OBJECTIVETo investigate the therapeutic effect of cranial-cervical aneurysms with stent-graft.

METHODSClinical data of 20 patients with cranial-cervical aneurysm treated with stent-graft in Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University from November 2006 to November 2015 were retrospectively analyzed. There were 15 male and 5 female patients with a mean age of 40 years (ranging from 22 to 67 years). There were 10 spontaneous cases, 5 trauma history cases and 5 surgery history cases. Postoperative follow-up were made by telephone, CT angiography or digital subtraction angiography, evaluating therapeutic effect.

RESULTSTwenty-four stent-grafts placement were carried out in 20 patients and all of them were successfully deployed in the parent artery. Intraoperative stent malapposition induced endoleak occurred in 3 cases, incomplete coverage of distal stent segment in 2 cases, acute thrombosis in 1 case and vessel lesion in 1 case. Eighteen cases were radiographically cured while the other 2 cases improved through additional stent placement, coil embolization or artery thrombolysis. Clinical symptoms of post-operative patients were improved to varying degrees. Follow-up of 1 to 96 months (average of 19 months) were accomplished. Delayed parent artery occlusion were encountered in 2 cases while endoleak still existed in 1 case.

CONCLUSIONApplication of stent-graft for cranial-cervical aneurysms is safe and effective and the short-term follow-up results are satisfied.

Adult ; Aged ; Angiography ; Arterial Occlusive Diseases ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation ; Endoleak ; Female ; Follow-Up Studies ; Humans ; Intracranial Aneurysm ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Stents ; Treatment Outcome ; Young Adult

Two angiographic instances of anomalous external carotid artery (ECA) and internal carotid artery (ICA) anastomosis are described, each occurring at the C2-3 level and bearing remnants of proximal ICA. The ICA remnant of one patient (identifiable immediately upon bifurcation of the common carotid artery) was hypoplastic, and that of the other patient was an occluded arterial stump. These features are not typical of non-bifurcating ICA. The occipital artery originated from an anomalous connection in one instance and from the main trunk of the ECA (just past the ECA-ICA connection) in the other.
Adult ; Arterial Occlusive Diseases/radiography ; Carotid Artery, External/*abnormalities/radiography/surgery ; Carotid Artery, Internal/*abnormalities/radiography/surgery ; Cerebral Angiography ; Humans ; Intracranial Aneurysm/*radiography/surgery ; Male ; Middle Aged

BACKGROUND/AIMS: As an underprivileged population, homeless people have a higher incidence of morbidity and mortality than do non-homeless people. Diabetes mellitus is a chronic disease associated with high complication rates; its incidence is increasing rapidly and it requires prompt, adequate treatment and care. Therefore, we investigated the quality of medical care provided to homeless diabetics in a general hospital and comorbidities associated with diabetes. METHODS: Between March 25, 2011 and December 31, 2012, we retrospectively investigated the medical records of the diabetes patients at a general hospital in Seoul. We assigned the patients into two groups: homeless (n = 82) and non-homeless (n = 242) patients. We subsequently compared the clinical and laboratory findings, comorbidities, and complications between the two groups. RESULTS: The homeless diabetics received treatment less regularly than the non-homeless patients and were diagnosed with diabetes while visiting the hospital for the treatment of other diseases. The homeless patients had higher glycated hemoglobin A1c levels than the non-homeless patients. The homeless patients had a higher rate of other diseases, such as peripheral artery disease, acute infectious disease, intracranial hemorrhage, and pulmonary tuberculosis; a higher incidence of acute infectious disease (odds ratio [OR], 15.671; 95% confidence interval [CI], 5.115-48.070); and a higher prevalence of pulmonary tuberculosis (OR, 6.423; 95% CI, 1.785-23.116) than the non-homeless patients, as determined by multivariate analysis. CONCLUSIONS: Comorbid acute infectious disease and pulmonary tuberculosis were found more frequently in homeless diabetes patients presenting to the hospital than in non-homeless diabetes patients. Therefore, attention should be paid to this differentiating factor.
Chronic Disease ; Communicable Diseases ; Comorbidity* ; Diabetes Mellitus ; Hemoglobin A, Glycosylated ; Homeless Persons ; Hospitals, General* ; Humans ; Incidence ; Intracranial Hemorrhages ; Medical Records ; Mortality ; Multivariate Analysis ; Peripheral Arterial Disease ; Prevalence* ; Retrospective Studies ; Seoul ; Tuberculosis, Pulmonary

OBJECTIVETo evaluate the clinical value of the three-dimensional (3D) CT module of the flat-panel digital subtraction angiography (DSA) system.

