Predictors of Perioperative Complications During Leo Baby Stent Treatment for Acutely Ruptured Intracranial Aneurysms: A Retrospective Multicenter Study.

BACKGROUND AND OBJECTIVES: Stent-assisted coiling (SAC) of acutely ruptured aneurysms has been controversial. Moreover, for aneurysms originating from small diameter vessels, the SAC presents more challenges. This study aimed to investigate the predictors of perioperative complications after SAC with Leo baby stent of acutely ruptured aneurysms. METHODS: We performed a retrospective multicenter analysis of 425 patients with acutely ruptured aneurysms treated with Leo baby. We compared clinical characteristics and outcomes among patients with perioperative complications and those without. Subgroup analysis, including thromboembolic and hemorrhagic complications, was also performed. RESULTS: Immediate postoperative angiograms showed Raymond 1 in 357 aneurysms (84.2%), 2 in 53 (12.5%), and 3 in 14 (3.3%). A total of 372 patients (87.5%) were independent (modified Rankin Scale [mRS] score 0-2) at discharge. Perioperative complications occurred in 18 cases (4.2%) harboring 13 cases (3.1%) of thromboembolic complications and 5 cases (1.2%) of hemorrhagic complications. Patients with perioperative complications had a higher rate of unfavorable outcomes at discharge (P = .018), especially with thromboembolic complications (P = .043). Multivariate analysis showed that higher preoperative mRS score (P = .004), irregular shape (P = .017), and larger aneurysms (P = .049) were independent predictors of the overall complications, whereas higher preoperative mRS score (P = .022) was an independent predictor for ischemic complications. The follow-up angiogram was available for 245 patients, and the follow-up angiograms revealed Raymond 1 in 223 aneurysms (91.0%), 2 in 19 (7.8%), and 3 in 3 (1.2%). CONCLUSION: Worse clinical condition, irregular shape, and larger aneurysms were independently associated with overall complications, whereas worse clinical condition was viewed as an independent predictor for thromboembolic complications. Attention to these factors is essential for the safe treatment and prognosis of patients with acutely ruptured aneurysms.

Activation of BMP4-pSmad1/5 pathway impairs the function of VSMCs in intracranial aneurysms.

Intracranial aneurysms (IAs) are characterized by abnormal dilatation of the cerebral vessels. Vascular smooth muscle cells (VSMCs) are implicated in maintaining vascular homeostasis. Disordered VSMCs are one of the most common causes for occurrence and development of IAs. The bone morphogenetic protein 4 (BMP4) signalling pathway is involved in regulating cell proliferation, apoptosis, and differentiation. This study aimed to investigate the effects of BMP4 on VSMCs and its underlying mechanisms. BMP4 was upregulated in the VSMCs of IAs and caused apoptosis of VSMCs through Smad1/5 phosphorylation. In addition, BMP4 overexpression significantly promoted the proliferation and migration of VSMCs and induced a phenotypic transformation from contractile to inflammatory. Our findings facilitate further understanding of the occurrence and development of IAs and provide a potential therapeutic target.

Role of Circulating Exosomes in Cerebrovascular Diseases: A Comprehensive Review.

Exosomes are lipid bilayer vesicles that contain multiple macromolecules secreted by the parent cells and play a vital role in intercellular communication. In recent years, the function of exosomes in cerebrovascular diseases (CVDs) has been intensively studied. Herein, we briefly review the current understanding of exosomes in CVDs. We discuss their role in the pathophysiology of the diseases and the value of the exosomes for clinical applications as biomarkers and potential therapies.

Identification of Prognostic Signature of Necroptosis-Related lncRNAs and Molecular Subtypes in Glioma.

