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Aneurysmal subarachnoid hemorrhage is a devastating condition causing significant morbidity and mortality. While outcomes from subarachnoid hemorrhage have improved in recent years, there continues to be significant interest in identifying therapeutic targets for this disease. In particular, there has been a shift in emphasis toward secondary brain injury that develops in the first 72 hours after subarachnoid hemorrhage. This time period of interest is referred to as the early brain injury period and comprises processes including microcirculatory dysfunction, blood-brain-barrier breakdown, neuroinflammation, cerebral edema, oxidative cascades, and neuronal death. Advances in our understanding of the mechanisms defining the early brain injury period have been accompanied by improved imaging and nonimaging biomarkers for identifying early brain injury, leading to the recognition of an elevated clinical incidence of early brain injury compared with prior estimates. With the frequency, impact, and mechanisms of early brain injury better defined, there is a need to review the literature in this area to guide preclinical and clinical study.

Mounting evidence has suggested a relationship between Chiari I malformation and idiopathic intracranial hypertension, with some studies implicating anomalies of the cerebral venous system in the development of these conditions. However, precise mechanisms explaining these associations are not well described. There is a clear need to clarify the interplay between these conditions to guide further study in this area. In tandem with these efforts, it is necessary to review proper diagnosis and management to improve outcomes in patients suffering from these diseases.

Rates of aneurysm occlusion following treatment with flow-diverting stents have been quantified at predefined time points in clinical trials, but data characterizing the continuous temporal progression of aneurysm occlusion are lacking. This study used real-world variability in timing of angiographic follow-up to characterize the time line of aneurysm occlusion following treatment with the Pipeline embolization device (PED).All aneurysms treated with a PED at our institution between 2011 and 2020 were screened. Nonsaccular or ruptured aneurysms were excluded. Aneurysm occlusion status and time since treatment were recorded for each follow-up angiogram. Aneurysm occlusion was characterized using Kaplan-Meier and Cox proportional hazards analysis after censoring at last follow-up or subsequent treatment.There were 290 aneurysms in 222 patients analyzed. The median time of observed aneurysm occlusion was 7.5 months, and overall rate of aneurysm occlusion was 77.9%. Larger aneurysms demonstrated a longer median time to occlusion and lower rate of aneurysm occlusion (P = 0.029). There were no observed differences in the time line of occlusion for aneurysms treated with a single PED or multiple PEDs (P = 0.889) or without or with adjunctive coiling (P = 0.771).Aneurysms treated with a PED had a median time to observed occlusion of 7.5 months. Occlusion of larger aneurysms occurred more slowly than occlusion of smaller aneurysms following flow diversion. The number of PEDs deployed or the use of adjunctive coiling did not affect the time line or likelihood of aneurysm occlusion. These findings may guide optimal timing of follow-up after treatment with a PED.

