Clinical Neurology and Neurosurgery最新文献

{"title":"Prognostic value of early creatinine trajectories in ischemic stroke patients: Insights from latent growth mixture modeling using MIMIC-IV","authors":"Xin Zuo ,&nbsp;Huan Zuo ,&nbsp;Pengyu Zhu","doi":"10.1016/j.clineuro.2026.109311","DOIUrl":"10.1016/j.clineuro.2026.109311","url":null,"abstract":"<div><h3>Background</h3><div>Renal dysfunction is common in ischemic ischemic ischemic stroke patients, but the prognostic value of dynamic creatinine trajectories remains unclear.</div></div><div><h3>Methods</h3><div>Using the MIMIC-IV database, we included 1998 ischemic ischemic stroke patients who had at least three creatinine measurements within 72 h of ICU admission. Latent growth mixture modeling (LGMM) was applied to identify creatinine trajectories. The primary outcome was 90-day in-hospital mortality. Cox regression, Kaplan–Meier survival analysis, and subgroup analyses were performed.</div></div><div><h3>Results</h3><div>Four distinct creatinine trajectories were identified: Class 1 (74.4 %) with stable low levels; Class 2 (20.9 %) with persistently moderate-to-high levels and a slight upward trend; Class 3 (2.2 %) with an initial increase followed by decline; and Class 4 (2.5 %) with high initial levels that decreased and then rose again. Significant differences in demographics, complications, and outcomes were observed across classes (all <em>P</em> &lt; 0.05). In unadjusted and partially adjusted models, Classes 2–4 were associated with higher mortality, but after full adjustment only Class 2 remained significant (HR = 1.55, <em>P</em> &lt; 0.001). Kaplan–Meier analysis confirmed significantly lower survival in non-Class 1 patients, most pronounced in Class 2. Subgroup analyses showed consistent results for Class 2 across sex, age, and comorbidity subgroups.</div></div><div><h3>Conclusion</h3><div>Early creatinine trajectories carry important prognostic value in ischemic stroke patients. The persistently moderate-to-high and gradually rising trajectory (Class 2) emerged as the strongest independent predictor of 90-day mortality, highlighting its potential role in risk stratification and clinical decision-making.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109311"},"PeriodicalIF":1.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145922893","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":"Occlusion of posterior communicating artery aneurysms with a ‘fetal’ type circulation treated with flow diversion","authors":"Kimberly Han,&nbsp;Aryan Wadhwa,&nbsp;Felipe Ramirez-Velandia,&nbsp;Alejandro Enriquez-Marulanda,&nbsp;Justin Granstein,&nbsp;Philipp Taussky,&nbsp;Christopher S. Ogilvy","doi":"10.1016/j.clineuro.2025.109290","DOIUrl":"10.1016/j.clineuro.2025.109290","url":null,"abstract":"<div><h3>Objective</h3><div>The fetal-type posterior communicating artery is a circle of Willis variant. Previous studies report lower complete occlusion rates (0–20 %) for fetal-type PComA (fPComA) aneurysms treated with flow diversion than non-fPComA aneurysms (70–75 %). This study evaluated the efficacy of Pipeline embolization devices (PED) in treating fPComA aneurysms and identified predictors of obliteration.</div></div><div><h3>Methods</h3><div>Retrospective analysis was performed on fPComA and non-fPComA aneurysms in patients treated from 2013 to 2023 with PED in the internal carotid artery covering the PComA origin. Demographic, fetal-type anatomy morphology, aneurysm characteristics, intervention technique, and outcome data (e.g., occlusion status at one year, complications, and retreatment rate) was collected. Aneurysm occlusion was assessed during angiographic follow-up. Univariate statistical analysis was performed to compare aneurysm occlusion rates.</div></div><div><h3>Results</h3><div>Among 96 patients treated for PComA aneurysms, 19 patients with a mean age of 61.6 ± 16.3 years had a fetal variant. Three patients were lost to follow-up. Flow diversion achieved complete or near-complete occlusion (&gt;90 % angiographic obliteration) in 12 fetal variant cases (75 %) at one year, matching PED-treated non-fPComA aneurysm occlusion rate (75 %). Two patients with fPComA aneurysms experienced in-stent thrombosis resulting in minor strokes without permanent deficits. Distal PED tip placement in the proximal M1 segment was significantly associated with complete fPComA aneurysm occlusion (p = 0.049).