Although some vertebral artery dissection (VADs) cases heal naturally, others progress to stroke, necessitating intervention. Endovascular treatment (EVT) has gained prominence as a viable approach for addressing VADs owing to its perceived low risk of procedure-related complications and high effectiveness. In this review, we share our practical experience of this technique by incorporating the indications and methods for VAD treatment via EVT. Our EVT strategies covered the management of both ruptured and selected cases of unruptured VADs. Unruptured cases that require treatment include those complicated by lesions with recurring or progressive ischemia, large dissecting aneurysms with mass effects, early changes in the VAD structure during follow-up, and involvement of the basilar or bilateral vertebral arteries (VAs). In cases of ruptured VADs, we aimed to occlude the site of rupture through either VA occlusion or stent-assisted coiling. For unruptured VADs, the goal is to restore the original blood flow dynamics using a range of stenting techniques. The choice of EVT technique should be made on a case-by-case basis, considering factors such as the patient's presenting symptoms, hemodynamic status, adequacy of collateral blood supply, and anatomical characteristics of the important arteries and perforators.

Traumatic brain injury (TBI) is a significant global health concern with substantial contributions to illness and mortality rates. This study aims to scrutinize the intricate interplay between neurological and circulatory abnormalities post-TBI, particularly focusing on the challenge posed by cardiac arrest in TBI patients. The study employs a comprehensive approach, utilizing clinical assessments, electrocardiograms, intracranial pressure monitoring, brain imaging, and biomarker utilization. It explores the effectiveness of these methods in detecting cardiac arrest in TBI patients. Additionally, the research delves into resuscitation techniques, hemodynamic stabilization, intracranial pressure management, and neurological enhancement as potential therapeutic modalities. The results highlight the importance of prompt initiation of cardiopulmonary resuscitation and adherence to advanced cardiac life support protocols in TBI patients with cardiac arrest. Prognostic factors such as injury severity, response time, effectiveness of resuscitation interventions, and pre-existing medical conditions are identified as crucial elements in predicting cardiac arrest outcomes in TBI patients. The study concludes by emphasizing the critical necessity of a comprehensive approach to understand and manage the complex relationship between cardiac arrest and TBI. Incorporating scientific discoveries, clinical perspectives, and technological advancements, the review underscores the importance of addressing this multifaceted medical challenge through a thorough analysis and effective management strategies.

Background: The development of endovascular devices and clinical experience, recanalization rate after intraarterial thrombectomy (IA-Tx) has increased. Recent papers reported that the amount of perfusion/diffusion (P/D)-mismatching in digital analysis from computer tomography perfusion (CTP) image is well correlated well with P/D-mismatching from magnetic resonance image. The purpose of this study is compare the patient clinical outcomes after IA-Tx, judging from CTP based and magnetic resonance imaging (MRI) based study. Methods: : 218 patients with anterior circulation large vessel occlusion (LVO) treated by IA-Tx were included in this analysis. In the MRI group (n=80), P/D-mismatching from MRI based image analysis by visual method and in the CTP group (n=138), and recently, P/D-mismatching was decided by automatized computer programmatic analyzed from CTP based image (Syngo.via program). Results: Favorable outcome (modified Rankin Score: 0–2), mortality, recanalization, and clinically significant hemorrhage was 56.3% (45/80), 6.25% (5/80), 81.3% (65/80) and 25% (20/80) in MRI group and 4.9% (62/138), 8.9%(18/138), 91.3%(126/138) and 40.6% (56/138) in CTP group (p=0.000, 0.235, 0.007 and 0.013). Reperfusion injury (27.5% vs, 15.0%, p=0.018) but favorable outcome was high 55.0% vs. 44.9 $, p=0.00) in the MRI study group. Conclusion : In our study, patient selection according to the P/D-mismatching from MR-based imaging and CTP-based image was not different in final clinical outcome. Recent IA-Tx, showed high recanalization rate but it also cause high incidence of reperfusion injury.

Background: The objective of this study is to summarize the evidence in Cochrane and non-Cochrane systematic reviews, the effects, and the benefits of monitoring intracranial pressure (ICP) in patients with head trauma with an indication of ICP monitoring Methods: The process of preparing this overview followed the guidelines established by the Joanna Briggs Institute (JBI) for umbrella reviews. Two independent reviewers evaluated the quality of reporting, bias risk, methodologies, and evidence using three different tools: the Risk of Bias in Systematic Reviews (ROBIS) instrument, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and A Measurement Tool to Assess Systematic Reviews (AMSTAR 2). Results: A total of five papers met the criteria for inclusion in the study. These papers consisted of 49 primary research studies and 19 unique primary research studies. One of the SRs indicated that using intracranial pressure (ICP) monitoring led to a reduction in mortality. Two of the SRs had mixed results with temporal variation, while two found no significant difference in mortality with ICP monitoring. It is important to note that the quality of the SRs varied, with some being of higher quality than others. Conclusion There was no conclusive evidence that ICP monitoring reduces mortality in TBI patients. There was high heterogeneity in included primary research studies. Future research should aim to address the limitations of these studies and provide more conclusive evidence regarding the effectiveness of ICP monitoring in reducing mortality in patients with traumatic brain injury.

