Neurología Vascular.artículos

Endovascular embolization of tentorial dural arteriovenous fistulas (EMBOTENT): a retrospective multicenter study

2026-05-04T00:00:00Z

Endovascular embolization of tentorial dural arteriovenous fistulas (EMBOTENT): a retrospective multicenter study Vollherbst, Dominik F.; Krug, Nadja; Zhang, Peng; Ma, Yongjie; Su, Xin; Limbucci, Nicola; Renieri, Leonardo; Mosimann, Pascal J.; Boutet, Alexandre; Cheng, How-Chung; Marnat, Gaultier; Barreau, Xavier; Szikora, Istvan; Czencz, Máté; González, Alejandro; Albóniga-Chindurza, Asier de; Scarcia, Luca; Kalsoum, Erwah; Alexandre, Andrea M.; Pujol Lereis, Virginia Andrea Background: Tentorial dural arteriovenous fistulas (TDAVFs) are rare but high risk vascular lesions. Although endovascular embolization is often the preferred treatment, large scale data on efficacy and safety are limited. Objective: To investigate the efficacy and safety of endovascular treatment for TDAVFs in a large, retrospective, multicenter cohort, and to analyze lesion characteristics and outcomes according to TDAVF location. Methods: Clinical, radiological, and interventional data from 585 patients treated in 32 international centers in 758 endovascular treatment sessions between 2012 and 2022 were analyzed. Patient demographics, fistula characteristics, endovascular treatment techniques, complications, and outcomes were assessed. Efficacy was measured by occlusion rates, safety by symptomatic complications, and modified Rankin Scale (mRS) scores. Results: In 31.3% of cases TDAVFs initially presented with hemorrhage, including 12.8% in low grade TDAVFs (absence of cortical venous reflux). Transarterial embolization was the primary approach in 84.7% of sessions. Complete occlusion was achieved in 74.2% of cases after the last treatment and 85.7% at the last imaging follow-up (mean 20.9 months). Symptomatic complications occurred in 9.4% of patients, with 2.6% permanent deficits and 1.0% mortality. At the last clinical follow-up (mean 30.6 months), 89.2% of patients had good functional outcome (mRS score 0-2). Location was significantly associated with fistula grade (eg, galenic and tentorial sinus TDAVFs being more often high grade, and torcular TDAVFs being more often low-grade). Conclusions: This large multicenter series demonstrated high occlusion rates, favorable functional outcomes, and acceptable complication rates, supporting endovascular therapy as a treatment of choice for TDAVFs. Considerable hemorrhage rates in low grade TDAVFs support the treatment even in the absence of cortical venous reflux.

Implementation of stroke prevention: a review of challenges and opportunities in the Americas

2026-05-22T00:00:00Z

Implementation of stroke prevention: a review of challenges and opportunities in the Americas Ouriques Martins, Sheila Cristina; Ordunez, Pedro; Borelli, Wyllians Vendramini; Ovbiagele, Bruce; Urrutia, Victor C.; Abanto, Carlos; Alet, Matías Javier; Almarie, Bassel; Álvarez, Tony Fabián; Amaya, Pablo; Ameriso, Sebastián Francisco; Arauz-Gongora, Antonio; Barboza, Miguel A.; Bayona, Hernán; Calleja, Juan; Cano Nigenda, Vanessa; Carbonera, Leonardo Augusto; Carrillo Larco, Rodrigo M.; Constanzo, Freddy; Pujol Lereis, Virginia Andrea Stroke remains a leading cause of death and disability throughout the Americas, disproportionately impacting low-and middle-income countries and underserved populations. In this review, we examine the status of stroke prevention in the Americas. Prevention is essential, yet unequal access to healthcare has led to major disparities - especially among rural populations, ethnic minorities, and lower socioeconomic status. Models like the WHO HEARTS Program demonstrate that evidence-based programs can be tailored to local contexts. Telehealth and digital tools play a critical role in empowering patients, educating communities, and supporting healthcare workers. Despite growing efforts, challenges persist due to health inequities, gaps between policy and implementation, and underinvestment. Strengthening prevention will support countries in achieving the United Nations Sustainable Development Goals, targeting a one-third reduction in premature deaths from non-communicable diseases by 2030. This paper outlines effective strategies for implementing stroke prevention, emphasizing healthy lifestyles, early detection of risk factors, and system-level interventions.

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

2026-02-18T00:00:00Z

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.

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

2025-07-23T00:00:00Z

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, Sebastián Francisco; Mammadova, Nargiz; Marchenko, Sergey; Ouriques Martins, Sheila Cristina; 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.