Background: In tumor progression and epigenetic regulation, long non-coding RNA (lncRNA) and necroptosis are crucial regulators. However, in glioma microenvironment, the role of necroptosis-related lncRNAs (NRLs) remains unknown. Method: In this study, the RNA-seq and clinical annotation of glioma patients were analyzed using the Cancer Genome Atlas (TCGA) and Chinese Glioma Genome Atlas (CGGA) databases. To investigate prognosis and tumor microenvironment of NRLs in gliomas, we conducted a prediction model based on the training cohort. The accuracy of the model was verified in the verification cohort. Results: A signature composed of 13 NRLs was identified, and all glioma patients were divided into two groups. We found that each group has unique survival outcomes, biological behaviors, and immune infiltrating status. The necroptosis-related lncRNA signature (NRLS) model was found to be an independent risk factor in multivariate Cox analysis. Immunosuppressive microenvironment was positively correlated with the high-risk group. Due to significantly different IC50 between risk groups, NRLS could be used as a guide for chemotherapeutic treatment. Further, the entire cohort was divided into two clusters depending on NRLs. Consensus clustering method and the risk scoring system were basically similar. Survival probability was higher in Cluster 2, while Cluster 1 has stronger immunologic infiltration. Conclusion: The predictive signature could be a prognostic factor independently and serve to detect the role of NRLs in glioma immunotherapy response.

Low profile visualized intraluminal support stent-assisted Hydrocoil embolization for acutely ruptured wide-necked intracranial aneurysms: A propensity score-matched cohort study.

PURPOSE: To compare the safety and efficacy of low profile visualized intraluminal support (LVIS) stent-assisted hydrogel coil embolization and LVIS stent-assisted bare platinum coil embolization for acutely ruptured wide-necked intracranial. METHODS: 89 patients who underwent LVIS stent-assisted hydrogel coil embolization (hydrogel coil group) and 145 patients who underwent LVIS stent-assisted bare platinum coil embolization (platinum coil group) were retrospectively reviewed after 1:2 propensity score matching (PSM). Procedure-related complications, clinical and angiographic follow-up outcomes were compared between the two groups. RESULTS: All baseline characteristics were equivalent between hydrogel coil group and platinum coil group after PSM. There were no statistical differences in immediate postoperative embolization results, clinical and angiographic follow-up outcomes between the two groups (P = 0.514, P = 0.323 and P = 0.949, respectively). Intraprocedural aneurysm rupture, intraprocedural thrombosis and postprocedural thrombosis occurred in 2 patients (2.2%, 2/89), 1 patient (1.1%, 1/89) and 1 patient (1.1%, 1/89) of the hydrogel coil group compared with 1 patient (0.7%, 1/145), 1 patient (0.7%, 1/145) and 2 patients (1.4%, 2/145) of the platinum coil group, respectively (P = 0.559, P = 1.000 and P = 1.000). Nevertheless, the rate of postprocedural aneurysm early rebleeding in the hydrogel coil group was significantly lower than that in the platinum coil group (0.0% vs 4.8%, P = 0.046). CONCLUSION: LVIS stent-assisted hydrogel coil embolization may reduce the risk of aneurysm early rebleeding compared with LVIS stent-assisted bare platinum coil embolization for the treatment of acutely ruptured wide-necked intracranial aneurysms, which implies that hydrogel coil may improve the safety of stent placement for ruptured intracranial aneurysms.

Effect of Proximal Parent Artery Stenosis on the Outcomes of Posterior Communicating Artery Aneurysms: A Preliminary Study Based on Case-Specific Hemodynamic Analysis.

OBJECTIVE: The objective of the study was to evaluate the effect of proximal parent artery stenosis on the hemodynamics of aneurysms in the internal carotid artery-posterior communicating artery (ICA-Pcom). METHODS: A retrospective study of 74 patients with aneurysms in the ICA-Pcom who underwent treatment at the Department of Neurosurgery of Changhai Hospital was conducted between January and June 2018. Patients with proximal parent artery stenosis were included. Case-specific three-dimensional images were reconstructed, and software-based simulations of different stenosis morphologies were performed, focusing on stenosis severity and the distance from the aneurysm to the stenosis. The wall shear stress (WSS) of the aneurysms and blood flow velocity of the aneurysm neck plane were calculated. We performed simulations to evaluate the outcomes of postballoon angioplasty by considering a virtual operation group. To further assess whether WSS after balloon angioplasty increases the risk of aneurysm rupture, a control group of ruptured ICA-Pcom aneurysms without parent artery stenosis was matched with the virtual operation group based on sex, age, history of hypertension, and aneurysm size. Thereafter, the normalized WSS of the 2 groups was calculated. RESULTS: Eight patients with parent artery stenosis were included (2 men and 6 women; average age: 64 ± 15 years). The patients were divided into eccentric and concentric stenosis groups according to the stenotic morphologies, with 4 patients in each group. In both groups, the average WSS of the aneurysm and average blood flow velocity at the neck plane increased with the severity of parent artery stenosis, whereas the WSS did not correlate with distance. In the concentric stenosis group, the average blood flow velocity generally decreased as the distance between stenosis and aneurysm increased; however, no such trend was observed in the eccentric stenosis group. The normalized WSS of aneurysms after virtual balloon angioplasty was higher than that of the ruptured aneurysms (0.599 [0.548, 0.800] vs. 0.367 [0.324, 0.407]; P = 0.007). CONCLUSIONS: Intensified severity of proximal stenosis increases the blood flow velocity and aneurysmal WSS, which may lead to the progression of ICA-Pcom aneurysms. Treatment of the stenosis can reduce the WSS of aneurysms; however, its effect on the prognosis of ICA-Pcom aneurysms requires more concrete evidence.

