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Objective:To investigate the safety and efficacy of Tubridge flow diverter for the treatment of recurrent internal carotid blood blister-like aneurysms after stent-assisted embolization.Methods:From June 2018 to April 2021, patients with recurrent internal carotid blood blister-like aneurysms treated with Tubridge flow diverter in the Department of Neurosurgery, Changhai Hospital, Naval Medical University were enrolled retrospectively. The perioperative safety, immediate postoperative and follow-up results were analyzed.Results:A total of 6 patients with recurrent internal carotid blood blister-like aneurysm after stent-assisted embolization were enrolled. The time interval from the first stent-assisted embolization to Tubridge placement was 14 to 90 d. Tubridge implantation alone was used in 4 patients, and Tubridge was implanted in the other 2 patients after the coils were packed. There were no complications during the perioperative period, and no rebleeding was observed after clinical follow-up for 5 to 36 months. Five patients were followed up by angiography for 1-3 months, and the aneurysms disappeared completely.Conclusion:Tubridge flow diverter for the treatment of recurrent internal carotid blood blister-like aneurysms is safe and effective.
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In addition to causing high disability and high fatality rates, ruptured intracranial aneurysms can also cause cognitive impairment. Although preventive surgical treatment can avoid intracranial aneurysm rupture and bleeding, patients may still have a certain degree of cognitive impairment, even in patients with good clinical recovery after surgery. There is no systematic review on the effect of different surgical methods on cognitive function, and the best surgical method is still inconclusive. This article reviews the cognitive impairment in patients with intracranial aneurysm, hoping to provide a basis for clinical treatment decisions.
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Intracranial aneurysm is a serious threat to human health, but the specific pathogenesis has not yet been identified. Circular RNA is a current research hotspot in non-coding RNA. It has a variety of biological functions and is widely involved in the regulation of gene expression in various diseases. This article focuses on the relationship between intracranial aneurysms and circular RNA, and investigates the potential effect of circular RNA on the pathogenesis of intracranial aneurysms.
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Objective To investigate the influencing factor of the morphology of unruptured intracranial aneurysms for aneurysm wall enhancement under the high-resolution magnetic resonance imaging. Methods From January 2015 to December 2016,the clinical and imaging data of 68 consecutive patients with unruptured intracranial aneurysm (86 aneurysms) in Changhai Hospital,the Second Military Medical University were enrolled retrospectively. Vascular wall imaging technology was used to conduct aneurysm scan,and the aneurysm wall enhancement was identified by the imaging features before and after contrast enhancement. They were divided into either an enhancement group ( n=32,34 aneurysms) or a non-enhancement group (n=45,52 aneurysms) according to whether having the abnormal enhancement of aneurysm wall or not ( because some patients also have enhanced aneurysms and non-enhanced aneurysms, the number of cases of the enhanced or not was calculated seperately in both groups ) . Morphological parameters were calculated by 3D image data,including aneurysm size,ratio of height to width,volume ratio, dome-to-neck ratio, transverse length ratio, bottleneck factor, and inflow angle. Univariate and multivariate logistic analyses were used to determine the morphological influence factors of aneurysm wall enhancement. Results (1) A total of 34 (39. 5%) aneurysms had aneurysm wall enhancement and 52 (60. 5％) aneurysms did not have aneurysm wall enhancement. There were no significant differences in sex, age, hypertension,diabetes, smoking, family history of subarachnoid hemorrhage, and aneurysm site in both groups (all P>0. 05). (2) The aneurysm size,ratio of height to width,volume ratio,dome-to-neck ratio, and bottleneck factor in the enhancement group were larger than those of the non-enhancement group. There were significant differences between the 2 groups (9. 19 [6. 54,11. 04] mm vs. 5. 31 [4. 17,7. 37] mm, (1. 18 [1. 