Intracranial Vessels Research Articles

Vascular Labeling of Extracranial Head and Neck Vessels Using Silicone Dye Injection: An Effective Method for Cadaver-Based Facial Surgery Training

Abstract Background Silicone dye injection is a well-described technique for studying vascular anatomy. Plastic surgeons routinely participate in cadaveric workshops and are involved in the preparation of vascular-labeled cadavers. However, sparse literature is available on dye studies of extracranial head and neck vessels, even with anatomists, and the preparation of these cadavers is a daunting task. Materials and Methods In this study, we describe a straightforward technique of silicone dye injection for extracranial head and neck vasculature and its application for filler injection training and other plastic surgical procedure demonstrations on cadavers. We used six soft-embalmed cadavers. The common carotid arteries and internal jugular veins were cannulated with infant feeding tubes. The vessels that could lead to dye extravasation into intracranial vessels and upper limbs were ligated. The vasculature was irrigated with water and then injected with color-coded silicone dyes (red: arterial; blue: venous). The solvent-to-catalyst ratios were varied to identify the ideal combination. Injected specimens were dissected 24 hours later to identify the staining quality. Results A clear demarcation of the extracranial head and neck vasculature in all cadavers was seen. The best solvent-to-catalyst ratio was identified in cadavers with the best staining of both large and small-sized blood vessels (<1 mm) with no dye spillage from arteries to the veins. Conclusion Silicone dye injection with the described technique can give excellent and predictable results. The technique also uses less quantity of dye, and the intracranial structures are spared, which can be used for other studies; hence, there is more economical utilization of cadavers.

Simulation-based optimization and experimental comparison of intracranial T2-weighted DANTE-SPACE vessel wall imaging at 3T and 7T.

T2-weighted DANTE-SPACE (Delay Alternating with Nutation for Tailored Excitation - Sampling Perfection with Application optimized Contrasts using different flip angle Evolution) sequences facilitate non-invasive intracranial vessel wall imaging at 7T through simultaneous suppression of blood and CSF. However, the achieved vessel wall delineation depends closely on the selected sequence parameters, and little information is available about the performance of the sequence using more widely available 3T MRI. Therefore, in this paper a comprehensive DANTE-SPACE simulation framework is used for the optimization and quantitative comparison of T2-weighted DANTE-SPACE at both 7T and 3T. Simulations are used to propose optimized sequence parameters at both 3T and 7T. At 7T, an additional protocol which uses a parallel transmission (pTx) shim during the DANTE preparation for improved suppression of inflowing blood is also proposed. Data at both field strengths using optimized and literature protocols are acquired and quantitatively compared in six healthy volunteers. At 7T, more vessel wall signal can be retained while still achieving sufficient CSF suppression by using fewer DANTE pulses than described in previous implementations. The use of a pTx shim during DANTE at 7T provides a modest further improvement to the inner vessel wall delineation. At 3T, aggressive DANTE preparation is required to achieve CSF suppression, resulting in reduced vessel wall signal. As a result, the achievable vessel wall definition at 3T is around half that of 7T. Simulation-based optimization of DANTE parameters facilitates improved T2-weighted DANTE-SPACE contrasts at 7T. The improved vessel definition of T2-weighted DANTE-SPACE at 7T makes DANTE preparation more suitable for T2-weighted VWI at 7T than at 3T.

Pathophysiology of Normal Pressure Hydrocephalus

The current perspective for the pathophysiology of normal pressure hydrocephalus is focusing on stiffness of the central nervous tissue, especially on a type of cerebrovascular disorder. Rigid intracranial vessels and tissues derived by either vascular risk factors or aging may lead into impaired dynamics of the cerebrospinal fluid such as increased pulsatility and decreased absorption of the cerebrospinal fluid. Enlarged ventricle may result in a decrease of blood perfusion in brain parenchyma, and in turn global hypoxia and neuro-inflammation along with a breakdown of the blood-brain-barrier. Deterioration of the glymphatic pathway, the crucial disposal pathway of the waste product of the brain, also might contribute to the irreversible injury of the nervous tissue by deposition of abnormal toxic proteins including amyloid beta. Of note, the pathophysiology of the normal pressure hydrocephalus is moving to a type of cerebrovascular disorder instead of the etiology of idiopathic.

