Abstract Background and aims Distinguishing posterior circulation stroke (PCS) from other causes of acute vertigo can be challenging. Blood biomarkers such as neurofilament light chain (NfL) and glial acidic fibrillary protein (GFAP) have been associated with (even small) stroke lesions and could therefore support selection for imaging and inpatient evaluation in acute vertigo patients. Methods This prospective, observational study included consecutive patients with acute vertigo from a neurological emergency department. All patients received neurological examination, laboratory testing and brain imaging. Plasma NfL (pNfL) and GFAP (pGFAP) were measured using Single Molecule Array (SIMOA) technique. pNfL and pGFAP Z-scores were compared between PCS patients and patients with non-central vertigo causes. Results 102 patients were included (mean age 57.9 years, 57.8% female). pNfL Z-scores were higher in PCS compared to non-central vertigo patients (median 2.1, IQR 1.5 versus median 0.7, IQR 1.9; p=0.004). A pNfL Z-score≥1.0 was associated with PCS (OR 8.8, 95%-CI 2.4-32.7), yielding a sensitivity of 84.2%, specificity of 62.4% and negative predictive value of 94.6%. pGFAP Z-scores were higher in PCS than in non-central vertigo patients (median 1.3, IQR 2.8 versus median 0.6, IQR 1.5; p=0.016). A pGFAP Z-score≥1.0 was associated with PCS (OR 3.5, 95%-CI 1.3-9.8), yielding a sensitivity of 57.9%, specificity of 71.8% and negative predictive value of 88.4%. Associations remained robust after correcting for symptom duration. Conclusions pNfL and pGFAP levels were higher in PCS compared to patients with non-central causes of vertigo. With its high negative predictive value, pNfL appears especially clinically useful to rule out PCS in acute vertigo. Conflict of interest Nothing to disclose regarding this abstract.

Abstract Background and aims Acute haemorrhagic manifestations of cerebral amyloid angiopathy (CAA) include intracerebral haemorrhage (ICH) and convexity subarachnoid haemorrhage (cSAH), both of which are associated with high risk of recurrent intracranial haemorrhage. However, it is uncertain whether the neuroimaging profile and recurrence risk between patients presenting with CAA-related ICH or cSAH differs. Methods We included patients who presented with first-ever symptomatic ICH or cSAH over a 14-year period with available MRI meeting the modified Boston criteria (v2.0) for probable CAA. We investigated differences in cerebrovascular risk factors, neuroimaging findings including cerebral microbleeds (CMBs), cortical superficial siderosis (CSS), white matter hyperintensities (WMH) and their patterns and risk of recurrent ICH. Results We identified 125 patients (mean age 73.9 years) with CAA-related intracranial haemorrhage (105 with ICH, 20 with cSAH). Patients with cSAH tended to be older (median age 77.0 vs. 73.3 years, p=0.06), with no differences in clinical risk factors. We found no statistically significant differences in the prevalence of CMBs in patients with ICH vs. cSAH (71.4% vs. 70.0%, p=0.84) or the presence of CSS (55.2% vs. 70.0%, p=0.22). WMH and their patterns and enlarged perivascular spaces in the centrum semiovale also had similar prevalences. Over a median follow-up period of 3.4 years, 50 patients (40.0%) had a recurrent ICH; this risk was similar for patients presenting with ICH and cSAH (40.0% vs. 40.0%, p=1.00). Conclusions We found no major differences in clinical factors, neuroimaging and ICH recurrence risk in patients with CAA presenting with ICH or cSAH. Conflict of interest Linda Fabisch: nothing to disclose, Eva Pommer: nothing to disclose, Markus Kneihsl: nothing to disclose, Gerit Wünsch: nothing to disclose, Christian Enzinger: nothing to disclose, Thomas Gattringer: nothing to disclose, David Werring: nothing to disclose, Simon Fandler-Höfler: nothing to disclose

