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Introduction: Cerebral venous sinus thrombosis (CVST) is an uncommon but fatal cause of stroke worldwide. Endovascular treatments could be life-saving in patients who don't treat with anticoagulants as a mainstay of treatment. Currently, there is no consensus considering the safety, efficacy, and also selected approaches of endovascular intervention for these patients. This systematic review evaluates the literature on endovascular thrombolysis (EVT) in CVST patients. Materials and Methods: A comprehensive search was conducted through PubMed and Scopus databases between 2010 and 2021, with additional sources identified through cross-referencing. The primary outcomes were the safety and efficacy of EVT in CVST, including catheter-related and non-catheter-related complications, clinical outcomes, and radiological outcomes. Results: A total of 10 studies comprising 339 patients were included. Most of the patients presented with headaches (86.72%) and/or focal neurologic deficits (45.43%) (modified Rankin Scale of 5 in 55.88%). Acquired coagulopathy and/or consuming estrogen/progesterone medication were the most frequent predisposing factors (45.59%). At presentation, 68.84% had multi-sinus involvement, and 28.90% had venous infarcts and/or intracranial hemorrhage (ICH). The overall complication rate was 10.3%, with a 2.94%, 1.47%, and 1.17% rate of ICH, herniation, and intracranial edema, respectively. The complete and partial postoperative radiographic resolution was reported in 89.97% of patients, increasing to 95.21% during the follow-up. Additionally, 72.22% of patients had no or mild neurologic deficit at discharge, rising to 91.18% at the last follow-up. The overall mortality rate was 7.07%. Conclusions: EVT can be an effective and safe treatment option for patients with refractory CVST or contraindications to systemic anticoagulation. [ABSTRACT FROM AUTHOR]

Objectives: Strain-gauge venous occlusion plethysmography (SGVOP) is a means of acquiring hemodynamic data non-invasively, unlike other methods used routinely for the diagnosis and follow-up of venous diseases. The present study compares the plethysmographic data with early- and mid-term routine data of patients with acute deep-vein thrombosis (DVT) who underwent pharmacomechanical thrombolysis. Patients and method: Included in this retrospective study were 118 patients with acute DVT, who underwent pharmacomechanical thrombolysis between February 2018 and July 2019. Pre- and post-procedure follow-up data including CIVIQ-20 (quality of life), VCSS (Venous Clinical Severity Score), D-Dimer, Doppler USG results, venous capacity (VC), and venous outflow (VO) obtained by SGVOP were recorded and compared. Results: In all 118 (100%) patients who underwent the procedure, early- and mid-term patency was seen to have been provided on Doppler USG follow-up, and various degrees of venous insufficiency were identified. A statistically significant improvement was observed in VCSS, CIVIQ-20, D-Dimer, VO, and VC measurements, although when the discrepancies between CIVIQ-20 and plethysmographic measurements were examined individually during the 6-month follow-up, nine (13.1%) patients were identified with comorbidities. Conclusions: Pharmacomechanical thrombolysis is an effective treatment approach for patients with acute DVT. Providing non-invasive objective data supporting the diagnosis and follow-up of venous diseases, the SGVOP approach offers significant benefits and should be considered more frequently as a viable therapy. [ABSTRACT FROM AUTHOR]

Objective To compare the therapeutic effects of direct aspiration and stent-retriever thrombectomy in patients with acute ischemic stroke (AIS) due to middle cerebral artery occlusion. Methods We included 59 patients with AIS due to middle cerebral artery occlusion who underwent endovascular thrombectomy in our hospital from January 2018 to December 2021. Among them, 25 cases underwent direct aspiration for thrombectomy, and 34 cases underwent stent-retriever thrombectomy. The two groups were compared in terms of basic data, successful recanalization rate, puncture-to-recanalization time, National Institutes of Health Stroke Scale (NIHSS) score before operation, change in NIHSS score immediately after operation (△1NIHSS score), change in NIHSS score at 24 h after operation (△2NIHSS score), the rate of thrombus escape, the rate of rescue treatment, the rate of intracranial hemorrhage at 7 d after operation, the mortality rate at 7 d after operation, and the percentage of patients with good prognosis at 90 d after operation. Results The time from puncture to successful recanalization was significantly shorter in the aspiration group than in the stent retriever group (t = 5.923, P0.05). Conclusion Both direct aspiration and stent-retriever thrombectomy have good effectiveness for the treatment of AIS due to middle cerebral artery occlusion, with similar vascular recanalization rate, neurological recovery degree, and prognosis, but direct aspiration can shorten the time from puncture to recanalization.

It is impossible to predict underlying anomalies in acute large vessel occlusion and it could be a problem when performing mechanical thrombectomy (MT). We report a case of MT for occlusion of the fenestrated middle cerebral artery (MCA) M1 segment. A 49-year-old woman presented to our hospital with dysarthria and left hemiparesis. Acute ischemic stroke due to right occluded MCA was diagnosed. During performing emergent MT, a part of the M1 segment was revealed to be slit-shaped by digital subtraction angiography, suggesting a fenestrated MCA. The aspiration catheter could not be advanced through the narrow limb of the fenestration, and the distal thrombus was retrieved using a stent retriever, additionally. Postoperatively, the patient's symptoms improved without complications. When occlusion of the fenestrated MCA is suspected, it is necessary to consider converting the strategy from an aspiration catheter alone to the combined use of a stent retriever.

Objectives: To develop and validate a deep learning model for predicting hemorrhagic transformation after endovascular thrombectomy using dual-energy computed tomography (CT). Materials and methods: This was a retrospective study from a prospective registry of acute ischemic stroke. Patients admitted between May 2019 and February 2023 who underwent endovascular thrombectomy for acute anterior circulation occlusions were enrolled. Hemorrhagic transformation was defined using follow-up magnetic resonance imaging or CT. The deep learning model was developed using post-thrombectomy dual-energy CT to predict hemorrhagic transformation within 72 h. Temporal validation was performed with patients who were admitted after July 2022. The deep learning model's performance was compared with a logistic regression model developed from clinical variables using the area under the receiver operating characteristic curve (AUC). Results: Total of 202 patients (mean age 71.4 years ± 14.5 [standard deviation], 92 men) were included, with 109 (54.0%) patients having hemorrhagic transformation. The deep learning model performed consistently well, showing an average AUC of 0.867 (95% confidence interval [CI], 0.815–0.902) upon five-fold cross validation and AUC of 0.911 (95% CI, 0.774–1.000) with the test dataset. The clinical variable model showed an AUC of 0.775 (95% CI, 0.709–0.842) on the training dataset (p < 0.01) and AUC of 0.634 (95% CI, 0.385–0.883) on the test dataset (p = 0.06). Conclusion: A deep learning model was developed and validated for prediction of hemorrhagic transformation after endovascular thrombectomy in patients with acute stroke using dual-energy computed tomography. Clinical relevance statement: This study demonstrates that a convolutional neural network (CNN) can be utilized on dual-energy computed tomography (DECT) for the accurate prediction of hemorrhagic transformation after thrombectomy. The CNN achieves high performance without the need for region of interest drawing. Key Points: • Iodine leakage on dual-energy CT after thrombectomy may be from blood-brain barrier disruption. • A convolutional neural network on post-thrombectomy dual-energy CT enables individualized prediction of hemorrhagic transformation. • Iodine leakage is an important predictor of hemorrhagic transformation following thrombectomy for ischemic stroke. [ABSTRACT FROM AUTHOR]

