Vertebrobasilar dolichoectasia (VBD) is a rare, progressive disorder characterized by significant expansion, elongation, and tortuosity of the vertebrobasilar arteries. This case series introduces a novel imaging sign observed in three patients with clinical manifestations of VBD. The presence of outside-stent flow (OSF) may serve as a potential predictor for aneurysm recurrence in VBD following endovascular intervention. Furthermore, OSF could indicate the need for embolization of the contralateral vertebral artery after stenting, with or without coil embolization, in patients with VBD aneurysms.

ObjectiveCurrent fractional flow (FF) approaches in quantifying the hemodynamic severity of intracranial atherosclerotic stenosis (ICAS) are invasive or require angiography. This study primarily evaluated a noninvasive FF method derived from magnetic resonance angiography (MRA-FF) against established reference standards, with an exploratory assessment of its ability to reflect hemodynamically relevant impairment.MethodsIn this retrospective study of 50 patients with ICAS, MRA-FF was computed from 3D vascular models using patient-specific flow boundary conditions. Agreement with invasive pressure-wire-derived FF (PW-FF, n = 18) and angiography-based FF (DSA-FF, n = 50) was assessed using intraclass correlation coefficients (ICC). Equivalence to DSA-FF was evaluated using the two one-sided tests procedure (TOST; δ = ±0.05). An exploratory analysis examined the ability of MRA-FF to discriminate hypoperfusion using receiver operating characteristic (ROC) analysis in the subset of patients with available perfusion imaging (n = 38).ResultsMRA-FF showed moderate-to-good agreement with PW-FF (ICC = 0.743; 95% CI, 0.437–0.895) and good agreement with DSA-FF (ICC = 0.784; 95% CI, 0.649–0.871). Equivalence to DSA-FF was confirmed by TOST (90% CI of difference, −0.016 to 0.035; p < 0.01). In the perfusion subset, MRA-FF was lower in patients with hypoperfusion than in those without (p = 0.022). The area under the ROC curve for discriminating hypoperfusion was 0.723 (95% CI, 0.54–0.90). Within this dataset, the exploratory optimal cutoff value was 0.855.ConclusionMRA-FF demonstrates good agreement with invasive and angiographic reference methods and shows the ability to discriminate hypoperfusion in an exploratory analysis. These findings support the feasibility and potential clinical utility of a fully noninvasive FF approach for functional assessment and hemodynamic characterization, although further external validation is required.

BACKGROUND:Noninvasive imaging is essential for long-term surveillance of flow diverter-treated intracranial aneurysms. We evaluate the image quality and feasibility of photon-counting detector CT (PCD-CT) in a real-world, non-contemporaneous follow-up setting, comparing it with intraoperative baseline DSA and flat-panel detector CT (VasoCT). METHODS:This retrospective cohort study included 30 patients (32 aneurysms) followed with PCD-CT (median: 6.5 months) after flow diverter treatment. Three neurointerventionalists, blinded to clinical data, assessed stent lumen visibility and diagnostic confidence using a 5-point Likert scale. Quantitative metrics included signal-to-noise ratio, contrast-to-noise ratio, relative metal artifact width, and radiation doses. A mixed linear model identified predictors of image quality. RESULTS:PCD-CT stent lumen visibility (4.6 ± 0.7) was significantly higher than baseline DSA (3.0 ± 0.5, P < 0.001) and VasoCT (3.1 ± 1.2, P < 0.001). Diagnostic confidence scores were significantly higher for DSA (5.0 ± 0.0) and PCD-CT (4.8 ± 0.6) than for VasoCT (3.4 ± 1.0, both P < 0.001), while PCD-CT was slightly but significantly lower than DSA (P = 0.031). Inter-observer agreement was excellent (ICC ≥ 0.945). PCD-CT effective dose (0.79 ± 0.07 mSv) was higher than localized DSA (0.13 ± 0.02 mSv) and VasoCT (0.55 ± 0.08 mSv) due to whole-brain coverage. Mixed model identified PCD-CT as the strongest positive predictor for lumen visibility (β = 1.65, P < 0.001), and this advantage remained robust across different aneurysm morphologies and the predominant stent designs evaluated in this cohort. CONCLUSION:PCD-CT provides superior stent lumen visualization compared to baseline imaging, while maintaining a sub-millisievert radiation dose. It represents a promising non-invasive surveillance tool, though prospective validation of its diagnostic accuracy for in-stent stenosis is required.

