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A 51‐year‐old male underwent vitrectomy with retrobulbar anesthesia for retinal detachment. Post surgery, he experienced systemic hypotension which normalized after 3 h. The day after, he complained of a central scotoma in the operated eye. Intraocular pressure was normal, but fundus examination revealed hemorrhages and whitening along the papillomacular bundle and macula, with additional whitening in the upper midperipheral region. Multimodal imaging confirmed branch retinal vein, artery, and cilioretinal artery occlusion. Further examination revealed mild‐to‐moderate obstructive sleep apnea syndrome. Vascular occlusions are potential complications of vitreoretinal surgery, warranting thorough preoperative assessment for underlying risk factors, even if causative mechanism is still unknown. [ABSTRACT FROM AUTHOR]

Introduction: The sheathless transradial (TR) technique is a novel approach that may offer potential benefits over the conventional TR approach. We aim to comprehensively investigate the safety and efficacy of sheathless versus conventional TR percutaneous coronary interventions (PCIs). Methods: We conducted comprehensive searches across PubMed, CENTRAL, Web of Science (WOS), Scopus, and EMBASE until July 2023. Pooled data were reported using risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes, along with a 95% confidence interval (CI). PROSPERO ID: CRD42023443834. Results: We included 11 studies with 15,392 patients. The radial artery spasm (RAS) (RR: 0.26, 95% CI: [0.09, 0.77], p = 0.02) and cross‐over to the femoral site (RR: 0.28, 95% CI: [0.10, 0.81], p = 0.02) were significantly lower in the sheathless group. However, radial artery occlusion (RAO) (RR: 2.84, 95% CI: [1.78, 4.54], p < 0.0001) and success rate (RR: 1.011, 95% CI: [1.004, 1.019], p = 0.002) were significantly higher in the sheathless group. Also, we did not find a significant difference between both groups in all‐cause mortality (RR: 0.41, 95% CI: [0.16, 1.04], p = 0.06). Conclusion: The sheathless TR approach showed lower rates of RAS and femoral conversion. Sheathless has a higher success rate; however, it also increased RAO. Thus, more trials are needed to confirm this technique's long‐term outcomes and complications. [ABSTRACT FROM AUTHOR]

Background: With the launch of mechanical thrombectomy (MT), the prognosis of patients with cerebral infarction associated with large-vessel occlusion has improved. However, good outcomes are still not achieved in a few patients because of technical difficulties. Case presentation: A 79-year-old Japanese woman was admitted with sudden-onset left hemiplegia. Tissue plasminogen activator was administered and MT was performed for internal carotid artery occlusion distal to a large paraclinoid aneurysm. Some technical difficulties were unique, including contrast agent retention, difficulty in guiding the system, and avoidance of rupture of the aneurysm. Here, we discuss the technical issues and solutions of the MT procedure employed in this case. Conclusions: The procedure used in flow-diverter devices should be referenced and a stent-retrieving into an aspiration catheter with proximal balloon technique may be the most appropriate method. [ABSTRACT FROM AUTHOR]

Background: One key focus of partial nephrectomy is preserving renal function. Segmental renal artery occlusion with microdissection at the renal hilum confines ischemia, effectively reducing warm ischemic injury. Ultrasound-Guided Renal Artery Balloon Catheter Occluded Hybrid Partial Nephrectomy (UBo-HPN) can achieve branch occlusion without the need for dissecting the renal hilum. Objective: To investigate the feasibility and safety of UBo-HPN of branch renal artery occlusion in the treatment of localized renal tumors. Subject and methods: A prospective single-arm analysis involving 20 patients with renal localized tumors underwent robot assisted UBo-HPN with branch renal artery occlusion from August 2021 to July 2023, with an average follow-up of 12 months. Results: All patient was successfully operated on without conversion to conventional arterial clamping or radical nephrectomy. One case (5%) of minor complication occurred in the whole cohort, which was bruising around the puncture site. The mean total operative time was 95.8 min, with a mean operative time of 21.25 min for vascular intervention. The mean warm ischemia time was 20.35 min, and the median estimated blood loss was 50 ml. The median eGFR preservation percentage at postoperative 48 h, 30 days, and the latest follow-up were 87.52%, 91.47%, and 92.2%, respectively. After a median follow-up of 10.2 (2.3–19.2) months, no patients had radiological tumor recurrence or died from tumor-related causes. Conclusions: UBo-HPN with renal artery branch occlusion emerges as an efficient alternative to partial nephrectomy (PN), which achieved branch artery occlusion without dissecting the renal hilum. Long-term follow-up is expected for functional outcomes. [ABSTRACT FROM AUTHOR]

Background: Psilocybin is a psychedelic 5HT2A receptor agonist found in "magic mushrooms". Recent studies have indicated that 5HT2A agonists, such as dimethyltryptamine, given before middle cerebral artery occlusion (MCAo), improve staircase behavior, increased BDNF expression, and reduce brain infarction in stroke rats. The objective of this study is to determine the protective effect of psilocybin in cellular and animal models of stroke. Methods: Adult male and timed-pregnant Sprague-Dawley rats were used for this study. The neural protective effects of psilocybin were determined in primary rat cortical neurons and adult rats. Rats were subjected to a 60-min middle cerebral artery occlusion. Brain tissues were collected for histological and qRTPCR analysis. Results: Psilocybin reduced glutamate-mediated neuronal loss in rat primary cortical neuronal cultures. Psilocybin-mediated protection in culture was antagonized by the BDNF inhibitor ANA12. Pretreatment with psilocybin reduced brain infarction and neurological deficits in stroke rats. Early post-treatment with psilocybin improved locomotor behavior, upregulated the expression of MAP2 and synaptophysin, and down-regulated the expression of IBA1 in the stroke brain. ANA12 significantly attenuated psilocybin-mediated reduction in brain infarction and improvements in locomotor behavior. Conclusions: Psilocybin reduced brain infarction and improved locomotor behavior in stroke rats; the protective mechanisms involve regulating BDNF expression. Our data support a novel therapeutic approach of psilocybin in stroke. Highlights: Psilocybin reduced glutamate-mediated neuronal loss in primary cortical neuronal cultures. ANA12 reduced psilocybin-mediated protection in culture. Psilocybin reduced brain infarction, reduced neurological deficits, and increased locomotor behavior in stroke rats. Psilocybin enhanced the expression of MAP2 and synaptophysin, and down-regulated IBA1 in the stroke rat brain. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Early diagnosis of large vessel occlusion (LVO) in acute stroke often requires CT angiography (CTA). Automated CT perfusion (CTP) software, which identifies blood flow abnormalities, enhances LVO diagnosis and patient selection for endovascular thrombectomy (EVT). This study evaluates the sensitivity of automated CTP images in detecting perfusion abnormalities in patients with acute ischemic stroke (AIS) and LVO or medium vessel occlusion (MeVO), compared to CTA.We screened acute ischemic stroke patients presenting within 24 h who underwent CT, CTA, and CTP as per institutional protocol. RAPID AI software processed CTP images, while neuroradiologists reviewed CTA for intracranial arterial occlusions. Sensitivity, specificity, and accuracy of automated CTP maps in detecting occlusions were assessed.Of 790 screened patients, 31 were excluded due to lack of RAPID CTP data or poor‐quality scans, leaving 759 for analysis. The median age was 71 years (IQR: 61–81), with 47% female. Among them, 678 had AIS, and 81 had AIS ruled out. CTA identified arterial occlusion in 562 patients (74%), with corresponding CTP abnormalities in 537 patients (Tmax > 6 sec). In the 197 without occlusion, CTP was negative in 161. Automated CTP maps had a sensitivity of 95.55% (CI 95: 93.50–97.10%), specificity of 81.73% (CI 95: 75.61–86.86%), negative predictive value of 98.22% (CI 95: 97.39–98.79%), positive predictive value of 63.54% (CI 95: 56.46–70.09%), and overall accuracy of 85.18% (CI 95: 82.45–87.64%).Automated CTP maps demonstrated high sensitivity and negative predictive value for LVOs and MeVOs, suggesting their usefulness as a rapid diagnostic tool, especially in settings without expert neuroradiologists. [ABSTRACT FROM AUTHOR]