AKG Attenuates Cerebral Ischemia-Reperfusion Injury through c-Fos/IL-10/Stat3 Signaling Pathway.

Inflammation is dominant in the pathogenesis of ischemic stroke (IS). Alpha-ketoglutarate (AKG), according to previous studies, has demonstrated a variety of pharmacological effects such as antioxidation and inhibitive inflammation activities. However, whether AKG ameliorates cerebral ischemic injury, as well as the underlying molecular events, is still unclear. Therefore, the effect and underlying mechanisms of AKG on ischemic brain injury should be identified. The study established a cerebral ischemia-reperfusion (I/R) model in mice as well as an oxygen-glucose deprivation/reperfusion (OGD/R) model in SH-SY5Y cells, respectively. It was observed that AKG markedly suppressed infarction volume and neuronal injuries and improved the neurological score in vivo. Moreover, AKG reduced the inflammatory response and lowered the expression of proinflammatory cytokines. In vitro, AKG treatment strongly inhibited OGD/R-induced neuronal injury and the proinflammatory factors. It was also found that the increased SOD and GSH levels, as well as the lower ROS levels, showed that AKG reduced oxidative stress in OGD/R-treated SY-SY5Y cells. Mechanistically, AKG largely promoted IL-10 expression in ischemic brain injury and OGD/R-induced neuronal injury. Furthermore, IL-10 silencing neutralized the protective effect of AKG on inflammation. Notably, it was discovered that AKG could upregulate IL-10 expression by promoting the translocation of c-Fos from the cytoplasm to the nucleus. The results indicated that AKG demonstrated neuroprotection on cerebral ischemia while inhibiting inflammation through c-Fos/IL-10/stat3 pathway.

The 8-year single-center experience of telescoping flow diverter for complex intracranial aneurysms treatment.

OBJECTIVE: Treatment of complex intracranial aneurysms (IAs) is still a challenging thing and this study aims to summarize the experience of telescoping flow diverters (FDs) in treating complex intracranial aneurysms. METHOD: Between April 2013 to November 2020, 381 IA cases treated by flow diverters (FD) were retrieved from the database of 4988 IA cases, and finally 20 cases treated by telescoping FDs were enrolled for further analysis. RESULT: Among 20 patients, 15 patients (75.0%) received Tubridge telescoping while 5 patients (25.0%) received PED telescoping. The technical success rate was 100%. The immediate occlusion results were: 7 cases of OKM grade A (35.0%), 11 cases of OKM grade B (55.0%), and 2 cases of OKM grade C (10.0%). No perioperative complications occurred. The clinical follow-up was available in 20 patients (100%) and the follow-up time was 6-96 months. One patient developed massive infarction and the other 19 patients were range between 0 and 2. The angiographic follow-up was available in 17 patients (85%) and the follow-up time was 6-27 months. The occlusion results were: 1 case of OKM grade B (5.9%), 6 cases of OKM grade C (35, 0.3%), and 10 cases of OKM grade D (58.8%). 2 patients (11.8%) developed occlusion of the patent artery. CONCLUSION: Telescoping flow diverters showed low perioperative complications and high IA occlusion rate when treating complex intracranial aneurysms in follow-up time, which provides an alternative manner beyond conventional strategy for neurosurgeons.

