OBJECTIVES:Chronic internal carotid artery occlusion (CICAO) poses a considerable risk for stroke. While endovascular revascularization holds promise as a potential therapy, its real-world efficacy, safety, and long-term outcomes remain underexplored. This study aims to assess the effectiveness, safety, and long-term outcomes of endovascular revascularization in symptomatic CICAO patients refractory to medical therapy. MATERIALS AND METHODS:A retrospective cohort study was conducted to collect clinical and surgical data from CICAO patients meeting the inclusion criteria for endovascular revascularization therapy. Patients were categorized into groups based on the success or failure of revascularization procedures. Follow-up assessments were undertaken to ascertain patients' prognoses and survival outcomes. Logistic multivariate analysis was employed to identify risk factors associated with primary and secondary outcome events. COX proportional hazard regression was used to compare the risk ratios of these events between the two groups. RESULTS:The study included 59 patients undergoing 62 procedures with a 75.81 % success rate for revascularization. Perioperative complications were 6.45 %, and the average follow-up duration was 36.53 ± 3.92 months. In the successful revascularization group, the primary endpoint event rate was 6.52 %, contrasting with 23.08 % in the non-revascularization group. Carotid artery occlusion and diabetes emerged as independent risk factors for primary endpoint events. A significant difference was observed between the two groups in both primary endpoint (RR 0.16, [95 %CI, 0.03-0.84]) and total endpoint event rates (RR 0.27, [95 %CI, 0.08-0.96]) CONCLUSIONS: Failure of revascularization may be associated with an increased risk of recurrent cerebrovascular events in patients with CICAO, while successful endovascular revascularization appears to be linked to a lower incidence of such events. However, these results should be interpreted with caution due the relatively small sample size.

BACKGROUND:Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has emerged as an effective therapy for Meige syndrome (MS). However, the optimal stimulation site within STN and the most effective stimulation fiber tracts have not been investigated. METHODS:Based on the discovery cohort (n = 65), we first identified the optimal stimulation site within the STN using the sweet spot mapping method. Second, we screened for the fiber tracts accounting for optimal clinical outcomes by the fiber filtering approach. Third, based on the above findings, we constructed outcome prediction models and estimated their predictive performance in the discovery cohort and an independent validation cohort (n = 20). Finally, we introduced two prospective cases to illustrate if and how the optimal stimulation site and fiber tracts could facilitate precise electrode targeting and postoperative programming. RESULTS:The optimal stimulation site was mapped to the anterodorsal portion of the STN-motor subregion. Superior STN-DBS outcomes were positively correlated with stimulation of the fibers projecting to the primary motor cortices, the supplementary motor areas, and the globus pallidus internus. Notably, spatial overlap between individual stimulation volumes and the resultant sweet spot or fiber filtering models could cross-predict symptom improvement in out-of-model patients. Moreover, the models could guide electrode implantation and active contact selection in prospective cases. CONCLUSION:Our study underscores the potential of optimizing stimulation sites and fibers to predict clinical improvement, and provides new insights into the ongoing efforts of precise surgical targeting and computer-assisted DBS programming.

In recent years, findings suggest that long noncoding RNAs (lncRNAs) are closely related to the development of atherosclerosis (AS), but there is a lack of studies on the involvement of lncRNA-regulated cytosolic burial in the regulation of AS. In this study, we investigated the mechanism by which lncRNA SCARNA8 affects macrophage cell burial to regulate AS. The cytosolic burial-associated target gene regulated by lncRNA SCARNA8 was PPARG. LncRNA SCARNA8 was increased in the carotid unstable plaque group, whereas PPARG was decreased. Ox-LDL led to the up-regulation of lncRNA SCARNA8 expression and apoptosis in Raw264.7 cells in a time-, concentration-dependent manner. Knockdown of lncRNA SCARNA8 upregulated PPARG and reduced apoptosis in Raw264.7 cells. In addition, knockdown of lncRNA SCARNA8 improved the stability of atherosclerotic plaques by promoting cellular burial of Raw264.7 cells. LncRNA SCARNA8 is a key regulator of plaque vulnerability, and targeting lncRNA SCARNA8 May provide a novel means for the prevention and treatment of AS.

