Objective To evaluate the efficacy of stent-assisted coiling in the treatment of unruptured vertebral dissecting aneurysm. Methods We retrospectively reviewed 59 consecutive patients with unruptured vertebral dissecting aneurysms that underwent endovascular treatment. 31 patients received single stent-assisted coiling, 28 patients received multiple stent-assisted coiling. Results Clinical outcome was favorable in 56 of the 59 patients, the modified Rankin Scale score had no difference in both groups (P = 0.24). The immediate obliteration grade in multiple-stent group was higher than that in single-stent group (75.0% vs. 41.9%, P=0.010). What′s more, the recurrence rate was lower in multiple-stent group (0% vs. 19.4%, P = 0.043). Conclusions Stent-assisted coiling in the treatment of unruptured vertebral dissecting aneurysm is safe and effective , multilayer disposition of stents with coils will decrease the complications and facilitate the aneurysmal occlusion. Larger , prospective studies are necessary to explore the long-term outcomes of reconstruction therapy.

Objective To evaluate the clinical effect of endovascular embolization for the treatment of cerebellar arteriouvenous malformations (AVMs) associated with aneurysm, and to discuss its technical points. Methods The clinical data of 142 patients with cerebellar AVMs were retrospectively analyzed. Of the 142 patients, 42 had concomitant aneurysms. The patients were divided into concomitant aneurysm group and without aneurysm group. Using univariate and multivariate statistical models, the patient’s gender and age, the presence or absence of hemorrhage, the lesion’s location and size, and the presence or absence of deep venous drainage were analyzed. Results A total of 61 concomitant aneurysms were detected in the 42 patients, which were located within the malformation mass (n=14) or on the feeding artery (n=47). The concomitant aneurysms located in the malformation were closely related to AVM hemorrhage and the deep venous drainage. During the follow-up period after endovascular embolization, no recurrence of bleeding was observed in all the 42 patients. Conclusion In order to reduce the relapse rate of hemorrhage, the formulation of therapeutic measures should be based on the management of the concomitant aneurysm when endovascular embolization treatment is employed for AVM associated with aneurysm.

Objective To compare the recurrence rate and long-term follow-up angiographic findings between stent-assisted coil embolization and simple coil embolization in treating large and giant intracranial aneurysms.Methods The clinical data and imaging materials of a total of 90 patients with large and giant intracranial aneurysms (＞10 mm,91 aneurysms in total),who were admitted to authors' hospital during the period from January 2004 to January 2016 to receive interventional embolization therapy,were retrospectively analyzed.Of the 90 patients,52 patients (52 lesions in total) received simple coil embolization (SCE group)and 38 patients (39 lesions in total) received stent-assisted coil embolization (SACE group).Postoperative recurrence rates of aneurysm were compared between the two groups,and recurrence risk factors were analyzed.Results The whole postoperative recurrence rate of aneurysm and re-treatment rate were 38.5％(35/91) and 20.9％(19/91) respectively;the recurrence rate and re-treatment rate of SACE group were 35.9％ (14/39) and 17.9％ (7/39) respectively,while those of SCE group were 40.4％ (21/52) and 23.1％ (12/52) respectively;the differences between the two groups were not statistically significant (P＞0.05).Multivariate logistic regression indicated that the recurrence risk factors of large or giant intracranial aneurysms included rupture of aneurysm (OR=0.284,95％CI=0.083-0.978,P=0.046),simple coil embolization (OR=5.03,95％ CI=1.04-24.44,P=0.045),concurrent hypertension (OR =0.13,95％ CI=0.036-0.51,P=0.003)and long time after operation (OR=1.002,95％CI=1.001-1.003,P=0.002).Conclusion Compared with simple coil embolization,stent-assisted coil embolization can reduce the recurrence rate of aneurysm.Rupture of aneurysm,simple coil embolization,long time after operation and concurrent hypertension are independent risk factors for recurrence of aneurysm after transcatheter arterial embolization.

