Objectives This study aimed to identify factors at baseline associated with visual outcomes of patients with idiopathic intracranial hypertension (IIH) with venous sinus stenosis who underwent venous sinus stenting. Methods The study eyes were divided into two groups according to mean deviation (MD) at 6-month post-stenting follow-up: MD better than −2.0 dB (the favorable visual outcome group) and equal to −2.0 or worse (the poorer visual outcome group). Variables at baseline between the two groups were compared. A multivariable logistic regression model was performed to identify the factors at baseline associated with poorer MD outcomes at 6 months. Results The poorer recovery group had a lower incidence of tinnitus (5.9% vs 27.5%, P=0.015), worse initial best corrected visual acuity (0.22 vs 0, in logMAR, P=0.000), worse preoperative MD (−8.64 vs −3.05, P=0.000) and higher trans-stenotic gradient pressure (19.5 vs 16, P=0.002) and total cranial gradient pressure (TCGP) (25.75 vs 18, P=0.000), lower ganglion cell complex (GCC) thickness (90.5 vs 99, P=0.005), higher focal loss volume percentage (2.35 vs 0.84, P=0.002) and global loss volume percentage (4.87 vs 1.8, P=0.012) of GCC. Multivariate analysis showed that worse preoperative MD and higher TCGP (OR 45.61, 95% CI 5.21 to 399.48; P=0.001 and OR 8.45, 95% CI 1.60 to 44.67; P=0.012, respectively) were associated with an increased risk of poorer MD outcomes at the 6-month follow-up. Conclusion This study found that worse preoperative MD and higher TCGP at baseline may be associated with poorer visual outcomes after stenting treatment.

Background:Despite significant advancements in endovascular treatment (EVT) over the past decade, symptomatic intracerebral hemorrhage (sICH) persists as a serious complication, especially in patients with acute ischemic stroke (AIS) related to intracranial atherosclerotic stenosis (ICAS), which is characterized by complex and calcified plaques. The present study aimed to develop a predictive nomogram for assessing the risk of sICH in AIS patients with ICAS and large-vessel occlusion (LVO) who undergo EVT. Methods:We analyzed data from 183 patients with acute ischemic stroke (AIS) due to intracranial atherosclerotic stenosis-related large vessel occlusion (ICAS-LVO) who underwent endovascular treatment (EVT) between January 2022 and December 2023. The primary safety outcome was the incidence of symptomatic intracranial hemorrhage (sICH). A nomogram was developed based on a multivariable logistic regression model, and the calibration of the model was evaluated using Spiegelhalter's Z-test. Results:In our developed nomogram, elevated D-dimer levels (odds ratio [OR] 2.87; 95% confidence interval [CI], 1.53-5.39; p = 0.001), longer onset-to-recanalization time (OR 1.00; 95% CI, 1.00-1.01; p = 0.004), and larger core infarct volume (OR 1.04; 95% CI, 1.01-1.06; p = 0.002) were identified as independent predictors of symptomatic intracranial hemorrhage (sICH) in stroke patients undergoing endovascular treatment (EVT). The goodness-of-fit of the model was confirmed by a non-significant Spiegelhalter's Z-test (p = 0.941). Conclusion:A nomogram integrating D-dimer levels, onset-to-recanalization time, and core infarct volume offers a reliable and practical method for estimating the risk of symptomatic intracranial hemorrhage in acute ischemic stroke patients with intracranial atherosclerotic stenosis-related large vessel occlusion receiving endovascular therapy.

