Explantador de Cabrera: un nuevo dispositivo para explantar endoprótesis aórticas después de reparo endovascular de aneurisma de aorta, un estudio experimental ex vivo / Cabrera explanter: a new device to explant aortic stents after endovascular aortic aneurysm repair, an ex vivo experimental study

Introducción. Las complicaciones posteriores a la reparación endovascular de aneurisma (EVAR) pueden resolverse con técnicas endovasculares. Sin embargo, cuando está indicada, la explantación de una endoprótesis es un procedimiento complejo, que se asocia a lesiones vasculares o viscerales, con alta morbimortalidad, en pacientes con edad avanzada y múltiples comorbilidades, y por lo tanto, alto riesgo quirúrgico. No existen dispositivos producidos por la industria para explantar las endoprótesis aórticas, por lo que el objetivo de este trabajo fue desarrollar un dispositivo para la explantación de endoprótesis aórticas. Métodos. Se llevó a cabo un estudio experimental, en fase preclínica, para desarrollar un dispositivo para la explantación de endoprótesis aórticas, con pruebas en modelos 3D y en un modelo animal porcino cadavérico. Resultados. Es factible desarrollar un modelo experimental de un nuevo dispositivo para explantar endoprótesis aórticas, denominado explantador de Cabrera, y comprobar su funcionamiento en un modelo animal cadavérico. El uso del explantador de Cabrera limitó el daño de la pared aórtica por parte de la endoprótesis en un 100 % al momento de su explantación en un modelo experimental ex vivo. Conclusión. Usando una jeringa septo, el explantador de Cabrera es superior a la técnica estándar de explantación de una endoprótesis al limitar la lesión de la pared aórtica, al colapsar y liberar los ganchos de fijación suprarrenal de forma controlada y segura al interior de la luz aórtica y, posteriormente, extraerla de forma rápida y efectiva, conservando la mayor cantidad de aorta sana para la posterior reconstrucción aorto-ilíaca.

Introduction. Complications after endovascular aneurysm repair (EVAR) can be resolved with endovascular techniques; however, when indicated, stent explantation is a complex procedure, which is associated with vascular or visceral injuries, with high morbidity and mortality in patients, with advanced age and multiple comorbidities, and therefore high surgical risk. There are no devices produced by the industry to explant aortic endoprostheses, so the objective of this work was to develop a device for the explantation of aortic endoprostheses. Methods. An experimental study was carried out, in the preclinical phase, to develop a device for the explantation of aortic endoprostheses, with tests in 3D models and in a cadaveric porcine animal model. Results. It is feasible to develop an experimental model of a new device for explanting aortic endoprostheses, called Cabrera explanter, and verify its operation in a cadaveric animal model. The use of the Cabrera explanter limited damage to the aortic wall by the endoprosthesis by 100% at the time of explantation in an ex vivo experimental model. Conclusions. Using a septum syringe, the Cabrera explanter is superior to the standard stent explantation technique by limiting injury to the aortic wall, collapsing and releasing the adrenal fixation hooks in a controlled and safe manner into the aortic lumen, and subsequently, extract it quickly and effectively, preserving the greatest amount of healthy aorta for the subsequent aorto-iliac reconstruction.

Manejo de aneurismas cerebrales: revisión de la literatura pasada, presente y futura / Management of cerebral aneurysms: Review of the past, present, and future literature

Resumen Introducción: El manejo de los aneurismas cerebrales ha ido evolucionando con el paso de los siglos, se busca evaluar el manejo médico, endovascular y quirúrgico de los aneurismas cerebrales rotos y no rotos a lo largo del tiempo, desde las primeras veces en que fueron tratados hasta las innovaciones que se están llevando a cabo. Materiales y métodos: Se realizó una revisión de artículos buscados en la base de datos de PubMed, buscando "Mesh Terms" (o descriptores en ciencias de la salud) con palabras seleccionadas relacionadas al tema y también se seleccionaron artículos según el criterio de los autores; además de la extracción de datos en Rayyan. Resultados: Se seleccionaron 48 artículos dentro de la búsqueda en Pubmed y según criterios propios de los autores, de los cuales 8 artículos se incluyeron en la sección "pasado", 35 artículos en la sección "presente" y 5 artículos en la sección "futuro". Discusión: Se dividió el manejo de aneurismas en tres secciones: pasado (pasado-1999), presente (20002020) y futuro (2021-futuro). Cada sección tuvo tres grupos: manejo médico, endovascular y quirúrgico. Conclusiones: El manejo de los aneurismas no rotos y rotos tiene métodos farmacológicos, de neuro-intervencionismo y neuro-quirúrgicos para abordar, de la mejor manera, la patología de cada paciente de forma individualizada e integral.

