Background: Cardiac computed tomographic angiography (CTA) detects patent foramen ovale (PFO) with variable accuracy. This study investigated factors affecting CTA detectability for PFO in patients with suspected PFO-associated stroke. Methods: Consecutive patients with cryptogenic stroke and positive findings on contrast transcranial Doppler (cTCD) examinations were enrolled between November 2020 and April 2023 in this retrospective study. Each participant underwent transesophageal echocardiography (TEE) and cardiac CTA. Patients with confirmed PFO on TEE were categorized into two groups based on CTA detectability: the CTA-positive group (PFO identified by CTA) and the CTA-negative group (PFO missed by CTA). Univariate and multivariate logistic regression analyses were performed to identify predictors of CTA false-negative results. Results: Among 108 patients (mean age 46.7 ± 14.9 years, 47.2% male), the prevalence of PFO by TEE was 94.4% (102/108). Compared to TEE, cardiac CTA had a sensitivity of 70% (95% CI 61–79%), a specificity of 100% (95% CI 54–100%), a positive predictive value of 100% (95% CI 95–100%), and a negative predictive value of 16% (95% CI 6–32%). Among patients with PFO confirmed by TEE (n = 102), the incidence of moderate to large right-to-left shunts (RLS) was significantly higher in the CTA-positive group than in the CTA-negative (77.5% vs. 22.5%, p < 0.001). After adjusting for confounders, patients with moderate to large shunts showed a significantly lower likelihood of a CTA false-negative result compared to those with small shunts (OR 0.113, 95% CI 0.035–0.365, p < 0.001). In patients with moderate to large RLS, the sensitivity of cardiac CTA for diagnosing PFO increased to 90.16% (95% CI 82.69–97.64%). Conclusions: Cardiac CTA could be an effective complementary modality for selected patients with suspected PFO-associated stroke. Its diagnostic performance appears more reliable for identifying PFO in patients with moderate-to-large RLS than in those with small RLS.

Background High variability of intracranial arterial blood flow velocities by Transcranial color-coded sonography (TCCS) has been found in clinical practice. This study aimed to improve diagnostic accuracy by analyzing influencing factors of middle cerebral artery (MCA) blood flow velocity detected by TCCS. Methods In total, 328 MCA vessels were classified as normal (27.1 %) or having mild (30.2 %), moderate (23.2 %), and severe (19.5 %) stenosis based on computed tomography angiography (CTA). Based on morphology, MCAs were classified as type I (98) or type II (230). Differences in peak systolic velocity (PSV) detected by TCCS and TCD were analyzed at different degrees of MCA stenosis (MCAS), correction angles, and morphology. Results The mean rank of MCAS of TCCS was higher than that of TCD and CTA (P < 0.05), with no significant difference between TCD and CTA. The PSV measured by TCCS was significantly higher than that of TCD, but when the correction angle of TCCS was ≤30°, the two PSVs were comparable (P > 0.05). TCCS and TCD measured significantly different PSVs when the TCCS correction angles were >30° in type I and at all correction angles in type II (P < 0.05). The optimal cut-off values for MCAS diagnosis using TCCS increased with increasing correction angles. Conclusions The differences in PSVs measured using TCCS and TCD were related to the correction angles and morphology of the MCA. Using optimal cut-off values based on the correction angles allows for more accurate MCAS diagnosis.

Objectives- This study analyzed carotid artery remodeling characteristics in early carotid atherosclerosis (ECAS). Methods- The 1021 participants were evaluated using ultrasonography and categorized into three groups: Group A, 391 participants with increased intima-media thickness (IMT); Group B, 300 participants with atherosclerotic plaque only on the carotid bulb (CB); and the control group (330 participants). The ratios of the diameters in the CB to those in the common carotid artery (D-CCA) and internal carotid artery (D-ICA) were defined as carotid index1 (CI1) and 2 (CI2 ). Results- Group A had a higher D-CCA, D-CB, and CI(2 )than the controls (P < .05). Group B had a smaller D-CB, CI1, and CI(2 )than Group A, and higher D(CCA )and smaller CI(1)than the controls (P < .05). Logistic regression showed that CI(2 )was a positive influencing factor for increased IMT (OR: 3.42, 95% CI: 1.74-6.70, P < .001), and CI(1 )was a negative independent factor for CB plaque formation (OR: 0.11, 95% CI: 0.04-0.28, P < .001). Multiple linear regression showed that only in Group B, the vessel side had a significant influence on CI1 (beta = 0.055, P < .05), while age, sex, body mass index, and cerebrovascular risk factors had no significant correlation with CI. Conclusions- The CB and common carotid artery showed positive remodeling with increased IMT, however, the CB showed negative remodeling with plaque formation. CI changes were consistent with CB remodeling. CI was an independent influencing factor for ECAS, and it was only affected by vessel side, providing an objective predictive parameter for ECAS.

