Posterior circulation (PC) ischemic stroke accounts for approximately a fourth of all acute ischemic strokes and is associated with high disability and mortality. Rapid diagnosis and management can be challenging as it often presents with non-specific signs and symptoms. We performed a systematic review and meta-analysis to describe the prevalence of signs and symptoms in PC ischemic stroke. Two databases (PubMed and EMBASE) were searched for English-written observational studies reporting data on signs and symptoms in patients with a diagnosis of PC ischemic stroke. Data were extracted by two independent researchers. We assessed the risk of bias (RoB) and calculated the pooled prevalence and 95

Focal brain lesions are thought to induce sleep-like slow-wave activity in perilesional cortex through altered excitation-inhibition balance and structural disconnection, but whether these dynamics extend to remote yet structurally intact regions remain unclear. Here we combined source-reconstructed high-density EEG (128 channels) with structural disconnection mapping in 49 acute stroke patients and 20 age-matched controls. Cortical regions were classified as perilesional, structurally disconnected, or non-disconnected using individual lesion masks registered to normative white-matter atlases. Perilesional cortex showed increased delta and theta power and reduced beta power relative to controls. Critically, structurally disconnected regions exhibited electrophysiological changes comparable to perilesional cortex, including enhanced low-frequency activity and steeper aperiodic spectral slopes. These alterations correlated with neurological severity and multidomain behavioral impairment. Our findings demonstrate that post-stroke slow-wave activity propagates along structural disconnection pathways, providing direct electrophysiological evidence for connectional diaschisis and identifying distributed network targets for physiology-guided neuromodulation.

Abstract Background and aims Mechanical thrombectomy (MT) is an effective stroke treatment, preventing damage to hypoperfused regions suffering from reversible ischemia. Recent studies have shown that lesion topography is crucial to determine stroke impairment and recovery. In this study, we tested whether topography of rescued hypoperfusion predicts clinical improvement after MT and compared the prediction of topographical measures with demographic and volumetric variables. Methods We retrospectively enrolled patients with large-vessel occlusion stroke treated with MT at the Stroke Unit and Neurology Clinic of Padova between January 2018 and June 2022. Clinical improvement was quantified as the difference in NIHSS between admission and 7 days. Individual maps of rescued tissue were obtained by subtracting 1-week lesion masks from baseline hypoperfused regions and normalized to a standard template. Using the Lesion Quantification Toolkit, we quantified disconnection of key white matter tracts (cortico-spinal, superior longitudinal fasciculus, arcuate fasciculus) and large-scale brain network involvement. Clinical improvement was used as the dependent variable in a regression model with bootstrapping. We compared demographic, volumetric, and topographic models based on R2adjusted values and tested the same predictors using hierarchical linear regression models. Results We included a total of n=56 patients (72±13 years old). Topographical model showed the highest predictive accuracy (R2 = 0.34), outperforming demographic (R2 = 0.07) and volumetric models (R2 = 0.15). The combined model integrating all predictors achieved the best performance (R2 = 0.42), significantly improving predictive accuracy (F-test-p-value=0.048). Conclusions These results demonstrate that hypoperfusion topography is a key determinant of clinical improvement after successful MT. Conflict of interest All authors have nothing to disclose. Figure 1 - belongs to Background and aims Figure 2 - belongs to Methods Figure 3 - belongs to Results

