Comprehensive classifications for the endovascular recanalization of vertebral artery stump syndrome

Background:and purpose:To share our single-center vertebral artery stump syndrome(VASS)treatment experience and assess the role of comprehensive classification based on anatomic development,proximal conditions,and distal conditions(PAD).Materials and methods:Data were retrospectively collected from patients who underwent endovascular thrombectomy(EVT)at the Stroke Center of the First Hospital of Jilin University between January 2016 and December2021.Among patients with acute ischemic stroke in the posterior circulation,those with acute occlusion of the intracranial arteries and occlusion at the origin of the vertebral artery confirmed by digital subtraction angiography were selected.The clinical data were summarized and analyzed.Results:Fifteen patients with VASS were enrolled in the study.The overall success rate of surgical recanalization was 80%.The successful proximal recanalization rate was 70.6%,and the recanalization rates for P1,P2,P3,and P4 were 100%,71.4%,50%,and 66.67%,respectively.The mean operation times for the A1 and A2 types were124 and 120 min,respectively.The successful distal recanalization rate was 91.7%,and the recanalization rates for types D1,D2,D3,and D4 were 100%,83.3%,100%,and 100%,respectively.Five patients experienced perioperative complications(incidence rate:33.3%).Distal embolism occurred in three patients(incidence rate:20%).No dissection or subarachnoid hemorrhage occurred in any patient.Conclusion:EVT is a technically feasible treatment for VASS,and comprehensive PAD classification can,to a certain extent,help initially estimate the difficulty of surgery and provide guidance for interventional procedures.

Predictive value of intracranial high-density areas in neurological function

BACKGROUND Intracranial high-density areas(HDAs)have attracted considerable attention for predicting clinical outcomes;however,whether HDAs predict worse neurological function and mental health remains controversial and unclear,which requires further investigation.In this prospective study,96 patients with acute ischemic stroke(AIS)who accepted endovascular mechanical thrombectomy(EMT)were included.The enrolled patients underwent cranial computed tomography(CT)examination within 24 hours after EMT.Clinical data in terms of National Institutes of Health Stroke Scale(NIHSS),the 3-month modified Rankin Scale(mRS),self-rating depression scale(SDS),and self-rating anxiety scale(SAS)scores were collected and compared between patients with HDAs and non-HDAs and between patients with good and poor clinical prognosis.Compared to patients without HDAs,patients with HDAs presented severe neurological deficits(admission NIHSS score:18±3 vs 19±4),were more likely to have post-stroke disabilities(mRS<3:35%vs 62%),and suffered more severe depression(SDS score:58±16 vs 64±13)and anxiety disorder(SAS score:52±8 vs 59±10).Compared to patients with a good prognosis,patients with a poor prognosis presented severe neurological deficits(admission NIHSS score:17±4 vs 20±3),were more likely to have HDAs on CT images(64%vs 33%),and suffered more severe depression(SDS score:55±19 vs 65±11)and anxiety(SAS score:50±8 vs 58±12).Multivariate analysis revealed that HDAs were independent nega-tive prognostic factors.CONCLUSION In conclusion,HDAs on CT images predicted poor prognosis and severe depressive and anxiety symptoms in patients with AIS who underwent EMT.