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Objective@#Idiopathic intracranial hypertension (IIH) is a condition of unknown etiology associated with venous sinus stenosis. This study aimed to develop a magnetic resonance venography (MRV)-based radiomics model for predicting a high trans-stenotic pressure gradient (TPG) in IIH patients diagnosed with venous sinus stenosis. @*Materials and Methods@#This retrospective study included 105 IIH patients (median age [interquartile range], 35 years [27– 42 years]; female:male, 82:23) who underwent MRV and catheter venography complemented by venous manometry. Contrast enhanced-MRV was conducted under 1.5 Tesla system, and the images were reconstructed using a standard algorithm. Shape features were derived from MRV images via the PyRadiomics package and selected by utilizing the least absolute shrinkage and selection operator (LASSO) method. A radiomics score for predicting high TPG (≥ 8 mmHg) in IIH patients was formulated using multivariable logistic regression; its discrimination performance was assessed using the area under the receiver operating characteristic curve (AUROC). A nomogram was constructed by incorporating the radiomics scores and clinical features. @*Results@#Data from 105 patients were randomly divided into two distinct datasets for model training (n = 73; 50 and 23 with and without high TPG, respectively) and testing (n = 32; 22 and 10 with and without high TPG, respectively). Three informative shape features were identified in the training datasets: least axis length, sphericity, and maximum three-dimensional diameter.The radiomics score for predicting high TPG in IIH patients demonstrated an AUROC of 0.906 (95% confidence interval, 0.836– 0.976) in the training dataset and 0.877 (95% confidence interval, 0.755–0.999) in the test dataset. The nomogram showed good calibration. @*Conclusion@#Our study presents the feasibility of a novel model for predicting high TPG in IIH patients using radiomics analysis of noninvasive MRV-based shape features. This information may aid clinicians in identifying patients who may benefit from stenting.
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Objective To investigate the feasibility, safety and efficacy of the stent-assisted coil embolization for the treatment of wide-necked anterior communicating artery (ACoA) aneurysms. Methods From November 2011 to November 2014, the clinical data of the patients with wide-necked ACoA aneurysms treated by using the stent-assisted coil embolization were analyzed retrospectively. The clinical and radiographic effects were summarized. The perioperative complications were focused on. Results The ACoA wide-neck aneurysms of 29 patients were treated with stent-assisted coil embolization. Two of them abandoned the interventional treatment because of stents could not be in place and release. The immediate results of interventional treatment showed that 21 were embolized completely (78% ), 5 were near totaly embolized (19% ), and 1 was partialy embolized (3% ). Three patients had intraoperative thrombosis (recanalization achieved after thrombosis, one of them died of cerebral hemorrhage after thrombolysis). One patient suffered cerebral angiospasm, one had aneurysm rupture, and one had distal rupture of the anterior cerebral artery. Twenty-seven patients received clinical folow-up, and the folow-up time ranged from 2 to 36 months (mean 17 months). None of the patients had hemorrhagic or ischemic complications. Sixteen patients received imaging folow-up, and the folow-up ranged from 6 to 12 months (mean 7 months). None of the aneurysms had recurrence. Conclusions Stent-assisted coil embolization of wide-necked ACoA aneurysm is overal feasible, safe, and effective although there are certain risks.
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@#Objective To summarize the technique of stent combined with coils to treat middle cerebral artery bifurcation wide-necked aneurysms. Methods 15 patients were reported. Results 11 of 15 aneurysms were completely occluded and 4 were incompletely (>95%) occluded. Transient ischemia of cerebral occurred in a case. 8 aneurysms were followed up for 6～12 months, 1 presented neck remnant growth. Conclusion It is satisfied to use the stent combined with coils to treat middle cerebral artery bifurcation wide-necked aneurysm, which may protect the parent artery.
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@# ObjectiveTo summarize the technique and preliminary outcome of Neuroform stent combined with Guglielmi detachable coil (GDC) to treat wide-necked intracranial aneurysms. Methods32 cases with aneurysms which underwent 32 endovascular procedures performed by using stent were retrospectively analyzed.The ratio of aneurysm neck/body is 1/2～1/1. Results24 aneurysms were completely occluded and other 8 were incompletely (>95%) occluded. Transient ischemia of cerebral occured in 2 cases. 14 aneurysms were followed up 0.5～1 year after. 2 aneurysms of them appeared neck remnant growth.ConclusionUsing Neuroform stent combined with GDC to treat wide-necked intracranial aneurysm may prevent the herniation of GDC into the artery and increase the outcome of wide-necked intacranial aneurysm.
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Objective To evaluate the efficacy of facial vein-superior ophthalmic vein approach to embolize carotid-cavernous sinus fistulas.Metheds The involved cavernous sinus was catheterized through the femoral vein-facial vein- superior ophthalmic vein approach, GDC, EDC, free microcoil, or silk were used to pack the sinus and occlude the shunt. If therer was any difficulty in catheterizing the faical vein, facial vein was exposed surgically and punctured, and then, through the superior opthalmic vein, the cavernous sinus was packed. Results 16 cavernous sinuses in 14 CCF patients(5 traumatic CCFs, 9 dural CCFs) were catheterized through facial vein-superior ophthalmic vein approach, and the technical success was achieved in 15 cavernous sinuses. Immediate angiographic cure of the shunts was achieved in 11cases, residual shunts with inferior petral sinus drainage in 2. Facial vein occlusion was encountered in 1 patient during the facial vein catheterization, further packing of the cavernous sinus was not performed, but follow-up angiography at the 21 st day revealed the spontaneous cure of the shunt. The VI cranial nerve palsy present after balloon embolization in a type A CCF was not improved after the packing of the cavernous sinus. Ocular symptoms in other patients disappeared after tranvenous embolization. The clinical follow-up period ranged from 3 to 21 months, no recurrence of the symptoms was found. Follow-up angiography in 2 patients with residual shunting showed the unchanged shunts, no further embolization was performed. No follow-up angiography was performed in other patients.Conclusions The facial vein-superior ophthalmic vein approach can be chosen as an optimum treatment for dural CCFs, and an important alternative treatment for type A CCFs after the failure of the initial balloon embolization.