Collateral Assessment Research Articles

Recruitment of pial collaterals and carotid occlusive disease in large-vessel occlusion ischemic stroke

Background and purposeDespite the fundamental role of pial collateral vessels in limiting the progression of ischemic tissue injury in acute stroke with large vessel occlusion (LVO), in addition to the fact that collateral vessel abundance varies naturally from person to person for genetic reasons, there is limited knowledge regarding potential factors contributing to inherent interindividual variation in pial collateral supply. As it has been repeatedly hypothesized that chronic carotid occlusive disease may favor pial collateralization, we aimed to investigate the association between quantitatively assessed leptomeningeal collateral supply and pre-existing carotid stenosis in patients with acute stroke due to LVO.Materials and methodsPatients with proximal middle cerebral artery (MCA) occlusion with or without additional internal carotid artery (ICA) occlusion were included. The degree of collateral supply was quantitatively assessed based on signal variance in T2*-weighted time series in perfusion-weighted magnetic resonance imaging (PWI). Patients were stratified into two groups according to quantitative collateral status (poor and fair to good collateral supply). The prevalence of high-grade ICA stenosis (≥70%) was evaluated in both groups.ResultsA total of 98 patients (mean age 68.8 ± 16.1 years, n = 52 (53.1%) of whom were female individuals) with MCA and/or ICA occlusion were included in the final analysis. Out of these patients, 42 had poor collateral supply, while 56 exhibited fair to good collateral supply. Additionally, 18 patients showed ipsilateral high-grade ICA stenosis. After classifying the entire cohort based on their collateral status (poor vs. fair to good collateral supply), there was no significant difference in the proportion of the patients with ipsilateral high-grade ICA stenosis between the two groups. Specifically, 6 (14.3%) patients had poor collateral supply, and 12 (21.1%) patients had fair to good collateral supply. The odds ratio (OR) was 1.58, with a 95% confidence interval (CI) of 0.490–5.685 and the p-value of 0.440. In the entire patient cohort, signal variance-based collateral supply was significantly correlated with initial stroke severity (r = −0.360, p < 0.001), baseline ischemic core volume (r = −0.362, p < 0.001), and functional outcomes (score on the modified Rankin Scale) at discharge (r = −0.367, p < 0.01).ConclusionIn this study, we performed a quantitative and observer-independent MRI-based collateral assessment in patients with LVO. We found no significant difference in the prevalence of pre-existing high-grade ICA stenosis between patients with fair to good collateral supply and those with poor collateral supply. The potential influence of demographic and clinical variables on pial collateral supply in patients with acute stroke warrants further exploration in future studies. MRI-based collateral supply is significantly related to initial stroke severity, ischemic core volume, and early functional outcomes.

A novel case of simultaneous tracheal stenting and endobronchial valve (EBV) deployment for tracheal stenosis and persistent air leak guided by an endobronchial collateral ventilation assessment system and digital chest drain in malignant esophageal carcinoma.

Persistent air leak may complicate malignant disease of the thorax, causing significant morbidity and mortality. A 51-year-old male with a 30-pack-year history of smoking was diagnosed with metastatic esophageal carcinoma with invasion into the right upper lobe of the lung. He developed a large right hydropneumothorax complicated by empyema leading to persistent air leak despite the insertion of two chest drains. Computed Tomography imaging with 3-dimensional reconstruction showed severe tracheal compression from the enlarging esophageal tumour as well as bronchopleural fistulas in the right upper lobe. Rigid bronchoscopy with metallic tracheal stenting was performed. This was followed by localization and quantification of air leak with an endobronchial collateral ventilation assessment system and a digital chest drain to guide endobronchial valve placement, in a single operative procedure. This novel combination of interventional bronchoscopy techniques enabled successful transition to an ambulatory chest drain and subsequent hospital discharge.

MRI-based Quantitative Collateral Assessment in Acute Stroke : AComparison with Single-phase CTA in Drip-and-ship Patients with Serial Imaging.

