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Digital Subtraction Angiography (DSA) is the gold-standard imaging modality in acute cerebrovascular diagnosis. The role of DSA has become increasingly prominent since the incorporation of endovascular therapy in standards of care for acute ischemic stroke. It is used in the assessment of cerebral vessel patency; however, the therapeutic role of DSA from a prognostic standpoint merits further investigation. The current paper provides an update on current practice on diagnostic, therapeutic and prognostic use of DSA in acute cerebrovascular diseases and various indications and perspectives that may apply, or limit its use, in ongoing surveillance or prognosis. Pre-clinical and clinical studies on the aspects, including but not limited to the morphology of cerebrovasculature in acute ischaemic stroke, are required to delineate and inform its prognostic role., (© 2021. Belgian Neurological Society.)

Objective: There is an ongoing debate regarding the benefits of using transradial access (TRA) over transfemoral access (TFA) in endovascular therapies including endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) patients. This study sought to investigate the association of TRA and TFA with procedural success, access-site complications, first-pass reperfusion (FPR), puncture-to-recanalisation (PTR) time and hemorrhagic transformation (HT) by performing a meta-analysis., Materials and Methods: PubMed, EMBASE and Scopus were searched. Studies with patients aged ≥ 18 years and head-to-head TRA vs TFA comparisons were included. Random-effects modeling was performed to obtain summary effects and forest plots were plotted to study the association of TFA with access site complications, FPR, HT, PTR time and procedural success., Results: Six studies encompassing 945 patients (347 TRA and 598 TFA) were included in the meta-analysis. Meta-analysis revealed that in AIS patients receiving EVT, TRA was significantly associated with a decreased risk of access-site complications (RR 0.17, 95% CI 0.05 0.54; p = 0.003, z = -2.957) and HT (RR 0.07, 95% CI 0.02 0.27; p < 0.0001, z = -3.8841). However, TRA was not significantly associated with procedural success (RR 0.96, 95% CI 0.90 1.01; p = 0.141, z = -1.473), FPR (RR 0.91, 95% CI 0.79 1.05; p = 0.194, z = -1.299) and PTR time (SMD -0.14, 95% CI -0.42 -0.14; p = 0.323, z = -0.989)., Conclusion: Our meta-analysis demonstrated that TRA is a safe alternative to TFA, in AIS patients receiving EVT, with significantly decreased access-site complications and HT with TRA, albeit with comparable procedural success, FPR and PTR time to TFA., Data Availability Statement: The original contributions presented in the study are included in the article/Supplementary information, further inquiries can be directed to the corresponding author., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background and Purpose: Interventional Neuroradiology (INR) procedures are often complex, requiring prolonged high-dose exposures. This leads to increased radiation exposure to both patient and operating staff. The purpose of this study is to identify parameters related to the complexity of acute ischemic stroke (AIS) procedures that increase patient exposure and derive DRLs according to ICRP 135., Methods: Data from 145 patients treated for AIS between 2017 and 2019 in a Hub Stroke center were retrospectively analyzed. Dosimetric parameters, demographic and clinical data were collected for each patient. The INR operator and the fluoroscopy system used were included., Results: A multivariable analysis was performed to identify which parameters significantly influence the dosimetric data. Thrombus location and the use of stent retriever were noted as the most likely parameters of complex INR procedures. Male sex is an indicator of complex procedure only with regards to the Kerma area product and the air kerma. Patient age significantly affects the exposure time alone. Senior or more experienced operator's data demonstrated reduced patient's exposure time and therefore the KAP and Kar values. The type of X-ray equipment influenced the outcome of the procedure in terms of number of images acquired. Typical values obtained are 168 Gycm 2 , 0.68 Gy, 19 min and 181 images., Conclusion: Typical values derived in this study promote patient dose optimization, when considering the complexity of INR procedures. The clinical variables related to the complexity of procedure that mainly affect the dosimetric data in our experience are thrombus location and use of stent retrievers., (Copyright © 2020 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.)

Objective: This study aims to develop and validate the Futile Recanalization Prediction Score (FRPS), a novel tool designed to predict the severity risk of FR and aid in pre- and post-EVT risk assessments. Methods: The FRPS was developed using a rigorous process involving the selection of predictor variables based on clinical relevance and potential impact. Initial equations were derived from previous meta-analyses and refined using various statistical techniques. We employed machine learning algorithms, specifically random forest regression, to capture nonlinear relationships and enhance model performance. Cross-validation with five folds was used to assess generalizability and model fit. Results: The final FRPS model included variables such as age, sex, atrial fibrillation (AF), hypertension (HTN), diabetes mellitus (DM), hyperlipidemia, cognitive impairment, pre-stroke modified Rankin Scale (mRS), systolic blood pressure (SBP), onset-to-puncture time, sICH, and NIHSS score. The random forest model achieved a mean R-squared value of approximately 0.992. Severity ranges for FRPS scores were defined as mild (FRPS < 66), moderate (FRPS 66–80), and severe (FRPS > 80). Conclusions: The FRPS provides valuable insights for treatment planning and patient management by predicting the severity risk of FR. This tool may improve the identification of candidates most likely to benefit from EVT and enhance prognostic accuracy post-EVT. Further clinical validation in diverse settings is warranted to assess its effectiveness and reliability. [ABSTRACT FROM AUTHOR]