Objective To explore the risk factors of perioperative complications of cerebral aneurysms after stent-assisted coiling. Methods A retrospective analysis of clinical data of 395 patients with cerebral aneurysms after stent-assisted coiling, admitted to our hospital from January 1, 2011 to December 31, 2017, was performed. Univariate and multivariate Logistic regression analyses were used to determine the risk factors of perioperative complications of cerebral aneurysms after stent-assisted coiling (intraoperative stent thrombosis and bleeding events, postoperative ischemic and hemorrhage events, and other unclassified complications). The preoperative aneurysm status was analyzed by Hunt-Hess grading and Trend test was conducted to analyze its statistical significance. Results Intraprocedural thrombosis and hemorrhage occurred in 2.28％ patients (9/395) and 1.01％patients (4/395), respectively. Postprocedural ischemic stroke and hemorrhage occurred in 3.54％ patients (14/395) and 1.27％ patients (5/395), respectively. One patient suffered intraprocedural thrombosis and postprocedural ischemic stroke. Univariate Logistic regression analysis showed that pretreatment ruptured aneurysm was the risk factor of perioperative complications (OR=2.466, 95％CI: 1.267-4.797, P=0.008).In multivariate Logistic regression analysis, diabetes and pretreatment ruptured aneurysm were independent risk factors of perioperative complications (OR=4.275, 95％CI: 1.260-14.508, P=0.020;OR=2.442, 95％CI: 1.182-5.043, P=0.016). As compared with patients with low Hunt-Hess grading, patients with high Hunt-Hess grading had higher risk of perioperative complications in tests for linear trend (OR=1.509, 95％CI: 1.142-1.993, P=0.004). Conclusions The incidence of perioperative complications is high in patients with diabetes or pretreatment ruptured aneurysm. Hunt-Hess grading can accurately determine the risk of perioperative complications.

Atrial fibrillation, also known as atrial fibrillation, is a common cardiac arrhythmia, and its incidence increases with age. Catheter ablation is considered to be an effective means to treat atrial fibrillation and maintain sinus rhythm. The common ablation technologies are radiofrequency ablation and cryoablation. However, the existing catheter ablation technology has a "zero-sum effect", and it is difficult to control the optimal dose clinically. In this study, a new method of pulsed electric field ablation for atrial fibrillation was proposed, which effectively solved the "zero-sum effect" problem of temperature ablation. The clinical application results show that the proposed technology effectively overcomes the shortcomings of existing temperature ablation, and can form durable pulmonary vein isolation.

Objective To indentify the risk factors of hemorrhage of cerebral arteriovenous malformations (AVMs) in children,and further conclude the treatment strategies and safety of these patients by endovascular embolization.Methods The clinical data of 56 patients with AVMs aged 3-14 years,admitted to our hospital from June 2005 to June 2015,were retrospectively analyzed.The risk factors of hemorrhage of these patients were identified by univariate and multivariate analyses;and the treatment strategies by endovascular embolization were analyzed.Results Univariate analysis indicated that small size of malformation vascular mass was the independent risk factor of hemorrhage for patients with AVMs in children (OR=0.292,95％CI:0.106-0.805,P=0.017).For 56 patients treated by endovascular embolization,a total of 121 feeding pedicles were embolized,and the mean obliteration rate of AVMs was 79％ (20％-100％).Finally,only 9 patients (7.9％) suffered embolization-related complications,such as headache,facial paralysical,hemianopsia,and activity obstacle;however,no patients suffered severe disability or death.After a follow-up of 2 months to 36 months (mean=17 months),all childem had favorable outcome,and none suffered intracerebral hemorrhage or recurrent AVMs.Conclusions Small size of malformation vascular mass is the independent risk factor of hemorrhage of patients with AVMs in children.The endovascular embolization of patients with intracranial AVM in children is efficacy and safe with few complications.

Objective To investigate the association between RNF213 rs6565666 polymorphisms and intracranial cystic aneurysms in patients from Guangdong province. Methods Two hundred and fifty patients with intracranial cystic aneurysms, admitted to and conformed by digital substraction angiography (DSA) in our hospital from February 2016 to October 2018, were selected as experimental group; and 250 patients without intracranial aneurysms conformed by DSA, CT angiography or magnetic resonance angiography at the same time period were used as control group. The genotypes of rs6565666 locus of RNF213 gene were detected by polymerase chain reaction-ligase detection reaction (PCR-LDR). Results As compared with those in the control group, percentages of AG and AA genotypes were significantly higher and percentage of GG genotype was statistically higher at rs6565666 locus of patients from the experimental group (P<0.05). The proportion of allele A at rs6565666 locus in the experimental group was statistically higher as compared with that in the control group (P<0.05). In the experimental group, 112 patients had ruptured aneurysms and 138 patients did not have ruptured aneurysms; there was no statistically significant difference in the genotype distribution of rs6565666 between the ruptured group and the non-ruptured group (P>0.05). Conclusion RNF213 gene rs6565666 polymorphism is associated with intracranial cystic aneurysms in patients from Guangdong province.

