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Vertebrobasilar dolichoectasia is a rare and challenging disorder. Vertebrobasilar dolichoectasia is closely related to enzyme action and hemodynamic changes, and is characterized by ischemic stroke, neurological compression symptoms, hydrocephalus, and other clinical symptoms. With development of interventional techniques and materials in recent years, endovascular treatment of vertebrobasilar dolichoectasia has become the focus. This article summarizes the current endovascular treatment of vertebrobasilar dolichoectasia, aiming to provide references for clinicians.
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Objective:To investigate the effect of neutrophils on cell pyroptosis and its mechanisms in mice with early brain injury (EBI) following subarachnoid hemorrhage (SAH).Methods:Seventy six male C57BL/6J mice were randomly divided into sham-operated group, SAH group, SAH+vehicle group, and SAH+anti-ly6G group ( n=19). SAH models in the latter 3 groups were established by modified endovascular perforation. Mice in the SAH+vehicle group and SAH+anti-ly6G group received intravenous injection of equal normal saline or anti-ly6G antibody (4 mg/kg) 24 h before SAH. At 24 h after SAH, immunofluorescent staining was used to detect the locations/expressions of neutrophils, S100 calcium binding protein A8 (S100A8) and gasdermin D (GSDMD); FJC staining was performed to assess the neuronal injury; modified Garcia test and rotarod test were used to evaluate the neurological functions, and brain water content test was applied to evaluate the brain edema; Western blotting was used to detect the expressions of S100A8, Toll-like receptor 4 (TLR4), NOD-like receptor thermal protein domain associated protein 3 (NLRP3), cleaved cysteinyl aspartate specific proteinase-1 (cleaved-caspase1), and cleaved N-terminal gasdermin D (GSDMD-N). Results:(1) Compared with those in the sham-operated group, neutrophil infiltration at the damaged cortex with highly expressed S100A8 in neutrophils was observed in the SAH group, and increased GSDMD expression at the damaged cortex and GSDMD co-localization in astrocytes, microglia and neurons were observed in the SAH group. (2) Compared with the sham-operated group, the SAH group and SAH+vehicle group had significantly increased numbers of infiltrated neutrophils and FJC-positive neurons, significantly decreased falling latency in the modified Garcia score and rotarod test, significantly increased brain water content, and significantly elevated expressions of S100A8, TLR4, NLRP3, cleaved-caspase1 and GSDMD-N ( P<0.05); the SAH+anti-ly6G group had statistically decreased numbers of infiltrated neutrophils and FJC-positive neurons, statistically increased falling latency in the modified Garcia score and rotarod test, statistically decreased brain water content, and statistically decreased expressions of S100A8, TLR4, NLRP3, cleaved-caspase1 and GSDMD-N compared with the SAH group and SAH+vehicle group ( P<0.05). Conclusion:Inhibition of neutrophils can down-regulate the S100A8 expression after SAH and attenuate TLR4/NLRP3 activation-mediated cell pyroptosis, thereby improving EBI.
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Objective:To explore the clinical application of portable head and neck magnetic resonance imaging (MRI) device in neurosurgery.Methods:A total of 213 patients with brain diseases who were scanned by portable head and neck MRI device in Center of Neurosurgery, Zhujiang Hospital, Southern Medical University from June to September 2022 were selected. The portable head and neck MRI images and 3.0T conventional MRI images of 10 randomly selected patients were compared; the differences in signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of different sequences were analyzed. Thirty-one patients accepted tracheal intubation/tracheotomy, or ventilator-assisted breathing were selected as special patient group, and another 30 patients were as general patient group; the differences in comprehensive diagnostic scores of portable head and neck MRI images were compared. Noise intensity differences in different sequences between 3.0T conventional MRI and portable head and neck MRI were statistically compared. Twenty hospitalized volunteers with normal hearing in our center from July to August 2022 were selected, conventional 3.0T MRI and portable head and neck MRI were performed successively, and the noise intensity of different sequences in them was evaluated by using a 5-point system.Results:Compared with those in 3.0T conventional MRI images, the SNR and CNR of T1WI, T2WI, and Liquid attenuated reverse recovery sequence (FLAIR) sequences in portable head and neck MRI images were significantly lower ( P<0.05). No significant difference was noted in the comprehensive diagnostic scores of portable head and neck MRI images between special patients and general patients ( P>0.05). Compared with that in the 3.0T conventional MRI, the noise intensity of different sequences in portable head and neck MRI was significantly reduced ( P<0.05). These volunteers had significantly reduced noise intensity scores of different sequences in portable head and neck MRI compared with that in conventional 3.0T MRI ( P<0.05). Conclusion:Portable head and neck MRI device is easy to use, enjoying high safety, imaging quality and suitability, which meets the clinical needs for neurosurgery patients.
