Clinical application of Neuroform Atlas stent-assisted coiling in the treatment of unruptured wide-neck intracranial aneurysms / 北京大学学报(医学版)

OBJECTIVE@#To assess the safety and efficacy of Neuroform Atlas stent used in treatment of unruptured wide-neck intracranial aneurysms.@*METHODS@#Clinical data of 62 patients with unruptured wide-neck intracranial aneurysms undergoing Neuroform Atlas stent-assisted coiling from August 2020 to September 2021 were retrospectively analyzed. There were 64 aneurysms in those 62 patients. Among them, 25 aneurysms were located at the bifurcation of M1 segment on middle cerebral artery, 16 at the anterior communicating artery, 10 at the C7 segment of internal carotid artery, 5 at the C6 segment of internal carotid artery, 4 at the apex of basilar artery, 3 at the A3 segment of anterior cerebral artery, and 1 at the M2 segment of middle cerebral artery. All the patients underwent Neuroform Atlas stent-assisted coiling, including 49 patients with single stent assisted coiling and 15 patients with dual stents assisted coiling (14"Y"style and 1"X"style). After the procedure, the immediate DSA was performed to evaluate the status of aneurysm occlusion and the parent artery patency. The clinical follow-up was performed 3 months after the operation and evaluated based on the modified Rankin Scale(mRS).DSA image was reviewed at 6 months after operation and Raymond grading scale was used to assess the status of aneurysm occlusion and the parent artery patency.@*RESULTS@#A total of 62 patients with 64 aneurysms were all achieved technical success(100%).The immediate post-procedural Raymond scale was assessed, including Raymond Ⅰ in 57 aneurysms(89.1%, 57/64), Raymond Ⅱ in 6 aneurysms(9.3%, 6/64) and Raymond Ⅲ in 1 aneurysm(1.6%, 1/64). The peri-procedural complications rate was 4.8%(3/62), 2 patients developed intraoperative thrombosis and 1 patient suffered from local subarachnoid hemorrhage. Among them, 55 patients obtained 3 months clinical follow-up after operation and all the patients had good outcomes (mRS≤2), 50 patients with 52 aneurysms were followed up with DSA 6 months after operation, including Raymond Ⅰ in 45 aneurysms(86.5%, 45/52), Raymond Ⅱ in 4 aneurysms(7.7%, 4/52) and Raymond Ⅲ in 3 aneurysms(5.8%, 3/52).@*CONCLUSION@#Neuroform Atlas stent for the treatment of unruptured wide-neck intracranial aneurysms has high safety and good efficacy, and has its advantages over other traditional stents.

Antepartum cerebral angiopathy presenting as middle cerebral artery aneurysm rupture – A rare case report from India

The incidence of middle cerebral artery aneurysm rupture in pregnancy is rare. Rupture of an intracranial aneurysm is the most common cause of subarachnoid hemorrhage in pregnancy and during puerperium. Intracranial aneurysm rupture during pregnancy is disastrous for the mother as well as the fetus. We report a case of a dissecting left middle cerebral artery aneurysm in a 25-year-old woman, G2P1L1, at 18 weeks of gestation, who presented with a 1-day history of giddiness, slurring of speech, and facial deviation to the left.

Symptomatic internal carotid artery dissection and kinking in a patient with fibromuscular dysplasia / Dissecção e acotovelamento sintomáticos da artéria carótida interna em paciente com displasia fibromuscular

Abstract Isolated dissection of the internal carotid artery (ICA) is rare in young patients and is a cause for strong suspicion of fibromuscular dysplasia (FMD), especially when associated with artery elongation and tortuosity. The natural history of cerebrovascular FMD is unknown and management of symptomatic patients can be challenging. We report the case of a 44-year-old female patient with a history of transient ischemic attack in the absence of cardiovascular risk factors, associated with an isolated left ICA dissection and kinking. Carotid duplex ultrasound confirmed the diagnosis of dissection and demonstrated severe stenosis of the left ICA. The patient underwent surgical repair and histopathological evaluation confirmed the diagnosis of FMD with dissection. An autogenous great saphenous vein bypass was performed and the patient had an uneventful recovery. Cervical carotid artery dissection can be related to underlying arterial pathologies such as FMD, and the presence of ICA tortuosity highlights certain peculiarities for optimal management, which might be surgical.

