Intracranial Artery Occlusion Research Articles

Meta-analysis on the primary approach: Aspiration versus stent retrieval for internal carotid artery occlusion.

Previous studies have not provided consistent findings regarding the efficacy of aspiration thrombectomy versus stent retriever thrombectomy in patients with acute internal carotid artery occlusion. This study aimed to evaluate the preferable endovascular technique (aspiration or stent retriever) and the impact of stent retriever utilization on both clinical and angiographic outcomes. We collected potential scholarly articles from a variety of databases including the PubMed, Web of Science, Embase, Cochrane Library, ClinicalTrials.gov, and the World Health Organization, International Clinical Trials Registry Platform. The search spanned from the establishment of electronic databases up to March 2024. Additionally, gray literature was sourced from the references cited in the included literature reports. Statistical analysis of the combined data was performed using STATA version 11.0 (Stata Corporation, TX). Our analysis comprises a total of 4 studies, involving 759 participants in total. Among these individuals diagnosed with internal carotid artery occlusion, 435 were assigned to the aspiration group, while 324 were designated to the stent retriever group. The findings indicated a significant increase in the rate of successful reperfusion in the stent retriever group compared to the aspiration group. Furthermore, it was observed that the incidence of overall complications, intracerebral hemorrhage, embolization formation, puncture to reperfusion time, and onset to reperfusion time in the stent retriever group did not significantly exceed that in the aspiration group. In our review on intracranial internal carotid artery occlusion, stent retrievers outperformed direct aspiration in achieving successful reperfusion. However, further studies evaluating the effects of different approaches to internal carotid artery clot removal are required to confirm these results.

Mimicking aneurysm in a patient with chronic occlusion of the left middle cerebral artery

The chronic occlusion of intracranial arteries generally has no or mild clinical symptoms, and the clinical symptoms of acute cerebral artery occlusion are mostly manifested as severe cerebral infarction symptoms, which often make early diagnosis difficult, thus losing the best treatment opportunity. Once cerebral infarction occurs, the consequences are difficult to recover. This is also an important reason for the high misdiagnosis rate and mortality of this disease. In this paper, the characteristics of the disease were analyzed to provide clinical reference.

Prognostic analysis of endovascular mechanical thrombectomy in stroke patients with acute internal carotid artery obstruction based on circle of Willis variation.

Endovascular mechanical thrombectomy (EVMT) is widely employed in patients with acute intracranial carotid artery occlusion (AIICAO). This study aimed to predict the outcomes of EVMT following AIICAO by utilizing anatomic classification of the circle of Willis and its relative position to the thrombus. In this study, we retrospectively analyzed a cohort of 108 patients with AIICAO who underwent endovascular mechanical thrombectomy (EVMT) at Shaoxing People's Hospital. Based on variations in the circle of Willis, as well as the size and location of the thrombus occluding the middle cerebral artery (MCA), anterior cerebral artery (ACA), and posterior cerebral artery (PCA), we classified AIICAO into four grades using digital subtraction angiography (DSA). EVMT was initiated upon admission, and baseline data including demographic characteristics, vascular risk factors, angiographic features, initial National Institutes of Health Stroke Scale (NIHSS) scores, Alberta Stroke Program Early CT Score (ASPECT), and etiology classification were compared across these four grades. The prognosis and mortality rates at 90 days post-stroke were evaluated for the different grades and within each grade, patients were further categorized into two subtypes based on vascular compensation and occluded vessels. Significant differences were observed among the four grades of Willis compensation concerning etiologic classification (p = 0.008), postoperative modified treatment in cerebral ischemia (mTICI, p = 0.017), postoperative symptomatic intracranial hemorrhage (sICH, p = 0.007), NIHSS score at admission (p = 0.001), and favorable outcomes at 90 days (modified Rankin Score 0-2) (p = 0.003). The mortality rate at 90 days exhibited a significant difference across the four grades of Willis compensation (p = 0.05). However, prognosis did not reveal any significant differences among the various subtypes within the same grade (p > 0.05). The assessment of the degree of Willis compensation can be improved by evaluating the integrity of the circle of Willis, as well as the size and location of the clot in cases of isolated internal carotid artery occlusion (iICAo). This approach provides valuable prognostic indicators and important insights for the pre-selection of patients prior to endovascular mechanical thrombectomy (EVMT).

