Has collateral blood flow any effect on restenosis rate? Our experience.

Objectives: Restenosis is one of the important factors affecting the effectiveness of percutaneous transluminal angioplasty and stenting in the treatment of intracranial atherosclerotic stenosis. We aimed to clarify whether recruitable collateral flow could cause restenosis in patients treated with percutaneous transluminal angioplasty and stenting. Material and methods: Our study retrospectively analyzed patients with symptomatic severe intracranial atherosclerotic stenosis (≥70%) who underwent percutaneous transluminal angioplasty and stenting. We enrolled 28 patients with restenosis and 71 patients without restenosis. We analyzed baseline data, perioperative events, and follow-up results of patients in the two groups. Binary logistic regression analysis was used to identify restenosis predictors. Results: For preoperative stroke, the restenosis group had a greater likelihood of having a previous stroke (89.3%), which was less prevalent in the non-restenosis group (66.2%) (P = 0.020). The restenosis group had a higher rate of re-stroke (21.4 vs. 4.2%, P = 0.022). After binary logistic regression analysis, collateral circulation and residual stenosis were independent risk factors of restenosis, with overall risk (95% confidence intervals) of 5.034 (1.484-4.066, P < 0.001) and 1.064 (1.006-1.125, P = 0.030), respectively. Restenosis risk increased 1.456-fold for each collateral circulation grade increase. However, for each 1% increase in residual stenosis, restenosis risk increased by 5.9% (P = 0.03). The chance of restenosis is minimal when the residual stenosis rate after percutaneous transluminal angioplasty and stent implantation is 15.85%. Conclusions: Good collateral circulation was significantly associated with restenosis in patients undergoing intracranial angioplasty, the residual stenosis rate tends to be 15.85% to reduce restenosis risk. Compared to patients with restenosis, those without restenosis have a low stroke risk during follow-up.

Predictive factors of poor outcome and mortality among anterior ischaemic stroke patients despite successful recanalisation in China: a secondary analysis of the CAPTURE trial.

OBJECTIVES: This work aimed to analyse the risk factors for poor outcomes and mortality among patients with anterior large vessel occlusion (LVO) ischaemic stroke, despite successful recanalisation. SETTING AND PARTICIPANTS: This study conducted a secondary analysis among patients who underwent successful recanalisation in the CAPTURE trial. The trial took place between March 2018 and September 2020 at 21 sites in China. The CAPTURE trial enrolled patients who had an acute ischaemic stroke aged 18-80 years with LVO in anterior circulation. INTERVENTIONS: Thrombectomy was immediately performed using Neurohawk or the Solitaire FR after randomisation in CAPTURE trial. Rescue treatment was available for patients with severe residual stenosis caused by atherosclerosis. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary goal was to predict poor 90-day survival or mortality within 90 days post-thrombectomy. Univariate analysis, using the χ2 test or Fisher's exact test, was conducted for each selected factor. Subsequently, a multivariable analysis was performed on significant factors (p≤0.10) identified through univariate analysis using the backward selection logistic regression approach. RESULTS: Among the 207 recruited patients, 79 (38.2%) exhibited poor clinical outcomes, and 26 (12.6%) died within 90 days post-thrombectomy. Multivariate analysis revealed that the following factors were significantly associated with poor 90-day survival: age ≥67 years, internal carotid artery (ICA) occlusion (compared with middle cerebral artery (MCA) occlusion), initial National Institutes of Health Stroke Scale (NIHSS) score ≥17 and final modified Thrombolysis in Cerebral Infarction (mTICI) score 2b (compared with mTICI 3). Additionally, the following factors were significantly associated with mortality 90 days post-thrombectomy: initial NIHSS score ≥17, ICA occlusion (compared with MCA occlusion) and recanalisation with more than one pass. CONCLUSIONS: Age, NIHSS score, occlusion site, mTICI score and the number of passes can be independently used to predict poor 90-day survival or mortality within 90 days post-thrombectomy. TRIAL REGISTRATION NUMBER: NCT04995757.

Involvement of estrogen receptor activation in kaempferol-3-O-glucoside's protection against aging-related cognition impairment and microglial inflammation.

