Occluded Segment Research Articles

Intra-arterial tenecteplase after successful endovascular recanalisation in patients with acute posterior circulation arterial occlusion (ATTENTION-IA): multicentre randomised controlled trial

ObjectiveTo assess whether intra-arterial tenecteplase administered after successful endovascular recanalisation improves outcomes in patients with acute arterial occlusion of the posterior circulation.DesignMulticentre randomised controlled trial.Setting31 hospitals in China, 24 January...

Internal carotid artery dissection leading to occlusion in a patient with nonelongated styloid process: illustrative case.

Eagle syndrome is characterized by an elongated styloid process causing mechanical stress on the internal carotid artery (ICA). The authors present the case of a patient who had cervical ICA dissection with a nonelongated styloid process. A 43-year-old man presented with left hemiparesis and hemispatial neglect. The patient underwent endovascular treatment for tandem occlusion of the M1 segment of the right middle cerebral artery and right cervical ICA. After M1 segment thrombectomy, stenting of the right cervical ICA dissection was performed. Notably, the tip of the styloid process matched the caudal end of the dissection cavity, which was located on the lateral side of the ICA, where the styloid process was located. Based on these findings, the authors concluded that mechanical stress from the styloid process caused ICA dissection. After reducing antiplatelet therapy, the styloid process was surgically removed. Mechanical stress from a nonelongated styloid process can lead to ICA dissection-induced occlusion. In patients with cervical ICA dissection, the anatomical relationship between the styloid process and dissection site, as well as the distance between the ICA and styloid process, should be evaluated. https://thejns.org/doi/10.3171/CASE24719.

Hybrid Deep Learning-Based Enhanced Occlusion Segmentation in PICU Patient Monitoring.

Remote patient monitoring has emerged as a prominent non-invasive method, using digital technologies and computer vision (CV) to replace traditional invasive monitoring. While neonatal and pediatric departments embrace this approach, Pediatric Intensive Care Units (PICUs) face the challenge of occlusions hindering accurate image analysis and interpretation. Goal: In this study, we propose a hybrid approach to effectively segment common occlusions encountered in remote monitoring applications within PICUs. Our approach centers on creating a deep-learning pipeline for limited training data scenarios. Methods: First, a combination of the well-established Google DeepLabV3+ segmentation model with the transformer-based Segment Anything Model (SAM) is devised for occlusion segmentation mask proposal and refinement. We then train and validate this pipeline using a small dataset acquired from real-world PICU settings with a Microsoft Kinect camera, achieving an Intersection-over-Union (IoU) metric of 85%. Results: Both quantitative and qualitative analyses underscore the effectiveness of our proposed method. The proposed framework yields an overall classification performance with 92.5% accuracy, 93.8% recall, 90.3% precision, and 92.0% F1-score. Consequently, the proposed method consistently improves the predictions across all metrics, with an average of 2.75% gain in performance compared to the baseline CNN-based framework. Conclusions: Our proposed hybrid approach significantly enhances the segmentation of occlusions in remote patient monitoring within PICU settings. This advancement contributes to improving the quality of care for pediatric patients, addressing a critical need in clinical practice by ensuring more accurate and reliable remote monitoring.

Diminished spinal cord perfusion despite distal aortic perfusion: an acute translational large animal experiment with occluded segmental arteries.

