Hilmiye Tokmak

Background/Objectives: Carotid perivascular adipose tissue (PVAT) density on computed tomography angiography (CTA) is a noninvasive surrogate marker of local vascular inflammation, but its relevance to stroke etiology in a homogeneous cohort of patients undergoing mechanical thrombectomy (MT) remains unclear. Methods: We retrospectively analyzed 146 consecutive patients with acute ischemic stroke treated with MT for acute middle cerebral artery (MCA) occlusion between May 2018 and August 2024. Baseline CTA was used to quantify carotid PVAT density with two 2–3 mm² circular regions of interest per internal carotid artery (ICA), placed ≥1 mm from the vessel wall. Measurements were performed bilaterally, and the ICA ipsilateral to the occluded MCA was defined as the stroke-side ICA. Etiology was classified according to the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) system and grouped as large-artery atherosclerosis (LAA), cardioembolism (CE), and other/undetermined (OD/UD). Interobserver agreement was assessed using the intraclass correlation coefficient. Results: The mean age was 72.21 ± 12.39 years; 83.6% of patients achieved successful recanalization (mTICI ≥ 2b), and 47.9% had a favorable 90-day outcome (mRS ≤ 2). In the LAA subgroup (n = 38), ipsilateral PVAT density was significantly higher (less negative) than contralateral PVAT density (−64.24 ± 11.74 vs. −78.22 ± 9.13 HU; p < 0.001). Ipsilateral PVAT density differed significantly across TOAST groups (ANOVA p = 0.004), being higher in LAA than in CE (Δ = 11.19 HU; p = 0.003) and OD/UD (Δ = 9.54 HU; p = 0.004). ROC analysis showed modest discrimination for LAA versus non-LAA stroke (AUC 0.67, 95% CI 0.58–0.75), with an optimal cutoff of −79 HU (sensitivity 92.1%, specificity 40.7%). In multivariable logistic regression, higher ipsilateral PVAT density was independently associated with LAA etiology (per 1-HU increase: OR 1.048, 95% CI 1.018–1.079; p = 0.0016). PVAT density was not associated with recanalization success or 90-day functional outcome. Conclusions: In patients with acute MCA occlusion undergoing MT, higher carotid PVAT density on the stroke side was independently associated with LAA stroke etiology but had limited value for predicting MT success or short-term clinical outcome.

Objective: Early diagnosis of acute ischemic stroke patients with large vessel occlusion (LVO) and the transfer of patients who require endovascular treatment to specialized stroke centers are critical for patients. Pentraxin-3 (PTX-3) is a biomarker of vascular inflammation, and its role in stroke, including its relationship with clinical features, is being investigated. In this study, we evaluated the value of PTX-3 levels in the diagnosis of LVO and their relationship with clinical features. Methods: This study included retrospectively and prospectively enrolled patients diagnosed with acute ischemic stroke. Patients were divided into two groups according to imaging findings: those with and those without LVO. Serum PTX-3 levels were measured and compared between the groups. Stroke severity was evaluated at admission using the National Institutes of Health Stroke Scale (NIHSS), and clinical outcome was evaluated at the 90th day using the modified Rankin Scale (mRS). Correlation, ROC analysis, and logistic regression methods were used in statistical analyses. Results: Data from 81 patients were analyzed. Although PTX-3 levels were higher in patients with LVO, the difference was not statistically significant. The discriminative power of PTX-3 for LVO was limited (AUC = 0.58). A positive correlation was found between PTX-3 levels and admission NIHSS. Although an association between PTX-3 and poor clinical outcome was observed in univariate analyses, PTX-3 was not an independent marker in multivariable analyses. The addition of PTX-3 to clinical models did not increase predictive power. Conclusion: In patients with acute ischemic stroke with LVO, PTX-3 was not a sufficient biomarker for confirming the diagnosis. Although PTX-3 was associated with stroke severity, it could not predict clinical outcome independently. Based on the current findings, PTX-3 does not appear to have a clear contribution to the clinical decision-making process.

Objective: Early diagnosis of acute ischemic stroke patients with large vessel occlusion and the transfer of patients who require endovascular treatment to stroke centers specific for treatment are of critical importance for patients. Pentraxin-3 (PTX-3) is a biomarker indicating vascular inflammation, and its role in stroke and its relationship with clinical features are being investigated. In this study, the value of PTX-3 levels in the diagnosis of LVO and its relationship with clinical features were evaluated. Methods: Retrospective and prospective patients diagnosed with acute ischemic stroke were included in this study. Patients were divided into two groups as those with and without LVO according to imaging findings. Serum PTX-3 levels were measured and compared between the groups. Stroke severity was evaluated at admission using the National Institutes of Health Stroke Scale (NIHSS), and clinical outcome was evaluated at the 90th day using the modified Rankin Scale (mRS). Correlation, ROC analysis, and logistic regression methods were used in statistical analyses. Results: Data of 81 patients were analyzed in the study. Although PTX-3 levels were found to be higher in patients with LVO, this difference was not statistically significant. The discriminative power of PTX-3 for LVO was found to be limited (AUC = 0.58). A positive correlation was found between PTX-3 levels and admission NIHSS. Although an association between PTX-3 and poor clinical outcome was observed in univariate analyses, it was shown that it was not an independent marker in multivariable analyses. The addition of PTX-3 to clinical models did not increase predictive power. Conclusion: In patients with acute ischemic stroke with LVO, PTX-3 was found not to be a sufficient biomarker in confirming the diagnosis. Although PTX-3 was found to be associated with stroke severity, it cannot predict clinical outcome on its own. Based on the current findings, PTX-3 does not appear to have a clear contribution to the clinical decision-making process.

