Search Results (76)

Background: This study aimed to evaluate associations between baseline clinical status, radiological findings, prior medical history, procedural characteristics, and recanalization success with neurological outcome at discharge (NIHSS) and functional status at 90 days (mRS). Methods: This single-center retrospective study included 100 consecutive patients with acute ischemic stroke treated with MT within 24 h of symptom onset. Clinical data, CT perfusion parameters, comorbidities, prior therapies, and detailed procedural characteristics (including anesthesia type, recanalization grade, blood pressure variability, hemorrhagic transformation, and procedure duration) were analyzed. Nonparametric tests (Mann–Whitney U, Kruskal–Wallis) and Spearman’s rank correlation were applied. Statistical significance was set at p < 0.05. Results: Early ischemic signs on baseline imaging were associated with higher NIHSS scores at discharge and worse 90-day mRS (p < 0.05). Patients undergoing CT perfusion imaging had higher discharge NIHSS. Admission NIHSS showed a moderate positive correlation with discharge NIHSS (rho = 0.367, p = 0.003). Strong correlations were observed between NIHSS at 24 h and discharge NIHSS (rho = 0.802, p < 0.001), as well as between 24 h NIHSS and 90-day mRS (rho = 0.842, p < 0.001). Successful recanalization was significantly associated with long-term outcomes, with mTICI 3 associated with the lowest 90-day mRS scores (p = 0.003). Intraprocedural blood pressure variability, hemorrhagic transformation, infections, and in-hospital complications were all linked to higher 90-day mRS values. Prolonged procedure duration showed a weak but significant correlation with worse 90-day outcome (rho = 0.232, p = 0.020). In contrast, prior comorbidities and pre-stroke therapy were not significantly associated with outcomes. A multivariable binary logistic regression analysis identified only the NIHSS score at 24 h remained as an independent predictor of favorable functional outcome at 90 days. Conclusions: Baseline stroke severity, early neurological evolution, successful reperfusion, procedural hemodynamic stability, and prevention of in-hospital complications are strongly associated with both early neurological recovery and long-term functional outcome after mechanical thrombectomy. Full article

Background/Objectives: The type of anesthesia in patients with acute stroke is still controversial. This study aimed to investigate the effect of anesthesia management on clinical outcomes in patients with anterior circulation stroke undergoing mechanical thrombectomy. Methods: In this observational, retrospective study, patients with acute anterior circulation stroke who underwent mechanical thrombectomy between January 2021 and March 2025 were retrospectively reviewed. Patients were divided into groups according to the type of anesthesia administered. Functional independence was assessed at 90 days using the modified Rankin Scale. A TICI of 2b or higher was defined as successful reperfusion. In the conscious sedation (CS) and general anesthesia (GA) groups, patients were analyzed based on baseline characteristics and clinical outcomes using Propensity Score Matching. Results: In the propensity score-matched cohort, there was no significant difference between the two groups in terms of good functional outcome (mRS ≤ 2) (p = 0.82). When compared by successful reperfusion rate (TICI 2b or higher), it was significantly higher in the GA group (p = 0.01). Conclusions: In this study, the use of GA resulted in higher recanalization rates in patients with anterior circulation stroke undergoing mechanical thrombectomy. However, no differences were observed between the GA and CS groups in terms of functional outcomes, mortality, or peri-procedural/post-procedural complications. Full article

