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Objective:To develop a nomogram model for early prediction of the risk of futile recanalization after endovascular therapy (EVT) in patients with acute basilar artery occlusion (ABAO).Methods:Patients with ABAO who underwent EVT and achieved successful recanalization (modified Thrombolysis in Cerebral Infarction [mTICI] grade ≥2b) at the First Affiliated Hospital of Soochow University from January 2017 to September 2022 were retrospectively included. According to modified Rankin Scale score at 90 days after onset, they were categorized into effective recanalization group (0-3) and futile recanalization group (4-6). Univariate analysis and mutivariate logistic regression analysis were used to identify independent risk factors for futile recanalization. A nomogram prediction model was then developed based on the independent risk factors. The model’s discrimination, calibration, and clinical utility were evaluated using receiver operator characteristic (ROC) curves, calibration curves, and clinical decision curves, respectively. Results:A total of 83 patients were included. Their age was 64.2±11.8 years, and 58 were male (69.9%). The median baseline National Institutes of Health Stroke Scale (NIHSS) score was 20 (interquartile range, 12-26). Forty patients (48.2%) experienced futile recanalization. The multivariate logistic regression analysis showed that the Basilar Artery on Computed Tomography Angiography (BATMAN) score at admission, failure to achieve first-pass effect during EVT, NIHSS score at 24 h after EVT, and neutrophil-to-lymphocyte ratio (NLR) within 24 h after EVT were the independent risk factors for futile recanalization (all P<0.05). The area under the ROC curve for the nomogram model developed from these four risk factors was 0.898 (95% confidence interval 0.831-0.964), with a predictive sensitivity of 75.0% and specificity of 90.7%. The calibration curve of this model was close to the ideal curve. The decision curve analysis showed that the model also had significant clinical net benefits. Conclusions:The nomogram model developed from BATMAN score at admission, first-pass effect, NIHSS score at 24 h after EVT, and NLR within 24 h after EVT has good predictive ability and clinical practicality, and can early predict futile recanalization in patients with ABAO at 1 day after EVT.
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Atherosclerosis is a chronic inflammatory disease. In clinical practice, the main intervention target is to reduce low density lipoprotein cholesterol. Recent clinical data of several new lipid lowering drugs in the "post statin era" show that despite the use of high-intensity lipid lowering therapy, a large number of patients still have "residual inflammatory risk". In fact, in recent years, a large number of clinical studies have shown that anti-inflammatory treatment can effectively reduce the clinical complications of atherosclerosis, but it is also found that directly targeting/blocking inflammation may lead to increased immunosuppression or infection probability. Inflammation is a complex network involving the activation of multiple inflammatory cells, the release of inflammatory factors and the activation of inflammatory pathways. Therefore, it is necessary and significant to find effective and safe anti-inflammatory targets. Existing clinical evidence shows that targeting NOD-like receptor thermal protein domain associated protein 3/interleukin-1β/interleukin-6/hypersensitive-C-reactive protein pathway is an effective intervention target. In addition, targeted adaptive immunity, chemokines, and the release of proinflammatory regression mediators also show anti atherosclerosis effects. This article will summarize the latest progress in anti-inflammatory treatment of atherosclerosis in recent years, including the latest clinical research and the important progress still in the basic research stage, and look forward to the broad prospects of anti-inflammatory treatment of atherosclerosis.
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OBJECTIVE@#To investigate the association between current and former smoking and the risk of mortality in elderly Chinese men.@*METHODS@#Our study participants were elderly (≥ 60 years) men recruited in a suburban town of Shanghai. Cigarette smoking status was categorized as never smoking, remote (cessation > 5 years) and recent former smoking (cessation ≤ 5 years), and light-to-moderate (≤ 20 cigarettes/day) and heavy current smoking (> 20 cigarettes/day). Cox proportional hazards models and restricted cubic splines were used to examine the associations of interest.@*RESULTS@#The 1568 participants had a mean age of 68.6 ± 7.1 years. Of all participants, 311 were never smokers, 201 were remote former smokers, 133 were recent former smokers, 783 were light-to-moderate current smokers and 140 were heavy current smokers. During a median follow-up of 7.9 years, all-cause, cardiovascular and non-cardiovascular deaths occurred in 267, 106 and 161 participants, respectively. Heavy current smokers had the highest risk of all-cause and non-cardiovascular mortality, with an adjusted hazard ratio (HR) of 2.30 (95% CI: 1.34-4.07) and 3.98 (95% CI: 2.03-7.83) versus never smokers, respectively. Recent former smokers also had a higher risk of all-cause (HR = 1.62, 95% CI: 1.04-2.52) and non-cardiovascular mortality (HR = 2.40, 95% CI: 1.32-4.37) than never smokers. Cox regression restricted cubic spline models showed the highest risk of all-cause and non-cardiovascular mortality within 5 years of smoking cessation and decline thereafter. Further subgroup analyses showed interaction between smoking status and pulse rate (≥ 70 beats/min vs. < 70 beats/min) in relation to the risk of all-cause and non-cardiovascular mortality, with a higher risk in current versus never smokers in those participants with a pulse rate below 70 beats/min.@*CONCLUSIONS@#Cigarette smoking in elderly Chinese confers significant risks of mortality, especially when recent former smoking is considered together with current smoking.
