Introduction: Although stentrievers (SRs) have been a mainstay of mechanical thrombectomy (MT), and current guidelines recommend the use of SRs in the treatment of large vessel occlusion stroke (LVO), there is a paucity of studies in the literature comparing SRs directly against each other in terms of mechanical and functional properties. Timely access to endovascular therapy and the ability to restore intracranial flow in a safe, efficient, and efficacious manner have been critical to the success of MT. This study aimed to investigate the impact of contemporary SR characteristics, including model, brand, size, and length, on the first-pass effect (FPE) in patients with acute ischemic stroke. Methods: Consecutive patients with M1 occlusion treated with a single SR+BGC were recruited from the ROSSETTI registry. The primary outcome was the FPE that was defined as modified (mFPE) or true (tFPE) for the achievement of modified thrombolysis in cerebral infarction (mTICI) grades 2b-3 or 3 after a single device pass, respectively. We compared patients who achieved mFPE with those who achieved tFPE according to SR characteristics. Results: We included 610 patients (52.3% female and 47.7% male, mean age 75.1 ± 13.62 years). mFPE was achieved in 357 patients (58.5%), whereas tFPE was achieved in 264 (43.3%). There was no significant association between SR characteristics and mFPE or tFPE. Specifically, the SR size did not show a statistically significant relationship with improvement in FPE. Similarly, the length of the SR did not yield significant differences in the mFPE and tFPE, even when the data were grouped. Conclusions: Our data indicate that contemporary SR-mediated thrombectomy characteristics, including model, brand, size, and length, do not significantly affect the FPE.

Introduction: Psychometrics plays a vital role in evaluating educational research, including the analysis of multiple-choice exams. This study aims to improve the discriminatory ability of the “Médico Interno Residente” (MIR) medical exam in Spain, used to rank candidates for specialized healthcare training, through psychometric analysis. Methods: We analyzed 2,890 MIR exam questions from 2009 to 2021 (totaling 147,214 exams), categorizing them based on methodology and response type. Evaluation employed classical test theory and item response theory (IRT). Classical test theory determined difficulty and discrimination indices, while IRT assessed the relationship between knowledge levels and question performance. Results: Question distribution varied across categories and years. Frequently addressed knowledge areas included various medical specialties. Non-image-associated clinical cases were the easiest, while case-based clinical questions exhibited the highest discriminatory capacity, differing significantly from image-based case or negative questions. High-quality questions without images had longer stems but shorter answer choices. Adding images reduced discriminatory power and question difficulty, with image-based questions being easier. Clinical cases with images had shorter stems and longer answer choices. Conclusions: For improved exam performance, we recommend using a clinical case format followed by direct short-answer questions. Questions should be of low difficulty, providing clear and specific answers based on scientific evidence and avoiding ambiguity. Typical clinical cases with key characteristic features should be presented, excluding uncertain boundaries of medical knowledge. Questions should have lengthy stems and concise answer choices, minimizing speculation. If images are used, they should be typical, clear, consistent with the exam, and presented within clinical cases using clinical semiotics and propaedeutics.

BACKGROUND: In the case of failed reperfusion or severe stenosis during endovascular treatment of acute stroke, intracranial stenting is a growing practice. We aimed to study clinical and radiological outcomes in a large multicenter cohort. METHODS: The RESISTANT registry (Registry of Endovascular Salvage for Intracranial Stenting in Thrombectomy-Refractory Stroke; 2016–2023) is a multicenter single-arm retrospective registry of patients with acute stroke who underwent intracranial stenting during endovascular treatment across 36 international centers. The primary end point was functional outcome at 90 days. Secondary end points were final successful reperfusion (modified Thrombolysis in Cerebral Infarction, 2b-3) and stent patency at 24 hours. Safety outcomes included procedural complications, symptomatic intracranial hemorrhage, and in-hospital mortality. Logistic regression models including those variables that achieved statistical significance, along with age, baseline National Institutes of Health Stroke Scale, and baseline modified Rankin Scale, were used to define independent predictors. RESULTS: Among 904 patients enrolled, 876 fulfilled inclusion criteria. Median age was 67.0 (interquartile range, 59.0–77.0) years, 567 (64.8%) were men, and the median National Institutes of Health Stroke Scale score was 12.0 (interquartile range, 7.0–19.0). Anterior circulation was involved in 624 (71.6%), and the rate of tandem extracranial/intracranial occlusion was 4.9%. Stenting was performed in 469 patients (53.5%), owing to failed reperfusion (expanded Thrombolysis in Cerebral Infarction, 0-2a), and in 320 patients (36.5%) because of residual severe stenosis. After stenting, immediate successful recanalization was achieved in 777 (89.5%). At 90 days, the rate of modified Rankin Scale score of 0 to 2 was 41.2%. The number of thrombectomy attempts (adjusted odds ratio, 0.810 [95% CI, 0.707–0.929]; P =0.003) and the final successful recanalization (adjusted odds ratio, 19.394 [95% CI, 5.486–68.560]; P <0.001) were associated with good functional outcome. During admission, the reocclusion rate was 12.2%, most of them within 48 hours. Symptomatic intracranial hemorrhage was diagnosed in 8.4% of patients; no variables were independently associated with a higher probability. CONCLUSIONS: Acute intracranial stenting was a feasible therapy for patients with failed reperfusion or severe stenosis. Successful reperfusion and a lower number of thrombectomy attempts predicted functional outcome. Prospective studies are warranted to confirm efficacy and safety.

