Neuroradiology最新文献

{"title":"Recanalizing distal and small medium vessel occlusions - single-center experience with the new Q catheters.","authors":"Michael Griessmair, Christian Maegerlein, Dominik Sepp, Dennis Martin Hedderich, Jannis Bodden, Silke Wunderlich, Claus Zimmer, Jan Kirschke, Maria Berndt-Mück, Martin Renz, Tobias Boeck-Behrens","doi":"10.1007/s00234-026-04026-4","DOIUrl":"https://doi.org/10.1007/s00234-026-04026-4","url":null,"abstract":"<p><strong>Background: </strong>Mechanical recanalization of distal and small medium vessel occlusions (DVOs and MeVOs) is technically challenging and likely associated with higher complication rates. Previous studies have shown promising results using Q aspiration catheters in MeVOs. We report our experience with Q catheters in an even more distal cohort of DVOs and small MeVOs, focusing on safety and efficacy.</p><p><strong>Methods: </strong>We retrospectively reviewed our institutional stroke database for patients with DVOs or MeVOs treated using Q catheters. Baseline characteristics, technical outcomes including modified Thrombolysis in Cerebral Infarction (mTICI) score and modified first pass effect (mFPE), as well as clinical outcomes measured by the 90-day modified Rankin Scale (mRS) were analyzed. Outcomes were stratified by occlusion type and treatment technique. Periprocedural complications and their clinical impact were systematically assessed.</p><p><strong>Results: </strong>57 occlusions in 47 patients were included. Mean age was 75.5 ± 12.7 years. Median National Institutes of Health Stroke Scale score was 7.7 ± 4.6 at admission and 4.9 ± 5.5 at discharge, while the rate of 90-day- mRS ≤ 2 was 37%. 39 were DVOs and 18 small MeVOs. Successful recanalization (mTICI ≥2b) was achieved in 75% overall, with lower rates in DVOs (71%) than MeVOs (83%). Stent retriever-assisted aspiration resulted in higher recanalization rates than aspiration alone (82% vs. 37%). mFPE was achieved in 42%. Periprocedural complications occurred in 9% of cases with no symptomatic intracranial hemorrhage (sICH) or PH2.</p><p><strong>Conclusion: </strong>Q catheters appear to be safe and effective for DVOs and small MeVOs, achieving favorable recanalization rates with an acceptable complication profile. While the study is limited by its small sample size and retrospective design, these findings support the potential of Q catheters as a valuable tool in the treatment of distal and small vessel occlusions. Nevertheless, consistent to the recently published large distal trials, recanalization rates are lower, and complications occur more often in DVOs than in MeVOs, reflecting a different balance between the technical challenges and the smaller expected clinical benefit.</p>","PeriodicalId":19422,"journal":{"name":"Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856819","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 the DTI-ALPS index in neuromyelitis optica spectrum disorder: a cross-sectional study of its correlation with disease duration and disability.","authors":"Antonio Carlos Senra Filho, Felipe von Glehn, Fernando Cendes, Clarissa Yasuda, Alfredo Damasceno, André Monteiro Paschoal","doi":"10.1007/s00234-026-04013-9","DOIUrl":"https://doi.org/10.1007/s00234-026-04013-9","url":null,"abstract":"<p><strong>Purpose: </strong>This study evaluates the utility of the Diffusion-Tensor Imaging Analysis along the Perivascular Space (DTI-ALPS) index as an imaging marker for neuromyelitis optica spectrum disorder (NMOSD). We investigated its correlation with disease duration, clinical severity, and its specificity relative to a Multiple Sclerosis (MS) cohort.</p><p><strong>Methods: </strong>We conducted a cross-sectional study involving patients with NMOSD (n = 21), RRMS (n = 42), and healthy controls (n = 34). DTI-ALPS values were calculated from 3T MRI data using a standardized automated pipeline. Correlations between DTI-ALPS and clinical metrics-including the Expanded Disability Status Scale (EDSS) and disease duration-were analyzed. Comparisons were performed between all three groups to assess the index's ability to differentiate neuroinflammatory pathologies.