Aditya Swarup Pandey

BACKGROUND: To evaluate global stroke pathways in pediatric acute ischemic stroke care, including availability of personnel, imaging practices, hyperacute therapies available, and institutional resources. METHODS: A 25-question survey designed by the Society of Neurointerventional Surgery Pediatric Special Interest Group was distributed internationally via pediatric and neurointerventional societies. The survey collected data on institutional settings, stroke team composition, imaging protocols, use of artificial intelligence, and access to thrombectomy and thrombolysis. Responses from 103 stroke care providers were analyzed using descriptive statistics. Participation was voluntary and anonymous, and >1 respondent from the same institution was permitted. RESULTS: Ninety-one of 103 respondents (88%) reported managing pediatric acute ischemic stroke. However, only 65% offered both intravenous thrombolysis and thrombectomy. Computed tomography and computed tomography angiography were the most commonly used first-line imaging modality (34%), whereas perfusion imaging and artificial intelligence tools were underutilized. Pediatric neurologists were the most common decision-makers for thrombolysis (38%). Posterior circulation thrombectomy was widely unavailable (offered at only 45% of centers). CONCLUSIONS: Survey results revealed considerable variability in pediatric acute ischemic stroke pathways globally and a lack of standardization in treatment. Disparities in access to imaging, hyperacute therapies, and trained personnel underscore the need for standardization, international collaboration, and the creation of systems utilizing available resources to improve pediatric stroke care.

Stroke, a leading cause of mortality and long-term disability, induces complex cascades of oxidative stress and neuroinflammation that exacerbate brain injury. The peroxiredoxin (Prx; Prdx) family, composed of six thiol-dependent antioxidant enzymes (Prx1–6), plays a pivotal role in regulating redox homeostasis and immune responses in the brain. This review synthesizes current knowledge on the isoform-specific roles of Prxs in both ischemic and hemorrhagic stroke, highlighting their dual and context-dependent functions. Intracellular Prxs generally protect neurons and maintain blood–brain barrier (BBB) integrity, while extracellular Prxs—particularly Prx1 and Prx2—act as damage-associated molecular patterns (DAMPs), activating toll-like receptor signaling and amplifying inflammation. Isoforms such as Prx3 and Prx4 exhibit mitochondrial and endothelial protective effects, respectively, whereas Prx6 demonstrates complex roles influenced by its acidic, Ca²⁺-independent, phospholipase A2 (aiPLA2) activity and cellular localization. We also discuss emerging tools for studying Prx biology and explore the translational potential of Prxs as biomarkers and therapeutic targets. Ultimately, a nuanced understanding of Prx dynamics offers new avenues for stroke diagnosis, prognosis, and treatment.

Background: Glioblastoma (GBM) is a lethal, highly invasive, and recurrent brain tumor. Standard treatment combines maximal surgical resection, radiation, and chemotherapy; however, such approaches are often infeasible for tumors in eloquent brain regions. Objective: Histotripsy is a noninvasive, nonthermal ultrasound-based mechanical ablation modality that employs focused acoustic energy for targeted tissue destruction. This study aimed to investigate the feasibility, safety, and therapeutic effect of a one-time transcranial histotripsy treatment in a pre-clinical murine GBM model. Methods: GL261 GBM cells were orthotopically implanted into C56BL/6 mouse brains. Transcranial histotripsy was performed using a stereotactically guided 2 MHz transducer targeting either lower (25%) or higher (75%) tumor volume, with 5 or 10 pulses per location (PPL) administered. Tumor growth and cerebral injury were monitored with weekly magnetic resonance imaging (MRI) following treatment. At the study endpoint, hematoxylin and eosin (H&E) histology assessed residual tumor burden and histotripsy-induced tissue changes. Results: Mice receiving 5 PPL high-percent treatment (>30 sites) showed a statistically significant median survival extension of 5 days (18.5%) compared to untreated controls. MRI demonstrated marked tumor volume reduction in the high-percent treatment group at week 4, while H&E confirmed increased tumor necrosis and cellular damage in the treated cohort. Conclusions: Single-session, incisionless transcranial histotripsy was well tolerated and conferred mild yet meaningful survival advantages in this GBM model. These results support ongoing exploration of histotripsy, alone or in combination with existing therapies, for safe and effective treatment of challenging brain tumors.

Selective brain cooling (SBC) is achieved by cooling the carotid artery of rats with an extravascular thermoelectric concentrated cooling probe. The efficacy of this technique is established by directly measuring temperature at the brain, rectal/core, and intrajugular locations. The level of brain cooling achieved is compared against that of a conventional clinical hypothermia intervention, simulated with a cooling blanket placed on the rat's abdomen. With the probe, brain temperature decreased rapidly (4.19 ± 3.15 °C/h) and independently of the core (−0.84 ± 2.59 °C/h) when applying 0 °C. Histological evaluations of the carotid tissue and blood samples showed no adverse pathological changes from the technique. By contrast, systemic hypothermia via cooling blanket showed steep brain cooling (−8.22 ± 3.35 °C/h) at the expense of significant losses in core temperature (−15.31 ± 6.60 °C/h). Localized brain cooling as demonstrated with the probe allows increased controllability and potential for therapeutic use provided it is validated in larger animal models. A sophisticated SBC technique will enable future investigations into decoupling and reducing the detrimental side effects of systemic hypothermia from its benefits.

