BACKGROUND AND PURPOSE:Early ischemic changes on pretreatment NCCT quantified using ASPECTS have been demonstrated to predict outcomes after IAT. We sought to determine the interobserver reliability of ASPECTS for patients with AIS with PAO and to determine whether pretreatment ASPECTS dichotomized at 7 would demonstrate at least substantial agreement.

SUMMARY:Coil displacement during endovascular coiling procedures may require coil retrieval in the context of flow limitation or thromboembolic risk. No standard recommended method of coil retrieval exists. We present a consecutive series of 14 patients with displaced coil during aneurysm coiling in whom the complication was effectively managed with the use of a stent retriever system. Two illustrative cases from the 14 are described, and technical notes are detailed regarding use of the technique. The use of stent retrievers presents a simple, safe, and effective choice for removal of prolapsed coils during aneurysm coiling. ABBREVIATION: ACA ϭ anterior cerebral artery

Introduction: The role of collaterals for acute ischemic stroke patients who qualify for endovascular thrombectomy (EVT) in the late therapeutic window (>6 hours from last known normal) remains unknown. We hypothesize that good collaterals on CT angiography (CTA) will moderate neurologic outcome and the effect of EVT. Methods: This is a prespecified analysis of DEFUSE 3. The primary outcome is functional independence (modified Rankin scale ≤2). Additional outcomes include baseline infarct volume, change from baseline in the infarct volume at 24 hours, and death at 90 days. Results: Of 130 patients, 33 (25%) had poor and 97 (75%) had good collaterals. There was no difference in the rate of functional independence with good versus poor collaterals (30% vs. 39%, p=0.3), but good collaterals were associated with significantly smaller infarct volume and less infarct growth. The difference in the treatment effect of EVT between good versus poor collaterals was not significant (p=0.8). Collateral status did not affect the rate of death [19% vs. 24%, p=0.5]. Conclusion: In DEFUSE 3 patients, good leptomeningeal collaterals on CTA were not predictive of functional independence or death. These findings introduce the possibility that CTA collaterals may not have a causal relationship with neurologic outcome for anterior circulation large vessel occlusion patients with Target Mismatch in the late window.

Background and Purpose We sought to validate a previously described model combining clinical and MRI thresholds to predict outcome in acute ischemic stroke in a larger cohort, and evaluate effects of reperfusion therapy and stroke side. Materials and Methods 123 consecutive anterior circulation AIS patients underwent MRI within 6 hours of stroke onset. DWI and PWI volumes were measured. Lesion volume and NIH Stroke Scale Score thresholds were used in models predicting good three-month clinical outcome (mRS 0-2). Patients were stratified by treatment and stroke side. Results ROC analysis demonstrated 95.6% and 100% specificity for DWI > 70mL and NIH Stroke Scale Score > 20 to predict poor outcome, and 92.7% and 91.3% specificity for PWI (mean transit time) < 50mL and NIH Stroke Scale Score < 8 to predict good outcome. Combining clinical and imaging thresholds led to 88.8% (71/80) positive predictive value with 65.0% (80/123) prognostic yield. 100 percent specific thresholds for DWI (103 versus 31 mL) and NIHSSS (20 versus 17) to predict poor outcome were significantly higher in treated (intravenous and/or intraarterial) versus untreated patients. Prognostic yield was lower in right versus left-sided strokes for all thresholds (10.4-20.7 vs. 16.9-40.0%). Patients with right-sided strokes had higher 100 percent specific DWI (103.1 vs. 74.8 mL) thresholds for poor outcome, and positive predictive value was lower. Conclusion Our predictive model is validated in a much larger patient cohort. Outcome may be predicted in up to two-thirds of patients, and thresholds are affected by stroke side and reperfusion therapy.