Full list of authors: Jorstad, S. G.; Marscher, A. P.; Raiteri, C. M.; Villata, M.; Weaver, Z. R.; Zhang, H.; Dong, L.; Gomez, J. L.; Perel, M., V; Savchenko, S. S.; Larionov, V. M.; Carosati, D.; Chen, W. P.; Kurtanidze, O. M.; Marchini, A.; Matsumoto, K.; Mortari, F.; Aceti, P.; Acosta-Pulido, J. A.; Andreeva, T.; Apolonio, G.; Arena, C.; Arkharov, A.; Bachev, R.; Bonnoli, G.; Borman, G. A.; Bozhilov, V; Carnerero, M., I; Damljanovic, G.; Ehgamberdiev, S. A.; Elsasser, D.; Frasca, A.; Gabellini, D.; Grishina, T. S.; Gupta, A. C.; Hagen-Thorn, V. A.; Hallum, M. K.; Hart, M.; Hasuda, K.; Hemrich, F.; Hsiao, H. Y.; Ibryamov, S.; Irsmambetova, T. R.; Ivanov, D., V; Joner, M. D.; Kimeridze, G. N.; Klimanov, S. A.; Knoett, J.; Kopatskaya, E. N.; Kurtanidze, S. O.; Kurtenkov, A.; Kuutma, T.; Larionova, E. G.; Leonini, S.; Lin, H. C.; Lorey, C.; Mannheim, K.; Marino, G.; Minev, M.; Mirzaqulov, D. O.; Morozova, D. A.; Nikiforova, A. A.; Nikolashvili, M. G.; Ovcharov, E.; Papini, R.; Pursimo, T.; Rahimov, I; Reinhart, D.; Sakamoto, T.; Salvaggio, F.; Semkov, E.; Shakhovskoy, D. N.; Sigua, L. A.; Steineke, R.; Stojanovic, M.; Strigachev, A.; Troitskaya, Y., V; Troitskiy, I. S.; Tsai, A.; Valcheva, A.; Vasilyev, A. A.; Vince, O.; Waller, L.; Zaharieva, E.; Chatterjee, R., Blazars are active galactic nuclei (AGN) with relativistic jets whose non-thermal radiation is extremely variable on various timescales1,2,3. This variability seems mostly random, although some quasi-periodic oscillations (QPOs), implying systematic processes, have been reported in blazars and other AGN. QPOs with timescales of days or hours are especially rare4 in AGN and their nature is highly debated, explained by emitting plasma moving helically inside the jet5, plasma instabilities6,7 or orbital motion in an accretion disc7,8. Here we report results of intense optical and γ-ray flux monitoring of BL Lacertae (BL Lac) during a dramatic outburst in 2020 (ref. 9). BL Lac, the prototype of a subclass of blazars10, is powered by a 1.7 × 108 MSun (ref. 11) black hole in an elliptical galaxy (distance = 313 megaparsecs (ref. 12)). Our observations show QPOs of optical flux and linear polarization, and γ-ray flux, with cycles as short as approximately 13 h during the highest state of the outburst. The QPO properties match the expectations of current-driven kink instabilities6 near a recollimation shock about 5 parsecs (pc) from the black hole in the wake of an apparent superluminal feature moving down the jet. Such a kink is apparent in a microwave Very Long Baseline Array (VLBA) image. © 2022 Springer Nature Limited., The research reported here is based on work supported in part by US National Science Foundation grants AST-2108622 and AST-2107806, and NASA Fermi GI grants 80NSSC20K1567, 80NSSC21K1917 and 80NSSC21K1951; by Shota Rustaveli National Science Foundation of Georgia under contract FR-19-6174; by the Bulgarian National Science Fund of the Ministry of Education and Science under grants DN 18-10/2017, DN 18-13/2017, KP-06-H28/3 (2018), KP-06-H38/4 (2019) and KP-06-KITAJ/2 (2020), and by National RI Roadmap Project D01-383/18.12.2020 of the Ministry of Education and Science of the Republic of Bulgaria; by JSPS KAKENHI grant #19K03930 of Japan; by the Ministry of Education, Science and Technological Development of the Republic of Serbia (contract 451-03-9/2021-14/200002) and observing grant support from the Institute of Astronomy and Rozhen NAO BAS through the bilateral joint research project ‘Gaia Celestial Reference Frame (CRF) and fast variable astronomical objects’; by the Agenzia Spaziale Italiana (ASI) through contracts I/037/08/0, I/058/10/0, 2014-025-R.0, 2014-025-R.1.2015 and 2018-24-HH.0 to the Italian Istituto Nazionale di Astrofisica (INAF). H.Z. is supported by the NASA Postdoctoral Program at Goddard Space Flight Center, administered by ORAU. M.V.P. is partially supported by the Russian Foundation for Basic Research grant 20-02-00490. G.B. acknowledges support from the State Agency for Research of the Spanish MCIU through the ‘Center of Excellence Severo Ochoa’ award to the Instituto de Astrofísica de Andalucía (SEV-2017-0709) and from the Spanish ‘Ministerio de Ciencia e Innovacíon’ (MICINN) through grant PID2019-107847RB-C44. M.D.J. thanks the Brigham Young University Department of Physics and Astronomy for continued support of the extragalactic monitoring programme under way at the West Mountain Observatory. R.C. thanks ISRO for support under the AstroSat archival data utilization programme and BRNS for support through a project grant (sanction no. 57/14/10/2019-BRNS). The measurements at the Hans Haffner Observatory, Hettstadt, Germany, were supported by Baader Planetarium, Mammendorf, Germany. This study was based (in part) on observations conducted using the 1.8-m Perkins Telescope Observatory (PTO) in Arizona, USA, which is owned and operated by Boston University. These results made use of the Lowell Discovery Telescope (LDT) at Lowell Observatory. Lowell Observatory is a private, non-profit institution dedicated to astrophysical research and public appreciation of astronomy, and operates the LDT in partnership with Boston University, the University of Maryland and the University of Toledo. This paper is partly based on observations made with the IAC-80 operated on the island of Tenerife by the Instituto de Astrofisica de Canarias in the Spanish Observatorio del Teide and on observations made with the LCOGT telescopes, one of whose nodes is located at the Observatorios de Canarias del IAC on the island of Tenerife in the Observatorio del Teide. This paper is partly based on observations made with the Nordic Optical Telescope, owned in collaboration by the University of Turku and Aarhus University, and operated jointly by Aarhus University, the University of Turku and the University of Oslo, representing Denmark, Finland and Norway, the University of Iceland and Stockholm University at the Observatorio del Roque de los Muchachos, La Palma, Spain, of the Instituto de Astrofisica de Canarias. The VLBA is an instrument of the NRAO, USA. The NRAO is a facility of the National Science Foundation operated under cooperative agreement by Associated Universities, Inc.

