Semi-automatic computed tomography angiography quantification assessment is an alternative method to digital subtraction angiography in intracranial stenosis: a multicenter study.

Background: The recent randomized controlled trials studying intracranial atherosclerotic stenosis (ICAS) have used digital subtraction angiography (DSA) to quantify stenosis and enroll patients. However, some disadvantages of DSA such as invasive features, contrast agent overuse, and X-ray radiation overexposure, were not considered in these studies. This study aimed to explore whether computed tomography angiography (CTA) with semi-automatic analysis could be an alternative method to DSA in quantifying the absolute stenotic degree in clinical trials. Methods: Patients with 50-99% ICAS were consecutively screened, prospectively enrolled, and underwent CTA and DSA between March 2021 and December 2021 at 6 centers. This study was registered at www.chictr.org.cn (ChiCTR2100052925). The absolute stenotic degree of ICAS on CTA with semi-automatic analysis was calculated by several protocols using minimal/maximum/mean diameters of stenosis and reference site from a semi-automatic analysis software. Intraclass correlation coefficient (ICC) was used to evaluate the reliabilities of quantifying stenotic degree on CTA. The optimal protocol for quantifying ICAS on CTA was explored. The agreements of quantifying ICAS in calcified or non-calcified lesions and 50-69% or 70-99% stenosis on CTA and DSA were assessed. Results: A total of 191 participants (58.8±10.7 years; 148 men) with 202 lesions were enrolled. The optimal protocol for quantifying ICAS on CTA was calculated as (1 - the minimal diameter of stenosis/the mean diameter of reference) × 100% for its highest agreement with DSA [ICC, 0.955, 95% confidence interval (CI): 0.944-0.966, P<0.001]. Among the 202 lesions, 80.2% (162/202) exhibited severe stenosis on DSA. The accuracy of CTA in detecting severe ICAS was excellent (sensitivity =95.1%, positive predictive value =98.1%). The agreements between DSA and CTA in non-calcified lesions (ICC, 0.960 vs. 0.849) and severe stenosis (ICC, 0.918 vs. 0.841) were higher than those in calcified lesions and moderate stenosis. Conclusions: CTA with semi-automatic analysis demonstrated an excellent agreement with DSA in quantifying ICAS, making it promising to replace DSA for the measurement of absolute stenotic degree in clinical trials.

Prediction of futile recanalisation after endovascular treatment in acute ischaemic stroke: development and validation of a hybrid machine learning model.

BACKGROUND: Identification of futile recanalisation following endovascular therapy (EVT) in patients with acute ischaemic stroke is both crucial and challenging. Here, we present a novel risk stratification system based on hybrid machine learning method for predicting futile recanalisation. METHODS: Hybrid machine learning models were developed to address six clinical scenarios within the EVT and perioperative management workflow. These models were trained on a prospective database using hybrid feature selection technique to predict futile recanalisation following EVT. The optimal model was validated and compared with existing models and scoring systems in a multicentre prospective cohort to develop a hybrid machine learning-based risk stratification system for futile recanalisation prediction. RESULTS: Using a hybrid feature selection approach, we trained and tested multiple classifiers on two independent patient cohorts (n=1122) to develop a hybrid machine learning-based prediction model. The model demonstrated superior discriminative ability compared with other models and scoring systems (area under the curve=0.80, 95% CI 0.73 to 0.87) and was transformed into a web application (RESCUE-FR Index) that provides a risk stratification system for individual prediction (accessible online at fr-index.biomind.cn/RESCUE-FR/). CONCLUSIONS: The proposed hybrid machine learning approach could be used as an individualised risk prediction model to facilitate adherence to clinical practice guidelines and shared decision-making for optimal candidate selection and prognosis assessment in patients undergoing EVT.

High-Resolution Magnetic Resonance Imaging in Endovascular Treatment of Vertebrobasilar Junction Stenosis.