Purpose: Acute ischemic stroke (AIS) is the most prevalent stroke subtype. Given the brain–heart interaction, this study investigated the association between cardiac parameters on admission routine preoperative chest CT and recanalization following thrombectomy in AIS patients. Method: We retrospectively analyzed 215 AIS patients (August 2018–June 2022) who underwent admission of none contrast chest computed tomography (NCCT) and thrombectomy within 24 h. Successful recanalization was defined as modified Treatment in Cerebral Ischemia (mTICI) score 2b-3. Multivariable logistic regression identified independent predictors. A nomogram was developed and validated using ROC, calibration, and decision curve analyses. Result: The cohort had a median age of 72 years; 63.7% were male. Hypertension (65.1%), atrial fibrillation (25.1%), and pleural effusion (56.3%) were prevalent. Successful recanalization occurred in 172 patients (80%). Independent predictors included mean arterial pressure (OR: 1.022, CI: 1.003–1.041, p = 0.025), left pulmonary artery diameter (OR: 0.838, CI: 0.733–0.958, p = 0.010), RV/A ratio (standardized) (OR:1.908, CI: 1.293–2.817, p = 0.001), septal angle (OR: 1.055, CI: 1.018–1.094, p = 0.004), and intraventricular septal angle (OR: 0.973, CI: 0.952–0.995, p = 0.015). The model achieved an AUC of 0.774 (p < 0.001) with strong calibration and net benefit. Conclusions: Cardiac parameters on routine preoperative chest CT correlate with recanalization following thrombectomy in AIS patients. The developed nomogram offers a reliable tool for clinical risk stratification. Full article

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. Full article

Background: Deep medullary vein (DMV) drainage has been suggested as a new biomarker for predicting clinical outcomes in patients with acute ischemic stroke (AIS). We evaluated this hypothesis in patients who received endovascular treatment (EVT) within 24 h of symptom onset. Methods: We performed a retrospective study of consecutive AIS patients at a single institution treated with EVT achieving successful recanalization (final mTICI score ≥2b). DMV drainage was graded on a three-point scale (0-1-2) during the second peak venous phase of mCTA by assessing contrast filling, with grade 2 indicating a favorable DMV profile. Our primary outcomes were functional independence, defined as a modified Rankin Scale (mRS) score of 0–2 at 90 days, and ordinal mRS shift at 90 days. Secondary outcomes were excellent clinical status (mRS 0–1 at 90 days), hemorrhagic transformation, and symptomatic intracranial hemorrhage. We investigated independent associations using multivariable logistic and ordinal regression analyses as appropriate, adjusting for age, sex, baseline mRS, NIHSS at onset, occlusion site, intravenous thrombolysis, onset-to-CT time, and ASPECTS. Results: We included 506 patients; the mean age was 76 years. A favorable DMV profile was present in 394 (78%) patients. We found that DMV doubled the odds of achieving functional independence (OR = 2.22; 95% CI = 1.28–3.85) and was associated with a shift towards better functional outcomes in ordinal regression analysis (cOR = 1.93; 95% CI = 1.24–3.02), whereas we did not find any association between a favorable DMV profile and secondary outcomes. Conclusions: In AIS patients successfully recanalized with EVT, a favorable DMV profile was associated with better functional outcomes. Further investigations may clarify the clinical use and predictive ability of this novel radiological marker. Full article

Background and Aims: Patients with malignancy are frequently excluded from randomized thrombectomy trials, and evidence regarding the safety and efficacy of mechanical thrombectomy (MT) in this population remains incompletely defined. We aimed to compare procedural success, functional outcomes, and mortality between acute ischemic stroke (AIS) patients with and without malignancy undergoing MT. Methods: We retrospectively analyzed 110 patients treated with MT. Patients were stratified into two groups: those with malignancy (n = 48) and those without malignancy (n = 62). Baseline demographics, vascular risk factors, procedural metrics, angiographic outcomes, and clinical outcomes including functional independence (modified Rankin Scale [mRS] 0–2), 90-day mortality and intracranial hemorrhage were compared. Results: Baseline demographics and admission stroke severity were similar between groups. Smoking was significantly more frequent in the malignancy group (25% vs. 11.3%, p < 0.001). Successful reperfusion (TICI 2b-3) was achieved in 95.8% of malignancy patients and 98.4% of controls (p = 0.51). Functional independence at 90 days was lower in the malignancy group (42.6% vs. 61.3%, p = 0.04), whereas 90-day mortality was significantly higher (44.7% vs. 19.4%, p = 0.004); this increase in mortality remained significant after multivariate analysis. There were no significant differences in rates of intracranial hemorrhage between groups (p = 0.53). Conclusions: Mechanical thrombectomy is technically effective and safe in patients with malignancy; however, long-term functional recovery and survival are significantly worse, likely reflecting the effect of cancer itself rather than procedural factors. Careful patient selection and multidisciplinary decision-making are essential in this population. Full article

