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Introduction Mechanical thrombectomy (MT) is a well‐established treatment for acute ischemic stroke (AIS) due to large vessel occlusion (LVO). However, its role in cervical artery dissection‐related (CeAD) LVO remains debated due to anatomical complexities and procedural challenges. This systematic review and meta‐analysis aims to evaluate the safety, efficacy, and clinical outcomes of MT in patients with AIS due to CeAD‐related LVO, compared with other AIS etiologies. Methods PubMed, Embase, and Scopus were systematically searched from inception through March 2025. Comparative observational studies evaluating the use of MT in adult patients with AIS due to LVO were included, specifically those comparing outcomes in those with CeAD versus non‐CeAD etiologies. Most studies were retrospective and multicentric. Eligible interventions included stent retriever thrombectomy, direct aspiration (ADAPT), or combined approaches. Results Nine studies with a total of 4889 patients were included, comprising 446 CeAD‐related and 4443 non‐CeAD LVO cases. MT for CeAD‐related AIS showed no statistically significant difference in successful recanalization compared with non‐CeAD cases (OR:0.81, CI: [0.63,1.04], p=0.10). However, CeAD patients had significantly higher rates of 90‐day functional independence (mRS 0‐2) (OR:2.17, CI: [1.55, 3.05], p < 0.0001) and lower 90‐day mortality (OR:0.34, CI: [0.22, 0.53], p < 0.0001). Rates of distal embolization (OR:1.60, CI: [0.69, 3.70], p = 0.27), symptomatic ICH (OR:0.84, CI: [0.51, 1.38], p=0.49), or iatrogenic dissection (OR:1.58, CI: [0.59, 4.22], p=0.36) did not differ significantly. Conclusions Mechanical thrombectomy in CeAD‐related LVO is safe and associated with clinical outcomes comparable to patients with non‐CeAD acute ischemic causes. They demonstrated a similar patient safety profile, such as functional outcomes and mortality.

Introduction Spontaneous intracranial hypotension (SIH) has been underdiagnosed, primarily due to limited clinical recognition and diagnostic capabilities. Recent improvements in diagnostic awareness and the implementation of advanced imaging techniques, notably targeted myelography and photon‐counting computed tomography (PCCT), have improved detection of cerebrospinal fluid‐venous fistulas (CSFVFs). We provide an updated SIH incidence within a defined U.S. County and quantify the proportional contribution of CSFVFs in this evolving diagnostic context. Methods We performed a retrospective, population‑based cohort study of adults evaluated for SIH from January 2019 through August 2025 at a quaternary referral center. Standard evaluation included brain MRI, whole‑spine MRI screening for spontaneous spinal CSF leaks (SLEC), and targeted myelography (lateral‑decubitus digital subtraction or dynamic CT/PCCT when available). Incident SIH was defined as the first imaging‑confirmed leak per patient. Incidence per 100,000 adult person‑years used adult population denominators with exact Poisson 95% CIs. Results We identified 33 incident SIH cases; 22/33 (66.7%) were CSFVF. Overall SIH incidence was 4.02 (95% CI 2.77‐5.65) per 100,000 person‑years; CSFVF‑specific incidence was 2.68 (95% CI 1.68‐4.06), 2.35 in women (95% CI 1.25‐4.02) and 1.50 in men (95% CI 0.65‐2.96). Significant upward trends were observed in annual incidence rates for SIH (Incidence Rate Ratio [IRR]: 1.23, 95% CI: 1.02‐1.48, p = 0.027) and specifically for CSFVFs (IRR: 1.29, 95% CI: 1.03‐1.63, p = 0.029). The symptom duration before diagnosis had a median of 4 months and appears to be shortening over time: 7 months in 2019‐2021 versus 4 months in 2022‐2025, consistent with faster recognition and targeted imaging. Conclusion The incidence of SIH, particularly due to CSFVFs, has increased significantly, likely attributable to improved clinical recognition and advanced imaging techniques rather than a true epidemiological shift. This highlights an urgent clinical message: maintain a high index of suspicion, image accordingly, and treat promptly. image image