Neuroprotective measures have been established in open thoraco-abdominal aortic aneurysm repair to reduce the incidence of postoperative paraplegia. Distal aortic perfusion (DaP) is meant to increase blood flow to the abdominal organs and the spinal cord. Cerebrospinal fluid (CSF) drainage is part of peri- and postoperative clinical routine. We aimed to investigate the effect of both techniques on spinal cord perfusion in an acute large animal model with segmental artery occlusion. Eight pigs underwent minimally invasive segmental artery coil embolization prior to establishment of cardiopulmonary bypass with DaP. After initiation of DaP, CSF pressure was increased three-fold by infusion of blood plasma. Collateral network near-infrared spectroscopy was used as an additional real-time monitoring method for indirect perfusion monitoring. Microspheres were injected for post mortem regional spinal cord blood flow analysis. DaP led to an increase in spinal cord perfusion limited to the very lower spinal cord (L3-S, up to 400% of baseline) and the corresponding paraspinous muscle area. The most vulnerable region between T8 and L2 was not reached by DaP (between 14% and 46% of baseline). After initiation of DaP a 10%-increase in oxygenation via cnNIRS was observed for the low lumbar region. The increase in CSF pressure counteracted enhanced perfusion inflow leading to a decrease in net tissue perfusion. DaP is effective in increasing blood flow to the distal spinal cord (effectively counteracting CSF pressure increase) and paraspinous muscles, despite occluded segmental arteries, resulting in hyperperfusion potentially leading to spinal cord oedema and delayed paraplegia postoperatively.

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...

Early and concomitant administration of norepinephrine and ilomedin improves microcirculatory perfusion without impairing macrocirculation in an intestinal ischemia-reperfusion injury swine model : a randomized experimental trial.

Intestinal ischemia-reperfusion injury is associated with both macrocirculatory and microcirculatory failure. Association of a vasoconstrictor in combination with a vasodilator such as ilomedin may improve macrocirculation parameters, microcirculation perfusion and reduce endothelial dysfunction. The primary objective was to demonstrate a difference in mean arterial pressure (MAP) after intestinal reperfusion with the concomitant administration of norepinephrine and ilomedin during ischemia compared with traditional hemodynamic treatment strategies (fluid resuscitation and vasopressors only). Secondary objectives were to demonstrate an improvement in peripheral and intestinal microcirculatory perfusion and endothelial dysfunction after intestinal reperfusion using this association. We conducted a randomized preclinical trial in twenty-one large white pigs, in which a 2-hour small bowel ischemia was performed using a segmental mesenteric occlusion model, followed by a 2-hour reperfusion. Pigs were randomized into 3 groups: goal directed fluid therapy, early administration of norepinephrine before reperfusion and early administration of ilomedin and norepinephrine before reperfusion. Macrocirculatory (MAP and Cardiac Index (CI)), microcirculatory (Sublingual with SideStream Dark Field system and intestinal hemoglobin oxygen saturation with hyperspectral imaging (HSI)) measurements and biological analysis (biomarkers of endothelial dysfunction) were performed. There were no significant differences in the MAP (p = 0.499) and the CI (p = 0.659) between the 3 groups. Perfused Vessel Density (PVD) in sublingual microcirculation was significantly higher immediately after reperfusion and 2 hours after reperfusion in the early administration of ilomedin and norepinephrine group compared with the other 2 groups (p < 0.05). Hemoglobin oxygen saturation measured at the intestinal level was significantly higher immediately after reperfusion in the early administration of ilomedin and norepinephrine group compared with the other 2 groups (p < 0.01). There were no significant differences in biomarkers of endothelial dysfunction between the 3 groups. Creatinine, AST and alkaline phosphatases increased significantly 2 hours after reperfusion in the early administration of ilomedin and norepinephrine group compared with baseline (p < 0.05). Early administration of norepinephrine and ilomedin during ischemia improved short-term post-reperfusion sublingual and intestinal microcirculation without worsening macrocirculatory parameters in an intestinal ischemia-reperfusion injury model. However, use of this strategy seemed to worsen both liver and kidney function.

Perfusion-Based Relative Cerebral Blood Volume Is Associated With Functional Dependence in Large-Vessel Occlusion Ischemic Stroke.

