BACKGROUND:Whether the long-term benefit of stroke prevention when stenting is added to medical therapy (MT) over MT alone for symptomatic severe intracranial artery stenosis offsets the perioperative risks of the stenting has not been directly evaluated in a randomized trial. We aimed to compare the long-term (>3 years) effect of stenting versus MT alone in patients with symptomatic severe intracranial artery stenosis in a randomized trial. METHODS:We extended the follow-up of 358 subjects enrolled in a multicenter, open-label, randomized trial conducted at 8 centers in China. Patients with transient ischemic attack or stroke attributed to severe intracranial stenosis (70% to 99%) were recruited between March 5, 2014, and November 10, 2016. The primary outcome was a composite of stroke or death within 30 days or stroke in the territory of the qualifying artery beyond 30 days. Other secondary outcomes included stroke in the territory of the qualifying artery, as well as disabling stroke or death after enrollment. RESULTS:A total of 358 patients (stenting 176 versus MT 182) were recruited from March 5, 2014, and followed up till January 22, 2024. The median duration of follow-up was 7.4 years (interquartile range, 6.0-8.0). The primary outcome was not significantly different (stenting 14.8% versus MT 14.3%; hazard ratio, 1.02 [95% CI, 0.58-1.77]; P=0.97). No significant difference was found between groups for the secondary outcomes: stroke in the territory of qualifying artery (14.8% versus 14.3%; hazard ratio, 1.02 [95% CI, 0.58-1.77]; P=0.97), disabling stroke or death (16.5% versus 14.3%; hazard ratio, 1.12 [95% CI, 0.66-1.91]; P=0.70), and death (9.1% versus 7.1%; hazard ratio, 1.22 [95% CI, 0.58-2.58]; P=0.60). CONCLUSIONS:This study provides compelling evidence that, even over prolonged observed periods, the addition of stenting to MT does not confer additional benefits to MT alone in patients with symptomatic severe intracranial artery stenosis. These results underscore the importance of MT as the cornerstone of long-term stroke prevention in this patient population. REGISTRATION:URL: https://www.clinicaltrials.gov; Unique identifier: NCT01763320.

Objective To explore the technical key points, clinical efficacy and safety of hybrid operation for symptomatic chronic common carotid artery occlusion (CCAO). Methods and Results A total of 10 patients with symptomatic chronic CCAO who underwent hybrid operation in The First Affiliated Hospital of Harbin Medical University from December 2022 to October 2024 were included. The median preoperative modified Rankin Scale (mRS) score was 2 (1, 2). All patients successfully completed revascularization with a technical success rate of 10/10, including 6 cases treated with carotid endarterectomy (CEA) combined with retrograde transcarotid recanalization (for patients with short CCA residual stumps) and 4 cases treated with CEA combined with antegrade transfemoral recanalization (for patients with long CCA residual stumps). Postoperative complications included one case of cerebral hyperperfusion syndrome (CHS), with no occurrence of neck hematoma, hemorrhagic stroke, ischemic stroke or transient ischemic attack. During a median follow-up of 10 (9, 12) months, there were no cases of restenosis requiring retreatment, ipsilateral ischemic stroke or transient ischemic attack. The median mRS score at last follow-up was 0 (0, 1). The last follow-up mRS score was lower than the preoperative mRS score (Z = - 0.289, P = 0.004). Conclusions The hybrid operation is safe and effective for treating symptomatic chronic CCAO. In clinical practice, CEA combined with retrograde transcarotid recanalization may demonstrate relatively significant advantages for symptomatic chronic CCAO with shorter residual stumps, potentially facilitating more optimal revascularization outcomes. However, further case validation remains necessary.

