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Background: Evidence from randomized controlled trials has shown a benefit for endovascular treatment in basilar artery occlusion. We aimed to show the effect of the recanalization result on outcome and determine the role of underlying basilar stenosis in a real-world setting. Methods: A retrospective, single-center study of patients who received endovascular treatment for basilar artery occlusion from March 2008 to June 2022 was conducted. Clinical and outcome characteristics were gathered. Multivariate logistic regression analysis was performed to predict poor outcomes (post-treatment mRS 5 or 6). MRS shift analysis was performed. Results: This study includes 210 patients (mean age, 71.4 years +/− 13.3 [standard deviation]; 124 men). The variables age (OR, 1.04; 95% CI: 1.01–1.08; p = 0.014), underlying basilar stenosis (OR: 4.86; 95% CI: 2.15–10.98; p < 0.001), admission NHISS (OR: 1.09; 95% CI: 1.04–1.13; p < 0.001), and TICI (OR: 1.89; 95% CI: 1.09–3.25; p = 0.022) independently predicted a poor outcome. Patients with occlusions due to underlying stenosis had significantly worse recanalization rates. Median post-treatment mRS in all patients with embolic occlusion was 4; IQR, 2–5 (only patients with embolic occlusion: mTICI 0-2a, median: 5 [IQR, 4–5.5]; mTICI 2b, median: 4 [IQR, 2.5–6]; mTICI 3, median: 3 [IQR, 1–5]; p = 0.037). Median post-treatment mRS in all patients with occlusions due to underlying stenosis was 5; IQR, 4–6 (only patients with embolic occlusions: mTICI 0-2a, median: 6 [IQR, 4.5–6]; mTICI 2b, median: 6 [IQR, 4.25–6]; mTICI 3, median: 5 [IQR, 3.5–5.25]; p = 0.059). Conclusions: Successful recanalization is essential for preventing poor outcomes in basilar artery occlusion. Underlying basilar stenosis diminishes the effect of successful recanalization on the overall outcome. [ABSTRACT FROM AUTHOR]

Background: Evidence from randomized controlled trials has shown a benefit for endovascular treatment in basilar artery occlusion. We aimed to show the effect of the recanalization result on outcome and determine the role of underlying basilar stenosis in a real-world setting. Methods: A retrospective, single-center study of patients who received endovascular treatment for basilar artery occlusion from March 2008 to June 2022 was conducted. Clinical and outcome characteristics were gathered. Multivariate logistic regression analysis was performed to predict poor outcomes (post-treatment mRS 5 or 6). MRS shift analysis was performed. Results: This study includes 210 patients (mean age, 71.4 years +/− 13.3 [standard deviation]; 124 men). The variables age (OR, 1.04; 95% CI: 1.01–1.08; p = 0.014), underlying basilar stenosis (OR: 4.86; 95% CI: 2.15–10.98; p < 0.001), admission NHISS (OR: 1.09; 95% CI: 1.04–1.13; p < 0.001), and TICI (OR: 1.89; 95% CI: 1.09–3.25; p = 0.022) independently predicted a poor outcome. Patients with occlusions due to underlying stenosis had significantly worse recanalization rates. Median post-treatment mRS in all patients with embolic occlusion was 4; IQR, 2–5 (only patients with embolic occlusion: mTICI 0-2a, median: 5 [IQR, 4–5.5]; mTICI 2b, median: 4 [IQR, 2.5–6]; mTICI 3, median: 3 [IQR, 1–5]; p = 0.037). Median post-treatment mRS in all patients with occlusions due to underlying stenosis was 5; IQR, 4–6 (only patients with embolic occlusions: mTICI 0-2a, median: 6 [IQR, 4.5–6]; mTICI 2b, median: 6 [IQR, 4.25–6]; mTICI 3, median: 5 [IQR, 3.5–5.25]; p = 0.059). Conclusions: Successful recanalization is essential for preventing poor outcomes in basilar artery occlusion. Underlying basilar stenosis diminishes the effect of successful recanalization on the overall outcome.

