Sunil A. Sheth

The Contour Neurovascular System Versus Woven Endobridge for Endovascular Embolization of Cerebral Aneurysms: A Propensity Score-matched Cohort Study

BACKGROUND AND OBJECTIVES: The Woven Endobridge (WEB) and the Contour Neurovascular System (Contour) are both intrasaccular devices used to treat cerebral aneurysms. We compared outcomes of these 2 devices using data from 2 large registries. METHODS: Data were sourced from the WorldWideWEB Consortium, which included 1363 cases treated with WEB from 2017, and a registry of 277 Contour cases from 10 European centers starting the same year. Patient demographics, aneurysm characteristics, procedural specifics, and outcomes were analyzed. Propensity score matching was applied for comparison. RESULTS: Before matching, the Contour group had more men (37.9% vs 30.8%), more asymptomatic cases (83.4% vs 70.3%), and fewer acute subarachnoid hemorrhage cases (10.8% vs 26.2%). After matching, no significant differences were found in demographics or aneurysm characteristics between groups. The median age was 60 years, and median aneurysm dimensions were comparable. Logistic regression showed no significant differences between WEB and Contour in achieving complete occlusion (odds ratio [OR] = 1.01, 95% CI, 0.67-1.52, P = .971), adequate occlusion (OR = 0.85, 95% CI, 0.41-1.76, P = .665), or achieving modified Rankin Scale 0 to 2 at last follow-up (OR = 0.48, 95% CI, 0.21-1.02, P = .064). Retreatment (OR = 2.23, P = .086), thromboembolic complications (OR = 0.75, P = .452), and adjunctive treatment use (OR = 1.93, P = .141) were also similar. CONCLUSION: The WEB and Contour demonstrated comparable clinical and angiographic outcomes in this large multicenter study comprised majority small, asymptomatic cerebral aneurysms.

Beyond the Threshold: Continuous Creatinine Change and Outcomes After Endovascular Thrombectomy for Acute Ischemic Stroke

BACKGROUND: Contrast-associated acute kidney injury (CA-AKI) after endovascular thrombectomy (EVT) worsens outcomes in acute ischemic stroke, but threshold-based definitions do not capture prognostic information from subthreshold changes. We tested whether early creatinine change within 48 hours of EVT conveys graded prognostic information beyond dichotomous CA-AKI. METHODS: We performed a secondary analysis of the CAN-REST (Contrast-Associated Nephropathy After Endovascular Stroke Treatment; REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT06596603) registry, a retrospective multicenter observational cohort study of 6638 EVT-treated adults with acute ischemic stroke enrolled at 73 centers in 16 countries between January 1 and December 31, 2023. Early creatinine change was quantified as the natural logarithm ratio of 48-hour creatinine to baseline creatinine (ln[48-hour/baseline creatinine]), with CA-AKI defined per Kidney Disease: Improving Global Outcomes criteria (≥0.3 mg/dL or ≥1.5× baseline rise within 48 hours). Multivariable logistic regression adjusted for prespecified baseline and periprocedural covariates examined associations with 90-day modified Rankin Scale shift and in-hospital mortality; linear versus restricted cubic spline specification was selected by likelihood ratio testing, and contrasts were estimated at ±10%, ±25%, and ±50%. RESULTS: Greater creatinine worsening within 48 hours of EVT was independently associated with an unfavorable 90-day modified Rankin Scale shift (adjusted common odds ratio per 1-unit log-ratio increase, 1.48 [95% CI, 1.07-2.04]; linear) and in-hospital mortality (nonlinear dose-response, of larger magnitude). A 10% increase in creatinine at 48 hours-well below Kidney Disease: Improving Global Outcomes threshold-was associated with worse functional outcome (adjusted common odds ratio, 1.04 [95% CI, 1.01-1.07]) and death (adjusted odds ratio, 1.22 [95% CI, 1.13-1.32]); a 10% decrease in creatinine at 48 hours was associated with lower odds of both outcomes (adjusted common odds ratio, 0.96 [95% CI, 0.93-0.99] and 0.74 [95% CI, 0.65-0.86]). The functional-outcome association concentrated at upper modified Rankin Scale cut-points (severe disability, death); effect modification by baseline renal function was not significant. CONCLUSIONS: Early creatinine change after EVT conveys graded, outcome-specific prognostic information extending below formal CA-AKI thresholds, with a dose-response detectable at changes as modest as ±10%, complementing binary CA-AKI as a framework for post-EVT renal risk assessment. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT06596603.

