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Treatment of small-caliber vessel lesions using flow diverters remains challenging because of vasculature's narrow luminal diameter and tortuosity. This in turn makes navigation and delivery of conventional devices with standard microcatheters more difficult. The Silk Vista Baby (SVB, Balt) flow diversion device was designed for ease of use in vessels with a smaller diameter, distal lesions, and 0.017 ″ microcatheter delivery systems.To report the outcomes of the SVB device on the treatment of posterior inferior cerebellar artery (PICA) aneurysms.Databases from different centers were retrospectively reviewed for PICA aneurysms treated with SVB. Demographic information, clinical presentation, radiographic characteristics, procedural complications, and immediate postprocedure outcomes were obtained.Fourteen patients harboring 15 true PICA aneurysms were treated between January 2019 and June 2021. Nine were female (n = 9/14; 64.2%), and the mean age was 51 ± 14.9 years. Most patients had previously ruptured aneurysms, treated by another endovascular technique. Six aneurysms were located distally (n = 6/15; 40%). The mean neck size was 3 mm (SD 1.35, range 2.5-5 mm), whereas the mean PICA diameter was 1.6 mm (SD 0.26, range 1.5-1.7 mm). The mean length of follow-up was 6 months (SD 8.28, range 4.5-16 months). Treatment-related adverse events included 1 case of transient hypoesthesia. Two additional events were reported, but adjudicated as unrelated to the procedure. Complete occlusion, measured as Raymond-Roy class I, was achieved in all cases.The SVB device was safely and effectively used in the treatment of PICA aneurysms. The smaller delivery system profile reduces the risk of procedure complications and creates new treatment options for distal lesions.

Computational fluid dynamics (CFD) of cerebral venous flows has become popular owing to the possibility of using local hemodynamics and hemoacoustics to help diagnose and plan treatments for venous diseases of the brain. Lumen geometries in low-pressure cerebral veins are different from those in cerebral arteries, often exhibiting fenestrations and flattened or triangular cross section, in addition to constrictions and expansions. These can challenge conventional size-based volume meshing strategies, and the ability to resolve nonlaminar flows. Here we present a novel strategy leveraging estimation of length scales that could be present if flow were to become transitional or turbulent. Starting from the lumen geometry and flow rate boundary conditions, centerlines are used to determine local hydraulic diameters and cross-sectional mean velocities, from which flow length scales are approximated using conventional definitions of local Kolmogorov and Taylor microscales. By inspection of these scales, a user specifies minimum and maximum mesh edge lengths, which are then distributed along the model in proportion to the approximated local Taylor length scales. We demonstrate in three representative cases that this strategy avoids some of the pitfalls of conventional size-based strategies. An exemplary CFD mesh-refinement study shows convergence of high-frequency flow instabilities even starting from relatively coarse edge lengths near the lower bounds of the approximated Taylor length scales. Rational consideration of the length scales in a possibly nonlaminar flow may thus provide a useful and replicable baseline for denovo meshing of complicated or unfamiliar venous lumen geometries.

Background:Sex disparities have been reported across many aspects of acute ischemic stroke (AIS) care; however, there is a relative paucity of research examining sex differences in outcomes following endovascular treatment (EVT). Some studies report worse functional independence for females following EVT. Few, if any of these studies account for differences in age, baseline function, and comorbidity burden. This retrospective cohort study aimed to assess for sex differences in functional outcomes following EVT by comparing 90-day modified Rankin Scale (mRS) of males and females while controlling for baseline function and comorbidity burden.Methods:Baseline demographic and clinical data, and stroke severity were compared for 230 consecutive patients undergoing EVT for AIS between October 2014 and July 2019 at a tertiary stroke centre in Toronto, Canada. Effect of sex on likelihood of functional independence post-EVT was assessed using regression analysis with and without correction for age, baseline mRS, and Charlson Comorbidity Index (CCI).Results:Females undergoing EVT for AIS were older (75 ± 13 vs. 66 ± 15, p < 0.0001), with worse clinical and functional baselines. Unadjusted, males were more functionally independent (90-day mRS < 3) [OR = 1.831, 95%CI 1.082–3.098]. After controlling for age, baseline mRS and CCI, there was no difference between groups [OR 1.21, 95%CI 0.61–2.37].Conclusions:This study provides evidence that prior findings of sex disparities in function after EVT may be accounted for by differences in age, baseline clinical status and functional independence between males and females when a comprehensive measure of comorbidity burden is utilized.

The spin Hall effect (SHE) is usually observed as a bulk effect in high-symmetry crystals with substantial spin–orbit coupling (SOC), where the symmetric spin–orbit field imposes a widely encountered trade-off between spin Hall angle (θSH) and spin diffusion length (Lsf), and spin polarization, spin current and charge current are constrained to be mutually orthogonal. Here, we report a large θSH of 0.32 accompanied by a long Lsf of 2.2 μm at room temperature in a low-symmetry few-layered semimetal MoTe2, thus identifying it as an excellent candidate for simultaneous spin generation, transport and detection. In addition, we report that longitudinal spin current with out-of-plane polarization can be generated by both transverse and vertical charge current, due to the conventional and a newly observed planar SHE, respectively. Our study suggests that manipulation of crystalline symmetries and strong SOC opens access to new charge-spin interconversion configurations and spin–orbit torques for spintronic applications. A large spin Hall angle and long spin diffusion length are found in the low-symmetry, few-layer semimetal MoTe2 at room temperature, thus identifying this material as an excellent candidate for simultaneous spin generation, transport and detection.

