Neurología

Comparative safety, efficacy, and predictors of complete occlusion of flow diverter devices in the treatment of unruptured distal anterior cerebral artery aneurysms

Wed, 18 Feb 2026 00:00:00 GMT

Comparative safety, efficacy, and predictors of complete occlusion of flow diverter devices in the treatment of unruptured distal anterior cerebral artery aneurysms Salim, Hamza Adel; Scarcia, Luca; Clarençon, Frédéric; Hajjeh, Orabi; Daraghma, Motaz; Simonato, Davide; Li, Yan-Lin; Shotar, Eimad; Premat, Kevin; Jabbour, Pascal; Tjoumakaris, Stavropoula I.; Gooch, Reid; Psychogios, Marios; Ntoulias, Nikos; Sporns, Peter; Puri, Ajit S.; Singh, Jasmeet; Ferrario, Ángel; Pujol Lereis, Virginia Andrea; CRETA Investigators BACKGROUND: Flow diverters (FDs) are increasingly used for cerebral aneurysms, including distal anterior cerebral artery (DACA) aneurysms, but comparative data between devices in this challenging location are limited. OBJECTIVE: To compare the safety and efficacy of Pipeline, Silk Vista Baby (SVB), and FRED Jr. FDs for unruptured DACA aneurysms and identify predictors of complete occlusion. METHODS: We retrospectively analyzed 166 patients treated with FDs at 39 centers in 14 countries (2018–2022) from the CRETA registry. Outcomes included aneurysm occlusion (O’Kelly–Marotta [OKM] scale), complications, retreatment, modified Rankin Scale (mRS) scores, and independent predictors of complete occlusion using multivariable Cox regression. RESULTS: Aneurysms were predominantly saccular and located on the pericallosal artery. Complete occlusion (OKM D) was achieved in 73%, and neck remnants (OKM C) in 12%, with no differences across devices. Ischemic complications occurred in 11% (mostly asymptomatic), hemorrhagic complications in 5%, and in-stent stenosis in 17%. Retreatment was performed in 1.3%. At last follow-up, 98% had mRS ≤ 2. Independent predictors of complete occlusion were female sex (HR 1.85), asymptomatic presentation (HR 1.79), smaller aneurysm neck (HR 0.83/mm), radial access (HR 2.20), and aspirin plus ticagrelor therapy (HR 1.84); device type was not predictive. CONCLUSION: Pipeline, SVB, and FRED Jr. FDs show similar safety and efficacy for unruptured DACA aneurysms. Complete occlusion is influenced by clinical and procedural factors, supporting individualized device selection.

Temporal dynamics of white matter hyperintensities related to Alzheimer's disease in adults with Down syndrome

Sun, 01 Feb 2026 00:00:00 GMT

Temporal dynamics of white matter hyperintensities related to Alzheimer's disease in adults with Down syndrome Morcillo Nieto, Alejandra O.; Rozalem Aranha, Mateus; Maure Blesa, Lucia; Rodríguez-Baz, Íñigo; Arriola-Infante, José Enrique; Franquesa Mullerat, Maria; Zsadanyi, Sara E.; Vaqué Alcázar, Lídia; Allende Parra, José; Zhao, Zili; Arranz, Javier; Videla, Laura; Barroeta, Isabel; Del Hoyo Soriano, Laura; Benejam, Bessy; Fernández, Susana; Sanjuan Hernandez, Aida; Pertierra, Lucía; Giménez, Sandra; Alcolea, Daniel Introduction: White matter hyperintensities (WMH) are common in Down syndrome (DS), yet their longitudinal evolution and associations with Alzheimer's disease (AD) remain unclear. Methods: Longitudinal MRI study, including 80 DS adults and 53 euploid controls. WMH were segmented on serial FLAIR using a longitudinal pipeline. We assessed the effects of demographic, genetic factors, AD clinical stage, AD-related fluid, and cerebrovascular biomarkers on annual WMH volume changes. Results: In DS, annual WMH changes were relatively stable until age 40, and then exhibited fluctuations, with a significant decrease at the group level. Declines were larger in symptomatic cases, particularly in periventricular and fronto-parieto-occipital regions. Higher baseline WMH and microbleeds presence related to greater WMH reduction. Visual ratings and adjustment for white matter volume supported the robustness of the results. Discussion: WMH trajectories were heterogeneous in DS and declined over time with AD symptoms. This unexpected reduction may reflect different underlying pathological processes, including neurodegeneration or neuroinflammation.