01,1. 69] vs. 0. 91 [0. 72,1. 25],(3. 62 [2. 30,4. 63] vs. 2. 18 [1. 37,2. 76],1. 52 [1. 25, 1. 99] vs. 1. 19 [1. 03,1. 51],and 1. 21 [1. 11,1. 69] vs. 1. 05 [0. 94,1. 31],all P<0. 01). The proportion of irregular morphologic aneurysms in the enhancement group was higher than that in the non-enhancement group. There was significant difference between the 2 groups (55. 9％ [19/34] vs. 17. 3％ [9/52],P<0. 01 ) . There were no significant differences in transverse length ratio and inflow angle between the 2 groups (all P>0. 05). (3) Because the ratio of height to width,volume ratio,dome-to-neck ratio,and bottleneck factor were related to the aneurysm size,the aneurysm size,inflow angle,and irregular shape were included in the multivariate logistic regression analysis. The results showed that aneurysm size ( OR,3. 727,95％CI 1. 933-6. 971,P<0. 01) and irregular shape (OR,3. 990,95％CI 1. 219-13. 065,P=0. 022) were the independent risk factors for aneurysm wall enhancement. Conclusions The size and irregular shape of unruptured intracranial aneurysms are the independent risk factors for aneurysm wall enhancement. High-resolution magnetic resonance wall imaging may become an effective and noninvasive imaging method for evaluating the ruptured risk of intracranial aneurysms.
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Objective To investigate the safety and efficacy of endovascular treatment of distal middle cerebral artery aneurysms. Methods From January 2009 to December 2016,the medical records of 13 consecutive patients with distal middle cerebral artery aneurysm (a total of 14 aneurysms)were reviewed and enrolled. Endovascular treatment included coils,coils with liquid embolic materials,or using liquid embolic material alone for embolization of aneurysms or occlusion of parent arteries. The immediate outcome of aneurysm treatment was evaluated by Raymond classification,and the clinical prognosis was evaluated by the modified Rankin scale (mRS). DSA was use to conduct imaging follow-up study and was compared with the immediate treatment outcome in order to determine whether the aneurysms recurred or not. Results Of the 13 patients,8 were males,with an average age of 40 ±14 years. The maximum diameter of aneurysm was 1. 0 -12. 0 mm,the median size was 4. 5 mm. Fourteen aneurysms were successfully treated by endovascular treatment,4 of them were embolized,and the parent aneurysms were retained;10 aneurysms and parent arteries were occluded. Twelve aneurysms did not develop immediately after operation,and 2 of them had residual aneurysms. No new nerve dysfunction and related complications were found after endovascular treatment. The clinical follow-up period was 9 -96 months,and the median time was 30. 9 months. Twelve aneurysms were followed up for 6 -24 months with a median time of 15. 2 months. No recurrence of aneurysms were observed. Conclusions Using endovascular treatment technology for the treatment of distal middle cerebral artery aneurysms is safe and effective. It can be considered in the development of treatment programs.
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Objective To assess the risk of hyperperfusion induced intracranial hemorrhage (HICH) after carotid artery stenting (CAS) in patients with symptomatic severe carotid stenosis.Methods From June 2009 to June 2015,the clinical data of 210 patients with symptomatic severe carotid stenosis (70％-99％) treated with CAS at Department of Neurosurgery,Changhai Hospital,the Second Military Medical University,were analyzed retrospectively.Seven of them (3.3 ％) developed HICH after operation.The relationship between the clinical baseline and imaging characteristics and HICH were assessed.All patients received the evaluation of cerebral CT perfusion examination.The time to peak (TTP) index of cerebral blood flow was defined as the TTP ratio of the affected and contralateral sides,t test was used to conduct the comparison of measurement data,and Poisson test was used to conduct the comparison of the enumeration data.Results There was significant difference in the TTP index between the HICH group and non-HICH group (1.15 ± 0.10 vs.1.30 ± 0.15,t =4.461,P ＜ 0.01).The receiver operating characteristic (ROC)curve analysis results suggested that the TTP index ＞ 1.22 could be used as a risk factor for predicting HICH (sensitivity 100％,specificity 75.9％).Conclusion Under the condition of prompting the preoperative TTP index ＞ 1.22,the risk of HICH may be higher after CAS in patients with severe carotid stenosis.
