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Objective ToexploretheapplicationofVasoCT,astentimagingtechnique,instent-assisted coilaneurysmembolization.Methods Twentyconsecutivepatientswith23intracranialaneurysmswere treated with stent-assisted aneurysm embolization in the General Hospital of Armed Police Forces from December 2013 to November 2014 were enrolled. The patients performed VasoCT scan immediately after procedure. Then all the available images were used for stent-optimized reconstruction respectively. Under the XpertCT mode,the available images were observed with both volume imaging and maximum intensity projection. The available images were analyzed and they were divided into very clear,less clear,and not clearaccordingtothestentdevelopingclarity.Results Ofthe22aneurysmstreatedwithstent-assisted embolization,16 were occluded completely,6 were occluded partially. All the stents were expanded completely and were released to the expected locations;11 aneurysm stents developed clearly,9 developed less clearly,and 2didnotdevelopclearly.Conclusion VasoCTcanbeusedinthestent-assistedaneurysmembolization.It can clearly reveal the microscopic structure of the stents,location,relationship with the artery wall,and relationship between stents and coils. The clarity of stent development is associated with the diameters of the packed coils,and the stents are also affected by the metal artifacts projecting direction and the dense degree of the packing coils.
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Objective Toinvestigatethemolecularmechanismsofmitochondrialpathway-mediated apoptosisinintracranialaneurysminitiationinrabbits.Methods FifteenNewZealandwhiterabbitswere divided into 3 groups using the computer random method. After using bilateral carotid artery ligation for modeling basilar artery aneurysm,they were divided into a 2-day group (n=3),a 7-day group (n=6)(3 of them were used for real-time quantitative polymerase chain reaction [PCR]analysis),and a sham operation group (n=6)(3 of them were used for real-time quantitative PCR analysis). The tissue of apex of basilar artery was harvested and the histopathological changes in the vascular wall were observed. TUNEL staining was used to detect apoptotic cells and immunohistochemical staining,and quantitative analysis was used to analyze inflammatory cell distribution. Real-time quantitative PCR was used to detect the expression of apoptosis-related protein mRNA. Results (1 )After modeling,the apoptotic cells were found at the apex of basilar artery in rabbits (the site of internal elastic layer lesion )of the 2-day group and 7-day group. In the 2-day group after operation,the numbers of apoptotic cells (4. 02 ± 0. 21)were significantly higher than those of the basilar artery trunk (0. 40 ± 0. 13),the left posterior cerebral artery (0. 41 ± 0.22),and the right posterior cerebral artery (0. 29 ± 0. 11). The differences were statistically significant (P<0. 05). After modeling,the numbers of apoptotic cells (5. 01 ± 0. 29)of the 7-day group were significantly higher than those of the basilar artery trunk (0. 49 ± 0. 21),the left posterior cerebral artery (0. 31 ± 0. 12),and the right posterior cerebral artery (0. 41 ± 0. 19)(P<0. 05). The internal elastic layer lesions and apoptotic cells were not observed in the rabbits of the sham operation group. (2)After modeling, the expression levels of caspase 9 (1. 97 ± 0. 23)and caspase-3 mRNA (2. 31 ± 0. 40)at the apex of basilar artery in rabbits of the 7-day group were increased significantly compared with that of the sham group (P<0.01).Conclusion Apoptosisisinvolvedintheearlyprocessofaneurysmsinsimple hemodynamics-induced basilar terminus aneurysm formation. Its molecular mechanisms are activated by Bcl-2-mediated mitochondrial pathway through caspase-9.
