Vertebrobasilar dolichoectasia (VBD) is a rare, progressive disorder characterized by significant expansion, elongation, and tortuosity of the vertebrobasilar arteries. This case series introduces a novel imaging sign observed in three patients with clinical manifestations of VBD. The presence of outside-stent flow (OSF) may serve as a potential predictor for aneurysm recurrence in VBD following endovascular intervention. Furthermore, OSF could indicate the need for embolization of the contralateral vertebral artery after stenting, with or without coil embolization, in patients with VBD aneurysms.

ObjectiveCurrent fractional flow (FF) approaches in quantifying the hemodynamic severity of intracranial atherosclerotic stenosis (ICAS) are invasive or require angiography. This study primarily evaluated a noninvasive FF method derived from magnetic resonance angiography (MRA-FF) against established reference standards, with an exploratory assessment of its ability to reflect hemodynamically relevant impairment.MethodsIn this retrospective study of 50 patients with ICAS, MRA-FF was computed from 3D vascular models using patient-specific flow boundary conditions. Agreement with invasive pressure-wire-derived FF (PW-FF, n = 18) and angiography-based FF (DSA-FF, n = 50) was assessed using intraclass correlation coefficients (ICC). Equivalence to DSA-FF was evaluated using the two one-sided tests procedure (TOST; δ = ±0.05). An exploratory analysis examined the ability of MRA-FF to discriminate hypoperfusion using receiver operating characteristic (ROC) analysis in the subset of patients with available perfusion imaging (n = 38).ResultsMRA-FF showed moderate-to-good agreement with PW-FF (ICC = 0.743; 95% CI, 0.437–0.895) and good agreement with DSA-FF (ICC = 0.784; 95% CI, 0.649–0.871). Equivalence to DSA-FF was confirmed by TOST (90% CI of difference, −0.016 to 0.035; p < 0.01). In the perfusion subset, MRA-FF was lower in patients with hypoperfusion than in those without (p = 0.022). The area under the ROC curve for discriminating hypoperfusion was 0.723 (95% CI, 0.54–0.90). Within this dataset, the exploratory optimal cutoff value was 0.855.ConclusionMRA-FF demonstrates good agreement with invasive and angiographic reference methods and shows the ability to discriminate hypoperfusion in an exploratory analysis. These findings support the feasibility and potential clinical utility of a fully noninvasive FF approach for functional assessment and hemodynamic characterization, although further external validation is required.

BACKGROUND:Noninvasive imaging is essential for long-term surveillance of flow diverter-treated intracranial aneurysms. We evaluate the image quality and feasibility of photon-counting detector CT (PCD-CT) in a real-world, non-contemporaneous follow-up setting, comparing it with intraoperative baseline DSA and flat-panel detector CT (VasoCT). METHODS:This retrospective cohort study included 30 patients (32 aneurysms) followed with PCD-CT (median: 6.5 months) after flow diverter treatment. Three neurointerventionalists, blinded to clinical data, assessed stent lumen visibility and diagnostic confidence using a 5-point Likert scale. Quantitative metrics included signal-to-noise ratio, contrast-to-noise ratio, relative metal artifact width, and radiation doses. A mixed linear model identified predictors of image quality. RESULTS:PCD-CT stent lumen visibility (4.6 ± 0.7) was significantly higher than baseline DSA (3.0 ± 0.5, P < 0.001) and VasoCT (3.1 ± 1.2, P < 0.001). Diagnostic confidence scores were significantly higher for DSA (5.0 ± 0.0) and PCD-CT (4.8 ± 0.6) than for VasoCT (3.4 ± 1.0, both P < 0.001), while PCD-CT was slightly but significantly lower than DSA (P = 0.031). Inter-observer agreement was excellent (ICC ≥ 0.945). PCD-CT effective dose (0.79 ± 0.07 mSv) was higher than localized DSA (0.13 ± 0.02 mSv) and VasoCT (0.55 ± 0.08 mSv) due to whole-brain coverage. Mixed model identified PCD-CT as the strongest positive predictor for lumen visibility (β = 1.65, P < 0.001), and this advantage remained robust across different aneurysm morphologies and the predominant stent designs evaluated in this cohort. CONCLUSION:PCD-CT provides superior stent lumen visualization compared to baseline imaging, while maintaining a sub-millisievert radiation dose. It represents a promising non-invasive surveillance tool, though prospective validation of its diagnostic accuracy for in-stent stenosis is required.