In acute ischemic stroke with large-vessel occlusion (LVO), collateral assessment with single-phase computed tomography angiography (CTA) might underestimate pial collateral supply in aconsiderable proportion of patients. We aimed to compare time-resolved magnetic resonance imaging (MRI)-based quantitative collateral mapping to conventional collateral imaging with CTA. This retrospective single-center study covering aperiod of 6years (2012-2018) included drip-and-ship LVO patients who underwent MR imaging after initial imaging evaluation with CT. For MRI-based collateral assessment, T2*-weighted time series from perfusion-weighted imaging (PWI) were processed to compute aquantitative collateral vessel index (CVIPWI) based on the magnitude of signal variance across the entire acquisition time. CTA-based collateral scores (Tan and Maas) and CVIPWI were investigated in terms of inter-modality associations between collateral measures, as well as their relationships with stroke severity, infarct volume and early functional outcome. The final analysis included n = 56patients (n = 31female, mean age69.9 ± 14.21 years). No significant relationship was found between MR-based quantitative collateral supply (CVIPWI) and CT-based collateral scores (r = -0.00057, p = 0.502 and r = -0.124, p = 0.797). In contrast to CVIPWI, CTA-based collateral scores showed no significant relationship with clinical stroke severity and infarct volume. While MR-based CVIPWI was independently associated with favorable early functional outcome in multivariate analysis (OR 1.075, 95% CI 1.001-1.153, p = 0.046), CTA-based collateral scores were not significantly associated with outcome. Since collateral scores based on single-phase CTA do not accurately reflect infarct progression and might underestimate pial collateralization in arelevant proportion of patients, they are not associated with early functional outcome in LVO patients. In contrast, CVIPWI represents arobust imaging parameter of collateral supply and is independently associated with functional outcome.

Collateral assessment on magnetic resonance imaging/angiography up to 30 hours after stroke onset.

We aimed to validate hyperintense vessel sign (HVS) on FLAIR imaging or posterior cerebral artery (PCA) laterality on MR angiography beyond 4.5 hours after stroke onset. Data from acute ischemic stroke patients with internal carotid or middle cerebral artery occlusion who underwent CT perfusion imaging at baseline, follow-up MR perfusion imaging and angiography within 30 hours after stroke, without effective recanalization on follow-up imaging, were analysed retrospectively. Patients were separately classified as high or low HVS (>5 or ≤5 slices of HVS), and PCA laterality positive or negative group. We compared core and penumbra volumes at follow-up imaging and neurological outcomes between high or low HVS group, and between PCA laterality positive or negative group. Of 49 patients analyzed, four patients with artifacts were excluded and 45 were classified into high (n = 23) or low (n = 22) HVS group. High group had a smaller core volume (median 32 ml versus 109 ml, p = 0.004), larger penumbra volume at follow-up (68 ml versus 0 ml, p = 0.001), and better outcomes (modified Rankin Scale at three months, 3 versus 5, p = 0.03). For PCA laterality analysis, 1 patient with previously occluded PCA was excluded and 48 patients were classified as positive (n = 22) or negative (n = 26). Positive group had larger core volume (116 ml versus 37 ml), and no significant differences in penumbral volumes or outcomes. Prominent HVS in later time was associated with small core volume, persistent penumbra volume and favorable outcomes.

Reconstructive Endovascular Treatment of Compensative-Flow-Related Posterior Circulation Aneurysms With Anterior Circulation Artery Occlusion.

The aim of this study was to delineate the reconstructive endovascular treatment and periprocedural management of compensative-flow-related posterior circulation aneurysms with anterior circulation artery occlusion. A total of 87 patients were enrolled in this retrospective double-center cohort study from May 2011 to November 2023. The baseline demographics, aneurysm characteristics, etiology and status of anterior circulation artery occlusion, treatment modalities, anesthesia management, complications, and clinical and angiographic outcomes of the patients were retrospectively analyzed in this study. Atherosclerosis and moyamoya disease were found to be the two main etiologies of anterior circulation artery occlusion. The mean American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology scores were significantly higher in patients with posterior communicating artery trunk collaterals than those with posterior cerebral artery pial collaterals (P < .05). Treatment strategies included stent-assisted coiling (55, 63.2%), standard coiling (22, 25.3%), and flow diversion or flow diversion-assisted coiling (8, 9.2%). The overall rate of procedure-related ischemic and hemorrhagic complications (10.3%) was considered acceptable. The ischemic complication was significantly associated with a >20% drop in mean arterial pressure (P < .05) during the procedure. Finally, 86.2% of all patients showed a modified Rankin Scale score of 0 to 2 at the final clinical follow-up. Our study indicates that reconstructive endovascular treatments are feasible and effective strategies for compensative-flow-related posterior circulation aneurysms with anterior circulation artery occlusion. However, these treatments are associated with a risk of periprocedural ischemic complications, which can be reduced by collateral arterial assessment, appropriate periprocedural anesthesia management, and antiplatelet treatment.