INTRODUCTION:Glomerular hyperfiltration has previously been associated with cardiovascular events and mortality but has scarcely been investigated in patients with stroke. PATIENTS AND METHODS:We used pooled data from an individual patient data meta-analysis of prospective, cohort studies of stroke or TIA populations. For this analysis, we included participants from study sites that collected estimated glomerular filtration rate (eGFR) at stroke presentation. Using Cox proportional hazards regression, we investigated the risk of death, any stroke and vascular death according to glomerular hyperfiltration, defined as having an eGFR greater than the age- and sex-adjusted 95th percentile. We also investigated these outcomes according to eGFR as a continuous variable, modelled using fractional polynomials. RESULTS:A total of 11,175 patients (mean age 70.7 years, 42% female) were included in the analysis, 554 (4.9%) with hyperfiltration. Compared to the normofiltration group (absence of hyperfiltration and eGFR ≥ 60 mL/min/1.73 m2), the hyperfiltration group had a higher rate of all-cause death, 147 per 1000 person-years (95% CI, 119-180) vs 61 (95% CI, 57-66). Compared to normofiltration, hyperfiltration was independently associated with the risk of death from any cause (adjusted hazard ratio [HR] 1.76; 95% CI, 1.46-2.11; P < .001) and the risk of vascular death (adjusted HR 1.68; 95% CI, 1.29-2.17; P < .001). There were non-linear associations of eGFR with risk of death and vascular death, with increasing risk at both low and high eGFR (Pnon-linearity < .001 for both). DISCUSSION AND CONCLUSION:Glomerular hyperfiltration was associated with a 76% increased risk of death and a 68% increased risk of vascular death in multivariable models adjusted for age, sex and comorbidities. Glomerular hyperfiltration may be associated with adverse health outcomes, specifically in patients with ischaemic stroke. Further research is needed to confirm these findings.

BACKGROUND:The HERMES-24 score has recently been proposed to estimate the 90-day outcome in patients with anterior circulation large vessel occlusion (LVO) stroke. AIM:We aimed to further validate the HERMES-24 score in a real-world setting of LVO patients who had received endovascular stroke treatment (EVT). METHODS:We used data of consecutive LVO patients treated with EVT in six Austrian stroke centers. The performance of the HERMES-24 score for outcome prediction at 90 days (modified Rankin Scale (mRS)) was investigated in predefined subgroups of anterior and vertebrobasilar LVO and within or beyond 6 h/unknown time windows. RESULTS:We analyzed 1571 patients with available 90-day follow-up. The HERMES-24 score was predictive of 90-day mRS ⩽ 2 for the total cohort, those with anterior LVO <6 h, anterior LVO ⩾6 h/unknown, vertebrobasilar LVO < 6 h, and vertebrobasilar LVO ⩾ 6 h/unknown with c-statistics (95% confidence interval (CI)) 0.90 (0.88-0.92), 0.90 (0.88-0.92), 0.89 (0.86-0.92), 0.88 (0.79-0.98) and 0.98 (0.96-1.0), respectively. The HERMES-24 score also yielded excellent outcome prediction for 90-day mRS ⩽ 3, an ordinal mRS, and mortality in all subgroups (c-statistics: 0.83-0.99). CONCLUSION:The HERMES-24 score is highly predictive for 90-day outcome in real-world patients with LVO stroke treated with EVT regardless of LVO localization or symptom onset to treatment time.

Post-stroke epilepsy (PSE) is a clinically relevant complication after ischemic stroke. While lesion location and established clinical risk factors contribute to PSE risk, the role of lesion-induced disruption of neurotransmitter-specific brain networks remains unclear. We retrospectively analyzed 251 patients with acute large-vessel occlusion ischemic stroke treated with mechanical thrombectomy. Binary lesion masks were embedded into normative neurotransmitter-informed structural connectomes derived from PET-based receptor and transporter density maps, yielding damage scores for 19 neurotransmitter systems and a global measure of structural disconnection. Partial least squares (PLS) regression was used for feature selection, followed by multivariable logistic regression adjusted for age, sex, and SeLECT. As a secondary internal resampling analysis, elastic-net logistic regression with repeated stratified cross-validation was used to assess whether the identified pattern remained informative under regularization. Twenty-six patients (10.4%) developed PSE. PLS identified a neurochemical signature dominated by serotonergic and µ-opioid–informed systems. In adjusted models, damage to 5-HT1a, 5-HT2a, and µ-opioid networks showed the strongest and most robust associations with PSE, independent of clinical predictors and global structural disconnection. Cholinergic network measures showed weaker and less consistent effects. In repeated internal cross-validation, the same networks were selected more consistently and were associated with higher discrimination than the clinical base model. Lesion-induced disruption of specific neurotransmitter-informed structural networks, most robustly serotonergic and µ-opioid systems, is associated with PSE and showed incremental signal in internal cross-validation beyond established clinical risk factors. These findings provide a mechanistically interpretable extension to existing PSE risk models.

