Endovascular Treatment of the Huge Dissecting Aneurysms Involving the Basilar Artery by the Internal Trapping Technique: Technical Note / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The endovascular strategy of the huge dissecting aneurysms involving the basilar artery (BA) is controversial and challenging. This study was to investigate the clinical and angiographic outcomes of the treatment of the huge dissecting aneurysms involving the BA by the internal trapping (IT) technique.</p><p><b>METHODS</b>We retrospectively studied 15 patients with the huge dissecting aneurysms involving the BA treated by the IT technique between September 2005 and September 2014 in Department of Interventional Neuroradiology of Beijing Tiantan Hospital. Clinical and angiographic data were reviewed and evaluated.</p><p><b>RESULTS</b>All patients were treated by the IT technique. That meant the dissecting artery and aneurysm segments were completed occlusion. After the procedure, the angiography demonstrated that all the dissecting artery and aneurysm segments were completed occlusion. Follow-up angiography was performed at 3-6 months or 12-18 months after the endovascular treatment (median 8 months), 14 patients had a good recovery. Re-canalization occurred in one patient whose aneurysm involved in bilateral vertebral arteries and the two third of the middle-lower BA. After the second treatment, the patient died by the ventricular tachycardia.</p><p><b>CONCLUSIONS</b>The IT technique is a technically feasible and safe alternative for the treatment of BA dissecting aneurysms, but it is not necessarily the safest or most definitive treatment modality. The ideal treatment of the huge dissecting aneurysms involving the BA remains debatable and must be investigated on a case-by-case basis.</p>

Endovascular treatment of a giant internal carotid artery bifurcation aneurysm with drainage into cavernous sinus / 中华医学杂志(英文版)

This report documents the treatment of a giant aneurysm of the internal carotid artery bifurcation with a fistula to the cavernous sinus, which appeared following closed head trauma. A 39-year-old man suffered from a blunt head trauma in an automobile accident. Two weeks after the trauma, progressive chemosis of left eye was presented. Four months after the trauma, digital subtraction angiography showed an internal carotid artery bifurcation aneurysm, with drainage into the cavernous sinus. The lesion was successfully obliterated with preservation of the parent artery by using coils in conjunction with Onyx. Follow-up angiography obtained 3 months postoperatively revealed persistent obliteration of the aneurysm and fistula as well as patency of the parent artery. Endovascular treatment involving the use of coils combined with Onyx appears to be a feasible and effective option for treatment of this hard-to-treat lesion.

Embolization of brain arteriovenous malformations with ethylene vinyl alcohol copolymer: technical aspects / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Endovascular therapy plays an important role in the treatment of brain arteriovenous malformations (BAVMs). Ethylene vinyl alcohol copolymer (Onyx) is a novel liquid embolic material. This study aimed to summarize our experience of using Onyx for embolization of BAVMs with the focus on embolization technique.</p><p><b>METHODS</b>From September 2003 to November 2007, 115 patients (43 women and 72 men, with a mean age of 29 years) with BAVMs were endovascularly treated with Onyx in our department. The following features of all AVMs were evaluated prior to treatment: type of nidus and shunt, draining veins, and feeding arteries. A total of 196 endovascular procedures were performed.</p><p><b>RESULTS</b>The course of endovascular treatment was completed in 88 patients. Additional sessions were planned in 27 patients. Of the 88 patients, total occlusion was obtained in 23 patients (26.1%), near-total (> 80% of the original volume) occlusion was obtained in 35 patients (39.8%) and partial occlusion (< 80% of the original volume) was obtained in 30 patients (34.1%) using embolization as the sole therapeutic technique. Mean volume reduction was 72% (range 30% - 100%) in 115 patients. Thirty four patients (38.6%, 34/88) underwent radiosurgical treatment. Additional embolization sessions were planned in 27 patients. Complications occurred in 19 patients (16.5%, 19/115), leading to death in one patient (mortality 0.9%) and permanent disabling in 3 patients (morbidity 2.6%).</p><p><b>CONCLUSIONS</b>Onyx was shown to be feasible and safe for embolization of BAVMs. Proper use of the Onyx injection technique largely improved the endovascular treatment of BAVMs. Large AVMs can be adequately reduced in size through the use of additional treatment.</p>

