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Abstract Aims. This study aimed to understand gender differences in the management and treatment of acute coronary syndrome in patients treated at the emergency and cardiology departments of a university hospital in Spain. Methods. A descriptive mixed-methods study was conducted, including both quantitative and qualitative phases. Data from patients diagnosed with ACS between 2016 and 2021 were analyzed. Interviews were conducted with patients and physicians to understand their perceptions and experiences. Results. This study included 478 patients, 70.51% men and 29.49% women. Men were younger on average than women (66.43±12.79 vs. 72.54±13.94 years, p<0.001). Tobacco was the most common risk factor. Men with acute coronary syndrome with high segment T presented with elevated enzymatic markers. Women were found to have a greater delay in seeking medical help and received fewer pharmacological treatments and revascularization procedures than men did. According to the multifactorial analysis, fibrinolysis and angioplasty were performed more often in men. Despite similar symptomatology, differences were found in physicians' perceptions of severity. Conclusions. Although symptomatology is similar between men and women, there are differences in the management and treatment of acute coronary syndrome. These findings suggest the influence of psychosocial factors in women's delay in seeking medical help, as well as gender biases in physicians' perceptions of severity. These results have important implications for improving equity in the care of patients with acute coronary syndrome.

Resumen Objetivo. Este estudio tuvo como objetivo analizar las diferencias de género en el manejo y tratamiento del síndrome coronario agudo en pacientes atendidos en un Servicio de Urgencias y Cardiología de un hospital universitario terciario en España. Métodos. Se realizó un estudio descriptivo con metodología mixta, que incluyó fases cuantitativas y cualitativas. Se analizaron los datos de los pacientes diagnosticados de SCA entre 2016 y 2021. Se realizaron entrevistas a pacientes y médicos para conocer percepciones y experiencias. Resultados. El estudio incluyó 478 pacientes, con un 70,51% de hombres y un 29,49% de mujeres. Los hombres eran más jóvenes de media que las mujeres (66,43±12,79 vs 72,54±13,94 años, p<0,001). El tabaco fue el factor de riesgo más frecuente. Los hombres con síndrome coronario agudo con elevación del segmento ST mostraron mayores elevaciones enzimáticas. Se observó que las mujeres presentaban un mayor retraso en la búsqueda de ayuda médica y recibían menos tratamientos farmacológicos y procedimientos de revascularización que los hombres. En el análisis multifactorial, la fibrinólisis y la angioplastia fueron más frecuentes en los hombres. A pesar de una sintomatología similar, hubo diferencias en la percepción de la gravedad por parte de los médicos. Conclusiones. Existen diferencias en el manejo y tratamiento del Síndrome Coronario Agudo. Los hallazgos sugieren la influencia de factores psicosociales en el retraso de las mujeres a la hora de buscar ayuda médica, así como sesgos de género en la percepción de la gravedad por parte de los médicos, lo que condiciona la mayor morbimortalidad de las mujeres con estas patologías. Estos resultados tienen importantes implicaciones para mejorar la equidad en la atención a los pacientes con Síndrome Coronario Agudo.

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INTRODUCTION: Peripheral arterial disease in the superficial femoral and popliteal arteries is common and increasingly treated with drug coated technologies. While drug coated balloons (DCB) are typically used following pre-dilatation with an uncoated balloon; the procedure and patient follow-up are otherwise essentially identical. Published literature demonstrates improved primary patency and reduced target lesion revascularisation with DCB use, however there is little published data on potential cost implications of using this additional device. We hypothesise there is cost equivalence with DCB use when adjusted for reduced re-intervention rate. METHODS: An updated systematic search was performed to identify reintervention rates, restricted to RCT level evidence. Weighted averages of reintervention rates at 1-5 year time points were applied to a local patient cohort, and cost projections calculated to 5 years based on assumed DCB device costs of $900 and $1500 (exaggerated). RESULTS AND CONCLUSION: In a claudicant biased population, cost projections favour DCB at 1, 2, 3, and 5 year time points. For the exaggerated cost group, DCB is also favourable at 1-3 years, with near equivalence at 5 years. Further benefits such as reduced hospital admissions, QALY and angiography suite opportunity costs are not assessed in our projections; but remain important considerations.

