Abstract Background and aims To determine the prevalence of retinal ischemic complications after carotid artery stenting (CAS), identify associated procedural and systemic vascular risk factors, and explore their relationship with neurological and visual outcomes. Methods Participants underwent optical coherence tomography (OCT)/OCT angiography with simultaneous confocal scanning superluminescent ophthalmoscope imaging centered on the optic nerve head and macular fovea 1–3 days before and 4 days after CAS. Vascular risk factors, stenting location, and perioperative complications were recorded. Main Outcome Measures include: Incidence of retinal ischemic complications, neurological deficits, and retinal/choroidal vascular metrics. Results New-onset retinal complications after CAS included cotton-wool spots (CWS), paracentral acute middle maculopathy (PAMM), retinal artery/vein occlusion (RAO/RVO), and non-arteritic anterior ischemic optic neuropathy, often co-occurring. Post-CAS rates were significantly higher for CWS (8.45% vs. 2.59%), RAO (2.47% vs. 0.78%), and PAMM (2.99% vs. 1.29%). Stent coverage of the ophthalmic artery origin increased complication risk (CWS 28.57% vs. 6.63%; RAO 21.43% vs. 1.81%; RVO 7.14% vs. 0%; PAMM 14.29% vs. 2.11%; p < 0.001). Retinal complications were associated with subjective vision impairment (p < 0.05), and retinal complications overall correlated with neurological deficits (p = 0.006). Conclusions Stent placement across the ophthalmic artery origin and systemic vascular risks contribute to retinal ischemia after CAS. Routine perioperative retinal screening in high-risk patients may aid early detection and enhance cerebral safety monitoring. Conflict of interest Tianxiang Lan. nothing to disclose.

Abstract Background and aims This study aimed to comprehensively characterize retinal and choroidal alterations in carotid artery dissection (CAD), compare them with those in atherosclerotic carotid artery stenosis (CAS), and analyze their associations with clinical and neuroimaging features, including cerebral infarction, stenotic degree, and infarction location. Methods This observational study included CAD patients and stenotic-degree-matched CAS patients. Retinal ischemic signs—cotton wool spots (CWS), retinal artery occlusion (RAO), and paracentral acute middle maculopathy (PAMM)—were evaluated using optical coherence tomography (OCT) and angiography (OCTA) centered at foveal. Retinal vascular metrics (superficial and deep vascular complex density) and choroidal metrics (choriocapillaris density, choroidal thickness, choroidal vascular volume [CVV], and the choroidal vascular index [CVI]) were analyzed. Results The final analysis included 863 eyes from 467 participants. CAD patients showed a significantly higher prevalence of PAMM than CAS patients (6.4% vs. 0.61%, p < 0.001). Eyes ipsilateral to CAD exhibited reduced retinal vascular density compared with both contralateral and control eyes. Furthermore, CAD-affected eyes demonstrated significantly higher choriocapillaris density, CVV, CVI, and choroidal thickness relative to both control eyes and CAS-affected eyes. PAMM presence was significantly associated with cerebral infarction and severe stenosis/occlusion. Subcortical infarctions were more frequently associated with PAMM, while cortical infarctions tended to co-occur with CWS and RAO. Conclusions CAD exhibit more pronounced retinal hemodynamic impairment, higher thromboembolic risk, and distinct vascular alteration patterns compared with atherosclerotic stenosis. Retinal imaging provides a non-invasive window into CAD pathophysiology, offering valuable insights for clinical assessment and risk stratification. Conflict of interest Le Cao, Hang Wang, and Bo Wu: nothing to disclose

