(1) Background: The mechanism responsible for stroke in patients younger than 50 often remains unknown. This study was designed to assess whether high-resolution intracranial vessel wall MR imaging (icVWI) may be instrumental in determining stroke cause. (2) Methods: Young stroke patients with and without an identified cause of stroke despite an exhaustive investigation were prospectively included. Patients who underwent icVWI were compared to those who did not. We next compared patients with and without intracranial vulnerable plaques on icVWI. (3) Results: Overall, 47 young stroke patients were identified over the span of 2 years and included in this study. Of those, 20 (42%) underwent intracranial icVWI. Cancer prevalence was higher among patients who did not have an icVWI study (19% vs. 0% p = 0.042) but there were no other significant differences between patients who had an icVWI study and those who did not have an icVWI. Among patients who had an icVWI, 11 (55%) had vulnerable plaques and the remaining nine studies were negative. Patients with positive icVWI scans had significantly higher stroke severity at admission (mean ± SD NIHSS score 5.5 ± 3.5 vs. 1.7 ± 2.3, p = 0.012). Patients with positive icVWI scans were more often treated with antiplatelets upon discharge (100% vs. 67%, p = 0.038). (4) Conclusions: icVWI can add significant information relevant to stroke pathogenesis and secondary prevention among young stroke patients with a negative exhaustive diagnostic workup.

(1) Background: Cervical arterial dissections (CeAD) are a common cause of stroke in young adults. CeAD can be spontaneous (sCeAD) or traumatic (tCeAD). Whether CeAD subtypes differ in clinical, radiological, and outcome characteristics remains unexplored. (2) Methods: Patients with CeAD were identified and divided between sCeAD and tCeAD. Demographics, clinical features, risk factors, imaging findings, treatments, and outcomes were compared between the groups. Logistic regressions were used to determine characteristics associated with favorable outcome. (3) Results: Overall, 154 patients were included (106 sCeAD and 48 tCeAD). Patients with sCeAD were significantly older (mean ± SD 46 ± 12 vs. 35 ± 14, p < 0.001) and were more likely to have hyperlipidemia (19% vs. 4%, p = 0.016), but other risk factors did not differ. Patients with tCeAD less often had signs of early infarction on imaging (21% vs. 49%, p = 0.001) and had lower stroke severity on admission (NIHSS, median, interquartile range [IQR] 0 (0–9) vs. 2 (0–4), p = 0.012), but more often had symptomatic intracranial hemorrhages (12.5% vs. 2%, p = 0.006). Patients with tCeAD less often had favorable outcomes at 90 days (78% vs. 97%, p < 0.001). In the regression analysis, the only variables associated with favorable outcome were age (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.03–1.24), initial stroke severity (OR 0.84, 95% CI 0.73–0.97), degree of vessel stenosis (OR 0.35, 95% CI 0.14–0.83), and involvement of multiple vessels on presentation (OR 0.04, 95% CI 0.02–0.70), whereas dissection subtype was not associated (OR 0.45, 95% CI 0.03–68.80). (4) Conclusions: Dissection subtype is not an independent modifier of the chances of attaining functional independence.

Introduction: Data on safety of endovascular therapy (EVT) in the very elderly are scarce. Using data from a large prospective EVT registry, we aimed at providing better evidence for EVT decision-making in patients aged 90 years and older. Patients and methods: In this multicentre observational study from the EVA-TRISP collaboration outcomes were compared between patients aged ⩾90 years with those aged <90 years using multivariate logistic regression analysis and reporting odds ratios and 95% confidence intervals. Outcomes were occurrence of poor functional outcome in survivors (modified Rankin Scale (mRS) 3–5 if pre-stroke mRS 0–2 and mRS higher than pre-stroke mRS if pre-stroke mRS 3–5), mortality at 3 months after stroke, unsuccessful recanalization (mTICI 0–2a) and symptomatic intracranial hemorrhage (sICH, defined by ECASS-II-/III-criteria). Results: Of 13,306 eligible patients, 892 were ⩾90 years old (6.7%). The very elderly had a higher median National Institutes of Health Stroke Scale (NIHSS) on admission (16 vs 14) and were more likely to have a pre-stroke mRS of 3–5 (38.0% vs 8.7%). The odds of poor functional outcome (OR _adjusted 2.35 (95%-CI 1.87–2.97); 61.6% vs 38.7%), death (OR _adjusted 3.04 (95%-CI 2.60–3.55); 53.9% vs 21.3%) and unsuccessful recanalization (OR _adjusted 1.34 (95%-CI 1.14–1.57); 32.4% vs 27.2%) were higher in patients aged ⩾90 years. The odds of sICH did not differ (OR _adjusted 0.92 (95%-CI 0.66–1.28); 5.1% vs 5.0%). Discussion and conclusion: EVT-treated stroke patients ⩾90 years had higher odds of poor functional outcome, mortality and unsuccessful recanalization than younger patients. However, the probability of sICH after EVT was not increased. The decision in favor of or against EVT in the very elderly should not be based on age alone.