Braided stents assisted coiling for endovascular management of posterior cerebral artery aneurysms: a preliminary mid-term experience.

PURPOSE: Posterior cerebral artery (PCA) aneurysms are rare. This study is to evaluate the preliminary experience of braided stents applied in PCA aneurysms treatment. METHODS: Angiographic and clinical data of 28 PCA patients treated with braided stents from July 2016 and September 2020 were retrospectively analyzed. RESULTS: A total of 28 PCA aneurysms were enrolled. 22 (78.6%) aneurysms were dissecting aneurysms, while 6 (21.4%) aneurysms were saccular aneurysms. Thirty-five braided stents were implanted with dual stents implanted in 7 cases. Immediate angiographic results show that Raymond class I was obtained in 13 patients (46.4%), Raymond class II was obtained in 4 patients (14.3%), and Raymond class III was obtained in 11 patients (39.3%). Perioperative hemorrhagic events occurred in 1 patient (3.6%). Twenty-four patients (85.7%) received angiographic follow-up, and the mean follow-up time was 11.2 ± 4.9 months. Two patients (8.3%) were confirmed with IA neck recurrence, and 3 patients (12.5%) were confirmed asymptomatic parent artery occlusion (PAO). The other 19 patients were confirmed promoted occlusion with 18 Raymond class I (75%) and 1 Raymond class II (4.2%). Twenty-seven patients (96.4%) received clinical follow-up, and the mean follow-up time was 32.2 ± 13.5 months. One patient (3.7%) confirmed the death event 2 weeks after discharge. The other 27 patients (96.3%) got favorable clinical outcomes with an mRS score of 0-2. CONCLUSIONS: Braided stent-assisted coiling with a high occlusion rate and relatively low complication rate provides an alternative strategy in treating PCA aneurysms. Long-term outcomes need further randomized study with larger case numbers.

Hsa_circ_0031608: A Potential Modulator of VSMC Phenotype in the Rupture of Intracranial Aneurysms.

Background and Purpose: Phenotypic modulation of vascular smooth muscle cells (VSMCs) plays an important role in the development of intracranial aneurysms (IAs). Growing evidence has demonstrated that circular RNAs (circRNAs) may serve as a potential modulator of VSMC phenotype in various vascular diseases. This study aimed to assess the potential function of circRNAs in the rupture of IAs and VSMC phenotypic modulation. Methods: Using surgically dissected human ruptured (n = 8) and unruptured (n = 8) IA lesions, differentially expressed circRNAs were screened by transcriptomic sequencing and verified using qRT-PCR. Based on the screened circRNA, we predicted and screened the combined miRNA and downstream mRNAs to construct circRNA-miRNA-mRNA networks. Further in vitro experiments were performed to investigate the relationship between the validated circRNA and the phenotypic switching of VSMCs. Results: We found 1,373 differentially expressed genes in ruptured versus unruptured aneurysms. The top five dysregulated circRNAs were selected for qRT-PCR validation. We found hsa_circ_0031608 was both highly expressed in ruptured IAs and pro-inflammatory transformation of VSMCs. Then, a regulatory circRNA-miRNA-mRNA with one circRNA node, six miRNA nodes, and 84 mRNA nodes was constructed. GO analysis and KEGG pathway enrichment analysis were performed on mRNAs in the network. Then, a PPI network was built based on these mRNAs and five hub genes were identified (FOXO3, DICER1, CCND2, IGF1R, and TNRC6B) by the cytoHubba plugin in Cytoscape software. In vitro, overexpression of hsa_circ_0031608 influenced the expression of VSMC phenotypic markers validated by qPCR and Western blotting. Furthermore, hsa_circ_0031608 promoted the migration and proliferation capacity of VSMCs. Conclusion: hsa_circ_0031608 regulated the phenotypic modulation of VSMCs and played an important role in the rupture of IAs. The specific mechanism should be further studied and confirmed.

Low-profile LEO baby stents using dual stenting technique in treating complex intracranial aneurysms located in small artery: Initial and mid-term outcome.

