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Objective To investigate the therapies choice of paraclinoid carotid micro-aneurysm.Methods Eighteen patients suffered from paraclinoid carotid microaneurysm,definitely diagnosed by clinical measures and images,were chosen in our study; their clinical data were retrospective analyzed; among them,4 cases suffered from carotid ophthalmic aneurysms,including 3 accepted endovascular treatment and 1 microsurgical clipping; 10 cases suffered from internal carotid artery posterior communicating artery aneurysm,and 3 of them got endovascular treatment and 1 microsurgical clipping; 3 cases had anterior choroidal artery aneurysm of internal carotid artery,including 1 received endovascular treatment and 2 microsurgical clipping; and one was diagnosed as having internal carotid artery bifurcation aneurysms and clipping was performed.Results One patient suffered from carotid ophthalmic aneurysm died from re-rupture after endovascular treatment.One patient suffered from internal carotid artery posterior communicating artery aneurysm died from re-rupture after stent assisted coil embolization.One suffered from internal carotid artery posterior communicating artery aneurysm got good recovery (a spring ring escaped when taking coil embolization of aneurysm,and microsurgical clipping was then performed).Others got well.Conclusion Micro-aneurysms located in supraclinoid intemal carotid arteries and ophthalmic artery can be performed stent assisted loose coil embolization,and others can be preferred craniotomy operation to clip the neck of aneurysms.
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Objective To study the effect ofT-786C polymorphism of endothelial NO synthase gene on cerebral circulation in smokers with aneurysmal subarachnoid hemorrhage. Methods Three hundred and ninety-four patients with aneurysmal subarachnoid hemorrhage were adopted in our study;smokers and nonsmokers were defined by 200 and 0, respectively, according to the smoking index (quantity of cigarettes per year). Transcranial color-coded Doppler (TCCD) was employed to detect the alterations of flow velocity of cerebral arteries. Genotyping ofT-786C was performed by using a newly developed allele-specific polymerase chain reaction. Degree of oxidative stress of these patients were evaluated by measuring the level of F2-isoprostane excretion in the urine. Results The mean flow velocity (Vm) of middle cerebral artery (MCA) and internal carotid artery (ICA) was obviously increased as compared with that of the other normal ones in most of the smokers. The Vm of MCA and ICA in nonsmokers was not obviously different as compared with the normal values. The 3 genotypes ofT-786C in smokers showed significant difference in Vm of MCA and ICA (P＜0.05); the Vm of CC genotype ([60.73±63.58] cm/s) was obviously increased as compared with that of TT ([95.8±53.5] cm/s) and TC ([93.6±51.6] cm/s) genotypes (P＜0.05). The 3 genotypes ofT-786C in nonsmokers did not show significant difference in Vm of MCA and ICA (P＞0.05). The level of F2-isoprostane excretion in smokers was significantly higher than that in nonsmokers (P＜0.05). Conclusion The T-786C polymorphism of endothelial NO synthase gene can increase cerebrovascular Vm by enhancing the cerebrovascular circulation of smokers with aneurysmal subarachnoid hemorrhage.
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Objective To evaluate the efficacy of mechanical thrombectomy on embolic cerebral infarction with magnetic resonance diffusion weighted imaging (DWI). Methods Forty New Zealand white rabbits were performed carotid artery injection of blood clot emboli to induce the animal models of acute cerebral infarction; these models were equally randomized into 4 groups (n=10);non-treatment group was given no treatment; mechanical thrombectomy via femoral artery was performed under DSA 6, 8 and 12 h after the inducement in the 3 treatment groups, respectively. MR-DWI, T1WI and T2WI were performed and the apparent diffusion coefficient (ADC) and infarct volume were calculated in each group 6, 8, 12 and 24 h after the inducement. Results DWI demonstrated the ischemic area in all the 40 rabbit models at hyper-acute stage (within 6 h of inducement) with hyperintensity, while T1WI and T2WI showed normal signals. MR-DWI, T1WI and T2WI had significant difference in the relevance ratio of cerebral infarction in these rabbit models at acute stage (within 24 h of inducement, P＜0.05). The DAC value was gradually decreased and the ischemic area was gradually increased at acute stage in the rabbit models of non-treatment group and group of performing mechanical thrombectomy at the 12thh of inducement, however, rabbit models of groups of performing mechanical thrombectomy at the 6th and 8th h of inducement enjoyed the opposite position. The DAC value was higher and the ischemic area was lower 24 h after the inducement in the rabbit models of groups of performing mechanical thrombectomy the 6th and 8th h of inducement as compared with those in the non-treatment group and group of performing mechanical thrombectomy at the 12th h of inducement. Conclusion Mechanical thrombectomy at early stage enjoys significant good results; MR-DWI is a sensitive way in dynamic observing the treatment efficacy of acute cerebral infarction.