Use of Onyx Frontier™ for intracranial stenting in stroke patients: A multicenter retrospective study.

Acute ischemic stroke (AIS) due to intracranial atherosclerotic disease (ICAD) carries a high risk of recurrence despite aggressive medical management. The aim of our study is to present our initial experience with the Onyx Frontier™ balloon-mounted drug-eluting stent (Medtronic, Santa Rosa, CA) for AIS due to ICAD. We conducted a multicenter retrospective cohort study describing the technical feasibility, safety, and performance of using the Onyx Frontier™ balloon-mounted drug-eluting stent in patients with acute intracranial vessel occlusion due to ICAD across three comprehensive stroke centers in the United States. We included 23 patients in our study (mean age 67.3 [10.7]; females: n = 13/23, 56.5%). Most patients were Black (n = 14/23, 60.9%). The most common site of vessel occlusion was the M1 branch of the middle cerebral artery (MCA) (n = 14/23, 60.9%), followed by the vertebrobasilar system (n = 5/23, 21.7%), and the internal carotid artery (n = 3/23, 13.0%). Treatment with the Onyx Frontier™ stent was associated with a final mTICI score ≥2b for 100% of patients, with no vessel perforations or distal embolization. None of the patients had any restenosis or re-treatment over a median follow-up of 3.5 months (interquartile range [IQR] 7.8). All cases required a single stent except for one, where two were deployed. Transfemoral access was used in most cases (n = 18/23, 78.3%), with one in-hospital death due to access site complication (n = 1/23, 4.3%). This is the largest multicenter cohort study demonstrating the feasibility and safety of using the Onyx Frontier™ balloon-mounted zotarolimus-eluting stent to treat symptomatic AIS due to ICAD.

Structure preservation constraints for unsupervised domain adaptation intracranial vessel segmentation.

Unsupervised domain adaptation (UDA) has received interest as a means to alleviate the burden of data annotation. Nevertheless, existing UDA segmentation methods exhibit performance degradation in fine intracranial vessel segmentation tasks due to the problem of structure mismatch in the image synthesis procedure. To improve the image synthesis quality and the segmentation performance, a novel UDA segmentation method with structure preservation approaches, named StruP-Net, is proposed. The StruP-Net employs adversarial learning for image synthesis and utilizes two domain-specific segmentation networks to enhance the semantic consistency between real images and synthesized images. Additionally, two distinct structure preservation approaches, feature-level structure preservation (F-SP) and image-level structure preservation (I-SP), are proposed to alleviate the problem of structure mismatch in the image synthesis procedure. The F-SP, composed of two domain-specific graph convolutional networks (GCN), focuses on providing feature-level constraints to enhance the structural similarity between real images and synthesized images. Meanwhile, the I-SP imposes constraints on structure similarity based on perceptual loss. The cross-modality experimental results from magnetic resonance angiography (MRA) images to computed tomography angiography (CTA) images indicate that StruP-Net achieves better segmentation performance compared with other state-of-the-art methods. Furthermore, high inference efficiency demonstrates the clinical application potential of StruP-Net. The code is available at https://github.com/Mayoiuta/StruP-Net .

SPIRiT-Diffusion: Self-Consistency Driven Diffusion Model for Accelerated MRI.

