Pub Date : 2026-01-01DOI: 10.1093/esj/23969873251350882
Frederik J Reitsma, Sander M J van Kuijk, David J Werring, Gargi Banerjee, Charlotte Cordonnier, Olfa Kaaouana, Laurent Puy, Anand Viswanathan, Robert J van Oostenbrugge, Julie Staals, Rob P W Rouhl
Introduction: Predicting the occurrence of late seizures after intracerebral haemorrhage may help in making clinical decisions about treatment. Currently, the CAVE score is the best performing risk score. We aimed to design a different, pragmatic risk prediction score and compared it to the CAVE score.
Patients and methods: The South Limburg (Netherlands) intracerebral haemorrhage registry, consisting of patients with a primary intracerebral haemorrhage in 2004-2009, was used for the derivation cohort. We made a prediction model using Cox proportional hazard analyses; comparisons between models were made with the c-statistic. We validated our model externally in three independent cohorts.
Results: Our derivation cohort consisted of 781 patients, of whom 78 (10%) developed late seizures. We found the following independent predictors for late seizures: any neurosurgical procedure, age < 65 years, lobar haemorrhage, and early seizures (occurring within the first week). These formed our new prediction score (LEAN score), which had an optimism-corrected c-statistic of 0.80 (95%-confidence interval 0.78-0.86). The LEAN score predicts late seizure risk as 0.7%, 1.6%, 8.8%, 22.0%, 29.8%, 43.5%, 100% for the increasing score groups respectively. External validation showed comparable optimism-corrected c-statistics for both the LEAN score and the CAVE score.
Conclusion: The newly developed LEAN score consists of easily available clinical variables and performs equally to the CAVE score. Additionally, the high risk of late seizures in patients with the maximum LEAN score might make a diagnosis of epilepsy possible according to international guidelines despite these patients only had early seizures.
{"title":"Development and external validation of the LEAN score to predict late seizures after intracerebral haemorrhage.","authors":"Frederik J Reitsma, Sander M J van Kuijk, David J Werring, Gargi Banerjee, Charlotte Cordonnier, Olfa Kaaouana, Laurent Puy, Anand Viswanathan, Robert J van Oostenbrugge, Julie Staals, Rob P W Rouhl","doi":"10.1093/esj/23969873251350882","DOIUrl":"https://doi.org/10.1093/esj/23969873251350882","url":null,"abstract":"<p><strong>Introduction: </strong>Predicting the occurrence of late seizures after intracerebral haemorrhage may help in making clinical decisions about treatment. Currently, the CAVE score is the best performing risk score. We aimed to design a different, pragmatic risk prediction score and compared it to the CAVE score.</p><p><strong>Patients and methods: </strong>The South Limburg (Netherlands) intracerebral haemorrhage registry, consisting of patients with a primary intracerebral haemorrhage in 2004-2009, was used for the derivation cohort. We made a prediction model using Cox proportional hazard analyses; comparisons between models were made with the c-statistic. We validated our model externally in three independent cohorts.</p><p><strong>Results: </strong>Our derivation cohort consisted of 781 patients, of whom 78 (10%) developed late seizures. We found the following independent predictors for late seizures: any neurosurgical procedure, age < 65 years, lobar haemorrhage, and early seizures (occurring within the first week). These formed our new prediction score (LEAN score), which had an optimism-corrected c-statistic of 0.80 (95%-confidence interval 0.78-0.86). The LEAN score predicts late seizure risk as 0.7%, 1.6%, 8.8%, 22.0%, 29.8%, 43.5%, 100% for the increasing score groups respectively. External validation showed comparable optimism-corrected c-statistics for both the LEAN score and the CAVE score.</p><p><strong>Conclusion: </strong>The newly developed LEAN score consists of easily available clinical variables and performs equally to the CAVE score. Additionally, the high risk of late seizures in patients with the maximum LEAN score might make a diagnosis of epilepsy possible according to international guidelines despite these patients only had early seizures.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":"11 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146087532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maaike P Cliteur, Lotte Sondag, Sjoert A H Pegge, Wilmar M T Jolink, D Verbaan, Hieronymus D Boogaarts, Marieke J H Wermer, Ruben Dammers, Floris H B M Schreuder, Catharina J M Klijn
Introduction: In patients with intracerebral haemorrhage (ICH), perihaematomal oedema (PHO) is considered a marker of secondary injury and is associated with worse functional outcomes. Minimally invasive surgery (MIS) has been suggested to reduce PHO when performed within 72 h of symptom onset. However, the effect of early surgery on PHO formation remains unclear. We aimed to determine the effect of MIS within 8 h of ICH onset on PHO formation.
Patients and methods: We included patients with spontaneous, supratentorial ICH ≥10 mL undergoing MIS within 8 h from the DIST-pilot study and compared them to patients receiving standard care from a cohort study. ICH and PHO volumes at baseline and 24(±12) h were manually segmented. The primary outcome was absolute PHO (aPHO) volume at 24 h. Secondary outcomes included aPHO growth between baseline, and 24 h and oedema extension distance (OED).
Results: We included 34 patients (median age 61 years, 68% male) undergoing MIS and 16 patients (median age 65 years, 69% male) receiving standard medical care. At baseline, median ICH, aPHO and OED volume were similar between groups. Median aPHO volume at 24 h was similar between groups (median difference -3.0 mL, 95% CI, -19.4 to 9.8, P =.67), while median aPHO growth was smaller in the MIS-group (median difference -6.8 mL, 95% CI, -18.67 to 0.33, P =.002). Median OED was greater in the MIS-group (median difference 0.18 cm, 95% CI, 0.05-0.40, P =.002).
Conclusion: Absolute PHO growth in the first 24 h after ICH was less pronounced after early MIS than after standard care, suggesting that early MIS may ameliorate secondary injury after ICH.