Purpose: Liquid embolic agents (LEAs) are commonly used in the endovascular treatment of vascular malformations for their penetration, visibility, and reflux control. This study presents our experience with N-hexyl cyanoacrylate (NHCA), also known as "Magic Glue," and its strengths and limitations. Methods: A retrospective single-center case series study was conducted to assess outcomes among patients with complex head and neck vascular lesions treated with NHCA injection at Hospital Universitario Central de Asturias, Oviedo, Spain, between January 2022 and December 2023. Procedure and outcome measures included justification for using NHCA, technical success (defined as the outcome achieved based on objective), materials used for catheterization, dilution ratio of NHCA, and observations of technical significance during the procedure. Results: A total of 24 NHCA injections were performed in 22 patients with intra- and extracranial vascular lesions. An arteriovenous malformation (AVM) was treated in 83.3% (20/24) of cases, including nidal pseudoaneurysms in ruptured AVMs (8/24, 33.3%), arterial feeder embolization in AVM treatment (7/24, 29.2%), and single-feeder AVMs (5/24, 20.8%). The remaining cases included bone or skin vascular malformations (2/24, 8.3%) and dural arteriovenous fistulas (2/24, 8.3%). In 87.5% (21/24) of cases, procedures were successful using a 1:4 dilution ratio of NHCA in lipiodol. In 70.8% (17/24) of cases, the HeadWay Duo 167 cm microcatheter was used to gain arterial access, and the Magic 1.2F 165 cm microcatheter was used in the remaining cases. Injection durations ranged from 27 seconds to 9 minutes and 38 seconds. No clinically significant complications occurred, and microcatheter retrieval was successful in 100% of cases. Complete occlusion with a single NHCA injection into the arterial feeder was achieved in 12.5% (3/24) of cases. NHCA demonstrated optimal penetration and advancement capacity in both intranidal and proximal injections, allowing effective embolization of complex vascular structures. Conclusion: NHCA demonstrated safe and effective penetration and advancement in both intranidal and proximal injections, allowing successful embolization of complex vascular structures. Further research is necessary to establish its long-term efficacy and optimize its clinical applications.

Purpose: The optimal anesthetic approach for intracranial stenting in acute stroke remains unclear. We compared outcomes of patients under general anesthesia (GA) versus local anesthesia or conscious sedation. Methods: The RESISTANT registry is a multicenter observational study on acute intracranial stenting during thrombectomy. Patients treated between January 2016 and June 2023 were included and stratified into GA and local anestesia/conscious sedation groups. The primary outcome was an adjusted shift analysis of the modified Rankin Scale (mRS) at 90 days. Secondary outcomes included mRS 0–2 at 90 days and final modified Thrombolysis in Cerebral Infarction (mTICI) 2c/3 scores. Safety outcomes were symptomatic intracranial hemorrhage (sICH) and mortality. Adjusted ordinal and logistic regression with mixed-effects models were performed. Results: Of 876 patients, 445 (50.8%) received GA. Median age was 67 years [59–77]; 567 (64.8%) were men. No differences were found in 90-day mRS (adjusted common OR = 1.256 [0.887–1.780], p = 0.199). Rates of functional independence (39.0% vs 44.5%; aOR = 0.956 [0.606–1.507], p = 0.846), mTICI 2c/3 (68.9% vs 68.7%; aOR = 0.941 [0.602–1.471], p = 0.790), and sICH (8.0% vs 8.6%; aOR = 0.769 [0.374–1.584], p = 0.477) were comparable. In-hospital (23.0% vs 12.0%; aOR = 2.39 [1.35–4.22], p = 0.003) and 90-day mortality (33.3% vs 21.1%; aOR = 2.017 [1.227–3.315], p = 0.006) were higher in the GA group. Conclusion: In patients undergoing intracranial stenting during thrombectomy, anesthesia modality was not associated with better outcomes. GA was linked to higher mortality, likely due to indication bias.