Pretreatment computed tomography perfusion parameter relative cerebral blood volume (rCBV) lesion volume has been shown to predict 90-day modified Rankin Scale score in small-core strokes with Alberta Stroke Program Early Computed Tomography Score ≥5, including those with medium-vessel occlusions (mid and distal M2 segment occlusions). Hence, in this study we aim to assess the performance of different rCBV lesion volume thresholds (rCBV <42%, rCBV <38%, and rCBV <34%) with 90-day modified Rankin Scale score including patients with large core (Alberta Stroke Program Early Computed Tomography Score <5) and strictly including only patients with anterior circulation large-vessel occlusion. In this retrospective evaluation of our prospectively collected database, inclusion criteria were (1) Computed tomographic angiography confirmed anterior circulation large-vessel occlusion from September 1, 2017, to October 1, 2023; and (2) diagnostic computed tomography perfusion. Student t test, Mann-Whitney U test, and χ2 test were used in the univariate data analysis. Spearman's rank correlation analysis was used to assess correlations. Outcome measure was dichotomized into good functional outcome (90-day modified Rankin Scale score, 0-2) and poor functional outcome (90-day modified Rankin Scale score, 3-6) for logistic regression and receiver operating characteristic analysis. P≤0.05 was considered significant. In total, 229 patients met our inclusion criteria. The majority of the patients (n=161) in our cohort had M1 occlusion. All the rCBV thresholds were significantly higher in patients with poor 90-day functional outcomes and were independently associated with the outcome. Spearman's rank correlation analysis revealed a slightly stronger correlation of rCBV <42% (ρ=0.27, P<0.001), as compared with rCBV <38% (ρ=0.25, P<0.001) and rCBV <34% (ρ=0.24, P<0.001) with functional outcome. Receiver operating characteristic analysis revealed that rCBV <42% (area under the curve, 0.67 [95% CI, 0.60-0.74]; P<0.001) performed marginally better than rCBV <38% (area under the curve, 0.66 [95% CI, 0.59-0.73]; P<0.001), and rCBV <34% (area under the curve, 0.65 [95% CI, 0.58-0.72]; P<0.001). All the rCBV thresholds were independently associated with poor 90-day functional outcome; however, the rCBV <42% marginally outperformed rCBV <38% and rCBV <34% lesion volumes.

A Study of Occluded Person Re-Identification for Shared Feature Fusion with Pose-Guided and Unsupervised Semantic Segmentation

The human body is often occluded by a variety of obstacles in the monitoring system, so occluded person re-identification is still a long-standing challenge. Recent methods based on pose guidance or external semantic clues have improved the representation and related performance of features; there are still problems, such as weak model representation and unreliable semantic clues. To solve the above problems, we proposed a feature extraction network, named shared feature fusion with pose-guided and unsupervised semantic segmentation (SFPUS). This network will extract more discriminative features and reduce the occlusion noise on pedestrian matching. Firstly, the multibranch joint feature extraction module (MFE) is used to extract feature sets containing pose information and high-order semantic information. This module not only provides robust extraction capabilities but can also precisely segment occlusion and the body. Secondly, in order to obtain multiscale discriminant features, the multiscale correlation feature matching fusion module (MCF) is used to match the two feature sets, and the Pose–Semantic Fusion Loss is designed to calculate the similarity of the feature sets between different modes and fuse them into a feature set. Thirdly, to solve the problem of image occlusion, we use unsupervised cascade clustering to better prevent occlusion interference. Finally, performances of the proposed method and various existing methods are compared on the Occluded-Duke, Occluded-ReID, Market-1501 and Duke-MTMC datasets. The accuracy of Rank-1 reached 65.7%, 80.8%, 94.8% and 89.6%, respectively, and the mAP accuracy reached 58.8%, 72.5%, 91.8% and 80.1%. The experiment results demonstrate that our proposed SFPUS holds promising prospects and performs admirably compared with state-of-the-art methods.

