Recanalization for symptomatic chronic internal carotid artery occlusion: a preliminary study / 中华放射学杂志

Objective:To evaluate the value of endovascular recanalization and hybrid recanalization for chronic internal carotid artery occlusion(COICA), and to evaluate its feasibility, safety, success rate, and clinical outcomes.Methods:Totally 35 patients who received endovascular recanalization or hybrid recanalization with symptomatic COICA were enrolled from January 2019 to December 2019 in Department of Cerebrovascular Disease,Zhengzhou University People′s Hospital. The clinical characteristics, treatment strategies, success rate, and major events of the patients were analyzed retrospectively.Results:Thirty of 35 patients were successfully recanalized. Among them, hybrid recanalization was performed in 3 cases, carotid endarterectomy was performed in 1 case, and endovascular recanalization was performed in 26 cases, 5 patients failed because they could not reach the distal true cavity. Among the successful patients, 5 patients had operation-related complications, 3 patients had embolism cerebral infarction, 1 patient had hyperperfusion cerebral hemorrhage, 1 patient still had transient ischemic attack after operation. All patients were followed up clinically, 2 patients had reoccurrence of obstruction, 2 patient had restenosis, the remaining patients had no hemodynamic stenosis or reocclusion.Conclusion:In highly-selected cases, intracavitary recanalization for symptomatic COICA is feasible, relatively safe and effective.

Clinical analysis of 5 cases of dural arteriovenous fistulas complained of pulsatile tinnitus / 中华耳鼻咽喉头颈外科杂志

Objective@#The clinical characteristics of dural arteriovenous fistula with pulsatile tinnitus were analyzed to deepen the understanding of the disease.@*Methods@#The clinical data of five patients complained of pulsatile tinnitus and diagnosed dural arteriovenous fistula in Henan People's Hospital from May 2013 to June 2018 were retrospectively analyzed, including 3 males and 2 females, aged 27-65 years.@*Results@#The main clinical symptoms of the five patients were continuous pulsatile tinnitus, accompanied/not accompanied by headache, memory decline, etc., with a course of three months to 20 years. They were diagnosed as dural arteriovenous fistula by digital subtraction angiography, and three cases of tinnitus disappeared and two cases of tinnitus were relieved after embolization.@*Conclusions@#The dural arteriovenous fistula is a rare and complicated disease. When the patient complain of the pulsatile tinnitus, the related etiology should be considered and managed properly.

Comparative study of interventional and conservative treatment of intracranial vertebrobasilar artery trunk large aneurysms / 中华放射学杂志

Objective:To evaluate the safety and efficacy of endovascular interventional treatment of the intracranial vertebrobasilar trunk large aneurysms (VBTLAs) compared with conservative treatment.Methods:This is a prospective multi-center cohort study. From October 2012 to October 2018, a total of 69 patients with intracranial vertebrobasilar trunk large aneurysm (diameter>10 mm) from Henan Province People's Hospital and People's Liberation Army Rocket Medical Center were included in this study. Patients themselves chose either endovascular interventional therapy (interventional group) or conservative treatment (conservative group) after discussion with their doctors. The χ 2 test was used to compare the incidence of deaths, stroke, and all other serious adverse events including other site bleeding, myocardial infarction and others between the two groups. Results:A total of 69 patients were enrolled, of whom 51 patients were enrolled in interventional group, 18 patients underwent endovascular reconstructive therapy, 11 patients underwent deconstructive therapy, and 4 patients underwent conjunction interventional treatments. Eighteen patients were enrolled in conservative group, of whom 11 cases received simple risk factor control, 7 cases received antiplatelet and risk factors control. The proportions of hypertensive patients 94.4% (17/18) and giant aneurysms 50.0% (9/18) in the conservative group were higher than those in the surgery group 64.7% (33/51, χ 2=4.500, P=0.034), 19.6% (10/51, χ 2=4.730, P= 0.030).The incidence of all serious adverse events associated with protocol was 15.7% (8/51) in the interventional group and 44.4% (8/18) in the conservative group [risk ratio (RR) =0.353, 95% confidence intervals (CI): 0.156-0.801], and the difference was significant (χ 2=4.668, P=0.031). The incidence of fatal events associated with protocol was 2.0% (1/51) in the interventional group and 38.9% (7/18) in the conservative group (RR=0.050, 95%CI: 0.007-0.382), and the difference was significant (χ 2=14.281, P<0.001). The incidence of hemorrhage events associated with protocol was 2.0% (1/51) in the interventional group and 22.2% (4/18) in the conservative group (RR=0.088, 95%CI: 0.011-0.738), and the difference was significant (χ 2 =5.391, P=0.020). Follow-up imaging showed that the occlusion rate of aneurysms in 44 patients in the interventional group was 56.8% (25/44) after a median follow-up of 6 months. Imaging follow-up was obtained in 9 patients, whose occlusion rate of aneurysms was 0 and the median follow-up time was 12 months, in the conservative group. The difference was significant(χ 2 =7.534, P=0.006). Conclusion:Compared with conservative treatment, endovascular intervention of the intracranial VBTLAs has lower incidences of serious adverse events and death events.

