[Multiple factors related with intracranial hemorrhage of dural arteriovenous fistula: clinical analysis].

OBJECTIVE: To discuss the relevant predicative factors of dural arteriovenous fistula (dAVF) in intracranial hemorrhage. METHODS: A total of 144 consecutive patients with dAVFs were recruited for a retrospective analysis from 1996 to 2006. The relevant factors of gender, age, fistula flow rate, arterial supply, lesion and venous drainage pattern were analyzed to evaluate the outcome of intracranial hemorrhage. RESULTS: Univariate analysis showed that gender, lesion and venous drainage pattern were statistical significant for intracranial hemorrhage of DAVF (P < 0.05). However, only venous drainage pattern was significant in the predication of intracranial hemorrhage (P < 0.05). CONCLUSION: Only venous drainage pattern is significant in the predication of dural arteriovenous fistulas in intracranial hemorrhage. Both gender and lesion may be confounding factors.

Risk factors for repeated recurrence of cerebral aneurysms treated with endovascular embolization.

Purpose: To explore the risk factors of recurrence after second endovascular embolization of recurrent aneurysms and the characteristics of recurrent refractory aneurysms to help clinical decision-making. Materials and methods: Forty-nine patients with recurrent aneurysms who underwent repeated embolization were retrospectively enrolled and divided into the recurrent and non-recurrent group. The risk factors of recurrence, complications and follow-up results of repeated embolization, and characteristics of recurrent refractory aneurysms were analyzed. Results: Among the 49 patients with the second embolization, 5 were lost to follow-up, 9 recurred, and 35 did not. Univariate analysis showed that aneurysm size (P = 0.022), aneurysm classification (P = 0.014), and Raymond-Roy grade after the second embolization (P = 0.001) were statistically different between the two groups. Multivariate analysis demonstrated the Raymond-Roy grade as an independent risk factor for the recurrence of aneurysms after the second embolization (P = 0.042). The complication rate after the second embolization was 4%. There were five recurrent refractory aneurysms with an average aneurysm size of 23.17 ± 10.45 mm, including three giant aneurysms and two large aneurysms. To achieve complete or near-complete embolization of the recurrent refractory aneurysms, multiple treatment approaches were needed with multiple stents or flow diverting devices. Conclusion: Aneurysm occlusion status after the second embolization is an independent risk factor for the recurrence of intracranial aneurysms. Compared with near-complete occlusion, complete occlusion can significantly reduce the risk of recurrence after second embolization. In order to achieve complete or near-complete occlusion, recurrent refractory aneurysms need multiple treatments with the use of multiple stents or flow diverting devices.

[Three-dimensional numerical simulation and hemodynamic analysis of intracranial longitypical aneurysms].

OBJECTIVE: To establish a model of three-dimensional numerical simulation of intracranial longitypical aneurism and analyze the hemodynamic features thereof. METHODS: Ten patients with intracranial longitypical aneurism underwent surgical treatment. Intracranial vascular ultrasonography was conducted before operation. Intra-operatively three-dimensional angiography of the aneurysm was conducted and multifunctional physiological monitor was used to record the dynamic pressure and pressure wave form of the main branch parent artery. Matlab, Ansys, and Fluent software were used to simulate the blood flow of the longitypical aneurysms. RESULTS: The hemodynamic parameter levels were the highest at the inflow tract, followed by those at the outflow tract, and were the lowest at the top of aneurysm, for example, the blood flow velocity was (1.07+/-0.23) m/s, the dynamic pressure was (574+/-186) Pa, and the wall shear stress was (7.7+/-2.0) Pa at the inflow tract, all significantly higher than those at the top [(0.15+/-0.07) m/s, (37+/-13) Pa, and (0.40+/-0.13) Pa respectively, all P<0.05]. No eddy or just simple eddy occurred in the aneurysm. CONCLUSION: The dynamic pressure, velocity, and wall shear stress are the lowest at the top of longitypical aneurysm which may contribute to the rupture of aneurysm.

A complex cavernous sinus dural arteriovenous fistula secondary to covered stent placement for a traumatic carotid artery-cavernous sinus fistula: case report.

Authors present the case of a patient with a direct carotid artery-cavernous sinus fistula caused by head trauma in whom a self-expanding covered stent was successfully used to obliterate the fistula. However, at the 9-month follow-up an angiogram revealed a complex caroticocavernous fistula that was completely obliterated with Onyx 18 transarterially.

Transvenous embolization with a combination of detachable coils and Onyx for a complicated cavernous dural arteriovenous fistula.

