Stroke (Hoboken, N.J.)最新文献

{"title":"Standardizing Global Pediatric Stroke Pathways: Insights From a Global Survey Conducted by the Society of Neurointerventional Surgery Pediatric Special Interest Group.","authors":"Mesha Martinez, Aaron Rodriguez-Calienes, Alhamza R Al-Bayati, Joseph J Gemmete, Todd Abruzzo, Karen Chen, Daniel L Cooke, Lucas Elijovich, Johanna T Fifi, Michael T Froehler, Steven W Hetts, Peter Kan, Prakash Muthusami, Gary M Nesbit, Darren B Orbach, Aditya S Pandey, Carmen Parra-Farinas, Monica Smith Pearl, Adam Rennie, Alfred Pokmeng See, Ali Shaibani, Neeraj Chaudhary, Santiago Ortega-Gutierrez","doi":"10.1161/SVIN.126.002317","DOIUrl":"10.1161/SVIN.126.002317","url":null,"abstract":"<p><strong>Background: </strong>To evaluate global stroke pathways in pediatric acute ischemic stroke care, including availability of personnel, imaging practices, hyperacute therapies available, and institutional resources.</p><p><strong>Methods: </strong>A 25-question survey designed by the Society of Neurointerventional Surgery Pediatric Special Interest Group was distributed internationally via pediatric and neurointerventional societies. The survey collected data on institutional settings, stroke team composition, imaging protocols, use of artificial intelligence, and access to thrombectomy and thrombolysis. Responses from 103 stroke care providers were analyzed using descriptive statistics. Participation was voluntary and anonymous, and >1 respondent from the same institution was permitted.</p><p><strong>Results: </strong>Ninety-one of 103 respondents (88%) reported managing pediatric acute ischemic stroke. However, only 65% offered both intravenous thrombolysis and thrombectomy. Computed tomography and computed tomography angiography were the most commonly used first-line imaging modality (34%), whereas perfusion imaging and artificial intelligence tools were underutilized. Pediatric neurologists were the most common decision-makers for thrombolysis (38%). Posterior circulation thrombectomy was widely unavailable (offered at only 45% of centers).</p><p><strong>Conclusions: </strong>Survey results revealed considerable variability in pediatric acute ischemic stroke pathways globally and a lack of standardization in treatment. Disparities in access to imaging, hyperacute therapies, and trained personnel underscore the need for standardization, international collaboration, and the creation of systems utilizing available resources to improve pediatric stroke care.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 4","pages":"e002317"},"PeriodicalIF":3.1,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392791","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":"Endovascular Thrombectomy in Medium and Distal Vessel Occlusions: A Focused Guideline From the Society of Vascular and Interventional Neurology Guidelines and Practice Standards Committee.","authors":"Shahram Majidi, Amol Mehta, Sami Al-Kasab, Kaustubh Limaye, Adam A Dmytriw, Adam de Havenon, Farhan Siddiq, Robin Novakovic, Alexandra L Czap, Ossama Mansour, Cynthia L Kenmuir, Ameer E Hassan, David Liebeskind, Thanh N Nguyen, Waldo R Guerrero","doi":"10.1161/SVIN.125.002314","DOIUrl":"10.1161/SVIN.125.002314","url":null,"abstract":"<p><strong>Background: </strong>The authors present an overview of the current evidence and management recommendations for evaluation and treatment of adults with acute ischemic stroke from distal- and medium-vessel occlusion (DMVO) for endovascular thrombectomy (EVT). The intended audiences are prehospital care providers, physicians, and allied health professionals.</p><p><strong>Methods: </strong>The Society of Vascular and Interventional Neurology Guidelines and Practice Standards committee formed a writing group to conduct a structured literature review on EVT for DMVO-related acute ischemic stroke and to draft practice recommendations in accordance with the Society of Vascular and Interventional Neurology Guidelines and Practice Algorithm. A structured literature search was conducted across PubMed, MEDLINE, and the Cochrane Library from January 2015 through February 2026, supplemented by manual review of reference lists from key studies and conferences. Recommendations were developed with consensus from an expert panel and the Guidelines and Practice Standards committee, with final approval by the Society of Vascular and Interventional Neurology Board of Directors.