BACKGROUND AND PURPOSE:The aim of this study was to report the CT evolution and clinical significance of HCA after intra-arterial mechanical thrombectomy (revascularization by using retrievers and/or other mechanical devices without concomitant delivery of intra-arterial thrombolytics) in our patients. These lesions are common after intra-arterial thrombolysis, being considered a negative prognostic sign. Their significance after pure mechanical thrombectomy remains unknown.

The prevalence of dementia was low, despite a high prevalence of aMCI and CIND. Dementia was strongly associated with age and education. CIND was associated with living in a rural area and with female sex, while aMCI was associated with illiteracy.

Background: Coronavirus disease 2019 (COVID-19) has placed a tremendous strain on healthcare services. This study, prepared by a large international panel of stroke experts, assesses the rapidly growing research and personal experience with COVID-19 stroke and offers recommendations for stroke management in this challenging new setting: modifications needed for prehospital emergency rescue and hyperacute care; inpatient intensive or stroke units; posthospitalization rehabilitation; follow-up including at-risk family and community; and multispecialty departmental developments in the allied professions. Summary: The severe acute respiratory syndrome coronavirus 2 uses spike proteins binding to tissue angiotensin-converting enzyme (ACE)-2 receptors, most often through the respiratory system by virus inhalation and thence to other susceptible organ systems, leading to COVID-19. Clinicians facing the many etiologies for stroke have been sobered by the unusual incidence of combined etiologies and presentations, prominent among them are vasculitis, cardiomyopathy, hypercoagulable state, and endothelial dysfunction. International standards of acute stroke management remain in force, but COVID-19 adds the burdens of personal protections for the patient, rescue, and hospital staff and for some even into the postdischarge phase. For pending COVID-19 determination and also for those shown to be COVID-19 affected, strict infection control is needed at all times to reduce spread of infection and to protect healthcare staff, using the wealth of well-described methods. For COVID-19 patients with stroke, thrombolysis and thrombectomy should be continued, and the usual early management of hypertension applies, save that recent work suggests continuing ACE inhibitors and ARBs. Prothrombotic states, some acute and severe, encourage prophylactic LMWH unless bleeding risk is high. COVID-19-related cardiomyopathy adds risk of cardioembolic stroke, where heparin or warfarin may be preferable, with experience accumulating with DOACs. As ever, arteritis can prove a difficult diagnosis, especially if not obvious on the acute angiogram done for clot extraction. This field is under rapid development and may generate management recommendations which are as yet unsettled, even undiscovered. Beyond the acute management phase, COVID-19-related stroke also forces rehabilitation services to use protective precautions. As with all stroke patients, health workers should be aware of symptoms of depression, anxiety, insomnia, and/or distress developing in their patients and caregivers. Postdischarge outpatient care currently includes continued secondary prevention measures. Although hoping a COVID-19 stroke patient can be considered cured of the virus, those concerned for contact safety can take comfort in the increasing use of telemedicine, which is itself a growing source of patient-physician contacts. Many online resources are available to patients and physicians. Like prior challenges, stroke care teams will also overcome this one. Key Messages: Evidence-based stroke management should continue to be provided throughout the patient care journey, while strict infection control measures are enforced.

Background and Purpose-Futile recanalization after acute ischemic stroke occurs in almost half of the patients despite optimal angiographic results. Multimodal neuroimaging may help to improve patient's selection but is still dismissed by many interventionalists. Our aim was to evaluate the accuracy of each parameter of multimodal computed tomography (CT) and their combination for predicting futile recanalization after successful thrombectomy. Methods-We retrospectively reviewed a cohort of consecutive patients with anterior circulation stroke, fully assessable multimodal CT, and successful recanalization. Nonenhanced CT, CT angiography source images, cerebral blood volume (CBV), cerebral blood flow (CBF), and mismatch CBV-CBF maps were studied by Alberta Stroke Program Early CT Score (ASPECTS); collaterals on CT angiography were graded as poor or good (≤50% or >50% of the middle cerebral artery territory). Futile recanalization was defined as modified Rankin Scale score >2 at 3 months despite successful recanalization. Results-One hundred fifty patients were included and 57% of them had futile recanalization. They had lower ASPECTS on nonenhanced CT, CT angiography source images, CBV, CBF, and mismatch CBV-CBF and presented more frequently poor collaterals (all P<0.001). Among them, CBV showed the highest area under the curve (0.83; 95% confidence interval, 0.76-0.88). In multivariate analyses, CT angiography source images ≤5 (odds ratio, 5.1; 95% confidence interval, 1.2-21.9), CBV≤6 (odds ratio, 3.5; 95% confidence interval, 1.2-9.7), and poor collaterals (odds ratio, 8.6; 95% confidence interval, 1.8-41.7) were independent predictors of futile recanalization. A combined score of these 3 parameters added complementary information: 57% of the patients with score-1, 89% with score-2, and 100% with score-3 had futile recanalization. Reclassification analyses indicated that this score improved prediction of futile recanalization. Conclusions-In this population, a combined multimodal CT score predicted futile recanalization.