Diffusion models have emerged as a leading methodology for image generation and have proven successful in the realm of magnetic resonance imaging (MRI) reconstruction. However, existing reconstruction methods based on diffusion models are primarily formulated in the image domain, making the reconstruction quality susceptible to inaccuracies in coil sensitivity maps (CSMs). k-space interpolation methods can effectively address this issue but conventional diffusion models are not readily applicable in k-space interpolation. To overcome this challenge, we introduce a novel approach called SPIRiT-Diffusion, which is a diffusion model for k-space interpolation inspired by the iterative self-consistent SPIRiT method. Specifically, we utilize the iterative solver of the self-consistent term (i.e., k-space physical prior) in SPIRiT to formulate a novel stochastic differential equation (SDE) governing the diffusion process. Subsequently, k-space data can be interpolated by executing the diffusion process. This innovative approach highlights the optimization model's role in designing the SDE in diffusion models, enabling the diffusion process to align closely with the physics inherent in the optimization model-a concept referred to as model-driven diffusion. We evaluated the proposed SPIRiT-Diffusion method using a 3D joint intracranial and carotid vessel wall imaging dataset. The results convincingly demonstrate its superiority over image-domain reconstruction methods, achieving high reconstruction quality even at a substantial acceleration rate of 10. Our code are available at https://github.com/zhyjSIAT/SPIRiT-Diffusion.

Intracranial Aneurysms and Cerebral Small Vessel Disease: Is There an Association between Large- and Small-Artery Diseases?

Background/Objectives: Intracranial aneurysms (IAs) may be connected to interactions between large and small intracranial vessels. We aimed to investigate the association between IAs and cerebral small-vessel disease (CSVD) and assess CSVD impact on IA patient management. Methods: This retrospective study analyzed clinical data and MRI features of CSVD in 192 subarachnoid hemorrhage (SAH) patients: 136 with incidental IA, 147 with severe CSVD without SAH/IA, and 50 controls without SAH, IA, or severe CSVD. MRI assessments followed the Standards for Reporting Vascular Changes on Neuroimaging (STRIVE), with a total burden of small-vessel disease (TBSVD) score calculated. Statistical analyses included forward selection and binary logistic regression. Results: TBSVD differed significantly across groups (p < 0.001), except between SAH and IA groups (p = 0.8). Controls had the lowest TBSVD (1.00; 1.22 ± 0.996), followed by SAH (2.00; 2.08 ± 1.013) and IA groups (2.00; 2.04 ± 1.141), with the highest in the CSVD group (1.00; 1.22 ± 0.996). White-matter hyperintensity (WMH) patterns varied with IA rupture status (p = 0.044); type A was prevalent in SAH patients and type D in the IA group. Incorporating MRI CSVD features and TBSVD into risk assessments did not enhance IA prediction or outcome models. Conclusions: IA patients exhibit a higher CSVD burden than controls, suggesting a link between small and large intracranial vessels. WMH patterns distinguish between ruptured and unruptured IA patients, offering potential markers for IA rupture risk assessment and signaling a paradigm shift in understanding IAs and CSVD.

In-depth cerebrovascular lipidomics profiling for discovering novel biomarkers and mechanisms in moyamoya and intracranial atherosclerotic disease.

Despite considerable research efforts, the precise etiology and underlying pathways contributing to Moyamoya Disease (MMD) remain poorly understood. Moreover, the overlapping vascular pathologies shared between MMD and Intracranial Atherosclerotic Disease (ICAD) pose challenges in clinical differentiation, even with gold-standard cerebral angiography. An in-depth exploration of lipidomic alterations in cerebral intracranial MMD vessels could offer valuable insights into the pathogenesis of MMD-related mechanisms, encompassing MMD and ICAD, and unveil novel biomarkers and potential therapeutic targets. However, to date, comprehensive lipidomic profiling has been lacking. To discover novel biomarkers and unravel the pathophysiological mechanisms underlying MMD, we conducted a lipidomics analysis to characterize various lipid species in matched human extracranial and intracranial artery tissues from patients diagnosed with MMD (n=99) and ICAD (n=12). Our analysis identified 569 lipid species and delineated a robust panel of lipidomic biomarkers capable of effectively distinguishing MMD from ICAD (area under curve=0.98), as determined by receiver operating characteristic curve analysis. Notably, we observed a significantly more pronounced positive correlation of diacylglycerols and a negative association of triglycerides in intracranial artery tissues of MMD patients compared to those with ICAD, suggesting a potential role of dysregulated diacylglycerol-induced signaling in MMD pathogenesis. Furthermore, our investigation into the correlations of critical differential intracranial artery vessel lipid species between MMD and ICAD and clinical parameters revealed negative associations with plasma iron levels, implying a potential link between plasma iron metabolism and artery lipid homeostasis during MMD pathogenesis. These findings offer promising prospects for advancing clinical diagnosis for enhanced differentiation between the two disease conditions. Additionally, they shed light on the fundamental mechanisms implicated in MMD pathogenesis and suggest potential therapeutic avenues through targeting artery vessel lipids or plasma iron levels.