BACKGROUND: We aimed to investigate whether rescue stenting (RS) following failed mechanical thrombectomy (MT) for acute basilar artery occlusion results in superior functional outcomes and enhanced safety compared with the natural history of failed MT. METHODS: This retrospective cohort study utilized data from the Posterior Circulation Ischemic Stroke Evaluation: Analyzing Radiographic and Intra-Procedural Predictors for Mechanical Thrombectomy registry, encompassing 8 high-volume centers in the United States and covering the period from 2015 to 2021. Patients with basilar artery occlusion who experienced failed MT (modified Thrombolysis in Cerebral Infarction score of 0–2a after at least 1 attempt of clot retrieval) were categorized based on whether they received additional intervention with RS. The primary outcome was a shift analysis of the 90-day modified Rankin Scale. Multivariable logistic regression was used to assess both efficacy and safety outcomes. RESULTS: Of a total of 444 patients, 119 presented failed MT and were included in the analysis. The RS group comprised 65 (14.6%) patients, while the control group consisted of 54 (12.2%) patients. After adjusting, the RS group showed a favorable shift in the overall 90-day modified Rankin Scale distribution (adjusted common odds ratio, 4.56 [95% CI, 1.67–12.45]; P =0.003) and higher rates of 90-day 0 to 3 modified Rankin Scale score (RS: 44.6% versus control: 18.5%; adjusted odds ratio, 7.57 [95% CI, 1.91–30.12]; P =0.004) compared with the control group. RS also showed lower rates of 90-day mortality (RS: 43.1% versus control: 64.8%; adjusted odds ratio, 0.27 [95% CI, 0.09–0.80]; P =0.018) and comparable rates of symptomatic intracranial hemorrhage (RS: 3.1% versus control: 13%; adjusted odds ratio, 0.31 [95% CI, 0.05–1.95]; P =0.214). CONCLUSIONS: Our study demonstrated that RS is associated with improved functional outcomes and reduced mortality in basilar artery occlusion patients presenting MT failure. Further randomized trials are needed to validate these findings.

Introduction: Dural carotid-cavernous fistulas (dCCFs), also known as indirect carotid-cavernous fistulas, represent abnormal connections between the arterial and venous systems within the cavernous sinus that are typically treated via endovascular approach. We aim to investigate the clinical characteristics of patients with dCCFs based on the endovascular treatment approach and assess angiographic and clinical outcomes. Methods: A systematic review of the literature was performed. Data including number of patients, demographics, presenting clinical symptoms, etiology of fistula, Barrow classification, and embolization material were collected and evaluated. Outcome measures collected included degree of fistula occlusion, postoperative symptoms, complications, and mean follow-up time. Results: A total of 52 studies were included examining four primary endovascular approaches for treating dCCFs: transarterial, transfemoral–transvenous (transpetrosal or other), transorbital (percutaneous or via cutdown), and direct transfacial access. Overall data was collected from 736 patients with 817 dCCFs. Transarterial approaches exhibit lower dCCF occlusion rates (75.6%) compared to transvenous techniques via the inferior petrosal sinus (88.1%). The transorbital approach via direct puncture or surgical cutdown offers a more direct path to the cavernous sinus, although with greater complications including risk of orbital hematoma. The direct transfacial vein approach, though limited, shows up to 100% occlusion rates and minimal complications. Conclusion: We provide a comprehensive review of four main endovascular approaches for dCCFs. In summary, available endovascular treatment options for dCCFs have expanded and provide effective solutions with generally favorable outcomes. While the choice of approach depends on individual patient factors and technique availability, traditional transvenous procedures have emerged as the first-line endovascular treatment. There is growing, favorable literature on direct transorbital and transfacial approaches; however, more studies directly comparing these general transvenous options are necessary to refine treatment strategies.

We present the first reported case that describes the complete resolution of a meningioma following endovascular embolization. A man in his 70s who presented with gait abnormalities and recurrent falls was diagnosed with normal pressure hydrocephalus (NPH) and found to have a small incidental meningioma. Due to ventriculoperitoneal (VP) shunt placement for cerebrospinal fluid diversion, the patient developed a bilateral subdural hematoma (SDH) requiring evacuation and drain placement. The patient also underwent bilateral middle meningeal artery (MMA) embolization. During the embolization, the known right frontal meningioma was embolized as it was supplied by the right MMA. The patient remained neurologically stable after this procedure. His follow-up magnetic resonance imaging (MRI) 1 year and 2 years after the procedure demonstrated complete resolution of the meningioma.