Cerebrovascular diseases, encompassing a spectrum of conditions affecting the blood vessels supplying the brain, represent a significant global health burden. Among the diverse mechanisms implicated in cerebrovascular pathology, emerging evidence highlights the role of ferroptosis, a regulated form of cell death characterized by iron-dependent lipid peroxidation. The review also elucidates the molecular mechanisms underlying ferroptosis, emphasizing the pivotal role of iron, the intracellular antioxidant system, and lipid metabolism. Subsequently, it explores the growing body of literature implicating ferroptosis in the pathogenesis of various cerebrovascular diseases, including atherosclerosis, ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. Special attention is given to the interplay between ferroptosis and other established mechanisms, such as oxidative stress, and inflammation. Moreover, pharmacological interventions and therapeutic strategies aimed at modulating key players in the ferroptosis cascade are explored, with a focus on their translational potential for clinical application. Finally, the review addresses current gaps in knowledge and proposes future research directions, emphasizing the need for a deeper understanding of the specific roles of ferroptosis in the pathogenesis of cerebrovascular diseases. The elucidation of these aspects holds promise for advancing our comprehension of cerebrovascular pathology and opening new avenues for therapeutic intervention in these debilitating conditions.

Aim Moyamoya disease (MMD) is a chronic, occlusive cerebrovascular disorder with no unified management guidelines. This consensus aims to provide updated, evidence-based recommendations for the diagnosis and treatment of MMD.Methods We integrated recent findings from epidemiology, genetics and imaging studies—particularly those published since 2017—along with expert input from over 20 clinical centres. Advances in diagnostic criteria, treatment strategies and perioperative management were reviewed and incorporated to update the 2017 consensus.Results Refinements in diagnosis include high-resolution imaging and revised Suzuki staging supplemented by new collateral circulation grading. Treatment strategies emphasise individualised surgical planning, especially extracranial-intracranial bypass, and pharmacological management targeting ischaemic events, cognitive decline and collateral vessel formation. Perioperative care focuses on managing complications such as transient neurological dysfunction and stroke through haemodynamic monitoring and timely imaging.Conclusions This updated consensus underscores the value of early diagnosis using advanced imaging, personalised interventions and standardised perioperative care. This initiative aims to enhance clinical outcomes and health-related quality of life in MMD patients, offering a contemporary, evidence-based approach to managing MMD.

Cavernous sinus dural arteriovenous fistula (CS-DAVF) is a rare vascular disorder, with clinical manifestations largely determined by venous drainage patterns. Conventional endovascular treatment via the inferior petrosal sinus or superior ophthalmic vein may be unsuccessful when these access routes are occluded. We report a case of an CS-DAVF (Barrow type D) in which two prior endovascular attempts failed, and complete obliteration of the fistula was subsequently achieved through direct puncture of the cavernous sinus under endoscopic endonasal guidance. Postoperatively, the patient experienced complete resolution of pulsatile tinnitus and stabilization of ocular function. This case suggests that the endoscopic endonasal approach may represent a safe and effective alternative for carefully selected indirect CS-DAVF patients when standard endovascular access is not feasible.

