Search Results (735)

Stroke is the second-largest cause of death and disability worldwide, and many patients require intensive care for airway compromise, hemodynamic instability, cerebral edema, or systemic complications. This review summarizes key aspects of ICU management in both acute ischemic stroke (AIS) and hemorrhagic stroke (HS). Priorities are airway protection, oxygenation, individualized blood pressure targets, and strict control of temperature and glucose. Neurological monitoring and prompt management of intracranial pressure (ICP), together with timely surgical interventions (hemicraniectomy or hematoma evacuation), are central to acute care. Seizures are treated promptly, while routine prophylaxis is not recommended. Prevention of aspiration pneumonia, venous thromboembolism, infections, and other intensive care unit (ICU) complications is essential, along with early nutrition, mobilization, and rehabilitation. Prognosis and decisions about intensity of care require shared discussions with families and involvement of palliative services, when appropriate. Many practices remain based on observational data or extrapolation from other populations, underlining the need for stroke-specific clinical trials. Outcomes are consistently better when patients are managed in specialized stroke or neurocritical care units with a multidisciplinary treatment approach Full article

Background/Objectives: Superior cerebellar artery (SCA) infarction is a rare but clinically significant subtype of posterior circulation stroke. Extensive swelling in the SCA territory may cause downward brainstem compression and appear as brainstem hypodensity on computed tomography, potentially leading to premature treatment withdrawal. Methods: We report the case of a 50-year-old woman with acute SCA-territory infarction (NIHSS = 7) presenting with vertigo, dysphagia, dysarthria, and diplopia. Initial computed tomography suggested extensive brainstem infarction, prompting withdrawal of treatment. Diffusion-weighted MRI revealed reversible edema with brainstem sparing. The patient underwent suboccipital decompressive craniectomy and ventricular drainage with favorable neurological recovery. In addition, a systematic literature search was conducted according to PRISMA 2020 guidelines in PubMed, Web of Science, and Scopus (studies published since 1 January 2015). Fifteen studies met predefined eligibility criteria. Results: Magnetic resonance imaging findings were decisive in avoiding a falsely dismal prognosis and inappropriate withdrawal of care. Across the literature, infarct volume (>30–35 mL), brainstem involvement and bilateral cerebellar infarction emerged as key predictors of malignant course. Early decompressive surgery was consistently associated with improved survival, though functional outcomes varied. Fast magnetic resonance imaging techniques and volumetric imaging improved risk stratification and surgical decision-making. Conclusions: SCA infarction can mimic brainstem infarction on computed tomography due to secondary compression rather than true ischemia. Magnetic resonance imaging is essential to guide treatment and prevent avoidable mortality. Multimodal imaging combined with interdisciplinary management allows for accurate prognostication and optimized surgical timing in malignant SCA infarction. Full article

Background and Objectives: Semaphorins are immunoregulatory proteins involved in inflammation and neurovascular modulation. Their roles in ischemic stroke pathogenesis and prognosis have recently gained attention. This study aimed to evaluate serum levels of semaphorin 3A, 3F, 4A, 4D, and 7A in patients with acute ischemic stroke and investigate their relationship with disease severity and prognosis. Materials and Methods: A total of 45 patients with acute ischemic stroke and 39 control individuals were enrolled. Serum semaphorin levels were measured using ELISA. Clinical data, including TOAST classification, NIHSS scores, and laboratory parameters, were recorded. Correlations between semaphorin levels and clinical or biochemical variables were analyzed statistically. Results: Semaphorin 4A levels were significantly lower and semaphorin 7A levels significantly higher in the patient group compared to controls (p < 0.001). Semaphorin 7A positively correlated with NIHSS scores (r = 0.390. p = 0.008). Semaphorin 3A and 4A levels showed significant correlations with inflammatory markers and lipid profiles. Semaphorin 3A was higher in female patients. No associations were found with TOAST subtypes or treatment modalities. Five (11.1%) patients died due to stroke-related complications, no significant differences in semaphorin levels were observed between survivors and non-survivors. Conclusions: Semaphorin 3A, 4A, and 7A levels may serve as potential biomarkers for inflammation and disease severity in acute ischemic stroke. Semaphorin 7A, in particular, showed strong prognostic value due to its association with stroke severity. These findings suggest that semaphorins could aid in clinical risk stratification and early intervention planning in ischemic stroke. Full article

