The success of superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass in moyamoya disease (MMD) depends not only on anastomotic patency but on whether the revascularized territory corresponds to the most hemodynamically compromised region. We report a case of postoperative posterior MCA territorial infarction attributable to hemodynamic territory mismatch. A 47-year-old woman with bilateral MMD presented with progressive left hemiparesis. Preoperative computed tomography (CT) perfusion demonstrated markedly reduced cerebral blood flow (CBF) and diffuse mean transit time (MTT) prolongation, most pronounced in the right posterior MCA and posterior cerebral artery (PCA) territory. Digital subtraction angiography (DSA) identified prominent choroidal periventricular anastomosis (ChA-PA) as a marker of deep perforator territory hemodynamic stress. She underwent right single-barrel STA-MCA bypass using the frontal STA branch anastomosed to a temporal M4 branch, combined with encephalo-duro-arterio-synangiosis (EDAS). Despite confirmed patency on intraoperative indocyanine green (ICG) videoangiography, she developed acute infarction in the right posterior MCA territory on postoperative day 1 - the region not covered by the temporal anastomosis. Two-month follow-up DSA demonstrated bypass patency and regression of ChA-PA. This case highlights the importance of preoperative perfusion-guided bypass planning to avoid hemodynamic territory mismatch. In patients with posterior MCA territory compromise, anastomosis should target the most ischemic region, or double-barrel bypass should be considered.
Transradial approach (TRA) has been widely adopted in neuroendovascular procedures because of its lower incidence rates of access-site complications and improved patient comfort. However, anatomical variations of the upper extremity arteries and aortic arch can significantly affect catheter stability and procedural feasibility. We report a technical note describing the treatment of a cerebral aneurysm in a 38-year-old woman with concomitant aberrant right subclavian artery (ARSA) and right brachioradial artery (BRA). Diagnostic cerebral angiography performed through the right upper extremity revealed difficulty with selective catheterization of the anterior circulation due to these vascular anomalies. Based on these findings, left TRA was selected. Preprocedural assessment, including left upper extremity angiography, confirmed the feasibility of this approach. A flow-diverter stent was successfully deployed for a left internal carotid artery paraclinoid aneurysm using a Simmons-type guiding system through left transradial access, without procedural instability or major complications. In patients with multiple upper extremity arterial variations, including ARSA and BRA anomalies, right TRA may be technically challenging. Careful preprocedural evaluation of vascular anatomy and flexible selection of the access route are critical. Left TRA may serve as a safe and effective alternative when right-sided anatomical variants compromise catheter stability.
Objective:To evaluate single-operator outcomes of a standardized proximal Middle Meningeal Artery Embolization (MMAE) technique using platinum microcoils across the subdural hematoma (SDH) acuity spectrum, and to identify clinical and anatomical predictors associated with adjunct surgical drainage. Methods:We retrospectively reviewed 100 consecutive adult patients (standalone MMAE: n=53; MMAE with surgical drainage: n=47). Continuous variables were assessed for normality via the Shapiro-Wilk test. Multivariable binomial logistic regression identified independent predictors of surgical requirement. Baseline characteristics, procedural metrics, and 6-month outcomes were stratified by acuity: acute (<3 days; n=19), subacute (3-21 days; n=54), and chronic (>21 days; n=27). Results:Continuous variables exhibited non-normal distributions (p≤0.010); median cohort body mass index (BMI) was 26.6 kg/m² (IQR 22.5-29.8). In multivariable analysis (AUC 0.745), higher BMI (aOR 1.09; 95% CI 1.01-1.17; p=0.028), presentation with headache (aOR 2.86; 95% CI 1.03-7.99; p=0.045), and left-sided hematoma location (aOR 0.31; 95% CI 0.10-0.97; p=0.043) were significant independent predictors of surgical requirement. Technical success was 100%, with zero periprocedural complications and zero surgical re-evacuations at 6 months (0%). Fluoroscopy time (p=0.969) and coil count (p=0.393) were uniform across acuity cohorts. Conclusions:Proximal MMAE with microcoils is safe, highly feasible, and technically consistent across all SDH acuity phases. Although hematoma thickness traditionally guides surgical intervention, elevated BMI, headache presentation, and hemispheric laterality serve as vital independent clinical predictors for adjunct surgical drainage.
