Cerebral Arteries In Patients Research Articles

Volumetric microscopy of cerebral arteries with a miniaturized optical coherence tomography imaging probe.

Endovascular interventions are increasingly becoming the preferred approach for treating strokes and cerebral artery diseases. These procedures rely on sophisticated angiographical imaging guidance, which encounters challenges because of limited contrast and spatial resolution. Achieving a more precise visualization of the underlying arterial pathology and neurovascular implants is crucial for accurate procedural decision-making. In a human study involving 32 patients, we introduced the clinical application of a miniaturized endovascular neuro optical coherence tomography (nOCT) imaging probe. This technology was designed to navigate the tortuous paths of the cerebrovascular circulation and to offer high-resolution imaging in situ. The nOCT probe is compatible with standard neurovascular microcatheters, integrating with the procedural workflow used in clinical routine. Equipped with a miniaturized optical fiber and a distal lens, the probe illuminates the tissue and collects the backscattered, near-infrared light. While rotating the fiber and the lens at high speed, the probe is rapidly retracted, creating a spiral-shaped light pattern to comprehensively capture the arterial wall and implanted devices. Using nOCT, we demonstrated volumetric microscopy of cerebral arteries in patients undergoing endovascular procedures. We imaged the anterior and posterior circulation of the brain, including distal segments of the internal carotid and middle-cerebral arteries, as well as the vertebral, basilar, and posterior cerebral arteries. We captured a broad spectrum of neurovascular pathologies, such as brain aneurysms, ischemic stroke, arterial stenoses, dissections, and intracranial atherosclerotic disease. nOCT offered artifact-free, high-resolution visualizations of intracranial artery pathology and neurovascular devices.

Association of vulnerable plaques with white matter hyperintensities on high-resolution magnetic resonance imaging.

One of the widespread manifestations of cerebral small vessel disease (CSVD) of the brain parenchyma is white matter lesion, which appears as white matter hyperintensities (WMHs) on magnetic resonance imaging (MRI). Previous studies have illustrated that large artery atherosclerosis is related to CSVD, but the precise progress of pathogenesis remains unknown. High-resolution MRI (HR-MRI) has the ability to delineate intracranial vascular walls, enabling a thorough exploration of the structure and composition of unstable plaques. This study aimed to apply HR-MRI to characterize the wall changes and plaque characteristics of middle cerebral arteries in patients with WMHs and to investigate the correlation between plaque vulnerability parameters and different degrees of WMHs. In this study, 138 patients with acute ischemic stroke at Harbin Medical University's First Clinical Hospital (May 2021 to October 2023) were cross-sectionally reviewed and underwent conventional brain and HR-MRI using T1-weighted 3D volumetric isotropic turbo spin echo acquisition (T1W-3D-VISTA) of the unilateral middle cerebral artery (MCA). According to Fazekas grade (0-6), the patients were divided into two groups: Fazekas score 0-2, no-or-mild WMHs; and Fazekas 3-6, moderate-to-severe WMHs. The intraplaque hemorrhage, plaque distribution, plaque enhancement, plaque load, remodeling pattern, and stenosis of the two groups were measured. Binary logistic regression analysis was conducted to evaluate the relationship between vulnerable plaques and WMHs. Of the participants who were initially considered for inclusion, 71 were deemed eligible, among whom 34 were placed in the no-or-mild WMH group and 37 in the moderate-to-severe WMH group. Between the two groups, there were significant differences in intraplaque hemorrhage (P=0.01), a wide distribution (P=0.02), and plaque enhancement (P=0.02). Univariate analysis showed that WMHs were associated with age [odds ratio (OR) =1.080; 95% confidence interval (CI): 1.020-1.144; P=0.008], hypertension (OR =3.500; 95% CI: 1.276-9.597; P=0.01), intraplaque hemorrhage (OR =3.955; 95% CI: 1.247-12.538; P=0.02), a wide distribution (OR =3.067; 95% CI: 1.159-8.115; P=0.02), and significant plaque enhancement (OR =4.372; 95% CI: 1.101-17.358; P=0.03); however, the multivariate results showed that the only independent factors associated with WMHs were age (OR =1.095; 95% CI: 1.019-1.176; P=0.01) and intraplaque hemorrhage (OR =5.88; 95% CI: 1.466-23.592; P=0.01). Our findings suggest that age and intraplaque hemorrhage may be associated with more severe WMHs in patients with acute ischemic stroke, which may be helpful for further clinical examination and intervention treatment.