Background Whether thrombectomy alone is equally as effective as intravenous alteplase plus thrombectomy remains controversial. We aimed to determine whether thrombectomy alone would be non-inferior to intravenous alteplase plus thrombectomy in patients presenting with acute ischaemic stroke. Methods In this multicentre, randomised, open-label, blinded-outcome trial in Europe and Canada, we recruited patients with stroke due to large vessel occlusion confirmed with CT or magnetic resonance angiography admitted to endovascular centres. Patients were randomly assigned (1:1) via a centralised web server using a deterministic minimisation method to receive stent-retriever thrombectomy alone or intravenous alteplase plus stent-retriever thrombectomy. In both groups, thrombectomy was initiated as fast as possible with any commercially available Solitaire stent-retriever revascularisation device (Medtronic, Irvine, CA, USA). In the combined treatment group, intravenous alteplase (0.9 mg/kg bodyweight, maximum dose 90 mg per patient) was administered as early as possible after randomisation for 60 min with 10% of the calculated dose given as an initial bolus. Personnel assessing the primary outcome were masked to group allocation; patients and treating physicians were not. The primary binary outcome was a score of 2 or less on the modified Rankin scale at 90 days. We assessed the non-inferiority of thrombectomy alone versus intravenous alteplase plus thrombectomy in all randomly assigned and consenting patients using the one-sided lower 95% confidence limit of the Mantel-Haenszel risk difference, with a prespecified non-inferiority margin of 12%. The main safety endpoint was symptomatic intracranial haemorrhage assessed in all randomly assigned and consenting participants. This trial is registered with ClinicalTrials.gov, NCT03192332, and is closed to new participants. Findings Between Nov 29, 2017, and May 7, 2021, 5215 patients were screened and 423 were randomly assigned, of whom 408 (201 thrombectomy alone, 207 intravenous alteplase plus thrombectomy) were included in the primary efficacy analysis. A modified Rankin scale score of 0-2 at 90 days was reached by 114 (57%) of 201 patients assigned to thrombectomy alone and 135 (65%) of 207 patients assigned to intravenous alteplase plus thrombectomy (adjusted risk difference -7 .3%, 95% CI -16.6 to 2.1, lower limit of one-sided 95% CI -15.1%, crossing the non-inferiority margin of - 12%). Symptomatic intracranial haemorrhage occurred in five (2%) of 201 patients undergoing thrombectomy alone and seven (3%) of 202 patients receiving intravenous alteplase plus thrombectomy ( risk difference -1.0%, 95% CI -4.8 to 2 .7). Successful reperfusion was less common in patients assigned to thrombectomy alone (182 [ 91%] of 201 vs 199 [96%] of 207, risk difference -5.1%, 95% CI -10.2 to 0. 0, p=0.047). Interpretation Thrombectomy alone was not shown to be non-inferior to intravenous alteplase plus thrombectomy and resulted in decreased reperfusion rates. These results do not support omitting intravenous alteplase before thrombectomy in eligible patients. Copyright (C) 2022 Elsevier Ltd. All rights reserved.

Given recent evidence suggesting the clot composition may be associated with revascularization outcomes and stroke etiology, clot composition research has been a topic of growing interest. It is currently unclear what effect, if any, pre-thrombectomy thrombolysis has on clot composition. Understanding this association is important as it is a potential confounding variable in clot composition research. We retrospectively evaluated the composition of retrieved clots from ischemic stroke patients who did and did not receive pre-treatment tPA to study the effect of tPA on clot composition.Consecutive patients enrolled in the Stroke Thromboembolism Registry of Imaging and Pathology (STRIP) were included in this study. All patients underwent mechanical thrombectomy and retrieved clots were sent to a central core lab for processing. Histological analysis was performed using Martius Scarlett Blue (MSB) staining and area of the clot was also measured on the gross photos. Student's t test was used for continuous variables and chi-squared test for categorical variables.A total of 1430 patients were included in this study. Mean age was 68.4±13.5 years. Overall rate of TICI 2c/3 was 67%. A total of 517 patients received tPA (36%) and 913 patients did not (64%). Mean RBC density for the tPA group was 42.97±22.62% compared to 42.80±23.18% for the non-tPA group (P=0.89). Mean WBC density for the tPA group was 3.74±2.60% compared to 3.42±2.21% for the non-tPA group (P=0.012). Mean fibrin density for the tPA group was 26.52±15.81% compared to 26.53±15.34% for the non-tPA group (P=0.98). Mean platelet density for the tPA group was 26.22±18.60% compared to 26.55±19.47% for the non-tPA group (P=0.75). tPA group also had significantly smaller clot area compared to non-tPA group.Our study 1430 retrieved emboli and ischemic stroke patients shows no interaction between tPA administration and clot composition. These findings suggest that tPA does not result in any histological changes in clot composition.

