Clinical Neurology and Neurosurgery最新文献_第2页

Predictors of symptomatic intracranial hemorrhage after endovascular thrombectomy in acute ischemic stroke: A retrospective study 急性缺血性卒中血管内取栓术后症状性颅内出血的预测因素：一项回顾性研究。

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2026-01-29 DOI: 10.1016/j.clineuro.2026.109319

Wei Hong , Xiaoyu Wang , Shanshan Hu , Yuzhu Ma , Deju Yin

Background

Intracranial hemorrhage (ICH) is a serious potential complication of stroke mechanical thrombectomy (MT). We evaluated the predictors of symptomatic ICH (sICH) after MT for patients with acute ischemic stroke (AIS).

Methods

This retrospective study analyzed 170 consecutive patients with anterior circulation large vessel occlusion (LVO) undergoing MT. Outcomes were stratified as no hemorrhagic transformation (HT), asymptomatic ICH (aICH) and sICH. RAPID-processed perfusion parameters included ischemic core volume (rCBF<30 %), hypoperfusion volume (Tmax>6 s), mismatch volume, and hypoperfusion intensity ratio (HIR). Multivariable logistic regression with backward stepwise selection identified independent sICH predictors from ten candidate variables spanning clinical, laboratory, imaging and procedural domains.

Results

Among 170 patients, any ICH occurred in 67 (39.4 %), of whom 22 met sICH criteria. Platelet counts, balloon dilatation, ischemic core volume, Tmax> 6 s volume and HIR differed significantly across groups (all p < 0.05). Door-to-puncture time was longer for aICH group than no HT group (159.82 ± 64.05 vs. 131.99 ± 68.47; p < 0.05). Compared with the aICH group, the sICH group had lower platelet counts (141.82 ± 43.56 vs. 176.98 ± 72.36; p < 0.05), a larger ischemic core volume (77.50 ± 61.71 vs. 31.88 ± 34.87; p < 0.05) and higher HIR (0.64(0.45, 0.80) vs. 0.40(0.15, 0.57); p < 0.05). Multivariable analysis identified ischemic core volume (OR 3.62, 95 %CI 2.16–6.67, p < 0.001) and thrombocytopenia (OR 6.53, 95 %CI 2.03–25.41, p = 0.003) as independent sICH predictors. The integrated model achieved robust discrimination (AUC 0.874, accuracy 85.6 %).

Conclusions

Ischemic core volume and thrombocytopenia independently predict sICH following MT.

背景：颅内出血（ICH）是脑卒中机械取栓术（MT）的严重潜在并发症。我们评估了急性缺血性脑卒中（AIS）患者MT后症状性脑出血（sICH）的预测因素。方法：本回顾性研究分析了170例连续接受MT治疗的前循环大血管闭塞（LVO）患者。结果分为无出血转化（HT）、无症状脑出血（aICH）和脑出血（siich）。快速处理的灌注参数包括缺血核心体积（rCBF6 s）、失配体积和低灌注强度比（HIR）。采用反向逐步选择的多变量逻辑回归从临床、实验室、影像和程序领域的10个候选变量中确定了独立的siich预测因子。结果：170例患者中有67例（39.4 %）发生脑出血，其中22例符合脑出血标准。血小板计数、球囊扩张、缺血性核体积、Tmax> 6 s体积和HIR在各组间差异显著（均p ）结论：缺血性核体积和血小板减少独立预测MT后siich。

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引用次数: 0

Incidental carotid webs in trauma patients 创伤患者颈动脉偶发网。

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2026-01-29 DOI: 10.1016/j.clineuro.2026.109337

Felipe M. Ferreira , Lorena S. Viana , Savio Batista , Theja Yelam , Raul G. Nogueira , Alhamza R. Al-Bayati , Jason W. Allen , Charlie C. Park , Nirav Bhatt , Michael R. Frankel , Diogo C. Haussen

Introduction

Carotid web (CaW) is notably prevalent among young patients with cryptogenic stroke. Data investigating its occurrence in asymptomatic individuals remains scarce. We evaluated the prevalence of CaWs in a cohort of trauma patients.