OBJECTIVE Catheter-based cerebral angiography is commonly used for neurovascular diagnosis in children. In this work, the authors aimed to quantify the complication rate of cerebral angiography in children, characterize these complications, and identify risk factors for complications. METHODS Relevant clinical data were retrospectively obtained for 587 consecutive cerebral angiography procedures performed in 390 children from March 2002 to March 2020. Complications were categorized as neurological or nonneurological, and severity was graded using a standard schema. Incidences of complications were reported as point estimates. Associations between risk factors and complications were characterized in univariate analysis using the two-tailed Fisher exact test and in multivariate analysis using multiple logistic regression with bidirectional elimination based on the Akaike information criterion. In both univariate and multivariate analyses, statistical significance was corrected for multiple comparisons using the Benjamini-Hochberg method. RESULTS Complications occurred in 6.5% of procedures, including neurological complications in 1.9% and nonneurological complications in 4.8%. Permanent deficits occurred in only 0.2% of cases. Overall, 0.5% of procedures resulted in major complications, while 6.0% resulted in minor complications. Female sex and a history of hypertension or ischemic stroke were associated with an increased risk of complications, while femoral artery access was associated with a decreased risk of complications. CONCLUSIONS Pediatric cerebral angiography was shown to have a low rate of major or permanent complications. Children who were female and those with a history of hypertension or ischemic stroke were shown to be at higher risk of complications, while the use of femoral access carried a lower risk of complications.

BACKGROUND Intracranial fusiform aneurysms are circumferential dilations of cerebral arteries that can lead to complications including ischemic stroke due to vessel occlusion, subarachnoid hemorrhage, or intracerebral hemorrhage. Treatment options for fusiform aneurysms have expanded significantly in recent years. Microsurgical treatment options include proximal and distal surgical occlusion and microsurgical trapping of the aneurysm, usually in association with high-flow bypass procedures. Endovascular treatment options include the placement of coils and/or flow diverters. OBSERVATIONS Here the authors report a case of aggressive surveillance and treatment of a man with multiple progressive, recurrent, and de novo fusiform aneurysms of the left anterior cerebral circulation over 16 years. Because the long-term course of his treatment coincided with the recent expansion of endovascular treatment options, he underwent every type of treatment listed above. LESSONS This case demonstrates the wide range of therapeutic options for fusiform aneurysms and how the treatment model for these lesions has evolved.

Background The benefit of intravenous thrombolysis (IVT) before mechanical thrombectomy (MT) in patients with large vessel occlusion (LVO) stroke is uncertain. Conventional metrics of final modified thrombolysis in cerebral ischemia (mTICI) score and 90-d modified Rankin Scale may be insensitive to IVT effects on procedural complexity and duration. Objective To study the effect of IVT prior to MT on clot survival. Methods We performed a single-center retrospective analysis of 257 acute stroke patients with LVO undergoing MT and analyzed the effect of IVT prior to MT using a novel, pass-by-pass clot survival methodology. Results The use of IVT was associated with a significantly lower number of passes to attain mTICI 2B or greater (P = .002) or mTICI 3 (P = .039) reperfusion. The number of patients who achieved mTICI 2B or greater after the first pass was significantly higher in the IVT group (P = .003). This increased rate of reperfusion persisted into subsequent passes. Conclusion IVT prior to MT reduces the number of thrombectomy passes required to achieve mTICI 2B or mTICI 3 reperfusion. This information should be considered as the merits of IVT prior to MT are debated.