Vessel wall MRI evaluation for the safety of endovascular recanalization of non-acute intracranial anterior circulation artery occlusions

BackgroundVessel wall MRI (VWMRI) can reveal the morphological features of intracranial artery occlusion (ICAO). This study aimed to investigate the imaging features of ICAO on VWMRI and explore their correlation...

Long and Large Stentrievers Improve Reperfusion Outcomes in Acute Intracranial Terminal Internal Carotid Artery Occlusion: Interim Results of the Rossetti Registry.

Although stentrievers (SRs) are widely used for mechanical thrombectomy (MT), the impact of device dimensions on optimizing reperfusion outcomes in high clot burden cases is unclear. Our study aimed to investigate the effect of SR size on angiographic and clinical outcomes in patients with acute terminal internal cerebral artery (TICA) occlusion. We analyzed ROSSETTI registry data to compare technical and clinical outcomes of TICA occlusion patients treated with MT without rescue therapy, according to SR diameter and length: 6 × 41-50 mm, 6 × 20-40 mm, and <6 × 20-50 mm. The first-pass effect (FPE) was defined as achieving aTICI2c‑3 after asingle pass. We included 491 patients, 240 (41.5%) in 6 × 41-50 group, 117 (20.2%) in 6 × 20-40 group, and 134 (23.2%) in < 6 × 20-50 group. The MT procedure time for the 6 × 41-50 group was shorter, but the FPE rate was similar across all groups. The highest final mTICI2c‑3 rate was in 6 × 41-50 group (81.2%), compared to 6 × 20-40 group (68.4%) and 4-6 × 20-50 group (72.4%) (p = 0.016). Distal catheter use was associated with final mTICI0-2b (62% of patients). Clinical outcomes were similar between the groups. Larger diameter and longer length of the SR, as well as not using an intermediate catheter, were independent predictors of final mTICI2c‑3. The use of 6 × 41-50 SRs (OR 1.64, 95% CI 1.06-2.52; p = 0.024) and distal catheter use (OR 0.62, 95%CI 0.40-0.96; p = 0.034) were independent predictors of final mTICI2c‑3. Use of longer and larger SRs in acute intracranial TICA occlusion improves final reperfusion rate.

Imaging characteristics and treatment strategies for carotid artery occlusion caused by skull base fracture.

The internal carotid artery occlusion caused by head and neck trauma, also known as traumatic intracranial artery occlusion, is relatively rare clinically. Traumatic skull base fracture is a common complication of traumatic brain injury. Traumatic skull base fracture is one of the causes of traumatic internal carotid artery occlusion. If not detected early and treated in time, the prognosis of patients is poor. This editorial makes a relevant analysis of this disease.

Contemporary Management of Acute Ischemic Stroke.

In the past decade, adding mechanical thrombectomy (MT) of intracranial arterial occlusions to intravenous (IV) thrombolysis has revolutionized the treatment of acute ischemic stroke (AIS) by expanding the therapeutic window to 24h. Treatment decisions require establishing a high probability of AIS; confirming time since last known well (LKW); assessing severity of the neurological deficit; determining any contraindications to IV thrombolysis; and performing neuroimaging, usually noncontrast computed tomography (NCCT), to exclude intracerebral hemorrhage. If time since LKW is less than 4.5h, patients with disabling stroke without contraindications can proceed immediately to IV thrombolysis while the decision about MT is under way. For some patients, the MT decision can be made on the basis of clinical assessment, NCCT, and CT angiography showing a large vessel occlusion. Others may require additional neuroimaging. Patients who are not candidates for IV thrombolysis within 4.5h or MT should be immediately evaluated for eligibility for extended-window IV thrombolysis or early antiplatelet treatment.