Basilar artery perforator aneurysms (BAPAs) are rare causes of spontaneous subarachnoid hemorrhage and may be occult on initial vascular imaging. We report a 55-year-old woman who presented with headache and was found to have subarachnoid hemorrhage (modified Fisher grade 3, Hunt-Hess grade 2). Initial computed tomography angiography, same-day digital subtraction angiography, and follow-up magnetic resonance angiography on hospital day 4 were negative. On hospital day 6, her mental status deteriorated to stupor, and computed tomography demonstrated a new hemorrhage in the interpeduncular and suprasellar cisterns with hydrocephalus, suggesting rebleeding. Emergency repeat digital subtraction angiography demonstrated a small aneurysmal lesion with pseudoaneurysm-like morphology arising from a left basilar artery perforator. Endovascular treatment, including stenting, was considered; however, conservative management was chosen because of concerns regarding thromboembolic events and perforator infarction. External ventricular drainage was performed, and conservative management was continued. Her mental status gradually improved, and follow-up digital subtraction angiography performed 6 and 18 days after lesion identification demonstrated complete disappearance of the lesion. Follow-up magnetic resonance angiography at 4 months and 1 year after discharge revealed no recurrence. This case highlights that repeat angiography should be considered in initially angiography-negative subarachnoid hemorrhage and that carefully selected basilar perforator lesions may resolve with close conservative management, even after rebleeding.
Objective:The larger (≧1 mm) conducting and distributing arteries to the brain are sources of collateral during acute stroke, and include the cervical carotid, ophthalmic, and Circle of Willis (CoW) vessels. This study assessed their anatomy for relationships with stroke severity in large vessel occlusion (LVO), and with common grading scales of cerebral collateral. Methods:One hundred consecutive endovascular thrombectomy (EVT) patients had imaging measurements made on 16 large (≧1 mm) candidate arteries visualized on axial source computed tomography angiography (CTA). Admission National Institutes of Health Stroke Scale score (NIHSS), Alberta Stroke Program Early CT Score (ASPECTS), and multiphasic CTA collateral scores were used as outcome measures. Results:Ophthalmic arteries show a significant connection with stroke severity and collateral scores. A 1-mm increase in ophthalmic artery diameter leads to a lower NIHSS score of 4.8 points (p<0.008) in multivariable analysis, and 1.53-point increase in ASPECTS (p<0.001). The opposite applies to the contralateral ophthalmic: a 6.3-point higher NIHSS score and 2.6-point drop in ASPECTS. Conclusions:Native collateral and stroke severity scores are significantly affected by ophthalmic artery size.
Spontaneous acute subdural hematoma (aSDH) is an uncommon neurosurgical emergency, and aneurysms of the accessory meningeal artery (AMA) are an exceptionally rare cause. We report a case of recurrent spontaneous aSDH attributed to rupture of an AMA aneurysm, which was identified as the most likely source of both the initial and recurrent hemorrhages, successfully treated with endovascular embolization. A 36-year-old hypertensive man presented with progressive headache and drowsiness without preceding trauma. Computed tomography (CT) demonstrated a left convexity acute-on-chronic subdural hematoma with significant mass effect, while CT angiography revealed no vascular abnormality. Emergency decompressive craniectomy and hematoma evacuation were performed, but no bleeding source was identified. Although the patient initially recovered well, he developed recurrent aSDH one week later. Digital subtraction angiography (DSA) subsequently identified a saccular aneurysm arising from the accessory meningeal artery. Endovascular coil embolization achieved complete aneurysm occlusion with no further recurrence, and the patient remained neurologically intact. This case highlights that ruptured AMA aneurysms may remain occult despite negative CT angiography and should be considered in unexplained or recurrent nontraumatic aSDH. Early DSA is essential for definitive diagnosis, and prompt endovascular treatment can prevent recurrence and achieve favorable neurological outcomes.