Importance Transradial access (TRA) has emerged as a promising alternative to standard transfemoral access (TFA) for interventional cardiac procedures, but its application for examination of the cerebral circulation has not been tested in a clinical trial. Objective To compare the efficacy and safety of TRA with TFA for diagnostic cerebral angiography. Design, Setting, and Participants This investigator-initiated, multicenter, open-label, noninferiority randomized clinical trial with a blinded outcome assessment was conducted at 13 sites in China. Patients eligible for cerebral angiography were randomized between September 15, 2023, and November 4, 2024, with final follow-up performed on November 27, 2024. The primary analysis was performed in the intention-to-treat population; secondary analyses were performed in the per-protocol population. Interventions Patients were randomly allocated to TRA (n = 431) or TFA (n = 430) for diagnostic cerebral angiography. Main Outcomes and Measures The primary outcome was the success of diagnostic cerebral angiography. Secondary outcomes were success in achieving an accurate diagnosis, duration of angiography and fluoroscopy, time in bed, and patient-reported satisfaction on an 11-point visual analog scale for pain (ranging from 0 [none] to 10 [worst possible]) within 24 hours after the procedure. The noninferiority margin was an absolute difference of 5% in success of angiographic diagnosis and success of accurate diagnosis. Results A total of 858 patients (median age, 58.4 [IQR, 52.0-67.0] years; 479 [55.8%] male) completed the trial. Success of diagnostic cerebral angiography in the TRA group was lower than that in the TFA group (392 of 431 [91.0%] vs 409 of 427 [95.8%]; difference, −4.8 percentage points [pp] [95% CI, −8.1 to −1.5 pp]; relative risk [RR], 0.95 [95% CI, 0.92-0.98]; P = .46 for noninferiority test). The success rate of accurate diagnosis was 78.9% in the TRA group vs 91.1% in the TFA group (difference, −12.2 pp [95% CI, −16.9 to −7.5 pp]; RR, 0.87 [95% CI, 0.82-0.92]; P = .99 for noninferiority test). Compared with the TFA group, the TRA group had longer median times for angiography (33.7 [IQR, 23.0-40.0] vs 38.7 [IQR, 26.0-47.0] minutes; P < .001) and fluoroscopy (10.6 [IQR, 5.6-12.9] vs 11.8 [IQR, 6.2-15.0] minutes; P = .02); the TRA group had significantly shorter median time in bed (188.4 [IQR, 3.0-180.0] vs 1079.0 [IQR, 842.0-1366.0] minutes; P < .001) and lower median pain scores (0.5 [IQR, 0.0-1.0] vs 0.7 [IQR, 0.0-1.0]; P < .001). Overall angiography complications were comparable between the groups (19 of 445 [4.3%] vs 25 of 413 [6.1%]; P = .28), but TRA had more radial artery puncture failures than TFA. Conclusions and Relevance In this randomized clinical trial of patients undergoing diagnostic cerebral angiography, TRA was not shown to be noninferior to TFA with regard to the success rate of diagnostic cerebral angiography. Additional research, including superiority trials, is needed to clearly define the comparative benefits of TRA and TFA. Trial Registration ClinicalTrials.gov Identifier: NCT05401669

Microglia-mediated neuroinflammation is closely associated with the pathogenesis of secondary brain injury following spontaneous intracerebral hemorrhage (ICH). However, the relationship between immune response regulation and metabolic patterns in microglia remains unclear. Histone Deacetylases 1 and 2, a class of lysine deacetylases, regulates gene transcription by modulating histone acetylation modifications and is widely involved in various cellular activities of microglia. In this study, we observed that knockout of HDAC1/2 in microglia alleviated neurological deficits caused by ICH, preserved white matter integrity, and accelerated hematoma clearance post-ICH. Mechanistically, we found that after ICH, microglia exhibited increased expression of hexokinase 2 (HK2) and enhanced glycolysis. HDAC1/2 knockout/pharmacological inhibition affected the acetylation level of HK2, inhibited its glycolytic activity, and promoted a metabolic shift in activated microglia from glycolysis to fatty acid oxidation. This shift was associated with reduced pro-inflammatory responses and enhanced phagocytic activity in microglia. Enhanced fatty acid oxidation may have a detrimental effect on mitochondrial function, and HDAC1/2 inhibition simultaneously promoted mitophagy in microglia. Additionally, HDAC1/2 inhibition triggered microglial apoptosis and suppressed proliferation, ultimately leading to a reduction in microglial cell numbers. Overall, this study reveals the potential mechanisms by which targeting HDAC1/2, through acetylation modifications and transcriptional regulation, modulates microglial function and metabolism after ICH, thereby exerting protective effects.