</p><p><strong>Results: </strong>Data from all randomized controlled trials, prior meta-analyses, and subgroup analyses were extracted to evaluate the latest evidence on the safety and efficacy of EVT in patients presenting with DMVO acute ischemic stroke. The guideline outlines practical considerations for patient selection, procedural technique, and systems of care.</p><p><strong>Conclusions: </strong>These guidelines provide focused practical recommendations based on recent evidence regarding patient selection and decision-making for EVT in patients presenting with acute DMVO. Routine EVT for DMVO is not supported by current evidence; however, performing EVT in patients with disabling acute dominant M2 occlusion remains reasonable.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 4","pages":"e002314"},"PeriodicalIF":3.1,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331429/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392891","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":"Sex Differences in the Protective Effect of Brain Volume: Age Attenuates Protection in Women.","authors":"Javier Gomez-Farias, Ngoc Mai Le, Joseph N Samaha, Bruna Kfoury, Hussain M Azeem, Ritesh Bajaj, Mahnoor Khalid, Freya Kanakhara, Shikha Tripathi, Shayan Shams, Luca Giancardo, Eunyoung A Lee, Robert W Regenhardt, Louise D McCullough, Sunil A Sheth","doi":"10.1161/SVIN.125.002217","DOIUrl":"10.1161/SVIN.125.002217","url":null,"abstract":"<p><strong>Background: </strong>Sex differences in outcomes after acute ischemic stroke are well recognized, but mechanisms remain unclear. This study evaluates whether parenchymal brain volume (PBV), age, and final infarct volume explain sex-specific differences in poststroke disability.</p><p><strong>Methods: </strong>We analyzed a prospectively collected multicenter registry of acute ischemic stroke patients treated between 2015 and 2024. Automated pipelines quantified PBV from noncontrast computed tomography and diffusion-weighted imaging-derived final infarct volume from 24- to 48-hour magnetic resonance imaging. With the primary outcome being 90-day functional independence (modified Rankin Scale score 0-2), sex-stratified logistic regression models evaluated its association with PBV. Stratified logistic and linear models examined sex-specific relationships among covariables, and interaction terms were added to assess effect modification by sex.</p><p><strong>Results: </strong>Among 1103 patients, 48% were women, the median age was 66 (interquartile range, 56-77), the median National Institutes of Health Stroke Scale score was 9 (interquartile range, 4-17), and the median diffusion-weighted imaging-derived final infarct volume was 7.8 (interquartile range, 0.2-36.3). Functional independence at 90 days was achieved in 51.7% of men versus 44.9% of women (<i>P</i>=0.025). In univariable analyses, greater PBV was associated with higher odds of functional independence in both men (odds ratio [OR], 1.30 [95% CI, 1.11-1.53]) and women (OR, 1.35 [95% CI, 1.13-1.61]). After ruling out multicollinearity (mean variance inflation factor, 1.32), multivariable analyses showed a persistent association in men (adjusted odds ratio, 1.30 per 100 cm³ [95% CI, 1.10-1.60]) but not in women (adjusted odds ratio, 1.10 [95% CI, 0.90-1.33]). Each decade of age reduced the odds of functional independence by 30% in women (adjusted odds ratio, 0.70 [95% CI, 0.62-0.79]) versus 15% in men (adjusted odds ratio, 0.85 [95% CI, 0.72-0.97]; <i>P</i> for interaction=0.019). In stratified analyses, age was associated with larger infarcts in women (+4.22 cm³/decade; <i>P</i>=0.033) but not in men ([95% CI, -4.75 to 2.91]; <i>P</i>=0.637).</p><p><strong>Conclusions: </strong>PBV was independently associated with functional independence in men but not significantly in women, in whom stronger age-related associations with infarct size and severity may attenuate its effect. These findings highlight the relevance of sex and brain volume in outcome modeling.