OBJECTIVE:Aortic calcification (AC) is increasingly recognized as a marker associated with cardiovascular disease, but its role in acute aortic syndromes such as type B aortic dissection (TBAD) is not well understood. This study aimed to characterize AC distribution in TBAD patients, examine its association with initial aortic anatomy, and assess its prognostic value after thoracic endovascular aortic repair (TEVAR). METHODS:The study included 150 patients who were retrospectively enrolled from our center (cohort 1) and 120 patients from a clinical trial (cohort 2). First, based on the combined cohorts, the preoperative AC volume on different aortic segments, and the correlation between preoperative AC volume and initial TBAD anatomy, were cross-sectionally evaluated. Second, the prognostic value of AC volume on different segments were evaluated by survival analysis and multivariable Cox regression 1-year post-TEVAR in cohort 2Results:Based on the 2 cohorts (n=270), AC volume appears to intrinsically correlate to the preoperative unfavorable TBAD anatomy, characterized by increased aortic size and tortuosity. AC volume in the thoracic aorta may be a preferable predictor of composite events post-TEVAR (hazard ratio [HR] 2.396, 95% confidence interval [CI] 1.204-4.768, p=0.013), thoracic aorta expansion (HR 6.266; 95% CI 1.199-32.748; p=0.030), and abdominal aorta expansion (HR 2.569; 95% CI 1.113-5.929; p=0.027). CONCLUSIONS:Aortic calcification severity, particularly in the thoracic aorta, may closely link to unfavorable anatomical features in TBAD and may independently predict the risk of subsequent aortic expansion following TEVAR. These findings highlight the potential of AC volume as an image biomarker for risk stratification and management of TBAD patients.Clinical ImpactAortic calcification (AC) has long been an underestimated marker for understanding the development, severity, and progression of type B aortic dissection (TBAD). AC severity may be a surrogate for the initial unfavourable anatomy of TBAD. Increased calcification volume in the thoracic aorta may predict a high risk of postoperative aortic expansion after TEVAR.

Objective:This study was performed to outline the aortic dimensions of type A aortic dissection and to investigate the association between the ascending aortic length and sporadic, non-syndromic type A aortic dissection in a Chinese population. Methods:In this cross-sectional study, all consecutive patients diagnosed with type A aortic dissection between January 2016 and December 2020 were identified. Parameters were measured based on the centerline method. The predissection aortic diameter and length were calculated. Multivariate logistic regression models were used to assess the association between the ascending aortic length and type A aortic dissection. A receiver operating characteristic analysis was performed to calculate the area under the curve and optimal cutoff value. Results:A total of 146 patients and 146 propensity score-matched controls were included in the study. The median length of the ascending aorta was 21 mm longer in the patient group than in the control group (median, 110.0 mm vs. 89.0 mm), and was still 15.4 mm longer after adjusting for the predissection length (median, 104.4 mm). The ascending aortic length was independently associated with type A aortic dissection (odds ratio, 5.34; 95% confidence interval, 3.59-7.92). The ascending aortic length revealed a larger area under the curve, and an optimal cutoff value of 9.8 cm was revealed. Conclusion:The ascending aortic length (AAL) appears to be associated with type A aortic dissection (TAAD) and may complement the aortic diameter in morphologic risk assessment, but additional prospective studies with standardized measurements and body-size adjustment are required before clinical thresholds can be established. Observed AAL values associated with TAAD were lower in this Chinese cohort than in the Western population.

Critical limb ischemia (CLI) represents the severe stage of peripheral arterial disease. Angioplasty can restore blood flow to failing limbs, yet some patients still face amputation. Limited researches have explored how risk factors predict post-procedure outcomes. A thorough search was conducted in PubMed, EMBASE, and the Cochrane Library for pertinent articles released by April 21 2025. A random-effects meta-analysis was used to calculate pooled odds ratios (ORs) along with 95

