In-stent restenosis (ISR) remains a major challenge following vertebral artery origin (VAO) stenting. Dedicated rapamycin-eluting vertebral artery stents were developed specifically for vertebral artery. This study aimed to compare the efficacy and safety of dedicated drug-eluting stents (DES) versus bare metal stents (BMS) in this anatomically complex lesion. In this observational prospective, single-center cohort study, consecutive patients with symptomatic severe vertebral artery origin stenosis (VAOS) undergoing either dedicated DES or BMS implantation between January 2021 and December 2023 were enrolled. The primary efficacy endpoint was the 1-year ISR rate (> 50% luminal stenosis within or adjacent to the stent). The primary safety endpoint was 30-day stroke/death. Secondary endpoints included stroke occurring between 31 days and 1 year, symptomatic ISR within 1 year, all-cause mortality from 31 days to 1 year, stent fracture, and perioperative complications. A total of 217 patients were enrolled, including 150 dedicated DESs and 67 BMSs. Compared with the BMS group, the dedicated DES group showed Significantly lower 1-year ISR rates (14 [9.3%] vs. 25 [37.3%]; HR 0.22, 95% CI 0.11 − 0.45; p < 0.001), indicating a 75.1% relative risk reduction. No significant differences were observed in 30-day stroke/death (1 [0.7%] vs. 0 [0%]; p > 0.99) or 31-day to 1-year stroke (6 [4.0%] vs. 5 [7.5%]; OR 0.57, 95% CI 0.12 − 2.82; p = 0.49) between the two groups. Symptomatic ISR occurred exclusively in BMS group (2.6%, 1/39). Stent fracture rates were numerically higher with dedicated DES (13 [8.7%] vs 3 [4.5%], p = 0.60), with ISR occurring in 25.0% (4/16) of fractured versus 17.4% (35/201) of nonfractured stents. Mortality beyond 30 days was similar (1 [0.7%] vs 1 [1.5%], p > 0.99). Rapamycin-eluting vertebral artery stents significantly reduced ISR rates compared to BMS in symptomatic severe VAOS, while maintaining comparable short- and mid-term safety. Stent fracture warrants further investigation as a potential modulator of ISR risk.

As the largest subcortical commissural fiber, the corpus callosum plays an important role in cerebral functions and has abundant blood supply from bilateral circulation. Isolated corpus callosum infarction (ICCI) may have specific characteristics. The aim of the study is to evaluate the clinical features, etiology, and 6-month prognosis of ICCI. Consecutive patients with acute ICCI treated at the China-Japan Friendship Hospital between June 2012 and June 2016 were retrospectively assessed for clinical and imaging findings. These cases were compared with patients suffering from other isolated supratentorial subcortical infarctions, matched for age, sex, and infarction size (n=60; control group). ICCI etiology and 6-month prognosis were further analyzed. ICCI cases accounted for 2.9% (33/1125) of all acute ischemic strokes and 30 patients were included. Most patients (n=28, 93.3%) presented nonspecific clinical symptoms, and only two (6.7%) with diffuse infarction developed callosal disconnection syndrome (CDS). The splenium was the most frequent site (37.5%). Large artery atherosclerosis (LAA) (n=16, 53.3%) was the most common etiology. Only four (13.3%) patients developed transient ischemic attacks (n=1, 3.3%) or cerebral infarction (n=3, 10%) during the 6-month follow-up. The frequency of good prognosis (modified Rankin score of 1-2 and without cardiovascular events) was higher in patients with ICCI compared with controls (P=0.024). Poor prognosis was associated with multiple cerebrovascular stenosis, diffuse/large infarction, and diabetes (all P<0.05). ICCI is a rare stroke type, frequently involving the splenium; its common etiology is likely LAA. Most patients show nonspecific symptoms, with only a few developing CDS. ICCI generally shows favorable short-term outcome.