Methods

Cross sectional retrospective analysis of consecutive patients who underwent thin-cut neck CT angiograms between October 2015 and August 2018 at a Level 1 Trauma Center. The scans were independently reviewed by two fellowship-trained vascular neurologists who were blinded to demographics and clinical information, and all CaW were reviewed by a fellowship-trained neurointerventionist.

Results

A total of 1157 CTAs in consecutive trauma patients were identified within the study period, and 998 were included. The median age was 39 years [IQR 27.0 – 55.0], 621 (61.3 %) were males, and 626 (62.7 %) were identified as Black or African Americans. 912 (91.4 %) patients had one CTA and 86 (8.6 %) patients had 2 or more CTAs available for review. 1320 (66.1 %) normal carotid bulbs were observed while 16 carotids were found to have a CaW (0.8 % of all carotids) in 15 patients (1.5 % of patients), in which 1 patient had bilateral webs. The lesion involved the postero-lateral carotid bulb wall in 46.7 % of cases, followed by posterior involvement in 33.3 %, postero-medial in 13.3 %, and anterior in 6.7 %. The mean web length was 2.6 ± 0.9 millimeters. Atherosclerotic lesions were otherwise identified in 484 carotid bulbs (24.2 % of all carotid arteries), affecting 394 patients (39.5 %)

Conclusion

Incidental CaW were identified in 1.5 % of trauma patients undergoing CTA. Incidental CaW may be more common than previously recognized and underscore the need for further studies to determine its clinical relevance.

颈动脉网（CaW）在年轻的隐源性卒中患者中非常普遍。调查其在无症状个体中发生的数据仍然很少。我们在一组创伤患者中评估了caw的患病率。方法：对2015年10月至2018年8月在某一级创伤中心连续接受薄切颈部CT血管造影的患者进行横断面回顾性分析。扫描结果由两名接受过奖学金培训的血管神经科医生独立审查，他们不了解人口统计学和临床信息，所有的CaW都由一名接受过奖学金培训的神经介入医生审查。结果：在研究期间，连续创伤患者共发现1157例cta，其中998例纳入研究。中位年龄为39岁[IQR 27.0 - 55.0]， 621例（61.3 %）为男性，626例（62.7 %）为黑人或非裔美国人。912例（91.4 %）患者有1例CTA， 86例（8.6 %）患者有2例或2例以上CTA可供回顾。1320例（66.1% %）颈动脉球囊正常，16例颈动脉有CaW（占所有颈动脉的0.8 %），15例（1.5% %），其中1例有双侧颈动脉网。46.7% %的病例累及颈动脉后外侧球壁，33.3% %的病例累及颈动脉后内侧，13.3% %的病例累及颈动脉前壁，6.7% %的病例累及颈动脉后外侧球壁。平均网长为2.6 ± 0.9 mm。另有484例颈动脉球茎（占所有颈动脉的24.2% %）发现动脉粥样硬化病变，影响394例患者（39.5% %）结论：在接受CTA的创伤患者中，1.5 %发现偶发CaW。偶发性CaW可能比以前认识到的更常见，并强调需要进一步研究以确定其临床相关性。

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引用次数: 0

Comment on: “Usefulness of T1 volumetric isotropic turbo spin-echo acquisition black-blood magnetic resonance imaging for follow-up evaluation after flow diverter implantation” 评论：“T1体积各向同性涡轮自旋回波采集黑血磁共振成像在分流器植入后随访评价中的应用”

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2026-01-28 DOI: 10.1016/j.clineuro.2026.109335

Aman Advani , Ahad Jawaid

引用次数: 0

Anti-LGI-1 autoimmune encephalitis: Insights from literature and a very late-onset case report 抗lgi -1自身免疫性脑炎：从文献和非常晚发病例报告的见解

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2026-01-28 DOI: 10.1016/j.clineuro.2026.109336

Cansu Sarıkaya , Bengül Fatma Gölge , Canan Aykut Bingöl , Berrin Aktekin, Rana Karabudak

Background

Anti–leucine-rich glioma-inactivated protein 1 (LGI-1) autoimmune encephalitis is a rare but increasingly recognized cause of seizures and cognitive decline. Most cases occur in middle-aged or elderly adults, whereas very late-onset presentations above 80 years are exceptionally uncommon and may mimic neurodegenerative, metabolic or cerebrovascular conditions, contributing to diagnostic delays.

