Anterior Cerebral Research Articles

Atypical Manifestation of Zoster Meningitis Presented with Headache and Multiple Cerebral Vasoconstrictions

Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by headaches and multiple transient cerebral vasoconstrictions. Central nervous system (CNS) infections related to the varicella zoster virus (VZV) can complicate various neurological disorders, including cerebral vasculopathy. We present the case of a patient who complained of a severe headache without any other symptoms or focal neurological signs. Brain magnetic resonance angiography showed multiple focal stenoses, especially in the right middle cerebral artery (MCA), and transcranial Doppler sonography revealed increased velocities in the MCA and right anterior cerebral artery. Initially, the headache was attributed to RCVS, and nimodipine infusion was initiated; however, the headache worsened. A cerebrospinal fluid study showed pleocytosis, increased protein levels, and positive polymerase chain reaction markers for VZV. No skin lesions or fever were observed during treatment. Our case emphasizes considering VZV meningitis as a cause of cerebral vasoconstriction, even in the absence of typical signs of CNS infection.

The Lateral Supraorbital Approach: 2-Dimensional Operative Video.

The lateral supraorbital approach (LSO), a minimally invasive alternative to the pterional approach, can be used for anterior circulation aneurysms (except distal anterior cerebral artery), some posterior circulation aneurysms, and tumors located around the sellar and suprasellar regions. Performing one-layer myocutaneous flap that is retracted anteriorly, exposure of the superior temporal line, and zygomatic process of the frontal bone and the inferior limit of the craniotomy represent the upper edge of the Sylvian fissure, exposing the anterolateral skull base. Skin incision behind the hairline, one-layer myocutaneous flap retracted anteriorly, minimal detachment of the temporalis muscle, burr hole over the superior temporal line, and craniotomy of 4 cm in diameter (inferior limit of the craniotomy represents the Sylvian fissure). Potential risks include opening of the frontal sinus, entering the orbit and exposure of the orbital fat, wrong craniotomy location, and limited exposure. Inadequate craniotomy size limits instruments maneuverability. To avoid complication, identification of anatomic landmarks, sinus closure, preoperative evaluation of computed tomography scans, and use of neuronavigation are necessary. This requires surgical expertise and familiarity of minimal invasive craniotomies. Anatomic limitations of the LSO include temporomesial region, distal Sylvian +/-, posterior communicating artery aneurysms medial projection, retro carotid space, and carotid cave. For pathologies requiring an additional lateral trajectory, we use an extended LSO, drilling the sphenoid wing through the fronto-pterio-orbital window without drilling of the temporal bone. Additional variations include performing an intradural or extradural clinoidectomy. The patient consented to the procedure and to the publication of their image.

Exploring the impact of super-resolution deep learning on MR angiography image quality.

The aim of this study is to assess the effect of super-resolution deep learning-based reconstruction (SR-DLR), which uses k-space properties, on image quality of intracranial time-of-flight (TOF) magnetic resonance angiography (MRA) at 3 T. This retrospective study involved 35 patients who underwent intracranial TOF-MRA using a 3-T MRI system with SR-DLR based on k-space properties in October and November 2022. We reconstructed MRA with SR-DLR (matrix = 1008 × 1008) and MRA without SR-DLR (matrix = 336 × 336). We measured the signal-to-noise ratio (SNR), contrast, and contrast-to-noise ratio (CNR) in the basilar artery (BA) and the anterior cerebral artery (ACA) and the sharpness of the posterior cerebral artery (PCA) using the slope of the signal intensity profile curve at the half-peak points. Two radiologists evaluated image noise, artifacts, contrast, sharpness, and overall image quality of the two image types using a 4-point scale. We compared quantitative and qualitative scores between images with and without SR-DLR using the Wilcoxon signed-rank test. The SNRs, contrasts, and CNRs were all significantly higher in images with SR-DLR than those without SR-DLR (p < 0.001). The slope was significantly greater in images with SR-DLR than those without SR-DLR (p < 0.001). The qualitative scores in MRAs with SR-DLR were all significantly higher than MRAs without SR-DLR (p < 0.001). SR-DLR with k-space properties can offer the benefits of increased spatial resolution without the associated drawbacks of longer scan times and reduced SNR and CNR in intracranial MRA.

