Stroke (Hoboken, N.J.)最新文献

{"title":"Clinical and Angiographic Outcomes in Patients With Tandem Occlusion Thrombectomy: Analysis From the ASSIST International Registry.","authors":"Yazan Ashouri, Mohammad AlMajali, Jasmine M Olvany, Amit Chaudhari, Salvador Miralbés, Bharath Naravetla, Alejandro Spiotta, Eugene Lin, Christian Loehr, Mario Martínez-Galdámez, Ryan McTaggart, Luc Defreyne, Pedro Vega, Varun Chaubal, Paul Jenkins, David S Liebeskind, Rishi Gupta, Markus Möhlenbruch, Osama O Zaidat","doi":"10.1161/SVIN.125.002157","DOIUrl":"10.1161/SVIN.125.002157","url":null,"abstract":"<p><strong>Background: </strong>Tandem lesions (TLs) are a subtype of acute ischemic stroke, which involve an extracranial carotid lesion (ie, severe carotid stenosis ≥70%) with large vessel occlusion. While large vessel occlusion has a standard approach with mechanical thrombectomy (MT), the best practice for intervention of the carotid lesion is not well-established. Utilizing data from the ASSIST registry, we investigated the differences in clinical and procedural outcomes between acute versus nonacute stenting.</p><p><strong>Methods: </strong>The ASSIST registry (an international acute ischemic stroke MT prospective study) was utilized to identify the subgroup of patients with acute ischemic stroke secondary to TL who received MT. The TLs were grouped by MT+acute carotid stenting (CAS) versus MT+acute carotid nonstenting. The demographics and clinical outcomes (90-day modified Rankin Scale score) were compared between TL and non-TL groups, and between MT+CAS and MT+acute carotid nonstenting. Multivariable analyses were performed to determine independent predictors of clinical outcomes.</p><p><strong>Results: </strong>A total of 183 of 1270 (14.4%) TLs were identified in the ASSIST registry. MT+CAS was performed in 83 of 183 (45.4%) subjects, and 100 of 183 (54.6%) received MT+acute carotid nonstenting. There are no significant differences at baseline between the 2 groups in the National Institutes of Health Stroke Scale score, Alberta Stroke Program Early Computed Tomography Score, or target vessel. Achieving a modified Rankin Scale score of 0 to 2 at 90 days was 70.9% in the MT+CAS group versus 48.9% in the MT+acute carotid nonstenting group (<i>P</i>=0.001), with a modified Rankin Scale score of 0 to 2 being significantly associated with the MT+CAS group in multivariable analysis (odds ratio, 2.14 [95% CI, 1.01-4.51]). There was no significant difference in mortality or symptomatic intracerebral hemorrhage between the groups.</p><p><strong>Conclusions: </strong>In acute ischemic stroke, secondary to TLs treatment with thrombectomy and acute carotid stenting is associated with improved 90-day functional outcome without an increase in symptomatic intracerebral hemorrhage compared with no acute stenting approach.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT03845491.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 3","pages":"e002157"},"PeriodicalIF":3.1,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847302","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":"Extra-Carotid Arterial Webs: A Single-Center Series and Systematic Review.","authors":"Eric A Grin, Evan G Stein, Lara Balick, Austin Chen, Scott E Kasner, Sara K Rostanski, Erez Nossek, Michela Rosso","doi":"10.1161/SVIN.125.002220","DOIUrl":"10.1161/SVIN.125.002220","url":null,"abstract":"<p><strong>Background: </strong>Carotid webs are increasingly recognized as a cause of ischemic stroke, but less is known about morphologically similar lesions in other arteries. We present the first study characterizing the clinical and radiographic features of extra-carotid arterial webs through a single-center case series and systematic review.</p><p><strong>Methods: </strong>Patients with possible extra-carotid webs were identified from 2017 to 2025 using a natural language processing search of radiology reports at our institution. Candidate cases underwent imaging review with multiplanar and 3-dimensional reconstructions to distinguish webs from fenestrations, vessel tortuosity, dissection, or atherosclerotic plaque. In parallel, we performed a Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review (Web of Science and PubMed, inception to September 2025) to identify published cases of extra-carotid web. Data on demographics, vascular location, imaging modality, clinical presentation, treatment, and outcomes were extracted and synthesized descriptively.