Distal Occlusion Research Articles

The duration of orthodontic treatment and the number of visits depending on the degree of difficulty when using modern orthodontic equipment

The aim of the study is to analyze the estimated and actual duration of treatment and the number of visits to the orthodontist by patients using modern orthodontic equipment. Analysis of the duration of orthodontic treatment of patients with varying degrees of difficulty and comparison of the estimated and actually spent time for its implementation. 308 medical records of patients who underwent orthodontic treatment were analyzed. According to the Siebert - Malygin method, the degree of difficulty of treatment, its duration, the number of necessary visits were calculated and the data obtained were compared with the actual time spent on correcting dental and occlusion anomalies and the number of visits by the patient to the orthodontist. The results of treatment of 308 patients who underwent orthodontic treatment with modern non-removable equipment (braces) are analyzed in the clinic of LLC «Prime dentistry» in Ryazan. Before starting treatment, the preliminary treatment time was calculated using the method of determining the difficulty of orthodontic treatment of Siebert - Malygin. The calculation of the degree of difficulty of treatment, its duration, and the number of necessary visits was carried out. The data obtained were compared with the actual time spent on correction of dental and occlusion anomalies and the number of visits by the patient to an orthodontist. It was found that, despite the use of modern equipment, the treatment time practically does not decrease, but the number of visits to achieve the desired result is significantly reduced. Coefficients have been calculated to clarify the required number of visits to the orthodontist. In the treatment of anomalies in the position of teeth (APD), it is 0.77, APD, combined with distal occlusion - 0.79 deep - 0.78, open - 0.66 and mesial - 0.69. The use of modern orthodontic equipment reduces the number of patient visits to the doctor, which saves time, reduces labor costs and allows you to provide the necessary assistance to more people in need. The coefficients calculated during the study to determine the required number of visits to an orthodontist by a patient, depending on the existing orthodontic pathology, make it possible to predict the treatment time with greater accuracy when using the Siebert - Malygin method. This is very relevant when planning upcoming manipulations and to more accurately justify the cost of treatment depending on the required time and number of visits to eliminate APS.

Результат комплексного подхода к диагностике и лечению коморбидного пациента: клинический случай

AIM. Show the feasibility and possibility of diagnosing and treating a comorbid patient (neurology, dentistry) MATERIAL AND METHODS. Clinical example of a patient with concomitant pathology; dynamic observation for 5 years. CASE PRESENTATION. A male patient has been observed in the clinic for 5 years. The positive dynamics of neurological and dental statuses as a result of therapeutic measures is shown. Undifferentiated connective tissue dysplasia was revealed, manifested by the following symptom complex: asthenic physique, Gothic palate, distal occlusion, ingrown earlobes, hypermobility of joints. Dynamic monitoring throughout the entire period of observation, diagnosis and treatment. In the neurological status, emotional and vegetative lability can be distinguished (the patient gets tired quickly, there is daytime drowsiness, there is a violation of concentration, and as a result, memory problems), sleep disturbance — insomnia. Manifested by difficulties falling asleep, frequent awakenings, restless sleep, with vivid dreams, as well as difficulties waking up (a symptom of sleep intoxication). RESULTS AND DISCUSSION. The dynamics and the result of the treatment process are presented using the example of a patient with comorbid pathology in the dental and jaw system. CONCLUSION. Patients with undifferentiated connective tissue dysplasia who have neurological and dental disorders should be observed as part of comorbid pathology, jointly by neurologists and dentists, to obtain successful results. KEYWORDS: emotional disorders, distal occlusion, sagittal fissure, connective tissue dysplasia, clinic, diagnosis, treatment

Сучасні принципи ортодонтичного лікування дистальної оклюзії при порушеній функції дихання в періоді змінного прикусу (Огляд літератури)

Introduction. In recent years, there has been a significant increase in the number of scientific publications and interest in the correlation between orthodontic treatment and respiratory function. Most studies of the effects of orthodontic appliances on the airway in the past have been limited by the technological limitations of cephalometric imaging, meaning that reliable analysis of mediolateral airway width has not been possible. Of great interest is the study of the effect of fixed and removable functional devices in the treatment of distal occlusion and impaired respiratory function in the period of variable bite. Purpose: based on the analysis of literary sources, to determine the effect of functional orthodontic equipment on the effectiveness of treatment of distal occlusion and normalization of respiratory function in the period of variable bite. Materials and methods. Information search and analysis of scientific sources was carried out using scientometric databases Web of Science, PubMed, Google Scholar over the past 15 years. Conclusion. The results of numerous scientific studies presented in the review confirm the positive impact of functional orthodontic equipment on the effectiveness of treatment of distal occlusion and normalization of respiratory function during the variable bite period and the need for a multidisciplinary approach to their complex treatment. Key words: distal occlusion, functional orthodontic equipment, variable bite, breathing disorder.