Abstract 460: Variation Of Bowhunter's Syndrome: Right Vertebral Artery Occlusion From Cervical Disc Herniation ‐ A Case Report

Introduction Bowhunter's syndrome (BHS) occurs when an individual turns their head, often greater than 45 degrees, causing mechanical occlusion of the ipsilateral vertebral artery (VA). Common causes include osteophytes or disc herniations [1]. This dynamic stenosis results in symptoms of vertebrobasilar insufficiency (VBI) such as vertigo, nystagmus, dizziness, and changes in vision and gait [3]. BHS is a rare but curable cause of VBI. Methods/Case Presentation A 59‐year‐old woman with a history of congestive heart failure, hypertension, obstructive sleep apnea, cervical spondylosis, thoracic spondylosis, atherosclerotic cardiovascular disease, hyperlipidemia, and type 2 diabetes mellitus presented with recurrent presyncope, vertigo, and progressive right upper and lower extremity weakness. Her symptoms worsened with head rotation to the right. Cerebral angiogram showed chronic occlusion of the left VA and rotational occlusion of the V2 segment of the right VA, which had 50% baseline occlusion and 80% occlusion with head turned to the right. The stenosis occurred greatest at C3‐4 due to a lateral cervical disc herniation. The patient possessed a small right posterior communicating artery and lacked collateral flow from the left VA. Results She was treated with a C3‐4 anterior cervical discectomy and fusion (ACDF) and skeletonization of right VA with resolution of positional occlusion of the VA. Postoperatively, her dizziness and instability resolved, but she experienced new dysphagia and operative site discomfort. Right extremity weakness persisted with 4/5 muscle strength in the right deltoid, bicep, tricep, wrist extension, grasp, and iliopsoas. Postoperative x‐rays showed good positioning of her C3‐4 interbody graft, anterior cervical plate, and screws. Two months later, a follow‐up cerebral angiogram confirmed resolution of right VA stenosis in all head positions. Conclusion This case provides insights into alternative presentations of BHS. Notably, the right VA was the primary symptomatic vessel, whereas the left VA is historically more affected [2]. More common causes like cervical spine trauma, neoplastic growths, and osteophytes may present with a larger constellation of symptoms that delay diagnosis [4]. A key takeaway is the body's adaptation to changes in head and neck perfusion. In healthy individuals, the contralateral VA compensates for posterior circulation demands [3]. This patient showed a combination of contralateral VA atherosclerosis and a lack of protective collateralization. Conservative management is effective for approximately 75‐90% of cervical spine disc herniations, but the risk of cerebrovascular complications in this patient necessitated surgical intervention [5]. The anterior approach to discectomy has shown better outcomes compared to posterior decompression, with fewer instances of VA injury [6]. Vertebral stenting is an alternative that has historically shown success [7]. However, the risk of stent deformation and fracture in the cervical spine was considered too great. Her persistent right extremity weakness suggests possible secondary etiology or lasting deficits from transient cerebral hypoperfusion. As with any cause of VBI, BHS should be considered as a risk factor for severe cerebrovascular events. This case continues to support digital subtraction angiograms for diagnosis and ACDF for surgical treatment as a successful pathway for those with BHS [6].

Detachment of a Guidewire Tip as an Intraoperative Complication during Revascularization of Chronic Coronary Artery Occlusion: A Clinical Case

