The aim of this study was to compare the measure of grip strength against other validated methods of measuring frailty. This was a single-center, cross-sectional study that took place at the Westchester Medical Center Pre-Procedural Testing Clinic. The patient population included n = 73 patients ≥65 years of age evaluated for elective surgery. During the study, patients’ grip strength, CFS-I (Clinical Frailty Score of Investigator), CFS-P (Clinical Frailty Score of Participant), and FRAIL (Fatigue, Resistance, Aerobic capacity, Illnesses, and Loss of weight) scores were measured. Grip strength correlated negatively with the CFS-I, CFS-P, and FRAIL scores for females. Reduced grip strength in females correlated with higher frailty scores and vice versa. Male grip strength showed no significant relationship with the frailty scales. In addition, multivariate linear regression analysis revealed that the independent measure that demonstrated a significant inverse association with grip strength was age (β= -0.43, p = <0.001). There exists a difference in the utility of grip strength as a measure of frailty between males and females.

Background/Objectives: Recent studies reveal an “obesity paradox”, suggesting better clinical outcomes after intracranial hemorrhage for obese patients compared to patients with a healthy BMI. While this paradox indicates improved survival rates for obese individuals in stroke cases, it is unknown whether this trend remains true across all forms of intracranial hemorrhage. Therefore, the objective of our study was to investigate the incidence, characteristics, and outcomes of hospitalized obese patients with intracranial hemorrhage. Methods: The National Inpatient Sample (NIS) database was queried for data from 2015 to 2019 to identify adult patients aged 18 years and older with a primary diagnosis of non-traumatic intracranial hemorrhage. Using International Classification of Disease 10th Edition codes, patients were stratified by BMI categories: healthy weight, overweight, class I–II obesity, and class III obesity. The cohorts were examined for demographic characteristics, comorbidities, stroke severity, inpatient complications, interventions, and clinical outcomes, including length of stay (LOS), discharge disposition, and inpatient mortality. Results: Of 41,960 intracranial hemorrhage patients identified, 13,380 (33.0%) also had an obese BMI. Class I–II obese intracranial hemorrhage patients were more likely to be of white race (OR: 1.101, 95% CI: 1.052, 1.152, p < 0.001), less likely to be female (OR: 0.773, 95% CI: 0.740, 0.808, p < 0.001), and more likely to have diabetes mellitus (OR: 1.545, 95% CI: 1.477, 1.616, p < 0.001) and hypertension (OR: 1.828, 95% CI: 1.721, 1.943, p < 0.001) in comparison to healthy-weight patients. In a matched cohort analysis adjusting for demographics and severity, intracranial hemorrhage patients with class I–II obesity had a shorter length of stay (LOS) (OR 0.402, 95% CI: 0.118, 0.705, p < 0.001), reduced inpatient mortality (OR 0.847, 95% CI: 0.798, 0.898, p < 0.001), and more favorable discharge disposition (OR 1.395, 95% CI: 1.321, 1.474, p < 0.001) compared to their healthy-weight counterparts. Furthermore, these patients were less likely to require decompressive hemicraniectomy (OR 0.697, 95% CI: 0.593, 0.820, p < 0.001). Following an analysis of individual ICH subtypes, obese subarachnoid hemorrhage (SAH) patients demonstrated reduced mortality (OR: 0.692, 95% CI: 0.577–0.831, p < 0.001) and LOS (OR: 0.070, 95% CI: 0.466–0.660, p = 0.039), with no differences in discharge disposition. Similarly, intracerebral hemorrhage patients demonstrated reduced mortality (OR: 0.891, 95% CI: 0.827–0.959, p = 0.002) and LOS (OR: 0.480, 95% CI: 0.216–0.743, p < 0.001). Other ICH subtypes showed improved discharge outcomes (OR: 1.504, 95% CI: 1.368–1.654, p < 0.001), along with decreased mortality (OR: 0.805, 95% CI: 0.715–0.907, p < 0.001) and LOS (OR: −10.313, 95% CI: −3.599 to −2.449, p < 0.001). Conclusions: Intracranial hemorrhage patients with class I–II obesity exhibited more favorable clinical outcomes than those who were of a healthy weight or overweight. Despite its association with risk factors contributing to intracranial hemorrhage, class I–II obesity was associated with improved outcomes, lending support to the existence of the obesity paradox in stroke.

Purpose: Endovascular treatment has become the standard of care for the treatment of patients with acute ischemic stroke with large vessel occlusion, however, the optimal first-line strategy for mechanical thrombectomy continues to be debated. Recent advancements in large-bore aspiration catheters have enhanced the efficacy of A Direct Aspiration First Pass Technique (ADAPT), offering promising improvements in procedural success. This study aims to evaluate the characteristics and technical outcomes associated with endovascular treatment for acute ischemic stroke following the inaugural global use of the CEREGLIDE™ 71 Intermediate Catheter at our institution. Materials and methods: In this retrospective, single-center study, a total of 25 consecutive patients with verified large vessel occlusion in the anterior circulation were included from October 2023 to May 2024. All patients were treated with endovascular therapy using a CEREGLIDE™ 71 intermediate catheter. The angiographic outcome was assessed using the thrombolysis in cerebral infarction (TICI) scale. Results: A total of 25 patients were included in the study. The mean age at baseline was 72.3 years old, and 52% of patients were female. Mean National Institutes of Health Stroke Scale score at admission was 16.4. Occlusion locations included the M1 segment of the middle cerebral artery (MCA) (60%), internal carotid artery terminus (20%), and M2 segment of MCA (16%). The average number of passes per intervention was 2.2. Successful reperfusion (TICI 2b, TICI 2c, and TICI 3) was achieved in 88% of patients. Conclusions: This report of the first center to implement the CEREGLIDE™ 71 Intermediate Catheter for acute ischemic stroke demonstrated successful recanalization rates. This is largely attributed to the large inner diameter of the catheter, which results in higher aspiration force as well as improved trackability allowing for enhanced navigation through cerebrovascular anatomy.