INTRODUCTION:Early identification of stroke aetiology, hemodynamic monitoring and detection of complications represent key challenges for vascular neurologists. Stroke-point-of-care ultrasound (Stroke-POCUS) has emerged as a structured framework for integrating multimodal bedside ultrasound into stroke management. PATIENTS AND METHODS:Stroke-POCUS involves the comprehensive bedside use of various ultrasound modalities, including cervical and transcranial ultrasound, orbital ultrasound, echocardiography, venous system ultrasound, lung ultrasound, abdominal ultrasound and interventional ultrasound. These modalities are applied in an integrated manner to assess stroke patients in the acute setting, aiming to support diagnosis, etiological investigation, detection of complications and monitoring of treatment response, as an adjunct, not a substitution for computed tomography, magnetic resonance imaging, or standard comprehensive ultrasound examination. RESULTS:The integration of multiple ultrasound modalities within Stroke-POCUS enables clinicians to obtain rapid, noninvasive answers to well-defined clinical questions at the patient's bedside and in real time. This capability is particularly critical for patients requiring expedited diagnostics prior to urgent treatment initiation, for clinically unstable patients in whom intrahospital transport carries an increased risk of complications, as well as for assessing potential underlying causes, identifying secondary complications and monitoring treatment efficacy. DISCUSSION AND CONCLUSION:Stroke-POCUS represents a comprehensive bedside imaging strategy that enhances the evaluation and management of stroke patients. By integrating multiple ultrasound techniques, it provides a more holistic view of stroke pathophysiology, complications and treatment monitoring, potentially improving clinical decision-making and individualised patient care.

BACKGROUND AND PURPOSE:Transcranial Doppler (TCD) detects microembolic signals (MES), reflecting ongoing cerebral embolization. MES have been studied across stroke subtypes and may clarify etiology, monitor treatment, and predict recurrence. We aimed to determine the prevalence of MES in acute ischemic stroke (AIS), explore clinical and laboratory associations, and assess their role in etiological workup. METHODS:We conducted a prospective single-center study over 3 years including anterior circulation AIS patients within 24 h of onset. Stroke subtype was classified by TOAST criteria. Bilateral middle cerebral artery TCD monitoring was performed for 30 min to detect and quantify MES. RESULTS:Among 136 patients (mean age 60.1 ± 12.4 years), MES were detected in 22 (16.2%; 95% CI: 10.4%-23.5%). MES(+) patients had more often multiple-territory infarcts (36.4% vs. 10.5%, p = 0.005), newly detected atrial fibrillation (13.6% vs. 0.9%, p = 0.013), and cancer-associated stroke (18.2% vs. 0.9%, p = 0.002), whereas cryptogenic etiology was less common (18.2% vs. 41.2%, p = 0.041). MES were absent in lacunar stroke. MES positivity correlated with higher D-dimer levels (median 932 vs. 456 ng/mL, p < 0.001), and MES counts correlated strongly with D-dimer values (Spearman coefficient: 0.393, p < 0.001). CONCLUSIONS:MES were detected in one-sixth of anterior circulation AIS patients, but were absent in lacunar stroke. Their presence was associated with multiple-territory infarcts, newly detected atrial fibrillation, and cancer-related stroke. MES counts correlated with D-dimer levels, supporting their role as markers of ongoing cerebral embolization and underlying prothrombotic state, with potential utility in revealing occult embolic mechanisms.

BACKGROUND:Embolic stroke of undetermined source (ESUS) accounts for up to one quarter of ischemic strokes, with occult atrial fibrillation (AF) as a key underlying cause. Implantable cardiac monitors (ICMs) markedly improve AF detection but are limited by cost and resource demands. Existing AF-prediction models show modest accuracy and lack longitudinal validation. We developed and validated the CATCH-AF score to provide a simple, clinically applicable tool for stratifying early and long-term AF risk after ESUS. METHODS:We analyzed 543 consecutive ESUS patients systematically monitored with ICMs. Variable selection used LASSO-penalized Cox regression. Model performance was assessed with time-dependent ROC curves, restricted mean survival time (RMST) analysis, and 10-fold cross-validation. To evaluate geographic generalizability, internal-external cross-validation was performed across seven participating centers, estimating discrimination and calibration for each held-out cohort. Based on the final multivariable model, a point-based score was derived including age, coronary artery disease, heart failure, and prior transient ischemic attack or ischemic stroke. RESULTS:During 1558.5 patient-years of follow-up, 118 patients (22%) developed new AF. The CATCH-AF score showed excellent discrimination (AUC 0.85, 95% CI 0.82-0.89), stable over 4.5 years (0.84-0.87). Compared with low-risk patients (0-2 points), those at high risk (⩾5 points) had a 19-fold higher hazard of AF detection (HR 19.2, 95% CI 9.4-39.4; p < 0.001) and 918 fewer AF-free days (95% CI -1080 to -757). CONCLUSIONS:The CATCH-AF score provides a robust, interpretable, and easily applicable tool for predicting AF after ESUS, supporting targeted and cost-effective rhythm monitoring.