OBJECTIVE:To precise classify sacral meningeal cysts, effective guide minimally invasive neurosurgery and postoperative personalized rehabilitation by multiple dimensions radiographic reconstruction MRI. METHODS:From March to December 2021, based on the original 3D-fast imaging employing steadystate acquisition (FIESTA) scanning sequence, 92 patients with sacral meningeal cysts were pre-operatively evaluated by multiple dimensional reconstruction MRI. The shape of nerve root and the leakage of cyst were reconstructed according to the direction of nerve root or leakage track showed on original MRI scans. Sacral canal cysts were accurately classified as including nerve root and without nerve root, so as to accurately design the incision of skin and formulate corresponding open range of the posterior wall of the sacral canal. Under the microscope intraoperation, the shape of the nerve roots inside cysts or leakage track of the cysts without nerve roots were verified and explored. After the reinforcement and shaping operation, several reexaminations of multiple dimensional reconstruction MRI were performed to understand the deformation of the nerve root and hydrops in the operation cavity, so as to formulate a persona-lized rehabilitation plan for the patients. RESULTS:Among the 92 patients with sacral mengingeal cyst, 58 (63.0%) cysts with nerve root cyst, 29 (31.5%) cysts without nerve root cyst, and 5 (5.4%) cysts with mixed sacral canal cyst. In 58 patients with nerve root cysts, the accuracy of preoperative clinical classification on MRI image reached 96.6% (56/58) through confirmation by operating microscope. Only 2 cases of large single cyst with nerve root on the head of cyst were mistaken for without nerve root type. In 29 patients with sacral cyst without nerve root, the accuracy of preoperative image reached 100% through confirmation by operating microscope. The accuracy of judging the internal nerve root and leakage of 12 cases with recurrent sacral cyst was also 100%. Two cases of delayed postoperative hydrops were found one month after operation. After rehabilitation treatment by moxibustion and bathing, the hydrops disappeared 4-6 months after operation. CONCLUSION:Multiple dimensional reconstruction MRI can precisely make clinical classification of sacral meningeal cysts before operation, guide minimally invasive neurosurgery effectively, and improve the rehabilitation effect.

BACKGROUND:The cerebellum has been widely implicated in the pathogenesis of craniocervical dystonia (CCD). Subthalamic nucleus deep brain stimulation (STN-DBS) has emerged as an effective therapy for CCD. However, the roles of cerebellar afferent and efferent pathways in CCD pathogenesis and STN-DBS treatment remain poorly understood. OBJECTIVES:To identify microstructural and connectivity alterations in the cerebellar afferent/efferent pathways in CCD, and to investigate their associations with clinical characteristics. METHODS:We enrolled 31 CCD patients undergoing STN-DBS and 33 age- and sex-matched healthy controls. Probabilistic tractography was performed to reconstruct three paired tracts: decussating dentato-rubro-thalamic tract (d-DRTT), non-decussating dentato-rubro-thalamic tract (nd-DRTT), and subthalamo-ponto-cerebellar tract (SPCT). First, we quantified and compared whole-tract mean fractional anisotropy (FA), along-tract FA, and structural connectivity strength between groups. Second, we assessed correlations between these structural metrics and clinical variables (disease duration, baseline severity, and DBS improvement). Finally, volume of tissue activated (VTA)-seeded tractography was conducted to explore its relationship with DBS outcomes in the CCD group. RESULTS:Compared with healthy controls, CCD patients presented significantly higher FA in bilateral nd-DRTT, particularly in regions corresponding to the red nucleus and superior cerebellar peduncle. Moreover, bilateral VTA-cerebellum connectivity showed a significant positive association with DBS outcomes. CONCLUSIONS:Our study revealed a functional segregation of cerebellar pathways in CCD: the efferent pathways were linked to disease pathogenesis, whereas the afferent pathways were associated with STN-DBS outcomes. This study will foster a better understanding of the pathophysiological mechanisms of CCD and facilitate the development of optimized DBS strategies. © 2025 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Oral and craniofacial bone regeneration remains challenging due to unique anatomical and functional demands. Rodent models have limited translational value because of significant structural differences from humans. The study reveals high similarity in calvarial periosteal cell composition between miniature pigs and humans at single-cell resolution. ALPL+PDGFD+ (AP+) cells are identified as distinct calvarial periosteal stem cells (PeSCs) that possess self-renewal and differentiation potential in both swine and human calvarial periosteum. Postnatally, AP+ PeSCs exhibit reduced activity compared to their embryonic counterparts, with EGR1 recognized as a crucial factor for their activation. Upon activation, these cells effectively facilitate the repair of craniofacial bone injuries. EGR1 regulates PeSCs development by modulating BMP signaling through its Znf2 domain and activating these cells via the CTNNB1/WNT10B pathway through its Znf2/3 domains in response to injury. The validation of the findings using human cranial periosteal samples from various developmental stages (embryonic and adult) further supports the results obtained from large animal experiments, providing a solid scientific foundation for the clinical application of AP+ cranial periosteal stem cells. Additionally, targeting specific EGR1 domains for in situ activation of PeSCs offers a promising strategy for enhancing bone regeneration.