Background and Purpose: Complete angiographic reperfusion (TICI 3) is considered the optimal procedural endpoint of mechanical thrombectomy (MT) in acute ischemic stroke. However, new diffusion-weighted imaging (DWI) lesions are frequently observed despite apparent angiographic success. We aimed to investigate the incidence, morphological patterns, and clinical relevance of these lesions in a strictly defined TICI 3 cohort. Methods: In this retrospective single-center study, 89 patients with anterior circulation large-vessel occlusion (LVO) who achieved true TICI 3 were analyzed. Baseline and follow-up Magnetic Resonance Imaging (MRI) within 48 h were systematically compared using paired diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) maps to identify new lesions. Lesions were classified according to morphology and distribution. Stroke etiology was assessed using TOAST criteria. Functional outcomes were evaluated using the 90-day modified Rankin Scale (mRS) with the Rankin Focused Assessment. Results: New DWI lesions were detected in 28 of 89 patients (31.5%). The predominant pattern was millimetric cortical foci (85.7%), most frequently ipsilateral to the recanalized vessel (78.6%), with fewer contralateral (14.3%) and bilateral (7.1%) lesions. Territorial infarcts and isolated basal ganglia infarcts were each identified in 14.3% of patients, with some overlap between categories. No significant differences were observed between patients with and without new lesions regarding baseline characteristics or procedural metrics (all p > 0.05). Importantly, the presence of new DWI lesions was not associated with 90-day functional outcome (p = 0.930) or survival (p = 0.613). Conclusions: New DWI lesions are common even after complete angiographic reperfusion, highlighting a persistent dissociation between macrovascular success and tissue-level integrity. Although predominantly small and clinically silent in the short term, these findings underscore the limitations of angiographic endpoints alone and support the need for strategies targeting microvascular protection and prevention of distal embolization. Full article

Background/Objectives: There is no consensus on standardized treatment algorithms for patients with acute ischemic stroke due to anterior circulation tandem occlusions. This study evaluated the outcomes of mechanical thrombectomy and carotid artery stenting in such patients, with a particular focus on a standardized, adaptive, and escalating antithrombotic strategy. Methods: This single-center retrospective study included patients with atherosclerotic tandem occlusion treated between January 2019 and July 2023 at our comprehensive stroke center. All patients underwent mechanical thrombectomy and carotid artery stenting and received a standardized antithrombotic regimen, including the administration of the GPIIb/IIIa antagonist eptifibatide as rescue therapy. Results: Sixty-seven patients were included in the analysis. Thirty-five patients (52.2%) received eptifibatide due to acute stent thrombosis. Subtotal to total revascularization (mTICI 2b-3) was achieved in 98.5% of patients. The carotid artery reocclusion rate was 3.4% at discharge. Symptomatic intracranial hemorrhage occurred more frequently in patients treated with eptifibatide (9.0% vs. 0%, p = 0.021) but was not associated with mortality or favorable outcome (mRS 0–2) at 90 days. In univariable regression analysis, eptifibatide administration was not significantly associated with symptomatic intracranial hemorrhage (OR 1.9, 95% CI 0.3–11.4; p = 0.465). Older age was associated with mortality. Conclusions: Our adaptive antithrombotic protocol demonstrated high revascularization and low carotid reocclusion rates. Rescue use of eptifibatide was not significantly associated with symptomatic intracranial hemorrhage; however, a clinically relevant risk cannot be excluded. These findings highlight the importance of tailored antithrombotic strategies in acute ischemic stroke to maintain stent patency while minimizing hemorrhagic complications. Full article