Out-of-hospital cardiac arrest (OHCA) is a global health problem affecting approximately 4.4 million individuals yearly. OHCA has a poor survival rate, specifically when unwitnessed (accounting for up to 75% of cases). Rapid recognition can significantly improve OHCA survival, and consumer wearables with continuous cardiopulmonary monitoring capabilities hold potential to "witness" cardiac arrest and activate emergency services. In this study, we used an arterial occlusion model to simulate cardiac arrest and investigated the ability of infrared photoplethysmogram (PPG) sensors, often utilized in consumer wearable devices, to differentiate normal cardiac pulsation, pulseless cardiac (i.e., resembling a cardiac arrest), and non-physiologic (i.e., off-body) states. Across the classification models trained and evaluated on three anatomical locations, higher classification performances were observed on the finger (macro average F1-score of 0.964 on the fingertip and 0.954 on the finger base) compared to the wrist (macro average F1-score of 0.837). The wrist-based classification model, which was trained and evaluated using all PPG measurements, including both high- and low-quality recordings, achieved a macro average precision and recall of 0.922 and 0.800, respectively. This wrist-based model, which represents the most common form factor in consumer wearables, could only capture about 43.8% of pulseless events. However, models trained and tested exclusively on high-quality recordings achieved higher classification outcomes (macro average F1-score of 0.975 on the fingertip, 0.973 on the finger base, and 0.934 on the wrist). The fingertip model had the highest performance to differentiate arterial occlusion pulselessness from normal cardiac pulsation and off-body measurements with macro average precision and recall of 0.978 and 0.972, respectively. This model was able to identify 93.7% of pulseless states (i.e., resembling a cardiac arrest event), with a 0.4% false positive rate. All classification models relied on a combination of time-, power spectral density (PSD)-, and frequency-domain features to differentiate normal cardiac pulsation, pulseless cardiac, and off-body PPG recordings. However, our best model represented an idealized detection condition, relying on ensuring high-quality PPG data for training and evaluation of machine learning algorithms. While 90.7% of our PPG recordings from the fingertip were considered of high quality, only 53.2% of the measurements from the wrist passed the quality criteria. Our findings have implications for adapting consumer wearables to provide OHCA detection, involving advancements in hardware and software to ensure high-quality measurements in real-world settings, as well as development of wearables with form factors that enable high-quality PPG data acquisition more consistently. Given these improvements, we demonstrate that OHCA detection can feasibly be made available to anyone using PPG-based consumer wearables. [ABSTRACT FROM AUTHOR]

Postoperative care is essential to upper extremity replantation success and includes careful and frequent monitoring of the replanted part. During this period, pharmacologic agents such as antithrombotic and anticoagulants may prevent complications such as arterial thrombosis and venous congestion. Dressings and therapy can also impact short- and long-term outcomes following replantation. This article reviews the literature to provide guidance for postoperative protocols following upper extremity replantation. [ABSTRACT FROM AUTHOR]

Lipids and their bioactive metabolites, notably lysophosphatidylcholine (LPC), are increasingly important in ischemic stroke research. Reduced plasma LPC levels have been linked to stroke occurrence and poor outcomes, positioning LPC as a potential prognostic or diagnostic marker. Nonetheless, the connection between plasma LPC levels and stroke severity remains unclear. This study aimed to elucidate this relationship by examining plasma LPC levels in conjunction with brain LPC levels to provide a deeper understanding of the underlying mechanisms. Adult male Sprague–Dawley rats underwent transient middle cerebral artery occlusion and were randomly assigned to different groups (sham-operated, vehicle, LPC supplementation, or LPC inhibition). We measured multiple LPC species in the plasma and brain, alongside assessing sensorimotor dysfunction, cerebral perfusion, lesion volume, and markers of BBB damage, inflammation, apoptosis, and oxidative stress. Among five LPC species, plasma LPC(16:0) and LPC(18:1) showed strong correlations with sensorimotor dysfunction, lesion severity, and mechanistic biomarkers in the rat stroke model. Despite notable discrepancies between plasma and brain LPC levels, both were strongly linked to functional outcomes and mechanistic biomarkers, suggesting that LPC's prognostic value is retained extracranially. This study advances the understanding of LPC as a blood marker in ischemic stroke and highlights directions for future research to further elucidate its association with stroke severity, particularly through investigations in more clinically representative models. [ABSTRACT FROM AUTHOR]

Introduction : In this study, we aimed to evaluate and compare whether perioperative additional intravenous (IV) Iloprost therapy to percutaneous balloon angioplasty for peripheral arterial occlusive disease improves patency and reintervention. Methods : Between January 2018 and August 2020, 183 patients underwent Percutaneous transluminal angioplasty (PTA) with Drug-Eluting Balloons (DEB) for femoropopliteal lesions (TASC 2 A-C) due to claudication, and 161 patients (133 male, 28 female, mean age 63.65 ± 11.16 years, range 30-86 years) were included in this study. The patients were divided into two groups as DEB+ Intravenous Iloprost administration and DEB alone. Primary patency, reintervention, bailout stenting, and survival rates were analyzed in this retrospective study. Results : Primary patency rate at 12 months (79 vs 57 patients, 89.7 vs 78%, p = 0.041) and assisted primary patency rate (81 vs 59 patients, 92 vs 80.8%, p = 0.035) were found to be higher and Bailout stent deployment was lower in DEB + Iloprost group (3 vs 9 patients, 3.4 vs 12.3% p = 0.031). The reinterventions rate at 12 months was also lower among the DEB + Iloprost group (9 vs 16 patients, 10.2 vs 21.9%, p = 0.041). Conclusion : The present study demonstrated that primary patency at 12 months and assisted primary patency rates, freedom from reintervention was significantly higher and bailout stenting was found to be significantly lower. We believe that perioperative Intravenous Iloprost therapy is beneficial for PTA and improves outcomes. [ABSTRACT FROM AUTHOR]

The article highlights a significant advantage of endovascular thrombectomy for patients suffering from acute basilar artery occlusion, showing that the positive outcomes not only sustained at three months but also improved at one year. Topics discussed include the comparison of endovascular therapy to medical management, the differing results of various trials in assessing treatment effectiveness, and the implications of one-year outcomes for patients with basilar artery occlusions.

Purpose: To develop thrombus radiomics models based on dual-energy CT (DECT) for predicting etiologic cause of stroke. Methods: We retrospectively enrolled patients with occlusion of the middle cerebral artery who underwent computed tomography (NCCT) and DECT angiography (DECTA). 70 keV virtual monoenergetic images (simulate conventional 120kVp CTA images) and iodine overlay maps (IOM) were reconstructed for analysis. Five logistic regression radiomics models for predicting cardioembolism (CE) were built based on the features extracted from NCCT, CTA and IOM images. From these, the best one was selected to integrate with clinical information for further construction of the combined model. The performance of the different models was evaluated and compared using ROC curve analysis, clinical decision curves (DCA), calibration curves and Delong test. Results: Among all the radiomic models, model NCCT+IOM performed the best, with AUC = 0.95 significantly higher than model NCCT, model CTA, model IOM and model NCCT+CTA in the training set (AUC = 0.88, 0.78, 0.90,0.87, respectively, P < 0.05), and AUC = 0.92 in the testing set, significantly higher than model CTA (AUC = 0.71, P < 0.05). Smoking and NIHSS score were independent predictors of CE (P < 0.05). The combined model performed similarly to the model NCCT+IOM, with no statistically significant difference in AUC either in the training or test sets. (0.96 vs. 0.95; 0.94 vs. 0.92, both P > 0.05). Conclusion: Radiomics models constructed based on NCCT and IOM images can effectively determine the source of thrombus in stroke without relying on clinical information. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to investigate whether the spatial coefficient of variation of arterial spin labeling (ASL-CoV) acquired in clinical settings can be used to estimate decreased cerebrovascular reactivity (CVR) measured with single-photon emission computed tomography (SPECT) and acetazolamide challenge in patients with atherosclerotic stenosis of intra- or extracranial arteries. Methods: We evaluated the data of 27 atherosclerotic stenosis patients who underwent pseudocontinuous ASL and SPECT. After spatial normalization, regional values were measured using the distributed middle cerebral artery territorial atlas of each patient. We performed comparisons, correlations, and receiver operating characteristic (ROC) curve analyses between ASL-cerebral blood blow (CBF), ASL-CoV, SPECT-CBF and SPECT-CVR. Results: Although the ASL-CBF values were positively correlated with SPECT-CBF values (r = 0.48, 95% confidence interval (CI) = 0.28–0.64), no significant difference in ASL-CBF values was detected between regions with and without decreased CVR. However, regions with decreased CVR had significantly greater ASL-CoV values than regions without decreased CVR. SPECT-CVR was negatively correlated with ASL-CoV (ρ = -0.29, 95% CI = -0.49 - -0.06). The area under the ROC curve of ASL-CoV in predicting decreased CVR (0.66, 95% CI = 0.51–0.81) was greater than that of ASL-CBF (0.51, 95% CI = 0.34–0.68). An ASL-CoV threshold value of 42% achieved a high specificity of 0.93 (sensitivity = 0.42, positive predictive value = 0.77, and negative predictive value = 0.75). Conclusion: ASL-CoV acquired by single postlabeling delay without an acetazolamide challenge may aid in the identification of patients with decreased CVR on SPECT. [ABSTRACT FROM AUTHOR]