BackgroundIntracranial mechanical thrombectomy (MT) is increasingly indicated for use in acute ischemic stroke patients. We analyzed recent trends in the characteristics and geographic distributions of physicians providing this service with frequency to Medicare beneficiaries.MethodsWe linked public data sources to elucidate and visualize trends in high-volume MT providers between 2016 and 2019.ResultsHigh-volume MT providers increased by 184% between 2016 and 2019. The number of neurosurgeons, neurologists, and radiologists in this physician population increased by 251%, 205%, and 139%, respectively. Male practitioners accounted for 96% of providers in the most recent year of analysis. International medical graduates accounted for roughly one-third of these physicians across all 4 years of analysis. As of 2019, the three states with the most high-volume MT providers were Florida, California, and Texas, accounting for 7%, 7%, and 6% of providers, respectively.ConclusionsHigh-volume providers of MT services for Medicare beneficiaries represent a dynamic and rapidly expanding subset of physicians with diverse specialty backgrounds.

Flow diversion of intracranial aneurysms with the pipeline embolization device (PED) may produce angiographically apparent stenosis within the PED, which can lead to secondary ischemic complications. In-stent stenosis can be treated medically with dual antiplatelet therapy (DAPT), but the safety and efficacy of this approach are unknown. In this work, we review the safety and efficacy of DAPT to prevent progression of in-stent stenosis or development of cerebral ischemia.Clinical and angiographic data from eligible patients were assessed from a prospectively maintained neurointerventional database. Details surrounding in-stent stenosis and DAPT were extracted. Patients were included in this study if in-stent stenosis was detected at any angiographic follow-up and managed with DAPT. The primary efficacy endpoint was lack of angiographic progression of in-stent stenosis or new ipsilateral infarct following initiation of medical therapy.In total, 23 PED constructs developed in-stent stenosis and were managed with DAPT. Follow-up angiography was available for 19 constructs. Eighty-nine percent (17/19) of PED constructs achieved the primary endpoint of lack of stenosis progression and lack of new ipsilateral ischemic events. Of the 2 PED constructs that failed to achieve the primary endpoint of this study, one demonstrated worsening of in-stent stenosis from 55% to 76% over 16 months, while the other developed ipsilateral ischemic stroke 4 months after detection of in-stent stenosis. In addition, one patient experienced intracranial hemorrhage 9 months after the initiation of DAPT.Progression of in-stent stenosis and new ipsilateral ischemic events are limited in the presence of DAPT. However, hemorrhagic events related to DAPT may occasionally occur.

BackgroundThis prospective randomized trial is designed to compare the performance of conventional transarterial chemoembolization (cTACE) using Lipiodol-only with additional use of degradable starch microspheres (DSM) for hepatocellular carcinoma (HCC) in BCLC-stage-B based on metric tumor response.MethodsSixty-one patients (44 men; 17 women; range 44–85) with HCC were evaluated in this IRB-approved HIPPA compliant study. The treatment protocol included three TACE-sessions in 4-week intervals, in all cases with Mitomycin C as a chemotherapeutic agent. Multiparametric magnetic resonance imaging (MRI) was performed prior to the first and 4 weeks after the last TACE. Two treatment groups were determined using a randomization sheet: In 30 patients, TACE was performed using Lipiodol only (group 1). In 31 cases Lipiodol was combined with DSMs (group 2). Response according to tumor volume, diameter, mRECIST criteria, and the development of necrotic areas were analyzed and compared using the Mann–Whitney-U, Kruskal–Wallis-H-test, and Spearman-Rho. Survival data were analyzed using the Kaplan–Meier estimator.ResultsA mean overall tumor volume reduction of 21.45% (± 62.34%) was observed with an average tumor volume reduction of 19.95% in group 1 vs. 22.95% in group 2 (p = 0.653). Mean diameter reduction was measured with 6.26% (± 34.75%), for group 1 with 11.86% vs. 4.06% in group 2 (p = 0.678). Regarding mRECIST criteria, group 1 versus group 2 showed complete response in 0 versus 3 cases, partial response in 2 versus 7 cases, stable disease in 21 versus 17 cases, and progressive disease in 3 versus 1 cases (p = 0.010). Estimated overall survival was in mean 33.4 months (95% CI 25.5–41.4) for cTACE with Lipiosol plus DSM, and 32.5 months (95% CI 26.6–38.4), for cTACE with Lipiodol-only (p = 0.844), respectively.ConclusionsThe additional application of DSM during cTACE showed a significant benefit in tumor response according to mRECIST compared to cTACE with Lipiodol-only. No benefit in survival time was observed.

