Yigit Can Senol

All Publications

• Angioscopic study of the major dural venous sinuses in human cadavers JOURNAL OF NEUROINTERVENTIONAL SURGERY Senol, Y., Liu, A., Krishnan, N., Haider, A., Orscelik, A., Kumar, P., Krishnan, N., Cho, B., Pardalidis, P., Amans, M., Savastano, L. 2026

  Abstract

  Neurointerventional surgery is witnessing a growth in transvenous procedures by using endovascular devices and techniques developed, optimized, and used in the arterial system. However, major dural venous sinuses differ from arteries in their non-circular (often triangular) cross sectional geometry and in the multiple structures that protrude or cross their lumens, such as septations, false channels, ostia of draining veins (cortical and dural venous channels), intraluminal bands, and arachnoid granulations. To address this gap in the literature, we used the 'live' cadaver model previously developed and validated to study the anatomical phenotypes of intraluminal structures with angiography and high resolution angioscopy.The internal jugular veins (IJVs) of six head and neck human cadaveric specimens were catheterized, and a peristaltic pump was used to infuse 0.9% saline. Cerebral venograms, including two-dimensional and three-dimensional cone beam CT venograms, were performed by injecting iodinated contrast at the confluence of the major dural sinuses. Then, an angioscope was used to study the anatomical structures in the lumen of transverse/sigmoid sinuses (n=12) and superior sagittal sinuses (SSSs) (n=6). Angioscopic evaluation was done retrogradely through the IJVs and anterogradely by direct transcranial access through burr holes (at the anterior sagittal sinus and one on the torcular Herophili). Descriptive statistics were performed to evaluate anatomical structures.In six cadaveric specimens, arachnoid granulations were identified in 10 of 12 transverse sinuses (83.3%), most commonly in the proximal (or medial) and middle segments, and less frequently in the distal (or lateral) segment. Arachnoid granulations were more often identified on the left side (6/6, 100%) than on the right (4/6, 66.7%). The SSS demonstrated septations in five of six specimens (83.3%), each containing two or more septa. Arachnoid granulations within the SSS were observed in five specimens (83.3%), typically clustered along the middle to posterior third. The transverse sinus contained an average of 3.0±0.9 of intraluminal bands per side, distributed nearly symmetrically (right 3.0±0.8; left 2.8±0.8). Ostial openings were identified along all segments of the SSS, with the highest concentration at the junction of the middle and posterior segments.The intraluminal anatomy of the major dural venous sinuses differed markedly from that of the cerebral arteries, underscoring its relevance for endovascular venous approaches. Crossing septations and bands, protruding arachnoid granulations, and ostia of venous branches were consistently identified. These structures may interact with devices and directly affect procedural safety and efficacy in endovascular venous interventions.

  View details for DOI 10.1136/jnis-2025-024857

  View details for Web of Science ID 001755866200001

  View details for PubMedID 42055820

• Evaluating a calcium chloride-elastase combination for creating large aneurysms in the endovascular rabbit elastase model INTERVENTIONAL NEURORADIOLOGY Bilgin, C., Bayraktar, E., Ding, Y., El Hajj, G., Oliver, A. A., Senol, Y., Kallmes, D. F., Kadirvel, R. 2025: 15910199251390598

  Abstract

  PurposeLarge aneurysms have a higher rupture risk, yet no available in vivo animal model consistently produces large aneurysms for testing endovascular therapies. Recent research suggests that adding calcium chloride (CaCl2) to elastase yields larger aneurysms in a surgical rabbit model. We evaluated whether this effect translates to an endovascular approach by comparing aneurysm sizes created using elastase alone versus a CaCl2-elastase combination.MethodsAneurysms were created in the right common carotid artery of New Zealand rabbits. One group received 1 mL porcine elastase; the other received elastase plus 0.055 g CaCl2 (0.5 M). After four weeks, patency was confirmed via digital subtraction angiography. Two blinded co-authors measured the neck, width, and height of the aneurysms. Aneurysm volumes were estimated using AngioCalc.com. Statistical analyses were performed using either the Mann-Whitney U-test or t-test based on data distribution.ResultsTwenty-nine (29) New Zealand rabbits were included in the study: six in the CaCl2 and elastase groups, 23 in the elastase-alone group. All induced aneurysms remained patent at follow-up. Mean neck size was significantly larger in the CaCl2 + elastase group than in the elastase-alone group (4.4 ± 1.1 mm vs 3.5 ± 0.95 mm; respectively, p = 0.02). Differences in width (4.1 ± 0.92 mm vs 3.4 ± 0.36 mm; p = 0.06), height (9.0 ± 1.1 mm vs 9.1 ± 2.1 mm; p = 0.46), and volume (83.5 ± 38.35 mm³ vs 53.0 ± 16.94 mm³; p = 0.11) were not significant between CaCl2 + elastase and elastase-alone, respectively.ConclusionsCaCl2 modestly increased neck size but did not significantly enlarge overall aneurysm dimensions. Further studies are needed to assess its utility in endovascular aneurysm models.

  View details for DOI 10.1177/15910199251390598

  View details for Web of Science ID 001599784100001

  View details for PubMedID 41138264

  View details for PubMedCentralID PMC12553547

• Comparative analysis of endovascular treatment methods for anterior choroidal aneurysms: single center study with 80 aneurysms ACTA NEUROCHIRURGICA Senol, Y., Ciftci, H., Oz, Z., Duman, D., Sayin, B., Akmangit, I., Ozbakir, M., Divanlioglu, D., Belen, A., Daglioglu, E. 2025; 167 (1): 235

  Abstract

  Anterior choroidal artery (AChoA) aneurysms are rare and pose a significant treatment challenge due to the artery's small caliber and critical vascular territory. Endovascular treatment (EVT) has become a preferred approach, but optimal management strategies remain debated. This study compares the efficacy and safety of different EVT techniques, including primary coiling, stent-assisted coiling (SAC), and flow diversion (FD), in treating AChoA aneurysms.Patients were categorized by endovascular technique, aneurysm morphology, and rupture status. Angiographic occlusion rates were assessed using the Raymond-Roy Occlusion Scale (RROS), and clinical outcomes were measured via the Modified Rankin Scale (mRS) at discharge and follow-ups. Statistical analyses compared occlusion rates, procedural complications, and functional outcomes among treatment groups.In this study, 60 patients with 80 anterior choroidal artery aneurysms were treated. Among these, 44 aneurysms (55%) were classified as dependent, meaning the choroidal branch arose from the aneurysm dome or neck, while 36 aneurysms (45%) were independent, originating from the carotid artery near the choroidal branch. Primary coiling was used in 29 cases, stent-assisted coiling (SAC) in 21, and flow diversion (FD), with or without additional coiling, in 30 cases. Complete occlusion rates were significantly higher with SAC (83.3%) and FD (76.1%) compared to primary coiling (31.8%) (p < 0.05). Flow diversion was associated with more technical complications (25%), and ischemic events were more common in dependent aneurysms (p < 0.05). Importantly, no cases of symptomatic AChoA occlusion occurred after FD treatment. The overall mortality rate was 5%, with all deaths occurring in the primary coiling group among patients with ruptured aneurysms.EVT of AChoA aneurysms is effective, with SAC and FD demonstrating superior occlusion rates compared to primary coiling. FD carries a higher risk of technical complications but maintains AChoA patency. To optimize outcomes, treatment choice should be guided by aneurysm morphology and patient risk factors.

  View details for DOI 10.1007/s00701-025-06647-9

  View details for Web of Science ID 001564695600001

  View details for PubMedID 40888948

  View details for PubMedCentralID PMC12402016

• Development and validation of a perfused cadaveric model for neurovascular transradial access with insights from angiography and angioscopy JOURNAL OF NEUROINTERVENTIONAL SURGERY Senol, Y., Krishnan, N., Asghariahmadabad, M., Madhani, S., Liu, A., Orscelik, A., Mattay, R., Han, W., Amans, M., Savastano, L. 2026; 18 (4): 1119-1125

  Abstract

  The development of safe and effective endovascular devices is dependent on accurate simulation of anticipated use environments during preclinical testing. We sought to optimize and evaluate the human 'live cadaver' neurovascular model for the purpose of testing radial access catheters. We aimed to assess the realism of our model during simulated neurointerventional procedures as well as explore and characterize potential challenges of radial access catheters.A human 'live cadaver' model was developed from a cadaveric specimen consisting of the head, neck, bilateral upper limbs, and thorax. Catheters were inserted into the heart and thoracic aorta. Blood-mimicking fluid made by 0.7% carboxymethyl cellulose + 0.25% sodium propionate was circulated through the vasculature using an external peristaltic pump. Bilateral radial access was obtained using 7F sheaths. Experienced neurointerventionists (n=5) were provided with a questionnaire using a validated 5-point Likert scale and tasked with assessing the model's radial artery, aortic arch, and carotid/vertebral arteries on the parameters of anatomical accuracy, roadmap angiography, device manipulation, haptic feedback, comparison to clinical cases, radio-opacity of devices, and overall similarity to actual patients. Challenging mechanisms were identified and described by evaluation of fluoroscopic and endoscopic videos.A total of six cadavers were used. Formalin-fixed arteries showed mechanical properties comparable to those of fresh human arteries, including maximum stretch and increased tensile strength/stiffness. The contrast angiographies revealed no obstruction in the micro- or macro-vasculature. Overall similarity scores for arms (radial, brachial, axillary, and subclavian arteries) were 34.6±2.3 out of 40, for aortic arch 30.3±5.4 out of 40, and for carotid/vertebral artery access 33.0±4.2 out of 40. We identified three distinct challenges associated with market radial access catheters: (1) torque build-up followed by sudden release and whipping; (2) catheter tip entry into ulcerated or nodular aortic atheroma preventing free motion; and (3) catheter catching at a septum-like structure at the medial edge of the brachiocephalic trunk; the latter two result in herniation of the system into the arch even with favorable aortic arch angles.The model provided a reliable and accurate human radial and aortic vasculature simulation, allowing for the evaluation of catheter performance and identification of challenging mechanisms likely to occur in clinical settings. These findings suggest that the modified human live cadaveric model could be a valuable testing platform to support the development of next-generation transradial systems for improved clinical performance.

  View details for DOI 10.1136/jnis-2025-023465

  View details for Web of Science ID 001511423800001

  View details for PubMedID 40506220

• Device-anatomy interactions in the dural venous sinuses: angioscopic insights from a perfused human cadaveric model JOURNAL OF NEUROINTERVENTIONAL SURGERY Senol, Y., Krishnan, N., Liu, A., Krishnan, N., Cho, B., Haider, A., Kumar, P., Pardalidis, P., Leong, D., Amans, M., Savastano, L. 2026

  Abstract

  Neuroendovascular venous interventions are increasingly performed using technologies originally developed for arterial procedures and indications. However, the major dural venous sinuses possess a unique intraluminal anatomy that is not present in arteries, raising concerns about device-anatomy interactions that may affect procedural performance. We used a perfused human cadaveric model with direct intraluminal angioscopic visualization to evaluate currently available endovascular devices within the dural venous sinuses and to characterize mechanisms of device-anatomy interactions associated with technical difficulty and failure.Six fresh human head-and-neck cadaveric specimens were perfused with 0.9% saline solution via bilateral internal jugular vein catheterization using a peristaltic pump. Direct intraluminal angioscopic visualization was achieved through transcranial access to the major dural venous sinuses, allowing real-time observation of target segments during device manipulation. Standard endovascular maneuvers were performed within the dural venous sinuses, including guidewire and microcatheter navigation, catheter advancement, venous stent deployment, stent retriever deployment, aspiration thrombectomy, and balloon angioplasty. Angioscopic and fluoroscopic recordings were independently reviewed by experienced neurointerventionists to identify and categorize technical challenges and failure mechanisms.Angioscopy revealed multiple device-intraluminal interactions that were not fully appreciated on fluoroscopy alone. Several representative technical challenge and failure scenarios were identified and grouped into four principal mechanisms: (1) catheterization of venous channels parallel to the main sinus lumen, resulting in catheter entrapment and incomplete expansion of venous stents and stent retrievers; (2) device deformation or incomplete expansion due to intraluminal bands, including stent deformation, malposition, and constrained balloon angioplasty; (3) arrested or impaired device advancement caused by intraluminal bands, frequently necessitating microcatheter-assisted support to overcome ledge effects; and (4) interaction with arachnoid granulations leading to occlusion of aspiration catheter inlets and impeded intraluminal navigation.The venous system differs fundamentally from arteries in luminal geometry and internal architecture. Our findings demonstrate that arterial-derived devices incompletely accommodate these differences, resulting in parallel channel navigation, constrained expansion and deformation of stents, and occlusion of suction catheters. These findings highlight the fact that veins are not arteries and underscore the need for venous-specific techniques and technologies.

  View details for DOI 10.1136/jnis-2026-025277

  View details for Web of Science ID 001792895500001

  View details for PubMedID 42285760

• Comparative analysis of syringes versus pump devices in benchtop aspiration thrombectomy models: A systematic review and meta-analysis INTERVENTIONAL NEURORADIOLOGY Senol, Y., Li, J., Orscelik, A., Kobeissi, H., Bilgin, C., Oliver, A. A., Ghozy, S., Kadirvel, R., Kallmes, D. F. 2026; 32 (3): 891-897

  Abstract

  BackgroundAlthough direct contact aspiration has emerged as one of the leading techniques for mechanical thrombectomy (MT), there is still ongoing debate about the aspiration/suction pump devices that can optimize recanalization rates. To address this gap, we conducted a meta-analysis comparing the aspiration efficacy of 60 ml syringe and pump devices in benchtop MT models.MethodsSystematic literature review was conducted using Medline, Embase, Web of Science, and Scopus in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Outcomes of interest included flow rate and vacuum pressure delivered by a 60 ml syringe and several aspiration pumps. We used a random effects model to calculate the mean difference (MD) with 95% confidence intervals (CIs) and a statistically significant difference was considered as a two-sided p-value of less than 0.05.ResultsWe included six benchtop studies comparing 60 ml syringes and vacuum pumps. Our meta-analysis showed that there were no significant differences in vacuum pressure (MD:0.71inHg, 95% CI: [-0.81;2.23], p = 0.359) and flow rate (MD:0.27 mL/s, 95% CI: [-3,07; 3.61], p = 0.873) between 60 ml syringes and vacuum pumps groups.ConclusionsOur study demonstrated comparable performance in terms of vacuum pressure and flow rates between a 60 ml syringe and a heterogeneous combination of commercially available aspiration pumps.

  View details for DOI 10.1177/15910199231222305

  View details for Web of Science ID 001133702200001

  View details for PubMedID 38151033

  View details for PubMedCentralID PMC13304995

• The safety profile of single antiplatelet therapy with flow diverters: Systematic review and meta-analysis INTERVENTIONAL NEURORADIOLOGY Senol, Y., Orscelik, A., Ghozy, S., Hassan, K., Arul, S., Bilgin, C., Kadirvel, R., Kallmes, D. F. 2026; 32 (3): 732-740

  Abstract

  BackgroundDual antiplatelet therapy (DAPT) is frequently used in treating cerebral aneurysms with flow diverters (FDs), whereas single antiplatelet therapy (SAPT) is used mostly with coated FDs and in ruptured aneurysms. We conducted a systematic review and meta-analysis to explore the safety profile of SAPT in FDs.MethodsPubMed, Web of Science, OVID Embase, OVID Medline, and Scopus were searched to 1st November 2022. Outcomes of interest included ischemic and hemorrhagic complications, conversion to DAPTs, and in-stent stenosis rates under long-term SAPT. SAPT is divided into aspirin (ASA) vs. non-ASA group (ticagrelor or prasugrel). Subgroup analysis was performed for ruptured vs. non-ruptured aneurysms and coated vs. non-coated FDs. All data were analyzed using R software version 4.2.2.ResultsTwelve studies with 240 total patients (43 patients in the ASA group and 197 patients in the non-ASA group) were included in our meta-analysis. The pooled ischemic occlusion rate was 9.8% (95% CI = 4.87-18.95: p-value = 0.09) for SAPTs. The ASA group had significantly higher ischemic complication rates compared to the non-ASA group (20.8% vs. 6.3%, respectively, p-value = 0.02). The pooled hemorrhagic complication rate was 3.5% (95% CI = 1.38-8.81: p-value > 0.99). The hemorrhagic rates of ASA group were 9.3%% (95% CI = 3.54-22.30) over the non-ASA group 2.1% (95% CI = 0.58-7.54) (p-value > 0.99). The overall in-stent stenosis rate was 2.3% (95% CI = 1.06-5.14: p-value > 0.99). The ischemic complication rates were comparable between coated vs non-coated FDs (10.7% vs. 5.5% p-value = 0.39). In stent stenosis rate were 1.9% (95% CI = 0.72-4.96) in coated FDs over 4.4% (95% CI = 1.11-16.11) (p-value = 0.32). The ruptured and non-ruptured groups also showed comparable results in terms of ischemic (17.6% vs. 7.1% respectively, p-value = 0.24) and hemorrhagic complications (9.8% vs. 1.1%, respectively, p-value = 0.08).ConclusionsFlow diverter treatment under ASA monotherapy resulted in relatively high ischemic complication rates. However, SAPT with prasugrel or ticagrelor monotherapy is promising for coated FDs and ruptured aneurysm treatments. Given the overall small sample size and also the likely presence of known and unknown biases regarding choice of antiplatelet therapy between groups, larger cohort studies are needed to evaluate SAPT treatment outcomes.

  View details for DOI 10.1177/15910199231168669

  View details for Web of Science ID 000974227100001

  View details for PubMedID 37071551

  View details for PubMedCentralID PMC13305368

• Impact of branch arteries on efficacy of endoluminal flow diverters: Insights from posterior communicating artery aneurysms INTERVENTIONAL NEURORADIOLOGY Bilgin, C., Kandemirli, S., Ghozy, S., Orscelik, A., Kobeissi, H., Senol, Y., Shehata, M., Kadirvel, R., Brinjikji, W., Kallmes, D. F. 2026; 32 (3): 780-789

  Abstract

  BackgroundFlow diverter treatment may inevitably require jailing of the branch vessels. While the patency of covered branch arteries and associated safety risks have been a topic of substantial interest, the question of whether the characteristics of branch vessels affect flow diversion's efficacy remains unanswered. In this study, we aimed to assess the impact of branch arteries on the efficacy of endoluminal flow diverters, specifically focusing on posterior communicating artery (Pcomm) aneurysms.MethodsFollowing PRISMA guidelines, we systematically searched the MEDLINE, EMBASE, Scopus, Web of Science, and Cochrane databases with predefined keywords. Studies providing data for flow diversion outcomes in Pcomm aneurysms were included. Outcomes of interest included complete and adequate aneurysm obliteration, ischemic and hemorrhagic complications, and Pcomm occlusion in the follow-up period. A random or fixed effects model was used to calculate the odds ratios (ORs) and pooled event rates with their corresponding confidence intervals (CI).ResultsThe overall complete and adequate aneurysm occlusion rates were 72.25% (95% CI: 64.46-78.88%) and 88.37% (95% CI: 84.33-92.6), respectively. Fetal-type Pcomm aneurysms had significantly lower complete aneurysm occlusion rates than the nonfetal-type Pcomm aneurysms (OR: 0.12, 95% CI: 0.05-0.29). Overall ischemic and hemorrhagic complication rates were 2.62% (95% CI = 0.71-5.32) and 0.71% (95% CI: 0-2.24), respectively. There were no significant associations between Pcomm morphology and complications (OR: 3.61, 95% CI = 0.42-31.06 for ischemic complications and OR: 2.31, 95% CI = 0.36-14.6 for hemorrhage). Overall Pcomm occlusion rate was 32.04% (95% CI = 19.96-47.13), and the Pcomm patency was significantly lower in nonfetal-type Pcomm aneurysms (OR: 0.10, 95% CI = 0.02-0.44).ConclusionOur meta-analysis suggests that flow diversion is a safe treatment option for Pcomm aneurysms, regardless of fetal-type Pcomm morphology. However, on the other hand, our findings indicate that Pcomm anatomy or the presence of jailed large branches can affect the efficacy of flow diverter treatment.

  View details for DOI 10.1177/15910199231186036

  View details for Web of Science ID 001027193000001

  View details for PubMedID 37437217

  View details for PubMedCentralID PMC13294542

• Distal versus conventional transradial access for diagnostic cerebral angiography and neurointerventional procedures: A systematic review and meta-analysis INTERVENTIONAL NEURORADIOLOGY Orscelik, A., Senol, Y., Kobeissi, H., Ghozy, S., Bilgin, C., Arul, S., Kadirvel, R., Brinjikji, W., Kallmes, D. F. 2026; 32 (3): 881-890

  Abstract

  BackgroundDistal transradial artery access (dTRA) has received increasing consideration for performing diagnostic cerebral angiography and neurointerventional procedures. In this meta-analysis, we aim to evaluate the safety and efficacy of dTRA compared to conventional transradial access (cTRA) for cerebral angiography and neurointerventions.MethodA systematic review and meta-analysis were conducted on studies investigating outcomes of dTRA and cTRA in neurointerventions. The primary outcome was technical success rates. Secondary outcomes included access site complication rates, crossover rates to alternative vessels, fluoroscopy time, and contrast volume. The random effects model was used to calculate the mean difference (MD) and odds ratios (OR) with 95% confidence intervals (Cl).ResultsEight retrospective observational studies with a total of 1477 patients who underwent 1175 diagnostic cerebral angiography and 516 neurointerventional procedures using 546 dTRA and 1164 cTRA approaches were included in our meta-analysis. The technical success rate was similar between dTRA and cTRA groups (95.8% vs 91.4%; OR:1.65; 95% Cl: 0.52 to 5.22; P = 0.40). Similarly, no difference was seen in dTRA and cTRA regarding access site complications (2% vs 1.4%; OR: 1.31; 95% CI: 0.47 to 3.61; P = 0.61) and access site crossover (2.1% vs 5.3%; OR: 0.55; 95% Cl: 0.28 to 1.05; P = 0.07). After resolving heterogeneity among included studies, dTRA was associated with a shorter fluoroscopy time (MD: -0.91 min; 95% CI: -1.74 to -0.09; P = 0.03) and lower contrast volume (MD: -8.32 mL; 95% CI = -14.7 to -1.94; P = 0.011).ConclusionOur findings suggest that the dTRA approach is a safe and effective alternative to the cTRA approach in patients undergoing cerebral angiography and neurointerventions.

