Despite growing evidence over the last few years of the efficacy and safety of direct thrombus aspiration using a large bore distal access catheter as a type of mechanical thrombectomy procedure in acute stroke large-vessel occlusion patients, the experience and evidence of this technique for managing thromboembolic complications in endovascular aneurysm treatment is still limited and little research is available regarding this topic. We present a case of a thromboembolic occlusion of the left middle cerebral artery during the preprocedural angiograms of a large and fusiform left internal carotid artery aneurysm. This complication was successfully managed by navigating an already-placed distal access catheter intended for support during the opening of the flow-diverting stent; therefore, the thrombus was manually aspirated for two minutes, and Thrombolysis in Cerebral Infarction (TICI) scale 3 flow was restored. This case should encourage the use of a distal access catheter, already placed for aneurysm treatment, to perform zero-delay direct thrombus aspiration as a rescue approach for thromboembolic complications during endovascular treatments.

Background and Objectives: Posterior circulation ischemic stroke (PCIS) is a life-threatening disease with a poor prognosis. It has nonspecific symptoms. It is very difficult to diagnose. The aim of the study is to examine to what degree radiological methods, in addition to standard clinical indicators, can serve as a reliable and independent predictor of death in patients with PCIS. Materials and Methods: It is a retrospective study on 175 patients at the Special Hospital “Saint Sava” (2023–2025) with symptoms of acute PCIS, who did not have proven PCIS on the initial non-contrast computed tomography (NCCT). The radiology protocol included NCCT, CT perfusion (CTP) and CT angiography (CTA). The experimental group (n = 116, CTP+) and the control group (n = 59, CTP-) were monitored clinically and radiologically, with a follow-up NCCT after 24 h when all had confirmed acute PCIS. At discharge, the outcome was monitored on the National Institutes of Health Stroke Scale (NIHSS 2) and the Modified Rankin Scale (mRs). Results: Of 175 patients with acute PCIS, 24% died within 30 days. Those who died were older (p < 0.05), had a lower Posterior Circulation Alberta Stroke Program Early CT Score (pcASPECT), and more often had hyperdensity (26.2% vs. 7.5%), occlusions (69% vs. 31.6%), and symptomatic blood vessels on CTA and CTP+ (81% vs. 61.7%, p < 0.01). Multivariate regression singled out CTP+ (OR = 4.08), complications (OR = 2.96), Israeli Vertebrobasilar Stroke Scale (IVBSS) (OR = 1.22) and Trial of Org 10172 in Acute Stroke Treatment (TOAST) (OR = 1.92) as predictors of mortality, with shorter survival in CTP+ (949 vs. 1449 days, Log-rank p = 0.015), more NIHSS/mRS, lower Glasgow Coma Score, and more frequent obesity in the deceased. Conclusions: Negative CTP represents the protective factor against death in patients with acute PCIS. Complications, higher IVBSS, and TOAST classification (large vessels atherosclerosis) represent an increased risk. The importance of CTP for early detection of acute PCIS and early risk assessment is highlighted.

Background: This study aimed to evaluate associations between baseline clinical status, radiological findings, prior medical history, procedural characteristics, and recanalization success with neurological outcome at discharge (NIHSS) and functional status at 90 days (mRS). Methods: This single-center retrospective study included 100 consecutive patients with acute ischemic stroke treated with MT within 24 h of symptom onset. Clinical data, CT perfusion parameters, comorbidities, prior therapies, and detailed procedural characteristics (including anesthesia type, recanalization grade, blood pressure variability, hemorrhagic transformation, and procedure duration) were analyzed. Nonparametric tests (Mann–Whitney U, Kruskal–Wallis) and Spearman’s rank correlation were applied. Statistical significance was set at p < 0.05. Results: Early ischemic signs on baseline imaging were associated with higher NIHSS scores at discharge and worse 90-day mRS (p < 0.05). Patients undergoing CT perfusion imaging had higher discharge NIHSS. Admission NIHSS showed a moderate positive correlation with discharge NIHSS (rho = 0.367, p = 0.003). Strong correlations were observed between NIHSS at 24 h and discharge NIHSS (rho = 0.802, p < 0.001), as well as between 24 h NIHSS and 90-day mRS (rho = 0.842, p < 0.001). Successful recanalization was significantly associated with long-term outcomes, with mTICI 3 associated with the lowest 90-day mRS scores (p = 0.003). Intraprocedural blood pressure variability, hemorrhagic transformation, infections, and in-hospital complications were all linked to higher 90-day mRS values. Prolonged procedure duration showed a weak but significant correlation with worse 90-day outcome (rho = 0.232, p = 0.020). In contrast, prior comorbidities and pre-stroke therapy were not significantly associated with outcomes. A multivariable binary logistic regression analysis identified only the NIHSS score at 24 h remained as an independent predictor of favorable functional outcome at 90 days. Conclusions: Baseline stroke severity, early neurological evolution, successful reperfusion, procedural hemodynamic stability, and prevention of in-hospital complications are strongly associated with both early neurological recovery and long-term functional outcome after mechanical thrombectomy.

Micro-credentials have attracted intense scholarly and policy attention, yet recent practitioner evidence, most notably the 2026 UPCEA survey of US institutions, the catalyst for this review, suggests that institutional commitment has plateaued even as individual engagement deepens. This hybrid review examines whether the peer-reviewed literature can account for that pattern. Sixty-five peer-reviewed studies (2020–2026) and eight major practitioner and policy reports were coded against an identical six-dimension framework spanning adoption, purposes, integration mechanisms, enabling conditions, barriers, and evidence of value. The two evidence streams proved strikingly complementary—and strikingly disconnected. The scholarly literature richly documents purposes, enabling conditions, and barriers, but measures adoption rarely, examines integration mostly in proposal rather than operation, and contains no direct study of the plateau; systematic adoption evidence resides almost entirely in practitioner reporting. Across both streams, recognition emerges as the binding constraint: employers, learners, and quality-assurance systems consistently condition the value of micro-credentials on the credit-bearing integration that most institutions have approached only tentatively. The review concludes that micro-credential value is conferred by institutional integration rather than intrinsic to the credentiaand proposes a research agenda centred on longitudinal adoption trajectories, verified outcomes, and integration observed in practice.