Cervical artery diseases, encompassing both atherosclerotic and non-atherosclerotic disorders of the carotid and vertebral arteries, remain a major cause of ischemic stroke and transient ischemic attack (TIA) worldwide. Although luminal stenosis has traditionally guided diagnostic and therapeutic decision-making, recent advances have shifted the focus toward comprehensive vascular assessment, incorporating plaque vulnerability, vessel wall pathology, inflammatory activity, and individualized cerebrovascular risk stratification. Simultaneously, substantial progress in multimodal vascular imaging, intensive medical therapy, carotid revascularization techniques, and endovascular interventions has transformed the contemporary management of cervical artery disease. This review provides a comprehensive and clinically oriented overview of the diagnosis and management of extracranial carotid and vertebral artery diseases, including both atherosclerotic and non-atherosclerotic etiologies such as cervical artery dissection, fibromuscular dysplasia, and large-vessel vasculitides. Current evidence regarding clinical presentation, screening strategies, physical examination, multimodal imaging, optimal medical therapy, carotid endarterectomy, carotid artery stenting, and endovascular treatment is critically reviewed in light of the most recent international guidelines and landmark clinical trials. Particular emphasis is placed on emerging concepts including vulnerable plaque imaging, high-resolution vessel wall magnetic resonance imaging, advanced computed tomography techniques, and evolving imaging biomarkers that facilitate personalized risk assessment and treatment selection. Future perspectives regarding artificial intelligence, radiomics, quantitative plaque characterization, and precision cerebrovascular medicine are also discussed. By integrating current evidence with practical clinical decision-making, this review aims to provide clinicians with an updated framework for the diagnosis, risk stratification, and evidence-based management of cervical artery diseases while highlighting evolving directions that are expected to shape future stroke prevention strategies.
Objective: The aim of this study was to evaluate the association of various inflammatory parameters with early neurologic damage and three-month functional outcomes in patients with acute distal middle cerebral artery (MCA) occlusion who received intravenous thrombolytic treatment (IV tPA). Materials and Methods: This retrospective exploratory study included 75 patients who underwent IV tPA for distal MCA infarction and had complete clinical and laboratory data. Inflammatory indices were calculated from blood parameters at admission, early neurologic status was assessed using the National Institutes of Health Stroke Scale (NIHSS), and three-month functional status was assessed using the Modified Rankin Score (mRS). Results: Systemic Immune-Inflammation Index (SII), Systemic Inflammatory Response Index (SIRI) and Neutrophil-to-Albumin Ratio (NAR) were positively correlated with mRS in univariate analyses. The NAR also showed an association with the NIHSS score at presentation and demonstrated modest discrimination for the mRS 3-6 group on ROC analysis (AUC=0.694). In multivariable logistic regression adjusted for baseline clinical confounders and onset-to-needle time, the inflammatory indices lost their independent predictive significance, while admission NIHSS remained the strongest independent predictor. Conclusions: While indices such as SII, SIRI and NAR show potential preliminary associations with early neurologic damage and unadjusted three-month functional outcomes in patients with distal MCA infarction treated with IV tPA, they do not carry robust independent prognostic value beyond initial clinical severity. Admission NIHSS remains the most critical predictor of clinical course.
Objective: Describe the clinical presentation, diagnostic challenges, and surgical management of Bow Hunter’s Syndrome, detailing the operative strategy, technical considerations, and postoperative outcomes associated with decompressing the mechanically compressed vertebral artery. Case Presentation. A 41-years-old man with a history of multiple cervical injections presented with an eleven-month history of gait disturbance and chronic vertigo, exclusively induced by rightward head rotation and relieved in the neutral position. Neurological examination was largely unremarkable aside from features consistent with vertebrobasilar insufficiency. Dynamic angiography demonstrated an >80% reduction in the caliber of the left vertebral artery during contralateral head rotation. Surgical decompression was thererefore indicated. Intraoperatively, several fibrous bands compressing the vertebral artery were identified and resected, and the C1 transverse foramen was enlarged to achieve complete decompression. Postoperatively the patient experienced an uneventful recovery, with full resolution of symptoms and imaging confirming adequate decompression. Conclusion: Prior cervical interventions may predispose to the development of fibrous adhesions and should be considered during etiologic assessment. Surgical decompression can provide definitive symptom resolution in patients with refractory or disabling dynamic vertebrobasilar insufficiency.
Objective: Stress hyperglycemia reflects the neuroendocrine stress response of the body during acute illness, independent of chronic glycemic status. This study aimed to evaluate the association between the stress hyperglycemia ratio (SHR) and clinical outcomes in patients with cerebral venous thrombosis (CVT). Methods: A total of 72 adult patients diagnosed with cerebral venous thrombosis (CVT) were retrospectively analyzed. The stress hyperglycemia ratio (SHR) was calculated as the ratio of admission plasma glucose to estimated average glucose (eAG). Variables between groups were compared using the chi-square test and Mann–Whitney U test, as appropriate. Receiver operating characteristic (ROC) curve analysis and multivariable binary logistic regression analyses were performed to evaluate the prognostic significance of SHR. Results: Of the patients, 61.1% (n=44) were female, and the median age was 38.0 years (IQR: 32.0–47.2). Acute onset and hemorrhagic transformation were significantly more frequent in patients with poor outcomes (p=0.016 and p=0.029, respectively). SHR and admission glucose levels were significantly higher in the poor outcome group (p<0.001). ROC analysis demonstrated that SHR had a high predictive value for poor outcomes (AUC: 0.895; 95% CI: 0.810–0.981), with an optimal cut-off value of 1.30, yielding a sensitivity of 95.5% and a specificity of 80.0%. Multivariable logistic regression analyses demonstrated that both SHR and admission glucose were independently associated with poor clinical outcomes. Conclusion: This study suggests that the stress hyperglycemia ratio (SHR) may be associated with poor clinical outcomes in patients with CVT. These findings indicate that SHR could have potential prognostic relevance not only in arterial stroke but also in cerebrovascular diseases of venous origin.
Fibrocartilaginous embolism (FCE) is a rare and highly morbid cause of spinal cord infarction. Diagnosis can be difficult in the absence of predisposing factors. Treatment is controversial. The probable mechanism is retrograde embolism of nucleus pulposus material into the arterial system of the spinal cord. A previously healthy 70-year-old male patient presented to our emergency department with neck and back pain that started 24 hours after carrying firewood, followed by sudden quadriparesis. The patient’s clinical findings and neuroimaging results were consistent with spinal cord ischemia secondary to acute vertebral disc herniation at the C4-5 level (extending between C5-8). Laboratory investigations revealed no evidence of infectious, autoimmune, inflammatory, or neoplastic causes. After ruling out other possible diagnoses, he was diagnosed with spinal cord ischemia secondary to fibrocartilaginous embolism. We wanted to present this rare phenomenon, which often goes undiagnosed unless it’s considered.
