Esra Ünal

Age is one of the most critical non-modifiable risk factors for stroke. With the increasing aging of the global population, the incidence of stroke is expected to increase. The current evidence makes treatment decisions regarding MT in patients over 90 years of age challenging. The aim of this study is to evaluate the efficacy of mechanical thrombectomy (MT) and the factors associated with outcomes in patients aged 90 years and older. This is an observational study that follows STROBE guidelines. Patients aged 90 years and older with a pre-stroke Modified Rankin Scale (mRS) score of 0–1 a proximal large-vessel occlusion, who did not receive IV tPA were included in the study. A total of 28 patients were included. To assess clinical outcomes, the 90-day mRS score was evaluated. Patients were categorized into two groups: good clinical outcome (mRS 0–2) and poor clinical outcome (mRS 3–6). The mean age was 91.2 ± 1.5 years. Female patients accounted for 71.4%. The mean National Institutes of Health Stroke Scale (NIHSS) score was 18.7 ± 4.3. Hypertension was the most common comorbidity. The admission glucose levels were significantly higher in the poor clinical outcome group ( p = 0.03). Type 3 aortic arch was significantly more frequent in the group with poor clinical outcomes. Isolated middle cerebral artery (MCA) occlusion was significantly more common in the good clinical outcome group ( p = 0.03). Our findings suggest that MT can be successful in certain nonagenarian patients. In this study, we identified that admission blood glucose level, aortic arch morphology, location of the occluded vessel, and puncture-to-recanalization time are determinant factors for clinical outcomes.

Background/Objectives: The C-reactive protein-to-lymphocyte ratio (CLR) has emerged as an inflammatory biomarker reflecting innate and adaptive immune responses. Its prognostic value in acute ischemic stroke patients undergoing mechanical thrombectomy remains unclear. This study investigated whether CLR predicts functional outcome, mortality, and symptomatic intracranial hemorrhage (sICH). Methods: In this multicenter retrospective study, 714 patients with anterior circulation large-vessel occlusion treated with mechanical thrombectomy between January 2024 and January 2025 were analyzed. Clinical, angiographic, and laboratory data, including CLR, were collected. CLR was calculated as CRP divided by lymphocyte count/1000. Outcomes were 90-day modified Rankin Scale (mRS; poor outcome = 3–6; mortality = 6) and sICH per ECASS II. Receiver operating characteristic (ROC) analyses identified optimal CLR cut-offs. Logistic regression analyses determined independent predictors of outcomes. Results: sICH occurred in 39 patients (5.5%). CLR correlated with higher baseline NIHSS and lower ASPECTS. ROC analyses showed that CLR predicted poor functional outcome and mortality with an identical cut-off (≥7.51; AUCs 0.634 and 0.664), and demonstrated strong discrimination for sICH (cut-off ≥ 10.64; AUC 0.855). In multivariable analyses, CLR remained an independent predictor across all outcomes (ORs 1.02, 1.02, and 1.03, all p < 0.001), in addition to established clinical factors. Conclusions: Admission CLR was independently associated with poor outcomes, mortality, and sICH after mechanical thrombectomy. As an easily obtainable marker from routine laboratory tests, CLR may provide additional prognostic information and complement established predictors, but prospective validation is required.

Capsular warning syndrome (CWS) is characterized by recurrent episodes of TIAs within a 24-hour, affecting at least two regions of the face, upper and/or lower extremities, and the absence of cortical symptoms. CWS accounts for small percentage of TIAs. However, it is associated with a higher risk of stroke and permanent neurological deficits. In this article, we present the findings, treatment and prognosis of CWS. This study reviewed the data of patients with cerebral small vessel disease. The clinical findings, the number and duration of CWS attacks, and treatments were noted. The NIHSS and the 3-month-mRS of the patients were evaluated to determine their prognosis. A total of 27 CWS cases were included, with an average age of 71.25 and 74.1% male. The most common lesion location was the internal capsule(51.8%), followed by the corona radiata. Dual antiplatelet therapy was the preference in 81.5% of patients. It was observed that the mean 3-month-mRS was 3.60 in the anticoagulation group and 0.90 in the antiplatelet group. Our study highlights important information regarding lesion location, attack durations and treatment and shows that especially dual antiplatelet therapy is more effective in preventing permanent neurological deficits and CWS attacks.

Background: Stroke remains a leading cause of morbidity and mortality worldwide, with dyslipidemia playing a crucial role in atherosclerosis and stroke development. The Atherogenic Index of Plasma (AIP), calculated as log(triglyceride/HDL), has emerged as a biomarker for atherosclerosis and cardiovascular risk. However, its relationship with stroke prognosis remains unclear. This study aimed to investigate the association between AIP and favorable clinical outcomes at three months in acute ischemic stroke patients undergoing mechanical thrombectomy. Methods: We conducted a retrospective analysis of 222 patients who underwent mechanical thrombectomy between December 2019 and April 2023. The association between AIP and demographic variables, etiology, successful recanalization, intracerebral hemorrhage, and three-month mRS was evaluated. AIP values were compared between patients with good (mRS 0–2) and poor (mRS 3–6) clinical outcomes. Results: The most common comorbidity was hypertension (72.1%), followed by AF (50%). Stroke etiologies included large artery atherosclerosis (16.2%), cardioembolism (57.2%), and undetermined causes (26.6%). AIP values were significantly lower in patients with good functional outcomes. Additionally, AIP values were inversely associated with AF but positively correlated with DM and previous stroke history. No significant relationship was observed between the AIP and successful recanalization or intracerebral hemorrhage. Conclusions: This study is the first to demonstrate that elevated AIP is associated with poor functional outcomes after three months in patients undergoing mechanical thrombectomy. Given its strong correlation with prognosis, the AIP may serve as a valuable biomarker for identifying high-risk patients. Future prospective studies are needed to further validate these findings and explore the potential role of the AIP in stroke management.

Introduction: Carotid artery stenosis is the presence of 50% or more stenosis in the internal carotid artery (ICA) according to the North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria and is one of the leading etiological factors of ischemic stroke. The severity of stenosis is associated with stroke risk. The prevalence of bilateral carotid artery stenosis (BCAS) varies. This study aims to evaluate the clinical outcomes and complications associated with carotid artery stenting in patients with BCAS or occlusion in a comprehensive stroke center.Methods: The data of patients who underwent carotid artery stenting (CAS) between January 2020 and September 2024 were scanned. The demographic data and comorbidities were noted from the patients’ files. Then, the patients were divided into two groups. The first group is “bilateral 50%–99% ICA stenosis” and the second group is “one side ICA occluded contralateral side ICA ≥50% stenosis”. Both groups were also listed as symptomatic and asymptomatic. Demographic and endovascular procedure data were analyzed.Results: A total of 82 patients were included in this study, 69 male (84.14%) and 13 female (15.85%). The mean age was 69.46 ± 7.24. Hypertension (HT) was the most common comorbid disease (69.51%). Sixty‐six patients (80.50%) were symptomatic and 16 (19.50%) were asymptomatic. TIA developed in one patient in the first group. Two minor (The National Institutes of Health Stroke Scale [NIHSS] 1–3) and two major strokes developed in the second group. Only three patients (two in the first group, one in the second group) underwent postdilatation balloon angioplasty.Conclusion: Endovascular treatment seems to be an acceptable strategy in comprehensive stroke centers where the possible complication risks can be well managed in this group of patients.