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Objective To investigate the medium- and long-term effects and safty of Pipeline embolization device ( PED) for the treatment of large and giant intracranial anterior circulation aneurysms. Methods From December 2014 to December 2016,the data of 36 consecutive patients with large and giant aneurysm ( 36 large and giant intracranial anterior circulation aneurysms ) treated with PED in Donglei Brain Doctor Group were analyzed retrospectively. The diameter of the aneurysms was 12 -33 mm, (mean16.6±4.5mm),andthenecksizewas4-10mm(mean6.1±1.5mm).Eightaneurysmswere located in the carotid cavernous sinus segment,22 in the ophthalmic artery segment,5 in the internal carotid artery posterior communicating segment, and 1 in the M1 segment of middle cerebral artery. Seven aneurysms were only treated by PED,28 aneurysms were treated by PED in combination with coil embolization,and 1 aneurysm was treated by double PEDs. The modified Rankin scale ( mRS) score was used to evaluate the prognosis of the patients. Results (1) The clinical prognosis of the patients was followed up by telephone and outpatient department for 6-33 months. Twenty-five patients were followed up by DSA,23 aneurysms (92%) were occluded totally (Raymond gradeⅠ) and 2 (8％) were occluded near totally ( Raymond grade Ⅱ) . ( 2 ) Seven patients were treated with PED alone. Four patients were cured totally after 6 months follow-up,1 was occluded subtotally,2 were not cured;6 were cured in the last follow-up (33 months),and the other aneurysm was gradually reduced;17 of 28 patients treated with PED in combination with coils received DSA follow-up. They were followed up for 6-8 months. All the aneurysms were totally occluded ( Raymond grade Ⅰ) . 1 aneurysm was treated by 2 PEDs, DSA revealed micro-aneurysm-like development at 8 months after procedure. The aneurysms were basically occluded after 15-month follow-up. (3) MRI confirmed after operation that 10 patients had asymptomatic scattered spotted ischemic foci,4 had cerebral parenchymal hemorrhage,1 of them died,1 recovered well after treatment (mRS 1),and the other 2 were asymptomatic cerebral hemorrhage. The occupying effect of 24 cases disappeared, 8 had obvious improvement,and 3 did not have any obvious change. Conclusions The occlusion rate of the treatment of large and giant intracranial aneurysms with PED was high. The results of medium-term follow-up showed that the occlusion rate of PED in combination with coils in the treatment of aneurysms was higher than that of PED alone. The long-term follow-up results showed that the occlusion rate of patients treated with PED alone (including one or more) was gradually increased with time. The safety of the surgery needs to be further confirmed by a large sample study.
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Objective To evaluate the efficacy and safety of Willis covered stent in the treatment of traumatic carotid cavernous fistulae (tCCF).Methods The imaging and clinical data of 7 patients with tCCF treated with Willis covered stent in Shanghai Punan Hospital from November 2015 to June 2018 were analyzed retrospectively.Results Seven Willis covered stent were used in 7 patients.Immediately after stent release,angiography showed that the fistulae completely disappeared in 6 cases.One patient had a small amount of endoleak,and there was still a small amount of endoleaks after balloon dilatation.It was not further treated.There were no operative complications.During 3-12 months follow-up,no new neurological deficits were found in all patients.Angiographic follow-up of 2 patients showed that the fistulae completely disappeared without recurrence.The internal carotid arteries were patent,no in-stent stenosis and stent displacement.Conclusions Wills covered stent can be used as a treatment for tCCF.Its efficacy is satisfactory and the safety is good.
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Flow-diverting stent that appears in recent years is a new method for the treatment of complex intracranial aneurysms.This article reviews the principles,composition,development,advantages and disadvantages,indications,main complications and some problems of flow-diverting stent.
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Objective To investigate the changes in physique and the bone age,and the correlation between the changes in cardiac structure and function and the bone age index (BAI) in atrial septal defect (ASD) children.Methods The experimental group included 48 cases of ASD patients,and 30 cases of healthy children were assigned as the control group;the children of both groups were measured for height and weight.Philips ie33 ultrasonic detector was used to detect the indicators of cardiac structure and function,and Philips digital X-ray machine was used to radiograph the left hand and the wrist.Then the bone age was assessed in order to calculate the BAI.Fourteen cases of ASD patients who underwent repairing surgery were measured for orifice area in surgery.The differences in physique and the bone age between the 2 groups were analyzed,and Pearson correlation analysis method was used to observe the correlation between the cardiac structure and function indicators,defect area and BAI in the experimental group.Results There was no significant difference in the age,height,bone age (t =-0.02,-1.31,-1.69,all P ＞ 0.05),while the weight and BAI were significantly different between the 2 groups (t =-2.28,-9.06,all P ＜ 0.05).The height,weight and BAI were significantly different in different pulmonary artery systolic pressure (PASP) patients (F =27.630,23.537,16.704,all P ＜ 0.01),while the age and weight had no difference (t =-1.218,-0.046,all P ＞ 0.05).The height and BAI were significantly different in patients with different defect size(t =2.561,2.191,all P ＜ 0.05).There was no correlation between the age and the BAI in children with ASD(r =-0.175,P ＞ 0.05).The defect size,defect size/atrial septal stretched diameter,PASP were all negatively correlated with BAI (r =-0.349,P ＜ 0.05 ; r =-0.412,P ＜0.01 ;r =-0.539,P ＜0.01).The defect area was positively related to the defect size in 14 cases of children with ASD underwent surgery (r =0.599,P ＜ 0.05),and the defect area was negatively correlated with BAI (r =-0.655,P ＜ 0.05).Conclusions The physical development in ASD patients evidently lagged behind the healthy children,particularly for weight.The BAI of ASD patients is significantly smaller than that of the healthy children,in other words,the growing speed of bone in ASD patients is significantly slower than that of the healthy children at the same age.The lagging extent of physical development and the bone age are related to the PASP and defect size.PASP has more influence on the height,yet the defect size has influence on height and weight of ASD children.There is no correlation between physical development and the bone age with the course of disease.
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Patients with moyamoya disease often have cognitive impairment.The specific mechanisms are unclear.Surgical intervention relieving low perfusion state of cerebral blood flow may be the only effective way in the treatment of moyamoya disease,maintain or improve cognitive function at present; however the related surgical indications,timing of surgery,postoperative hyperperfusion syndrome,as well as long-term efficacy and other issues must be resolved.
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Objective To investigate the protective effect of recombinant mouse OP 1 (rmOP 1) on renal ischemia reperfusion injury. Methods The full length open reading frame of mouse OP 1 was cloned by RT PCR. The rmOP 1 was prepared and its osteogenesis was assayed in vitro. Thirty Wistar rat models of renal ischemia reperfusion were randomly divided into 3 groups: preventive group, therapeutic group and control group. The former two groups were administered with rmOP 1 (250 ?g/kg) via the superior mesenteric vein at different time points. The renal function and structure were assessed by serum BUN, Cr, histological findings and the modified Miller's scoring. Results rmOP 1 showed osteoinductive activities in vitro. The level of serum BUN, Cr and Miller's scoring were higher in control group than the others ( P 0.05 ). Histological finding showed that rmOP 1 minimized the cell necrosis. Conclusion rmOP 1 has an protective effect on renal function and structure.