{"title":"The effect of minimally invasive intracerebral haematoma evacuation on early perihaematomal oedema formation.","authors":"Maaike P Cliteur, Lotte Sondag, Sjoert A H Pegge, Wilmar M T Jolink, D Verbaan, Hieronymus D Boogaarts, Marieke J H Wermer, Ruben Dammers, Floris H B M Schreuder, Catharina J M Klijn","doi":"10.1093/esj/aakaf025","DOIUrl":"https://doi.org/10.1093/esj/aakaf025","url":null,"abstract":"<p><strong>Introduction: </strong>In patients with intracerebral haemorrhage (ICH), perihaematomal oedema (PHO) is considered a marker of secondary injury and is associated with worse functional outcomes. Minimally invasive surgery (MIS) has been suggested to reduce PHO when performed within 72 h of symptom onset. However, the effect of early surgery on PHO formation remains unclear. We aimed to determine the effect of MIS within 8 h of ICH onset on PHO formation.</p><p><strong>Patients and methods: </strong>We included patients with spontaneous, supratentorial ICH ≥10 mL undergoing MIS within 8 h from the DIST-pilot study and compared them to patients receiving standard care from a cohort study. ICH and PHO volumes at baseline and 24(±12) h were manually segmented. The primary outcome was absolute PHO (aPHO) volume at 24 h. Secondary outcomes included aPHO growth between baseline, and 24 h and oedema extension distance (OED).</p><p><strong>Results: </strong>We included 34 patients (median age 61 years, 68% male) undergoing MIS and 16 patients (median age 65 years, 69% male) receiving standard medical care. At baseline, median ICH, aPHO and OED volume were similar between groups. Median aPHO volume at 24 h was similar between groups (median difference -3.0 mL, 95% CI, -19.4 to 9.8, P =.67), while median aPHO growth was smaller in the MIS-group (median difference -6.8 mL, 95% CI, -18.67 to 0.33, P =.002). Median OED was greater in the MIS-group (median difference 0.18 cm, 95% CI, 0.05-0.40, P =.002).</p><p><strong>Conclusion: </strong>Absolute PHO growth in the first 24 h after ICH was less pronounced after early MIS than after standard care, suggesting that early MIS may ameliorate secondary injury after ICH.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":"11 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146086826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lukas Mayer-Suess, Kurt Moelgg, Heinrich Rinner, Christian Boehme, Anel Karisik, Benjamin Dejakum, Silvia Felicetti, Thomas Toell, Silvia Praxmarer, Johann Willeit, Stefan Kiechl, Michael Knoflach
Introduction: Observed disparities in stroke care between the biological sexes are based on observational data from stroke centres or focus on single aspects of stroke care. Hence, we offer a comprehensive analysis encapsulating the entire stroke treatment path.
Patients and methods: The quality-controlled, population-based Tyrolean Stroke Care pathway, recording all ischemic stroke cases in the entire federal state independent of treating hospital or department, was applied. Data from all patients (2019-2023) were analysed, which encompass information from stroke call activation to the time of recurrent stroke associated re-hospitalisation.
Results: 5733 ischemic stroke cases (men/women 56.0%/44.0%) were recorded with an incidence of first ever stroke of 133/100,000 inhabitants. Men were numerically more likely to suffer a stroke during that time period (149 vs 118/100,000 respectively). After adjusting for age, National Institute of Stroke Scale, and the pre-stroke modified Rankin Scale, no differences in pre-hospital stroke care, post-stroke rehabilitation access as well as most in-hospital metrics were seen. Still, women were less likely to be admitted to stroke units (odds ratio [OR] 0.89 [0.80, 1.00]) and less frequently underwent MRI (OR 0.85 [0.74, 0.96]) or echocardiography (OR 0.85 [0.76, 0.96]) during their hospital stay. However, women less frequently suffered serious post-stroke in-house complications (OR 0.80 [0.66, 0.97]). Upon follow-up, men had higher rates of all cause-mortality (OR 0.81 [0.69, 0.94]) as well as recurrent stroke-related re-admission (OR 0.63 [0.48, 0.83]).
Conclusion: Within a highly structured and quality-controlled stroke care pathway, disparities in stroke care between sexes are low. Differences exist in terms of diagnostic algorithms, post-stroke mortality and recurrent stroke-related re-admissions, which merit further research.
{"title":"Biological sex-dependent differences in acute and post-acute stroke care-a population-based case-control study.","authors":"Lukas Mayer-Suess, Kurt Moelgg, Heinrich Rinner, Christian Boehme, Anel Karisik, Benjamin Dejakum, Silvia Felicetti, Thomas Toell, Silvia Praxmarer, Johann Willeit, Stefan Kiechl, Michael Knoflach","doi":"10.1093/esj/aakaf014","DOIUrl":"https://doi.org/10.1093/esj/aakaf014","url":null,"abstract":"<p><strong>Introduction: </strong>Observed disparities in stroke care between the biological sexes are based on observational data from stroke centres or focus on single aspects of stroke care. Hence, we offer a comprehensive analysis encapsulating the entire stroke treatment path.</p><p><strong>Patients and methods: </strong>The quality-controlled, population-based Tyrolean Stroke Care pathway, recording all ischemic stroke cases in the entire federal state independent of treating hospital or department, was applied. Data from all patients (2019-2023) were analysed, which encompass information from stroke call activation to the time of recurrent stroke associated re-hospitalisation.</p><p><strong>Results: </strong>5733 ischemic stroke cases (men/women 56.0%/44.0%) were recorded with an incidence of first ever stroke of 133/100,000 inhabitants. Men were numerically more likely to suffer a stroke during that time period (149 vs 118/100,000 respectively). After adjusting for age, National Institute of Stroke Scale, and the pre-stroke modified Rankin Scale, no differences in pre-hospital stroke care, post-stroke rehabilitation access as well as most in-hospital metrics were seen. Still, women were less likely to be admitted to stroke units (odds ratio [OR] 0.89 [0.80, 1.00]) and less frequently underwent MRI (OR 0.85 [0.74, 0.96]) or echocardiography (OR 0.85 [0.76, 0.96]) during their hospital stay. However, women less frequently suffered serious post-stroke in-house complications (OR 0.80 [0.66, 0.97]). Upon follow-up, men had higher rates of all cause-mortality (OR 0.81 [0.69, 0.94]) as well as recurrent stroke-related re-admission (OR 0.63 [0.48, 0.83]).</p><p><strong>Conclusion: </strong>Within a highly structured and quality-controlled stroke care pathway, disparities in stroke care between sexes are low. Differences exist in terms of diagnostic algorithms, post-stroke mortality and recurrent stroke-related re-admissions, which merit further research.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":"11 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146087154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christoph Riegler, Christian H Nolte, Regina von Rennenberg, Kerstin Bollweg, Marianne Hahn, Timo Uphaus, Anna Alegiani, Till Illies, Johannes Wischmann, Lars Kellert, Kathleen Bernkopf, Silke Wunderlich, Florian Hennersdorf, Sven Poli, Leonhard Mann, Fee Keil, Ala Jamous, Marielle-Sophie Ernst, Franziska Bürkle, Martin Wiesmann, Burakhan Akkurt, Tobias Faizy, Heinrich J Audebert, Mike P Wattjes, Eberhard Siebert, Jawed Nawabi
Introduction: ICH is a common complication following endovascular therapy (EVT) for ischaemic stroke. While sICH is known to worsen outcomes, the impact of ICH without early neurological deterioration (END), commonly referred to as "asymptomatic" (aICH), remains controversial. This study aimed to assess imaging patterns of aICH and its effect on clinical outcomes.