Endovascular treatment of wide-necked intracranial aneurysms using of "remodeling technique" with the HyperForm balloon / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Aneurysms with wide-necked or a large neck/fundus ratio, especially located on an arterial bifurcation or a small artery, are challenges for interventional neuroradiologist because of the risk of coil migration or coil protrusion into the parent vessels. Our study was designed to improve the efficacy and safety of the "remodeling technique" with the HyperForm balloon for these difficult aneurysms and was confirmed by a follow-up result.</p><p><b>METHODS</b>From June 2004 to September 2006, forty-two patients (20 men, 22 women) with wide-necked or large neck/fundus ratio aneurysms were treated by using the "remodeling technique" with the HyperForm balloon.</p><p><b>RESULTS</b>Forty wide-necked aneurysms were successfully treated with the HyperForm balloon remodeling technique with only two failed cases. Final results consisted of total occlusion in 34 cases (80.9%), subtotal in 4 (9.5%) and incomplete in 2 (4.8%). One aneurysmal rupture occurred, but no clinical consequence was shown. No thromboembolic events were observed during treatment. Final angiographic follow-up time ranged from 3 to 18 months.</p><p><b>CONCLUSIONS</b>The "remodeling technique" with the HyperForm balloon is a very useful tool in the treatment of wide-necked or unfavorable neck/fundus ratio intracranial aneurysms-located on an arterial bifurcation or a small artery and, especially, located on the bifurcation of a large artery and a small one. In our experience, this technique provided a safe and efficient treatment for difficult aneurysms when the standard remodeling technique might have failed.</p>

Transvenous embolization with a combination of detachable coils and Onyx for a complicated cavernous dural arteriovenous fistula / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Treatment of cavernous dural arteriovenous fistulas (DAVF) is usually made by a transarterial approach. However, in many complicated patients, treatments via transarterial approaches can not be achieved, and only an operation via a transvenous approach is feasible. We aimed to study the feasibility of transarterial embolization of cavernous dural arteriovenous fistulas with a combination detachable coils and Onyx to embolize a complicated cavernous DAVF via a transvenous approach.</p><p><b>METHODS</b>From August 2006 to August 2007, six cases of complicated cavernous DAVF were embolized with a combination of detachable coils and Onyx via a transvenous approach. Three cases were male and the other three were female. Their ages ranged from 36 to 69 years old. The fistula was in the right lateral cavernous sinus in one case, in the left lateral cavernous sinus in another, and in the bilateral cavernous sinus in 4 cases. One fistula was fed by the right internal carotid artery and its meningohypophyseal trunk; one was fed by the branches of the left internal carotid artery and left external carotid artery; four were fed by the branches of the bilateral internal carotid artery and/or the bilateral external carotid artery. One case was drained via one lateral inferior petrosal sinus; three were drained via bilateral inferior petrosal sinuses; one was drained via one lateral ophthalmic and facial veins; one was drained via the inferior petrosal sinus and the ophthalmic and facial veins. Four were embolized via the inferior petrosal sinus, and two were embolized via the ophthalmic and facial veins.</p><p><b>RESULTS</b>Among six cases of complicated cavernous DAVF, four were fully embolized with Onyx by a single operation, and two cases were fully embolized with Onyx following two operations. Transient headache was found after operation in all patients, but was cured after several days by the symptomatic treatments. In one case, the first operation via the inferior petrosal sinus was a failure; the feeding branches of the external carotid artery were embolized, and transient facial palsy was appeared after operation. The fistula was fully embolized with Onyx via the inferior petrosal sinus after two months with no complications. One bilateral cavernous sinus DAVF was embolized with Onyx via the inferior petrosal sinus by two operations, and transient abducens nerve palsy occurred after embolization.</p><p><b>CONCLUSIONS</b>Because Onyx may be injected via a transvenous approach and the microcatheter is easily withdrawn, cavernous sinus via transvenous catheterization and embolization is a safe and efficient way to treat complicated cavernous dural arteriovenous fistulas, especially those for which operations via transarterial approaches have failed, or spontaneous cavernous dural arteriovenous fistulas.</p>