Multi-phase CT-Angiography outperforms angiographic careggi collateral score and predicts functional outcome in acute ischemic stroke.

Collaterals are a strong determinant of clinical outcome in acute ischemic stroke (AIS) patients undergoing Endovascular Treatment (EVT). Careggi Collateral Score (CCS) is an angiographic score that demonstrated to be superior to the widely suggested ASITN/SIR score. Multi-phase CT-Angiography (mCTA) could be alternatively adopted for collateral assessment. We investigated whether mCTA had an equivalent predictive performance for functional outcome compared to CCS. Consecutive AIS patients undergoing EVT for large vessel occlusion within 24h from onset were analyzed. Receiver operating characteristic curves and multivariable logistic regression were investigated to evaluate the predictive performance of mCTA collateral score (range 0-5) and CCS (range 0-4) for good functional outcome (three-months modified Rankin Scale 0-2). We included 201 subjects (59.7% females, mean age 75), of whom 96 (47.7%) had good outcome at three-months. Both CCS (OR = 14.4, 95% CI = 6.3-33.8) and mCTA (OR = 23.8, 95% CI = 10.1-56.4) collateral scores were independent predictors of outcome. The AUC of CCS was 0.80 (95% CI 0.73-0.86) and the best cut-off was ≥ 3 (87% sensitivity, 71% specificity), while the AUC of mCTA collateral score was 0.84 (95% CI 0.78-0.90) with an optimal cut-off of ≥ 4 (85% sensitivity, 87% specificity). Patients with good mCTA collaterals experienced smaller (16.6 vs. 63.7 mL, p < 0.001) infarct lesion as compared to those with mCTA poor collaterals. mCTA discriminative ability for three-months 0-2 mRS was found to be comparable to CCS. mCTA appears a valid, non-invasive imaging modality for evaluating collaterals of AIS patients potentially eligible for EVT.

Collaterals at angiography guide clinical outcomes after endovascular stroke therapy in HERMES

BackgroundRobust collateral circulation has been linked with better reperfusion and clinical outcomes. It remains unclear how individual assessments of collateral circulation may be translated into clinical practice.MethodsThe pooled Highly Effective...

Quantitative Assessment of Acute Intracranial Clot and Collaterals on High-Resolution Magnetic Resonance Imaging.

There has been an increasing demand for imaging methods that provide a comprehensive evaluation of intracranial clot and collateral circulation, which are helpful for clinical decision-making and predicting functional outcomes. We aimed to quantitatively evaluate acute intracranial clot burden and collaterals on high-resolution magnetic resonance imaging (HR-MRI). We analyzed acute ischemic stroke patients with internal carotid artery or middle cerebral artery occlusion in a prospective multicenter study. The clot burden was scored on a scale of 0-10 based on the clot location on HR-MRI. The collateral score was assigned on a scale of 0-3 using the minimum intensity projection from HR-MRI. Uni- and multivariable logistic regression analyses were performed to assess their correlation with clinical outcome (modified Rankin Scale &gt;2 at 90 days). Thresholds were defined to dichotomize into low- and high-score groups, and predictive performances were assessed for clinical and radiologic outcomes. Ninety-nine patients (mean age of 60.77 ± 11.54 years) were included in the analysis. The interobserver correlation was 0.89 (95% CI: 0.77-0.95) for the clot burden score and 0.78 (95% CI: 0.53-0.90) for the collateral score. Multivariable logistic regression analysis demonstrated that the collateral score (odds ratio: 0.41, 95% CI: 0.19-0.90) was significantly associated with clinical outcomes. A better functional outcome was observed in the group with clot burden scores greater than 7 (p = 0.011). A smaller final infarct size and a higher diffusion-weighted imaging-based Alberta Stroke Program Early Computed Tomography Score were observed in the group with collateral scores greater than 1 (all p &lt; 0.05). HR-MRI offers a new tool for quantitative assessment of clot burden and collaterals simultaneously in future clinical practices and research endeavors.

Hypoperfusion intensity ratio correlates with collaterals and predicts outcome and infarct volume in acute ischemic stroke patients.