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Objective:To investigate the correlation between serum CXCL12 and the outcomes after intravenous thrombolytic therapy in patients with acute ischemic stroke.Methods:Consecutve patients with acute ischemic stroke treated with intravenous thrombolytic therapy in the Department of Neurology, the First Affiliated Hospital of Soochow University from January 1, 2020 to August 31, 2021 were enrolled retrospectively. Serum CXCL12 was measured by enzyme-linked immunosorbent assay within 24 h of onset. No improvement in early neurological function was defined as the National Institutes of Health Stroke Scale (NIHSS) 24 h after thrombolysis decreased by <4 compared with the baseline. The clinical outcome was evaluated by the modified Rankin Scale at 90 d after onset, and >2 were defined as a poor outcome. Multivariate logistic regression analysis was used to evaluate the correlation between serum CXCL12 and the outcome after intravenous thrombolysis, and the predictive value of serum CXCL12 for no improvement of early neurological function and poor short-term outcome was analyzed by the receiver operating characteristic (ROC) curve. Results:A total of 66 patients were enrolled, and the serum CXCL12 was 15.72±6.52 g/L. Twenty-seven patients (40.9%) had poor outcomes, and 34 (51.5%) had no improvement in early neurological function. Multivariate logistic regression analysis showed that higher serum CXCL12 was an independent predictor of poor outcome (odds ratio [ OR] 1.245, 95% confidence interval [ CI] 1.093-1.419; P=0.001) and no improvement in early neurological function ( OR 1.250, 95% CI 1.100-1.420; P=0.001). ROC curve analysis showed that the area under the curve of serum CXCL12 for predicting poor outcome was 0.793 (95% CI 0.679-0.908), the best cut-off value was 15.38 μg/L, and the corresponding sensitivity and specificity were 81.5% and 76.9%, respectively. The area under the curve of serum CXCL12 for predicting no improvement of early neurological function was 0.849 (95% CI 0.748-0.951), and the best cut-off value was 15.68 μg/L, and the corresponding sensitivity and specificity were 76.5% and 87.5%, respectively. Conclusion:Serum CXCL12 had a better predictive value for the outcomes of patients with acute ischemic stroke after intravenous thrombolytic therapy.
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The reperfusion therapies for acute ischemic stroke (AIS) patients in the past have set strict limits on time window. However, with the imaging assessment algorithms for "tissue window" becoming more mature, the time window for reperfusion therapies has been continuously extended. Nowadays the time window of intravenous thrombolysis has been extended to 9 hours after onset of stroke and is expected to be further broadened to 24 hours. At the same time, clinical studies of mechanical thrombectomy for posterior circulation large vessel occlusion (LVO), LVO with large ischemic cores and distal and medium vessel occlusion are all in hot progress. This article summarized diverse imaging assessment algorithms for "tissue window" and the latest advances of clinical research related to different fibrinolytic drugs for intravenous thrombolysis, mechanical thrombectomy for various vascular occlusion and bridging therapy of AIS in the extended time window. The objective of this review was to provide some references for the clinical diagnosis and therapy of stroke beyond time window.
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Ischemic stroke is one of the primary causes of death and disability worldwide. Neutrophils can release depolymerized chromatin and proteins to form neutrophil extracellular traps (NETs) and participate in intravascular thrombus formation. In recent years, NETs have received increasing attention in the study of acute ischemic stroke. The results indicate that NETs play an important role in the pathogenesis of acute ischemic stroke. This review presented recent advances in the study of NETs in acute ischemic stroke.
