Neurovascular Intervention

Removing a clot blocking a medium- or small-sized artery in the brain mechanically is a safe treatment for a common type of stroke; however, it did not lessen disability more than best medical treatment (including clot-busting medication if indicated) alone, according to preliminary late-breaking science presented today at the American Stroke Association's International Stroke Conference 2025. The conference, in Los Angeles, Feb. 5-7, 2025, is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

In-stent restenosis (ISR) is the primary cause of stroke recurrence after intracranial stenting. Drug-eluting stents (DES) have recently shown great potential for reducing restenosis. This systematic review aimed to evaluate the efficacy and safety of DES compared with bare-metal stents (BMS) for intracranial atherosclerotic stenosis (ICAS).

This study indicated a favorable midterm clinical outcome of the novel intracranial DES NOVA stent, with a low rate of ISR and without increasing the incidence of periprocedural complications in highly selected patients. The NOVA stent represents a promising new therapy to treat ICAS. However, the clinical results need to be further verified by larger sample size controlled studies with longer follow-up periods.

The question of whether aneurysms under 5mm should undergo treatment at all, and whether it is safe to do it, has been lingering in the minds of researchers and clinicians for at least the past two decades. The COAST study has made an important step towards a better understanding of the consequences of such a treatment. In order to better put these results in perspective, however, we should take into consideration the natural history of intracranial aneurysms, look at ruptured and unruptured aneurysms separately, and discuss blood blister-like aneurysms as well. One of the most often-heard arguments in favour of treatment when discussing small aneurysms is the discrepancy between natural history studies, showing a low longitudinal risk of haemorrhage from small aneurysms, on one hand, and retrospective analyses showing a preponderance of small aneurysms in large subarachnoid haemorrhage (SAH) series on the other.

While intracranial atherosclerotic disease (ICAD) is often cited in the context of its greater prevalence among patients in China and other parts of Asia, discussions at the recent BRAIN conference (2–4 December, London, UK) emphasised its relevance as an underlying—and also under-addressed—cause of ischaemic stroke across many global regions.

Q’Apel Medical has announced that it has received CE-mark certification for its Armadillo SelectFlex neurovascular access system. As noted in a company press release, this “first-of-its-kind” 7Fr system features the patented SelectFlex technology and is indicated for the introduction of interventional devices into the neurovasculature.

While stroke treatment has dramatically changed in recent years, still around 795,000 people experience a new or recurrent stroke each year and, of all strokes, 87% are ischaemic.1 A high variability in accessing stroke treatments exists across different countries or different regions within the same nation, even if, at present, guidelines are quite definitive in indicating endovenous thrombolysis and mechanical thrombectomy (MT) in selected cases as key treatment points. However, treatment indications are continuously evolving and so the vascular surgery world should be prepared to evolve accordingly.

Measuring less than 5 mm in size, microplastics are formed over time as plastic materials break down but don’t biodegrade. Exposure to these substances can come through food, air, and skin absorption. While scientists are learning more about how these substances are absorbed by the body, questions remain about how much exposure is safe, what effect — if any — microplastics could have on brain function, and what clinicians should tell their patients.

While much research has been conducted on Glu’s role in MDD and other neurological diseases, the study of post-neurological depression (such as PSD, post-TBI, and epilepsy-associated depression) remains limited. We hypothesize that Glu plays a significant role in these sequelae and targeting this pathway could lead to strategies for preventing and treating these debilitating disorders, thereby reducing the burden of these diseases and improving quality of life after major neurological insults. This review has focused on three conditions, but future studies should explore additional avenues where Glu’s role can be applied to reduce depression incidence after other neurological disorders.

Young people may feel invincible but that alone isn't enough to prevent a stroke. The number of younger people having strokes has risen, with the CDC reporting a 15 percent increase in stroke risk among Americans under 65 over the past decade. Stroke prevalence has risen by 14.6 percent in those aged 18–44 and 15.7 percent in those aged 45–64. Strokes are characterized by sudden numbness or weakness on one side of the body, trouble speaking or understanding, confusion, loss of balance, vision problems, or severe headaches with no clear cause. Obesity and high blood pressure are cited as key risk factors.

Both bare and PLLA-coated MgBRFDs had excellent biocompatibility. The PLLA-coated MgBRFD has greater clinical feasibility because of its delayed bioresorption.

Endovascular treatment of intracranial wide-necked and bifurcation aneurysms (WNBA) is technically challenging. The Nautilus Intrasaccular System is designed to provide a mechanical barrier at the aneurysm neck to support coil embolization. We report the results of a single-center series of patients treated for intracranial aneurysms with the Nautilus.

Among Chinese patients with unsuccessful recanalisation or who are at risk of reocclusion after thrombectomy, BAOS did not improve clinical outcome at 90 days, and incurred more complications compared with standard therapy. The off-label use of tirofiban might have affected our results and their generalisability, but our findings do not support the addition of BAOS for such patients with LVO-AIS.

Shanghai HeartCare Medical Technology Co., Ltd. (stock code: 06609.HK) was established in 2016. The company is committed to improving the accessibility of innovative medical technology and protecting life and health. In the past seven years, HeartCare Medical has pioneered the creation of the first one-stop solution for stroke treatment and prevention in China in the field of neurological intervention. It owns the whole product pipeline from acute ischemic stroke and neurovascular stenosis treatment, ischemic stroke prevention and hemorrhagic stroke treatment to interventional access equipment, and has applied for more than 300 patents, and its sales channels cover all provinces nationalwide other than Hong Kong and Macao.

