OBJECTIVE:To investigate the association between use of aspirin or statins and aneurysm wall enhancement (AWE) on 3T magnetic resonance vessel wall imaging (MR-VWI) in patients with unruptured intracranial aneurysms (UIAs). METHODS:For this cross-sectional study, we obtained individual patient data from three prospective UIA follow-up registries in which patients underwent 3.0T MR-VWI. Regular medication use was defined as aspirin ≥100 mg at least three times per week for ≥6 months, and statins at ≥20 mg daily for ≥6 months. AWE was classified as no AWE (no visible enhancement), focal AWE (enhancement limited to part of the aneurysm wall), or circumferential AWE (enhancement involving the entire wall). Multivariable ordinal logistic regression was used to assess the association between medication use and AWE in the full cohort. To isolate the effect of each drug, we conducted two separate propensity score matching analyses (PSM): statin users were excluded from the aspirin analysis, and aspirin users from the statin analysis. Logistic regression analyses were repeated within each matched group. RESULTS:We included 1351 patients with 1416 UIAs, of whom 141 (10.4%) used aspirin and 145 (10.7%) used statin. In the full cohort, multivariable ordinal logistic regression showed that aspirin use was associated with a lower likelihood of AWE (OR=0.51; 95%CI, 0.35-0.74), whereas statin use was not significantly associated with AWE (OR=1.44; 95% CI, 0.98-2.12). PSM based on age, sex, hypertension, diabetes, dyslipidemia, and aneurysm size yielded 83 matched pairs in the aspirin cohort and 97 in the statin cohort. In the matched cohorts, aspirin use remained inversely associated with AWE (OR=0.47; 95% CI, 0.26-0.85), while statin use remained unassociated (OR=1.49; 95% CI, 0.88-2.50). CONCLUSION:In this cross-sectional analysis, aspirin use was independently associated with reduced AWE in patients with UIAs, while statin use was not. However, the cross-sectional design precludes causal inference regarding a direct anti-inflammatory effect on the aneurysm wall.

OBJECTIVE:The aim of this study was to compare the long-term risk of hemorrhagic stroke and death between conservative management and monotherapy intervention in patients with Spetzler-Martin (SM) grade I and II brain arteriovenous malformations (AVMs). METHODS:The authors included AVMs that underwent conservative management and monotherapy intervention between August 2011 and December 2021 from a nationwide multicenter prospective collaboration registry. Patients were categorized into unruptured and ruptured cohorts for comparison of long-term outcomes, with hemorrhagic stroke and death defined as primary outcomes and neurological status as a secondary outcome. The efficacy of various intervention strategies, including resection, embolization, and stereotactic radiosurgery (SRS), was also evaluated. Stratified analyses based on intervention strategies and different SM grade subtypes were conducted. RESULTS:Of 4286 AVMs in the registry, 1013 patients were eligible for inclusion (387 with unruptured AVMs and 626 with ruptured AVMs). Overall, the intervention group showed a lower incidence of long-term hemorrhagic stroke and death compared with the conservative management group (0.43 vs 0.88 per 100 patient-years; adjusted HR [aHR] 0.61 [95% CI 0.24-1.52]), although this difference did not reach statistical significance. The results were similar in the two subgroups: aHR 0.95 (95% CI 0.28-3.18) for unruptured AVMs and aHR 0.29 (95% CI 0.06-1.32) for ruptured AVMs. Stratified analyses based on different intervention strategies and different SM grade subtypes showed that resection might benefit both unruptured (0.00 vs 0.79 per 100 patient-years, p = 0.006) and ruptured (aHR 0.12 [95% CI 0.03-0.53], p = 0.033) AVMs, while SRS might only benefit ruptured AVMs (aHR 0.04 [95% CI 0.01-0.34], p = 0.163). Embolization and SRS might not be beneficial for unruptured low-grade AVMs. CONCLUSIONS:In this observational prospective cohort study, intervention demonstrated benefit over conservative management in preventing long-term hemorrhagic stroke or death in patients with SM grade I or II AVMs. Among specific monotherapy interventions, resection proved favorable for both unruptured and ruptured SM grade I and II AVMs, while SRS might serve as a reasonable alternative in ruptured cases.

