Carotid Cerebral Artery Research Articles

Effectiveness of Compound Dilong Capsules in Patients with Asymptomatic Cerebral Carotid Artery Stenosis: A Retrospective Case-Control Study.

Asymptomatic cerebral carotid artery stenosis (ACCAS) benefits from secondary prevention via statins and antiplatelets; nonetheless, the impact of medication alone is often limited. Evidence has suggested enhanced therapeutic outcomes when Chinese patent medicine-specifically, compound dilong capsules (CDC)-is integrated with conventional secondary prevention measures. We retrospectively analyzed 319 ACCAS patients from January 2018 to December 2022 at Xuanwu Hospital, Capital Medical University. Depending on the clinical outcomes-improvement or stabilization versus progression-patients were classified into effective or ineffective treatment groups. Patient medical records and questionnaire responses were the primary data sources. The study accounted for demographic variables, clinical history, and medication details, with the primary focus on CDC use and its duration. Treatment outcomes were gauged alongside Transcranial color-coded sonography and Carotid Doppler ultrasonography findings. We employed both univariate and multivariate statistical methods to assess the data. CDC administration (aOR=2.51, 95% CI 1.39-4.54, P=0.002) and extended usage beyond six months (aOR=3.54, 95% CI 1.71-7.32, P=0.001) demonstrate a statistically significant correlation with treatment efficacy. Gender (aOR=2.54, 95% CI 1.30-5.00, P=0.007), hypertension management (aOR=0.56, 95% CI 0.33-0.95, P=0.031), and antiplatelet therapy with aspirin (aOR=9.53, 95% CI 1.15-78.89, P=0.037) or clopidogrel (aOR=9.97, 95% CI 1.10-90.12, P=0.041) also influenced the therapeutic outcome significantly. Incorporating CDC as part of a secondary prevention strategy for over six months can beneficially modulate and limit the progression of vascular stenosis in ACCAS. These findings underscore the value of combining traditional Chinese medicine with modern pharmacological interventions in ACCAS management.

Filling Defect of Ipsilateral Transverse Sinus in Acute Large Artery Occlusion

Background and PurposeCerebral venous systems play a key role in regulating stroke outcomes. We aimed to elucidate the effect of the transverse sinus (TS) filling patterns on edema expansion and neurological outcomes in patients with acute large artery occlusion (LAO).Materials and MethodsWe recruited consecutive patients with acute M1 middle cerebral artery and/or internal carotid artery occlusion who underwent pretreatment computed tomographic perfusion (CTP). On the reconstructed 4-dimensional computed tomographic angiography derived from CTP, the filling defect of the ipsilateral transverse sinus (FDITS) was defined as the length of contrast filling defect occupying at least half of the ipsilateral TS. An unfavorable outcome was defined as having a modified Rankin Scale (mRS) score of 3–6 at 3 months.ResultsA total of 318 patients were enrolled in the final analysis and 70 (22.0%) patients had baseline FDITS. The presence of FDITS was associated with the baseline NIHSS (odds ratio [OR] 1.119; 95% CI, 1.051–1.192; p < 0.001) and poor arterial collaterals (OR 3.665; 95% CI 1.730–7.766; p = 0.001). In addition, FDITS was associated with 24-h brain edema expansion (OR 7.188; 95% CI, 3.095–16.696; p < 0.001) and 3-month unfavorable outcome (OR 8.143; 95% CI 2.547–26.041; p < 0.001) independent of arterial collateral status. In the subgroup analysis of patients with FDITS who received reperfusion therapy, no significant difference was found in the rate of edema expansion and unfavorable outcome between non-reperfusion and reperfusion subgroups (both p > 0.05).ConclusionFilling defect of the ipsilateral transverse sinus was associated with edema expansion and an unfavorable outcome irrespective of the baseline arterial collateral status in patients with acute LAO, indicating that FDITS may be an important stroke-related prognostic imaging marker.

