Stroke (Hoboken, N.J.)最新文献

{"title":"Impact of Balloon Guide Catheter on Thrombectomy Outcomes in Intracranial Carotid Artery Embolic Occlusion: A Retrospective Cohort Study.","authors":"Jinfeng Miao, Hanrong Dong, Yanmin Wu, Ding-Lai Lin, Xiao-Hui Lin, Zhinan Pan, Li-San Zeng, Wenhuo Chen, Tingyu Yi","doi":"10.1161/SVIN.125.002088","DOIUrl":"10.1161/SVIN.125.002088","url":null,"abstract":"<p><strong>Background: </strong>The balloon guide catheter (BGC) is widely used in endovascular thrombectomy, but evidence of its effect in intracranial internal carotid artery embolic occlusion is limited, and recent randomized trials have reported contradictory outcomes. We aimed to explore the potential association between BGC use and outcomes of thrombectomy in intracranial internal carotid artery embolic occlusion.</p><p><strong>Methods: </strong>Patients with acute intracranial internal carotid artery occlusion from a prospectively maintained 2-center stroke registry were classified according to BGC use. Propensity score matching and overlap weighting were used to balance baseline differences. The primary outcome was functional independence at 90 days (modified Rankin Scale score, 0-2). Secondary outcomes included first-pass complete reperfusion (expanded Thrombolysis in Cerebral Infarction grade 3), distal emboli, and 90-day modified Rankin Scale score shift.</p><p><strong>Results: </strong>Among 397 patients (median age, 72 years; 45.1% men), 90 (22.7%) underwent BGC-assisted endovascular thrombectomy. After 1:2 propensity score matching (84 BGC versus 168 non-BGC), the groups were well balanced. BGC use was associated with higher odds of 90-day functional independence (propensity score matching odds ratio [OR], 2.24 [95% CI, 1.07-4.72]; overlap weighting OR, 1.97 [95% CI, 1.07-3.62]), higher rates of first-pass expanded Thrombolysis in Cerebral Infarction 3 reperfusion (propensity score matching OR, 1.98 [95% CI, 1.09-3.60]; overlap weighting OR, 1.74 [95% CI, 1.05-2.89]), and fewer distal emboli (overlap weighting OR, 0.49 [95% CI, 0.25-0.97]). The 90-day modified Rankin Scale score distribution favored BGC use, but was not statistically significant (<i>P</i>=0.20).</p><p><strong>Conclusions: </strong>In acute intracranial internal carotid artery embolic occlusion, BGC use was associated with better functional outcomes, higher first-pass reperfusion rates, and fewer distal emboli. These findings suggest that BGC may be a beneficial adjunct in this population and warrant validation in prospective trials.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 4","pages":"e002088"},"PeriodicalIF":3.1,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331444/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392184","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":"Beyond the Catheter: Contemporary Aspiration Pump Systems in Neurointerventional Stroke Therapy.","authors":"Sai Sanikommu, Connor Berger, Alejandro N Santos, Caleigh Roach, Victor M Lu, Emade Jaman, Sima M Vazquez, Ahmed Abdelsalam, Romil Singh, Tiffany Eatz, Ali Mortezaei, Alick P Wang, Evan Luther, John W Thompson, Christopher P Kellner, Robert M Starke","doi":"10.1161/SVIN.126.002487","DOIUrl":"10.1161/SVIN.126.002487","url":null,"abstract":"<p><p>Acute ischemic stroke is the greatest cause of morbidity and mortality among cerebrovascular pathologies. Over time, several therapeutic options have been developed for treating patients with stroke, including IV r-tPA (intravenous recombinant tissue-type plasminogen activator) and IV-TNK (intravenous tenecteplase) thrombolysis, and endovascular mechanical thrombectomy, with the latter showing favorable recanalization rates. Stent retrievers and mechanical aspiration, the 2 types of mechanical thrombectomy, are used for acute ischemic stroke due to large-vessel occlusions. The first reported aspiration thrombectomy dates back to 2002, during which a 50 mL syringe was used to generate negative pressure and aspirate a clot. Since then, extensive research and development have transformed aspiration thrombectomy. Penumbra's first system paved the way for present-day aspiration systems in neurointerventional surgery, such as the Penumbra engine and Thunderbolt aspiration systems. Ongoing