</p><p><strong>Results: </strong>NMOSD and MS patients demonstrated significantly lower DTI-ALPS values compared to controls (P_CON.NMOSD < 1.03 × 10^- 7 and P_{CON, MS} < 4.03 × 10^- 5, respectively). However, no significant difference was observed between the NMOSD and MS cohorts (P_{NMOSD, MS} = 0,241). In the NMOSD group, a significant negative correlation was found between DTI-ALPS and EDSS (R = -0.462, P = 0.011), whereas no such association was observed in the MS cohort (R = -0.035, P = 0.772). Furthermore, disease duration strongly correlated with the ALPS index (R = -0.799, P = 0.013), with patients exceeding five years of disease showing a more pronounced decline in perivascular diffusivity.</p><p><strong>Conclusion: </strong>The DTI-ALPS index is a sensitive marker for capturing cumulative neuroinflammatory and neurodegenerative changes in NMOSD. Interestingly, the correlation with clinical disability was unique to the NMOSD group, suggesting that the index may track disease progression differently across demyelinating pathologies. While the index successfully differentiates patients from healthy individuals, the comparable values found in the MS cohort suggest that DTI-ALPS reflects a common pathway of image biomarker for glymphatic or microstructural impairment across demyelinating diseases rather than NMOSD-specific pathology. These findings support its use as a rapid, complementary metric for monitoring disease progression at a group level.</p>","PeriodicalId":19422,"journal":{"name":"Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856835","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":"Beyond the total NIHSS score: association between impaired level of consciousness and early neurological deterioration in mild large vessel occlusion stroke.","authors":"Qiangze Ji, Liangliang Sun, Zenghui Liu, Hanqing Zhao, Jing Yu, Ying Zhang, Kaiyue Duan, Lili Guo, Qiuyi Zhang","doi":"10.1007/s00234-026-04019-3","DOIUrl":"https://doi.org/10.1007/s00234-026-04019-3","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the association between baseline level of consciousness (LOC), measured by National Institutes of Health Stroke Scale (NIHSS) item 1a, and early neurological deterioration (END) in patients with mild anterior circulation large vessel occlusion (LVO) stroke (NIHSS < 6) treated with medical management.</p><p><strong>Methods: </strong>Consecutive patients were retrospectively included between January 2019 and December 2024. END was defined as an increase of ≥ 4 points in the NIHSS score within 24 h after symptom onset, attributable to ischemic causes. Multivariable logistic regression analysis was performed to identify factors associated with END.</p><p><strong>Results: </strong>A total of 247 patients were included, of whom 53 (21.5%) developed END. The incidence of END increased stepwise with worsening baseline LOC, occurring in 15.2%, 41.7%, and 63.2% of patients with NIHSS item 1a scores of 0, 1, and 2, respectively (P for trend < 0.001). After multivariable adjustment, NIHSS item 1a score 1 (adjusted odds ratio [aOR] 2.21, 95% confidence interval [CI] 1.05-4.63) and score 2 (aOR 3.76, 95% CI 1.42-9.97), larger Tmax > 6 s volume (per 20-mL increase; aOR 1.19, 95% CI 1.08-1.44), and internal carotid artery occlusion (aOR 2.34, 95% CI 1.02-5.38) were associated with END. Receiver operating characteristic analysis yielded areas under the curve of 0.760 and 0.828 for NIHSS item 1a thresholds of ≥ 1 and 2, respectively, in predicting END.</p><p><strong>Conclusion: </strong>In medically managed mild LVO stroke, impaired LOC was associated with an increased risk of END, highlighting its potential as a complementary bedside indicator.