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Objective:To investigate the safety and efficacy of stent-assisted coil embolization in acute intracranial ruptured wide-necked aneurysms, and explore the safety of different antiplatelet drug regimens during perioperative period and the risk factors for prognoses.Methods:A perspective multicenter study was performed. A total of 417 patients with intracranial ruptured wide-necked aneurysms treated by stent-assisted coil embolization in Neurosurgery Departments of 4 hospitals (First Affiliated Hospital of Wenzhou Medical University [ n=41], Zhujiang Hospital of Southern Medical University [ n=111], Tangdu Hospital of Air Force Military Medical University [ n=100], and Xuanwu Hospital of Capital Medical University [ n=165]) from June 2017 to January 2020 were included. According to the different antiplatelet drugs regimens used in perioperative period, these patients were divided into loaded clopidogrel group ( n=87), loaded clopidogrel combined with aspirin group ( n=212), and tirofiban group ( n=118). Clinical data and perioperative complications of 3 groups were compared. Modified Rankin scale (mRS) was used to evaluate the prognoses of patients at discharge; differences of clinical data between the poor prognosis group and good prognosis group were compared. Independent risk factors for prognoses of patients with intracranial ruptured wide-necked aneurysms were analyzed by multivariate Logistic regression analysis. Receiver operating characteristic (ROC) curve was used to analyze the predictive values of risk factors in poor prognosis. Results:Degrees of aneurysm embolization immediately after surgery: Raymond grading I was noted in 351 patients (84.2%), grading II in 44 patients (10.6%), and grading III in 22 patients (5.2%). Perioperative complications were noted in 44 patients (10.6%), and death was noted in 4 (1%). Intraoperative thrombosis incidence of the loaded clopidogrel group, loaded clopidogrel combined with aspirin group and tirofiban group was 5.7% (5/87), 5.7% (12/212) and 0.8% (1/118); that in tirofiban group was significantly lower than that in the loaded clopidogrel group and loaded clopidogrel combined with aspirin group ( P<0.05). At discharge, 360 patients (86.3%) had good prognosis and 57 patients (13.7%) had poor prognosis. Multivariate Logistic regression analysis showed age≥60 years ( OR=3.407, 95% CI: 1.620-7.166, P=0.001), preoperative Hunt-Hess grading 3 ( OR=11.445, 95% CI: 3.584-36.547, P<0.001), preoperative Hunt-Hess grading 4 ( OR=88.951, 95% CI: 14.519-544.948, P<0.001), preoperative Hunt-Hess grading 5 ( OR=64.949, 95% CI: 12.809-329.325, P<0.001), and multiple stenting ( OR=4.709, 95% CI: 1.215-18.248, P=0.025) were independent risk factors for poor prognosis of these patients. ROC curves showed that area under the curve of combination of age, number of implanted stents, and preoperative Hunt-Hess grading in predicting poor prognosis of these patients was 0.821, with optimal diagnostic threshold of 0.500, sensitivity of 0.667, and specificity of 0.833. Conclusion:Stent-assisted coil embolization is safe and effective in acute intracranial ruptured wide-necked aneurysms; tirofiban is safe as perioperative antiplatelet drug; patients with old age, preoperative Hunt-Hess grading≥3, and multiple stents are prone to have poor prognosis.
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Objective:To evaluate the safety and effectiveness of stent-assisted coil embolization in treatment of acute intracranial rupture wide-necked aneurysms.Methods:A total of 249 patients with acute intracranial wide-necked aneurysms (301 aneurysms) treated with stent-assisted coil embolization in our hospital from January 2014 to December 2018 were chosen in our study; these patients were divided into ruptured group ( n=114) and non-ruptured group ( n=135). The differences in the prognoses (modified Rankin scale [mRS] scores) and perioperative complications, mortality, and aneurysm recurrence rate were retrospectively analyzed. Univariate analysis and multivariate Logistic regression analysis were used to screen the risk factors for perioperative complications and recurrence of aneurysms in patients from the ruptured group. Results:The incidence of perioperative complications in the ruptured group (10.5%) was slightly higher than that in the un-ruptured group (6.6%), and the recurrence rate of aneurysms in the un-ruptured group (12.8%) was slightly higher than that in the ruptured group (9.6%), but the differences were not statistically significant ( P>0.05); except for 2 patients in the ruptured group who died of postoperative recurrent hemorrhage, the prognosis of the rest patients in the 2 groups was good (mRS scores≤3). Univariate analysis showed that there was significant difference in the age distribution between the complication group and the non-complication group in the ruptured patients ( P<0.05), and the sizes and degrees of embolization between the ruptured group and un-ruptured group showed significant differences ( P<0.05). Multivariate Logistic regression analysis showed that ages at 40-60 years was independent risk factor for perioperative complication ( OR=17.819, 95%CI: 2.356-137.719, P=0.005), and aneurysm diameter>10 mm and aneurysm Raymond grading 3 embolization were independent risk factors for aneurysm recurrence ( OR=36.823, 95%CI: 0.862-768.308, P=0.000; OR=52.813, 95%CI: 2.967-938.152, P=0.007). Conclusion:Stent-assisted coil embolization in the treatment of acute intracranial rupture wide-necked aneurysms is safe and effective, but patients aged 40-60 years should be wary of high incidence of perioperative complications, and patients with large aneurysms and incomplete embolization should be wary of their high risk of aneurysm recurrence.
