Stroke (Hoboken, N.J.)最新文献

{"title":"Intensive Versus Standard Systolic Blood Pressure Targets Following Successful Endovascular Thrombectomy for Acute Ischemic Stroke: A Systematic Review With Frequentist and Bayesian Meta-Analysis.","authors":"Ahmed Ibrahim, AlMothana Manasrah, M Rafiqul Islam, Ibrahim Khalil, Ali Saad Al-Shammari, Sohaila Mourad, Elsayed Balbaa, Hossam Elbenawi, Yasar Sattar, Aristeidis H Katsanos, Giuseppe Andò","doi":"10.1161/SVIN.125.002200","DOIUrl":"10.1161/SVIN.125.002200","url":null,"abstract":"<p><strong>Background: </strong>Blood pressure management following successful reperfusion with endovascular thrombectomy for acute ischemic stroke due to large vessel occlusion remains debated. This meta-analysis aimed to determine whether intensive systolic blood pressure (SBP) management improves clinical outcomes compared with a standard approach after endovascular thrombectomy.</p><p><strong>Methods: </strong>We systematically searched PubMed, Scopus, Embase, and Web of Science through October 2025 for relevant randomized controlled trials comparing intensive (SBP target <140 mm Hg) versus standard (SBP target <180 mm Hg) management. The primary efficacy and safety outcomes were functional independence (modified Rankin Scale score, 0-2) and any intracranial hemorrhage, respectively. We performed frequentist and Bayesian random-effects meta-analyses, supplemented by trial sequential analysis.</p><p><strong>Results: </strong>Six randomized controlled trials comprising 1972 patients were included. In frequentist analysis, intensive SBP management was associated with a significantly reduced likelihood of achieving functional independence (risk ratio, 0.83 [95% CI, 0.73-0.93]). Bayesian analysis confirmed this harmful effect (posterior median risk ratio, 0.83 [95% credible interval, 0.7-1.02]), with a posterior probability of benefit of only 3.2%. Furthermore, ordinal shift analysis indicated that intensive SBP management was associated with a significant shift toward worse functional outcomes across the full modified Rankin Scale score distribution (common odds ratio, 1.26 [95% CI, 1.10-1.44]), a finding supported by a low posterior probability of benefit of 2.1%. No significant differences were observed in the risk of any intracranial hemorrhage (risk ratio, 1.05 [95% CI, 0.96-1.16]). The corresponding Bayesian analysis yielded a posterior risk ratio estimate of 1.05 (95% credible interval, 0.90-1.21) for any intracranial hemorrhage, with a posterior probability of benefit of 23%. Trial sequential analysis indicated that the cumulative evidence reached the boundary for harm and futility for the primary efficacy and safety outcomes, respectively.</p><p><strong>Conclusions: </strong>In patients with acute ischemic stroke following successful endovascular thrombectomy, intensive SBP management was associated with worse functional outcomes and provided no clear safety benefit. These findings support a standard, guideline-based SBP management strategy over an intensive approach.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 3","pages":"e002200"},"PeriodicalIF":3.1,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847343","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":"Medical Complications After Mechanical Thrombectomy: Analysis of Trends in US Admissions From 2010 to 2022.","authors":"Yaxel Levin-Carrion, Ahmed Sabra, Aydan Kahriman, Caryn J Ha, Momotaz Begum, Ronald Miller, Nemanja Novakovic, Anurag Sahoo, Trong Huynh, Nader El Seblani, David Landzberg, Amit Singla, Kunakorn Atchaneeyasakul, Priyank Khandelwal, Fadar Oliver Otite","doi":"10.1161/SVIN.125.002147","DOIUrl":"10.1161/SVIN.125.002147","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The prevalence of medical complications in patients with acute ischemic stroke undergoing mechanical thrombectomy (MT) is sparse. This study aims to quantify and evaluate trends in common medical complications in acute ischemic stroke MT hospitalizations in the United States over the past decade.