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Objective To evaluate the efficacy and risk of endovascular thrombolysis with Urokinase and Tirofiban in patients with cerebral venous sinus thrombosis (CVST).Methods Nine patients with severe CVST were performed selective intravenous sinus Urokinase and Tirofiban thrombolysis combined with mechanical thrombus maceration in our hospital from January 2009 to January 2011; their clinical data and treatment efficacy were analyzed.Results Normal cerebrospinal fluid (CSF) pressure was noted in 8 patients before discharging from the hospital; DSA indicated that 7 achieved complete recanalization of main branch of the venous sinus,cortical veins and deep vein.Only 1 achieved reeanalization of sinuses partly,and partial compensation was noted in the cortical veins.No operation-related complication was noted during and after the surgery.After thrombolysis,symptoms and signs of 8 patients improved obviously,and headache disappeared in 7 of them with only mild degree in 1; 1 patient died.Conclusion Intravenous sinus Urokinase and Tirofiban thrombolysis is an effective and safe method for patients with potentially catastrophic intracranial dural sinus thrombosis.
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Objective To observe the treatment effect of endovascular embolization on intracranial aneurysms combined with hemorrhagic moyamoya disease (MMD). Methods The clinical features and outcomes of 8 patients with intracranial aneurysms combined with MMD, performed endovascular embolizafion in our hospital from January 2002 to February 2010, were retrospectively analyzed. The aneurysms in 6 patients with major artery aneurysm were successfully embolized with Guglielmi detachable coil, and the other 2 (the peripheral artery type) with n-butyl cyanoacrylate (NBCA). Results In the 6 patients performed embolization with Guglielmi detachable coil, 3 got complete embolization, 2 vestigital of the aneurysm neck, 1 partial embolization and all the parent arteries were unobstructed. In the 2 patients performed embolization with NBCA, no imaging was noted on the parent arteries and aneurysms, and no cerebral infarction appeared in the distal blood supply region.Conclusion For MMD patients with aneurysms, we can treat the aneurysms with endovascular embolization safely and effectively.
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<p><b>OBJECTIVE</b>To study whether endothelial nitric oxide synthase gene (eNOS) polymorphisms is implicated in the development of cerebral vasospasm following subarachnoid hemorrhage.</p><p><b>METHODS</b>Three groups of patients with subarachnoid hemorrhage were selected to test this hypothesis, including 98 patients with cerebral vasospasm following aneurysmal subarachnoid hemorrhage (ASAH), 96 with cerebral vasospasm following traumatic subarachnoid hemorrhage (TSAH), and 195 patients without cerebral vasospasm following aneurysmal or traumatic subarachnoid hemorrhage. The parents of 194 patients and 100 control subjects were also examined for transmission disequilibrium test according to a family-based study design to test the associations.</p><p><b>RESULTS</b>We examined four eNOS gene polymorphisms, and two of these polymorphisms, the T to C substitution in the promoter at position -786 and the a-deletion/b-insertion in intron 4, were found to associate with cerebral vasospasm in subarachnoid hemorrhage in the case-control comparisons. For the former polymorphism, the risk of cerebral vasospasm was higher in C allele homozygotes than in the other two genotypes (odds ratio: 2.8, 95% CI: 1.4 to 5.6); for the latter polymorphism, the a-deletion carriers were exposed to a increased risk (odds ratio: 2.3, 95% CI: 1.3 to 4.0) in comparison with the noncarriers. The two polymorphisms were analyzed together as haplotypes in a family-based study using the transmission disequilibrium test. The C/a-deletion haplotype was transmitted from the heterozygous parents to cases of cerebral vasospasm in subarachnoid hemorrhage with a significantly higher frequency than expected (P=0.005).</p><p><b>CONCLUSION</b>The findings of the case-control and family-based studies clearly demonstrate that DNA sequence differences in eNOS gene influence the risk of cerebral vasospasm in subarachnoid hemorrhage.</p>
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Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Case-Control Studies , Genotype , Nitric Oxide Synthase Type III , Genetics , Polymorphism, Genetic , Risk Factors , Subarachnoid Hemorrhage , Genetics , Vasospasm, IntracranialABSTRACT
<p><b>OBJECTIVE</b>To assess the effect of a liquid embolic agent 2-poly-hydroxyethyl -methacrylate (2-P-HEMA) for renal artery embolization in rabbits.</p><p><b>METHODS</b>The precipitation time of different concentrations (2%, 3.5%, 5%, 6.5%, 8% and 9.5%) of 2-P-HEMA dissolved in different solutions (ethanol, ethanol/iobitridol, and ethanol/Bi2O3) were determined in flowing water. The mixtures of 2-P-HEMA (2%, 5%, and 8%) with ethanol/ Bi2O3 were injected into the renal arteries of the rabbits, and the artery-embolizing effects were assessed using angiography at 2 and 12 weeks after the injection, with also macroscopic and microscopic examination of the embolized kidneys.