</div></div><div><h3>Conclusion</h3><div>PED treatment for fPComA aneurysms in our cohort demonstrates a 75 % occlusion rate, exceeding rates of prior studies and matching non-fPComA cases. PED placement technique was significantly associated with this high occlusion rate. These findings highlight PED as a potentially safe and effective intervention for these aneurysms.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109290"},"PeriodicalIF":1.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839648","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 subthalamic nucleus volume and outcomes one year after bilateral subthalamic nucleus deep brain stimulation for Parkinson’s disease","authors":"Yilong Zheng ,&nbsp;Yi Zhan Cai ,&nbsp;Li Wei ,&nbsp;Seyed Ehsan Saffari ,&nbsp;Hwee Lan Ng ,&nbsp;Hui Ping Oh ,&nbsp;Wai-Yung Yu ,&nbsp;Louis Chew Seng Tan ,&nbsp;Wai Hoe Ng ,&nbsp;Shermyn Xiumin Neo ,&nbsp;Kai Rui Wan","doi":"10.1016/j.clineuro.2025.109305","DOIUrl":"10.1016/j.clineuro.2025.109305","url":null,"abstract":"<div><h3>Introduction</h3><div>Deep brain stimulation (DBS) is an effective adjunctive therapy for Parkinson’s disease (PD), but there are few biomarkers for the prediction of treatment response. Here, we aimed to evaluate whether subthalamic nucleus (STN) volume could serve as a biomarker for predicting treatment response to STN DBS in PD.</div></div><div><h3>Methods</h3><div>This was a retrospective study of patients who underwent bilateral STN DBS for PD between 2008 and 2021 at our center. Preoperative T2-weighted MRI scans were used to quantify STN volumes, while outcomes were evaluated using both the Hoehn and Yahr scale and Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) total and subcomponent scores at one-year follow-up. Univariate and multivariate linear regression analysis were applied to examine potential relationships between STN volume and clinical outcomes.</div></div><div><h3>Results</h3><div>Of 94 PD patients treated with DBS, 32 met the inclusion criteria for analysis. Our analysis revealed no significant association between STN volume and motor symptom improvement, as assessed by one-year changes in MDS-UPDRS Parts II (β=0.04; 95 % CI=-0.12–0.20; p = 0.590), III (β=0.07; 95 % CI=-0.35–0.48; p = 0.753), IV (β=-0.02; 95 % CI=-0.07–0.03; p = 0.430), and Hoehn and Yahr scale (β=0.01; 95 % CI=0.00–0.01; p = 0.136. Similarly, STN volume showed no association with MDS-UPDRS Part I total score (β=0.12; 95 % CI=-0.02–0.26; p = 0.096) for non-motor symptoms. However, we identified significant positive associations between STN volume and specific non-motor components, including the “anxious mood” (β=0.02; 95 % CI=0.00–0.04; p = 0.031) and the “pain and other sensation” (β=0.02; 95 % CI=0.00–0.04; p = 0.022) components, though these associations were not significant after adjusting for potential confounders.</div></div><div><h3>Conclusions</h3><div>In our cohort of patients who underwent bilateral STN DBS for PD, exploratory analyses revealed that larger STN volumes were significantly associated with an increased risk of developing affective symptoms approximately one year postoperatively. No significant association was observed between STN volume and improvement in motor outcomes. Further validation studies are warranted to corroborate the findings from this exploratory analysis.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109305"},"PeriodicalIF":1.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882391","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":"Corrigendum to: “Assessing glibenclamide’s efficacy on functional recovery in aneurysmal subarachnoid hemorrhage: A meta-analysis of randomized controlled trials”","authors":"Luciano Falcão ,&nbsp;Pedro Antonio Lopes Gomes,&nbsp;Rafael Andrade Sampaio Silva,&nbsp;Kenzo Ogasawara,&nbsp;João Victor Pereira Gonzalez,&nbsp;André Nishizima,&nbsp;Victor Arthur Ohannesian,&nbsp;Lara Souza Magalhães,&nbsp;Davi J. Fontoura Solla","doi":"10.1016/j.clineuro.2025.109294","DOIUrl":"10.1016/j.clineuro.2025.109294","url":null,"abstract":"","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109294"},"PeriodicalIF":1.