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Neurol Res 2021 Jun 10:1-8. Epub 2021 Jun 10.

Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

Objective: The aim of this study was to find out the relationship between serum biomarkers and cerebral collateral status in acute ischemic stroke with cerebral large artery atherosclerosis.

Methods: We enrolled patients with ischemic stroke due to large artery atherosclerosis within 7 days of symptom onset, age 18-80 years, from August 2016 to December 2017. Twelve biomarkers representing different pathophysiological mechanisms were tested after admission. Read More

Stroke Vasc Neurol 2021 Jun 8. Epub 2021 Jun 8.

Department of Neurology-Stroke Unit, CIC-P 1433, INSERMU1116, Université de Lorraine, Nancy Regional University Hospital Center, Nancy, France

Background: For patients with stroke with large-vessel occlusion (LVO), study of factors predicting response to intravenous thrombolysis (IVT) would allow identifying subgroups with high expected gain, and those for whom it could be considered as futile, and even detrimental. From patients included in the Mechanical Thrombectomy After Intravenous Alteplase vs Alteplase Alone After Stroke trial, we investigated clinical-imaging factors associated with optimal response to IVT.

Methods: We included patients receiving IVT alone. Read More

J Cereb Blood Flow Metab 2021 Jun 8:271678X211023660. Epub 2021 Jun 8.

Human Phenome Institute, Fudan University, Shanghai, China.

The accurate identification of irreversible infarction and salvageable tissue is important in planning the treatments for acute ischemic stroke (AIS) patients. Computed tomographic perfusion (CTP) can be used to evaluate the ischemic core and deficit, covering most of the territories of anterior circulation, but many community hospitals and primary stroke centers do not have the capability to perform CTP scan in emergency situation. This study aimed to identify AIS lesions from widely available non-contrast computed tomography (NCCT) and CT angiography (CTA) using deep learning. Read More

J Neuroimaging 2021 Jun 8. Epub 2021 Jun 8.

Medical City Plano, Medical City Healthcare, Plano, Texas, USA.

Background And Purpose: Complete reperfusion (TICI 3) after the first thrombectomy attempt or first pass effect (FPE) is associated with best clinical outcomes in large-vessel occlusion (LVO) acute ischemic stroke. While endovascular therapy techniques have improved substantially, FPE remains low (24-30%), and new methods to improve reperfusion efficiency are needed.

Methods: In a prospective observational cohort study, 40 consecutive patients underwent cyclical aspiration thrombectomy using CLEAR Aspiration System (Insera Therapeutics Inc. Read More

Nervenarzt 2021 Jun 7. Epub 2021 Jun 7.

Hirnschlagzentrum, Klinik für Neurologie, Universitätsspital Basel, 4031, Basel, Schweiz.

Mechanical thrombectomy (MT) has become the standard procedure in the treatment of patients with acute ischemic stroke (AIS) due to occlusion of a large proximal cerebral artery of the anterior circulation. Nevertheless, according to the current guidelines large patient collectives are still excluded from this highly effective treatment method. Therefore, this article gives an overview of possible extensions of the indications for treatment with MT. Read More

J Neurol Sci 2021 May 28;427:117513. Epub 2021 May 28.

Unité Neurovasculaire, Département de Neurologie, Hôpital Gui de Chauliac, Montpellier, France. Electronic address:

Background And Purpose: Carotid webs (CaW) may be an under-recognized cause of anterior circulation cryptogenic ischemic stroke (ACIS). Prevalence is still unknown in European patients with ACIS.

Objective: To evaluate the prevalence of CaW in ACIS and describe patients with CaW phenotype in a cohort of patients from a French stroke center. Read More

Neuroradiol J 2021 Jun 6:19714009211019383. Epub 2021 Jun 6.

Department of Radiology, Boston Medical Center, USA.

Background And Purpose: The diagnosis and management of acute fetal posterior cerebral artery occlusion are challenging. While endovascular treatment is established for anterior circulation large vessel occlusion stroke, little is known about the course of acute fetal posterior cerebral artery occlusions. We report the clinical course, radiological findings and management considerations of acute fetal posterior cerebral artery occlusion stroke. Read More

Acta Neurol Belg 2021 Jun 6. Epub 2021 Jun 6.

Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, Australia.

Pre-intervention CT imaging-based biomarkers, such as hyperdense middle cerebral artery sign (HMCAS) may have a role in acute ischaemic stroke prognostication. However, the clinical utility of HMCAS in settings of reperfusion therapy and the level of prognostic association is still unclear. This systematic review and meta-analysis investigated the association of HMCAS sign with clinical outcomes and its prognostic capacity in acute ischaemic stroke patients treated with reperfusion therapy. Read More

BMC Nephrol 2021 Jun 5;22(1):213. Epub 2021 Jun 5.