Objective:To identify clinically relevant age cutoffs and prognostic factors influencing functional outcomes in patients over 80 years undergoing mechanical thrombectomy (MT) for acute ischemic stroke (AIS). Methods:We analyzed 108 patients aged ≥81 years treated with endovascular therapy between January 2015 and September 2020. Recursive partitioning analysis identified the optimal age cutoff at 85.5 years, stratifying patients into younger (age<85.5, n=68) and older (age≥86, n=40) groups. Baseline characteristics, procedural metrics, and clinical outcomes were compared. Univariate and multivariate logistic regression analyses identified independent predictors of a favorable outcome (modified Rankin Scale ≤2 at 90 days). Results:Overall the favorable outcome was 38.9%, with significant differences between age groups (48.5% vs. 22.5%, P=0.007). Successful recanalization rates were similar (88.2% vs. 92.5%, P=0.479). Age≥86 years, higher initial National Institutes of Health Stroke Scale, longer procedure time, and medical complications, including pulmonary complications and acute kidney injury, were significant in univariate analysis. Multivariate analysis identified age≥86 years (OR 3.463, 95% CI 1.033-11.611, P=0.044), initial NIHSS (OR 1.146, 95% CI 1.048-1.252, P=0.003), procedure time (OR 1.033, 95% CI 1.013-1.054, P=0.001), pulmonary complications (OR 3.459, 95% CI 1.040-11.505, P=0.043), and acute kidney injury (OR 7.690, 95% CI 1.073-55.097, P=0.042) as independent predictors of unfavorable outcome. Conclusions:Age significantly affects functional outcomes in patients over 80 years old receiving MT. While procedural recanalization success remains high, medical complications, particularly pulmonary and renal complications, emerge as critical independent predictors of poor prognosis in this elderly population. Enhanced perioperative management of medical comorbidities may improve outcomes.
Objective:Cerebral vasospasm (CVS) could be an undetected reason for worsening condition in ruptured arteriovenous malformation (AVM) patients during the course. It is important to investigate the risk factors associated with vasospasm in order to establish preventive and therapeutic treatments in a timely manner. This study aimed to describe the risk factors of CVS associated with ruptured AVM. Methods:We systematically searched electronic databases (PubMed, Science Direct, Cochrane Library, and SSRN) for studies assessing risk factors of CVS associated with spontaneous ruptured AVM. Risk factors assessed include demographic conditions, comorbidities, substance use, lab and vital parameters, and also the severity of bleeding. Meta-analysis was performed using data extracted from each study then Review Manager was used to analyze the risk ratio (RR) with 95% confidence intervals (95% CI). Results:There were a total of 14 studies included. Chronic renal disease (RR=0.5 [95% CI 0.46-0.67]) and hyperlipidemia (RR=0.78 [95% CI 0.73-0.84]) as comorbid conditions both were found as protective factors. Then the use of substances, including smoking and stimulants, was found to tend to increase the incidence of CVS (RR=1.31 [95% CI 1.11-1.54] and RR=1.31 95% CI 1.11-1.51]) respectively. In the lab and vital parameters section, 8 of them showed results as risk factors for CVS, including leukocytosis (RR=1.58 [95% CI 1.35-1.84]), hyperglycemia (RR=1.17 [95% CI 1.07-1.29]), hyponatremia (RR=1.45 [95% CI 1.23-1.71]), hypokalemia (RR=1.28 [95% CI 1.20-1.36]), fever (RR=1.38 [95% CI 1.23-1.54]), hypovolemia (RR=1.39 [95% CI 1.15-1.67]), acute hypotension (RR=1.4 [95% CI 1.26-1.55]), and electrocardiogram (ECG) abnormality (RR=1.74 [95% CI 1.34-2.26]). Conclusions:Chronic renal disease and hyperlipidemia were found as protective factors. Meanwhile, smoking, stimulant use, leukocytosis, hyperglycemia, hyponatremia, hypokalemia, fever, hypovolemia, acute hypotension, and ECG abnormalities are risk factors for CVS in patients with AVM rupture.