Association of renal biomarkers with fast progressor phenotype and related outcomes in anterior circulation large vessel occlusion stroke.

Renal dysfunction is a known predictor of long-term functional dependency after anterior circulation large vessel occlusion (ACLVO) stroke. However, the impact of renal dysfunction on early infarct growth rate (IGR) has not been previously demonstrated. The objective of this study was to define the association of creatinine-based renal biomarkers with fast or slow progressor phenotypes and related clinical outcomes in ACLVO stroke. This retrospective study examined patients with acute intracranial internal carotid artery or middle cerebral artery-M1 occlusions admitted between 2014 and 2019. Patients were included if they received baseline CT perfusion (CTP) or MRI on presentation within 24 h of estimated stroke onset. Infarct growth rate (IGR) was determined by ischemic core volume on CTP or MRI divided by time from stroke onset to imaging. IGR was used to stratify fast progressor (IGR ≥10 mL/h) and slow progressor (IGR < 10 mL/h) status. Renal dysfunction was assessed based on serum creatinine and estimated glomerular filtration rate (eGFR) on presenting laboratories. Logistic regression models, adjusted for significant covariates, identified independent associations between renal dysfunction biomarkers, progressor status, and clinical outcomes based on modified Rankin Scale (mRS) at 90 days. Among 230 patients with ACLVO, 29% were fast progressors, with median serum creatinine levels higher than slow progressors (1.1 vs. 0.9 mg/dL, p < 0.05) and lower median eGFR (66.2 vs. 69.0 mL/min/1.73m2, p < 0.05). Elevated creatinine (≥1.2 mg/dL) was independently associated with fast progressor status (adjusted OR 2.37, 95% CI 1.18-4.77), worse 90-day mRS (adjusted OR 1.88, 95% CI 1.01-3.51) and mortality (adjusted OR 2.57, 95% CI 1.14-5.79). Reduced eGFR (<60 mL/min/1.73m2) was independently associated with fast progressor status (adjusted OR 2.38, 95% CI 1.14-4.94), but not with 90-day mRS or mortality. Serum creatinine-based biomarkers of renal dysfunction were associated with fast progressor phenotype of ACLVO stroke, and worse clinical outcomes, which may help identify such patients earlier during emergency evaluation for expedited access to EVT. Future prospective studies are warranted to confirm and test implementation of these findings.

Endovascular therapy in patients with acute intracranial non-terminal internal carotid artery occlusion (ICA-I).

Acute intracranial occlusion of the internal carotid artery (ICA) can be distinguished into (a) occlusion of the terminal ICA, involving the proximal segments of the middle or anterior cerebral artery (ICA-L/-T) and (b) non-terminal intracranial occlusions of the ICA with patent circle of Willis (ICA-I). While patients with ICA-L/-T occlusion were included in all randomized controlled trials on endovascular therapy (EVT) in anterior large vessel occlusion, data on EVT in ICA-I occlusion is scarce. We thus aimed to evaluate effectiveness and safety of EVT in ICA-I occlusions in comparison to ICA-L/-T occlusions. A large international multicentre cohort was searched for patients with intracranial ICA occlusion treated with EVT between 2014 and 2023. Patients were stratified by ICA occlusion pattern, differentiating ICA-I and ICA-L/-T occlusions. Baseline factors, technical (modified thrombolysis in cerebral infarction (mTICI) scale) and functional outcomes (modified Rankin scale [mRS] at 3 months) as well as rates of (symptomatic) intracranial hemorrhage ([s]ICH) were analyzed. Of 13,453 patients, 1825 (13.6%) had isolated ICA occlusion. ICA-occlusion pattern was ICA-I in 559 (4.2%) and ICA-L/-T in 1266 (9.4%) patients. Age (years: 74 vs 73), sex (female: 45.8% vs 49.0%) and pre-stroke functional independency (pre-mRS ⩽ 2: 89.9% vs 92.2%) did not differ between the groups. Stroke severity was lower in ICA-I patients (NIHSS at admission: 14 [7-19] vs 17 [13-21] points). EVT was similarly successful with respect to technical (mTICI2b/3: 76.1% (ICA-I) vs 76.6% (ICA-L/-T); aOR 1.01 [0.76-1.35]) and functional outcome (mRS ordinal shift cOR 1.01 [0.83-1.23] in adjusted analyses. Rates of ICH (18.9% vs 34.5%; aOR 0.47 [0.36-0.62] and sICH (4.7% vs 7.3%; aOR 0.58 [0.35-0.97] were lower in ICA-I patients. EVT might be performed safely and similarly successful in patients with ICA-I occlusions as in patients with ICA-L/-T occlusions.

