Objective To investigate the safety and efficacy of flow-directed devices(flow diverter,FD)in the treatment of intracranial anterior cerebral artery aneurysms(ACAA).Methods The clinical data of 21 patients with ACAA,who were admitted to the Department of Neurointerventional Medicine of the First Affiliated Hospital of Zhengzhou University of China to receive FD treatment between February 2019 and August 2022,were retrospectively analyzed.After the treatment,O'Kelly Marotta(OKM)grading criteria was used to determine the degree of occlusion of the aneurysm,and the modified Rankin Scale(mRS)score was adopted to assess the clinical prognosis(0-2 points being defined as a good prognosis,and 3-5 points being defined as a poor prognosis).Results A total of 24 FD stents were implanted in 24 patients(24 aneurysms in total),and the technical success rate of stent implantation was 100％.During the perioperative period,complications occurred in 2 patients(8.3％),including hemorrhagic event(n=l)and ischemic event(n=l).The mRS score in all the 24 patients was ≤2 points.Follow-up imaging examination showed that OKM grade B was seen in 2 patients(8.3％),grade C in 6 patients(25％),and grade D(complete healing)in 16 patients(66.7％).Conclusion For the treatment of ACAA,the FD stent implantation is a safe and effective method.During the postoperative and the long-term follow-up period,neither serious ischemic or hemorrhagic complications nor neurological complications are observed.

Objective To investigate the long-term incidence of in-stent stenosis(ISS)in patients with intracranial aneurysms receiving pipeline embolization device(PED)who showed no ISS at short-to-medium term follow-up examination.Methods The clinical data of patients,who received PED treatment at the Department of Neurointervention,First Affiliated Hospital of Zhengzhou University of China between April 2015 and June 2022,were retrospectively collected.The patients with intracranial aneurysms,who showed no ISS at the initial follow-up with DS A and completed＞12 months long-term follow-up check after treatment at the same hospital,were screened out,and their relevant clinical data and imaging materials were collected.The incidence of ISS occurring in postoperative＞12 months long-term follow-up was calculated.The ISS was defined as a＞25％lumen loss of the parent artery when compared with its lumen size measured immediately after PED implantation.Results A total of 57 patients with 61 aneurysms were enrolled in this study,and a total of 68 PEDs were implanted.Forty-one(67.21％)aneurysms were treated by PED implantation only,and 20(32.79％)aneurysms by PED plus spring coils.The median initial follow-up time was 184.0 days(119.0,212.5).At postoperative＞12 months long-term follow-up visit,DSA was employed for 35(57.38％)aneurysms,CTA was adopted for 22(36.07％)aneurysms,and 3D-SPACE sequence MR scan was performed in 4(6.56％)aneurysms.The median follow-up time was 538.0 days(407.5,678.0),and the incidence of ISS was 0％.No ISS-related neurological symptoms occurred in all patients.Conclusion In treating intracranial aneurysms with PED,the postoperative incidence of ISS is low.No ISS is found during the short-term follow-up period,and long-term follow-up results tend to indicate that no ISS events have occurred.

Objective:To evaluate the necessity, safety and efficacy of endovascular treatment for cerebral infarction caused by middle cerebral artery (MCA) stenosis with hypoperfusion in the blood supply area of the lenticulostriate artery.Methods:The clinical and surgical data of patients with MCA atherosclerotic disease who underwent endovascular treatment in the First Affiliated Hospital of Zhengzhou University from January 2014 to October 2021 were retrospectively analyzed. A total of 6 patients with cerebral infarction caused by MCA stenosis with hypoperfusion in the blood supply area of the lenticulostriate artery were selected. The preoperative and postoperative clinical imaging characteristics, perioperative complications and follow-up of these 6 patients were summarized and evaluated.Results:After the endovascular treatment, the imaging of the lenticulostriate artery in all the 6 patients was clearer than that before the operation, and the number of main trunks of the lenticulostriate artery shown by imaging in 2 patients was more than that before operation. The computer tomography perfusion of 6 patients after the endovascular treatment showed that perfusion in the supply area of the lenticulostriate artery was significantly improved compared with pre-operation. No stroke, transient ischemic attack (TIA) and death occurred during the perioperative period. The time of clinical follow-up was 360 (322, 495) days, and there were no stroke, TIA or death occurring in the corresponding artery. All the 6 patients underwent imaging follow-up, of which 3 patients underwent digital subtraction angiography and 3 underwent CT angiography. The lumen of the target vessels showed patency in all patients.Conclusions:With rigorous imaging evaluation, endovascular treatment may be safe and effective for cerebral infarction caused by MCA stenosis with hypoperfusion in the blood supply area of the lenticulostriate artery.