Cerebral vasospasm is a reversible narrowing of intracranial arteries that most commonly occurs after aneurysmal subarachnoid hemorrhage but can also result from central nervous system infections. Infectious vasospasm poses unique therapeutic challenges, as traditional medical and endovascular interventions are not well established in this context. This report presents a case of severe infectious vasospasm following bacterial meningitis and subdural empyema treated successfully with the NeVa VS retrievable stent device. A male in his twenties developed progressive hemiparesis and vasospasm of the right supraclinoid internal carotid and middle cerebral arteries, confirmed on angiography. Initial intra-arterial verapamil provided only a transient improvement. Due to hemodynamic instability, endovascular angioplasty was performed using the NeVa VS retrievable stent, resulting in restored vessel caliber and cerebral perfusion. The patient subsequently underwent empyema evacuation and showed significant neurological recovery. This case demonstrates the feasibility and potential benefit of retrievable stent angioplasty for refractory infectious cerebral vasospasm, extending the utility of the NeVa VS device beyond its established role in aneurysmal subarachnoid hemorrhage-related vasospasm.
Hypoglossal canal dural arteriovenous fistulas (HC-dAVFs) are rare skull base vascular lesions with complex venous drainage. We report a case of a 52-year-old man who presented with 6 months of left-sided pulsatile tinnitus, sleep disturbance, and anxiety. Magnetic resonance angiography demonstrated venous engorgement near the left hypoglossal canal, and transfemoral cerebral angiography revealed early venous shunting involving the anterior condylar confluence, internal jugular vein, vertebral venous plexus, and cavernous sinus. Conventional workstation-based three-dimensional (3D) reconstruction was limited by poor differentiation of arterial and venous structures, particularly on lateral views. To better delineate the fistulous anatomy, 3D Slicer was used to independently segment arterial and venous phases from DICOM source images and generate a color-coded fused model. This reconstruction clarified the spatial relationship among the feeding arteries, draining veins, and fistulous convergence point, facilitating microcatheter trajectory planning and accurate transvenous access. Transvenous coil embolization via the right femoral vein achieved complete obliteration of the fistula. The patient's pulsatile tinnitus resolved immediately, and no postoperative neurological deficits were observed, including preserved cranial nerve IX through XII function. Follow-up at 1 month and 1 year confirmed sustained complete remission without recurrence. This case highlights the value of 3D Slicer-based preoperative reconstruction for precise angioarchitectural analysis and procedural planning in HCdAVFs when conventional 3D workstation imaging is limited by vessel overlap.
Objective:We aimed to compare aneurysm wall enhancement post-coil embolization between patients with and without subarachnoid hemorrhage (SAH). We hypothesized that ruptured aneurysms in SAH patients exhibit different enhancement patterns compared to incidentally found unruptured aneurysms. To account for potential confounders affecting wall enhancement, coil packing density and aneurysm size were evaluated. Methods:This retrospective cross-sectional single-center study included patients who underwent coil embolization for intracranial aneurysms. These patients were monitored with digital subtraction angiography (DSA) and magnetic resonance imaging (MRI), including a contrast-enhanced black-blood sequence. Aneurysm wall enhancement was assessed by ROI-based signal intensity measurements and supplementary visual scoring, and compared between groups using the Student's t-test and Mann-Whitney U test, respectively. In addition, linear and multivariable regression analyses were performed to explore the effects of coil density and aneurysm size on wall enhancement and to assess the independence of the observed group differences. Results:Among the 31 patients studied, non-SAH patients showed higher wall signal intensity than SAH patients (ROI measurements: SAH: 813 SI vs. no SAH: 1151 SI, p<0.01; visual assessment showed a consistent trend, p=0.055). Neither coil packing density nor aneurysm size independently predicted wall enhancement, and SAH status remained the only significant independent predictor in multivariable analysis. Conclusions:Aneurysm wall enhancement following coil embolization differs significantly between patients with and without SAH. The observed signal differences are preliminary and should be regarded as hypothesis-generating, warranting further investigation in future prospective studies.