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Duchenne muscular dystrophy (DMD) is a serious and progressive hereditary muscle disease. The DMD gene mutation on the X chromosome causes the loss of dystrophin, causing progressive muscle weakness and muscular atrophy. Most patients die for heart and lung failure. Current gene therapy methods are mainly aimed at restoring the expression of dystrophin, including read-through therapy, exon skipping therapy, vector-mediated gene replacement therapy and gene editing therapy. This article reviews the mechanisms of these different treatments and important advances in clinical research, and analyzes the challenges and application prospects of these treatments.
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AIM: To investigate the efficacy of orbicularis oculi muscle resection combined with orbicularis oculi muscle shortening and lower eyelid retractor reduction in the treatment of elderly lower eyelid entropion.METHODS:A retrospective study was conducted among 97 elderly patients(175 eyes)with lower eyelid entropion who admitted to the hospital from June 2019 to June 2021. According to the treatment method, the patients were divided into control group(47 patients of 82 eyes treated with orbicularis oculi muscle resection)and combination group(50 patients of 93 eyes treated with orbicularis oculi muscle resection combined with orbicularis oculi muscle shortening and lower eyelid retractor reduction). The two groups were compared in terms of short-term curative effect, perioperative indexes, scores of symptoms and signs before and after surgery, width of palpebral fissure before and after surgery, direction of eyelashes, exposure rate of lacrimal caruncle, complications, and patient satisfaction.RESULTS: The total response rate in the combination group was significantly higher than that in the control group(95% vs 80%, P=0.004). The intraoperative blood loss, operation time and hospital stay of the combination group were significantly more/longer than those of the control group(P<0.001). The scores of symptoms and signs such as lacrimation, foreign body sensation, photophobia and irritation in the combination group after the surgery were significantly lower than those in the control group(all P<0.001). After surgery, the width of palpebral fissure, direction of eyelashes and exposure rate of lacrimal caruncle in the combination group were higher than those in the control group(P<0.001). The incidence of postoperative complications in the combination group was lower than that in the control group(8% vs 18%, P=0.032). The patient satisfaction scores of comfort level, trichiasis correction, scar appearance, eyes symmetry and appearance in the combination group were higher than those in the control group(all P<0.001).CONCLUSION: Orbicularis oculi muscle resection combined with orbicularis oculi muscle shortening and lower eyelid retractor reduction is effective and safe in the treatment of elderly lower eyelid entropion, which can meet the requirements of the patients.
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Objective:To investigate the effects of white matter hyperintensity (WMH) of different lesion areas and severities on early neurological deterioration (END) in acute ischemic stroke (AIS) patients after intravenous recombinant tissue plasminogen activator (rt-PA) thrombolysis.Methods:Three hundred and seventy-three AIS patients, admitted to our hospital from April 2019 to July 2021, were chosen in our study. These patients were treated with intravenous rt-PA thrombolysis within 4.5 h of onset. According to the presence or absence of END, these patients were divided into END group ( n=89) and non-END group ( n=284). Fazekas scale was used to assess the periventricular WMH (PVWMH) and subcortical WMH (SCWMH): none-mild PVWMH/SCWMH was defined at 0-1 score and moderate to severe PVWMH/SCWMH was defined at 2-3 scores; the sum scores of the two sites were calculated, and none-mild WMH was defined at 0-2 scores and moderate-severe WMH was defined at 3-6 scores. Univariate analysis was used to compare the baseline data of the two groups, and multivariate Logistic regression was used to determine the correlations of END with WMH lesion areas and severities. Results:Univariate analysis showed that there was significant difference between the END group and non-END group in age, baseline blood glucose, baseline National Institutes of Health Stroke Scale (NIHSS) scores, Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, hemorrhagic transformation after thrombolysis, and PVWMH, SCWMH, and WMH scores ( P<0.05). Multivariate Logistic analysis showed that only baseline NIHSS scores ( OR=1.064, 95%CI: 1.019-1.111, P=0.005), hemorrhagic transformation after thrombolysis ( OR=3.931, 95%CI: 2.007-7.701, P=0.000), moderate-severe WMH ( OR=4.736, 95%CI: 2.737-8.195, P=0.000), and moderate-severe SCWMH ( OR=5.557, 95%CI: 3.156-9.783, P=0.000) were independently related to the occurrence of END. Conclusion:Patients with moderate-severe SCWMH, moderate-severe WMH, or high NIHSS scores after thrombolysis trend to have END.