Background and purpose Flow diversion of aneurysms located in the M1 segment and middle cerebral artery bifurcation with Pipeline embolization device is sometimes performed, but further study is needed to support its regular use in aneurysm treatment. Here, we report measures of safety and efficacy for Pipeline embolization in the proximal middle cerebral artery in a multi-center cohort. Materials and methods Clinical and angiographic data of eligible patients were retrospectively obtained from participating centers and assessed for key clinical and angiographic outcomes. Additional details were extracted for patients with complications. Results In our multi-center cohort, complete aneurysm occlusion was achieved in 71% (17/24) of treated aneurysms. There were no deaths or disabling strokes, but non-disabling ischemic strokes occurred in 8% (2/24) of patients. For aneurysms in the M1 segment, complete aneurysm occlusion was observed in 75% (12/16) of aneurysms, aneurysm volume reduction was observed in 100% (16/16) of aneurysms, and non-disabling ischemic strokes occurred in 13% (2/16) of patients. For aneurysms at the middle cerebral artery bifurcation, complete aneurysm occlusion was observed in 63% (5/8) of aneurysms, aneurysm volume reduction occurred in 88% (7/8) of aneurysms, and ischemic or hemorrhagic complications occurred in 0% (0/8) of patients. Conclusion Pipeline embolization of cerebral aneurysms in the M1 segment and middle cerebral artery bifurcation demonstrated a 71% rate of complete aneurysm occlusion. There were no deaths or disabling strokes, but there was an 8% rate of non-disabling ischemic strokes.

Background and purpose Flow diversion is commonly used to treat intracranial aneurysms in various regions of the cerebral vasculature, but is only approved for use in the internal carotid arteries. Treatment of distal PICA aneurysms with PED is sometimes performed but has not been well studied. Here, we report our experience with flow diversion of distal PICA aneurysms with PED. Materials and methods Clinical and angiographic data of eligible patients was retrospectively obtained and assessed for key demographic characteristics and clinical and angiographic outcomes. Principal outcomes included rates of aneurysm occlusion, ischemic or hemorrhagic complication, technical complication, and in-stent stenosis. Results Three female and 2 male patients underwent placement of PED in the PICA for treatment of 5 distal PICA aneurysms. Clinical and angiographic follow-up was obtained for all patients. Complete aneurysm occlusion was observed in 100% (5/5) of treated aneurysms at 6 month and longest angiographic follow-up. While there were no ischemic or device-related complications, delayed hemorrhagic complications occurred in 20% (1/5) of patients. Conclusion Pipeline embolization of distal PICA aneurysms can be performed in select patients. Further study is necessary in larger cohorts to better define clinical scenarios in which flow diversion in the distal PICA should be considered.

In this paper, we consider a 2D polychromatic transparency serving as an object in front of a dispersive thick lens. The RGB based constituent colors are treated in terms of a center wavelength with a spectral spread, thereby enabling the phasor interpretation and tracking along axial image planes. It turns out that any individual color of the input transparency has a unique focal length or image position in the (meridional) observation plane after propagation through the lens. Under dispersion, image characteristics such as foci, axial location, magnification, and amplitude are controlled by narrow sidebands around a monochromatic carrier. The analytical results (derived numerically) are compared with standard non-dispersive imaging. Particular attention is given to the nature of transverse paraxial images in fixed axial planes, whereby defocusing effects due to dispersion are demonstrated in the manner of spherical aberration. Such selective axial focusing of individual wavelengths may find applications in improving the conversion efficiency of solar cells and photodetectors exposed to white light illumination.

Study question Does iron overload affect ovarian reserve markers in women with transfusion-dependent beta thalassaemia major? Summary answer Ovarian reserve markers were lower in women with transfusion dependent beta thalassaemia major as compared to controls suggesting an impact of iron overload on ovary What is known already Although spontaneous fertility and successful pregnancies have been reported in well-chelated and transfused women with beta thalassaemia major (BTM), majority of women are subfertile due to hypogonadotropic hypogonadism (HH). Little is known about the effect of iron overload on ovarian follicles and whether ovarian reserve is affected by the disease or treatment status. Study design, size, duration This study compares the markers of ovarian reserve in women with transfusion-dependent beta thalassaemia major over a period of ten years with healthy women from a control population. It is a 10-year mixed (retrospective and prospective) longitudinal study in 17 women with transfusion-dependent beta thalassaemia major from thalassaemia clinic in a tertiary teaching hospital between July 2007 to June 2017. The results were compared with 52 age-matched healthy women without any medical conditions (control population). Participants/materials, setting, methods Study compared 17 women with transfusion-dependent beta thalassaemia major with 52 age-matched healthy women without any medical conditions attending fertility clinic. Patient demographics, medical history, menstrual history, hormonal parameters (serum levels of FSH, estradiol, TSH and AMH) and antral follicle count (AFC) were recorded in all women from both groups. Serum levels of ferritin, cardiac T2*, liver iron concentration, thyroid function (TSH) and liver function test results were also recorded at three different time points. Main results and the role of chance Serum AMH levels, estradiol levels and antral follicle count were significantly lower in women with beta thalassaemia major compared with the control group (p Limitations, reasons for caution The sample size was small, and bias cannot be entirely ruled out due to part retrospective nature of the study. We could not verify how many of the BTM women with amenorrhoea needed induction of puberty with certainty. Wider implications of the findings The belief that the gonad might be spared from effects of transfusional iron overload in women with BTM is questionable. Ovarian reserve markers were significantly lower in women with transfusion dependent BTM compared to controls. Further studies are required to elucidate mechanisms by which iron overload can adversely affect ovaries. Trial registration number Not applicable