Abstract Introduction: The management of brain aneurysms has evolved over the centuries, it seeks to evaluate the medical, endovascular and surgical management of the broken and not broken brain aneurysms over time, from the first times they were treated even the innovations that are being carried out. Materials and methods: A review of articles searched in the PubMed database was carried out, searching for Mesh Terms with selected words related to the topic and articles were also selected according to the author's criteria. Data extraction in Rayyan. Results: 48 articles were selected within the Pubmed search and according to the author's own criteria. 8 articles were included in the Past section, 35 articles in the Present section, and 5 articles in the Future section. Discussion: Aneurysm management was divided into 3 sections: past (past-1999), present (2000-2020) and future (2021-future). Each section had 3 groups: medical, endovascular and surgical management. Conclusions: The management of non-broken and broken aneurysms has pharmacological, neuro-interventionism and neuro-surgical methods to be able to address each patient's pathology in an individualized and integral way.

Umbral crítico de administración en pacientes con trauma severo y reanimación endovascular: ¿Un concepto útil? / Critical Administration Threshold in severe trauma patients and endovascular resuscitation: A useful concept?

Introducción. Se describe la utilidad del umbral crítico de administración (CAT por su denominación en inglés) como herramienta para la reanimación hemostática en pacientes con trauma severo y oclusión endovascular aórtica. Métodos. Revisión retrospectiva de pacientes adultos con hemorragia por trauma, con o sin oclusión endovascular aórtica (REBOA), atendidos entre enero de 2015 y junio de 2020, en un centro de trauma nivel I en Cali, Colombia. Se registraron variables demográficas, severidad del trauma, estado clínico, requerimiento transfusional, tiempo hasta CAT+ y CAT alcanzado (1, 2 ó 3). Resultados. Se incluyeron 93 pacientes, se utilizó REBOA en 36 y manejo tradicional en 57. El grupo REBOA presentó mayor volumen de sangrado (mediana de 3000 ml, RIC: 1950-3625 ml) frente al grupo control (mediana de1500 ml, RIC: 700-2975ml) (p<0,001) y mayor cantidad de glóbulos rojos transfundidos en las primeras 6 horas (mediana de 5, RIC:4-9); p=0,015 y en las primeras 24 horas (mediana de 6, RIC: 4-11); p=0,005. No hubo diferencias estadísticamente significativas en número de pacientes CAT+ entre grupos o tiempo hasta alcanzarlo. Sin embargo, el estado CAT+ durante los primeros 30 minutos de la cirugía fue mayor en grupo REBOA (24/36, 66,7 %) frente al grupo control (17/57, 29,8 %; p=0,001), teniendo este mayor tasa de mortalidad intrahospitalaria frente a los pacientes CAT-. Conclusión. El umbral crítico de administración es una herramienta útil en la reanimación hemostática de pacientes con trauma y REBOA, que podría predecir mortalidad precoz.

Introduction. The objective is to describe the utility of the Critical Administration Threshold (CAT) as a tool in hemostatic resuscitation in patients with severe trauma and REBOA. Methods. Retrospective review between January 2015 and June 2020 of adult patients with hemorrhage secondary to trauma with or without REBOA in a level I trauma center in Cali, Colombia. Demographic variables, trauma severity, clinical status, transfusion needs, time to CAT+ and number of CAT achieved (1, 2 or 3) were recorded. Results. Ninety-three patients were included, in which REBOA was used in 36 and traditional management in 57. The REBOA group had a higher bleeding volume (3000 ml), IQR: 1950-3625 ml vs the control group (1500 ml, IQR: 700-2975 ml) (p<0.001) and a higher rate of PRBC units transfused in the first 6 hours (median 5, IQR: 4-9); p=0.015 and in the first 24 hours (median 6, IQR: 4-11); p=0.005. There were no statistically significant differences in the number of CAT+ patients between groups or time to CAT+. However, CAT+ status during the first 30 minutes of surgery was higher in the REBOA Group (24/36, 66.7%) vs. the control group (17/57, 29.8%; p=0.001), having this group a higher in-hospital mortality rate vs. CAT- patients. Conclusion. CAT is a useful tool in the hemostatic resuscitation of patients with trauma and REBOA that could predict early mortality.

Neuroprotective therapy for acute ischemic stroke in the era of endovascular therapy / 国际脑血管病杂志

In recent years, endovascular therapy has become the most important progress in the field of the treatment of acute ischemic stroke caused by large vessel occlusion. However, the vascular recanalization shown by imaging after endovascular treatment cannot fully translate into effective tissue reperfusion and functional outcome, a phenomenon known as "futile recanalization". Combined neuroprotective therapy after vascular recanalization is expected to reduce the occurrence of futile recanalization and improve the outcome of patients. This article briefly summarizes the main application progress of commonly used neuroprotective therapies in clinical practice (edaravone dexborneol, glucocorticoids, hypothermia, and remote ischemic conditioning). It explores the trend and direction of combining endovascular therapy and neuroprotective therapy for patients with acute ischemic stroke caused by large vessel occlusion, and provides further reference and suggestions for intervention measures after endovascular therapy.