Absolute ethanol in treatment of brain arteriovenous malformations / 中华放射学杂志

Objective:To investigate the feasibility of absolute ethanol in the treatment of brain arteriovenous malformation (bAVM).Methods:The clinical data of 25 patients with bAVM treated with absolute ethanol in the specialty of intracranial vascular malformations in Henan Provincial People′s Hospital from September 2018 to May 2019 were retrospectively analyzed. There were 14 males and 11 females, aged 7-62 years, with a median age of 26 years. Among the 25 patients, 18 cases had ruptured bAVM, 7 cases had unruptured bAVM. Spezler-Martin grade<Ⅲ were found in 14 cases, Ⅲ grade in 7 cases, and >Ⅲ grade in 4 cases. The clinical effect and perioperative complications were observed.Results:Among 25 patients, the overall technical success rate was 96.0% (24/25), one of which the target lesion with anhydrous ethanol could not be ablated. The overall complication rate was 28.0% (7/25) with no death. All complications were ischemic, and the incidence of severe complications was 12.0% (3/25). Twenty-five patients were followed up 3 months after the operation, 4 of which had mild complications, 2 recovered completely and 2 made reasonable recovery. In the 3 patients with severe complications, 2 patients made reasonable recovery and 1 patient had significant improvement. The modified rankin scale (MRS) score of all patients with complications was ≤2, and the remaining 18 patients had no new onset clinical symptoms. Thirteen patients were followed up by DSA and MRI. DSA showed no recurrence in the lesions ablated by absolute ethanol. In 2 patients with partial residual malformation after operation, the residual deformities disappeared completely at the time of reexamination. MRI showed that brain edema disappeared in all patients.Conclusions:The ablation of absolute ethanol in bAVM has a high operation success rate, definite clinical effect and low recurrence rate of postoperative bAVM. It can be used as an exploratory treatment.

Cerebrovascular Drug-Eluting Stent versus Bare-Metal Stent in the Treatment of Vertebral Artery Stenosis: A Non-Inferiority Randomized Clinical Trial / 대한뇌졸중학회지

No abstract available.

Klippel-Trenaunay syndrome complicated by spinal arteriovenous fistula and subarachnoid hemorrhage: report of one case with literature review / 介入放射学杂志

Objective To discuss the clinical value of interventional treatment for Klippel-Trenaunay syndrome complicated by spinal arteriovenous fistula and subarachnoid hemorrhage, and to report 1 patients with this disease who were successfully treated with interventional treatment. Methods One female children patient with clinically confirmed Klippel-Trenaunay syndrome complicated by spinal arteriovenous fistula and subarachnoid hemorrhage were enrolled in this study, who was underwent the embolization of arteriovenous fistula in the spinal. Results The interventional procedure was successfully accomplished in this case. The patient's clinical symptoms was disappeared gradually. No complications occurred. Conclusion For the treatment of Klippel-Trenaunay syndrome complicated by spinal arteriovenous fistula and subarachnoid hemorrhage, interventional management is minimally-invasive, safe and Reliable.

