ABSTRACT Background: Venous sinus stenting (VSS) has emerged as a novel treatment option for idiopathic intracranial hypertension (IIH) with transverse sinus stenosis (TSS). However, the efficacy of stenting in atypical IIH patients (body mass index [BMI] < 24 kg/m 2 , ≥ 50 years of age, or male) has not been fully investigated. Methods: The data of IIH + TSS patients who experienced conventional medical treatment failure and received VSS treatment at Beijing Tiantan Hospital in China between May 2021 and December 2022 were retrospectively reviewed in a prospectively maintained database. Baseline characteristics and periprocedural features were collected, and follow‐up clinical outcomes (intracranial pressure [ICP], stent‐adjacent stenosis, and symptoms and ophthalmic improvements) were compared between typical and atypical patients. Results: Data were available for 24 IIH + VSS patients. The median age was 37 years, and 95.8% were female. There were 9/24 atypical patients (37.5%). At baseline, atypical patients had milder visual field defects than typical patients did, as reflected by the mean deviation (MD) of the worse eye (median of −3.08 decibel (dB) vs. −7.63 dB, p = 0.027). Periprocedurally, 1–2 carotid self‐expandable stents with 7–9 mm in length and 40–50 mm in diameter were deployed at the site of the TSS. The median follow‐up duration was 12 months (range 8–22 months). At the last visit of follow‐up, stenting intervention significantly decreased the ICP and grade of papilledema and improved the best corrected visual acuity in the worse eye and MD in the fellow eye in both typical and atypical patients. The clinical outcomes of typical and atypical IIH + TSS patients were not significantly different, except that the MD of the worse eye in the atypical group was greater than that in the typical group (−1.33 dB vs. −5.31 dB, p = 0.001). Conclusions: This study indicates a considerable proportion of atypical IIH cases among IIH + TSS patients with conventional medical treatment failure. Moreover, VSS seems to be an effective and safe therapeutic modality for atypical IIH + TSS.
Background: Collateral circulation provides compensatory flow to ischemic brain regions in acute large vessel occlusion (LVO), which had been associated with better outcomes after endovascular treatment (EVT). Aims: We aimed to reveal the pre-EVT collateral status and its associations with outcomes after EVT, in patients with acute LVO with different etiologies. Methods: Based on a prospective, multicenter registry, we analyzed patients with acute, intracranial anterior-circulation LVO due to large artery atherosclerosis (LAA) and cardioembolism (CE), who underwent EVT within 24 hours. Pre-EVT leptomeningeal collateral status was classified on digital subtraction angiography by ASITN/SIR grading system. Outcomes included good 3-month functional outcome (modified Rankin Scale [mRS] 0-2), 3-month mRS distribution, successful recanalization, early neurological deterioration, symptomatic intracranial hemorrhage (sICH), and 3-month mortality. Results: Among 805 patients (median age 66 years), 450 and 355 respectively had LVO due to LAA and CE, of whom 57.8% and 56.6% (p=0.742) had good pre-EVT collaterals. In LAA patients, good collaterals were associated with lower risk of sICH (adjusted odds ratio [OR]=0.40; 95% CI 0.17-0.94; p=0.036) but not functional outcomes. In CE patients, good collaterals were associated with a higher chance of good functional outcome (adjusted OR=1.55; 95% CI 0.96-2.51; p=0.072) and lower mRS at 3 months (adjusted common OR=0.64; 95% CI 0.43-0.94; p=0.021). However, there was no significant CE/LAA and collateral status interaction on any outcome. Conclusions: The study revealed comparable pre-EVT collateral status in patients with LVO due to LAA versus CE who received EVT within 24 hours, but the pre-EVT collaterals may have different protective effects for post-EVT outcomes in these two groups of patients.