To report our initial experience with the novel low-profile APERIO Hybrid17 Thrombectomy Device (AP17) for proximal and distal vessel occlusions in acute ischemic stroke. A multicentric retrospective analysis of patients treated with the AP17 was performed. The primary effectiveness endpoint was first-pass TICI ≥2b (Thrombolysis in cerebral infarction scale). The primary safety endpoint was the occurrence of hemorrhagic complications. Further outcome measures were number of passes, device-related complications, and 3-month functional outcome. The AP17 was used in 71 patients (mean age: 73 years) with a median baseline National Institutes of Health Stroke Scale score of 9. Treated vessels were the carotid-T in 8 cases (11%), the M1-segment in 16 (23%), the M2-segment in 29 (41%), the anterior cerebral artery in 3 (4%), and basilar/posterior cerebral arteries in 15 (21%). The rates of first-pass and final TICI ≥2b were 75.6% and 92.7%, retrospectively, with a mean number of passes of 3 ± 2. Final TICI ≥2b rates were comparable between large and medium vessel occlusions. Symptomatic intracranial hemorrhages were recorded in 2 cases (2.8%). At 3-month clinical follow-up, a modified Rankin scale score ≤2 was achieved in 69.0% (29/42). The all-cause mortality at discharge was 17.4%. The AP17 was associated with a reasonable safety and efficacy profile for both proximal and distal vessel occlusions. These results may contribute to establish mechanical thrombectomy for distal occlusions. [ABSTRACT FROM AUTHOR]

Background: In patients with acute ischemic stroke with large vessel occlusion, various angiographic features are important in patient selection and predicting outcome. Objective: We evaluated angiographic features like collaterals, clot burden score, angiographic recanalization, number of passes, and intracranial atherosclerotic disease (ICAD) with the functional outcome at 90 days. Materials and Methods: This was a retrospective analysis of prospectively collected data of 163 patients with acute ischemic stroke with large vessel occlusion who underwent mechanical thrombectomy within 24 hours of symptom onset. Angiographic data were reviewed blinded to clinical data. The outcome was defined as modified Rankin scale (mRS) at 90 days (good outcome mRS ≤2) Results: The median age of patients was 60 years and 34.4% were females. The median National Institutes of Health Stroke Scale (NIHSS) and Alberta Stroke Programme Early CT Score (ASPECTS) at admission were 17 and 6, respectively. On bivariate analysis, ASPECTS was >6, clot burden score was ≥7, recanalization of TICI was ≥2b, absence of ICAD, showed a positive correlation with the good outcome at 90 days (P-values of 0.003, 0.0001, and 0.03, respectively). Multiple attempts of device passes were associated with poor recanalization (P = 0.001) and it was seen more in ICAD patients. On multivariate analysis, independent predictors of poor outcome were clot burden score <7 (P = 0.043) and TICI score <2b (P = 0.048). Out of 41 patients (26%) with ICAD, 29 had a poor outcome at 90 days. Conclusion: Lower clot burden and less degree of recanalization were associated with poor outcome in acute ischemic stroke due to Large vessel occlusion (LVO). The presence of ICAD also predicted poor outcome. [ABSTRACT FROM AUTHOR]

Introduction: Acute administration of alteplase with collateral patency has been systematically evaluated in acute ischemic stroke (AIS) patients. Large studies evaluating alteplase demonstrate a significant association of successful recanalization (TICI score) and good clinical outcome (mRS) with ASITN/SIR collateral grade greater than 2. However there is paucity of data looking at the association between IV tenecteplase (TNK) and acute collateralization. Our objective was to investigate early TNK use association for the degree of collateralization in subjects with AIS secondary to large vessel occlusion (LVO). Methods: Collateralization was assessed on digital subtraction angiography using the American Society of Intervention and Therapeutic Neuroradiology/Society of Interventional Radiology (ASTIN/SIR) scale. Grades were defined by the following: 0 no collaterals to ischemic region; 1 slow collaterals peripherally; 2 rapid collaterals peripherally; 3 slow collaterals within ischemic region; 4 complete retrograde perfusion to ischemic region. Subjects with LVO undergoing mechanical thrombectomy status post TNK as part of the pilot early clinical use of TNK within 4.5 hours of last known well were assigned a grade. Mean ASITN/SIR collateral grade was determined. Spearman’s rho was used to measure association of collateral grade with thrombolysis in cerebral infarction (TICI) score. Patients with TNK‐associated recanalization at time of cerebral angiogram were excluded from study. Social Science Statistics was used for data analysis. Results: From October 2020 to April 2021, 16 subjects (6 females; age, 63.25 95% CI [54.9207, 71.5793]) received TNK and underwent mechanical thrombectomy. From those subjects, 25 % (n = 4) had IV TNK‐associated recanalization with normalization of collateral blood flow and were excluded. Of the rest (n = 12, 75%) had a mean ASITN/SIR collateral grade of 1.08 (95% CI [0.5762, 1.5838]). Association between collateral grade and final TICI score was not statistically significant (rs = ‐0.33576, p = 0.28598) suggesting inability of TNK to result in/maintain a robust collateral flow. Conclusions: Poor correlation of collateral grade and final TICI score may have implications of faster progression in patients with ischemic stroke receiving TNK in the setting of LVO if immediate recanalization is not achieved. Larger prospective studies are needed to evaluate the effect of TNK on collateralization when compared to Alteplase.

