Stroke (Hoboken, N.J.)最新文献

{"title":"Progress in Intra-Arterial Stem Cell Therapy for Ischemic Stroke: A Review.","authors":"Nadia McMillan, Roshni Thakkar, Shreyas Kuddannaya, Vishal Chavda, Shashvat Desai, Dileep R Yavagal","doi":"10.1161/SVIN.125.001648","DOIUrl":"10.1161/SVIN.125.001648","url":null,"abstract":"<p><p>Stroke kills almost 130 000 Americans each year-that is 1 in every 18 deaths. Until 2015, intravenous thrombolysis was the only approved acute reperfusion therapy available but has several limitations in its application. The last decade has witnessed tremendous advances in acute ischemic stroke therapy, particularly with the widespread use of mechanical thrombectomy as a first-line treatment for patients presenting with acute large vessel occlusion. Mechanical thrombectomy is superior to standard medical care about recanalization and has one of the lowest number-needed-to-treat for disability in all of medicine. Yet, only about 1 in 2 patients with large vessel occlusion stroke achieve functional independence. This is due to several patient factors but ultimately results from cell death and limited ability of the brain for repair. Stem cell therapy as an adjunct to intravenous thrombolysis or mechanical thrombectomy in ischemic stroke is currently under investigation in both translational and clinical models to improve recovery. Intra-arterial delivery, in particular, has gained attention because clinicians can readily combine it with thrombectomy to directly target the stroke lesion in a minimally invasive manner. In this review, we summarize the current literature on stem cell therapy for stroke, highlighting translational considerations, delivery challenges, and clinical applications, with particular emphasis on the procedural, safety, and practice implications of intra-arterial administration for neurointervention.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 5","pages":"e001648"},"PeriodicalIF":3.1,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radial Versus Femoral Access for Carotid Artery Stenting in Patients With Carotid Artery Stenosis: Protocol of the Multicenter RACE-CAS Randomized Trial.","authors":"Rui Liu, Kang Yuan, Xuehan Liu, Wen Sun, Xianjun Huang, Hao Wang, Tingyu Yi, Xin Liu, Qin Yin, Ruidong Ye, Minmin Ma, Wusheng Zhu, Xinfeng Liu","doi":"10.1161/SVIN.126.002482","DOIUrl":"10.1161/SVIN.126.002482","url":null,"abstract":"<p><strong>Background: </strong>Carotid artery stenting (CAS) is conventionally performed via transfemoral access (TFA), which requires prolonged postoperative immobilization and is associated with access-site complications. Transradial access (TRA) has emerged as an alternative to TFA for suitable vessel caliber and improved patient comfort. However, high-quality evidence directly comparing TRA and TFA for CAS in patients with carotid artery stenosis is still lacking. This trial aims to determine whether TRA is noninferior to TFA in patients treated with CAS due to carotid artery stenosis.</p><p><strong>Methods: </strong>The RACE-CAS (Radial Versus Femoral Access for Carotid Artery Stenting in Patients With Carotid-Artery Stenosis) is a prospective, randomized, open-label, blinded-end point, multicenter trial. Up to 3000 patients with carotid artery stenosis will be randomly assigned in a 1:1 ratio to receive CAS treatment via either TRA or TFA across 70 centers in China.</p><p><strong>Results: </strong>The primary end point is the incidence of death, new-onset stroke, myocardial infarction, or severe hemorrhage events within 30 days post-procedure, analyzed in the full analysis set using risk differences with 2-sided 95% CIs for noninferiority testing. Key secondary outcomes include the successful rate of CAS and angiography, patient comfort, and each individual component of the primary end point within 48 hours or 30 days post-procedure. Safety outcomes include all adverse events and severe adverse events. The RACE-CAS trial enrolled its first patient on July 3, 2022, and recruitment is ongoing. At the time of manuscript submission, the sample size required for the first planned interim analysis had been completed.</p><p><strong>Conclusions: </strong>The RACE-CAS trial will provide definitive, high-level evidence on the comparative efficacy and safety of TRA versus TFA for carotid artery stenting in patients with carotid artery stenosis, with the goal of guiding clinical practice.