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Objective Todetecttheexpressionlevelsoftumornecrosisfactor-α(TNF-α)and interleukin-6(IL-6)inintracranialaneurysms.Methods Sixteenconsecutivepatients(aneurysm group)with intracranial aneurysm confirmed by digital subtraction angiography (DSA)and clipped by microneurosurgery were enrolled retrospectively. A total of 19 trauma patients without vascular disease confirmed by CT and magnetic resonance imaging (MRI)in the same period were used as a control group. Hematoxylin-eosin (HE)staining and immunohistochemical staining were used to detect the aneurysm wall tissue and the colored portions of TNF-α and IL-6 in normal vessel wall,the mean value of optical density after its expression was analyzed,and the intensity of staining was compared. Results (1)Each layer of artery walls of the control group had no obvious TNF-α and IL-6 expression. The inner,media and out membranes of the aneurysm wall tissue of the aneurysm group had positive expression of TNF-αand IL-6. (2)The mean optical densities of TNF-α and IL-6 in patients of the aneurysm group were 0. 182 ± 0. 069 and 0. 148 ± 0.062 respectively,and they were higher than 0. 144 ± 0. 031 and 0. 105 ± 0. 020 of the control group. The differences were statistically significant (all P<0. 05). (3)The mean optical densities of TNF-α expression of each layer of the inner,media and out membranes in the aneurysm walls were 0. 224 ± 0. 071,0. 134 ± 0. 040,and 0. 106 ± 0. 065,respectively. There were significant differences (P<0.01). (4)The mean optical density expressed by IL-6 in the out membrane of the aneurysm walls was lower than the media and inner membranes (0. 096 ± 0. 018 vs. 0. 145 ± 0. 050,and 0. 148 ± 0. 070). There were significant differences (P<0. 05). (5)The results of Spearman correlation analysis showed that the mean optical density of TNF-αof the aneurysm group was positively correlated with that of IL-6 (r=0. 452, P<0.05).Conclusion TheexpressionlevelsofTNF-αandIL-6intheaneurysmwalltissueare higher,and they may be involved in intracranial aneurysm formation and rupture.
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ObjectiveToinvestigatetheroleofimmuneinflammatoryreactionintheformationof intracranial aneurysm. Methods The intracranial aneurysms in 40 patients of craniotomy ( intracranial aneurysm group) and the vascular specimens in 20 craniotomy patients w ith traumatic brain injury (control group) w ere col ected. Fluorescence quantitative polymerase chain reaction w as used to detect the expression of interleukin (IL)-17 receptor in the arterial w al . Flow cytometry w as used to detect the Th-17 cel s in peripheral blood. Enzyme-linked immunosorbent assay w as used to measure the levels of IL-17, IL-6 in the arterial w al and tumor necrosis factor-α( TNF-α) in peripheral blood. Results There w ere no significant differences in the age (62.6 ±8.7 years vs.61.4 ±7.9 years;t=0.342;P=0.681), proportions of male (60.0%vs.65.0%; χ2 =0.246, P=0.434), hypertension ( 12.5%vs.10.0%; χ2 =0.315, P=0.492), diabetes (75.0%vs.10.0%; χ2 =0.284, P=0.482), and smoking (35.5%vs.30.0%; χ2 =0.224, P=0.413) betw een the intracranial aneurysms group and the control group. The expression of IL -17 receptor in the arterial w al (0.106 ±0.032 vs.0.264 ±0.071; t=5.115, P=0.001) and the proportion of Th17 cels in peripheral blood (2.75%±0.53%vs.7.18%±1.54%; t=8.436, P<0.001) and IL-17 level ( 7.32 ±1.82 μg/L vs.22.64 ±4.51 μg/L; t= 8.357, P< 0.001 ) in the control group w ere significantly low er than those in the intracranial aneurysm group. The levels of IL-6 (1.15 ±0.24 μg/L vs. 19.64 ±4.16 μg/L; t=9.527, P<0.001) and TNF-α(1.43 ±0.31 μg/L vs.26.17 ±4.32 μg/L; t=9.816, P<0.001) in the arterial wal in the control group were significantly lower than those in the intracranial aneurysm group. Conclusions The expression of IL-17 receptor in the arterial w al , the proportion of the Th17 cels and IL-17 level in peripheral blood were increased in patients with intracranial aneurysms. Immune inflammation may be involved in the formation of intracranial aneurysm.