Resumo A dissecção isolada da artéria carótida interna em pacientes jovens é rara, e a displasia fibromuscular deve ser altamente suspeitada principalmente quando estiver associada a alongamento e tortuosidade da artéria. A história natural da displasia fibromuscular cerebrovascular é desconhecida, e o manejo de pacientes sintomáticos pode ser desafiador. Apresentamos o caso de uma paciente de 44 anos com histórico de ataque isquêmico transitório sem fatores de risco cardiovasculares, associado a dissecção e acotovelamento isolados da artéria carótida interna esquerda. O ultrassom duplo das carótidas confirmou o diagnóstico de dissecção e demonstrou estenose grave na artéria carótida interna esquerda. A paciente foi submetida a reparo cirúrgico, e a avaliação histopatológica confirmou o diagnóstico de displasia fibromuscular com dissecção. Foi realizada cirurgia de ressecção do segmento e reconstrução com veia safena magna autógena, e a paciente se recuperou sem complicações. A dissecção da artéria carótida cervical pode estar relacionada a doenças arteriais subjacentes, como a displasia fibromuscular, e a presença da tortuosidade da artéria carótida interna destaca algumas particularidades no manejo ideal, o qual pode ser cirúrgico.

Study of umbilical coiling index and perinatal outcome

Background: Study was to evaluate the relationship between umbilical coiling index (UCI) and hypo-and hyper coiling of the umbilical cord and parity, neonatal weight, Ponderal Index (PI), APGAR (Appearance, pulse, grimace, activity, and respiration) score, meconium staining of the amniotic fluid, Intrauterine growth restriction (IUGR), hypertensive disorders of pregnancy and delivery interventions.Method: A prospective analytical study was performed from January 2017 to December 2018. Total of 300 patients giving birth at labour room of SCB Medical College, Cuttack were taken into study. Immediately following delivery, the umbilical cord was clamped at the foetal end and cut with scissors. UCI, mode of delivery and perinatal outcome was followed up.Results: There were 149 lower segment caesarean sections accounting to 49.7% and 151 vaginal deliveries including instrumental deliveries which was accounting to 50.3%. Minimum number of coils observed was 2. The maximum number of coils observed was 50. Caesarean section was more in hypo coiling group. APGAR score at 5 min was calculated and there was a total of 109 neonates who had APGAR <7 at 5 minutes (36.33%) out of which there were 17 neonates with hypo coiling (2.33%), 77 neonates with normo-coiling (25.66%) and 15 neonates with hyper coiling (5%). Meconium staining and instrumental delivery was more associated with hyper coiling.Conclusion: Both hyper-coiling and hypo-coiling had significant correlation with adverse perinatal outcome. If the UCI can be measured reliably in utero by ultrasound, then it might be a promising prognostic marker for adverse pregnancy outcome.

A rare case of gastroduodenal artery aneurysm in a highly active antiretroviral therapy induced acute pancreatitis case presenting with lump in abdomen

Gastroduodenal artery (GDA) aneurysm is a rare but potentially fatal vascular disease, with chronic pancreatitis being reported as the commonest etiological factor. Rupture, which is not uncommon, carries a high risk of mortality. The typical patient with palpable epigastric mass, upper gastrointestinal bleeding and pain, may not present in the emergency and the lesion is often picked up incidentally on abdominal ultrasound or a computed tomography. We describe a critical case presenting with lump in abdomen which was found out to be gastroduodenal artery aneurysm on scanning, developing in a patient with recurrent highly active antiretroviral therapy (HAART) induced pancreatitis managed with transfemoral catheter embolization. The patient in question succumbed due to post procedure hepatic failure. The management of aneurysms since historic times have been challenging, the open procedures are being gradually replaced by endovascular techniques, which are yielding better results.