Gut microbiota-derived acetate promotes long-term recovery through angiogenesis guided by lymphatic ingrowth in older adults with stroke.

Ischemic stroke is a leading cause of morbidity and mortality in older adults. Therefore, in this study, we sought to understand the interplay between the microbiota, gut, and brain in the context of stroke in older adults. To determine whether gut microbiota from younger individuals promotes recovery through angiogenesis in both elderly stroke patients and aged stroke mice, we explored the changes in gut microbiota and the correlation between short-chain fatty acids (SCFAs) and angiogenesis in the aged stroke population. Then, we altered the gut microbiome in aged mice by transplanting microbiota from younger donors before inducing experimental stroke to explore the mechanism by which gut microbiota-derived SCFAs promote angiogenesis. Part I: We conducted a single-center, double-blind trial to compare gut microbiota diversity and SCFA levels in fecal samples from older stroke patients with those from younger stroke patients. Additionally, we measured levels of vascular endothelial growth factor (VEGF) and VEGFC levels in plasma to assess their correlation with SCFA levels. Part II: We performed fecal microbiota transplantation (FMT) 3 days before inducing ischemic stroke in aged male mice (16-18) via distal middle cerebral artery occlusion (dMCAO). The FMT was conducted using gut microbiomes from either young donors (2-3 months) or aged donors (16-18 months). In older stroke patients, gut microbiota diversity was significantly reduced compared to that in younger stroke patients. Furthermore, levels of acetate, a bacterially derived SCFA, were lower and positively correlated with angiogenesis markers (VEGF and VEGF-C). In aged stroke mice, transplantation of young microbiota improved stroke outcomes by promoting angiogenesis, which was facilitated by lymphatic ingrowth into the cortex. This protective effect was linked to gut microbiota-derived acetate, which enhanced lymphangiogenesis by replenishing acetyl coenzyme A. (a) Gut microbiota-derived acetate promotes angiogenesis post-stroke and (b) lymphatic ingrowth into the cerebral cortex was observed in post-dMCAO mice. These findings suggest that selectively promoting SCFA-producing bacteria, particularly acetate-producers, could be a promising therapeutic strategy to reduce functional impairments in older stroke subjects.

Pretreatment CTP Collateral Parameters Predict Good Outcomes in Successfully Recanalized Middle Cerebral Artery Distal Medium Vessel Occlusions.

Distal medium vessel occlusions (DMVOs) account for alarge percentage of vessel occlusions resulting in acute ischemic stroke (AIS) with disabling symptoms. We aim to assess whether pretreatment quantitative CTP collateral status (CS) parameters can serve as imaging biomarkers for good clinical outcomes prediction in successfully recanalized middle cerebral artery (MCA) DMVOs. We performed aretrospective analysis of consecutive patients with AIS secondary to primary MCA-DMVOs who were successfully recanalized by mechanical thrombectomy (MT) defined as modified thrombolysis in cerebral infarction (mTICI) 2b, 2c, or 3. We evaluated the association between the CBV index and HIR independently with good clinical outcomes (modified Rankin score0-2) using Spearman rank correlation, logistic regression, and ROC analyses. From 22 August 2018 to 18 October 2022 8/22/2018 to 10/18/2022, 60consecutive patients met our inclusion criteria (mean age 71.2 ± 13.9 years old [mean ± SD], 35female). The CBV index (r = -0.693, p < 0.001) and HIR (0.687, p < 0.001) strongly correlated with 90-day mRS. ACBV index ≥ 0.7 (odds ratio, OR, 2.27, range 6.94-21.23 [OR] 2.27 [6.94-21.23], p = 0.001)) and lower likelihood of prior stroke (0.13 [0.33-0.86]), p = 0.024)) were independently associated with good outcomes. The ROC analysis demonstrated good performance of the CBV index in predicting good 90-day mRS (AUC 0.73, p = 0.003) with athreshold of 0.7for optimal sensitivity (71% [52.0-85.8%]) and specificity (76% [54.9-90.6%]). The HIR also demonstrated adequate performance in predicting good 90-day mRS (AUC 0.77, p = 0.001) with athreshold of 0.3for optimal sensitivity (64.5% [45.4-80.8%]) and specificity (76.0% [54.9-90.6%]). ACBV index ≥ 0.7may be independently associated with good clinical outcomes in our cohort of AIS caused by MCA-DMVOs that were successfully treated with MT. Furthermore, a HIR < 0.3 is also associated with good clinical outcomes. This is the first study of which we are aware to identify aCBV index threshold for MCA-DMVOs.

