BACKGROUND:Hydrocephalus is commonly treated using invasive surgical shunt placement with associated morbidity and frequent revision in children. The eShunt System, an endovascular miniature transdural shunt implanted via the inferior petrosal sinus (IPS), has shown promise in adults, but its pediatric application remains undefined because of limited data on IPS and cerebellopontine angle cistern (CPAC) morphometry. MATERIALS AND METHODS:Consecutive patients from two pediatric hospitals with high-resolution brain MRI were retrospectively analyzed. IPS and CPAC measurements were evaluated against adult anatomical criteria for safe implantation (IPS size ≥2 mm, IPS angle <150, and ≥5 mm distance from the dural access point to the brainstem or major artery). Regression analyses assessed the relationship between age and IPS/CPAC measurements. RESULTS:One hundred patients were included: 20 toddlers (1-2 years), 24 preschool age (3-5), 27 school age (6-11), and 29 adolescents (12-18). Median IPS size was 2.8 mm (2.4-3.3 mm) and 2.8 (2.5-3.4 mm) while median CPAC depth was 7.6 mm (5.6-9.0 mm) and 6.8 mm (5.5-8.5 mm) for the right and left side, respectively. While younger age was associated with smaller IPS diameter (P<0.001 for both), the correlation was weak (R² = 13.9% and 13.5% for right and left, respectively). Age was not associated with differences in other metrics after multivariable adjustments. Endovascular shunt placement was deemed feasible based on adult criteria in 67% of patients, with no age-based differences in eligibility (P=0.57). CONCLUSION:A majority of patients over 1 year of age met IPS and CPA anatomical criteria for placement of the eShunt System.

INTRODUCTION:Middle meningeal artery embolization (MMAE) is increasingly used for chronic subdural hematoma (cSDH), but outcomes in patients with chronic kidney disease (CKD) remain poorly defined. Because CKD is associated with medical complexity and renal vulnerability, we evaluated whether CKD is associated with worse outcomes after MMAE and whether MMAE remains beneficial among patients with CKD. METHODS:We performed a retrospective cohort study using the TriNetX US Collaborative Network. Adults with cSDH who underwent MMAE between January 1, 2016, and April 12, 2026, were identified using ICD-10-CM and ICD-10-PCS codes. Patients were stratified by baseline CKD status. Propensity-score matching was performed using 35 baseline characteristics, including demographics, comorbidities, cSDH subtype, concurrent procedures, antiplatelet exposure, hemodialysis, serum creatinine, estimated glomerular filtration rate, and blood urea nitrogen. Outcomes over 180 days included all-cause mortality, subsequent cSDH surgery, and acute kidney failure. A supplementary CKD-only analysis compared matched CKD patients treated with MMAE versus non-MMAE management. RESULTS:Among 2,710 patients with cSDH treated with MMAE, 576 had CKD and 2,134 did not. After matching, 531 patients were included in each cohort. CKD was associated with higher 180-day mortality (17.9% vs 11.5%; HR, 1.55; 95% CI, 1.12-2.14; p = 0.007) and acute kidney failure (25.2% vs 8.9%; HR, 3.06; 95% CI, 2.20-4.27; p < 0.001), while subsequent cSDH surgery was similar (10.4% vs 10.9%; HR, 0.93; 95% CI, 0.64-1.35; p = 0.513). In the CKD-only matched analysis, MMAE was associated with lower subsequent cSDH surgery compared with non-MMAE management (10.1% vs 18.0%; HR, 0.53; 95% CI, 0.38-0.73; p < 0.001), similar acute kidney failure (26.3% vs 27.8%; HR, 0.93; 95% CI, 0.75-1.17; p = 0.547), and a trend toward lower mortality (18.7% vs 23.3%; HR, 0.78; 95% CI, 0.60-1.00; p = 0.052). CONCLUSION:CKD was associated with higher mortality and acute kidney failure among cSDH patients undergoing MMAE, while subsequent cSDH surgery rates were similar to those of non-CKD patients. In the CKD-only analysis, MMAE was associated with lower subsequent cSDH surgery and similar acute kidney failure compared with non-MMAE management, supporting its feasibility in appropriately selected CKD patients.