Estrogens have been demonstrated to inhibit age-related cognitive decline via binding to estrogen receptors (ERs). As a natural flavonoid component of Cuscuta Chinensis Lam., Kaempferol-3-O-glucoside (K-3-G) not only possesses anti-neuroinflammatory potential but also functions as an agonist for ERα and ERß. This study aimed to determine whether K-3-G improved cognition during the aging process, with an emphasis on its effect on microglial inflammation. In vivo, K-3-G (5 or 10 mg/kg/day) was orally given to the senescence-accelerated mouse prone 8 (SAMP8) mice from six to eight-month old. In addition to mitigating the memory and learning deficits of SAMP8 mice, K-3-G upregulated the expression of ERα and ERß in their hippocampal CA1 region, with the higher dose being more effective. Less Iba-1+ microglial cells presented in SAMP8 mice treated with K-3-G. The formation of NLR Family Pyrin Domain Containing 3 (NLRP3) complex, production of pro-inflammatory cytokines and oxidative stress-related markers, as well as expression of pro-apoptotic proteins were reduced by K-3-G. In vitro, BV2 microglial cells exposed to oligomeric amyloid beta (Aß)1-42 were treated with 100 µM K-3-G. K-3-G showed similar anti-inflammatory effects on BV2 cells as in vivo. K-3-G-induced alterations were partly diminished by fulvestrant, an ER antagonist. Moreover, dual-luciferase reporter system demonstrated that K-3-G induced ER expression by activating the transcription of estrogen-response elements (EREs). Collectively, these findings demonstrate that K-3-G may be a novel therapeutic agent for senescence-related cognitive impairment by inhibiting microglial inflammation through its action on ERs.

Factors Influencing the Outcome of Symptomatic Intracranial Artery Stenosis With Hemodynamic Impairment After Short and Long-Term Stent Placement.

Objective: Stent placement is a feasible approach worldwidely for patients with symptomatic intracranial artery stenosis (sICAS) and hemodynamic impairment (HI) who are at high risk of recurrent stroke after medical treatment. Exploration of factors associated with poor outcomes after stent placement could help develop better individualized therapeutic strategies. Methods: This study conducted a post-hoc analysis of a prospective, multicenter registry study of stent use for sICAS with HI in China. Patient and clinical demographics, and stenotic lesion images were analyzed using univariate and multivariate Cox regression to the time until any endpoints or the end of the follow-up period. The short-term endpoint included any transient ischemic attack (TIA), stroke, or death within 1 month after stent placement. The long-term endpoints included the short-term endpoints and any TIA or stroke in the region of the affected artery that occurred more than 1 month after stent placement. Results: Two hundred and ninety two patients were included, with 13 short-term and 39 long-term endpoints. Multivariate Cox regression analysis revealed that lesions at the arterial origin or bifurcation (Hazard Ratio (HR) = 7.52; 95% CI, 1.89-29.82; p = 0.004) were significantly associated with higher short-term risk. Baseline renal insufficiency reduced the risk (HR = 0.08; 95% CI: 0.01-0.68; p = 0.021). Factors significantly associated with higher long-term risk included irregular or ulcerated plaques at the lesion (HR = 2.15; 95% CI: 1.07-4.33; p = 0.031). Subgroup analyses indicated that higher risk occurred in the older age group (age>59 years, HR = 3.73, 95% CI: 1.27-10.97, p = 0.017), and not in the younger group (age≤59 years, HR = 1.12, 95% CI: 0.42-3.03, p = 0.822). Conclusion: Irregular or ulcerated plaques in older patients and lesions at the arterial opening or bifurcation were more likely to result in adverse endpoints for stent placement during long or short -term follow-up. Investigation of these factors might facilitate the development of individualized therapeutic strategies for this population. Clinical Trial Registration: http://www.clinicaltrials.gov, identifier: NCT01968122.

Focal white matter microstructural alteration after anthracycline-based systemic treatment in long-term breast cancer survivors: a structural magnetic resonance imaging study.