Patients and methods: This study used data from the prospective, multicentre German Stroke Registry-Endovascular Treatment. Bleedings were assessed on follow-up imaging at 24 hours applying the Heidelberg Bleeding Classification. European Cooperative Acute Stroke Study III (ECASS)-III criteria were used to stratify patients into (1) no ICH, (2) aICH and (3) sICH. The primary outcome was functional independence (mRS ≤ 2) at 3 months. Secondary outcomes included mRS shift and 3-month mortality.
Results: Among 4834 patients with EVT (median age 76, 51% female, median NIHSS 14), ICH occurred in 13.2% (aICH: 9.7%, sICH: 3.5%). Haemorrhage patterns differed, with sICH being more often parenchymal (48.2% vs 34.6%), multicompartmental (34.1% vs 20.2%) and involving the ventricular system (18.8% vs 7.6%), while aICH were predominantly haemorrhagic transformation (34.6% vs 21.8%). Functional independence at 90 days was reached by 40.0% (no ICH), 25.4% (aICH; adjusted odds ratio [aOR] 0.43 [0.32-0.58]) and 6.5% (sICH; aOR 0.06 [0.03-0.14]), respectively. aICH was associated with worse overall recovery (mRS shift adjusted common OR 0.51 [0.41-0.63]) and higher 90-day mortality (35.5% vs 24.9%; aOR 1.90 [1.44-2.51]), when compared to no ICH.
Conclusion: ICH after EVT was associated with worse functional recovery and higher mortality, even in the absence of END. Given these results, the term "asymptomatic ICH" warrants reconsideration.
脑出血是缺血性脑卒中血管内治疗(EVT)后常见的并发症。虽然已知sICH会使预后恶化,但没有早期神经系统恶化(END)的脑出血的影响,通常被称为“无症状”(aICH),仍然存在争议。本研究旨在评估aICH的影像学特征及其对临床预后的影响。患者和方法:本研究使用来自前瞻性、多中心德国卒中登记-血管内治疗的数据。采用Heidelberg出血分级对24小时的随访影像进行出血评估。采用欧洲急性卒中合作研究III (ECASS)-III标准将患者分为(1)非脑出血、(2)轻度脑出血和(3)重度脑出血。主要终点是3个月时的功能独立性(mRS≤2)。次要结局包括mRS转移和3个月死亡率。结果:4834例EVT患者(中位年龄76岁,女性51%,中位NIHSS 14)中脑出血发生率为13.2% (aICH: 9.7%, siich: 3.5%)。出血类型不同,siich多为实质性(48.2% vs 34.6%)、多室性(34.1% vs 20.2%)和累及心室系统(18.8% vs 7.6%),而aICH主要为出血性转化(34.6% vs 21.8%)。90天功能独立性分别为40.0%(无脑出血)、25.4%(有脑出血,调整比值比[aOR] 0.43[0.32-0.58])和6.5%(有脑出血,aOR 0.06[0.03-0.14])。与无脑出血患者相比,急性脑出血患者总体恢复较差(经mRS移位调整的常见OR为0.51[0.41-0.63]),90天死亡率较高(aOR为1.90[1.44-2.51])。结论:EVT后脑出血与较差的功能恢复和较高的死亡率相关,即使在没有END的情况下也是如此。鉴于这些结果,术语“无症状脑出血”值得重新考虑。
{"title":"Intracranial haemorrhage without early clinical deterioration after mechanical thrombectomy: rethinking the \"asymptomatic\" label.","authors":"Christoph Riegler, Christian H Nolte, Regina von Rennenberg, Kerstin Bollweg, Marianne Hahn, Timo Uphaus, Anna Alegiani, Till Illies, Johannes Wischmann, Lars Kellert, Kathleen Bernkopf, Silke Wunderlich, Florian Hennersdorf, Sven Poli, Leonhard Mann, Fee Keil, Ala Jamous, Marielle-Sophie Ernst, Franziska Bürkle, Martin Wiesmann, Burakhan Akkurt, Tobias Faizy, Heinrich J Audebert, Mike P Wattjes, Eberhard Siebert, Jawed Nawabi","doi":"10.1093/esj/aakaf009","DOIUrl":"https://doi.org/10.1093/esj/aakaf009","url":null,"abstract":"<p><strong>Introduction: </strong>ICH is a common complication following endovascular therapy (EVT) for ischaemic stroke. While sICH is known to worsen outcomes, the impact of ICH without early neurological deterioration (END), commonly referred to as \"asymptomatic\" (aICH), remains controversial. This study aimed to assess imaging patterns of aICH and its effect on clinical outcomes.</p><p><strong>Patients and methods: </strong>This study used data from the prospective, multicentre German Stroke Registry-Endovascular Treatment. Bleedings were assessed on follow-up imaging at 24 hours applying the Heidelberg Bleeding Classification. European Cooperative Acute Stroke Study III (ECASS)-III criteria were used to stratify patients into (1) no ICH, (2) aICH and (3) sICH. The primary outcome was functional independence (mRS ≤ 2) at 3 months. Secondary outcomes included mRS shift and 3-month mortality.</p><p><strong>Results: </strong>Among 4834 patients with EVT (median age 76, 51% female, median NIHSS 14), ICH occurred in 13.2% (aICH: 9.7%, sICH: 3.5%). Haemorrhage patterns differed, with sICH being more often parenchymal (48.2% vs 34.6%), multicompartmental (34.1% vs 20.2%) and involving the ventricular system (18.8% vs 7.6%), while aICH were predominantly haemorrhagic transformation (34.6% vs 21.8%). Functional independence at 90 days was reached by 40.0% (no ICH), 25.4% (aICH; adjusted odds ratio [aOR] 0.43 [0.32-0.58]) and 6.5% (sICH; aOR 0.06 [0.03-0.14]), respectively. aICH was associated with worse overall recovery (mRS shift adjusted common OR 0.51 [0.41-0.63]) and higher 90-day mortality (35.5% vs 24.9%; aOR 1.90 [1.44-2.51]), when compared to no ICH.</p><p><strong>Conclusion: </strong>ICH after EVT was associated with worse functional recovery and higher mortality, even in the absence of END. Given these results, the term \"asymptomatic ICH\" warrants reconsideration.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":"11 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146087247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1093/esj/23969873251345374
Jorge Pagola, Piergiorgio Lochner, Radim Licenik, Giulio Maria Fiore, Felipe A Montellano, Victor Gonzalez, Valérie Pavlicek, Juan Alvarez-Cienfuegos, Sergio Moral, Roberto Muñoz Arrondo, Alberto Vera, Angel Ruiz, Jesús González Mirelis, Jorge Rodríguez-Pardo, Esther Pérez-David, Juan Manuel García-Sánchez, Lara Ruiz Gómez, Laura Amaya Pascasio, Elvira Carrión Ríos, Tania Rodriguez-Ares, Charigan Abou, María Payá, Laura Guerra, Ana de Arce, Ainhoa Benegas Arostegui, Muhammad Khaled Hasan, Vlatka Reskovic
Introduction: Focused cardiac ultrasound (FoCUS) has a high diagnostic yield and a rapid theoretical learning curve. FoCUS can be applied in stroke assessments performed by stroke neurologists when a cardioembolic stroke is suspected.
