Efficacy and Safety of Flow-Diverter Therapy for Recurrent Aneurysms after Stent-Assisted Coiling.

BACKGROUND AND PURPOSE: Flow-diverter treatment for previously stented aneurysms has been reported to be less effective and prone to complications. In this study, we evaluated the effectiveness and safety of flow diverters for recurrent aneurysms after stent-assisted coiling. MATERIALS AND METHODS: Patients who underwent flow-diverter placement for recurrent aneurysms after stent-assisted coiling between March 2015 and March 2019 were recruited. Clinical and radiographic characteristics and clinical and angiographic outcomes were retrospectively evaluated. RESULTS: Among 133 patients who underwent flow-diverter insertion, 17 (male/female ratio = 5:12; mean age, 53.8 years) were treated for recurrent aneurysms after stent placement with (n = 16) or without (n = 1) coiling. Eight patients initially presented with subarachnoid hemorrhage; 7, with headache; and 2, with visual field defects. Angiographic morphology included large/giant saccular in 12 patients, dissecting in 2, fusiform in 1, traumatic pseudoaneurysm in 1, and ruptured blood blister-like aneurysm in 1. The duration between the first treatment and flow-diverter placement ranged from 2 weeks to 15 months (median, 6 months). Flow-diverter placement was successful in all cases without any complications. All patients had favorable outcomes (mRS, 0-2), without any newly appearing symptoms. Aneurysms were followed up with conventional angiography at least once in 6-18 months. Sixteen aneurysms showed complete occlusion, and 1 aneurysm was enlarged. CONCLUSIONS: Results from this case series investigating flow-diverter placement for recurrent aneurysms after stent-assisted coiling suggested that the procedure is safe and effective. Further study in a larger population may be warranted.

Association between Postprocedural Infarction and Antiplatelet Drug Resistance after Coiling for Unruptured Intracranial Aneurysms.

BACKGROUND AND PURPOSE: Procedure-related thromboembolism is a major limitation of coil embolization, but the relationship between thromboembolic infarction and antiplatelet resistance is poorly understood. The purpose of this study was to verify the association between immediate postprocedural thromboembolic infarction and antiplatelet drug resistance after endovascular coil embolization for unruptured intracranial aneurysm. MATERIALS AND METHODS: This study included 338 aneurysms between October 2012 and March 2015. All patients underwent postprocedural MR imaging within 48 hours after endovascular coil embolization. Antiplatelet drug resistance was checked a day before the procedure by using the VerifyNow system. Abnormal antiplatelet response was defined as >550 aspirin response units and >240 P2Y12 receptor reaction units. In addition, we explored the optimal cutoff values of aspirin response units and P2Y12 receptor reaction units. The primary outcome was radiologic infarction based on postprocedural MR imaging. RESULTS: Among 338 unruptured intracranial aneurysms, 134 (39.6%) showed diffusion-positive lesions on postprocedural MR imaging, and 32 (9.5%) and 105 (31.1%) had abnormal aspirin response unit and P2Y12 receptor reaction unit values, respectively. Radiologic infarction was associated with advanced age (65 years and older, P = .024) only with defined abnormal antiplatelet response (aspirin response units ≥ 550, P2Y12 receptor reaction units ≥ 240). P2Y12 receptor reaction unit values in the top 10th percentile (>294) were associated with radiologic infarction (P = .003). With this cutoff value, age (adjusted odds ratio, 2.29; 95% confidence interval, 1.28-4.08), P2Y12 receptor reaction units (>294; OR, 3.43; 95% CI, 1.53-7.71), and hyperlipidemia (OR, 2.05; 95% CI, 1.04-4.02) were associated with radiologic infarction in multivariate analysis. CONCLUSIONS: Radiologic infarction after coiling for unruptured aneurysm was closely associated with age. Only very high P2Y12 receptor reaction unit values (>294) predicted postprocedural infarction. Further controlled studies are needed to determine the precise cutoff values, which could provide information regarding the optimal antiplatelet regimen for aneurysm coiling.

Forced collapse of the blastocoel cavity improves developmental potential in cryopreserved bovine blastocysts by slow-rate freezing and vitrification.

This study was conducted to evaluate the effectiveness of forced collapse of the blastocoel before slow-rate freezing and vitrification of bovine blastocysts. Cryopreservation of bovine blastocysts has been proposed as a tool to improve the feasibility of cattle production using the embryo transfer technique. However, the low efficiency of frozen-thawed embryos survival and further development is a crucial problem. In this study, bovine in vitro and in vivo blastocysts were slow-rate frozen and vitrified after forced blastocoele collapse (FBC) of the blastocyst cavity by puncturing the blastocoele with a pulled Pasteur pipet. Differences in the developmental potential of frozen-thawed blastocysts derived from FBC and non-FBC groups were found in both slow-rate freezing and vitrification. Furthermore, we found that the total cell number of blastocysts in FBC groups was increased and the index of apoptosis in FBC groups was decreased. Consistent with these results, real-time RT-PCR analysis data showed that expression of the anti-apoptotic Bcl-XL gene was significantly increased by FBC groups, whereas expression of the pro-apoptotic Bax gene was significantly decreased by FBC groups. Our results also showed that pregnancy outcomes in both slow-rate frozen and vitrified bovine in vivo blastocysts could be improved by reducing the fluid content after FBC of the blastocyst cavity. Therefore, we suggest that FBC of the blastocyst cavity with a pulled Pasteur pipet is an effective pre-treatment technique for both slow-rate freezing and vitrification of bovine blastocysts.