Objective: Unusual clinical course Background: Duplicate inferior vena cava (IVC) accompanied by deep venous thrombosis is rare. The optimal treatment plan is determined according to the results of imaging, including venography. In this report, we present a case of successful treatment of a patient with duplicate IVC and deep venous thrombosis (DVT). Case Report: An 84-year-old man with history of hypertension was admitted to the hospital because of 4 days of moderate left lower-limb edema. A thorough examination led to the diagnosis of the DVT. The duplicate IVC was discovered during venography. As the blood from the left common iliac vein mainly flowed to the left IVC, and there were no other communicating branches before the convergence of the left and right IVCs, which was located above the 1st lumbar vertebrae body near the junction of the hepatic vein and the IVC, the strategy of placing only 1 filter in the left inferior vena cava were chosen, rather than placing 1 filter above the confluence of bilateral IVC, or placing a filter in each IVC below the level of renal veins on each side. Following that, the DVT was safely treated with thrombolysis and aspiration without the risk of pulmonary embolism. Conclusions: This case report presented the complete evaluation and management of a patient with lower-limb DVT accompanied by the malformation of duplicate IVC. The filter placement strategy with duplicate IVC in the literature was summarized. We concluded that even in emergency situations, with comprehensive consideration, it is possible to perform endovascular intervention successfully and achieve satisfactory treatment results. [ABSTRACT FROM AUTHOR]

Objective: Numerous studies have indicated that early decompressive craniectomy (DC) for patients with major infarction can be life-saving and enhance neurological outcomes. However, most of these studies were conducted by neurologists before the advent of intra-arterial thrombectomy (IA-Tx). This study aims to determine whether neurological status significantly impacts the final clinical outcome of patients who underwent DC following IA-Tx in major infarction. Methods: This analysis included 67 patients with major anterior circulation major infarction who underwent DC after IA-Tx, with or without intravenous tissue plasminogen activator. We retrospectively reviewed the medical records, radiological findings, and compared the neurological outcomes based on the "surgical time window" and neurological status at the time of surgery. Results: For patients treated with DC following IA-Tx, a Glasgow coma scale (GCS) score of 7 was the lowest score correlated with a favorable outcome (p=0.013). Favorable outcomes were significantly associated with successful recanalization after IA-Tx (p=0.001) and perfusion/diffusion (P/D)-mismatch evident on magnetic resonance imaging performed immediately prior to IA-Tx (p=0.007). However, the surgical time window (within 36 hours, p=0.389; within 48 hours, p=0.283) did not correlate with neurological outcomes. Conclusion: To date, early DC surgery after major infarction is crucial for patient outcomes. However, this study suggests that the indication for DC following IA-Tx should include neurological status (GCS ≤7), as some patients treated with early DC without considering the neurological status may undergo unnecessary surgery. Recanalization of the occluded vessel and P/D-mismatch are important for long-term neurological outcomes. [ABSTRACT FROM AUTHOR]

Aim Stroke treatment is a time-critical condition. Understanding the impact of timing and types of treatment on patient outcomes can help develop and optimize stroke management strategies. The study aimed to analyse the effect of different time intervals and mechanical thrombectomy methods on outcomes of stroke patients in Kazakhstan. Methods The patient data, including demographic information, clinical characteristics, and specific time intervals from stroke onset to hospital admission, stroke onset to surgery initiation, and hospital admission to surgery initiation were collected. A total of 100 patients were analysed. Patients' neurological status was evaluated using the National Institutes of Health Stroke Scale (NIHSS), Modified Rankin Scale (mRS), and Glasgow Coma Scale (GCS) before and after the surgical treatment. Results Most patients had concomitant arterial hypertension, and almost 25 % had diabetes mellitus. The average time from stroke onset to hospital admission was 123.2±7.6 minutes, and from hospital admission to surgery initiation, it was 134.7±13.1 minutes. A shorter duration from the onset of stroke to hospitalization and surgery was associated with better clinical outcomes. Our results demonstrated a statistically significant decrease in NIHSS, mRS after surgical treatment compared to baseline. The association between the extended time from stroke onset to hospitalization and reduced survival rates was observed. Conclusion Our findings indicate the essential role of timely intervention in managing stroke patients, as well as the need for a comprehensive and patient-centred approach to stroke care. [ABSTRACT FROM AUTHOR]

There is an urgent need to develop a national program and allocation of resources to improve stroke care in India. Management of stroke requires a multidisciplinary approach and close collaboration not only among physicians from different specialties but also among paramedical personnel and patient transport services. Here we propose a healthcare model of providing acute stroke therapies to patients in central India to minimize the wide supply mismatch we face in providing adequate care to our patients. Observations and the proposed model presented below were based on personal experience and a review of the literature on stroke care available in central India.

Objective To explore the clinical application of quantitative electroencephalography (qEEG) in predicting the early prognosis of acute ischemic stroke after mechanical thrombectomy. Methods A total of 71 patients who underwent acute ischemic stroke mechanical thrombectomy from April 2021 to September 2022 were enrolled in He'nan Provincial People's Hospital, all of them performed qEEG after surgery. Modified Rankin Scale (mRS) was used to evaluate the prognosis on the 90 d after the surgery. Univariate and multivariate backward Logistic regression analyses were used to screen risk factors for prognosis in acute ischemic stroke after mechanical thrombectomy. Receiver operating characteristic (ROC) curve was used to predict the value of qEEG for the prognosis of neural function. Results Patients in dismal prognosis group (mRS score 3-5, n = 28) had higher NIHSS score at admission (t = 2.686, P = 0.009), higher proportion of thrombectomy performed more than 3 times (χ2 = 4.201, P = 0.040), higher values of DTABR on the affected side (t = 2.183, P = 0.032), higher ratio of DTABR on affected side/ unaffected side (t = 6.230, P = 0.000), and higher proportion of immediately Thrombolysis in Cerebral Infarction (TICI) < 2b after surgery (χ2 = 5.420, P = 0.020) compared to favorable prognosis group (mRS score 0-2, n = 43). Logistic regression analysis showed higher NIHSS score at admission (OR = 1.542, 95%CI: 1.368-1.725；P = 0.012), DTABR on affected side/unaffected side (OR = 3.428, 95%CI: 2.673-7.314; P = 0.008), percent alpha variability (PAV) grade Ⅱ (OR = 2.983, 95%CI: 2.625-4.682; P = 0.003) and grade Ⅲ (OR = 4.088, 95%CI: 3.825-5.349; P = 0.002), amplitude electroencephalography (aEEG) grade Ⅱ (OR = 2.536, 95%CI: 1.942-5.287; P = 0.005) and grade Ⅲ (OR = 3.924, 95%CI: 2.012-6.378; P = 0.003) were risk factors of dismal prognosis in acute ischemic stroke after mechanical thrombectomy. ROC curve showed the area under the curve (AUC) of NIHSS score was 0.676 (95%CI: 0.554-0.782, P = 0.000), DTABR on affected side/unaffected side was 0.887 (95%CI: 0.789-0.950, P = 0.000), the PAV was 0.760 (95%CI: 0.643-0.853, P = 0.000), aEEG was 0.778 (95%CI: 0.664-0.868, P = 0.000), and the combined indicators classification was 0.943 (95%CI: 0.861-0.984, P = 0.000). Among them, the predictive power of the combined indicators is higher than that of the NIHSS score at admission (Z = 4.150, P = 0.000), PAV (Z = 4.006, P = 0.000) and aEEG (Z = 3.462, P = 0.001). Conclusions qEEG is an effective method to predict the early prognosis of acute ischemic stroke after mechanical thrombectomy.