Background: Prior randomised trials have shown no benefit of stenting added to medical therapy for patients with symptomatic severe intracranial atherosclerotic stenosis (ICAS). But the potential for stenting to provide benefits over a longer time horizon remains to be explored. We aimed to directly compare the long-term effect of stenting versus medical therapy alone in a randomised trial. Methods: We extended the follow-up of subjects enrolled in a multicentre, open-label, randomised trial conducted at 8 centres in China. Patients with TIA or ischaemic stroke (mRS 0-2) attributed to severe symptomatic ICAS (70%-99%) were enrolled. Eligible patients were randomised in a 1:1 ratio to stenting plus medical therapy vs. medical therapy alone. The primary outcome was a composite of stroke or death within 30 days or stroke in territory of qualifying artery beyond 30 days. Other secondary outcomes included stroke in territory of qualifying artery, as well as disabling stroke or death after enrollment. This trial was registered in ClinicalTrials.gov with identifier NCT01763320. Findings: 358 patients (stenting 176 vs. medical 182) were recruited from Mar 5, 2014 and followed up till Jan 22, 2024. The median duration of follow-up was 7·4 years (IQR 6·0-8·0). The primary outcome was not significantly different (stenting 14·8% vs. medical 14·3%; HR, 1·02 [95% CI, 0·58-1·77]; P = 0·97). No significant difference was found between groups for the secondary outcomes: stroke in territory of qualifying artery (14·8% vs. 14·3%; HR, 1.02 [95% CI, 0·58-1·77]; P = 0·97), disabling stroke or death (16·5% vs. 14·3%; HR, 1·12 [95% CI, 0·66-1·91]; P = 0·70) and death (9·1% vs. 7·1%; HR, 1·22 [95% CI, 0·58-2·58]; P = 0·60). Interpretations: This study provides compelling evidence that, even over prolonged observed periods, the addition of stenting to medical therapy does not confer additional benefits to medical therapy alone in patients with symptomatic severe ICAS. These results underscore the importance of medical therapy as the cornerstone of long-term stroke prevention in this patient population. Trial Registration: This trial was registered in ClinicalTrials.gov with identifier NCT01763320. Funding: This work was supported by a research grant (2011BAI08B04) from the National Health Commission of the People’s Republic of China. Stryker Neurovascular (Stryker neurovascular, Fremont, CA, USA) provided supplemental funding for third-party site monitoring and auditing. This work was supported by a research grant (2011BAI08B04) from the National Health Commission of the People’s Republic of China. Stryker Neurovascular (Stryker neurovascular, Fremont, CA, USA) provided supplemental funding for third-party site monitoring and auditing. Declaration of Interest: CPD reports consultancy to the Penumbra, NoNO, and Euphrates Vascular Inc. Dr Jiao reported receiving grants from the Ministry of Science and Technology of the People’s Republic of China (2011BAI08B04) and Stryker Neurovascular during the conduct of the study, as well as grants from Ministry of Science and Technology of the People’s Republic of China (SQ2016YFSF110141) outside the submitted work. No other disclosures were reported. All other authors declare no competing interests. Ethical Approval: The institutional review board of Xuanwu Hospital reviewed and approved the study ([2013]013).

BackgroundA recent trial failed to show any benefit of stenting plus medical therapy over medical therapy alone in patients with symptomatic intracranial stenosis. We aimed to examine whether the symptomatic qualifying artery modifies the effect of stenting plus medical therapy. MethodsThis is a post-hoc analysis of the CASSISS trial that included patients with symptomatic intracranial stenosis, randomly assigned to undergo stenting plus medical therapy or medical therapy alone; 358/380 patients were included. Multivariable logistic regression analysis was used with an interaction term to estimate the altered treatment effect by the qualifying artery. The primary outcome was a composite of stroke or death within 30 days or stroke in the qualifying artery territory beyond 30 days through 1 year. The five secondary outcomes included stroke or death related to the qualifying artery territory at 2 and 3 years. ResultsNo significant treatment allocation-by-stenosis site interaction was observed (P-interaction=0.435). Compared with medical therapy alone, the adjusted ORs for stenting plus medical therapy were 2.73 (95% CI 0.42 to 17.65) for internal carotid artery stenosis, 1.20 (95% CI 0.29 to 4.99) for M1 stenosis, 0.23 (95% CI 0.02 to 2.31) for vertebral artery stenosis, and 1.33 (95% CI 0.34 to 5.28) for basilar artery stenosis. Of the five secondary outcomes, none showed a significant treatment allocation-by-stenosis site interaction including stroke in the qualifying artery territory at 2 years (P-interaction=0.659) and 3 years (P-interaction=0.493). ConclusionsAmong patients with transient ischemic attacks or ischemic stroke due to severe intracranial atherosclerotic stenosis, there was no evidence that the symptomatic qualifying artery could determine the addition of stenting to medical therapy.