Introduction. Cardiovascular diseases occupy a leading position in the structure of mortality in the world. In particular, coronary heart disease causes mortality in 48% of cases among cardiovascular diseases. Surgical treatment of patients with coronary heart disease is aimed at eliminating stenotic or occlusive lesions in the coronary arteries by heart bypass and/or percutaneous coronary intervention with stenting. The success rate of the procedure accounts for about 85%. In the remaining 15%, revascularization fails to achieve its goal, which may be caused, among other things, by a pronounced calcification of the occlusive segment of the coronary artery. Aim: to demonstrate the development of one of complications after revascularization of chronic coronary artery occlusion and a method for its elimination. Materials and methods. The paper demonstrates a clinical case of an 86­year­old patient with coronary heart disease treated in a non­emergency hospital. Coronary angiography revealed a multivessel lesion. Coronary artery bypass grafting was recommended after an intraoperative consultation with a cardiologist and a vascular surgeon. The next day, the patient underwent emergency coronary angiography in order to revascularize chronic occlusion. Results and discussion. The patient underwent attempted revascularization of chronic calcified occlusion, which resulted in such a complication as deformities and “detachment” of the distal tip of the guidewire. This complication was resolved with the help of a trifold snare and the creative and cold­blooded thinking of the operating surgeon. Conclusion. The clinical case shows that, despite any encouraging statistical success rate, the operating surgeon should be ready for possible intraoperative complications. The key to solving this problem lies in the availability of modern medical tools for coronary interventions, as well as in relevant experience of an operating surgeon and creativity in making certain decisions.

Poor venous outflow is associated with hyperintense acute reperfusion marker on follow-up MRI in patients with acute ischemic stroke with a large vessel occlusion

BackgroundHyperintense acute reperfusion marker (HARM) refers to delayed enhancement in the subarachnoid or subpial space on post-contrast fluid attenuated inversion recovery (FLAIR) images. HARM is a measure of blood–brain barrier...

Ultrasound-guided renal artery balloon catheter occluded hybrid partial nephrectomy (UBo-HPN) with branch renal artery occlusion: a single arm trial

BackgroundOne key focus of partial nephrectomy is preserving renal function. Segmental renal artery occlusion with microdissection at the renal hilum confines ischemia, effectively reducing warm ischemic injury. Ultrasound-Guided Renal Artery Balloon Catheter Occluded Hybrid Partial Nephrectomy (UBo-HPN) can achieve branch occlusion without the need for dissecting the renal hilum.ObjectiveTo investigate the feasibility and safety of UBo-HPN of branch renal artery occlusion in the treatment of localized renal tumors.Subject and methodsA prospective single-arm analysis involving 20 patients with renal localized tumors underwent robot assisted UBo-HPN with branch renal artery occlusion from August 2021 to July 2023, with an average follow-up of 12 months.ResultsAll patient was successfully operated on without conversion to conventional arterial clamping or radical nephrectomy. One case (5%) of minor complication occurred in the whole cohort, which was bruising around the puncture site. The mean total operative time was 95.8 min, with a mean operative time of 21.25 min for vascular intervention. The mean warm ischemia time was 20.35 min, and the median estimated blood loss was 50 ml. The median eGFR preservation percentage at postoperative 48 h, 30 days, and the latest follow-up were 87.52%, 91.47%, and 92.2%, respectively. After a median follow-up of 10.2 (2.3–19.2) months, no patients had radiological tumor recurrence or died from tumor-related causes.ConclusionsUBo-HPN with renal artery branch occlusion emerges as an efficient alternative to partial nephrectomy (PN), which achieved branch artery occlusion without dissecting the renal hilum. Long-term follow-up is expected for functional outcomes.

Endothelial Dysfunction Does Not Occur after Acute, Elevated Homocysteine Exposure of the Lumen of the Iliac Artery of the Anaesthetised Pig

Introduction: Elevated luminal homocysteine has been linked with cardiovascular disease; however, whether there is a direct effect of homocysteine on blood vessel endothelium is not clear. In this study, the acute effect of luminal homocysteine on iliac artery endothelial function was assessed in the anaesthetised pig. Methods: Hyperhomocysteinaemic blood was injected into an occluded segment of the iliac in the anaesthetised pig for 20 min, and the effect on atrial diameter during the occlusion and during the reactive hyperaemia assessed. Results: No significant changes in arterial diameter or pressure were observed during the incubation period at homocysteine concentrations of 10, 20, 40 and 100 µM. There was also no difference in the magnitude of the iliac diameter increase in the response to reactive hyperaemia when the incubation period was completed. Conclusion: There is no evidence of endothelial dysfunction in response to an acute 20-min elevation in homocysteine in an intact conduit artery.