METHODSA retrospective analysis was conducted among 278 patients receiving examination with rotational 3D-CT of INNOVA 3100 flat-panel DSA system. AW4.3-04 workstation was used to perform the 3D reconstruction and INNOVA CT reconstruction, and the imaging data were analyzed in comparison with the clinical results.

RESULTSThe 3D-CT of the flat panel DSA system displayed the conditions of cerebral aneurysms in 54 cases, cerebral arteriovenous malformation in 25 cases, and the intracranial conditions in 24 cases. The blood supply and tumor vessels were clearly displayed in 57 cases, and the effects of embolization and endovascular stenting were evaluated in 27 and 21 cases, respectively. The rotational 3D-CT was used to evaluate complete embolization in 24 cases, and failed to display the feeding arteries of small tumors in 11 cases. The vascular lesions, biliary tract lesions, and the occurrence of hemorrhage during interventional therapy were observed in 58, 5 and 25 cases, respectively.

CONCLUSIONThe 3D-CT module of the flat-panel DSA system can easily display abnormal vascular lesions and provide comprehensive anatomical information to facilitate interventional therapies and complication monitoring.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Angiography, Digital Subtraction ; instrumentation ; methods ; Carotid Artery, Internal ; diagnostic imaging ; pathology ; Cerebral Angiography ; methods ; Cerebral Arterial Diseases ; diagnostic imaging ; pathology ; Female ; Hepatic Artery ; diagnostic imaging ; Humans ; Imaging, Three-Dimensional ; Intracranial Aneurysm ; diagnostic imaging ; pathology ; Male ; Middle Aged ; Retrospective Studies ; Tomography, X-Ray Computed ; methods ; Young Adult

OBJECTIVEThe aim of the study was to determine the prevalence and the distribution pattern of lesion site of intracranial vascular stenosis and to identify risk factors for the stenosis in patients with essential hypertension.

METHODSA total of 231 consecutive inpatients with essential hypertension were included in this study. Patients with the history of cerebrovascular diseases and relevant neurological symptoms were excluded. Intracranial vascular stenosis (>50% diameter reduction) was detected using CT angiography (CTA).

RESULTSOf 231 patients, 69 (29.87%) had intracranial artery stenosis. The most common stenosis site is middle cerebral artery (43.69%), followed by carotid siphon (20.39%). The stenosis in internal carotid arterial system (78.64%) was more common than in vertebrobasilar arterial system (21.56%, P < 0.05). The patients with intracranial vascular stenosis were older, had longer history of hypertension, higher levels of systolic blood pressure, higher plasma cholesterol, higher LDL-C. Lp (a), higher urinary microalbumin excretion, thicker ventricular septum, and lower levels of HDL-C than the patients without stenosis. Logistic analysis showed that systolic blood pressure (OR 1.650, 95% CI 1.134 - 2.400, P = 0.023), course of hypertension (OR 1.238, 95% CI 1.072 - 1.429, P = 0.006), LDL-C (OR 2.103, 95% CI 1.157 - 3.823, P = 0.014) and type 2 diabetes (OR 2.325, 95% CI 1.161 - 4.341, P = 0.011) were the independent risk factors of asymptomatic intracranial arterial stenosis.

CONCLUSIONSNearly 30% inpatients with essential hypertension had asymptomatic intracranial artery stenosis. The most common site of stenosis was middle cerebral artery. Hypertension, dyslipidemia and diabetes were risk factors for the development of intracranial arterial stenosis.

Aged ; Cerebral Angiography ; Female ; Humans ; Hypertension ; epidemiology ; pathology ; Intracranial Arterial Diseases ; epidemiology ; Male ; Middle Aged ; Prevalence ; Risk Factors

OBJECTIVETo investigate the incidence, case fatality and risk factors of acute cerebral arterial thrombosis complicated by multiple organ dysfunction syndrome (MODS).

METHODSA retrospective study was conducted in 830 patients with acute cerebral arterial thrombosis, among whom 89 also developed MODS.

