The vascular architecture characteristics of the complex direct cavernous sinus arteriovenous fistula and its interventional treatment / 介入放射学杂志

Objective To analyze the vascular architecture characteristics of the complex direct cavernous arteriovenous fistula (cd-CAVF) and to discuss its treatment and the curative effect of interventional embolization. Methods The hospitalization records, imaging features and operation records of 12 patients with cd-CAVF were retrospectively analyzed. Results In the 12 patients with cd-CAVF, the lesion’s blood supply arteries included internal carotid artery (ICA,n=8), primary trigeminal artery (PTA,n=1), middle cerebral artery (MMA,n=2) and basilar artery (BA,n=1). Different degrees of “arterial steal” phenomenon could be observed in all patients. The drainage routes included the superior ophthalmic vein and the inferior petrosal sinus (n=10), and cortical vein (n=2). Interventional embolization was carried out via ICA (n=4), through both ICA and BA (n=5), through MMA (n=2), or through BA (n=1). For the embolization of the lesion the balloons were used in 8 patients, steel coils were adopted in 2 patients, and balloons together with coils were employed in 2 patients. All the patients were followed up for 3-6 months. After the treatment the clinical symptoms and signs disappeared, and the lesions were completely cured in all patients with no complications. During the follow-up period of (60.2 ±26.8) months no recurrence of CAVF was observed. Conclusion The blood supply of cd-CAVF comes directly from the rupture of the blood vessels surrounding the cavernous sinus wall, the “arterial steal” phenomenon is prone to occur, and the drainage via the superior ophthalmic vein and the inferior petrosal sinus is more often seen. Transarterial balloon embolization is very effective for the treatment of cd-CAVF, and the use of coils together with multi-artery approaches is an effective supplementary method.

Mechanical thrombectomy versus Intra-arterial Thrombolysis in Patients with Stroke Caused by Acute ce-rebral Arterial Occlusions：A Single-center study / 中国神经精神疾病杂志

Objective To investigate the safety and efficacy of mechanical thrombectomy (MT) compared with In?tra-arterial Thrombolysis (IAT) treatment in patients with severe acute ischemic stroke (AIS) caused by large cerebral ar?tery occlusion. Method The patients with AIS caused by large cerebral artery occlusion and underwent MT or IAT from 2005 May to 2014 May was included. A retrospective analysis was conducted on the onset to emergency(OTE)time, emergency to acupuncture(ETA)time, acupuncture to recanalization (ATR) time, stroke severity as measured by the Na?tional Institutes of Health Stroke Scale (NIHSS) score, and site of arterial occlusion on magnetic resonance angiography (MRA). A comparison was made between MT and IAT patients in rates of recanalization, symptomatic intracranial bleed?ing (SIB), mortality, and functional outcome. Three-month favourable outcome was defined as a modified Rankin Scale (mRS) score≤2. Result One hundred and two AIS patients were treated with MT and 50 with IAT. There was no differ?ence between MT and IAT groups with regard to demographics, onset NIHSS score (13.37±6.95 vs. 12.70±6.11;P=0.572) and discharge NIHSS score (8.40 ± 6.69 vs. 7.53 ± 7.28, P= 0.522) and the change of NIHSS score (3.87 ± 7.14 vs. 4.26 ± 5.42, P=0.766). There were significantly differences between MT and IAT groups in the OTE time (Median 300 min vs. 120 min,Z=-5.704,P=0.000) , ATR time (Median 30 min vs. 65 min,Z=-5.011,P=0.001) ,recanalization (91.2%vs. 60.0%,P =0.01),the rate of AIB(21.7% vs. 36.0%,P =0.046),3-month mortality (16.6% vs. 26.0%,P =0.043). The above parameters were better in MT group than in the IAT group. There were no significant differences between MT and IAT groups in the rate of SIB (12% vs. 16%,P =0.055), the NIHSS change(Median 3 vs. 4,Z =-0.236,P =0.823) and mRS score on 90d ( 48.2%vs. 46.0%, P=0.823). MT patients had significantly higher percentages of stent use (22.5%vs. 8%,P=0.018) . The Recanalization for ICA(81.8%vs. 55.6%,P=0.048),BA(93.1%vs. 55.6%,P=0.032)and MCA( 97.5% vs. 60.0%,P =0.026)was higher in MT group than in IAT group .The SIB rate for ICA(13.8% vs. 33.3%,P =0.000),BA(13.8%vs. 33.3%,P=0.000)was lower in MT group than in IAT group . The mortality rate of was significant?ly lower in MT than in IAT group for MCA (2.5%vs. 20.0%,P=0.000) . the good outcome rate for BA was higher in MT group than in IAT group(41.3%vs. 22.2%,P﹤0.01). Conclusions Compared to IAT,MT can provide broader time win?dow,higher recanalization rate and better outcome in patients with severe acute ischemic stroke (AIS) caused by large ce?rebral artery occlusion.