The complications of the Pipeline embolization device in treating complex cerebral aneurysm / 中华放射学杂志

Objective To evaluate the complications of the Pipeline embolization device in treating complex cerebral aneurysm. Methods Consecutive data of 53 patients who suffered from complex cerebral aneurysm and underwent Pipeline device treatment were retrospectively collected and analyzed. Clinical and imaging data including aneurysm location, type, size and the using of coils, were recorded to investigate the complications. Results Pipeline embolization device was successfully implanted, and 27 patients were combined with coils. Five complications occurred in the 1-month perioperative stage, of which, 1 was disable and 1 was fatal. Two non-disability complications occurred in the later stage beyond 1 month, of which, 1 was cerebral infraction and 1 was intraparenchymal hemorrhage. The Logistic regression analysis demonstrated that the posterior circulation location, types, large size and the using of coils were not statistically significant risk factors for complications. The median imaging follow-up for 43 patients with 58 aneurysms was 6 months, the complete and sub-complete occlusion rate of aneurysms was 74.1％ (43 / 58) and 3 non-symptomatic stenosis occurred in the patients with Pipeline embolization device. Conclusions The occlusion rate of Pipeline embolization device in treating Chinese complex cerebral aneurysm is high , but another further research should be done for the mechanism and the prevention methods of the complications.

Feasible study of endovascular embolization for treating cerebral arteriovenous malformations via internal jugular vein approach / 中华放射学杂志

Objective To evaluate the feasibility of transvenous embolization treatment for cerebral arteriovenous malformations(bAVM). Methods From November 2016 to April 2017, the information of 6 patients with brain arteriovenous malformation in our center accepting the intravenous radical embolization were collected, who were ruptured bAVM, bAVM with a single drainage vein, not suitable for surgery confirmed by neurosurgeon consultation or explicitly refused craniotomy. The modified Rankin Scale score of five patients were smaller than three before treatment.The location of draining vein flowing venous sinus was shown by rotational DSA and 3D reconstructed images.A liquid embolic agent was injected via Sonic catheter to completely embolism the brain arteriovenous malformation under controlling blood pressure and blocking the blood provisionally.The perioperative complications and modified Rankin Scale score were observed and recorded 30 days after treatment. Results The transvenous embolization treatment was successfully performed in six patients with 7 embolization procedures.There were no definite operation-related complications. the mRS of all cases were ≤1 within 30 days after operation. Conclusion The embolization technique via the internal jugular vein is feasible for bAVM patients with a single drainage vein,while the long-term outcome need more evaluations.

Intracranial hemorrhage secondary to carotid artery stenting angioplasty: clinical analysis / 介入放射学杂志

Objective To investigate the clinical features,pathogenesis and treatment of intracranial hemorrhage occurring after carotid artery stenting (CAS) angioplasty.Methods The clinical data and imaging materials of 5 patients with carotid artery stenosis,who were admitted to authors' hospital during the period from January 2008 to January 2017 to receive CAS and developed intracranial hemorrhage after CAS,were retrospectively analyzed.Results Of the 513 patients with carotid artery stenosis who received CAS angioplasty,5 patients (0.97％) developed intracranial hemorrhage,which was confirmed by postoperative cranial CT and/or DSA.The 5 patients included 3 males and 2 females,with an average age of (71.4±5.0) years.The stenosis rate of carotid artery ranged from 90％ to 99％.The intracranial hemorrhage occurred during CAS procedure or within 10 days after CAS.DSA examination demonstrated moyamoya vessels at ipsilateral basal ganglia region in one patient and perforating artery bleeding in another patient.Conservative medication was employed in 3 patients,one of them recovered well and the other two died.Two patients received hematoma puncture drainage and developed hemiplegia.Conclusion The incidence of intracranial hemorrhage after CAS is very low,but intracranial hemorrhage carries higher mortality and morbidity.Clinically,there are a lot of causes that can induce intracranial hemorrhage.Sufficient preoperative assessing and screening of the risk factors are helpful for reducing the occurrence of intracranial hemorrhage.Once intracranial hemorrhage after CAS occurs,active measures,including control of blood pressure,drug sedation,discontinuation of anticoagulant,reduction or discontinuation of antiplatelet drugs and surgical intervention,can improve the survival rate of patients.