BackgroundOpen-cell self-expanding stents have been used for vertebral artery origin (VAO) atherosclerotic stenosis; however, data on their safety and durability remain limited.MethodsWe retrospectively screened 96 patients who were evaluated for potential open-cell self-expanding stent treatment of angiographically confirmed VAO stenosis between February 2015 and December 2020. After exclusion of 62 patients (47 with vertebral artery diameter <4.0 mm and 15 with vertebral artery diameter > = 4.0 mm who declined self-expanding stent treatment), the final treated cohort comprised 34 consecutive eligible symptomatic patients who underwent open-cell self-expanding stent implantation. Clinical outcomes were assessed perioperatively and during follow-up. The 30-day safety endpoint included stroke, myocardial infarction, and death. ISR was evaluated among patients who completed imaging follow-up; DSA-confirmed ISR and ISR among all patients with imaging surveillance were both reported.ResultsOf 96 screened patients, 34 symptomatic treated patients were included. Three patients entered the symptomatic 50–69% stenosis pathway after insufficient response to medical therapy, and 31 entered the symptomatic > = 70% high-risk anatomic stenosis pathway. Technical success was 100%. VAO stenosis improved from 75.7 +/− 7.9% preprocedure to 8.4 +/− 7.6% immediately after stenting (p < 0.001). Distal embolic protection was used in all procedures. Periprocedural complications occurred in 2/34 patients (5.9%; 95% CI, 1.6–19.1%), including 1 symptomatic acute cerebral infarction. No myocardial infarction or death occurred within 30 days. Clinical follow-up was available in 31/34 patients (91.2%); long-term telephone follow-up had a median duration of 43.0 months (IQR, 35.0–55.0; range, 10–83), with no treatment-requiring recurrent symptoms reported. Imaging follow-up was available in 24/34 patients (70.6%) for a median of 6.0 months (IQR, 3.8–13.5; range, 1–60). DSA-confirmed ISR occurred in 1/16 patients (6.3%; 95% CI, 1.1–28.3%) who underwent DSA follow-up; among all patients with imaging surveillance, ISR was observed in 1/24 (4.2%; 95% CI, 0.7–20.2%).ConclusionIn this single-center retrospective series, open-cell self-expanding stent implantation for atherosclerotic VAO stenosis appeared technically feasible and was associated with infrequent periprocedural adverse events. Longer-term durability and optimal patient selection require confirmation in larger prospective studies with standardized imaging follow-up.

BACKGROUND:In this study, we analyzed the characteristics of different stenosis types in idiopathic intracranial hypertension (IIH) patients with venous sinus stenosis (VSS) using intravascular ultrasound (IVUS).METHODS:We retrospectively reviewed data from patients who underwent IVUS evaluation during venography or stenting procedures between January 2014 and February 2022.RESULTS:Among the 80 patients with intrinsic lesions, 47 cases were identified, including 41 single lesions and 6 multiple lesions. Single lesions consisted of 36 cases of AG, 3 cases of brain herniation, and 2 cases of septation. Multiple intrinsic lesions were found in 6 patients, with AG observed in the transverse sinus and sigmoid sinus. IVUS features varied depending on the anatomical variations of intrinsic stenosis. Additionally, among the 33 cases of extrinsic stenosis, two types were observed: unilateral compression (22 cases) and bilateral compression (11 cases), primarily affecting the transverse sinus.CONCLUSION:IVUS effectively differentiated intrinsic and extrinsic types of stenosis and identified intraluminal and mural components of intrinsic stenosis.

BACKGROUND:At present, neurointerventional surgery requires angiographers to perform operations in the digital subtraction angiography (DSA) room. Ionising radiation and chronic joint damage are still unavoidable for angiographers. Therefore, we researched and developed a neurointerventional robot-assisted system, which is operated by angiographers in an operating room outside the DSA room. We have conducted a prospective, multicentre, randomised controlled trial to evaluate the safety and efficacy of a robot-assisted system in human cerebral angiography. In the future, this research will provide a platform for the research and development of an intelligent surgical system and bring revolutionary progress in neurointerventional surgery. METHODS:From December 2020 to December 2021, 260 patients were enrolled from three medical centres, who were randomly and equally divided into a robot-assisted system group and a clinical routine cerebral angiography group. The success rate of angiography, the rate of the catheter reaching the target vessel, the operation time, X-ray radiation exposure and the incidence of related adverse events were compared between the two groups. RESULTS:A total of 257 patients completed this trial; baseline characteristics of the two groups did not differ significantly. The success rate of angiography in both the control group and the experimental group was 100%. The rate of the catheter reaching the target vessel was 99.23% and 100.00% in the control and experimental groups, respectively. For the control versus experimental groups, the angiographic operation time was 48.59±25.60 min versus 47.94±27.49 min, respectively; the X-ray radiation dose was 735.01±554.77 mGy versus 821.65±705.45 mGy, respectively; and the incidence of adverse events was 23.44% versus 22.48%, respectively. No statistical differences were present between the two groups. CONCLUSION:The robot-assisted surgical system is more convenient for cerebral angiography and is as safe and effective as the traditional cerebral angiography.

