Clinical Neurology and Neurosurgery最新文献

{"title":"Incidence and outcomes of unplanned escalation-of-care complications for patients with traumatic brain injury","authors":"Vikas N. Vattipally ,&nbsp;S. Farzad Maroufi ,&nbsp;Mazin Elshareif ,&nbsp;Patrick Kramer ,&nbsp;Jacob Jo ,&nbsp;Jose I. Suarez ,&nbsp;Joseph V. Sakran ,&nbsp;Elliott R. Haut ,&nbsp;Judy Huang ,&nbsp;Chetan Bettegowda ,&nbsp;Tej D. Azad","doi":"10.1016/j.clineuro.2026.109341","DOIUrl":"10.1016/j.clineuro.2026.109341","url":null,"abstract":"<div><h3>Introduction</h3><div>Traumatic brain injury (TBI) is a leading cause of morbidity and mortality, and unplanned escalation-of-care complications such as intubations, intensive care unit (ICU) transfers, and operating room (OR) visits may reflect both injury severity and gaps in triage. Although linked to adverse outcomes in general trauma populations, they remain poorly characterized in TBI. The objective of this study was to define the frequency, co-occurrence, and consequences of these unplanned complications.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of adults with blunt TBI in the ACS TQIP database (2017–2022). Exposures were unplanned ICU admission, intubation, and OR visit, examined individually and cumulatively. Outcomes included hospital length of stay (LOS), discharge disposition, and inpatient mortality. Descriptive analyses characterized complication frequency and overlap, spline models assessed risk across presenting Glasgow Coma Scale (GCS), and regression models evaluated associations with complication burden and mortality among surgically-managed patients.</div></div><div><h3>Results</h3><div>Among 132,984 patients (median age, 63 years), 3.5 % experienced at least one unplanned complication. Rates were higher among surgically-managed patients, and intubation with ICU transfer was the most common combination. The probability of unplanned complications followed a non-linear relationship with GCS, peaking in the moderate range (10−12) and consistently higher among surgical patients. Increasing complication burden was associated with longer LOS and lower rates of favorable discharge. In adjusted models, unplanned intubations strongly predicted mortality (OR 1.80; 95 % CI, 1.43–2.27), unplanned ICU transfers were associated with lower mortality (OR 0.57; 95 % CI, 0.42–0.76), and unplanned OR visits showed no significant association.</div></div><div><h3>Conclusions</h3><div>Unplanned escalation-of-care complications are uncommon but clinically meaningful in TBI, disproportionately affecting surgically-managed patients. These complications carry distinct prognostic significance, with intubation signaling high mortality risk, ICU transfer associated with lower risk, and higher complication burden linked to longer stays and poorer discharge outcomes. These unplanned complications represent reproducible indicators of acute instability and potential targets for improved triage and quality improvement.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"264 ","pages":"Article 109341"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146187642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of occluded-side M1 vessel diameter using pre-procedural magnetic resonance angiography","authors":"Takaaki Kitano,&nbsp;Hiroyuki Ikeda ,&nbsp;Hidenobu Hata,&nbsp;Natsuki Akaike,&nbsp;Mai Tanimura,&nbsp;Yasunori Yokochi,&nbsp;Takuya Osuki,&nbsp;Ryosuke Kaneko,&nbsp;Minami Uezato,&nbsp;Masanori Kinosada,&nbsp;Yoshitaka Kurosaki,&nbsp;Masaki Chin","doi":"10.1016/j.clineuro.2026.109345","DOIUrl":"10.1016/j.clineuro.2026.109345","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine whether the occluded-side M1 vessel diameter on post-procedural digital subtraction angiography (DSA) can be predicted from that on pre-procedural magnetic resonance angiography (MRA) and its usefulness for aspiration catheter selection.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 41 cases of M1 occlusion undergoing mechanical thrombectomy with successful recanalization and pre- and post-procedural MRA at our institution between January 2020 and December 2024. The relationship between the catheter-to-vessel ratio (CVR), calculated from aspiration catheter’s outer diameter and occluded-side M1 vessel diameter on pre-procedural MRA, and first-pass effect was assessed.