Symptomatic Stenosis Research Articles

Early evaluation and treatment of thoracolumbar kyphosis in children with achondroplasia.

Thoracolumbar kyphosis (TLK) is frequently reported in children with achondroplasia. The combination of TLK and the narrow spinal canal in achondroplasia increases the risk of developing symptomatic spinal stenosis. However, there is no consensus on the optimal management of TLK. This retrospective cohort study evaluated children under four years old with achondroplasia, monitoring TLK every six months. Pathologic TLK was defined as a Cobb angle of 20 degrees or more between T10 and L2. Management involved either a wait-and-see policy, which prohibited unsupported sitting, or bracing. Surgery was reserved for severe progressive TLK or spinal stenosis cases. TLK was evaluated over time. A receiver operating characteristic curve determined the baseline threshold where wait-and-see management failed to resolve TLK below 20 degrees. Multiple linear regression compared bracing versus wait-and-see management for cases exceeding 40 degrees. Sixty-two patients were included, with a median age of 10 months and a median follow-up of 31 months. TLK prevalence decreased from 85% at baseline to 42% at final follow-up. The mean Cobb angle decreased from 31 ± 11 degrees to 22 ± 16 degrees (p < 0.001). The threshold for ineffective wait-and-see management was identified as 33 degrees. Bracing resulted in significantly more TLK reduction than wait-and-see management for cases exceeding 40 degrees (15 degree difference, 95% CI 2-28, p = 0.023). Three patients required surgery. TLK is highly prevalent in achondroplasia, necessitating careful monitoring. A wait-and-see policy with restrictions on unsupported sitting is recommended initially, but early bracing should be considered for more severe cases.

Abstract WP286: MRI-derived Pressure Ratio for Stroke Risk Assessment of Symptomatic Intracranial Atherosclerotic Stenosis

Abstract WP286: MRI-derived Pressure Ratio for Stroke Risk Assessment of Symptomatic Intracranial Atherosclerotic Stenosis

Outcomes following stenting for symptomatic chronic iliofemoral venous stenosis – A comparison of three stent types

Outcomes following stenting for symptomatic chronic iliofemoral venous stenosis – A comparison of three stent types

Diagnostic yield and therapeutic implications of vascular imaging in acute ischemic stroke: prospective and consecutive study of small vessel versus large vessel ischemia.

To evaluate patients acute cerebral ischemia in order to assess for factors which may help to differentiate patients with small vessel involvement from those with large vessel involvement in an effort to determine diagnostic yield of vascular imaging. We prospectively and consecutively evaluated all acute ischemic stroke patients at our medical center from May 16, 2021 to December 10, 2021. Distinction between small vessel and large vessel involvement was based upon clinical presentation, the results of brain imaging and either computed tomographic angiography, in the vast majority, or magnetic resonance angiography. Patient demographics and risk factors for stroke as well as therapeutic intervention was assessed. Of the 90 patients studied, 59 had large vessel ischemia (66%) with 26 (44%) having large vessel occlusion and one had symptomatic high-grade middle cerebral artery stenosis. Conversely, none of the 31 patients with small vessel presentation (34%) had large vessel occlusion or high-grade stenosis. In addition, 19 out of 59 (32%) large vessel patients compared to 2 of 31 (6%) of the small vessel patients had atrial fibrillation identified as a potential mechanism with a p-value of 0.01 by univariate analysis and 0.17 by multivariate analysis. The routine use of vascular imaging in acute ischemic stroke is of very low yield in small vessel presentation with the presence of potential cardiogenic emboli is also relatively low. Efforts at accelerated identification of a small vessel mechanism, to avoid unnecessary testing, should provide significant value from both a patient management and cost standpoint.