Objective This study aims to evaluate the long-term outcomes of cerebral arteriovenous malformations (AVMs) with associated aneurysms in patients who underwent exclusive endovascular embolization.Methods Patients with aneurysmal AVMs were identified from China's nationwide MATCH registry. Propensity score matching balanced baseline differences between embolization and conservative management groups. The primary outcome was long-term hemorrhagic stroke or death; secondary outcomes included obliteration rate and neurological status. Subgroup and sensitivity analyses using various designs assessed the robustness of the results.Results In the MATCH study, 230 patients with AVMs and associated aneurysms received embolization or conservative treatment. After screening, 83 patients received conservative management and 108 underwent embolization; 64 matched pairs were analyzed after propensity score matching. The embolization group had a mean follow-up of 6.88 years, with a post-procedure rupture risk of 2.75% per patient-year and a complete obliteration rate of 21.88%. Embolization was associated with a lower rate of hemorrhagic stroke or death (absolute risk reduction -3.50% per patient-year; HR 0.50) and a higher obliteration rate compared with conservative management. Neurological outcomes were similar between the two groups. Stratified analysis showed that curative and targeted embolization significantly reduced hemorrhagic stroke whereas palliative embolization did not. Subgroup and sensitivity analyses confirmed these trends, although the statistical power varied.Conclusion This study suggests that embolization may reduce the risk of long-term hemorrhagic stroke or death in patients with aneurysmal AVMs. Curative and targeted approaches showed protective effects while palliative embolization had limited benefits.

BACKGROUND:Ischemic stroke (IS) related to atrial fibrillation (AF) represents a cardio-cerebral comorbidity, whereas diabetes-related IS reflects an advanced manifestation of panvascular disease. We aimed to analyze the burden trends in AF-related and diabetes-related IS, using Global Burden of Diseases 2021 data. METHODS:To quantify the burdens of AF- and diabetes-related IS, we applied the population-attributable fraction, the proportion of burden preventable by eliminating a risk factor. We calculated population-attributable fractions stratified by time, location, and age group. We analyzed the burdens using joinpoint regression, time-series projection to 2050, and age/sex-stratified. RESULTS:Globally, AF-related IS had a higher age-standardized incidence rate in 1990 but declined steadily (average annual percentage change =-0.81 [95% CI, -0.92 to -0.69]). Conversely, diabetes-related IS, despite a lower initial incidence, exhibited substantial and sustained increases (average annual percentage change=1.10 [95% CI, 1.02-1.18]). Middle-high socio-demographic index regions experienced the greatest burden from both comorbidities. In North America and Eastern Europe, the age-standardized incidence rates of AF-related IS stabilized (average annual percentage change=-1.45 [95% CI, -1.63 to -1.27]; -0.95 [95% CI, -1.06 to -0.84]), whereas the age-standardized incidence rates of diabetes-related IS continued to increase (average annual percentage change=1.18 [95% CI, 1.02-1.34]; 0.72 [95% CI, 0.56-0.88]). High body mass index emerged as a critical shared risk factor for AF, diabetes, and IS. Projections indicate a substantial increase in diabetes-related IS incidence over the next 3 decades, contrasting with minimal growth in AF-related IS. CONCLUSIONS:IS remains a critical global health challenge, primarily driven by the rising burden of diabetes-related IS. Our findings highlight the importance of age- and country-specific interventions.

