BACKGROUND:Recent trials have furthered uncertainty regarding the endovascular benefit for medium vessel occlusions (MeVO). Stent retrievers (SR) were employed in the first attempt in most interventional arm participants. We sought to compare outcomes in acute MCA M2 occlusions between frontline aspiration and SR, and to delineate procedural and anatomical covariates associated with differential treatment effect. METHODS:Retrospective analysis of a multicenter stroke thrombectomy cohort identified cases of MT for M2 occlusions. Unmatched and propensity score-matched (PSM) cohorts were generated comparing frontline aspiration to standalone and combined SR. The primary outcome was functional independence (mRS 0-2) at 90 days. Recanalization, symptomatic intracranial hemorrhage (sICH), mortality, and the effect of M2 laterality, division occlusion and procedure time were assessed. RESULTS:About 1734 patients with M2 occlusions underwent either frontline aspiration (n = 711) or SR/combined (n = 958) thrombectomy between 2013 and 2024. PSM analysis favored aspiration for functional independence (49.9% vs 44.0%, OR 1.27 (1.03-1.57)), complete recanalization (61.2% vs 48.7%, OR 1.66 (1.34-2.05)), complete first pass effect (35.0% vs 27.6%, OR 1.42 (1.13-1.78)), and sICH (3.5% vs 6.2%, OR 0.55 (0.33-0.91)), with no difference in mortality. Frontline aspiration had significantly shorter procedural times (median 28 [IQR 15-49.5] vs 51 [IQR 35-78] minutes; p < 0.001). For every minute increase in procedure time, the probability of functional independence decreased significantly (p < 0.001) less with frontline aspiration (0.35%) compared to SR/combined (1.61%). CONCLUSION:Frontline aspiration for M2 occlusions resulted in better clinical and angiographic outcomes compared to SRs. Future trials for MeVO with a focus on contact aspiration thrombectomy may succeed where recent trials have failed.

BACKGROUND:Portable low-field and ultra-low-field MRI enables bedside imaging, but its diagnostic performance for acute ischemic stroke (AIS) detection remains uncertain. PURPOSE:To evaluate the diagnostic performance of portable MRI for AIS detection. DATA SOURCES:Four databases were searched on February 2, 2026. STUDY SELECTION:Eligible studies enrolled adults with suspected or confirmed AIS undergoing portable MRI. Nine studies comprising 474 patients with AIS were included. DATA ANALYSIS:In studies with an appropriate reference standard, pooled sensitivity and specificity were synthesized using a bivariate random-effects model, and a hierarchical summary receiver operating characteristic curve was generated. Across all eligible AIS cohorts, the pooled lesion detection rate was estimated using a generalized linear mixed-effects model with random effects. DATA SYNTHESIS:In six comparative studies, the pooled sensitivity for AIS detection was 73.3% (95% CI, 65.4-80.0), corresponding to approximately one in four confirmed infarcts being missed, with missed lesions generally small or sub-centimetric. Pooled specificity was 79.3% (95% CI, 69.1-86.8), and the area under the curve was 0.818. The pooled AIS lesion detection rate was 87.65% (95% CI, 75.7-94.2). LIMITATIONS:There was substantial between-study heterogeneity (I2 = 74.2%). This estimate was interpreted as secondary and descriptive because it included case-only confirmed AIS cohorts. CONCLUSIONS:Portable low/ultra-low-field MRI showed moderate diagnostic performance for AIS detection in comparative studies and may serve as a bedside adjunct where conventional MRI is constrained. However, given the false-negative risk, portable MRI should not be relied upon as a stand-alone rule-out test for AIS when clinical suspicion persists.

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.

Super-bore aspiration catheters with an inner diameter ≥ 0.088 inches have been developed to enhance clot ingestion, improve first-pass reperfusion, and reduce the need for adjunctive thrombectomy techniques in acute ischemic stroke. A comprehensive synthesis of their technical performance, angiographic efficacy, and safety profile is lacking. A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. MEDLINE, Web of Science, and Scopus were searched from inception through December 7, 2025. Eligible studies included patients with acute ischemic stroke treated with super-bore aspiration catheters (inner diameter ≥ 0.088 inches). Pooled estimates were calculated using random-effects models. Eleven studies comprising 835 patients were included. Successful delivery of the aspiration catheter to the target clot was achieved in 90.4