Intravenous thrombolysis versus dual antiplatelet therapy in minor ischemic stroke within the thrombolytic window (TAMIS): a multicenter cohort study.

Intravenous thrombolysis (IVT) and dual antiplatelet therapy (DAPT) have been widely used in minor ischemic stroke (MIS) treatment. However, the clinical outcomes and safety of these two treatments have not been compared within the early thrombolytic time window. Here, we conducted a multicenter, ambispective cohort study involving patients with MIS presenting within 4.5 h of symptom onset at 3 affiliated hospitals of Jinan University from 2018-2022. The patients were divided into the IVT group and DAPT group. The primary outcome was a 90-day excellent outcome (mRS ≤ 1). A total of 1,026 patients were enrolled, of whom 492 were assigned to the IVT group and 534 were assigned to the DAPT group. The IVT group had better 90-day excellent outcomes (mRS ≤ 1) than the DAPT group (OR 1.69, 95% CI 1.14-2.52, P = 0.010). Among the 623 patients with nondisabling stroke, the proportion of mRS ≤ 1 in the IVT group was higher than the DAPT group (P = 0.009). In the subtypes of MIS with large vessel occlusion/stenosis and with isolated symptoms, the 90-day outcomes of the IVT group and DAPT group were not different (P > 0.05). In conclusion, compared with DAPT, IVT was associated with better 90-day clinical outcomes in patients with MIS (in particular, for those with mRS > 1), including earlier clinical improvement.IVT also benefited the early neurological improvement of patients with severe stenosis/occlusion of intracranial large vessels, nondisabling mild stroke, nondisabling mild stroke with isolated symptoms.

Comparison of computer-aided quantitative measurement and physician visual assessment in the evaluation of intracranial atherosclerotic stenosis: a vessel wall magnetic resonance imaging study.