The aim of this study was to use Field Emission Scanning Electron (FESEM) and Fourier transform infrared spectroscopy (FTIR), to investigate the structure and the film-forming capacity of Staphylococcus aureus, on two different surface materials, Chitin and Polycarbonate membrane filter. Both the substrates, having diverse properties, showed varied attachments of bacterial and biofilm development. FESEM showed that higher bacterial colonization and biofilm growth was obtained in the rough surface of chitin with complex structure, compared to that of polycarbonate membrane at different time intervals. Due to its high magnification and resolution, FESEM enabled a more detailed analysis of the biofilm cells, influenced by different structural organisations and morphology. On the other hand, FTIR analyses revealed the chemical conformation of the substrate and its biofilm state. However, the difference in the spectra of the two substrates was not large. Prominent band absorbance at 1200-800 cm-1 for polysaccharides and proteins at 1700- 1400 cm-1 were observed at its biofilm states. These findings promote the prospect of using FESEM and FTIR for understanding biofilm morphology and architecture, as well as its chemical interaction with the substrate.

The results obtained for Fresnel amplitude coefficients (FCs) corresponding to a magnetic achiral/chiral (ACC) interface under variable incident angles and permittivity/permeability ratios, is extended to comparative study between two methods (incidence conditions) for investigating propagation of plane waves with left- and right- circular polarization (LCP & RCP) incident upon a chiral/achiral (CAC) interface.

Introduction : Intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT) are both standard of care treatments for acute ischemic stroke patients with large vessel occlusion (LVO) who are eligible for one or both treatments. IVT may result in early recanalization in some patients with LVO. The objective of this study is to analyze whether IVT influences pre‐thrombectomy clot lysis in LVO acute ischemic strokes. Methods : We reviewed prospectively collected data for all patients with LVO ischemic strokes who were transferred to the angiography suite with intention to perform EVT at a single comprehensive stroke center between January 2016 to December 2018. We identified subjects who showed partial or complete clot lysis vs no lysis based on the first angiographic picture of the occluded territory at the time of the initial vessel selection. Descriptive statistics were used to summarize demographic and clinical characteristics. We compared key predictor variables between lysis and no lysis groups including baseline variables, effect of IVT, time from IVT to groin puncture, LVO location, final modified treatment in cerebral ischemia (mTICI) score and discharge Modified Rankin Scale (mRS). t‐test or Kruskal‐Wallis test for continuous variables and chi square test or Fisher’s Exact test for categorical variables. Results : Two hundred and fifty‐nine patients were included. Among these patients, 10.8% (28/259) showed partial or complete lysis of the clot vs 89.2% (231/259) with no lysis. Among these patients who showed clot lysis, 16/28 (57.1%) received IVT. The use of IVT did not show differences between both groups (p = 0.18). There were no differences in the baseline characteristics except for gender, which was the only variable significantly associated with clot lysis. Men had 2‐fold higher odds of spontaneous lysis compared to females (OR [95%CI]: 2.39 [1.01, 5.65], p = 0.04). There was significant difference in the final mTICI between both groups (p Conclusions : Our study showed that IVT in a modern practice was not associated with pre‐thrombectomy lysis. Some patients had pre‐thrombectomy lysis despite not receiving IVT.