INTRODUCTION: Vertebrobasilar junction (VBJ) stenosis is a challenge in endovascular treatment due to structural variants and complexities. The role of high-resolution magnetic resonance imaging (HRMRI) in endovascular treatment for patients with severe VBJ stenosis is uncertain. CASE REPORT: Four patients with symptomatic VBJ stenosis underwent HRMRI of the vessel wall before endovascular treatment. In 3 patients, the VBJ could not be visualized on luminal imaging. One of them had a hypoplastic artery and 2 of them had severe stenotic arteries on HRMRI. HRMRI showed an artery with a negative remodeling in a patient with a hypoplastic vertebral artery. One patient had intraplaque hemorrhage and calcification, and 2 patients had calcification in VBJ lesions. Endovascular treatment was performed utilizing HRMRI findings to guide the decision-making process. CONCLUSION: HRMRI provides additional information about the structure and angle of the VBJ, the characteristics and vulnerability of the plaques, and the lesion size, thus helping to improve the operation process and reduce the risk of complications.

Association between basilar artery stenosis features, vertebral artery stenosis and perforator stroke after stenting.

BACKGROUND AND PURPOSE: We investigated the relationship between basilar artery (BA) atherosclerotic stenosis features and vertebral artery (VA) stenosis and explored whether BA stenosis features are associated with perforator stroke after stenting. METHODS: Patients with BA stenosis who underwent HRMRI and DSA were recruited. Patients were divided into proximal BA stenosis and middle-or-distal BA stenosis groups, and then subgroup analyses were performed based on whether they had VA stenosis. BA plaque features were evaluated by HRMRI. Artery stenosis was measured by DSA. The incidence of perforator stroke after BA stenting was recorded, and the potential association between BA stenosis features and perforator stroke was analyzed. RESULTS: One hundred and seventy-four patients were consecutively enrolled. Patients with proximal BA stenosis had a higher proportion of severe stenosis than those with middle-or-distal BA stenosis (P = 0.027). In the subgroup analysis, this difference mainly existed in patients complicated with VA stenosis (P = 0.023). Patients with proximal BA stenosis had a higher proportion of strong plaque enhancement than those with middle-or-distal BA stenosis (P < 0.001), especially in those with vertebrobasilar junction (VBJ) stenosis (P < 0.001). Perforator stroke after BA stenting occurred in five patients, of whom four had lateral wall BA plaques, four had plaque enhancement and four had proximal BA stenosis. CONCLUSION: Patients with proximal BA stenosis had a higher proportion of severe stenosis and strong plaque enhancement, particularly in patients complicated with VA stenosis and VBJ stenosis. Perforator stroke after BA stenting may be related to distribution, burden and characteristics of BA lesions.

Small vessel disease burden may not portend unfavorable outcome after thrombectomy for acute large vessel occlusion.

OBJECTIVES: We aimed to investigate the correlation between an overall cerebral small vessel disease (CSVD) burden and outcomes after endovascular treatment (EVT) for patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO). METHODS: In a multicenter registry study, we enrolled patients with EVT for anterior-circulation LVO-stroke. In 3.0-T MR imaging, we assessed 4 CSVD imaging markers, lacunes, white matter hyperintensities, cerebral microbleeds, and enlarged perivascular spaces, each assigned a score of 0 or 1 and summed up to an overall CSVD burden score of 0-4. We dichotomized the overall CSVD severity as none to mild (score 0-2) and moderate to severe (3-4). Primary outcome was 90-day functional dependence or death (modified Rankin Scale (mRS) 3-6). Secondary outcomes included increase in NIH Stroke Scale ≥ 4 within 24 h (early neurological deterioration (END)) and within 7 days, symptomatic intracranial hemorrhage, 90-day mRS 2-6, and 90-day mortality. RESULTS: Among 311 patients (63.0% male; mean age 65.1 ± 12.7 years), 260 (83.6%) had none-to-mild and 51 (16.4%) had moderate-to-severe overall CSVD burden. Moderate-to-severe CSVD burden was not significantly associated with the primary outcome (47.1% versus 45.4%; p > 0.05 in univariate and multivariate logistic regression), or the secondary outcomes except for a higher risk of END (11.8% versus 3.1%; p < 0.05 in multivariate analyses). Sensitivity analyses with 0-1 versus 2-4 of the CSVD burden score, and the score as an ordinal variable, showed similar results. CONCLUSIONS: An overall moderate-to-severe CSVD burden was not associated with 90-day functional dependence or death, after EVT for anterior-circulation LVO. TRIAL REGISTRATION: ChiCTR1900022154 KEY POINTS: • Moderate-to-severe cerebral small vessel disease burden on MRI should not be an exclusion indicator in determining the eligibility of an acute ischemic stroke patient for endovascular treatment.

