Neurovascular Intervention

Intracranial aneurysms are perceived as multifaceted conditions typified by their onset, progression, and potential rupture. They are influenced by a myriad of genetic and external risk determinants that may affect one or multiple stages of the disease. While determining the impact of all recognized determinants on the likelihood of an individual developing an IA, or on the progression and potential rupture of an existing IA, it is imperative to also account for the interplay among these factors. This includes considering external risk determinants like tobacco usage. Undertaking such extensive analyses necessitates large cohorts with exhaustive data, demanding the collaboration of multiple research centers.

IV tenecteplase is an alternative to alteplase before mechanical thrombectomy (MT) in patients with large-vessel occlusion (LVO) ischemic stroke. Little data are available on its use in patients with large ischemic core. We aimed to compare the efficacy and safety of both thrombolytics in this population.

There are numerous reports indicating that a flavonoid-rich diet might be effective in alleviating symptoms of neurodegenerative diseases.[...] On the other hand, studies on the effects of these compounds, including in a diet, in human diseases gave less clear and not so straightforward results. A specific problem is the low bioavailability of flavonoids, especially when used as diet supplements, which has been suggested as one of the major limitations in their potential use as drugs for neurodegenerative diseases. In summary, there is some potential of flavonoids included in foods for the treatment of neurodegenerative diseases; however, further investigations are mandatory to precisely estimate their therapeutic potential and to develop optimal conditions for their potential use in the clinical practice.

Strokes are the second leading cause of death worldwide. Over the past few decades, the incidence of ischemic strokes has increased among younger populations, resulting in a higher prevalence in this age group. Risk factors for stroke include inactive lifestyles, smoking, obesity, hypertension, and diabetes, all of which are related to lifestyle and potentially modifiable. Additionally, a large Taiwanese study has suggested that periodontitis may also increase the risk of ischemic stroke, particularly among younger individuals.

Many serious clinical events can occur when blood flow is altered or blocked leading to a ischemic stroke. Other cerebrovascular diseases include aneurysm, haemorrhage, and moyamoya disease apart from others [2]. All of them can be considered serious leading to long-term repercussions [3]. Therefore, there is a need for better understanding and diagnosis of various abnormalities in brain circulation. This requires a broad multidisciplinary approach that involves medicine, mathematics, physics, and engineering.

WHtR, when used as a proxy measure for central obesity, is linearly associated with ischemic CVD in both sexes, which is independent of BF%. In contrast, the relationship of BF% with these health outcomes is predominantly driven by its correlation with WHtR.

Regardless of the number of MT attempts and intraprocedural complications, procedural time was associated with poor outcome and END. We suggest a deeper consideration of procedural time when treating anterior circulation occlusions refractory to MT.

Periodontitis, an inflammation of the structures supporting the teeth, significantly increases the risk of stroke in people under 50 years of age who do not have any known predisposing causes. A study in the Journal of Dental Research indicates that the more the inflammation had progressed in the mouth, the more serious the stroke.

Women who had overweight or obesity as teens or young adults had more than a twofold increased risk for stroke before age 55, new research suggested.

Exosomes offer an exciting therapeutic option for the treatment of stroke. Given their ease of isolation, potential for “off the shelf” storage, low immunogenicity, and lack of tumorigenicity, exosomes may be a viable alternative to cell-based therapies. To fully utilize the potential of exosomes, a standardized methodology for optimal exosome purification and characterization needs to be established. Depending on parent cell source, exosomes can contain a variety of molecules within their cargo, thereby enabling their diverse protective and restorative functions in the treatment of stroke. Future studies may continue to elucidate optimal methods by which exosomes can be engineered in order to provide the best possible neurological outcomes following stroke.

Fast and effective treatment of blood clots is essential for positive patient outcomes. This is especially true when they occur in the brain, where they can have fatal consequences. Mechanical thrombectomy devices powered by miniature motors are essential for clearing blood vessels and preventing further cell damage. A leading manufacturer recently approached Portescap to help deliver an optimal DC motor solution with an efficient, lightweight design for their new device.

For stroke patients, late administration of tenecteplase improved clinical outcomes in situations in which thrombectomy was not available immediately, according to the Chinese TRACE-III trial.

The recent literature is full of studies that focus on non-pharmacological interventions that target oxidative stress in MAFLD treatment. The role of vitamins such as vitamin E and vitamin D, together with silymarin, has been extensively shown to be positive, both in pre-clinical and clinical models. As for the role of EVOO, unfortunately, studies that have specifically analyzed the effects of EVOO or its components on NAFLD/MAFLD have been mostly inconclusive, and thus, it remains difficult to determine a definitive response regarding its effects on liver steatosis. From this point of view, clinical trials designed with rigorous methodology will be necessary to shed more light on this interesting and important topic.

Our data indicate that the characteristics of SR-mediated thrombectomy, including model, brand, size, and length, do not affect FPE in patients with isolated M1 occlusion. It is possible that anatomical, technical, and thrombus-related factors may have a greater impact on FPE than SR-mediated thrombectomy.