Background: The pulsatility index (PI) derived from transcranial Doppler (TCD) assessment may represent the cerebral resistance and altered cerebral blood flow. The purpose of this study was to assess the performance of the TCD PI in correlation with wire-based fractional pressure ratio (FPR).Methods: This study included 33 patients with symptomatic atherosclerotic lesions of the extracranial and intracranial large arteries, specifically the internal carotid artery, middle cerebral artery (MCA), vertebral artery (VA) V4 segment, and basilar artery (BA), all of which exhibited luminal stenosis ranging from 50% to 70%. TCD was performed prior to angiography in order to determine the flow distal to the lesion. We performed cerebrovascular angiography with a pressure wire to measure the FPR of vessels with stenotic lesions. Bland-Altman analysis and ordinal least square (OLS) linear regression were used to quantify the correlation between PI and FPR.Results: A total of 42 TCD data points were analyzed. At the TCD locations distal to the lesions, the correlation coefficients were no less than 0.90%, with almost all P values <0.001, which indicated very strong positive correlations; the exception to this was the distal TCD for MCA segment lesions (r=0.897; P=0.015) and VA V4 segment (r=0.964; P=0.036). The Bland-Altman plot demonstrated a small difference (0.003) between the distal TCD PI and the FPR, with an acceptable 95% confidence interval (95% CI: 0.06-0.12).Conclusions: The PI obtained through TCD assessment distal to the stenotic lesion exhibited a correlation with the FPR computed using pressure wire measurements.

This study aimed to investigate the factors influencing favourable clinical outcomes in idiopathic intracranial hypertension (IIH) patients with venous sinus stenosis (VSS) who received stenting treatment. In this prospective cohort study, we analyzed a total of 172 IIH patients with VSS treated with venous sinus stenting. Clinical outcomes were categorized as either “complete resolved” or “improved”. We employed multivariable logistic regression modeling to identify independent factors associated with the clinical outcomes. The predictive accuracy of the model was assessed using receiver operating characteristic (ROC) analysis. Out of the total cohort, 126 patients exhibited asymptomatic clinical outcomes, while 46 patients showed improved clinical outcomes. Patients with asymptomatic clinical outcomes demonstrated notably lower preoperative BMI (26.8 kg/m2 versus 28.7 kg/m2, P = 0.013). In multivariate analysis, preoperative BMI (odds ratio [OR] = 1.108, 95

PURPOSE This study aimed to evaluate the impact of the pressure gradient on papilledema after stenting in patients with idiopathic intracranial hypertension (IIH) patients and venous sinus stenosis (VSS). MATERIALS AND METHODS In this prospective cohort study, we examined 121 patients with IIH and VSS who underwent stenting. The papilledema Frisen grade at the 1-month follow-up was used as a grouping factor (favorable outcome: 0-1; unfavorable outcome: 2-5). We used multivariable logistic regression modeling to determine independent predictors of favorable outcome. The performance of the prediction model was evaluated using a receiver operating characteristic (ROC) analysis. RESULTS A total of 96 patients had papilledema grades 0 to 1, and 25 patients had papilledema grades 2 to 5. Patients with the first group had significantly lower gradient pressures preoperatively (15.2 mmHg vs. 21.4 mmHg, p=0.001) and postoperatively (2 mmHg vs. 3.3 mmHg, p=0.002) relative to those in the second group. Multivariate analysis indicated that preoperative pressure gradient (odds ratio [OR] = 1.119; 95% confidence interval [CI] = 1.034-1.211]) and postoperative pressure gradient (OR = 1.498; 95% CI = 1.147-1.957) were independent predictors of favorable outcome. In the ROC analysis, the cut-off pressure gradient for the highest sensitivity (0.44) and specificity (0.874) was 22.75 mmHg, with a Youden's index of 0.314. Survival analysis demonstrated that patients with a preoperative pressure gradient <22.75 mmHg had more rapid improvement of papilledema than did those with a pressure gradient >22.75 mmHg (mean+SD: 2.639+0.382 [95% CI: 1.890-3.388] versus mean+SD: 3.882+0.884 [95% CI: 2.149-5.616]; p=0.004). CONCLUSION A significant reduction in the pressure gradient appears to be strongly correlated with the success of VSS in patients with IIH. A higher preoperative pressure gradient may reduce stenting efficacy in patients with IIH. CLINICAL IMPACT Venous sinus stenting has the potential to yield substantial clinical advantages in individuals diagnosed with idiopathic intracranial hypertension with venous sinus stenosis. Nevertheless, a heightened preoperative pressure gradient could lead to less favorable results. Thus, the early adoption of venous sinus stenting is advised to avert additional irreversible clinical deterioration among idiopathic intracranial hypertension patients with venous sinus stenosis.