Communicating complex blood flow patterns generated from computational fluid dynamics (CFD) simulations to clinical audiences for the purposes of risk assessment or treatment planning is an ongoing challenge. While attempts have been made to develop new software tools for such clinical visualization of CFD data, these often overlook established medical imaging/visualization practice and data infrastructures. Here, leveraging the clinical ubiquity of the DICOM file format, we present techniques for the translation of CFD data to DICOM series, facilitating interactive visualization in standard radiological software.Unstructured CFD data (volumetric fields of velocity magnitude, Q-criterion, and pathlines) are resampled to structured grids. Novel raster-based techniques that simulate experimental optical blurring are presented for bringing simulated pathlines into structured image volumes. DICOM series are created by strategically encoding these data into the file's PixelArray tag. Lumen surface information is also strategically encoded into a different range of pixel intensities, allowing hemodynamics and morphology to be co-visualized in a single volume using opacity-based rendering transfer functions.We show that 3D temporal CFD data represented as structured DICOM series can be rendered interactively in Horos, a widely-used medical imaging/radiology software. Our transfer function-based approach allows for representations of scalar isosurfaces, volumetric rendering, and tubular pathlines to be modified in real-time, resembling conventional unstructured visualizations. Careful selection of voxelization ROIs helps to ensure that data are kept lightweight for real-time rendering and minimal storage.While our approach inherently sacrifices some of the advanced visualization capabilities of specialized software tools, we believe our closer consideration of standardization can help to facilitate meaningful clinical interaction. This work opens up possibilities for the complete integration of measured and simulated data in established radiological software environments and workflows from PACS storage to 3D/4D visualization.

BackgroundImaging assessment for acute ischemic stroke (AIS) patients in the angiosuite using cone beam CT (CBCT) has created increased interest since endovascular treatment became the first line therapy for proximal vessel occlusions. One of the main challenges of CBCT imaging in AIS patients is degraded image quality due to motion artifacts. This study aims to evaluate the prevalence of motion artifacts in CBCT stroke imaging and the effectiveness of a novel motion artifact correction algorithm for image quality improvement.MethodsPatients presenting with acute stroke symptoms and considered for endovascular treatment were included in the study. CBCT scans were performed using the angiosuite X-ray system. All CBCT scans were post-processed using a motion artifact correction algorithm. Motion artifacts were scored before and after processing using a 4-point scale.ResultsWe prospectively included 310 CBCT scans from acute stroke patients. 51% (n=159/310) of scans had motion artifacts, with 24% being moderate to severe. The post-processing algorithm improved motion artifacts in 91% of scans with motion (n=144/159), restoring clinical diagnostic capability in 34%. Overall, 76% of the scans were sufficient for clinical decision-making before correction, which improved to 93% (n=289/310) after post-processing with our algorithm.ConclusionsOur results demonstrate that CBCT motion artifacts are significantly reduced using a novel post-processing algorithm, which improved brain CBCT image quality and diagnostic assessment for stroke. This is an important step on the road towards a direct-to-angio approach for endovascular thrombectomy (EVT) treatment.

Spontaneous intracranial hypotension is caused by loss of CSF at the level of the spine. The most frequent symptom of this disorder is orthostatic headache, with the headache worsening in the upright position and subsiding after lying down. Neuroimaging has a crucial role in diagnosing and monitoring spontaneous intracranial hypotension, because it provides objective (albeit often subtle) data despite the variable clinical syndromes and often normal lumbar puncture opening pressure associated with this disorder. Spine imaging aims to classify and localise the site of CSF leakage as either (1) a ventral dural leak, (2) a leaking spinal nerve root diverticulum, or (3) a direct CSF-venous fistula. Searching for a CSF leak can be very difficult; the entire spine must be scrutinised for a dural breach often the size of a pin. Precisely locating the site of CSF leakage is fundamental to successful treatment, which includes a targeted epidural patch and surgical closure when conservative measures do not provide long-term relief. Increased awareness of spontaneous intracranial hypotension among clinicians highlights the need for dedicated diagnostic and therapeutic guidelines.

The photon-like behavior of electrons in graphene causes unusual confinement properties that depend strongly on the geometry and strength of the surrounding potential. We report bottom-up synthesis of atomically-precise one-dimensional (1D) arrays of point charges on graphene that allow exploration of a new type of supercritical confinement of graphene carriers. The arrays were synthesized by arranging F4TCNQ molecules into a 1D lattice on back-gated graphene, allowing precise tuning of both the molecular charge and the array periodicity. While dilute arrays of ionized F4TCNQ molecules are seen to behave like isolated subcritical charges, dense arrays show emergent supercriticality. In contrast to compact supercritical clusters, these extended arrays display both supercritical and subcritical characteristics and belong to a new physical regime termed “frustrated supercritical collapse”. Here carriers in the far-field are attracted by a supercritical charge distribution, but their fall to the center is frustrated by subcritical potentials in the near-field, similar to trapping of light by a dense cluster of stars in general relativity., Placement of charge centres with atomic precision on graphene allows exploration of new types of confinement of charge carriers. Here, the authors fabricate atomically precise arrays of point charges on graphene and observe the onset of a frustrated supercritical regime.