Surgical resection is essential for treating solid tumors, with success largely dependent on the complete excision of neoplastic cells. However, neurosurgical procedures must delicately balance tumor removal with the preservation of surrounding tissue. Achieving clear margins is particularly challenging in cases like glioblastoma due to the limitations of traditional white light visualization. These limitations often result in incomplete resections, leading to frequent recurrences, or excessive resection that harms vital neural structures, causing iatrogenic nerve damage, which can lead to sensory and functional deficits. Current statistics reveal a 90% recurrence rate for malignant gliomas. Similarly, an 8% incidence of iatrogenic nerve trauma contributes to an estimated 25 million cases of peripheral nerve injury globally each year. These figures underscore the urgent need for improved intraoperative techniques for lesion margin and nerve identification and visualization. Recent advances in neurosurgical imaging, such as fluorescence-guided surgery (FGS), have begun to address these challenges. Fluorescent agents used in FGS illuminate target tissues, although not all do so selectively. Despite the promising results of agents such as 5-aminolevulinic acid and indocyanine green, their applications are mainly limited by issues of sensitivity and specificity. Furthermore, these agents do not effectively address the need for precise nerve visualization. Nerve Peptide 41, a novel systemically administered fluorescent nerve-targeted probe, shows promise in filling this gap. This review assesses the major fluorescent imaging modalities in neurosurgery, highlighting each of their benefits, limitations, and potential.

Neutrophil to lymphocyte ratio (NLR) is a biomarker which is related with inflammation and atherosclerosis. Higher NLR is associated with vulnerability of carotid atherosclerotic plaques. Covert brain infarction (CBI) following carotid endarterectomy (CEA) indicates poor prognosis in cognization. In this study, we aimed to investigate the relationship between NLR and CBI in patients who accepted CEA. In this observational and retrospective cohort study, 333 patients who underwent CEA due to severe carotid artery stenosis were enrolled. NLR was acquired from routine blood tests upon admission. Postoperative CBI was detected on magnetic resonance imaging. Logistic regression analysis was used to examine the association between NLR and CBI. Patients with CBI had higher NLR (CBI patients: 2.45[1.76–3.58] vs. non-CBI patients: 2.31[1.82–2.88]; P = 0.05). NLR is a strong independent factor predicting the risk of CBI following CEA (odds ratio [OR], 1.740; 95