Rescue stent implantation for the treatment of acute ischemic stroke: initial experience in 13 patients / 介入放射学杂志

Objective To evaluate the safety and efficacy of stent implantation used as a rescue measure for acute ischemic stroke.Methods The clinical data of 13 patients with acute ischemic stroke caused by large artery occlusion of anterior c erebral circulation that occurred within 8 hours before clinical visit,who had received rescue stent implantation at authors' hospital,were retrospectively analyzed.Before stent implantation,all patients failed to respond to other recanalization treatments,including intravenous thrombolysis,intra-arterial thrombolysis,mechanical thrombec tomy with Penumbra device,and Solitaire stent thrombectomy.Angiography was performed immediately after stent implantation.Vascular recanalization condition was evaluated with blood flow grading that was based on thrombolysis in cerebral infarction (TICI) criterion.Perioperative bleeding and complications were recorded.National Institutes of Health Stroke Scale (NIHSS) score was used to assess the improvement of neurological function at one week after operation.Modified Rankin scale (mRS) score was used to evaluate the prognosis at 3 months after operation.Results A total of 16 stents were implanted in 13 patients.Before stent implantation,thrombectomy by using Solitaire retrievable stent was employed in 10 patients,mechanical thrombectomy with Penumbra device was adopted in 3 patients,intravenous thrombolysis with urokinase was used in one patient,and intra-arterial thrombolysis with urokinase was conducted in one patient.After stent implantation,partial or complete recanalization was achieved in 12 patients (TICI≥2b/3).NIHSS score was improved from preoperative (16.15±5.81) points to postoperative (8.08±5.61) points,the difference was statistically significant (P＜0.05).Three months after stenting treatment,good prognosis (mRS ≤2) was obtained in 7 patients (53.8％) and 2 patients died.Intracranial hemorrhage occurred in 2 patients and procedure-related embolism was observed in 3 patients.Conclusion For the treatment of acute ischemic stroke,intracranial stenting angioplasty,used as a rescue measure for thrombolytic therapy with different combinations of drugs,is safe and effective.

Progress in study on Pipeline embolization device treatment for postoperative complications of intracranial aneurysm / 介入放射学杂志

In recent years,endovascular treatment of intracranial aneurysms has been developed rapidly.Pipeline embolization device (PED),which is a novel blood flow guiding device,can creatively reconstruct the blood flow distribution of the aneurysm-bearing artery,and it has been widely employed in clinical practice.Satisfactory curative effect has been achieved by PED for intracranial aneurysms,especially for complex intracranial aneurysms.However,because of its high metal coverage rate,the complications such as aneurysm rupture,spontaneous cerebral parenchymal hemorrhage,branch artery occlusion,etc.are not uncommonly seen in patients after receiving flow divertion treatment,and the mortality rate is higher,to which sufficient attention should be paid by clinicians.This paper aims to make a review on the research progress concerning the postoperative complications of PED in the treatment of intracranial aneurysms.