Patients with symptomatic chronic internal carotid artery occlusion (ICAO) face a high risk of recurrent stroke despite receiving aggressive medical therapy. This study aimed to evaluate the effectiveness and safety of hybrid surgery in treating symptomatic chronic ICAO. This retrospective case series was conducted at a single center. From January 2019 to December 2022, patients with symptomatic chronic ICAO who underwent hybrid surgery were included. We collected baseline data, lesion characteristics, revascularization rates, perioperative complications, and follow-up outcomes. The study enrolled 27 patients, comprising 22 males and 5 females, with symptomatic chronic ICAO. The hybrid surgery achieved a technical success rate of 100

Moyamoya disease is a relatively rare cerebrovascular disease. Extracranial and intracranial vascular bypass is the first choice for moyamoya disease. However, due to the risk of complications and symptoms recurrence after surgery, there is still some controversy about surgical treatment. In recent years, with the development of minimally invasive interventional technology, the endovascular treatment of atherosclerotic ischemic cerebrovascular disease has been widely carried out in the world. Some doctors are also beginning to try endovascular treatment of ischemic moyamoya disease, but its efficacy and safety are still unclear. This article reviews the endovascular treatment of ischemic moyamoya disease.

目的 检测颈动脉粥样硬化(CAS)患者血清中总胆固醇(T C)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)以及miR-26水平,并通过CAS小鼠模型探索来自脂肪来源干细胞(ADSC-exos)外泌体的miR-26对颈动脉粥样硬化斑块稳定性的影响.方法 选择2020-2022年本院电生理科颈部血管彩超筛查的100例患者为研究对象,其中健康者50例,CAS患者50例,检测其血清miR-26含量.构建CAS小鼠模型以及miR-26过表达的脂肪间充质干细胞模型,将从细胞模型中提取的外泌体以200μL/小鼠的剂量注射到模型小鼠的尾静脉,在治疗2周后测量小鼠颈动脉宽度并检测血清中TC、HDL-C以及LDL-C水平,以验证miR-26对颈动脉粥样硬化斑块的影响.结果 CAS患者动脉粥样硬化程度与颈动脉内膜-中膜厚度(IMT)呈正相关(r=0.972,P<0.0001),与颈动脉血流速度呈负相关(r=-0.926,P<0.0001),与患者血清中miR-26水平呈负相关(r=-0.972,P<0.001),与血脂TC、LDL-C水平呈正相关(r=0.972,P<0.001;r=0.969,P<0.001),与HDL-C水平呈负相关(r=-0.950,P<0.0001).CAS小鼠模型血清中的miR-26水平相较于对照鼠明显降低,血清总胆固醇水平明显高于健康小鼠;血清HDL-C水平明显低于健康小鼠.这些指标经脂肪来源干细胞的外泌体miR-26治疗后得到明显改善.结论 miR-26在CAS中具有减小斑块体积、稳定斑块的积极作用,可能成为未来CAS治疗的新靶点.

BACKGROUND:Cerebral hyperperfusion syndrome (CHS) is known as a complication after bypass surgery for Moyamoya disease (MMD). However, the incidence of CHS has not been accurately reported, and there is no consensus on the risk factors associated with it. AIM:The aim of this study was to determine the risk factors associated with postoperative CHS after surgical combined revascularization used to treat adult patients with MMD. OBJECTIVE:To assess the frequency and characteristics of CHS in patients with MMD after revascularization operations. METHODS:Patients who received combined revascularization from Jan 2021 to Nov 2022 were retrospectively reviewed. Preoperative clinical characteristics and radiographic features were recorded. Postoperative CHS after surgery were examined. Multivariate logistic regression analyses were performed to identify the risk factors for CHS. RESULTS:A total of 133 patients (141 hemispheres) were included in this study. Postoperative CHS were observed in 28 hemispheres (19.8%), including focal cerebral hyperperfusion syndrome (FCHS) in 20 hemispheres (14.2%), hemorrhage in 4 (2.8%) hemispheres, seizures in 4 (2.8%) hemispheres. The results of multivariate logistic regression analysis indicated that preoperative hypertension (OR 4.705, 95% CI 1.323 ~ 12.554, p = 0.014), cerebral hemorrhage onset (OR 5.390, 95% CI 1.408 ~ 20.642, p = 0.014) and higher Hct level (OR 1.171, 95% CI 1.051 ~ 1.305, p = 0.004) were significantly associated with CHS after combined revascularization. CONCLUSIONS:Preoperative hypertension, cerebral hemorrhage onset, and higher Hct level were independent risk factors for CHS after combined revascularization.