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BackgroundThe treatment of hemodialysis access dysfunction include creating a new fistula, balloon dilation, or stent implantation. However, these options are not suitable for all patients. We adopted patch angioplasty to reconstruct the hemodialysis access and observed this group of cases to evaluate the feasibility, effectiveness, and safety of this surgical method.MethodsBetween 2021 and 2024, we performed 14 cases of patch angioplasty using PTFE patch material. We recorded the time of fistula establishment, time of patch angioplasty, surgical site, transitional dialysis status using central venous catheter, complications, and patency of the fistula in this group of cases.ResultsAll 14 patients successfully underwent patch angioplasty, with a technical success rate of 100%. During follow-up, 3 patients died respectively 2, 8, 9 months post-operation. The longest follow-up time was 38 months. The primary patency rates for target lesions were as follows: 92.3% at 3 months (12/13), 81.8% at 6 months (9/11), 77.8% at 12 months (7/9), and 57.1% at 24 months (4/7). The cumulative patency rates were: 3 months 100% (13/13), 6 months 90.9% (10/11), 12 months 88.9% (8/9), and 24 months 71.4% (5/7). No cases experienced infection, bleeding, pseudoaneurysm, or steal syndrome.ConclusionsPTFE patch angioplasty for hemodialysis access reconstruction yields a high technical success rate and serves as an effective solution after hemodialysis access dysfunction. It has high safety and good patency rates, making it a recommended method for access reconstruction.

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OBJECTIVE: To compare in-hospital and long-term outcomes between conventional carotid endarterectomy with patch angioplasty (cCEA) and eversion carotid endarterectomy (eCEA). METHODS: Patients undergoing eCEA or cCEA from January 1, 2012, to December 31, 2024, were identified using the Vascular Quality Initiative database and included in the study. Inverse probability weighting was used to yield balanced study groups. Propensity-weighted logistic regression was used to compare binary outcomes and propensity-weighted Cox regression to compare all-cause mortality. RESULTS: Overall, 157,729 patients undergoing cCEA and 22,296 patients undergoing eCEA were included in the study. eCEA was associated with lower odds of cranial nerve injury (adjusted odds ratio [aOR], 0.69; 95% confidence interval [CI], 0.66-0.73). This was consistent for injuries to cranial nerves VII, IX, X, and XII, as well as other cranial nerves. Similarly, eCEA had lower odds of in-hospital myocardial infarction (aOR, 0.71; 95% CI, 0.65-0.78) and long-term myocardial infarction (aOR, 0.92; 95% CI, 0.87-0.98) compared with cCEA. The odds of in-hospital stroke or transient ischemic attack (aOR, 1.06; 95% CI, 0.99-1.12) and long-term stroke or transient ischemic attack (aOR, 1.03; 95% CI, 0.98-1.07) were similar in both groups. However, the odds of in-hospital stroke (aOR, 0.89; 95% CI, 0.81-0.99) and long-term stroke (aOR, 0.92; 95% CI, 0.85-0.98) were lower for eCEA. All-cause mortality was similar in both groups (aOR, 1.05; 95% CI, 0.99-1.11). Patients who were younger, had a higher body mass index, underwent general anesthesia, and underwent surgery later in the study period were found to derive greater benefit from undergoing eCEA. CONCLUSIONS: eCEA was associated with a lower odds of stroke, cranial nerve injury, and myocardial infarction, but similar all-cause mortality rates compared with cCEA. Given its superior effectiveness and safety, eCEA may be a better alternative to cCEA for the treatment of flow-limiting carotid disease.