OBJECTIVE The Pipeline embolization device (PED) is widely used for the treatment of intracranial aneurysms, including in off-label applications. In this work, the authors compared the real-world efficacy and safety of PED use in on-label and off-label aneurysm treatments. METHODS Clinical and angiographic data of patients who underwent PED placement at a high-volume academic medical center were retrospectively obtained. Treatments were classified as on-label if they fell within the applications approved by the United States Food and Drug Administration as of 2021. Recorded outcomes included aneurysm occlusion, procedural complications, ischemic events, in-stent stenosis, intracranial hemorrhage, postprocedural functional status, and death. RESULTS In total, 416 aneurysms in 330 patients were treated with PED, comprising 256 aneurysms that received on-label treatments and 160 that received off-label treatments. The overall rate of complete aneurysm occlusion was 76.4% for on-label aneurysms and 75.6% for off-label aneurysms (p = 0.898). The risk of ischemic stroke in patients who underwent off-label treatments was 15.2%, which was higher than the 4.2% rate in patients who underwent on-label treatment (p = 0.003). All other clinical complications, procedural complications, and long-term functional status were comparable between the on-label and off-label groups. CONCLUSIONS In real-world practice, off-label use of PED is common and can achieve similar efficacy as on-label use. However, in aggregate, off-label use was found to carry an increased rate of ischemic complications. With judicious attention to safety and individual patient characteristics, these results highlight the scale and general feasibility of off-label PED use by experts.

Traumatic cerebrovascular injuries following blunt or penetrating trauma are common and carry a high risk of permanent disability or death. Proper screening, diagnosis, and treatment of these lesions is essential to improve patient outcomes. Advances in imaging continue to improve the accuracy of non-invasive diagnosis of these injuries while new clinical data provide better evidence for optimal management, whether medical or invasive. Here, we review screening, diagnosis, and treatment of traumatic cerebrovascular injuries.

Tremendous advancements in the treatment of acute ischemic stroke in the last 25 years have been based on the principle of reperfusion in early time windows and identification of small core infarct for intravenous thrombolysis and mechanical thrombectomy. Advances in neuroimaging have made possible the safe treatment of patients with acute ischemic stroke in longer time windows and with more specific selection of patients with salvageable brain tissue. In this review, we discuss the history of endovascular stroke thrombectomy trials and highlight the neuroimaging-based trials that validated mechanical thrombectomy techniques in the extended time window with assessment of penumbral tissue. We conclude with a survey of currently open trials that seek to safely expand eligibility for this highly efficacious treatment.

Introduction/Purpose Flow diversion of aneurysms located in the M1 segment and middle cerebral artery bifurcation with Pipeline embolization device is sometimes performed, but further study is needed to support its regular use in aneurysm treatment. Here, we report measures of safety and efficacy for Pipeline embolization in the proximal middle cerebral artery in a multi-center cohort. Materials and Methods Clinical and angiographic data of eligible patients undergoing Pipeline embolization of aneurysms located in the M1 segment and middle cerebral artery bifurcation were retrospectively obtained from participating centers and assessed for key clinical, angiographic, and cross-sectional imaging outcomes. Additional details were extracted for patients with complications. Results In our multi-center cohort, complete aneurysm occlusion was achieved in 71% (17/24) of treated aneurysms. There were no deaths or disabling strokes, but non-disabling ischemic strokes occurred in 8% (2/24) of patients. For aneurysms in the M1 segment, complete aneurysm occlusion was observed in 75% (12/16) of aneurysms, aneurysm volume reduction was observed in 100% (16/16) of aneurysms, and non-disabling ischemic strokes occurred in 13% (2/16) of patients. An illustrative example of an M1 aneurysm treated with PED is provided in figure 1. For aneurysms at the middle cerebral artery bifurcation, complete aneurysm occlusion was observed in 63% (5/8) of aneurysms, aneurysm volume reduction occurred in 88% (7/8) of aneurysms, and ischemic or hemorrhagic complications occurred in 0% (0/8) of patients. 19% (3/16) of patients that remained asymptomatic in the follow-up period and underwent cross-sectional imaging had clinically silent basal ganglia infarcts identified. Conclusion Pipeline embolization of cerebral aneurysms in the M1 segment and middle cerebral artery bifurcation demonstrated a 71% rate of complete aneurysm occlusion. There were no deaths or disabling strokes, but there was an 8% rate of non-disabling ischemic strokes. Further work is necessary to describe the long-term effects of silent basal ganglia infarcts caused by PED. Disclosures D. Lauzier: None. B. Root: None. Y. Kayan: 2; C; Microvention, Penumbra, Medtronic. J. Delgado Almandoz: 2; C; Medtronic, Microvention. J. Osbun: 2; C; Medtronic, Microvention. A. Chatterjee: None. K. Whaley: None. M. Tipps: None. C. Moran: 2; C; Medtronic, Cerenovus. A. Kansagra: 2; C; Penumbra, Microvention, iSchemaView.

Fresnel coefficients are examined for electromagnetic (EM) propagation across an achiral/chiral (ACC) boundary. It is found that upon both transmission and reflection, the incident plane (specifica...

