Neurologia medico-chirurgica最新文献

{"title":"Experimental and Clinical Evaluation of Spongostan as a Substitute for Spongel in Sellar Floor Reconstruction during Endoscopic Transsphenoidal Surgery.","authors":"Kazutaka Sugimoto, Junji Ohgi, Yosuke Okinaka, Reo Kawano, Yuna Tosano, Sadahiro Nomura, Norihiro Nishida, Hirokazu Sadahiro, Kazuma Sugahara, Hideyuki Ishihara","doi":"10.2176/jns-nmc.2025-0388","DOIUrl":"10.2176/jns-nmc.2025-0388","url":null,"abstract":"<p><p>Absorbable gelatin sponges are widely used as hemostatic and reconstructive materials in neurosurgery. Global discontinuation of Gelfoam and withdrawal of Spongel from the Japanese market have created an urgent need for alternatives. This study was performed to evaluate the utility of Spongostan as a substitute for Spongel and Gelfoam in sellar floor reconstruction using the fibrin glue-soaked gelatin sponge method.Two gelatin sponges (Spongel and Spongostan) and 2 fibrin sealants (Beriplast and Bolheal) were combined to prepare 4 fibrin glue-soaked gelatin sponge combinations. Adhesive strength was measured using a tensile strength test according to ASTM F2458-05 and analyzed using 2-way analysis of variance. A retrospective review was also conducted for patients who underwent endoscopic transsphenoidal surgery for pituitary adenoma between May 2024 and October 2025, in which fibrin glue-soaked gelatin sponge prepared with Spongostan was used for sellar floor reconstruction.Spongostan showed significantly higher adhesive strength than Spongel (F (1,20) = 13.72, p = 0.0014), whereas neither the fibrin sealant type nor the sponge-fibrin sealant interaction was significant (both p = 0.73). In 11 clinical cases (mean age 66 ± 16 years), intraoperative cerebrospinal fluid leakage occurred in 5 cases and postoperative leakage in one case, in a patient who had undergone prior radiotherapy. No hemorrhage, meningitis, or material-related complications occurred. These findings suggest that Spongostan may serve as a feasible alternative to Spongel for fibrin glue-soaked gelatin sponge-based sellar floor reconstruction during endoscopic transsphenoidal surgery.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"475-479"},"PeriodicalIF":1.6,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13441521/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148043172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomic Variations of the Zygomatic Arch: Rethinking the Indications for the Orbitozygomatic Approach.","authors":"Daisuke Nakashima, Tetsuya Negoto, Nobuyuki Takeshige, Kiyohiko Sakata, Syuichi Tanoue, Takayuki Kawano, Motohiro Morioka","doi":"10.2176/jns-nmc.2025-0357","DOIUrl":"10.2176/jns-nmc.2025-0357","url":null,"abstract":"<p><p>Temporary zygomatic arch removal (zygomectomy) in the orbitozygomatic approach is sometimes used in surgeries involving complex lesions. Although the orbitozygomatic approach provides wider exposure than the pterional approach, it is more invasive and carries a higher risk of complications. We hypothesized that adequate exposure could be achieved without zygomectomy when the zygomatic arch lies well below the floor of the middle cranial fossa. This study introduces the concept of \"Low-set Zygoma\" and examines its clinical and anatomical relevance. High-resolution cranial computed tomography scans from 105 adults without craniofacial anomalies (210 sides) were analyzed to measure the vertical distance from the superior margin of the zygomatic arch to the middle cranial fossa floor (middle cranial fossa height). In this study, a Low-set Zygoma was defined as a middle cranial fossa height of ≥ -3.0 mm. Participants were stratified into 2 groups [Low-set Zygoma (≥ -3.0 mm) and non-Low-set Zygoma (< -3.0 mm) ], and demographic variables were assessed using univariate and multivariate statistical analyses. We performed 3 pterional approaches in patients with Low-set Zygoma, where orbitozygomatic approach was typically indicated. Adequate exposure was achieved in all patients, with no complications. Based on computed tomography data, the mean vertical distance from the zygomatic arch to the middle cranial fossa floor was -2.36 mm. Body height was the only independent predictor of a Low-set Zygoma (p = 0.037); individuals shorter than 162.5 cm were significantly more likely to exhibit this anatomical feature. A Low-set Zygoma appears to be a reliable anatomical indicator for avoiding unnecessary zygomectomy and may support more individualized preoperative planning.