Stroke remains a leading cause of death and disability globally, with cervical artery disease accounting for a significant proportion of ischemic cerebrovascular events. Atherosclerotic narrowing of carotid and vertebral arteries causes approximately 15–20% of ischemic strokes, while non-atherosclerotic conditions such as cervical artery dissection, fibromuscular dysplasia, and large-vessel vasculitides represent important causes, particularly in younger patients. The diagnostic and therapeutic approach to cervical artery disease has transformed substantially over two decades. Historically, clinical decisions relied on luminal stenosis severity based on landmark trials like NASCET and ECST; however, emerging evidence demonstrates that stenosis alone inadequately predicts vascular lesion behavior. Contemporary assessment now emphasizes plaque vulnerability, intraplaque hemorrhage, fibrous cap integrity, inflammatory activity, and hemodynamic characteristics. Advanced imaging modalities including high-resolution vessel wall magnetic resonance imaging, multidetector computed tomography angiography, and contrast-enhanced magnetic resonance angiography now provide complementary biological and functional information. Artificial intelligence, radiomics, and quantitative imaging biomarkers have emerged as promising tools for improved plaque characterization. Therapeutically, management has evolved beyond revascularization to include intensive medical therapy, vascular risk factor modification, individualized antithrombotic strategies, and careful patient selection for carotid endarterectomy or stenting.

Perfuze announced final results from the MARRS pivotal study, published in the Journal of Neurointerventional Surgery, demonstrating strong efficacy for its Millipede Aspiration System in treating acute ischemic stroke. The prospective, multicenter trial enrolled 180 patients across 22 hospitals in the United States and Europe and met its primary endpoint, achieving successful reperfusion (mTICI 2b-3) in 89% of patients without rescue therapy, exceeding the prespecified performance goal. The study showed a 75% first-pass effect (mTICI 2c-3) in middle cerebral artery M1 occlusions and 96% delivery success using the Millipede88 catheter. The device's patented Corrugated™ technology enables standalone direct aspiration through a super-bore 0.088-inch catheter, eliminating the need for adjunctive devices like stent retrievers in the majority of cases. Rescue therapy was required in fewer than 8% of cases. Safety data were favorable, with a 2.3% symptomatic intracranial hemorrhage rate, no vessel perforations, and no device-related serious adverse events. These results, based on independent core laboratory adjudication, represent the highest first-pass and reperfusion rates reported in a prospective thrombectomy study and supported FDA 510(k) clearance of the Millipede88 Aspiration Catheter.

Ruptured basilar artery dissecting aneurysms (BADAs) represent rare but life-threatening conditions with elevated risks of rebleeding, brainstem ischemia, and mortality. Unlike vertebral artery dissections, the basilar trunk cannot typically be sacrificed due to its supply of critical pontine perforators, making treatment decisions particularly complex. This retrospective single-center cohort study examined 22 patients with angiographically confirmed ruptured BADA treated between February 2015 and April 2024, comparing outcomes between flow diverter (FD)-based treatment and conventional endovascular approaches. Five patients received FD-based reconstruction as primary treatment, while seventeen underwent conventional endovascular therapy. The FD group exhibited more frequent fusiform morphology (80.0% versus 23.5%) and numerically larger aneurysm diameters. At final follow-up, 80.0% of FD-treated patients achieved favorable functional outcomes (modified Rankin Scale 0–2) compared to 52.9% in the conventional group, with respective mortality rates of 20.0% and 47.1%. Although these results were not statistically significant, the findings suggest that flow diverter-based reconstruction represents a feasible option for anatomically complex or fusiform basilar dissecting aneurysms, supporting individualized treatment strategies rather than establishing clear superiority of either approach.

