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.

PurposeThe cause of spontaneous subarachnoid hemorrhage (SAH) is unknown in 10% of cases. The aim of this study was to demonstrate the characteristics of patients with angiography-negative subarachnoid hemorrhage (anSAH) and to analyze factors influencing the clinical outcome in patients suffering from anSAH.MethodsA retrospective cohort of 75 patients with anSAH [26 perimesencephalic (pmSAH) and 49 non-perimesencephalic SAH (npmSAH)] admitted between January 2016 and June 2022 was included. We analyzed demographic, clinical data and 6-month functional outcomes. Enter regression analysis was performed to identify factors associated with outcomes.ResultsUnfavorable outcome was achieved in 10 of 75 patients (13.3%). Unfavorable outcome was associated with senior adults (p = 0.008), Hijdra cistern score (HCS) elevation (p = 0.015), long-time lumbar cistern continuous drainage (LCFD; p = 0.029) and hydrocephalus (p = 0.046). The only significant risk factor for unfavorable outcome after npmSAH was the HCS (OR 1.213 (95%CI 1.007–1.462), p = 0.042).ConclusionOur study provides valuable information on both SAH patterns and functional outcome in patients suffering from anSAH and should be taken into consideration during management of these patients.

OBJECTIVE:Many intracranial aneurysms often have branch arteries, and it is especially important to protect them during embolization. The purpose of the present study was to evaluate the curative effect and safety of the "stilted building" technique.METHODS:25 patients with intracranial aneurysms with branch arteries that have been treated by coil embolization with the "stilted building" technique were retrospectively reviewed. Clinical follow-up was performed after endovascular treatment.RESULTS:All 25 patients successfully underwent aneurysm embolization. During the operation, the ruptured sac and most of the body of the aneurysm were embolized using the "stilted building" technique. Immediate imaging showed that the blood flow to the branch arteries from the neck or sidewall of the aneurysm was unobstructed. The mRS scores of the 25 patients during the follow-up period were mRS 0 for twenty-one patients, mRS 1 for three patients, and mRS 6 for one patient. No aneurysms recurred among the patients who completed the follow-up.CONCLUSIONS:In an aneurysm with a branch artery, when a balloon or stent cannot be effectively used to protect the branch artery, the use of "stilted building" embolization can achieve good therapeutic effects, and the short-term follow-up results are satisfactory; the technique can effectively protect branch arteries originating from aneurysms.

Objective To summarize operation experiences in applying microcoils embolization for the treatment of intracranial wide-necked aneurysms using the low-profile visualized intraluminal stent support (LVIS) in elderly patients.Methods We reviewed data of 47 elderly patients (48 aneurysms) with intracranial wide-necked aneurysms treated with LVIS stent-assisted microcoils embolization.Results Forty-seven aneurysms were embolized successfully,one stent was withdrawn because its midpiece failed to stretch.Instant Raymond classifications evaluation after the surgery showed Grade Ⅰ in 52.1％ (25/48 aneurysms),Grade Ⅱ in 37.5％ (18/48 aneurysms),and Grade Ⅲ in 8.3 ％ (4/48 aneurysms).Besides,the effective rate of aneurysms embolization was 91.5 ％.During 3 to 12-month follow-up with digital subtraction angiography (DSA) in 36 patients (36 aneurysms),mRS was scored 0 (best effectiveness) in 28 cases,scored 1 in 4 cases,scored 2 in 3 cases,and scored 3 in 1 case,and the total favorable rate was 97％.Conclusions LVIS stent-assisted microcoils embolization for the treatment of intracranial wide-necked aneurysms in elderly patients may avoid or reduce the incidence of complication.

目的 探讨脑血管造影术后发生皮质盲的危险因素.方法 行脑血管造影术患者4 206例根据术后是否发生皮质盲进行分组,对比组间差异,分析皮质盲的相关危险因素.结果 术后皮质盲22例(0.52%),其中视物模糊19例,双眼失明3例,经治疗后均基本恢复.单因素分析表明,不同性别术后皮质盲发生率差异无统计学意义(P>0.05);不同体重、年龄、吸烟史、合并高血压、造影剂剂量、操作时间、术后皮质盲发生率差异有统计学意义(P<0.05).将上述单因素分析具有统计学差异的纳入多因素分析,体重、造影剂剂量为影响术后皮质盲独立危险因素.结论 脑血管造影术后皮质盲临床症状主要表现为视物模糊,影响术后皮质盲因素较多,体重和造影剂剂量为影响术后皮质盲的独立危险因素,应采取有效的预防措施,减少术后皮质盲的发生.