BackgroundThe role of flow diverters (FDs) in middle cerebral artery (MCA) M1 aneurysms is not well established. We assessed their safety, efficacy, and predictors of incomplete occlusion.MethodsConsecutive MCA M1 aneurysms treated with FDs (January 2022–May 2024) were retrospectively reviewed. Clinical, imaging, and procedural variables were analyzed for associations with ischemic complications and angiographic outcomes.ResultsFifty-eight patients (mean age 57.5 years; 46.6% female) underwent treatment with Pipeline (56.9%), Tubridge (20.7%), Surpass Evolve (12.1%), or Lattice (10.3%) devices. Postprocedural cerebral ischemia occurred in 25.9% (15/58), significantly more often in ruptured versus unruptured aneurysms (26.7% vs. 2.3%, p = 0.013). Rupture independently predicted ischemia (OR 15.273, 95% CI 1.547–150.765; p = 0.020). At a median follow-up of 13 months, complete occlusion was achieved in 77.4% (41/53). Aneurysm wall enhancement on MRI independently predicted incomplete occlusion (OR 6.566, 95% CI 1.395–30.903; p = 0.017).ConclusionFDs may be an option for carefully selected MCA M1 aneurysms. Ruptured aneurysms are associated with a markedly higher risk of postoperative ischemic complications, and aneurysm wall enhancement on preoperative MRI independently predicts incomplete aneurysm occlusion after FDs treatment.

Neurometabolic profiling in population samples across different stages of vascular cognitive impairment (VCI) holds great promise for elucidating the disease's pathogenesis. However, high-throughput neurometabolic profiling remains challenging due to the limited detection of low-abundance metabolites with poor ionization efficiency. Here, we present a novel photoreactive probe, 5-methoxy-2-nitrobenzaldehyde, combined with TiO2 P25, to create a mass spectrometry in-source photoderivatization (MSIPD) platform for neurometabolic profiling, with a focus on enhancing the detection of neurotransmitters (NTs). This platform allows for covalent and nanosecond laser-triggered derivatization of monoamine NTs and a 2-fold increase in metabolite coverage compared to underivatized samples, using laser desorption/ionization mass spectrometry (LDI-MS). Our approach demonstrates high derivatization efficiency (over 93%), high reproducibility (≤8.2%), minimal sample consumption (∼1 μL), and rapid analysis speed (∼5 s per sample), without complex sample pretreatment. Application to CSF from 103 VCI patients and 100 controls revealed 12 significantly altered neuro-metabolites. An additional cohort of 131 VCI patients stratified by cognitive status showed stage-dependent alterations, including decreased histamine, histidine, phenylalanine, and homovanillic acid in severe cases, corroborated in a mouse model of cerebral ischemia. These findings underscore NT metabolic dysregulation in VCI pathogenesis and establish MSIPD as a powerful tool for translational neurometabolic profiling.

Importance:Transradial access (TRA) has emerged as a promising alternative to standard transfemoral access (TFA) for interventional cardiac procedures, but its application for examination of the cerebral circulation has not been tested in a clinical trial. Objective:To compare the efficacy and safety of TRA with TFA for diagnostic cerebral angiography. Design, Setting, and Participants:This investigator-initiated, multicenter, open-label, noninferiority randomized clinical trial with a blinded outcome assessment was conducted at 13 sites in China. Patients eligible for cerebral angiography were randomized between September 15, 2023, and November 4, 2024, with final follow-up performed on November 27, 2024. The primary analysis was performed in the intention-to-treat population; secondary analyses were performed in the per-protocol population. Interventions:Patients were randomly allocated to TRA (n = 431) or TFA (n = 430) for diagnostic cerebral angiography. Main Outcomes and Measures:The primary outcome was the success of diagnostic cerebral angiography. Secondary outcomes were success in achieving an accurate diagnosis, duration of angiography and fluoroscopy, time in bed, and patient-reported satisfaction on an 11-point visual analog scale for pain (ranging from 0 [none] to 10 [worst possible]) within 24 hours after the procedure. The noninferiority margin was an absolute difference of 5% in success of angiographic diagnosis and success of accurate diagnosis. Results:A total of 858 patients (median age, 58.4 [IQR, 52.0-67.0] years; 479 [55.8%] male) completed the trial. Success of diagnostic cerebral angiography in the TRA group was lower than that in the TFA group (392 of 431 [91.0%] vs 409 of 427 [95.8%]; difference, -4.8 percentage points [pp] [95% CI, -8.1 to -1.5 pp]; relative risk [RR], 0.95 [95% CI, 0.92-0.98]; P = .46 for noninferiority test). The success rate of accurate diagnosis was 78.9% in the TRA group vs 91.1% in the TFA group (difference, -12.2 pp [95% CI, -16.9 to -7.5 pp]; RR, 0.87 [95% CI, 0.82-0.92]; P = .99 for noninferiority test). Compared with the TFA group, the TRA group had longer median times for angiography (33.7 [IQR, 23.0-40.0] vs 38.7 [IQR, 26.0-47.0] minutes; P < .001) and fluoroscopy (10.6 [IQR, 5.6-12.9] vs 11.8 [IQR, 6.2-15.0] minutes; P = .02); the TRA group had significantly shorter median time in bed (188.4 [IQR, 3.0-180.0] vs 1079.0 [IQR, 842.0-1366.0] minutes; P < .001) and lower median pain scores (0.5 [IQR, 0.0-1.0] vs 0.7 [IQR, 0.0-1.0]; P < .001). Overall angiography complications were comparable between the groups (19 of 445 [4.3%] vs 25 of 413 [6.1%]; P = .28), but TRA had more radial artery puncture failures than TFA. Conclusions and Relevance:In this randomized clinical trial of patients undergoing diagnostic cerebral angiography, TRA was not shown to be noninferior to TFA with regard to the success rate of diagnostic cerebral angiography. Additional research, including superiority trials, is needed to clearly define the comparative benefits of TRA and TFA. Trial Registration:ClinicalTrials.gov Identifier: NCT05401669.

