BACKGROUND: Intraoperative 2D quantitative angiography (QA) for intracranial aneurysms (IAs) has accuracy challenges due to the variability of hand injections. Despite the success of singular value decomposition (SVD) algorithms in reducing biases in computed tomography perfusion (CTP), their application in 2D QA has not been extensively explored. This study seeks to bridge this gap by investigating the potential of SVD-based deconvolution methods in 2D QA, particularly in addressing the variability of injection durations.
OBJECTIVE: Building on the identified limitations in QA, the study aims to adapt SVD-based deconvolution techniques from CTP to QA for IAs. This adaptation seeks to capitalize on the high temporal resolution of QA, despite its two-dimensional nature, to enhance the consistency and accuracy of hemodynamic parameter assessment. The goal is to develop a method that can reliably assess hemodynamic conditions in IAs, independent of injection variables, for improved neurovascular diagnostics.
METHODS: The study included three internal carotid aneurysm (ICA) cases. Virtual angiograms were generated using computational fluid dynamics (CFD) for three physiologically relevant inlet velocities to simulate contrast media injection durations. Time-density curves (TDCs) were produced for both the inlet and aneurysm dome. Various SVD variants, including standard SVD (sSVD) with and without classical Tikhonov regularization, block-circulant SVD (bSVD), and oscillation index SVD (oSVD), were applied to virtual angiograms. The method was applied on virtual angiograms to recover the aneurysmal dome impulse response function (IRF) and extract flow related parameters such as Peak Height PHIRF, Area Under the Curve AUCIRF, and Mean transit time MTT. Next, correlations between QA parameters, injection duration, and inlet velocity were assessed for unconvolved and deconvolved data for all SVD methods. Additionally, we performed an in vitro study, to complement our in silico investigation. We generated a 2D DSA using a flow circuit design for a patient-specific internal carotid artery phantom. The DSA showcases factors like x-ray artifacts, noise, and patient motion. We evaluated QA parameters for the in vitro phantoms using different SVD variants and established correlations between QA parameters, injection duration, and velocity for unconvolved and deconvolved data.
RESULTS: The different SVD algorithm variants showed strong correlations between flow and deconvolution-adjusted QA parameters. Furthermore, we found that SVD can effectively reduce QA parameter variability across various injection durations, enhancing the potential of QA analysis parameters in neurovascular disease diagnosis and treatment.
CONCLUSIONS: Implementing SVD-based deconvolution techniques in QA analysis can enhance the precision and reliability of neurovascular diagnostics by effectively reducing the impact of injection duration on hemodynamic parameters.

Arteriovenous malformation (AVM) is an abnormal connection of vasculature resulting in capillary bed bypassing and leading to neurological deterioration and high risk of bleeding. Intramedullary AVMs in the cervical spinal cord are rare and require precise diagnostics and treatment. We present a clinical case of recurrent AVMs in a 28-year-old Caucasian female with sudden and severe neck pain and variable neurological symptoms along with current diagnostic and treatment modalities. Conservative treatment was partially effective. MRI and DSA confirmed AVMs at C4 level with subsequent several endovascular treatment sessions at the age of 15 and 24 with mild neurological improvement. Afterwards the patient underwent rehabilitation with minor neurological improvement. This case highlights the clinical progression and treatment of AVMs along with showcasing current pathophysiology, classification, and imaging.

UNASSIGNED: Cerebral Cavernous Malformations (CCMs) are neurovascular abnormalities in the central nervous system (CNS) caused by loss of function mutations in KRIT1 (CCM1), CCM2, or PDCD10 (CCM3) genes. One of the most common symptoms in CCM patients is associated with motor disability, weakness, seizures, stress, and anxiety, and the extent of the symptom or symptoms may be due to the location of the lesion within the CNS or whether multiple lesions are present. Previous studies have primarily focused on understanding the pathology of CCM using animal models. However, more research has yet to explore the potential impact of CCM lesions on behavioral deficits in animal models, including effects on short-term and long-term memory, motor coordination, and function.
UNASSIGNED: We used the accelerating RotaRod test to assess motor and coordination deficits. We also used the open field test to assess locomotor activity and pathology-related behavior and Pavlovian fear conditioning to assess short-and long-term memory deficits. Our behavioral studies were complemented by proteomics, histology, immunofluorescence, and imaging techniques. We found that neuroinflammation is crucial in behavioral deficits in male and female mice with neurovascular CCM lesions (Slco1c1-iCreERT2; Pdcd10 fl/fl ; Pdcd10 BECKO ).
UNASSIGNED: Functional behavior tests in male and female Pdcd10 BECKO mice revealed that CCM lesions cause sudden motor coordination deficits associated with the manifestation of profound neuroinflammatory lesions. Our findings indicate that maturation of CCM lesions in Pdcd10 BECKO mice also experienced a significant change in short- and long-term memory compared to their littermate controls, Pdcd10 fl/fl mice. Proteomic experiments reveal that as CCM lesions mature, there is an increase in pathways associated with inflammation, coagulation, and angiogenesis, and a decrease in pathways associated with learning and plasticity. Therefore, our study shows that Pdcd10 BECKO mice display a wide range of behavioral deficits due to significant lesion formation in their central nervous system and that signaling pathways associated with neuroinflammation and learning impact behavioral outcomes.
UNASSIGNED: Our study found that CCM animal models exhibited behavioral impairments such as decreased motor coordination and amnesia. These impairments were associated with the maturation of CCM lesions that displayed a neuroinflammatory pattern.