BackgroundCOVID-19 and Fontan physiology have each been associated with an elevated risk of venous thromboembolism (VTE), however little is known about the risks and potential consequences of having both.Case presentationA 51 year old male with tricuspid atresia status post Fontan and extracardiac Glenn shunt, atrial flutter, and sinus sick syndrome presented with phlegmasia cerulea dolens (PCD) of the left lower extremity in spite of supratherapeutic INR in the context of symptomatic COVID-10 pneumonia. He was treated with single session, catheter directed mechanical thrombectomy that was well-tolerated.ConclusionsThis report of acute PCD despite therapeutic anticoagulation with a Vitamin K antagonist, managed with emergent mechanical thrombectomy, calls to attention the importance of altered flow dynamics in COVID positive patients with Fontan circulation that may compound these independent risk factors for developing deep venous thrombosis with the potential for even higher morbidity.

There is an urgent need to develop a national program and allocation of resources to improve stroke care in India. Management of stroke requires a multidisciplinary approach and close collaboration not only among physicians from different specialties but also among paramedical personnel and patient transport services. Here we propose a healthcare model of providing acute stroke therapies to patients in central India to minimize the wide supply mismatch we face in providing adequate care to our patients. Observations and the proposed model presented below were based on personal experience and a review of the literature on stroke care available in central India. [ABSTRACT FROM AUTHOR]

Background: Endovascular mechanical thrombectomy (EVT) for large vessel occlusions has had a dramatic impact on the management of acute ischemic stroke. Extended use of EVT beyond American Heart Association guidelines has been successful in carefully selected cases. Case Report: A 71-year-old male presented to our comprehensive stroke center upon awakening with mild left hemiparesis. He was found to have a chronic occlusion of the right supraclinoid segment of the internal carotid artery. Angiography demonstrated large vessel occlusion of the contralateral A1-A2 junction that was successfully recanalized. Imaging at 24 hours displayed no evidence of infarct, the patient rapidly improved during hospitalization, and he was discharged on postoperative day 7 with a National Institutes of Health Stroke Scale score of zero. Conclusion: We describe successful EVT of a patient presenting with false-localizing symptoms consistent with a right hemispheric acute ischemic stroke secondary to left A1-A2 junction large vessel occlusion. This case demonstrates the importance of a high index of suspicion when evaluating atypical stroke presentations and the effectiveness of EVT in the treatment of distal small caliber vessels. [ABSTRACT FROM AUTHOR]

BACKGROUND AND PURPOSE: Recent data suggest that intra-arterial thrombolytics may be a safe rescue therapy for patients with acute ischemic stroke after unsuccessful mechanical thrombectomy; however, safety and efficacy remain unclear. Here, we evaluate the use of intra-arterial rtPA as a rescue therapy in the Systematic Evaluation of Patients Treated with Neurothrombectomy Devices for Acute Ischemic Stroke (STRATIS) registry. MATERIALS AND METHODS: STRATIS was a prospective, multicenter, observational study of patients with acute ischemic stroke with large-vessel occlusions treated with the Solitaire stent retriever as the first-line therapy within 8 hours from symptom onset. Clinical and angiographic outcomes were compared in patients having rescue therapy treated with and without intra-arterial rtPA. Unsuccessful mechanical thrombectomy was defined as any use of rescue therapy. RESULTS: A total of 212/984 (21.5%) patients received rescue therapy, of which 83 (39.2%) and 129 (60.8%) were in the no intra-arterial rtPA and intra-arterial rtPA groups, respectively. Most occlusions were M1, with 43.4% in the no intra-arterial rtPA group and 55.0% in the intra-arterial rtPA group (P = .12). The median intra-arterial rtPA dose was 4 mg (interquartile range = 2-12 mg). A trend toward higher rates of substantial reperfusion (modified TICI  ≥ 2b) (84.7% versus 73.0%, P = .08), good functional outcome (59.2% versus 46.6%, P = .10), and lower rates of mortality (13.3% versus 23.3%, P = .08) was seen in the intra-arterial rtPA cohort. Rates of symptomatic intracranial hemorrhage did not differ (0% versus 1.6%, P = .54). CONCLUSIONS: Use of intra-arterial rtPA as a rescue therapy after unsuccessful mechanical thrombectomy was not associated with an increased risk of symptomatic intracranial hemorrhage or mortality. Randomized clinical trials are needed to understand the safety and efficacy of intra-arterial thrombolysis as a rescue therapy after mechanical thrombectomy.

BACKGROUND: Routing patients directly to endovascular capable centers (ECCs) would decrease time to mechanical thrombectomy (MT), but may delay intravenous thrombolysis (IVT). OBJECTIVE: To study the clinical outcomes of patients with a stroke transferred directly to ECCs compared with those transferred to ECCs from non-endovascular capable centers (nECCs). METHODS: Data from the STRATIS registry were analyzed to evaluate process and clinical outcomes under five routing policies: (1) transport to nearest nECC; (2) transport to STRATIS ECC over any distance or (3) within 20 miles; (4) transport to ideal ECC (iECC), over any distance or (5) within 20 miles. RESULTS: Among 236 patients, 117 (49.6%) were transferred by ground, of whom 62 (53%) were transferred within 20 miles. Median MT start time was accelerated in all direct transport models. IVT start was prolonged with direct transport across all distances, but accelerated with direct transport to iECC ≤20 miles. With bypass limited to ≤20 miles, the median modeled EMS arrival to IVT interval decreased for both iECCs and ECCs (by 12 min and 6 min, respectively), and median EMS arrival to puncture time decreased by up to 94 min. In this cohort, no patient would have become ineligible for IVT. Bypass to iECC modeling under 20 miles showed a significant reduction in the level of disability at 3 months, with freedom from disability (modified Rankin Scale score 0-1) at 3 months increased by 12%. CONCLUSIONS: Direct routing of patients with a large vessel occlusion to ECCs, especially when within 20 miles, may lead to better clinical outcomes by accelerating the start of MT without any delay of IVT. CLINICAL TRIAL REGISTRATION NUMBER: http://www.clinicaltrials.gov. Unique identifier: NCT02239640.

ABSTRACT Despite there being a robust amount of literature and numerous randomized clinical trials regarding acute ischemic stroke treatment, the trials have not included some frequent controversial situations for which decision-making strategies are an urgent and unmet need in clinical practice. This article tries to summarize the current evidence about some selected situations (mechanical thrombectomy in low ASPECTS, low NIHSS with proximal occlusion, acute basilar occlusion, distal and medium vessel occlusion, among others), make suggestions on how to approach them in clinical practice and show what to expect in acute stroke research in the near future.