Background and purpose:Diabetes Mellitus (DM) is a common concomitant disease of spontaneous intracranial hemorrhage (ICH). Postoperative major adverse cerebrovascular events (post-MACEs) may diminish the surgical benefits of patients with ICH. However, evidence regarding the impact of DM on post-MACEs remains limited. Methods:This was a multicenter cohort study that enrolled ICH patients presenting to eight neurosurgery departments between January 1, 2015, and May 31, 2021. Patients were categorized into DM group and no diabetes mellitus (nDM) group, based on the presence or absence of DM. Intergroup comparisons were performed using chi-square tests for categorical variables and Mann-Whitney U tests for continuous variables. Multivariate logistic regression analysis was conducted to assess the impact of DM on post-MACEs and 30-days mortality after adjusting for confounding factors. A stratified analysis was also conducted based on the type of post-MACEs. Results:A total of 688 ICH patients were included in the study, of whom 576 (83.7%) were classified into the nDM group and 112 (16.3%) into the DM group. Compared with the nDM group, the DM group exhibited significantly higher incidences of overall post-MACEs (28.6%), ischemic post-MACEs (14.3%), hemorrhagic post-MACEs (23.2%), and 30-days mortality (9.8%). After adjusting for potential confounding factors including sex, age, alcohol, coronary heart disease, dyslipidemia, antiplatelet therapy, and intraventricular hemorrhage, DM remained a significant predictor of overall post-MACEs (OR: 1.790, 95%CI: 1.072-2.990, p = 0.026), ischemic post-MACEs (OR: 2.139, 95%CI: 1.090-4.197, p = 0.027), hemorrhagic post-MACEs (OR: 1.778, 95%CI: 1.015-3.114, p = 0.044), and 30-days mortality (OR: 3.593, 95%CI: 1.536-8.406, p = 0.003). Conclusion:In conclusion, this study demonstrates that DM serves as a significant risk factor for ischemic post-MACEs, hemorrhagic post-MACEs, and 30-days mortality among patients with ICH.

IntroductionThis study aims to utilize a DenseNet based deep learning framework to predict brain age in patients with Moyamoya disease (MMD), examining the relationship between brain age and disease severity to enhance diagnostic and prognostic capabilities.MethodsWe analyzed unenhanced MRI scans from 432 adult MMD patients and 565 normal controls collected between January 2018 and December 2022. Data preprocessing involved converting DICOM files to NIFTI format and labeling based on established diagnostic criteria. A DenseNet121 architecture, implemented using PyTorch, was employed to predict brain age. Statistical analyses included correlation assessments and comparisons between predicted brain age, chronological age, and MRA scores.ResultsThe predicted brain age for MMD patients was significantly higher than their chronological age, averaging 37.9 years versus 35.8 years (p < 0.01). For normal controls, predicted brain age matched chronological age at 36.5 years. Delta age (difference between predicted brain age and chronological age) was significantly elevated in MMD patients (p < 0.001) and positively correlated with MRA scores, indicating a link between arterial stenosis severity and accelerated brain aging.DiscussionThe DenseNet based model effectively predicts brain age, revealing that MMD patients experience accelerated brain aging correlated with disease severity. These findings highlight the potential of brain age prediction as a biomarker for MMD, aiding in personalized treatment strategies and early intervention. Future research should explore multi-center datasets and longitudinal data to validate and extend these findings.