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 4","pages":"e002217"},"PeriodicalIF":3.1,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392752","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":"Initial Experience With a Deep Learning Algorithm for Detecting Posterior Circulation Large Vessel Occlusion on Noncontrast Computed Tomography.","authors":"Anderson Brito, Judith Cendrero, Leonardo Tanzi, Leonardo Cruz-Criollo, Nashwa Abdelhakim, Eric Kontowicz, William Davis Haselden, Jorge Cespedes, Victor Salvia, Agustina Urtasun, Cristian Martí, Pere Canals, Tudor G Jovin, Demetrius Lopes, Ansaar Rai, Marc Ribo, Santiago Ortega-Gutierrez","doi":"10.1161/SVIN.125.002250","DOIUrl":"10.1161/SVIN.125.002250","url":null,"abstract":"<p><strong>Background: </strong>Detection of large vessel occlusions using a deep learning (DL) algorithm for the anterior circulation has shown promising results. However, the role of DL algorithms in detecting posterior circulation large vessel occlusion (PC-LVO) remains uncertain. We aimed to evaluate the diagnostic performance of a DL algorithm (Methinks PC-LVO) for detecting PC-LVO using noncontrast computed tomography.</p><p><strong>Methods: </strong>This is a retrospective, multicenter, observational cohort study that included patients with PC-LVO who underwent both noncontrast computed tomography and computed tomography angiography. The diagnostic performance of the DL algorithm was assessed by analyzing sensitivity, specificity, and area under the curve for PC-LVO detection of consecutive PC-LVO strokes. For comparative analysis, the area under the curve of the DL algorithm was also evaluated against the performance of a neuroradiologist interpreting noncontrast computed tomography. Ground truth labels were established through consensus readings by expert neuroradiologists. Subgroup analyses were performed according to clot location (proximal posterior cerebral artery and basilar artery) and National Institutes of Health Stroke Scale (NIHSS) score (NIHSS score ≥6, NIHSS score ≥8, and NIHSS score ≥10).</p><p><strong>Results: </strong>A total of 196 patients were included, of whom 74 patients had PC-LVO. Among these, 43 had basilar artery occlusions, and 34 had proximal posterior cerebral artery occlusions. The overall sensitivity and specificity of the software were 55.4% and 80.9%, respectively, with an area under the curve of 0.72. The neuroradiologist achieved a sensitivity of 27.4% and specificity of 91.8%. Among patients with proximal posterior cerebral artery occlusion, sensitivity was 55.9%, whereas for basilar artery occlusion, it was 53.5%. When stratified by NIHSS score ≥10, sensitivity in the proximal posterior cerebral artery was 56.2%, and for the basilar artery with NIHSS score ≥10, it increased to 61.5%.</p><p><strong>Conclusions: </strong>Our initial experience with a DL algorithm for the detection of PC-LVO showed promising results. However, further improvements are required before the algorithm can be implemented in clinical practice.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 4","pages":"e002250"},"PeriodicalIF":3.1,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392330","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":"Turnover Time in Neuroangiography Suites: Comparison Between Cases Performed at an Ambulatory Neurosurgery Center Versus a Tertiary Hospital.","authors":"Pui Man Rosalind Lai, Vinay Jaikumar, Erika L Leasher, Varun Sridhar, Gustavo M Cortez, Aimee C Degaetano, Elad I Levy","doi":"10.1161/SVIN.125.002286","DOIUrl":"10.1161/SVIN.125.002286","url":null,"abstract":"<p><strong>Background: </strong>Efficient turnover time (TOT) and adherence to first-start time (FST) in operating and angiography suites are critical for optimizing workflow, reducing costs, and maximizing patient satisfaction. Hospitals face challenges in maintaining these metrics due to operational constraints and unexpected emergent cases. Our goal was to compare TOT, FST, and total admission time for elective cases performed in angiography suites at an ambulatory neurosurgery center (ANSC) versus a tertiary hospital (TH).