Introduction: Mechanical thrombectomy (MT) has become the standard treatment of acute ischemic stroke (AIS) caused by large vessel occlusion (LVO), with different techniques used to achieve revascularization of the occluded vessel. However, early re‐occlusion of the target vessels could still take place in a considerable proportion of patients who already underwent MT for LVO. Therefore, we conducted this systematic review and individual participant data (IPD) meta‐analysis to provide more comprehensive evidence regarding the efficacy of repeat thrombectomy for recurrent LVO in early after successful first‐time MT. Methods: A computerized search on MEDLINE via PubMed, SCOPUS, Web of Science, EMBASE, and Cochrane library using the relevant keywords was performed. The retrieved references were screened, and the relevant data were extracted. STATA and SPSS were used to perform this IPD meta‐analysis. Results: Twenty studies were included, of which ten studies were observational studies (n = 21,251 patients) and 10 cases reports (n = 10 patients). Out of the included patients, 266 patients (62.78% females) were identified with recurrent LVO. The overall prevalence of recurrent LVO was 1.6%, 95% CI (1.0% to 2.8%), p

Introduction: Mechanical thrombectomy (MT) has become the current standard of care for large vessel occlusion stroke but is associated with an increased risk of intracranial hemorrhage (ICH). Although several studies have investigated the risk factors, there is still limited, not well‐established data. This study aims to evaluate the risk factors of HT after MT. Methods: We retrospectively reviewed all MT patients who were treated at a single comprehensive stroke center from 12/2016 to 7/2019. Variables included initial NIHSS, blood glucose, initial systolic blood pressure, age, gender, IV tPA, time from door to recanalization, and TICI score. Outcome measures were HT on post‐procedure or 24‐hour post‐tPA head CT/MRI as well as modified Rankin scale (mRS) upon discharge. Results: Among 74 patients (68.8 ± 14 years, men 47.3%), 9 (12.2%) experienced hemorrhagic transformation after thrombectomy. Average admitting NIHSS was significantly higher in the HT group (22 vs 16.8, p = 0.041). TICI 3 after MT was protective for HT (OR 0.078, 95% CI 0.009‐0.663). IV tPA (OR 3.86, 95% CI 1.448‐10.326) was associated with good neurological outcome at discharge (mRS < = 2), but HT was not (OR 0.114, 95% CI 0.013‐0.964). Patients with mRS < = 2 upon discharge were younger (65.2±12 vs 71.9±15, p = 0.04) and had lower initial BG (124±45.8 vs 157±69.6, P = 0.02). Conclusions: TICI 3 score, decreased NIHSS, and lower BG were associated with less HT and better outcomes in our MT cohort. Admitting NIHSS > = 20 may be a reasonable threshold to predict HT after MT. Our findings are consistent with the TICI‐ASPECTS‐glucose (TAG) score to predict sICH; however, we used initial NIHSS as a surrogate for ASPECTS. Further studies may utilize additional quantitative measures such as CTP data to predict HT.

The NeVa M1 thrombectomy device is a novel hybrid-cell stent retriever with multifunctional zones for optimized retrieval of resistant clots located in the M1 segment of the middle cerebral artery. The objective was to evaluate the safety and efficacy of the NeVa in a "real-life" setting. Twenty-nine consecutive patients (median age: 77 years) treated with the NeVa M1 for acute ischemic stroke of the M1 segement were retrospectively reviewed. First-pass and final modified thrombolysis in cerebral infarction (mTICI) scores, device-related complications, symptomatic intracranial hemorrhage, and 90-day modified Rankin scale (mRS) scores are reported. Primary outcome parameters were first-pass mTICI 2b-3 reperfusion and mRS 0–2 at 90 days. Median National Institutes of Health Stroke Scale scores decreased from 16 to 12 after treatment. mTICI 2b-3 reperfusion rates were 55% after the first pass, 79% after 1–2 passes, and 100% after the final pass. mTICI 2c-3 was obtained in 48% after the first pass, 62% after 1–2 passes, and 72% after the final pass. Rescue treatment was performed in 4 patients (14%). Device-related complications included 1 asymptomatic caroticocavernous fistula, 1 asymptomatic M2 dissection, and 1 symptomatic intracranial hemorrhage. The procedure-related vasospasm rate was 48%. A 90-day mRS of 0–2 was achieved by 31%. The NeVa M1 provides a high first-pass complete reperfusion rate with an adequate safety profile. To retrieve resistant clots, the stent design exerts high mechanical traction forces, which may trigger vasospasm and vessel wall damage. Large, comparative studies are warranted to draw a definite conclusion on this device. [ABSTRACT FROM AUTHOR]