The Prognostic Value of a Naples Score in Determining in-Hospital Mortality in Patients with Acute Ischemic Stroke Undergoing Endovascular Treatment.

Background/Objectives: The Naples prognostic score (NPS), reflecting inflammation and nutritional status, has prognostic value, especially in cancer. This study evaluated its ability to predict in-hospital mortality in acute ischemic stroke (AIS) patients undergoing endovascular treatment (EVT). Methods: We retrospectively studied 244 patients with AIS who were admitted between April 2020 and December 2023. Patients were included if they presented within 6 h of symptom onset with evidence of intracranial proximal arterial occlusion. The EVT was performed using aspiration catheters, stent retrievers, or both. The NPS was calculated based on the neutrophil-lymphocyte ratio, lymphocyte-monocyte ratio, and albumin and total cholesterol levels. Results: We found a significant association between higher NPS scores and in-hospital mortality. Patients with a high NPS (3 or 4) had a mortality rate of 41.6% compared to 21.0% in the low-NPS group (0, 1, or 2). The full model incorporating NPS showed superior predictive ability for in-hospital mortality compared with the baseline model (areas under the curve 0.881 vs. 0.808). A receiver-operating characteristic analysis at a cutoff of >2.5 for the NPS showed a sensitivity of 86.6% and specificity of 41.9%. This study demonstrated that incorporating the NPS into the predictive model improved the accuracy and calibration for predicting in-hospital mortality. A decision curve analysis showed the net benefit of using the full model incorporating NPS over the baseline model, emphasizing its potential clinical application in prognostication. Conclusions: NPS is a reliable predictor of in-hospital mortality in AIS patients undergoing EVT. Incorporating NPS into clinical practice could help to identify high-risk patients and improve outcomes through tailored interventions.

Endovascular thrombectomy for childhood stroke (Save ChildS Pro): an international, multicentre, prospective registry study