Deficiency of the transcription factor PLAG1 results in aberrant coiling and morphology of the epididymis / 亚洲男科学杂志(英文版)

Mice deficient in the transcription factor pleomorphic adenoma gene 1 (PLAG1) exhibit reproductive issues that are characterized, in part, by decreased progressive sperm motility in the male. However, the underlying cause of this impairment is unknown. As epididymal transit is critical for sperm maturation and motility, the morphology of the epididymis of Plag1-deficient mice was investigated and the spatial expression patterns of PLAG1 protein and mRNA were identified. Using X-gal staining and in situ hybridization, PLAG1 was shown to be widely expressed in both the epithelium and stroma in all regions of the mouse epididymis. Interestingly, the X-gal staining pattern was markedly different in the cauda, where it could be suggestive of PLAG1 secretion into the epididymal lumen. At all ages investigated, the morphology of epididymides from Plag1 knockout (KO) mice was aberrant; the tubule failed to elongate and coil, particularly in the corpus and cauda, and the cauda was malformed, lacking its usual bulbous shape. Moreover, the epididymides from Plag1 KO mice were significantly reduced in size relative to body weight. In 20% of Plag1-deficient mice, the left testicle and epididymis were lacking. The impaired morphogenesis of the epididymal tubule is likely to be a major contributing factor to the fertility problems observed in male Plag1-deficient mice. These results also establish PLAG1 as an important regulator of male reproduction, not only through its involvement in testicular sperm production, but also via its role in the development and function of the epididymis.

Long-term clinical outcomes of patients with aneurysmal subarachnoid hemorrhage in Yunnan Province / 南方医科大学学报

OBJECTIVE@#To investigate the clinical outcomes of patients with aneurysmal subarachnoid hemorrhage (aSAH) after surgeries in Yunnan Province.@*METHODS@#We retrospectively analyzed the demographic features, vascular risk factors, severity at admission, and aneurysm locations in 85 patients with aSAH receiving surgical interventions in Yunnan Province. All the patients were treated by aneurysm clipping or coiling and followed up for clinical outcomes and recovery of daily activities evaluated by modified Rankin Scale (mRS) and Activities of Daily Living (ADL) scale, respectively.@*RESULTS@#Thirty-four of the patients (40.0%) underwent aneurysm clipping and 51 (60.0%) underwent aneurysm coiling. During a median follow- up period of 66.23 months (IOR, 12.03 months), 84.7% of the patients had low mRS scores, and 78.8% lived independently. The WFNS grade at admission was significantly correlated with the follow-up mRS scores (95%: 1.48-19.09, =0.011) and ADL (95%: 2.55-28.77, 0.05), but the cost of hospitalization was significantly higher in coiling group than in the clipping group ( < 0.001).@*CONCLUSIONS@#Both aging and a high WFNS grade at admission are associated with a poor prognosis of aSAH, for which aneurysm clipping and coiling have similar long- term outcomes, but for patients with a high WFNS score, aneurysm clipping is favored over coiling in terms of health economics.