Contemporary quality control methods are often insufficient in predicting clinical outcomes after revascularization in lower extremity arterial disease (LEAD) patients. This study evaluates the potential of near-infrared fluorescence imaging with indocyanine green to predict the clinical outcome following revascularization. Near-infrared fluorescence imaging was performed before and within 5 days following the revascularization procedure. Clinical improvement was defined as substantial improvement of pain free walking distance, reduction of rest- and/or nocturnal pain, or tendency toward wound healing. Time-intensity curves and 8 perfusion parameters were extracted from the dorsum of the treated foot. The quantified postinterventional perfusion improvement was compared within the clinical outcome groups. Successful near-infrared fluorescence imaging was performed in 72 patients (76 limbs, 52.6% claudication, 47.4% chronic limb-threatening ischemia) including 40 endovascular- and 36 surgical/hybrid revascularizations. Clinical improvement was observed in 61 patients. All perfusion parameters showed a significant postinterventional difference in the clinical improvement group (P -values <.001), while no significant differences were seen in the group without clinical improvement (P -values.168–.929). Four parameters demonstrated significant differences in percentage improvement comparing the outcome groups (P -values within.002–.006). Near-infrared fluorescence imaging has promising additional value besides clinical parameters for predicting the clinical outcome of revascularized LEAD patients. [ABSTRACT FROM AUTHOR]

Objectives This study reported a single-center clinical trial of endovascular treatment for symptomatic nonacute occlusion of the intracranial large artery (NA-ILAO). The aim of this study was to evaluate the safety, feasibility, and clinical effect of simple balloon dilatation and stent implantation. Methods The patients diagnosed with symptomatic NA-ILAO were enrolled. A total of 40 cases were included in this study. While recanalization failed in 4 patients, it was successful in 36 patients, who were then divided into two groups for further analysis: balloon dilatation group (n = 24) and stent implantation group (n = 12). The perioperative complications, clinical outcome, and follow-up results were analyzed. Results Perioperative complications in the stent implantation group were significantly higher than those in the simple balloon dilatation group (p < 0.05). There were 21 and 10 cases of 90-day good clinical outcome (modified Rankin scale [mRS] ≤ 2) in the balloon and stent groups, respectively (p = 0.518). All patients with successful recanalization underwent digital subtraction angiography (DSA) or CT angiography (CTA) during an average follow-up of 14 months. There were two cases of restenosis in the balloon dilatation group and one in the stent implantation group (p = 1.000). There were two cases of re-occlusion in the stent group and none in the balloon dilatation group (p < 0.001). Stroke recurred in two cases in the stent group and in one case in the simple balloon dilatation group (p = 0.013). Conclusion Endovascular recanalization is safe and feasible for patients with symptomatic NA-ILAO. Compared with stent implantation, simple balloon dilation may be a better recanalization method, but larger randomized controlled trials are needed to confirm it. [ABSTRACT FROM AUTHOR]

Lower limb arterial occlusive disease is treated with intraluminal devices, such as paclitaxel (PTX)-coated balloons (PCBs); however, post-procedural restenosis remains a significant challenge. NLRP3 activation is known to play a significant role in atherosclerosis, but its involvement in restenosis following PCB intervention remains to be investigated. We identified that NLRP3 was differentially expressed in lower-limb arterial tissues sourced from healthy controls and patients with arterial occlusive disease. Through cell experiments, we confirmed that PTX is involved in the activation of NLRP3. Subsequently, we demonstrated that NLRP3 activation promotes the proliferation and migration of vascular smooth muscle cell (VSMC), thereby reducing their sensitivity to PTX. NLRP3 activation also stimulates the secretion of the inflammatory cytokine interleukin IL-1β. RNA sequencing of IL-1β-treated VSMC revealed the upregulation of BRD4 and LIN9. Further mechanistic investigations confirmed that IL-1β facilitates BRD4 recruitment, leading to enhanced LIN9 expression. The transcription factor LIN9 binds to the promoter region of the cell-cycle regulator AURKA, thereby promoting its transcription and subsequently upregulating the expression of the cell proliferation-associated molecule FOXM1. These processes ultimately mediate the proliferation, migration, and PTX resistance of VSMC. Additionally, we discovered that JQ1 inhibited the overexpression of the above molecules, and exhibited a synergistic effect with PTX. Our conclusions were validated through in vivo experiments in Sprague-Dawley rats. Collectively, our findings provide insights into the molecular mechanisms underlying restenosis following PCB therapy, and suggest that the combined use of JQ1 and PTX devices may represent a promising therapeutic strategy. [ABSTRACT FROM AUTHOR]

Stroke related to large vessel occlusion is a leading cause of disability and death worldwide. Advances in endovascular therapy to reopen occluded arteries have been shown to reduce patient disability and mortality. Expanded indications to treat patients with large vessel occlusion in the late window (>6 h from symptom onset), with basilar artery occlusion, and with large ischaemic core at presentation have enabled treatment of more patients with simplified imaging methods. Ongoing knowledge gaps include an understanding of which patients with large ischaemic infarct are more likely to benefit from endovascular therapy, the role of endovascular therapy in patients who present with low National Institutes of Health Stroke Scale scores or medium or distal vessel occlusion, and optimal management of patients with underlying intracranial atherosclerotic disease. As reperfusion can now be facilitated by intravenous thrombolysis, mechanical thrombectomy, or both, the development of cytoprotective or adjunctive drugs to slow infarct growth, enhance reperfusion, or decrease haemorrhagic risk has gained renewed interest with the hope to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Introduction Aims Methods Results Conclusion Limb dominancy has been suggested, by some, to influence arterial occlusion pressure (AOP). However, we hypothesized that the differences in AOP between the dominant and nondominant legs were more likely explained by differences in cuff position.To determine the impact of limb dominance, composition, and cuff position on AOP in the context of error associated with measuring AOP twice on the same leg.Fifty‐eight adults (30 males) volunteered to have AOP measured on their dominant legs with the cuff bladder covering their inner thighs and on their nondominant legs with the bladder covering their inner and outer thighs (in random order). Thigh circumference and muscle and fat thicknesses were also measured on each leg.We found evidence for differences in AOP between legs [median δ of −0.222, 95% credible interval: (−0.429, −0.016)] when the cuff position was matched. The mean difference was −2.8 mmHg, and the 95% limit of agreement in a Bland–Altman plot was −24.8 to 19.0 mmHg. When plotting this alongside an error range (i.e., 95% limits of agreement) of taking the same measurement twice from our previous study (Spitz et al., 2020), 52 out of 58 measurements were within the error range. This difference was not due to the cuff position. Additionally, there was no evidence that thigh circumference or composition (muscle/fat thickness) moderated any difference between limbs.The difference in AOP between limbs is small and is mostly indistinguishable from the difference observed from taking the measurement twice on the same limb. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of this paper are to evaluate the incidence of early graft occlusion during hospital stays following coronary bypass surgery (CABG) and to assess the factors influencing the odds of in-hospital early graft occlusion. Methods: Reports evaluating the early in-hospital occlusion of coronary bypass grafts were identified through PubMed, Embase, and Cochrane databases. The primary endpoint was to determine the incidence of early graft occlusion following CABG before discharge and to identify and quantify the impact of demographic, clinical, and procedural risk factors on the occurrence of early graft occlusion. The meta-analysis was conducted using a random-effects inverse-variance model with the DerSimonian–Laird estimator, assessing incidence rates, risk factors, and study heterogeneity, with statistical analysis performed using Stata. Results: A total of 22 studies with 35,798 patients were included in the analysis. The overall incidence of in-hospital early graft occlusion was 5% (95% CI: 3% to 7%). In studies using symptom-driven patency assessment, the incidence of occlusion was 2%, whereas in those employing systematic graft patency assessment, it was 6%. Only the presence of a vein graft OR 2.13 (95% CI: 1.19–3.82) was significantly associated with in-hospital graft occlusion. Conclusions: The incidence of in-hospital early graft occlusion seems substantially underestimated if imaging is restricted only to symptomatic patients. Moreover, female gender, increased PI, and the presence of a composite graft could also be potential risk factors for this complication. [ABSTRACT FROM AUTHOR]

