Long Non-coding RNA MALAT1/microRNA-143/VEGFA Signal Axis Modulates Vascular Endothelial Injury-Induced Intracranial Aneurysm.

The roles of some long non-coding RNAs (lncRNAs) in intracranial aneurysm (IA) have been investigated in many studies. The aim of this study is to elucidate the mechanism of lncRNA metastasis-associated lung adenocarcinoma transcript 1 (MALAT1)/microRNA-143 (miR-143)/vascular endothelial growth factor-A (VEGFA) signal axis in vascular endothelial injury-induced IA. MALAT1, miR-143, and VEGFA expression in IA tissues and normal arterial tissues were detected. Matrix metalloproteinase 9 (MMP-9) in tissues, von Willebrand factor (vWF) in serum and tissues, and endothelin-1 (ET-1) in serum were detected. The modeled IA rats were injected with silenced or overexpressed MALAT1 for detecting vascular endothelial injury. Vascular endothelial cells from patients with IA were abstracted and transfected with silenced or overexpressed MALAT1 to verify the impacts of MALAT1 on cell viability and apoptosis. The connections among MALAT1, miR-143, and VEGFA were verified by online prediction, luciferase activity, and RNA-pull down assays. Overexpression of MALAT1 and VEGFA and poor expression of miR-143 were found in IA tissues. Downregulation of MALAT1 inhibited blood pressure, the expression of ET-1, vWF, and MMP-9, as well as the apoptotic index of vascular endothelial cells of rats with IA. Downregulated MALAT1 inhibited apoptosis and promoted viability of vascular endothelial cells in IA. MALAT1 bound to miR-143 and miR-143 targeted VEGFA. This study suggests that MALAT1 elevates VEGFA expression through competitive binding to miR-143, thereby boosting apoptosis and attenuating viability of vascular endothelial cells in IA.

Endovascular treatment of irregular and complicated intracranial aneurysms with coils using double microcatheter technique.

Embolisation of irregular and complicated aneurysms is a great challenge for neuroradiologists. To overcome possible complications of endovascular treatment of these type of aneurysms, methods such as intracranial stents, balloon remodelling, and the double microcatheter technique have been developed. The aim of the study was to report our preliminary experience with endovascular treatment of irregular and complicated intracranial aneurysm with coils using double microcatheter technique, and evaluation of its feasibility and clinical advantages. In this retrospective study, 37 cases diagnosed with irregular and complicated intracranial aneurysms and treated using double microcatheter method from July, 2013 to May, 2015, were followed up for six months after discharge. All the aneurysms were successfully embolized using the double microcatheter technique. Immediate post-embolization angiography showed no residual contrast filling in 35 cases, and residual filling in 2 cases. At discharge, according to the modified Rankin Scale score, all the patients recovered without any complications or death. A follow-up of 24 cases with digital subtraction angiography for 6 months revealed no recanalization. In conclusion, the double microcatheter technique for irregular intracranial aneurysms is effective and simple with few complications.

The recovery time of traumatic carotid-cavernous fistula-induced oculomotor nerve paresis after endovascular treatment with detachable balloons.

