Abstract: The relationship between intracranial hypertension (IH) and cerebral venous outflow insufficiency (CVOI), including cerebral venous sinus stenosis (CVSS) and internal jugular vein stenosis (IJVS), remains controversial. Although elevated intracranial pressure (ICP) is often regarded as a hallmark of CVOI, recent evidence indicates that a subset of patients with radiologically confirmed CVSS or IJVS exhibit normal or only mildly elevated ICP (< 250 mmH 2 O). This challenges the notion that ICP elevation is essential for diagnosis and raises concern about misdiagnosis when relying solely on ICP thresholds. This review summarizes the clinical features, imaging findings, and hemodynamic characteristics of CVOI and examines the bidirectional relationship between CVOI and ICP. Possible mechanisms for normal ICP include preserved lymphatic cerebrospinal fluid drainage, collateral venous pathways, and anatomical variation. Moreover, persistent ICP elevation may itself cause secondary venous collapse, creating a feedback loop. These findings suggest that ICP elevation is neither necessary nor sufficient for diagnosing CVOI. A multidimensional diagnostic framework, integrating symptomatology, venographic morphology, and venous flow dynamics, is essential to improve diagnostic accuracy and guide individualized management. Recognizing the complexity of this condition may prevent underdiagnosis and optimize outcomes for patients with CVOI.

Cerebral venous sinus thrombosis (CVST) is a distinct type of stroke that predominantly affects young individuals, particularly pregnant women. Approximately 60% of CVST patients develop venous cerebral infarction or hemorrhage, which is defined as severe CVST. Currently, various methods are employed both domestically and internationally to induce CVST in animal models. However, these models fail to fully replicate the pathophysiological mechanisms underlying severe CVST, thereby limiting basic research on this condition. A novel rat model of severe CVST can be established through semi-ligation in combination with ferric chloride and thrombin. Semi-ligation was achieved by measuring the cerebral blood flow (CBF) in the region of interest (ROI) before and after ligation of the superior sagittal sinus (SSS) using a Perfusion Speckle Imager (PSI). Semi-ligation of the SSS induces blood stasis within the venous sinus. The topical application of ferric chloride on the surface of the SSS leads to endothelial injury, while direct injection of thrombin into the sinus creates a localized hypercoagulable state. This approach effectively mimics the three key components of thrombosis formation: stasis, endothelial damage, and hypercoagulability. The resulting model exhibits a substantial thrombotic burden involving multiple venous sinuses simultaneously. The induced thrombus remains stable for at least 1 week. The 2,3,5-triphenyltetrazolium chloride (TTC) staining demonstrates that this model can consistently produce large-area venous cerebral infarction, which persists for up to 7 days. This model can even induce epileptic seizures in rats, a capability that previous models were unable to achieve. The disruption of the blood-brain barrier was observed using Evans blue (EB) staining. Therefore, the severe CVST model established through semi-ligation combined with ferric chloride and thrombin administration more accurately replicates the pathophysiological progression of severe CVST in humans, demonstrating stability and reliability.

Neutrophil-mediated neuroinflammation plays a crucial role in secondary brain injury following severe cerebral venous thrombosis (CVT). Although previous studies have reported that the combination of glucocorticoids (GCs) and anticoagulation is associated with improved clinical outcomes, its mechanism remains unknown. We hypothesized that the combination therapy may exert benefit by modulating neutrophil-driven inflammation. This study included a cohort of 50 patients diagnosed with severe CVT who were undergoing treatment with the combination therapy. We investigated the dynamic alterations in the NLRP3/NETosis inflammatory process by analyzing paired serum and cerebrospinal fluid (CSF) samples collected at baseline and 1 week post-treatment. Neurological function was systematically evaluated using the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS). The combined therapy was associated with reduced CSF levels of key NLRP3/NETosis mediators, including NOD-like receptor family pyrin domain containing 3 (NLRP3), polymorphonuclear neutrophil elastase (PMN Elastase), myeloperoxidase (MPO), and citrullinated histone H3 (CitH3), while the corresponding serum levels were unchanged. Baseline CSF levels of NLRP3, PMN Elastase, and MPO strongly correlated with admission NIHSS and mRS. Early reductions in these central markers were associated with neurological improvement at discharge (ΔNIHSS). Moreover, patients with unfavorable outcomes (discharge mRS > 1) had significantly higher baseline NIHSS and CSF NLRP3 levels. The combined therapy may alleviate severe CVT by modulating the central NLRP3/NETosis inflammatory process.