Introduction: Cervical arterial dissections (CeAD) can involve either single (sCeAD) or multiple (mCeAD) arteries. Whether the involvement of a single versus multiple arteries is associated with outcomes remains unclear. We aimed to study associations between the number of affected arteries and clinical, imaging and outcome parameters. Patients and methods: Patients with CeAD from the STOP-CAD multicenter registry study were included. Clinical, imaging, treatment and outcome parameters were compared between patients with sCeAD and mCeAD. Regression analyses were performed to identify associations with multi-arteries involvement. Results: Overall, 3858 STOP-CAD patients were included in this analysis and 443 (11.5%) had mCeAD. The presence of mCeAD was associated with age (adjusted odds ratio [aOR] 95% confidence intervals [95% CI] 0.99; (0.98–1.00)), female sex (aOR 1.5; 95% CI 1.17–1.91), recent upper respiratory infection (aOR 2.25; 95% CI 1.55–3.27), presence of connective tissue disease (aOR 3.11; 95% CI 2.32–4.17), severe arterial stenosis (aOR 1.95; 95% CI 1.95–2.58), intracranial extension (aOR 1.47; 95% CI 1.04–2.09), vertebral artery involvement (aOR 2.50; 95% CI 1.94–3.22) and presence of dissecting aneurysm (aOR 2.59; 95% CI 1.95–3.42). In adjusted analyses, mCeAD was not associated with clinical outcomes (ischemic stroke, mortality, and sICH; all p > 0.05). Conclusions: mCeAD does not appear to increase risk of subsequent stroke as compared to sCAD despite baseline risk factors suggestive of vasculopathy. mCeAD patients who did develop a stroke presented with milder strokes and less often had vessel occlusions compared to those with sCeAD. The presence of mCeAD did not impact outcomes.

BACKGROUND: Successful target vessel recanalization in patients with large vessel occlusion stroke is associated with favorable clinical outcomes. Conversely, unsuccessful recanalization (UR) is associated with higher chances of poor outcomes. UR occurs in up to 30% of endovascular thrombectomy (EVT) procedures, and there are significant knowledge gaps in identifying factors associated with UR. METHODS: Prospectively enrolled EVT-treated patients from the EVATRISP registry, which included patients from 18 academic medical centers across Europe between the years 2015 and 2024, were retrospectively studied. Patients had to have data on prestroke and 3-month functional status and recanalization status at the end of EVT. UR was defined as a modified Thrombolysis in Cerebral Infarction score <2b and compared with successful recanalization (modified Thrombolysis in Cerebral Infarction ≥2b). Regression analyses were performed to identify predictors of UR, and a predictive tool was subsequently constructed. RESULTS: Of the 15 549 patients enrolled in EVATRIPS, 10 942 fulfilled entry criteria and were included in the current analysis. Overall, 8000 (73%) achieved successful recanalization, while 2942 (27%) had UR. In multivariate analysis, factors independently associated with higher odds of UR included older age, higher prestroke mRS, wake-up stroke, interhospital transfer for EVT, higher National Institutes of Health Stroke Scale score at presentation, tPA (tissue-type plasminogen activator) administration, and occlusion of the M2 segment of the middle cerebral artery or proximal anterior or posterior cerebral arteries. Dyslipidemia and occlusion of the M1 middle cerebral artery or basilar artery were associated with successful recanalization. UR was associated with poor clinical outcomes, and higher mortality rates. A predictive tool derived from these variables demonstrated limited discriminatory ability (area under the curve, 0.579 [95% CI, 0.567–0.591]; P <0.001). CONCLUSIONS: UR is frequent among patients undergoing EVT and is associated with poor clinical outcomes. Although several pre-EVT factors were independently associated with UR, accurately predicting which patients will experience UR remains highly challenging. Our findings suggest that all eligible patients should undergo EVT.