Objective To investigate technique methods of dense emolization of intracranial aneurysms, factors resulting incomplete embolization. Methods 58 patients with intracranial aneurysms, using different embolization technique treated narrow and wide aneurysms with GDC. Dense emolization rate of aneurysms was elevated. Results dense emolization 50 aneurysms (86.2%), 95% in 3 aneurysms (5.2%), 90% in 3 aneurysms (5.2%), 80% in 2 aneurysms (3.4%). All embolizated aneurysms showed no enlarging recurrence or rebleeding.Conclusions Dense embolization of intracranial aneurysms should try to obtain.

Objective To summarize the application of endovascular treatment of the acute ruptured intracranial aneurysms with the new Trufill detachable coil system.Methods Thirty five patients with the acute ruptured intracranial aneurysms were treated with DCS or DCS Orbit within 72 hours. Results All 35 cases were successful with compact embolization in 29 aneurysms,95% in 3 aneurysms,90% in 2 aneurysms,80% in 1 anearysm.One case hemorrhaged during operation and 1 case had thrombosis after operation,but with good prognosis of both.One case died of pneurmonia.Thirty cases achieved clinic follow-up 1 to 15 months after operation with only one rebleeing.Sixteen cases achieved DSA follow-up 3 to 12 months after the operation.Partial recurrence of the occluded aneurysm was shown in 1 case.Conclusions Trufill DCS or DCS Orbit is a safe,reliable and effective therapy for the endovascular treatment of intracraranial aneurysms.

Objective To investigate the preliminary experience of mechanical thrombectomy with a tri-axial system of the Solitaire AB stent through a Neuro delivery catheter to treat intracranial large artery occlusion. Methods A tri-axial system was used to deliver the Solitaire AB stent through a Neuro delivery catheter to provide intracranial aspiration in close proximity to the stent. This technique was used in 1 case of acute middle cerebral artery occlusion and 1 case of acute basilar artery occlusion. Results Successful revascularization was achieved in these 2 cases. Thrombolysis in cerebral infarction (TICI)score was 3. The clot length of acute middle cerebral artery occlusion was 3 cm and the modified Rankin Scale (mRS)score of this case was 3 at 90 days follow-up. Another patient with acute bilateral vertebral occlusion was revealed successful recanalization by angiography. Conclusion The results suggest that this technique of a tri-axial system used of the Solitaire stent through a Neuro delivery catheter can effectively retrieve clots from the occlusive artery and minimize the chance of antegrade blood flow dislodging the thrombus.

Objective To investigate the effect of hyperglycemia at admission in patients with acute ischemic stroke on endovascular treatment outcome.Methods From May 2012 to December 2016,200 consecutive patients with acute ischemic stroke (excluding patients with diabetes mellitus) underwent endovascular mechanical thrombectomy at the Department of Neurosurgery,the First People's Hospital of Changzhou were enrolled retrospectively.They were divided into either a hyperglycemia group (hyperglycemia was defined as glucose ＞7.8 nmol/L at admission,n =57) or a non-hyperglycemia group (n =143) according to the blood glucose levels at admission.The neurological function of the patients was evaluated by the National Institutes of Health Stroke Scale (NIHSS) at admission and discharge.The modified thrombolysis in cerebral infarction (mTICI) grade was used to evaluate the degree of recanalization.The modified Rankin scale (mRS) was used to evaluate the prognosis of the patients at 90 d after procedure.The general information of the patients were analyzed,including sex,age,past history,hospitalization time,onset to recanalization time (ORT),TOAST classification of cerebral infarction,and recanalization.The endovascular treatment outcomes of both groups were compared.Results (1) There were no significant differences in TOAST classification,age,hypertension history,atrial fibrillation history,stroke history,coronary heart disease history,ORT,NIHSS at admission between the patients of the two groups (all P ＞ 0.05).(2) There were no significant differences in days of hospitalization,mTICI grade,and number of thrombectomy between the patients of the two groups (P ＞0.05).(3) The discharge mortality and incidence of in-hospital neurological deterioration in the patients of the hyperglycemia group were 28.1％ (16/57) and 31.6％ (18/57) respectively,while those in the non-hyperglycemia group were 14.7％ (21/143) and 18.2％ (26/143) respectively.There were significant differences between the two groups (P =0.028 and 0.039 respectively).Conclusion Hyperglycemia at admission may have adverse effects on the prognosis in patients after receiving mechanical thrombectomy.