BackgroundIntracranial aneurysm neck width tends to be overestimated when measured with three-dimensional rotational angiography (3DRA) compared with two-dimensional digital subtraction angiography (2D-DSA), owing to high curvature at the neck. This may affect morphological and hemodynamic analysis in support of treatment planning. We present and validate a method for extracting high curvature features, such as aneurysm ostia, during segmentation of 3DRA images.MethodsIn our novel SURGE (segmentation with upsampled resolution and gradient enhancement) approach, the gradient of an upsampled image is sharpened before gradient-based watershed segmentation. Neck measurements were performed for both standard and SURGE segmentations of 3DRA for 60 consecutive patients and compared with those from 2D-DSA. Those segmentations were also qualitatively compared for surface topology and morphology.ResultsCompared with the standard watershed method, SURGE reduced neck measurement error relative to 2D-DSA by >60%: median error was 0.49 mm versus 0.17 mm for SURGE, which is less than the average pixel resolution (~0.33 mm) of the 3DRA dataset. SURGE reduced neck width overestimations >1 mm from 13/60 to 5/60 cases. Relative to 2D-DSA, standard segmentations were overestimated by 16% and 93% at median and 95th percentiles, respectively, compared with only 6% and 37%, respectively, for SURGE.ConclusionSURGE provides operators with high-level control of the image gradient, allowing recovery of high-curvature features such as aneurysm ostia from 3DRA where conventional algorithms may fail. Compared with standard segmentation and tedious manual editing, SURGE provides a faster, easier, and more objective method for assessing aneurysm ostia and morphology.

BackgroundThe use of robotics in medicine may enable increased technical accuracy, reduced procedural time and radiation exposure, and remote completion of procedures. We have previously described the first-in-human, robotic-assisted cerebral aneurysm treatment using the CorPath GRX Robotic System. In this report we discuss our early experiences and outcomes using this robotic device for endovascular treatment of intracranial aneurysms using stent-assisted coil embolization and flow diversion.MethodsThe patient and disease characteristics, procedural details, and follow-up imaging and clinical outcomes of consecutive patients undergoing robotically-assisted intracranial aneurysm embolization between November 2019 and February 2020 are presented.ResultsSix patients underwent robotically-assisted embolization of intracranial aneurysms. Four of the patients were treated with a neck-bridging stent (with or without coiling) and two patients were treated with a flow-diverting stent. Two patients were treated in the subacute period of subarachnoid hemorrhage and four patients were treated electively. All of the procedures could be completed robotically and there was no need for unplanned manual intervention. The technical success rate of the procedures was 100%. There was no morbidity or mortality associated with the procedures. One year follow-up imaging showed that four aneurysms were completely obliterated (Raymond-Roy Occlusion Classification (RROC) class I) and the remaining two were occluded with a residual neck (RROC class II).ConclusionsThe Corpath GRX Robotic System demonstrated a precise control over the microcatheter, wire and stent during aneurysm treatment. Robotic neuro-procedures seem to be safe and effective and demonstrate stable occlusion results in the midterm follow-up.

Supplemental material, sj-pdf-2-wso-10.1177_17474930211005740 for Clinical effectiveness of endovascular stroke treatment in the early and extended time windows by Raul G Nogueira, Diogo C Haussen, David S Liebeskind, Tudor G Jovin, Rishi Gupta, Jeffrey L Saver, Ashutosh P Jadhav, Ronald F Budzik, Blaise Baxter, Antonin Krajina, Alain Bonafe, Ali Malek, Ana Paula Narata, Mahmoud H Mohammaden, Yanchang Zhang, Patricia Morgan, Minyi Ji, Bruno Bartolini, Joey English, Gregory W Albers, Michael Mlynash, Maarten G Lansberg, Michael R Frankel, Vitor M Pereira, Erol Veznedaroglu and for the Trevo Registry, SWIFT Prime, DEFUSE 3 and DAWN Trial Investigators in International Journal of Stroke

Supplemental material, sj-pdf-1-wso-10.1177_17474930211005740 for Clinical effectiveness of endovascular stroke treatment in the early and extended time windows by Raul G Nogueira, Diogo C Haussen, David S Liebeskind, Tudor G Jovin, Rishi Gupta, Jeffrey L Saver, Ashutosh P Jadhav, Ronald F Budzik, Blaise Baxter, Antonin Krajina, Alain Bonafe, Ali Malek, Ana Paula Narata, Mahmoud H Mohammaden, Yanchang Zhang, Patricia Morgan, Minyi Ji, Bruno Bartolini, Joey English, Gregory W Albers, Michael Mlynash, Maarten G Lansberg, Michael R Frankel, Vitor M Pereira, Erol Veznedaroglu and for the Trevo Registry, SWIFT Prime, DEFUSE 3 and DAWN Trial Investigators in International Journal of Stroke

We adapted a recently proposed framework to characterize the optical response of interacting electrons in solids in order to expedite its computation without compromise in accuracy at the microscopic level. Our formulation is based on reliable parametrizations of Hamiltonians and Coulomb interactions, which allows economy and flexibility in obtaining response functions. It is suited to computing the optical response to fields of arbitrary temporal shape and strength, to arbitrary order in the field, and natively accounts for excitonic effects. We demonstrate the approach by computing the frequency-dependent susceptibilities of MoS2 and hexagonal BN monolayers up to the third harmonic. Grounded on a generic nonequilibrium many-body perturbation theory, this framework allows extensions to handle generic interaction models or to describe electronic processes taking place at ultrafast time scales., SCOPUS: ar.j, info:eu-repo/semantics/published

