Effectiveness, Safety and Risk Factors of Woven EndoBridge Device in the Treatment of Wide-Neck Intracranial Aneurysms: Systematic Review and Meta-Analysis.

OBJECTIVE: To assess the current efficacy, safety, and risk factors of the Woven EndoBridge (WEB) in treating wide-neck intracranial aneurysms. METHODS: We searched the PubMed, Ovid MEDLINE, and Embase databases between December 1, 2012 and June 30, 2018. Studies were included if they featured ≥5 patients undergoing WEB for wide-neck intracranial aneurysms, reported an angiographic or clinical outcome and risk factors, and were published after December 1, 2012. Major outcomes included initial or short-term complete and adequate occlusion. Secondary outcomes included treatment failure, recanalization, mortality, morbidity, and complication rates. A random-effect model was used to pool the data. To assess risk factors for short-term angiographic outcomes and the most common complications, we conducted subgroup analyses. RESULTS: We included 36 studies (1759 patients with 1749 aneurysms). The initial complete and adequate occlusion rates were 35% and 77%, respectively. The short-term (mean follow-up, 9.34 months) complete and adequate occlusion rates were 53% and 80%, respectively. Thromboembolism and recanalization had the highest occurrence (both 9%), followed by mortality (7%), morbidity (6%), failure (5%) and intraoperative rupture (3%). The following factors were related to higher short-term obliteration rates: unruptured status, in the anterior circulation, a medium neck (4-9.9 mm), newer-generation WEB, and treatment without additional devices. Ruptured status, anterior circulation, preoperative antiplatelet therapy, and newer-generation WEB were not significantly related to thromboembolism. CONCLUSIONS: WEB is safe and shows promising efficacy in treating wide-neck intracranial aneurysms. We preliminarily identified several risk factors for short-term angiographic outcomes.

Risk Factors for Recurrence of Chronic Subdural Hematoma: A Single Center Experience.

OBJECTIVE: Chronic subdural hematoma (CSDH) is a common form of intracranial hemorrhage with a substantial recurrence rate. We aimed to investigate the predictive factors for the postsurgical recurrence of CSDH. METHODS: We retrospectively reviewed the medical records of patients with CSDH who underwent surgery in West China Hospital between January 2012 and June 2018. Univariate and multivariate analyses were performed to identify the relationships between recurrence of CSDH and factors such as age, sex, history of injury, Markwalder grading, computed tomography findings, surgical methods, and outcomes. RESULTS: A total of 328 patients (281 men and 47 women) aged 22-93 years (mean age, 65.14 ± 13.76 years) were included. Computed tomography findings at admission showed mixed density hematoma in 136 patients, isodensity hematoma in 140, high-density hematoma in 34, and low-density hematoma in 18. The mortality and recurrence rate were 0.30% (1 of 328) and 2.44% (8 of 328), respectively. Six months postoperatively, 327 patients had Markwalder grade 0. Hematoma recurred in 8 patients of which 7 were mixed density hematoma and 1 was isodensity hematoma. Six patients who underwent craniotomy had thickened inner neomembrane that was resected. Univariate and multivariate analyses found mixed density hematoma to be an independent risk factor for the recurrence of CSDH. CONCLUSIONS: Burr hole craniostomy with irrigation and closed-system drainage is effective for the surgical treatment of CSDH. Mixed density hematoma is an independent predictor for the recurrence of CSDH. Presence of thick inner neomembrane might be the primary cause of CSDH recurrence.

Application of the Willis Covered Stent in the Treatment of Ophthalmic Artery Segment Aneurysms: A Single-Center Experience.

OBJECTIVE: The purpose of this study is to introduce our initial experience with the evaluation of the feasibility of using Willis covered stents (WCSs) in the treatment of complicated ophthalmic artery (OA) segment aneurysms. METHODS: Of the 162 patients with OA segment aneurysms treated by endovascular techniques in West China Hospital from January 2015 to August 2017, a total of 26 patients treated with WCSs were included in the study. RESULTS: Twenty-six patients with 26 aneurysms were included (mean age, 57.0 years; range, 22-76 years). The cohort had 20 patients with large or giant aneurysms, 3 patients with blood blister aneurysms, and 3 patients with pseudoaneurysms. Ten aneurysms were OA type, and 16 were internal carotid artery (ICA) type. Twenty-four patients were treated with 1 stent, and 2 patients were treated with 2 stents. Among the 26 patients, 2 patients had minimal endoleak, and 24 patients had complete occlusion after immediate postoperative angiography. One patient who had complete occlusion experienced contrast agent extravasation, and this phenomenon disappeared by balloon compression during the procedure. The 3- to 15-month angiographic follow-up showed that all patients experienced complete occlusion, including 2 patients with minimal endoleak during immediate postprocedural angiography. Two patient showed signs of in-stent stenosis. Clinical follow-up demonstrated that no delayed thromboembolic or ischemic events were recorded in the stent-grafted vascular region and no bleeding occurred in any of the patients (except 1 patient who experienced subarachnoid hemorrhage, left frontal lobe hemorrhage, and hydrocephalus 10 days after the procedure). CONCLUSIONS: WCSs may provide an alternative solution for treating complex OA segment aneurysms by reconstruction and preservation of the ICA. Our study also confirms the safety, efficacy, and midterm durability of WCSs for complex OA segment aneurysms.