Case presentation

We report an 84-year-old woman who presented with progressive somnolence, speech disturbance, and focal motor seizures. MRI demonstrated bilateral temporal lobe T2 hyperintensities, while EEG revealed temporal epileptiform discharges. Fluorodeoxyglucose positron emission tomography (FDG-PET) showed hypermetabolism in the temporal lobes and basal ganglia. Serum testing confirmed the presence of LGI-1 antibodies. The patient received a 7-day course of intravenous methylprednisolone followed by clinical monitoring. Rapid neurological improvement was observed within the first week, and no escalation to second-line immunotherapy was required. Over a four-year follow-up period, she remained clinically stable without relapse.

Conclusion

This case expands the upper age spectrum of anti-LGI-1 encephalitis and emphasizes the importance of considering autoimmune etiologies in elderly patients presenting with new-onset seizures and cognitive impairment. Neuroimaging and electrophysiological findings play a crucial role in diagnosis, particularly when classical faciobrachial dystonic seizures are absent. Timely corticosteroid therapy may provide sustained remission even in very late-onset cases, highlighting the potential efficacy of conservative immunotherapeutic strategies.

抗富亮氨酸胶质瘤失活蛋白1 （LGI-1）自身免疫性脑炎是一种罕见但越来越多的认识到癫痫发作和认知能力下降的原因。大多数病例发生在中年或老年人中，而80岁以上的非常迟发性症状非常罕见，可能类似神经退行性、代谢或脑血管疾病，导致诊断延迟。我们报告一位84岁的女性，她表现为进行性嗜睡、语言障碍和局灶性运动癫痫。MRI显示双侧颞叶T2高信号，脑电图显示颞叶癫痫样放电。氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）显示颞叶和基底神经节高代谢。血清检测证实存在LGI-1抗体。患者接受7天静脉注射甲基强的松龙，随后进行临床监测。在第一周内观察到神经系统的快速改善，不需要升级到二线免疫治疗。在四年的随访期间，她保持临床稳定，没有复发。结论本病例扩大了抗lgi -1脑炎的上年龄谱，强调了在出现新发癫痫和认知障碍的老年患者中考虑自身免疫性病因的重要性。神经影像学和电生理检查在诊断中起着至关重要的作用，特别是当经典的面臂肌张力障碍发作不存在时。及时的皮质类固醇治疗可以提供持续的缓解，甚至在非常晚发的病例，强调了保守的免疫治疗策略的潜在功效。

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引用次数: 0

Educational impact of 3D-printed models in enhancing endoscopic intracerebral hemorrhage removal: An international survey based on the EVACUATE trial 3d打印模型在增强内窥镜脑出血清除中的教育影响：一项基于疏散试验的国际调查

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2026-01-22 DOI: 10.1016/j.clineuro.2026.109326

Alejandro N. Santos , Seevakan Chidambaram , Bashar Dawoud , Sai Sanikommu , John Laidlaw , Timothy Kleinig , Bruce C.V. Campbell , Christopher P. Kellner , Amal Abou-Hamden

Background

Intracerebral hemorrhage (ICH) is a critical stroke subtype with high morbidity and mortality, and current surgical interventions offer limited improvements. Minimally invasive surgery (MIS) and 3D-printed models are gaining traction for training neurosurgeons in safer, more effective ICH removal techniques.

Methods

During the 2024 APSC, a hands-on workshop on MIS ICH removal used 3D-printed models derived from patient CT scans. These models replicated neuroanatomy, vascularity, and tissue properties to provide realistic tactile feedback. Physicians completed a survey rating anatomical accuracy, haptics, and educational value.