Effect of occlusion site on the effectiveness and safety of endovascular thrombectomy for large ischemic cores: A cohort study.

Recent clinical trials have shown that patients with large ischemic cores have better outcomes with endovascular thrombectomy (EVT) compared with standard medical treatment (SMT) alone.We aim to assess whether the relationship between EVT and improvements in clinical outcomes varies depending on the location of the occlusive sites. This study is a subgroup analysis conducted within a prospective, nationwide, multi-center registry. The cohort included patients with acute large vessel occlusion in the anterior circulation and an Alberta Stroke Program Early Computed Tomography Score of 0 to 5 within 24 hours from last known well. We utilized the adjusted common odds ratio for a shift toward better outcome on the modified Rankin Scale after EVT compared with SMT alone as the primary outcome. Safety outcomes included symptomatic intracranial hemorrhage (sICH). A total of 745 patients with large ischemic cores were included: 272(36.5%) with internal carotid artery occlusion, 392(52.6%) with M1 segment of the middle cerebral artery occlusion, and 81(11.0%) with M2 segment of the middle cerebral artery occlusion. The adjusted common odds ratios were as follows: 1.98 (95% CI, 1.01-3.89) for ICA occlusions, 2.09 (95% CI, 1.35-3.23) for M1 occlusions, and 1.13 (95% CI, 0.43-2.94) for M2 occlusions. There was no significant treatment-by-occlusion site interaction observed (P=0.69). However, the incidence of sICH was significantly greater in all groups receiving EVT than in those receiving SMT alone. Additionally, we observed that the secondary outcomes and subgroup analyses were generally consistent with the main outcomes. In this study, we found that patients with internal carotid artery and M1 occlusion demonstrated a better outcome with EVT, while the benefit for patients with M2 occlusion remains uncertain.

StentRetriever- aspiration (SRa) vs direct aspiration (DA) in the treatment of acute M2 segment occlusion of middle cerebral artery: A single center randomized prospective study

Decision making and patient selection for isolated occlusion of the M2 segment of the middle cerebral artery is challenging, with the efficacy of treatment for such distal occlusions still controversial in recent studies, as occlusion in such small and thin vessels tends to manifest with less severe symptoms initially and hold higher surgical risks. It is even less clear which endovascular technique is more effective for this type of occlusion, with the choice usually left to the radiologist's preference. We conducted a controlled prospective study of consecutive patients presenting to Novara Hospital with an acute M2 occlusion diagnosed at the AngioCt and, following a predetermined randomization, we divided them into two treatment arms with either stent retriever aspiration (SRa) or direct aspiration (DA). All patients were examined on admission, at discharge and after 3 months, and clinical data as well as mRS and NIHSS scale scores were recorded. Our primary aim was to evaluate the difference in recanalization rate in the two groups by comparing the angiographic eTICI obtained with the two techniques. We then investigated whether there were differences in clinical outcomes and complications. Our data confirm a good recanalization rate with an eTICI ≥ 2b in 76.19% of patients in the cohort. An overall good outcome was achieved in 57% of patients as ∆NIHSS and in 50.79% of patients considering mRS. We found no statistically significant difference in recanalization rate nor higher complication rate in either the SRa or DA group. Both techniques are safe, effective and can be considered equally.

Revascularization of superior mesenteric artery occlusion via the arc of Buhler: A case report and literature review.

To report revascularization of a superior mesenteric artery (SMA) ostial occlusion via the Arc of Buhler. A 62-year-old female presented with 2 months of recurrent abdominal distension and postprandial pain. Computed tomography angiography (CTA) revealed ostial occlusion of the SMA with distal perfusion via the Arc of Buhler (connecting the celiac trunk and SMA). Conventional endovascular techniques failed. A 0.014 guidewire was passed retrograde through the occlusion via the Arc of Buhler. The guidewire was captured from the femoral sheath and balloon angioplasty with stent placement was performed. The patient had complete symptom resolution post-procedure. Retrograde revascularization via the Arc of Buhler is an effective method for treating the initial segment occlusion of the SMA.

