A superb study and a highly relevant one...
The technology, infrastructure and the medical services have decreased the fatality in stroke. while this does lead to independence for ADL and professional activities also in some cases, many stay dependent, putting a burden on the family and the society.
What we have to do is not just to improve the post-event medical facilities, but to improve the pre-event medical system so that stroke does not happen. That would be our true victory....and sadly no business for me, an interventional neuroradiologist.

Remarkable Decline in Ischemic Stroke Mortality Is not Matched by Changes in Incidence [Original Contributions]:
Background and Purpose—
In Western Europe, mortality from ischemic stroke (IS) has declined over several decades. Age–sex-specific IS mortality, IS incidence, 30-day case fatality, and 1-year mortality after hospital admission are essential for explaining recent trends in IS mortality in the new millennium.
Methods—
Data for all IS deaths (1980–2010) in the Netherlands were grouped by year, sex, and age. A joinpoint regression was fitted to detect points in time at which significant changes in the trends occur. By linking nationwide registers, a cohort of patients first admitted for IS between 1997 and 2005 was constructed and age–sex-specific 30-day case fatality and 1-year mortality were computed. IS incidence (admitted IS patients and out-of-hospital IS deaths) was computed by age and sex. Mann–Kendall tests were used for trend evaluation.
Results—
IS mortality declined continuously between1980 and 2000 with an attenuation of decline in the 1990s in some of the age–sex groups. A remarkable decline in IS mortality after 2000 was observed in all age–sex groups, except for young men. An improved decline in 30-day case fatality and in 1-year mortality was also observed in almost all age–sex groups. In contrast, IS incidence remained stable between 1997 and 2005 or even increased slightly.
Conclusions—
The recent remarkable decline in IS mortality was not matched by a decline in the number of incident nonfatal IS events. This is worrying, because IS is already a leading cause of adult disability, claiming a heavy human and economic burden. Prevention of IS is therefore now of the greatest importance.

A very interesting article.....I have thought of doing IAT for such 'distal  MCA' occlusions often but somehow always found noninvasive management better -either IVT  or medical management as indicated...
The problem for me is the smaller infarct volume and relatively preserved clinical status of such patients, at least in my practice, and the complication rate associated with the IAT.
But of course 50+ % success rate is reasonably good....but in our center we have fairly good clinical  outcomes in such patient with IVT...
I am still not impressed in spite of this article...

Is Intra-Arterial Thrombolysis Beneficial for M2 Occlusions? Subgroup Analysis of the PROACT-II Trial [Brief Report]:
Rahme, R et al, Stroke ASAP Dec 2012
Background and Purpose—
The role of endovascular therapy for acute M2 trunk occlusions is debatable. Through a subgroup analysis of Prolyse in Acute Cerebral Thromboembolism-II, we compared outcomes of M2 occlusions in treatment and control arms.
Methods—
Solitary M2 occlusions were identified from the Prolyse in Acute Cerebral Thromboembolism-II database. Primary endpoints were successful angiographic reperfusion (TICI 2–3) at 120 minutes and functional independence (mRS 0–2) at 90 days.
Results—
Forty-four patients with solitary M2 occlusions, 30 in the treatment arm and 14 in the control arm, were identified. Successful reperfusion (TICI 2–3) was achieved in 53.6% and 16.7% of patients in the treatment and control arms, respectively (P=0.04). A favorable clinical outcome (mRS 0–2) was observed in 53.3% and 28.6%, respectively (P=0.19). Baseline characteristics were similar between the 2 groups.
Conclusions—
Intra-arterial thrombolysis may lead to a 3-fold increase in the rate of early reperfusion of solitary M2 occlusions and could potentially double the chance of a favorable functional outcome at 90 days.
Clinical Trial Registration—
This trial was not registered because enrollment began before July 1, 2005.

Aneurysm come in all shape and sizes and at all locations.

This one was in a 42 years old female patient with Grade I SAH and a ruptured right PcomA aneurysm.

The anatomy was odd with a bulbous, rather blister like proximal part, then a narrowing, then the body, again a narrowing then a teat like portion. The Pcom, of course, had to arise from the aneurysm; specifically it came at the site of first narrowing mentioned.

The aneurysm was directed laterally and posteriorly and had a curved structure rather.

The proximal bulbous portion measured 2.67 mm in diameter with equal neck and the distal narrower portions 2 mm.

So, I used an Echelon and Xpedion –ten system- to access the aneurysm.

Then i was in a fix as to how to go about fixing the aneurysm.

I put in a 2x6 3D AXIUM in the mid part of the aneurysm beyond the Pcom origin. The coil loops did try to go in the distal teat but somehow the entire coil could be fit in there.

Angio showed complete cessation of flow within that portion, with contrast stasis in the teat and the Pcom stayed patent.

However in the native images, still some space appeared within the coil mesh, so I took an AXIUM 2x4 Helix coil and pushed in.

The loops went into the first coil and then started to come into the proximal portion. Somehow, the loops in this part stayed horizontal thus restructuring the inflow zone and contrast flowing into the pcom.

But the last loop could not be fit in and kept pushing the microcatheter tip into the arterial lumen.

So I left the procedure at that point and put my hands up.

The patient is fine, and we all are happy, but do not know what this anueurysm was ot how best to treat it.

My surgeon too told he would have clipped in the midpart  so the result would have been same, or rather bad as this looked to me like an infundibulum which had ruptured and the distal portion to me was nothing but a pseudoaneurysm.

I am keeping my fingers crossed. let’s see….