BackgroundChronic total occlusion (CTO) of the internal carotid artery relies on collateral circulation, often involving retrograde ophthalmic artery (OA) flow. However, the differential vascular patterns of the retina and choroid associated with this hemodynamic alteration remain unclear. We aimed to characterize these alterations using optical coherence tomography (OCT) and OCT angiography (OCTA).MethodsThis multicenter cross-sectional study enrolled patients with CTO, severe carotid artery stenosis (CAS), and controls. OA flow direction was verified by digital subtraction angiography. Swept-source OCT/OCTA was used to quantify vessel length density (VLD) in the superficial and deep vascular complexes and choroidal parameters (vascular volume [CVV] and vascular index [CVI]).ResultsA total of 216 patients with CTO (419 eyes), 192 with CAS (376 eyes), and 247 controls (467 eyes) were analyzed. Retinal VLD was significantly lower in CTO eyes than in CAS and control eyes (all p < 0.05). In contrast, choroidal parameters were relatively preserved in CTO compared with CAS (both p < 0.05). Within the CTO group, ipsilateral eyes showed reduced retinal VLD compared with contralateral eyes (both p < 0.001), without significant choroidal differences. Among ipsilateral CTO eyes, retrograde OA flow was associated with further even lower retinal VLD but significantly higher CVV and CVI compared with antegrade OA flow (all p < 0.05).ConclusionRetrograde OA flow in CTO is associated with divergent ocular vascular profiles, characterized by more severe retinal microvascular loss and paradoxical choroidal vascular expansion. These findings highlight the distinct hemodynamic sensitivities of the retinal and choroidal circulations and support OCTA-derived metrics as noninvasive biomarkers for collateral-dependent perfusion.

Purpose:Large artery stenosis (LAS) can drive cognitive impairment and neurodegeneration even without overt infarction, yet scalable biomarkers for capturing this silent vascular brain injury are limited. We investigated whether retinal and choroidal microvascular and neurostructural measures reflect cerebral atrophy and cognitive impairment in noninfarcted LAS. Methods:In a multicenter cohort of 1239 participants (1035 patients with noninfarcted LAS and 204 community-based controls), we integrated optical coherence tomography/angiography (OCT/OCTA), brain magnetic resonance imaging volumetry, and cognitive assessments. Machine learning models were trained internally (n = 891) and externally validated (n = 348) to evaluate the predictive value of combined retinal and choroidal features for cerebral atrophy and cognitive impairment. Results:LAS was associated with ganglion cell-inner plexiform layer (GCIPL) thinning and profound retinal and choroidal microvascular rarefaction, which tracked closely with reduced gray matter (GM) and white matter (WM) volumes (all P < 0.001). These retina-brain associations were strongest in bilateral subcortical and medial temporal regions (all P < 0.05). Crucially, integrating OCT/OCTA metrics into machine learning models substantially improved prediction of cerebral atrophy and cognitive impairment beyond the enhanced clinical baseline model: random forest achieved an external test R2 of 0.456 versus 0.254 for GM volume and 0.430 versus 0.251 for WM volume, while the support vector machine achieved the best classification performance for cognitive impairment (area under the curve = 0.794 vs. 0.668). Conclusions:Retinal and choroidal microvascular measures are sensitive, noninvasive biomarkers of silent, vascular-driven neurodegeneration. They offer substantial incremental value for individual risk stratification in vascular contributions to cognitive impairment and dementia.

INTRODUCTION:While both Alzheimer's disease (AD) and cerebral small vessel disease (CSVD) involve vascular dysfunction, the ocular microvascular differences between them remain largely underinvestigated. METHODS:This cross-sectional study included 650 participants (149 AD, 276 CSVD, and 225 cognitively unimpaired individuals). Optical coherence tomography angiography (OCTA) metrics were analyzed to characterize ocular microvascular alterations. RESULTS:CSVD patients exhibited a higher burden of retinal ischemic perivascular lesions (RIPLs) than AD patients (all p < 0.05), whereas AD patients showed reduced choriocapillaris (CC) density (p = 0.031). In the CSVD group, RIPLs were associated with total CSVD score (p = 0.049), while reduced CC density was associated with elevated phosphorylated tau 181 in the AD group (p = 0.001). Machine learning models integrating OCTA metrics effectively differentiated AD from CSVD (area under the curve = 0.86). DISCUSSION:AD and CSVD exhibit distinct ocular microvascular alterations, supporting OCTA-derived measures as potential non-invasive biomarkers. TRIAL REGISTRATION NUMBER:ChiCTR2000041386.

