Hale Zeynep Batur Çağlayan

Background/Objectives: Carotid artery stenting (CAS) is a preventive treatment for symptomatic moderate-to-severe and asymptomatic severe carotid stenosis. This study evaluated short- and long-term complications and outcomes of CAS. Methods: We retrospectively analyzed 584 patients who underwent CAS at our Neurology Clinic between January 2004 and December 2020. Results: Of 584 patients, 271 (46.6%) were symptomatic and 311 (53.4%) asymptomatic. At 30 days, myocardial infarction (MI) occurred in 2.2%, major stroke in 2.4%, major adverse cardiac and cerebrovascular events (MACCE) in 4.1%, and vascular death in 1.4%. Mean Charlson Comorbidity Index (CCI) was higher in patients with 30-day MACCE (p=0.014) and vascular death (p=0.003). Atrial fibrillation (AF) independently predicted 30-day MACCE (OR 3.57, 95% CI 1.17-10.89) and vascular death (OR 10.17, 95% CI 2.18-47.42); CCI independently predicted MACCE at 5 and 10 years. Diabetes mellitus (69.7%) was not independently associated with MACCE, restenosis, or mortality after adjusting for CCI. Smoking, rather than sex, independently predicted 5-year restenosis (OR 4.61, 95% CI 1.80-11.79); the higher crude restenosis rate in men appears attributable to smoking prevalence. Actuarial analysis showed 10-year overall survival of 81.0%, MACCE-free survival of 75.3%, and restenosis-free survival of 73.4%. Conclusions: CAS is generally safe, but close follow-up is necessary to monitor complications, and careful preoperative risk assessment is essential. CCI and AF status should be considered alongside stroke history, carotid anatomy, and smoking status for perioperative risk assessment.

Background: Serum albumin and albumin based immunonutritional indices have been investigated as prognostic and/or risk factors in various vascular diseases. Based on this evidence, we aimed to evaluate their potential contribution to predicting stroke recurrence. Methods: Albumin, Prognostic Nutritional Index (PNI), and C-Reactive Protein–Albumin–Lymphocyte (CALLY) indices were analyzed in 963 patients retrospectively to assess differences for recurrence in 2 year median follow-up. Logistic regression were constructed in three models, and cox regression analysis was also performed to assess temporal effect. Results: Albumin (p = .002) and PNI (p = .032) were significantly associated with recurrence in comparative analyses. In logistic regression lower albumin quartiles—even within the normal range—were associated with recurrence (Q1≤3.7 g/dL: OR=2.36, 95%CI=1.27–4.38, p=.007; Q2=3.71–4.0 g/dL: OR=2.13, 95%CI=1.12–4.03, p=.021). After adjustment for other biochemical markers (free T4, potassium, uric acid), albumin retained its significance (Q1: OR=2.05, 95%CI=1.09–3.87; Q2: OR=2.00, 95%CI=1.05–3.83). However, when major clinical predictors (previous stroke and adherence to antithrombotic therapy) were added to the model, this statistical significance was lost. In Cox regression, previous stroke was the only variable that remained associated with recurrence. Discussion and Conclusion: Albumin may represent a more stable indicator of nutritional risk compared with PNI and CALLY, which are potentially more susceptible to fluctuations driven by lymphocyte count or inflammation. Although malnutrition risk may contribute to recurrence, the predictive value of albumin does not exceed that of major clinical determinants. Therefore, albumin may serve as a complementary risk marker in secondary stroke prevention but is unlikely to function as an independent predictor.

Diagnostic performance of vector flow imaging–derived wall shear stress and radiofrequency echo-tracking–derived arterial stiffness indices in severe carotid stenosis

Objectives: This study aimed to investigate the etiology in patients with Horner syndrome (HS) using neuroimaging studies based on demographic and clinical characteristics and to contribute to clinical practice by developing a practical algorithm based on our findings and integrating current neuroimaging techniques. Patients and methods: This retrospective, two-center study evaluated 54 patients (28 males, 26 females; mean age: 49.3 ± 14.1 years; range, 21 to 76 years) with HS between January 2013 and February 2022. Demographic and clinical features of the patients, the response to apraclonidine, and neuroimaging study findings were evaluated. Results: Of the cases included in the study, 18 (33.3%) were idiopathic, three (5.5%) were congenital, 13 (24.1%) were central (first-order neuron), 11 (20.4%) were preganglionic (second-order neuron), and nine (16.7%) were postganglionic (third-order neuron). Localized etiology was affirmed in 33 (61.8%) of 54 patients. Conclusion: This study showed that neuroimaging methods easily identified etiology in patients with additional neurological findings in HS. The underlying causes could not be defined in a significant part of patients with isolated HS. However, it is essential to carry out detailed neuroimaging studies according to clinical findings to exclude life-threatening causes in patients with HS.