The blood–brain barrier (BBB) represents a major challenge in effective drug delivery systems intended for treating neurological disorders. It restricts the transport of therapeutic agents to the brain. Chitosan-based nanoparticles (CNPs) can be used for brain drug delivery because of their biocompatibility, biodegradability, and ability to enhance drug permeability across the BBB. This review article discusses the design and application of CNPs for brain-targeted drug delivery, exploring their mechanisms of action, including adsorptive-mediated and receptor-mediated endocytosis. Surface modifications with ligands such as chlorotoxin are discussed for improving specificity and therapeutic results. Findings show that CNPs allow controlled drug release, enhance stability, and reduce side effects, which make them effective for treating multiple neurological conditions, including Alzheimer’s disease, Parkinson’s disease, brain tumors, and ischemic stroke. CNPs can encapsulate multiple therapeutic agents, such as anti-inflammatory drugs, cytotoxic agents, and genetic materials, and maintain stability under different physiological conditions. Intranasal delivery routes are mainly discussed in this paper for their ability to bypass systemic circulation and achieve direct brain targeting. This review also addresses challenges such as cytotoxicity and the need for optimizing nanoparticle size, charge, and surface properties to improve the therapy results. While CNPs are suitable for brain drug delivery, there is a research gap, which is the lack of systematic studies evaluating their long-term effects on brain tissue and health. Most studies focus on acute therapeutic outcomes and in vitro or short-term in vivo analysis, which do not address some questions about the chronic exposure risks, biodistribution, and clearance pathways of CNPs. This review also explores the use of chitosan-based nanoparticles to deliver drugs to the brain for the treatment of multiple neurological disorders. Full article

Background: The management of acute ischemic stroke (AIS) in anticoagulated patients presents a clinical challenge, as concerns about safety and efficacy often limit access to recanalization therapies. Despite the widespread use of direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs), their impact on functional recovery and mortality following intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) remains uncertain. Therefore, this study investigates the association between prior anticoagulation and 90-day outcomes in AIS patients undergoing reperfusion therapy. Methods: We conducted a retrospective cohort analysis using our institutional stroke registry, including AIS patients admitted to the Department of Neurology at our university between February 2023 and 2025. Anticoagulated patients were 1:1 propensity score-matched with non-anticoagulated controls (n = 126 per group) using Mahalanobis distance matching with a caliper, adjusting for age, sex, hypertension, diabetes, stroke severity (National Institutes of Health Stroke Scale [NIHSS] at admission and 72 h), and pre-stroke functional status (pre-morbid modified Rankin Scale [pre-mRS]). Primary endpoints at 90 days were functional independence (modified Rankin Scale [mRS] ≤ 2), mRS-shift, and mortality (mRS = 6). Predictors of outcome were assessed using multivariable logistic regression and generalized additive models (GAMs). Subgroup analyses evaluated the effects of anticoagulation type and treatment modality. Results: Among 866 AIS patients (DOAC n = 100, VKA n = 48, non-anticoagulated n = 718), 426 (49.2%) underwent reperfusion therapy (IVT n = 195, MT n = 163, IVT + MT n = 68). Before matching, anticoagulated patients were less likely to achieve functional independence (34.5% vs. 52.1%, odds ratio [OR] = 0.48, 95% confidence interval [CI] [0.33–0.70], p < 0.001), had a greater mRS-shift (2.53 vs. 1.79, p < 0.001), and higher mortality (30.4% vs. 14.5%, OR = 2.58, 95% CI [1.72–3.88], p < 0.001). However, after matching, these differences were no longer statistically significant. NIHSS, 72hNIHSS, and pre-mRS were the strongest independent predictors of outcome (p < 0.001), while anticoagulation status had no significant effect. Conclusions: Recanalization therapy was not associated with worse functional outcomes in selected anticoagulated AIS patients. These findings suggest that prior anticoagulation alone should not preclude reperfusion therapy in otherwise eligible patients, and underscore the importance of individualized, evidence-based decision-making in acute stroke care. Full article