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Objective To explore the risk factors of perioperative complications of cerebral aneurysms after stent-assisted coiling. Methods A retrospective analysis of clinical data of 395 patients with cerebral aneurysms after stent-assisted coiling, admitted to our hospital from January 1, 2011 to December 31, 2017, was performed. Univariate and multivariate Logistic regression analyses were used to determine the risk factors of perioperative complications of cerebral aneurysms after stent-assisted coiling (intraoperative stent thrombosis and bleeding events, postoperative ischemic and hemorrhage events, and other unclassified complications). The preoperative aneurysm status was analyzed by Hunt-Hess grading and Trend test was conducted to analyze its statistical significance. Results Intraprocedural thrombosis and hemorrhage occurred in 2.28％ patients (9/395) and 1.01％patients (4/395), respectively. Postprocedural ischemic stroke and hemorrhage occurred in 3.54％ patients (14/395) and 1.27％ patients (5/395), respectively. One patient suffered intraprocedural thrombosis and postprocedural ischemic stroke. Univariate Logistic regression analysis showed that pretreatment ruptured aneurysm was the risk factor of perioperative complications (OR=2.466, 95％CI: 1.267-4.797, P=0.008).In multivariate Logistic regression analysis, diabetes and pretreatment ruptured aneurysm were independent risk factors of perioperative complications (OR=4.275, 95％CI: 1.260-14.508, P=0.020;OR=2.442, 95％CI: 1.182-5.043, P=0.016). As compared with patients with low Hunt-Hess grading, patients with high Hunt-Hess grading had higher risk of perioperative complications in tests for linear trend (OR=1.509, 95％CI: 1.142-1.993, P=0.004). Conclusions The incidence of perioperative complications is high in patients with diabetes or pretreatment ruptured aneurysm. Hunt-Hess grading can accurately determine the risk of perioperative complications.
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Objective To investigate the association between RNF213 rs6565666 polymorphisms and intracranial cystic aneurysms in patients from Guangdong province. Methods Two hundred and fifty patients with intracranial cystic aneurysms, admitted to and conformed by digital substraction angiography (DSA) in our hospital from February 2016 to October 2018, were selected as experimental group; and 250 patients without intracranial aneurysms conformed by DSA, CT angiography or magnetic resonance angiography at the same time period were used as control group. The genotypes of rs6565666 locus of RNF213 gene were detected by polymerase chain reaction-ligase detection reaction (PCR-LDR). Results As compared with those in the control group, percentages of AG and AA genotypes were significantly higher and percentage of GG genotype was statistically higher at rs6565666 locus of patients from the experimental group (P<0.05). The proportion of allele A at rs6565666 locus in the experimental group was statistically higher as compared with that in the control group (P<0.05). In the experimental group, 112 patients had ruptured aneurysms and 138 patients did not have ruptured aneurysms; there was no statistically significant difference in the genotype distribution of rs6565666 between the ruptured group and the non-ruptured group (P>0.05). Conclusion RNF213 gene rs6565666 polymorphism is associated with intracranial cystic aneurysms in patients from Guangdong province.
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Objective To explore the efficacy and safety of stent-assisted coil embolization of acutely ruptured wide-necked intracranial aneurysms. Methods One hundred and sixty patients with acutely ruptured wide-necked intracranial aneurysms (160 ruptured aneurysms), admitted to and underwent stent-assisted coil embolization in our hospital from January 201l to May 2018, were chosen. The clinical data, outcomes and complications of these patients were retrospectively analyzed. The differences of clinical data between patients with and without complications were compared. Modified Rankin scale (mRS) was used to evaluate the prognoses of these patients. Univariate and multivariate Logistic regression analyses were conducted to analyze the risk factors of prognoses. Results All 160 stents were successfully released. Complete occlusion after endovascular procedures was achieved in 127 patients (79.4％); 17 aneurysms (10.6％) had neck residual and 16 aneurysms (10.0％) had aneurysm residual. Surgery-related complications occurred in 17 patients (10.6％), of which, 6 (3.8％) showed hemorrhagic events and 11 (6.9％) had ischemic events. The distributions of aneurysm sites between patients with ischemia related complications and those without ischemia related complications were statistically different (P<0.05). Poor prognosis was noted in 24 patients (15％) and good prognosis was noted in 136 (85％). The mRS scores, preoperative Hunt-Hess grades and distributions of stent types between patients with good prognosis and patients with poor prognosis were statistically different (P<0.05). Logistic regression analysis indicated that baseline mRS scores ≥4 (OR=39.000, 95％ CI:10.861-140.038, P=0.000), preoperative Hunt-Hess grading IV-V (OR=13.000, 95％CI: 4.063-41.596, P=0.015), and Solitaire stents placement (OR=3.333, 95％CI: 1.332-8.339, P=0.028) were the independent risk factors for poor clinical outcomes in patients with acutely ruptured wide-necked intracranial aneurysms. Conclusion Stent-assisted coil embolization is suggested to be a safe and efficacious way to treat acutely ruptured wide-necked intracranial aneurysms, and patients with baseline mRS scores≥4, preoperative Hunt-Hess grading IV-V and Solitaire stents placement are more prone to having poor clinical outcomes.