PURPOSE:To evaluate the hemodynamic performance and clinical implications of the WeFlow-Tribranch modular endograft system using patient-specific computational fluid dynamics (CFD) analysis. METHODS:Pre- and postoperative CTA data sets from 3 patients treated with the WeFlow-Tribranch system were used to reconstruct 3-dimensional aortic models. CFD simulations were performed to compare changes in blood flow patterns, branch perfusion, and wall shear stress (WSS) parameters. The analysis focused on clinical metrics including branch perfusion distribution and hemodynamic markers associated with thrombus risk (TAWSS: time-averaged wall shear stress, OSI: oscillatory shear index, and RRT: relative residence time). RESULTS:In the 3 analyzed cases, postoperative simulations showed that the device successfully restored more organized flow patterns in the aortic arch and effectively excluded aneurysms. Perfusion to the left common carotid artery (LCCA) improved in all 3 cases (+13% to +56%). However, perfusion to the brachiocephalic trunk (BCT) and left subclavian artery (LSA) varied substantially among the cases. Furthermore, simulations identified localized regions of low TAWSS and high OSI within the reconstructed branch tunnels, indicating potential sites for flow stagnation despite improvements in the main aortic flow. CONCLUSION:This preliminary CFD evaluation suggests that the WeFlow-Tribranch system has the potential to restore aortic arch hemodynamics and enhance LCCA perfusion in these specific cases. However, simulations indicated that the embedded branch design may compromise flow to the BCT or LSA in certain anatomical configurations, potentially inducing localized flow disturbances. These findings underscore the importance of patient-specific preoperative planning to anticipate perfusion changes and suggest that meticulous monitoring of branch patency is warranted. To fully evaluate its long-term performance and optimize its use, further studies involving larger patient cohorts and correlation with clinical outcomes are recommended.Clinical ImpactThe WeFlow-Tribranch™ system offers a modular, minimally invasive solution for complex aortic arch pathologies. This CFD study demonstrates that while the device restores organized aortic flow and improves LCCA perfusion, its embedded branch design introduces localized flow disturbances and patient-specific variations in BCT and LSA perfusion. For clinicians, these findings emphasize that anatomical feasibility alone is insufficient for patient selection. Meticulous pre-operative planning and rigorous post-operative surveillance of branch patency are essential to mitigate risks of thrombosis or ischemia induced by non-physiological wall shear stress.

Introduction: The anatomic suitability of the iliac branch device remains limited, particularly in East Asians, in whom the common iliac arteries (CIAs) are notably short. This study aimed to evaluate the safety and haemodynamic effects of the physician modified inner branch iliac branch device (PM-IIBD) via clinical outcomes and computational fluid dynamics (CFD) analysis. Method: In this observational case series study, clinical safety was evaluated in ten patients treated with the PM-IIBD for internal iliac artery preservation. CFD analyses were performed before surgery and at 12 month follow up to compare haemodynamic changes in four CIA regions. CFD parameters included velocity, pressure, time averaged wall shear stress (TAWSS), relative residence time, oscillatory shear index (OSI), energy loss, and flow distribution ratios. Results: Technical success was 100%, with no peri-operative or follow up adverse events. CFD revealed minimal changes in pressure and velocity after PM-IIBD implantation, with only a slight post-operative decrease in external iliac artery average velocity (0.51 ± 0.12 m/s vs. 0.45 ± 0.16 m/s, p = .039). High oscillatory shear index areas in the CIA region significantly decreased after surgery (0.22 ± 0.14 vs. 0.11 ± 0.07, p = .036). In the PM-IIBD region, both the average TAWSS (0.40 ± 0.45 vs. 0.72 ± 0.22, p = .015) and maximum TAWSS increased statistically significantly (4.47 ± 4.16 vs. 8.44 ± 6.52, p < .001). The PM-IIBD inner branch region showed an increase in high TAWSS areas (0.11 ± 0.39 vs. 0.20 ± 1.44, p = .002). Energy loss decreased significantly after surgery (3.82 ± 2.13 vs. 3.11 ± 1.76, p = .013), with no significant changes in the relative residence time and flow distribution ratio. Conclusion: Preliminary clinical and CFD analyses have demonstrated the efficacy and haemodynamic stability of the PM-IIBD. By reducing spatial demands on the CIA, the PM-IIBD expands anatomic suitability, offering a feasible solution for internal iliac artery preservation in East Asians.

