Nonopacification of Frontal and Parietal Branches After Middle Meningeal Artery Embolization: A Radiographic Benchmark.

Background: Middle meningeal artery embolization (MMAE) has revolutionized the armamentarium for chronic subdural hematoma (CSDH) treatment. Technical and angiographic benchmarks to guide procedural and clinical success are less well established.

Methods: A single-center database was reviewed to compare outcomes after standalone MMAE with and without resultant residual angiographic opacification of frontal and parietal (F/P) branches.

Admission hyperglycemia effect on symptomatic intracranial hemorrhage in tenecteplase versus alteplase before large vessel occlusion stroke thrombectomy.

Introduction: Intravenous thrombolysis (IVT) with alteplase (TPA) in hyperglycemic stroke patients is associated with an increased risk of symptomatic intracranial hemorrhage (sICH) and poor functional outcomes. We aimed to explore the association between admission hyperglycemia and sICH in large vessel occlusion stroke (LVOS) patients treated with TNK versus TPA before endovascular thrombectomy (EVT).

Methods: We reviewed consecutive LVOS patients treated with TPA or TNK before EVT from 01/2020 to 06/2023.

Sustained efficacy of angioplasty for cerebral vasospasm after aneurysmal subarachnoid hemorrhage: Risk features and device comparison.

Background: Cerebral vasospasm is a leading source of delayed morbidity and mortality after aneurysmal subarachnoid hemorrhage (aSAH). Angioplasty may improve vasospasm, while optimal target and device selection remains controversial. This study aimed to identify features and devices associated with sustained efficacy.

Improved Outcomes Among Octogenarians with Ruptured Aneurysms: Endovascular Treatment as Right-of-First-Refusal in the Second Post-trial Decade.

Background: Treatment outcomes of octogenarians with aneurysmal subarachnoid hemorrhage (aSAH) are often considered poor. With ongoing advancements and experience in endovascular technology, we sought to evaluate the outcomes of octogenarians treated for aSAH in the second post-International Subarachnoid Aneurysm Trial (ISAT)/Barrow Ruptured Aneurysm Trial (BRAT) decade.

Method: A single-center database of aSAH was reviewed to identify patients aged 80 years or above undergoing aneurysm treatment.

Middle Meningeal Artery Embolization for "Trial-Ineligible" Chronic Subdural Hematomas.

Background And Objectives: The benefit of middle meningeal artery embolization (MMAE) in the treatment of chronic subdural hematoma (CSDH) has been recently demonstrated in a series of clinical trials. Whether MMAE benefits "trial-ineligible" patients remains elusive. We thus sought to explore the potential benefit of MMAE in neurologically stable (modified Rankin Scale ≤3) patients with "trial-ineligible" CSDHs because of large size: Thickness >15 mm and/or midline shift ≥5 mm.

Intracranial aneurysms and abducent nerve palsy.

Background: Cranial nerve (CN) palsy may manifest as an initial presentation of intracranial aneurysms or due to the treatment. The literature reveals a paucity of studies addressing the involvement of the 6 CN in the presentation of cerebral aneurysms.

Methods: Clinical patient data, aneurysmal characteristics, and CN 6 palsy outcome were retrospectively reviewed and analyzed.

Pharmaceutical Modulation of Intracranial Aneurysm Development and Rupture.

Management of intracranial aneurysms (IAs) is determined by patient age, risk of rupture, and comorbid conditions. While endovascular and microsurgical interventions offer solutions to mitigate the risk of rupture, pharmacological management strategies may complement these approaches or serve as alternatives in appropriate cases. The pathophysiology of IAs allows for the targeting of inflammation to prevent the development and rupture of IAs.

Impact of Embolisate Penetration, Type, and Technique on Results After Standalone Middle Meningeal Artery Embolization for Chronic Subdural Hematoma.

Background And Objectives: Middle meningeal artery embolization (MMAE) has emerged as a promising modality for chronic/subacute subdural hematoma treatment; however, consensus regarding embolization technique and embolisate has not been achieved. We thus sought to compare the efficacy of distinct MMAE techniques and embolisate.

Methods: An institutional registry was reviewed to identify patients undergoing standalone MMAE for symptomatic chronic/subacute subdural hematoma.

Medications and "Risk" of Aneurysm Rupture Based on Presentation: Setting the Record Straight.

Objective: Studies assessing aneurysm rupture "risk" based on comparative retrospective analyses of medications taken on presentation may be subject to presentation bias. Are patients with ruptured aneurysms simply less likely to be taking medications than those with unruptured aneurysms?