Abstract TP274: The Changes in Long-term Disease Burden Associated with the Progression from Asymptomatic to Symptomatic Intracranial Stenosis: A Hospital-Based Cohort Study

Abstract TP274: The Changes in Long-term Disease Burden Associated with the Progression from Asymptomatic to Symptomatic Intracranial Stenosis: A Hospital-Based Cohort Study

Abstract TMP98: Low-dose Rivaroxaban plus Antiplatelet Treatment in Patients With Symptomatic Intracranial Atherosclerotic Stenosis：A Prospective Observational Study

Background: The secondary prevention of symptomatic intracranial atherosclerotic stenosis (sICAS) remains a significant challenge. In the recent COMPASS (Cardiovascular Outcomes for People Using Anticoagulation Strategies) trial, the combination of low-dose rivaroxaban with antiplatelet therapy demonstrated better efficacy in preventing vascular events in patients with coronary atherosclerosis compared to antiplatelet therapy alone. This study aimed to evaluate the efficiency of dual pathway inhibition on recurrent stroke and vascular events in patients with sICAS. Methods: Patients with sICAS admitted within 7 days of symptom onset were identified from the hospital-based database from January 2019 to June 2023. We compared the clinical outcomes of low-dose rivaroxaban combined with antiplatelet therapy (Rivaroxaban 2.5mg bid plus asprin or clopidogrel) and antiplatelet therapy alone (dual antiplatelet therapy or antiplatelet monotherapy) among patients with sICAS. The primary outcome was a composite of all-cause death, ischemic stroke or transient ischemic attack, and acute coronary syndrome within one year post-stroke. Propensity score matching was performed in a 1:3 ratio for the two groups of patients to mitigate confounders, adjusted hazard ratios (HR) were estimated using multivariate Cox regression model. The win-ratio method was employed to assess the composite outcome. Results: Among 1,308 patients, 123 (9.4%) were prescribed rivaroxaban and antiplatelet therapy. In the matched population, the primary endpoint event rate in this group was lower (11/123 [8.9%] vs. 63/369 [17.1%], P=0.029). Multivariate Cox regression analysis revealed a significant benefit from low-dose rivaroxaban (adjusted HR=0.459, 95% CI: 0.234-0.897, P=0.023). In addition, coronary heart disease (adjusted HR=1.674, 95% CI: 1.013-2.766, P=0.044) was identified as a risk factor associated with composite outcome during the 1-year follow-up. In the analysis of the hierarchical composite end point, the results for the primary end point favored rivaroxaban plus antiplatelet therapy (win ratio=1.948, 95% CI: 1.134-3.346, P=0.016). Conclusions: Low-dose rivaroxaban combined with antiplatelet therapy was superior to antiplatelet therapy alone for the prevention of all-cause death, recurrent stroke and acute coronary syndrome among patients with sICAS. These findings are preliminary and warrant further investigation through randomized controlled trials.

Abstract 39: Timing of Intracranial Stent Placement and One month Stroke and/or Death Rates in Patients with High Grade Symptomatic Intracranial Stenosis: Pooled Analysis of SAMMPRIS and VISSIT Trials

Abstract 39: Timing of Intracranial Stent Placement and One month Stroke and/or Death Rates in Patients with High Grade Symptomatic Intracranial Stenosis: Pooled Analysis of SAMMPRIS and VISSIT Trials

Abstract 38: Evolocumab added to statin is superior to statin alone in reversing symptomatic intracranial atherosclerotic stenosis

Abstract 38: Evolocumab added to statin is superior to statin alone in reversing symptomatic intracranial atherosclerotic stenosis

Correlation of Imaging Characteristics of Carotid Plaque with Clinical and Histopathological Features and Application of Artificial Intelligence Techniques in Identifying Carotid Disease