BACKGROUND AND OBJECTIVES:Contrast-associated acute kidney injury (CA-AKI) is a potentially preventable complication after exposure to iodinated contrast media. In patients undergoing endovascular thrombectomy (EVT) for acute ischemic stroke (AIS), the incidence and clinical impact are poorly characterized, and no validated prediction tool is currently available. The aim of this study was to assess the incidence and prognostic significance of CA-AKI in EVT-treated patients with AIS and to develop and validate a predictive score. METHODS:A retrospective, multicenter cohort study was conducted involving EVT-treated patients across 73 centers in 16 countries (January-December 2023). Inclusion criteria were age ≥18 years, absence of dialysis, availability of preprocedural and 48-hour postprocedural creatinine levels, and available 90-day follow-up (modified Rankin Scale [mRS] score). The primary outcome was CA-AKI, defined by KDIGO (Kidney Disease: Improving Global Outcomes criteria;creatinine increase ≥0.3 mg/dL or ≥1.5 times baseline, within 48 hours). Secondary outcomes were (1) in-hospital mortality, (2) 90-day mRS score, and (3) 90-day severe disability or death (mRS score >3). Logistic models assessing associations with outcomes accounted for within-center clustering by applying robust standard errors. CA-AKI prediction models were developed across imputed data sets using univariable selection (p < 0.20), backward elimination (p < 0.05), and coefficient-based scoring after categorization of continuous predictors, with internal validation by bootstrap to obtain optimism-adjusted estimates. RESULTS:Among 6,638 patients (median age 74 years; 48.7% male), CA-AKI occurred in 326 (4.9%) and was independently associated with in-hospital mortality (adjusted odds ratio [aOR] 2.269; 95% CI 1.615-3.190), higher 90-day mRS scores (adjusted common odds ratio 1.584; 95% CI 1.110-2.258), and 90-day severe disability or death (aOR 1.530; 95% CI 1.057-2.216). A preprocedural risk model including 12 routine clinical variables-sex, ethnicity, arterial hypertension, dyslipidemia, chronic kidney disease, antiplatelet therapy, NIH Stroke Scale score at admission, serum glucose, estimated glomerular filtration rate, hemoglobin, mean arterial pressure, and IV thrombolysis-demonstrated acceptable discrimination (area under the receiver operating characteristic curve 0.710 [95% CI 0.682-0.738]; precision-recall area under the curve 0.13 [95% CI 0.10-0.16]), good calibration (slope 0.870 [95% CI 0.759-0.928]), good overall performance (Brier score 0.045 [95% CI 0.042-0.049]). A second model that included EVT-related variables (e.g., contrast volume) showed similar performances. DISCUSSION:In this large, international cohort, CA-AKI occurred in approximately 1 in 20 EVT-treated patients with AIS and was independently associated with poor outcomes. A simple preprocedural risk score enables early identification of high-risk individuals and may support preventive strategies.

