A Novel Flow Diverter (Tubridge) for the Treatment of Recurrent Aneurysms: A Single-Center Experience

OBJECTIVE: The Tubridge flow diverter (FD) is a novel device aimed at reconstructing the parent artery and occluding complex aneurysms. Retreatment of recurrent aneurysms using the FD is challenging. We report our initial experience in the repair of aneurysm recurrence with the FD. MATERIALS AND METHODS: A database was reviewed prospectively, and 8 patients with 8 recurrent aneurysms (mean size, 16.7 mm) were identified. Four aneurysms had previously ruptured. The previous aneurysm treatment consisted of coiling in 1 aneurysm and single-stent-assisted coiling in 7 aneurysms. The procedural complications and clinical and angiographic outcomes were analyzed. RESULTS: Six aneurysms were treated by using a single Tubridge FD alone, while the remaining 2 were treated with FD + coiling. The immediate results of the 8 aneurysms were that they all showed incomplete occlusion. Neither major ischemic nor hemorrhagic complications occurred; however, 1 patient experienced a vasospasm. Follow-up angiographies were available for 7 aneurysms; the mean follow-up was 16.9 months (7–36 months). Five aneurysms were completely occluded, whereas 2 had a residual neck. Severe asymptomatic stenosis of 1 parent artery of a vertebral artery dissecting aneurysm was found. All visible branches covered by the FD were patent. All patients were clinically assessed as having attained a favorable outcome (modified Rankin Scale score ≤ 2) at discharge and follow-up. CONCLUSION: In selected patients, the Tubridge FD can provide a safe and efficient option for the retreatment of recurrent aneurysms. Nevertheless, attention should be paid to several technical points.

Safety and efficacy of stent placement for treatment of intracranial aneurysms: a systematic review / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the safety and efficacy of stent placement for the treatment of complex intracranial aneurysms.</p><p><b>DATA SOURCES</b>We searched six databases, including Pubmed, Embase, SCI-expanded, the Cochrane Library, ISI Proceedings and ProQuest Dissertations & Theses for the relevant studies using multiple key words from December, 1997 to February, 2009.</p><p><b>STUDY SELECTION</b>Thirty-three studies about stent placement for intracranial aneurysms were identified, which reported data from a total of 1069 patients with 1121 intracranial aneurysms.</p><p><b>DATA EXTRACTION</b>We prepared a standardized data extraction form (DEF), which was used by two independent researchers to extract data from the included 33 studies.</p><p><b>RESULTS</b>The overall initial complete occlusion rate was 52.5% (456/869, 95%CI: 49.2% - 55.8%). The overall complication rate was 14.3% (162/1130, 95%CI: 12.3% - 16.4%), of which 3.6% (38/1044, 95%CI: 2.5% - 4.8%) were permanent. Clinical follow-up showed a dependence rate of 8.4% (39/465, 95%CI: 5.9% - 10.9%). Angiographic follow-up showed an improvement rate of 24.3% (117/481, 95%CI: 20.5% - 28.2%) and a recurrence rate of 12.9% (62/481, 95%CI: 9.9% - 15.9%). Chi-squared tests were performed to compare the following subgroups: self-expandable vs. balloon-expandable stents, unruptured vs. acutely ruptured aneurysms, and with vs. without pre-medication. Statistical significance was reached in eight tests.</p><p><b>CONCLUSIONS</b>Intracranial stent is a safe and effective tool for embolizing complex intracranial aneurysms. Self-expandable stents are significantly easier and safer than balloon-expandable stents with respect to navigation and deployment through the tortuous cerebral vasculature. Patients with acutely ruptured aneurysms are more likely to be dependent, but not more likely to suffer more procedure-related complications.</p>

Toll-like receptor 4: the potential therapeutic target for neuropathic pain / 中国医学科学院学报

Activation of microglia plays a vital role in the initiation and maintenance of specific neuropathic pain states. By activating microglia in central nervous system, Toll-like receptor 4 (TLR4) can promote the release of proinflammatory cytokines and neuroactive compounds, participate in the initiation and maintenance of neuropathic pain, and trigger the opiate side effects. Therefore, TLR4 may be a potential therapeutic target for neuropathic pain. Inhibition of TLR4 has shown some biological effects in neuropathic pain models and ibudilast (the TLR4 pathway-inhibiting agent) has been approved for for phase 2 clinical trials. This article briefly reviews the structure, function, and mechanism of TLR4 as well as the development of TLR4-targeted drugs.