Artificial intelligence research has profound implications for the future of radiology, making it essential to understand funding patterns and diffusion rate from the National Institutes of Health (NIH), historically the leading source of biomedical research funding in the United States. Recent changes in federal funding further necessitate understanding the trends and focus areas for future comparison and strategic decisions by researchers, institutions, and policymakers adapting to the evolving funding landscape. This retrospective study searched and analyzed active NIH-funded projects as of January 2025 and temporally over the last decade (2015–2024) using the NIH RePORTER and ExPORTER databases. An automated large language model pipeline was employed for thematic extraction and categorization of active projects. Diffusion rate analyses were performed to examine the progression of funding distribution across institutes. Descriptive statistics were provided for grant types, administering institutes, principal investigator details, organizations, geography, and research topics. Among active grants focused on AI in radiology, the National Cancer Institute led in total projects (188; 117.0 M), while the National Heart, Lung, and Blood Institute had the greatest funding (167.3 M). The most common grant type for AI in radiology was R01 (547 projects; 326.1 M), followed by R21 (85 projects;24.2 M) and U01 (51 projects; 65.6 M). Funding was concentrated in major academic institutions. Over the years, annual funding grew approximately 13.7-fold from46.4 M (FY2015) to 633.5 M (FY2024), and integration of AI projects into radiology research increased approximately eightfold (from 3.9

Intravenous thrombolysis outcomes in acute ischemic stroke (AIS) vary widely due to heterogeneous clot responsiveness. Defining the molecular basis of thrombolysis resistance is critical to improving treatment efficacy. Sixty-one clots from 59 AIS patients underwent ex vivo thrombolysis with rtPA and were classified as resistant, undefined, or susceptible based on 1-h lysis rates. Quantitative proteomics was performed on a subset (n = 6/group) using mass spectrometry. Whole-genome sequencing (n = 13) explored genetic associations. Clot composition was assessed using Martius Scarlet Blue staining (n = 11) and correlated with thrombolysis. At 1 h, 37 clots were resistant (0– < 25

INTRODUCTION:Mechanical thrombectomy for acute ischemic stroke is often limited by the tortuous anatomy and the 'ledge effect' caused at the junction of a large-bore aspiration catheter and smaller inner devices. Novel delivery assist catheters with smooth tapered distal tips have been developed to facilitate the navigation of aspiration or microcatheters to the clot. METHODS:We performed a PRISMA-guided systematic review of these tapered delivery assist catheters, analyzing their design, regulatory status, and all available evidence on technical performance, clinical outcomes, and safety. A comprehensive literature search (through July 2025) was conducted for studies and reports on the above devices. RESULTS:A total of 18 reports met the inclusion criteria, covering 7 distinct assist catheters. All devices share a common design of a variably stiff, single-lumen catheter with an atraumatic tapered distal segment that minimizes the gap between the inner device and the outer aspiration catheter. Use of these catheters enabled successful trackability and clot engagement in >90% of cases across most series, often without a guidewire, and with low complication rates. CONCLUSIONS:Tapered delivery assist catheters represent an innovation in thrombectomy. Ongoing studies and broader adoption will further clarify their impact on procedural efficiency and patient outcomes.

OBJECTIVE:Endovascular thrombectomy (EVT) for acute large-vessel occlusion stroke is well established, yet its role in patients presenting with minor stroke symptoms (National Institutes of Health Stroke Scale [NIHSS] score < 6) remains unclear. Prior studies have not accounted for intraprocedural factors that may influence outcomes in this subgroup. METHODS:The authors analyzed 5693 patients from the STAR (Stroke and Thrombectomy and Aneurysm Registry), including 398 with low NIHSS scores, to evaluate the association between procedure time (PT) and outcomes. Among patients with low NIHSS scores, propensity score matching was used to compare outcomes between those with PT ≤ 35 versus > 35 minutes, a cutoff defined using receiver operating characteristic curve analysis. The authors performed a meta-analysis of studies reporting best medical management (BMM) outcomes in patients with low NIHSS scores. To compare these with EVT-treated patients, a matched BMM comparator cohort using stratification on pooled baseline characteristics was constructed. Outcomes included 90-day functional independence (modified Rankin Scale [mRS] scores 0-2), intracranial hemorrhage, and mortality. RESULTS:PT had a stronger negative effect on outcomes in patients with low NIHSS scores compared with those with high scores, with a steeper decline in functional independence per minute of PT (slope: -0.45% vs -0.21%; p = 0.03 for interaction). Among patients with low scores, PT ≤ 35 minutes was associated with higher 90-day functional independence compared with the propensity score-matching cohort with PT > 35 minutes (82.6% vs 59.0%, p < 0.001). When benchmarked against BMM (75.2% mRS scores 0-2), patients undergoing EVT within 35 minutes had superior outcomes (85.1%, p = 0.047). In contrast, EVT with PT > 35 minutes resulted in worse outcomes than BMM (mRS scores 0-2: 59.8%, p = 0.008). The number needed to treat for PT ≤ 35 minutes was 10, whereas PT > 35 minutes yielded a number needed to harm of 6. CONCLUSIONS:PT critically modulates the benefit of EVT in minor stroke. While efficient EVT yields better outcomes than BMM, prolonged procedures are associated with harm. These findings may explain prior inconsistent evidence on EVT in patients with low NIHSS scores and underscore the need to individualize procedural thresholds in this population.

