Clinical Neuroradiology最新文献

{"title":"Comment on ESO/EANS/ESMINT Guideline on Aneurysmal Subarachnoid Haemorrhage.","authors":"Stephan Meckel, Matthias Gawlitza, Klaus Kaier, Franziska Dorn, Stefan Rohde, Peter Schramm, Ansgar Berlis","doi":"10.1007/s00062-026-01708-7","DOIUrl":"10.1007/s00062-026-01708-7","url":null,"abstract":"","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uncovering Individual Language Vulnerability in Epilepsy Through Functional Connectivity Laterality.","authors":"Radheshyam Stepponat, Mehmet S Yildirim, Marc Berger, Laurin Schäfer, Joel A Leinkauf, Kathrin Kollndorfer, Ekaterina Pataraia, Silvia Bonelli, Gregor Kasprian, Florian Ph S Fischmeister","doi":"10.1007/s00062-026-01709-6","DOIUrl":"https://doi.org/10.1007/s00062-026-01709-6","url":null,"abstract":"<p><strong>Background: </strong>Language processing is organized in brain networks, generally lateralized to the left hemisphere. In clinical routine, task-based functional MRI (fMRI) is the gold standard for non-invasive evaluation of language lateralization. However, standard fMRI does not account for the individual heterogeneity of language networks. fMRI-based functional connectivity analysis (FCA) has addressed this shortcoming by identifying correlates of dysfunctional language networks in epilepsy patients. In order to individualize FCA, translation of group-based network analysis to individual epilepsy patients is necessary. Here, we introduce the functional connectivity laterality index (LI_FC) as a potential clinical parameter.</p><p><strong>Methods: </strong>This retrospective study included adults with unilateral temporal lobe epilepsy (TLE) who underwent task-based fMRI and a control group. To account for individual variations, fMRI was performed at a 3T scanner and processed entirely in native space. Laterality indices were computed from both activation maps and seed-based functional connectivity across frontal, temporal, and combined language regions. Group comparisons and associations with neuropsychological language performance were analysed.</p><p><strong>Results: </strong>Forty patients with unilateral TLE and 25 healthy controls were included. Groups were comparable in terms of sex, handedness, imaging findings, and epilepsy duration, although the controls were younger. Classical LI showed predominantly left-lateralization, while LI_FC showed mostly bilateral language lateralization. Neuropsychological performance did not differ between TLE-left and TLE-right patients. While a difference in semantic fluency was initially observed, it did not survive correction for multiple comparisons. However, analyses based on functional network organization revealed a critical pattern: Patients with language networks lateralized to the seizure side-as quantified by LI_FC-showed significantly poorer semantic fluency and lower composite language scores. This potential clinically relevant result was exclusive to FCA and was not captured by activation data alone.</p><p><strong>Conclusion: </strong>Our findings suggest an individual vulnerability of language networks to seizure burden, although this uncorrected, exploratory finding requires replication in larger, independent samples. Incorporating functional connectivity measures into presurgical clinical fMRI analysis may enhance our ability to predict and protect language function in patients with TLE by prioritizing further therapies or surgical interventions for those at higher risk of language decline.</p>","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do Current Endpoints Underestimate Benefit in MeVO Stroke? A Call for Cognitive Profiling.","authors":"Polona Rus Prelog, Matija Zupan, René Chapot, Senta Frol","doi":"10.1007/s00062-026-01706-9","DOIUrl":"https://doi.org/10.1007/s00062-026-01706-9","url":null,"abstract":"","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148629809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Unfavorable Outcome After Endovascular Thrombectomy for Acute Basilar Artery Occlusion with Mild Symptoms.","authors":"Sung Hyun Baik, Cheolkyu Jung, Byung Moon Kim, Dong Joon Kim","doi":"10.1007/s00062-026-01704-x","DOIUrl":"https://doi.org/10.1007/s00062-026-01704-x","url":null,"abstract":"<p><strong>Purpose: </strong>Unfavorable outcome is not uncommon after endovascular thrombectomy (EVT) in patients with acute basilar artery occlusion (BAO) presenting with mild symptoms, but predictors remain unclear. This study aimed to identify clinical and imaging predictors of unfavorable outcome in patients with BAO and mild symptoms.