Rapid and reliable identification of large vessel occlusions and critical stenoses is essential for guiding treatment in acute ischemic stroke. Conventional MR angiography (MRA) and PET protocols are constrained by trade-offs among acquisition time, spatial resolution, and motion tolerance. A multimodal MR–PET angiography reconstruction framework is introduced that integrates joint Hankel-structured sparsity with topology-preserving multitask learning to overcome these limitations. High-resolution time-of-flight MRA and perfusion-sensitive PET volumes are reconstructed from undersampled data using a cross-modal low-rank Hankel prior coupled to a super-resolution generator optimized with adversarial, perceptual, and pixel-wise losses. Vesselness filtering and centerline continuity terms enforce preservation of fine arterial topology, while learned k-space and sinogram sampling concentrate measurements within vascular territories. Motion correction, blind deblurring, and modality-specific denoising are embedded to improve robustness under clinical conditions. A multitask output head estimates occlusion probability, stenosis localization, and collateral flow, with hypoperfusion mapping generated for dynamic PET. Evaluation on clinical and synthetically undersampled MR–PET studies demonstrated consistent improvements over MR-only, PET-only, and conventional fusion methods. The framework achieved higher image quality (MRA PSNR gains up to 3.7 dB and SSIM improvements of 0.042), reduced vascular topology breaks by over 20%, and improved large vessel occlusion detection by nearly 10% in AUROC, while maintaining at least a 40% reduction in sampling. These findings demonstrate that embedding vascular-aware priors within a joint Hankel–sparse MR–PET framework enables accelerated acquisition with clinically relevant benefits for early stroke assessment. Full article

Cardiovascular diseases (CVDs) remain a leading cause of mortality worldwide. According to the WHO, every year, there is an increase in the rate of death globally due to CVDs, stroke, and myocardial infarction. Several risk factors contribute to the development of CVDs, one of which is hypoxia, defined as a reduction in oxygen levels. This major stressor affects aerobic species and plays a crucial role in the development of cardiovascular disease. Research has uncovered the “hypoxia-inducible factors (HIFs) switch” and investigated the onset, progression, acute and chronic effects, and adaptations of hypoxia, particularly at high altitudes. The hypoxia signalling pathways are closely linked to natural rhythms such as the circadian rhythm and hibernation. In addition to genetic and evolutionary factors, epigenetics also plays an important role in postnatal cardiovascular responses to hypoxia. Oxidized LDL-C initiates atherosclerosis amidst oxidative stress, inflammation, endothelial dysfunction, and vascular remodelling in CVD pathogenesis. Anti-inflammatory and antioxidant biomarkers are needed to identify individuals at risk of cardiovascular events and enhance risk prediction. Among these, C-reactive protein (CRP) is a recognized marker of vascular inflammation in coronary arteries. Elevated pro-atherogenic oxidized LDL (oxLDL) expression serves as an antioxidant marker, predicting coronary heart disease in apparently healthy men. Natural antioxidants and anti-inflammatory molecules protect the heart by reducing oxidative stress, enhancing vasodilation, and improving endothelial function. For instance, the flavonoid quercetin exerts antioxidant and anti-inflammatory effects primarily by activating the Nrf2/HO-1 signaling pathway, thereby enhancing cellular antioxidant defense and reducing reactive oxygen species. Carotenoids, such as astaxanthin, exhibit potent antioxidant activity by scavenging free radicals and preserving mitochondrial integrity. The alkaloid berberine mediates cardiovascular benefits through activation of AMO-activated protein kinase (AMPK) and inhibition of nuclear factor kappa B [NF-kB] signalling, improving lipid metabolism and suppressing inflammatory cytokines. Emerging evidence highlights microRNAs (miRNAs) as potential regulators of oxidative stress via endothelial nitric oxide synthase (eNOS) and silent mating-type information regulation 2 homolog (SIRT1). While the exact mechanisms remain unclear, their benefits are likely to include antioxidant and anti-inflammatory effects, notably reducing the susceptibility of low-density lipoproteins to oxidation. Additionally, the interactions between organs under hypoxia signalling underscore the need for a comprehensive regulatory framework that can support the identification of therapeutic targets, advance clinical research, and enhance treatments, including FDA-approved drugs and those in clinical trials. Promising natural products, including polysaccharides, alkaloids, saponins, flavonoids, and peptides, as well as traditional Indian medicines, have demonstrated anti-hypoxic properties. Their mechanisms of action include increasing haemoglobin, glycogen, and ATP levels, reducing oxidative stress and lipid peroxidation, preserving mitochondrial function, and regulating genes related to apoptosis. These findings emphasise the importance of anti-hypoxia research for the development of effective therapies to combat this critical health problem. A recent approach to controlling CVDs involves the use of antioxidant and anti-inflammatory therapeutics through low-dose dietary supplementation. Despite their effectiveness at low doses, further research on ROS, antioxidants, and nutrition, supported by large multicentre trials, is needed to optimize this strategy. Full article