Background To investigate whether preoperative renal artery involvement independently predicts postoperative acute kidney injury (AKI) and renal atrophy in patients with DeBakey IIIb aortic dissection who underwent thoracic endovascular aortic repair (TEVAR), and to explore the association between AKI and renal atrophy. Methods Retrospective analysis of 82 patients was performed. AKI was defined per Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Renal atrophy was defined as a renal length reduction >1.00 cm. Univariate analysis compared clinical variables between groups, while binary logistic regression analyzed AKI risk factors and generalized estimating equations (GEEs) identified independent predictors of renal atrophy. Results Patients with renal artery involvement had higher postoperative serum creatinine and lower preoperative/postoperative estimated glomerular filtration rate (P < 0.05). AKI incidence was identical between groups (9.76% each, P = 1.00). GEE analysis showed renal artery involvement was an independent predictor of renal atrophy [odds ratio (95% confidence interval): 4.71 (1.94-11.44), P = 0.001]. No factors were significantly associated with AKI in logistic regression. Conclusion Preoperative renal artery involvement does not correlate with postoperative AKI but independently predicts long-term renal atrophy after TEVAR in DeBakey IIIb dissection.

Background The composite dietary antioxidant index (CDAI) is a scoring system designed to assess overall dietary antioxidant capacity and has been associated with a reduced risk of cardiovascular diseases. However, its specific impact on aortic aneurysm and dissection (AA/AD) remains unclear. This study aimed to investigate the associations of CDAI with both the incidence and mortality of AA/AD. Methods In this UK Biobank-based study, univariate and multivariate logistic regression models were used to assess the association between CDAI and the incidence of AA/AD, the association of CDAI with mortality was evaluated using Cox proportional hazards models. We employed restricted cubic spline (RCS) analyses to examine potential linear or non-linear relationships between the key nutrient components of the CDAI and the outcomes. Furthermore, mediation analysis was performed to assess the potential mediating effects of selected metabolic indicators. Results A total of 172,450 participants were included in this study, of whom 1,486 developed AA/AD. Univariate logistic regression analysis revealed a significant inverse association between CDAI and the incidence of AA/AD (OR = 0.93, 95% CI: 0.88-0.99, p = 0.024). A significantly lower risk of AA/AD mortality was observed in participants within the highest quartile of CDAI compared to those in the lowest quartile (HR = 0.83, 95% CI: 0.71-0.96, p = 0.018), based on the Cox regression analysis. RCS analysis indicated a linear relationship between CDAI and the mortality of AA/AD (P for overall < 0.001; P for nonlinear > 0.05). Furthermore, mediation analysis suggested that uric acid, neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP), and high-density lipoprotein cholesterol (HDL-C) mediated the association between CDAI and AA/AD incidence. Conclusion This study supports the pathogenic role of oxidative stress and inflammation in AA/AD, demonstrating that a higher CDAI is associated with lower incidence and mortality of AA/AD in a UK-based adult population. These findings provide new insights, suggesting that dietary antioxidant intervention could serve as a potential preventive strategy against these conditions.

Background To investigate the clinical outcomes of use of a novel off-the-shelf multibranched endovascular stent graft in patients with type Ia endoleak after endovascular aortic repair (EVAR). Methods Patients who received the G-Branch endograft for type Ia endoleak after EVAR at our institution between November 2021 and July 2024 were retrospectively reviewed. The G-Branch endograft system, which has a hybrid configuration comprising 2 inner branches for the celiac axis and superior mesenteric artery and 2 outer branches for the renal arteries, was used in all cases. Follow-up assessments were scheduled at 1, 6, and 12 months after the index procedure and annually thereafter. Results Technical success was achieved in all cases. No deaths, cases of spinal cord ischemia, or other major adverse events occurred within 30 days postprocedure. No type Ia or type III endoleaks were detected during a median follow-up of 24 months. One patient (14.3%) underwent reintervention for type II endoleak. All target vessels remained patent without significant stenosis. No instances of dilatation of the aneurysm sac were observed. Conclusion The G-Branch endograft represents a promising option for management of type Ia endoleak after EVAR, with favorable short-term to medium-term outcomes. A large multicenter study is warranted to confirm our findings.

