November 2025 | Issue 60
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Featured in this issue:
ESMINT 2025
Dual- versus singlelayer stent retrievers for cancer-related stroke page 4
Weighing up current options in MMA embolisation page 9
Profile Paul Bhogal
In-utero intervention shows promise in foetal VOGM management
page 10
page 15
WHO unveils new report on global brain health
ANGEL-COAST
Contact aspiration’s first-pass benefits seemingly “offset” by inferior final recanalisation versus stent retrievers in basilar occlusion stroke In patients with vertebrobasilar artery occlusion (VBAO) stroke undergoing mechanical thrombectomy, first-line contact aspiration appears to produce a greater first-pass effect (FPE) compared to a stent retriever-only approach. However, stent retriever-first techniques may yield better final reperfusion rates, resulting in no significant difference in overall clinical outcomes between the two. As such, researchers believe that technique selection based on the underlying occlusion aetiology may be critical, and further analyses are warranted to clarify this relationship.
T
hese were the concluding messages delivered by Raul Nogueira (University of Pittsburgh School of Medicine, Pittsburgh, USA) at the 2025 World Stroke Congress (WSC; 22–24 October, Barcelona, Spain) based on new data from the ANGEL-COAST study—the findings of which Nogueira himself presented alongside co-investigator Dapeng Sun (Beijing Tiantan Hospital, Beijing, China). In his presentation, Nogueira noted that the superior FPE observed with contact aspiration was “offset” by a reduction in successful final recanalisation, leading to similar 90-day functional outcomes between groups of patients randomised to each of the two thrombectomy techniques. The presenter also highlighted the fact that first-line aspiration was not associated with an increased risk of periprocedural complications or intracranial haemorrhage (ICH), while the procedural durations
were comparable across both study groups. ANGEL-COAST was a multicentre, prospective, open-label, blinded-endpoint randomised controlled trial that enrolled 338 VBAO acute ischaemic stroke patients across 22 sites in China, allocating these patients to receive either contact aspiration or stent retrieval as a first-line thrombectomy approach. Its primary endpoint was FPE—defined as expanded thrombolysis in cerebral infarction (eTICI) 2c/3 recanalisation after the first thrombectomy attempt, without any rescue strategies—while notable secondary outcomes of interest included successful recanalisation, use of rescue therapies, procedure times and 90day modified Rankin scale (mRS) scores. According to Nogueira, within intention-to-treat analyses, Continued on page 7
NEUROLOGICAL CONDITIONS now affect more than 40% of the worldwide population—over three billion people—according to the World Health Organization’s (WHO) Global Status Report on Neurology, released at the 2025 World Congress of Neurology (WCN; 12–15 October, Seoul, South Korea). The report reveals that neurological conditions affect roughly one in three people, with more than 80% of this burden being in low- and middle-income countries. Despite this prevalence, too few countries have a standalone or integrated policy on neurology, only a minority include neurological services in universal health coverage benefit packages, and workforce shortages remain profound. “The science is clear and the path is practical,” said the WHO’s Tarun Dua. “If countries embed brain health in universal coverage, strengthen primary care, ensure access to essential medicines, reduce stigma, and invest in data systems, we can measurably improve lives, especially in settings where the need is greatest.” At WCN 2025, Dua called for an accelerated, society-wide push to make brain health a policy priority in every country. She urged physicians, policymakers and partners to align on integrated strategies that move care “from fragmented to coordinated”, and from urban specialty settings to strong, community-based primary care. “This is not a siloed agenda; it’s an integrated public health imperative,” Dua added.