ObjectiveTo assess the safety and efficacy of low-dose gamma knife radiosurgery (SRS) in treating brain arteriovenous malformations (AVMs) using a nationwide multicenter cohort. Specifically, we aim to evaluate the outcomes of AVM obliteration, hemorrhagic stroke risk, and neurological status post-SRS, comparing the efficacy and safety of lower radiation doses with traditional high-dose SRS protocols.MethodsThis observational prospective cohort study utilized registry data from the Multimodality Treatment for Brain AVMs in Mainland China (MATCH study), analyzing patients treated with gamma knife between August 2011 and December 2021. The cohort comprised 677 patients, stratified by treatment approach (combined embolization and SRS, combined surgical resection and SRS, and SRS alone). Baseline characteristics, including age, sex, AVM location, and nidus complexity, were recorded, and clinical outcomes were followed for up to 20 years.ResultsOf the 677 patients, 340 (50.2%) achieved AVM obliteration, with an annual post-SRS hemorrhagic stroke risk of 0.92%. Significant predictors of obliteration included younger age, smaller lesion diameter (<3 cm), and lower Spetzler-Martin grades. The cumulative post-SRS hemorrhagic stroke risk was highest in the first 5 years (2.56% annually). Multivariable analysis revealed that deep venous drainage was significant protective factor of AVM obliteration and flow-related aneurysm was significant predictors of failure to achieve obliteration. Additionally, pre-treatment AVM rupture was associated with a lower risk of post-SRS hemorrhagic stroke.ConclusionsLow-dose gamma knife treatment could be effective for AVM obliteration, with a favorable risk profile, particularly in younger patients with smaller, less complex lesions. The findings emphasize the importance of individualized SRS strategies and highlight the lower incidence of complications with low-dose protocols. Further studies with longer follow-up and larger sample sizes are needed to validate these results and refine treatment strategies.

Microplastics and nanoplastics (MNPs) are emerging global contaminants of concern, owing to their ability to penetrate human tissues, although their health risks are unknown. MNPs have been detected in several organs, including the brain, but their concentrations in, and effects on, this organ remain largely unexplored. To address this knowledge gap, we analysed 156 diseased brain samples from 113 patients with brain tumours, alongside 35 healthy brain samples from five post-mortem donors. MNPs were present in 99.4% of diseased brain samples and 100% of healthy brain samples. Significant differences in MNP concentration and diameter across tissues suggest distinct pathways for MNP accumulation. A higher MNP concentration was observed in peritumoural brain tissues than in healthy brain tissues, suggesting that the compromised blood–brain barrier in cancer may aid MNP entry. A positive correlation between microplastic surface area and tumour proliferation was observed. This study provides evidence of MNP presence in the living human brain, highlighting a need for further research to understand causal links between MNPs and human disease. Microplastics and nanoplastics were found at a higher level in brain tumour samples from living patients than in healthy human brain samples from cadavers, with a correlation between microplastic surface area and tumour proliferation.

BackgroundBrain arteriovenous malformation (bAVM) is a rare vascular disorder that can lead to severe neurological symptoms. The molecular mechanisms driving bAVM development and progression of bAVM remain poorly understood. This study aimed to investigate the molecular changes potentially associated with bAVM pathogenesis by performing RNA-seq on human microvascular endothelial cells (HMEC-1) overexpressing KRAS, a key driver of BAVM.ResultsHMEC-1 cells overexpressing KRAS were established as an in vitro model of bAVM. RNA-seq were conducted and transcriptomic analysis revealed that differentially expressed genes in HMEC-1 cells overexpressing KRAS were predominantly enriched in pathways related to cell adhesion, signaling, and transport, which may contribute to bAVM pathogenesis. Specifically, upregulated genes were mainly located in the cell-substrate junctions and focal adhesion, whereas downregulated genes were primarily located in the ribosomal subunits, ribosome, mitochondrial protein complex, and mitochondrial inner membrane.ConclusionsOur findings provided a preliminary delineation of molecular mechanisms after KRAS overexpression in endothelial cells, which may contribute to the development of bAVM. Future work will focus on validating these results in clinical specimens, functionally characterizing the dysregulated pathways, and exploring their potential as novel therapeutic targets.

Aneurysm wall enhancement (AWE) on 3T magnetic resonance aneurysm wall imaging (MR-AWI) predicts aneurysm growth and rupture during follow-up. However, its association with hypertension and the impact of blood pressure (BP) control remain unclear. This study aims to evaluate the association between hypertension, BP control, and AWE in patients with unruptured intracranial aneurysms (UIAs). We retrospectively analyzed patients with UIAs from three prospective cohorts (IARP-CP, 100-Project, 100-Project II) who had 3.0 T MR-AWI. AWE was categorized into three patterns: no enhancement, focal enhancement, and circumferential enhancement. Hypertension was defined as a history of hypertension and/or use of antihypertensive drugs. Hypertensive patients were categorized as well-controlled (systolic BP [SBP] < 140 mmHg and diastolic BP [DBP] < 90 mmHg) or poorly controlled (SBP ≥ 140 mmHg or DBP ≥ 90 mmHg). Propensity score matching (PSM) (1:1) balanced confounders (age, sex, BMI, comorbidities, aneurysm characteristics). Ordinal logistic regression assessed associations between hypertension, BP control, and AWE. From a cohort of 1351 patients with 1416 UIAs who had MR-AWI, we matched 427 hypertensive patients with 427 normotensive patients. Hypertension was associated with higher AWE prevalence in both the total cohort (odds ratio (OR) 1.98, 95