BACKGROUND:Cerebral hyperperfusion syndrome (CHS) is a serious complication following revascularization in moyamoya disease (MMD) patients, yet reliable predictors remain scarce. This study aims to evaluate subcortical hemodynamics intraoperatively using a novel ultrasound imaging technique, synchronous arbitrary gate spectral Doppler (SAGSD), and to identify indicators associated with CHS. METHODS:A total of thirty adult MMD patients undergoing revascularization were included. Intraoperative SAGSD imaging, conventional Doppler ultrasound, and indocyanine green videoangiography (ICG-VA) were performed to assess subcortical hemodynamics at multiple sites before and after anastomosis. RESULTS:All thirty patients underwent revascularization, and five of the six CHS patients exhibited a distinctive "mountain" sign on SAGSD, characterized by three or more discrete velocity peaks within a single cardiac cycle observed simultaneously across two or more sampling sites. The CHS patients showed a significant increase in velocity-time integral (VTI) change (median Δ + 0.48 cm [95% CI, 0.31 to 0.65], p < 0.001) post-anastomosis on SAGSD, while conventional Doppler showed no significant change in flow velocity (all p > 0.05). Notably, in CHS patients, ICG-VA showed no statistical difference in flow velocity, delay, and time to peak after anastomosis (all p > 0.05), whereas SAGSD demonstrated hemodynamic changes such as VTI (median Δ + 0.67 cm [95% CI, 0.43-0.90], p < 0.001) via Doppler spectrum. CONCLUSION:SAGSD enables highly sensitive, multi-position, and contrast-free hemodynamic evaluation of deep cerebral microvasculature. The "mountain" sign, a novel spectral morphology corroborated by quantitative VTI elevation, is a specific intraoperative biomarker strongly associated with CHS, offering a potential predictor for early intervention and improved surgical outcomes.

BACKGROUND AND OBJECTIVES:Middle meningeal artery embolization (MMAE) has emerged as an alternative technique with minimally invasive nature in nonacute subdural hematomas (NASDH). However, whether MMAE alone can replace burr-hole surgery (BHS) remains unclear. METHODS:This exploratory secondary study used data from the MAGIC-MT randomized controlled trial to compare standalone MMAE and BHS. The primary outcomes were symptomatic recurrence and progression of hematomas. Overlap weighting (OW) was used to balance baseline variables between groups. Propensity score matching (PSM) was used as sensitivity analysis. RESULTS:A total of 291 BHS and 77 MMAE patients were included. After balancing baseline features, the incidence of primary outcomes in MMAE was significantly higher than that in BHS (OW: 10.9% vs 3.2%, P=0.021; PSM: 10.7% vs 0%, P=0.027). Hematoma volume was an independent risk factor to predict the primary outcomes (adjusted OR, 1.02 (1.01-1.03), P=0.001). In the subgroup with hematoma volume <98 mL, both MMAE and BHS demonstrated low primary outcomes rate (OW: 1.8% vs 0%, P=0.713; PSM: 2.9% vs 0%, p>0.999). Moreover, patients benefited from standalone MMAE with shorter length of hospital stay (OW: P=0.011, PSM: P=0.001). However, in the subgroup with hematoma volume >98 mL, standalone MMAE showed a significantly higher rate of primary outcomes than BHS (OW: 23.5% vs 8.2%, P=0.049; PSM: 23.8% vs 0%, P=0.021). CONCLUSION:Given the advantage of its minimally invasive nature and low primary outcome rates when hematoma volume is <98 mL, standalone MMAE was an alternative strategy to replace BHS in this population. When hematoma volume is >98 mL, standalone MMAE cannot be routinely recommended to replace BHS.