Reversible cerebral vasoconstriction syndrome (RCVS) is a complex and etiologically diverse neurovascular disorder that typically presents with severe thunderclap headaches (TCH) as the primary symptom, accompanied by reversible vasoconstriction of the cerebral arteries. The clinical course may include focal neurological deficits or epileptic seizures. There are two types: idiopathic RCVS and secondary RCVS, the latter triggered by various substances, medical interventions, or diseases. In clinical practice, various medical specialists may initially encounter this condition, underscoring the importance of accurate recognition and diagnosis of RCVS. The clinical course often appears monophasic and self-limiting, with recurrences reported in only 1.7% of cases annually. Complications such as cerebral hemorrhages and cerebral ischemia can lead to death in 5-10% of cases. This article utilizes a case study to explore RCVS, its complications, and the diagnostic procedures involved.
UNASSIGNED: Das reversible zerebrale Vasokonstriktionssyndrom (RCVS) ist eine komplexe und ätiologisch vielfältige neurovaskuläre Erkrankung, die typischerweise mit Donnerschlagkopfschmerz („thunderclap headache“, TCH) als Hauptkriterium sowie einer reversiblen sekundären Vasokonstriktion der Hirnarterien einhergeht. Das RCVS kann mit oder ohne fokal-neurologische Defizite oder epileptische Anfälle verlaufen. Man unterscheidet zwischen einem idiopathischen RCVS und einem sekundären RCVS, welches durch verschiedene Substanzen, medizinische Eingriffe oder Erkrankungen ausgelöst wird. Den ersten Kontakt mit dieser Erkrankung haben in der täglichen Praxis verschiedene Spezialisten; die richtige Erkennung und Diagnose von RCVS bleiben weiterhin eine Herausforderung. Der klinische Verlauf ist in der Regel monophasisch und selbstlimitierend, wobei Rezidive lediglich in 1,7 % der Fälle pro Jahr auftreten. Komplikationen wie Hirnblutungen und zerebrale Ischämien führen in 5–10 % der Fälle zum Tod. In dieser Arbeit wird ein Fallbeispiel verwendet, um das RCVS und seine Komplikationen vorzustellen sowie die diagnostischen Verfahren zu erläutern.

Vascular neurosurgery has developed significantly in Nigeria, but its burden and challenges remain unclear. This study systematically reviewed vascular neurosurgical literature from Nigeria.
Four research databases and gray literature sources were searched from 1962-2021. ROBINS-I tool was used to assess risk of bias. Descriptive, narrative, and statistical analyses were conducted on all variables. Where appropriate, paired t-tests and Chi-squared independence tests were used (α = 0.05).
56 articles were included and 3203 patients pooled for analysis. Risk of bias was moderate-high. Most articles were published over the last 20 years with retrospective cohort studies and case reports being the most common study designs. The cohort had a relatively even gender split and an average age of 49 years (±22). Cerebrovascular accidents accounted for over 85% of diagnoses, with most etiologies being traumatic. Headache and motor deficit were the most prevalent clinical features. X-ray and carotid angiography were the most commonly reported imaging modalities, closely followed by computed tomography (CT) and CT angiography. The top two radiological diagnoses were ischemic cerebrovascular disease and intracerebral hematoma. Aneurysmal clipping and hematoma evacuation were the most commonly reported treatment modalities. Outcome at last follow-up was favorable in 48%. The mortality rate was 6%. Post-treatment complications included chest infection and rebleeding.
This study illustrates the epidemiological burden of neurovascular pathology (based on the available data in published literature) in Nigeria, and raises awareness amongst service providers and researchers of the attendant challenges and epochal trends seen within vascular neurosurgery in Nigeria.

BACKGROUND: The rapid progress in imaging techniques has led to an upsurge in the incidence of optic nerve arteriovenous malformations (AVMs) diagnoses. Nevertheless, a comprehensive integration addressing their diagnostic and therapeutic attributes remains elusive.
UNASSIGNED: In this report, we present a case of optic nerve AVM in a patient who initially presented with progressive visual deterioration in the right eye. An orbital magnetic resonance imaging (MRI) scan revealed an abnormal signal intensity within the optic nerve region of the affected eye, and Computed Tomography Angiography (CTA) demonstrated the presence of a vascular malformation involving the optic nerve in the right eye. The diagnosis of optic nerve AVMs relies on Digital Subtraction Angiography (DSA). Given the challenging nature of surgical intervention, the patient opted for conservative management. Upon subsequent evaluation, no significant changes were observed in the patient\'s right visual acuity and visual field. Furthermore, a comprehensive literature review was conducted.
CONCLUSIONS: In summary, the principal clinical presentations associated with optic nerve AVMs include a deterioration in both visual acuity and visual field. Angiography serves as the preferred diagnostic modality to confirm optic nerve AVMs. Microsurgical intervention or interventional embolization techniques may offer effective management approaches to address this complex condition.