Objective: Although an Alberta Stroke Program Early CT Score (ASPECTS) < 7 is known to be associated with poor clinical outcomes in patients with acute ischemic stroke (AIS), the relationship between regional differences in infarct location within the ASPECTS territory and clinical outcome has not been fully clarified. The aim of this study is to evaluate the association between infarct area localization and clinical outcomes in AIS patients with large vessel occlusion and to investigate whether these regional patterns can be used to predict prognosis independently of the total ASPECTS. Methods: In this retrospective, single-center study, patients with acute ischemic stroke who had undergone non-contrast brain CT prior to endovascular thrombectomy between January 2020 and July 2023 and were found to have internal carotid artery (ICA) and/or middle cerebral artery (MCA) M1 segment occlusion were included. Patients with a premorbid modified Rankin Scale (mRS) score of 0–2 were eligible for inclusion. Patients with unavailable imaging or clinical follow-up data were excluded. Clinical outcomes were assessed using the modified Rankin Scale at 90 days. An mRS score of 0–2 was defined as a good clinical outcome, whereas an mRS score of 3–6 was defined as a poor clinical outcome. Results: A total of 283 patients were included (median age 73 years; 57.2% female), of whom 147 (51.9%) achieved a good clinical outcome. The poor outcome group had higher NIHSS scores and lower total ASPECTS values (both p < 0.001). In the regional analysis, involvement of the internal capsule (32.4% vs. 4.1%; p < 0.001) and ASPECTS M1 region (26.5% vs. 10.2%; p < 0.001) was associated with poor outcome. In multivariable analysis, internal capsule involvement (adjusted odds ratio [aOR] ≈ 12) and M1 region involvement (aOR ≈ 2.7) remained independent predictors. In the subgroup with successful recanalization, only internal capsule involvement remained an independent predictor (aOR ≈ 19). In hemisphere-stratified analyses, M1 involvement in the right hemisphere and internal capsule involvement in the left hemisphere were independently associated with poor outcome. Conclusions: The prognostic contribution of individual ASPECTS regions is not uniform in patients with acute ischemic stroke undergoing endovascular thrombectomy (EVT). In particular, involvement of the internal capsule and the M1 region shows a strong association with poor clinical outcome independent of the total ASPECTS. However, these findings suggest that regional localization alone is not sufficient for EVT patient selection. Further large-scale, multicenter studies are needed to clarify the role of regional ASPECTS assessment in clinical decision-making.

Contrast-induced encephalopathy (CIE) is a rare but potentially serious complication associated with the administration of contrast media. We report the case of a 70-year-old woman undergoing diagnostic cerebral angiography for asymptomatic common carotid artery stenosis who developed transient drowsiness during the procedure. Shortly after angiography, she experienced generalized tonic-clonic seizures involving the left upper and lower extremities, accompanied by leftward gaze deviation. Computed tomography revealed cortical high-density signals consistent with contrast leakage, leading to a diagnosis of CIE. This case highlights the need for vigilant monitoring for acute neurological changes during and immediately after angiographic procedures, even when only small amounts of contrast agents are used.

Background: Despite current developments in mechanical thrombectomy (MT), successful recanalization cannot be achieved in all patients. One of the factors related to this is the characteristics of the thrombus. In this study, we aimed to evaluate the effects of thrombus length and permeability on procedural success and clinical outcome. Methods: Patients with intracranial ICA, middle cerebral artery M1, or M2 occlusions, who underwent MT between November 2019 and January 2022 were included in the study. Thrombus length, density and permeability were calculated and the relationship between recanalization success and modified Rankin Scores (mRS) at the 3rd month was evaluated. Good clinical outcome was defined as an mRS score of 2 or less. Results: Forty-six of the 79 patients included in the study had a good clinical outcome. Although thrombus length was shorter and permeability was higher in patients with good clinical outcome, statistical significance was not achieved. There was a positive correlation between thrombus density, thrombus length and the number of passes, and a negative correlation between permeability. There was no significant difference in thrombus length, density and permeability between patients with and without successful recanalisation. Thrombus length was found to be a predictor of clinical outcome at 3 months in univariate analysis, whereas only age was found to be an independent predictor in multivariate analysis. Conclusions: In conclusion, despite certain findings not achieving statistical significance, the observed trends offer valuable insights for future research. A comprehensive understanding of thrombus nature could guide personalized stroke treatment strategies in the future.

Background The relationship between collateral circulation and prognosis after endovascular treatment in anterior circulation strokes has been reported in many studies. Objective In this study, we aimed to compare the predictive power of clinical outcome by comparing five different collateral scores that are frequently used. Methods Among the patients who underwent endovascular treatment in our clinic between November 2019 and December 2021, patients with premorbid mRS < 3, intracranial ICA and/or MCA M1 occlusion, and a pre-procedural multiphase CTA examination were included in the study. Demographic, technical, and duration information about the procedure, major events after the procedure, and clinical outcomes at 3 months were recorded. The mCTA, Tan, Maas, Miteff, and rLMC collateral scores of the patients were evaluated. Results Clinical outcome at 3 months were good in 37 of the 68 patients included in the study (mRS ≤ 2). Only the mCTA and rLMC collateral scores were statistically significantly higher in those with a good clinical outcome. Significant correlation with 3-month mRS was detected only in mCTA and rLMC scores. Although rLMC and mCTA collateral scores showed a statistically significant association with prognosis, they were not sufficient to be an independent predictor of prognosis. Conclusion mCTA and rLMC were found to have the highest predictive power of clinical outcome and the highest correlation with the 3-month clinical outcome. Our study suggests that it would be beneficial to develop a new scoring system over multiphase CTA, which combines regional and temporal evaluation, which are the strengths of both collateral scoring.