Pulmonary embolism (PE) is a clinical syndrome in which the pulmonary artery or its branches are obstructed by endogenous or exogenous emboli, resulting in circulatory abnormalities and cardiac dysfunction. A case of acute pulmonary embolism in the third trimester of pregnancy was successfully treated. The patient was admitted to our hospital because of "threatened preterm labor". Venous thromboembolism assessment on admission did not indicate high risk. However, the patient developed palpitation, chest tightness and dyspnea after forced defecation on the fourth day of admission. The patient had the increased heart rate, decreased blood oxygen, normal blood pressure, and increased D-dimer, and no other obvious abnormalities. Electrocardiogram showed the moderate ST depression and abnormal T wave. Ultrasound examination showed a very slow flow rate of deep veins of both lower limbs, mild pulmonary hypertension, and slightly enlarged right ventricle. Other ultrasound examination showed no obvious abnormalities. After multidisciplinary consultation and discussion, the acute pulmonary embolism during pregnancy was considered. This disease was characterized by acute onset and rapid progress. Therefore, the patient after the emergency cesarean section of the lower uterine segment was transferred to the ICU of the general hospital for treatment. After the transfer, the patient had respiratory failure and mechanical ventilation could not maintain oxygenation. The patient was treated with veno-venous extracorporeal membrane oxygenation (V-V ECMO) to maintain oxygenation, and then received symptomatic treatment such as thrombectomy and thrombolysis. After active treatment, the patient had a good prognosis. The purpose of this case report is to improve the awareness and alertness of pulmonary embolism during pregnancy, and to remind clinicians that the risk factors should be dynamically and individually assessed, to achieve early detection and timely prevention, so as to save the lives of mothers and infants and reduce the fatality. [ABSTRACT FROM AUTHOR]

Cerebral venous sinus thrombosis (CVST) is a special type of stroke. At present, anticoagulant therapy is the main treatment, but the mortality rate is higher in severe patients with ineffective anticoagulant therapy, and endovascular treatment can improve the prognosis of these patients. However, there is a lack of large randomized controlled trials to verify the endovascular treatment of CVST currently, so the effectiveness and safety of endovascular treatment is questionable. This article is to analyze the current status and problems of endovascular treatment for CVST in recent years, in order to guide clinical practice.

Objective To investigate the efficacy and safety of combined anticoagulants with endovascular treatment for subacute and chronic cerebral venous sinus thrombosis (CVST) under the assistance of high resolution magnetic resonance black⁃blood thrombus imaging (MRBTI). Methods and Results A retrospective study was performed on the patients with CVST who were treated at Department of Neurosurgery of Tianjin Huanhu Hospital from January 2019 to January 2021. Preoperative high resolution MRBTI confirmed 15 patients with subacute and chronic CVST, and endovascular treatment was performed on the basis of systemic anticoagulant therapy. The results showed that 10 cases were in subacute stage and 5 cases were in chronic stage. After treatment, the venous sinus was completely recanalized in 4 cases and partially recanalized in 11 cases. Complications occurred in 2 cases (intracranial hematoma enlarged in one case, microguide wire penetrated straight sinus wall during surgery in one case), contact thrombolytic therapy was continued after the condition stabilized. The mean indwelling time of microcatheter in straight sinus was (6.27 ± 0.21) d and the mean length of hospital stay was (11.53 ± 1.30) d. The degree of impairment of consciousness [Glasgow Coma Scale (GCS) score] was improved at discharge [at discharge (13.67 ± 2.02) score vs. at admission (11.67 ± 2.13) score; t = 9.165, P = 0.000], the degree of neurological impairment [modified Rankin Scale (mRS) score] was improved 6 months after surgery [at 6 months after surgery 1 (0, 2) score vs. at admission 3 (2, 4) score; Z = ⁃ 3.624, P = 0.000]. Conclusions High resolution MRBTI is an effective technique to identify subacute and chronic CVST patients. For these patients, the combination of systemic anticoagulation and endovascular treatment can reduce venous sinus thrombosis load and improve symptoms in a short time, which is a safe, effective and preferred treatment.

Objective To report a case of spontaneous intracranial hypotension (SIH) with cerebral venous thrombosis (CVT) and subdural hematoma (SDH), summarize its clinical manifestations and imaging features, and improve clinicians' ability of diagnosis and differential diagnosis, as well as the recognition of the related complications. Methods and Results The patient was a 56⁃year⁃old male with a subacute to chronic disease course, with the onset of orthostatic headache, progressive exacerbation, and developed numbness and weakness in the right limb. Imaging findings revealed diffuse enhancement of dura mater, bilateral chronic SDH and CVT. After rehydration, anticoagulation, mechanical thrombectomy and thrombolytic therapy, the CVT was significantly reduced. Due to the continuous increasion in bleeding tendency and the expansion of SDH, after discontinuation of anticoagulant and craniotomy for hematoma removal, the condition was controlled, and the volume of SDH decreased. Follow⁃up 3 months after discharge, head MRI showed that there was basically no filling defect in the venous sinus, and the visualization was significantly improved; the patient's orthostatic headache disappeared, and no focal neurological dysfunction remained. Conclusions Although SIH with cerebral venous system thrombosis and SDH, treated by fluid replacement, anticoagulation, and endovascular treatment, the symptoms and signs induced by venous thrombosis can be improved, these measures can't prevent the further expansion of the SDH, early detection of leaks and repairs may be more conducive to the recovery.

Objective According to the diagnosis and treatment process of a case of spontaneous intracranial hypotension (SIH) with cerebral venous sinus thrombosis (CVST), the etiology, diagnosis and treatment were analyzed in order to improve the clinicians' understanding. Methods and Results A 34⁃year⁃old male patient developed persistent headache in the occipital region accompanied by intermittent throb⁃like pain. The onset was independent of body position or circadian rhythm, and the symptoms were progressively aggravated. The patient was initially diagnosed with CVST, and gained a poor curative effect of endovascular treatment and anticoagulant therapy. The subsequent diagnosis of SIH with CVST was corrected by head MRI and magnetic resonance myelography (MRM). After bedrest, hydration, steroids, anticoagulation and defibration therapy, the headache symptoms disappeared and the laboratory test results returned to the normal range. There was no recurrence after discharge. Conclusions For CVST patients without typical orthostatic headache, more attentions should be paid to the analysis of imaging findings and clinical data, in order to avoid the possibility of missed diagnosis of intracranial hypotension syndrome (IHS).

Objectives: Intravenous thrombolysis alone has poor recanalization rates in large vessel occlusion strokes. Bridging thrombolysis has evolved as a standard treatment approach in emergent large vessel occlusions. Patients who undergo thrombectomy have a higher probability of favorable outcomes irrespective of the use of prior intravenous thrombolysis. Our aim was to compare bridging thrombolysis with direct thrombectomy in ischemic stroke due to large vessel occlusion. Methods: We included patients from our stroke registry, with large vessel occlusion strokes, presenting

Large vessel occlusion stroke contributes to disability and mortality out of proportion to its incidence. Over time it was noted that intravenous thrombolysis alone was not sufficient for this stroke type. Slowly, endovascular approach and mechanical clot retrieval have come out to be the biggest advances in the field of neurology as well as modern medicine. Although the careful selection of patients is needed as standardized by landmark trials. At the same time, thrombectomy is now being studied in patients excluded by previous trials and is seemingly coming out be effective in the vast majority of patients with large vessel occlusions. Further, techniques and devices are getting refined day by day to achieve the maximum possible benefit.