Mid- and long-term follow-up of revascularization and stenting of nonacute intracranial vertebrobasilar artery occlusion / 中华放射学杂志

Objective To evaluate the mid-and long-term follow-up outcome of revascularization and stenting of nonacute intracranial vertebrobasilar artery occlusion. Methods Consecutive data of 27 patients who suffered from nonacute intracranial vertebrobasilar artery occlusion beyond 24 hours and underwent endovascular revascularization, were retrospectively collected and analyzed. Complications and recurrent ischemic events during the follow-up period were recorded. The modified Rankin scale(mRS) scores were used and compared between pre-and postoperation. Results All 27 patients except one(96.3%) obtained successful recanalization. After the procedure, 13 patients showed improvement, 11 were stable, and 3 worse. The decline of median mRS scores, which was 4(interquarter range-IR, 2-5) preoperatively and 3(IR, 1-5) on discharge. Five patients suffered from procedural complications and three of them resulted in aggravation. Nineteen patients received imaging follow-up during the median 10 months, 6 restenosis occurred and 3 of them were symptomatic. During median 55 months clinical follow-up after operation, 2 ipsilateral stroke and 2 ipsilateral transient ischemic attack occurred. The mRS scores decreased significantly in the first one year after procedure. Conclusions Revascularization and stenting of nonacute intracranial vertebrobasilar artery occlusion can prevent recurrent ipsilateral ischemic event and improve disability recovery in the first one year.

Comparison of the perioperative complications among three prophylactic antiplatelet strategies in unruptured intracranial aneurysms treated by stent assisted coiling / 中华放射学杂志

Objective To compare the perioperative complications of prophylactic use of three antiplatelet strategies in unruptured intracranial aneurysms treated by stent assisted coiling. Methods A total of 203 consecutive patients were brought into this retrospective study including the following three groups:the loading group (n=54), with a loading dose of 300 mg to 600 mg clopidogrel at 2 h to 24h before the stenting; tirofiban group (n=50), a loading dosage of tirofiban (8 μg/kg/min over 3 min) followed by a 0.1μg/kg/min maintenance dosage; dual antiplatelet group (n=99), dual oral antiplatelet drugs (clopidogrel 75 mg + aspirin 100 mg) pretreated for 3-5 days before the operation. Events of hemorrhage and thromboembolism were recorded and the complications were compared to assess the safety and efficacy of various antiplatelet strategies. Chi-square or Fisher exact tests were used for categorical variables. Results The hemorrhagic rates were 11.1% in loading group, 2.0% in dual antiplatelet group, and 0% in tirofiban group, respectively, while the thromboembolic rates were 7.4% in loading group, 4.0% in dual antiplatelet group, and 0% in tirofiban group, respectively. For total complications, significant difference (P0.05). The hemorrhagic rate in loading group was significantly higher than that of the dual group (P=0.023) and tirofiban group (P=0.027), while there was no significant difference between tirofiban group and dual antiplatelet group (P>0.05). In subgroup analysis of the loading group, the postoperative thromboembolic rate was significantly higher in those exposed to low molecular weight heparin than those not (P=0.039) with no increase of hemorrhagic events (P>0.05). Conclusions When compared with the dual antiplatelet strategy, tirofiban strategy may be used as a new prophylactic protocol in unruptured intracranial aneurysms treated by stent assisted coiling. Those treated by low molecular weight heparin postoperatively after receiving dual antiplatelet therapy may increase the hemorrhagic risk, although there was a significant decrease in thromboembolic events postoperatively.

Short-term follow up of pipeline embolization device (PED) deployment for treatment of intracranial carotid aneurysm / 中华放射学杂志