Abstract WP255: Cyfip2 Genotype Contributes To Variation In Stroke Vulnerability Among C57BL/6 Mouse Substrains

C57BL/6 mouse substrains of the N lineage derived from the NIH colony later than the separation of the Bailey line in the early 1960s show increased stroke vulnerability relative to C57BL/6J. A missense mutation in Cyfip2 , encoding cytoplasmic FMR1 interacting protein 2, is one of several known variants with a corresponding substrain distribution. This study evaluated reciprocal mouse lines in which the N Cyfip2 variant had been either introduced into C57BL/6J (J- Cyfip2 &lt;N&gt;) or corrected in C57BL/6NJ (NJ- Cyfip2 &lt;J&gt;) by CRISPR-Cas9 editing. Stroke was produced by permanent surgical occlusion of the middle cerebral and ipsilateral common carotid arteries under isoflurane anesthesia, and infarct volume was measured as the region of pallor in brain slices incubated with triphenyltetrazolium chloride at 24 hours. Figure illustrates mean ± SEM (group sizes in parentheses) for mice of the current study, along with prior data for parent substrains. Introduction of the N-lineage mutation markedly increased infarct size in both males and females (†) while maintaining the sex difference seen in J mice (*). Correction of the mutation in NJ had no significant effect. At face value these results establish Cyfip2 genotype as an important determinant of stroke vulnerability since the variant alone is sufficient to increase infarct volume in the J background. However, it is not the sole basis for differing stroke outcome among substrains, and at least one other variant must underlie the heterogeneity in sex difference. Cyfip2 encodes a protein with recognized functional roles in brain and the immune system, but the precise intersection with stroke pathology remains to be established.

Abstract P486: Mechanical Embolectomy Using a Novel Telescopic System Featuring a Specialized Delivery and 0.088” Aspiration Catheter for the Treatment of Acute Ischemic Stroke: Preliminary Results of the SUMMIT NZ Trial

Background: The treatment approach of aspiration rather than use of a stent retriever as first-line therapy is increasingly regarded as standard of care for acute ischemic stroke. Continued technological advances include the ongoing development of aspiration embolectomy catheters that are larger in bore, guided by delivery catheters that are more maneuverable through the tortuous neurovasculature. Methods: SUMMIT NZ (ACTRN12619000890134p) was designed as a prospective, single-arm, open label clinical trial at two sites in New Zealand. Eligible participants were patients presenting with acute ischemic stroke from either anterior or posterior circulation large-vessel occlusion within 24 hours of onset, a National Institutes of Health Stroke Scale Score ≥ 6 and a pre-stroke modified Rankin Score of ≤ 2. A novel tapered tip delivery catheter was specifically designed to deliver 0.070” and 0.088” aspiration catheters telescoped through a specialized 8F 90 cm introducer sheath (Route 92 Medical, Inc. San Mateo, CA). The primary effectiveness endpoint was arterial revascularization as measured by a modified Thrombosis in Cerebrovascular Infarction (mTICI) score of 2b or greater at the end of angiography after all endovascular treatments as adjudicated by an independent core laboratory. The primary safety endpoints were device-related peri-procedural complications such as dissection or perforation, symptomatic Intracranial Cerebral Hemorrhage (SICH) at 24 hours and embolization to a previously uninvolved territory. Results: From September 27, 2019 to June 23, 2020, 18 subjects (mean age 69.5, NIHSSS 15.2, time last known well 6.2 hours) were enrolled with a diagnosis of acute ischemic stroke. Acute occlusion was located in the middle cerebral artery (78%, 14/18) and internal carotid artery (22%, 4/18). Successful revascularization was achieved in 94% (17/18) of subjects. No serious adverse device effects have been reported. Conclusions: Preliminary findings suggest that aspiration first mechanical embolectomy using a novel telescoping system including an 0.088” inner diameter aspiration catheter achieves a high rate of arterial revascularization with an acceptable safety profile. A full report on enrollment and results are to be presented.

Transcranial Doppler Screening In Children with Sickle Cell Disease of South Gujarat Population

Background: TCD (Transcranial Doppler) is a well-established study to predict Cerebrovascular stroke in SCD (Sickle cell disease). We aim to establish baseline TCD findings in Indian children with SCD and compare the results with the available STOP (Stroke prevention trial in Sickle Cell Anemia) protocol. We would also compare TCD findings in homozygous sickle cell disease and heterozygous sickle cell trait.&#x0D; Material and Methods: Seventy nine children with SCD were included in this study for one year period. TCD was performed and TAMMV (time-averaged maximum mean) velocity in the middle cerebral, anterior cerebral, posterior cerebral and internal carotid arteries was measured. Children were divided into two groups. Group I (56 homozygos–70.88%) and group II (23 heterozygos–29.11%).&#x0D; Results: In group I, 50 children fall in normal range with average TAMM velocity of 127.59 ± 17.48 cm/s. There was 1 (1.78%) abnormal result and 5 (8.9%) conditional results in group I. All results were normal in group II with average TAMM velocity of 116.33 ± 12.412 cm/sec. Middle cerebral artery was the only affected vessels amongst all.&#x0D; Conclusions: In our study, there was low prevalence of abnormal TCD results as compared to STOP protocol. The difference was significant in TAMM velocity between two groups, with all children being within normal range in group II. Result of this study differs from previous studies, done in western countries probably due to difference in haplotype.

