Medicine › Pulmonary and Respiratory Medicine

Cerebrovascular and Carotid Artery Diseases

Works Count: 116309

Wikipedia

Description

This cluster of papers focuses on the diagnosis and treatment of carotid artery disease, including carotid artery stenosis, endarterectomy, stenting, atherosclerotic plaque, intracranial arterial stenosis, plaque inflammation, neovascularization, and stroke prevention.

Keywords

Carotid Artery Stenosis; Endarterectomy; Stenting; Atherosclerotic Plaque; Intracranial Arterial Stenosis; Plaque Inflammation; Cerebrovascular Events; Magnetic Resonance Imaging; Neovascularization; Stroke Prevention

Kinetics of cellular proliferation after arterial injury. I. Smooth muscle growth in the absence of endothelium.

1983-09-01

Clowes Aw , Reidy Ma , Clowes Mm

30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non-inferiority trial

2006-08-11

Peter A. Ringleb , J.-R. Allenberg , H. Brückmann +7 more

Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomised trial

2001-06-01

Martin M. Brown , Jason H. Rogers , J Martin Bland

Trabeculectomy

1968-10-01

J E Cairns

Effects of Blood Pressure Lowering With Perindopril and Indapamide Therapy on Dementia and Cognitive Decline in Patients With Cerebrovascular Disease

2003-05-12

Christophe Tzourio , Craig S. Anderson , Neil Chapman +4 more

<h3>Background</h3> High blood pressure and stroke are associated with increased risks of dementia and cognitive impairment. This study aimed to determine whether blood pressure lowering would reduce the risks of … <h3>Background</h3> High blood pressure and stroke are associated with increased risks of dementia and cognitive impairment. This study aimed to determine whether blood pressure lowering would reduce the risks of dementia and cognitive decline among individuals with cerebrovascular disease. <h3>Methods</h3> The Perindopril Protection Against Recurrent Stroke Study (PROGRESS) was a randomized, double-blind, placebo-controlled trial conducted among 6105 people with prior stroke or transient ischemic attack. Participants were assigned to either active treatment (perindopril for all participants and indapamide for those with neither an indication for nor a contraindication to a diuretic) or matching placebo(s). The primary outcomes for these analyses were dementia (using<i>DSM-IV</i>criteria) and cognitive decline (a decline of 3 or more points in the Mini-Mental State Examination score). <h3>Results</h3> During a mean follow-up of 3.9 years, dementia was documented in 193 (6.3%) of the 3051 randomized participants in the actively treated group and 217 (7.1%) of the 3054 randomized participants in the placebo group (relative risk reduction, 12% [95% confidence interval, −8% to 28%];<i>P</i>= .2). Cognitive decline occurred in 9.1% of the actively treated group and 11.0% of the placebo group (risk reduction, 19% [95% confidence interval, 4% to 32%];<i>P</i>= .01). The risks of the composite outcomes of dementia with recurrent stroke and of cognitive decline with recurrent stroke were reduced by 34% (95% confidence interval, 3% to 55%) (<i>P</i>= .03) and 45% (95% confidence interval, 21% to 61%) (<i>P</i><.001), respectively, with no clear effect on either dementia or cognitive decline in the absence of recurrent stroke. <h3>Conclusions</h3> Active treatment was associated with reduced risks of dementia and cognitive decline associated with recurrent stroke. These findings further support the recommendation that blood pressure lowering with perindopril and indapamide therapy be considered for all patients with cerebrovascular disease.

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Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial

2004-05-01

Alison Halliday , A O Mansfield , Joanna Marro +4 more

A Standardized Method for Measuring Intracranial Arterial Stenosis

2000-04-01

Owen Samuels , Gregg J. Joseph , Michael Lynn +2 more

BACKGROUND AND PURPOSE: Atherosclerosis of the major intracranial arteries is an important cause of ischemic stroke. We established measurement criteria to assess percent stenosis of a major intracranial artery (carotid, … BACKGROUND AND PURPOSE: Atherosclerosis of the major intracranial arteries is an important cause of ischemic stroke. We established measurement criteria to assess percent stenosis of a major intracranial artery (carotid, middle cerebral, vertebral, basilar) and determined the interobserver/intraobserver agreements and interclass/intraclass correlations of these measurements. METHODS: We defined percent stenosis of an intracranial artery as follows: percent stenosis = [(1 − (D stenosis /D normal ))] × 100, where D stenosis = the diameter of the artery at the site of the most severe stenosis and D normal = the diameter of the proximal normal artery. If the proximal segment was diseased, contingency sites were chosen to measure D normal : distal artery (second choice), feeding artery (third choice). Using a hand-held digital caliper, three neuroradiologists independently measured D stenosis and D normal of 24 stenotic intracranial arteries. Each observer repeated the readings 4 weeks later. We determined how frequently two observers9 measurements of percent stenosis of each of the 24 diseased arteries differed by 10% or less. RESULTS: Among the three pairs of observers, interobserver agreements were 88% (observer 1 versus observer 2), 79% (observer 1 versus observer 3), 75% (observer 2 versus observer 3) for the first reading and were 75% (observer 1 versus observer 2), 100% (observer 1 versus observer 3), and 71% (observer 2 versus observer 3) for the second reading. Intraobserver agreement for each of the observers was 88%, 83%, and 100%. Interclass correlation was 85% (first reading) and 87% (second reading). Intraclass correlation was 92% (first and second readings combined). CONCLUSION: This method shows good interobserver and intraobserver agreements for the measurement of intracranial stenosis of a major artery. If validated in subsequent studies, this method may serve as a standard for the measurement of percent stenosis of an intracranial artery.

Area V5 of the Human Brain: Evidence from a Combined Study Using Positron Emission Tomography and Magnetic Resonance Imaging

1993-01-01

J D Watson , R. Myers , R. S. J. Frackowiak +5 more

In pursuing our work on the organization of human visual cortex, we wanted to specify more accurately the position of the visual motion area (area V5) in relation to the … In pursuing our work on the organization of human visual cortex, we wanted to specify more accurately the position of the visual motion area (area V5) in relation to the sulcal and gyral pattern of the cerebral cortex. We also wanted to determine the intersubject variation of area V5 in terms of position and extent of blood flow change in it, in response to the same task. We therefore used positron emission tomography (PET) to determine the foci of relative cerebral blood flow increases produced when subjects viewed a moving checkerboard pattern, compared to viewing the same pattern when it was stationary. We coregistered the PET images from each subject with images of the same brain obtained by magnetic resonance imaging, thus relating the position of V5 in all 24 hemispheres examined to the individual gyral configuration of the same brains. This approach also enabled us to examine the extent to which results obtained by pooling the PET data from a small group of individuals (e.g., six), chosen at random, would be representative of a much larger sample in determining the mean location of V5 after transformation into Talairach coordinates. After stereotaxic transformation of each individual brain, we found that the position of area V5 can vary by as much as 27 mm in the left hemisphere and 18 mm in the right for the pixel with the highest significance for blood flow change. There is also an intersubject variability in blood flow change within it in response to the same visual task. V5 nevertheless bears a consistent relationship, within each brain, to the sulcal pattern of the occipital lobe. It is situated ventrolaterally, just posterior to the meeting point of the ascending limb of the inferior temporal sulcus and the lateral occipital sulcus. In position it corresponds almost precisely with Flechsig's Feld 16, one of the areas that he found to be myelinated at birth.

Race-Ethnicity and Determinants of Intracranial Atherosclerotic Cerebral Infarction

1995-01-01

Ralph L. Sacco , Douglas E. Kargman , Qiong Gu +1 more

Background and Purpose The aim of this investigation was to determine the importance of race as a determinant of intracranial atherosclerotic stroke in a community-based stroke sample. Methods Residents from … Background and Purpose The aim of this investigation was to determine the importance of race as a determinant of intracranial atherosclerotic stroke in a community-based stroke sample. Methods Residents from northern Manhattan over age 39 years hospitalized for acute ischemic stroke (n=438, black 35%, Hispanic 46%, white 19%) were prospectively evaluated. Index ischemic strokes were classified as atherosclerotic (17%), lacunar (30%), cardioembolic (21%), cryptogenic (31%), and other (1%). Atherosclerotic infarcts were subdivided into extracranial (9%) and intracranial (8%) atherosclerosis. Results The proportion of extracranial atherosclerotic stroke was similar among the three race-ethnic groups, while intracranial atherosclerosis was more frequent in blacks and Hispanics. The unadjusted odds ratio for nonwhites (blacks and Hispanics combined) was 0.8 (confidence interval [CI], 0.4 to 1.8) for extracranial and 7.8 (CI, 1.04 to 57.7) for intracranial atherosclerosis. Patients with intracranial disease were significantly younger and had an increased frequency of hypercholesterolemia and insulin-dependent diabetes compared with those with nonatherosclerotic disease. The odds ratio for the association of nonwhite race-ethnicity and intracranial atherosclerosis was reduced to 5.2 (CI, 0.7 to 40) after controlling for age and to 4.4 (CI, 0.6 to 35) after controlling for age, education, insulin-dependent diabetes, and hypercholesterolemia. Conclusions The greater prevalence of diabetes and hypercholesterolemia among blacks and Hispanics from northern Manhattan accounted for much of the increased frequency of intracranial atherosclerotic stroke. Further control of these risk factors could reduce the frequency of this stroke subtype and minimize the disparities among different race-ethnic groups.

Lacunar strokes and infarcts

1982-08-01

Christopher Fisher

At least 20 different lacunar syndromes have been described and can be recognized by characteristic clinical features. Almost all occur in patients with hypertension. Small lacunes are usually due to … At least 20 different lacunar syndromes have been described and can be recognized by characteristic clinical features. Almost all occur in patients with hypertension. Small lacunes are usually due to lipohyalinosis, larger ones to atheromatous or embolic occlusion of a penetrating vessel. The concept of the “lacunar state” is examined in the light of recent knowledge with the conclusion that the clinical deficit is primarily related to unrecognized normal pressure hydrocephalus rather than to the presence of a few lacunes. The notion that lacunes occur haphazardly is criticized because the first or only lacune tends to be symptomatic. The incidence of cerebral lacunes has declined since the introduction of antihypertensive therapy, an indication that therapy is effective.

Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis

2003-01-01

P M Rothwell , Michael Eliasziw , SA Gutnikov +5 more

MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis

1991-05-01

Charles Warlow

Protected Carotid-Artery Stenting versus Endarterectomy in High-Risk Patients

2004-10-06

Jay S. Yadav , Mark H. Wholey , Richard E. Kuntz +7 more

Carotid endarterectomy is more effective than medical management in the prevention of stroke in patients with severe symptomatic or asymptomatic atherosclerotic carotid-artery stenosis. Stenting with the use of an emboli-protection … Carotid endarterectomy is more effective than medical management in the prevention of stroke in patients with severe symptomatic or asymptomatic atherosclerotic carotid-artery stenosis. Stenting with the use of an emboli-protection device is a less invasive revascularization strategy than endarterectomy in carotid-artery disease.

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Pulsatile flow and atherosclerosis in the human carotid bifurcation. Positive correlation between plaque location and low oscillating shear stress.

1985-05-01

David N. Ku , Don P. Giddens , Christopher K. Zarins +1 more

Fluid velocities were measured by laser Doppler velocimetry under conditions of pulsatile flow in a scale model of the human carotid bifurcation. Flow velocity and wall shear stress at five … Fluid velocities were measured by laser Doppler velocimetry under conditions of pulsatile flow in a scale model of the human carotid bifurcation. Flow velocity and wall shear stress at five axial and four circumferential positions were compared with intimal plaque thickness at corresponding locations in carotid bifurcations obtained from cadavers. Velocities and wall shear stresses during diastole were similar to those found previously under steady flow conditions, but these quantities oscillated in both magnitude and direction during the systolic phase. At the inner wall of the internal carotid sinus, in the region of the flow divider, wall shear stress was highest (systole = 41 dynes/cm2, diastole = 10 dynes/cm2, mean = 17 dynes/cm2) and remained unidirectional during systole. Intimal thickening in this location was minimal. At the outer wall of the carotid sinus where intimal plaques were thickest, mean shear stress was low (-0.5 dynes/cm2) but the instantaneous shear stress oscillated between -7 and +4 dynes/cm2. Along the side walls of the sinus, intimal plaque thickness was greater than in the region of the flow divider and circumferential oscillations of shear stress were prominent. With all 20 axial and circumferential measurement locations considered, strong correlations were found between intimal thickness and the reciprocal of maximum shear stress (r = 0.90, p less than 0.0005) or the reciprocal of mean shear stress (r = 0.82, p less than 0.001). An index which takes into account oscillations of wall shear also correlated strongly with intimal thickness (r = 0.82, p less than 0.001). When only the inner wall and outer wall positions were taken into account, correlations of lesion thickness with the inverse of maximum wall shear and mean wall shear were 0.94 (p less than 0.001) and 0.95 (p less than 0.001), respectively, and with the oscillatory shear index, 0.93 (p less than 0.001). These studies confirm earlier findings under steady flow conditions that plaques tend to form in areas of low, rather than high, shear stress, but indicate in addition that marked oscillations in the direction of wall shear may enhance atherogenesis.

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In Vivo 18F-Fluorodeoxyglucose Positron Emission Tomography Imaging Provides a Noninvasive Measure of Carotid Plaque Inflammation in Patients

2006-10-18

Ahmed Tawakol , Raymond Q. Migrino , Gregory Bashian +7 more

Classification and natural history of clinically identifiable subtypes of cerebral infarction

1991-06-01

John Bamford , Peter Sandercock , Martin Dennis +2 more

Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries

1982-12-01

Rune Aaslid , Thomas-Marc Markwalder , H. Nornes

✓ In this report the authors describe a noninvasive transcranial method of determining the flow velocities in the basal cerebral arteries. Placement of the probe of a range-gated ultrasound Doppler … ✓ In this report the authors describe a noninvasive transcranial method of determining the flow velocities in the basal cerebral arteries. Placement of the probe of a range-gated ultrasound Doppler instrument in the temporal area just above the zygomatic arch allowed the velocities in the middle cerebral artery (MCA) to be determined from the Doppler signals. The flow velocities in the proximal anterior (ACA) and posterior (PCA) cerebral arteries were also recorded at steady state and during test compression of the common carotid arteries. An investigation of 50 healthy subjects by this transcranial Doppler method revealed that the velocity in the MCA, ACA, and PCA was 62 ± 12, 51 ± 12, and 44 ± 11 cm/sec, respectively. This method is of particular value for the detection of vasospasm following subarachnoid hemorrhage and for evaluating the cerebral circulation in occlusive disease of the carotid and vertebral arteries.

Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery

2004-03-01

PM Rothwell , Misha Eliasziw , SA Gutnikov +2 more

The North American Symptomatic Carotid Endarterectomy Trial

1999-09-01

Gary G. Ferguson , Michael Eliasziw , Hugh W. K. Barr +7 more

Background and Purpose —This study reports the surgical results in those patients who underwent carotid endarterectomy in the North American Symptomatic Carotid Endarterectomy Trial (NASCET). Methods —The rates of perioperative … Background and Purpose —This study reports the surgical results in those patients who underwent carotid endarterectomy in the North American Symptomatic Carotid Endarterectomy Trial (NASCET). Methods —The rates of perioperative stroke and death at 30 days and the final assessment of stroke severity at 90 days were calculated. Regression modeling was used to identify variables that increased or decreased perioperative risk. Nonoutcome surgical complications were summarized. The durability of carotid endarterectomy was examined. Results —In 1415 patients there were 92 perioperative outcome events, for an overall rate of 6.5%. At 30 days the results were as follows: death, 1.1%; disabling stroke, 1.8%; and nondisabling stroke, 3.7%. At 90 days, because of improvement in the neurological status of patients judged to have been disabled at 30 days, the results were as follows: death, 1.1%; disabling stroke, 0.9%; and nondisabling stroke, 4.5%. Thirty events occurred intraoperatively; 62 were delayed. Most strokes resulted from thromboembolism. Five baseline variables were predictive of increased surgical risk: hemispheric versus retinal transient ischemic attack as the qualifying event, left-sided procedure, contralateral carotid occlusion, ipsilateral ischemic lesion on CT scan, and irregular or ulcerated ipsilateral plaque. History of coronary artery disease with prior cardiac procedure was associated with reduced risk. The risk of perioperative wound complications was 9.3%, and that of cranial nerve injuries was 8.6%; most were of mild severity. At 8 years, the risk of disabling ipsilateral stroke was 5.7%, and that of any ipsilateral stroke was 17.1%. Conclusions —The overall rate of perioperative stroke and death was 6.5%, but the rate of permanently disabling stroke and death was only 2.0%. Other surgical complications were rarely clinically important. Carotid endarterectomy is a durable procedure.

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Stenting versus Endarterectomy for Treatment of Carotid-Artery Stenosis

2010-05-27

Thomas G. Brott , Robert W. Hobson , George Howard +7 more

Carotid-artery stenting and carotid endarterectomy are both options for treating carotid-artery stenosis, an important cause of stroke. Carotid-artery stenting and carotid endarterectomy are both options for treating carotid-artery stenosis, an important cause of stroke.

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Carotid Artery Stenosis: Gray-Scale and Doppler US Diagnosis—Society of Radiologists in Ultrasound Consensus Conference

2003-11-01

Edward G. Grant , Carol B. Benson , Gregory L. Moneta +7 more

The Society of Radiologists in Ultrasound convened a multidisciplinary panel of experts in the field of vascular ultrasonography (US) to come to a consensus regarding Doppler US for assistance in … The Society of Radiologists in Ultrasound convened a multidisciplinary panel of experts in the field of vascular ultrasonography (US) to come to a consensus regarding Doppler US for assistance in the diagnosis of carotid artery stenosis. The panel’s consensus statement is believed to represent a reasonable position on the basis of analysis of available literature and panelists’ experience. Key elements of the statement include the following: (a) All internal carotid artery (ICA) examinations should be performed with gray-scale, color Doppler, and spectral Doppler US. (b) The degree of stenosis determined at gray-scale and Doppler US should be stratified into the categories of normal (no stenosis), <50% stenosis, 50%–69% stenosis, ≥70% stenosis to near occlusion, near occlusion, and total occlusion. (c) ICA peak systolic velocity (PSV) and presence of plaque on gray-scale and/or color Doppler images are primarily used in diagnosis and grading of ICA stenosis; two additional parameters, ICA-to–common carotid artery PSV ratio and ICA end-diastolic velocity may also be used when clinical or technical factors raise concern that ICA PSV may not be representative of the extent of disease. (d) ICA should be diagnosed as (i) normal when ICA PSV is less than 125 cm/sec and no plaque or intimal thickening is visible; (ii) <50% stenosis when ICA PSV is less than 125 cm/sec and plaque or intimal thickening is visible; (iii) 50%–69% stenosis when ICA PSV is 125–230 cm/sec and plaque is visible; (iv) ≥70% stenosis to near occlusion when ICA PSV is greater than 230 cm/sec and visible plaque and lumen narrowing are seen; (v) near occlusion when there is a markedly narrowed lumen at color Doppler US; and (vi) total occlusion when there is no detectable patent lumen at gray-scale US and no flow at spectral, power, and color Doppler US. (e) The final report should discuss velocity measurements and gray-scale and color Doppler findings. Study limitations should be noted when they exist. The conclusion should state an estimated degree of ICA stenosis as reflected in the above categories. The panel also considered various technical aspects of carotid US and methods for quality assessment and identified several important unanswered questions meriting future research. © RSNA, 2003

Carotid Endarterectomy and Prevention of Cerebral Ischemia in Symptomatic Carotid Stenosis

1991-12-18

Marc R. Mayberg

<h3>Objective.</h3> —To determine whether carotid endarterectomy provides protection against subsequent cerebral ischemia in men with ischemic symptoms in the distribution of significant (>50%) ipsilateral internal carotid artery stenosis. <h3>Design.</h3> —Prospective, … <h3>Objective.</h3> —To determine whether carotid endarterectomy provides protection against subsequent cerebral ischemia in men with ischemic symptoms in the distribution of significant (>50%) ipsilateral internal carotid artery stenosis. <h3>Design.</h3> —Prospective, randomized, multicenter trial. <h3>Setting.</h3> —Sixteen university-affiliated Veterans Affairs medical centers. <h3>Patients.</h3> —Men who presented within 120 days of onset of symptoms that were consistent with transient ischemic attacks, transient monocular blindness, or recent small completed strokes between July 1988 and February 1991. Among 5000 patients screened, 189 individuals were randomized with angiographic internal carotid artery stenosis greater than 50% ipsilateral to the presenting symptoms. Forty-eight eligible patients who refused entry were followed up outside of the trial. <h3>Outcome Measures.</h3> —Cerebral infarction or crescendo transient ischemic attacks in the vascular distribution of the original symptoms or death within 30 days of randomization. <h3>Intervention.</h3> —Carotid endarterectomy plus the best medical care (n = 91) vs the best medical care alone (n=98). <h3>Results.</h3> —At a mean follow-up of 11.9 months, there was a significant reduction in stroke or crescendo transient ischemic attacks in patients who received carotid endarterectomy (7.7%) compared with nonsurgical patients (19.4%), or an absolute risk reduction of 11.7% (<i>P</i>=.011). The benefit of surgery was more profound in patients with internal carotid artery stenosis greater than 70% (absolute risk reduction, 17.7%;<i>P</i>=.004). The benefit of surgery was apparent within 2 months after randomization, and only one stroke was noted in the surgical group beyond the 30-day perioperative period. <h3>Conclusions.</h3> —For a selected cohort of men with symptoms of cerebral or retinal ischemia in the distribution of a high-grade internal carotid artery stenosis, carotid endarterectomy can effectively reduce the risk of subsequent ipsilateral cerebral ischemia. The risk of cerebral ischemia in this subgroup of patients is considerably higher than previously estimated. (<i>JAMA</i>. 1991;266:3289-3294)

Silent brain infarcts: a systematic review

2007-06-19

Sarah E. Vermeer , W.T. Longstreth , Peter J. Koudstaal

Homocystine-induced arteriosclerosis. The role of endothelial cell injury and platelet response in its genesis.

1976-09-01

Laurence A. Harker , Russell Ross , S. J. Slichter +1 more

The atherogenic mechanism of homocystinemia has been defined by measuring endothelial cell loss and regeneration, platelet consumption, and intimal lesion formation in a primate model. Three groups of baboons were … The atherogenic mechanism of homocystinemia has been defined by measuring endothelial cell loss and regeneration, platelet consumption, and intimal lesion formation in a primate model. Three groups of baboons were studied: (a) 8 control animals; (b) 15 animals after 3 mo of continuous homocystinemia; and (c) 11 animals after 3 mo of combined homocystinemia and oral treatment with dipyridamole. Experimental homocystinemia caused patchy endothelial desquamation comprising about 10% of the aortic surface despite a 25-fold increase in endothelial cell regeneration. Neither endothelial cell loss nor regeneration was changed significantly by dipyridamole. Homocystine-induced vascular deendothelialization produced a threefold increase in platelet consumption that was interrupted by dipyridamole inhibition of platelet function. All homocystinemic animals developed typical arteriosclerotic or preatherosclerotic intimal lesions composed of proliferating smooth muscle cells averaging 10-15 cell layers surrounded by large amounts of collagen, elastic fibers, glycosaminoglycans, and sometimes lipid. Intimal lesion formation was prevented by dipyridamole therapy. We conclude that homocystine-induced endothelial cell injury resulted in arteriosclerosis through platelet-mediated intimal proliferation of smooth muscle cells that can be prevented by drug-induced platelet dysfunction.

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Embolic strokes of undetermined source: the case for a new clinical construct

2014-03-20

Robert G. Hart , Hans‐Christoph Diener , Shelagh B. Coutts +5 more

Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial

2010-02-27

Jörg Ederle , Joanna Dobson , Roland L Featherstone +7 more

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Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis

2011-09-07

Marc I. Chimowitz , Michael Lynn , Colin P. Derdeyn +7 more

Atherosclerotic intracranial arterial stenosis is an important cause of stroke that is increasingly being treated with percutaneous transluminal angioplasty and stenting (PTAS) to prevent recurrent stroke. However, PTAS has not … Atherosclerotic intracranial arterial stenosis is an important cause of stroke that is increasingly being treated with percutaneous transluminal angioplasty and stenting (PTAS) to prevent recurrent stroke. However, PTAS has not been compared with medical management in a randomized trial.

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Lacunes

1965-08-01

C. Miller Fisher

LACUNES may be defined as ischemic infarcts of restricted size in the deeper parts of the brain.Absent from the cerebral and cerebellar cortex, they are best known in the chronic … LACUNES may be defined as ischemic infarcts of restricted size in the deeper parts of the brain.Absent from the cerebral and cerebellar cortex, they are best known in the chronic healed stage when they form irregular cavities, 0.5 to 15 mm. in diameter, principally in the basal ganglia and basis pontis (Figs. 1, 2, 3, 4, and 5 ) . Although outnumbering all the

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Cerebral white matter lesions, vascular risk factors, and cognitive function in a population‐based study

1994-07-01

Monique M.B. Breteler , John C. van Swieten , Michiel L. Bots +7 more

Cerebral white matter lesions are a common finding on MRI in elderly persons. We studied the prevalence of white matter lesions and their relation with classic cardiovascular risk factors, thrombogenic … Cerebral white matter lesions are a common finding on MRI in elderly persons. We studied the prevalence of white matter lesions and their relation with classic cardiovascular risk factors, thrombogenic factors, and cognitive function in an age- and gender-stratified random sample from the general population that consisted of 111 subjects 65 to 84 years of age. Overall, 27% of subjects had white matter lesions. The prevalence and severity of lesions increased with age. A history of stroke or myocardial infarction, factor VIIc activity, and fibrinogen level were each significantly and independently associated with the presence of white matter lesions. Significant relations with blood pressure level, hypertension, and plasma cholesterol were present only for subjects aged 65 to 74 years. White matter lesions tended to be associated with lower scores on tests of cognitive function and were significantly associated with subjective mental decline. This study suggests that classic cardiovascular risk factors, as well as thrombogenic factors, are associated with white matter lesions in subjects over 65 years of age in the general population, and that these lesions may be related to cognitive function.

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Imaging Atherosclerotic Plaque Inflammation With [ <sup>18</sup> F]-Fluorodeoxyglucose Positron Emission Tomography

2002-06-11

James H.F. Rudd , Elizabeth A. Warburton , Tim D. Fryer +7 more

Background — Atherosclerotic plaque rupture is usually a consequence of inflammatory cell activity within the plaque. Current imaging techniques provide anatomic data but no indication of plaque inflammation. The glucose … Background — Atherosclerotic plaque rupture is usually a consequence of inflammatory cell activity within the plaque. Current imaging techniques provide anatomic data but no indication of plaque inflammation. The glucose analogue [ 18 F]-fluorodeoxyglucose ( 18 FDG) can be used to image inflammatory cell activity non-invasively by PET. In this study we tested whether 18 FDG-PET imaging can identify inflammation within carotid artery atherosclerotic plaques. Methods and Results — Eight patients with symptomatic carotid atherosclerosis were imaged using 18 FDG-PET and co-registered CT. Symptomatic carotid plaques were visible in 18 FDG-PET images acquired 3 hours post- 18 FDG injection. The estimated net 18 FDG accumulation rate (plaque/integral plasma) in symptomatic lesions was 27% higher than in contralateral asymptomatic lesions. There was no measurable 18 FDG uptake into normal carotid arteries. Autoradiography of excised plaques confirmed accumulation of deoxyglucose in macrophage-rich areas of the plaque. Conclusions — This study demonstrates that atherosclerotic plaque inflammation can be imaged with 18 FDG-PET, and that symptomatic, unstable plaques accumulate more 18 FDG than asymptomatic lesions.

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Endarterectomy versus Stenting in Patients with Symptomatic Severe Carotid Stenosis

2006-10-18

Jean‐Louis Mas , Gilles Chatellier , B. Beyssen +7 more

Carotid stenting is less invasive than endarterectomy, but it is unclear whether it is as safe in patients with symptomatic carotid-artery stenosis.We conducted a multicenter, randomized, noninferiority trial to compare … Carotid stenting is less invasive than endarterectomy, but it is unclear whether it is as safe in patients with symptomatic carotid-artery stenosis.We conducted a multicenter, randomized, noninferiority trial to compare stenting with endarterectomy in patients with a symptomatic carotid stenosis of at least 60%. The primary end point was the incidence of any stroke or death within 30 days after treatment.The trial was stopped prematurely after the inclusion of 527 patients for reasons of both safety and futility. The 30-day incidence of any stroke or death was 3.9% after endarterectomy (95% confidence interval [CI], 2.0 to 7.2) and 9.6% after stenting (95% CI, 6.4 to 14.0); the relative risk of any stroke or death after stenting as compared with endarterectomy was 2.5 (95% CI, 1.2 to 5.1). The 30-day incidence of disabling stroke or death was 1.5% after endarterectomy (95% CI, 0.5 to 4.2) and 3.4% after stenting (95% CI, 1.7 to 6.7); the relative risk was 2.2 (95% CI, 0.7 to 7.2). At 6 months, the incidence of any stroke or death was 6.1% after endarterectomy and 11.7% after stenting (P=0.02). There were more major local complications after stenting and more systemic complications (mainly pulmonary) after endarterectomy, but the differences were not significant. Cranial-nerve injury was more common after endarterectomy than after stenting.In this study of patients with symptomatic carotid stenosis of 60% or more, the rates of death and stroke at 1 and 6 months were lower with endarterectomy than with stenting. (ClinicalTrials.gov number, NCT00190398 [ClinicalTrials.gov].).