Objective:To investigate the changes of mean venous sinus pressure (MVP) and trans-stenosis pressure gradient in patients with idiopathic intracranial hypertension (IIH) under awake setting and general anesthesia.Methods:Thirty-eight patients with IIH accepted venous sinus stent implantation in our hospital from January 2010 to January 2020 were chosen in our study; their clinical data were analyzed retrospectively. The manometry results of these 38 patients were recorded under awake setting and general anesthesia before stenting; MVP and trans-stenosis pressure gradient were obtained and compared.Results:MVP in the superior sagittal sinus, torcular, transverse sinus and sigmoid sinus showed no significant difference between patients under awake setting and general anesthesia ( P>0.05). Mean trans-stenosis pressure gradient in patients under awake setting ([22.784±7.606] mmHg) was significantly higher as compared with that in patients under general anesthesia ([18.388±8.992] mmHg, P<0.05). Conclusion:Mean trans-stenosis pressure gradient in patients under awake setting is higher as compared with that in patients under general anesthesia, and selection for venous sinus stent implantation should be decided by trans-stenosis pressure gradient in patients under awake setting.

Objective To evaluate the safety and efficacy of the use of Enterprise stent in the treatment of symptomatic intracranial atherosclerotic stenosis (sICAS) . Methods The clinical data of 27 patients with sICAS, who were treated with Enterprise stent implantation at First Affiliated Hospital of Zhengzhou University, China, during the period from January 2012 to December 2017, were retrospectively collected. The patient's basic parameters, characteristics of target lesions, technical success rate, perioperative safety and follow-up results were analyzed. Results A total of 27 patients (28 lesions in total) were enrolled in this study, and a total of 28 Enterprise stents were implanted. The preoperative mean stenosis degree of lesions was (75.7 ±6.7) ％, the postoperative residual stenosis degree was (23.2 ±16.6) ％. The technical success rate was 100％. Postoperative complication of perforating branch events occurred in 2 patients. No severe complications such as hemorrhage, artery dissection, in-stent thrombosis, hyper-perfusion syndrome, or cardiovascular events occurred. All patients were followed up for (10.8±9.1) months, and 3 instent restenosis lesions (≥50％) were detected although the patients had no target lesion-related symptoms, the incidence of in-stent restenosis was 10.7％. No newly-developed stroke caused by responsible blood vessel, bleeding events or death occurred. Conclusion For the treatment of sICAS, balloon dilatation followed by Enterprise stent implantation is technically feasible, and clinically safe and effective. The incidence of perioperative complications is low and the follow-up results are satisfactory. Further randomized controlled trials are still needed before its long-term efficacy is clarified.

Objective:To assess the impact of zero makeup policy for drug and medical supplies on hospitals. Methods:Descrip-tive statistics and comparative analysis were used to analyze the related indicators, profit and loss calculation and the cost of patients from April 2014 to March 2017.Results:After the policy was implemented, the number of outpatients and the number of outpatients choosing general doctors decreased. The average length of hospitalization was 8.88 days, and the proportion of drug consumption was 34.10%. The number of outpatients choosing medical experts, the number of inpatients and the proportion of surgical treatment in-creased. Although the policy benefited patients,the average medical expenditure still increased. There was policy loss in the hospital. Conclusion:The reform promotes the implementation of hierarchical medical system, optimizes the hospital income structure and re-duces drug proportion significantly,which achieves the original intentions of the policy to some extent.

Objective To discuss the establishment of cerebral venous sinus thrombosis (CVST) model in rabbits by local application of ferric chloride at sinuses sagittalis superior (SSS) combined with thrombin injection, and to evaluate its feasibility and application value. Methods A total of 39 New Zealand white rabbits were randomly and equally divided into three groups with 13 rabbits in each group, local application of cotton piece saturated with saline at SSS for 10 minutes was performed for the rabbits of group A, SSS local application of cotton piece saturated with 40％ ferric chloride for 10 minutes was adopted for the rabbits of group B, while SSS local application of cotton piece saturated with 40％ ferric chloride for 5 minutes together with injection of thrombin was carried out for the rabbits of group C. Whole cerebral DSA was performed immediately after modeling to judge if there was formation of thrombosis. Two days after the modeling, every 3 rabbits from each group were sacrificed to make 2, 3, 5-chloride triphenyl tetrazole (TTC) staining. Seven days after the modeling, the remaining 10 rabbits of each group were examined with DSA, the vascular recanalization rates were calculated, and the histopathological examination was made. Results In group B and group C, SSS thrombosis with surrounding cerebral infarction, edema, inflammatory cell aggregation and other pathological changes were observed. The 7-day vascular recanalization rate in group C was strikingly lower than that in group B (10％ vs 70％, P＜0.05). Surrounding cortical vein thrombus and subcortex petechial hemorrhages were obviously seen in group C. Conclusion For the establishment of CVST model in rabbits, local application of ferric chloride at SSS together with thrombin injection is effective and feasible. The thrombus thus induced is quite stable, and its pathogenesis and pathophysiology are quite similar to clinical manifestations. Therefore, this method can be used for basic research and clinical trials of CVST.