BACKGROUND: Endovascular treatment of complex intracranial aneurysms (IAs) was challenging. Our retrospective study aimed to assess the efficacy and safety of LEO Baby stents using the dual stenting technique for complex IAs. METHODS: Clinical and angiographic data of 15 IAs located in small arteries treated by LEO Baby stents in our neurosurgical center were retrospectively collected and analyzed between April 2019 to January 2021. RESULTS: 15 patients received dual stent-assisted coiling procedures and the stent configurations include 7 cases of T- configuration, 5 cases of parallel- configuration, 2 cases of Y- configuration, and 1case of X- configuration. 11 patients received dual stents deployment with only LEO Baby stents and 4 patients received LEO Baby stent combined with LVIS stent. Immediate postprocedural results showed Raymond I in 4 patients (26.7%), Raymond II in 5 patients (33.3%), and Raymond III in 6 patients (40.0%). One patient (6.7%) was confirmed with an ischemic complication during the procedure. All 15 patients (100%) received clinical follow-up ranging between 6 and 28 months. An mRS score of 0-2 was reached in all patients. 13 patients (86.7%) received angiographic clinical follow-up ranging between 6 and 20 months. The results revealed that Raymond I was achieved in 10 patients (76.9%) and Raymond II was achieved in 3 patients (23.1%). One patient (7.7%) in 6 months after the procedure was confirmed with asymptomatic in-stent stenosis. CONCLUSION: This preliminary study suggests that dual stents deployment of LEO Baby stents was a feasible strategy for the treatment of complex IAs located in the small arteries.

SDF-1α/CXCR4 Pathway Mediates Hemodynamics-Induced Formation of Intracranial Aneurysm by Modulating the Phenotypic Transformation of Vascular Smooth Muscle Cells.

The objective of this study is to explore the role of the SDF-1α/CXCR4 pathway in the development of intracranial aneurysm (IA) induced by hemodynamic forces. We collected 12 IA and six superficial temporal artery samples for high-throughput sequencing, hematoxylin and eosin staining, and immunohistochemistry to examine vascular remodeling and determine the expression of the components of the SDF-1α/CXCR4 pathway, structural proteins (α-SMA and calponin) of vascular smooth muscle cells (VSMCs), and inflammatory factors (MMP-2 and TNF-α). Computational fluid dynamics (CFD) was used for hemodynamic analysis. Mouse IA model and dynamic co-culture model were established to explore the mechanism through which the SDF-1α/CXCR4 pathway regulates the phenotypic transformation of VSMCs in vivo and in vitro. We detected a significant elevation of SDF-1α and CXCR4 in IA, which was accompanied by vascular remodeling in the aneurysm wall (i.e., the upregulation of inflammatory factors, MMP-2 and TNF-α, and the downregulation of contractile markers, α-SMA and calponin). In addition, hemodynamic analysis revealed that compared with unruptured aneurysms, ruptured aneurysms were associated with lower wall shear stress and higher MMP-2 expression. In vivo and in vitro experiments showed that abnormal hemodynamics could activate the SDF-1α/CXCR4, P38, and JNK signaling pathways to induce the phenotypic transformation of VSMCs, leading to IA formation. Hemodynamics can induce the phenotypic transformation of VSMCs and cause IA by activating the SDF-1α/CXCR4 signaling pathway.

Pharmacological inhibition of epidermal growth factor receptor attenuates intracranial aneurysm formation by modulating the phenotype of vascular smooth muscle cells.