Introduction: Stroke is the third-leading cause of death. Carotid artery stenosis (CAS) accounts for 8%–37% of strokes. Landmark carotid trials have shown carotid endarterectomy (CEA) superior to best medical therapy (BMT) for symptomatic moderate stenosis and asymptomatic high-grade stenosis. This study aims to correlate imaging characteristics of vulnerable plaque (VP) with clinical and histopathological features and to assess the ability of artificial intelligence (AI) techniques to identify VP and disease burden using duplex ultrasound (DU) data. Materials and Methods: This prospective study from August 2022 to April 2024 used DU and computerized tomographic angiography (CTA) or magnetic resonance angiography (MRA) to assess carotid plaques in patients planned for CEA and subjected plaques to histology. We also imaged carotid plaques using DU in asymptomatic patients on BMT. YOLOv8 deep learning and U-Net AI models were used to analyze ultrasound (US) images. Results: One hundred and fiftyOne hundred and fifty patients were included in the study. Sixty (40%) were symptomatic. The age range was 33–84 years (mean 58.9). One hundred and fifteen (76.7%) were males. Hypertension, diabetes, dyslipidemia, and smoking were seen in 59%, 56%, 49%, and 40%, respectively and were more prevalent in patients with VP (90%, 60%, 70%, and 50%). Of the 70 patients who underwent CEA, 60 were symptomatic and 10 asymptomatic. 70% of symptomatic patients had a RANKIN (mRS) score of 2–3. All surgical patients underwent DU, 49 CTA, and 21 MRA. Based on the US, 53/60 (88%) symptomatic patients had VP. 56/60 (93%) were confirmed VP on histology. Positive predictive value (PPV) for VP was highest for DU (95%), followed by MRA (89%) and CTA (73%). PPV of DU screening in operated asymptomatic patients was 100%. AI showed 96% PPV for identifying &gt;50% stenosis. Model training in identifying VP accuracy increased from 0.73 to 0.94 metrics. Conclusion: DU is an excellent modality to identify the nature of carotid plaque and can be a good tool to identify VP in asymptomatic CAS. More data will improve AI accuracy.

Short-term outcome of endovascular stenting for symptomatic vertebrobasilar stenosis

BackgroundStroke is a global health concern, causing blood supply interruption to the brain. Vertebrobasilar stenosis (VBS) is the main concern, causing stroke or ischemic attacks. Treatment includes antithrombotic therapy and lifestyle modifications, but invasive intervention like endovascular angioplasty is needed in indicated patients. This study aims to investigate the short-term outcome of endovascular stenting, especially, drug-eluting stents (DES) for symptomatic vertebrobasilar stenosis. In this prospective cohort study, we selected patients with ischemic events, including transient ischemic attack (TIA) or non-disabling stroke, diagnosed by CT or MRI brain, MRA, and over 70% diameter stenosis of the basilar or vertebral artery suggested by angiography. Patients with previous stent at the target lesion, acute stroke, heavily calcified lesion, complete artery occlusion, massive infarction with marked neurological deficit, intracranial hemorrhage, intracranial brain tumors, contraindicated to antithrombotic and/or anticoagulant, pregnant women, and patients susceptible to follow-up loss were excluded.ResultsThis study involved 17 patients evaluated for ischemic events in the vertebrobasilar system, with a mean age of 58.47 ± 9.41 years. The most prevalent comorbidity was a previous transient ischemic attack (TIA) in 15 patients (88.2%), followed by hypertension in 12 patients (70.6%), diabetes and hyperlipidemia in 10 patients each (58.8% for both). Ischemic heart disease was present in 6 patients (35.3%), and smoking was reported by 5 patients (29.4%). The predominant stenosis location was intracranial in 11 patients (64.7%), with extracranial being the second most prevalent site in 6 patients (35.3%). The most prevalent kind of stenosis observed was atherosclerosis, affecting 11 patients (64.7%), followed by dissection in 6 patients (35.2%). The peri-procedural outcomes were good in 15 patients (88.2%) and bad in 2 patients (11.8%). The modified Rankin score (MRS) score was significantly decreased after 5-month follow-up than pre-operative. There was no statistically significant difference between extracranial and intracranial stenosis regarding the final outcome, residual stenosis, or peri-procedural complications.ConclusionsOur findings emphasize the potential advantages of stenting for carefully chosen individuals with symptomatic vertebrobasilar stenosis and simple lesion morphologies (Mori types A and B). However, further research is needed for patient selection and therapy optimization.