</p><p><strong>Results: </strong>Four extra-carotid webs were identified at our institution (3 basilar and 1 subclavian). None were associated with stroke, and all patients remained stable on conservative management during 9 months to 4 years of follow-up. Across 16 published studies, 22 additional extra-carotid webs were identified, yielding 26 patients in aggregate (mean age, 52.7 years; 61.5% male). The vertebral artery was the most common site (53.8%), followed by the basilar (30.8%) and subclavian (15.4%) arteries. Ten patients with vertebral or basilar web presented with posterior circulation ischemic stroke, with recurrent events in 4 patients. Most patients were managed with antiplatelet therapy or observation, while 3 vertebral webs with recurrent stroke were successfully treated with stenting.</p><p><strong>Conclusions: </strong>Extra-carotid webs share morphological and clinical features with carotid webs and may represent a unified disease spectrum of cervical artery webs. Vertebral and basilar webs, though rare, may be an underrecognized source of posterior circulation stroke. Recognition of these lesions may broaden the differential for cryptogenic stroke though the lack of histopathologic visualization remains a critical limitation of our study.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 3","pages":"e002220"},"PeriodicalIF":3.1,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847110","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":"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","doi":"10.1161/SVIN.125.002264","DOIUrl":"10.1161/SVIN.125.002264","url":null,"abstract":"","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 3","pages":"e002264"},"PeriodicalIF":3.1,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847318","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":"Detecting Basilar Artery Wall Pathology in Isolated Pontine Infarction With Short-TE SWI Magnitude Images.","authors":"Hon-Man Liu, Adam Huang, Chih-Hui Wu, Yung-Chuan Huang, Li-Shan Hsu, Ning Yang, Kuo-Chi Lin","doi":"10.1161/SVIN.125.002131","DOIUrl":"10.1161/SVIN.125.002131","url":null,"abstract":"<p><strong>Background: </strong>Intracranial atherosclerotic ischemic stroke often involves plaques without luminal stenosis. Existing imaging techniques struggle to detect vessel wall pathology effectively. This study evaluates short-echo time susceptibility-weighted imaging magnitude images (STE-MI) for identifying cerebral microbleeds and reducing artifacts around the basilar artery (BA) compared with susceptibility-weighted angiography (SWAN), enabling its application in detecting BA wall pathology in acute isolated pontine infarction, particularly in patients with nonstenotic noncardioembolic disease.</p><p><strong>Methods: </strong>This study presents a retrospective analysis of an ongoing prospective observational brain vascular imaging study focused on intracranial atherosclerosis in patients with acute ischemic stroke. Conducted from March 2022 to March 2025, imaging was performed using a 3.0 T magnetic resonance imaging scanner with advanced protocols, including SWAN and STE-MI sequences. The study evaluated cerebral microbleed detection, artifact reduction, and vessel wall imaging quality, with interobserver agreement assessed using Cohen <i>κ</i>. Clinical data, including risk factors and demographic information, were analyzed alongside imaging findings.</p><p><strong>Results: </strong>Among 33 subjects, STE-MI detected 86% of the microbleeds identified by SWAN, with excellent interobserver agreement (Cohen <i>κ</i>=0.828). Blooming artifacts around the BA were minimized in 96.9% of 2475 cases using STE-MI, compared with only 5.5% with SWAN (<i>P</i>=3.469×10^-18). Of the 16 patients with nonstenotic noncardioembolism with isolated pontine infarction, 12 were male, with a mean age of 68.1 years (SD=7.7). Among these patients, 10 (62.5%) exhibited extraluminal BA pathology on STE-MI (mixed hypo-/intermediate intensity in 6 cases, hypointensity in 4 cases), correlating with diffusion-weighted imaging lesion locations (Cohen <i>κ</i>=0.833). Univariate logistic regression analysis identified triglycerides (<i>P</i>=0.033) and smoking (<i>P</i>=0.041) as significant risk factors.