Journal of Clinical Neuroscience最新文献

{"title":"Neuromonitoring of recurrent laryngeal nerve using continuous intraoperative neuromonitoring system during anterior cervical spine surgery: A porcine model study","authors":"Dong Suk Kim ,&nbsp;Tae Sik Goh ,&nbsp;Yoon Jae Cho ,&nbsp;Jung Sub Lee","doi":"10.1016/j.jocn.2025.111427","DOIUrl":"10.1016/j.jocn.2025.111427","url":null,"abstract":"<div><h3>Purpose</h3><div>Recurrent laryngeal nerve (RLN) injury is a recognized complication of anterior cervical spine surgery (ACSS), particularly during anterior cervical discectomy and fusion (ACDF). This study explores the use of continuous intraoperative neurophysiological monitoring (CIONM) with an endotracheal electromyography (EMG) tube during ACSS in a porcine model, focusing on adverse EMG signal events during retraction and the differences in RLN injury and recovery between surgical levels and approach side (left or right).</div></div><div><h3>Materials and methods</h3><div>All 12 pigs were intubated with an EMG-equipped endotracheal tube. All surgical procedures were performed via an anterior approach. RLN injury caused by traction was assessed in four segments (C3/4, C4/5, C5/6, C6/7) on both sides, respectively. Laryngeal EMG was continuously measured through electrical stimulation of the vagus nerve using automatic periodic stimulation with CIONM. During surgery, an alarm was set to activate if the EMG amplitude decreased by more than 50% or latency increased by more than 10%, indicating nerve injury. When the alarm was triggered, traction was stopped, and EMG changes were observed. Traction time and recovery time were recorded until the EMG returned to baseline.</div></div><div><h3>Results</h3><div>There were no statistically significant differences in traction or recovery times between the left and right sides (p &gt; 0.05). However, traction times significantly differed by cervical level (p &lt; 0.001), with longer durations at C3/4 and C4/5. Recovery times also differed significantly by level (p &lt; 0.001), with notably prolonged recovery at C6/7, where some nerves failed to return to baseline within 30 min.</div></div><div><h3>Conclusion</h3><div>These findings suggest that lower cervical levels, particularly C6/7, are more vulnerable to nerve damage, requiring heightened attention during ACSS. The study highlights the advantages of CIONM, including real-time detection of RLN stretch and its benefits during complex surgeries.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"139 ","pages":"Article 111427"},"PeriodicalIF":1.9,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144481294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A finite element biomechanical investigation of lumbar spine segments through novel intervertebral disc design","authors":"Ashutosh Khanna ,&nbsp;Pushpdant Jain ,&nbsp;C.P. Paul","doi":"10.1016/j.jocn.2025.111425","DOIUrl":"10.1016/j.jocn.2025.111425","url":null,"abstract":"<div><div>Advancements in laser additive manufacturing have significantly contributed to the design and optimization of complex, biomimetic, and patient-specific spinal implants, particularly intervertebral disc (IVD) replacements. The proposed study investigates the biomechanical performance of a novel titanium alloy artificial IVD, engineered with an auxetic cellular core to restore spinal stiffness while enhancing biocompatibility and mechanical compliance. A validated finite element (FE) model of the lumbar spine was established from DICOM datasets, incorporating anatomically accurate geometries and material properties for cortical and cancellous bone, annulus fibrosus (AF), nucleus pulposus (NP), and major spinal ligaments. Simulations were conducted to compare the mechanical responses of stress, strain, and deformation for the intact spine (ISM), the spine implanted with a SB Charité™ (SBC), and a proposed novel implant (XCEL). Loading conditions along with human physiological motion activities such as flexion, extension, lateral bending, and twisting were considered. For one of the key results obtained by the application of a 1000 N compressive load and 10 Nm moment during the twisting motion, the maximum von-Mises stress observed was 116 MPa, 191.82 