BACKGROUND AND OBJECTIVE:Idiopathic intracranial hypertension (IIH) is associated with venous sinus stenosis (VSS). While stenting has shown potential as a treatment for VSS in patients diagnosed with IIH, clinical outcomes remain variable. Current predictive markers for treatment success are limited. This study aimed to investigate the predictive value of the Upstream Stasis (US) sign, recently proposed based on our imaging observations, in forecasting treatment success in venous sinus stenting for patients diagnosed with IIH. METHODS:We retrospectively analyzed data from 102 patients with IIH who underwent venous sinus stenting between May 2016 and August 2024. Patients were categorized based on the presence or absence of the US sign, identified through color-coded cerebral blood flow (CBF) maps. Clinical outcomes were assessed at the 12 month follow-up. Multivariate logistic regression was used to identify independent predictors of favorable outcomes, adjusting for demographic and anatomical factors. RESULTS:The US sign was present in 64.7% of patients and was significantly associated with favorable clinical outcomes (sensitivity 74%, specificity 88%, C-statistic 0.81). Multivariate analysis confirmed that both the US sign (OR 31.6, 95% CI 7.15 to 232.2) and intrinsic stenosis (OR 7.68, 95% CI 2.00 to 36.3) were independent predictors of favorable outcome. Subgroup analysis suggested that the US sign provided additional prognostic value beyond morphological classification into intrinsic and extrinsic stenosis. CONCLUSION:Our study suggests that the US sign may serve as a valuable imaging biomarker for predicting the outcomes of stenting in patients with IIH and VSS. Large-scale prospective studies are warranted to validate its clinical utility and broader applicability.

BACKGROUND:Although most unruptured intracranial aneurysms (UIAs) have good prognosis after flow diverter (FD) treatment, some remain unoccluded for extended periods, posing a persistent rupture risk. This study aims to develop a predictive model for UIA occlusion after FD treatment through integrating morphological and hemodynamic parameters, which may be critical for personalized postoperative management. METHODS:Data from patients with single UIAs treated with stand-alone FD were collected from June 2018 to December 2022 in four cerebrovascular disease centers. Morphological parameters were obtained from 3D reconstructed aneurysm models, and hemodynamic parameters were derived by computational fluid dynamics (CFD) analysis. A predictive model for aneurysm occlusion was constructed using various machine learning algorithms, including logistic regression, Random Forest, XGBoost, and K-Nearest Neighbors. Model performances were evaluated through repeated cross-validation, 0.632 bootstrap, and 0.632+ bootstrap. Shapley additive explanation (SHAP) analysis was employed to assess the contribution of each parameter to UIA occlusion. RESULTS:Seventy-nine patients were reviewed; a total of 51 cases met the criteria, with an average age of 53.9 ± 9.9 years. The average aneurysm diameter was 3.72 ± 2.72 mm, comprising 29 occlusions and 22 non-occlusions. Five variables were selected for further modeling, including follow-up time > 6 months, aneurysm rupture ratio (ArR), occlusion ratio (OsR), parent artery wall shear stress (WSS), and the change of parent artery WSS. Logistic regression outperformed other algorithms, achieving an area under the curve (AUC) above 0.75, indicating good predictive performance. SHAP analysis revealed that the change of parent artery WSS contributed most significantly to accurate and early prediction. Additionally, a web application software was developed to assist clinicians in real-time aneurysm occlusion prediction. CONCLUSIONS:This study developed a robust predictive model for UIA occlusion following FD treatment by integrating morphological and hemodynamic parameters, which may provide potentially valuable decision-making support for optimizing treatment strategies.