BACKGROUND AND OBJECTIVE:Idiopathic intracranial hypertension (IIH) is associated with venous sinus stenosis (VSS). While stenting has shown potential as a treatment for VSS in patients diagnosed with IIH, clinical outcomes remain variable. Current predictive markers for treatment success are limited. This study aimed to investigate the predictive value of the Upstream Stasis (US) sign, recently proposed based on our imaging observations, in forecasting treatment success in venous sinus stenting for patients diagnosed with IIH. METHODS:We retrospectively analyzed data from 102 patients with IIH who underwent venous sinus stenting between May 2016 and August 2024. Patients were categorized based on the presence or absence of the US sign, identified through color-coded cerebral blood flow (CBF) maps. Clinical outcomes were assessed at the 12 month follow-up. Multivariate logistic regression was used to identify independent predictors of favorable outcomes, adjusting for demographic and anatomical factors. RESULTS:The US sign was present in 64.7% of patients and was significantly associated with favorable clinical outcomes (sensitivity 74%, specificity 88%, C-statistic 0.81). Multivariate analysis confirmed that both the US sign (OR 31.6, 95% CI 7.15 to 232.2) and intrinsic stenosis (OR 7.68, 95% CI 2.00 to 36.3) were independent predictors of favorable outcome. Subgroup analysis suggested that the US sign provided additional prognostic value beyond morphological classification into intrinsic and extrinsic stenosis. CONCLUSION:Our study suggests that the US sign may serve as a valuable imaging biomarker for predicting the outcomes of stenting in patients with IIH and VSS. Large-scale prospective studies are warranted to validate its clinical utility and broader applicability.

Silent magnetic resonance angiography (S-MRA) is primarily utilized to assess the blood flow in aneurysms and parent vessels of treated intracranial aneurysms. This study aimed to compare the diagnostic value of S-MRA and three-dimensional time of flight (3D-TOF) MRA for unruptured intracranial aneurysms. We included patients diagnosed with unruptured intracranial aneurysms using digital subtraction angiography (DSA) who subsequently underwent S-MRA and 3D-TOF MRA. Two independent neuroimaging and neurointerventional doctors evaluated the DSA images and measured aneurysm dimensions. Using DSA results as the gold standard, we determined the sensitivity and specificity of S-MRA and 3D-TOF MRA, as well as their accuracy in measuring aneurysm size and identifying aneurysms with daughter sacs. We detected a total of 41 intracranial aneurysms (in 37 patients) on both S-MRA and 3D-TOF MRA, with both techniques achieving a sensitivity and specificity of 100%. For aneurysm height, the intraclass correlation coefficient (ICC) was 0.977 (P < 0.001) between S-MRA and DSA, and 0.908 (P < 0.001) between 3D-TOF MRA and DSA. For neck width, the ICC was 0.663 (P < 0.001) between S-MRA and DSA, and 0.563 (P < 0.001) between 3D-TOF MRA and DSA. In terms of daughter aneurysm detection, 3D-TOF MRA Sensitivity 40%; specificity 92%: positive predictive value 100%; S-MRA sensitivity 60%; specificity 89%; positive predictive value 42%. In conclusion, S-MRA and 3D-TOF MRA did not significantly differ in aneurysm detection ability. For the detection of aneurysm with dauthger sacs indicators, the sensitivity is also higher.