Endovascular thrombectomy (EVT) for large vessel occlusion (LVO) stroke is increasingly performed across diverse hospital settings, but the impact of hospital characteristics on patient outcomes remains unclear. Previous studies have shown a negative correlation between EVT volume and outcomes, while others paradoxically found better outcomes at lower-volume centers. Other hospital characteristics, such as teaching status and ownership structure may also impact EVT outcomes, though data are scarce. In this retrospective cohort study, we utilize the US Nationwide Readmissions Database (NRD) to examine the association between hospital characteristics and clinical outcomes following EVT for LVO stroke. Our primary hypothesis is that treatment at non-profit, high-volume teaching centers (NP-HVTCs) results in superior outcomes compared to treatment at other facilities. We identified adult patients who underwent EVT for LVO stroke using ICD-10-CM procedure codes within the NRD from 2016 to 2022. We defined NP-HVTCs as facilities with bed size ≥500, annual EVT volume ≥100, and metropolitan teaching hospital designation. The primary outcome was routine discharge home. Secondary outcomes included in-hospital mortality, intracranial hemorrhage (ICH), and non-ICH complications. Multivariable logistic regressions and causal mediation analyses were used to examine associations and mechanisms. A total of 101,247 EVT patients were identified with 17,444 (17.2%) treated at NP-HVTCs. NP-HVTC treatment was associated with higher rates of routine discharge (27.7% vs 22.9%; aOR 1.19 [95%CI 1.03–1.39], p=.021) and lower mortality (9.9% vs 13.4%; aOR 0.75 [95%CI 0.64–0.86], p<.001). NP-HVTCs also had lower rates of ICH (23.4% vs. 26.0%, aOR 0.88 [95%CI 0.81–0.96], p=0.006) and non-ICH complications (43.0% vs. 47.7%, aOR 0.92 [95%CI 0.85 to 1.01], p<.001), particularly respiratory complications (27.6% vs. 34.4%, aOR 0.73 [95%CI, 0.65–0.81], p<0.001). Mediation analyses showed that respiratory complications accounted for 34.5% of the association with routine discharge and 41.3% of the association with mortality (both p<0.001), whereas ICH explained <5% of the effect. Treatment at NP-HVTCs was associated with improved EVT outcomes, largely mediated by lower rates of respiratory complications. These findings highlight the importance of comprehensive perioperative and critical care in optimizing stroke outcomes and suggest avenues for quality improvement across hospital settings.

Background: Despite recent advances in stroke care, endovascular thrombectomy (EVT) availability remains concentrated in metropolitan areas, and many patients with large vessel occlusions (LVO) strokes require interhospital transfer to receive EVT. It remains unclear how changes in blood pressure metrics in transit influence radiographic and clinical evolution. Methods: This was a retrospective study of LVO patients transferred to a comprehensive stroke center (CSC) for EVT within 1.5 to 6 hours of initial imaging. Clinical and radiographic data were collected at outside hospital and at CSC. Blood pressure (BP) metrics, including systolic blood pressure (SBP) and mean arterial pressure (MAP), were collected at the time of initial stroke imaging and upon arrival at CSC. BP changes were calculated as percentage deviations from initial measurements compared to measurements at CSC arrival. Primary outcomes were Alberta Stroke Programme Early Computed Tomography Score (ASPECTS) and NIH Stroke Scale (NIHSS) change from initial diagnosis to CSC arrival, adjusted for demographics, time from last known well, comorbidities, laboratory values, initial ASPECTS, initial NIHSS, intravenous thrombolysis (IVT) administration, transit time, and initial BP using multivariable linear regression analyses. Results: A total of 335 patients were included. Mean age was 68.5 years, 49.9% were male, 47.8% received IVT, and mean transit time was 199 minutes. Mean presenting SBP was 151.3 mmHg, and mean MAP was 107.1 mmHg. Mean ASPECTS decay was 2, and mean NIH stroke scale deterioration was 1.1. In multivariable regression analysis, change in SBP during transit was independently and significantly associated with ASPECTS decay (-0.48 per 20% decrease in SBP, p=0.003) and numerically associated with NIHSS worsening (+0.73 per 20% decrease in SBP, p=0.079). Similarly, change in MAP was associated with ASPECTS decay (-0.35 per 20% decrease in MAP, p=0.019) and NIHSS worsening (+0.82 per 20% decrease in SBP, p=0.030). Conclusions: Blood pressure changes during interhospital transfer for EVT are significantly associated with radiographic and clinical evolution of LVO stroke. BP decreases were associated with ASPECTS decay and NIHSS worsening. These findings have significant implications for BP management during EVT transfer, as well as clinical appropriateness of procedures such as endotracheal intubation and intravenous thrombolysis administration.

