Stroke (Hoboken, N.J.)最新文献

Arteriovenous malformations (AVMs) and intracranial aneurysms contribute to a high degree of morbidity and mortality due to the risk of intracranial hemorrhage observed in each of these cerebrovascular disorders. Due to the morbidity present in each condition, preclinical modeling of AVMs and intracerebral aneurysms is essential for advancing treatment options. A multitude of techniques and animal models have been described to model both AVM and intracranial aneurysm. In the present study, we sought to provide a comprehensive overview of the different models used to recapitulate AVM and intracranial aneurysm, highlighting advantages and disadvantages of each model. We conducted a comprehensive literature search for all preclinical animal models of AVM and intracerebral aneurysm. The studies included in the literature review were obtained from PubMed and included original studies, reviews, and systematic reviews. In this review, we highlight various animal models of AVM and intracranial aneurysm through the use of genetic models as well as surgical models. An overview of each model is thoroughly described and advantages and disadvantages of each model are outlined. Through the evaluation of current literature, the best models for AVM and aneurysm depend on the goal of the underlying study. Overall, we recommend using rodents and swine for modeling AVM and aneurysm as these animal species provide versatility, reliability, and accessibility for vascular research. Additionally, these species best recapitulate human AVM and aneurysm.

Background: We automated subarachnoid hemorrhage volume (SAHV) calculation with artificial intelligence (SAHVAI) and created 3-dimensional volumetric images (SAHVAI-3D) using noncontrast head computed tomography data for patients with aneurysmal SAH. We also defined 4-dimensional SAHVAI (SAHVAI-4D), representing SAHV over time. We aimed to compare automated SAHVAI values and computational times to manual SAHV measurement methods, explore the potential of imaging biomarkers to identify at-risk brain regions for delayed cerebral ischemia and explore potential insights in future neurotherapeutic interventions for patient recovery after SAH.

Methods: A training set of 10 consecutive patients with aneurysmal SAH was used to manually compute SAHV, SAHVAI-3D, and SAHVAI-4D, including 92 noncontrast computed tomography scans (182 slices each). The SAHVAI deep learning algorithm generated automated SAHV values in cubic centimeters. A 3-dimensional SAH brain map was created for each patient for the SAHVAI and manual evaluations. Blood volumetric outputs were analyzed and compared to neurologic outcomes at discharge, including delayed cerebral ischemia events, symptomatic vasospasm, and areas with the thickest SAH blood concentration.

Results: SAHVAI quantified SAHV in a mean of 6.7 seconds per scan, significantly faster than the manual method, which took >60 minutes per scan (Fisher exact test, P<0.001). SAHVAI demonstrated an accuracy of 99.8%, Dice score of 0.701, false-positive rate of 0.0005, and negative predictive value of 0.999. The mean absolute error between SAHVAI and manual methods was 5.67 mL. SAHVAI-3D brain map and total SAHV at admission were inversely associated with Glasgow Coma Scale (R² = 0.23, P = 0.017) and directly associated with length of hospital stay (R² = 0.175, P = 0.004), especially in regions with dense blood concentration.

Conclusion: SAHVAI-3D and SAHVAI-4D brain mapping techniques represent innovative imaging biomarkers for SAH. These advancements enable rapid evaluation and targeted interventions, potentially improving patient care in SAH management.

Background: For patients with acute ischemic stroke (AIS) due to cervical artery dissection (CAD), endovascular stenting can improve and maintain vessel patency for severely stenotic or occlusive lesions. Athough prior reports have suggested equivocal functional outcomes with stenting versus no stenting for AIS-CAD, there are currently no data on stenting and stroke recurrence.

Methods: This was a retrospective cohort study of the 2016-21 Nationwide Readmissions Database in the United States. Adult patients hospitalized for AIS-CAD were included. Patients who did and did not undergo endovascular stenting were matched using propensity scores calculated using logistic regression models accounting for demographics, stroke severity, and comorbidities. The primary end point was recurrent ischemic stroke within 180 days. Secondary end points include outcomes of the index AIS-CAD hospitalization such as routine discharge to home without rehabilitation needs, death, and intracranial hemorrhage.

Results: A total of 20 434 patients were included; 2368 (11.6%) underwent endovascular stenting. After propensity score matching, 2215 patients remained in the no stenting group, and 2244 remained in the stenting group. The stenting group had a significantly lower stroke recurrence risk than the no-stenting group within 180 days (hazard ratio 0.50 [95% CI: 0.27-0.95], P = 0.034). Among patients with at least 180 days of follow-up, the rate of recurrent stroke was 1.2% in the stenting group, which was significantly lower than 3.5% in the no-stenting group (P = 0.017). During the index AIS-CAD hospitalization, stenting was not associated with a different rate of routine discharge (43.8% versus 44.8%, P = 0.65) or death (8.7% versus 7.3%, P = 0.34); however, it was associated with a higher rate of intracranial hemorrhage (21.9% versus 19.0%, P = 0.027).

Conclusion: For patients with AIS-CAD, endovascular stenting was associated with a lower rate of stroke recurrence. Although stenting was associated with a higher rate of intracranial hemorrhage, this phenomenon did not culminate in different rates of short-term morbidity or mortality.