OBJECTIVE:To investigate the long-term outcomes of stenting for isolated pulsatile tinnitus (PT) caused by cerebral venous sinus stenosis. STUDY DESIGN:Retrospective study. SETTING:The First Medical Center, Chinese PLA General Hospital. PATIENTS:Patients diagnosed to have isolated PT secondary to cerebral venous sinus stenosis at our institution between December 2009 and March 2023. INTERVENTION:Cerebral venous sinus stenting. MAIN OUTCOME MEASURES:Morphological features of the cerebral venous sinus, endovascular technique, and clinical outcomes. RESULTS:The study included 80 patients with a mean age of 39.4 ± 9.6 years and an average body mass index of 23.9 kg/m. The mean age at symptom onset was 35.1 ± 8.7 years. Seventy-five of the patients (93.8%) were women. PT was the primary symptom. All patients reported feeling anxious because PT had severely affected their day-to-day lives. The PT was right-sided in 52 cases (65%). All procedures were technically successful. The mean trans-stenotic pressure gradient decreased from 4.3 ± 3.3 mm Hg before stenting to 0.4 ± 0.9 mm Hg after stent placement. Twenty-one patients (26.3%) experienced poststenting headache. The mean follow-up duration was 80.5 ± 46.3 months, with 26 patients followed for over 120 months. PT resolved in all cases after stenting, and there were no recurrences. Follow-up radiographic examination of 23 patients (28.8%) at a mean of 71.2 ± 43.1 months identified only one case of restenosis. CONCLUSIONS:Long-term follow-up of these patients confirmed the efficacy and safety of stenting for isolated venous sinus stenosis-related PT.

There is no dedicated stent for isolated venous pulsatile tinnitus (IVPT). This retrospective study aimed to evaluate the the clinical outcomes and associated factors of Precise stent (Cordis) implantation in the management of IVPT. We analyzed data from IVPT patients treated at our center between December 2009 and August 2024. Baseline characteristics, venous sinus morphology, endovascular techniques, clinical outcomes, and follow-up data were reviewed. Among 111 IVPT patients, 64 (57.7

ObjectivesTo evaluate the diagnostic accuracy of the quantitative flow ratio (QFR) for hemodynamic exploration of intracranial atherosclerotic stenosis, using the invasive cerebrovascular pressure ratio (CVPR) and resting full-cycle ratio (RFR) as reference standards.Materials and methodsPatients with symptomatic unifocal intracranial atherosclerotic stenosis were included. The CVPR was defined as the ratio of the proximal and distal pressures. All patients underwent angioplasty under general anesthesia. The QFR was calculated based on digital subtraction angiography. Using the CVPR as a reference, we compared its correlation with the QFR across different degrees and locations of stenosis.ResultsThe CVPR and QFR were measured in 34 vessels of 32 patients. The QFR demonstrated a high correlation and excellent agreement(r = 0.8227, p < 0.001) with the CVPR in distal stenosis before intervention. In the subgroup with diameter stenosis >80%, the QFR showed a high correlation (r = 0.8812, p < 0.001) with the CVPR. In the anterior circulation subgroup, the QFR showed an excellent correlation (r = 0.9066, p < 0.001) with the CVPR. In the posterior circulation subgroup, the QFR showed a high correlation with the CVPR (r = 0.7706, p < 0.001). Diameter stenosis rates showed a moderate negative correlation with the CVPR.ConclusionThere was a strong correlation between the QFR and wire-based CVPR, especially for anterior circulation lesions before intervention. The QFR may serve as a predictive factor for evaluating hemodynamic changes in intracranial atherosclerotic stenosis.