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Objective To evaluate the application value of Smart Mask technology guiding micro-catheter in place for intracranial aneurysm embolization in endovascular interventional treatment. Methods The DSA data of 61 consecutive patients with unruptured intracranial aneurysm in the Department Neurosurgery,Changhai Hospital,the Second Military Medical University from August 5 to December 20,2016 were collected retrospectively. The conditions of the guildewire catheter reaching the aneurysms and the coil embolization in the Smart Mask technology group (n = 31)and conventional road map group (n = 30)were compared. The observation indexes included the differences in contrast agent dosage,exposure time,and operation time. Results The contrast agent dosage of the Smart Mask technology group and road map technology group were 192 ± 37 and 215 ± 40 ml respectively,the X-ray illumination quantity were 5913 ±1682 and 6975 ±2036 mGy respectively,and the operation time were 2. 62 ± 0. 29 h and 2. 94 ± 0. 35 h respectively. The differences were statistically significant (all P < 0. 05 ). Conclusion Using Smart Mask technology to assist endovascular embolization of intracranial aneurysms can effectively shorten the operation time,reduce the amount of X-ray radiation and contrast agent,and reduce the risk of operation.
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Objective To preliminarily investigate the safety and long-term efficacy of endovascular overlapping multi-stent angioplasty for the treatment of vertebral artery dolichoectasia.Methods From May 2009 to January 2011,the clinical and imaging data of 3 patients with vertebral artery dolichoectasia treated with overlapping multi-stent implantation at the Department of Neurosurgery,Changhai Hospital,the Second Military Medical University were analyzed retrospectively.All 3 patients had prolongation and dilation on the left intracranial vertebral artery.One suffered compression of left medulla oblongata accompanied by old infarction of right thalamus,one complicated with ruptured aneurysm of left posterior cerebral artery received coil occlusion of the parent artery,and the other had a lacuna infarction on the left medulla oblongata with left intracranial vertebral artery dissection.Results 2-5 LEO stents were implanted into the left vertebral artery of each patient and the lesions were covered completely.The revascularization was successful in all patients and no perioperative complications occurred.The 3 patients were followed up for 5-8 years and no new clinical symptoms occurred.The modified Rankin scale score was 0.The DSA follow-up revealed that the vascular morphology of 2 cases was significantly improved compared with that before procedure.Conclusion The preliminary experience has shown that overlapping multi-stent angioplasty for the treatment of vertebral artery dolichoectasia is safe and the long-term effect of revascularization is satisfactory.
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Objective To analyze the effects of quality supervision and continuous improvement system on optimizing in-hospital diagnosis and treatment process in patients with acute ischemic stroke (AIS).Methods From September 2013 to May 2016,424 consecutive patients with AIS treated with intravenous thrombolysis and/or endovascular therapy in Changhai Hospital,the Second Military Medical University were enrolled retrospectively.They were analyzed according to the annual running process (the first year[from September 2013 to August 2014],the second year[from September 2014 to August 2015],and the third year[from September 2015 to May 2016]).The spend time and delay (DTN>60 min,DTP>90 min) rate of each treatment process in the first,second,and third year (time from door-to-imaging[DTI],door-to-needle[DTN],imaging-to-needle (ITN),door-to-groin puncture (DTP) and imaging-to-groin puncture (ITP) were compared.Taking the time periods (>median) of having significant differences of the spend time of the treatment processes as the dependent variables in the first,second,and third year,the influence of the years and treatment modalities on delay was observed.The difference of constituent ratio of the reasons for delay in intravenous thrombolysis and endovascular therapy (objective reasons/other reasons) in different years were analyzed.Results (1) DTIs were 23.0 (11.0,42.0) min,22.0 (10.1,39.0) min,and 13.0 (6.0,27.0) min,respectively,and DTNs were 50.0 (30.0,77.1) min,45.0 (30.0,70.2) min,and 36.0 (24.0,57.0) min,respectively in the first,second,and third year.The spending time was shortened year by year.There were significant differences among the different years (all P0.05).(2) The DTN delay rates were 33.3% (40/120),20.7% (29/140),and 8.1% (9/111),respectively in the first,second,and third year.There were significant differences among the 3 years (x2=22.111,P0.05).(4) During the three years,the delay of intravenous thrombolysis was mainly due to objective reasons.The constituent ratio of other reasons caused delay of intravenous thrombolysis was decreased year by year.There was no other reasons for delay in the third year).There was no significant difference in the constituent ratio of the delay reasons in endovascular treatment (x2=3.622,P=0.164).Conclusion Under the existing process and resource allocation,setting the DTN target time and implementing continuous quality improvement are conducive to the effective implementation of brain CT scan and continuous optimization of intravenous thrombolysis in the processes in AIS patients with the first diagnosis.