Neurovascular ultrasound is an easily applicable bed-side tool for guiding the diagnosis and monitoring of cerebrovascular disease. Although sonography training is increasingly integrated in medical school curricula, neurovascular ultrasound has been largely neglected in these efforts. We therefore aimed to assess the feasibility and efficacy of a neurovascular ultrasound training course for medical students. Five small-group neurovascular ultrasound course offerings were conducted between 2016 and 2019 at the Medical University of Graz, Austria. This study represents a retrospective analysis of prospectively collected educational course evaluation data. Each course offering followed the same course structure and assessment schedule and was offered to 2nd - to 5th -year medical students. Demographics and previous ultrasound experience were documented. To test pre-course knowledge, all participants completed a theoretical test, followed by the 20-hour hands-on training course comprising a standardized step-by-step examination of the extra- and intracranial brain-supplying arteries. Afterwards, all students underwent a practical exam in single-station Objective Structured Clinical Examination format, conducted by neurovascular ultrasound experts, blinded to the study’s scope and data, using a predefined standard protocol. A total of 51 students (median age: 23 years, IQR: 1; range: 21–28; 24 females, 47

Ischemic stroke in young adults is a significant social and economic burden. Machine learning (ML) techniques can potentially predict the outcomes of recurrence and functional status after a stroke more accurately than traditional statistical methods. We sought to predict these outcomes in young individuals with stroke with machine learning and compare that with traditional statistical methods. This study is part of Global Outcome Assessment Lifelong After Stroke in Young Adults (GOAL) initiative, which collects individual patient data from hospital-based young stroke (18–50 years) cohorts from 29 countries covering all continents worldwide. We compared several common machine learning models with traditional logistic regression to investigate the best models for predicting functional outcome, as measured by the modified Rankin scale at three months post-stroke, and stroke recurrence during follow-up. Functional outcome was available for 7937 patients, and stroke recurrence for 9366 patients. Poor functional outcomes post-stroke occurred in 27.0

BACKGROUND/AIM:Endovascular stroke therapy (EVT) improves functional outcome and reduces mortality in patients with large vessel occlusion. However, data on risk factors for early mortality after EVT are scarce. We investigated the predictive value of clinical information already available on the day of hospital admission on early mortality following EVT. METHODS:We analyzed data from the nationwide Austrian Stroke Unit Registry (ASUR) covering consecutive stroke patients that had received EVT between 2013 and 2023. We used multivariable regularized regression analysis to identify factors associated with early mortality (defined as deceased within 7 days post-stroke). We further tested the accuracy of a modified version of the 'Predicting Early Mortality of Ischemic Stroke' (mPREMISE) score extending the original model by post-EVT recanalization status. RESULTS:The data showed that 5900 patients (median age: 75 years, 52.4% female) had received EVT, of whom 340 (5.7%) died within 7 days after admission. Stroke severity at admission, followed by higher age, incomplete recanalization (Thrombolysis in Cerebral Infarction scores (TICI) ≤2 a), vertebrobasilar occlusion site, diabetes, chronic heart disease, and pre-stroke disability (modified Rankin Scale >1) were independently associated with early mortality. The area under the receiver operating curve (AUC-ROC) for the mPREMISE score was 0.74 (95% confidence interval (CI), 0.71 to 0.77). Patients with a score ≥9 had a 25.8% (95% CI, 25.4 to 26.2%) risk of early mortality. CONCLUSION:In this nationwide analysis, we identified risk factors for early mortality after EVT that can be assessed on the admission day. The mPREMISE score seems to be a reasonable tool for estimating early mortality in stroke patients undergoing EVT.