Background The Silk Vista Baby (SVB, BALT) is a first-in-class flow-diverter device delivered using a 0.017” microcatheter, designed for the treatment of intracranial aneurysms, including those in small diameter vessels. This study reports a systematic literature review (SLR) to evaluate the safety and efficacy of using SVB to treat intracranial aneurysms in vessels less than 3.5 mm in diameter. Methods We performed a PRISMA-compliant SLR to evaluate the outcomes of SVB in the treatment of aneurysms in small intracranial vessels. Primary outcomes were occlusion status and major stroke, and secondary outcomes included all-cause mortality, procedure-related neurologic death, and post-operative aneurysm rupture. Data were expressed as descriptive statistics only. Results A total of four studies, including 163 patients with 173 intracranial aneurysms, were included. The most common aneurysm locations were the anterior cerebral artery (24.9% [43/173]), the middle cerebral artery (24.3% [42/173]), and the anterior communicating artery (23.1% [40/173]). Parent artery diameter ranged from 0.9 mm to 3.6 mm, and 29% were acutely or previously ruptured aneurysms. Overall, complete or near-complete occlusion was 72.1% on early-term follow-up. Mortality rate among the studies was 2.5%, with 3 instances adjudicated as neurologic deaths (1.8%). Major stroke was noted in 1.2% of cases, and branch occlusion or stent thrombus formation in 5.5%. Conclusion Our review suggests that SVB is a safe and effective treatment for intracranial aneurysms in small vessels. Further prospective and comparative studies with patient outcome data specific to aneurysm location are needed to confirm the safety and efficacy of SVB.

The spin polarization induced by the spin Hall effect (SHE) in thin films typically points out of the plane. This is rooted on the specific symmetries of traditionally studied systems, not in a fundamental constraint. Recently, experiments on few-layer ${\rm MoTe}_2$ and ${\rm WTe}_2$ showed that the reduced symmetry of these strong spin-orbit coupling materials enables a new form of {\it canted} spin Hall effect, characterized by concurrent in-plane and out-of-plane spin polarizations. Here, through quantum transport calculations on realistic device geometries, including disorder, we predict a very large gate-tunable SHE figure of merit $\lambda_s\theta_{xy}\sim 1\text{--}50$ nm in ${\rm MoTe}_2$ and ${\rm WTe}_2$ monolayers that significantly exceeds values of conventional SHE materials. This stems from a concurrent long spin diffusion length ($\lambda_s$) and charge-to-spin interconversion efficiency as large as $\theta_{xy} \approx 80$\%, originating from momentum-invariant (persistent) spin textures together with large spin Berry curvature along the Fermi contour, respectively. Generalization to other materials and specific guidelines for unambiguous experimental confirmation are proposed, paving the way towards exploiting such phenomena in spintronic devices. These findings vividly emphasize how crystal symmetry and electronic topology can govern the intrinsic SHE and spin relaxation, and how they may be exploited to broaden the range and efficiency of spintronic materials and functionalities., Comment: Published version, Phys. Rev. Reserach

We derive an effective tight-binding model that captures, in real space and with only two parameters, the dominant Coulomb interactions and superconducting pairing near half-filling of magic-angle twisted bilayer graphene. We show that, in an antiferromagnetic Mott insulating ground state with intervalley coherence, magnetic fluctuations and doping mediate superconducting pairing. We find the pairing wave function to have chiral $d$-wave symmetry and obtain a self-consistent mean-field phase diagram in line with experiments on the doping-induced insulator-to-superconductor transition. We further reveal the existence of chiral Majorana edge modes implied by the nontrivial pairing symmetry, which establishes twisted bilayer graphene as a potential platform for topological superconductivity. This effective model opens the door to systematic scrutiny of the competition between correlated states in this system.

We report an unconventional quantum spin Hall phase in the monolayer WTe2, which exhibits hitherto unknown features in other topological materials. The low symmetry of the structure induces a canted spin texture in the yz plane, which dictates the spin polarization of topologically protected boundary states. Additionally, the spin Hall conductivity gets quantized (2e2/h) with a spin quantization axis parallel to the canting direction. These findings are based on large-scale quantum simulations of the spin Hall conductivity tensor and nonlocal resistances in multiprobe geometries using a realistic tight-binding model elaborated from first-principle methods. The observation of this canted quantum spin Hall effect, related to the formation of topological edge states with nontrivial spin polarization, demands for specific experimental design and suggests interesting alternatives for manipulating spin information in topological materials., M. V. acknowledges support from “La Caixa” Foundation and the Centre for Advanced 2D Materials at the National University of Singapore for its hospitality. X. W. acknowledges the ANR Flagera GRANSPORT funding. ICN2 authors were supported by the European Union Horizon 2020 research and innovation programme under Grant Agreement No. 881603 (Graphene Flagship) and No. 824140 (TOCHA, H2020-FETPROACT-01-2018). ICN2 is funded by the CERCA Programme/Generalitat de Catalunya, and is supported by the Severo Ochoa program from Spanish MINECO (Grant No. SEV2017-0706). V. M. P. acknowledges the support of the National Research Foundation (Singapore) under its Medium-Sized Centre Programme (R-723-000-001-281).