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We utilized the 2010 to 2022 Nationwide Inpatient Sample (NIS) to conduct a serial cross-sectional study. All adult acute ischemic stroke MT hospitalizations (aged ≥18 years) were identified using &lt;i&gt;International Classification of Diseases&lt;/i&gt; codes. We computed the weighted prevalence of acute myocardial infarction, acute renal failure, deep venous thrombosis, gastrointestinal bleeding (GIB), pneumonia, pulmonary embolism, sepsis, and urinary tract infection (UTI) across age and sex strata. Poisson regression models were utilized to evaluate the association of each complication with hospital-level factors and to study trends over time.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 233 812 weighted MT hospitalizations (50.3% women; mean age 68.9 years), 35.9% had at least 1 complication. The age and sex-standardized prevalence was highest for acute renal failure (15.6%), UTI (11.3%), and pneumonia (6.8%), whereas acute myocardial infarction (4.7%), GIB (2%), deep venous thrombosis (4.3%), and pulmonary embolism (1.9%) were less common. Disparities in complication burden were present by age/sex (GIB: women 18-39 years, 0.9%; men ≥80 years, 2.7%). Age/sex-standardized prevalence of acute renal failure increased ≈2-fold across the study period from 11.0% in 2010 to 18.5% in 2022, whereas prevalence of sepsis, pulmonary embolism, and acute myocardial infarction also increased marginally over time (all &lt;i&gt;P&lt;/i&gt;-for-trend &lt;0.05; deep venous thrombosis rose 5%/y in women; UTI declined in both sexes; pneumonia declined in men (all &lt;i&gt;P&lt;/i&gt;-for-trend &lt;0.05); GIB was stable. We report prevalence risk ratios (PRRs); for example, PRR 1.81 indicates an 81% higher prevalence. Each unit increase in National Institutes of Health Stroke Scale score (UTI PRR, 1.02 [95% CI, 1.01-1.02]) and early mechanical ventilation (pneumonia PRR, 3.41 [95% CI, 3.03-3.83]) were associated with increased prevalence of all complications, while intravenous thrombolysis was associated with lower risk for most events (UTI: PRR, 0.91 [95% CI, 0.86-0.96]; sepsis: PRR, 0.77 [95% CI, 0.70-0.84]; pneumonia: PRR, 0.81 [95% CI, 0.75-0.88]). Mortality fell from 23.7% (2010) to 11.8% (2022), whereas routine home discharge rose from 11.9% to 19.9%. All complications were associated with a lower likelihood of routine home discharge, and all except UTI were associated with an increase in in-hospital mortality (sepsis: PRR, 1.55 [95% CI, 1.42-1.67]).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The prevalence of pneumonia and UTI declined, whereas acute renal failure prevalence more than doubled in acute ischemic stroke MT hospitalizations over the last dec","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 3","pages":"e002147"},"PeriodicalIF":3.1,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847321","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":"RNS60 RESCUE Trial in Acute Ischemic Stroke: Post Hoc Analysis in Participants Enrolled <12 Hours Since Last Known Well.","authors":"Supurna Ghosh, Jordan Dubow, Christopher G Favilla, Jocelyn Sutherland, Andreas Kalmes, Jarrad Mock, David Chiu, Wayne M Clark, Sameer A Ansari, Jessie Nicodemus-Johnson, Landon Anderson, David S Liebeskind, Marc Fisher, Ryan A McTaggart","doi":"10.1161/SVIN.125.002196","DOIUrl":"10.1161/SVIN.125.002196","url":null,"abstract":"<p><strong>Background: </strong>Adjunct therapies are needed for patients with acute ischemic stroke who fare poorly, despite standard-of-care endovascular thrombectomy (EVT). RESCUE (A Randomized, Blinded, Placebo-Controlled, Parallel Group Design to Determine the Safety of RNS60 in Large Vessel Occlusion Stroke Patients Undergoing Endovascular Thrombectomy) tested the cytoprotective experimental drug RNS60 in patients with acute ischemic stroke, adjunct to EVT with or without prior standard-of-care thrombolytic treatment.</p><p><strong>Methods: </strong>RESCUE, a randomized, placebo-controlled, double-blind, phase 2 study, enrolled 83 participants eligible for EVT within 24 hours since last known well, assigned 1:1:1 to 48-hour infusion of RNS60 0.5 mL/kg per hour, RNS60 1.0 mL/kg per hour, or placebo 1.0 mL/kg per hour. A post hoc analysis evaluated safety and efficacy in a subpopulation of 62 participants enrolled within 12 hours since last known well. Efficacy end points included modified Rankin Scale score, post-EVT infarct growth, National Institutes of Health Stroke Scale score, Barthel Index score, EuroQoL, and duration of hospitalization and discharge disposition.