Patients and methods: An international multicenter, prospective validation study was conducted to assess neurologists' ability to perform FoCUS. The FoCUS examination was defined as a simplified 2D transthoracic echocardiography. Neurologists and cardiologists performed the FoCUS independently and blinded. A twenty-question test evaluated neurologists' ability to recognize sources of cardioembolic stroke from recorded FoCUS studies.
Results: A total of 432 paired studies involving 216 patients were conducted across 11 centers. No significant differences were found between neurologists and cardiologists in detecting: Left Ventricle (LV) dysfunction (7.4% vs 7.9%, p = 0.834), LV dilation (2.8% vs 2.3%, p = 0.766), VC collapsibility (7.2% vs 9.1%, p = 0.501), Right Ventricle dysfunction (0.9% vs 0.9%, p = 0.999), and pericardial effusion (0.5% vs 1.9%, p = 0.212). Cohen Kappa showed substantial agreement for LV dysfunction (0.640), moderate for LV dilation (0.589), and fair for VC collapsibility (0.226). Neurologists demonstrated 93.82% sensitivity and 92.92% specificity for detecting embolic sources. Success rate for LV akinesia was 88% (16/18), LV dysfunction 83% (15/18), complex aortic plaque 88% (16/18), and mitral stenosis 55% (10/18).
Discussion and conclusion: Properly trained neurologists can reliably perform FoCUS, particularly for assessing LV function and dilation, with better results in patients with favorable echocardiographic windows. While VC assessment requires further training, neurologists demonstrated high accuracy in identifying cardioembolic sources (over 90% of cases correctly identified). This study supports implementing standardized FoCUS training for neurologists through collaboration with cardiology specialists to enhance stroke diagnostics and management.
聚焦心脏超声(FoCUS)具有高诊断率和快速的理论学习曲线。当怀疑心脏栓塞性中风时,中风神经科医师可将焦点应用于中风评估。患者和方法:进行了一项国际多中心前瞻性验证研究,以评估神经科医生执行FoCUS的能力。FoCUS检查被定义为简化的二维经胸超声心动图。神经学家和心脏病学家独立、盲法进行FoCUS试验。一项包含20个问题的测试评估了神经科医生从记录的FoCUS研究中识别心脏栓塞性中风来源的能力。结果:11个中心共进行了432项配对研究,涉及216名患者。在左心室功能障碍(7.4% vs 7.9%, p = 0.834)、左室舒张(2.8% vs 2.3%, p = 0.766)、左室湿陷性(7.2% vs 9.1%, p = 0.501)、右心室功能障碍(0.9% vs 0.9%, p = 0.999)、心包积液(0.5% vs 1.9%, p = 0.212)的检测上,神经科医师与心内科医师无显著差异。Cohen Kappa对左室功能障碍的诊断结果一致(0.640),对左室扩张的诊断结果一致(0.589),对左室坍缩的诊断结果一致(0.226)。神经学家对栓塞源的检测灵敏度为93.82%,特异性为92.92%。左室运动障碍成功率88%(16/18),左室功能障碍成功率83%(15/18),复杂主动脉斑块成功率88%(16/18),二尖瓣狭窄成功率55%(10/18)。讨论与结论:经过适当训练的神经科医生可以可靠地执行FoCUS,特别是评估左室功能和扩张,在超声心动图窗口有利的患者中效果更好。虽然VC评估需要进一步的培训,但神经科医生在识别心脏栓塞源方面表现出很高的准确性(超过90%的病例被正确识别)。这项研究支持通过与心脏病专家合作,对神经科医生实施标准化的焦点培训,以提高中风的诊断和管理。
{"title":"Focused cardiac ultrasound conducted by neurologists in patients with stroke: A validation study.","authors":"Jorge Pagola, Piergiorgio Lochner, Radim Licenik, Giulio Maria Fiore, Felipe A Montellano, Victor Gonzalez, Valérie Pavlicek, Juan Alvarez-Cienfuegos, Sergio Moral, Roberto Muñoz Arrondo, Alberto Vera, Angel Ruiz, Jesús González Mirelis, Jorge Rodríguez-Pardo, Esther Pérez-David, Juan Manuel García-Sánchez, Lara Ruiz Gómez, Laura Amaya Pascasio, Elvira Carrión Ríos, Tania Rodriguez-Ares, Charigan Abou, María Payá, Laura Guerra, Ana de Arce, Ainhoa Benegas Arostegui, Muhammad Khaled Hasan, Vlatka Reskovic","doi":"10.1093/esj/23969873251345374","DOIUrl":"https://doi.org/10.1093/esj/23969873251345374","url":null,"abstract":"<p><strong>Introduction: </strong>Focused cardiac ultrasound (FoCUS) has a high diagnostic yield and a rapid theoretical learning curve. FoCUS can be applied in stroke assessments performed by stroke neurologists when a cardioembolic stroke is suspected.</p><p><strong>Patients and methods: </strong>An international multicenter, prospective validation study was conducted to assess neurologists' ability to perform FoCUS. The FoCUS examination was defined as a simplified 2D transthoracic echocardiography. Neurologists and cardiologists performed the FoCUS independently and blinded. A twenty-question test evaluated neurologists' ability to recognize sources of cardioembolic stroke from recorded FoCUS studies.</p><p><strong>Results: </strong>A total of 432 paired studies involving 216 patients were conducted across 11 centers. No significant differences were found between neurologists and cardiologists in detecting: Left Ventricle (LV) dysfunction (7.4% vs 7.9%, p = 0.834), LV dilation (2.8% vs 2.3%, p = 0.766), VC collapsibility (7.2% vs 9.1%, p = 0.501), Right Ventricle dysfunction (0.9% vs 0.9%, p = 0.999), and pericardial effusion (0.5% vs 1.9%, p = 0.212). Cohen Kappa showed substantial agreement for LV dysfunction (0.640), moderate for LV dilation (0.589), and fair for VC collapsibility (0.226). Neurologists demonstrated 93.82% sensitivity and 92.92% specificity for detecting embolic sources. Success rate for LV akinesia was 88% (16/18), LV dysfunction 83% (15/18), complex aortic plaque 88% (16/18), and mitral stenosis 55% (10/18).</p><p><strong>Discussion and conclusion: </strong>Properly trained neurologists can reliably perform FoCUS, particularly for assessing LV function and dilation, with better results in patients with favorable echocardiographic windows. While VC assessment requires further training, neurologists demonstrated high accuracy in identifying cardioembolic sources (over 90% of cases correctly identified). This study supports implementing standardized FoCUS training for neurologists through collaboration with cardiology specialists to enhance stroke diagnostics and management.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":"11 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146087552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yoel Schwartzmann, Mirjam R Heldner, Hamza Jubran, Marcel Arnold, Philipe S Breiding, Fatma Shalabi, Tamer Jubeh, Issa Metanis, Annika Nordanstig, Paul J Nederkoorn, Nabila Wali, Anne van der Meij, Susanne Wegener, Lukas Otto, Hannah Lea Handelsmann, Patrik Michel, Davide Strambo, Alexander Salerno, Gian Marco De Marchis, Tolga Dittrich, Sami Curtze, Nicolas Martinez-Majander, Henrik Gensicke, Stefan Engelter, Valerian Altersberger, Simon Trüssel, Christian H Nolte, Christoph Riegler, Andrea Zini, Federica Naldi, Guido Bigliardi, Livio Picchetto, Joao Pedro Marto, José Pedro Costa, Jeremy Molad, Hen Hallevi, Carlo W Cereda, Alessandro Pezzini, Mauro Magoni, Visnja Padjen, Marialuisa Zedde, Ronen R Leker
