Introduction Catheter-mediated (Dotter) angioplasty has been previously described for extracranial/peripheral arteries. Tenzing (Route 92 Medical, San Mateo, California, USA), a shelf-reducing delivery catheter, has an atraumatic tapered distal tip that progressively enlarges to maximal outer diameter of 1.2 mm (Tenzing 5), 1.6 mm (Tenzing 7), and 2.1 mm (Tenzing 8). Objective To report our initial experience treating acutely symptomatic intracranial atherosclerotic disease (ICAD) using Dotter angioplasty with Tenzing (Tenzingplasty). Methods After institutional review board approvals, we retrospectively reviewed clinical and procedural data of patients with underlying ICAD treated with off-label Tenzingplasty between 2022 and 2025, either as part of endovascular treatment for large vessel occlusion, or after medical therapy failure <96 hours from presentation. Results We identified 53 consecutive patients with symptomatic ICAD who underwent Tenzingplasty, median (IQR) age 63 (57-70) years, 29 (55%) male. ICAD locations were: M1 (24), M2 (9), internal carotid artery (3), vertebral V4 segment (7), basilar (8), vertebrobasilar junction (1), and A2 anterior cerebral artery (1). First pass aspiration thrombectomy for patients with an initial modified Thrombolysis in Cerebral Infarction score 0 (without crossing the ICAD lesion) was performed in 34/53 (64%). After median 1 (IQR 1-2) Tenzingplasty pass, median (IQR) stenosis improved from 100% (95-100) to 60% (42-76) post-Tenzingplasty (P<0.0001). Subsequent balloon angioplasty or stenting was performed in 4% and 21%, respectively. Successful final reperfusion (expanded Thrombolysis in Cerebral Infarction 2b-3) was achieved in 81%, with one Tenzingplasty-related complication (a non-flow limiting dissection), and no perforations. In follow up, 25/44 (57%) had a 90-day modified Rankin Scale score of 0-2. Conclusion Tenzingplasty may be a feasible and safe rescue therapy for improving luminal caliber, flow restoration, and/or lesion preparation for stenting in acutely symptomatic ICAD.

Introduction: Prolonged hospitalization following carotid artery stenting (CAS) increases healthcare costs and patient morbidity. Predictive models specific to interventional radiology are lacking. Materials and methods: We retrospectively analyzed patients who underwent CAS between 2012 and 2020. Patients with carotis near-occlusions, underwent cardiac surgery after CAS, bilateral CAS stenting in the same session and patients with missed data were excluded. 386 patients were eligable for the final analyses having pre-follow-up imagings/recordings. A novel scoring system—the Ankara University Risk Analysis and Scoring System—was developed to predict prolonged hospitalization based on clinical and procedural factors. The proposed risk factors used for the assessment were; advanced age(> 80years), symptomatic status, pulmonary disease, elevated creatinine levels, severe contralateral carotid stenosis, longer intervention times and long atherosclerotic plaque(> 2cm)/irregular plaque surface. Results: 87 patients (22.5%) needed prolonged hospitalizations (> 1days) regardless of experiencing any kinds of complications and 30 days neurological complications rates were 4.7% (18patients). 3.1% (12patients) of the patients had non-neurologic and 2.3% (9patients) of the patients had transient complications. A score ≥ 9 identified patients at high risk for complications and extended hospitalization with acceptable sensitivity and specificity values. Besides a more compact scoring system was also proposed with less factors included in the scoring (≥ 3 for prolonged hospitalization, ≥ 4 for complications). ROC analysis demonstrated high predictive performance for both systems (AUC = 0.647–0.730, p < 0.001). Conclusion: Our proposed scoring system shows promise in identifying patients at increased risk for complications and prolonged hospitalization following CAS. Further validation in larger, multi-center cohorts is warranted to confirm its clinical utility.