Objective: The number of operators performing mechanical thrombectomy (MT) may influence procedural outcomes; however, evidence remains limited and conflicting. This study aimed to comprehensively evaluate the impact of single versus dual operators on procedure time, radiation dose, and angiographic success in patients undergoing MT for acute ischemic stroke. Methods: In this single-center, retrospective cohort study, 285 consecutive patients who underwent MT for large-vessel occlusion between January 2020 and December 2024 were included. Patients were grouped according to institutional workflow: single-operator procedures (n = 157) and dual-operator procedures (n = 128). The primary endpoints were procedure time and radiation dose parameters, including total Kerma-Area Product (PKA). Secondary endpoints included successful reperfusion (TICI ≥ 2b), complete reperfusion (TICI 3), and first-pass success (FPS, defined as TICI 2c/3 with a single pass). Results: Baseline characteristics were comparable between groups. The dual-operator group had significantly shorter median procedure times (52.5 vs. 85.0 min, p < 0.001) and lower total PKA (p < 0.001). Reperfusion rates were significantly higher in the dual-operator group, both for successful reperfusion (TICI ≥ 2b: 80.5% vs. 64.3%, p = 0.004) and complete reperfusion (TICI 3: 76.6% vs. 58.5%, p = 0.002). First-pass success was also more frequent (60.0% vs. 44.5%, p = 0.0146), and the mean number of passes was lower (1.66 vs. 2.00, p = 0.0057). Conclusions: Mechanical thrombectomy performed with two experienced operators was associated with greater procedural efficiency, reduced patient radiation exposure, and higher angiographic success compared with single-operator procedures. These findings support considering the dual-operator model as an approach that may inform workforce planning and workflow decisions in stroke centers. Full article

This case study in Foz do Iguaçu, Brazil, addresses the urban problem of the degradation of road corridors used by public transport, affecting the accessibility, safety, and efficiency of urban mobility. To address this issue, a multi-criteria methodology based on MIVES (Integrated Value Model for Sustainable Assessments) was applied, combined with the AHP (Analytic Hierarchy Process) method, allowing the evaluation of 20 key urban roads using a hierarchical set of indicators linked to infrastructure, accessibility, and mobility. The assessment was operationalized through the Transport Infrastructure Condition Index (TICI), which yielded results ranging from 0.32 to 0.88, reflecting significant contrasts in the road’s upkeep and maintenance conditions. The lowest scores were associated with deficiencies in universal accessibility, cycling infrastructure, signage, and adaptations for people with reduced mobility, highlighting structural limitations in sustainability and urban inclusion. The model facilitates the prioritization of road interventions based on urgency and criticality, becoming a useful tool for guiding public investment decisions. Its comprehensive approach and replicability make it a valuable methodological alternative for other Latin American contexts, where pressure to improve urban services coexists with budgetary constraints, contributing to more efficient and sustainable strategic planning of public transportation. Full article

Background: Catheter ablation is an established rhythm-control strategy for atrial fibrillation (AF), yet peri-procedural embolic stroke may still occur despite uninterrupted NOAC therapy. Case presentation: A 49-year-old woman on dabigatran developed acute ischemic stroke three days after AF ablation, presenting with left hemiparesis and dysarthria. Idarucizumab (5 g) enabled safe intravenous thrombolysis followed by emergency endovascular thrombectomy (EVT), achieving complete recanalization (mTICI 3). Angiography revealed an incidental 7 mm right MCA aneurysm at the occlusion site. Dabigatran was resumed on day 4, and one month later, the aneurysm was successfully treated with stent-assisted coil embolization. She remained asymptomatic at two months. Conclusions: This case illustrates how idarucizumab reversal expands reperfusion options by enabling both IVT and EVT in NOAC-treated patients and highlights the diagnostic role of EVT in revealing underlying vascular pathology, emphasizing the need for individualized post-procedural antithrombotic management. Full article

