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Occlusion of ruptured vertebral artery dissecting aneurysms via bilateral vertebral artery approach an efficacy analysis

Xinggen FANG ; Zhenbao LI ; Guangfu DI ; Degang WU ; Xiaochun JIANG ; Yi DAI ; Shanshui XU

Chinese Journal of Cerebrovascular Diseases.2014;(5):256-259. doi:11.3969/j.issn.1672-5921.2014.05.008

Objective To investigate the effect of endovascular treatment of intracranial ruptured vertebral artery dissecting aneurysms via bilateral vertebral artery approach. Methods The symptoms and imaging results of 5 patients with ruptured vertebral artery dissecting aneurysms were analyzed retrospectively. They were all treated with coil embolization via bilateral vertebral artery approach. The two ends of dissection aneurysms were packed densely,the middle segments were packed loosely,and the arteries were isolated from the blood circulation. Results Of the 5 patients after treated,the clinical symptoms were improved rapidly in 4 patients no abnormal limbs activity and mental disorders. After treatment,the modified Rankin scale (mRS)was 0 in four cases after six-month follow-up. One patient turned clear consciousness after 4 weeks, and their mRS was 3 at 6-month follow-up. Before treatment,DSA showed vertebral artery dilation and stenosis. The mean length of involvement in vertebral arteries was 9. 3 ± 1. 5 mm;after treatment,the dissecting aneurysms of 5 patients did not develop completely,no further bleeding occurred,and no new infarcts were observed. No recurrence of the aneurysms and parent artery recanalization were found at the follow-up after 6 months. Conclusion The occlusion of ruptured vertebral artery dissecting aneurysms via bilateral vertebral artery approach is technically feasible. It may be an effective treatment to prevent rebleeding.

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Clinical analysis of headache in patients with cerebral venous sinus thrombosis

Xiangjun DOU ; Guogang LUO ; Xingyun YUAN ; Qiang ZHANG ; Liyun ZHANG ; Jingjie LIU ; Qiuli ZHANG

Chinese Journal of Cerebrovascular Diseases.2014;(5):246-249. doi:11.3969/j.issn.1672-5921.2014.05.006

Objective To analyze the characteristics of the common first attack of headache in patients with cerebral venous sinus thrombosis (CVST). Methods The clinical data of 51 patients who were diagnosed as CVST with MR venography (MRV)or DSA were collected retrospectively. The patients were divided into either a acute group (≤3 week,n= 32)or a chronic group (>3 weeks, n=19). Results (1)The age of onset of symptoms in these patients was 20 to 40 years,and most of them were females. Of all the first symptoms,headache ranked first,accounting for 84. 3%(43/51 );headache only accounted for 52. 9%(27/51 ),headache with other symptoms (ophthalmic symptoms, hemiplegia,and aphasia,etc. )accounted for 31. 4%(16/51 ),and other symptoms such as epilepsy, paralysis,and ophthalmic symptoms accounted for 15. 7%(8/51). (2)The proportion of headache only as the first symptom in the acute group was higher than that in the chronic group (65. 6% vs. 31. 6%,P<0. 05), and the proportion of chronic headache with other symptoms as the first symptom in the chronic group was higher than that of the acute group (P<0. 05). In addition,the proportion of the first symptom including ophthalmic manifestations in the chronic group was higher than that of the acute group (P <0.01 ). (3)Forty-three patients with headache,dull headache or distensible pain accounted for 72. 1%(31/43), thunderclap headache accounted for 11. 6%(5/43),and other kinds of headache accounted for 16. 3%(6/43),however,there were no significant differences about the types of headache between the two groups (all P>0. 05 ). Conclusion Young patients without previous history of migraine,especially women of childbearing age with sudden onset and progressive worsening headache,and the patients with idiopathic intracranial hypertension,CVST should be considered as an important possibility.