Objective:The purpose of this study was to evaluate the effectiveness and safety of drip and ship (DS) for acute ischemic stroke (AIS) by comparing three treatment strategies: 1) patients seen at a primary stroke center, started on emergency intravenous thrombolysis and then transported to a comprehensive stroke center (drip and ship, DS); 2) patients immediately transferred to comprehensive stroke center without starting intravenous thrombolysis, for mechanical thrombectomy (non-drip and ship, non-DS); and 3) patients admitted directly to the comprehensive stroke center for assessment and subsequent bridging thrombolysis (mothership, MS). Methods:We retrospectively reviewed the data of patients that underwent mechanical thrombectomy for AIS from November 2020 to May 2022 at our institution. Patients were divided into three groups: DS, non-DS, and MS. Time course, multimodal CT features and clinical results were compared among the three groups. Results:The study included 62 patients, with 19, 18, and 25 patients in DS, non-DS, and MS groups, respectively. Baseline characteristics did not differ among the three groups. The DS group had a significantly longer median onset to groin time than the MS group (395 min vs 244 min; P < 0.001), a significantly shorter onset to primary stroke center time than the non-DS group (90 min vs 463 min; P < 0.001), and a longer primary stroke center to groin puncture time than the non-DS group (277 min vs 162 min; P = 0.002). The onset to needle time was longer in the MS group than the DS group (151.2 min vs 111.8 min; P = 0.041). The intravenous thrombolysis to puncture time was shorter in the MS group compared with DS (56 min vs 278 min; P < 0.001). No significant differences were present among groups in post-operative variables measured. Conclusions:DS is a safe and effective method, with no increased risk of postoperative complications or death compared to non-DS and MS methods. The study provides a reference for the selection of transport modes for AIS patients.

目的 探讨椎动脉起始部支架成形术后支架内再狭窄(ISR)患者的治疗与预后.方法 收集2008年1月至2022年7月于首都医科大学附属北京朝阳医院因动脉粥样硬化性重度狭窄而行椎动脉起始部支架成形术治疗的147例患者的临床资料,分析支架成形术前与术后狭窄率,ISR发生情况,ISR症状与椎动脉直径、供血侧别的关系,不同ISR症状患者的治疗及预后情况.结果 147例患者的手术成功率为100％,共20例患者发生ISR,其中,症状加重的ISR患者9例,症状未加重或无症状的ISR患者11例;椎动脉直径≥3.5mm患者7例,椎动脉直径﹤3.5 mm患者13例;优势及均势供血侧患者4例,非优势供血侧患者16例.未发生ISR患者和发生ISR患者的术前动脉狭窄率分别为(73.7±7.6)％、(76.4±8.3)％,术后动脉狭窄率分别为7.4％(6.1％,9.6％)和8.9％(7.4％,10.3％).症状加重的ISR患者的术前动脉狭窄率为(79.4±7.1)％,术后动脉狭窄率为9.4％(8.2％,11.4％);症状未加重或无症状的ISR患者的术前动脉狭窄率为(75.2±8.1)％,术后动脉狭窄率为7.5％(6.8％,8.6％).不同病变动脉直径、供血侧别动脉粥样硬化性重度狭窄患者的术后ISR发生情况及症状情况比较,差异均有统计学意义(P﹤0.05).随访期间,发生ISR的患者均未见新发症状及症状未再次加重.结论 ISR更易发生于椎动脉直径﹤3.5 mm或非优势供血侧,但发生ISR后大部分患者症状较轻,可通过介入治疗或药物治疗获得较好的预后.椎动脉直径≥3.5 mm或优势及均势供血侧发生ISR的风险较低,一旦发生ISR,患者的症状可能明显加重,可以通过再次行球囊扩张或支架成形术获得较好的预后.