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Objective To establish a comprehensive,simple,and effective scoring model for predicting the recurrence risk after endovascular embolization of intracranial aneurysms in order to assess the possibility of recurrence and to provide guidance for the selection of surgical protocols and postoperative management.Methods From May 2012 to May 2014,434 patients (441 aneurysms) with intracranial aneurysm treated with endovascular embolization at the Department of Neurosurgery,Changhai Hospital,the Second Military Medical University were enrolled retrospectively,and they were used as a modeling group.After modeling,109 patients (109 aneurysms) were used as a validation group.In the modeling cohort,a predictive scoring model of recurrence risk was established according to the results of multivariate logistic regression analysis;the model was validated in the validation cohort.According to the scoring model of the modeling group,the scoring table of best cut-off value of the receiver operating characteristic (ROC) curves was divided into a low-risk and a high-risk of recurrence.The recurrence risk score model was compared with the North America aneurysm recanalization stratification scale (ARSS) model,and Raymond grade.Results Multivariate logistic regression analysis showed that the 3 factors included in the scores and finally,a established scoring model of recurrence risk prediction were non-stent assisted embolization (1 point),Raymond grade ≥Ⅱ (1 point),and the size of aneurysm (aneurysm >25 mm[3 points)],aneurysm 10-25 mm[1 point],and aneurysm <10 mm[0 point]).The validation indicated that the scoring system had higher predictive value (AUC=0.738,95%CI 0.641-0.834,P<0.05) and goodness of fit (Hosmer-Lemeshow χ2=2.109,P=0.146).The scoring table was further divided into the low-risk recurrence (0-1 point) and high-risk recurrence (2-5 points),its sensitivity was 72.73% (48/66) and specificity was 68.80% (258/375).The predictive ability of the aneurysm recurrence risk score model was similar to that of the ARSS score (χ2=0.54,P=0.462),and it was better than the Raymond grade (χ2=15.10,P<0.01).Conclusion The established simple aneurysm recurrence risk predicting score model in this study may accurately predict the recurrence of aneurysms,however,a multicenter,large sample prospective study is needed for further validation.
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Objective To evaluate the safety and effectiveness of Pipeline embolization device (PED) for the treatment of large and giant intracranial aneurysms.Methods Frorn November 2014 to May 2016,the clinical and radiological data of 33 patients with intracranial aneurysm confirmed by DSA or head CT angiography (CTA) or head magnetic resonance angiography (MRA) at the Department of Neurosurgery,Changhai Hospital,the Second Military Medical University were enrolled retrospectively.Its safety and effectiveness were evaluated.Results The Pipelines were successfully released in 33 patients with 35 aneurysms,10 aneurysms were implanted by using PED alone,25 were implanted by using PED combined with coil embolization (including 2 were implanted by using Pipeline bridging technology).During the perioperative period,1 thrombotic event(one aneurysm) occurred and had hemorrhagic transformation.One(one aneurysm) died of fatal aneurysm delayed bleeding.Thirty-one patients (33 aneurysms) were followed up clinically,the follow-up time was 4-18 months,no bleeding or thrombosis events occurred.Eighteen aneurysms received a short-term postoperative imaging follow-up (3-5 months,enhanced MRA or DSA),of which 10 had neck residue or aneurysm development,and 8 aneurysms did not have development at all,and 19 achieved postoperative mid-term imaging follow-up (6-16 months,enhanced MRA or DSA).Two of them had neck residue and 17 did not develop at all.Conclusion Pipeline for the treatment of intracranial large and giant aneurysms may be safe and effective.However,the complications of intracranial hemorrhage cannot be ignored after implantation of embolization device.Its related mechanism needs to be further studied.
