General anaesthesia (GA) during endovascular thrombectomy has been associated with worse patient outcomes in observational studies compared with patients treated without GA. We assessed functional outcome in ischaemic stroke patients with large vessel anterior circulation occlusion undergoing endovascular thrombectomy under GA, versus thrombectomy not under GA (with or without sedation) versus standard care (ie, no thrombectomy), stratified by the use of GA versus standard care. For this meta-analysis, patient-level data were pooled from all patients included in randomised trials in PuMed published between Jan 1, 2010, and May 31, 2017, that compared endovascular thrombectomy predominantly done with stent retrievers with standard care in anterior circulation ischaemic stroke patients (HERMES Collaboration). The primary outcome was functional outcome assessed by ordinal analysis of the modified Rankin scale (mRS) at 90 days in the GA and non-GA subgroups of patients treated with endovascular therapy versus those patients treated with standard care, adjusted for baseline prognostic variables. To account for between-trial variance we used mixed-effects modelling with a random effect for trials incorporated in all models. Bias was assessed using the Cochrane method. The meta-analysis was prospectively designed, but not registered. Seven trials were identified by our search; of 1764 patients included in these trials, 871 were allocated to endovascular thrombectomy and 893 were assigned standard care. After exclusion of 74 patients (72 did not undergo the procedure and two had missing data on anaesthetic strategy), 236 (30%) of 797 patients who had endovascular procedures were treated under GA. At baseline, patients receiving GA were younger and had a shorter delay between stroke onset and randomisation but they had similar pre-treatment clinical severity compared with patients who did not have GA. Endovascular thrombectomy improved functional outcome at 3 months both in patients who had GA (adjusted common odds ratio (cOR) 1·52, 95% CI 1·09-2·11, p=0·014) and in those who did not have GA (adjusted cOR 2·33, 95% CI 1·75-3·10, p<0·0001) versus standard care. However, outcomes were significantly better for patients who did not receive GA versus those who received GA (covariate-adjusted cOR 1·53, 95% CI 1·14-2·04, p=0·0044). The risk of bias and variability between studies was assessed to be low. Worse outcomes after endovascular thrombectomy were associated with GA, after adjustment for baseline prognostic variables. These data support avoidance of GA whenever possible. The procedure did, however, remain effective versus standard care in patients treated under GA, indicating that treatment should not be withheld in those who require anaesthesia for medical reasons. Medtronic.

Background and Purpose— The high risk of recurrence and comorbidity after a stroke associated with atrial fibrillation (AF) justifies an aggressive diagnostic approach so that anticoagulant treatment can be initiated. Methods— The clinical and paraclinical characteristics of consecutive ischemic stroke patients with and without documented AF were recorded. Independent predictive factors were then used to produce a predictive grading score for diagnosing AF, derived by logistic regression analysis: Score for the Targeting of Atrial Fibrillation (STAF). Results— STAF, calculated from the sum of the points for the 4 items (possible total score 0 to 8): age >62 years (2 points); NIHSS ≥8 (1 point); left atrial dilatation (2 points); absence of symptomatic intraor extracranial stenosis ≥50%, or clinico-radiological lacunar syndrome (3 points). STAF ≥5 identified patients with AF with a sensitivity of 89% and a specificity of 88%. Conclusions— STAF can be used as part of a novel and simple strategy for the targeting of AF in the secondary prevention of ischemic stroke. A multicenter study is now required to validate STAF in a larger number of patients.

Objectives: Relationship between low-level air pollution and stroke is conflicting. This study was conducted to document the relationship between outdoor air pollution and ischaemic stroke occurrence. Design: Time-stratified case-crossover analysis. Setting: University Hospital of Nice, France. Participants: All consecutive patients with ischaemic stroke living in Nice admitted in the University Hospital of Nice (France) between January 2007 and December 2011. Main outcome measure: Association (adjusted OR) between daily levels of outdoor pollutants (ozone (O ₃ ), nitrogen dioxide (NO ₂ ), particulate matter (PM10) and sulfur dioxide (SO ₂ )) and ischaemic stroke occurrence. Results: 1729 patients with ischaemic stroke (mean age: 76.1±14.0 years; men: 46.7%) were enrolled. No significant association was found between stroke occurrence and short-term effects of all pollutants tested. In stratified analysis, we observed significant associations only between recurrent (n=280) and large artery ischaemic stroke (n=578) onset and short-term effect of O ₃ exposure. For an increase of 10 µg/m ³ of O ₃ level, recurrent stroke risk (mean D-1, D-2 and D-3 lag) was increased by 12.1% (95% CI 1.5% to 23.9%) and large artery stroke risk (mean D-3 and D-4 lag) was increased by 8% (95% CI 2.0% to 16.6%). Linear dose–response relationship for both subgroups was found. Conclusions: Our results confirm the relationship between low-level O ₃ exposure and ischaemic stroke in high vascular risk subgroup with linear exposure–response relation, independently of other pollutants and meteorological parameters. The physiopathological processes underlying this association between ischaemic stroke and O ₃ exposure remain to be investigated.

A case of multiple cerebral aneurysms caused by left atrial myxoma is reported. We present the details of this case and discuss the hypothetical pathogenesis, radiological aspects and treatment of these neoplastic aneurysms.