Intracranial atherosclerotic stenosis is a leading cause of ischemic stroke in China. Accurate assessment of intracranial atherosclerotic stenosis through imaging techniques is crucial for guiding therapeutic interventions and prognostic stratification. Vessel wall magnetic resonance imaging (VWMRI) has emerged as a reliable method for evaluating intracranial arterial vessels. With the advancement of technology, computer-aided quantitative measurement (CAQM) is increasingly used in imaging assessment. This study aimed to compare physician visual assessment (PVA) with CAQM in the VWMRI evaluation of intracranial atherosclerotic stenosis. This retrospective cross-sectional study consecutively enrolled patients diagnosed with intracranial atherosclerotic stenosis through imaging examinations at the Fourth Affiliated Hospital of China Medical University from December 2018 to December 2023. Clinical data were collected for analysis. Two radiologists independently and separately conducted CAQM and PVA on the VWMRI images of intracranial atherosclerotic stenosis patients. The imaging features evaluated encompassed stenosis severity, vessel wall remodeling, vessel wall thickening patterns, fibrous cap characteristics, lipid core ratio, and plaque enhancement degree. The study further assessed the discrepancies and concordance between the assessment results obtained from the two methods using paired sample t-tests, Wilcoxon signed-rank tests, and Cohen's kappa coefficient analysis. This study enrolled a total of 589 patients. The PVA time was shorter than CAQM (12.02±3.63 vs. 20.48±6.50 min). However, compared with digital subtraction angiography, the CAQM had a better area under the curve (0.88) than the PVA (0.80) in assessing luminal stenosis degree. The proportions of vessel wall remodeling (227/38.5%) and plaque surface irregularity (127/21.6%) evaluated by PVA were both lower than those by CAQM (438/74.4%, 171/29.0%). Meanwhile, no statistically significant differences were found in the patterns of wall thickening (P=0.12/0.39) and the proportion of plaque lipid core (P=0.65 and P=0.27), with good agreement between the two methods (K=0.67/0.85, K=0.97/0.94). While there were no statistical differences in the assessment of plaque enhancement degree in specific arteries (middle cerebral artery and basilar artery) (n=77/36, P=0.08/0.21), an overall statistical difference was observed (n=113, P=0.03). Additionally, there was poor agreement in assessing plaque enhancement degree, with Cohen's kappa values of 0.13 (-0.05 to 0.32) and 0.16 (-0.06 to 0.39). This study revealed disparities between PVA and CAQM in the evaluation of intracranial atherosclerotic stenosis of VWMRI. CAQM is recommended for assessing stenosis degree, vessel wall remodeling, and fibrous cap characteristics. However, PVA is suggested to assess wall thickening patterns and lipid core ratio to expedite diagnosis. Further research is needed to validate CAQM's superiority in evaluating plaque enhancement degrees.

Outcomes of Mechanical Thrombectomy for Patients With Stroke Presenting With Low Alberta Stroke Program Early Computed Tomography Score in Early and Late Time Windows.

This study aimed to compare outcomes of low Alberta Stroke Program Early Computed Tomography Score (ASPECTS) patients with stroke who underwent mechanical thrombectomy (MT) within 6 hours or 6 to 24 hours after stroke onset. A retrospective cohort study was conducted using data from a large multicenter international registry from 2013 to 2023. Patients with low ASPECTS (2-5) who underwent MT for anterior circulation intracranial large vessel occlusion were included. A propensity matching analysis was conducted for patients presented in the early (<6 hours) vs late (6-24 hours) time window after symptom onset or last known normal. Among the 10 229 patients who underwent MT, 274 met the inclusion criteria. 122 (44.5%) patients were treated in the late window. Early window patients were older (median age, 74 years [IQR, 63-80] vs 66.5 years [IQR, 54-77]; P < .001), had lower proportion of female patients (40.1% vs 54.1%; P = .029), higher median admission National Institutes of Health Stroke Scale score (20 [IQR, 16-24] vs 19 [IQR, 14-22]; P = .004), and a higher prevalence of atrial fibrillation (46.1% vs 27.3; P = .002). Propensity matching yielded a well-matched cohort of 84 patients in each group. Comparing the matched cohorts showed there was no significant difference in acceptable outcomes at 90 days between the 2 groups (odds ratio = 0.90 [95% CI = 0.47-1.71]; P = .70). However, the rate of symptomatic ICH was significantly higher in the early window group compared with the late window group (odds ratio = 2.44 [95% CI = 1.06-6.02]; P = .04). Among patients with anterior circulation large vessel occlusion and low ASPECTS, MT seems to provide a similar benefit to functional outcome for patients presenting <6 hours or 6 to 24 hours after onset.

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.