A novel arterial pouch model of saccular aneurysm by concomitant elastase and collagenase digestion / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

<p><b>BACKGROUND</b>An ideal aneurysm model of cerebral aneurysm is of great importance for studying the pathogenesis of the lesion and testing new techniques for diagnosis and treatment. Several models have been created in rabbits and are now widely used in experimental studies; however, every model has certain intrinsic limitations. Here we report the development of a novel saccular aneurysm model in rabbits using an arterial pouch that is subject to in vitro pre-digestion with combined elastase and collagenase.</p><p><b>METHODS</b>A segment of right common carotid artery (CCA) was dissected out and treated with elastase (60 U/ml, 20 min) followed by type I collagenase (1 mg/ml, 15 min) in vitro. The graft was anastomosed to an arterial arch built with the left CCA and the remaining right CCA, while the other end of the graft was ligated. The dimension and tissue structure of the pouch were analysed immediately, 2 or 8 weeks after operation.</p><p><b>FINDINGS</b>Ten terminal aneurysms were produced. The gross morphology of the aneurysm resembles the human cerebral terminal aneurysms. We have observed the following pathological changes: (1) growth of the aneurysm (mean diameter increased from (2.0+/-0.1) to (3.2+/-0.3) mm at 2 weeks, P<0.001, n=7-10); (2) thinning of the aneurysmal wall (the mean wall thickness decreased to 44% at 2 weeks), which was accompanied by significant losses of elastic fibres, collagen and the cellular component; and (3) spontaneous rupture (3 out of 9, one aneurysm ruptured 24 h after operation with the other two at 2 and 4 weeks respectively).</p><p><b>CONCLUSION</b>This rabbit arterial pouch model mimics human cerebral aneurysms in relation to morphology and histology. In particular, this model exhibited an increased tendency of spontaneous rupture.</p>

Transvenous embolization of cavernous dural arteriovenous fistula: report of 28 cases / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Usually, cavernous dural arteriovenous fistula can be treated via transarterial approaches. However, in many complicated patients, transvenous approaches are superior to the transarterial ones because of the difficulties during a transarterial operation. In this study, we retrospectively analyzed the outcomes of 28 patients with cavernous dural arteriovenous fistula treated by transvenous embolization.</p><p><b>METHODS</b>From September 2001 to December 2005, 28 patients with 31 cavernous dural arteriovenous fistulae were treated with transvenous embolization in Beijing Tiantan Hospital. The involved cavernous sinuses were catheterized via the femoral vein-inferior petrosal sinus approach or the femoral-facial-superior ophthalmic vein approach, and embolized with coils (GDC, EDC, Matrix, Orbit or free coil) or coils plus silk. The patients were followed up for 3 to 26 months.</p><p><b>RESULTS</b>All the 31 cavernous sinuses in the 28 patients were successfully embolized. Complete angiographic obliteration of the fistulae was achieved immediately in 25 patients. Residual shunting was observed in the other 3, who had drainage through the pterygoid plexus (2 patients) or the inferior petrosal sinus (1) after the operation. Headache and vomiting were the most common symptoms after the embolization. In 3 patients, who achieved complete angiographic obliteration immediately, the left oculomotor nerve palsy remained unchanged after the operation. Transient abducens nerve palsy was encountered in 1. In 1 patient, the occular symptoms were improved after the operation, but recurred 4 days later, and then disappeared spontaneously after 5 days. During the follow-up, no patient had recurrence. Three months after the operation, angiography was performed on the 3 patients with residual shunting. Two of them had angiographic cure, the other had residual drainage through the pterygoid plexus.</p><p><b>CONCLUSIONS</b>Transvenous catheterization and embolization of the cavernous sinus is a safe and efficient way to treat complicated cavernous dural arteriovenous fistulae. It is an alternative to the patients with spontaneous cavernous dural arteriovenous fistulae or those in whom transarterial embolization failed.</p>