BACKGROUND AND PURPOSE:Acute vertebrobasilar occlusion is an ominous disease with few proved effective treatments. Experience with stent retrievers is scarce and limited to combined therapies (stent retrievers associated with previous intravenous fibrinolysis, intra-arterial thrombolysis, or other mechanical devices). We present our experience with 18 patients treated with direct thrombectomy by using stent retrievers.

Only few published data are available on ticks and tick-borne zoonotic pathogens in Bolivia. To evaluate rickettsial seroprevalence and infection in dogs and ticks, during February-April 2007, we collected whole blood, sera, and ticks from dogs living in the rural, peri-urban, and urban areas of Cochabamba, Bolivia. Dog sera were subjected to enzyme-linked immunosorbent assay test to detect IgG antibodies against Rickettsia rickettsii and 68.2% of samples were found to be positive (n = 30; 95% confidence interval [CI]: 52.4-81.4). Blood samples and ticks were tested using polymerase chain reaction to detect spotted fever group (SFG) rickettsiae. One blood sample was positive for Rickettsia parkeri (2.3%; 95% CI: 0.06-12.3). Ticks were collected from 10 dogs and were identified as Amblyomma tigrinum (n = 44) and Rhipicephalus sanguineus (n = 1). All A. tigrinum ticks were collected from resident dogs from the rural areas of Cochabamba, whereas R. sanguineus was from a dog originating from Santa Cruz. Of 42 DNA samples extracted from ticks, 23 (54.8%; 95% CI: 38.7-70.1) were polymerase chain reaction positive for Rickettsia spp. Sequencing analysis identified 22 samples as R. parkeri and one as Rickettsia aeschlimannii. Positive ticks (all A. tigrinum) were collected from six dogs, all of which were seropositive. This is the first report of SFG rickettsiae in A. tigrinum, suggesting that this tick-like others species in the Amblyomma maculatum group--may play a role in the biological cycle of Ri. parkeri. The high infection prevalence of SFG rickettsiae in ticks and the even higher seroprevalence in dogs suggest an active circulation of agents of rickettsiosis in the study area, although there are no confirmed cases of infection in humans. Our study supports the use of canine serology as risk indicator for SF rickettsioses.

Objective: Procedural characteristics, including stent design, may influence the outcome of carotid artery stenting (CAS). A thorough comparison of the effect of stent design on outcome of CAS is thus warranted to allow for optimal evidence-based clinical decision making. This study sought to evaluate the effect of stent design on clinical and radiological outcomes of CAS.Methods: A systematic search was conducted in MEDLINE, Embase, and Cochrane databases in May 2018. Included were articles reporting on the occurrence of clinical short-and long-term major adverse events (MAE, any stroke or death) or radiological adverse events (new ischemic lesions on postprocedural magnetic resonance diffusion-weighted imaging (MR-DWI), restenosis or stent fracture) in different stent designs used to treat carotid artery stenosis.Random effects models were used to calculate combined overall effect sizes. Meta-regression was performed to identify the effect of specific stents on MAE rates. Results: From 2,654 unique identified articles, two randomized controlled trials and 66 cohort studies were eligible for analysis (including 46,728 procedures). Short-term clinical MAE rates were similar for patients treated with open cell versus closed cell or hybrid stents. Use of Acculink stent was associated with a higher risk of MAE compared to Wallstent (RR: 1.51, p=0.03), as was true for use of Precise stent versus Xact stent (RR: 1.55, p<0.001). Long-term clinical MAE rates were similar for open versus closed cell stents. Use of open cell stents predisposed to a 25% higher chance (RR: 1.25; p=0.03) of developing postprocedural new ischemic lesions on MR-DWI. No differences were observed in incidence of restenosis, stent fracture, or intraprocedural hemodynamic depression with respect to different stent design. [Type here] Conclusions: Stent design does not affect short-or long-term clinical MAE rates in patients undergoing CAS. Furthermore, the division in open and closed cell stent design might conceal true differences in single stent efficacy. Nevertheless, open cell stenting resulted in a significantly higher number of MR-DWI-detected subclinical postprocedural new ischemic lesions compared with closed cell stenting. An individualized patient data meta-analysis,including future studies with prospective homogenous study design, is required to adequately correct for known risk factors and provide definite conclusions with respect to carotid stent design for specific subgroups.

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