In recent two years, new reports about concepts, technologies, materials, and especially new clinical trial results for endovascular treatment of cerebrovascular diseases, has provided tremendous promise for further progress. Mechanical thrombectomy becomes a guideline-recommended therapy for acute ischemic stroke patients with large vessel occlusion, which is considered as a landmark event. The superiority of endovascular coiling over neurosurgical clipping has been further proved for intracranial aneurysm. New devices are constantly developing for aneurysm occlusion. For brain arteriovenous malformation, application of detachable-tip microcatheters improves safety of embolization procedure, and successful transvenous embolization has been also achieved in a few cases. Long-term result of carotid stenting for symptomatic patients has been proved to be noninferior to carotid endarterectomy. Meanwhile, some new trials only obtain negative results, for example, endovascular stenting for intracranial or vertebral artery stenosis both show worse outcomes compared with medical therapy alone. More advancements and investigations are needed.
Embolization, Therapeutic ; instrumentation ; Endarterectomy, Carotid ; Humans ; Intracranial Aneurysm ; therapy ; Intracranial Arteriovenous Malformations ; therapy ; Stents ; Stroke ; therapy ; Thrombectomy ; Vertebrobasilar Insufficiency ; therapy

Humans ; Neck Injuries ; therapy ; Vertebral Artery ; injuries ; Vertebrobasilar Insufficiency

OBJECTIVETo compare the efficacy on vertebrobasilar insufficiency (VBI) between auricular acupuncture therapy and oral administration of medicine.

METHODSSixty patients of VBI were randomized into an auricular acupuncture therapy group and a medicine group, 30 cases in each one. In the auricular acupuncture group, acupuncture was applied bilaterally to gan (CO12) and jiejie (HX8) on the ears and needles were retained for 15 min. After needle withdrawal, the vaccariae semen were fixed with plaster at naogan (AT3, 4i), zhen (AT3), jing (AH12), shen (CO10) and pi (CO13) on the ears. In the medicine group, flunarizine hydrochloride capsules (Sibelium), 5mg were prescribed for oral administration, once every night. The treatment lasted continuously for 2 weeks (14 days) in the two groups. In 2 weeks, the clinical efficacy was assessed and the transcranial doppler (TCD) examination was performed.

RESULTSAfter treatment, the symptom scores were all apparently reduced in the patients of the two groups (P < 0.01, P < 0.05). Compared with the medicine group, the reduced score was much more obvious in the auricular acupuncture group (P < 0.05), indicating the significant difference. After treatment, with TCD examination, the blood velocity was increased to different degrees in the patients of low velocity type in the auricular acupuncture group and the medicine group; that was reduced to different degrees in the patients of high velocity type in the auricular acupuncture group and the medicine group. All of them were different significantly as compared with those before treatment (all P < 0.05). But the difference was not significant between the two groups (both P > 0.05). In comparison of clinical efficacy between the two groups, the effective rate was 93.3% (28/30) in the acupuncture group and better than 76.7% (23/30) in the medicine group, indicating the significant difference in comparison (P < 0.05).

CONCLUSIONThe auricular acupuncture therapy achieves the definite efficacy on VBI and the efficacy is better than flunarizine hydrochloride capsules.

Acupuncture Points ; Acupuncture, Ear ; Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Vertebrobasilar Insufficiency ; therapy

No abstract available.
Basilar Artery* ; Brain Infarction ; Brain Stem ; Endovascular Procedures ; Stroke* ; Thrombolytic Therapy ; Vertebrobasilar Insufficiency

OBJECTIVE: To investigate the value of high-frequency stimulation ABR in the diagnosis and treatment of posterior circulation ischemia. METHOD: Twenty-three patients complaining vertigo diagnosed by neurologist were selected to accept the examination of high-frequency stimulation ABR. After two weeks of treatment, they were tested again. At the same time,20 healthy persons were chosen as control group. The data were analyzed. RESULT: The patients had longer ABR latency and wave interval than the normal controls, and the results improved after the proper treatment. CONCLUSION High-frequency stimulation ABR can be used to facilitate the diagnosis and to evaluate the therapeutic effect of posterior circulation ischemia.
Acoustic Stimulation ; methods ; Adult ; Case-Control Studies ; Evoked Potentials, Auditory, Brain Stem ; Female ; Humans ; Male ; Middle Aged ; Vertebrobasilar Insufficiency ; diagnosis ; therapy

OBJECTIVETo observe the differences in therapeutic effect between penetrating needling on head points and acupuncture of syndrome division in the treatment of vertigo caused by vertebral-basilar arterial blood-supply insufficiency.

