Anaesthesia-related complications after endovascular therapy for acute ischaemic stroke under general anaesthesia with early extubation: A single-centre retrospective cohort study.

Impact of ultrasound-guided popliteal sciatic nerve block on endovascular therapy for below-the-knee lesions in chronic limb-threatening ischemia.

Infrainguinal bypass with alternative conduits in diabetic patients with chronic limb-threatening ischemia.

A novel technique for preventing distal embolism during endovascular therapy for femoropopliteal lesions: The flow-controlled anti-embolic technique.

Endovascular therapy is the preferred option for arteriovenous fistula dysfunction. The aim of this trial is to compare the 12-month efficacy and safety outcomes of cutting balloon with the drug-coated balloon. The DRAGON study is a multicenter, prospective, observational cohort study. One hundred and eighty patients with stenosis of the venous segment of arteriovenous fistula will be recruited for treatment with the cutting balloon or the drug-coated balloon. The primary efficacy endpoint is the 12-month target-lesion primary patency rate. The secondary efficacy endpoints are the 3- and 6-month target-lesion primary patency rate, the 6- and 12-month access-circuit primary patency rate, the total number of target-lesion reintervention, the 12-month target-lesion reintervention rate, and the 12-month access-circuit thrombosis rate. The safety endpoints included complications and death. The Dragon study has been registered at www. gov (registration number: NCT06527963). The study protocol has been approved by the Institutional review board and Human Research Ethics Committee of Renji Hospital, School of Medicine, Shanghai Jiao Tong University (Approved number: LY2024-102-B). The results will be disseminated by publication in a peer-reviewed journal.

In preparation for a planned change of Emergency Medical Services triaging of suspected stroke dispatch in Alberta, we conducted a modeling exercise to predict the return on investment (ROI) of switching from the current endovascular thrombectomy (EVT) within a 6 h window to a 24 h window. Using the Alberta Health Services administrative databases, we estimated the health service utilization (HSU) (including inpatient, outpatient, physician services and prescription drugs) cost of patients with stroke treated with EVT24h following the case-mix group plus methodology. The impact of EVT on HSU cost avoidance (B) and the cost (C) of EVT24h implementation were estimated, including costs for EVT procedure, diagnostic imaging and ambulance for all suspected strokes. Finally, ROI was calculated as the benefit divided by the cost (ROI = B/C). Threshold, deterministic and probabilistic sensitivity analyses were performed. There were 288 patients treated with EVT24h between 2021/22 and 2023/24. The HSU cost per patient in the year following EVT treatment was estimated at $92,201. Given the impact of EVT was 30%, the benefit of EVT was estimated at $39,515. The cost of EVT24h implementation was $24,358 per EVT patient. Accordingly, ROI was estimated at 1.6 (ranged 0.7-2.0), and cost avoidance per patient was $15,157 (ranged - $8013 to $25,362). Given that there were 96 EVT24h per year, the cost avoidance for the health system would be $1.5 million annually. The probabilistic sensitivity analysis showed that the probability for EVT24h to be cost-avoidable (or ROI > 1) was 88.5%. The expansion of EVT from 6 to 24 h is expected to result in a positive ROI.

