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Chronic limb-threatening ischemia (CLTI) represents the advanced stages of peripheral arterial disease (PAD) and is caused by atherosclerotic damage in the lower limbs, having a greater risk of major amputation. The aim of this study was to analyze the impact of systemic immune index (SII), systemic inflammation response index (SIRI), and the aggregate index of systemic inflammation (AISI) on the clinical severity and long-term risk of amputation among patients with CLTI after percutaneous transluminal angioplasty (PTA). This is a retrospective observational study involving 104 patients diagnosed with CLTI and treated with PTA. Based on clinical severity, the cohort was divided into two groups: stage III Leriche-Fontaine and stage IV Leriche-Fontaine. We observed higher levels of SII (p = 0.027), SIRI (p = 0.0008), and AISI (p = 0.0024) in patients with trophic lesions. Kaplan–Meier analysis showed that patients with values of SII (p = 0.008), SIRI (p = 0.022), and AISI (p = 0.006) above the median at the time of admission are at a higher risk of major amputation in the long term following PTA. At the multivariate regression analysis, high baseline values of SIRI (odds ratio (OR) = 2.28; p = 0.017) and AISI (OR = 2.32; p = 0.043) were associated with stage IV Leriche-Fontaine, but not SII (OR = 1.71; p = 0.055). Additionally, in the Cox regression analysis, we found that SII (hazard ratio (HR) = 1.56; p = 0.010), SIRI (HR = 1.63; p = 0.009), and AISI (HR = 1.55; p = 0.016) are predictive factors for long-term risk of major amputation after endovascular treatment. Elevated levels of SIRI and AISI have been found to be linked with the severity of clinical symptoms and an increased risk of long-term major amputation in patients with CLTI following PTA. Additionally, higher baseline values for SII were associated with a greater risk of major amputation, but not with clinical severity in the same group of patients. [ABSTRACT FROM AUTHOR]

The current paper presents an examination of the emerging role of deep learning-based simulation software in enhancing preprocedural planning for intracranial aneurysm treatment using flow diverters. Intracranial aneurysms pose significant risk due to their potential rupture leading to life-threatening subarachnoid hemorrhage. Innovative endovascular treatment options like flow diverters, which redirect blood flow and promote healing, are gaining attention. The role of simulation software in optimizing these procedures is becoming increasingly crucial. This study involves a 47-year-old female patient diagnosed with an intracranial aneurysm. Through diagnostic angiography and 3D rotational angiography imaging, the complex aneurysm anatomy was determined and the need for flow diverter placement ascertained. The Sim&Size™ software was used to simulate the size and placement of the flow diverter, based on the patient's specific vascular anatomy. The procedure, including the placement of the flow diverter as per the simulation, was successful. The Sim&Size™ simulation software significantly contributes to the enhancement of intracranial aneurysm treatment planning. By providing patient-specific simulations, it improves procedural precision and reduces the risk of complications, thus potentially optimizing patient outcomes. However, the quality of the simulation is contingent on the accuracy of the input data, and it does not account for physiological dynamics. Despite these limitations, this tool represents a promising development in neurointerventional practice. [ABSTRACT FROM AUTHOR]

Objective: The aim of this article is to determine the predictive value of the leukocyte-glycemic index in the long-term evolution of diabetic patients with peripheral arterial disease following endovascular treatment. Methods: This retrospective observational study enrolled 127 diabetic patients diagnosed with peripheral arterial disease requiring endovascular treatment. Patients were categorized into two groups based on the severity of the infrapopliteal atherosclerotic lesions identified during the pre-operative Computer Tomography Angiography examination. Group 1 includes patients without severe damage to the infrapopliteal artery, while Group 2 includes patients with severe infrapopliteal artery damage, identified by stenosis greater than 70% on all infrapopliteal arteries. The primary outcome was to assess the association between leukocyte-glycemic index value at baseline and the severity of infrapopliteal atherosclerotic lesions and long-term major amputation after percutaneous transluminal angioplasty. Results: Patients in Group 2 had a higher incidence of cardiovascular events (p=0.009), stage IV Leriche-Fontaine (p=0.016), and incidence of major amputation (p<0.001), as well as an increased value of leukocyte-glycemic index (p=0.004). During the follow-up, patients with above-median leukocyte-glycemic index value have a higher risk of major amputation (p=0.034), as seen in the Kaplan-Meier analysis. Moreover, at cox-regression, elevated biomarker values were associated with long-term risk of major amputation, independent of age, sex, cardiovascular risk factors, and below-the-knee arterial occlusion (HR:2.69, p=0.001). Conclusions: Elevated values of leukocyte-glycemic index are associated with the severity of infrapopliteal atherosclerotic lesions and major amputation in the long term. [ABSTRACT FROM AUTHOR]