Hypoperfusion Intensity Ratio (HIR) is associated with collaterals and outcome in acute ischemic stroke (AIS). We investigated whether a combined assessment of HIR and collaterals could provide an added value. Retrospective single-center study, including AIS patients with large vessel occlusion and endovascular treatment 0-24 h from onset. Predictors of FIV and outcome (90 days modified Rankin Scale 0-1) were investigated with linear and logistic regression respectively. Subjects were stratified in three groups: poor collaterals (grade 0-3) with poor HIR (≥.4), good collaterals (grade 4-5) with poor HIR/poor collaterals with good HIR (<.4) and good collaterals with good HIR. We included 337 patients (median age 77, 53.1% males), of whom 100 (29.7%) had excellent outcome. One hundred and forty five patients with favourable collateral and HIR profiles had smaller infarct (median poor collaterals with poor HIR 41 mL, good collaterals with poor HIR/poor collaterals with good HIR 21 mL and good collaterals with good HIR 11 mL, p <.001) and higher rates of excellent outcome (poor collaterals with poor HIR 15.7%, good collaterals with poor HIR/poor collaterals with good HIR 26.2% and good collaterals with good HIR 39.3% p =.001). Logistic regression showed that patients with favourable collateral and HIR profiles had the highest odds of good outcome (OR: 3.83, 95% CI 1.62-9.08, p =.002). Collaterals and HIR are independent predictors of final infarct lesion and outcome in stroke patients and their integration provides an added value. These findings might inform clinical practice and future trials.

The clinical and imaging data fusion model for single-period cerebral CTA collateral circulation assessment.

The Chinese population ranks among the highest globally in terms of stroke prevalence. In the clinical diagnostic process, radiologists utilize computed tomography angiography (CTA) images for diagnosis, enabling a precise assessment of collateral circulation in the brains of stroke patients. Recent studies frequently combine imaging and machine learning methods to develop computer-aided diagnostic algorithms. However, in studies concerning collateral circulation assessment, the extracted imaging features are primarily composed of manually designed statistical features, which exhibit significant limitations in their representational capacity. Accurately assessing collateral circulation using image features in brain CTA images still presents challenges. To tackle this issue, considering the scarcity of publicly accessible medical datasets, we combined clinical data with imaging data to establish a dataset named RadiomicsClinicCTA. Moreover, we devised two collateral circulation assessment models to exploit the synergistic potential of patients' clinical information and imaging data for a more accurate assessment of collateral circulation: data-level fusion and feature-level fusion. To remove redundant features from the dataset, we employed Levene's test and T-test methods for feature pre-screening. Subsequently, we performed feature dimensionality reduction using the LASSO and random forest algorithms and trained classification models with various machine learning algorithms on the data-level fusion dataset after feature engineering. Experimental results on the RadiomicsClinicCTA dataset demonstrate that the optimized data-level fusion model achieves an accuracy and AUC value exceeding 86% . Subsequently, we trained and assessed the performance of the feature-level fusion classification model. The results indicate the feature-level fusion classification model outperforms the optimized data-level fusion model. Comparative experiments show that the fused dataset better differentiates between good and bad side branch features relative to the pure radiomics dataset. Our study underscores the efficacy of integrating clinical and imaging data through fusion models, significantly enhancing the accuracy of collateral circulation assessment in stroke patients.

Analisis Sistem Penyaluran Kredit Perbankan (Studi Kasus Pada PT BPR Supra Artapersada Kantor Pusat Operasional)

The banking industry has a role to support the economy which can be done through collecting funds and channeling it back in the form of credit, so that the bank is tasked with being a financial intermediary that connects existing funds from economic units with excess funds to economic units that need financial assistance (deficit), whether it's for working capital, investment and consumption (Effendi 2020). This study aims to find out whether the credit distribution system implemented by PT BPR Supra Artapersada at the Operational Head Office is based on procedures. Use of Qualitative Description as a method in this study, the data used is by collecting data from research objects and analyzing procedures and credit distribution systems. The research data was collected through interviews, observation, and documentation. The results of the research show that credit distribution processes are carried out in various stages of the procedure, namely: the credit application stage, the interview stage, data analysis, debtor visits, collateral assessment, credit analysis, credit decisions, credit binding, and credit disbursement. By having an in-depth understanding of this process and the factors that influence it, we can identify areas for improvement and implement relevant measures to enhance the success of the credit distribution system.

Vascular Endothelial Growth Factor (VEGF) and Its Role in the Cardiovascular System.