CTA and CTP for Detecting Distal Medium Vessel Occlusions: A Systematic Review and Meta-analysis.

The optimal imaging method for detecting distal medium vessel occlusions (DMVOs) remains undefined. The objective of this study is to compare the diagnostic performance of CTA with CTP in detecting DMVOs. We searched PubMed, EMBASE, Web of Science Core Collection, and Cochrane Central Register of Controlled Trials up to March 31, 2023 (PROSPERO: CRD42022344006). A total of 12 studies reporting accuracy values of CTA and/or CTP were included, comprising 2607 patients with 479 cases (18.3%) of DMVOs. Pooled sensitivity and specificity of both imaging methods were compared using a random-effects model. Subgroup analyses were performed based on the technique used in CTA (multi or single-phase) and the subtype of DMVOs (M2-only vs. M2 and other DMVOs). We applied Quality Assessment of Diagnostic Accuracy (QUADAS-2) tool and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) quality assessment criteria. CTA demonstrated significantly lower sensitivity compared to CTP in detecting DMVOs [0.74, 95%CI (0.63-0.82) vs. 0.89, 95% CI (0.82-0.93), P < 0.01]. When subgrouped into single-phase and multi-phase CTA, multi-phase CTA exhibited higher sensitivity for DMVO detection than single-phase CTA [0.91, 95%CI (0.85-0.94) vs. 0.64, 95%CI (0.56-0.71), P < .01], while reaching similar levels to CTP. The sensitivity of single-phase CTA substantially decreased when extending from M2 to other non-M2 DMVOs [0.74, 95%CI (0.63-0.83) vs. 0.61, 0.95%CI (0.53-0.68), P = .02]. We identified an overall high risk of bias and low quality of evidence, attributable to the design and reference standards of most studies. Our findings highlight a significantly lower sensitivity of single-phase CTA compared to multi-phase CTA and CTP in diagnosing DMVOs.

Endovascular therapy versus medical management for mild strokes due to medium and distal vessel occlusions

Background Distal and medium vessel occlusion (DMVO) strokes account for up to 40% of all acute ischemic strokes, many of which have a low initial deficit severity. Increasingly, endovascular treatment (EVT) is considered for these patients. However, there is a paucity of data comparing potential safety and efficacy of EVT versus best medical management (BMT) in these patients, particularly when presenting with mild symptoms. Methods We retrospectively analyzed consecutive DMVO patients with NIHSS ≤6 who presented between January 2018 and December 2021 within 24 h from last seen well. We compared early and late clinical outcomes, as well as safety outcomes using multivariable linear and logistic regression analyses to determine whether EVT was independently associated with the outcomes of interest. Results We included 80 subjects that fulfilled our study criteria (n = 41 BMT and n = 39 EVT). On adjusted analyses, when comparing EVT and BMT groups, there was no statistical difference in the NIHSS at discharge (Coefficient = −0.6, 95%-CI = −3.45–2.26, p = 0.678) or in the modified Rankin scale (mRS) at discharge (Coefficient = 0.37, 95%-CI = −0.52–1.25, p = 0.408). Furthermore, there was no difference in the 3-month mRS defined as good (mRS 0–2) (OR = 0.56, 95%-CI = 0.17–1.83, p = 0.341) or excellent (mRS 0–1) (OR = 0.45, 95%-CI = 0.15–1.34, p = 0.152). Finally, there was no difference in the incidence of all-type parenchymal hemorrhage (OR = 0.9, 95%-CI = 0.22–3.62, p = 0.879). Conclusions We found that among DMVO patients with low admission NIHSS treatment with EVT versus BMT was associated with similar outcomes. Larger prospective studies are required to confirm these findings.