Combined stent and coil in endovascular treatment of intracranial wide-necked and fusiform aneurysms / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Wide-necked and fusiform aneurysms are challenges for interventional neuroradiologists and neurosurgeons since they may involve entire vessels or be irregular in shape, making is possible for Guglielmi detachable coil to protrude into the parent arteries. This study was to evaluate the endovascular treatment of intracranial wide-necked and fusiform aneurysms by using a combination of stents and coils.</p><p><b>METHODS</b>From October 2000 to July 2001, eighteen patients with intracranial wide-necked or fusiform aneurysms were treated with intraluminal stenting in combination with endosaccular coiling.</p><p><b>RESULTS</b>Stent placement and coil packing were technically successful in all patients. There were no complications related to the procedure except for the migration of the stent in four cases. The aneurysms were embolized with the coils after precise stenting, and total occlusion was obtained in 13 cases, neck remnants in 3, and loose occlusion in 2. All the patients recovered well. Short-term follow-up angiograms suggested patency of the parent arteries without recanalization.</p><p><b>CONCLUSIONS</b>A combination of endovascular stenting and coil packing may be a favorable alternative for the treatment of intracranial aneurysms that are unsuitable for surgical clipping or coil embolization. Further study is necessary to assess the long-term outcome.</p>

Safety and short-term results of stent-assisted angioplasty for the treatment of intracranial arterial stenosis / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety and short-term outcome of endovascular stent-assisted angioplasty for the treatment of intracranial arterial stenosis.</p><p><b>METHODS</b>Angioplasty and stent placement were administered to treat 46 patients with lesions of atherosclerotic intracranial stenosis, including 16 lesions of basilar artery, 12 of vertebral artery, 13 of internal carotid artery and 9 of middle cerebral artery.</p><p><b>RESULTS</b>Technical success was achieved in 49 of 50 vessels (98%), with no procedure-related death or cerebral ischemic attack. Extracranial internal carotid artery dissection occurred in 1 patient and was successfully treated with a self-expand stent. One patient had subarachnoid hemorrhage because of perforation by microwire with no permanent neurologic deficit, and another 2 patients had groin hematoma. Angiographic examination immediately after stenting revealed that the stenosis rate was significantly reduced (72.4% +/- 12.3% vs 10.6% +/- 7.8%). There was no cerebral ischemic attack in the 37 patients who were clinically followed up (6 - 18 months, mean of 8.5 months).</p><p><b>CONCLUSION</b>Angioplasty and stenting for the treatment of intracranial stenosis is safe and feasible, and it may be favorable for decreasing the incidence of ischemic attack.</p>

Treatment of posterior-communicating wide-necked aneurysms with endovascular stent and Guglielmi detachable coils / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize our clinical experience in treating posterior-communicating wide-necked aneurysms using endovascular stent and Guglielmi detachable coils (GDCs).</p><p><b>METHODS</b>The coronary stents were implanted across the neck of 32 posterior-communication wide-necked aneurysms. Microcatheters were introduced into the aneurysm sac through stent mesh, GDCs were used to embolize aneurysms.</p><p><b>RESULTS</b>All operations were successful. Total occlusion was achieved in 26 patients, over 90% in 4, 60 - 70% in 2. The patients were perfectly recovered with patency of the parent arteries.</p><p><b>CONCLUSION</b>Endovascular therapy combined with stent implatation and GDC placement is a valid approach to the treatment of posterior-communication wide-necked aneurysms.</p>