Department of Neurology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Linkou Branch, 5, Fu Hsing Street, 333, Taoyuan, Taiwan.

Background: The incidence of cerebral stroke, including ischemic infarction and intracranial hemorrhage (ICH), increases in patients with nephrotic syndrome (NS). However, the clinical characteristics of patients with NS and stroke remain elusive. We aimed to investigate the clinical presentation and prognosis among patients with NS and ischemic stroke (IS) or ICH. Read More

Neurology 2021 Jun 4. Epub 2021 Jun 4.

Department of Clinical Neuroscience, Karolinska Institutet.

Objective: To test the hypothesis that intravenous thrombolysis (IVT) treatment prior to endovascular thrombectomy (EVT) is associated with better outcomes in patients with anterior circulation large artery occlusion (LAO) stroke, we examined a large real-world database, the SITS-International Stroke Thrombectomy Register (SITS-ISTR).

Methods: We identified centers recording ≥10 consecutive patients in the SITS-ISTR, with at least 70% available modified Rankin Scale (mRS) scores at 3 months during 2014-19. We defined LAO as intracranial internal carotid artery, first and second segment of middle cerebral artery and first segment of anterior cerebral artery. Read More

Age Ageing 2021 Jun 3. Epub 2021 Jun 3.

Department of Neurology, Medical Faculty, RWTH Aachen University, Aachen D-52074, Germany.

Introduction: Frailty is a disorder of multiple physiological systems impairing the capacity of the organism to cope with insult or stress. It is associated with poor outcomes after acute illness. Our aim was to study the impact of frailty on the functional outcome of patients with acute ischemic stroke (AIS) submitted to endovascular stroke treatment (EST). Read More

J Neurosurg 2021 Jun 4:1-8. Epub 2021 Jun 4.

3Neurosurgery, University of Michigan, Ann Arbor, Michigan.

Objective: Despite advancement of thrombectomy technologies for large-vessel occlusion (LVO) stroke and increased user experience, complete recanalization rates linger around 50%, and one-third of patients who have undergone successful recanalization still experience poor neurological outcomes. To enhance the understanding of the biomechanics and failure modes, the authors conducted an experimental analysis of the interaction of emboli/artery/devices in the first human brain test platform for LVO stroke described to date.

Methods: In 12 fresh human brains, 105 LVOs were recreated by embolizing engineered emboli analogs and recanalization was attempted using aspiration catheters and/or stent retrievers. Read More

Br J Hosp Med (Lond) 2021 May 26;82(5):1-7. Epub 2021 May 26.

Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, People's Republic of China.

Trousseau syndrome is a cancer-associated hypercoagulative state leading to venous or arterial thromboembolic events. Cerebral infarction is the most common result of arterial embolism and the pathogenesis is complicated, mainly associated with hypercoagulation and non-bacterial thrombotic endocarditis. On magnetic resonance imaging, multiple lesions are dispersed in more than two territories of the brain, often simultaneously involving the bilateral anterior and posterior circulation. Read More

Life (Basel) 2021 May 20;11(5). Epub 2021 May 20.

Department of Neurology, Medical School, University of Pécs, 7623 Pécs, Hungary.

Introduction: Acute ischemic strokes (AIS) due to tandem occlusion (TO) of intracranial anterior large vessel and concomitant extracranial internal carotid artery (EICA) are represent in 15-20% of all ischemic strokes. The endovascular treatment (EVT) strategy for those patients is still unclear. Although the intracranial mechanical thrombectomy (MT) is considered as a standard treatment approach, the EICA lesion stent necessity remains a matter of debate. Read More

J Neurol 2021 May 29. Epub 2021 May 29.

Neurology, Massachusetts General Hospital, 55 Fruit St, WAC-7-721, Boston, MA, USA.

Introduction: Sex-specific differences in ischemic stroke outcomes are prevalent. We sought to investigate sex differences in the determinants of reperfusion and functional outcomes after endovascular thrombectomy (EVT) for emergent large vessel occlusion ischemic stroke (ELVO).

Methods: Patients presenting to a single referral center with an anterior circulation ELVO that underwent EVT from 2011 to 2019 were included in this retrospective analysis. Read More

J Int Med Res 2021 May;49(5):3000605211019645

Department of Neurology, Wuxi No.5 People's Hospital, Wuxi, China.