BACKGROUND:The use of balloon guide catheter (BGC) has been associated with better reperfusion and clinical outcomes in mechanical thrombectomy (MT) for large vessel occlusion stroke. However, the impact of BGC on angiographic and clinical outcomes in patients with distal medium vessel occlusion (DMVO) strokes undergoing MT has not been extensively investigated. METHODS:This is a retrospective analysis of a prospectively collected database from 14 comprehensive stroke centers in the United States and Europe. Patients with anterior circulation DMVO due to middle cerebral artery (MCA) M3/M4 or anterior cerebral artery (ACA) A1/A2-3 were included. The cohort was divided into BGC and non-BGC groups. Multivariable logistic regression and inverse probability of treatment weighting (IPTW) were used for comparison. The primary outcome was first pass effect (FPE) defined as modified treatment in cerebral infarction (mTICI) grade 2C/3 after single device pass. RESULTS:Among 199 patients who were eligible for analysis, 81 (40.7%) were female. The median age was 69 (60-81) years, and National Institutes of Health Stroke Scale score was 13 (7-18). The BGC group (n=73) had higher rates of FPE (53.4% vs 13.7%; IPTW aOR 5.63, 95%CI (2.43 to 13.10), P<0.001) compared with the non-BGC group (n=126). The BGC group had higher rates of modified Rankin Scale (mRS) 0-1 (42.9% vs 27.1%; IPTW aOR 2.78, 95% CI (1.10 to 7.07), P=0.031), mRS 0-2 (60.3% vs 41.5%; IPTW aOR 4.31, 95% CI (1.66 to 11.19), P=0.003), and lower rates of mortality at 90-days (12.7% vs 25.4%; IPTW aOR 0.32, 95% CI (0.11 to 0.98), P=0.047) compared with the non-BGC group. The rates of successful reperfusion at the end of the procedure and symptomatic intracerebral hemorrhage were comparable between both groups. CONCLUSION:The present study suggests that the use of BGC in DMVO undergoing MT may be associated with improved angiographic and clinical outcomes with no safety concerns. Prospective studies are warranted.

INTRODUCTION:Endovascular thrombectomy (EVT) is an effective treatment for basilar artery occlusion (BAO) stroke in select patients. While there is a growing body of literature suggesting that advanced imaging modalities such as computed tomography perfusion (CTP) and magnetic resonance (MR) may not be necessary for selecting anterior circulation large vessel occlusion stroke patients for EVT, whether advanced imaging may be superior to conventional imaging (non-contrast CT and CT angiography) in identifying good treatment candidates among BAO patients is less clear. PATIENTS AND METHODS:This was a multicenter retrospective cohort study of BAO EVT patients treated from 2013 to 2022 in the Stroke Thrombectomy and Aneurysm Registry. Patients selected for EVT by advanced imaging (CTP or MR) were matched with those selected by conventional imaging using propensity score matching (PSM) accounting for possible confounders. Primary outcome was functional independence at 90 days. Other outcomes include bedridden state or death at 90-days and symptomatic intracranial hemorrhage (sICH). RESULTS:268 patients were included. 150 patients were selected for BAO EVT by conventional imaging, 86 by CTP, and 32 by MR. Patients selected by advanced imaging were significantly older than those selected by conventional imaging (median age 71 vs 64 years, p = 0.001); patient characteristics were otherwise similar between cohorts. After PSM, 90-day outcomes were similar between the two cohorts (p = 0.56), with similar rates of functional independence (39.4% vs 35.1%, p = 0.65), bedridden state or death (40.4% vs 44.7%, p = 0.66), and sICH (3.3% vs 5.7%, p = 0.49) for conventional and advanced imaging groups, respectively. Results were similar across treatment time windows (all p > 0.05). CONCLUSIONS:Selecting patients for basilar EVT using conventional versus advanced imaging did not result in different clinical outcomes, regardless of treatment time windows. Conventional imaging appears sufficient as a first-line tool for selecting basilar EVT patients in routine clinical practice.

