Transcarotid artery revascularization (TCAR) is a hybrid technique that incorporates features of both carotid endarterectomy (CEA) and carotid artery stenting (CAS). In this procedure, the common carotid artery is directly exposed and punctured under visualization to allow precise stent placement. Since its approval in the United States in 2015, TCAR has become an important treatment option for cervical internal carotid artery stenosis. Although many studies have reported favorable outcomes with TCAR, the overall level of supporting scientific evidence remains limited. CEA is still regarded as the evidence-based standard treatment for carotid artery stenosis, and its significantly lower cost compared with TCAR or CAS is considered another barrier to wider TCAR adoption. Given this background, the introduction of TCAR in Japan-where the clinical outcomes of CAS have been excellent-is of great interest. Moving forward, it will be important to monitor how patient selection criteria and clinical indications for TCAR are defined and how the procedure is ultimately incorporated into routine clinical practice.

Endovascular treatment of large, wide-necked intracranial aneurysms has been challenged by high recurrence rates following coil embolization. Flow diverters, designed to redirect blood flow away from the aneurysm sac and promote thrombosis and vessel wall reconstruction, have transformed therapeutic strategies. These devices, characterized by high mesh density compared to conventional stents, have become cornerstones in aneurysm management. Since the approval of the Pipeline device in 2008, multiple flow diverters have been developed worldwide; clinical use in Japan began in 2015, with expanded indications after 2020. Currently, Pipeline Flex with Shield Technology, FRED X, and Surpass Evolve are available domestically, each with distinct structural features, deployment characteristics, and antithrombotic properties. This article provides an overview of their differences, focusing on device selection, deployment techniques, and clinical applicability. By integrating device-specific considerations with structured preoperative planning, flow-diverter therapy offers a paradigm shift in treating complex aneurysms, thereby expanding options for cases resistant to conventional interventions.

Coil embolization remains an important technique for treating cerebral aneurysms, even with the development of new devices such as flow diverters and flow disruption systems. To achieve stable occlusion, it is important to use coils in three steps: framing, filling, and finishing. The framing coil creates the initial support inside the aneurysm and helps prevent rupture during the procedure. Filling coils are then placed to pack the aneurysm densely and evenly. Finishing coils are used at the end to close the small space near the neck and reduce the risk of recurrence. As aneurysms vary in shape-simple, irregular, or very small-the optimal coil strategy differs from case to case. Selecting the appropriate type of coil for the aneurysm shape and catheter position is essential for both safety and effectiveness. This review explains practical considerations for each step and shows how aneurysm morphology can guide coil selection to improve treatment outcomes.

Cardiovascular diseases, particularly heart failure (HF), are leading causes of morbidity and mortality worldwide. Limited patient knowledge about HF is associated with poor treatment adherence and worse health outcomes, emphasizing the importance of educational interventions. This randomized clinical trial evaluated the effectiveness of a nurse-led educational intervention combining home visits and telephone follow-up on patients' knowledge and quality of life (QoL). Conducted in six Brazilian hospitals, the study included 120 patients hospitalized with decompensated HF and randomly assigned to a control group (CG) or an intervention group (IG). The IG received structured education at discharge, followed by home visits on days 7, 30, and 60 and telephone follow-up on days 15 and 45, while the CG received usual care. Outcomes were assessed at 60 days. At this time point, adequate HF knowledge was observed in 82% of patients in the IG compared with 38% in the CG, and good QoL in 73% versus 33%, respectively (p < 0.001). The intervention was effective in improving knowledge and QoL in patients with HF.

To assess whether the timing of ischemic stroke onset demonstrates circadian variability in children.

We performed a retrospective cohort study evaluating children with arterial ischemic stroke and known time of stroke onset who were enrolled in a large, multicenter pediatric stroke registry. Clinical and radiographic features were compared according to 4 time epochs-6:00-11:59 (morning), 12:00-17:59 (afternoon), 18:00-23:59 (evening), and 00:00-5:59 (night)-using Kruskal-Wallis and chi-square tests. Pairwise comparisons were conducted when needed.