The impact of age on outcomes in patients with large ischemic stroke [defined as Alberta Stroke Program Early Computed Tomography Score (ASPECTS) ≤ 5] remains unclear. This study aimed to explore the effect of age on clinical outcomes after endovascular therapy (EVT) for acute anterior circulation large ischemic stroke. This subanalysis enrolled patients with acute large ischemic stroke from a prospective multicenter cohort registry from 38 stroke centers across China between November 2021 and February 2023. Patients were stratified into the EVT and standard medical treatment (SMT) groups. The effectiveness outcomes included the distribution of modified Rankin Scale (mRS) score and functional outcomes (mRS 0-2, 0-3, and 0-4) at 90days. Safety outcomes included 90-day mortality, symptomatic intracranial hemorrhage (ICH) within 48h, and any ICH. A total of 745 eligible patients were included in the analysis. Compared with SMT, EVT showed improved 90-day outcomes across different age groups [aged ≤ 65years, adjusted common odds ratio (acOR): 2.11, 95% confidence interval (CI) 1.16-3.81, P = 0.01; aged 66-79years, acOR: 1.23, 95% CI 0.79-1.92, P = 0.36; aged ≥ 80years, acOR: 2.80, 95% CI 1.26-6.22, P = 0.01], while the predicted probabilities of achieving mRS 0-3 decreased and mortality rate increased both in the EVT and SMT groups with advancing age (P for interaction = 0.88 and 0.84, respectively). In conclusion, age is a significant predictor of clinical outcomes in anterior circulation large ischemic stroke. While EVT benefits show progressive age-related decline, meaningful advantages persist even in patients aged ≥ 80years, suggesting that age alone should not contraindicate EVT. However, further validation through large-scale randomized controlled trials is warranted.

Contemporary Systematic review and Meta-analysis of Outcomes associated with femoropopliteal above-the-knee non-autologous surgical bypass.

Pediatric intracranial aneurysms (PIAs) are rare and present with distinct clinical and morphological features compared to adult cases. They are often associated with congenital anomalies, larger size, and unusual locations. Despite advancements in diagnosis and treatment, data about PIAs remain scarce. This study presents a 20-year single center experience in the management of PIAs, alongside a comprehensive literature review. A retrospective review of pediatric patients diagnosed with intracranial aneurysms at a tertiary center between January 2005 and January 2025. Demographic, clinical, radiological, and treatment data were collected. Functional outcomes were assessed using the Glasgow Outcome Scale (GOS). Descriptive statistics, chi-square tests were used for analysis. A narrative literature review was also performed. 38 patients with 61 aneurysms were included (63.2% male; mean age 12.3years). Index aneurysm for each patient was included in the analysis of location and size. Most aneurysms were located in the anterior circulation, particularly the ICA bifurcation (34.2%) and MCA (23.7%). Ruptured aneurysms seen in 73.7% of cases, 44.7% presenting with Fisher grade 4 hemorrhage. Treatment microsurgical clipping (50%), endovascular therapy (36.8%), and conservative management (7.9%). There was no statistically significant association between treatment modality and outcome (p = 0.153). Good functional recovery (GOS 5) achieved in 60.5% of patients; with a mortality rate of 13.2%. PIAs frequently present with rupture and require individualized, multidisciplinary management. Both surgical and endovascular approaches are effective in selected patients, with comparable outcomes. Our findings align with global literature and reinforce the need for early diagnosis, tailored intervention, and long-term follow-up in this unique population.

Accurate and rapid identification of large vessel occlusion (LVO) on CT angiography (CTA) is crucial for optimal management, especially regarding endovascular therapy decisions. Automated tools for LVO detection, including RapidAI and Viz.ai, have been employed in some small studies, but their accuracy has rarely been compared in a large consecutive patient series. The purpose of this study was to evaluate RapidAI and Viz.ai's LVO detection software on CTA in a consecutive series of suspected stroke patients at a comprehensive stroke center. Both software programs were used in parallel for two years to compare the diagnostic accuracy. CTA data from 1,589 consecutive stroke alerts were retrospectively reviewed. Radiology reports and expert review of CTA and CTP imaging confirmed the LVO diagnosis. LVO was defined as occlusion or high-grade stenosis of the intracranial ICA or MCA M1 segment. Cases were excluded if not sent to the software or if there was poor bolus, metal artifact, or brain hemorrhage. 1,523 cases met the inclusion criteria. Among these, 147 (10%) had LVOs. RapidAI processed 1,521 cases (>99%), and Viz.ai processed 1,430 (90%). RapidAI identified 144 LVO cases (98%) vs. 108 (73%) by Viz.ai (P<0.0001). RapidAI correctly identified 94% of LVO-negative cases vs. 91% by Viz.ai (P=0.004). RapidAI detected a higher percentage of LVOs compared to Viz.ai (98% vs 73%) and correctly identified more LVO-negative cases (94% vs 91%). Viz.ai did not detect 39 LVOs. The number of LVOs missed by the Viz.ai software (26%) could potentially lead to delays in LVO diagnosis and treatment times.