AIM: To study the effect of pharmacological inhibition of epidermal growth factor receptor (EGFR) on intracranial aneurysm (IA) initiation. METHODS: Human IA samples were analyzed for the expression of p-EGFR and alpha smooth muscle actin (α-SMA) by immunofluorescence (IF). Rat models of IA were established to evaluate the ability of the EGFR inhibitor, erlotinib, to attenuate the incidence of IA. We analyzed anterior cerebral artery tissues by pathological and proteomic detection for the expression of p-EGFR and relevant proteins, and vessel casting was used to evaluate the incidence of aneurysms in each group. Rat vascular smooth muscle cells (VSMCs) and endothelial cells were extracted and used to establish an in vitro co-culture model in a flow chamber with or without erlotinib treatment. We determined p-EGFR and relevant protein expression in VSMCs by immunoblotting analysis. RESULTS: Epidermal growth factor receptor activation was found in human IA vessel walls and rat anterior cerebral artery walls. Treatment with erlotinib markedly attenuated the incidence of IA by inhibiting vascular remodeling and pro-inflammatory transformation of VSMC in rat IA vessel walls. Activation of EGFR in rat VSMCs and phenotypic modulation of rat VSMCs were correlated with the strength of shear stress in vitro, and treatment with erlotinib reduced phenotypic modulation of rat VSMCs. In vitro experiments also revealed that EGFR activation could be induced by TNF-α in human brain VSMCs. CONCLUSIONS: These results suggest that EGFR plays a critical role in the initiation of IA and that the EGFR inhibitor erlotinib protects rats from IA initiation by regulating phenotypic modulation of VSMCs.

Flow diversion for aneurysms beyond the circle of Willis: A preliminary experience.

OBJECTIVE: To evaluate the safety and efficacy of flow diversion (FDs) for the aneurysms beyond the circle of Willis. METHODS AND MATERIALS: We retrospectively reviewed the prospectively maintained database in our center and enrolled patients with aneurysms beyond the circle of Willis (defined as at or distal to the M1, A2, and P2 segments) that were treated with FDs. RESULTS: Between July 2017 to December 2020, 28 patients with 28 aneurysms met the inclusion criteria and were included in this study, with a median age of 50 years old (IQR, 36-63 years). Thirty FDs, including 5 Pipelines and 25 Tubridge FDs, were deployed. Perioperative complications were noticed in 2 patients (7.1%), while asymptomatic adverse events occurred in another three patients (10.7%). Delayed complications occurred in 3.6% of patients (1/28). All patients received clinical follow-up, with the mortality and long-term morbidity of 0 and 3.6% (1/28), respectively. Angiographic follow-up data were available for 26 patients (92.9%) with an interval of 10 ± 7 months (ranged 2-26 months). Sixteen patients (61.5%) showed complete or nearly complete occlusion of aneurysms (OKM grading scale D and C); 6 cases (23.1%) were revealed incomplete occlusion (OKM grading scale B), and 4 cases (15.4%) remained unchanged (OKM grading scale A). The existence of the perforators derived from aneurysms was associated with a lower occlusion rate (p = 0.032). CONCLUSION: Flow diversion is reliable in the treatment of distal aneurysms with a high technical success rate and low permanent disability rate. The presence of side branches derived from aneurysms was associated with a lower aneurysm occlusion rate.

Underlying mechanism of hemodynamics and intracranial aneurysm.

In modern society, subarachnoid hemorrhage, mostly caused by intracranial aneurysm rupture, is accompanied by high disability and mortality rate, which has become a major threat to human health. Till now, the etiology of intracranial aneurysm has not been entirely clarified. In recent years, more and more studies focus on the relationship between hemodynamics and intracranial aneurysm. Under the physiological condition, the mechanical force produced by the stable blood flow in the blood vessels keeps balance with the structure of the blood vessels. When the blood vessels are stimulated by the continuous abnormal blood flow, the functional structure of the blood vessels changes, which becomes the pathophysiological basis of the inflammation and atherosclerosis of the blood vessels and further promotes the occurrence and development of the intracranial aneurysm. This review will focus on the relationship between hemodynamics and intracranial aneurysms, will discuss the mechanism of occurrence and development of intracranial aneurysms, and will provide a new perspective for the research and treatment of intracranial aneurysms.

Treatment delay from aneurysmal subarachnoid hemorrhage to endovascular treatment: a high-volume hospital experience.