Recent studies of platelet endothelial cell adhesion molecule-1 (PECAM-1 [CD31])-deficient mice have revealed that this molecule plays an important role in controlling the activation and survival of cells on which it is expressed. In this review, we focus on the complex cytoplasmic domain of PECAM-1 and describe what is presently known about its structure, posttranslational modifications, and binding partners. In addition, we summarize findings that implicate PECAM-1 as an inhibitor of cellular activation via protein tyrosine kinase–dependent signaling pathways, an activator of integrins, and a suppressor of cell death via pathways that depend on damage to the mitochondria. The challenge of future research will be to bridge our understanding of the functional and biochemical properties of PECAM-1 by establishing mechanistic links between signals transduced by the PECAM-1 cytoplasmic domain and discrete cellular responses.

The role of platelets in hemostasis and thrombosis is dependent on a complex balance of activatory and inhibitory signaling pathways. Inhibitory signals released from the healthy vasculature suppress platelet activation in the absence of platelet receptor agonists. Activatory signals present at a site of injury initiate platelet activation and thrombus formation; subsequently, endogenous negative signaling regulators dampen activatory signals to control thrombus growth. Understanding the complex interplay between activatory and inhibitory signaling networks is an emerging challenge in the study of platelet biology, and necessitates a systematic approach to utilize experimental data effectively. In this review, we will explore the key points of platelet regulation and signaling that maintain platelets in a resting state, mediate activation to elicit thrombus formation, or provide negative feedback. Platelet signaling will be described in terms of key signaling molecules that are common to the pathways activated by platelet agonists and can be described as regulatory nodes for both positive and negative regulators.

While current oral antiplatelet therapies benefit many patients, they deregulate the hemostatic balance leaving patients at risk of systemic side-effects such as hemorrhage. Dual antiplatelet treatment is the standard approach, combining aspirin with P2Y12 blockers. These therapies mainly target autocrine activation mechanisms (TxA2, ADP) and, more recently, the use of thrombin or thrombin receptor antagonists have been added to the available approaches. Recent efforts to develop new classes of anti-platelet drugs have begun to focus on primary platelet activation pathways such as through the immunoreceptor tyrosine-based activation motif (ITAM)-containing collagen receptor GPVI/FcRγ-chain complex. There are already encouraging results from targeting GPVI, with reduced aggregation and smaller arterial thrombi, without major bleeding complications, likely due to overlapping activation signaling pathways with other receptors such as the GPIb–V–IX complex. An alternative approach to reduce platelet activation could be to inhibit this signaling pathway by targeting the inhibitory pathways intrinsic to platelets. Stimulation of endogenous negative modulators could provide more specific inhibition of platelet function, but is this feasible? In this review, we explore the potential of the two major platelet immunoreceptor tyrosine-based inhibitory motif (ITIM)-containing inhibitory receptors, G6b-B and PECAM-1, as antithrombotic targets.

Von Willebrand factor (VWF) and VWF propeptide (VWFpp) are stored in eccentric nanodomains within platelet alpha-granules. VWF and VWFpp can undergo differential secretion following Weibel-Palade body exocytosis in endothelial cells; however, it is unclear if the same process occurs during platelet alpha-granule exocytosis. Using a high-throughput 3-dimensional super-resolution imaging workflow for quantification of individual platelet alpha-granule cargo, we studied alpha-granule cargo release in response to different physiological stimuli.

Brain aneurysms are weak, bulging spots in brain artery walls that risk rupture and life-threatening subarachnoid hemorrhage. Two primary treatment approaches exist: surgical clipping, where neurosurgeons place a small metal clip across the aneurysm through a skull opening, and endovascular coiling, which fills the aneurysm with soft coils delivered via catheter through groin or wrist arteries. Both methods are employed for ruptured aneurysms as emergency treatment and for selected unruptured aneurysms with significant bleeding risk. Newer techniques include flow diverters—stent-like mesh tubes redirecting blood flow—and stent-assisted coiling for specific aneurysm configurations. Treatment decisions depend on aneurysm characteristics including size, location, shape, and neck width, alongside patient age and health status. Not all aneurysms require intervention; many small incidental findings never cause symptoms. Multidisciplinary teams comprising neurosurgeons, neuroradiologists, and neurologists determine appropriate treatment by weighing aneurysm rupture risk against procedural risks. Detailed imaging including CT scans and angiograms guides treatment planning and selection.