Objective To explore the technical skills and short-term efficacy of Pipeline Embolization Device (PED) deployment for endovascular treatment of complex intracranial carotid aneurysm. Methods The medical charts of 6 cases who underwent PED implant procedure in our institute from Jan. to Jun. 2015 were reviewed, including 4 female and 2 male; the mean age was (56 ± 13) years, ranging from 34—70 years. All the 6 cases suffered from intracranial carotid aneurysm and PED implant procedures were performed to cover the aneurismal neck under general anesthesia, while dual antiplatelet treatment (Bayaspirin+Plavix) was administered. The basic characteristics and peri-procedural adverse events were recorded, interview and mRS score were done by telephone 1 month after procedure, clinical examination and DSA angiographic re-check were made 3 months following procedure, respectively. Status of aneurysm occlusion was evaluated by Raymond grading scale. Results All 6 aneurysms involved were unruptured. Technical success was achieved in all procedures for 6 cases, of which 3 cases were single PED implantation and the other 3 PED adjuncted to coiling. No procedure related complication was detected during 30 days after operation. Follow up with 1.5—4.8 months (median 2.8 months) were conducted and last follow up revealed good outcome (mRS<2) in all cases. The control angiography showed contrast filling aneurismal sac even after PED implantation, DSA recheck performed in 2 cases at 3 months after operation and revealed good obstruction of aneurysm (Raymond grade≤2). Conclusion Domestic preliminary study shows PED implantation seems to be a safe and effective modality for treatment of complex intracranial carotid aneurysms.

Safety and efficacy of the treatment for symptomatic atherosclerotic high-grade stenosis in middle cerebral artery with Wingspan stent / 中华放射学杂志

Objective To assess the safety and efficacy of the treatment for symptomatic atherosclerotic high-grade stenosis in middle cerebral artery with Wingspan stent.Methods The medical records of Wingspan stenting for 102 cases with symptomatic middle cerebral artery high-grade stenosis from February 2008 to May 2012 in our hospital were reviewed retrospectively.All of the patients suffered from ischemic stroke or transient ischemic attack ( TIA ) attributed to the atherosclerotic high-grade stenosis in middle cerebral artery and the stenosis of 70%to 99%was confirmed by DSA before the stenting procedure.All the stroke, death, TIA within 30 days after the stenting procedure or during the follow-up beyond 30 days were observed and recorded.In-stent restenosis were recorded after DSA or CTA was performed 6 months later.χ2 test or Fisher exact test was used to compare in-stent restenosis rate among patients with different clinical and pathological conditions.Results Stenting procedure were successfully performed in 100 patients (98.0%,100/102).The mean degree of stenosis was reduced from (81.0 ±8.4)% to (15.3 ±6.7)%right after surgery.Eight adverse cardiovascular events (7.8 %, 8/102) occured within 30 days ,including seven stroke or death ( 6.9%, 7/102 ) and 1 TIA.The mean clinical follow-up duration was ( 29 ± 15) months in 82 patients, and 9 ischemic events were documented (4 cases of ipsilateral recurrent stroke , 3 cases of ipsilateral TIA, and 2 cases of contralateral ischemic stroke ).The mean radiological follow-up duration was (11 ±9) months in 55 patients.Among them, 8 patients (14.3%) had in-stent restenosis and 3 patients had symptomatic restenosis.The restenosis rate in patients with age ≤49 years.(25.0%,7/28) was higher than those with age >49 years ( 3.7%,1/27 ) ( P>0.05 ).The restenosis rate in patients with lesion size>7.5 mm(25.0%,7/28) was higher than those with lesion size ≤7.5 mm (3.7%,1/27)(P>0.05).Conclusions The treatment of symptomatic middle cerebral artery high-grade stenosis with Wingspan system was relatively safe and associated with a low perioperative complication rate.The long-term efficacy of the treatment for symptomatic atherosclerotic high-grade stenosis in middle cerebral artery with Wingspan stent is prominent.

