Background: A low ankle-brachial index (ABI) is associated with a higher risk of cardiovascular diseases, stroke, and systemic inflammation. Intracranial aneurysms (IAs) share similar risk factors with other cardiovascular diseases. However, there is a lack of studies that investigate the association between low ABI and IAs. Aims: To study whether low, borderline, or high ABI is associated with an increased risk of IAs compared to a normal ABI. Methods: We conducted a retrospective review of all patients (n=2751) who had ABI measurements at our tertiary hospital between 2011 and 2013. Patients with available cerebrovascular imaging or a diagnosis of a ruptured IA were included in the study (n=776) to examine the association between ABI and saccular IAs. The patients were classified into four groups as follows: low ABI (≤0.9, n=464), borderline ABI (0.91-0.99, n=47), high ABI (>1.4, n=56), and normal ABI (1.00-1.40, n=209). Results: The prevalence of IAs was 20.3% (18.1% unruptured IAs) in the low ABI group, 14.9% (12.8% unruptured IAs) in the borderline ABI group, 7.0% (5.3% unruptured IAs) in the high ABI group, and 2.4% (1.9% unruptured IAs) in the normal ABI group (p <0.001). In the multinomial regression, which included clinically relevant variables, low ABI (odds ratio [OR], 11.3; 95% confidence interval [CI], 4.1-31.5; p < 0.001) and borderline ABI (OR, 7.1; 95% CI, 1.9-26.6; p <0.001) were the only variables significantly associated with unruptured IAs. Conclusions: Patients with low ABI and borderline ABI had a higher prevalence of IAs compared to patients with a normal ABI. The prevalence of IAs was almost 9-fold higher in the low ABI group and nearly 7-fold higher in the borderline ABI group when compared to the normal ABI group.
BackgroundThe flow-diverter stent (FD) has been proven to be a safe and efficient device in the treatment of large and giant wide-necked proximal internal carotid artery aneurysms.PurposeTo report the outcomes using Flow Re-Direction Endoluminal Device Junior (Fred Jr) flow diverters in the treatment of aneurysms in or distal to the circle of Willis with parent artery diameter < 2.5 mm.Material and MethodsAll electively treated aneurysms with this FD at our institution between September 2015 and December 2016 were retrospectively reviewed. Technical issues, immediate and follow-up radiological findings, and clinical outcomes were assessed. Fifteen patients with 15 aneurysms were included in the study.ResultsNo technical difficulties or complications were encountered during the FD procedure. No FD-related post-procedural complications or mortality occurred. The patients were discharged with unaltered National Institute of Health Stroke Scale (NIHSS) or modified Ranking Scale (mRS). Complete occlusion was reached in 13/15 aneurysms (87%) as assessed from the most recent radiological follow-up (6–24 months).ConclusionOur preliminary results show that the device worked technically well with no complications for aneurysms located on small intracranial arteries. The occlusion rates are comparable to those of other FDs that have been used in small arteries. The device offers a good choice in treating aneurysms that are unmanageable with conventional endovascular techniques or surgery.
Background: Acute brain injuries, including aneurysmal subarachnoid hemorrhage (aSAH), ischemic stroke (IS), and traumatic brain injury (TBI), entail complex recovery processes involving brain plasticity and synaptic regeneration mechanisms. Exploring lipidomic profiles, microRNA expression, and metabolomic changes can yield insights into recovery mechanisms, unveil conserved molecular associations, and identify potential biomarkers. Hypotheses: We hypothesized that regardless of injury type, variations in lipidomic and metabolomic profiles, along with differentially expressed microRNAs, share common characteristics. These changes likely mirror essential biological mechanisms and may correlate with outcomes. Methods: We studied a prospective cohort of patients with IS, aSAH, and TBI (N=71). Serum samples were collected once, followed by comprehensive profiling: lipidomics (Lipidyzer™ Platform), metabolomics (Orbitrap Profiling), and microRNA sequencing (DESeq2). Results: Univariate analysis unveiled candidate molecules predictive of outcomes. Multivariate combinatory linear discriminant analysis (LDA) demonstrated significant prognostic potential for favorable outcomes. The LDA equation combining eight biomarkers was: -0.239[LPC17:0] - 1.125[TAG51:2:FA15:0] + [TAG51:2:FA18:1] + [D-glucuronic Acid] + 0.416[hsa-miR-146b-3p] + 0.082[hsa-miR-485-3p] + 0.433[hsa-miR-5010-5p] + 0.727[hsa-miR-485-5p], effectively predicting favorable outcomes. The AUC was 95.8%, 95% CI (0.88 - 1.00), p-value 0.023, indicating strong discriminatory power of the combinatory biomarker (OR 8.7, 95% CI 1.35-56.9). Conclusion: Findings reveal a shared pattern of lipidomic, metabolomic, and microRNA changes across distinct acute brain injuries. This warrants further investigation and validation, offering prospects for biomarker development, mechanistic validation, and therapeutic interventions in brain recovery. These shared features underscore the importance of interdisciplinary research for targeted, personalized interventions in diverse acute brain injuries.