Sizing of flow diverters (FDs) is a challenging task in the treatment of intracranial aneurysms due to their foreshortening behavior. The purpose of this study is to evaluate the difference between the sizing results from the AneuGuide (TM) software and from conventional 2D measurement. Ninety-eight consecutive patients undergoing pipeline embolization device (PED) treatment between October 2018 and April 2023 in the First Medical Center of Chinese PLA General Hospital (Beijing, China) were retrospectively analyzed. For all cases, the optimal PED dimensions were both manually determined through 2D measurements on pre-treatment 3D-DSA and computed by AneuGuide (TM) software. The inter-rater reliability between the two sets of sizing results for each methodology was analyzed using intraclass correlation coefficient (ICC). The degree of agreement between manual sizing and software sizing were analyzed with the Bland-Altman plot and Pearson's test. Differences between two methodologies were analyzed with Wilcoxon signed rank test. Statistical significance was defined as p < 0.05. There was better inter-rater reliability between AneuGuide (TM) measurements both for diameter (ICC 0.92, 95%CI 0.88-0.95) and length (ICC 0.93, 95%CI 0.89-0.96). Bland-Altman plots showed a good agreement for diameter selection between two methodologies. However, the median length proposed by software group was significantly shorter (16 mm versus 20 mm, p < 0.001). No difference was found for median diameter (4.25 mm versus 4.25 mm). We demonstrated that the AneuGuide (TM) software provides highly reliable results of PED sizing compared with manual measurement, with a shorter stent length. AneuGuide (TM) may aid neurointerventionalists in selecting optimal dimensions for FD treatment.

Background Subarachnoid hemorrhage (SAH) is a subtype of hemorrhagic stroke characterized by high mortality and low rates of full recovery. This study aimed to investigate the epidemiological characteristics of SAH between 1990 and 2021. Methods Data on SAH incidence, mortality, and disability-adjusted life-years (DALYs) from 1990 to 2021 were obtained from the Global Burden of Disease Study (GBD) 2021. Estimated annual percentage changes (EAPCs) were calculated to evaluate changes in the age-standardized rate (ASR) of incidence and mortality, as well as trends in SAH burden. The relationship between disease burden and sociodemographic index (SDI) was also analyzed. Results In 2021, the incidence of SAH was found to be 37.09% higher than that in 1990; however, the age-standardized incidence rates (ASIRs) showed a decreased [EAPC: -1.52; 95% uncertainty interval (UI) -1.66 to -1.37]. Furthermore, both the number and rates of deaths and DALYs decreased over time. It was observed that females had lower rates compared to males. Among all regions, the high-income Asia Pacific region exhibited the highest ASIR (14.09/100,000; 95% UI 12.30/100,000 - 16.39/100,000) in 2021, with an EPAC for ASIR < 0 indicating decreasing trend over time for SAH ASIR. Oceania recorded the highest age-standardized mortality rates (ASMRs) and age-standardized DALYs rates among all regions in 2021 at values of respectively 8.61 (95% UI 6.03 - 11.95) and 285.62 (95% UI 209.42 - 379.65). The burden associated with SAH primarily affected individuals aged between 50 - 69 years old. Metabolic risks particularly elevated systolic blood pressure were identified as the main risk factors contributing towards increased disease burden associated with SAH when compared against environmental or occupational behavioral risks evaluated within the GBD framework. Conclusions The burden of SAH varies by gender, age group, and geographical region. Although the ASRs have shown a decline over time, the burden of SAH remains significant, especially in regions with middle and low-middle SDI levels. High systolic blood pressure stands out as a key risk factor for SAH. More specific supportive measures are necessary to alleviate the global burden of SAH.

