OBJECTIVE:During eversion carotid endarterectomy (CEA), optimizing the bifurcation angle can reduce hemodynamic disturbances and postoperative restenosis risk. However, determining the precise degree of bifurcation angle modification during eversion CEA remains an unresolved issue. This study aims to investigate the correlation between TLR2 expression in carotid artery plaque and the carotid bifurcation angle. METHODS:In this cross-sectional study, 128 patients were enrolled. For all subjects before surgery, carotid bifurcation angle were measured with picture archiving and communication system. After surgery, the expression of inflammation factor TLR2, NF-κB, and MYD88 in the plaque specimens was analyzed using RT-qPCR. RESULTS:Relative higher bifurcation angles were positively correlated with increased TLR2. A univariate analysis displayed a significant positive correlation between bifurcation angles and TLR2 expression (p = 0.004). In multivariate piecewise linear regression and restricted cubic spline, the levels of TLR2 increased with the elevation of bifurcation angles when bifurcation angles was more than 49.1. CONCLUSION:This study demonstrated that TLR2 expression in carotid atherosclerotic plaque exhibited a significant positive correlation with the carotid bifurcation angle. When the bifurcation angle exceeded 49.1°, TLR2 expression increased sharply, suggesting a therapeutic potential of angle-optimized eCEA, particularly in patients with wider bifurcation angles. CLINICAL TRIAL REGISTRATION:https://www.chictr.org.cn/index.html identifier: ChiCTR2500102233.

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.

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.

Introduction and Objective: Patients with diabetes (DM) are at high risk for restenosis after arterial stenting. Information relating the risk of superficial femoral artery (SFA) angioplasty and stent implantation to prediabetes is limited. Methods: We retrospectively analyzed data of 305 patients (mean age 61.5±3.8 yrs, 65.4% of men) who undertook SFA angioplasty and stent implantation at between Jan 2017 and Dec 2021. Baseline measures included blood pressure (BP), body mass index (BMI), fasting plasma glucose, lipid profile, HbA1c, C-reactive protein (C-RP), and 2-hour capillary glucose. All patients had follow-up Lower extremity computed tomography angiography (LE-CTA) 3.2 years after stent implantation. SFA in-stent restenosis was defined as ≧ 50% stenosis in stent or within 5 mm adjacent to stent. The rate of restenosis was compared among patients with normal glucose tolerance (NGT, n=58), impaired glucose regulation (IGR, n=79), and DM (n=129) according to their baseline glucose levels or prior history of DM. Results: Patients with DM had highest levels of BMI, BP, triglycerides (TG), and C-RP, followed by those with IGR and NGT (p<0.05). At year 3, the rate of restenosis, evaluated by LE-CTA, were 9.8%, 14.5%, and 23.8% in patients with NGT, IGT, and DM, respectively (p<0.05). Among DM subgroup, compared with patients with A1c<8%, those with A1c>8% had increased rate of restenosis (18.6% vs. 25.4%, p<0.05). In the logistic regression model, the odd ratio (OR) of having restenosis was 1.61 (95%CI: 1.13-2.58) for DM and 1.33 (95% CI: 1.09-1.94) for IGR, after adjusting for age, smoking, use of statin, use of anticoagulant drug, BMI, BP, LDL-C, TG, HbA1c and C-RP. Conclusion: SFA in-stent restenosis is more frequent in patients with DM. Prediabetes is associated with increased risk of restenosis after SFA angioplasty and stent implantation during a 3-year follow-up period. The data indicates that intervention of hyperglycemia should be addressed in the management of Lower extremity arterial disease. G. Guo: None. L. Zhang: None. L. Li: None. J. Wang: None. Y. Liu: None.