Objective:While improved cerebral blood flow is expected following stent placement for cerebrovascular atherosclerotic disease, objective quantification of these hemodynamic changes remains limited. Quantitative magnetic resonance angiography (qMRA) offers a non-invasive, reproducible method to measure volumetric flow and evaluate both immediate and long-term hemodynamic effects of stenting. Methods:We retrospectively reviewed all patients who underwent stenting for cerebrovascular atherosclerotic disease using Onyx drug-eluting stents (DES) between January 2018 and September 2024. Demographics, clinical presentation and follow-up, radiographic findings, procedural details, and complications were collected. Outcomes assessed were procedural success, periprocedural stroke, in-stent restenosis (ISR) requiring reintervention, and qMRA flow measurements obtained pre-stenting, post-stenting, and at long-term follow-up. The median long-term follow-up duration was 9.4 months for qMRA. Results:A total of 63 patients with 84 Onyx DES were included (mean age 63.1±11.37 years; 33.3% female). The median number of stents deployed per patient was 1.0; mean stent length and diameter were 11.02±3.92 mm and 2.5±0.88mm, respectively. ISR occurred in 15.9% of patients. Technical and clinical complications each occurred in 4.8% of patients. qMRA across all vessels demonstrated a significant increase in flow post-stent and remained elevated at long-term follow-up. Vessel-specific analysis confirmed significant and persistent post-stent flow augmentation in the basilar, vertebral (VA), middle cerebral, and internal carotid arteries (ICA). Although mean VA and ICA flow declined modestly from post-stent to long-term follow-up, values remained markedly elevated compared to pre-stent baselines and flow augmentation was comparable across vessels. Conclusions:qMRA demonstrated robust, persistent improvements in cerebral blood flow following Onyx stenting for cerebrovascular atherosclerotic disease.
Intracranial dural arteriovenous fistulas (dAVFs) with perimedullary venous reflux are uncommon but can lead to progressive myelopathy. Although most dAVFs are idiopathic or associated with dural sinus thrombosis, a falx cerebelli dAVF developing after an occipital bone fracture is exceedingly rare and clinically important. We report a 77-year-old patient who presented with 1 month of progressive bilateral lower-extremity weakness, urinary retention, and hiccups, 1 year after an occipital bone fracture. Magnetic resonance imaging showed longitudinal T2-weighted imaging hyperintensity from the medulla to the C4 level with ventral perimedullary flow voids. Cerebral angiography demonstrated a falx cerebelli dAVF fed by bilateral occipital arteries traversing the fracture line with retrograde reflux to intracranial and spinal veins (Borden type III, Cognard type V). Transarterial embolization with n-butyl-2-cyanoacrylate achieved complete angiographic obliteration, and the magnetic resonance imaging abnormalities resolved by 9 months. Falx cerebelli dAVFs after skull fracture are extremely rare but should be considered in patients with progressive myelopathy.
Objective:Sickle cell disease (SCD) is a hereditary hemoglobinopathy associated with various cerebrovascular complications. Although ischemic stroke is the most common manifestation, subarachnoid hemorrhage (SAH) secondary to ruptured intracranial aneurysms represents a rare but life-threatening condition in this population. Data regarding the optimal management of aneurysmal SAH in SCD patients remain limited. Methods:We retrospectively analyzed eight patients with confirmed SCD who were diagnosed with aneurysmal SAH and treated at a tertiary referral center. Clinical severity was assessed using the Glasgow Coma Scale (GCS), World Federation of Neurosurgical Societies (WFNS) grade, Hunt-Hess grade, and Fisher score. Aneurysm characteristics, including size, location, and multiplicity, were recorded. All patients underwent endovascular coil embolization. Hematologic parameters and peri-procedural multidisciplinary management strategies were reviewed. Aneurysm occlusion status was evaluated using the Raymond-Roy Occlusion Classification (RROC) at 6-month follow-up. Results:A total of 11 aneurysms were identified in 8 patients (mean age: 34.5 years; 5 males, 3 females). Three patients (37.5%) had multiple aneurysms. Six aneurysms (54.5%) were located in the anterior circulation and five (45.5%) in the posterior circulation. Four patients (50%) developed clinical and radiological vasospasm requiring intra-arterial therapy. All aneurysms were successfully treated with endovascular coiling. At discharge, modified Rankin Scale (mRS) scores ranged from 0 to 6. At 6-month follow-up, complete occlusion (RROC Class I) was achieved in the majority of treated aneurysms. Multidisciplinary perioperative management, including hematology consultation and transfusion strategies, was applied in all cases. Conclusions:Ruptured intracranial aneurysms in patients with SCD require careful multidisciplinary management due to disease-specific hematologic and vascular risks. Endovascular coil embolization appears to be a safe and effective treatment modality in this population. Early aneurysm securing combined with optimized hematologic management may improve clinical outcomes and reduce procedure-related complications.