ObjectivesGlycoprotein (GP) IIb/IIIa receptor antagonists (Tirofiban) are often used as antiplatelet agents in patients undergoing interventional therapy due to acute coronary syndrome and cerebrovascular diseases. Thrombocytopenia is a common complication of GP IIb/IIIa receptor antagonist, with an incidence of 1%–5%, whereas acute profound thrombocytopenia (platelet count<20 × 109/L) is extremely rare. We reported a case of acute profound thrombocytopenia due to tirofiban treatment to inhibit platelet aggregation during and after surgery in a patient who underwent stent-assisted embolization for ruptured intracranial aneurysm.Case presentationA 59-year-old female patient, who visited the Emergency Department of our hospital due to sudden headache, vomiting, and unconsciousness for 2 hours. Neurological examination: the patient was unconscious, the pupils on both sides had the same roundness, and the reflection on light was slow. The Hunt-Hess grade was IV. Head CT showed subarachnoid hemorrhage and Fisher's score was 3. We immediately implemented LVIS stent-assisted embolization, intraoperative heparinization, and intraoperative jailing technology to perform dense embolism on aneurysms. The patient was treated with mild hypothermia and Tirofiban 5mL/h intravenous pump. Since then, the patient had developed acute profound thrombocytopenia.ConclusionWe reported a case of acute profound thrombocytopenia due to tirofiban treatment during and after interventional therapy. For patients after unilateral nephrectomy, we should pay more attention to avoid the occurrence of thrombocytopenia caused by abnormal metabolism of tirofiban, although the Laboratory examination showed normal results.

This study aimed to identify predictors of rapid improvement of papilledema after stenting and develop a simple preintervention scale. A prospective cohort of idiopathic intracranial hypertension (IIH) with venous sinus stenosis (VSS) treated with stenting in a tertiary hospital from January 2014 to December 2019 was reviewed. We categorized papilledema improvement into favorable (grades 0–1) and unfavorable (grades 2–5). We employed logistic regression analysis to find the predictive factors and develop the predictive scale. We then estimated the performance of the scale using the ROC curve and Hosmer-Lemeshow test. There were 110 patients who underwent venous sinus stenting, with a mean age of 37.1 years and a predominance of females (77.3

目的 评价不同引流静脉类型对支架治疗特发性颅内高压合并静脉窦狭窄疗效的影响.方法 连续入组2014年1月-2019年12月在首都医科大学附属北京天坛医院接受静脉窦支架置入术的特发性颅内高压患者,对病历资料进行回顾性分析.按照静脉引流类型分为横窦单侧引流组和横窦双侧引流组,比较2组的临床特点和术后1个月随访时头痛、视力障碍和视盘水肿等症状和体征的改善情况.结果 115例患者接受了支架治疗,年龄18～62岁,中位年龄38(31～46)岁,女性90例(78.3％),其中横窦单侧引流组87例,横窦双侧引流组28例.横窦单侧引流组高脂血症发生率低于横窦双侧引流组(8.0％?vs.?21.4％,P=0.022),静脉窦狭窄率高于横窦双侧静脉引流组(79.2％?vs.?73.9％,P=0.018).1个月随访结果显示,13例(11.3％)患者的头痛、视力障碍及视盘水肿等症状和体征消失,101例(87.8％)上述症状和体征有改善,1例(0.9％)症状和体征无改善或恶化.横窦单侧引流组比横窦双侧引流组视盘水肿体征的改善更明显(P=0.031),2组头痛和视力损害症状以及总体改善情况差异无统计学意义.结论 静脉窦支架置入可改善特发性颅内高压患者的症状,横窦单侧静脉引流患者的视盘水肿体征改善较双侧引流患者更明显.

Background This prospective cohort study compared the outcomes of stenting and medical treatment for patients with idiopathic intracranial hypertension (IIH) and venous sinus stenosis (VSS). Methods In this single-center cohort study, patients with IIH and VSS were evaluated between January 2014 and December 2019 with follow-up periods of 1, 3, and 6 months. The patients received either stenting or medical treatment. The two groups underwent 1:1 matching using propensity score analysis, and the clinical outcomes were compared. Results Following 1:1 matching, 36 patients who underwent stenting and 36 who underwent medical treatment were matched. The median improvements in the papilledema Frisen grade were greater in the stenting group at 1 month (-2 vs 0), 3 months (-3 vs -1), and 6 months (-3 vs -1) than in the medical treatment group. Patients who received stenting treatment had a significantly higher prevalence of complete resolution of their respective symptoms (headache, tinnitus, or visual disturbances) at 3 months (58.3% vs 13.9%, OR 8.68, 95% CI 2.74 to 27.52) and 6 months (80.6% vs 22.2%, OR 14.50, 95% CI 4.64 to 45.32) than those receiving medical treatment. Conclusions This matched-control study shows that stenting has a greater efficacy rate and rapid resolution of papilledema and its respective symptoms compared with medical treatment.