</p><p><strong>Results: </strong>In this subpopulation, RNS60 1.0 mL/kg per hour was generally safe and well tolerated and reduced post-EVT infarct growth compared with placebo (least squares mean difference, 22.2; <i>P</i>=0.05). Of the participants treated with RNS60 1.0 mL/kg per hour, 72.2% achieved a 90-day modified Rankin Scale score of 0 to 2, and 72.2% achieved a Barthel Index score ≥95, compared with 36.8% (for both measures) of those receiving placebo, although the differences were not statistically significant (<i>P</i>=0.09 for both modified Rankin Scale and Barthel Index scores). Consistent but smaller differences to placebo were seen in the RNS60 0.5 mL/kg per hour group, which suggests a dose-dependent effect of RNS60. Participants in the RNS60 1.0 mL/kg per hour group were also released earlier from the hospital than those in the placebo group (mean [SD]: 6.0 [5.10] days versus 10.8 [6.84] days; mean difference [SE], -4.8 [1.99]; <i>P</i>=0.02). Final infarct volumes at 48 hours post-EVT correlated with modified Rankin Scale scores at day 90 for RNS60 1.0 mL/kg per (Pearson <i>r</i>=0.65; <i>P</i>=0.005) and placebo (<i>r</i>=0.65; <i>P</i>=0.007).</p><p><strong>Conclusions: </strong>Effects of RNS60 were favorable compared with placebo in the analyzed subpopulation, warranting further investigation in this population.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT04693715.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 3","pages":"e002196"},"PeriodicalIF":3.1,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847266","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":"Preoperative Embolization of a Spinal Metastasis With Obsidio Conformable Embolic: A Case Report.","authors":"Aaron Higginbotham, Kevin Le, Lane Fry, Ari Williams, Frank A De Stefano, Ernest J Madarang, Koji Ebersole, Jeremy Peterson","doi":"10.1161/SVIN.125.002270","DOIUrl":"10.1161/SVIN.125.002270","url":null,"abstract":"","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 3","pages":"e002270"},"PeriodicalIF":3.1,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847338","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":"Five-Year Efficacy and Safety of the FRED Flow-Diverting Stent for Intracranial Aneurysms: Results From a Prospective Cohort.","authors":"Leopoldo Guimaraens, Elio Vivas, Jesus Saldaña, Rafael Mercedes-Terrero, Ernest Balaguer, Dunia Mon, Elisa Cuadrado-Godia, Joan Jiménez-Balado, Angel Ois, Daniel Guisado-Alonso","doi":"10.1161/SVIN.125.002187","DOIUrl":"10.1161/SVIN.125.002187","url":null,"abstract":"<p><strong>Background: </strong>Flow diversion is a well-established endovascular treatment for intracranial aneurysms, yet long-term outcome data remain scarce. Our aim was to report efficacy and safety at 5 years for the flow redirection endoluminal device in a consecutive cohort with protocolized follow-up.</p><p><strong>Methods: </strong>All consecutive patients with intracranial aneurysms treated with a flow redirection endoluminal device between December 2015 and July 2020 at 2 university hospitals were included in a prospective registry. Treatment decisions and procedural protocols were standardized. Clinical and imaging follow-up, including scheduled 3-dimensional rotational digital subtraction angiography, continued through August 2025. The primary end point was complete or near-complete occlusion at 5 years, defined as O'Kelly-Marotta (angiographic grading scale) grades C to D. Ischemic, hemorrhagic, and device-related events were prospectively recorded.</p><p><strong>Results: </strong>A total of 203 patients (mean age, 54.7 years; 77.3% women) with 236 intracranial aneurysms were analyzed. At 5 years, complete or near-complete occlusion (O'Kelly-Marotta grades C-D) was achieved in 225 aneurysms (95.3%), comprising 203 of 211 (96.2%) in the anterior circulation and 22 of 25 (88.0%) in the posterior circulation. Retreatment was required in 5 aneurysms (2.1%), all treated before 2019. Symptomatic complications occurred in 12 of 203 patients (5.9%): 10 ischemic (4.9%) and 2 hemorrhagic (1.0%); no treatment-related deaths, rebleeding, or delayed rupture occurred. One patient had moderate permanent disability, and one died from a contralateral hypertensive hemorrhage deemed unrelated to the device. Asymptomatic device-related findings occurred in 22 of 236 aneurysms (9.3%).