Search Results (593)

Ischemic stroke is a primary cause of cerebrovascular diseases and continues to be one of the leading causes of death and disability among patients worldwide. Pathological processes caused by vascular damage due to stroke occur in a time-dependent manner and are classified into three categories: acute, subacute, and chronic. Current treatments for ischemic stroke are limited to effectiveness in the early stages. In this study, we investigated the therapeutic effect of an oriental medicine, Gosha-jinki-gan (TJ107), on improving chronic ischemic stroke using the mouse model with middle cerebral artery occlusion (MCAO). The changes in the intracerebral inflammatory response (macrophages (F4/80), TLR2•4, IL-23, IL-17, TNF-α, and IL-1β) were examined using real-time RT-PCR. The MCAO mice showed the increased expression of glial fibrillary acidic protein (GFAP) and of F4/80, TLR2, TLR4, IL-1β, TNF-α, and IL-17 in the brain tissue from the MCAO region. This suggests that they contribute to the expansion of the ischemic stroke infarct area and to the worsening of the neurological symptoms of the MCAO mice in the chronic phase. On the other hand, the administration of TJ107 was proven to reduce the infarct area, with decreased GFAP expression, suppressed macrophage infiltration in the brain, and reduced TNF-α, IL-1β, and IL-17 production compared with the MCAO mice. This study first demonstrated Gosha-jinki-gan’s therapeutic effects on the chronic ischemic stroke. Full article

Obstructive sleep apnea (OSA) is a common condition associated with intermittent hypoxia, systemic inflammation, and vascular dysfunction; mechanisms implicated in retinal disease pathogenesis. This real-world retrospective cohort study used data from the TriNetX Research Network to assess whether continuous positive airway pressure (CPAP) therapy reduces retinal disease incidence among adults with OSA and BMI between 25.0 and 30.0 kg/m². After 1:1 propensity score matching, 101,754 patients were included in the analysis. Retinal outcomes included diabetic retinopathy (DR), age-related macular degeneration (AMD), retinal vein occlusion (RVO), and central serous chorioretinopathy (CSC). CPAP use was associated with a modest but statistically significant reduction in DR (3.2% vs. 3.4%, RR: 0.922, p = 0.016) and AMD (2.1% vs. 2.3%, RR: 0.906, p = 0.018), while no significant differences were found for RVO or CSC. These findings support prior evidence linking CPAP to improved retinal microvascular health and suggest a protective effect against specific retinal complications. Limitations include a lack of data on CPAP adherence, OSA severity, and imaging confirmation. Still, this study highlights the importance of interdisciplinary care between sleep and eye health, and the need for further prospective studies to validate CPAP’s role in preventing retinal disease progression in OSA patients. Full article

Minimally invasive cosmetic procedures, such as dermal fillers, botulinum toxin injections, autologous fat grafting, intense pulsed light (IPL) treatments, and platelet-rich plasma (PRP) treatments, are increasingly popular worldwide due to their convenience and aesthetic benefits. While generally considered safe, these procedures can result in rare but serious ophthalmological complications. The most catastrophic adverse events include central retinal artery occlusion and ischemic optic neuropathy, which may lead to irreversible vision loss. Other complications include diplopia, ptosis, dry eye, and orbital cellulitis, with varying degrees of severity and reversibility. Awareness of potential ocular risks, appropriate patient selection, and adherence to safe injection techniques are crucial for preventing complications. This narrative review summarizes the incidence, mechanisms, clinical features, risk factors, diagnostic approaches, and management strategies of ocular complications associated with aesthetic medical procedures. A narrative literature review was conducted, emphasizing data from clinical studies, case series, and expert consensus published between 2015 and 2025. Special attention is given to anatomical danger zones, the pathophysiological pathways of filler embolization, and the roles of hyaluronidase and hyperbaric oxygen therapy in acute management. Although many complications are self-limited or reversible, prompt recognition and intervention are critical to prevent permanent sequelae. The increasing prevalence of these procedures demands enhanced education, informed consent, and interdisciplinary collaboration between aesthetic providers and ophthalmologists. Full article