Outcomes Following First-Pass Direct Aspiration Versus Stent Retriever for Endovascular Thrombectomy in Primary Medium or Distal Vessel Occlusion: An Analysis of the SVIN Registry

Registry analysis finds direct aspiration speeds recanalization but stent retrievers yield higher first-pass success in medium vessel occlusions, indicating distinct procedural advantages.

Racial disparities in off-guideline endovascular treatments for acute ischaemic stroke

Registry analysis finds racial disparities in off-guideline endovascular treatment for acute stroke, indicating inequitable adoption of expanded therapies.

Millipede Aspiration for Revascularization in Stroke (MARRS): prospective trial of a novel 0.088 inch corrugated catheter

Prospective single-arm trial demonstrates high revascularization rates with a corrugated aspiration catheter in acute ischemic stroke, highlighting effective large vessel occlusion treatment.

US-based RCTs in stroke guidelines drop ~54%, while China-based trials triple.

Clinicians should monitor the shifting geographic sources of stroke evidence; this analysis extends global RCT trends while leaving applicability questions open.

Role of Perfusion Parameters on Outcomes and Safety of Endovascular Therapy in Posterior Cerebral Artery Stroke.

Observational analysis evaluates the relationship of perfusion parameters with outcomes in isolated posterior cerebral artery occlusion, suggesting cautions in endovascular therapy.

Role of Perfusion Parameters on Outcomes and Safety of Endovascular Therapy in Posterior Cerebral Artery Stroke

Randomized trial investigates perfusion imaging's role in outcomes of endovascular therapy for PCA occlusion, suggesting risks may vary.

MAD-MT Score: A Tool to Optimize Patient Selection for Mechanical Thrombectomy in Distal Vessel Occlusions

Faster reperfusion with combined delivery catheter systems in aspiration-first stroke thrombectomy: a multicenter analysis

Retrospective analysis shows improved efficiency with aspiration-first catheter systems in strokes, suggesting benefits for treatment protocols.

Woven Endobridge device for ruptured vs. unruptured aneurysms: insights from the WorldWideWEB study

PURPOSE: Although the Woven EndoBridge (WEB) device is increasingly used for the treatment of wide-neck intracranial aneurysms, including in the acute rupture setting, comparative evidence assessing the impact of rupture status remains limited. This study compared angiographic, safety, and clinical outcomes between ruptured and unruptured intracranial aneurysms treated with WEB. METHODS: We conducted a retrospective analysis of prospectively collected data from the multicenter cohort registry WorldWideWEB, including consecutive adult patients with intracranial aneurysms treated with the WEB. Patients were stratified into groups of ruptured and unruptured aneurysms. Propensity score matching was used to balance baseline characteristics between both groups. Retreatment rate was the primary outcome. Secondary outcomes included mRS, safety events (thromboembolic complications) and angiographic outcomes (periprocedurally and last follow-up). RESULTS: Among 1,220 patients, 342 (28.0%) presented with ruptured aneurysms. Propensity-score-matched analyses revealed no significant difference in thromboembolic complications (11.8% vs. 5.9%, p = 0.056), similar periprocedural adequate occlusion (53.3% vs. 53.8%, p > 0.9), and similar retreatment rates (11.8% (95% CI 7.8-17.6%) vs. 7.1% (95% CI 4.1-12.0%), p = 0.14); however, adequate occlusion at follow-up was lower (82.2% vs. 93.3%, p = 0.002) and functional outcomes were worse (mRS ≥ 2 in 34.1% vs. 21.9%, p = 0.012) among patients with ruptured aneurysms. CONCLUSION: Ruptured aneurysms demonstrated expected inferior follow-up functional and angiographic outcomes when compared with unruptured aneurysms, but no difference in retreatment rate and procedural safety. These findings support WEB as a safe and effective treatment option for appropriately selected ruptured intracranial aneurysms in routine clinical practice.