</p><p><strong>Conclusions: </strong>Flow redirection endoluminal device achieved durable aneurysm occlusion with a low rate of clinically relevant complications. These findings support sustained efficacy and safety across diverse aneurysm morphologies and locations.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 3","pages":"e002187"},"PeriodicalIF":3.1,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847120","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":"Dose-Specific Intra-Arterial Thrombolysis After Endovascular Thrombectomy for Large-Vessel Occlusion Stroke: A Network Meta-Analysis of Randomized Trials.","authors":"Luiz Eduardo Caliman Frechiani, Helena Libardi Louzada","doi":"10.1161/SVIN.125.002292","DOIUrl":"10.1161/SVIN.125.002292","url":null,"abstract":"<p><strong>Background: </strong>Randomized trials evaluating adjunctive intra-arterial (IA) thrombolysis after endovascular thrombectomy (EVT) for large-vessel occlusion acute ischemic stroke have recently emerged, and the optimal agent and dose remain uncertain. We compared the efficacy and safety of dose-specific IA thrombolysis regimens following successful EVT.</p><p><strong>Methods: </strong>We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials from inception to October 30, 2025, for randomized controlled trials enrolling adults with large-vessel occlusion acute ischemic stroke who achieved angiographic reperfusion after EVT and were randomized to adjunctive IA alteplase, tenecteplase, or urokinase versus EVT alone. We performed a frequentist random-effects network meta-analysis and estimated odds ratios with 95% CIs. Treatments were ranked using P-scores. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and certainty of evidence was evaluated using Grading of Recommendations, Assessment, Development and Evaluation adapted for network meta-analysis.</p><p><strong>Results: </strong>Seven randomized controlled trials comprising 2126 patients (median age ≈69 years; ≈40% women; predominantly anterior circulation stroke) formed a coherent 6-node treatment network. For excellent functional recovery (modified Rankin Scale score, 0-1 at 90 days), IA alteplase 0.225 mg/kg showed higher odds versus control (odds ratio, 1.94 [95% CI, 1.31-2.87]), followed by tenecteplase 0.125 mg/kg (odds ratio, 1.90 [95% CI, 1.12-3.23]). Lower-dose tenecteplase regimens (0.0625 and 0.03125 mg/kg) and urokinase showed attenuated or uncertain effects. No regimen demonstrated a statistically significant difference in symptomatic intracranial hemorrhage or 90-day mortality compared with control, and safety estimates were imprecise. Global heterogeneity and inconsistency were low across outcomes.</p><p><strong>Conclusions: </strong>In this dose-specific network meta-analysis of randomized controlled trials, IA alteplase 0.225 mg/kg and tenecteplase 0.125 mg/kg showed a signal consistent with improved excellent functional recovery after successful EVT for large-vessel occlusion acute ischemic stroke. Effects on broader functional outcomes were attenuated, and safety estimates were imprecise. These findings are hypothesis-generating and should inform the design of future dose-specific randomized controlled trials rather than guide current clinical practice.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 3","pages":"e002292"},"PeriodicalIF":3.1,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847114","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 Therapy for Acute Ischemic Stroke Beyond 24 Hours After Onset: A Nationwide Registry-Based Analysis.","authors":"Ryoma Inui, Kanta Tanaka, Kazunori Toyoda, Sohei Yoshimura, Kaori Miwa, Tomohide Yoshie, Junji Miyazaki, Toshio Machida, Takashi Tsuzuki, Kenichi Morita, Jin Nakahara, Yoshihiro Miyamoto, Kazuo Minematsu, Masatoshi Koga","doi":"10.1161/SVIN.125.002024","DOIUrl":"10.1161/SVIN.125.002024","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate the real-world status of endovascular therapy for acute ischemic stroke >24 hours after onset.