</p><p><strong>Methods: </strong>We retrospectively analyzed 71 patients with acute BAO and baseline NIHSS ≤ 10 who underwent EVT. Patients were classified by 90-day modified Rankin Scale (mRS) scores into favorable (0-2) and unfavorable (3-6) outcome groups. Clinical and imaging variables, including perfusion parameters, were compared. Independent predictors for unfavorable outcome were assessed using multivariable logistic regression. Subgroup analyses were performed according to onset-to-puncture time (early ≤ 6 h vs. late > 6 h) and door-to-puncture time (immediate ≤ 120 min vs. delayed > 120 min).</p><p><strong>Results: </strong>Of 71 patients, 25 (35.2%) had unfavorable outcomes. These patients were older, had higher admission NIHSS score, and more frequently showed pons-midbrain-thalamus (PMT) hypoperfusion (Tmax > 6 s). Multivariable analysis identified PMT hypoperfusion as an independent predictor of unfavorable outcome (adjusted OR, 3.93; 95% CI, 1.02-15.23; P = 0.047). Stratified analysis showed PMT hypoperfusion was strongly associated with unfavorable outcome in patients treated in the late time window (aOR, 14.90; 95% CI, 1.35-163.75; P = 0.028) and delayed EVT (aOR, 16.12; 95% CI, 1.16-230.70; P = 0.038), but not in the early or immediate treatment.</p><p><strong>Conclusion: </strong>In BAO with mild symptoms, perfusion imaging may predict the outcome. PMT hypoperfusion independently predicted unfavorable outcome, particularly in patients treated in the late window or with delayed EVT.</p>","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148583828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Learning Curve of Mechanical Thrombectomy: Procedural Efficiency and Clinical Outcomes in Early Operator Experience.","authors":"Samira Michel, Gergely Bertalan, Tilman Schubert, Patrick Thurner, Miklos Krepuska, Anna Kyselyova, Francesco Morra, Zsolt Kulcsar","doi":"10.1007/s00062-026-01696-8","DOIUrl":"https://doi.org/10.1007/s00062-026-01696-8","url":null,"abstract":"<p><strong>Purpose: </strong>The learning curve for interventional neuroradiologists starting independent mechanical thrombectomy (MT) remains insufficiently understood. This study investigated associations between operator experience, procedural performance, and clinical outcomes to estimate the number of procedures for expert-level performance.</p><p><strong>Methods: </strong>We retrospectively analyzed MT procedures from our stroke registry (2020-2024). Operators with low-to-intermediate prior neurovascular experience were followed during their first 20-50 independent cases. Procedural outcomes included procedure duration, number of passes, door-to-groin-puncture time, first-pass success, reperfusion success (modified treatment in cerebral infarction (mTICI) ≥ 2b-3), and complications. Learning curves were benchmarked against expert operator performance. Associations between operator experience and outcomes were evaluated with mixed-effects models. Clinical outcomes were assessed using changes in the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) from admission to discharge and at 3‑month follow-up.</p><p><strong>Results: </strong>295 MT procedures were performed by seven operators (median 50 each; interquartile range 25-50). Procedure duration decreased significantly with experience (β = -0.7 min per procedure; 95% CI -1.2 to -0.1; p = 0.01). Linear extrapolation suggested that procedural efficiency comparable to the local expert benchmark may be reached after approximately 188 procedures, although this estimate should be interpreted cautiously. Other procedural metrics showed non-significant improvements. NIHSS at discharge and mRS at 3‑month follow-up did not differ by experience level.</p><p><strong>Conclusion: </strong>Increasing operator experience was associated with shorter procedure duration, whereas no significant associations were observed for other procedural metrics. No differences in procedural complications or clinical outcomes were detected between operator experience groups.