  View details for DOI 10.1177/15910199231210411

  View details for Web of Science ID 001098518000001

  View details for PubMedID 37936400

  View details for PubMedCentralID PMC13305570

• Delphi Consensus on Early Neurologic Improvement after Mechanical Thrombectomy. AJNR. American journal of neuroradiology Bilgin, C., Ospel, J., Kobeissi, H., Ghozy, S., Senol, Y. C., Bayraktar, E. A., Orscelik, A., Desai, S., Zhang, X., Hassan, A. E., Schirmer, C. M., Zaidat, O. O., Amans, M., Abdalkader, M., Dmytriw, A. A., Fischer, U., Nogueira, R. G., Brinjikji, W., Yaghi, S., Savastano, L., Rabinstein, A., Hendrix, P., Heit, J. J., Raymond, J., Nagel, S., Jadhav, A., Goyal, M., Nguyen, T. N., Kallmes, D. F. 2026; 47 (4): 950-955

  Abstract

  Early neurologic improvement (ENI) following mechanical thrombectomy (MT) has been a topic of substantial interest. The literature has more than 40 ENI definitions, yet no consensus has been reached. In this Delphi study, we sought to investigate experts' perspectives on the available ENI definitions and determine whether a consensus can be achieved.The Delphi approach assessed experts' perspectives on available ENI definitions. Following a systematic literature review, the first survey round was prepared and sent to 20 experts using a Web-based anonymous survey platform (qualtrics.com). The first round of questions was publicly shared on the letsgetproof.com platform to gather perspectives of neurointerventionalists worldwide on ENI definitions. Expert and volunteer answers formed the basis of subsequent rounds, in which closed-ended questions were sent only to experts. Consensus was defined as an agreement of ≥70% for binary closed-ended questions and ≥50% for closed-ended questions with >2 response options.Experts completed 3 survey rounds. They recognized that the heterogeneity in ENI definitions is the most critical factor limiting the use of ENI in clinical practice and stroke research. All experts acknowledged that stroke physicians need a standardized universal ENI definition. Consensus was reached on the notion that a unified ENI definition should focus on predicting functional independence at 3 months. They agreed that NIHSS improvement of ≥8 points at 24 hours could serve as the unified ENI definition. They acknowledged that incorporating prestroke comorbidities, occlusion location, baseline NIHSS scores, and procedure-related parameters would complicate the ideal ENI definition and limit its use in clinical settings. The experts could not reach a consensus on the potential utility of ENI as a primary end point in MT trials.In our Delphi analysis, experts agreed on an ENI definition. They did not endorse using different ENI criteria for patients with comorbidities, posterior circulation occlusions, or high baseline NIHSS scores. Further prospective studies are needed to validate or refine ENI definitions and to address the paucity of data on the prognostic utility of ENI in specific clinical scenarios.

  View details for DOI 10.3174/ajnr.A9164

  View details for PubMedID 41927335

  View details for PubMedCentralID PMC13045910

• Middle meningeal artery embolization combined with surgical evacuation for chronic subdural hematoma: A single-center experience of 75 cases INTERVENTIONAL NEURORADIOLOGY Orscelik, A., Senol, Y., Bilgin, C., Kobeissi, H., Arul, S., Cloft, H., Lanzino, G., Kallmes, D. F., Brinjikji, W. 2026; 32 (2): 162-169

  Abstract

  BackgroundChronic subdural hematoma (cSDH) is a challenging and common neurosurgical condition. Our goal is to demonstrate that middle meningeal artery (MMA) embolization combined with surgical evacuation can be a promising adjuvant option for treatment of cSDHs and prevent recurrence in symptomatic patients who require surgical treatment.MethodWe retrospectively collected data from patients who underwent MMA embolization using polyvinyl alcohol particles and surgical evacuation with burr hole or craniotomy in a single center for the treatment of new and recurrent cSDHs. The primary outcome was recurrence of cSDH requiring surgical rescue during follow up, and secondary outcomes were defined as >50% decrease in the maximum width of cSDHs on the longest follow-up computed tomography (CT) scan, complications following procedure, and improvement in modified Rankin scale (mRS) score.ResultsA total of 51 patients successfully underwent 72 MMA embolization procedures (96% of the total 75 cases in the cohort) combined with surgical evacuation. Seventy cases (93.3%) achieved at least 50% reduction in the size of the cSDHs on the last CT imaging. A surgical evacuation was required in five cases (6.7%) due to cSDH recurrence during the follow-up period. There were three complications (6.0%) related to embolization procedure. Forty patients (78.4%) showed improvement in mRS score. There was one mortality (2%) regardless of the embolization and evacuation.ConclusionsOur study demonstrates the safety and efficacy of adjunct MMA embolization in significantly reducing size and recurrence of cSDHs.

  View details for DOI 10.1177/15910199231196453

  View details for Web of Science ID 001063890900001

  View details for PubMedID 37635326

  View details for PubMedCentralID PMC13100395

• Endovascular treatment outcomes in patients with residual cerebral aneurysmatic filling after open surgery NEUROSURGICAL REVIEW Gurpinar, I., Ozbakir, O., Ayhan, B., Senol, Y., Daglioglu, E. 2026; 49 (1): 146

  Abstract

  Residual or recurrent aneurysmatic filling may be detected during follow-up after open aneurysm surgery and can necessitate retreatment. In this study, we descriptively report the safety and radiological/clinical outcomes of endovascular treatment (EVT) in patients who previously underwent microsurgical clipping (MSC) or surgical wrapping. We retrospectively reviewed patients treated between 2012 and 2022 at Ankara Numune Training and Research Hospital and Ankara City Hospital. Demographics, timing of initial surgery and EVT, aneurysm location, and EVT modality (flow diverter, stent-assisted coiling, primary coiling) were recorded. Clinical outcomes were assessed using the modified Rankin Scale (mRS). Radiological outcomes were assessed using the O’Kelly–Marotta (OKM) scale for flow diversion and the Modified Raymond–Roy Classification (MRRC) for coiling techniques. Procedure-related complications, mortality, and permanent morbidity were evaluated. A total of 70 aneurysms in 68 patients were treated. Complete occlusion (OKM-D or MRRC-1) was achieved in 64% of aneurysms at follow-up; when near-complete occlusion (OKM-C or MRRC-2) was included, the overall angiographic success rate was 92%. Permanent morbidity was 4.4% and mortality was 1.4%. Functional outcomes improved over follow-up, and clinical results were generally favorable across EVT techniques. EVT appears to be a feasible and effective retreatment option in selected patients with residual or recurrent aneurysmatic filling after prior open aneurysm surgery. Given the retrospective design and limited subgroup sizes, the present findings should be interpreted as descriptive. Larger prospective studies with longer follow-up are warranted to further define optimal retreatment strategies.

  View details for DOI 10.1007/s10143-025-04073-0

  View details for Web of Science ID 001669572200003

  View details for PubMedID 41575607

  View details for PubMedCentralID PMC12830492

• Global, Regional, and National Burden of Cardiovascular Diseases and Risk Factors in 204 Countries and Territories, 1990-2023 JACC-JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY Stark, B. A., DeCleene, N. K., Desai, E. C., Hsu, J. M., Johnson, C. O., Lara-Castor, L., LeGrand, K. E., Bhoomadevi, A., Aalipour, M., Aalruz, H., Abafita, B. J., Abaraogu, U. O., Abavisani, M., Abbas, N., Abbasi, M., Abbasian, M., Abbastabar, H., Al Magied, A., ElHafeez, S., Abdelalim, A., Abdelfattah, O. M., Abdel-Hameed, R., Abdelnabi, M., Abdel-Rahman, W. M., Abdi, P., Abdisa, W., Abdissa, D., Abdous, A., Abdullah, M., Abdullahi, A., Abdykerimova, K., Abebe, M., Abedi, A., Abedi, A., Abejew, A., Abhilash, E. S., Abiodun, O., Abiodun, O., Kasem, R., Aboagye, R., Abohashem, S., Abolhassan, H., Abonie, U., Aborode, A., Abourashed, N., Abramov, D., Abreu, L., Abtahi, D., Abu Farha, R., Abubaka, A., Abubakar, I., Abu-Elala, N., Abu-Gharbieh, E., Abukhadijah, H. J., Aburuz, S., Abushanab, D., Acharya, A., Acharya, A., Acharya, S., Achore, M., Adal, O., Adams, L. C., Adamu, L., Adao, R., Addo, I., Adebayo, O., Adebisi, T., Adedia, D., Adedokun, K., Adegbile, O. E., Adegboye, O. A., Adegoke, N. A., Adekanmbi, V., Adeleke, O., Adetunji, C., Adeyomoye, O., Adha, R., Adhikari, K., Adhikary, R., Adikusuma, W., Parvar, T., Adnan, M., Adnani, Q., Adoma, P., Adzigbli, L., Adzrago, D., Afifi, A. M., Afolabi, H., Afrashteh, F., Afrooghe, A., Afzal, M., Afzal, S., Agampodi, S., Agarwal, D., Agarwal, G., Agarwal, P., Ageru, T., Aggarwal, N., Aghajanian, S., Sobrinho, C., Agyemang-Duah, W., Ahadi, M., Ahammed, B., Ahinkorah, B., Ahmad, A., Ahmad, F., Ahmad, K., Ahmad, M. M., Ahmad, S., Ahmad, S., Ahmad, T., Ahmadzadeh, K., Ahmed, A., Ahmed, A., Ahmed, A., Ahmed, G., Ahmed, H., Ahmed, J., Ahmed, L. A., Ahmed, M., Ahmed, M., Ahmed, M., Ahmed, M., Ahmed, N., Ahmed, N., Ahmed, S., Ahmed, S., Ajakwe, S., Ajami, M., Aji, B., Akalu, Y., Akeju, O., Akhigbe, R., Akhmedullin, R., Akindele, M., Akinosoglou, K., Akiska, Y., Akkaif, M., Akram, H., Akrami, A. E., Al Awaidy, S., Al Hamad, H., Al Hasan, S., Al Omari, O., Al Qadire, M., Al Thaher, Y., Al Zoubi, M., Al-Ajlouni, Y., Alalwan, T. A., Al-Aly, Z., Alam, K., Alam, M., Alam, M., Alam, Z., Al-Amer, R., Alansari, A., Alanzi, T. M., Alarifi, A., Al-Ashwal, F. Y., Alavi, R., Albashtawy, M., Al-Daken, L., Aldawsari, K. A., Aldhahir, A., Aldossary, M. S., Aleidi, S. M., Alemayehu, B., Alemayehu, T., Alemi, H., Algammal, A. M., Al-Gheethi, A., Alhajri, N., Alhalaiqa, F., Al-Hanawi, M., Alharrasi, M., Alhumaidi, A., Ali, A., Ali, E., Ali, K., Ali, M., Ali, M., Ali, R., Ali, S. A., Ali, S., Ali, S., Al-Ibraheem, A., Al-Iede, M., Alif, S., Rokny, H., Al-Jabi, S. 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R., Shahwan, M., Shaikh, M., Shaikh, N., Shamim, M., Shams-Beyranvand, M., Shamshad, H., Shamsi, A., Shamsutdinova, A., Shan, D., Shanawaz, M., Shanmugasundaram, D., Sharath, M., Sharew, N., Sharif, M., Sharifan, A., Sharma, A., Sharma, B., Sharma, K., Sharma, M., Sharma, U., Sharma, V., Shastry, S., Shawahna, R., Shawel, S., Shayan, A., Bappah, B., Sheida, F., Sheidaei, A., Shekhar, S., Shen, J., Shenoy, R., Shetty, P. H., Shi, H., Shi, W., Shibuya, K., Shiferaw, D., Shimaponda-Mataa, N., Shimels, T., Shimul, M., Shin, M., Shiri, R., Shittu, A., Shivarov, V., Shlobin, N. A., Shoaib, A., Shojaie, S., Eshkiki, Z., Shool, S., Shorofi, S., Shrestha, S., Shuval, K., Si, L., Si, Y., Sibuyi, N. R. S., Siddig, E., Siddiqi, A., Sidiq, M., Siegel, M., Sikdar, M., Rodrigues Silva, L., Lamesgin, G., Simegn, G., Simkhada, P., Singh, A., Singh, A., Singh, B., Singh, B., Singh, H., Singh, H., Singh, J. A., Singh, L. 2025; 86 (22): 2167-2243

  Abstract

  Cardiovascular diseases (CVDs) are the leading cause of mortality and are among the foremost causes of disability globally. CVD burden has continued to increase in most countries since 1990, with trends driven by changing exposures to harmful risk factors, population growth, and population aging.We report estimates of global, national, and subnational CVD burden, including 18 subdiseases and 12 associated modifiable risk factors. We analyzed change in CVD burden from 1990 to 2023 and identified drivers of change including population growth, population aging, and risk factor exposure.The Global Burden of Disease (GBD) 2023 study, a multinational collaborative research study, quantified burden due to 375 diseases including CVD burden and identified drivers of change from 1990 to 2023 using all available data and statistical models. GBD 2023 estimated the population-level burden of diseases in 204 countries and territories from 1990 to 2023.CVDs were the leading cause of disability-adjusted life years (DALYs) and deaths estimated in the GBD. As of 2023, there were 437 million (95% UI: 401 to 465 million) CVD DALYs globally, a 1.4-fold increase from the number in 1990 of 320 million (292 to 344 million). Ischemic heart disease, intracerebral hemorrhage, ischemic stroke, and hypertensive heart disease were the leading cardiovascular causes of DALYs in 2023 globally. As of 2023, age-standardized CVD DALY rates were highest in low and low-middle Socio-demographic Index (SDI) settings and lowest in high SDI settings. The number of CVD deaths increased globally from 13.1 million (95% UI: 12.2 to 14.0 million) in 1990 to 19.2 million (95% UI: 17.4 to 20.4 million) in 2023. The number of prevalent cases of CVD more than doubled since 1990, with 311 million (95% UI: 294 to 333 million) prevalent cases of CVD in 1990 and 626 million (95% UI: 591 to 672 million) prevalent cases in 2023 globally. A total of 79.6% (95% UI: 75.7% to 82.5%) of CVD burden is attributable to modifiable risk factors 347 million [95% UI: 318 to 373 million] DALYs in 2023). Globally, high systolic blood pressure, dietary risks, high low-density lipoprotein cholesterol, and air pollution were the modifiable risks responsible for most attributable CVD burden in 2023. Since 1990, changes in exposure to modifiable risk factors have had mixed effects on CVD burden, with increases in high body mass index, high fasting plasma glucose, and low physical activity leading to higher burden, while reductions in tobacco usage have mitigated some of these increases. Population growth and population aging were the main drivers of the increasing burden since 1990, adding 128 million (95% UI: 115 to 139 million) and 139 million (95% UI: 126 to 151 million) CVD DALYs to the increase in CVD burden since 1990.CVD remains the leading cause of disease burden and death worldwide with the greatest burden in low, low-middle, and middle SDI regions. Large variation exists in CVD burden even for countries at similar levels of development, a gap explained substantially by known, modifiable risk factors that are inadequately controlled. The decades-long increase in CVD burden was the result of population growth, population aging, and increased exposure to a subset of risk factors led by metabolic risks. Countries will need to adopt effective health system and public health strategies if they are to progress in achieving global goals to reduce the burden of CVD.

  View details for DOI 10.1016/j.jacc.2025.08.015

  View details for Web of Science ID 001630601900021

  View details for PubMedID 40990886

• Burden of Central Nervous System Cancer in the United States, 1990-2021. JAMA neurology Han, H. J., Kim, Y. S., Park, S., Shin, J. I., Kim, M. S., Moon, J. H., Kim, Y. B., Ababneh, H. S., Abu-Zaid, A., Areda, D., Arul, S., Azzam, A. Y., Bardhan, M., Bayat Tork, M. A., Behnam, B., Bilgin, G. B., Bhardwaj, P. V., Bhuyan, S. S., Lomer, N. B., Chen, M. X., Chennapragada, S. S., Dai, X., Dean, F. E., Deekonda, S., Ding, X., Doshi, O. P., E'mar, A. R., Elhadi, M., Fares, J., Fazeli, P., Fisher, J. L., Fotouhi, M., Gholamrezanezhad, A., Ida, F., Iwu, C. D., Jalloh, M., Jani, C. T., Kalani, R., Kankam, S. B., Kazemi, F., Keshwani, A., Khosla, A. A., Lim, S. S., Mehboob, R., Mestrovic, T., Mokdad, A. H., Murray, C. J., Naik, G., Natto, Z. S., Nguyen, D., Nugen, F., Orscelik, A., Parikh, R. R., Penberthy, L., Pestell, R. G., Prabhu, D., Puvvula, J., Ramasamy, S. K., Sabet, C. J., Schumacher, A. E., Senol, Y. C., Sham, S., Sherchan, S. P., Simegn, G. L., Singh, J. A., Solanki, R., Srichawla, B. S., Taiba, J., Tanwar, M., Amirikah, M. T., Verma, A., Yunusa, I., Zheng, D. X., Yon, D. K., Park, K. Y. 2025

  Abstract

  Primary brain and central nervous system cancer (collectively referred to as CNS cancer) comprises 2% of all human cancers and poses significant health and economic challenges in the United States.To analyze CNS cancer burden in the US, stratified by time, location (state and division), sex, age group, and Sociodemographic Index (SDI).This cross-sectional study involved a repeated analysis of Global Burden of Disease Study (GBD) 2021 data in 2024. Using data from 183 sources, CNS cancer metrics in the US were estimated across states and years. US CNS cancer metrics across all sexes and age groups were included in the GBD.CNS cancer diagnosis.Overall and age-standardized estimates of the incidence, prevalence, mortality, disability-adjusted life-years (DALYs), years of life lost, and years lived with disability per 100 000 population, including 95% uncertainty intervals (UIs), and time trends.In 2021, for all age groups and sexes across the US, there were 31 780 incident cases (95% UI, 29971.1 to 32843.9). Age-standardized incidence, DALYs, and mortality rates per 100 000 population were 6.91 (95% UI, 6.58 to 7.12), 134.38 (95% UI, 129.83 to 137.95), and 4.1 (95% UI, 3.87 to 4.22), respectively. Despite no significant change observed in the overall incidence between 1990 and 2021, DALY and mortality rates decreased by 15.77% (95% UI, -17.75% to -13.68%) and 8.41% (95% UI, -11.09% to -6.22%), respectively. Substantial geographic variability was noted. Mississippi, Alabama, Kentucky, and Kansas (West North Central and East South Central divisions) and West Virginia faced persistently high burdens over the past 30 years. Sex differences were evident; disease burden was consistently higher in males compared with females. Age-specific estimates showed a bimodal distribution: the youngest group (<5 years) showed a significant decrease in incidence rate (-34.42% to -11.56%), whereas older age groups (>70 years) experienced increasing trends. DALYs and mortality rates were negatively correlated with SDI (ρ = -0.6860 and ρ = -0.6391; P < .001).These findings provide valuable insights into the CNS cancer burden across the US by age, sex, location, and SDI, enabling better public health status assessments, health care policy restructuring, and resource redistribution for improved care.

