ABSTRACT
Objective It is difficult to conduct the intravascular interventional treatment of A1 segment anterior cerebral ar-tery aneurysms. This article aimed to investigate the effect of stent-assisted coil embolization for the treatment of A1 segment anterior cerebral artery aneurysms. Methods Retrospective analysis was made on the clinical data of 8 patients with A1 segment anterior cer-ebral artery aneurysms who were treated in Department of Neurosurgery in Nanjing General Hospital of Nanjing Military Command from June 2015 to July 2017. All the patients underwent endovascular intervention under static inhalation combined with general anesthesia. Immediately after the operation,angiography was performed to observe the embolization of the aneurysm and imaging follow-up was per-formed. The follow-up period was 6 to 30 months,with an average of (13±9) months,followed by Glasgow Outcome Scale (GOS) sco-ring. Results Immediate postoperative angiography showed that all 8 aneurysms were completely embolized and the parent artery re-mained. Seven patients had no ruptured hemorrhage and no new neu-rological dysfunction,with 5 points of GOS score and good prognosis. Five patients underwent DSA follow-up after surgery with no developed aneurysm. Conclusion Stent-assisted coil embolization is techni-cally feasible in treating A1 segment anterior cerebral artery aneu-rysms,which is a choice worthy of clinical promotion.
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Objective Intravascular interventional embolization has become the preferred method for the treatment of anterior communicating artery aneurysms.The purpose of this paper was to study the guiding significance of dual vessel fusion technique for in -terventional surgery of complex anterior communicating artery aneurysms. Methods A retrospective analysis was conducted on the clinical data of 31 patients with complicated anterior communicating artery aneurysms in our department from March 2015 to June 2016. All patients underwent two-vessel fusion, DSA angiography, and three-dimensional reconstruction of unilateral internal carotid artery and the images were compared to identify whether the aneurysm met the true size,the exact convergence point of bilateral A 1 and ante-rior communicating artery, anterior communicating artery aneurysm and anterior communicating artery and so on. Results There were 31 cases identified by dual vessel fusion technique on the consistency of aneurysms to true volume and 28 cases by three-dimensional reconstruction of unilateral internal carotid artery.There were 31 cases identified by dual vessel fusion technique on the exact convergence point of bilateral A 1 and anterior communicating artery and 9 cases by DSA angiography.There were 31 cases identified by dual vessel fusion technique on variations of anterior communicating artery complex and 24 cases by DSA angiography.There were 27 pa-tients who attained the optimal DSA machine projection angle by the dual vessel fusion technique which was the same as that of the unilateral internal carotid artery,in addition,the other 4 cases got better optimal DSA machine projection angle than those by three-dimensional reconstruction of unilateral internal carotid artery. Conclusion The dual vessel fusion technique helps surgeons to fully understand the anatomical relationship between anterior communicating artery complex and aneurysm,which has important guiding significance in making surgical strategies for complicated anterior communicating artery aneurysms,selecting embolization work angles and real-time observation during embolization.
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Objective The stent-assisted technique is widely applied in the treatment of subarachnoid hemorrhage caused by ruptured vertebral artery dissecting aneurysm(VADA). This study investigated the perioperative complications and long-term clinical effect of stent-assisted coiling in the management of VADA-induced subarachnoid hemorrhage. Methods The clinical data on 19 cases of VADA-induced subarachnoid hemorrhage were analyzed retrospec-tively. All the patients underwent digital subtraction angiography (DSA)and stent-assisted coiling within 24 hours after admission.Two of the patients were diagnosed with bilateral VADA and treated with double stents,4 with a single stent,2 with the low-profile visualized intraluminal support device(LVIS),and 11 with double Enter-prise stents. Results Operations were successfully performed in all the cases. Three of the patients died within 2 weeks after surger-y,2 from post-operative rebleeding and the other 1 from some unknown cause;1 patient developed severe postoperative cognitive dys-function,while the other 15 were well recovered. The survived patients were followed up for 6 to 36 months,during which no obvious new neurological deficits were observed. Follow-up DSA revealed 2 cases of recurrence,1 case of stenosis in the stent,and 2 cases of vertebral artery occlusion. Conclusion Stent-assisted coiling is a safe and effective method for the management of VADA-induced subarachnoid hemorrhage,and double-stent implantation may achieve an even better effect.
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Objective The management of poor-grade ruptured aneurysm is important and challenging in intravascular inter-vention. This study aimed to investigate the safety of external ventricular drainage(EVD)after stent-assisted embolization for patients with poor-grade ruptured aneurysm in the acute stage. Methods From January 2015 to July 2017,27 patients with poor-grade rup-tured aneurysm underwent EVD after endovascular embolization by stent-assisted coiling(n=14)or simple coiling(n=13). We com-pared the clinical data about and the postoperative complications between the two groups of patients. Results There were no statisti-cally significant differences in the patients'age,gender,Glasgow Coma Scale(GCS)scores before embolization and discharge,the in-terval between EVD and the end of embolization,preoperative intraventricular hemorrhage and hydrocephalus,puncture-related bleed-ing after EVD,catheter-indwelling time,perioperative bleeding in other parts,or poor prognosis between the stent-assisted coiling and simple coiling groups(all P>0.05). Conclusion EVD after stent-assisted embolization is a relatively safe strategy for the treatment of poor-grade ruptured aneurysm in the acute stage.