Introduction: Posterior circulation strokes (PCS) account for one-quarter of ischemic strokes and differ from anterior circulation events in presentation, vascular anatomy, and treatment implications. Prognostic tools for PCS are scarce, and existing scores apply mainly to basilar artery occlusion, despite their potential to guide acute treatment and trial design. We aimed to develop and externally validate the Posterior Circulation Clot Burden Score (pc-CBS), a CTA/MRA-based tool to predict 3-month functional outcome across the entire posterior circulation. Methods: This investigator-initiated, retrospective cohort study included 488 consecutive PCS patients with CTA/MRA-confirmed occlusion from the ASTRAL registry (Lausanne, Switzerland) in the derivation/internal validation cohort. External validation used individual-level data from 1,340 patients across 21 stroke centers in 3 continents. Eight arterial segments (extracranial/intracranial vertebral, proximal/mid/distal basilar, P1/P2 posterior cerebral, posterior communicating arteries) were graded as patent or occluded/hairline (<1mm) and interrater reliability was tested both in CTA and MRA. The segments were then weighted via ordinal logistic regression for 3-month modified Rankin Scale (mRS). Predictive accuracy was assessed with Harrell’s C-statistics; independent contribution via likelihood ratio test (LRT). The study was registered on ClinicalTrials.gov as NCT07122934. Results: Interrater agreement was almost perfect for both CTA (n=60, κ=0.89) and MRA (n=60, κ=0.89). The 10-point pc-CBS assigns full points for complete vertebrobasilar patency and deducts for each affected segment. C-statistic were 0.70 (95%CI 0.60–0.80) for internal and 0.72 (95%CI 0.69–0.74) validation. Each 1-point decrease increased odds of unfavorable outcome (mRS 3–6) by 14% (internal) and 8% (external). Adding nine clinical outcome predictors (age, sex, prestroke mRS, NIHSS, ASPECTS, glucose, decreased consciousness, IVT, EVT) improved C-statistic to 0.84 (internal) and 0.85 (external), with pc-CBS retaining independent predictive value (LRT=6.4 and 6.3; p=0.01). Conclusions: pc-CBS is a reproducible CTA/MRA-based score for any occlusive vertebrobasilar stroke, providing independent prognostic value for functional 3-month outcome. Its simplicity, high reliability, and external validation support its use in clinical decision-making and trial stratification for PCS.

Distinguishing posterior circulation stroke (PCS) from peripheral or other causes of acute vertigo can be challenging. Blood biomarkers, such as plasma neurofilament light chain (pNfL) and glial acidic fibrillary protein (pGFAP), have been associated with (even small) stroke lesions and could support patient selection for neuroimaging and inpatient evaluation in acute vertigo. This prospective study included consecutive patients presenting with acute vertigo to a neurological emergency department. All patients received neurological examination, laboratory testing and neuroimaging. pNfL and pGFAP were measured using Single Molecule Array (SIMOA) technique. pNfL and pGFAP levels were compared between PCS and patients with non-central vertigo. 102 patients were included (mean age 57.9 years, 57.8

Background: Delirium affects 10–30% of acute stroke patients, is associated with poor outcomes and places a substantial burden on healthcare staff. Evidence-based prevention and treatment strategies are limited, resulting in heterogeneous and poorly standardised delirium management in acute stroke care. Objectives: We aimed to describe real-world delirium management in German and Austrian stroke units (SUs) and to delineate the extent of practice variation in prevention and treatment. Design: We conducted a cross-sectional, web-based survey of stroke neurologists working at SUs in Austria and Germany. Methods: The 30-item questionnaire assessed professional background, delirium prevention and pharmacological treatment approaches. Descriptive statistics and exploratory subgroup analyses were performed. Results: Seventy responses from 63 SUs were analysed (median physician SU experience, 14.5 years). Delirium was estimated to affect 20% of patients and was perceived as highly burdensome for both physicians and nurses (median score, 9/10 each). Delirium prevention measures were established in 42 (67%) SUs but routinely applied to all patients in only 12 (19%), mainly due to staffing shortages (nurses, 48%; physicians, 25%). Pharmacological delirium treatment was reported by all respondents. Benzodiazepines were preferred for alcohol withdrawal delirium (60%) and antipsychotics for hyperactive or mixed delirium (59%). α2-Agonists were the most common escalation therapy across these subtypes (46%–67%). Conclusion: Delirium management in German and Austrian SUs is highly heterogeneous, limited by staffing constraints and strongly relies on non-evidence-based pharmacological strategies. These findings highlight critical gaps in care and call for enhanced staffing and stroke-specific trials to inform evidence-based delirium management.