MPa, and 127.45 MPa in ISM, SBC, and XCEL, respectively. The proposed implant demonstrated improved stress distribution and mechanical resilience. Moreover, the auxetic core, characterized by a re-entrant geometry and the endplate curvatures closely mimicked those of natural lumbar vertebral endplates. Range of motion (ROM) analysis under flexion revealed the values of 17.3°, 11.9° and 11° for ISM, SBC and XCEL respectively. These findings confirm the suitability of the titanium alloy-based implant to restore near physiological ROM and spinal mechanics. The predicted parameters revealed that XCEL geometry implant can be engineered to the required ROM, effectively restoring natural biomechanics when replacing a natural IVD, highlighting its future clinical potential. Advanced models can be applied to customized, patient-oriented design, micro-structure mimicking manufacturing, pre-surgery planning, clinical follow-up, testing, and overall implant success.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"139 ","pages":"Article 111425"},"PeriodicalIF":1.9,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144490759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lentiform fork sign in acute onset chorea after vomiting and diarrhea","authors":"Carolina Correia ,&nbsp;Rafaela Costa ,&nbsp;Luísa Sampaio ,&nbsp;Pedro Abreu ,&nbsp;Carolina Soares","doi":"10.1016/j.jocn.2025.111421","DOIUrl":"10.1016/j.jocn.2025.111421","url":null,"abstract":"","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"139 ","pages":"Article 111421"},"PeriodicalIF":1.9,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144490760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application, utility and safety of intraoperative 3T magnetic resonance imaging in pediatric epilepsy surgery: A 10-year retrospective single-center experience","authors":"Arthur R. Kurzbuch ,&nbsp;Ben Cooper ,&nbsp;John Kitchen ,&nbsp;Andrea McLaren ,&nbsp;Volker Tronnier ,&nbsp;Jonathan R. Ellenbogen ,&nbsp;on behalf of the NorCESS Team","doi":"10.1016/j.jocn.2025.111392","DOIUrl":"10.1016/j.jocn.2025.111392","url":null,"abstract":"<div><h3>Background</h3><div>Intraoperative magnetic resonance imaging (ioMRI) is increasingly used in neurosurgery to enhance surgical precision and decision-making. However, its implementation remains limited due to high costs, infrastructure demands, and workflow considerations. While well studied in adult neurosurgery, the role of ioMRI in pediatric epilepsy surgery is less clear. Reported challenges include wound complications, infections, and positioning difficulties. This study evaluates the application, utility, and safety of intraoperative 3T MRI in pediatric epilepsy surgery over a ten-year period at a tertiary specialized referral center.</div></div><div><h3>Methods</h3><div>This retrospective study analyzed data from all pediatric epilepsy surgeries performed between 2013 and 2022 in our unit. We reviewed patient demographics, the treated pathologies, the application of intraoperative 3T MRI (ioMRI), the extent of continued ioMRI-guided surgery, seizure outcomes at one year postoperatively, and the requirement for reoperation. Intraoperative MRI-related complications documented within 90 days of surgery were also assessed.</div></div><div><h3>Results</h3><div>Altogether, 125 pediatric epilepsy patients underwent surgery. Resections were performed in 107 (85.6 %) and disconnection procedures in 18 (14.4 %) patients. Their overall median age was 10 years (range 0.5–19 years). In total, 108 (86.4 %) patients underwent surgery with ioMRI. Of these, 91 (84.3 %) had resection and 17 (15.7 %) had disconnection surgery. Of the 108 patients with ioMRI 56 (51.9 %) returned to theater, 45 (49.5 %) out of 91 for further resection, and 11 (64.7 %) out of 17 to complete disconnection. Thirteen (12 %) of the 108 patients were reoperated upon later in another session. In total, 17 (13.6 %) patients had surgery without ioMRI, 16 (94.1 %) of these for resection and 1 (5.9 %) for disconnection surgery; of these 3 (17.6 %) were reoperated upon later in another session. The complication rate for surgeries performed with ioMRI was 3.7 %. There were no wound healing disorders, position-related damages, or anesthesia-related complications.