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Application value of carotid artery ultrasonography,CT angiography and DSA in the diagnosis of carotid artery dissection

Yanfang SHI ; Jian WU ; Haiqing SONG ; Qian ZHANG ; Xiaoqin HUANG

Chinese Journal of Cerebrovascular Diseases.2014;(5):242-245. doi:11.3969/j.issn.1672-5921.2014.05.005

Objective To investigate the diagnostic value of carotid artery ultrasonography,CT angiography (CTA)and digital subtraction angiography (DSA)for carotid artery dissection. Methods The image data of carotid artery ultrasonography,CTA,and DSA of 24 patients with carotid artery dissection were analyzed retrospectively. Results Twenty-four,16,and 21 patients were examined with DSA,CTA,and carotid artery ultrasonography respectively. The detection rates of carotid artery dissection with DSA,CTA, and carotid artery ultrasonography were 95. 8%,75.0%,and 71. 4% respectively. The DSA mostly showed the line-like sign (n=12,50 %). CTA and carotid artery ultrasonography mostly showed the double lumen sign;they were 37. 5%(n=6)and 52. 4%(n=11)respectively. Compared with DSA,the concordance rates of carotid artery ultrasonography and CTA were 66. 7% and 81. 3% respectively. There was no significant difference (Kappa=0. 39,P=0. 08 and Kappa=0. 43,P =0. 22 respectively). The concordance rate of ultrasonography in combination with CTA and DSA reached 87. 5%(n=15,Kappa=0. 67,P =0.047). There was significant difference. Conclusion DSA is a gold standard for the diagnosis of carotid artery dissection,and it is irreplaceable. Carotid artery ultrasonography in combination with CTA can improve the diagnostic rate. Carotid artery ultrasonography can be used as a screening method for carotid artery dissection.

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Application of three-dimensional magnetic resonance imaging and DSA in the diagnosis of cerebral venous sinus thrombosis

Jun HU ; Shugui SHI ; Kangning CHEN

Chinese Journal of Cerebrovascular Diseases.2014;(4):188-191. doi:10.3969/j.issn.1672-5921.2014.04.005

Objective To investigate the diagnostic value of three-dimensional magnetic resonance imaging (MRV ) and digital subtraction arteriography (DSA ) in cerebral venous sinus thrombosis (CVST). Methods Twenty-nine patients with CVST admitted to the First Affiliated Hospital of the Third Military Medical University (Southwest Hospital)from January 2008 to February 2014 were enrolled retrospectively. Eleven of them were males and 18 were females. Their course of disease ranged from 3 days to 3 months. Nine patients were in the acute phase (<1 week),12 were in the subacute phase (1-2 weeks),and 8 were in the chronic phase (>2 weeks). All the patients were underwent magnetic resonance (MR)(T1 or T2 weighted image ),three-dimensional MRV,and DSA examinations. Results DSA detected 29 and MRV detected 24 patients. MRI revealed 12 patients had cerebral infarction and 7 had cerebral infarct and hemorrhage. On T2-weighted sequences,16 patients showed the flow void effect of venous sinus disappeared,and thromboses with different signals in the sinuses. MRV showed part development of the veins in 14 cases and no development in 10 cases,including 4 with collateral circulation. Compared with DSA,the positive detection rate of MRV was 82. 8%. The lesion sites of 3 patients involving the transverse sinus and 2 involving the sagittal sinus were not detected on MRV. Conclusion Compared with DSA,the MRV has a certain percentage of missed diagnosis rate for CVST. In clinical work,if MRV diagnosis is negative,it can not exclude the diagnosis of CVST,and further DSA examination is needed.

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Clinical manifestations and pathological features of cortical vein thrombosis

Yingxin YU ; Zonghong ZHU ; Sheng YAO ; Jianguo LIU ; Feng DUAN ; Xiaokun QI

Chinese Journal of Cerebrovascular Diseases.2014;(4):183-187. doi:10.3969/j.issn.1672-5921.2014.04.004

Objective To analyze the clinical,imaging and pathological features of cortical vein thrombosis (CoVT). Methods Ten patients with CoVT (4 patients with CoVT alone and 6 patients with CoVT and venous sinus thrombosis)treated at Navy General Hospital from January 2006 to Jun 2013 were collected retrospectively.Its etiology,imaging,and pathological features of brain tissue in 3 patients were analyzed. Results Of the 10 patients with CoVT,3 were female and 7 were male.Their mean age was 31 ± 15 years old.(1)Brain CT scan and MRI showed hemorrhagic cerebral infarction,and contrast-enhanced MRI showed scattered heterogeneous enhancement within lesions. DSA could find CoVT at different parts.(2)3 patients underwent brain biopsy because they were initially diagnosed as brain tumor. Pathological examination showed glial cell,endothelial proliferation and phagocytic reaction.Scattered spotty bleeding was observed,and significant expansion of small veins,A few of them had blood stasis and thrombosis. Conclusion CoVT is one kind of intracranial venous thrombosis. It is more common occurred in young and middle aged adults,and most of them were venous sinus thrombosis.It is caused by retrograde thrombosis and spread to cortical veins.CoVT is easily to be misdiagnosed as brain tumor.Combination of clinical and imaging findings is needed for accurate diagnosis.