Introduction: Endovascular thrombectomy (EVT) is the treatment of choice for LVO stroke, yet nearly half of successfully recanalised patients fail to achieve functional independence, a phenomenon termed futile recanalisation (FR). Predictors of FR remain poorly defined in large, heterogeneous populations. Therefore, we aimed to develop a predictive score for FR.
Patients and methods: Endovascular thrombectomy-treated LVO patients from the prospective, multicentre EVATRISP collaboration were included. All patients had known pre-stroke functional status, modified thrombolysis in cerebral infarction (mTICI) score and 90-day mRS. Futile recanalisation was defined as mRS > 2 at 90 days despite mTICI ≥ 2b. Patients with FR were compared to those with successful recanalisation and mRS ≤ 2. The cohort was randomly split into derivation (70%) and validation (30%) sets. Multivariable logistic regression identified independent predictors that were used to construct the futile recanalisation following endovascular thrombectomy (FRET) score.
Results: Of 9909 patients, 7272 (73%) achieved successful recanalisation and 3420 (47%) of them experienced FR. In the derivation set, FR was independently associated with older age, diabetes, ischaemic heart disease, higher NIHSS, anterior cerebral artery occlusion, seizures at presentation, non-use of intravenous thrombolysis and lower Alberta Stroke Program Early CT Score (ASPECTS) or posterior circulation ASPECTS. Futile recanalisation patients had longer hospital stays and higher mortality rates. The FRET score demonstrated good discrimination (area under the curve [AUC] 0.721; 95% CI, 0.702-0.740), with FRET ≥ 3 indicating high risk. The validation cohort yielded similar performance (AUC 0.708; 95% CI, 0.680-0.737).
Conclusion: The FRET score enables early identification of EVT patients at high risk for FR.
{"title":"FRET score: predictors of futile recanalisation following endovascular thrombectomy-a multicentre cohort study from the EVATRISP collaboration.","authors":"Yoel Schwartzmann, Mirjam R Heldner, Hamza Jubran, Marcel Arnold, Philipe S Breiding, Fatma Shalabi, Tamer Jubeh, Issa Metanis, Annika Nordanstig, Paul J Nederkoorn, Nabila Wali, Anne van der Meij, Susanne Wegener, Lukas Otto, Hannah Lea Handelsmann, Patrik Michel, Davide Strambo, Alexander Salerno, Gian Marco De Marchis, Tolga Dittrich, Sami Curtze, Nicolas Martinez-Majander, Henrik Gensicke, Stefan Engelter, Valerian Altersberger, Simon Trüssel, Christian H Nolte, Christoph Riegler, Andrea Zini, Federica Naldi, Guido Bigliardi, Livio Picchetto, Joao Pedro Marto, José Pedro Costa, Jeremy Molad, Hen Hallevi, Carlo W Cereda, Alessandro Pezzini, Mauro Magoni, Visnja Padjen, Marialuisa Zedde, Ronen R Leker","doi":"10.1093/esj/aakaf013","DOIUrl":"https://doi.org/10.1093/esj/aakaf013","url":null,"abstract":"<p><strong>Introduction: </strong>Endovascular thrombectomy (EVT) is the treatment of choice for LVO stroke, yet nearly half of successfully recanalised patients fail to achieve functional independence, a phenomenon termed futile recanalisation (FR). Predictors of FR remain poorly defined in large, heterogeneous populations. Therefore, we aimed to develop a predictive score for FR.</p><p><strong>Patients and methods: </strong>Endovascular thrombectomy-treated LVO patients from the prospective, multicentre EVATRISP collaboration were included. All patients had known pre-stroke functional status, modified thrombolysis in cerebral infarction (mTICI) score and 90-day mRS. Futile recanalisation was defined as mRS > 2 at 90 days despite mTICI ≥ 2b. Patients with FR were compared to those with successful recanalisation and mRS ≤ 2. The cohort was randomly split into derivation (70%) and validation (30%) sets. Multivariable logistic regression identified independent predictors that were used to construct the futile recanalisation following endovascular thrombectomy (FRET) score.</p><p><strong>Results: </strong>Of 9909 patients, 7272 (73%) achieved successful recanalisation and 3420 (47%) of them experienced FR. In the derivation set, FR was independently associated with older age, diabetes, ischaemic heart disease, higher NIHSS, anterior cerebral artery occlusion, seizures at presentation, non-use of intravenous thrombolysis and lower Alberta Stroke Program Early CT Score (ASPECTS) or posterior circulation ASPECTS. Futile recanalisation patients had longer hospital stays and higher mortality rates. The FRET score demonstrated good discrimination (area under the curve [AUC] 0.721; 95% CI, 0.702-0.740), with FRET ≥ 3 indicating high risk. The validation cohort yielded similar performance (AUC 0.708; 95% CI, 0.680-0.737).</p><p><strong>Conclusion: </strong>The FRET score enables early identification of EVT patients at high risk for FR.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":"11 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146087557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1093/esj/23969873251365504
Basel Musmar, Hammam Abdalrazeq, Joanna M Roy, Nimer Adeeb, Elias Atallah, Kareem El Naamani, Ching-Jen Chen, Roland Jabre, Hassan Saad, Jonathan A Grossberg, Adam A Dmytriw, Aman B Patel, Mirhojjat Khorasanizadeh, Christopher S Ogilvy, Andre Monteiro, Adnan Siddiqui, Gustavo M Cortez, Ricardo A Hanel, Alejandro M Spiotta, Anthony J Piscopo, David M Hasan, Mohammad Ghorbani, Joshua Weinberg, Shahid M Nimjee, Mohamed M Salem, Jan-Karl Burkhardt, Akli Zetchi, Charles Matouk, Brian M Howard, Rosalind Lai, Rose Du, Rawad Abbas, Abdelaziz Amllay, Alfredo Munoz, Nabeel A Herial, Stavropoula I Tjoumakaris, Michael Reid Gooch, Christina Notarianni, Bharat Guthikonda, Robert H Rosenwasser, Pascal Jabbour
Introduction: Asymptomatic moyamoya angiopathy (MMA) is increasingly detected through noninvasive imaging; however, its optimal management remains controversial. This multicenter retrospective cohort study compared outcomes in asymptomatic versus symptomatic MMA patients undergoing surgical revascularization.