Methods: A retrospective chart review was conducted among patients with treated aneurysms from June 2016 to July 2023. A step-wise comparison of demographics, clinical characteristics (rupture status), and medications taken upon presentation was performed between ruptured and unruptured cases.

Traumatic Cerebral Venous Sinus Thrombosis: Management and Outcomes.

Background: Traumatic brain injury (TBI) with skull fractures parallel to or crossing venous sinuses is a recognized risk factor for traumatic cerebral venous sinus thrombosis (tCVST). Despite the recognition of this traumatic pathology in the literature, no consensus regarding management has been achieved. This study aimed to evaluate the impact of tCVST on TBI outcomes and related complications.

Assessment of the safety and efficacy of the Zoom 45 and 55 reperfusion catheters for medium and distal mechanical thrombectomies: A multi-institutional study.

Introduction: The Zoom aspiration catheters harbor novel dimensions and construction to enhance trackability and deliverability. In addition, a beveled tip may improve thrombus interaction and aspiration force for a set inner diameter. This study evaluates their utility in medium and distal vessel occlusions.

Advances in biomarkers for vasospasm - Towards a future blood-based diagnostic test.

Objective: Cerebral vasospasm and the resultant delayed cerebral infarction is a significant source of mortality following aneurysmal SAH. Vasospasm is currently detected using invasive or expensive imaging at regular intervals in patients following SAH, thus posing a risk of complications following the procedure and financial burden on these patients. Currently, there is no blood-based test to detect vasospasm.

General Versus Nongeneral Anesthesia for Middle Meningeal Artery Embolization for Chronic Subdural Hematomas: Multicenter Propensity Score Matched Study.

Background And Objectives: The choice of anesthesia type (general anesthesia [GA] vs nongeneral anesthesia [non-GA]) in middle meningeal artery embolization (MMAE) procedures for chronic subdural hematomas (cSDH) differs between institutions and left to care team discretion given lack of standard guidelines. We compare the outcomes of GA vs non-GA in MMAE.

Methods: Consecutive patients receiving MMAE for cSDH at 14 North American centers (2018-2023) were included.

Flow Diverters with Surface Modification in Patients with Intracranial Aneurysms: A Systematic Review and Meta-Analysis.

Background: Flow diverters with surface modification (FDSM) are increasingly being used in the treatment of intracranial aneurysms (ANs). We aimed to evaluate the effectiveness and safety across different devices and antiplatelet therapies using a systematic review and meta-analysis.

Methods: A systematic review was performed to identify original studies of ≥10 patients with intracranial ANs treated with FDSM from database inception through August 2023.

Subarachnoid Hemorrhage Outcomes in an Endovascular Right of First Refusal Neurosurgical Environment.

Background: Randomized controlled trials demonstrate that endovascular techniques yield improved outcomes compared with microsurgical approaches. However, not all patients are suitable candidates for endovascular management. This study aimed to determine if healthy patients managed microsurgically could achieve functional outcomes comparable to patients managed endovascularly.

Bow Hunter Syndrome: An Illustrative Case and Operative Management.

The differential for vertebrobasilar insufficiency is wide and can be caused by posterior circulation infarcts, steal-type phenomena, or other systemic causes. In the absence of imaging findings explaining symptomology, the utility of appropriate history gathering and dynamic angiography cannot be understated in identifying Bow Hunter's syndrome, a rare cause of dynamic vertebrobasilar insufficiency. We present a case of a 69-year-old man who complained of presyncope and severe dizziness when turning his head towards the right.

Toward Optimized and Cost-Efficient Protocols for Inferior Petrosal Sinus Sampling in the Diagnosis of Cushing Disease.

Background And Objective: Conventional protocols for inferior petrosal sinus sampling (IPSS) during the workup of hypercortisolemia require adrenocorticotrophic hormone (ACTH) measurement at multiple time points with corticotropic-releasing hormone (CRH) used as a stimulator. Modernized evidence-based protocols must also reflect the increased utilization of desmopressin (DDAVP) for ACTH stimulation as the manufacturing shortage of traditionally used CRH continues. We model the diagnostic accuracy and potential economic savings of DDAVP utilization and reduced time point sampling.

Clopidogrel Is Associated with Reduced Likelihood of Aneurysmal Subarachnoid Hemorrhage: a Multi-Center Matched Retrospective Analysis.

Maladaptive inflammation underlies the formation and rupture of human intracranial aneurysms. There is a growing body of evidence that anti-inflammatory pharmaceuticals may beneficially modulate this process. Clopidogrel (Plavix) is a commonly used irreversible P2Y12 receptor antagonist with anti-inflammatory activity.