</div></div><div><h3>Results</h3><div>The mean occluded-side M1 vessel diameter was 2.2 ± 0.3 mm on pre-procedural MRA and 2.4 ± 0.4 mm on post-procedural DSA; the latter showed a strong correlation with the former (r = 0.925, p &lt; 0.001), and the regression equation was as follows: occluded-side M1 vessel diameter on post-procedural DSA (mm) = 0.19 + 1.025 × occluded-side M1 vessel diameter on pre-procedural MRA (mm) (R² = 0.856). The occluded-side M1 vessel diameter on post-procedural DSA approximated from the mean occluded-side M1 vessel diameter on pre-procedural MRA was pre-procedural MRA measurement + 0.2 mm. First-pass effect was achieved in 66.7 % of cases with CVR ≥ 0.80 and in 25.0 % of cases with CVR &lt; 0.80 (p = 0.049).</div></div><div><h3>Conclusion</h3><div>When treating M1 occlusion, adding 0.2 mm to the occluded-side M1 vessel diameter on pre-procedural MRA measurement allows prediction of the actual M1 vessel diameter. Selecting an aspiration catheter with CVR ≥ 0.80 may help achieve first-pass effect.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"264 ","pages":"Article 109345"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146161890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuroimaging correlates of cognitive stages in Parkinson's disease: A multimodal MRI study","authors":"Hannah L. Combs ,&nbsp;Sarah R. Heilbronner ,&nbsp;Stephen R. McCauley ,&nbsp;Christof Karmonik ,&nbsp;Elizabeth Wilde ,&nbsp;Michele K. York","doi":"10.1016/j.clineuro.2026.109343","DOIUrl":"10.1016/j.clineuro.2026.109343","url":null,"abstract":"<div><h3>Objective</h3><div>Cognitive impairment in Parkinson’s disease (PD) ranges from mild executive deficits to dementia. This exploratory study aimed to characterize neuroanatomical correlates of cognitive subtypes to improve understanding of disease-related cognitive heterogeneity. Structural and diffusion-weighted MRI were used to examine preliminary patterns of brain–behavior relationships across PD cognitive stages.</div></div><div><h3>Methods</h3><div>38 patients with PD and 10 healthy controls underwent neuropsychological testing, structural MRI, and diffusion-weighted imaging (dMRI). Patients with PD were classified as cognitively intact (PDi), mild cognitive impairment (PD-MCI), or dementia (PDD) using Movement Disorder Society guidelines. Volumetric and dMRI analyses focused on hippocampal volume and white matter integrity in key tracts.</div></div><div><h3>Results</h3><div>Volumetric analyses revealed smaller hippocampi in PDD (Left M = 3.71 cm³, Right M = 3.69 cm³) compared to PD-MCI and PDi (<em>p</em> &lt; .03). Patients with PDD had significantly larger lateral ventricles (Left M = 21.17 cm³, <em>p</em> = .05). dMRI analyses showed reduced fractional anisotropy (FA) in the left posterior limb of the internal capsule (<em>p</em> = .002) and increased apparent diffusion coefficient (ADC) in the same region (<em>p</em> = .003). These findings reflect stage-related correlates of cognitive impairment rather than predictive markers of future decline. Cognitive domains correlated with FA and ADC values in the internal capsule and splenium.</div></div><div><h3>Conclusions</h3><div>Present findings revealed isolated regions of volume loss and white matter abnormalities in patients with PDD as compared to other cognitive subtypes. Hippocampal atrophy and white matter disruption were observed in patients with PDD and should be interpreted as correlates of advanced cognitive impairment rather than predictive biomarkers. Longitudinal studies are needed to determine whether these imaging features track or precede cognitive decline.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"264 ","pages":"Article 109343"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146161891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Baseline characteristics of patients recruited to the mannitol for cerebral oedema after acute intracerebral haemorrhage (MACE-ICH) trial","authors":"Kailash Krishnan ,&nbsp;Emma Grace ,&nbsp;Lisa Woodhouse ,&nbsp;Christine Roffe ,&nbsp;Jesse Dawson ,&nbsp;Timothy J. England ,&nbsp;David W. Hewson ,&nbsp;Rob A. Dineen ,&nbsp;Zhe Kang Law ,&nbsp;Stefan Pszczolkowski ,&nbsp;Keenan Wells ,&nbsp;Amanda Buck ,&nbsp;Jennifer Craig ,&nbsp;Diane Havard ,&nbsp;Mary J. Macleod ,&nbsp;David J. Werring ,&nbsp;Fergus N. Doubal ,&nbsp;Nikola Sprigg ,&nbsp;Philip M. Bath","doi":"10.1016/j.clineuro.2026.109342","DOIUrl":"10.1016/j.clineuro.2026.109342","url":null,"abstract":"<div><h3>Background</h3><div>Mannitol, an osmotic diuretic and free radical scavenger might decrease cerebral oedema after acute intracerebral haemorrhage.