Impaired dynamic cerebral autoregulation measured in the middle cerebral artery in patients with vertebrobasilar ischemia is associated with autonomic failure.

ObjectivesTo assess whether vertebrobasilar artery ischemia (VBI) affects cortical cerebral blood flow (CBF) regulation. Material and Methods107 consecutive patients (mean age 65 ± 15 years; women 21) with VBI underwent structured stroke care with assessment of dynamic cerebral autoregulation (dCA) in both middle cerebral arteries (MCAs) by transfer function analysis using spontaneous oscillations of blood pressure (BP) and CBF velocity that yields by extraction of phase and gain information in the very low (0.02-0.07 Hz), low (0.07-0.15 Hz) and high frequency (0.15-0.5 Hz) ranges. Additionally, power spectrum analysis of BP and heart rate variability (HRV) was performed. The control group consists of 29 age- and sex-matched healthy persons. ResultsCompared to controls, phase in the VBI patients was significantly reduced and gain increased in the very low frequencies (VLF), in the low (LF), phase was significantly reduced only ipsilaterally. In the high frequencies (HF), phase reduction was only marginally significant. BP power spectral density (PSD) was much higher in the patients than in the controls across all frequencies. In the PSD of heart rate variability the controls but not the patients exhibited a strong peak around 0.11Hz, while the patients, but not the controls, exhibit a strong peak around 0.36 Hz. In regression analysis, patient's phase and gain results were not related to age, sex, arterial hypertension, diabetes mellitus, renal dysfunction, heart failure as indicated by left ventricular ejection fraction, stroke subtype, presence or absence of cerebral small vessel disease. ConclusionPatients with VBI exhibit bilateral cortical autoregulation impairment in association with an autonomic nervous system disbalance. ClinicalTrials.gov IdentifierNCT04611672

Retracted: Correlation between Lpa, APO-A, APO-B, and Stenosis of Middle Cerebral Artery in Patients with Cerebral Ischemic Stroke.

[This retracts the article DOI: 10.1155/2022/6403645.].

КЛИНИЧЕСКОЕ ЗНАЧЕНИЕ НЕПАРНОЙ ПЕРЕДНЕЙ МОЗГОВОЙ АРТЕРИИ

Introduction. Vascular variations in the Circle of Willis occur rather frequently and, according to some observations, are often associated with some cerebrovascular diseases. A single azygos anterior cerebral artery is characteristic of mammals but rare in humans. Increased hemodynamic loads due to the blood supply of both hemispheres by a single azygos anterior cerebral artery can lead to the formation of aneurysms in it. Aim. This study is aimed at assessing the incidence of the azygos anterior cerebral artery and its association with cerebrovascular pathology. Materials and Methods. We analyzed Russian and foreign publications on the structural variants of anterior cerebral arteries over the years 2000-2022. This period was selected due to the wide implementation of cerebral angiographic studies in those years. We also presented two cases of our clinical patients having an azygos anterior cerebral artery. Results and Discussion. According to the literature review, an azygos anterior cerebral artery occurs in 0.3-4% of cases. Azygos anterior cerebral artery is most frequently associated with the development of distal aneurysms. Thrombosis of this artery leads to bilateral ischemic foci in the medial parts of the frontal and parietal lobes. We present clinical cases of a single azygos anterior cerebral artery in patients with distal aneurysms and arteriovenous malformation. Conclusions. A single azygos anterior cerebral artery is a rare variant of the Circle of Willis structure and may predispose to the development of cerebrovascular pathology.