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Objective To evaluate the influence of aneurismal inclination angle in the intracranial aneurysm rupture and hemorrhage. Methods A total of 2064 patients with intracranial aneurysms (1086 without rupture and hemorrhage, and 978 with rupture and hemorrhage), admitted to our hospital from January 2010 to April 2018, were chosen in our study. DSA examination and three-dimensional reconstruction were used for morphological evaluation of aneurysms, including aneurysm size, location, morphous feature, aneurismal inclination angle, vessel angle, aspect ratio (AR) and size ratio (SR). Risk factors of intracranial aneurysm rupture were analyzed by univariate and multivariate regression models; two-piecewise linear regression model and smooth curve fitting were used to analyze the saturation threshold effect of aneurismal inclination angle on aneurysm rupture and hemorrhage to evaluate the correlation between aneurismal inclination angle and aneurysm rupture and hemorrhage. Stratified analysis was conducted to clarify the influence of aneurismal inclination angle changes in risk of aneurysm rupture and hemorrhage in presence of various stratified factors (cerebral microbleeds [CMBs], diabetes, and hyperlipidemia). Results Aneurysm inclination angle was an independent risk factor for aneurysm rupture and hemorrhage (HR=1.02, 95％CI: 1.01-1.03, P=0.000). Risk of aneurysm rupture and hemorrhage increased when aneurismal inclination angle was more than 106.3 degrees for each additional degree; each degree of increase in aneurysm inclination increased the risk of aneurysm rupture and hemorrhage by 3％. As compared with patients without CMBs, risk of aneurysm rupture and hemorrhage increased extra 7％in patients with CMBs for each additional degree of aneurismal inclination angle;as compared with patients without diabetes mellitus MD, for each additional degree of aneurismal inclination angle, risk of aneurysm rupture and hemorrhage increased extra 2％in diabetes patients with fasting blood-glucose (FBG)≤ 6.0 mmol/L, and increased extra 4％in diabetes patients with FBS>6.0 mmol/L, respectively; as compared with patients without hyperlipemia, risk of aneurysm rupture and hemorrhage increased extra 3％in patients with hyperlipemia for each additional degree of aneurismal inclination angle. Conclusion The aneurismal inclination angle is closely related to intracranial aneurysm rupture and hemorrhage, and accurate measurement of aneurismal inclination angle has important clinical significance in assessing the risk of aneurysm rupture and hemorrhage.
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Objective To investigate the role of hesperitin in regulating inflammatory response in early brain injury after subarachnoid hemorrhage (SAH). Methods A total of 96 adult male SD rats were divided into sham-operated group, SAH group, solvent group and intervention group (n=24) by random number table method. The SAH rat models in the latter three groups were prepared by carotid artery puncture method; the rats in the intervention group were given oral administration of hesperidin solution, which was dissolved in 5％ dimethyl sulfolide (DMSO), with a concentration of 1 mg/100 μL and a dosage of 40 mg/kg within 30 min after operation; rats in the solvent group were given oral administration of an equal volume of 5％ DMSO solution. Modified Garcia behavioral scale was used to evaluate the neurobehavior of rats, and the wet/dry weight method was used to measure the water content in the brain tissues of the left and right hemispheres of the rats 24 h after SAH. Immunofluorescence staining was used to detect the microglia activation, Fluoro-dyed Jade C staining was used to assess the brain neuron degeneration, enzyme-linked immunosorbent assay (ELISA) was employed to detect the inflammatory factors interleukin (IL)-1β, IL-6 and tumor necrosis factor-α (TNF-α) content in the brain tissues, and Western blotting was used to detect the nuclear factor-κB (NF-κB) and phosphorylated (p) -NF-κB protein expressions. Results As compared with the solvent group, intervention group had significantly increased improved modified Garcia behavioral scale scores (10.08±1.73 vs. 13.83±1.70), and significantly decreased water content of brain tissues in the left and right hemispheres ([81.44 ± 1.05]％ vs. ([79.14±0.82]％; [80.55±1.55]％ vs. [78.79±1.02]％), significantly smaller number of CD68+ and Iba1+ microglias (30.17±1.04 vs. 10.67±0.75; 29.33±1.16 vs. 12.00±0.41), significantly smaller number of degenerate neurons (53.21±0.94 vs. 31.33±0.28), significantly reduced levels of inflammatory cytokines IL-1β, IL-6 and TNF-α ([429.88±106.32] pg/mL vs. [221.50±48.80] pg/mL; [1015.50±221.80] pg/mL vs. [448.11±93.40] pg/mL; [1021.75±149.17] pg/mL vs. [595.71±190.81] pg/mL), and significantly lower p-NF-κB/NF-κB ratio (1.13±0.07 vs. 0.71±0.02, P<0.05). Conclusion Hesperitin may reduce the inflammatory response mediated by microglia after subarachnoid hemorrhage by inhibiting NF-κB pathway, thereby improving the neurological dysfunction of rats.