Cardiovascular diseases remain the leading cause of death worldwide, with ischemic heart disease (IHD) as the most common. Ischemia-induced angiogenesis is a process in which vascular endothelial growth factor (VEGF) plays a crucial role. To conduct research in the field of VEGF's association in cardiovascular diseases, it is vital to understand its role in the physiological and pathological processes in the heart. VEGF-based therapies have demonstrated a promising role in preclinical studies. However, their potential in human therapies is currently under discussion. Furthermore, VEGF is considered a potential biomarker for collateral circulation assessment and heart failure (HF) mortality. Additionally, as VEGF is involved in angiogenesis, there is a need to elucidate the impact of VEGF-targeted therapies in terms of cardiovascular side effects.

Economic Sociology Review of Car Pawn Practices in Pinrang Regency

This thesis delves into the Economic Sociology Review of Car Pawn Practices in Pinrang Regency. The study aims to explore the practice of car pawning, factors influencing people's decision to pawn their cars, and the economic sociology perspective on car pawning. The research adopts a qualitative approach, specifically phenomenology. Data collection techniques include interviews, observations, and documentation, with data validity assessed through credibility, transferability, dependability, and confirmability. Key findings of the study include: 1) Car pawning practices are prevalent in Lanrisang and Siparappe neighborhoods in Pinrang Regency, with pawnshops operating without registration with the Financial Services Authority. The assessment of collateral is conducted by the pawnbroker, impacting the loan amount and monthly interest rates. Transactions are documented through receipt slips, and if the loan defaults, ownership of the collateral is transferred or sold by the pawnbroker. 2) People opt for car pawning due to its lenient requirements, non-restrictive operating hours, and minimal conditions for loan approval. 3) Economic actions in the context of economic sociology are characterized as irrational actions influenced by motives, interests, experiences, and expectations. These actions fall into the categories of affective and traditional actions. Keywords: Economic Sociology, Car Pawn

The impact of large core and late treatment trials: An update on the modelled annual thrombectomy eligibility of UK stroke patients.

To support decisions about thrombectomy provision, we have previously estimated the annual UK population eligible for treatment as ∼10% of stroke admissions. Since then, eight further randomised trials that could alter the eligibility rate have reported in 2021-23. We updated our estimates of the eligible population from these trials and other recent studies. An updated decision tree describing the EVT eligible population for UK stroke admissions was produced. Decision criteria were derived from the highest level of evidence available. For nodes where no specific RCT data existed, evidence was obtained from the latest systematic review(s) or the highest quality observational data. We estimate that 15,420 (approximately 15%) of admitted UK stroke patients are now eligible for thrombectomy, or 14,930 if advanced brain imaging using MRI/CT perfusion or collateral assessment were used in all patients. This is a 54% increase in our previous estimate in 2021. Over 50% of LAO strokes are now potentially eligible for thrombectomy. The increase in eligibility is principally due to a much larger cohort of later presenting and/or larger ischaemic core patients. Most previously independent LAO stroke patients presenting within 24 h, even in the presence of a large ischaemic core on initial non-contrast CT, should be considered for thrombectomy with use of advanced brain imaging in those presenting beyond 12 h to identify salvageable penumbral brain tissue. Treatment in most patients remains critically time-dependent and our estimates should be interpreted with this in mind.

Abstract WMP66: Detecting Medium Vessel Occlusions and Collateral Assessment With Multimodality AI Approach

Introduction: Recent advances and the use of Artificial intelligence (AI) is changing the standards of care in stroke patients. AI software has a high sensitivity and specificity for identifying Large Vessel Occlusions (LVOs), but the accuracy for detecting Medium Vessel Occlusions (MeVOs) is limited. We investigated the performance of the combination of two different AI modules for the identification of MeVOs. Methods: 150 patients with MeVOs were identified on CTA, using CTP to help localize the lesions, from retrospective databases at the MUSC, Stanford, and Royal Melbourne. Additionally, 55 patients with LVOs on CTA were included. A neuroradiologist confirmed the occluded vessel on CTA for each patient. LVOs were defined as occlusions of the intracranial ICA or horizontal segment of the M1. MeVOs were defined at M2, M3, ACA (A2/A3), or PCA (P2/P3) occlusions. All cases were processed through Rapid LVO, the Rapid Vessel Density module (which assesses hemispheric differences in blood vessel density), and Rapid CTP (Ischemaview Inc., Menlo Park, CA), [AZ1] using automated hypoperfusion intensity ratio (HIR) on CT perfusion (CTP), which estimates collateral flow, differed in LVOs vs. MeVOs. Results: Rapid LVO alone identified occlusions in 41/150 (27.3%) of MeVO patients. Rapid Vessel Density maps identified an additional 38/150 (25.3%) patients with either a 20-25% vessel density reduction or 26-40% reduction. Together, these two modules identified 79/150 (52.6%) of MeVO patients. 54/55 (98.1%) of the LVOs were detected by the Rapid LVO module. The mean HIR was lower in MeVO vs. LVO patients (0.25 vs. 0.45, P-value &lt; 0.001). Patients with M1 or ICA occlusions (LVOs) had average HIRs of 0.46 and 0.47 respectively. Patients with M2, M3, ACA, or PCA occlusions (MeVOs) had average HIRs of 0.30, 0.14, 0.22, and 0.20 respectively. Conclusion: MeVos detection was almost doubled with the use of the RapidAI Vessel Density in conjunction with the LVO module.