目的 比较伴脑缺血症状的大脑中动脉瘤患者行显微外科夹闭与血管内治疗的安全性差异.方法 回顾性连续纳入2014 年1 月至2022 年9 月于哈尔滨医科大学附属第一医院就诊的135 例伴脑缺血症状的大脑中动脉未破裂动脉瘤患者,并根据治疗方式将所有患者分为血管内治疗组和显微外科夹闭组.收集患者的基线资料和影像学资料并进行组间比较.基线资料包括年龄、性别、高危因素(高血压病、糖尿病、吸烟史、饮酒史)、脑缺血症状类型[短暂性脑缺血发作(TIA)、脑梗死]、末次脑缺血症状至入院时间、术前改良Rankin量表(mRS)评分.影像学资料包括动脉瘤部位、动脉瘤最大径、是否合并血管重度狭窄(狭窄率70%～99%)、合并血管重度狭窄的部位(前循环、后循环)、合并血管狭窄侧别(动脉瘤同侧、动脉瘤对侧)、是否合并多支血管狭窄.分析并比较两组在主要终点事件及次要终点事件发生率上的差异.主要终点事件定义为术后30d内与治疗相关的严重不良事件(SAEs)的发生率;次要终点事件定义为术后即刻至末次随访期间(≥6 个月)与治疗相关的任何神经系统并发症发生率、致残性卒中发生率、病死率及动脉瘤完全闭塞率.随访期间,采用DSA评估患者的动脉瘤完全闭塞情况;采用MRI或CT评估患者的术后神经系统并发症;采用mRS评分评估患者的临床预后.结果 血管内治疗组纳入46 例患者共48 个动脉瘤,显微外科夹闭组纳入89 例患者共100 个动脉瘤,两组的术前基线资料差异均无统计学意义(均P＞0.05).术后30d内共有26 例(19.3%)患者出现与治疗相关的SAEs,其中血管内治疗组5 例(10.9%),显微外科夹闭组21 例(23.6%),差异有统计学意义(P =0.035).所有患者接受了临床随访,中位随访时间为27.5(12.0,58.5)个月.末次临床随访结果显示,血管内治疗组、显微外科夹闭组术后即刻至末次随访期间与治疗相关的任何神经系统并发症发生率分别为17.4%(8/46)和33.7%(30/89),差异有统计学意义(P =0.022);致残性卒中的发生率分别为8.7%(4/46)和16.9%(15/89),差异无统计学意义(P =0.199);病死率分别为4.3%(2/46)和4.5%(4/89),差异无统计意义(P =0.969);血管内治疗组、显微外科夹闭组末次随访时mRS评分≤2 分患者占比分别为91.3%(42/46)和86.5%(77/89),差异无统计学意义(P =0.418).共有89 例(65.9%)患者(90 个动脉瘤)完成了DSA随访,其中血管内治疗组37 例(38 个动脉瘤)、显微外科夹闭组52 例(52 个动脉瘤),随访中位时间为11.5(6.0,12.0)个月;末次DSA随访结果显示,血管内治疗组、显微外科夹闭组动脉瘤完全闭塞率差异无统计学意义(76.3%比90.4%,P =0.066).结论 对于伴脑缺血症状的大脑中动脉瘤患者,血管内治疗术后30d与治疗相关的SAEs的发生率和术后即刻至末次随访期间的任何与治疗相关的神经系统并发症的发生率均低于显微外科夹闭组,结论仍需大型多中心随机对照研究进一步验证.

