Neuroradiology最新文献

{"title":"Large vessel occlusion in a carotid terminus pure arterial malformation treated with mechanical thrombectomy and early re-occlusion.","authors":"Francesco Biraschi, Carlo Cirelli, Luca Milonia, Francesco Arbia, Francesco Diana","doi":"10.1007/s00234-026-04124-3","DOIUrl":"https://doi.org/10.1007/s00234-026-04124-3","url":null,"abstract":"<p><p>Pure arterial malformations (PAMs) are rare arterial anomalies typically considered incidental, and their role in acute large vessel occlusion is not well defined. We describe a case of acute large vessel occlusion occurring in direct anatomical association with a carotid terminus PAM, treated with mechanical thrombectomy and followed by early selective re-occlusion of the malformed segment. Multimodal imaging and clinical history suggested pre-existing hemodynamic compromise and in situ thrombosis with distal embolization. Mechanical thrombectomy across the PAM segment was technically feasible and resulted in distal reperfusion, but durable patency of the malformed tract was not maintained. This case expands the recognized ischemic spectrum of PAM and suggests that selected morphologically complex lesions may behave as hemodynamically unstable substrates rather than incidental vascular variants.</p>","PeriodicalId":19422,"journal":{"name":"Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897718","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":"European Society of Neuroradiology (ESNR).","authors":"","doi":"10.1007/s00234-026-04167-6","DOIUrl":"https://doi.org/10.1007/s00234-026-04167-6","url":null,"abstract":"","PeriodicalId":19422,"journal":{"name":"Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888127","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":"Enlarged perivascular spaces are associated with more severe microstructural damage in white matter lesions among people with relapsing-remitting multiple sclerosis.","authors":"Kai Zhang, Qiyuan Zhu, Xiaojuan Dong, Zhuowei Shi, Zichun Yan, Feiyue Yin, Bin Yang, Yixian Li, Xiaoya Chen, Yongmei Li","doi":"10.1007/s00234-026-04179-2","DOIUrl":"https://doi.org/10.1007/s00234-026-04179-2","url":null,"abstract":"<p><strong>Background and objectives: </strong>Growing evidence has linked MRI-visible perivascular spaces (PVS) to multiple sclerosis (MS) pathogenesis. However, whether PVS are associated with increased microstructural damage in white matter lesions (WML) remains unclear. Using diffusion kurtosis imaging (DKI), we aimed to explore the associations between PVS and the microstructural damage of WML in relapsing-remitting multiple sclerosis (RRMS) people with or without disease-modifying therapies (DMT) and their correlations with clinical biomarkers of disability and cognitive function.</p><p><strong>Methods: </strong>The study included 68 people with RRMS and 47 age- and sex-matched HCs. WML were categorized into four groups based on two factors: whether the lesions were penetrated by perivascular spaces (P_WML vs. NP_WML) through visual assessment, and whether patients received DMT (MS + vs. MS-). The diffusion metrics, including fractional anisotropy (FA), kurtosis fractional anisotropy (KFA), mean diffusivity (MD) and mean kurtosis (MK), were normalized using ROI-specific z-scores derived from HCs and used to assess the microstructural damage in WML. Lesion-wise group comparisons were performed using linear mixed-effects models and Spearman partial correlation analysis between diffusion metrics of WML and cognitive performance and clinical disability were performed.</p><p><strong>Results: </strong>In the MS- and MS+ groups, the MK_index in P_WML was significantly lower than NP_WML (MS-: estimate [95%CI] = -1.23 [-2.24, -0.22], p = 0.009; MS+: estimate [95%CI] = -1.94 [-3.39, -0.49], p = 0.003). In the MS+ group, MK_index and MD_index in P_WML were significantly associated with the Montreal Cognitive Assessment scores in RRMS (MD: r [95%CI] = -0.71 [-0.90, -0.31], FDR-p = 0.016; MK: r [95%CI] = 0.69 [0.27, 0.90], FDR-p = 0.016).</p><p><strong>Conclusion: </strong>WML with PVS involvement exhibited distinct microstructural characteristics compared with WML without PVS involvement. Furthermore, diffusion abnormalities in WML may be related to cognitive performance in RRMS.