Evaluation of CINA® LVO artificial intelligence software for detection of large vessel occlusion in brain CT angiography

ObjectiveTo systematically evaluate the ability of the CINA® LVO software to detect large vessel occlusions eligible for mechanical thrombectomy on CTA using conventional neuroradiological assessment as gold standard. MethodsRetrospectively, two hundred consecutive patients referred for a brain CTA and two hundred patients that had been subject for endovascular thrombectomy, with an accessible preceding CTA, were assessed for large vessel occlusions (LVO) using the CINA® LVO software. The patients were sub-grouped by occlusion site. The original radiology report was used as ground truth and cases with disagreement were reassessed. Two-by-two tables were created and measures for LVO detection were calculated. ResultsA total of four-hundred patients were included; 221 LVOs were present in 215 patients (54 %). The overall specificity was high for LVOs in the anterior circulation (93 %). The overall sensitivity for LVOs in the anterior circulation was 54 % with the highest sensitivity for the M1 segment of the middle cerebral artery (87 %) and T-type internal carotid occlusions (84 %). The sensitivity was low for occlusions in the M2 segment of the middle cerebral artery (13 % and 0 % for proximal and distal M2 occlusions respectively) and in posterior circulation occlusions (0 %, not included in the intended use of the software). ConclusionsLVO detection sensitivity for the CINA® LVO software differs largely depending on the location of the occlusion, with low sensitivity for detection of some LVOs potentially eligible for mechanical thrombectomy. Further development of the software to increase sensitivity to all LVO locations would increase the clinical usefulness.

Induction of Acute Ischemic Stroke in Mice Using the Distal Middle Artery Occlusion Technique.

Ischemic stroke remains the predominant cause of mortality and functional impairment among the adult populations globally. Only a minority of ischemic stroke patients are eligible to receive intravascular thrombolysis or mechanical thrombectomy therapy within the optimal time window. Among those stroke survivors, around two-thirds suffer neurological dysfunctions over an extended period. Establishing a stable and repeatable experimental ischemic stroke model is extremely significant for further investigating the pathophysiological mechanisms and developing effective therapeutic strategies for ischemic stroke. The middle cerebral artery (MCA) represents the predominant location of ischemic stroke in humans, with the MCA occlusion serving as the frequently employed model of focal cerebral ischemia. In this protocol, we describe the methodology of establishing the distal MCA occlusion (dMCAO) model through transcranial electrocoagulation in C57BL/6 mice. Since the occlusion site is located at the cortical branch of MCA, this model generates a moderate infarcted lesion restricted to the cortex. Neurological behavioral and histopathological characterization have demonstrated visible motor dysfunction, neuron degeneration, and pronounced activation of microglia and astrocytes in this model. Thus, this dMCAO mouse model provides a valuable tool for investigating the ischemiastroke and worth of popularization.

Pretreatment parameters associated with hemorrhagic transformation among successfully recanalized medium vessel occlusions.

Although pretreatment radiographic biomarkers are well established for hemorrhagic transformation (HT) following successful mechanical thrombectomy (MT) in large vessel occlusion (LVO) strokes, they are yet to be explored for medium vessel occlusion (MeVO) acute ischemic strokes. We aim to investigate pretreatment imaging biomarkers representative of collateral status, namely the hypoperfusion intensity ratio (HIR) and cerebral blood volume (CBV) index, and their association with HT in successfully recanalized MeVOs. A prospectively collected registry of acute ischemic stroke patients with MeVOs successfully recanalized with MT between 2019 and 2023 was retrospectively reviewed. A multivariate logistic regression for HT of any subtype was derived by combining significant univariate predictors into a forward stepwise regression with minimization of Akaike information criterion. Of 60 MeVO patients successfully recanalized with MT, HT occurred in 28.3% of patients. Independent factors for HT included: diabetes mellitus history (p = 0.0005), CBV index (p = 0.0071), and proximal versus distal occlusion location (p = 0.0062). A multivariate model with these factors had strong diagnostic performance for predicting HT (area under curve [AUC] 0.93, p < 0.001). Lower CBV indexes, distal occlusion location, and diabetes history are significantly associated with HT in MeVOs successfully recanalized with MT. Of note, HIR was not found to be significantly associated with HT.