Central post-stroke pain (CPSP) of thalamic origin is one of the most frequent subtypes in all kinds of CPSP, and often be refractory to treatments and affect the long-term prognosis of thalamic stroke patients, while the mechanism remains unclear. We aim to investigate brain network alterations in patients with CPSP after thalamic stroke and explore whether these changes underlie clinical symptoms.Ninety-two participants were finally enrolled in this observational study (26 had CPSP of thalamic origin, 41.9%) and 30 were healthy controls (HCs). Structural (SC) and functional connectivity (FC) networks were constructed using diffusion spectrum imaging (DSI) and resting-state functional imaging (fMRI), respectively. Brain network topological characteristic and structural-functional connectivity (SC-FC) couplings at a multi-modular level were obtained through graph theoretical.Compared with non-CPSP patients, distinct SC topological changes were found in CPSP patients, characterized as a higher clustering coefficient (Cp), global efficiency (Eg), local efficiency (Eloc), and lower characteristic path length (Lp) and normalized characteristic path length (Lambda) values (PBonferroni<0.05). CPSP patients had significantly lower SC-FC couplings at the global and the structural Hub-modular levels. Further, we found significant and various correlations between pain severity and structural Lp, Eloc, global and Hub-modular SC-FC couplings (PAdjusted<0.05).Thalamic stroke-induced distinct structural network dysfunction and diverse SC-FC decoupling may be a novel neural mechanism for the occurrence of CPSP. Our results may provide new insights for future refined targeted neuromodulation therapies and individualized rehabilitative strategies in patients with CPSP. PERSPECTIVE: Central post-stroke pain (CPSP) following thalamic stroke reflects large-scale brain network dysfunction. We identify distinct structural network reorganization and impaired structure-function coupling in CPSP patients, correlating with clinical pain. These findings provide a novel pathophysiological framework and potential network-based biomarkers for this treatment-resistant neuropathic pain condition.

BACKGROUND:Hemodynamic depression is common after carotid artery stenting (CAS), but whether its two phenotypes, persistent hypotension and bradycardia, reflect shared or distinct autonomic responses remains unclear. We aimed to characterize perioperative autonomic changes associated with these outcomes via continuous Holter monitoring. METHODS:In this prospective, single-center cohort, consecutive CAS patients were enrolled, and a prospective subcohort underwent Holter monitoring from 24 hours before to 24 hours after stenting. Sympathetic activity index (SAI) and parasympathetic activity index (PAI) were derived from heartbeat series to reflect autonomic modulation. Persistent hypotension was defined as systolic blood pressure<90 mmHg or vasopressor requirement for ≥6 hours, and persistent bradycardia as heart rate<60 beats/min for ≥6 hours within 24 hours after CAS. Exploratory mediation-style analysis examined the extent to which autonomic changes accounted for each outcome. RESULTS:Among 735 enrolled patients, 301 had valid recordings for autonomic analysis. In this monitored subcohort, CAS was associated with a reciprocal autonomic shift, with decreased SAI and increased PAI (both p<0.001). Reduced SAI statistically explained a larger proportion of the modeled association with bradycardia (88.9%; residual association p=0.570), whereas autonomic indices explained only a modest proportion of the modeled association with hypotension (SAI 20.0%; PAI 16.1%; both mediation p<0.001), with a significant residual association remaining (p<0.001). CONCLUSIONS:CAS was associated with sympathetic withdrawal and parasympathetic activation. These exploratory findings suggest that bradycardia was more tightly associated with heart rate-derived autonomic changes than hypotension, which was less fully captured by SAI/PAI and may involve additional factors.