Relationship of umbilical coiling index and cord twist direction with adverse perinatal outcomes

Background: The main objectives of this study were to examine - (1) relationship of pregnancy-related factors (maternal age, gestational diabetes mellitus, pregnancy-induced hypertension, oligohydramnios, small for gestational age (GA), and fetal gender) and postnatally measured umbilical coiling index (UCI); (2) association of UCI and cord twist directions with the following adverse perinatal outcomes, meconium staining of amniotic fluid, non-reassuring FHR on CTG, low Apgar score (<7) at one and five minutes, low birth weight, and NICU admission.Methods: The inclusion criteria were singleton live-birth pregnancy with GA > 34 weeks. The cases were categorized in hypocoiled (UCI <10th percentile), hypercoiled (UCI >90th percentile) and normocoiled groups. To study relationship of pregnancy-related factors and UCI multivariate logistic regression was used; whereas bivariate analysis was used to study impact of UCI on various adverse perinatal outcomes. UCI was measured by a single observer.Results: In total, 100 subjects were enrolled. The mean UCI was 0.268 (SD = 0.13; 10th percentile = 0.139; 90th percentile =0.410) coils/cm. Pregnancy-related factors had non-significant relationship with UCI. For adverse perinatal outcomes, only the non-reassuring/abnormal FHR patterns were significantly associated with hypercoiled groups (OR = 4.5; CI= 1.15-17.58). Both the cord directions had almost equal distribution without any significant difference in outcomes; however, anticlockwise twisted cords were found to have significantly high UCI.Conclusions: No significant relationship was observed with pregnancy-related factors and UCI. However, it was observed that hypercoiled cords had significant association with non-reassuring/abnormal FHR patterns on CTG.

Approaches To A-Com Artery Aneurysms: Different Paths For One Goal

BACKGROUND: A-com artery aneurysms are the most common intracranial aneurysms. Clipping and coiling are the two options available for treatment of these aneurysms. Microsurgical clipping, although invasive, is more suitable for the economically challenged sector of our society. AIM:To evaluate the mortality and morbidity of clipping A-com artery aneurysms by different surgical approaches.Settings and Design: This is a non-randomized prospective multiple centre study. MATERIALS AND METHODS:Patients with A-com artery aneurysm fullling the inclusion criteria and managed with microsurgical clipping were included in the study. Patients were evaluated preoperatively and postoperatively with CT Scan Brain (Plain), 3D- CT Angiogram of Brain or Digital substraction Angiography of Brain.STATISTICAL ANALYSIS:Data collection and analysis, was performed using the statistical package for the social sciences version 16 (SPSS, INC, Chicago, IL). RESULTS:A total of 34 patients of A-com aneurysms (non-giant) were included in the study. Male: Female ratio of 1.62:1 with male preponderance. All the aneurysms were microsurgically clipped by either Pterional transsylvian or modied gyrus rectus or interhemispheric approach. The mortality and morbidity in different surgical approaches were analyzed. CONCLUSION:Mortality depends on the preoperative grade of subarachnoid hemorrhage. Type of surgical approach has no relation to mortality or morbidity.

Endovascular treatment of ruptured tiny aneurysms

OBJECTIVE: Endovascular coiling of ruptured tiny aneurysms (RTAs) in the brain has been known to be technically challenging owing to the higher rate of adverse events, such as thromboembolism and intraoperative rupture. The aim of this study was to report our ex-periences of endovascular treatment of RTAs (size, ≤3 mm).METHODS: From January 2006 to December 2017, 35 RTAs in 35 patients were treated at our institution with an endosaccular coiling. Procedural data and clinical and angiographic results were retrospectively reviewed.RESULTS: The mean size of the RTAs was 2.53 mm (SD: 0.38). The neck remodeling technique was applied to 14 aneurysms, including stent-assisted coiling (n=7) and balloon-assisted coiling (n=7). Procedure-related complications included intraprocedural rupture (n=2), thromboembolic event (n=1), and early rebleeding (n=2), which needed recoiling. Regarding immediate angiographic control, complete occlusion was achieved in 25 aneurysms (71.4%), small neck remnant in 5 (14.3%), and definite remnant in 5 (14.3%). At the end of follow-up, 31 of the 35 patients (88.6%) were able to function independently. Twenty-two of the 35 patients underwent follow-up conventional angiography (mean, 468 days). Stable occlusion was achieved in 20 of the 22 patients (90.9%), minor recanalization in 1 (4.5%), and major recanalization, which required recoiling, in 1 (4.5%).CONCLUSION: Our experiences demonstrate that endovascular treatment for RTAs is both feasible and effective. However, periprocedural rebleedings were found to occur more often (11.4%) than what is generally suspected.