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Objective To evaluate the effect of cerebral microbleeds (CMBs) on intracranial aneurysm rupture and hemorrhage. Methods A total of 2023 patients with intracranial single aneurysms (944 un-ruptured aneurysms and 1029 ruptured aneurysms) were enrolled in our study. The 3D-DSA was applied to all patients to evaluate the aneurysm sizes, locations, and morphous features, and to confirm the presence of A1 dominance and variations of Circle of Willis; moreover, aspect ratio (AR), size ratio (SR) and aneurismal inclination angle were measured. The presence of CMBs identified by T2-weighted gradient-recalled-echo sequence on magnetic resonance imaging (MRI) was evaluated; the clinical data of combined with/without CMBs patients were compared. Ninety-two untreated intracranial aneurysms patients combined with CMBs were followed up to evaluate the incubation periods of CMBs-related intracranial aneurysm rupture and hemorrhage; the clinical data of patients with un-ruptured aneurysms and ruptured aneurysms were compared; the risk factors of intracranial aneurysm rupture and hemorrhage were analyzed by univariate and multivariate Logistic regression analyses. Results CMBs confirmed by MR imaging were presented in 158 patients, with 7.81％ incidence rate (158/2023). Age, proportion of smokers, aneurysm inclination Angle, SR, narrow neck, irregular aneurysm shape, proportion of rupture and hemorrhage, aneurysm sites, and hypertension showed significant differences between patients without CMBs and patients with CMBs (P<0.05). In the untreated intracranial aneurysms patients combined with CMBs, 27 had intracranial aneurysm rupture and 65 did not appear intracranial aneurysm rupture; the rupture time was 3-46 months, with an average of (15.07± 10.76) months. As compared with the un-ruptured group, the ruptured group had a statistically higher proportion of patients with irregular aneurysm morphology (P<0.05). Univariate analysis showed that CMBs, female, age, aneurysm size, aneurysm morphology, ICA and ACA aneurysms, AR, variations of Circle of Willis, hypertension grading II and III, diabetes mellitus with fasting blood glucose≤6.0 mmol/L, hyperlipidemia, coronary heart disease, and drinking alcohol were important factors affecting intracranial aneurysm rupture, and the differences were statistically significant (P<0.05). Multivariate Logistic regression analysis showed that CMB was an independent risk factor for intracranial aneurysm rupture and hemorrhage; as compared with patients without CMBs, patients with CMBs had a 1.75 fold increased risk of aneurysm rupture. Conclusions Patients with intracranial aneurysms with older age, smaller aneurysm inclination Angle and larger SR are more likely to be associated with CMBs. Intracranial aneurysms with CMBs patients with irregular morphology are prone to have rupture and hemorrhage. CMBs is an independent risk factor for intracranial aneurysm rupture and hemorrhage.
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Objective To investigate the effect of bone marrow mesenchymal stem cells (BMSCs) transplantation on recovery of neurological functions and Nogo-A expression in cerebral ischemia rats at recovery stage.Methods BMSCs were isolated and cultured by whole bone marrow adherence method.Thirty-six SD rats were randomized into sham-operated group,ischemia group and BMSCs transplantation group (n=12).The middle cerebral artery occlusion (MCAO) models in the ischemia group and BMSCs transplantation group were established with Zea Longa line embolism.After 21 d of MCAO,one mL ofBMSCs (3×106) were transplanted into rats of the BMSCs transplantation group,and same amount of phosphate buffer was given to the rats of the sham-operated group and ischemia group.After 14 and 28 d of treatment,neurological functions of the rats were evaluated by modified neurological severity scale (mNSS);the brain infarct sizes were tested by TTC staining;the pathological alterations were tested by HE staining,and the Nogo-A expression was determined by immunofluorescence.Results After 14 and 28 d of treatment,as compared with the ischemia group,BMSCs group had significantly lower mNSS scores (14 d∶ 7.50±0.55 vs.6.17±0.75;28 d∶ 7.33±0.52 vs.5.67±0.82),statistically smaller brain infarct sizes (14 d∶ 31.38％±1.02％ vs.26.32％±1.19％;28 d∶27.71％±0.55％ vs.21.68％±1.09％),and significantly lower Nogo-A expression (14 d∶ 39.33％±2.08％ vs.33.67％±2.52％;28 d∶ 30.33％±0.58％ vs.25.67％±4.39％,P＜0.05).What's more,rats in the BMSCs group had milder cell damage and decreased scar tissues as compared with those in the ischemia group.Conclusion BMSCs transplantation can improve the neurological function of cerebral ischemia rats at recovery stage,and it may work via regulation of Nogo-A expression.