Background Contact aspiration remains a frontline approach for mechanical thrombectomy (MT) in acute ischemic stroke (AIS). Early evidence correlates catheter size with procedural efficiency and clinical outcomes. Larger‐bore (LB) aspiration catheters may enhance clot ingestion, increase aspiration force, and facilitate faster and more complete recanalization. However, the transition from standard LB catheters (0.068‐0.072″) to super‐large‐bore (SLB, ≥0.080″) devices has raised questions regarding both safety and clinical benefit. Although the use of SLB catheters is increasing, comparative data on their performance versus LB catheters remain limited. This study aims to evaluate the safety and efficacy of SLB compared with LB catheters including data from a large multicenter international registry. Methods We retrospectively analyzed patients with AIS due to LVO treated at 46 international stroke centers between January 2013 and June 2025. Among eligible patients, propensity score matching (PSM) at a 5:1 ratio was used to balance baseline characteristics between those treated with standard LB catheters and those treated with SLB catheters. Safety endpoints included intraprocedural complications, symptomatic intracranial hemorrhage (sICH), distal embolization, and 90‐day mortality. Efficacy endpoints included functional independence at 90 days (modified Rankin Scale [mRS] 0‐2), successful recanalization (TICI ≥2b), first‐pass effect (TICI ≥2b on the first aspiration attempt), and procedural timing to TICI2b. Results A total of 3,100 patients were included (LB n=3,024; SLB n=67). After PSM (LB n=335; SLB n=67), safety outcomes were comparable between groups in terms of intraprocedural complications occurred (p=0.5), sICH (p>0.9), embolization to new territory (p=0.2), and 90‐day mortality (p>0.9). Efficacy outcomes were similarly consistent for functional independence (mRS 0‐2) (p>0.9), successful recanalization (p>0.9), first‐pass effect (p=0.5), and time to TICI ≥2b (27.6 vs. 24.5 minutes; p=0.9). These findings remained consistent in the subgroup with ICA and M1 occlusions, with no significant differences in safety (intraprocedural complications [p=0.4], sICH [p>0.9], embolization to new territory [p=0.6], or 90‐day mortality [p>0.9], nor in efficacy outcomes (functional independence at 90 days [p>0.9], successful recanalization [p=0.9], first‐pass effect [p=0.6], and time to TICI ≥2b [p=0.9]). Conclusion In this large multicenter analysis, the use of SLB aspiration catheters demonstrated comparable safety and efficacy to standard LB catheters for MT in AIS. Despite theoretical advantages in aspiration dynamics, SLB devices did not confer significant procedural or clinical benefit over LB catheters. These findings suggest that while SLB catheters are a feasible alternative, technical and clinical outcomes remain comparable to LB catheters. Further prospective studies are warranted to clarify potential clinical advantages. image

Introduction For large vessel occlusion (LVO) ischemic strokes, three major techniques of mechanical thrombectomy have demonstrated efficacy. In this study, we compared stent retrievers (SR),contact aspiration (Asp), and a combined approach to provide an updated comparison of key outcomes for each strategy. Methods We followed PRISMA guidelines to conduct a systematic review and meta‐analysis across PubMed, EMBASE, Scopus, and Web of Science databases up to September 2024. Studies were included if they included outcomes for patients with ischemic stroke who underwent mechanical thrombectomy using a stent retriever, contact aspiration, or a combination of both techniques. Results Twenty‐four studies comprising a total of 12,845 patients were included in the analysis. Compared to the Asp technique alone, the combined mechanical thrombectomy (MT) approach was associated with a higher risk of arterial dissection (RR: 2.00; 95% CI [1.15, 3.44]), longer procedure duration (MD: 13.35 minutes; 95% CI [5.87, 20.83]) and associated with a lower risk of arterial dissection (RR: 0.50; 95% CI [0.29, 0.87]). However, Asp was associated with a lower rate of first‐pass effect (FPE) compared to combined MT (RR: 0.67; 95% CI [0.46, 0.96]). Additionally, stent retriever (SR) use was linked to a higher procedure duration compared to Asp(MD: 13.39 minutes; 95% CI [5.55, 21.22]) and a lower FPE rate (RR: 0.75; 95% CI [0.59,0.96]). No significant differences were observed between groups in terms of successful recanalization, 90‐day functional outcomes, or mortality. Conclusion In our analysis, all three techniques demonstrated similar recanalization rates and functional outcomes. However, aspiration was associated with shorter procedure times and fewer arterialdis section complications, while the combination technique showed a higher first pass effect. Given the comparable overall efficacy, the choice of technique should be guided by the physician's preference, expertise, and confidence, tailored to the individual patient's profile.