BACKGROUND: Early treatment for patients with aneurysmal subarachnoid hemorrhage (aSAH) could significantly reduce the risk of re-bleeding and improve clinical outcomes. We assessed the different time intervals from the initial hemorrhage, admission, and endovascular treatment and identified the risk factors contributing to delay. METHODS: Between February 2017 and December 2019, 422 consecutive aSAH patients treated in a high-volume hospital were collected and reviewed. Risk factors contributing to admission delay and treatment delay were analyzed with univariate and multivariate analysis. RESULTS: One hundred twenty-two (28.9%) were admitted to the high-volume hospital at the day of symptom onset and 386 (91.5%) were treated with endovascular management at the same day of admission. The multivariate analysis found that younger age (P = 0.022, OR = 0.981, 95% CI 0.964-0.997) and good Fisher score (P = 0.002, OR = 0.420, 95% CI 0.245-0.721) were independent risk factors of admission delay. None was found to be related with treatment delay. Multivariate analysis (OR (95% CI)) showed that higher age 1.027 (1.004-1.050), poorer Fisher score 3.496 (1.993-6.135), larger aneurysmal size 1.112 (1.017-1.216), and shorter interval between onset to admission 1.845 (1.018-3.344) were independent risk factors of poorer clinical outcome. CONCLUSION: Treatment delay was mainly caused by pre-hospital delay including delayed admission and delayed transfer. Our experience showed that cerebrovascular team could provide early treatment for aSAH patients. Younger age and good Fisher score were significantly related with admission delay. However, admission delay was further significantly correlated with better clinical outcome.

The biology of bone morphogenetic protein signaling pathway in cerebrovascular system.

Bone morphogenetic protein belongs to transcription growth factor superfamily ß; bone morphogenetic protein signal pathway regulates cell proliferation, differentiation, and apoptosis among different tissues. Cerebrovascular system supplies sufficient oxygen and blood into brain to maintain its normal function. The disorder of cerebrovascular system will result into serious cerebrovascular diseases, which is gradually becoming a major threat to human health in modern society. In recent decades, many studies have revealed the underlying biology and mechanism of bone morphogenetic protein signal pathway played in cerebrovascular system. This review will discuss the relationship between the two aspects, aiming to provide new perspective for non-invasive treatment and basic research of cerebrovascular diseases.

Endovascular treatment of symptomatic intracranial atherosclerotic stenosis with low profile visualized intraluminal support stent.

OBJECTIVE: Severe intracranial atherosclerotic stenosis has become one of the main causes resulting transient ischemic attack and stroke. This study aimed to evaluate the efficacy and safety of low profile visualized intraluminal support (LVIS) stent in treating symptomatic intracranial atherosclerotic stenosis. METHODS: Data of 31 patients with at least 70% stenosis treated with LVIS stent in our center were retrospectively collected between July 2017 and November 2020. Further evaluation of lesion characteristics, technical success rate, preoperative complication, clinical and angiographic follow-up outcome, delayed in-stent stenosis were conducted. RESULTS: Stent delivery and deployment were successfully achieved in all 31 patients (100%). 22 cases (71%) were located in anterior circulation and 9 cases (29%) were located in posterior circulation. The mean degree of stenosis lesion before stent deployment was 85.6 ±â€¯9.4%, while after stenting was 11.2 ±â€¯11.8%. One patient suffered from ischemic complication in stenting procedure, and timely delivery of rt-PA successfully recanalized the artery. Clinical follow-up was available in all 31patients (100%) with mean follow-up time 15.0 ±â€¯12.1(3-45) months. No patients experienced the recurrence of stroke or TIA or death after discharge. Angiographic follow-up was available in 21patients (67.7%) with mean follow-up time 11.43 ±â€¯6.8 (6-36) months. 19 patients (90.5%) were stable while 2 patients (9.5%) developed ISR in their last angiographic follow-up. The 2 patients received balloon angioplasty and reached satisfactory results after retreatment. CONCLUSION: This preliminary study suggests that LVIS stent deployment was a feasible approach in treating intracranial atherosclerotic stenosis with satisfactory procedure success rate, low complication rate and favorable long-term outcome.

Safety and efficacy of stent-assisted coiling for acutely ruptured wide-necked intracranial aneurysms: comparison of LVIS stents with laser-cut stents.