</p><p><strong>Methods: </strong>We conducted a retrospective analysis of data for patients who underwent elective diagnostic or interventional neuroendovascular procedures at the TH or ANSC from January 2024 through October 2024. TOT was defined as the time between the end of one case and the start of the next. FST was defined as the time the first patient of the day entered the suite. In addition, digital subtraction angiography cases at the ANSC were age- and indication-matched with same-day discharge digital subtraction angiography cases from the TH to compare total admission, preprocedural wait, procedural, and postprocedural times (minutes).</p><p><strong>Results: </strong>A total of 1174 procedures were performed at the TH and 155 at the ANSC. Mean TOT was longer at the TH (30.6 ± 25 minutes) than the ANSC (12 ± 2.8 minutes; <i>P</i><0.0001). Mean FST was later at the TH (7:29 am±29 minutes) than the ANSC (7:22 am±21 minutes; <i>P</i>=0.02). In the matched digital subtraction angiography case-cohort analysis, mean total admission time was significantly longer at the TH (TH: 566 ± 148.9 versus ANSC: 279 ± 66.2 minutes; <i>P</i><0.01). This difference was consistent across preprocedural wait (TH: 213.1 ± 120.3 versus ANSC: 103.8 ± 59.6 minutes; <i>P</i><0.001), procedural (TH:59.8 ± 20.7 versus ANSC36.7 ± 10.6; <i>P</i><0.001), and postprocedural (TH: 293.3 ± 107.6 versus ANSC: 138.4 ± 35.9; <i>P</i><0.001) times.</p><p><strong>Conclusions: </strong>Data for ANSC procedures demonstrated significantly improved operational efficiency compared with TH procedures, with shorter TOT, earlier FST, and reduced total admission durations for elective digital subtraction angiography cases. These findings support the growing role of ANSCs in optimizing resource utilization and efficiency while maintaining high-quality patient care.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 4","pages":"e002286"},"PeriodicalIF":3.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392797","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":"Navigating the Complexity and Heterogeneity of Thrombectomy Decision-Making for Medium-Vessel Occlusion Stroke: Where Do We Go From Here?","authors":"Mayank Goyal, Ronda Lun, Johanna Maria Ospel, Aravind Ganesh","doi":"10.1161/SVIN.126.002439","DOIUrl":"10.1161/SVIN.126.002439","url":null,"abstract":"<p><p>Endovascular thrombectomy for medium-vessel occlusion (MeVO) stroke has emerged as a major area of clinical and research uncertainty. Unlike large-vessel occlusions, MeVO stroke encompasses substantial heterogeneity in neurological severity, occlusion location, and vessel caliber, complicating both bedside decision-making and trial design. Recent randomized trials of endovascular thrombectomy for MeVO stroke have produced heterogeneous and sometimes conflicting results, leaving clinicians uncertain about patient selection and equipoise. In this review, we examine how differences in occlusion location, vessel size, and baseline National Institutes of Health Stroke Scale across recent MeVO trials may influence observed treatment effects, safety signals, and interpretation of trial results. We review how procedural risk varies across anatomic and clinical phenotypes and summarize subgroup findings that highlight important limitations of treating MeVO stroke as a uniform entity. We then propose a pragmatic, anatomy- and severity-informed framework to guide clinical decision-making and trial design, delineating scenarios where endovascular thrombectomy is beneficial, those where harm likely outweighs benefit, and a broad intermediate group requiring individualized approaches. Lastly, we discuss implications for future trials, including the need for explicit stratification, reconsideration of outcome measures, and exploration of alternative reperfusion strategies in select MeVO populations.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 4","pages":"e002439"},"PeriodicalIF":3.