PURPOSE: The recovery time of traumatic carotid-cavernous fistula-induced oculomotor nerve paresis (ONP) after endovascular embolization with detachable balloons has not yet been adequately evaluated. This study was performed to make a deep analysis of the factors, which affect the prognosis of ONP after endovascular treatment of traumatic carotid-cavernous fistula (TCCF). MATERIALS AND METHODS: We retrospectively evaluated the clinical characteristics and the outcome of oculomotor nerve function in a series of 98 consecutive patients with ONP due to traumatic carotid-cavernous fistula which were endovascular treated with detachable balloons. Univariate analysis was applied to test the association between the time of ONP recovery and clinical variables. RESULTS: Ninety-eight consecutive patients (62 males, 36 females, mean age 34.2±12.7years) having presented with ONP underwent endovascular treatment with detachable balloons were enrolled in this study. ONP was complete in 22 (22.4%) patients and partial in 76 (77.6%) patients. Ninety (91.8%) patients were successfully occluded by single-session endovascular embolization. Retreatments by transarterial routes had to be performed in 8 (8.2%) patients because of recurrent fistula having occurred within 4weeks after embolization. ONP was recovered completely in all the patients, among who 4 (4.1%) were treated with occlusion of internal carotid artery. Factors showing significant association with the recovery time of ONP were the location of the fistula (P=0.007), the degree of preoperative ONP (P=0.003), the number of detachable balloon used (P=0.000) and the length of ONP before endovascular treatment (P=0.000). CONCLUSION: Endovascular treatment of traumatic carotid-cavernous fistula-induced ONP with detachable balloons is a safe and effective method. The length of ONP before endovascular treatment, the location of the fistula, the degree of preoperative ONP, the number of detachable balloons used were the statistically significant predictors of the length of ONP complete recovery.

Surgical cannulation of the superior ophthalmic vein for the treatment of previously embolized cavernous sinus dural arteriovenous fistulas: serial studies and angiographic follow-up.

OBJECTIVE: The purpose of this study was to evaluate the safety and efficacy of transorbital puncture for the retreatment of previously embolized cavernous sinus dural arteriovenous fistulas (DAVFs) via a superior ophthalmic vein (SOV) approach. MATERIALS AND METHODS: During a 12-year period, 9 consecutive patients with previously embolized cavernous sinus DAVFs underwent retreatment via the transorbital SOV approach. RESULTS: All of the nine cases of previously embolized cavernous sinus DAVFs were successfully embolized. Clinical follow-ups were conducted in all nine cases at the duration of 17-141 months (61.22 ± 39.13 months). No recanalization occurred during the follow-up period. A subtle ptosis appeared in two patients and disappeared in one of the two cases after a 4-year follow-up. One patient suffered from paroxysmal positional vertigo and bruit for nearly 2 years after the treatment, but the follow-up angiography demonstrated no recurrence. One patient had persistent visual impairment caused by the initial venous stasis retinopathy. One patient with a history of a procedure-related transient decrease in visual acuity had it return to the normal level. The remaining four cases had clear improvement in the ocular symptoms and became completely asymptomatic during the follow-up period. No patient worsened or developed new symptoms. CONCLUSION: The approach of surgical cannulation of the SOV for the retreatment of previously embolized cavernous sinus DAVFs was proved feasible and efficient, especially when the transarterial and transfemoral venous approaches were inaccessible. However, if the SOV is not dilated enough or is located deeply in the orbit, transorbital venous puncture access may not be possible.

The effect of Neuroform stent-assisted coil embolization of wide-necked intracranial aneurysms and clinical factors on progressive aneurysm occlusion on angiographic follow-up.

Stent-assisted coil embolization is an endovascular treatment for wide-necked intracranial aneurysms, but the durability of this treatment is not well known. The aim of this study is to investigate the effect of the Neuroform stent (Boston Scientific/Target, Fremont, CA, USA) in progressive occlusion of wide-necked intracranial aneurysms, and to assess any correlation between clinical factors and angiographic follow-up results. The records of 52 patients treated with a Neuroform stent were retrieved for analysis of population characteristics, initial and follow-up angiographic results, and clinical outcomes. Initial angiographic results showed complete occlusion in 21 (40.4%), neck remnants in 22 (42.3%), and residual aneurysms in nine (17.3%). Angiographic follow-up was available in 45 of 52 (86.5%) patients: complete occlusion was achieved in 32 (71.1%), neck remnants were present in eight (17.8%) and residual aneurysms in five (11.1%). Of 31 patients with immediate incomplete obliteration, progressive complete occlusion was achieved in 16 of 28 (57.1%) patients. Clinical follow-up showed good outcomes according to the modified Rankin Scale score. A univariate analysis showed that there was no effect of the tested clinical variables of patient age (p=0.823), gender (p=0.419), aneurysm location (p=0.394), size (p=0.625) and rupture status (p=0.721) on aneurysm occlusion at follow-up. We conclude that the Neuroform stent-assisted neck remodelling technique improves progressive occlusion of wide-necked intracranial aneurysms with good clinical outcomes.