Evaluation of oxidative stress in experimental rabbit aneurysms / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the roles of oxidative stress in the generation and development of aneurysms.</p><p><b>METHODS</b>Five terminal aneurysms and 8 lateral aneurysms were rebuilt on rabbits, and 6 normal artery vessels were prepared as control. The levels of malondialdehyde (MDA), superoxide dismutase (SOD), and anti-reactive oxygen species unit (anti-ROS unit) were measured with chemical methods.</p><p><b>RESULTS</b>The levels of MDA in terminal and lateral aneurysms were (33.85 +/- 8.66) and (27.87 +/- 5.78) nmol/mg prot, respectively, which were significantly higher than (10.91 +/- 2.72) nmol/mg prot in control group (P < 0.01). The levels of SOD in terminal and lateral aneurysms were (28.30 +/- 3.58) and (33.00 +/- 8.09) U/mg prot, respectively, which were significantly lower than (127.27 +/- 38.72) U/mg prot in control group (P < 0.01). The levels of anti-ROS unit in terminal and lateral aneurysms were (47.86 +/- 5.00) and (62.64 +/- 13.87) U/ mg prot, respectively, which were significantly lower than (116.94 +/- 9.22) U/mg prot in control group (P < 0.01). No significant differences were shown between terminal aneurysm and lateral aneurysm in MDA and SOD except anti-ROS unit (P = 0.014). MDA had negative correlations with both SOD and anti-ROS unit, and the correlation coefficients were -0. 830 and -0. 852, respectively.</p><p><b>CONCLUSION</b>Oxidative stress may play an important role in the development of aneurysms. Oxidative stress seems similar among various aneurysms.</p>

Endovascular treatment of cerebral arteriovenous malformations with Onyx embolization / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>In the past 5 years, new treatment materials and techniques offering a different concept in endovascular treatment have been described for cerebral arteriovenous malformations (CAVMs). The aim of this study was to assess the endovascular treatment of CAVMs by using a liquid embolic material, Onyx (Micro Therapeutics. Inc., Irvine, CA, USA).</p><p><b>METHODS</b>From September 2003 to September 2004, Onyx was used to treat 22 patients with CAVMs. Ten AVMS were located in functional areas, 8 in deep cerebral areas, and 4 in the cerebellar hemisphere. The size of CAVMs was about 3 cm in diameter in 5 patients, 3-6 cm in 11, and more than 6 cm in 6.</p><p><b>RESULTS</b>In the 22 patients, Onyx embolization was successful. Nidus occlusion was complete in 3 patients, > 90% in 8, > 80% and < 90% in 6, and > 50% and < 80% in 5. Complications included transient neurological deficits in 2 patients, and adherence of microcatheter to the site of injection in 2.</p><p><b>CONCLUSIONS</b>Being non-adhesiveness, Onyx is a safe and satisfactory embolic material in the treatment of CAVMs. But its long-term efficacy awaits further follow-up.</p>

Transvenous occlusion of carotid cavernous fistula / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the treatment of carotid cavernous fistula with the transvenous approaches.</p><p><b>METHODS</b>Seventeen patients (14 males and 3 males) with carotid cavernous fistula (CCF) were retrospectively analyzed.</p><p><b>RESULTS</b>Totally 18 cavernous sinus of 17 patients were occluded. Nine operations were performed via inferior petrosal sinus approaches and 6 via the facial vein. One patient (bilateral fistula) received both two approaches. The fistula were completely occluded immediately after the procedures in 12 patients. Small shunts remained in four of other patients (2 pterygoid drainage and 2 inferior petrosal sinus, respectively). Facial vein catheterization failed because of vein vasospasm in one patient; his symptoms relieved 5 days later and angiography showed the CCF disappeared another 2 days later.</p><p><b>CONCLUSION</b>Transvenous embolization of CCF is effective, safe, and easy to perform.</p>