</div></div><div><h3>Conclusions</h3><div>While the technology may present certain logistical and financial challenges, we observed a lower rate of reoperations and a low complication rate in ioMRI-guided resective epilepsy surgeries in children compared to surgeries without ioMRI. These findings require confirmation through larger, multi-center studies to better define the role of ioMRI in pediatric epilepsy surgery.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"138 ","pages":"Article 111392"},"PeriodicalIF":1.9,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144471980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of microdiscectomy and fragmentectomy on clinical outcomes for single level lumbar disc herniation: a systematic review and meta-analysis of comparative studies","authors":"James Kelbert ,&nbsp;Nikhil Dholaria ,&nbsp;Giovanni Barbagli ,&nbsp;Diego T. Soto Rubio ,&nbsp;Annie Pico ,&nbsp;Courtney Deaver ,&nbsp;Amna Hussein ,&nbsp;Michael Prim ,&nbsp;Ali Baaj","doi":"10.1016/j.jocn.2025.111416","DOIUrl":"10.1016/j.jocn.2025.111416","url":null,"abstract":"<div><h3>Background</h3><div>Lumbar disc herniation can lead to radiculopathy, pain, and weakness. Surgery is indicated if patients remain symptomatic despite medical management, or if they develop significant neurological deficits like footdrop or cauda equina syndrome. There is no consensus on whether fragmentectomy alone or aggressive discectomy leads to improved resolution of radicular pain and leads to lower reherniation rates. To the best of our knowledge, this systematic review presents the most comprehensive and up-to-date evaluation of comparative studies comparing microdiscectomy and fragmentectomy within the last ten years.</div></div><div><h3>Methods</h3><div>A systematic review was conducted according to PRISMA guidelines. A search was conducted on March 19th, 2024, of PubMed, EMBASE, Scopus and Web of Science databases. The systematic review software Rayyan was used to include or exclude studies with additional filters. After full text analysis for final inclusion, demographic data as well as those regarding reherniation rates and changes in axial and radicular pain were collected. Continuous meta-analysis and meta-analysis of proportions were conducted using R versions 4.3.3. Radiographic changes were described qualitatively, as there was not enough quantitative evidence to metaanalyze.</div></div><div><h3>Results</h3><div>A total of 9 comparative studies with 574 microdiscectomy and 449 fragmentectomy only patients were ultimately included after screening through a total of 183 unique papers. A random effects model meta-analysis of axial pain found a standardized mean difference of 0.09 [−0.33, 0.51] (p = 0.67) with an I2 of 91%. A random effects model meta-analysis of radicular pain demonstrated an overall standardized mean difference of 0.01 [−0.14, 0.17] (p = 0.87) with an I2 of 0%. Metaanalysis of proportions for reherniation showed a relative risk of 0.96 [0.54, 1.71] (p = 0.88) with an I2 of 0%. Reoperation rates between groups showed a relative risk of 0.86 [0.47, 1.55] (p = 0.61) with an I2 of 0%. The relative risk of complication rates was 0.96 [0.35, 2.66] (p = 0.93) with an I2 of 0 %.</div></div><div><h3>Conclusions</h3><div>There is no statistically significant difference between VAS axial and radicular pain relief after fragmentectomy alone or aggressive microdiscectomy based on this meta-analysis. The reherniation rate was 5 % for both groups and similarly there was no difference between reoperation and complication rates. Despite advances in technique, technology, and our understanding of lumbar disc herniation, this current and comprehensive review demonstrates that both fragmentectomy and aggressive microdiscectomy are equally effective.