Previously, a conditional probability model was developed to determine which transport method, drip and ship (transport to the primary stroke center for thrombolysis and then transfer to an endovascular therapy center) or mothership (direct transport to an endovascular therapy center), predicts the best outcomes for patients with suspected acute ischemic stroke. We compare and validate the conditional probability model based on the RACECAT (Rapid Arterial Occlusion Evaluation in Catalan Trial [Transfer to the Local Stroke Center Versus Direct Transfer to Endovascular Center of Acute Stroke Patients With Suspected Large Vessel Occlusion in the Catalan Territory]). Regional and individual level comparisons were performed by applying the conditional probability model to predict the best transport method compared with actual transport and outcomes. The primary outcome was the modified Rankin Scale score at 90 days. Ordinal logistic regression was used to assess the influence of matching transport methods on 90-day modified Rankin Scale outcomes. Subanalysis was performed to evaluate outcomes of patients with hemorrhagic stroke. The conditional probability model was highly consistent with the RACECAT result overall: transport method outcomes were similar. 66.1% of Catalonia was predicted to have near equivalent outcomes for drip and ship compared with mothership. Drip and ship best predicted transport in larger areas in the daytime, and mothership for larger areas in the night. There was no significant difference in 90-day modified Rankin Scale outcomes between patients with matching versus mismatched transport methods (odds ratio, 1.13 [95% CI, 0.93-1.37]). Patients with hemorrhagic stroke had worse outcomes in those predicted and randomized to mothership versus those predicted to mothership and randomized to drip and ship (odds ratio, 3.53 [95% CI, 1.12-11.12]). The conditional probability model for stroke transport successfully predicted the RACECAT clinical trial results, showing no difference in outcomes between drip and ship and mothership transport methods. URL: https://www.clinicaltrials.gov; Unique identifier: NCT02795962.

Background and purposeAlthough systolic blood pressure variation (ΔSBP) has been regarded as a predictor of poor outcome after endovascular therapy (EVT), its effect at the different time intervals on the prognosis of acute anterior large vessel occlusion remains unclear. The study aims to assess the impact of ΔSBP at different time intervals on futile recanalisation (FRT) of acute anterior circulation large-vessel occlusion stroke after EVT.MethodsA total of 554 consecutive patients who achieved successful recanalisation after EVT were enrolled from the Effect of Endovascular Treatment Alone versus Intravenous Alteplase Plus Endovascular Treatment on Functional Independence in Patients with Acute Ischemic Stroke (DEVT) and Effect of Intravenous Tirofiban versus Placebo Before Endovascular Thrombectomy on Functional Outcomes in Large Vessel Occlusion Stroke (RESCUE BT) trials. ΔSBP was defined as SBP max minus SBP min at different time intervals, including 0–6 hours, 6–12 hours and 12–24 hours after EVT. The primary outcome was FRT at 90 days, defined as a modified Rankin Scale score of 3 to 6. The secondary outcome was symptomatic intracranial haemorrhage within 48 hours.ResultsAmong these patients, 278 patients underwent FRT and 276 achieved useful recanalisation at 90 days. ΔSBP 0–6 hours was found to be positively associated with an increased likelihood of FRT (adjusted OR (aOR) per 5 mm Hg SBP change, 1.014, 95% CI 1.002 to 1.026). Large variation of SBP (ΔSBP >40 mm Hg) in the first 6 hours had a higher probability of FRT (aOR, 1.817, 95% CI 1.059 to 3.117) compared with a ΔSBP of 0–20 mmHg.ConclusionSBP variation within the first 6 hours after EVT was associated with FRT. Large fluctuations (ΔSBP >40 mm Hg) of SBP in 0–6 hours following EVT were found to increase the probability of FRT.

