Purpose: Carotid artery stenting (CAS) has evolved as a first-line therapeutic option for carotid revascularization in indicated patients for stroke prevention, but there is still a lack of data on its effect on cognitive function (CF), especially among Indian patients. To determine the effect of CAS on CF and to study the immediate and delayed complications of CAS in Indian patients.Materials and Methods: This was a prospective, observational, single-center study. CF was assessed using Addenbrooke’s cognitive examination version III (ACE) before and 3 months after stenting. The demographic and clinical parameters were also assessed. A follow-up evaluation after 3 months was done to compare CF and to observe the occurrence of any complications.Results: Out of 31 patients, 3 were lost to follow up. There were no immediate or delayed procedure-related complications. There was a statistically significant improvement in overall ACE score and memory before and after stenting. On subgroup analysis of those with and without strokes, there was a significant improvement in visuospatial function and mean ACE score. Those with left CAS had significant improvement in memory, visuospatial, language, and ACE scores than right CAS.Conclusion: CAS was associated with significant improvement in CF in patients.

ObjectiveStudy and compare clinico-epidemiological data and long-term outcomes in pediatric (<18 yrs) and adult AIE patients based on serostatus.BackgroundIndia is a burgeoning hub for autoimmune diseases. Studies on AIE comparing seropositive and seronegative outcomes in pediatric and adult population are lacking. We highlight age and serostatus specific approach in low resource country settings.Design/MethodsRetro-prospective study from Narayana Institute of Neurosciences, Bangalore (2016-2021) included AIE patients as per Autoimmune Encephalitis International Working Group and Autoimmune Encephalitis Alliance Clinicians Network. Serum and CSF autoimmune encephalitis panels, CSF meningitis panel was incorporated to exclude infections and other demyelinating disorders. With phone calls and outpatient follow ups (1-4 yrs), results were statistically analyzed and compared based on age and serostatus.ResultsAdult AIE was commoner than pediatric (75% vs 25%,n = 60) and seronegative than seropositive (56.7% vs43.3%) with overall male preponderance. NMDAR (11.7%), MOG (8.3%), LGI1 and GAD65 (5% each) were common antibodies (MOG commoner than NMDAR in children; NMDAR, LGI1 and GAD 65 equally predominant in adults). Common presentations included seizures (75%) and memory disturbances (66.7%) independent of serostatus. There were no differences in MRI and EEG parameters based on age or serostatus. Methylprednisolone mono-therapy (46.6%) was multitude than add on rescue immunosuppressants [IVIG (28.3%),rituximab (10%), PLEX & cyclophosphamide (3.3% each)]. Pediatric age, specific antibodies, status epilepticus and dysautonomia were markers requiring aggressive immunotherapy. Oral steroids (61.7%),mycophenolate (8.3%)and azathioprine (6.7%) were maintenance immunosuppressants. 10% patients (mostly seropositive) had poor outcome with Modified Rankin Scale (MRS) >3. Deaths (all adults) though rare was slightly preponderant in seronegative type owing to lack of consent for aggressive immunosuppression. Clinical relapse was noted in 10% (mostly seropositive). 86% patients were weaned off maintenance immunosuppression (earlier in seronegative).ConclusionsSeronegative and pediatric AIE had better long term outcomes. Methylprednisolone mono-therapy is efficacious in majority of the cases when started early. Early recognition and aggressive management in high risk groups has pivotal role. Further multi-centric studies are needed to confirm these findings.

Context: Recanalization failure rate in mechanical thrombectomy (MT) for large vessel occlusions is up to 30%. Outcome greatly depends on recanalization success and, thus, there is an urgent need to adopt new strategies to improve recanalization. Aims: To report on the feasibility, safety, and outcome of rescue strategies (stenting and/or angioplasty) in cases of failed MT for acute ischemic stroke (AIS) in anterior circulation. Materials and Methods: It was a retrospective observational study where patients undergoing MT were divided into two groups. The first group (MT-only) was of patients who had undergone only MT with the standard tools (stentriever and/or aspiration). The second group (MT-plus) consisted of patients who underwent a rescue procedure after failure of the standard MT. The two groups were compared based on the demographics, risk factors, stroke severity, and the extent of infarct on imaging. The angiographic findings, procedural details, periprocedural care, and angiographic and clinical outcome were also compared. Results: Out of 181 cases, 142 were in MT-only while 39 were included in MT-plus group. The two groups had comparable baseline stroke severity, extent of infarct on imaging and door to puncture time. The MT-plus patients had significantly longer time of onset and puncture to recanalization time. The clinical outcome was favorable in both groups with 57.7% and 59% patients achieving mRS 0–2 in MT-only and MT-plus groups, respectively. Successful recanalization was achieved in 80.3% and 89.7% in MT-only and MT-plus groups, respectively. There was no significant increase in symptomatic intracranial hemorrhage and mortality after rescue procedures. Conclusions: Rescue stenting and/or angioplasty after failed MT is a safe and effective recanalization method for AIS in anterior circulation without increasing mortality or morbidity.