We explore in detail the electronic phases of a system consisting of three noncolinear arrays of coupled quantum wires, each rotated ${120}^{\ensuremath{\circ}}$ with respect to the next. A perturbative renormalization-group analysis reveals that multiple correlated states can be stabilized: a $s$-wave or $d\phantom{\rule{0.16em}{0ex}}\ifmmode\pm\else\textpm\fi{}\phantom{\rule{0.16em}{0ex}}id$ superconductor, a charge density wave insulator, a two-dimensional Fermi liquid, and a 2D Luttinger liquid (also known as smectic metal or sliding Luttinger liquid). The model provides an effective description of electronic interactions in small-angle twisted bilayer graphene and we discuss its implications in relation to the recent observation of correlated and superconducting ground states near commensurate densities in magic-angle twisted samples, as well as the ``strange metal'' behavior at finite temperatures as a natural outcome of the 2D Luttinger liquid phase.

Summary Background Previous randomised trials have shown an overwhelming benefit of mechanical thrombectomy for treating patients with stroke caused by large vessel occlusion of the anterior circulation. Whether endovascular treatment is beneficial for vertebrobasilar artery occlusion remains unknown. In this study, we aimed to investigate the safety and efficacy of endovascular treatment of acute strokes due to vertebrobasilar artery occlusion. Methods We did a multicentre, randomised, open-label trial, with blinded outcome assessment of thrombectomy in patients presenting within 8 h of vertebrobasilar occlusion at 28 centres in China. Patients were randomly assigned (1:1) to endovascular therapy plus standard medical therapy (intervention group) or standard medical therapy alone (control group). The randomisation sequence was computer-generated and stratified by participating centres. Allocation concealment was implemented by use of sealed envelopes. The primary outcome was a modified Rankin scale (mRS) score of 3 or lower (indicating ability to walk unassisted) at 90 days, assessed on an intention-to-treat basis. The primary safety outcome was mortality at 90 days. Secondary safety endpoints included the rates of symptomatic intracranial haemorrhage, device-related complications, and other severe adverse events. The BEST trial is registered with ClinicalTrials.gov , NCT02441556 . Findings Between April 27, 2015, and Sept 27, 2017, we assessed 288 patients for eligibility. The trial was terminated early after 131 patients had been randomly assigned (66 patients to the intervention group and 65 to the control group) because of high crossover rate and poor recruitment. In the intention-to-treat analysis, there was no evidence of a difference in the proportion of participants with mRS 0–3 at 90 days according to treatment (28 [42%] of 66 patients in the intervention group vs 21 [32%] of 65 in the control group; adjusted odds ratio [OR] 1·74, 95% CI 0·81–3·74). Secondary prespecified analyses of the primary outcome, done to assess the effect of crossovers, showed higher rates of mRS 0–3 at 90 days in patients who actually received the intervention compared with those who received standard medical therapy alone in both per-protocol (28 [44%] of 63 patients with intervention vs 13 [25%] of 51 with standard therapy; adjusted OR 2·90, 95% CI 1·20–7·03) and as-treated (36 [47%] of 77 patients with intervention vs 13 [24%] of 54 with standard therapy; 3·02, 1·31–7·00) populations. The 90-day mortality was similar between groups (22 [33%] of 66 patients in the intervention vs 25 [38%] of 65 in the control group; p=0·54) despite a numerically higher prevalence of symptomatic intracranial haemorrhage in the intervention group. Interpretation There was no evidence of a difference in favourable outcomes of patients receiving endovascular therapy compared with those receiving standard medical therapy alone. Results might have been confounded by loss of equipoise over the course of the trial, resulting in poor adherence to the assigned study treatment and a reduced sample size due to the early termination of the study. Funding Jiangsu Provincial Special Program of Medical Science.

Rotational-symmetry-protected topological crystalline insulators (TCIs) are expected to host unique boundary modes, in that the surface normal to the rotational axis can feature surface states with ‘unpinned’ Dirac points, which are not constrained to lie on high symmetry points or lines, but can lie at any general k point in the Brillouin zone. Also, as a higher order bulk boundary correspondence is involved here, a three-dimensional (3D) TCI can support one-dimensional (1D) helical edge states. Using first-principles band structure calculations, we identify the van der Waals material -Bi4Br4 as a purely rotation symmetry protected TCI. We show that the surface of Bi4Br4 exhibits a pair of unpinned topological Dirac fermions which are related to the presence of a two-fold rotation axis. These unpinned Dirac fermions possess an exotic spin texture which will be highly favorable for spin transport, and a band structure that consists of van Hove singularities due to a Lifshitz transition. We also identify 1D topological hinge states along the edges of an -Bi4Br4 rod. We comment on how the predicted topological features in -Bi4Br4 could be accessed experimentally.

The details of the superconducting to quantum metal transition (SQMT) at T = 0 are an open problem that invokes great interest in the nature of this exotic and unexpected ground state (Ephron et al., 1996; Mason and Kapitulnik, 1999; Chervenak and Valles, 2000). However, the SQMT was not yet investigated in a crystalline 2D superconductor with coexisting and fluctuating quantum orders. Here, we report the observation of a SQMT in 2D ion-gel-gated 1T-TiSe2 (Li et al., 2016) driven by a magnetic field. A field-induced crossover between Bose quantum metal and vortex quantum creeping with an increasing field is observed. We discuss the interplay between superconducting and CDW fluctuations (discommensurations) and their relation to the anomalous quantum metal (AQM) phase. From our findings, gate-tunable 1T-TiSe2 emerges as a privileged platform to scrutinize, in a controlled way, the details of the SQMT, the role of coexisting fluctuating orders and, ultimately, to obtain a deeper understanding of the fate of...