Circulus Willis Anomalies Diagnosed with CT Angiography and Evaluation of Their Relations with Ischemic Stroke

Our aim in this study is examining the frequency of posterior communicating artery (PCoM), Anterior Cerebral Artery A1 segment (ACA AI) and Fetal type posterior cerebral artery (FPCA) anomalies and their effects on ischemic stroke by retrospectively analyzing examinations of Computerized Tomography Angiography (CTA) taken in our hospital within 2017. 22 cases (26.5%) diagnosed with bilateral hypoplastic / aplastic PCoA anomaly, were diagnosed with anterior circulation infarct, 24 cases (28.9%) were diagnosed with posterior circulation infarct, but 37 cases (44.6%) were not diagnosed with ischemic stroke. 17 (37.8%) of the cases who have unilateral hypoplastic / aplastic PCoA anomaly, were diagnosed with anterior circulation infarct, 14 cases (31.1%) were diagnosed with posterior circulation infarct. 13 (26%) of 50 cases diagnosed with unilateral hypoplastic / aplastic ACA A1 segment, were diagnosed with anterior circulation infarct, 10 cases (20%) were diagnosed with posterior circulation infarct. 27 cases (54%) were not diagnosed with ischemic stroke. Both of 2 cases diagnosed with bilateral hypoplastic / aplastic ACA A1 segment, had anterior circulation infarct. 4 (30.8%) of 13 cases diagnosed with unilateral FPCA anomaly, were diagnosed with anterior circulation infarct, 3 cases (23.1%) were diagnosed with posterior circulation infarct, 6 cases (46.2%) did not have ischemic stroke symptoms. In conclusion, even though these variations’ role in optimum stroke prophylaxis in individuals having one or more stroke risk factors, has not determined yet, there is no doubt that clinical researcher will eliminate these uncertainties in future studies.

Improving the impact of different input arteries on cerebral CT perfusion parameters and ischemic penumbra

This study aims to examine the impact of different input arteries on cerebral perfusion parameters and the volume of core infarction, ischemic area, and penumbra automatically measured by software in post-processing 256-slice CT brain perfusion images. Retrospective analysis was conducted on brain perfusion images of 58 patients who underwent 256-slice multidetector CT examination for cerebral infarction. Various input arteries, including bilateral internal carotid artery (ICA), bilateral middle cerebral artery (MCA), anterior cerebral artery (ACA), and basilar artery (BA), were selected for image processing and measurements. The volumes of core infarction, ischemic area, and penumbra were automatically calculated using software. Additionally, manual measurements were per-formed by experienced doctors. Perfusion parameters including cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), and time to peak (TTP) were evaluated. The change of input artery resulted in a significant difference in CBF and MTT in the penumbra and normal brain tissue areas. However, no significant difference was observed in CBV, TTP, and perfusion parameters in the core infarct area. The volumes of core infarction acquired from different input arteries showed no significant difference. Nonetheless, significant differences were found in the volume of the ischemic area and the mismatched area. The selection of different input arteries affects CT cerebral perfusion parameter values and the automatic measurement of the ischemic area and penumbra by software. Thus, when performing post-processing of CT cerebral perfusion images, it is advisable to choose the thicker internal carotid artery on the healthy side as the input artery.