Objective To investigate the perioperative complications and therapeutic effects of balloon-assisted coiling (BAC) and stent-assisted coiling (SAC) in patients with ruptured intracranial aneurysms in the acute phase. Methods Totally 91 patients with 91 intracranial ruptured aneurysms were treated with BAC or SAC in our hospital between January 2014 and December 2016. Among them, 37 patients were treated with BAC and 54 patients with SAC respectively. Of the two groups, the position distribution and shape of aneurysms, and the complications after procedures and the therapeutic effects were summarized and evaluated retrospectively using chi-square test. Results The width of the aneurysm neck was narrower in the BAC-treated group compared to the SAC-treated group (3.31±1.63 mm vs. 4.35±2.10 mm, P=0.01). The aneurysm body/neck ratio (B/N) was lower in the BAC-treated group than in the SAC-treated group (1.64 ± 0.46 vs. 1.35±0.66, P=0.025). The recurrence rate was higher in the BAC-treated group than that in the SAC-treated group (18.9％ vs. 0.9％, P=0.005). There was no statistical difference in perioperative complication in both the BAC-treated group and SAC-treated group. However, 2 patients died due to the relative postoperative intracranial bleeding in the SAC-treated group. Better outcomes (Modified Rankin Score, mRS, 0-2) were achieved in the BAC-treated group compared to the SAC-treated group (94.6％ vs. 88.9％, P=0.028) at the follow-up visit. Conclusions These findings suggested that there is no difference between the BAC-treated group and the SAC-treated group in the risk of complication. BAC can achieve a better prognosis,but it is more prone to relapse. The SAC method was more appropriate for wider neck aneurysms. It was also an option to coiling the aneurysm in BAC in acute phase firstly, followed by additional treatment in SAC during the follow-up period.

目的 探讨早期持续腰大池引流对颅内动脉瘤栓塞术患者的疗效.方法 100例颅内动脉瘤行栓塞术治疗的老年患者随机分为观察组和对照组各50例.对照组采用腰椎穿刺术释放脑脊液,观察组采用腰大池引流术.比较两组治疗期间红细胞数、颅内压、大脑中动脉平均血流速度变化,栓塞术后脑血管痉挛(CVS)、迟发性脑积水的发生率.结果 观察组在栓塞术后3、7、10及14 d红细胞数、颅内压水平、大脑中动脉平均血流速度均显著低于对照组(P<0.05);观察组栓塞术后CVS、迟发性脑积水发生率(8％、10％)显著低于对照组(28％、30％,P<0.05).结论 颅内动脉瘤行栓塞术后的老年患者早期应用腰大池引流优于腰椎穿刺,可显著提高治疗效果,降低术后CVS及迟发性脑积水发生率.

Objective: To analyse the related risk factors for vasovagal reaction associated with cerebral angiography via femoral catheterisation and discuss treatment measures and prevention and control methods. Methods: The data of 3107 patients on whom cerebral angiography was performed in two high-volume interventional neuroradiology centres within 8 years were retrospectively analysed. Patients were divided into the vasovagal reaction and non-vasovagal reaction groups according to whether vasovagal reaction developed. The two groups' clinical data were analysed using univariate and multivariate logistic regression analysis to examine vasovagal reaction-related factors. Results: Of the 3107 patients included, 127 developed vasovagal reaction (4.09%). Of the 127 patients who developed vasovagal reaction, 123, three and one had vasovagal reaction after sheath removal, during cerebral angiography and upon femoral artery compression device removal, respectively. Differences in age, body mass index, sex ratios, proportions of patients with hypertension, diabetes and hyperlipemia, and adoption rate of femoral artery compression device were not statistically significant between the two groups (P > 0.05). Compared with the control group, the vasovagal reaction group had a significantly longer preoperative fasting time (P < 0.05). Multivariate logistic regression analysis revealed preoperative fasting time as the only risk factor for vasovagal reaction that was associated with cerebral angiography (P < 0.001). Conclusion: Excessive fasting time before cerebral angiography is the most important risk factor for vasovagal reaction associated with cerebral angiography.