Unilateral rete mirabile in multiple intracranial arteries with ipsilateral agenesis of the internal carotid artery: a case report

BackgroundRete mirabile of the cerebral artery is a rare anomaly, with most previous cases occurring in the middle cerebral artery or internal carotid artery. Here, we present the first report of unilateral rete mirabile in multiple intracranial arteries with ipsilateral internal carotid artery agenesis.Case presentationA 64-year-old Japanese woman was brought to the emergency department of our hospital in a deep coma. Computed tomography of the head showed severe intraventricular hemorrhage with subarachnoid hemorrhage. Computed tomography angiography showed not only congenital left internal carotid artery agenesis, but also rete mirabile of the left posterior communicating artery, the left posterior cerebral artery, and the left anterior cerebral artery. This unilateral vessel anomaly complex may have contributed to the formation of a peripheral aneurysm arising from a perforating branch of the pericallosal artery, which ruptured. The patient underwent urgent bilateral external ventricular drainage, but deteriorated and was declared brain dead.ConclusionsWe report the first case of unilateral rete mirabile in multiple intracranial arteries. Because the cerebral arteries in patients with rete mirabile may be vulnerable, close attention should be paid to the development of cerebral aneurysms.

Automatic Alberta Stroke Program Early Computed Tomographic Scoring in patients with acute ischemic stroke using diffusion-weighted imaging.

Alberta Stroke Program Early Computed Tomographic Scoring (ASPECTS) is a reliable method for assessing early ischemic changes in the blood supply area of the middle cerebral artery in patients with acute ischemic stroke. This study aims to propose a deep learning based automatic evaluation strategy for DWI-ASPECTS to serve as a reference for clinicians in urgent decision making for endovascular thrombectomy. Ten ASPECTS regions are extracted from the DWI series to train the independent classification network for each region, the accurate training labels of which are confirmed by neuroradiologists. Two classical convolutional neural networks (VGG-16 and ResNet-50) are validated. Subsequently, the innovative CBAM-VGG is designed to improve the accurate scoring of four small-volume DWI-ASPECTS regions, including caudate nucleus, lenticular nucleus, internal capsule, and insular lobe. Average F1-score of 0.929 and 0.840 and the average accuracy of 94.75% and 84.99% are obtained when scoring on six cortical regions M1-M6 and four small ASPECTS regions, respectively. In addition, the modified algorithm CBAM-VGG shows a significant improvement in the accuracy of estimating the four ASPECTS regions with smaller volumes. The experimental results demonstrate that the deep learning methods facilitate the efficiency and robustness of automatic DWI-ASPECTS scoring, which can provide a reference for clinical decision-making.

Cerebrovascular Phenotype in Fabry Disease Patients Assessed by Ultrasound.

Fabry disease (FD) is a rare X-linked lysosomal storage disorder with variable phenotypes, including neurological symptoms. These can be influenced by vascular impairment. Extracranial and transcranial vascular sonography is an effective and noninvasive method for measuring arterial structures and blood flow. The study aims to investigate cerebrovascular phenotype characteristics in FD patients compared to controls using neurosonology. This is a single-center, cross-sectional study of 130 subjects-65 patients (38 females), with genetically confirmed FD, and 65 sex- and age-matched controls. Using ultrasonography, we measured structural and hemodynamic parameters, including distal common carotid artery intima-media thickness, inner vertebral artery diameter, resting blood flow velocity, pulsatility index, and cerebral vasoreactivity (CVR) in the middle cerebral artery. To assess differences between FD and controls and to identify factors influencing investigated outcomes, unadjusted and adjusted regression analyses were performed. In comparison to sex- and age-matched controls, FD patients displayed significantly increased carotid artery intima-media thickness (observed FD 0.69 ± 0.13 mm versus controls 0.63 ± 0.12 mm; Padj = .0014), vertebral artery diameter (observed FD 3.59 ± 0.35 mm versus controls 3.38 ± 0.33 mm; Padj = .0002), middle cerebral artery pulsatility index (observed FD 0.98 ± 0.19 versus controls 0.87 ± 0.11; Padj < .0001), and significantly decreased CVR (observed FD 1.21 ± 0.49 versus controls 1.35 ± 0.38; Padj = .0409), when adjusted by age, BMI, and sex. Additionally, FD patients had significantly more variable CVR (0.48 ± 0.25 versus 0.21 ± 0.14; Padj < .0001). Our results suggest the presence of multiple vascular abnormalities and changes in hemodynamic parameters of cerebral arteries in patients with FD.

