Objective To evaluate the correlation between 3D morphological parameters of aneurysms based on the computer-assisted semi-automated measurement and the risk of aneurysm rupture.Methods From October 2019 to October 2022,patients with ruptured multiple aneurysms admitted to the Department of Neurosurgery of Xuanwu Hospital,Capital Medical University were retrospectively included.Aneurysmal morphological parameters(including aneurysmal diameter,maximum diameter,width,neck width,volume,flow angle,parental artery diameter,surface area,wave index and non-spherical index)were measured by computer-assisted semi-automated measurement methods.The length-to-width ratio,wide-to-neck ratio,aspect ratio and size ratio were calculated,and the aneurysm location information was recorded.The ruptured aneurysms in multiple aneurysms were included in the ruptured group,and the remaining aneurysms were included in the unruptured group.Uni variable analysis and binary Logistic analysis were used to evaluate the differences in morphological parameters and location information between the ruptured and unruptured groups.Results All 56 patients with multiple ruptured aneurysms and a total of 126aneurysms were included in the group for analysis.Concerning morphology,including diameter＞5 mm(51.8％[29/56]vs.15.7％[11/70],P＜0.01),maximum diameter＞6mm(57.1％[32/56]vs.25.7％[18/70],P＜0.01),flow angle＞107°(57.1％[32/56]vs.35.7％[25/70],P=0.016),wide-to-neck ratio＞1.1(50.0％[28/56]vs.30.0％[21/70],P=0.022),aspect ratio＞1.1(46.4％[26/56]vs.25.7％[18/70],P=0.015)and size ratio＞1.9(57.1％[32/56]vs.10.0％[7/70],P＜0.01),there was significant difference between the ruptured and unruptured group;Concerning locations,aneurysms are mainly located in the posterior communicating segment of the internal carotid artery(39.3％[22/56])and the middle cerebral artery(23.2％[13/56])in ruptured group,while in the middle cerebral artery(28.6％[20/70])and the non-posterior communicating segment of internal carotid artery(27.1％[19/70])in unruptured group,and there was significant difference in distribution of aneurysm locations(P=0.003).Multivariate Logistic regression analysis showed that size ratio＞1.9 was an independent risk factor for aneurysm rupture(OR,11.62,95％CI 2.40-56.15;P=0.002).Concerning locations,posterior communicating artery aneurysms had a significantly higher risk of rupture compared with the non-posterior communicating segment of internal carotid artery(OR,19.25,95％CI 2.19-169.51;P=0.008).Conclusion For multiple intracranial aneurysms,the size ratio of the three-dimensional morphological parameters of aneurysms＞1.9 is an independent risk factor for aneurysm rupture,and the rupture risk of posterior communicating artery aneurysms is significantly higher than that of non-posterior communicating segment of internal carotid artery.

Objective To investigate the value of non-contrast CT(NCCT)-based radiomics for identifying acute unilateral middle cerebral artery occlusion(MCAO)with negative hyperdense artery sign(HAS).Methods All 80 patients with acute unilateral MCAO confirmed by angiography(MR angiography[MRA]or CT angiography[CTA]or DSA)and presenting with negative NCCT presentation for HAS were enrolled from January 2015 to June 2023 in the Emergency Department of Stroke Center of Affiliated Hospital of Yangzhou university.On the NCCT images,the occluded segment of the middle cerebral artery on the affected side of each case and the corresponding segment of the vessel on the normal side were used as the regions of interest,and a total of 108 radiomic features were extracted.The least absolute shrinkage and selection operator(LASSO)was used to screen the key features,construct and calculate the radiomics score,and four imaging histology models,support vector machine(SVM),light gradient boosting machine(LightGBM),GradientBoosting and adaptive boosting(AdaBoost),were built respectively to predict MCAO.Predictive performance was evaluated by the area under the receiver operating characteristic curves,and comparisons between the modeled receiver operating characteristic curves were made using the Delong test.Finally,the value of the application of radiological modeling was assessed by clinical decision curve analysis(DCA).Results The NCCT images based on 160 vessels were finally screened for 6 key features,including skewness,energy,gray level size zone matrix(GLSZM)-gray uneven,GLSZM-low gray area emphasis,GLSZM-size area non-uniform standardization,GLSZM-area entropy.The area under the curve(AUC)of the SVM-test was 0.688(95％CI 0.497-0.878)with an accuracy of 0.688;the AUC of the LightGBM-test was 0.787(95％CI 0.620-0.955)with an accuracy of 0.781;the AUC of the GradientBoosting-test was 0.654(95％CI 0.457-0.852)with an accuracy of 0.688;the AUC of the AdaBoost-test was 0.707(95％CI 0.515-0.899)with an accuracy of 0.750.The Delong test showed a statistically significant difference between LightGBM-test and GradientBoosting-test(P=0.040),and no statistically significant difference in performance between the remaining models(all P＞0.05).DCA showed that the LightGBM-test performed better.Conclusion NCCT-based radiomics has good diagnostic efficacy for identifying acute unilateral MCAO with negative HAS,and this conclusion needs to be further verified by multi-center and large sample studies.