Introduction: We aimed to clarify the influence of the thrombus composition on ischemic stroke endovascular thrombectomy (EVT) efficiency by utilizing various staining methods for patients that presented with occlusions of the middle cerebral artery (MCA). Methods: Between September 2017 and May 2021, we analyzed thrombi retrieved during endovascular thrombectomy EVT in patients with acute ischemic stroke due to middle cerebral artery (MCA) occlusion. Patients with reperfusion failure, intracranial atherosclerotic occlusions, and inadequate staining were excluded. The thrombus composition was stratified using three staining techniques—Hematoxylin and Eosin (H&E), Martius Scarlet Blue (MSB) staining, and immunohistochemistry (IHC) for red blood cells (RBCs), white blood cells (WBCs), fibrin (Fibrin II), and platelets (CD41). Associations between EVT efficiency outcomes and the thrombus composition were evaluated. Results: During the study period, thrombus was available for analysis in 159 patients. A total of 59 patients were included in the main analysis. Increases in the trichotomized RBS tertiles were associated with decreases in the components of various platelet/other components but not for fibrin. A modified first pass effect (mFPE) of the modified Thrombolysis in Cerebral Infarction perfusion scale (mTICI) 2b or higher was associated with larger thrombus surface area (16.0 ± 11.6 vs. 47.4 ± 62.3 mm², p = 0.005), a higher MSB fibrin content (29.8 ± 10.7 vs. 21.3 ± 10.9%, p = 0.002), and IHC fibrin (28.5 ± 14.5 vs. 20.1 ± 11.4%, p = 0.008). There was a marginal association between the mTICI 2b mFPE and lower MSB platelet/other components (27.6 ± 20.9 vs. 34.4 ± 14.9%, p = 0.078). The discrepancy between MSB platelet/others and IHC platelets was greater in the mFPE (-) group, suggesting that components other than platelets may contribute to EVT resistance. A mFPE of mTICI 2c or higher was associated with greater thrombus surface area (17.8 ± 11.9 vs. 37.7 ± 55.0 mm², p = 0.015) and MSB fibrin (32.1 ± 10.3 vs. 22.8 ± 11.0%, p = 0.002). There was a marginal reverse association between the mTICI 2c mFPE and MSB RBCs (33.4 ± 20.2% vs. 41.5 ± 17.3%, p = 0.062). There was no significant association between final near-complete reperfusion and the thrombus composition. Conclusions: In patients presenting with occlusions of the MCA, a higher thrombus fibrin content is associated with better EVT efficiency. Both a higher MSB platelet/other components and RBC content may have a negative influence on EVT efficiency. These results may help identify preprocedural biomarkers beyond the conventional assessment of RBCs, WBCs, and fibrin compositions, which could guide decision-making during mechanical thrombectomy. Full article

Background: Medium vessel occlusions (MeVOs) are an increasingly recognized but heterogeneous target for endovascular therapy (EVT). This study aims to compare primary MeVO, rescue MeVO, and large vessel occlusion (LVO) thrombectomy cases to identify which MeVO subtypes derive a meaningful benefit from EVT under appropriate safety conditions. Methods: We retrospectively analyzed a multicenter registry of patients undergoing EVT for acute ischemic stroke. MeVO was defined as the occlusion of the A1-A3, M2-M3, P1-P3, fetal PCA, or PICA segments and classified as primary or rescue. Clinical outcomes were assessed by NIHSS score at baseline, discharge, and 90 days; functional outcome by the modified Rankin scale (mRS); and reperfusion by modified thrombolysis in cerebral infarction (mTICI). Safety endpoints included intracranial hemorrhage and mortality. Results: Among 603 EVT patients, 202 (33.5%) had MeVO. Compared to LVO, MeVO patients were older and had more prior strokes but achieved similar reperfusion and safety outcomes. At 90 days, mRS distribution differed, with MeVO showing more mRS 2 and LVO more mRS 1, while higher-disability strata were comparable. Within MeVO, 119 (58.9%) were primary and 83 (41.1%) rescue occlusions. Rescue MeVO patients presented with higher baseline severity (NIHSS score of 19 vs. 18) and, despite similar reperfusion, experienced worse 90-day outcomes and higher mortality (21.7% vs. 0.8%). Conclusions: EVT for primary MeVO is feasible, effective, and safe, whereas rescue MeVO is associated with poor functional outcomes and markedly higher mortality. These findings highlight rescue MeVO as a distinct phenotype and support a selective approach prioritizing disabling syndromes, proximal/dominant branch occlusions, and IVT non-response. Full article