Introduction CAR T‐cell therapy is an immunotherapy essential in treating blood and plasma cancers. A common side effect of CAR T‐cell therapy is ICANS (Immune Effector Cell‐Associated Neurotoxicity Syndrome), with mechanism including excessive cytokine response resulting in endothelial dysfunction and blood brain barrier (BBB) disruption with CART cell migration to the CNS. Manifestations of ICANS includes aphasia, dysgraphia, tremor and other features of encephalopathy. PRES (posterior reversible encephalopathy syndrome) has a similar proposed mechanism of endothelial dysfunction and BBB breakdown while acute ischemic stroke can present similarly with aphasia. This is a case report of a patient who developed ICANS grade 3 found to have PRES on neuro imaging with initial improvement before again decompensating and found to have acute ischemic stroke. Methods N/A Results This was a 63‐year‐old female with multiple myeloma who underwent CAR T‐cell therapy. She developed encephalopathy and tremors consistent with grade 3 neurotoxicity with MR brain showing findings of mild PRES. She improved with ICANS treatment of steroids, Anakinra, tocilizumab, IT methotrexate/hydrocortisone and management of PRES with SBP control. Unfortunately, she had acute decompensation a week after these treatments with aphasia concerning for relapsed ICANS or PRES, however MR brain revealed a hyperacute left MCA stroke, not a candidate for treatment due to lack of LVO and thrombocytopenia. Subsequently she went into atrial fibrillation with RVR and was noted to have HfrEF. Repeat neuro imaging with CT head revealed multifocal strokes and R ICA occlusion. No obvious vasospasm on vessel imaging to support co‐existing RCVS given prior findings of PRES. Conclusion As CAR T‐cell therapy becomes widely utilized, it is important to be aware of the presentation of ICANS and remain diligent in ruling out ICAN mimics such as PRES and acute ischemic stroke. image image

Introduction The association between retinal vessel diameters and cerebrovascular disease is well known. Additionally, retinal vascular measures provide a direct and objective modality to study Alzheimer's disease (AD) ‐ associated vasculopathy. Herein, we aimed to study the association between automatically quantified retinal arteries and veins diameters and AD. Methods We have identified 1039 subjects from the UK Biobank that had good‐quality macula‐centered color fundus photographs (220 with AD, 202 with Parkinson's disease (PD), 516 normal controls (NC)), of which 86.9% were right and 71.2% left eyes. We quantified retinal vascular measures in Hubbard zones B and C (central retinal vein equivalent (CRVE), central retinal artery equivalent (CRAE) and arterio‐venous ratio (AVR)) using Automorph. We assessed inter‐eye correlation between the vascular features using Spearman correlation coefficient. We adjusted for confounding patient characteristics between groups where present (age, gender, hypertension, diabetes mellitus (DM)) and the presence of APOE4 carrier allele. Group‐level adjusted mean estimates and mean differences for AD vs NC and AD vs PD with 95% confidence intervals (CI) were constructed using regression modeling. Results Subjects with AD were significantly older than NC (mean (SD) age 64.9(4.4) vs 55.9(8.1) years, p<0.001), had similar gender distribution, similar incidence of hypertension (27.7% vs 22.7%, p=0.1428), significantly more DM (6.8% vs 3.5%, p=0.04) and more likely to be APOE4 carriers (64.4% vs 30.8%, p<0.001). When compared to PD subjects, AD were older (mean (SD) age 64.9 (4.4) vs 62.6 (5.3) years, p<0.001), less commonly male (46.4% vs 61.4%, p=0. 0007), had similar incidence of hypertension (27.7% vs 31.0%, p=0.4152) and DM (6.8% vs 6.3%, p=0. 8020) but were more likely to be APOE4 carriers (64.4% vs 29.6%, p<0.001). All CRAE, CRVE, and AVR measures showed significant correlations between right and left eyes, hence we report only right eye measures given greater sample size. Between AD and NC, age and DM adjusted retinal vascular measures showed greater CRVE in Hubbard zone B (mean difference (CI) 2.042 (0.61, 3.47), p=0.005) and zone C (mean difference (CI) 1.859 (0.41, 3.29), p =0.01). After additional adjustment for APOE4, CRVE in zone B only remained significantly greater in AD when compared to NC (mean difference (CI) 1.97 (0.15, 3.79), p=0.03). When we compared AD and PD subjects, age and gender adjusted retinal vascular measures also exhibited greater CRVE in AD in both zones B and C, that remained significant after additional adjustment for APOE carrier status (mean difference (CI) 2.531 (0.946, 4.117), p=0.0018). CRAE and AVR showed non‐significant differences between AD and NC, as well as AD and PD, in all zones (p>0.05 for all comparisons). Conclusions The central retinal vein equivalent was significantly greater in subjects with AD in the UK Biobank, after adjusting for demographic, vascular co‐morbidities and APOE4 carrier status. These results suggest that wider retinal venules are indicators of AD‐associated retinal vasculopathy and degeneration.

