Background The use of flow diverter stent (FDS) has limitations in cases of subarachnoid haemorrhage caused by ruptured aneurysm, due to the need for double antiplatelet therapy and the delay in the aneurysm occluding. The p48 MW and the p64 MW (Phenox) are available with Hydrophilic Polymer Coating (HPC), that reduces the risk of thrombus formation. Purpose of this study is to evaluate the safety and efficacy of p48 and p64 MW HPC with single antiplatelet therapy for the acute treatment of ruptured aneurysm. Methods We retrospectively evaluated all patients treated for acutely ruptured aneurysms with a p48 MW HPC or p64 MW HPC from October 2019 to April 2020 using single antiplatelet therapy. For each patient, we considered demographic and aneurysm-related data, clinical presentation, size and location of the implanted flow diverter stent, intra- and post-procedural complications, aneurysm occlusion. Results Seven patients were included. The ruptured aneurysms were four saccular, two blister-like and one dissecting, six in the anterior and one in posterior circulation. No intraprocedural stent thrombosis and rebleeding was observed. In two cases the aneurysm is completely excluded, in one patient it was found only neck perfusion, in three cases there were mild reduction of the sac and in one case there was a persistent perfusion. No patients needed retreatment in this series. Conclusion In our experience, FDS HPC appears a potential treatment option in selected cases. Our study is limited by small population and short-term follow-up. We report our preliminary data, but further investigations are necessary.

Introduction Mechanical thrombectomy with ADAP-technique of ischemic stroke has been reported as fast and effective. Aim of this study is to evaluate imaging criteria as possible predictors of stroke severity, therapeutic success, and outcome. Materials and Methods Patients (30) presenting from October 2015 to April 2017 with Emergent Large Vessel Occlusion of the anterior circulation were treated with ADAP-technique. 22 received also IV tPA; 8 underwent endovascular treatment only. Every patient was evaluated with noncontrast CT, multiphase angiography-CT, and perfusion CT. Clinical and radiological characteristics were measured. Good clinical outcome was an improvement of 8 points on NIHSS at discharge or a modified Rankin Scale ≤2 at discharge and at 90 days. Results Successful revascularization was obtained in 57% of patients, no procedural complications were witnessed, and only two hemorrhages were reported. Good outcome at discharge was obtained in 11 patients (37%) and predicted by NCCT ASPECT and TICI; outcome at 90 days was predicted by NCCT ASPECT, clot length, and premorbid mRS. Mortality was 23% at discharge and 30% at 90 days. Conclusion ADAPT is an effective endovascular method of stroke treatment with fast procedural times. Multimodal CT evaluation is effective in assessing stroke severity, providing important prognostic information, which is able to select patients for the appropriate treatment.

Background: Although it is clear that stroke is a time-dependent and age-associated disease, we still need more evidence regarding the efficacy and outcomes in elderly patients who were excluded from the first trials of mechanical thrombectomy. The aim of this study is to highlight patient characteristics, the timing of medical attention and therapy, successful recanalization, and functional outcomes in patients over 80 y/o who underwent mechanical thrombectomy at the Ospedale Maggiore della Carità di Novara (Hub) since endovascular stroke treatment was first started here. Methods: all 122 consecutive patients over 80 y/o at admission who underwent mechanical thrombectomy between 2017 and 2022 at our Hub center were retrospectively included in our database. A good functional outcome in these elderly patients was considered as the 90 days modified Rankin Scale (mRS) ≤ 3 and/or a decrease in functional status as ∆mRS ≤ 1 in order to interpret the results for patients with intact intellect and basal mRS > 3. Successful recanalization as a score of TICI ≥ 2b (Thrombolysis in Cerebral Infarction) was analyzed as a secondary outcome. Results: Good functional outcome (mRS ≤ 3 and/or ∆mRS ≤ 1) was observed in 45.90% (56/122). The rate of successful recanalization (TICI ≥ 2b) was 65.57% (80/122). Conclusion: Our data confirm that a good outcome in the elderly age group has a correlation with age; being younger, with a milder NIHSS (National Institutes of Health Stroke Scale) at the onset and with a lower pre-morbid mRS is statistically associated with a better outcome. However, age should not be a criterion to exclude older patients from mechanical thrombectomy. Decision-making should take into consideration the pre-morbid mRS and the severity of the stroke on the NIHSS scale, especially in the age group over 85 y/o.

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Brain health may be threatened by aneurysm ruptures, and early recognition of these vascular malformations allows for neuroradiological intervention. Neurointerventional procedures are usually performed with femoral artery access. In patients with severe anatomical complexity of the supra-aortic vessels, however, treatment by this approach could be hindered or impossible. Flow-diverter stent deployment is an effective and safe treatment for large, wide necked intracranial aneurysms, but it requires a complete and firm stability of the coaxial system to achieve a correct and precise deployment of the device. We present the first reported Italian case of a patient with an intracranial aneurysm which was treated with Flow-diverter stent (DERIVO®; AcandisGmbH & Co. KG; Pforzheim; Germany) by direct common carotid artery puncture due to severe tortuosity of supra-aortic trunks.