BACKGROUND:Venous thromboembolism (VTE) is a multifactorial disease that is associated with long-term morbidity, dysfunction, and mortality. Although numerous studies reported on the prevalence and risk factors of VTE in hospitalized patients, the results varied due to the complexity of the disease and differences in genetic characteristics, social environment, and disease spectrum. Therefore, this study aimed to investigate the prevalence, clinical features, and risk factors for VTE in hospitalized patients in the eastern Liaoning. METHODS:A cross-sectional study was conducted at Liaoning Province Benxi Central Hospital to select patients hospitalized between January and December 2021. All patients underwent a Doppler ultrasound, and medical data, including demographic factors, risk factors, and clinical characteristics, were collected from the Benxi Clinical Biobank. Chi-square tests and logistic regression analysis were employed to identify independent risk or related factors. RESULTS:A total of 1200 inpatients were eligible for inclusion in the study. The prevalence of VTE was 21.4%. In the multifactorial analysis, five variables were independent risk factors for VTE: age (odds ratio (OR) 1.035; 95% confidence interval (CI) 1.022-1.047), History of confirmed VTE (OR 6.666; 95% CI 3.602-12.338), previous surgical intervention (OR 1.771; 95% CI 1.099-2.854), central venous catheterization (OR 1.852; 95% CI 1.126-3.044), and recent acute infection (OR 1.521; 95% CI 1.101-2.102). Limb pitting edema was an independent clinical correlate of VTE, either unilateral (OR 5.528; 95% CI 3.638-8.402) or bilateral (OR 1.679; 95% CI 1.069-2.637). Of the 238 patients with deep vein thrombosis (DVT) in the lower limbs (with or without pulmonary embolism), distal DVT was more common than proximal DVT (64.3% vs. 20.6%). CONCLUSION:The prevalence of VTE in hospitalized patients in eastern Liaoning was high, with certain population-specific risk factors and the vascular location of VTE. It is worthwhile to expand the study of the sample.

Background & Aims: Pre-emptive transjugular intrahepatic portosystemic shunt (TIPS) improves outcomes in high-risk acute variceal bleeding but its use is limited by hepatic encephalopathy (HE). While stent diameter and post-TIPS portacaval pressure gradient (PPG) targets may influence HE risk, evidence-based standards are lacking. This study aimed to compare 8-mm vs. 10-mm diameter stents and evaluate PPG thresholds to balance HE risk and therapeutic efficacy. Methods: In this multicenter observational study, 470 patients with cirrhosis and acute variceal bleeding receiving pre-emptive TIPS (8-mm: n = 384; 10-mm: n = 86) were analyzed. Competing risks regression and restricted cubic splines were used to assess associations between stent diameter, PPG, and clinical outcomes. Results: At 1 year, 8-mm stents reduced overt HE incidence (28.9% vs. 45.4%; subdistribution hazard ratio [sHR] 0.57, 95% CI 0.40–0.82) and further decompensation (40.4% vs. 52.3%; sHR 0.68, 95% CI 0.48–0.95) compared to 10-mm stents, without increasing the risk of further bleeding (12.0% vs. 9.3%; p = 0.471) or mortality (13.3% vs. 14.0%; p = 0.813). Non-linear analysis identified a PPG range of 7–13 mmHg associated with minimized overt HE risks (sHR 1.43 for PPG <7 vs. 7–13 mmHg; 95% CI 1.01–2.01) and portal hypertensive complications (sHR 2.76 for PPG >13 vs. 7–13 mmHg; 95% CI 2.69–9.39). A significantly greater proportion of patients in the 8-mm group attained the optimal 7–13 mmHg target range compared to the 10-mm group (71.1% vs. 55.8%, p <0.001). Conclusions: Pre-emptive TIPS with 8-mm stents reduces HE and further decompensation without compromising efficacy. Immediate post-TIPS PPG measurements may aid intraprocedural decision-making, with a 7–13 mmHg range serving as a pragmatic guide for initial stent calibration in high-risk acute variceal bleeding. Impact and implications: This multicenter study of 470 patients with cirrhosis and acute variceal bleeding shows that pre-emptive transjugular intrahepatic portosystemic shunt (TIPS) placement using 8-mm stents reduces the 1-year incidence of overt hepatic encephalopathy by 43% compared to 10-mm stents, while maintaining similar efficacy in preventing rebleeding. Non-linear analysis identified a post-TIPS portacaval pressure gradient (PPG) range of 7–13 mmHg as an optimal target, minimizing risks of both overt hepatic encephalopathy and portal hypertensive complications. A significantly higher proportion of patients achieved this PPG range with 8-mm stents. These results address a key dilemma in high-risk AVB management, demonstrating that 8-mm stents balance encephalopathy prevention with effective portal decompression. The 7–13 mmHg PPG range provides a practical intraprocedural guide for individualized TIPS calibration, helping interventional radiologists optimize shunt diameter selection.

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.