</p>","PeriodicalId":19422,"journal":{"name":"Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888135","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":"Mapping without tasks: resting-state fMRI for motor and language localization in neuro-oncology.","authors":"Esmat Mahmoud, Taha A E Ashraf, Nada K Abdelsattar, Ayman Nada","doi":"10.1007/s00234-026-04174-7","DOIUrl":"https://doi.org/10.1007/s00234-026-04174-7","url":null,"abstract":"<p><strong>Purpose: </strong>Presurgical functional mapping is essential for maximizing tumor resection while preserving motor and language function. While task-based fMRI (tb-fMRI) is the current non-invasive standard, its utility is substantially limited in patients with aphasia, paresis, or cognitive impairment who cannot comply with active paradigms. Resting-state fMRI (rs-fMRI) offers a task-free alternative, yet its spatial fidelity and clinical validity compared to task-based methods remain under rigorous evaluation.</p><p><strong>Methods: </strong>In this prospective study, we evaluated 12 patients with histologically confirmed brain tumors who underwent rs-fMRI and tb-fMRI for preoperative sensorimotor and language mapping. Motor mapping utilized a bilateral finger tapping block-design paradigm. Language mapping utilized three distinct task paradigms (Silent Word Generation, Rhyming, and Synonym). Spatial concordance was quantified using Dice Similarity Coefficients (DSC), Jaccard Indices, and Receiver Operating Characteristic (ROC) analysis.</p><p><strong>Results: </strong>rs-fMRI demonstrated fair to moderate spatial concordance with tb-fMRI. For motor mapping, the mean DSC was 0.62 ± 0.08 with high specificity (0.93 ± 0.02). In the language domain, rs-fMRI showed the highest concordance with the Silent Word Generation task (DSC 0.63 ± 0.11). Notably, rs-fMRI exhibited superior signal stability, with significantly fewer motion-censored volumes compared to language task paradigms (p < 0.01). While rs-fMRI demonstrated moderate sensitivity (~ 0.62), it achieved high specificity (0.93-0.94) across all domains however the moderate sensitivity indicates that functionally important regions may remain undetected.</p><p><strong>Conclusions: </strong>In this preliminary single-center study, rs-fMRI demonstrates fair to moderate spatial concordance with tb-fMRI and high specificity in delineating core eloquent cortex, though with moderate sensitivity that may leave functionally important regions undetected. The study provides hypothesis-generating evidence supporting the integration of rs-fMRI into multimodal presurgical workflows for neuro-oncology patients who cannot comply with task-based paradigms.</p>","PeriodicalId":19422,"journal":{"name":"Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888136","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":"Volumetric and functional connectivity alterations of the thalamus and thalamic nuclei groups in drug-resistant focal epilepsy: A 7T MRI study.","authors":"Daniel Uher, Lars H M J Vermeer, Jacobus F A Jansen, Stefanie Chambers, Paul A M Hofman, Louis G Wagner, Rick H G J Lanen, Guido Widman, Roy A M Haast, Christianne M Hoeberigs, Albert J Colon, Olaf E M G Schijns, Walter H Backes, Gerhard S Drenthen","doi":"10.1007/s00234-026-04159-6","DOIUrl":"https://doi.org/10.1007/s00234-026-04159-6","url":null,"abstract":"<p><strong>Purpose: </strong>Through its global and extensive connections with multiple brain structures, the thalamus can play an important role in seizure propagation. This study investigated volumetric and functional connectivity alterations of the thalamus and more specifically the thalamic nuclei subgroups using 7T MRI in patients with MRI-negative drug-resistant focal epilepsy (DRE).</p><p><strong>Methods: </strong>Twenty-nine patients with MRI-negative DRE and 49 healthy controls underwent 7T MRI, including T1-weighted and resting-state functional MRI sequences. Thalamic nuclei segmentations were derived using automated segmentation tools and split into anterior (ANT), medial, ventral, and posterior nuclei groups. Functional connectivity with the rest of the brain was assessed using degree centrality (DC). Linear regression models evaluated group differences and relationships with epilepsy characteristics while controlling for age and sex. Asymmetry indices assessed the ipsi- vs. contralateral differences in the patient cohort.