Background: Transfemoral access (TFA) is a valuable alternative to upper extremity access (UEA) for branched endovascular aortic repair (bEVAR). However, TFA requires large introducer sheaths, which can reduce blood flow to lower limbs and the pelvis. This study aimed to evaluate the efficacy of sheath downsizing to maintain lower limb perfusion during TFA–bEVAR. Methods: A single-center retrospective review was conducted including patients managed with TFA-performed bEVAR between December 2020 and May 2021. Intra-operative lower limb perfusion was assessed using non-invasive ankle blood pressure measurements and great toe pulse oximetry, with measurements being taken prior to puncture (baseline), one minute after 10F-sheath insertion, three minutes after the main body delivery system insertion, and three minutes after downsizing to a 14F sheath. Outcomes included the incidence of limb perfusion reduction (LPR), defined as a drop in the ankle–brachial index (ABI) < 0.5 or peripheral oxygen saturation (SpO2) < 90%. Results: Out of 47 patients, 24 met the inclusion criteria. LPR occurred in 4.2% of cases after 10F-sheath placement, and 87.5% after main body delivery system placement, and decreased to 12.6% after downsizing to a 14F sheath. No periprocedural major bleeding occurred. Two patients required revision for inadequate hemostasis post-operatively. SCI occurred in 16% of patients, all recovered by discharge. Pre-operative hypogastric artery occlusion was related to persistent LPR after downsizing (100% vs. 16%, p = 0.009). Conclusions: Downsizing the introducer sheath during bEVAR is feasible and safe to restore lower limb and pelvic perfusion. Further research is needed to clarify the access downsizing value during bEVAR. [ABSTRACT FROM AUTHOR]

Background and Purpose: Thrombo‐inflammation is a key feature of stroke pathophysiology and provides multiple candidate drug targets. Thrombin exerts coagulation‐independent actions via protease‐activated receptors (PAR), of which PAR1 has been implicated in stroke‐associated neuroinflammation. The role of PAR4 in this context is less clear. This study examined if the selective PAR4 antagonist ML354 provides neuroprotection in experimental stroke and explored the underlying mechanisms. Experimental Approach: Mouse primary cortical neurons were exposed to oxygen–glucose deprivation (OGD) and simulated reperfusion ± ML354. For comparison, functional Ca2+‐imaging was performed upon acute stimulation with a PAR4 activating peptide or glutamate. Male mice underwent sham operation or transient middle cerebral artery occlusion (tMCAO), with ML354 or vehicle treatment beginning at recanalization. A subset of mice received a platelet‐depleting antibody. Stroke size and functional outcomes were assessed. Abundance of target genes, proteins, and cell markers was determined in cultured cells and tissues by qPCR, immunoblotting, and immunofluorescence. Key Results: Stroke up‐regulated PAR4 expression in cortical neurons in vitro and in vivo. OGD augments spontaneous and PAR4‐mediated neuronal activity; ML354 suppresses OGD‐induced neuronal excitotoxicity and apoptosis. ML354 applied in vivo after tMCAO reduced infarct size, apoptotic markers, macrophage accumulation, and interleukin‐1β expression. Platelet depletion did not affect infarct size in mice with tMCAO ± ML354. Conclusions and Implications: Selective PAR4 inhibition during reperfusion improves infarct size and neurological function after experimental stroke by blunting neuronal excitability, apoptosis, and local inflammation. PAR4 antagonists may provide additional neuroprotective benefits in patients with acute stroke beyond their canonical antiplatelet action. [ABSTRACT FROM AUTHOR]

Moyamoya disease, characterized by basal cerebral artery obstruction, was studied for differential protein expression to elucidate its pathogenesis. Proteomic analysis of cerebrospinal fluid from 10 patients, categorized by postoperative angiography into good and poor prognosis groups, revealed 46 differentially expressed proteins. Notably, cadherin 18 (CDH18) was the most significantly upregulated in the good prognosis group. In addition, the expression of cadherin 18 (CDH18) and phenotypic transformation-related proteins were measured by qRT-PCR and western blot. The effects of CDH18 in vascular smooth muscle cells were detected by CCK-8, EdU, transwell and wound healing assays. The overexpression of CDH18 in vascular smooth muscle cells (VSMCs) was found to inhibit proliferation, migration, and phenotypic transformation. These findings suggest CDH18 as a potential therapeutic target in moyamoya disease. [ABSTRACT FROM AUTHOR]

Brain edema robustly increases mortality and hinders functional recovery after acute ischemic stroke. However, there are currently no effective therapies available for treating or preventing it. The unchecked opening of the transient receptor potential M4 (TRPM4) channel results in an excessive influx of Na+ and water, which contributes significantly to the formation of brain edema after ischemic stroke. 9‐phenanthrol (9‐Phe), a potent TRPM4 inhibitor, has limited clinical applicability due to its potential cytotoxicity and poor solubility. A brain‐targeting T7 (HAIYPRH)‐modified lipid nanoparticle (LNP) encapsulated 9‐Phe (9‐Phe@T7‐LNP) is designed and synthesized to improve the physicochemical properties and pharmacokinetic properties of 9‐Phe for treating brain edema in vivo. These results demonstrated that 9‐Phe@T7‐LNP can penetrate the intact blood‐brain barrier (BBB) in normal mice and target the brain parenchyma. Moreover, 9‐Phe@T7‐LNP effectively reduced infarct volume and brain edema, prevented neuronal loss and BBB disruption, improved survival, and facilitated neurological function recovery after transient middle cerebral artery occlusion in mice. Additionally, 9‐Phe@T7‐LNP scavenged oxygen‐free radicals and prevented neuronal apoptosis in cultured neurons subjected to oxygen and glucose deprivation/reperfusion. In summary, these findings showed that 9‐Phe@T7‐LNP holds strong potential as a promising targeted therapy for brain edema after stroke, providing superior pharmacological neuroprotection against brain edema. [ABSTRACT FROM AUTHOR]

Ischemic stroke is a common cause of mortality and severe disability in human and currently lacks effective treatment. Neuronal activation and neuroinflammation are the major two causes of neuronal damage. However, little is known about the connection of these two phenomena. This study uses middle cerebral artery occlusion mouse model and chemogenetic techniques to study the underlying mechanisms of neuronal excitotoxicity and severe neuroinflammation after ischemic stroke. Chemogenetic inhibition of neuronal activity in ipsilesional M1 alleviates infarct area and neuroinflammation, and improves motor recovery in ischemia mice. This study identifies that ischemic challenge triggers neuron to produce unique small extracellular vesicles (EVs) to aberrantly activate adjacent neurons which enlarge the neuron damage range. Importantly, these EVs also drive microglia activation to exacerbate neuroinflammation. Mechanistically, EVs from ischemia-evoked neuronal activity induce neuronal apoptosis and innate immune responses by transferring higher miR-100-5p to adjacent neuron and microglia. MiR-100-5p can bind to and activate TLR7 through U18U19G20-motif, thereby activating NF-κB pathway. Furthermore, knock-down of miR-100-5p expression improves poststroke outcomes in mice. Taken together, this study suggests that the combination of inhibiting aberrant neuronal activity and the secretion of specific EVs-miRNAs may serve as novel methods for stroke treatment. [ABSTRACT FROM AUTHOR]