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OBJECTIVE: We hypothesized that stents in stent-assisted coil embolization during endovascular treatment (EVT) may reduce the risk of symptomatic vasospasm following aneurysmal subarachnoid hemorrhage (aSAH) and its treatment. This study aimed to evaluate the impact of stent placement on the occurrence of symptomatic vasospasm, identify the associated risk factors, and analyze symptomatic vasospasm occurrence according to treatment modality and aneurysm location. METHODS: We retrospectively analyzed 546 aSAH patients treated from 2013 to 2022. The primary outcome was symptomatic vasospasm occurrence. Potential risk factors for symptomatic vasospasm were evaluated using multivariate logistic regression. Propensity score matching was used to assess the impact of stent use during EVT, treatment modality (coiling vs clipping), and aneurysm location (anterior vs posterior circulation) on symptomatic vasospasm occurrence. RESULTS: Multivariate analysis identified younger age (OR 0.954, 95% CI 0.934 to 0.974, P<0.001), external ventricular drainage (EVD) placement (OR 2.470, 95% CI 1.404 to 4.346, P=0.002), higher white blood cell (WBC) count (OR 1.057, 95% CI 1.006 to 1.109, P=0.027), and higher modified Fisher scale score (OR 4.303, 95% CI 1.725 to 10.736, P=0.002) as significant risk factors. Propensity score matched analysis revealed that stent use during EVT significantly reduced the risk of symptomatic vasospasm (OR 0.413, 95% CI 0.176 to 0.970, P=0.042); however, treatment modality and aneurysm location showed no significant influence. CONCLUSIONS: We found that stent placement during EVT significantly reduced the occurrence of symptomatic vasospasm after aSAH. Additional risk factors included younger age, EVD placement, higher WBC count, and higher modified Fisher scale score. Further studies are warranted to validate these findings and explore their implications for clinical practice.

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BACKGROUND: Predicting the success of endovascular recanalization in non-acute internal carotid artery occlusion (NICAO) remains a challenge. OBJECTIVE: To examine the hypothesis that the concentric ring sign observed on high-resolution magnetic resonance vessel wall imaging (MR-VWI) could serve as a potential imaging biomarker to improve the accuracy of predicting recanalization success and guide treatment decisions. METHODS: A retrospective analysis was conducted on patients with NICAO who underwent endovascular treatment at our institution between January 2020 and December 2023. Baseline data and details of preoperative digital subtraction angiography (DSA) and MR-VWI, perioperative complications, technical success rates, and follow-up outcomes were collected. A nomogram model was constructed via stepwise regression based on statistically significant variables to predict recanalization success. RESULTS: In total, 63 cases were included in this study. The overall recanalization success rate was 82.5% (52/63), and the periprocedural complication rate was 12.7% (8/63). Stepwise regression identified key predictors, including tapered stumps, occlusion segments ≤4, short occlusion duration, and the C2 concentric ring sign (P<0.05). The resulting nomogram demonstrated excellent predictive capabilities for successful recanalization (area under the curve 0.971). CONCLUSION: The predictive model, integrating MR-VWI and digital subtraction angiography features-including the newly identified 'concentric ring sign'-exhibited excellent predictive performance and clinical usefulness, providing a reliable tool for preoperative evaluation and treatment planning in patients with NICAO.