目的 探究自膨胀式支架治疗颅内动脉粥样硬化性狭窄(ICAS)术后出现不良事件及再狭窄的危险因素.方法 回顾性连续纳入2017年6月至2020年6月哈尔滨医科大学附属第一医院神经外科应用自膨胀式支架(Enterprise、Wingspan支架)治疗的ICAS患者.记录患者基线资料、实验室检查及影像检查资料(病变部位、术前狭窄程度、狭窄长度及Mori分型、术后残余狭窄率等)及治疗相关资料(手术时间以及支架和球囊品牌、类型及直径),观察术后即刻支架移位及血栓形成发生情况,术后30 d内根据患者的临床表现及影像学检查判断有无手术相关卒中(出血性卒中、缺血性卒中)、短暂性脑缺血发作或死亡等安全性结局发生.术后定期通过电话或门诊进行临床随访,术后6个月后,通过DSA或CT血管成像(CTA)或MR血管成像(MRA)检查进行影像学随访,观察与置入支架的责任区域相关的缺血性事件(缺血性卒中、短暂性脑缺血发作)、死亡及支架内再狭窄(ISR,狭窄率≥70％)情况.应用单因素分析及多因素Logistic回归分析研究影响术后30 d内安全性结局及随访时ISR发生的因素.结果 共纳入311例患者,女106例(34.1％),男205例(65.9％);平均年龄(58±9)岁.术前平均狭窄率为(86±8)％,平均狭窄长度为(10±4)mm.手术均成功,无术后即刻支架移位及血栓形成,术后平均残余狭窄率为(25±9)％.术后30 d内发生与手术相关的任何卒中或死亡27例(8.7％),其中蛛网膜下腔出血9例,脑实质出血7例,缺血性卒中11例,1例出血性卒中患者死亡.单因素分析结果显示,合并糖尿病、冠心病与术后30 d内安全性结局事件发生相关(均P<0.05),多因素Logistic回归分析并未发现与术后30 d内安全性结局相关的独立危险因素.281例(90.9％)患者接受临床随访,随访中位时间375(320,480)d,发生与责任区域相关的缺血性事件23例(8.2％;缺血性卒中12例,短暂性脑缺血发作11例).237例(76.7％)患者接受影像随访,随访中位时间360(240,502)d,出现ISR 32例(13.5％),15例(6.3％)为症状性.多因素Logistic回归分析结果显示,术后残余狭窄程度与ISR的发生相关(OR=1.07,95％CI:1.02～1.12;P=0.004).结论 自膨胀式支架可用于治疗ICAS,未发现与手术相关并发症的独立危险因素,术后残余狭窄程度与术后远期ISR独立相关.

目的 探讨复合手术治疗症状性椎动脉颅外段闭塞的疗效.方法 回顾性分析2021年4月至2022年8月哈尔滨医科大学附属第一医院神经外科采用复合手术治疗的9例症状性椎动脉颅外段闭塞患者的临床资料.所有患者均采用椎动脉内膜切除术联合血管内治疗(复合手术).术后观察手术切口愈合、声带功能、瞳孔及眼睑活动情况.术后7 d内复查头颅MRI弥散加权成像(DWI)、椎动脉颅外段CT血管成像(CTA)或数字减影血管造影(DSA),出院时评估改良Rankin量表评分(mRS).术后3个月进行临床和影像学随访,临床随访内容包括mRS,以及后循环缺血性卒中、死亡事件;影像学随访方法包括CTA或DSA.结果 9例患者的椎动脉颅外段均成功再通,术中出现血管夹层1例.9例患者均置入支架,其中置入1枚1例,2枚3例,3枚5例.术后无一例发生症状性或无症状性脑梗死.术后出现Homer综合征2例,声音嘶哑2例,局部切口感染1例.复查椎动脉颅外段CTA结果显示,8例血管再通良好,1例出现无症状性血管闭塞.出院时mRS 0分7例,1分2例.9例患者的随访时间为3～18个月.至末次随访,mRS 0分7例,1分2例,9例患者均未出现后循环新发脑梗死;8例患者的椎动脉血流通畅.结论 初步观察发现,复合手术治疗症状性椎动脉颅外段闭塞患者的疗效较好,且具有一定的安全性.