Spontaneous intracerebral haemorrhage (sICH) is a major cause of morbidity and mortality. Large-scale trials have shown neutral outcomes for surgical interventions. The recent trial suggested functional benefits from surgical intervention. Surgical treatment for sICH is likely increasing.
Somatostatin receptor subtype 2A (SSTR2A) is a potential therapeutic target in gliomas. Data on SSTR2A expression in different glioma entities, however, is particularly conflicting. Our objective was to characterize SSTR2A status and explore its impact on survival in gliomas classified according to the specific molecular signatures of the updated WHO classification. In total, 184 glioma samples were retrospectively analyzed for SSTR2A expression using immunohistochemistry with monoclonal antibody UMB-1. Double staining with CD68 was used to exclude microglia and macrophages from analyses. SSTR2A staining intensity and its localization in tumor cells was evaluated and correlated with glioma entities and survival. Diagnoses included 101 glioblastomas (93 isocitrate dehydrogenase (IDH) -wildtype, 3 IDH-mutant, 5 not otherwise specified (NOS)), 60 astrocytomas (22 IDH-wildtype, 37 IDH-mutant, 1 NOS), and 23 oligodendrogliomas (19 IDH-mutant and 1p/19q-codeleted, 4 NOS). SSTR2A expression significantly associated with oligodendrogliomas (79% SSTR2A positive) compared to IDH-mutant or IDH-wildtype astrocytomas (27% and 23% SSTR2A positive, respectively), and especially glioblastomas of which only 13% were SSTR2A positive (p < 0.001, Fisher's exact test). The staining pattern in glioblastomas was patchy whereas more homogeneous membranous and cytoplasmic staining was detected in oligodendrogliomas. Positive SSTR2A was related to longer overall survival in grade II and III gliomas (HR 2.7, CI 1.2-5.8, p = 0.013). In conclusion, SSTR2A expression is infrequent in astrocytomas and negative in the majority of glioblastomas where it is of no prognostic significance. In contrast, oligodendrogliomas show intense membranous and cytoplasmic SSTR2A expression, which carries potential diagnostic, prognostic, and therapeutic value.
BACKGROUND AND OBJECTIVES: The trend in detection rates of asymptomatic unruptured intracranial aneurysms (UIAs) on brain computed tomography angiography/magnetic resonance angiography (CTA/MRA) is not well established. Our objective was to evaluate time trends in asymptomatic UIA detection rates on brain CTA/MRA between 2005 and 2019. METHODS: We conducted a retrospective study of all brain computed tomography/magnetic resonance scans (n = 288 336 scans in 130 621 patients) performed between January 2005 and December 2019 at a tertiary referral hospital. Patients who underwent brain CTA/MRA examinations were included (n = 81 261 scans in 48 037 patients). The annual detection rate of new UIA cases was calculated based on the first brain CTA/MRA imaging. Detection rates were compared between three periods and across different age groups. RESULTS: The number of first CTA/MRA examinations increased significantly from 2005 to 2009 (n = 12 190 patients) to 2010–2014 (n = 14 969 patients) and 2015–2019 (n = 20 878 patients) ( P < .001). The UIA detection rate also increased significantly from 1.7% in 2005–2009 to 2.5% in 2010–2014 and 3.4% in 2015–2019 ( P < .001). The UIA detection rate increased significantly from 2010–2014 to 2015–2019 (relative risk [RR], 1.33; 95% CI, 1.17-1.51), particularly in patients aged 60–69 years (RR, 1.29; 95% CI, 1.01-1.63), 70–79 years (RR, 1.71; 95% CI, 1.30-2.25), and >79 years (RR, 2.33; 95% CI, 1.56-3.47). Furthermore, the detection rate of <5-mm UIAs increased from 2010–2014 to 2015–2019 (RR, 1.51; 95% CI, 1.28-1.77). CONCLUSION: The detection rate of asymptomatic UIAs, particularly in elderly patients, has increased significantly over the past 15 years, coinciding with the increased use of CTA/MRA imaging. Furthermore, the size of the identified UIAs has decreased. These findings raise concerns about the management strategies for UIAs, indicating the need for further research.
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