Angiographic features and clinical significance of kinking of extracranial internal carotid artery / 中华放射学杂志

Objective To investigate the clinical manifestations, angiographic features and clinical significance of kinking of extracranial internal carotid artery (ICA). Methods The clinical and radiological data of 21 patients with kinking of extracranial ICA were retrospectively reviewed in our hospital from April 2003 to July 2007. Fisher exact test was performed. Results Of the 21 patients, 7 hod no clinical symptoms, the other 14 showed manifestations of cerebral iachemia with varying degree. One of the characteristic clinical manifestations that neck rotation or specific positions of head and neck might induce the occurrence of clinical symptoms was found in 5 cases. The whole-brain coverage DSA accurately showed the location of kinking of extracranial ICA and the degree of vascular stenosis. In patients with α < 66%, 80% > α≥ 66% and α≥ 80%, clinical symptoms were found in 3 out of 5,7 out of 10 and 4 out of 6 patients, respectively. Fisher exact test revealed that the positive rates of clinical symptoms in three groups had no significant difference (P > 0. 05). Conclusion Kinking of extracranial ICA is a frequent vascular morphologic variation, and it is also a kind of potential disease. The whole-brain coverage DSA is a relatively reliable method to detect this variation.

The clinical observation of local intraarterial thrombolysis in acute ischemic stroke of the anterior circulation / 中国综合临床

Objective To evaluate the short-term outcome of local intraarterial thrombolysis in patients with acute ischemic stroke of the anterior circulation. Methods 24 patients with acute ischemic stroke of the anterior cir-culation within 8 hours were treated by local intraarterial thrombolysis. Arterial recanalization was divided into total, partial and occlusive respectively according to angiography. Evaluation of clinical outcome was performed on the 30th day after thrombolysis,and was classified as good for Modified Rankin Scale (MRS) scores of 0 to Ⅲ and poor for MRS scores of Ⅳ to Ⅵ. Results Total recanalization was obtained in 54.2 % of patients, partial recanalization in 25.0%. Clinical outcome was good in 15 patients (62.5%). Cerebral hemorrhage occurred in 4 patients (16.7%). Four patients died (16.7%). Conclusion Local intraarterial thrombolysis is an effective method for treatment of a-cute iachemic stroke of the anterior circulation. It needs further practice and long-term follow-up study on safety and long-term efficacy.

Three-dimensional CT angiography with volume rendering for the dignosis of multiple intracranial aneurysms / 中国脑血管病杂志

Objective:To evaluate the importance of 3D-CTA with volume rendering for the diagnosis of multiple intracranial aneurysms. Methods: Axial source images were obtained by helical CT scanning and reconstruction of 3D-CTA images was done by volume rendering technique in conjunction with multiplanar reformation. Results: In the past one year,there were 10 patients diagnosed as having multiple intracranial aneurysms by 3D-CTA and altogether 24 aneurysms were visualized,including 10 small aneurysms(≤5mm.Three dimensional CT angiography with volume rendering demonstrated aneurysms very well and provided useful information concerning the site,shape,size and spatial relationship with the surrounding vessels and bone anatomy. Conclusion: Three-dimensional CT angiography with volume rendering is a quick,reliable,and relatively noninvasive method for diagnosing multiple intracranial aneurysms.It delineates detailed aneurysmal morphology,and provides useful information for planning microsurgical approaches.

Primitive trigeminal artery-cavernous sinus fistula and ICA-primitive trigeminal artery aneurysm:report of two cases and review of literatures / 中国脑血管病杂志