</div></div><div><h3>Aims</h3><div>The Mannitol for cerebral oedema after acute intracerebral haemorrhage trial is testing the feasibility of performing a phase II trial to define the optimal approach for a phase III trial of testing mannitol in patients with cerebral oedema or at risk of it to improve outcome.</div></div><div><h3>Methods</h3><div>MACE-ICH is a multicentre, prospective, randomised, open-label, blinded-endpoint outcome assessment trial. Participants presenting within 72 h of ictus were randomised to one of three groups: 1:1 g/kg 10 % single dose mannitol infusion at 10 ml/min, in addition to standard care; 1 g/kg 10 % mannitol at 10 ml/min followed by a second dose 1 g/kg repeated 24 h later (providing serum osmolality &lt;320 mOsm/Kg and sodium&lt;160 mmol/L), in addition to standard care or standard care alone. The trial was registered prospectively: ISRCTN15383301.</div></div><div><h3>Results</h3><div>46 (of planned 45) participants were recruited from 8 sites between February 2024-April 2025. Baseline characteristics: mean age 74.7 years (standard deviation 12.0); male 69 %; onset-to-randomisation 22.9 h; severity (National Institutes of Health Stroke Scale) 12.1 (8.3); blood pressure 155.3 (29.0)/78.9 (16.5) mmHg. Haematoma characteristics: lobar 58 %, mass effect 58.7 %, midline shift (34.8 %). The mean maximum haemorrhage diameter was 4.3 cm.</div></div><div><h3>Conclusion</h3><div>MACE-ICH successfully enroled patients with cerebral oedema after acute intracerebral haemorrhage to assess the feasibility and safety of intravenous mannitol. The trial is novel with a dose-comparative approach with assessment of single and repeated mannitol dosing regimens, addressing an important gap in clinical practice.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"264 ","pages":"Article 109342"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146161892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between bone mineral density and spondylolisthesis: A matched case-control study using DXA","authors":"Elif Dilara Topcuoglu ,&nbsp;Nursima Aydın ,&nbsp;Mihrimah Kan ,&nbsp;Burcu Narin ,&nbsp;Ahmet Nedim Kahraman ,&nbsp;Esin Derin Cicek","doi":"10.1016/j.clineuro.2026.109318","DOIUrl":"10.1016/j.clineuro.2026.109318","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the association between dual-energy X-ray absorptiometry (DXA) T-scores (lumbar spine, total femur and femoral neck) and the presence of spondylolisthesis (SL) in a matched case-control design.</div></div><div><h3>Materials and Methods</h3><div>Between January 2020 and November 2024, patients who underwent lumbar magnetic resonance imaging (MRI) and DXA in the same year were retrospectively reviewed. Patients with SL were identified and matched 1:1 with controls by age, sex, and body mass index category. Group differences were assessed using t-tests and logistic regression.</div></div><div><h3>Results</h3><div>Of 1573 lumbar MRI scans, 173 patients with SL (mean age 69.3 ± 9.9 years, 158 women) were matched with 173 controls. Osteoporosis and osteopenia were significantly more prevalent in the SL group (p &lt; 0.001 for both). Patients with SL had significantly lower lumbar spine (−0.85 ± 1.60 vs. −0.15 ± 1.68), femoral neck (−1.23 ± 1.08 vs. −0.84 ± 1.03), and total femur (−0.91 ± 1.16 vs. −0.40 ± 1.23) T-scores (all p &lt; 0.001). Multivariable logistic regression confirmed that lumbar spine T-scores were independently associated with SL (OR 0.76, 95 % CI 0.58–1.00, p = 0.047), with a stronger effect in women (OR 0.61, 95 % CI 0.45–0.82, p = 0.001). Obesity was associated with higher T-scores but did not protect against SL.</div></div><div><h3>Conclusion</h3><div>Reduced lumbar spine T-scores are independently associated with SL, particularly in postmenopausal women, indicating that lumbar bone mineral density may be clinically relevant in this population. These findings support consideration of DXA assessment as part of preoperative evaluation in patients with SL.