Patients and methods: A total of 475 patients treated with bypass surgery across multiple academic centers were included, with 56 (11.8%) classified as asymptomatic and 419 (88.2%) as symptomatic. Baseline demographics, surgical characteristics, and outcomes-including perioperative stroke, intraoperative complications, and follow-up stroke events-were collected. Asymptomatic MMA was defined as the absence of any prior ischemic or hemorrhagic stroke, seizures, or other neurological symptoms at the time of diagnosis. Both unadjusted analyses and propensity score weighting using inverse probability of treatment weighting (IPTW) were performed to adjust for potential confounders.
Results: In the unadjusted analysis, asymptomatic patients had significantly lower rates of all perioperative strokes (1.7% vs 11.4%; p = 0.05) and intraoperative complications (1.7% vs 11.2%; p = 0.05) compared to symptomatic patients. Additionally, follow-up stroke rates were lower in the asymptomatic group (1.7% vs 11.2%; p = 0.05). After IPTW adjustment, the reduction in intraoperative complications (OR: 0.08, 95% CI: 0.01-0.64; p = 0.01) and follow-up stroke rates (OR: 0.12, 95% CI: 0.01-0.91; p = 0.04) persisted, while differences in overall perioperative stroke were not statistically significant.
Conclusion: Bypass surgery in selected asymptomatic MMA patients is associated with reduced intraoperative complications, and fewer follow-up stroke rates. These findings support the careful consideration of surgical intervention in asymptomatic patients, emphasizing the importance of patient selection for optimal outcomes.
无症状烟雾血管病(MMA)越来越多地通过无创成像检测出来;然而,其最优管理仍存在争议。这项多中心回顾性队列研究比较了无症状和有症状的MMA患者接受手术血运重建术的结果。患者和方法:共有475例患者在多个学术中心接受了搭桥手术,其中56例(11.8%)被归类为无症状,419例(88.2%)被归类为有症状。收集基线人口统计学、手术特征和结果——包括围手术期卒中、术中并发症和随访卒中事件。无症状MMA定义为在诊断时没有任何先前的缺血性或出血性中风,癫痫发作或其他神经系统症状。采用未调整分析和使用治疗加权逆概率(IPTW)的倾向评分加权来调整潜在的混杂因素。结果:在未经调整的分析中,无症状患者围手术期卒中发生率(1.7% vs 11.4%, p = 0.05)和术中并发症发生率(1.7% vs 11.2%, p = 0.05)均显著低于有症状患者。此外,无症状组的随访卒中发生率较低(1.7% vs 11.2%; p = 0.05)。调整IPTW后,术中并发症(OR: 0.08, 95% CI: 0.01-0.64; p = 0.01)和随访卒中发生率(OR: 0.12, 95% CI: 0.01-0.91; p = 0.04)持续降低,而围术期卒中总体差异无统计学意义。结论:选择无症状MMA患者行搭桥手术可减少术中并发症,减少随访卒中发生率。这些发现支持对无症状患者进行手术干预的仔细考虑,强调患者选择对最佳结果的重要性。
{"title":"Outcomes of bypass surgery in asymptomatic moyamoya angiopathy: A multicenter study with propensity-score weighting.","authors":"Basel Musmar, Hammam Abdalrazeq, Joanna M Roy, Nimer Adeeb, Elias Atallah, Kareem El Naamani, Ching-Jen Chen, Roland Jabre, Hassan Saad, Jonathan A Grossberg, Adam A Dmytriw, Aman B Patel, Mirhojjat Khorasanizadeh, Christopher S Ogilvy, Andre Monteiro, Adnan Siddiqui, Gustavo M Cortez, Ricardo A Hanel, Alejandro M Spiotta, Anthony J Piscopo, David M Hasan, Mohammad Ghorbani, Joshua Weinberg, Shahid M Nimjee, Mohamed M Salem, Jan-Karl Burkhardt, Akli Zetchi, Charles Matouk, Brian M Howard, Rosalind Lai, Rose Du, Rawad Abbas, Abdelaziz Amllay, Alfredo Munoz, Nabeel A Herial, Stavropoula I Tjoumakaris, Michael Reid Gooch, Christina Notarianni, Bharat Guthikonda, Robert H Rosenwasser, Pascal Jabbour","doi":"10.1093/esj/23969873251365504","DOIUrl":"https://doi.org/10.1093/esj/23969873251365504","url":null,"abstract":"<p><strong>Introduction: </strong>Asymptomatic moyamoya angiopathy (MMA) is increasingly detected through noninvasive imaging; however, its optimal management remains controversial. This multicenter retrospective cohort study compared outcomes in asymptomatic versus symptomatic MMA patients undergoing surgical revascularization.</p><p><strong>Patients and methods: </strong>A total of 475 patients treated with bypass surgery across multiple academic centers were included, with 56 (11.8%) classified as asymptomatic and 419 (88.2%) as symptomatic. Baseline demographics, surgical characteristics, and outcomes-including perioperative stroke, intraoperative complications, and follow-up stroke events-were collected. Asymptomatic MMA was defined as the absence of any prior ischemic or hemorrhagic stroke, seizures, or other neurological symptoms at the time of diagnosis. Both unadjusted analyses and propensity score weighting using inverse probability of treatment weighting (IPTW) were performed to adjust for potential confounders.</p><p><strong>Results: </strong>In the unadjusted analysis, asymptomatic patients had significantly lower rates of all perioperative strokes (1.7% vs 11.4%; p = 0.05) and intraoperative complications (1.7% vs 11.2%; p = 0.05) compared to symptomatic patients. Additionally, follow-up stroke rates were lower in the asymptomatic group (1.7% vs 11.2%; p = 0.05). After IPTW adjustment, the reduction in intraoperative complications (OR: 0.08, 95% CI: 0.01-0.64; p = 0.01) and follow-up stroke rates (OR: 0.12, 95% CI: 0.01-0.91; p = 0.04) persisted, while differences in overall perioperative stroke were not statistically significant.</p><p><strong>Conclusion: </strong>Bypass surgery in selected asymptomatic MMA patients is associated with reduced intraoperative complications, and fewer follow-up stroke rates. These findings support the careful consideration of surgical intervention in asymptomatic patients, emphasizing the importance of patient selection for optimal outcomes.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":"11 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146087566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1093/esj/23969873251381974
Johannes Kaesmacher, Adnan Mujanovic, Seraina Beyeler, Lukas Bütikofer, Morin Beyeler, Eike I Piechowiak, Tomas Dobrocky, Mira Katan, Pasquale Mordasini, Grégoire Boulouis, Zsolt Kulcsar, Marios Psychogios, Mikael Mazighi, Daniel Strbian, Götz Thomalla, Robin Lemmens, Jan-Hendrik Schäfer, Franziska Dorn, Olav Jansen, Roland Schwab, Helge Kniep, Jens Fiehler, Wenjie Zi, Jan Gralla, Urs Fischer
Rationale: Intra-arterial fibrinolytics may be used for distal remaining vessel occlusions after incomplete mechanical thrombectomy (MT). However, their efficacy in improving reperfusion in this specific clinical scenario is unclear. While better reperfusion may lead to improved clinical outcomes, additional fibrinolytics could also increase the risk of hemorrhagic complications.