Endovascular treatment with or without intravenous alteplase for acute ischaemic stroke due to basilar artery occlusion.

BACKGROUND AND PURPOSE: It remains controversial if endovascular treatment (EVT) can improve the outcome of patients with acute basilar artery occlusion (BAO). This study aims to compare the functional outcomes between EVT with and without intravenous thrombolysis (IVT) first in patients who had acute ischaemic stroke (AIS) due to BAO. METHODS: Patients who had AIS with BAO who underwent EVT within 24 hours of onset were enrolled in this multicentre cohort study, and the efficacy and safety were compared between IVT+EVT and direct EVT. The primary outcome was 90-day functional independence. All outcomes were assessed with adjusted OR (aOR) from the multivariable logistic regression. In addition, a meta-analysis was performed on all recently published pivotal studies on functional independence after EVT in patients with BAO. RESULTS: Of 310 enrolled patients with BAO, 241 (78%) were treated with direct EVT and 69 (22%) with IVT+EVT. Direct EVT was associated with a worse functional outcome (aOR, 0.46 (95% CI 0.24 to 0.85), p=0.01). IVT+EVT was associated with a lower percentage of patients who needed ≥3 passes of stent retriever (10.14% vs 20.75%). The meta-analysis regression revealed a potential positive correlation between bridging with IVT first and functional independence (r=0.14 (95% CI 0.05 to 0.24), p<0.01). CONCLUSIONS: This study showed that compared with direct EVT, EVT with IVT first was associated with better functional outcomes in patients with BAO treated within 24 hours of onset. The meta-analysis demonstrated similar favourable efficacy of IVT first followed by EVT in patients with BAO.

Exploring diagnostic performance of T2 mapping in diffuse glioma grading.

BACKGROUND: To evaluate the diagnostic performance of T2 mapping in differentiating WHO grade II glioma from high-grade glioma (HGG). METHODS: We conducted a single-center, retrospective diagnostic study. Confirmed diffuse glioma (WHO grade II-IV) patients who underwent post-contrast T1-weighted imaging, T2-weighted imaging, and T2 mapping were included. All diagnoses were based on histological and molecular tests. Seventy-five percent of cases were subsampled to generate receiver operating characteristic (ROC) curves and areas under the curve (AUC), while the remaining cases were used to test the accuracy of T2 mapping. Subsampling was repeated four times. Age, T2 relaxation time, and contrast-enhancement status were used to generate a multivariable ROC curve. T2 relaxation time was also used to generate ROC curves to predict the isocitrate dehydrogenase (IDH) status. RESULTS: A total of 159 patients were included in the study. After four repeats of subsampling, the AUCs of the T2 mapping ROC curve were 0.801 (95% CI: 0.724-0.879), 0.795 (95% CI: 0.714-0.875), 0.803 (95% CI: 0.723-0.884), and 0.801 (95% CI: 0.716-0.886), with an average sensitivity of 0.753 and an average specificity of 0.767. When applied to the remaining 25% of cases, the accuracy was 75%, 93.75%, 82.50%, and 71.74%. The AUC of the multivariable ROC was 0.927 (95% CI: 0.882-0.971). IDH-mutant and IDH-wildtype gliomas have significantly different T2 relaxation times (146.28 and 124.10 ms, respectively; P=0.001), and the AUC of IDH-mutant prediction was 0.687 (95% CI: 0.585-0.789). CONCLUSIONS: Quantitative T2 mapping differentiated WHO grade II glioma from HGG with moderate sensitivity and specificity. Given the advantages of short acquisition times and the absence of a contrast agent, our study suggests the application of T2 mapping in pre-operative glioma grading is feasible.