ImportancePrior randomized trials have generally shown harm or no benefit of stenting added to medical therapy for patients with symptomatic severe intracranial atherosclerotic stenosis, but it remains uncertain as to whether refined patient selection and more experienced surgeons might result in improved outcomes.ObjectiveTo compare stenting plus medical therapy vs medical therapy alone in patients with symptomatic severe intracranial atherosclerotic stenosis.Design, Setting, and ParticipantsMulticenter, open-label, randomized, outcome assessor-blinded trial conducted at 8 centers in China. A total of 380 patients with transient ischemic attack or nondisabling, nonperforator (defined as nonbrainstem or non-basal ganglia end artery) territory ischemic stroke attributed to severe intracranial stenosis (70%-99%) and beyond a duration of 3 weeks from the latest ischemic symptom onset were recruited between March 5, 2014, and November 10, 2016, and followed up for 3 years (final follow-up: November 10, 2019).InterventionsMedical therapy plus stenting (n = 176) or medical therapy alone (n = 182). Medical therapy included dual-antiplatelet therapy for 90 days (single antiplatelet therapy thereafter) and stroke risk factor control.Main Outcomes and MeasuresThe primary outcome was a composite of stroke or death within 30 days or stroke in the qualifying artery territory beyond 30 days through 1 year. There were 5 secondary outcomes, including stroke in the qualifying artery territory at 2 years and 3 years as well as mortality at 3 years.ResultsAmong 380 patients who were randomized, 358 were confirmed eligible (mean age, 56.3 years; 263 male [73.5%]) and 343 (95.8%) completed the trial. For the stenting plus medical therapy group vs medical therapy alone, no significant difference was found for the primary outcome of risk of stroke or death (8.0% [14/176] vs 7.2% [13/181]; difference, 0.4% [95% CI, -5.0% to 5.9%]; hazard ratio, 1.10 [95% CI, 0.52-2.35]; P = .82). Of the 5 prespecified secondary end points, none showed a significant difference including stroke in the qualifying artery territory at 2 years (9.9% [17/171] vs 9.0% [16/178]; difference, 0.7% [95% CI, -5.4% to 6.7%]; hazard ratio, 1.10 [95% CI, 0.56-2.16]; P = .80) and 3 years (11.3% [19/168] vs 11.2% [19/170]; difference, -0.2% [95% CI, -7.0% to 6.5%]; hazard ratio, 1.00 [95% CI, 0.53-1.90]; P > .99). Mortality at 3 years was 4.4% (7/160) in the stenting plus medical therapy group vs 1.3% (2/159) in the medical therapy alone group (difference, 3.2% [95% CI, -0.5% to 6.9%]; hazard ratio, 3.75 [95% CI, 0.77-18.13]; P = .08).Conclusions and RelevanceAmong patients with transient ischemic attack or ischemic stroke due to symptomatic severe intracranial atherosclerotic stenosis, the addition of percutaneous transluminal angioplasty and stenting to medical therapy, compared with medical therapy alone, resulted in no significant difference in the risk of stroke or death within 30 days or stroke in the qualifying artery territory beyond 30 days through 1 year. The findings do not support the addition of percutaneous transluminal angioplasty and stenting to medical therapy for the treatment of patients with symptomatic severe intracranial atherosclerotic stenosis.Trial RegistrationClinicalTrials.gov Identifier: NCT01763320.

ObjectiveSeveral forms of cerebral revascularization have been carried out to treat moyamoya disease, however, the existing methods are accompanied by a variety of complications. In this study, the authors aimed to evaluate the clinical and angiographic outcomes of a new surgical procedure: superficial temporal artery–middle cerebral artery (STA-MCA) anastomosis combined with multiple burr hole (MBH) surgery and dural inversion synangiosis for the treatment of moyamoya disease in adults.MethodsPatients treated for moyamoya disease from August 2019 to July 2021 were retrospectively reviewed. Clinical data, including perioperative complications and follow-up outcomes, were noted. Preoperative and postoperative angiograms were compared, and the diameters of the frontal branch of the superficial temporal artery (F-STA), the deep temporal artery (DTA), the distal superficial temporal artery (STA) before the bifurcation and the middle meningeal artery (MMA) were measured on preoperative and postoperative angiograms. Meanwhile, a Matsushima score was assigned from postoperative angiograms.ResultsThis study included 66 patients (67 hemispheres). During the follow-up period, a median of 18 (IQR, 13–21) months, no stroke or death occurred in any of the patients. The clinical outcomes were excellent in 27 patients (40.9%), good in 34 patients (51.6%), fair in 4 patients (6.0%), and poor in 1 patient (1.5%); the overall rate of favorable clinical outcomes (excellent and good) was 92.5%. The modified Rankin Scale (mRS) score was significantly improved at follow-up (P < 0.001). There were 41 hemispheres imaged by cerebral angiography after the operation, at a median postoperative interval of 9 (IQR, 8–12) months; among them, 34 (82.9%) hemispheres had Matsushima scores of grade A and grade B. The average postoperative diameters in the STA, DTA and MMA were increased significantly in 41 hemispheres at follow-up (P < 0.001). Sixteen (24.2%) patients suffered from perioperative complications, including focal hyperperfusion syndrome (HS) in 8 (12.2%) patients, cerebral infarction in 3 (4.5%) patients (including one case accompanied by wound infection), cerebral hemorrhage in 2 (3.0%) patients, seizures in 2 (3.0%) patients, and subdural effusion in 1 (1.5%) patient.ConclusionsThe procedure of STA-MCA anastomosis combined with MBH surgery and dural inversion synangiosis may be a safe and effective treatment for adult patients with moyamoya disease.