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BACKGROUND: Studies have been conducted to explore the potential predictive indicators of unfavorable outcomes in patients with acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). However, few studies have proposed a comprehensive predictive model combined with clinical baseline data and ancillary examination before surgery. METHOD: In a retrospective study, we collected data on 823 patients with AIS-LVO who had undergone endovascular therapy (EVT); 562 patients who achieved successful revascularization with complete clinical and prognostic information were incorporated into the study. Those patients with a 90-day modified Rankin Scale (mRS) score of 0-2 were defined as having a favorable outcome, while a score of 3-6 represented an unfavorable outcome or futile reperfusion. To build up a predictive model, we applied multivariate logistic regression stepwise backward selection to decide which factors are supposed to be the components of the predictive model. Final model validity was testified by the variance inflation factor test and the Hosmer-Lemeshow (HL) goodness of fit test. The ultimate efficacy was supported by an area under the curve (AUC) value in both training groups and validation groups. RESULTS: 562 patients were enrolled in our study and divided into the training group and verification group in a ratio of 7:3. Factors of baseline data with P<0.1 in univariate logistic regression analysis were enrolled as the potential risk variables to conduct stepwise backward selection. The model was constructed by eight variables; higher mRS score (adjusted OR (aOR) 93.64, 95% CI 12.05 to 727.82, P<0.01), age >80 years (aOR 91.11, 95% CI 1.36 to 6116.36, P<0.05), National Institutes of Health Stroke Scale (NIHSS) >14 (aOR 0.15, 95% CI 0.02 to 0.99, P<0.05), operation history (aOR 8.13, 95% CI 1.32 to 50.20, P<0.05), creatinine (aOR 1.10, 95% CI 1.04 to 1.17, P<0.01), and neutrophil count (aOR 1.07, 95% CI 1.01 to 1.13, P<0.05) were associated with poor outcomes. CONCLUSION: We established an estimation model for invalid reperfusion in AIS-LVO patients and constructed the nomogram for individualized predictions. The AUC of the training group and validation group were both 0.96, with excellent HL and decision curve analysis, presenting excellent clinical prediction efficiency and application potential.

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BACKGROUND: For acute symptomatic intracranial atherosclerotic disease (ICAD) with high-grade stenosis, endovascular strategies include balloon angioplasty (PTA) and angioplasty with stenting (PTAS). Comparative evidence in the acute phase and tools for predicting restenosis remain limited. This study aims to compare outcomes of PTAS versus PTA and develop a 12-month restenosis prediction model. METHODS: We conducted a single-center retrospective cohort of patients with acute symptomatic ICAD (time from symptom onset to intervention ≤14 days, ≥70 % stenosis/occlusion) treated between 2019-2024. Patients were grouped by final procedure (PTAS vs PTA). Primary endpoint was 12-month stroke/TIA in the target territory. Secondary outcomes included residual stenosis, restenosis ≥ 50 %, recovery scores (NIHSS, mRS, MoCA, ADL), perfusion imaging, and inflammatory biomarkers. Weighted analyses and propensity matching were applied. RESULTS: Among 262 patients (PTAS n = 141; PTA n = 121), PTAS achieved lower residual stenosis (21.3 % vs 34.1 %, p < 0.001) with comparable 30-day stroke/death (4.3 % vs 4.1 %). PTAS improved cerebral perfusion metrics and reduced inflammatory markers versus PTA. Twelve-month stroke/TIA occurred in 7.8 % vs 14.0 % (HR 0.62; IPTW-HR 0.58 (95 % CI 0.35-0.97), p = 0.039). Restenosis ≥ 50 % was less frequent with PTAS (12.8 % vs 24.2 %, OR 0.47, p = 0.029). MoCA scores improved more with PTAS (p = 0.034). A prediction model incorporating procedure type, residual stenosis, lesion length, diabetes, smoking, and LDL-C achieved AUROC 0.79 with good calibration. CONCLUSIONS: PTAS provided superior angiographic, perfusion, inflammatory, and restenosis outcomes over PTA, without increased early risk. A validated restenosis model may guide individualized treatment and surveillance.