Right ventricular function outcomes of percutaneous balloon mitral valvuloplasty: a 3-dimensional echocardiography and 2-dimensional speckle tracking analysis

Abstract Background Rheumatic heart disease (RHD) is a significant cause of mitral stenosis (MS), particularly affecting young adults in developing regions. Percutaneous Balloon Mitral Valvuloplasty (PBMV) is a recognized intervention for severe symptomatic mitral stenosis with favorable morphology. However, its impact on various cardiac parameters needs thorough evaluation by new imaging techniques to increase measurement accuracy and decrease inter-observer variability. Purpose This study aims to evaluate the impact of PBMV on cardiac function and structure among patients with severe rheumatic mitral stenosis, focusing on mitral valve function, Pulmonary artery systolic pressure (PASP) and right ventricular (RV) parameters. Methods A prospective study was conducted involving 30 patients (80% female, mean age 33.1 years) diagnosed with severe rheumatic mitral stenosis. All participants underwent PBMV. Pre- and 30 days post-procedure assessments included conventional echocardiographic parameters, three-dimensional (3D) RV assessment and two-dimensional (2D) strain RV analysis. Statistical analyses were performed to determine significant changes post-PBMV. Results Echocardiographic evaluation showed a decrease in trans-mitral mean pressure gradient and Pressure Half Time (both P&amp;lt;0.001). Improvements were also noted in 2D and 3D mitral valve planimetry values (P&amp;lt;0.001). However, mitral regurgitation (MR) severity increased in some cases (P=0.022). Regarding right ventricular analysis, significant reductions were observed in RV basal, mid and longitudinal diameters (P&amp;lt;0.001 for all). RV Fractional Area Change (FAC%) increased significantly (P&amp;lt;0.001). TAPSE also showed a significant increase (P&amp;lt;0.001), reflecting improved RV functional performance. PASP and TR severity both showed marked reductions (P&amp;lt;0.001), whereas a subgroup analysis indicated that patients with atrial fibrillation (AF) had a less pronounced decrease in PASP compared to those with sinus rhythm. Strain analysis revealed substantial improvements in RV strain parameters, with significant increases in basal, mid, apical, and mean (RVFW) free wall strain (P&amp;lt;0.001) and RV global longitudinal strain (RV GLS) (P&amp;lt;0.001). 3D echocardiography demonstrated significant decreases in RV end-systolic volume (P=0.004) and marked increases in RV EF ejection fraction (P&amp;lt;0.001) and stroke volume (P&amp;lt;0.001), while end-diastolic volume showed no significant change (P=0.061). the study demonstrates that the decline in PASP can significantly predict improvements in both 2D and 3D RV function parameters following PBMV. Conclusion RV performance showed substantial improvement early post-PBMV, as evidenced by marked increases in 3D right ventricular ejection fraction (3DRVEF), right ventricular free wall (RVFW) strain, and RV global longitudinal strain. These enhancements were significantly predicted by the reduction in pulmonary artery systolic pressure (PASP). RV conventional Echocardiographic Parame RV 3D echocardiography and 2D speckle tr

Outcomes Profile of Balloon Angioplasty for Symptomatic Intracranial Atherosclerotic Stenosis at Pelni Hospital from January 2021 to July 2024

Background: Intracranial atherosclerotic stenosis (ICAS) is a major cause of ischemic stroke, posing challenges due to its progressive nature and high recurrence risk. Endovascular interventions like balloon angioplasty show promise in improving blood flow and stabilizing stenotic arteries, particularly in symptomatic ICAS (sICAS) patients unresponsive to medical therapy. This study evaluates outcomes of balloon angioplasty for sICAS at Pelni Hospital over 3.5 years. Methods: A retrospective cohort study of 31 sICAS patients undergoing balloon angioplasty (January 2021–July 2024) assessed demographics, lesion locations, procedural success, and outcomes. Standard endovascular techniques under fluoroscopic guidance were used, focusing on procedural success, complications, and patient stability. Results: Balloon angioplasty was successful in all patients (100%). Most lesions were in the posterior circulation, particularly the vertebrobasilar artery (54.8%), with anterior circulation lesions in the internal carotid (25.8%) and middle cerebral arteries (19.4%). Complications occurred in 2 patients (6.5%), both resulting in adverse outcomes, including death. The remaining 29 patients (93.5%) experienced no significant complications and remained stable during follow-up. Conclusions: Balloon angioplasty demonstrates high success with low complication rates for sICAS, offering a viable therapeutic option for severe stenosis unresponsive to medical therapy. Further research is needed to confirm long-term efficacy, refine patient selection, and enhance clinical outcomes. Keywords: Balloon Angioplasty, Endovascular Treatment, Intracranial Atherosclerotic Stenosis