Objective: To investigate the relationship between the aortic arch Tortuosity Index (TI) and post-TEVAR aortic enlargement in patients with type B aortic dissection (TBAD) requiring left subclavian artery (LSA) reconstruction with a single-branched stent-graft. Methods: We retrospectively analyzed 120 patients enrolled in a prospective multicenter clinical trial between December 2020 and November 2021. The aortic arch TI was measured to quantify arch tortuosity. The study evaluated the independent association between TI and the risk of post-TEVAR aortic enlargement using multivariable Cox regression analysis. Furthermore, we estimated enlargement-free survival in patients stratified by TI levels and verified the diagnostic performance of TI for both thoracic and abdominal aortic enlargement. Results: The mean age was 57.0 ± 10.6 years. Multivariable Cox regression revealed TI was independently associated with both thoracic (HR, 3.8; 95% CI, 2.2-6.6; p < 0.001) and abdominal aortic enlargement (HR, 2.5; 95% CI, 1.6-4.1; p < 0.001). Kaplan-Meier survival curves demonstrated that freedom from aortic enlargement was significantly lower in the High-TI group (p < 0.001). ROC curves confirmed excellent discriminative ability for thoracic (AUC: 0.857, 95% CI, 0.775-0.940) and abdominal (AUC: 0.833, 95% CI, 0.756-0.910) enlargement. Conclusions: In TBAD patients requiring LSA reconstruction with a single-branched stent-graft, the aortic arch tortuosity is independently associated with post-TEVAR aortic enlargement. Preoperative measurement of the aortic arch tortuosity contributes to risk stratification in patients with TBAD and may identify those requiring intensified postoperative surveillance.

Abstract Purpose This prospective, multicenter, single-arm clinical trial evaluated the safety and efficacy of the Jetstream Atherectomy System in 72 Chinese patients with calcified femoropopliteal artery occlusive disease (FPOAD). Materials and methods The study protocol was approved by the institutional review boards of all participating centers, and all participants provided written informed consent. The primary endpoints were 30-day major adverse events (MAE) and changes in angiographic stenosis. Secondary endpoints included vessel patency, clinical improvement, and adverse events during follow-up. Results The study cohort had a mean age of 67.5 ± 9.0 years, with a high prevalence of hypertension (79.2%) and diabetes (37.5%). Severe calcification (PACSS, Peripheral Arterial Calcium Scoring System, grade 3–4) was present in 43.1% of lesions. Technical success (≤ 30% residual stenosis) was achieved in 91.7% of cases. The 30-day major adverse events (MAE) rate was 1.4%, with one target lesion revascularization (TLR), and no deaths or amputations were recorded. Mean stenosis was reduced from 87.8 to 48.5%, with a mean lumen gain of 40.2%. At 12 months, primary patency was 68.4%; secondary patency was 89.7%. Clinical improvement was evidenced by an increase in the mean ankle-brachial index (ABI) from 0.52 ± 0.15 to 0.76 ± 0.18, and 91.7% (66/72) of patients showed an improvement of at least one Rutherford class after 1 year. Conclusions This study confirms the Jetstream system’s clinical value in Chinese FPOAD patients. Its combination of mechanical cutting and aspiration makes it particularly suitable for Asian-specific calcified lesions, achieving favorable clinical outcomes.

Abdominal aortic calcification (AAC), a significant predictor of cardiovascular events and mortality, lacks a simple predictive tool for early risk stratification. This study aimed to develop and validate a clinical nomogram for predicting AAC risk using accessible demographic, comorbidity, and lifestyle factors. Utilizing data from the 2013–2014 National Health and Nutrition Examination Survey (NHANES) cohort, AAC was assessed via dual-energy X-ray absorptiometry (DXA) using the Kauppila scoring system (score > 0 defined AAC). Participants were stratified into training (n = 2,198) and validation (n = 942) cohorts. The nomogram was developed through multi-algorithm consensus, incorporating predictors selected by three robust methodologies: Least Absolute Shrinkage and Selection Operator (LASSO) regression, the best subsets regression (BSR) method and the Boruta algorithm. Model performance was evaluated through ROC, calibration, and decision curve analysis (DCA) curves. Five predictors—age, BMI, cardiovascular disease (CVD), hypertension, and smoking status—were identified. The nomogram demonstrated robust discrimination, with AUCs of 0.747 (95