Purpose: Extended thrombolysis in cerebral infarction (eTICI) score results of 2b or higher are known to be predictors for favorable outcome after acute stroke. Additionally, time is a major factor influencing outcome after ischemic stroke. Until today only little is known about the impact of time on angiographic results regarding the outcome after mechanical thrombectomy; however, this impact might be of interest if an initially unfavorable angiographic result has to be improved. Methods: Retrospective study of 164 patients with large vessel occlusion of the anterior circulation treated by mechanical thrombectomy. Multiple logistic regression analysis of relevant periprocedural and procedural times in respect to the probability of achieving functional independence at 90 days in respect to different eTICI results was performed to build a time and TICI score-dependent model for outcome prediction in which the influence of time was assumed to be steady among the TICI grades. Results: The probability of achieving a favorable outcome is significantly different between eTICI2b-50, 67, TICI2c and TICI3 results (p < 0.001). The odds for achieving a favorable outcome decrease over time and differ for each TICI category and time point. The individual odds for each patient, time point and TICI grade can be calculated based on this model. Conclusion: The impact of periprocedural and procedural times and eTICI reperfusion results adds a new dimension to the decision-making process in patients with primary unfavorable angiographic results. [ABSTRACT FROM AUTHOR]

Thrombectomy improves outcomes in patients with basilar artery (BA) occlusion. We hypothesized that the anatomic configuration of the BA bifurcation, classified as T- or Y-shaped, may impact the outcome as a T-shaped BA would involve more deep penetrating arteries of the midbrain and thalamus. In this 2-center retrospective cohort study, we included patients with stroke due to distal BA occlusion and performed blinded classification of their BA distal bifurcation as either T- or Y-shaped. The primary outcomes were favorable outcome at 90-days (modified Rankin Scale 0 – 2) and successful recanalization (TICI scores 2B or 3). 70 patients (mean age 66 years, 36% women) were included. 38 had T- and 32 had Y-shaped bifurcations. Baseline characteristics were similar for both groups, including demographics, onset to arterial puncture time, baseline NIHSS, THRIVE score, posterior circulation collateral score, and presence of tandem occlusion. Comparing the T- to the Y- shape, there was no difference in the likelihood of successful recanalization (RR: 1.02, CI: [0.86–1.21], p=1.00) nor 90-day favorable mRS (0-2) score (RR: 0.58, CI: [0.25–1.32]; p=0.18). Similarly, mortality at 30 and 90-days were not significantly affected by the type of bifurcation. The configuration of the basilar artery does not significantly impact on recanalization success or stroke outcome in our study. Further studies are needed to confirm our observations. [ABSTRACT FROM AUTHOR]

Background: Recent studies suggested that modified Thrombolysis in Cerebral Infarction grade (mTICI) 3 reperfusions are associated with superior outcome to mTICI2b reperfusions, questioning if neurointerventionalists should generally strive to achieve mTICI3.Methods: Retrospective analysis of successfully reperfused MCA occlusions (n=246) with available angiography runs between every manoeuvre was performed. Final reperfusion success and those between all single manoeuvres were evaluated applying the modified version of the TICI score (including TICI2c). Final TICI2c/3 reperfusions were dichotomized as 'direct' (reperfusion before final manoeuvre ≤mTICI2a) or 'secondary improved' (mTICI2b was achieved).Results: Patients with mTICI2c reperfusion had similar outcome to patients with mTICI3 rather than mTICI2b reperfusions. Compared with mTICI2c/3-patients, mTICI2b-patients had lower rates of neurological improvement (33.3% vs. 61.2%, p<0.001) and good functional outcome (28.7% vs. 46.5%, p=0.008). In 28 patients, mTICI2b reperfusion was improved to mTICI2c/3 without complications. Outcome of patients with 'direct' or 'secondary improved' mTICI2c/3 did not differ (p>0.5).Conclusion: Improving mTICI2b reperfusions to mTICI2c/3 reperfusions is sometimes technically feasible and safe, and associated with clinical benefit comparable to 'direct' mTICI2c/3 reperfusions. If confirmed, a more aggressive treatment approach in cases of already achieved mTICI2b may be justified, although proper patient selection is needed.Key Points: • Patients with mTICI2c or 3 reperfusions have a comparable clinical course. • mTICI2c/3 are associated with a larger therapeutic benefit than are mTICI2b reperfusions. • Improving reperfusion from mTICI2b to mTICI2c/3 is sometimes feasible and reasonably safe. • Outcome of patients with 'secondary improved' and 'direct' mTICI2c/3 is not different. [ABSTRACT FROM AUTHOR]