Aim: To assess the safety and reperfusion efficacy of intra-arterial tenecteplase (TNK) compared to no further interventional treatment in patients with incomplete reperfusion and mechanically non-amendable residual occlusions after MT.
Methods and design: This is an international, multicenter, randomized (1:1) controlled, two-arm, open, assessor-blinded, surrogate endpoint trial. The interventional arm receives 3 mg (not weight-adjusted) intra-arterial TNK, administered as close as possible to the residual occlusion. The control arm receives no further interventional treatment.
Sample size: TECNO will randomize 156 participants 1:1 to 3 mg intra-arterial tenecteplase or no further interventional treatment. This sample size is based on anticipated absolute improvements in early and late reperfusion with intra-arterial TNK of 25% and 30%, respectively.
Outcomes: The two co-primary imaging outcomes are early and late reperfusion. Early reperfusion is defined as an extended Thrombolysis in Cerebral Infarction (eTICI) score ⩾ 2a for residual occlusions on angiography 25 min after randomization. Late reperfusion is defined as the absence of a wedge-shaped perfusion delay on delay-sensitive perfusion maps assessed on 24 h ± 6 h perfusion imaging. Standard secondary clinical outcomes will be assessed at 24 h and 90 ± 15 days.
Discussion: The TECNO trial will provide evidence on the safety and reperfusion efficacy of locally administered intra-arterial TNK in patients with residual occlusions following MT.
{"title":"Safety and efficacy of intra-arterial tenecteplase for non-complete reperfusion of intracranial occlusions: Methodology of a randomized, controlled, multicenter study.","authors":"Johannes Kaesmacher, Adnan Mujanovic, Seraina Beyeler, Lukas Bütikofer, Morin Beyeler, Eike I Piechowiak, Tomas Dobrocky, Mira Katan, Pasquale Mordasini, Grégoire Boulouis, Zsolt Kulcsar, Marios Psychogios, Mikael Mazighi, Daniel Strbian, Götz Thomalla, Robin Lemmens, Jan-Hendrik Schäfer, Franziska Dorn, Olav Jansen, Roland Schwab, Helge Kniep, Jens Fiehler, Wenjie Zi, Jan Gralla, Urs Fischer","doi":"10.1093/esj/23969873251381974","DOIUrl":"https://doi.org/10.1093/esj/23969873251381974","url":null,"abstract":"<p><strong>Rationale: </strong>Intra-arterial fibrinolytics may be used for distal remaining vessel occlusions after incomplete mechanical thrombectomy (MT). However, their efficacy in improving reperfusion in this specific clinical scenario is unclear. While better reperfusion may lead to improved clinical outcomes, additional fibrinolytics could also increase the risk of hemorrhagic complications.</p><p><strong>Aim: </strong>To assess the safety and reperfusion efficacy of intra-arterial tenecteplase (TNK) compared to no further interventional treatment in patients with incomplete reperfusion and mechanically non-amendable residual occlusions after MT.</p><p><strong>Methods and design: </strong>This is an international, multicenter, randomized (1:1) controlled, two-arm, open, assessor-blinded, surrogate endpoint trial. The interventional arm receives 3 mg (not weight-adjusted) intra-arterial TNK, administered as close as possible to the residual occlusion. The control arm receives no further interventional treatment.</p><p><strong>Sample size: </strong>TECNO will randomize 156 participants 1:1 to 3 mg intra-arterial tenecteplase or no further interventional treatment. This sample size is based on anticipated absolute improvements in early and late reperfusion with intra-arterial TNK of 25% and 30%, respectively.</p><p><strong>Outcomes: </strong>The two co-primary imaging outcomes are early and late reperfusion. Early reperfusion is defined as an extended Thrombolysis in Cerebral Infarction (eTICI) score ⩾ 2a for residual occlusions on angiography 25 min after randomization. Late reperfusion is defined as the absence of a wedge-shaped perfusion delay on delay-sensitive perfusion maps assessed on 24 h ± 6 h perfusion imaging. Standard secondary clinical outcomes will be assessed at 24 h and 90 ± 15 days.</p><p><strong>Discussion: </strong>The TECNO trial will provide evidence on the safety and reperfusion efficacy of locally administered intra-arterial TNK in patients with residual occlusions following MT.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":"11 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146087592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1093/esj/23969873251350124
Pere Canals, Alvaro García-Tornel, Giulio Maria Fiore, Marc Rodrigo-Gisbert, Blanca Sastre, Jordi Mayol, Marc Ribo
Introduction: Neutral results from trials assessing mechanical thrombectomy (MT) for medium/distal vessel occlusions (MDVO) suggest the need for better selection criteria in these patients. Tortuous vascular anatomies may negatively influence MT efficacy and safety.