</p><p><b>RESULTS</b>The mixtures of 2-P-HEMA and ethanol formed flocculent precipitation a few seconds after injection into flowing water, and the precipitation time showed no significant variations with the concentration of 2-P-HEMA in the mixture. Low and moderate concentrations of 2-P-HEMA could pass through the microcatheter smoothly with little injection resistance, and resulted in complete occlusion of the renal arteries without adhesion to the microcatheter. Angiography at 2 and 12 weeks detected no recanalization of the occluded renal arteries. Macroscopically, the lumen of the renal arteries was found to be occluded by the embolic agents, and deep penetration of the embolic agents into the glomerular arteries was observed microscopically. The mixture containing high-concentration 2-P-HEMA was difficult to deliver through the microcatheter due to high injection resistance.</p><p><b>CONCLUSION</b>2-P-HEMA can be rapidly precipitated after injection into flowing water, and allows complete embolization of the renal arteries of rabbits at proper concentrations, suggesting its great potential as an endovascular liquid embolic agent.</p>
Subject(s)
Animals , Female , Male , Rabbits , Embolization, Therapeutic , Methods , Polyhydroxyethyl Methacrylate , Radiography , Random Allocation , Renal Artery , Diagnostic Imaging , PathologyABSTRACT
Objective To establish a kind of animal model and methods for neuroendoscope training. Methods With rat abdominal cavity hypothesized as cerebral ventricle, a set of programs for neuroendoscopic operative skill training were designed, including endoscopic techiniques, electronic coagulation, suction, flush, biopsy and balloon dilatation, and so on. Results Simulation operation was performed on rat abdomen under neuroendoscope. The procedure helped to practice the endoscopic manipulation, get to know well how to perform endoscope, coagulation, suction, flash instruments, be familiar with the usage of electric coagulation in the liquid condition. The emphasis was put on the basic skills of pure neuroendoscopic operation such as balloon dilatation, electric coagulation, cutting off,forcep biopsy and flush. Conclusions The rat model can provide a way to train pure neuroendoscopic operation. The trainer can get basic experience with regard to endoscopic manipulation, balloon dilatation, electric coagulation, suction, flush and biopsy under endoscope. The method can be an important part of neuroendoscopic laboratory training.
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<p><b>OBJECTIVE</b>To investigate the biocompatibility of polyurethane-BaFe(12)O(19) magnetic composite microsphere as a new endovascular embolization material.</p><p><b>METHODS</b>The biocompatibility of BaFe(12)O(19) particle was evaluated in vitro using Ames test, cell toxicity test, acute and subacute systemic toxicity test, hemolysis test, bleeding time and clotting time test and blood clotting function assay.</p><p><b>RESULTS</b>Ames test showed that the MR values of this particle leaching solution were all less than 2 without mutagenicity. Cell toxicity test showed that leaching solution at different concentrations had grade I toxicity on L929 cells. Acute and subacute systemic toxicity test showed that the experimental animals had good general condition without obvious pathological abnormality. The hemolysis rate of experimental group was 2.43%, which met the ISO standard (no more than 5%). The bleeding time and clotting time in mice were comparable between the experimental group and control group (P>0.05). There were no significant differences in blood clotting function between experimental group and control group (P>0.05).</p><p><b>CONCLUSION</b>The material has no obvious toxicity or mutagenicity, and does not cause hemolysis or hemopexis or affect the bleeding time and clotting time. Polyurethane-BaFe(12)O( 19) particle possesses satisfactory biocompatibility.</p>
Subject(s)
Animals , Barium Compounds , Chemistry , Toxicity , Biocompatible Materials , Cell Line, Tumor , Embolization, Therapeutic , Ferric Compounds , Chemistry , Toxicity , Microspheres , Polyurethanes , Chemistry , Toxicity , Toxicity TestsABSTRACT
<p><b>OBJECTIVE</b>To evaluate the long-term effect of endovascular occlusion with microcoils on traumatic pseudoaneurysms (TPAs) in the common carotid artery in rabbits.</p><p><b>METHODS</b>TPAs in the right common carotid artery were surgically made in 16 rabbits. At 3-4 weeks after operation, the survived 12 models were randomly divided into a control group (n=3) with no treatment and an experimental group (n=9), in which TPAs were intraluminally embolized with microcoils and corresponding therapy was given. Three months after embolization, the TPAs were examined with digital subtraction angiography and pathology.</p><p><b>RESULTS</b>The 3 rabbits in the control group all died of rupture of TPA. Among the 9 TPAs occluded with microcoils, 4 were completely occluded, 4 were partially occluded, and 1 was excluded due to the microcoils migrating into the parent artery. Three months after embolization, the 4 TPAs which were completely occluded remained obliterated as determined by digital subtraction angiographic findings. The parent artery remained unobstructed and the structure of the TPAs were replaced by a mass of scar tissues. The 4 TPAs which were partially occluded remained unruptured and the microcoils were compressed.</p><p><b>CONCLUSIONS</b>The lumen in TPA can be completely occluded by microcoils and the parent artery is unblocked. Partial occlusion of the lumen can also prevent the rupture of TPA.</p>