Acute mesenteric ischaemia (AMI) is a serious disease with mortality between 50 and 80 %. Oxidative stress plays a major role in the pathophysiology of AMI. AMI should be considered for any acute abdominal pain that requires analgesia with morphine and for which no other obvious aetiology is found. CT is the main diagnostic procedure to confirm the diagnosis of AMI. There is no specific diagnostic biomarker for AMI that can be used in routine practice. AMI is an urgent diagnostic and therapeutic situation. Treatment of AMI includes a protocol combining digestive rest, curative anticoagulant, antiplatelet, antibiotic therapy, arterial revascularisation to salvage viable bowel and resection of necrotic digestive segments. The strategy of revascularisation depends on the mechanism of arterial occlusion, the morphological appearance of the lesions and the indications for exploratory laparotomy. Endovascular and open surgical techniques can be combined and complemented. Open surgical revascularisation is indicated in case of failure or impossibility of endovascular revascularisation and in case of need for laparotomy. Early diagnosis and timely surgical intervention are the cornerstones of modern treatment to reduce the high mortality of AMI. The emergence of endovascular approaches and modern imaging techniques is developing and providing new treatment options. A multidisciplinary approach based on early diagnosis and treatment is necessary. [ABSTRACT FROM AUTHOR]

We have previously demonstrated a rapid secretion of matrix metalloproteinase‐2 (MMP‐2) in the ischemic brain. Since Scube2 can interact with Sonic hedgehog (Shh) to maintain blood–brain barrier (BBB) integrity via regulating the interaction between brain capillary endothelial cells (ECs) and perivascular astrocytes, and it is also a substrate of MMP‐2, we hypothesized that the secreted MMP‐2 could degrade Scube2 and contribute to ischemic BBB disruption. Using an in vitro ischemic model of 90‐min oxygen–glucose deprivation/3‐h reoxygenation (OGD/R) and an in vivo mouse stroke model of 90‐min middle cerebral artery occlusion (MCAO) with 3‐h reperfusion, we established an important role of MMP‐2‐mediated Scube2 degradation in early ischemic BBB disruption. Exposure of C8‐D1A cells and bEnd.3 cells to OGD/R increased MMP secretion in both cells, and C8‐D1A cells appeared to secrete more MMPs than bEnd.3 cells. Co‐IP and double‐immunostaining revealed that Scube2 co‐localized well with MMP‐2 in C8‐D1A cells and could be pulled down by MMP‐2 antibodies. In MCAO mice, Scube2 protein showed a drastic reduction in ischemic brain tissue, which was accompanied by suppressed expression of Shh and its downstream molecules. Of note, specific knockdown of astrocytic Scube2 with AAV‐shScube2 augmented MCAO‐induced Shh suppression and exacerbated BBB leakage and inflammatory reactions in the ischemic brain. Last, incubation of bEnd.3 cells with conditioned medium derived from OGD‐treated C8‐D1A cells led to a significant inhibition of the Shh pathway in bEnd.3 cells and degradation of VE‐cadherin and ZO‐1. Inhibition of MMP‐2 with SB‐3CT or over‐expression of Scube2 with plasmids in C8‐D1A cells alleviated the above effect of C8‐D1A cells‐derived conditioned medium. Taken together, our data indicate that ischemia‐induced secretion of MMP‐2 may contribute to early BBB disruption in ischemic stroke via interrupting the shared Scube2‐Shh pathway between brain capillary ECs and perivascular astrocytes. [ABSTRACT FROM AUTHOR]

Background: The neurovascular unit (NVU) and neurovascular trophic coupling (NVTC) play a key regulatory role in brain injury caused by ischemic stroke. Salvianolic acids (SAL) and Panax notoginseng saponins (PNS) are widely used in China to manage ischemic stroke. Neuroprotective effects of SAL and PNS, either taken alone or in combination, were examined in this research. Methods: Wistar rats were randomly divided into the following groups: Sham group (Sham), cerebral ischemia/reperfusion group (I/R), I/R with SAL group (SAL), I/R with PNS group (PNS), I/R with SAL combined with PNS (SAL + PNS), and I/R with edaravone group (EDA). Treatment was administered once daily for two days after modeling of middle cerebral artery occlusion/reperfusion (MCAO/R). Results: Compared with the I/R group, SAL, PNS, or SAL + PNS treatment reduced infarct size, improved neurological deficit score, reduced Evans blue extravasation, increased expression of CD31 and tight junction proteins (TJs), including zonula occludens‐1 (ZO‐1), zonula occludens‐2 (ZO‐2), and junctional adhesion molecule‐1 (JAM‐1). Furthermore, SAL, PNS, or SAL + PNS suppressed the activations of microglia and astrocyte and led to the amelioration of neuron and pericyte injury. Treatment also inhibited NVU dissociation of GFAP/PDGFRβ and Collagen IV/GFAP while upregulated the expression level of BDNF/TrkB and BDNF/NeuN. Conclusions: SAL and PNS have significantly remedied structural and functional disorders of NVU and NVTC in I/R injury. These effects were more pronounced when SAL and PNS were combined than when used separately. [ABSTRACT FROM AUTHOR]

Rapid identification of the type and origin of a stroke is crucial for prompt and appropriate treatment, which can significantly influences patient outcomes. We report a multidisciplinary management case involving a 76-year-old man who presented with left-sided weakness and mild dysarthria. Imaging revealed a completely occluded right internal carotid artery. Despite multiple endovascular recanalization attempts, adequate flow could not be achieved, leading to the decision to perform an open thrombo-endarterectomy. The patient underwent carotid endarterectomy with microsurgical techniques under general anesthesia. The atheroma plaque and central thrombus were removed, which reestablished flow. Continuous intraoperative neuromonitoring was utilized to ensure patient safety. The patient woke up without new deficits and was discharged for rehabilitation. Follow-up imaging confirmed arterial patency, and the patient eventually made an excellent recovery, including being independent over one and a half years. Emergent recanalization with carotid endarterectomy following a failed endovascular recanalization is both safe and feasible, emphasizing the need for collaboration between different treatment providers to ensure optimal patient outcomes. Our report highlights the importance of a multidisciplinary approach and the advantages of a hybrid operating room in the treatment of acute complete carotid artery occlusion. [ABSTRACT FROM AUTHOR]

Aim: Central retinal artery occlusion (CRAO) leads to significant, non-painful loss of sight due to retinal infarction. Most CRAO patients have atherosclerotic risk factors. Pulse wave velocity (PWV) and Flow-mediated dilatation (FMD) can provide insights into the onset and development of atherosclerosis. This research aims to assess arterial stiffness measures and identify endothelial dysfunction in individuals with CRAO. Materials and Methods: 33 consecutive CRAO patients (63 ± 7 years, 21 men (63.6%)) were recruited in the study. 35 age/sex-matched participants were included as a control group. FMD and PWV were measured from the brachial artery, as indicators of endothelial dysfunction and atherosclerosis in the arterial wall, respectively. Additionally, the transthoracic echocardiographic parameters of the patients were investigated. Results: CRAO patients had significantly higher frequencies of hypertension, hyperlipidemia, and smoking status. Furthermore, the frequency of diabetes was also higher in the CRAO group, but this difference did not reach statistical significance. CRAO patients showed markedly elevated PWV and reduced FMD. However, no notable differences were observed between groups in terms of left ventricle systolic and diastolic functions. Conclusion: Our study showed that CRAO patients may have increased arterial stiffness and endothelial dysfunction. Systemic endothelial dysfunction and atherosclerosis may be linked to the development of CRAO. [ABSTRACT FROM AUTHOR]

Glutamine is a critical amino acid that serves as an energy source, building block, and signaling molecule for the heart tissue and the immune system. However, the role of glutamine metabolism in regulating cardiac remodeling following myocardial infarction (MI) is unknown. In this study, we show in adult male mice that glutamine metabolism is altered both in the remote (contractile) area and in infiltrating macrophages in the infarct area after permanent left anterior descending artery occlusion. We found that metabolites related to glutamine metabolism were differentially altered in macrophages at days 1, 3, and 7 after MI using untargeted metabolomics. Glutamine metabolism in live cells was increased after MI relative to no MI controls. Gene expression in the remote area of the heart indicated a loss of glutamine metabolism. Glutamine administration improved left ventricle (LV) function at days 1, 3, and 7 after MI, which was associated with improved contractile and metabolic gene expression. Conversely, administration of BPTES, a pharmacological inhibitor of glutaminase-1, worsened LV function after MI. Neither glutamine nor BPTES administration impacted gene expression or bioenergetics of macrophages isolated from the infarct area. Our results indicate that glutamine metabolism plays a critical role in maintaining LV contractile function following MI and that glutamine administration improves LV function. Glutamine metabolism may also play a role in regulating macrophage function, but macrophages are not responsive to exogenous pharmacological manipulation of glutamine metabolism. NEW & NOTEWORTHY: Glutamine metabolism is altered in both infarct macrophages and the remote left ventricle (LV) following myocardial infarction (MI). Supplemental glutamine improves LV function following MI while inhibiting glutamine metabolism with BPTES worsens LV function. Supplemental glutamine or BPTES does not impact macrophage immunometabolic phenotypes after MI. [ABSTRACT FROM AUTHOR]