  View details for DOI 10.1001/jamaneurol.2025.4286

  View details for PubMedID 41182787

  View details for PubMedCentralID PMC12584065

• Burden of 375 diseases and injuries, risk-attributable burden of 88 risk factors, and healthy life expectancy in 204 countries and territories, including 660 subnational locations, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023 LANCET Hay, S. I., Ong, K., Santomauro, D. F., Bhoomadevi, A., Aalipour, M., Aalruz, H., Ababneh, H. S., Abaraogu, U. O., Abate, B., Abbafati, C., Abbas, N., Abbasifard, M., Abbasi-Kangevari, M., Abd ElHafeez, S., Abdalla, A., Abdalla, M., Abdallah, E. M., Abdeeq, B., Razeq, N., Abdelgalil, A., Abdel-Hameed, R., Abdelmasseh, M., Abdelnabi, M., Abdel-Rahman, W. M., Abd-Elsalam, S., Abdi, S., Abdollahi, M., Abdoun, M., Abdous, A., Aziz, J., Abdulah, D., Abdulkader, R., Abdullahi, A., Abdullahi, A., Abdul-Rahman, T., Abdykerimova, K., Getahun, H., Abedi, A., Abedi, A., Abejew, A., Zuniga, R., Abhilash, E. 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  Abstract

  For more than three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has provided a framework to quantify health loss due to diseases, injuries, and associated risk factors. This paper presents GBD 2023 findings on disease and injury burden and risk-attributable health loss, offering a global audit of the state of world health to inform public health priorities. This work captures the evolving landscape of health metrics across age groups, sexes, and locations, while reflecting on the remaining post-COVID-19 challenges to achieving our collective global health ambitions.The GBD 2023 combined analysis estimated years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 375 diseases and injuries, and risk-attributable burden associated with 88 modifiable risk factors. Of the more than 310 000 total data sources used for all GBD 2023 (about 30% of which were new to this estimation round), more than 120 000 sources were used for estimation of disease and injury burden and 59 000 for risk factor estimation, and included vital registration systems, surveys, disease registries, and published scientific literature. Data were analysed using previously established modelling approaches, such as disease modelling meta-regression version 2.1 (DisMod-MR 2.1) and comparative risk assessment methods. Diseases and injuries were categorised into four levels on the basis of the established GBD cause hierarchy, as were risk factors using the GBD risk hierarchy. Estimates stratified by age, sex, location, and year from 1990 to 2023 were focused on disease-specific time trends over the 2010-23 period and presented as counts (to three significant figures) and age-standardised rates per 100 000 person-years (to one decimal place). For each measure, 95% uncertainty intervals [UIs] were calculated with the 2·5th and 97·5th percentile ordered values from a 250-draw distribution.Total numbers of global DALYs grew 6·1% (95% UI 4·0-8·1), from 2·64 billion (2·46-2·86) in 2010 to 2·80 billion (2·57-3·08) in 2023, but age-standardised DALY rates, which account for population growth and ageing, decreased by 12·6% (11·0-14·1), revealing large long-term health improvements. Non-communicable diseases (NCDs) contributed 1·45 billion (1·31-1·61) global DALYs in 2010, increasing to 1·80 billion (1·63-2·03) in 2023, alongside a concurrent 4·1% (1·9-6·3) reduction in age-standardised rates. Based on DALY counts, the leading level 3 NCDs in 2023 were ischaemic heart disease (193 million [176-209] DALYs), stroke (157 million [141-172]), and diabetes (90·2 million [75·2-107]), with the largest increases in age-standardised rates since 2010 occurring for anxiety disorders (62·8% [34·0-107·5]), depressive disorders (26·3% [11·6-42·9]), and diabetes (14·9% [7·5-25·6]). Remarkable health gains were made for communicable, maternal, neonatal, and nutritional (CMNN) diseases, with DALYs falling from 874 million (837-917) in 2010 to 681 million (642-736) in 2023, and a 25·8% (22·6-28·7) reduction in age-standardised DALY rates. During the COVID-19 pandemic, DALYs due to CMNN diseases rose but returned to pre-pandemic levels by 2023. From 2010 to 2023, decreases in age-standardised rates for CMNN diseases were led by rate decreases of 49·1% (32·7-61·0) for diarrhoeal diseases, 42·9% (38·0-48·0) for HIV/AIDS, and 42·2% (23·6-56·6) for tuberculosis. Neonatal disorders and lower respiratory infections remained the leading level 3 CMNN causes globally in 2023, although both showed notable rate decreases from 2010, declining by 16·5% (10·6-22·0) and 24·8% (7·4-36·7), respectively. Injury-related age-standardised DALY rates decreased by 15·6% (10·7-19·8) over the same period. Differences in burden due to NCDs, CMNN diseases, and injuries persisted across age, sex, time, and location. Based on our risk analysis, nearly 50% (1·27 billion [1·18-1·38]) of the roughly 2·80 billion total global DALYs in 2023 were attributable to the 88 risk factors analysed in GBD. Globally, the five level 3 risk factors contributing the highest proportion of risk-attributable DALYs were high systolic blood pressure (SBP), particulate matter pollution, high fasting plasma glucose (FPG), smoking, and low birthweight and short gestation-with high SBP accounting for 8·4% (6·9-10·0) of total DALYs. Of the three overarching level 1 GBD risk factor categories-behavioural, metabolic, and environmental and occupational-risk-attributable DALYs rose between 2010 and 2023 only for metabolic risks, increasing by 30·7% (24·8-37·3); however, age-standardised DALY rates attributable to metabolic risks decreased by 6·7% (2·0-11·0) over the same period. For all but three of the 25 leading level 3 risk factors, age-standardised rates dropped between 2010 and 2023-eg, declining by 54·4% (38·7-65·3) for unsafe sanitation, 50·5% (33·3-63·1) for unsafe water source, and 45·2% (25·6-72·0) for no access to handwashing facility, and by 44·9% (37·3-53·5) for child growth failure. The three leading level 3 risk factors for which age-standardised attributable DALY rates rose were high BMI (10·5% [0·1 to 20·9]), drug use (8·4% [2·6 to 15·3]), and high FPG (6·2% [-2·7 to 15·6]; non-significant).Our findings underscore the complex and dynamic nature of global health challenges. Since 2010, there have been large decreases in burden due to CMNN diseases and many environmental and behavioural risk factors, juxtaposed with sizeable increases in DALYs attributable to metabolic risk factors and NCDs in growing and ageing populations. This long-observed consequence of the global epidemiological transition was only temporarily interrupted by the COVID-19 pandemic. The substantially decreasing CMNN disease burden, despite the 2008 global financial crisis and pandemic-related disruptions, is one of the greatest collective public health successes known. However, these achievements are at risk of being reversed due to major cuts to development assistance for health globally, the effects of which will hit low-income countries with high burden the hardest. Without sustained investment in evidence-based interventions and policies, progress could stall or reverse, leading to widespread human costs and geopolitical instability. Moreover, the rising NCD burden necessitates intensified efforts to mitigate exposure to leading risk factors-eg, air pollution, smoking, and metabolic risks, such as high SBP, BMI, and FPG-including policies that promote food security, healthier diets, physical activity, and equitable and expanded access to potential treatments, such as GLP-1 receptor agonists. Decisive, coordinated action is needed to address long-standing yet growing health challenges, including depressive and anxiety disorders. Yet this can be only part of the solution. Our response to the NCD syndemic-the complex interaction of multiple health risks, social determinants, and systemic challenges-will define the future landscape of global health. To ensure human wellbeing, economic stability, and social equity, global action to sustain and advance health gains must prioritise reducing disparities by addressing socioeconomic and demographic determinants, ensuring equitable health-care access, tackling malnutrition, strengthening health systems, and improving vaccination coverage. We live in times of great opportunity.Gates Foundation and Bloomberg Philanthropies.

  View details for DOI 10.1016/S0140-6736(25)01637-X

  View details for Web of Science ID 001606031100001

  View details for PubMedID 41092926

  View details for PubMedCentralID PMC12535840

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  Abstract

  Comprehensive, comparable, and timely estimates of demographic metrics-including life expectancy and age-specific mortality-are essential for evaluating, understanding, and addressing trends in population health. The COVID-19 pandemic highlighted the importance of timely and all-cause mortality estimates for being able to respond to changing trends in health outcomes, showing a strong need for demographic analysis tools that can produce all-cause mortality estimates more rapidly with more readily available all-age vital registration (VR) data. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) is an ongoing research effort that quantifies human health by estimating a range of epidemiological quantities of interest across time, age, sex, location, cause, and risk. This study-part of the latest GBD release, GBD 2023-aims to provide new and updated estimates of all-cause mortality and life expectancy for 1950 to 2023 using a novel statistical model that accounts for complex correlation structures in demographic data across age and time.We used 24 025 data sources from VR, sample registration, surveys, censuses, and other sources to estimate all-cause mortality for males, females, and all sexes combined across 25 age groups in 204 countries and territories as well as 660 subnational units in 20 countries and territories, for the years 1950-2023. For the first time, we used complete birth history data for ages 5-14 years, age-specific sibling history data for ages 15-49 years, and age-specific mortality data from Health and Demographic Surveillance Systems. We developed a single statistical model that incorporates both parametric and non-parametric methods, referred to as OneMod, to produce estimates of all-cause mortality for each age-sex-location group. OneMod includes two main steps: a detailed regression analysis with a generalised linear modelling tool that accounts for age-specific covariate effects such as the Socio-demographic Index (SDI) and a population attributable fraction (PAF) for all risk factors combined; and a non-parametric analysis of residuals using a multivariate kernel regression model that smooths across age and time to adaptably follow trends in the data without overfitting. We calibrated asymptotic uncertainty estimates using Pearson residuals to produce 95% uncertainty intervals (UIs) and corresponding 1000 draws. Life expectancy was calculated from age-specific mortality rates with standard demographic methods. For each measure, 95% UIs were calculated with the 25th and 975th ordered values from a 1000-draw posterior distribution.In 2023, 60·1 million (95% UI 59·0-61·1) deaths occurred globally, of which 4·67 million (4·59-4·75) were in children younger than 5 years. Due to considerable population growth and ageing since 1950, the number of annual deaths globally increased by 35·2% (32·2-38·4) over the 1950-2023 study period, during which the global age-standardised all-cause mortality rate declined by 66·6% (65·8-67·3). Trends in age-specific mortality rates between 2011 and 2023 varied by age group and location, with the largest decline in under-5 mortality occurring in east Asia (67·7% decrease); the largest increases in mortality for those aged 5-14 years, 25-29 years, and 30-39 years occurring in high-income North America (11·5%, 31·7%, and 49·9%, respectively); and the largest increases in mortality for those aged 15-19 years and 20-24 years occurring in Eastern Europe (53·9% and 40·1%, respectively). We also identified higher than previously estimated mortality rates in sub-Saharan Africa for all sexes combined aged 5-14 years (87·3% higher in GBD 2023 than GBD 2021 on average across countries and territories over the 1950-2021 period) and for females aged 15-29 years (61·2% higher), as well as lower than previously estimated mortality rates in sub-Saharan Africa for all sexes combined aged 50 years and older (13·2% lower), reflecting advances in our modelling approach. Global life expectancy followed three distinct trends over the study period. First, between 1950 and 2019, there were considerable improvements, from 51·2 (50·6-51·7) years for females and 47·9 (47·4-48·4) years for males in 1950 to 76·3 (76·2-76·4) years for females and 71·4 (71·3-71·5) years for males in 2019. Second, this period was followed by a decrease in life expectancy during the COVID-19 pandemic, to 74·7 (74·6-74·8) years for females and 69·3 (69·2-69·4) years for males in 2021. Finally, the world experienced a period of post-pandemic recovery in 2022 and 2023, wherein life expectancy generally returned to pre-pandemic (2019) levels in 2023 (76·3 [76·0-76·6] years for females and 71·5 [71·2-71·8] years for males). 194 (95·1%) of 204 countries and territories experienced at least partial post-pandemic recovery in age-standardised mortality rates by 2023, with 61·8% (126 of 204) recovering to or falling below pre-pandemic levels. There were several mortality trajectories during and following the pandemic across countries and territories. Long-term mortality trends also varied considerably between age groups and locations, demonstrating the diverse landscape of health outcomes globally.This analysis identified several key differences in mortality trends from previous estimates, including higher rates of adolescent mortality, higher rates of young adult mortality in females, and lower rates of mortality in older age groups in much of sub-Saharan Africa. The findings also highlight stark differences across countries and territories in the timing and scale of changes in all-cause mortality trends during and following the COVID-19 pandemic (2020-23). Our estimates of evolving trends in mortality and life expectancy across locations, ages, sexes, and SDI levels in recent years as well as over the entire 1950-2023 study period provide crucial information for governments, policy makers, and the public to ensure that health-care systems, economies, and societies are prepared to address the world's health needs, particularly in populations with higher rates of mortality than previously known. The estimates from this study provide a robust framework for GBD and a valuable foundation for policy development, implementation, and evaluation around the world.Gates Foundation.

  View details for DOI 10.1016/S0140-6736(25)01330-3

  View details for Web of Science ID 001614779400001

  View details for PubMedID 41092927

  View details for PubMedCentralID PMC12535839

• Global burden of 292 causes of death in 204 countries and territories and 660 subnational locations, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023 LANCET Naghavi, M., Kyu, H., Bhoomadevi, A., Aalipour, M., Aalruz, H., Ababneh, H. S., Abafita, B. J., Abaraogu, U. O., Abbafati, C., Abbasi, M., Abbaspour, F., Abbastabar, H., Abd Al Magied, A. H. A., ElHafeez, S., Abdalla, A., Abdalla, M., Abdallah, E. M., Abdeeq, B., Razeq, N., Abdelgalil, A., Abdel-Hameed, R., Abdelmasseh, M., Abdelnabi, M., Abdel-Rahman, W. M., Abdous, A., Abdrabou, M. M., Aziz, J., Abdulah, D., Abdullahi, A., Abdul-Rahman, T., Getahun, H., Abedi, A., Abedi, A., Abedi, P., Abejew, A., Zuniga, R., Al Abid, S., Abidi, S., Abie, A., Abiodun, O., Aboagye, R., Abohashem, S., Abolhassani, H., Abonie, U., Abourashed, N. M., Abouzid, M., Abramov, D., Abreu, L., Abtahi, D., Abu Farha, R., Abuadas, F. A., Abubakar, A., Abu-Elala, N., Abu-Gharbieh, E., Abuhammad, S., Abuhelwa, A. 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  Abstract

  Timely and comprehensive analyses of causes of death stratified by age, sex, and location are essential for shaping effective health policies aimed at reducing global mortality. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 provides cause-specific mortality estimates measured in counts, rates, and years of life lost (YLLs). GBD 2023 aimed to enhance our understanding of the relationship between age and cause of death by quantifying the probability of dying before age 70 years (70q0) and the mean age at death by cause and sex. This study enables comparisons of the impact of causes of death over time, offering a deeper understanding of how these causes affect global populations.GBD 2023 produced estimates for 292 causes of death disaggregated by age-sex-location-year in 204 countries and territories and 660 subnational locations for each year from 1990 until 2023. We used a modelling tool developed for GBD, the Cause of Death Ensemble model (CODEm), to estimate cause-specific death rates for most causes. We computed YLLs as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. Probability of death was calculated as the chance of dying from a given cause in a specific age period, for a specific population. Mean age at death was calculated by first assigning the midpoint age of each age group for every death, followed by computing the mean of all midpoint ages across all deaths attributed to a given cause. We used GBD death estimates to calculate the observed mean age at death and to model the expected mean age across causes, sexes, years, and locations. The expected mean age reflects the expected mean age at death for individuals within a population, based on global mortality rates and the population's age structure. Comparatively, the observed mean age represents the actual mean age at death, influenced by all factors unique to a location-specific population, including its age structure. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 250-draw distribution for each metric. Findings are reported as counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2023 include a correction for the misclassification of deaths due to COVID-19, updates to the method used to estimate COVID-19, and updates to the CODEm modelling framework. This analysis used 55 761 data sources, including vital registration and verbal autopsy data as well as data from surveys, censuses, surveillance systems, and cancer registries, among others. For GBD 2023, there were 312 new country-years of vital registration cause-of-death data, 3 country-years of surveillance data, 51 country-years of verbal autopsy data, and 144 country-years of other data types that were added to those used in previous GBD rounds.The initial years of the COVID-19 pandemic caused shifts in long-standing rankings of the leading causes of global deaths: it ranked as the number one age-standardised cause of death at Level 3 of the GBD cause classification hierarchy in 2021. By 2023, COVID-19 dropped to the 20th place among the leading global causes, returning the rankings of the leading two causes to those typical across the time series (ie, ischaemic heart disease and stroke). While ischaemic heart disease and stroke persist as leading causes of death, there has been progress in reducing their age-standardised mortality rates globally. Four other leading causes have also shown large declines in global age-standardised mortality rates across the study period: diarrhoeal diseases, tuberculosis, stomach cancer, and measles. Other causes of death showed disparate patterns between sexes, notably for deaths from conflict and terrorism in some locations. A large reduction in age-standardised rates of YLLs occurred for neonatal disorders. Despite this, neonatal disorders remained the leading cause of global YLLs over the period studied, except in 2021, when COVID-19 was temporarily the leading cause. Compared to 1990, there has been a considerable reduction in total YLLs in many vaccine-preventable diseases, most notably diphtheria, pertussis, tetanus, and measles. In addition, this study quantified the mean age at death for all-cause mortality and cause-specific mortality and found noticeable variation by sex and location. The global all-cause mean age at death increased from 46·8 years (95% UI 46·6-47·0) in 1990 to 63·4 years (63·1-63·7) in 2023. For males, mean age increased from 45·4 years (45·1-45·7) to 61·2 years (60·7-61·6), and for females it increased from 48·5 years (48·1-48·8) to 65·9 years (65·5-66·3), from 1990 to 2023. The highest all-cause mean age at death in 2023 was found in the high-income super-region, where the mean age for females reached 80·9 years (80·9-81·0) and for males 74·8 years (74·8-74·9). By comparison, the lowest all-cause mean age at death occurred in sub-Saharan Africa, where it was 38·0 years (37·5-38·4) for females and 35·6 years (35·2-35·9) for males in 2023. Lastly, our study found that all-cause 70q0 decreased across each GBD super-region and region from 2000 to 2023, although with large variability between them. For females, we found that 70q0 notably increased from drug use disorders and conflict and terrorism. Leading causes that increased 70q0 for males also included drug use disorders, as well as diabetes. In sub-Saharan Africa, there was an increase in 70q0 for many non-communicable diseases (NCDs). Additionally, the mean age at death from NCDs was lower than the expected mean age at death for this super-region. By comparison, there was an increase in 70q0 for drug use disorders in the high-income super-region, which also had an observed mean age at death lower than the expected value.We examined global mortality patterns over the past three decades, highlighting-with enhanced estimation methods-the impacts of major events such as the COVID-19 pandemic, in addition to broader trends such as increasing NCDs in low-income regions that reflect ongoing shifts in the global epidemiological transition. This study also delves into premature mortality patterns, exploring the interplay between age and causes of death and deepening our understanding of where targeted resources could be applied to further reduce preventable sources of mortality. We provide essential insights into global and regional health disparities, identifying locations in need of targeted interventions to address both communicable and non-communicable diseases. There is an ever-present need for strengthened health-care systems that are resilient to future pandemics and the shifting burden of disease, particularly among ageing populations in regions with high mortality rates. Robust estimates of causes of death are increasingly essential to inform health priorities and guide efforts toward achieving global health equity. The need for global collaboration to reduce preventable mortality is more important than ever, as shifting burdens of disease are affecting all nations, albeit at different paces and scales.Gates Foundation.

  View details for DOI 10.1016/S0140-6736(25)01917-8

  View details for Web of Science ID 001605004700001

  View details for PubMedID 41092928

  View details for PubMedCentralID PMC12535838

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A., Yaya, S., Ye, P., Yesuf, S., Yezli, S., Yin, D., Yirdaw, B., Yon, D., Yonemoto, N., Younis, M. Z., Yousefi, Z., Yu, C., Yuan, C., Zadnik, V., Zafar, S., Zaghampour, M., Zakham, F., Zaki, N., Zamagni, G., Zaman, B., Bin Zaman, S., Sakhvidi, M., Zastrozhin, M., Zawiah, M., Zeariya, M. G. M., Zemariam, A., Zensen, S., Zhang, J., Zhang, J., Zhang, L., Zhang, X., Zhang, Z., Zhao, Y., Zheng, D. X., Zheng, J., Zheng, M., Zhong, A., Zhong, C., Zhou, J., Zhou, J., Zhu, B., Zhumagaliuly, A., Zielinska, M., Zitoun, O. A., Zrieq, R., Zuber, M., Zyoud, S. H., Zyoud, S. H., Vos, T., Murray, C. J. L., GBD 2023 Canc Collaborators 2025; 406 (10512): 1565-1586

  Abstract

  Cancer is a leading cause of death globally. Accurate cancer burden information is crucial for policy planning, but many countries do not have up-to-date cancer surveillance data. To inform global cancer-control efforts, we used the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 framework to generate and analyse estimates of cancer burden for 47 cancer types or groupings by age, sex, and 204 countries and territories from 1990 to 2023, cancer burden attributable to selected risk factors from 1990 to 2023, and forecasted cancer burden up to 2050.Cancer estimation in GBD 2023 used data from population-based cancer registration systems, vital registration systems, and verbal autopsies. Cancer mortality was estimated using ensemble models, with incidence informed by mortality estimates and mortality-to-incidence ratios (MIRs). Prevalence estimates were generated from modelled survival estimates, then multiplied by disability weights to estimate years lived with disability (YLDs). Years of life lost (YLLs) were estimated by multiplying age-specific cancer deaths by the GBD standard life expectancy at the age of death. Disability-adjusted life-years (DALYs) were calculated as the sum of YLLs and YLDs. We used the GBD 2023 comparative risk assessment framework to estimate cancer burden attributable to 44 behavioural, environmental and occupational, and metabolic risk factors. To forecast cancer burden from 2024 to 2050, we used the GBD 2023 forecasting framework, which included forecasts of relevant risk factor exposures and used Socio-demographic Index as a covariate for forecasting the proportion of each cancer not affected by these risk factors. Progress towards the UN Sustainable Development Goal (SDG) target 3.4 aim to reduce non-communicable disease mortality by a third between 2015 and 2030 was estimated for cancer.In 2023, excluding non-melanoma skin cancers, there were 18·5 million (95% uncertainty interval 16·4 to 20·7) incident cases of cancer and 10·4 million (9·65 to 10·9) deaths, contributing to 271 million (255 to 285) DALYs globally. Of these, 57·9% (56·1 to 59·8) of incident cases and 65·8% (64·3 to 67·6) of cancer deaths occurred in low-income to upper-middle-income countries based on World Bank income group classifications. Cancer was the second leading cause of deaths globally in 2023 after cardiovascular diseases. There were 4·33 million (3·85 to 4·78) risk-attributable cancer deaths globally in 2023, comprising 41·7% (37·8 to 45·4) of all cancer deaths. Risk-attributable cancer deaths increased by 72·3% (57·1 to 86·8) from 1990 to 2023, whereas overall global cancer deaths increased by 74·3% (62·2 to 86·2) over the same period. The reference forecasts (the most likely future) estimate that in 2050 there will be 30·5 million (22·9 to 38·9) cases and 18·6 million (15·6 to 21·5) deaths from cancer globally, 60·7% (41·9 to 80·6) and 74·5% (50·1 to 104·2) increases from 2024, respectively. These forecasted increases in deaths are greater in low-income and middle-income countries (90·6% [61·0 to 127·0]) compared with high-income countries (42·8% [28·3 to 58·6]). Most of these increases are likely due to demographic changes, as age-standardised death rates are forecast to change by -5·6% (-12·8 to 4·6) between 2024 and 2050 globally. Between 2015 and 2030, the probability of dying due to cancer between the ages of 30 years and 70 years was forecasted to have a relative decrease of 6·5% (3·2 to 10·3).Cancer is a major contributor to global disease burden, with increasing numbers of cases and deaths forecasted up to 2050 and a disproportionate growth in burden in countries with scarce resources. The decline in age-standardised mortality rates from cancer is encouraging but insufficient to meet the SDG target set for 2030. Effectively and sustainably addressing cancer burden globally will require comprehensive national and international efforts that consider health systems and context in the development and implementation of cancer-control strategies across the continuum of prevention, diagnosis, and treatment.Gates Foundation, St Jude Children's Research Hospital, and St Baldrick's Foundation.