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@#Objective To evaluate the efficacy and safety of intravenous thrombolysis in acute mild ischemic stroke patients (National Institution of Health Stroke Scale≤5),moreover,to verify the effectiveness of multi-modality assessment in screening high-risk patients.Methods We retrospectively included 227 patients identified with acute mild neurological deficits treated with or without intravenous thrombolysis.Odds ratios (OR) with their confidence intervals (CI) for different outcomes between groups were assessed by using multivariable binary logistic regression analyses.And the heterogeneity of treatment effect magnitude for excellent outcome[modified Rankin scale (mRS) 0~1 was estimated in different subgroups stratified by optimal cut-off value from receiver operating characteristic curve.Results In multivariate analysis,intravenous thrombolysis could both achieve higher rate of excellent outcome(OR=3.302,95%CI1.488~7.326,P=0.003) and 7 day significant improvement (OR=2.566,95%CI1.287~5.118,P=0.007).However,there was no significant difference in the risk of early neurological deterioration,intracranial hemorrhage transformation or the 90 day stroke recurrence(P>0.05).It is indicated from the subgroup analysis that,compared with non-thrombolytic group,the classification of large artery atherosclerosis(OR=9.448,95%CI1.129~79.035,P=0.038) and baseline ABCD-2 score of 5 or more(OR=2.664,95%CI1.150~6.168,P=0.022) might benefit more from intravenous thrombolysis.Conclusion For acute mild ischemic stroke patients,we reassured the safety and especially the efficacy of intravenous thrombolysis at 7 days and 90 days.Patients with ABCD-2 score of 5 or more and classification of large artery atherosclerosis might benefit more from intravenous thrombolytic therapy.
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Endovascular mechanical thrombectomy (EMT) has become the main treatment of acute ischemic stroke, but the pathological study of thrombi retrieved with EMT is still very limited. This article reviews the routine staining, special components, expression of immune factors, electron microscopic morphology, imaging features of the pathological components of thrombi retrieved with EMT, and their correlation with the etiological differentiation and outcomes of stroke.
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Cardiac stroke is a stroke that occurs when a heart mural thrombus falls off and embolizes in the cerebral arterial system caused by various causes of heart disease, accounting for about 30% of all ischemic strokes. At present, in order to find evidence that emboli may originate from the heart, a large number of auxiliary examinations are needed. Good blood biomarkers are essential for the rapid identification of ischemic stroke in the emergency department. However, there is no breakthrough in this area. Brain natriuretic peptide is secreted in ventricular muscle and hypothalamus. It may be an important bridge between brain and heart diseases. However, the application of brain natriuretic peptide in the diagnosis and treatment of cardiogenic stroke is still very limited. This article reviews the current research status of brain natriuretic peptide levels and cardiogenic stroke and proposes further research trends and prospects.
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Objective:To investigate the predictive value of regional leptomeningeal collateral (rLMC) score on CT angiography (CTA) for the outcome after endovascular therapy in patients with late window anterior circulation stroke.Methods:Patients with acute anterior circulation large vessel occlusive stroke received endovascular treatment 6 to 24 h after onset in the Department of Neurology, the First Affiliated Hospital of Soochow University from January 2018 to July 2021 were enrolled retrospectively. At 3 months after onset, the outcome was evaluated according to the modified Rankin Scale. A score of ≤ 2 was defined as good outcome, and a score of >2 was defined as poor outcome. The clinical data, non-enhanced CT and CTA parameters of the patients were collected. Multivariate logistic analysis was used to determine the independent influencing factors of poor outcomes after endovascular treatment. Results:A total of 74 patients with acute anterior circulation large vessel occlusive stroke treated with endovascular treatment in the late window were enrolled. Their age was 64.41±12.98 years, 43 were males (58.1%). The baseline National Institutes of Health Stroke Scale (NIHSS) score was 13.18±5.22, and the median time from onset to puncture was 527.5 min. Fifty-three patients (71.6%) chose direct thrombectomy and 21 (28.4%) chose intravenous thrombolysis and bridging thrombectomy. Thirty-six patients (48.6%) had a good outcome and 38 (51.4%) had a poor outcome, including 4 (5.4%) died. Univariate analysis showed that there were significant differences in age, atrial fibrillation, fasting blood glucose, NIHSS score, Alberta Stroke Program Early CT Score (ASPECTS), rLMC score and clot burden score between the good outcome group and the poor outcome group (all P<0.05). Multivariate logistic regression analysis showed that higher ASPECTS (odds ratio 0.352, 95% confidence interval 0.157-0.791; P=0.012) and rLMC score (odds ratio 0.550, 95% confidence interval 0.329-0.919; P=0.022) were the independent predictors of good outcomes after endovascular therapy. Conclusion:ASPECTS and rLMC scores were the independent predictors of clinical outcomes after endovascular therapy in patients with late window anterior circulation large vessel occlusive stroke. It had certain guiding value for the decision-making of endovascular treatment in such patients.