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"466-474"},"PeriodicalIF":1.6,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13441520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147964319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practical Guide to Clazosentan Administration in Patients with Aneurysmal Subarachnoid Hemorrhage.","authors":"Hidenori Suzuki, Yosuke Akamatsu, Hiroshi Abe, Satoshi Iihoshi, Fusao Ikawa, Tsuyoshi Izumo, Hidenori Endo, Hiroharu Kataoka, Shunsuke Kawamoto, Kenichiro Kikuta, Yuichiro Kikkawa, Yuichi Kubota, Hiroki Kurita, Satoshi Kuroda, Atsushi Saito, Makoto Sakamoto, Masaaki Shojima, Taku Sugiyama, Jun C Takahashi, Ichiro Nakagawa, Hirofumi Nakatomi, Yu Hasegawa, Morito Hayashi, Tomohito Hishikawa, Miki Fujimura, Nobutaka Horie, Mitsuhito Mase, Tatsushi Mutoh, Motohiro Morioka, Atsuo Yoshino, Masataka Yoshimura","doi":"10.2176/jns-nmc.2025-0439","DOIUrl":"10.2176/jns-nmc.2025-0439","url":null,"abstract":"","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"411-425"},"PeriodicalIF":1.6,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13441528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147964303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visualizing Non-linear Prognosis: A Vital Tool for Shared Decision-making in Aneurysmal Subarachnoid Hemorrhage.","authors":"Andreas K Demetriades","doi":"10.2176/jns-nmc.2025-0454","DOIUrl":"10.2176/jns-nmc.2025-0454","url":null,"abstract":"","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"500-501"},"PeriodicalIF":1.6,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13441527/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147964257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multicenter Experience and Diameter Analysis of the Low-profile Visualized Intraluminal Support EVO™ in the Treatment of Unruptured Intracranial Aneurysms.","authors":"Kazutaka Uchida, Shinichi Yoshimura, Manabu Shirakawa, Hitoshi Hasegawa, Akira Ishii, Masakazu Okawa, Hirotoshi Imamura, Toshiyuki Fujinaka, Kenji Sugiu, Yuji Matsumaru, Nobuyuki Sakai, Shigeru Miyachi","doi":"10.2176/jns-nmc.2026-0016","DOIUrl":"10.2176/jns-nmc.2026-0016","url":null,"abstract":"<p><p>The Low-Profile Visualized Intraluminal Support EVO stent enables full fluoroscopic visualization and provides higher metal coverage than conventional devices used to assist coil embolization of wide-neck unruptured intracranial aneurysms. We conducted a prospective multicenter clinical trial to assess its efficacy and safety in stent-assisted coil embolization. A total of 41 patients were enrolled across 6 centers. The primary endpoint of clinical success was achieved in 39 of 40 implanted cases (97.5%; 95% confidence interval, 86.8%-99.9%). These findings demonstrate the efficacy and safety of Low-Profile Visualized Intraluminal Support EVO as an assist stent for wide-neck aneurysms. Given that concerns remain regarding thrombotic risk with small-diameter devices (2.5-3.0 mm), a subgroup analysis comparing the results of small-diameter Low-Profile Visualized Intraluminal Support EVO (2.5-3.0 mm) versus those of larger Low-Profile Visualized Intraluminal Support EVO (3.5-4.0 mm) was conducted. Fifteen cases were included in the small-diameter group, and 25 were included in the comparative group. Ischemic events occurred in 1 of 15 (6.7%) patients in the small-diameter group and in 2 of 25 (8.0%) patients in the larger-diameter group, with no statistically significant difference between the 2 groups, and all events were transient or asymptomatic. At 6 months, 13 of 14 (92.9%) patients in the small-diameter group achieved complete occlusion (Raymond-Roy Class I, core laboratory adjudicated). Overall, small-diameter Low-Profile Visualized Intraluminal Support EVO did not confer a significantly higher risk of ischemic complications compared with larger-diameter devices and demonstrated favorable therapeutic potential for the treatment of wide-neck aneurysms. Trial registration: jRCT2042230075.