Results

A total of 6 specialized neurosurgeons completed the survey. The majority rated the models highly for anatomical accuracy and realism. On a scale of 1–5, the mean score for anatomical accuracy was 4.77, with 83.3 % of participants agreeing that the models closely resembled real-life surgical conditions. Haptic feedback was rated similarly, with 66.7 % of respondents considering it high quality. Additionally, 83.3 % of participants agreed that the models improved visualization and surgical planning compared to 2D imaging. The models enhanced the understanding of neuroanatomical relationships, with a mean score of 4.79, and 100 % of participants indicated that they should be integrated into neurosurgical training programs. Furthermore, 82 % of participants believed that 3D-printed models should supplement traditional surgical training methods, such as lectures and cadaveric dissections.

Conclusions

This patient-specific, perfused 3D-printed endoscopic ICH evacuation training platform was feasible to implement in a hands-on workshop and was rated favorably by a small cohort of participants (n = 6). These results reflect perceived realism and perceived educational utility rather than demonstrated educational effectiveness. Larger studies incorporating objective performance metrics are needed before conclusions about training effectiveness or generalizability can be made.

背景：脑出血（ICH）是一种高发病率和死亡率的关键卒中亚型，目前的外科干预措施改善有限。微创手术（MIS）和3d打印模型在培训神经外科医生更安全、更有效的脑出血切除技术方面越来越受欢迎。方法：在2024年APSC期间，一个关于MIS ICH去除的实践研讨会使用了来自患者CT扫描的3d打印模型。这些模型复制了神经解剖学、血管分布和组织特性，以提供真实的触觉反馈。医生完成了一项调查，评估解剖准确性、触觉和教育价值。结果共6名神经外科专科医生完成调查。大多数人对这些模型的解剖准确性和真实感评价很高。在1-5的范围内，解剖准确性的平均得分为4.77,83.3 %的参与者同意这些模型与现实生活中的手术条件非常相似。触觉反馈的评价类似，66.7 %的受访者认为它是高质量的。此外，83.3 %的参与者同意，与2D成像相比，模型改善了可视化和手术计划。这些模型提高了对神经解剖学关系的理解，平均得分为4.79,100% %的参与者表示他们应该纳入神经外科训练计划。此外，82% 的参与者认为3d打印模型应该补充传统的外科训练方法，如讲座和尸体解剖。结论：该患者特异性的灌注3d打印内镜ICH疏散培训平台在实践车间中实施是可行的，并得到了一小群参与者的好评（ = 6）。这些结果反映了感知到的现实主义和感知到的教育效用，而不是证明的教育有效性。在得出关于培训有效性或普遍性的结论之前，需要进行包含客观绩效指标的更大规模的研究。