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Objective Distal anterior cerebral artery aneurysm(DACAA)is rare and difficult to be treated. The aim of this study was to investigate the clinical effect of stent-assisted coiling in the treatment of DACAA. Methods We retrospectively analyzed the clinical data about 15 patients with 15 DACAAs treated by stent-assisted coiling,with all the aneurysms occluded and the parent ar-teries preserved,including 4 ruptured and 11 unruptured aneurysm,8 in the A2 and 7 in the A3 segment. The follow-up ranged from 6 to 33 months,during which we evaluated the prognosis of the patients by radiological and clinical examinations. Results There were no operation-related complications in any of the cases. One patient died of subarachnoid hemorrhage-induced cerebral vasospasm. Fol-low-up angiogram revealed complete occlusion of the aneurysms in 9 cases. The last follow-up Glasgow Outcome Scale score was 5 in all the 14 survived patients. No rupture,rebleeding or fresh neurologic deficits was observed in any of the patients. Conclusion Stent-assisted coiling is safe and effective,with a low short-term recurrence rate,in the treatment of distal anterior cerebral artery aneurysm.
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Objective Reports are rarely seen on the treatment of blood blister-like aneurysm(BBA)of the internal carotid artery with the overlapping low-profile visualized intraluminal support device(LVIS)stent. This study was to investigate the effects of overlapping versus non-overlapping LVIS stent-assisted coiling in the treatment of BBA. Methods We retrospectively analyzed the clinical data about 15 cases of BBA of the internal carotid artery treated in our hospital from February 2015 to February 2017,11 by o-verlapping and the other 4 by non-overlapping LVIS stent-assisted coiling. Using Raymond-Roy Occlusion Classification(RROC),we evaluated the effects of treatment immediately and at 1 week after operation. We followed up the patients from April 2015 to October 2017 and analyzed the results of follow-up digital subtraction angiogra-phy(DSA)and modified Rankin Scale scores(mRS)of the patients. Results RROC showed 10 cases of grade Ⅰ and 1 case of grade Ⅲocclusion in the overlapping group and 3 cases of gradeⅠand 1 case of gradeⅡin the non-overlapping group right after operation. In com-parison,there were 11 cases of gradeⅠin the overlapping group and 2 cases of grade Ⅰ and 2 cases of grade Ⅱ in the non-overlapping group at 1 week postoperatively.DSA at the end of the follow-up exhibited 9 cases of gradeⅠand 1 case of gradeⅡin the overlapping group and 1 case of grade Ⅰ,2 cases of grade Ⅱ and 1 case of gradeⅢin the non-overlapping group. Satisfactory prognosis was ob-served in all the 15 cases,with mRS=0 in 9 cases and mRS = 1 in 2 cases in the overlapping group and with mRS=0 in 3 cases in mRS=1 in 1 case in the non-overlapping group. Conclusion Overlapping LVIS stent-assisted coiling is safe and effective for treat-ment of BBA of the internal carotid artery.
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K21. The mean t1/2(?) was (2.7?0.4) h, Vd was about 11.18 L?kg-1.The C-T profile conformed to two compartment open model. The plasma Dau concentration-time curves showed a double-peak phenomenon in all dosages of all dogswhen dauricine was given by intragastric was.The tpeak(1) was (0.8?0.6) ～(1.2?0.5) h,tpeak(2) was (5.2?3.2) ～(6.5?1.9)h,Cmax(2) 0.05) and the AUC was increased in proportion.The drug is eliminated non-linearly when the dosage is above 50 mg?kg-1, the parameters t1/2(el),CL, AUC/X0 shows great difference (P
ABSTRACT
Aim The relative bioavailability of domestic ibudilast sustained release capsules in healthy volunteers was observed.Methods A single oral dose of 20 mg of imported and domestic ibudilast sustained release capsules and 10 mg of ibudilast raw material was separately given to 12 healthy volunteers in a randomized crossover study. Ibudilast concentration in plasma was determined by HPLC method.Results The Cmax were (54.9?9.7),(60.7?9.1) and (62.2?11.5) ?g?L-1; the tmax were (3.8?0.8),(3.9?0.8) and (1.8?0.3) h;the t1/2(ke) were (1.5?1.4),(12.1?1.0) and (3.5?0.5) h,and the AUC(0～t) were (618.1?57.7),(588.1?66.6) and (233.0?46.4) ?g?h?L-1 in imported capsule group, domestic capsule group and raw material group respectively. The relative bioavailability of domestic sustained release capsules of ibudilast is (95.6?11.0)%. Conclusion The results of statistical analysis demonstrate that the imported and domestic sustained capsules have significant character of significantly sustained release and are bioequivalent.