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"371-376"},"PeriodicalIF":1.6,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13338783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Exoscopic and Microscopic Carotid Endarterectomy for Asymptomatic Carotid Stenosis: A Retrospective Study.","authors":"Tomoaki Murakami, Shingo Toyota, Hiroya Matsumoto, Kosei Okochi, Koichi Nakashima, Motoki Nakamura, Shuhei Yamada, Takanori Fukunaga, Maki Kobayashi, Koji Takano, Haruhiko Kishima","doi":"10.2176/jns-nmc.2025-0404","DOIUrl":"10.2176/jns-nmc.2025-0404","url":null,"abstract":"<p><p>Exoscopic surgery provides superior ergonomics compared with conventional microscopic surgery. This retrospective study aimed to compare the clinical outcomes between exoscopic and conventional microscopic carotid endarterectomy for asymptomatic carotid stenosis. We retrospectively analyzed 23 consecutive microscopic carotid endarterectomy cases between March 2012 and November 2018 and 21 consecutive exoscopic carotid endarterectomy cases between December 2018 and August 2024. Patient demographics, lesion characteristics, operative parameters, and postoperative outcomes were compared between the groups. There were no significant differences in baseline characteristics between the microscopic and exoscopic carotid endarterectomy groups. The mean indocyanine green volume was significantly lower in the exoscopic (2 ± 1 mL) vs. microscopic carotid endarterectomy groups (6 ± 2 mL) (p < 0.0001). Similarly, the mean skin incision length was shorter in the exoscopic vs. microscopic group (74 ± 10 mm vs. 90 ± 18 cm, respectively; p = 0.0016). The microsurgical time was significantly shorter in the exoscopic vs. microscopic groups (157 ± 63 min vs. 219 ± 97 min, respectively; p = 0.04). There were no significant differences in safety or clinical outcomes between the 2 groups. Exoscopic carotid endarterectomy demonstrated safety and clinical outcomes comparable to those of microscopic carotid endarterectomy while offering certain benefits associated with advances in equipment and surgical technology.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"395-402"},"PeriodicalIF":1.6,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13338784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147964283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frailty and Severe White Matter Lesions Are Risk Factors for Surgical Treatment for Unruptured Cerebral Aneurysm in Older Adults.","authors":"Fumihiro Matano, Yasuo Murai, Takayuki Mizunari, Minoru Ideguchi, Kenta Koketsu, Takehiko Sasaki, Toru Nishi, Shigeo Yamashiro, Isao Date, Tomohito Hishikawa, Fusao Ikawa, Shigeyuki Sakamoto, Katsumi Takizawa, Tohru Kobayashi, Kentaro Mori, Junta Moroi, Toshiaki Osato, Masanori Suzuki, Hiromu Hadeishi, Yoshiaki Shiokawa, Atsushi Saito, Masaaki Uno, Shigeo Sora, Akitsugu Kawashima, Tohru Mizutani, Tomonori Tamaki, Rokuya Tanikawa, Akio Morita","doi":"10.2176/jns-nmc.2025-0241","DOIUrl":"10.2176/jns-nmc.2025-0241","url":null,"abstract":"<p><p>It remains unclear whether frailty and white matter lesions are risk factors for surgical treatment of unruptured intracranial aneurysms in older adults. We conducted a prospective multicenter study of 397 patients aged ≥60 years with unruptured intracranial aneurysms enrolled from 20 hospitals in Japan. Unruptured intracranial aneurysms were treated by either microsurgical clipping or endovascular treatment according to institutional protocols. The primary endpoint was functional outcome at discharge assessed using the modified Rankin scale (mRS). Poor outcome was defined as a deterioration of 1 or more points in the mRS score at discharge compared with the preoperative baseline. Unruptured intracranial aneurysm size ranged from 2.1 to 26 mm (mean, 6.93 mm). Poor outcome occurred in 52 patients (13.1%). There was no significant association between poor outcome and age (p = 0.089) or treatment modality (clipping vs. coiling, p = 0.4739). In multivariate regression analysis, poor outcome was significantly associated with larger unruptured intracranial