Abstract WP270: Etiopathologies of Symptomatic and Asymptomatic Intracranial Large Arterial Disease: The Results of HR-MRI and Genetic Studies

Introduction: Intracranial large arterial disease (ILAD) is common, especially in Asians. We compared clinical, genetic, and imaging features between symptomatic and asymptomatic ILAD. Methods: We conducted a prospective study of patients with acute symptomatic ILAD and subjects with asymptomatic ILAD diagnosed during medical checkups. Patients who had steno-occlusive lesions on the middle cerebral artery and/or distal internal carotid artery underwent high-resolution MRI (HR-MRI) and RNF213 (p.Arg4810Lys variant) gene studies. We excluded patients who had proximal embolic sources in ipsilateral carotid and heart. A presumptive etiology of ILAD was made based on HR-MRI and RNF213 gene studies. Patients were classified into intracranial atherosclerosis (ICAS) when relevant plaques existed on HR-MRI; moyamoya disease (MMD) when patients had RNF213 variant and HR-MRI showed no plaque but characteristic features of MMD (negative remodeling and basal collaterals); and intracranial arterial dissection (ICAD) when pathognomic features (intimal flap/double lumen or mural hematoma) exist on HR-MRI. Results: Among 224 patients analyzed, 124 were symptomatic and 100 were asymptomatic. ICAS-type was more common in symptomatic ILAD than in asymptomatic ILAD (61.4% vs. 45.0%, p=0.009). The RNF213 variant was observed in one third of ICAS-type ILAD (37.0% in asymptomatic and 38.6% in symptomatic). Similarly, the proportion of MMD-type was similar between asymptomatic (33, 21.3%) and symptomatic (32, 19.0%) ILAD. Multivariate testing showed that symptomatic ILAD was associated with the presence of intracranial plaque on HR-MRI, regardless of the presence of the RNF213 variant, site of ILAD, and number of tandem stenosis. Conclusions: While various etiopathologies can cause ILAD, ICAS is an important pathology of symptomatic ILAD and should be target for medical management.

Abstract WP367: Effect of Early Blood Pressure Reduction on Infarct Size in Patients With Large Vessel Occlusion

Introduction: In patients with large vessel occlusion presenting with acute ischemic stroke, cerebral perfusion is a major determinant of stroke severity. However, limited data exists to guide hemodynamic management of these patients early after presentation. In this study, we aim to evaluate the effect of blood pressure reductions during the hyper-acute period on infarct size. Methods: From a clinical stroke registry at a single comprehensive stroke center, we reviewed patients with middle cerebral artery (M1) or internal carotid artery occlusion who underwent hyperacute magnetic resonance imaging (MRI) for endovascular treatment decision in 2018. Infarct volume was determined by area of reduced apparent diffusion coefficient using RAPID software. Collateral circulation was scored based on baseline CT angiogram (good collaterals constituted &gt;50% filling, poor collaterals ≤50% filling). Average mean arterial pressure (MAP) readings from the first hour of presentation were compared to average MAP readings from the hour prior to magnetic resonance imaging. For the purposes of our study, a drop of &gt; 20% in the average MAP was regarded as a significant decrease. We hypothesized that both significant drop in MAP and the presence of good collateral circulation were independent predictors of infarct volume expressed as a logarithmic value in multivariable regression model. Results: Of the 35 patients (mean age 67, mean NIHSS 16) meeting inclusion criteria, 11% of patients experienced an early significant drop in MAP prior to time of MRI. Among patients with a significant drop in MAP, the average decrease was 35 mm Hg ±3.3 among those with significant drop from a baseline mean MAP of 125 mm Hg. In the multivariable analysis adjusting for collateral status, a significant drop in average MAP was independently associated with an increase in infarct volume (β = -0.727, p=0.0306). Collateral status also independently predicted infarct size (β=0.775, p=0.0007). Conclusion: Among ischemic stroke patients with large vessel occlusion, a &gt;20% drop in MAP during the hyper-acute period is associated with larger infarct volumes. Further studies are needed to optimize early blood pressure management in these patients.