  View details for DOI 10.1016/S0140-6736(25)01635-6

  View details for Web of Science ID 001601147600001

  View details for PubMedID 41015051

  View details for PubMedCentralID PMC12687902

• Rescue management of recurrent or growing non-acute subdural hematoma following standalone or adjunctive middle meningeal artery embolization: A case series and systematic review INTERVENTIONAL NEURORADIOLOGY Orscelik, A., Senol, Y., Chaney, E., Narsinh, K., Amans, M., Raper, D. M. S., Winkler, E., Hetts, S., Cooke, D., Savastano, L. E. 2025: 15910199251370600

  Abstract

  ObjectiveRecurrent or growing non-acute subdural hematoma (SDH) following standalone or adjunctive middle meningeal artery embolization (MMAe) present a complex clinical challenge. This study aims to investigate the multifactorial causes of recurrence and growing SDH, including vascular and systemic contributors, and explores management strategies to improve outcomes.MethodsWe conducted a retrospective analysis of 22 patients with non-acute SDH requiring rescue treatment after adjunctive or stand-alone MMAe. Patients with documented trauma deemed responsible for the SDH expansion were excluded. Data were collected on patient demographics, clinical presentations, imaging findings, treatment approaches, and outcomes. A systematic review was also conducted across PubMed, Web of Science, Scopus, and Embase databases, adhering to PRISMA guidelines.ResultsNon-traumatic recurrent or growing SDHs were associated with MMA recanalization (27%), contralateral supply from the contralateral MMA (27%), CSF-venous fistulas (5%), and recruitments of vascular collaterals such as deep temporal artery (5%). Management strategies included, respectively, repeat MMAe using polyvinyl alcohol particles, coils, and liquid agents; contralateral MMAe, transvenous embolization for CSF-venous fistulas; and targeted embolization for other vascular contributors. Follow-up assessments were available for 14 patients (64%). Of these, 10 patients (45%) achieved complete resolution of symptoms, three patients (14%) experienced symptomatic improvement, and one patient (5%) had worsening symptoms. In terms of hematoma resolution, nine patients (41%) had complete or near-complete resolution, three patients (14%) exhibited stable hematoma size, and two patients (9%) demonstrated a reduction in hematoma size. Notably, no recurrences were observed after the final treatment. Two patients (9%) died within 10 days of the final embolization treatment due to malignancies.ConclusionRecurrent or growing SDHs following MMAe are linked to subdural membrane vascularity and intracranial hypotension which must be investigated and addressed. Treatment of these issues results in high cure rates.

  View details for DOI 10.1177/15910199251370600

  View details for Web of Science ID 001555845000001

  View details for PubMedID 40853366

  View details for PubMedCentralID PMC12378119

• Infantile ruptured acom aneurysm treated with endovascular stent-coil embolization: case report BMC NEUROLOGY Senol, Y., Ciftci, H., Ozkan, N., Sayin, B., Daglioglu, E. 2025; 25 (1): 334

  Abstract

  A 15-month-old infant presented with an episode of acute agitation, characterized by crying, refusal to feed, and a focal seizure involving the left arm and leg lasting 1-2 min. Following the seizure, the infant fell asleep but experienced another brief seizure during transport to the hospital. Initial assessment at a private hospital in Mersin, Turkey, led to a referral to our center, where imaging revealed an intraparenchymal hemorrhage in the left frontobasal region. The hemorrhage extended into all ventricles and the right retrosellar area, with notable rightward shift and ventricular enlargement. CTA confirmed a ruptured Acom aneurysm with a bleb. Diagnostic angiography was performed, and an endovascular stent coiling procedure was performed without hematoma evacuation. At 1-year follow-up, patients' symptoms improved without neurological sequelae, and MR angiography revealed no residual filling in the aneurysm.

  View details for DOI 10.1186/s12883-025-04366-3

  View details for Web of Science ID 001551275400001

  View details for PubMedID 40804713

  View details for PubMedCentralID PMC12344916

• Proximal coiling versus liquid agents in treatment for middle meningeal artery embolization: A single-center study with 94 patients JOURNAL OF CLINICAL NEUROSCIENCE Senol, Y., Sayin, B., Cifci, H., Sipahi, O., Orscelik, A., Ertugrul, Y., Guler, A., Ozbakir, M., Orhan, G., Belen, A., Daglioglu, E. 2025; 140: 111549

  Abstract

  Middle meningeal artery (MMA) embolization has emerged as a promising stand-alone or adjunctive treatment for chronic subdural hematoma (cSDH). The choice of embolic material, such as proximal coiling or liquid agents, may influence procedural outcomes and complication rates. This study compares clinical and radiological outcomes between the two endovascular techniques.A retrospective analysis of consecutive cases of MMA embolization using proximal coiling or liquid agents was conducted from a prospectively maintained. Patient demographics, cSDH characteristics, clinical outcomes (admission vs. 90-day follow-up), radiological outcomes (midline shift, SDH width, fluoroscopy time), and periprocedural events were compared.The study cohort included 94 patients with 114 cSDH. Subdural hematoma characteristics showed no significant differences, including laterality, maximum width, and midline shift. Stand-alone embolization constituted the majority of cases (83.3 %), with adjunct procedures performed in 16.7 %, showing no statistical difference between groups. Clinical outcomes at 90-day follow-up revealed no significant differences in modified Rankin Scale (mRS) scores, with 76.6 % of patients achieving an mRS of 0-2 (p = 0.32). Complications were reported in 4.2 % of cases, occurring in the liquid group (4.8 %) vs coiling group(3.2 %), with no significant difference in retreatment rates (7.4 %, p = 0.92). Procedural time was slightly longer in the coiling group (34.3 ± 8.6 min) compared to the liquid group (32.4 ± 17.3 min), though the difference lacked clinical significance. 87.7 % of patients showed improvement in mRS from admission to last follow-up in the overall cohort.MMA embolization with either proximal coiling or liquid agents is a safe and effective treatment for cSDH. Both approaches demonstrate comparable clinical outcomes and procedure times. Proximal coiling may be a viable alternative in cases where liquid agents or DMSO-compatible catheters are unavailable.

  View details for DOI 10.1016/j.jocn.2025.111549

  View details for Web of Science ID 001578199100001

  View details for PubMedID 40784210

• Preclinical feasibility study for transvascular drainage of non-acute subdural hematomas JOURNAL OF NEUROINTERVENTIONAL SURGERY Liu, Y., Madhani, S., Larco, J., Shahid, A., Senol, Y., Lylyk, P. N., Savastano, L. 2026; 18 (5): 1355-1363

  Abstract

  Non-acute or chronic subdural hematoma (cSDH) is commonly treated with surgical evacuation followed by middle meningeal artery embolization (MMAe). This two step approach increases procedural complexity and redundancy, hospitalization duration, and patient risk. We hypothesized that cSDH could be managed through a single session endovascular procedure and conducted a multimodal preclinical study to evaluate feasibility.We performed three-dimensional heat mapping of hematoma distribution from preoperative CT scans (n=69) and analyzed middle meningeal artery (MMA) and superior sagittal sinus (SSS) anatomy and perforation trajectories using imaging from 107 patients. Rheological properties of 41 SDH samples were assessed using hybrid rheometry and modeled with the Carreau equation. Aspiration feasibility was tested using a 0.027 inch microcatheter (n=16), and dura perforation forces were quantified with a 28 G needle in fresh cadaveric dura (n=10).Heat mapping localized cSDH to the parietal convexities (>80% probability) under the branches of the MMA, with limited midline involvement and proximity to the SSS (<10%). The posterior division of the MMA (diameter 1.23±0.23 mm) accommodated a 0.027 inch microcatheter in >90% of cases, with perforation trajectories targeting high probability hematoma zones in 105 of 107 cases. SDH samples exhibited shear thinning viscosity (η ₀=172 mPa×s, η ∞=2.78 mPa×s), with mean aspiration times of 1.21±0.54 min per 10 mL. Perforation forces averaged 0.68±0.24 N in normal and 1.29±0.48 N in calcified dura (P=0.05).Anatomical, rheological, and biomechanical data from this study support the feasibility of endovascular drainage of cSDH through the MMA.

  View details for DOI 10.1136/jnis-2025-023794

  View details for Web of Science ID 001547273900001

  View details for PubMedID 40780814

• Global, regional, and national trends in routine childhood vaccination coverage from 1980 to 2023 with forecasts to 2030: a systematic analysis for the Global Burden of Disease Study 2023. Lancet (London, England) GBD 2023 Vaccine Coverage Collaborators, Haeuser, E., Byrne, S., Nguyen, J., Raggi, C., McLaughlin, S. A., Bisignano, C., Harris, A. A., Smith, A. E., Lindstedt, P. A., Smith, G., Herold, S. J., Nesbit, O. D., Noyes, T., Shalev, N., Olana, L. T., Aalipour, M. A., Aalruz, H., Abbasifard, M., Abbaspour, F., Abbastabar, H., Abd ElHafeez, S., Abdallah, E. M., Abdel-Hameed, R., Abdelkader, A., Abd-Elsalam, S., Abdisa, W. M., Abdoun, M., Abdous, A., Abdulah, D. M., Abdullahi, A., Abdullahi, A., Abdul-Rahman, T., Abdykerimova, K., Abedi, A., Abejew, A. A., Abeldano Zuniga, R. A., Abidi, S. H., Abiodun, O., Abo Kasem, R., Aboagye, R. G., Abolhassani, H., Abonie, U. S., Aborode, A. T., Abourashed, N. M., Abouzid, M., Abramov, D., Abreu, L. G., Abtahi, D., Abu Farha, R. K., Abubakar, B., Abu-Gharbieh, E., Abukhadijah, H. J., Aburuz, S., Acharya, A. B., Achore, M., Acuna, J. M., Adal, O., Adams, L. C., Adamu, A. A., Adebisi, T. A., Adedia, D., Adedokun, K. A., Adegbile, O. E., Adegboye, O. A., Adegoke, N. A., Adeleke, O. T., Adetunji, J. B., Adhana, M. T., Adhikary, R. K., Adiga, U., Adnan, M., Adnani, Q. E., Adoma, P. O., Adzigbli, L. A., Affinito, G., Afolabi, A. A., Afolabi, H. A., Afolabi, R. F., Afzal, S., Agampodi, S. B., Agarwal, D. M., Aghajanian, S., Aguilera Arriagada, C. E., Agyemang-Duah, W., Ahadi, M., Ahmad, A., Ahmad, D., Ahmad, K., Ahmad, R., Ahmad, S., Ahmad, T., Ahmed, A., Ahmed, H., Ahmed, M. S., Ahmed, M. B., Ahmed, M., Ahmed, N., Ahmed, S. A., Ajakwe, S. O., Ajala, D. E., Akalu, G. T., Akeju, O., Akhigbe, R. E., Akinosoglou, K., Akkaif, M. A., Akram, H., Akrami, A. E., Al Amiry, A., Al Awaidy, S., Al Hamad, H., Al Nawayseh, M. K., Al Omari, O., Al Thaher, Y., Al Zaabi, O. A., Al Zoubi, M. 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I., Hassan, M., Hassan, N., Hayat, K., He, J., He, W., Hegazy, M. I., Heidari, G., Heidari, M., Heidari Almasi, M., Hewage, S. A., Heydari, M., Hezam, K., Hiraike, Y., Hossain, A., Hossain, L., Hossain, M. M., Hossain, M. S., Hossain, M. J., Hosseinzadeh, M., Hossen, M. M., Hostiuc, M., Hotwani, P., Hoven, H., Hu, C., Huang, J., Hushmandi, K., Hussain, J., Hussain, M. A., Hussein, N. R., Husseiny, M. I., Huynh, H., Hwang, B., Ibitoye, S. E., Ibrahim, K. S., Ibrahim, N., Ibrayeva, A., Ilesanmi, O. S., Ilic, I. M., Ilic, M. D., Imam, M. T., Inok, A., Isa, M. A., Iskandar, B., Iskander, T. R., Islam, M. S., Islam, M. F., Islam, S. M., Ismail, F., Ismail, L., Ituka, M. C., Iwagami, M., Iwu-Jaja, C. J., Jacob, L., Jadidi, A., Jafarzadeh, A., Jahrami, H., Jain, A., Jairoun, A. A., Jakovljevic, M., Jalloh, M., Jamal, A., Jamal, Q. M., Jameie, M., James, J., Jamil, H., Jamora, R. D., Javaid, S. S., Jawaid, T., Jawell Odah Abed, Q., Jayaram, S., Jeong, S., Jha, R. P., Jin, W., Jokar, M., Jose, J., Jose, J., Joseph, N., Joshua, C. E., Josten, K., Joukar, F., Jozwiak, J. J., Kabir, Z., Kadashetti, V., Kadir, D. H., Kakkar, A. K., Kamal, M. M., Kamal, M., Kamath, R., Kamorudeen, R. T., Kamyari, N., Kamyshnyi, O., Kanaan, M., Kanaan, S. F., Kang, J., Kankam, S. B., Kanmodi, K. K., Kannan S, S., Kantar, R. S., Kapoor, N., Karami, J., Karasneh, R. A., Karaye, I. M., Karch, A., Karobari, M. I., Karpinski, T. M., Kashyap, M. K., Khajuria, H., Khaksar, M. A., Khalid, N., Khalil, A. A., Khamesipour, F., Khan, A. A., Khan, A., Khan, F. U., Khan, G., Khan, M., Khan, M. A., Khan, M. A., Khan, M. U., Khan, R. M., Khan, S. K., Khan, U., Khan, Y. S., Khan, Z., Khanal, V., Khasbage, S. U., Khatab, K., Khatatbeh, H., Khatatbeh, M. M., Khazaei, A., Kheirallah, K. A., Khosravi, F., Kim, G., Kim, J., Kim, K., Kim, M. S., Kimokoti, R. W., Kinfu, Y., Kisa, A., Kisa, S., Km, S., Kochhar, S., Kokkorakis, M., Kolahi, A., Kompani, F., Korshunov, V. A., Korzh, O., Kostev, K., Koul, P. A., Kretchy, I. A., Kretchy, J., Krishan, K., Kuate Defo, B., Kuchay, R. A., Kuddus, M., Kuitunen, I., Kulimbet, M., Kumah, E., Kumar, D., Kumar, G. A., Kumar, J., Kumar, K., Kumar, N., Kumar, R., Kundu, S., Kunutsor, S. K., Kurniasari, M. D., Kushawaha, P. K., Kusnali, A., Kusuma, D., Kuttybayev, A., Kwong, W. H., Kyei-Arthur, F., Kyto, V., L C, D. P., La Vecchia, C., Ladan, M. A., Lahariya, C., Lakanova, B., Landires, I., Lasrado, S., Lau, C. L., Le, H., Le, M. H., Le, N. H., Le, T. D., Ledda, C., Lee, S. V., Lee, S. W., Lee, W., Legesse, A. Y., Leong, E., Li, M., Li, P., Li, W., Ligade, V. S., Lin, J., Lin, J. C., Lin, Q., Liu, G., Liu, H., Liu, J., Liu, P. Y., Liu, X., Liu, Z., Llanaj, E., Lopez-Gil, J. F., Lopukhov, P. D., Lucchetti, G., Ludhiadch, A., Luo, P., Lutambi, A. M., Lv, L., Lwin, K. S., Lytras, M. D., Lytvyak, E., M Afifi, A., Ma, K. S., Ma, Z. F., Ma'aruf, S. Y., Mabrok, M., Machoy, M., Madadi, F., Madadizadeh, F., Madinezad, S. 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D., Panos, L. D., Papa, M. V., Papadimopoulos, I., Pardhan, S., Parekh, U., Parikh, R. R., Park, C., Passera, R., Patel, M., Patel, N. N., Patil, S., Patoulias, D., Pawar, S., Pawar, S., Pazoki Toroudi, H., Pekarcikova, J., Pepito, V. C., Peprah, P., Pereira, G., Perez Chacon, G., Perna, S., Petakh, P., Peter, O. J., Pham, N. T., Pham, T. T., Piracha, Z. Z., Pirera, E., Poddighe, D., Polibin, R. V., Poluru, R., Pourasghary, S., Pourbabaki, R., Pourghazi, F., Pourtaheri, N., Prakash, A., Prates, E. J., Purohit, J., Puvvula, J., Qanash, H., Qasim, N. H., Qazi, A. S., Qi, X., Qi, Z., Qian, G., Rabiee, N., Rachmat, B., Radhakrishnan, V., Rahim, F., Rahimi, S., Rahimi-Movaghar, V., Rahman, F. M., Rahman, M. M., Rahman, M. O., Rahman, M., Rahman, M. A., Rahmani, S., Rahmoune, H., Raina, S. K., Raj, J. P., Raja, A., Rajendran, G., Rajendran, J., Rajizadeh, M. A., Rajpurohit, S., Ramadan, M. M., Ramasamy, C., Ramasamy, S. K., Ramphul, K., Rana, K., Rana, R. K., Ranabhat, C. 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C., Sathian, B., Satpathy, M., Savabi Far, M., Sawhney, M., Saya, G. K., Schinckus, C., Schneider, I. J., Schuermans, A., Sedigh, A., Semreen, M. H., Senapati, S., Sendekie, A. K., Sengupta, P., Senol, Y. C., Senthilkumaran, S., Serban, D., Sethi, Y., Seyed Alshohadaei, S. M., Sha'aban, A., Shahab, M., Shahid, S., Shahid, S. A., Shahid, W., Shahkarami, F., Shahrahmani, F., Shahwan, M. J., Shaikh, A., Shaikh, M. A., Shaikh, N., Shakeri, A., Shams-Beyranvand, M., Shamshirgaran, M. A., Shamsi, A., Shamsutdinova, A., Shan, D., Shannawaz, M., Sharifan, A., Sharma, B., Sharma, M., Sharma, V., Shawahna, R., Shayan, M., Shenoy, S. M., Sherchan, S. P., Shetty, S., Shimul, M. M., Shittu, A., Shokati Eshkiki, Z., Shokri, A., Shool, S., Shorofi, S. A., Shuval, K., Siavashpour, Z., Siddig, E. E., Siddiqua, A., Silva, G. C., Silva, L. M., Singh, A., Singh, B., Singh, B. P., Singh, H., Singh, J. A., Singh, K., Singh, P. S., Singh, S., Singh, S., Sinha, M. K., Siraj, E. A., Skhvitaridze, N., Skryabin, V. Y., Sohel, M. S., Sokhan, A., Soliman, A. M., Soliman, M. M., Soliman, N. S., Soliman, S. S., Song, W., Sood, A., Sood, P., Soraneh, S., Sorensen, R. J., Sorrentino, M., Spartalis, M., Sra, M. S., Sreeramareddy, C. T., Srichawla, B. S., Srinivasalu, V. A., Srinivasan, M., Srivastava, D. B., Stergachis, A., Stevanovic, A., Subasi, O., Sulaiman, S. K., Suleiman Odidi, M. O., Suleman, M., Sullman, M. J., Sultan Meo, A., Sun, Z., Sundaram, T., Sunkersing, D., Suvvari, T. K., Swain, C. K., Szarpak, L., Tabares-Seisdedos, R., Tabatabaeizadeh, S., Tabche, C., Tabibi, R., Tabuchi, T., Tadesse, L. S., Taghizadeh-Hesary, F., Taheri Soodejani, M., Tajabadi, S., Talaat, I. M., Talukder, B., Tampa, M., Tamuzi, J. L., Tan, K., Tariq, S., Tasnim, A., Tat, N. Y., Tat, V. Y., Taye, B. T., Tefera, Y. M., Teferi, G. H., Teklehaimanot, W. Z., Temsah, M., Temsah, R. M., Tesfamariam, W. B., Tewari, J., Thankappan, K. R., Tharwat, S., Thiruvengadam, M., Ticoalu, J. H., Tincho, M. B., Tomo, S., Tovani-Palone, M. R., Trabelsi, K., Tran, Q. T., Tran, T. Q., Tran, T. H., Tran Minh Duc, N., Trihandini, I., Tripathi, T., Tromans, S. J., Truppa, C., Tsai, D. H., Tsatsakis, A., Tsedalu Amare, A. T., Tumurkhuu, M., Tusa, B. S., Tzivian, L., Ullah, A., Ullah, R., Ullah, S., Umar, L., Umar, M., Unim, B., Upadhyay, E., Urmey, J. M., Usman, J. S., Uzuncibuk, H., Uzzaman, N., Vadagam, P., Vaithinathan, A. G., Van den Eynde, J., Varghese, J., Vasankari, T. J., Vasudevan, S. S., Venkidasamy, B., Villa, S., Villafane, J. H., Villani, L., Vinayak, M., Violante, F. S., Visaga Ambi, S., Waheed, Y., Walia, M., Wang, C., Wang, Q., Wang, R., Wang, W., Wang, X., Waqar, A. B., Waqas, M., Ward, J. L., Wassie, Y. A., Weerasekara, I., Wickramasinghe, N. D., Wilandika, A., Willeit, P., Wojewodzic, M. W., Wondmeneh, Y. C., Wondyifraw, H. G., Wongnaah, F. G., Worku, M. C., Wu, F., Wu, J. F., Xia, Q., Xiao, G., Xiao, L., Xie, W., Xu, S., Xue, M., Yadav, M. K., Yaghoubi, S., Yahoo Syed, S., Yahya, G., Yang, H., Yang, X., Yao, L., Yassin, M. A., Yasufuku, Y., Yaya, S., Yeganeh, M., Yesuf, S. A., Yezli, S., Yismaw, Y. E., Yon, D. K., Yonemoto, N., Yu, C., Yuan, C., Yunus, G., Yunusa, U., Zaghampour, M., Zakham, F., Zamagni, G., Zastrozhin, M., Zawiah, M., Zeariya, M. G., Zemariam, A. B., Zhan, T., Zhang, C. J., Zhang, J., Zhang, X., Zhong, A., Zhou, J., Zhu, B., Zhumagaliuly, A., Zia, H., Zielinska, M., Zoghi, G., Zrieq, R. M., Zyoud, A. H., Zyoud, S. H., Zyoud, S. H., Vollset, S. E., Hay, S. I., Lim, S. S., Mosser, J. F. 2025; 406 (10500): 235-260