Objective To investigate the safety and clinical efficacy of PED in the treatment of intracranial aneurysms in elderly patients.Methods The clinical data of 30 elderly patients（39 aneurysms） with intracranial aneurysms who were treated with PED in the Department of Neurology of the First Medical Center of Chinese PLA General Hospital from October 2018 to October 2022 were retrospectively analyzed.The occlusion of intracranial aneurysms was evaluated using the OKM grading scale.The clinical prognosis of elderly patients at discharge and during follow-up was assessed with the mRS.Results Totally 34 PEDs was implanted in the 30 patients, with a procedure success rate of 100%.DSA indicated that there were 29（74.4%） of OKM grade A,10（25.6%） of grade B,0 of grade C,and 0 of grade D immediately after PED implantation.The good prognosis rate（with mRS score ranging from 0 to 2） was 96.7% at discharge.Among the 21 aneurysms（14 patients） receiving DSA during follow-up, 19（90.5%） obtained aneurysm reduction and 12（57.1%） aneurysm occlusion（OKM grade C+D）,and no aneurysm recurrence or enlargement, stent restenosis or neurological symptoms was observed.All the 30 patients were followed up by telephone for a median follow-up time of 9 months, and the good prognosis rate was 100.0%.Conclusion PED for intracranial aneurysms in elderly patients has advantages of less intraoperative complications and good short-term efficacy.

Objective:To investigate the safety and efficacy of Neuroform Atlas stent-assisted coil embolization for treatment of intracranial aneurysms at middle cerebral artery (MCA) bifurcation.Methods:A retrospective analysis was conducted on the clinical data of 21 patients with aneurysms at MCA bifurcation who underwent endovascular treatment using Neuroform Atlas device in the Department of Neurology, Chinese PLA General Hospital from July 2020 to October 2022. The immediate postoperative embolization degree was assessed using Raymond grading system and perioperative complications were documented. DSA was performed at 6-month follow-up for evaluation of aneurysm embolization degree and related complications.Results:Among 21 cases of MCA bifurcation aneurysms, single-stent treatment was administered in 18 cases and double-stent treatment in 3 cases. All stents were accurately located and implanted. The successful rate of procedure was 100%. As revealed in immediate angiography after the procedure, there were 3 cases (14.3%) of grade Ⅰ, 1 case (4.8%) of grade Ⅱ and 17 cases (80.9%) of grade Ⅲ. There were 2 perioperative complications documented which included 1 case of in-stent thrombosis developing during surgery and 1 case of postoperative transient ischemic attack. Both of them had no obvious symptom or sign of neurological dysfunction. A total of 13 patients underwent DSA review at 6-month follow-up which revealed grade Ⅰ in 11 cases, grade Ⅱ in 1 case and grade Ⅲ in 1 case. There were 1 case of recurrence, 3 cases of in-stent stenosis of parent vessel and 1 case of blocking of MCA branch on the contralateral side of aneurysm.Conclusion:It has been preliminarily suggested that application of Neuroform Atlas stent in the treatment of MCA bifurcation aneurysm is associated with high safety and favorable short-term embolization efficacy.

目的 探析早期神经介入栓塞在老年破裂颅内动脉瘤患者治疗中的应用效果.方法 连续收集2014年1月至2020年10月在解放军总医院第一医学中心神经内科住院的老年破裂颅内动脉瘤患者68例,采用随机数字表法分为对照组(32例)和观察组(36例).观察组于早期实施神经介入栓塞治疗(动脉瘤破裂后24 h内),对照组于非早期神经介入治疗(动脉瘤破裂24 h后),比较2组卧床时间、住院时间、美国国立卫生研究院卒中量表(NIHSS)评分、并发症发生率及栓塞程度.结果 观察组卧床时间、住院时间显著短于对照组[(4.95±1.15)d vs(6.42±0.89)d,(10.21±2.34)d vs(14.57±2.31)d,P=0.000];观察组完全栓塞比例显著高于对照组(88.89％vs 68.75％,P=0.040);2组入院时及术后2周NIHSS评分、肺部感染、再破裂出血、下肢静脉血栓、脑水肿发生率、大部分栓塞、部分栓塞比例比较,差异无统计学意义(P>0.05).结论 早期神经介入栓塞术在老年破裂颅内动脉瘤患者治疗中应用效果显著,其有助于患者神经功能、生活自理能力改善,且能够降低并发症发生率.