innovations have focused on improving access to challenging vascular locations and enabling the removal of large thrombi. Over time, aspiration techniques have also evolved. However, despite successful first-pass complete revascularization, a subset of patients continues to experience poor functional outcomes, highlighting the multifactorial nature of stroke recovery. In this review, we outline in detail the historical development of aspiration pump systems in neuroendovascular surgery, describe the different systems and their technical characteristics, highlight the clinical trials evaluating their efficacy, with particular attention to distinctions between devices, and discuss avenues for future growth.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 4","pages":"e002487"},"PeriodicalIF":3.1,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392868","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":"Territorial Stroke in SAMMPRIS: Critical Analyses of Stroke Prevention in Intracranial Atherosclerosis.","authors":"Sheetal Hegde, Muhammad Bilal Tariq, Naoki Kaneko, Jason D Hinman, David S Liebeskind","doi":"10.1161/SVIN.125.002100","DOIUrl":"10.1161/SVIN.125.002100","url":null,"abstract":"<p><strong>Background: </strong>Current guidelines do not support the addition of stenting to maximal medical therapy (MMT) for severe symptomatic intracranial atherosclerotic disease as first-line treatment. This is largely due to the SAMMPRIS trial (Stenting and Aggressive Medical Management Therapy for Preventing Recurrent Stroke in Intracranial Arterial Stenosis) results, which featured a high periprocedural stroke rate. In this study, we examined the rates of ischemic stroke in the territory of the qualifying artery (stroke in territory [SIT]) over time between MMT alone and stent+MMT.</p><p><strong>Methods: </strong>The primary outcome was SIT. Periprocedural stroke was considered <7 days from stent placement. Log-rank analysis, Cox proportional hazards models, and Kaplan-Meier survival curves compared time to SIT between MMT and stent+MMT (day of stenting considered day 0).</p><p><strong>Results: </strong>In total, 435 patients were included (MMT: n=227; stent+MMT: n=208). The SIT event rate was 15.6% (68 events-MMT: n=31/227 (13.7%); stent+MMT: n=37/208 (17.8%). Twenty of the 37 stented patients had periprocedural SIT (7 early; 13 delayed). When periprocedural SIT was excluded, there were zero SIT events in the stent+MMT arm at 30 and 60 days, which was significantly lower than the MMT arm (<i>P</i><0.01). Similarly, at 1 year, stent+MMT had a significantly lower rate of SIT (hazard ratio, 0.47 [95% CI, 0.23-0.98]; <i>P</i>=0.04). The difference in SIT between MMT and stent+MMT was not significant (<i>P</i>=0.2) over the entire follow-up period (1626 days), with 31 strokes in MMT and 17 nonperiprocedural strokes in stent+MMT (<i>P</i>=0.1). Thirteen patients with SIT were stented early (<7 days from qualifying ischemic event) with similar time of stent insertion to SIT compared to delayed stenting (<i>P</i>=0.9). Of patients with stent+MMT and SIT, there was no difference in periprocedural SIT based on early versus delayed stenting (<i>P</i>=0.9). No significant difference in total SIT was seen over time when compared between early and delayed stenting (<i>P</i>=0.6).</p><p><strong>Conclusions: </strong>Contrary to Food and Drug Administration recommendations, periprocedural SIT rates did not vary by time of stenting after qualifying ischemic event. Most SIT was periprocedural, and the rate of SIT over the study period was higher in MMT when excluding periprocedural strokes. These findings are exploratory but may suggest that MMT alone may not be the most effective treatment for intracranial atherosclerotic disease and that with improvements in periprocedural safety, intracranial stenting may remain a viable treatment option.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT00576693.