Background and purpose: Tirofiban and oral antiplatelet drugs can be used to inhibit reocclusion and restore microvascular reperfusion during endovascular treatment (EVT). This study compared recanalization rates, symptomatic intracranial hemorrhage (sICH), 90-day mortality, and functional outcomes between periprocedural tirofiban and antiplatelet therapy in patients with acute intracranial atherosclerosis-related vertebrobasilar artery occlusion. Methods: A total of 105 consecutive patients with acute intracranial atherosclerosis-related vertebrobasilar artery occlusion who underwent EVT + tirofiban + oral antiplatelet or EVT + oral antiplatelet therapy at the Beijing Tiantan Hospital between January 2012 and July 2018 were included. Baseline characteristics, procedural parameters, and functional outcomes were assessed. Results: Among the 105 patients, 74 underwent EVT + tirofiban + oral antiplatelet therapy, while 31 underwent EVT + oral antiplatelet drug therapy. EVT + tirofiban + oral antiplatelet therapy resulted in higher recanalization rates compared to EVT + oral antiplatelet drug therapy (93.24% versus 77.42%; p=0.038), whereas the risk for sICH, 90-day mortality, and functional independence outcomes did not differ between the groups. Logistic regression analysis revealed that EVT + tirofiban + oral antiplatelet therapy had an increased probability of higher recanalization rates (OR 0.18 [95% confidence interval (CI) 1.24–24.39]; p=0.025). There were no differences in sICH (OR 0.00 [95% CI 0.00–Inf; p=0.998), 90-day mortality (OR 1.19 [95% CI 0.17–4.05]; p=0.826) or functional independence (modified Rankin score 0 to ≤ 2) (OR 1.43 [95% CI 0.23–2.17]; p=0.538) between the groups. Conclusions: Ninety-day functional outcomes of EVT + tirofiban + oral antiplatelet therapy were not superior to those of EVT + oral antiplatelet drug therapy; however, the recanalization rate was higher and the risks for sICH and 90-day mortality were lower.
Corrigendum: Long-Term Risk Factors for Intracranial In-Stent Restenosis from a Multicenter Trial of Stenting for Symptomatic Intracranial Artery Stenosis Registry in ChinaXu Guo, Ning Ma, Feng Gao, Da-Peng Mo, Gang Luo and Zhong-Rong Miao*Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.* Correspondence: zhongrongm@163.comKeywords: cerebrovascular disease; endovascular treatment; interventional neurology; intracranial in-stent restenosis; strokeA Corrigendum onLong-Term Risk Factors for Intracranial In-Stent Restenosis from a Multicenter Trial of Stenting for Symptomatic Intracranial Artery Stenosis Registry in Chinaby Guo X, Ma N, Gao F, Mo DP, Luo G, Miao ZR. (2021). Front Neurol. 11:601199. doi: 10.3389/fneur.2020.601199.In the original article, there were errors. Three numbers due to mistaken data import from SPSS into the submitted manuscript. A correction has been made to DISCUSSION, The Type and Length of the Stent of Sub-section, Paragraph 1. We concluded that 19 patients presented restenosis by performing balloon-mounted stents, including seven cases with basilar artery stenosis and four cases with intracranial vertebral artery stenosis. We apologize for the errors in the number of cases in our manuscript. This correction does not change the scientific conclusions of the article in any way. The original article has been updated.
To identify and compare the predictors of failure of early neurological improvement (fENI)after successful EVT for anterior circulation large vessel occlusion (ACLVO) and posterior circulation LVO (PCLVO).
Parenchymal hemorrhage (PH) is a troublesome complication after endovascular treatment (EVT).To investigate the incidence, independent predictors, and clinical impact of PH after EVT in patients with acute ischemic stroke (AIS) due to anterior circulation large vessel occlusion (LVO).Subjects were selected from the ANGEL-ACT Registry. PH was diagnosed according to the European Collaborative Acute Stroke Study classification. Logistic regression analyses were performed to determine the independent predictors of PH, as well as the association between PH and 90-day functional outcome assessed by modified Rankin Scale (mRS) score.Of the 1227 enrolled patients, 147 (12.0%) were diagnosed with PH within 12-36 hours after EVT. On multivariable analysis, low admission Alberta Stroke Program Early CT score (ASPECTS)(adjusted OR (aOR)=1.13, 95% CI 1.02 to 1.26, p=0.020), serum glucose >7 mmol/L (aOR=1.82, 95% CI 1.16 to 2.84, p=0.009), and neutrophil-to-lymphocyte ratio (NLR; aOR=1.05, 95% CI 1.02 to 1.09, p=0.005) were associated with a high risk of PH, while underlying intracranial atherosclerotic stenosis (ICAS; aOR=0.42, 95% CI 0.22 to 0.81, p=0.009) and intracranial angioplasty/stenting (aOR=0.37, 95% CI 0.15 to 0.93, p=0.035) were associated with a low risk of PH. Furthermore, patients with PH were associated with a shift towards to worse functional outcome (mRS score 4 vs 3, adjusted common OR (acOR)=2.27, 95% CI 1.53 to 3.38, p<0.001).In Chinese patients with AIS caused by anterior circulation LVO, the risk of PH was positively associated with low admission ASPECTS, serum glucose >7 mmol/L, and NLR, but negatively related to underlying ICAS and intracranial angioplasty/stenting.NCT03370939.