The establishment of a peripheral ECMO circuit can lead to significant arterial and venous complications in 10–30% of patients. Vascular complications, particularly acute limb ischemia, are associated with worsening overall outcomes. Limb ischemia occurs significantly more frequently in the early stages of VA ECMO than in VV ECMO. Mechanisms of limb ischemia include arterial obstruction, cannulation injury, loss of pulsatile flow, thromboembolism, venous stasis from compressive obstruction with large venous cannulas, and systemic vasoconstriction due to shock and pharmacologic vasoconstriction. The care team may use several mitigation strategies to prevent limb ischemia. Arterial and venous complications can be mitigated by careful access site selection, minimizing cannula size, placement of distal perfusion and/or outflow catheter(s), and continuous NIRS monitoring. Rapid intervention, when ischemia or compartment syndrome occurs, can reduce limb loss but may not affect the mortality and morbidity of the ECMO patient in the long term due to their underlying conditions and the etiology of the ECMO need. [ABSTRACT FROM AUTHOR]

While there has been an increase in the use of the transradial approach when performing percutaneous coronary angiography and intervention, there is evidence of variations in international practice. Ensuring that operators' practices are supported by evidence is important to ensure optimal outcomes. Interventional cardiologists and advanced trainees completed a cross-sectional survey followed by semi-structured interviews to map current practices for transradial coronary artery procedures in Australia and New Zealand and explore factors that influence clinical decision-making around procedural practice. The right radial artery was the preferred access site (88%). Over a third (37%) of the participants indicated that they tested the hand circulation pre-procedure. Over a quarter of respondents (28.6%) reported that they would carry out transradial procedures regardless of the patient's coagulation status. Most participants (77.8%) described radial artery spasm in around 10% of transradial procedures performed. Only 62% of participants assessed for radial artery occlusion post-catheterisation. Interview data revealed four themes that guided clinical decision-making, namely (1) Decision-making based on research, (2) Using clinical experience, (3) Being led by their training, and (4) Individual patient factors. This study has demonstrated that despite clinical guidelines, substantial practice variation exists in transradial coronary artery catheterisation across Australia and New Zealand. The variation in practice and factors impacting clinical decision-making highlight a need for future strategies to optimise evidence translation and implementation across clinical settings. [ABSTRACT FROM AUTHOR]

Ischemic stroke-induced mitochondrial dysfunction in the blood-brain barrier-forming brain endothelial cells (BECs) results in long-term neurological dysfunction post-stroke. We previously reported data from a pilot study where intravenous administration of human BEC (hBEC)-derived mitochondria-containing extracellular vesicles (EVs) showed a potential efficacy signal in a mouse middle cerebral artery occlusion (MCAo) model of stroke. We hypothesized that EVs harvested from donor species homologous to the recipient species (e.g. , mouse) may improve therapeutic efficacy, and therefore, use of mouse BEC (mBEC)-derived EVs may improve post-stroke outcomes in MCAo mice. We investigated potential differences in the mitochondria transfer of EVs derived from the same species as the recipient cell (mBEC-EVs and recipient mBECs or hBECs-EVs and recipient hBECs) vs. cross-species EVs and recipient cells (mBEC-EVs and recipient hBECs or vice versa). Our results showed that while both hBEC- and mBEC-EVs transferred EV mitochondria, mBEC-EVs outperformed hBEC-EVs in increasing ATP levels and improved recipient mBEC mitochondrial function via increasing oxygen consumption rates. mBEC-EVs significantly reduced brain infarct volume and neurological deficit scores compared to vehicle-injected MCAo mice. The superior therapeutic efficacy of mBEC-EVs in MCAo mice support the continued use of mBEC-EVs to optimize the therapeutic potential of mitochondria-containing EVs in preclinical mouse models. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: To compare distal (dTRA) and classical (cTRA) transradial approaches for coronary catheterization with respect to puncture attempts, puncture time, operator and patient comfort, and safety outcomes. Methods: In this prospective observational study, patients undergoing coronary catheterization for standard indications via dTRA or cTRA approaches from July 2019 to May 2020 were included. Clinicodemographic and laboratory characteristics were recorded. Puncture time, number of puncture attempts, operator and patient comfort on the visual analogue scale (VAS), and access site complications like hematoma and radial artery occlusion were recorded. Patients were analyzed in the same group as the initial puncture, even if there was a cross-over. Results: Of the 130 patients (40.8% women), 50.8% and 49.2% belonged to dTRA and cTRA groups, respectively. dTRA group required more than one puncture attempt more frequently than cTRA group (30.3% vs. 15.6%; P=.047); consequently, puncture time was longer (60s vs. 50s; P=.031, respectively). However, puncture time was comparable if the puncture was successful in the first attempt (47.5s vs. 45s; P=.492). Patient comfort was comparable (7.2 ± 0.9 vs. 7.2 ± 1.2; P=.852), but operator comfort was more with cTRA approach (8.3 ± 1.6 vs. 8.8 ± 1.2; P=.048). Post-procedure, cTRA had more minor bleeding than dTRA approach. There was no major bleeding in either group. The occurrence of radial artery occlusion was comparable in both groups. Conclusion: Although dTRA needed more attempts for successful puncture, puncture time was comparable with cTRA when puncture was successful on the first attempt. Therefore, one attempt at dTRA puncture could be a reasonable approach in patients undergoing coronary catheterization. [ABSTRACT FROM AUTHOR]

Acute basilar artery occlusion (ABAO) accounts for 1% of all ischemic stroke cases, but has a high rate of severe complications and mortality (75-91%). Intracranial atherosclerosis is an significant cause of ischemic stroke. Revascularization using stents has shown good efficacy. However, intra-stent thrombosis and in-stent restenosis (ISR) are significant complications following stent placement. Drug-coated balloons (DCB), coated with the anti-proliferative drug paclitaxel (an inhibitor of endothelial proliferation), can prevent in-stent restenosis. Successful use of DCB dilation in the coronary and lower extremity vasculature has been reported. In our case, a 68-year-old Chinese male with ABAO was successfully revascularized by DCB dilation and showed dramatic improvement in stroke symptoms. This report may inform future treatment of patients with ABAO. [ABSTRACT FROM AUTHOR]

Significance: Near‐infrared spectroscopy (NIRS) measurement is a widely used technique to measure muscle oxygenation. A knowledge of the reproducibility of NIRS measurements is essential for the correct interpretation of data. Aim: Our aim was to test the reproducibility and sex differences of NIRS measurements during brachial artery occlusion in healthy participants. Approach: An NIRS device was used to measure muscle oxygenation and microvascular function during a 5 min brachial occlusion. Muscle oxygen consumption (mVO2) and tissue saturation index (TSI%) were used. The occlusion test was performed three times on separate days for males (n = 13, 28 ± 8 years) and females (n = 13, 29 ± 7 years). Results: During the occlusion phase, the reproducibility of mVO2 was excellent (intraclass correlation; ICC = 0.90). During the reperfusion phase, the maximal change in TSI% revealed the best reproducibility (ICC = 0.77). There were no sex differences in reproducibility. Male participants had higher muscle oxygenation during occlusion (mVO2, 0.054 ± 0.010 vs. 0.038 ± 0.012 mLO2/min/100 g, p = 0.001, male and female, respectively). There were no sex differences during the reperfusion phase. Conclusion: The reproducibility of NIRS to measure muscle oxygenation and microvascular function during circulation occlusion and reperfusion is good to excellent. Muscle oxygen capacity measured during occlusion is higher in males compared to females, and there are no sex differences in microvascular function during the reperfusion phase. [ABSTRACT FROM AUTHOR]