We introduce a McMillan-Ginzburg-Landau theory to describe the cooperative coexistence of charge-density and superconducting order in two-dimensional crystals. With a free-energy that explicitly accounts for the competition between commensurate and incommensurate ground states, we are able to map the transition between these phases and monitor the development of discommensurations in the near-commensurate regime. Attributing the enhancement of superconducting order to density-wave fluctuations, we propose a coupling scheme that yields a phase diagram in qualitative agreement with experiments in conducting transition metal dichalcogenides. The model predicts the development of non-uniform superconductivity similar to that arising from a pair-density wave, with a spatial texture driven by the underlying charge-density wave fluctuations.

A population imbalance at different valleys of an electronic system lowers its effective rotational symmetry. We introduce a technique to measure such imbalance - a valley polarization - that exploits the unique fingerprints of this symmetry reduction in the polarization-dependent second-harmonic generation (SHG). We present the principle and detection scheme in the context of hexagonal two-dimensional crystals, which include graphene-based systems and the family of transition metal dichalcogenides, and provide a direct experimental demonstration using a 2H-MoSe$_{2}$ monolayer at room temperature. We deliberately use the simplest possible setup, where a single pulsed laser beam simultaneously controls the valley imbalance and tracks the SHG process. We further developed a model of the transient population dynamics which analytically describes the valley-induced SHG rotation in very good agreement with the experiment. In addition to providing the first experimental demonstration of the effect, this work establishes a conceptually simple, com-pact and transferable way of measuring instantaneous valley polarization, with direct applicability in the nascent field of valleytronics.

The ability to switch magnetic elements by spin-orbit-induced torques has recently attracted much attention for a path toward high-performance, nonvolatile memories with low power consumption. Realizing efficient spin-orbit-based switching requires the harnessing of both new materials and novel physics to obtain high charge-to-spin conversion efficiencies, thus making the choice of spin source crucial. Here, the observation of spin-orbit torque switching in bilayers consisting of a semimetallic film of 1T'-MoTe2 adjacent to permalloy is reported. Deterministic switching is achieved without external magnetic fields at room temperature, and the switching occurs with currents one order of magnitude smaller than those typical in devices using the best-performing heavy metals. The thickness-dependence can be understood if the interfacial spin-orbit contribution is considered in addition to the bulk spin Hall effect. Further threefold reduction in the switching current is demonstrated with resort to dumbbell-shaped magnetic elements. These findings foretell exciting prospects of using MoTe2 for low-power semimetal-material-based spin devices.

Recent experiments suggest that excitonic degrees of freedom play an important role in precipitating the charge density wave (CDW) transition in $1T\text{\ensuremath{-}}{\mathrm{TiSe}}_{2}$. Through systematic calculations of the electronic and phonon spectrum based on density functional perturbation theory, we show that the predicted critical doping of the CDW phase overshoots the experimental value by 1 order of magnitude. In contrast, an independent self-consistent many-body calculation of the excitonic order parameter and renormalized band structure is able to capture the experimental phase diagram in extremely good qualitative and quantitative agreement. This demonstrates that electron-electron interactions and the excitonic instability arising from direct electron-hole coupling are pivotal to accurately describe the nature of the CDW in this system. This has important implications to understand the emergence of superconductivity within the CDW phase of this and related systems.

In relation to our original paper [M. Droth et al., Phys. Rev. B 94, 075404 (2016)], the Comment by Li et al. [Phys. Rev. B 98, 167403 (2018)] claims to have identified a "mistake in constructing the adiabatic process of the piezoelectricity". More specifically, they write that in our original work "the erroneous usage of the polarization difference formula in Eq. (4) leads to an invalid analytical expression of piezoelectric constant in Eq. (12) of Reference 1". We explain below why these and other minor claims in the Comment are unwarranted, and why we maintain that our result is correct and physically sound., 4 pages manuscript + 8 pages supplemental material

There is increasing use of automated computed tomography perfusion (CTP) to aid thrombectomy decision in emergent large vessel occlusion. It is important to understand the performance of these software packages in predicting ischemic core and tissue-at-risk in the real-world setting. The aim of this study was to evaluate whether ischemic core on non-contrast CT (NCCT) and automated CTP correspond and predict infarct extent after thrombectomy for ischemic stroke.Consecutive patients with acute anterior circulation large vessel occlusion undergoing successful thrombectomy (TICI 2b/3) were studied. All patients had baseline CT, CTP with RAPID post-processing software (RAPID-CTP), and post-thrombectomy 24 h CT. Ischemic cores were assessed by two blinded raters independently using the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) on each modality. The interrater agreement for ASPECTS, and correlation between baseline CT-ASPECTS, RAPID-CTP-ASPECTS, and 24h CT-ASPECTS were calculated.A total of 86 patients with a mean age of 70.3 years (SD 16.5) were studied. The median baseline CT-ASPECTS was 9.5 (interquartile range, IQR 8-10), median RAPID-CTP-ASPECTS was 9 (IQR 8-10), and mean RAPID-CTP-ischemic core volume was 14.4 ml (SD 27.9 ml). The mean mismatch volume (difference of Tmax 6s and cerebral blood flow (CBF) 30%) was 128.6 ml (SD 126.0 ml). There was substantial correlation between baseline and 24h CT-ASPECTS (rIn this series of successfully revascularized patients, ischemic core as estimated by RAPID-CTP-ASPECTS did not correlate with the baseline CT and tended to depict a larger infarct core than the infarct extent as assessed by 24h CT-ASPECTS.

