Objective To summarize the technique and efficiency of combined endovascular stenting and Guglielmi detachable coils (GDC) packing for the treatment of intracranial wide-necked bifurcation aneurysms and recanalized aneurysms.Methods The coronary stents were implanted across the necks of 5 intracranial wide-necked aneurysms (two at bifurcation of ICA, one at basilar artery and two recanalized PcoA aneurysms). The porous stents covered the ostia of vital side branches and perforating vessels in three cases. Microcatheters were introduced into the aneurysmal sac through the stent mesh and then followed by GDCs embolizing the aneurysms. Results The stents were deployed in parent artery in all cases. Total occlusion was obtained in 4 cases, while more than 90% in one case with patency of the parent arteries and vital perforating arteries. Follow-up angiography performed in all patients 3-6 months later revealed no intra-stent stenosis. All the patients recovered well except Ⅲ nerve palsy in one patient which diminished 3 months later.Conclusion Endovaseular therapy combined stent implantation and microcoil placement maybe a valid alteration for the treatment of wide-necked bifurcation aneurysms and recanalized aneurysms, which shows promise clinical application in the future. The ostia of vital side branches covered with stents showed no effect on hemodynamics.

The hemodynamic mechanism has been considered to be the main factor related to the cerebral aneurismal growth and rupture. Virtual numerical research has become an important method for the study of cerebral aneurismal hemodynamics, which lead to a deep insight into the field of hemodynamic mechanism.We reviewed the correlative researches in this field during recent years and made a summarization concerning about, the relationship between intra-aneurysmal hemodynamics like velocity,wall tangential stress and pressure field under variable conditions and the biological behaviors such as growth and rupture of aneurysms; and further discussion on the topic of clinical application.

Objective To investigate the relationship between endothelin-1(ET-1)and NO in cerebral spinal fluid(CSF) and cerebral vasospasm(CVS) following experimental subarachnoid hemorrhage(SAH).Methods An experimental CVS model was achieved by twice injections of fresh autologous arterial blood into the cisterna magna of each animal. The contents of ET-1 and NO in CSF were measured by radioimmunological analysis and activated cadmium reduction method respectively.The degrees of CVS were analyzed through cerebral angiography(%reduction of basilar artery diamiter,%RBAD). Results The contents of ET-1 in CSF increased significantly than that before injection after SAH(P

Objective To investigate the effect of lumbar subarachnoid space continuous drainage on cerebral vasospasm(CVS) prevention and treatment following experimental subarachnoid hemorrhage(SAH), and further explore the mechanism of CVS prevention and treatment.Methods An experimental SAH was achieved by twice injections of fresh autologous arterial blood into cisterna magna of each dog. The dogs were randomly divided into drainage group and control group and it was just after the second injection of fresh blood that the drainage group began to drain blood cerebral spinal fluid(CSF).The contents of red blood cell(RBC), endothelin-1(ET-1) and nitric oxygen(NO) in CSF were measured respectively. The degree of CVS was analyzed through angiography (%reduction of basilar artery diamiter,%RBAD). The angiographic results of CVS were analyzed and the changes of RBC, ET-1 and NO in CSF at different stages were compared between two groups. Results The drainage group had fewer cases of CVS and the severity of CVS was more slight compared with control group.Drainage group had a significantly higher cleaning rate of RBC.In drainage group,the content of ET-1 was lower and the content of NO was higher significantly than control group.Conclusions Through cleaning the vasogenic substances in subarachnoid space,lumbar subarachnoid space continuous drainage can change the levels of ET-1 and NO in CSF and may prevent and reverse CVS following.

The platelet glucoprotein(GP)Ⅱb/Ⅲa inhibitors prossess inhibiting platelet aggregation effectly. As new drugs of antiplatelet, they are different in mechanism with action, application and dosage between the Ⅱb/Ⅲa inhibitors and other tradional antiplatelet drugs such as aspirin or clopidogrel. In familiar with the pharmacologic action and clinical application of Ⅱb/Ⅲa inhibitors is important for endovascular interventional radiology, especially with important significance for obtaining high quality neuro-endovascular stenting in the perioperative period.