Predictive value of FLAIR vascular hyperintensity in patients with acute ischemic stroke underwent endovascular treatment / 国际脑血管病杂志

Endovascular treatment has become the standard treatment method for acute ischemic stroke caused by large vessel occlusion. The application of neuroimaging techniques for appropriate patient selection and prognosis prediction is of great significance for successful endovascular treatment. This article reviews the application progress of fluid-attenuated inversion recovery sequence vascular hyperintensity in patients with acute ischemic stroke underwent endovascular treatment.

Endovascular therapy combined with laparoscopic surgery for acute mesentery artery occlusion / 中华普通外科杂志

Objective:To explore the efficacy and safety of endovascular intervention combined with preoperative laparoscopic exploration in the treatment of patients with acute mesenteric artery ischemia.Methods:This was a prospective cohort study (NCT04686981). The study enrolled 31 patients with acute mesenteric artery ischemia from Oct 1, 2020 to Oct 1, 2022. Among them, 26 patients (84%) were male, with a mean age of (67±13) years and a mean time to onset of (21±8) hours. All patients underwent laparoscopic exploration in the hybrid operating room. If the presence of intestinal necrosis or suspected necrosis was clearly determined, the patient would undergo open surgery (mesenteric artery embolization, intestinal resection and intestinal double stoma) as the treatment by gastrointestinal surgeon. If intestinal necrosis or suspected necrosis was not found by laparoscopy, the patient would undergo endovascular intervention by vascular surgeon. The primary observational endpoints of this study were the proportion of patients who were not dependent on total parenteral nutrition and all-cause mortality within 30 days after operation. The secondary observational endpoints were the rate of mesenteric vascular patency within 30 days and the proportion of interventions that were converted to open surgery.Results:Six patients underwent open surgery and 25 patients underwent endovascular intervention, including 13 cases of thrombus reduction alone, 3 cases of stent implantation during the same period after reduction, and 9 cases of stent implantation alone. Twenty-four patients (77%) were completely weaned from the TPN within 30 days after the procedure, and all-cause mortality was observed in 3 cases (9.7%). The patency rate of the mesenteric artery within 30 days after the procedure was 82.1%. The rate of conversion to open surgery after intervention was 16%.Conclusions:Endovascular intervention combined with preoperative laparoscopic exploration can clarify intestinal ischemia in acute mesenteric patients as early as possible, and individualized treatment strategies for each patient by multidisciplinary care team can potentially improve the prognosis of such patients.

Alopecia temporária após tratamento endovascular relacionada a uma malformação arteriovenosa em face: relato de caso / Temporary alopecia after endovascular treatment related to an arteriovenous malformation in the face: case report / Alopecia temporal posterior a tratamiento endovascular relacionado con malformación arteriovenosa en la cara: reporte de caso

Objetivo: relatar um caso de alopecia temporária após tratamento endovascular com exposição por fluoroscopia devido a uma malformação arteriovenosa na face. Detalhamento do caso: sexo masculino, 34 anos, com queixa de lesão na asa nasal, lábio superior e lateral da face (direita). O paciente trouxe exame de angioressonância apresentando uma malformação arteriovenosa em face com nutrição pela artéria facial e drenagem pela veia mandibular. Como tratamento foi optado uma arteriografia diagnóstica para melhor avaliação de vascularização da malformação arteriovenosa seguida de embolização com onyx® (mistura de etileno vinil álcool copolímero) que fornece o contraste necessário para a visibilização da mistura sob fluoroscopia. O procedimento foi realizado 14 dias após a 1ª consulta, sem intercorrências indicando sucesso terapêutico. No retorno, terceira semana após o procedimento, apresentou alopecia setorial em região occipitoparietal direita. Não havia manchas em região, bem como outros sintomas associados. Foi realizado como tratamento o uso de Minoxidil tópico e Cilostazol via oral. Após o tratamento houve retorno do crescimento espontâneo em cerca de 2 meses. Considerações finais: a embolização com onyx® mostrou-se uma valiosa opção terapêutica com uma maior conservação das estruturas nobres em malformações arteriovenosas, com baixa taxa de complicações no médio e longo prazo.

Objective: to report a case of temporary alopecia after endovascular treatment with fluoroscopy exposure due to an arteriovenous malformation on the face. Case detail: male, 34 years old, complaining of a lesion on the nasal wing, upper lip and side of the face (right). The patient brought an angioresonance exam showing an arteriovenous malformation in the face with nutrition through the facial artery and drainage through the mandibular vein. As a treatment, a diagnostic arteriography was chosen for a better assessment of the vascularity of the arteriovenous malformation followed by embolization with onyx® (mixture of ethylene vinyl alcohol copolymer), which provides the necessary contrast for visualization of the mixture under fluoroscopy. The procedure was performed 14 days after the 1st consultation, with no intercurrences indicating therapeutic success. On return, third week after the procedure, he presented sectoral alopecia in the right occipitoparietal region. There were no stains in the region, as well as other associated symptoms. The use of topical Minoxidil and oral Cilostazol was carried out as treatment. After treatment there was a return of spontaneous growth in about 2 months. Final considerations: embolization with onyx® proved to be a valuable therapeutic option with greater conservation of noble structures in arteriovenous malformations, with a low rate of complications in the medium and long term.