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18F-fluoride positron emission tomography for identification of ruptured and high-risk coronary atherosclerotic plaques: a prospective clinical trial

2013-11-11

Nikhil Joshi , Alex Vesey , Michelle C. Williams +7 more

The use of non-invasive imaging to identify ruptured or high-risk coronary atherosclerotic plaques would represent a major clinical advance for prevention and treatment of coronary artery disease. We used combined … The use of non-invasive imaging to identify ruptured or high-risk coronary atherosclerotic plaques would represent a major clinical advance for prevention and treatment of coronary artery disease. We used combined PET and CT to identify ruptured and high-risk atherosclerotic plaques using the radioactive tracers (18)F-sodium fluoride ((18)F-NaF) and (18)F-fluorodeoxyglucose ((18)F-FDG).In this prospective clinical trial, patients with myocardial infarction (n=40) and stable angina (n=40) underwent (18)F-NaF and (18)F-FDG PET-CT, and invasive coronary angiography. (18)F-NaF uptake was compared with histology in carotid endarterectomy specimens from patients with symptomatic carotid disease, and with intravascular ultrasound in patients with stable angina. The primary endpoint was the comparison of (18)F-fluoride tissue-to-background ratios of culprit and non-culprit coronary plaques of patients with acute myocardial infarction.In 37 (93%) patients with myocardial infarction, the highest coronary (18)F-NaF uptake was seen in the culprit plaque (median maximum tissue-to-background ratio: culprit 1·66 [IQR 1·40-2·25] vs highest non-culprit 1·24 [1·06-1·38], p<0·0001). By contrast, coronary (18)F-FDG uptake was commonly obscured by myocardial uptake and where discernible, there were no differences between culprit and non-culprit plaques (1·71 [1·40-2·13] vs 1·58 [1·28-2·01], p=0·34). Marked (18)F-NaF uptake occurred at the site of all carotid plaque ruptures and was associated with histological evidence of active calcification, macrophage infiltration, apoptosis, and necrosis. 18 (45%) patients with stable angina had plaques with focal (18)F-NaF uptake (maximum tissue-to-background ratio 1·90 [IQR 1·61-2·17]) that were associated with more high-risk features on intravascular ultrasound than those without uptake: positive remodelling (remodelling index 1·12 [1·09-1·19] vs 1·01 [0·94-1·06]; p=0·0004), microcalcification (73% vs 21%, p=0·002), and necrotic core (25% [21-29] vs 18% [14-22], p=0·001).(18)F-NaF PET-CT is the first non-invasive imaging method to identify and localise ruptured and high-risk coronary plaque. Future studies are needed to establish whether this method can improve the management and treatment of patients with coronary artery disease.Chief Scientist Office Scotland and British Heart Foundation.

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Comparison of Warfarin and Aspirin for Symptomatic Intracranial Arterial Stenosis

2005-03-30

Marc I. Chimowitz , Michael Lynn , Harriet Howlett-Smith +7 more

Atherosclerotic intracranial arterial stenosis is an important cause of stroke. Warfarin is commonly used in preference to aspirin for this disorder, but these therapies have not been compared in a … Atherosclerotic intracranial arterial stenosis is an important cause of stroke. Warfarin is commonly used in preference to aspirin for this disorder, but these therapies have not been compared in a randomized trial.We randomly assigned patients with transient ischemic attack or stroke caused by angiographically verified 50 to 99 percent stenosis of a major intracranial artery to receive warfarin (target international normalized ratio, 2.0 to 3.0) or aspirin (1300 mg per day) in a double-blind, multicenter clinical trial. The primary end point was ischemic stroke, brain hemorrhage, or death from vascular causes other than stroke.After 569 patients had undergone randomization, enrollment was stopped because of concerns about the safety of the patients who had been assigned to receive warfarin. During a mean follow-up period of 1.8 years, adverse events in the two groups included death (4.3 percent in the aspirin group vs. 9.7 percent in the warfarin group; hazard ratio for aspirin relative to warfarin, 0.46; 95 percent confidence interval, 0.23 to 0.90; P=0.02), major hemorrhage (3.2 percent vs. 8.3 percent, respectively; hazard ratio, 0.39; 95 percent confidence interval, 0.18 to 0.84; P=0.01), and myocardial infarction or sudden death (2.9 percent vs. 7.3 percent, respectively; hazard ratio, 0.40; 95 percent confidence interval, 0.18 to 0.91; P=0.02). The rate of death from vascular causes was 3.2 percent in the aspirin group and 5.9 percent in the warfarin group (P=0.16); the rate of death from nonvascular causes was 1.1 percent and 3.8 percent, respectively (P=0.05). The primary end point occurred in 22.1 percent of the patients in the aspirin group and 21.8 percent of those in the warfarin group (hazard ratio, 1.04; 95 percent confidence interval, 0.73 to 1.48; P=0.83).Warfarin was associated with significantly higher rates of adverse events and provided no benefit over aspirin in this trial. Aspirin should be used in preference to warfarin for patients with intracranial arterial stenosis.

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A review of 3D vessel lumen segmentation techniques: Models, features and extraction schemes

2009-08-13

David Lesage , Elsa D. Angelini , Isabelle Bloch +1 more

MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70–99%) or mild (0–29%) carotid stenosis

1992-06-01

Gregorio A. Sicard

Benefit of Carotid Endarterectomy in Patients with Symptomatic Moderate or Severe Stenosis

1998-11-12

Henry J.M. Barnett , D. Wayne Taylor , Michael Eliasziw +7 more

Previous studies have shown that carotid endarterectomy in patients with symptomatic severe carotid stenosis (defined as stenosis of 70 to 99 percent of the luminal diameter) is beneficial up to … Previous studies have shown that carotid endarterectomy in patients with symptomatic severe carotid stenosis (defined as stenosis of 70 to 99 percent of the luminal diameter) is beneficial up to two years after the procedure. In this clinical trial, we assessed the benefit of carotid endarterectomy in patients with symptomatic moderate stenosis, defined as stenosis of less than 70 percent. We also studied the durability of the benefit of endarterectomy in patients with severe stenosis over eight years of follow-up.

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Efficacy of Carotid Endarterectomy for Asymptomatic Carotid Stenosis

1993-01-28

Robert W. Hobson , David G. Weiss , William S. Fields +4 more

The efficacy of carotid endarterectomy in patients with asymptomatic carotid stenosis has not been confirmed in randomized clinical trials, despite the widespread use of operative intervention in such patients. The efficacy of carotid endarterectomy in patients with asymptomatic carotid stenosis has not been confirmed in randomized clinical trials, despite the widespread use of operative intervention in such patients.

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Association between Plasma Homocysteine Concentrations and Extracranial Carotid-Artery Stenosis

1995-02-02

Jacob Selhub , Paul F. Jacques , Andrew G. Bostom +7 more

Epidemiologic studies have identified hyperhomocysteinemia as a possible risk factor for atherosclerosis. We determined the risk of carotid-artery atherosclerosis in relation to both plasma homocysteine concentrations and nutritional determinants of … Epidemiologic studies have identified hyperhomocysteinemia as a possible risk factor for atherosclerosis. We determined the risk of carotid-artery atherosclerosis in relation to both plasma homocysteine concentrations and nutritional determinants of hyperhomocysteinemia.

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North American Symptomatic Carotid Endarterectomy Trial. Methods, patient characteristics, and progress.

1991-06-01

Fifty North American centers have combined to evaluate the benefit of carotid endarterectomy in randomized patients who have experienced symptoms related to arteriosclerotic stenosis of the carotid artery and who … Fifty North American centers have combined to evaluate the benefit of carotid endarterectomy in randomized patients who have experienced symptoms related to arteriosclerotic stenosis of the carotid artery and who have received either best medical therapy alone or best medical therapy plus carotid endarterectomy. The outcome events are nonfatal and fatal stroke or death. A three-tier system identifies and adjudicates the type, severity, and location of each stroke and the cause of any death. Data about patients submitted to carotid endarterectomy outside the trial are compiled at the Nonrandomized Data Center at the Mayo Clinic. Between December 27, 1987, and October 1, 1990, 1,212 patients were randomized, 596 to medical therapy, 616 to carotid endarterectomy. Cross-over from the medical to the surgical arm has been low (4.2%). Patients eligible for the trial, but not randomized totaled 1,044; their characteristics were similar to those randomized so that, for the type of symptomatic patient in this study, our conclusions about the benefit of carotid endarterectomy can be generalized. Patients excluded by medical criteria totaled 679. Another 1,591 had carotid endarterectomy, but either lacked the disease under study, were asymptomatic, or received inadequate investigation to meet entry criteria. We set sample size at 1,900 patients, with continuing enrollment. The Monitoring Committee reviews at intervals the confidential analyses performed on the groups with moderate (30-69%) and severe (70-99%) stenosis. Stopping rules will be invoked for one or both groups if unequivocal benefit or harm is identified.

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Stroke Risk Factors, Genetics, and Prevention

2017-02-02

Amelia K. Boehme , Charles Esenwa , Mitchell S.V. Elkind

Stroke is a heterogeneous syndrome, and determining risk factors and treatment depends on the specific pathogenesis of stroke. Risk factors for stroke can be categorized as modifiable and nonmodifiable. Age, … Stroke is a heterogeneous syndrome, and determining risk factors and treatment depends on the specific pathogenesis of stroke. Risk factors for stroke can be categorized as modifiable and nonmodifiable. Age, sex, and race/ethnicity are nonmodifiable risk factors for both ischemic and hemorrhagic stroke, while hypertension, smoking, diet, and physical inactivity are among some of the more commonly reported modifiable risk factors. More recently described risk factors and triggers of stroke include inflammatory disorders, infection, pollution, and cardiac atrial disorders independent of atrial fibrillation. Single-gene disorders may cause rare, hereditary disorders for which stroke is a primary manifestation. Recent research also suggests that common and rare genetic polymorphisms can influence risk of more common causes of stroke, due to both other risk factors and specific stroke mechanisms, such as atrial fibrillation. Genetic factors, particularly those with environmental interactions, may be more modifiable than previously recognized. Stroke prevention has generally focused on modifiable risk factors. Lifestyle and behavioral modification, such as dietary changes or smoking cessation, not only reduces stroke risk, but also reduces the risk of other cardiovascular diseases. Other prevention strategies include identifying and treating medical conditions, such as hypertension and diabetes, that increase stroke risk. Recent research into risk factors and genetics of stroke has not only identified those at risk for stroke but also identified ways to target at-risk populations for stroke prevention.

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Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST)

1998-05-01

*North American Symptomatic Carotid Endarterectomy Trial (NASCET) Steering Committee. Beneficial Effect of Carotid Endarterectomy in Symptomatic Patients with High-Grade Carotid Stenosis.

1991-08-15

Alastair M. Buchan

Editor's Choice – Management of Atherosclerotic Carotid and Vertebral Artery Disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS)

2017-08-26

A.R. Naylor , Jean‐Baptiste Ricco , Gert J. de Borst +7 more

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Beneficial Effect of Carotid Endarterectomy in Symptomatic Patients with High-Grade Carotid Stenosis

1991-08-15

H. J. M. Barnett , D. Wayne Taylor , R. Brian Haynes +7 more

Without strong evidence of benefit, the use of carotid endarterectomy for prophylaxis against stroke rose dramatically until the mid-1980s, then declined. Our investigation sought to determine whether carotid endarterectomy reduces … Without strong evidence of benefit, the use of carotid endarterectomy for prophylaxis against stroke rose dramatically until the mid-1980s, then declined. Our investigation sought to determine whether carotid endarterectomy reduces the risk of stroke among patients with a recent adverse cerebrovascular event and ipsilateral carotid stenosis.

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MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis. European Carotid Surgery Trialists' Collaborative Group.

1991-05-25

Troels S. Jensen

Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study

1995-05-10

Michael Walker , John R. Marler , Murray Goldstein +7 more

To determine whether the addition of carotid endarterectomy to aggressive medical management can reduce the incidence of cerebral infarction in patients with asymptomatic carotid artery stenosis.Prospective, randomized, multicenter trial.Thirty-nine clinical … To determine whether the addition of carotid endarterectomy to aggressive medical management can reduce the incidence of cerebral infarction in patients with asymptomatic carotid artery stenosis.Prospective, randomized, multicenter trial.Thirty-nine clinical sites across the United States and Canada.Between December 1987 and December 1993, a total of 1662 patients with asymptomatic carotid artery stenosis of 60% or greater reduction in diameter were randomized; follow-up data are available on 1659. At baseline, recognized risk factors for stroke were similar between the two treatment groups.Daily aspirin administration and medical risk factor management for all patients; carotid endarterectomy for patients randomized to receive surgery.Initially, transient ischemic attack or cerebral infarction occurring in the distribution of the study artery and any transient ischemic attack, stroke, or death occurring in the perioperative period. In March 1993, the primary outcome measures were changed to cerebral infarction occurring in the distribution of the study artery or any stroke or death occurring in the perioperative period.After a median follow-up of 2.7 years, with 4657 patient-years of observation, the aggregate risk over 5 years for ipsilateral stroke and any perioperative stroke or death was estimated to be 5.1% for surgical patients and 11.0% for patients treated medically (aggregate risk reduction of 53% [95% confidence interval, 22% to 72%]).Patients with asymptomatic carotid artery stenosis of 60% or greater reduction in diameter and whose general health makes them good candidates for elective surgery will have a reduced 5-year risk of ipsilateral stroke if carotid endarterectomy performed with less than 3% perioperative morbidity and mortality is added to aggressive management of modifiable risk factors.