BACKGROUND:The optimal management of isolated posterior cerebral artery occlusion (iPCAO) remains unclear. We investigated whether baseline perfusion imaging parameters are associated with clinical outcomes and whether they modify the association between endovascular therapy (EVT) and outcomes in iPCAO. METHODS:This prespecified secondary analysis of the international, multicenter, observational PLATO (Posterior Cerebral Artery Occlusion) registry (35 centers, 10 countries, 2015-2025) included consecutive adults with unilateral iPCAO and baseline perfusion imaging (computed tomography or magnetic resonance imaging) with reconstructed parameters. The primary end point was an excellent 90-day outcome (modified Rankin Scale score, 0-1). Perfusion parameters included hypoperfusion volume, infarct core volume, and mismatch ratio. The primary analysis used multivariable mixed-effects regression models (center as random effect) to assess associations between perfusion parameters and outcomes, adjusting for age, sex, treatment year, prestroke modified Rankin Scale score, baseline National Institutes of Health Stroke Scale score, diabetes, stroke cause, posterior circulation Acute Stroke Prognosis Early Computed Tomography Score, occlusion site, intravenous thrombolysis, and onset-to-door time. To test whether the association between EVT and outcomes varies according to baseline perfusion parameters, we evaluated treatment-by-perfusion interactions by including interaction terms (treatment×perfusion parameter) in inverse probability of treatment weighting-adjusted models, with results expressed as ratios of odds ratios (ORs). RESULTS:Of 1811 patients with iPCAO, 443 met inclusion criteria (median age, 74 years; 41.8% female). Larger hypoperfusion volume was associated with lower odds of excellent outcome (adjusted OR, 0.72 [95% CI, 0.58-0.89] per 1-unit increase in natural logarithm-transformed volume). No interaction between perfusion parameters and EVT was observed for the primary outcome. However, increasing core volume was associated with a progressively less favorable modified Rankin Scale score shift (ratio of OR, 0.66 [95% CI, 0.48-0.90]; Pinteraction=0.009) and higher mortality (ratio of OR, 1.82 [95% CI, 1.10-3.03]; Pinteraction=0.021) with EVT compared with medical management. Increasing hypoperfusion volume was associated with a higher risk of symptomatic intracranial hemorrhage with EVT (ratio of OR, 10.15 [95% CI, 1.06-96.93]; Pinteraction=0.044). CONCLUSIONS:In iPCAO, perfusion imaging provides independent prognostic information but does not identify patients with potential benefit from EVT and may instead indicate those at higher procedural risk. REGISTRATION:URL: https://osf.io/62mwt; Unique identifier: NCT05291637.

Background Temporomandibular joint replacement (TMJR) can result in large volume blood loss (BL) from the underlying internal maxillary artery (IMA). Pre-operative IMA embolization has been utilized to reduce intra-operative BL, but prior studies are limited to small case series. Methods Adult patients undergoing pre-operative IMA embolization for TMJR between June 2014 and September 2024 at a single institution were included. Electronic medical records were reviewed for demographic information, treatment details, and outcomes. Historical controls were identified via citations and PubMed searches. Results Pre-operative IMA embolization was performed in 73 patients (108 sides) undergoing TMJR. Coils were used in 96% of the patients, with a median of three coils used per side (interquartile range (IQR) 3–4). Middle meningeal artery (MMA) was occluded in 26% of the sides completed. There was one intra-procedural complication of a self-limited retrograde femoral artery dissection. Median operative BL/side during TMJR was 100 mL (IQR 50–181). There were no embolization-related complications in hospital or at follow-up (median follow-up of 12 months (IQR 4–24)). Using the BL per side beyond the third quartile of the historical controls as the definition of excessive BL, the embolized cohort contained half the number of patients with excessive BL (12.5%) compared with the historical cohort (25.0%). Conclusion Pre-operative IMA embolization is safe and may be effective at reducing BL and excessive hemorrhage during TMJR. A randomized controlled trial is needed to ascertain its benefits compared with the conventional approach.

BACKGROUND:The Millipede AspiRation for Revascularization in Stroke (MARRS) pivotal study was a prospective, multicenter, single arm trial evaluating the safety and efficacy of the corrugated Millipede catheter system in patients with acute ischemic stroke due to large vessel occlusion. METHODS:Patients aged 18-85 years with internal carotid artery, M1, M2, or basilar artery occlusions treatable within 8 hours were eligible. Catheter selection was based on target vessel diameter (Millipede88 >2.7 mm; Millipede70 >2.2 mm). The primary efficacy endpoint was modified Thrombolysis in Cerebral Infarction (mTICI) ≥2b within ≤3 passes without rescue therapy. Imaging and clinical outcomes were independently adjudicated. Secondary endpoints included first pass effect (mTICI ≥2c). RESULTS:180 patients were treated (57% US, 43% EU). Median age was 69 years, mean baseline National Institutes of Health Stroke Scale score was 17, and median Alberta Stroke Program Early CT Score was 9. M1 occlusion was the most common target lesion (62%). The primary endpoint was achieved in 160/180 patients (88.9%; 95% CI lower bound 84.3%) in the intention-to-treat cohort. Direct first pass aspiration was performed with Millipede88 and Millipede70 in 64% and 36% of patients, respectively. Navigation success was 96% with Millipede88 and 99% with Millipede70. Among Millipede88 patients, first pass mTICI ≥2c was achieved in 60%, increasing to 75% in the M1 subgroup. Final mTICI ≥2c was achieved in 85% of primary Millipede88 cases. Symptomatic intracranial hemorrhage occurred in 2.3%, intracranial dissection in 1.1%, no perforations occurred, and 90 day all cause mortality was 13.9%. CONCLUSIONS:The Millipede aspiration system demonstrated excellent deliverability and high rates of first pass and final mTICI ≥2c, particularly in M1 occlusions, with low rates of adverse events. TRIAL REGISTRATION NUMBER:ClinicalTrials.gov NCT05714501.