[Magnetic Resonance Imaging for Diagnosis of Idiopathic Pediatric Meningiomas].

Objective To analyze the radiological features of idiopathic pediatric meningiomas and explore their relationships with pathological grading,misdiagnoses,and blood loss during surgery.Methods We retrospectively reviewed 29 cases of pathologically confirmed pediatric meningiomas with pre-operative magnetic resonance imaging in Beijing Tiantan Hospital from November 2014 to July 2018.We assessed the imaging features to explore their relationships with pathological grading,misdiagnoses,and blood loss during surgery. Results Among the 29 cases,7 intraparenchymal meningiomas,5 extraparenchymal meningiomas,4 ventricular meningiomas,and 1 transcranial meningioma were misdiagnosed.Tumor location was significantly associated with possibility of misdiagnoses(P=0.021),and intraparenchymal tumors were most likely to be misdiagnosed.Twelve patients had positive dural tail sign,and 4 of them were misdiagnosed;16 patients did not have dural tail sign,and 12 of them were misdiagnosed.Fisher exact test showed that positive dural tail sign was associated with decreased possibility of misdiagnoses(one-sided P=0.034).Univariable regression analysis showed that the feature of tumor surrounding arteries or interfering with veins(P=0.020)and the tumor maximum diameter(P=0.001)had positively linear relationships with blood loss volume during surgery.Combining these two variables,the multivariable regression model showed better fitting performance($R_{ad}^2$=0.468).Conclusions Pediatric meningiomas are extremely rare,with scarce radiological characteristics.They are hard to diagnose,and the intraparenchymal meningiomas are very likely to be misdiagnosed and therefore should be treated with extra caution.Among all the radiological features,tumor surrounding arteries or interfering with veins and tumor maximum diameter were associated with increased blood loss during surgery.

Matrix metallopeptidase 9 and placental growth factor may correlate with collateral status based on whole-brain perfusion combined with multiphase computed tomography angiography.

OBJECTIVE: The aim of this study was to find out the relationship between serum biomarkers and cerebral collateral status in acute ischemic stroke with cerebral large artery atherosclerosis. METHODS: We enrolled patients with ischemic stroke due to large artery atherosclerosis within 7 days of symptom onset, age 18-80 years, from August 2016 to December 2017. Twelve biomarkers representing different pathophysiological mechanisms were tested after admission. Whole-brain perfusion combined with multiphase computed tomography angiography was performed to assess cerebral collateral structure and function. RESULTS: Fifty-two patients completed the test of candidate biomarkers and recruited in this study. The mean age was 55.0 (11.1) years, 42 (80.8%) patients were male, 20 (38.5%) had poor collateral, 36 (69.2%) patients had anterior circulation stenosis or occlusion. Compared with poor collateral group, the level of MMP-9 (135,475.00 pg/ml vs. 103,612.00 pg/ml, p = 0.040) and PGF (5.75 pg/ml vs. 3.46 pg/ml, p = 0.046) was significantly higher in good collateral group. The adjusted OR (95%CI) of MMP-9 and PGF were 5.533 (1.10-27.74, p = 0.038), 7.73 (1.41-42.39, p = 0.018), respectively. sTie-2 level had a positive correlation with proportion of Tmax 4-6 (r = 0.302, p = 0.033) and HMW-KGN had negative correlation with proportion of Tmax 6-8 (r = -0.338, p = 0.02). After adjustment, the correlation of sTie-2 level and proportion of Tmax 4-6 was statistically significant (p = 0.003), and correlation of HMW-KGN and Tmax6-8 was not statistically significant (p = 0.056). DISCUSSION: Serum PGF and MMP-9 levels may correlate with collateral status based on MP-CTA in acute ischemic stroke patients with cerebral large artery atherosclerosis. Higher PGF and MMP-9 concentration associated with good collateral status.