Collateral status may facilitate clot removal and affect rates of successful reperfusion following endovascular therapy (EVT) for acute ischemic stroke (AIS).Following the PRISMA guidelines, a systematic literature review of the English language literature was conducted using PubMed, Scopus, Web of Science, and Embase. Papers which focused on collateral status and patients treated with EVT for AIS were included in our analysis. Outcomes of interest included collateral score grading, rates of successful reperfusion defined as thrombolysis in cerebral infarction (TICI) score 2b-3 and onset to revascularization time. We calculated pooled odds ratio (OR) or mean difference (MD) and their corresponding 95% confidence intervals (CI) based on collateral status.16 studies, with 6073 patients, were included in our analysis. Among the included studies, there were six different collateral grading scales, which were dichotomized into “good to moderate” and “poor” collaterals. Odds of successful reperfusion were significantly higher among patients with good to moderate collateral circulation compared to those with poor collaterals (OR =  1.61; 95% CI = 1.24 to 2.09; P-value < 0.001); however, there was heterogeneity among included studies (I2 = 5 4%; P-value = 0.008). Onset to revascularization time was comparable between patients with good to moderate collateral circulation compared to those with poor collaterals (MD = 3.91 min; 95% CI = −8.71 to 16.53; P-value = 0.544); however, there was heterogeneity among included studies (I2= 60%; P-value = 0.014).The presence of good collaterals may increase the odds of achieving successful reperfusion following EVT for AIS. Improved collateral flow was associated with improved angiographic outcomes, although future work is needed to determine if a causal relationship exists. [ABSTRACT FROM AUTHOR]

Background A new generation of highly navigable large-bore aspiration catheters and retriever devices for intracranial mechanical thrombectomy has markedly improved recanalization rates, time and clinical outcomes. We report collected clinical data utilizing a new technique based on combined large lumen aspiration catheter and partially resheathed stent retriever (ARTS: Aspiration (catheter)–(stent) Retriever Technique for Stroke). This technique is applied, especially in presence of bulky/rubbery emboli, when resistance is felt while retracting the stent retriever; at that point the entire assembly is locked and removed in-toto under continuous aspiration with additional flow arrest. Methods A retrospective data analysis was performed to identify patients with large cerebral artery acute ischemic stroke treated with ARTS. The study was conducted between August 2013 and February 2015 at a single high volume stroke center. Procedural and clinical data were captured for analysis. Results Forty-two patients (median age 66 years) met inclusion criteria for this study. The ARTS was successful in achieving Thrombolysis in Cerebral Infarction (TICI) ≥2b revascularization in 97.6% of cases (TICI 2b = 18 patients, TICI 3 = 23 patients). Patients’ median National Institutes of Health Stroke Scale score at admission was 18 (6–40). A 3-month follow-up modified Rankin Scale value of 0–2 was achieved in 65.7% of the successfully treated patients (average 2.4). Two patients (4.8%) developed symptomatic intraparenchymal hemorrhages. Six procedure unrelated deaths were observed. Conclusions We found that ARTS is a fast, safe and effective method for endovascular recanalization of large vessel occlusions presenting within the context of acute ischemic stroke. [ABSTRACT FROM AUTHOR]