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Objective To investigate the safety and effectiveness of using low-profile visualized intraluminal support (LVIS) stents for the treatment of aneurysms in the small intracranial vessels (diameter <2.5 mm).Methods Between October 2014 and April 2016,the clinical data of all 30 patients with intracranial saccular aneurysm treated with LVIS stents with the small parent arteries <2.5 mm in diameter in Changhai Hospital,the Second Military Medical University were analyzed retrospectively,including 7 ruptured aneurysms and 23 unruptured aneurysms.The anterior circulation aneurysm accounted for 93.3% (n=28),and the diameters of the parent arteries were 1.6-2.4 mm.The complications associated with surgery,angiography,clinical outcomes,and mid-term follow-up data were analyzed.Results The success rate of stent implantation was 100%.Immediate embolization results:Raymond grade Ⅰ in 12 cases (40.0%),Raymond grade Ⅱ in 11 cases (36.7%),and Raymond grade Ⅲ in 7 cases (23.3%).Complications occurred in 2 cases,including one perforating artery occlusion and one intraoperative rupture.Twenty-five patients accepted the angiographic follow-up (Raymond grade Ⅰ in 21 cases,grade Ⅱ in 3 cases,and grade Ⅲ in 1 case).The follow-up time ranged from 4 to 14 months,with an average of 8.1± 2.6 months.One patient had asymptomatic intracranial artery stenosis in the distal end of the stent.No new neurological dysfunction or death occurred.Conclusion The deployment of LVIS stents in small vessels is safe and feasible,the effect of mid-term follow-up is better.However,a larger sample study and long-term follow-up results are needed.
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Objective To preliminarily discuss the efficacy and safety of balloon protection technique in venous sinus in the embolization of lateral sinus dural arteriovenous fistula.Methods FromDecember 2012 to August 2016,7 consecutive patients with lateral sinus dural arteriovenous fistula embolized with Onyx under the protection of venous sinus balloon were enrolled retrospectively. Their clinical data,imaging data,and follow-up results were analyzed.Results In 7 patients,the fistulas of 3 cases were located in the sigmoid sinus and the fistulas of 4 cases were located in the transverse sinus. Immediately after operation, 5 patients were embolized completely and 2 were embolized mostly. All balloon protected venous sinuses maintained patency. Seven patients were followed up clinically and the follow-up time was 6-43 months. No new neurological deficits were observed. All 7 patients received whole DSA reexamination and the follow-up time was 6-11 months. It is suggested that 5 patients were completely cured,among them,the venous sinuses were patent in 4 cases,the venous sinus was occluded in 1 case;the fistula was stable and venous sinus patency in 1 case;and 1 had newly complicated venous sinus occlusion.Conclusion At the same time of embolization of the fistulas,the dural arteriovenous fistulas were embolized under the protection of venous sinus balloon. It could maintain long-term patency of venous sinus and be conductive to maintaining the stability of the embolization effect.