Endovascular revascularization for nonacute intracranial vertebrobasilar artery occlusion / 中华放射学杂志

Objective To evaluate the technical feasibility,safety and mid-term effect of endovascular revascularization of nonacute intracranial vertebrobasilar artery occlusion.Methods Consecutive data of patients who suffered from nonacute intracranial vertebrobasilar artery occlusion beyond 24 hours and underwent endovascular revascularization,were retrospectively collected and analyzed.Complications and recurrent events during the follow-up period were recorded.The modified Rankin scale (mRS) scores were used to compare the symptoms before and after the procedure.Results All 27 patients but 1 (96.3％) obtained successful recanalization.After the procedure,13 patients showed improvements,11 were stable,and 3 worse.The decline of median mRS scores,which was 4 [interquarter range(IR),2-5) preoperatively and 3 (IR,1-5) on discharge,showed significant statistical difference (Z =3.116,P =0.002).Five patients had procedural complications,namely 2 dissection,1 in-stent thrombosis during the operation,1 thrombus disruption and translocation during the operation and 1 acute reocclusion after operation.During the follow-up period with the median of 21 months,3 death,1 stroke and 2 transient ischemic attack occurred.The latest median mRS scores were 1 (IR,0-3).The ratio of patients with mRS ≤ 2 increased from 25.9％ (7/27) before operation to 63.0％ (17/27) at the follow up.Seventeen patients received imaging follow-up during the 9 months,with restenosis in 6 and symptom in 3 of them.Subgroup analyses revealed better functional recovery (lower mRS) both in patients with vertebral artery occlusion (Z =2.111,P =0.035) and those with basilar artery occlusion (Z =2.333,P =0.020).Conclusions Endovascular revascularization for the nonacute intracranial vertebrobasilar artery occlusion beyond 24 hours is technically feasible,and improves disability recovery.However,the rates of procedural complication and restenosis are high.

Peri-procedural compfications and associated risk factors in wingspan stent-assistant angioplasty of intracranial artery stenosis / 中华放射学杂志

Objective To retrospectively evaluate the cerebrovascular complications from stenting for symptomatic intracranial stenosis and to detect the factors associated with complications.Methods Medical records of Wingspan stenting were reviewed for 306 cases with symptomatic intracranial stenosis from July 2007 to February 2012,including transient ischemic attack,ischemic stroke,death and intracranial hemorrhage as clinical in-hospital complications.The location of lesions included middle cerebral artery level M1 (114 lesions),intracranial portion of the internal carotid artery (50 lesions),vertebral artery 4(75 lesions),venebro-basilar artery (14 lesions),basilar artery (76 lesions).Complications were evaluated and analyzed to find out whether they were associated with patient-or stenosis-related risk factors using x2test.Results The technical success rate was 99％ (303/306).Cerebrovascular complications rate was 6.9％ (21/303),with 1.6％ (14/303) of disabling stroke events and 0.7％ (2/303) of deaths.Hemorrhagic events were consisted of procedure-related events (3 cases),hyperperfusion (3 cases),ischemic events of perforator stroke (8 cases),transient ischemic attack (3 cases),embolization (2 cases),thrombosis in stent (2 cases).Hemorrhagic events were associated with significantly higher morbidity and mortality rates(x2 =2.908,P ＜ 0.05) and occurred more frequently after treatment of middle cerebral artery stenosis than other lesions(x2 =1.168,P ＜ 0.05).Perforating branches were detected to be affected mainly in the basilar artery than other locations (x2 =4.263,P ＜ 0.05).Conclusion The complication rates in the study are preliminary consistent with the previously published data.Hemorrhagic events are prone to occur in the treatment of middle cerebral artery stenosis,while perforating branches are affected mainly in the basilar artery.

Long term follow up of carotid cavernous fistula patients treated with carotid occlusion / 中华放射学杂志