Abstract Background and aims Inflammation contributes to severe cerebral venous thrombosis (CVT) pathophysiology and correlates with disease occurrence, severity, and poor prognosis. Cohort data suggest steroid pulse therapy may improve functional outcomes. Methods To determine whether steroids adjunctive therapy improves functional outcomes and is safe in patients with acute/subacute severe CVT. Results This is a multicentre, randomized controlled trial with blinded endpoint assessment. We plan to enroll 310 patients (December 2025–December 2027), randomizing 1:1 to steroid plus anticoagulation or anticoagulation alone. All receive immediate anticoagulation; the intervention group additionally receives a 12–14 day methylprednisolone pulse course (≈2040 mg total) within 2 days post-randomization. Other treatments are unrestricted. The primary outcome is the distribution of 90-day mRS scores. Secondary outcomes include 14-day mRS and NIHSS scores, hormone-related adverse events, and all-cause mortality. An exploratory biomarker sub-study will be conducted in a pre-defined subgroup of patients from both arms, involving serial measurements of intracranial pressure, serum high-sensitivity C-reactive protein (hs-CRP), and interleukin 6 (IL-6) during hospitalisation, with papilloedema (graded by the Frisén scale) assessed at baseline and at the 90-day follow-up. Conclusions The glucocorticoid group is expected to demonstrate a shift towards better (lower) scores on the 90-day mRS, without increased safety events. In the exploratory subgroup, the glucocorticoid group is also anticipated to show greater reductions in intracranial pressure and inflammatory markers during hospitalization, and a greater reduction in Frisén scores from baseline to the 90-day follow-up. Conflict of interest

Background Cerebral venous congestion (CVC), including internal jugular vein stenosis (IJVS) and cerebral venous sinus stenosis (CVSS), can impair venous drainage, leading to secondary reductions in cerebral blood flow (CBF) and neurological symptoms such as non-auditory tinnitus (NAT). While arterial spin labeling (ASL) primarily measures arterial perfusion, it also provides insights into global perfusion changes in venous pathologies. This study investigates CBF alterations in CVC patients, particularly those with NAT. Methods A cross-sectional study was conducted with 87 participants, including 34 NAT+ patients, 17 NAT- patients, and 36 healthy controls (HC). Multi-delay pseudo-continuous ASL was used to quantify whole-brain and regional CBF based on the anatomical automatic labeling atlas version 3 (AAL3v1), adjusted for arterial transit time. Group differences in CBF were assessed, and correlations with clinical variables were analyzed, including tinnitus duration, sleep quality, anxiety, depression, and cognitive function. Results Patients in the NAT+ group exhibited significant CBF reductions in the left hemisphere, cerebrum, and specific regions, including the insula, paracentral lobule, and precentral gyrus, compared to those in the NAT- and HC groups. Reduced CBF in NAT+ patients was correlated with longer tinnitus duration, poorer sleep quality, and worse depression scores. Further analysis revealed that the affected regions were part of the attention, sensorimotor, default mode, and cerebellar networks. Conclusion This study identified a distinct pattern of cerebral perfusion alterations in patients with CVC, particularly those with NAT. The findings highlight characteristic regional reductions in CBF associated with impaired venous outflow, offering new insights into the venous pathophysiological mechanisms underlying NAT. Moreover, reduced CBF was found to be associated with clinical symptoms such as sleep disturbances and emotional dysregulation. These findings support a link between venous pathology and altered cerebral perfusion patterns with symptom correlations, warranting confirmation in larger and longitudinal cohorts.