Abstract 56: Neuroimaging in Ischemic Stroke is Different Between Men and Women in the Defuse 3 Cohort

Introduction: Clinical deficits from ischemic stroke are more severe in women but the pathophysiological basis of this sex difference is unknown. Sex differences in core and penumbral volumes were assessed in this sub-study of the Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke (DEFUSE)-3 clinical trial. Methods: DEFUSE 3 randomized patients to thrombectomy or medical management who presented 6-16 hours from last known well with proximal middle cerebral artery or internal carotid artery occlusion and had target core and perfusion mismatch volumes on CT or MRI. Using univariate and adjusted regression models, the effect of sex was assessed on pre-randomization measures of core, perfusion, and mismatch volumes and hypoperfusion intensity ratio, and on core volume growth using 24-hour scans. Results: All patients were included in the analysis (n=182) with 90 men and 92 women. There was no sex difference in the site of baseline arterial occlusion. Adjusted by age, baseline NIHSS, baseline modified Rankin score, time to randomization, and imaging modality, women had smaller core, hypoperfusion, and penumbral volumes than men. Median (IQR) volumes for core were 8.0 mL (1.9-18.4) in women vs 12.6 mL (2.7-29.6) in men, for T max &gt;6 seconds 89.0 mL (63.8-131.7) vs 133.9 mL (87.0-175.4), and for mismatch 82.1 (53.8-112.8) vs 108.2 (64.1-149.2). The hypoperfusion intensity ratio was lower in women, 0.31 (0.15-0.46) vs. 0.39 (0.26-0.57), p = 0.006, indicating better collateral circulation, which was consistent with the observed slower ischemic core growth than men within the medical group (p = 0.003). Conclusions: In the large vessel ischemic stroke cohort selected for DEFUSE 3, women had imaging evidence of better collateral circulation, smaller baseline core volumes, and slower ischemic core growth. These observations suggest sex differences in hemodynamic and temporal features of anterior circulation large artery occlusions.

Abstract WP370: Inpatient Outcomes and Resource Utilization Among Patients With Large Hemispheric Infarction Who Developed Cerebral Edema: An Analysis of U.S. Real-World Data

Introduction: Patients with large hemispheric infarction (LHI) may suffer from life-threatening complications, including cerebral edema. Published data among these patients in real-world settings are limited. This study describes inpatient outcomes and resource utilization associated with cerebral edema among hospitalized patients with LHI. Methods: A retrospective cohort study was conducted using the MarketScan Hospital Drug Database (2015Q3-2017Q4). As infarct volume is not captured in the data, patients were included based on diagnosis codes for infarction of the middle cerebral artery or carotid artery, which are most closely associated with LHI. Within this group, cerebral edema was determined based on a diagnosis code of cerebral edema (ICD-10-CM G93.6) or herniation (G93.5), or a craniectomy procedure. Logistic regressions, comparing patients with edema vs. those without edema, were used to estimate the odds ratio of death, ICU admission, and tracheostomy/intubation during the hospital stay. Linear regression models were used to estimate the mean difference in length of hospital stay, length of ICU stay, and hospital charges. All models controlled for age, sex, and admission type. Results: A total of 11,772 patients were designated as likely LHI cases; 869 (7%) were identified with cerebral edema. Table 1 compares inpatient outcomes and resource utilization in patients with vs. without cerebral edema. Patients with cerebral edema had significantly higher odds of death, ICU admission and tracheostomy/intubation. They also had longer hospital stays, longer stays in the ICU, and higher hospital charges. Conclusion: This study provides evidence in a real-world setting, highlighting the substantial clinical and economic burden associated with cerebral edema among patients hospitalized with LHI. Given the unmet needs, management strategies and interventions focusing on reducing cerebral edema among patients with LHI are warranted.

Transcranial Doppler to detect early abnormalities in cerebral hemodynamics following traumatic brain injury in adult patients

Background Transcranial Doppler (TCD) can be a valuable tool in detecting early changes in cerebral blood flow (CBF) velocities following traumatic brain injury (TBI). We designed this prospective observational study to screen for early abnormalities in CBF following TBI using TCD and to evaluate its ability to predict the patients’ outcome. Patients and methods The study was carried out on 66 adult patients admitted to the ICU with TBI. TCD was performed on admission by insonating the middle cerebral arteries and extracranial internal carotid arteries, and flow velocities were recorded, and pulsatility index (PI) and Lindegaard ratio were calculated. End-diastolic velocity (EDV) less than 25 cm/s and PI more than 1.3 were considered abnormal. The patient outcome was evaluated at discharge from the hospital using the Glasgow Outcome Scale. Results Admission TCD revealed that EDV less than 25 cm/s was present in 11.1% of the patients with mild-to-moderate TBI [Glasgow Coma Score (GCS)>8] and in 46.7% of the patients with severe TBI (GCS≤8). PI more than 1.3 was present in 16.7% of the patients with GCS more than 8 and in 46.7% of the patients with GCS less than or equal to 8. The incidence of vasospasm was highest on the fifth day after trauma as it was detected in 16.7% of the patients with GCS more than 8 and in 40% of the patients with GCS less than or equal to 8. The logistic regression analysis of outcome predictors showed that the initial PI more than 1.3 had 91% sensitivity and 89% specificity and EDV less than 25 cm/s had 88% specificity and sensitivity 85% in predicting poor outcome; meanwhile, cerebral vasospasm had 84% sensitivity and 75% specificity in poor outcome prediction. Conclusion Early abnormal CBF velocity detected by TCD following TBI can predict poor outcome at discharge from the hospital.