PURPOSE:Randomized controlled trials (RCTs) comparing hydrogel-coated coils (HGCs) with bare platinum coils (BPCs) have yielded heterogeneous results, and the clinical relevance of longitudinal angiographic assessment remains uncertain. Following the publication of the HYBRID trial, which emphasized occlusion trajectory rather than static end points, a post-HYBRID updated meta-analysis is warranted to compare angiographic durability and safety outcomes between these coil types. METHODS:A systematic literature search of MEDLINE, Web of Science, and Scopus was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RCTs comparing HGCs with BPCs for the treatment of intracranial aneurysms were included. RESULTS:Six RCTs comprising 2,486 patients and 2,513 treated intracranial aneurysms were included in the analysis. There was no statistically significant difference between HGCs and BPCs in immediate complete occlusion [risk ratio (RR): 0.87; 95% confidence interval (CI), 0.70-1.09; I²: 63.0%] or immediate adequate occlusion (RR: 0.96; 95% CI, 0.85-1.07; I²: 31.0%). Immediate residual aneurysm was significantly more frequent with HGCs than with BPCs (RR: 1.12; 95% CI, 1.01-1.24; I²: 0.0%; P = 0.041). At the last available angiographic follow-up, complete occlusion, adequate occlusion, and residual neck rates remained comparable between HGCs and BPCs. However, residual aneurysm at follow-up was significantly less frequent with HGCs than with BPCs (RR: 0.75; 95% CI, 0.68-0.83; I²: 0.0%; P = 0.006). HGCs were also associated with a significantly lower rate of major recurrence than BPCs (RR: 0.71; 95% CI, 0.54-0.94; P = 0.024). Safety and clinical outcomes were similar between treatment groups. CONCLUSION:Despite comparable safety and clinical outcomes between HGCs and BPCs, HGCs demonstrated superior angiographic durability, as reflected by lower rates of residual aneurysm and major recurrence. CLINICAL SIGNIFICANCE:HGCs may offer improved long-term aneurysm durability compared with BPCs by reducing residual aneurysm and major recurrence without compromising safety or clinical outcomes. These findings support consideration of HGCs when durable occlusion is a priority in endovascular treatment planning for intracranial aneurysms.

BACKGROUND:Flow-diverter stents (FDS) have become the standard of care for a wide range of intracranial aneurysms, but their efficacy/safety in the context of recurrent/recanalized aneurysms following stent-assisted coiling (SAC) is not well established. We evaluate the outcomes of FDS retreatment in a large multicenter cohort. METHODS:We retrospectively analyzed data from 118 patients across 22 institutions who underwent FDS retreatment for recurrent/persistent aneurysms after SAC (2008-22). The primary outcome was angiographic occlusion status at last follow-up, categorized as complete (100%), near-complete (90-99%), or incomplete (<90%) occlusion. Secondary outcomes included procedural complications and clinical outcomes measured by the modified Rankin Scale (mRS). RESULTS:A total of 118 patients (median age 57, 74.6% female) with median follow-up of 15.3 months were identified. Complete occlusion was achieved in 62.5% and near-complete occlusion in 25%. FDS deployment within the pre-existing stent was successful in 98.3% of cases. Major complications occurred in 3.4% of cases, including postoperative aneurysmal rupture with resultant mortality (1.6%) and thromboembolic events with long-term disability (1.6%). Favorable clinical outcomes (mRS 0-2) were observed in 95.1% of patients. Wider aneurysm neck diameter was a significant predictor of incomplete occlusion (adjusted OR (aOR) 1.23 per mm, P=0.044), with male sex trending towards association with non-occlusion (aOR 3.2, P=0.07), while baseline hypertension was associated with complete occlusion (aOR 0.32, P=0.048). CONCLUSIONS:FDS treatment for recurrent/residual aneurysms after SAC represents a viable treatment option for these challenging cases with acceptable safety and reasonable occlusion rates, although lower than de novo FDS occlusion rates.