Predictors of 90-Day Functional Outcome in Large Infarct Core Endovascular Therapy

Cohort study finds endovascular therapy outcomes linked to age and NIHSS in patients with large core strokes, suggesting factors for better recovery.

Scoring System for Pre-Thrombectomy Diagnosis of ICAD in Posterior Circulation Strokes

Retrospective analysis shows a scoring system for ICAD improves predictive accuracy in posterior circulation strokes, highlighting its potential clinical utility.

Unwitnessed stroke onset shows no difference in 90-day functional outcomes vs witnessed onset after thrombectomy.

In the extended time window, patients with unwitnessed large-vessel occlusion stroke undergoing endovascular thrombectomy have similar likelihoods of favorable outcomes compared to those with witnessed onset.

Sex Differences in the Protective Effect of Brain Volume: Age Attenuates Protection in Females

Background Sex differences in outcomes after acute ischemic stroke (AIS) are well recognized, but mechanisms remain unclear. This study evaluates whether parenchymal brain volume (PBV), age, and final infarct volume (DWI-FIV) explain sex-specific differences in post-stroke disability. Methods We analyzed a prospectively collected multicenter registry of AIS patients treated between 2015 and 2024. Automated pipelines quantified PBV from non-contrast CT and DWI-FIV from 24–48-hour MRI. With the primary outcome being 90-day functional independence (mRS 0–2), sex-stratified logistic regression models evaluated its association with PBV. Logistic and linear models examined sex-specific relationships among covariables. Results Among 1,103 patients, 48% were female, median age was 66 [IQR 56–77], median NIHSS was 9 [IQR 4-17], and median DWI-FIV was 7.8 [IQR 0.2-36.3]. Functional independence at 90 days was achieved in 51.7% of males versus 44.9% of females ( p = 0.025). In univariable analyses, greater PBV was associated with higher odds of functional independence in both males (OR 1.30; 95% CI: 1.11–1.53) and females (OR 1.35; 95% CI: 1.13–1.61). After ruling out multicollinearity (mean VIF = 1.32), multivariable analyses showed persistent association in males (aOR 1.30 per 100 cm 3 ; 95% CI: 1.10–1.60) but not in females (aOR 1.10; 95% CI: 0.90–1.33). Each decade of age reduced the odds of functional independence by 30% in females (aOR 0.70; 95% CI: 0.62– 0.79) versus 15% in males (aOR 0.85; 95% CI: 0.72–0.97; p i nteraction = 0.019). Age was also associated with larger infarcts in females (+4.22 cm 3 /decade; p = 0.033) but not in males. Conclusion PBV was protective in males but less so in females, where stronger age-related effects on infarct size and severity abrogated its benefit. These suggest aging weakens brain reserve in women, emphasizing the importance of sex and brain volume measurements in outcome models.

Cardioembolic thrombi contained significantly higher number of CD11b positive cells (248.2 ± 137.4) compared to strokes from large artery atherosclerosis (138.3 ± 92.1, p = 0.01).

Thrombus CD11b levels may aid AF detection post-thrombectomy; leaves open whether inflammation distinguishes cardioembolic etiology.

Sedation vs General Anesthesia for Endovascular Therapy in Acute Ischemic Stroke

Randomized trial shows GA improved 90-day outcomes in acute ischemic stroke patients, suggesting better therapeutic strategies.

Factors associated with Early Neurological Deterioration in Minor Distal Medium Vessel Acute Ischemic Stroke: A Multinational Multicenter Study

Multinational analysis identifies key factors affecting early neurological deterioration in minor strokes, suggesting careful treatment planning.

Should We Stop Endovascular Treatment of M2 Occlusions?: A Critical Look at Recent Evidence

This review critically examines endovascular treatment outcomes for M2 occlusions in acute ischemic stroke, suggesting refined treatment guidelines.

A novel automated CT biomarker to predict outcomes in acute ischemic stroke: net water uptake

Observational analysis compares net water uptake and ASPECTS for predicting outcomes in acute ischemic stroke patients, indicating promising performance.