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882390","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":"Hemodynamic changes during simulation of sub-maximal handgrip maneuver in small basilar tip aneurysms: A computational fluid dynamics and one-way fluid-structure interaction analysis","authors":"Felipe Ramirez-Velandia ,&nbsp;Vitor Lauar Pimenta de Figueiredo ,&nbsp;Vincenzo T.R. Loly ,&nbsp;Natalia Anna Koc ,&nbsp;Bruno Galelli Chieregatti ,&nbsp;Rafael T. Tatit ,&nbsp;Emmanuel O. Mensah ,&nbsp;Mark Rotondo ,&nbsp;João de Sá Brasil Lima ,&nbsp;Jorge Rios-Zermeno ,&nbsp;Johnny S. Sandhu ,&nbsp;Rabih G. Twak ,&nbsp;Christopher S. Ogilvy ,&nbsp;Carlos E. Baccin","doi":"10.1016/j.clineuro.2025.109304","DOIUrl":"10.1016/j.clineuro.2025.109304","url":null,"abstract":"<div><h3>Objective</h3><div>Evaluate through computational fluid dynamics (CFD) and fluid structure interaction (FSI) simulations basilar tip aneurysms (BTAs) hemodynamics at rest and during early (PLT1) and late (PLT2) phases of a sub-maximal handgrip (HG) maneuver.</div></div><div><h3>Methods</h3><div>Vascular segmentation used 3D rotational angiograms, and meshes were generated for accurate simulation. Time-averaged wall shear stress (TAWSS) at the aneurysm/parent vessel, oscillatory shear index (OSI), relative residence time (RRT), low and high shear stress area ratio (LSAR/HSAR), and wall deformation metrics (Von Mises stress, wall displacement, and strain) were calculated and compared.</div></div><div><h3>Results</h3><div>Seven patients (mean age: 60 ± 4.3 years; mean aneurysm size: 5.00 ± 1.76 mm) were included. 3 aneurysms were irregular, and 2 were ruptured. Ruptured BTAs were smaller (3.58 vs. 5.56 mm; p = 0.2009), had higher RRT (0.66 vs. 0.43 m²/N; p = 0.0276) and LSAR (5.11 % vs. 0 %; p = 0.0326). In unruptured BTAs, HG increased TAWSS (PLT1 +28.4 %, p = 0.0002; PLT2: +23.9 %, p = 0.0002), reduced RRT (PLT1 −21.7 %, p = 0.0009; PLT2: −18.6 %; p = 0.0016), increased HSAR (PLT1 +82.1 %, p = 0.0431, PLT2 +68.9 %, p = 0.0431), increased peak von Mises stress (PLT1 +18.6 %, p = 0.0223, PLT2 +31.9 %; p = 0.0087), maximum wall displacement (PLT1 +8.0 %, p = 0.0431; PLT2 +12.8 %, p = 0.0431) and maximum strain (PLT1 +7.13 %, p = 0.0201; PLT2 +11.8 %, p = 0.0043). Ruptured aneurysms showed similar trends with higher TAWSSR increases (PLT1 +31.6 %, p = 0.0225; PLT2 +28.2 %, p = 0.0391) and larger reductions in RRT (PLT1 −24.4 %, p = 0.0178; PLT2 −23.8 %, p = 0.0411).</div></div><div><h3>Conclusion</h3><div>In unruptured BTAs, PLT1 produced the greatest TAWSS increase and RRT reduction, whereas PLT2 led to maximal wall deformation. Ruptured aneurysms demonstrated greater TAWSSR increases and RRT reductions during simulation.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109304"},"PeriodicalIF":1.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882389","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":"A comment on cohort structure in Chiari I malformation studies","authors":"Shiva A. Nischal,&nbsp;Shaan Patel,&nbsp;Jayaratnam Jayamohan","doi":"10.1016/j.clineuro.2025.109295","DOIUrl":"10.1016/j.clineuro.2025.109295","url":null,"abstract":"","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109295"},"PeriodicalIF":1.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839650","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":"“Eiffel-by-night” sign in hypertrophic pachymeningitis: Clinical and radiological correlates","authors":"Daniela Ohlweiler Brescovit ,&nbsp;Leandro Tavares Lucato ,&nbsp;Luiz Henrique Martins Castro ,&nbsp;Suely Kazue Nagahashi Marie ,&nbsp;Guilherme Diogo Silva","doi":"10.1016/j.clineuro.2025.109291","DOIUrl":"10.1016/j.clineuro.2025.109291","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the clinical significance of the “Eiffel-by-night” (EBN) sign in hypertrophic pachymeningitis, focusing on its frequency, etiological associations, and prognostic value for recurrence, which improves diagnostic workflows, facilitating earlier, targeted therapeutic interventions.</div></div><div><h3>Methods</h3><div>We conducted a retrospective observational study at the Autoimmune Meningitis Outpatient Clinic at Hospital das Clínicas, Universidade de São Paulo (Brazil), from January 2024 to April 2025, including patients with HP confirmed by MRI dural thickening and enhancement, excluding infectious and neoplastic cases. Clinical, cerebrospinal fluid (CSF), and imaging data were obtained from medical records. Two independent raters assessed the presence of the EBN sign on post-contrast T1-weighted on baseline and follow-up MRIs, comparing EBN+ and EBN– groups.</div></div><div><h3>Results</h3><div>Forty-five patients fulfilled eligibility criteria; 8 (17.7 %) of whom were EBN+, mostly middle-aged women. EBN sign was more common in idiopathic HP (62.5 %), and less so in IgG4-related disease, neurosarcoidosis, and ANCA-associated vasculitis. Clinical and CSF profiles were similar between groups, except for two male EBN+ patients, with marked pleocytosis. Most EBN+ patients (75 %) had a relapsing disease course. The sign persisted in 86 % of cases on the last follow-up.