</p>","PeriodicalId":19422,"journal":{"name":"Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840660","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":"Bleomycin electroembolotherapy in a rare mixed extra- and intracranial scalp-dural vascular malformation with high- and low-flow components.","authors":"Francesco Mistretta, Riccardo Russo, Stefano Molinaro, Umberto Amedeo Gava, Mattia Mastrangelo, Jacopo Brino, Andrea Discalzi, Floriana Nardelli, Margherita Viglione, Francesco Praticò, Mauro Bergui","doi":"10.1007/s00234-026-04020-w","DOIUrl":"https://doi.org/10.1007/s00234-026-04020-w","url":null,"abstract":"<p><p>A rare extra- and intracranial mixed vascular malformation involving the scalp soft tissues and the dura mater, associated with skull erosion, and characterized by both a low-flow capillary-venous component and a high-flow component consistent with a dural arteriovenous fistula involving a diploic vein, represents a complex therapeutic challenge. An 18-year-old man underwent multimodal imaging for evaluation of non-disabling headaches and intermittent pulsatile sensation. MRI and CT demonstrated focal calvarial erosion, while MRA and digital subtraction angiography revealed a direct shunt between the middle meningeal artery and a diploic vein, in addition to a diffuse low-flow capillary-venous network supplied by branches of the external carotid artery and the middle meningeal artery. Treatment consisted of selective embolization of the shunt using n-butyl cyanoacrylate, followed by intra-arterial bleomycin administration combined with reversible electroporation targeting the slow-flow component. At 6-month follow-up, the patient was asymptomatic, with only localized alopecia at electrode application sites. Follow-up MRI demonstrated near-complete resolution of the dural component and marked reduction of the extracranial lesion, indicating a favorable clinical and radiological outcome.</p>","PeriodicalId":19422,"journal":{"name":"Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840786","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":"IDH status shapes glioma oncotopy: voxel-wise mapping of 644 adult diffuse gliomas.","authors":"Freya Garhöfer, Yeong Chul Yun, Sabine Wolf, Katharina Holz, Johann M E Jende, Anja Hohmann, Philipp Vollmuth, Martin Bendszus, Corrado Santarosa, Karl-Olof Lövblad, Heinz-Peter Schlemmer, Felix Sahm, Sabine Heiland, Varun Venkataramani, Felix T Kurz","doi":"10.1007/s00234-026-03991-0","DOIUrl":"https://doi.org/10.1007/s00234-026-03991-0","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to characterize the anatomical and imaging features of adult-type diffuse gliomas across histomolecular subtypes.</p><p><strong>Methods: </strong>Clinical 3-Tesla brain MRI images from 644 patients with pathologically confirmed adult-diffuse glioma before treatment was retrospectively evaluated: 527 IDH-wildtype glioblastoma, 71 astrocytoma, and 46 oligodendroglioma. Pre- and post-contrast T1-weighted, T2-weighted and FLAIR sequences were part of the MRI protocol. Contrast-enhancing tumors and non-enhancing lesions (NEL) were automatically segmented using HD-GLIO. We used a voxel-wise Fisher-exact-test followed by random-permutation (ADIFFI) to identify regions with higher occurrence of tumor associated with IDH-mutation status or 1p/19q-codeletion status. Mann-Whitney-U-test was used to compare signal intensities in CET and NEL across the three different subtypes of adult-diffuse glioma investigated here.</p><p><strong>Results: </strong>We observed a significant correlation of IDH-mutant gliomas with a predominance in the frontal lobe adjacent to the rostral extension of the lateral ventricles. IDH-wildtype tumors had larger NEL volumes than IDH-mutant gliomas (p < 0.0001). Signal intensity analysis demonstrated consistently lower T1w and T1-CE values and higher T2w and FLAIR values in IDH-mutant gliomas (all p < 0.0001). Oligodendrogliomas showed higher signal intensity on T1-CE images compared to astrocytomas (p = 0.035).</p><p><strong>Conclusion: </strong>We analyzed a large radio-genomic patient cohort consisting of glioblastoma, astrocytoma and oligodendroglioma. Our findings are in line with previously analyzed smaller patient cohorts. Our findings underline the importance of the IDH-mutation for determining tumor location and potentially point to a cell of origin along the rostral extension of the lateral ventricles.