Symptomatic Cervical Carotid Artery Stenosis: Evolving Paradigms in Risk Stratification and Intervention.

Symptomatic carotid disease, characterized by atherosclerotic or non-atherosclerotic internal carotid artery disease with ipsilateral stroke symptoms, represents a critical condition in stroke neurology. This "hot carotid" state carries a high risk of stroke recurrence, with almost one-fourth of the patients experiencing recurrent ischemic events within 2 weeks of initial presentation. The global prevalence of significant carotid stenosis (conventionally defined as ≥50% narrowing) is estimated at around 1.8% in men and 1.2% in women and increases with age. Management of symptomatic carotid disease remains challenging, requiring a balance between urgent medical and surgical interventions and their associated risks. Current treatment approaches combine medical management, focusing on optimal antithrombotic therapy, with revascularization procedures such as carotid endarterectomy or carotid artery stenting. However, decision making has evolved beyond considering stenosis degree alone, now incorporating advanced imaging data on plaque composition and intraluminal characteristics. Even though there are numerous randomized trials, uncertainties persist regarding optimal management, particularly in light of improved medical therapies and emerging concepts like symptomatic non-stenotic carotid disease. Future research directions include exploring newer antithrombotic regimens, refining patient selection criteria for revascularization, and evaluating novel techniques like transcarotid artery revascularization.

P1282 Type 2 diabetes mellitus in IBD patients: a case control study through a long follow up period

Abstract Background The characterization of patients with Inflammatory Bowel disease (IBD) and Type 2 Diabetes Mellitus (T2DM), as a new category, has not been detailed yet. The main endpoint was evaluating how diabetes may affect IBD course. Additionally, we analysed the prevalence of liver steatosis and liver damage in these patients. Methods We conducted a retrospective case-control study, comparing the occurrence of a severe IBD in patients with IBD+T2DM (cases) versus patients with IBD alone (controls). Among 1047 medical records, we selected all the patients with IBD-T2DM, randomly choosing controls in a 1:4 ratio. We defined severe IBD as the occurrence of at least one of the following factors: IBD-related surgery; initiation of target therapy; over two courses of systemic corticosteroids in a year; IBD-related hospitalization; diarrhoea for more than 12 months with nocturnal awakenings/urgency; symptomatic intestinal stenosis. We defined liver damage as a Fib-4 value &amp;gt; 1.3; hepatic steatosis was assessed via instrumental exams. Results We included 79 IBD-T2DM patients comparing them with 308 patients with IBD alone. The presence of a severe disease was similar in the two groups (59.5% vs 59.7%; p=0.97). Statistically significant differences emerged about the presence of hepatic steatosis (62.9%vs 27.2%; p&amp;lt;0.0001) and liver damage (55.4% vs 26.6%; p&amp;lt;0.0001). In univariate analysis, hypertension (HR: 1.61; p = 0.047), dyslipidaemia (HR: 1.68. p = 0.03) and being naïve to thiopurines (HR: 1.81 p = 0.02) contribute to increase liver damage risk, though these variables were not significant in multivariate analysis. In the IBD-T2DM group, we found a higher current (2.6% vs 1.4%) and past (64.9% vs 34.7%; p&amp;lt;0.0001) use of systemic corticosteroids and a lower current (7.6% vs 12.8%) and past (7.6% vs 20.2%) use of anti-TNF-alpha drugs (p=0.007). Median age at diagnosis of IBD was higher in cases (48.0 vs 32.0; p &amp;lt; 0.0001). In a sub-analysis of Crohn’s disease (CD), 24.3% of the CD-T2DM group had an exclusively colonic involvement vs 5% in the group without T2DM (p=0.003). Conclusion In our study, T2DM was not associated with an IBD worse clinical course. Secondly, we observed an increased presence of steatosis and liver injury, but the IBD-T2DM combination was not a multiplicative risk factor for these outcomes. In clinical practice, we observed a larger use of systemic corticosteroids and a lower use of anti-TNF-alpha drugs in IBD-T2DM patients. Differences such as age of disease onset, colonic involvement, and liver damage, suggest that IBD-T2DM patients could configure a special population worthy of further studies. References Yarur AJ, Strobel SG, Deshpande AR, Abreu MT. Predictors of aggressive inflammatory bowel disease. Gastroenterol Hepatol (NY). 2011;7(10):652-659. CDC. National Diabetes Statistics Report. Diabetes. Published June 6, 2024. Accessed June 12, 2024.https://www.cdc.gov/diabetes/php/data-research/index.html Gomollón F, Dignass A, Annese V, et al. 3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn’s Disease 2016: Part 1: Diagnosis and Medical Management. Journal of Crohn’s and Colitis. 2017;11(1):3-25. doi:10.1093/ecco-jcc/jjw168