Introduction: Intracranial aneurysms are not rare, and endovascular treatment is one of the main options. However, when distal aneurysms combined with severe stenosis of the carotid artery exist, the treatment becomes complicated. Staging surgeries can increase the risk of cerebral ischemic or hemorrhagic stroke. Case report: Four patients diagnosed with severe stenosis of the carotid artery were reviewed in whom internal carotid artery-posterior communicating artery aneurysm, anterior communicating artery aneurysm, and middle cerebral artery aneurysm were found at the distal part of the lesions, respectively. The maximum diameter of the aneurysm was <5 mm. All the patients underwent single-stage endovascular treatment under general anesthesia: carotid angioplasty and stenting were performed first, and then the guiding catheter was inserted into the internal carotid artery through the stent, after which embolization of the intracranial aneurysm was performed. The surgeries of all four patients were successful. Brain stroke did not occur in the perioperative period. Stent restenosis and recurrence of aneurysms were not found in follow-up digital subtraction angiography. Conclusion: These cases show that treatment of carotid artery stenosis and its distal intracranial aneurysm during the same stage of endovascular operation is safe and feasible, and it also could reduce the risk of staged surgeries.

目的 分析影响老年颅内动脉瘤性蛛网膜下腔出血(SAHa)预后的危险因素.方法 SAHa患者193例采用格拉斯哥预后评分(GOS)评估预后并分为观察组(预后不良,GOS≤3分)41例及对照组(GOS>3分)152例.采用单因素及Logistics回归模型分析影响老年SAHa预后不良的危险因素.结果 单因素分析显示,年龄≥60岁、多发动脉瘤比例、出血破入脑室比例、高Hunt分级(Ⅳ~Ⅴ)及脑积水比例是影响老年SA-Ha预后的可能危险因素.将单因素所得阳性结果纳入Logistics回归模型,分析结果显示年龄≥70岁、Hunt分级、多次出血、多发动脉瘤及脑积水是影响SAHa预后的独立风险因素(P<0.05).结论 基于危险因素有助于制定更为个体化、针对性强的SAHa患者诊疗方案.

Objective To investigate the correlation between the diameter of the stent implanted in carotid artery bifurcation and hemodynamic depression (HD) post carotid artery steming (CAS).Methods A total of 104 patients treated with stem angioplasty at bifurcation of carotid artery due to the stenosis of atherosclerosis were collected in our hospital.All patients were divided into two groups:A group who were implanted with larger diameter stent according to the traditional principle,and B group who were implanted with smaller diameter stent.The correlation between the stenosis rate before/post operation,diameter of the stent,the diameter of the balloon and the risk rate of HD were analyzed retrospectively.Results The symptoms were improved in all of the patients after CAS.Diameter of the stents in group A were(9.1±0.3)mm compared with the diameter (8.3±0.2)mm in group B(P＜0.01).HD were happened in 21 cases (45.7％) in group A compared with 10 cases (14.7％) in group B (P＜0.01);The stenosis rate were (76±9)％ and(74±8)％,and the diameter of the expanding balloon were (4.9±0.2)mm and (4.8±0.1)mm respectively.Ischemic evidence were happened in one case in group A,but none in group B.Conclusions In CAS of carotid bifurcation,more risk of HD after procedure were found in the cases implanted larger diameter stent,but less risk and coequality improvement in stenosis were found in the cases implanted smaller diameter contrarily.

Objective To investigate the application and clinical efficacy of endovascular treatment in traumatic intracranial pseudoaneurysms.Methods The clinical data of 21 patients with traumatic intracranial pseudoaneurysms treated with endovascular treatment at the Department of Neurosurgery,Beijing Chaoyang Hospital,Capital Medical University from December 2006 to June 2015 were analyzed retrospectively.All 21 patients were treated with endovascular treatment,including 3 patients were treated with simple coil ernbolization,10 were treated with stent-assisted coil embolization,and 8 were treated with covered stent placement.The follow-up time ranged from 3 to 24 months.Results In 21 patients with pseudoaneurysm except 1 died,the remaining 20 were occluded completely,and they were followed up.The modified Rankin scale (mRS) score 0 was in 13 cases and the mRS score 1 was in 7 cases.In 8 patients treated with covered stents,postoperative angiography immediately after procedure suggested that all the aneurysms did not develop.One patient showed distal in-stent stenosis during the reexamination,however,he did not have any symptom.The other 7 patients did not have recurrence and other complications.Of the 3 patients treated with the simple coil embolization,the aneurysms of 2 cases were occluded completely;the aneurysm of 1 case recurred.After being treated with stent-assisted coil embolization,the result was satisfactory.He was reexamined and did not find recrudescence.Of the 10 patients treated with stent-assisted coil embolization,all the embolizations were satisfactory,1 died of aneurysm rupture after procedure.The remaining 9 cases were followed up and no recurrence was observed.Conclusion Endovascular treatment may achieve safe and effective treatment outcomes through a reasonable choice of surgical options for the treatment of traumatic intracranial pseudoaneuvysms.

