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Objective To summarize operation experiences in applying microcoils embolization for the treatment of intracranial wide-necked aneurysms using the low-profile visualized intraluminal stent support (LVIS) in elderly patients.Methods We reviewed data of 47 elderly patients (48 aneurysms) with intracranial wide-necked aneurysms treated with LVIS stent-assisted microcoils embolization.Results Forty-seven aneurysms were embolized successfully,one stent was withdrawn because its midpiece failed to stretch.Instant Raymond classifications evaluation after the surgery showed Grade Ⅰ in 52.1％ (25/48 aneurysms),Grade Ⅱ in 37.5％ (18/48 aneurysms),and Grade Ⅲ in 8.3 ％ (4/48 aneurysms).Besides,the effective rate of aneurysms embolization was 91.5 ％.During 3 to 12-month follow-up with digital subtraction angiography (DSA) in 36 patients (36 aneurysms),mRS was scored 0 (best effectiveness) in 28 cases,scored 1 in 4 cases,scored 2 in 3 cases,and scored 3 in 1 case,and the total favorable rate was 97％.Conclusions LVIS stent-assisted microcoils embolization for the treatment of intracranial wide-necked aneurysms in elderly patients may avoid or reduce the incidence of complication.
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Objective To investigate the perioperative complications and therapeutic effects of balloon-assisted coiling (BAC) and stent-assisted coiling (SAC) in patients with ruptured intracranial aneurysms in the acute phase. Methods Totally 91 patients with 91 intracranial ruptured aneurysms were treated with BAC or SAC in our hospital between January 2014 and December 2016. Among them, 37 patients were treated with BAC and 54 patients with SAC respectively. Of the two groups, the position distribution and shape of aneurysms, and the complications after procedures and the therapeutic effects were summarized and evaluated retrospectively using chi-square test. Results The width of the aneurysm neck was narrower in the BAC-treated group compared to the SAC-treated group (3.31±1.63 mm vs. 4.35±2.10 mm, P=0.01). The aneurysm body/neck ratio (B/N) was lower in the BAC-treated group than in the SAC-treated group (1.64 ± 0.46 vs. 1.35±0.66, P=0.025). The recurrence rate was higher in the BAC-treated group than that in the SAC-treated group (18.9％ vs. 0.9％, P=0.005). There was no statistical difference in perioperative complication in both the BAC-treated group and SAC-treated group. However, 2 patients died due to the relative postoperative intracranial bleeding in the SAC-treated group. Better outcomes (Modified Rankin Score, mRS, 0-2) were achieved in the BAC-treated group compared to the SAC-treated group (94.6％ vs. 88.9％, P=0.028) at the follow-up visit. Conclusions These findings suggested that there is no difference between the BAC-treated group and the SAC-treated group in the risk of complication. BAC can achieve a better prognosis,but it is more prone to relapse. The SAC method was more appropriate for wider neck aneurysms. It was also an option to coiling the aneurysm in BAC in acute phase firstly, followed by additional treatment in SAC during the follow-up period.
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Objective To investigate the distribution of in-stent recurrent stenosis (1RS) after balloon-angioplasty and stenting in elderly cerebral ischemic patient and its correlative factors.Methods Totally 158 elderly cerebral ischemic patients with extra-and/or intracranial artery stenosis were treated with 172 stents in our hospital.The inhibition of platelet function was assessed by using the thrombus elasticity chart system in perioperative period,and the anti-platelet agents were adjusted correspondingly.150 patients were followed up by digital subtraction angiography (DSA) and the other 8 patients were followed up by CT angiography,during an average follow-up duration of 8.3 months.Results There were 11 (6.4％) IRS lesions,among which 10 lesions were at the vertebral artery origin and 1 lesion was at common carotid artery bifurcation.23.8％ of IRS happened after vertebral artery origin stenting,and all in-stent recurrent stenosis were in the origin of non-dominant vertebral artery,whose IRS rate was 66.7％.Conclusions IRS are more common found in vertebral artery origin than in other parts of vertebral artery and are more common found in nondominant side than in dominant side.
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<p><b>BACKGROUND</b>Intensive insulin therapy has been found to lessen the progress of diabetic retinopathy (DR) to some extent, while it has also been implicated to be responsible for decrease of DR. We investigated visual function and morphological changes in the macular area in short-term follow-up of patients with type 2 diabetes mellitus after intensive insulin therapy.</p><p><b>METHODS</b>This was a prospective clinical study of nonproliferative DR patients (102 eyes, 120 patients) undergoing intensive insulin therapy. The Contrast Glare Tester (Takagi CGT-1000) was used to examine contrast sensitivity (CS) and Heidelberg Retina Tomograph (HRT) II and Stratus Model 3000 OCT were used to observe the changes of morphology in the macular area. Follow-up times were pre-intensive therapy, 3 and 6 months post-intensive therapy.</p><p><b>RESULTS</b>CS at low and middle frequencies was higher at 3 and 6 months post-therapy compared with pre-therapy (P < 0.05). Significant differences in CS at low frequency were found between 6 and 3 months post-therapy (P < 0.05). Macular edema index was lower in the first, second, and third rings of the macular area after intensive therapy compared with pre-therapy (P < 0.05). Compared with 3 months post-therapy, the macular edema index was lower in the first, second, and third rings of the macular area at 6 months post-therapy (P > 0.05). No significant differences in the thickness of the first, second, and third rings of the macular area were detected between 3 and 6 months post-therapy and pre-therapy (P > 0.05).</p><p><b>CONCLUSION</b>CS and macular edema indexes were significantly improved in nonproliferative diabetic retinopathy patients after intensive insulin therapy, but thickness of the macular area was unchanged.</p>