A total of 478 patients were included, with 54% male and a mean age of 9.9 ± SD 5.7 years. We observed a rise in stroke frequency in the morning that plateaued around 10:00, with a sustained high frequency into the early afternoon; most strokes occurred in the afternoon (n = 185, 38.7%), followed by the morning (n = 156, 32.6%). Arteriopathy risk factors were more prevalent in nighttime strokes (23/36, P = .034). Patients in the <2, 2-5, and 6-11-year-old age groups had a higher proportion of strokes in the afternoon (42%, 38%, and 45%, respectively). There was a trend for better median 6-month pediatric stroke outcome measure scores after evening strokes (0.5, IQR 0-1.5) compared with morning strokes (1, IQR 0.5-2) and afternoon strokes (1, IQR 0.5-3), P = .033, but this was not statistically significant after adjustment for multiple comparisons.

Circadian influence on stroke timing appears to differ between adults and children. These findings could influence stroke systems of care and treatment strategies for pediatric stroke.

High-intensity endurance exercise is linked to increased atrial fibrillation (AF) risk. P wave indices are established AF risk markers, but their role in ultramarathon athletes is unexplored. This study aimed to compare P wave indices between ultramarathon athletes and healthy controls. This cross-sectional study enrolled 74 ultramarathon athletes and 38 age- and sex-matched healthy volunteers (2:1 ratio). Athletes had completed ≥1 race of ≥100 km or ≥60 km in the past year. Participants with AF, atrial flutter, cardiovascular diseases, or structural heart abnormalities were excluded. Resting 12-lead ECGs evaluated P wave indices: maximum P wave duration, P wave dispersion, P wave terminal force in lead V1 (PTFV1), and P wave amplitude in lead II (PWAII). The cohort's mean age was 44.8 ± 8.2 years, 70% male. Ultramarathon athletes had significantly higher maximum P wave duration (114.24 ± 7.95 ms vs. 105.76 ± 7.15 ms, p < 0.001), P wave dispersion (18.77 ± 5.75 ms vs. 7.87 ± 2.51 ms, p < 0.001), PTFV1 (5795.66 ± 3212.27 μV·ms vs. 2399.17 ± 1140.19 μV·ms, p < 0.001) and PWAII (0.16 ± 0.05 mV vs. 0.12 ± 0.04 mV). Abnormal P wave duration (>120 ms) and PTFV1 (≥4000 μV·ms) were significantly more prevalent in ultramarathon athletes (25.7% vs. 5.3%, p = 0.010; 63.5% vs. 5.3%, p < 0.001). Similar findings were observed across genders. Ultramarathon runners demonstrate significant atrial electrical remodeling, as evidenced by abnormal P wave indices, may have potential relevance to arrhythmia risk. Further longitudinal studies are warranted to assess clinical outcomes.

Rural populations in the United States have less access to cardiovascular care relative to their urban counterparts while bearing a higher burden of heart disease. To understand rural patients' access to cardiovascular care services, we conducted a qualitative study investigating which cardiovascular services rural-serving primary care practitioners offered, how they adapted care, and what factors influenced cardiovascular scope of practice and adaptations among rural-serving primary care practitioners and cardiologists.

We conducted semi-structured interviews with rural-serving primary care physicians, advanced practice providers, and pharmacists, as well as cardiologists, in Alaska, Idaho, and Washington state.

Twenty health care practitioners participated in this study. We identified two themes characterizing cardiovascular services: expanded scope of practice (e.g., primary care physician prescribing a higher-risk anti-arrhythmic medication, dofetilide, for atrial fibrillation) and altered care (e.g., cardiologist ordering fewer cardiovascular imaging tests when needed technology was unavailable). Using a socio-ecological approach, we found factors affecting care adaptations at four levels: local communities; individual practitioners; local clinics and health systems; and the broader health care, law, and policy environment.