</p>","PeriodicalId":19422,"journal":{"name":"Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840809","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":"Safety and efficacy of combined subdural evacuating port system (SEPS) and middle meningeal artery embolization (MMAE) for chronic subdural hematomas: a systematic review and meta-analysis.","authors":"John Jy Zhang, Keng Siang Lee, Rambert Wee, Christen Ong, Sai Liang, Julian Han, Tien Meng Cheong","doi":"10.1007/s00234-026-04011-x","DOIUrl":"https://doi.org/10.1007/s00234-026-04011-x","url":null,"abstract":"<p><strong>Background: </strong>The combined use of the Subdural Evacuating Port System (SEPS) and middle meningeal artery embolization (MMAE) offers a less invasive alternative to conventional surgical drainage of chronic subdural hematomas (cSDH), while potentially maintaining low retreatment rates. We aimed to perform the first systematic review and meta-analysis to evaluate the outcomes of combined SEPS and MMAE in the treatment for cSDH.</p><p><strong>Methods: </strong>Searches of the following three electronic databases were undertaken: Ovid Medline, Ovid Embase, and Cochrane Central Register of Controlled Trials. Searches were performed in each database from its inception until 19th August 2025. The primary outcome was recurrence requiring re-evacuation. Secondary outcomes included perioperative complications, mortality, length of stay (LOS), functional and radiological outcomes.</p><p><strong>Results: </strong>Four studies comprising 341 cases of SEPS and MMAE were included. Pooled recurrence rate after SEPS and MMAE was 9.1% (95% CI: 5.6-13.2, I² = 0% [p = 0.521]). Reported complication rates varied between studies (4.0% and 30.4). Pooled 30-day mortality was 2.1% (95% CI: 0.2-5.3, I² = 23.6% [p = 0.271]). Pooled mean length of stay (LOS) was 6.6 days (95% CI: 6.1-7.2, I² = 0% [p = 0.478]). Functional outcomes were variably reported. In two studies, 64% and 75.4% of patients achieved postoperative mRS 0-2, with one of these studies showing an improvement in mRS among 53% of patients. In another study, median discharge mRS was 2 (IQR 2-3). Radiological improvement including reduction in the volume of cSDH or midline shift, was reported in two studies.</p><p><strong>Conclusion: </strong>Preliminary evidence of combined SEPS and MMAE demonstrated its potential to achieve promising retreatment rates for well-selected cSDH patients. However, these results are hypothesis-generating, and prospective randomized controlled trials are required to inform on its feasibility and safety for routine clinical use.</p>","PeriodicalId":19422,"journal":{"name":"Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841083","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":"Carotid stump syndrome in radiation-induced bilateral carotid occlusive vasculopathy.","authors":"Xin Yee Liew, Carolyn Orr, Ferry Dharsono, Jerome Freund, David Prentice, Paul Parizel","doi":"10.1007/s00234-026-04017-5","DOIUrl":"https://doi.org/10.1007/s00234-026-04017-5","url":null,"abstract":"<p><strong>Purpose: </strong>To document the occurrence of radiation-induced vasculopathy as a delayed complication in the treatment of head and neck cancers.</p><p><strong>Methods: </strong>We present the case history and review the imaging findings in a 51-year-old man with a history of nasopharyngeal cancer, treated with radiotherapy 10 years prior to admission, who presented with a stroke syndrome. The pathophysiology, clinical and imaging features, and development of collateral pathways due to radiation-induced vasculopathy are discussed.</p><p><strong>Results: </strong>The patient had occlusion of the right and left common carotid arteries, as well as of the left internal carotid artery and the right subclavian artery. The proximally occluded vessels ended in tapered \"stumps\". CT angiography with Maximum Intensity Projection (MIP) and 3D Volume Rendering Technique (VRT) displayed the collateralisation of the occluded arteries via the thyrocervical trunks and ascending cervical arteries.</p><p><strong>Conclusion: </strong>Radiation therapy for head and neck cancer is associated with a significantly increased incidence of radiation-induced vasculopathy and cerebrovascular ischaemic events. Carotid stump syndrome should be considered as a rare but serious cause of recurrent stroke and stroke-like symptoms.