Asociación entre calcificaciones de la glándula pineal y enfermedad aterosclerótica intracraneal en adultos mayores

Background: This study assesses whether pineal gland calcification (PGC) – a surrogate for reduced endogenous melatonin production – is associated with significant stenosis of large intracranial arteries – a biomarker of intracranial atherosclerotic disease (ICAD). Methods: Individuals aged ≥60 years enrolled in the Three Villages Study received head CT to assess PGC and MRA to estimate stenosis of large intracranial arteries. Multivariate logistic regression models were fitted to assess the association between PGC and ICAD, after adjusting for relevant confounders. Inverse probability of exposure weighting was used to estimate the effect of PGC on ICAD. Results: A total of 581 individuals were enrolled. PGC and ICAD were associated in a fully-adjusted logistic regression model (p=0.032). Inverse probability of exposure weighting showed an estimate for the proportion of ICAD among those without PGC of 3.7% and the adjusted-effect coefficient was 5.7% higher among those with PGC (p=0.031). Conclusions: PGC is associated with ICAD. Study results provide grounds for evaluating the role of melatonin deficiency in ICAD progression. Keywords: Pineal gland calcification, intracranial atherosclerosis, stenosis of large intracranial arteries, melatonin; population study, older adults

Double-barrel STA-MCA bypass and partial trapping of a ruptured mycotic MCA aneurysm with flash fluorescence technique

Mycotic brain aneurysms are rare and unusual cerebrovascular lesions arising from septic emboli that degrade the elastic lamina and vessel wall of intracranial arteries, which results in pathologic dilatation. Mycotic aneurysms are nonsaccular lesions that are not often suitable for clipping and instead require bypass, trapping, and flow reversal. This case demonstrates the use of indocyanine green “flash fluorescence” to identify the cortical distribution supplied by an aneurysm’s outflow, facilitating safe treatment with a double-barrel extracranial-intracranial bypass and partial trapping and conversion of a deep bypass to a superficial one. The video can be found here: https://stream.cadmore.media/r10.3171/2021.10.FOCVID21163

Impact of gender and age on inner diameter of arteries forming circle of Willis assessed by multidetector CT

Introduction: The circle of Willis (CoW), which is located at the base of the brain is the most important anastomosis between the internal carotid and vertebral system. It is the main distributor of blood to the brain. Methods: CT head and CT angiography were performed using standard scan parameters. Only the tests with normal radiological reports and appropriate technical standards were included in the study. Component of circle of Willis: Anterior cerebral artery (ACA), Middle cerebral artery (MCA), Anterior communicating artery (Acom), Posterior Communicating artery (PCom), Basilar artery (BA) and Posterior cerebral artery (PCA) were identified and their internal diameter were measured. Results: Basilar artery was the artery with largest internal diameter with mean diameter of 2.5 ±0.52 mm. Men had significantly larger arterial sizes than women in all of the intracranial arteries examined except right PCom, Left PCom and right MCA. Right ACA had significantly larger internal diameter in <40 years’ age group. BA, left PCA, Bilateral PCom and MCA showed larger diameter in age group ≥40 years. Conclusion: Men had significantly larger arterial sizes than women in all of the intracranial arteries examined except right PCom, Left PCom and right MCA.

Novel Blood Clot Retriever for Ischemic Stroke

Stroke is the second leading cause of death in the world. Ischemic stroke, caused by the blockage of intracranial arteries, accounts for approximately 80% of strokes. Among this proportion, acute ischemic stroke, usually caused by the sudden formation of blood clots, can cause fatal blockages in arteries. We proposed a unique blood clot retriever for the treatment of acute ischemic stroke, and conducted a series of tasks, including design, computer simulation, prototyping, and bench testing, for the proof of concept. Unlike most blood clot retrievers used today, our novel design deviates from traditional stent-like blood clot retrievers and uses large closed cells, irregular spikes, and strut protrusions to achieve maximum entanglement for better retrieval performance. Experimental results showed that the retrieval rate of our blood clot retriever was 79%, which demonstrated the feasibility of our new design concept.

Blood Flow Velocity Pulsatility and Arterial Diameter Pulsatility Measurements of the Intracranial Arteries Using 4D PC-MRI

Abstract4D phase contrast magnetic resonance imaging (PC-MRI) allows for the visualization and quantification of the cerebral blood flow. A drawback of software that is used to quantify the cerebral blood flow is that it oftentimes assumes a static arterial luminal area over the cardiac cycle. Quantifying the lumen area pulsatility index (aPI), i.e. the change in lumen area due to an increase in distending pressure over the cardiac cycle, can provide insight in the stiffness of the arteries. Arterial stiffness has received increased attention as a predictor in the development of cerebrovascular disease. In this study, we introduce software that allows for measurement of the aPI as well as the blood flow velocity pulsatility index (vPI) from 4D PC-MRI. The internal carotid arteries of seven volunteers were imaged using 7 T MRI. The aPI and vPI measurements from 4D PC-MRI were validated against measurements from 2D PC-MRI at two levels of the internal carotid arteries (C3 and C7). The aPI and vPI computed from 4D PC-MRI were comparable to those measured from 2D PC-MRI (aPI: mean difference: 0.03 (limits of agreement: −0.14 – 0.23); vPI: 0.03 (−0.17–0.23)). The measured blood flow rate for the C3 and C7 segments was similar, indicating that our proposed software correctly captures the variation in arterial lumen area and blood flow velocity that exists along the distal end of the carotid artery. Our software may potentially aid in identifying changes in arterial stiffness of the intracranial arteries caused by pathological changes to the vessel wall.