BACKGROUND AND AIMS:Coexisting atherosclerosis across vascular territories is a critical facet of multimorbidity in aging populations and is associated with adverse outcomes, yet it often remains underdiagnosed. Early identification through noninvasive screening is needed, given that atherosclerosis frequently affects polyvascular beds simultaneously and current guidelines lack specific recommendations for detecting polyvascular disease. METHODS AND RESULTS:We performed a subset analysis of a prospective registry (BHC-C, NCT05961748) enrolling 719 Chinese patients (mean age 62 ± 11; 32.8% female) who underwent one-stop cerebral and carotid combined coronary (CCC) CTA plus comprehensive lipid profiling. Coronary atherosclerosis was most prevalent (80.7%), followed by extracranial carotid (77.9%) and intracranial (63.1%) plaques. Moderate-to-severe stenosis (≥50% luminal narrowing) was detected in 43.1%, 27.0%, and 26.6% of coronary, extracranial, and intracranial arteries, respectively. Notably, 11.8% of patients had triple-vessel coronary disease, and 8.7% exhibited concurrent intracranial, extracranial, and coronary involvement. Patients with polyvascular disease paradoxically showed lower LDL-C and Lp-PLA2 levels on average. This inverse cross-sectional association should be interpreted cautiously and may reflect prior ASCVD, intensive lipid-lowering or other preventive therapy, advanced disease stage, and residual confounding rather than a protective causal effect of lower Lp-PLA2. CONCLUSIONS:CCC CTA plus lipid panel evaluation may help reveal occult polyvascular atherosclerosis. This approach enabled comprehensive visualization of multi-bed plaques alongside risk factor assessment, demonstrating potential to improve early detection and holistic management of CCC comorbidity in both primary and secondary prevention settings. TRIAL REGISTRATION:ClinicalTrials.gov ID NCT05961748. Date of registration: 2023-09-21.

OBJECTIVES:Arteriovenous malformation (AVM) rupture can be life-threatening, necessitating accurate predictive methodologies. We developed and validated the normalized stasis index (NSI), derived from quantitative digital subtraction angiography (qDSA), for predicting AVM rupture risk. METHODS:In this multicenter, retrospective, observational study, we enrolled consecutive AVM patients who underwent DSA examination between 2017 and 2022. qDSA was used to calculate hemodynamic parameters. We performed univariate and multivariate analyses to assess NSI's association with AVM rupture, evaluated its predictive performance through receiver operating characteristic (ROC) curve analysis, and compared it with existing prediction models using DeLong's test. An independent cohort provided external validation. RESULTS:The study included 663 patients (internal cohort: n=523; external validation cohort: n=140) with 324 ruptured and 339 unruptured AVMs. The ruptured group demonstrated significantly higher NSI values than the unruptured group (median: 9.03 vs 2.11; p<0.001). Across multivariate models, NSI maintained an independent association with AVM rupture after adjusting for vascular structural factors (p=0.009), hemodynamic factors (p<0.001), combined factors (p=0.029), and demographic factors (p=0.027). Integration of NSI into existing R2eD and VALE predictive models significantly enhanced their performance (R2eD: area under the curve (AUC) 0.768; VALE: AUC 0.792; both p<0.001). CONCLUSIONS:NSI demonstrates an independent association with AVM rupture and exhibits robust predictive capability for rupture events, providing valuable insights for clinical risk stratification and therapeutic decision-making.