Collateral status provides compensatory flow to ischemic regions in acute large vessel occlusion (LVO) patients and is closely linked to clinical outcomes after endovascular therapy (EVT). This study aimed to evaluate the association between the triglyceride-glucose (TyG) index and collateral status in ischemic stroke patients undergoing EVT, focusing on sex-based differences. Atotal of 789 patients undergoing EVT between September 2018 and January 2024 were retrospectively included in this study. Collateral status was assessed using the ASITN/SIR grading system based on digital subtraction angiography (DSA), classifying patients into poor (grades 0-1) and good (grades 2-4) collateral groups. The association between the TyG index and collateral status was evaluated using multivariable logistic regression analysis, and restricted cubic spline modeling. Among EVT patients (median age69years, 55.8% male), 256 were included in poor collateral group. The TyG index was significantly elevated in patients with poor collaterals compared to those with good collaterals (8.86 [8.43, 9.54] vs. 8.74 [8.35, 9.30], P = 0.021). Logistic regression analysis revealed that an elevated TyG index was independently associated with the risk of poor collateral status (OR = 1.30, 95% CI: 1.05-1.62, P = 0.017), with the association being significant in males (OR = 1.50, 95% CI: 1.08-2.08, P = 0.016) but not in females (OR = 1.21, 95% CI: 0.90-1.64, P = 0.205). In addition, restricted cubic spline modeling showed apositive linear association between the TyG index and poor collateral status in the total patients and males. In this study, we found that the TyG index was significantly associated with poor collateral status in patients undergoing EVT, particularly in males.

Abdominal aortic dissection aneurysm (AADA) with severe proximal stenosis often fails to meet the anatomical criteria for standard endovascular aneurysm repair (EVAR). We report a case of a Chinese Han woman in her 50s who declined open surgery and was successfully treated with an off-label use of a dedicated iliac branch device (IBD) system. This approach appears to be a promising solution for highly stenotic and tortuous aortic anatomy. A Chinese Han woman in her 50s was diagnosed with an abdominal aortic dissection aneurysm during routine screening. Computed tomography angiography (CTA) revealed an infrarenal dissection with extreme proximal aortic stenosis (minimum diameter: 5.5 mm), an aneurysm measuring 23.2 mm in diameter, and a neck length of 11.5 mm. The procedure included balloon pre-dilation of the stenotic segment, coil embolization of the inferior mesenteric artery (IMA), deployment of a G-iliac™ main body stent and a SilverFlow™ iliac limb, adjunctive sac coiling, and simultaneous bilateral "kissing balloon" angioplasty. The patient recovered uneventfully. At one-year follow-up, CTA demonstrated a 13% reduction in aneurysm size, with no endoleak, stent migration, or occlusion, and complete resolution of symptoms. The IBD system represents a viable minimally invasive option for patients with anatomically complex AADA, particularly when conventional EVAR is not feasible and open repair is declined. Tailored device selection combined with meticulous technique may expand the boundaries of endovascular therapy and offer a novel strategy for managing rare aortic pathologies.

The clinical data of 42 consecutive patients with extracranial carotid artery aneurysms (ECAA) who underwent surgical treatment in the Department of Vascular Surgery, the Second Affiliated Hospital of Nanchang University, from January 2012 to December 2024 were retrospectively collected. Based on the Attigah classification of aneurysms, while evaluating anatomical characteristics such as bifurcation involvement, proximal and distal landing zone conditions, and parent artery tortuosity, combined with etiological risks including infection, inflammation, or trauma, individualized treatment plans were formulated. Ultimately, 36 patients underwent endovascular treatment and 6 cases underwent open surgical treatment. In the perioperative period, immediate postoperative digital subtraction angiography (DSA) or postoperative computed tomography angiography (CTA) was used to evaluate aneurysm exclusion and parent-artery patency. The patients were aged (53.3±7.3) years, including 17 females and 25 males. Among them, there were 20 true aneurysms, 19 pseudoaneurysms, and 3 dissecting aneurysms. The surgical technical success rate was 97.6% (41/42). During the perioperative period, 1 (2.2%) patient developed cranial nerve injury after open surgery. The postoperative follow-up time was (18.5±4.6) months, no deaths occurred, and 2 (4.8%) patients developed in-stent restenosis at 6 months postoperatively. Treatment of ECAA should be individualized according to etiology and anatomic characteristics, and endovascular therapy represents a relatively straightforward, safe, and effective option for ECAA.