Background Hematoma recurrence and progression remain common challenges in nonacute subdural hematomas (SDHs). The understanding of indications for middle meningeal artery embolization (MMAE) is limited. Purpose To investigate the utility of the hyperdense capsule sign (HDCS) at noncontrast CT for identifying potential candidates for MMAE for nonacute SDH. Materials and Methods In this post hoc analysis of the MAGIC-MT randomized controlled trial (September 2022 to December 2023) comparing adjunctive MMAE and usual care, participants were grouped by HDCS presence or absence at noncontrast CT. The primary outcome was symptomatic recurrence or progression of SDH. The Cochran-Mantel-Haenszel χ2 test, propensity score matching (PSM), multivariable analysis, and P value for interaction were used for subgroup comparisons. Results Among 697 participants included in this analysis (median age, 69 years [IQR, 61-74 years]; 575 male participants), 444 (63.7%) showed HDCS presence. Primary outcome incidence was lower in the embolization versus usual-care group among participants with the HDCS (5.0% vs 12.0%, P = .009; after PSM: 4.1% vs 11.2%, P = .04) but not among those without the HDCS (9.4% vs 5.6%, P = .24; after PSM: 10.3% vs 5.0%, P = .13), with an interaction between MMAE and HDCS presence (P = .01; after PSM: P = .01). The proportion of participants experiencing a serious adverse event was lower in the embolization versus usual-care group among those with the HDCS (5.9% vs 15.1%, P = .002; after PSM: 5.8% vs 15.5%, P = .02) but not among those without the HDCS (8.7% vs 5.6%, P = .34; after PSM: 9.4% vs 5.8%, P = .30), with a significant interaction (P = .01; after PSM: P = .02). Conclusion For participants with nonacute SDH, the presence of the HDCS was associated with a lower rate of recurrence or progression among those who underwent MMAE compared with those receiving usual care. HDCS may potentially help identify candidates for MMAE for nonacute SDH. Clinical trial registration no. NCT04700345 © RSNA, 2026 Supplemental material is available for this article. See also the editorial by Kallmes in this issue.

Cerebrovascular diseases pose significant health risks worldwide. Digital subtraction angiography (DSA) imaging is the gold standard for diagnosing these conditions. Due to the temporal and spatial complexity of DSA, diagnostic accuracy largely depends on the experience of clinicians. Therefore, developing an automated diagnostic model for cerebrovascular diseases based on DSA imaging holds significant clinical implications for enhancing diagnostic efficiency and reducing physician workload. First, we propose an X-CLIP-based dual-branch fusion video classification framework that adaptively integrates complementary features from dual branches via cross-attention mechanisms. Second, we introduce SwapNorm modules to address multi-center imaging distribution shifts. Finally, we establish an FPFN network to enhance the model's capability for extracting valuable features. The model was trained and evaluated on a comprehensive dataset of 1350 DSA cases. Experimental results demonstrate that our method achieves 95.98% accuracy in classifying four types of DSA videos (aneurysm, moyamoya disease, arteriovenous malformation, and normal), representing a 5% improvement over conventional SOTA methods. This study provides an automated, efficient, and accurate paradigm for DSA-based cerebrovascular disease diagnosis.