Background:An increasing number of studies find uric acid to albumin ratio (UAR) plays an important role in predicting prognosis of cardiovascular disease. Nevertheless, the clinical significance of UAR in aneurysmal subarachnoid hemorrhage (aSAH) is unclear. This study aims to investigate the correlation between UAR and prognosis of aSAH. Methods:In this research, we retrospectively reviewed data of aSAH patients based on the LongTEAM registry. The primary endpoint is the functional outcome at 90 days after discharge and the secondary endpoint is the postoperative complications. Modified Rankin scale (mRS) was used to evaluate the functional outcome (mRS 0-2 was defined as favorable outcome and mRS 3-6 was defined as unfavorable outcome). Multivariate logistic regression was applied to evaluate the association between UAR and prognosis of aSAH. Receiver operating characteristic (ROC) curve was used to explore the predictive ability of UAR. Finally, patients were categorized into four groups based on the quartiles of UAR, and the association between UAR and in-hospital complications was assessed using multivariate logistic regression analysis. Results:A total of 937 patients were included in this study. After adjusting potential covariates, multivariate logistic regression showed that UAR was an independent risk factor of poor prognosis (OR (95%CI): 1.317 (1.235-1.405), p < 0.001). Furthermore, compared with reference quartile, patients in Q4 (UAR > 5.348) had a higher risk of postoperative major adverse cardiovascular events (OR (95%CI): 1.930 (1.286-2.898), p = 0.002), and postoperative pneumonia (OR (95%CI): 1.873 (1.210-2.898), p = 0.005). The ROC curve showed UAR had a satisfactory predictive performance (area under curve = 0.704). Conclusion:Elevated UAR levels were associated with high risk of unfavorable clinical outcomes, postoperative major adverse cardiovascular events, and pneumonia. UAR might be a simple, reliable, and cost-effective predictive marker for prognosis of aSAH. Clinical trial registration:https://clinicaltrials.gov/study/NCT04785976, NCT04785976.

BACKGROUND:Delayed cerebral ischemia (DCI) is a severe postoperative complication of aneurysmal subarachnoid hemorrhage (aSAH). Appropriate selection of the optimal surgical modality plays a critical role. It was widely known that two landmark clinical trials, International Subarachnoid Aneurysm Trial (ISAT) and Barrow Ruptured Aneurysm Trial (BRAT), have compared the efficacy of two major treatments for patient with aSAH. However, we still need a large-scale observational study to prove the association between treatment modality and DCI risk. Thus, we intended to validate the impact of treatment modality on DCI and short-term functional outcome. METHODS:A total of 2748 patients were previously admitted to Beijing Tiantan hospital in China from January 2012 to December 2023. The primary outcome was DCI. The functional outcome at 3-month was evaluated by modified Rankin Scale (mRS). A propensity score matching (PSM) was used to balance the differences between microsurgical treatment and endovascular treatment, respectively. Multivariate analysis before and after PSM were performed to evaluating the potential risk factors associated with DCI and 3-month mRS. RESULTS:All the 2748 patients with a median age of 55 (48,63) were included, and 1616 (58.8%) were female. Multivariate adjusted analysis before PSM and after PSM demonstrated that microsurgical treatment (OR 2.510, 95%CI 2.081-3.028, P < 0.001; OR 2.715, 95%CI 2.202-3.347, P < 0.001) was a risk factor independently associated with DCI. Over the past 12 years, this large-scale cohort study revealed an overall declining trend in the incidence of DCI for both treatment modality, during which the utilization rate of microsurgical treatment and the incidence of DCI demonstrated a largely parallel trend. CONCLUSIONS:Microsurgical treatment, compared with endovascular treatment, is independently associated with the occurrence of DCI and poor functional outcome. In this 12-year cohort study, the incidence of DCI exhibited an overall decline alongside a parallel trend in microsurgical utilization. Concurrently, there was a marked increment in the adoption of endovascular strategy.