Rapid revascularization is highly effective for acute stroke, but animal studies suggest that reperfusion edema may attenuate its beneficial effects. We investigated the relationship between reperfusion and edema in patients from the Echoplanar Imaging Thrombolysis Evaluation Trial (EPITHET) and Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy (MR RESCUE) cohorts. Reperfusion percentage was measured as the difference in perfusion-weighted imaging lesion volume between baseline and follow-up (day 3-5 for EPITHET; day 6-8 for MR RESCUE). Midline shift (MLS) and swelling volume were quantified on follow-up MRI. We found that reperfusion was associated with less MLS (EPITHET: Spearman ρ = -0.46; P

Background: In patients with acute ischemic stroke due to large vessel occlusion (AIS–LVO), development of extensive early ischemic brain edema is associated with poor functional outcomes, despite timely treatment. Robust cortical venous outflow (VO) profiles correlate with favorable tissue perfusion. We hypothesized that favorable VO profiles (VO+) correlate with a reduced early edema progression rate (EPR) and good functional outcomes. Methods: Multicenter, retrospective analysis to investigate AIS–LVO patients treated by mechanical thrombectomy between May 2013 and December 2020. Baseline computed tomography angiography (CTA) was used to determine VO using the cortical vein opacification score (COVES); VO+ was defined as COVES ⩾ 3 and unfavorable as COVES ⩽ 2. EPR was determined as the ratio of net water uptake (NWU) on baseline non-contrast CT and time from symptom onset to admission imaging. Multivariable regression analysis was performed to assess primary (EPR) and secondary outcome (good functional outcomes defined as 0–2 points on the modified Rankin scale). Results: A total of 728 patients were included. Primary outcome analysis showed VO+ (β: –0.03, SE : 0.009, p = 0.002), lower presentation National Institutes of Health Stroke Scale (NIHSS; β: 0.002, SE : 0.001, p = 0.002), and decreased time from onset to admission imaging (β: –0.00002, SE : 0.00004, p < 0.001) were independently associated with reduced EPR. VO+ also predicted good functional outcomes (odds ratio (OR): 5.07, 95% CI: 2.839–9.039, p < 0.001), while controlling for presentation NIHSS, time from onset to imaging, general vessel reperfusion, baseline Alberta Stroke Program Early CT Score, infarct core volume, EPR, and favorable arterial collaterals. Conclusions: Favorable VO profiles were associated with slower infarct edema progression and good long-term functional outcomes as well as better neurological status and ischemic brain alterations at admission. [ABSTRACT FROM AUTHOR]

Background and Objectives: The benefit of mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS) with basilar artery occlusion (BAO) and a baseline National Institute of Health Stroke Scale (NIHSS) score <10 is unclear because this subpopulation has been substantially excluded from large clinical trials. The aim of our study was to determine whether MT ± IV thrombolysis (IVT) improves functional outcomes compared with IVT alone in patients with BAO and a NIHSS score <10., Methods: We emulated a hypothetical trial including adult patients with BAO, a baseline NIHSS score <10, and prestroke modified Rankin scale (mRS) scores 0-2, comparing MT (±IVT) with IVT alone. We acquired data from patients receiving MT (±IVT) within 24 hours of onset from the Italian Registry of Endovascular Treatment in Acute Stroke and data from patients treated only with IVT within 9 hours of symptom onset from the SITS International Stroke Thrombolysis Register, from 2011 until 2021. We used inverse probability weighting (IPW) adjusted for prespecified covariates to weight each individual's contribution to the outcome. The primary outcome was 90-day mRS scores 0-2. Secondary outcomes included 90-day mRS scores 0-1, 90-day mRS scores 4-5, mortality at 90 days, in-hospital death, and symptomatic intracerebral hemorrhage., Results: Among the 764 patients recruited from the 2 databases (477 men [62.4%]; mean age [±SD] 67.88 [±13.9] years), 410 (53.7%) received MT±IVT and 354 (46.3%) only IVT. After applying IPW, our population was composed of 710 MT and 707 IVT patients. Of these, 454 MT-treated (63.9%) and 383 IVT-treated (54.2%) patients had a 90-day mRS score of 0-2 (adjusted odds ratio (aOR) 1.56 [95% CI 1.04-2.03]). MT was also associated with a higher rate of mRS scores 0-1 (aOR 2.01 [95% CI 1.37-2.95]) and a lower rate of in-hospital death (aOR 0.45 [95% CI 0.25-0.78]). Among the subgroups tested, MT had a larger effect on 90-day mRS scores 0-2 for patients with NIHSS scores 6-9 than for patients with a NIHSS score <6 ( p for interaction 0.02)., Discussion: In a large-scale target trial emulation on patients with stroke from BAO and a NIHSS score <10, MT was associated with better functional outcomes compared with IVT alone. Further research is needed to confirm the benefit of MT in patients with a NIHSS score <6., Classification of Evidence: This study provides Class III evidence that MT ± intravenous thrombolysis is associated with better 90-day functional outcomes in patients with BAO and a NIHSS score < 10 compared with intravenous thrombolysis alone.

Aim: To investigate the prognostic implication (mortality at 3 months) of acute kidney injury (AKI) in acute ischemic stroke treated with mechanical thrombectomy (MT)., Material and Methods: A literature search was performed using PubMed/OVID/Cochran's CENTRAL database (time frame: inception to January 2023). Study characteristics, patient status, clinical outcomes, AKI incidence, and sample size were recorded. The exclusion criteria were non-English literature, no human subjects, and <10 patients as the sample size. Studies were assessed using the MINORS/GRADE system. Meta-analysis and meta-regression with a random-effects model were performed., Results: 3314 studies were retrieved. After applying the exclusion criteria, the final population included of 18/3314 studies (0.5%). Among them, only 6/18 (33.3%) studies reported results in two separate groups (AKI vs non-AKI), allowing for inference statistics for a total population of 3229 (538.6 ± 403.7). The I^2 was 34.6 and Q's Cochrane was 7.80. The pooled odds ratio (OR) for mortality at 3 months in patients with AKI was 5.8 (95% confidence interval [95% CI] 95% CI 3.62 to 9.52). Leave-one-out meta-analysis showed no significant sources of heterogeneity. In the meta-regression, diabetes prevalence was associated with a higher mortality rate (OR 1.14, 95% CI 1.03 to 1.28), and lower age and a small amount of contrast media were negatively correlated (0.91 [95% CI 0.83 to 0.99] and OR 0.97 [95% CI 0.94 to 1.00], respectively)., Conclusion: AKI was significantly associated with the mortality rate in MT-treated stroke patients (OR 5.8 [95% CI 3.62 to 9.36])., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: Intravenous thrombolysis alone has poor recanalization rates in large vessel occlusion strokes. Bridging thrombolysis has evolved as a standard treatment approach in emergent large vessel occlusions. Patients who undergo thrombectomy have a higher probability of favorable outcomes irrespective of the use of prior intravenous thrombolysis. Our aim was to compare bridging thrombolysis with direct thrombectomy in ischemic stroke due to large vessel occlusion. Methods: We included patients from our stroke registry, with large vessel occlusion strokes, presenting <4.5 hr from onset. Bridging thrombolysis was the standard approach. Direct thrombectomy was done in patients with contraindications to intravenous thrombolysis. The primary outcome was the modified Rankin scale at 3 months. Secondary outcomes were National Institute of Health Stroke Scale at 24 hr post-procedure, door to puncture time, puncture to recanalization time, the extent of recanalization, and the number of passes required. Safety outcomes were any occurrence of intracranial hemorrhage or other complications related to procedure or death. Logistic regression analysis was used to find the factors affecting the outcome. Results: Total 76 patients were included, 29 underwent bridging thrombolysis and 47 underwent direct thrombectomy. A favorable outcome (mRS 0-2) was achieved in 19 (65.5%) patients in the bridging group and 25 (58.1%) patients in the direct group (P = 0.4, Chi-square test). There was no significant difference in any of the secondary outcomes as well. Symptomatic intracranial hemorrhage occurred in 2 (2.6%) patients and a total of 10 (13.9%) were dead at 3-month follow-up, comparable in both groups. Conclusion: Direct thrombectomy has comparable outcomes to bridging thrombolysis in emergent large vessel occlusions. [ABSTRACT FROM AUTHOR]