Researchers have evaluated the Contour Neurovascular System, a medical device used in neurovascular interventions, by analyzing how pre-treatment geometric and hemodynamic characteristics can predict clinical outcomes. The study examined patient data to identify which structural and blood flow parameters measured before treatment were most predictive of post-intervention success. By applying computational analysis to anatomical and hemodynamic features—such as vessel dimensions, flow patterns, and lesion geometry—the investigators developed predictive models to forecast treatment efficacy. These findings matter significantly for clinical practice, as they enable physicians to better identify which patients will likely benefit most from Contour Neurovascular System treatment before proceeding with intervention. This approach supports personalized medicine by allowing clinicians to optimize patient selection and potentially improve overall outcomes while reducing unnecessary procedures for unsuitable candidates. The research contributes valuable insights to interventional neurology and vascular surgery planning.

NeuroVita has announced the Chinese regulatory approval and commercial launch of SECURA™, a coated intracranial stent system designed to assist in treating wide-neck intracranial aneurysms. SECURA combines low metal coverage with eG™ NTMA, a coating technology invented and developed by AlchiMedics, intended to reduce platelet adhesion and thrombosis risk. Its optimised “dragon-scale” mesh promotes vessel-wall apposition and stable support in complex anatomy. Compatibility with 0.017-inch and 0.021-inch microcatheters, together with tipped and tipless configurations, provides flexibility across different access routes and procedural needs. The device complements NeuroVita’s AUCURA™ flow-diverting stent, expanding the company’s portfolio for intracranial aneurysm treatment.

The CSI-based 3-group categorization provides a more clinically meaningful assessment of PTIAs treated with FDs than conventional angiographic classifications, because it uniquely captures size changes of the thrombosed mass and correlates with functional outcomes.

Although the quality of evidence is lower than for coronary interventions due to a lower number of patients and procedures, neurointerventional antiplatelet and antithrombotic management shares several themes. Prospective and randomized studies are needed to strengthen the data supporting these recommendations.

The FREDX device shows improved complete occlusion rates at 1 year compared with the FRED device while maintaining a favourable safety profile, indicating its potential advantage in the treatment of cerebral aneurysms.

p64/p48 MW HPC flow diverters with prasugrel single antiplatelet therapy were associated with safety from aneurysm re-rupture and high occlusion rates at medium- and long-term follow-up in managing ruptured aneurysms. Adequate management of single antiplatelet therapy with prasugrel is crucial, particularly with higher doses than usual, to avoid both ischemic and hemorrhagic complications.

Flow-diverters with antithrombogenic coatings have been developed to reduce thrombogenicity and support endothelialization. This study is the first to compare in vivo DERIVO® 2heal® with its uncoated counterpart, the DERIVO®2 with early HF-OCT and histology under single antiplatelet therapy. DERIVO® 2heal® reduces thrombi formation immediately post- implantation in our rabbit model.

This case report, published in the Chinese Neurosurgical Journal in September 2026, documents a complex clinical scenario involving a recurrent perforator aneurysm of the A1 segment of the anterior cerebral artery. The patient had previously undergone endovascular electrocoagulation therapy, a minimally invasive technique designed to occlude the aneurysm through electrical coagulation delivered via catheter. Despite this initial intervention, the aneurysm recurred, necessitating a more definitive surgical approach. The clinical team elected to perform surgical clipping, the traditional open neurosurgical technique involving direct microsurgical access to place a clip across the aneurysm neck. This case illustrates an important clinical challenge in cerebrovascular surgery: treatment failure and recurrence following endovascular approaches, particularly in anatomically difficult locations such as perforator vessels. The report highlights the ongoing role of conventional microsurgical techniques as a salvage strategy when less invasive interventions prove inadequate, emphasizing the need for careful patient selection and multimodal treatment planning in managing recurrent intracranial aneurysms.