When caring for rural cardiovascular patients, primary care practitioners and referring cardiologists expanded their scope of practice and altered care. Multiple factors affected these shifts. Future research could address whether and how expansion of scope of practice (e.g., through team-based care) may improve access to cardiovascular care among rural populations.

Hypertension disparities persist across communities, driven by interactions between social determinants of health (SDOH) and behavioral factors. This study examines geographic and demographic patterns of hypertension in Nashville, Tennessee, to assess how socioeconomic, environmental, and behavioral factors contribute to inequities in prevalence, treatment, and control. Granular ZIP code-level analyses highlight community-specific drivers and the need for policy reforms to advance health equity.

Using 2022 data from the U.S. Census Bureau's American Community Survey and CDC PLACES, we analyzed 199 Nashville ZIP codes. K-means clustering identified five population clusters. Lower-income clusters (e.g., Hardship Heartland: 37.2% hypertension prevalence; Urban Renters: 33.7%) exhibited elevated physical inactivity (30.9%), insufficient sleep (38.9%), smoking (22.6%), alongside limited healthcare access. Affluent clusters (Elite Enclaves: 30.8%) demonstrated better cardiovascular health. Non-Hispanic Black residents in urban cores faced disproportionately higher hypertension rates (35.4%) compared to non-Hispanic white residents in the same clusters (e.g., 43.8% white residents in Urban Renters).

Structural inequities-poverty, housing instability, and unequal healthcare access-drive hypertension disparities. Multi-sector interventions targeting upstream SDOH (e.g., affordable housing, equitable healthcare, and community wellness programs) are critical to reduce cardiovascular risk. Policy reforms prioritizing place based strategies in high-burden communities could mitigate disparities and improve population health.

Hutchinson-Gilford progeria syndrome (HGPS) is a rare genetic disorder that manifests itself in premature aging. Craniofacial and skeletal abnormalities, cardiovascular pathology, concomitant cerebrovascular diseases, and potential airway problems in HGPS significantly increase the degree of anesthetic risk and make anesthetic management more challenging in these patients.

We present the case of the girl with HGPS who undertook two episodes of dental treatment using general anesthesia at the ages of 8 and 10 years old. In both cases, airway was secured by fiberoptic intubation.

This case increases the awareness of HGPS and the features of anesthesia in patients with HGPS. For long-term dental treatment, general anesthesia with tracheal intubation using fiberoptic access is the optimal method of anesthesia in these patients.

Hypertension remains a significant public health challenge worldwide, with an estimated 1.28 billion adults aged 30-79 years affected, two-thirds of whom reside in low- and middle-income countries. It accounts for approximately 12.8% of global mortality, and in Ghana, hypertension-induced deaths constitute about 5.2% of total mortality. One of the major challenges in hypertension management is poor adherence to antihypertensive medications, which can lead to uncontrolled blood pressure and an increased risk of complications. This study assessed medication adherence rates and predictors among patients attending the hypertension clinic at Cape Coast Teaching Hospital (CCTH) in Ghana.

A cross-sectional study was conducted among 292 participants receiving care at the hypertension clinic at CCTH. Data on sociodemographic characteristics and medication adherence were collected using a semi-structured electronic questionnaire. Additionally, anthropometric measurements, systolic and diastolic blood pressure readings were recorded for all participants.

The mean age of the study participants was 63.1 years (SD ± 11.0), with 77.7% being female. The majority of participants were married or cohabiting (66.3%), self-employed (40.9%), and had at least a tertiary level of education (37.5%). The overall medication adherence rate was 67.8%. In multivariable logistic regression, ethnicity (non-Akan, aOR = 3.52, p = 0.02), regular blood pressure monitoring (aOR = 1.853, p = 0.012), knowledge of medications (aOR = 4.395, p < 0.001), dosage schedules (aOR = 5.274, p < 0.001) and medication availability (aOR = 4.156, p = 0.001) were significant predictors of antihypertensive medication adherence.

The study revealed a moderately high adherence rate among participants. Continuous efforts to improve drug adherence regular by promoting significant predictors of adherence such as regular BP monitoring, medication availability and other patient-friendly measures are warranted.