Objective To report the treatment of intracranial fusiform or wide-necked aneurysms with combined endovascular stenting and Guglielmi detachable coils packing, and to evaluate its indication, technique, outcome, and complications. Methods The coronary stents were implanted across the necks of 5 fusiform aneurysms and 12 wide-necked aneurysms. Microcatheters were introduced into the aneurysmal sac through stent mesh, and GDCs were used to embolize the aneurysms. Results The stents were deployed in 16 cases, and total occlusion was obtained in 13 cases,while more than 90% in 3 cases. One aneurysm was embolized with GDCs alone after the attempt of stenting was failed. All the patients recovered well with patency of the parent arteries. Conclusion Endovascular therapy combined with stent implantation and microcoil placement may be a valid alteration for the treatment of intracranial fusiform or wide-necked aneurysms. Further study was necessary for long-term outcome.

Objective To summarize the early experience and results of endovascular stenting for symptomatic stenosis of middle cerebral artery. Methods We performed percutaneous endovascular stent assisted angioplasty in 20 patients with symptomatic high grade stenosis of MCA, who had either recurrent transient ischemic attacks (TIAs) resistant to medical therapy or perfusion problems. After stenting, the patients was administrated with antiplatelet drug and followed up with DSA、TCD and SPECT. Results Stent placement and angioplasty were successfully performed in all patients except one with MCA rupture during the procedure. The mean degree of stenosis reduced from (78.3?4.7)% to (15.6?4.4)%, and the degree of residual stenosis were less than 30%. None of these patients developed TIAs or stroke during the follow up period. Angiography revealed no evidence of restenosis. TCD and SPECT suggested significant improvement of cerebral perfusion. Conclusions Endovascular stenting for MCA stenosis seems to be a safe and effective therapeutic method. Further study is needed for long term outcome.

Objective To analyse the preliminary outcome and its relevant factors of endovascular stent assisted angioplasty for intracranial stenosis. Methods Sixty one atherosclerotic intracranial stenoses in 57 patients (23 stenoses in posterior and 38 in anterior circulation) were treated with endovascular angioplasty using balloon expandable coronary stents. Results Technical success was achieved in all patients, with no procedural and associated complications except one of intracranial hemorrhage. Angiographic results immediately after stenting suggested that the residual postprocedure stenosis was 0%～32% (mean 8.7%?4.4%), with significant reduction from preprocedure stenosis (74.5%?6.7%). The patients were clinically asymptomatic and had no recurrent TIA and stroke. Follow up angiogram in 43 patients revealed no restenosis (

Objective To investigate the safety and efficacy of domestic contrast iodixanol injection in the application of interventional neuroradiology. Methods A total of 442 patients from 11 research centers using iodixanol injection for whole brain DSA examination or interventional therapy were enrolled in a prospective,multicenter,and non-controlled clinical trial. The recording and evaluation indicators included the adverse reactions after drug treatment,changes of creatinine and urea nitrogen indicators before and after drug treatment,DSA types,DSA effects,the dosage of contrast agent,etc. The renal function damage, incidence of adverse drug reactions,and image quality were counted and analyzed. Results All the 442 patients were completed the examination or treatment. (1)All the results of intraoperative angiography achieved excellent,including 98. 2% (n = 434)were excellent and 1. 8% (n = 8)were good. There were significant differences in the comparison of angiographic results in the 4 different types of DSA (SIEMENS,PHILIPS,GE,and TOSHIBA)(χ2 = 31. 518,P < 0. 001 ). (2 )Only 1 patient had increased serum creatinine > 44. 2 μmol / L. There was no urea nitrogen abnormality of clinical signifi-cance. None of the patients had renal insufficiency. (3)Three patients had adverse drug reaction (0. 7%) during procedure,including 2 patients had dermal allergic reactions and 1 patient had transient blurred vision. Conclusion Domestic iodixanol injection is safe and effective and has less adverse reaction in the clinical application of interventional neuroradiology. The different types of DSA may impact on the contrast image quality.

Spontaneous intracerebral hemorrhage (sICH) accounts for approximately 10% to 15% of stroke patients. The key factor affecting the prognosis of sICH is whether the initial hematoma volume and hematoma enlarge. Current research indicates that sICH is a common disease caused by rupture of small blood vessels with poor prognosis. More than 30% of patients have persistent bleeding after the first onset, indicating that the disease is a dynamic process. This persistent bleeding, also known as hematoma expansion (HE), is an independent predictor of neurological deterioration and poor prognosis. This article reviews the research progress of CT image features and specific imaging findings on CTA in predicting HE in patients with sICH.