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Objective To evaluate the predictors of anterior communicating artery (AcoA) intracranial aneurysm formation by regression analysis using three-dimensional digital subtraction angiography (3D-DSA) and transcranial color-coded duplex (TCCD) with emphasis on Willis circle variation and hemodynamic forces alteration,and provide references for high-risk population screening for intracranial aneurysm and prevention in the future.Methods Eighty-one patients with AcoA aneurysm,admitted to our hospital from November 2010 to November 2011 and confirmed by DSA,were selected as aneurysm group;3D-DSA images were carefully evaluated to confirm the vascular structural abnormality,including the presence of A1 dominance and Willis circle variation;additionally,TCCD was performed to record the hemodynamic parameters which were used to calculate shearing stress and mechanical stretch.One hundred and eighteen patients who have a negative result checked by DSA were chosen as controls at the same period.Differences ofhemodynamic parameters and vascular architecture between the two groups were compared.The risk factors ofAcoA aneurysm formation were analyzed by using receiver operating characteristic (ROC) curve and multivariate Logistic regression with emphasis on Willis circle variation and hemodynamic forces alteration.Results There were significant differences in the aspects of A1 dominance,angle between A2 segments of bilateral anterior cerebral artery (ACA) and shearing stress between AcoA aneurysm group and control group (P＜0.05).Additionally,the ROC curve showed that the angle between A2 segments of bilateral ACA and shearing stress and significantly characterize the formation of AcoA aneurysms (P＜0.05).Gender,hypertension (grade Ⅱ),Willis circle variation (OR=14.152,95％CI:1.006-199.012,P=0.049),A1 dominance (OR=25.048,95％CI:1.438-436.337,P=0.027) are risk factors ofAcoA aneurysm formation.Diabetes (FBG at the normal level),shearing stress (OR=0.053,95％CI:0.011-0.249,P=0.000),angle between A2 segments of bilateral ACA (OR=0.037,95％CI:0.007-0.211,P=0.000) are identified as protective factors.Conclusions Willis circle variation,A1 dominance,shearing stress,angle between A2 segments of bilateral ACA are influencing factors ofAcoA aneurysm formation.There is great clinical significance to accurately assess the influencing factors of AcoA aneurysm in guiding clinical prevention and treatment decision making.
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Objective To explore the effect of Willis circle variation and hemodynamic forces alteration arised from vascular structural abnormity on intracranial aneurysm (IA) rupture using 3D-digital subtraction angiography (DSA) and transcranial color Doppler (TCCD) detection.Methods Two hundred and twenty-three patients with IA,admitted to and conformed by DSA in our hospital from November 2010 to November 2011,were divided into ruptured IA group (n=182) and un-ruptured IA group (n=41).The 3D-DSA was applied in all patients to carefully evaluate the aneurysm sizes,locations,and morphous features,and to confirm the presence of A1 dominance and Willis circle variation.Moreover,aneurysmal neck area,diameter of parent artery,angle between A2 segments of bilateral anterior cerebral artery,angle between aneurysmal longitudinal axis and parent artery,aortic diameter (AD) and aspect ratio (AR) were measured with assistance of 3D-DSA images.Besides,TCCD was applied to all patients,and the hemodynamic parameters were recorded to calculate wall shear stress (WSS) and mechanical stretch.The risk factors of IA rupture were analyzed by receiver operating characteristic (ROC) curve and multivariate Logistic regression with emphasis on Willis circle variation and hemodynamic forces alteration.Results Whether it was in ruptured IA group or in un-ruptured IA group,the incidence rate of variation of anterior Willis circle was higher than that of variation of posterior Willis circle.A1 dominance on the left side was the most common asymmetry.As compared with those in un-ruptured IA group,statistically elder age,smaller AD,larger angle between aneurysmal longitudinal axis and parent artery,decreased WSS and increased mechanical stretch in the ruptured IA group were noted (P＜0.05).ROC curve indicated that angle between aneurysmal longitudinal axis and parent artery,AD,WSS and mechanical stretch could be used to evaluate IA rupture (area under the curve:0.606、0.618、0.396、0.637).Age (OR=8.618,95％CI:2.866-25.917,P=0.000),hypertension (grade Ⅲ OR=16.320,95％CI:1.628-163.556,P=0.018),angle between aneurysmal longitudinal axis and parent artery (OR=3.053,95％CI:1.131-8.242,P=0.028),AD (OR=5.638,95％CI:1.507-20.251,P=0.008) and mechanical stretch (OR=4.230,95％CI:1.554-11.516,P=0.000) were risk factors of IA rupture.A1 dominance (OR=0.242,95％CI:0.074-0.785,P=0.018),small aneurysms (2-5 mm,OR=0.207,95％CI:0.054-0.788,P=0.002) and WSS (OR=0.021,95％CI:0.060-0.672,P=0.009) were identified as protective factors.Conclusions Willis circle variation exists in IA patients.Age,hypertension (grade ⅢD,angle between aneurysmal longitudinal axis and parent artery,AD and mechanical stretch are risk factors of IA rupture,while A1 dominance,small aneurysm (2-5 mm) and WSS are identified as protective factors.Accurate assessment of these factors is of great clinical significance for the prevention and treatment of IA in the future.