Background: Sex-related disparities in long-term outcomes after large vessel occlusion (LVO) following mechanical thrombectomy (MT) have been repeatedly shown. Notably, a lower likelihood of achieving functional independence 90 days post-stroke has been found in women. However, most studies showed equal outcomes for both sexes after MT. It remains unclear whether there are sex differences in the prognostic values of clinical and neuroradiological parameters. Our investigation aimed to discern the divergent prognostic values of multiple markers between sexes. Methods: We retrospectively examined 183 stroke patients with LVO who received MT. Using multivariable logistic regression models, we investigated sex-specific associations of various parameters, including ASPECTS, lesion core volume, penumbra volume, collateral status, and time to reperfusion, concerning outcomes at discharge and 90 days post-stroke. Results: We observed no significant difference between men and women in achieving a favorable outcome defined as modified Rankin Scale (mRS) 0–2. However, when considering the full mRS, women exhibited less favorable overall outcomes. In women, NIHSS, TICI score, and penumbra volume were associated with outcome, whereas in men, core lesion volume and ASPECTS were associated. Age was the only factor associated with outcome in both sexes. Conclusions: Considering the full spectrum of mRS may provide more sophisticated understanding of sex-related outcome differences. Further, these findings highlight the importance sex-specific prognostic factors in outcome assessment. Unraveling sex-specific prognostic biomarkers of recovery has the potential to advance precision medicine and personalized clinical management in stroke. Full article

Background/Objectives: Downstream occlusion (DOC) is a commonly observed, yet frequently overlooked, angiographic event during mechanical thrombectomy (MT) for acute large vessel occlusion (LVO). This phenomenon has the potential to complicate procedures and influence outcomes. However, its prevalence, predictors, and endovascular trajectories remain poorly understood. Methods: A retrospective analysis of 703 patients who underwent MT for acute intracranial LVO between 2010 and 2021 at a tertiary stroke center was conducted. DOC was angiographically identified as a newly developed occlusion in a downstream artery following recanalization of the primary occlusion. Multivariate logistic regression was employed to analyze the clinical and procedural predictors of DOC. Endovascular and clinical outcomes were compared between patients with and without DOC. The DOC trajectory, including immediate reperfusion status, subsequent recanalization attempts, and final outcomes, was analyzed based on the occlusion location. Results: DOC was identified in 254 patients (36.1%). Atrial fibrillation and proximal occlusion were independently associated with DOC. Despite DOC adversely affecting endovascular procedural details, patients with DOC demonstrated comparable rates of final successful recanalization (92.5% vs. 91.3%; p = 0.577) and 90-day functional independence (40.2% vs. 46.3%; p = 0.114). Notably, about half of the patients exhibited an immediate modified Thrombolysis In Cerebral Infarction (mTICI) grade 2b at the time of DOC. Further recanalization attempts were undertaken in 67.7% of DOC cases, resulting in enhanced mTICI grades in 76.7% of cases and achieving final successful recanalization in 94.2% of cases. The functional advantages of additional recanalization attempts varied depending on DOC location but were generally limited. Conclusions: Despite its procedural complexity, DOC did not significantly compromise final recanalization or functional outcomes. Many cases were effectively managed with additional endovascular treatment, highlighting the importance of achieving sufficient final recanalization. Full article