BACKGROUND:Aortic arch pathologies are complex to treat. Alternatives include open surgery, hybrid surgery (endovascular aortic stent-grafting and open surgical debranching procedures) and total endovascular solutions with branched stent-grafts. Branched stent-grafts are the mainstream approach for endovascular repair, but they are primarily available only as dedicated custom-made devices. The aim of this study was to evaluate the safety and effectiveness of a non-customized modular aortic arch stent-graft. METHOD:This trial was led by the Chinese PLA General Hospital and 16 additional aortic centres in China. All included patients were treated with a non-customized modular inner branched stent-graft (Endonom Medtech, Hangzhou, China). The study endpoints were 30-day death and stroke, technical success, clinical success, early and late complications, reintervention, and death during follow-up. Follow-up via clinical examination and CT angiography scan were scheduled post surgery at 1, 6, and 12 months, and annually thereafter. RESULTS:From June 2021 to December 2024, a total of 88 patients were enrolled in this study. Technical success rate was 100%. The mean follow-up was 28.6 ± 11.7 months. The overall 30-day mortality rate was 3%, and the 30-day stroke rate was 9%. Overall survival was 91% ± 3%, 86% ± 4%, and 81% ± 4% at 12, 24, and 36 months respectively. A total of 10 patients developed endoleaks, none of which required reintervention. CONCLUSION:Modular branched stent-graft repair for aortic arch disease is feasible and with comparative rates of safety with custom made branched endovascular stent-grafts, hybrid techniques and open surgery. Long-term comparative effectiveness studies are required to establish whether it is superior to alternative interventions.

Thoracic aortic calcification (TAC) is a valuable predictor for assessing the risk of cardiovascular disease. However, there is limited evidence clarifying the specific determinants of TAC and its impact on the thoracic aortic diameter. A total of 446 patients who underwent lung nodule screening between August 2020 and April 2023 were included. TAC volume and thoracic aortic diameter were measured separately based on three predefined aortic segments on unenhanced computed tomography. Univariate analysis and regression models were used to identify independent determinants of TAC volume. Additionally, univariate and multivariate generalized linear regression analyses were conducted to explore the association between TAC volume and thoracic aortic diameter. The mean age of the patients was 55.6 years, and 45.5

The anatomical eligibility of the Iliac Branch Device (IBD) remains limited, primarily caused by the additional common iliac artery (CIA) space occupied by its outer branch. Given that East Asian populations typically have smaller CIA diameters and lengths than Western populations, the anatomical eligibility of IBD in East Asians is <30%. Thus, we developed a novel Physician-Modified Inner Iliac Branch Device (PM-IIBD) to reduce CIA spatial demands. The PM-IIBD was used for 10 patients’ internal iliac artery (IIA) reconstruction, achieving a 100% technical success with no perioperative complications. The 12-month postoperative CTA follow-up showed that no type I or III endoleaks and all EIA and IIA were patent. Seven cases showed sac shrinkage, and 3 showed sac stability. This study demonstrates the safety and efficacy of the PM-IIBD in CIA lesions. The PM-IIBD significantly reduces spatial demands on the CIA, expanding the anatomical eligibility for IBD.

Artery rupture is a very rare but severe complication of neurofibromatosis type 1 (NF1), an autosomal-dominant genetic disorder, and the optimal treatment is not yet clear. We present two cases who presented with different types of artery rupture related to NF1 at our center within a short period and review similar cases reported previously to discuss the suitable therapy for this complication. We concluded that an NF1 gene mutation affects the structure of the artery, makes the artery fragile, thick, and prone to rupture, and endovascular treatment should be considered as the first choice.

BACKGROUND:Endovascular aortic repair was introduced in China in 1997, with domestically produced devices emerging post-2000. Despite progress, treatment of complex aortic pathologies remains limited, necessitating innovative endovascular solutions. METHODS:Our center developed 8 off-the-shelf endovascular innovations, including 3 inner branch stent graft systems for aortic arch reconstruction, 2 branched/fenestrated stent grafts for thoracoabdominal and juxtarenal aortic aneurysms, 1 iliac branch device for internal iliac artery preservation, and 2 novel devices-EndoPatch and EndoSeal (Endonom Medtech)-designed to seal distal tears and occlude false lumen in aortic dissections. These advancements integrate technologies such as steerable delivery systems, preloaded navigation aids, and mixed or inner branch configurations to accommodate anatomical variations. RESULTS:Preliminary clinical applications demonstrated promising technical success rates and acceptable complication profiles. Two devices have been approved by China's National Medical Products Administration for clinical use, while others remain under investigation. Key challenges include anatomical variability, branch vessel patency concerns, and the absence of long-term outcomes for most devices. CONCLUSION:These innovations establish a comprehensive endovascular strategy for extensive aortic pathologies, addressing critical gaps in China's device landscape. Early outcomes demonstrate the feasibility of standardized off-the-shelf solutions for complex anatomies, though multicenter trials and long-term follow-up remain essential to confirm safety and efficacy.