Introduction: The indication for mechanical thrombectomy for acute ischemic stroke (AIS) secondary to large vessel occlusion has substantially increased in the past few years, but predictors of symptomatic intracranial hemorrhage (sICH) remain largely unstudied. A recent study assessing these predictors, led to the development of the TICI-ASPECTS-glucose (TAG) score, an internally validated model to predict sICH following thrombectomy.Methods: To externally validate this scoring system and identify other potential risk factors for hemorrhagic conversion following endovascular therapy for AIS, 420 consecutive patients treated with mechanical thrombectomy from 2014-2017 were retrospectively reviewed. Data were collected pertaining to admission factors, procedural metrics, and functional outcomes. The components comprising the TAG score consist of modified thrombolysis in cerebral infarction (mTICI) score (mTICI 0-2a=2 points; 2b-3=0 points), Alberta stroke program early CT (ASPECTS) score (<6=4 points, 6-7=2 points, ≥8=0 points), and glucose (≥150 mg/dL=1 point, <150 mg/dL=0 points). Statistical analyses including univariate analysis, logistic regression analysis, and area under the receiver-operating curve (AUROC) were performed to validate the predictive capability of the model.Results: The patients with sICH presented with lower ASPECTS (8.13±1.55 v 9.16±1.24, p < 0.001), but no significant correlation with mTICI scores and admission glucose was observed. Decreasing ASPECTS correlated with increased risk of sICH (OR 1.57, 95% CI 1.25-1.96, p < 0.001), and increasing TAG score was associated with increased sICH (OR 1.46, 95% CI 1.11-1.94, p < 0.01). AUROC of the model was 0.633. Stratifying patients into low (TAG 0-2), intermediate,3,4 and high5-7 risk groups identified similar results to the original study with sICH risks of 5.2%, 10.5%, and 33.3%, respectively.Conclusion: The TICI-ASPECTS-glucose (TAG) score adequately predicts sICH following mechanical thrombectomy, and appropriately stratifies individual patient risk. Further inclusion of additional predictors of sICH would likely yield a more robust model. [ABSTRACT FROM AUTHOR]

Introduction: Diagnostic tools to show emboli reliably and protection techniques against embolization when employing stent retrievers are necessary to improve endovascular stroke therapy. The aim of the present study was to investigate iatrogenic emboli using susceptibility-weighted imaging (SWI) in an open series of patients who had been treated with stent retriever thrombectomy using emboli protection techniques. Methods: Patients with anterior circulation stroke examined with MRI before and after stent retriever thrombectomy were assessed for iatrogenic embolic events. Thrombectomy was performed in flow arrest and under aspiration using a balloon-mounted guiding catheter, a distal access catheter, or both. Results: In 13 of 57 patients (22.8 %) post-interventional SWI sequences detected 16 microemboli. Three of them were associated with small ischemic lesions on diffusion-weighted imaging (DWI). None of the microemboli were located in a new vascular territory, none showed clinical signs, and all 13 patients have been rated as Thrombolysis in Cerebral Infarction (TICI) 2b ( n = 3) or 3 ( n = 10). Retrospective reevaluation of the digital subtraction angiography (DSA) detected discrete flow stagnation nearby the iatrogenic microemboli in four patients with a positive persistent collateral sign in one. Conclusion: Our study demonstrates two things: First, SWI seems to be more sensitive to detect emboli than DWI and DSA and, second, proximal or distal protected stent retriever thrombectomy seems to prevent iatrogenic embolization into new vascular territories during retraction of the thrombus, but not downstream during mobilization of the thrombus. Both techniques should be investigated and refined further. [ABSTRACT FROM AUTHOR]

Abstract: Intravenous recombinant tissue plasminogen activator is associated with significant recanalisation failure in the setting of large artery occlusion. Endovascular treatment by stentriever achieves improved rates of recanalisation but its impact on clinical outcomes remains unclear. We hypothesise that successful recanalisation, unattentuated by age and stroke severity, is associated with improved clinical outcomes in patients treated with the Solitaire stentriever (ev3 Endovascular, Plymouth, MN, USA). We conducted a retrospective study of 60 consecutive acute ischaemic stroke patients treated with the Solitaire stentriever. The data included demographics, vascular risk factors, ictal onset time, National Institutes of Health Stroke Scale (NIHSS) score at presentation, angiographic findings, post-procedure imaging, and clinical follow-up. Recanalisation success was defined as a thrombolysis in cerebral infarction score (TICI)⩾2b. Good clinical outcome was defined as a modified Rankin Scale score (mRS)⩽2 at 3months. Of the 60 patients, the mean age was 64.1 (standard deviation 13.4) years and 68.3% were men. Median NIHSS score at presentation was 18 (interquartile range 14–22). Successful recanalisation (TICI⩾2b) was achieved in 44 patients (73.3%). Of these 44 patients, 25 patients (56.8%) achieved mRS⩽2 at 3months. Multiple logistic regression showed significant association between recanalisation success and improved clinical outcome (p =0.019). Of all patients, four (6.7%) developed symptomatic intracranial haemorrhage. Overall mortality was 28.3%. In conclusion, the Solitaire stentriever was associated with improved recanalisation rates. We showed that successful recanalisation is associated with good clinical outcomes after adjustments for age, sex and stroke severity. [Copyright &y& Elsevier]