Interventions in Budd-Chiari syndrome: an updated review.

Budd Chiari syndrome is a potentially treatable disease, and imaging is the key to its diagnosis. Clinical presentations may vary, ranging from asymptomatic to fulminant disease. Subacute BCS is the most common type encountered in clinical practice, characterized by ascites, hepatosplenomegaly, dilated abdominal wall veins, and varicosities in the lower limb and scrotum. While hepatic vein thrombosis is the leading cause in the West, membranous and short segmental occlusion are predominant in the Asian populations. These geographical variations have an impact on the treatment algorithm in managing BCS. Anticoagulation alone often fails to prevent disease progression, demanding further interventional therapy. Interventional therapy carries a lower morbidity and mortality than surgery. Anatomical recanalization and portosystemic shunting form the basis of endovascular management. Membranous or short-segment occlusion are best treated by angioplasty, which restores the physiological venous outflow and possibly disease reversal. Suboptimal results with angioplasty require stenting. Transjugular intrahepatic shunt (TIPS) or direct IVC to portal vein shunt (DIPS) decompresses the portal pressure and reduces the sinusoidal congestion, which in turn diminishes hepatocellular damage and hepatic fibrosis. Despite its ability to modify the disease course, TIPS carries several procedure and shunt-related complications, mainly hepatic encephalopathy. Thus, anatomical recanalization precedes TIPS in the traditional step-up approach in managing BCS. However, this concept is challenged by some authors, necessitating future reseach. TIPS is a valid bridge therapy in BCS with acute live failure awaiting liver transplantation. Despite all, interventional therapies fail in a subset of BCS patients, leaving them with only option of liver transplantation.

Clinical and perfusion imaging characteristics of acute large vessel occlusion in intracranial atherosclerosis

ObjectivesThis study aimed to compare clinical and perfusion imaging profiles in acute ischemic stroke with large vessel occlusion (AIS-LVO) between patients with intracranial atherosclerotic disease (ICAD) and non-ICAD who underwent endovascular treatment (EVT). MethodsData from AIS-LVO patients over the anterior circulation undergoing EVT across two stroke centers were retrospectively analyzed. Clinical profiles and perfusion parameters from automated processing of perfusion imaging were compared between ICAD and non-ICAD groups. Ischemic core was defined as relative cerebral blood flow < 30 % on CT perfusion or apparent diffusion coefficient ≤ 620 × 10−6 mm2/s on MR diffusion weighted imaging. ResultsA total of 111 patients were included (46 ICAD, 65 non-ICAD). The ICAD group exhibited a higher male proportion (60.9 % vs. 35.4 %), more M1 segment occlusions (78.3 % vs. 56.9 %), lower atrial fibrillation rates (17.4 % vs. 63.1 %), and lower baseline NIH Stroke Scale (NIHSS) scores (median [IQR]: 13 [8.75-18] vs. 15 [10-21]) at presentation compared to non-ICAD (all p < 0.05). However, there was no difference in NIHSS scores at discharge or in good functional outcomes (modified Rankin Scale 0-2) at 3 months between the two groups. ICAD patients also had smaller median ischemic core volumes (0 [IQR 0-9.7] vs. 4.4 [0-21.6] ml, p = 0.038), smaller median Tmax >6s tissue volulmes (89.3 [IQR 51.1-147.1] vs. 124.4 [80.5-178.6] ml, p = 0.017) and lower median HIR (hypoperfusion intensity ratio defined as Tmax >10s divided by Tmax >6s; 0.28 [IQR 0.09-0.42] vs. 0.44 [0.24-0.60], p = 0.003). Higher baseline NIHSS scores correlated with larger Tmax >6s lesion volumes as well as higher HIR value in non-ICAD patients, but not in ICAD patients. ConclusionsIn anterior circulation of AIS-LVO, ICAD patients exhibited distinct clinical presentations and perfusion imaging characteristics when compared to non-ICAD patients. Perfusion imaging profiles may serve as indicators for identifying ICAD patients before EVT.