Perfuze announced final results from the MARRS pivotal study, published in the Journal of Neurointerventional Surgery, demonstrating strong efficacy for its Millipede Aspiration System in acute stroke treatment. The prospective, multicenter trial enrolled 180 patients across 22 hospitals in the United States and Europe, with all imaging and safety endpoints independently adjudicated. The study met its primary endpoint, achieving successful reperfusion (mTICI 2b-3) in 89% of patients without rescue therapy, exceeding the prespecified performance goal. Notably, the Millipede88 super-bore aspiration catheter delivered a 75% first-pass effect in middle cerebral artery M1 occlusions with 96% delivery success, representing the highest first-pass rates reported in a prospective thrombectomy study. The device demonstrated a favorable safety profile with 2.3% symptomatic intracranial hemorrhage, no vessel perforations, and no device-related serious adverse events. Rescue therapy was required in fewer than 8% of cases. The results support the FDA 510(k) clearance of the Millipede88, utilizing Perfuze's patented Corrugated technology to maintain aspiration force and enable standalone direct aspiration without adjunctive devices in most cases.

# Professional Summary A comprehensive subgroup analysis of the ECOSA registry examined the safety, efficacy, and angiographic outcomes of endovascular coiling for very small unruptured intracranial aneurysms measuring 3mm or smaller. This study, led by Yazan Ashouri and colleagues across multiple institutions, evaluated treatment approaches including balloon-assisted coiling and stent-assisted coiling techniques for this challenging patient population. The research integrated findings with established risk stratification tools such as the PHASES score and ISUIA natural history data to contextualize procedural outcomes. This analysis is clinically significant as it addresses a critical evidence gap regarding optimal management strategies for very small aneurysms, where treatment decisions traditionally involve careful consideration of rupture risk versus intervention-related morbidity. By providing detailed safety and efficacy data from a large multicenter registry, this work informs clinical decision-making for neurointerventionalists managing patients with diminutive aneurysms and contributes to the evidence base for personalizing treatment recommendations based on individual patient risk profiles and anatomical characteristics.

Mechanical thrombectomy has revolutionized acute ischemic stroke treatment by enabling the physical removal of blood clots from cerebral vessels. This comprehensive review examines the current evidence landscape and future trajectory of the field. The article traces the evolution of mechanical thrombectomy techniques and highlights significant advances in patient selection strategies and imaging protocols that have improved treatment outcomes. A key focus area is the expanding application of thrombectomy to more distal vessel occlusions, which were previously considered beyond the reach of intervention. The review also addresses ongoing technical developments that continue to enhance procedural efficacy and safety. Understanding where the evidence currently stands is critical for clinicians making treatment decisions, while insights into emerging directions—such as improved patient identification criteria and extended anatomical reach—promise to further optimize outcomes and potentially expand the eligible patient population for this life-saving intervention.

Activase (alteplase), a thrombolytic agent used in acute ischemic stroke treatment, carries significant risks that require careful clinical management. The medication can cause severe internal or external bleeding, particularly at arterial and venous puncture sites, with fatal hemorrhage cases reported following traumatic intubation. While heparin and aspirin have been used concomitantly with Activase in myocardial infarction and pulmonary embolism management, their concurrent use with Activase for acute ischemic stroke within 24 hours of symptom onset remains uninvestigated, necessitating vigilant bleeding monitoring. Hemorrhage risk is substantially elevated in patients with recent major surgery, cerebrovascular disease, intracranial hemorrhage, gastrointestinal or genitourinary bleeding, trauma, hypertension, hepatic or renal dysfunction, pregnancy, diabetic retinopathy, or those receiving oral anticoagulants. Additionally, hypersensitivity reactions including urticarial responses, anaphylaxis, and angioedema have been documented, with rare fatal outcomes reported. Close patient monitoring during and after Activase infusion is essential to detect and manage bleeding complications and hypersensitivity reactions promptly, ensuring therapeutic benefits outweigh inherent risks.