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"139 ","pages":"Article 111416"},"PeriodicalIF":1.9,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144481117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular coiling vs microsurgical clipping for unruptured aneurysms of the anterior circulation: A systematic review and meta-analysis","authors":"Anderson Matheus Pereira da Silva ,&nbsp;Mariana Leticia de Bastos Maximiano ,&nbsp;Lucas Silva Cabeça ,&nbsp;Anderson Silva Corin ,&nbsp;Ocilio de Deus ,&nbsp;Ariane Barros Mesquita Cunha ,&nbsp;Gabrielle Silva Vieira ,&nbsp;Julia Oliveira Franco ,&nbsp;Eberval Gadelha Figueiredo ,&nbsp;Gustavo Sousa Noleto","doi":"10.1016/j.jocn.2025.111419","DOIUrl":"10.1016/j.jocn.2025.111419","url":null,"abstract":"<div><h3>Background</h3><div>Despite extensive research, the optimal approach for treating unruptured anterior circulation aneurysms (UACs) remains uncertain because of heterogeneous findings and limited robust data. To compare the outcomes of microsurgical clipping (MSC) with endovascular treatment (EVT) for UACs.</div></div><div><h3>Methods</h3><div>A systematic search was conducted in PubMed, Embase, Cochrane Library, Web of Science, and Scopus up to December 2024. Eligible studies included patients with UCAs treated with MSC or EVT. The primary outcomes were functional outcomes (mRS 0–2), recurrence rates, procedural complications, and mortality. Odds Ratios (OR) with 95% Confidence Intervals (CI) were calculated using a random-effects model. The Mantel-Haenszel method with a random-effects model was employed for the <em>meta</em>-analyses. All statistical analyses were conducted using R version 4.4.2.</div></div><div><h3>Results</h3><div>The analysis included data from 17 studies with 7,176 patients, of whom 3,810 (53.1 %) underwent EVT and 3,366 (46.9 %) received MSC. Complete occlusion rates were higher with MSC (OR 0.29; 95 % CI 0.15–0.56; p &lt; 0.01), while procedural success also favored MSC (OR 0.42; 95 % CI 0.23–0.78; p &lt; 0.01). Complications were less frequent with EVT, including serious adverse events (OR 0.53; 95 % CI 0.33–0.84; p &lt; 0.01), vasospasm (OR 0.63; 95 % CI 0.44–0.89; p = 0.04), and thrombotic events (OR 2.23; 95 % CI 0.84–5.96; p = 0.12). However, EVT was associated with higher rates of residual aneurysms (OR 4.57; 95 % CI 1.75–11.97; p = 0.95), residual neck (OR 5.31; 95 % CI 2.81–10.02; p = 0.22), and need for retreatment (OR 5.65; 95 % CI 2.35–13.54; p = 0.99).</div></div><div><h3>Conclusion</h3><div>EVT offers advantages in reducing perioperative complications, while MSC provides greater long-term durability. Considering comparable functional outcomes and mortality, individualized treatment decisions should be based on patient profiles, aneurysm characteristics.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"139 ","pages":"Article 111419"},"PeriodicalIF":1.9,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144471826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Types of stent retrievers used in mechanical thrombectomy for acute ischaemic stroke: A scoping review","authors":"Jane Song ,&nbsp;Kevin Z. Zhou ,&nbsp;Davor Pavlin-Premrl ,&nbsp;Ashu Jhamb ,&nbsp;Calvin Gan ,&nbsp;Ali Khabaza ,&nbsp;Julian Maingard ,&nbsp;Andrew Gauden ,&nbsp;Lee-Anne Slater ,&nbsp;Justin Moore ,&nbsp;Numan Kutaiba ,&nbsp;Ronil V. Chandra ,&nbsp;Anousha Yazdabadi ,&nbsp;Mark D. Brooks ,&nbsp;Hong Kuan Kok ,&nbsp;Christen Barras ,&nbsp;Hamed Asadi","doi":"10.1016/j.jocn.2025.111412","DOIUrl":"10.1016/j.jocn.2025.111412","url":null,"abstract":"<div><div>Mechanical thrombectomy using stent retrievers is the standard endovascular treatment for acute ischaemic stroke due to large vessel occlusion. With the rapid evolution in device design, this scoping review aims to map the current landscape of stent retriever types used in clinical practice, as well as their application across different sites of vessel occlusion. A comprehensive literature search was conducted using MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials to identify primary studies reporting on the safety and efficacy of stent retrievers in mechanical thrombectomy for acute stroke. After screening and data extraction by two independent reviewers, 133 studies were included, encompassing 22 distinct stent retriever devices. Frequencies of thrombectomy procedures were analysed according to device type and occlusion location. The Solitaire and Trevo devices accounted for the majority of cases (57 %), with the most commonly treated occlusion sites being the M1 segment of the middle cerebral artery and the internal carotid artery (51 % and 19 %, respectively). In contrast, anterior cerebral artery and M3 or more distal occlusions were underrepresented, each comprising only 1 % of the data. This review highlights a strong evidence base for conventional stent retrievers in large vessel occlusions, particularly M1, while also revealing a significant gap in knowledge regarding newer generation stent retrievers and their use in distal medium vessel occlusions. Further research is needed to evaluate device safety and effectiveness in these smaller, more challenging vessels.