Predictive value of follow-up infarct volume on functional outcomes in middle cerebral artery M2 segment vessel occlusion stroke treated with mechanical thrombectomy.

Medium vessel occlusion (MeVO) strokes, particularly affecting the M2 segment of the middle cerebral artery, represent a critical proportion of acute ischemic strokes, posing significant challenges in management and outcome prediction. The efficacy of mechanical thrombectomy (MT) in MeVO stroke may warrant reliable predictors of functional outcomes. This study aimed to investigate the prognostic value of follow-up infarct volume (FIV) for predicting 90-day functional outcomes in MeVO stroke patients undergoing MT. This multicenter, retrospective cohort study analyzed data from the Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy (MAD-MT) registry, covering patients with acute ischemic stroke due to M2 segment occlusion treated with MT. We examined the relationship between 90-day functional outcomes, measured by the modified Rankin Scale (mRS), and follow-up infarct volume (FIV), assessed through CT or MRI within 12-36 h post-MT. Among 130 participants, specific FIV thresholds were identified with high specificity and sensitivity for predicting outcomes. A FIV ⩽5 ml was highly specific for predicting favorable and excellent outcomes. The optimal cut-off for both prognostications was identified at ⩽15 ml by the Youden Index, with significant reductions in the likelihood of favorable outcomes observed above a 40 ml threshold. Receiver Operator Curve (ROC) analyses confirmed FIV as a superior predictor of functional outcomes compared to traditional recanalization scores, such as final modified thrombolysis in cerebral infarction score (mTICI). Multivariable analysis further highlighted the inverse relationship between FIV and positive functional outcomes. FIV within 36 h post-MT serves as a potent predictor of 90-day functional outcomes in patients with M2 segment MeVO strokes. Establishing FIV thresholds may aid in the prognostication of stroke outcomes, suggesting a role for FIV in guiding post intervention treatment decisions and informing clinical practice. Future research should focus on validating these findings across diverse patient populations and exploring the integration of FIV measurements with other clinical and imaging markers to enhance outcome prediction accuracy.

Labial mucosal grafting onlay ureteroplasty without omental wrap for ureteral stricture with occlusion: initial results.

The treatment of complex ureteral stricture has always been a hot and difficult topic in urology. The aim of our study is to investigate the feasibility and clinical efficacy of labial mucosal graft (LMG) onlay ureteroplasty without omental wrap for ureteral stricture with occlusion and present our initial experience. We retrospectively reviewed perioperative and follow-up data of 12 patients admitted to The First Affiliated Hospital of Chongqing Medical University who underwent the LMG ureteroplasty with ureteral occlusion from April 2022 to September 2023. After stricture and occluded segments were incised longitudinally, the LMG was used to expand the ureteral lumen without omental wrap. All patients had successful surgery with no intraoperative complications. The median length of ureteral stricture was 3.5 cm (range, 3-5 cm), the median length of the occlusion was 1.5 cm (range, 1-2 cm), the median length of the LMGs is 4.5 cm (range, 4-6 cm). Ureteroscopy confirmed that the reconstructed ureteral lumen was unobstructed except for one patient with thin film-like ureteral stricture. Only one patient had slight contracture at the graft site, which did not affect movement of lip and appearance. No persistent and obvious discomfort was observed at the graft site in the remaining patients. Our experience suggests that LMG onlay ureteroplasty without omentum wrap appears to be a feasible and safe option for reconstruction of ureteral occlusion.