  Abstract

  BACKGROUND: Since its inception in 1974, the Essential Programme on Immunization (EPI) has achieved remarkable success, averting the deaths of an estimated 154 million children worldwide through routine childhood vaccination. However, more recent decades have seen persistent coverage inequities and stagnating progress, which have been further amplified by the COVID-19 pandemic. In 2019, WHO set ambitious goals for improving vaccine coverage globally through the Immunization Agenda 2030 (IA2030). Now halfway through the decade, understanding past and recent coverage trends can help inform and reorient strategies for approaching these aims in the next 5 years.METHODS: Based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2023, this study provides updated global, regional, and national estimates of routine childhood vaccine coverage from 1980 to 2023 for 204 countries and territories for 11 vaccine-dose combinations recommended by WHO for all children globally. Employing advanced modelling techniques, this analysis accounts for data biases and heterogeneity and integrates new methodologies to model vaccine scale-up and COVID-19 pandemic-related disruptions. To contextualise historic coverage trends and gains still needed to achieve the IA2030 coverage targets, we supplement these results with several secondary analyses: (1) we assess the effect of the COVID-19 pandemic on vaccine coverage; (2) we forecast coverage of select life-course vaccines up to 2030; and (3) we analyse progress needed to reduce the number of zero-dose children by half between 2023 and 2030.FINDINGS: Overall, global coverage for the original EPI vaccines against diphtheria, tetanus, and pertussis (first dose [DTP1] and third dose [DTP3]), measles (MCV1), polio (Pol3), and tuberculosis (BCG) nearly doubled from 1980 to 2023. However, this long-term trend masks recent challenges. Coverage gains slowed between 2010 and 2019 in many countries and territories, including declines in 21 of 36 high-income countries and territories for at least one of these vaccine doses (excluding BCG, which has been removed from routine immunisation schedules in some countries and territories). The COVID-19 pandemic exacerbated these challenges, with global rates for these vaccines declining sharply since 2020, and still not returning to pre-COVID-19 pandemic levels as of 2023. Coverage for newer vaccines developed and introduced in more recent years, such as immunisations against pneumococcal disease (PCV3) and rotavirus (complete series; RotaC) and a second dose of the measles vaccine (MCV2), saw continued increases globally during the COVID-19 pandemic due to ongoing introductions and scale-ups, but at slower rates than expected in the absence of the pandemic. Forecasts to 2030 for DTP3, PCV3, and MCV2 suggest that only DTP3 would reach the IA2030 target of 90% global coverage, and only under an optimistic scenario. The number of zero-dose children, proxied as children younger than 1 year who do not receive DTP1, decreased by 74·9% (95% uncertainty interval 72·1-77·3) globally between 1980 and 2019, with most of those declines reached during the 1980s and the 2000s. After 2019, counts of zero-dose children rose to a COVID 19-era peak of 18·6 million (17·6-20·0) in 2021. Most zero-dose children remain concentrated in conflict-affected regions and those with various constraints on resources available to put towards vaccination services, particularly sub-Saharan Africa. As of 2023, more than 50% of the 15·7 million (14·6-17·0) global zero-dose children resided in just eight countries (Nigeria, India, Democratic Republic of the Congo, Ethiopia, Somalia, Sudan, Indonesia, and Brazil), emphasising persistent inequities.INTERPRETATION: Our estimates of current vaccine coverage and forecasts to 2030 suggest that achieving IA2030 targets, such as halving zero-dose children compared with 2019 levels and reaching 90% global coverage for life-course vaccines DTP3, PCV3, and MCV2, will require accelerated progress. Substantial increases in coverage are necessary in many countries and territories, with those in sub-Saharan Africa and south Asia facing the greatest challenges. Recent declines will need to be reversed to restore previous coverage levels in Latin America and the Caribbean, especially for DTP1, DTP3, and Pol3. These findings underscore the crucial need for targeted, equitable immunisation strategies. Strengthening primary health-care systems, addressing vaccine misinformation and hesitancy, and adapting to local contexts are essential to advancing coverage. COVID-19 pandemic recovery efforts, such as WHO's Big Catch-Up, as well as efforts to bolster routine services must prioritise reaching marginalised populations and target subnational geographies to regain lost ground and achieve global immunisation goals.FUNDING: The Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance.

  View details for DOI 10.1016/S0140-6736(25)01037-2

  View details for PubMedID 40578370

• Are orbital branches of the middle meningeal artery underestimated? A human cadaveric angiographic study INTERVENTIONAL NEURORADIOLOGY Senol, Y., Liu, A., Krishnan, N., Kumar, P., Orscelik, A., Savastano, L. 2025: 15910199251349658

  Abstract

  ObjectiveUnderstanding anatomical variations of the middle meningeal artery (MMA), particularly the meningolacrimal anastomosis (MLA), is essential for the safe execution of MMA embolization (MMAe) procedures. Due to the small size of these dural branches, detailed anatomical dissections have been challenging, and conventional clinical angiography often underrepresents their frequency because of competing orbital blood flow. This study aimed to determine the prevalence and anatomical characteristics of the MLA using isolated high-resolution angiography and DynaCT in human cadaveric specimens.MethodsA prospective angiographic study was conducted in eight fresh human cadaveric specimens. Microcatheters were navigated into proximal MMA branches, followed by contrast injection and imaging with angiography and DynaCT. MLA identification, length, diameter, and branching patterns were recorded. Descriptive statistics were used to analyze anatomical characteristics.ResultsThe MLA was visualized in 15 of 16 (93.7%) MMAs. A single MLA was observed in 87.5% of cases; one specimen showed two branches. The mean length of the intradural segment of the MLA (from the origin at the MMA to the entry into the orbit) was 1.77 ± 0.70 cm. The mean diameter of the MLA was 0.93 ± 0.29 mm, and the MMA diameter at the origin of the MLA measured 2.15 ± 0.51 mm. There were no statistically significant differences between genders in any of the parameters.ConclusionsOrbital branches of the MMA, particularly the MLA, are more prevalent than previously appreciated in standard angiography. This has significant implications for the safety of MMAe. Cadaveric angiography may reveal critical anastomoses underrepresented in in vivo imaging, underscoring the need for anatomical vigilance during embolization.

  View details for DOI 10.1177/15910199251349658

  View details for Web of Science ID 001522695100001

  View details for PubMedID 40611736

  View details for PubMedCentralID PMC12227432

• Proximal Protection Devices for Carotid Artery Stent Placement: A Benchtop Assessment of Flow Reversal Performance AMERICAN JOURNAL OF NEURORADIOLOGY Li, J., Bayraktar, E., Bilgin, C., Liu, Y., Senol, Y., Cortese, J., Kadirvel, R., Brinjikji, W., Kallmes, D. F. 2025; 46 (8): 1603-1608

  Abstract

  Proximal protection devices, such as TransCarotid Artery Revascularization (TCAR), aim to yield better outcomes in carotid artery stent placement (CAS) than distal protection devices by preventing plaque embolization to the brain. However, transfemoral catheters may not fully reverse flow from the external carotid artery (ECA) to the ICA. We assess a new balloon-sheath device, Femoral Flow Reversal Access for Carotid Artery Stent placement (FFRACAS), for this purpose.The FFRACAS prototype (inner diameter [ID] = 0.117 inches; L = 80 cm) was compared with TCAR (ID = 0.104 inches, L = 30 cm) and Mo.Ma (ID = 0.083 inches, L = 90 cm) in a pulsatile flow model with blood simulant at 800 mL/min. Mo.Ma was used according to labeled instructions, with both CCA and ECA balloon inflation, without CCA-femoral vein shunt placement, and in an off-label fashion with single balloon occlusion in the CCA and shunt. Flow rates of the ICA, ECA, and shunt, when applicable, were monitored during CAS stages: CCA flow arrest, shunt activation, and stent delivery. Experiments were conducted under 2 ECA inflow conditions (-10 and -20 mL/min). Statistical comparison of ICA flow rates was conducted by using ANOVA and Tukey post hoc tests.The on-label use of Mo.Ma maintained retrograde ICA flow (-0.3 mL/min) throughout CAS. On shunt activation, TCAR and FFRACAS reversed ICA flow similarly under low ECA inflow (ICA = -5.10 mL/min versus -4.83 mL/min; P = .349), but neither achieved ICA flow reversal under high ECA inflow or during stent delivery. Mo.Ma off-label use failed to reverse ICA flow.FFRACAS presents a potential alternative to TCAR, achieving similar degrees of flow reversal from a transfemoral approach to that achieved with the transcarotid approach. The Mo.Ma system reliably prevents anterograde flow in ICA during CAS.

  View details for DOI 10.3174/ajnr.A8664

  View details for Web of Science ID 001522127000001

  View details for PubMedID 39843216

  View details for PubMedCentralID PMC12453493

• Spontaneous cervical epidural hematoma following persistent cough in a patient on dual antiplatelet therapy INTERDISCIPLINARY NEUROSURGERY-ADVANCED TECHNIQUES AND CASE MANAGEMENT Guler, A., Senol, Y. 2025; 40

  View details for DOI 10.1016/j.inat.2025.102047

  View details for Web of Science ID 001510977400002

• Global, regional, and national prevalence of adult overweight and obesity, 1990-2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021. Lancet (London, England) 2025; 405 (10481): 813-838

  Abstract

  Overweight and obesity is a global epidemic. Forecasting future trajectories of the epidemic is crucial for providing an evidence base for policy change. In this study, we examine the historical trends of the global, regional, and national prevalence of adult overweight and obesity from 1990 to 2021 and forecast the future trajectories to 2050.Leveraging established methodology from the Global Burden of Diseases, Injuries, and Risk Factors Study, we estimated the prevalence of overweight and obesity among individuals aged 25 years and older by age and sex for 204 countries and territories from 1990 to 2050. Retrospective and current prevalence trends were derived based on both self-reported and measured anthropometric data extracted from 1350 unique sources, which include survey microdata and reports, as well as published literature. Specific adjustment was applied to correct for self-report bias. Spatiotemporal Gaussian process regression models were used to synthesise data, leveraging both spatial and temporal correlation in epidemiological trends, to optimise the comparability of results across time and geographies. To generate forecast estimates, we used forecasts of the Socio-demographic Index and temporal correlation patterns presented as annualised rate of change to inform future trajectories. We considered a reference scenario assuming the continuation of historical trends.Rates of overweight and obesity increased at the global and regional levels, and in all nations, between 1990 and 2021. In 2021, an estimated 1·00 billion (95% uncertainty interval [UI] 0·989-1·01) adult males and 1·11 billion (1·10-1·12) adult females had overweight and obesity. China had the largest population of adults with overweight and obesity (402 million [397-407] individuals), followed by India (180 million [167-194]) and the USA (172 million [169-174]). The highest age-standardised prevalence of overweight and obesity was observed in countries in Oceania and north Africa and the Middle East, with many of these countries reporting prevalence of more than 80% in adults. Compared with 1990, the global prevalence of obesity had increased by 155·1% (149·8-160·3) in males and 104·9% (95% UI 100·9-108·8) in females. The most rapid rise in obesity prevalence was observed in the north Africa and the Middle East super-region, where age-standardised prevalence rates in males more than tripled and in females more than doubled. Assuming the continuation of historical trends, by 2050, we forecast that the total number of adults living with overweight and obesity will reach 3·80 billion (95% UI 3·39-4·04), over half of the likely global adult population at that time. While China, India, and the USA will continue to constitute a large proportion of the global population with overweight and obesity, the number in the sub-Saharan Africa super-region is forecasted to increase by 254·8% (234·4-269·5). In Nigeria specifically, the number of adults with overweight and obesity is forecasted to rise to 141 million (121-162) by 2050, making it the country with the fourth-largest population with overweight and obesity.No country to date has successfully curbed the rising rates of adult overweight and obesity. Without immediate and effective intervention, overweight and obesity will continue to increase globally. Particularly in Asia and Africa, driven by growing populations, the number of individuals with overweight and obesity is forecast to rise substantially. These regions will face a considerable increase in obesity-related disease burden. Merely acknowledging obesity as a global health issue would be negligent on the part of global health and public health practitioners; more aggressive and targeted measures are required to address this crisis, as obesity is one of the foremost avertible risks to health now and in the future and poses an unparalleled threat of premature disease and death at local, national, and global levels.Bill & Melinda Gates Foundation.

  View details for DOI 10.1016/S0140-6736(25)00355-1

  View details for PubMedID 40049186

• Global, regional, and national prevalence of child and adolescent overweight and obesity, 1990-2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021. Lancet (London, England) 2025; 405 (10481): 785-812

  Abstract

  Despite the well documented consequences of obesity during childhood and adolescence and future risks of excess body mass on non-communicable diseases in adulthood, coordinated global action on excess body mass in early life is still insufficient. Inconsistent measurement and reporting are a barrier to specific targets, resource allocation, and interventions. In this Article we report current estimates of overweight and obesity across childhood and adolescence, progress over time, and forecasts to inform specific actions.Using established methodology from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021, we modelled overweight and obesity across childhood and adolescence from 1990 to 2021, and then forecasted to 2050. Primary data for our models included 1321 unique measured and self-reported anthropometric data sources from 180 countries and territories from survey microdata, reports, and published literature. These data were used to estimate age-standardised global, regional, and national overweight prevalence and obesity prevalence (separately) for children and young adolescents (aged 5-14 years, typically in school and cared for by child health services) and older adolescents (aged 15-24 years, increasingly out of school and cared for by adult services) by sex for 204 countries and territories from 1990 to 2021. Prevalence estimates from 1990 to 2021 were generated using spatiotemporal Gaussian process regression models, which leveraged temporal and spatial correlation in epidemiological trends to ensure comparability of results across time and geography. Prevalence forecasts from 2022 to 2050 were generated using a generalised ensemble modelling approach assuming continuation of current trends. For every age-sex-location population across time (1990-2050), we estimated obesity (vs overweight) predominance using the log ratio of obesity percentage to overweight percentage.Between 1990 and 2021, the combined prevalence of overweight and obesity in children and adolescents doubled, and that of obesity alone tripled. By 2021, 93·1 million (95% uncertainty interval 89·6-96·6) individuals aged 5-14 years and 80·6 million (78·2-83·3) aged 15-24 years had obesity. At the super-region level in 2021, the prevalence of overweight and of obesity was highest in north Africa and the Middle East (eg, United Arab Emirates and Kuwait), and the greatest increase from 1990 to 2021 was seen in southeast Asia, east Asia, and Oceania (eg, Taiwan [province of China], Maldives, and China). By 2021, for females in both age groups, many countries in Australasia (eg, Australia) and in high-income North America (eg, Canada) had already transitioned to obesity predominance, as had males and females in a number of countries in north Africa and the Middle East (eg, United Arab Emirates and Qatar) and Oceania (eg, Cook Islands and American Samoa). From 2022 to 2050, global increases in overweight (not obesity) prevalence are forecasted to stabilise, yet the increase in the absolute proportion of the global population with obesity is forecasted to be greater than between 1990 and 2021, with substantial increases forecast between 2022 and 2030, which continue between 2031 and 2050. By 2050, super-region obesity prevalence is forecasted to remain highest in north Africa and the Middle East (eg, United Arab Emirates and Kuwait), and forecasted increases in obesity are still expected to be largest across southeast Asia, east Asia, and Oceania (eg, Timor-Leste and North Korea), but also in south Asia (eg, Nepal and Bangladesh). Compared with those aged 15-24 years, in most super-regions (except Latin America and the Caribbean and the high-income super-region) a greater proportion of those aged 5-14 years are forecasted to have obesity than overweight by 2050. Globally, 15·6% (12·7-17·2) of those aged 5-14 years are forecasted to have obesity by 2050 (186 million [141-221]), compared with 14·2% (11·4-15·7) of those aged 15-24 years (175 million [136-203]). We forecasted that by 2050, there will be more young males (aged 5-14 years) living with obesity (16·5% [13·3-18·3]) than overweight (12·9% [12·2-13·6]); while for females (aged 5-24 years) and older males (aged 15-24 years), overweight will remain more prevalent than obesity. At a regional level, the following populations are forecast to have transitioned to obesity (vs overweight) predominance before 2041-50: children and adolescents (males and females aged 5-24 years) in north Africa and the Middle East and Tropical Latin America; males aged 5-14 years in east Asia, central and southern sub-Saharan Africa, and central Latin America; females aged 5-14 years in Australasia; females aged 15-24 years in Australasia, high-income North America, and southern sub-Saharan Africa; and males aged 15-24 years in high-income North America.Both overweight and obesity increased substantially in every world region between 1990 and 2021, suggesting that current approaches to curbing increases in overweight and obesity have failed a generation of children and adolescents. Beyond 2021, overweight during childhood and adolescence is forecast to stabilise due to further increases in the population who have obesity. Increases in obesity are expected to continue for all populations in all world regions. Because substantial change is forecasted to occur between 2022 and 2030, immediate actions are needed to address this public health crisis.Bill & Melinda Gates Foundation and Australian National Health and Medical Research Council.

  View details for DOI 10.1016/S0140-6736(25)00397-6

  View details for PubMedID 40049185

• Impact of carotid artery tortuosity on mechanical thrombectomy outcomes: A systematic review NEURORADIOLOGY JOURNAL Bilgin, C., Gupta, R., Orscelik, A., Hassankhani, A., Senol, Y., Kobeissi, H., Ghozy, S., Kadirvel, R., Brinjikji, W., Kallmes, D. F. 2025; 38 (6): 668-675

  Abstract

  BackgroundCarotid artery tortuosity (CAT) may complicate mechanical thrombectomy (MT), potentially causing delays or preventing recanalization. However, the relationship between CAT and MT outcomes remains largely unexplored. This systematic review aims to evaluate the existing evidence regarding the impact of CAT on MT outcomes.MethodsFollowing PRISMA guidelines, a systematic literature search was conducted using MEDLINE, EMBASE, Web of Science, Cochrane, and Scopus databases. Studies providing data for MT outcomes based on CAT status were included. Outcomes of interest included successful recanalization, first-pass efficacy (FPE), procedure time, functional independence, and procedure-related complications.ResultsOur search identified nine studies with 2737 patients. Three studies employed DSA to assess tortuosity, whereas the remaining six studies preferred CTA. In seven studies, CAT was associated with prolonged procedure times. In five studies, successful recanalization rates were significantly lower in CAT patients as compared to patients with non-tortuous arteries. Two studies showed that CAT could alter FPE or successful recanalization rates of first-line MT techniques. No study found statistically significant relationships between CAT and functional independence. Three studies examined the association between CAT and safety outcomes, and only one study found increased intracranial hemorrhage rates in patients with CAT. All nine studies employed different CAT criteria.ConclusionsDespite the vast MT literature, the number of studies reporting CAT status remains low. CAT may affect procedure time and technical outcomes of MT. Therefore, employing a uniform CAT definition and reporting CAT more frequently can provide insights into management of patients with acute large vessel occlusions.