Objective To investigate the efficacy of endovascular treatment (EVT) in acute cardioembolic large vessel occlusion (LVO) of anterior circulation and its influencing factors.Methods The clinical data of 83 patients with acute cardioembolic LVO of anterior circulation treated with EVT during June 2014 to June 2016 were analyzed retrospectively.The neurological outcomes in these patients were evaluated by National Institutes of Health Stroke Scale (NIHSS) on admission;cerebral vascular re-canalization after procedure was classified according to thrombolysis in cerebral infarction (TICI) grading;the recovery of neurological outcomes was classified by modified Rankin scale (mRS) at discharge.According to the mRS scores at discharge,these patients were divided into two groups:good curative effect group and poor curative effect group.Single factor analysis was performed on all clinical parameters that might influence the surgical outcomes;in addition,the influencing factors of surgical outcomes were analyzed by multiple factor Logistic regression analysis.Results Eighty-one patients (97.59％) had good re-canalization (TICI grading 2b-3) after EVT;41 patients (49.40％) had better curative effect (mRS scores ≤3 at discharge),and 42 patients (50.60％) had poor curative effect (mRS scores ≥4 at discharge);postoperative hemorrhagic transformation appeared in 26 patients,and 16 patients (19.28％) accepted decompressive craniectomy resulting from massive cerebral infarction,severe encephaledema or hemorrhagic transformation,and had poor curative effect.The single factor analysis showed that the differences of NIHSS scores on admission,occlusion site,angiographic re-canalization,time from the symptom onset to the vessel re-canalization and whether hemorrhagic transformation after operation between the good curative effect group and poor curative effect group were statistically significant (P＜0.05);multiple factor Logistic regression analysis showed that NIHSS scores on admission,angiographic re-canalization,time from the symptom onset to the vessel re-canalization and whether hemorrhagic transformation after procedure were significantly correlated to the treatment efficacy (OR=1.171,95％CI:1.028-1.333,P=0.017;OR=3.623,95％CI:0.931-14.095,P=0.063;OR=l.012,95％ CI:1.003-1.021,P=0.008;OR=3.146,95％CI:0.875-11.309,P=0.079).Conclusions Endovascular thrombectomy is an effective approach for cardioembolic acute anterior circulation stroke.Furthermore,the influential factors of surgical treatment are NIHSS scores on admission,angiographic re-canalization,time from the symptom onset to the vessel re-canalization and whether hemorrhagic transformation after procedure.

Objective:To explore the efficacy and safety of domestic RECO flow restoration device in acute intracranial large-vessel occlusion (LVO).Methods:This study was a multicenter, prospective, randomized, open, controlled trial; 136 patients with acute intracranial LVO at 7 Chinese stroke centers from February 2014 to August 2016 were randomly assigned into an experimental group (thrombectomy by RECO device, n=67) and a control group (thrombectomy by Solitaire device, n=69). The efficacy and safety of patients from the two groups were compared and analyzed. The primary efficacy end point was set as achievement of good recanalization (modified thrombolysis in cerebral infarction [mTICI] grading≥2); the secondary efficacy end points included good prognosis (modified Rankin scale scores≤2 90 d after thrombectomy), time from puncture to achieving good recanalization/time from puncture to final angiogram on condition that good recanalization was not gained, or mortality within 90 d of thrombectomy. The safety end points included any device-related serious adverse events, symptomatic intracerebral hemorrhage or serious adverse events within 24 of thrombectomy. Results:There was no statistically significant difference between the experimental group and the control group in successful rate of good recanalization (91.0% vs. 86.9%), good prognosis rate (62.7% vs. 46.4%), time from puncture to achieving good recanalization/time from puncture to final angiogram on condition that good recanalization was not gained([85.4±47.0] min vs. [89.9±53.3] min), and mortality within 90 d of thrombectomy (13.4% vs. 23.2%, P>0.05). There were no device-related serious adverse events in all patients. No significant differences were found in the incidences of symptomatic intracranial hemorrhage (1.5% vs. 7.4%) or serious adverse events (death [1.5% vs. 1.4%] and brain hernia [4.5% vs. 0.0%]) between the two groups ( P>0.05). Conclusion:The domestic RECO flow restoration device is an effective and safe mechanical thrombectomy stent retriver for acute intracranial LVO.