Background and Purpose: Acute ischemic stroke may occur in patients with coronavirus disease 2019 (COVID-19), but risk factors, in-hospital events, and outcomes are not well studied in large cohorts. We identified risk factors, comorbidities, and outcomes in patients with COVID-19 with or without acute ischemic stroke and compared with patients without COVID-19 and acute ischemic stroke. Methods: We analyzed the data from 54 health care facilities using the Cerner deidentified COVID-19 dataset. The dataset included patients with an emergency department or inpatient encounter with discharge diagnoses codes that could be associated to suspicion of or exposure to COVID-19 or confirmed COVID-19. Results: A total of 103 (1.3%) patients developed acute ischemic stroke among 8163 patients with COVID-19. Among all patients with COVID-19, the proportion of patients with hypertension, diabetes, hyperlipidemia, atrial fibrillation, and congestive heart failure was significantly higher among those with acute ischemic stroke. Acute ischemic stroke was associated with discharge to destination other than home or death (relative risk, 2.1 [95% CI, 1.6–2.4]; P <0.0001) after adjusting for potential confounders. A total of 199 (1.0%) patients developed acute ischemic stroke among 19 513 patients without COVID-19. Among all ischemic stroke patients, COVID-19 was associated with discharge to destination other than home or death (relative risk, 1.2 [95% CI, 1.0–1.3]; P =0.03) after adjusting for potential confounders. Conclusions: Acute ischemic stroke was infrequent in patients with COVID-19 and usually occurs in the presence of other cardiovascular risk factors. The risk of discharge to destination other than home or death increased 2-fold with occurrence of acute ischemic stroke in patients with COVID-19.

Intracranial atherosclerotic disease and resultant intracranial stenosis is a global leading cause of stroke, and poses an ongoing treatment challenge. Among patients with intracranial stenosis, those with hemodynamic compromise are at high risk for recurrent stroke despite medical therapy and risk factor modification. Revascularization of the hypoperfused territory is the most plausible treatment strategy for these high-risk patients, yet surgical and endovascular therapies have not yet shown to be sufficiently safe and effective in randomized controlled trials. Advances in diagnostic and therapeutic technologies have led to a resurgence of interest in surgical and endovascular treatment strategies, with a growing body of evidence to support their further evaluation in the treatment of select patient populations. This review outlines the current and emerging endovascular and surgical treatments and highlights promising future management strategies.

BACKGROUND: Emerging evidence from observational studies, meta‐analyses, and clinical trials has reshaped the treatment landscape of chronic subdural hematoma (CSDH). This guideline provides updated recommendations on diagnosis, patient selection, and medical, surgical, and endovascular management. METHODS: The Society of Vascular and Interventional Neurology Guidelines and Practice Standards committee formed a writing group of interdisciplinary experts to review current literature. Recommendations were based on clinical trial data, observational studies, and expert consensus, following the Society of Vascular and Interventional Neurology Class of Recommendation and Level of Evidence framework. RESULTS: EMBOLISE (Embolization of the Middle Meningeal Artery With ONYX Liquid Embolic System for Subacute and Chronic Subdural Hematoma), STEM (SQUID Trial for the Embolization of the Middle Meningeal Artery for Treatment of Chronic Subdural Hematoma), MAGIC‐MT (Managing Non‐acute Subdural Hematoma Using Liquid Materials: A Chinese Randomized Trial of MMA Treatment), and MEMBRANE (Middle Meningeal Artery Embolization for the Treatment of Subdural Hematomas With TRUFILL n‐butyl cyanoacrylate) trials highlight the efficacy and safety of middle meningeal artery embolization (MMAE) in CSDH. EMBOLISE (n = 400; MMAE with surgery, n = 197; surgery alone, n = 203) showed that MMAE plus surgery reduced 90‐day hematoma recurrence to 4.1% versus 11.3% with surgery alone (relative risk = 0.36; 95% CI = 0.11–0.80; P = 0.008). Functional deterioration was 11.9% versus 9.8%, and 90‐day mortality was 5.1% versus 3.0%. Serious embolization‐related events, including 2 disabling strokes, occurred in 2.0% by 30 days. The STEM trial (310 patients enrolled: MMAE plus standard treatment, n = 149; standard treatment alone, n = 161) found that MMAE with Squid significantly reduced 180‐day recurrent/residual hematoma or reoperation/rescue surgery to 16% versus 36% with standard treatment (odds ratio = 0.36; 95% CI = 0.20–0.66; P = 0.001). 30‐day mortality or major disabling stroke was 3% in both groups. However, 180‐day mortality was 8% with the MMAE group, and 5% with standard treatment, and no death was attributed to MMAE or embolic agent. MAGIC‐MT (722 patients; MMAE plus standard treatment, n = 360; standard treatment alone, n = 362) reported 90‐day symptomatic recurrence or progression in 6.7% of the MMAE group (using Onyx) versus 9.9% in the standard treatment group (difference: −3.3%; 95% CI: −7.4–0.8; P = 0.10). Serious adverse events were less common in the MMAE group (6.7% versus 11.6%; P = 0.02). The MEMBRANE trial (376 patients; MMAE plus standard treatment, n = 188; standard treatment alone, n = 188) found that MMAE using n‐butyl cyanoacrylate plus surgery improved outcomes at 6 months. CONCLUSIONS: These results suggest that MMAE plus standard treatment of CSDH shows promising results and may become a standard of care for managing CSDH in selected patients. These guidelines provide evidence‐based recommendations for the diagnosis, patient selection, and treatment of CSDH.