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ObjectiveToinvestigatetheclinicalfeatures,riskfactorsforbleedingandtreatment outcomes in moyamoya disease patients w ith intracranial aneurysms. Methods The clinical symptoms, location and size of aneurysm, treatment and the long-term folow-up results of the moyamoya disease patients w ith intracranial aneurysms w ere analyzed retrospectively. Results A total of 34 moyamoya disease patients w ith intracranial aneurysms (35 aneurysms) w ere enrol ed, including 22 (64.7%) in the intracranial hemorrhage group and 12 ( 35.3%) in the non-intracranial hemorrhage group. Of the 35 intracranial aneurysms, 23 (main artery type 11, peripheral artery type 12) w ere in the intracranial hemorrhage group and 12 (main artery type 11, peripheral artery type 1) w ere in the non-intracranial hemorrhage group. There w ere 29 smal aneurysms and 6 medium aneurysms (al w ere patients w ith hemorrhagic moyamoya disease). The aneurysms w ere mainly peripheral arterial type in the intracranial hemorrhage group, and the aneurysms w ere mainly artery type in the non-intracranial hemorrhage group. There w as significant difference in aneurysm typing betw een the tw o groups ( P= 0.013 ). Tw o patients did not perform encephalo-duro-arterio-synangiosis (EDAS) in the intracranial hemorrhage group, other patients and those of the non-intracranial hemorrhage group performed EDAS. Angiographical reexamination revealed that 3 patients w ith peripheral aneurysm disappeared, and 1 aneurysm recurred after aneurysm embolization, and the remaining aneurysms did not have any change. Long-term fol ow-up show ed that 1 patient died of sudden cerebral hemorrhage at 1 year after procedure in the intracranial hemorrhage group, and the others did not have ischemic or hemorrhagic stroke. The modified Rankin scale scores w ere improved in 21 patients. Conclusions There are differences in moyamoya disease patients w ith intracranial aneurysm typing w ith different clinical manifestations. Moyamoya disease patients w ith intracranial aneurysms are mostly smal aneurysms and they can not temporarily be treated directly and can perform EDAS directly. Intracranial aneurysms after procedure may remain long-term stability, and some peripheral aneurysms may disappear.
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Objective Toinvestigatetheimpactofthedifferentrupturepoints(sac,neck,andtop) of intraoperative aneurysm rupture (IAR)on the prognosis of patients in anterior circulation aneurysm clipping.Methods Theclinicaldataof135consecutivepatients(148aneurysms)acceptedmicrosurgical aneurysm clipping from May 2009 to March 2012 were analyzed retrospectively. The prognostic evaluation of the patients after procedure was assessed by using the Glasgow outcome scale (GOS). The different aneurysm rupture points of IAR were used as influencing factors,and the relationship between the different rupture pointsandtheprognosisofpatientswasanalyzed.Results Duringclippingof148aneurysmsin 135 patients,31 aneurysms in 30 patients had intraoperative rupture (20. 9% of the aneurysms, 22.2% of the patients). Nine rupture points occurred on the top of aneurysms,17 occurred on the sac,and 5 occurred on neck. The Glasgow outcome scale (GOS)scores 5,4,3,2 and 1 were in 17,8,2,1 and 2 patients,respectively. A total of 25 patients had good prognosis and 5 cases had poor prognosis. There were no significant differences in the impact of different rupture points of IAR on the prognosis in patients of IAR (OR,100. 00,95% confidence interval 6. 764-18. 344,P=0. 006). Of the 25 patients with aneurysm sac or top rupture,1 case had poor prognosis. Of the 5 patients with aneurysm neck rupture, 4caseshadpoorprognosis.Conclusion Inanteriorcirculationaneurysmclipping,thedifferent aneurysm rupture points may have significant impact on the prognosis of patients,the aneurysm neck rupture is a main factor for resulting in the poor prognosis of patients.
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Objective To evaluate the role and effect of intraoperative microvascular Doppler ultrasonography(IMD)in the in-tracranial aneurysm clipping operation.Methods The blood flow velocities of aneurysmal sac,adjacent vessels and parental arteries were determined by IMD before and after clipping in 79 cases of intracranial aneurysm clippings;the influence of IMD on the effect of craniotomy for intracranial aneurysm clipping was comparatively analyzed.Results IMD demonstrated that the clip adj ustment was more likely to happen in the patients with anterior intracranial artery(ACA),anterior communication artery(ACoA)and middle intracranial artery(MCA)aneurysms,and the patients with complex,giant aneurysm due to the change of blood flow velocity in ad-jacent vessels and parental arteries caused by inadvertent occlusion or incomplete closure.In addition,the higher the preoperative Hunt-Hess classification,the easier the inadvertent occlusion or incomplete closur;the patients with conventional use of intraopera-tive IMD were significantly superior to those without intraoperative IMD in the aspects of the postoperative hospital stay,reopera-tion rate,postoperative GOS and complication occurence rate.Conclusion The routing use of IMD in the intracranial aneurysm clip-ping operation conduces to find the inadvertent occlusion or incomplete closure and the timely adj ust the aneurysm clip position;the IMD can assist operation can significantly improve the postoperative GOS score,short the hospital stay and reduce the reoperation rate and the probability of complication occurrence.