  View details for DOI 10.1177/19714009251317499

  View details for Web of Science ID 001410519600001

  View details for PubMedID 39891596

  View details for PubMedCentralID PMC11787724

• The effects of admission hyperglycemia and diabetes mellitus on mechanical thrombectomy outcomes: A systematic review and meta-analysis INTERVENTIONAL NEURORADIOLOGY Bilgin, G., Bilgin, C., Jabal, M., Kobeissi, H., Ghozy, S., Senol, Y., Orscelik, A., Kadirvel, R., Brinjikji, W., Kallmes, D. F., Rabinstein, A. A. 2025: 15910199241306774

  Abstract

  The impact of certain comorbidities on mechanical thrombectomy (MT) outcomes remains largely unexplored. Diabetes mellitus (DM) and admission hyperglycemia have been associated with poor clinical outcomes for patients treated with MT. In this study, we sought to investigate the effects of DM and admission hyperglycemia on MT outcomes.Following PRISMA guidelines, a systematic literature search was conducted in Medline, Embase, Scopus, and Web of Science databases. Data regarding successful recanalization (modified Thrombolysis in Cerebral Infarction [mTICI] ≥2b), functional independence (modified Rankin Scale [mRS] 0-2), excellent outcomes (mRS 0-1), symptomatic intracranial hemorrhage (sICH), and mortality were extracted from the included studies. The pooled odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were calculated using random effects model.Twenty-one studies comprising 9708 patients were included. A total of 2311 patients (24%) had a history of DM, and 2026 patients (21%) had admission hyperglycemia. Admission hyperglycemia was associated with significantly lower odds of mTICI ≥2b (OR = 0.7, 95% CI = 0.55-0.89), mRS 0-2 (OR = 0.47, 95% CI = 0.41-0.53), and mRS 0-1 (OR = 0.43, 95% CI = 0.34-0.55) as compared to normoglycemic state. Patients with hyperglycemia had significantly higher rates of sICH (OR = 2.05, 95% CI = 1.66-2.54) and mortality (OR = 1.99, 95% CI = 1.58-2.52) than normoglycemic patients. Diabetes mellitus was associated with significantly high rates of mortality (OR = 1.74, 95% CI = 1.31-2.3) and lower rates of mRS 0-2 (OR = 0.60, 95% CI = 0.48-0.76) in sensitivity analyses.Our results indicate that admission blood glucose levels and DM can negatively affect MT outcomes. Further research should focus on optimizing MT outcomes for these patients.

  View details for DOI 10.1177/15910199241306774

  View details for Web of Science ID 001398260700001

  View details for PubMedID 39819212

  View details for PubMedCentralID PMC11748406

• A case of recurrent subdural hematoma after unilateral MMA embolization that resolved after contralateral MMA embolization INTERVENTIONAL NEURORADIOLOGY Senol, Y., Asghariahmadabad, M., Cooke, D. L., Savastano, L. E. 2024: 15910199241267342

  Abstract

  Middle meningeal artery embolization (MMAe) is rapidly emerging as a valuable intervention to decrease the risk of recurrent subdural hematoma (SDH) after surgical evacuation. The role of upfront bilateral MMAe for unilateral SDH and the value of contralateral MMAe after SDH recurrence post evacuation and ipsilateral MMAe are still unknown. Here, we report the case of an elderly patient that presented with a large acute on chronic SDH and underwent surgical drainage and ipsilateral MMAe (with Contour PVA particles, 150-250 µm). At one month follow-up, he was found to have a significant radiographic recurrence of the SDH with interval acute hemorrhage. Angiography revealed complete occlusion of the trunk of the previously embolized ipsilateral MMA, and the presence of robust anastomotic branches from the contralateral MMA crossing the midline to collateralize patent distal branches of the previously embolized MMA. Decision was made to proceed with contralateral MMAe, which resulted in near complete SDH resolution at 6 months follow-up.

  View details for DOI 10.1177/15910199241267342

  View details for Web of Science ID 001374312800001

  View details for PubMedID 39660509

  View details for PubMedCentralID PMC11632714

• Circulating miRNA profiles as predictive biomarkers for aneurysm healing following endovascular treatment: a prospective study INTERVENTIONAL NEURORADIOLOGY Arul, S., Jassen, E., Ayers-Ringler, J., Mereuta, O., Senol, Y., Orscelik, A., Ghozy, S., Brinjikji, W., Kallmes, D. F., Kadirvel, R. 2024: 15910199241298321

  Abstract

  Aneurysm treatments are crucial to minimize the rupture risk. The underlying molecular processes mediating cellular remodeling, endothelialization, and aneurysm healing following endovascular treatment are poorly understood. The current study aims to explore circulating miRNA as a treatment and outcome-associated biomarkers in patients undergoing endovascular treatment.Patients undergoing endovascular interventions for unruptured intracranial aneurysms, using either flow diverter placement or coil embolization, were enrolled. Blood samples were collected before the intervention and during a follow-up period between 6 and 18 months. Total mRNA/miRNA was isolated from plasma, followed by RNA-seq analysis. Gene Ontology analysis was used to identify pathways linked to altered miRNA expression.Twenty-three patients participated, with 13 (56.5%) undergoing flow diversion and 10 (43.5%) coil embolization. The median follow-up sample collection time was 10.70 months (SEM ± 1.32). No significant differences in angiographic occlusion were noted between intervention groups. Differentially expressed miRNAs were not identified between groups at baseline. However, at follow-up, 39 miRNAs were upregulated and 41 were downregulated, independent of intervention. Notably, three miRNAs (miR-4746-5p, miR-4685-3p, and miR-490-3p) were downregulated in the flow diversion group compared to the coil embolization group. Bioinformatics analysis revealed associations with upregulated fluid shear stress, p53, adherens junction pathways, along with downregulated apoptosis pathways.This study suggests that fluid shear stress and apoptosis may influence aneurysm healing or thromboembolic events in flow diverter-treated patients. Further research is warranted to elucidate the functional significance of these findings in treatment outcomes, providing valuable insights for improved patient care in intracranial aneurysm management.

  View details for DOI 10.1177/15910199241298321

  View details for Web of Science ID 001356694700001

  View details for PubMedID 39552445

• Comparative analysis of single plane and biplane angiography systems for mechanical thrombectomy for acute ischemic stroke: a systematic review and meta-analysis JOURNAL OF NEUROINTERVENTIONAL SURGERY Orscelik, A., Bilgin, C., Cortese, J., Cayme, J. J., Zandpazandi, S., Senol, Y., Musmar, B., Ghozy, S., Bayraktar, E., Beizavi, Z., Brinjikji, W., Kallmes, D. F. 2025; 17 (6): 567-573

  Abstract

  The choice of angiography system could influence the outcomes of mechanical thrombectomy (MT) in the treatment of acute ischemic stroke (AIS), but its impact is not yet well understood. This study aims to compare the clinical and technical outcomes of MT performed with single plane versus biplane angiography systems.We conducted a systematic review and meta-analysis, following PRISMA guidelines, by searching PubMed, Embase, Web of Science, and Scopus to include studies on patients with AIS who underwent MT with either single plane or biplane angiography up to May 4, 2024. The primary outcome was a favorable outcome defined as a modified Rankin Scale (mRS) score of 0-2 at 90 days after the procedure. Data were analyzed using a random-effects model and heterogeneity was assessed using the I2 test and Q statistics.Five studies with a total of 1562 patients were analyzed. Of these, 68.4% were treated with biplane systems and 31.6% with single plane systems. Single plane angiography was associated with a significantly higher rate of favorable outcomes (OR 1.43; 95% CI 1.13 to 1.80; P<0.01). There were no significant differences in successful recanalization, periprocedural complications, procedure time, total fluoroscopy time, or contrast volume between the two systems.While single plane angiography systems may offer slightly better outcomes in MT for AIS, both systems appear equally effective in most clinical and technical perspectives, suggesting that system selection may be more dependent on availability and procedural requirements rather than inherent superiority. Our findings may encourage clinicians to use single-plane angiography in settings where the biplane angiography suite availability is limited, but it should be noted that this observation may have been influenced by selection bias, particularly since the larger studies included in our meta-analysis did not observe this effect in adjusted analyses for potential confounder factors.

  View details for DOI 10.1136/jnis-2024-022381

  View details for Web of Science ID 001353934800001

  View details for PubMedID 39438134

• Creation of a predictive calculator to determine adequacy of occlusion of the woven endobridge (WEB) device in intracranial aneurysms-A retrospective analysis of the WorldWide WEB Consortium database INTERVENTIONAL NEURORADIOLOGY Musmar, B., Adeeb, N., Gendreau, J., Horowitz, M., Salim, H., Sanmugananthan, P., Aslan, A., Brown, N. J., Cancelliere, N. M., McLellan, R. M., Algin, O., Ghozy, S., Dibas, M., Orscelik, A., Senol, Y., Lay, S., Guenego, A., Renieri, L., Carnevale, J., Saliou, G., Mastorakos, P., El Naamani, K., Shotar, E., Premat, K., Moehlenbruch, M., Kral, M., Doron, O., Chung, C., Salem, M. M., Lylyk, I., Foreman, P. M., Vachhani, J. A., Shaikh, H., Zupancic, V., Hafeez, M. U., Catapano, J., Waqas, M., Tutino, V. M., Gokhan, Y., Imamoglu, C., Bayrak, A., Rabinov, J. D., Ren, Y., Schirmer, C. M., Piano, M., Kuehn, A. L., Michelozzi, C., Elens, S., Starke, R. M., Hassan, A. E., Ogilvie, M., Nguyen, A., Jones, J., Brinjikji, W., Nawka, M. T., Psychogios, M., Ulfert, C., Bengzon Diestro, J., Pukenas, B., Burkhardt, J., Huynh, T., Martinez-Gutierrez, J., Essibayi, M., Sheth, S. A., Spiegel, G., Tawk, R., Lubicz, B., Panni, P., Puri, A. S., Pero, G., Nossek, E., Raz, E., Killer-Oberfalzer, M., Griessenauer, C. J., Asadi, H., Siddiqui, A., Brook, A. L., Altschul, D., Ducruet, A. F., Albuquerque, F. C., Regenhardt, R. W., Stapleton, C. J., Kan, P., Kalousek, V., Lylyk, P., Boddu, S., Knopman, J., Aziz-Sultan, M. A., Tjoumakaris, S., Clarencon, F., Limbucci, N., Bydon, M., Hasan, D., Cuellar-Saenz, H. H., Jabbour, P. M., Pereira, V., Patel, A. B., Dmytriw, A. A. 2024: 15910199241267320

  Abstract

  Endovascular treatment with the woven endobridge (WEB) device has been widely utilized for managing intracranial aneurysms. However, predicting the probability of achieving adequate occlusion (Raymond-Roy classification 1 or 2) remains challenging.Our study sought to develop and validate a predictive calculator for adequate occlusion using the WEB device via data from a large multi-institutional retrospective cohort.We used data from the WorldWide WEB Consortium, encompassing 356 patients from 30 centers across North America, South America, and Europe. Bivariate and multivariate regression analyses were performed on a variety of demographic and clinical factors, from which predictive factors were selected. Calibration and validation were conducted, with variance inflation factor (VIF) parameters checked for collinearity.A total of 356 patients were included: 124 (34.8%) were male, 108 (30.3%) were elderly (≥65 years), and 118 (33.1%) were current smokers. Mean maximum aneurysm diameter was 7.09 mm (SD 2.71), with 112 (31.5%) having a daughter sac. In the multivariate regression, increasing aneurysm neck size (OR 0.706 [95% CI: 0.535-0.929], p = 0.13) and partial aneurysm thrombosis (OR 0.135 [95% CI: 0.024-0.681], p = 0.016) were found to be the only statistically significant variables associated with poorer likelihood of achieving occlusion. The predictive calculator shows a c-statistic of 0.744. Hosmer-Lemeshow goodness-of-fit test indicated a satisfactory model fit with a p-value of 0.431. The calculator is available at: https://neurodx.shinyapps.io/WEBDEVICE/.The predictive calculator offers a substantial contribution to the clinical toolkit for estimating the likelihood of adequate intracranial aneurysm occlusion by WEB device embolization.

  View details for DOI 10.1177/15910199241267320

  View details for Web of Science ID 001334813700001

  View details for PubMedID 39127463

  View details for PubMedCentralID PMC11571495

• Pipeline versus non-pipeline flow diverter treatment for M1 aneurysms: A systematic review and meta-analysis NEURORADIOLOGY JOURNAL Senol, Y., Orscelik, A., Bilgin, C., Kobeissi, H., Ghozy, S., Arul, S., Kallmes, D. F., Kadirvel, R. 2025; 38 (2): 133-141

  Abstract

  BackgroundThe flow diversion treatment of aneurysms located distal to the Circle of Willis has recently increased in frequency. We conducted a systematic review and meta-analysis of the clinical and radiological outcomes of flow diverter (FD) embolization in treating M1 aneurysms.MethodsPubMed, Web of Science, Ovid Medline, Ovid Embase, and Scopus were searched up to May 2024 using the Nested Knowledge platform. We included studies assessing the long-term clinical and radiological outcomes for M1 aneurysms. Results of FDs classified as Pipeline Embolization Devices (PED) versus other types of FDs. Angiographic occlusion rates, ischemic and hemorrhagic complications, and favorable clinic outcomes were included. All data were analyzed using R software version 4.2.2.ResultsThirteen studies with 112 total patients (58 patients for PED and 54 patients for other FD devices) were included in our meta-analysis. The overall adequate (complete + near-complete) occlusion rates were 85.1%. The complete occlusion rate was higher with PED than with other FD devices (72.9% PED and 41.6% for non-PED FDs, respectively, p-value <.01). The ischemic complications were 9.9% and 9.0% for the PED and non-PED groups, respectively (p-value = .89). The overall modified Rankin Scale 0-2 was 100% for the non-PED and 97.1% for the PED group (p-value = .51). In-stent stenosis rate was 7.5% for PED devices compared to 2.6% in the non-PED group (p-value = .35).ConclusionsThis relatively small meta-analysis showed high rates of adequate and complete occlusion in FD treatment of M1 segment aneurysms, with favorable safety profiles. PEDs were associated with higher rates of complete aneurysm occlusion compared to other types of FDs.

  View details for DOI 10.1177/19714009241260805

  View details for Web of Science ID 001276894700001

  View details for PubMedID 39033417

  View details for PubMedCentralID PMC11571521

• Reversal of Middle Cerebral Artery Stenosis by Minimally Invasive Intracerebral Hematoma Evacuation NEUROSURGERY PRACTICE Senol, Y., Asghariahmadabad, M., Haddad, A., Smith, W. S., Savastano, L. E. 2024; 5 (2): e00087

  Abstract

  Acute intracerebral hematomas are known to induce significant mass effects within the brain, leading to critical complications such as cerebral midline shift, herniation, and increased intracranial pressure. The timing and efficacy of intracerebral hematoma evacuation remain subjects of ongoing debate in current literature.In our case report, we present a 74-year-old female patient diagnosed with basal ganglia hematoma. The resultant mass effect from the intracerebral hematoma led to middle cerebral artery (MCA) stenosis. Notably, early-stage minimally invasive hematoma evacuation was pivotal in facilitating successful revascularization of the MCA.Our case underscores the significance of prompt identification and management of MCA stenosis arising from intracerebral hematoma. Early intervention through minimally invasive hematoma evacuation proved instrumental in achieving successful MCA revascularization. These findings emphasize the critical role of timely interventions in mitigating potential complications associated with intracerebral hematoma.

  View details for DOI 10.1227/neuprac.0000000000000087

  View details for Web of Science ID 001284932600002

  View details for PubMedID 39958237

  View details for PubMedCentralID PMC11783603

• The impact of pre-stroke metformin use on clinical outcomes after acute ischemic stroke: A systematic review and meta-analysis JOURNAL OF STROKE & CEREBROVASCULAR DISEASES Pakkam, M., Orscelik, A., Musmar, B., Tolba, H., Ghozy, S., Senol, Y., Bilgin, C., Nayak, S., Kadirvel, R., Brinjikji, W., Rabinstein, A. A., Kallmes, D. F. 2024; 33 (6): 107716

  Abstract

  Stroke is a leading cause of mortality and disability globally, with limited treatment options available for acute ischemic stroke (AIS) patients. Type 2 diabetes mellitus (T2DM) is not only widespread but also a known risk factor for stroke. Our meta-analysis aims to assess the influence of pre-stroke metformin use on the clinical outcomes in AIS patients with T2DM.We conducted this study following PRISMA guidelines, searching the following databases: Medline, Embase, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials up to February 29, 2024. All studies providing separate data on AIS patients using metformin were included, and statistical analysis was conducted using R software to pooled odds ratios (ORs) and their corresponding 95% confidence intervals (CI).Out of 1051 studies, 7 met the inclusion criteria for our meta-analysis with a total of 11589 diabetic patients, including 5445 patients taking metformin and 6144 diabetic patients in the non-metformin group. Compared to the non-metformin group, the metformin group had a significantly higher rate of mRS 0-2 score at discharge (OR 1.56; 95% CI 1.25:1.95; p=< 0.01) and a lower rate of 90-day mortality (OR 0.51; 95% CI 0.42:0.61; p=< 0.01), with no significant difference in sICH (OR 0.88; 95% CI 0.47:1.64; p= 0.68) between the two groups.Our meta-analysis demonstrated that pre-stroke metformin use is associated with higher functional independence and lower mortality in AIS patients with T2DM.

  View details for DOI 10.1016/j.jstrokecerebrovasdis.2024.107716

  View details for Web of Science ID 001230001600001

  View details for PubMedID 38604350

• Endovascular outcomes for anterior choroidal artery aneurysms: systematic review and meta-analysis JOURNAL OF STROKE & CEREBROVASCULAR DISEASES Senol, Y., Orscelik, A., Musmar, B., Ghozy, S., Bilgin, G., Kobeissi, H., Pakkam, M., Kallmes, D. F., Kadirvel, R. 2024; 33 (6): 107679

  Abstract

  Anterior choroidal artery (AchoA) aneurysms are relatively rare compared to other types of aneurysms. However, the occurrence of transient or permanent occlusion of the choroidal artery during endovascular or surgical treatment is an uncommon but potentially serious complication. In this study, we aim to investigate the safety and efficacy profile of endovascular treatment (EVT) for AchoA aneurysms.The primary outcome of interest was angiographic and clinical outcomes. Secondary outcome variables transient and permanent ischemic complications, symptomatic choroidal artery occlusion and retreatment rates. A random-effects model was used to calculate prevalence rates and their corresponding 95 % confidence intervals (CI), and subgroup analyses were performed to assess the complication rates for Type 1(arterial type, directly arising from ICA) and Type 2(neck type, arising from AchoA branch)) AchoA aneurysms, ruptured vs non-ruptured and for flow diverter (FD) treatment versus coiling.Our study included 10 studies with 416 patients with 430 AchoA aneurysms. The overall good clinical outcome rate (mRS score 0-2) is 94.5 % with a retreatment rate of 2.0 %. A subgroup analysis showed no statistical difference between coiling(75.3 %) and flow diverter(80.9 %) treatment in terms of complete occlusion(p-value:0.62). Overall permanent complication rate is 1.4 % (p-value:0.54) and transient ischemic complications rate is 4.2 %(p-value:0.61). Symptomatic choroidal artery occlusion rate is 0.8 %(p-value:0.51)Type 2 AchoA aneurysms had a significantly higher complication rate of 9.8 % (p-value<0.05) compared to Type 1 aneurysms. Unruptured aneurysms have significantly better clinical outcomes than ruptured aneurysms(OR: 0.11; [0.02;0.5], p-value:<0.05) CONCLUSION: Endovascular treatment of AchoA aneurysms demonstrated positive clinical results, with low rates of retreatment and complications. Coiling and flow diverters proved similar outcomes in achieving aneurysm occlusion. Ruptured aneurysms have lower good clinical outcomes comparing to unruptured aneurysms. Type 2 AchoA aneurysms had a higher risk of complications compared to Type 1.

  View details for DOI 10.1016/j.jstrokecerebrovasdis.2024.107679

  View details for Web of Science ID 001220722200001

  View details for PubMedID 38499080

  View details for PubMedCentralID PMC11088492

• Mechanical thrombectomy for the treatment of large vessel occlusion due to cancer-related cerebral embolism: A systematic review INTERVENTIONAL NEURORADIOLOGY Toruno, M., Al-Janabi, O., Karaman, I., Ghozy, S., Senol, Y., Kobeissi, H., Kadirvel, R., Ashdown, B., Kallmes, D. F. 2024: 15910199241230356

  Abstract

  Cancer-related cerebral embolism due to direct tumor embolization results in a rare acute ischemic stroke with large vessel occlusion (LVO). Despite the established status of mechanical thrombectomy (MT) in LVO management, its effectiveness and safety remains inadequately explored in this specific patient group.We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using the Nested Knowledge AutoLit software, encompassing databases like Embase, PubMed, Scopus, and Web of Science, from their inception up to 9 May 2023.In the review of 35 studies encompassing 37 cases, mean patient age was 52 years, and 30% were female. Cardiac myxoma (29.7%), cardiac papillary fibroelastoma (16.2%), and squamous cell carcinoma of the lung (8.1%) were the most frequent underlying cancers. The left middle cerebral artery was the most commonly affected occlusion site (24.3%). Of the patients, 67.5% underwent MT alone, while 32.5% received MT combined with intravenous thrombolysis. Successful reperfusion (thrombolysis in cerebral infarction (TICI) 2b-3) was achieved in 89.1% of cases, with 59.4% reaching TICI 3. Functional independence was observed in 29.7% of patients.While limitations exist, this comprehensive study highlights the potential benefits of MT in a patient group historically excluded from major trials, warranting further investigation.

