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Objective@#: To evaluate the safety and efficacy of an overlapped stenting-assisted coiling technique in treating vertebral artery dissecting aneurysm (VADA) via Low-profile Visualized Intraluminal Support (LVIS) stent-within-Neuroform EZ stent. @*Methods@#: From January 2017 to June 2019, 18 consecutive patients with VADAs (ruptured : unruptured=5 : 13) were treated with the overlapping stents assisted-coiling technique in our center. The overlapping manner was a Neuroform EZ stent being deployed first, followed by LVIS stents placement using the ‘shelf’ technique. The patients’ clinical characteristics, technical feasibility and safety, and immediate and follow-up angiographic results were retrospectively reviewed. @*Results@#: Seventeen (94.4%) procedures were technically successful with an exact deployment of the stents and patent parent or perforator arteries. The immediate angiographies after procedure confirmed Raymond class I, II, and III occlusion of VADAs were in 12 (66.7%), two (11.1%), and four cases (22.2%), respectively. Post-procedural complications developed in one patient (5.6%) with minor brainstem infarctions, which resulted from an in-stent thrombosis during the procedure. Angiographic follow-up at 5.7 months (range 3 to 9 months) demonstrated Raymond class I and II occlusion were in all cases (100%). The modified Rankin Scale scores at 21.3 months (range 15 to 42 months) 0–2 in 17 cases (94.4%) and three in one case (5.6%). @*Conclusion@#: Overlapping stents via LVIS stent-within-Neuroform EZ stent combined with coiling is safe and effective for patients with VADA in the midterm results.
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Objective Few researches have been reported about thromboelastography(TEG)in detecting the complications after stent-assisted coiling for intracranial aneurysms. This study aimed to investigate the value of TEG in predicting thromboembolic complications in patients with intracranial aneurysms after stent-assisted coiling. Methods We retrospectively analyzed the clinical data on 152 cases of intracranial aneurysms undergoing stent-assisted coiling in our department,18 with and 134 without thrombosis. We assessed the effects of antiplatelet drugs by TEG,recorded the general data and postoperative complications,and identified the po-tential risk factors for thromboembolic complications by multivariate logistic regression analysis. Results The incidence rate of aspi-rin resistance was significantly lower than that of clopidogrel resistance(10.5% vs 30.3%,P<0.05). Thromboembolic complications were observed in 18 patients during the perioperative and follow-up periods. Multivariate logistic regression analysis showed that the in-dependent risk factors for thromboembolic complications were the maximum amplitude of TEG(OR=1.152,95% CI:1.002-1.300, P=0.021)and aspirin resistance(OR=4.945,95% CI:1.408-17.375,P=0.013). Conclusion TEG is effective in evaluating the effects of antiplatelet drugs in patients with intracranial aneurysms undergoing stent-assisted coiling. Elevated maximum amplitude of TEG and aspirin resistance may increase the risk of thromboembolic complications.
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OBJECTIVE: To determine the relationship between intravoxel incoherent motion (IVIM) imaging derived quantitative metrics and serum soluble CD40 ligand (sCD40L) level in an embolic canine stroke model. MATERIALS AND METHODS: A middle cerebral artery occlusion model was established in 24 beagle dogs. Experimental dogs were divided into low- and high-sCD40L group according to serum sCD40L level at 4.5 hours after establishing the model. IVIM imaging was scanned at 4.5 hours after model establishment using 10 b values ranging from 0 to 900 s/mm². Quantitative metrics diffusion coefficient (D), pseudodiffusion coefficient (D*), and perfusion fraction (f) of ischemic lesions were calculated. Quantitative metrics of ischemic lesions were normalized by contralateral hemisphere using the following formula: normalized D = D(stroke) / D(contralateral). Differences in IVIM metrics between the low- and high-sCD40L groups were compared using t test. Pearson's correlation analyses were performed to determine the relationship between IVIM metrics and serum sCD40L level. RESULTS: The high-sCD40L group showed significantly lower f and normalized f values than the low-sCD40L group (f, p 0.05). Both f and normalized f values were negatively correlated with serum sCD40L level (f, r = −0.789, p 0.05). CONCLUSION: The f value derived from IVIM imaging was negatively correlated with serum sCD40L level. f value might serve as a potential imaging biomarker to assess the formation of microvascular thrombosis in hyperacute period of ischemic stroke.