Clinical effect of staged stent-assisted embolization after initial coiling of acute ruptured wide-neck saccular intracranial aneurysms / 中国脑血管病杂志

Objective: To evaluate the safety and efficacy of coiling in the acute phase followed by staged stenting for ruptured wide-neck saccular intracranial aneurysms. Methods: From November 2006 to December 2017, We retrospectively reviewed 58 consecutive patients with acute ruptured wide-neck saccular intracranial aneurysms(58 ruptured wide-neck saccular intracranial aneurysms) who were treated with staged stent-assisted embolization after initial coiling in the Department of Neurosurgery of NO. 971 Hospital of PLA Navy and the Department of Neurosurgery of First Hospital Affiliated to Naval Medical University. Simple coiling embolization was performed in the acute phase, and stent implantation was performed in the second stage. The immediate postoperative and follow-up angiographic results were assessed using the Raymond scale, and the outcome of clinical follow-up was assessed using the modified Rankin Scale(MRS). Results: All 58 patients(58 ruptured wide-neck saccular intracranial aneurysms) were successfully treated with staged stent-assisted embolization. The median interval of staged stenting treatment was 4. 4(4. 1, 4. 9) weeks. No aneurysm rebleeding occurred prior to the staged stenting treatment. During the treatment of staged stenting, coils were used as many as possible for embolization under the mechanical protection of stents in order to achieve complete occlusion. Immediately after stenting, angiography showed 30 aneurysms (51. 7%) with complete occlusion, 22 aneurysms (37. 9%) with neck remnant and 6aneurysms(10. 3%) with residual sac. One patient suffered in-stent thrombosis two hours after stent implantation, which was relieved with the use of tirofiban. When discharging hospital, showing that a total of 46 patients (79.3%) had MRSO-2, 8 patients(13.8%) had MRS 3 and 4 patients(6.9%) had MRS 4. Imaging follow-up ranged 6-35 months (median 16 months), showing 47 aneurysms (81. 0%) with complete occlusion, 7 aneurysms(12. 1%) with residual neck and 4 aneurysms(6. 9%) with residual sac. There was no recurrence, and the parent arteries were patent in all cases. Clinical follow-up ranged 6-36 months(median 18 months), showing that a total of 8 patients(13. 8%) had MRS 0-2 and 50 patients (86. 2%) had MRS 3. There was no new neurological dysfunction or death. Conclusion: Treatment of ruptured wide-neck saccular aneurysms with coiling in the acute phase followed by staged stenting is safe and effective.

Safety of stent-assisted coiling versus coiling-only in treatment of acute ruptured intracranial wide-necked aneurysms: A comparitive study / 第二军医大学学报

Objective To compare the peri-procedural complications and mortality between stent-assisted coiling versus coiling-only in the treatment for acute ruptured intracranial wide-necked aneurysms. Methods We retrospectively collected the clinical data of patients with acute ruptured intracranial wide-necked aneurysms who underwent stent-assisted coiling (stent group, n＝133) or coiling-only (coiling-only group, n＝289) between Jan. 2012 and Dec. 2014 in Changhai Hospital of Second Military Medical University. After 1∶1 propensity score matching, 104 cases were matched in each group. Baseline characteristics, peri-procedural complication incidences and mortality were compared between the two groups. Results The baseline characteristics (gender, age, location, relationship with parent vessel, maximum diameter, Hunt-Hess grade and Fisher grade of the aneurysms) were similar in the two groups (all P0.05). The hemorrhagic and thromboembolic complication incidences and mortality in the stent and coiling-only groups were 6.7% (7/104), 3.8% (4/104) and 1.9% (2/104), and 1.9% (4/104), 1.9% (4/104) and 1.0% (1/104), respectively, and the differences were not statistically significant (χ2＝1.858, 0.172, 0.000; P＝0.173, 0.679, 1.000). Conclusion The stent-assisted coiling and coiling-only are both safe and feasible for acute ruptured intracranial wide-necked aneurysms. Stents do not increase the risk of peri-procedural complication.