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"263 ","pages":"Article 109318"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146017350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing combined effects of RAI, GNRI, and Anemia on morbidity and mortality in elderly patients after subdural hematoma evacuation","authors":"Shaila D. Ghanekar ,&nbsp;Paul Serrato ,&nbsp;Ethan D.L. Brown ,&nbsp;Sina Sadeghzadeh ,&nbsp;Apratim Maity ,&nbsp;Syed I. Khalid ,&nbsp;Michael DiLuna ,&nbsp;Aladine A. Elsamadicy","doi":"10.1016/j.clineuro.2026.109340","DOIUrl":"10.1016/j.clineuro.2026.109340","url":null,"abstract":"<div><h3>Background/Objectives</h3><div>This study aims to assess the composite impact of frailty, malnutrition, and anemia on postoperative outcomes for elderly subdural hemorrhage (SDH) patients.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was performed using the 2011–2023 NSQIP database. All patients <u>&gt;</u> 65 years who underwent SDH evacuation were identified using CPT and ICD codes. The study population was divided based on RAI-rev frailty status, with frail patients being further subdivided based on anemia and Geriatric Nutritional Risk Index (GNRI) nutritional status. Using receiver operating characteristic (ROC) and multivariable analyses, we compared the discriminative thresholds and independent associations of these health condition combinations with extended hospital length of stay (LOS), any 30-day adverse event (AE), non-routine discharge (NRD), and 30-day mortality.</div></div><div><h3>Results</h3><div>Of 3136 elderly SDH patients, 610 (19.5 %) were Frail Alone (F), 712 (22.7 %) were Frail + Anemic (FA), 464 (14.8 %) were Frail + Malnourished (FM), 1226 (39.1 %) were FA + Malnourished (FAM), and 124 (4.0 %) were Not Frail (NF). RAI-rev was a risk factor for extended LOS (<em>aOR: 1.03, 95 % CI: 1.01–1.06)</em>, AEs (<em>aOR: 1.04, 95 % CI: 1.02–1.06</em>), and mortality (<em>aOR: 1.05, 95 % CI: 1.03–1.08</em>). GNRI was a predictor of decreased odds of extended LOS (<em>aOR: 0.98, 95 % CI: 0.97–0.99</em>) and NRD (<em>aOR: 0.98, 95 % CI: 0.97–1.00</em>), whereas anemia only predicted AEs (<em>aOR: 1.58, 95 % CI: 1.27–1.96</em>). On ROC analysis, adding anemia and GNRI to RAI-rev was associated with statistically significant (<em>p = 0.034</em>) but modest improvements in discrimination for 30-day adverse events.</div></div><div><h3>Conclusion</h3><div>Our findings suggest that adding anemia and GNRI to RAI-rev is associated with a modest incremental improvement in discrimination for 30-day adverse events in elderly SDH patients.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"263 ","pages":"Article 109340"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146141319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delayed deformation of the Neuroform Atlas Stent during follow-up: Observational findings and clinical implications","authors":"Lee Hwangbo ,&nbsp;Jun Kyeung Ko","doi":"10.1016/j.clineuro.2026.109320","DOIUrl":"10.1016/j.clineuro.2026.109320","url":null,"abstract":"<div><h3>Objective</h3><div>The Neuroform Atlas Stent (NAS) has become one of the most widely used stents for stent-assisted coil embolization of wide-necked intracranial aneurysms, owing to its low-profile design, flexible deliverability, and compatibility with 0.017-inch microcatheters. However, data on its long-term durability are limited. The purpose of this study is to evaluate the incidence, angiographic features, and clinical significance of NAS deformation or crumpling that occurs during the follow-up period.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 174 patients with unruptured intracranial aneurysms who underwent NAS-assisted coiling from March 2018 to December 2024, all of whom had follow-up digital subtraction angiography. Stent deformation or crumpling was defined as a noticeable change in the position or spacing of the stent markers on unsubtracted images between the immediate post-procedural and follow-up examinations.</div></div><div><h3>Results</h3><div>Significant NAS deformation was observed in 7 of 174 patients (4.02 %). All aneurysms were located in the anterior circulation, with the most common site being the ophthalmic segment of the internal carotid artery. The mean aneurysm dome and neck sizes were 4.1 mm and 3.3 mm, respectively. Despite the marker changes, all aneurysms remained stable or showed progressive occlusion. In-stent stenosis of more than 30 % occurred in one patient. Antiplatelet response was adequate in almost all patients, with only one patient showing a high P2Y12 reaction unit value.