Newly developed DWI hyperintensities and changes in cerebral blood flow after carotid stent placement for unilateral symptomatic carotid artery stenosis.

This study aimed to evaluate changes in cerebral blood flow and perioperative outcomes in patients with unilateral symptomatic carotid artery stenosis before and after carotid artery stenting (CAS), providing insights to guide surgical decision-making. Ninety-six patients with moderate to severe unilateral symptomatic carotid artery stenosis (>50%) admitted to the Neurology Department of the Second Affiliated Hospital of Zhejiang University from June 2023 to April 2024 were included. All patients underwent CAS and magnetic resonance imaging, including diffusion-weighted imaging (DWI) and 3D quasi-continuous arterial spin-labeled perfusion imaging, within 3 days preoperatively and on the third postoperative day. Patients were categorized into microembolic and non-embolic groups based on the presence of new diffusion-weighted imaging hyperintensities. Newly developed diffusion-weighted imaging hyperintensities were detected in 68 patients (70.8%), with a total of 704 lesions, though only 4 cases exhibited symptoms. Most lesions were localized to the frontal-parietal cortex and subcortical areas on the affected side (60.8%) and were <3 mm in size (92.6%). Postoperatively, cerebral blood flow in the frontal-parietal lobe was significantly higher than in the temporal lobe on both the affected (50.49 ± 8.02 vs 47.94 ± 9.08, t = 2.179, P < .05) and healthy sides (50.16 ± 5.79 vs 48.00 ± 5.98, t = 3.835, P < .05). Additionally, cerebral blood flow in the affected frontal and temporal lobes significantly increased after surgery (P < .05). Preoperative frontal-parietal cerebral blood flow was lower in the microembolic group compared to the non-embolic group (P < .05). Microemboli are common after CAS but are unlikely to result from immediate hemodynamic changes. Instead, they appear to be associated with chronic preoperative hypoperfusion, which impairs cerebral blood flow regulation.