Coil embolization for ruptured distal anterior cerebral artery aneurysm at the supracallosal portion: Two case reports

Background: Distal anterior cerebral artery (ACA) aneurysms occur more frequently in the genu portion and much less frequently in the supracallosal portion (A4–A5). This report describes two cases of ruptured cerebral aneurysms occurring at the supracallosal portion successfully treated with coil embolization. Case Description: Case 1 involved a 61-year-old female with sudden-onset headache and vomiting attributed to subarachnoid hemorrhage (SAH). Digital subtraction angiography (DSA) revealed a bihemispheric ACA and aneurysm in the supracallosal portion. Coil embolization was performed, and the patient was discharged without neurological deficit. Case 2 involved a 35-year-old man with severe headache and disturbance of consciousness caused by SAH. DSA showed an aneurysm in A4 of the accessory ACA, and coil embolization was performed. After rehabilitation, he was discharged with a modified Rankin scale score of 2. Conclusion: Coil embolization for a ruptured aneurysm at the supracallosal portion can yield good results if the patient is appropriately selected.

Efficacy of enhanced extracorporeal counterpulsation combined with atorvastatin in the treatment of cognitive impairment after stroke.

Cerebral apoplexy patients are prone to cognitive impairment, and it is very important to choose appropriate treatment methods to improve their cognitive impairment after stroke. To evaluate the effects of enhanced external counterpulsation (EECP) in conjunction with atorvastatin on cognitive function, neurotransmitter levels, and the repair of brain tissue damage in patients with cognitive impairment due to stroke. In this retrospective study, data from 60 patients with poststroke cognitive impairment due to stroke who were treated in our hospital from February 2021 to July 2022 were analyzed and divided into a treatment group (n = 30) and a control group (n = 30) according to the different nursing methods applied. Patients in the treatment group received EECP in addition to atorvastatin, while those in the control group received atorvastatin alone. Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and activities of daily living (ADL) scale scores were compared between the two groups. Additionally, the two groups were compared in terms of serum acetylcholine (ACh), acetylcholinesterase (AChE), nitric oxide (NO), endothelin-1 (ET-1), β2-microglobulin (β2-MG), glial fibrillary acidic protein (GFAP), and visinin-like protein 1 (VILIP-1) in the serum. Blood flow measurements from the anterior cerebral artery (ACA), middle cerebral artery (MCA) and posterior cerebral artery (PCA) were compared between the two groups before and after treatment, and the pulsatility index (PI) and resistance index (RI) of each artery were determined. MMSE, MoCA, and ADL scores all improved in both groups following treatment, with the study group showing more improvement than the control group (P < 0.05). After treatment, there were statistically significant increases in both ACh and NO levels, whereas decreases occurred in AChE, ET-1, β2-MG, VILIP-1, and GFAP, levels and the PI and RI of the left-ACA, right-ACA, left-MCA, right-MCA, left-PCA, and right-PCA. The study group showed greater gains in all metrics than the control group (P < 0.05). EECP combined with atorvastatin is effective in the treatment of cognitive impairment after stroke and can effectively improve the cognitive function, neurotransmitter levels, and brain tissue damage status of patients.

A data-driven computational methodology towards a pre-hospital Acute Ischaemic Stroke screening tool using haemodynamics waveforms

Background and ObjectiveAcute Ischaemic Stroke (AIS), a significant global health concern, results from occlusions in cerebral arteries, causing irreversible brain damage. Different type of treatments exist depending on the size and location of the occlusion. Challenges persist in achieving faster diagnosis and treatment, which needs to happen in the first hours after the onset of symptoms to maximize the chances of patient recovery. The current diagnostic pipeline, i.e. “drip and ship”, involves diagnostic via advanced imaging tools, only available in large clinical facilities, which poses important delays. This study investigates the feasibility of developing a machine learning model to diagnose and locate occluding blood clots from velocity waveforms, which can be easily be obtained with portable devices such as Doppler Ultrasound. The goal is to explore this approach as a cost-effective and time-efficient alternative to advanced imaging techniques typically available only in large hospitals. MethodsSimulated haemodynamic data is used to conduct blood flow simulations representing healthy and different AIS scenarios using a population-based database. A Machine Learning classification model is trained to solve the inverse problem, this is, detect and locate a potentially occluding thrombus from measured waveforms. The classification process involves two steps. First, the region where the thrombus is located is classified into nine groups, including healthy, left or right large vessel occlusion, left or right anterior cerebral artery, and left or right posterior cerebral artery. In a second step, the bifurcation generation of the thrombus location is classified as small, medium, or large vessel occlusion. ResultsThe proposed methodology is evaluated for data without noise, achieving a true prediction rate exceeding 95% for both classification steps mentioned above. The inclusion of up to 20% noise reduces the true prediction rate to 80% for region detection and 70% for bifurcation generation detection. ConclusionsThis study demonstrates the potential effectiveness and efficiency of using haemodynamic data and machine learning to detect and locate occluding thrombi in AIS patients. Although the geometric and topological data used in this study are idealized, the results suggest that this approach could be applicable in real-world situations with appropriate adjustments. Source code is available in https://github.com/ahmetsenemse/Acute-Ischaemic-Stroke-screening-tool-.