Emerging evidence suggests that endovascular thrombectomy is beneficial for treatment of childhood stroke, but the safety and effectiveness of endovascular thrombectomy has not been compared with best medical treatment. We aimed to prospectively analyse functional outcomes of endovascular thrombectomy versus best medical treatment in children with intracranial arterial occlusion stroke. In this prospective registry study, 45 centres in 12 countries across Asia and Australia, Europe, North America, and South America reported functional outcomes for children aged between 28 days and 18 years presenting with arterial ischaemic stroke caused by a large-vessel or medium-vessel occlusion who received either endovascular thrombectomy plus best medical practice or best medical treatment alone. Intravenous thrombolysis was considered part of best medical treatment and therefore permitted in both groups. The primary outcome was the difference in median modified Rankin Scale (mRS) score between baseline (pre-stroke) and 90 days (±10 days) post-stroke, assessed by the Wilcoxon rank test (α=0·05). Efficacy outcomes in the endovascular thrombectomy and best medical treatment groups were compared in sensitivity analyses using propensity score matching. The Save ChildS Pro study is registered at the German Clinical Trials Registry, DRKS00018960. Between Jan 1, 2020, and Aug 31, 2023, of the 241 patients in the Save ChildS Pro registry, 208 were included in the analysis (115 [55%] boys and 93 [45%] girls). 117 patients underwent endovascular thrombectomy (median age 11 years [IQR 6-14]), and 91 patients received best medical treatment (6 years [3-12]; p<0·0001). The median Pediatric National Institutes of Health Stroke Scale (PedNIHSS) score on admission was 14 (IQR 10-19) in the endovascular thrombectomy group and 9 (5-13) in the best medical treatment group (p<0·0001). Both treatment groups had a median pre-stroke mRS score of 0 (IQR 0-0) at baseline. The change in median mRS score between baseline and 90 days was 1 (IQR 0-2) in the endovascular thrombectomy group and 2 (1-3) in the best medical treatment group (p=0·020). One (1%) patient developed a symptomatic intracranial haemorrhage (this patient was in the endovascular thrombectomy group). Six (5%) patients in the endovascular thrombectomy group and four (5%) patients in the best medical treatment group had died by day 90 (p=0·89). After propensity score matching for age, sex, and PedNIHSS score at hospital admission (n=79 from each group), the change in median mRS score between baseline and 90 days was 1 (IQR 0-2) in the endovascular thrombectomy group and 2 (1-3) in the best medical treatment group (p=0·029). Regarding the primary outcome for patients with suspected focal cerebral arteriopathy, endovascular thrombectomy (n=18) and best medical treatment (n=33) showed no difference in 90-day median mRS scores (2 [IQR 1-3] vs 2 [1-4]; p=0·074). Clinical centres tended to select children with more severe strokes (higher PedNIHSS score) for endovascular thrombectomy. Nevertheless, endovascular thrombectomy was associated with improved functional outcomes in paediatric patients with large-vessel or medium-vessel occlusions compared with best medical treatment. Future studies need to investigate whether the positive effect of endovascular thrombectomy is confined to older and more severely affected children. None.

Vascular Abnormalities and Neurofibromatosis Type 1: A Paediatric Case Series.

Neurofibromatosis type 1 (NF1) is a multisystemic neurocutaneous disease caused by a heterozygous mutation of the NF1 gene that encodes neurofibromin. Complications include vascular and neurologic abnormalities such as moyamoya syndrome, a cerebrovascular disorder with progressive occlusion of the large intracranial arteries, leading to ischemic events and the formation of abnormal vascular networks. Stenosis of the renal artery is another frequent complication of neurofibromatosis type 1, and it represents the most common cause of secondary hypertension in these patients. The purpose of the article is to describe the clinical manifestations of neurofibromatosis type 1 vasculopathy in 4 patients presenting with a wide range of neurologic and reno-vascular manifestations, as well as to examine current diagnostic management and follow-up, current therapeutic options, and to discuss further perspectives in terms of screening, diagnosis, and treatment.

Utility of automated CT perfusion software in acute ischemic stroke with large and medium vessel occlusion.