Application of the Willis Covered Stent in the Treatment of Carotid-Cavernous Fistula: A Single-Center Experience.

BACKGROUND: The purpose of the present study was to describe our single-institutional experience of treating direct carotid-cavernous fistulas (DCCFs) with Willis covered stents (WCSs). METHODS: Of a total of 31 DCCFs, 10 were treated with WCSs (Microport, Shanghai, China) at West China Hospital from January 2015 to December 2016. The indications for treatment, perioperative findings, and postoperative and follow-up results were collected and analyzed. RESULTS: All 10 patients had successful deployment of WCSs. Complete exclusion of the fistula was achieved in 6 patients immediately after deployment of 1 stent. Endoleak was observed in 4 patients (patients 2, 4, 5, and 9). Thus, repeat dilation of the stent with greater pressure was performed, which resolved the endoleak in 2 patients (patients 2 and 9). The endoleak of the other 2 patients persisted after repeat dilation of the balloon. Hence, a second stent was deployed in these 2 patients (patients 4 and 5), which eliminated the endoleak in patient 4. However, patient 5 continued to have a minimal endoleak. Nine patients had fistulas successfully occluded by WCSs during the follow-up period. One patient experienced recurrence of a DCCF at the 10-day follow-up point. We chose coil embolization to address this DCCF. No stenosis of the internal carotid artery or DCCF recurrence, except that in the abovementioned patient, was observed. CONCLUSIONS: WCS was proved to be an alternative treatment method for complex DCCFs through reconstruction and preservation of the internal carotid artery. Our study also confirmed the safety, efficacy, and midterm durability of WCSs for complex DCCFs without any serious delayed complications.

Application of the Willis Covered Stent in the Treatment of Blood Blister-Like Aneurysms: A Single-Center Experience and Systematic Literature Review.

OBJECTIVE: The purpose of the present study was to introduce our initial experience with the use and feasibility of the Willis covered stent (WCS) in the treatment of blood blister-like aneurysms (BBAs) and to present a systematic review of the reported data on the treatment of BBAs with covered stents. METHODS: Fourteen consecutive patients with BBAs had been treated with WCSs at West China Hospital from January 2015 to August 2017. The patient medical records, angiographic findings, and endovascular treatment reports were reviewed by interventional neuroradiologists and neurosurgeons to obtain relevant clinical and angiographic information. We conducted a systematic review of all reports of BBAs treated with covered stents. We searched the reported data using PubMed, Embase, China National Knowledge Infrastructure, and Wanfang databases and commercial Internet search engines. We included BBAs located at nonbranching portions of the internal carotid artery (ICA). RESULTS: The present study included 9 men and 5 women, with a mean age of 54.5 years (range, 30-79). All patients had complete occlusion found on immediate postoperative angiography. The ophthalmic artery was occluded in 2 patients (14.3%). No mortality or morbidity had occurred during the procedure. Two patients (14.3%) experienced a mild recurrence. One patient (7.1%) had developed mild in-stent stenosis. The clinical follow-up period was 6-15 months for all the patients. Of the 14 patients, 11 (78.6%) had a modified Rankin scale score of 0, and 1 (7.1%) had a modified Rankin scale score of 1 during the follow-up period. One patient (7.1%) experienced subarachnoid hemorrhage at 7 days postoperatively and had died 10 days after surgery. None of the patients experienced visual defects. Of our 14 patients, 13 (92.9%) survived, as determined by outpatient department visits or telephone interviews. A total of 8 reports, including 38 patients, met our criteria. Of these 38 patients, 37 (97.3%) had successful delivery to the diseased ICA, and 34 (89.5%) had experienced complete occlusion during follow-up. The overall rate of complete occlusion was 83.0% (95% confidence interval, 68%-91%). CONCLUSIONS: Patients with ruptured BBAs treated with WCSs can achieve satisfactory clinical results. Therefore, for BBAs, the implementation of the WCS could be safe and feasible. This strategy could be a promising option for this type of high-risk aneurysm. However, patients with tortuous ICAs or aneurysms close to essential branch arteries should be carefully evaluated before the WCS is used.

Prognosis of Symptoms and Complications After Microvascular Decompression for Hemifacial Spasm: A Single-Center Experience.