A rare anatomical variation of the circle of Willis in a patient with an ischemic stroke

Purpose &#x0D; The cerebral arterial circuit provides collateral circulation to the brain and protects the brain from ischemia, by sustaining tissue perfusion in case of reduced or impaired blood flow through its branches. Although many random anatomical variations in the circle of Willis (CoW) are of minor importance, some increase the risk of ischemic events, aneurysm, and atherosclerosis, and play an important role in endovascular and surgical treatment planning. &#x0D; Case presentation &#x0D; We report a rare arterial variation of the CoW diagnosed by computed tomography angiography in a patient with ischemic stroke. We found aplasia of the A1 segment of the left anterior cerebral artery and ipsilateral hypoplasia of the P1 segment of the left posterior cerebral artery. &#x0D; Conclusion &#x0D; For neurosurgeons, neurologists, and neuroradiologists, detailed knowledge of the numerous anatomical variations in the arterial supply to the brain is crucial to make a correct diagnosis and choose the appropriate treatment. The type of CoW variation influences stroke severity and outcome, with an incomplete CoW related to more severe conditions (higher National Institutes of Health Stroke Scale scores, more severe neurological deficits, and worse neurological outcomes) and poor prognosis.

Differential sensitivities to blood pressure variations in internal carotid and intracranial arteries: a numerical approach to stroke prediction

Stroke remains a global health concern, necessitating early prediction for effective management. Atherosclerosis-induced internal carotid and intra cranial stenosis contributes significantly to stroke risk. This study explores the relationship between blood pressure and stroke prediction, focusing on internal carotid artery (ICA) branches: middle cerebral artery (MCA), anterior cerebral artery (ACA), and their role in hemodynamics. Computational fluid dynamics (CFD) informed by the Windkessel model were employed to simulate patient-specific ICA models with introduced stenosis. Central to our investigation is the impact of stenosis on blood pressure, flow velocity, and flow rate across these branches, incorporating Fractional Flow Reserve (FFR) analysis. Results highlight differential sensitivities to blood pressure variations, with M1 branch showing high sensitivity, ACA moderate, and M2 minimal. Comparing blood pressure fluctuations between ICA and MCA revealed heightened sensitivity to potential reverse flow compared to ICA and ACA comparisons, emphasizing MCA's role. Blood flow adjustments due to stenosis demonstrated intricate compensatory mechanisms. FFR emerged as a robust predictor of stenosis severity, particularly in the M2 branch. In conclusion, this study provides comprehensive insights into hemodynamic complexities within major intracranial arteries, elucidating the significance of blood pressure variations, flow attributes, and FFR in stenosis contexts. Subject-specific data integration enhances model reliability, aiding stroke risk assessment and advancing cerebrovascular disease understanding.

Proximal Clipping and Distal High-Flow Bypass in the Treatment of Giant/Complex Intracranial Aneurysm: An Opportunity or a Risk from a Fluid-Structural Interaction Analysis.