Background: Traumatic intracranial pseudoaneurysms (TIPAs) are exceedingly rare, representing <1% of all intracranial aneurysms, and are associated with high morbidity and mortality. They often remain occult on initial imaging, particularly when masked by concomitant subdural hematomas (SDHs). Case Description: We report two patients with traumatic pseudoaneurysms presenting as evolving SDHs. To the best of our knowledge, this is one of the few reports describing cortical middle cerebral artery (MCA) and posterior cerebral artery (PCA) pseudoaneurysms manifesting as SDHs in elderly patients. Case 1: An 86-year-old man presented with interhemispheric and tentorial SDHs. Serial computed tomography and magnetic resonance imaging (MRI) revealed progressive thickening and a 10 mm enhancing lesion. Cerebral angiography confirmed a 4.5 × 6.5 mm PCA pseudoaneurysm, which was successfully treated with Onyx embolization. He remained neurologically intact with stable follow-up imaging. Case 2 : An 83-year-old woman sustained a fall with left convexity, falcine, and tentorial subacute SDHs. MRI demonstrated a 7 mm focal contrast enhancement within the hematoma, and cerebral angiography during prophylactic middle meningeal artery embolization revealed a 5.8 × 5.6 mm distal MCA pseudoaneurysm. TIPA was treated with microsurgical clipping. She ultimately made a full recovery with near complete resolution of the SDH. Conclusion: These cases illustrate that TIPAs may remain angiographically occult early and present only with an evolving SDH. Key diagnostic red flags include recurrent or tentorial SDH and focal cortical enhancement on MRI. Multidisciplinary management with timely angiographic evaluation and tailored surgical and/or endovascular therapy is essential to reduce the risk of catastrophic rebleeding.

Background: The optimal timing of intracranial angioplasty/stenting during mechanical thrombectomy (MT) for large vessel occlusion strokes (LVOS) remains uncertain. We aimed to determine whether the timing of rescue angioplasty/stenting impacts functional outcomes in LVOS patients undergoing MT. Methods: We conducted a pooled analysis of the Society of Vascular and Interventional Neurology Registry data from 2010 to 2023. Included patients had a pre-stroke modified Rankin Scale (mRS) ≤2, underwent MT for ICA or MCA-M1/M2 occlusions, and had available 90-day mRS data. Patients who achieved successful reperfusion after a single pass were excluded. Patients were divided into 4 groups: A) multiple passes without angioplasty/stenting regardless of the final recanalization, B) angioplasty/stenting during 1st or 2nd pass, C) angioplasty/stenting during 3rd or 4th pass, and D) angioplasty/stenting after 4th pass. The primary outcome was the shift in disability at 90-days, measured by mRS. Secondary outcomes included functional independence (90-day mRS0-2), symptomatic intracranial hemorrhage (sICH), and 90-day mortality. All outcomes were adjusted for relevant confounders. Results: Of 9,238 patients, 1,673 met inclusion criteria; multiple passes without angioplasty/stenting (n=1,477), angioplasty/stenting during 1st or 2nd pass (n=112), angioplasty/stenting during 3rd or 4th pass (n=50), and angioplasty/stenting after 4th pass (n=34). Baseline characteristics are shown in the Table . In ordinal shift analysis, early angioplasty/stenting was associated with significantly better functional outcomes compared to no rescue (mRS shift; acOR1.79, 95%CI1.23-2.62, p=0.002, and 90-day mRS0-2; aOR2.06, 95%CI1.31-3.25, p=0.002). There was no difference between angioplasty/stenting during the 3rd or 4th pass (mRS shift; acOR1.14, 95%CI0.67-1.94, p=0.62 and 90-day mRS0-2; aOR1.23, 95%CI0.61-2.46, p=0.57) and multiple passes without angioplasty/stenting. Patients with late rescue after 4th pass have numerically lower rates of functional independence compared to no rescue (mRS shift; acOR1.01, 95%CI0.51-2.00, p=0.98 and 90-day mRS0-2; aOR0.65, 95%CI0.21-2.02, p=0.46) Figure 1 . No differences in mortality or sICH were observed across groups Figure 2. Conclusions: The current analysis suggests that early rescue angioplasty/stenting is associated with improved functional outcomes compared to no rescue or late intervention in LVOS patients undergoing MT. Large prospective studies are warranted.