</p><p><strong>Methods: </strong>From the data set of Japan Stroke Data Bank, a nationwide, multicenter prospective registry of stroke within 7 days of onset, patients with acute ischemic stroke who underwent endovascular therapy from 2016 through 2021 were included. Patients were categorized into 3 groups according to time from onset to hospital arrival: early (<4.5 hours), late (4.5-24 hours), and very late (>24 hours). The primary outcome was a favorable functional status defined as a modified Rankin Scale (mRS) score of 0 to 2 at discharge for patients with a prestroke mRS score of 0 to 2, and return to prestroke mRS score at discharge for patients with a prestroke mRS score of 3 to 5.</p><p><strong>Results: </strong>A total of 5862 patients were included (median age, 78 years; 42.7% women; median National Institutes of Health Stroke Scale score, 17; 83.8% with prestroke mRS score, 0-2), with 3988 in the early group, 1548 in the late group, and 326 in the very late group. The very late group was younger, had lower National Institutes of Health Stroke Scale scores, and a higher proportion of large artery atherosclerosis. The favorable functional status was achieved in 41.4%, 35.3%, and 45.7% of the early, late, and very late groups, respectively. In multivariable logistic analyses, both the late (adjusted odds ratio, 0.60 [95% CI, 0.52-0.69]) and very late (adjusted odds ratio, 0.72 [95% CI, 0.62-0.83]) groups showed lower odds of achieving a favorable functional status compared with the early group. When stratified by National Institutes of Health Stroke Scale score, achievement of the favorable functional status was less frequent in the late and very late groups, in that order, compared with the early group, particularly when the National Institutes of Health Stroke Scale score exceeded ≈10.</p><p><strong>Conclusions: </strong>In this nationwide registry, patients undergoing endovascular therapy >24 hours showed distinct clinical profiles, with crude outcomes comparable to patients treated in earlier time windows. These findings provide important context for the design and validation of randomized trials.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 3","pages":"e002024"},"PeriodicalIF":3.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138444/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847136","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":"Evaluating the Impact of a System-Wide Prehospital Teleconsultation on Rural Stroke Transportation Efficiency.","authors":"Sona Ohanyan, Emily S Sugars, Victor Carrasco Wall, Mary-Lou Halabi, Jillian M Stang, Jessalyn K Holodinsky, Annette Bredenkamp, Shannon Erfle, Balraj Mann, Gregory Vogelaar, John Montpetit, Mark MacKenzie, Mahesh P Kate, Thomas Jeerakathil, Aravind Ganesh, Andrew M Demchuk, Michael D Hill, Brian H Buck","doi":"10.1161/SVIN.125.002143","DOIUrl":"10.1161/SVIN.125.002143","url":null,"abstract":"<p><strong>Background: </strong>Geographic disparities in urban-rural stroke outcomes are in part due to limited and delayed access to reperfusion therapies such as endovascular thrombectomy. This study evaluated the impact of a prehospital telephone consultation on transportation patterns and efficiency for rural patients with suspected large vessel occlusion stroke.</p><p><strong>Methods: </strong>This retrospective cohort study utilized administrative data from consecutive patients in Alberta, Canada, who underwent an emergency medical services-initiated rural field consultation for suspected acute stroke with a Los Angeles Motor Scale score of ≥4 between April 2017 and March 2023. The impact of field calls on transport efficiency was quantified using a novel metric: the Stroke Speedometer, calculated as the distance from the emergency medical services origin to the final destination (in kilometers) divided by the travel time (in hours).</p><p><strong>Results: </strong>Of the 704 included rural field consultations, 476 patients (67.6%) were directly transported to a comprehensive stroke center, 192 (27.3%) to a primary stroke center, and 36 (5.1%) to a nonstroke center. Direct transport to a comprehensive stroke center was associated with a significantly faster Stroke Speedometer (53±18 versus 44±24 km/h; <i>P</i><0.001), younger patient age (median, 74 years versus 78 years; <i>P</i>=0.005), and increased likelihood of endovascular thrombectomy (adjusted relative risk, 2.25 [95% CI, 1.44-3.50]) compared with initial transport to a noncomprehensive stroke center hospital.