ObjectiveTo explore efficacy,durability and possible impacts on life quality of carotid occlusion treatment to carotid cavernous fistula (CCF) patients.MethodsCCF patients since 2001 were retrospectively analyzed,the clinical features,2 weeks post procedure mRS score and ratio of carotid occlusion were recorded.Headache impact test (HIT-6) and Short form health survey(SF-36) were used to assess impact of sequelae in patients' daily life,by phone call,questionnaire and clinic recheck.Results Total 96 cases were studied composed of 81 direct CCF and 15 dural AVF.Thirty-two direct CCF cases underwent carotid occlusion during procedure and many ophthalmologic signs but visual impairment got recovery after 2 weeks,the mRS score less than 2 were revealed.The one year post operation HIT-6 score more than 50 was more likely found in carotid occlusion cases comparing with those preserved carotid artery while the 3 year SF-36 scores of carotid occlusion cases revealed inferior to those with patent artery,especially in body pain,general health and vitality subscales.ConclusionCarotid occlusion seems to be a feasible,effective and durable alternative for CCF treatment,but which could play a negative role on quality of patients' life in the long run.

Endovascular revascularization for symptomatic sub-acute and chronic intracranial vertebrobasilar artery occlusion / 中华放射学杂志

Objective To evaluate the technical feasibility,safety and treatment effect of endovascular revascularization of symptomatic sub-acute and chronic intracranial vertebrobasilar artery occlusion.Methods Twenty-one consecutive patients with symptomatic sub-acute and chronic intracranial vertebrobasilar occlusion underwent endovascular revascularization.Perioperative complications and recurrent events during the follow-up period were recorded. The modified Rankin scale ( mRS ) scores and blood stream thrombolysis in myocardial infarction (TIMI) scores for all patients preoperatively,postoperatively and at follow-up were evaluated.The results were analyzed using Wilcoxon rank sum test and Fisher exact test.Results All 21 patients but 1 (95.2％,20/21 ) obtained successful recanalization. After the procedure,9 patients showed improvements,10 were stable,and 2 worse. The decline of median mRS scores,which was 4 preoperatively [ inter-quartile range ( IR ) 2.5-5.0 ] and 4 ( IR 1.0-5.0 ) on discharge from the hospital respectively,showed significant statistical difference (Z =2.810,P ＜ 0.01 ).Three ( 14.3％ ) patients suffered periprocedural complications,namely basal arterial dissection,intra-stent thrombosis and postoperatively acute occlusion in each one.There was no death,stoke or recurrent transient ischemic attack (TIA) occurring 30 days after the procedure. During the 7 months after operation,which was the mean clinical follow-up duration,TIA and recurrent stoke occurred in one patient respectively,and two patients died of systemic complications. The median mRS scores were 2.0 (IR 1.0-4.0 )in all 21 patients and 1 ( IR 1.0-4.0) in the surviving subjects.Conclusions Endovascular revascularization for the recanalization of symptomatic sub-acute and chronic vertebrobasilar artery occlusion is technically feasible,and helps to prevent ischemic events and improve disability recovery. However,its exact effect needs further verification by future random controlled studies.

Preliminary experience on early mechanical recanalization of middle cerebral artery for acute ischemic stroke and literature review / 中华放射学杂志

Objective To evaluate the feasibility,efficacy and complication of early middle cerebral artery(MCA) mechanical recanalization(MER) for treatment of acute ischemic stroke.Methods Seven cases undergone MER of MCA for the treatment of acute cerebral infarct were retrospectively reviewed and analyzed,including the etiology,mechanism,Qureshi grading scale,location and size of infarcts,NIHSS score of pre and post procedure,endovascular technique and complications.Referring to the literature,the indications of MCA recanalization were further identified.Results A total of 7 cases with mean age of 48 yrs were reviewed,which included 3 cases of atherosclerotic thrombosis and 4 embolic cases with pre NIHSS score ranging from 3 to 22.Mechanical recanalization succeeded in 6 cases,but 2 cases of cardiogenic embolism died of intrac ranial hemorrhage postoperatively.Favorable clinical outcomes were achieved in 4 cases whereas 1 deteriorated.Overall complications seemed to be consistent with literatures reviewed.Conclusions Early MER of MCA may benefit to a certain subset of acute ischemia stroke patients,however,embolic cases,elder patients and those with severe neurologic deficits are often accompanied by higher complications and unfavorable outcome.