Clipping of cerebral aneurysm complicated by intraoperative rupture

Despite the development of neurosurgical treatment of brain aneurysm (BA), the problem of intraoperative aneurysm rupture (IAR) remains relevant. The IAR is the most common intraoperative complication, which, according to various authors, occurs in 5.6–35.0 % cases. There are contact and non-contact IAR. Noncontact are those that occur at the early stages of the operation, before the dissection of dura mater, when there is no mechanical effect on the aneurysm. Noncontact IAR accounts for 2.5–9.0 % of the total amount of IAR. Contact IAR occurs in 91–94 % of observations. IAR occurs predominantly in arachnoid dissection (48–81 %). The main criteria and risk factors for the IAR are the size of BA, its localization, the operation duration after the initial rupture of BA, the presence of hypertension and the severity of the patient’s condition before surgery. The greatest risk of IAR is predisposed by aneurysms of the anterior communicating artery complex — an anterior cerebral artery and internal carotid artery. Performing surgery at the early stages after aneurysm rupture in the presence of cerebral edema along with the difficult access to BA and with the need to perform sufficient traction of the brain substance is more often accompanied by IAR. IAR results in deterioration of the results of operations and an increase in mortality by 1.5–3.0 times. The prognosis of survival of patients after IAR at the stages of aneurysm isolation and clipping is more favourable than at the initial stages of surgery.

Systematization and Description of the Arterial Blood Supply of the Paleopallia areas in the Brain Surface of the Wild Boar (Sus scrofa scrofa)

Background: The study was performed on wild boar (Sus scrofa scrofa) wich is a wild ancestor of the domestic pig and is not part of Brazilian fauna. The arterial blood supply of the encephalus has been studied by some researchers, who have systematized the cerebral blood supply from the rostral and caudal epidural rete mirabile and its sources in wild boar until the blood supply of the base of the brain. The objective was to improve the understanding of the arterial blood supply of the brain, particularly the paleopallium, of the wild boar and to provide a reference for comparative anatomy studies. Materials, Methods &amp; Results: A total of 30 brains were obtained from an officially authorised slaughterhouse and approved by Brazilian Institute of Environment and Natural Renowable Resources. The animals were desensitized, followed by bleending of the jugular veins and common carotid arteries near the entrance of the thorax, according to the slaughter procedure. Finally, the animals were decapitated at the level of axis vertebra. The cerebral arterial system of each animal was rinsed (cooled saline containing 2500 IU of heparin) and drained by the jugular veins, and vessels were filled with latex 603 stained with specific red dye. The heads were submerged for one hour in running water immersed in 20% formaldehyde for fixation; the brains were removed along with a cervical segment of the spinal cord. The duramater was removed, and the arteries were dissected. Schematic drawings of the ventral view of the all preparations were made using magnifying glasses and photographic records. The Nomina Anatomica Veterinaria was used to named the cerebral arteries and their branches, and calculation of pecentages was applied in the statistical analysis. The cerebral carotid artery originating from the rostral epidural rete mirabile emitted a rostral branch and a caudal branch on the side of the hypophysis gland. The rostral branch emitted one to three middle cerebral arteries and continued as rostral cerebral artery. The latter emitted the superficial and perforating central arteries, lateral rhinal artery, ethmoidal artery, medial branch and medial rhinal artery. Discussion: Wild boar is a macrosmatic animal, it presents well-developed areas of the paleopallium that are exclusively olfactory. Its extensive paleopallium was nourished by branches of the rostral cerebral artery and its collateral branches, including the lateral rhinal, ethmoidal, and medial branch and the medial rhinal artery. The rostral cerebral arteries and their collateral branches supplied blood to the olfactory bulb, olfactory peduncle, two-thirds of the lateral olfactory tract, medial olfactory tract, and rostral two-thirds of the olfactory trigone. The medial cerebral arteries within the lateral fossa of the brain, emitted superficial rostral central branches to the paleopallium, perforating central branches (striated) to the lateral fossa of the brain and caudal third of the olfactory trigone and caudal central branches to the piriform lobe. The rostral most two-thirds of a small medial band of the piriform lobe was vascularised by central branches originating mainly from the rostral branch of the cerebral cartotid artery. The paleopallium in the wild boar was nourished by branches of the cerebral rostral, middle and caudal arteries and by the central branches of the cerebral carotid artery. The arterial blood supply of the paleopallium in the wild boar was compared to the chinchilla, nutria, rabbit and pampas fox. Three cerebral vessels were mainly responsable for the emission of the central branches that supplied blood to the paleopallium, namely the middle, rostral, and caudal cerebral arteries. The differences or variations among these species were due to the type of cerebral blood supply in the formation of the cerebral arterial circle.Keywords : anatomy, brain, paleopallia, arteries, Artiodactila, wild boar.