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Objective To evaluate the risk factors for interventional treatment of neurological complications in elderly patients with rupture intracranial aneurysms.Methods Form December 2004 to December 2014,520 consecutive old patients (≥ 60 years) with ruptured intracranial aneurysm treated at the Department of Neurosurgery,Changhai Hospital,the Second Military Medical University were enrolled retrospectively.The imaging and clinical follow-up results at day 30 after procedure were documented.According to whether the occurrence of interventional therapy-related neurological complications (including intraoperative aneurysm rupture,interventional therapy-related thromboembolic events,early postoperative aneurysm rebleeding,new postoperative subdural hemorrhage or intraparenchymal hemorrhage),they were divided into a complication group (n =68) and a non-complication group (n =452).Univariate statistical analysis and multivariate Logistic regression analysis were used to screen the independent risk factors for the occurrence of neurologic complications after interventional therapy.Results The incidence of neurological complications in 520 patients with aneurysm was 13.1％ (n =68).Multivariate Logistic regression analysis showed that the history of hypertension (OR,2.207,95 ％ CI 1.149-4.240,P ＜ 0.05),Hunt-Hess grade Ⅳ-Ⅴ (OR,4.287,95％ CI 2.048-8.971,P ＜ 0.01),Fisher grade Ⅲ-Ⅳ (OR,2.686,95％ CI 1.483-4.865,P ＜ 0.01),wide-neeked aneurysm (OR,2.884,95 ％ CI 1.511-5.505,P ＜ 0.01),aneurysm bleb (OR,4.560,95 ％ CI 2.500-8.321,P ＜ 0.01),and aneurysm ＜ 3 mm (OR,5.748,95 ％ CI 2.122-15.570,P ＜ 0.01) were the independent risk factors for treatment-related neurological complications in the interventional treatment of intracranial ruptured aneurysms in the elderly.Conclusion The history of hypertension,high Hunt-Hess grade,high Fisher grade,wide-neck aneurysm,aneurysm bleb,and micro-aneurysm are the independent risk factors for treatment-related neurological complications in interventional treatment of intracranial ruptured aneurysms in the elderly.
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Objectives To study the risk factors for influencing recrudescence after endovascular embolization of intracranial aneurysms and to establish a regression model to predict the risk of recrudescence in patients with specific intracranial aneurysm after endovascular embolization. Methods From May 2012 to May 2014,429 patients (a total of 441 aneurysms)with intracranial saccular aneurysm who met the inclusion criteria and treated with endovascular embolization at the Cerebrovascular Treatment Center, Changhai Hospital,the Second Military Medical University were analyzed retrospectively. Multiple aneurysms were calculated separately according to per aneurysm. The aneurysms were divided into either a recurrent group (n = 66)or an unrecurrent group (n = 375)according to whether they had recrudescence or not. The differences of 11 factors such as clinical features,treatment technology and materials,and aneurysm anatomy of both groups were compared. Logistic regression was used to analyze the risk factors for recrudescence after endovascular embolization of intracranial aneurysms,and its effectiveness of predicting recrudescence was evaluated. Results There were significant differences in the size of aneurysms (χ2 = 46. 352,P 10 -25 mm)(OR,4. 914,95% CI 2. 277 -10. 604,P 25 mm)(OR,35. 743,95% CI 3. 511 -363. 837,P = 0. 003) were the risk factors for recrudescence after aneurysm embolization. The effective test results of the regression model in predicting recrudescence showed that the area under the curve of the recrudescence predicting model was 73. 5% . Raymond grade was 56. 6%,and the non -stent embolization was 60. 1%,and the size of aneurysms was 40. 3% . Z test was used to calculate the differences of recurrent scores and non-stent embolization,Raymond grade,the area under ROC curve of aneurysm size. The Z values were 2. 662, 3. 513,and 6. 308,respectively,and the P values were 0. 007,0. 004,and 0. 001,respectively. Conclusions Large or giant aneurysms,non - stent - assisted embolization,incomplete embolization immediately after procedure were associated with the recrudescence after endovascular embolization of intracranial aneurysms. The established regression model may reflect the size of the recurrent risk.