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT05416853.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 5","pages":"e002482"},"PeriodicalIF":3.1,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: Cerebral Foreign Body Granulomatous Reaction Secondary to Hydrophilic Polymer Embolization Post-Mechanical Thrombectomy: A Case Report and Overview of Differential Diagnosis.","authors":"Kaiying Wang, Sam White, Esther Quick, Stephen Bacchi, Rebecca Scroop, Rudy Goh, Karyn Boundy","doi":"10.1161/SVIN.0000000000000003","DOIUrl":"https://doi.org/10.1161/SVIN.0000000000000003","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1161/SVIN.125.002264.].</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 5","pages":"e000003"},"PeriodicalIF":3.1,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Garden.","authors":"Swetha Sriramoju","doi":"10.1161/SVIN.126.002701","DOIUrl":"https://doi.org/10.1161/SVIN.126.002701","url":null,"abstract":"","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 5","pages":"e002701"},"PeriodicalIF":3.1,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diving MCA and First-Pass Effect: A Subgroup Analysis From the ARISE II Study.","authors":"Yazan Ashouri, Mohammad AlMajali, Amit Chaudhari, Tommy Andersson, Jeffrey L Saver, Alex Bou Chebl, Saif Bushnaq, Nicholas Liaw, Hormozd Bozorgchami, Marc Ribo, Varun Chaubal, Heinrich P Mattle, René Chapot, Ana Paula Narata, Olivier François, Ashutosh P Jadhav, Jonathan A Grossberg, Christian Heiner Riedel, Alejandro Tomasello, Wayne M Clark, Hannes Nordmeyer, Eugene Lin, Raul G Nogueira, Albert J Yoo, Tudor G Jovin, Adnan H Siddiqui, Osama O Zaidat","doi":"10.1161/SVIN.125.002247","DOIUrl":"10.1161/SVIN.125.002247","url":null,"abstract":"<p><strong>Background: </strong>The impact of internal carotid artery tortuosity on achieving first-pass effect in mechanical thrombectomy has been described; however, middle cerebral artery (MCA) tortuosity remains understudied. We investigated the association of MCA tortuosity with radiographic and functional outcome using quantitative and qualitative measures.</p><p><strong>Methods: </strong>The ARISE II study (Analysis of Revascularization in Ischemic Stroke With EmboTrap) was used to identify patients with anterior circulation stroke. MCA tortuosity was calculated using the Inflection Count Metric by 2 readers blinded to the angiographic/clinical outcomes. The total cohort was trichotomized into 3 groups (A, B, and C) based on M1 tortuosity tertiles, with group A representing the lowest tertile and group C representing the highest tertile. The primary efficacy end point was the achievement of first-pass expanded Thrombolysis in Cerebral Ischemia reperfusion ≥2c. A good functional outcome was defined as a 90-day modified Rankin Scale score of 0 to 2. Baseline and procedural data were compared between groups.</p><p><strong>Results: </strong>A total of 168 patients with M1 or M2 occlusion and measurable MCA tortuosity were identified. Patients in group C were more likely to have renal disease and hyperlipidemia, whereas patients in group A were more likely to have hypertension (<i>P</i><0.05). There were no significant differences in the National Institutes of Health Stroke Scale score at presentation or the Alberta Stroke Program Early Computed Tomography Score between groups. First-pass effect was more likely in group A than in groups B and C (51.8% versus 37.5% and 26.8%, respectively; <i>P</i>=0.024). The rate of final expanded Thrombolysis in Cerebral Ischemia reperfusion ≥2c was higher in group A (87.5%) versus in groups B and C (77.8% and 66%, respectively; <i>P</i>=0.026); achieving modified Rankin Scale score of 0 to 2 was more likely in group A (77.8%) versus in groups B and C (74.5% and 52.7%, respectively; <i>P</i>=0.008). There were no differences in distal emboli or symptomatic intracranial hemorrhage. First-pass effect and angiographic outcomes were consistent with standard angle of curvature tortuosity.</p><p><strong>Conclusions: </strong>Patients with higher MCA tortuosity were less likely to achieve first-pass effect, successful reperfusion, and good functional outcome at 90 days postmechanical thrombectomy for acute ischemic stroke.</p><p><strong>Registration: </strong>URL: http://clinicaltrials.gov; Unique identifier: NCT02488915.