Coronavirus disease 2019 (COVID-19) causes cardiovascular complications, which contributes to the high mortality rate of the disease. Emerging evidence indicates that aberrant vascular smooth muscle cell (SMC) function is a key driver of vascular disease in COVID-19. While antivirals alleviate the symptoms of COVID-19, it is not known whether these drugs directly affect SMCs. Accordingly, the present study investigated the ability of three approved COVID-19 antiviral drugs to influence SMC function. Treatment of SMCs with remdesivir (RDV), but not molnupiravir or nirmatrelvir, inhibited cell proliferation, DNA synthesis, and migration without affecting cell viability. RDV also stimulated an increase in heme oxygenase-1 (HO-1) expression that was not observed with molnupiravir or nirmatrelvir. The induction of HO-1 by RDV was abolished by mutating the antioxidant responsive element of the promoter, overexpressing dominant-negative NF-E2-related factor-2 (Nrf2), or treating cells with an antioxidant. Finally, silencing HO-1 partly rescued the proliferative and migratory response of RDV-treated SMCs, and this was reversed by carbon monoxide and bilirubin. In conclusion, the induction of HO-1 via the oxidant-sensitive Nrf2 signaling pathway contributes to the antiproliferative and antimigratory actions of RDV by generating carbon monoxide and bilirubin. These pleiotropic actions of RDV may prevent occlusive vascular disease in COVID-19. Full article

Background/Objectives: Posterior inferior cerebellar artery (PICA) aneurysms are one of the most difficult cerebrovascular lesions to treat and account for 0.5–3% of all intracranial aneurysms. They have deep anatomical locations, broad-neck configurations, high perforator density, and a close association with the brainstem, which creates considerable technical challenges for either microsurgical or endovascular treatment. Despite its acceptance as the standard of care for most posterior circulation aneurysms, PICA aneurysms are often associated with flow diversion using a coil or flow diversion due to incomplete occlusions, parent vessel compromise and high rate of recurrence. This case aims to describe the utility of microsurgical clipping as a durable and definitive option demonstrating the value of tailored surgical planning, preservation of anatomy and ancillary technologies for protecting a genuine outcome in ruptured PICA aneurysms. Methods: A 66-year-old male was evaluated for an acute subarachnoid hemorrhage from a ruptured and broad-necked fusiform left PICA aneurysm at the vertebra–PICA junction. Endovascular therapy was not an option due to morphology and the center of the recurrence; therefore, a microsurgical approach was essential. A far-lateral craniotomy with a partial C1 laminectomy was carried out for proximal vascular control, with careful dissection of the perforating arteries and precise clip application for the complete exclusion of the aneurysm whilst preserving distal PICA flow. Results: Post-operative imaging demonstrated the complete obliteration of the aneurysm with unchanged cerebrovascular flow dynamics. The patient had progressive neurological recovery with no new cranial nerve deficits or ischemic complications. Long-term follow-up demonstrated stable aneurysm exclusion and full functional independence emphasizing the sustainability of microsurgical intervention in challenging PICA aneurysms. Conclusions: This case intends to highlight the current and evolving role of microsurgical practice for treating posterior circulation aneurysms, particularly at a time when endovascular alternatives are limited by anatomy and hemodynamics. Advances in artificial intelligence cerebral aneurysm rupture prediction, high-resolution vessel wall imaging, robotic-assisted microsurgery and new generation flow-modifying implants have the potential to revolutionize treatment paradigms by embedding precision medicine principles into aneurysm management. While the discipline of cerebrovascular surgery is expanding, it can be combined together with microsurgery, endovascular technologies and computational knowledge to ensure individualized, durable, and minimally invasive treatment options for high-risk PICA aneurysms. Full article

Background/Objectives: An aberrant internal carotid artery (aICA) in the middle ear is a rare vascular anomaly with potentially catastrophic consequences if injured during otologic procedures. Given its rarity, standardized treatment recommendations are lacking. This study aims to present four cases of aICA bleeding, systematically review the literature, and evaluate the outcomes of conservative and interventional management. Methods: A retrospective review of four patients treated for intraoperative aICA hemorrhage at two tertiary referral centers was performed. A systematic review was conducted following PRISMA guidelines. Neurologic and otologic outcomes, hemostasis, and complications were analyzed. Results: Two patients were treated conservatively with external auditory canal packing, while two required endovascular coil embolization due to pseudoaneurysm formation or persistent bleeding. One patient suffered a stroke due to traumatic ICA occlusion. The systematic review identified 20 additional cases. Conservative treatment alone sufficed in 37.5% of cases, whereas 62.5% required vessel occlusion via coiling, balloon occlusion, or stenting. Neurologic complications occurred in 25% of patients, while otologic outcomes varied widely and were inconsistently reported. Conclusions: Initial external auditory canal packing and a CT angiogram should be recommended for all patients. Initial conservative management may be appropriate for cases with early hemostasis if close monitoring is ensured. Endovascular treatment is often necessary, particularly in cases of pseudoaneurysm or rebleeding. Full article