BACKGROUND:Chronic kidney disease (CKD) is a frequent comorbidity of patients with intracerebral haemorrhage (ICH) and is associated with more severe cerebral small vessel disease. Whether CKD is associated with recurrent stroke after ICH is unknown. PATIENTS AND METHODS:We conducted a retrospective cohort study of 2 comprehensive stroke centres, collecting data from consecutive patients with ICH. Patients with secondary causes of ICH were excluded. We defined CKD according to Kidney Disease: Improving Global Outcomes definitions, namely 2 measurements of estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 ≥ 3 months apart. The primary outcome was time to any stroke (recurrent ICH or ischaemic stroke), investigated using Cox regression adjusted for age, sex and comorbidities. Outcomes were confirmed by neuroimaging review. RESULTS:A total of 1062 patients (mean age 68 ± 14 years, 45% female) with ICH were included, 239 with CKD. Over a median (IQR) follow-up of 2.3 (0.7-5.0) years, there was a higher rate of any stroke in the CKD group, 8.4 (95% CI, 6.2-11.1) events per 100 person-years vs 4.4 (3.6-5.3) events in the group with normal eGFR (adjusted hazard ratio [aHR] 1.75: 95% CI, 1.23-2.50, P = .002). CKD was also independently associated with both recurrent ICH (aHR 1.81: 95% CI, 1.15-2.85) and ischaemic stroke (aHR 1.78: 95% CI, 1.06-3.01). CONCLUSION:Patients with ICH and CKD are at increased risk of recurrent ICH and ischaemic stroke compared to those with normal eGFR. Further research is needed into this high-risk patient group to identify new prevention treatments.

BACKGROUND:We aimed to conduct an individual patient data meta-analysis on blood neurofilament light chain (NfL) in ischemic stroke (IS) to enhance its clinical applicability. METHODS:We performed a systematic literature search of studies on blood NfL measured in adult patients within 30 days after IS onset and derived age- and BMI-adjusted Z-scores based on a previously published reference population of healthy controls. We collected clinical, radiological and biochemical parameters of IS patients and tested associations of NfL at defined timepoints after IS onset (D1: < 24 h; D2: 24-48 h; D3: 48-72 h; D4-5: 72-120 h; D6-7: 120-168 h; D8-30: > 168 h) with baseline characteristics and 3-month follow-up outcomes (modified Rankin Scale, mRS; survival). RESULTS:We included 4081 blood NfL values from 2872 participants (IS n = 1985, transient ischemic attack n = 88, healthy controls n = 799) of 18 published studies and 3 unpublished cohorts. In patients with IS, NfL Z-score progressively increased from D1 [median: 2.0 (IQR: 0.9-2.9)] to D6-7 [median: 3.5 (IQR: 3.0-3.8)], with discriminative ability being high for IS vs. controls (AUC: 0.79-0.97) and fair for IS vs. TIA (AUC: 0.64-0.80). Higher NfL Z-score at D1 was associated with greater risk of symptomatic intracranial hemorrhage (aOR = 1.33, p = 0.014) and, from D2 onwards, with larger infarct lesion volume (highest Spearman's rho: 0.795 at D6-7). NfL independently predicted a mRS > 2 (aOR = 1.31, p < 0.001) and mortality (aOR = 1.67, p < 0.001) at 3 months. CONCLUSIONS:Blood NfL level was progressively elevated after IS, could discriminate IS from healthy controls with high accuracy and had prognostic value for intra-hospital complications and 3-month clinical outcomes in IS.