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Objective To present our preliminary experience and short-term safety and efficacy of pipeline embolization device (PED) for endovascular of intracranial aneurysms.Methods Six patients treated with PED in our hospital from February 2016 to June 2016 were chosen.Their clinical data and short-term safety and efficacy were retrospectively analyzed.Results Six patients with 6 intracranial aneurysms were treated during the study period.Mean aneurysm size was 18.3±9.2 mm.PED was technically successful in all aneurysms (100％).A total of 8 PEDs were used,and the mean number of devices per aneurysm was 1.3.Treatment was achieved with one single PED in 5 aneurysms,with 3 overlapping PEDs in one aneurysm.Adjunctive coiling was performed in 3 aneurysms.Retention of contrast agent in the tumor cavity was detected by immediate radiography:Kamran grade Ⅰ was noted in 4 patients and grade Ⅱ in 2 patients.No procedure-related complications occurred.Five patients achieved good clinical outcome (mRS score 0 in 2 patients,one in 3 patients and 3 in one patient).MRA was performed in 5 patients 3 months after surgery,indicating no arterial aneurysm residual and far-endvascular patency;and one of these 5 patients was performed DSA showing no arterial aneurysm relapse.Conclusions In our series,early results of the PED are encouraging.However,larger studies with longer follow-up duration are warranted to assess the safety and efficacy of PED for treating intracranial aneurysms.
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Objective The timing of definitive aneurysm treatment (coiling or clipping) in subarachnoid hemorrhage (SAH) patients has been a controversial topic.The purpose of this retrospective study is to analyze whether ultra-early coiling of ruptured intracranial aneurysms improves the clinical outcomes of SAH patients.Methods One hundred and fifty-eight patients with ruptured intracranial aneurysm induced SAH,admitted to our hospital from February 2012 to February 2017,were chosen in our study;80 patients were coiled within 24 h after SAH (ultra-early coiling group) and 78 patients were coiled ≥24 h after SAH (non ultra-early coiling group).The clinical data of these patients were retrospectively analyzed;the incidences of re-bleeding before embolization and postoperative complications,percentages of total embolization and number of patients with good prognosis were compared between the two groups.Results As compared with non ultra-early coiling group,ultra-early coiling group had lower incidences of re-bleeding before embolization (17.6％ vs.5％),postoperative cerebral infarction (16.2％ vs.6.2％) and hydrocephalus (25％ vs.10％),and higher percentage of total embolization (64.1％ vs.85.0％),with statistical differences (P＜0.05).The number of patients with good prognosis between the two groups showed no significant difference (P＞0.05).Conclusions Ultra-early coiling (＜24 h after SAH) of ruptured aneurysms can reduce the preoperative re-bleeding rate,post-operative cerebral infarction and hydrocephalus rates,but not influence the clinical outcomes of the patients.
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Objective To explore the factors that may influence the prognosis of patients with cerebral venous thrombosis (CVST) combined with intracranial hematoma (ICH). Methods Twenty-eight consecutive patients with CVST combined with ICH, admitted to our hospital from April 2007 to April 2017, were chosen in our study; 17 accepted combined treatment (endovascular treatment combined with anticoagulation therapy or endovascular treatment combined with surgery) and 11 of them accepted single therapy (anticoagulation therapy or surgery). Their clinical data were retrospectively reviewed. Follow-up outcomes were evaluated using modified Rankin Scale (mRs) and risk factors of recurrence were analyzed. Results Fifteen patients had good outcomes and 13 had poor outcomes. As compared with patients with good outcomes, patients with poor outcomes had significantly higher incidence rate of disturbance of consciousness, statistically higher percentages of hematoma volume>30 mL and midline shift>10 mm and ratio of single treatment (P<0.05). Conclusions The prognoses of CVST patients with ICH may be influenced by disturbance of consciousness, hematoma volume>30 mL, midline shift>10 mm and treatment protocol.