Background: In the early stages of hyperthyroidism (HTH), cardiovascular symptoms are not prominent, and heart function impairment may occur before structural changes. The non-invasive left ventricular (LV) pressure-strain loop (PSL) allows for early, quantitative assessment of changes in LV systolic function. However, previous studies have not grouped hyperthyroid patients based on the presence or absence of tachycardia. This study aimed to assess the LV function in individuals diagnosed with HTH who exhibit varying heart rates, utilizing the PSL technique. Methods: Seventy-eight hyperthyroid patients were recruited between December 2022 and September 2023 using a random method and then stratified into two groups based on the presence or absence of tachycardia, designated as HTH1 (tachycardia) group and HTH2 (non-tachycardia) group, respectively. Additionally, a control group comprising 38 healthy volunteers was included for comparison purposes. Standard echocardiographic parameters and LV global longitudinal strain (GLS) were quantified. Furthermore, LV myocardial work parameters, encompassing global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE), were assessed using the PSL technique. The main statistical methods included one-way analysis of variance, LSD-t test, Kruskal-Wallis H test, Bonferroni correction, and chi(2) test. Results: Compared to the control group, the systolic blood pressure (SBP), pulse pressure differential, serum free triiodothyronine (FT3) and free thyroxine (FT4) levels of HTH1 and HTH2 subgroups demonstrated elevation, whereas serum thyroid-stimulating hormone (TSH) levels exhibited reduction (P<0.05). Moreover, comparisons between the HTH1 and HTH2 subgroups revealed significantly higher SBP, pulse pressure differential, FT3, and FT4 concentrations in the former relative to the latter (P<0.05). LV ejection fraction (LVEF) exhibited a statistically significant increase in the HTH group compared to the control group (P<0.05). GLS, GWI, and GWE in the HTH group were less compared to the control group, while GWW exhibited an increase in the HTH group relative to the control group (P<0.05). Within the HTH group, both GWI and GWE were significantly lower in the HTH1 subgroup compared to the HTH2 subgroup. Conclusions: PSL method enables the quantitative assessment of LV myocardial work alterations in individuals with HTH exhibiting varying heart rates, which may help clinical physicians make an accurate early diagnosis and take timely treatment measures.

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.

BackgroundThe aim of this study is to assess the feasibility of identifying the hemodynamic status of intracranial atherosclerotic stenosis (ICAS) using angio-based fractional flow (FF) calculated from a single angiographic view, with wire-based FF as the reference standard.MethodThe study retrospectively recruited 100 ICAS patients who underwent pressure wire measurement and digital subtraction angiography. The AccuICAD software was used to calculate angio-based FF, with the wire-measured value serving as the reference standard for evaluating the accuracy, consistency, and diagnostic performance of angio-based FF.ResultsThe mean±SD value of wire-based FF was 0.77±0.18, while the mean value of angio-based FF was 0.77±0.19. A good correlation between angio-based FF and wire-based FF was evident (r=0.90, P<0.001), with good agreement (mean difference 0.00±0.08). The diagnostic accuracy of angio-based FF and percent diameter stenosis (DS%) were 93.23% versus 72.18%, 91.73% versus 72.93%, and 89.47% versus 78.95% for predicted wire-based FF thresholds of 0.70, 0.75, and 0.80, respectively. The area under the curve (AUC) values for angio-based FF and DS% were 0.975 versus 0.822, 0.970 versus 0.814, and 0.943 versus 0.826 at the respective thresholds, respectively.ConclusionThe FF calculated from a single angiographic view can be considered an effective tool for functional assessment of cerebral arterial stenosis.

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.

BackgroundIntracranial atherosclerotic stenosis (ICAS) is one of the leading causes of ischemic stroke. Conventional anatomical analysis by CT angiography, MRI, or digital subtraction angiography can provide valuable information on the anatomical changes of stenosis; however, they are not sufficient to accurately evaluate the hemodynamic severity of ICAS. The goal of this study was to assess the diagnostic performance of the pressure ratio across intracranial stenoses (termed as fractional flow (FF)) derived from cerebral angiography for the diagnosis of hemodynamically significant ICAS defined by pressure wire-derived FF. MethodsThis retrospective study represents a feasible and reliable method for calculating the FF from cerebral angiography (AccuFFicas). Patients (n=121) who had undergone wire-based measurement of FF and cerebral angiography were recruited. The accuracy of the computed pressure ratio was evaluated using wire-based FF as the reference standard. ResultsThe mean value of wire-based FF was 0.78 +/- 0.19, while the computed AccuFFicas had an average value of 0.79 +/- 0.18. Good correlation (Pearson's correlation coefficient r=0.92, P<0.001) between AccuFFicas and FF was observed. Bland-Altman analysis showed that the mean difference between AccuFFicas and FF was -0.01 +/- 0.07, indicating good agreement. The area under the curve (AUC) of AccuFFicas in predicting FF <= 0.70, FF <= 0.75, and FF <= 0.80 was 0.984, 0.986, and 0.962, respectively. ConclusionAngiography-based FF computed from cerebral angiographic images could be an effective computational tool for evaluating the hemodynamic significance of ICAS.