Background: Pulsatile tinnitus (PT) is frequently caused by venous sinus stenosis and may be associated with idiopathic intracranial hypertension (IIH). Venous sinus stenting (VSS) directly addresses venous outflow obstruction and has emerged as a therapeutic option; however, outcome data remain heterogeneous. We performed an updated systematic review and meta-analysis to evaluate the efficacy and durability of VSS for PT and to compare outcomes between IIH-associated and isolated PT. Methods: MEDLINE, Scopus, and Web of Science were searched from inception through December 2025 following PRISMA guidelines. Clinical studies reporting PT outcomes after VSS were included. Random-effects meta-analyses of proportions were conducted to estimate pooled rates of overall improvement, complete resolution, and recurrence. Prespecified subgroup analyses compared IIH versus isolated PT. Results: Thirty-two studies comprising 850 patients were included (641 with IIH; 209 with isolated PT). Venous sinus stenosis accounted for 90.3% of treated etiologies. The pooled rate of overall PT improvement was 89.8% (95% CI, 85.5-92.9). Complete resolution occurred in 87.1% (95% CI, 82.5-90.6). Recurrence at last follow-up was 10.9% (95% CI, 8.3-14.2). Improvement and complete resolution rates did not differ significantly between IIH and isolated PT. Recurrence was higher in IIH (12.0%) than in isolated PT (5.7%), without reaching statistical significance. Conclusions: VSS is associated with high rates of PT improvement and complete resolution with low recurrence. Recurrence trends appear higher in IIH, suggesting underlying pathophysiology may influence durability.

The Woven EndoBridge (WEB) device is a prevalent treatment for intracranial aneurysms. While many studies have assessed the obliteration rate post-WEB embolization, few have focused on long-term outcomes in partially thrombosed aneurysms. To assess whether partially thrombosed aneurysms are at higher risk of recurrence or retreatment following WEB embolization compared with non-thrombosed aneurysms. We evaluated data from 22 academic institutions, focusing on previously untreated cerebral aneurysms treated with the WEB device. Logistic regression was utilized to analyze factors predicting long-term aneurysm obliteration and retreatment necessity. Among 1303 patients, 26 presented with a partially thrombosed aneurysm. In the partially thrombosed group, the mean aneurysm maximal diameter was 10.7±4 mm with a neck ratio of 1.99±1.19 mm, larger than in the control group where the mean aneurysm maximal diameter was 6.81±2.37 mm with a neck ratio of 1.64±0.51 mm (P<0.001 for both maximal diameter and neck ratio). At the final follow-up, partially thrombosed aneurysms treated by the WEB device had a 38.5% retreatment rate, compared with 7.0% for non-thrombosed aneurysms (P<0.001). Among partially thrombosed aneurysms, the Raymond-Roy type IIIa/b occlusion rate was higher (38.5% vs 9.9%, P<0.001). On multivariate analysis, partially thrombosed aneurysms compared with non-thrombosed aneurysms had an increased rate of retreatment (OR 3.64, 95% CI 1.28 to 10.1). Partially thrombosed aneurysms are associated with a poorer occlusion rate and a higher rate of retreatment following WEB embolization. For partially thrombosed aneurysms, the WEB device appears suboptimal as a first-line treatment, and therefore alternative techniques should be prioritized.