Objetivo: reportar un caso de alopecia transitoria posterior a tratamiento endovascular con exposición radioscópica debido a una malformación arteriovenosa en la cara. Detalle del caso: varón, 34 años, que se queja de una lesión en el ala nasal, labio superior y lado de la cara (derecha). El paciente trajo un examen de angiorresonancia que mostró una malformación arteriovenosa en la cara con nutrición a través de la arteria facial y drenaje a través de la vena mandibular. Como tratamiento se optó por una arteriografía diagnóstica para una mejor valoración de la vascularización de la malformación arteriovenosa seguida de embolización con onyx® (mezcla de copolímero de etileno alcohol vinílico), que proporciona el contraste necesario para la visualización de la mezcla bajo fluoroscopia. El procedimiento se realizó 14 días después de la 1.ª consulta, sin intercurrencias que indicaran éxito terapéutico. A su regreso, a la tercera semana del procedimiento, presenta alopecia sectorial en región occipitoparietal derecha. No había manchas en la región, así como otros síntomas asociados. Como tratamiento se realizó el uso de Minoxidil tópico y Cilostazol oral. Después del tratamiento hubo un retorno del crecimiento espontáneo en aproximadamente 2 meses. Consideraciones finales: la embolización con onyx® demostró ser una valiosa opción terapéutica con mayor conservación de las estructuras nobles en las malformaciones arteriovenosas, con una baja tasa de complicaciones a medio y largo plazo.

Evaluation of the relationship between computed tomography angiography collateral scores and clinical outcome / Avaliação da relação entre escores colaterais da angiotomografia computadorizada e evolução clínica

Abstract Background The relationship between collateral circulation and prognosis after endovascular treatment in anterior circulation strokes has been reported in many studies. Objective In this study, we aimed to compare the predictive power of clinical outcome by comparing five different collateral scores that are frequently used. Methods Among the patients who underwent endovascular treatment in our clinic between November 2019 and December 2021, patients with premorbid mRS < 3, intracranial ICA and/or MCA M1 occlusion, and a pre-procedural multiphase CTA examination were included in the study. Demographic, technical, and duration information about the procedure, major events after the procedure, and clinical outcomes at 3 months were recorded. The mCTA, Tan, Maas, Miteff, and rLMC collateral scores of the patients were evaluated. Results Clinical outcome at 3 months were good in 37 of the 68 patients included in the study (mRS ≤ 2). Only the mCTA and rLMC collateral scores were statistically significantly higher in those with a good clinical outcome. Significant correlation with 3-month mRS was detected only in mCTA and rLMC scores. Although rLMC and mCTA collateral scores showed a statistically significant association with prognosis, they were not sufficient to be an independent predictor of prognosis. Conclusion mCTA and rLMC were found to have the highest predictive power of clinical outcome and the highest correlation with the 3-month clinical outcome. Our study suggests that it would be beneficial to develop a new scoring system over multiphase CTA, which combines regional and temporal evaluation, which are the strengths of both collateral scoring.

Resumo Antecedentes A relação entre circulação colateral e prognóstico após tratamento endovascular em acidentes vasculares cerebrais de circulação anterior tem sido relatada em muitos estudos. Objetivo Neste estudo, nosso objetivo foi comparar o poder preditivo do desfecho clínico comparando cinco escores colaterais diferentes que são frequentemente utilizados. Métodos Entre os pacientes submetidos a tratamento endovascular em nossa clínica entre novembro de 2019 e dezembro de 2021, foram incluídos no estudo pacientes com mRS pré-mórbido < 3, oclusão intracraniana de ICA e/ou MCA M1 e exame de CTA multifásico pré-procedimento. Foram registradas informações demográficas, técnicas e de duração sobre o procedimento, eventos importantes após o procedimento e resultados clínicos em três meses. Foram avaliados os escores colaterais mCTA, Tan, Maas, Miteff e rLMC dos pacientes. Resultados Os resultados clínicos aos três meses foram bons em 37 dos 68 pacientes incluídos no estudo (mRS ≤ 2). Apenas os escores colaterais mCTA e rLMC foram estatisticamente significativamente maiores naqueles com boa evolução clínica. Correlação significativa com mRS de três meses foi detectada apenas nos escores mCTA e rLMC. Embora os escores colaterais de rLMC e mCTA tenham mostrado uma associação estatisticamente significativa com o prognóstico, eles não foram suficientes para serem um preditor independente de prognóstico. Conclusão Verificou-se que mCTA e rLMC têm o maior poder preditivo do resultado clínico e a maior correlação com o resultado clínico de três meses. Nosso estudo sugere que seria benéfico desenvolver um novo sistema de pontuação em vez de CTA multifásico, que combinasse avaliação regional e temporal, que são os pontos fortes de ambas as pontuações colaterais.