Objective: To characterise the relationship between fasting blood glucose (FBG) and the incidence of subsequent vascular events (SVE) during the 6 months following a mild ischaemic stroke (MIS) in Chinese patients.

Methods: Data from patients with MIS were retrospectively analysed. The primary endpoint was an SVE during the 6-month follow-up period. Read More

Int J Gen Med 2021 17;14:1865-1871. Epub 2021 May 17.

Department of CT/MRI, Handan Central Hospital, Handan, 056001, People's Republic of China.

Objective: The present study investigated the predictive value of each perfusion parameter of the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) in CT perfusion (CTP) imaging for the prognosis of endovascular treatment at the time of admission in patients with acute ischemic stroke in the anterior circulation.

Patients And Methods: The imaging data of 62 patients with acute ischemic stroke in the anterior circulation with an onset time of 6 h or less were retrospectively analyzed. All patients underwent the one-stop whole-brain dynamic volume four-dimensional (4D) CT angiography (CTA)-CTP and cranial magnetic resonance imaging (MRI) within seven days after treatment. Read More

J Neurointerv Surg 2021 May 26. Epub 2021 May 26.

Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA

Background: Most conventional 0.088 inch guide catheters cannot safely navigate intracranial vasculature. The objective of this study is to evaluate the safety of stroke thrombectomy using a novel 0. Read More

Stroke 2021 May 27:STROKEAHA120031880. Epub 2021 May 27.

Department of Neurology, Seattle Children's Hospital and University of Washington (M.S.W., C.A.-L.).

Background And Purpose: Focal cerebral arteriopathy (FCA) of childhood with unilateral stenosis of the anterior circulation is reported to account for up to one-quarter of childhood arterial ischemic stroke, with stroke recurrence in 25% of cases. Limited knowledge regarding pathophysiology and outcome results in inconsistent treatment of FCA.

Methods: Children with arterial ischemic stroke due to FCA between January 1, 2009, and January 1, 2019, were retrospectively identified at our institution which serves the US Pacific Northwest region. Read More

J Int Med Res 2021 May;49(5):3000605211013179

Medical College of Soochow University, Suzhou, China.

Objective: To investigate the relationship between asymmetric prominent hypointense vessels (prominent vessel sign, PVS) on susceptibility-weighted imaging (SWI) and leptomeningeal collateralization in patients with acute ischemic stroke due to large vessel occlusion.

Methods: We retrospectively enrolled patients with M1 segment occlusion of the middle cerebral artery who underwent emergency magnetic resonance imaging and digital subtraction angiography within 24 hours from stroke onset. The extent of PVS on SWI was assessed using the Alberta Stroke Program Early CT Score (ASPECTS). Read More

J Neurointerv Surg 2021 May 25. Epub 2021 May 25.

Radiology, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada

Background: The effectiveness and safety of endovascular thrombectomy (EVT) for medium vessel occlusions (MeVO) in the anterior intracranial circulation for patients with acute ischemic stroke (AIS) has yet to be definitively established. We compared outcomes in patients undergoing EVT for large vessel occlusion (LVO) versus those with MeVO.

Methods: This retrospective cohort study, using an intention to treat design, compared the 90-day modified Rankin Scale (mRS) score between 43 patients with MeVO and 199 with LVO in the anterior intracranial circulation. Read More

J Neurol Sci 2021 May 18;427:117499. Epub 2021 May 18.

Department of Neurology, Stroke Service, Massachusetts General Hospital, Boston, USA.

Introduction: Posterior circulation strokes (PCS) have been less extensively studied than anterior circulation strokes (ACS), especially regarding revascularization therapies. We analyzed the differences in baseline stroke characteristics, revascularization therapy and 3-month outcomes between PCS and ACS in a large prospective multicentre Indian stroke registry.

Methods: Patients with acute ischemic stroke recruited in the Indo-US collaborative stroke project from January 2012 to August 2014 were classified into PCS and ACS based on imaging-confirmed infarct location. Read More

Clin Neurol Neurosurg 2021 May 13;206:106677. Epub 2021 May 13.

Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA. Electronic address:

Owing to systemic inflammation and widespread vessel endotheliopathy, SARS-CoV-2 has been shown to confer an increased risk of cryptogenic stroke, particularly in patients without any traditional risk factors. In this report, we present a case of a 67-year-old female who presented with acute stroke from bilateral anterior circulation large vessel occlusions, and was incidentally found to be COVID-positive on routine hospital admission screening. The patient had a large area of penumbra bilaterally, and the decision was made to pursue bilateral simultaneous thrombectomy, with two endovascular neurosurgeons working on each side to achieve a faster time to recanalization. Read More

Med Sci Monit 2021 May 21;27:e930014. Epub 2021 May 21.