Objective:To evaluate the association between angular morphometric parameters of anterior communicating artery (AComA) aneurysms and intraoperative rupture, and to assess the relationship of inflammatory biomarkers (high-sensitivity C-reactive protein (hs-CRP), homocysteine) with aneurysm wall inflammation. Methods:In this prospective observational study, 37 patients with AComA aneurysms undergoing microsurgical clipping (Jan 2023-Dec 2025) were included. All presented with aneurysmal subarachnoid hemorrhage (Fisher Grade ≥1). Morphometric parameters-aneurysm size, aspect ratio, size ratio, height-width ratio, vessel angle, flow angle, parent vessel angle, and inclination angle-were measured using computed tomography (CT) angiography and intraoperative microscopy. Aneurysm inflammation was defined by macroscopic features (wall thickening, discoloration, adhesions, friability). Preoperative hs-CRP and homocysteine levels were recorded. Patients were categorized into intraoperative rupture (n=13) and unruptured (n=24) groups. Statistical analysis used SPSS v26.0 (p≤0.05). Results:Vessel angle (74.76±15.9 vs. 56.8±25.8; p=0.03) and flow angle (153.24±15.3 vs. 137.58±22.4; p=0.035) were significantly higher in ruptured cases. Parent vessel angle was higher in unruptured aneurysms (121.88±33.4 vs. 98.85±10.2; p=0.02). hs-CRP (68.86±57.3 vs. 30.86±49.8; p=0.032) and homocysteine (12.47±5.2 vs. 9.38±3.4; p=0.041) were elevated in inflamed aneurysms but showed no association with intraoperative rupture. Conclusions:Vessel, flow, and parent vessel angles are significantly associated with intraoperative rupture risk. While hs-CRP and homocysteine reflect aneurysm inflammation, they do not predict intraoperative rupture. CT Angiography (CTA)-based morphometric parameters may assist in surgical risk stratification.
Sturge-Weber syndrome (SWS) is a neurocutaneous disorder associated with various intracranial abnormalities, such as leptomeningeal angiomatosis, the characteristic facial port wine stain (PWS), among others. However, several non-classic ones, such as non-traumatic carotid cavernous fistulas (CCF), represent not only life-threatening but commonly unrecognized abnormalities, posing a significant risk to these patients. Objective:We present a comprehensive analysis of current literature to describe vascular anomalies associated with SWS and present a case of a CCF in a patient with SWS. Methods:A case with an unusual concurrent finding of CCF and SWS is presented following CARE guidelines. Additionally, we conducted a literature review using MEDLINE, Scopus, and Web of Science databases focusing exclusively on vascular anomalies associated with SWS. Results:Our review identified 243 cases describing vascular anomalies in patients with SWS, with a minor number of cases describing a cavernous sinus anomaly. Conclusions:The co-occurrence of SWS and CCF appears to be underreported. Although SWS is associated with multiple vascular anomalies, current evidence supports a predisposing vascular environment rather than a direct causal relationship with CCF. Although other vascular anomalies are significantly associated with SWS, there is still a research gap with ample area of opportunity to define their clinical impact and the most appropriate management.