</p><p><strong>Results: </strong>Patients showed decreased bilateral medial and increased bilateral ventral relative volumes, alongside a right-sided ANT volume increase, compared with controls. DC was increased in the left posterior and ventral nuclei. Both volume and DC in the medial, ventral, and whole-thalamic ROIs were related to epilepsy duration, while ventral and whole-thalamic DC asymmetry distinguished patients by seizure type and seizure duration.</p><p><strong>Conclusions: </strong>Both structural and functional alterations of the thalamic nuclei groups in patients with DRE were observed. Ventral, medial, and posterior nuclei metrics show promise as imaging biomarkers of disease burden and seizure severity, thus encouraging further research into both structural and functional properties of thalamic nuclei in focal epilepsy.</p>","PeriodicalId":19422,"journal":{"name":"Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888120","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":"Symptomatic cerebral venous outflow resistance responds to stenting even in the absence of intracranial hypertension on manometry: a multicentre study.","authors":"Vishnu Suresh, Siddharth Srinivasan, Heitor Cabral Frade, Tara Samiee, Anqi Luo, Sujani Bandela, Vinu Philip, Zorain Khalil, Aspin Denson, Liam Lynch, Sara Wattier, Daniel Surdell, William Thorell, Mithun Sattur, Michael Abraham, Lee Birnbaum, Nicholas Borg","doi":"10.1007/s00234-026-04172-9","DOIUrl":"https://doi.org/10.1007/s00234-026-04172-9","url":null,"abstract":"<p><strong>Purpose: </strong>The relative contribution of venous outflow obstruction and intracranial pressure (ICP) to symptomatology and treatment response in Idiopathic Intracranial Hypertension (IIH) remains uncertain. Venous sinus stenting (VSS) is indicated in patients with significant trans-stenotic pressure gradients (TPG) and concordant symptoms. A subset of these patients demonstrates conventionally normal superior sagittal sinus (SSS) pressures. As SSS pressure is often interpreted as a surrogate for ICP, it remains uncertain whether these patients derive benefit from VSS.</p><p><strong>Methods: </strong>A multicentre VSS registry was retrospectively queried to identify IIH patients with normal SSS pressure (≤ 15 mmHg). These patients were matched 1:1 to patients with elevated SSS pressure (> 15 mmHg) based on pre-stent TPG. Primary outcomes were improvement in headache, tinnitus and papilledema. Multivariable regression assessed the association between SSS pressure and clinical outcomes, adjusting for residual differences in pre-stent TPG.</p><p><strong>Results: </strong>Among 517 patients undergoing VSS, 33 (6.4%) were eligible for inclusion in the normal SSS pressure cohort (median 12.0 mmHg) and matched to 33 patients with elevated SSS pressures (median 20.0 mmHg). Despite matching, median pre-stent TPG remained lower in the normal SSS group (6.0 vs. 8.0 mmHg, p < 0.01). Rates of headache, papilledema and tinnitus improvement were comparable between groups (82.8% vs. 69.7%, 90.9% vs. 77.3%, and 78.3% vs. 84.6%, respectively). After adjustment for TPG, SSS pressure was not associated with clinical outcomes.</p><p><strong>Conclusion: </strong>VSS appears beneficial even in the absence of intracranial hypertension on manometry. These findings support the relevance of venous outflow resistance in guiding stenting decisions.</p>","PeriodicalId":19422,"journal":{"name":"Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881234","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":"Clinical outcome after rescue intracranial stenting: a comparison of the ACCLINO flex and the CREDO heal stenting platforms after failed mechanical thrombectomy.","authors":"Christoph M Mooshage, Niclas Schmitt, Fabian Preisner, Tim Hilgenfeld, Kianush Karimian-Jazi, Michael O Breckwoldt, Daniel Schwarz, Alexander Hubert, Sophia Hohenstatt, Julius M Kernbach, Alexandra Filipov, Damjan Mirkov, Peter A Ringleb, Christian Herweh, Martin Bendszus, Dominik F Vollherbst, Markus A Möhlenbruch","doi":"10.1007/s00234-026-04165-8","DOIUrl":"https://doi.org/10.1007/s00234-026-04165-8","url":null,"abstract":"<p><strong>Purpose: </strong>Mechanical thrombectomy (MT) is the first-line therapy for patients with acute ischemic stroke due to large vessel occlusion; however, despite substantial advances in MT techniques and devices, mechanical recanalization remains unsuccessful in up to 15% of patients. Intracranial rescue stenting represents a promising option to achieve successful recanalization and good clinical outcomes in patients with failed MT.