目的 分析脑静脉窦血栓及静脉窦狭窄血管腔内操作相关并发症.方法 回顾性连续纳入2000年1月至2021年6月解放军总医院第一医学中心神经内科明确诊断的脑静脉窦血栓或静脉窦狭窄且接受脑静脉系统血管腔内操作的患者456例,腰椎穿刺示脑脊液压力≥250 mmH2 O,全脑DSA检查证实存在静脉窦狭窄(狭窄两端压力差≥10 mmHg)或静脉窦血栓形成.记录患者年龄、性别、主要临床症状、头部影像学检查结果及治疗过程.腔内操作方法包括脑静脉窦内溶栓、脑静脉窦测压、脑静脉窦支架置入,并发症发生的原因包括导丝导管穿刺损伤血管壁、支架状态异常所致的静脉回流障碍及其他,即血管穿孔性并发症(硬膜下出血、蛛网膜下腔出血、硬膜外血肿、腹膜后出血、股动脉假性动脉瘤)、回流障碍性并发症(急性支架内血栓形成、皮质静脉回流障碍)及静脉窦分隔,其中严重的急性并发症为急性硬膜下出血、蛛网膜下腔出血、急性支架内血栓形成、支架置入静脉窦分隔及支架术后皮质静脉回流障碍.于术后3～12个月进行门诊或电话随访,随访内容主要是头痛及视力变化情况.建议患者出院后6～12个月住院复查腰椎穿刺术、视力、视野及DSA检查,观察颅内静脉系统的变化.结果 共纳入脑静脉窦血栓或静脉窦狭窄患者456例,其中男112例(24.6％),女344例(75.4％);平均年龄(39±9)岁;共完成血管内介入治疗术644例次,其中脑静脉窦内溶栓89例次,脑静脉窦测压274例次,脑静脉窦支架置入281例次.22例患者发生了操作相关并发症,其中1例患者出现了2个并发症(支架置入静脉窦分隔结构,并伴硬膜外出血),故全部操作相关并发症发生率为3.6％(23/644),其中严重的急性并发症包括蛛网膜下腔出血2例(0.3％)、硬膜下出血2例(0.3％)、支架置入静脉窦分隔2例(0.3％)、支架内急性血栓形成1例(0.2％)、皮质静脉回流障碍12例(1.9％).结论 脑静脉系统结构与动脉结构迥异,手术操作具有特殊性,熟悉这些可能的并发症并恰当及时地应对,有助于患者获得良好的神经功能预后.

Objective: To evaluate the efficacy of endovascular stenting of various types of venous sinus stenosis in idiopathic intracranial hypertension (IIH). Method: Clinical, radiological, and manometric data before and after stenting in venous sinus stenosis were retrospectively analyzed in 99 IIH patients who were refractory to medical therapy or rapidly progressed between July 2004 to July 2019. The follow-up period was between 2.3 months to 11 years. Results: Our study enrolled 21 men (21.2%)and 78 women (78.8%) with average body mass index (BMI) 19.2-40.6(27.0±4.4) kg/m2 and median age 37 years. Before stent placement, the mean transverse sinus stenosis gradient was 1-59(26±8) mmHg. Patients with extrinsic stenosis were younger than those with intrinsic and mixed stenosis. In all cases, stenting was effective for papilledema. Fifty patients complained of headaches. Pulsatile tinnitus in twenty-eight patients completely alleviated after stenting. In one patient, replacement of stent did not improve symptoms, and a subsequent CSF diversion procedure was performed and effective. Conclusion: Irrespective of the type of stenosis, stenting of venous sinus stenosis is an effective treatment for IIH. Patients with persistent papilledema post-stenting and elevated transverse pressure pre-stenting should be followed closely as high risk of stenting failure may occur and further diversion procedure is needed.