Abstract Background and aims To evaluate effects of glucocorticoids treatment on outcomes in stroke patients with large hemispheric infarction (LHI). Methods This multicenter study included patients with LHI. Outcome measures included mortality and unfavorable functional outcomes (modified Rankin Scale score of 4 to 6) at 3 months. We explored effects of glucocorticoids treatment on outcomes, using inverse probability of treatment weighting to calculate weighted odds ratios (OR) and 95% confidence intervals (CIs). Confounders included in logistic regression were age, National Institutes of Health Stroke Scale (NIHSS) scores, thrombectomy, and use of hypertonic saline. Results We included 282 patients with LHI (median age 70, interquartile range [IQR] 58–78 years; admission NIHSS 15, IQR 12–19). Thirty-nine patients (13.8%) received glucocorticoids (31 on dexamethasone and 8 on methylprednisolone), administered intravenously with a median of 10 mg (IQR 10-15) of standardized dexamethasone once daily and initiated at a median of 86 h (IQR 39-146) since stroke onset for a median of 4 days (IQR 3-5). Of 275 patients completing 3-month follow-up, 106 (38.5%) died and 200 (72.7%) had unfavorable functional outcomes. Patients treated with glucocorticoids had lower risks of 3-month mortality (13.5% vs. 42.4%, weighted OR = 0.29, 95% CI 0.09-0.91, p = 0.03) compared to the control group. There was no significant difference in unfavorable functional outcomes between glucocorticoids and control groups (70.3% vs. 73.1%, weighted OR = 0.94, 95% CI 0.42-2.12, p = 0.89). Conclusions A short course of intravenous glucocorticoids might reduce risks of death at 3 months in patents with LHI. Conflict of interest Yanan Wang, Haoyang He, Xing Hua, Zhi Liu, Na Tang, Bijoy K. Menon, Craig S. Anderson, Ming Liu, Jiangang Duan and Simiao Wu have nothing to disclose.

患者 男性,55岁,因头痛、视物模糊2月余,于2017年 7月 12日收入首都医科大学宣武医院急诊科.患者入院前2月余无明显诱因出现头部持续性胀痛,偶有恶心、呕吐,呕吐物为非喷射性少量胃内容物,右眼视物模糊,无复视,伴有睡眠增多,于2017年 6月 8日至我院眼科门诊就诊,眼底照相检查显示视盘水肿(图 1),光学相干断层扫描术(OCT)显示盘周各象限视网膜神经纤维层(RNFL)增厚(表1),荧光素眼底血管造影(FFA)显示动脉早期视盘充盈延迟,晚期荧光渗漏(图2),建议进一步完善相关检查.

Corticosteroids are frequently used in practice to treat patients with neurological disorders. However, its effect for stroke and traumatic brain injury (TBI) remains controversial. This study aimed to systematically review and evaluate efficacy and safety of corticosteroids for the treatment of stroke and TBI. We searched Ovid-Medline and Ovid-Embase databases for randomised controlled trials (RCTs) and cohort studies evaluating the efficacy and safety of corticosteroids in patients with ischaemic stroke, intracerebral haemorrhage (ICH), subarachnoid haemorrhage (SAH) or TBI. The treatment intervention was corticosteroid, and the control was placebo or routine care. Outcome measures were death, functional outcomes and adverse events. We calculated odds ratio (OR) and 95