Background/objectives: Being overweight increases the predisposition to obesity and type 2 diabetes (T2D), which significantly elevate stroke risk and the likelihood of severe post-stroke disability. Dietary nitrate (NO₃⁻) supplementation can mitigate obesity and metabolic impairments, making it a promising approach to halt overweight people from developing overt obesity/T2D, thereby potentially also improving stroke outcome. We determined whether NO3⁻ supplementation prevents overweight mice from progressing into obesity and T2D and whether this intervention improves stroke outcome. Methods: An overweight condition was induced via 6 weeks of a high-fat diet (HFD), after which animals were randomized to either a HFD or a HFD with NO₃⁻ supplementation. After 24 weeks, when HFD-mice without NO₃⁻ developed obesity and T2D, all animals were subjected to transient middle cerebral artery occlusion and stroke outcome was assessed via behavioral testing and infarct size. The effect of NO₃⁻ on post-stroke neuroinflammation, neurogenesis, and neovascularization was analyzed by immunohistochemistry. Results: Sustained NO₃⁻ supplementation in overweight mice did not prevent obesity or insulin resistance. However, it attenuated weight gain, prevented hyperglycemia, and significantly improved functional recovery after stroke, without affecting infarct size. Moreover, NO₃⁻ decreased post-stroke neuroinflammation by reducing microglial infiltration. NO₃⁻ did not affect stroke-induced neurogenesis or vascularization. Conclusion: These results highlight the potential of NO₃⁻ supplementation to prevent metabolic impairment in the overweight population and improve stroke prognosis in this large group of people at risk of stroke and severe stroke sequelae. Full article

Background: Left atrial appendage occlusion (LAAO) is a valuable alternative to long-term anticoagulation in patients with atrial fibrillation (AF) and a high bleeding risk. However, effective vascular closure following large-bore venous access remains a clinical challenge, particularly in patients with multiple comorbidities. This study compares two venous closure techniques—Z-sutures and the suture-mediated ProGlide™ device—regarding their safety and efficacy in patients undergoing LAAO. Methods: We conducted a single-center observational study including 163 patients treated with LAAO between 2021 and 2024. Closure was achieved via a Z-suture (n = 126) or the ProGlide™ (n = 37) based on operator preference. The primary endpoint was clinically relevant bleeding (BARC ≥ 2). The secondary endpoints included 30-day mortality and hospital stay duration. Results: The Z-suture group included older and more comorbid patients. Despite these differences, the bleeding rates were comparable between groups. Clinically relevant bleeding was infrequent (Z-suture: 12.6%; ProGlide™: 13.5%). No 30-day deaths occurred in either group, and their hospital stay durations were similar. Conclusions: Both the Z-suture and ProGlide™ techniques demonstrated comparable safety and efficacy. Due to their simplicity and potential cost advantage, Z-sutures may be a practical alternative in routine care for high-risk patients. Full article

Low-load conditioning activity with blood flow restriction has been addressed as an efficient method to enhance an individual’s performance during their main exercise activity. However, the optimal degree of blood flow restriction remains unclear. Therefore, this study investigated the acute effects of low-load conditioning activity with different degrees of blood flow restriction on muscle strength, power, and perceived exertion. Twenty recreationally trained men (20.9 ± 2.3 years) participated in a randomized crossover design including three conditions: control, low-load blood flow restriction at 50%, and 75% of total arterial occlusion pressure. Participants performed squats (three sets of ten reps) followed by isokinetic assessments of the knee flexor and extensor performance at 7 and 10-min post-exercise. The session rating of perceived exertion (SRPE) was recorded 30 min after each session. No significant effects were observed for condition, time, or their interaction on peak torque, total work, or average power (p < 0.05). However, SRPE was significantly higher in the 75% BFR condition compared to both the 50% BFR and control conditions (p < 0.05), with no difference between the 50% BFR and control. These findings suggest that low-load conditioning activity with blood flow restriction does not acutely enhance neuromuscular performance. However, a higher degree of restriction increases perceived exertion. Full article