Intraluminal Thrombus and Outcomes of Patients With Acute Large Vessel Occlusive Stroke Undergoing Endovascular Treatment.

BACKGROUND AND PURPOSE: Intraluminal thrombus (ILT) is an emerging imaging marker in acute ischemic stroke. We aimed to investigate the association of ILT with outcomes of acute large vessel occlusion (LVO) patients receiving endovascular treatment. METHODS: Acute LVO stroke patients who underwent endovascular treatment within 24 hours, in a prospective, nationwide registry were enrolled. Pretreatment digital subtraction angiography was reviewed for the presence of ILT. The primary outcome was 90-day functional dependence (modified Rankin Scale scores, 3-6). Secondary outcomes included 24-hour LVO, 90-day death, and symptomatic intracranial hemorrhage. RESULTS: Among 711 patients enrolled, 75 (10.5%) with ILT were less likely to have 90-day functional dependence compared with those without ILT (adjusted odds ratio, 0.53 [95% CI, 0.31-0.90]; P=0.021). The same trend was found among those with successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b-3; P=0.008) but not in those without successful reperfusion (P=0.107). Presence of ILT was also independently associated with a lower rate of 24-hour LVO (adjusted odds ratio 0.34 [95% CI, 0.13-0.89]; P=0.028). However, those with or without ILT had similar risks of symptomatic intracranial hemorrhage and 90-day death. CONCLUSIONS: Among acute LVO patients receiving endovascular treatment, pretreatment ILT-positive patients may have a better 90-day functional outcome (versus ILT-negative) but similar risk of death and symptomatic intracranial hemorrhage. The possibly favorable effect of ILT patients remained in those with successful reperfusion. Registration: URL: http://www.chictr.org.cn; Unique identifier: ChiCTR1900022154.

Adverse Outcomes Associated With Higher Mean Blood Pressure and Greater Blood Pressure Variability Immediately After Successful Embolectomy in Those With Acute Ischemic Stroke, and the Influence of Pretreatment Collateral Circulation Status.

Background To investigate whether collateral status could modify the associations between post-thrombectomy blood pressure (BP) measures and outcomes. Methods and Results Patients with anterior-circulation large-vessel-occlusion successfully recanalized in a multicenter endovascular thrombectomy registry were enrolled. Pretreatment collateral status was graded and dichotomized (good/poor) in angiography. Maximum, minimum, and mean systolic BP (SBP) and BP variability (assessed by the SD, coefficient of variation) during the initial 24 hours after endovascular thrombectomy were obtained. The primary outcome was unfavorable 90-day outcome (modified Rankin Scale score 3-6). Secondary outcomes included symptomatic intracranial hemorrhage and 90-day mortality. Adjusted odds ratios (aOR) of BP parameters over the outcomes were obtained in all patients and in patients with good/poor collaterals. Among 596 patients (mean age 66 years; 59.9% males), 302 (50.7%) patients had unfavorable 90-day outcome. In multivariable analyses, higher mean SBP (aOR, 1.59 per 10 mm Hg increment; 95% CI, 1.26-2.02; P<0.001), mean SBP >140 mm Hg (versus ≤120 mm Hg; aOR, 4.27; 95% CI, 1.66-10.97; P=0.002), and higher SBP SD (aOR, 1.08 per 1-SD increment; 95% CI, 1.01-1.16; P=0.02) were respectively associated with unfavorable 90-day outcome in patients with poor collateral but not in those with good collateral. A marginal interaction between SBP coefficient of variation tertiles and collaterals on 90-day functional outcome (P for interaction, 0.09) was observed. A significant interaction between SBP coefficient of variation tertiles and collaterals on 90-day mortality (P for interaction, 0.03) was observed. Conclusions Higher postprocedural BP is associated with 90-day unfavorable outcomes after successful endovascular thrombectomy in patients with poor collateral. Registration URL: https://www.chictr.org.cn; Unique identifier: ChiCTR1900022154.

Cortical Microinfarcts Associated With Worse Outcomes in Patients With Acute Ischemic Stroke Receiving Endovascular Treatment.