OBJECTIVE:Randomized trials from high-income countries have shown that endovascular treatment (EVT) yields similar benefits in elderly and non-elderly patients with large vessel occlusion stroke (LVOS). However, evidence from low/middle-income countries remains scarce. We aimed to assess the impact of age on outcomes and determine whether age modifies the effect of EVT under the resource-limited conditions of a public healthcare system in a developing country. METHODS:Pre-specified subgroup analysis of the RESILIENT trial, a multicenter, randomized, controlled trial in Brazil comparing EVT versus medical treatment alone in anterior circulation LVOS. Patients were categorized as non-elderly (<70 years), elderly (≥70 years), and very elderly (≥80 years). The primary endpoint was functional independence (modified Rankin scale 0-2) at 90 days. Logistic regression was performed to identify independent predictors of outcome and to assess age as an effect modifier. RESULTS:Among 221 randomized patients (47.1% females; median [IQR] National Institutes of Health Stroke Scale, 18 [14-21]), 89 (40.2%) were elderly and 37 (16.7%) very elderly. Increasing age was independently associated with lower odds of functional independence in the entire study population (odds ratio [OR]: 0.97; 95% confidence interval [CI]: 0.95-0.99, p = 0.01). Age significantly modified the treatment effect of EVT. Non-elderly patients derived substantial benefit from EVT (OR: 4.08; 95% CI: 1.71-9.76), whereas the benefit was attenuated in elderly (OR: 0.90; 95% CI: 0.17-5.42; pinteraction = 0.03) and very elderly (OR: 0.36; 95% CI: 0.11-3.21; pinteraction = 0.03). INTERPRETATION:The effect of EVT appears significantly diminished among elderly patients in a public healthcare system in a developing country. Further studies are needed to understand the mechanism underlying these findings and properly assess the efficacy of EVT in this vulnerable population. ANN NEUROL 2026;100:644-652.

BACKGROUND:The middle meningeal artery (MMA) has emerged as an endovascular route for treating chronic subdural hematoma (CSDH), meningioma, and refractory headaches. The third ARISE roundtable convened experts from neurology, neurosurgery, neuroradiology, industry, and regulatory agencies to develop consensus guidance on current evidence for MMA-based therapies METHODS: Over 50 experts participated in a multi-stakeholder discussion. Evidence from randomized and observational studies, early-phase interventional series, and preclinical work was reviewed. Breakout groups focused on four domains: (1) MMA embolization (MMAE) for CSDH, (2) preoperative embolization of meningiomas, (3) MMA-targeted therapies for headache, and (4) transvascular access for endovascular drainage of subdural hematomas. Consensus recommendations were developed by a writing committee RESULTS: Randomized trials support MMAE as an adjunct to surgery or medical management for selected patients with non-acute, symptomatic CSDH to reduce recurrence, progression, and reoperation. Evidence remains insufficient to support MMAE for acute or asymptomatic subdural hematomas. For meningioma, observational data suggest that preoperative embolization in experienced centers can reduce blood loss and operative time and may delay recurrence in large, hypervascular tumors with predominant dural or external carotid supply; primary embolization and intra-arterial oncologic therapies remain investigational. Early series of MMA-directed lidocaine infusion for refractory migraine, status migrainosus, and post-subarachnoid hemorrhage headache show short-term benefit, highlighting the need for controlled trials. Preclinical and first-in-human studies of combined MMAE and transvascular drainage for CSDH demonstrate high technical success, rapid radiographic and clinical improvement, and no early recurrences CONCLUSION: The MMA represents a vascular pathway for an expanding spectrum of neurointerventional therapies.

