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Supplemental Digital Content is available in the text, Thrombotic thrombocytopenic purpura (TTP) is a life-threatening disease, and its mortality rate is 10% to 20%. However, there are currently only a few markers to predict the prognosis in patients with TTP. We aimed to identify several clinical indices and laboratory parameters for predicting the prognosis of TTP at admission. A single-centre observational cohort study that included patients with TTP from the First Affiliated Hospital of Zhengzhou University in China was conducted from January 1, 2012 to November 30, 2018. The primary outcome was prognosis, including in-hospital mortality, major thromboembolic events, or failure to achieve remission at discharge. We used the random forest method to identify the best set of predictors. Eighty-seven patients with TTP were identified, of whom 12 died during the treatment. The total number of patients within-hospital mortality, major thromboembolic events, and failure to achieve remission at discharge was 58. The machine learning method showed that the D-dimer level was the strongest predictor of the primary outcome. Receiver operating characteristic (ROC) analysis demonstrated that the sensitivity and specificity of the D-dimer level alone for identifying high-risk patients were 78% and 81%, respectively, with an optimum diagnostic cut-off value of 770 ng/mL. The area under the ROC curve (AUC) was 0.80, and the 95% confidence interval (CI) was 0.70 to 0.90. This study found that the D-dimer level exhibited a good predictive ability for prognosis in patients with TTP. These findings may aid in the development of new and intensive treatment strategies to achieve remission among high-risk patients. However, external validation is necessary to confirm the generalizability of our approach across populations and treatment practices.

One case had a symptomatic vertebral artery stenosis coupled with a coincidental unruptured cerebral aneurysm at the same arterial anatomic segment. And another case had an asymptomatic vertebral artery stenosis coupled with a ruptured cerebral aneurysm at the same arterial anatomic segment. They underwent intracranial stenting. Both lesions were treated successfully and neither complications nor strokes occurred after the procedures. Covered stent placement in an intracranial stenosis with an adjacent ruptured or unruptured aneurysm may be a feasible method.

Headache is a clinical diagnosis linked to a number of medical and surgical disorders. A common etiology has not yet been established. It would seem that these cases can be related to some degree of cerebral venous outflow obstruction. We report 2 cases of chronic superior sagittal sinus thrombosis causing isolated intracranial hypertension. The patients were treated with intrasinus thrombolytic therapy.

AIM This study aims to investigate the influence of different surgical timing on outcome of patients with aneurysmal subarachnoid hemorrhage and to explore the surgical techniques for ruptured intracranial aneurysms. MATERIAL AND METHODS The clinical data were from 327 cases. 304 cases of the surgical group were further assigned to early surgery (89 cases), intermediate surgery(164 cases) and delayed surgery(51 cases) according to the surgical timing. The other 23 cases were the nonsurgical group. The ultimate outcome of all cases was graded according to the Glasgow Outcome Scale. After the cases of the no-surgical group were re-assigned to different surgical subgroups according to the rebleeding time, the ultimate outcome was graded once more. RESULTS There was no significant difference among the 3 groups' pre-operative clinical data. After re-assigning the cases of no-surgical group to the different surgical subgroups, there was no significant difference among the 3 groups' preooperative clinical data, while the ultimate outcome grades of early surgery (3.6 ± 1.8) and intermediate surgery (3.5 ± 2.2) were superior to that of delayed surgery (2.9 ± 2.8). CONCLUSION This retrospective study has demonstrated that early surgery can not only prevent re-rupture of aneurysm to decrease mortality rate but also improve the ultimate outcome.

Objective To explore and evaluate the efficacy of intrasinus thrombolysis (IST) in patients with cerebral venous sinus thrombosis (CVST) during postpartum period. Methods 11 patients during postpartum period with CVST who received IST during July 2007–November 2011 were included. Urokinase was infused into the sinuses via a microcatheter. Magnetic resonance venography (MRV) was performed to assess the recanalization of venous sinuses. Results Before discharge, the intracranial pressure in 11 patients was under 200 mmH 2 O. MRV confirmed that venous sinus of 9 patients were smooth. The cortex venous and deep venous recovered to normal. Venous sinus of 2 patients recanalized partly, and cortex venous and deep venous had compensation. 9 patients had good outcome and 2 patients had only mild deficits. Conclusion Intrasinus thrombolysis is safe and effective in patients with severe cerebral venous sinus thrombosis during postpartum period.

A significant proportion of patients with infarcts from large-vessel lesions have shown a poor response to systemic thrombolysis. Stents have been used to recanalize occluded or severely stenosed intracranial arteries in patients with acute stroke. This study evaluated the feasibility, efficacy, and safety of intracranial artery recanalization for acute middle cerebral artery (MCA) occlusion using emergent angioplasty and stent placement without thrombolysis. All patients from a retrospectively collected database who met the inclusion criteria and were treated with an intracranial stent for acute MCA occlusion were included. Treatment comprised angioplasty and stenting without interventional thrombolytic therapy. Recanalization was assessed by angiography immediately after stent placement based on the Thrombolysis in Myocardial Infarction (TIMI) score. Complications related to the procedure and outcomes were assessed. Neurologic status was evaluated before and after treatment. Eleven patients were treated with emergent angioplasty and stent placement. Partial or complete recanalization (TIMI 2 and 3) was achieved in 11 patients (100%) assessed by digital subtraction angiography immediately after MCA stenting. One patient died due to reocclusion of MCA 2 days after the procedure. Among the survivors, 7 patients (70%) had a good outcome (modified Rankin Scale score, 0-2) and 3 patients (30%) had a moderate outcome (modified Rankin Scale score, 3). Follow-up computed tomography angiography or magnetic resonance angiography revealed mild restenosis in 2 of the 10 patients. This preliminary experience demonstrates the technical feasibility and high rate of recanalization with emergent angioplasty and stenting without thrombolysis in patients with acute MCA occlusion.