RESULTSThe incidence of MODS in these patients was 10.7% with case fatality of 58.4%. The presence of concurrent infection and increased number of organ involved both resulted in higher case fatality. The preceding health status, number of failing organs and score of neurologic impairment were the main fetal factors according to logistic regression analysis.

CONCLUSIONMODS usually occurs in two weeks after the onset of acute cerebral arterial thrombosis. Prevention of MODS involves rigorous treatment of the compromised organs and comprehensive systemic therapy in addition to the management of the primary diseases.

Cerebral Arterial Diseases ; complications ; diagnosis ; epidemiology ; mortality ; Female ; Humans ; Intracranial Thrombosis ; complications ; diagnosis ; epidemiology ; mortality ; Male ; Middle Aged ; Multiple Organ Failure ; complications ; diagnosis ; epidemiology ; mortality ; Prognosis ; Risk Factors

Adult ; Aneurysm, False ; etiology ; therapy ; Embolization, Therapeutic ; Humans ; Intracranial Arterial Diseases ; etiology ; therapy ; Male ; Wounds and Injuries ; therapy

The greatest advances in understanding and treating stroke have occurred during the past 30 years. The advantages of ultrasound for vascular diagnosis are well known: it is a fast, portable, non-invasive, repeatable and inexpensive technique. Among various clinical situations for the application of ultrasound to stroke care, the best established ones include: (1) early detection and characterization of extracranial atherosclerosis and occlusive diseases especially at the carotid bifurcation; (2) evaluation of consequences of proximal arterial occlusive disease on the distal cerebral vasculature; (3) follow-up of the natural history and response to treatment of acute arterial occlusion that causes hyperacute stroke; (4) detection of microemboli associated with cardiac and aortic pathology and carotid artery surgical manipulation; and (5) follow-up of the time course and reversibility of cerebral vasospasm after subarachnoid hemorrhage. The field of ultrasonic diagnosis also has detractors and limitations. Even now, the technique is 'operator-dependent' in terms of the accuracy and validity of its results. Newer technology has provided significant advances in this regard; however, it is necessary for each laboratory to maintain a strict quality control in order to maximize the benefits that this powerful technology can provide.
Arterial Occlusive Diseases ; Atherosclerosis ; Carotid Arteries ; Diagnosis* ; Follow-Up Studies ; Natural History ; Pathology ; Quality Control ; Stroke* ; Subarachnoid Hemorrhage ; Ultrasonography* ; Vasospasm, Intracranial

OBJECTIVETo evaluate the safety and short-term outcome of endovascular stent-assisted angioplasty for the treatment of intracranial arterial stenosis.

METHODSAngioplasty and stent placement were administered to treat 46 patients with lesions of atherosclerotic intracranial stenosis, including 16 lesions of basilar artery, 12 of vertebral artery, 13 of internal carotid artery and 9 of middle cerebral artery.

RESULTSTechnical success was achieved in 49 of 50 vessels (98%), with no procedure-related death or cerebral ischemic attack. Extracranial internal carotid artery dissection occurred in 1 patient and was successfully treated with a self-expand stent. One patient had subarachnoid hemorrhage because of perforation by microwire with no permanent neurologic deficit, and another 2 patients had groin hematoma. Angiographic examination immediately after stenting revealed that the stenosis rate was significantly reduced (72.4% +/- 12.3% vs 10.6% +/- 7.8%). There was no cerebral ischemic attack in the 37 patients who were clinically followed up (6 - 18 months, mean of 8.5 months).

CONCLUSIONAngioplasty and stenting for the treatment of intracranial stenosis is safe and feasible, and it may be favorable for decreasing the incidence of ischemic attack.

Aged ; Angioplasty ; adverse effects ; methods ; Brain Ischemia ; etiology ; metabolism ; Constriction, Pathologic ; surgery ; Female ; Follow-Up Studies ; Humans ; Intracranial Arterial Diseases ; surgery ; Male ; Middle Aged ; Stents

3 cases of intracranial aneurismal residue following clipping at Viet Duc Hospital were studied. The causes of this condition were anatomical and technical. It is necessary to identified prior surgery the cause of hemorrhage, to limit the disruption of aneurism, to expose entirely the neck of aneurism before the setting of clip and to explore throughly the place of clip- Anterigraphy or systematic Xray control should be made for checking the results
Intracranial Aneurysm ; etiology ; Aneurysm ; Intracranial Arterial Diseases