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BACKGROUND: Treatments for chronic thromboembolic pulmonary hypertension (CTEPH) include PH-specific pharmacotherapy (PHSP), balloon pulmonary angioplasty (BPA), and pulmonary endarterectomy (PEA). We evaluated a sequential multimodal strategy (SMS) combining PHSP, BPA, and PEA in selected high-surgical-risk patients with distal lesions in one lung and proximal lesions in the other. METHODS: In this prospective observational study, patients were selected to the SMS by a multidisciplinary panel, based on hemodynamic severity, location of lesions, and comorbidity profile. Characteristics and complications of procedures were collected. Clinical, laboratory, and hemodynamic data were compared at baseline, before BPA, before PEA, and 6 months after PEA. RESULTS: We enrolled 61 patients, aged 61.9 ± 13.0 years, between 2017 and 2023. At baseline, mean pulmonary artery pressure (mPAP), cardiac output (CO), and pulmonary vascular resistance (PVR) were 49.0 ± 11.7 mmHg, 4.3 ± 1.2 L/min and 9.9 ± 4.0 WU, respectively. The most common complications were hemoptysis (13.1%) and pulmonary artery dissection (6.5%) for BPA and acute kidney injury (34.4%) and reperfusion pulmonary edema (31.1%) for PEA. The New York Heart Association functional class improved significantly and mPAP and PVR decreased significantly after each step of the strategy. Compared to baseline, the mPAP decrease was -49.4% ± 16.7% and the PVR decrease was -69.3% ± 15.9%. Three patients died in the first 2 months following surgery. The overall survival rate 14 months after PEA was 95%. CONCLUSION: Our multimodal strategy was safe and effective in selected patients with severe CTEPH in whom upfront PEA was deemed unacceptably hazardous due to a high surgical risk and mixed anatomical lesions.

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INTRODUCTION: Fibromuscular dysplasia (FMD) is a rare disease with diverse clinical presentations. The need for a bespoke clinic providing individualized care was deemed a patient priority at the United Kingdom's (UK) first patient information day on FMD. In response, a multidisciplinary clinic was established at Salford Royal Hospital in November 2019, integrating renal, neurology, interventional radiology, and neuro-radiology expertise. It has since evolved into the UK's first national FMD clinic. This study aimed to describe baseline patient characteristics and identify contributing factors in disease progression. METHODS AND RESULTS: This prospective observational study included 215 patients reviewed over 5 years. All underwent brain-to-pelvis imaging at least once to radiologically confirm FMD. FMD mimics were identified more often than expected (n = 87, 40.4%), predominantly due to sub-optimal imaging artefacts. Of 128 confirmed FMD patients, median age was 49 years; focal FMD patients were younger than multifocal FMD patients [median (interquartile range or IQR): 44 (27-58) vs. 45 (36-49) years; P = 0.038]. Sixty-seven percent were Caucasian and 85.3% female, and 66.7% had multivessel disease, 29.3 and 19.6% had aneurysms or dissections at presentation. Multifocal disease, aneurysms and dissections were more common in multivessel disease. Follow-up data defined risk factors for clinical or radiological disease progression: younger age at FMD onset [odds ratio (OR) 0.97, P = 0.042], current smoking (OR 3.78, P = 0.006), baseline history of hypertension (OR 6.2, P = 0.017). CONCLUSION: This study emphasizes the importance of a dedicated multidisciplinary FMD service for confirming diagnosis and identifying FMD mimics to facilitate personalized care. Early diagnosis, smoking cessation and blood pressure management are key to preventing disease progression.

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Background: It has been a great challenge to treat clinical stage 4 Diabetic foot ulcers (DFUs) due to high rates of major amputations and prolonged healing time. This study aimed to assess the effectiveness of a three-stage sequential surgical approach, which based on the Integrated Surgery Wound Treatment (ISWT) mode, to manage clinical stage 4 DFUs and compare the benefit of incorporating tibial cortex transverse transport (TTT) surgery at stage 3 treatment. Methods: Twenty-three patients with clinical stage 4 DFUs aged 45-75 years treated between January 2022 and February 2023 were retrospectively analyzed. Eleven patients (Group A) received wound debridement, antibiotic-loaded bone cement (ALBC) at stage 1 treatment, percutaneous transluminal angioplasty (PTA), wound debridement, and ALBC at stage 2 treatment, and skin grafting with TTT at stage 3 treatment, while twelve patients (Group B) received the same treatment without TTT. Assessed clinical outcomes included length of hospital stay, ulcer healing duration, ulcer recurrence rate, reintervention (re)-PTA rate, amputation rate, mortality rate, visual analog scale (VAS) scores, ankle-brachial index (ABI), and two-point discrimination (2-PD) ability. The computed tomographic angiography (CTA) was used to evaluate vascular hyperplasia. Results: Group A showed no occurrences of re-PTA (P = 0.037) and similar ulcer healing times (P = 0.975) compared to Group B. Ulcer outcome, amputation, and mortality rate were also alike in the two groups (P > 0.05). One year after surgery, Group A demonstrated improvement in VAS scores, ABI, and 2-PD, while Group B showed no significant changes. Additionally, Group A exhibited enhanced lower limb artery characteristics compared to Group B. Conclusion: The sequential three-stage approach based on the ISWT mode effectively manages clinical stage 4 DFUs. Incorporating TTT surgery at stage 3 extends the benefits of PTA surgery.