OBJECTIVE:The safety of intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) patients with pituitary neoplasms is unclear. This study aims to assess IVT's safety and efficacy in this patient population. METHODS:We reviewed PubMed, Scopus, EMBASE, and Web of Science through July 2025 for reports of IVT administration in AIS patients with pituitary neoplasia. We also performed a retrospective analysis of the Nationwide Readmissions Database (NRD) from 2016 to 2022 to compare outcomes of IVT versus no IVT for AIS patients with pituitary neoplasia, and outcomes of IVT-treated AIS patients with versus without pituitary neoplasia. Outcomes of interest include post-stroke functional status, intracranial hemorrhage (ICH), mortality, and pituitary apoplexy. Multivariate regression analyses were performed to adjust for confounders. RESULTS:The literature review identified 5 AIS patients with pituitary neoplasia, of whom 3/5 (60%) experienced intracranial hemorrhage and none developed apoplexy. In the nationwide analysis of 1,246,750 AIS patients, 1661 (0.13%) had concomitant pituitary neoplasm. Among these patients, IVT was associated with higher odds of functional independence at discharge (adjusted OR 2.46 [95%CI 1.56-3.87]), without increased risk of ICH or in-hospital death (p > 0.05). No cases of pituitary apoplexy were observed. Outcomes among all IVT-treated AIS patients did not differ between those with and without pituitary neoplasms (all p > 0.05). INTERPRETATION:Only five cases of IVT for AIS patients with pituitary neoplasia were identified, highlighting a striking lack of clinical data. In a large U.S. cohort of AIS patients, IVT was associated with improved hospitalization outcomes without increased risk of ICH or pituitary apoplexy.

OBJECTIVE:While pre-existing dementia is a known negative predictor for good endovascular thrombectomy (EVT) outcomes, comparative efficacy and safety data of EVT versus best medical management (BMM) for large vessel occlusion (LVO) patients with dementia are limited. This study compares hospitalisation outcomes of EVT versus BMM for LVO patients with underlying dementia. METHODS:Using the US Nationwide Readmissions Database from 2016 to 2022, we retrospectively identified adult patients with dementia who presented with LVO stroke. The primary outcome was discharge to home. Secondary outcomes included in-hospital mortality, length-of-stay and complications. Patients who underwent EVT were compared to those who received BMM after propensity score matching. Interaction and subgroup analyses assessed treatment effect heterogeneity associated with age and dementia type. RESULTS:Among 37 298 patients included, 6618 EVT and 13 092 BMM patients remained after propensity score matching. Home discharge rates were similar between groups (27.1% vs 26.4%, P = .51). EVT was associated with longer length-of-stay (median 7 vs 6 days, P < .001) and increased intracranial haemorrhage (23.9% vs 11.1%, P < .001), with no significant difference in mortality (15.0% vs 14.9%, P = .87). Patient age significantly moderated EVT effectiveness (interaction P < .001), and EVT among patients <75 years old was significantly associated with higher rates of home discharge (36.7% vs 26.8%, P < .001). Additionally, EVT appeared more effective for patients with vascular dementia (vs Alzheimer's disease, interaction, P = .014), among whom EVT was associated with significantly higher rates of home discharge (32.7% vs 25.2%, P = .007). INTERPRETATION:Treatment response to EVT among LVO stroke patients with dementia was heterogeneous, and EVT was beneficial for patients <75 years old and those with vascular dementia.

