Ghozy, Sherief

Abstract Stroke thrombi are heterogeneous; their composition influences their mechanical properties, including stiffness, elasticity, and adhesiveness, which in turn affect their response to therapy. Systemic characterization of the thrombi components could help select therapeutic techniques and anticipate outcomes. We conducted a systematic review and meta-analysis to evaluate associations between thrombi composition and angiographic and functional outcomes in acute ischemic stroke (AIS). Up to May 2025, relevant studies were sourced from four databases: PubMed, Web of Science, Scopus, and Embase. We included cohort studies whose populations are patients with AIS in relation to thrombi composition. Thirty-six studies involving 5,462 patients matched our eligibility criteria. Angiographic success (Thrombolysis in Cerebral Infarction ≥ 2b/3) did not differ significantly between red blood cell (RBC)-rich and fibrin-rich thrombi (risk ratio [RR] 1.02, 95% confidence interval [CI] 0.85–1.22; p = 0.84; I 2 = 63.8%; very low certainty). However, thrombi from patients with good angiographic outcomes had a significantly higher RBC content compared to patients with poor outcomes (mean difference = 7.22%, 95% CI 3.31–11.13; p < 0.001; low certainty). No significant difference was observed between RBC-rich and fibrin-rich thrombi regarding functional independence at 90 days (modified Rankin Scale 0–2) (RR = 1.22, 95% CI 0.73–2.05; p = 0.31; low certainty). While RBC-rich thrombi are associated with more favorable angiographic performance, thrombus composition alone does not predict functional outcomes. Stroke outcomes remain multifactorial, dominated by time to reperfusion, collateral circulation, and baseline severity. Preinterventional assessment of clot composition via imaging or biomarkers may support individualized therapy but should complement, not replace, other prognostic determinants.

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.

Abstract Background and aims Intravenous thrombolysis (IVT) is the most common acute ischemic stroke (AIS) treatment. This study compared the efficacy and safety of different IVT agents to determine the optimal option for AIS management. Methods A comprehensive search was conducted in PubMed, Scopus, Web of Science, and Cochrane CENTRAL until 23 March 2025. Randomized controlled trials (RCTs) on alteplase (tPA), tenecteplase (TNK), reteplase, and recombinant human pro-urokinase (rhPro-UK) of any dose in AIS were included. A frequentist network meta-analysis was conducted using R software to pool risk ratios (RRs) with 95% confidence intervals (CIs). Results Twenty-one RCTs (10,852 patients) were included. Compared with tPA 0.9 mg/kg, tPA 0.6 mg/kg showed a lower risk of symptomatic intracranial hemorrhage (RR, 95% CI: 0.48 [0.27–0.86]), whereas TNK 0.4 mg/kg showed a higher risk (RR, 95% CI: 1.88 [1.06–3.35]). Reteplase 18 + 18 mg (RR, 95% CI: 1.13 [1.05–1.21]) and TNK 0.25 mg/kg (RR, 95% CI: 1.05 [1.01–1.10]) were associated with higher rates of excellent functional outcome at 90 days (mRS 0–1) compared with tPA 0.9 mg/kg. No significant differences were observed among interventions in 90-day mortality and favorable function outcomes (mRS 0–2), or serious adverse events. Conclusions Thrombolytic efficacy and safety in AIS appear to be dose dependent. A lower tPA dose (0.6 mg/kg) improved safety; reteplase 18 + 18 mg and TNK 0.25 mg/kg favored functional recovery, whereas a higher TNK dose increased sICH risk, underscoring the importance of dose optimization in IVT selection. Conflict of interest Haneen Sabet: nothing to disclose, Moaz Elsayed Abouelmagd: nothing to disclose, Abdelrahman Shata: nothing to disclose, Mohamed El-Moslemani: nothing to disclose, Diana Kadi: nothing to disclose, Dina Essam Abo-elnour: nothing to disclose, Abdallah Abbas: nothing to disclose, Ramanathan Kadirvel: nothing to disclose, Sherief Ghozy: nothing to disclose Figure 1 - belongs to Results