Intracranial atherosclerotic disease (ICAD) is a common cause of ischemic stroke worldwide. We assessed the clinical outcomes of endovascular treatment in acute large vessel occlusion (LVO) strokes caused by ICAD and compared them with large vessel occlusion strokes not associated with intracranial atherosclerosis (non-ICAD LVO). We included consecutive adult patients diagnosed with LVO stroke who underwent endovascular therapy at Rhode Island Hospital from July 2015 to March 2023, and data were collected retrospectively. We compared baseline characteristics and outcomes, including recurrent in-hospital large vessel occlusion, disability, and mortality between these 2 groups (ICAD LVO vs. non-ICAD LVO). We used the t test, χ 2 , and Fisher exact tests were used for the comparison of groups and adjusted binary logistic regression to compare outcomes between the 2 groups. Our study comprised 1390 adult patients diagnosed with LVO stroke who underwent endovascular therapy at Rhode Island Hospital from July 2015 to March 2023, and data were collected retrospectively. Among these, 68 patients were ICAD LVO, while 1322 individuals were categorized as non-ICAD LVO. In the ICAD-LVO group, 38 patients received stenting, while 30 did not, of whom 23 underwent angioplasty. Patients with ICAD LVO group had a higher odds of reocclusion during hospitalization (11.8% vs. 4%, P =0.008), but there was no significant difference in good 90-day functional outcome (mRS ≤2) (OR: 0.89; 95% CI: 0.45-1.79; P =0.749) and 90-day mortality rate (OR: 1.47; 95% CI: 0.69-3.14; P =0.320) between the ICAD LVO and non-ICAD LVO groups. Our study showed increased odds of reocclusion during hospitalization in the ICAD LVO group following endovascular therapy. However, we did not observe any statistically significant differences in measures of disability and mortality between the 2 groups.

This case report presents mid- to long-term outcomes of thoracic endovascular aortic repair for high-risk type B aortic dissection in a 15-year-old patient with myosin heavy chain protein 11 genetic mutations. A CT scan showed the primary entry tear located on the lesser curvature near the left subclavian artery, and the dissection originated from the descending aorta to the abdominal aorta, accompanied by 80% narrowing of the true lumen. Following successful endovascular therapy using stent-grafts, the patient recovered well. A four-year follow-up CT scan showed significant thoracic aorta remodelling.

Low vision is often observed in patients with chronic limb-threatening ischemia (CLTI) and tissue loss. However, the impact of low vision on wound healing in these patients has not been previously described. We aimed to investigate the relationship between low vision and the wound healing rate in CLTI patients with tissue loss. A total of 74 CLTI patients with de novo tissue loss who underwent endovascular therapy between January 2017 and December 2022 was enrolled in this study. The patients were divided into 2 groups based on the National Eye Institute's criteria for low vision: a low vision group with 24 patients, and a normal vision group with 50 patients. The primary endpoint was the 2-year wound healing rate. The rates of diabetes and renal disease requiring hemodialysis were significantly higher in the low vision group. The 2-year wound healing rate was significantly lower in the low vision group than in the normal vision group (33.3% vs 76.0%; P<0.001). In multivariate analysis, low vision showed an independent association with wound healing outcomes. The wound healing rate was lower in CLTI patients with low vision than in those without low vision. Low vision should be considered a factor associated with wound healing outcomes in CLTI patients.