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 5","pages":"e002247"},"PeriodicalIF":3.1,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Reperfusion in Basilar Artery Occlusion Stroke Managed With Tenecteplase Versus Alteplase Before Endovascular Treatment.","authors":"Dylan N Wolman, Rahul R Karamchandani, Kwadwo Darko, Tyler M Bielinski, Nitin Goyal, Jeremy B Rhoten, Mahesh V Jayaraman, Christian T Sidebottom, Bradley A Gross, Alhamza R Al-Bayati, Mohamed F Doheim, Matthew K Tobin, Anoop Chinthala, Avi Gajjar, Justin Mascitelli, Matthew R Webb, Jan-Karl Burkhardt, Kyle W Scott, Visish Srinivasan, Daniel Tonetti, Manisha Koneru, David J Altschul, Dhrumhil Vaishnav, Sumeet Multani, Thana Theofanis, William J Ares, Je Yeong Sone, Ramin Zand, Sasan Bahrami, Jiang Li, Gary Defilipp, Dale Strong, Radmehr Torabi, Krisztina Moldovan, Clemens M Schirmer, Raul G Nogueira, Bradley N Bohnstedt, Alexandra R Paul, Philipp Hendrix","doi":"10.1161/SVIN.126.002392","DOIUrl":"10.1161/SVIN.126.002392","url":null,"abstract":"<p><strong>Background: </strong>Timely reperfusion is a critical determinant of favorable outcomes in basilar artery occlusion (BAO) stroke. We aimed to examine whether the choice of thrombolytic agent predicts early reperfusion (ER) in BAO stroke managed with tenecteplase versus alteplase before endovascular treatment.</p><p><strong>Methods: </strong>This was a retrospective, multicenter US cohort of consecutive patients with BAO from 14 stroke centers treated with tenecteplase or alteplase within 4.5 hours of last known well before endovascular treatment. The primary end point was ER, defined as angiographic ER (expanded Thrombolysis in Cerebral Infarction grade 2b to 3 on the first diagnostic angiogram), or clinical ER, defined as substantial neurological improvement precluding endovascular treatment and a good functional outcome (modified Rankin Scale score 0-3).</p><p><strong>Results: </strong>Among 163 patients with BAO and a median last known well-to-needle time of 135 minutes (interquartile range, 100-193) and last known well-to-puncture time of 228 minutes (interquartile range, 166-307), ER was observed in 27 (16.6%) patients. Rates of ER were comparable between tenecteplase (14/75, 18.7%) and alteplase (13/88, 14.8%; adjusted odds ratio, 1.082 [95% CI, 0.444-2.631]; <i>P</i>=0.862). In addition, rates of angiographic ER and clinical ER subgroups did not differ between thrombolytic agents. Higher Basilar Artery on Computed Tomography Angiography scores and a nonatherothrombotic cause independently predicted ER. In multivariable analysis, a good functional outcome was associated with younger age, lower stroke burden, and shorter last known well-to-puncture time.</p><p><strong>Conclusions: </strong>In BAO treated within 4.5 hours of last known well, tenecteplase and alteplase produced comparable early reperfusion rates. Achieving ER did not modify the association between thrombolytic agent and good functional outcome, consistent with rapid thrombectomy in patients with no ER.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 5","pages":"e002392"},"PeriodicalIF":3.1,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Computed Tomography-Based Imaging Scores in Basilar Artery Occlusions: A Comparison of Predictive Abilities for Functional Outcomes.","authors":"Ronda Lun, Parshva Shah, Lia Carolina Franco, Carlo W Cereda, Michael Mlynash, Nicole Yuen, Abid Y Qureshi, Archana Hinduja, Seena Dehkharghani, Adam E Goldman Yassen, Kevin Li-Chun Hsieh, Dan Victor Giurgiutiu, Dan Gibson, Emmanuel Carrera, Fana Alemseged, Tobias D Faizy, Jens Fiehler, Marco Pileggi, Bruce Campbell, Claire Wells, Jeremy J Heit, Gregory W Albers","doi":"10.1161/SVIN.125.002185","DOIUrl":"10.1161/SVIN.125.002185","url":null,"abstract":"<p><strong>Background: </strong>Posterior circulation large-vessel occlusion strokes have significant morbidity and mortality, but patient selection for acute interventions remains understudied. Multiple computed tomography (CT)-based scores exist, including the CT perfusion-based critical area perfusion score (CAPS), CT angiography-based basilar artery treatment management and posterior circulation CT angiography scores, and CT angiography source image or noncontrast CT-based posterior circulation Alberta Stroke Program Early CT Score, but their predictive values for long-term outcomes after thrombectomy have not been directly compared.