Differences in acute ischemic stroke treatment: A cross-sectional study from international Registry of Stroke Care Quality (RES-Q)

Wed, 23 Jul 2025 00:00:00 GMT

Differences in acute ischemic stroke treatment: A cross-sectional study from international Registry of Stroke Care Quality (RES-Q) Mikulik, Robert; Neto, Geraldo; Sedani, Rupal; Ameriso, Sebastian Francisco; Mammadova, Nargiz; Marchenko, Sergey; Martins, Sheila; Milanov, Ivan; Constanzo, Freddy; Muñoz, Mario; Budincevic, Hrvoje; Šrámek, Martin; Ramos, Cristina; Fouad Zakaria, Magd; Kõrv, Janika; Tsivgoulis, Georgios; Szapary, Laszlo; Pandian, Jeyaraj; Nulkhasanah, Adin; Batayha, Waleed Background: Stroke globally impacts mortality and disability. Compliance with international standards and evidence-based practices for acute stroke management would improve patient outcomes. Objectives: We aimed to present a descriptive analysis of the quality of acute stroke care across different countries using the Registry of Stroke Care Quality (RES-Q). Method: In a cross-sectional study, data from key quality indicators such as Emergency Medical Services (EMS) deployment rates, hospital arrival to imaging time (door-to-imaging: DIT), hospital arrival to thrombolysis time (door-to-needle: DNT), and Stroke Unit Care/Intensive Care Unit (SU/ICU) admission frequencies were examined. The analysis employed descriptive statistics and Spearman correlation tests. Results: Of 334,184 patients from 1130 hospitals in 70 countries, 218,832 patients (65.5%) from 47 countries were diagnosed with acute ischemic stroke after exclusions. The number of patients per country ranged from 226 to 62,080. International variability in care quality was observed: EMS (7-97%); SU/ICU (12-100%); and median DIT (7-41 min); and DNT (20-75 min). IVT rates varied markedly across countries, ranging from <1% to 52%. Higher patient volumes were positively correlated with SU/ICU admission and negatively with DIT and DNT (ρ = 0.10, -0.22, -0.42, respectively). Conclusion: This study demonstrates substantial international variation in the use of quality monitoring in clinical practice as well as in key indicators of acute ischemic stroke care, including intravenous thrombolysis rates and treatment timelines. The extent of variability highlights opportunities for benchmarking and targeted quality improvement efforts across diverse healthcare systems.

Teleneuropsychology in Latin America : Experiences and challenges during the COVID-19 pandemic

Fri, 06 Mar 2026 00:00:00 GMT

Teleneuropsychology in Latin America : Experiences and challenges during the COVID-19 pandemic Olavarría, Loreto; Dechent, Claudia; Parra Rodriguez, Mario Alfredo; Crivelli, Lucía; Custodio Capuñay, Nilton Santos; Dozzi Brucki, Sonia María; Okada de Oliveira, Maira; Robert, Phillip; Quiroz, Yakeel T.; Antivilo Bruna, Andrés; Arboleda Ramírez, Alejandra; Lillo, Patricia; Carello, María Agostina; Torralba, Teresa; Ramos, Teresita; Duran Aniotz, Claudia; Allegri, Ricardo Francisco; Slachevsky, Andrea La pandemia de COVID-19 aceleró el uso de la teleneuropsicología (TeleNP) para ofrecer servicios neuropsicológicos remotos en entornos con acceso limitado a clínicas. Objetivo: Examinar las prácticas de TeleNP en América Latina (AL), centrándose en las percepciones de los clínicos sobre su utilidad, validez y barreras. Métodos: Se realizó una encuesta descriptiva, exploratoria y de corte transversal entre noviembre de 2020 y enero de2021 entre profesionales de la salud que ejercen la neuropsicología en AL. El instrumento, validado mediante un proceso Delphi, evaluó los antecedentesprofesionales, el uso de TeleNP, los perfiles de los pacientes, las pruebas aplicadas y las ventajas y desafíos percibidos. Resultados: Participaron un totalde 212 clínicos de 10 países (edad media=42,7 años; experiencia=12,3 años). Los participantes fueron principalmente psicólogos (75,9%), aunquetambién se incluyeron neurólogos, geriatras, psiquiatras y terapeutas del lenguaje. La adopción de TeleNP aumentó de un uso regular de 4,2% y un usoocasional de 13,7% antes de la pandemia a un 58% en el momento de la encuesta, con una variación significativa entre países (χ2=79,0; gl=30; p<0.001).La TeleNP se utilizó principalmente para entrevistas con pacientes (90%) e informantes (89,5%), cribado (screening) (71,8%) y, en la mitad de los casos,evaluaciones más exhaustivas. Las ventajas reportadas fueron la mejora de acceso (81,5%), la reducción de los costos de transporte (79,8%), la comodidaddel paciente (66,1%) y la facilidad de programación de citas (66,1%). La principal barrera identificada fue la limitada conectividad de los pacientes (84,7%).El conocimiento normativo fue heterogéneo: el 36,7% informó tener autorización para la TeleNP en su país, el 23,5% informó no tener autorización y el39,8% no estaba seguro. Conclusión: La adopción de TeleNP en AL aumentó durante la pandemia y se percibe como una modalidad válida y accesiblepara abordar las disparidades geográficas en la atención neuropsicológica. Sin embargo, la implementación heterogénea, la incertidumbre regulatoria y laslimitaciones tecnológicas siguen siendo desafíos importantes, lo que subraya la necesidad de directrices estandarizadas.