</div></div><div><h3>Conclusion</h3><div>The EBN sign occurred in fewer than one-fifth of HP cases, primarily in idiopathic disease. Despite no clear clinical or CSF distinctions, its persistence correlated with frequent relapse.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109291"},"PeriodicalIF":1.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839620","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":"Development of a stereotactic frame for neurosurgery targeting: A prospective pre-clinical study","authors":"Ahmed Abdelwahab ,&nbsp;Hasna Loulida ,&nbsp;Mohammad Mahdi Bagheri Asl ,&nbsp;Marwa Abdelrasoul ,&nbsp;Qian Chang Gallo ,&nbsp;Erick Lemon ,&nbsp;Sami Al Kasab ,&nbsp;Nathan C. Rowland ,&nbsp;Alejandro M. Spiotta ,&nbsp;Istvan Takacs","doi":"10.1016/j.clineuro.2025.109293","DOIUrl":"10.1016/j.clineuro.2025.109293","url":null,"abstract":"<div><h3>Objectives</h3><div>Current commercial stereotactic frames have several limitations and are geometrically complex. They utilize imaginary, physically unreachable reference points, and they are expensive. We designed a three-dimensional, low-cost, and easy-to-assemble frame that can both visualize and physically reach the reference point at (0, 0, 0). Our frame allows simultaneous bilateral targeting via distinct trajectories, thereby reducing operative time while providing wider facial exposure for airway protection.</div></div><div><h3>Methods</h3><div>In a prospective phantom experiment (August–October 2025), five operators each performed five passes at four radiopaque intracranial targets (100 attempts). Before every pass, the frame was physically re-zeroed to the reference point. For each attempt, we recorded the three-dimensional Euclidean target registration error (TRE) and the signed axis-specific offsets. Linear mixed-effects modelling with operator and target location as random factors, intraclass correlation, and Bland-Altman agreement were utilized for statistical analyses.</div></div><div><h3>Results</h3><div>All 100 trajectories contacted their intended target. Mean±SD TRE was 0.19 ± 0.07 mm. Every attempt fell within 1 mm of the target (100 %, 95 %CI 96.4–100 %). Axis-wise biases were negligible (Δx = 0.01 mm, Δy = -0.01 mm, Δz = -0.01 mm; all p &gt; 0.33). Bland-Altman limits of agreement were ±0.23 mm (x), ±0.24 mm (y), and ±0.24 mm (z) with no trend across the measurement range. Mixed-effects modelling attributed 12.5 % of the residual variance to operators, 7.1 % to target location, and 80.4 % to unexplained (within-trial) error; the adjusted ICC was 0.20, indicating low between-operator variability relative to total variance. Neither repetition order (p = 0.38) nor location (p = 0.08) influenced TRE. The mean setup-to-trajectory time was under 10 min per operator.</div></div><div><h3>Conclusion</h3><div>Our stereotactic system delivered reproducible, near-millimeter accuracy in phantom testing while simplifying setup, reducing operative time, and eliminating expensive software dependency. These findings justify advancing to cadaveric studies and early clinical trials to broaden access to frame-based stereotaxy for urgent procedures, such as external ventricular drain placement, across diverse healthcare environments.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109293"},"PeriodicalIF":1.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145862522","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":"Serotonin reuptake inhibition and intracerebral hemorrhage risk after ischemic stroke: A multicenter retrospective study","authors":"Sean Y. Li ,&nbsp;Aritra Nag ,&nbsp;David Ben-Israel ,&nbsp;Alfred Bowles Jr. ,&nbsp;Sandeep Muram ,&nbsp;Deven Reddy ,&nbsp;Michael L. Kelly","doi":"10.1016/j.clineuro.2026.109309","DOIUrl":"10.1016/j.clineuro.2026.109309","url":null,"abstract":"<div><h3>Background</h3><div>Selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors (SRIs) are common medications used in the management of post-stroke depression. However, their antiplatelet effects may increase the risk of intracerebral hemorrhage (ICH) in patients already at elevated risk following ischemic stroke.