</p><p><strong>Methods: </strong>We conducted a retrospective multicenter cohort study of patients with basilar artery occlusions treated with endovascular thrombectomy. Four CT-based scores were assessed: posterior circulation Alberta Stroke Program Early CT Score, basilar artery treatment management score, posterior circulation CT angiography score, and CAPS. The primary outcome of interest for the study was a favorable functional outcome at 3 months (modified Rankin Scale score, 0-3). We calculated sensitivity, specificity, positive and negative predictive values, and generated receiver operating characteristic curves measuring area under the curve (AUC), which were compared with nonparametric methods.</p><p><strong>Results: </strong>Ninety-eight patients were included for analysis, with an average age of 64.9 ± 15.6 years. The median National Institutes of Health Stroke Scale score was 13.5 (interquartile range, 7.0-23.0). AUC values were highest for the CAPS (AUC, 0.72 [95% CI, 0.63-82]) and lowest for the posterior circulation CT angiography score (AUC, 0.57 [95% CI, 0.45-0.68]; <i>P</i>=0.019). There was a trend toward the CAPS outperforming the basilar artery treatment management score (AUC, 0.66 [95% CI, 0.55-0.77]) and posterior circulation Alberta Stroke Program Early CT Score (AUC, 0.63 [95% CI, 0.52-0.75]) though this was not statistically significant (<i>P</i>=0.29 and <i>P</i>=0.23, respectively). CAPS ≤3 demonstrated 100% sensitivity and negative predictive value (95% CI, 92.6-100.0%; 95% CI, 75.7-100.0%, respectively) for good outcome but had low specificity (24.0% [95% CI, 14.3-37.4]).</p><p><strong>Conclusions: </strong>The CT perfusion-based CAPS had the best performance for predicting good functional outcome at 3 months and had high sensitivity and negative predictive values though our finding is limited by the small number of patients who had CAPS >3. The CAPS should be validated in prospective studies.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 5","pages":"e002185"},"PeriodicalIF":3.1,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"At-Home BCI Rehabilitation Therapy for Chronic Upper Extremity Deficit After Stroke (BCI-REHAB): A Randomized Trial.","authors":"Eric C Leuthardt, Seth J Wilk, Lauren Souders, Kelly B Carr, Robert Coker, Gregory E Wilding, Dorothee Zuleger, Benjamin T Acland, Alexandre R Carter","doi":"10.1161/SVIN.126.002345","DOIUrl":"10.1161/SVIN.126.002345","url":null,"abstract":"<p><strong>Background: </strong>At-home stroke rehabilitation methods have strong potential to supplement limited clinical resources, but realizing that potential for survivors in the chronic phase of recovery requires developing and validating more effective options than the home exercise programs typically used today. BCI-REHAB (At-Home BCI Rehabilitation Therapy for Chronic Upper Extremity Deficit After Stroke) compared an at-home brain-computer interface (BCI) therapy system (IpsiHand System) versus an at-home exercise program for improving upper extremity function in patients with chronic hemiparetic stroke.</p><p><strong>Methods: </strong>Participants aged 18 to 85 years with a history of stroke ≥6 months before enrollment and right or left upper extremity paresis or plegia were screened and randomly assigned to either an at-home exercise program or to a BCI electroencephalogram system coupled to a range-of-motion assist handpiece. Participants completed 12 weeks of at-home therapy (5 sessions per week). The primary outcome was the change in the Upper Extremity Fugl-Meyer Assessment from baseline to 12 weeks.</p><p><strong>Results: </strong>Overall, 109 participants were assessed for eligibility; 85 met the inclusion criteria and were randomized (43 intervention, 42 control). Of the 42 control participants, n=17 declined to participate further due to dissatisfaction with study arm assignment. A total of 62 participants were analyzed for the primary outcome (37 intervention, 25 control). The primary outcome (mean change) was significantly higher in the BCI group (6.0 [95% CI, 3.9-8.1]; <i>P</i><0.0001) versus the control group (1.5 [95% CI, -0.1 to 3.1]; <i>P</i>=0.07), with an estimated treatment difference of 4.5 ([95% CI, 1.9-7.1]; <i>P</i>=0.0007). Participants who received the BCI intervention showed an estimated response rate of 55.5% (95% CI, 33.7%-77.2%), compared with 9.6% (95% CI, -2.9% to 22.1%) in the control group. This corresponds to an absolute increase in response of 45.8% ([95% CI, 20.9%-70.8%]; <i>P</i>=0.0003), yielding a number needed to treat of 2.2.