Kawthar Faisal Kushara

Background: Multiple trials have evaluated the benefits of endovascular thrombectomy (EVT) in patients with large-core ischemic stroke. This study aimed to determine the efficacy and safety of EVT compared with medical management (MM) alone in patients with large ischemic core infarcts. Methods: This study was registered in PROSPERO (CRD420261360129). A comprehensive search of PubMed, Web of Science, and the Cochrane Library was conducted to identify all relevant studies published up to April 2026. Effect sizes were calculated as risk ratios (RRs) using random-effects or fixed-effects models, as appropriate. Study quality was assessed using the Cochrane Risk of Bias tool and the Newcastle–Ottawa Scale. Subgroup and sensitivity analyses were performed to explore heterogeneity and evaluate outcomes across different patient populations. Outcomes assessed included excellent functional independence (mRS 0–2) and favorable functional outcome (mRS 0–3) at 3 months, mean mRS at 3 and 12 months, symptomatic intracranial hemorrhage, and all-cause mortality at 3 and 12 months. Results: Nine eligible studies (5 randomized controlled trials [RCTs] and 4 cohort studies; total sample size = 2252) were included to evaluate the comparative efficacy and safety of EVT versus MM alone in patients with acute ischemic stroke (AIS) secondary to large vessel occlusion. Our pooled analysis demonstrated a significantly higher rate of achieving a modified Rankin Scale (mRS) score of 0–2 in the EVT group compared with the MM group (RR = 2.64, 95% CI [1.79–3.90], p < 0.00001). Similarly, the likelihood of achieving an mRS score of 0–3 was significantly greater with EVT than with MM (RR = 1.78, 95% CI [1.40–2.26], p < 0.00001). The mean mRS score at 3 months was also significantly lower in the EVT group (MD = −0.58, 95% CI [−0.77 to −0.39], p < 0.00001). Safety outcomes were comparable between groups, with no significant differences in the rates of symptomatic intracranial hemorrhage (sICH) (RR = 1.36, 95% CI [0.88–2.11], p = 0.17) or mortality (RR = 0.96, 95% CI [0.65, 1.42], p = 0.84, I² = 75%). Conclusions: Our findings suggest that EVT is associated with improved functional outcomes compared with MM alone, particularly in evidence derived from RCTs, while maintaining an acceptable safety profile. Further high-quality RCTs are warranted to strengthen the evidence base and validate these findings.

Background and objectives: Cerebrovascular strokes and transient ischemic attacks (TIAs) remain leading causes of global mortality and long-term disability. Emerging evidence suggests that pre-existing structural brain frailty—driven by chronic cerebral small vessel disease (CSVD)—critically limits neuroplastic compensation and determines overall recovery potential. This systematic review aims to synthesize current evidence evaluating brain frailty as an independent determinant of functional and cognitive outcomes. Methods: Following PRISMA and Cochrane SWiM guidelines, a comprehensive literature search was conducted across PubMed, Web of Science, Embase, and Scopus. Methodological quality was evaluated using the Newcastle–Ottawa Scale (NOS). Due to anticipated clinical and methodological heterogeneity, data were synthesized via a structured narrative approach. A total of 15 studies comprising more than 18,000 participants met the inclusion criteria, including prospective cohorts, retrospective cohorts, registry analyses, pooled cohort studies, and post hoc analyses of randomized controlled trials. Results: Structural disconnection burden emerged as one of the strongest predictors of post-stroke cognitive impairment, demonstrating remarkably large effect sizes at both 6 months (OR 9.96, 95% CI 2.21–52.40) and 36 months (OR 12.27, 95% CI 2.80–63.40). Additionally, blood–brain barrier (BBB) leakage was significantly associated with longitudinal cognitive decline (β −3.62 to −0.16, p < 0.001). Pre-existing brain frailty was also consistently associated with poorer functional recovery following acute ischemic stroke, even among patients undergoing advanced reperfusion strategies such as endovascular thrombectomy or intravenous thrombolysis. Conclusions: Brain frailty should be integrated into clinical prognostic frameworks as a key marker for predicting long-term cognitive function and functional independence in stroke patients. However, the substantial methodological and clinical heterogeneity observed across the included literature must be acknowledged as a key limitation of the current evidence base. Large-scale, prospective, multicenter longitudinal studies are required to better standardize brain frailty metrics and validate their utility in clinical practice.

Background: Vestibular migraine (VM) is a neurological disorder characterized by episodic vertigo in patients with migraine, contributing to substantial functional impairment. Although VM is relatively common, a consensus on effective prophylactic treatments is lacking. This systematic review aimed to evaluate the efficacy and safety of pharmacological and adjunct non‐pharmacological interventions for VM management. Methods: The systematic review was conducted following the PRISMA 2020 guidelines. PubMed, Web of Science, and Google Scholar were searched from inception to April 2025. Randomized controlled trials or cohort (retrospective and prospective) studies assessing prophylactic pharmacological or adjunct non‐pharmacological management in adults diagnosed with VM were included. The risk of bias was evaluated using the Cochrane RoB 2 and MINORS tools. Results: Nine studies (three RCTs, six cohort studies; total n = 687) met the inclusion criteria. Beta‐blockers, particularly propranolol, and antiepileptics, such as topiramate, consistently reduced VM symptoms, as measured using validated scales (Dizziness Handicap Inventory, Vertigo Symptom Scale, and Vestibular Activities of Daily Living). Anti‐CGRP monoclonal antibodies (erenumab and galcanezumab) showed favorable efficacy and tolerability. By contrast, calcium channel blockers and antidepressants yielded inconsistent outcomes. Vestibular rehabilitation, when used as an adjunct therapy, demonstrated functional benefits. Reported adverse effects were generally mild and treatment specific. Substantial heterogeneity in treatment protocols, outcome assessments, and follow‐up intervals precluded meta‐analysis; therefore, findings were synthesized qualitatively. Conclusion: Moderate‐quality evidence supports the use of propranolol and topiramate as first‐line prophylactic treatments for VM. Emerging data suggest that anti‐CGRP agents may be beneficial for refractory cases. Larger, rigorously designed trials are necessary to establish standardized and individualized treatment protocols.