Objective To explore the efficacy and safety of venous sinus stenting in the treatment of refractory idiopathic intracranial hypertension (IIH) complicated with venous sinus stenosis. Methods We reviewed our clinical database for 18 patients with resistant or fulminant IIH and cerebral venous sinus stenosis,who underwent placement of venous sinus stents between January 2013 and December 2016. Patients were considered eligible for stenting based on the following criteria: (1) medically refractory IIH;(2)papilledema confirmed by an ophthalmologist;and(3)dural venous sinus stenosis of the dominant venous outflow system with a gradient of ≥10 mmHg(1 mmHg=0.133 kPa). Prior to intervention, diagnostic angiography and venous pressure measurements were performed. Clinical follow-up was available in all patients at 6 to 48 months after stenting.Angiography to evaluate stent patency and restenosis was performed at 6 months after intervention;Relevant clinical, demographic and radiographic data were extracted after review of these records. The paired t test was used to compare the changes before and after the operation. Results The mean lumbar CSF pressure was reduced from (385±72) mmH2O(1 mmH2O=0.009 8 kPa) to (201±24)mmH2O(t=13.02,P<0.05).The mean pressure gradient across the venous stenosis was reduced from(31.5±11.4)mmHg before the procedure to(2.5±2.1)mmHg(t=10.96,P<0.05).Headache in 13 cases,vision in 14 were resolved. Papilledema and pulsatile tinnitus resolved in all patients. There was no instances of restenosis among the 18 patients with follow-up imaging.Conclusion In patients with IIH and documented evidence of venous sinus stenosis with a high pressure gradient,venous sinus senting represents an effective treatment strategy.

Objective To analyze the etiology of cerebral ischemic complications occurring in perioperative period of interventional therapy for intracranial aneurysms,and to discuss its prevention and treatment.Methods From January 2011 to March 2015,a total of 1106 patients with intracranial aneurysms underwent interventional therapy at the First Affiliated Hospital of Zhengzhou University,China.Among the 1106 patients,48 patients developed cerebral ischemic complications;their clinical data and the imaging materials were retrospectively analyzed.The factors associated with complications,the effective therapeutic scheme and the clinical preventive methods were discussed.Three months after the treatment,the recovery of neurological function was assessed with modified Rankin Scale (mRS).Results The causes of ischemic complications were,in order of decreasing frequency,cerebral vasospasm/unable elimination of microemboli (n=19),thrombus (n=16),impaired blood flow of adjacent perforating or distal vascular branches caused by embolization (n=6),intra-procedural hypotension (n=4) and cerebral edema (n=3).Combined treatments,including integrated anticoagulation,anti-platelet aggregation,anti-vasospasm,medication of elevating blood pressure,endovascular intervention,etc.were adopted.The patients were followed up for 3 months.Thirty-four patients (70.8％) obtained a mRS of ≤2 (no serious sequelae),and mRS＞2 (poor prognosis) was seen in 14 patients (29.2％).Conclusion The etiology of cerebral ischemia occurring during interventional treatment of intracranial aneurysms is complicated.It is necessary to take useful measures such as individualized anticoagulation,anti-platelet aggregation,anti-vasospasm,etc.during perioperative period of interventional therapy.The procedure-related complications can be effectively treated with interventional therapy and reliably prevented by careful and skilled surgical manipulation.

Cerebral venous and sinus Thrombosis (CVST) is a rare ischemic cerebrovascular disease,the lesions of 60% patients are involved in multiple venous sinus,of which the superior sagittal sinus thrombosis is most common.The pathogenesis and pathophysiology of CVST has not yet been fully elucidated,and the establishment of stable and ideal animal models can provide a basis for the study of its development,prognosis and efficacy assessment.This article summarizes the characteristics and advantages of several available CVST models,but each method has its own limitations.Therefore,the establishment of a more ideal animal model will help to fully understand the pathogenesis and pathological process of CVST.