Abstract Background and aims Carotid artery stenting (CAS) is frequently complicated by hemodynamic depression (HD). This study aimed to evaluate the effect of CAS on autonomic function and its association with HD. Methods This prospective cohort study enrolled patients with atherosclerotic stenosis at the carotid sinus who underwent CAS. Perioperative autonomic function was assessed using long-term electrocardiographic monitoring and heart rate variability analysis. Specific indices—sympathetic activity index (SAI) and parasympathetic activity index (PAI)—were derived from orthonormal Laguerre basis expansions based on heartbeat time series. Post-stenting hypotension and bradycardia were defined as systolic blood pressure < 90 mmHg or heart rate < 60 beats/min, respectively, lasting more than 6 hours. Longitudinal associations between autonomic function and HD were evaluated using generalized linear mixed models. Results A total of 735 patients who underwent CAS between March 2020 and December 2024 were included in the final analysis, among whom 301 had valid ECG recordings. Compared with the pre-stenting phase, SAI decreased and PAI increased after CAS (both P < 0.001). Patients who developed hypotension or bradycardia exhibited greater changes in autonomic indices (both P < 0.001). Mediation analysis indicated that SAI and PAI significantly mediated the effect of CAS on both hypotension and bradycardia (all P < 0.001). Conclusions CAS induces significant alterations in autonomic activity, which are associated with the development of HD. Long-term ECG monitoring combined with HRV analysis may help identify the underlying etiology of hypotension, such as hypovolemia or autonomic reflex mechanisms, facilitating targeted management. Conflict of interest Le Cao, Hang Wang, and Bo Wu: nothing to disclose

Background To contrast retinal and choroidal vascular alterations between carotid artery dissection (CAD) and carotid artery stenosis (CAS), and analyze their associations with cerebral infarction patterns and stenosis severity. Methods This observational study included stenotic‐degree‐matched patients with CAD and patients with CAS. Retinal ischemic signs—cotton wool spots, retinal artery occlusion, and paracentral acute middle maculopathy—were evaluated using fovea‐centered optical coherence tomography/angiography. Retinal vascular density and choroidal metrics (choriocapillaris density, thickness, vascular volume, and index) were analyzed. Results The final analysis included 863 eyes from 467 participants (85 with CAD, 274 with CAS, 108 controls). Patients with CAD showed a significantly higher prevalence of paracentral acute middle maculopathy than Patients with CAS (6.4% versus 0.61%, P<0.001). Although ipsilateral eyes in both groups showed reduced retinal vascular density (P<0.017), a divergent pattern was observed in the choroid: CAD‐affected eyes demonstrated significantly higher choriocapillaris density, choroidal vascular volume, and choroidal thickness relative to both control and CAS‐affected eyes (P<0.017). Clinically, retinal ischemic signs in CAD were significantly associated with cerebral infarction (P=0.022) and severe stenosis/occlusion (P=0.008). Notably, retinal signs correlated with cerebral infarction topography: subcortical infarctions were predominantly associated with paracentral acute middle maculopathy, whereas cortical infarctions were linked to cotton wool spots and retinal artery occlusion (P=0.004). Conclusions Compared with atherosclerotic stenosis, CAD exhibits a distinct oculovascular phenotype characterized by a higher burden of acute retinal ischemia but compensatory choroidal hyperperfusion. Retinal imaging serves as a noninvasive window into CAD pathophysiology, offering biomarkers for assessing hemodynamic stability and thromboembolic risk. Registration URL: www.chictr.org.cn; Unique identifier: ChiCTR2300074640.