</div></div><div><h3>Conclusion</h3><div>Stent deformation or crumpling of the NAS can occur as a rare, delayed finding. While this observational study found that this mechanical change did not compromise short-term aneurysm occlusion, its long-term clinical implications remain unclear. The thin profile of the NAS may contribute to a degree of vulnerability within the intracranial circulation until sufficient endothelialization is achieved. Long-term follow-up is necessary to clarify the clinical implications of this crumpling phenomenon.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"263 ","pages":"Article 109320"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146017338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of symptomatic intracranial hemorrhage after endovascular thrombectomy in acute ischemic stroke: A retrospective study","authors":"Wei Hong ,&nbsp;Xiaoyu Wang ,&nbsp;Shanshan Hu ,&nbsp;Yuzhu Ma ,&nbsp;Deju Yin","doi":"10.1016/j.clineuro.2026.109319","DOIUrl":"10.1016/j.clineuro.2026.109319","url":null,"abstract":"<div><h3>Background</h3><div>Intracranial hemorrhage (ICH) is a serious potential complication of stroke mechanical thrombectomy (MT). We evaluated the predictors of symptomatic ICH (sICH) after MT for patients with acute ischemic stroke (AIS).</div></div><div><h3>Methods</h3><div>This retrospective study analyzed 170 consecutive patients with anterior circulation large vessel occlusion (LVO) undergoing MT. Outcomes were stratified as no hemorrhagic transformation (HT), asymptomatic ICH (aICH) and sICH. RAPID-processed perfusion parameters included ischemic core volume (rCBF&lt;30 %), hypoperfusion volume (Tmax&gt;6 s), mismatch volume, and hypoperfusion intensity ratio (HIR). Multivariable logistic regression with backward stepwise selection identified independent sICH predictors from ten candidate variables spanning clinical, laboratory, imaging and procedural domains.</div></div><div><h3>Results</h3><div>Among 170 patients, any ICH occurred in 67 (39.4 %), of whom 22 met sICH criteria. Platelet counts, balloon dilatation, ischemic core volume, Tmax&gt; 6 s volume and HIR differed significantly across groups (all p &lt; 0.05). Door-to-puncture time was longer for aICH group than no HT group (159.82 ± 64.05 vs. 131.99 ± 68.47; p &lt; 0.05). Compared with the aICH group, the sICH group had lower platelet counts (141.82 ± 43.56 vs. 176.98 ± 72.36; p &lt; 0.05), a larger ischemic core volume (77.50 ± 61.71 vs. 31.88 ± 34.87; p &lt; 0.05) and higher HIR (0.64(0.45, 0.80) vs. 0.40(0.15, 0.57); p &lt; 0.05). Multivariable analysis identified ischemic core volume (OR 3.62, 95 %CI 2.16–6.67, p &lt; 0.001) and thrombocytopenia (OR 6.53, 95 %CI 2.03–25.41, p = 0.003) as independent sICH predictors. The integrated model achieved robust discrimination (AUC 0.874, accuracy 85.6 %).</div></div><div><h3>Conclusions</h3><div>Ischemic core volume and thrombocytopenia independently predict sICH following MT.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"263 ","pages":"Article 109319"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146112490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating long-term outcomes of endovascular revascularization in symptomatic chronic internal carotid artery occlusion: A multicenter cohort study","authors":"Xiaoliang Yin ,&nbsp;Xiaodong Chen ,&nbsp;Jiachun Liu ,&nbsp;Junjie Wang ,&nbsp;Jun Lu ,&nbsp;Qi Peng ,&nbsp;Yiling Cai ,&nbsp;Xiaogang Li ,&nbsp;Yu Fu ,&nbsp;Xumin Pan ,&nbsp;Wei Guo ,&nbsp;Ying Liu ,&nbsp;Huishu Yuan ,&nbsp;Haibo Wu ,&nbsp;Jun Yang ,&nbsp;Daming Wang","doi":"10.1016/j.clineuro.2025.109135","DOIUrl":"10.1016/j.clineuro.2025.109135","url":null,"abstract":"<div><h3>Objectives</h3><div>Chronic internal carotid artery occlusion (CICAO) poses a considerable risk for stroke. While endovascular revascularization holds promise as a potential therapy, its real-world efficacy, safety, and long-term outcomes remain underexplored. This study aims to assess the effectiveness, safety, and long-term outcomes of endovascular revascularization in symptomatic CICAO patients refractory to medical therapy.