Phase-contrast Magnetic Resonance Angiography of Foot at Ultra-high field 5 T System: Visualization of Distal Small Vessels and Enhancement by Warm Water Immersion

Ultra-high field strength MR system has been proved to offer improved visualization of the distal intracranial vessels and branches, but its effectiveness on peripheral vasculatures was not investigated. We aim to assess the visualization of lower-extremity vessels using three-dimensional phase contrast MR angiography (3D PC-MRA) at 5T field-strength through the feet with warm water immersion (WWI). Participants were prospectively recruited and underwent 3T, 5T 3D PC-MRA on feet with and without WWI (water temperature between 40 to 45 ℃ for a duration of 10minutes). Patients with suspected lower-extremity vessel diseases underwent CTA for lesion identification. Signal-to-noise ratio (SNR), subjective scoring, quantitative vessel segmentation and flow velocity were performed to assess vessel visualization before and after WWI. Friedman's test was conducted to determine statistical significance. Out of thirty participants (mean age, 46.2±5.9; males, 20; lower-extremity vessel disease, 10), 900 vessel segments were available for evaluation. 5T images showed significantly higher scores of image quality and foot vessel visualization than 3T (all P <.05). WWI further improved the visualizing scores (percentage of score 3: 40.2% vs 66.2%, P =.008), SNR (44.27 vs 67.78, P <.001), total branch count (151.92 ± 29.17 vs 225.63 ± 16.76; P <.001), and the flow velocity (0.72 ± 0.03 vs 0.48 ± 0.11cm/s; P <.001). 3D PC-MRA at 5T effectively visualizes foot vessels in patients with lower-extremity disease. Furthermore, WWI can significantly enhance the depiction of distal and small vessels.

The Sensitivity and Specificity of Susceptibility Weighted Imaging Phase (Swip) in Detecting Intracranial Large Artery Calcium Stenosis Compared to Cone Beam CT

Introduction: Intracranial calcifications are common and often associated with advanced stages of atherosclerosis. Studies estimating the prevalence of intracranial calcifications using other imaging modalities are common, however, studies comparing the diagnostic accuracies of cone-beam computed tomography (CBCT) and susceptibility-weighted imaging (SWI) and generated scoring systems for SWI are not well established. Aims: The objectives of the present study are to identify locations of intracranial calcifications; estimate the sensitivity and specificity rates for each intracranial vessel and each modality; estimate the sensitivity and specificity rates for diagnosing each grade of stenosis for each modality; and generate cutoff value for predicting each grade of intracranial stenosis and for each modality; as well as to develop a scoring system for estimating intracranial stenosis using SWI. Material and Methods: The study employs a prospective cross-sectional study design to collect brain data from 146 stroke patients who had initially undergone CBCT and SWI examinations. Data were collected using pro forma from January 2021 to December 2022 at Hospital Pengajar Universiti Putra Malaysia. Results: The results show an estimated prevalence of intracranial calcification of 87.7% and 92.5% for CBCT and SWI respectively. Regarding intracranial calcium grades, the prevalence of minimum – mild, moderate, and severe grade stenosis were 18.5%, 58,9%, and 10.3% respectively for CBCT and 2.7%, 33.8%, and 57.5% for SWI. Further, the results revealed that CBCT attained a sensitivity of 100% for the anterior cerebral artery, 71% for the middle cerebral artery, and 100% for the vertebral artery as well as a specificity of 90%, 80%, and 42% for the anterior cerebral artery, middle cerebral artery, and vertebral artery respectively. However, with the SWI modality, basilar, vertebral, and middle cerebral arteries reached a sensitivity of 90%, 63%, and 87% and a specificity of 82%, 95%, and 59%. Conclusion: In conclusion, both CBCT and SWI demonstrate reliable means of detecting intracranial calcifications and vessel stenosis with SWI outperforming CBCT.

Prevalence and Distribution of Intracranial Vessel Occlusion on Angiography and Its Association with Functional Outcome in Patients with Atrial Fibrillation Presenting with Ischemic Stroke.