Abstract Background and aims Hyperreflective foci (HRF) on optical coherence tomography (OCT) may serve as biomarkers of retinal structural damage in idiopathic intracranial hypertension (IIH), but their clinical relevance remains underexplored. We aimed to characterize HRF in IIH and evaluate their associations with disease severity, visual function, and retinal structural/microvascular changes. Methods This multicenter, cross-sectional, and longitudinal study included patients with IIH from three tertiary hospitals in Chengdu, China, between December 2020 and March 2024. HRF metrics (number and volume), intracranial pressure (ICP), Frisén score, visual acuity (VA), visual field mean deviation (MD), and OCT/OCTA-derived retinal layer thicknesses and microvascular densities were collected. HRF metrics were automatically analyzed using a validated artificial intelligence algorithm. Results 113 IIH patients (225 eyes) and 248 healthy controls (496 eyes) were included in final analysis. Compared with controls, IIH patients exhibited significantly higher HRF burden (all P < 0.01). HRF metrics correlated positively with ICP (P < 0.01) and Frisén score (P < 0.001) and negatively with VA (P < 0.001) and MD (P < 0.001). Baseline HRF predicted longitudinal retinal thinning (P < 0.001) and visual impairment at follow-up (AUC = 0.94, 95% CI: 0.88–0.99). Conclusions HRF are robust biomarkers of disease severity and visual dysfunction in IIH, offering a non-invasive tool for monitoring progression and guiding treatment. Conflict of interest Tianxiang Lan. nothing to disclose.

Retinal alterations in multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) remain unclear, especially the specific patterns and extent of microvascular change. This study aimed to compare these alterations and to develop logistic regression and machine learning models using combined retinal microvascular and structural metrics for disease differentiation. Patients with MS or NMOSD in clinically stable phases underwent swept-source optical coherence tomography (OCT) and OCT angiography (OCTA). Quantified OCTA metrics included density, perfusion, and microdensity of superficial and deep vascular complex (SVC, DVC), choroidal vascular, and stromal volumes (CVV, CSV). Structural OCT metrics included retinal nerve fiber layer (RNFL) and ganglion cell–inner plexiform layer (GCIPL) thickness. Logistic regression and machine learning models were developed for classification. The study enrolled 658 participants (167 MS patients, 221 NMOSD patients, and 270 age- and sex-matched healthy controls) with 1277 eyes. In optic neuritis (ON) eyes, NMOSD showed significantly lower SVC metrics than MS, whereas in non-ON eyes, MS exhibited more severe microvascular loss (most p < 0.017); correspondingly, EDSS-related SVC decline was steeper in ON eyes of NMOSD but steeper in non-ON eyes of MS (interaction p < 0.05 for most comparisons). The logistic regression model with microvascular metrics achieved an AUC of 0.900. Among machine learning classifiers, support vector machine performed best (AUC 0.912, accuracy 84.5

Background:The optimal blood pressure (BP) management following successful endovascular treatment (EVT) in acute ischaemic stroke (AIS) patients remains unclear. This study investigated the safety and efficacy of intensive BP control in AIS patients who had received EVT within 6 h. Methods:This randomised, multicentre, open-label, blinded-endpoint clinical trial (ChiCTR2200057770) was conducted at 63 stroke centres in China. Eligible participants had AIS due to large vessel occlusion in anterior circulation, underwent EVT within 6 h, and achieved successful recanalisation. Patients were randomised to intensive (systolic BP target <130 mm Hg) or standard (systolic BP target <180 mm Hg) management, maintained until 24 h post-EVT. The primary outcome was unfavourable functional outcome (modified Rankin Scale score of 3-6) at 90 days. The trial was terminated following a neutral interim analysis results and publication of counterpart randomised trials. Findings:Between October 14, 2022 and March 18, 2024, 383 patients were randomised. Unfavourable functional outcome occurred in 71.0% (130/183) of the intensive-management group and 67.5% (135/200) of the standard-management group (risk ratio, 1.05; 95% CI, 0.92-1.20; p = 0.45). There was no significant difference in symptomatic intracerebral haemorrhage, malignant brain oedema, or all-cause death at 90 days. Interpretation:Intensive BP management to <130 mm Hg did not improve outcomes in AIS patients undergoing EVT within 6 h and achieved successful recanalisation. The optimal BP management strategies require further investigation. Funding:Sichuan University West China Hospital, National Natural Science Foundation of China, National Key R&D Programme of China, and Science and Technology Department of Sichuan Province.