INTRODUCTION:Causes of intracerebral haemorrhage (ICH), in particular cerebral small vessel disease (SVD), are a frequent subject of current research, yet the potential role of sex differences remains uncertain. Therefore, we aimed to investigate whether there are sex-related differences in aetiology, MRI features of SVD and risks of recurrent cerebrovascular events in patients with ICH. PATIENTS AND METHODS:We included patients from 2 large observational ICH study cohorts (London/UK, Graz/Austria) with available MRI. ICH aetiology was defined based on brain MRI, vascular imaging as well as clinical findings. Multivariable regression models were fitted to assess sex differences in aetiology, SVD MRI features and recurrent stroke events. RESULTS:We identified 1043 patients (mean age 66 years, 58% male) with acute ICH. Males had a higher prevalence of cryptogenic ICH than females (aOR 1.53; 95% CI, 1.01-2.33). Males also had a higher rate of presence of any lacune (aOR 1.47; 95% CI, 1.11-1.94), severely enlarged perivascular spaces in the basal ganglia (aOR 1.45; 95% CI, 1.04-2.02) and presence of small asymptomatic diffusion-weighted imaging lesions (aOR 1.51; 95% CI, 1.06-2.15). There were no sex differences regarding recurrent ICH, incident ischaemic stroke or mortality. DISCUSSION AND CONCLUSION:The higher rate of presence of any lacune and enlarged perivascular spaces in men with ICH implies a higher severity of arteriolosclerosis. The mechanisms underlying the higher occurrence of cryptogenic ICH in men might include transient risk factors or incipient SVD.

Background: Atrial fibrillation detected after stroke (AFDAS) is frequently diagnosed after embolic stroke of undetermined source (ESUS) and has important implications for secondary stroke prevention. Although prediction scores have been proposed to identify patients at increased risk of AFDAS, prospective evidence supporting their implementation to guide rhythm monitoring in routine clinical practice is limited. Methods: In this prospective, population-based implementation cohort study, adults with ESUS were enrolled between January 2022 and December 2024 across all stroke centers in Styria, Austria. The Graz AF Risk Score was prospectively implemented as part of a risk-adapted diagnostic pathway for cardiac rhythm monitoring. Patients with a score ≥4 were recommended for implantable loop recorder monitoring, whereas monitoring in those with scores <4 remained at the treating physician's discretion. The primary outcome was AFDAS detection; recurrent ischemic stroke and recurrent stroke etiology were secondary outcomes. Results: Among 784 patients (median age 73 years [IQR 64-80], 45.7% women), AFDAS was detected in 166 patients (21.2%) during a median follow-up of 26.3 months (IQR 20-34). AFDAS detection was substantially higher in patients with a Graz AF Risk Score ≥4 than <4 (38.1% vs. 3.9%; p<0.001). After adjustment for age, sex and ILR monitoring, a score ≥4 independently predicted AFDAS (HR 6.3, 95% CI 3.5-11.2; p<0.001) and recurrent ischemic stroke (HR 2.2, 95% CI 1.1-4.1; p=0.023). Only one recurrent stroke in patients with a score <4 was attributable to atrial fibrillation (AF) (1/18, 5.6%). Conclusions: Prospective implementation of the Graz AF Risk Score identified patients with ESUS at markedly different risks of AFDAS. A Graz AF Risk Score ≥4 was also independently associated with recurrent ischemic stroke. These findings support a risk-adapted approach to cardiac rhythm monitoring after ESUS. ### Competing Interest Statement The authors have declared no competing interest. ### 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: The study was conducted in accordance with the principles of the Declaration of Helsinki. Ethical approval was obtained from the Ethics Committee of the Medical University of Graz (REC number 29?285 ex 16/17). 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 Data from this study are available from the corresponding author upon reasonable request.

INTRODUCTION:Whether thrombectomy with or without emergent carotid stenting improves outcomes in patients with large vessel occlusion (LVO) stroke due to carotid artery dissection (CAD) is unknown. PATIENTS AND METHODS:International multicentre observational study. Patients with LVO due to CAD undergoing thrombectomy with emergent stenting were compared to those without emergent stenting. The primary outcome was functional independence (modified Rankin Scale 0-2) at 3 months, secondary outcomes included early neurological improvement (ENI) within 24-48 h, successful recanalisation, symptomatic intracerebral haemorrhage (sICH) and mortality at 3 months. Inverse probability of treatment weighting and multivariable Poisson regression were used to adjust for group imbalances and to estimate the effect size, respectively. RESULTS:Of 516 patients (mean age 53.8 years, 76% male) undergoing thrombectomy, 167 (32.4%) and 349 (67.6%) were treated with or without emergent carotid stenting, respectively. After robust adjustment, emergent stenting was not associated with functional independence (adjusted risk ratio [aRR] = 1.01; 95% confidence interval [CI], 0.89-1.15) or ENI (aRR = 1.07; 95% CI, 0.95-1.21) but with successful recanalisation (aRR = 1.29; 95% CI, 1.10-1.50) and reduced mortality at 3 months (aRR = 0.39; 95% CI, 0.15-0.99). Risk of sICH was equivalent (aRR = 1.01; 95% CI, 0.95-1.06). CONCLUSION:In patients with LVO secondary to CAD, emergent stenting during endovascular procedure appeared safe, increased odds of successful recanalisation and reduced 3-month mortality rates. However, intraprocedural stenting was not associated with better functional outcome.