BACKGROUND AND PURPOSE: We aimed to evaluate the impact of cortical microinfarcts (CMIs) on functional outcome after endovascular treatment in patients with acute ischemic stroke. METHODS: In a multicenter registration study for RESCUE-RE (a registration study for Critical Care of Acute Ischemic Stroke After Recanalization), eligible patients with large vessel occlusion stroke receiving endovascular treatment, who had undergone 3T magnetic resonance imaging on admission or within 24 hours after endovascular treatment were analyzed. We evaluated the presence and numbers of CMIs with assessment of axial T1, T2-weighted images, and fluid-attenuated inversion recovery images. The primary outcome was functional dependence or death defined as modified Rankin Scale scores of 3 to 6 at 90 days. Secondary outcomes included early neurological improvement, any intracranial hemorrhage, symptomatic intracranial hemorrhage, and mortality. We investigated the independent associations of CMIs with the outcomes using multivariable logistic regression in overall patients and in subgroups. RESULTS: Among 414 patients (enrolled from July 2018 to May 2019) included in the analyses, 96 (23.2%) patients had at least one CMI (maximum 6). Patients with CMI(s) were more likely to be functionally dependent or dead at 90 days, compared with those without (55.2% versus 37.4%; P<0.01). In multivariable logistic regression analyses, presence of CMI(s) (adjusted odds ratio, 1.78 [95% CI, 1.04-3.07]; P=0.04) and multiple CMIs (CMIs ≥2; adjusted odds ratio, 7.41 [95% CI, 2.48-22.17]; P<0.001) were independently, significantly associated with the primary outcome. There was no significant difference between subgroups in the associations between CMI presence and the primary outcome. CONCLUSIONS: Acute large vessel occlusion stroke patients receiving endovascular treatment with CMI(s) were more likely to have a poor functional outcome at 90 days, independent of patients' characteristics. Such associations may be dose-dependent. Registration: URL: http://www.chictr.org.cn; Unique identifier: ChiCTR1900022154.

Cerebral Hemodynamic Changes After Endovascular Recanalization of Symptomatic Chronic Intracranial Artery Occlusion.

Objective: We performed this study to evaluate the hemodynamic changes over time after successful endovascular recanalization in patients with symptomatic chronic intracranial artery occlusion (CIAO). Materials and Methods: We included 20 patients with symptomatic CIAO in a high-volume stroke center from June 2014 to June 2019. All subjects were evaluated with CT perfusion (CTP) studies before and after the recanalization. The relative cerebral blood flows (rCBFs) in perforating artery territory (PAT) and cortical artery territory (CAT) of occluded arteries were compared before and after the recanalization. The patients were categorized into subgroups based on the time interval from revascularization to post-procedural CTP, occlusion sites, and restenosis status. The proportion of rCBF change (rCBFc%) was compared in variable subgroups. Results: The rCBF increased significantly from 0.52 to 0.71 in PAT (P < 0.001) and from 0.59 to 0.85 in CAT (P < 0.001) after recanalization, and there were also statistical differences in variable subgroups except for those with restenosis. The median and interquartile range (IQR) of rCBFc% were 35.2 and 18.6-56.6%. For patients with short-term follow-up (55.2%), the rCBFc% was relatively higher than that in patients with mid-term (35.4%) and long-term follow-up (32.7%), although without statistical difference (P = 0.273). For patients with restenosis, the rCBFc% was significantly lower than that in patients without restenosis (18.5 vs. 37.3%, P = 0.008). Conclusions: In patients with symptomatic CIAO, the CBF may increase and be relatively stable over time after successful recanalization except for restenosis.

Cerebral Hemodynamic Changes After Revascularization in Patients With Hemorrhagic Moyamoya Disease.