Spasticity-induced muscle changes affect structure and metabolism. Little is known about the effect of stroke-related muscle changes on peripheral muscle oxygenation. To investigate the effect of spasticity severity on peripheral muscle oxygenation in patients with hemiparetic stroke. This cross-sectional study was conducted with 20 hemiparetic stroke patients and 10 healthy individuals. The hemiparetic stroke patients were divided into the high-level spasticity group (HLS, MAS ≥ 2) and the low-level spasticity group (LLS, MAS < 2). Healthy individuals were included in the control group (CG). Gastrocnemius muscle oxygenation was measured with near-infrared spectroscopy at rest, during activity (6-minute walk test and stair climbing test) and after activity. Ankle plantar flexor spasticity was evaluated with the Modified Ashworth Scale (MAS). Secondary outcome measures were motor recovery, disability level, and calf adipose tissue thickness. Resting average muscle oxygenation was lower in HLS than in CG (p = .021). Muscle oxygenation changes from baseline to final values were lower in HLS than in LLS after 6-minute walk test (p = .037) and lower than in CG after stair climbing test (p = .011). Baseline and final muscle oxygen saturation were lower in HLS, differences were not significant. In HLS, muscle oxygen saturation during 6-minute walk test increased unexpectedly, while it decreased during recovery. Spasticity severity affected peripheral muscle oxygenation. In patients with high-level spasticity, resting average muscle oxygenation and changes in muscle oxygenation during recovery were lower, and different patterns were observed during 6MWT, suggesting impaired oxygen utilization and delivery, possibly related to spasticity severity. Clinical trial registry: NCT06362954.

Aim: Digital platforms such as YouTube are popular sources of health-related information. Although there are studies evaluating the quality of different online medical content, studies focusing on the quality of dementia-related content are limited. This study aimed to investigate the quality of YouTube videos related to dementia patient care. Material and Methods: Using the term "Dementia care" on the YouTube platform, 100 English videos that met the inclusion criteria were identified and analyzed. In addition to video popularity measurements, to evaluate content quality, the global quality scale (GQS), modified DISCERN scale, Journal of the American Medical Association (JAMA) quality scale, and the patient education materials assessment tool for audio/visual materials (PEMAT-A/V) are used. Results: It was observed that most of the videos were uploaded by non-academic health institutions (36%) and health professionals (23%). When the content of the videos was evaluated, it was determined that general care strategies were the most common content with 52%. Scores indicating high levels of reliability and accuracy were determined on all applied content quality scales. Videos sourced from academic healthcare institutions were found to have the highest scores on content quality scales. In correlation analyses, video metrics such as duration, view ratio, number of comments, and video power index values were positively correlated with content quality scores. Conclusion: Videos about dementia patient care on YouTube generally exhibit high popularity and content quality. Individuals seeking information about dementia care on online platforms should be directed to videos uploaded by healthcare institutions.

Background: This study assessed the consequences of hemodialysis (HD) on hemodynamic parameters of cerebral circulation by measuring middle cerebral artery blood flow velocities using transcranial Doppler ultrasound before and after a single dialysis session in patients with end-stage renal disease (ESRD). Materials and Methods: Fifty clinically stable patients with ESRD undergoing HD and 40 healthy controls were recruited for the study. Blood pressure, heart rate, and body weight were measured. Transcranial Doppler ultrasound evaluations and blood analyses were performed immediately before and after a single dialysis session. Results: The mean cerebral blood flow velocities (CBFVs) in the ESRD patients before HD was 65 ± 17 cm/second and did not differ from that of the normal controls (64 ± 14 cm/s) (P = 0.735). The postdialysis CBFV also did not differ from that of the controls (P = 0.054). Conclusion: Compensatory cerebral autoregulation and chronic adjustment to therapy may be the reason for the nondeviation of the CBFV values from normality observed in both sessions.