Refractory intracranial hypertension is a condition characterized by persistently elevated intracranial pressure that does not respond to conventional treatments. Diagnosis and management typically involve a combination of medical and surgical interventions. However, identifying the potential etiology can be particularly difficult under certain conditions. The causes of refractory intracranial hypertension due to non-traumatic brain injury are often difficult to detect. Untreated or ineffectively treated refractory intracranial hypertension can result in severe symptoms and potential vision loss. We reported a 15-year-old teenager with no history of trauma who experienced intermittent headaches and projectile vomiting over a 30-day period, accompanied by intracranial pressure exceeding 28 cmH2O. Through clinical reasoning combined with auxiliary examinations, including angiography and ultrasonography, and confirmed by follow-ups after experimental therapy, a final diagnosis of scalp arteriovenous fistula was established. This case highlights the importance of considering extracranial causes in cases of refractory intracranial hypertension and management strategy for patients with refractory intracranial hypertension.

The present study aimed to analyze the correlation between carotid atherosclerotic plaque (CAP) and/or subclavian atherosclerotic plaque (SAP) and coronary atherosclerosis disease (CASD). A total of 1343 patients hospitalized for chest pain or tightness due to coronary atherosclerotic disease and underwent initial coronary angiography (CAG) were evaluated by color Doppler flow imaging (CDFI) for CAP and SAP. The patients were divided into four groups: non-CAP non-SAP, only-SAP, only-CAP, or CAP SAP. Finally, 1,242 patients were included in this study. The incidence of CASD and main coronary artery disease in the CAP SAP group was higher than that in the CAP-only group. Moreover, the detection rate of three-vessel disease (3-VD) in the CAP SAP group was significantly higher than that in the CAP group (p < 0.05). The incidence of main coronary artery branch lesions in patients with CAP SAP was approximately 1.5 times higher than in those with only CAP. Male gender, hypertension, and diabetes were independent risk factors for main coronary artery branch lesions. If the patient had CAP SAP lesions and more than three cardiovascular disease risk factors, coronary artery main artery disease incidence was about 81.7

Objective: To investigate the frailty, as estimated by accumulated health deficits, in association with the symp-tomatic carotid atherosclerosis and in relation to five-year cardiovascular (CVD) outcomes. Methods: This is a five-year prospective cohort study. Secondary analysis of data from the Beijing Longitudinal Study on Aging. Community-dwelling people aged 55+ years (n = 1257) have been followed between 2009 and 2014, and having carotid ultrasonography examinations with no CVD events at baseline. Frailty was quantified using the deficit accumulation-based frailty index (FI), constructed from 37 health deficits assessed at baseline. The association between the degree of frailty and carotid atherosclerosis was examined using odds ratios (OR) with multivariate logistic regression analyses. Effects of frailty on the probability of five-year cardiovascular events and mortality were evaluated using Cox proportional hazard ratios (HR). The analyses were adjusted for demographics, baseline carotid atherosclerosis status, and CVD risk factors. Results: The FI showed characteristic properties and was independently associated with the major carotid atherosclerosis symptoms, including carotid artery intima-media thickening (the most frail vs. the least frail: OR = 4.39: 1.98-7.82), carotid plaque (OR = 3.41: 1.28-6.54), and carotid plaque stability (OR = 1.19, 95 % CI: 1.01-3.59). Compared with the least frail, the most frail individuals were more likely to develop a cardiovascular event in five years, including myocardial infarction (HR = 3.38, 95 % CI = 1.84-6.19), stroke (HR = 1.26, 95 % CI = 1.00-5.87), CVD death (HR = 6.33, 95 % CI = 1.69-11.02), and all-cause death (HR = 5.95, 95 % CI = 2.74-8.95). Conclusion: Deficit accumulation was closely associated with carotid atherosclerosis risks and strongly predicted five-year CVD events. The frailty index can be used to help identify older adults at high risks of CVD for improved preventive healthcare.

Background: The effect of anterior communicating artery (ACoA) patency on the flow velocity of the extracranial carotid arteries is unclear. Methods: A total of 285 patients with carotid artery stenosis were included between January 2019 and January 2021. All patients received unilateral carotid endarterectomy (CEA). The patients were classified into ACoA-patent (161) and ACoA-nonpatent (124) groups using digital subtraction angiography (DSA) and/or computed tomography angiography (CTA). The peak systolic velocity (PSV) and end-diastolic velocity (EDV) measured by carotid duplex ultrasonography (CDU) were compared between both groups, pre- and post-CEA. Results: There was no significant difference in the risk factors for cerebrovascular disease between the two groups. Within 1 week after CEA, the PSV and EDV on operative and nonoperative carotid (contralateral carotid in the same patient) arteries decreased significantly (both p < 0.01). Comparison of nonoperative carotid artery pre- and post-CEA between the two groups showed that post-CEA PSV and EDV in the ACoA-patent group were significantly lower than that of pre-CEA (PSV and EDV, t = 11.507 and 6.716, respectively, both p < 0.001) (according to the Society of Radiologists in Ultrasound Consensus Conference [SRUCC] PSV standard). There was no significant difference in the ACoA-nonpatent group (PSV: t = 1.924, p = 0.057; EDV: t = 1.237, p = 0.218). In the nonoperative carotid artery of the ACoA-patent group, the degree of stenosis assessed by CDU was inconsistent with that of DSA/CTA (κ = 0.294), whereas that in the ACoA-nonpatent group had a high consistency (κ = 0.982). Among 161 ACoA-patent cases, 68 showed overestimated stenosis. Conclusions: The patent ACoA increases PSV and EDV, causing an overestimation of carotid artery stenosis.