Recovery of posterior communicating artery aneurysm-induced oculomotor nerve paresis after endovascular treatment.

OBJECTIVE: Recovery of aneurysm-induced oculomotor nerve paresis (ONP) after endosaccular coiling has not yet been adequately assessed. The aim of this study was to investigate the factors that affect the outcome of ONP after endovascular treatment of posterior communicating artery (PcomA) aneurysms. MATERIALS AND METHODS: We retrospectively evaluated the clinical characteristics and the outcome of oculomotor nerve function in a series of 36 patients with ONP due to PcomA aneurysms treated by endovascular coiling. Univariate analysis was applied to test the association between ONP recovery and clinical variables. RESULTS: Thirty-six consecutive patients (20 women, 16 men; mean age, 54.3±9 years) presenting with ONP underwent endosaccular coiling were enrolled in this study. Subarachnoid hemorrhage was present in 21 patients. The mean size of the aneurysms was 9.3±3.9mm. ONP was complete in 14 patients (38.9%) and partial in 22 patients (61.1%) at admission. Seventeen patients (47.2%) had complete recovery of oculomotor nerve function, 15 had incomplete recovery (41.7%), and 4 (11.1%) remained unchanged after treatment. Factors showing significant association with recovery of oculomotor nerve function were the length and degree of ONP before treatment (P=0.035 and P=0.019, respectively). CONCLUSIONS: Endosaccular coiling of PcomA aneurysms in patients with ONP resulted in cure or improvement of oculomotor nerve dysfunction in the majority of patients. The length and degree of preoperative ONP were the statistically significant predictors of complete ONP recovery.

Impact of ultra-early coiling on clinical outcome after aneurysmal subarachnoid hemorrhage in elderly patients.

RATIONALE AND OBJECTIVES: The incidence of aneurysmal subarachnoid hemorrhage is increasing in the elderly as life expectancy increases. The purpose of this study was to analyze whether ultra-early coiling of ruptured intracranial aneurysms improves clinical outcomes in elderly patients. MATERIALS AND METHODS: Records of patients (aged ≥ 70 years) with aneurysmal subarachnoid hemorrhage treated with endovascular coiling were retrieved. Patients were classified into two groups: group A (patients coiled within 24 hours of subarachnoid hemorrhage) and group B (patients coiled ≥24 hours after subarachnoid hemorrhage). For each group, patient demographics, World Federation of Neurological Surgeons clinical grade, Fisher computed tomographic grade, aneurysm characteristics, and clinical outcomes were recorded. Outcomes were measured using the Modified Rankin Scale at 6 months. RESULTS: Fifty-six patients were coiled within 24 hours of subarachnoid hemorrhage (group A) and 40 patients at ≥24 hours after subarachnoid hemorrhage (group B). Groups A and B had similar clinical and angiographic characteristics. Clinical outcomes showed that a total of 87.5% of patient (49 of 56) in group A were independent (Modified Rankin Scale score 0-2) compared with 70.0% of patients (28 of 40) in group B (P = .034). In multivariate logistic regression analysis, ultra-early coiling (odds ratio, 3.860; 95% confidence interval, 1.125-13.249; P = .032) proved to be an independent predictor of better clinical outcome (Modified Rankin Scale score 0-2). CONCLUSIONS: Ultra-early (<24 hours after subarachnoid hemorrhage) coiling of ruptured aneurysms was marginally associated with improved clinical outcomes compared to coiling at ≥24 hours in elderly patients. Larger, prospective studies are required to adequately assess outcome differences between these two groups.