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"138 ","pages":"Article 111412"},"PeriodicalIF":1.9,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144364887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Symptom measurement of post‐stroke depression at rehabilitation stage: Development and validation of a new short form","authors":"Junya Chen ,&nbsp;Chong Mei Chan ,&nbsp;Nant Thin Thin ,&nbsp;Fen Xu ,&nbsp;Wen Ding ,&nbsp;Biji Xu ,&nbsp;Andong Liang","doi":"10.1016/j.jocn.2025.111422","DOIUrl":"10.1016/j.jocn.2025.111422","url":null,"abstract":"<div><h3>Background</h3><div>The Symptom Measurement of Post-Stroke Depression in the Rehabilitation Stage (SMPSD-RS) is a specialized measurement tool designed to detect early depressive symptoms in acute stroke patients, but it is too lengthy for use in busy clinical settings. This study aims to develop a shortened test version through statistical methods to reduce the assessment burden and validate its effectiveness.</div></div><div><h3>Methods</h3><div>During the three months from March 2024 to May 2024, 445 post-stroke patients completed two questionnaires: a demographic survey and the SMPSD-RS questionnaire. The item reduction process primarily involves item response theory (IRT), item analysis, exploratory factor analysis, and confirmatory factor analysis.</div></div><div><h3>Result</h3><div>The item reduction process results in a shortened 12-item questionnaire, demonstrating acceptable structural validity and internal reliability. Three factors are extracted, accounting for most of the total variance: “Cognition,” “Sleep,” and “Emotion.” All estimates of the confirmatory model fit indices meet the standard criteria. The standardized factor loadings for the 12 items meet the standard criteria, and the variance explained by the items is acceptable. Additionally, the internal reliability estimates for the 12-item questionnaire are acceptable, with corrected item-total correlations and item-subscale correlations questionnaire supporting the short-form questionnaire’s reliability.</div></div><div><h3>Conclusion</h3><div>The Symptom Measurement of Post-Stroke Depression in the Rehabilitation Stage Short Form (SMPSD-RSSF) demonstrates acceptable reliability and validity for screening depressive symptoms in post-stroke rehabilitation patients Which is useful to be used in a busy clinical setting.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"139 ","pages":"Article 111422"},"PeriodicalIF":1.9,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144365127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post stroke fatigue: Analysis of subtypes and associated factors","authors":"Mohammad Etoom ,&nbsp;Manal Al Battat ,&nbsp;Ibrahem Hanafi ,&nbsp;Nicola Manocchio ,&nbsp;Calogero Foti ,&nbsp;Alia Alghwiri","doi":"10.1016/j.jocn.2025.111418","DOIUrl":"10.1016/j.jocn.2025.111418","url":null,"abstract":"<div><h3>Background</h3><div>Post stroke fatigue (PSF) is a disabling complaint endorses stroke recovery. PSF is highly varied, while most of previous studies did not consider physical and cognitive subtypes. The current study aimed to investigate PSF prevalence and associated factors with consideration of fatigue subtypes.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted. Demographics, medical history, stroke characteristics, depression, anxiety, sleep quality, and stroke recovery were evaluated. The Modified Fatigue Impact Scale (MFIS) has been adopted to assess PSF and its subtypes (physical and cognitive). Descriptive statistics, t-tests for MFIS subscales comparisons, and regression analyses were performed.