{"title":"Educational impact of 3D-printed models in enhancing endoscopic intracerebral hemorrhage removal: An international survey based on the EVACUATE trial","authors":"Alejandro N. Santos , Seevakan Chidambaram , Bashar Dawoud , Sai Sanikommu , John Laidlaw , Timothy Kleinig , Bruce C.V. Campbell , Christopher P. Kellner , Amal Abou-Hamden","doi":"10.1016/j.clineuro.2026.109326","DOIUrl":"10.1016/j.clineuro.2026.109326","url":null,"abstract":"<div><h3>Background</h3><div>Intracerebral hemorrhage (ICH) is a critical stroke subtype with high morbidity and mortality, and current surgical interventions offer limited improvements. Minimally invasive surgery (MIS) and 3D-printed models are gaining traction for training neurosurgeons in safer, more effective ICH removal techniques.</div></div><div><h3>Methods</h3><div>During the 2024 APSC, a hands-on workshop on MIS ICH removal used 3D-printed models derived from patient CT scans. These models replicated neuroanatomy, vascularity, and tissue properties to provide realistic tactile feedback. Physicians completed a survey rating anatomical accuracy, haptics, and educational value.</div></div><div><h3>Results</h3><div>A total of 6 specialized neurosurgeons completed the survey. The majority rated the models highly for anatomical accuracy and realism. On a scale of 1–5, the mean score for anatomical accuracy was 4.77, with 83.3 % of participants agreeing that the models closely resembled real-life surgical conditions. Haptic feedback was rated similarly, with 66.7 % of respondents considering it high quality. Additionally, 83.3 % of participants agreed that the models improved visualization and surgical planning compared to 2D imaging. The models enhanced the understanding of neuroanatomical relationships, with a mean score of 4.79, and 100 % of participants indicated that they should be integrated into neurosurgical training programs. Furthermore, 82 % of participants believed that 3D-printed models should supplement traditional surgical training methods, such as lectures and cadaveric dissections.</div></div><div><h3>Conclusions</h3><div>This patient-specific, perfused 3D-printed endoscopic ICH evacuation training platform was feasible to implement in a hands-on workshop and was rated favorably by a small cohort of participants (n = 6). These results reflect perceived realism and perceived educational utility rather than demonstrated educational effectiveness. Larger studies incorporating objective performance metrics are needed before conclusions about training effectiveness or generalizability can be made.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"263 ","pages":"Article 109326"},"PeriodicalIF":1.6,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146075668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Corrigendum to “Evaluation of acute intraprocedural thromboembolism risk factors in endovascular treatment of unruptured intracranial aneurysms” [Clin. Neurol. Neurosurg. 252 (2025) 108837] 对未破裂颅内动脉瘤血管内治疗急性术中血栓栓塞危险因素的评价的更正[临床]。神经。神经外科杂志[j].中华神经外科杂志。

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2026-01-20 DOI: 10.1016/j.clineuro.2026.109324

Yunus Emre Senturk , Anil Arat

引用次数: 0

Association between oculomotor function testing parameters and Parkinson’s disease 动眼肌功能测试参数与帕金森病的关系

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2026-01-20 DOI: 10.1016/j.clineuro.2026.109325

Lei Zhang , Hong Yao , Xuelin Liang , Canfang Hu , Guojun Luo

Background

Parkinson's disease (PD) is characterized by motor and non-motor symptoms with oculomotor dysfunction being a notable feature. This study aimed to determine the oculomotor function in patients with PD using video-oculography (VOG) and to identify the association between physiologic parameters and PD.

Methods

The study enrolled 45 patients diagnosed with PD at onset and 45 age- and gender-matched healthy controls from July 2019 to July 2023. All participants underwent VOG testing. Eye movement parameters, including velocity, latency, gain, and accuracy, were quantified. The presence of square-wave jerks (SWJs) and abnormal tracking patterns was also assessed. Binary logistic regression and receiver operating characteristic (ROC) curve analyses were used to evaluate the associations between VOG testing parameters and PD.

Results

Patients with PD demonstrated a significantly higher SWJ rate, reduced pursuit gain, prolonged saccade latency, and slower saccade velocity compared to controls (P < 0.05). SWJs, decreased pursuit gain, and prolonged saccade latency were closely related to PD based on logistic regression analysis. The combined detection index incorporating these 3 parameters yielded an area under the ROC curve of 0.836 (95 % CI: 0.752–0.920; P < 0.001) with 77.8 % sensitivity and 82.2 % specificity.

Conclusion

Assessment of oculomotor function using VOG demonstrated notable abnormalities in patients with PD, especially with respect to fixation stability, smooth pursuit, and saccadic control. A combined index incorporating SWJs, pursuit gain, and saccade latency significantly improved PD screening precision.