Interdisciplinary approach to the diagnosis of dentofacial deformities and speech disorders in preschoolers

Relevance. Maxillofacial deformities and speech disorders are common types of oral pathology detected in children under seven years. Comprehensive rehabilitation of patients with a combination of these forms of pathology is a difficult task since there is no situational analysis of their prevalence; motivated specialists work in different institutions (education, healthcare) and have different guidelines for the treatment (correction) of existing diseases (disorders), which complicates planning and administering treatment, and predicting results.Material and methods. To identify the nature of the relationship between various forms of orthodontic and speech disorders in children, we conducted a comprehensive clinical dental examination of 80 children aged 4-6 years in a preschool educational institution, where children with speech disorders receive speech therapy assistance.Results. Maxillofacial deformities appeared to be in 56.25% of children with some speech sound disorder. Children with identified speech sound disorders combined with dentofacial deformities showed not only skeletal but also soft tissue defects: shifted midline (86.67 ± 0.10%), distal occlusion (42.22 ± 0.30%), deep overbite (46.68%), as well as tongue and upper lip ties in 51.10% and 22.20% of cases, respectively. On examination, 44.45% of patients demonstrated clinical signs of mouth breathing, 32.5% – reverse swallowing, and 53.33% – inefficient chewing.Conclusion. Analysis of the results of a comprehensive speech pathology assessment and dental examination allowed us to conclude that there is a need to rethink the methodology of diagnosis, prevention and treatment of combined speech and dental disorders due to the high frequency of their comorbidity in preschool children.

Proprotein convertase subtilisin/kexin type 9 inhibitor ameliorates cerebral ischemia in mice by inhibiting inflammation

ObjectivesTo investigate the potential protective effects of evolocumab, a proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor, on ischemic stroke and its underlying mechanisms. Materials and methodsWe established a mouse model with distal middle cerebral artery occlusion. We evaluated the therapeutic effects through neurological function and infarct size, while the underlying mechanisms were elucidated using western blotting and real-time polymerase chain reaction. ResultsEvolocumab improved neurological recovery, reduced the infarct volume, suppressed the activation of Toll-like receptor (TLR) 4 and nuclear factor-kappa B (NF-κB), and attenuated the increased levels of IL-1β and TNF-α after cerebral ischemia. ConclusionEvolocumab protects against cerebral ischemic injury by inhibiting inflammation. Therefore, the TLR4/NF-кB pathway may represent a major mechanism in ischemic stroke.

Microsurgical partial trapping for the treatment of unclippable vertebral artery aneurysms: Experience from 27 patients and review of literature

BACKGROUNDThe efficacy and safety of partial trapping for the treatment of unclippable vertebral artery aneurysms (UVAs) are still questionable. The partial trapping method (proximal or distal occlusion) was used in the treatment of aneurysms to simplify the surgical procedure and avoid postoperative complications. METHODSThis study included 27 patients with UVAs who underwent microsurgical partial trapping between January 2015 and August 2022, and their postoperative outcomes and complications were retrospectively reviewed and evaluated. RESULTSRuptured UVAs were detected in 25 (92.6%) patients, and 13 (48.1%) patients had poor-grade status. Fusiform dissection, dissecting, and fusiform aneurysms were observed in 17 (63%), 7 (25.9%), and 3 (11.1%) patients, respectively. By location, preposterior inferior cerebellar artery (PICA), PICA, post- PICA, and non-PICA types were noted in 7 (25.9%), 9 (33.3%), 6 (22.2%), and 5 (18.5%) patients, respectively. Microsurgical partial trapping was performed in all patients (blind-alley formation in 96.3%). Complete aneurysm obliteration was achieved in 26 (96.3%) patients. Immediate complete obliteration was achieved in 21 (77.8%) patients, delayed thrombosis within 7 days in 5 (18.5%), and nearly complete obliteration in 1 (3.7%). No re-bleeding was detected in all patients. Favorable outcomes 3 months after the operation were achieved by 92.9% of the patients in the good-grade group and 85.2% overall. CONCLUSIONSMicrosurgical partial trapping, especially the blind-alley formation technique, was a safe and effective treatment of UVAs with high rates of aneurysm thrombosis. The appropriate sites for clip occlusion were dependent on the angioarchitecture of UVAs.

Post-ASPECTS and Post-PC-ASPECTS Predict the Outcome of Anterior and Posterior Ischemic Stroke Following Thrombectomy.