Large vessel occlusion stroke contributes to disability and mortality out of proportion to its incidence. Over time it was noted that intravenous thrombolysis alone was not sufficient for this stroke type. Slowly, endovascular approach and mechanical clot retrieval have come out to be the biggest advances in the field of neurology as well as modern medicine. Although the careful selection of patients is needed as standardized by landmark trials. At the same time, thrombectomy is now being studied in patients excluded by previous trials and is seemingly coming out be effective in the vast majority of patients with large vessel occlusions. Further, techniques and devices are getting refined day by day to achieve the maximum possible benefit. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To evaluate the safety and efficacy of mechanical thrombectomy associated with standard medical treatment compared with standard medical treatment only to treat patients with acute ischemic stroke. Methods This was a systematic review and metaanalysis of randomized controlled trials. An electronic search was performed in the following databases: MEDLINE ® /PubMed ® , Cochrane Library (Trials), LILACS/IBECS (via Biblioteca Virtual em Saúde (BVS)) and Embase. Complementary searches were also conducted. The selection of studies and data collection were done by two investigators independently. Results The final analysis included 16 publications related to 15 studies. The mechanical thrombectomy was associated to a reduction in the risk of death of all cause (16.81% versus 20.13%; relative risk of 0.85; p=0.04), improvement in the number of patients with functional independence after 90 days (45.65% versus 27.45%; relative risk of 1.65; p

OBJECTIVE: To evaluate acute stroke care services in Sindh province of Pakistan. METHODS: This cross-sectional descriptive study, conducted from January to May 2024, assessed stroke care services in hospitals across Sindh, Pakistan. The study included hospitals that admitted more than one stroke patient per month and excluded facilities such as maternity homes and rehabilitation centers. Data were collected via structured proformas from hospital administrators through phone and email, focusing on stroke admissions, acute services, and rehabilitation capabilities. Informed consent was obtained, and ethical approval was granted by the Shifa International Hospital Ethical Committee. Data analysis utilized SPSS version 20 for continuous and categorical variables. RESULTS: Among the 34 surveyed hospitals, 15(44.1%) treated 1 to 10 stroke patients monthly, and 14 (41.2%) admitted over 300 patients annually. Neurologists were on staff in 15(44.1%) of hospitals, and 13 (38.2%) had stroke-trained physicians available 24/7. CT brain scans were accessible 24/7 in 23 (67.6%) of hospitals, with 19(55.9%) prioritizing these scans for stroke patients. Stroke units and 24/7 availability of intravenous tissue plasminogen activator (TPA) were available in 07 (20.6%) of hospitals only. Inpatient rehabilitation facilities were available in 21(61.8%) of hospitals, and 13 (38.2%) collaborated with external rehabilitation centers. Community stroke awareness programs were established in 12 (35.3%) of hospitals, and 09 (26.5%) had designed stroke prevention programs. CONCLUSION: The study highlights significant gaps in acute stroke care services in Sindh, Pakistan, emphasizing the need for improved access to thrombolytic therapy, specialized training, and community awareness programs. [ABSTRACT FROM AUTHOR]

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The surgical treatment of occlusive acute mesenteric ischemia (AMI) without revascularization is associated with an 80% overall mortality. Early diagnosis is crucial, and revascularization may reduce overall mortality in AMI by up to 50%. A diagnosis of AMI requires a high index of clinical suspicion and the collaborative effort of emergency department physicians, general and vascular surgeons, and radiologists. This article provides an overview of the etiology, physiology, evaluation, and management of acute mesenteric ischemia. [ABSTRACT FROM AUTHOR]

Background and purposeThe advent of intra-arterial neurothrombectomy (IAT) for acute ischemic stroke opens a potentially transformative opportunity to improve neuroprotection studies. Combining a putative neuroprotectant with recanalization could produce more powerful trials but could introduce heterogeneity and adverse event possibilities. We sought to demonstrate feasibility of IAT in neuroprotectant trials by defining IAT selection criteria for an ongoing neuroprotectant clinical trial.MethodsThe study drug, 3K3A-APC, is a pleiotropic cytoprotectant and may reduce thrombolysis-associated hemorrhage. The NeuroNEXT trial NN104 (RHAPSODY) is designed to establish a maximally tolerated dose of 3K3A-APC. Each trial site provided their IAT selection criteria. An expert panel reviewed site criteria and published evidence. Finally, the trial leadership designed IAT selection criteria.ResultsDerived selection criteria reflected consistency among the sites and comparability to published IAT trials. A protocol amendment allowing IAT (and relaxed age, National Institutes of Health Stroke Scale, and time limits) in the RHAPSODY trial was implemented on June 15, 2015. Recruitment before and after the amendment improved from 8 enrolled patients (601 screened, 1.3%) to 51 patients (821 screened, 6.2%; odds ratio [95% confidence limit] of 4.9 [2.3-10.4]; P

Background and purposeIn acute arterial occlusion, fluid-attenuated inversion recovery vascular hyperintensity (FVH) has been linked to slow flow in leptomeningeal collaterals and cerebral hypoperfusion, but the impact on clinical outcome is still controversial. In this study, we aimed to investigate the association between FVH topography or FVH-Alberta Stroke Program Early CT Score (ASPECTS) pattern and outcome in acute M1-middle cerebral artery occlusion patients with endovascular treatment.MethodsWe included acute M1-middle cerebral artery occlusion patients treated with endovascular therapy (ET). All patients had diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery before ET. Distal FVH-ASPECTS was evaluated according to distal middle cerebral artery-ASPECT area (M1-M6) and acute DWI lesion was also reviewed. The presence of FVH inside and outside DWI-positive lesions was separately analyzed. Clinical outcome after ET was analyzed with respect to different distal FVH-ASPECTS topography.ResultsAmong 101 patients who met inclusion criteria for the study, mean age was 66.2±17.8 years and median National Institutes of Health Stroke Scale was 17.0 (interquartile range, 12.0-21.0). FVH-ASPECTS measured outside of the DWI lesion was significantly higher in patients with good outcome (modified Rankin Scale [mRS] score of 0-2; 8.0 versus 4.0, P