OBJECTIVE: The aim of this study was to identify potential prognostic factors of hemifacial spasm (HFS) after microvascular decompression (MVD), to establish the appropriate way to tackle postprocedure symptoms and complications (PPSCs), and to find the incidence and duration of PPSCs. METHODS: Two hundred and forty-eight patients with HFS were monitored between December 2009 and December 2014. The mean follow-up duration was 24 months (range, 6-67 months). We divided patients based on their PPSC status and investigated the following factors: age, sex, spasm side, facial nerve block before MVD (botulinum toxin treatment), acupuncture before MVD, duration of HFS, hypertension, diabetes, hepatitis B virus (HBV) infection status, herpes simplex virus infection status, smoking status and alcohol use, offending vessels, Chiari malformation, electrophysiologic monitoring results, and postoperative HFS. Univariable analysis and multivariate logistic regression were used to find potential risk factors. Kaplan-Meier analysis was used to show the duration of postprocedure facial palsy. RESULTS: Age (odds ratio [OR], 1.037; 95% confidence interval [CI], 1.004-1.072; P = 0.03) and HBV status (OR, 18.256; 95% CI, 2.723-122.415; P = 0.03) were positive predictors of PPSCs. Postoperative HFS (OR, 0.249; 95% CI, 0.084-0.0739; P = 0.012) may be a protective factor for postprocedure facial palsy. Most PPSCs related to cranial nerves recovered spontaneously in 3 months. Infections and cerebrospinal fluid leakages were controlled by medical intervention in 1-2 weeks. The permanent complication rate was only 4.8%. CONCLUSIONS: Although the incidence of PPSCs after MVD is very high, most PPSCs related to cranial nerves recovered spontaneously in several days. Permanent complications after MVD for HFS are rare. Age may relate to the occurrence of PPSCs, and postoperative HFS may be a protective factor for patients with facial palsy after MVD.

In-stent stenosis in the patient with internal carotid aneurysm after treated by the Willis covered stent: Two case reports and literature review.

In-stent stenosis after treated by Willis covered stent-case reports. BACKGROUND: Advancements in minimally invasive technology have allowed endovascular reconstruction of internal carotid aneurysm. However, in-stent stenosis is an important and well-characterized complication of stenting after the treatment of internal carotid aneurysm. CASE DESCRIPTION: We would present 2 patients who were diagnosed with in-stent stenosis after the treatment of Willis covered stent. Case 1: A 57-year-old female with 2-week history of headache and vomiting before admission, whose digital subtraction angiography (DSA) demonstrated left internal carotid C6 aneurysm and showed about 20% stenosis 3 months later since operation in the position where Willis covered stent was deployed. Case 2: A 23-year-old male with skull base fracture, subarachnoid hemorrhage, right femoral fracture for 14 days and epistaxis for 9 hours caused by a car accident, whose DSA demonstrated left internal carotid paracliniod pseudoaneurysm. One year later, the patient went to our center again because he had headache and dizziness for 6 months after the interventional operation. His DSA demonstrated about 80% stenosis in the position where Willis covered stent was deployed. The clinical and radiologic characteristics and the experience in dealing with the stenosis are presented. CONCLUSIONS: In-stent stenosis after treated with Willis covered is uncommon, but not rare. Operators should pay more attention to the in-stent stenosis during the period of follow-up observation and monitor P2Y12 Reaction Unit (PRU) in the antiplatelet period, especially for the Willis covered stent. What is more, the treatment for stenosis ought to be carefully considered.

Prognosis research of delayed facial palsy after microvascular decompression for hemifacial spasm.

BACKGROUND: Although microvascular decompression (MVD) surgery has been widely accepted as an effective treatment for hemifacial spasm (HFS), delayed facial palsy (DFP) is not an unusual complication, but it has only been sporadically described in the literature. The purpose of this study was to examine the probability of occurrence, the risk/predisposing factors, and the prognosis and timing of DFP. METHODS: A prospective cohort study was conducted that included patients diagnosed with HFS and treated by MVD at our institution. All patients were followed up at the outpatient department or by telephone from December 2009 to December 2014. Categorical variables were analyzed using the Pearson's Chi-square test or Fisher's exact test. Continuous variables were compared using the independent Student's t test. The Spearman rank test was used to determine the correlation between the time of onset and the duration of DFP. The risk/predisposing factors were analyzed by the logistic regression method. RESULTS: We enrolled 248 patients who were treated by MVD for HFS. During the follow-up period, 16 patients (6.5 %) developed DFP. Fifteen of those patients had a complete recovery, and in one patient the facial palsy did not resolve. The average onset time was 10.2 days (range, 2-30 days) after surgery, and the mean duration of DFP after MVD, with exclusion of the permanent facial palsy patient, was 59.7 days (range, 7-220 days). The time of onset was correlated with the duration of DFP after MVD (p = 0.036). Furthermore, hypertension contributed to DFP (odds ratio [OR] 4.226, 95 % confidence interval [CI] 1.089-16.401, p = 0.037). CONCLUSIONS: Although the degree of facial palsy was variable, most patients experienced a complete recovery without requiring any special treatment. DFP may be a self-healing disease that resolves spontaneously without any treatment. The time of onset was correlated with the duration of DFP; i.e., an earlier development of DFP corresponded with a shorter duration, whereas a later development of DFP corresponded with a longer duration. Our results also suggest that hypertension contributes to DFP.