Thromboembolic events rarely occurred beyond 30 days after SAC/FD. The duration of DAPT may be shortened if patients have a periprocedural period without events. Further prospective studies are warranted to determine the optimal duration of antiplatelet therapy.

The study highlights multiple risk factors for ischemic stroke following stent-assisted treatment of cerebral aneurysms, including elevated BMI, hypertension, arterial stiffness, and specific antibody presence.

When it comes to emergency brain conditions, there may be confusion between brain aneurysms and strokes. Both conditions affect the brain’s blood vessels and require immediate medical attention, yet they have distinct causes, symptoms, and treatment approaches. The key difference lies in what happens to your blood vessels: a stroke occurs when blood flow to brain tissue is blocked or when a vessel bursts, while a brain aneurysm is a weakened, bulging area in an artery wall that may or may not rupture.

Flow diverter placement is a minimally invasive endovascular procedure used to treat certain brain aneurysms, particularly large, wide-necked, or complex ones. A fine mesh tube is placed inside the parent artery to redirect blood flow away from the aneurysm, allowing it to clot off and heal over months.

This prospective registry included patients treated with FRED and FREDX devices. Efficacy was assessed using digital subtraction angiography with 3D volumetric reconstruction at immediate and 1 year follow-ups. Safety was evaluated by recording complications, analyzed through univariate contrasts, generalized mixed models, and Bayesian network analyses.

Interventional neuroradiology represents a transformative shift in treating complex neurological conditions through minimally invasive, catheter-based procedures guided by advanced imaging technologies including fluoroscopy, digital subtraction angiography, and CT or MRI. This subspecialty, also known as endovascular neurosurgery, addresses life-threatening emergencies such as ruptured cerebral aneurysms, acute ischemic strokes, and vascular malformations without requiring open surgery. Key procedures include coil embolization of brain aneurysms, mechanical thrombectomy for stroke, and arterial stenting. The field has experienced dramatic expansion as patients increasingly seek these specialized services. The significance lies in time-critical treatment delivery—every minute matters in stroke and aneurysm cases where traditional open neurosurgery would cause greater physiological trauma. Aligned with the broader medical trend toward minimally invasive approaches, interventional neuroradiology enables treatment through small arterial punctures, allowing patients previously facing weeks of intensive care recovery to be discharged substantially faster with reduced complication rates and improved neurological outcomes.

This retrospective study evaluated the efficacy of balloon guide catheter (BGC) use during mechanical thrombectomy in 475 patients with anterior-circulation large-vessel occlusion (242 with BGC, 233 without). Researchers compared procedural, angiographic, and clinical outcomes between groups using multivariable logistic regression adjusted for multiple baseline factors including age, NIHSS score, collateral status, and occlusion location. BGC use was independently associated with higher odds of 90-day functional independence (modified Rankin Scale 0–2; adjusted OR 1.61) and significantly reduced embolization to new territory (adjusted OR 0.53). However, BGC use was also associated with increased vasospasm risk (adjusted OR 1.68). No significant associations were found with first-pass recanalization or hemorrhagic complications. Importantly, the benefits of BGC did not vary significantly by occlusion location. These findings suggest that BGC use during mechanical thrombectomy offers meaningful clinical benefits through improved functional outcomes and reduced thromboembolic complications, though with a tradeoff of increased vasospasm risk, supporting its broader clinical application in acute ischemic stroke treatment.

# Intraoperative Intra-aneurysmal Pressure Monitoring Summary Intraoperative pressure monitoring within cerebral aneurysms represents an innovative approach to improving surgical outcomes during aneurysm repair procedures. This research investigates the application of real-time intra-aneurysmal pressure measurement techniques to guide surgical decision-making and enhance procedural safety. By directly monitoring pressure dynamics within the aneurysm sac during intervention, surgeons can obtain critical hemodynamic data that informs treatment strategies and validates the effectiveness of repair methods such as clipping or endovascular techniques. The findings demonstrate that this monitoring capability provides actionable metrics for assessing aneurysm stability and predicting rupture risk during surgery. This development holds significant clinical importance as it enables more precise surgical planning, reduces complications from inadequate repair, and potentially improves patient outcomes by facilitating real-time adjustments to surgical technique. The ability to quantify intra-aneurysmal pressure offers a novel objective measure for confirming successful aneurysm treatment, moving beyond traditional anatomical visualization alone to incorporate functional hemodynamic data into intraoperative decision protocols.

The Neurocritical Care Society and the Society of Critical Care Medicine have released a focused guideline update addressing the management of antithrombotic-associated intracranial hemorrhage in adults. Published in September 2026, this open-access guideline provides evidence-based recommendations for clinicians treating patients who develop intracerebral bleeding while on anticoagulant or antiplatelet therapy. The update synthesizes current literature on reversal strategies, hemostatic interventions, and supportive care measures tailored to different antithrombotic agents, including warfarin, direct oral anticoagulants, and antiplatelet medications. These guidelines matter significantly because antithrombotic-associated intracranial hemorrhage represents a serious complication with high morbidity and mortality rates, and optimal management requires rapid, coordinated intervention. By establishing standardized treatment protocols, these recommendations aim to improve patient outcomes, reduce clinical variability, and guide resource allocation in neurocritical care settings. The open-access format ensures broad accessibility for healthcare professionals managing this complex and time-sensitive condition.