背景帕金森病（PD）以运动和非运动症状为特征，其中动眼肌功能障碍是一个显著特征。本研究旨在通过视频眼动摄影（VOG）确定PD患者的眼动功能，并确定生理参数与PD之间的关系。方法2019年7月至2023年7月，研究招募了45名发病时被诊断为PD的患者和45名年龄和性别匹配的健康对照组。所有参与者都进行了VOG测试。眼动参数，包括速度、潜伏期、增益和准确性被量化。还评估了方波抽搐（swj）和异常跟踪模式的存在。采用二元逻辑回归和受试者工作特征（ROC）曲线分析来评价VOG测试参数与PD之间的关系。结果与对照组相比，PD患者SWJ率显著升高，追逐增益降低，扫视潜伏期延长，扫视速度减慢（P <； 0.05）。logistic回归分析表明，swj、追逐增益降低、扫视潜伏期延长与PD密切相关。结合这3个参数的联合检测指数的ROC曲线下面积为0.836(95 % CI: 0.752-0.920; P <； 0.001)，灵敏度为77.8% %，特异度为82.2 %。结论用VOG评价PD患者的动眼肌功能有明显的异常，特别是在固定稳定性、平滑追求和跳眼控制方面。结合swj、追踪增益和扫视延迟的综合指数显著提高了PD筛查的精度。

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引用次数: 0

Delayed deformation of the Neuroform Atlas Stent during follow-up: Observational findings and clinical implications 神经形态Atlas支架在随访期间的延迟变形：观察结果和临床意义。

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2026-01-19 DOI: 10.1016/j.clineuro.2026.109320

Lee Hwangbo , Jun Kyeung Ko

Objective

The Neuroform Atlas Stent (NAS) has become one of the most widely used stents for stent-assisted coil embolization of wide-necked intracranial aneurysms, owing to its low-profile design, flexible deliverability, and compatibility with 0.017-inch microcatheters. However, data on its long-term durability are limited. The purpose of this study is to evaluate the incidence, angiographic features, and clinical significance of NAS deformation or crumpling that occurs during the follow-up period.

Methods

We retrospectively reviewed 174 patients with unruptured intracranial aneurysms who underwent NAS-assisted coiling from March 2018 to December 2024, all of whom had follow-up digital subtraction angiography. Stent deformation or crumpling was defined as a noticeable change in the position or spacing of the stent markers on unsubtracted images between the immediate post-procedural and follow-up examinations.

Results

Significant NAS deformation was observed in 7 of 174 patients (4.02 %). All aneurysms were located in the anterior circulation, with the most common site being the ophthalmic segment of the internal carotid artery. The mean aneurysm dome and neck sizes were 4.1 mm and 3.3 mm, respectively. Despite the marker changes, all aneurysms remained stable or showed progressive occlusion. In-stent stenosis of more than 30 % occurred in one patient. Antiplatelet response was adequate in almost all patients, with only one patient showing a high P2Y12 reaction unit value.

Conclusion

Stent deformation or crumpling of the NAS can occur as a rare, delayed finding. While this observational study found that this mechanical change did not compromise short-term aneurysm occlusion, its long-term clinical implications remain unclear. The thin profile of the NAS may contribute to a degree of vulnerability within the intracranial circulation until sufficient endothelialization is achieved. Long-term follow-up is necessary to clarify the clinical implications of this crumpling phenomenon.

目的：神经形态阿特拉斯支架（NAS）由于其低轮廓设计、可灵活输送、与0.017英寸微导管兼容，已成为支架辅助线圈栓塞颅内宽颈动脉瘤应用最广泛的支架之一。然而，关于其长期耐久性的数据有限。本研究的目的是评估随访期间NAS变形或皱缩的发生率、血管造影特征及临床意义。方法：回顾性分析2018年3月至2024年12月，174例未破裂的颅内动脉瘤患者行nas辅助卷曲术，所有患者均行数字减影血管造影。支架变形或皱褶被定义为在术后立即检查和随访检查之间的未减影图像上支架标记物的位置或间距的明显变化。结果：174例患者中有7例出现明显的NAS变形（4.02 %）。所有动脉瘤均位于前循环，最常见的部位是颈内动脉的眼段。动脉瘤穹窿和颈部的平均尺寸分别为4.1 mm和3.3 mm。尽管标记改变，所有动脉瘤保持稳定或表现进行性闭塞。1例患者发生超过30% %的支架内狭窄。几乎所有患者的抗血小板反应都足够，只有1例患者出现高P2Y12反应单位值。结论：NAS支架变形或皱褶是一种罕见的延迟发现。虽然这项观察性研究发现这种机械变化不会损害短期动脉瘤闭塞，但其长期临床意义尚不清楚。NAS的薄轮廓可能在颅内循环中造成一定程度的易损性，直到实现充分的内皮化。长期随访是必要的，以澄清这种皱缩现象的临床意义。