Background Chronic subdural hematoma (cSDH) is a common neurosurgical pathology associated with older age. The burr hole drainage is a predominant technique with a lower incidence of recurrence and morbidity. The blind placement of the subdural drain could result in intracerebral hemorrhage. This paper describes a simple and reliable technique for drainage catheter placement in cSDH to reduce intracerebral hemorrhage. Methods Forty-nine consecutive patients with cSDH were treated with The Guidewire-assisted Drainage Catheter Placement Technique between July 2019 and June 2021. Epidemiological, clinical and radiographical data were collected and reviewed. The operative technique consists of an angular guidewire tip and catheter. Under the navigation of the guidewire, the catheter is inserted into the subdural space and the length of catheter remaining in the subdural space was 4-5cm. The catheter was tunneled subcutaneously and fixed at the point where it emerged from the scalp. Results Forty-nine consecutive patients underwent 55 The Guidewire-assisted Drainage Catheter Placement. The gender distribution was 37 men and 12 women. The mean age was 69.3 years. The patients presented with headache (31 patients), weakness of limbs (28 patients), speech disturbances (7 patients), and Altered behavior (6 patients). Neither intracerebral hemorrhages nor post-operative seizure occurred. Forty-seven patients were improved after the operation. The recurrence occurred in one patient. Conclusions The Guidewire-assisted Drainage Catheter Placement Technique is a reliable method for the insertion of a subdural catheter to evacuate of the Chronic Subdural Hematoma, and is associated with an extremely low risk to cortical structures and cerebral veins.

BackgroundChronic subdural hematoma (cSDH) is a common neurosurgical pathology associated with older age. The burr hole drainage is a predominant technique with a lower incidence of recurrence and morbidity. The blind placement of the subdural drain could result in intracerebral hemorrhage. This paper describes a simple and reliable technique for drainage catheter placement in cSDH to reduce intracerebral hemorrhage.MethodsForty-nine consecutive patients with cSDH were treated with The Guidewire-assisted Drainage Catheter Placement Technique between July 2019 and June 2021. Epidemiological, clinical and radiographical data were collected and reviewed. The operative technique consists of an angular guidewire tip and catheter. Under the navigation of the guidewire, the catheter is inserted into the subdural space and the length of catheter remaining in the subdural space was 4–5 cm. The catheter was tunneled subcutaneously and fixed at the point where it emerged from the scalp.ResultsForty-nine consecutive patients underwent 55 The Guidewire-assisted Drainage Catheter Placement. The gender distribution was 37 men and 12 women. The mean age was 69.3 years. The patients presented with headache (31 patients), weakness of limbs (28 patients), speech disturbances (7 patients), and Altered behavior (6 patients). Neither intracerebral hemorrhages nor post-operative seizure occurred. Forty-seven patients were improved after the operation. The recurrence occurred in one patient.ConclusionsThe Guidewire-assisted Drainage Catheter Placement Technique is a reliable method for the insertion of a subdural catheter to evacuate of the Chronic Subdural Hematoma, and is associated with an extremely low risk to cortical structures and cerebral veins.