The authors described two cases with primitive trigeminal artery. Case 1 was a 32-year-old woman who suffered dizziness and a serious pulsatile intracranial bruit on the left ear, and sometimes associated with pulsatile intracranial bearing-pain on the left temporal side six months before she was admitted to the hospital. She also suffered from obvious diplopia on left lateral gaze for the last 5 months. She had suffered no recent trauma. Magnetic resonance imaging(MRI) demonstrated a suspected intracranial aneurysm located in left cavernous sinus. Digital subtraction angiography (DSA) was performed and a primitive trigeminal artery-cavernous sinus fistula in left side was found. Intraluminal occlusion of the fistula was successfully performed immediately after angiography using 6 Guglielmi detachable coils (GDC), and the patient was cured finally. Case 2 was a 28-year-old woman who suffered a serious intermittent cephalodynia associated with soreness on the left body two years before she was admitted to the hospital. She had suffered no recent trauma. Magnetic resonance angiography(MRA) demonstrated a suspected intracavernous aneurysm of the right internal carotid artery, Digital subtraction angiography (DSA) was performed. Right internal carotid angiography showed a primitive trigeminal artery (PTA) run between the cavernous segment of the internal carotid artery and the distal portion of the basilar artery. On initiation of PTA of R-ICA a small wide-necked saccular aneurysm was incidentally visualized. The aneurysm was successfully embolized after angiography using 2 Stent (Neuroform, 4.5mmm × 20mmm)-assisted detachable coils (Matrix), the ICA and PTA were preserved, and the patient was cured finally.

Interventional treatment of dural arteriovenous fistula / 中华外科杂志

<p><b>OBJECTIVES</b>To summarize the characteristics of interventional treatment of dural arteriovenous fistulae (DAVFs) and improve clinical curative effects.</p><p><b>METHODS</b>The clinical data from 135 patients with DAVFs were analyzed retrospectively.</p><p><b>RESULTS</b>Seventy-four patients were cured, 53 were significantly improved, 8 unchange, and 1 died of intracranial haemorrhage.</p><p><b>CONCLUSIONS</b>Clinical presentations and prognosis of DAVF depend on the types of venous drainage. Compression of the affected carotid artery and endovascular embolization are safe and effective.</p>

Interventional treatment of 126 patients with anterior communicating artery aneurysm / 中华外科杂志

<p><b>OBJECTIVES</b>To analyse the characteristics of interventional treatment for anterior communicating artery aneurysm (AcoAA) and improve curative effects.</p><p><b>METHODS</b>In 126 patients, detachable microcoils were used to embolize the AcoAA via endovascular approach. Those patients failed to be embolized were treated by surgical clipping.</p><p><b>RESULTS</b>Of the 109 patients who were embolized successfully, 97 were achieved 100% occlusion, 12 95% - 98% occlusion. In the other 17 patients who failed to interventional treatment 15 were treated surgically and 2 no treatment because of cerebral vascular spasm. 123 patients were cured, one died, and 2 had aneurysms disappeared without any operations, as proved by follow-up for 5 months to 1 years. Of 32 patients checked by cerebral angiography 3 weeks to 30 months after operation, 30 showed disappeared of aneurysms and 2 had recurrence. The recurred aneurysms were successfully reembolized.</p><p><b>CONCLUSIONS</b>Most of AcoAAs can be cured by endovascular interventional treatment. Those who failed to be treated by embolization can be cured surgically. Few patients may be healed spontaneously. The long term effects of treatment should be followed-up for a long time.</p>

THE DIAGNOSIS AND ENDOVASCULAR TREATMENT FOR THE INTRACRANIAL DURAL AND CEREBRAL ARTERIOVENOUS MALFORMATIONS / 解放军医学杂志

Objective To study the angiographic characteristics of congenital intracranial dural and cerebral arteriovenous malformations, and their relationship to the structural characteristics and clinical feature. Methods The clinical histories, cerebral angiograms, and endovascular treatment of 52 cases of the dural and cerebral arteriovenous malformations were analyzed. Results All 52 patients were treated successfully with interventional therapy with introduction of intravascular emboli through microcatheters. In 2 patients, surgical excision was performed after embolism. In another 4 patients, X-ray knife treatment was carried out. Seventeen patients resumed their work, comprising 44.7% of all patients, and in 16 patients symptoms of epilepsy or head ache were markely improved, comprising 42.1% of the group. Conclusion It is important to study structural characteristics with angiograms for successful treatment of congenital artero-venous anomalies of the brain. [HS(1*2/3]

Traumatic basilar-cavernous fistula associated with aneurysm of basilar artery / 中华创伤杂志(英文版)

A 19-year-old boy's left temporal region was struck by a screwdriver, he immedietly lost consciousness for several minutes, when he came back he had a serious headache and obvious left ptosis. CT scanning showed an intracranial air accumulation and obvious traumatic subarachnoid hemorrhage (SAH), 2 weeks later magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) showed a traumatic aneurysm in basilar artery. Digital subtraction angiography (DSA) was performed 4 weeks later, revealing a basilar-cavernous fistula and a saccular aneurysm of the basilar artery in his head. After the patient was treated with endovascular embolization therapies twice and with mechanical detachable spiral (MDS) for 5 months the patient was cured finally.