</p><p><strong>Conclusions: </strong>A prehospital telephone consultation (ie, rural field call) is feasible and helps identify and facilitate direct transport of rural patients with suspected large vessel occlusion to an endovascular thrombectomy-capable comprehensive stroke center. These findings highlight the value of integrating real-time, neurological consultation early into prehospital workflows to overcome the geographic and logistical barriers that contribute to rural-urban disparities in stroke care. The Stroke Speedometer metric represents a novel approach for assessing and enhancing prehospital stroke logistics.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 3","pages":"e002143"},"PeriodicalIF":3.1,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847056","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":"Impact of Aneurysm Size and Flow Diverter Use on Outcomes After Endovascular Therapy of Unruptured Paraclinoid Aneurysms.","authors":"Kazuhiro Fujishima, Kanta Tanaka, Tetsu Satow, Toshiyuki Fujinaka, Katsunori Asai, Tomohiko Ozaki, Jun C Takahashi, Koji Iihara, Hirotoshi Imamura, Akira Ishii, Yuji Matsumaru, Chiaki Sakai, Shinichi Yoshimura, Nobuyuki Sakai","doi":"10.1161/SVIN.125.002039","DOIUrl":"10.1161/SVIN.125.002039","url":null,"abstract":"<p><strong>Background: </strong>Flow diverters (FDs) are increasingly used for unruptured paraclinoid aneurysms, especially large or giant ones. However, their benefit over conventional endovascular therapy remains unclear. This study evaluated outcomes after endovascular therapy of unruptured paraclinoid aneurysms, with aneurysm size as the primary exposure, and further examined the modifying effect of FD use.</p><p><strong>Methods: </strong>We analyzed data of patients with unruptured paraclinoid aneurysms from the Japanese Registry of Neuroendovascular Therapy 4, a nationwide, multicenter registry enrolling patients who underwent endovascular therapy in 166 Japanese institutions from 2015 to 2019. The primary outcome was worsening in the modified Rankin Scale score ≥1 at 30 days. Secondary outcomes included ischemic and hemorrhagic complications. Outcomes were compared by aneurysm size (<10 mm versus ≥10 mm) and further stratified by FD use.</p><p><strong>Results: </strong>Of 3860 patients (3326 women, median age 59 years), 3048 had aneurysms <10 mm and 776 had aneurysms ≥10 mm. FD use was more common in aneurysms ≥10 mm (64.2% versus 3.0%). Worsening in modified Rankin Scale score occurred in 5.3% with aneurysms ≥10 mm versus 2.0% with <10 mm (adjusted odds ratio, 2.28 [95% CI, 1.48-3.49]). Ischemic complications were more frequent with larger aneurysms (5.7% versus 4.0%, <i>P</i>=0.035), though not significant after multivariable adjustment (adjusted odds ratio, 1.26 [95% CI, 0.87-1.84]). Hemorrhagic complication rates were similarly low across groups. There was no significant difference in modified Rankin Scale score worsening by FD use, regardless of aneurysm size. FD use was associated with significantly fewer ischemic complications in aneurysms ≥10 mm (3.2% versus 10.1%, <i>P</i><0.001), but not in aneurysms <10 mm (4.3% versus 3.9%, <i>P</i>=0.88; <i>P</i> for interaction=0.03).</p><p><strong>Conclusions: </strong>Endovascular embolization of unruptured paraclinoid aneurysms ≥10 mm was associated with a higher morbidity compared with aneurysms <10 mm. FD use may reduce ischemic complications in larger aneurysms; however, this benefit was not clearly reflected in 30-day functional outcomes.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 3","pages":"e002039"},"PeriodicalIF":3.1,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847329","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":"Neurointerventional Advances in 2025.","authors":"Amol Mehta, Sunil A Sheth, Ashutosh P Jadhav","doi":"10.1161/SVIN.125.002280","DOIUrl":"10.1161/SVIN.125.002280","url":null,"abstract":"","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 3","pages":"e002280"},"PeriodicalIF":3.1,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847308","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}