BACKGROUND:A substantial proportion of ischemic strokes remain classified as embolic stroke of undetermined source (ESUS) despite standard diagnostic evaluation. Prolonged cardiac monitoring with implantable cardiac monitors (ICMs) increases atrial fibrillation (AF) detection, but the optimal timing of ICM implantation after ESUS remains uncertain. AIMS:To evaluate whether early versus delayed ICM implantation after ESUS influences AF detection and time to diagnosis. METHODS:We conducted a multicenter observational cohort study emulating a target trial. Consecutive ESUS patients undergoing ICM implantation were classified as ICMEARLY (⩽30 days) or ICMDELAYED (31-365 days) implantation after the index event. Inverse probability weighting was applied to adjust for baseline confounding. Primary and secondary outcomes included AF detection within 30, 90, and 120 days after implantation, assessed using weighted logistic regression, Poisson models for detection rates per person-time, Cox proportional hazards models, and restricted mean survival time (RMST). Sensitivity analyses included center-level clustering and competing-risk models. RESULTS:Among 333 patients (90 ICMEARLY and 243 ICMDELAYED), early implantation was associated with significantly higher AF detection within 30 days (7.8% vs 1.6%; odds ratio (OR) = 4.49, 95% confidence interval (CI) = 1.17-17.27; p = 0.028) and higher detection rates per person-time (incidence rate ratio (IRR) = 4.26, 95% CI = 1.16-15.60; p = 0.029). Consistent associations were observed at 90 and 120 days. Time-to-event analyses showed higher hazards of AF detection with early implantation (hazard ratio (HR) = 4.29 at 30 days; HR = 2.97 at 90 days; HR = 2.77 at 120 days; all p < 0.01). RMST analyses demonstrated progressively shorter time to AF diagnosis in the ICMEARLY group across multiple time horizons. Results were robust across sensitivity analyses. CONCLUSION:Early ICM implantation after ESUS is associated with higher and faster AF detection compared with delayed implantation. When ICM monitoring is indicated, avoiding unnecessary delays may substantially enhance diagnostic yield.

Abstract Background and aims A substantial proportion of ischemic strokes remain classified as embolic stroke of undetermined source (ESUS). Although prolonged monitoring with implantable cardiac monitors (ICMs) improves atrial fibrillation (AF) detection, the optimal timing of implantation remains uncertain. We evaluated whether early versus delayed ICM implantation affects AF detection and time to diagnosis. Methods We conducted a multicentre observational cohort study emulating a target trial. Consecutive ESUS patients undergoing ICM implantation were classified as ICMEARLY (≤30 days) or ICMDELAYED (31–365 days) implantation after the index event. Inverse probability weighting was applied to adjust for baseline confounding. Primary and secondary outcomes included AF detection within 30, 90, and 120 days after implantation, assessed using weighted logistic regression, Poisson models for detection rates per person-time, Cox proportional hazards models, and restricted mean survival time (RMST). Results Among 333 patients (90 ICMEARLY, 243 ICMDELAYED), early implantation was associated with significantly higher AF detection within 30 days (7.8% vs 1.6%; OR 4.49, 95% CI 1.17–17.27) and higher detection rates per person-time (IRR 4.26, 95% CI 1.16–15.60). Consistent associations were observed at 90 and 120 days. Time-to-event analyses showed higher hazards of AF detection with early implantation (HR 4.29 at 30 days; HR 2.97 at 90 days; HR 2.77 at 120 days). RMST analyses demonstrated progressively shorter time to AF diagnosis in the ICMEARLYgroup across multiple time horizons. Conclusions Early ICM implantation after ESUS is associated with higher and faster AF detection compared with delayed implantation. When ICM monitoring is indicated, avoiding unnecessary delays may substantially enhance diagnostic Conflict of interest nothing to disclose

Background Normative atlas-based methods for estimating disconnection from brain lesions are increasingly used, but their predictive value for clinical recovery remains unclear. We tested whether these disconnectivity measures improve stroke outcome prediction beyond lesion characteristics and clinical factors. Methods We retrospectively included stroke patients with structural MRI or CT and 6- or 12-month Stroke Impact Scale (SIS) scores. For each patient, we computed lesion volume, location, and maps of structural and functional disconnection using normative atlases. We also calculated the proportion of known brain networks affected. SIS subitems underwent factorial analysis to extract components used as outcomes in regression models with bagging. Three models (lesion features, disconnection patterns at voxel-level, and atlas-based disconnection topology) were compared to a reference model (demographic/clinical variables) using bootstrapping and adjusted R2. Results Seventy-four patients (mean age 66.8 ± 10) were analyzed. Three SIS components emerged: mobility, cognition, and emotion. Models using disconnection features explained little variance (R²<0.07) for all components. Functional topology moderately predicted mobility (R²=0.202), significantly outperforming the reference model (R²=0.165, p = 0.007). Adding functional topology to clinical variables raised mobility prediction to 33%. Predictability for cognition and emotion remained low. Conclusions The SIS shows three components that can be predicted differently based on distinct lesion properties. Overall, the predictive value of indirect disconnection measures was low for all three components when considering disconnection patterns. On the contrary, the predictive value of a functional atlas-based framework was higher for the mobility factor. The cognitive and emotional factors presented lower values than the mobility component.