Low-load resistance training combined with vascular occlusion or hypoxia can increase muscle cross-sectional area (CSA), but the effect of such training on hormonal response and cardiovascular response is less clear. Thirty female netball athletes took part in a 5-week training of knee muscles in which low-load resistance exercise (20% 1-RM) was combined with either an occlusion pressure (KT, n = 10), hypoxic air (HT, n = 10), or no additional stimulus (CT, n = 10). Growth hormones (GHs), cardiovascular parameters, and CSA were measured before and after the training program. Compared to CT, both HT and KT showed a substantial increase in GH release after the first training bout (pre). After 5 weeks of training (post), the release of GH was substantially reduced in all groups. Compared to CT, HT showed a substantial decrease in SP (11.7 ± 11.3%, mean ± 90% CL) over the training period. The reduction in systolic blood pressure (SP) after hypoxic training resulted in a substantial decrease in the rate-pressure product (RPP) by 15.6 ± 9.6%, compared to CT. CSA from HT and KT is likely related to the heightened release of GH found after training. The hypoxic training protocol has a greater cardiovascular benefit than similar resistance training with blood flow restriction. Full article

The abnormal growth of smooth muscle cells (SMCs) contributes to the vascular remodeling associated with coronary artery disease, a leading cause of death in women. Estradiol (E2) mediates cardiovascular protective actions, in part, by inhibiting the abnormal growth (proliferation and migration) of SMCs through various mechanism. Since microRNAs (miRNAs) play a major role in regulating cell growth and vascular remodeling, we hypothesize that miRNAs may mediate the protective actions of E2. Following preliminary leads from E2-regulated miRNAs, we found that platelet-derived growth factor (PDGF)-BB-induced miR-193a in SMCs is downregulated by E2 via estrogen receptor (ER)α, but not the ERβ or G-protein-coupled estrogen receptor (GPER). Importantly, miR-193a is actively involved in regulating SMC functions. The ectopic expression of miR-193a induced vascular SMC proliferation and migration, while its suppression with antimir abrogated PDGF-BB-induced growth, effects that were similar to E2. Importantly, the restoration of miR-193a abrogated the anti-mitogenic actions of E2 on PDGF-BB-induced growth, suggesting a key role of miR-193a in mediating the growth inhibitory actions of E2 in vascular SMCs. E2-abrogated PDGF-BB, but not miR-193a, induced SMC growth, suggesting that E2 blocks the PDGF-BB-induced miR-193a formation to mediate its anti-mitogenic actions. Interestingly, the PDGF-BB-induced miR-193a formation in SMCs was also abrogated by 2-methoxyestradiol (2ME), an endogenous E2 metabolite that inhibits SMC growth via an ER-independent mechanism. Furthermore, we found that miR-193a induces SMC growth by activating the phosphatidylinositol 3-kinases (PI3K)/Akt signaling pathway and promoting the G1 to S phase progression of the cell cycle, by inducing Cyclin D1, Cyclin Dependent Kinase 4 (CDK4), Cyclin E, and proliferating-cell-nuclear-antigen (PCNA) expression and Retinoblastoma-protein (RB) phosphorylation. Importantly, in mice, treatment with miR-193a antimir, but not its control, prevented cuff-induced vascular remodeling and significantly reducing the vessel-wall-to-lumen ratio in animal models. Taken together, our findings provide the first evidence that miR-193a promotes SMC proliferation and migration and may play a key role in PDGF-BB-induced vascular remodeling/occlusion. Importantly, E2 prevents PDGF-BB-induced SMC growth by downregulating miR-193a formation in SMCs. Since, miR-193a antimir prevents SMC growth as well as cuff-induced vascular remodeling, it may represent a promising therapeutic molecule against cardiovascular disease. Full article

Coronary chronic total occlusions (CTOs) are diagnosed in a significant portion of patients undergoing coronary angiography and represent one of the most complex scenarios in contemporary percutaneous coronary interventions (PCI). This review systematically examines how adjunctive imaging modalities’—intravascular ultrasound (IVUS), optical coherence tomography (OCT), and coronary computed tomography angiography (CCTA)—co-registration enhances the precision and success rates of CTO-PCI during the procedure. The strategic integration of these technologies enables the development of patient-specific intervention strategies tailored to individual vascular architecture and lesion characteristics. This personalized approach marks a transition from standardized protocols to precision interventional cardiology, potentially optimizing procedural success rates while minimizing complications. Full article