This cross-sectional study investigates the prevalence, incidence, and mortality rate of stroke in China in 2020 using data from a nationally representative sample of rural and urban populations. Key Points Question What was the burden of prevalence, incidence, and mortality rate of stroke in China? Findings In this cross-sectional study of 676394 participants aged 40 years and older, the estimated overall prevalence, incidence, and mortality rate of stroke in mainland China in 2020 were 2.6%, 505.2 per 100000 person-years, and 343.4 per 100000 person-years, respectively. The prevalence of stroke was higher in urban areas than rural areas, but the incidence rate and mortality rate of stroke were higher in rural areas than urban areas. Meaning These findings suggest that there may be an urban-rural disparity in the burden of stroke in China, and an improved stroke prevention strategy is needed. Importance roke is the leading cause of death in China. However, recent data about the up-to-date stroke burden in China are limited. Objective To investigate the urban-rural disparity of stroke burden in the Chinese adult population, including prevalence, incidence, and mortality rate, and disparities between urban and rural populations. Design, Setting, and Participants This cross-sectional study was based on a nationally representative survey that included 676394 participants aged 40 years and older. It was conducted from July 2020 to December 2020 in 31 provinces in mainland China. Main Outcomes and Measures Primary outcome was self-reported stroke verified by trained neurologists during a face-to-face interviews using a standardized protocol. Stroke incidence were assessed by defining first-ever strokes that occurred during 1 year preceding the survey. Strokes causing death that occurred during the 1 year preceding the survey were considered as death cases. Results The study included 676394 Chinese adults (395122 [58.4%] females; mean [SD] age, 59.7 [11.0] years). In 2020, the weighted prevalence, incidence, and mortality rates of stroke in China were 2.6% (95% CI, 2.6%-2.6%), 505.2 (95% CI, 488.5-522.0) per 100000 person-years, and 343.4 (95% CI, 329.6-357.2) per 100000 person-years, respectively. It was estimated that among the Chinese population aged 40 years and older in 2020, there were 3.4 (95% CI, 3.3-3.6) million incident cases of stroke, 17.8 (95% CI, 17.5-18.0) million prevalent cases of stroke, and 2.3 (95% CI, 2.2-2.4) million deaths from stroke. Ischemic stroke constituted 15.5 (95% CI, 15.2-15.6) million (86.8%) of all incident strokes in 2020, while intracerebral hemorrhage constituted 2.1 (95% CI, 2.1-2.1) million (11.9%) and subarachnoid hemorrhage constituted 0.2 (95% CI, 0.2-0.2) million (1.3%). The prevalence of stroke was higher in urban than in rural areas (2.7% [95% CI, 2.6%-2.7%] vs 2.5% [95% CI, 2.5%-2.6%]; P=.02), but the incidence rate (485.5 [95% CI, 462.8-508.3] vs 520.8 [95% CI, 496.3-545.2] per 100000 person-years; P<.001) and mortality rate (309.9 [95% CI, 291.7-328.1] vs 369.7 [95% CI, 349.1-390.3] per 100000 person-years; P<.001) were lower in urban areas than in rural areas. In 2020, the leading risk factor for stroke was hypertension (OR, 3.20 [95% CI, 3.09-3.32]). Conclusions and Relevance In a large, nationally representative sample of adults aged 40 years or older, the estimated prevalence, incidence, and mortality rate of stroke in China in 2020 were 2.6%, 505.2 per 100 000 person-years, and 343.4 per 100000 person-years, respectively, indicating the need for an improved stroke prevention strategy in the general Chinese population.