Our study aimed to assess the influence of incorporating new oral anticoagulant (NOAC) therapy on clinical outcomes among patients who underwent endovascular intervention for below-the-knee (BTK) occlusions necessitating reintervention. The inclusion criteria encompassed patients with chronic limb-threatening ischemia (CLTI) and had undergone a successful endovascular intervention for BTK artery occlusion, necessitating reintervention. Patients who underwent endovascular interventions for BTK reocclusion were compared to those who received dual-pathway inhibition with NOAC (rivaroxaban 2.5 mg 2 × 1) and clopidogrel (NOAC group), or dual-antiplatelet therapy with clopidogrel and aspirin (DAPT group). The primary endpoints were target vessel reocclusion and target lesion revascularization (TLR) at the 1-year follow-up, while major and minor amputations served as the secondary endpoint. Additionally, a one-year comparison was conducted between the two groups for major bleeding events. 64 patients in our clinic treated with endovascular reintervention (NOAC = 28, DAPT = 34). The TLR rate is 10.7% in NOAC group (N = 3) and 32.4% in DAPT group (N = 11, p = 0.043). The target vessel reocclusion rate is 17.8% in NOAC group (N = 5) and 41.2% in DAPT group (N = 14, p = 0.048). Minor or major amputation rate at 1-year follow-up was 3.6% in NOAC group (N = 1) and 11.7% in DAPT group (N = 4, p = 0.245). The patency rate is significantly higher, and the TLR rate is significantly lower in the NOAC group compared to the DAPT group, with no significant difference in major bleeding between the two groups. Although no statistically significant difference exists in amputation rates, a numerical distinction is evident. [ABSTRACT FROM AUTHOR]

Stroke is a leading cause of morbidity and mortality in humans. Most strokes are ischemic in nature and early recanalization of occluded vessels determines good outcomes. Recanalization of occluded vessels depends on many angiographic and demographic features. These factors need to be identified for better patient overall outcomes. Better preoperative knowledge of factors can help in customizing our treatment approach and explaining the prognosis to the guardians of the patients. We aim to share our institutional experience with mechanical thrombectomy (MT) for stroke and studied factors that affect an angiographic recanalization of vessels. A retrospective single-center study was conducted involving 104 patients who underwent MT at our institution between January 2016 and December 2019. Patient demographics, baseline characteristics, pre- and postprocedural imaging findings, and other clinical data were meticulously reviewed. We divided patients into successful recanalization (modified thrombolysis in cerebral ischemia [mTICI] 2b or 3) and unsuccessful recanalization (mTICI 2a or 1) groups and various factors were analyzed to evaluate their impact on recanalization rates. In the univariate analysis, a significant association was observed between successful recanalization and several factors: the absence of rheumatic heart disease (RHD) as a risk factor (p = 0.035), the presence of a hyperdense vessel sign (p = 0.003), and the use of treatment methods including aspiration (p = 0.031), stent retriever (p = 0.001), and Solumbra (p = 0.019). However, in the multivariate analysis, none of these factors exhibited statistical significance. The presence of RHD is a risk factor associated with poor angiographic recanalization in all three MT treatment modalities. Based on the above variables we can guide the patients/relatives prior to MT procedure for their better outcome and risk–benefit ratio. [ABSTRACT FROM AUTHOR]

Pyroptosis has been regarded as caspase-1-mediated monocyte death that induces inflammation, showing a critical and detrimental role in the development of cerebral ischemia-reperfusion injury (IRI). MARCH1 is an E3 ubiquitin ligase that exerts potential anti-inflammatory functions. Therefore, the study probed into the significance of MARCH1 in inflammation and pyroptosis elicited by cerebral IRI. Middle cerebral artery occlusion/reperfusion (MCAO/R)-treated mice and oxygen glucose deprivation/reoxygenation (OGD/R)-treated hippocampal neurons were established to simulate cerebral IRI in vivo and in vitro. MARCH1 and PCSK9 expression was tested in MCAO/R-operated mice, and their interaction was identified by means of the cycloheximide assay and co-immunoprecipitation. The functional roles of MARCH1 and PCSK9 in cerebral IRI were subsequently determined by examining the neurological function, brain tissue changes, neuronal viability, inflammation, and pyroptosis through ectopic expression and knockdown experiments. PCSK9 expression was increased in the brain tissues of MCAO/R mice, while PCSK9 knockdown reduced brain damage and neurological deficits. Additionally, inflammation and pyroptosis were inhibited in OGD/R-exposed hippocampal neurons upon PCSK9 knockdown, accompanied by LDLR upregulation and NLRP3 inflammasome inactivation. Mechanistic experiments revealed that MARCH1 mediated ubiquitination and degradation of PCSK9, lowering PCSK9 protein expression. Furthermore, it was demonstrated that MARCH1 suppressed inflammation and pyroptosis after cerebral IRI by downregulating PCSK9 both in vivo and in vitro. Taken together, the present study demonstrate the protective effect of MARCH1 against cerebral IRI through PCSK9 downregulation, which might contribute to the discovery of new therapies for improving cerebral IRI. [ABSTRACT FROM AUTHOR]

Key points: ICA coil extrusion (ICA‐CE) occurs most frequently in the nasopharyngeal/sinonasal site.Evaluating the ICA coils stability, through an angiography, is of primary importance.ICA‐CE management needs to be decided based on the patient's symptoms and general status. [ABSTRACT FROM AUTHOR]

Background: Cerebral Revascularization (CR) remained an indispensable arm in the neurosurgical arsenal, especially managing symptomatic hemisphere with misery perfusion (SHMP). Method: We described an a mid-aged gentleman diagnosed with progressive middle cerebral steno-occlusion following carotid endarterectomy by employing individualized arterial reconstruction with tentative clamping method (TCM) under supervision of intraoperative monitoring. An operative video was also accompanied to demonstrate further details. Conclusion: The optimal treatment strategy for SHMP should be tailored by individuals. The risk of postoperative adverse sequel can be minimized and improved neuro-cognitive status was accomplished with an aid of TCM for such prophylactic procedure. Clinical trial registration: NA. [ABSTRACT FROM AUTHOR]

Background: Patients with symptomatic chronic internal carotid artery occlusion (ICAO) face a high risk of recurrent stroke despite receiving aggressive medical therapy. This study aimed to evaluate the effectiveness and safety of hybrid surgery in treating symptomatic chronic ICAO. Methods: This retrospective case series was conducted at a single center. From January 2019 to December 2022, patients with symptomatic chronic ICAO who underwent hybrid surgery were included. We collected baseline data, lesion characteristics, revascularization rates, perioperative complications, and follow-up outcomes. Results: The study enrolled 27 patients, comprising 22 males and 5 females, with symptomatic chronic ICAO. The hybrid surgery achieved a technical success rate of 100% for revascularization (n = 27), with a perioperative complication rate of 14.8% (n = 4). Following a median follow-up of 6.0 months (IQR, 4–10), 21 patients underwent a DSA or CT angiography reexamination, confirming a vascular patency rate of 90.5% (n = 19). One patient required surgery for severe in-stent restenosis, and another experienced asymptomatic occlusion. Clinical follow-ups were conducted for all 26 patients; no new strokes were reported in the qualifying artery territory, with 13 patients scoring 0, 12 scoring 1, and 1 scoring 2 on the mRS. Conclusion: Although hybrid surgery represent a promising option for treating chronic ICAO, they are also associated with a relatively high incidence of treatment-related complications. The application of composite surgery should be based on standardized technical guidelines and the careful selection of patients who are genuinely at high risk for recurrent strokes. [ABSTRACT FROM AUTHOR]

The prompt initiation of stroke treatment significantly influences patient outcomes, highlighting the crucial role of prehospital triage. This study aimed to assess the implementation of the 7-Item Japan Urgent Stroke Triage (JUST-7) score by emergency medical services (EMS) in our region and its effect on emergency transportation for suspected stroke patients. Data were collected from patients suspected of having an acute stroke with a Cincinnati Prehospital Stroke Scale (CPSS) score of 1 or more who were transferred by ambulance within 24 h of symptom onset. Two prehospital stroke scales were employed during different periods: period 1 with CPSS alone (January to December 2020) and period 2 with both CPSS and JUST-7 (January 2021 to March 2023). On-scene time data were obtained from the EMS crews, and data regarding the final diagnosis of patients and their outcomes were obtained from the respective hospitals to which the patients were transferred. These data were compared between periods 1 and 2 and between the CPSS and JUST-7. The results revealed that additional evaluation with JUST-7 did not affect ambulance transport time. The CPSS+JUST-7 approach demonstrated higher specificity in identifying stroke and major artery occlusion than with the CPSS alone; however, an appropriate cut-off value needs to be considered. The JUST-7 achieved a diagnostic concordance rate of 35.9% for the most likely stroke type and 64.0% for the first two most likely types. This research emphasizes the potential of JUST-7 as a valuable addition to prehospital stroke diagnosis protocols. Its flexibility in adapting cut-off values based on regional factors and available medical resources optimizes its utility in diverse healthcare settings. The JUST-7 score is a promising tool for improving patient outcomes through prompt and accurate prehospital assessments. [ABSTRACT FROM AUTHOR]