Background and purpose:Spontaneous intracerebral hemorrhage (sICH) significantly affects patient outcomes. Diabetes mellitus (DM) is a common comorbidity associated with sICH; however, the influence of DM on hematoma expansion (HE) and clinical prognosis in sICH patients remains a subject of debate. Methods:This multicenter retrospective study included sICH patients who visited the neurosurgery departments of eight hospitals between 1 January 2015 and 31 May 2021. These patients were followed up for 6 months post-sICH and divided into two groups: those with type 2 DM (DM group) and those with no diabetes mellitus (nDM group). The chi-square test, Mann-Whitney U test, and multivariate logistic regression analysis were employed to evaluate the impact of DM on HE and patient outcomes. Results:A total of 1,453 patients were admitted to the eight hospitals between 1 January 2015 and 31 May 2021. A total of 1,134 sICH patients were ultimately included in this study for further analysis, based on the inclusion and exclusion criteria. Of these, 182 (16.0%) patients were assigned to the DM group, while 952 (84.0%) patients were assigned to the nDM group. In the intergroup comparison, significant differences were observed in terms of gender, age, smoking, hypertension, coronary heart disease, antiplatelet therapy, ventricular hematoma, and heterogeneous hematoma density. After adjusting for the above confounders, DM was found to significantly increase the incidence of HE (3.552, 95% CI: 2.342-5.387, p = 0.000). Similarly, DM significantly increased all-cause mortality at 1 month (1.965, 95% CI: 1.006-3.840, p = 0.048), 3 months (1.980, 95% CI: 1.071-3.662, p = 0.029), and 6 months (1.776, 95% CI: 1.034-3.050, p = 0.038) in sICH patients. However, DM did not worsen functional prognosis in patients with sICH at 1 month (1.363, 95% CI: 0.909-2.043, p = 0.134), 3 months (1.124, 95% CI: 0.746-1.692, p = 0.577), and 6 months (1.177, 95% CI: 0.789-1.754, p = 0.425), after adjusting for confounding factors. Conclusion:DM is a risk factor for HE and all-cause mortality at 1, 3, and 6 months post-sICH. However, DM does not significantly worsen the functional prognosis of sICH patients at 1, 3, and 6 months.

OBJECTIVE:To explore the application and key points of microchannel approaches in resection of cervical intraspinal tumors.METHODS:A retrospective analysis was performed on 51 cases of cervical spinal canal tumors from February 2017 to March 2020. Among them, 5 cases were located epidural space, 6 cases were located epidural and subdural space, and 40 cases were located under the subdural extramedullary space(6 cases were located on the ventral side of the spinal cord). The maximum diameter ranged from 0.5 to 3.0 cm. The clinical manifestations included neck, shoulder or upper limb pain 43 cases, sensory disturbance (numbness) in 22 cases, and limb weakness in 8 cases. The microchannel keyhole technique was used to expose the tumor, and the tumor was resected microscopically.RESULTS:In this study, 35 patients underwent hemilaminectomy, 12 patients underwent interlaminar fenestration, 2 patients underwent medial 1/4 facetectomy on the basis of hemilaminectomy or interlaminar fenestration. Two tumors were resected through anatomy space (no bone was resected). The degree of tumor resection included total resection in 50 cases and subtotal resection in 1 case. The type of the tumor included 36 schwannomas, 12 meningiomas, 2 enterogenic cysts and 1 dermoid cyst. There was no infection and cerebrospinal fluid leakage postoperatively. Limb numbness occurred in 7 patients. The average follow-up time was 15 months (3 to 36 months). No deformity such as cervical instability or kyphosis was found. The tumor had no recurrence.CONCLUSION:The cervical spinal canal is relatively wide, cervical tumors with no more than three segments can be fully exposed by means of microchannel technology. Besides intramedullary or malignant tumors, they can be microsurgically removed. Preservation of the skeletal muscle structure of cervical spine is beneficial to recover the anatomy and function of cervical spine. The electrophysiological monitoring helps to avoid spinal cord or nerve root injury.

Spinal disorders pose a significant global health challenge, affecting nearly 5% of the population and incurring substantial socioeconomic costs. Over time, spinal neurosurgery has evolved from basic 19th-century techniques to today’s minimally invasive procedures. The recent integration of technologies such as robotic assistance and advanced imaging has not only improved precision but also reshaped treatment paradigms. This review explores key innovations in imaging, biomaterials, and emerging fields such as AI, examining how they address long-standing challenges in spinal care, including enhancing surgical accuracy and promoting tissue regeneration. Are we at the threshold of a new era in healthcare technology, or are these innovations merely enhancements that may not fundamentally advance clinical care? We aim to answer this question by offering a concise introduction to each technology and discussing in depth its status and challenges, providing readers with a clearer understanding of its actual potential to revolutionize surgical practices.