Department of Radiology, Faculty Hospital Trnava, Trnava, Slovakia.

BACKGROUND The purpose of this study was to evaluate outcomes of patients with mild stroke, defined by National Institutes of Health Stroke Scale (NIHSS) score <6, caused by large vessel occlusion treated with aspiration thrombectomy. MATERIAL AND METHODS Data from the endovascular stroke registry of our center were retrospectively analyzed. Anterior or posterior circulation strokes with NIHSS score <6 upon admission were analyzed. Read More

Stroke 2021 May 21:STROKEAHA120032867. Epub 2021 May 21.

Stroke and Ageing Research (STAR), Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC. (T.T., M.M., C.W., J.V., S.S., H.M., T.P.).

Background And Purpose: The circle of Willis (CoW) and leptomeningeal anastomoses play an important role in transforming infarct topography following middle cerebral artery occlusion. Their role in infarct topography following anterior cerebral artery occlusion is not well understood. The aim of this study was to evaluate the role of the CoW and leptomeningeal anastomoses in modifying regional variation in infarct topography following occlusion of the anterior cerebral artery and its branches. Read More

J Stroke Cerebrovasc Dis 2021 May 17;30(8):105852. Epub 2021 May 17.

Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan.

In specific cases of moyamoya disease (MMD), posterior cerebral artery (PCA) stenosis can develop after treatment of the anterior circulation and require additional revascularization. Here, we report two cases that underwent additional posterior indirect revascularization with multiple burr holes for PCA involvement after bilateral revascularization treatment of the anterior circulation. They presented with transient ischemic attack even after bilateral superficial temporal artery-middle cerebral artery bypass, and magnetic resonance angiography (MRA) showed that PCA stenosis had worsened. Read More

Stroke 2021 May 20:STROKEAHA120032066. Epub 2021 May 20.

Neurology Department, Hospital Clínico Universitario de Valladolid, Spain. (B.T., B.G.-V., J.F.A.).

Background And Purpose: We aimed to determine the prevalence and predictors of delayed neurological improvement (DNI) after complete endovascular reperfusion in anterior circulation acute ischemic stroke (AIS).

Methods: Retrospective analysis of an online multicenter prospective reperfusion registry of patients with consecutive anterior circulation AIS treated with endovascular thrombectomy (EVT) from January 2018 to June 2019 in tertiary stroke centers of the NORDICTUS (NORD-Spain Network for Research and Innovation in ICTUS) network. We included patients with AIS with a proximal occlusion in whom a modified Thrombolysis in Cerebral Infarction 3 reperfusion pattern was obtained. Read More

Sci Rep 2021 May 18;11(1):10479. Epub 2021 May 18.

Henan Provincial Cerebrovascular Hospital, Henan Provincial People's Hospital, Zhengzhou University, 7 Weiwu Road, Zhengzhou, 450003, Henan Province, China.

This study investigated factors affecting the safety and in-stent restenosis after intracranial stent angioplasty using the Enterprise stent for symptomatic intracranial atherosclerotic stenosis. Between January 2017 and March 2019, patients with intracranial atherosclerotic stenosis treated with Enterprise stent angioplasty were enrolled, including 400 patients in the modeling group and 89 patients in the validation group. The clinical factors affecting in-stent restenosis after Enterprise stent angioplasty in the modeling group were analyzed, and a logistic regression model of these factors was established and validated in the validation group. Read More

Sci Rep 2021 May 18;11(1):10544. Epub 2021 May 18.

Department of Neurology and Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland.

Distinct patient characteristics have been proposed for ischaemic stroke in the anterior versus posterior circulation. However, data on functional outcome according to stroke territory in patients with acute stroke treatment are conflicting and information on outcome predictors is scarce. In this retrospective study, we analysed functional outcome in 517 patients with stroke and thrombolysis and/or thrombectomy treated at the University Hospital Zurich. Read More

BMC Anesthesiol 2021 May 18;21(1):151. Epub 2021 May 18.

Department of Anesthesiology, Columbia University College of Physicians and Surgeons, NY, New York, USA.

Background: Anesthetic management of an adult with failing Fontan physiology is complicated given inherent anatomical and physiological alterations. Neurosurgical interventions including thromboembolectomy may be particularly challenging given importance of blood pressure control and cerebral perfusion.

Case Presentation: We describe a 29 year old patient born with double outlet right ventricle (DORV) with mitral valve atresia who after multi-staged surgeries earlier in life, presented with failing Fontan physiology. Read More