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BACKGROUND: Tirofiban is widely used in ischemic stroke, but its safety and efficacy during stenting of perforator-rich intracranial arteries are unclear. We speculate that prophylactic use of an intra-arterial bolus of tirofiban followed by intravenous maintenance after stenting of perforator-rich intracranial arteries may be safe and effective. METHODS: We retrospectively analyzed patients with atherosclerotic stenosis treated with stenting for perforator-rich intracranial arteries between January 2021 and December 2024. The tirofiban group received tirofiban 10 µg/kg immediately after stenting via a microcatheter into the target artery, followed by intravenous infusion of 0.1 µg/kg/min for 24-72 hours, while controls received dual oral antiplatelet therapy. The primary efficacy endpoints were the incidence of acute in-stent thrombosis (AST) within 30 min after stent implantation and ischemic stroke in the target vascular territory within 7 days post-procedure. Secondary endpoints included modified Rankin Scale score at 6 months and the incidence of in-stent restenosis. The primary safety endpoint was the incidence of symptomatic intracranial hemorrhage within 7 days post-procedure. RESULTS: 150 patients were included: 72 received tirofiban and 78 received dual antiplatelets. AST occurred in 2.8% of the tirofiban group versus 12.8% of controls (RR 0.89; 95% CI 0.82 to 0.98; P=0.02). AST was associated with uncontrolled diabetes, aspirin or clopidogrel resistance, and final residual stenosis. Recurrent ischemic stroke rates at 7 days (2.8% vs 6.4%; P=0.45), symptomatic intracranial hemorrhage (1.4% vs 1.3%), 6 month in-stent restenosis (7.1% vs 9.0%; P=0.68), and modified Rankin Scale scores at 6 months showed no significant differences. CONCLUSIONS: Periprocedural intra-arterial with intravenous tirofiban reduced early AST, without increasing the risk of hemorrhage, for stenting of perforator-rich intracranial arteries.

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PURPOSE: Reocclusion after endovascular therapy (EVT) may worsen the clinical outcome of patients undergoing EVT for intracranial atherothrombotic stroke with large vessel occlusion (AT-LVO), but the details and risk factors have not been fully investigated. METHODS: Patients with intracranial AT-LVO were enrolled in a multicenter retrospective registry study conducted at 51 centers in Japan and were divided into two groups based on whether reocclusion occurred within 90 days after recanalization of intracranial AT-LVO with EVT: the reocclusion group and the patent group. The primary outcome was a modified Rankin Scale score of 0-2 at 90 days after EVT. Risk factors for reocclusion were also assessed. RESULTS: A total of 461 patients were enrolled, 66 (14.3%) in the reocclusion group and 395 (85.7%) in the patent group. Intracranial stenting and differences in antithrombotic regimens were not associated with reocclusion. The rate of patients with the primary outcome was significantly lower in the reocclusion group than in the patent group (15.4% vs. 46.4%, adjusted odds ratio 0.15 [95% confidence interval 0.06-0.33], P < 0.001). Reocclusion was associated with recurrent ischemic stroke, additional EVT or surgery, symptomatic intracranial hemorrhage, and all-cause death. Direct aspiration and vessel perforation were independent factors for reocclusion (adjusted odds ratio 1.82 [95% confidence interval 1.02-3.25], P = 0.043; adjusted odds ratio 5.91 [95% confidence interval 1.005-35.35], P = 0.049, respectively). CONCLUSIONS: Reocclusion after EVT was associated with recurrent ischemic stroke, additional EVT or surgery, symptomatic intracranial hemorrhage, and poor clinical outcome at 90 days. Direct aspiration and vessel perforation were independent risk factors for reocclusion after EVT.