Correlation between Lpa, APO-A, APO-B, and Stenosis of Middle Cerebral Artery in Patients with Cerebral Ischemic Stroke.

Ischemic stroke (CIS) is characterized by a high incidence, disability, and mortality. Numerous studies have demonstrated that intracranial arterial stenosis is an important pathological basis of CIS, and its main cause is atherosclerosis. Dyslipidemia is an important risk factor for atherosclerosis. Lysophosphatidic acid (Lpa), apolipoprotein -A(APO-A), and apolipoprotein -B(APO-B) proved to be significantly correlated with the severity of coronary artery disease. This study retrospectively collected the case data of 186 patients with CIS treated from May 2020 to May 2022 and explored the correlation between Lpa, APO-A, APO-B, and middle cerebral artery (MCA) stenosis in CIS patients.

Wall characteristics of atherosclerotic middle cerebral arteries in patients with single or multiple infarcts: A high-resolution MRI Study.

Understanding the stroke mechanism of middle cerebral artery (MCA) atherosclerosis may inform secondary prevention. The aim of this study was to explore the relationship between vascular wall characteristics and infarction patterns using high-resolution magnetic resonance imaging (HRMRI) and diffusion-weighted imaging (DWI). From November 2018 to March 2021, patients with acute ischemic stroke due to MCA atherosclerotic disease were retrospectively analyzed. The wall characteristics of atherosclerotic MCA, including conventional characteristics and histogram-defined characteristics, were evaluated using HRMRI. Patients were divided into single-infarction and multiple-infarction groups based on DWI, and wall characteristics were compared between the two groups. Of 92 patients with MCA plaques, 59 patients (64.1%) had multiple infarcts, and 33 (35.9%) had single infarcts. The histogram-defined characteristics showed no differences between the single-infarction and multiple-infarction groups (P>0.05). Plaque burden, degree of stenosis, and prevalence of intraplaque hemorrhage (IPH) were significantly greater in the multiple-infarction group than in the single-infarction group (plaque burden: P = 0.001; degree of stenosis: P = 0.010; IPH: P = 0.019). Multivariate analysis showed that plaque burden (odds ratio: 1.136; 95% confidence interval: 1.054-1.224, P = 0.001) and IPH (odds ratio: 5.248; 95% confidence interval: 1.573-17.512, P = 0.007) were independent predictors for multiple infarction. IPH and plaque burden are independently associated with multiple infarcts. HRMRI may provide new insight into the mechanisms underlying the different MCA infarction patterns.

Comparative Study between the Effect of Nifedipine, Ritodrine and Indomethacin Therapy on Doppler Indices of Fetal Umbilical and Middle Cerebral Arteries in Patients with Preterm Labour

Comparative Study between the Effect of Nifedipine, Ritodrine and Indomethacin Therapy on Doppler Indices of Fetal Umbilical and Middle Cerebral Arteries in Patients with Preterm Labour

The Association between Migraine and Fetal-Type Posterior Cerebral Artery in Patients with Ischemic Stroke

Objective: The aim of the study was to determine if migraine is associated with fetal-type posterior cerebral artery (PCA) in patients with ischemic stroke. Method: In this cross-sectional study, patients with acute ischemic stroke were enrolled from two hospitals. The history of migraine headache was evaluated during a face-to-face interview. The variants of fetal-type PCA were assessed with MRA, CTA, or DSA. Patients with and without migraine were compared in terms of fetal-type PCA status and other clinic characteristics. Multivariate logistic regression analyses were performed to adjust for confounders and provide risk estimates for observed associations. Result: In 750 patients qualified for analysis, 85 (11.3%) were determined with migraine. Patients with migraine had a higher proportion of female gender (51.8% vs. 31.0%, p < 0.001), hypertension (72.9% vs. 57.7%, p = 0.007), and fetal-type PCA (36.5% vs. 20.1%, p = 0.001), while lower proportion of current smoking (25.9% vs. 38.3%, p = 0.025) than patients without migraine. National Institutes of Health Stroke Scale (NIHSS) score (3 vs. 2, p = 0.016) was also higher in migraineurs than in non-migraineurs. After adjustment for confounders, fetal-type PCA status was independently associated with migraine (odds ratio [OR] = 2.06; 95% confidence interval [CI], 1.25–3.38; p = 0.005). Other factors associated to migraine included female gender (OR = 2.03; 95% CI, 1.13–3.62; p = 0.017), hypertension (OR = 1.97; 95% CI, 1.17–3.34; p = 0.011), and NIHSS score (OR = 1.08; 95% CI, 1.01–1.16; p = 0.018). Conclusion: Migraine was associated with fetal-type PCA in patients with ischemic stroke. This finding supported the hypothesis that vascular mechanisms get involved in the migraine-stroke association.