PURPOSE: We aimed to evaluate the safety and effectiveness of a novel catheter-based mechanical thrombectomy device, XCOILTM, as a first line therapy to restore patency of thrombosed dialysis grafts and fistulae. METHODS: In 2010, 18 consecutive/sequential patients (11 male, 7 female; median age, 52 years; age range, 32-69 years) with occluded arteriovenous grafts (n=15) or fistulae (n=3) were treated with XCOILTM (NexGen Medical Systems Inc.) without adjunctive thrombolytic drugs. XCOILTM was advanced distal to the thrombus within the outflow vein as well as distal to the arterial inflow platelet thrombin plug, using a 4F angiographic catheter. The percentage of thrombus cleared, primary patency, procedure time, and XCOILTM performance were documented. RESULTS: Thrombosis occurred 1-30 days prior to the procedure. Thrombosed segments of graft/fistula measured 10-50 cm. Pre- and postprocedure angiography demonstrated that in 15 of 18 cases (83%) XCOILTM removed 80%-100% of the venous outflow thrombus. In 11 of 14 cases (79%), the platelet thrombin plug was also removed. Thrombectomy procedure time averaged 8 min, with one to three passes with the XCOILTM required. No evidence of distal embolization or graft/vessel injury was found on angiography following clot removal. In four cases in whom patency was not restored with XCOILTM, subsequent use of other clot removal devices also failed to restore patency. In one case with severe venous stenosis, the device failed to deploy and the thrombus was not captured. No intraprocedural complications related to XCOILTM use occurred. CONCLUSION: XCOILTM is an effective and safe first-line therapy option for the treatment of thrombosed hemodialysis grafts/fistulae. Rapid removal of intact thrombus and platelet thrombin plug can be achieved without adjunctive thrombolytics.

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To evaluate the safety and efficacy of mechanical thrombectomy associated with standard medical treatment compared with standard medical treatment only to treat patients with acute ischemic stroke. Methods: This was a systematic review and metaanalysis of randomized controlled trials. An electronic search was performed in the following databases: MEDLINE®/PubMed®, Cochrane Library (Trials), LILACS/IBECS (via Biblioteca Virtual em Saúde (BVS)) and Embase. Complementary searches were also conducted. The selection of studies and data collection were done by two investigators independently. Results: The final analysis included 16 publications related to 15 studies. The mechanical thrombectomy was associated to a reduction in the risk of death of all cause (16.81% versus 20.13%; relative risk of 0.85; p=0.04), improvement in the number of patients with functional independence after 90 days (45.65% versus 27.45%; relative risk of 1.65; p<0.01), and improvement in the rate of revascularization (76.2% versus 33.85%; relative risk of 2.20; p<0.01). There was no significant difference in terms of symptomatic intracranial hemorrhage (4.78% versus 3.88%; relative risk of 1.27; p=0.21). Conclusion: Mechanical thrombectomy associated with standard medical treatment seem to be safe and effective to treat patients with acute ischemic stroke compared with standard medical treatment only. [ABSTRACT FROM AUTHOR]

Deep vein thrombosis is relatively rare in the pediatric setting, though it carries significant risk for pulmonary embolism and post-thrombotic syndrome. We report a case of a 10-year-old girl diagnosed with pulmonary embolism and right iliofemoral vein deep vein thrombosis with concomitant granulomatosis with polyangiitis (formerly Wegener's granulomatosis) and acute glomerulonephritis. Owing to lifestyle-limiting venous claudication, we performed percutaneous, mechanical thrombectomy using the ClotTriever system with successful removal of likely both acute and chronic thrombus. After the procedure, the patient had near complete resolution of her venous claudication symptoms.

Purpose: To evaluate the safety and efficacy of additional aspiration thrombectomy (AT) or pharmacomechanical thrombectomy (PMT) after catheter-directed thrombolysis (CDT) for the treatment of acute iliofemoral deep vein thrombosis (AIFDVT). Materials and Methods : : Between May 2017 and December 2018, 40 patients with AIFDVT were enrolled. Twenty underwent AT after CDT (CDTAT), while the remaining 20 underwent PMT using an AngioJetTM device after CDT (CDTPMT). Thrombus clearance was assessed using computed tomography venography at 1 week after the procedure, as follows: grade I, ≤50%; grade II, 51% to 75%; grade III, >75%. Grade III was considered a successful outcome. Treatment outcomes (thrombus clearance, thrombolytic therapy duration, urokinase dose, major complications, residual filter thrombosis, and Villalta score) were compared between the groups. Results : : Successful thrombus clearance was achieved in 95% of the patients in both groups. Significant decreases in the thrombolytic therapy duration (P=0.018) and urokinase dose (P=0.014) were noted in the CDTPMT group. Major complications were not noted in both groups. Residual filter thrombi >10 mm were found in 6 filters in the CDTAT group and in 1 filter in the CDTPMT group (P=0.038). The Villalta scores at 6 months were 1.47±1.24 and 1.12±0.92 in the CDTAT and CDTPMT groups, respectively (P=0.372). Conclusion : : Both methods may be safe and effective management options for patients with AIFDVT. CDTPMT can reduce urokinase dosage, time and remained filter thrombus compared to CDTAT. Studies conducted in the future should compare the effects of overnight CDT followed by PMT with those of single-session PMT on patients with AIFDVT.

Acute ischemic stroke is one of the leading causes of disability and death around the world, especially in developed countries. Since the introduction of the 2nd generation devices, endovascular treatment of acute ischemic stroke has rapidly developed and is now considered to be a standard treatment. Here, we summarize the results of recent randomized clinical trials that have compared endovascular thrombectomy with conventional treatment for acute stroke and review the indications, current devices, and endovascular thrombectomy methods used.

Five randomized control clinical trials of N Engl J Med showed the efficacy of endovascular treatment (EVT) of acute ischemic stroke with large vessel occlusion (AIS ⁃ LVO) of anterior circulation. The "spring" of mechanical thrombectomy is coming. The international guideline changed and the treatment of AIS ⁃ LVO have been entering a new era. Mechanical thrombectomy became the one of milestones in the treatment of ischemic cerebrovascular events. The year of 2020 is the five years' anniversary since the "spring" of thrombectomy. What have we learned and where are we heading? To mark this anniversary year, this review takes you through the evolution of EVT from its tough beginnings to a way through the dark. DOI：10.3969/j.issn.1672⁃6731.2020.05.002

ABSTRACT Background: Stroke is a public health problem. For patients with ischemic stroke, venous thrombolysis and mechanical thrombectomy are effective therapeutic options. However, even after the National Stroke Treatment Guidelines were published in 2012, the number of cases treated is still lower than expected. Objective: To identify the determining factors for obtaining access to acute-phase therapies in the state of Espírito Santo (ES) and investigate the profile of stroke patients treated at the Central State Hospital (HEC). Methods: Retrospective data from the medical records of 1078 patients from May 2018 to December 2019 were analyzed. Results: Among the 1,078 patients, 54.9% were men and the most prevalent age group was 60 to 79 years. Systemic arterial hypertension was the main single risk factor. Regarding treatment modality among the patients who arrived at the HEC within the therapeutic window, 47% received some type of acute-phase therapy. Waking up with the deficit was the main contraindication for venous thrombolysis in these cases. Conclusions: Application of the flowchart established by SESA-ES seemed to be effective for enabling responsiveness of care for stroke victims. Public emergency transport services had a fundamental role in this process. In addition, the care provided by the tertiary stroke center provided excellent access to acute-phase therapies. However, despite the efficiency of the service provided at the HEC, it only reached a maximum of 50% of the ES population. This service model therefore needs to be expanded throughout the state.