OBJECTIVE:While most studies on adult moyamoya vasculopathy (MMV) have focused on the stroke incidence after bypass surgery, neurocognitive outcomes and predictors have rarely been investigated. The aim of this study was to evaluate the neurocognitive outcomes of adult patients with MMV after combined revascularization surgery and identify factors contributing to unfavorable outcomes. METHODS:Adult patients with MMV who underwent combined revascularization surgery from March 2019 to July 2024 at a single center were prospectively observed. Neuropsychological assessments and DSA were performed approximately 6 months after surgery. Neurocognitive changes were assessed using a distribution-based approach to calculate the minimal clinically important difference. RESULTS:A total of 204 patients (mean age 43.8 years) were included in the analysis, with a mean ± SD follow-up duration of 183.0 ± 18.2 days. Postoperatively, 166 patients (81.4%) demonstrated favorable neurocognitive outcomes, with 94 patients (46.1%) showing significant improvement and 72 patients (35.3%) remaining stable. Conversely, 38 patients (18.6%) experienced significant neurocognitive deterioration. The prevalence of vascular cognitive impairment (VCI) (p < 0.001) and the modified Rankin Scale scores (p = 0.002) significantly decreased following bypass. Multivariate analysis identified postoperative stroke complications (OR 3.57 [95% CI 1.47-8.68], p = 0.005) and posterior cerebral artery involvement (OR 2.23 [95% CI 1.01-4.93], p = 0.047) as independent risk factors for neurocognitive deterioration. Diabetes mellitus (OR 3.86 [95% CI 1.62-9.19], p = 0.002) and left-sided surgery (OR 2.01 [95% CI 1.09-3.70], p = 0.025) were independent risk factors against neurocognitive improvement, while the hemorrhagic type of MMV (OR 0.36 [95% CI 0.17-0.72], p = 0.004) was an independent protective factor. CONCLUSIONS:Combined revascularization surgery appears to be an effective treatment for improving neurocognition in patients with MMV and VCI. Insufficient preexisting collateral reserve and postoperative stroke complications might contribute to neurocognitive deterioration, while diabetes mellitus and left-sided surgery hindered neurocognitive improvement.

Background Endovascular treatment is a first-line therapeutic strategy for most intracranial dural arteriovenous fistulas (DAVFs). However, for refractory DAVFs treated via inaccessible transarterial and transvenous routes, the obliteration rate is extremely low. To overcome these challenges, we performed combined surgical and endovascular treatment in a hybrid operating suite. Materials and methods This retrospective cohort study enrolled patients with refractory DAVFs who underwent combined direct surgical access to the target vessel and embolization in a hybrid operating suite between September 2018 and September 2024. The baseline demographic, clinical and radiological features, surgical techniques and outcomes were collected and analyzed. Results A total of 12 patients (mean ± SD age 53.2 ± 10.8 years, range 39–68 years) were included in this study. Three patients presented with intracranial bleeding, and 9 had venous hypertension-related symptoms. The fistulas included cortical DAVFs in 3 patients, cavernous sinus DAVFs in 6 patients, tentorial DAVFs in 2 patients and torcular DAVFs in 1 patient. The Borden and Cognard DAVF classifications included high-grade DAVFs in all 12 patients (Borden type II + III, Cognard IIb, IIa + b, IV). Direct surgical access to the feeding artery, draining vein and sinus was achieved in 6, 4 and 2 patients, respectively. Among the 12 patients, 8 underwent craniotomy, 3 underwent orbital surgery, and 1 underwent endoscopic surgery. The cohort demonstrated 100% immediate obliteration of refractory DAVFs without complications. At the six-month follow-up, all the patients experienced symptom improvement without fistula recurrence. Conclusions These findings revealed that hybrid surgery was a safe and effective treatment for refractory DAVFs.