ОСОБЕННОСТИ ИЗМЕНЕНИЙ ПОКАЗАТЕЛЕЙ СИСТЕМЫ ИММУНИТЕТА У ПАЦИЕНТОВ ПРИ АТЕРОСКЛЕРОЗЕ

In patients with various forms of coronary heart disease (effort angina pectoris of tension II functional class (EAP II FC), myocardial infarction (MI)) an imbalance of immunological reactivity was revealed compared to practically healthy individuals, which was manifested by the increasing of the IL-6 concentration, IL-8, IgA, BAPNA-amidase activity, B-lymphocytes count, circulating immune complexes (CIC) and the decreasing of T-lymphocytes count, IgM and IgG concentration. It was also found that in patients with MI and EAP II FC, atherosclerosis was not limited to only one vascular region, lesions of the extracranial sections of the cerebral arteries, abdominal part of the aorta, arteries of the lower extremities were also recorded. The lesion of extracranial cerebral arteries in patients with EAP II FC was accompanied by the increase of neutrophil elastase activity, the number of СIC and the decrease of IgM concentration, IL-4, B-lymphocytes count, and in patients with MI it was accompanied by the increase of T-lymphocytes count and the decrease of B-lymphocytes count. When the abdominal aorta was affected, patients with EAP II FC had increased T-lymphocytes count, neutrophils and decreased IgM concentration, and patients with MI had increased T-lymphocytes count. The lesion of the lower extremities arteries in patients with EAP II FC was accompanied by the increase of T-lymphocytes count, sVCAM-1 adhesion molecules, the decrease of IgM concentration, BAPNA-amidase activity, and in patients with MI it was accompanied by the increasing of monocytes count, concentration of sVCAM-1 molecules and the decreasing of IL-6 concentration. At the same time, the development of multifocal atherosclerotic lesion (MFA) of peripheral arteries was accompanied only by the decrease of IgM concentration in patients with EAP II FC. The lesion of the anterior interventricular artery in patients with EAP II FC was combined with the increase of sVCAM-1 molecules concentration, and in patients with MI it was combined with the increase of IgG concentration and the decrease of IL-10 concentration. The lesion of the circumflex artery in patients with EAP II FC was combined with the increase of CIC concentration, TNF-α, and in patients with MI it was combined with increased IL-6 concentration. The lesion of the right coronary artery was not accompanied by any significant change in the immune system indicators in the studied groups of patients.

Numerical analysis of pulse wave of cerebral arteries in patients with thoracic aortic stent placement

Numerical analysis of pulse wave of cerebral arteries in patients with thoracic aortic stent placement

Peak Systolic Velocity in Middle Cerebral Artery in Patients with Severe Traumatic Brain Injury as an Indicator of Detrimental Rise in Intracranial Pressure