Background: Hand knob stroke is a rare clinical disorder frequently misdiagnosed as peripheral neuropathy. The purpose of this study is to recognize this particular type of stroke by analyzing clinical features, etiology, and prognosis.Methods: We enrolled 19 patients with acute hand knob stroke in the Department of Neurology of the Beijing Geriatric Hospital from January 2018 to January 2022, and the clinical and imaging data of the patients during hospitalization and follow-up were collected and summarized.Results: Acute hand knob stroke accounted for 0.9% of all acute stroke, and ischemic stroke (17 cases, 89.5%) was more than hemorrhagic stroke (2 cases, 10.5%). All patients presented sudden contralateral hand paresis, 12 (63.2%) of them had only isolated hand paralysis, and the location of the lesion corresponded to different finger weakness. The cause of hand knob hemorrhage was hypertension, while the causes of hand knob infarction were mainly small-vessel occlusion (SVO) (35.3%) and large-artery atherosclerosis (LAA) (35.3%), and the rare causes include carotid artery dissection and carotid body tumor. After a median follow-up 13.5 months, the prognosis of 94.7% patients was good, and one patient (5.3%) had recurrent stroke.Conclusions: Hand knob stroke is a rare stroke with a good prognosis and a low stroke recurrence rate. Ischemic stroke is the predominant type and the main clinical manifestation is hand paresis. The cause of hand knob hemorrhage is hypertensive, while SVO and LAA are the main causes of hand knob infarction, but there are some rare etiologies.

The awareness of this disease. Methods: Clinical and radiological information from consecutive individuals diagnosed with WD of bilateral MCPs following pontine infarction in three hospitals over the past 4 years between October 2012 and October 2016 were retrospectively investigated and compared with a control group (patients with pontine infarction had no secondary WD). Results: This study involved 30 patients with WD of MCPs, with a detection rate of only 4.9%. The primary infarctions (χ2 =24.791, P = 0.001, vs. control group) were located in the paramedian pons in 21 cases (70.0%), and ventrolateral pons in nine cases (30.0%). WD of the MCPs was detected 8–24 weeks after pons infarction using conventional magnetic resonance imaging (MRI); all secondary WDs were asymptomatic and detected incidentally. All WD lesions exhibited bilateral, symmetrical, and boundary blurring on MRI. The signal features were hypointense on T1-weighted imaging, hyperintense on T2-weighted imaging and fluid-attenuated inversion recovery, and slightly hyperintense or isointense on diffusion-weighted imaging and apparent diffusion coefficient maps. Secondary brainstem atrophy was found in six (20.0%) cases. A Modified Rankin Scale score 0–2 was found in 10 (33.3%) cases and score >2 in 20 (66.7%) cases at 90 days after discharge, and the short-term prognosis was worse than that in control group (χ2 =12.814, P = 0.001). Conclusions: Despite the rarity of bilateral and symmetrical lesions of MCPs, secondary WD should be highly suspected if these lesions occur within 6 months after pontine infarction, particularly paramedian pons. Conventional MRI appears to be a relatively sensitive method for detecting WD of MCPs, which might affect the short-term prognosis....

Background: Fenestration of vertebra-basilar artery is an uncommon congenital vascular anomaly, which is identified by incidental findings on imaging in patients presented without related symptoms or in patients with intracerebral hemorrhage secondary to concomitant artery aneurysm or arteriovenous malformations. Yet, cases of fenestration being misdiagnosed as cerebral artery dissection have never been reported. Case presentation: We present a patient of 66-year-old female with acute onset of dizziness after chiropractic manipulation of the neck. Neck computed tomography angiography (CTA) showed ‘double lumen’ sign and ‘intimal flap’ of the V1 segment of the vertebral artery, which led to the initial diagnosis of vertebral artery dissection (VAD). However, vertebral artery fenestration at V1 segment was eventually identified by multi-directional digital subtraction angiography (DSA). Interestingly, concomitant vertebral fenestration at V3 segment, basilar fenestration and basilar artery tip aneurysm was also revealed by DSA. Conclusion: The triple fenestration at vertebrobasilar artery with basilar tip artery aneurysm is extremely rare, and the fenestration at the V1 segment of vertebral artery was easily misdiagnosed as VAD due to the similar imaging morphology.