Intravenous tissue plasminogen activator (tPA), including alteplase and tenecteplase, represents standard therapeutic intervention for acute ischemic stroke in eligible patients. These fibrinolytic agents dissolve cerebral arterial clots within a critical 4.5-hour treatment window, potentially reversing neurological damage and significantly improving long-term patient outcomes. Before administration, clinicians must rapidly apply exclusion criteria to rule out contraindications including active bleeding, recent surgery, and severe hypertension, with hemorrhage definitively excluded via CT imaging. The treatment approach follows the "time is brain" principle, recognizing that millions of neurons are lost every minute without intervention. Early thrombolysis administration substantially enhances quality of life and functional recovery. Rapid recognition of stroke symptoms and emergency evaluation using the FAST test (Face, Arms, Speech, Time) are essential for identifying candidates for tPA therapy. Prompt medical attention and specialist assessment determine treatment eligibility and optimal management strategies for acute ischemic stroke patients.

Mechanical thrombectomy, or endovascular thrombectomy, is a minimally invasive procedure that removes blood clots from large brain arteries in acute ischemic stroke patients. A specially trained physician advances a catheter through an artery and uses a stent retriever, suction device, or combination of both to capture and restore blood flow. Effectiveness is maximized when performed early, though selected patients may benefit from treatment up to 24 hours after symptom onset, depending on imaging, blockage location, and clinical factors. Recent guidance has expanded eligibility criteria for this life-saving intervention. Treatment decisions should involve a coordinated stroke and neurointerventional team using current national protocols and advanced imaging to identify candidates. Intravenous thrombolytic agents like tenecteplase can be administered concurrently without delaying thrombectomy evaluation. Hospitals without thrombectomy capability must establish clear transfer protocols. Post-procedure care requires intensive neurological monitoring in specialized stroke units. While mechanical thrombectomy significantly improves patient outcomes, it carries procedural risks that should be discussed with patients when feasible.

Researchers have developed a sophisticated contact-resolved finite-element computational framework to model the deployment of the Contour Neurovascular System (CNS), an intrasaccular flow disruptor device used to treat wide-necked intracranial aneurysms. The framework represents the CNS as a dual-layer interwoven Nitinol braid using geometrically exact beam models while modeling the aneurysm wall as a deformable hyperelastic shell. During staged deployment, the model accounts for frictional contact governing wire-wire and wire-wall interactions. Testing across three patient-specific anatomies revealed that seated configuration is highly sensitive to device-wall tangential friction and release depth relative to the aneurysm neck plane. Frictionless contact permits substantial post-contact sliding, whereas finite friction significantly suppresses residual pole motion. Release depth critically influences both wall engagement onset and deployment trajectory. The study demonstrates that conventional geometric placement approaches, which prescribe final device configuration, cannot capture actual contact mechanics or wall-supported states. This mechanics-based framework enables more accurate deployed geometries for subsequent hemodynamic, fluid-structure interaction, and mechanobiological analyses, potentially improving treatment planning for intracranial aneurysm patients.

Baystate Health announced its participation in the PIONEER clinical trial, a national study investigating advanced treatment options for brain aneurysms. The trial represents a significant opportunity to evaluate innovative therapeutic approaches for patients with this serious neurological condition. By enrolling patients in this research initiative, Baystate Health aims to contribute to the broader medical community's understanding of effective aneurysm management strategies. The announcement, made on September 25, 2026, underscores the institution's commitment to offering cutting-edge treatment options and advancing clinical knowledge in neurovascular disease. Participation in such multicenter trials is crucial for developing evidence-based protocols that can improve patient outcomes and expand the therapeutic arsenal available to healthcare providers treating complex brain aneurysms.

During long-term antiplatelet agents (APAs) administration, patients with thrombotic diseases take a fairly high risk of life-threatening bleeding, especially when in need of urgent surgery. Rapid functional reversal of APAs remains an issue yet to be efficiently resolved by far due to the lack of any specific reversal agent in the clinic, which greatly restricts the use of APAs.

Our proposed SAPT regimen, consisting of ticagrelor or prasugrel with peri-interventional bridging using tirofiban, proved effective in preventing thromboembolic events and minimizing rebleeding in the treatment of ruptured BBAs by FDSs with surface modification. Further investigation through larger, randomized, multicenter studies is warranted to more robustly evaluate the safety and efficacy of this approach.