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 4","pages":"e002100"},"PeriodicalIF":3.1,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392726","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":"Full Visualization of Contact Endoscopy for Basal Ganglia Hemorrhage: A Multicenter Retrospective Study Comparing With Microscopy and Neuroendoscopy.","authors":"Shaofei Ni, Aojie Duan, Jiachen Liu, Yanni Zheng, Yubo Ren, Renjie Shou, Fei Wang, Zixuan Wang, Rui Huang, Li Zhang, Shan Gao, Linqiang Zhou, Qiang Zhou, Yanfei Liu, Weiguo Tan, Xigang Yan, Zhouqing Chen, Dengfeng Lu, Boyu Yang, Jing Wang, Xiaoou Sun, Zhong Wang","doi":"10.1161/SVIN.125.002172","DOIUrl":"10.1161/SVIN.125.002172","url":null,"abstract":"<p><strong>Background: </strong>Basal ganglia hemorrhage (BGH) is a severe subtype of spontaneous intracerebral hemorrhage. Surgical intervention remains a critical strategy for reducing hematoma volume, alleviating mass effect, and improving clinical outcomes. This study compared fully visualized contact endoscopy with microscopy and standard neuroendoscopy for BGH treatment.</p><p><strong>Methods: </strong>A retrospective, multicenter, observational cohort study was conducted on patients undergoing surgical evacuation for BGH (n=335) at 8 tertiary medical centers in Suzhou from January 2021 to May 2024, stratified into microscopy (n=217), neuroendoscopy (n=76), and contact endoscopy (n=42) groups. Surgical outcomes and prognostic indicators were systematically evaluated across groups, with multivariable analysis conducted to independently assess the impact of surgical methods on long-term prognosis.</p><p><strong>Results: </strong>Both endoscopic groups showed significantly shorter operation times, reduced blood loss, and shorter intensive care unit stays than the microscopy group (<i>P</i><0.05), with no difference between endoscopic techniques. Endoscopy was associated with lower intracranial infection rates (<i>P</i><0.0167). There were no significant differences in hematoma evacuation rates, neurological scores at 7 days, or functional outcomes (both Glasgow Outcome Scale scores and Karnofsky Performance Status scores) at 3 months. Multivariable analysis identified older age, hypertension, and larger hematoma volume, but not surgical technique, as independent predictors of poor long-term outcome.</p><p><strong>Conclusions: </strong>Microscopy, neuroendoscopy, and contact endoscopy all demonstrated effectiveness for hematoma evacuation and life preservation for BGH. Endoscopic approaches may offer superior perioperative safety profiles without significant long-term outcome differences. Contact endoscopy is a safe and feasible alternative for BGH surgery.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 4","pages":"e002172"},"PeriodicalIF":3.1,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391808","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":"The \"Ticking Time Bomb\" Within.","authors":"Fawaz Al-Mufti","doi":"10.1161/SVIN.126.002523","DOIUrl":"https://doi.org/10.1161/SVIN.126.002523","url":null,"abstract":"","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 4","pages":"e002523"},"PeriodicalIF":3.1,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392768","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":"A Key Distinction in EVT Decision-Making: Accurately Measured Core Volume Is a Prognostic Marker and Accurately Measured Penumbra Volume Is a Predictive Biomarker.","authors":"Amir Molaie, Jeffrey L Saver","doi":"10.1161/SVIN.126.002524","DOIUrl":"10.1161/SVIN.126.002524","url":null,"abstract":"","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 4","pages":"e002524"},"PeriodicalIF":3.1,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392842","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":"Mechanical Thrombectomy as Stroke Management in Pregnancy: A Systematic Review.","authors":"Shahad Al Jebeli, Abdulrahman Al Johani, Mohammed Al Manna, Reem Al Buhairan, Laila Al Qahtani, Joud Makki, Yousef Al Ghamdi, Ziad Al Oraini, Nadia Al Ghilan","doi":"10.1161/SVIN.125.002101","DOIUrl":"10.1161/SVIN.125.002101","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;To assess the safety, efficacy, and maternal and fetal outcome of mechanical thrombectomy (MT) for ischemic stroke in pregnancy, given the increased risk due to physiological cardiovascular and coagulation changes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and registered in the International Prospective Register of Systematic Reviews. Studies were