Early diagnosis of large vessel occlusion (LVO) in acute stroke often requires CT angiography (CTA). Automated CT perfusion (CTP) software, which identifies blood flow abnormalities, enhances LVO diagnosis and patient selection for endovascular thrombectomy (EVT). This study evaluates the sensitivity of automated CTP images in detecting perfusion abnormalities in patients with acute ischemic stroke (AIS) and LVO or medium vessel occlusion (MeVO), compared to CTA. We screened acute ischemic stroke patients presenting within 24 h who underwent CT, CTA, and CTP as per institutional protocol. RAPID AI software processed CTP images, while neuroradiologists reviewed CTA for intracranial arterial occlusions. Sensitivity, specificity, and accuracy of automated CTP maps in detecting occlusions were assessed. Of 790 screened patients, 31 were excluded due to lack of RAPID CTP data or poor-quality scans, leaving 759 for analysis. The median age was 71 years (IQR: 61-81), with 47% female. Among them, 678 had AIS, and 81 had AIS ruled out. CTA identified arterial occlusion in 562 patients (74%), with corresponding CTP abnormalities in 537 patients (Tmax > 6 sec). In the 197 without occlusion, CTP was negative in 161. Automated CTP maps had a sensitivity of 95.55% (CI 95: 93.50-97.10%), specificity of 81.73% (CI 95: 75.61-86.86%), negative predictive value of 98.22% (CI 95: 97.39-98.79%), positive predictive value of 63.54% (CI 95: 56.46-70.09%), and overall accuracy of 85.18% (CI 95: 82.45-87.64%). Automated CTP maps demonstrated high sensitivity and negative predictive value for LVOs and MeVOs, suggesting their usefulness as a rapid diagnostic tool, especially in settings without expert neuroradiologists.

Insoluble proteomics analysis of acute intracranial large vessel occlusive thrombus

BackgroundAcute large vessel occlusion (LVO) stroke is highly prevalent and severe. Despite thrombolytic therapy, many patients experience substantial complications. Understanding the origins, constituents, and pathologic processes involved in thrombus formation in acute intracranial large artery occlusion is crucial. ObjectivesTo identify the characteristics of insoluble proteins from different sources of cerebral thrombus. MethodsThis study included 13 patients with cardiogenic embolic (CE) thrombus and 15 with large artery atherosclerotic (LAA) thrombus. High-performance liquid chromatography and liquid chromatography-tandem mass spectrometry were used to analyze insoluble proteins in thrombi. Bioinformatics analyses explored differential proteins and associated functional pathways. Least absolute shrinkage and selection operator and random forest identified biomarkers for diagnosing thrombus sources, validated by parallel reaction monitoring. ResultsWe constructed an insoluble protein atlas of cerebral thrombi, identifying 6975 insoluble proteins, including 143 extracellular matrix (ECM)-related proteins. The enrichment pathways considerably varied between thrombi from different sources. Inflammation-related pathways, such as acute inflammatory response, along with ECM-related pathways such as laminin interactions, were notably upregulated in LAA compared with CE. Additionally, 2 biomarkers (IDH2 and HSPG2) exhibited strong diagnostic performance (area under the curve = 1) and robustness. ConclusionIn the insoluble proteomics of thrombus, we highlighted the crucial roles of immune responses and ECM proteins in thrombus formation, providing new insights into its mechanisms and potential drug development. Additionally, we identified 2 biomarkers that offer new methods for determining thrombus sources in patients with LVO.

Retraction Note: Application of optical magnetic resonance imaging detection in the safety of direct aspiration thrombectomy for acute intracranial arterial occlusion surgery

Retraction Note: Application of optical magnetic resonance imaging detection in the safety of direct aspiration thrombectomy for acute intracranial arterial occlusion surgery

Endovascular therapy for acute intracranial large vessel occlusion due to atherothrombosis: Multicenter historical registry

BackgroundAtherothrombotic stroke-related large vessel occlusion (AT-LVO) is caused by two etiologies, the intracranial artery occlusion due to in situ occlusion (intracranial group) or due to embolism from cervical carotid occlusion...

Diagnostic value of high-resolution vessel wall imaging technique in intracranial arterial stenosis and occlusion: a comparative analysis with digital subtraction angiography

Objective To analyze the diagnostic value of HR-VWI in intracranial arterial stenosis and occlusion and compare it with DSA. Methods A retrospective analysis of clinical data of 59 patients with intracranial arterial stenosis in our hospital was conducted to compare the diagnostic results of the two methods for different degrees of intracranial stenosis and various morphological plaques. Results The diagnosis of stenosis and occlusion by both methods showed no significant difference (p > 0.05). Comparison of plaque morphology detected by HR-VWI with pathological examination results showed no significant difference (p > 0.05); however, there was a significant difference between plaque morphology detected by DSA and pathological examination results (p < 0.05). Additionally, there was a significant difference between plaque morphology detected by HR-VWI and DSA (p < 0.05). Conclusion HR-VWI technique is comparable to DSA technique in diagnosing intracranial arterial stenosis and occlusion, but it is superior to DSA in plaque morphology diagnosis.

