Waffle-cone technique using solitaire AB stent for endovascular treatment of complex and wide-necked bifurcation cerebral aneurysms.

INTRODUCTION: To explore the safety and opportunity of the "waffle-cone" technique for the treatment of intracranial aneurysm. METHODS: From November 2009 and May 2012, consecutive data were collected from 136 patients with aneurysms treated by the stent-assisted coiling procedure. Six of these patients were treated using the "waffle-cone" technique. RESULTS: All the 6 patients were complex, wide-neck, bifurcation cerebral aneurysms. And the angles between the parent artery and distal vessels are acute. Two ruptured aneurysms located at the terminus of basilar artery, three ruptured aneurysms located at the anterior communicating artery, and one ruptured aneurysm located at trifurcation MCA. All the 6 patients were treated using the "waffle-cone" technique, 4 patients had Raymond classification Class I and 2 patients had Class II after the procedure. No complications occurred perioperative. There were no lesion-related strokes or deaths during the 6-month follow-up period. CONCLUSIONS: The "waffle-cone" technique is a safe, simple and alternative for the complex, wide-necked bifurcation aneurysms with acute angles between the parent artery and distal vessels. Long-term following-up results are needed to evaluate the efficacy of this technique.

[Comparative study of right anterolateral minithoracotomy and median sternotomy in the repair of atrial septal defects].

OBJECTIVE: To compare the effect of right anterolateral minithoractomy and median sternotomy for atrial septal defect closure. METHODS: In this study, 82 patients, whose age ranged from 4 to 46 years with a mean of 15.7+/-8.6 years, underwent surgical repair of the atrial septal defects on the beating heart through right anterolateral minithoractomy. Ten of these cases were complicated by moderate to severe pulmonary hypertension, and 3 by partial anomalous pulmonary venous connection. Another 67 patients with an age range of 3 to 49 years (mean 17.0+/-12.5 years) underwent surgical repair of the atrial septal defects through full-length median sternotomy with the heart beat arrested, and complication of moderate to severe pulmonary hypertension was identified in 11 cases and partial anomalous venous connection in 5. Comparisons were performed between the 2 groups in terms of the length of skin incision, cardiopulmonary bypass (CPB) time, postoperative mechanical ventilation time, intensive care unit stay, postoperative hospital stay, and the volume of postoperative drainage. RESULTS: There was no operative mortality in either of the 2 groups. In the former group, the CPB time (35.2+/-14.1 min), postoperative mechanical ventilation time (6.5+/-2.5 h), postoperative drainage volume (237.6+/-172.5 ml), postoperative hospital stay (7.4+/-1.2 d) and skin incision length (6.5+/-0.9 cm) were all significantly less than those of the latter group of patients, whose CPB time was 42.7+/-11.8 min, postoperative mechanical ventilation time 7.9+/-3.8 h, postoperative drainage volume 304.3+/-192.4 ml, postoperative hospital stay 9.0+/-2.9 d and skin incision length 15.9+/-1.7 cm (P < 0.01). The intensive care unit stay did not differ significantly between the 2 groups (35.1+/-16.2 h vs 32.3+/-24.1 h, P > 0.05). CONCLUSION: A right anterolateral minithoracotomy for repairs of atrial septal defects is a safe, effective and simple technique to ensure minimal surgical invasion with shorter postoperative hospital stay. Minithoracotomy can be performed to replace median sternotomy in the correction of atrial septal defects, including those complicated by partial anomalous pulmonary venous connection.