Objective: To explore the cerebral hemodynamic changes after revascularization in patients with hemorrhagic moyamoya disease (MMD). Materials and Methods: We retrospectively included 57 hemorrhagic MMD patients in a high-volume stroke center from January 2016 to December 2018. All subjects were evaluated with whole-brain CT perfusion (CTP) before and after surgical revascularization. Absolute and relative CTP values in the regions of cortical middle cerebral artery territory (CMT) and deep brain area (DBA) of hemorrhagic hemispheres were measured. Differences between pre- and post-operative CTP values were assessed comprehensively. The patients were categorized into subgroups based on revascularization subtypes and postoperative CTP intervals. Results: The relative cerebral blood volume (rCBV) in DBA and CMT significantly reduced in postoperative CTP (P < 0.05). The median and interquartile range of the proportion of rCBV decrease (rCBVc%) were 7.2% (2.3-13.2%). The rCBV reduction retained statistical significant in patients who received subtypes of revascularization, and in patients with variable intervals of follow-up (P < 0.05). There was no significant difference of rCBVc% between patients who received different revascularization and among patients with different postoperative CTP intervals (P > 0.05). The relative mean transit time (rMTT) and relative time to peak (rTTP) also showed downward trends, but without retainable statistical significance in stratified analysis. There was no significant change in relative cerebral blood flow (rCBF) (P > 0.05). Conclusion: In patients with hemorrhagic MMD, the CBV appeared to decrease and be relatively stable in the chronic phase after revascularization, with varying degrees of MTT and TTP shortening. However, there was no significant change in CBF.

Outcome of endovascular recanalization for intracranial in-stent restenosis.

BACKGROUND AND PURPOSE: In-stent restenosis (ISR) is one of the long-term adverse outcomes of endovascular angioplasty and stenting for symptomatic intracranial arterial stenosis. In this study, we try to evaluate the safety and efficacy of endovascular treatment for intracranial ISR. METHODS: We retrospectively collected patients with intracranial ISR who underwent endovascular treatment from June 2012 to August 2019 at a high-volume stroke center. Successful recanalization was defined as ≤30% residual stenosis. Stroke, myocardial infarction, and death after stenting within 30 days were used to evaluate periprocedural safety. Recurrent stroke in the territory of the culprit vessel and re-ISR in patients with clinical and vascular imaging follow-up data were used to evaluate the long-term outcome. RESULTS: 32 patients (59.6±7.2 years old) with ISR were recruited, including 22 patients (68.8%) treated with balloon dilatation, 8 patients (25%) with stenting, and 2 patients (6.3%) with failed procedures. Successful recanalization was achieved in 71.9% (23/32) of patients. There was no stroke, myocardial infarction or death within 30 days after the procedure. Recurrent stroke was found in 10.7% (3/28) of the patients, and re-ISR was found in 42.1% (8/19) of the patients. The re-ISR rate was lower in patients with stenting than in those with balloon dilatation (0% vs 57.1%, p=0.090), and in patients with successful recanalization than in those with unsuccessful recanalization (33.3% vs 75.0%, p=0.352), but with no statistically significant difference. CONCLUSIONS: The periprocedural safety of endovascular treatment for intracranial ISR may be acceptable, but the long-term rates of recurrent stroke and re-ISR remain at high levels.

Preliminary application of CT perfusion source images for evaluating regional collateral circulation in unilateral Moyamoya disease.

BACKGROUND: Collateral flow is associated with clinical outcomes for patients with Moyamoya disease and served as a parameter for patient selection of therapeutic strategies. Therefore, we explored whether a noninvasive imaging modality, computed tomography perfusion (CTP) source images (CTP-Sis), could be used to identify the presence and intensity of collateral flow using digital subtraction angiography (DSA) as a gold standard for collateral flow. METHODS: CTP-Sis and DSA were performed for 24 patients with unilateral Moyamoya disease. A collateral grading system was developed based on arterial and venous phase CTP-Sis, imitating the DSA score system. Two neuroradiologists scored the DSA images using a collateral grading scale for the regions of interest corresponding to the Alberta Stroke Program Early computed tomography Score (ASPECTS) methodology. Another two neuroradiologists scored CTP-Sis in a similar manner. Agreement between the CTP-Sis and DSA consensus scores was determined, including kappa statistics. RESULTS: The agreement between the CTP-Sis and DSA consensus readings was moderate to strong, with a weighted kappa value of 0.768 [95% confidence interval (CI), 0.703-0.832], but there was a better agreement for readers of CTP-Sis, as compared with those of DSA. The sensitivity and specificity for identifying collaterals with CTP-Sis were 0.714 (95% CI, 0.578-0.851) and 0.995 (95% CI, 0.985-1.000), respectively. CONCLUSIONS: CTP-Sis could help identify in a noninvasive manner the presence and intensity of collateral flow in patients with unilateral Moyamoya disease using DSA as a gold standard. Further study with a large number of cases is warranted. Further application of this method to other cerebrovascular diseases including acute ischemic stroke can also be warranted.