Blood flow guidance has become the backbone of modern endovascular aneurysm therapy. Various molecular surface modification techniques have been introduced to reduce the thrombogenicity of stents and to decrease the reliance on dual antiplatelet therapy. There is a lack of large-sample studies on the safety and efficacy of coated stents, and several small, single-center cohort studies (usually <50 cases) have been reported showing that postprocedural ischemic complications of coated stents in combination with monoclonal antibody therapy are comparable to those of bare-stent dual-antiplatelet therapy. These studies suggest that the use of coated dense mesh stents in combination with a single antiplatelet agent may be feasible and improve the problem of bleeding complications associated with prolonged postoperative dual-antibody, but further research evidence is needed.

Ultrathin DES were associated with reduced DOCE, TLR and TVR risks in diffuse ISR compared to DEBs.

Astaxanthin, a natural antioxidant carotenoid, has been shown to reduce cerebral ischemic injury in rodents. However, there have not been any studies specifically addressing whether preventive administration of astaxanthin can protect against cerebral ischemia. The purpose of this study was to examine whether pretreatment of astaxanthin can protect against ischemic injuries in the adult rats.

While medicine aims for a definitive cure, emphasis should also be placed on shielding individuals from stroke. This review inevitably has limitations, such as the small number of studies included. In addition, human clinical trials are required to evaluate the preventive and therapeutic impacts of ATX. At present, both in vivo and in vitro research on the chemoprotective properties of ATX is in its early stages. This situation presents an opportunity for further detailed investigations on ATX, encompassing a comprehensive evaluation of its metabolites, consideration of individual variability, examination of potential adverse effects and toxicity, and exploration of the long-term protective potentials of ATX.

Emerging evidence has brought platelet adhesion molecules back into the spotlight as targets for the development of novel anti-thrombotic agents. These potential antiplatelet targets mainly include the platelet receptors glycoprotein (GP) Ib-IX-V complex, β3 integrins (αIIb subunit and PSI domain of β3 subunit) and GPVI. Numerous efforts have been made aiming to balance the efficacy of inhibiting thrombosis without compromising hemostasis. This mini-review will update the mechanisms of thrombosis and the current state of antiplatelet therapies, and will focus on platelet adhesion molecules and the novel anti-thrombotic therapies that target them.

Foreign body embolization is a rare and potentially under-recognized complication of neuroendovascular procedures. This complication should be considered in the differential diagnosis for clinical or radiological deterioration following neurovascular interventions. We report a case of foreign body hydrophilic coating embolization that occurred following an attempted flow diversion of an intracranial aneurysm with dramatic flare-up after repeat exposure. We also provide a literature review of all reported cases of hydrophilic polymer embolization following flow diversion procedures.

Inquis Medical said Monday it has raised $40 million to complete a pivotal trial of its Aventus thrombectomy system and prepare to launch the product in 2025. Aventus, which first received 510(k) clearance in November 2023, enables non-surgical removal of clots from blood vessels. Like Inari Medical’s Flowtriever, the device uses aspiration to remove clots. Inquis’ attempts to differentiate its product center on sensing technology that tells the operator if the tip of the device is in contact with blood, a clot or vessel walls.

Through advancing the development of a novel RIC system, this study constitutes a step towards addressing an unmet need for efficacious pre-hospital stroke treatments. While the device was considered easy to use, paramedics also identified important areas for improvement. With a small, localized study sample, our findings are primarily applicable to the refinement of the RICovery system for use in future clinical trials in the same healthcare setting. However, feedback on the importance of mitigating potential interference of newly introduced procedures with those already established, robustness of equipment, and effective paramedic–patient communication may also help inform the design of other pre-hospital interventions.

PTX and SRL exhibit different pharmacodynamic properties, which translate into different clinical performance sand safety profiles. The divergent effects of PTX and SRL observed in preclinical models and varying conditions underscore the complexity of drug selection in clinical settings. While PTX has demonstrated potent cytotoxicity and antirestenotic effects, concerns about its safety in certain environments persist. Conversely, SRL’s mechanism of action, particularly its inhibition of the mTOR pathway, offers an alternative approach, but raises questions about effective drug distribution in the vessel wall and permanence. So far, we have sufficient information on when to use the more potent cytotoxic effect of paclitaxel, aiming at observing a higher lumen enlargement, or the more anti-inflammatory effect of sirolimus, with both devices aiming to optimize DCB use in clinical practice.

Ischemic stroke and cerebral venous thrombosis are both leading causes of disability. Both involve plasmatic coagulation, platelets, and immune cells, but pathomechanisms differ. Stroke is a thrombo-inflammatory disease with immune cell recruitment and barrier breakdown. Cerebral venous thrombosis is caused by thrombotic occlusion of cerebral veins and is a prime example of immunothrombosis.

Blood-repellency based on superhydrophobic surfaces has shown promise in numerous studies and could be a new way toward antithrombic surfaces compared to the commonly utilized smooth surfaces. Several different mechanisms have been proposed, but the full picture of the effect of the topography and the role of superhydrophobicity is not yet clear. A typical superhydrophobic surface, composed of a nanoscale topography and a hydrophobic surface chemistry, would have less overall area for platelet adhesion and uniform adhesion areas smaller than platelet-sized.