ImportancePrevious randomized clinical trials did not demonstrate the superiority of endovascular stenting over aggressive medical management for patients with symptomatic intracranial atherosclerotic stenosis (sICAS). However, balloon angioplasty has not been investigated in a randomized clinical trial.ObjectiveTo determine whether balloon angioplasty plus aggressive medical management is superior to aggressive medical management alone for patients with sICAS.Design, Setting, and ParticipantsA randomized, open-label, blinded end point clinical trial at 31 centers across China. Eligible patients aged 35 to 80 years with sICAS defined as recent transient ischemic attack (<90 days) or ischemic stroke (14-90 days) before enrollment attributed to a 70% to 99% atherosclerotic stenosis of a major intracranial artery receiving treatment with at least 1 antithrombotic drug and/or standard risk factor management were recruited between November 8, 2018, and April 2, 2022 (final follow-up: April 3, 2023).InterventionsSubmaximal balloon angioplasty plus aggressive medical management (n = 249) or aggressive medical management alone (n = 252). Aggressive medical management included dual antiplatelet therapy for the first 90 days and risk factor control.Main Outcomes and MeasuresThe primary outcome was a composite of any stroke or death within 30 days after enrollment or after balloon angioplasty of the qualifying lesion or any ischemic stroke in the qualifying artery territory or revascularization of the qualifying artery after 30 days through 12 months after enrollment.ResultsAmong 512 randomized patients, 501 were confirmed eligible (mean age, 58.0 years; 158 [31.5%] women) and completed the trial. The incidence of the primary outcome was lower in the balloon angioplasty group than the medical management group (4.4% vs 13.5%; hazard ratio, 0.32 [95% CI, 0.16-0.63]; P < .001). The respective rates of any stroke or all-cause death within 30 days were 3.2% and 1.6%. Beyond 30 days through 1 year after enrollment, the rates of any ischemic stroke in the qualifying artery territory were 0.4% and 7.5%, respectively, and revascularization of the qualifying artery occurred in 1.2% and 8.3%, respectively. The rate of symptomatic intracranial hemorrhage in the balloon angioplasty and medical management groups was 1.2% and 0.4%, respectively. In the balloon angioplasty group, procedural complications occurred in 17.4% of patients and arterial dissection occurred in 14.5% of patients.Conclusions and RelevanceIn patients with sICAS, balloon angioplasty plus aggressive medical management, compared with aggressive medical management alone, statistically significantly lowered the risk of a composite outcome of any stroke or death within 30 days or an ischemic stroke or revascularization of the qualifying artery after 30 days through 12 months. The findings suggest that balloon angioplasty plus aggressive medical management may be an effective treatment for sICAS, although the risk of stroke or death within 30 days of balloon angioplasty should be considered in clinical practice.Trial RegistrationClinicalTrials.gov Identifier: NCT03703635

ABSTRACT Background The goal of standard dual antiplatelet therapy (SDAT) in patients undergoing endovascular interventional treatment of intracranial aneurysms is to prevent thrombosis; however, some patients have a poor response to these drugs, which increases the risk of cerebral infarction. This study aims to examine whether adjusting antiplatelet therapy based on light transmission aggregometry (LTA) can reduce the incidence of ischemic events compared with SDAT. Methods We will conduct a cluster randomized controlled trial using 16 treatment teams from eight hospitals in mainland China, enrolling 590 patients with unruptured intracranial aneurysms treated using endovascular stent placement. The treatment teams serving as clusters will be randomly assigned to either the test or control group at a 1:1 ratio. Test group patients will receive an antiplatelet regimen guided by LTA. Control group patients will receive SDAT. Patients will be followed for 1 month after the treatment period. The primary outcome measure is cerebral ischemic events within 30 days of stent placement, including stent thrombosis, ischemic stroke, and transient ischemic attack. The safety measure is all bleeding events within 30 days of treatment. Discussion The trial aims to determine whether LTA-guided antiplatelet therapy reduces the incidence of ischemic events without increasing the risk of bleeding in patients with intracranial aneurysms treated with endovascular stenting. Completion of this clinical trial may provide an individualized safe and effective regimen for antiplatelet therapy. Trial registration ClinicalTrials.gov, NCT05825391 . Registered on April 11, 2023. What is already known on this topic Dual antiplatelet therapy is administered to reduce thrombotic events in neurointerventional therapy of intracranial aneurysms. Platelet function testing is used to evaluate the antiplatelet effect of aspirin and clopidogrel. What this study adds The trial aims to determine whether LTA-guided antiplatelet therapy reduces the incidence of ischemic events without increasing the risk of bleeding in patients with intracranial aneurysms treated with endovascular stenting. How this study might affect research, practice or policy For stent neurointerventional therapy of unruptured intracranial aneurysms, this study could provide a promising method for adjusting appropriate antiplatelet therapy.