We present a patient who had a ruptured distal middle cerebral artery (MCA) aneurysm at the M2-M3 junction with a temporal lobe hematoma, in which intraoperative ultrasound (iUS) proved critical for real-time aneurysm localization when neuronavigation was compromised by brain shift. An elderly patient with subarachnoid hemorrhage and a large temporal lobe intracerebral hematoma underwent craniotomy, hematoma evacuation, and aneurysm clipping. Preoperative computed tomography angiography (CTA) identified a 5-mm aneurysm at the left M2-M3 junction. During surgery, neuronavigation was initially planned but deemed unreliable after hematoma removal due to brain shift. Instead, iUS was used through the cortical surface to localize the aneurysm and parent vessels in real-time. iUS successfully visualized the aneurysmal sac and inflow vessel within the evacuated hematoma cavity. This allowed the surgical team to safely expose the parent vessel, identify the aneurysm neck, and clip the aneurysm without complications. Postoperative imaging confirmed complete hematoma evacuation and aneurysm obliteration. In patients with deep-seated ruptured distal MCA aneurysm accompanied by intracerebral hematoma, iUS can be a valuable real-time tool for localization when neuronavigation is unreliable, thereby improving surgical precision and safety.
Objective:Intracranial atherosclerotic disease (ICAD) is an important cause of ischemic stroke. Balloon angioplasty for ICAD with or without a stent is associated with a high complication rate. The Tenzing support catheter (Route92 Medical) is a tapering offset catheter designed for improving aspiration catheter delivery in large vessel occlusion ischemic stroke (LVO). In LVO secondary to ICAD, we noted that the Tenzing could be used for angioplasty. In this study, we report our experience with the Tenzing angioplasty technique (T-Plasty) for ICAD treatment in the absence of LVO. Methods:A prospectively maintained database of all adult ICAD patients without LVO treated with T-Plasty at our institution was reviewed. Information on demographics, procedural details, clinical outcomes, and complications is reported here based on the National Institute of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS). Student's T-test was applied to evaluate for statistical significance when appropriate. Results:From September 2024 to April 2025, 18 adult patients underwent T-Plasty for symptomatic ICAD without LVO. All patients experienced an improvement; the early cohort had a 4.5 points reduction in NIHSS immediate post T-Plasty, and both the elective and early cohorts experienced close to 1 point improvement in baseline mRS. No operative or post-operative related complications were noted up to 30-day follow-up. Conclusions:T-Plasty for the elective treatment of chronic symptomatic ICAD and acute hypoperfusion syndrome is an option for improving neurologic outcome.
Objective:Carotid webs, first described in 1968, are increasingly recognized as a surgically treatable cause of ischemic stroke, particularly in young patients. Despite growing attention, the literature remains fragmented. We conducted the first advanced bibliometric analysis of carotid web research to map its historical foundations, identify key contributors, and illustrate emerging trends. Methods:The Web of Science database (inception-2025) was queried for carotid web publications. Articles and metadata were analyzed using Bibliometrix (R) and Python libraries. Reference publication year spectroscopy (RPYS) was employed to analyze the field's roots by analyzing citation frequency by publication year. Results:A total of 281 publications from 109 sources and 1,129 authors were identified. Annual publication growth averaged 6.15%, with 90% published after 2016. International collaboration was modest (9-11%), led by the U.S., China, France, and Canada. Shifts in keyword frequency reflected the field's evolution from early nosological uncertainty toward recognition of carotid webs as a distinct, high-risk lesion underlying ischemic stroke. Stroke and Journal of Vascular Surgery emerged as early key sources. Author analysis identified the most prolific contributors, though coauthorship networks remained small. RPYS revealed 19 seminal studies (1968-2021) that shaped the field's progression from early pathology descriptions to recognition of carotid webs as high-risk lesions for stroke. Conclusions:Carotid web research has rapidly expanded, evolving into a multidisciplinary field. RPYS identified 19 seminal publications tracing the intellectual trajectory of the field. Ongoing challenges include limited collaboration, unresolved questions of pathogenesis, and variability in terminology and diagnostic criteria.