</p>","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148548047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Glymphatic System Activity in Pediatric Wilson Disease Patients Using Diffusion Tensor Imaging Along the Perivascular Space.","authors":"Sevgi Demiröz Taşolar, Hüseyin Ayvaz, Emre Gök, Hilal Er Ulubaba, Nurullah Dağ, Şükrü Güngör, Hakan Taşolar, Fatma İlknur Varol","doi":"10.1007/s00062-026-01700-1","DOIUrl":"https://doi.org/10.1007/s00062-026-01700-1","url":null,"abstract":"<p><strong>Purpose: </strong>Wilson disease is an autosomal recessive disorder of copper metabolism that results in toxic copper accumulation in the liver and brain, thereby causing neurological injury. Previous reports have described astrocyte dysfunction, oxidative stress, glial pathology, and impaired aquaporin-4-mediated water transport in Wilson disease, suggesting a potential disruption of glymphatic fluid dynamics. However, glymphatic function has not been quantitatively assessed in this population using diffusion tensor imaging analysis along the perivascular space (DTI-ALPS).</p><p><strong>Methods: </strong>This retrospective single-center study aimed to quantify glymphatic system function in pediatric patients with Wilson disease using the DTI-ALPS index. Brain MRI/DTI data (30 directions, b = 1000 s/mm²) from 43 patients younger than 18 years diagnosed according to the Leipzig criteria (2018-2025) were analyzed and compared with 43 age- and sex-matched healthy controls. Neuro-Wilson status was defined by MRI involvement plus neurological symptoms. ALPS indices were derived from regions of interest in the corona radiata and superior longitudinal fasciculus on color-FA maps. The analyses included group comparisons, correlations with clinical variables, and a secondary sensitivity ANCOVA adjusted for age and sex to confirm the robustness of group differences despite demographic matching.</p><p><strong>Results: </strong>Right-, left-, and mean ALPS indices were significantly lower in patients with Wilson's disease than in controls, with this group effect persisting after demographic adjustment (F = 13.90, p < 0.001; adjusted means: controls 1.51, WD 1.34, NWD 1.38). ALPS indices did not differ between the WD and NWD subgroups despite higher liver severity scores in the latter. ALPS values did not correlate with liver severity scores, urinary copper, ceruloplasmin or sex.</p><p><strong>Conclusion: </strong>These findings suggest that the DTI-ALPS index may reflect glymphatic system-related processes, as well as disease-related microstructural and perivascular alterations, in pediatric Wilson disease. The DTI-ALPS index may provide complementary, non-invasive imaging information regarding early perivascular microstructural alterations. Prospective multicenter longitudinal studies are warranted to clarify the temporal relationships among ALPS index changes, neurological progression, and treatment response.</p>","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148444822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can Dual-Energy CT Be Easily Adopted in Clinical Practice for Predicting Hemorrhagic Complications?","authors":"Kyubong Lee, Jung Hoon Han, Keon-Joo Lee, Chi Kyung Kim, Kyungmi Oh, Sung Hoon Kang, Sangil Suh","doi":"10.1007/s00062-026-01695-9","DOIUrl":"10.1007/s00062-026-01695-9","url":null,"abstract":"<p><strong>Background and purpose: </strong>Hemorrhagic transformation after endovascular thrombectomy (EVT) for acute ischemic stroke is associated with poor outcomes. Dual-energy CT (DECT) iodine maps may predict hemorrhagic transformation. Therefore, we investigated the predictive value of DECT for hemorrhagic complications and evaluated whether DECT can be adopted in clinical practice.</p><p><strong>Methods: </strong>We retrospectively analyzed 306 patients with anterior circulation stroke who underwent DECT after EVT (July 2017-March 2025). Maximal ROI values were measured bilaterally, and an ipsilateral-to-contralateral ratio was calculated. Analyses were focused on DECT within 1 h and DECT between 2-3 h after EVT. The association between the ROI ratio and hemorrhagic complications was evaluated using multivariable logistic regression. Predictive performance of DECT for any hemorrhage and parenchymal hematoma (PH) on follow-up MRI was assessed using AUC, sensitivity, specificity, and accuracy.