Introduction Mechanical thrombectomy (MT) is standard of care for large vessel occlusion stroke, but its role in medium vessel occlusion (MeVO) remains uncertain. Recent trials have not shown clear benefit, partly due to patient selection and technique variability. Several MT approaches have been described, including the direct aspiration first-pass technique and stent retriever thrombectomy. A novel macrowire has been introduced to deliver an aspiration catheter directly to the clot without a traditional microwire-microcatheter system. We evaluated the feasibility and safety of this approach in MeVO stroke. Methods Macrowire for Intracranial Thrombectomy-MeVO is a multicenter, retrospective, observational study of consecutive patients with MeVO treated with MT using a macrowire to deliver the aspiration catheter. Data were collected over 12 months and included demographics, vascular risk factors, baseline modified Rankin Scale, National Institutes of Health Stroke Scale (NIHSS), occlusion site, procedural metrics, angiographic outcomes, and complications. Results Fifty-nine patients were included (median age 65 years; 36% women). Median NIHSS was 11 (IQR 8–19) and median Alberta Stroke Program Early CT Score was 9 (range 7–10). Successful advancement of the aspiration catheter over the macrowire was achieved in 57/59 cases (96.6%). Median access-to-first pass time was 16 min (IQR 11–19) and median access-to-reperfusion time was 20 min (IQR 15.0–33.8). Successful reperfusion (thrombolysis in cerebral infarction (TICI) ≥2B) occurred in 91.5% of patients (TICI 3: 23; 2C: 22; 2B: 9). Two cases required microcatheter bailout, and no wire-related perforations were observed. Conclusions Macrowire-assisted aspiration thrombectomy appears safe and feasible for MeVO, enabling efficient catheter delivery and high rates of successful reperfusion. Trial registration number NCT06148675 .

During the past 5 years, transvenous techniques have rapidly expanded the neurointerventional landscape, offering new diagnostic and therapeutic strategies for a range of cerebrovascular conditions. This narrative review synthesizes contemporary evidence and technical advances across multiple venous applications, including transvenous embolization for AVMs and dural fistulas, treatment of CSF-venous fistulas, and venous sinus stent placement for pulsatile tinnitus, intracranial hypertension, and skull base leaks. Recent data underscore high efficacy rates and favorable safety profiles in carefully selected patients, often matching or surpassing traditional arterial approaches. Innovations such as fetal vein of Galen embolization, vein-targeted brain-computer interface implantation, and endovascular CSF shunting exemplify the therapeutic versatility of venous access. However, procedural challenges, such as venous anatomy, access, and embolic control, require meticulous planning and advanced skill sets. Trials like TATAM and DIVE-IIN are and will shape evidence-based indications for transvenous therapy. With expanding indications and growing operator expertise, the venous route is evolving from a niche adjunct into a cornerstone of neurovascular care.

Although the Woven EndoBridge (WEB) device is increasingly used for the treatment of wide-neck intracranial aneurysms, including in the acute rupture setting, comparative evidence assessing the impact of rupture status remains limited. This study compared angiographic, safety, and clinical outcomes between ruptured and unruptured intracranial aneurysms treated with WEB. We conducted a retrospective analysis of prospectively collected data from the multicenter cohort registry WorldWideWEB, including consecutive adult patients with intracranial aneurysms treated with the WEB. Patients were stratified into groups of ruptured and unruptured aneurysms. Propensity score matching was used to balance baseline characteristics between both groups. Retreatment rate was the primary outcome. Secondary outcomes included mRS, safety events (thromboembolic complications) and angiographic outcomes (periprocedurally and last follow-up). Among 1,220 patients, 342 (28.0

BACKGROUND AND OBJECTIVES:Aspiration catheters are an integral component of mechanical thrombectomy for acute ischemic stroke (AIS). Following early series demonstrating increasing procedural efficiency and improved outcomes with use of large-bore (LB) aspiration catheters, there is increased interest in the use of emerging superlarge-bore (SLB) catheters. METHODS:We retrospectively analyzed AIS patients with large vessel occlusion treated at 34 international centers (2018-2025) using SLB or LB aspiration catheters on the first attempt. We used propensity score matching (1:6) to define a balanced cohort based on baseline and technical confounders between the catheter groups. Safety, efficacy, and technical outcomes were compared, with the primary outcome being the first pass effect (FPE). RESULTS:A total of 2032 patients treated with aspiration as the frontline technique were included (SLB n = 107; LB n = 1925). After propensity score matching (SLB n = 107; LB n = 642), there was no significant difference in FPE between the SLB and LB groups (56.1% vs 54.8%; odds ratio [OR] 1.05, P = .8). Secondary efficacy outcomes were similarly comparable, including functional independence at 90 days (50.0% vs 46.9%; OR 1.13, P = .586), successful recanalization (modified thrombolysis in cerebral infarction ≥2b) (96.3% vs 93.5%; OR 1.78, P = .3), and median time to modified thrombolysis in cerebral infarction ≥2b (22.0 vs 22.8 minutes; β = -5.94, P = .7). Safety outcomes were also comparable, including intraprocedural complications (10.3% vs 8.2%, P = .5), symptomatic intracranial hemorrhage (8.7% vs 6.6%, P = .4), embolization to new territory (15.9% vs 13.1%, P = .4), and 90-day mortality (21.6% vs 27.1%, P = .3). Using a 10% noninferiority margin, LB aspiration catheters met the prespecified noninferiority criterion compared with SLB aspiration catheters for successful recanalization and FPE. Our findings remained consistent in the subgroup restricted to internal carotid artery and M1 occlusions. CONCLUSION:The use of SLB aspiration catheters showed comparable safety and efficacy with standard LB catheters for mechanical thrombectomy in AIS.

