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Purpose To describe the efficacy and complications of treating cerebral aneurysms with the Flow re-direction endoluminal Device (FRED) and to identify predictors for aneurysm occlusion. Methods A prospective observational registry including all consecutive aneurysms treated with FreD between December 2015 and July 2018 was designed in one therapeutic neuroangiography department. The primary endpoint for treatment efficacy was complete or near-complete occlusion (O'Kelly--Marotta (OKM) C--D), assessed by three- dimensional digital subtraction angiography. Major (all symptomatics) and minor complications were described and those with modified rankin scale scores 3--6 were considered clinically relevant. Univariate and multivariate analyses were performed to identify predictors of efficacy. Results A total of 185 aneurysms were analyzed in 150 patients (mean age 54.3±11.5 years). Mean follow- up was 18.99±11.32 months (range 0--43). Efficacy was evaluated in 156 (84.32%) cases: 132 (84.6%) had OKM C--D occlusion, 31/47 (66%) within the first year and 101/109 (92.7%) later on. Major complications were observed in 12 (6.5%) cases: three strokes (one transient ischemic accident, two minor strokes), six intrastent thrombosis, and three with bleeding, but only one (0.5%) was clinically relevant. Minor complications (all asymptomatic) were observed in 10 (5.4%) cases: three shortening/repositioning of stent; two arterial dissection, two arterial occlusion, and three intra- stent stenosis. independent predictors of occlusion were immediate OKM grade B--C--D (Or 4.01, 95% CI 1.51 to 10.62), single aneurysm (Or 3.29, 95% CI 1.05 to 10.32), and small size aneurysm (Or 4.74, 95% CI 1.57 to 14.30). Conclusion The FRED stent fully complied with efficacy and safety requirements for treatment of intracranial aneurysms. Three predictors of aneurysm occlusion were identified. [ABSTRACT FROM AUTHOR]

Background and purpose Our aim was to revalidate the race scale, a prehospital tool that aims to identify patients with large vessel occlusion (lVO), after its region-wide implementation in catalonia, and to analyze geographical differences in access to endovascular treatment (EVT). Methods We used data from the prospective cicaT registry (stroke code catalan registry) that includes all stroke code activations. The race score evaluated by emergency medical services, time metrics, final diagnosis, presence of LVO, and type of revascularization treatment were registered. sensitivity, specificity, and area under the curve (AUC) for the race cut-off value ≥5 for identification of both LVO and eligibility for EVT were calculated. We compared the rate of EVT and time to EVT of patients transferred from referral centers compared with those directly presenting to comprehensive stroke centers (CSC). results The race scale was evaluated in the field in 1822 patients, showing a strong correlation with the subsequent in-hospital evaluation of the national institute of health stroke scale evaluated at hospital (r=0.74, P<0.001). a race score ≥5 detected lVO with a sensitivity 0.84 and specificity 0.60 (AUC 0.77). Patients with race ≥5 harbored a LVO and received EVT more frequently than race <5 patients (LVO 35% vs 6%; EVT 20% vs 6%; all P<0.001). Direct admission at a CSC was independently associated with higher odds of receiving EVT compared with admission at a referral center (Or 2.40; 95% CI 1.66 to 3.46), and symtoms onset to groin puncture was 133 min shorter. Conclusions This large validation study confirms race accuracy to identify stroke patients eligible for EVT, and provides evidence of geographical imbalances in the access to EVT to the detriment of patients located in remote areas. [ABSTRACT FROM AUTHOR]

Background Many guidelines recommend urgent intervention for patients with two or more transient ischaemic attacks (TIAs) within 7 days (multiple TIAs) to reduce the early risk of stroke. Objective To determine whether all patients with multiple TIAs have the same high early risk of stroke. Methods Between April 2008 and December 2009, we included 1255 consecutive patients with a TIA from 30 Spanish stroke centres (PROMAPA study). We prospectively recorded clinical characteristics. We also determined the short-term risk of stroke (at 7 and 90 days). Aetiology was categorised using the TOAST (Trial of Org 10172 in Acute Stroke Treatment) classification. Results Clinical variables and extracranial vascular imaging were available and assessed in 1137/1255 (90.6%) patients. 7-Day and 90-day stroke risk were 2.6% and 3.8%, respectively. Large-artery atherosclerosis (LAA) was confirmed in 190 (16.7%) patients. Multiple TIAs were seen in 274 (24.1%) patients. Duration <1 h (OR=2.97, 95% CI 2.20 to 4.01, p<0.001), LAA (OR=1.92, 95% CI 1.35 to 2.72, p<0.001) and motor weakness (OR=1.37, 95% CI 1.03 to 1.81, p=0.031) were independent predictors of multiple TIAs. The subsequent risk of stroke in these patients at 7 and 90 days was significantly higher than the risk after a single TIA (5.9% vs 1.5%, p<0.001 and 6.8% vs 3.0%, respectively). In the logistic regression model, among patients with multiple TIAs, no variables remained as independent predictors of stroke recurrence. Conclusions According to our results, multiple TIAs within 7 days are associated with a greater subsequent risk of stroke than after a single TIA. Nevertheless, we found no independent predictor of stroke recurrence among these patients. [ABSTRACT FROM AUTHOR]

Objective: To describe the severity and early neurological deterioration (END) in patients with symptomatic carotid stenosis and to analyse the influence of related factors. Methods: Observational cohort study of patients with ischaemic stroke, ipsilateral carotid stenosis and without evidence of cardiac sources of embolism prospectively recorded since January 2003 to January 2012. Initial severity was categorised as mild (NIH stroke scale (NIHSS) ≤7), moderate (NIHSS 8-14) or high (NIHSS >14). Logistic ordinal and regression analyses were performed for stroke severity and END risk. Results: Of 2332 ischaemic strokes attended, 338 patients were included. Stroke severity was mild in 254 (75.1%) cases, moderate in 53 (15.7%) and severe in 31 (9.2%). Adjusted ORs (95% CI) for stroke severity were: degree of carotid stenosis, 2.20 (1.55 to 3.11, p<0.001); intracranial disease, 1.93 (1.18 to 3.17, p=0.009); plasma glucose, 1.01 (1.003 to 1.02, p<0.001); and previous transient ischaemic attack (TIA), 0.37 (0.17 to 0.82, p=0.014). 78 patients (23.1%) had END. Multivariate analysis showed independent association between END and degree of carotid stenosis (OR 1.64, 1.14 to 2.34, p=0.007), previous TIA (OR 2.40, 1.25 to 4.57, p=0.008) and mean arterial pressure (OR 1.02, 1.01 to 1.04, p=0.003). Conclusions: Strokes due to large vessel disease in the carotid artery are in general of mild severity and have a high rate of END. The degree of stenosis has a clear association with higher severity and END risk. [ABSTRACT FROM AUTHOR]