Introduction: Stroke is a common medical condition where the blood flow of the brain is suddenly stopped, leading to different neurological deficits. It mostly affects individuals aged 55 or above, but it can occur at any age. The stroke can come as an ischemic stroke, hemorrhagic stroke or even transient ischemic stroke. The most common type is the ischemic stroke, which can further come as large artery atherosclerosis, cardioembolic, small vessel disease, or other forms. Case Report: We present the case of a 37-year-old male patient who suffered an ischemic stroke. The patient underwent a comprehensive treatment protocol, including endovascular thrombectomy, following the identification of an obstruction of the internal carotid artery. Prior to the intervention, the patient underwent radiological and imaging investigations at the radiology department, where several CT scans were performed. The patient was referred to our clinic after a thorough neurological examination, with tandem stroke, trough simultaneous occlusion of the cervical segment of the internal carotid artery, and middle cerebral artery. Initially, aspiration thrombectomy was attempted using an aspiration catheter, yielding only partial success. Eventually, combined thrombectomy was performed, where an aspiration catheter alongside a stent retriever was deployed, to capture the thrombus. The procedure was complicated by the thrombus fragmentation and migration into the upper trunk of the middle cerebral artery. After numerous attempts, successful recanalization was obtained, with the ischemic stroke attributed to an embolic thrombus originating from the heart, associated with the patient's atrial fibrillation. Discussions : The presented case highlights the complexity often encountered in managing ischemic strokes, particularly in younger patients. The use of a comprehensive treatment approach, including endovascular thrombectomy, highlights the evolving landscape of stroke management, where timely intervention is crucial to mitigate potential long-term neurological deficits. The tandem occlusion of the cervical segment of the internal carotid artery and middle cerebral artery poses an incredible challenge, employing innovative strategies such as combined thrombectomy to address the obstruction effectively. Conclusions: In conclusion, this case highlights the challenges and complexities in managing ischemic strokes, particularly when tandem arterial occlusions occur with embolic origin. Despite procedural difficulties, successful recanalization was achieved, emphasizing the importance of strategizing, adaptability and perseverance in stroke interventions. [ABSTRACT FROM AUTHOR]

Introduction: Carotid angioplasty is a minimally invasive treatment procedure for atherosclerosis of the carotid arteries. Carotid angioplasty is necessary in the treatment of high-grade stenosis, as an alternative to surgical procedures (carotid endarterectomy). The intervention restores optimal blood circulation to the brain, thus preventing a transient ischemic attack or ischemic stroke. Carotid angioplasty is performed percutaneously, through a puncture in the skin, without the need for incisions. As a result, recovery is rapid and risks are minimal. Case Report: We present a case of carotid artery stenosis in a 73-year-old male patient. He underwent radiological and imaging investigations at the radiology department, where several CT scans were performed. The results indicated the presence of a carotid artery with an abnormally narrow diameter, significantly restricting blood flow to the brain. For treatment, it was decided to perform an endovascular percutaneus angioplasty, during which doctors dilated the narrowed area using a catheter and a small-sized expandable balloon, under the protection of a filter. Additionally, a stent was placed to maintain vessel patency. Despite the initial success of the intervention, migration of a thrombus formed on the stent was observed, obstructing the upper and lower branches of the middle cerebral artery, with consequences on blood circulation to the brain. After several aspiration thrombectomies, blood flow was restored and the normal diameter of the carotid artery was regained. Discussions : One of the most feared complications when approaching the supra-aortic vessels are formation of blood clots, and their intracerebral migration. Whether the angioplasty is performed under open surgery or through an endovascular approach, protection of the intracerebral vessels in mandatory. Even though the operating team used a filter placed in the petrous segment of the internal carotid artery, migration of a thrombus occurred after the filter was removed. Having a qualified operating team, with access to specialized equipment for thrombectomy is a second layer of prevention. In the presented case, the patient had an excellent outcome, with no neurological deficit, and improvement of the symptoms. Conclusions: In conclusion, despite the initial success of the endovascular percutaneous angioplasty procedure for carotid artery stenosis, the migration of a thrombus posed a significant challenge to blood circulation to the brain. However, timely intervention through aspiration thrombectomies ultimately led to the restoration of blood flow and improved patient outcomes. [ABSTRACT FROM AUTHOR]