</p>","PeriodicalId":19422,"journal":{"name":"Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840834","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":"Chronic optic neuropathy: correlating MR imaging features and etiology.","authors":"Steven Cajamarca, Rohini N Nadgir, Suyang Li, Dariah Lauer, Yael Steinberg, Suleman Khan, Artem Kaliaev, Osamu Sakai, V Carlota Andreu Arasa","doi":"10.1007/s00234-026-04000-0","DOIUrl":"https://doi.org/10.1007/s00234-026-04000-0","url":null,"abstract":"<p><strong>Background and purpose: </strong>Chronic optic neuropathy (CON) represents a final common pathway of sustained optic nerve injury from diverse etiologies, yet characteristic MRI features and their clinical correlations are not well defined. This study evaluated the predominant MR imaging findings of non-compressive CON and correlated these patterns with underlying clinical etiologies.</p><p><strong>Materials and methods: </strong>We retrospectively identified 186 patients with MRI reports referencing chronic optic neuritis or neuropathy from 2009 to 2024. Of these, 162 met inclusion criteria, defined as high-resolution orbital MRI and ophthalmologic confirmation of CON. Three reviewers assessed optic nerve caliber, T2/FLAIR signal abnormality, and post-contrast enhancement. Ophthalmologic records were reviewed to determine clinical laterality and etiology.</p><p><strong>Results: </strong>Among 162 patients, 66 (40.7%) demonstrated bilateral and 96 (59.3%) unilateral MRI findings. The predominant imaging pattern across etiologies was optic nerve atrophy (< 3 mm) with increased T2/FLAIR signal, present in 125 patients. Enhancement was rare (n = 7). Laterality mismatches were frequent: 42 patients (25.9%) demonstrated bilateral MRI findings despite unilateral clinical involvement, while 13 (8.0%) had bilateral clinical disease with unilateral imaging abnormalities. The leading etiologies were multiple sclerosis (20.0%), glaucoma (16.7%), unspecified optic neuritis (13.0%), and post-traumatic injury (5.5%). Across all etiologies, chronic changes were characterized by atrophy with or without T2/FLAIR hyperintensity. Enhancement, when present, was associated with recent or subacute demyelination.</p><p><strong>Conclusion: </strong>Optic nerve atrophy with increased T2/FLAIR signal and absent enhancement constitutes the dominant MRI pattern of non-compressive CON, most likely reflecting chronic axonal degeneration rather than active inflammation. These findings reliably indicate chronic optic nerve injury but have limited specificity for etiology. Frequent imaging and clinical laterality discrepancies suggest subclinical or asymmetric disease. MRI should therefore be interpreted in conjunction with ophthalmologic evaluation when determining the underlying cause of CON.</p>","PeriodicalId":19422,"journal":{"name":"Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147818402","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":"Endovascular treatment versus microsurgical clipping in elderly patients with aneurysmal subarachnoid hemorrhage: A systematic review and meta-analysis.","authors":"George Brown, Danesh Sivanesan, Siddarth Kannan, Conor Gillespie, Isabel Siow, Rory Fairhead, Marco Mancuso-Marcello, Paul Bhogal, Nivedh Dinesh, Bolem Nagarjun, Shiong Wen Low, Ira Sun, Jia Xu Lim, Anil Gopinathan, Tze Phei Kee, Wickly Lee, Nicole Keong, Tien Meng Cheong, Tseng Tsai Yeo, Vincent Diong Weng Nga, Julian Han, Ramez Kirollos, Keng Siang Lee","doi":"10.1007/s00234-026-04009-5","DOIUrl":"https://doi.org/10.1007/s00234-026-04009-5","url":null,"abstract":"<p><strong>Background: </strong>The optimal treatment strategy for elderly patients with aneurysmal subarachnoid hemorrhage (aSAH) remains uncertain. While endovascular coiling and surgical clipping are both established interventions, age-related physiological vulnerability and comorbidity burden may alter the risk-benefit profile. We performed a systematic review and meta-analysis to compare outcomes between these two modalities in elderly patients with aSAH.</p><p><strong>Methods: </strong>Searches of PubMed, Embase, Scopus, and Cochrane CENTRAL were conducted from inception to 20th July 2025. The definition of elderly patients aged ≥ 60 years was adopted as per the World Health Organization. Primary outcomes were favorable functional outcome (modified Rankin Scale [mRS] 0-2) and mortality. Secondary outcomes were delayed cerebral ischemia (DCI), delayed hydrocephalus and rebleed.