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引用次数: 0

Association between anesthetic administration and mortality in patients with hemorrhagic stroke: Analysis of the MIMIC-IV database 出血性卒中患者麻醉给药与死亡率的关系：MIMIC-IV数据库分析

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2026-01-19 DOI: 10.1016/j.clineuro.2026.109321

Mengyao Wang , Ju Gao , Shunyan Lin , Yaqun Li , Tianfeng Huang

Objective

Anesthetic drugs are used in patients with hemorrhagic stroke (HS). We explored the impact of anesthetics on in-hospital mortality in patients with HS using the Medical Information Mart for Intensive Care IV (MIMIC-IV) database.

Methods

Eligible patients with HS who were treated between 2008 and 2019 were selected from the MIMIC-IV (version 3.1) database. The Chi-squared test and Wilcoxon’s test were performed to compare the differences between deceased and surviving patients. Then, least absolute shrinkage and selection operator and multivariate logistic regression analyses were employed to identify variables associated with mortality, after which a nomogram was constructed to predict in-hospital mortality. The performance of this nomogram was assessed by receiver operating characteristic curve analysis.

Results

In total, 1541 patients were included, including 270 deceased patients (17.5 %) and 1271 surviving patients (82.5 %). Meanwhile, 970 (62.9 %) patients received anesthetics. The use of rocuronium (regression coefficient [β] = 1.033; odds ratio [OR] = 2.809; 95 % confidence interval [CI] = 1.054–7.357; P = 0.037) or morphine (β = 1.894; OR = 6.644; 95 % CI = 4.443–10.079; P < 0.001) was identified as a risk factor for in-hospital mortality in patients with HS. A nomogram was constructed using the statistically significant variables, and its area under curve was 0.924, indicating its high predictive accuracy for in-hospital mortality.

Conclusion

A significant percentage of patients with HS received anesthetics. The use of rocuronium and morphine was associated with an increased mortality risk. A nomogram including anesthetic administration could accurately predict in-hospital mortality in patients with HS.

目的麻醉药物用于出血性脑卒中（HS）患者。我们利用重症监护医疗信息市场IV （MIMIC-IV）数据库探讨了麻醉药对HS患者住院死亡率的影响。方法从MIMIC-IV（3.1版）数据库中选择2008 - 2019年治疗的符合条件的HS患者。采用卡方检验和Wilcoxon检验比较死亡和存活患者之间的差异。然后，采用最小绝对收缩、选择算子和多变量逻辑回归分析来识别与死亡率相关的变量，然后构建nomogram来预测住院死亡率。通过受试者工作特征曲线分析来评价该nomogram的性能。结果共纳入1541例患者，其中死亡患者270例（17.5% %），存活患者1271例（82.5 %）。同时，970例（62.9 %）患者接受了麻醉。使用罗库溴铵（回归系数[β] = 1.033；优势比[OR] = 2.809； 95 %置信区间[CI] = 1.054-7.357; P = 0.037）或吗啡（β = 1.894; OR = 6.644; 95 % CI = 4.443-10.079; P <； 0.001）被确定为HS患者院内死亡的危险因素。采用具有统计学意义的变量构建nomogram，其曲线下面积为0.924，表明其对院内死亡率的预测准确率较高。结论HS患者接受麻醉的比例较高。罗库溴铵和吗啡的使用与死亡风险增加有关。包括麻醉给药在内的心电图可以准确预测HS患者的住院死亡率。