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Objective To compare the recurrence rate and long-term follow-up angiographic findings between stent-assisted coil embolization and simple coil embolization in treating large and giant intracranial aneurysms.Methods The clinical data and imaging materials of a total of 90 patients with large and giant intracranial aneurysms (＞10 mm,91 aneurysms in total),who were admitted to authors' hospital during the period from January 2004 to January 2016 to receive interventional embolization therapy,were retrospectively analyzed.Of the 90 patients,52 patients (52 lesions in total) received simple coil embolization (SCE group)and 38 patients (39 lesions in total) received stent-assisted coil embolization (SACE group).Postoperative recurrence rates of aneurysm were compared between the two groups,and recurrence risk factors were analyzed.Results The whole postoperative recurrence rate of aneurysm and re-treatment rate were 38.5％(35/91) and 20.9％(19/91) respectively;the recurrence rate and re-treatment rate of SACE group were 35.9％ (14/39) and 17.9％ (7/39) respectively,while those of SCE group were 40.4％ (21/52) and 23.1％ (12/52) respectively;the differences between the two groups were not statistically significant (P＞0.05).Multivariate logistic regression indicated that the recurrence risk factors of large or giant intracranial aneurysms included rupture of aneurysm (OR=0.284,95％CI=0.083-0.978,P=0.046),simple coil embolization (OR=5.03,95％ CI=1.04-24.44,P=0.045),concurrent hypertension (OR =0.13,95％ CI=0.036-0.51,P=0.003)and long time after operation (OR=1.002,95％CI=1.001-1.003,P=0.002).Conclusion Compared with simple coil embolization,stent-assisted coil embolization can reduce the recurrence rate of aneurysm.Rupture of aneurysm,simple coil embolization,long time after operation and concurrent hypertension are independent risk factors for recurrence of aneurysm after transcatheter arterial embolization.
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Objective To indentify the risk factors of hemorrhage of cerebral arteriovenous malformations (AVMs) in children,and further conclude the treatment strategies and safety of these patients by endovascular embolization.Methods The clinical data of 56 patients with AVMs aged 3-14 years,admitted to our hospital from June 2005 to June 2015,were retrospectively analyzed.The risk factors of hemorrhage of these patients were identified by univariate and multivariate analyses;and the treatment strategies by endovascular embolization were analyzed.Results Univariate analysis indicated that small size of malformation vascular mass was the independent risk factor of hemorrhage for patients with AVMs in children (OR=0.292,95％CI:0.106-0.805,P=0.017).For 56 patients treated by endovascular embolization,a total of 121 feeding pedicles were embolized,and the mean obliteration rate of AVMs was 79％ (20％-100％).Finally,only 9 patients (7.9％) suffered embolization-related complications,such as headache,facial paralysical,hemianopsia,and activity obstacle;however,no patients suffered severe disability or death.After a follow-up of 2 months to 36 months (mean=17 months),all childem had favorable outcome,and none suffered intracerebral hemorrhage or recurrent AVMs.Conclusions Small size of malformation vascular mass is the independent risk factor of hemorrhage of patients with AVMs in children.The endovascular embolization of patients with intracranial AVM in children is efficacy and safe with few complications.
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Objective To explore the curative effect of embolism of cavernous sinus with Onyx and coils on cavernous sinus dural arteriovenous fistulas (csDAVFs) and to sum up the experiences.Methods Retrospective analysis of clinical data and radiographic records of 25 patients with csDAVFs who had received embolisation of cavernous sinus using Onyx or in combination with coils through inferior petrosal sinus between August 2008 and February 2013 was performed;all patients were diagnosed by conventional cerebral angiography and received ophthalmological examination before operation.Twenty-two patients used coils and Onyx,three patients used Onyx only.Results Twenty-five embolization sessions were conducted.The mean number of coils was 2.55±0.91 and the mean volume was 32.15±16.03 mm3per patient;the mean volume of Onyx was 2.57±0.86 mL per patient.Three patients (12.0％) who used only Onyx achieved subtotal occlusion and other 22 patients (88.0％) were completely occluded in the immediate angiography.All patients (100％) achieved complete occlusion in the follow-up angiography.Seven patients (28.0％) demonstrated no symptoms at discharge time and 18 patients (72.0％) demonstrated symptoms improvement.All patients remained asymptomatic in the subsequent follow-up periods.Six patients (24.0％) occurred complications and all the complications were cured after proper treatment.Conclusion Effective use of Onyx and coils is the key to cure cavernous sinus dural arteriovenous fistulas and reduce the complications.