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Interventional radiology (IR) is rapidly expanding in paediatric care due to technological advancements and research, as well as its minimal invasiveness compared to surgery. New therapeutic options have been developed to manage both benign and malignant conditions refractory to medical treatments or for which surgery has failed or is not feasible, particularly regarding locally advanced liver tumours, vascular malformations and vascular tumours of the liver, lymphatic disorders, portal hypertension and complications of liver transplantation. A multidisciplinary approach is essential for the optimal management of patients, as well as for increasing the awareness of paediatricians and surgeons regarding IR. This review article will discuss the pathologies affecting both the native and the transplant liver with focus on cutting-edge devices that have significantly influenced clinical practice, gaps of knowledge, research needs and potential collaborations.

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BACKGROUND: Olfactory groove meningiomas (OGMs) are benign anterior cranial fossa tumors that may encase critical neurovascular structures. While vasospasm is a well-established sequela of aneurysmal subarachnoid hemorrhage, its occurrence following meningioma resection remains rare and underrecognized. OBSERVATIONS: The authors present illustrative cases of 2 female patients (ages 70 and 39 years) with large OGMs who underwent resection via orbitozygomatic craniotomy. Both patients developed delayed postoperative vasospasm requiring intra-arterial pharmacological and endovascular intervention. In both cases, imaging revealed vasospasm involving the anterior circulation, including the anterior cerebral arteries and internal carotid arteries. The first patient was managed with intra-arterial verapamil alone, while the second underwent balloon-assisted angioplasty in addition to verapamil administration. Radiological improvement and favorable clinical outcomes were achieved, with 1 patient recovering full vision despite initial blindness. LESSONS: Postoperative vasospasm is an important but often overlooked complication following anterior skull base meningioma resection. Early recognition and aggressive management with intra-arterial therapy can mitigate ischemic complications. Neurosurgeons should maintain high suspicion for vasospasm in the setting of neurological decline after tumor resection near the circle of Willis. https://thejns.org/doi/10.3171/CASE25641.

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Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive condition characterized by persistent thromboembolic disease in the pulmonary arteries, leading to increased pulmonary vascular resistance and right heart failure. Medical therapy offers symptomatic relief but is not curative. Pulmonary thromboendarterectomy (PTE) remains the gold standard treatment; however, patients are often ineligible for surgery due to unfavorable anatomy, comorbidities, or preferences. Balloon pulmonary angioplasty (BPA) has emerged as a minimally invasive alternative, particularly for patients with inoperable CTEPH or post-PTE patients who remain symptomatic. Balloon catheters are used to dilate stenotic pulmonary arteries and to disrupt intraluminal webs and synechia, improving hemodynamics and leading to better quality of life. Careful patient selection for BPA is crucial, requiring a multidisciplinary approach to identify suitable candidates. Although BPA has demonstrated favorable outcomes, challenges remain in optimizing procedural techniques, reducing complication rates, and establishing standardized treatment protocols. This work aims to review BPA and its role in treating CTEPH, from patient selection to expected outcomes, as well as potential areas of future research, which includes the need for increased awareness and accessibility to specialized CTEPH centers, advancements in imaging technology, procedural standardization, and investigation of combination therapies to further support BPA efficacy and improve patient outcomes.

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Renovascular hypertension is a form of secondary hypertension caused by renal artery stenosis and often shows a limited response to medical treatment. Over recent years, renal artery interventions, primarily angioplasty and stenting, have been increasingly used as treatment options in selected patients. This narrative review summarizes current techniques, clinical outcomes, and evidence related to renal artery interventions in the management of renovascular disease. It also highlights existing knowledge, challenges, emerging technologies, and future directions for improving patient selection, procedural safety, and long-term effectiveness of intervention strategies. By consolidating recent developments and identifying critical knowledge gaps, this review provides an updated and practical overview for clinicians and offers guidance for future research in the field of renal artery intervention.