</p><p><strong>Results: </strong>Mean age was 70.3 years; 85.6% achieved successful reperfusion (mTICI ≥ 2b). Any hemorrhage occurred in 52.0%, and PH in 16.0%. The ROI ratio was significantly associated with hemorrhagic complications. Early DECT (within 1 h) better predicted any hemorrhage (AUC = 0.884), whereas delayed DECT (2-3 h) better predicted parenchymal hematoma (AUC = 0.813). Among patients without apparent hemorrhage on DECT, early DECT also better predicted any hemorrhage (AUC = 0.861), whereas delayed DECT better predicted parenchymal hematoma (AUC = 0.920).</p><p><strong>Conclusions: </strong>DECT comparably predicts hemorrhagic complications. Early DECT better predicts any hemorrhage, whereas delayed DECT better predicts PH, particularly in patients without immediate hemorrhagic findings.</p>","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148351076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Direct Comparison of Dual Antiplatelet Therapy with Prasugrel or Ticagrelor Versus Clopidogrel in Endovascular Treatment of Intracranial Aneurysms: a Meta-analysis.","authors":"Kyoung Min Jang, Hyun Ho Choi, Young Dae Cho","doi":"10.1007/s00062-026-01694-w","DOIUrl":"https://doi.org/10.1007/s00062-026-01694-w","url":null,"abstract":"<p><strong>Purpose: </strong>Clopidogrel (CPG)-based dual antiplatelet therapy (DAPT) is widely used prior to endovascular treatment of intracranial aneurysms to prevent procedural thromboembolic complications (TECs). Recently, newer-generation P2Y12 inhibitors - prasugrel and ticagrelor (PSG/TCG) - have emerged as potential alternatives. This meta-analysis aimed to evaluate the utility of PSG and TCG as first-line agents for DAPT by directly comparing their safety and efficacy with conventional CPG-based therapy.</p><p><strong>Method: </strong>Relevant studies were extracted from PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials by two independent reviewers. A random-effects model was used to compare the risk of TECs and hemorrhagic complications (HECs) between PSG/TCG-based and CPG-based DAPT, expressed as risk ratios (RRs) with 95% confidence intervals (CIs). Subgroup analyses were performed to compare platelet reactivity, measured by platelet reaction unit (PRU) values, between the two groups.</p><p><strong>Results: </strong>Six studies encompassing 1,071 patients were included. Compared with CPG-based DAPT, PSG/TCG-based DAPT was associated with a significantly lower risk of TECs (RR, 0.46; 95% CI, 0.23-0.93; p = 0.04) without a corresponding increase in HECs. Subgroup analysis demonstrated significantly lower PRU values in the PSG/TCG compared with the CPG group (p =0.01).</p><p><strong>Conclusion: </strong>This meta-analysis shows that PSG/TCG-based DAPT offers superior thromboembolic protection without increased hemorrhagic risk, compared to conventional CPG-based regimens in endovascular treatment of intracranial aneurysms. These results suggest that PSG/TCG-based DAPT is worth considering as a treatment option in this setting, and prospective randomized trials are needed to confirm these results and to evaluate its role as a first-line option.</p>","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148351153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Magnetic Resonance Imaging/Diffusion-Weighted Imaging-Guided Versus Perfusion-Guided Intravenous Thrombolysis with Alteplase Beyond 4.5-Hour Window: a Network Meta-Analysis of Randomized Controlled Trials.","authors":"Ocílio Ribeiro Gonçalves, Gabriel Caruso Novaes Tudella, Leonardo Januário Campos Cardoso, Giovana Menegucci, Augusto Utida Klostermann, Luis Felipe Porto, Carlos Daniel Santiago Azevedo, Anderson Matheus Pereira da Silva, Társis Vinícius Cronemberger, Jagkirat Singh, Wei Jun Lee, Leonardo Di Cosmo, Mariana Letícia de Bastos Maximiano, Ahmet Gunkan, Thanh Nguyen, Adam Andrew Dmytriw, Guillaume Turc, Frédéric Clarençon, Luca Scarcia","doi":"10.1007/s00062-026-01693-x","DOIUrl":"10.1007/s00062-026-01693-x","url":null,"abstract":"<p><strong>Background: </strong>The benefits and risks of intravenous thrombolysis (IVT) with alteplase for acute ischemic stroke (AIS) beyond 4.5 h are unclear. Decision-making is further limited by the lack of comparisons between imaging strategies used for patient selection, including magnetic resonance imaging with diffusion-weighted imaging (MRI/DWI) and perfusion-guided approaches such as MRI with perfusion-weighted imaging (MRI/PWI) or computed tomography perfusion (CTP). This study aims to evaluate the efficacy and safety of alteplase administered beyond 4.5 h and to compare MRI/DWI- and perfusion-guided IVT.