</p><p><strong>Conclusions: </strong>At-home BCI therapy provides clinically meaningful improvement in upper extremity function for chronic stroke survivors compared with standard at-home exercise programs.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT05965713.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 5","pages":"e002345"},"PeriodicalIF":3.1,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Timing of Middle Meningeal Artery Embolization and Surgery: Analysis of the EMBOLISE Trial.","authors":"Maxim Mokin, Jared Knopman, Jason M Davies, Ameer E Hassan, Robert E Harbaugh, Alexander Khalessi, Jens Fiehler, Elad I Levy, Bradley A Gross, Ramesh Grandhi, Jason Tarpley, Walavan Sivakumar, Mark Bain, R Webster Crowley, Thomas W Link, Justin F Fraser, Michael R Levitt, Peng Roc Chen, Ricardo A Hanel, Joe D Bernard, Mouhammad Jumaa, Patrick Youssef, Marshall C Cress, Mohammad Imran Chaudry, Hakeem J Shakir, Walter S Lesley, Joshua Billingsley, Jesse Jones, Matthew J Koch, Alexandra R Paul, William J Mack, Joshua W Osbun, Kathleen Dlouhy, Jonathan A Grossberg, Christopher P Kellner, Daniel H Sahlein, Justin Santarelli, Clemens M Schirmer, Paul Mazaris, Jesse J Liu, Aniel Q Majjhoo, Thomas Wolfe, Neil V Patel, Christopher Roark, Adnan H Siddiqui","doi":"10.1161/SVIN.126.002359","DOIUrl":"10.1161/SVIN.126.002359","url":null,"abstract":"<p><strong>Background: </strong>The EMBOLISE trial (The Embolization of the Middle Meningeal Artery With Onyx Liquid Embolic System in the Treatment of Subacute and Chronic Subdural Hematoma) demonstrated that middle meningeal artery embolization as an adjunct to surgical drainage reduces recurrence of symptomatic subacute and chronic subdural hematomas. We performed a subgroup analysis of the EMBOLISE surgical cohort to determine how the timing of embolization relative to surgery impacted various outcomes.</p><p><strong>Methods: </strong>We performed a post hoc subgroup analysis to examine the association of the timing of embolization relative to surgery with the primary end point (hematoma reoperation within 90 days), secondary end points (clinical and radiographic outcomes), and safety end points (serious adverse events, neurological death, all-cause death, and stroke).</p><p><strong>Results: </strong>Middle meningeal artery embolization before surgery (embolization-first group) and middle meningeal artery embolization after surgery (surgery-first group) were performed in 107 and 78 patients, respectively. Demographics and baseline clinical characteristics of the 2 groups were similar. The core laboratory confirmed the procedure to be successful in all patients with similar rates of distal penetration of Onyx into middle meningeal artery branches at the end of the embolization procedure in both groups (49.5% and 48.7%, respectively, <i>P</i>>0.99). Six of 103 patients in the embolization-first group (5.8%) and none in the surgery-first group needed reoperation within 90 days (analysis with observed data, <i>P</i>=0.08). Hematoma volumes at 90 and 180 days were similar except for lower hematoma thickness in the surgery-first group (2.3±3.0 mm versus 4.4±5.6 mm, <i>P</i>=0.03) at 180 days. Clinical and safety outcomes at 30, 90, and 180 days were similar.</p><p><strong>Conclusions: </strong>Performing surgical drainage before embolization in patients with subacute and chronic subdural hematomas may help minimize treatment failures and enhance hematoma resolution.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT04402632.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 5","pages":"e002359"},"PeriodicalIF":3.1,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carotid Revascularization in the Era of Modern Medical Therapy: Is Urgency Still Justified?","authors":"Calvin D De Louche, Alun H Davies","doi":"10.1161/SVIN.126.002500","DOIUrl":"10.1161/SVIN.126.002500","url":null,"abstract":"","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 5","pages":"e002500"},"PeriodicalIF":3.1,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}