Hans Henkes

Background and ObjectivesCardiac abnormalities are among the most common and complex risk factors of pediatric acute ischemic stroke (AIS). Although endovascular treatment (EVT) is increasingly use...

Background: Intracranial artery dissection (IADS) is an uncommon cause of acute ischemic stroke (AIS). In hyperacute settings, stenting is constrained by the need for intensive antiplatelet therapy. This study evaluated the antithrombogenic hydrophilic polymer–coated pEGASUS-HPC self-expanding stent for IADS-related AIS. Methods: This multicenter retrospective cohort study across seven stroke centers included consecutive patients with AIS and occlusion or severe flow-limiting stenosis caused by symptomatic IADS, who were treated with the pEGASUS-HPC. The outcomes were technical and angiographic success (device opening; mTICI score ≥2b when reperfusion was targeted), peri-procedural complications, mRS score, and follow-up patency. Results: In 36 treated patients (mean age 62.0 ± 19.6 years; 63.9% men), 91.7% of the dissections were spontaneous, and 80.6% were occlusive. Mechanical thrombectomy preceded stenting in 26/29 occlusive cases. Full stent opening occurred in 94.4%, and 100% reperfusion success was achieved in targeted vessels. Most patients received periprocedural intravenous antiplatelet bridging (75.0%) and were discharged on DAPT (77.8%). Whereas no intraprocedural complications occurred, four postprocedural events occurred during admission (11.1%), of which two were clinically significant and two were minor and asymptomatic. The mean NIHSS score improved from 11.8 at admission to 4.9 at discharge, and the mean discharge mRS score was 2.1. Clinical follow-up (mRS) was available in 33/36 patients (91.7%), with favorable functional outcome (mRS 0–2) in 27/33 (81.8%). Imaging follow-up at the early window (mean 94 days) was available in 27/36 (75.0%). In-stent stenosis ≥ 50% occurred in 14.8% and 4.2% of patients at early and mid-term follow-up, respectively, whereas no device occlusions or recurrent strokes occurred through mid-term follow-up. Long-term imaging follow-up (15/36, 41.7%) showed no new in-stent stenosis. Conclusions: pEGASUS-HPC stenting for IADS-related AIS was technically feasible and achieved high reperfusion rates and a low overall complication burden, thus supporting prospective evaluation with standardized antiplatelet protocols.

Objectives: To compare the feasibility, efficiency, and safety of the pEGASUS-HPC stent pusher-assisted catheterization (PAC) technique between ruptured and unruptured wide-neck intracranial aneurysms treated with stent-assisted coiling. Methods: Multicenter retrospective study (June 2021–June 2025) evaluating the pEGASUS-HPC PAC technique in ruptured and unruptured wide-neck intracranial aneurysms treated with stent-assisted coiling. A microwire-assisted catheterization (MAC) cohort was included as a reference cohort. Primary endpoints were catheterization success and catheterization time; safety endpoints included perforation, dissection, and vasospasm. Results: A total of 151 patients with 186 aneurysms were analyzed, including a PAC cohort of 91 patients with 111 aneurysms (27 ruptured, 84 unruptured) and a MAC reference cohort of 60 patients with 75 unruptured aneurysms. Catheterization success was achieved in 26/27 ruptured aneurysms (96.3%) and 79/84 unruptured aneurysms (94.0%) ( p = 0.637). Mean catheterization time was 44 ± 14 s in ruptured aneurysms and 43 ± 21 s in unruptured aneurysms ( p = 0.78). No catheterization-related perforations or dissections occurred in either PAC group, and no major procedural complications were recorded. Compared with the MAC reference cohort (289 ± 78 s), PAC was associated with significantly shorter catheterization times in both ruptured and unruptured aneurysms (both p < 0.001) while maintaining high technical success rates. Conclusion: The PAC technique demonstrated high catheterization success rates, short catheterization times, and a favorable safety profile in both ruptured and unruptured wide-neck intracranial aneurysms. Aneurysm rupture status did not significantly influence procedural performance or safety. Larger prospective studies are warranted to confirm these findings and further define patient- and anatomy-specific indications for the technique.