This study aimed to evaluate long-term outcomes and hemorrhage risk in patients aged 60 years and older with brain arteriovenous malformations (AVMs) across different real-world management modalities. We retrospectively analyzed 94 patients aged ≥ 60 years with AVMs from the MATCH study between August 2011 and December 2021. Patients were categorized into six treatment groups: conservative management, surgical resection, embolization, stereotactic radiosurgery (SRS), embolization plus resection, and combination therapy. Outcomes included annualized hemorrhage rate and functional status assessed by the modified Rankin Scale (mRS). Subgroup analyses were conducted based on sex, pretreatment hemorrhage, Spetzler–Martin grade, lesion location, flow-related aneurysm, and age. Among the 94 patients (2.19

Atherosclerosis is the leading cause of cardiovascular disease worldwide, yet current therapies remain limited and often fail to fully prevent disease progression. This study integrates genome-wide association study data from the FinnGen R10 cohort and the UK Biobank for coronary atherosclerosis and carotid-dominant cerebral atherosclerosis to prioritize genetically supported candidate targets. Mendelian randomization (MR), summary-based MR, Steiger tests, and colocalization analyses are performed across multiple proteomic, transcriptomic, and methylation QTL datasets, followed by validation using public plaque transcriptomic/proteomic resources and single-center Western blotting. Candidate targets are further investigated through database mining, molecular docking, and phenome-wide association analyses to assess druggability signals and potential safety liabilities. In addition, a machine-learning model is trained using MR-prioritized genes to evaluate plaque-based transcriptomic classification performance, whereas immune and single-cell analyses are conducted to investigate cell-type-specific expression patterns. Following sensitivity analyses and false discovery rate (FDR) correction, 43 proteins are prioritized as genetically supported candidate targets, including 3 for carotid-dominant cerebral atherosclerosis and 40 for coronary atherosclerosis. Sixteen proteins demonstrate consistent support across multiple omics layers and analytical filters. Novel candidates, including PRSS22, SPINK1, ACP6, DUSP13, PELO, and PPP1R14A, are identified for further investigation. This multi-omics MR framework provides a prioritized list of candidate targets with supporting evidence of disease relevance while further functional and pharmacological studies are required to evaluate their therapeutic efficacy and safety.

Background This study aimed to identify multiomics therapeutic targets for aneurysmal subarachnoid haemorrhage (aSAH) and unruptured intracranial aneurysm (uIA) using Mendelian randomisation (MR), summary-data-based MR (SMR) and postanalysis methods.Methods Significant genetic variables were extracted from multiple databases, including Expression Quantitative Trait Loci (eQTL) from eQTLGen and Genotype-Tissue Expression V.8, protein QTL from eight plasma studies and methylation QTL from the 2018 genome-wide methylation study. Key molecules linked to aSAH and uIA were identified through MR (SMR) and colocalisation analysis. Functional research and drug development relied on postanalysis approaches, including single-cell analysis, enrichment studies and molecular docking.Results Nine genes and one protein associated with aSAH, along with two genes and one protein for uIA, were identified. DNA methylation variations significantly influenced outcomes. Colocalisation analysis showed most key molecules shared genetic variants with the diseases. The prioritised targets were PSMA4, PRCP, TNFSF12 and RELT. Enrichment and protein-protein interaction studies indicated these proteins acted mainly through the Phosphoinositide 3-kinase-Ak strain transformation (PI3K-Akt) pathway and cytokine interactions. Molecular docking confirmed stable binding of PRCP with benazepril. Single-cell analysis revealed high expression of prioritised targets in inflammatory cells. Phenome-Wide Association Study suggested potential pleiotropy of priority targets.Conclusions The study identified key targets for aSAH and uIA, providing insights for developing preventive therapies and advancing research on intracranial aneurysm mechanisms.

