Objective: Acute ischemic stroke (AIS) is a leading cause of death, but isolated middle cerebral artery dissection (MCAD) is rarely reported. The aim of this article is to sum up the current information on this pathology and to explore the technical aspects of its endovascular treatment with emphasis on novel coated, antithrombogenic stents and antiplatelet management. Another part of this article offers our experience with the problematics represented by a small sample group of patients with an MCAD diagnosis who were treated in our center. Methods: We conducted literature research and a retrospective review of patients treated for anterior circulation AIS at our comprehensive stroke center from January 2022 to March 2024. The cohort included 16 patients diagnosed with isolated MCAD, 9 received antithrombogenic coated stents, while 7 received bare metal stents. Pharmacological management of coated stents involved the use of Cangrelor for acute antiplatelet therapy, transitioning to oral Ticagrelor. Results: Among the 16 patients treated, those with antithrombogenic coated stents showed no major complications and had a lower incidence of intracranial hemorrhage compared to the bare metal stent group. The average National Institutes of Health Stroke Scale (NIHSS) score at discharge improved in both groups. Functional outcomes and mortality rates were slightly better in the coated stent group, but no statistical significance was proven. Conclusions: Antithrombogenic coated stents, in conjunction with MAPT, demonstrated a safe and effective option for treating isolated MCAD. These stents offer promising potential for improved outcomes and reduced complications compared to traditional treatments. Further multicentric studies with larger cohorts are recommended to validate these findings.

BACKGROUND: Contrast-associated acute kidney injury (CA-AKI) after endovascular thrombectomy (EVT) worsens outcomes in acute ischemic stroke, but threshold-based definitions do not capture prognostic information from subthreshold changes. We tested whether early creatinine change within 48 hours of EVT conveys graded prognostic information beyond dichotomous CA-AKI. METHODS: We performed a secondary analysis of the CAN-REST registry (Contrast-Associated Nephropathy After Endovascular Stroke Treatment), a retrospective multicenter observational cohort study of 6638 EVT-treated adults with acute ischemic stroke enrolled at 73 centers in 16 countries between January 1 and December 31, 2023. Early creatinine change was quantified as the natural logarithm ratio of 48-hour creatinine to baseline creatinine (ln[48-hour/baseline creatinine]), with CA-AKI defined per Kidney Disease: Improving Global Outcomes criteria (≥0.3 mg/dL or ≥1.5× baseline rise within 48 hours). Multivariable logistic regression adjusted for prespecified baseline and periprocedural covariates examined associations with 90-day modified Rankin Scale shift and in-hospital mortality; linear versus restricted cubic spline specification was selected by likelihood ratio testing, and contrasts were estimated at ±10%, ±25%, and ±50%. RESULTS: Greater creatinine worsening within 48 hours of EVT was independently associated with an unfavorable 90-day modified Rankin Scale shift (adjusted common odds ratio per 1-unit log-ratio increase, 1.48 [95% CI, 1.07–2.04]; linear) and in-hospital mortality (nonlinear dose-response, of larger magnitude). A 10% increase in creatinine at 48 hours—well below Kidney Disease: Improving Global Outcomes threshold—was associated with worse functional outcome (adjusted common odds ratio, 1.04 [95% CI, 1.01–1.07]) and death (adjusted odds ratio, 1.22 [95% CI, 1.13–1.32]); a 10% decrease in creatinine at 48 hours was associated with lower odds of both outcomes (adjusted common odds ratio, 0.96 [95% CI, 0.93–0.99]; adjusted odds ratio, 0.74 [95% CI, 0.65–0.86]). The functional-outcome association concentrated at upper modified Rankin Scale cut-points (severe disability, death); effect modification by baseline renal function was not significant. CONCLUSIONS: Early creatinine change after EVT conveys graded, outcome-specific prognostic information extending below formal CA-AKI thresholds, with a dose-response detectable at changes as modest as ±10%, complementing binary CA-AKI as a framework for post-EVT renal risk assessment. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT06596603.

Objective: Acute ischemic stroke (AIS) remains one of the most common causes of death and disability in the world. Mechanical thrombectomy (MT) is the modality of choice in the treatment of AIS and large vessel occlusion (LVO). The endovascular treatment of medium and distal vessel occlusions (DMVO) is currently under intensive scientific investigation. The aim of our study was to prove the feasibility, effectiveness and safety of MT in patients with a primary, isolated occlusion of the M2 segment of the middle cerebral artery (MCA), with a focus on the recanalization level and the first-pass effect (FPE) as predictors. Methods: We prospectively assessed patients after MT for primary isolated occlusion of the M2 MCA segment that were treated at our center during a three-year period between July 2021 and June 2024. Our final cohort included 137 patients who met the inclusion criteria. Epidemiological, clinical and technical data, as well as the clinical and safety outcomes of MT procedures, were recorded and analyzed. The primary outcome was defined as a modified Rankin scale (mRS) score of 0–2. Secondary outcomes included excellent functional independence (mRS 0–1) and successful recanalization, defined by a modified thrombolysis in cerebral infarction (mTICI) score of 2c–3. Safety outcomes included symptomatic intracerebral hemorrhage (sICH), any intracerebral (IC) hemorrhage and 90-day mortality. Results: The mean age of our cohort was 71.8 ± 12.5 years; 59 were men (43.1%). The primary outcome (mRS 0–2) was achieved in 89 (65%) patients. An excellent functional outcome (mRS 0–1) was reached in 58 (42.3%) and successful recanalization (mTICI 2c–3) in 118 (86.1%) patients. sICH was present in 5 cases (3.7%), any IC hemorrhage in 42 (30.7%) and 90-day mortality in 28 (20.4%). We found a statistically significant correlation between the primary outcome (mRS 0–2) and a successful recanalization mTICI of 2c–3 (p—0.024). This correlation was even stronger between excellent functional outcomes and a recanalization mTICI of 2c-3 (p < 0.001). The study did not confirm the importance of the first-pass effect (FPE) during MT of the M2 segment (p—0.489). We also noticed a significant 31.3% mortality increase in the group of patients in which recanalization of the occluded M2 branch was insufficient. Conclusions: MT is a powerful and effective treatment method for AIS caused by an occlusion of the M2 segment in real-life conditions. Patients have a higher probability of a long-term good functional outcome when complete or near-complete reperfusion is achieved.