  View details for DOI 10.1177/15910199241230356

  View details for Web of Science ID 001160170800001

  View details for PubMedID 38332668

  View details for PubMedCentralID PMC11569766

• Comparison of Balloon Guide Catheter versus Non-Balloon Guide Catheter for Mechanical Thrombectomy in Distal Medium Vessel Occlusion Orscelik, A., Kallmes, D. F., Bilgin, C., Senol, Y., Kobeissi, H., Elawady, S., Cunningham, C., Spiotta, A. M. LIPPINCOTT WILLIAMS & WILKINS. 2024

  View details for DOI 10.1161/str.55.suppl_1.TP187

  View details for Web of Science ID 001350230203005

• Comparative efficacy, safety, and DMSO compatibility of detachable vs. non-detachable tip microcatheters in neurointerventional procedures: A systematic review and meta-analysis JOURNAL OF NEURORADIOLOGY Orscelik, A., Musmar, B., Bayraktar, E., Cortese, J., Senol, Y., Ghozy, S., Essibayi, M., Bilgin, G., Pakkam, M., Bilgin, C., Brinjikji, W., Kallmes, D. F. 2025; 52 (1): 101234

  Abstract

  The evolution of embolic agents necessitates the use of microcatheters compatible with dimethyl sulfoxide (DMSO), with detachable tip microcatheters (DTMs) emerging as a significant innovation aimed at reducing the risk of catheter entrapment in embolization procedures. This study aims to compare the efficacy, safety, and DMSO compatibility of DTMs with non-detachable tip microcatheters (Non-DTMs) in the context of embolization treatments for neurovascular diseases.Following PRISMA guidelines, a systematic literature search was conducted across PubMed, Scopus, Embase, and Web of Science databases until February 25, 2024. Primary outcomes included technical success and microcatheter-related complications, with a meta-analysis performed using a random-effects model to calculate proportions and odds ratios (OR) with 95 % confidence intervals (Cl).Forty-five studies involving 2185 patients and 3758 catheters (995 DTMs and 2763 Non-DTMs) were analyzed. Our analysis revealed that DTMs were associated with comparable rates of technical success (98.3 % vs. 97.6 %, p = 0.68), favorable outcomes (93.9 % vs. 93.6 %, p = 0.89), and microcatheter-related complications compared to Non-DTMs. Specifically, DTMs showed a 0.0 % rate of microcatheter entrapment and hemorrhagic complications. Intended detachment was achieved in 41.7 % (95 % CI = 27.02-57.98) of cases and premature detachment was rare (0.1 %; 95 % %CI = 0.00-1.23). In the analysis of comparative studies, microcatheter-related complications did not defer between DTM and Non-DTM groups.Our study demonstrates the safety and efficacy of DTMs in embolization treatments, emphasizing their compatibility with DMSO-based embolic agents and their potential to enhance patient outcomes in neurointerventional procedures. Future research should focus on well-designed, larger, prospective, comparative multi-center studies to strengthen the evidence base and further optimize the use of DTMs in endovascular interventions.

  View details for DOI 10.1016/j.neurad.2024.101234

  View details for Web of Science ID 001370552900001

  View details for PubMedID 39592084

• Endovascular Embolization Techniques for Cerebrospinal Fluid-Ve nous Fistula in the Treatment of Spontaneous Intracranial Hypotension RADIOLOGIC CLINICS OF NORTH AMERICA Orscelik, A., Cutsforth-Gregory, J. K., Madhavan, A., Senol, Y., Kobeissi, H., Bilgin, G., Bilgin, C., Kallmes, D. F., Brinjikji, W. 2024; 62 (2): 345-354

  Abstract

  Cerebrospinal fluid-venous fistula (CVF) is an important cause of spontaneous intracranial hypotension (SIH), a condition characterized by low cerebrospinal fluid (CSF) volume and orthostatic headaches. The pathogenesis of CVF is thought to be direct connection of the spinal dura to one or more veins in the epidural space, allowing unregulated flow of CSF into the venous system. Herein, we provide a comprehensive review of the endovascular management of CVF in patients with SIH. We also focus on the various techniques and devices used in endovascular treatment, as well as the pathogenesis, diagnosis, and alternative treatment options of CVF.

  View details for DOI 10.1016/j.rcl.2023.10.006

  View details for Web of Science ID 001171596200001

  View details for PubMedID 38272626

• Safety and efficacy profile of off-label use of the Pipeline Embolization Device: A systematic review and meta-analysis JOURNAL OF STROKE & CEREBROVASCULAR DISEASES Senol, Y., Orscelik, A., Bilgin, C., Kobeissi, H., Ghozy, S., Arul, S., Kallmes, D. F., Kadirvel, R. 2024; 33 (4): 107586

  Abstract

  The off-label utilization of the Pipeline Embolization Device (PED) is a common practice in numerous medical centers globally. Therefore, we conducted a systematic review and meta-analysis to evaluate the overall outcomes of this off-label usage of PEDs.PubMed, Web of Science, Ovid Medline, Ovid Embase, and Scopus were searched up to February 2023 using the Nested Knowledge platform to identify studies assessing the off-label use of PEDs. Any use of PED outside of the FDA-approved indication granted in 2018 is considered off-label use. Overall angiographic occlusion rates, ischemic and hemorrhagic complications, mortality, retreatment rates, and favorable clinic outcomes were included. Statistical analyses were performed to compare the overall outcome rates of anterior cerebral artery(ACA) vs. middle cerebral artery(MCA) and anterior vs posterior circulation subgroups.We included 26 studies involving a total of 1,408 patients. The overall rate of complete occlusion was 80.3 % (95 % CI= 76.0-84.1). Subgroup analysis demonstrated a statistically significant difference in the rate of complete occlusion between anterior circulation (78.9 %) and posterior circulation (69.2 %) (p value=0.02). The rate of good clinical outcomes was 92.8 % (95 % CI= 88.8-95.4). The mortality rate was 1.4 % (95 % CI= 0.5-2.7). The overall rate of ischemic complications was 9.5 % (95 % CI= 7.7-11.6), with a comparable difference between anterior circulation (7.7 %) and posterior circulation (12.8 %) (p value=0.07). There was no statistically significant difference in MCA vs ACA subgroups in all parameters.Off-label use of PEDs can be a safe and effective treatment option for intracranial aneurysms. However, there is a need for more prospective, high-quality, non-industry-funded registry studies and randomized trials to test the efficacy and safety of off-label usage of PEDs and to expand its indications.

  View details for DOI 10.1016/j.jstrokecerebrovasdis.2024.107586

  View details for Web of Science ID 001167972700001

  View details for PubMedID 38242183

  View details for PubMedCentralID PMC10939757

• Journal selection guide for radiology case reports CLINICAL IMAGING Bilgin, G., Bilgin, C., Kobeissi, H., Ghozy, S., Senol, Y., Jabal, M., Kadirvel, R., Brinjikji, W., Kallmes, D. F. 2024; 107: 110084

  Abstract

  Case reports and interesting images are valuable contributions to the radiology literature as they provide unique insights into uncommon conditions and rare presentations. Additionally, they serve as a rapidly expanding live image atlas and, therefore, can help radiologists to improve their diagnostics skills. However, due to high rejection rates and an increasing number of predatory publishers, publishing radiology case reports remains a daunting task for junior researchers. To overcome these challenges and ensure timely dissemination of their research findings, authors should consider several factors when selecting a target journal for case report publications. In this primer, we have summarized key considerations in journal selection and highlighted reputable journals that welcome radiology case reports.

  View details for DOI 10.1016/j.clinimag.2024.110084

  View details for Web of Science ID 001167492700001

  View details for PubMedID 38244404

• Endovascular embolization of cerebrospinal fluid-venous fistula: a comprehensive systematic review on its efficacy and safety for the management of spontaneous intracranial hypotension NEUROSURGICAL REVIEW Orscelik, A., Senol, Y., Musmar, B., Kobeissi, H., Bilgin, G., Zandpazandi, S., Bilgin, C., Pakkam, M., Brinjikji, W. 2024; 47 (1): 28

  Abstract

  Cerebrospinal fluid (CSF)-venous fistula can cause spontaneous intracranial hypotension (SIH) and poses a significant diagnostic and management challenge. This study aims to provide a comprehensive overview of the clinical and radiological outcomes of endovascular embolization as a novel treatment approach for CSF-venous fistula in patients with SIH. This systematic review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. The primary outcome was the efficacy of the embolization procedure in occlusion of the CSF-venous fistula, and secondary outcomes included procedural complications and improvement of clinical symptoms and radiological findings. A total of nine studies consisting of 77 patients met the inclusion criteria. Orthostatic and/or Valsalva headache was the most common symptom. The mean age of the patients was 57 ± 8.9 years, and females accounted for 59.7% (46/77) of the cases. Sixty-five (84.4%) patients reported complete resolution or significant improvement in symptoms. The Bern score, Headache Impact Test-6, and the Patient Global Impression of Change scales demonstrated significant improvements in radiological findings and patients' quality of life. Following the procedure, 22 patients (28.6%) experienced rebound intracranial hypertension and 27 patients (35.1%) had transient local pain at the site of the embolization. Our study showed that endovascular embolization is a safe and effective treatment for CSF-venous fistula in patients with SIH, providing complete resolution or significant improvement of clinical symptoms and radiological findings, and positive impacts on patients' quality of life.

  View details for DOI 10.1007/s10143-023-02264-1

  View details for Web of Science ID 001132778600004

  View details for PubMedID 38163843

  View details for PubMedCentralID 7575894

• Intraluminal Flow Diverter Design Primer for Neurointerventionalists AMERICAN JOURNAL OF NEURORADIOLOGY Oliver, A. A., Senol, Y., Bilgin, C., Schaffer, J. E., Kadirvel, R., Kallmes, D. F., Wainwright, J. M. 2023: 365-370

  Abstract

  The clinical use of flow diverters for the treatment of intracranial aneurysms has rapidly grown. Consequently, the market and technology for these devices has also grown. Clinical performance characteristics of the flow diverter are well-known to the clinician. However, the engineering design principles behind how these devices achieve ideal clinical performance are less understood. This primer will summarize flow diverter design parameters for neurointerventionalists with the aim of promoting collaboration between clinicians and engineers.

  View details for DOI 10.3174/ajnr.A8076

  View details for Web of Science ID 001134084900001

  View details for PubMedID 38164542

  View details for PubMedCentralID PMC11288553

• Outcomes of mechanical thrombectomy in M1 occlusion patients with or without hyperdense middle cerebral artery sign: A systematic review and meta-analysis NEURORADIOLOGY JOURNAL Orscelik, A., Senol, Y., Bilgin, C., Kobeissi, H., Ghozy, S., Musmar, B., Bilgin, G., Zandpazandi, S., Pakkam, M., Arul, S., Brinjikji, W., Kallmes, D. F. 2024; 37 (4): 454-461

  Abstract

  The comparison of mechanical thrombectomy (MT) outcomes between patients with the hyperdense middle cerebral artery sign (HMCAS) and non-HMCAS is important to evaluate the impact of this radiological finding on treatment efficacy. This meta-analysis aimed to assess the association between HMCAS and clinical outcomes in patients undergoing thrombectomy, comparing the outcomes over non-HMCAS.A systematic literature search was conducted in PubMed, Ovid Embase, Google Scholar, and Cochrane Library to identify studies on MT outcomes for M1 occlusions of HMCAS over non-HMCAS. Inclusion criteria encompassed modified Rankin Scale (mRS) score, mortality, symptomatic intracranial hemorrhage (sICH), and successful recanalization. Using R software version 4.1.2, we calculated pooled odds ratios (ORs) and their corresponding 95% confidence intervals (CI).The meta-analysis was performed for 5 studies with 724 patients. There was no association found between presence of HMCAS and achieving mRS 0-2 (OR = 0.65, 95% CI: 0.29-1.47; p = .544). Mortality analysis also showed no significant association with presence of HMCAS (OR = 0.78, 95% CI: 0.37-1.65; p = .520). No significant difference in sICH risk (OR = 1.54, 95% CI: 0.24-9.66; p = .646) was found between groups. Recanalization analysis showed a non-significant positive association (OR = 1.23, 95% CI: 0.67-2.28; p = .501). Heterogeneity was observed in all analyses.Our findings showed that there is no statistically significant difference in mRS scores, mortality, sICH, and recanalization success rates between the HMCAS and non-HMCAS groups.

  View details for DOI 10.1177/19714009231224446

  View details for Web of Science ID 001134712700001

  View details for PubMedID 38146685

  View details for PubMedCentralID PMC11366193

• Comparison of balloon guide catheter versus non-balloon guide catheter for mechanical thrombectomy in patients with distal medium vessel occlusion JOURNAL OF NEUROINTERVENTIONAL SURGERY Orscelik, A., Kallmes, D. F., Bilgin, C., Musmar, B., Senol, Y., Kobeissi, H., Elawady, S., Cunningham, C., Matsukawa, H., Zandpazandi, S., Sowlat, M., Maier, I., Al Kasab, S., Jabbour, P., Kim, J., Wolfe, S. Q., Rai, A., Starke, R. M., Psychogios, M., Samaniego, E. A., Arthur, A. S., Yoshimura, S., Cuellar, H., Howard, B. M., Alawieh, A., Romano, D. G., Tanweer, O., Mascitelli, J., Fragata, I., Polifka, A. J., Osbun, J. W., Crosa, R., Matouk, C., Park, M. S., Levitt, M. R., Moss, M., Dumont, T. M., Williamson, R., Navia, P., Kan, P., De Leacy, R., Chowdhry, S. A., Ezzeldin, M., Spiotta, A. M., Brinjikji, W., STAR Collaborators 2024; 16 (6): 587-594

  Abstract

  Several studies have established the safety and efficacy of balloon guide catheters (BGCs) for large vessel occlusions. However, the utility of BGCs remains largely unexplored for distal medium vessel occlusions (DMVOs). In this study, we aim to compare the outcomes of BGC vs. Non-BGC in patients undergoing mechanical thrombectomy (MT) for DMVO.This retrospective study from the Stroke Thrombectomy and Aneurysm Registry (STAR) encompassed adult patients with acute anterior cerebral artery, posterior cerebral artery, and middle cerebral artery-M2-3-4 occlusions. Procedure times, safety, recanalization, and neurological outcomes were compared between the two groups, with subgroup analysis based on first-line thrombectomy techniques.A total of 1508 patients were included, with 231 patients (15.3%) in the BGC group and 1277 patients (84.7%) in the non-BGC group. The BGC group had a lower modified Thrombolysis in Cerebral Infarction (mTICI) score ≥2C (43.2% vs 52.7%, P=0.01), longer time from puncture to intracranial access (15 vs 8 min, P<0.01), and from puncture to final recanalization (97 vs 34 min, P<0.01). In the Solumbra subgroup, the first pass effect (FPE) rate was lower in the BGC group (17.4% vs 30.7%, P=0.03). Regarding clinical outcomes, the BGC group had a lower rate of distal embolization (8.8% vs 14.9%, P=0.03).Our study found that use of BGC in patients with DMVO was associated with lower mTICI scores, decreased FPE rates, reduced distal embolization, and longer procedure times.

  View details for DOI 10.1136/jnis-2023-020925

  View details for Web of Science ID 001098823500001

  View details for PubMedID 37918906

• Comparison of the Particulate Steroids, Betamethasone and Methylprednisolone, in Caudal Steroid Injection Under Ultrasound Guidance WORLD NEUROSURGERY Guler, A., Senol, Y., Akpinar, A., Gunerhan, G., Dalgic, A. 2023; 178: E421-E426

  Abstract

  Pain relief in lumbar disc hernias is a challenging condition. This study retrospectively compared particulate steroids, methylprednisolone acetate (mid-term effective), against betamethasone acetate (long-term effective) on ultrasound-guided caudal epidural injection for lumbar disc herniation.A total of 40 patients with L4-5 and/or L5-S1 disc herniation were treated with ultrasound-guided caudal epidural injection between September 2021 and June 2022. Nineteen patients who were given methylprednisolone acetate (group A) as a steroid and a total of 21 patients who were used betamethasone acetate (Group B) were retrospectively collected, and their pain levels and functional improvement were compared retrospectively before, immediately after, and 3 weeks after the injection in terms of the visual analog scale (VAS) and Oswestry Disability Index (ODI) as the efficacy value.There was no statistically significant difference between the groups regarding age, gender, and body mass index (P > 0.05). In group A, preop VAS was 8.84 ± 0.76, immediate postop period 3.10 ± 1.37, and postop third week was 4.73 ± 2.32. In group B, the preop VAS was 8.76 ± 0.76, the postop early period was 3.14 ± 1.27, and the postop third week was 3.12 ± 1.30. In group A preop ODI was 49.84 ± 9.11 and postop third week was 22.84 ± 6.44. In group B, the preop ODI was 46.71 ± 16.15 and postop third week was 30.80 ± 17.65. Significant changes were observed in the reduction of VAS values after the procedure in both groups during the early postoperative period and the third week (P value < 0.05). However, a significant difference was not found between the changes in VAS values between the groups (P value > 0.005). Similarly, significant changes were observed in the decrease of ODI values after the procedure in both groups during the early postoperative period and the third week (P value < 0.05). However, no significant difference was observed in the ODI scores between the two groups.No significant difference was observed between betamethasone and methylprednisolone. Both steroid groups showed a substantial improvement in the preoperative pain scores of the patients.

  View details for DOI 10.1016/j.wneu.2023.07.083

  View details for Web of Science ID 001092106100001

  View details for PubMedID 37495099

• Middle meningeal artery embolization without surgical evacuation for chronic subdural hematoma: a single-center experience of 209 cases FRONTIERS IN NEUROLOGY Orscelik, A., Senol, Y., Bilgin, C., Kobeissi, H., Arul, S., Cloft, H., Lanzino, G., Kallmes, D. F., Brinjikji, W. 2023; 14: 1222131

  Abstract

  Middle meningeal artery (MMA) embolization is a minimally invasive treatment option for new and recurrent chronic subdural hematomas (cSDH).To examine the safety and efficacy profile of MMA embolization without surgical evacuation for cSDH patients.A single-center retrospective study of patients with cSDHs treated by MMA embolization was undertaken. Patient demographics, hematoma characteristics, procedural details, and clinical and radiological outcomes were collected. The primary outcome was the need for retreatment, and the secondary outcomes were at least a 50% reduction in the maximum width of cSDH on the last CT imaging, complications, and an improvement in the modified Rankin scale (mRS) score. All results were presented as descriptive statistics.A total of 209 MMA embolizations were successfully performed on 144 patients. Polyvinyl alcohol particles were the primary embolization agent in all procedures. Of the total of 206 cSDH, the median maximum width at pre-intervention and last follow-up were 12 and 3 mm, respectively, and the median reduction percentage was 77.5%, with a >50% improvement observed in 72.8% at the last follow-up imaging. A total of 13.8% of patients needed retreatment for recurrent, refractory, or symptomatic hematomas after embolization. The mRS score improved in 71 (49.3%) patients. Of 144 patients, 4 (2.8%) experienced complications related to the procedure, and 12 (8.4%) died during follow-up due to causes unrelated to the MMA embolization procedures.This study supports the fact that MMA embolization without surgical evacuation is a safe and effective minimally invasive option for the treatment of cSDHs.

  View details for DOI 10.3389/fneur.2023.1222131

  View details for Web of Science ID 001167131500001

  View details for PubMedID 37719752

  View details for PubMedCentralID PMC10501738

• Metabolite signature in acute ischemic stroke thrombi: a systematic review JOURNAL OF THROMBOSIS AND THROMBOLYSIS Arul, S., Ghozy, S., Mereuta, O., Senol, Y., Orscelik, A., Kobeissi, H., Gupta, R., Brinjikji, W., Kallmes, D. F., Kadirvel, R. 2023; 56 (4): 594-602

  Abstract

  Metabolites are reliable biomarkers for many diseases. However, their role in acute ischemic stroke (AIS) pathogenesis is not well understood. In this systematic review we aim to evaluate the current literature on the presence of metabolites in thrombi retrieved by mechanical thrombectomy from AIS patients. Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 guidelines, we searched OVID Medline, PubMed, OVID Embase, Scopus, and Web of Science until July 13, 2022. Metabolites lists were extracted, and pathway analysis was performed in MetaboAnalyst database. Four articles listing metabolites were included in this systematic review. D-Glucose, diacylglycerol, phytosphingosine, galabiosylceramide, glucosylceramide and 4-hydroxynonenal were reported to be associated with clots. Metabolomics data analysis showed that glycolysis, lactose, and sphingolipid metabolism pathways were enriched. In conclusion, results of the present study show that the thrombi niche has a glycolytic phenotype. Future studies should work to better understand the metabolic properties of AIS thrombi.

  View details for DOI 10.1007/s11239-023-02869-9

  View details for Web of Science ID 001047734900001

  View details for PubMedID 37580625

  View details for PubMedCentralID PMC11178128

• Endovascular treatment outcomes of vertebrobasilar junction aneurysms: Systematic review and meta-analysis INTERVENTIONAL NEURORADIOLOGY Senol, Y., Kobeissi, H., Orscelik, A., Bilgin, C., Ghozy, S., Arul, S., Kallmes, D. F., Kadirvel, R. 2026; 32 (3): 804-811

  Abstract

  BackgroundVertebrobasilar junction (VBJ) aneurysms represent a relatively rare and often anatomically complex subgroup of saccular aneurysms. This systematic review and meta-analysis aimed to assess the safety and efficacy of endovascular treatment (EVT) of VBJ aneurysms.MethodsPubMed, Web of Science, Ovid Medline, Ovid Embase, and Scopus were searched from inception to 20 December 2022. We included primary studies assessing the long-term clinical and angiographic outcomes for VBJ aneurysms treated with endovascular techniques. We excluded surgically managed studies. All data were analyzed using R software version 4.2.1. We calculated pooled prevalence rates and their corresponding 95% confidence intervals (CI).ResultsIn this meta-analysis, a total of 76 VBJ aneurysms from seven studies were included for quantitative analysis. The results showed that the rate of adequate occlusion (complete + near complete occlusion) was 94.1% (95% CI = 76.71-98.71), and the rate of complete occlusion was 77.7% (95% CI = 63.07-87.65). A modified Rankin Scale (mRS) score of 0-2 was achieved in 93.9% of patients (95% CI = 67.65-99.14). The mortality rate was found to be 5.9% (95% CI = 0.97-28.55), and the retreatment rate was 4.6% (95% CI = 1.50-13.36). The overall ischemic complication rate was 4.7% (95% CI = 0.73-25.4), while the overall hemorrhagic complication rate was 4.6% (95% CI = 1.5-13.36).ConclusionsThe treatment of VBJ aneurysms with EVT is effective in achieving curative treatment and is associated with good clinical outcomes and low mortality rates. These findings provide important insights into the clinical and angiographic outcomes and the complication rates of EVT for VBJ aneurysms.