Data on the blood pressure (BP) following mechanical thrombectomy (MT) is limited. In this study, we aimed to evaluate the correlation between BP and functional outcome following MT. We included patients who received MT between 6/12014 and 2/2017 at our institution. BP data included systolic, diastolic, and mean arterial BP readings recorded on an hourly interval for 24 h post-procedure. Functional outcome was assessed using 90-day modified Rankin Scale (mRS). Good outcome was defined as mRS ≤ 2, and poor outcome as mRS 3-6. A total of 298 patients were included. Mean age was 66.8 ± 15.2 years; 51% of patients were female, and mean NIHSS was 15.4 ± 7.7. Average systolic blood pressure (SBP) was 121 ± 11.5 mm Hg in the good outcome group and 125 ± 12.5 mm Hg in the poor outcome; P 0.001. Maximum SBP was 147.9 ± 20.5 mm Hg and 152.5 ± 18.3 mm Hg in the good and poor outcome group respectively, P 0.05. On multivariate analysis, higher average SBP was associated with a lower chance of good outcome (Odds ratio 0.97; 95% Confidence interval 0.94-0.998; P 0.026). Patients with average SBP of120 mm Hg in 24-hour post MT had a better 90-day outcome and a lower mortality rate when compared to patients with ≥120 mm Hg (median mRS; 2 (IQR 3) vs 3 (IQR4); P 0.001, mortality (12.1% vs 25.9%; P 0.01)). In conclusion, higher SBP in the acute phase post-MT was associated with a worse functional outcome. Prospective studies are urgently needed to determine the optimal BP goal post MT.

BackgroundEndovascular thrombectomy (ET) is the standard of care for treatment of acute ischemic stroke (AIS) secondary to large vessel occlusion. The elderly population has been under-represented in clinical trials on ET, and recent studies have reported higher morbidity and mortality in elderly patients than in their younger counterparts.ObjectiveTo use machine learning algorithms to develop a clinical decision support tool that can be used to select elderly patients for ET.MethodsWe used a retrospectively identified cohort of 110 patients undergoing ET for AIS at our institution to train a regression tree model that can predict 90-day modified Rankin Scale (mRS) scores. The identified algorithm, termed SPOT, was compared with other decision trees and regression models, and then validated using a prospective cohort of 36 patients.ResultsWhen predicting rates of functional independence at 90 days, SPOT showed a sensitivity of 89.36% and a specificity of 89.66% with an area under the receiver operating characteristic curve of 0.952. Performance of SPOT was significantly better than results obtained using National Institutes of Health Stroke Scale score, Alberta Stroke Program Early CT score, or patients’ baseline deficits. The negative predictive value for SPOT was >95%, and in patients who were SPOT-negative, we observed higher rates of symptomatic intracerebral hemorrhage after thrombectomy. With mRS scores prediction, the mean absolute error for SPOT was 0.82.ConclusionsSPOT is designed to aid clinical decision of whether to undergo ET in elderly patients. Our data show that SPOT is a useful tool to determine which patients to exclude from ET, and has been implemented in an online calculator for public use.

Despite the wide utilization of mechanical thrombectomy (MT) for acute ischemic stroke treatment, little is known about the incidence of early post-thrombectomy seizures, its predictors, and association with long-term outcome.Using a prospective registry of mechanical thrombectomy in ischemic stroke between January 2013 and July 2017, we identified patients who developed a seizure within 7 days (early seizure) of qualifying event. Backward stepwise regression analysis was used to assess independent predictors of seizure occurrence and the association between seizure and functional outcome (modified Rankin scale of 0-2 vs. ≥3).A total of 459 patients were included in the final analysis. Mean age was 67.5 (SD 15.1), and 49.9% of patients were female. Successful recanalization (TICI≥2B) was achieved in 92.8% of patients. Eleven (2.4%) patients developed at least one seizure. Only an Alberta Stroke Program Early CT (ASPECT) score of6 was independently associated with the occurrence of early seizures [Odds ratio, 95% confidence interval: 8.188, (2.219-30.214); P = .002]. On multivariate analysis, early seizures were associated with 90-day mortality rate [OR,6.487; 95% confidence interval, (1.481-28.405); P = .013] and poor functional outcome (OR, 4.7; 95% confidence interval (1.08-20.83); p = .039).In the studied cohort, 2.4% of ischemic stroke patients treated with MT developed at least one seizure within 7 days of stroke onset. A low ASPECT score was associated with the occurrence of early seizures. The occurrence of seizures was associated with 90-day mortality and poor functional outcome.