</div></div><div><h3>Methods</h3><div>A retrospective cohort study of adults with an ischemic stroke encounter diagnosis was conducted using the TriNetX database. Patients prescribed an SRI within 1 day to 3 months post-stroke were compared with patients without SRI prescriptions. Demographic, clinical, laboratory, and medication covariates were adjusted between the two cohorts using 1:1 propensity score matching (PSM). The primary outcome was nontraumatic ICH within 3 years. A p-value &lt; 0.01 and 95 % confidence intervals (CIs) &lt; 0.9 and &gt; 1.1 were considered statistically significant.</div></div><div><h3>Results</h3><div>After PSM, 42,310 patients were included in the SRI cohort and the non-SRI cohort. The overall incidence of ICH was significantly more frequent in the SRI group (HR [95 % CI]: 1.48 [1.29, 1.71]). ICH risk remained significant after excluding patients with alcohol or substance use disorders in a secondary analysis. GI bleeding events and mortality rates were also higher in the SRI cohort (HR [95 % CI]: 1.37 [1.27, 1.48] and HR [95 % CI]: 1.54 [1.47, 1.61], respectively) when compared to the non-SRI cohort.</div></div><div><h3>Conclusions</h3><div>SRI use following ischemic stroke was associated with an increased risk of ICH. These findings highlight the potential for cautious risk–benefit assessment when prescribing SRIs post-stroke and can serve as the basis for prospective studies with detailed clinical validation.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109309"},"PeriodicalIF":1.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145910668","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":"Recent outcomes of intravenous tissue plasminogen activator (t-PA) alone in the era of mechanical thrombectomy: A sub-analysis of the Kanagawa Intravenous and Endovascular Treatment (K-NET) registry","authors":"Noriko Usuki ,&nbsp;Toshihiro Ueda ,&nbsp;Masataka Takeuchi ,&nbsp;Masafumi Morimoto ,&nbsp;Yoshifumi Tsuboi ,&nbsp;Ryoo Yamamoto ,&nbsp;Satoshi Takaishi ,&nbsp;Kentaro Tatsuno ,&nbsp;Hidemichi Ito ,&nbsp;Takahiro Shimizu ,&nbsp;Yoshihisa Yamano ,&nbsp;on behalf of the K-NET Registry Investigators","doi":"10.1016/j.clineuro.2026.109316","DOIUrl":"10.1016/j.clineuro.2026.109316","url":null,"abstract":"<div><h3>Purpose</h3><div>Mechanical thrombectomy (MT) is now the standard of care for large vessel occlusion (LVO), leading to a decline in recent reports on the outcomes of intravenous tissue plasminogen activator (tPA) alone. This study aimed to assess the real-world effectiveness of intravenous tPA alone in the MT era, using data from the Kanagawa Intravenous and Endovascular Treatment (K-NET) registry, a prospective multicenter registry of acute ischemic stroke (AIS) in Japan.</div></div><div><h3>Methods</h3><div>Among 3954 AIS patients registered between 2018 and 2021, 767 received intravenous tPA without MT. Primary outcomes were the proportions of patients achieving a modified Rankin Scale (mRS) score of 0–1 or 0–2 at 90 days. Secondary outcomes included symptomatic intracranial hemorrhage (sICH) and 90-day mortality. Outcomes were further analyzed by occlusion site and stroke subtype.</div></div><div><h3>Results</h3><div>The median age was 77 years, and 42.9 % were female. The median National Institutes of Health Stroke Scale (NIHSS) score at presentation was 8. LVO was present in 24.1 % of patients. Favorable outcomes (mRS 0–2) at 90 days were observed in 47 % of all patients, and 56 % of those with pre-stroke mRS scores of 0–1. By the occlusion site, favorable outcome rates were highest in M3–4 occlusions (59 %) and lowest in internal carotid artery (ICA) occlusions (22 %). By stroke subtype, lacunar infarction (LI) showed the best outcomes (63.5 %), while cardioembolism (CE) had the worst (38.3 %). The overall sICH rate was 2.2 %, highest in basilar artery (BA) / vertebral artery (VA) occlusions (6.1 %) and CE cases (4.5 %).</div></div><div><h3>Conclusion</h3><div>Even in the MT era, intravenous tPA alone provides favorable outcomes in selected patients with AIS, particularly those without LVO. However, the proportion of LVO cases not receiving MT indicates gaps in referral and transfer systems. These findings underscore the significance of tPA alone as an important therapeutic option and as a potential indicator of the performance and equity of regional stroke care systems.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109316"},"PeriodicalIF":1.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145922890","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}