Objective: We aimed to identify unfavorable prognostic factors for the development of cerebral ischemic complications of surgical treatment in patients with moyamoya disease. Methods: We analyzed 80 patients with moyamoya disease, who underwent 134 surgical revascularizations. Persistent complications (ischemic strokes) developed in seven cases (5.3
INTRODUCTION:Intracranial aneurysms (IAs) are critical vascular defects potentially leading to subarachnoid hemorrhage. A Bayesian framework assists clinicians in assessing IA risks by evaluating multiple factors, including sex, due to its higher prevalence in women. METHODS:This study adopted the Bayesian theorem to quantify IA prevalence and the incidence of subsequent hemorrhage, examining sex as a pivotal risk factor for IA rupture stratification. RESULTS:The Bayesian analysis revealed a greater incidence of IAs among women yet indicated that sex does not have a significant impact on the rupture risk in diagnosed patients. This finding suggests the necessity of considering other cofactors in risk evaluation. CONCLUSIONS:Bayesian approaches provide clinicians with refined tools for IA risk assessment, emphasizing the complex interplay of various risk factors beyond sex. Acknowledging the limited influence of sex on rupture probability is crucial in guiding IA management. Continuous research is warranted to advance Bayesian methods, improving their clinical applicability and enhancing patient treatment outcomes.
Purpose: The analysis of the microstructure of dural arteriovenous fistulas (DAVFs) plays a crucial role in achieving the successful embolization of DAVFs associated with complex microanatomy. Recent advancements in high-resolution cone-beam computed tomography (CBCT) enable detailed visualizations of the microstructure of the shunt point. In this study, we retrospectively evaluated the efficacy of this imaging modality in terms of the clinical and angiographic outcomes of the endovascular approach. Methods: We retrospectively analyzed a total of 83 cases of dural arteriovenous fistulas (AVFs), including spinal lesions. High-resolution CBCT images with an 8-inch field of view and 1024 × 1024 pixel matrix detector at 80 kV were acquired. The anatomical variation and configuration of DAVFs were analyzed and compared with superselective angiography findings. Results: The sensitivity of the shunt location was over 96.3
Perfusion MRI via arterial spin labeling (ASL) could not precisely estimate cerebral ischemia severity in patients with occlusive cerebrovascular disease (CVD), because the delayed arrival of arterial blood spins (AB spins) in the affected vascular territories could not be corrected v single post-labeling delay (PLD) setting. In this study, new hemodynamic parameters for cerebral ischemia using dual ASL perfusion imaging under double PLD setting will be proposed. In 67 patients with moyamoya disease (MMD) and 22 patients with large artery atherosclerosis (LAA), hemodynamic parameters were investigated by using dual ASL perfusion imaging via 3.0 T MRI. PLD was fixed to 1525 ms (early image) and 2525 ms (late image). In early images, early slow-in of AB spins into cerebral tissue, and the early stagnation of AB spins within cortical arteries were investigated. In late images, late filling up (complete or incomplete) and both late stagnation and overstagnation were estimated. Early slow-in (65/67 = 97
Flow-augmentation bypass aims to enhance blood flow to hypoperfused brain regions in patients with cerebrovascular steno-occlusive diseases. This surgical procedure is indicated for ischemic and hemorrhagic moyamoya vasculopathy and for selected patients with chronic steno-occlusive disease and acute ischemic stroke. Flow-augmentation bypass has been rigorously evaluated in randomized clinical trials, including the EC-IC Bypass Trial, the Carotid Occlusion Surgery Study (COSS), the Japanese Adult Moyamoya (JAM) trial, and the recent Carotid and Middle Cerebral Artery Occlusion Surgery Study (CMOSS). In this article, we examine the current indications and outline the diagnostic and therapeutic decision-making processes for patients with steno-occlusive disease who are candidates for flow-augmentation bypass surgery.