Secondary prevention of vascular disease by prolonged antiplatelet treatment

1988-01-30

Thirty one randomised trials of antiplatelet treatment for patients with a history of transient ischaemic attack, occlusive stroke, unstable angina, or myocardial infarction were identified. Six were still in progress, … Thirty one randomised trials of antiplatelet treatment for patients with a history of transient ischaemic attack, occlusive stroke, unstable angina, or myocardial infarction were identified. Six were still in progress, and the results of the remaining 25 were reviewed. They included a total of some 29 000 patients, 3000 of whom had died. Overall, allocation to antiplatelet treatment had no apparent effect on non-vascular mortality but reduced vascular mortality by 15% (SD 4%) and non-fatal vascular events (stroke or myocardial infarction) by 30% (4%). This suggested that with good compliance these treatments might reduce vascular mortality by about one sixth, other vascular events by about a third, and total vascular events by about a quarter. There was no significant difference between the effects of the different types of antiplatelet treatment tested (300-325 mg aspirin daily, higher aspirin doses, sulphinpyrazone, or high dose aspirin with dipyridamole), nor between the effects in patients with histories of cerebral or cardiac disease. Thus antiplatelet treatment can reduce the incidence of serious vascular events by about a quarter among a wide range of patients at particular risk of occlusive vascular disease. The balance of risk and benefit, however, might be different for “primary” prevention among people at low absolute risk of occlusive disease if antiplatelet treatment produced even a small increase in the incidence of cerebral haemorrhage.

Failure of Extracranial–Intracranial Arterial Bypass to Reduce the Risk of Ischemic Stroke

1985-11-07

To determine whether bypass surgery would benefit patients with symptomatic atherosclerotic disease of the internal carotid artery, we studied 1377 patients with recent hemisphere strokes, retinal infarction, or transient ischemic … To determine whether bypass surgery would benefit patients with symptomatic atherosclerotic disease of the internal carotid artery, we studied 1377 patients with recent hemisphere strokes, retinal infarction, or transient ischemic attacks who had atherosclerotic narrowing or occlusion of the ipsilateral internal carotid or middle cerebral artery. Of these, 714 were randomly assigned to the best medical care, and 663 to the same regimen with the addition of bypass surgery joining the superficial temporal artery and the middle cerebral artery. The patients were followed for an average of 55.8 months. Thirty-day surgical mortality and major stroke morbidity rates were 0.6 and 2.5 per cent, respectively. The postoperative bypass patency rate was 96 per cent. Nonfatal and fatal stroke occurred both more frequently and earlier in the patients operated on. Secondary survival analyses comparing the two groups for major strokes and all deaths, for all strokes and all deaths, and for ipsilateral ischemic strokes demonstrated a similar lack of benefit from surgery. Separate analyses in patients with different angiographic lesions did not identify a subgroup with any benefit from surgery. Two important subgroups of patients fared substantially worse in the surgical group: those with severe middle-cerebral-artery stenosis (n = 109, MantelHaenszel chi-square = 4.74), and those with persistence of ischemic symptoms after an internal-carotid-artery occlusion had been demonstrated (n = 287, chi-square = 4.04). This study thus failed to confirm the hypothesis that extracranial—intracranial anastomosis is effective in preventing cerebral ischemia in patients with atherosclerotic arterial disease in the carotid and middle cerebral arteries. (N Engl J Med 1985; 313:1191–1200.)

Endarterectomy for Asymptomatic Carotid Artery Stenosis

1995-05-10

Michael Walker

Vascular smooth muscle. I. Normal structure, pathology, biochemistry, and biophysics.

1968-12-01

A P Somlyo , Avril V. Somlyo

Anti-thyroid Peroxidase Antibody Positivity and Chronic Hyperglycemia as Key Risk Factors for Peripheral Artery Disease in Type 2 Diabetes: A Retrospective Cohort Study

2025-06-25

Nadiya Mahmud , Duncan M. Mwangi , Rafiul Islam Shuvo +7 more | Cureus

Spatial transcriptomic profiling of human paravertebral sympathetic chain ganglia reveals diabetes-induced neuroplasticity

2025-06-25

Marisol Mancilla Moreno , Pooja Patel , Karin Goß +7 more | bioRxiv (Cold Spring Harbor Laboratory)

The paravertebral sympathetic chain ganglia (SCG) are autonomic ganglia critical for regulating the fight-or-flight response. Symptoms of sympathetic dysfunction are prevalent in diabetes, affecting up to 90% of patients. The … The paravertebral sympathetic chain ganglia (SCG) are autonomic ganglia critical for regulating the fight-or-flight response. Symptoms of sympathetic dysfunction are prevalent in diabetes, affecting up to 90% of patients. The molecular and cellular composition of the human SCG and its alteration in diabetes remains poorly defined. To address this gap, we performed spatial transcriptomic profiling of lumbar SCGs from diabetic and non-diabetic organ donors. We identified 3 three distinct neuronal populations, two noradrenergic (NA1 and NA2) and one cholinergic (CHO), based on tyrosine hydroxylase (TH) and SLC18A3 expression, respectively. We also characterized 9 non-neuronal populations consisting of Schwann cells, immune cells, fibroblasts, adipocytes, and endothelial cells. In diabetic SCGs, we observed a significant loss of myelinating Schwann cells and a phenotypic shift of cholinergic neurons toward a noradrenergic identity. Additionally, diabetes was associated with a significant reduction in the transcripts of vasodilatory neuropeptides, such as VIP and CALCA, suggesting a mechanism for impaired vascular control. Upstream regulator analysis highlighted altered neurotrophic signaling in diabetes, with enhanced NGF/TRKA and diminished BDNF/TRKB activity, potentially driven by target-derived cues. Comparison between SCG and dorsal root ganglia (DRG) neurons revealed ganglia-specific genes, like SCN3A and NPY (SCG) versus SCN10A and GPX1 (DRG), offering specific therapeutic targets for autonomic dysfunction or pain. Our findings provide a transcriptomic characterization of human SCG, revealing molecular signatures that underlie diabetic autonomic dysfunction. This work lays a foundation for the development of therapies to restore sympathetic function and avoid unintended autonomic effects in the development of analgesics.

Horner's Syndrome after Carotid Endarterectomy: A Case Report and Review of Literature

2025-06-25

Nadeem Ahmed Siddiqui , Fatima Suleman , Syed Muhammad +1 more | Asian Journal of Neurosurgery

Abstract Horner's syndrome, characterized by ptosis, miosis, and anhidrosis, results from oculosympathetic complex injury, often due to trauma affecting the superior cervical ganglion. Although rare following carotid surgery, we present … Abstract Horner's syndrome, characterized by ptosis, miosis, and anhidrosis, results from oculosympathetic complex injury, often due to trauma affecting the superior cervical ganglion. Although rare following carotid surgery, we present a case of Horner's syndrome after elective carotid endarterectomy (CEA). This report explores potential mechanism, including prolonged surgical retraction and hematoma formation, while reviewing similar cases in the literature. A 45-year-old woman presented with recurrent dizziness and progressive left-sided hearing impairment over 5 years. She also reported neck discomfort and experienced five episodes of amaurosis fugax in her left eye within 1 week. Computed tomography revealed occlusion of the right common and internal carotid artery (ICA), along with a 90% stenosis at the left common carotid bifurcation extending into the left ICA. Subsequently, an elective left CEA was performed. Within 24 hours postoperatively, she developed clinical signs of Horner's syndrome, including left-sided ptosis, miosis, anhidrosis, and concurrent facial nerve palsy. Notably, there was no evidence of hematoma formation or sensorimotor deficits. This case highlights the rare occurrence of Horner's syndrome as a postoperative complication of CEA. Surgeons should be mindful of anatomical variations and potential intraoperative mechanisms contributing to this complication to enhance prevention strategies. Recognizing this risk is essential for optimizing postoperative care and patient counseling.

Assessment of Cortical Plate Thickness and Lower Molar Inclination in Skeletal Class III Patients as Indicators for Corticotomy

2025-06-24

Aleksandra Anna Kołodziejska | International Journal of Oral and Maxillofacial Surgery

Ischemic stroke in women

2025-06-24

Н. В. Пизова , A. V. Pizov | Neurology neuropsychiatry Psychosomatics

Ischemic stroke (IS) affects all population groups, but women bear a greater burden of the disease compared to men. Stroke is the second leading cause of death among women worldwide. … Ischemic stroke (IS) affects all population groups, but women bear a greater burden of the disease compared to men. Stroke is the second leading cause of death among women worldwide. Stroke in women is characterized by numerous distinctions from stroke in men, including specific epidemiological and etiological features, different outcomes, and unique pathophysiological mechanisms. IS occurs more frequently in women than in men, which is associated with their longer life expectancy. The risk of IS increases during menstruation, pregnancy, the postpartum period, with the use of oral contraceptives, and during menopause. In older age, women more frequently present with arterial hypertension, diabetes mellitus, and atrial fibrillation. Stroke outcomes are more often unfavorable in women. They are also more likely to develop post-stroke depression.

A better prognosis and functional outcomes in Super-Selective Intra-Arterial Chemoradiotherapy compared to surgery for advanced oral cancer

2025-06-24

B. Teh , Wataru Kobayashi , K. Kubota +4 more | International Journal of Oral and Maxillofacial Surgery

Evaluating the Role of Post-Thrombectomy MRI in Predicting Functional Recovery in Basilar Artery Occlusion

2025-06-24

Nahal Farhani , Marco Ayroso , Susan E. Alcock +1 more | Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques

Endovascular carotid artery revascularization utilizing multiple distal embolic protection strategies: active and passive flow reversal in combination with balloon assisted reperfusion

2025-06-23

Jason H. Boulter , Janet Shapiro , Arthur G. Pratt +3 more | Journal of Clinical Neuroscience

Anatomical variation of circle of Willis in computed tomographic angiography study

2025-06-23

Abiral Barakoti , Shubhekshya Regmi , Hensan Khadka | Journal of Gandaki Medical College-Nepal

Introduction: The circle of Willis (CW) is located at the base of the brain, connecting the carotid and vertebral-basilar arterial systems. Cerebral computed tomographic angiography (CTA) has high sensitivity and … Introduction: The circle of Willis (CW) is located at the base of the brain, connecting the carotid and vertebral-basilar arterial systems. Cerebral computed tomographic angiography (CTA) has high sensitivity and specificity in detecting intracranial vascular variations. The aim of this study was to identify anatomic variations in the CW using cerebral CTA and to compare these variations based on age and gender. Methods: A cross-sectional study was conducted among total of 54 patients referred for CTA who met the inclusion criteria were evaluated. Data on age, gender, and the presence of anatomical variations in the CW were collected and analyzed using SPSS version 26.0. Results: The study included 54 participants, with a male-to-female ratio of 1.45:1 and ages ranging from 3 to 87 years. The most common anatomical configuration was Type A anterior CW (75.9%), followed by hypoplasia of the bilateral posterior communicating arteries / Type E posterior CW (38.9%). Complete anterior and posterior circulation was observed in 16.6% of participants, and the proportions of complete CW configuration were similar in males and females (p = 0.501 and 0.391 for anterior and posterior CW, respectively) as well as in younger (under forty) and adult (forty or older) participants (p=1 for both anterior and posterior CW), without statistically significant differences. Fetal PCA was observed in 24.1% of participants, with the unilateral type being more common (61.5%), and there was no correlation with the participants' gender. Conclusions: This study identified common anatomical variations in the Circle of Willis using cerebral CTA. Type A anterior CW and Type E posterior CW were most prevalent, with no significant differences in completeness based on gender or age. Fetal PCA was observed in 24.1% of participants, primarily in the unilateral form, without gender correlation. These findings highlight the importance of recognizing anatomical variations in the Circle of Willis for improved clinical decision-making and diagnostic accuracy in neurovascular assessments.

Spatial prior-guided UNet for automatic segmentation of carotid artery CT

2025-06-23

Yuting Guo , Xiaotian Yan , Jinghao Li +6 more | Biomedical Signal Processing and Control

Subclavian Steal Syndrome Unmasked by Large-Vessel Occlusion Stroke: A Case of Persistent Trigeminal Artery

2025-06-23

Joana Moniz Dionísio , Susana Blanco , Isabel Fragata +2 more | Stroke

Mapping cortical Alberta Stroke Program Early CT Score (ASPECTS) regions to functional brain networks

2025-06-23

Benedikt Sundermann , Christian Mathys

Abstract This atlas-based network correspondence analysis assessed how ASPECTS regions routinely assessed in clinical acute stroke imaging are related to functional brain networks. Cortical ASPECTS regions exhibit patterns of predominant … Abstract This atlas-based network correspondence analysis assessed how ASPECTS regions routinely assessed in clinical acute stroke imaging are related to functional brain networks. Cortical ASPECTS regions exhibit patterns of predominant overlap with functional brain networks, albeit with limited correspondence of ASPECTS region boundaries and network boundaries. Examples are associations of the left M1 mainly with the language and fronto-parietal cognitive control networks and the M2 regions with an auditory network.

PERFIL EPIDEMIOLÓGICO DOS CASOS DE INTERNAMENTOS POR ACIDENTE VASCULAR CEREBRAL NO BRASIL NO PERÍODO DE 2014 A 2024

2025-06-23

Idevânia G. Costa , Karen Luise Santana , Luka Guimarães Ribeiro +5 more | Revista fisio&terapia.

O Acidente Vascular Cerebral (AVC) é definido pela Organização Mundial da Saúde (OMS) como “sinais clínicos de desenvolvimento rápido de distúrbio focal (às vezes global) da função cerebral com duração … O Acidente Vascular Cerebral (AVC) é definido pela Organização Mundial da Saúde (OMS) como “sinais clínicos de desenvolvimento rápido de distúrbio focal (às vezes global) da função cerebral com duração superior a 24 horas ou levando à morte sem outra causa aparente além da de origem vascular”. A etiologia do AVC é diversa e os fatores predisponentes incluem fatores não modificáveis, como idade e sexo, e fatores modificáveis como hipertensão, diabetes mellitus, colesterol elevado, doenças cardiovasculares, sedentarismo, fibrilação atrial, tabagismo e consumo de álcool. Metodologia: Estudo epidemiológico descritivo e transversal, com abordagem quantitativa e comparativa, a partir da coleta de dados de 2014 a 2024 do Sistema de Informação de Morbidade Hospitalar (SIH/SUS) disponível no site do Departamento de Informática do Sistema Único de Saúde (DATASUS). Sendo analisadas as seguintes variáveis: regiões do Brasil, sexo, cor/raça, faixa etária, regime público ou privado e caráter eletivo ou de urgência, e aplicando a estatística descritiva para análise dos dados. Resultados e Discussão: Foram identificados 1.784.295 casos de internação por AVC nos últimos 10 anos. Além disso, foi possível observar que a região com maior quantidade de registros foi o Sudeste, seguida pelo Nordeste. A análise epidemiológica demonstra que o perfil mais afetado é o sexo masculino (52,31%), pardos (39,61%) e com maiores índices entre 70-79 anos. Quanto às características de atendimento 96,88% ocorreram no caráter de urgência e somente 3,11% eletivo. Conclusão: Foi possível analisar o perfil epidemiológico dos internamentos por AVC no Brasil entre 2014 e 2024. É notório que, os índices de internamentos ao longo da última década se apresentaram de uma forma muito importante, por isso fica evidente a necessidade de investimentos em campanhas de conscientização sobre fatores de risco, incentivo à prática de exercícios físicos e controle de doenças crônicas, buscando reverter a epidemiologia do quadro.