Background The efficacy and safety of endovascular treatment (EVT) in patients with basilar artery occlusion (BAO) stroke and low (score <10) National Institutes of Health Stroke Scale (NIHSS) score are unclear. Purpose To assess whether EVT improves outcomes in patients with low-scoring NIHSS BAO stroke. Materials and Methods A retrospective cohort study of the Nationwide Re-admissions Database (NRD; January 2016 to December 2022) was conducted. Adults with acute BAO stroke and NIHSS score 1-9 were identified and grouped by EVT (thrombectomy, angioplasty, and/or stenting) versus medical management (MM). Primary outcomes were routine discharge to home with self-care and in-hospital mortality. Propensity score matching was performed to balance EVT and MM cohorts, accounting for demographics, comorbidities, symptoms, stroke etiology, and other factors. Subgroup analyses were performed to identify sources of treatment-effect heterogeneity. χ2 tests and logistic regression analyses were used to compare outcomes. Results Among 9461 patients (median age, 68 years; IQR, 58-77 years; 5842 males), 1807 were administered EVT. After propensity score matching, 2888 and 1632 patients with MM and EVT, respectively, remained. Rates of routine discharge were similar (MM vs EVT, 34.0% vs 34.0%; P = .24), but the EVT arm had higher in-hospital mortality (16.0% vs 7.1%; P < .001). In subgroup analyses, EVT was associated with higher odds of routine discharge among patients with NIHSS score of 6-9 (odds ratio [OR], 1.42; 95% CI: 1.07, 1.90; P = .02), whereas it was not associated with higher odds of mortality among those with embolic stroke etiology (OR, 1.42; 95% CI: 0.71, 2.86; P = .32) or those who were 75 years or older (OR, 1.63; 95% CI: 0.79, 3.39; P = .19). Conclusion EVT was not associated with better outcomes but was associated with increased mortality among patients with low-score NIHSS BAO stroke; however, NIHSS score, stroke etiology, and patient age may be sources of clinically significant treatment effect heterogeneity. © RSNA, 2026 Supplemental material is available for this article.

The transition of the neurologically injured patient from the intensive care unit (ICU) environment toward recovery often requires placement of a ventriculo-peritoneal shunt (VPS) and a gastrostomy tube (g-tube). Prior work has demonstrated a significant association between g-tube placement and shunt infection, however, both procedures are typically performed during the same hospitalization. Thus, there remains a question regarding the optimal timing of g-tube relative to VPS placement and the risk of subsequent complications. The objective of this study is to examine the risk of complications on the basis of relative timing of VPS and g-tube placement. Patients admitted for intracranial hemorrhage who underwent both VPS and g-tube placement within 10 days of each other were retrospectively identified in the Nationwide Readmissions Database from 2016 to 2022. Patients were divided into three groups: VPS > 1 day before g-tube, g-tube > 1 day before VPS, and both procedures within 1 day. Primary outcomes were inpatient shunt infection or revision and delayed infection or revision within 180-days post-discharge. Overall, 3334 patients met the inclusion criteria. The most common period for the procedures to occur was within 24 h of each other. Excluding patients who received both VPS and g-tube within 1 day of separation (n = 530, 15.9

Amaurosis fugax is conventionally classified as a transient ischemic attack (TIA) subtype, yet the landmark trials guiding TIA management did not specifically enroll patients with amaurosis fugax. Clinicians frequently extrapolate TIA trial data to amaurosis fugax, potentially exposing patients to suboptimal diagnostic and treatment plans. We compared the risk of subsequent ischemic stroke after amaurosis fugax versus TIA. Using the Nationwide Readmissions Database (2016–2022), we identified non-elective hospitalizations with a primary diagnosis of TIA or amaurosis fugax. Patients with amaurosis fugax were matched 1:2 to TIA patients using propensity-score matching on 25 covariates. Primary and secondary outcomes were any ischemic stroke and disabling ischemic stroke readmission, respectively, over 300 days. Additional 300-day outcomes were any non-elective readmission, major hemorrhage, intracranial hemorrhage, and death. A total of 131,791 patients were identified, and after matching 4350 amaurosis fugax and 8,698 TIA patients remained. Patients with amaurosis fugax had significantly lower cumulative stroke probabilities (300-day: 1.5

