Treatment of direct carotid-cavernous fistula with Willis covered stent with midterm follow-up.

BACKGROUND: Willis covered stent is the first stent designed exclusively for intracranial vasculature, and its application in carotid-cavernous fistula is limited. The aim is to evaluate the feasibility and efficacy of this device in treating direct carotid-cavernous fistula. METHODS: Ten consecutive patients with direct carotid-cavernous fistula were treated in our institution with Willis covered stents from September 2013 to December 2015. The characteristics of these patients and the immediate and follow-up results were retrospectively reviewed. RESULTS: Of the 10 patients, 8 were treated for the first time, and 2 had been treated elsewhere. Willis covered stents were successfully released in 9 patients. Abnormal arteriovenous shunt disappeared in 6 cases immediately after stent deployment and endoleak occurred in 3 cases. Endoleak disappeared at 6-month angiography follow-up in one case and was sealed with coils through a pre-set microcatheter in another case. Parent artery was sacrificed as endoleak remained despite repeated balloon dilation and a second stent deployment in the third case. All patients got clinical follow-ups for at least 24 months and 7 patients received angiographic follow-up. Symptoms were relieved gradually in all cases except for slight oculomotor paralysis and visual acuity in one case, respectively. In-stent stenosis was found in 1 case, and no recurrence was observed. CONCLUSIONS: Willis covered stent is feasible for direct carotid-cavernous fistula.

Low-Profile Visualized Intraluminal Support Stent-Only Technique for Intracranial Aneurysms-A Report of 12 Cases with Midterm Follow-Up.

OBJECTIVE: To evaluate the safety and efficacy of stent-only technique with Low-profile Visualized Intraluminal Support (LVIS) for uncoilable intracranial aneurysms. METHODS: Twelve uncoilable aneurysms in 12 patients were treated with the stent-only technique in our department from January 1, 2016, to December 31, 2017. The characteristics of the aneurysms and the patients were analyzed. The midterm follow-up results of these patients also were analyzed. RESULTS: Twelve patients (7 male and 5 female) were enrolled in the series. The 12 aneurysms included 6 vertebral-basilar artery aneurysms, 3 internal carotid artery aneurysms (2 blood blister-like aneurysms and 1 posterior communicating artery aneurysm), 1 posterior cerebral artery dissecting, 1 anterior cerebral artery dissecting of the third segment, and 1 pseudoaneurysm at the first segment of the anterior cerebral artery. Seven aneurysms were? ruptured, whereas 5 remained unruptured. A total of 24 LVIS stents were deployed. Three aneurysms were covered by 3 overlapped stents, 6 aneurysms were covered by 2 stents, and the other 3 aneurysms were covered by 1 stent. All procedures were successful without any perioperative complications. Imaging follow-up between 3 and 10 months after operation was available in all 12 patients, with complete obliteration in 10 aneurysms, improvement in 1, and parent artery occlusion in 1. CONCLUSIONS: LVIS stent-only technique is safe and efficacious for uncoilable aneurysms, even for ruptured ones.

Prediction of the Outcome for Patients with Glioblastoma with lncRNA Expression Profiles.

BACKGROUND: Progress in gene sequencing has paved the way for precise outcome prediction of the heterogeneous disease of glioblastoma. The aim was to assess the potential of utilizing the lncRNA expression profile for predicting glioblastoma patient survival. MATERIALS AND METHODS: Clinical and lncRNA expression data were downloaded from the public database of the cancer genome atlas. Differentially expressed lncRNAs between glioblastoma and normal brain tissue were screened by bioinformatics analysis. The samples were randomly separated into the training and testing sets. Univariate Cox regression, least absolute shrinkage, selection operator regression, and multivariate Cox regression were performed to develop the prediction model with the training set, which was presented as a forest plot. The performance of the model was validated by discrimination and calibration analysis in both the training and testing sets. Patient survival between model-predicted low- and high-risk subgroups was compared in both the training and testing sets. RESULTS: One thousand two hundred and fifty-five differentially expressed lncRNAs between glioblastoma and normal brain tissues were screened. After univariate Cox regression and the least absolute shrinkage and selection operator regression, a 12 lncRNA constituted prediction model was developed by multivariate Cox regression. Of the 12 lncRNAs, 4 lncRNAs were independent risk factors for patient survival. The areas under the receiver operating characteristic curves of the model for predicting 0.5-, 1-, 1.5-, and 2-year patient survival was 0.788, 0.824, 0.874, and 0.886, respectively in the training set and 0.723, 0.84, 0.816, and 0.773 in the testing set. The calibration curves of the prediction model fitted well. Significant survival disparity was observed between the model dichotomized low- and high-risk subgroups in both the training and testing set. CONCLUSIONS: LncRNA expression signature can predict glioblastoma patient survival, promising lncRNA-based survival prediction.

Successful Closure of a Ventricular Septal Defect Using a Novel Non-Prosthesis Touching Technique Following Mechanical Aortic Valve Replacement.

Percutaneous intervention is preferred over reoperation for the treatment of iatrogenic membranous ventricular septal defects (VSDs). During the standard percutaneous procedure, an arterio-venous loop is used for occluder deployment, entailing the risk of device impingement on the prosthetic aortic valve, which may cause serious complications or even death. In this report, we describe a novel non-prosthesis touching procedure for the closure of a VSD in a patient with prior aortic valve replacement. The unique feature of this technique is the use of an apex-venous loop for occluder deployment, which prevents the device impingement on the prosthetic valve, thus avoiding difficulties, lengthy operation and serious complications associated with the standard procedure. Immediate and 1-year follow-up results showed that the VSD was successfully closed and no serious complications were observed.