PURPOSE: The Pipeline embolization device (PED) is approved in the USA for treating giant and large aneurysms arising from the petrous to superior hypophyseal segments of the internal carotid artery in patients older than 21 years of age. This study investigates off-label PED results in a large cohort. MATERIALS AND METHODS: Retrospective, single-center review of all patients who had off-label PED surgery. RESULTS: Sixty-two aneurysms (48 patients) underwent off-label PED treatment from 2012–2017. There were 44 females and four males (age 21 to 75 years; mean/median, 54.3/55.0 years). The most common presenting symptom was headache (47/62, 75.8%). All aneurysms were in the anterior circulation. Aneurysm size ranged from 1.4 to 25.0 mm (mean/median, 7.6/6.9 mm). Fifty-two aneurysms had post-operative imaging with total/near-complete occlusion of 84.6% (44/52). Aneurysm-based operative near-term complication rate was 9.7% while there were no permanent complications. For aneurysms and headache, 86.7% improved/resolved after embo-surgery, and were four times more likely to have a better clinical outcome (resolved or improved symptoms) after surgery (odds ratio [OR], 4.333; P=0.0325). Left-sided aneurysms had a higher occlusion rate (OR, 20; P=0.0073). Hypertension (OR, 4.2; P=0.0332) and smoking (OR, 7; P=0.0155) were more prone towards aneurysm occlusion. Patients without a family history were 14 times more likely to have favorable imaging outcome (P=0.0405). There is no difference of occlusion rates between untreated and previously treated aneurysms (P=0.6894). Overall, occlusion rate decreased by 14% with an increase of aneurysm size by 1 mm (P=0.0283). CONCLUSION: For anterior circulation aneurysms, the off-label application of PED is as effective and safe as reported for on-label intracranial aneurysms.
Aneurysm ; Carotid Artery, Internal ; Cohort Studies ; Female ; Headache ; Humans ; Hypertension ; Intracranial Aneurysm ; Male ; Retrospective Studies ; Smoke ; Smoking

Objective To observe the clinical effect of Xingnaojing injection combined with naloxone in the treatment of hypoxic ischemic encephalopathy.Methods 62 patients with hypoxia ischemia encephalopathy were randomly assigned into the control group(31 cases)and the treatment group(31 cases).The control group used naloxone treatment on the basis of the conventional treatment.The treatment group received Xingnaojing injection combined with naloxone treatment on the basis of routine treatment.The changes in different time of Glasgow Coma Scale(GCS) scores of the two groups after treatment were compared.Results After treatment for 1 ,5,1 0,1 5d,the GCS scores in the control group were (5.27 ±0.87)points,(9.03 ±0.72)points,(1 0.03 ±0.72)points,(1 3.03 ±0.72)points respectively,which in the treatment group were (5.1 4 ±1 .03)points,(9.24 ±1 .06)points,(1 3.31 ±2.83)points, (15.31 ±0.93)points.The differences of GCS scores after treatment for 15,10d between the two groups were statistically significant(t =1 5.1 1 3,1 0.501 ,P =0.00,0.00).In the control group,the total effective rate was 50.0%,which of the treatment group was 82.7%,the total effective rate between the two groups had statistically significant difference (χ2 =6.437,P <0.05).Conclusion On the basis of routine treatment,Xingnaojing injection combined with naloxone in the treatment of hypoxic ischemic encephalopathy has better effect than the single use of naloxone treatment.

A cerebral large vessel occlusion due to septic embolism with resultant stroke is a known complication of infective endocarditis and can cause severe neurologic disability. However, septic embolism rarely occurs in the absence of infective endocarditis, and emboli due to different organisms may behave differently. As such, it is important to recognize the different pathogens that can cause septic embolism resulting in cerebral large vessel occlusion and to have data on successful treatments. We describe here a case of mechanical thrombectomy for septic embolism secondary to Staphylococcus lugdunensis bacteremia without infective endocarditis.