Vascular intervention has advanced technically faster than it has matured methodologically. Across neurovascular, carotid, peripheral, and aortic practice, complications and outcomes are often reported using different definitions, thresholds, surveillance strategies, adjudication methods, follow-up schedules, and units of analysis. As a result, studies that appear to assess the same treatment may in fact be measuring different outcome constructs. This problem is particularly visible in neurovascular intervention, where technical, radiographic, and clinical outcomes are often combined within the same evaluative framework. In acute ischemic stroke thrombectomy, changes in reperfusion thresholds can alter the meaning of procedural success. In intracranial aneurysm treatment, angiographic occlusion, retreatment, delayed stenosis, and neurological morbidity are often reported together despite representing different dimensions of efficacy and safety, while the interpretation of surrogate angiographic outcomes may vary across device classes. Similar issues arise in carotid intervention, peripheral endovascular therapy, and endovascular aneurysm repair, where composite outcomes, imaging-detected complications, and inconsistent surveillance protocols further complicate interpretation. These variations limit cross-study comparability, weaken meta-analytic synthesis, and may distort judgments about treatment effectiveness and safety. Endpoint heterogeneity persists partly through disciplinary silos, device-driven evaluation frameworks, and regulatory pathways that favor surrogate over clinical endpoints; addressing it will require not only better reporting but standardized outcome constructs, coordinated international registries, and broader adoption of core outcome set methodology. Greater discipline in endpoint definition and reporting, together with broader adoption of standardized outcome frameworks and core outcome set methodology, is needed if evidence in vascular intervention is to accumulate coherently.

BACKGROUND: Twig-like middle cerebral artery (T-MCA) is an uncommon configuration in which the M1 segment is replaced by a plexiform network reconstituting the distal middle cerebral artery (MCA). It is often labeled congenital, yet adult de novo cases suggest acquired formation after focal M1 disease. OBSERVATIONS: A male neonate underwent angiography at 6 days of life for a suspected right brain arteriovenous malformation (AVM); the contralateral left M1 segment was normal. After staged AVM treatment, follow-up angiography at approximately 1 year showed a new left M1 irregularity and narrowing consistent with dissection, without ischemic lesions on serial MRI. Over the ensuing 2–3 years, serial angiography documented progression to left M1 occlusion with replacement of the M1 trunk by a plexiform collateral network that reconstituted the distal MCA, forming a classic T-MCA configuration by 4.5 years. The child remained neurologically intact. Molecular analysis of AVM tissue identified a likely pathogenic somatic KRAS in-frame duplication. LESSONS: This pediatric case shows that T-MCA can form postnatally after focal M1 injury and may be misclassified as congenital on a single late angiogram. The coexisting KRAS -mutated AVM raises a testable role for somatic vascular genetics in remodeling responses beyond RNF213 -focused testing. https://thejns.org/doi/10.3171/CASE2611

Background/Objectives: Dietary fiber has been associated with lower levels of inflammatory biomarkers, but nationally representative evidence using recent U.S. data remains limited. We evaluated the association between dietary fiber intake and inflammatory biomarkers in U.S. adults using the National Health and Nutrition Examination Survey (NHANES) 2017–2018, the last fully completed cycle before the COVID-19 pandemic, providing a pre-pandemic benchmark for future comparisons. Methods: We analyzed 3570 adults (≥20 years) from NHANES 2017–2018 with complete dietary and biomarker data. Fiber intake was averaged from two 24 h recalls. Outcomes included serum high-sensitivity C-reactive protein (hs-CRP; primary outcome), white blood cell count (WBC), and neutrophil count. Survey-weighted regression models adjusted for demographic, socioeconomic, lifestyle, clinical, and dietary covariates. Associations were examined continuously (per 5 g/day fiber), by quartiles, and with restricted cubic splines. Sensitivity analyses excluded participants with cardiometabolic conditions or modified covariate sets. Results: Each 5 g/day higher fiber intake was associated with 4–7% lower hs-CRP (p < 0.001). Participants in the highest versus lowest fiber quartile had 20.7% lower hs-CRP (95% CI −27.1, −14.4) and 47% lower odds of elevated hs-CRP (OR 0.53, 95% CI 0.32–0.85). Secondary outcomes showed significant inverse associations: each +5 g/day was associated with −0.98% WBC (95% CI −1.84, −0.13; p = 0.024) and −1.44% neutrophils (95% CI −2.62, −0.26; p = 0.017) in fully adjusted models. Spline analyses showed no nonlinearity for WBC (p = 0.227) but nonlinear inverse associations for neutrophils (p = 0.0017). Sensitivity analyses confirmed robustness to exclusion of individuals with diabetes, hypertension, or hyperlipidemia, and to alternative covariate specifications. Conclusions: Higher dietary fiber intake was independently associated with a more favorable inflammatory biomarker profile (hs-CRP, WBC, and neutrophils) in U.S. adults, providing a pre-pandemic benchmark for future comparisons. Longitudinal and interventional studies are needed to clarify temporality and causality.