BACKGROUND:The use of off-the-shelf multi-branched endografts for thoracoabdominal aortic aneurysm (TAAA) is increasing; however, these commercially available devices have limited anatomical feasibility for treating TAAA. This study aimed to assess the safety and efficacy of a novel G-branch off-the-shelf endograft for TAAA. MATERIALS AND METHODS:A total of 73 patients with TAAA were treated using the G-branch endograft at 14 sites across China. The primary endpoints were the 30-day technical success and major adverse events rates. The secondary endpoints were all-cause mortality, secondary intervention, endoleaks, target vessel patency, and freedom from renal function deterioration during a 1-year follow-up. RESULTS:The technical success rate was 95.9% (70/73). Renovisceral artery reconstruction was successful in 99.7% (291/292) of patients. Within 30 days, six patients (8.2%) experienced major adverse events, namely paraplegia (n = 2), acute kidney injury (n = 2), acute myocardial infarction (n = 1), and cerebral infarction (n = 1). During the 1-year follow-up, one patient died from aortic dissection, giving an overall survival rate of 98.6%. Four patients (5.5%) underwent secondary interventions, giving a freedom from secondary intervention rate of 92.8%. Endoleaks occurred in 12 patients (10 type II, 2 type III). The primary patency rate of the target vessels was 95.7%, and three bridged stent grafts were successfully recanalized, resulting in a secondary patency rate of 96.7%. Renal function deterioration occurred in six patients (8.2%), giving a freedom from renal function deterioration rate of 94.6%. CONCLUSIONS:The off-the-shelf G-Branch endograft appears safe, with favorable 30-day and 1-year mortality and morbidity rates for both elective and urgent TAAA treatment.

Severe abdominal aortic calcification (SAAC) is acknowledged as a significant contributor to cardiovascular morbidity and mortality, yet its relationship with sex steroid hormones remains unclear. Here, the unexplored link between serum sex steroid hormone levels and SAAC was investigated within the National Health and Nutrition Examination Survey (NHANES) cohort. This study utilized data from NHANES 2013–2014. SAAC was determined using the abdominal aortic calcification 24-point scale. Serum sex steroid hormones were categorized into quintiles 1–5 for analysis. Multivariable logistic regression and subgroup analyses were employed to investigate the potential relationship between serum sex steroid hormones and SAAC risk. Moreover, the Johnson-Neyman plot was applied to identify the presence of any threshold effects. Finally, to reveal the potential pathophysiological mechanism, mediation analyses were performed. A total of 1852 enrolled individuals were included, and the prevalence of SAAC stood at 8.00

OBJECTIVES:Chronic internal carotid artery occlusion (CICAO) poses a considerable risk for stroke. While endovascular revascularization holds promise as a potential therapy, its real-world efficacy, safety, and long-term outcomes remain underexplored. This study aims to assess the effectiveness, safety, and long-term outcomes of endovascular revascularization in symptomatic CICAO patients refractory to medical therapy. MATERIALS AND METHODS:A retrospective cohort study was conducted to collect clinical and surgical data from CICAO patients meeting the inclusion criteria for endovascular revascularization therapy. Patients were categorized into groups based on the success or failure of revascularization procedures. Follow-up assessments were undertaken to ascertain patients' prognoses and survival outcomes. Logistic multivariate analysis was employed to identify risk factors associated with primary and secondary outcome events. COX proportional hazard regression was used to compare the risk ratios of these events between the two groups. RESULTS:The study included 59 patients undergoing 62 procedures with a 75.81 % success rate for revascularization. Perioperative complications were 6.45 %, and the average follow-up duration was 36.53 ± 3.92 months. In the successful revascularization group, the primary endpoint event rate was 6.52 %, contrasting with 23.08 % in the non-revascularization group. Carotid artery occlusion and diabetes emerged as independent risk factors for primary endpoint events. A significant difference was observed between the two groups in both primary endpoint (RR 0.16, [95 %CI, 0.03-0.84]) and total endpoint event rates (RR 0.27, [95 %CI, 0.08-0.96]) CONCLUSIONS: Failure of revascularization may be associated with an increased risk of recurrent cerebrovascular events in patients with CICAO, while successful endovascular revascularization appears to be linked to a lower incidence of such events. However, these results should be interpreted with caution due the relatively small sample size.