Silent magnetic resonance angiography (S-MRA) is primarily utilized to assess the blood flow in aneurysms and parent vessels of treated intracranial aneurysms. This study aimed to compare the diagnostic value of S-MRA and three-dimensional time of flight (3D-TOF) MRA for unruptured intracranial aneurysms. We included patients diagnosed with unruptured intracranial aneurysms using digital subtraction angiography (DSA) who subsequently underwent S-MRA and 3D-TOF MRA. Two independent neuroimaging and neurointerventional doctors evaluated the DSA images and measured aneurysm dimensions. Using DSA results as the gold standard, we determined the sensitivity and specificity of S-MRA and 3D-TOF MRA, as well as their accuracy in measuring aneurysm size and identifying aneurysms with daughter sacs. We detected a total of 41 intracranial aneurysms (in 37 patients) on both S-MRA and 3D-TOF MRA, with both techniques achieving a sensitivity and specificity of 100%. For aneurysm height, the intraclass correlation coefficient (ICC) was 0.977 (P < 0.001) between S-MRA and DSA, and 0.908 (P < 0.001) between 3D-TOF MRA and DSA. For neck width, the ICC was 0.663 (P < 0.001) between S-MRA and DSA, and 0.563 (P < 0.001) between 3D-TOF MRA and DSA. In terms of daughter aneurysm detection, 3D-TOF MRA Sensitivity 40%; specificity 92%: positive predictive value 100%; S-MRA sensitivity 60%; specificity 89%; positive predictive value 42%. In conclusion, S-MRA and 3D-TOF MRA did not significantly differ in aneurysm detection ability. For the detection of aneurysm with dauthger sacs indicators, the sensitivity is also higher.

OBJECTIVE:To investigate the long-term outcomes of stenting for isolated pulsatile tinnitus (PT) caused by cerebral venous sinus stenosis. STUDY DESIGN:Retrospective study. SETTING:The First Medical Center, Chinese PLA General Hospital. PATIENTS:Patients diagnosed to have isolated PT secondary to cerebral venous sinus stenosis at our institution between December 2009 and March 2023. INTERVENTION:Cerebral venous sinus stenting. MAIN OUTCOME MEASURES:Morphological features of the cerebral venous sinus, endovascular technique, and clinical outcomes. RESULTS:The study included 80 patients with a mean age of 39.4 ± 9.6 years and an average body mass index of 23.9 kg/m. The mean age at symptom onset was 35.1 ± 8.7 years. Seventy-five of the patients (93.8%) were women. PT was the primary symptom. All patients reported feeling anxious because PT had severely affected their day-to-day lives. The PT was right-sided in 52 cases (65%). All procedures were technically successful. The mean trans-stenotic pressure gradient decreased from 4.3 ± 3.3 mm Hg before stenting to 0.4 ± 0.9 mm Hg after stent placement. Twenty-one patients (26.3%) experienced poststenting headache. The mean follow-up duration was 80.5 ± 46.3 months, with 26 patients followed for over 120 months. PT resolved in all cases after stenting, and there were no recurrences. Follow-up radiographic examination of 23 patients (28.8%) at a mean of 71.2 ± 43.1 months identified only one case of restenosis. CONCLUSIONS:Long-term follow-up of these patients confirmed the efficacy and safety of stenting for isolated venous sinus stenosis-related PT.

There is no dedicated stent for isolated venous pulsatile tinnitus (IVPT). This retrospective study aimed to evaluate the the clinical outcomes and associated factors of Precise stent (Cordis) implantation in the management of IVPT. We analyzed data from IVPT patients treated at our center between December 2009 and August 2024. Baseline characteristics, venous sinus morphology, endovascular techniques, clinical outcomes, and follow-up data were reviewed. Among 111 IVPT patients, 64 (57.7

ObjectivesTo evaluate the diagnostic accuracy of the quantitative flow ratio (QFR) for hemodynamic exploration of intracranial atherosclerotic stenosis, using the invasive cerebrovascular pressure ratio (CVPR) and resting full-cycle ratio (RFR) as reference standards.Materials and methodsPatients with symptomatic unifocal intracranial atherosclerotic stenosis were included. The CVPR was defined as the ratio of the proximal and distal pressures. All patients underwent angioplasty under general anesthesia. The QFR was calculated based on digital subtraction angiography. Using the CVPR as a reference, we compared its correlation with the QFR across different degrees and locations of stenosis.ResultsThe CVPR and QFR were measured in 34 vessels of 32 patients. The QFR demonstrated a high correlation and excellent agreement(r = 0.8227, p < 0.001) with the CVPR in distal stenosis before intervention. In the subgroup with diameter stenosis >80%, the QFR showed a high correlation (r = 0.8812, p < 0.001) with the CVPR. In the anterior circulation subgroup, the QFR showed an excellent correlation (r = 0.9066, p < 0.001) with the CVPR. In the posterior circulation subgroup, the QFR showed a high correlation with the CVPR (r = 0.7706, p < 0.001). Diameter stenosis rates showed a moderate negative correlation with the CVPR.ConclusionThere was a strong correlation between the QFR and wire-based CVPR, especially for anterior circulation lesions before intervention. The QFR may serve as a predictive factor for evaluating hemodynamic changes in intracranial atherosclerotic stenosis.