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Objective To investigate the safety and effectiveness of endovascular embolization combined with two-stage stereotacticradiosurgery (SRS)for the treatment of intracranial arteriovenous malformation (AVM). Methods From January 2010 to December 2012,the clinical data of 66 patients treated with endovascular embolization combined with two-stage SRS AVM comprehensive therapy at the Department of Neurosurgery,Changhai Hospital,the Second Military Medical University were analyzed retro-spectively. They were followed up by imaging. The followed-up time was 7 to 96 months. DSA revealed that the complete disappearance of vascular flow void shadow was regarded as a cure. The patients were divided into either a cured group (n = 29)or a not cured group (n = 37)according whether they were cured or not. The effects of different factors,such as AVM rupture or not,the volume size before embolization,and the degree of embolization on the cure rate of AVM with the comprehensive therapy were observed in both groups,and logistic regression was used to analyze the factors affecting the cure rate of comprehensive therapy. Results (1)There were 22 patients (75. 9%)had ruptured AVMs and 7 (24. 1%)had unruptured AVMs in the cured group. The diameters of the aneurysms < 3 cm and ≥3 cm were in 26 (89. 7%)and 3 (10. 3%)cases respectively. Spetzler-Martin (SM)grades of patients were Ⅰ to Ⅲ. In the not cured group,20 patients (54. 1%)had ruptured AVMs and 17 (45. 9%)had unruptured AVMs. The diameters< 3 cm and ≥3 cm were 18 (48. 6%)and 19 patients (51. 4%)respectively. The SM grade in 34 cases were Ⅰ to Ⅲ. (2)During the follow-up period,29 patients (43. 9%)achieved cure on imaging. The modified Rankin scale (mRS)scores in 64 cases (97%)were 0 to 1. Six patients had complications. (3)Multivariate logistic regression analysis showed that the size of AVM (OR,0. 141,95% CI 0. 035 -0. 570,P < 0. 01)and the degree of interventional embolization (OR,2. 414,95% CI 1. 038 -5. 613,P <0. 05)were the influencing factor of the cure rate. Conclusions Vascular interventional embolization in combination with SRS for the treatment of intracranial AVMs was both effective and safe. The diameter of AVM < 3 cm was the beneficial factor of cure rate of comprehensive therapy. The degree of interventional embolization not reaching cure on imaging was a risk factor for the cure rate of comprehensive therapy.
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Objective To study the role of risk factors associated with hemodynamics in patients with intracranial artery stenosis.Methods Eighteen patients with local stenosis of middle cerebral artery were recruited in this study retrospectively.According to patients′clinical symptoms and magnetic resonance imaging findings, they were divided into the symptomatic group (n=13) and the asymptomatic group (n=5).Wall shear stress ( WSS) , oscillatory shear index ( OSI) , velocity and pressure of the stenotic artery wall were compared between the two groups after reconstructing 3-dimentional model of hemodynamics.Then related risk factors of hemodynamics were analyzed in symptomatic intracranial atherosclerotic stenosis.Results There were no statistically significant differences between the two groups in the parameters such as age, sex, degree of artery stenosis, mean arterial pressure and some medical histories of hypertension and diabetes.The results showed obvious changes of hemodynamics in local artery stenosis.The WSS(78.69(68.15,117.65) Pa vs 39.34(22.76,60.54) Pa,U=4,P=0.003), pressure of the stenotic artery wall (1 815.14(1 242.44,4 398.84) Pa vs 735.55(361.17,1 528.78) Pa,U =7,P=0.010)and velocity of the local stenosis(3.87(2.58, 4.52) m/s vs 2.31(1.38,3.12) m/s,U=12,P=0.046) in the symptomatic group were much higher than those in the asymptomatic group; however, there were no significant differences between the two groups in OSI.Conclusions Hemodynamic features do exist in local intracranial atherosclerotic stenosis.The WSS, wall pressure and velocity of the local stenosis may be vital risk factors associated with symptomatic intracranial atherosclerotic stenosis.