ABSTRACTIntroductionWe aimed to explore the difference in choroidal vascular parameters using swept‐source optical coherence tomography (SS‐OCT) in patients with idiopathic intracranial hypertension (IIH) compared to controls. We also explored the ability of the choroidal parameters to reflect elevated intracranial pressure (ICP) in patients with IIH.MethodsThis observational study recruited patients diagnosed with IIH and healthy controls. A lumbar puncture was performed for ICP measurement. All the participants underwent OCT examinations. The choroid was automatically segmented and imaged by the OCT tool. The parafoveal choroidal vascular volume (CVV) and choroidal vascular index (CVI) were calculated in 3 mm annulus and 6 mm annulus.ResultsA total of 80 patients with IIH (34.67 ± 11.00 years; 37.50% males) and 92 controls (34.50 ± 12.08 years; 36.96% males) were included in the final analysis. Patients with IIH had higher BMI (< 0.001) and poor visual acuity (< 0.001) compared with controls. Patients with IIH demonstrated significantly lower parafovea CVI in both annuluses (p = 0.003 for 3 mm annulus, p = 0.001 for 6 mm annulus) compared to controls. Mean parafovea CVI in both annuluses was significantly correlated with ICP level (p = 0.014 for 3 mm annulus, p = 0.015 for 6 mm annulus). The combination of CVV and CVI in a 6 mm annulus demonstrated the highest diagnostic value with a mean AUC of 0.818.ConclusionCVI may serve as a potential marker for identifying IIH and reflecting ICP changes.

BACKGROUND:Reports have proposed the retinal choroid as a potential biomarker for dementia and cerebral age-related disorders. However, the clinical use of the choroid as a surrogate marker remains underexplored. This study investigated the associations among choroidal perfusion, white matter hyperintensity (WMH), and cognitive function. METHODS:WMH severity (volume and shape features) and choroidal characteristics, including choroidal vascular volume, choroidal vascularity index, and choriocapillaris flow density, were automatically quantified in aging adults. Partial Spearman correlation was used to examine the relationship between choroidal and WMH metrics. General linear models were used to examine the associations of choroidal metrics and WMH characteristics with cognitive performance, as well as to explore potential interaction effects, whereas generalized estimating equations were applied to account for within-subject correlations in eye-specific data. RESULTS:A total of 197 participants were included in the study. Choroidal vascular volume and choroidal vascular index were inversely correlated with total and periventricular WMH volumes. Irregular WMH shape and reduced choroidal vascular volume were both associated with poorer memory performance. A significant interaction was found between choroidal perfusion and periventricular WMH shape on memory, suggesting that the relationship between WMH features and memory function may be more pronounced in individuals with lower choroidal perfusion. CONCLUSIONS:The severity of WMH and the status of choroidal perfusion may jointly reflect memory performance, suggesting ischemia as a potential shared mechanism. Future research is warranted to assess the clinical usefulness of WMH and choroidal metrics in predicting cognitive decline.

BACKGROUND:The thalamus serves as a central hub in the brain's neural network, playing a crucial role in sensory processing, cognitive functions, and emotional regulation. Although isolated thalamic strokes are relatively rare, their profound impact on cognitive and emotional outcomes highlights the importance of comprehensive investigation into thalamic involvement in post-stroke neuropsychiatric deficits. METHOD:This study enrolled 44 patients with first-ever unilateral thalamic ischemic stroke. All participants underwent MRI acquisition and neuropsychological evaluation, including Beijing version of the Montreal Cognitive Assessment (MoCA-BJ), Symbol Trails Test (STT), Stroop Color-Word Test (Stroop), Chinese Auditory Verbal Learning Test (CAVLT), Hamilton Anxiety Rating Scale (HAMA), and Hamilton Depression Rating Scale (HAMD). Gray matter volume (GMV) was extracted using CAT12 across 170 ROIs. Partial least squares (PLS) regression was applied to examine the association between GMV and 11 neuropsychological scores. Variable Importance in Projection (VIP) and loading analysis were conducted to identify key contributing regions. Additionally, Partial Least Squares-Discriminant Analysis (PLS-DA) was performed using 80 lesioned-side and 80 contralateral GMV features to distinguish lesion laterality, further validating the discriminative contribution of selected ROIs. RESULTS:PLS regression with three components achieved the optimal balance between explanatory power and model performance. Several cerebellar, temporal, and limbic structures showed high VIP scores and strong loadings, indicating their contribution to neuropsychological impairment. PLS-DA yielded satisfactory classification performance (mean AUC = 0.928 ± 0.093), highlighting robust lateralized structural differences. CONCLUSION:This study shows that structural alterations in cerebello-thalamo-cortical circuits are significantly associated with cognitive and emotional deficits following thalamic infarction. The integration of PLS and PLS-DA approaches provides robust evidence for identifying relevant biomarkers, Future research should validate these findings.