Association Between Cerebral Hypoperfusion and Cognitive Impairment in Patients With Chronic Vertebra-Basilar Stenosis.

Objective: This study aimed to investigate the association between cognitive impairment and cerebral haemodynamic changes in patients with chronic vertebra-basilar (VB) stenosis. Methods: Patients with severe posterior circulation VB stenosis and infarction or a history of infarction for more than 2 weeks from January 2014 to January 2015 were enrolled (n = 96). They were divided into three groups, namely, the computed tomography perfusion (CTP) normal group, the CTP compensated group, and the CTP decompensated group. Cognitive function was assessed using a validated Chinese version of the Mini-Mental State Examination (MMSE), the Frontal Assessment Battery (FAB), and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Regression models were used to identify independent risk factors for cognitive impairment. Results: The MMSE and FAB scores of patients in the CTP decompensated group were significantly lower than those of patients in the CTP normal and CTP compensated groups (all p < 0.05). The RBANS total and its domain scores, including immediate memory, visual acuity, and delayed memory, in the CTP compensated and CTP decompensated groups were significantly lower than those in the CTP normal group (all p < 0.05). Multiple regression analyses showed that CTP compensation, CTP decompensation, severe VB tandem stenosis, and multiple infarctions were independent risk factors for cognitive impairment. Conclusions: Low perfusion caused by severe VB stenosis can lead to extensive cognitive impairments in areas such as immediate memory, visual span, and delayed memory.

[Association between the change regularity of peripheral blood mononuclear cell mitochondrial deoxyribonucleic acid content and human immunodeficiency virus-related lipodystrophy].

OBJECTIVE: To investigate the change regularity of peripheral blood mononuclear cell (PBMC) mtDNA (mitochondrial deoxyribonucleic acid) content and its association with HIV-LD (human immunodeficiency virus-related lipodystrophy) in HAART (highly active antiretroviral therapy). METHODS: At baseline, Months 6 and 24 of therapy, the cryopreserved PBMC were collected from 33 patients on a regular follow-up at our clinic. Among them, 17 had HIV-LD. Then total DNA was extracted and mtDNA content quantified by real-time PCR (polymerase chain reaction). RESULTS: The HIV/AIDS patients had a lower content of PBMC mtDNA (2(-ΔΔCt)) than the healthy controls at baseline (9.578 vs 17.195, P < 0.01). The mtDNA content was lower in the HIV-LD group than that in the no LD (NLD) group at each time point of therapy (13.619 vs 5.775, 6.360 vs 1.387, 7.170 vs 1.266, all P < 0.05). In the HIV-LD group, the half- and 2-year PBMC mtDNA content was markedly lower than those at baseline (both P < 0.05). And the change of mtDNA content (within half a year) was earlier than the onset of clinical HIV-LD at one year later. In the NLD group, the PBMC mtDNA content have an insignificant change after therapy. The mtDNA content decreased significantly in stavudine (d4T)-containing regimen group after treatment (P < 0.01), but showed no significant change in zidovudine (AZT)-containing regimen group after therapy. CONCLUSION: The decreased content of PBMC mtDNA after HIV infection and during HAART therapy is associated with HIV-LD. Nucleoside reverse transcriptase inhibitor, especially d4T, plays an important role in the progression of HIV-LD.