Understanding the neural correlates of cognitive problems in patients with breast cancer (BC) after systemic treatment have been a topic of increasing investigation. The heterogeneity of the systemic treatment regimens may undermine our ability to identify brain microstructural alterations resulting from any given regimen. We investigated the detrimental effects of the anthracycline-based systemic treatment (AST) regimen (epirubicin and cyclophosphamide + docetaxel + tamoxifen) on brain gray matter (GM) and white matter (WM) microstructural alteration in long-term BC survivors. We performed a battery of neuropsychological tests and structural magnetic resonance imaging (MRI) to 31 long-term BC survivors who had received the AST regimen (AST group) and 43 healthy controls (HC group). Voxel-based morphometry evaluated the whole-brain voxel-wise GM volume, while diffusion tensor imaging technique with tract-based spatial statistics analysis evaluated whole-brain WM microstructural alteration. Partial least squares regression (PLSR) was used to evaluate the relationship between cognitive impairment and brain microstructural alteration in BC survivors. Compared with the HC group, the AST group exhibited a significantly poorer performance in attention, as well as a marginal significantly poorer performance in verbal working memory and executive function. Significantly lower fractional anisotropy (FA), higher radial diffusivity (RD), and lower axial diffusivity (AD) in multiple brain WM regions were showed in AST group compared with the HC group. Overlap of lower FA and higher RD was found in the body of corpus callosum (CC) and bilateral superior corona radiata (SCR), whereas overlap of lower FA and AD was found in the body of CC and right SCR. The PLSR results showed that the WM regions with overlap of lower FA and AD were significantly associated with executive and verbal working memory decline. No significant difference was observed in the GM volume between groups. Our results suggest that microstructural abnormalities of certain vulnerable WM regions in the AST regimen-exposed brain may provide neuroimaging evidence for the identification of brain injury and cognitive impairment induced by specific chemotherapy regimens.

Risk factors associated with recurrence of ischemic stroke after intracranial stenting in china: a case-control study.

Objectives: To investigate the factors affecting the risk of recurrent stroke after intracranial artery stenting.Methods: This is a subgroup analysis of a prospective single-arm registry study with 20 participating sites. Patients aged 18-85 years old with symptomatic intracranial atherosclerotic stenosis caused by 70-99% stenosis combined with poor collaterals were included in this study. The median follow-up in this study was 26.4 months.Results: A total of 260 patients were recruited in this study. Ischemic stroke related to target vessel occurred in 11 patients (4.2%) from 30 days to the last follow-up. The multivariate analysis revealed age ≥60 years old (OR: 11.991, 95% CI: 1.400-102.716; p = 0.023), no smoking (OR: 0.087, 95% CI: 0.010-0.787; p = 0.030), and Mori C type (OR: 5.129, 95% CI: 1.242-21.178; p = 0.024) retained significance in the model. There was no significant difference in the ischemic stroke based on medical history of hypertension, diabetes, dyslipidemia, baseline percent stenosis, length of stenosis, residual stenosis, and different stent types.Conclusions: Recurrence of ischemic stroke after intracranial stenting may be associated with elderly age, non-smoking, and Mori C type lesion. These factors will need to be monitored in future trials of intracranial stenting.Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01968122.

Treatment of acute thrombosis during stent-assisted coil embolization of ruptured proximal posterior inferior cerebellar artery aneurysm.

Aneurysms located in the posterior inferior cerebellar artery (PICA) are not a majority of the intracranial aneurysms cases. Many challenges were addressed in the endovascular procedure to treat the disease. The authors have successfully diagnosed and treated a ruptured proximal PICA aneurysm. However, digital subtraction angiography showed acute thrombosis in the vertebral artery in the procedure, which probably could be an acute in-stent thrombosis. The tirofiban hydrochloride injection was subjected through a microcatheter, and then, the second Neuroform EZ stent was planted. In the 6-month follow-up, no recurrence of the aneurysm and complete patency of the right PICA at the site of aneurysm formation were found. We believe that the treatment of PICA aneurysms with Neuroform EZ stents could get a favorable result. Combination of tirofiban hydrochloride and Neuroform EZ stent could be an effective approach in treating acute thrombotic complications.

Tumor Immune Microenvironments (TIMEs): Responsive Nanoplatforms for Antitumor Immunotherapy.