Coiling method combined with bloodletting from the corpus cavernosum for penile incarceration with a metal ring: A case report and literature review / 中华男科学杂志

Objective@#To explore the treatment of penile incarceration with a metal ring.@*METHODS@#Based on our experience in the successful management of a case of penile incarceration with a metal ring by coiling and bloodletting from the corpus cavernosum, we reviewed the relevant literature and analyzed the indications, advantages and disadvantages of different methods for the treatment of penile incarceration with a circular foreign body.@*RESULTS@#The clamping and cutting methods were non-invasive, fast, effective, and with few complications, which could be applied to the treatment of penile strangulation at all levels. However, clamping was not desirable enough for a hard metal ring and the cutting method took a longer time and might increase the risk of unnecessary damage to the penile skin, urethra and cavernous body. Prepuce edema decompression and the thin tube-coiling method, with the advantages of minimal invasiveness, simple operation and no need of special tools, were suitable for penile strangulation injury under level 3, but might cause penile skin injury and potential postoperative erectile dysfunction. Surgical resection, as an invasive procedure, could be applied to severe penile strangulation at level 4 or 5.@*CONCLUSIONS@#The principle for the treatment of penile incarceration with a circular foreign body is to remove the foreign object as soon as possible and not to add secondary damage.

Frontiers and prospects in stent-assisted coiling in acutely ruptured intracranial aneurysms / 医学研究生学报

Stent-assisted coiling has been widely used in endovascular treatment of wide-necked,giant and fusiform intracra-nial aneurysm,and has become an important technique for endovascular treatment of intracranial aneurysms. However,for acutely rup-tured intracranial aneurysms,stent implantation will cause platelet aggregation and increase the incidence of ischemic events. There-fore,dual antiplatelet therapy should be used during perioperative period of endovascular treatment. However,the use of antiplatelet drugs may increase the risk of rebleeding and increase the difficulty and risk of subsequent external ventricular drainage and evacuation of intracranial hematoma. Therefore,the feasibility and safety of stent-assisted coiling in acutely ruptured intracranial aneurysms are still in dispute. In this article,we briefly introduce the progress in stent-assisted coiling in acutely ruptured intracranial aneurysms.

The therapeutic effect of balloon-assisted coiling and stent-assisted coiling of ruptured intracranial aneurysms in the acute phase / 中华急诊医学杂志

Objective To investigate the perioperative complications and therapeutic effects of balloon-assisted coiling (BAC) and stent-assisted coiling (SAC) in patients with ruptured intracranial aneurysms in the acute phase. Methods Totally 91 patients with 91 intracranial ruptured aneurysms were treated with BAC or SAC in our hospital between January 2014 and December 2016. Among them, 37 patients were treated with BAC and 54 patients with SAC respectively. Of the two groups, the position distribution and shape of aneurysms, and the complications after procedures and the therapeutic effects were summarized and evaluated retrospectively using chi-square test. Results The width of the aneurysm neck was narrower in the BAC-treated group compared to the SAC-treated group (3.31±1.63 mm vs. 4.35±2.10 mm, P=0.01). The aneurysm body/neck ratio (B/N) was lower in the BAC-treated group than in the SAC-treated group (1.64 ± 0.46 vs. 1.35±0.66, P=0.025). The recurrence rate was higher in the BAC-treated group than that in the SAC-treated group (18.9％ vs. 0.9％, P=0.005). There was no statistical difference in perioperative complication in both the BAC-treated group and SAC-treated group. However, 2 patients died due to the relative postoperative intracranial bleeding in the SAC-treated group. Better outcomes (Modified Rankin Score, mRS, 0-2) were achieved in the BAC-treated group compared to the SAC-treated group (94.6％ vs. 88.9％, P=0.028) at the follow-up visit. Conclusions These findings suggested that there is no difference between the BAC-treated group and the SAC-treated group in the risk of complication. BAC can achieve a better prognosis,but it is more prone to relapse. The SAC method was more appropriate for wider neck aneurysms. It was also an option to coiling the aneurysm in BAC in acute phase firstly, followed by additional treatment in SAC during the follow-up period.