Sizing of flow diverters (FDs) is a challenging task in the treatment of intracranial aneurysms due to their foreshortening behavior. The purpose of this study is to evaluate the difference between the sizing results from the AneuGuide (TM) software and from conventional 2D measurement. Ninety-eight consecutive patients undergoing pipeline embolization device (PED) treatment between October 2018 and April 2023 in the First Medical Center of Chinese PLA General Hospital (Beijing, China) were retrospectively analyzed. For all cases, the optimal PED dimensions were both manually determined through 2D measurements on pre-treatment 3D-DSA and computed by AneuGuide (TM) software. The inter-rater reliability between the two sets of sizing results for each methodology was analyzed using intraclass correlation coefficient (ICC). The degree of agreement between manual sizing and software sizing were analyzed with the Bland-Altman plot and Pearson's test. Differences between two methodologies were analyzed with Wilcoxon signed rank test. Statistical significance was defined as p < 0.05. There was better inter-rater reliability between AneuGuide (TM) measurements both for diameter (ICC 0.92, 95%CI 0.88-0.95) and length (ICC 0.93, 95%CI 0.89-0.96). Bland-Altman plots showed a good agreement for diameter selection between two methodologies. However, the median length proposed by software group was significantly shorter (16 mm versus 20 mm, p < 0.001). No difference was found for median diameter (4.25 mm versus 4.25 mm). We demonstrated that the AneuGuide (TM) software provides highly reliable results of PED sizing compared with manual measurement, with a shorter stent length. AneuGuide (TM) may aid neurointerventionalists in selecting optimal dimensions for FD treatment.

AbstractObjectivesParkinson disease (PD) is the third leading cause of mortality among middle‐aged and older individuals in China. This study aimed to explore the trends and distribution features of PD mortality in China from 2013 to 2021 and make predictions for the next few decades.MethodsRelevant data were obtained from the Chinese Center for Disease Control and Prevention Disease Surveillance Point system. The joinpoint regression model was used to evaluate trends. The R software was used to predict future trends.ResultsAge‐standardized mortality rate (ASMR) of PD increased from 0.59 per 100,000 individuals to 1.22 per 100,000 individuals from 2013 to 2021, with an average annual percent change (AAPC) of 9.50 (95% CI: 8.24–10.78). The all‐age ASMR of PD were higher in male individuals than in female individuals, and ASMR increased with age. The number of deaths and ASMR increased gradually from west to east and from rural to urban areas. Furthermore, ASMR is expected to increase to 2.66 per 100,000 individuals by 2040.ConclusionsThe heightened focus on the ASMR of PD among male individuals, urban areas, eastern China, and individuals aged ≥85 years has become a key determinant in further decreasing mortality, thereby exhibiting novel challenges to effective strategies for disease prevention and control.

ObjectivesThe presence of dural sinus septum has long been identified anatomically but is often neglected for its clinical significance. Our findings revealed the association of dural sinus septum with venous sinus stenting failure and complications supported by clinical evidence. MethodsThis retrospective study included 185 consecutive patients treated with cerebral venous sinus stenting from January 2009 to May 2022. We identified the dural sinus septa using digital subtraction angiography (DSA) and classified them into three types based on their location. The septa at the transverse sinus were defined as type I, those at the junction between the transverse sinus and sigmoid sinus were defined as type II and those at the sigmoid sinus were defined as type III. Based on the anatomic features and neuroimaging clues, we investigated the correlation of dural sinus septa with stenting failure and complications. Results32 (17.1%) out of 185 patients (121 with idiopathic intracranial hypertension and 64 with venous pulsatile tinnitus) were identified with dural sinus septa by DSA. More than half of the septa were type I (18/32, 56.2%), followed by type II (11/32, 34.4%) and type III (3/32, 9.4%). The dural sinus septa caused three stenting failures and complications, including one case of venous sinus injury with subdural haemorrhage and two cases of incomplete stent expansion. Statistical analysis revealed that the presence of dural sinus septum (p<0.01) was associated with complications of cerebral venous sinus stenting. DiscussionThe dural sinus septum is a common structure in the cerebral venous sinus. We found that the presence of dural sinus septa introduces uncertainties to cerebral venous sinus stenting and suggested precautions and ingenious skills in imaging and treatment.