Background There is an unmet need for high-quality data from prospective studies on the safety and effectiveness of direct oral anticoagulants (DOACs) for the treatment of cerebral venous thrombosis (CVT). We aimed to compare the safety and effectiveness of DOACs versus vitamin K antagonists (VKAs) for the treatment of CVT in a setting that reflects daily clinical practice. Methods DOAC-CVT was an international, prospective, observational cohort study done in 65 hospitals in 23 countries across five continents. Eligible patients were adults (aged >= 18 years) with radiologically confirmed CVT starting oral anticoagulant treatment with either DOACs or VKAs, as per local practice, within 30 days after diagnosis. Exclusion criteria were previous use of anticoagulants at the time of CVT diagnosis or an absolute contraindication to DOACs (eg, pregnancy and lactation, or severe renal or liver disease). Data were collected during routine clinical visits or telephone consultations at CVT diagnosis (baseline) and at 3 months, 6 months, and 12 months after CVT diagnosis. The primary endpoint was a composite of symptomatic venous thromboembolism and major bleeding events (International Society on Thrombosis and Haemostasis criteria) at 6 months. Main outcomes were adjusted for the confounders age, renal function, active cancer, CNS infections, concomitant antiplatelet use, country of inclusion's income status, Glasgow Coma Scale score, intracranial haemorrhage, antiphospholipid antibodies, previous major bleeding, and previous venous thromboembolism using inverse probability-of-treatment weighting. This study is registered at ClinicalTrials.gov (NCT04660747) and is ongoing. Findings Between Jan 27, 2021, and Jan 15, 2024, 619 patients were included; 401 (65%) patients started DOAC treatment, and 218 (35%) patients started VKA treatment. 390 (63%) of 619 patients were female and 229 (37%) of 619 patients were male. Patients' median age was 41 years (IQR 28-51). 6-month follow-up data were available for 617 (>99%) of 619 patients. 12 (3%) of 401 patients in the DOAC group and seven (3%) of 218 patients in the VKA group had a primary outcome event (weighted odds ratio [OR] 0.99 [95% CI 0.37-3.38]). Three (1%) of 401 patients in the DOAC group died versus three (1%) of 218 patients in the VKA group (weighted OR 0.55 [95% CI 0.11-2.80]). Interpretation The rate of recurrent thrombosis and major bleeding did not differ between patients with CVT treated with DOACs versus VKAs. This study adds to the increasing evidence that DOACs are a reasonable treatment option for CVT alongside VKAs.

ABSTRACT Cerebral venous sinus thrombosis (CVST) is frequently observed in younger adults and features in large thrombus volume. Due to the triangular-like cross-sectional shape and large diameter of the superior sagittal sinus, all the commercially available artery stent retrievers are not suitable for venous vessels. In this study, a dumbbell-like stent was designed and fabricated by 3D braided technology using NiTi wires; it was manually rotatable and stretchable with controlled length/diameter ratios (2.6–14.0) and reciprocating maneuverability. Computational modeling and an in vitro study were conducted to evaluate the mechanical properties of this device and its ability to trap and remove thrombi from occluded venous vessels was verified by using a swine model. A single-center retrospective clinical study of 10 patients using the Venus-TD to treat patients with CVST was also conducted. Pre/postoperative thrombus volume in 10 patients was quantitatively analysed (12 855.3 ± 6417.1 vs. 2373.1 ± 2759.0 mm³, P < 0.001) with a high recanalization rate, yielding favorable clinical outcomes. This study offers a novel treatment option for patients with extensive CVST.