This comprehensive review delves into the evolving field of neurointervention for intracranial aneurysms, exploring the critical adjunct of Dual Antiplatelet Therapy (DAPT) to endovascular coiling, stent-assisted coiling (SAC), flow-diversion stents, and flow-disruption (intrasaccular) devices. Despite growing evidence supporting the success of DAPT in reducing thromboembolic events, the lack of consensus on optimal regimens, doses, and duration is evident. Factors contributing to this variability include genetic polymorphisms affecting treatment response and ongoing debates regarding the clinical significance of hemorrhagic complications associated with DAPT. This review analyzes pre- and post-procedural antiplatelet usage across various interventions. The imperative lies in ongoing research to define optimal DAPT durations, ensuring a nuanced approach to the delicate balance between thrombosis and hemorrhage in intracranial aneurysm management.

A case report documents a dural arteriovenous fistula presenting with reversible Parkinsonism and cognitive decline that closely mimicked progressive supranuclear palsy. The patient exhibited parkinsonian features and cognitive impairment characteristic of PSP, a neurodegenerative disorder typically considered irreversible. However, imaging revealed an underlying dural arteriovenous fistula—an abnormal connection between dural arteries and venous sinuses causing venous hypertension and cerebral dysfunction. Following endovascular intervention to treat the fistula, the patient's neurological symptoms, including both parkinsonian features and cognitive decline, demonstrated significant reversibility. This case is clinically significant as it highlights the importance of considering vascular etiologies in the differential diagnosis of atypical parkinsonian syndromes. Dural arteriovenous fistulas can mimic neurodegenerative diseases through hemodynamic compromise and venous congestion affecting motor and cognitive circuits. Recognition of this treatable condition prevents misdiagnosis and unnecessary exposure to disease-modifying therapies for irreversible conditions, while identifying patients who may benefit from vascular intervention and achieve functional recovery.

Cribriform plate dural arteriovenous fistulas (DAVF) represent rare but dangerous neurovascular lesions in the anterior cranial fossa characterized by abnormal shunts between dural arteries and cortical veins. Unlike typical DAVFs, these lesions drain directly into fragile frontal pial veins rather than major dural sinuses, creating substantial hemorrhage risk with patients presenting acute subarachnoid or intraparenchymal bleeding. Diagnosis relies on magnetic resonance angiography and digital subtraction angiography identifying feeder networks from ethmoidal branches of the ophthalmic artery. Historically, transarterial embolization served as the primary treatment, with operators delivering liquid embolic agents through microcatheters via the ophthalmic artery. However, this approach presents significant limitations, including technical difficulty navigating the tiny, tortuous ethmoidal arteries, incomplete obliteration rates of only 53.8%, and serious complications such as central retinal artery occlusion causing permanent blindness. Recent clinical experience has prompted exploration of alternative transvenous approaches to overcome these drawbacks. Given the aggressive natural history of untreated lesions and high rebleeding mortality, improved endovascular techniques are essential for preventing catastrophic outcomes while minimizing procedural morbidity in this challenging patient population.

This systematic review and meta-analysis, conducted according to PRISMA 2020 guidelines, examined the safety of antiplatelet reversal before emergency intracranial surgery in patients with ruptured aneurysms treated with stent-assisted coiling or flow diversion. Analyzing sixty-three records from fifty-nine studies, including four randomized controlled trials and fifty-five comparative cohorts, researchers found that antiplatelet exposure during cerebrospinal fluid diversion significantly increased radiographic catheter-tract hemorrhage fourfold and symptomatic hemorrhage nearly fourfold. Notably, platelet concentrate transfusion provided no clinical benefit and was associated with increased mortality or dependence, whereas desmopressin administration reduced hematoma expansion. Pre-procedural P2Y12 reaction units demonstrated moderate predictive accuracy for complications, while thromboelastography with platelet mapping proved unreliable. These findings challenge current practice by suggesting that reversing antiplatelet therapy with transfusion may be harmful, and that pharmacological approaches like desmopressin offer superior safety profiles for managing emergency neurosurgery in antiplatelet-exposed patients.

Mechanical thrombectomy is an endovascular intervention for acute ischemic stroke caused by large vessel occlusion in the internal carotid artery, middle cerebral artery (M1 or proximal M2 segment), or basilar artery. The procedure uses stent retrievers or aspiration catheters to physically extract blood clots from cerebral arteries and is performed under local or general anesthesia in an interventional neuroradiology suite. Recent clinical trials, including DAWN and DEFUSE-3, have expanded the treatment window to 24 hours in carefully selected patients using CT perfusion or diffusion-weighted MRI mismatch criteria. The procedure is frequently combined with intravenous thrombolysis using alteplase or tenecteplase when patients meet eligibility criteria. Successful reperfusion, defined as TICI 2b-3 (Thrombolysis in Cerebral Infarction score), significantly reduces disability outcomes. This technique represents a critical advancement in acute stroke management, offering patients substantially improved functional recovery when performed within appropriate time windows and anatomical criteria.