Conventional clipping and endovascular treatment are difficult to apply for some giant intracranial aneurysms (GIAs), and sometimes extracranial-to-intracranial (EC-IC) bypass becomes the optional choice. However, not all GIA patients can benefit from it. This study aims to recognize the underlying problems. We included eligible patients in our care. Then, we researched from three levels: a retrospective review of clinical data, fluid-structural analysis from two representative patient-specific models, and fluid-structural interaction analysis for idealized models to investigate the hemodynamic and biomechanical mechanisms. In this article, we report nine patients with GIA who underwent EC-IC surgery. Of them, three experienced dangerous postoperative hemorrhage, and one patient died. Among these three patients, two lacked the A1 segment of the anterior cerebral artery (ACA). The numerical simulation showed that after surgery, for the patient with an unruptured aneurysm and existence of ACA, the wall deformation, wall stress, pressure, and area of the oscillatory shear index (OSI) > 0.2 were decreased by 43%, 39%, 33%, and 13%, while the patient without A1 segment having postoperative hemorrhage showed 36%, 45%, 13%, and 55% increased, respectively. Thus, we postulated a dangerous "stump phenomenon" in such conditions and further demonstrated it from idealized models with different sizes of ACA. Finally, we found a larger anastomosis angle and smaller diameter of the graft can alleviate this effect. Neurosurgeon should cautiously evaluate the opportunity and risk for such patients who have aplasia of the A1 segment of ACA when making clinical decisions.

Fusiform aneurysms of anterior cerebral artery: center experience and systematic literature review

Fusiform aneurysms of anterior cerebral artery: center experience and systematic literature review

Hemodynamic Failure Staging With Blood Oxygenation Level-Dependent Cerebrovascular Reactivity and Acetazolamide-Challenged (15O-)H2O-Positron Emission Tomography Across Individual Cerebrovascular Territories.

Staging of hemodynamic failure (HF) in symptomatic patients with cerebrovascular steno-occlusive disease is required to assess the risk of ischemic stroke. Since the gold standard positron emission tomography-based perfusion reserve is unsuitable as a routine clinical imaging tool, blood oxygenation level-dependent cerebrovascular reactivity (BOLD-CVR) with CO2 is a promising surrogate imaging approach. We investigated the accuracy of standardized BOLD-CVR to classify the extent of HF. Patients with symptomatic unilateral cerebrovascular steno-occlusive disease, who underwent both an acetazolamide challenge (15O-)H2O-positron emission tomography and BOLD-CVR examination, were included. HF staging of vascular territories was assessed using qualitative inspection of the positron emission tomography perfusion reserve images. The optimum BOLD-CVR cutoff points between HF stages 0-1-2 were determined by comparing the quantitative BOLD-CVR data to the qualitative (15O-)H2O-positron emission tomography classification using the 3-dimensional accuracy index to the randomly assigned training and test data sets with the following determination of a single cutoff for clinical application. In the 2-case scenario, classifying data points as HF 0 or 1-2 and HF 0-1 or 2, BOLD-CVR showed an accuracy of >0.7 for all vascular territories for HF 1 and HF 2 cutoff points. In particular, the middle cerebral artery territory had an accuracy of 0.79 for HF 1 and 0.83 for HF 2, whereas the anterior cerebral artery had an accuracy of 0.78 for HF 1 and 0.82 for HF 2. Standardized and clinically accessible BOLD-CVR examinations harbor sufficient data to provide specific cerebrovascular reactivity cutoff points for HF staging across individual vascular territories in symptomatic patients with unilateral cerebrovascular steno-occlusive disease.