BackgroundGliomas, originating from the most common non-neuronal cells in the brain (glial cells), are the most common brain tumors and are associated with high mortality and poor prognosis. Glioma cells exhibit a tendency to disrupt normal cell-cycle regulation, leading to abnormal proliferation and malignant growth. This study investigated the predictive potential of GJC1 in gliomas and explored its relationship with the cell cycle.MethodsRetrospective analysis of RNA-seq and single-cell sequencing data was conducted using the Chinese Glioma Genome Atlas (CGGA) and The Cancer Genome Atlas (TCGA) databases. The differential expression of GJC1 in gliomas with various pathological features and in different non-neuronal cell groups was analyzed. Functional data were examined using gene set variation analysis (GSVA). Furthermore, CellMiner was used to evaluate the relationship between GJC1 expression and predicted treatment response across these databases.ResultsGJC1 expression was enriched in high-grade gliomas and 1p/19q non-codeletion gliomas. GJC1 enrichment was observed in classical and mesenchymal subtypes within the TCGA glioma subtype group. In single-cell subgroup analysis, GJC1 expression was higher in glioma tissues compared to other non-neuronal cells. Additionally, the TCGA classical subtype of glioma cells exhibited more GJC1 expression than the other subgroups. GJC1 emerged as an independent prognostic factor for overall survival in glioma. GSVA unveiled potential mechanisms by which GJC1 may impact cell-cycle regulation in glioma. Finally, a significant correlation was observed between GJC1 expression and the sensitivity of multiple anti-cancer drugs.ConclusionThese findings confirmed GJC1 as a novel biomarker and provided insights into the differential gene expression in non-neuronal cells and the impact of the cell cycle on gliomas. Consequently, GJC1 may be used to predict glioma prognosis and has potential therapeutic value.

Memory modification technology (MMT) refers to the use of neurotechnologies to intervene in memories. Many scholars have reflected on the ethical issues in MMT, but a comprehensive review of this topic has not been seen. This article presents the first scoping review study of ethical issues in MMT using a bibliometric and systematic approach. After thorough examination, 133 records of key literature are included in this scoping review. Six core ethical themes are extracted: (1) self, identity, and authenticity; (2) autonomy and informed consent; (3) welfare and happiness; (4) safety and risks; (5) responsibility and obligation; (6) social and legal justice. More detailed analyses are conducted on the moral stances and reasons held by different scholars concerning these ethical themes. As can be seen, current debates exhibit certain shortcomings, including ambiguous ethical concepts and a restricted scope of analysis. Therefore, we call for deeper reflections on the philosophical foundations, more precise definitions of ethical terms, and more comprehensive examinations of neurotechnological applications, in order to better address the ethical challenges in the future.

组织蛋白酶B是一种特殊类型的多功能半胱氨酸蛋白酶。研究证实，其在成人胶质母细胞瘤中显著高表达，并且密切参与肿瘤增殖、凋亡抵抗、迁移、侵袭、上皮间质转化、肿瘤干细胞形成及维持、肿瘤新生血管形成、免疫细胞浸润、免疫抑制、应激及治疗抵抗等过程，被认为是成人胶质母细胞瘤恶性病理学特征和不良预后的新型分子生物学标志物和潜在的治疗靶点。本文就组织蛋白酶B对成人胶质母细胞瘤的作用及机制进行综述。

现代医学经历了循证医学、转化医学、精准医学时代的发展,已经取得了诸多革命性突破,在不断优化疾病预防、早期诊断、合理治疗和预后判断的基础上,更是不断地深化疾病的精准分型分期,但较多研究成果的临床转化在真实世界中的应用却未达到预期效果.随着数字化医学技术的快速发展,智能可视化技术为神经外科提供了所见即所得、有图有真相的新手段,也成为改善真实世界中患者临床预后的重要突破口.本文重点评述了数字化时代可视化医学的发展及其对神经外科发展的历史性意义,尤其指出未来智能神经外科发展中可视化技术的发展趋势.