OBJECTIVE:The objective was to evaluate the trajectories of hematoma resolution and functional improvement after middle meningeal artery embolization (MMAE) for chronic subdural hematoma (cSDH), model the temporal pattern of cSDH resolution, and identify factors associated with favorable outcomes. METHODS:This real-world multicenter retrospective study included cSDH patients treated with MMAE at 24 centers between 2019 and 2024. Hematoma thickness was measured at baseline and at follow-up intervals (1-4 weeks, 1-3 months, 3-6 months, 6-12 months, and > 12 months after embolization). Resolution patterns were modeled using exponential decay functions. Modified Rankin Scale (mRS) scores assessed functional outcomes. Good functional outcome was defined as mRS score ≤ 2. Resolution patterns were modeled using exponential decay functions to estimate time to 50% and 80% reduction. Patients were categorized as complete resolution (≥ 99%) or by quartile of the remaining distribution (substantial [73%-98%], moderate [53%-73%], partial [27%-53%], minimal [< 27%]). The primary outcome was good functional status (mRS score ≤ 2). RESULTS:The authors analyzed a total of 1781 patients with 2295 cSDHs who underwent MMAE. The mean ± SD age was 72.8 ± 12.4 years and 68.1% of patients were male. The initial mean hematoma thickness was 15.31 ± 6.53 mm, decreasing to 5.24 ± 5.91 mm at final follow-up (mean reduction 64.3% ± 42.1%). Resolution followed an exponential decay pattern, with an estimated time to 50% reduction of 1.8 months and to 80% reduction of 8.9 months. Complete resolution occurred in 1031 of 2224 patients (46.4%) with complete follow-up. The median (IQR) mRS score improved from 1 (0-3) at baseline to 0 (0-2) at > 12 months. Good functional outcomes were more common in patients with complete versus minimal resolution (68.9% vs 35.0%, p < 0.001). Achieving ≥ 73% resolution within 90 days was associated with better outcomes (good outcome in 76.9% of those with ≥ 73% resolution vs 67.3% in those without, p < 0.001). Neurological deterioration was the strongest predictor of lack of good outcome (23.7% in patients with neurological deterioration vs 82.4% without, p < 0.001). CONCLUSIONS:After MMAE for cSDH, reduction in hematoma thickness follows a predictable exponential decay pattern. Greater extent (≥ 80%) and faster timing (within 90 days) of resolution are valuable prognostic indicators. Functional outcomes improve progressively through 6-12 months after the procedure. The relationship between resolution extent and functional outcomes provides quantitative benchmarks for evaluating treatment response.