目的 采用超声造影检测分析颈动脉粥样硬化性易损斑块内新生血管(IPN)与缺血性脑血管病症状发生的相关性.方法 回顾性连续纳入2019年1月至2021年12月首都医科大学宣武医院神经内外科经常规超声检查发现颈动脉斑块并接受超声造影检查的缺血性脑血管病患者122例.根据是否出现缺血性脑血管病症状将患者分为无症状组和症状组.分析两组患者颈动脉粥样硬化责任斑块超声造影特征(斑块厚度、斑块长度及回声特征)的差异性,以及IPN、溃疡性斑块、动脉狭窄程度(狭窄率≥70％为重度狭窄)等因素与缺血性脑血管病症状发生的相关性.结果 122例患者中,无症状组47例,症状组75例.症状组MRI缺血性病灶患者比例、血管重度狭窄比例、IPN患者比例均明显高于无症状组[分别为80.0％(60/75)比46.8％(22/47),χ2=14.44,P<0.01;84.0％(63/75)比51.1％(24/47),χ2=15.32,P<0.01;78.7％(59/75)比34.0％(16/47),χ2=8.74,P<0.01],症状组斑块长度明显长于无症状组[26.00(20.30,30.01)mm比20.20(17.28,25.75)mm,Z=-3.20,P=0.01].多因素Logistic回归分析结果显示,IPN、血管重度狭窄是缺血性脑血管病症状发生的独立预测因素(OR=6.77,95％CI:2.24～20.46,P<0.01;OR=9.92,95％CI:2.37～41.64,P<0.01),溃疡性斑块并非缺血性脑血管病症状发生的危险因素(OR=0.70,95％CI:0.24～2.00,P=0.50).结论 IPN是缺血性脑血管病症状发生的独立危险因素.

Carotid arteries vulnerable plaques are a crucial factor in the screening of atherosclerosis by ultrasound technique. However, manual plaque segmentation may be time-consuming and variable, moreover, the unstable plaques are contaminated by various noises such as artifacts and speckle noise. This paper proposes an automatic convolutional neural network (CNN) method for plaque segmentation in carotid ultrasound images using a small dataset. Firstly, a parallel network with three independent scale decoders is utilized as our base segmentation network, and pyramid dilated convolutions are used to enlarge receptive fields in three decoder sub-networks. Subsequently, the merged feature maps from the three decoders are rectified by the SENet. Thirdly, in the testing, the initial segmented plaque is refined by the maximal contour postprocessing method to obtain the final segmentation result. The dataset consists of 30 carotid ultrasound images with severe stenosis plaques from 30 patients. Test results show that the proposed method yields a Dice value of 0.820, IoU of 0.701, Accuracy of 0.969, and modified Hausdorff distance (MHD) of 1.43 by 10-fold cross-validation, it outperforms some CNN-based methods on these metrics. Additionally, we apply an ablation experiment to show the validity of each proposed module. Our method may be useful in actual applications for carotid unstable (easily ruptured or severe stenosis) plaques segmentation from ultrasound images.

目的 分析无心脑血管病史及危险因素的成年受检者不同年龄、性别、侧别的颈动脉管腔结构、血流速度差异性,以及血流速度与颈动脉指数(CI)的相关性.方法 纳入2019 年12 月至2021 年12 月国内53 家医院筛查既往无心脑血管病史及其危险因素的健康成年受检者2 738 例(男787 例,女1 951 例),记录颈动脉超声检查结果,分析年龄[40 岁以上年龄组(≥40 岁组)与40 岁以下年龄组(＜40 岁组)]、性别、左右侧别之间颈总动脉(CCA)、颈动脉球部(BULB)、颈内动脉(ICA)的内径(DCCA、DBULB、DICA)及血流速度[收缩期峰值流速(PSV),包括双侧CCA和ICA的PSV(PSVCCA、PSVICA);舒张期末流速(EDV),包括双侧CCA和ICA的EDV(EDVCCA、EDVICA)]的差异性.分析组间CI[CIBULB/ICA(DBULB与DICA比值)、CIBULB/CCA(DBULB与DCCA比值)、CIICA/CCA(DICA与DCCA比值)]的差异性并与对应颈动脉血流速度进行相关性分析.结果 (1)≥40 岁组DCCA、DBULB、DICA均大于＜40 岁组[分别为6.2(5.7,6.7)mm比6.0(5.6,6.4)mm,7.0(6.4,7.8)mm比6.7(6.1,7.4)mm,4.6(4.1,5.1)mm比4.5(4.1,5.0)mm].男性DCCA、DBULB、DICA均大于女性[分别为6.2(5.8,6.7)mm比6.0(5.6,6.4)mm,7.1(6.4,7.8)mm比6.7(6.1,7.4)mm,4.8(4.4,5.3)mm比4.4(4.1,4.9)mm],差异均有统计学意义(均P＜0.01).左侧DCCA小于右侧[6.0(5.6,6.5)mm比6.1(5.7,6.5)mm],右侧DICA小于左侧[4.5(4.0,5.0)mm比4.5(4.1,5.0)mm],差异均有统计学意义(均P＜0.05).(2)＜40 岁组受检者的PSVCCA、PSVICA、EDVCCA、EDVICA均高于≥40 岁组[分别为95(80,112)cm/s比77(63,92)cm/s,85(72,98)cm/s比77(65,92)cm/s,28(24,33)cm/s比26(21,31)cm/s,33(28,39)cm/s比32(26,38)cm/s],女性PSVICA、EDVCCA、EDVICA均高于男性[分别为84(71,97)cm/s比79(66,95)cm/s,28(23,33)cm/s比27(22,32)cm/s,34(28,40)cm/s比30(25,35)cm/s],左侧PSVCCA、EDVCCA均高于右侧[分别为91(75,108)cm/s比87(72,104)cm/s,28(23,33)cm/s比27(22,32)cm/s],差异均有统计学意义(均P＜0.01).(3)≥40 岁组CIBULB/CCA、CIBULB/ICA均高于＜40岁组[1.14(1.04,1.25)比1.12(1.03,1.21),1.53(1.38,1.69)比1.47(1.33,1.60)],CIICA/CCA低于＜40 岁组[0.74(0.68,0.82)比0.75(0.69,0.82)],且女性CIBULB/ICA大于男性[1.50(1.36,1.64)比1.45(1.33,1.61)],而CIICA/CCA小于男性[0.75(0.69,0.81)比0.76(0.70,0.84)],差异均有统计学意义(均P＜0.01).左侧CIBULB/CCA、CIICA/CCA大于右侧[分别为1.13(1.04,1.23)比1.12(1.03,1.22),0.75(0.69,0.83)比0.75(0.69,0.81)],差异均有统计学意义(均P＜0.01).(4)CIICA/CCA与PSVCCA、EDVCCA之间均呈正相关(rs值分别为0.122、0.056,均P＜0.01),与PSVICA、EDVICA之间均呈负相关(rs值分别为-0.050、-0.201,均P＜0.01).CIBULB/ICA与PSVCCA、EDVCCA均呈负相关(rs值分别为-0.111、-0.069,均P＜0.01),与EDVICA呈正相关(rs值为0.064,P＜0.01).CIBULB/CCA与PSVICA、EDVICA均呈负相关(rs分别为-0.057、-0.151,均P＜0.01).结论 无心脑血管疾病危险因素的成年人颈动脉管腔、血流速度存在年龄、性别及侧别的差异性.CI与血流速度的变化相关.