Staged carotid artery stenting for nilotinib-induced cervical internal carotid artery stenosis: illustrative case.

2025-06-23

Kakeru Kushino , Tomoya Kamide , Takashi Muranaka +6 more | PubMed

Nilotinib is known to cause vascular adverse events. No case of staged carotid artery stenting (CAS) for cervical internal carotid artery (ICA) stenosis by nilotinib has been reported. This report … Nilotinib is known to cause vascular adverse events. No case of staged carotid artery stenting (CAS) for cervical internal carotid artery (ICA) stenosis by nilotinib has been reported. This report describes a case of staged CAS for nilotinib-induced cervical ICA stenosis. A 67-year-old man who had been receiving nilotinib for 13 years for chronic myelogenous leukemia (CML) and had undergone stent placement for arteriosclerosis obliterans 10 years after starting nilotinib treatment developed transient right hemiparesis. MRI and MR angiography showed disseminated high-intensity areas in the left hemisphere and severe stenosis of the left cervical ICA. Single-photon emission CT revealed severe steal phenomenon in the left hemisphere. Therefore, a staged CAS was performed. He made good progress to recovery and was discharged a week after the endovascular surgery. An increasing number of patients are being treated with nilotinib because of its effectiveness in treating CML. Therefore, clinicians should recognize that patients treated with nilotinib may develop adverse vascular events, including those affecting the cervical and intracranial arteries. https://thejns.org/doi/10.3171/CASE25153.

7T MRI in the evaluation of ischemic stroke: a systematic review

2025-06-23

Felix T. Kurz , Daniela Dumitriu La Grange , Daniele Botta +6 more | Frontiers in Neuroscience

Introduction 7T magnetic resonance imaging (MRI) has advanced in managing neurological and neurovascular diseases. With improved spatial resolution and signal-to-noise ratio, 7T MRI enhances spatial and functional imaging, benefiting ischemic … Introduction 7T magnetic resonance imaging (MRI) has advanced in managing neurological and neurovascular diseases. With improved spatial resolution and signal-to-noise ratio, 7T MRI enhances spatial and functional imaging, benefiting ischemic stroke diagnosis, monitoring, and treatment planning. Methods To highlight the advances made with ultra-high field MRI in the evaluation of ischemic stroke patients, a systematic review was conducted on the MEDLINE and Web of Science databases using PRISMA guidelines to find peer-reviewed articles from January 1, 1992, to September 1st, 2024. Search terms included “ischemic stroke,” “7T,” “ultra-high field,” “vessel,” “angiography,” and “MRI.” Studies on 7T MRI in adult ischemic stroke patients were included; exclusions were non-human, post-mortem, or pediatric studies. Results We identified 16 studies on the use of 7T MRI for prolonged periods after stroke symptom onset, highlighting its higher spatial resolution for depicting ischemic lesions and vascular imaging. Vessel wall imaging (VWI) at 7T was effective for assessing vascular alterations post-thrombectomy and evaluating atherosclerotic lesions, with notable applications in identifying culprit plaques and studying glutamate metabolism changes. Conclusion 7T MRI advancements open new perspectives for clinical applications and research, particularly in evaluating the impact of thrombectomy strategies and developing treatments to prevent stroke recurrence. Continued research and protocol validation are essential for integrating 7T MRI into routine practice, improving management of neurological and neurovascular diseases.

Recent Advances in Stroke Surgery

2025-06-23

Johanna M. Ospel , Giuseppe Lanzino | Stroke

Resolution of Carotid Artery Stenosis: A 7-Year Ultrasonographic Observation

2025-06-23

Sumito Sato , Ryosuke Sato , Shigeki Muto | Stroke

July 2025 <i>Stroke</i> Highlights

2025-06-23

José R. Romero | Stroke

Cognitive impairment and quality of life in patients with carotid artery stenosis pre-revascularization: a scoping review

2025-06-22

Mohammad M. Alnaeem | Neurological Research

Carotid artery stenosis (CAS) reduces cerebral blood flow and is frequently associated with cognitive impairment and reduced quality of life (QoL), particularly in severe CAS. Although carotid revascularization (stenting or … Carotid artery stenosis (CAS) reduces cerebral blood flow and is frequently associated with cognitive impairment and reduced quality of life (QoL), particularly in severe CAS. Although carotid revascularization (stenting or endarterectomy) can improve blood flow and potentially enhance cognitive function and QoL, the impact of CAS before revascularization remains unclear. This review aimed to synthesize the literature exploring the relationship between CAS, cognitive impairment, and QoL, focusing on pre-revascularization outcomes. A comprehensive scoping review was conducted using PubMed, CINAHL, MEDLINE, EMBASE, PsycINFO, EBSCO, and Scopus to identify relevant studies published between 2015 and 2023. This review identified consistent evidence linking severe CAS (≥70%) to significant cognitive decline, particularly in areas such as memory, attention, and executive function. Although carotid revascularization showed promise in improving cognitive performance, the extent of recovery varied. Studies also highlighted the profound impact of CAS on QoL, with patients frequently experiencing anxiety, depression, and physical limitations. While revascularization procedures were associated with improvements in physical functioning and overall well-being, emotional recovery often delayed. CAS substantially affects both cognitive functioning and QoL, even before revascularization. Although some studies suggested that revascularization may lead to improvements in cerebral perfusion and certain domains of cognitive function, the trajectory of psychosocial and emotional recovery; including depressive symptoms, anxiety, and fear of future cerebrovascular events, demonstrates delayed improvement. These emotional outcomes mediate overall QoL and should be a focus of both clinical assessment and future longitudinal studies. Standardization of cognitive and psychosocial outcome measures is essential.

Carotid Artery Stenosis as a Risk Factor for Crescendo Transient Ischemic Attack: Case Report

2025-06-22

Carissa Maharani Amry , Yudhisman Imran , Mulia Rahmansyah +2 more | Majalah Kedokteran Neurosains Perhimpunan Dokter Spesialis Saraf Indonesia

Latar Belakang Transient Ischemic Attack (TIA) merupakan prediktor terjadinya stroke iskemik. TIA yang frekuensi, durasi, dan tingkat keparahannya meningkat disebut dengan Crescendo Transient Ischemic Attack (cTIA). Pada cTIA memiliki berbagai … Latar Belakang Transient Ischemic Attack (TIA) merupakan prediktor terjadinya stroke iskemik. TIA yang frekuensi, durasi, dan tingkat keparahannya meningkat disebut dengan Crescendo Transient Ischemic Attack (cTIA). Pada cTIA memiliki berbagai faktor risiko yang salah satunya adalah stenosis pada arteri karotis. Deskripsi Kasus Laki-laki usia 49 tahun datang ke Instalasi Gawat Darurat (IGD) RS atas rujukan dari RS sebelumnya dengan keluhan kelemahan tubuh sisi kiri mendadak pada 3 hari yang lalu. Keluhan kelemahan tubuh sisi kiri dirasakan hilang timbul. Awalnya pasien tiba-tiba mengalami kelemahan tubuh sisi kiri 5 hari sebelum masuk rumah sakit pada pukul 14.00 WIB kemudian keluhan tersebut membaik seperti semula. Malam hari nya pada pukul 20.00 WIB pasien kembali mengalami kelemahan tubuh sisi kiri mendadak kemudian membaik menjadi normal. Empat hari sebelum masuk rumah sakit pada pukul 12.00 WIB pasien kembali mengalami kelemahan tubuh sisi kiri dan bicara pelo kemudian keluhan tersebut membaik. Sebelum dirujuk, pasien telah dilakukan pemeriksaan CT scan kepala tanpa kontras dengan hasil tidak tampak perdarahan. Pemeriksaan fisik neurologis dalam batas normal. Pasien dirawat inap dan diberikan terapi berupa dual antiplatelet therapy (Aspilet dan Clopidogrel), Ranitidin, Citicolin, Mecobalamin, dan Atorvastatin. Pasien pulang pada hari ke dua dan tidak ada defisit neurologis selama perawatan. Pasien kontrol ke poli saraf, direncanakan untuk dilakukan pemeriksaan CT angiografi Carotis, dan didapatkan hasil moderate stenosis (50 – 69% stenosis NASCET Scale) a. carotis interna dekstra dan mild stenosis (< 50% stenosis NASCET scale) a. carotis interna sinistra. Kesimpulan Crescendo Transient Ischemic Attack (cTIA) merupakan penanda terjadinya stroke iskemik sehingga membutuhkan rawat inap. Pada cTIA perlu dilakukan pemeriksaan penunjang Computed tomography angiography (CTA) yang memiliki sensitivitas tinggi untuk mendeteksi stenosis dan oklusi intrakranial yang merupakan faktor risiko TIA berulang. Pada pasien TIA risiko tinggi, DAPT (aspirin dan clopidogrel) harus dimulai lebih awal untuk mengurangi risiko stroke iskemik berulang. Kata kunci: Transient Ischemic Attack, Crescendo Transient Ischemic Attack (cTIA), Computed tomography angiography

Artificial Intelligence in the Diagnostic Use of Transcranial Doppler and Sonography: A Scoping Review of Current Applications and Future Directions

2025-06-21

Giuseppe Miceli , Maria Grazia Basso , Elena Cocciola +1 more | Bioengineering

Artificial intelligence (AI) is revolutionizing the field of medical imaging, offering unprecedented capabilities in data analysis, image interpretation, and decision support. Transcranial Doppler (TCD) and Transcranial Color-Coded Doppler (TCCD) are … Artificial intelligence (AI) is revolutionizing the field of medical imaging, offering unprecedented capabilities in data analysis, image interpretation, and decision support. Transcranial Doppler (TCD) and Transcranial Color-Coded Doppler (TCCD) are widely used, non-invasive modalities for evaluating cerebral hemodynamics in acute and chronic conditions. Yet, their reliance on operator expertise and subjective interpretation limits their full potential. AI, particularly machine learning and deep learning algorithms, has emerged as a transformative tool to address these challenges by automating image acquisition, optimizing signal quality, and enhancing diagnostic accuracy. Key applications reviewed include the automated identification of cerebrovascular abnormalities such as vasospasm and embolus detection in TCD, AI-guided workflow optimization, and real-time feedback in general ultrasound imaging. Despite promising advances, significant challenges remain, including data standardization, algorithm interpretability, and the integration of these tools into clinical practice. Developing robust, generalizable AI models and integrating multimodal imaging data promise to enhance diagnostic and prognostic capabilities in TCD and ultrasound. By bridging the gap between technological innovation and clinical utility, AI has the potential to reshape the landscape of neurovascular and diagnostic imaging, driving advancements in personalized medicine and improving patient outcomes. This review highlights the critical role of interdisciplinary collaboration in achieving these goals, exploring the current applications and future directions of AI in TCD and TCCD imaging. This review included 41 studies on the application of artificial intelligence (AI) in neurosonology in the diagnosis and monitoring of vascular and parenchymal brain pathologies. Machine learning, deep learning, and convolutional neural network algorithms have been effectively utilized in the analysis of TCD and TCCD data for several conditions. Conversely, the application of artificial intelligence techniques in transcranial sonography for the assessment of parenchymal brain disorders, such as dementia and space-occupying lesions, remains largely unexplored. Nonetheless, this area holds significant potential for future research and clinical innovation.

A Systematic Review and Meta-Analysis of Outcome After Repeat Revascularization for Primary Carotid Artery Restenosis

2025-06-21

Menno Kok , Franziska Röder , Reinoud P.H. Bokkers +3 more | Journal of Endovascular Therapy

Objective: Carotid artery restenosis can occur after both carotid artery stenting (CAS) and carotid endarterectomy (CEA). This systematic review and meta-analysis aim to determine which revascularization technique, CAS, or CEA, … Objective: Carotid artery restenosis can occur after both carotid artery stenting (CAS) and carotid endarterectomy (CEA). This systematic review and meta-analysis aim to determine which revascularization technique, CAS, or CEA, is superior for treating primary carotid restenosis, irrespective of the initial revascularization method used. Design: Systematic review and meta-analysis. Methods: MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRALs) databases were searched for eligible studies on December 19th, 2023. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed. Primary endpoint was the occurrence of transient ischemic attack (TIA) or any stroke. Secondary endpoints were technical success, death within 30 days, myocardial infarction (MI), local complications, cerebral hyperperfusion syndrome (CHS), cranial nerve injury (CNI), dys-/arrythmia, secondary restenosis, repeat revascularization, and long-term survival. Results were adjusted for symptomatic status and primary treatment strategy. Results: Nineteen studies comprising 10,171 procedures in 10,041 patients were included. Baseline characteristics were comparable between groups. Main findings were (1) No difference in primary outcome; however, if adjusted for symptomatic status the rate of TIA/any stroke is higher (OR: 2.05, 95% CI: 1.29–3.27, p < 0.01) after CEA compared to CAS; (2) Significant higher rate of MI (OR: 1.85, 95% CI: 1.19–2.86, p < 0.01) after CEA; (3) Besides CNI, which appears to be commonly temporary and occurred only after CEA (7.56%, 95% CI: 4.21%–13.22%), no significant differences in other secondary endpoints were observed between groups. Long-term risk of secondary restenosis was similar between CEA compared to CAS (OR: 0.98, 95% CI: 0.39–2.49, p = 0.95); (4) Correction for the index procedure did not affect conclusions. Conclusion: Based on limited-quality studies, mostly retrospective and nonrandomized in design, both CAS and CEA represent feasible treatment approaches for patients with primary restenosis, with comparable primary outcome between the two groups. However, based on the obtained results, CAS appears to be preferable. Patients should be critically evaluated in a multidisciplinary team and further research is desirable. Clinical Impact This review expands on previous studies by incorporating a larger patient cohort and more recent literature while offering new insights into restenosis. Unlike earlier research, this study uniquely evaluates first repeat revascularization outcomes (CAS and CEA) independently of the initial procedure, suggesting that patient and plaque characteristics might be more influential than the primary technique. Sensitivity analysis confirmed this, as stratification by index procedure did not alter conclusions. Although lower TIA/stroke and mortality rates were observed in CAS-treated patients, these findings were not statistically significant in the overall group. These results may help guide clinical decision-making for optimal restenosis management.