Objective To explore the clinical prognosis and factors after mechanical thrombectomy (MT) in patients with large cerebral infarction assessed by computed tomographic perfusion (CTP)and the optimal threshold of cerebral blood flow (CBF) for estimating ischemic core. Methods We analyzed data from the anterior circulation database of our hospital (August 2018–June 2021). Multivariate logistic regression analyses identified the predictors of clinical outcomes for patients with large baseline infarcts (>50 ml) assessed by the MIStar software. The receiver operating characteristic (ROC) analysis was used to explore the cutoff value of factors. Results The present study included one hundred thirty-seven patients with large baseline infarcts. Moreover, 23 (16.8%) patients achieved functionally independent outcomes, and 50 (36.5%) patients died at 90 days. A total of 20 (14.7%) patients had symptomatic intracranial hemorrhage (sICH). The multivariable analysis showed that higher age and larger core volume were independent of poor outcomes. The cutoff value of core volume was 90 ml, and the age was 76 years. Hypertension and rt-PA treatment were independent factors of sICH. Higher age and larger ischemic volume were independent risk factors of mortality. Conclusions Mechanical thrombectomy can be applied in patients with large ischemic core volumes. Patients older than 76 years with large cores (>90 ml) are unlikely to benefit from MT. These findings may be helpful in selecting patients with large baseline infarcts to be treated by MT. The threshold of CBF < 30% is the independent factor, and this is worth evaluating in future studies to find the optimal threshold of CBF.

Background Glioblastoma multiforme (GBM) is the most aggressive type of primary brain tumor. Ferroptosis is a form of cell death that is involved in regulating the biological behavior of tumors, and could become a promising potential biomarker in tumor diagnosis and treatment. Methods We used the expression of ferroptosis related genes in the Cancer Genome Atlas (TCGA) and Chinese Glioma Cooperative Group (CGCG) datasets to construct a prognostic prediction model and verified the expression by real-time polymerase chain reaction (RT-qPCR). Using TCGA genomic and epigenetic data, we analyzed the factors that regulate the expression of these ferroptosis related genes. Results We used 15 ferroptosis related genes related to the prognosis of GBM to establish a prognostic predictive risk model. The area under the curve (AUC) of this model was 0.907, which had good utility in predicting the prognosis of GBM, and could be used as an independent prognostic indicator for GBM patients. We verified the expression of these risk genes by RT-qPCR in 30 independent pairs of tumors and adjacent tissues. Genomic and epigenetic analysis of risk genes found that the expressions of these genes were mainly regulated by methylation, not copy number variation in GBM. Conclusions The ferroptosis related characteristics proposed in this study can potentially predict the prognosis of GBM patients, and these prognostic-related genes are generally regulated by methylation.

Objective:To evaluate the safty and effect of the treatment of middle meningeal artery (MMA) embolization combined with hematoma drainage on chronic subdural hematoma (CSDH).Methods:From July 2019 to Feburary 2021, forty CSDH patients received surgical treatment in Beijing Chaoyang Hospital, Capital Medical University. Thirty five of them recived hematoma drainage. Five patients recieved MMA embolization, and if necessary, extra hematoma drainage. Selective branches of MMA embolizations was performed by Onyx. After embolization, the hematoma drainage was perfomed immediately if obvious mass effect or midline shift was confirmed on computer tomography (CT) scan. Hematoma volume resorption, recurrence and complications associated with treatment was observed during follow up.Results:One hundred persent of the operations were successful. Hematoma volume reduced in all the patients and no recurrence and complication that related to the treatment was seen during the follow up. Thirty-five patients received hematoma drainage. The average follow up time was (8.1 ± 3.7) weeks, two recurrences (5.7%) were seen during follow up. Five CSDH patients received a total of 7 MMA embolizations. Four of the 5 patients were primary CSDH, one of the 5 patients was recurrent. A total of 3 patients underwent unilateral interventions and 2 of them underwent bilateral interventions. The median follow up time was (19.0 ± 7.0) weeks.Conclusions:Method of MMA embolization combined with hematoma drainage was safe and effective in treating CSDH, and futher result to be expected.