RNA editing, a common and potentially highly functional form of RNA modification, encompasses two different RNA modifications, namely adenosine to inosine (A-to-I) and cytidine to uridine (C-to-U) editing. As inosines are interpreted as guanosines by the cellular machinery, both A-to-I and C-to-U editing change the nucleotide sequence of the RNA. Editing events in coding sequences have the potential to change the amino acid sequence of proteins, whereas editing events in noncoding RNAs can, for example, affect microRNA target binding. With advancing RNA sequencing technology, more RNA editing events are being discovered, studied, and reported. However, RNA editing events are still often overlooked or discarded as sequence read quality defects. With this position paper, we aim to provide guidelines and recommendations for the detection, validation, and follow-up experiments to study RNA editing, taking examples from the fields of cardiovascular and brain disease. We discuss all steps, from sample collection, storage, and preparation, to different strategies for RNA sequencing and editing-sensitive data analysis strategies, to validation and follow-up experiments, as well as potential pitfalls and gaps in the available technologies. This paper may be used as an experimental guideline for RNA editing studies in any disease context.

BACKGROUND: Predicting a challenging clot when performing mechanical thrombectomy in acute stroke can be difficult. One reason for this difficulty is a lack of agreement on how to precisely define these clots. We explored the opinions of stroke thrombectomy and clot research experts regarding challenging clots, defined as difficult to recanalize clots by endovascular approaches, and clot/patient features that may be indicative of such clots.
METHODS: A modified DELPHI technique was used before and during the CLOTS 7.0 Summit, which included experts in thrombectomy and clot research from different specialties. The first round included open-ended questions and the second and final rounds each consisted of 30 closed-ended questions, 29 on various clinical and clot features, and 1 on number of passes before switching techniques. Consensus was defined as agreement ≥ 50%. Features with consensus and rated ≥ 3 out of 4 on the certainty scale were included in the definition of a challenging clot.
RESULTS: Three DELPHI rounds were performed. Panelists achieved consensus on 16/30 questions, of which 8 were rated 3 or 4 on the certainty scale, namely white-colored clots (mean certainty score 3.1), calcified clots under histology (3.7) and imaging (3.7), stiff clots (3.0), sticky/adherent clots (3.1), hard clots (3.1), difficult to pass clots (3.1) and clots that are resistant to pulling (3.0). Most panelists considered switching endovascular treatment (EVT) techniques after 2-3 unsuccessful attempts.
CONCLUSIONS: This DELPHI consensus identified 8 distinct features of a challenging clot. The varying degree of certainty amongst the panelists emphasizes the need for more pragmatic studies to enable accurate a priori identification of such occlusions prior to EVT.

The aim of this review is to highlight novel findings in 2019 in the area of neurovascular disease. Experimental studies have provided insight into disease development, molecular determinants of pathology, and putative novel therapeutic targets. Studies in genetic experimental models as well as monogenic forms of human cerebrovascular diseases identified pathogenic molecules that may also be relevant to sporadic cases. There have been advances in understanding the development of cerebral cavernous angiomas and arteriovenous malformations, and putative curative treatments have been suggested from experimental models. Key pathogenic pathways involved in vessel calcification and stiffness have also been identified. At the cellular level, studies showed that proper function of endothelial and mural cells, particularly pericytes, is crucial to ensure full endothelial differentiation and blood-brain barrier integrity. Moreover, recent discoveries support the existence of a homeostatic crosstalk between vascular cells and other neural cells, including neurons. Cerebrovascular diseases are strongly associated with inflammation. Beyond pathogenic roles of specific components of the inflammatory response, new discoveries showed interesting interactions between inflammatory molecules and regulators of vascular function. Clinical investigation on cerebrovascular diseases has progressed by combining advanced imaging and genome-wide association studies. Finally, vascular cognitive impairment and dementia are receiving increasing attention. Recent findings suggest that high-salt intake may cause cerebrovascular dysfunction and cognitive impairment independent of hypoperfusion and hypertension. These and other recent reports will surely inspire further research in the field of cerebrovascular disease that will hopefully contribute to improved prevention and treatment.

Platelets are important cellular targets in cardiovascular disease. Based on insights from basic science, translational approaches and clinical studies, a distinguished anti-platelet drug treatment regimen for cardiovascular patients could be established. Furthermore, platelets are increasingly considered as cells mediating effects \"beyond thrombosis\", including vascular inflammation, tissue remodeling and healing of vascular and tissue lesions. This review has its focus on the functions and interactions of platelets with potential translational and clinical relevance. The role of platelets for the development of atherosclerosis and therapeutic modalities for primary and secondary prevention of atherosclerotic disease are addressed. Furthermore, novel therapeutic options for inhibiting platelet function and the use of platelets in regenerative medicine are considered.