BACKGROUND AND AIMS:The safety and effectiveness of mechanical thrombectomy (MT) in patients with cervical artery dissection (CeAD) remain uncertain. This study aimed to evaluate the safety, recanalization rates, and functional outcomes of MT in LVO-AIS patients with and without CeAD. METHODS:Retrospective multicenter study based on data prospectively collected from June 2021 to June 2024. CeAD-related LVO-AIS patients treated with MT were compared with matched anterior and posterior circulation AIS patients without CeAD. Primary outcomes included procedural adverse events, recanalization rates, and favorable functional outcomes at 3 months. A meta-analysis of similar studies from 2015 to 2025 was conducted to support generalizability. RESULTS:Of 1861 LVO-AIS patients, 164 (8.7%) patients had a CeAD. Despite a higher prevalence of tandem occlusion (63.0% vs. 20.0%, SDM: 0.99), CeAD patients showed similar rates of overall procedural adverse events (17.7% vs. 16.3%, p = 0.684), recanalization rates (90.0% vs. 87.5%, p = 0.563), and 90-day favorable functional outcome (59.1% vs. 58.5%, p = 0.917) as compared to non-CeAD patients. Additionally, CeAD patients had a significantly lower mortality rate at 90 days (4.3% vs. 13.1%, p = 0.023). A subgroup analysis of posterior circulation LVO-AIS showed no significant differences in safety and clinical outcomes. Meta-analysis of six studies suggested better MT outcomes in CEAD-related LVO-AIS (p < 0.001, with I2 = 60.02% [13.48-83.33 95% CI]). CONCLUSIONS:Despite procedural challenges, this multicenter study has shown that in both anterior and posterior circulation CeAD-related LVO-AIS, MT is as safe as in non-CeAD stroke patients, achieves high recanalization rates, and is associated with similar favorable functional outcomes.

Large vessel occlusion (LVO) acute ischemic stroke represents a leading cause of disability despite successful endovascular treatment (EVT). Venous outflow has recently emerged as a potential predictor of functional outcome in ischemic stroke. We aimed to investigate whether a comprehensive venous drainage evaluation is associated with stroke evolution and functional outcome. Prospective study on acute stroke patients with anterior LVO who underwent optimal recanalization from February 2023 to February 2024. Opacification and drainage time of superficial and deep veins were evaluated on digital subtraction angiography sequences. Clinical outcome was functional recovery at 90 days, whereas neuroradiological outcomes were ischemic lesion growth (ILG) and hemorrhagic transformation (HT). Multivariate logistic and linear regression models were performed. 24/50 patients (48