Objective: Carotid artery stenting (CAS) has become an alternative strategy to carotid endarterectomy for carotid artery stenosis. Residual stenosis was an independent risk factor for restenosis, with the latter affecting the long-term outcomes of CAS. This multicenter study aimed to evaluate the echogenicity of plaques and hemodynamic alteration by color duplex ultrasound (CDU) examination and investigate their effects on the residual stenosis after CAS. Methods: From June 2018 to June 2020, 454 patients (386 males and 68 females) with a mean age of 67.2 +/- 7.9 years, who underwent CAS from 11 advanced stroke centers in China were enrolled. One week before recanalization, CDU was used to evaluate the responsible plaques, including the morphology (regular or irregular), echogenicity of the plaques (iso-, hypo-, or hyperechoic) and calcification characteristics (without calcification, superficial calcification, inner calcification, and basal calcification). One week after CAS, the alteration of diameter and hemodynamic parameters were evaluated by CDU, and the occurrence and degree of residual stenosis were determined. In addition, magnetic resonance imaging was performed before and during the 30-day postprocedural period to identify new ischemic cerebral lesions. Results: The rate of composite complications, including cerebral hemorrhage, symptomatic new ischemic cerebral le-sions, and death after CAS, was 1.54% (7/454 cases). The rate of residual stenosis after CAS was 16.3% (74/454 cases). After CAS, both the diameter and peak systolic velocity (PSV) improved in the preprocedural 50% to 69% and 70% to 99% stenosis groups (P < .05). Compared with the groups without residual stenosis and with <50% residual stenosis, the PSV of all three segments of stent in the 50% to 69% residual stenosis group were the highest, and the difference in the midsegment of stent PSV was the largest (P < .05). Logistic regression analysis showed that preprocedural severe (70% to 99%) stenosis (odds ratio [OR], 9.421; P = .032), hyperechoic plaques (OR, 3.060; P = .006) and plaques with basal calcification (OR, 1.885; P = .049) were independent risk factors for residual stenosis after CAS. Conclusions: Patients with hyperechoic and calcified plaques of the carotid stenosis are at a high risk of residual stenosis after CAS. CDU is an optimal, simple and noninvasive imaging method to evaluate plaque echogenicity and hemody-namic alterations during the perioperative period of CAS, which can help surgeons to select the optimal strategies and prevent the occurrence of residual stenosis.