To determine the prevalence and distribution of intracranial vessel occlusion identified on computed tomography (CT) or magnet resonance (MR) angiography and to explore its association with functional outcome in patients with atrial fibrillation (AF) and ischemic stroke. Multicenter cohort study enrolling consecutive patients with AF with imaging-confirmed ischemic stroke who underwent CT- or MR-angiography on admission (2014-2022). Multivariable regression was used to explore the association between intracranial vessel occlusion and poor functional outcome (modified Rankin Scale score 3-6) at 90 days. The analysis included 10,164 patients (median age 81.5 years, 47.8% female, median National Institutes of Health Stroke Scale score on admission 6; 14.7% on a vitamin K antagonist [VKA], 27.5% on a direct oral anticoagulant [DOAC], 57.8% not receiving oral anticoagulation). Angiography showed intracranial vessel occlusion in 5,190 patients (51.1%), affecting the anterior cerebral circulation in 87.4%. Overall, 29.2% and 29.4% of patients received thrombolysis and mechanical thrombectomy, respectively. The proportion of patients with poor functional outcome at 90 days was 60.6% and 42.7% in those with and without vessel occlusion, respectively. In multivariable analyses, vessel occlusion was associated with poor functional outcome (adjusted odds ratio [aOR]: 1.95, 95% confidence interval [CI]: 1.71-2.22) with consistent results in subgroups according to oral anticoagulation use (VKA, aOR: 1.98, 95% CI: 1.40-2.80; DOAC, aOR: 2.35, 95% CI: 1.83-3.03; none, aOR: 1.76, 95% CI: 1.49-2.09). Intracranial vessel occlusion is common in patients with AF with ischemic stroke, mainly affects the anterior circulation and is associated with poor functional outcome. ANN NEUROL 2024.

Angioplasty and/or stenting following successful mechanical thrombectomy for intracranial atherosclerosis-related emergent large vessel occlusive stroke (ASSET): protocol of a multicentre randomised trial

RationaleThe management of residual stenosis after mechanical thrombectomy in patients with intracranial atherosclerotic stenosis-related emerge large vessel occlusive (ICAS-LVO) stroke is still unclear question in clinical practice.AimTo demonstrate the design...

Endovascular treatment for proximal middle cerebral artery occlusion due to underlying intracranial atherosclerotic disease: A retrospective single-center case series

ObjectiveTo compare treatment outcomes between patients who received a front-line stent-retriever thrombectomy (SRT) or first stenting without retrieval (FRESH) for treating proximal M1 occlusion due to underlying intracranial atherosclerotic disease (ICAD). MethodsWe retrospectively reviewed consecutive acute ischemic stroke (AIS) patients with intracranial large vessel occlusion (LVO) in the anterior circulation who underwent endovascular treatment (EVT) between January 2017 and August 2021 at Yeungnam University Medical Center. LVO in the anterior circulation was classified according to etiology as follows: Embolic group and ICAD group. Occlusion of the proximal M1 due to ICAD were enrolled in this study. The ICAD group was divided into SRT and FRESH groups according to the treatment method. ResultsAmong the 72 patients in the ICAD group, 55 patients had occlusion of the M1, and 27 had occlusion of the proximal M1 (27/55, 49.1 %). Among the 27 patients, 11 (40.7 %) underwent SRT and 16 (59.3 %) underwent FRESH. The puncture-to-recanalization time was significantly shorter in the FRESH group (28 min vs. 52 min, p = 0.023). Symptomatic ICH tended to occur more frequently in the SRT group than in the FRESH group (27.3 % vs. 0.0 %, p=0.056). There was a nonsignificant trend towards a good functional outcome in the FRESH group compared to the SRT group (81.3 % vs. 45.5 %, p=0.097). ConclusionIn the FRESH group, the puncture-to-recanalization time was significantly shorter, symptomatic ICH tended to occur less frequently, and good functional outcomes were more common.