Background Subarachnoid hemorrhage (SAH) is a subtype of hemorrhagic stroke characterized by high mortality and low rates of full recovery. This study aimed to investigate the epidemiological characteristics of SAH between 1990 and 2021. Methods Data on SAH incidence, mortality, and disability-adjusted life-years (DALYs) from 1990 to 2021 were obtained from the Global Burden of Disease Study (GBD) 2021. Estimated annual percentage changes (EAPCs) were calculated to evaluate changes in the age-standardized rate (ASR) of incidence and mortality, as well as trends in SAH burden. The relationship between disease burden and sociodemographic index (SDI) was also analyzed. Results In 2021, the incidence of SAH was found to be 37.09% higher than that in 1990; however, the age-standardized incidence rates (ASIRs) showed a decreased [EAPC: -1.52; 95% uncertainty interval (UI) -1.66 to -1.37]. Furthermore, both the number and rates of deaths and DALYs decreased over time. It was observed that females had lower rates compared to males. Among all regions, the high-income Asia Pacific region exhibited the highest ASIR (14.09/100,000; 95% UI 12.30/100,000 - 16.39/100,000) in 2021, with an EPAC for ASIR < 0 indicating decreasing trend over time for SAH ASIR. Oceania recorded the highest age-standardized mortality rates (ASMRs) and age-standardized DALYs rates among all regions in 2021 at values of respectively 8.61 (95% UI 6.03 - 11.95) and 285.62 (95% UI 209.42 - 379.65). The burden associated with SAH primarily affected individuals aged between 50 - 69 years old. Metabolic risks particularly elevated systolic blood pressure were identified as the main risk factors contributing towards increased disease burden associated with SAH when compared against environmental or occupational behavioral risks evaluated within the GBD framework. Conclusions The burden of SAH varies by gender, age group, and geographical region. Although the ASRs have shown a decline over time, the burden of SAH remains significant, especially in regions with middle and low-middle SDI levels. High systolic blood pressure stands out as a key risk factor for SAH. More specific supportive measures are necessary to alleviate the global burden of SAH.

BACKGROUND:Cerebrovascular disease (CVD) ranks among the foremost factors responsible for mortality on a global scale. The mortality patterns of CVDs and temporal trends in China need to be well-illustrated and updated. METHODS:We collected mortality data on patients with CVD from Chinese Center for Disease Control and Prevention's Disease Surveillance Points (CDC-DSP) system. The mortality of CVD in 2020 was described by age, sex, residence, and region. The temporal trend from 2013 to 2019 was evaluated using joinpoint regression, and estimated rates of decline were extrapolated until 2030 using time series models. RESULTS:In 2019, the age-standardized mortality in China (ASMRC) per 100,000 individuals was 113.2. The ASMRC for males (137.7/10 5 ) and rural areas (123.0/10 5 ) were both higher when stratified by gender and urban/rural residence. The central region had the highest mortality (126.5/10 5 ), the western region had a slightly lower mortality (123.5/10 5 ), and the eastern region had the lowest mortality (97.3/10 5 ). The age-specific mortality showed an accelerated upward trend from aged 55-59 years, with maximum mortality observed in individuals over 85 years of age. The age-standardized mortality of CVD decreased by 2.43% (95% confidence interval, 1.02-3.81%) annually from 2013 to 2019. Notably, the age-specific mortality of CVD increased from 2013 to 2019 for the age group of over 85 years. In 2020, both the absolute number of CVD cases and the crude mortality of CVD have increased compared to their values in 2019. The estimated total deaths due to CVD were estimated to reach 2.3 million in 2025 and 2.4 million in 2030. CONCLUSION:The heightened focus on the burden of CVD among males, rural areas, the central and western of China, and individuals aged 75 years and above has emerged as a pivotal determinant in further decreasing mortalities, consequently presenting novel challenges to strategies for disease prevention and control.