BACKGROUND: Lack of a dedicated thrombectomy device for cerebral venous thrombosis hinders the recanalization ability of endovascular treatment (EVT). Novel NiTi-braided stent retriever (Venous-TD) is a dedicated venous sinus thrombectomy device. This study aims to demonstrate the safety and efficacy of Venous-TD. METHODS: In this pilot, prospective, randomized, single-blind, parallel-group control, single-center clinical study, patients with cerebral venous thrombosis from Beijing Xuanwu Hospital were included. Randomization was performed to EVT with either the Venous-TD or Angioguard with Sterling balloon (control group). The primary efficacy outcome was the proportion of immediate complete recanalization during EVT. Secondary outcomes included the proportion of functional independence and moderate to severe residential headache at 180 days after EVT. Safety outcomes included peri-procedural complications, all-cause mortality, and symptomatic intracranial hemorrhage after EVT. RESULTS: A total of 61 patients were enrolled and randomized. Thirty-one patients were randomized to the Venous-TD group, and 30 were randomized to the control group. The median (interquartile range) age was 28 (21-45) in the Venous-TD group and 34 (24-43) in the control group. The proportion of patients with a National Institutes of Health Stroke Scale score >8 on admission was 8 (25.8%) in the Venous-TD group and 11 (36.7%) in the control group. During EVT, Venous-TD significantly improved the proportion of complete recanalization compared with Angioguard (23 [76.7%] versus 6 [20.0%]; relative risk, 3.833 [95% CI, 1.825-8.054]). The proportions of long-term functional independence at 180 days in the Venous-TD group and the control group were not significantly different. The proportion of patients with severe residual headache at 180 days in the Venous-TD group was significantly lower than that in the control group (3 [9.7%] versus 10 [35.7%]; relative risk, 0.271 [95% CI, 0.083-0.886]). Safety outcomes showed no statistically significant difference between the 2 groups. CONCLUSIONS: This trial indicated that Venous-TD did not increase complications in EVT of cerebral venous thrombosis and can significantly increase the proportion of complete recanalization. A multicenter phase III randomized control trial assessing efficacy and safety of Venous-TD is warranted.

BACKGROUND:Inflammation plays a critical role in severe cerebral venous thrombosis (CVT) pathogenesis, but the benefits of anti-inflammatory therapies remain unclear. This study aimed to investigate the association between steroid therapy combined with anticoagulation and the prognosis of acute/subacute severe CVT patients. METHODS:A prospective cohort study enrolled patients with acute/subacute severe CVT at Xuanwu Hospital (July 2020-January 2024). Patients were allocated into steroid and non-steroid groups based on the treatment they received. Functional outcomes (modified Rankin scale [mRS]) were evaluated at admission, discharge, and 6 months after discharge. Serum high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), cerebrospinal fluid (CSF) IL-6, and intracranial pressure were measured at admission and discharge in the steroid group. Fundoscopic Frisén grades were assessed at admission and 6 months after discharge. Univariate and multivariate logistic regression were used to evaluat associations between steroid use and favorable outcomes (mRS ≤2) at the 6-month follow-up. Paired tests assessed changes in hs-CRP and other variables before and after treatment, and Spearman's correlations were used to analyze relationships between these changes and functional improvements. RESULTS:A total of 107 and 58 patients in the steroid and non-steroid groups, respectively, were included in the analysis. Compared with the non-steroid group, the steroid group had a higher likelihood of achieving an mRS score of 0-2 (93.5% vs . 82.5%, odds ratio [OR] = 2.98, P  = 0.037) at the 6-month follow-up. After adjusting for confounding factors, the result remained consistent. Pulsed steroid therapy did not increase mortality during hospitalization or follow-up, nor did it lead to severe steroid-related complications (all P  >0.05). Patients in the steroid group showed a significant reduction in serum hs-CRP, IL-6, CSF IL-6, and intracranial pressure at discharge compared to at admission, as well as a significant reduction in the fundoscopic Frisén grade at the 6-month follow-up compare to at admission (all P  <0.001). A reduction in serum inflammatory marker levels during hospitalization positively correlated with improvements in functional outcomes ( P  <0.05). CONCLUSION:Short-term steroid use may be an effective and safe adjuvant therapy for acute/subacute severe CVT when used alongside standard anticoagulant treatments, which are likely due to suppression of the inflammatory response. However, these findings require further validation in randomized controlled trials. TRAIL REGISTRATION:ClinicalTrials.gov , NCT05990894.