Background: Transfemoral access (TFA) has been the traditional approach for diagnostic cerebral angiography, but it is associated with several limitations and complications, including pain, discomfort, retroperitoneal hemorrhage, pulmonary embolism, and increased hospital admissions. Transradial cerebral angiography (TRA) offers a promising alternative to address these issues, though its application in cerebral angiography has not been widely studied. Methods: TransRadial versus transfemoral Access for CErebral angiography (TRACE) study is a multicenter, randomized, open-label trial with blinded outcome assessment, comparing TRA and TFA for diagnostic cerebral angiography. A total of 858 participants were randomized 1:1 to TRA or TFA across 13 sites in China. The primary outcome was the success rate of diagnostic cerebral angiography, with secondary outcomes including accurate diagnosis rate, procedure duration, fluoroscopy time, flat time, and Visual Analogue Scale (VAS) score within 24 hours. Safety outcomes focused on angiographic complications. The study was powered for non-inferiority (97% TRA vs. 98% TFA success rate, -5% margin) and included an interim analysis of 430 participants reviewed by an independent Data and Safety Monitoring Board (DSMB). Recruitment ran from September 15, 2023, to November 4, 2024. Discussion: This trial will assess and compare the safety and efficacy of TRA versus TFA for diagnostic cerebral angiography. A total of 858 subjects are planned to be enrolled in this study, and randomized to the treatment group (cerebral angiography via TRA) and the control group (cerebral angiography via TFA) at the ratio of 1:1. The primary outcome is the rate of successful diagnostic cerebral angiography. Trial registration: ClinicalTrials.gov. Identifier: NCT05401669.

Subarachnoid hemorrhage (SAH) is a form of severe acute stroke with very high mortality and disability rates. Early brain injury (EBI) and delayed cerebral ischemia (DCI) contribute to the poor prognosis of patients with SAH. Currently, some researchers have started to focus on changes in amino acid metabolism that occur in brain tissues after SAH. Taurine is a sulfur-containing amino acid that is semi-essential in animals, and it plays important roles in various processes, such as neurodevelopment, osmotic pressure regulation, and membrane stabilization. In acute stroke, such as cerebral hemorrhage, taurine plays a neuroprotective role. However, the role of taurine after subarachnoid hemorrhage has rarely been reported. In the present study, we established a mouse model of SAH. We found that taurine administration effectively improved the sensorimotor function of these mice. In addition, taurine treatment alleviated sensorimotor neuron damage and reduced the proportion of apoptotic cells. Furthermore, taurine treatment enhanced the polarization of astrocytes toward the neuroprotective phenotype while inhibiting their polarization toward the neurotoxic phenotype. This study is the first to reveal the relationship between taurine and astrocyte polarization and may provide a new strategy for SAH research and clinical treatment.

BACKGROUND:Currently, there is no established criterion for determining when interventional treatment is necessary or which strategy is appropriate for basilar artery (BA) aneurysms. Through this study, we aimed to propose an algorithm that can effectively determine the optimal endovascular treatment (EVT) option for BA aneurysms. METHODS:We enrolled patients with BA aneurysms from June 2016 to December 2022 and performed procedures based on the algorithm. The analysis included demographic, clinical, and aneurysmal characteristics, procedural details, complications, angiographic outcomes, and clinical outcomes. RESULTS:This study included 124 patients (mean age 55.0 years) with a BA aneurysm who underwent EVT. Of these, 21 aneurysms were treated in the setting of subarachnoid hemorrhage. The majority of the aneurysms were located at the basilar apex (74), followed by the basilar trunk (30) and vertebrobasilar junction (20). Coiling was used in 18.5% of the cases, while stent-assisted coiling embolization was chosen for 58.9%. Overlapping stents were used in 12.9%, flow diverter implantation in 3.2%, Y/T stent techniques in 4.8%, and stent adjunctive coiling with unilateral vertebral artery occlusion in only 1.6%. Procedure-related complications occurred in 15 patients (12.1%). The patients had a modified Rankin Scale score of 0.74 ± 1.62; 98 (86.7%) had a good prognosis with modified Rankin Scale scores ranging from 0 to 2 at the last follow-up. Digital subtraction angiography was performed on 105 (84.7%) patients, revealing that 101 (81.5%) achieved complete or near-complete occlusion. CONCLUSIONS:The criteria for EVT of BA aneurysms based on multi-characteristics were safe and effective. However, further evidence from large cohort studies is needed.