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OBJECTIVE@#To observe the clinical therapeutic effect of electroacupuncture (EA) combined with tamsulosin hydrochloride sustained release capsule on chronic prostatitis (CP) of damp and heat stasis.@*METHODS@#A total of 70 patients with CP of damp and heat stasis were randomized into an acupuncture plus medication group (35 cases, 4 cases dropped off) and a medication group (35 cases, 5 cases dropped off). In the medication group, tamsulosin hydrochloride sustained release capsule was given orally, 0.2 mg a time, once each night. On the basis of treatment in the medication group, EA was applied at Guanyuan (CV 4), Sanyinjiao (SP 6) and Yinglingquan (SP 9), with disperse-dense wave, 5 mA in intensity for 30 min. Treatment for 30 days was as one course, and totally 3 courses were required in both groups. Before treatment, 1, 2, 3 months into treatment and at the follow-up of 2 months after treatment, the TCM syndrome score and National Institutes of Health chronic prostatitis symptom index (NIH-CPSI) score were observed, and the clinical efficacy was evaluated in both groups.@*RESULTS@#Compared before treatment, the TCM syndrome scores of 3 months into treatment and follow-up were decreased in the acupuncture plus medication group (@*CONCLUSION@#Acupuncture combined with medication can improve the clinical symptoms in patients with CP of damp and heat stasis, and its therapeutic effect is superior to simple western medication.
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Humans , Male , Acupuncture Points , Acupuncture Therapy , Chronic Disease , Hot Temperature , Prostatitis/drug therapy , Treatment OutcomeABSTRACT
Objective:To investigate the expression of costimulatory molecule OX40 in peripheral CD4 +CD25 +CD127 low regulatory T (Treg) cells and its clinical significance in patients with acute cerebral infarction (ACI). Methods:Seventy-five patients with first-onset ACI, admitted to our hospital from April 2019 to December 2019, and 36 age- and gender-matched volunteers (control group) were selected in this study. OX40 expression on CD4 +CD25 +CD127 low Treg cells in peripheral blood samples in the two groups were analyzed by immunofluorescent labeling and flow cytometry. Correlations of OX40 +Treg cell percentage with National Institute of Health stroke scale (NIHSS) scores, ischemic penumbra volume, core infarct volume, and infarct volume in the patient group were analyzed. The changes of OX40 +Treg cell percentage in the patient group before and after endovascular treatment or intravenous thrombolysis were compared. Results:As compared with that in the control group, the Treg cell percentage in peripheral blood samples of the patient group was significantly decreased, while OX40 +Treg cell percentage was significantly increased ( P<0.05). OX40 +Treg cell percentage was positively correlated with NIHSS scores in ACI patients ( r s=0.271, P=0.018). Meanwhile, OX40 +Treg percentage was significantly correlated with ischemic penumbra volume, core infarct volume, and infarct volume in the patient group ( r s=0.435, P=0.000; r s=0.343, P=0.003; r s=0.245, P=0.034). OX40 +Treg cell percentage in ACI patients 7 d after endovascular treatment was significantly decreased as compared with that before treatment ( P<0.05); OX40 +Treg percentage in ACI patients 3 and 7 d after intravenous thrombolysis was significantly decreased as compared with that before treatment ( P<0.05). Conclusion:OX40 is abnormally expressed on peripheral Treg cells in ACI patients, and is closely correlated with neurological deficits, imaging features and reperfusion therapy.