sourced from PubMed, Cochrane Central Register of Controlled Trials, Medical Literature Analysis and Retrieval System Online, and Excerpta Medica Database, including records up to May 2024. All relevant studies reporting on pregnant patients diagnosed with ischemic stroke and treated with MT, either alone or in combination with thrombolytics (tPA [tissue-type plasminogen activator]), were included regardless of study design. Endovascular MT techniques, including stent retrievers and aspiration thrombectomy, were evaluated. Patient demographics and procedural characteristics were extracted and analyzed. Primary maternal stroke-related outcomes included functional independence at 90 days, defined by a modified Rankin Scale (mRS) score of ≤2, and successful recanalization based on a modified Treatment in Cerebral Infarction score of ≥2B. Maternal safety outcomes assessed the occurrence of any complications (deep vein thrombosis/pulmonary embolism and intracranial hemorrhage) and mortality. Neonatal outcomes were evaluated based on mortality and overall health at follow-ups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The database search initially identified 785 records. After removal of duplicates, 143 studies remained for screening. Of these, 46 full-text articles were assessed for eligibility, yielding 16 studies that met the inclusion criteria. Cumulatively, the study included 26 cases, with a mean maternal age of 32.6 years. Stroke occurred most frequently in the first and third trimesters (each n=11/26; 42.3% [95% CI, 23.4-63.1]), followed by the second trimester (n=4/26; 15.4% [95% CI, 4.4-34.9]). MT was performed using various techniques, including a combination of stent retrievers and aspiration thrombectomy (n=11/25; 44.0% [95% CI, 24.4-65.1]), stent retrievers alone (n=5/25; 20.0% [95% CI, 6.8-40.7]), and aspiration thrombectomy alone (n=9/25; 36.0% [95% CI, 18.0-57.5]). Successful recanalization (modified Treatment in Cerebral Infarction score ≥2B) was achieved in 21 of 23 cases (91.3% [95% CI, 72.0-98.9]), with 7 achieving complete reperfusion (modified Treatment in Cerebral Infarction score, 3). No maternal deaths were reported; minor residual neurological symptoms (mRS score, 1) and slight disabilities (mRS score, 2) were observed in 11 cases, while 9 patients had no symptoms at follow-up (mRS score, 0). Among patients with reported follow-up mRS scores, functional independence (mRS score, 0-2) was achieved in 20 of 20 cases (100.0% [95% CI, 83.2-100.0]). Fe","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 4","pages":"e002101"},"PeriodicalIF":3.1,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331421/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392770","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":"Final Infarct Volume as a Surrogate End Point in Anterior Circulation ICAS-LVO Stroke: Post Hoc Secondary Analysis of RESCUE-ICAS.","authors":"Ahmad Abu Qdais, Mustafa Ismail, Ahmed Abdelwahab, Eyad Almallouhi, Shadi Yaghi, Violiza Inoa-Acosta, Francesco Capasso, Michael Nahhas, Robert M Starke, Isabel Fragata, Matthew T Bender, Krisztina Moldovan, Ilko Maier, Jonathan A Grossberg, Pascal Jabbour, Marios Psychogios, Edgar A Samaniego, Jan-Karl Burkhardt, Brian Jankowitz, Mohamad Abdalkader, Ashley Choi, Ameer E Hassan, David Altschul, Justin Mascitelli, Robert W Regenhardt, Stacey Wolfe, Mohamad Ezzeldin, Kaustubh Limaye, Hosam Al Jehani, Muhammad H Niazi, Nitin Goyal, Stavropoula Tjoumakaris, Ali Alawieh, Mohammed Almekhlafi, Eytan Raz, Adam Mierzwa, Syed Zaidi, Alejandro M Spiotta, Kimberly Kicielinski, Jonathan Lena, Zachary Hubbard, Osama O Zaidat, Colin P Derdeyn, Ramesh Grandhi, Thanh N Nguyen, Adam de Havenon, Sami Al Kasab, Mouhammad Jumaa","doi":"10.1161/SVIN.125.002105","DOIUrl":"10.1161/SVIN.125.002105","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Final infarct volume (FIV) on 24-hour magnetic resonance imaging is a well-established imaging biomarker linked to functional recovery after ischemic stroke, yet its prognostic value in intracranial atherosclerosis-related large vessel occlusion remains poorly explored. The impact of adjunct intracranial stenting on both infarct size and progression also remains unclear in this