BACKGROUND AND PURPOSE: FD stent placement is a promising therapy for challenging intracranial aneurysms. Long-term evaluations about angiographic and morphologic results are still missing. This is the aim of this multicenter series.

Background and Purpose: The efficiency of prehospital care chain response and the adequacy of hospital resources are challenged amid the coronavirus disease 2019 (COVID-19) outbreak, with suspected consequences for patients with ischemic stroke eligible for mechanical thrombectomy (MT). Methods: We conducted a prospective national-level data collection of patients treated with MT, ranging 45 days across epidemic containment measures instatement, and of patients treated during the same calendar period in 2019. The primary end point was the variation of patients receiving MT during the epidemic period. Secondary end points included care delays between onset, imaging, and groin puncture. To analyze the primary end point, we used a Poisson regression model. We then analyzed the correlation between the number of MTs and the number of COVID-19 cases hospitalizations, using the Pearson correlation coefficient (compared with the null value). Results: A total of 1513 patients were included at 32 centers, in all French administrative regions. There was a 21% significant decrease (0.79; [95%CI, 0.76–0.82]; P <0.001) in MT case volumes during the epidemic period, and a significant increase in delays between imaging and groin puncture, overall (mean 144.9±SD 86.8 minutes versus 126.2±70.9; P <0.001 in 2019) and in transferred patients (mean 182.6±SD 82.0 minutes versus 153.25±67; P <0.001). After the instatement of strict epidemic mitigation measures, there was a significant negative correlation between the number of hospitalizations for COVID and the number of MT cases ( R 2 −0.51; P =0.04). Patients treated during the COVID outbreak were less likely to receive intravenous thrombolysis and to have unwitnessed strokes (both P <0.05). Conclusions: Our study showed a significant decrease in patients treated with MTs during the first stages of the COVID epidemic in France and alarming indicators of lengthened care delays. These findings prompt immediate consideration of local and regional stroke networks preparedness in the varying contexts of COVID-19 pandemic evolution.

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Question: Is early neurological deterioration of ischemic origin (END i ) predictable in minor strokes with large vessel occlusion (LVO) treated with intravenous thrombolysis (IVT)?Findings: In a multicentric retrospective cohort of minor stroke patients (NIHSS≤5) with LVO intended for IVT alone (n=729), an easily applicable score based on occlusion site and thrombus length -two independent predictors of END i -showed good discriminative power for END i risk prediction, and was successfully validated in an independent cohort (n=347).Meaning: END i can be reliably predicted in IVT-treated minor strokes with LVO, which may help to select the best candidates for direct transfer for additional thrombectomy.

Background: Intra-arterial thrombolysis may reduce mortality in acute basilar artery (BA) occlusion. We wanted to identify an easy-to-use pre-treatment MR-based predictor of clinical outcome in patients with acute BA occlusion treated with IAT. Methods: We analyzed 16 patients with acute BA occlusion prospectively. Vascular risk factors, as well as National Institutes of Health Stroke Scale (NIHSS) and Glasgow Coma Scale (GCS) scores were recorded on admission, together with a 10-point semiquantitative score reflecting the number of acute ischaemic brain lesions on diffusion-weighted imaging. The recanalization grade was evaluated by angiography. The clinical outcome, using the modified Rankin scale (mRs), was measured 3 months later. Results: Risk factors, NIHSS and GCS scores, time from symptom onset to treatment, recanalization rate, outcome and outcome predictors (such as age, NIHSS and GCS scores) were comparable to other studies. Haemorrhagic transformation of infarction occurred in 2 patients (12.5%). We found that a high lesion score was an additional predictor of poor outcome (p = 0.026). Conclusions: In patients with acute BA occlusion, treated with intra-arterial recombinant tissue plasminogen activator, a high number of acute ischaemic lesions, based on diffusion-weighted imaging, is a predictor of poor clinical outcome.

EVT of MCA aneurysms was safe and long-term monitoring of patients showed a low rate of recurrence requiring retreatment. However, complex anatomy and long-term recurrences have to be addressed when considering EVT for MCA aneurysms.

BACKGROUND AND PURPOSE:Clinical outcome and initial and midterm angiographic results of EVT of complex MCA aneurysms by using the stent-assisted coiling technique were retrospectively evaluated in our center where EVT of intracranial aneurysms is the first treatment option.

BACKGROUND AND PURPOSE: Flow-diverter technology has proved to be a safe and effective treatment for intracranial aneurysm based on the concept of flow diversion allowing parent artery and collateral preservation and aneurysm healing. We investigated the patency of covered side branches and flow modification within the parent artery following placement of the Pipeline Embolization Device in the treatment of intracranial aneurysms.