BACKGROUND: To compare the safety and efficacy of LVIS stent-assisted coiling with those of laser-cut stent-assisted coiling for the treatment of acutely ruptured wide-necked intracranial aneurysms. METHODS: Patients with acutely ruptured wide-necked intracranial aneurysms treated with LVIS stent-assisted coiling (LVIS stent group) and laser-cut stent-assisted coiling (laser-cut stent group) were retrospectively reviewed from January 2014 to December 2017. Propensity score matching was used to adjust for potential differences in age, sex, aneurysm location, aneurysm size, neck width, Hunt-Hess grade, and modified Fisher grade. Perioperative procedure-related complications and clinical and angiographic follow-up outcomes were compared. Univariate and multivariate analyses were performed to determine the associations between procedure-related complications and potential risk factors. RESULTS: A total of 142 patients who underwent LVIS stent-assisted coiling and 93 patients who underwent laser-cut stent-assisted coiling were enrolled after 1:2 propensity score matching. The angiographic follow-up outcomes showed that the LVIS stent group had a slightly higher complete occlusion rate and lower recurrence rate than the laser-cut stent group (92.7% vs 80.6%; 3.7% vs 9.7%, P = 0.078). The clinical outcomes at discharge and follow-up between the two groups demonstrated no significant differences (P = 0.495 and P = 0.875, respectively). The rates of intraprocedural thrombosis, postprocedural thrombosis, postoperative early rebleeding, and procedure-related death were 0.7% (1/142), 1.4% (2/142), 2.8% (4/142), and 2.1% (3/142) in the LVIS stent group, respectively, and 4.3% (4/93), 2.2% (2/93), 1.1% (1/93), and 3.2% (3/93) in the laser-cut stent group, respectively (P = 0.082, 0.649, 0.651, and 0.683). Nevertheless, the rates of overall procedure-related complications and intraprocedural rupture in the LVIS stent group were significantly lower than those in the laser-cut stent group (5.6% vs 14.0%, P = 0.028; 0.7% vs 6.5%, P = 0.016). Multivariate analysis showed that laser-cut stent-assisted coiling was an independent predictor for overall procedure-related complications (OR = 2.727, P = 0.037); a history of diabetes (OR = 7.275, P = 0.027) and other cerebrovascular diseases (OR = 8.083, P = 0.022) were independent predictors for ischemic complications, whereas none of the factors were predictors for hemorrhagic complications. CONCLUSIONS: Compared with laser-cut stent-assisted coiling, LVIS stent-assisted coiling for the treatment of acutely ruptured wide-necked intracranial aneurysms could reduce the rates of overall procedure-related complications and intraprocedural rupture.

Safety and Long-term Efficacy of Stent-assisted Coiling for the Treatment of Complex Posterior Cerebral Artery Aneurysms.

OBJECTIVE: To evaluate the safety and long-term efficacy of stent-assisted coiling for the treatment of complex posterior cerebral artery (PCA) aneurysms. METHODS: Angiographic and clinical data of 23 patients harboring 23 complex PCA aneurysms treated with stent-assisted coiling from March 2010 to March 2017 were retrospectively reviewed. RESULTS: In this study 8 (34.8%) aneurysms were located at the P1 segment, 7 (30.4%) at the junction of P1 and P2 segments (P1-2), and 8 (34.8%) at the P2 segment. The aneurysms were ruptured in 7 cases (30.4%). Thirteen were dissecting in nature, while the other 10 were classical saccular aneurysms. Of the patients, 5 (21.7%) had of history of recent head trauma, immediate angiographic results were Raymond class I in 5 (21.7%) cases, Raymond class II in 8 (34.8%), and Raymond class III in 10 (43.5%). Perioperative complications occurred in one case with occlusion of the PA due to acute in-stent thrombosis without any neurologic deficit at discharge. The last angiographic follow-up (mean 18.7 months) results demonstrated complete aneurysmal occlusion in 20 (87.0%) cases, PA occlusion in 1 (4.3%) and recurrence in 2 (8.7%). Of the two patients with aneurysm recurrence, one was treated by PA occlusion, and the other was treated with two overlapping stents. Clinical follow-up (mean 58.3 months) was available for all 23 patients, 22 (95.7%) patients had good neurologic outcomes (mRS score 0-2), and 1 (4.3%) patient died 7 months after the procedure for unknown reasons. CONCLUSION: Stent-assisted coiling for the treatment of complex PCA aneurysms is safe and durable with a relatively low rate of complication and a relatively high rate of complete occlusion at long-term follow-up and is a promising alternative strategy for the reconstruction of the PCA.