Interest in cancer immunotherapy has rapidly risen since it offers many advantages over traditional approaches, such as high efficiency and prevention of metastasis. Efforts have primarily focused on two major strategies for regulating the body's antitumor immune response mechanisms: "enhanced immunotherapy" that aims to amplify the immune activation, and "normalized immunotherapy" that corrects the defective immune mechanism in the tumor immune microenvironments (TIMEs), which returns to the normal immune trajectory. However, due to the complexity and heterogeneity of the TIMEs, and lack of visualization research on the immunotherapy process, cancer immunotherapy has not been widely used in clinical setting. Recently, through the design and modification of nanomaterials, intelligent TIME-responsive nanoplatforms were developed from which encouraging results in many aspects of immunotherapy have been achieved. In this mini review, the status of designed nanomaterials for nanoplatform-based immune regulation of TIMEs has been emphasized, particularly with respect to the aforementioned approaches. It is envisaged that future prospects will focus on a combination of multiple immunotherapies for more efficient cancer inhibition and elimination.

Synthesis of Ordered Mesoporous Zr-Al Composite Oxides with Excellent Structural and Textural Properties and Extremely High Stability.

Ordered mesoporous Zr-Al composite oxide materials (denoted as OMZA-x) with different Zr contents have been synthesized by a solvent evaporation-inducing self-assembly procedure associated with a thermal treatment at 100 °C. A cooperative co-assembly process of amphiphilic triblock copolymer F127 molecules and inorganic hydroxyl species originated from the hydrolysis of Zr and Al precursors was proposed to explain the synthesis of OMZA-x. Compared to ordered mesoporous alumina prepared without introducing Zr species, the resultant OMZA-x exhibited a much more ordered mesostructure combined with a distinct increase in the pore volume and specific surface area. The highly homogenous doping of Zr into the mesopore walls together with the formation of Zr-O-Al bonds can effectively enhance the thermal and hydrothermal stability of OMZA-x. For instance, the ordered mesostructure and excellent textural properties of OMZA-6 prepared with the optimum atomic ratio of Al to Zr of 6 could be well maintained even after a high-temperature treatment at 1000 °C for 1 h or a hydrothermal treatment at 100 °C for 6 h.

Comparison of safety and mid-term effects between direct stenting and angioplasty before stenting in the basilar artery.

OBJECTIVES: Symptomatic atherosclerotic disease of the basilar artery (BA) portends a poor prognosis, and BA seemed to be the most dangerous site for stenting. The authors review their interventional results and mid-term results with or without predilation in BA stenting to find a safer interventional approach. PATIENTS AND METHOD: A database review identified 94 patients with severe symptomatic BA stenosis were treated with stenting. According to with balloon predilation or not, they were divided into two groups: direct stenting group and angioplasty before stenting group. Baseline data, lesion characteristics, complications and follow-up data from the two groups were compared and analyzed. RESULTS: The length of lesion in angioplasty before stenting group was longer than that in the direct stenting group (8.12 ± 2.76 mm versus 6.83 ± 2.27 mm, p = 0.015). The proportions of Mori C type lesion was higher in angioplasty before stenting group (31.3 % versus 8.7 %, p = 0.006). The residual stenosis was higher in angioplasty before stenting group (12.66 ± 9.24 % versus 7.67 ± 8.01 %, p = 0.006). There were no significant differences in TIA, stroke, and death between the two groups in the perioperative and postoperative > 1 year follow-up (p > 0.05). CONCLUSION: BA stenting is relatively safe and has a good results for experienced operators. Angioplasty before stenting is a good way for BA stenting, it makes the operations on difficult lesions as safe as normal one. More optimized stents and safer interventional approach need to be further explored and verified.

Early versus delayed stenting for intracranial atherosclerotic artery stenosis with ischemic stroke.