Mechanical thrombectomy effectively restores blood flow in patients with acute ischaemic stroke caused by large vessel occlusion. While mechanical thrombectomy has improved functional outcomes, 35%-60% of patients still experience residual disabilities. Typically, patients are selected for mechanical thrombectomy based on degree of hypoperfusion around the core measured on a vascular atlas. This study had two aims: (i) to evaluate the prognostic value of lesion topography onto functional outcome at 3 months post-mechanical thrombectomy, when the lesion is localized either onto a vascular atlas or large-scale, functional or structural, network atlases; and (2) to examine patterns of post-stroke structural and functional disconnection significantly related to the most common stroke functional outcome scale, i.e. the modified Rankin scale at 3 months post-event. A retrospective analysis was conducted on 70 acute stroke patients who underwent mechanical thrombectomy at the Padua University Hospital (January 2018-June 2022). Inclusion criteria involved first ever ischaemic strokes with anterior circulation large vessel occlusion. Imaging data from sub-acute structural MRI and CT scans were used to estimate indirect structural and functional disconnections. Outcome measures included the modified Rankin Scale at 3 months, with prediction analysis performed using Lasso regression across vascular, grey matter and white matter atlases. Three-month modified Rankin Scale was best predicted using Yeo's functional atlas (R 2 = 0.382), followed by the functional white matter atlas (R 2 = 0.338); the vascular atlas yielded the weakest prediction (R 2 = 0.146). Lesion damage to the corticospinal tract and corona radiata was significantly associated with the modified Rankin Scale. Functional disconnection significantly correlated with disability, particularly in sensorimotor, dorsal attention (DAN) and visual networks. Structural disconnections in the corticospinal tract, corpus callosum, corona radiata, thalamic radiation and left inferior and superior longitudinal fasciculus were also associated with poor functional outcome. This study demonstrates that lesion topography embedded in a network framework provides a more robust prediction of functional outcome. These findings emphasize the importance of understanding network alterations to enhance recovery prediction and optimize treatment strategies for stroke patients. Further research should explore the integration of network-based assessments in clinical practice for evaluating revascularization treatment eligibility.

Importance:Cervical artery dissection (CeAD) is a leading cause of stroke in young people and can occur during pregnancy. In women with prior CeAD, it is unclear whether future pregnancies increase the risk of recurrent CeAD, stroke, or death. Objective:To compare the frequency of recurrent CeAD, stroke, or death as a composite outcome between patients with CeAD who became pregnant vs those who did not. Design, Setting, and Participants:The Long-Term Risk of Recurrent Cervical Artery Dissection and Stroke After Pregnancy (LONG-RECAP) study was an international, multicenter, registry-based, explorative cohort study with data from May 1, 1990, and April 30, 2023, among patients with CeAD at 33 stroke centers across 9 countries who had at least 6 months of follow-up for whom detailed information was available on absence vs presence of subsequent pregnancies and the occurrence of outcome events. Exposure:Pregnancy after CeAD. Main Outcomes and Measures:Composite of recurrent CeAD, stroke (any type), and death (all causes) during follow-up at least 6 months after initial CeAD. Secondary outcomes were the components of the composite outcome. Cox proportional hazards regression analysis with and without adjustment for age was used to examine the association between pregnancy and outcomes. Results:Among 1013 female patients with CeAD (median [IQR] age, 42 [35-48] years), 114 (11.3%) became pregnant during a median (IQR) follow-up of 5.3 (2.0-11.3) years. The composite outcome occurred in 10 of 114 patients (8.8%), including 7 patients with recurrent CeADs, 2 with ischemic strokes, and 1 with intracerebral hemorrhage, in the pregnancy group compared with 65 of 899 patients (7.2%), including 32 with recurrent CeAD, 26 with ischemic strokes, 4 with intracerebral hemorrhages, and 5 deaths (2 patients had 2 outcomes), in the nonpregnancy group (unadjusted hazard ratio, 1.08; 95% CI, 0.56-2.08; age-adjusted hazard ratio, 0.77; 95% CI, 0.38-1.56). Five of 10 events in the pregnancy group occurred post partum (4 CeADs and 1 stroke). Age-adjusted hazard ratios for secondary outcomes were 1.03 (95% CI, 0.43-2.46) for recurrent CeAD, 0.53 (95% CI, 0.13-2.12) for ischemic stroke, 1.01 (95% CI, 0.11-9.32) for intracerebral hemorrhage, and 0.90 (95% CI, 0.03-24.88) for death. Conclusions and Relevance:In this cohort study of women with a history of CeAD, becoming pregnant was not associated with an increased risk of recurrent CeAD, stroke, or death. These findings may be helpful for individual counseling and family planning for women with prior CeAD.