Acute aortic dissection is the most frequent presentation of acute aortic syndromes and remains a rapidly progressive and life-threatening condition requiring immediate diagnosis and treatment. Advances in surgical techniques, hybrid strategies, and endovascular technologies have expanded treatment options, particularly for high-risk and anatomically complex patients. This narrative review summarizes current evidence and guideline-based strategies for the management of aortic dissection, with emphasis on acute type A disease. The review integrates data from registries, contemporary clinical trials, meta-analyses, and recent international guidelines. Open surgical repair remains the standard of care for acute type A aortic dissection, providing reliable entry tear exclusion, restoration of true lumen perfusion, and prevention of rupture. Expanded surgical strategies such as frozen elephant trunk improve distal aortic remodeling and reduce late reinterventions in selected patients. Hybrid and adjunctive technologies, including modular dissection stents and branched stented anastomosis techniques, aim to improve distal perfusion and simplify arch reconstruction. Endovascular repair of the ascending aorta is emerging as a potential alternative for high-risk or inoperable patients, supported by early feasibility data and dedicated device development. Management of aortic dissection is rapidly evolving toward individualized, anatomy-driven strategies that integrate open, hybrid, and endovascular therapies. While open surgery remains the cornerstone for acute type A dissection, emerging endovascular technologies may expand treatment eligibility in selected patients. Future progress will depend on continued device innovation, multidisciplinary aortic team models, and prospective clinical trials to define optimal treatment algorithms.

Acute limb ischemia (ALI) is a limb- and life-threatening vascular emergency that necessitates prompt revascularization. While both surgical and endovascular interventions are established treatment modalities, contemporary comparative data remain limited. The study aims to evaluate and compare outcomes between these revascularization strategies. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-guided systematic review and meta-analysis were performed. Three databases were searched through January 2026. All studies comparing endovascular versus surgical treatment for ALI were identified. Outcomes of interest included periprocedural and mid-term mortality, major amputation, and reintervention rates. Mid-term outcomes were defined as events occurring at any point during the reported follow-up period. Risk ratios (RRs) or hazard ratios (HRs) with 95% confidence intervals (CIs) were extracted and analyzed using a random-effects model. Twenty-four studies (5 randomized controlled trials, 2 prospective, and 17 retrospective observational studies) comprising 382 465 patients (endovascular: 172 308; surgical: 210 157) were analyzed. In these studies, there was no difference in periprocedural mortality between endovascular and surgical treatment (RR 0.84, 95% CI 0.62-1.14). Endovascular treatment was associated with lower mid-term mortality compared with surgical revascularization (HR 0.84, 95% CI 0.76-0.94). Major amputation showed a similar trend, with comparable periprocedural risk (RR 0.93, 95% CI 0.51-1.71) and reduced mid-term risk with endovascular therapy (HR 0.84, 95% CI 0.77-0.91). Periprocedural reintervention rates were significantly higher in the endovascular group (RR 1.94, 95% CI 1.80-2.08), while mid-term reintervention rates were comparable (HR 1.79, 95% CI 0.79-4.06). In this contemporary meta-analysis of patients treated for ALI, endovascular revascularization was associated with lower mid-term mortality and major amputation rates, whereas surgical intervention was linked to a lower risk of periprocedural reintervention. These findings underscore the importance of a multidisciplinary approach involving a dedicated vascular team to ensure optimal, patient-tailored management. Prospective Register of Systematic Reviews, ID=1042195.Clinical ImpactAcute limb ischemia (ALI) carries high morbidity and mortality, yet comparative data on endovascular versus surgical revascularization are limited. In this meta-analysis of 24 studies including 382 465 patients, periprocedural mortality was similar between approaches, but endovascular therapy reduced mid-term mortality and major amputation risk, despite higher periprocedural reintervention rates. These findings suggest that endovascular-first strategies may be a safe and effective alternative to surgical revascularization. Optimal care requires a multidisciplinary vascular team to tailor interventions, balancing immediate procedural risks with long-term outcomes for each patient.