Association of matrix metalloproteinases and adhesive molecules with important aspects of carotid artery stenosis

Background: As symptom risk assessment in carotid artery stenosis (CAS) could be improved by parameters that reflect additional risk aspects such as chronic inflammation rate, and atherosclerotic activity on a systemic level, we investigated the association of serum matrix metalloproteinases-2,7,9 (MMP-2,7,9), vascular cell adhesion molecule-1 (VCAM-1) and selectins-P and E with symptomatic status, stenosis degree and plaque morphology in CAS patients in order to select parameters that associate to important clinical determinants of the symptom development risk. Methods: The study included 119 CAS patients and 46 healthy subjects. Carotid arteries were examined by color flow Doppler and B-mode Duplex ultrasound. Serum parameters were assessed using commercially available enzyme-linked immunosorbent assays (ELISA). Difference was tested by Mann-Whitney U, Kruskal-Wallis and Chi-square tests, and Spearman’s correlation was tested. Results: MMP-7 and selectin-P levels were higher in CAS than in controls (p&lt;0.001). Positive correlation with stenosis degree was found for MMP-7 (r=0.155, p=0.007), VCAM-1 (r=0.127, p=0.029) and selectin-P (r=.269, p&lt;0.001). MMP-7 and selectin-P were higher in subjects with Grey-Weale 2, comparing to subjects with Grey-Weale 3 plaques (p=0.036, p=0.009). Selectin-P was lower in the presence of Grey-Weale 4 than in Grey-Weale 2 (p=0.045). Conclusions: Concurrent association of MMP-7 and selectin-P with both stenosis degree and carotid plaque morphology shows the joint influence of these important determinants of symptom risk that is reflected in serum parameters. This indicates that they can supply additional information outside ultrasound CAS assessment only, and their integration in a future multiscale approach for CAS risk prediction could be beneficial

Diagnosis and treatment of pediatric arterial stenosis associated with neurofibromatosis type 1

BackgroundNeurofibromatosis type 1 (NF1) is an autosomal dominant genetic disorder affecting multiple systems. However, arterial stenosis is a rare manifestation in patients with NF1. Since the symptoms of arterial stenosis caused by NF1 are often atypical and have a high under-diagnosis rate, this can lead to serious complications such as hypertension, ischemic stroke, or even death. The aim of our research is to analyse the clinical characteristics of arterial stenosis in pediatric patients with NF1 and to summarise its diagnosis, treatment and prognosis.MethodsWe conducted a retrospective review of data from patients with NF1 treated at Beijing Children’s Hospital from 2016 to 2020. Patients diagnosed with arterial stenosis, identified through clinical symptoms, physical examination, arterial ultrasonography, or imaging studies, were included in this study. These patients received symptomatic drug and/or surgical treatments and were followed up regularly. We summarized demographic characteristics, sites of arterial stenosis, clinical manifestations, and treatment outcomes.ResultAmong the 258 patients with NF1 treated at our hospital, 12 (4.7%) had arterial stenosis, comprising 9 males and 3 females with a median age of 7 years (range: 1–14 years). Renal artery stenosis was diagnosed in 7 patients (58.3%), while internal carotid artery (ICA) stenosis was diagnosed in 5 patients (41.7%). The predominant symptoms of renal artery and ICA stenosis were renal hypertension and convulsions, respectively. Antihypertensive drugs were effective in 5 patients with renal hypertension; 2 patients required balloon dilatation of the renal artery due to inadequate response to medication. Oral antiepileptic treatment was effective in 3 patients with ICA stenosis, and encephaloduroarteriosynangiosis was effective in the remaining 2 cases. The follow-up period ranged from 2 to 6 years, with a median duration of 3 years. No deterioration or mortality was observed during the follow-up period.ConclusionsArterial stenosis was present in approximately 4.7% of patients with NF1, predominantly affecting the renal artery and ICA. Renal hypertension and convulsions were the primary symptoms of renal artery and ICA stenosis, respectively. Early diagnosis and intervention can substantially improve the prognosis of these patients.