Clinical Risk Factors for Stroke and Associations With Microembolic Signals on Transcranial Doppler

2025-06-20

Abdullah A. Adil , Carol Mitchell , Thomas D. Cook +5 more | Journal for Vascular Ultrasound

Introduction: Transcranial Doppler (TCD) has been used to identify microembolic signals (MES) in individuals with carotid atherosclerosis (CAS). The MES are hypothesized to originate from unstable carotid plaque and have … Introduction: Transcranial Doppler (TCD) has been used to identify microembolic signals (MES) in individuals with carotid atherosclerosis (CAS). The MES are hypothesized to originate from unstable carotid plaque and have been identified in symptomatic and asymptomatic individuals with CAS. The purpose of this study is to examine the relationship of clinical risk factors for stroke (CRFs) and the presence of MES in patients with advanced CAS. Methods: Participants scheduled for carotid endarterectomy (CEA) (>60% stenosis NASCET and ACAS Criteria) were preoperatively evaluated for CRFs and the presence of MES with TCD. Kendall tau correlation coefficients, Pearson χ 2 , and logistic regression analysis were used to examine the relationship between MES and CRFs. Results: Participants (n = 89) had a median (interquartile range) age of 71 (13) years, 30 (33.7%) were female, and 53 (59.6%) were symptomatic. Microembolic signals were detected in 32 (36%) participants. There was significant evidence of association between MES with older age ( P = .026) and male sex ( P = .007). No other clinical variables showed significant association with MES (all P -values > .05). Logistic regression demonstrated that a model including age ( P = .018), sex ( P = .013) and hyperlipidemia ( P = .083) was significantly associated with the presence of MES ( P = .001). Conclusion: Microembolic signals were associated with older age and male sex in a cohort with advanced carotid atherosclerosis. Symptomatic status was not a predictor for MES in this cohort, suggesting that plaques in both symptomatic and asymptomatic individuals have the ability to release microemboli, highlighting the need for further work to be done to identify unstable plaques.

A commentary on “Anatomical predispositions for silent cerebral infarction postcarotid artery stenting: a retrospective cohort”

2025-06-20

Chunfang Li , Ming Qi | International Journal of Surgery

Outcomes Of Carotid Artery Stenting Without Embolic Protection in Yemen: A Resource Constrained Experience

2025-06-20

Aussan Al-Athwari

Abstract BACKGROUND Carotid Artery stenting (CAS) have been reported to be safe and effective option for treating carotid atherosclerotic diseases. The published data support the use of embolic protection devices … Abstract BACKGROUND Carotid Artery stenting (CAS) have been reported to be safe and effective option for treating carotid atherosclerotic diseases. The published data support the use of embolic protection devices (EPDs) to reduce periprocedural stroke. However, reports and studies from resource limited countries are scarce. This study aimed to evaluate the outcome of CAS procedures without EPDs in Yemen as one of the lowest-income countries. METHODS This is a retrospective cohort study regarding carotid artery stenting (CAS) for symptomatic carotid artery stenosis that was conducted at the stroke center of and American Modern Hospital (AMH) during the period from March 2023 to March 2025. All Patients with symptomatic carotid artery stenosis were included in the study. CAS procedures were performed by a single interventional neurologist. The primary outcome included a 30-day periprocedural mortality, stroke, and myocardial infarction or arrythmia. Any other complications are considered secondary outcomes. RESULTS A total of 62 (53 males) patients included in this study, mean age 60.2 ± 9.68 years. All Patients had symptomatic carotid artery stenosis. Technical success rate was 100%. (%). One patient developed transient dysarthria but DW-MRI was negative. Significant bradycardia occurred in two patients and responded immediately to atropine. Three patients developed mild local hematoma and one patient had femoral pseudoaneurysm. Closed-Cell Carotid Wall Stent (Boston Scientific) was used as a single stent in all patients. CONCLUSION CAS conducted by a trained interventional neurologist without EPDs, demonstrates a low complication rate and it is effective and safe option in countries with-limited resources.

Intraplaque Hemorrhage Volume and Ischemic Stroke Risk

2025-06-20

Shahriar Faghani , Bradley J. Erickson , Erik Albach +6 more | American Journal of Neuroradiology

Intraplaque hemorrhage (IPH) in carotid atherosclerotic plaques is the best-established biomarker of plaque vulnerability. However, the relationship between IPH volume and ischemic neurologic symptoms remains scarcely studied. This study explored … Intraplaque hemorrhage (IPH) in carotid atherosclerotic plaques is the best-established biomarker of plaque vulnerability. However, the relationship between IPH volume and ischemic neurologic symptoms remains scarcely studied. This study explored the association between carotid IPH volume and ischemic event severity. A retrospective analysis was conducted on consecutive patients with suspected carotid atherosclerosis, evaluated from December 2015 to January 2021. Patients underwent carotid plaque MRI using T1-weighted imaging with fat suppression for IPH detection. Included patients had documented neurological symptoms, classified as amaurosis fugax (AF), TIA, and/or stroke. MRI scans were reviewed for presence and volume of IPH, with semi-automated software used for volumetric segmentation. Statistical analyses, including Mann-Whitney U tests and Receiver Operating Characteristic (ROC) curves, were performed to evaluate IPH volume thresholds and their association with symptom severity. The study included 358 patients, of whom 120 had IPH-positive carotid plaques. A higher incidence of ischemic events was noted on the left side, with 28 strokes, 6 AF, and 12 TIAs observed in left-sided events, and 19 strokes, 1 AF, and 3 TIAs in right-sided events. No significant differences in IPH volumes were found across symptom categories or event laterality. ROC analysis identified IPH volume thresholds with AUC values of 0.579 (0.396, 0.748) for left-sided events and 0.618 (0.333, 0.910) for right-sided events, indicating limited discriminatory power for predicting ischemic event severity. While carotid IPH volume is detectable across various neurological symptom categories, our findings indicate that IPH volume alone does not significantly correlate with ischemic event severity. Threshold IPH volumes showed low diagnostic accuracy, suggesting that other plaque characteristics and systemic factors may be more relevant in determining ischemic stroke risk. IPH＝Intraplaque hemorrhage; AF＝Amaurosis fugax; ROC＝Receiver Operating Characteristic.

Postpartum Vertebral Artery Occlusion and Stenosis Following Cesarean Section

2025-06-20

Hatice S Ercin , Suzan Özer | Cureus

Carotid plaque segmentation and classification using MRI-based plaque texture analysis and convolutional neural network

2025-06-20

Zakarya Hasan Ahmed Abu Alregal , Gehad Abdullah Amran , Ali A. AL-Bakhrani +5 more | Frontiers in Medicine

Background Accurate segmentation and classification of carotid plaques are critical for assessing stroke risk. However, conventional methods are hindered by manual intervention, inter-observer variability, and poor generalizability across heterogeneous datasets, … Background Accurate segmentation and classification of carotid plaques are critical for assessing stroke risk. However, conventional methods are hindered by manual intervention, inter-observer variability, and poor generalizability across heterogeneous datasets, limiting their clinical utility. Methods We propose a hybrid deep learning framework integrating Mask R-CNN for automated plaque segmentation with a dual-path classification pipeline. A dataset of 610 expert-annotated MRI scans from Xiangya Hospital was processed using Plaque Texture Analysis Software (PTAS) for ground truth labels. Mask R-CNN was fine-tuned with multi-task loss to address class imbalance, while a custom 13-layer CNN and Inception V3 were employed for classification, leveraging handcrafted texture features and deep hierarchical patterns. The custom CNN was evaluated via K10 cross-validation, and model performance was quantified using Dice Similarity Coefficient (DSC), Intersection over Union (IoU), accuracy, and ROC-AUC. Results The Mask R-CNN achieved a mean DSC/IoU of 0.34, demonstrating robust segmentation despite anatomical complexity. The custom CNN attained 86.17% classification accuracy and an ROC-AUC of 0.86 ( p = 0.0001), outperforming Inception V3 (84.21% accuracy). Both models significantly surpassed conventional methods in plaque characterization, with the custom CNN showing superior discriminative power for high-risk plaques. Conclusion This study establishes a fully automated, hybrid framework that synergizes segmentation and classification to advance stroke risk stratification. By reducing manual dependency and inter-observer variability, our approach enhances reproducibility and generalizability across diverse clinical datasets. The statistically significant ROC-AUC and high accuracy underscore its potential as an AI-driven diagnostic tool, paving the way for standardized, data-driven cerebrovascular disease management.

Medical Therapy Is as Effective as Revascularization for Some With Symptomatic Carotid Artery Stenosis, Study Finds

2025-06-19

Thomas Collins | Neurology Today

Reentry Technique for Rescue Recanalization of Carotid Near-Total Occlusion after Subintimal Penetration.

2025-06-19

Dang-Khoi Tran , Hang Thuy Nguyen , Chih‐Wei Huang +2 more | PubMed

Carotid stent placement is an effective alternative for stroke prevention in patients with carotid stenosis. However, endovascular recanalization of near-total carotid occlusion remains challenging, with subintimal dissection sometimes unavoidable. We … Carotid stent placement is an effective alternative for stroke prevention in patients with carotid stenosis. However, endovascular recanalization of near-total carotid occlusion remains challenging, with subintimal dissection sometimes unavoidable. We present the case of an adult in their 70s with symptomatic carotid stenosis. During plaque crossing with a microwire, unintentional subintimal dissection occurred. The reentry technique, using a specialized reentry catheter, was performed, followed by carotid stent placement, achieving successful recanalization. The patient made a good clinical recovery. In selected cases, subintimal recanalization of carotid occlusion using the rescue re-entry technique can be performed safely after entry into the false lumen.1-5.

Partially thrombosed internal carotid artery: A diagnostic dilemma

2025-06-19

Sachin Khanduri , Avani Kanojia , Archiya Habib +3 more | Indian Journal of Case Reports

Acute or chronic thrombosis of the internal carotid artery (ICA) is a rare but life-threatening condition that can result in ischemic stroke, transient ischemic attacks (TIAs), or significant neurological deficits. … Acute or chronic thrombosis of the internal carotid artery (ICA) is a rare but life-threatening condition that can result in ischemic stroke, transient ischemic attacks (TIAs), or significant neurological deficits. The ICA is a major blood vessel supplying oxygenated blood to the brain, and its occlusion can lead to devastating consequences, including cerebral infarction, hemodynamic insufficiency, and embolic complications. Acute thrombosis occurs suddenly, often due to embolism, arterial dissection, or hypercoagulable states, leading to abrupt-onset neurological symptoms such as hemiparesis, hemianesthesia, aphasia, or visual disturbances. It requires urgent intervention, including thrombolysis or mechanical thrombectomy. Chronic thrombosis develops over time, typically secondary to atherosclerosis or vessel narrowing, allowing collateral circulation to compensate. Patients may remain asymptomatic or experience gradual cognitive decline, TIAs, or progressive stroke-like symptoms.

Automated machine learning for predicting perioperative ischemia stroke in endovascularly treated ruptured intracranial aneurysm patients

2025-06-19

Yuhang Peng , Ke Bi , Xiaolin Zhang +7 more | Frontiers in Neurology

Objective This study aims to develop and validate an automated machine learning model to predict perioperative ischemic stroke (PIS) risk in endovascularly treated patients with ruptured intracranial aneurysms (RIAs), with … Objective This study aims to develop and validate an automated machine learning model to predict perioperative ischemic stroke (PIS) risk in endovascularly treated patients with ruptured intracranial aneurysms (RIAs), with the goal of establishing a clinical decision-support tool. Methods In this retrospective cohort study, we analyzed RIA patients undergoing endovascular treatment at our neurosurgical center (December 2013–February 2024). The least absolute shrinkage and selection operator (LASSO) method was used to screen essential features associated with PIS. Based on these features, nine machine learning models were constructed using a training set (75% of participants) and assessed on a test set (25% of participants). Through comparative analysis, using metrics such as area under the receiver operating characteristic curve (ROCAUC) and Brier score, we identified the optimal model—random forest (RF)—for predicting PIS. To interpret the RF models, we utilized the Shapley Additive exPlanations (SHAP). Results The final cohort comprised 647 consecutive RIA patients who underwent endovascular intervention. LASSO regression identified 13 clinically actionable predictors of PIS from the initial variables. These predictors encompassed: vascular risk factors (hyperlipidemia, arteriosclerosis); neuroimaging indicators of severity (modified Fisher scale, aneurysm location, and neck-to-diameter ratio); clinical status (Glasgow Coma Scale score, Hunt-Hess grade, age, sex); procedural complications (intraprocedural rupture, periprocedural re-rupture); and therapeutic determinants (therapy method and history of ischemic comorbidities). Nine machine learning algorithms were evaluated using stratified 10-fold cross-validation. Among them, the RF model demonstrated the best performance, with the ROCAUC of 92.11% (95%CI: 89.74–94.48%) on the test set and 87.08% (95%CI: 81.23–92.93%) on the training set. Finally, in a prospective validation cohort, the RF predictive model demonstrated an accuracy of 88.23% in forecasting the incidence of PIS. Additionally, based on this predictive model, this study developed a highly convenient web-based calculator. Clinicians only need to input the patient’s key factors into this calculator to predict the postoperative incidence of PIS and provide individualized treatment plans for the patient. Conclusion We successfully developed and validated an interpretable machine learning framework, integrated with a clinical decision-support system, for predicting postprocedural PIS in endovascularly treated RIAs patients. This tool effectively predicted the likelihood of PIS, enabling high-risk patients to promptly take specific preventive and therapeutic measures.

Revascularization surgical options after carotid trauma: Case report from a cerebrovascular blood flow preservation overview

2025-06-19

Javier Degollado-García , Carlos Fernando Nicolás-Cruz , Diana Marmolejo-Moreno +1 more | Journal of Cerebrovascular and Endovascular Neurosurgery

An 18-year-old male underwent a tracheostomy that was complicated by an iatrogenic left-sided common carotid artery laceration, leading to loss of blood flow and a minor stroke in the anterior … An 18-year-old male underwent a tracheostomy that was complicated by an iatrogenic left-sided common carotid artery laceration, leading to loss of blood flow and a minor stroke in the anterior and medial territories of the left cerebral circulation. After the lesion was identified, carotid exploration was performed, followed by a vascular reconstruction using a synthetic graft to repair the damaged segment. This manuscript details the microsurgical techniques utilized and discusses the indications for this intervention, with a particular emphasis on stroke prevention.