OBJECTIVE:Cerebral venous thrombosis (CVT) presents clinical challenges due to non-specific symptoms and limited biomarkers for assessing severity. Effective treatments for severe CVT are lacking. This study investigates inflammatory biomarkers linked to disease severity and evaluates glucocorticoids' therapeutic potential in severe CVT. METHODS:A prospective cohort study of 78 CVT patients assessed disease severity using neurological scores and analyzed inflammatory biomarkers, including hs-CRP, IL-6, neutrophil count, lymphocyte count, and NLR. Changes in severity and biomarkers were evaluated before and after glucocorticoid treatment. RESULTS:Severe CVT patients had elevated high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and neutrophil percentage, with reduced lymphocyte counts compared to non-severe cases. Neutrophil count, NLR, hs-CRP, and IL-6 positively correlated with neurological scores at admission, while lymphocyte percentage showed a negative correlation. Glucocorticoid treatment improved neurological function and reduced hs-CRP and IL-6 levels, suggesting anti-inflammatory benefits. CONCLUSION:Neutrophils, hs-CRP, and IL-6 are promising biomarkers for CVT severity and treatment response. Glucocorticoids may improve outcomes by modulating inflammation, warranting further research into their mechanisms and long-term efficacy in CVT management.

Endovascular treatment (EVT) is gaining popularity for the management of severe forms of cerebral venous thrombosis (CVT), but the evidence supporting its efficacy and safety is limited. This multicenter study included patients with CVT admitted to 104 hospitals in 31 provinces/cities in China between January 2018 and June 2022. Propensity score weighting models were used to adjust baseline confounding variables to determine the association of EVT on the primary outcome of good functional status, defined as score 0 − 1 on the modified Rankin Scale after hospital discharge. Of 3063 patients identified through hospital records searches, 2774 adults [age (42 ± 15.8) years, female 50.3

Introduction: Supratentorial intracerebral hemorrhage (ICH) is a devastating stroke subtype with high mortality and morbidity, and hematoma clearance is a critical therapeutic target. Remote ischemic conditioning (RIC) with transient ischemia and reperfusion applied to the arm has been shown to accelerate hematoma resolution in both animal and clinical studies. The RICH-2 trial investigated whether RIC could improve the functional outcomes of patients with ICH. Methods: In this investigator-initiated, multicentre, prospective, randomized, sham-controlled, outcome-blinded parallel-group trial conducted in 20 centers in China, patients (age 18 to 80 years) with supratentorial ICH presenting within 24-48 h of ictus who do not need surgical therapy were randomly allocated (1:1, stratified by baseline NIHSS and clot size) to receive RIC or sham RIC for 7 consecutive days after randomization in addition to best medical management. The primary outcome was a score of 0-2 on the modified Rankin Scale at 90 days, analyzed in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, NCT04657133. Results: Between Apr 22, 2021, and Oct 30, 2023, 458 patients were randomly assigned, with 229 in each group. 134 (29.3%) were women, and 324 (70.7%) were men, the median age was 58 years (IQR 51-68), the median NIHSS score was 9.0 (IQR 7.0-13.0), and the median hematoma volume was 12.6 mL (IQR 10.0-18.0). 156 (68.1%) of 229 patients in the RIC group and 163 (71.2%) of 229 patients in the sham group had a mRS score of 0-2 at 90 days (adjusted RR 0.98; 95% CI 0.88-1.09; adjusted p=0.69). Prespecified subgroup analysis showed a trend in favor of RIC in patients with clot size larger than 20 ml (RR 1.26, 95% CI 0.80-1.98, p=0.31). At 180-day follow-up, 169 (73.8%) of 229 patients receiving RIC and 175 (76.4%) of 229 patients receiving sham RIC achieved a mRS score of 0-2 (adjusted RR 0.98; 95% CI 0.89-1.08; adjusted p=0.64). Serious adverse events occurred in 16 (7.0%) of 229 patients receiving RIC and 12 (5.2%) of 229 patients receiving sham RIC (adjusted RR 1.29, 95% CI, 0.63-2.67, p=0.48). No important unexpected adverse events or side effects of RIC were observed. Conclusions: RIC did not improve the proportion of patients who achieved functional independence 90 days after ICH in patients who did not need surgical therapy. Further studies of RIC in this population should target patients with large clot sizes and address the RIC protocol.