</p><p><strong>Conclusions: </strong>STE-MI effectively minimizes artifacts and detects BA wall pathology in acute isolated pontine infarction, particularly in nonstenotic noncardioembolic stroke. This approach may enhance the identification of culprit lesions, potentially improving risk stratification and guiding targeted therapeutic strategies.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 3","pages":"e002131"},"PeriodicalIF":3.1,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847008","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":"Saved Flow.","authors":"Dorothea Altschul","doi":"10.1161/SVIN.125.002046","DOIUrl":"https://doi.org/10.1161/SVIN.125.002046","url":null,"abstract":"","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 2","pages":"e002046"},"PeriodicalIF":2.8,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12959419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147438293","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":"Jevons Paradox: Rise of the Machines May Create More Work for Physicians.","authors":"Jens Fiehler","doi":"10.1161/SVIN.126.002321","DOIUrl":"10.1161/SVIN.126.002321","url":null,"abstract":"","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 2","pages":"e002321"},"PeriodicalIF":3.1,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12959442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147437798","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":"Prehospital Detection of Large Vessel Occlusion and Intracerebral Hemorrhage Using a Dual-Biomarker Point-of-Care Test.","authors":"Arnab Ghosh, Noah L A Nawabi, Diana Alcedo, Rodolfo E Alcedo Guardia, Juan Vicenty-Padilla, Saef Izzy, Nirav J Patel, Rose Du, Adam A Dmytriw, Alfred P See, Mohammed Ali Aziz-Sultan, Toby I Gropen, David Liebeskind, Erickson F Torio, Anil Can, Lennard Spanehl, Edoardo Gaude, Joshua D Bernstock","doi":"10.1161/SVIN.125.002170","DOIUrl":"10.1161/SVIN.125.002170","url":null,"abstract":"<p><strong>Background: </strong>Timely identification of stroke subtype is critical for triage and treatment. Existing prehospital stroke scales have limited diagnostic accuracy, especially in differentiating large vessel occlusion (LVO) from intracerebral hemorrhage (ICH). The LVOne point-of-care test measures d-dimer and GFAP (glial fibrillary acidic protein), biomarkers associated with thrombotic and hemorrhagic stroke, enabling biologically informed triage.</p><p><strong>Methods: </strong>We validated a new version of the LVOne assay using plasma samples from 210 suspected stroke patients presenting within 6 hours of symptom onset, enrolled in the TIME (Testing of Identification Markers for Stroke) prospective observational cohort. This article reports a retrospective (secondary) laboratory analysis of these prospectively collected samples and clinical data. Samples were collected before neuroimaging or thrombolysis. LVOne version 1 combined d-dimer positivity, GFAP negativity, and Field Assessment Stroke Triage for Emergency Destination scoring for LVO detection only; version 2 uses improved GFAP measurement and a clinical decision rule enabling simultaneous diagnosis of LVO and ICH. Diagnostic performance (sensitivity, specificity, positive predictive value, negative predictive value) was calculated for each version. Receiver operating characteristic analyses and biomarker correlations with Field Assessment Stroke Triage for Emergency Destination were also performed.</p><p><strong>Results: </strong>Both LVOne versions achieved high accuracy for LVO detection (sensitivity, 0.75; specificity, 0.92; negative predictive value, 0.97). Version 2 improved ICH specificity (0.99 versus 0.90) and positive predictive value (0.83 versus 0.23) versus version 1. Biomarker levels correlated with Field Assessment Stroke Triage for Emergency Destination scores but with limited explanatory power (GFAP <i>R</i> ²=0.077; d-dimer <i>R</i> ²=0.047), suggesting added information beyond clinical severity scales. In a specimen-matrix comparison (n=25), qualitative GFAP/d-dimer classification was concordant across plasma, venous whole blood, and capillary whole blood.