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Effect of carotid calcification on the prognosis in patients with ischemic stroke

Yumeng ZHANG ; Li WANG ; Liping CAO ; Ling ZHENG ; Zhizhong ZHANG ; Zongjun ZHANG ; Biyang CAI ; Xinfeng LIU ; Guangming LU ; Gelin XU

Chinese Journal of Cerebrovascular Diseases.2014;(4):173-177. doi:10.3969/j.issn.1672-5921.2014.04.002

Objective To investigate the relationship between the carotid calcification and the prognosis in patients with ischemic stroke. Methods A total of 522 patients with non-cardiac ischemic stroke registered in the Nanjing Stroke Registry Program (NSRP )from December 2009 to October 2012 were enrolled. All patients underwent head and neck CT angiography (CTA). The original data of CT scan were transmitted into the Siemens workstation. Calcium score measurement was performed using the same reconstruction conditions and Agatston calcium score to measure calcification score. The patients were divided into no (0),mild (0

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Efficacy analysis of endovascular stenting for aortic arch artery stenosis after nasopharyngeal carcinoma radiotherapy

Xiaoming YIN ; Jieqing WAN ; Yiling FAN ; Yaohua PAN ; Shenghao DING ; Lei CHEN ; Jiyao JIANG

Chinese Journal of Cerebrovascular Diseases.2014;(4):196-200. doi:10.3969/j.issn.1672-5921.2014.04.007

Objective To investigate the efficacy of endovascular stenting for aortic arch artery stenosis after nasopharyngeal carcinoma radiotherapy. Methods The clinical data of 8 patients with symptomatic severe aortic arch artery stenosis after nasopharyngeal carcinoma radiotherapy were analyzed retrospectively. The patients were all received endovascular stenting,and their improvement of cerebral ischemic symptoms was observed. They were followed up by cervical color Doppler ultrasound.Results The whole brain vascular DSA confirmed that there were 24 severe arterial stenoses on the aortic arch arteries of extracranial segments in 8 patients,including 11 in internal carotid artery,2 in common carotid artery,10 in vertebral artery and 1 in subclavian artery. The patients were treated with vascular angioplasty and stenting respectively. All the patients were followed up for 1 year;there were no recurrence of cerebral ischemic symptoms.Cervical color Doppler ultrasound did not reveal any obvious restenosis. Conclusion Endovascular stent angioplasty for the treatment of aortic arch artery stenosis after nasopharyngeal carcinoma radiotherapy is relatively safe and feasible.

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Parent artery occlusion with Onyx for the treatment of distal intracranial aneurysms:a follow-up analysis

Qi WU ; Xin ZHANG ; Qingrong ZHANG ; Handong WANG ; Chunhua HANG ; Jixin SHI

Chinese Journal of Cerebrovascular Diseases.2014;(4):192-195. doi:10.3969/j.issn.1672-5921.2014.04.006

Objective To investigate the effect of parent artery occlusion with liquid embolic agents (Onyx)for the treatment of distal intracranial aneurysms. Methods The clinical data of 27 patients with 29 ruptured distal intracranial aneurysms were analyzed retrospectively.Seventeen aneurysms located in the posterior inferior cerebellar artery,3 in the anterior inferior cerebellar artery,2 in the superior cerebellar artery,2 in the posterior cerebral artery,1 in the anterior cerebral artery,and 4 in the middle cerebral artery.Twenty-eight aneurysms were treated with Onyx to occlude proximal parent arteries and aneurysms, and 1 distal middle cerebral artery aneurysm was occluded spontaneously. Results All the aneurysms treated were occluded completely.One patient died of intraoperative hemorrhage.The remaining patients were followed up for 8 to 67 months.The final Glasgow outcome scale (GOS)scores were 5 in 23 patients and 4 in 3 patients. 17 patients were followed up with digital subtraction angiography (DSA)and 5 were followed up with computed tomography angiography (CTA)after procedure.There was no recurrence of the aneurysm. Four patients were followed up clinically.No new neurological disturbance or rebleeding was found in all the survived patients. Conclusion Medium-long term follow-up results have shown that the clinical efficacy of proximal parent artery occlusion with Onyx for the treatment of distal intracranial aneurysms is satisfactory,and the recurrence rate is low.