Background: Dual antiplatelet therapy (DAPT), combining aspirin with a P2Y12 receptor inhibitor (P2Y12i), remains central to the management of acute myocardial infarction (MI), especially in patients undergoing percutaneous coronary intervention (PCI). However, the pharmacodynamic response to antiplatelet therapy may vary with body composition. This study investigates the association between body mass index (BMI) and clinical outcomes in MI patients treated with PCI and DAPT. Methods: This retrospective cohort study analyzed data from 52,119 MI patients treated with coronary stenting from 2014 to 2021, sourced from the Hungarian Myocardial Infarction Registry. Patients were stratified into clopidogrel-based (n = 44,480) and potent P2Y12i-based (prasugrel or ticagrelor; n = 7639) DAPT cohorts. Clinical outcomes—including 12-month mortality and ischemic events—were assessed across BMI categories. Kaplan–Meier analysis and LASSO Cox regression identified predictors of mortality, while decision curve analysis (DCA) evaluated the net clinical benefit of potent P2Y12i across BMI strata. Results: Univariate and multivariate Cox regression analyses identified BMI and potent P2Y12i treatment as significant predictors of 365-day mortality, with higher BMI associated with lower observed rates of mortality, major adverse cardiovascular events (MACEs), and stroke. However, higher BMI was also associated with an increased risk of repeat revascularization and PCI. This study found that the protective effect of potent P2Y12i treatment was consistent across different BMI categories. Conclusions: In patients with MI undergoing PCI, elevated BMI was paradoxically associated with more favorable short-term outcomes, including reduced mortality. Potent P2Y12i therapy demonstrated a consistent benefit across BMI categories, supporting its broad application irrespective of body mass. Full article

Left ventricular thrombus (LVT) remains a clinically significant complication following acute myocardial infarction (MI). Although its incidence has declined in the era of primary percutaneous coronary interventions (PCIs), the best treatment remains unclear. For decades, vitamin K antagonists (VKAs) such as warfarin have been the mainstay of therapy, supported by guidelines recommendations. However, the limitations of warfarin, including a narrow therapeutic range, the need for frequent monitoring, and food/drug interactions, have spurred interest in direct oral anticoagulants (DOACs). This review summarizes the available evidence on anticoagulation strategies for LVT after MI, focusing on observational studies and recent randomized controlled trials. A total of 12 studies were included in this review: 9 retrospective cohorts and 3 randomized controlled trials. Patient populations ranged from small single-center cohorts to large multicenter registries. DOACs, compared with warfarin, were associated with a higher rate of thrombus resolution, a lower rate of stroke and systemic embolism, and a similar mortality. The usage of DOACs marginally reduced the rate of major bleeding compared with warfarin. The current evidence indicates that DOACs may offer comparable efficacy and potentially improved safety relative to warfarin, although most randomized trials remain small and underpowered for definitive conclusions. Larger, adequately powered studies are still required before DOACs can be routinely considered equivalent alternatives. The RIVAWAR randomized trial provides the strongest evidence to date regarding the use of DOACs in LVT after MI, but further large-scale randomized studies are required to establish definitive guidance. Until then, anticoagulation therapy including DOACs should be individualized, balancing the thromboembolic risk, bleeding risk, and practical considerations of anticoagulant use. Full article