In this study, we aimed to determine whether post-Alberta Stroke Project Early CT Changes Score (post-ASPECTS) in anterior stroke and post-(posterior circulation) PC-ASPECTS in posterior stroke on CT can predict post-endovascular thrombectomy (EVT) functional outcomes among patients with acute ischemic stroke (AIS) after EVT. A total of 247 consecutive patients aged 18 and over receiving EVT for LVO-related AIS were recruited into a prospective database. The data was retrospectively analyzed between March 2019 and February 2022 from two comprehensive tertiary care stroke centers: Foshan Sanshui District People's Hospital and First People's Hospital of Foshan in China. Patient parameters included EVT within 24 hr of symptom onset, premorbid modified Rankin scale (mRS) ≤2, presence of distal and terminal cerebral blood vessel occlusion, and subsequent 24-72-hr post-stroke onset CT scan. Univariate comparisons were performed using the Fisher's exact test or χ2 test for categorical variables and the Mann-Whitney U-test for continuous variables. Logistic regression analysis was performed to further analyze for adjusting for confounding factors. A p-value of ≤0.05 was statistically significant. Overall, 236 individuals with 196 anterior circulation ischemic strokes and 40 posterior strokes of basilar artery occlusion were examined. Post-ASPECTS in anterior stroke and post-pc-ASPECTS as strong positive markers of favorable outcome at 90 days post-EVT; and lower rates of inpatient mortality/hospice discharge, 90-day mortality, and 90-day poor outcome were observed. Moreover, patients in the post-ASPECTS ≥ 7 cohort experienced shorter door-to-recanalization time (DRT), puncture-to-recanalization time (PRT), and last known normal-to-puncture time (LKNPT). Post-ASPECTS ≥7 in anterior circulation AIS and post-pc-ASPECTS ≥7 in posterior circulation can serve as strong prognostic markers of functional outcome after EVT.

Clinical consequence of vessel perforations during endovascular treatment of acute ischemic stroke.

Endovascular treatment (EVT) of acute ischemic stroke can be complicated by vessel perforation. We studied the incidence and determinants of vessel perforations. In addition, we studied the association of vessel perforations with functional outcome, and the association between location of perforation on digital subtraction angiography (DSA) and functional outcome, using a large EVT registry. We included all patients in the MR CLEAN Registry who underwent EVT. We used DSA to determine whether EVT was complicated by a vessel perforation. We analyzed the association with baseline clinical and interventional parameters using logistic regression models. Functional outcome was measured using the modified Rankin Scale at 90days. The association between vessel perforation and angiographic imaging features and functional outcome was studied using ordinal logistic regression models adjusted for prognostic parameters. These associations were expressed as adjusted common odds ratios (acOR). Vessel perforation occurred in 74 (2.6%) of 2794 patients who underwent EVT. Female sex (aOR 2.0 (95% CI 1.2-3.2)) and distal occlusion locations (aOR 2.2 (95% CI 1.3-3.5)) were associated with increased risk of vessel perforation. Functional outcome was worse in patients with vessel perforation (acOR 0.38 (95% CI 0.23-0.63)) compared to patients without a vessel perforation. No significant association was found between location of perforation and functional outcome. The incidence of vessel perforation during EVT in this cohort was low, but has severe clinical consequences. Female patients and patients treated at distal occlusion locations are at higher risk.

Initial Experience with the Solitaire X 3 mm Stent Retriever for the Treatment of Distal Medium Vessel Occlusions

Endovascular therapy (EVT) is the standard treatment for ischemic stroke caused by a large vessel occlusion (LVO). The effectiveness of EVT for distal medium vessel occlusions (MDVOs) is still uncertain, but newer, smaller devices show potential for EVT in MDVOs. The new Solitaire X 3 mm device offers a treatment option for MDVOs. Our study encompassed consecutive cases of primary and secondary MDVOs treated with the Solitaire X 3 mm stent-retriever as first-line EVT device between January and December 2022 at 12 European stroke centers. The primary endpoint was a first-pass near-complete or complete reperfusion, defined as a modified treatment in cerebral infarction (mTICI) score of 2c/3. Additionally, we examined reperfusion results, National Institutes of Health Stroke Scale (NIHSS) scores at 24 h and discharge, device malfunctions, complications and procedural technical parameters. Sixty-eight patients (38 women, mean age 72 ± 14 years) were included in our study. Median NIHSS at admission was 11 (IQR 6–16). In 53 (78%) cases, a primary combined approach was used as the frontline technique. Among all enrolled patients, first-pass mTICI 2c/3 was achieved in 22 (32%) and final mTICI 2c/3 in 46 (67.6%) patients after a median of 1.5 (IQR 1–2) passes. Final reperfusion mTICI 2b/3 was observed in 89.7% of our cases. We observed no device malfunctions. Median NIHSS at discharge was 2 (IQR 0–4), and no symptomatic intracranial hemorrhages were reported. Based on our analysis, the utilization of the Solitaire X 3 mm device appears to be both effective and safe for performing EVT in cases of MDVO stroke.