</div></div><div><h3>Materials and methods</h3><div>A retrospective cohort study was conducted to collect clinical and surgical data from CICAO patients meeting the inclusion criteria for endovascular revascularization therapy. Patients were categorized into groups based on the success or failure of revascularization procedures. Follow-up assessments were undertaken to ascertain patients' prognoses and survival outcomes. Logistic multivariate analysis was employed to identify risk factors associated with primary and secondary outcome events. COX proportional hazard regression was used to compare the risk ratios of these events between the two groups.</div></div><div><h3>Results</h3><div>The study included 59 patients undergoing 62 procedures with a 75.81 % success rate for revascularization. Perioperative complications were 6.45 %, and the average follow-up duration was 36.53 ± 3.92 months. In the successful revascularization group, the primary endpoint event rate was 6.52 %, contrasting with 23.08 % in the non-revascularization group. Carotid artery occlusion and diabetes emerged as independent risk factors for primary endpoint events. A significant difference was observed between the two groups in both primary endpoint (RR 0.16, [95 %CI, 0.03–0.84]) and total endpoint event rates (RR 0.27, [95 %CI, 0.08–0.96])</div></div><div><h3>Conclusions</h3><div>Failure of revascularization may be associated with an increased risk of recurrent cerebrovascular events in patients with CICAO, while successful endovascular revascularization appears to be linked to a lower incidence of such events. However, these results should be interpreted with caution due the relatively small sample size.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"263 ","pages":"Article 109135"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146075667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between anesthetic administration and mortality in patients with hemorrhagic stroke: Analysis of the MIMIC-IV database","authors":"Mengyao Wang ,&nbsp;Ju Gao ,&nbsp;Shunyan Lin ,&nbsp;Yaqun Li ,&nbsp;Tianfeng Huang","doi":"10.1016/j.clineuro.2026.109321","DOIUrl":"10.1016/j.clineuro.2026.109321","url":null,"abstract":"<div><h3>Objective</h3><div>Anesthetic drugs are used in patients with hemorrhagic stroke (HS). We explored the impact of anesthetics on in-hospital mortality in patients with HS using the Medical Information Mart for Intensive Care IV (MIMIC-IV) database.</div></div><div><h3>Methods</h3><div>Eligible patients with HS who were treated between 2008 and 2019 were selected from the MIMIC-IV (version 3.1) database. The Chi-squared test and Wilcoxon’s test were performed to compare the differences between deceased and surviving patients. Then, least absolute shrinkage and selection operator and multivariate logistic regression analyses were employed to identify variables associated with mortality, after which a nomogram was constructed to predict in-hospital mortality. The performance of this nomogram was assessed by receiver operating characteristic curve analysis.</div></div><div><h3>Results</h3><div>In total, 1541 patients were included, including 270 deceased patients (17.5 %) and 1271 surviving patients (82.5 %). Meanwhile, 970 (62.9 %) patients received anesthetics. The use of rocuronium (regression coefficient [β] = 1.033; odds ratio [OR] = 2.809; 95 % confidence interval [CI] = 1.054–7.357; <em>P</em> = 0.037) or morphine (β = 1.894; OR = 6.644; 95 % CI = 4.443–10.079; <em>P</em> &lt; 0.001) was identified as a risk factor for in-hospital mortality in patients with HS. A nomogram was constructed using the statistically significant variables, and its area under curve was 0.924, indicating its high predictive accuracy for in-hospital mortality.</div></div><div><h3>Conclusion</h3><div>A significant percentage of patients with HS received anesthetics. The use of rocuronium and morphine was associated with an increased mortality risk. A nomogram including anesthetic administration could accurately predict in-hospital mortality in patients with HS.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"263 ","pages":"Article 109321"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145996197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}