Treatment of severe vertebral compressive fractures in the elderly with percutaneous vertebroplasty / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the efficacy of treating severe and chronic vertebral compressive fractures in the elderly with percutaneous vertebroplasty.</p><p><b>METHODS</b>Sixteen patients who suffered from severe back pain and whose daily living was badly affected were retrospectively reviewed. The average age was 72.5 years, the average disease history was 19 months, and the average compressive rate of the affected vertebral bodies was 74.1%.</p><p><b>RESULTS</b>Nineteen affected compressive vertebral bodies in 16 cases were treated with percutaneous vertebroplasty. All the procedures were successful without any complication. After 3.5-7 ml of cement was injected into the lesions, complete relief was achieved in 3 cases, remarkable relief was achieved in 11 cases, and improvement was observed in 2 cases. The scores of 6-point Behavioral Rating Scale and Activity of Daily Living (ADL) declined significantly after the treatment (P < 0.001).</p><p><b>CONCLUSION</b>Percutaneous vertebroplasty can significantly improve the symptoms and quality of life in the elderly patients with severe and chronic vertebral compressive fractures.</p>

Treatment of vertebral hemangioma with percutaneous vertebroplasty / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the efficacy of percutaneous vertebroplasty in the treatment of vertebral hemangioma.</p><p><b>METHODS</b>Seven patients with vertebral hemangiomas were treated by percutaneous vertebroplasty, including one case of cervical, three cases of thoracic, and three cases of lumbar hemangiomas. The average score of the 6-point behavioral pain rating scale was 2.67 +/- 0.41, and the average score of ambulation was 2.83 +/- 0.33. Guilty vertebral bodies were orientated with fluoroscopy. The procedures were performed under local anesthesia. The image features were also analyzed. Unipedicular or bipedicular approaches were used in 6 cases of thoracic and lumbar hemangiomas. The cervical anterior-lateral approach was adopted in one case of cervical hemangioma. 4-7 ml of 15%-20% bone cement was mixed and injected into the vertebral body to form a cast in the lesions. Re-examination of clinical symptoms, plain film, and CT were made for 1, 3, and 9 months of post-procedure follow-up.</p><p><b>RESULTS</b>Good results were achieved in all the seven cases. Pain was completely relieved in 5 cases and partially relieved in 2 cases. Symptom was also recovered in 2 patients with radiculopathy. No recurrence was found after 1-9 months of postoperative follow-up.</p><p><b>CONCLUSION</b>Treatment of vertebral hemangioma with percutaneous vertebroplasty is safe and effective with minimal invasion.</p>

Embolization of intracranial aneurysms with new mechanically detachable coils / 中国医学科学院学报

<p><b>OBJECTIVE</b>To primarily embolize intracranial aneurysms with new-developed mechanically detachable coils, which is called Detachable Coil System (DCS).</p><p><b>METHODS</b>Five intracranial aneurysms were embolized with DCS, in which 2 were giant aneurysms. DCS with J coils were initially used to make baskets in giant aneurysms, and then other kinds of coils were utilized to pact the aneurysmal cavity. Whereas, spiral coils were mostly used in smaller aneurysms. Coils of DCS were detached by rotating the delivering wire after the coils were satisfactorily positioned in aneurysms.</p><p><b>RESULTS</b>Two of the 5 cases were totally occluded with DCS. Two was sub-totally embolized. Pushing, withdrawal, and adjusting of DCS were safe and efficient. Detachment of DCS was fast. In one case of wide-necked giant aneurysm, coils could not stay inside the aneurysm, which was treated by occlusion of the parent artery.</p><p><b>CONCLUSIONS</b>DCS is a new addition to the interventional radiologist's armamentarium. Detachment is faster. J coils are suitable for giant aneurysms for its unique way of coiling. But more evaluation depends on accumulation of the clinical usage.</p>