Refractory intracranial hypertension is a condition characterized by persistently elevated intracranial pressure that does not respond to conventional treatments. Diagnosis and management typically involve a combination of medical and surgical interventions. However, identifying the potential etiology can be particularly difficult under certain conditions. The causes of refractory intracranial hypertension due to non-traumatic brain injury are often difficult to detect. Untreated or ineffectively treated refractory intracranial hypertension can result in severe symptoms and potential vision loss. We reported a 15-year-old teenager with no history of trauma who experienced intermittent headaches and projectile vomiting over a 30-day period, accompanied by intracranial pressure exceeding 28 cmH2O. Through clinical reasoning combined with auxiliary examinations, including angiography and ultrasonography, and confirmed by follow-ups after experimental therapy, a final diagnosis of scalp arteriovenous fistula was established. This case highlights the importance of considering extracranial causes in cases of refractory intracranial hypertension and management strategy for patients with refractory intracranial hypertension.

BACKGROUND:Approximately half of AIS patients have an unfavorable outcome even after complete reperfusion. White blood cell (WBC) count to mean platelet volume (MPV) ratio (WMR) may be a promising predictive factor for futile recanalization. This study aimed to determine the predictive value of WMR in identifying individuals at higher risk of futile recanalization. METHODS:In this retrospective cohort study, 296 patients who achieved complete reperfusion after endovascular treatment (EVT) were included in the analysis. WBC count and MPV were collected at admission. Multivariable logistic regression was used to examine the independent association of the WMR with functional outcomes at three months. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) analyses were used to compare the accuracy of WMR for predicting futile recanalization. RESULTS:The adjusted odds ratios for the fourth quartile of WMR were 3.142 (95% CI 1.405- 7.027, P = 0.005) for unfavorable outcomes at 3 months in comparison with the first quartile. The inclusion of WMR in the traditional model enabled a more accurate prediction of unfavorable outcomes (NRI 0.250, P = 0.031; IDI 0.022, P = 0.017). CONCLUSION:Elevated WMR at admission was independently associated with futile recanalization among AIS patients who received EVT and might be useful in identifying futile recanalization.

Background and Objective. Approximately 50% of acute ischemic stroke (AIS) patients who achieve complete recanalization after endovascular therapy (EVT) experience unfavorable outcomes that are potentially partially attributed to incomplete microvascular reperfusion, which can possibly be improved by antiplatelet treatment. This study aimed to evaluate the effect of periprocedural tirofiban on AIS patients who achieved complete recanalization with EVT. Methods. Anterior circulation large-vessel occlusion stroke patients who achieved complete recanalization after EVT were retrospectively analyzed. Patients were dichotomized into tirofiban and nontirofiban groups and compared. Propensity score matching (PSM) was used to balance baseline confounders. 3-month functional independence (modified Rankin scale: 0–2), any intracranial hemorrhage (ICH), symptomatic ICH (sICH), arterial reocclusion, in-hospital mortality, and 3-month mortality were evaluated. Results. This study included 303 patients with 118 and 185 in the nontirofiban and tirofiban groups, respectively. After PSM, 85 couples with balanced baseline characteristics were generated. 49 (57.6%) and 36 patients (42.4%) in the tirofiban and nontirofiban groups achieved functional independence at 3 months with a significant difference (risk ratio: 1.361, 95% confidence interval: 1.001–1.852, P=0.046 ). However, there was no significant difference between the tirofiban and nontirofiban groups in terms of the other outcomes (all P>0.05 ). Conclusions. In anterior circulation, large-vessel occlusion AIS patients who achieved complete recanalization with EVT, periprocedural tirofiban may improve the functional outcomes and does not appear to increase the rate of ICH and sICH.