Background Endovascular therapy is known to achieve a high rate of recanalization in patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) and is currently the standard of care. Hemorrhagic conversion is a severe complication that may occur following AIS in patients undergoing endovascular thrombectomy (EVT). There is a scarcity of data on the risk factors related to HV in post-EVT patients, especially those who develop symptomatic hemorrhagic conversion. The main objective of our study is to identify independent predictors of radiographic and symptomatic hemorrhagic conversion in our diverse patient population with multiple baseline comorbidities that presented with AIS and were treated with EVT as per the most updated guidelines and practices. Methodology This is a retrospective chart review in which we enrolled adult patients treated with EVT for AIS at a comprehensive stroke center in the Bronx, NY, over a four-year period. Bivariate analyses followed by multiple logistic regression modeling were performed to determine the independent predictors of all and symptomatic hemorrhagic conversion. Results A total of 326 patients who underwent EVT for AIS were enrolled. Of these, 74 (22.7%) had an HC, while 252 (77.3%) did not. In total, 25 out of the 74 (33.7%) patients were symptomatic. In the logistic regression model, a history of prior ischemic stroke (odds ratio (OR) = 2.197; 95% confidence interval (CI) = 1.062-4.545; p-value = 0.034), Alberta Stroke Program Early CT Score (ASPECTS) of <6 (OR = 2.207; 95% CI = 1.477-7.194; p-value = 0.019), and Thrombolysis in Cerebral Infarction (TICI) 2B-3 recanalization (OR = 2.551; 95% CI = 1.998-6.520; p-value=0.045) were found to be independent predictors of all types of hemorrhagic conversion. The only independent predictor of symptomatic hemorrhagic conversion on multiple logistic regression modeling was an elevated international normalized ratio (INR) (OR = 11.051; 95% CI = 1.866-65.440; p-value = 0.008). Conclusions History of prior ischemic stroke, low ASPECTS score, and TICI 2B-3 recanalization are independent predictors of hemorrhagic conversion while an elevated INR is the only independent predictor of symptomatic hemorrhagic conversion in post-thrombectomy patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Javed et al.)

Objective: The frequency incidence of decompressive hemicraniectomy following intra-arterial thrombectomy (IAT) in acute ischemic stroke (AIS) involving the middle cerebral artery (MCA) territory was assessed as a surrogate for morbidity., Methods: A single-institution retrospective chart review was conducted involving 209 consecutive patients between September 2014 and May 2017 with infarctions affecting the MCA territory and who subsequently underwent IAT. The outcomes of interest included the frequency of hemicraniectomy following IAT and the effects of intravenous tissue plasminogen activator (IV tPA) use and primary occlusion site on the Thrombolysis in Cerebral Infarction (TICI) score., Results: Thirty-one patients were excluded for infarctions not involving the MCA territory. A total of 178 patients were included in the study. Sixty-eight patients (38.6%) had infarctions of less than one-third of the MCA territory, 50 (28.4%) had infarctions between one-third and two-thirds, and 58 (33%) had infarctions involving greater than two-thirds with 54.3% suffering infarctions of the left side. Only four patients (2.2%) required a hemicraniectomy with no statistically significant association found between TICI score and hemicraniectomy (p=0.41) or between administration of IV tPA and hemicraniectomy (p=0.36). The primary occlusion site was found to influence TICI score (p=0.045)., Conclusion: A very small number of patients required hemicraniectomy after IAT as compared to previously published rates in the literature. However, several factors may prevent the patient from being an appropriate hemicraniectomy candidate in the first place and the small number of these patients in this study limits statistical analysis. The variables that determine a patient's candidacy for decompressive hemicraniectomy remains multi-factorial., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Salehani et al.)