BACKGROUND Spinal dural arteriovenous fistulas are rare vascular malformations predominantly affecting middle-aged and elderly males. The thoracolumbar region is the most common site, yet Spinal dural arteriovenous fistulas in the craniocervical junction region represents only 2% of cases. Patients with Spinal dural arteriovenous fistulas typically presented with subarachnoid hemorrhage and progressive myelopathy with chronic or subacute onset. However, brainstem dysfunction as the main clinical manifestation is rare, and it can easily be misdiagnosed as spondylitis, spinal cord tumor, or demyelination, resulting in incorrect treatment decisions and negative treatment outcomes, even life-threatening. CASE DESCRIPTION: A 60-year-old woman with an acute onset initially misdiagnosed as cerebral infarction and inflammatory demyelination.Despite receiving various glucocorticosteroids and medications, she experienced fluctuated clinical manifestations. The diagnosis of cerebrospinal arteriovenous fistula in the craniocervical junction region was confirmed by Digital Subtraction Angiography. Tragically, the patient experienced sudden respiratory and cardiac arrest and subsequently died the day after undergoing Digital Subtraction Angiography . CONCLUSION This case highlights a rare situation of Spinal dural arteriovenous fistulas in the craniocervical junction region that is characterized by brainstem dysfunction and acute onset. Importantly, the case illustrates a high level of vigilance is indicated to recognize spinal dural arteriovenous fistulas when observing symptomatic fluctuations related to steroid therapy and characteristic brain imaging findings such as increased vascularity or flow-voiding shadows.

Objectives: This study aimed to explore the distribution features and trends of dementia mortality in China from 2011 to 2020 and make a prediction for the next decade.Methods: Mortality-relevant data were gathered from the Chinese Center for Disease Control and Prevention's Disease Surveillance Points system. Joinpoint regression was applied to evaluate the trends.Results: Crude Mortality Rate (CMR) of AD and other dementias increased from 3.7 per 100,000 to 6.2 per 100,000 in 2011-2020, with an Average Annual Percent Change (AAPC) of 5.3% (95% CI 4.4%-6.3%). Age-Standardized Mortality Rate (ASMR) slightly decreased from 5.0 per 100,000 to 4.1 per 100,000 in 2011-2020, with AAPC of -0.4% (95% CI -2.5%-1.8%). CMR will increase to 9.66 per 100,000 while ASMR will decline to 3.42 per 100,000 in the following decade.Conclusion: The upward trend in CMR and downward trend in ASMR suggested the further development of population aging and dementia mortality in the past and future decades. In China, there were gender, urban-rural, regional and age differences.

Fluid-attenuated inversion recovery (FLAIR) vessel hyperintensity(FVH)refers to the hyperintensity corresponding to the arteries in the subarachnoid space. It is caused by critically slowed blood flow and is commonly encountered in patients with large artery steno-occlusions. Quite a few studies have focused on the clinical significance of FLAIR vessel hyperintensity in terms of its relationship to the prognosis of transient ischemic attack (TIA), baseline severity or infarction volume, early neurological deterioration or infarction growth, and functional outcomes in acute ischemic stroke (AIS). However, inconsistent or conflicting findings were common in these studies and caused confusion in the clinical decision-making process guided by this imaging marker. Through reviewing the available studies on the etiologic mechanism of FVH and investigating findings on its clinical significance in AIS and TIA, this review aims to elucidate the key factors for interpreting the clinical significance of FVH individually.

Objective:To investigate the safety and efficacy of Neuroform Atlas stent-assisted coil embolization for treatment of intracranial aneurysms at middle cerebral artery (MCA) bifurcation.Methods:A retrospective analysis was conducted on the clinical data of 21 patients with aneurysms at MCA bifurcation who underwent endovascular treatment using Neuroform Atlas device in the Department of Neurology, Chinese PLA General Hospital from July 2020 to October 2022. The immediate postoperative embolization degree was assessed using Raymond grading system and perioperative complications were documented. DSA was performed at 6-month follow-up for evaluation of aneurysm embolization degree and related complications.Results:Among 21 cases of MCA bifurcation aneurysms, single-stent treatment was administered in 18 cases and double-stent treatment in 3 cases. All stents were accurately located and implanted. The successful rate of procedure was 100%. As revealed in immediate angiography after the procedure, there were 3 cases (14.3%) of grade Ⅰ, 1 case (4.8%) of grade Ⅱ and 17 cases (80.9%) of grade Ⅲ. There were 2 perioperative complications documented which included 1 case of in-stent thrombosis developing during surgery and 1 case of postoperative transient ischemic attack. Both of them had no obvious symptom or sign of neurological dysfunction. A total of 13 patients underwent DSA review at 6-month follow-up which revealed grade Ⅰ in 11 cases, grade Ⅱ in 1 case and grade Ⅲ in 1 case. There were 1 case of recurrence, 3 cases of in-stent stenosis of parent vessel and 1 case of blocking of MCA branch on the contralateral side of aneurysm.Conclusion:It has been preliminarily suggested that application of Neuroform Atlas stent in the treatment of MCA bifurcation aneurysm is associated with high safety and favorable short-term embolization efficacy.