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Objective To investigate the safety and efficacy of domestic contrast iodixanol injection in the application of interventional neuroradiology. Methods A total of 442 patients from 11 research centers using iodixanol injection for whole brain DSA examination or interventional therapy were enrolled in a prospective,multicenter,and non-controlled clinical trial. The recording and evaluation indicators included the adverse reactions after drug treatment,changes of creatinine and urea nitrogen indicators before and after drug treatment,DSA types,DSA effects,the dosage of contrast agent,etc. The renal function damage, incidence of adverse drug reactions,and image quality were counted and analyzed. Results All the 442 patients were completed the examination or treatment. (1)All the results of intraoperative angiography achieved excellent,including 98. 2% (n = 434)were excellent and 1. 8% (n = 8)were good. There were significant differences in the comparison of angiographic results in the 4 different types of DSA (SIEMENS,PHILIPS,GE,and TOSHIBA)(χ2 = 31. 518,P 44. 2 μmol / L. There was no urea nitrogen abnormality of clinical signifi-cance. None of the patients had renal insufficiency. (3)Three patients had adverse drug reaction (0. 7%) during procedure,including 2 patients had dermal allergic reactions and 1 patient had transient blurred vision. Conclusion Domestic iodixanol injection is safe and effective and has less adverse reaction in the clinical application of interventional neuroradiology. The different types of DSA may impact on the contrast image quality.
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Objective To investigate the effect of mechanical thrombectomy device Solitaire AB for the treatment of distal occlusion of the intracranial artery caused acute anterior circulation ischemic stroke. Methods The clinical data of 9 patients with arterial occlusion of distal anterior circulation treated by using the Solitaire AB thrombectomy device were analyzed retrospectively. Seven of them had M2 middle cerebral artery occlusion and 2 had A3 occlusion. Their clinical features,imaging data,treatment,and the results of 3-month clinical follow-up were analyzed. The effectiveness of treatment was evaluated through the recanalization rate after stent thrombectomy,the National Institutes of Health Stroke Scale (NIHSS)scores before and after treatment,the modified Rankin scale (mRS)scores,and the 3-month clinical follow-up results. The surgery-related complications and mortality of patients were used to evaluate the safety of the treatment. Results (1 )Of the 9 intracranial arterial occlusions,8 were recanalized successfully. The modified thrombolysis in cerebral infarction (mTICI)was 2b or grade 3. (2)The NIHSS score median 9. 5 (3. 0,15. 5)at discharge dropped significantly compared with 19. 0 (16. 0,22. 0)before procedure. (Z=2. 703,P=0. 007). No permanent complications related to operation occurred. Four of the recanalized patients had good prognosis (mRS 0-1)and 4 had disability (mRS 3-4 ). The mRS score of one non-recanalized patient was 4 at the 3 months follow-up. Conclusion The embolectomy effect is good whom using Solitaire AB device for acute occlusion occurred in the intracranial artery M2 or A3 segment. Its efficacy,safety,and indications still need to be further explored in a larger sample controlled trial.
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Objective To investigate the feasibility of the arterial wall imaging technology of high-resolution magnetic resonance imaging ( HR-MRI) in the risk assessment of intracranial aneurysm rupture. Methods Fifty-four patients with 66 intracranial aneurysms underwent 3. 0 T HR-MRI multiple sequences arterial wall imaging from November 2013 to March 2015 were analyzed retrospectively. Five patients with ruptured aneurysm were used as a control group. The characteristic differences of aneurysm lesions between an unruptured intracranial aneurysm ( UIA) wall enhancement group and a non-enhancement group were compared. The risk factors for rupture were analyzed according to the size,location, and basic clinical characteristics of aneurysm. Results (1) HR-MRI revealed that whether the aneurysm walls enhanced or not,there were no significant differences in the location size,wide-necked aneurysm or not,and ratios of aneurysm height and neck width (all P >0. 05). (2) The enhancement rates of the aneurysm volume <2 group and ≥2 group were 20%(8/40) and 61. 9%(13/21) respectively,the incidence of the ruptured aneurysm asci was higher than that of UIA,and there was significant difference ( all P<0. 05). There were no significant differences in neck width,rate of aneurysm volume,ratios of aneurysm height and neck width,and enhancement rates among the groups. Conclusion The preliminary results of this study have showed that there is a related trend between the HR-MRI aneurysm wall enhancement and the risk of rupture,but a further large sample follow-up study is needed.