Objective To explore the impacts of compensatory function of the anterior communicating artery(ACoA)on the measurement of blood flow velocity and the degree of stenosis of the non-operative carotid artery in patients with bilateral carotid atherosclerotic stenosis.Methods A total of 161 patients with carotid artery stenosis and the ACoA patency,who underwent unilateral carotid endarterectomy(CEA)from January 2019 to January 2021,were enrolled into this study.Examination was performed using transcranial color-coded Doppler(TCCD)and(or)transcranial Doppler ultrasound(TCD)and confirmed by DSA and(or)CT angiography(CTA).According to whether the ACoA compensation was complete,all patients were divided into complete ACoA group(69 cases)and incomplete ACoA group(92 cases).The peak systolic velocity(PSV)and end-diastolic velocity(EDV)measured by the carotid ultrasound were compared between the complete ACoA group and the incomplete ACoA group before and after CEA.In addition,the results of stenosis degree of non-operative carotid artery evaluated by the ultrasound and DSA or CTA were analysed for the consistency.Results There was no significant difference in age,gender and risk factors for cerebrovascular disease between the two groups(all P＞0.05).Within 1 week after CEA,the PSV([107±35]cm/s,[122±40]cm/s)and EDV([37±12]cm/s,[47±16]cm/s)of the nonoperative carotid artery decreased significantly when compared with those before CEA in both complete and incomplete ACoA patent groups(PSV[177±58]cm/s,[163±54]cm/s and EDV[64±21]cm/s,[76±25]cm/s,all P＜0.01).In the complete ACoA group,the stenosis degrees of non-operative carotid arteries assessed by the CDU were inconsistent with that assessed by the DSA or CTA(Kappa=0.074).Of the 58 patients with mild stenosis assessed by DSA or CTA,55(94.8％)were overestimated as moderate stenosis,and 2(3.4％)were overestimated as severe stenosis.Of the 9 patients with moderate stenosis assessed by DSA or CTA,8 had ultrasound overestimation to severe stenosis.In the incomplete ACoA group,it was highly consistent with that assessed by the DSA or CTA(Kappa=0.920).Of 70 patients with mild stenosis assessed by DSA or CTA,2 cases(2.9％)were overestimated as moderate stenosis by ultrasound.Of the 9 patients with moderate stenosis assessed by DSA or CTA,1 was overestimated by ultrasound to be severe stenosis.Conclusion Non-operative carotid artery PSV and EDV were significantly higher in patients with bilateral carotid artery stenosis with patency and complete compensatory function of ACoA,leading to overestimation the degree of carotid artery stenosis.

Objective To analyze the correlation between vertebral artery asymmetry and vertebral artery origin stenosis(VAOS)lesions in population without risk factors for cardiovascular and cerebrovascular diseases.Methods A total of 6 423 participants without cardiovascular and cerebrovascular high-risk factors who underwent cervical atherosclerosis ultrasound screening in the"standardized evaluation database for cerebral vascular ultrasound screening in the high-risk population of stroke"from December 2019 to December 2021 were consecutively enrolled.The general information of the participants was collected before the examination,including gender,age,body mass index(BMI),and bilateral vertebral artery ultrasound parameters,i.e.,the internal diameter of the intervertebral segment(V2 segment)and the degree of VAOS(mild,moderate,severe,and occlusion)assessed by hemodynamic parameters(peak systolic flow velocity[PSV],end-diastolic flow velocity[EDV],and PSVinitiation/PSVintervertebral segment).According to the ultrasound results,the participants were divided into VAOS group and no stenosis group(non-VAOS group).Vertebral artery diameter ≤ 2.0 mm was defined as vertebral artery hypoplasia(VAH).According to the difference in the inner diameter of the V2 segment of the bilateral vertebral arteries,the participants were classified as vertebral artery dominance(VAD)group(inner diameter difference ≥1.2 mm)and non-VAD group(inner diameter difference＜1.2 mm).In the final statistical analysis,if there is a side involved,each group will be counted by the number of cases,and if no side differentiation is involved,each group will be counted by the number of cases.Taking the occurrence of VAOS as the dependent variable,the general information and anatomical factors(VAH,VAD)were analyzed by univariate Logistic regression.The item of P＜0.05 was used as the independent variable,and the independent influencing factors of VAOS were further analyzed by multivariate Logistic regression.Results A total of 6 423 participants were included,including 1 985 males and 4 438 females,with an average age of(43±13)years from 19 to 80 years.There were 628 cases in the VAD group and 5 795 cases in the non-VAD group.(1)Compared with the VAD group,the proportion of females in the non-VAD group was higher(69.9％vs.61.3％,P＜0.01),and the age was younger([43±13]vs.[45±14]years,P＜0.01),and the proportion of those aged＜40 years was higher than that in the VAD group(46.3％vs.38.4％,P＜0.01).The proportion of VAH patients and the incidence of VAOS were lower than those in the VAD group(0.6％vs.17.2％and 1.5％vs.4.0％,respectively,both P＜0.01).(2)Univariate Logistic regression analysis of the incidence of VAOS among participants without cardiovascular and cerebrovascular risk factors showed that the proportion of male,age,BMI,VAH and VAD ratios in the VAOS group were higher than those in the non-VAOS group,with statistical significance(all P＜0.05).Multivariate Logistic regression analysis showed that male(OR,1.92,95％CI 1.30-2.85,P=0.001),age(OR,1.12,95％CI1.10-1.14,P＜0.01)and VAD(OR,2.14,95％CI 1.30-3.40,P=0.002)were independent risk factors for VAOS in participants without cardiovascular and cerebrovascular risk factors.Conclusions The occurrence of VAD is affected by gender and age.VAD is an independent risk factor for VAOS in population without cardiovascular and cerebrovascular risk factors.