Rupture Risk Factors and Strategies for Unruptured Distal Anterior Cerebral Artery Aneurysms

Distal anterior cerebral artery (dACA) aneurysms are rare. Ruptured dACA aneurysms typically present with subarachnoid hemorrhage in conjunction with intracerebral hematoma and cause neurological deterioration. This study aimed to determine their risk of rupture and examine associated factors. We retrospectively analyzed patients with dACA aneurysms to compare patient and aneurysm characteristics between ruptured and unruptured aneurysms. Clinical outcome was used the modified Rankin scale. Univariate analyses were performed to identify rupture risk factors. One hundred three patients with dACA aneurysms were examined (51 ruptured and 52 unruptured). The median aspect ratio of ruptured and unruptured aneurysms was 1.69 and 1.22, respectively (P<0.01). The median maximum diameter of ruptured and unruptured aneurysms was 5.2 and 3.1mm, respectively (P<0.01). The median size ratio of ruptured and unruptured aneurysms was 3.32 and 2.17, respectively (P<0.01). Maximum diameter was <5mm in 45.2% of ruptured dACA aneurysms. dACA aneurysm, showing size ratio >2.4 and aspect ratio >1.4, had ruptured in 71.4% and 78.6%, respectively. We suggested that these are the threshold of size ratio and aspect ratio for rupture of dACA aneurysms. A total percentatge of 78.1% of aneurysms with aspect ratio >1.4 and size ratio >2.4 had ruptured. Distal anterior cerebral artery (dACA) aneurysms may rupture, even when small. We found a significant difference between ruptured and unruptured aneurysms with respect to maximum diameter, aspect ratio, and size ratio. Treatment for small aneurysms should be considered based on size ratio and aspect ratio, not just size.

Three-Vessel Anastomosis for Direct Multiterritory Cerebral Revascularization: Case Series.

Cerebral revascularization of multiple territories traditionally requires multiple constructs, serial anastomoses, or a combination of direct and indirect approaches. A novel 3-vessel anastomosis technique allows for direct, simultaneous multiterritory cerebral revascularization using a single interposition graft. We herein present our experience with this approach. Retrospective review of perioperative data and outcomes for patients undergoing multiterritory cerebral revascularization using a 3-vessel anastomosis from 2019 to 2023. Five patients met inclusion criteria (median age 53 years [range 12-73]). Three patients with complex middle cerebral artery aneurysms (1 ruptured) were treated with proximal ligation or partial/complete clip trapping and multiterritory external carotid artery-M2-M2 revascularization using a saphenous vein interposition graft. Two patients with moyamoya disease, prior strokes, and predominately bilateral anterior cerebral artery hypoperfusion were treated with proximal superficial temporal artery-A3-A3 revascularization using a radial artery or radial artery fascial flow-through free flap graft. No patients experienced significant surgery-related ischemia. Bypass patency was 100%. One patient had new strokes from vasospasm after subarachnoid hemorrhage. One patient required a revision surgery for subdural hematoma evacuation and radial artery fascial flow-through free flap debridement, without affecting bypass patency or neurologic outcome. On hospital discharge, median Glasgow Outcome Scale and modified Rankin Scale scores were 4 (range 3-5) and 2 (range 0-5), respectively. On follow-up, 1 patient died from medical complications of their presenting stroke; Glasgow Outcome Scale and modified Rankin Scale scores were otherwise stable or improved. The 3-vessel anastomosis technique can be considered for simultaneous revascularization of multiple intracranial territories.

Safety and Efficacy of Endovascular Coils and Non–Flow-Diverting Stents for Management of Unruptured Intracranial Aneurysms: A Location-Specific Outcomes Analysis

IntroductionThe relationship between the anatomical location of an unruptured saccular aneurysm, the efficacy and the potential complications associated with coil and non-flow-diverting stents remains poorly documented. Therefore, the aim of this study is to evaluate the efficacy and safety of endovascular treatment based on the anatomical position of the unruptured intracranial aneurysm (UIA). MethodsA retrospective cohort study was conducted using an anonymized database of patients who underwent endovascular therapy for UIA between 2014 and 2021. Results138 patients with 147 UIA were included. The immediate Raymond Roy I-II occlusion was achieved in 99.2% of patients in all anatomical locations, with a 96.2% occlusion rate at the 12-month follow-up. Complications occurred more frequently in the anterior cerebral artery (35%) and the internal carotid artery in its ophthalmic segment (25%), however the difference was not statistically significant. ConclusionOur study shows that endovascular treatment with stents and coils is effective and safe for managing unruptured intracranial aneurysms in various anatomical locations. Thromboembolic complications were significantly higher in the anterior cerebral artery located aneurysms.