Background Intracranial pressure (ICP) is the major concern for neurosurgeons while treating patients with severe traumatic brain injury, as any troublesome escalation in intracranial pressure heralds feared complications leading to definite morbidity or even mortality.&#x0D; Objective This study focuses on analyzing the correlation between peak systolic velocity in middle cerebral artery derived from transcranial doppler ultrasonographic spectral analysis and intracranial pressure values derived from invasive intracranial pressure monitoring system in a patient with severe traumatic brain injury.&#x0D; Method A prospective observational study was performed using a convenience sample technique including all adult patients with severe traumatic brain injury who had invasive intracranial monitors placed as part of their clinical care. Transcranial doppler ultrasonography was performed with a 2 MHz linear probe of ACUSON X300 ultrasound system while simultaneous intracranial pressure readings were obtained directly from invasive intracranial pressure monitoring. The association between peak systolic velocity in the middle cerebral artery and invasive intracranial pressure was assessed with Pearson’s correlation coefficient.&#x0D; Result One hundred one transcranial doppler ultrasound spectral analysis was performed on 26 individual patients. The mean age of the population involved in this study is 43.57 years ± S.D. 19.95 (range 18-78 years), with male preponderance in a ratio of 5.5:1. Pearson’s correlation coefficient of peak systolic velocity in middle cerebral artery and intracranial pressure was 0.715 (p &lt; 0.000) demonstrating a significant positive correlation. With further evaluation of area under curve characteristics, peak systolic velocity in middle cerebral artery of 39.6 cm/s yielded the most favorable balance of test characteristics to diagnose elevation of intracranial pressure, with a resulting sensitivity of 82.1% and specificity of 84.4%.&#x0D; Conclusion Peak systolic velocity in middle cerebral artery can be explored further as a dependable screening tool to evaluate intracranial pressure among patients with severe traumatic brain injury in settings with unavailability of invasive intracranial pressure monitoring facilities.

Computed Tomography Image under Optimized Iterative Reconstruction Algorithm to Analyze the Characteristics of Blood Flow Field in Cerebral Aneurysm before and after Stent Implantation

In order to analyze the change characteristics of blood flow field in cerebral aneurysms before and after stent implantation, this study first constructed an optimized iterative reconstruction algorithm to reconstruct CT images of patients with cerebral aneurysms and used it to solve the problem of image sharpness. In addition, backprojection image reconstruction algorithm and Fourier transform analytic method were introduced. According to the CT images of cerebral arteries of patients, the lesions were presented in a three-dimensional and visual way through the reconstructed three-dimensional images, thus achieving the effects of simulation and simulation. The results showed that the sensitivity, specificity, and accuracy of the optimized iterative reconstruction algorithm were 90.78%, 83.27%, and 94.82%, which were significantly higher than those of the backprojection image reconstruction algorithm and Fourier transform analysis method, and the difference was statistically significant ( P &lt; 0.05 ). Before operation, the blood flow velocity in the neck of aneurysm was 7.35 × 10−2 m/s, the exit velocity was 1.51 × 10−1 m/s, and the maximum velocity appeared in the upstream part of the exit. After passing through the aneurysm, the blood flow velocity began to decrease gradually, forming a vortex at the top of the tumor. After stent implantation, the neck and outlet velocities of cerebral aneurysm were 9.352 × 10−2 m/s and 1.897 × 10−2 m/s, respectively. The velocity of blood flow decreased after entering the aneurysm, and there was no vortex at the top of the aneurysm. Among the outlet velocities of arterial blood vessels, the velocity before stent implantation was significantly lower than that after stent implantation, and the difference was statistically significant ( P &lt; 0.05 ). Compared with prestent, the shear force distribution on the wall of cerebral aneurysm showed a significant decrease, and the difference was statistically significant ( P &lt; 0.05 ). To sum up, pelvic floor ultrasound based on hybrid iterative reconstruction algorithm has high accuracy in diagnosing the changes of blood flow field in cerebral aneurysms. The application of CT images in the diagnosis of cerebral aneurysms can objectively provide imaging data for clinical practice and has high application value.

Correlation of carbon dioxide and systolic velocity of the middle cerebral artery in patients with spontaneous subarachnoid hemorrhage of aneurysmal origin

BackgroundAneurysmal Subarachnid Hemorhage (aSAH) secondary to an aneurysm is the most common presentation of nontraumatic SAH. Worldwide, the incidence varies, affecting more frequently women with an average age of 55 years. One of its main complications is cerebral vasospasm. ObjectiveThe objective of this study was to evaluate the correlation between blood flow of the middle cerebral artery and arterial CO2 levels in patients with aSAH, comparing those who presented vasospasm in relation to those who did not. Material and methodsObservational, historical cohort study, including patients between 18 and 85 years old, diagnosed with Aneurysmal Subarachnoid Hemorrhage (aSAH) secondary to an aneurysm (aSAH) Spearman/Pearson correlation coefficient was used to determine the correlation between mean velocity flow (MVF) by transcranial doppler and levels CO2 serum according to the analysis group (with or without vasospasm). A value <0.05 was determined for statistical significance. ResultsBetween 2015 and 2019 a total of 54 patients diagnosed with aSAH were treated in our institution, our results indicate a positive correlation between the SVRMCA and SVLMCA with the presence of vasospasm (p value = <0.001). No correlation was observed between serum CO2 levels and SVRMCA or SVLMCA, irrespective of the presence of vasospasm. ConclusionIn patients with aneurysmal subarachnoid hemorrhage, serum CO2 levels do not correlate with cerebral systolic velocities. Further studies are required to confirm this finding.