METHODSSixty cases of vertigo caused by vertebral-basilar arterial blood-supply insufficiency were divided into 2 groups: a penetrating needling on head points group (group A) and an acupuncture of syndrome division group (group B), 30 cases in each one. In group A, penetrating needling technique was applied from Baihui (GV 20) towards Qianding (GV 21), Shuaigu (GB 8) towards Qubin (GB 7) and Yuzhen (BL 9) towards Tianzhu (BL 10). Electric stimulation was added. In group B, the acupoints were selected according to syndromes. For example, upper disturbance of wind yang: Ganshu (BL 18), Xingjian (LR 2),etc. were selected; upper disturbance of turbid phlegm: Yinlingquan (SP 9), Fenglong (ST 40), etc. were selected; qi and blood deficiency: Baihui (GV 20), Xuehai (SP 10), etc. were selected; liver and kidney yin deficiency: Ganshu (BL 18), Shenshu (BL 23), etc. were selected. Electric stimulation and needling manipulation were conducted on those acupoints. Ten treatments made one session. After continuous 2 sessions of treatment, the efficacy, symptom score and physical sign score were compared between two groups. Transcranial Doppler (TCD) examination was done to observe hemodynamic changes of anterior cerebral artery (ACA), middle cerebral artery (MCA) and posterior cerebral artery (PCA) before and after treatment.

RESULTSThe total effective rate in group A was 96.7% (29/30) that was obviously better than 83.3% (25/30) in group B (P<0.05). The scores of vertigo degree, vertigo frequency, duration and accompanied symptoms after treatment were lower obviously as compared with those before treatment in two groups (all P<0.05). The improvements in group A were much significant (all P<0.05). The highest mean velocity(Vm) of bilateral MCA, ACA and PCA were apparently reduced after treatment in two groups (P< 0.05, P<0.01). The improvements in group A were much more apparently (all P<0.05).

CONCLUSIONThe penetrating needling on head points can effectively relieve vertigo caused by vertebral-basilar arterial blood-supply insufficiency, reduce the attack frequency and improve in its accompanied symptoms. Its clinical efficacy is significantly superior to that in acupuncture of syndrome division group.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Basilar Artery ; physiopathology ; Blood Circulation ; Female ; Head ; blood supply ; Humans ; Male ; Middle Aged ; Vertebral Artery ; physiopathology ; Vertebrobasilar Insufficiency ; complications ; therapy ; Vertigo ; etiology ; physiopathology ; therapy

OBJECTIVETo observe the intervention on the disturbance of blood flow velocity in vertebral artery in patients with vertebrobasilar insufficiency (VBI) treated with acupuncture at Taichong (LR 3) so that the clinical evidences could be provided for the research of acupoint specificity.

METHODSOne hundred cases of VBI were tested with Transcranial Doppler (TCD) and 43 vessels of low velocity of blood flow and 79 vessels of high velocity of blood flow were discovered. Additionally, 50 cases of normal people were selected in control group, including totally 100 vertebral arteries. The velocity changes in systolic period (Vs) of vertebral artery were observed before and after acupuncture at Taichong (LR 3). RESULTS; After acupuncture at Taichong (LR 3), Vs of vertebral artery in low velocity cases was increased apparently. Vs in 5 to 10 min after acupuncture and half a hour after needle withdrawal was different significantly in statistics as compared with Vs before acupuncture (both P < 0.01). Vs of vertebral artery in high velocity cases was reduced apparently. Vs in 5 to 10 min after acupuncture and half a hour after needle withdrawal was different significantly in statistics as compared with Vs before acupuncture (both P < 0.01). There was no significant difference in statistics in comparison before and after acupuncture in control group (P > 0.05).

CONCLUSIONAcupuncture at Taichong (LR 3) improves blood supply in vertebral artery in the mode of dual regulation and rectifies the disturbance of vertebral artery blood flow in dynamics.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Blood Flow Velocity ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Ultrasonography, Doppler, Transcranial ; Vertebrobasilar Insufficiency ; physiopathology ; therapy

OBJECTIVE: To evaluate our early experience using self-expanding stents to treat atherosclerotic vertebral artery ostial stenosis (VAOS), with respect to technical feasibility and clinical and imaging follow-up results. MATERIALS AND METHODS: A total of 20 lesions in 20 patients underwent stenting of the VAOS using a self-expanding stent (Precise RX; Cordis Neurovascular, Miami Lakes, FL). Two patients were asymptomatic. We analyzed the technical success rate, causes of technical failure, occurrence of any vascular or neurological event, and the occurrence of any neurological abnormality or in-stent restenosis (ISR) seen on follow-up. The imaging follow-up was performed with Doppler ultrasound (DUS) as a primary screening modality. RESULTS: One instance of technical failure was caused by failure of the guidewire passage. The stent diameter was 5 mm, and post-stenting balloon dilatations were necessary in all cases. Stent misplacement requiring placement of an additional stent occurred in four cases. Following a 14.8 month average clinical follow-up time, two patients showed anterior circulation ischemia, which was not attributed to the VAOS we treated. Following a 13.7 month average DUS follow-up, five patients showed a mild degree of diffuse or focal intimal thickening in the stent lumen; however, none of the stenosis showed luminal loss of more than 50% and no stent fracture was noted. CONCLUSION: The use of self-expanding stents for treating VAOS was technically feasible and helped to improve artery patency during our limited follow-up interval.
Aged ; Blood Vessel Prosthesis Implantation/methods ; Feasibility Studies ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; *Stents ; Treatment Outcome ; Ultrasonography, Doppler/methods ; Vascular Patency ; Vertebral Artery/surgery/*ultrasonography ; Vertebrobasilar Insufficiency/*therapy