Astragaloside IV promotes cerebral angiogenesis and neurological recovery after focal ischemic stroke in mice via activating PI3K/Akt/mTOR signaling pathway

Our previous work has shown that activating PI3K/Akt/mTOR signaling pathway is involved in angiogenesis after ischemic stroke, and recent studies have revealed that astragaloside IV (AS-IV) exerts beneficial effects on cerebral protection after ischemic stroke. However, it is unclear whether the beneficial effects of AS-IV against ischemic stroke is related to angiogenesis and PI3K/Akt/mTOR signaling pathway. The aim of this study was to investigate the effects of AS-IV on angiogenesis and long-term neurological recovery after focal ischemic stroke as well as the underlying mechanisms. After mice model of distal middle cerebral artery occlusion (dMCAO), AS-IV was administered with low dose (10 mg/kg), medium dose (20 mg/kg) or high dose (40 mg/kg) once daily for 14 days. We report herein that AS-IV (20 mg/kg) significantly ameliorated long-term neurological recovery and attenuated histological damage, while promoting cerebral blood flow recovery in ischemic mice. Moreover, AS-IV administration enhanced microvessel density as well as astrocyte and pericyte coverage around microvessels in the peri-infarct cortex. In vitro, AS-IV promoted endothelial cells (ECs) proliferation and tube formation after oxygen-glucose deprivation (OGD), which was partially inhibited by the specific PI3K inhibitor LY294002. Finally, AS-IV increased the expression of vascular endothelial growth factor (VEGF) through activating the PI3K/AKT/mTOR signaling pathway in the process of promoting angiogenesis. These results suggested that AS-IV may promote angiogenesis after ischemic stroke through increasing the expression of VEGF via PI3K/Akt/mTOR pathway, which unveils novel therapeutic effects of AS-IV and suggests promising application of AS-IV in ischemic stroke.

Enhanced angiogenesis in the thalamus induced by a novel TSPO ligand ameliorates cognitive deficits after focal cortical infarction

Neuronal loss in the ipsilateral thalamus after focal cortical infarction participates in post-stroke cognitive deficits, and enhanced angiogenesis in the thalamus is expected to reduce neuronal damage. We hypothesize that novel translocator protein (TSPO) ligand, 2-Cl-MGV-1, can promote angiogenesis, attenuate neuronal loss in the thalamus, and ameliorate post-stroke cognitive deficits. Cortical infarction was induced by distal middle cerebral artery occlusion (dMCAO) in stroke-prone renovascular hypertensive rats. 2-Cl-MGV-1 or dimethyl sulfoxide was administered 24 h after dMCAO and then for 6 or 13 days. Spatial learning and memory were assessed using the Morris water maze. Neuronal loss, TSPO expression, angiogenesis, and intrinsic pathway were determined by immunofluorescence and immunoblotting 7 and 14 days after dMCAO. Cortical infarction caused post-stroke cognitive deficits and secondary neuronal loss with gliosis in the ipsilateral thalamus within 14 days of dMCAO. Increased angiogenesis and elevated expression of vascular TSPO were detected in the ipsilateral thalamus, and treatment with 2-Cl-MGV-1 enhanced angiogenesis by stimulating the PI3K-AKT-mTOR pathway. The effects of 2-Cl-MGV-1 on angiogenesis coincided with reduced neuronal loss in the thalamus and contributed to improvements in post-stroke cognitive deficits. Our findings suggest that 2-Cl-MGV-1 stimulates angiogenesis, ameliorates neuronal loss in the thalamus, and improves post-stroke cognitive deficits.