STUDY OF “MAGNETIC RESONANCE IMAGING IN STROKE PATIENTS AT A TERTIARY HEALTH CARE CENTER”

Background: One of the main causes of mortality and disability worldwide is stroke. Cerebral infarction, non-traumatic subarachnoid hemorrhage, primary intracranial hemorrhage, and various dural sinus/cerebral vein obstruction are the different types of stroke. About 80–90% of strokes are ischemic strokes, which are the most frequent form of stroke. Aim of the Study: The aim of this study was to study “Magnetic resonance imaging in stroke patients at a tertiary health care center.” Methods: This was 18-month cross-sectional research conducted in the Department of Radiodiagnosis at the Shrisatyasai Medical College and Research Institute in Chengalpattu, Tamil Nadu, from December 2020 to June 2021. Results: In the present study, middle cerebral artery is 43.3%, posterior cerebral artery (PCA) is 16.7%, anterior cerebral artery is 13.3%, lacunar infarcts is 16.7%, multiple infarcts is 8.3%, and basilar excluding PCA is 1.7% in the present study. About 73.3% of the patients (44/60) had infarcts, 10% had hemorrhage (6/60), and 16.7% had stroke mimics (10/60). Conclusion: DWI is a better imaging method than conventional MRI in detecting early ischemic lesions in stroke patients with Sensitivity of 94% and specificity of 100% was observed among acute infarct patients.

The Safety and Efficacy of Leo Stents with Coiling or Alone for Anterior Cerebral Artery Aneurysms.

Treatment of anterior cerebral artery (ACA) aneurysms is still not well established. The Leo stent with blood flow direction is a retrievable stent for intracranial aneurysms, whereas it needs to be studied clearly in patients with ACA aneurysms. Consecutive patients with ACA aneurysms were retrospectively enrolled in three neurosurgical centers between January 2016 and October 2021. The data on demographics, aneurysm characteristics, symptom resolution, and postoperative course were collected and analyzed. The aneurysm occlusion status was appraised by Raymond-Ray Occlusion Class (RROC). A total of 57 patients with ACA aneurysms were included in our study. Immediate postprocedural angiograms showed that 20 aneurysms (35.1%) were in complete occlusion (RROC 1), 26 aneurysms (45.6%) were in near-complete occlusion (RROC 2), 11 aneurysms (19.3%) were in incomplete occlusion (RROC 3). The angiographic follow-up found that the rate of complete occlusion increased to 57.9%, and near-completion and incomplete occlusion dropped to 29.8% and 12.3%, respectively. The angiographic result of the last follow-up improved significantly (Z=- 2.805, P=0.005). Univariate analysis indicated that distal location of aneurysms (Z=4.538, P=0.033) and ruptured aneurysms (χ2=.6120, P=0.032) were potential risk factors for intra-parent artery narrowing. Furthermore, multivariate logistic regression analysis found that A3 aneurysms (95% CI 1.427~32.744, P=0.016) are the key risk factor for intra-parent artery narrowing. The Leo stent is safe and effective for aneurysms located in ACA circulations. The overall occlusion degree improved during follow-up. A distal, small artery was the risk factor for intra-parent artery narrowing.