</p><p><strong>Methods: </strong>Databases were searched for RCTs enrolling AIS patients treated with alteplase beyond 4.5 h. Efficacy outcomes included excellent (mRS 0-1) and favorable (mRS 0-2) functional outcomes at 90 days, and major neurological improvement up to 72 h. Safety outcomes included any intracranial hemorrhage (aICH), symptomatic ICH (sICH), parenchymal hemorrhage (PH), and 90-day mortality.</p><p><strong>Results: </strong>Seven RCTs comprising 1685 patients were included. There were no differences between imaging strategies in any efficacy or safety outcome. Alteplase administered beyond 4.5 h was associated with higher rates of excellent (RR 1.24; 95% CI 1.12-1.38) and favorable (RR 1.17; 95% CI 1.09-1.26) functional outcomes, and increased major neurological improvement (RR 1.28; 95% CI 1.11-1.49). The risks of aICH (RR, 2.82; 95% CI 1.17-6.80), sICH (RR, 3.31; 95% CI 1.42-7.74), and PH (RR, 2.95; CI 95% 1.33-6.53) were higher in the alteplase group, while mortality showed no difference (RR 1.27; 95% CI 0.91-1.76).</p><p><strong>Conclusion: </strong>This network meta-analysis did not detect a statistically significant difference between perfusion-guided and DWI/FLAIR mismatch-guided selection; however, this comparison was indirect, based on a limited number of trials, and not powered to demonstrate equivalence, and should not be interpreted as evidence that the two paradigms are interchangeable.</p>","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148344138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multiparametric Characterization of Tough Clots Following Stroke Thrombectomy.","authors":"Kianush Karimian-Jazi, Vasileios Kapralos, Daniel Schwarz, Dominik Vollherbst, Manuel Fischer, Volker Sturm, Niclas Schmitt, Tim Hilgenfeld, Christian Herweh, Fabian Preisner, Christoph Mooshage, Sophia Hohenstatt, Stefan Hamelmann, Felix Hinz, Felix Sahm, Sabine Heiland, Wolfgang Wick, Peter Ringleb, Martin Bendszus, Markus Möhlenbruch, Michael Breckwoldt","doi":"10.1007/s00062-026-01691-z","DOIUrl":"https://doi.org/10.1007/s00062-026-01691-z","url":null,"abstract":"<p><strong>Purpose: </strong>Thrombectomy (TE) is the standard of care for stroke patients with large vessel occlusion. While TE achieves high recanalization rates, a subset of clots requires three or more thrombectomy maneuvers (\"challenging or tough clots\") which is associated with increased complication rates and poor clinical outcome. The underlying biological properties of tough clots are poorly understood, and it remains unclear whether these have distinct structural characteristics or etiology that might contribute to their resistance to TE.</p><p><strong>Methods: </strong>We performed a prospective, single-center study which analyzed clot composition in 33 consecutive ischemic stroke patients. This included 16 tough clots (48%) which were analyzed in a predefined subgroup analysis. Clots were assessed by preinterventional imaging, ex vivo high field MRI (\"MR-microscopy\", 9.4 T) and histopathology. Imaging data was correlated with clinical parameters and outcome.</p><p><strong>Results: </strong>MR microscopy showed mainly platelet-rich clots (white, 21 clots, 64%), whereas mixed (9 clots 27%) and red blood cell-rich (3 clots, 9%) were less frequent. Tough clots were mostly white (14/16 clots, 87.5%), had increased procedure time and required more maneuvers to achieve recanalization (mean number of maneuvers: white clots: 3.2 ± 1.4, mixed clots: 1.7 ± 0.9, RBC-rich clots 1.3 ± 0.6 passes). Cancer patients undergoing thrombectomy and cardiac patients with periprocedural emboli often exhibited tough clots (63% and 67% respectively). TE patients with concomitant cancer had inferior outcome both at discharge and at 90 days follow-up.</p><p><strong>Conclusion: </strong>Tough clots are platelet-rich, show an association with underlying comorbidities and are associated with malignancies. This highlights the combined influence of clot composition and pre-existing comorbidities on thrombectomy success and supports the need for individualized stroke management.</p>","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148307227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}