Surgeon Recommendation and Outcomes of Decompression With vs Without Fusion in Patients With Degenerative Spondylolisthesis

The ability of surgeons to choose the right patient for fusion in addition to decompression when operating for degenerative spondylolisthesis with symptomatic spinal stenosis is debated. The addition of fusion increases risk, morbidity, and costs but has been claimed to give better results for selected patients. To investigate whether following surgeons' opinions regarding fusion was associated with clinical outcomes. This cohort study was conducted alongside the Norwegian Degenerative Spondylolisthesis and Spinal Stenosis randomized clinical trial, which showed noninferiority for decompression alone compared with decompression with fusion. From February 12, 2014, to December 18, 2017, trial surgeons from 16 Norwegian departments denoted their preferred treatment for 222 of 267 patients with symptomatic spinal stenosis and degenerative spondylolisthesis. For this analysis, the clinical outcomes of the patients who were and were not randomized to the recommended treatment were compared. The primary outcome was a reduction of at least 30% from baseline to 2 years after surgery on the Oswestry Disability Index, ranging from 0 (no impairment) to 100 (maximum impairment). Secondary outcomes included the Zürich Claudication Questionnaire, leg and back pain scores, and the EuroQol 5-Dimension score. Among 222 patients (155 [70%] female; mean [SD] age, 66.2 [7.7] years), decompression alone was recommended for 112 patients, of whom 59 received only decompression, and additional fusion for 110 patients, of whom 57 received fusion. At 2-year follow-up, 87 of 116 patients (75%) who received surgery in agreement with the surgeons' recommendations and 77 of 106 (73%) who received surgery in disagreement with the surgeons' recommendations reached the primary outcome (difference, 2.4 percentage points; 95% CI, -9.1 to 13.9 percentage points). All secondary outcomes were in the same direction as the primary outcome. In this cohort study of 222 patients with degenerative spondylolisthesis who participated in a randomized clinical trial, surgeons' recommendations were not associated with better outcomes than a random allocation when deciding between decompression alone and decompression with instrumented fusion. The results suggest that surgeons performing degenerative spondylolisthesis surgery could rely safely on evidence of operating with decompression alone, despite the conflict of expert opinion.

Evaluation of circadian rhythm and prognostic variability pre-and post-CEA or CAS treatment in patients with carotid artery stenosis.

Carotid artery stenosis, primarily caused by atherosclerosis, is a major risk factor for ischemic stroke. Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are established interventions to reduce stroke risk and restore cerebral blood flow. However, the effect of these treatments on circadian rhythms, and their influence on stroke recovery, remains underexplored. This study aims to assess how disruptions in circadian rhythms-specifically sleep quality and blood pressure variability-impact recovery in patients undergoing CEA or CAS. We conducted a prospective study involving 177 patients with carotid artery stenosis, all treated with either CEA or CAS. Patients were followed for 90 days post-treatment, with neurological outcomes evaluated using the NIHSS Stroke Scale (NIHSS). Circadian rhythm-related factors, including sleep quality (Pittsburgh Sleep Quality Index [PSQI]) and blood pressure variability (daytime systolic and nighttime diastolic BP), were assessed pre-and post-treatment. Stepwise regression was used to identify predictors of stroke recovery. In a cohort of 177 patients with symptomatic carotid atherosclerotic stenosis, stepwise regression identified post-treatment changes in PSQI, nighttime diastolic blood pressure, and the presence of coronary heart disease as significant independent predictors of poor neurological outcomes (p < 0.001). Both CEA and CAS significantly improved daytime systolic (p < 0.01) and nighttime diastolic blood pressure (p < 0.01). Patients with poorer prognosis had higher post-treatment PSQI scores (p < 0.001). Additionally, increased physical activity after treatment was linked to improved neurological recovery. This study highlights the critical role of circadian rhythm regulation and cardiovascular health in stroke recovery following CEA or CAS. Stepwise regression analysis revealed that sleep quality, blood pressure stability, and coronary heart disease were key predictors of neurological outcomes, underscoring the importance of integrating circadian rhythm management into rehabilitation strategies. These results provide a robust scientific foundation for further investigation into the role of circadian rhythms in clinical practice.

Hemodynamic evaluation of symptomatic and asymptomatic intracranial atherosclerotic stenosis using cerebral angiographic images: an exploratory study

BackgroundPrevious studies suggest that it may be inappropriate to determine treatment strategies solely based on the degree of stenosis for patients with intracranial atherosclerotic stenosis (ICAS). In order to better...