Background/Objectives: One of the neurotoxic components from the sea trumpet polyps, Protopalythoa variabilis (Cnidaria, Anthozoa), is a 26-residue, V-shape helical peptide (PpVα). Its synthetic versions, i.e., the linear, the single-disulfide-bonded analog, and the chimeric peptide with a 6-residue stretch of the N-terminal native homologous peptide covalently linked to the linear sequence, were investigated for their activity on ion channels responsible for cellular excitability and synaptic transmission. Methods: Molecular docking analyses and dynamic simulations focused on the ability of PpVα peptides to bind ion channels selectively through interaction with critical residues at their binding sites. Results: Electrophysiological studies using the patch clamp technique with sympathetic bovine chromaffin cells from the adrenal medulla confirmed that PpVα analogs can block both sodium and calcium currents, which are responsible for initiating and propagating action potentials, respectively, and for neurotransmitter release. Additionally, the peptides displayed neuroprotective effects, attenuating cellular damage induced by veratridine, which interferes with sodium channel activity, and by oligomycin and rotenone (O/R), which affect mitochondrial function. Conclusions: The block of calcium and sodium channels and the neuroprotective effects against oxidative stress make the PpVα peptide scaffold an attractive template for developing agents that has significant clinical potential in several areas, such as the treatment of neurological diseases (epilepsy, multiple sclerosis, and neurodegenerative diseases), neuroprotection in acute events (stroke and traumatic brain or spinal cord injuries), the management of neuropathic pain, the prevention of ischemic damage, and psychiatric disorders (anxiety and bipolar disorder). Full article

Lipid debris generated after ischemic stroke overwhelms myeloid cells, leading to foam cell-like dysfunction and chronic neuroinflammation. 2-hydroxypropyl-β-cyclodextrin (HPβCD), a cholesterol-mobilizing agent, has been shown to improve recovery and reduce chronic inflammation after stroke by enhancing lipid processing and cholesterol efflux in infarcts. To identify plasma biomarkers of HPβCD activity and gain mechanistic insight into lipid pathway modulation, aged (21-month-old) male mice underwent the distal middle cerebral artery occlusion + hypoxia (DH) model of stroke and received 2 g/kg HPβCD twice daily beginning 1 d after stroke. Plasma metabolomic and lipidomic profiling was performed 4 d after stroke using untargeted (Global Discovery) and targeted (Complex Lipid, Oxysterols, and Lipid Mediators of Inflammation) panels. Acute neuroprotection was assessed by magnetic resonance imaging (MRI) quantification of infarct, ventricle, and hippocampus volumes 2 d after stroke and by plasma neurofilament light (NfL) levels 4 d after stroke. HPβCD treatment did not provide acute neuroprotection; however, HPβCD did induce distinct plasma metabolomic and lipidomic signatures, including decreases in sphingolipids, cholesterol, long-chain fatty acids, 4β-hydroxycholesterol, 7-dehydrocholesterol, and 8-dehydrocholesterol and increases in 27-hydroxycholesterol and 7α-hydroxy-3-oxo-4-cholestenoic acid (7-HOCA), consistent with enhanced cholesterol efflux and metabolism. Pro-inflammatory oxylipins were also suppressed by HPβCD treatment. These results support the role of HPβCD in promoting lipid debris clearance and suppressing inflammatory lipid pathways after stroke and, together with prior studies demonstrating improved long-term recovery, highlight HPβCD as a biomarker-supported therapeutic candidate for stroke recovery. 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