BACKGROUNDEndovascular therapy is a treatment option for localized occlusion of the subclavian artery. In this report the long-term experience with 59 patients is presented.

METHODSBetween June 1998 and September 2008, we used endovascular therapy to treat 61 subclavian arterial obstructive lesions in 59 patients (46 males and 13 females, 34 - 82 years of age with a mean age (61.9 + or - 11.0) years). Twenty patients (34%) had clinical symptoms due to vertebrobasilar insufficiency, 26 (44%) had disabling arm ischemia, and 13 (22%) had both symptoms. We performed all procedures under local anesthesia. The approaches were from the femoral artery (n = 47), brachial artery (n = 1, involving bilateral subclavian disease) or both (n = 11). Sixty stents were implanted. All patients were followed-up at 1, 3, 6, and 12 months post-procedure, and annually thereafter.

RESULTSWe achieved technical success in 58 (95.1%) arteries, all of which were stented. There were three technical failures; two were due to the inability to cross over an occlusion, necessitating the switch to an axillo-axillary bypass, and the third was due to shock after digital subtraction angiography and prior to stenting. Arterial stenosis pre- and post-stenting was (83.6 + or - 10.8)% and (2.5 + or - 12.5)% (P < 0.01). Clinical success was achieved in 55 of the 59 patients (93.4%). Of the four clinical failures, three were technical and the remaining patient had a stent thrombosis. Systolic blood pressure difference between the two brachial arteries was (44.7 + or - 18.5) vs. (2.2 + or - 3.9) mmHg (P < 0.01). Primary patency was 98% at 12 months, 93% at 24 months, and 82% at 5 years. Five patients were lost to follow-up by 12 months post-stenting. Significant recurrent obstruction developed in five patients with resumption of clinical symptoms. The overall survival rate was 98.2% at 12 months, 89.5% at 24 months, and 84.5% at 5 years.

CONCLUSIONSEndovascular therapy for proximal subclavian arterial obstructive lesions is effective and successful. This minimally invasive treatment may be the first choice of treatment for proximal subclavical arterial obstructive lesions.

Adult ; Aged ; Aged, 80 and over ; Arterial Occlusive Diseases ; pathology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Stents ; Subclavian Artery ; pathology ; Subclavian Steal Syndrome ; pathology ; therapy ; Vertebrobasilar Insufficiency ; pathology ; therapy

OBJECTIVETo compare the difference of the therapeutic effect of acupuncture and western medicine on the patients with vertebral-basilar insufficiency (VBI), and investigate its mechanism.

METHODSAccording to the different velocity of blood flow recorded by Transcranial Doppler (TCD), sixty patients with VBI were divided into an acupunture group (31 cases) and a western medicine group (29 cases). In the acupuncture group, the patients were punctured at Fengchi (GB 20) and "Gongxue" (Extra). In the western medicine group, the patients were orally given the Flunarizine hydrochlorid capsules. Before and after two-week treatment, the clinical symptoms and related data of TCD were compared, analyzed and evaluated.

RESULTSThe clinical symptoms were obviously improved in the acupuncture group, which was better than the western medicine group (P < 0.05). Acupuncture not only could up-regulate the velocity of vertebral-basilar blood flow (VBF) on the patients with slower VBF of peak-systolic phase (Vs), end-diastolic phase (Vd) and mean value (Vm), but also reduced the VBF on the patients with faster Vs, Vd and Vm. In comparison of the data before and after treatment, there were significantly differences in two groups (P < 0.05), however, there were no difference between the two groups (all P > 0.05). On the index of vascular pulsation (PI), resistance index (RI) and Vs/Vd, there were no difference in both groups before and after treatment (all P > 0.05).

CONCLUSIONAcupuncturing at Fengchi (GB 20) and "Gongxue" has bidirectional and beneficial function of regulation on the VBF, but no active role on the compatibility of vertebral-basilar blood vessel.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Vertebrobasilar Insufficiency ; therapy ; Young Adult