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.

Background Angiography headache (AH) is common but not negligible, and the criteria for AH have been based on only a few studies. The purpose of this study was to investigate the incidence, risk factors and possible mechanism of AH and reappraise the diagnostic criteria for AH in the International Classification of Headache Disorders 3 (ICHD-3). Methods Two hundred and seventy-nine patients completed this prospective, non-randomized study, including 107 patients who underwent cerebral angiography, 101 patients who underwent coronary intervention and 71 patients who underwent extremities arterial intervention. Patients were followed up with questionnaires immediately after the procedure and 24 h, 72 h, 1 week and 2 weeks after the procedure. Results The incidence of headache was 22.4% (24/107) in cerebral angiography group, 23.8% (24/101) in coronary intervention group, and 16.9% (12/71) in extremities arterial intervention group. Headache still occurred in 12.1% (13/107), 14.9% (15/101) and 11.3% (8/71) of patients 24 h after the procedure in the three groups, respectively. Two types of headache were observed in cerebral angiography group and coronary intervention group, one during and one after the procedure, while only postoperative headache was observed in extremities arterial intervention group. Previous headache history was a risk factor for headache in the three groups ( p = 0.003 in cerebral angiography group, p = 0.006 in coronary intervention group, and p = 0.016 in extremities arterial intervention group). In addition, female ( p = 0.008) was a risk factor for cerebral angiography group. Headache characteristics were described in detail. Conclusions The diagnostic criteria for 6.7.2 angiography headache in ICHD-3 may miss a number of cerebral AH with onset later than 24 h after the procedure. Therefore, it is recommended to revise it according to the literature and further studies. The incidence of headache was high during and after angiography and interventional procedure. It was suggested that the definition of headache due to coronary intervention and headache due to extremities arterial intervention should be added in ICHD.

Importance In-stent restenosis (ISR) is the primary reason for stroke recurrence after intracranial stenting in patients who were treated with a standard bare-metal stent (BMS). Whether a drug-eluting stent (DES) could reduce the risk of ISR in intracranial atherosclerotic stenosis (ICAS) remains unclear. Objective To investigate whether a DES can reduce the risk of ISR and stroke recurrence in patients with symptomatic high-grade ICAS. Design, Settings, and Participants A prospective, multicenter, open-label randomized clinical trial with blinded outcome assessment was conducted from April 27, 2015, to November 16, 2018, at 16 medical centers in China with a high volume of intracranial stenting. Patients with symptomatic high-grade ICAS were enrolled, randomized, and followed up for 1 year. Intention-to-treat data analysis was performed from April 1 to May 22, 2021. Interventions Patients were randomly assigned to receive DES (NOVA intracranial sirolimus-eluting stent system) or BMS (Apollo intracranial stent system) treatment in a 1:1 ratio. Main Outcomes and Measures The primary efficacy end point was ISR within 1 year after the procedure, which was defined as stenosis that was greater than 50% of the luminal diameter within or immediately adjacent to (within 5 mm) the implanted stent. The primary safety end point was any stroke or death within 30 days after the procedure. Results A total of 263 participants (194 men [73.8%]; median [IQR] age, 58 [52-65] years) were included in the analysis, with 132 participants randomly assigned to the DES group and 131 to the BMS group. The 1-year ISR rate was lower in the DES group than in the BMS group (10 [9.5%] vs 32 [30.2%]; odds ratio, 0.24; 95% CI, 0.11-0.52; P < .001). The DES group also had a significantly lower ischemic stroke recurrence rate from day 31 to 1 year (1 [0.8%] vs 9 [6.9%]; hazard ratio, 0.10; 95% CI, 0.01-0.80; P = .03). No significant difference in the rate of any stroke or death within 30 days was observed between the DES and BMS groups (10 [7.6%] vs 7 [5.3%]; odds ratio, 1.45; 95% CI, 0.54-3.94; P = .46). Conclusions and Relevance This trial found that, compared with BMSs, DESs reduced the risks of ISR and ischemic stroke recurrence in patients with symptomatic high-grade ICAS. Further investigation into the safety and efficacy of DESs is warranted. Trial Registration ClinicalTrials.gov Identifier: NCT02578069.