Topological crystalline insulators (TCI) are insulating electronic phases of matter with nontrivial topology originating from crystalline symmetries. Recent theoretical advances have provided powerful guidelines to search for TCIs in real materials. Using density functional theory, we identify a class of new TCI states in the tetragonal lattice of the Ca$_2$As material family. On both top and side surfaces, we observe topological surface states protected independently by rotational and mirror symmetries. We show that a particular lattice distortion can single out the newly proposed topological protection by the rotational symmetry. As a result, the Dirac points of the topological surface states are moved to generic locations in momentum space away from any high symmetry lines. Such topological surface states have not been seen before. Moreover, the other family members, including Ca$_2$Sb, Ca$_2$Bi and Sr$_2$Sb, feature different topological surface states due to their distinct topological invariants. We thus further propose topological phase transitions in the pseudo-binary systems such as (Ca$_{1-x}$Sr$_x$)$_2$As and Ca$_2$As$_x$Sb$_{1-x}$. Our work reveals rich and exotic TCI physics across the Ca$_2$As family of materials, and suggests the feasibility of materials database search methods to discover new TCIs., 5 pages, 4 figures

Recent experiments suggest that excitonic degrees of freedom play an important role in precipitating the charge density wave (CDW) transition in 1T-TiSe_{2}. Through systematic calculations of the electronic and phonon spectrum based on density functional perturbation theory, we show that the predicted critical doping of the CDW phase overshoots the experimental value by 1 order of magnitude. In contrast, an independent self-consistent many-body calculation of the excitonic order parameter and renormalized band structure is able to capture the experimental phase diagram in extremely good qualitative and quantitative agreement. This demonstrates that electron-electron interactions and the excitonic instability arising from direct electron-hole coupling are pivotal to accurately describe the nature of the CDW in this system. This has important implications to understand the emergence of superconductivity within the CDW phase of this and related systems.

Supplementary information accompanies this paper at https://doi.org/10.1038/s41598-018-28374-1, We report the first detailed characterization of the sheet third-harmonic optical susceptibility, χ(3)s, of tungsten diselenide (WSe2). With a home-built multiphoton microscope setup developed to study harmonics generation, we map the second and third-harmonic intensities as a function of position in the sample, pump power and polarization angle, for single- and few-layers flakes of WSe2. We register a value of |χ(3)s| ≈ 0.9 × 10-28 m3 V-2 at a fundamental excitation frequency of ℏω = 0.8 eV, which is comparable in magnitude to the third-harmonic susceptibility of other group-VI transition metal dichalcogenides. The simultaneously recorded sheet second-harmonic susceptibility is found to be |χ(2)s| ≈ 0.7 × 10-19 m2 V-1 in very good agreement on the order of magnitude with recent reports for WSe2, which asserts the robustness of our values for |χ(3)s|., Y.W.H. acknowledges scholarship support from NGS. G.E. acknowledges financial support from National Research Foundation of Singapore (NRF Research Fellowship NRF-NRFF2011-02 and medium-sized centre programme) and Ministry of Education of Singapore (AcRF Tier 2 MOE2015-T2-2-123). V. M. P. acknowledges fnancial support from Ministry of Education of Singapore (FRC AcRF Tier 1 R-144-000-386-114). J.C.V.G. acknowledges fnancial support from CA2DM through National Research Foundation of Singapore (NRF-CRP Grant No. R-144-000-295-281).

We investigate the excitonic spectrum of MoS$_2$ monolayers and calculate its optical absorption properties over a wide range of energies. Our approach takes into account the anomalous screening in two dimensions and the presence of a substrate, both cast by a suitable effective Keldysh potential. We solve the Bethe-Salpeter equation using as a basis a Slater-Koster tight-binding model parameterized to fit ab initio MoS$_2$ band structure calculations. The resulting optical conductivity is in good quantitative agreement with existing measurements up to ultraviolet energies. We establish that the electronic contributions to the C excitons arise not from states in the vicinity of the $\Gamma$ point, but from a set of $k$-points over extended portions of the Brillouin zone. Our results reinforce the advantages of approaches based on effective models to expeditiously explore the properties and tunability of excitons in TMD systems., Comment: Published version, 16 pages, 10 figures

We investigate the impact of strained nanobubbles on the conductance characteristics of graphene nanoribbons using a combined molecular dynamics - tight-binding simulation scheme. We describe in detail how the conductance, density of states, and current density of zigzag or armchair graphene nanoribbons are modified by the presence of a nanobubble. In particular, we establish that low-energy electrons can be confined in the vicinity or within the nanobubbles by the delicate interplay between the pseudomagnetic field pattern created by the shape of the bubble, mode mixing, and substrate interaction. The coupling between confined evanescent states and propagating modes can be enhanced under different clamping conditions, which translates into Fano resonances in the conductance traces., 13 pages, 8 figures