</p><p><strong>Conclusions: </strong>The updated LVOne assay enables simultaneous biomarker-based identification of both LVO and ICH in suspected stroke patients. Its rapid, low-complexity format supports prehospital use and may improve triage, reduce time to treatment, and optimize outcomes. Prospective field validation is warranted.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT04292600.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 3","pages":"e002170"},"PeriodicalIF":3.1,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847291","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":"First-in-Human Treatment of Medically Refractory Idiopathic Intracranial Hypertension With the eShunt System: Case Report.","authors":"Pedro Lylyk, Ivan Lylyk, Carlos Bleise, Esteban Scrivano, Pedro N Lylyk, Brandon M Beneduce, Dhruv Vajipayajula, Carl B Heilman, Adel M Malek","doi":"10.1161/SVIN.125.002285","DOIUrl":"10.1161/SVIN.125.002285","url":null,"abstract":"","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 3","pages":"e002285"},"PeriodicalIF":3.1,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847063","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 Treatment in Subtypes of Posterior Large Vessel Occlusion: A Pooled Analysis From 2 Registries.","authors":"Li Wei, Yusi Fu, KaiLai Huang, Liying Pan, Rong Chen, Zhizhong Yan, Weidong Hu, Zhiliang Li, Hongmei Xu, Wentong Ling, Qingyun Lei, Huajian Li, Lue Chen, Fan Zhang, Shizhang Li, Chong Zheng, Jianheng Wu, Min Zhang, Delang Liu, Jie Pu, Guoyi Peng, Guang Zhang, Yunyun Li, Luming Chen, Geng Liao, Lei Yu, Fei Chen, Xi Li, Zhangbao Guo, Mingchao Li, Zheng Dai, Yonggang Hao, Yangyang Duan, Zhongming Qiu, Chang Liu, Tingyu Yi, Mohamed F Doheim, Zhenqiang Zhao","doi":"10.1161/SVIN.125.002093","DOIUrl":"10.1161/SVIN.125.002093","url":null,"abstract":"<p><strong>Background: </strong>Current evidence on differential outcomes of endovascular therapy for the different pathological subtypes of vertebrobasilar artery occlusion is still limited. The study aimed to compare characteristics and clinical outcomes among distinct pathological subtypes of vertebrobasilar artery occlusion undergoing endovascular therapy.</p><p><strong>Methods: </strong>This was a posthoc pooled analysis of 1320 patients from the BASILAR (Endovascular Treatment for Acute Basilar Artery Occlusion Study; 2014-2019) and the PERSIST (Posterior Circulation Ischemic Stroke Registries; 2015-2018) registries. This analysis included adults (≥18 years) with moderate to severe vertebrobasilar artery occlusion who underwent endovascular therapy within 24 hours of their last known well. Patients were stratified by stroke mechanism: group 1 (embolism without vertebral stenosis), group 2 (tandem embolism from vertebral stenosis/occlusion), and group 3 (in situ atherosclerotic thrombosis). Baseline characteristics, procedural details, and clinical outcomes were compared across these 3 groups. The primary outcome was a favorable functional outcome, defined as a modified Rankin Scale score of 0 to 3 at 90 days. Baseline characteristics, procedural details, and clinical outcomes were compared across these 3 groups. Because the primary independent variable was categorical with no single referent category, all comparisons among the 3 groups were conducted as exploratory analyses.