Objective To present treatment results with stent angioplasty of vertebral stenosis in post circulation ischemic patients. Methods Vertebral artery stent angioplasty were proformed in totally 47 patients confirmed vertebral artery stenosis with 52 stents. Among them, there were 46 stents implanted in vertebral ostim and 6 stents in V4 segment. All of the patients were followed by digital distraction angiography(DSA) and CT angiography. Average follow up duration was 6.3 months. Results ALL the stents were implanted successfully. Symptoms were improved in 85.1%(40/47) of the patients. The stenosis rate before stenting were (75.2±6.7)% compared with (7.6±6.1)% post stenting. In-stent recurrent stenosis (IRS) were conformed in 9(17%) stents, however 8 stents were implanted in vertebral ostium(V1 segment),1 stent were in V4 segment. Conclusions In experienced hands, stenting for symptomatic VAS can be accomplished with a very high success rate (100%),with few complications. We conclude that endovascular stenting of vertebral artery stenosis is safe and effective for ischemic disease.IRS should be avoided. Key words: Stent; Vertebral artery ostium; Angioplasty; In-stent rcurrent senosis

Objective To investigate the distribution of in-stent recurrent stenosis (1RS) after balloon-angioplasty and stenting in elderly cerebral ischemic patient and its correlative factors.Methods Totally 158 elderly cerebral ischemic patients with extra-and/or intracranial artery stenosis were treated with 172 stents in our hospital.The inhibition of platelet function was assessed by using the thrombus elasticity chart system in perioperative period,and the anti-platelet agents were adjusted correspondingly.150 patients were followed up by digital subtraction angiography (DSA) and the other 8 patients were followed up by CT angiography,during an average follow-up duration of 8.3 months.Results There were 11 (6.4％) IRS lesions,among which 10 lesions were at the vertebral artery origin and 1 lesion was at common carotid artery bifurcation.23.8％ of IRS happened after vertebral artery origin stenting,and all in-stent recurrent stenosis were in the origin of non-dominant vertebral artery,whose IRS rate was 66.7％.Conclusions IRS are more common found in vertebral artery origin than in other parts of vertebral artery and are more common found in nondominant side than in dominant side.

Objective To investigate the correlation between the in-stent restenosis (IRS) and dominant blood supply side of this vertebral artery and its prognosis after stent angioplasty at vertebral artery origin in patients with cerebral ischemia.Methods A total of 52 patients treated with stent angioplasty at vertebral artery origin were collected from January 2008 to December 2013,and 54 balloon-expanding stents were implanted.The mean followed up time of the patients was 8.5 months after surgery.The correlation between IRS and the sides of diseased vertebral arteries and their prognosis were analyzed retrospectively.Results The symptoms were improved in most patients after implantation of 54 stents.In the vertebral arteries of performing stent angioplasty,the diameters of normal arteries of the stent distal ends of the dominant blood supply (19 branches),the balance blood supply arteries (5 branches),and non-dominant blood supply sides (30 branches) were 4.78 ± 0.86 mm,4.05 ± 0.67 mm,and 3.27 ± 0.59 mm,respectively (P ＜0.01).IRS occurred in 13 stents,and they were all on the non-dominant blood supply sides (24.1％).The incidence of IRS on the non-dominance blood supply sides was 43％ (13/30 branches).The preoperative and postoperative stenosis rates were 72.5 ± 8.2％ and 12.3 ± 9.7％ respectively in 13 lesions,the follow-up stenosis rate was 78.7 ± 15.5％,and 2 of them had complete instent occlusion.After in-stent balloon dilatation,the follow-up stenosis rate was 25.7 ± 6.1％.Conclusion The non-dominance blood supply side is more prone to IRS after stent angioplasty at vertebral artery origin.The prognosis is better for patients with IRS after balloon re-dilatation.

Objective To explore the feasibility of Solitaire self-expanding stent in the treatment of intracranial arterial stenosis.Methods Five patients with intracranial arterial atherosclerotic stenosis were reviewed, in whom angioplasty with solitaire stents were performed, and a total of 6 stents were placed. Lesions located in the middle cerebral artery M1 segment in 3 cases, basilar artery segment in 1 case, and internal artery C2 segment in 1 case. The length of lesion was (8+2.9)mm, the stenosis rate was (73+8.5)%.Results All patients were received Solitaire stents implanation successfully. Residual stenosis rate was (14+4.2)%. The mean follow-up time of DSA was 10.5 months, no stent restenosis occurred. Twice transient ischemia attack were happened in 1 patient. Conclusions The use of Solitaire self-expanding stent could be feasibility for angioplasty for severe intracranial stenosis, but it needs further study.