Background Pathologic vertebral compression fractures (pVCFs) are associated with significant pain and worsened quality of life. Spinal interventions such as kyphoplasty, vertebroplasty, and radiofrequency ablation can improve patient outcomes; however, there is a paucity of data on the optimal timing of these procedures. This study aims to evaluate the real-world effectiveness of inpatient spinal interventions versus conservative management (CM) for pVCF patients. Methods This is a retrospective cohort analysis of the Nationwide Readmissions Database from 2016 to 2022. Adult patients admitted non-electively for pathologic thoracolumbar wedge compression fractures were included. The primary outcome was hospital discharge to home. Outcomes for patients who underwent spinal intervention (kyphoplasty, vertebroplasty, and/or radiofrequency ablation) versus CM were compared using Poisson or logistic regression analyses. Results 2933 patients were included (median age 77 years, 54.1% female) of whom 921 (31.4%) underwent spinal intervention. Compared with CM, those who underwent intervention were significantly more likely to be discharged home (61.1% vs 52.5%; adjusted OR 1.50, 95% CI 1.11 to 2.03, P=0.009), had significantly longer lengths of hospital stay (median 6 vs 4 days; Poisson rate ratio 1.61, 95% CI 1.12 to 2.10, P<0.001), and higher hospitalization cost (adjusted B 10.7, 95% CI 9.5 to 12.0, P<0.001). Among those discharged home during the index admission, there was no difference in 180-day major morbidity or mortality between groups. Conclusion For pVCF patients, early inpatient spinal intervention was significantly associated with higher odds of discharge to home without increased adverse events.

BACKGROUND AND PURPOSE:Neuroradiology is facing workforce shortages, and international medical graduates (IMGs) have helped in staffing and providing access to care. However, little research attention has been paid to their representation in the workforce. We aimed to characterize their distribution within the U.S. neuroradiology workforce and compare demographic, geographic and practice patterns providing care to Medicare patients. MATERIALS AND METHODS:A retrospective analysis of Medicare Fee-for-Service Provider Utilization and Payment Data and the CMS National Plan and Provider Enumeration System (NPPES) National Downloadable Files between 2017 and 2021 was performed to identify and categorize neuroradiologists practicing within the United States as IMGs or USMGs (United States Medical Graduates) based on their medical schools. Sub-group analysis was performed for academic status, practice size, rurality, and geographic region of practice. Differences were assessed using chi-square, Wilcoxon rank-sum tests and multivariate regression analysis. RESULTS:Between 2017 and 2021, 2,730 neuroradiologists were identified, of whom 692 (25.3%) were IMGs, with their representation increasing from 22.9% in 2017 to 26.7% in 2021. Compared to USMGs, IMGs had higher female representation (25.6% vs 18.3%) and greater representation in academic radiology (48.3% vs 35.6%). IMGs represented 35.6% of all neuroradiologists in academic practices. In multivariable analysis adjusting for clustering within practice groups, female gender (OR 1.41, 95% CI 1.12-1.79) and academic practice setting (OR 1.56, 95% CI 1.21-2.01) were independently associated with IMG status. Female gender and academic employment are the principal independent predictors of IMG status among neuroradiologists. CONCLUSION:IMGs represent over one-quarter of the U.S. neuroradiology workforce, with even higher representation in academic practices. IMG contribution in facilitating patient access to sub-specialized radiology services and training of the next generation of radiologists is especially important given ongoing national radiologist shortages and increasing demand for imaging.

Middle meningeal artery embolization (MMAE) plus surgical evacuation is increasingly used for chronic subdural hematoma (cSDH), but predictors of length of stay (LOS) and outcomes associated with early discharge remain unclear. We performed a multicenter MESH Registry study (2019–2024) of patients undergoing MMAE and surgical evacuation for symptomatic cSDH. Short-stay discharge was defined as LOS ≤4 days. Predictors were identified using multivariable logistic regression. The 90-day composite adverse event was defined as cSDH recurrence requiring intervention, reintervention (repeat MMAE or surgical evacuation), or 30-day all-cause readmission. Safety was assessed using adjusted logistic regression, generalized estimating equations (GEE), inverse probability of treatment weighting (IPTW), and multiple imputation by chained equations (MICE). Among 647 patients (mean age 72.6 years; 74.0