population. This study aimed to examine the association between FIV and clinical outcome, evaluate the effect of adjunct stenting on FIV and infarct progression, and assess the relationship between infarct progression and functional independence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a post hoc secondary analysis of the RESCUE-ICAS registry (Registry of Emergent Large Vessel Occlusion due to Intracranial Stenosis); only patients with anterior circulation large vessel occlusion with magnetic resonance imaging after thrombectomy were included. FIV was measured on diffusion-weighted magnetic resonance imaging performed 24 to 36 hours postthrombectomy. Infarct progression was defined as the difference between baseline computed tomography perfusion infarct volume (cerebral blood flow &lt;30%) on presentation and 24- to 36-hour FIV. The primary outcome was 90-day functional independence (modified Rankin Scale score 0-2). Additional analyses evaluated the association between adjunct intracranial stenting and FIV, and the association between infarct progression and 90-day functional outcome. Associations were analyzed using multivariable logistic regression and inverse probability of treatment weighting.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 417 patients included in RESCUE-ICAS, 203 had anterior circulation intracranial atherosclerosis-related large vessel occlusion and underwent magnetic resonance imaging 24 to 36 hours postthrombectomy. Among these, 80 patients (39%) received adjunct stenting. FIV was independently associated with 90-day functional independence (adjusted odds ratio per 10 mL increase, 0.8 [95% CI, 0.68-0.94]; &lt;i&gt;P&lt;/i&gt;=0.007). Adjunct stenting was associated with a significant relative reduction in FIV, with inverse probability of treatment weighting-adjusted analyses demonstrating a 37.8% lower FIV compared with no stenting (&lt;i&gt;β&lt;/i&gt;=-0.47 [95% CI, -0.93 to -0.02]; &lt;i&gt;P&lt;/i&gt;=0.043). Among 108 patients with baseline computed tomography perfusion data, infarct progression was strongly associated with outcome, with each additional 10 mL associated with ≈25% lower odds of achieving modified Rankin Scale score 0 to 2 at 90 days (adjusted odds ratio, 0.74 [95% CI, 0.60-0.90]; &lt;i&gt;P&lt;/i&gt;=0.004), although infarct progression did not differ significantly between stented and nonstented groups (Δ -9.53 mL [95% CI -37.9 to 18.8]; &lt;i&gt;P&lt;/i&gt;=0.506). In inverse probability of treatment weighting-weighted models adjusted for successful recanalization, stenting was not independently associated with reduced FIV (&lt;i&gt;β&lt;/i&gt;=-0.41; &lt;i&gt;P&lt;/i&gt;=0.066), bu","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 4","pages":"e002105"},"PeriodicalIF":3.1,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392860","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":"Identifying High-Risk Patients With Cerebral Venous Thrombosis for Early Intervention.","authors":"Pichatorn Suppakitjanusant, Myriam Vijil, Chanaka Kahathuduwa, Katie Hodges, Saji Bushnaq, Brittany L Nordhaus, Mohamad Ezzeldin, Saif Bushnaq","doi":"10.1161/SVIN.125.002222","DOIUrl":"10.1161/SVIN.125.002222","url":null,"abstract":"<p><strong>Background: </strong>Cerebral venous thrombosis presents with diverse clinical features, making early recognition of patients at risk for deterioration challenging. The cerebral venous thrombosis score was developed by our group and later renamed the CLOTS-EVT score as a mnemonic to facilitate recall and improve ease of clinical use. This 10-point tool, including decreased consciousness (C), low platelets and sodium (L), absence of oral contraceptive use (O), thrombosis burden >3 sinuses (T), seizure (S), and papilledema (E), was developed to predict early deterioration and guide timely venous thrombectomy. We aimed to externally validate this score.</p><p><strong>Methods: </strong>We retrospectively analyzed adults with cerebral venous thrombosis treated between 2015 and 2017 across 12 centers. Clinical, laboratory, and imaging data were collected, and the CLOTS-EVT score was applied to each patient. Predictive performance was evaluated using sensitivity, specificity, predictive values, and the area under the receiver operating characteristic curve. Correlation with functional outcome at discharge and hospital length of stay was assessed.