Transverse diameter of brainstem infarction is a strong predictor of miserable outcome after mechanical thrombectomy for acute basilar artery occlusion.

Although the efficacy of mechanical thrombectomy (MT) for acute basilar artery occlusion (ABAO) has been established in two randomized controlled studies, many patients have miserable clinical outcomes after MT for ABAO. Predicting severe disability prior to the procedure might be useful in determining the appropriateness of treatment interventions. Among the ABAO cases treated at 10 hospitals between July 2014 and December 2021, 144 were included in the study, all of whom underwent MRI before treatment. A miserable outcome was defined as a modified Rankin Scale (mRS) of 5-6 at 3 months. The associations between clinical, imaging, and procedural factors and miserable outcomes were evaluated. A miserable outcome was observed in 54 cases (37.5%). Multivariate analysis identified the National Institutes of Health Stroke Scale (NIHSS), transverse diameter of brainstem infarction, and symptomatic intracerebral hemorrhage as independent factors associated with miserable outcomes, with cutoff values of NIHSS 22 and transverse diameter of brainstem infarction 15 mm. Cases with a higher preoperative severity may result in miserable postoperative outcomes. Particularly, the transverse diameter of a brainstem infarction can be easily measured and serves as a useful criterion for determining treatment indications.

Validity about Diameter of Guiding Catheter for Posterior Circulation Derived by MRA Study.

Objective: The development of large-bore aspiration catheters (ACs) has advanced the treatment of mechanical thrombectomy (MT) and their use requires larger guiding catheters (GCs). However, due to the small vessel diameter of the vertebral artery (VA), it can be difficult to cannulate large-bore GC to the VA. This study aims to determine the percentage of VAs that are amenable to GC placement based on the use of a large-bore AC and to clarify the diameters of VAs in the general population using neck MRA. Methods: Left and right VA diameters were measured in 1394 consecutive adult patients who underwent neck MRA at our hospital between April 2020 and June 2021. Sex and left/right differences in the VA diameters, as well as the conformity ratios of GCs (6, 7, and 8 French) to right and left VAs, were examined. Results: The patients ranged in age from 18 to 98 years (mean 70.8 ± 13.5 years), with 770 (55.2%) males. The left and right VA mean diameters were 2.82 ± 0.75 mm (range 0-5.1 mm) and 2.65 ± 0.75 mm (range 0-5.3 mm), respectively. The conformity ratios of 6, 7, and 8 French GC to left and right VAs were 85.3% and 79.9%, 74.9% and 68.4%, and 60.9% and 53.7%, respectively. Conclusion: When performing MT for the posterior circulation system, a large-bore AC of 0.060 inches or larger is usually required, and GC placement of 7-French or larger is necessary. The results of this study showed that 7-French GC placement is achievable in approximately 70% of these cases.

The Safety and Efficacy of Triple Antiplatelet Therapy after Intracranial Stent-Assisted Coil Embolization.

BACKGROUND: Stent-assisted coil embolization is effective for intracranial aneurysms, especially for wide-necked aneurysms; however, the optimal antiplatelet regimens for postoperative ischemic events have not yet been established. We aimed at determining the efficacy and safety of a triple antiplatelet therapy regimen after intracranial stent-assisted coil embolization. METHODS: We retrospectively evaluated patients who underwent stent-assisted coil embolization for unruptured intracranial aneurysms or during the chronic phase of a ruptured intracranial aneurysm (≥ 4 weeks after subarachnoid hemorrhage onset). We recorded the incidence of ischemic and bleeding events 140 days postoperatively. RESULTS: We assessed 79 cases in patients who received either dual (n = 51) or triple (n = 28) antiplatelet therapy. The duration of triple antiplatelet therapy was 49 ± 29 days. Seven patients in the dual group experienced postoperative ischemic events. Compared to the dual group, the triple group had a similar incidence of postoperative bleeding events but a significantly lower incidence of postoperative ischemic events (P < .05). CONCLUSIONS: Triple antiplatelet therapy had a significantly lower incidence of postoperative ischemic events and a similar incidence of postoperative bleeding events 140 days postoperatively.