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However, the complexity of this technique justifies the development of collaborative stroke center networks with interhospital transfers of eligible patients. 6 To date, these stroke care networks have been implemented in regional settings, connecting a comprehensive stroke center (CSC) with primary stroke centers and general hospitals. 6 This approach has been designed principally to improve the rates of IVT in IS, but it has also played an important role in patients eligible Background and Purpose-The complexity of endovascular revascularization treatment (ERT) in acute ischemic stroke and the small number of patients eligible for treatment justify the development of stroke center networks with interhospital patient transfers. However, this approach might result in futile transfers (ie, the transfer of patients who ultimately do not undergo ERT). Our aim was to analyze the frequency of these futile transfers and the reasons for discarding ERT and to identify the possible associated factors. Methods-We analyzed an observational prospective ERT registry from a stroke collaboration ERT network consisting of 3 hospitals. There were interhospital transfers from the first attending hospital to the on-call ERT center for the patients for whom this therapy was indicated, either primarily or after intravenous thrombolysis (drip and shift). Results-The ERT protocol was activated for 199 patients, 129 of whom underwent ERT (64.8%). A total of 120 (60.3%) patients required a hospital transfer, 50 of whom (41%) ultimately did not undergo ERT. There were no differences in their baseline characteristics, the times from stroke onset, or in the delays in interhospital transfers between the transferred patients who were treated and those who were not treated. The main reasons for rejecting ERT after the interhospital transfer were clinical improvement/arterial recanalization (48%) and neuroimaging criteria (32%). Conclusions-Forty-one percent of the ERT transfers were futile, but none of the baseline patient characteristics predicted this result. Futility could be reduced if repetition of unnecessary diagnostic tests was avoided.

MT is more laborious and shows more procedural complications in BAO than in anterior circulation strokes. The likelihood of futile recanalization is higher in BAO and is associated with greater age and longer procedure duration. A refinement of endovascular procedures for BAO might help optimize the results.

SAH is a severe and complex disease which must be managed in specialised centres by professionals with ample experience in relevant diagnostic and therapeutic processes.

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Implementation of a collaborative network to provide EVT for AIS is feasible and effective. Results are good in terms of re-canalization rates and clinical outcomes.

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Infarction in the vertebrobasilar system presenting as a posterior fossa mass lesion is extremely rare in children. We recently studied and treated a 9-year-old boy with cerebellar infarct produced by angiographicalh/ confirmed Type I fibromuscular dysplasia of the vertebral artery, complicated by a dissecting aneurysm. This case appears to be the first reported in the literature. (Stroke 1988; 19:521-524) I nfarction in the vertebrobasilar system presenting as a posterior fossa mass lesion is extremely rare in children. Of only 21 cases published in the literature, the cause was unknown in half. The etiologic factors in the others were trauma in four cases, infection in three cases, and dehydration, cervical spine anomaly, and basilar artery migraine in one case each. A congenital vascular anomaly was implicated only once. 1 We recently treated a 9-year-old boy with cerebellar infarct produced by Type I fibromuscular dysplasia (FMD). Angiography confirmed this diagnosis and revealed a dissecting aneurysm. To our knowledge this is the first case of this type reported in the literature. Case ReportThis 9-year-old boy was well until July 15, 1986, when he had a 10-minute episode of loss of consciousness, ocular deviation, and myoclonus in the upper extremities. Similar episodes accompanied by vomiting were repeated 2 and 4 days later. He was admitted to a local hospital on July 21, 1986, when computed tomography (CT scan) was performed and he was transferred to our hospital. His medical history was unremarkable. His 36-year-old mother had suffered from convulsive seizures between the ages of 10 and 20 years.The findings of a general physical examination were normal. Neurologic examination revealed a somnolent boy who opened his eyes and responded to simple commands when aroused. He had weakness of the right lateral rectus muscle and no papilledema; the other cranial nerves were normal. His motor function showed general hypotonia, hyporeflexia, and flexor plantar responses. His gait was ataxic.From the