Background Clot analogs are essential in animal and in vitro experiments on mechanical thrombectomy devices for treating acute ischemic stroke. Clot analogs should be capable of reproducing a variety of arterial clots observed in clinical practice in terms of histological composition and mechanical properties. Methods Bovine blood with added thrombin was stirred in a beaker so that clots could be formed under the condition of dynamic vortical flow. Static clots were also prepared without stirring, and the properties of the static clots and dynamic clots were compared. Histological and scanning electron microscopy experiments were performed. Compression and relaxation tests were performed to evaluate the mechanical properties of the two types of clots. Thromboembolism and thrombectomy tests were conducted in an in vitro circulation model. Results Compared to the static clots, the dynamic clots prepared under vortical flow displayed a higher fibrin content, and their fibrin network was denser and sturdier than that of the static clots. The stiffness of the dynamic clots was significantly higher than that of the static clots. The stress of both types of clots could decay quickly under large sustained strain. The static clots could break at the bifurcation in the vascular model, while the dynamic clots could be firmly stuck in the vascular model. Conclusions Dynamic clots generated in dynamic vortical flow differ significantly from static clots in terms of their composition and mechanical properties, which may be beneficial information for preclinical research on mechanical thrombectomy devices.

HomeStrokeVol. 54, No. 9Asymmetrically Dilated Perivascular Space and Impaired Perfusion in Bilateral Middle Cerebral Artery Occlusion No AccessCase ReportRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessCase ReportRequest AccessFull TextAsymmetrically Dilated Perivascular Space and Impaired Perfusion in Bilateral Middle Cerebral Artery Occlusion Bin Lv and Chenglin Tian Bin LvBin Lv https://orcid.org/0000-0001-9858-8778 Department of Neurology, The First Medical Center, Chinese PLA General Hospital, Beijing, China. Search for more papers by this author and Chenglin TianChenglin Tian Correspondence to: Chenglin Tian, MD, Department of Neurology, The First Medical Center of PLA General Hospital, No. 28, Fuxing Rd, Beijing, China, 100853. Email E-mail Address: [email protected] https://orcid.org/0000-0002-2455-6930 Department of Neurology, The First Medical Center, Chinese PLA General Hospital, Beijing, China. Search for more papers by this author Originally published13 Jul 2023https://doi.org/10.1161/STROKEAHA.123.043663Stroke. 2023;54:e421–e422"Asymmetrically Dilated Perivascular Space and Impaired Perfusion in Bilateral Middle Cerebral Artery Occlusion." Stroke, 54(9), pp. e421–e422FootnotesFor Sources of Funding and Disclosures, see page e421.Correspondence to: Chenglin Tian, MD, Department of Neurology, The First Medical Center of PLA General Hospital, No. 28, Fuxing Rd, Beijing, China, 100853. Email tianchenglin@301hospital.com.cnREFERENCES1. Rasmussen MK, Mestre H, Nedergaard M. The glymphatic pathway in neurological disorders.Lancet Neurol. 2018; 17:1016–1024. doi: 10.1016/S1474-4422(18)30318-1CrossrefMedlineGoogle Scholar2. Park AY, Chung TS, Suh SH, Choi HS, Lee YH. Asymmetric dilatation of virchow-robin space in unilateral internal carotid artery steno-occlusive disease.J Comput Assist Tomogr. 2011; 35:298–302. doi: 10.1097/RCT.0b013e31820baf1eCrossrefGoogle Scholar3. Sahin N, Solak A, Genc B, Akpinar MB. Dilatation of the Virchow-Robin spaces as an indicator of unilateral carotid artery stenosis: correlation with white matter lesions.Acta Radiol. 2015; 56:852–859. doi: 10.1177/0284185114544243CrossrefMedlineGoogle Scholar eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetails September 2023Vol 54, Issue 9 Advertisement Article InformationMetrics © 2023 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.123.043663PMID: 37439206 Originally publishedJuly 13, 2023 Keywordsdilationcarotid stenosismagnetic resonance angiographyperfusioninfarctionPDF download Advertisement SubjectsCerebrovascular Disease/StrokeMagnetic Resonance Imaging (MRI)