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392785","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":"Defining Social and Cultural Barriers to Global Stroke Care: A SVIN-Mission Thrombectomy Initiative.","authors":"Fawaz Al-Mufti, Alexandria F Naftchi, Andre Calixte, Eric Feldstein, Aarti Kishore Jain, Nimrod Gozum, Eris Spirollari, Akash Thaker, Jason Singh, Sedna Gandhi, Priyank Khandelwal, Victor Urrutia, Nabeel Herial, Pankajavalli Ramakrishnan, Gabor Toth, Mohamad El-Ghanem, Krishna Amuluru, Viktor Szeder, Jonathan Crowe, Karol Budohoski, Zurab Nadareishvili, Kaustubh Limaye, Fazeel Siddiqui, Hamza Shaikh, Nishita Singh, Hesham Masoud, Sushanth R Aroor, Shashvat Desai, Santiago Ortega-Gutierrez, Tareq Kass-Hout, Kaiz Asif, Dileep Yavagal","doi":"10.1161/SVIN.125.002168","DOIUrl":"10.1161/SVIN.125.002168","url":null,"abstract":"<p><p>Stroke has become the single leading neurological illness that results in neurological disability and is the second most common cause of death worldwide. Approximately 85% of strokes are ischemic, whereas the remaining 15% are hemorrhagic. With the advent of increasingly effective treatment modalities, such as intravenous thrombolytics and endovascular mechanical thrombectomy, there has been a growing disparity in the ability to provide standard of care, despite substantial efforts made in lower- and middle-income countries. substantial effort in high-income countries to provide the current standard of care to patients with stroke, with the hope of improving outcomes. Extensive research has shown that the disparities in treatment among various countries stem from multiple sociocultural barriers and the lack of robust healthcare infrastructure. The societal influences in play include the lack of knowledge of stroke symptoms, cultural beliefs, health, and spiritual fatalism, which are then associated with delayed healthcare-seeking behaviors. As a result, it is imperative to increase access to treatment for patients with stroke to address inequities in stroke care and diminish the global burden of stroke. This narrative review highlights causes of major gaps in stroke treatment infrastructure in several global communities and examines the pertinent sociocultural factors that impede progress in stroke treatment.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 4","pages":"e002168"},"PeriodicalIF":3.1,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392913","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":"Practicing Medicine at Life's Discontinuities.","authors":"Sunil A Sheth, Hussein A Zeineddine","doi":"10.1161/SVIN.126.002434","DOIUrl":"https://doi.org/10.1161/SVIN.126.002434","url":null,"abstract":"","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 4","pages":"e002434"},"PeriodicalIF":3.1,"publicationDate":"2026-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392723","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":"Remote Ischemic Conditioning on Infarct Growth in Patients With Acute Ischemic Stroke: Subgroup Analysis From the RESIST Trial.","authors":"Simon Lysdahlgaard, R A Blauenfeldt, G Andersen, I K Mikkelsen, K D Hougaard, M F Gude, O Gerke, R B Dalby","doi":"10.1161/SVIN.125.002216","DOIUrl":"10.1161/SVIN.125.002216","url":null,"abstract":"<p><strong>Background: </strong>Remote ischemic conditioning (RIC) is a promising cerebroprotective strategy, but its effects on early infarct dynamics are unclear. We assessed whether RIC reduces acute-to-24-hour infarct growth on magnetic resonance imaging in this predefined RESIST substudy (Remote Ischemic Conditioning in Patients With Acute Stroke).</p><p><strong>Methods: </strong>We included consecutive patients with acute ischemic stroke from a single RESIST center where acute and 24-hour magnetic resonance imaging were acquired. Infarcts were automatically segmented on diffusion-weighted images using a combined deep learning algorithm. For the primary analysis, brain infarct volume (mL) was analyzed using a linear mixed-effects model with group (RIC versus sham), scan time (baseline/24 hours), their interaction (group×scan), age, and prehospital stroke severity as predictors. Secondary analyses comprised stratified subgroup analyses by age, sex, smoking, diabetes, hypertension, arterial fibrillation, previous acute ischemic stroke, National Institutes of Health Stroke Scale scores, reperfusion treatment, and change from baseline.