Objective:Spinal meningeal cysts (SMCs) are currently classified into three types: extradural cysts without nerve root fibers (Type I), extradural cysts with nerve root fibers (Type II), and intradural cysts (Type III). However, the sacral terminal filar cyst is a distinct subtype with the filum terminale rather than nerve roots within the cyst. This study aimed to investigate the clinicoradiological characteristics and surgical outcomes of sacral terminal filar cysts.Methods:A total of 32 patients with sacral terminal filar cysts were enrolled. Clinical and radiological profiles were collected. All patients were surgically treated, and preoperative and follow-up neurological functions were evaluated.Results:Chronic lumbosacral pain and sphincter dysfunctions were the most common symptoms. On MRI, the filum terminale could be identified within the cyst in all cases, and low-lying conus medullaris was found in 23 (71.9%) cases. The filum terminale was dissociated and cut off in all cases, and the cyst wall was completely resected in 23 (71.9%) cases. After a median follow-up period of 26.5 ± 15.5 months, the pain and sphincter dysfunctions were significantly improved (both P < 0.0001). The cyst recurrence was noted in only 1 (3.1%) case.Conclusions:Sacral terminal filar cysts are rare, representing a distinct variant of SMCs. Typical MRI features, including filum terminale within the cyst and low-lying conus medullaris, may suggest the diagnosis. Although the optimal surgical strategy remains unclear, we recommend a combination of resection of the cyst wall and dissociation of the filum terminale. The clinical outcomes can be favorable.

To compare the differences in the short-term recovery from neurological symptoms (SRN) (≤ 6 months) and clinical characteristics of patients with different Shamblin classifications carotid body tumor (CBT) resection and to analyze the risk factors affecting SRN after surgery. Patients who underwent CBT resection between June 2018 and September 2022 were recruited. Perioperative factors and indicators of the nature of the tumor were recorded. The risk factors affecting SRN after CBT resection were analyzed using logistic regression analysis. Eighty-five patients (43.86 ± 12.7 years, 46 females) were included, 40 (47.06

Objective: To investigate the differences in serum iron index and iron metabolizing protein expression in plaques in patients with different degrees of carotid artery stenosis and the relationship with plaque traits. Methods: A total of 100 patients eligible for carotid endarterectomy (CEA) from August 2021 to February 2022 were included. Patients completed a computed tomography (CTA) scan for patient grouping and a magnetic resonance imaging (MRI) for precise quantification of carotid plaque traits within 1 week prior to surgery. Clinical indicators associated with the progression of carotid stenosis to occlusion were analyzed using ordered logistic regression. Twenty carotid plaques were analyzed immunohistochemically to investigate the relationship between plaque traits and the iron metabolism indexes. Results: No significant correlation between high serum ferritin (SF), unsaturated iron binding capacity (UIBC) and progression of carotid stenosis (OR 1.100, 95% CI 0.004–0.165, p = 0.039; OR 1.050, 95% CI 0.005–0.094, p = 0.031). SF and serum transferrin receptor (sTfR) were correlated with normalized wall index (NWI) (R = 0.470, p = 0.036; R = 0.449, p = 0.046), and the results of multiple linear regression suggested that SF and sTfR remained associated with NWI (R = 0.630, R2 = 0.397, Adjusted R2 = 0.326, p = 0.014). In plaques, H-type ferritin (H-FT) was correlated with NWI and lipid-rich necrotic core (LRNC) volume (R = 0.502, p = 0.028; R = 0.468, p = 0.043). Transferrin receptor 1 (TfR1) was correlated with LRNC volume and intraplaque hemorrhage (IPH) volume (R = 0.538, p = 0.017; R = 0.707, p = 0.001). Conclusions: There were statistical differences in the expression of iron metabolism proteins in carotid plaques with different degrees of stenosis. Serum iron metabolism index (SF and sTfR) and expression of iron metabolizing proteins (H-FT and TfR1) in plaques were positively correlated with carotid plaque vulnerability index (NWI, LRNC volume).