Laterality of Posterior Cerebral Artery and White Matter Hyperintensities in Patients with Severe Internal Carotid Artery Stenosis.

Background: Collateral status of the circle of Willis was associated with white matter hyperintensities (WMHs) in patients with internal carotid artery (ICA) stenosis, but few have investigated the effect of leptomeningeal anastomoses. Objective: The aim of this study was to observe the association between WMHs and the laterality of the posterior cerebral artery (PCA) that presents leptomeningeal anastomoses in patients with severe ICA stenosis. Materials and Methods: WMHs and ipsilateral PCA laterality were evaluated in patients with unilateral ICA stenosis ≥70% (including occlusion) and contralateral ICA stenosis <50% or no stenosis. Ipsilateral PCA laterality was compared between two groups of no/mild and severe score of global, deep and periventricular WMHs, respectively. Results: We included 115 patients with unilateral ICA stenosis ≥70%. There were 60 patients with no/mild and 55 with severe global WMHs. The patients with severe global WMHs were older (OR = 1.849, 95% CI: 1.058-3.229, P = 0.031) and had higher incidence of negative PCA laterality (OR = 3.301, 95% CI: 1.140-9.558, P = 0.028). The patients with severe deep WMHs were also older (OR = 2.031, 95% CI: 1.130-3.651, P = 0.018) and had higher incidence of negative PCA laterality (OR = 4.250, 95% CI: 1.501-12.032, P = 0.006). There was no significant difference between the patients with no/mild and severe periventricular WMHs in the incidence of negative PCA laterality. Conclusions: The incidence of negative PCA laterality was higher in patients with severe global and deep WMHs, but not higher in patients with severe periventricular WMHs. The leptomeningeal anastomoses may affect the deep WMHs in patients with severe ICA stenosis.

Research on the network handoff strategy based on the best access point name decision.

To improve the network switching performance and efficiency of mobile phone terminals and establish an efficient mobile communication network connection, this paper constructs the SDN+MPTCP+CP (Software Defined Network, Multi-Path TCP, and Mobile Terminal) mobile communication network model and designs a network switching algorithm with a preselected available access point name (APN) based on the potential game method. The constructed network model integrates a 5G mobile communication network, satellite communication, the SDN network, and the MPTCP multi-way communication technology. APN access point is preselected by using Kalman filtering theory, and dual problems are resolved with the Lagrange function. To determine the MPTCP sub-flow transmission path, the differential derivative calculation is introduced. The performance of the network switching strategy is evaluated based on the Jacobian matrix. Then, the game coefficient is designed, and the game function is calculated. A potential game balance point is found, and an updating strategy is formulated to determine the best APN access point. The simulation network model is constructed, and the parameters of the performance evaluation are defined to find the performance comprehensively. The experimental results demonstrated the extreme reliability, stability, and compatibility of the proposed algorithm.

Pre-treatment cerebral microbleeds and intracranial hemorrhage in patients with ischemic stroke receiving endovascular therapy: a systematic review and meta-analysis.

BACKGROUND AND PURPOSE: Predicting the risk of intracranial hemorrhage (ICH) is an important aspect for improving the efficacy and safety of endovascular therapy (EVT). We intended to perform a systematic review and meta-analysis to show whether pre-treatment cerebral microbleeds (CMBs) were associated with an increased incidence of ICH in patients with ischemic stroke receiving EVT. METHODS: We searched PubMed, EMBASE, Web of Science and Cochrane Library from their dates of inception to December 18, 2018, and also manually searched reference lists of relevant articles. Cumulative prevalence of CMBs and ICH was calculated. Relative risk and 95% confidence interval (CI) were calculated for the incidence of ICH in patients with CMBs versus those without after EVT. RESULTS: Four studies involving 598 patients were included. The pooled prevalence of CMBs was 18% (95% CI 15-21%) and the pooled prevalence of ≥ 5 CMBs was 1% (95% CI 0-2%). The pooled incidence of ICH was 29% (95% CI 8-49%) in all patients, 25% (95% CI 5-45%) in those with CMBs and 29% (95% CI 8-50%) in those without CMBs. The pooled relative risk of ICH was 0.90 (95% CI 0.65-1.25, P = 0.528; I2 = 0%, P = 0.949) in patients with CMBs versus those without CMBs. CONCLUSIONS: There is no evidence that pre-treatment CMBs were associated with an increased incidence of ICH in patients with ischemic stroke receiving EVT.

Completeness of circle of Willis and white matter hyperintensities in patients with severe internal carotid artery stenosis.