目的 分析椎动脉起始段狭窄(VAOS)与椎动脉解剖学因素(走行变异、管径和起源情况)的相关性.方法 回顾性连续性纳入2019 年12 月至2021 年12 月"脑卒中高危人群筛查脑颈动脉超声规范化评估数据库"中11255 例颈部动脉粥样硬化性病变患者.根据椎动脉血流动力学参数[收缩期峰值流速(PSV)、舒张期末流速(EDV)和PSV起始段/PSV椎间隙段]确定VAOS的程度,分为轻度(狭窄率＜50%)、中度(狭窄率50%～＜70%)、重度(狭窄率70%～99%)狭窄及闭塞,并依据VAOS的程度将颈部动脉粥样硬化性病变患者分为VAOS组(轻、中、重度狭窄及闭塞)与正常组(无狭窄).收集患者的一般情况,包括性别、年龄、体质量指数(BMI);椎动脉解剖学因素,包括椎动脉走行变异、起源异常、椎间隙段(V2 段)内径;心脑血管疾病相关危险因素,包括高血压病、糖尿病、高脂血症、吸烟史、饮酒史、肥胖(BMI≥28 kg/m2).最终统计分析时,若涉及侧别,各组以侧数进行统计,其中双侧颈部动脉粥样硬化病变分别计入左侧和右侧;若未涉及侧别,各组以例数进行统计.以发生VAOS作为因变量,将一般情况、解剖学因素及心脑血管疾病相关危险因素进行单因素Logistic回归分析,并将其中P＜0.05 的项目作为自变量,进一步采用多因素Logistics回归分析VAOS的独立影响因素.结果 (1)11255 例颈部动脉粥样硬化性病变患者中,剔除基本信息不完整、彩色多普勒超声数据缺失或录入错误者819 例,共纳入符合纳排标准的患者10436 例,其中VAOS组547 例,正常组9889 例.(2)10436 例颈部动脉粥样硬化性病变患者共20872 侧椎动脉,其中VAOS组634 侧(右侧399 侧、左侧235 侧),右侧VAOS检出率(1.9%)高于左侧(1.1%),两侧差异有统计学意义(χ2 =43.75,P＜0.01);正常组20238 侧(右侧10037 侧、左侧10201 侧).右侧椎动脉的VAOS组均无椎动脉走行变异,V2 段内径较正常组粗,两组椎动脉走行变异比例及V2 段内径的差异均有统计学意义[走行变异:正常组2.98%(229/10037),χ2 =9.31;V2 段内径:3.5(3.1,3.8)mm比3.2(2.9,3.5)mm,Z =8.21;均P＜0.01].左侧椎动脉的VAOS组无椎动脉起源异常,V2 段内径较正常组粗,椎动脉走行变异、起源异常比例及V2 段内径的差异均有统计学意义[走行变异:正常组2.90%(296/10201),VAOS组0.43%(1/235),χ2 =5.09;起源异常:正常组1.75%(179/10201);V2 段内径:3.7(3.3,4.0)mm比3.4(3.1,3.8)mm,Z =5.46;均P＜0.05].(3)多因素Logistic回归分析结果显示,年龄(OR =1.08,95%CI:1.07～1.09,P＜0.01)、吸烟史(OR =1.91,95%CI:1.53～2.37,P＜0.01)、高血压病(OR =1.90,95%CI:1.56～2.31,P＜0.01)、高脂血症(OR =1.30,95%CI:1.01～1.65,P＜0.05)、糖尿病(OR =1.44,95%CI:1.14～1.80,P =0.002)是颈部动脉粥样硬化性病变患者发生VAOS的独立危险因素,而女性(OR =0.53,95%CI:0.42～0.66,P＜0.01)、走行变异(OR =0.47,95%CI:0.26～0.80,P =0.009)为保护因素.结论 VAOS与椎动脉解剖学因素可能存在关联,VAOS患者中走行变异比例较低,且走行变异为VAOS的保护因素.本研究结果有待进一步验证.

Evaluating carotid artery plaque by ultrasound technique is a crucial factor in the screening of atherosclerosis. However, vulnerable plaque segmentation remains a challenging task because of the heterogeneities of inter-plaques and intra-plaques, and obscure boundaries of plaques. In this paper, we propose an automated HRU-Net transfer learning method for segmenting carotid vulnerable plaques. Based on the U-Net encoder-decoder paradigm, cross-domain knowledge from natural images is transferred for plaque segmentation using pre-trained ResNet-50. Besides, a cropped blood vessel image augmentation is tailored for the limited images during only training. Moreover, to exploit the implicit discrimination feature of high-level plaque semantic information, the hybrid atrous convolutions are applied to obtain various scale long-range dependence of plaques for refining segmentation. 10-fold cross-validation using 40 carotid ultrasound images with severe stenosis shows that the proposed method yields a Dice value of 0.821, IoU of 0.701, Acc of 0.977, and modified Hausdorff distance (MHD) of 1.69 for the segmentation results, it outperforms some of the state-of-the-art CNN-based methods, and the improvements on metrics of Dice and MHD are statistically significant (p < 0.05). The proposed method can be used as an alternative for automatic vulnerable plaque segmentation in carotid ultrasound images clinically.