Abstract 23: Results of CRISP2: CTP and CTA Assessment of Collaterals Predicts Inter-Hospital Infarct Growth

Background: Acute ischemic stroke patients with a large vessel occlusion (LVO) who present in a primary stroke center (PSC) without endovascular treatment capability, are often transferred to a comprehensive stroke center (CSC) for thrombectomy. CRISP2 was a prospective NIH funded multi-center study that aimed to determine characteristics associated with infarct growth during inter-hospital transfer. Methods: Data from patients with an anterior circulation LVO transferred to two CSCs were collected. A CT perfusion (CTP) was obtained at the PSC followed by an MRI at the CSC, before consideration of thrombectomy. The inter-hospital infarct growth rate was defined as the difference between the co-registered infarct volumes on MRI and CTP, divided by the time between the two scans. Multivariable logistic regression was used to determine characteristics associated with fast inter-hospital progression, defined as a growth rate ≥ 5ml/h. The hypoperfusion intensity ratio (HIR) was calculated automatically from the CTP, while the Tan collateral score was visually rated on baseline CT angiography. Results: A total of 183 patients, of whom 45% were fast progressors, were included. Baseline characteristics are presented in Table 1 . An HIR ≥0.40 identified fast infarct growth with a sensitivity of 0.76 (95%CI 0.65-0.84) and a specificity of 0.55 (95%CI 0.44-0.65), whereas for Tan 0-1 sensitivity was 0.37 (95%CI 0.27-0.48) and specificity 0.93 (95%CI 0.86-0.97). In multivariable models, baseline core volume and poor collaterals defined as either an HIR ≥ 0.40 (aOR = 2.18 (95%CI 1.10-4.42); p = 0.03) or a Tan score of 0-1 (aOR = 4.74 (95%CI 1.90-13.07); p=0.001), remained independently associated with fast infarct growth. Conclusion: An HIR ≥ 0.40 is a predictor of fast inter-hospital infarct growth with high sensitivity and a Tan score of 0-1 predicts fast growth with high specificity. These are promising imaging markers for patient selection in future neuroprotective trials.

Automated evaluation of collateral circulation for outcome prediction in acute ischemic stroke

IntroductionThe assessment of collateral circulation in acute ischemic stroke management is essential. Modern tools, such as Brainomix's e-CTA, powered by artificial intelligence, provide detailed insights into collateral assessment. This retrospective study aims to identify factors contributing to favorable collateral status and compare outcomes between patients with good collaterals (grade 3) and fair collaterals (grade 0–2). MethodThis retrospective study included 97 patients admitted to the Stroke Unit at the Hospital de Clínicas of the Federal University of Paraná, Brazil, from September 2021 to January 2023. Comparative analyses involved demographic factors, cardiovascular risk factors, and the combined outcome of mortality and moderate to severe disability at discharge, 30-day, and 90-day follow-ups. ResultsAmong the 97 cases, 58.8 % showed 'good collaterals' with a grade 3 status. Variables affecting collateral status included age (p = 0.042), neutrophil-lymphocyte ratio (p = 0.005), and initial NIHSS scores (p<0.001). The presence of good collaterals according to e-CTA reduced the odds of death and moderate-severe disability at discharge (p = 0.003; OR 0.27) and at 30 days (p = 0.015; OR 0.33), although this effect diminished at the 90-day mark after multivariate analysis. DiscussionAutomated collateral assessment through e-CTA is a valuable tool in acute ischemic stroke evaluation. Good e-CTA collateral score serve as a promising imaging biomarker, guiding informed clinical decisions during Stroke Unit hospitalizations. This study highlights the relationship between collaterals and stroke outcomes and underscores the potential for AI-driven tools to enhance stroke care management.