</p><p><strong>Methods: </strong>In this retrospective, observational single-center analysis 77 consecutive patients who underwent failed MT and a maximum of 4 unsuccessful device passes were included. The ACCLINO flex stent / CREDO^® heal stent were used in 38 / 39 patients. The study endpoint was a clinically favorable outcome defined as mRS ≤ 3 at 90 days.</p><p><strong>Results: </strong>A clinically favorable outcome was achieved in 64.1% (25/39) of patients treated with the CREDO heal stent and in 39.5% (15/38) of patients treated with the ACCLINO flex stents (p = 0.031). Rescue stenting with the CREDO heal stent (aOR 3.51 95% CI 1.11-11.13, p = 0.033), baseline NIHSS (aOR 0.97 95% CI 0.85-0.97, p = 0.005) and pmRS (aOR 0.52 95% CI 0.31-0.89, p = 0.016) were independently associated with a favorable clinical outcome. Baseline characteristics did not differ between both groups.</p><p><strong>Conclusions: </strong>This study suggests that the design of the implanted stent device may influence the clinical outcome. Features such as optimized radial force and thrombogenicity-reducing surfaces of stents used for RIS may improve clinical outcomes of patients treated with intracranial rescue stenting in unsuccessful MT. These findings are hypothesis-generating and require confirmation in prospective, randomized studies.</p>","PeriodicalId":19422,"journal":{"name":"Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881173","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":"Early- versus Late-Window Mechanical Thrombectomy for Isolated M2/M3 Middle Cerebral Artery Occlusions: 90-Day Outcomes and Procedural Characteristics in a Single-Center Cohort.","authors":"Weis Naziri, Marcel Cedric Berger, Stefan Daniel Gheorghe, Philipp Dietrich, Andreas Simgen, Abdallah Aburub","doi":"10.1007/s00234-026-04168-5","DOIUrl":"https://doi.org/10.1007/s00234-026-04168-5","url":null,"abstract":"<p><strong>Background: </strong>Randomized evidence for mechanical thrombectomy (MT) in medium vessel occlusions, particularly beyond 6 h, is heterogeneous. In a secondary analysis of a previously reported single-center cohort, we compared MT for isolated M2/M3 occlusions within versus beyond 6 h from last known well.</p><p><strong>Methods: </strong>Consecutive patients treated between January 2020 and August 2023 were retrospectively stratified by last-known-well-to-groin-puncture time (≤ 6 h vs. > 6 h). The primary outcome was functional independence (modified Rankin Scale [mRS] 0-2) at 90 days. Because all patients underwent MT, superiority over medical management cannot be addressed. Logistic regression was adjusted for age and baseline NIHSS.</p><p><strong>Results: </strong>Seventy-six patients were analyzed (56 early, 20 late). No significant difference was detected in 90-day functional independence (8/20 [40.0%] vs. 22/56 [39.3%]; absolute risk difference + 0.7%, 95% confidence interval [CI] - 24.3 to + 25.7; p = 1.00), the ordinal 90-day mRS (median 3 vs. 3; p = 0.56), or 90-day mortality (15.0% vs. 10.7%; p = 0.69). After adjustment, late-window treatment was not associated with functional independence (adjusted odds ratio 0.75, 95% CI 0.22-2.56). Late-window procedures required more retrieval maneuvers (median 2 [1-3] vs. 1 [1, 2]; p = 0.017) and rescue therapy (50.0% vs. 14.3%; p = 0.004) and numerically achieved complete first-pass reperfusion less often (20.0% vs. 46.4%; p = 0.070). Symptomatic intracranial hemorrhage was numerically higher in the late group (10.0% vs. 1.8%; p = 0.17).</p><p><strong>Conclusions: </strong>No statistically significant 90-day outcome difference was detected, although wide confidence intervals do not exclude clinically meaningful differences and a medical-management comparator was absent. Late-window procedures involved greater procedural effort. Findings are descriptive and hypothesis-generating.</p>","PeriodicalId":19422,"journal":{"name":"Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881228","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":"White matter microstructural alterations correlate with clinical characteristics in craniocervical dystonia.","authors":"Zhebin Feng, Bin Liu, Xinyuan Yan, Zhiguo Ma, Rong Lu, Yanyang Zhang","doi":"10.1007/s00234-026-04085-7","DOIUrl":"10.1007/s00234-026-04085-7","url":null,"abstract":"<p><strong>Background: </strong>To characterize white matter pathology, identify clinical correlates, and explore relevant biomarkers for deep brain stimulation (DBS) outcomes in craniocervical dystonia (CCD) using diffusion tensor imaging (DTI).