Comparing Stenting with Medical Therapy Versus Medical Therapy Alone in Patients with Intracranial Atherosclerotic Stenosis: A Current Systematic Review and Meta-Analysis

2025-06-19

Kusai Aziz , Hussam Alhathlol , F. Aziz +5 more | Clinics and Practice

Background: Intracranial atherosclerotic stenosis (ICAS) is a significant cause of ischemic stroke worldwide, with high recurrence rates despite optimal medical therapy. While endovascular stenting has been proposed as an adjunctive … Background: Intracranial atherosclerotic stenosis (ICAS) is a significant cause of ischemic stroke worldwide, with high recurrence rates despite optimal medical therapy. While endovascular stenting has been proposed as an adjunctive treatment, its clinical benefit remains controversial as a first line therapy. Objective: To evaluate the efficacy and safety of stenting plus medical therapy (STN+MT) compared to medical therapy alone (MT) in patients with symptomatic ICAS through a systematic review and meta-analysis of randomized controlled trials (RCTs). Methods: We systematically searched PubMed, Web of Science, the Cochrane Library, Embase, Scopus, and EBSCO for RCTs comparing STN+MT with MT in adult patients with symptomatic ICAS. Primary outcomes included transient ischemic attack (TIA), stroke, intracerebral hemorrhage (ICH), and death at 30 days and 1 year. Pooled risk ratios with 95% confidence intervals were calculated using random-effects or fixed-effects models as appropriate. Meta-regression was conducted to assess effect modification by study-level characteristics. Results: Four trials comprising 990 patients were included. STN+MT was associated with significantly higher 30-day risk of stroke and ICH compared to MT alone. No significant differences in TIA, stroke, ICH, or death were found at 1 year. Meta-regression revealed no significant effect modifiers, suggesting consistent findings across subgroups. Conclusions: Our meta-analysis consolidates the evidence that intracranial stenting as a first line therapy offers no significant advantage over medical therapy in preventing stroke in symptomatic ICAS, while it does pose added early risks. This holds true across different trials, patient demographics, and clinical scenarios examined. The consistency of this message across multiple RCTs provides a high level of evidence to guide practice. At present, aggressive medical therapy alone should be the default management for most patients. Endovascular intervention should be reserved for clinical trial settings or carefully selected salvage cases, until and unless new evidence emerges to change the risk-benefit calculus such as the promising use of balloon angioplasty in the BASIS trial.

CT Perfusion for Predicting Ischemic Stroke in Patients With Symptomatic Carotid or Middle Cerebral Artery Occlusion: A Post Hoc Analysis of the CMOSS Study

2025-06-19

Tao Wang , Yifan Yang , Haibo Wang +7 more | Stroke

BACKGROUND: It is unknown whether computed tomographic perfusion (CTP) parameters predict ischemic stroke in patients with symptomatic chronic carotid or middle cerebral artery occlusion. METHODS: A post hoc analysis of … BACKGROUND: It is unknown whether computed tomographic perfusion (CTP) parameters predict ischemic stroke in patients with symptomatic chronic carotid or middle cerebral artery occlusion. METHODS: A post hoc analysis of medically treated patients enrolled in the CMOSS trial (Carotid or Middle Cerebral Artery Occlusion Surgery Study; REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01758614), a randomized controlled trial conducted at 13 centers in China between June 2013 and March 2018. It aimed to compare extracranial-intracranial bypass surgery to medical therapy in patients with symptomatic carotid or middle cerebral artery occlusion and hemodynamic insufficiency. CTP-derived mean transit time and relative cerebral blood flow were collected. The primary outcome was defined as ischemic stroke in the territory of the qualifying artery within 2 years after randomization. The predictive value of CTP for the primary outcome was analyzed by a Cox regression model. Receiver operating characteristic curves were used to calculate optimal cutoff values of CTP parameters. RESULTS: All 165 per-protocol patients (median age=53.7 years, 81.2% males) treated with medical treatment alone were analyzed. Sixteen (9.7%) patients suffered the primary outcome during the 2-year follow-up. Cutoff values of mean transit time >6.5 seconds (symptomatic side) and relative cerebral blood flow ≤0.5 were associated with recurrent stroke. In multivariate Cox regression, mean transit time (adjusted hazard ratio, 3.50 [95% CI, 1.19–10.30]; P =0.02) and relative cerebral blood flow (adjusted hazard ratio, 7.36 [95% CI, 2.27–23.85]; P =0.001) were independently associated with the primary outcome. CONCLUSIONS: CTP-based hemodynamic parameters are predictive of recurrent ischemic stroke in symptomatic patients with chronic carotid or middle cerebral artery occlusion. CTP could be used in patient selection for stratified secondary prevention of stroke in future studies. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01758614.

Quantitative plaque characteristics based on 3D high-resolution vessel wall imaging predict long-term recurrence in intracranial atherosclerotic stroke

2025-06-19

Ying Zhao , Jiajia Yang , Yao Dai +4 more | Neuroradiology

Arterial, Venous, and Cerebrospinal Fluid Flow and Pulsatility in Stroke-Related Cerebral Small Vessel Disease: A Longitudinal Analysis

2025-06-18

Alasdair G. Morgan , Michael J. Thrippleton , Michael Stringer +7 more | Stroke

BACKGROUND: Cerebral small vessel disease (SVD) causes up to 45% of dementias and 25% of ischemic strokes, but the understanding of vascular pathophysiology is limited. We aimed to investigate the … BACKGROUND: Cerebral small vessel disease (SVD) causes up to 45% of dementias and 25% of ischemic strokes, but the understanding of vascular pathophysiology is limited. We aimed to investigate the contribution of pulsatility of intracranial arteries, veins, and cerebrospinal fluid (CSF) and cerebral blood flow to long-term imaging and clinical outcomes in SVD. METHODS: We prospectively recruited participants in Edinburgh/Lothian, Scotland, with lacunar or nonlacunar ischemic stroke (modified Rankin Scale score ≤2, as controls) and assessed medical and brain magnetic resonance imaging characteristics at baseline and 1 year (2018–2022). We used phase-contrast magnetic resonance imaging to measure flow and pulsatility in major cerebral vessels and CSF to investigate independent associations with baseline white matter hyperintensity (WMH) and perivascular space (PVS) volumes and their progression, as well as with recurrent stroke, functional, and cognitive outcomes at 1 year. We applied linear, logistic, and ordinal regression models in our analysis. RESULTS: We recruited 210 participants; 205 (66.8% male; aged 66.4±11.1 years) had useable data. In covariate-adjusted analyses, higher baseline arterial pulsatility was associated with larger volumes of baseline WMH (B=0.26 [95% CI, 0.08–0.44]; P =0.01) and basal ganglia PVS (B=0.12 [95% CI, 0.04–0.20]; P <0.01) but not with their change at 1 year (WMH: B=0.01 [95% CI, −0.05 to 0.06]; P =0.78; basal ganglia PVS: B=0.02 [95% CI, −0.04 to −0.07]; P =0.62) or cognition, dependency, or recurrent stroke at 1 year. Neither cerebral blood flow nor CSF pulsatility was related to baseline SVD severity, WMH/PVS progression, or clinical outcomes at 1 year. CONCLUSIONS: Associations between vascular/CSF pulsatility, cerebral blood flow, WMH/PVS, and clinical SVD features are complex. The lack of association between intracranial arterial, venous, or CSF pulsatility, cerebral blood flow, and WMH or PVS longitudinal change in this large, covariate-adjusted analysis questions the presumption that high intracranial vascular pulsatility causes SVD and its progression, consistent with other recent longitudinal studies. Intracranial pulsatility may differ from systemic vascular measures in their cause-pathogenic role(s) in SVD and should be considered separately.

Echogenicity of carotid plaques as a predictor of regression following lipid-lowering therapy

2025-06-18

Chenghui Fan , Ying Hao , Lyu-Fan Chen +4 more | Thrombosis Journal

Atherosclerotic plaque regression under lipid-lowering therapy shows considerable individual variation, and the factors influencing this variability remain incompletely understood. This study aimed to investigate the relationship between carotid plaque echogenicity … Atherosclerotic plaque regression under lipid-lowering therapy shows considerable individual variation, and the factors influencing this variability remain incompletely understood. This study aimed to investigate the relationship between carotid plaque echogenicity and plaque regression in patients receiving lipid-lowering therapy, and to identify ultrasound characteristics that might predict plaque regression. A total of 838 patients with carotid plaques receiving lipid-lowering therapy were enrolled between July 2020 and May 2024 and followed up for 12 months. Carotid ultrasound was performed at baseline and follow-up to evaluate plaque characteristics. Plaque regression was defined as meeting any of the following criteria: (1) reduction in plaque area ≥ 5%, (2) decrease in plaque thickness ≥ 0.4 mm, or (3) reduction in plaque number, as assessed by vascular ultrasound imaging. Plaque echogenicity was classified into three types: hypoechoic, hyperechoic, and mixed echogenicity. Cox proportional hazards regression analysis was performed to assess the association between plaque echogenicity and plaque regression, adjusting for potential confounding factors. Hypoechoic plaques showed higher rates of regression (72.8%) compared to hyperechoic (37.7%) and mixed echogenicity plaques (50.0%) (p < 0.001). After adjusting for confounding variables, hypoechoic plaques exhibited greater odds of regression compared to hyperechoic plaques (adjusted HR = 4.52, 95% CI: 3.18-6.43, p < 0.001). Additionally, the median percentage reduction in plaque size was more pronounced in hypoechoic plaques, (15.2%, IQR: 7.7-22.3%) compared with other echogenicities (p < 0.001). Carotid plaque echogenicity is strongly associated with the likelihood plaque regression, with hypoechoic plaques exhibiting higher regression rates and greater reductions in plaque size. These findings may help guide personalized treatment strategies and improve risk assessment.

Serum High-Density Lipoprotein Levels and Risk of In-Stent Restenosis Following Carotid Artery Stenting: A Multivariate Analysis-Based Retrospective Cohort Study

2025-06-18

Yuting Tang , Long-Shen Dong , Feifan Sun +2 more | Research Square (Research Square)

<title>Abstract</title> <bold>Objective: </bold>To investigate the relationship between serum high-density lipoprotein (HDL) levels and the risk of in-stent restenosis (ISR) following carotid artery stenting (CAS), aiming to provide potential targets for … <title>Abstract</title> <bold>Objective: </bold>To investigate the relationship between serum high-density lipoprotein (HDL) levels and the risk of in-stent restenosis (ISR) following carotid artery stenting (CAS), aiming to provide potential targets for ISR prevention and treatment. <bold>Methods: </bold>A retrospective analysis was conducted on 132 patients who underwent CAS in the Department of Neurosurgery at Wenzhou Central Hospital between March 2019 and January 2024 and had 6-month (±1 month) follow-up data available. Patients were divided into ISR group (96 cases) and non-ISR group (36 cases) based on the occurrence of ISR. Demographic, clinical, and laboratory data were collected for both groups. Independent predictors of ISR were identified using t-test, Mann-Whitney U test, chi-square test, and logistic regression analysis. The predictive performance of the model was evaluated using ROC curve analysis. <bold>Results: </bold>Serum HDL levels were significantly lower in the ISR group than in the non-ISR group (p < 0.001). Univariate logistic regression analysis showed that male gender, smoking, hypertension, high BMI, and elevated serum globulin levels were positively associated with ISR risk (p < 0.05), while higher serum HDL levels were negatively associated with ISR risk (p < 0.05). Multivariate logistic regression analysis further confirmed that smoking, hypertension, and elevated serum globulin levels were independent risk factors for ISR (p < 0.05), while higher serum HDL levels were an independent protective factor for ISR (p < 0.05). ROC curve analysis indicated that the multivariable model had good predictive performance for ISR, with an AUC of 0.84. At the optimal cutoff point, the model demonstrated a sensitivity of 92% and a specificity of 75%. <bold>Conclusion: </bold>Serum high-density lipoprotein (HDL) plays a crucial protective role in the development of ISR. Monitoring and increasing serum HDL levels may help prevent ISR and improve patient prognosis.

Safety assessment of symptomatic intracranial atherosclerotic stenosis: a comparison between sole balloon angioplasty and medical treatment

2025-06-18

Wenfeng Cao , An Wen , Xian-min Cao +7 more | Frontiers in Neurology

Background Patients with symptomatic intracranial arterial stenosis (sICAS) are at risk of perioperative complications associated with stent placement and medication recurrence. Simple balloon angioplasty (SBA), a less invasive and safer … Background Patients with symptomatic intracranial arterial stenosis (sICAS) are at risk of perioperative complications associated with stent placement and medication recurrence. Simple balloon angioplasty (SBA), a less invasive and safer alternative to stent placement, is an effective alternative treatment for sICAS. Methods We conducted a retrospective analysis on patients with sICAS treated at the Jiangxi Provincial People’s Hospital between January 2020 and December 2023. Patients with severe stenosis (70–99%) were divided into the medical management (MM) and SBA groups. Demographics, medical histories, National Institutes of Health Stroke Scale (NIHSS) scores, vessel stenosis, postoperative residual stenosis, and 30-day outcomes were also assessed. Results This study enrolled 176 patients, including 95 (66 males, mean age 57.4 ± 1.07 years) and 81 (55 males, mean age 61.1 ± 0.94 years) in the MM and SBA groups, respectively. Patients in the SBA group were significantly older than those in the MM group ( p &lt; 0.05). No significant differences were observed in sex, comorbidities (hypertension, diabetes, hyperlipidemia, smoking/alcohol use, and prior stroke), or baseline NIHSS scores (all p &gt; 0.05). Pre-treatment stenosis rates were similar between groups: 80.90 ± 0.85% vs. 79.60 ± 1.01% ( p &gt; 0.05). One patient in the SBA group failed due to vessel tortuosity, while the remaining 80 procedures were successful. Of these, 15 patients (18.5%) required rescue stenting—11 because of elastic recoil and 4 because of flow-limiting dissection. The immediate residual stenosis rate was 24.68 ± 1.41%. Within 30 days, endpoint events occurred in four patients (4.2%) in the medical group (progressive infarction) and seven patients (8.6%) in the angioplasty group, including intracerebral and subarachnoid hemorrhage ( n = 2), perforator infarction ( n = 3), infarct progression ( n = 1), and cortical infarction ( n = 1). No deaths occurred in either group. The difference in the event rates was not statistically significant ( p &gt; 0.05). Subgroup analysis revealed that arterial dissection was significantly associated with postoperative endpoint events ( p &lt; 0.05), while occurrence was correlated with lesion length ( p &lt; 0.05), but not with the selected balloon size ( p &gt; 0.05). There was no significant difference in endpoint events between submaximal (&lt; 90% of normal vessel diameter) and aggressive (&gt; 90% of normal vessel diameter) angioplasties ( p &gt; 0.05). Conclusion Overall, this study suggests that SBA does not significantly increase the 30-day risk of stroke or death in patients with sICAS compared with medical therapy. Both submaximal and aggressive angioplasty are safe. Further research is warranted to refine patient selection, optimize balloon size, and develop strategies to minimize the need for rescue stenting and reduce the risk of arterial dissection.