The vascular cognitive impairment (VCI) is quite common in moyamoya vasculopathy (MMV). However, the abnormality of cerebellar glucose metabolism in MMV and its relationship with patients’ neurocognitive performance were few reported. In this study, we aimed to investigate the relationship between neurocognitive performance and cerebellar glucose metabolism. Furthermore, the cerebellar glucose metabolism changes after combined revascularization surgery were also researched. We retrospectively analyzed the 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography ([18F]FDG PET) images and their neuropsychological scales in 93 eligible MMV patients by comparing their cerebellar standardized uptake values ratio (SUVR) and metabolic covariant network (MCN) among different neurocognitive groups. Then, forty-two MMV patients with VCI who underwent combined revascularization surgery were prospectively observed. According to their neuropsychological performance at 6-month follow-up, these patients were assigned to cognitive improved group (n = 22) and non-improved group (n = 20). The cerebellar SUVR and MCN changes were also analyzed. SUVR of right Lobule VI/Crus II/VIII decreased when cognitive impairment progression (P < 0.05, Least-Significant Difference [LSD] post hoc analysis). The cerebellar glucose metabolic pattern can be divided into two parts, in which the cerebellar posterior lobe was positively related to patients’ neurocognitive performance, while the vermis and anterior lobe showed negative relationship with the neurocognitions (P < 0.001). Further MCN analysis expound that the degree of right Lobule VI/Crus II/VIII displayed decreased tendency as cognitive impairment worsened (P < 0.05, LSD post hoc analysis). After revascularization surgery, the SUVR of right cerebellar posterior lobe significantly promoted in improved group (P < 0.001). Besides, we also witnessed the SUVR improvement in left cerebral hemisphere, thalamus, and red nucleus (P < 0.001). The MCN analysis revealed that the posterior connective strength improvement among right Lobule VI and several cerebral regions significantly correlated with memory and executive screening (MES) score (P < 0.001, false discovery rate corrected). We found that the hypometabolism of cerebellar posterior lobe, especially in the right Lobule VI, was associated with MMV patients’ neuropsychological performance, while the anterior lobe and vermis showed opposites tendencies. Combined revascularization surgery improved the posterior cerebellar metabolism and was associated with favorable neurocognitive outcomes, which might be related to the activation of cortico-rubral-cerebellar pathway.

The alteration of neural interactions across different cerebral perfusion states remains unclear. This study aimed to fulfill this gap by examining the longitudinal brain dynamic information interactions before and after cerebral reperfusion. Electroencephalogram in eyes-closed state at baseline and postoperative 7-d and 3-month follow-ups (moyamoya disease: 20, health controls: 23) were recorded. Dynamic network analyses were focused on the features and networks of electroencephalogram microstates across different microstates and perfusion states. Considering the microstate features, the parameters were disturbed of microstate B, C, and D but preserved of microstate A. The transition probabilities of microstates A-B and B-D were increased to play a complementary role across different perfusion states. Moreover, the microstate variability was decreased, but was significantly improved after cerebral reperfusion. Regarding microstate networks, the functional connectivity strengths were declined, mainly within frontal, parietal, and occipital lobes and between parietal and occipital lobes in different perfusion states, but were ameliorated after cerebral reperfusion. This study elucidates how dynamic interaction patterns of brain neurons change after cerebral reperfusion, which allows for the observation of brain network transitions across various perfusion states in a live clinical setting through direct intervention.

Moyamoya disease (MMD) is a progressive cerebrovascular disorder that increases the risk of intracranial ischemia and hemorrhage. Timely diagnosis and intervention can significantly reduce the risk of new-onset stroke in patients with MMD. However, the current diagnostic methods are invasive and expensive, and non-invasive diagnosis using biomarkers of MMD is rarely reported. To address this issue, nanoparticle-enhanced laser desorption/ionization mass spectrometry (LDI MS) was employed to record serum metabolic fingerprints (SMFs) with the aim of establishing a non-invasive diagnosis method for MMD. Subsequently, a diagnostic model was developed based on deep learning algorithms, which exhibited high accuracy in differentiating the MMD group from the HC group (AUC = 0.958, 95% CI of 0.911 to 1.000). Additionally, hierarchical clustering analysis revealed a significant association between SMFs across different groups and vascular cognitive impairment in MMD. This approach holds promise as a novel and intuitive diagnostic method for MMD. Furthermore, the study may have broader implications for the diagnosis of other neurological disorders.