Role of Endovascular Thrombectomy in Improving the Functional Outcome in Acute Stroke Patients Presenting 6-12 Hours after Stroke Onset

Abstract Background Based on the World Health Organization (WHO) statistics, there are 15 million strokes annually. The aim of the treatment in acute ischemic stroke is rapid restoration of perfusion to the ischemic area by minimizing the time between the occurrence of symptoms and the treatment. This is crucial for saving the salvageable brain tissue (penumbra) by restoration of flow and metabolism to normal Aim of Work The aim of work is to evaluate the safety and efficacy of endovascular thrombectomy (EVT) in patients presenting 6-12 hours from onset of stroke symptoms secondary to large vessel occlusion. Patients and Methods 50 Patients presenting with acute ischemic stroke with causative occlusion of major vessels in anterior circulation, underwent mechanical thrombectomy Results Two-thirds of the patients had their intracranial arterial occlusion at M1 segment of the middle cerebral artery. The median baseline NIHSS score, ASPECTS, and mRS score of the studied patients was 16 (IQR 11-20), 8 (IQR 7-9) and 0 (IQR 0-1), respectively. The median final infarct volume, NIHSS score, ASPECTS post-intervention and mRS score at 90 days of the studied patients was 40 ml (IQR 26.5-70) (P &amp;lt; 0.001), 9 (IQR 4-16) (P &amp;lt; 0.001), 8(IQR 5-9) (P &amp;lt; 0.01), and 2 (IQR1-4) (P &amp;lt; 0.001), respectively and (90 %) of them had revascularization type TICI 2b- 3. More than half of the studied patients (52%) had mRS score at 90 days of ≤ 2 and mortality rate was 12%. Conclusions The current study showed that endovascular thrombectomy techniques are safe and effective in the treatment of acute ischemic stroke.

Preliminary outcomes of endovascular treatment of moyamoya disease

PurposeThis study aimed to investigate the effectiveness and safety of endovascular revascularisation of intracranial artery occlusion and stenosis in moyamoya disease using stent angioplasty. Materials and methodsWe recruited 12 patients (8 women and 4 men) with occlusion and stenosis of intracranial arteries in the context of moyamoya disease who underwent endovascular stent angioplasty. Clinical data, baseline conditions, lesion location, treatment outcomes, periprocedural complications, and follow-up outcomes were analysed. ResultsThe occlusion was located at the M1 segment of the middle cerebral artery in 8 patients, at both the M1 and A2 segments in one patient, and at the C7 segment of the internal carotid artery in 3. Thirteen stents were deployed at the occlusion site, including the low-profile visualized intraluminal support (LVIS) device in 8 patients, an LVIS device and a Solitaire AB stent in one, and a Leo stent in 3, with a success rate of 100% and no intraprocedural complications. Plain CT imaging after stenting revealed leakage of contrast agent, which disappeared on the second day, resulting in no clinical symptoms or neurological sequelae. Follow-up angiography studies were performed in all patients for 6–12 months (mean, 8.8). Slight asymptomatic in-stent stenosis was observed in 2 patients (16.7%), and no neurological deficits were observed in the other patients. All preoperative ischaemic symptoms completely disappeared at follow-up. ConclusionStent angioplasty is a safe and effective treatment for occlusion and stenosis of intracranial arteries in moyamoya disease.

Application of high-resolution magnetic imaging in the perioperative period of mechanical thrombectomy for acute intracranial large artery occlusion

Application of high-resolution magnetic imaging in the perioperative period of mechanical thrombectomy for acute intracranial large artery occlusion