Patients and methods: Consecutive patients with middle cerebral artery (MCA)-MDVO (M2/M3) who underwent MT at our center between January 2017 and September 2024 were included. Baseline CTAs were semi-automatically analyzed using an in-house vascular analysis framework. The internal carotid artery (ICA) tortuosity index (TI) and anatomical features of the MCA were extracted. Logistic regression adjusted for intravenous thrombolysis administration and onset-to-puncture time evaluated associations of anatomical features with treatment efficacy and safety endpoints. Primary endpoints were complete recanalization (final eTICI 2c/3) and symptomatic intracranial hemorrhage (sICH).
Results: 213 patients (81 years IQR 72-87, 51.2% female) were included. MCA bending length (aOR 0.48 [95%CI 0.27-0.86], p = 0.013), MCA-TI (aOR 0.77 [0.60-0.98], p = 0.032) and ICA-TI (aOR 0.59 [0.36-0.96], p = 0.034) were associated with lower probability of complete recanalization. ICA-TI (aOR 0.51 [0.31-0.84], p = 0.008) and mean MCA diameter (aOR 0.34 [0.13-0.90], p = 0.030) correlated with decreased odds of first-pass recanalization. Large mean MCA diameter was associated with lower likelihood of excellent functional outcome (aOR 0.30 [0.09-0.96], p = 0.042). Regarding safety endpoints, larger diameter at occlusion was associated with sICH (aOR 4.04 [1.03-15.87], p = 0.046), while MCA bending length (aOR 2.47 [1.24-4.92], p = 0.010) was linked to subarachnoid hemorrhage.
Discussion: Automatic evaluation of anatomical vascular features may predict safety and efficacy of MT in stroke patients with MCA-MDVO. The value of these features as inclusion criteria for future MCA-MDVO clinical trials should be explored.
Conclusion: Intracranial vascular tortuosity is associated to poor thrombectomy outcomes in patients with MDVO.
导言:评估机械取栓(MT)治疗中/远端血管闭塞(MDVO)的试验中性结果表明,这些患者需要更好的选择标准。弯曲的血管解剖结构可能会对MT的疗效和安全性产生负面影响。患者和方法:纳入2017年1月至2024年9月在本中心连续行MT的大脑中动脉(MCA)-MDVO (M2/M3)患者。基线cta使用内部血管分析框架进行半自动分析。提取颈内动脉(ICA)弯曲指数(TI)和MCA的解剖特征。经静脉溶栓给药和起病至穿刺时间调整后的Logistic回归评估了解剖特征与治疗疗效和安全性终点的关联。主要终点是完全再通(最终eTICI 2c/3)和症状性颅内出血(sICH)。结果:纳入213例患者,年龄81岁(IQR 72 ~ 87),女性51.2%。MCA弯曲长度(aOR 0.48 [95%CI 0.27-0.86], p = 0.013)、MCA- ti (aOR 0.77 [0.60-0.98], p = 0.032)和ICA-TI (aOR 0.59 [0.36-0.96], p = 0.034)与较低的完全再通概率相关。ICA-TI (aOR 0.51 [0.31-0.84], p = 0.008)和平均MCA直径(aOR 0.34 [0.13-0.90], p = 0.030)与首次再通几率降低相关。中动脉平均直径大与良好功能预后的可能性较低相关(aOR 0.30 [0.09-0.96], p = 0.042)。关于安全性终点,闭塞处直径较大与蛛网膜下腔出血相关(aOR 4.04 [1.03-15.87], p = 0.046),而MCA弯曲长度(aOR 2.47 [1.24-4.92], p = 0.010)与蛛网膜下腔出血相关。讨论:血管解剖特征的自动评估可以预测MT治疗卒中合并MCA-MDVO患者的安全性和有效性。这些特征作为未来MCA-MDVO临床试验纳入标准的价值值得探讨。结论:颅内血管弯曲与MDVO患者取栓效果差有关。
{"title":"Prognostic value of intracranial vascular tortuosity in thrombectomy for distal vessel occlusion.","authors":"Pere Canals, Alvaro García-Tornel, Giulio Maria Fiore, Marc Rodrigo-Gisbert, Blanca Sastre, Jordi Mayol, Marc Ribo","doi":"10.1093/esj/23969873251350124","DOIUrl":"https://doi.org/10.1093/esj/23969873251350124","url":null,"abstract":"<p><strong>Introduction: </strong>Neutral results from trials assessing mechanical thrombectomy (MT) for medium/distal vessel occlusions (MDVO) suggest the need for better selection criteria in these patients. Tortuous vascular anatomies may negatively influence MT efficacy and safety.</p><p><strong>Patients and methods: </strong>Consecutive patients with middle cerebral artery (MCA)-MDVO (M2/M3) who underwent MT at our center between January 2017 and September 2024 were included. Baseline CTAs were semi-automatically analyzed using an in-house vascular analysis framework. The internal carotid artery (ICA) tortuosity index (TI) and anatomical features of the MCA were extracted. Logistic regression adjusted for intravenous thrombolysis administration and onset-to-puncture time evaluated associations of anatomical features with treatment efficacy and safety endpoints. Primary endpoints were complete recanalization (final eTICI 2c/3) and symptomatic intracranial hemorrhage (sICH).</p><p><strong>Results: </strong>213 patients (81 years IQR 72-87, 51.2% female) were included. MCA bending length (aOR 0.48 [95%CI 0.27-0.86], p = 0.013), MCA-TI (aOR 0.77 [0.60-0.98], p = 0.032) and ICA-TI (aOR 0.59 [0.36-0.96], p = 0.034) were associated with lower probability of complete recanalization. ICA-TI (aOR 0.51 [0.31-0.84], p = 0.008) and mean MCA diameter (aOR 0.34 [0.13-0.90], p = 0.030) correlated with decreased odds of first-pass recanalization. Large mean MCA diameter was associated with lower likelihood of excellent functional outcome (aOR 0.30 [0.09-0.96], p = 0.042). Regarding safety endpoints, larger diameter at occlusion was associated with sICH (aOR 4.04 [1.03-15.87], p = 0.046), while MCA bending length (aOR 2.47 [1.24-4.92], p = 0.010) was linked to subarachnoid hemorrhage.</p><p><strong>Discussion: </strong>Automatic evaluation of anatomical vascular features may predict safety and efficacy of MT in stroke patients with MCA-MDVO. The value of these features as inclusion criteria for future MCA-MDVO clinical trials should be explored.</p><p><strong>Conclusion: </strong>Intracranial vascular tortuosity is associated to poor thrombectomy outcomes in patients with MDVO.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":"11 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146087595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}