Tratamento endovascular de urgência do aneurisma justarrenal utilizando técnica de stents em paralelo / Urgent endovascular treatment of juxtarenal aneurysm using a parallel grafts technique

Resumo O aneurisma da aorta abdominal pode representar um desafio terapêutico em várias condições anatômicas, tornando complexo o seu tratamento endovascular. O aneurisma de aorta abdominal justarrenal (AAA-JR) é definido pela ausência de uma zona proximal de fixação no segmento infrarrenal, e, dessa forma, técnicas são utilizadas para obter um colo adequado para a fixação das endopróteses sem promover a oclusão das artérias renais e dos ramos viscerais. As técnicas de stents em paralelo, fenestração em bancada, customização pela indústria e utilização de endoprótese ramificada de prateleira são utilizadas nos aneurismas abdominais com colo proximal inadequado, porém cada técnica apresenta indicação, limitação e riscos. Neste desafio terapêutico, apresenta-se um caso de tratamento endovascular de urgência de um AAA-JR com a técnica de stents em paralelo com boa evolução a médio prazo e discute-se suas opções terapêuticas.

Abstract Abdominal aortic aneurysms can constitute a therapeutic challenge in several anatomical scenarios, making endovascular treatment more complex. A juxtarenal abdominal aortic aneurysm (JR-AAA) is defined by the absence of a proximal landing zone in the infrarenal segment and, therefore, techniques must be used to obtain an adequate neck for fixing the endoprostheses without provoking occlusion of renal arteries and visceral branches. The parallel grafts technique, physician-modified stent-graft, industry customized endoprostheses, and off-the-shelf branched endoprosthesis are techniques used in abdominal aneurysms with inadequate proximal neck, but each technique has its indications, limitations, and risks. In this therapeutic challenge, we present a case of urgent endovascular treatment of a JR-AAA using a parallel grafts technique, with good medium-term results, and discuss the therapeutic options.

Embolización de aneurismas intracraneales múltiples en sesión única

Objetivo: Determinar los resultados clínicos y angiográficos en pacientes con aneurismas intracraneales múltiples tratados endovascularmente en una única sesión. Materiales y Métodos: Se incluyó a todos los pacientes mayores de 18 años con aneurismas múltiples (≥2), rotos o no rotos, tratados con terapia endovascular en una única sesión entre 2019 y 2021. Se recolectaron los datos clínicos y angiográficos. Se determinó la tasa de oclusión inmediata y del seguimiento. La escala de Rankin modificado se usó para valorar el resultado clínico. Resultados: Se trataron 25 pacientes, de los cuales 14 se presentaron con hemorragia subaracnoidea. Se diagnosticaron un total de 78 aneurismas, de los cuales 59 aneurismas fueron tratados. La localización más frecuente fue el segmento oftálmico. La altura máxima promedio fue de 5.2mm, lo cual tuvo diferencia estadística significativa con el estado de ruptura (p ≤ 0.02). El principal tipo de tratamiento endovascular fue la técnica de remodeling en el 39 % de casos. El Raymond Roy inmediato fue I en el 60 % y IIIa en el 35 % de casos. La tasa de complicaciones fue del 24 % y de mortalidad fue del 8 %. Conclusiones: El tratamiento endovascular en una única sesión es una opción efectiva y segura en casos de aneurismas intracraneales múltiples en nuestra institución con tasa de oclusión y complicaciones aceptable.

Objective: To determine clinical and angiographical outcomes in patients with multiple intracranial aneurysms who underwent endovascular therapy in a single session. Materials and Methods: Patients older than 18 years with multiple (≥2) ruptured or non-ruptured aneurysms were included, and all of them underwent endovascular therapy in a single session between 2019 and 2021. Clinical and angiographic data was collected. Immediate occlusion and follow-up data were collected. Rankin modified scale was used for assessing clinical outcomes. Results: Twenty-five patients were treated, and fourteen had subarachnoid hemorrhage. Seventy-eight aneurysms were diagnosed, and 59 of them were treated. The most frequent location was at the ophthalmic segment. Maximum average height was 5.2- mm, which showed significant statistical difference with a ruptured condition (p≤0.02). The main modality for endovascular therapy was the remodeling technique, which was used in 39% of all cases. Immediate Raymond Roy staging was I in 60% of all cases, and IIIa in 35% of all cases. Complication rate was 24%, and mortality rate was 8%. Conclusions: Single session endovascular therapy is an effective and safe option for cases of multiple intracranial aneurysms in our institution. Occlusion and complication rates were acceptable.