Objective To explore the efficacy and safety of stent-assisted coil embolization of acutely ruptured wide-necked intracranial aneurysms. Methods One hundred and sixty patients with acutely ruptured wide-necked intracranial aneurysms (160 ruptured aneurysms), admitted to and underwent stent-assisted coil embolization in our hospital from January 201l to May 2018, were chosen. The clinical data, outcomes and complications of these patients were retrospectively analyzed. The differences of clinical data between patients with and without complications were compared. Modified Rankin scale (mRS) was used to evaluate the prognoses of these patients. Univariate and multivariate Logistic regression analyses were conducted to analyze the risk factors of prognoses. Results All 160 stents were successfully released. Complete occlusion after endovascular procedures was achieved in 127 patients (79.4％); 17 aneurysms (10.6％) had neck residual and 16 aneurysms (10.0％) had aneurysm residual. Surgery-related complications occurred in 17 patients (10.6％), of which, 6 (3.8％) showed hemorrhagic events and 11 (6.9％) had ischemic events. The distributions of aneurysm sites between patients with ischemia related complications and those without ischemia related complications were statistically different (P<0.05). Poor prognosis was noted in 24 patients (15％) and good prognosis was noted in 136 (85％). The mRS scores, preoperative Hunt-Hess grades and distributions of stent types between patients with good prognosis and patients with poor prognosis were statistically different (P<0.05). Logistic regression analysis indicated that baseline mRS scores ≥4 (OR=39.000, 95％ CI:10.861-140.038, P=0.000), preoperative Hunt-Hess grading IV-V (OR=13.000, 95％CI: 4.063-41.596, P=0.015), and Solitaire stents placement (OR=3.333, 95％CI: 1.332-8.339, P=0.028) were the independent risk factors for poor clinical outcomes in patients with acutely ruptured wide-necked intracranial aneurysms. Conclusion Stent-assisted coil embolization is suggested to be a safe and efficacious way to treat acutely ruptured wide-necked intracranial aneurysms, and patients with baseline mRS scores≥4, preoperative Hunt-Hess grading IV-V and Solitaire stents placement are more prone to having poor clinical outcomes.

Objective To evaluate the influence of aneurismal inclination angle in the intracranial aneurysm rupture and hemorrhage. Methods A total of 2064 patients with intracranial aneurysms (1086 without rupture and hemorrhage, and 978 with rupture and hemorrhage), admitted to our hospital from January 2010 to April 2018, were chosen in our study. DSA examination and three-dimensional reconstruction were used for morphological evaluation of aneurysms, including aneurysm size, location, morphous feature, aneurismal inclination angle, vessel angle, aspect ratio (AR) and size ratio (SR). Risk factors of intracranial aneurysm rupture were analyzed by univariate and multivariate regression models; two-piecewise linear regression model and smooth curve fitting were used to analyze the saturation threshold effect of aneurismal inclination angle on aneurysm rupture and hemorrhage to evaluate the correlation between aneurismal inclination angle and aneurysm rupture and hemorrhage. Stratified analysis was conducted to clarify the influence of aneurismal inclination angle changes in risk of aneurysm rupture and hemorrhage in presence of various stratified factors (cerebral microbleeds [CMBs], diabetes, and hyperlipidemia). Results Aneurysm inclination angle was an independent risk factor for aneurysm rupture and hemorrhage (HR=1.02, 95％CI: 1.01-1.03, P=0.000). Risk of aneurysm rupture and hemorrhage increased when aneurismal inclination angle was more than 106.3 degrees for each additional degree; each degree of increase in aneurysm inclination increased the risk of aneurysm rupture and hemorrhage by 3％. As compared with patients without CMBs, risk of aneurysm rupture and hemorrhage increased extra 7％in patients with CMBs for each additional degree of aneurismal inclination angle;as compared with patients without diabetes mellitus MD, for each additional degree of aneurismal inclination angle, risk of aneurysm rupture and hemorrhage increased extra 2％in diabetes patients with fasting blood-glucose (FBG)≤ 6.0 mmol/L, and increased extra 4％in diabetes patients with FBS>6.0 mmol/L, respectively; as compared with patients without hyperlipemia, risk of aneurysm rupture and hemorrhage increased extra 3％in patients with hyperlipemia for each additional degree of aneurismal inclination angle. Conclusion The aneurismal inclination angle is closely related to intracranial aneurysm rupture and hemorrhage, and accurate measurement of aneurismal inclination angle has important clinical significance in assessing the risk of aneurysm rupture and hemorrhage.