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引用次数: 0

Systemic Microvasculature Frailty: Brain frailty score predicts contrast-associated acute kidney injury after thrombectomy for stroke 全身微血管衰弱：脑衰弱评分预测脑卒中取栓后对比相关急性肾损伤

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2026-01-19 DOI: 10.1016/j.clineuro.2026.109323

Thiago Oscar Goulart , Amanda Sanae Esaki , João Brainer Clares de Andrade , Millene Rodrigues Camilo , Daniel Giansante Abud , Octávio Marques Pontes-Neto

Background

Contrast-associated acute kidney injury (CA-AKI) is a frequent complication after mechanical thrombectomy (MT). Cerebral small vessel disease (CSVD) reflects cerebral microvascular dysfunction driven by systemic vascular risk factors that also affect renal integrity, and may therefore serve as a surrogate marker of renal vulnerability.

Methods

We prospectively included 351 patients with anterior circulation large-vessel occlusion who underwent MT. Baseline non-contrast CT was used to derive the modified small vessel disease (mSVD) score and the Brain Frailty Score (BFS). CA-AKI was defined as ≥ 0.5 mg/dL or ≥ 25 % increase in serum creatinine within 48–72 h after MT. Multivariable logistic regression, Firth penalized models, and XGBoost machine learning identified independent predictors.

Results

CA-AKI occurred in 42 patients (12.0 %). Affected patients were older (68 vs. 62 years), had higher glucose (143 vs. 118 mg/dL), elevated systolic pressure, and more pronounced CSVD features. Severe BFS (score=3) independently predicted CA-AKI (OR=5.13; 95 % CI 1.46–91.28; p = 0.039) after adjustment for age, glucose, and recanalization, whereas mSVD and individual imaging markers were not significant. The final model showed good discrimination and calibration (AUC=0.73; Brier=0.08) and remained stable in sensitivity analyses. In Firth regression, BFS remained significant (OR=4.26; 95 % CI 1.23–22.54). XGBoost achieved an AUC= 0.84, confirming the consistent predictive relevance of vascular, metabolic, and imaging factors across models.

Conclusions

BFS predicts CA-AKI after thrombectomy, outperforming both conventional CSVD scoring and individual imaging markers. These findings support the concept of Systemic Microvasculature Frailty,

in which cerebral microangiopathy reflects global endothelial vulnerability with acute renal implications.

造影剂相关急性肾损伤（CA-AKI）是机械取栓（MT）后常见的并发症。脑血管病（CSVD）反映了全身血管危险因素驱动的脑微血管功能障碍，也影响肾脏完整性，因此可以作为肾脏易感性的替代标志物。方法前瞻性纳入351例行MT的前循环大血管闭塞患者。采用基线非对比CT计算改良小血管病变（mSVD）评分和脑衰弱评分（BFS）。CA-AKI定义为MT后48-72 小时内血清肌酐升高≥ 0.5 mg/dL或≥ 25 %。多变量logistic回归、Firth惩罚模型和XGBoost机器学习确定了独立预测因子。结果42例患者发生sca - aki（12.0 %）。受影响的患者年龄较大（68岁对62岁），血糖升高（143对118 mg/dL），收缩压升高，CSVD特征更明显。在调整年龄、血糖和再通后，严重BFS（评分=3）独立预测CA-AKI (OR=5.13; 95 % CI 1.46-91.28; p = 0.039)，而mSVD和个体影像学标志物无统计学意义。最终模型具有良好的判别性和定标性（AUC=0.73; Brier=0.08），在敏感性分析中保持稳定。在第五次回归中，BFS仍然显著（OR=4.26; 95 % CI 1.23-22.54）。XGBoost实现了AUC= 0.84，证实了不同模型中血管、代谢和成像因素的一致预测相关性。结论sbfs预测取栓后CA-AKI，优于常规CSVD评分和个体影像学指标。这些发现支持了系统性微血管衰弱的概念，其中脑微血管病变反映了急性肾影响的整体内皮易感性。

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