OBJECTIVE:Cerebral hyperperfusion syndrome (CHS) is a rare but serious complication following carotid endarterectomy (CEA). The aim of this study was to identify intraoperative transcranial Doppler (TCD) hemodynamic predictors of CHS after CEA. METHODS:Between January 2013 and December 2018, intraoperative TCD monitoring was performed for 969 patients who underwent CEA. The percentage increase in the mean velocity of the middle cerebral artery (MCAV%) at 3 postdeclamping time points (immediately after declamping, 5 minutes after declamping, and after suturing the skin) over baseline was compared between CHS and non-CHS patients. RESULTS:CHS was diagnosed in 31 patients (3.2%), including 11 with intracranial hemorrhage. The MCAV% values at the 3 postdeclamping time points over baseline were 177% (81%-275%), 90% (41%-175%), and 107% (55%-191%) in the CHS group, significantly higher than those in the non-CHS group (40% [14%-75%], 15% [1%-36%], and 18% [3%-41%], respectively, all P < 0.001). Receiver operating characteristic curve analysis showed that the 3 intraoperative MCAV% parameters all had excellent accuracy in identifying CHS (areas under the curve: 0.854, 0.839, and 0.858, respectively, all P < 0.001). The predictive value of the model consisting only of preoperative parameters was significantly increased by adding the intraoperative TCD hemodynamic parameters (area under the curve: 0.747 vs. 0.858, P = 0.006). Multivariate analyses identified the intraoperative MCAV% immediately after declamping (odds ratio: 9.840, 95% confidence interval: 2.638-36.696, P < 0.001) as an independent predictor of CHS. CONCLUSIONS:Our results indicate that intraoperative TCD monitoring helps predict CHS after CEA at an early stage.

Orthostatic hypotension (OH) is an early non-motor manifestation of Parkinson's disease (PD). However, the underlying mechanism of hemodynamic changes in patients with PD and OH remains unclear. This study aimed to investigate the dynamic cerebral autoregulation changes in patients with PD with OH. Ninety patients with PD and 20 age- and sex-matched healthy controls (HCs) were recruited. The patients' non-invasive blood pressure (BP) and cerebral blood flow velocity were simultaneously recorded at supine and orthostatic positions during the active standing test (AST). Transfer function analysis was used to determine autoregulatory parameters including gain [i.e., damping effect of dynamic cerebral autoregulation (dCA) on the magnitude of BP oscillation] and phase difference (i.e., the time delay of the cerebral blood flow response to BP). Sixteen patients (17.8%) in the PD population were diagnosed with OH (PD-OH). The AST results were normal for 74 patients (82.2%) (PD-NOR). In the supine position, the PD-OH group had a lower phase degree than the PD-NOR group (50.3 ± 23.4 vs. 72.6 ± 32.2 vs. 68.9 ± 12.1, p = 0.020); however, no significant difference was found upon comparing with the HC group. In the orthostatic position, the normalized gain was significantly higher for the symptomatic OH group than for the asymptomatic OH group and HC group (1.50 ± 0.58 vs. 0.97 ± 0.29 vs. 1.10 ± 0.31, p = 0.019). A symptomatic OH in the PD population indicates an impaired cerebral autoregulation ability in the orthostatic position. Cerebral autoregulation tends to be impaired in the supine position in the OH population.

The intima-media thickness (IMT) of the carotid artery is commonly used for monitoring atherosclerosis. However, the intima-media complex (IMC) segmentation for the IMT calculation is a tedious task due to confused IMC boundaries and class-imbalance issues. In this paper, we propose an automatic method named CSM-Net for the joint segmentation of IMC on near and far walls, and Lumen in carotid ultrasound images. In the encoder-decoder CSM-Net, firstly, the cascaded dilated convolutions combined with the squeeze-excitation module are introduced for exploiting more contextual features on the last encoder layer. Secondly, a multi-scale triple spatial attention module is utilized for capturing serviceable features on each decoder layer. Lastly, a weighted hybrid loss function is employed to resolve the class-imbalance issue. Experiments are performed on a private dataset of 100 images from one center using the 10-fold cross-validation, the results of the proposed method on the IMC Dice, Lumen Dice, Precision, Recall, and F1 metrics are 0.814 ±0.061,0.941 ±0.024,0.911 ±0.044,0.916 ±0.039, and 0.913 ±0.027, respectively, which precede some cutting-edge methods. The proposed method may be useful for the IMC segmentation of carotid ultrasound images in the clinic.