BACKGROUND:Primary intracranial pure endodermal sinus tumor (EST) is a rare malignant nongerminomatous germ cell tumor. There is still lack of knowledge about the treatment and prognosis. METHODS:We studied 6 cases of primary intracranial pure EST patients in Beijing Tiantan Hospital from June 2009 to June 2015. A comprehensive literature search was performed on Pubmed's electronic database using the search terms "primary intracranial endodermal sinus tumor", "primary intracranial yolk sac tumor" and "malignant germ cell tumor". Survival rates based on age, gender, tumor location, treatment, resection degree and metastatis were collected and analyzed. RESULTS:Total resection was achieved in three patients and subtotal resection was achieved in three patients. Blood AFP level continuously decreased after tumor removal. In our case series, the longest survival time was 99 months; this patient received surgery+adjuvant therapy. Fifty-two cases were eligible and met the inclusion criteria for the review analysis. The majority of the population were in the young child to adolescent age and there is a male predominance in this study. In the Kaplan-Meier survival analysis, age, gender, tumor location and metastasis did not affect patients' OS. Better OS was found in patients who had subtotal and gross total resection of the tumor. Patients who had surgery combined with adjuvant therapy showed better OS compared to those who just had surgery. CONCLUSION:Total resection of the tumor is necessary and EST is sensitive to adjuvant therapy.

Objective:To investigate the imaging quality of CT angiography (CTA) with intracranial stents.Methods:The participants included patients who were enrolled in Beijing Chaoyang Hospital affiliated to Capital Medical University from July 2016 to October 2019 with indwelling stents in the intracranial artery. CTA and digital subtraction angiography (DSA) were used to evaluate the postoperative stent conditions and conduct a retrospective study. The 35 patients consisted of 28 males and 7 females aged 37-83 (60.6±7.9) years and included 35 indwelling stents. DSA was used as the standard to classify the evaluation effect (image quality) of CTA on stent condition. A statistical analysis was conducted on the correlation between the grading results and the relevant anatomical features of the stent site (the diameter of the intracranial artery, whether it ran close to the skull, and the presence or absence of coils).Results:The Cohen's kappa coefficient of the grading results was 0.826 (95% confidence interval 0.638-1.014), which had strong consistency. CTA's role in stent evaluation was closely related to the artery diameter. Analysis of receiver operating curve was performed according to the evaluation quality level. The blood vessel diameter Youden index was 2.505 mm, and the area under the curve(AUC) was 0.933. No statistical difference on whether the anatomical part of the artery where the stent is located is close to the skull was found between the two groups (χ 2=0.282, P>0.05). A statistical difference on whether a coil existed adjacent to the stent was observed between the two groups (χ 2=24.820, P<0.01). Conclusions:For patients with intracranial stents, CTA assessment of the imaging quality is related to the stent diameter. Good imaging quality can be achieved when the diameter of the stent is greater than 2.5 mm. The imaging quality is affected by the presence of the coil but not by the skull.

目的 探究计算机断层扫描血管造影(computed tomography angiography,CTA)对于颅内外支架留置术后随访的诊断准确性及相关影响因素.方法 收集2016年12月到2019年11月的颅内和颅外支架留置术患者共26例进行回顾性研究.其中男性18例、女性8例;平均年龄(62.6±10.6)岁,支架37枚;全部使用CTA和数字减影血管造影(digital subtraction angiography,DSA)进行随访.以DSA为评判标准,将CTA的支架内动脉显影质量进行分级,并将分级结果与包括支架所在动脉的直径、位于颅内或颅外、是否紧贴颅骨走行以及临近弹簧圈存在与否诸因素的相关性,进行统计分析.结果 支架内的动脉成像质量与动脉直径密切相关,使用Youden指数得出血管直径的最佳界值为2.5 mm.在颅内、颅外两组间差异有统计学意义(P<0.001);支架内动脉的成像质量在是否紧贴颅骨走行两组间差异无统计学意义(P=0.321);在弹簧圈的有、无两组间差异有统计学意义(P<0.001).结论 颅内外动脉留置支架术后,CTA随访的准确性与支架所在动脉直径相关,大于2.5 mm时具有较高的准确性;颅骨对成像质量无明显影响;临近的弹簧圈对成像质量有严重影响.