Abstract 1122‐000207: Mechanical Thrombectomy of the Fetal Posterior Cerebral Artery

Introduction : Fetal posterior cerebral artery (FPCA) occlusion is a rare but potentially disabling cause of stroke. While endovascular treatment is established for acute large vessel occlusion (LVO) stroke, FPCA occlusions were excluded from acute ischemic stroke trials. We aim to report the feasibility, safety and outcome of mechanical thrombectomy (MT) in acute FPCA occlusions. Methods : We performed a multi‐center retrospective review of consecutive patients who underwent MT of acute FPCA occlusion. Primary FPCA occlusion was defined as an occlusion that was identified on the pre‐procedure CT angiogram or baseline angiogram whereas a secondary FPCA occlusion was defined as an occlusion that occurred secondary to embolization to a new territory after recanalization of a different LVO. Demographics, clinical presentation, imaging findings, endovascular treatment and outcome were reviewed. Results : There were twenty‐five patients with acute FPCA occlusion who underwent MT, distributed across 14 centers. Median NIHSS on presentation was 16. There were 76% (19/25) of patients who presented with primary FPCA occlusion and 24% (6/25) of patients who had a secondary FPCA occlusion. The configuration of the FPCA was full in 64% patients and partial or “fetal‐type” in 36% of patients. FPCA occlusion was missed on initial CTA in 21% of patients with primary FPCA occlusion (4/19). The site of occlusion was posterior communicating artery in 52%, P2 segment in 40% and P3 in 8% of patients. TICI 2b/3 reperfusion was achieved in 96% of FPCA patients. There were no intra‐procedural complications. At 90 days, 48% (12/25) were functionally independent as defined by mRS≤2. Conclusions : Endovascular treatment of acute FPCA occlusion is safe and technically feasible. A high index of suspicion is important to detect occlusion of the fetal posterior cerebral artery in patients presenting with anterior circulation stroke syndrome and patent anterior circulation.

Cerebral hemodynamic measures using four-dimensional flow magnetic resonance imaging

Dr Zarrinkoob and colleagues conducted an intense evaluation of four-dimensional (4D) magnetic resonance imaging (MRI) in measuring the blood flow in the cerebral arteries of patients who had undergone carotid endarterectomy (CEA) for symptomatic carotid stenosis. The authors observed that the total cerebral blood flow (tCBF) was only increased postoperatively in patients with recruited collaterals and not in those without collateral recruitment and that MCA laterality was only observed in patients with collaterals recruited postoperatively.

Clinical Study of Endovascular Treatment of Severe Middle Cerebral Artery Stenosis or Occlusion and Vascular Cognitive Impairment

Objective: It is very important to study the factors affecting the incidence, progress and prognosis of patients with vascular dementia. Methods: 50 cases of severe middle cerebral artery stenosis or occlusion underwent endovascular treatment (25 cases of mild cognitive dysfunction, 25 cases of moderate cognitive dysfunction) were divided into two groups, where a medical drug treatment group and a control group established with 25 cases in each group. The cognitive function of each group of patients was evaluated before operation, 7 days after operation, 30 days after operation, and 180 days after operation. CTP was used to compare the hemodynamic changes in patients before and after operation. Results: The severe stenosis or occlusion of the middle cerebral artery in patients can be improved, and the intracranial blood supply of patients with poorly compensated medial cranial circulation and hypoperfusion can be restored to a certain extent. Meanwhile, improvement of cognitive function was definitive in some patients with cognitive dysfunction. Conclusion: To guide the formulation of treatment plans for patients with severe middle cerebral artery stenosis or occlusion.