OBJECTIVE: To evaluate the clinical outcomes of early stenting (≤14 days) or late stenting (>14 days) in patients who underwent intracranial stent placement. METHODS: Patients with ischemic stroke caused by 70-99% intracranial atherosclerotic stenosis combined with poor collaterals were enrolled. The early stenting group, who underwent stenting within 14 days of last ischemic symptoms, were compared with the late stenting group who underwent stenting >14 days from last ischemic symptom. The patients were treated either with a balloon-mounted stent or a self-expanding stent as determined by the operators following a guideline. The baseline characteristics and clinical outcomes were evaluated and compared. RESULTS: One hundred and fifteen stroke patients were recruited into the study. Four patients (4/41) in the early stenting group and two patients (2/74) in the late stenting group were diagnosed with a cerebral vascular event associated with stenting within 3 days (p=0.184). In the long-term follow-up, eight patients in the early stenting group had restenosis ≥50%, which was higher than patients in the late stenting group (8/41 vs 4/74, p=0.018). The total rates of any ischemic stroke, transient ischemic attack, hemorrhagic stroke, and death in the early stenting group were higher than in the late stenting group (9/41 vs 6/74, p=0.035). The recurrence rate of ischemic stroke in the early stenting group was higher than in the late stenting group (5/41 vs 2/74, p=0.041). CONCLUSIONS: Stent placement in the setting of ischemic stroke caused by intracranial artery stenosis within 14 days may confer a higher risk of long-time cerebral vascular events and lead to a higher risk of restenosis. CLINICAL TRIAL REGISTRATION: NCT01968122.

Balloon-mounted versus self-expanding stents for symptomatic intracranial vertebrobasilar artery stenosis combined with poor collaterals.

Objectives: To compare the technical and 1-year outcomes of balloon-mounted versus self-expanding stents for symptomatic intracranial vertebrobasilar artery stenosis. Methods: 167 patients with severe intracranial vertebrobasilar artery atherosclerotic stenosis with poor collaterals were enrolled. Both balloon-mounted stenting and self-expanding stent placement were selected to treat patients. The baseline characteristics, cerebral angiography and clinical follow-up were assessed between the two groups. Results: The overall mean stenosis degree was reduced from 82.8 ± 11.8% pre-stent placement to 9.41 ± 8.20% post-stent placement. Patients treated with self-expanding stent were more likely to undergo general anesthesia (81.2% versus 67.3%; P = 0.048) and have longer operative times (91.0 ± 25.1 min versus 67.9 ± 17.1 min, P = 0.012) than those treated with self-expanding stents. Patients treated with self-expanding stents were more likely to require longer and larger diameter stents (14.99 ± 3.26 mm versus 9.23 ± 2.46 mm, P = 0.000; 3.28 ± 0.57 mm versus 2.74 ± 0.30 mm, P = 0.000, respectively). The degree of residual stenosis in self-expanding stent group was higher than patients treated with balloon-mounted stents (13.39 ± 8.64% versus 6.70 ± 6.62%, P = 0.000). The rates of stroke, transient ischemic attack or death at 1-year follow-up were not significantly different between two groups (P > 0.05). Conclusions: Stenting for patients with severe symptomatic intracranial vertebrobasilar arterial stenosis with poor collaterals can be performed safely with efficacy. Patients treated with balloon-mounted stents appear to have shorter operative times and lower re-stenosis rates than treated with self-expanding stents.

Balloon-Mounted versus Self-Expanding Stent Outcomes in Symptomatic Middle Cerebral Artery Stenosis Combined with Poor Collaterals in China: A Multicenter Registry Study.

OBJECTIVE: To compare the technical and 1-year clinical outcome in balloon-mounted versus self-expanding stenting for symptomatic severe stenosis of the middle cerebral artery combined with poor collaterals in China. METHODS: Ninety-one patients with severe middle cerebral artery atherosclerotic stenosis combined with poor collaterals were recruited in the study. Balloon-mounted stent or self-expanding stent were selected to treat patients following a guideline. The baseline characteristics, cerebral angiography, and outcomes were compared between the patients treated with balloon-mounted stent and self-expanding stent. RESULTS: The mean degree of stenosis was 85.5% ± 6.37% in the balloon-mounted stenting group and 85.4% ± 7.73% in the self-expanding stenting group before treatment (P = 0.930). A longer operative time occurred in patients treated with self-expanding stent than in those treated with balloon-mounted stent (96.7 vs. 68.6 minutes, respectively; P = 0.002). Patients with self-expanding stent had a higher rate of residual stenosis than those with balloon-mounted stent (67.3% vs. 38.9%, respectively; P = 0.014). The patients in balloon-mounted stenting group was less likely to have restenosis (6.1% vs. 26.5%, P = 0.019) and had a lower degree of stenosis (5.0% ± 0.0% vs. 26.9% ± 29.2%, P = 0.019) compared with patients in the self-expanding stenting group. During the 1-year follow-up, the recurrence rate of ischemic stroke, transient ischemic attack, hemorrhage stroke, and death was not significantly different between the 2 groups (1/33 vs. 2/49, P = 0.804; 1/33 vs. 1/49, P = 0.776; 0/33 vs. 2/49, P = 0.240; 1/33 vs. 0/49, P = 0.220, respectively). CONCLUSIONS: Balloon-mounted stents may have a shorter operative time and lower restenosis occurrence than self-expanding stents. No significant difference in 1-year outcome was observed between the 2 groups.