Effect of intensive blood pressure control after successful endovascular therapy on outcomes in patients with anterior circulation stroke: a multicentre, open-label, blinded-endpoint, randomized controlled trial / 国际脑血管病杂志

Objective:To compare the effects of intensive and standard blood pressure control on the outcomes of patients with acute ischemic stroke in the anterior circulation who have successfully recanalized after endovascular therapy (EVT).Methods:A multicenter, open-label, blinded-endpoint, randomized controlled design was used. Patients with anterior circulation stroke received EVT and successfully recanalized in Nanjing First Hospital, Nanjing Medical University and several branch hospitals from July 2020 to October 2022 were prospectively included. They were randomly divided into the intensive blood pressure control group (target systolic blood pressure [SBP] 100-120 mmHg) or the standard blood pressure control group (target SBP 121-140 mmHg). The blood pressure of both groups needs to achieve the target within 1 h and maintain for 72 h. The primary outcome endpoint was outcome at 90 d, and the good outcome was defined as a score of 0-2 on the modified Rankin Scale. Secondary outcome endpoints included early neurological improvement, symptomatic intracranial hemorrhage (sICH) within 24 h, and death and serious adverse events within 90 d.Results:A total of 120 patients were included, including 63 in the intensive blood pressure control group and 57 in the standard blood pressure control group. There was no statistically significant difference in baseline characteristics between the two groups. The SBP at 72 h after procedure was 122.7±8.1 mmHg in the intensive blood pressure control group and 130.2±7.4 mmHg in the standard blood pressure control group, respectively. There were no significantly differences in the good outcome rate (54.0% vs. 54.4%; χ2=0.002, P=0.963), the early neurological improvement rate (45.2% vs. 34.5%; χ2=1.367, P=0.242), the incidence of sICH (6.3% vs. 3.5%; P=0.682), mortality (7.9% vs. 14.0%; χ2=1.152, P=0.283) and the incidence of serious adverse events (12.7% vs. 15.8%; χ2=0.235, P=0.628) at 90 d between the intensive blood pressure control group and the standard blood pressure control group. Conclusion:In patients with anterior circulation stroke and successful revascularization of EVT, early intensive blood pressure control don’t improve clinical outcomes and reduce the incidence of sICH.

Treatment of basilar artery trunk aneurysms / 国际脑血管病杂志

Basilar artery trunk aneurysms (BTAs) are relatively rare, with poor natural prognosis, high disability and mortality rates. The treatment options for BTAs includes conservative treatment, craniotomy, and endovascular treatment. Due to the deep anatomical structure, rich perforating vessels, and complex pathological structure of the basilar artery, craniotomy is more difficult. There is currently no consensus on the treatment of BTAs. This article reviews the current treatment status of BTAs, aiming to provide reference for clinical work.

A decision tree model to predict successful endovascular recanalization of non-acute internal carotid artery occlusion / 国际脑血管病杂志

Objective:To investigate predictive factors for successful endovascular recanalization in patients with non-acute symptomatic internal carotid artery occlusion (SICAO), to develop a decision tree model using the Classification and Regression Tree (CART) algorithm, and to evaluate the predictive performance of the model.Methods:Patients with non-acute SICAO received endovascular therapy at 8 comprehensive stroke centers in China were included retrospectively. They were randomly assigned to a training set and a validation set. In the training set, the least absolute shrinkage and selection operator (LASSO) algorithm was used to screen important variables, and a decision tree prediction model was constructed based on CART algorithm. The model was evaluated using the receiver operating characteristic (ROC) curve, Hosmer-Lemeshow goodness-of-fit test and confusion matrix in the validation set.Results:A total of 511 patients with non-acute SICAO were included. They were randomly divided into a training set ( n=357) and a validation set ( n=154) in a 7:3 ratio. The successful recanalization rates after endovascular therapy were 58.8% and 58.4%, respectively. There was no statistically significant difference ( χ2=0.007, P=0.936). A CART decision tree model consisting of 5 variables, 5 layers and 9 classification rules was constructed using the six non-zero-coefficient variables selected by LASSO regression. The predictive factors for successful recanalization included fewer occluded segments, proximal tapered stump, ASITN/SIR collateral grading of 1-2, ischemic stroke, and a recent event to endovascular therapy time of 1-30 d. ROC analysis showed that the area under curve of the decision tree model in the training set was 0.810 (95% confidence interval 0.764-0.857), and the optimal cut-off value for predicting successful recanalization was 0.71. The area under curve in the validation set was 0.763 (95% confidence interval 0.687-0.839). The accuracy was 70.1%, precision was 81.4%, sensitivity was 63.3%, and specificity was 79.7%. The Hosmer-Lemeshow test in both groups showed P>0.05. Conclusion:Based on the type of ischemic event, the time from the latest event to endovascular therapy, proximal stump morphology, the number of occluded segments, and the ASITN/SIR collateral grading constructed the decision tree model can effectively predict successful recanalization after non-acute SICAO endovascular therapy.