Background: Cerebral venous thrombosis (CVT) is a rare condition that presents with significant treatment challenges and has traditionally been managed with anticoagulation. However, for patients who fail anticoagulation or present with severe symptoms, endovascular thrombectomy (EVT) has emerged as a favorable treatment modality. This study examines the outcomes, complications, and comorbidities associated with EVT in patients with CVT. Methods: A query of the 2015-2019 National (Nationwide) Inpatient Sample was performed for patients admitted to hospitals with ICD-10 diagnosis codes for CVT and ICD-10 procedure codes for usage of EVT. Demographic information, baseline comorbidities, complications, and discharge dispositions were compared between patients who underwent EVT and those who were managed medically. Results: A total of 36,005 patients diagnosed with CVT were identified from 2015(Q4) to 2019. Of these patients, 325 (0.9%) received EVT. Patients who underwent EVT were older (<0.001), more likely to be female (p = 0.016), and had higher rates of diabetes mellitus (p = 0.012), hypertension (p < 0.001), and obesity (p < 0.001). These patients also presented with more severe neurological symptoms, including higher National Institutes of Health Stroke Scale scores (p < 0.001), coma (p < 0.001), and cerebral edema (p < 0.001). Patients undergoing EVT had a higher incidence of in-hospital mortality (p = 0.007) and were less likely to be discharged routinely (p < 0.001). Conclusions: This study found that patients with CVT who underwent EVT were older, more likely to be female, and presented with more severe neurological conditions. After controlling for severity, EVT in patients with CVT was associated with significant risks, including higher rates of complications and inpatient mortality. Although EVT is associated with significant risks, the findings of this study suggest that its outcomes may reflect the severity of the underlying condition rather than the procedure itself. Careful patient selection and individualized management strategies are essential for optimizing outcomes in this high-risk population.

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have emerged as potentially impactful agents in improving spinal fusion outcomes. While several recent studies have investigated the effect of these agents on lumbar spinal procedures, the current evidence of the impact of these agents on cervical spinal fusion is limited. This study aims to investigate the impact of GLP-1RA use on perioperative clinical outcomes of posterior cervical spinal fusion. This analysis queried the TriNetX Research Network to identify patients receiving posterior cervical spinal fusion for degenerative pathology. Patients on GLP-1RAs for at least 12 weeks prior to the surgery were compared to patients who were never on GLP-1RAs. Propensity score matching (1:1) was performed for preoperative clinical characteristics and prior spine procedures. Investigated outcomes included postoperative pseudoarthrosis, readmission, reoperation, cervicalgia, radiculopathy, myelopathy, mortality, cerebrospinal fluid leak, infection, and implant failure at 1-year follow-up. A total of 737 patients with preoperative GLP-1RA use and 18,882 patients with no GLP-1RA use were identified. Prior to propensity score matching, patients on GLP-1RAs had a significantly higher risk of postoperative radiculopathy (p<.001), infection (p=.013), and readmission (p<.001), with a significantly reduced risk of pseudoarthrosis (p=.002). After propensity score matching, the risk of radiculopathy remained significantly elevated in the GLP-1RA cohort (hazard ratio: 1.367, 95% CI: 1.110–1.684, p=.003). The incidence of pseudoarthrosis remained significantly reduced in the GLP-1RA cohort (2.7% vs. 5.2%, p=.019), while a reduced risk of pseudoarthrosis trended toward significance (hazard ratio: 0.586, 95% CI: 0.336–1.022, p=.057). Preoperative GLP-1RA use was associated with increased postoperative risk of radiculopathy and decreased rates of pseudoarthrosis. The findings from this investigation may help optimize medical and surgical decision-making for posterior cervical spinal fusion patients on GLP-1 agonists.

Background: Spinal dural arteriovenous fistulas (SDAVFs) are the most common type of spinal arteriovenous malformation. Typically, these malformations present with a wide range of nonspecific symptoms indicative of thoracolumbar myelopathy. However, patients with spinal dural arteriovenous fistulas may rarely present with subarachnoid hemorrhage. Methods: A systematic review of MEDLINE and Embase databases was performed querying for cases of spinal dural arteriovenous fistulas with subarachnoid hemorrhage. Patient characteristics and outcomes investigated included spinal level of the fistula, delay of diagnosis, Hunt and Hess grade, interventions, recurrence of the fistula, and postoperative disability. Additionally, we present a unique case in which subarachnoid hemorrhage resulted from a spinal dural arteriovenous fistula that was refractory to multiple endovascular and open surgical interventions. Results: Of 116 records identified, 45 studies were included comprising 80 patients with spinal dural arteriovenous fistula and subarachnoid hemorrhage. The most common locations of the spinal dural arteriovenous fistula were in the cervical spine (57.5%) and at the craniocervical junction (35%). Patients were treated with open surgical ligation (60.0%), endovascular embolization (22.5%), or an open surgical procedure following persistent symptoms after endovascular treatment (10.0%). Overall, the prognoses among the treated patients were favorable with only two reported (2.5%) mortalities. Rates of neurologic recovery were similar when comparing endovascular and open surgical treatment. Endovascular treatment with coil embolization of a C1–C2 spinal dural arteriovenous fistula presenting as subarachnoid hemorrhage is also described. Conclusion: Spinal dural arteriovenous fistulas, particularly in the cervical spine, could be considered as a potential etiology for subarachnoid hemorrhage patients with no obvious intracranial cause. Treatment with either open surgery or embolization appears to offer a positive prognosis for both functional and angiographic outcomes.