Seven-year data from the Chinese CASSISS trial have, in the investigators’ view, provided “compelling evidence” that percutaneous transluminal angioplasty and stenting (PTAS) plus medical therapy does not confer additional benefits over medical therapy alone in patients with symptomatic, severe intracranial atherosclerotic stenosis. Peng Gao (Capital Medical University, Beijing, China) presented these findings at the 2024 European Stroke Organisation Conference (ESOC; 15–17 May, Basel, Switzerland), informing audiences that “these results underscore the importance of medical therapy as the cornerstone of long-term stroke prevention in this patient population”.

Endovascular treatments, such as balloon angioplasty alone, balloon-mounted stents, and self-expandable stents, may be of benefit for carefully selected ICAS patients. Two prospective, multicenter, RCT are presently underway to re-evaluate the benefits of endovascular treatments in carefully selected patients (CASSISS trial, and the Wingspan Stent System Post-Market Surveillance Study (WEAVE) trial) (70, 71). These trials' strict selection criteria, identification of stroke mechanisms of intracranial atherosclerosis, as well as use of experienced neurointerventionists in high-volume centers are what makes them of interest for the re-evaluation of invasive ICAS treatment.

Given the limitations of existing risk stratification models, which often fail to account for the complex interplay of genetic, environmental, and clinical factors influencing thrombus formation and stability, the ability to accurately measure clot permeability and thereby assess individual thrombotic risk is crucial for developing personalized prophylactic and therapeutic strategies. The precision and repeatability of our proposed device’s measurements are enhanced by its design, which minimizes the influence of external variables.

The randomized SELECT2 trial recently showed that patients with large-core ischemic stroke benefit from thrombectomy compared with medical management. Now, a new secondary analysis of the data shows that in patients with a volume of severe hypodensity ≥ 26 mL within their ischemic lesions —– which indicates more evolved tissue injury — the benefit from thrombectomy is uncertain and the risk for hemicraniectomy is increased.

Cardiovascular diseases have been primarily characterized by the dysfunction of the myocardium as the primary and major cause of morbidity and mortality and have shown an increased rate across the globe. Both experimental and clinical studies show that the activation of inflammatory responses, myocardial necrotic, apoptotic, and autophagic processes substantially aggravate cardiac dysfunction, leading to the development of heart failure, ventricular arrhythmias, and sudden cardiac death.

Mitigating the foreign body response (FBR) to implantable medical devices (IMDs) is critical for successful long-term clinical deployment. The FBR is an inevitable immunological reaction to IMDs, resulting in inflammation and subsequent fibrotic encapsulation. Excessive fibrosis may impair IMDs function, eventually necessitating retrieval or replacement for continued therapy. Therefore, understanding the implant design parameters and their degree of influence on FBR is pivotal to effective and long lasting IMDs. This review gives an overview of FBR as well as anti-FBR strategies. Furthermore, we highlight recent advances in biomimetic approaches to resist FBR, focusing on their characteristics and potential biomedical applications.

Gao began by noting that prior randomised trials, including SAMMPRIS and VISSIT—as well as initial follow-up data from CASSISS itself, published in 2022—have indicated no benefit when adding PTAS to medical therapy in symptomatic, severe intracranial atherosclerotic stenosis patients. However, he added that it “remains uncertain” whether PTAS can enable improved outcomes at five years or more. With three-year results having already been published, Gao and colleagues’ present analysis of CASSISS sought to shed further light on stenting versus medical therapy in these patients at an even longer follow-up timepoint.

Endovascular treatments, such as balloon angioplasty alone, balloon-mounted stents, and self-expandable stents, may be of benefit for carefully selected ICAS patients. Two prospective, multicenter, RCT are presently underway to re-evaluate the benefits of endovascular treatments in carefully selected patients (CASSISS trial, and the Wingspan Stent System Post-Market Surveillance Study (WEAVE) trial) (70, 71). These trials' strict selection criteria, identification of stroke mechanisms of intracranial atherosclerosis, as well as use of experienced neurointerventionists in high-volume centers are what makes them of interest for the re-evaluation of invasive ICAS treatment.

Ceretrieve's mission is to transform stroke care, save lives, minimize disability, and significantly improve post-stroke quality of life. Ceretrieve's aspiration catheter is at the forefront of this mission, delivering aspiration capabilities that are far superior when compared to existing devices, allowing clot(s) removal in a single pass, while fully restoring blood flow. Designed for seamless integration within a conventional 6Fr delivery catheter, Ceretrieve's device offers exceptional trackability and maneuverability, ensuring efficient access to the clot location.

This study provides Class II evidence that in patients with acute ischemic stroke due to intracranial internal carotid artery (ICA) or M1 segment MCA occlusion, including tandem extracranial ICA occlusions, EVT compared with best medical therapy increased odds of favorable cognitive outcome.

Researchers at Brigham and Women’s Hospital developed a new test by combining blood-based biomarkers with a clinical score to identify patients experiencing large vessel occlusion strokes (LVO) with high accuracy.