Background: Stroke and traumatic brain injury (TBI) represent two major health concerns worldwide. There is growing evidence suggesting a potential association between TBI and stroke. In this systematic review and meta-analysis, we aim to explore the association between TBI and stroke risk, with a specific focus on overall stroke risk and subgroup variations based on stroke type, severity, and the post-TBI time period. Methods: PubMed, Web of Science (WOS), Scopus, and Cochrane Library were systematically searched for studies exploring the link between stroke and TBI. The pooled hazard ratios (HRs) with a 95% confidence interval (CI) were calculated. The Comprehensive Meta-Analysis (CMA) software was used for the analysis. Subgroup analyses were conducted based on stroke type, TBI severity, and post-TBI phase. The Newcastle–Ottawa Scale (NOS) was utilized for the quality assessment. Results: We included a total of 13 observational studies, with data from 8 studies used for quantitative analysis. A history of TBI was associated with a significantly higher odds of stroke compared to controls (HR = 2.3, 95% CI (1.79 to 2.958), p < 0.001). The risk was greater for hemorrhagic stroke (HR = 4.8, 95% CI (3.336 to 6.942), p < 0.001) than for ischemic stroke (HR = 1.56, 95% CI (1.28 to 1.9), p < 0.001). Both moderate-to-severe TBI (HR = 3.64, 95% CI (2.158 to 6.142), p < 0.001) and mild TBI (HR = 1.81, 95% CI (1.17 to 2.8), p = 0.007) were associated with a significantly higher risk of stroke. The risk was also higher in the early post-TBI phase (1–30 days) (HR = 4.155, 95% CI (2.25 to 7.67), p < 0.001) compared to later phases (HR = 1.68, 95% CI (1.089 to 2.59), p = 0.019) from 30 days to 1 year and (HR = 1.87, 95% CI (1.375 to 2.544), p < 0.001) after 1 year. Conclusions: This systematic review confirms a significant association between TBI and an increased risk of stroke, regardless of TBI severity, type, or timing of stroke. The findings highlight the need for early monitoring and advocating preventive strategies for stroke in patients with a history of TBI.

Background: Stent-assisted coil embolization (SACE) is a common endovascular technique for managing intracranial aneurysms. The permanent presence of a stent inside the cerebral artery necessitates the postoperative use of antiplatelets. However, a consensus about how long to continue on it remains debated. This systematic review aims to discuss and quantify the risk of ischemic complications after antiplatelet discontinuation following SACE. Methods: PubMed, Cochrane Library, Scopus, and Web of Science (WOS) were systematically searched for studies assessing the outcomes after antiplatelet discontinuation following SACE for cerebral aneurysms. The primary outcome was the odds of ischemic complications after antiplatelet discontinuation. Using a random-effects model, the pooled event rate, along with a 95% confidence interval (CI), was calculated. The Comprehensive Meta-Analysis software (CMA) software was used for the analysis. The Newcastle–Ottawa Scale (NOS) was used for the quality assessment. Results: A total of five observational cohort studies were included in this systematic review. The studies recruited cases from 2009 and 2020, predominantly in Korea and Japan. Data from 18,425 cases obtained from four studies were analyzed. The duration of antiplatelet therapy varied widely across the included studies. Additionally, most studies reported a median follow-up of 24 months or more after antiplatelet discontinuation. We extracted and analyzed the odds of thromboembolic complications occurring within 6 to 24 months after the discontinuation of antiplatelets. The pooled rate of thromboembolism after antiplatelet discontinuation in this meta-analysis was 0.01 (95% CI: 0.006 to 0.018). Conclusion: This review demonstrates that the risk of thromboembolic complications after discontinuing antiplatelet therapy post-SACE is low. However, no strong consensus exists on the ideal duration for maintaining dual- or single-antiplatelet therapy. Further prospective studies with longer follow-ups are warranted to clarify the optimal durations needed to balance thromboembolic risk with hemorrhagic complications.

Background and Objectives: Minimally invasive surgery (MIS) has emerged as a less invasive alternative to medical management (MM) in intracerebral hemorrhage (ICH), but its comparative effectiveness remains uncertain. Materials and Methods: We searched PubMed, Web of Science, Scopus, and Cochrane Library for RCTs and prospective matched studies comparing MIS with MM in supratentorial spontaneous ICH. Primary outcomes were functional recovery and mortality; secondary outcomes were adverse events, rebleeding, and ICU stay. Meta-analysis was performed using RevMan 5.4 with 95% confidence intervals (CI). Results: Thirteen studies (11 RCTs, 2 cohorts; 1503 MIS, 1401 MM) were included. MIS significantly improved functional outcomes (Risk Ratio, RR 1.18, 95% CI 1.01 to 1.38), driven mainly by studies including both deep and lobar hematomas, whereas deep-only studies showed inconsistent effects. The benefit was largely attributable to stereotactic aspiration with local thrombolytics (RR 1.23, 95% CI 1.07 to 1.41), while other MIS techniques showed no significant advantage. Early intervention (<24 h) demonstrated better outcomes (RR 1.16, 95% CI 1.07–1.26). Thirty-day mortality was lower with MIS (RR 0.63, 95% CI 0.49–0.80). No significant differences were observed for ICU stay (Mean Difference, MD –0.15 days, 95% CI −1.34 to 1.05) or rebleeding (RR 1.57, 95% CI 0.84–2.97). Severe adverse events were lower in MIS (RR 0.80, 95% CI 0.71–0.89). Conclusions: MIS may reduce mortality and improve functional outcomes in supratentorial ICH, particularly using stereotactic aspiration with thrombolytics. The benefit in deep hematomas remains uncertain. Early intervention and careful patient selection are essential. Further high-quality RCTs are warranted.