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Introduction: Hybrid coronary revascularization (HCR) is a combined approach for multivessel coronary artery disease (MVD), integrating surgical grafting of the left internal mammary artery (LIMA) to the left anterior descending artery (LAD) with percutaneous coronary intervention (PCI) for non-LAD lesions. It aims to reduce invasiveness while maintaining effectiveness. Aim: To summarize current evidence on the safety, effectiveness, and clinical outcomes of HCR compared to coronary artery bypass grafting (CABG), PCI, and off-pump coronary artery bypass (OPCAB). Methods: A review of current literature including clinical trials, meta-analyses, and observational studies was conducted. Focus was placed on procedural techniques, patient selection, and outcomes. Results: HCR is associated with shorter hospital stays, reduced bleeding, and faster recovery compared to CABG. Compared to PCI, it shows improved LAD patency and fewer repeat interventions. Outcomes are similar to OPCAB, with lower myocardial injury. Despite its benefits, HCR remains underused due to technical demands and limited availability of hybrid facilities. Conclusions: Further randomized trials are needed to confirm its long-term safety, effectiveness, and cost-efficiency.

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BACKGROUND: Native coarctation of the aorta (CoA) accounts for 6-8% of congenital heart defects and poses significant morbidity and mortality risks if untreated. By incorporating the most recent evidence, focusing on the pediatric population, this protocol outlines the planned approach for a systematic review and meta-analysis update that will compare the long-term safety and effectiveness of surgical repair, balloon angioplasty, and stenting in CoA patients. METHODS: Following PRISMA guidelines, a systematic review and meta-analysis will be conducted. Electronic databases, including Scopus, LILACS, MEDLINE, CENTRAL, EMBASE, IBECS, OpenGrey, and major trial registries, will be searched for comparative studies of stent versus surgery and of balloon angioplasty versus surgery. Randomized control trials and observational studies focused on pediatric patients will be eligible. Two independent reviewers will screen the titles and abstracts based on predefined eligibility criteria, and two will assess the full texts of relevant studies. Quality assessment will be done with the Cochrane Risk of Bias tool for RCTs and the Newcastle-Ottawa Scale for observational studies. Pre-planned analyses, including quantitative and sensitivity analyses, are detailed within this protocol. R Studio will be used to analyze the data. The strength of the body of evidence will be assessed using GRADE. DISCUSSION: Despite recent advances in surgical and percutaneous techniques for CoA, there remains uncertainty on the best strategy for achieving long-term safety and effectiveness of treatment, particularly in the pediatric population. This study's comprehensive comparative outcomes analysis will help bridge these gaps and inform clinical decision-making. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42024549170. Registered on May 20th 2024.

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Angioplasty and coronary artery bypass grafting (CABG) are common interventions for the management of coronary artery disease aiming to address atherosclerotic plaques in the epicardial coronary arteries. However, many patients experience recurrent angina and other complications such as low cardiac output and even mortality due to other undiagnosed pathologies. Coronary microvascular dysfunction (CMD), which causes impaired blood flow in the microvascular network is a critically overlooked factor in this regard. Such microvascular dysfunction occurs due to the endothelial abnormalities leading to vascular remodelling, and increased resistance to blood flow. The mobilization of unstable plaques during operative procedures such as stenting, angioplasty, and bypass surgery can also contribute to the microcirculatory obstruction, potentially resulting in fatal coronary embolization. Also, such plaque rupture release emboli that can migrate and obstruct the distal arterioles, resulting in low cardiac output, recurrent angina, and ischemia. These microvascular blocks resulting from preexisting dysfunction or iatrogenic embolization are mostly undiagnosed after a CABG or angioplasty. Diagnosis of CMD is challenging, as conventional imaging techniques only focus on macrovascular assessment, neglecting the importance of microvascular hemodynamics. Current diagnostic protocols need a re-evaluation to include methods to assess microvascular perfusion dynamics in postoperative patients.