P103: Middle Cerebral Artery Stenosis is Associated with Severity of Depression in Elderly Patients: Magnetic Resonance Angiography (MRA) Findings

Objective:Vascular abnormalities have been frequently reported in elderly adults as a potential risk factor of late-life depression. However, it is still unclear whether stenosis of cerebral arteries may increase risk of depression in the elderly.Methods:Study participants were 365 patients 65 years or older with depressive disorder who had undergone brain MRI and angiography (MRA) which were assessed by trained radiologists, and the 15-item Geriatric Depression Scale (GDS-15) and the Mini Mental State Examination (MMSE), and blood glucose and lipid profiles.Results:Of the 365 subjects, 108 had at least one location of cerebral artery stenosis (29.59%). Stenosis was associated with age, marital status, infarction, and atherosclerosis. In multivariable linear regression analysis of different locations of stenosis among the whole sample, only bilateral middle cerebral artery (MCA) stenosis was found to have a significant association with higher GDS-15 score (p= 0.0138), and more than 8 scores in the GDS-15 (p= 0.0045), but no significant associations with ACA (anterior cerebral artery), PCA (posterior cerebral artery) or ICA (internal carotid artery). In multivariable linear logistic analysis of different locations among patients with at least one cerebral artery stenosis, left MCA was found to be significantly related to higher GDS-15 scores but not with right MCA (p = 0.0202).Conclusion:MCA stenosis is significantly associated with severity of depression in elderly adults with cerebral artery stenosis, especially in those with left MCA stenosis.Key pointsPatients with cerebral artery stenosis found with brain magnetic resonance angiography (MRA) were associated with higher depression severity.Stenosis of both left and right middle cerebral artery (MCA) was associated with greater depression severity, with left MCA stenosis having a greater influence on depression severity than right MCA stenosis.Higher depression severity in patients with MCA stenosis suggests that depression in elderly patients is mediated at least in part by vascular pathology of MCA supplied regions and careful investigation and management of cerebral artery stenosis and their risk factors may help reduce the severity of depression in elderly patients who visit psychiatrists.

Characterization of brain metabolism, volume, and vasculature of the 5xFAD mouse model of Alzheimer’s Disease across lifespan.

AbstractBackgroundThe MODEL‐AD Consortium seeks to develop the next generation of Alzheimer’s Disease models based on human data. A popular model of familial AD is the 5xFAD mouse, characterized by early amyloid‐β deposition and cognitive decrements. Despite numerous studies, the 5xFAD mouse has not been comprehensively phenotyped for vascular and metabolic features over its lifespan.MethodMale and female 5xFAD and WT littermates underwent in vivo 18F‐FDG‐PET imaging at 4, 6, and 12 months of age to evaluate regional glucose metabolism. A separate cohort of mice (4, 8, 12 months) underwent “vessel painting” that labels all cerebral vessels with a fluorescent dye. “Vessel painted” brains were analyzed for vascular characteristics such as vessel density, junction density, vessel length, network complexity, number of collaterals and vessel diameter.ResultsOur analyses revealed that vessel length, vessel and junction densities increased from 4 to 12 months on the cortical surface in both 5xFAD and WT mice. The number of collateral vessels between the middle cerebral artery (MCA) and the anterior and posterior cerebral arteries decreased with age but their diameters were significantly increased only in 5xFAD mice. MCA average vessel length was decreased in 5xFAD mice compared to WT. Analysis of 18F‐FDG cortical uptake found significant interactions between WT and 5xFAD mice spanning 4‐12 months of age in retrosplenial, somatosensory and visual cortices. Broadly, 5xFAD males had increased 18F‐FDG uptake at 12 months of age compared to WT mice. In most cortical regions, female 5xFAD mice had reduced FDG uptake compared to WT across the lifespan. In males these metabolic increases coincided with decreased vessel characteristics.ConclusionThe 5xFAD mouse exhibits AD‐like cognitive deficits with age that are associated with increasing amyloid‐β deposition. No significant differences were found in cortical vascular features although males and females exhibited opposite effects in 18F‐FDG uptake. The MCA supplies blood to large portions of the motor cortex and increased vessel lengths and decreased collaterals along with higher metabolic rates in 5xFAD mice may be related to increasing behavioral deficits via metabolic insufficiency or other mechanisms.