</div></div><div><h3>Results</h3><div>A total of 92 participants were included; 45 % were female, age ranged between 27 and 85 years. The PSF prevalence rate was 71.7 %. The MFIS physical subscale demonstrated a significantly higher prevalence and severity than cognitive subscale (t = 11.1, p &lt; 0.001). Perceived stroke recovery, depression, anxiety, and sleep quality were related with the MFIS total score as well as its two subscales (B = 0.21–3.32). Diabetes mellitus (B = 0.05, p = 0.02), hypercholesterolemia (B = 0.06, p = 0.018), and left hemisphere stroke (B = -0.04, p = 0.027) were associated with the MFIS cognitive subscale, while recurrent stroke was related to the MFIS physical subscales (B = 0.08, p = 0.04). Anxiety and perceived stroke recovery represented the common significant predictors for MFIS total score and all its subscales (B = 0.13–1.16). Depression and left hemisphere stroke were significant predictors for MFIS total score and cognitive subscale (B = 0.87–7.51). Sleep quality (B = 0.64, p = 0.026) and being male (B = 3.32, p = 0.049) were additional significant predictors for MFIS cognitive fatigue.</div></div><div><h3>Conclusion</h3><div>PSF is highly prevalent. PSF subtypes were markedly varied in prevalence, severity and associated factors. Future research and clinical protocols should consider different PSF subtypes rather than conceptualizing PSF as one entity.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"139 ","pages":"Article 111418"},"PeriodicalIF":1.9,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144365128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular carotid artery revascularization utilizing multiple distal embolic protection strategies: active and passive flow reversal in combination with balloon assisted reperfusion","authors":"Jason H. Boulter ,&nbsp;Jeffrey D. Shapiro ,&nbsp;Amber M. Pratt ,&nbsp;Kristin Viaggio ,&nbsp;Albert J. Schuette ,&nbsp;Michael F. Stiefel","doi":"10.1016/j.jocn.2025.111413","DOIUrl":"10.1016/j.jocn.2025.111413","url":null,"abstract":"<div><h3>Background</h3><div>Carotid artery stenosis is a common cause of stroke. Carotid artery stenting (CAS) includes multiple approaches to endovascular carotid revascularization, including transfemoral/transradial CAS (TF-CAS/TR-CAS) and transcarotid artery revascularization (TCAR). Although CAS has declined in frequency since the development of TCAR, distal embolic protection (DEP) strategies differ between the two procedures, with studies reporting a lower risk of stroke with TCAR. TCAR uses open surgical common carotid artery clamping combined with passive flow reversal (PFR), whereas traditional TF-CAS/TR-CAS often employs a DEP device. Modifications to TF-CAS/TR-CAS include balloon guide catheter (BGC) carotid occlusion and PFR for additional DEP, mirroring aspects of TCAR.</div></div><div><h3>Methods</h3><div>Patients underwent endovascular carotid artery revascularization (ECAR) using either transfemoral or transradial approaches (i.e., TF-CAS/TR-CAS) with the implementation of multiple DEP strategies: proximal flow arrest with a BGC, active flow reversal (AFR) and PFR, DEP device, and balloon-assisted reperfusion (BAR).</div></div><div><h3>Results</h3><div>Two patients underwent successful TF-CAS/TR-CAS utilizing a DEP device in combination with novel adjuvant endovascular techniques. BGC occlusion of the common carotid artery provided anterograde flow arrest. AFR was employed during scenarios where PFR was not feasible or insufficient. BAR was performed with transient balloon occlusion of the proximal internal carotid artery during common carotid artery reperfusion and restoration of anterograde blood flow.</div></div><div><h3>Conclusion</h3><div>Adjuvant endovascular techniques can be employed during TF-CAS/TR-CAS that provide similar, if not more, DEP strategies to those used during TCAR. A purely endovascular approach lends itself to a multitude of specialists and eliminates wound care post-procedure, contributing to higher patient satisfaction and fewer complications.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"139 ","pages":"Article 111413"},"PeriodicalIF":1.9,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144365129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}