Endovascular mechanical thrombectomy combined with continuous intrasinus thrombolysis for the treatment of severe hemorrhagic cerebral venous sinus thrombosis: a case series study / 国际脑血管病杂志

Objective:To investigate the feasibility and safety of endovascular mechanical thrombectomy (EMT) combined with continuous intrasinus thrombolysis for the treatment of severe hemorrhagic cerebral venous sinus thrombosis (CVST).Methods:The clinical and imaging data of 5 consecutive patients with severe hemorrhagic CVST who received EMT combined with continuous intrasinus urokinase thrombolysis in Beijing Tiantan Hospital from March 2019 to February 2020 were retrospectively analyzed.Results:The average age of 5 patients was 39 years (range, 19-65 years). Two were males and 3 were females. Risk factors associated with CVST were identified in 3 patients. Four had more than two venous sinuses involved, with a total of 10 blood vessels affected by CVST. The affected venous sinus thrombus burden was high, the lesion volume was large, and the clinical manifestations were severe. The average duration of heparin anticoagulation therapy before EMT was 2.3 d (range, 0.5-7 d), and the average duration of intrasinus thrombolysis was 64 h (range, 30-95 h). After treatment, 1 vessel was completely recanalized and 7 vessels were partially recanalized. Four patients who achieved recanalization had good long-term clinical outcomes (modified Rankin Scale score: 0-2 at 3 months, 0-1 at 1 year). One patient failed to achieve recanalization and underwent decompressive craniectomy due to intracranial hypertension, had residual hemiparesis at 1-year follow-up. No procedure-related complications occurred.Conclusion:EMT combined with continuous intrasinus thrombolysis is a potential treatment option for patients with severe hemorrhagic CVST.

Blood pressure variability and outcomes in patients with acute ischemic stroke receiving reperfusion therapy / 国际脑血管病杂志

Stroke has become a major health issue worldwide, bringing a heavy burden to patients, families, and society. Effective reperfusion therapy can significantly improve the outcomes of patients with acute ischemic stroke (AIS). The secondary prevention guidelines in various countries recommend reducing stroke risk by strictly controlling blood pressure. With the widespread application of 24-hour ambulatory blood pressure monitoring, the study of blood pressure variability (BPV) has gradually become a hot topic in the field of stroke prevention and treatment. However, the impact of BPV on the outcomes of patients with AIS receiving reperfusion therapy remains controversial. This article mainly reviews the concept and the related parameters of BPV, as well as the relationship and possible mechanisms between BPV and the outcomes of patients with AIS receiving reperfusion therapy.

Cerebral circulation time: evaluation methods and clinical significance in patients with acute ischemic stroke / 国际脑血管病杂志

Cerebral circulation time is defined as the difference between the time to peak of the cavernous sinus segment of the internal carotid artery and the Trolard vein, which is easily obtained in digital subtraction angiography and is closely associated with hemodynamics. Cerebral circulation time can be used to evaluate the outcome of acute ischemic stroke, especially in patients receiving endovascular treatment. This article reviews the evaluation methods of cerebral circulation time and its clinical significance in patients with acute ischemic stroke.

Postoperative hypoalbuminemia in patients with acute ischemic stroke with successful recanalization by endovascular therapy: risk factors and their impact on outcomes / 国际脑血管病杂志

Objective:To investigate the risk factors of hypoalbuminemia (HA) in patients with acute ischemic stroke (AIS) caused by large vessel occlusion (LVO) after endovascular mechanical thromboectomy (EMT) and impact on outcomes.Methods:Patients first diagnosed with anterior circulation LVO-AIS and underwent emergency EMT at the Department of Acute Stroke, the Affiliated Hospital of Jining Medical University from June 1, 2020 to April 31, 2023 were retrospectively included. According to the first follow-up serum albumin examination after procedure (6-8 d), the patients were divided into HA group (<35 g/L) and non-HA group (≥35 g/L). According to the modified Rankin Scale score at 90 d after EMT, the patients were divided into a good outcome group (0-2) and a poor outcome group (3-6). Univariate and multivariate logistic analysis was used to determine independent risk factors for HA after EMT and their impact on outcomes. Results:A total of 144 patients were enrolled, including 107 males (74.30%) with a median age of 64 years (interquartile range, 56-71 years). There were 50 patients (34.72%) in the HA group and 94 (65.28%) in the non-HA group; 60 (41.67%) in the good outcome group, and 84 (58.33%) in the poor outcome group. Multivariate logistic regression analysis showed that age (odds ratio [ OR] 1.061, 95% confidence interval [ CI] 1.014-1.111; P=0.011) and pulmonary infection ( OR 5.136, 95% CI 1.917-13.760; P=0.001) were independent risk factors for HA; HA ( OR 4.345, 95% CI 1.367-13.814; P=0.013), pneumonia ( OR 5.113, 95% CI 1.217-12.528; P=0.026), and onset to reperfusion time ( OR 5.473, 95% CI 1.090-16.05; P=0.038) were independent risk factors for poor outcomes. Conclusions:Age and pulmonary infection are independent risk factors for HA in LVO-ASI patients after EMT, and HA is the independent risk factor for poor outcomes of the patients.