Practice expense (PE) is one of three components that contribute to total relative value units (RVUs). Across the Medicare Physician Fee Schedule, PE accounts for nearly half of total RVUs. In radiology, however, this number is even higher, largely because of the nature and particularities of the specialty. This makes radiology especially sensitive to changes and updates in the inputs, methodology, and pricing used to calculate PE. In this review, the authors explore the Resource-Based Relative Value Scale RVU system with an emphasis on PE, its direct and indirect components, and its impact on radiology reimbursement. The authors explore how calculation methodologies as well as budget-neutrality adjustment mechanisms have the potential to significantly affect radiology reimbursement and provide practical considerations.

BACKGROUND:Rapid and complete recanalization is a primary goal in the endovascular treatment of large vessel occlusion stroke. The effectiveness and safety of super large bore aspiration catheters (0.088″ inner diameter) for the treatment of large vessel occlusion stroke have not been demonstrated in a randomized trial. METHODS:SUMMIT MAX (A Prospective, Randomized, Controlled, Interventional Clinical Trial to Evaluate the Safety and Effectiveness of the Route 92 Medical MonoPoint Reperfusion System for Aspiration Embolectomy in Acute Ischemic Stroke Patients) was a prospective, randomized, controlled, open-label clinical trial of patients with internal carotid artery and middle cerebral artery M1 occlusions, comparing the super large bore HiPoint Reperfusion system (Route 92 Medical) to the Vecta Aspiration system (Stryker Neurovascular). We hypothesized that the effectiveness and safety of the HiPoint reperfusion system were noninferior (12.5% noninferiority margin) to the Vecta Aspiration system. The primary effectiveness end point was successful reperfusion, defined as modified Treatment in Cerebral Infarction≥2b as adjudicated by an independent core lab, using only the assigned study device, with any use of a nonstudy device before or after the use of study device defined as failure. The primary safety end point was symptomatic intracranial hemorrhage within 24 hours (-8/+24) post-procedure. RESULTS:There were 250 patients enrolled of whom 166 met the criteria for the modified intent-to-treat population: 89 in HiPoint and 77 in Vecta. The median age was 69 years; 54.2% were female. Successful reperfusion with any adjunctive therapy counted as a failure was 77.5% (69/89) in the HiPoint group versus 50.6% (39/77) in the Vecta group (P<0.0001 for noninferiority). Symptomatic intracranial hemorrhage within 24 hours (-8/+24 hours) post-procedure was similar between groups (3.6% versus 2.7%, respectively). At 90 days, good clinical outcome (mRS score of ≤2) was achieved in 50.6% in the HiPoint group and 53.3% in the Vecta group (absolute difference, -2.8% [95% CI, -18.2% to 12.7%]; P=0.75). CONCLUSIONS:In this randomized trial of patients with anterior large vessel occlusion, the super large bore HiPoint system was noninferior to the Vecta system in achieving successful reperfusion, with a similar safety profile. This study supports the super large bore HiPoint system for mechanical thrombectomy. REGISTRATION:URL: https://www.clinicaltrials.gov; Unique identifier: NCT05018650.

Background: Racial, gender, and socioeconomic disparities in stroke outcomes are well documented, but their impact on procedural success and clinical outcomes after endovascular treatment (EVT) for acute ischemic stroke remains unclear. Methods: We retrospectively analyzed 584 acute ischemic stroke patients who underwent EVT (2016-2023), evaluating procedural reperfusion (TICI 2B-3), stroke severity (NIHSS/mRS) at admission and discharge, functional outcomes at discharge and 90 days (mRS), discharge disposition, and thrombolysis (tPA) administration. Multivariable logistic regression assessed independent predictors of outcomes. Results: Successful reperfusion was achieved in 90.8%, with no significant differences by race, gender, or insurance status. Black patients and Medicare-insured individuals presented with significantly greater stroke severity (NIHSS ?9, p<0.05). Poor functional outcomes (mRS 3-6) at discharge and 90 days were significantly higher among Black patients, females, and Medicare-insured patients (p<0.05). Medicare and Medicaid patients were more frequently discharged to non-home settings. Insurance status was significantly associated with lower likelihood of tPA administration (p=0.006). Logistic regression showed that initial stroke severity strongly predicted outcomes, while procedural success was uniform across demographic groups. Conclusions: Procedural success of EVT was equitable; however, disparities persisted in stroke severity at admission and long-term outcomes. These findings highlight the need for systemic interventions addressing pre-hospital care, prevention, and equitable post-stroke rehabilitation access. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial This study was a retrospective analysis and was not registered as a clinical trial. IRB approval was obtained for this research. ### Funding Statement This research received no external funding. The authors and their institutions did not receive any payment or services from a third party related to the submitted work. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was approved by the Institutional Review Board at Baptist Health South Florida (Miami Neuroscience Institute) with a waiver of informed consent due to its retrospective design. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The data that support the findings of this study are available from the corresponding author upon reasonable request, in accordance with institutional policies and patient privacy regulations.