Die zerebrale Sinusvenenthrombose (CSVT) ist eine seltene zerebrovaskuläre Erkrankung, die bevorzugt junge Frauen betrifft und sich klinisch äußerst variabel präsentiert. Leitsymptom sind progressive Kopfschmerzen, die in über 90

Delirium, defined as an acute, fluctuating disturbance in consciousness, attention and cognition, is a common stroke complication and associated with poor functional outcome. Although resource-intensive prevention strategies could reduce delirium rates, their implementation in unselected stroke patients is challenging. This study aimed to develop a risk score for predicting delirium in acute ischemic stroke (PREDELIS). We retrospectively included all ischemic stroke patients admitted to five stroke units of Styria, Austria, between 2013 and 2021. Data were retrieved from a comprehensive medical information system using semi-automated data extraction. The PREDELIS score was based on multivariable logistic regression analysis to identify admission variables associated with delirium. 14,475 acute ischemic stroke patients (median age: 76 years, 46

Importance The net clinical effect of early vs later direct oral anticoagulant (DOAC) initiation after atrial fibrillation-associated ischemic stroke is unclear. Objective To investigate whether early DOAC treatment is associated with a net clinical benefit (NCB). Design, Setting, and Participants This was a post hoc analysis of the Early Versus Late Initiation of Direct Oral Anticoagulants in Post-Ischaemic Stroke Patients With Atrial Fibrillation (ELAN) open-label randomized clinical trial conducted across 103 sites in 15 countries in Europe, the Middle East, and Asia between November 6, 2017, and September 12, 2022, with a 90-day follow-up. Participants included patients with atrial fibrillation-associated acute ischemic stroke, excluding those with therapeutic anticoagulation at stroke onset or with severe hemorrhagic transformation of the ischemic infarct. Intervention Early DOAC initiation (<48 hours after minor and moderate stroke, 6-7 days after major stroke) vs later initiation (3-4 days after minor stroke, 6-7 days after moderate stroke, and 12-14 days after major stroke). Main Outcomes and Measures The main measure was the NCB of early treatment over later treatment, calculated by subtracting the weighted rate of excess bleeding events (major extracranial or intracranial hemorrhage) attributable to early treatment from the rate of excess ischemic events (recurrent stroke or systemic embolism) possibly prevented by early treatment within 30 days (main analysis) or 90 days (ancillary analysis). An established weighting scheme was used to account for the different clinical impact of bleeding relative to ischemic outcomes. Event rates were derived from adjusted logistic models. The analysis included all evaluable randomized ELAN participants. Results Of the original 2013 ELAN participants, 1966 were eligible for analysis (977 [49.7%] assigned to early DOAC initiation, 989 [50.3%] assigned to later DOAC initiation; median [IQR] age 77 [70-84] years; 1075 [54.7%] male). The 30-day NCB of early treatment over later treatment ranged from 1.73 (95% CI, 0.06-3.40) to 1.72 (95% CI, -0.63 to 3.98) weighted events possibly prevented per 100 participants for intracranial hemorrhage weights 1.5 to 3.3. The 90-day NCB ranged from 2.16 (95% CI, 0.30-3.87) to 2.14 (95% CI, -0.26 to 4.41) weighted events per 100 participants. Conclusions and Relevance This post hoc analysis of a randomized clinical trial estimated a sizeable NCB of early anticoagulation for patients after atrial fibrillation-associated ischemic stroke. Although estimates cannot exclude the possibility of no benefit or small net harm, the findings suggest that early treatment may be more favorable. Trial Registration ClinicalTrials.gov Identifier: NCT03148457