Background: The link between arterial stiffness, measured by estimated pulse wave velocity (ePWV), and outcomes following endovascular thrombectomy (EVT) has not been tested. This study aimed to determine whether ePWV predicts post-EVT outcome in patients with acute ischemic stroke.

Methods: This was a secondary analysis of the OPTIMAL-BP (Outcome in Patients Treated With Intraarterial Thrombectomy-Optimal Blood Pressure Control) trial, which enrolled 302 EVT patients from 19 stroke centers in South Korea between June 18, 2020 and November 28, 2022. The ePWV was calculated using a regression equation based on age and mean blood pressure (BP) at trial enrollment: ePWV = 9.587-0.402×age+4.560×10^-3×age²-2.621×10^-5×age²×mean BP+3.176×10^-3×age×mean BP-1.832×10^-2×mean BP. The primary outcome was functional independence at 3 months, defined as a modified Rankin Scale score of 0-2. Logistic, ordinal, or linear regression analyses were employed to estimate adjusted odds ratios with 95% CIs for outcomes per 1 m/s or quartile ePWV increase.

Results: Among 302 patients (mean age 73.1±11.5 years, 59.6% men), higher ePWV was independently associated with a lower likelihood of functional independence at 3 months (adjusted odds ratio, 0.80 [95% CI, 0.68-0.94] per 1 m/s increase; adjusted odds ratio, 0.36 [95% CI, 0.14-0.95] for the fourth quartile). A reduction in ePWV at 24 hours after EVT increased the likelihood of functional independence at 3 months in patients receiving conventional BP management (adjusted odds ratio, 3.41 [95% CI, 1.02‒11.38]) but not in those receiving intensive BP management. Incorporating ePWV significantly improved prognostic model performance, with net reclassification improvement of 0.28 (95% CI, 0.06-0.50) and integrated discrimination improvement of 0.02 (95% CI, 0.003-0.04).

Conclusion: The ePWV independently predicts functional independence after EVT, suggesting its potential as a practical prognostic indicator using age and baseline BP.

Background: Rescue intracranial stenting (RICS) is increasingly recognized as a potentially effective rescue strategy following failed mechanical thrombectomy (MT) for large vessel occlusion due to intracranial atherosclerosis, but population-level data on contemporary patterns of RICS utilization in MT are lacking. The aim of this study is to describe trends in the utilization of RICS in MT in the United States in the last decade.

Methods: We conducted a serial cross-sectional study using all primary acute ischemic stroke (AIS) admissions with MT in the 2010-2020 National Inpatient Sample. RICS admissions were defined as those with procedural codes for "percutaneous insertion of intracranial vascular stent" on same day as MT. We used joinpoint regression to evaluate trends in RICS over time and utilized multivariable-adjusted regression to compare odds of in-hospital mortality and routine home discharge between RICS versus non-RICS admissions over time.

Results: Of the 5 190 148 primary AIS admissions in the United States across the study period, 3.0% had codes for MT. The proportion of MT admissions increased by over 8-fold from 0.8% in 2010 to 6.5% in 2020. RICS was utilized in 1.8% of MT admissions but this proportion declined by 5.4% annually (annualized percentage change [APC] -5.4% [95% CI, -7.7% to -3.1%]). However, as a proportion of all AIS admissions, RICS in all AIS increased by 20.5% annually (APC 20.5%, [95% CI, 16.0%-25.2%]). Odds of in-hospital mortality did not differ between RICS compared to non-RICS MT admissions (odds ratio 1.39 [95% CI, 0.83-2.32]) but RICS admissions had 50% lower odds of routine home discharge compared with non-RICS admissions.

Conclusion: RICS is utilized in just under 2% of MT admissions in the United States. This proportion has declined over time but because of increased MT usage in AIS over time, overall utilization in AIS has increased exponentially over time.

The middle meningeal artery plays a vital role in supplying the cranial dura mater and is frequently targeted in some therapies. We describe another case of the pharyngo-tympano-stapedial variant of the middle meningeal artery found incidentally in a patient undergoing a cerebral angiogram. This anatomical variation finds the middle meningeal artery branching from the proximal segment of the cervical internal carotid artery. Understanding these anatomical variations is crucial to avoiding neurological complications during procedures.

Posterior reversible encephalopathy syndrome is a multifactorial neurological disorder characterized by clinical and neuroimaging findings. The "vasogenic theory" suggests that, in this condition, disrupted cerebrovascular autoregulation leads to blood-brain barrier failure and vasogenic edema. Posterior reversible encephalopathy syndrome is commonly associated with hypertension, chemotherapy, and transplantation, but neurosurgical patients, including those undergoing digital subtraction angiography, are also at elevated risk. A patient with a history of traumatic brain injury underwent surveillance digital subtraction angiography for a clipped pseudoaneurysm. Periprocedurally, the patient developed left gaze deviation, right hemiplegia, seizures, and magnetic resonance imaging findings consistent with posterior reversible encephalopathy syndrome. The diagnosis relied on distinct radiographic features, normal laboratory results, electroencephalography consistent with encephalopathy, no evidence of infection, a history of traumatic brain injury, and spontaneous clinical improvement. Posterior reversible encephalopathy syndrome can be triggered by cerebral blood flow changes or cytotoxic endothelial damage, particularly in individuals with compromised blood-brain barrier integrity. Awareness of risk factors, pathophysiology, and clinical and radiographic patterns is crucial for accurate diagnosis.