BACKGROUND AND PURPOSE:Endovascular venous sinus stent placement (VSS) is a promising new treatment for select patients with idiopathic intracranial hypertension (IIH) refractory to medical management. This study aims to investigate the safety and efficacy of VSS compared with neurosurgical CSF shunting in real-world clinical practice. MATERIALS AND METHODS:This was a retrospective cohort study of the 2016-2022 Nationwide Readmissions Database in the United States. Adult patients who underwent elective IIH treatment with VSS or CSF shunting were identified. Propensity score matching (PSM) was performed to balance treatment groups. The primary outcome was IIH treatment failure, defined as hospital readmission for IIH-related symptoms, hardware complications, repeat surgery, or death within 300 days. Safety outcomes include morbidity and mortality, both periprocedurally and during follow-up. Rates of perioperative ischemic strokes, intracranial hemorrhage (ICH), and death were also assessed. RESULTS:A total of 7795 patients were identified; 1511 (19.3%) underwent VSS. After PSM, 1370 VSS and 2786 CSF shunting patients remained. VSS was associated with a lower rate of treatment failure (hazard ratio [HR] 0.59 [95% CI, 0.43-0.80]; P < .001). The risk of morbidity/mortality was lower in the VSS group, both periprocedurally (2.2% versus 5.5%; P < .001) and throughout study follow-up (HR 0.38 [95% CI, 0.25-0.58]; P < .001). Rates of periprocedural ischemic stroke, ICH, and death were low for both cohorts (<1% for all). CONCLUSIONS:In this nationally representative study of real-world hospitalization data in the United States, endovascular VSS is associated with lower rates of treatment failure compared with conventional CSF shunting, as well as lower risk of morbidity and mortality. These findings provide real-world evidence that VSS is a safe and effective alternative to neurosurgical CSF shunting in select patients with IIH.

Middle meningeal artery embolization (MMAE) has emerged as a treatment for chronic subdural hematoma (cSDH), but comprehensive real-world safety data remain limited. We performed a multicenter retrospective analysis of 1781 consecutive patients undergoing MMAE for cSDH (2019–2025). The primary outcome was any procedure-related complication within 30 days. Inverse probability of treatment weighting (IPTW) assessed the association between technical success and complications, adjusting for demographic, clinical, and procedural confounders. Mean age was 72.8 ± 12.4 years; 68.1

BACKGROUND: Unruptured intracranial aneurysms (UIAs) affect up to 5% of the population, and rupture can lead to devastating subarachnoid hemorrhage. GLP-1RAs (glucagon-like peptide-1 receptor agonists) have anti-inflammatory and vasculoprotective effects, but their impact on aneurysm stability and subarachnoid hemorrhage outcomes is unexplored. This study evaluated whether GLP-1RA use is associated with reduced rupture risk and attenuated severity in the event of a rupture. METHODS: We conducted a retrospective cohort study using the TriNetX US Collaborative Network (2016-2024). Cohort 1 included patients with newly diagnosed, untreated UIA; cohort 2 included those who suffered aneurysm rupture. GLP-1RA exposure was defined as use before or within 3 months of UIA diagnosis (cohort 1) or before rupture (cohort 2). The primary outcome was aneurysm rupture risk in cohort 1. Secondary outcomes include presentation severity, vasospasm, and mortality in cohort 2. Propensity score matching balanced demographics, comorbidities, and medications. RESULTS: After propensity score match, cohort 1 of patients with untreated UIA included 8088 GLP-1RA users and 8088 nonusers. GLP-1RA use was associated with significantly lower probabilities of aneurysm rupture at 1-year (0.65% versus 1.51%; P<0.001), 3-year (1.18% versus 1.85%; P<0.001), and 5-year (1.49% versus 2.10%; P<0.001) timepoints, representing a 48% decrease in hazards (hazard ratio, 0.52 [95% CI, 0.38-0.69]). Among patients who suffered aneurysm rupture (cohort 2, N=298 after propensity score match), prerupture GLP-1RA use (n=149) was associated with lower rates of intraparenchymal hemorrhage (17.4% versus 33.6%; P<0.001), intraventricular hemorrhage (10.1% versus 23.5%; P<0.001), and clinically significant vasospasm (10.7% versus 24.2%; P=0.002), as well as numerically lower rates of 30-day mortality (9.4% versus 14.1%; P=0.21). CONCLUSIONS: For patients with untreated UIA, GLP-1RA use was associated with a 48% reduction in aneurysm rupture risk and, among those who suffered aneurysm rupture, milder clinical and radiographic severity. These findings suggest possible neuroprotective and vascular stabilizing effects of GLP-1RAs for patients with UIA.