BACKGROUND:Microembolic signals (MES) can be detected using transcranial Doppler (TCD) ultrasound in several clinical scenarios, including acute ischemic stroke (AIS). This narrative review aims to provide insights into their role in AIS patient management and outcomes. METHODS:The present narrative review consolidates current observational and randomized evidence on the prevalence and clinical relevance of MES in different AIS subtypes and settings. RESULTS:MES prevalence is higher in AIS patients with large artery atherosclerosis, indicating unstable or vulnerable plaques, and lower in those with small vessel disease. Detecting MES can significantly aid in managing AIS patients, particularly when the cause is unclear, as MES detected in different cerebral arteries can indicate conditions like covert cardioembolism, aortic arch atherosclerosis, or coagulation disorders, including cancer-related stroke. MES are associated with higher risk of stroke recurrence, independently of the underlying stroke mechanism. The detection of MES during and after acute systemic or endovascular reperfusion procedures in large-vessel occlusion patients appears to be predictive of adverse clinical outcomes and recurrent stroke. Finally, a reduction in MES detection may serve as surrogate marker and intermediate endpoint evaluating secondary stroke prevention treatments in the settings of randomized-controlled clinical trials. CONCLUSION:MES detection on TCD in AIS remains a useful diagnostic tool as it helps the clinicians to approach the stroke underlying mechanism by detecting and quantifying ongoing cerebral embolization and localizing an embolic source in real time. In addition, it allows monitoring and treatment individualization in stroke patients, while further determining recurrent stroke risk.

Introduction: We investigated the burden of microembolic signals (MES) in patients with acute ischaemic stroke (AIS) and atrial fibrillation (AF), assessing their impact on functional outcomes. Patients and methods: This multicentre international prospective cohort study involved patients with AIS and either a known or newly diagnosed anticoagulant-naïve AF. All centres utilised the same transcranial Doppler machine for 1-h monitoring with bilateral 2 MHz probes within 24 h of symptom onset. Recordings underwent MES analysis by a blinded central reader. The primary objectives were to ascertain the MES proportion and its association with functional outcomes assessed by the modified Rankin scale (mRS) score at 90 days. Results: Between September 2019 and May 2021, we enrolled 61 patients, with a median age of 78 years (interquartile range 73–83) and a median stroke severity score of 11 (interquartile range 4–18). MES were observed in 14 patients (23%), predominantly unilateral (12/14, 86%), with a median rate of 6 counts/hour (interquartile range 4–18). MES occurrence was higher post-thrombectomy and among those with elevated brain natriuretic peptide levels ( p < 0.05). A worse mRS score of 3–6 was more frequent in patients with MES, occurring in 11/14 (79%), compared to those without MES, 20/47 (43%), with an adjusted odds ratio of 5.04 (95% CI, 1.15–39.4), p = 0.04. Conclusions: Nearly a quarter of patients with AIS and AF exhibited silent microembolization after the index event. Detecting MES within 24 h post-stroke (using transcranial Doppler) could signify a marker of poor functional outcomes. Subsequent trials will assess if very early antithrombotic treatment might enhance outcomes in this highly selective group of cardioembolic stroke patients. (Clinicaltrials.gov ID: NCT06018090).

Transcranial color Doppler (TCD) is currently the only noninvasive bedside tool capable of providing real-time information on cerebral hemodynamics. However, being operator dependent, TCD monitoring is not feasible in many institutions. Robotic assisted TCD (ra-TCD) was recently developed to overcome these constraints. The aim of this study was to evaluate the safety and feasibility of cerebral monitoring with a novel ra-TCD in acute neurovascular care. This is a two-center prospective study conducted between August 2021 and February 2022 at Padua University Hospital (Padua, Italy) and Kepler University Hospital (Linz, Austria). Adult patients with conditions impacting cerebral hemodynamics or patients undergoing invasive procedures affecting cerebral hemodynamics were recruited for prolonged monitoring (> 30 min) of the middle cerebral artery with a novel ra-TCD (NovaGuide Intelligent Ultrasound, NeuraSignal, Los Angeles, CA). Manual TCD was also performed for comparison by an experienced operator. Feasibility and safety rates were recorded. A total of 92 patients (age: mean 68.5 years, range 36–91; sex: male 57 [62