BACKGROUND:Calcification has been proven to be a marker of atherosclerosis and is related to an increased risk of ischemic stroke. Additionally, calcification was reported to be prevalent in patients with stenotic lesions of the intracranial vertebral artery. Thus, reliable imaging facilities for evaluating plaque calcification have remarkable significance in guiding stenting and predicting patient outcomes. Optical coherence tomography (OCT) has a unique advantage in its ability to detect calcium and to achieve three-dimensional volumetric calcium characterization.METHODS:From March 2017 to September 2018, seven cases of calcified lesions with intracranial vertebral artery stenosis were investigated using OCT, before and after the placement of an Apollo balloon-mounted stent. Transcranial color-coded duplex sonography was performed to identify restenosis with a mean follow-up time of 13.3 months in this case series.RESULTS:All calcified lesions were evaluated quantitatively and qualitatively using OCT. Among all cases, five had macrocalcifications and two had spotty calcifications. Severe in-stent restenosis was observed in two cases, both with macrocalcifications.CONCLUSIONS:This study suggests a potential relationship between macrocalcifications and the risk of in-stent restenosis of the intracranial vertebral artery. These preliminary findings obtained from a limited sample should be verified by prospective large-scale studies.

Background The stroke burden in China has increased during the past 40 years. The present study aimed to deter-mine the recent trends in the prevalence of stroke from 2013 to 2019 stratified by sociodemographic characteristics, including sex, age, residence, ethnicity, and province within a population-based screening project in China. Methods We made use of data generated from 2013 to 2019 in the China Stroke High-risk Population Screening Program. All living subjects with confirmed stroke at interview were considered to have prevalent stroke. All analyses of prevalence of stroke were weighted and results were presented as percentage and 95% confidence interval (CI). Findings A total of 4229,616 Chinese adults aged >= 40 years from 227 cities in the 31 provinces were finally included. The enrollment rate ranged from 58.8% (2017) to 67.8% (2013). The weighted prevalence of stroke increased annually from 2013 to 2019, being 2.28% (95% CI: 2.28-2.28%) in 2013, 2.34% (2.34-2.35%) in 2014, 2.43% (2.43-2.43%) in 2015, 2.48% (2.48-2.48%) in 2016, 2.52% (2.52-2.52%) in 2017, 2.55% (2.55-2.55%) in 2018, and 2.58% (2.58-2.58%) in 2019 (p for trend <0.001). The weighted prevalence of stroke was higher for male sex, older age, and residence in rural and northeast areas. Interpretation The prevalence of stroke in China and most provinces has continued to increase in the past 7 years (2013-2019). These findings, especially in provinces with high stroke prevalence, can help public health officials to increase province capacity for stroke and related risk factors prevention. Fundings This study was supported by grants from the National Major Public Health Service Projects. Copyright (c) 2022 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

BACKGROUND The effects and risks of endovascular thrombectomy 6 to 24 hours after stroke onset due to basilar-artery occlusion have not been extensively studied. METHODS In a trial conducted over a 5-year period in China, we randomly assigned, in a 1:1 ratio, patients with basilar-artery stroke who presented between 6 to 24 hours after symptom onset to receive either medical therapy plus thrombectomy or medical therapy only (control). The original primary outcome, a score of 0 to 4 on the modified Rankin scale (range, 0 to 6, with a score of 0 indicating no disability, 4 moderately severe disability, and 6 death) at 90 days, was changed to a good functional status (a modified Rankin scale score of 0 to 3, with a score of 3 indicating moderate disability). Primary safety outcomes were symptomatic intracranial hemorrhage at 24 hours and 90-day mortality. RESULTS A total of 217 patients (110 in the thrombectomy group and 107 in the control group) were included in the analysis; randomization occurred at a median of 663 minutes after symptom onset. Enrollment was halted at a prespecified interim analysis because of the superiority of thrombectomy. Thrombolysis was used in 14% of the patients in the thrombectomy group and in 21% of those in the control group. A modified Rankin scale score of 0 to 3 (primary outcome) occurred in 51 patients (46%) in the thrombectomy group and in 26 (24%) in the control group (adjusted rate ratio, 1.81; 95% confidence interval [CI], 1.26 to 2.60; P<0.001). The results for the original primary outcome of a modified Rankin scale score of 0 to 4 were 55% and 43%, respectively (adjusted rate ratio, 1.21; 95% CI, 0.95 to 1.54). Symptomatic intracranial hemorrhage occurred in 6 of 102 patients (6%) in the thrombectomy group and in 1 of 88 (1%) in the control group (risk ratio, 5.18; 95% CI, 0.64 to 42.18). Mortality at 90 days was 31% in the thrombectomy group and 42% in the control group (adjusted risk ratio, 0.75; 95% CI, 0.54 to 1.04). Procedural complications occurred in 11% of the patients who underwent thrombectomy. CONCLUSIONS Among patients with stroke due to basilar-artery occlusion who presented 6 to 24 hours after symptom onset, thrombectomy led to a higher percentage with good functional status at 90 days than medical therapy but was associated with procedural complications and more cerebral hemorrhages. (Funded by the Chinese National Ministry of Science and Technology; BAOCHE ClinicalTrials.gov number, NCT02737189.).