Abstract TP563: White Matter Hyperintensities are Associated With Intracranial Internal Carotid Artery Calcifications in a Cohort of Patients With Acute Ischemic Stroke or Transient Ischemic Attack

Introduction: Previous studies of the relationship between cerebral small vessel disease (CSVD) lesions and carotid artery (CA) calcifications have yielded conflicting results. Hypothesis: We hypothesized that intracranial ICA (ICICA) calcifications are most closely associated with CSVD in comparison to extracranial ICA (ECICA) and common CA (CCA) calcifications. Methods: Acute ischemic stroke and transient ischemic attack patients were recruited into a hospital-based prospective stroke registry. Total CSVD burden score including white matter hyperintensity (WMH), lacunes, microbleeds (MBs) and enlarged perivascular spaces (PVS) was measured according to Staals et al. Fazekas scale was used to rate the periventricular and deep WMH (PVMH and DWMH respectively). ICICA calcifications were measured on plain head CT scan according to Subedi et al. ECICA and CCA calcifications were measured according to Yamada et al on the neck CT angiography. Univariate analyses were used to test the relationship between CSVD lesions and CA calcifications. Binary and ordered logistic regression analyses were performed to adjust for the effect of age, sex, race, history of hypertension, diabetes and current smoking for the variables that showed significance in the univariate analyses. Results: 141 patients (age 64.5±15.3, 49% females, total CSVD score 1.6±1.4, ICICA, ECICA and CCA calcification scores were 7.8±9.9, 10.3±13.4 and 2.1±6.9, respectively). In Univariate analyses, ICICA calcification score showed significant relationships with PVMH, DWMH, lacunes, MBs and total CSVD scores ( P values: &lt;0.0001, 0.0005, 0.0078, 0.049 and 0.0026 respectively). ECICA calcification score showed significant relationships with PVWMH and DWMH (P values: 0.0062 and 0.0332, respectively) while CC calcification score showed significant relationships with PVMWH, DWMH, MBs and PVS (P values: 0.0008, 0.034, 0.045 and 0.013). Multivariate analyses showed significant relationships only for PVWMH and DWMH with ICICA calcification (P values: 0.008 and 0.05, respectively). Conclusions: ICICA calcifications are most closely linked to PVMW and DWMH. Further studies are required to investigate the pathophysiological mechanisms behind this relationship.

Correlation of serum uric acid level with acute cerebral infarction and carotid artery lesions in type 2 diabetic patients

The clinical data of 103 patients with type 2 diabetes (diabetic group) and 111 diabetic patients with acute cerebral infarction (ACI) admitted from August 2016 to October 2017 were reviewed and 101 health subjects served as normal controls (group NC). The examination results of carotid ultrasound, serum uric acid (SUA) levels and blood biochemistry were compared among three groups. The results show that SUA in diabetic patients with ACI was significantly higher (P<0.01). The correlation analysis showed that SUA was positively correlated with intimal medial thickness (IMT) of carotid artery, diabetes with ACI (r=0.521 and 0.489, P<0.01). Logistic regression analysis showed that SUA was an independent risk factor for diabetes with ACI (OR=1.012, 95%CI: 1.007-1.017, P<0.01). Multiple stepwise regression analysis showed that high SUA and systemic blood pressure (SBP) were independent risk factors of increased IMT. Logistic regression analysis showed that SUA was an independent risk factor for vulnerable carotid plaques (OR=1.052, 95%CI: 1.039-1.065, P<0.01). Key words: Uric acid; Brain infarction, acute; Diabetes mellitus, type 2; Tunica intima, carotid arteries