Generation of a square pulse with ultra-wide tuning range in a passively mode-locked Yb-doped fiber laser.

We have experimentally demonstrated a square pulse in a passively mode-locked Yb-doped fiber ring laser operating in the dissipative soliton resonance (DSR) region based on the nonlinear polarization rotation technique. In our experiment, a 1.5-km long single-mode fiber (SMF) is inserted into the cavity to increase the cavity length. The total cavity is 1501.8 m. With increasing pump power, the pulse duration can be tuned from 209.8 ns to 812.4 ns without wave-breaking, and the maximum output single pulse energy is 42.34 nJ. To the best of our knowledge, this is the widest pulse in any Yb-doped mode-locked fiber laser. Moreover, the relationship between pulse width and cavity length is investigated. When the total cavity length is decreased to 1001.8 m and 501.8 m, the tuning range of square pulse is 372.4 ns (from 58.6 ns to 431 ns) and 138 ns (from 26 ns to 164 ns), respectively, and the maximum output single pulse energy is 13.85 nJ and 8.75 nJ, respectively.

Stable L-band multi-wavelength SOA fiber laser based on polarization rotation.

We propose and experimentally demonstrate a stable multi-wavelength fiber ring laser operating in the L-band with wavelength spacing of 25 GHz. The mechanism is induced by a polarization rotation intensity equalizer consisting of a semiconductor optical amplifier and polarization devices. A Fabry-Perot filter is inserted into the cavity to serve as a multi-wavelength selection device. Stable L-band multi-wavelength lasing with 3 dB uniformity of 21.2 nm, and simultaneous oscillation of 101 lines with wavelength spacing of 25 GHz, is obtained.

[Efficacy of splenic artery trunk embolization with detachable balloon for portal hypertension and hypersplenism].

OBJECTIVE: To investigate the efficacy of detachable balloon for splenic artery trunk embolization in patients with cirrhotic portal hypertension and hypersplenism. METHODS: Eight patients with cirrhotic portal hypertension received splenic artery trunk disconnection using detachable balloons under the guidance of digital subtraction angiography. The diameter and blood flow of the portal vein, the superior mesenteric vein, the splenic vein and the hepatic artery were measured by color Doppler ultrasound. Markers of liver function and blood coagulation, and routine blood parameters were assessed. Gastroscopy was used to evaluate to the degree of gastroesophageal varices. All complications experienced during the perioperative period were recorded. RESULTS: The portal vein diameter decreased from 1.55±0.38 cm to 1.55±0.38 cm, and the splenic artery diameter decreased from 1.45±0.10 cm to 1.41±0.09 cm (P < 0.05). The portal vein blood flow was reduced from 971.52±174.77 ml/min to 785.86±100.17 ml/min, and the splenic vein blood flow decreased from 938.01±208.86 ml/min to 644.02±188.15 ml/min, while the hepatic artery blood flow increased from 261.25±65.47 ml/min to 449.32±84.05 ml/min (P < 0.05). The symptoms of splenism were improved effectively, with platelet counts rising from 37.75±10.61*109/L to 138.63±28.22*109/L after the procedure (P < 0.05). There were no episodes of severe complications or death in the perioperative period, and all patients showed remarkable improvement in markers of liver function and coagulation function, and improvement of esophagogastric varices. CONCLUSIONS: The interventional disconnection technique of the splenic artery trunk using detachable balloon for the treatment of portal hypertension and hypersplenism is safe and effective.