CREDIT RISK MANAGEMENT OF “HALYK BANK” JSC: PROBLEMS AND SOLUTIONS

The purpose of the research work is to reveal the essence of the credit risk system, study the causes of its occurrence, and conduct a detailed analysis of the loan portfolio and credit risk management methods on the example of the commercial bank "Halyk Bank of the Republic of Kazakhstan" JSC. The authors analyze the loan portfolio of the bank using CAMELS, Z - score methods and build a regression analysis using R-studio, identify the main problems in credit risk management in a commercial bank and propose some solutions. In this article such problems in credit risk management as incomplete credit risk assessment, weak credit risk monitoring, insufficient collateral assessment, improper risk diversification, insufficient credit risk management policy are identified, and several solutions and methods for their improvement are proposed. The informational approach to solving the set goals is formed based on existing scientific research, published periodicals, scientific articles and financial statements of the bank, and its statistical data is used as material for writing a research paper.

A Quantitative Computed Tomography Analysis of Fissure Integrity and Emphysema Destruction in Japanese Patients with Severe Chronic Obstructive Pulmonary Disease.

Objective Bronchoscopic lung volume reduction (BLVR) using a one-way endobronchial valve (EBV) can provide clinically meaningful benefits to chronic obstructive pulmonary disease (COPD) patients. Although the Japanese Pharmaceuticals and Medical Devices Agency approved EBVs in November 2022, information regarding the number of Japanese patients with severe COPD eligible for BLVR treatment is still lacking. We therefore screened computed tomography (CT) images of patients with severe COPD using a quantitative CT (QCT) analysis to estimate the proportion of candidates eligible for BLVR treatment with an EBV. Methods CT scans of COPD patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages 3 and 4 were retrospectively analyzed using QCT to evaluate fissure integrity and tissue destruction. The difference in volume-weighted percentage was measured using the density scores of the target lobe and ipsilateral non-target lobe at -910 Hounsfield units. The target lobe was defined as the most affected lobe, with an emphysema destruction score of >50% for each patient. Results High-resolution CT scans of 32 patients (GOLD 3=19, GOLD 4=13) were analyzed. The target lobe could not be identified in 1 patient, whereas the target lobes for 8 patients were not surrounded by fissures with ≥80% completeness. Conversely, in 13 patients, the target lobes were surrounded by fissures with >95% completeness. The remaining 10 patients had fissure completeness between 80% and 95% at the target lobes and were considered candidates for collateral ventilation assessment. Conclusion A QCT analysis showed that 23 of 32 patients with severe COPD could be considered for a thorough examination of BLVR treatment with EBV.

The Bank's Authority In Determining The Value Of The Collateral Post Implementation Of The Minister Of Finance Regulation Number 228/PMK.01/2019 Concerning The Second Amendment To The Regulation Of The Minister Of Finance Number 101/PMK.01/2014 Concernin

Assessing collateral as an important aspect in providing credit, the fact is that the majority of internal banking appraisers are not required to fulfill the definition of competency as intended in Minister of Finance Regulation Number 228/PMK.01/2019, namely having a certification exam and further professional education, p. Another fact that is a fact is the obstacles in banking, especially in areas where there are no independent appraisal branches. The formulation of the problem raised in this research is what is the authority of collateral appraisers in carrying out collateral assessments after the issuance of changes to Minister of Finance Regulation Number 228/PMK.01/2019 and what obstacles are faced, especially by banks, after the issuance of Minister of Finance Regulation Number 228/PMK.01/2019 . This type of research is Normative legal research. This research uses a statutory approach. From this research, there is a lack of clarity regarding the implementation of Minister of Finance Regulation Number 228/PMK.01/2019 with Bank Indonesia Regulation Number 18/16/PBI/2016 so that there are still many collateral appraisers who do not meet the competency requirements in question who still carry out collateral appraisal as a basis for the credit analysis process. banking, and this will be very risky for the results of the collateral assessment both in terms of quality and also in terms of legal legality. Another thing is that banks in several regions are hampered in the credit process because there is no Public Appraisal Service Office branch which is mandatory.