Clinical, demographic and neuroradiological features of different types of cerebral border zone infarcts in North-west India

Abstract Background Whether there are different pathogenic mechanisms for different types of cerebral border zone infarct is still not clear as most of previous studies had conflicting results. Furthermore there is no data available for Indian population. Objectives To study the demographic, clinical and radiological profile of different types of border zone infarct (BZI) patients in North-west India. Methods We prospectively analyzed 672 consecutive patients with ischemic stroke. Among them 86 border zone infarct patients were selected and further categorized as external border zone infarct (EBI), internal border zone infarct (IBI) and mixed border zone infarct (MBI) based on diffusion-weighted imaging characteristics. Baseline patient characteristics, clinical courses, and neuroradiological features were compared between different types. Results We identified 31 patients with EBI, 21 with IBI and 34 with MBI. When compared with the EBI patients, IBI and MBI patients had significant middle cerebral or internal carotid artery stenosis (P-0.008). Concomitant small cortical infarcts were more seen with EBI. More patients in IBI group had early clinical deterioration and poor outcome at 1 month after stroke than in EBI group. Conclusions IBI are mainly caused by hemodynamic compromise, whereas embolic mechanism responsible for the genesis of EBI. Patients with IBI had worse hospital course and poor outcome than EBI patients. Different therapeutic approaches may be required for different types of border-zone infarcts to improve outcome.

Coexistent Ipsilateral Internal Carotid Artery Occlusion and Cerebral Venous Thrombosis in Hepatitis C.

A 58-year-old male, known to have hepatitis C virus (HCV), presented with intermittent headaches and left-sided sensorimotor symptoms. There were no focal neurological deficits on examination. Electrocardiogram was unremarkable. Computed tomography angiography head and neck displayed extracranial right internal carotid artery occlusion. Magnetic resonance imaging showed right cortical vein thrombosis, with hemorrhagic infarction. Echocardiography with bubble study was unremarkable. Hypercoagulable workup was significant for protein S deficiency. He was treated with warfarin for 6 months. Repeat protein S levels remained low 9 months later. The coexistence of arterial and venous thrombotic events gives rise to a limited differential. In this case, it may be related to chronic HCV infection. The underlying pathogenesis is not clear; however, it is possible the patient had chronic high-grade internal carotid artery stenosis, which occluded leading to his presenting symptoms. The cortical vein thrombosis is likely an incidental finding here. The extent by which HCV contributed to the cerebral thrombosis and carotid artery occlusion in our case is not clear; however, the hypercoagulable and atherosclerotic properties of the virus cannot be disregarded. The virus can promote carotid atherosclerosis and cerebral venous thrombosis as well as other venous and arterial thromboembolic events. Furthermore, HCV is associated with impaired venous flow and procoagulant properties, which can fuel a hypercoagulable state. Also of note cirrhosis is associated with protein S deficiency. We recommend considering an underlying hypercoagulable state including both arterial and venous thrombosis in HCV infection.

P504Comparison of outcomes of acute stroke patients with isolated middle cerebral artery occlusion versus terminal internal carotid artery (T-type) occlusion treated with endovascular intervention

P504Comparison of outcomes of acute stroke patients with isolated middle cerebral artery occlusion versus terminal internal carotid artery (T-type) occlusion treated with endovascular intervention

Basicranium of an elasmosaurid plesiosaur from the Campanian of European Russia

Zverkov, N.G., Averianov, A.O. & Popov E.V., April 2017. Basicranium of an elasmosaurid plesiosaur from the Campanian of European Russia. Alcheringa 42, 528-542. ISSN 0311-5518 The braincase of elasmosaurid plesiosaurs is poorly known. Here, we describe the exceptionally well-preserved elasmosaurid basicranium from the Rybushka Formation (lower Campanian) of Saratov Province, Russia. The material provides new anatomical information and peculiar features: single anterior foramen for the cerebral carotid arteries, anteroposteriorly elongated sella turcica and deep canal on the basioccipital process. This allow us to reconstruct a carotid circulation in plesiosaurs and propose new basicranial features (anteroposteriorly elongated sella turcica and single anterior foramen for the cerebral carotids), which could be potentially synapomorphic for a clade within the Elasmosauridae. Nikolay G. Zverkov* [ zverkovnik@mail.ru ], Department of Palaeontology, Geological Faculty, Lomonosov Moscow State University, 1 Leninskie Gory, 119991 Moscow; Laboratory of Phanerozoic Stratigraphy, Department of Stratigraphy, Geological Institute of the Russian Academy of Sciences, Pyzhevsky lane 7, 119017 Moscow, Russia; Alexander O. Averianov [ dzharakuduk@mail.ru ], Zoological Institute of the Russian Academy of Sciences, Universitetskaya Emb. 1, Saint Petersburg 199034; Department of Sedimentary Geology, Geological Faculty, Saint Petersburg State University, 16 liniya VO 29, 199178 Saint Petersburg, Russia; Evgeny V. Popov [ elasmodus74@gmail.com ], Department of Historical Geology and Paleontology, Geological Faculty, Saratov State University, 83 Astrakhanskaya Str., 410012 Saratov; Institute of Geology and Petroleum Technology, Kazan Federal University, Kremlevskaya Str. 4/5, 420008 Kazan, Russia.