Endovascular treatment is a highly effective treatment for acute ischemic stroke.Cerebral arterial collateral circulation has traditionally been recognized as a significant factor in making endovascular treatment decisions and predicting clinical outcomes.However,recent studies indicated that cerebral venous collateral circulation was also crucial for the clinical outcomes of stroke patients.Venous collaterals not only provide perfusion for cerebral blood flow but also correlate with multiple outcomes including clinical prognosis,early neurological deterioration,futile recanalization,hemorrhagic transformation,and cerebral edema formation.The authors summarized the research progress of cerebral venous collateral evaluation in the endovascular treatment of acute ischemic stroke,and explored the potential mechanisms and clinical applications,aiming to provide new perspectives on stroke prevention and treatment.

Ischemic stroke has a high rate of disability and mortality and is often accompanied by white matter injury(WMI).WMI patients often have cognitive disorders,emotional disorders,sensorimotor disorders,urinary incontinence and other symptoms,which seriously affect daily life.WMI can be detected early through imaging techniques,but there is a lack of appropriate intervention and specific treatment.Studying the pathological mechanism of WMI after ischemic stroke is helpful to prevent the occurrence of WMI,delay its progression,and contribute to the development of effective drugs or specific treatments.This article reviewed the research progress of WMI mechanism after ischemic stroke in order to provide scientific basis for clinical prevention and treatment.

The epidemiology of ischemic stroke is characterized by a high incidence,high mortality and disability rates,and a high recurrence rate,yet current clinical treatment methods are limited.The onset of ischemic stroke is closely related to mitochondrial transfer.Mitochondria plays a crucial role in cellular energy supply,signal transmission,and other functions.In recent years,research on the application of mitochondrial transfer in the treatment of ischemic stroke has made progress.The authors reviewed the current research progress on mitochondrial transfer following ischemic stroke,aiming to highlight the existing research gaps and future prospects.This review provides guidance for the development of new clinical treatment methods for ischemic stroke.

Ring finger protein 213(RNF213)was first identified as a susceptible gene for Moyamoya disease,and also found to be associated with various vascular related diseases such as intracranial artery occlusion/stenosis,ischaemic stroke,intracranial aneurysm,cerebral arteriovenous malformation,etc.This article systematically reviewed the literature of RNF213,providing an overview of the association and possible mechanisms between RNF213 variation and related diseases,in order to provide reference for the prevention,diagnosis,and treatment of related diseases.

Stroke is a major disease that endangers the health of human beings.Since 2015,mechanical thrombectomy has emerged as the primary therapeutic method for acute ischemic stroke.Present guidelines lean towards treating patients with mechanical thrombectomy within a therapeutic window,while the efficacy of thrombectomy beyond 24-hour remains a matter of contention.The authors manuscript undertook a retrospective review of extant clinical research,scrutinizing its safety and efficacy from the standpoint of research design,and offering a detailed synthesis concerning on predictive factors and imaging modalities for selection.

Progressing stroke(PS)as a special type of ischemic stroke,accounts for approximately 10％to 40％of ischemic strokes.Compared with non-progressing stroke,PS has a higher mortality and disability rate.Large vessel disease is the most common cause of PS.However,due to the extended onset time,there is still considerable debate over the endovascular treatment of PS,and current treatment is primarily based on medication.This article provides a review of the current status of research on endovascular treatment for progressive stroke caused by large vessel disease,with the aim of offering a reference for clinical diagnosis,treatment,and related research.