aneurysm size (p = 0.033), higher Clinical Frailty Scale score (p = 0.006), higher preoperative mRS score (p = 0.039), lower hemoglobin level (p = 0.016), absence of regular exercise (p = 0.046), slower walking speed (p = 0.002), severe white matter lesions (p = 0.001), and lower intraoperative blood pressure (p = 0.032). Severe white matter lesions were associated with a higher risk of postoperative ischemia (p ≤ 0.042) and intracranial hemorrhage (p = 0.0017). These findings indicate that preoperative frailty and severe white matter lesions are significant predictors of poor outcomes after unruptured intracranial aneurysm surgery in older adults.Trial registration: umin.ac.jp/ctr Identifier: UMIN 000029977.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"354-362"},"PeriodicalIF":1.6,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13338788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147964332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First-year Experience with Brivaracetam in Japan: Real-world Data from Juntendo Epilepsy Center.","authors":"Yasushi Iimura, Kazuki Nomura, Takumi Mitsuhashi, Hiroharu Suzuki, Tetsuya Ueda, Kazuki Nishioka, Taiji Tsunemi, Shinichi Ueno, Hidenori Sugano, Akihide Kondo","doi":"10.2176/jns-nmc.2025-0293","DOIUrl":"10.2176/jns-nmc.2025-0293","url":null,"abstract":"<p><p>Approximately 30% of patients still develop drug-resistant epilepsy despite the introduction of newer antiseizure medications. Brivaracetam, a high-affinity synaptic vesicle protein 2A ligand with a mechanism of action similar to that of levetiracetam, was only recently approved in Japan in June 2024 and became available at our institution in September 2024. Clinical data in real-world settings remain limited. To date, no real-world clinical data have been systematically reported in patients in Japan, and the present study aimed to characterize the initial real-world experience with Brivaracetam use shortly after its approval. We retrospectively analyzed 73 patients with focal epilepsy who initiated Brivaracetam at our center between September 2024 and August 2025, evaluating patient characteristics, seizure outcomes, treatment retention, and adverse events. Among 41 patients with at least 3 months of follow-up, seizure freedom was achieved in 5%, whereas 44% of patients were responders with ≥50% seizure reduction. Overall, 59 patients continued Brivaracetam, with a treatment retention rate of 76.5% and a mean treatment duration of 7.4 months. Adverse events were observed in 18 patients (24%), most frequently somnolence, followed by dizziness and irritability. Brivaracetam discontinuation occurred in 14 patients (19%), with psychiatric symptoms leading to discontinuation in only 3 patients (4%), a lower rate compared with prior reports of levetiracetam. These findings suggest that Brivaracetam is effective and generally well tolerated in patients in Japan with focal epilepsy. Future multicenter prospective studies with longer follow-up are warranted to further evaluate the role of Brivaracetam, including as monotherapy and in patients with multilobar epilepsy.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"363-370"},"PeriodicalIF":1.6,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13338785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147623467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between the A1 Segment Asymmetry and Severe Clinical Presentation in Ruptured Anterior Communicating Artery Aneurysms.","authors":"Hiroki Karita, Shunichiro Miki, Yoshiro Ito, Takuma Hara, Satoshi Miyamoto, Kazuya Uemura, Eiichi Ishikawa, Yuji Matsumaru","doi":"10.2176/jns-nmc.2025-0320","DOIUrl":"10.2176/jns-nmc.2025-0320","url":null,"abstract":"<p><p>The asymmetry of the A1 segment of the anterior cerebral artery has been implicated in the development and rupture of anterior communicating artery aneurysms; however, its relationship with the severity of subarachnoid hemorrhage remains unclear. We retrospectively analyzed 114 patients with subarachnoid hemorrhage due to ruptured anterior communicating artery aneurysms (mean age, 64.2 ± 13.9 years; 56 males, 58 females) treated at 2 institutions between January 2014 and