Advances in endovascular treatment of acute ischaemic stroke from intracranial large vessel occlusions have continued in the past decade. Here, we performed a detailed review of all the new trials and studies that had the highest evidence, the guidelines for mechanical thrombectomy, the selection of the particular population outside the guidelines and endovascular therapeutic strategies for acute ischemic stroke from occluded intracranial arteries.
Background To investigate whether collateral status could modify the associations between post-thrombectomy blood pressure (BP) measures and outcomes. Methods and Results Patients with anterior-circulation large-vessel-occlusion successfully recanalized in a multicenter endovascular thrombectomy registry were enrolled. Pretreatment collateral status was graded and dichotomized (good/poor) in angiography. Maximum, minimum, and mean systolic BP (SBP) and BP variability (assessed by the SD, coefficient of variation) during the initial 24 hours after endovascular thrombectomy were obtained. The primary outcome was unfavorable 90-day outcome (modified Rankin Scale score 3-6). Secondary outcomes included symptomatic intracranial hemorrhage and 90-day mortality. Adjusted odds ratios (aOR) of BP parameters over the outcomes were obtained in all patients and in patients with good/poor collaterals. Among 596 patients (mean age 66 years; 59.9% males), 302 (50.7%) patients had unfavorable 90-day outcome. In multivariable analyses, higher mean SBP (aOR, 1.59 per 10 mm Hg increment; 95% CI, 1.26-2.02; P<0.001), mean SBP >140 mm Hg (versus ≤120 mm Hg; aOR, 4.27; 95% CI, 1.66-10.97; P=0.002), and higher SBP SD (aOR, 1.08 per 1-SD increment; 95% CI, 1.01-1.16; P=0.02) were respectively associated with unfavorable 90-day outcome in patients with poor collateral but not in those with good collateral. A marginal interaction between SBP coefficient of variation tertiles and collaterals on 90-day functional outcome (P for interaction, 0.09) was observed. A significant interaction between SBP coefficient of variation tertiles and collaterals on 90-day mortality (P for interaction, 0.03) was observed. Conclusions Higher postprocedural BP is associated with 90-day unfavorable outcomes after successful endovascular thrombectomy in patients with poor collateral. Registration URL: https://www.chictr.org.cn; Unique identifier: ChiCTR1900022154.
β-Amyloid (Aβ)-induced neuronal toxicity is an early event in the pathogenesis of Alzheimer's disease. Quetiapine (QTP) is an atypical antipsychotic drug that has neuroprotectant properties, but little is known about its direct protective effects on neurons against the Aβ-induced cell toxicity. In the present study, we investigated the neuroprotective effects of QTP on Aβ25–35-induced cell death and the possible underlying mechanisms in primary cultures of neurons. Exposure of cortical neurons to 10 μM or more Aβ25–35 caused significant viability loss in a MTT assay, and the toxic effects were not significantly prevented by the simultaneous coadministration of QTP. However, pretreated astrocyte conditioned medium (ACM) with QTP (ACMQTP) for 24 h markedly protected the neurons against the amyloid-induced cell loss. Furthermore, we revealed that QTP increased both the release of brain-derived neurotrophic factor from cultured astrocytes and the phosphorylation of extracellular signal–regulated kinase after 24 h of treatment, which might be responsible for its protective effects on neurons. Consistent with the aforementioned findings, the protective effects of ACM on neurons could potentially be abolished by the extracellular signal–regulated kinase inhibitor and tropomyosin receptor kinase B receptor blocker. In conclusion, our data demonstrated that QTP exerted its neuroprotective effects against amyloid toxicity by enhancing the brain-derived neurotrophic factor release from astrocytes.
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