Kissing Aneurysms at Fenestrated Proximal Basilar Artery: Double-barrel Stent-assisted Coiling Using Dual Closed-cell Stents

Kissing aneurysms associated with a proximal basilar artery fenestration are an exceedingly rare and unique therapeutic challenge due to anatomical complexity. This report describes double-barrel stent-assisted technique with dual closed-cell stents for the successful endovascular coiling of kissing aneurysms from a proximal basilar artery fenestration.

The effect of ultra-early stent-assisted coil embolization in the treatment of ruptured wide-necked intracranial aneurysms / 天津医药

Objective To explore the efficacy of ultra-early stent-assisted coil (SAC) in the treatment of intracranial rupture of wide- necked aneurysms. Methods The angiographic and clinical data of 24 patients (including 8 male, 16 female, age ranged from 29 to 86 years, with a median age 59) with acutely ruptured wide-necked intracranial aneurysms treated with SAC were retrospectively analyzed. The postoperative complications and clinical results were observed. The postoperative embolization was assessed according to the Raymond grading standard. The assessment of the follow-up results from 6 to 12 months after procedure was observed according to the modified Rankin Scale (mRS) score. Results Procedure-related complications occurred in 3 patients (12.5%). All of them were hemorrhagic events, of which 2 cases died. Perioperative death was found in 3 cases. Of the 19 surviving patients, 17 showed good recovery (mRS 0-2). After 6 to 12 months of DSA, no recurrence of aneurysm was found in 10 follow-up patients. Conclusion Ultra-early stent-assisted coil treatment for intracranial wide-neck rupture aneurysm can improve the success rate of embolization and reduce the recurrence.

Preoperative Coiling of Coexisting Intracranial Aneurysm and Subsequent Brain Tumor Surgery

OBJECTIVE: Few studies have investigated treatment strategies for brain tumor with a coexisting unruptured intracranial aneurysm (cUIA). The purpose of this study was to evaluate the safety and efficacy of preoperative coiling for cUIA, and subsequent brain tumor surgery. MATERIALS AND METHODS: A total of 19 patients (mean age, 55.2 years; M:F = 4:15) underwent preoperative coiling for 23 cUIAs and subsequent brain tumor surgery. Primary brain tumors were meningiomas (n = 7, 36.8%), pituitary adenomas (n = 7, 36.8%), gliomas (n = 3, 15.8%), vestibular schwannoma (n = 1, 5.3%), and Rathke's cleft cyst (n = 1, 5.3%). cUIAs were located at the distal internal carotid artery (n = 9, 39.1%), anterior cerebral artery (n = 8, 34.8%), middle cerebral artery (n = 4, 17.4%), basilar artery top (n = 1, 4.3%), and posterior cerebral artery, P1 segment (n = 1, 4.3%). The outcomes of preoperative coiling of cUIA and subsequent brain tumor surgery were retrospectively evaluated. RESULTS: Single-microcatheter technique was used in 13 cases (56.5%), balloon-assisted in 4 cases (17.4%), double-microcatheter in 4 cases (17.4%), and stent-assisted in 2 cases (8.7%). Complete cUIA occlusion was achieved in 18 cases (78.3%), while residual neck occurred in 5 cases (21.7%). The only coiling-related complication was 1 transient ischemic attack (5.3%). Neurological deterioration did not occur in any patient during the period between coiling and tumor surgery. At the latest clinical follow-up (mean, 29 months; range, 2–120 months), 15 patients (78.9%) had favorable outcomes (modified Rankin Scale, 0–2), while 4 patients (21.1%) had unfavorable outcomes due to consequences of brain tumor surgery. CONCLUSION: Preoperative coiling and subsequent tumor surgery was safe and effective, making it a reasonable treatment option for patients with brain tumor and cUIA.