Background: This study explored the serum concentrations of miR-26 in patients with carotid atherosclerosis (CAS) and defined the roles and mechanisms of miR-26 derived from the exosomes of adipose-derived stem cells (ADSC-exos). Methods: The carotid artery width was diagnosed by ultrasound examination in patients with different degrees of CAS. The serum levels of total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) in patients were detected by biochemistry. The serum levels of miR-26 were determined by quantitative polymerase chain reaction (qPCR). A model of CAS in ApoE(-/-) mice fed with a rich-fat diet was established to analyze the regulatory effects of serum miR-26 on blood lipids in mice. Adipose mesenchymal stem cell lines transfected with miR-26 were established. The regulatory relationship between the expression levels of inflammatory factors, including tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6) and IL-1 beta, and the expression levels of miR-26 in the supernatant of each group of cells was determined by qPCR. The ADSC-exos were extracted from ADSCs and injected into model mice through the tail vein. The therapeutic effect of ADSCs expressing miR-26 on model mice was evaluated by detecting the levels of inflammatory factors and blood lipids in the serum of the mice. Results: The degree of atherosclerosis (AS) was positively associated with the intima-media thickness (IMT) of the carotid artery. The serum levels of miR-26 in patients were inversely correlated with the levels of blood lipids (TC, TG, and LDL-C), and positively correlated with HDL-C levels. Similarly, in the CAS mouse model, the serum levels of miR-26 were inversely correlated with the levels of blood lipids (TC, TG, and LDL-C), and positively correlated with HDL-C level. In ADSCs transfected with miR-26, the miR-26 expression in the cell supernatant was negatively regulated by the expression of inflammatory factors, TNF-alpha, IL-6, and IL-1 beta, in the cell supernatant. ADSC-exos expressing miR-26 has positive effects on correcting blood lipids and inflammatory factors in the mouse model of CAS. Conclusions: miR-26 has an active role in CAS and may be a novel target for the treatment of CAS in the future.

Acute ischemic stroke (AIS) continues to be one of the most important medical and social problems in our country. Carotid endarterectomy (CEA) is the standard and effective surgical treatment for AIS prevention in patients with significant carotid artery stenosis. Even though CEA is a safe procedure when performed by an experienced surgeon, it is still associated with risks of operative complications inherent to any surgical intervention. Therefore, immediate postoperative appropriate adjuvant or neurological salvage therapy for AIS patients after CEA is necessary. In this study,we report three patients in our institution who received immediate post-operative interventional therapy for neurological salvage, in the setting of cerebral embolism after CEA.

Because of the anatomical characteristics and the complexity of procedures, the treatment of complex anterior circulation aneurysms is a real challenge. Direct surgery, whether by interventional neuroradiology or microsurgical clipping, are not always applicable. In patients that would not tolerate parent or collateral artery sacrification, the adjunction of revascularization procedure by using bypass technique might be necessary. In this article, the authors introduce different aspects in the management of patients with a complex anterior circulation aneurysm using bypass, the indications and types of bypass, surgical techniques and complications.

PURPOSE:Using retinal optical coherence tomography angiography (OCTA), we aimed to investigate the changes in important indicators of cerebral microcirculatory disorders, such as the properties of the radial peripapillary capillaries, vascular complexes, and the retinal nerve fiber layer, caused by carotid stenosis and postoperative reperfusion.METHODS:In this prospective longitudinal cohort study, we recruited 40 carotid stenosis patients and 89 healthy volunteers in the First Affiliated Hospital of Harbin Medical University (Harbin, China). Eyes with ipsilateral carotid stenosis constituted the experimental group, while the fellow eyes constituted the contralateral eye group. Digital subtraction angiography, CT perfusion imaging (CTP), and OCTA examinations were performed in all subjects. The vessel density of the radial peripapillary capillaries (RPC), superficial retinal vascular complexes (SVC), deep vascular complexes (DVC), choriocapillaris (CC), and the thickness of the retinal nerve fiber layer (RNFL) were assessed. Propensity-matched analysis was undertaken to adjust for covariate imbalances. Intergroup comparative analysis was conducted, and the paired sample t-test was used to evaluate the preoperative and postoperative changes in OCTA variables.RESULTS:The ocular vessel density in the experimental group was significantly lower than that in the control group (RPC: 55.95 vs. 57.24, P = 0.0161; SVC: 48.65 vs. 52.22, P = 0.0006; DVC: 49.65 vs. 57.50, P < 0.0001). Participants with severe carotid stenosis have reduced contralateral ocular vessel density (RPC 54.30; SVC 48.50; DVC 50.80). Unilateral stenosis removal resulted in an increase in vessel density on both sides, which was detected by OCTA on the 4th day (RPC, P < 0.0001; SVC, P = 0.0104; DVC, P = 0.0104). Moreover, the ocular perfusion was consistent with that established by CTP.CONCLUSION:OCTA can be used for sensitive detection and accurate evaluation of decreased ocular perfusion caused by carotid stenosis and may thus have the potential for application in noninvasive detection of cerebral microcirculation disorders. This trial is registered with NCT04326842.