</p><p><strong>Results: </strong>Eighty patients were analyzed (median age, 38.5 years; 66% female). Headache was the most common symptom; oral contraceptive use was reported in one-third of women. Additional risk factors included pregnancy (7.5%), central nervous system infection (1.25%), malignancy (6.25%), hereditary thrombophilia (3.75%), and smoking (15%). The transverse and sigmoid sinuses were most frequently involved. Anticoagulation was initiated in nearly all patients; 10% underwent endovascular therapy. Overall, 63.8% achieved favorable outcomes, 80% were discharged home, and mortality was 3.8%. In this cohort, 41.3% had decreased consciousness, 47.5% had sodium <139 mEq/L, 38.8% had platelets <225 000/μL, 68.75% were not using oral contraceptives, 25% had thrombosis in >3 sinuses, 20% had seizures, and 22.5% had papilledema. A CLOTS-EVT score ≥4 predicted early deterioration with 82% sensitivity, 61% specificity, and an area under the receiver operating characteristic curve of 0.718. Higher scores correlated with longer hospital stay (r=0.325) and worse functional outcome (r=0.363).</p><p><strong>Conclusions: </strong>The CLOTS-EVT score demonstrated acceptable performance as a predictor of early deterioration in cerebral venous thrombosis. By combining standard clinical, laboratory, and imaging variables, it provides a practical tool for risk stratification and may inform consideration of venous thrombectomy alongside anticoagulation.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 4","pages":"e002222"},"PeriodicalIF":3.1,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392190","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":"Mechanical Thrombectomy for Pediatric Acute Ischemic Stroke With Large Vessel Occlusion: Technical Guide and Case Series.","authors":"Zachary A Sorrentino, Wuyang Yang, Brandon P Lucke-Wold, Danyas Sarathy, Amanda Stanton, Zahra Hasanpour Segherlou, Hunter Hutchinson, Alexandra Stern, Shawna Amini, Alfred P See, Matthew J Koch, Brian L Hoh, Nohra Chalouhi","doi":"10.1161/SVIN.125.002180","DOIUrl":"10.1161/SVIN.125.002180","url":null,"abstract":"<p><strong>Background: </strong>Pediatric acute ischemic stroke is a rare entity, and mechanical thrombectomy (MT) in this population can be technically challenging. We aim to discuss key technical aspects of pediatric MT and report our experience in this population.</p><p><strong>Methods: </strong>Pediatric patients were identified from our prospectively maintained database of MT patients. Inclusion criteria were pediatric patients' age >28 days and <18 years undergoing MT for large vessel occlusion at a single center between 2012 and 2023.</p><p><strong>Results: </strong>Seven patients were included in this case series. Patient age ranged from ≈1 to 17 (10.0±6.2) years. Causes of large vessel occlusion included hypercoagulability disorders, cardiac disorders, and iatrogenic during neurointerventions. Most patients (n=5, 71.4%) had middle cerebral artery or internal carotid artery occlusions. Six patients (85.7%) were successfully treated with MT, achieving modified Thrombolysis in Cerebral Infarction grade 2C or above. Five patients were treated with stent retriever MT and the other 2 patients with aspiration MT alone, with an average of 2.3±1.5 passes total. Five patients (71.4%) made an excellent clinical recovery with a pediatric modified Rankin Scale score ≤2 at last outpatient follow-up (pediatric modified Rankin Scale score, 1.8±1.2). Average follow-up duration was 2.7±2.4 years.</p><p><strong>Conclusions: </strong>Recent advancements in catheter technology have facilitated MT in pediatric patients. Pediatric MT appears to be safe and effective for treating cerebral large vessel occlusions; however, technical limitations can arise secondary to small vessel diameters. A technical guide based on patient age and femoral artery diameter is provided.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 4","pages":"e002180"},"PeriodicalIF":3.1,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392747","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}