Introduction: Since the publication of endovascular treatment trials and European Stroke Guidelines, Portugal has re-organized stroke healthcare. The nine centers performing endovascular treatment are not equally distributed within the country, which may lead to differential access to endovascular treatment. Our main aim was to perform a descriptive analysis of the main treatment metrics regarding endovascular treatment in mainland Portugal and its administrative districts. Material and Methods: A retrospective national multicentric cohort study was conducted, including all ischemic stroke patients treated with endovascular treatment in mainland Portugal over two years (July 2015 to June 2017). All endovascular treatment centers contributed to an anonymized database. Demographic, stroke-related and procedure-related variables were collected. Crude endovascular treatment rates were calculated per 100 000 inhabitants for mainland Portugal, and each district and endovascular treatment standardized ratios (indirect age-sex standardization) were also calculated. Patient time metrics were computed as the median time between stroke onset, first-door, and puncture. Results: A total of 1625 endovascular treatment procedures were registered. The endovascular treatment rate was 8.27/100 000 inhabitants/year. We found regional heterogeneity in endovascular treatment rates (1.58 to 16.53/100 000/year), with higher rates in districts closer to endovascular treatment centers. When analyzed by district, the median time from stroke onset to puncture ranged from 212 to 432 minutes, reflecting regional heterogeneity. Conclusion: The overall national rate of EVT in the first two years after the organization of EVT-capable centers is one of the highest among European countries, however, significant regional disparities were documented. Moreover, stroke-onset-to-first-door times and in-hospital procedural times in the EVT centers were comparable to those reported in the randomized controlled trials performed in high-volume tertiary hospitals.

Background: While mechanical thrombectomy is considered standard of care for large vessel occlusions, scientific evidence to support treatment for distal and medium vessel occlusions remains scarce., Purpose: To evaluate feasibility, safety, and outcomes in patients with low National Institute of Health Stroke Scale scores undergoing mechanical thrombectomy for treatment of distal medium vessel occlusions., Materials and Methods: Retrospective data review and analysis of prospectively maintained databases at 41 academic centers in North America, Asia, and Europe between January 2017 and January 2022. Characteristics and outcomes were compared between groups with low stroke scale score (≤ 6) versus and higher stroke scale scores (> 6). Propensity score matching using the optimal pair matching method and 1:1 ratio was performed., Results: Data were collected on a total of 1068 patients. After propensity score matching, there were a total of 676 patients included in the final analysis, with 338 patients in each group. High successful reperfusion rates were seen in both groups, 90.2% in ≤ 6 and 88.7% in the > 6 stroke scale groups. The frequency of excellent and good functional outcome was seen more common in low versus higher stroke scale score patients (64.5% and 81.1% versus 39.3% and 58.6%, respectively). The 90-day mortality rate observed in the ≤ 6 stroke scale group was 5.3% versus 13.3% in the > 6 stroke scale group., Conclusion: Mechanical thrombectomy in distal and medium vessel occlusions, specifically in patients with low stroke scale scores is feasible, though it may not necessarily improve outcomes over IVT., (© 2024. Springer-Verlag GmbH Germany, part of Springer Nature.)

Acute thrombosis and its complications are leading global causes of disability and death. Existing thrombolytic drugs, such as alteplase and urokinase (UK), carry a significant bleeding risk during clinical treatments. Thus, the development of a novel thrombolysis strategy is of utmost urgency. Based on the previous work, the hollow structure of microcapsules (MC) is fabricated. Subsequently, armor-piercing MC, known as Fucoidan/S-Nitrosoglutathione/Melanin@MC (FGM@MC) is obtained, using a layer-by-layer (LBL) self-assembly method. Utilizing near-infrared (NIR) light as a trigger, the FGM@MC demonstrated photothermal thrombolysis at the site of thrombus due to its stable and outstanding photothermal properties. Simultaneously, photothermal stimulation leads to the release of a significant amount of nitric oxide from the FGM@MC, resulting in cavitation effects for mechanical thrombolysis. In vivo experiments confirmed the stable release of nitric oxide under NIR light irradiation. Treatment of femoral vein thrombosis in rats revealed that the thrombolytic effectiveness of FGM@MC+NIR (53.71%) is comparable to that of UK (59.70%). Notably, FGM@MC does not interfere with the coagulation function of rats and exhibits a favorable safety profile. In conclusion, this study demonstrates that the drug-free armor-piercing microcapsule has significant potential in the treatment of thrombosis, offering a safe and effective alternative to traditional thrombolytic therapies., (© 2024 Wiley‐VCH GmbH.)

Objective: AngioJet rheolytic thrombectomy (ART) has been used as a catheter-based treatment for acute pulmonary embolism (PE). In this study, based on our 7-year experience with ART in patients with PE, we evaluated the efficacy and safety outcomes of ART. Methods: Our study is based on retrospective evaluation of 56 patients with high- and intermediate-high-risk PE, with an average age of 62 years [interquartile range (IQR) 50-73 years] who underwent ART. Results: High and intermediate-high risks were noted in 21.4% and 78.6% of the patients, respectively. The ART duration was 304 (IQR: 246-468) seconds. Measures of obstruction, right to left ventricle diameter ratio, right to left atrial diameter ratio, and pulmonary arterial pressures were improved (p<0.001 for all). During the hospital stay, acute renal failure, major and minor bleeding, and mortality rates were 37.5%, 7.1%, 12.5%, and 8.9%, respectively. Aging related to post-procedural nephropathy while high-risk status was associated with in-hospital mortality (p=0.006) and long-term mortality. Conclusion: ART resulted in significant and clinically relevant improvements in the pulmonary arterial thrombotic burden, right ventricle strain, and hemodynamics in patients with PE at high and intermediate-high risk. Aging increased the risk of post-procedural nephropathy, whereas baseline high-risk status predicted in-hospital and long-term mortality. [ABSTRACT FROM AUTHOR]

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BackgroundCollaterals may affect revascularization, ischemic severity, and clinical outcomes in acute stroke owing to internal carotid artery (ICA) occlusion.ObjectiveTo examine the hypothesis that morphology of occlusive thrombus and collateral flow patterns may influence the outcome of ICA occlusions after mechanical thrombectomy.MethodsPooled analyses of ICA occlusions in the MERCI and Multi-MERCI trials employed central angiography review readings to categorize lesions as I, L, or T clots and functional lesions based on collateral flow patterns. Demographic variables, procedural details, and clinical outcomes were compared across ICA lesion types.ResultsA total of 72 subjects (mean age 67 years (SD 16), 51% female, median National Institutes of Health Stroke Scale 20 (range 8-35)) were included, with 90-day modified Rankin score ≤2 in 28% and 51% mortality. Clots were categorized as an I lesion in 9/72 (12.5%), L lesion in 12/72 (16.7%), and T lesion in 51/72 (70.8%). Based on collateral flow patterns, cases were categorized as having a functional I lesion in 7/72 (9.7%), functional L in 38/72 (52.8%), and functional T in only 27/72 (37.5%). Multivariate analyses showed that a functional T lesion, with insufficient collateral flow to ipsilateral anterior cerebral arteries via the contralateral ICA, was a strong predictor of both revascularization success and subsequent clinical outcomes.ConclusionsCollateral flow patterns distinguish the nature and impact of ICA occlusions on expected revascularization and subsequent clinical outcomes in acute ischemic stroke. The nomenclature of terminal ICA occlusions introduced here (carotid I's, L's, and T's) may enhance future endovascular trials targeting such proximal occlusions.Trial registration numberNCT00318071 (http://clinicaltrials.gov). MERCI was not registered because enrollment began before July 1, 2005.