Recovery, selection and procedural judgement: Biplane Weekly No. 1

LAIS randomised 998 patients at 32 Chinese centres to intravenous loberamisal or placebo alongside standard care. Treatment began within 48 hours and continued for ten days; 997 patients entered the primary analysis. Participants were aged 18–80 years with NIHSS 7–20; median NIHSS was eight. At 90 days, mRS 0–1 occurred in 350/502 (69.7%) versus 279/495 (56.3%): RR 1.24 (95% CI 1.12–1.36), an absolute difference of 13.28 percentage points.

Serious adverse events occurred in 8.6% versus 10.7%, and mortality in 1.2% versus 2.0%. These descriptive safety results accompany a substantial recovery signal.

The registered eligibility criteria excluded planned or completed thrombectomy. LAIS therefore supplies evidence for the enrolled acute-stroke population, not for adding loberamisal to an endovascular pathway. For neurointervention, the next useful question is whether the effect survives testing in patients receiving reperfusion procedures.

The prespecified one-year ANGEL-TNK analysis assessed 241 of 255 randomised patients after successful anterior-circulation thrombectomy at 4.5–24 hours, without preceding intravenous thrombolysis. Excellent recovery (mRS 0–1) occurred in 55/120 (45.8%) with intra-arterial tenecteplase and 34/121 (28.1%) with standard treatment: reported RR 1.55 (95% CI 1.05–2.29). Multiple-imputation analysis remained significant.

Functional independence, disability shift and mortality did not differ significantly. The one-year analysis supports a sustained benefit of intra-arterial tenecteplase at the excellent-recovery threshold. It extends observation of the original randomised cohort rather than independently replicating the result.

ATTENTION LATE randomised 332 patients at 40 Chinese centres; two withdrew consent. Participants had basilar occlusion, NIHSS ≥10 and direct presentation to thrombectomy-capable centres 4.5–24 hours after onset. Ninety-day mRS 0–2 occurred in 50/165 (30%) receiving intravenous tenecteplase plus thrombectomy and 50/164 (30%) receiving thrombectomy alone: adjusted RR 0.92 (95% CI 0.67–1.25).

Symptomatic intracranial haemorrhage occurred in 8/166 versus 6/164, and mortality in 66/166 versus 70/164. Superiority was not demonstrated; the confidence interval does not establish equivalence.

Unlike ANGEL-TNK, this is a test of intravenous treatment before thrombectomy in late basilar occlusion. It leaves early-window bridging and transfer pathways unanswered. Route, timing and vascular territory explain why the two trials should be read separately.

The CREST-2 cognitive analysis included 2,165 participants across the separate stenting and endarterectomy trials. Blinded telephone testing assessed five cognitive domains at baseline and annually. The adjusted four-year composite differences versus intensive medical management were 0.03 SD (95% CI −0.09 to 0.15) for stenting and 0.02 SD (−0.09 to 0.14) for endarterectomy; individual tests also showed no significant differences. Mean follow-up was 2.24 years.

The CREST-H substudy likewise did not demonstrate that baseline haemodynamic impairment modified cognitive benefit, although its smaller complete-data sample limits precision.

These results address measured cognition rather than the trials’ stroke-prevention outcomes. They do not compare stenting directly with endarterectomy. When cognitive symptoms enter a carotid consultation, the randomised evidence gives no basis for promising improvement from either procedure.

Among 5,107 treated unruptured aneurysms in a multicentre registry, 783 measured ≤3 mm. Intraoperative complications occurred in 5.2% of tiny versus 5.1% of 3–5 mm aneurysms; postprocedural complications occurred in 8.4% versus 8.7%. These separate endpoints should not be added to produce a total rate.

Anterior communicating and posterior communicating artery locations were associated with intraoperative complications: OR 4.92 (95% CI 1.34–18.1) and 4.08 (1.40–11.9), respectively. Stent-assisted coiling was also associated with higher intraoperative risk relative to clipping (OR 3.98, 1.33–11.9), with anatomical and treatment-selection differences potentially contributing.

This is a registry of lesions selected for treatment. It helps describe procedural risk, but does not establish equivalence across sizes or a net advantage over surveillance. A technically treatable tiny aneurysm still needs an indication grounded in the individual lesion and patient.

A single-centre retrospective study followed 563 patients with aneurysmal subarachnoid haemorrhage, including 419 transferred from 77 referring facilities. Among 307 patients with paired scans, hydrocephalus increased from 15.6% before transfer to 33.2% on arrival; 17.6% developed new hydrocephalus in transit. Glasgow Coma Scale deterioration was recorded in 10.3% of transferred patients.

Twelve-month independence was reported in 51.9% with newly developed hydrocephalus and 45.7% with persistent hydrocephalus, versus 69.4% without hydrocephalus. These observational associations do not identify a causal transfer intervention.

The practical contribution is a changing clinical picture: the examination and CT at referral may no longer describe the patient arriving at the receiving centre.

A single-centre series described 45 patients younger than 18 years receiving endovascular treatment for cerebral venous sinus thrombosis. Mean age was 14.8 years; 88.9% had multiple sinuses involved and 31.1% had parenchymal haemorrhage. Treatment combined varying proportions of catheter-directed thrombolysis and thrombectomy.

Two sinus perforations and one symptomatic intracranial haemorrhage were reported. All patients were described as having favourable functional outcomes at a median 68-month follow-up. The long observation period is valuable, but an anticoagulation-only comparator and a standardised rescue pathway were absent.

The report adds technical experience in a predominantly adolescent population. Keeping the procedural injuries beside the recovery figures makes it more useful for a multidisciplinary rescue discussion than treating the favourable outcomes as proof of comparative efficacy.

A technical series used sequential diluted and undiluted contrast injections to produce a density gradient during cone-beam CT of dural arteriovenous fistulas. Injection timing was based on arterial and venous opacification on DSA. Across 55 sessions in 45 consecutive patients, all acquisitions ultimately succeeded; two required repeat acquisition after timing adjustment, and no imaging-related adverse events were reported.

The reconstructions aimed to distinguish arterial feeders, shunt points and venous drainage, including the functional sinus lumen. That is an attractive planning problem when overlapping structures obscure the target. The series establishes feasibility of the acquisition method, rather than blinded diagnostic accuracy or improved treatment outcomes.