PURPOSE:Retinal ischemic perivascular lesions (RIPLs) have been reported as potential biomarkers for cardiovascular diseases and stroke. The authors aimed to investigate the RIPLs in patients with carotid artery stenosis (CAS) and their association with stenotic degree. METHODS:Patients with unilateral CAS or carotid artery occlusion were recruited. Optical coherence tomography was conducted for assessing the presence, number, and distribution of RIPLs. Optical coherence tomography angiography was used for evaluating microvascular density in superficial vascular complex and deep vascular complex. RESULTS:Eight hundred and fifty-four eyes from 474 patients with CAS were included. Ipsilateral eyes had more PRILs compared with contralateral eyes (all P < 0.01). Patients with CAS with cerebral infarction had a higher incidence and broader distribution of RIPLs compared with those without infarction (both P < 0.05). The presence, number, and distribution of RIPLs were positively associated with stenotic degree (all P < 0.001). Eyes with RIPLs had lower superficial vascular complex density ( P = 0.020) compared with eyes without RIPLs. CONCLUSION:Retinal ischemic perivascular lesions are anatomical markers of ischemia and are suggested to be associated with cerebral infarction and stenotic degree in patients with CAS. Optical coherence tomography/optical coherence tomography angiography is a noninvasive tool to detect retinal ischemic changes and quantitatively measure retinal microvascular changes in patients with CAS.

BACKGROUND AND OBJECTIVES:Thalamic infarction (TI) can lead to gait disturbances (GDs), even in the absence of significant motor impairments. Understanding the characteristics of GDs in TI patients is crucial for developing targeted rehabilitation strategies. Nonetheless, very little is known about the detailed gait changes in TI patients. This study aimed to investigate and characterize these parameters in TI patients. METHODS:Ninety participants, including 45 subacute TI patients and 45 age-sex-matched healthy controls, were cross-sectionally and consecutively included from West China Hospital, Sichuan University. A detailed set of spatiotemporal gait analyses was performed with forty-one parameters as output, evaluated using the "ReadyGo" three-dimensional motion balance testing system. Additionally, we analyzed the correlation between cerebral small vessel disease (CSVD) and gait parameters in TI and healthy controls (HC) and performed a Fisher z-test to determine whether there was a significant difference. RESULTS:Variability, stride length, stride speed, and swing velocity significantly differed in the affected and unaffected sides of TI patients. TI patients exhibited differences in thirty-eight gait parameters compared to controls. Coordination analysis revealed impairments in the timed up and go test, with longer total time, turn time, stand-up time, and reduced stride speed. Additionally, deficits were noted in the Heel-Knee-Shin test and Finger-Nose test. However, no differences were found in Romberg's test. Balance assessment showed variations in sit time, torso rocking degree, torso forward roll degree, and walking speed. The correlation between gait parameters and CSVD in TI and HC is presented. Additionally, it was found that total burden leads to a decrease in step width in TI patients and increases trunk sway degree in the tandem stance test in TI. CONCLUSION:This study demonstrates distinct spatiotemporal gait impairment patterns, coordination, and balance deficits in TI patients. Additionally, our findings suggest that the mechanisms underlying GDs may differ between TI patients and HC in relation to CSVD. These findings emphasize the need for personalized rehabilitation strategies to target these specific GDs in TI patients.