ABSTRACT Sudden sensorineural hearing loss (SSNHL) is most often idiopathic or related to benign conditions such as Meniere's disease. However, SSNHL caused by vertebrobasilar ischemia is rare and may precede life‐threatening neurological deficits. We present the case of a 67‐year‐old male with hypertension and hyperlipidemia who developed acute vertigo, left‐sided hearing loss, dysarthria, right facial droop, and right‐sided weakness. Initial non‐contrast CT was unremarkable, but computed tomography angiography (CTA) revealed a near‐occlusive thrombus in the mid‐basilar artery. MRI showed an acute infarct in the left cerebellum within the anterior inferior cerebellar artery (AICA) distribution, which supplies the internal auditory artery. Subsequent audiometry confirmed bilateral SSNHL, more severe on the left. The patient was outside the thrombolysis window but underwent cerebral angiography, which confirmed chronic left vertebral occlusion and high‐grade basilar stenosis. He was started on dual antiplatelet therapy and high dose statin therapy and discharged to rehabilitation with residual vertigo and hearing loss. This case emphasizes that SSNHL and vertigo can be early signs of posterior circulation stroke. High‐grade basilar stenosis affecting AICA flow may compromise perfusion to the auditory and vestibular systems. Clinicians should maintain a high index of suspicion for vertebrobasilar ischemia in patients presenting with audiovestibular symptoms, even in the absence of classic stroke findings. Early imaging with MRI and CTA is critical for diagnosis. Recognizing these atypical presentations enables timely management and may reduce long‐term neurologic impairment.

Abstract Purpose 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. Methods 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). Results Among 1,220 patients, 342 (28.0%) presented with ruptured aneurysms. There was no significant difference in the rate of thromboembolic complications between groups (11.8% vs 5.9%, p = 0.056). At follow-up, adequate occlusion was lower (82.2% vs 93.3%, p < 0.002) and functional outcomes were worse (mRS ≥2 in 34.1% vs 21.9%, p = 0.012) among patients with ruptured aneurysms. Periprocedural adequate occlusion (53.3% vs 53.8%, p>0.9) and retreatment rates (11.8% vs 7.1%, p = 0.14) did not differ between groups after matching. Conclusion Ruptured aneurysms demonstrated expected inferior follow-up functional and angiographic outcomes when compared with unruptured aneurysms, but no difference in retreatment rate and procedural safety. These findings support WEB as a safe and effective treatment option for appropriately selected ruptured intracranial aneurysms in routine clinical practice.

Background Resuming anticoagulation in patients with mechanical heart valves after intracranial hemorrhage presents a clinical dilemma. The optimal timing must balance the risk of thromboembolism against hemorrhagic expansion. Prior studies have addressed this issue, but most were limited by small sample sizes. This systematic review and meta‐analysis aimed to determine the optimal timing for anticoagulation resumption in this population. Methods We conducted a systematic review and meta‐analysis using PubMed, Embase, Web of Science, and Scopus from database inception to August 23, 2024. The target population included adults with intracranial hemorrhage who required anticoagulation for mechanical heart valves. Results Thirteen studies involving 788 patients were included: 12 retrospective and 1 prospective observational study. While off anticoagulation, 32 patients developed ischemic stroke, with a pooled event rate of 5.23% (95% CI, 3.80–7.20%) and negligible heterogeneity ( I 2 = 0%). The pooled average time to stroke was 8.08 days (95% CI, 1.99–14.18). After anticoagulation resumption, 73 patients experienced hemorrhagic recurrence, corresponding to a pooled event rate of 10.95%, with nonsignificant heterogeneity ( I 2 = 40.4%). Conclusions Withholding anticoagulation for up to 7 days after intracranial hemorrhage in patients with mechanical heart valves appears relatively safe. Hemorrhagic recurrence after resumption was more common than ischemic stroke during interruption. However, the included studies were observational and carried serious or critical risk of bias. Prospective multicenter studies, and ideally randomized trials, are needed to provide more definitive evidence.