invasive imaging.

Bien que l’âge chronologique soit l'un des facteurs pronostiques les plus déterminants après un AVC ischémique, l'impact de l’âge cérébral, un biomarqueur personnalisé de santé cérébrale, reste inconnu. Nous formulons l'hypothèse que l'analyse radiomique de l'imagerie T2-FLAIR peut déterminer l’âge cérébral et qu'un âge cérébral avancé chez des patients souffrant d'un AVC ischémique est associé à plus de facteurs de risque (FdR) cardiovasculaire et à un pronostic fonctionnel péjoratif.

Purpose:To compare the postoperative computed tomography angiography (CTA) assessment made by vascular surgeons and interventional radiologists after endovascular aneurysm repair (EVAR) at a tertiary vascular clinic to an outside core review facility. Methods:One hundred patients (mean age 78.7 years, range 88–55; 84 men) with consecutive, elective, routine CTA controls after EVAR were retrospectively studied. Consultant vascular surgeons or radiologists had evaluated all original scans and written the original report. All scans were then reevaluated by an independent core clinic. Findings were classified as vascular or extravascular and stratified as clinically significant or clinically nonsignificant by an independent external reviewer. Results:The number of vascular findings detected by the vascular clinic was 72 vs 69 by the core clinic. The vascular clinic reported more clinically significant findings (primarily stent compression or kinks) as well as endoleaks and their origin. The core clinic reported more pseudoaneurysms (24 vs 12). None of the patients with puncture complications needed reintervention. Interrater analysis of all findings between the 2 clinics showed good agreement when comparing endoleaks overall (without subclassification) and moderate agreement when assessing aneurysm growth. The core clinic reported extravascular findings in 58 patients; 37 of these were classified as clinically significant. The vascular clinic reported extravascular findings in 23 patients; 7 of these were clinically significant. The core clinic also reported 2 cases of suspected malignancies, which had not been reported by the vascular clinic. Conclusion:During routine CTA follow-up after EVAR, a significant number of vascular and nonvascular findings are detected. Whereas a highly dedicated vascular clinic identifies most vascular findings regardless of the specialty of the reader, some extravascular findings are missed. However, the frequency of clinically significant findings or findings that might warrant reintervention was low in this study.

Introduction:About ~10% of acute ischemic stroke (AIS) patients experience multiple acute lesions (MAL). However, the spatial distribution and clinical implications of such MAL are incompletely understood. Here, we scrutinized MAL in a large, radiologically deep-phenotyped cohort of AIS patients.Methods:We analyzed imaging and clinical data of 2.485 AIS patients [age: 63.3±14.8, 39%women] of the multi-site MRI-GENIE study. We computed occurrences of (i) MAL within one and, (ii) MAL in several vascular supply territories (with single or multiple lesions within single territories). We furthermore evaluated associations between the presence of MAL in multiple territories and stroke severity, white matter hyperintensity (WMH) and stroke lesion volumes, etiology, age and sex.Results:Half of all patients, i.e., 49.7%, presented with a single lesion. Another 37.3% experienced MAL in a single vascular territory, while 13% featured lesions in multiple vascular territories. For most vascular territories (anterior, middle and posterior cerebral artery, cerebellum) the ratio between single to multiple lesions in that territory equaled ~52%, only the brainstem region comprised fewer multiple compared to single lesions (19%). Combinations of anterior and posterior circulation lesions occurred in 5.6% of all patients, bilateral stroke in the anterior circulation in 3.4%. When comparing patients with lesions in only one compared to in more than one territory, there were no significant differences in WMH or lesion volume, stroke severity, age or sex (pFDR-corrected>0.05). Patients with lesions in multiple territories had a significantly lower frequency of small vessel occlusions, but a significantly higher frequency of stroke of undetermined etiology. Differences in cardioembolic stroke frequency were only significant before correction for multiple comparisons (puncorrected=0.025). Frequencies of large vessel occlusions did not differ between the groups.Conclusions:Multiple lesions, especially those within one vascular territory, occurred frequently. Overall, there were no significant associations between MAL and stroke severity or cardioembolic stroke. Future studies are warranted to explore these findings in greater detail.