BACKGROUND Mechanical thrombectomy (MT) is a well‐established treatment for acute ischemic stroke (AIS) due to large vessel occlusion (LVO). However, its role in cervical artery dissection‐related (CeAD) LVO remains debated due to anatomical complexities and procedural challenges. This systematic review and meta‐analysis aims to evaluate the safety, efficacy and clinical outcomes of MT in patients with AIS due to CeAD‐related LVO, compared with other AIS etiologies. Methods PubMed, Embase, and Scopus were systematically searched from inception through March 2025. Comparative observational studies evaluating the use of MT in adult patients with AIS due to LVO were included, specifically those comparing outcomes in those with CeAD versus non‐CeAD etiologies. Most studies were retrospective and multicentric. Eligible interventions included stent retriever thrombectomy, direct aspiration (ADAPT), or combined approaches. Results Nine studies with a total of 4889 patients were included, comprising 446 CeAD‐related and 4443 non‐CeAD LVO cases. MT for CeAD‐related AIS showed no statistically significant difference in successful recanalization compared with non‐CeAD cases (OR:0.81, CI: [0.63,1.04), p=0.10). However, CeAD patients had significantly higher rates of 90‐day functional independence (mRS 0‐2) (OR:2.17, CI: [1.55, 3.05), p < 0.0001) and lower 90‐day mortality (OR:0.34, CI: [0.22, 0.53), p < 0.0001). Rates of distal embolization (OR:1.60, CI: [0.69, 3.70), p=0.27, symptomatic ICH (OR:0.84, CI: [0.51, 1.38), p=0.49), or iatrogenic dissection (OR:1.58, CI: [0.59, 4.22), p=0.36) did not differ significantly. CONCLUSIONS Mechanical thrombectomy in CeAD‐related LVO is safe and associated with clinical outcomes comparable to patients with non‐CeAD acute ischemic causes. They demonstrated similar patient safety profile such as functional outcomes and mortality.

Background Retinal vascular imaging offers a non‐invasive window into the central nervous system health and has shown promise in the study of neurodegenerative diseases. Emerging evidence highlights that Parkinson's disease (PD) exhibits structural and functional changes in the retina, including vascular alterations. This pilot study evaluated whether retinal vascular morphological features, quantified using the deep learning tool Automorph, discriminate PD from non‐PD subjects in the UK Biobank cohort. Methods We analyzed color fundus photographs (CFPs) from 303 PD participants (mean age 62.6 ± 5.4 years, hypertension (HTN) = 67%, diabetes mellitus (DM) = 13%) and 516 non‐PD controls (age = 55.9±8.1, HTN = 22.8%, DM = 3%) enrolled in the UK Biobank. Six retinal vascular morphology features were quantified: fractal dimension, vessel density, average width, distance tortuosity, squared curvature tortuosity, and tortuosity density. General linear models were used to assess group differences while adjusting for age, hypertension, and diabetes. We also evaluated the association between retinal features and age, and the left‐right eye retinal fractal measures correlations using Pearson correlation and Fisher Z‐test. Results Compared to non‐PD individuals, PD patients showed significantly altered retinal vessel average width, both without (p = 0.001) and with (p = 0.002) vascular covariate adjustment. Group‐by‐age interaction effects were also significant for fractal dimension (p = 0.010) and vessel density (p = 0.023). Furthermore, inter‐eye correlation of vessel density differed significantly between groups (p = 0.034), suggesting altered bilateral vascular symmetry in PD. Conclusion Measurable alterations in retinal vascular morphology in PD support the potential of retina vascular imaging for non‐invasive neurodegenerative disease research. These results warrant further validation in larger cohorts, with improved analytic robustness and automated retinal vascular grading.