Abstract TP5: What is “Near Complete” Recanalization? Rethinking TICI 2b in Modern Thrombectomy Era

Background and purpose: The Thrombolysis in Cerebral Infarction (TICI) 2b classification is defined as “near complete” recanalization for acute ischemic stroke. While this category has historically combined with TICI 3 (“complete reperfusion”) as “successful recanalization”, recent studies have suggested that TICI 3 and a proposed intermediate TICI 2c (“near complete reperfusion except for slow flow or distal emboli”) should be distinguished from TICI 2b due to differences in outcomes. In this study, we examined if early neurologic improvement differed significantly between patients with TICI 2b, TICI 2c, and TICI 3 recanalization for emergent large vessel occlusions treated with mechanical thrombectomy (MT). Methods: Retrospective analysis was performed using data from 133 consecutive patients with middle cerebral artery or internal carotid artery occlusions treated with MT from January 2015 to June 2016. Patient angiograms were graded independently and blinded to clinical data by two experienced readers based on original TICI (oTICI), modified TICI (mTICI), and modified TICI with TICI 2c (mTICI 2c) grading scales. Early neurologic improvement was assessed using change in NIHSS by discharge. General linear modeling was used to evaluate difference in NIHSS delta scores between TICI scales with SAS/PROC GLIMMIX. Multiple comparisons were evaluated using Tukey corrections with significance established at the .05 level. Results: Without the TICI 2c category, there was not a significant difference in change in NIHSS observed between TICI 3 and TICI 2b for both the oTICI (delta 1.4, p=0.355) and mTICI scales (delta 2.1, p=0.190). However, when an additional category (TICI 2c) was added, there was a significant difference in change in NIHSS observed between TICI 3 and TICI 2b (delta 3.8, p= 0.026) as well as between TICI 2c and TICI 2b (delta 3.7, p=0.019). Conclusion: Utilizing a TICI recanalization grading system that adds an additional category beyond TICI 2b allows for improved prediction of neurological improvement in patients treated with MT. Higher levels of recanalization are associated with greater neurologic improvement.

Arterial vascularization of the brain of the agouti (Dasyprocta aguti Linnaeus, 1766)

The agouti, a rodent that is geographically distributed throughout South America, is greatly valued for its meat. This paper describes the arterial vascularization of the base of the agouti’s brain, characterizing behavior, and arterial origin and distribution. Ten animals from the Center for the Multiplication of Wild Animals (CEMAS/UFERSA) were used and the study was approved by SISBIO (report number 32413- 1) and the Ethics Committee on Animal Use (CEUA/UFERSA) (protocol 02/2010). After euthanasia, the animals were incised in the thoracic cavity by an injection of red-stained Neoprene latex 650 and the skulls were subsequently opened. The brains were extracted from the skulls for ventral surface analysis and then fixed in an aqueous 10% formaldehyde solution. The agouti’s arterial vascularization of the brain has two main components, namely the carotid and vertebrobasilar systems. The agouti’s carotid system accounts for vascularization of almost the entire forebrain, while the vertebrobasilar system accounts for vascularization of almost the entire posterior brain (medulla oblongata, pyramid, trapezoid body, cerebellum, bridge, and part of the third caudal section of the forebrain) through the caudal cerebral arteries originating from the terminal branches of the basilar artery. The main arteries on the brain surface include the basilar artery, which is unique, and the arterial pairs, specifically the vertebral arteries, cerebellar caudal arteries, trigeminal artery, rostral cerebellar artery, basilar terminal branch artery, cerebral caudal artery, communicating caudal branch of the cerebral carotid artery, cerebral carotid artery, communicating branch rostral cerebral carotid artery, choroidal rostral artery, medial branch of the communicating branch rostral artery, internal ophthalmic artery, middle cerebral artery, and rostral cerebral artery.