Background/Objectives: In septic shock, microcirculatory dysfunction contributes to organ failure and mortality. While sidestream dark-field (SDF) imaging is the reference method for assessing microvascular perfusion, its complexity limits routine use. This study evaluates near-infrared spectroscopy (NIRS) with vascular occlusion testing (VOT) as a potential bedside tool for monitoring microcirculatory changes following fluid resuscitation. Methods: Sixty-three fluid-responsive patients with sepsis were randomized to receive either 20% albumin or crystalloid. NIRS-VOT and sublingual SDF measurements were obtained at baseline and 60 min post-resuscitation. The reoxygenation slope (ReOx) derived from NIRS was calculated and compared with clinical severity scores and SDF-derived microcirculatory parameters. Results: ReOx significantly increased from baseline to 60 min in the albumin group (p = 0.025), but not in the crystalloid group. However, between-group differences at 60 min were not statistically significant. ReOx at 60 min was inversely correlated with APACHE II score (ρ = −0.325) and lactate (ρ = −0.277) and showed a weak inverse trend with norepinephrine dose. AUROC for ICU survival based on ReOx was 0.616. NIRS ReOx showed weak correlations with SDF parameters, including the number of crossings (p = 0.03) and the consensus proportion of perfused vessels (CPPV; p = 0.004). Conclusions: NIRS-VOT detected microcirculatory trends after albumin administration but showed limited agreement with SDF imaging. These findings suggest that NIRS and SDF assess different physiological domains. Further studies are warranted to define the clinical utility of NIRS as a microcirculation monitoring tool (Clinicaltrials.gov: NCT05357339). Full article

Background: Retinal vascular occlusion (RVO) and retinal artery occlusion (RAO) have been reported as rare adverse events following COVID-19 vaccination, raising concerns about vaccine safety. This review synthesizes cohort and case–control studies assessing the association between COVID-19 vaccines and RVO/RAO, while exploring potential pathophysiological mechanisms. Methods: We analyzed large-scale population-based studies from South Korea, Europe, and the TriNetX database, focusing on odds ratios (OR), hazard ratios (HR), and relative risks (RR) across mRNA and adenoviral vector vaccines. Pathological processes were hypothesized based on molecular and clinical evidence. Results: Studies investigating the association between COVID-19 vaccination and retinal vascular occlusion show conflicting results; some studies report no association (e.g., OR 0.93, 95% CI 0.60–1.45), others suggest reduced risk (e.g., OR 0.80, 95% CI 0.64–0.99), and one indicates increased risk over two years (HR 2.19, 95% CI 2.00–2.39). Adenoviral vector vaccines, particularly ChAdOx1, show higher RAO incidence in specific cohorts. Proposed mechanisms include vaccine-induced immune thrombotic thrombocytopenia (VITT) via anti-PF4 antibodies, spike protein-mediated endothelial dysfunction, and adjuvant-driven inflammation. Conclusions: While causality remains unproven, temporal heterogeneity and vaccine type-specific risks warrant further investigation. Longitudinal studies with robust controls are needed to clarify these associations in the post-pandemic context. Full article

Cardiovascular diseases are responsible for a large number of severe disability cases and deaths worldwide. Strong research in this field has been extensively carried out, in particular for the associated complications, such as the occlusion of small-diameter (<6 mm) vessels. Accordingly, in the present research, two random copolyesters of poly(butylene 2,5-furandicarboxylate) (PBF) and poly(butylene isophthalate) (PBI), were successfully synthesized via two-step melt polycondensation and were thoroughly characterized from molecular, thermal, and mechanical perspectives. The copolymeric films displayed a peculiar thermal behavior, being easily processable in the form of films, although amorphous, with T_g close to room temperature. Their thermal stability was high in all cases, and from the mechanical point of view, the materials exhibited a high ultimate strength, together with values of elastic moduli tunable with the chemical composition. The long-term stability of these materials under physiological conditions was also demonstrated. Cytotoxicity was assessed using a direct contact assay with human umbilical vein endothelial cells (HUVECs). In addition, hemocompatibility was tested by evaluating the adhesion of blood components (such as the adsorption of human platelets and fibrinogen). As a result, a proper chemical design and, in turn, both the solid-state and functional properties, are pivotal in regulating cell behavior and opening new frontiers in the tissue engineering of soft tissues, including vascular tissues. Full article