BACKGROUND: We investigated whether completeness of the circle of Willis (CoW) protected patients with severe internal carotid artery (ICA) stenosis against white matter hyperintensities (WMHs). METHODS: We included 115 patients with unilateral ICA stenosis ≥ 70%. The completeness of CoW was assessed and WMHs were rated on a visual scale. The score of deep and periventricular WMHs was compared between patients with complete and incomplete CoW and between the two hemispheres, ipsilateral and contralateral to stenosed ICA. RESULTS: We included 115 patients with severe ICA stenosis, 60 patients had a complete CoW (52.17%) and 55 had an incomplete CoW (47.83%). The patients with incomplete CoW had higher score of deep WMHs (OR = 1.82, 95% CI 1.08-3.06, P = 0.023) and periventricular WMHs (OR = 4.53, 95% CI 2.09-9.81, P = 0.000) than those with complete CoW. In the patients with incomplete CoW, the score of deep WMHs (OR = 4.14, 95% CI 1.33-12.93, P = 0.014) and periventricular WMHs (OR = 5.46, 95% CI 1.16-25.62, P = 0.032) was higher in the hemisphere ipsilateral to stenosed ICA than that in the contralateral hemisphere. In the patients with complete CoW, there was no significant difference in the score of deep WMHs (OR = 2.10, 95% CI 0.37-11.91, P = 0.401) and periventricular WMHs (OR = 2.83, 95% CI 0.99-8.05, P = 0.051) between the ipsilateral and contralateral hemispheres to stenosed ICA. CONCLUSION: The completeness of CoW protected patients with severe ICA stenosis against WMHs.

Antiplatelet Therapy, Cerebral Microbleeds, and Intracerebral Hemorrhage: A Meta-Analysis.

BACKGROUND AND PURPOSE: Antiplatelet therapy is associated with the presence of cerebral microbleeds (CMBs) with limited studies. We further investigate the topic focusing on different effects of antiplatelet therapy on strict lobar and deep/infratentorial MBs. METHODS: We searched PubMed and EMBASE from January 1, 1997 to December 1, 2017, for relevant studies, calculated the pooled odds ratios (OR) for CMB incidence and distribution (strictly lobar, deep/infratentorial) in antiplatelet users versus nonantiplatelet users and calculated the OR for the incidence of intracerebral hemorrhage in antiplatelet users with CMBs versus those without. RESULTS: We included 20 988 participants from 37 studies. CMBs were more frequent in antiplatelet users than those in nonantiplatelet users (pooled OR, 1.21; 95% confidence interval, 1.07-1.36; P=0.002). There was a significant association of antiplatelet therapy with strictly lobar MBs (OR, 1.45; 95% confidence interval, 1.15-1.84; P=0.002) rather than deep/infratentorial MBs (OR, 1.37; 95% confidence interval, 0.98-1.90; P=0.062). Intracerebral hemorrhage incidence was higher in participants with CMBs than those without CMBs (OR, 3.40; 95% confidence interval, 2.00-5.78; P=0.000) in antiplatelet users. CONCLUSIONS: Antiplatelet drug use was associated with increased risk of strictly lobar MBs and increased the intracerebral hemorrhage incidence in participants with CMBs.

White matter hyperintensities and their subtypes in patients with carotid artery stenosis: a systematic review and meta-analysis.

OBJECTIVE: We aimed to perform a systematic review and meta-analysis to clarify the association between white matter hyperintensities (WMHs) and carotid artery (CA) stenosis. STUDY DESIGN: Systematic review and meta-analysis. PARTICIPANTS: CA stenosis was set at ≥50%, and WMHs were assessed by MRI and evaluated quantitatively or semiquantitatively. DATA SOURCES: A comprehensive literature search was performed in PubMed, EMBASE and Cochrane Library for studies evaluating the association between WMHs and CA stenosis ≥50% from inception to 13 September 2017. MAIN OUTCOMES AND MEASURES: Standardised mean difference (SMD) with 95% CI was used to evaluate the association between WMHs and CA stenosis. Results were presented in a forest plot with a fixed-effects model or random-effects model. We assessed the quality of included studies using the Newcastle-Ottawa Scale. Funnel plots and Egger's and Begg's tests were conducted to assess publication bias. Sensitivity analysis was performed to evaluate the influence of each individual study. RESULTS: Eight studies enrolling 677 patients were included. There was a positive relationship between the total WMHs and CA stenosis, with a pooled fixed-effects SMD of 0.326 (95% CI 0.194 to 0.459, p=0.000). Heterogeneity and publication bias were low among these studies. Subgroup analysis of three studies enrolling 225 patients showed an association between periventricular WMHs and CA stenosis, with a pooled fixed-effects SMD of 0.412 (95% CI 0.202 to 0.622, p=0.000). CONCLUSION: This meta-analysis showed that the total WMHs and periventricular WMHs were associated with CA stenosis. WMHs may be considered as an individual risk stratification score when choosing a proper plan for therapy of CA stenosis.