Multimodal deep learning for predicting unsuccessful recanalization in refractory large vessel occlusion

2025-06-18

J. González , Pere Canals , Marc Rodrigo‐Gisbert +3 more | European Journal of Radiology

This study explores a multi-modal deep learning approach that integrates pre-intervention neuroimaging and clinical data to predict endovascular therapy (EVT) outcomes in acute ischemic stroke patients. To this end, consecutive … This study explores a multi-modal deep learning approach that integrates pre-intervention neuroimaging and clinical data to predict endovascular therapy (EVT) outcomes in acute ischemic stroke patients. To this end, consecutive stroke patients undergoing EVT were included in the study, including patients with suspected Intracranial Atherosclerosis-related Large Vessel Occlusion ICAD-LVO and other refractory occlusions. A retrospective, single-center cohort of patients with anterior circulation LVO who underwent EVT between 2017-2023 was analyzed. Refractory LVO (rLVO) defined class, comprised patients who presented any of the following: final angiographic stenosis > 50 %, unsuccessful recanalization (eTICI 0-2a) or required rescue treatments (angioplasty +/- stenting). Neuroimaging data included non-contrast CT and CTA volumes, automated vascular segmentation, and CT perfusion parameters. Clinical data included demographics, comorbidities and stroke severity. Imaging features were encoded using convolutional neural networks and fused with clinical data using a DAFT module. Data were split 80 % for training (with four-fold cross-validation) and 20 % for testing. Explainability methods were used to analyze the contribution of clinical variables and regions of interest in the images. The final sample comprised 599 patients; 481 for training the model (77, 16.0 % rLVO), and 118 for testing (16, 13.6 % rLVO). The best model predicting rLVO using just imaging achieved an AUC of 0.53 ± 0.02 and F1 of 0.19 ± 0.05 while the proposed multimodal model achieved an AUC of 0.70 ± 0.02 and F1 of 0.39 ± 0.02 in testing. Combining vascular segmentation, clinical variables, and imaging data improved prediction performance over single-source models. This approach offers an early alert to procedural complexity, potentially guiding more tailored, timely intervention strategies in the EVT workflow.

Hemodynamic changes and their relationship with white matter hyperintensities in CSVD patients with cognitive impairment: a 4D flow study

2025-06-18

Jiajun Cao , Yuan Chang , Zhenpeng Zhang +7 more | Frontiers in Aging Neuroscience

Objective To observe the hemodynamics of intracranial arteries and veins in patients with cerebral small vessel disease (CSVD) with cognitive impairment (CI), and to explore the association between these flow … Objective To observe the hemodynamics of intracranial arteries and veins in patients with cerebral small vessel disease (CSVD) with cognitive impairment (CI), and to explore the association between these flow features and white matter hyperintensities (WMH). Materials and methods A total of 53 patients with CSVD were included in the study, comprising 30 patients with CI (CI group) and 23 patients with non-CI (NCI group); Meanwhile, 25 age-matched cognitively healthy volunteers were recruited. WMH burden was evaluated using a 2D axial T2-FLAIR sequence. A 4D flow MRI was employed to measure intracranial hemodynamic features, including cross-sectional area, flow rate, blood flow velocity, wall shear stress (WSS), pulsatility index, and resistive index in the internal carotid artery (ICA), middle cerebral artery, basilar artery (BA), transverse sinus (TS), straight sinus (SS), and superior sagittal sinus (SSS). CSF-Q flow, a 2D PC MRI sequence, was performed to calculate the CSF fluid dynamics in the midbrain aqueduct. Results The CSVD with CI population reported a statistically significant decrease in flow rate, blood flow velocity, and WSS, as well as an increase in PI, RI, CSF flow quantity, and velocity compared to age-matched cognitively healthy control participants. There was a moderately positive correlation between MMSE, MoCA score and flow rate, flow velocity, and WSS ( r = 0.226–0.544, all P &lt; 0.05), and a moderately negative correlation between MMSE, MoCA score and PI, RI ( r = −0.230 to −0.406, all P &lt; 0.05). Multiple linear regression indicated that, the flow rate and mean velocity in venous sinuses (β = −0.472 to −0.381, all P &lt; 0.05) and the WSS in arterial segments (β = −0.771 to −0.441, all P &lt; 0.05) had independently negative association with WMH burden; Meanwhile, a significant positive relationship was found between PI in arterial segments and specific-distributed WMH (PVWMH and S-CC WMH) (β = 0.239 to 0.356, all P &lt; 0.05). Conclusion The intracranial hemodynamics were associated with CI and WMH in patients with CSVD. 4D flow MRI can be used as a non-invasive method to assess cerebrovascular hemodynamics and helps to identify patients who may benefit from interventions to improve the functions of the cerebral circulatory system and provides a potential new path for clinical treatment.

Elevated monocyte-to-high-density lipoprotein ratio is associated with increased risk of cognitive impairment and severe cerebral small vessel disease burden

2025-06-18

Yueshan Zhao , Meixi Li , J. Zhang +5 more | Frontiers in Aging Neuroscience

Background Monocyte-to-high-density lipoprotein ratio (MHR), as a novel biomarker, has shown potential in predicting the onset and progression of various diseases. However, the relationship between MHR and cerebral small vessel … Background Monocyte-to-high-density lipoprotein ratio (MHR), as a novel biomarker, has shown potential in predicting the onset and progression of various diseases. However, the relationship between MHR and cerebral small vessel disease (CSVD) as well as cognitive impairment (CI), which are inflammation-related conditions remains unclear. This research explores the relationship between MHR and total CSVD burden as well as CI. Methods This retrospective analysis included 212 eligible patients. On the basis of Mini-Mental State Examination (MMSE) scores, patients were classified into CI and no CI groups. Total CSVD burden was assessed using a composite score incorporating four MRI-based imaging markers. Participants were further stratified into mild and severe CSVD burden groups. MHR was determined by dividing the blood monocyte count by the high-density lipoprotein (HDL) concentration. Statistical analyses, including logistic regression, trend tests, restricted cubic spline modeling, and mediation analysis, were conducted using SPSS 26.0 and R software to explore the associations of MHR with CI, and CSVD burden. Results Non-parametric analysis revealed that patients with CI and those with severe CSVD burden exhibited significantly higher MHR levels ( p &lt; 0.05) compared to their respective counterparts. Multivariable logistic regression identified elevated MHR (OR = 1.462, 95%CI: 1.057–2.022, p = 0.022) and severe CSVD burden (OR = 2.456, 95%CI: 1.306–4.617, p = 0.005) as significant risk factors for CI. Additionally, higher MHR levels were independently associated with severe CSVD burden (OR = 1.596, 95%CI: 1.092–2.334, p = 0.016). Compared to the lowest MHR tertile, the highest tertile exhibited a remarkably higher risk of CI (OR = 3.743, 95%CI: 1.557–8.995; P trend = 0.010) and severe CSVD burden (OR = 2.594, 95%CI: 1.086–6.195; P trend = 0.019). Restricted cubic spline analysis confirmed a non-linear association between MHR and both CI and severe CSVD burden. Mediation analysis further demonstrated that CSVD burden significantly mediated the relationship between MHR and CI. Conclusion Elevated MHR is related to increased CSVD burden and CI. The mediating roles of severe CSVD burden indicates that a high MHR level may contribute to the progression of CSVD, thereby elevating the risk of CI.

Histological Analysis of Intracranial Cerebral Arteries for Elastin Thickness, Wall Thickness, and Vessel Diameters: An Atlas for Computational Modeling and a Proposed Predictive Multivariable Model of Elastin Thickness

2025-06-17

Nishanth Thiyagarajah , Alex M Witek , Mark A. Davison +7 more | Journal of Clinical Medicine

Background/Objectives: Fluid dynamic models of the cerebral vasculature are being developed to evaluate intracranial vascular pathology. Fluid-structure interaction modeling provides an opportunity for more accurate simulation of vascular pathology by … Background/Objectives: Fluid dynamic models of the cerebral vasculature are being developed to evaluate intracranial vascular pathology. Fluid-structure interaction modeling provides an opportunity for more accurate simulation of vascular pathology by modelling the vessel wall itself in conjunction with the fluid forces. Accuracy of these models is heavily dependent on the parameters used. Of those studied, elastin has been considered a key component used in aortic and common carotid artery modeling. We studied elastin thickness to determine if there was significant variation between cerebral artery territories to suggest its importance in cerebral blood vessel biomechanical response and provide reference data for modeling intracranial elastin. Elastin thickness was compared to vessel location, thickness, diameter, and laterality within human intracranial arteries. Methods: Tissue was taken from five human cadaveric heads preserved in formaldehyde from each intracranial vessel distribution bilaterally and stained with Van Gieson stain for elastin. A total of 160 normal cerebral vascular artery specimens were obtained from 17 different cerebrovascular regions. Two reviewers measured elastin thickness for each sample at five different locations per sample using Aperio ImageScope (Leica Biosystems, Deer Park, IL, USA). Statistical analysis of the samples was performed using mixed-models repeated measures regression methods. Results: There was a significant difference between anterior circulation (6.01 µm) and posterior circulation (4.4 µm) vessel elastin thickness (p-value < 0.05). Additionally, two predictive models of elastin thickness were presented, utilizing a combination of anterior versus posterior circulation, vessel diameter, and vessel wall thickness, which demonstrated significance for prediction with anterior versus posterior combined with vessel diameter and wall thickness. Conclusions: Elastin thicknesses are significantly different between anterior and posterior circulation vessels, which may explain the differences seen in aneurysm rupture risk for anterior versus posterior circulation aneurysms. Additionally, we propose two potential models for predicting elastin thickness based on vessel location, vessel diameter, and vessel wall thickness, all of which can be obtained using preoperative imaging techniques. These findings suggest that elastin plays an important role in cerebral vascular wall integrity, and this data will further enable fluid-structure interaction modeling parameters to be more precise in an effort to provide predictive modeling for cerebrovascular pathology.

Subclavian artery anatomical variations and its branching patterns: Literature review

2025-06-17

Hassan Mohamed , El Haisam Mohamed Taha , Osama Salah El Din Mahmoud +1 more | Anatomy Journal of Africa

The human body exhibits a variety of morphological patterns. These variances are rather common and frequently have no discernible effect on the health of the patient. Precise awareness of typical … The human body exhibits a variety of morphological patterns. These variances are rather common and frequently have no discernible effect on the health of the patient. Precise awareness of typical anatomical differences leads to better clinical practice outcomes. Anatomical variations are usually discovered during imaging prior to operation and surgery, as well as routine dissection. Furthermore, scientific methods for identifying anatomical variances include observational studies employing cadaveric dissection, medical imaging, and evidence-based anatomy. This literature aimed to give an overview of the various subclavian artery variations that have been found in various studies and to compile them all into a single study so that anatomists could easily access all variations and gain insight into their origin, course, branching patterns, and clinical significance. This study concluded and according to other studies, the most common variations are aberrant right subclavian artery (ARSA), bicarotid trunk, high origin of the subclavian artery, and variant branching patterns. The courses and associated anomalies of subclavian artery in these variations is recorded. This is scientifically importantfor surgeons to be aware of this variation to avoid injury to the artery and to plan the surgical approach accordingly. If they wish to perform procedures in the neck and chest region, surgeons, radiologists, and other medical professionals must understand these anatomical variations.

A Prospective Analysis of Risk Factors and Outcomes of Intracranial Atherosclerosis

2025-06-17

V Balambighai , Neeraja Ponnala , Sathasivam Sureshkumar | Cureus

Is the Eversion Technique Associated with Lower Peri-operative Stroke or Death Compared with Carotid Endarterectomy with Patch Angioplasty? Secondary Data Analysis of the German Statutory Quality Assurance Database

2025-06-17

Christoph Knappich , Bianca Bohmann , Felix Kirchhoff +4 more | Journal of Vascular Surgery

Incremental value of serum inflammatory biomarkers to carotid atherosclerotic plaque burden for prediction of ipsilateral ischemic stroke recurrence

2025-06-17

Lin Wang , Chun Yuan , Thomas S. Hatsukami +4 more | Acta Radiologica

Background The relationship between serum inflammatory biomarkers, carotid atherosclerotic plaque characteristics, and the recurrence of ischemic events remains a subject of ongoing debate. Purpose To investigate whether the combination of … Background The relationship between serum inflammatory biomarkers, carotid atherosclerotic plaque characteristics, and the recurrence of ischemic events remains a subject of ongoing debate. Purpose To investigate whether the combination of carotid atherosclerotic plaque burden and serum inflammatory biomarkers could help predict ipsilateral ischemic stroke recurrence. Material and Methods Patients with cerebral infarction were prospectively recruited and received three-dimensional vessel wall imaging (VWI). Baseline serum level of high-sensitivity C-reactive protein (hs-CRP) and the neutrophil-to-lymphocyte ratio (NLR) was recorded. Plaque burden was independently measured by two trained readers. Stroke recurrence was assessed at 1 year after discharge. Factors associated with stroke recurrence were analyzed. Receiver operating characteristic curves were used to calculate areas under the curve (AUCs) of inflammatory biomarkers and plaque burden for predicting stroke recurrence. Results A total of 56 patients were included, with recurrence in nine patients. hs-CRP (odds ratio [OR] = 1.60, 95% confidence interval [CI] = 1.17–2.19; P = 0.017) and carotid normalized wall index (NWI) (OR = 1.08, 95% CI = 1.01–1.16; P = 0.023) were found associated with stroke recurrence. Multivariate logistic regression showed that hs-CRP (OR = 1.67, 95% CI = 1.17–2.38; P = 0.005) and NWI (OR = 1.10, 95% CI = 1.01–1.20, P = 0.023) remained associated with stroke recurrence. Hs-CRP (AUC = 0.806; P = 0.002) and NWI (AUC = 0.738; P <0.001) were predictors of stroke recurrence. The combination of hs-CRP with NWI (AUC = 0.811, P <0.001) demonstrated the best performance in terms of predicting stroke recurrence. Conclusion Both hs-CRP and NWI were independently associated with stroke recurrence. The combination of hs-CRP and NWI may be a good predictor of 1-year stroke recurrence.

MHAHF-UNet: a multi-scale hybrid attention hierarchy fusion network for carotid artery segmentation

2025-06-17

Cuixia Jiang , Lin Gao , Wei Li +3 more | International Journal of Computer Assisted Radiology and Surgery