</p><p><strong>Results: </strong>A total of 1067 patients were included (group 1, n=257 [24.08%]; group 2, n=176 [16.49%]; group 3, n=634 [59.42%]). The overall successful recanalization rate was 84.72% (904/1067), and the favorable functional outcome (90-day modified Rankin Scale score of 0-3) rate was 33.40% (275/1063). The procedure time in group 1 was significantly shorter than that in groups 2 and 3 (median time, 90 versus 135 and 110 minutes, <i>P</i><0.001). There was no significant difference in the primary outcome of a favorable functional outcome among the 3 groups. After adjusting for potential confounders, group 1 exhibited a significantly higher proportion of patients achieving excellent outcomes at 90 days (modified Rankin Scale score, 0-1) compared with groups 2 and 3 (21.9% versu 17.1%, adjusted odds ratio, 0.57 [95% CI, 0.32-0.99]; 21.9% versus 16.5%, adjusted odds ratio, 0.59 [95% CI, 0.37-0.95]). No significant differences were observed in recanalization rates, favorable functional outcome, symptomatic intracranial hemorrhage, or mortality among the 3 groups.</p><p><strong>Conclusions: </strong>The outcome of endovascular therapy for vertebrobasilar artery occlusion may vary based on the stroke mechanism; patients with embolism without vertebral artery steno-occlusion may achieve excellent outcomes compared with other causes.</p><p><strong>Registration: </strong>URL: http://www.chictr.org.cn; Unique identifier: CTR1800014759 and CTR2000033211.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 2","pages":"e002093"},"PeriodicalIF":3.1,"publicationDate":"2026-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12959435/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147438260","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":"Recurrence of Angiographically Cured AVMs: Influence of Age, Angioarchitecture, and Hemorrhagic Presentation and Implications for Follow-Up.","authors":"Matteo Palermo, Gianluca Trevisi, Giuseppe Lanzino, Marco Maria Fontanella, Alessandro Olivi, Francesco Doglietto, Alessio Albanese, Carmelo Lucio Sturiale","doi":"10.1161/SVIN.125.002156","DOIUrl":"10.1161/SVIN.125.002156","url":null,"abstract":"<p><strong>Background: </strong>Arteriovenous malformation (AVM) recurrence after complete surgical resection is a rare but significant clinical event. The underlying mechanisms and factors that predict recurrence remain incompletely defined.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. We included case series reporting on AVM recurrence following an angiographically documented complete resection. Data on initial clinical presentation, patients' demographics, AVM features, and patterns of recurrence were extracted and analyzed.</p><p><strong>Results: </strong>We included 15 studies with a total of 1287 patients in our meta-analysis. The overall estimated recurrence rate was 5.4%. Hemorrhagic presentation appeared as a major predictor: in fact, 94% of recurrences occurred in patients with a prior rupture, corresponding to a 7.3% (95% CI, 0.049-0.098) recurrence rate within this high-risk subgroup. Ruptured AVMs were associated with 4-fold higher odds of recurrence compared with unruptured AVMs (odds ratio, 4.072 [95% CI, 1.492-11.113]). Younger age was also found to be a key factor, with pediatric patients accounting for 89% of all recurrences. Deep venous drainage was associated with a nearly 5-fold increased risk of recurrence (odds ratio, 4.96 [95% CI, 1.801-13.662]), while eloquent brain location was not found as a statistically significant predictor. The mean time to recurrence was 39.6 (95% CI, 27.80-51.41) months, while follow-ups varied among patients.</p><p><strong>Conclusions: </strong>Hemorrhagic presentation, younger age, and deep venous drainage demonstrated to be significant predictors of AVM recurrence after complete resection, whereas vascular aging appears protective. In older individuals, proangiogenic mediators (VEGF [vascular endothelial growth factor], HIF-1 [hypoxia-inducible factor-1] α, eNOS [endothelial nitric oxide synthase], and MMPs [matrix metalloproteinases]) are downregulated via aging-related pathways, limiting neovascularization and making recurrence biologically less likely. These findings underscore the need for prolonged, risk-adapted surveillance protocols, particularly for high-risk pediatric patients who present with hemorrhage.</p>","PeriodicalId":74875,"journal":{"name":"Stroke (Hoboken, N.J.)","volume":"6 2","pages":"e002156"},"PeriodicalIF":3.1,"publicationDate":"2026-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12959450/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147438222","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}