</p><p><strong>Methods: </strong>We involved 37 CCD patients (22 undergoing bilateral subthalamic DBS [STN-DBS]) and 42 matched healthy controls. Using Tract-Based Spatial Statistics (TBSS) for whole-brain analysis and Automated Fiber Quantification (AFQ) for 20 specific tracts, DTI measurements of fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD) and mean diffusivity (MD) were extracted. Between-group metric comparisons and correlations with clinical features and treatment outcomes were assessed.</p><p><strong>Results: </strong>TBSS revealed reduced FA in left anterior corona radiata and right posterior thalamic radiation, increased AD in splenium of corpus callosum, and widespread elevated MD/RD (p < 0.0125, family-wise error combined threshold-free cluster enhancement corrected). AFQ identified segmental increased MD/RD across several tracts, most notably within anterior thalamus radiation (ATR), corticospinal tract, cingulum cingulate, callosum forceps, and inferior fronto-occipital fasciculus (uncorrected p < 0.01). Microstructural alterations correlated with earlier disease onset, severe baseline blepharospasm, and botulinum toxin exposure (p < 0.01, uncorrected). Crucially, at an uncorrected threshold of p < 0.01, lower MD in the left ATR was associated with greater eye symptom improvement after STN-DBS surgery (r = -0.57, p = 0.009).</p><p><strong>Conclusion: </strong>CCD exhibits distributed white matter microstructural alterations across multiple networks, potentially serving as the neurostructural substrate for motor and non-motor symptoms. Left ATR integrity is negatively associated with DBS outcomes.</p>","PeriodicalId":19422,"journal":{"name":"Neuroradiology","volume":" ","pages":"2997-3008"},"PeriodicalIF":2.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148339472","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 web in patients with embolic stroke of undetermined source undergoing endovascular therapy for anterior circulation large vessel occlusion.","authors":"Juntao Yin, Wan Wang, Xuemeng Zhao, Weiwei Wang, Yu Wang, Tingting Liu, Haikun Luo, Yuqing Wei","doi":"10.1007/s00234-026-04092-8","DOIUrl":"10.1007/s00234-026-04092-8","url":null,"abstract":"<p><strong>Objective: </strong>Carotid web (CaW) is an emerging cause of embolic stroke of undetermined source (ESUS), yet its prevalence and clinical implications among ESUS patients presenting with anterior circulation intracranial large vessel occlusion (LVO) treated with endovascular therapy (EVT) remain unclear.</p><p><strong>Methods: </strong>We conducted a multicenter retrospective cohort study across three tertiary stroke centers, consecutively enrolling adults with acute ischemic stroke due to anterior circulation intracranial LVO (M1/M2) who underwent EVT between January 2017 and November 2025. ESUS was diagnosed after standardized etiologic workup. CaW was assessed on vascular imaging by two blinded neuroradiologists. Patients were stratified into CaW + and non-CaW ESUS groups. Baseline characteristics, procedural parameters, and 90-day functional outcomes assessed by the modified Rankin Scale (mRS) were compared.</p><p><strong>Results: </strong>Among 1170 EVT-treated anterior circulation LVO patients, 263 (22.5%) met ESUS criteria, of whom 40 (15.2%) had ipsilateral CaW. Patients with CaW were more frequently female (52.5% vs. 31.4%; P = 0.047), while baseline NIHSS, ASPECTS, occlusion distribution, reperfusion rates and hemorrhagic complications were similar. Favorable 90-day outcome was more frequent in the CaW-positive group (87.5% vs. 55.2%; P < 0.001). During a median follow-up of 18 months, recurrent ischemic stroke occurred in 28.0% (7/25) of medically treated CaW patients, whereas no recurrence was observed after carotid revascularization.</p><p><strong>Conclusions: </strong>Ipsilateral CaW was identified in approximately 15% of EVT-treated ESUS patients with anterior circulation intracranial LVO and was associated with better functional outcomes without increased hemorrhagic risk. High recurrence under medical therapy warrants prospective evaluation of optimal secondary prevention strategies.</p>","PeriodicalId":19422,"journal":{"name":"Neuroradiology","volume":" ","pages":"2633-2639"},"PeriodicalIF":2.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148345778","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}