March 2024. Patients were categorized into Symmetric and Asymmetric A1 groups, with asymmetry defined as a diameter ratio of ≥2 between sides. Among the 114 patients, 72 (63.2%) and 42 (36.8%) had symmetric and asymmetric A1 segments, respectively. The Asymmetric A1 group demonstrated significantly larger aneurysm size, a higher incidence of World Federation of Neurosurgical Surgeons grade IV-V, and more frequent intracerebral hemorrhage. Surgical clipping was more frequently performed in the Asymmetric A1 group (p = 0.04), likely due to associated intracerebral hemorrhage. The A1 diameter ratio was negatively correlated with aneurysm angle (r = -0.27, p < 0.01) and positively correlated with aneurysm length (r = 0.28, p < 0.01). Multivariate analysis showed an association of A1 asymmetry with severe clinical presentation but not with functional outcome. The effect of A1 asymmetry on severity was attenuated after adjustment for intracerebral hemorrhage, the strongest predictor of both severity and outcome. These findings suggest that in ruptured anterior communicating artery aneurysms, A1 asymmetry is associated with larger aneurysms, more severe subarachnoid hemorrhage, and higher rates of intracerebral hemorrhage.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"347-353"},"PeriodicalIF":1.6,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13338791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147623479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantitative Aortic Arch Calcification Is Associated with Non-ipsilateral Ischemic Lesions after Transfemoral Carotid Artery Stenting.","authors":"Koji Shimonaga, Yoshito Hirata, Masakazu Mitsunobu, Ryo Ogami, Yoshihiro Kiura, Atsushi Tominaga, Nobutaka Horie","doi":"10.2176/jns-nmc.2025-0391","DOIUrl":"10.2176/jns-nmc.2025-0391","url":null,"abstract":"<p><p>Non-ipsilateral ischemic lesions after carotid artery stenting are considered to arise from emboli originating in the aortic arch, but the quantitative contribution of aortic arch calcification to post-carotid artery stenting ischemic lesions remains unclear. This study aimed to investigate the association between volumetric aortic arch calcification and non-ipsilateral diffusion-weighted imaging hyperintense lesions after transfemoral carotid artery stenting.We retrospectively analyzed 99 consecutive transfemoral carotid artery stenting procedures performed between January 2018 and December 2023. Aortic arch calcification volume was quantified using preoperative computed tomography angiography using threshold-based segmentation. Postprocedural diffusion-weighted imaging performed within 48 h was assessed for hyperintense lesions in the contralateral hemisphere or cerebellum. Variables were evaluated using univariate and multivariate logistic regression analyses. Receiver operating characteristic curve analysis was used to determine the optimal cut-off value for predicting non-ipsilateral lesions.Non-ipsilateral high-intensity diffusion-weighted imaging lesions occurred in 14 patients (14.1%), who showed significantly higher aortic arch calcification volumes than did those without lesions (median 2.2 vs. 1.0 mL, p = 0.005). Receiver operating characteristic analysis identified an optimal cutoff of 1.3 mL (sensitivity 78.6%, specificity 62.3%, area under the curve 0.73). Both age (odds ratio 1.1 per year, p = 0.039) and aortic arch calcification volume (odds ratio 1.3 per mL, p = 0.040) were independently associated with non-ipsilateral lesions. Aortic arch type and guiding catheter size showed no significant associations. Quantitative aortic arch calcification on preoperative computed tomography angiography was independently associated with non-ipsilateral ischemic lesions after transfemoral carotid artery stenting. Incorporating calcification volume into preprocedural assessments may assist in selecting alternative access routes or protective strategies for patients at high risk.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"387-394"},"PeriodicalIF":1.6,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13338787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147964279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}