Background/Objectives: Thrombotic diseases, such as ischemic stroke, acute myocardial infarction, and venous thromboembolism, are leading causes of global morbidity and mortality. Traditional thrombolytic therapies like systemic tissue plasminogen activator (tPA) are limited by bleeding risks, poor targeting, and inconsistent efficacy. This review explores emerging non-pharmacological technologies aimed at overcoming these challenges through targeted, minimally invasive thrombolysis. Methods: A narrative synthesis of recent advancements was conducted, focusing on six innovative approaches: ultrasound-mediated thrombolysis (UMT), microrobots, electrothrombectomy, photothrombectomy, magnetic targeted thrombolysis, and nanotechnology. Preclinical and clinical studies were reviewed to assess mechanisms, efficacy, safety, and translational potential, prioritizing technologies with demonstrated success in animal or early human trials. Results: Technologies like microbubble-enhanced UMT, magnetically actuated microrobots, and fibrin-targeted nanoparticles showed promising results. UMT improved recanalization in ischemic stroke and pulmonary embolism, while electrothrombectomy demonstrated safe, effective clot extraction in human trials. However, challenges remain in scalability, biocompatibility, and clinical integration, with microrobots and photothrombectomy still in preclinical stages. Conclusions: Emerging thrombolysis technologies offer safer, more targeted alternatives to conventional treatments. Clinical adoption will depend on overcoming translational hurdles, including large-scale trials, miniaturization, and interdisciplinary collaboration, with a focus on hybrid approaches and real-time imaging integration. Full article

Background: CT perfusion (CTP) is increasingly used in the evaluation of acute ischemic stroke (AIS) and may complement non-contrast CT (NCCT) and CT angiography (CTA). This review aimed to assess the role of CTP in patient selection for reperfusion therapy, its prognostic value, and the influence of technical factors, collateral assessment, and post-processing software. Methods: A literature search of PubMed, DOAJ, and Google Scholar (2014–2025) identified 119 articles; after screening, 39 met inclusion criteria. Only studies on adult AIS patients investigated with CTP were included. Data were synthesized across eight thematic categories: core/penumbra estimation, prognosis, treatment selection, collateral assessment, software validation, technical parameters, reliability, and safety. Results: CTP improved identification of infarct core, penumbra, and collateral status, aiding patient selection for endovascular therapy, particularly beyond 6 h. Limitations included variability in tissue thresholds, “ghost infarct core,” and differences across software. Technical advances, such as “one-stop-shop” protocols and low-kV acquisition, reduced treatment delays and radiation. Reliability studies showed CTP to be less accurate than diffusion-weighted MRI, while safety analyses confirmed a low risk of contrast-induced nephropathy. Conclusions: CTP enhances patient stratification and outcome prediction, supporting individualized treatment strategies. Standardization of protocols and validation of software remain necessary before CTP can serve as a reliable alternative to MRI-DWI. Full article

Background: Hemorrhagic transformation (HT) is a major complication of endovascular thrombectomy (EVT) for acute ischemic stroke (AIS). Objectives: To investigate the factors as sociated with HT in patients with successful recanalization and examine the impact of collateral status (CS) on ischemic progression and outcomes. Methods: We retrospectively analyzed patients with AIS with successful recanalization (modified treatment in cerebral infarction (mTICI) 2B-3) who underwent dual-energy CT (DECT) within 24 h and MRI within 10 days post-EVT. Patients with posterior circulation stroke, missing multiphase CT angiography (CTA) collateral scores, or missing 3-month modified ranking scale scores were excluded from the study. Results: Among the 86 patients, those with HT had a significantly lower proportion of 3-month excellent outcomes and worse imaging scores, including non-contrast CT (NCCT)-Alberta Stroke Program Early CT Score (ASPECTS), virtual non-contrast (VNC)-ASPECTS, and diffusion-weighted imaging (DWI)-ASPECTS. Patients with HT with poor CS had a significantly lower proportion of 3-month excellent outcomes, poorer post-EVT National Institutes of Health Stroke Scale (NIHSS) score, worse imaging scores, including VNC-ASPECTS, and DWI-ASPECTS. In the predictive factor analysis, post-EVT NIHSS and VNC-ASPECTS scores were significantly associated with 3-month excellent functional outcomes (modified Rankin Scale (mRS) 0-1). Conclusions: In patients with successfully recanalized AIS, HT with poor CS was associated with poorer functional outcomes and worse imaging scores, and a 24 h combined measure (post-EVT NIHSS and DECT VNC-ASPECT) show promise for early risk stratification; prospective external validation is warranted before routine use. Full article