METHODS:Thirty-three consecutive patients with 34 TVIAs were prospectively recruited and treated with endovascular techniques. The volume of TVIAs and the required length of coils were calculated by the AngioSuite software before embolization. The treatment efficacy of TVIAs was assessed using the Raymond scale (Rs) and the modified Rankin scale (mRs).RESULTS:Of the 34 aneurysms with an average volume of 7.16 mm3, 13 aneurysms were treated with sole coil embolization, 19 by stent-assisted embolization, and 2 by balloon-assisted embolization. The average coil length was 5.32 cm, and the average packing density was 41.21%. The immediate DSA showed that total occlusion (Rs = 1) was achieved in 15 aneurysms, subtotal (Rs = 2) in 9, and partial (Rs = 3) in 11. Total occlusion was achieved in 30 aneurysms and subtotal in the other 4 aneurysms at 6-month follow-up. Baseline volume and diameter of aneurysms were significantly correlated with the coil length (r = 0.801, P < 0.001; r = 0.711, P < 0.001).CONCLUSIONS:Coil embolization of TVIAs was easy to achieve high packing density. According to the data from AngioSuite, relative few coils can increase the safety in procedure and stenting may reduce risk of aneurysmal recurrence.

Objective:This study aimed to evaluate the safety and efficacy of Neuroform EZ stent and Solitaire AB stent in the treatment of severe symptomatic intracranial atherosclerotic stenosis (ICAS).Methods:The clinical data of 142 patients (47 females, 95 males; [57.7±9.7] years old) with symptomatic ICAS treated by Neuroform EZ stent and Solitaire AB stent implantation in the First Medical Center of PLA General Hospital from July 2018 to December 2019 were retrospectively analyzed. The patients were divided into the Neuroform EZ group (EZ group, 91 cases) and the Solitaire AB group (AB group, 51 cases). Operation time, success rate, residual stenosis rate, and perioperative complications were analyzed. The patients were regularly followed up, and the modified Rankin score (mRS) was used to evaluate the recovery of neurological functions 3 months after the operation. Digital subtraction angiography (DSA) was performed to evaluate the rate of in-stent restenosis 6 months after the operation.Results:A total of 91 Neuroform EZ stents and 51 Solitaire AB stents were implanted in the EZ group and the AB group, respectively. The success rate of operation in both groups was 100%. Operation time was (2.4±0.4) h in the EZ group and (2.5±0.5) h in the AB group. The rate of stenosis in the EZ group was reduced from 83.8%±10.1% to 21.5%±12.0% and that in the AB group was reduced from 85.6%±6.2% to 19.2%±4.6%. The difference in operation time and residual stenosis rate between the two groups was not significant (all P values>0.05). The EZ group had three cases of perforator infarction and one case of intracranial hemorrhage. The AB group had two cases of perforator infarction. No hyperperfusion syndrome occurred in the two group. The incidence of postoperative complications was 4.4% (4/91) in the EZ group and 3.9% (2/51) in the AB group, and the difference was not statistically significant( P>0.05). Fifty-one patients (51 stents) in the EZ group were followed up for 6-13 months (8.27±3.18), whereas 28 patients (28 stents) in the AB group were followed up for 6-14 months (8.61±4.38). mRS was used to evaluate neurological functions 3 months after the operation. The prognosis of both groups was good. mRS was (1.3±0.4) points in the EZ group and (1.4±0.2) points in the AB group. The difference in mRS between the two groups was not significant ( P>0.05). DSA examination 6 months after the operation showed that the in-stent restenosis rate was 15.7% (8/51) in the EZ group and 14.3% (4/28) in the AB group, and the difference was not significant ( P>0.05). Conclusions:Both Neuroform EZ stent and Solitaire AB stent are safe and effective treatment options for symptomatic ICAS.