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Efficacy observation of endovascular therapy and medical therapy for symptomatic intracranial artery stenosis

Yongge HOU ; Jing WANG ; Yilong LIU ; Dongxin WANG ; Xiaofeng LIU ; Qian YANG

Chinese Journal of Cerebrovascular Diseases.2014;(6):294-299. doi:11.3969/j.issn.1672-5921.2014.06.004

Objective To investigate the efficacy comparison of endovascular therapy and simple medical therapy for symptomatic intracranial artery stenosis. Methods A total of 145 patients with intracranial artery stenosis were analyzed retrospectively. They were divided into either an endovascular therapy group (n=72) or a medical therapy group (n=73). They were treated with endovascular therapy (gateway balloon,wingspan stents,Apollo stents) or medical therapy (aspirin 100 mg/d,clopidogrel 75mg/d, and atorvastatin 20-40 mg/d) according the willingness of the patients or their family members. The incidences of stroke and transient ischemic attack ( TIA ) , and restenosis rate ( stenosis rate >50% as a standard) during 1-,3-,6-,9-,and 12-month follow-up periods were observed and compared. Results On the basis of medical therapy,the patients of the endovascular therapy group were successfully stented. The success rate of stenting was 98. 6% (70/71). Seven patients had complications in the endovascular therapy group (9.9%),2 of them complicated with hemorrhage(one of was died),drinking cough,hoarseness, dizziness,headache,and excitement were one case in each, the other patients were cured and discharged with active medical treatment, and they did not have serious sequelae. At 12 months after treatment, the stroke recurrence rate of the endovascular therapy group was 8. 4% (n=6,both were TIA),and that of the medical therapy group was 26. 0% (84. 2% was minor stroke). There was significant difference (χ2 =7. 752,P<0. 01);at 12 months after treatment,the incidences of restenosis and aggravated stenosis were 5. 6% (n=4) and 6. 8% (n=5) respectively. There was no significant difference (χ2 =0. 091,P>0. 05). Conclusion Compared with the medical therapy,the efficacy of endovascular therapy for symptomatic intra-cranial arterial stenosis is more significant. The improvement of clinical prognosis is superior to medical therapy.

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Clinical features of moyamoya disease in children and the efficacy analysis of encephaloduroarterio-synangiosis

Bing ZHU ; Xiangyang BAO ; Lian DUAN

Chinese Journal of Cerebrovascular Diseases.2014;(6):284-288. doi:11.3969/j.issn.1672-5921.2014.06.002

Objective To investigate the clinical features of moyamoya disease in children and the prognosis of encephaloduroarteriosynangiosis ( EDAS) . Methods According to the age of first operated patients,317 children with moyamoya disease who received EDAS from January 2004 to December 2010 were divided into 3 groups:infant group (n=16,<3 years of age),preschool group (n=42,3 to 6 years of age),and adolescent group (n=259,6 to 17 years of age). The clinical data and the efficacy of operation of the patients were analyzed retrospectively. Results (1) Among the 3 groups of patients,the incidences of cerebral infarction in the infant group (81. 2%,13/16) or the preschool group (69. 0%,29/42) before procedure were significantly higher than the adolescent group (48. 3%,125/259). There were significant differences (χ2 =11. 741,P<0. 01). (2) Before surgical intervention,the infarct volume enlargement or the recurrence of infarction rate at different parts of brain in the infant group (62. 5%,10/16) was higher than that of the preschool group (31. 0%,13/42) and adolescent group (3. 9%,10/259). There was significant difference (χ2 =77. 437,P <0. 01). (3) The overall rate of favourable prognosis was 86. 4% (274/317). There were significant differences between the 3 groups (χ2 =9. 026,P<0.02). Conclusion The conditions of children with moyamoya disease progresses rapidly and their clinical prognosis is poor. It is safe and effective to perform EDAS early moyamoya disease in children.

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