Background Rapid stroke type identification is essential for time‐sensitive interventions, yet timely neuroimaging remains limited, especially in pre‐hospital and resource‐constrained settings. The EMVision emu™ Brain Scanner is a portable neurodiagnostic device using non‐ionizing electromagnetic signals to distinguish stroke subtypes. In an Australian prevalidation study enrolling 277 suspected stroke patients, it demonstrated diagnostic accuracy with sensitivity and specificity of 92% and 85% for hemorrhagic and 95% and 80% for ischemic strokes, respectively. Case studies and image reconstructions provided (figures 1 and 2). This follow‐up study aims to validate the diagnostic performance of emu™ for detecting intracranial hemorrhage in an international cohort, targeting ≥80% sensitivity and specificity. Methods A prospective, multi‐center, international, paired diagnostic accuracy study, with 4 US sites and 2 Australian sites. It will enroll 300 patients presenting within 12 hours of stroke onset. Patients will be stratified into two arms: intracranial hemorrhage, and ischemic stroke, TIA, or stroke mimic. Participants will undergo standard imaging, followed by non‐invasive scan by the emu™ device. Ground‐truth diagnoses will be adjudicated by a blinded expert panel. The primary endpoints are the sensitivity and specificity of the emu™ device for detecting hemorrhage, calculated against the reference standard. Statistical inference will rely on whether the lower bound of the 95% confidence interval for sensitivity and specificity exceeds 80%. Results First Australian and US enrollments occurred on June 11, 2025, and July 3, 2025, respectively. Latest progress in the study will be presented at the time of conference. Conclusion This is the first international validation study of a portable electromagnetic brain scanner for intracranial hemorrhage detection; a novel, non‐ionizing, diagnostic tool that can revolutionize acute stroke triage, enabling earlier treatment decisions, improved workflows, and equitable access to neuroimaging. image image

Oral nimodipine is the only drug approved for aneurysmal subarachnoid hemorrhage (aSAH). However, bioavailability is poor and peak plasma concentrations fluctuate widely, leading to dose‐limiting hypotension. Administration is problematic in patients who cannot swallow. An enteral liquid formulation exists but causes severe diarrhea. GTX‐104 is an intravenous (IV) nimodipine formulation that has 100% bioavailability and is not affected by swallowing, gastrointestinal absorption and first pass effects. When administered in pharmacokinetically‐equivalent doses to oral nimodipine in healthy humans, GTX‐104 has more consistent plasma concentrations and causes less hypotension than oral nimodipine. To conduct a randomized, open label, blinded endpoint study to determine the safety and tolerability of GTX‐104 compared with oral nimodipine in patients with aSAH We conducted a multicenter, prospective, randomized, open‐label safety and tolerability study of GTX‐104 compared to oral nimodipine in aSAH. Inclusion/exclusion criteria matched prescribing information for oral nimodipine and included adults with aSAH of all Hunt/Hess grades. Subjects were randomized 1:1 to GTX‐104 or oral nimodipine. The primary endpoint was the proportion of subjects with clinically significant hypotension (hypotension requiring treatment, with a reasonable likelihood of being due to study drug, as determined by an independent, blinded committee). Secondary endpoints included all episodes of hypotension, adverse events, EQ‐5D‐3L and modified Rankin scale within 90 days of aSAH. 102 subjects were randomized at 24 sites in the USA. Demographics reflected those of aSAH. There was a 20% relative reduction in clinically significant hypotension with GTX‐104 compared to oral nimodipine (28% versus 35%). 54% of GTX‐104 subjects got >95% of the prescribed dose compared to 8% on oral nimodipine. Favorable outcome (90‐day mRS 0‐2) was more common in the GTX‐104 group compared with oral nimodipine (62% versus 48%). Fewer patients on GTX‐104 (36% versus 48% oral nimodipine) had serious adverse events. There were no safety issues with GTX‐104. GTX‐104, an IV formulation of nimodipine that can be administered through central or peripheral veins, is safer and potentially more efficacious than oral nimodipine.