Background and Purpose: Endovascular mechanical thrombectomy is emerging as a promising therapeutic approach for acute ischemic stroke. This study was aimed at identifying factors influencing outcomes after thrombectomy with a Solitaire stent device., Materials and Methods: Forty-five consecutive patients treated with thrombectomy using Solitaire FR were retrospectively included. Clinical, imaging and logistic variables were analyzed. A multivariate logistic regression analysis was used to identify variables influencing clinical outcome, based on discharge NIHSS score change and mRS at 3 months., Results: Patient mean age and initial NIHSS score was 58 years (range 24-88) and 17 (range 6-32), respectively. An MRI was performed for 80% of patients, showing severe DWI lesion for 28% of patients and associated FLAIR hyperintensity for 58% of patients. Mean time from symptom onset to recanalization was 299min for the 32 ACO and 473min for the 13 PCO. Angiographic efficacy (TICI 2b-3) was achieved for 93% of patients and good clinical outcomes at discharge and at 3 months (mRS≤2) were achieved for 49% and 58% of patients, respectively. Independent prognostic factors for predicting good clinical outcomes at discharge were a short time to recanalization and FLAIR negativity. At 3 months, they were a short time to recanalization and patient age. DWI lesion severity was an associated prognostic factor., Conclusion: Two main prognostic factors for predicting a good clinical outcome after thrombectomy at 3 months were short time from symptom onset to recanalization and patient age., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Purpose: To investigate the safety and efficacy of the self-expanding Solitaire stent used during intravenous thrombolysis (IVT) for intracranial arterial occlusion (IAO) in acute ischemic stroke (AIS)., Materials and Methods: Consecutive nonselected patients with AIS with IAO documented on computed tomographic angiography or magnetic resonance angiography and treated with IVT were included in this prospective study. Stent intervention was initiated and performed during administration of IVT without waiting for any clinical or radiologic signs of potential recanalization. Stroke severity was assessed by National Institutes of Health Stroke Scale (NIHSS), and 90-day clinical outcome was assessed by modified Rankin scale (mRS), with a good outcome defined as an mRS score of 0-2. Recanalization was rated by thrombolysis in cerebral infarction (TICI) scale., Results: Fifty patients (mean age, 66.8 y ± 14.6) had a baseline median NIHSS score of 18.0. Overall recanalization was achieved in 94% of patients, and complete recanalization (ie, TICI 3 flow) was achieved in 72% of patients. The mean time from stroke onset to maximal recanalization was 244.2 minutes ± 87.9, with a median of 232.5 minutes. The average number of device passes was 1.5, with a mean procedure time to maximal recanalization of 49.5 minutes ± 13.0. Symptomatic intracerebral hemorrhage occurred in 6% of patients. The median mRS score at 90 days was 1, and 60% of patients had a good outcome (ie, mRS score 0-2). The overall 3-month mortality rate was 14%., Conclusions: Combined revascularization with the Solitaire stent during IVT appears to be safe and effective in the treatment of acute IAO., (Copyright © 2013 SIR. Published by Elsevier Inc. All rights reserved.)

Purpose: To assess safety and efficacy of intraarterial mechanical thrombectomy for treatment of ischemic stroke in a community hospital by peripheral interventional radiologists employing computed tomography (CT) perfusion imaging for patient selection., Materials and Methods: Forty patients, 11 men (27.5%) and 29 women (72.5%), were treated between February 2008 and October 2011. Eligible patients had a National Institutes of Health Stroke Scale (NIHSS) score greater than 8 and diagnosis of large-vessel ischemic stroke by head CT angiogram, and met previously reported CT perfusion imaging triage criteria., Results: The baseline NIHSS score was 18.0 ± 7.9 (range, 8-35). Sixteen patients (40%) had a baseline NIHSS score greater than 20. Symptom onset was unknown in five patients. Symptom onset to device time in the remaining 35 patients was 254.8 minutes ± 150.9 (range, 75-775 min). A total of 65% of patients showed thrombolysis in cerebral infarction (TICI) 2a, 2b, or 3 flow following the procedure. Symptomatic intracranial hemorrhage was seen in four patients (10.0%). At 90 days, 32 patients (80%) were alive and eight (20%) had died. The modified Rankin scale (mRS) score at 90 days was no more than 2 in 20 patients (50.0%). The mean mRS score at 90 days was 2.9 ± 2.0 (range, 0-6). NIHSS score at 90 days was 5.1 ± 6.1 (range, 0-24). In patients with successful recanalization (ie, TICI 2 or 3 flow), a good clinical outcome (ie, mRS score ≤ 2) was achieved in 65.3% of patients (mean, 2.4 ± 1.9; range, 0-6), and 90-day mortality rate was 15.4%, compared with 28.6% in patients with TICI 0/1 flow., Conclusions: Peripheral interventional radiologists who use CT perfusion imaging for patient triage can have good neurologic outcomes and provide sustainable, safe, and complete around-the-clock coverage for endovascular stroke treatment., (Copyright © 2013. Published by Elsevier Inc.)