Solitaire FR with intracranial support catheter for mechanical thrombectomy in patients with progressive cerebral venous sinus thrombosis / 国际脑血管病杂志

Objective:To investigate the safety and effectiveness of Solitaire FR with intracranial support catheter for mechanical thrombectomy (SWIM) in the treatment of cerebral venous sinus thrombosis (CVST).Methods:Patients with progressive CVST treated with SWIM technology in the Neurology Department, Zhongshan Hospital of Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine from June 2019 to March 2022 (including 4 patients with intracranial hemorrhage) were retrospectively included. The venous sinus recanalization after procedure and during follow-up was observed. The modified Rankin Scale (mRS) was used to evaluate the outcome at 3 months after procedure.Results:A total of 9 patients with progressive CVST were treated with SWIM technology, including 6 males with a median age of 37.0 years (range, 15-78). Immediately post-procedural angiography showed complete recanalization of the venous sinuses in 6 cases and partial recanalization in 3 cases. At 3 months after procedure, the mRS score showed that 3 cases was 0, 3 cases was 1, 2 cases was 2, and 1 case was 4.Conclusion:SWIM technology may be a safe and effective method in the treatment of progressive CVST.

Cardio-cerebral infarction / 国际脑血管病杂志

Acute myocardial infarction (AMI) and acute ischemic stroke (AIS) are leading causes of death and disability in the world population. Cardio-cerebral infarction (CCI) is a rare clinical syndrome of AMI combined with AIS, which refers to the critical symptoms of simultaneous acute focal neurological deficits and precordial pain or electrocardiogram changes. The incidence of CCI ranges from 0.09% to 1.6%, but patients have a critical condition, poor prognosis, and high mortality and disability rates. Due to the complexity of the condition, diverse etiology, and limited evidence and mechanistic research, the management of patients with CCI is challenging. This article summarizes the pathogenesis related to CCI, the effectiveness of drug treatment, indications for endovascular treatment, and the selection of surgical sequence, with the aim of shortening thrombolysis/endovascular treatment time and improving outcomes of patients.

Impact of anesthesia modality on functional outcome after endovascular therapy in patients with anterior circulation ischemic stroke aged 80 years and older: comparison between conscious sedation and general anesthesia / 国际脑血管病杂志

Objective:To investigate the impacts of conscious sedation and general anesthesia on the functional outcome after endovascular therapy (EVT) in elderly patients with acute ischemic stroke with large vessel occlusion (AIS-LVO).Methods:The clinical and imaging data of elderly patients with AIS-LVO (≥80 years) underwent EVT at the Affiliated Hospital of Nantong University from January 2020 to January 2023 were collected retrospectively. They were divided into conscious sedation group and general anesthesia group according to anesthesia modality, and divided into good outcome group (0-2 points) and poor outcome group (>2 points) based on the modified Rankin Scale score at 90 d after onset. The multivariate logistic regression analysis was used to investigate the impact of anesthesia modality on functional outcome after EVT. Results:A total of 77 elderly patients with AIS-LVO were enrolled, including 35 males (45.5%) and 42 females (54.5%); median age of 82.0 years (interquartile range, 80.0 to 84.0 years); the median baseline NIHSS score was 16.0 (interquartile range, 10.0-20.0). Conscious sedation was used in 21 cases (27.3%) and general anesthesia was used in 56 cases (72.7%); 17 (22.1%) had good outcome, while 60 (77.9%) had poor outcome. Compared with the general anesthesia group, the conscious sedation group had a longer procedure time (110.0 min vs. 89.0 min; P=0.049), but a higher rate of good outcome at 90 d (38.1% vs. 16.1%; P=0.038), a lower incidence of stroke-associated pneumonia (33.3% vs. 58.9%; P=0.045), and a lower proportion of patients who underwent tracheostomy after procedure (4.8% vs. 25.0%; P=0.046). Compared with the poor outcome group, the good outcome group had shorter procedure time (75 min vs. 99 min; P=0.033), lower incidence of stroke-associated pneumonia (29.4% vs. 58.3%; P=0.035), lower tracheotomy rate (0% vs. 25%; P=0.022), and a lower proportion of patients who received conscious sedation (47.1% vs. 21.7%; P=0.038). Multivariate logistic regression analysis showed that conscious sedation was an independent predictor of good outcome (odds ratio 0.090, 95% confidence interval 0.010-0.771; P=0.028). Conclusion:Conscious sedation may be more appropriate for elderly patients with anterior circulation AIS-LVO undergoing endovascular treatment.