Background Achieving excellent recanalization (Modified Thrombolysis in Cerebral Infarction 2c/3) in fewer attempts improves clinical outcomes. Previous studies suggest that switching techniques after a failed first pass may enhance reperfusion rates. This study evaluates whether technique switching improves subsequent reperfusion in a large multicenter registry.Methods We analyzed retrospective and prospective SVIN (Society of Vascular and Interventional Neurology) registry data from 12 US centers (October 2014-December 2021) involving endovascular therapy for M1 or internal carotid artery-terminus (ICA-T) occlusions. Patients with at least 2 recanalization attempts using stent retriever (SR), contact aspiration (CA), or combined technique (CT) were included. Primary outcome was the likelihood of achieving TICI 2c/3 reperfusion with or without technique switching on the second pass. Secondary outcomes included the likelihood of final TICI 2c/3 stratified by the technique and occlusion location.Results Among 2893 endovascular therapy treatments, 1089 patients (37.6%) had successful reperfusion after the first pass. First-pass TICI 2c/3 rates for ICA-T occlusions were 36.0% with SR, 23.6% with CA, and 35.8% with CT; for M1 occlusions, the rates were 38.8% with SR, 39.3% with CA, and 38.6% with CT. A total of 1420 treatments included at least 2 passes. ICA-T occlusions occurred in 20.4% and M1 occlusions in 79.6%. In multivariable analysis, in M1 occlusions, switching from CT to alternative technique after a failed first pass significantly increased the odds of achieving TICI 2c/3 after the second pass (adjusted odds ratio, 2.08 [95% CI, 1.18-3.67]). Patients who had 2 failed attempts using CA had significantly higher odds of achieving final TICI 2c/3 compared with those with 2 failed passes using the SR technique (adjusted odds ratio 1.65, [95% CI, 1.09-2.51]).Conclusion In M1-middle cerebral artery occlusion, switching from CT to SR or CA was associated with an improvement in TICI2c/3 rates on the second pass. In addition, after 2 failed passes with CA, additional passes increased the odds of achieving complete reperfusion compared with SR.

Stent development has focused recently on low-profile, self-expandable stents compatible with 0.0165-inch microcatheters. The LVIS EVO is the second generation version of the Low-Profile Visualized Intraluminal Support (LVIS) with improved visibility as a result of drawn filled tube (DFT) wires consisting of an inner platinum wire and an outer nitinol wire. The LVIS EVO underwent a limited premarket release (PMR) in December 2023. This is a multicenter retrospective observational study evaluating patients who underwent treatment of an intracranial aneurysm with an LVIS EVO stent after the limited PMR. All physicians who had placed an LVIS EVO stent were asked to input their cases after IRB approval was obtained. The data was then sent to a single center for analysis. 53 patients with 55 aneurysms underwent treatment with the LVIS EVO stent at 15 institutions. 100% of cases had successful deployment. Coils were placed in 48 cases (87.2%) and a microcatheter was jailed in 98% of those cases. The EVO was used as a standalone flow diverter in 5 cases and as an adjunct to a WEB device in 1 case. There were no delayed thromboembolic or hemorrhagic complications. The LVIS EVO is a braided, self-expanding, retrievable stent with enhanced visibility and smaller cell size. The DFT technology results in improved visibility of the stent allowing for more controlled stent positioning and visualization of vessel wall apposition. All cases in our series had complete neck coverage and good wall apposition. There were no thromboembolic or hemorrhagic complications.

Intracranial atherosclerotic disease (ICAD) is one of the leading causes of ischemic stroke worldwide. Despite advances in its diagnosis and management, there is no clear consensus on best practices to manage ICAD. This report summarizes the ARISE II (Roundtable Discussion With Industry and Stroke Experts) consensus in treating ICAD. The consensus underscored the importance of lifestyle modification and medical management in patients with ICAD. Patients who fail medical management are candidates for endovascular treatment. Open surgery is not recommended in patients who lack demonstrated hemodynamic insufficiency. The consensus also identified gaps in knowledge about the optimal duration of antithrombotics, the effect of the CYP2C19 genotype on medical management, the need for newer devices, and the standardization of antithrombotic protocols before stenting in an acute setting. Optical coherence tomography requires additional clinical data before defining its role in the diagnosis of ICAD.