</p><p><strong>Results: </strong>Twenty studies (2 randomized controlled trials, 18 observational) were included. A total of 44,526 patients were included with 24,724 aneurysms clipped and 19,802 coiled. The mean age was 72.1 years in the coiling cohort and 72.8 years in the clipping cohort. Aneurysm location was anterior in 94% of cases. Hypertension was more prevalent in the coiling cohort (OR 1.25, 95% CI 1.03-1.51; p = 0.024). There was no association between poor-grade WFNS score 4-5 and treatment modality (OR = 0.89, 95% CI: 0.62-1.27; p = 0.471). There was no significant difference between coiling and clipping in achieving favorable outcomes (OR 1.07, 95% CI 0.75-1.52; p = 0.712) or mortality (OR 0.89, 95% CI 0.64-1.23; p = 0.471). Rates of delayed cerebral ischemia, hydrocephalus, and rebleeding were also comparable.</p><p><strong>Conclusions: </strong>Current evidence, derived from mainly observational studies, does not suggest difference in functional outcomes nor mortality between endovascular coiling and surgical clipping in elderly patients with aSAH. However, significant selection bias, variability in age definitions and the lack of randomized comparisons should be considered when interpreting these findings.</p>","PeriodicalId":19422,"journal":{"name":"Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147818336","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":"Efficacy and safety of bridging intravenous thrombolysis prior to endovascular treatment in patients over 80 years old with acute ischemic stroke.","authors":"Yimin Chen, Isabel Siow, Keng Siang Lee, Qibei Dai, Xiao Xiao, Apar Garg, Anil Gopinathan, Cunli Yang, Benjamin Tan, Mingxue Jing, May Zin, Hock Luen Teoh, Ching Hui Sia, Mingzhu Feng, Jicai Ma, Lue Chen, Sijie Zhou, Zunbao Xu, Yongting Zhou, Yuzheng Lai, Wenhong Peng, Yihua He, Mohammad Mofatteh, Thanh Nguyen, Suyue Pan, Leonard Yeo","doi":"10.1007/s00234-026-03997-8","DOIUrl":"https://doi.org/10.1007/s00234-026-03997-8","url":null,"abstract":"<p><strong>Introduction: </strong>Endovascular treatment (EVT) is an effective treatment for patients with acute ischemic stroke (AIS); however, it remains to be determined if treatment with intravenous thrombolysis (IVT) prior to EVT confers any benefit in octogenarians and older. This study aimed to address if bridging tPA has improved functional outcomes or complications in patients 80 years and older.</p><p><strong>Methods: </strong>This multicentre retrospective cohort study included patients 80 years old and above who underwent endovascular therapy for large vessel occlusion acute ischaemic stroke in 10 compressive stroke centres across China and Singapore between 2018 and 2024. Clinical and procedural factors of patients in Singapore and China were compared using multivariate binary logistic regression. The primary outcome measured was 3-month functional independence defined as modified rankin scale (mRS) 0-2. Secondary outcomes included 3-month independent ambulation as defined as mRS 0-3, 3-month mortality rates and achieving successful recanalization. Data on intracranial haemorrhage was also collected.</p><p><strong>Results: </strong>Bridging IVT was not associated with improvement in 3-month functional independence (24.47% vs. 20.97%; p = 0.505), improvement in 3-month independent ambulation (32.80% vs. 41.49%; p = 0.512), 3-month mortality rates (36.17% vs. 33.33%; p = 0.637) or increased rates of successful recanalisation (89.36% vs. 87.63%; p = 0.672),. Instead, patients who underwent bridging IVT had higher rates of haemorrhage compared to patients who did not undergo bridging IVT even after adjusting for confounding factors (OR = 1.921; 95% CI 1.026-3.596; p = 0.041).</p><p><strong>Conclusion: </strong>The findings of this study suggest that bridging IVT prior to EVT may not improve functional outcomes or mortality rates. However, it appears to be associated with an increase in risk of intracranial haemorrhage.</p>","PeriodicalId":19422,"journal":{"name":"Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147818319","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}