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Objective: The role of endovascular mechanical thrombectomy (MT) in patients presenting with "minor" stroke is uncertain. We aimed to compare outcomes after MT for ischemic stroke patients presenting with National Institutes of Health Stroke Scale (NIHSS) 5 and - within the low NIHSS cohort - identify predictors of a favorable outcome, mortality, and symptomatic intracranial hemorrhage (ICH)., Methods: We retrospectively analyzed a prospectively maintained, international, multicenter database., Results: The study cohort comprised a total of 7568 patients from 29 centers. NIHSS was low (<5) in 604 patients (8%), and > 5 in 6964 (92%). Patients with low NIHSS were younger (67 + 14.8 versus 69.6 + 14.7 years, p < 0.001), more likely to have diabetes (31.5% versus 26.9%, p = 0.016), and less likely to have atrial fibrillation (26.6% versus 37.6%, p < 0.001) compared to those with higher NIHSS. Radiographic outcomes (TICI > 2B 84.6% and 84.3%, p = 0.412) and complication rates (8.1% and 7.2%, p = 0.463) were similar between the low and high NIHSS groups, respectively. Clinical outcomes at every follow up interval, including NIHSS at 24 h and discharge, and mRS at discharge and 90 days, were better in the low NIHSS group, however patients in the low NIHSS group experienced a relative decline in NIHSS from admit to discharge. Mortality was lower in the low NIHSS group (10.4% versus 24.5%, p < 0.001)., Conclusions: Relative to patients with high NIHSS, MT is safe and effective for stroke patients with low NIHSS, and it is reasonable to offer it to appropriately selected patients presenting with minor stroke symptoms. Our findings justify efforts towards a randomized trial comparing MT versus medical management for patients with low NIHSS., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Aneurysms of the posterior inferior cerebellar artery (PICA) are rare, comprising 0.5% to 3% of intracranial aneurysms. Because their anatomic location relative to the PICA origin is variable, several endovascular techniques are used in their management., Objective: To evaluate and discuss endovascular techniques for the treatment of PICA aneurysms., Methods: We analyzed our prospectively maintained database to identify PICA aneurysms treated over a 12-year period from 1999 to 2011., Results: Twenty patients were assessed angiographically for endovascular treatment. Treatment was successfully performed in 17, but 3 were deemed unsuitable and were referred for surgery. Patients ranged in age from 15 to 82 years (mean, 60.5); 85% (17/20) were women. Thirteen (65%) presented with subarachnoid hemorrhage, and 3 (15%) had been previously treated surgically. Although the aneurysms were located at the PICA origin in 13 (65%), their involvement with the PICA and vertebral artery was variable. Some arose distinctly from the origin, and others incorporated the PICA itself. Five patients were treated for distal PICA aneurysms. Treatment techniques included direct coiling, vertebral artery balloon remodeling with coiling, PICA balloon remodeling with coiling, and parent vessel sacrifice of PICA with either coiling or glue embolization. Complete occlusion was initially achieved in 11 of 17 patients. Of the 6 remaining patients, 3 improved to complete occlusion at follow-up, 2 underwent re-treatment, and 1 remained stable. No patient experienced posttreatment hemorrhage., Conclusion: A variety of endovascular techniques are required for the management of PICA aneurysms. Specific techniques vary according to the location of the aneurysm in relation to the PICA origin, distal course of the artery, and the vertebral artery., Abbreviations: BRAT, Barrow Ruptured Aneurysm TrialmRS, modified Rankin scorenBCA, n-butyl cyanoacrylatePICA, posterior inferior cerebellar arterySAH, subarachnoid hemorrhageVA, vertebral artery.