Purpose: This study aimed to investigate the effectiveness and safety of endovascular revascularisation of intracranial artery occlusion and stenosis in moyamoya disease using stent angioplasty. Materials and methods: We recruited 12 patients (8 women and 4 men) with occlusion and stenosis of intracranial arteries in the context of moyamoya disease who underwent endovascular stent angioplasty. Clinical data, baseline conditions, lesion location, treatment outcomes, periprocedural complications, and follow-up outcomes were analysed. Results: The occlusion was located at the M1 segment of the middle cerebral artery in 8 patients, at both the M1 and A2 segments in one patient, and at the C7 segment of the internal carotid artery in 3. Thirteen stents were deployed at the occlusion site, including the low-profile visualized intraluminal support (LVIS) device in 8 patients, an LVIS device and a Solitaire AB stent in one, and a Leo stent in 3, with a success rate of 100% and no intraprocedural complications. Plain CT imaging after stenting revealed leakage of contrast agent, which disappeared on the second day, resulting in no clinical symptoms or neurological sequelae. Follow-up angiography studies were performed in all patients for 6–12 months (mean, 8.8). Slight asymptomatic in-stent stenosis was observed in 2 patients (16.7%), and no neurological deficits were observed in the other patients. All preoperative ischaemic symptoms completely disappeared at follow-up. Conclusion: Stent angioplasty is a safe and effective treatment for occlusion and stenosis of intracranial arteries in moyamoya disease. Resumen: Objetivos: Evaluamos la eficacia y la seguridad de la revascularización endovascular de oclusiones y estenosis de arterias intracraneales mediante angioplastia con stent en pacientes con enfermedad de moyamoya. Materiales y métodos: Incluimos a 12 pacientes (8 mujeres y 4 hombres) con oclusiones y estenosis de arterias intracraneales en el contexto de enfermedad de moyamoya que se sometieron a angioplastia con stent. Recogimos datos clínicos e información sobre enfermedades existentes, localización de la lesión, resultados terapéuticos, complicaciones periprocedimiento y resultados de seguimiento. Resultados: La oclusión afectaba al segmento M1 de la arteria cerebral media en 8 pacientes, a los segmentos M1 y A2 en un paciente, y al segmento C7 de la arteria carótida interna en los 3 restantes. Se colocaron 13 stents en el lugar de la oclusión: stents LVIS en 8 pacientes, un stent LVIS y un stent Solitaire AB en un paciente y stents Leo en 3 pacientes. La tasa de éxito fue del 100%, sin complicaciones durante el procedimiento. Una TC tras el procedimiento detectó fugas del medio de contraste, que desaparecieron al segundo día y no provocaron síntomas ni secuelas neurológicas. Se realizó un seguimiento de todos los pacientes con angiografía durante 6-12 meses (media: 8,8 meses). Dos pacientes (16,7%) presentaron una ligera reestenosis intrastent asintomática; el resto de los pacientes no presentaron déficits neurológicos. Todos los síntomas isquémicos previos desaparecieron durante el seguimiento. Conclusiones: La angioplastia con stent es un tratamiento eficaz y seguro de las oclusiones y estenosis de arterias intracraneales en pacientes con enfermedad de moyamoya.

儿童缺血性卒中的发病率低，年发病率约为1/10万，其发病原因多样，目前尚无规范的治疗方法。本文报道1例急诊采用机械取栓术治疗的因心脏黏液瘤引发的急性缺血性卒中患儿。术后24 h美国国立卫生研究院卒中量表评分为9分，术后第3天为0分；无手术相关并发症。因术前未行静脉溶栓治疗，术后第5天即行心房黏液瘤切除术。术后3个月随访，患儿恢复良好。

Purpose To investigate the effect and safety of endovascular embolization of tiny aneurysms (≤3 mm) within 72 h of subarachnoid hemorrhage compared with larger ones. Materials and methods Patients with intracranial aneurysms treated with endovascular embolization within 72 h were retrospectively enrolled and divided into group A ( n = 33) with ruptured tiny aneurysms (≤3 mm) and group B ( n = 244) with ruptured larger aneurysms (>3 mm). The clinical and angiographic data before and after embolization were analyzed. Results Most tiny aneurysms were located at the posterior communicating artery (36.4%) followed by anterior communicating artery (18.2%). The stent-assisted coiling technique was used mostly in group A with 18 stents deployed (51.5%), but only 24 (9.8%) patients had stent-assisted coiling in group B, with the stent-assisted coiling technique more significantly ( P < 0.001) frequently used in group A. No significant ( P > 0.05) difference existed in the total, subtotal and incomplete occlusion of aneurysms in two groups. The procedure-related complication rate was not significantly ( P > 0.05) different between groups A (24.2%) and B (17.0%). At discharge, no significant ( P > 0.05) difference existed in the neurological abnormality between the two groups. Follow-up was performed in 64.5% (20/31) in group A and 75.6% (177/234) in group B. No significant ( P > 0.05) difference existed in the aneurysm recurrence rate, deaths, and prognosis. Conclusion Early embolization of tiny cerebral aneurysms within 72 h of subarachnoid hemorrhage is safe and effective compared with ruptured large aneurysms treated in the same manner.

BACKGROUND: Little literature is available on mechanical thrombus aspiration in acute ischemic stroke with coincident ipsilateral unruptured aneurysm, especially with aneurysm proximal to the occlusion site. In this report, we describe a case of ischemic stroke in a patient with acute occlusion of M1 segment of the middle cerebral artery with coincident ipsilateral internal carotid arteryLposterior communicating artery aneurysm who was successfully treated by mechanical clot retrieval using the Sofia (6F) PLUS technique (MicroVention Terumo, Tustin, California, USA). CASE DESCRIPTION: A 52-year-old woman presented at our hospital 6 hours after sudden onset of dysarthria and right limb hemiplegia on waking up in the morning. She was managed using a direct aspiration first pass technique for distal middle cerebral artery mechanical aspiration using the Sofia (6F) PLUS catheter. The thrombus was manually aspirated in 2 minutes, and Thrombolysis in Cerebral Infarction scale 3 flow was restored. Next, LVIS (MicroVention Terumo, Tustin, California, USA) stent-assisted coiling of the aneurysm of the posterior communicating segment of the left internal carotid artery was immediately undertaken. The National Institutes of Health Stroke Scale score was 4 at day 1 and 0 at day 7 postoperatively. No device-related or catheter-related complications occurred. CONCLUSIONS: Ischemic stroke patients with coincident aneurysm are at increased risk of aneurysmal rupture and should be managed with tailored endovascular strategies. Our case shows that a direct aspiration first pass technique using the Sofia (6F) PLUS catheter provides a safe, effective approach for thrombus aspiration in stroke patients.