Easy Advancement of a Large-Profile Microcatheter (Excelsior XT27(TM)) by Parallel Use of Two Microguidewires For Stent Delivery / 신경중재치료의학

PURPOSE: In the endovascular treatment of cerebral aneurysms, navigating a large-bore microcatheter for delivery of an open-cell stent can be challenging, especially in wide-necked bifurcation aneurysms. We were able to overcome this difficulty by parallel use of two microguidewires through the stent-delivery microcatheter. MATERIALS AND METHODS: From December 2014 to April 2015, we treated 15 patients with wide-necked bifurcation aneurysms. For stent delivery, we used a 300-cm 0.014-in microguidewire (Transend), which was placed into the target branch using an exchange technique. A 0.027-in microcatheter (Excelsior XT-27), which was designed for the stent, was advanced over the exchange microguidewire. If we had trouble in advancing the microcatheter over the exchange microguidewire, we inserted a regular microguidewire (Traxcess), into the microcatheter lumen in a parallel fashion. We also analyzed the mechanism underlying microcatheter positioning failure and the success rate of the 'parallel-wire technique'. RESULTS: Among the 15 cases, we faced with navigation difficulty in five patients. In those five cases, we could advance the microcatheter successfully by applying the parallel-wire technique. There were no procedure-related complications. CONCLUSION: Simply by using another microguidewire together with pre-existing microguidewire in a parallel fashion, the stent-delivery microcatheter can be easily navigated into the target location in case of any advancement difficulty.

Efficacy comparison of Solitaire AB and Enterprise stent-assisted embolization of intracranial wide-necked aneurysms / 中国脑血管病杂志

Objective To compare the effect of Solitaire AB and Enterprise stent-assisted endovascular embolization of intracranial wide-necked aneurysms. Methods The clinical data 218 patients with intracranial aneurysm treated with Solitaire AB stent or Enterprise stent in Guangdong General Hospital from January 2012 to December 2014 were analyzed retrospectively. Seventy patients were treated with Solitaire AB stents and 148 were treated with Enterprise stents. They were followed up after procedure (2 months to 2 years). The Raymond grade and the modified Rankin scale (mRS)scores were used to compare the efficacy of the 2 kinds of stents. Results There were no significant differences in patients before procedure in the Hunt-Hess grade (Z = 1. 550,P = 0. 121),Fisher grade (Z =1. 537,P =0. 124),aneurysm size (Z =0. 192,P =0. 848),and position (χ2 = 0. 337,P = 0. 736)between the 2 stent groups,while there were no significant differences in patients after procedure in the instant Raymond grade (Z = 0. 682,P = 0. 495), follow-up Raymond grade (Z = 0. 206,P =0. 837),and mRS score (P =0. 662)between the 2 stent groups. Further multivariate Logistic regression analysis showed that the stent type (Solitaire AB stent or Enterprise stent),Raymond grade follow-up grade (OR,0. 029 ,95% CI 0. 126 - 0. 199,P = 0. 661 ),and postoperative mRS score (OR,2. 000,95% CI 0. 204 - 19. 603,P = 0. 552)had no influence on the prognosis. Conclusions In the assisted embolization of intracranial wide-necked aneurysms using the Solitaire AB and Enterprise stents,the effects of both stents are good in the assisted embolization of intracranial wide-necked aneurysms.