Although some vertebral artery dissection (VADs) cases heal naturally, others progress to stroke, necessitating intervention. Endovascular treatment (EVT) has gained prominence as a viable approach for addressing VADs owing to its perceived low risk of procedure-related complications and high effectiveness. In this review, we share our practical experience of this technique by incorporating the indications and methods for VAD treatment via EVT. Our EVT strategies covered the management of both ruptured and selected cases of unruptured VADs. Unruptured cases that require treatment include those complicated by lesions with recurring or progressive ischemia, large dissecting aneurysms with mass effects, early changes in the VAD structure during follow-up, and involvement of the basilar or bilateral vertebral arteries (VAs). In cases of ruptured VADs, we aimed to occlude the site of rupture through either VA occlusion or stent-assisted coiling. For unruptured VADs, the goal is to restore the original blood flow dynamics using a range of stenting techniques. The choice of EVT technique should be made on a case-by-case basis, considering factors such as the patient's presenting symptoms, hemodynamic status, adequacy of collateral blood supply, and anatomical characteristics of the important arteries and perforators.

Traumatic brain injury (TBI) is a significant global health concern with substantial contributions to illness and mortality rates. This study aims to scrutinize the intricate interplay between neurological and circulatory abnormalities post-TBI, particularly focusing on the challenge posed by cardiac arrest in TBI patients. The study employs a comprehensive approach, utilizing clinical assessments, electrocardiograms, intracranial pressure monitoring, brain imaging, and biomarker utilization. It explores the effectiveness of these methods in detecting cardiac arrest in TBI patients. Additionally, the research delves into resuscitation techniques, hemodynamic stabilization, intracranial pressure management, and neurological enhancement as potential therapeutic modalities. The results highlight the importance of prompt initiation of cardiopulmonary resuscitation and adherence to advanced cardiac life support protocols in TBI patients with cardiac arrest. Prognostic factors such as injury severity, response time, effectiveness of resuscitation interventions, and pre-existing medical conditions are identified as crucial elements in predicting cardiac arrest outcomes in TBI patients. The study concludes by emphasizing the critical necessity of a comprehensive approach to understand and manage the complex relationship between cardiac arrest and TBI. Incorporating scientific discoveries, clinical perspectives, and technological advancements, the review underscores the importance of addressing this multifaceted medical challenge through a thorough analysis and effective management strategies.

Background: The development of endovascular devices and clinical experience, recanalization rate after intraarterial thrombectomy (IA-Tx) has increased. Recent papers reported that the amount of perfusion/diffusion (P/D)-mismatching in digital analysis from computer tomography perfusion (CTP) image is well correlated well with P/D-mismatching from magnetic resonance image. The purpose of this study is compare the patient clinical outcomes after IA-Tx, judging from CTP based and magnetic resonance imaging (MRI) based study. Methods: : 218 patients with anterior circulation large vessel occlusion (LVO) treated by IA-Tx were included in this analysis. In the MRI group (n=80), P/D-mismatching from MRI based image analysis by visual method and in the CTP group (n=138), and recently, P/D-mismatching was decided by automatized computer programmatic analyzed from CTP based image (Syngo.via program). Results: Favorable outcome (modified Rankin Score: 0–2), mortality, recanalization, and clinically significant hemorrhage was 56.3% (45/80), 6.25% (5/80), 81.3% (65/80) and 25% (20/80) in MRI group and 4.9% (62/138), 8.9%(18/138), 91.3%(126/138) and 40.6% (56/138) in CTP group (p=0.000, 0.235, 0.007 and 0.013). Reperfusion injury (27.5% vs, 15.0%, p=0.018) but favorable outcome was high 55.0% vs. 44.9 $, p=0.00) in the MRI study group. Conclusion : In our study, patient selection according to the P/D-mismatching from MR-based imaging and CTP-based image was not different in final clinical outcome. Recent IA-Tx, showed high recanalization rate but it also cause high incidence of reperfusion injury.

Background: The objective of this study is to summarize the evidence in Cochrane and non-Cochrane systematic reviews, the effects, and the benefits of monitoring intracranial pressure (ICP) in patients with head trauma with an indication of ICP monitoring Methods: The process of preparing this overview followed the guidelines established by the Joanna Briggs Institute (JBI) for umbrella reviews. Two independent reviewers evaluated the quality of reporting, bias risk, methodologies, and evidence using three different tools: the Risk of Bias in Systematic Reviews (ROBIS) instrument, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and A Measurement Tool to Assess Systematic Reviews (AMSTAR 2). Results: A total of five papers met the criteria for inclusion in the study. These papers consisted of 49 primary research studies and 19 unique primary research studies. One of the SRs indicated that using intracranial pressure (ICP) monitoring led to a reduction in mortality. Two of the SRs had mixed results with temporal variation, while two found no significant difference in mortality with ICP monitoring. It is important to note that the quality of the SRs varied, with some being of higher quality than others. Conclusion There was no conclusive evidence that ICP monitoring reduces mortality in TBI patients. There was high heterogeneity in included primary research studies. Future research should aim to address the limitations of these studies and provide more conclusive evidence regarding the effectiveness of ICP monitoring in reducing mortality in patients with traumatic brain injury.