目的 分析高龄颅内动脉瘤破裂患者神经介入治疗效果.方法 回顾性连续纳入2017年11月～2020年5月解放军总医院第一医学中心神经内科医学部住院并接受神经介入治疗的高龄(年龄≥80岁)动脉瘤性蛛网膜下腔出血(aSAH)患者12例,Hunt-Hess Ⅰ级3例,Ⅱ级4例,Ⅲ级5例,收集入选者一般临床资料、手术情况,术后随访6～12个月,应用改良的Rankin量表(mRS)、格拉斯哥预后评分(GOS)进行功能评价.结果 12例患者住院时间6～56(25±18)d,随访过程中,9例(75.0％)恢复良好(mRS评分0～2分,GOS 4～5分),3例(25.0％)伴有神经功能障碍(mRS评分3～5分,GOS 2～3分).早期或后期迟发脑积水3例(25.0％).结论 高龄aSAH患者应考虑接受治疗,尤其是对于低Hunt-Hess分级(Ⅰ～Ⅲ级),神经介入治疗仍是最优选的选择.

目的 探讨急性前循环大血管闭塞患者接受机械取栓治疗前应用毛细血管指数(CIS)评估颅脑侧支循环的价值及其与治疗预后的相关性.方法 回顾性分析接受血管内取栓治疗的急性前循环大血管闭塞患者42例.所有患者术前完成全脑数字减影血管造影术(DSA),并根据DSA进行的CIS评分分为充盈良好(fCIS)组28例和充盈不良(pCIS)组14例.根据术后1～3个月随访患者改良的Rankin量表(mRS)评分分为预后良好组25例和预后不良组1 7例.采用单因素分析比较2种不同分组患者的临床基线资料,多因素Poisson回归分析CIS与术后1～3个月mRS的相关性.结果 pCIS组预后不良发生率明显高于fCIS组(71.4％ vs 17.9％,P=0.001).预后不良组发病至血运重建时间明显高于预后良好组[(353.5±131.0)min vs (232.4±79.7)min,P=0.002].多因素Poisson回归分析显示,CIS为术后1～3个月mRS评分的危险因素(OR=0.576,95％CI:0.459～0.723,P=0.000).结论 CIS作为一种侧支循环的评估办法,是影响血管内机械取栓患者1～3个月后临床改善的重要因素,且有预估作用.

目的 采用计算机断层扫描灌注成像(CTP)观察颅内动脉粥样硬化性狭窄(ICAS)患者脑组织血管表面渗透性(PS)和血流动力学状态及治疗后改变.方法 对59例ICAS患者(ICAS组)及16名志愿者(对照组)行全脑CTP,并对ICAS组17例行责任血管支架植入术.采用定量分析软件测量责任动脉供血区血管PS、血流动力学参数[脑血流量(CBF)、血容量(CBV)及平均通过时间(MTT)],并获得健侧镜像值,比较2组血管PS及血流动力学参数的差异,对比ICAS组支架植入前后血管PS及血流动力学参数变化,分析血管PS与血流动力学参数的相关性.结果 相比对照组,ICAS组患侧血管PS值增高、CBF减低、MTT延长(t=7.77、-4.84、7.47,P均＜0.05).相比健侧,ICAS组患侧血管PS值增高、CBF减低、CBV增加、MTT延长(t=-4.38、-4.48、4.49、8.35,P均＜0.05);植入支架后患侧血管PS值、CBF、MTT与术前差异均有统计学意义(t=0.95、-4.05、3.50,P均＜0.05).血管PS与MTT、CBV分别呈高度、中度正相关(r=0.86、0.59,P均＜0.05),与CBF呈低度负相关(r=-0.31,P＜0.05).结论 血管PS可作为定量评价ICAS治疗效果的影像学标志物.ICAS患者患侧脑组织血管PS明显增加,植入支架后较术前明显降低.PS结合血流动力学参数能更准确地反映脑组织病理生理改变,为个性化治疗ICAS及评估疗效提供参考.