Background: We sought to examine the feasibility, safety and preliminary efficacy of anterior cerebral artery (ACA) occlusions in patients undergoing endovascular treatment. Methods: Four hundred five consecutive patients with large-vessel occlusion treated with endovascular treatment were analysed to identify all patients with acute ACA occlusion who underwent endovascular treatment. Results: Twenty had ACA occlusion (primary ACA occlusion: 9, rescue ACA occlusion: 11), 395 patients had other occlusions (internal carotid artery and MCA). The median [IQR] mRS score in the third month was significantly higher in the ACA-rescue occlusion group versus the ACA-primary occlusion group. The rate of haematoma in patients with ACA-occlusions was significantly higher compared with the ACA-primary occlusion group. Moreover, the three-month mortality rate was higher in patients with ACA-rescue than the patients with ACA-primary. Conclusions: Although endovascular treatment can be considered in patients with primary ACA occlusions, our data suggest that future clinical trials are needed to determine the efficacy of endovascular treatment for ACA occlusions. Unfavourable outcomes in our study were considered to occur in the rescue ACA occlusions. [ABSTRACT FROM AUTHOR]

Acute myocardial infarction (AMI) is a severe disease caused by the persistent coronary artery obstruction, posing a great threat to people's health. In recent years, Toll-like receptor 4 (TLR4), an important pattern recognition receptor, has been widely studied and found to play a crucial role in AMI. This review introduces the recent progress of TLR4 in regulating the progression and prognosis of AMI, and summarizes recent TLR4-targeted therapies using clinical drugs, TLR4 inhibitors, mesenchymal stem cells, and natural bioactive molecules, providing valuable insights for addressing myocardial damage caused by AMI and improving prognosis. [ABSTRACT FROM AUTHOR]

Purpose: Superior vena cava (SVC) syndrome is a constellation of symptoms that results from partial or complete SVC obstruction. Endovascular SVC stenting is an effective treatment for SVC syndrome with rapid clinical efficacy and low risk of complications. In this study, we assess the technical and clinical outcomes of a cohort of patients with SVC syndrome treated with the AbreTM self-expanding venous stent (Medtronic, Inc, Minneapolis, MN, USA). Methods: An institutional database was used to retrospectively identify patients with SVC syndrome treated with AbreTM venous self-expanding stent placement between 2021-2023. Patient demographic data, technical outcomes, treatment effectiveness, and adverse events were obtained from the electronic medical record. Nineteen patients (mean age 58.6) were included in the study. Thirteen interventions were performed for malignant compression of the SVC, 5 for central venous catheter-related SVC stenosis, and 1 for HD fistula-related SVC stenosis refractory to angioplasty. Results: Primary patency was achieved in 93% of patients (17/19). Two patients (7%) required re-intervention with thrombolysis and angioplasty within 30 days post-stenting. Mean duration of clinical and imaging follow-up were 228.7 ± 52.7 and 258.7 ± 62.1 days, respectively. All patients with clinical follow-up experienced significant improvement in clinical symptoms post-intervention. No stent related complications were identified post-intervention. Conclusions: Treatment of SVC syndrome with the AbreTM self-expanding venous stent has high rates of technical and clinical success. No complications related to stent placement were identified in this study. [ABSTRACT FROM AUTHOR]

One of the most feared and devastating complications of carotid revascularization procedures is hyperperfusion hemorrhage. The acute onset of an ipsilateral mydriatic pupil following carotid endarterectomy (CEA) or carotid artery stenting (CAS) should prompt immediate neurosurgical evaluation to rule out hyperperfusion injury. We describe a case of benign, transient ipsilateral mydriasis following CAS. After undergoing right common and internal carotid artery (ICA) angioplasty and stenting with distal embolic protection, the patient developed anisocoria with a right-sided 5 mm minimally reactive pupil. Imaging demonstrated no acute pathology, and the mydriasis resolved spontaneously within 48 hours. We hypothesise that the pathophysiologic mechanism is secondary to transient ischemia of parasympathetic structures within the petrous/cavernous ICA from arterial ostium occlusion that occurred during device placement. Alternatively, sympathetic stimulation during angioplasty is also plausible. Although an ipsilateral mydriatic pupil following carotid revascularization necessitates evaluation, it may represent a self-limiting process especially in the absence of other focal neurologic deficits. [ABSTRACT FROM AUTHOR]

Objective Patients with secondary RP show a wide range of symptoms depending on the condition of vascular structures. If the symptoms are localized to specific fingers and angiography reveals a discrete segment of occlusion of a proper digital artery, we perform proper digital artery reconstruction with an interposition vein graft. The objective of this study was to evaluate the results of the surgery in patients with chronic hand ischaemia. Methods A retrospective chart review was performed on patients who underwent proper digital artery reconstruction. Each digit that underwent grafting was analysed separately. The results of surgical intervention and recurrence based on patient symptoms were evaluated. Cox proportional hazards regression models were used to identify independent risk factors associated with recurrence, and the Kaplan–Meier method was used to predict the 5-year recurrence-free rate. Results A total of 79 digits from 57 patients were included in this study. The majority of patients demonstrated resolution of ischaemic pain and ulceration (97.5% and 95.3%, respectively). Recurrence occurred in 16 (20.3%) patients during the follow-up period. In two cases (2.5%) surgery had no effect. In the multivariate Cox regression analysis, smoking and concomitant periarterial sympathectomy were significant factors associated with recurrence. In the Kaplan–Meier analysis, the 5-year recurrence-free rate in the total study population was 69.3%. Conclusions Digital artery reconstruction using an interposition vein graft is an effective procedure for improving ischaemic pain and ulceration in patients with RP. Smoking and concomitant periarterial sympathectomy were significantly associated with recurrence. [ABSTRACT FROM AUTHOR]

The retina is one of the highest metabolically active tissues with a high oxygen consumption, so insufficient blood supply leads to visual impairment. The incidence of related conditions is increasing; however, no effective treatment without side effects is available. Furthermore, the pathomechanism of these diseases is not fully understood. Our aim was to develop an optimal ischemic retinopathy mouse model to investigate the retinal damage in a time-dependent manner. Retinal ischemia was induced by bilateral common carotid artery occlusion (BCCAO) for 10, 13, 15 or 20 min, or by right permanent unilateral common carotid artery occlusion (UCCAO). Optical coherence tomography was used to follow the changes in retinal thickness 3, 7, 14, 21 and 28 days after surgery. The number of ganglion cells was evaluated in the central and peripheral regions on whole-mount retina preparations. Expression of glial fibrillary acidic protein (GFAP) was analyzed with immunohistochemistry and Western blot. Retinal degeneration and ganglion cell loss was observed in multiple groups. Our results suggest that the 20 min BCCAO is a good model to investigate the consequences of ischemia and reperfusion in the retina in a time-dependent manner, while the UCCAO causes more severe damage in a short time, so it can be used for testing new drugs. [ABSTRACT FROM AUTHOR]

Transcatheter heart valve (THV) procedures require careful planning and consideration to prevent coronary artery obstruction (CAO), which poses a significant and potentially life-threatening condition, especially in patients undergoing valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR). Despite identifying predictors of CAO and utilization of computed tomography and inputting THV features, a significant uncertainty remains in predicting CAO. The ShortCut™ device (Pi-Cardia, Rehovot, Israel) was purposefully designed to modify the leaflets in patients undergoing TAVR, especially prior to ViV procedures, to overcome the risk for CAO. This review aims to detail the device's objectives, structure, procedural steps, the available clinical data, and future directions for its intended utilization in the structural arena for the prevention of CAO. Central illustration. Leaflet modification with the ShortCut™ device to prevent coronary artery obstruction during TAVR. [Display omitted] • Coronary artery obstruction during TAVI is a life-threatening condition. • Leaflet modification reduces the risk for coronary artery obstruction. • The ShortCut device is a dedicated leaflet modification device. • Further clinical trials should evaluate these devices' efficacy and safety. [ABSTRACT FROM AUTHOR]