BACKGROUND:Delayed cerebral ischemia (DCI) is a major contributor to poor outcomes after aneurysmal subarachnoid hemorrhage (aSAH), yet its molecular correlates and early blood-based candidate biomarkers remain incompletely understood. This study aimed to characterize plasma proteomic changes associated with DCI and identify exploratory candidate protein signatures. METHODS:An observational cohort study was conducted including patients with aSAH. Propensity score matching (PSM) was applied to minimize baseline confounding. Plasma samples collected within 72 h after admission were analyzed using data-independent acquisition (DIA)-based proteomics. Candidate differentially expressed proteins between the DCI and non-DCI groups were identified using exploratory criteria. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the discriminatory performance of selected representative candidate proteins. Bioinformatic analyses, including protein-protein interaction (PPI) network construction, Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and gene set enrichment analysis (GSEA), were performed to explore potential biological processes. RESULTS:After PSM, 21 matched pairs were included. Using exploratory criteria, 95 candidate proteins were identified, including 49 nominally upregulated and 46 nominally downregulated proteins in the DCI group. Five representative candidate proteins, including RGS10, ENSA, ECM2, ALDH1A1, and HBD, showed moderate discriminatory performance, with AUC values ranging from 0.730 to 0.766. PPI network analysis identified hub proteins such as SLC4A1, EPB42, AHSP, and HBD. Exploratory functional enrichment analyses suggested pathway-level patterns related to oxidative stress, energy metabolism, and cytoskeletal regulation. GSEA further suggested alterations in VEGF signaling and chemokine-related pathways. CONCLUSIONS:Plasma proteomic alterations were observed in association with DCI after aSAH and may provide early candidate protein signatures for DCI risk assessment. These findings offer preliminary biological clues regarding DCI-associated processes and support further validation of blood-based proteomic markers in larger independent cohorts.

OBJECTIVES:This study evaluated the natural history of giant cerebral arteriovenous malformations (AVMs) over 6 cm and compared long-term outcomes of interventional treatment versus conservative management. MATERIALS AND METHODS:Patients with AVMs > 6 cm were identified from a national multicenter prospective registry (MATCH). Rupture risk factors were analyzed with uni- and multivariate models. Propensity score matching balanced intervention and conservative groups. The primary outcome was long-term hemorrhagic stroke or death; secondary outcomes included obliteration rates and neurological status. Subgroup and sensitivity analyses assessed robustness. RESULTS:From August 2011 to December 2021, 380 patients with giant AVMs were enrolled. Annual rupture risk was 2.4% for unruptured lesions, 9.4% for previously ruptured, and 3.6% overall. Ventricular involvement (OR = 3.61) and draining vein stenosis (OR = 2.61) were independent hemorrhage risk factors. Over a mean follow-up of 7.3 years, intervention did not significantly reduce hemorrhagic stroke or death compared to conservative management but was associated with higher hemorrhagic stroke risk (HR = 2.04) and neurological deterioration, despite higher obliteration rates (39.1%). Stratified analysis suggested microsurgery and embolization alone were less favorable, while embolization plus radiosurgery more effectively reduced hemorrhagic stroke or death. Subgroup analysis indicated conservative management was preferable for higher S-M grades, unruptured AVMs, and eloquent brain regions. CONCLUSION:The annual rupture rate of giant AVMs (> 6 cm) is approximately 3.6%. Interventional treatment for giant AVMs is not superior to conservative management, and the risks of hemorrhagic stroke and neurological deterioration remain substantial-particularly for unruptured, high-grade, or eloquently located AVMs.

Objectives This study evaluated the natural history of infratentorial brain arteriovenous malformations (AVMs) and compared long-term outcomes of intervention versus conservative management.Materials and methods Infratentorial AVMs from the nationwide MATCH registry were analyzed. Propensity score matching was used to balance the baseline characteristics. The primary outcome was long-term hemorrhagic stroke or death, while secondary outcomes included obliteration rates and neurological status. Subgroup and sensitivity analyses were used to assess the robustness of the results.Result Of 4286 AVMs, 523 (12.2%) were infratentorial. The pretreatment annual rupture rate was 7.05% per patient-year. Independent hemorrhage risk factors included flow-related aneurysms, single draining vein, and vein stenosis. After matching, 144 cases (72 per group) were analyzed with a median follow-up of 6.12 years. Post-intervention the annual rupture risk was 2.17% and obliteration rate was 72.22%. Intervention was linked to higher rates of hemorrhagic stroke or death and higher obliteration rates compared with conservative management, with no significant neurological status difference. Only embolization increased the risk of hemorrhage, while microsurgery and radiosurgery did not. Trends were consistent in subgroup analyses.Conclusion Intervention for infratentorial AVMs may increase the risk of hemorrhagic stroke or death. Embolization therapy may pose long-term risks, and there is no evidence to suggest that surgical resection and stereotactic radiosurgery carry higher risks compared with conservative treatment.