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Objective:To evaluate the efficacy and safety of reperfusion therapy in patients with wake-up stroke (WUS) under the guidance of "tissue-window" by comparing with patients with non-WUS who received reperfusion therapy within "time-window".Methods:Two hundred and thirty-five acute ischemic stroke patients admitted to our hospital from January 2018 to December 2019 were enrolled in our study. Patients with non-WUS received reperfusion therapy within "time-window"; patients with WUS accepted multimodal CT examination at Emergency right after admission, Mistar software was used to reconstruct CT perfusion imaging (CTP) images, and reperfusion therapy was given to these patients after the judgement of "tissue-window". The differences of clinical data, prognoses, and safety indexes were compared between patients with WUS and non-WUS.Results:In these 235 patients, 45 patients were with WUS and 190 were with non-WUS. As compared with patients with non-WUS, those with WUS had significantly lower percentages of patients with hypertension history and patients accepted intravenous thrombolysis ( P<0.05). In 153 patients accepted intravenous thrombolysis, 23 patients were with WUS and 130 were with non-WUS; the time from admission to intravenous thrombolysis in WUS patients was significantly longer than that in non-WUS patients ( P<0.05); the clinical data, prognoses, and safety indexes showed no significant differences between these patients with WUS and non-WUS ( P>0.05). In 82 patients accepted bridging thrombectomy and direct thrombectomy, 22 patients were with WUS and 60 were with non-WUS; the clinical data, prognoses, and safety indexes showed no significant differences between these patients with WUS and non-WUS ( P>0.05). Conclusion:By comparing with patients with non-WUS who received reperfusion therapy within "time-window", reperfusion therapy is effective and safe for WUS patients under the guidance of multimodal CT "tissue-window".
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Wake-up stroke (WUS) is clinically defined as ischemic stroke that is associated with neurological deficits on awakening,accounting for approximately one in five individuals presenting with an acute ischemic stroke.At present,the mechanism of WUS onset is still unclear,and whether circadian mechanisms are involved deserves further exploration.Previously,these patients were missed the opportunity of reperfusion therapy due to unknown onset time.Recent studies have changed this concept.Intravenous thrombolysis or mechanical thrombectomy can be performed in appropriate patients after imaging evaluation,thus improving the prognosis of some patients with WUS.This article summarizes the latest research in recent years.
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Objective:To improve awareness about infratentorial dural arteriovenous fistula (DAVF).Methods:Three cases of DAVF in the First Affiliated Hospital of Soochow University from September 2017 to September 2019 were retrospectively analyzed in terms of clinical features, cerebrospinal fluid (CSF) analysis, brain imaging and treatment, and followed up through telephone call.Results:Case 1: A 43-year-old woman, in chronic but acute aggravated course, presented with weakness of both lower limbs and urination and defecation dysfunction. Brain magnetic resonance imaging (MRI) revealed abnormal signal in medulla. CSF analysis demonstrated aquaporin-4 antibodies positive. Misdiagnosed as neuromyelitis optica spectrum disorders, the treatment was poor. Then digital subtraction angiography (DSA) showed DAVF at the left infratentorial area, and endovascular treatment was operated. Relapse was not observed in two-year follow up. Case 2: A 57-year-old woman, in chronic progressive course, mainly manifested as memory loss, but progressed with dysphagia, fever, coma. Treatment as “central nervous infection” was poor. Then DSA showed DAVF at the bilateral transverse-sigmoid sinus area, and endovascular treatment was operated with embolized partial fistulas. The patient died from lung infection within two months. Case 3: A 52-year-old man, in subacute course, was treated in the Gastroenterology Department with clinical manifestion of stubborn nausea and vomiting. Brain MRI revealed abnormal signal in medulla, with prominent vessel flow voids nearby. Then DSA showed DAVF at the craniocervical junction, and endovascular treatment was operated. Relapse was not observed in six-month follow up.Conclusions:DAVF has a variety of clinical manifestations, and infratentorial DAVF can manifest as acute neurological dysfunction involving the brain stem, cerebellum, spinal cord, which may be easily misdiagnosed. When brain MRI showed intracranial abnormal signal, the possibility of DAVF should be considered. DSA remains the gold standard to diagnose DAVF. Endovascular embolization is the main treatment of infratentorial DAVF at present. Prognosis depends on clinical presentation and fistula classification.