  View details for DOI 10.1177/15910199231194687

  View details for Web of Science ID 001047873800001

  View details for PubMedID 37574971

  View details for PubMedCentralID PMC13294571

• First-pass effect in posterior acute ischemic stroke undergoing endovascular thrombectomy: A systematic review and meta-analysis JOURNAL OF STROKE & CEREBROVASCULAR DISEASES Kobeissi, H., Adusumilli, G., Ghozy, S., Dmytriw, A. A., Senol, Y., Orscelik, A., Bilgin, C., Kadirvel, R., Brinjikji, W., Kallmes, D. F. 2023; 32 (10): 107304

  Abstract

  First-pass effect (FPE) has been shown to be a predictor of favorable clinical outcomes following endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) in the anterior circulation. Literature regarding FPE for posterior circulation AIS is sparse; we conducted a systematic review and meta-analysis to explore FPE in posterior circulation stroke undergoing EVT.We conducted a systematic review of the English literature in PubMed, Embase, Scopus, and Web of Science. FPE was defined as thrombolysis in cerebral infarction (TICI) 2c-3 and modified FPE (mFPE) was defined as TICI 2b-3 in one pass. Definitions of non-FPE and non-mFPE varied among studies. The primary outcome of interest was modified Rankin Scale (mRS) 0-2. Secondary outcomes of interest were mRS 0-3, symptomatic intracranial hemorrhage (sICH), and mortality. We calculated odds ratios (OR) and corresponding 95% confidence intervals (CI). Heterogeneity was assessed with Q statistic and I2 test.Seven studies with 417 patients in the mFPE group, 942 in the non-mFPE group, 545 in the FPE group, and 1023 in the non-FPE group were included. Overall, FPE was associated with greater rates of 90-day mRS 0-2 (OR= 2.78, 95% CI= 2.11-3.65; P-value< 0.001) and mRS 0-3 (OR= 2.67, 95% CI= 1.98-3.60; P-value< 0.001); however, there was significant heterogeneity among studies for both mRS 0-2 (I2= 69%; P-value< 0.001) and mRS 0-3 (I2= 69%; P-value< 0.001). FPE and non-FPE were associated with similar rates of sICH (OR= 0.65, 95% CI= 0.40-1.07; P-value= 0.09), and no heterogeneity was observed (I2= 0%; P-value= 0.95). FPE was associated with lower rates of mortality (OR= 0.44, 95% CI= 0.33-0.58; P-value< 0.001), although heterogeneity was observed (I2= 58%; P-value= 0.01).FPE is associated with favorable clinical outcomes in patients undergoing EVT for posterior circulation AIS. Future studies should work to further quantify the impact of FPE on outcomes in the posterior circulation.

  View details for DOI 10.1016/j.jstrokecerebrovasdis.2023.107304

  View details for Web of Science ID 001060936500001

  View details for PubMedID 37579638

• 2b Or 2c-3? A meta-analysis of first pass thrombolysis in cerebral infarction 2b vs multiple pass thrombolysis in cerebral infarction 2c-3 following mechanical thrombectomy for stroke INTERVENTIONAL NEURORADIOLOGY Kobeissi, H., Ghozy, S., Amoukhteh, M., Arul, S., Bilgin, C., Can, S., Orscelik, A., Elfil, M., Dmytriw, A., Kadirvel, R., Kallmes, D. F. F. 2026; 32 (1): 33-38

  Abstract

  BackgroundProcedural success following mechanical thrombectomy for acute ischemic stroke is assessed using the thrombolysis in cerebral infarction scale. We conducted a systematic review and meta-analysis to determine whether outcomes differed between first pass thrombolysis in cerebral infarction 2b and multiple pass thrombolysis in cerebral infarction 2c-3.MethodsWe conducted a systematic review of the literature using PubMed, Embase, Scopus, and Web of Science. We included original studies in which outcomes were stratified based on first pass thrombolysis in cerebral infarction 2b and multiple pass thrombolysis in cerebral infarction 2c-3. The primary outcome of interest was the rate of modified Rankin Scale 0-2. Secondary outcomes of interest were rates of modified Rankin Scale 0-1, symptomatic intracranial hemorrhage, and mortality. We calculated odds ratios and corresponding 95% confidence intervals.ResultsFour studies with 1554 patients were included in the quantitative analysis. Rate of modified Rankin Scale 0-2 (odds ratio = 0.91, 95% confidence interval = 0.70-1.18; P-value = 0.49), modified Rankin Scale 0-1 (odds ratio = 1.21, 95% confidence interval = 0.86-1.71; P-value = 0.27), symptomatic intracranial hemorrhage (odds ratio = 1.36, 95% confidence interval = 0.47-3.98; P-value = 0.57), and mortality (odds ratio = 0.91, 95% confidence interval = 0.67-1.25; P-value = 0.56) did not differ between first pass thrombolysis in cerebral infarction 2b and multiple pass thrombolysis in cerebral infarction 2c-3. There was no heterogeneity among included studies for modified Rankin Scale 0-2, modified Rankin Scale 0-1, or mortality; however, there was moderate heterogeneity among studies for symptomatic intracranial hemorrhage (I2 = 53%, P-value = 0.12).ConclusionsClinical and safety outcomes did not differ between first pass thrombolysis in cerebral infarction 2b and multiple pass thrombolysis in cerebral infarction 2c-3. Future prospective studies and clinical trials should determine whether first pass thrombolysis in cerebral infarction 2b is a viable endpoint to thrombolysis in cerebral infarction 2c-3.

  View details for DOI 10.1177/15910199231193925

  View details for Web of Science ID 001044116900001

  View details for PubMedID 37551104

  View details for PubMedCentralID PMC12852626

• Treatment of Ruptured Anterior Choroidal Artery Aneurysms by Acute Coiling Followed by Flow Diversion WORLD NEUROSURGERY Senol, Y., Sayin, B., Oz, Z., Gurpinar, I., Dereli, B., Ozbakir, M., Akmangit, I., Daglioglu, E. 2023; 176: E162-E172

  Abstract

  Flow-diverter treatments are successful endovascular treatments in protecting important perforating branches during aneurysm treatments. Because these treatments are performed under antiplatelet therapy, acute flow-diverter treatments in ruptured aneurysms are still controversial. Acute coiling followed by flow diversion has emerged as an intriguing and feasible treatment option for ruptured anterior choroidal artery aneurysm treatment. As a single-center retrospective case series study, this study reported the clinical and angiographic results of staged endovascular treatment in patients with a ruptured anterior choroidal aneurysm.This is a single-center retrospective case series study between March 2011 and May 2021. Patients with ruptured anterior choroidal aneurysm received flow-diverter therapy in a different session after acute coiling. Patients treated with primary coiling or only flow diversion were excluded. Preoperative demographic and presenting symptoms, aneurysm morphology, perioperative and postoperative complications, and long-term clinical and angiographic outcome as measured using the modified Rankin Scale and O'Kelly Morata Grading scale and also Raymond-Roy occlusion classification respectively.Sixteen patients underwent coiling in the acute phase to undergo flow diversion later. The mean maximum aneurysm diameter is 5.44 ± 3.39 mm. All patients had a subarachnoid hemorrhage and were treated acutely between days 0 and 3 of acute bleeding. The mean age at the presentation was 54.12 ± 12 years (32-73 years). Two patients (12.5%) had minor ischemic complications, which are seen on magnetic resonance angiography as clinically silent infarcts, after the procedure. One patient (6.2%) had a technical complication with the flow-diverter shortening and deployed a second flow diverter telescopically. No mortality or permanent morbidity was reported. The mean interval time between the 2 treatments was 24.06 ± 11.83 days. All patients were followed up with digital subtraction angiography; 14/16 patients (87.5%) had aneurysms that were completely occluded and 2/16 (12.5%) showed near-complete occlusion. Mean follow-up was 16.62 ± 3.22 months; all patients had modified Rankin Scale scores ≤2; 14/16 (87.5%) had a total occlusion 14/16 (87.5%) had near-complete occlusion. None of the patients had retreatment or rebleeding.Staged treatment of ruptured anterior choroidal artery aneurysms with acute coiling and flow-diverter treatment after recovery from subarachnoid hemorrhage is safe and effective. In this series, no cases of rebleeding occurred during the interval between coiling and flow diversion. Staged treatment should be considered a valid option in patients with challenging ruptured anterior choroidal aneurysms.

  View details for DOI 10.1016/j.wneu.2023.05.023

  View details for Web of Science ID 001052828700001

  View details for PubMedID 37178914

• Phenox HPC and Phenox flow modulation devices for the endovascular treatment of intracranial aneurysms: a systematic review and meta-analysis JOURNAL OF NEUROINTERVENTIONAL SURGERY Bilgin, C., Senol, Y., Kobeissi, H., Orscelik, A., Ghozy, S., Oliver, A. A., Kadirvel, R., Brinjikji, W., Kallmes, D. F. 2024; 16 (7): 706-714

  Abstract

  Surface-modified flow diverters are increasingly used in clinical settings. However, their safety profiles and additional benefits over non-coated devices still need to be explored. In this meta-analysis, we aimed to investigate and compare the clinical outcomes of the uncoated Phenox and coated Phenox HPC flow diverters.A systematic literature review was performed using PubMed, Scopus, Embase, and Web of Science databases. Collected data were pooled and corresponding 95% confidence intervals (CI) were calculated. Outcomes of interest included aneurysm occlusion (>6 months) and complication rates. Additionally, the safety outcomes of prophylactic single (SAPT) and dual antiplatelet treatment (DAPT) approaches were compared for patients treated with coated Phenox HPC flow diverters.We included 17 studies with 1238 patients. The overall complete occlusion rates were 80% (95% CI 74.01% to 86.56%) for Phenox HPC and 71.3% (95% CI 59.71% to 85.20%) for non-coated Phenox flow diverters (p=0.24). Ischemic complication rates were 7.3% (95% CI 4.6% to 11.39%) with the Phenox HPC and 5.3% (95% CI 4.07% to 6.91%) with the Phenox (p=0.24). For patients treated with Phenox HPC, the SAPT (5.5%; 95% CI 2.83% to 10.85%) and DAPT (7.1%; 95% CI 1.23% to 41.45%) approaches resulted in comparable ischemic complication rates (p=0.79). The DAPT group (4.8%; 95% CI 1.46% to 16.24%) had higher hemorrhagic complication rates than the SAPT group (1.7%; 95% CI 0.52% to 6.09%), but the difference was not statistically significant for patients treated with Phenox HPC (p=0.25).Our findings indicate that Phenox HPC is equally as safe and effective as non-coated Phenox devices. Additionally, our results suggest that prasugrel monotherapy might effectively prevent ischemic complications in patients treated with Phenox HPC flow diverters.

  View details for DOI 10.1136/jnis-2023-020514

  View details for Web of Science ID 001043308000001

  View details for PubMedID 37536930

• Isolated Cerebral Cyst Hydatid Removal with Dowling's Technique in a 6-Year-Old Pediatric Patient: Case Report. Asian journal of neurosurgery Senol, Y. C., Ozkan, N. D., Guresci, S., Daglioglu, E., Belen, A. D. 2023; 18 (2): 372-376

  Abstract

  Hydatid disease, caused by the Echinococcus parasite, is a worldwide zoonosis produced by the larval stage of the tapeworm. In urban living patients with cerebral abscesses, hydatid cysts should not be excluded from the differential diagnosis. We report an exceptional primary cerebral hydatid cyst in which imaging showed a large, round, contrast-enhancing lesion with a mass effect. The patient presented with a dull headache for over a year and progressively worsened left hemiparesis. The magnetic resonance imaging showed a huge intracranial mass, and the pathology was corrected with cyst hydatid. Surgery was performed via Dowling's technique, and the patient recovered without neurologic deficits. Echinococcosis should be considered a differential diagnosis for single or multiple cerebral abscesses, even in the absence of liver infections. The history of living in rural areas does not exclude cerebral hydatid cysts and Echinococcus .

  View details for DOI 10.1055/s-0043-1768600

  View details for PubMedID 37397039

• Effects of intravenous thrombolysis on stent retriever and aspiration thrombectomy outcomes: a systematic review and meta-analysis of the randomized controlled trials JOURNAL OF NEUROINTERVENTIONAL SURGERY Bilgin, C., Tolba, H., Ghozy, S., Kobeissi, H., Hassankhani, A., Senol, Y., Arul, S., Kadirvel, R., Kallmes, D. F. 2024; 16 (2): 163-170

  Abstract

  Risks and benefits of intravenous thrombolysis (IVT) in patients undergoing mechanical thrombectomy (MT) have been a topic of interest. However, IVT's specific effects on stent retriever (SR) and aspiration thrombectomy (ASP) outcomes remain largely unexplored. In this meta-analysis, we aimed to investigate the effects of IVT on SR and ASP thrombectomy outcomes.In accordance with PRISMA guidelines, a systematic literature review was conducted using Medline, Embase, Scopus, Web of Science, and Cochrane Center of Clinical Trials databases. Outcomes of interest included successful recanalization (modified Thrombolysis In Cerebral Infarction (mTICI) ≥2b), modified first pass efficacy (mFPE), functional independence (modified Rankin Scale (mRS) ≤2), symptomatic intracranial hemorrhage (sICH), and embolization to new territories (ENT).Four randomized controlled trials with 1176 patients were included. SR and ASP resulted in similar mTICI ≥2b, mFPE, and mRS 0-2 rates in patients with and without IVT administration. SR without IVT was associated with a significantly lower rate of mFPE compared with the SR+IVT (RR 0.85, 95% CI 0.74 to 0.97). Furthermore, ASP without IVT resulted in a lower rate of mRS 0-2 than the ASP+IVT with a strong trend towards significance (RR 0.78, 95% CI 0.60 to 1.01). Finally, bridging therapy did not increase sICH and ENT rates after ASP or SR thrombectomy.Our findings suggest that SR and ASP thrombectomy have comparable safety and efficacy profiles, regardless of prior IVT administration. Additionally, our results indicate that the addition of IVT may improve certain efficacy outcomes based on the employed first-line MT technique.

  View details for DOI 10.1136/jnis-2023-020360

  View details for Web of Science ID 000999702800001

  View details for PubMedID 37258225

• EFFECTIVENESS OF ULTRASONOGRAPHYGUIDED CAUDAL EPIDURAL STEROID INJECTION IN IMPROVING PAIN AND FUNCTIONAL STATUS OF GERIATRIC PATIENTS WITH SPINAL PAIN TURKISH JOURNAL OF GERIATRICS-TURK GERIATRI DERGISI Guler, A., Can Senol, Y., Akpinar, A., Ciftci, H., Yigit, M., Gence Oz, Z., Orhun, E., Dalgic, A. 2023; 26 (3): 258-266

  View details for DOI 10.29400/tjgeri.2023.352

  View details for Web of Science ID 001139540100005

• The Evaluation of Low-Profile Surpass EvolveTM Flow Diverter for Endovascular Treatment of Distal Cerebral Artery Aneurysms: A Single-Center Experience TURKISH NEUROSURGERY Sayin, B., Dereli, B., Senol, Y., Akmangit, I., Karaman, A., Daglioglu, E., Belen, A. 2023; 33 (3): 477-487

  Abstract

  To report our experience with the 2.5-mm Surpass EvolveTM flow diverter (FD) in the treatment of distal small cerebral artery aneurysms.This study included 41 patients with 52 aneurysms. Clinical and radiological records and procedural and follow-up outcomes were reviewed retrospectively.The aneurysm morphology was saccular in 45 patients, dissecting in five patients, and fusiform in two patients. Fifty-two aneurysms were treated with 41 Surpass Evolve FDs. The mean diameters of the proximal and distal parent arteries were 2.56 and 2.17 mm, respectively. The mean duration of follow-up was 16.2 ± 6.6 (6-28) months. Four (10%) patients had acute subarachnoid hemorrhage. In the same session, two patients with two tandem aneurysms and one patient with four tandem aneurysms were treated using a single FD. Intraprocedural hemorrhage and femoral artery pseudoaneurysm occurred in two patients during the procedure. Digital subtraction angiography was performed on 38/41 (92%) patients with 47/52 (88%) having aneurysms. Complete occlusion (OKM D) was observed in 39/47 (82%) aneurysms, and near complete-complete occlusion (OKM C-D) was observed in 46/47 (98%) aneurysms.Endovascular treatment of distal cerebral artery aneurysms with the 2.5-mm Surpass Evolve < sup > TM < /sup > FD provides a high rate of aneurysm occlusion with low periprocedural complications, even in ruptured and tandem aneurysms.

  View details for DOI 10.5137/1019-5149.JTN.42071-22.1

  View details for Web of Science ID 000996128800017

  View details for PubMedID 37222015

• Primary, Dural-based, Ewing sarcoma in a pediatric patient: presentation of a rare tumor entity with literature review CHILDS NERVOUS SYSTEM Guler, A., Senol, Y. 2023; 39 (4): 1071-1075

  Abstract

  Primary Ewing's sarcoma originating from the calvaria bone and/or underlying Dural involvement has been reported relatively rarely in the literature. Those originating from the dura and invading the bone above it in both directions, both towards the brain parenchyma and via the dura, are even rarer. CASE DESCRIPTION: We present a case of a 14-year-old girl with no known focal neurological deficit who presented with the complaint of vertigo for only 2 months. In neuroradiological examination, the left frontoparietal region of the brain showed the presence of a tumor originating from the dura, invading both bone and brain parenchyma. No other tumor location was discovered after radiological examination. Since the patient had a shift in the brain and progressive loss of strength on the right side, the patient was taken to surgery for tumor excision. The frozen result sent per-operatively was consistent with a round blue cell tumor. Adjuvant chemotherapy treatment was given to the patient after the definitive pathology report was compatible with Ewing's sarcoma. CONCLUSION: The patient had an uneventful neurological recovery without permanent neurological deficit. When the patient was kept under close clinical and radiological surveillance 1 year after the operation, no recurrence of the disease was observed. Bone marrow biopsy results and pet computerized tomography results confirmed the case of primary intracerebral Ewing sarcoma. This case illustrates an extremely rare location of primary Ewing's sarcoma with a set of clinical signs and symptoms extremely rare for this location of this rare disease entity.

  View details for DOI 10.1007/s00381-022-05767-2

  View details for Web of Science ID 000887870100002

  View details for PubMedID 36422696

• Endovascular treatment of challenging aneurysms with FRED Jr flow diverter stents: a single-center experience JAPANESE JOURNAL OF RADIOLOGY Sayin, B., Senol, Y., Daglioglu, E., Ozbakir, M., Orhan, G., Akmangit, I. 2023; 41 (3): 322-334

  Abstract

  To analyze clinical safety and efficacy of flow re-direction endoluminal device (FRED) Jr flow diverter for treatment of unruptured, ruptured, or recanalyzed aneurysms.Between October 2019 and February 2022, 25 patients with 31 aneurysms treated with FRED Jr were included in the study. Clinical and radiological records, procedural details, and follow-up outcomes were retrospectively evaluated. Eighteen (72%) patients were female. Median age was 48.8 (age range 9-85). Mean follow-up was 21 months (6-28 months). Location of the aneurysms were as follows; 13 in middle cerebral artery (MCA), 7 in anterior cerebral artery (ACA), 4 in posterior cerebral artery (PCA), 3 in true posterior communicating artery (PCom), 2 in anterior communicating artery (ACom), 1 in superior cerebellar artery (SCA), 1 in true ophthalmic artery. Five patients (20%) presented with acute subarachnoid hemorrhage (aSAH).In all procedures, FRED Jr was successfully deployed. Three true Pcom aneurysms and a true ophthalmic aneurysm were treated with FRED Jr. Three patients with two adjacent aneurysms were treated with a single FRED Jr. In two (8%) patients in-stent thrombosis occurred intraoperatively, they were treated with iv tirofiban and thrombectomy without any sequelae. Post-discharge 2 weeks later, intraparenchymal hemorrhage occurred in a patient. He was treated with surgical drainage, the clinical course was modified Rankin score (mRS) 2. Digital subtraction angiography (DSA) was performed on 16 (64%) patients with 21 (67%) aneurysms. Near complete-complete occlusion (O'Kelly-Morata grading scale (OKM C-D) was documented in 15/16 (93.7%) patients, 20/21 (95.2%) aneurysms. In nine (36%) patients, no residual filling was observed in the magnetic resonance angiography (MRA). Good clinical outcome (mRS 0-1) was achieved in 24/25 (96%) of patients.Endovascular treatment of small cerebral aneurysms with FRED Jr is safe and effective even in complex and challenging morphologies allowing high rates of aneurysm occlusion with low periprocedural complications. Our cohort, consisting of a rate 20% acute ruptured aneurysms, is the major additive data to the published literature.

  View details for DOI 10.1007/s11604-022-01354-2

  View details for Web of Science ID 000876842800001

  View details for PubMedID 36315360

  View details for PubMedCentralID PMC9619020

• An infant with posterior fossa hemangioma with aortic stenosis: Case report and review of the literature JOURNAL OF PEDIATRIC NEUROSCIENCES Senol, Y., Daglioglu, E., Basaran, O., Belen, A. 2022; 17 (4): 346-350

  View details for DOI 10.4103/jpn.JPN_15_21

  View details for Web of Science ID 001380248000014