BACKGROUND: The benefit of endovascular thrombectomy (EVT) beyond 24 hours from last known well in acute ischemic stroke remains uncertain. Although some slow progressors may retain salvageable tissue, supporting evidence in this ultra-late window comes mainly from small observational studies. METHODS: We systematically searched PubMed, Embase, Scopus, Web of Science, and Cochrane Central up to February 2025 for studies comparing EVT and best medical therapy in patients with acute ischemic stroke treated >24 hours from last known well. Eligible studies reported functional independence (90-day 0–2 modified Rankin Scale score), excellent clinical outcome (90-day 0–1 modified Rankin Scale score), symptomatic intracranial hemorrhage, or 90-day mortality. Pooled unadjusted and adjusted odds ratios (ORs) with 95% CIs were calculated using random-effects meta-analyses. Subgroup analyses were performed by study design, stroke severity, imaging modality, and occlusion territory. Statistical heterogeneity was assessed using the I² statistic and the Cochran Q test, and the certainty of evidence (CoE) was assessed using the Grading of Recommendation, Assessment, Development, and Evaluation approach. RESULTS: Ten observational studies (3 prospective and 7 retrospective) comprising 1871 patients (EVT: 866; best medical therapy: 1009) were included. EVT was associated with significantly higher odds of functional independence (8 studies; adjusted OR, 4.62 [95% CI, 3.30–6.47]; I ²=0%; low CoE) and excellent clinical outcome (2 studies; adjusted OR, 5.68 [95% CI, 2.49–12.97]; I ²=0%; very-low CoE). EVT increased the risk of symptomatic intracranial hemorrhage (4 studies; adjusted OR, 9.54 [95% CI, 3.78–21.07]; I ²=0%; low CoE), but 90-day mortality did not differ significantly between groups (4 studies; adjusted OR, 0.63 [95% CI, 0.30–1.31]; I ²=41.2%; very-low CoE). All subgroup analyses aligned with the main findings. CONCLUSIONS: Our results revealed that EVT was associated with improved functional outcomes without an increase in 90-day mortality, despite a higher symptomatic intracranial hemorrhage risk. Given the limited CoE and overall study quality, ongoing randomized trials are essential to confirm these findings and guide patient selection in the ultra-late time window.

BACKGROUND AND OBJECTIVES: As the aging population increases, the incidence of chronic subdural hematomas (cSDHs) is expected to rise. Surgical evacuation, though effective, sees up to 30% recurrence. Middle meningeal artery (MMA) embolization, particularly with n-butyl cyanoacrylate (n-BCA) glue diluted in D5W for distal penetration, has shown promise in reducing recurrences. Limited reports have investigated the safety and technical feasibility of n-BCA as a primary liquid embolic agent using the D5W push technique in cSDH. This series is the largest in the literature investigating the outcomes of this technique in cSDH. METHODS: A multicenter retrospective database analysis was conducted on consecutive patients who underwent MMA embolization using n-BCA embolisate. Data collected included patient demographics, procedural information, angiographic data, and periprocedural complications. RESULTS: The study included 269 patients with a median age of 76 years. Nearly half of the patients had previous surgeries, and 93 underwent contralateral embolization for bilateral cSDH. Successful MMA embolization with effective distal penetration was achieved in all cases. The complication rate was 2.2%. Significant improvements were noted at a 60-day follow-up, with a median reduction in cSDH diameter of 40.6% (P < .001) and 53% of patients showing neurological improvement. No recurrent cSDH or need for retreatment was observed in patients who underwent follow-up. CONCLUSION: MMA embolization using n-BCA with the D5W push technique is safe and technically feasible. It can be used adjunctively or as an alternative to surgery in patients with cSDH, resulting in decreased recurrence, high technical success, improved distal penetration, and low complication rates.

Background: Patient-reported outcomes (PROs) are increasingly recognized as essential endpoints in neuro-oncology, yet their prognostic value for survival across brain tumor trials remains incompletely defined. We conducted a systematic review and meta-analysis to quantify the association between key PRO domains and overall survival (OS) and progression-free survival (PFS)in patients with glioma. Methods: Following PRISMA 2020 guidelines, we included randomized controlled trials that reported baseline PROs using the European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 or European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Brain Neoplasm-20 questionnaires, with corresponding survival outcomes. Hazard ratios (HRs) per 10-point increase in each PRO domain were extracted. Random-effects models generated pooled HRs. Heterogeneity, risk of bias (ROB 2), and certainty of evidence (GRADE) were assessed. Results: Eight trials comprising 6,846 patients were included. Higher baseline cognitive functioning was significantly associated with improved OS (HR = 0.94, 95% CI [0.91–0.97]), as was physical functioning (HR = 0.97, 95% CI [0.94-1.00]). Pooled functional domains showed a protective association (HR = 0.96, 95% CI [0.93-1.00]), while BN-20 domains showed no association with overall survival. Pooled analysis of studies reporting EORTC QLQ-C30 scales was associated with improved PFS (HR = 0.99, 95% CI [0.99–0.99]). Subgroup analysis of physical functioning showed an association with improved PFS (HR = 0.99, 95% CI [0.97-1.0]), and the pooled analysis of all functional scales showed the same direction (HR = 0.99, 95% CI [0.99–0.99]). Conclusions: Functional and cognitive PRO domains appear to have potential to be robust prognostic markers of survival in glioma trials, and these findings support the complementary role of PROs alongside clinical, radiographic, and molecular measures. Our findings support integrating PROs into response assessment selection in future neuro-oncology trials.