Safety and efficacy of endovascular thrombectomy for primary and secondary MeVO

BackgroundMedium-vessel occlusions (MeVO) are emerging as a new target for endovascular treatment (EVT). Primary MeVO occur de novo, while secondary MeVO arise from large vessel occlusion (LVO) through clot migration or fragmentation - spontaneously, following intravenous thrombolysis or EVT. We aimed to evaluate efficacy and safety of EVT in primary and EVT-induced secondary MeVO. MethodsRetrospective single-center study on consecutive EVT-treated acute ischemic stroke, from 2019-to-2021. We considered: (1) exclusive-LVO, patients with LVO and – in case of residual distal occlusion – no rescue endovascular procedure; (2) primary MeVO: initial A2, A3, M2 non-dominant, M3, P2, P3 occlusions; (3) EVT-induced secondary MeVO, presenting LVO with subsequent (treated) EVT-induced MeVO. We compared (univariable/multivariable logistic regression) EVT efficacy (eTICI≥2b, 3-month modified Rankin Scale [mRS] 0-2) and safety (EVT-complications [vessel dissection, perforation, persistent-SAH], symptomatic ICH) in all MeVO versus exclusive-LVO, primary MeVO versus exclusive-LVO, EVT-induced secondary MeVO versus exclusive-LVO and EVT-induced secondary MeVO versus primary MeVO. ResultsWe included 335 patients: 221 (66.0 %) exclusive-LVO and 114 (34.0 %) MeVO (55 [48.2 %] primary, 59 [51.8 %] secondary). Compared to exclusive-LVO, primary MeVO had higher rates of EVT complications (aOR 3.77 [95%CI 1.58-9.00],p=0.003), lower rates of eTICI≥2b (aOR 0.32 [95%CI 0.12-0.88],p=0.027) and mRS 0-2 (aOR 0.28 [95%CI 0.13-0.63],p=0.002). EVT-induced secondary MeVO had no major differences in efficacy and safety outcomes compared to exclusive-LVO, but a better mRS 0-2 (aOR 8.00 [95%CI 2.12-30.17],p=0.002) compared to primary MeVO. ConclusionsPrimary and EVT-induced secondary MeVO showed different safety/efficacy EVT-related profiles. Dedicated randomized data are needed to identify the best acute reperfusion strategy in the two categories.

Efficacy of nonocclusive separate freezing technique of cryoballoon pulmonary vein isolation: comparison of novel and conventional cryoballoon system

Abstract Background/Introduction Complete occlusion of pulmonary vein (PV) with cryoballoon is an important factor to achieve enough temperature drop and successful pulmonary vein isolation (PVI). However, it is sometimes difficult to occlude PV completely because of large diameter or anatomical difference. Distal cryoblloon positioning in the PV can achieve complete occlusion but it may increase risk of phrenic nerve injury or PV stenosis. Nonocclusive separate freezing technique, freezing superior and inferior portion of the PV at proximal side with no complete occlusion, may be useful for that situation but efficacy of the technique is not well elucidated. Purpose The purpose of this study is to investigate efficacy of nonocclusive separate freezing technique and compare procedure details of the POLARx and the Arctic Front Advance Pro (AFA-Pro). Methods We retrospectively analyzed consecutive patients who underwent cryoballoon ablation with nonocclusive separate freezing technique from September 2019 to February 2023. We defined failure of the nonocclusive separate freezing as the case which needed distal complete occlusion with cryoballoon or touch up radiofrequency ablation to achieve PVI. We analyzed success rate of nonocclusive separate freezing and evaluated nadir temperature, freezing time and number of application times. We also explored incidence of stop of freezing due to phrenic nerve injury (PNI) or esophageal temperature drop during the procedure and permanent PNI and gastroesophageal complications after the procedure between the POLARx and the AFA-Pro. Results One-hundred and one patients, 73 were male (72.3%) and mean age was 66.8 ± 10.5 years, were analyzed. Total PVs were 121 (left superior (LS) PV 31, right superior (RS) PV 53, left common (LC) PV 37) and the POLARx was 45 (LSPV 18, RSPV 24, LCPV 3) and the AFA-Pro was 76 (LSPV 13, RSPV 29, LCPV 34). Success rates of the separate freezing of the POLARx was 84.4% and the AFA-Pro was 77.6% (p=0.48). There were no significant differences in freezing time and number of application times but nadir temperature was significantly lower in the POLARx (-52.1 ± 4.7 °C vs -42.9 ± 7.2 °C, p&amp;lt;0.001). The incidence of stop of freezing had no significant difference between the POLARx and the AFA-Pro but nadir temperature of stop of freezing due to esophageal temperature drop was significantly lower in the POLARx (-53.8 ± 4.3 °C vs -44.7 ± 7.7 °C, p=0.039). Permanent PNI was not seen but two gastric hypomotility events occurred in the POLARx. Conclusions There was no significant difference of success rate of the nonocclusive separate freezing technique but it tended to be higher and nadir temperature was significantly lower in the POLARx. There was no obvious complication in the AFA-Pro but two gastric hypomotility events were seen in the POLARx.