BACKGROUND:CSF-venous fistulas (CVFs) are an important and underrecognized cause of spontaneous intracranial hypotension. Accurate localization is essential for effective treatment. However, data regarding which areas of the spine are at higher risk are limited. PURPOSE:To evaluate the prevalence of affected laterality and spinal levels in patients with CVFs. DATA SOURCES:Scopus, Web of Science, Embase, and PubMed databases. STUDY SELECTION:Studies involving 3 or more patients with confirmed CVFs that specified the level and side of involvement were included. When multiple studies originated from the same institution or research group, they were further reviewed and narrowed to avoid data overlap, prioritizing inclusion of the largest studies. DATA ANALYSIS:Meta-analysis of demographic characteristics, side of involvement, and spinal levels of CVFs. Pooled prevalence rates were computed, and age and gender distribution across studies were analyzed. Pair-wise meta-regression was used, and laterality was further assessed at each spinal level to determine the distribution of right-versus left-sided leaks. Heterogeneity was assessed using Q statistics and the I2 test, with significance defined as an I2 value >50% or a P value <.05. DATA SYNTHESIS:Thirty-six observational studies consisting of 1145 patients (63% women) were analyzed. Most CVFs involved the lower portion of the thoracic spine, including T7 (28/180; 19%; 95% CI: 0.13-0.28), T9 (33/238; 19%; 95% CI: 0.13-0.30), and T10 (31/190; 17%; 95% CI: 0.13-0.24). More CVFs occurred on the right side of the spine (394/709; 67%; 95% CI: 0.62-0.73; P <.001) when compared to the left (214/786; 31%; 95% CI: 0.24-0.39) and bilaterally (18/313; 8%; 95% CI: 0.04-0.18). LIMITATIONS:Study limited by retrospective approach, reporting bias, and paucity of large published series of patients with CVFs. Furthermore, reporting was not standardized, making statistical comparison difficult. CONCLUSIONS:In patients with CVFs, the thoracic spine appears to be the most heavily involved region, especially on the right side.

BACKGROUND:Venous sinus stenting (VSS) is a treatment option for patients with pulsatile tinnitus (PT); however, comparative outcome data between braided and laser-cut stent designs remain limited. MATERIALS AND METHODS:A systematic literature search of MEDLINE, Web of Science, and Scopus was conducted in accordance with PRISMA guidelines. Pooled analyses were performed using random-effects models with generalized linear mixed-effects modeling for proportional outcomes. Subgroup analyses were conducted according to stent design (braided versus laser-cut) and etiology (idiopathic intracranial hypertension (IIH) versus isolated PT). RESULTS:Forty studies comprising 995 patients were included. Overall, PT recurrence occurred in 7.77% of patients (95% CI 4.71-12.55), complete resolution was achieved in 91.59% (95% CI 82.85-96.09), and symptomatic improvement was reported in 91.42% (95% CI 86.63-94.60). The overall complication rate was 3.57% (95% CI 1.68-7.43). In stent-type subgroup analyses, improvement rates were 91.78% for braided stents (95% CI 81.40-96.61) and 93.27% for laser-cut stents (95% CI 85.15-97.10; P = 0.74). Complete resolution was achieved in 89.51% of patients treated with braided stents (95% CI 76.52-95.72) and 89.04% of those treated with laser-cut stents (95% CI 67.97-96.88; P = 0.95). Recurrence rates were 7.20% for braided stents (95% CI 2.72-17.72) and 7.91% for laser-cut stents (95% CI 3.54-16.73; P = 0.881), while complication rates were 3.24% (95% CI 0.81-12.07) and 3.63% (95% CI 1.14-10.95), respectively (P = 0.89). When stratified by etiology, improvement rates were 90.91% in IIH and 96.57% in isolated PT (P = 0.32), while complete resolution was achieved in 91.90% and 98.81%, respectively (P = 0.22). Recurrence rates were 8.08% (95% CI 4.64-13.69) in IIH and 2.43% (95% CI 0.32-16.24) in isolated PT (P = 0.24), and complication rates were 3.99% (95% CI 1.92-8.31) in IIH and 0.30% (95% CI 0.00-76.62) in isolated PT (P = 0.46), with no statistically significant differences detected between groups. CONCLUSIONS:VSS is associated with high rates of symptom improvement and low complication rates in patients with PT, with no significant differences in clinical outcomes between braided and laser-cut stents or between IIH and isolated PT.

Data on the use of Woven EndoBridge (WEB) devices in the treatment of narrow-neck intracranial aneurysms (NNA) are limited. We compared the efficacy and safety of single-layer (SL) and single-layer spherical (SLS) WEB devices in treating NNA. We conducted a multicenter retrospective analysis of adult patients with NNA (neck ≤ 4 mm and width-to-neck ratio ≥ 2) treated with SL or SLS WEB devices between January 2011 and December 2022. Patients with fusiform or blister aneurysms, adjunctive treatments, or devices other than SL or SLS were excluded. Propensity score matching was used to adjust for confounding variables. Outcomes included procedural complications, angiographic occlusion rates using the Raymond Roy classification, major device compaction, need for retreatment, and functional outcomes assessed by the modified Rankin Scale (mRS). After matching, resulting in 101 patients in each group, baseline characteristics were well-balanced. Thromboembolic complications occurred in 2.0