Risk factor differences in five-year progression of Intracranial artery stenosis and cerebral small vessel disease in general population

BackgroundIntracranial artery stenosis (ICAS) and cerebral small vessel disease (CSVD) are associated with a heavy socioeconomic burden; however, their longitudinal changes remain controversial.MethodsWe conducted a longitudinal analysis on 756 participants of Shunyi Cohort who underwent both baseline and follow-up brain magnetic resonance imaging (MRI) and MR angiography in order to investigate the risk factors for ICAS and CSVD progression in community population. Incident ICAS was defined as new stenosis occurring in at least one artery or increased severity of the original artery stenosis. CSVD markers included lacunes, cerebral microbleeds (CMB), and white matter hyperintensities (WMH).ResultsAfter 5.58 ± 0.49 years of follow-up, 8.5% of the 756 participants (53.7 ± 8.0 years old, 65.1% women) had incident ICAS. Body mass index (BMI) (OR = 1.09, 95% CI = 1.01–1.17, p = 0.035) and diabetes mellitus (OR = 2.67, 95% CI = 1.44–4.93, p = 0.002) were independent risk factors for incident ICAS. Hypertension was an independent risk factor for incident lacunes (OR = 2.12, 95% CI = 1.20–3.77, p = 0.010) and CMB (OR = 2.32, 95% CI = 1.22–4.41, p = 0.011), while WMH progression was primarily affected by BMI (β = 0.108, SE = 0.006, p = 0.002). A higher LDL cholesterol level was found to independently protect against WMH progression (β = −0.076, SE = 0.027, p = 0.019).ConclusionsModifiable risk factor profiles exhibit different in patients with ICAS and CSVD progression. Controlling BMI and diabetes mellitus may help to prevent incident ICAS, and antihypertensive therapy may conduce to mitigate lacunes and CMB progression. LDL cholesterol may play an inverse role in large arteries and small vessels.

The Dual-layer CGuard Stent Is Safe and Effective in Emergent Carotid Artery Stenting and in Tandem Occlusions: aMulti-centric Study.

Dual-layer stents have fallen into disrepute after several studies reported high rates of in-stent occlusions in acute stroke treatments. The CGuard stent is anew-generation hybrid dual-layer stent that has been designed to provide less thrombogenicity and to prevent peri- and postinterventional emboli. The aim of the study is to evaluate the safety and efficacy of the CGuard stent for the acute treatment of occlusion or high-grade stenosis of the extracranial internal carotid artery (ICA) in patients with acute ischemic stroke (AIS) with and without concomitant intracranial large vessel occlusion (LVO). All patients who underwent emergent carotid artery stenting (CAS) with the CGuard stent were identified and analyzed from the stroke registries from four tertiary German stroke centers. Clinical, procedural, and imaging data were evaluated. Stent patency within 72 h, intracranial hemorrhage, and modified Rankin score (mRS) at discharge were the safety and efficacy end points. Overall, ninety-six patients were included (mean age70.2 ± 11.8, 66males (68.8%), median NIHSS score at admission 11 (7-17), IVlysis: n = 44 (45.8%)). Stent placement was successful in all patients. Eighty-three (86.4%) patients had tandem occlusions. In-stent occlusion occurred in 5patients (5.2%) and 3patients developed early in-stent stenosis (3.1%). Median mRS at discharge was 2 (1-4). In this multicenter study, the use of the dual-layer CGuard stent for emergent CAS, particularly in tandem occlusions, was safe and resulted in low rates of in-stent occlusions.

Study on the comprehensive treatment of migraine with traditional Chinese medicine based on the new pathophysiological mechanism: A review.

Migraine is a ubiquitous neurological disorder that affects approximately 1 billion people worldwide. Migraine is the second leading cause of illness in people of all ages worldwide. Uncertainty in migraine diagnosis leads to unnecessary testing and increases the treatment costs. To date, the pathogenesis of migraine is not fully understood, but it is generally believed that migraine involves the trigeminal nerve and its axonal projections to intracranial blood vessels. Pain signals from the trigeminal neurovascular system are transmitted to the brain, resulting in migraines. As an important component of complementary and alternative medicine, traditional Chinese medicine (TCM) has shown significant efficacy in the treatment of migraine, and has attracted increasing attention worldwide. This review is based on the pathophysiology of migraines in modern medicine. To explore the comprehensive treatment of migraine using TCM, acupuncture, and various other TCM treatments.