</p><p><strong>Results: </strong>Of 384 screened patients with acute ischemic stroke, 346 were analyzed (RIC=162; sham=184) with similar baseline characteristics (age, 71 [interquartile range, 62-80] versus 73 [interquartile range, 64-78] years; female 34% versus 36%). Median infarct growth was similar (RIC, 0.45 [interquartile range, -0.54 to 2.86] versus sham, 0.40 mL [interquartile range, -0.50 to 4.74]). The mean infarct growth from acute to 24-hour magnetic resonance imaging was comparable between the RIC group (6.19 [range, -44.94 to 277.01] mL) and the sham group (5.80 [range, -66.18 to 182.13] mL). No significant differences in infarct growth were found between groups, and subgroup analyses likewise showed no significant differences across National Institutes of Health Stroke Scale score or reperfusion categories.</p><p><strong>Conclusions: </strong>In this RESIST substudy, combined prehospital and early in-hospital RIC was not associated with differences in early diffusion-weighted imaging-based infarct growth compared with sham.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 4","pages":"e002216"},"PeriodicalIF":3.1,"publicationDate":"2026-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392760","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":"Cervical Internal Carotid Artery Reocclusion After Endovascular Thrombectomy in Tandem Occlusion: A Meta-Analysis.","authors":"Alonso Alvarado-Bolanos, Annika Mascarenhas, Chrysi Bogiatzi, Sachin Pandey, Sebastian Fridman","doi":"10.1161/SVIN.125.002165","DOIUrl":"10.1161/SVIN.125.002165","url":null,"abstract":"<p><strong>Background: </strong>Reocclusion after endovascular thrombectomy in tandem occlusions may contribute to disability, but its mechanism and the role of emergent carotid artery stenting remain unclear. We conducted a meta-analysis to evaluate the impact of cervical internal carotid artery (c-ICA) reocclusion on functional outcomes, recurrent ischemic stroke, and the potential benefit of emergent stenting.</p><p><strong>Methods: </strong>We systematically searched Medline, EMBASE, and Scopus for studies reporting c-ICA reocclusion after endovascular thrombectomy for tandem occlusions. The primary outcome was c-ICA reocclusion incidence; secondary outcomes included recurrent ischemic stroke and 90-day functional outcome (modified Rankin Scale score, 0-2). Random-effects models were used. Metaregression, sensitivity, and power analyses were performed.</p><p><strong>Results: </strong>Fifty-one studies (4998 patients: 3444 received emergent carotid artery stenting and 1554 did not) were included. Overall, c-ICA reocclusion incidence was 10.8% (95% CI, 8.0%-14.3%). In patients treated with emergent carotid artery stenting, reocclusion occurred in 10.9% versus 28.2% without stenting (risk difference, -14.7% [95% CI, -20.2 to -9.2]). c-ICA treatment approach was not associated with recurrent ischemic stroke (odds ratio, 1.00 [95% CI, 0.33-3.01]), whereas c-ICA reocclusion was associated with worse functional outcome (odds ratio, 0.45 [95% CI, 0.28-0.71]). Metaregression identified no significant moderators. Sensitivity analyses confirmed adequate power to detect moderate associations.</p><p><strong>Conclusions: </strong>c-ICA reocclusion after endovascular thrombectomy in tandem occlusions is common and associated with worse functional outcome, likely due to infarct progression. Emergent carotid artery stenting reduces reocclusion rates but does not modify the risk of ischemic stroke. Future studies should refine procedural strategies and integrate physiological markers to better characterize the risk of reocclusion and outcomes.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 4","pages":"e002165"},"PeriodicalIF":3.1,"publicationDate":"2026-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392910","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}