Objective To investigate the effectiveness and safety of mechanical thrombectomy with solitaire AB stents in combination with intra-arterial thrombolysis for treatment of acute ischemic stroke. Methods The clinical data of 18 consecutive patients with acute is-chemic stroke treated with mechanical thrombectomy, using Solitaire AB stents in combination with intra-arterial thrombolysis in our hospital from January 2010 to October 2014, were analyzed retrospectively. The patients were followed up for three months after the procedure. Re-sults Complete or part recanalization was achieved by mechanical thrombectomy with solitaire AB stents in combination with intraarterial thrombolysis in all eighteen patients. The National Institute of Health Stroke Scale ( NIHSS) score was obviously lower after treatment than before treatment, with a significant difference ( P<0. 05 ) . During the follow-up period lasting three months, 17 patients had a good mRS score, including 10 cases with a mRS score of zero, 6 cases with one and 1 case with two. One patient had a mRS score of four. Re-obstruc-tion occurred in none of the patients. Conclusion It appears to be safe and effective for endovascular treatment of acute ischemic stroke by using mechanical thrombectomy with solitaire AB stents in combination with intra-arterial thrombolysis.

目的 研究在亚急性行期移植PlGF基因转染的人间充质干细胞(hMSCs)对于大鼠梗塞心肌的血管新生作用.方法 使用腺病毒将P1GF基因转染人间充质干细胞(hMSCs),测定体外hMSCs及PlGF-hMSCs的PlGF蛋白表达水平.大鼠心肌梗塞一周后随机分成三组,对照组(DMEM)、hSMCs移植组、PlGF-hMSCs移植组.在移植后一个月观察心肌梗塞交界区的P1GF蛋白表达水平、血管新生以及心肌梗塞体积,并进行评价.结果 体外实验中,PlGF-hMSCs的PlGF蛋白表达水平显著高于hMSCs及对照组.移植后一个月,hMSCs及PlGF-hMSCs两组在缺血心肌的梗塞交界处P1GF的蛋白水平、血管新生数量都显著高于对照组;心肌梗塞体积显著低于对照组;而上述观察指标在PlGF-hMSCs移植组显著好于hMSCs移植组.结论 PlGF因子对于心肌梗塞缺血有促进血管新生,缩小心肌梗塞体积的作用,提示着PlGF-hMSCs在临床治疗心肌梗塞方面可能有着更好的治疗作用.

Objective To evaluate the clinical application of three-dimensional rotational angiography (3D-RA)as emergency procedure in the treatment of ruptured intracranial aneurysms .Methods Between Jan 2010 and May 2012, sixty-three patients underwent 3D-RA as emergency procedure and intracranial aneurysms were confirmed in all those patients .Endovascular treatment and surgical clipping were scheduled according to the results of the procedures .The initial 3D-RA results were evaluated and compared with endovascular and surgical findings .Clinical outcome and follow up results were recorded and analyzed . Results A total of 66 cerebral aneurysms were detected by 3D-RA and treated.3D-RA with reconstructed CT images correlated well with the surgical findings in 19 patients(surgical group).Meanwhile,47 aneurysms in 44 patients(endovascular group)were treated by endovascular procedures .Clinical follow up was completed for a mean duration of 10 months.Complications were revealed during the follow up in 6 cases in the endovascular group .One aneurysm coiling procedure failed because of unsuccessful micro-catheterization and the patient was transferred to surgical clipping successfully .The technique success rate was 100.0% in the surgical group and 97.7% in the endovascular group .Conclusions Emergency 3D-RA provides enough evidence to determine the optimal treatment plan for ruptured intracranial aneurysms .A strategy of using 3D-RA for aneurysmal hemorrhage appears to be practical and safe with multi-disciplinary team work in selected cases and qualified clinical centers .

<正>1病例介绍患者,男,40岁,主因"突发左侧肢体无力2 h"于2011年3月30日入院。患者2 h前安静状态下无明显诱因出现左侧肢体无力,伴言语不清、不能行走、意识模糊。无视物旋转、视物成双、耳鸣、恶心、呕吐,无饮水呛咳及吞咽困难,无流涎,无肢体抽搐,无大小便失禁。当日就诊于首都医科大学附属北京朝阳医院急诊,行头颅磁共振成像(magneticresonance imaging,MRI)示:右侧额叶、顶叶、颞叶、枕叶、岛叶及右侧基底节区等大脑中动脉供血区可见大片浅淡状略长T_1、长T_2信号,弥散加权