BACKGROUND: Treatment of cavernous dural arteriovenous fistulas (DAVF) is usually made by a transarterial approach. However, in many complicated patients, treatments via transarterial approaches can not be achieved, and only an operation via a transvenous approach is feasible. We aimed to study the feasibility of transarterial embolization of cavernous dural arteriovenous fistulas with a combination detachable coils and Onyx to embolize a complicated cavernous DAVF via a transvenous approach. METHODS: From August 2006 to August 2007, six cases of complicated cavernous DAVF were embolized with a combination of detachable coils and Onyx via a transvenous approach. Three cases were male and the other three were female. Their ages ranged from 36 to 69 years old. The fistula was in the right lateral cavernous sinus in one case, in the left lateral cavernous sinus in another, and in the bilateral cavernous sinus in 4 cases. One fistula was fed by the right internal carotid artery and its meningohypophyseal trunk; one was fed by the branches of the left internal carotid artery and left external carotid artery; four were fed by the branches of the bilateral internal carotid artery and/or the bilateral external carotid artery. One case was drained via one lateral inferior petrosal sinus; three were drained via bilateral inferior petrosal sinuses; one was drained via one lateral ophthalmic and facial veins; one was drained via the inferior petrosal sinus and the ophthalmic and facial veins. Four were embolized via the inferior petrosal sinus, and two were embolized via the ophthalmic and facial veins. RESULTS: Among six cases of complicated cavernous DAVF, four were fully embolized with Onyx by a single operation, and two cases were fully embolized with Onyx following two operations. Transient headache was found after operation in all patients, but was cured after several days by the symptomatic treatments. In one case, the first operation via the inferior petrosal sinus was a failure; the feeding branches of the external carotid artery were embolized, and transient facial palsy was appeared after operation. The fistula was fully embolized with Onyx via the inferior petrosal sinus after two months with no complications. One bilateral cavernous sinus DAVF was embolized with Onyx via the inferior petrosal sinus by two operations, and transient abducens nerve palsy occurred after embolization. CONCLUSIONS: Because Onyx may be injected via a transvenous approach and the microcatheter is easily withdrawn, cavernous sinus via transvenous catheterization and embolization is a safe and efficient way to treat complicated cavernous dural arteriovenous fistulas, especially those for which operations via transarterial approaches have failed, or spontaneous cavernous dural arteriovenous fistulas.

Endovascular treatment of wide-necked intracranial aneurysms using of "remodeling technique" with the HyperForm balloon.

BACKGROUND: Aneurysms with wide-necked or a large neck/fundus ratio, especially located on an arterial bifurcation or a small artery, are challenges for interventional neuroradiologist because of the risk of coil migration or coil protrusion into the parent vessels. Our study was designed to improve the efficacy and safety of the "remodeling technique" with the HyperForm balloon for these difficult aneurysms and was confirmed by a follow-up result. METHODS: From June 2004 to September 2006, forty-two patients (20 men, 22 women) with wide-necked or large neck/fundus ratio aneurysms were treated by using the "remodeling technique" with the HyperForm balloon. RESULTS: Forty wide-necked aneurysms were successfully treated with the HyperForm balloon remodeling technique with only two failed cases. Final results consisted of total occlusion in 34 cases (80.9%), subtotal in 4 (9.5%) and incomplete in 2 (4.8%). One aneurysmal rupture occurred, but no clinical consequence was shown. No thromboembolic events were observed during treatment. Final angiographic follow-up time ranged from 3 to 18 months. CONCLUSIONS: The "remodeling technique" with the HyperForm balloon is a very useful tool in the treatment of wide-necked or unfavorable neck/fundus ratio intracranial aneurysms-located on an arterial bifurcation or a small artery and, especially, located on the bifurcation of a large artery and a small one. In our experience, this technique provided a safe and efficient treatment for difficult aneurysms when the standard remodeling technique might have failed.

Transvenous embolization of cavernous dural arteriovenous fistula: report of 28 cases.

BACKGROUND: Usually, cavernous dural arteriovenous fistula can be treated via transarterial approaches. However, in many complicated patients, transvenous approaches are superior to the transarterial ones because of the difficulties during a transarterial operation. In this study, we retrospectively analyzed the outcomes of 28 patients with cavernous dural arteriovenous fistula treated by transvenous embolization. METHODS: From September 2001 to December 2005, 28 patients with 31 cavernous dural arteriovenous fistulae were treated with transvenous embolization in Beijing Tiantan Hospital. The involved cavernous sinuses were catheterized via the femoral vein-inferior petrosal sinus approach or the femoral-facial-superior ophthalmic vein approach, and embolized with coils (GDC, EDC, Matrix, Orbit or free coil) or coils plus silk. The patients were followed up for 3 to 26 months. RESULTS: All the 31 cavernous sinuses in the 28 patients were successfully embolized. Complete angiographic obliteration of the fistulae was achieved immediately in 25 patients. Residual shunting was observed in the other 3, who had drainage through the pterygoid plexus (2 patients) or the inferior petrosal sinus (1) after the operation. Headache and vomiting were the most common symptoms after the embolization. In 3 patients, who achieved complete angiographic obliteration immediately, the left oculomotor nerve palsy remained unchanged after the operation. Transient abducens nerve palsy was encountered in 1. In 1 patient, the occular symptoms were improved after the operation, but recurred 4 days later, and then disappeared spontaneously after 5 days. During the follow-up, no patient had recurrence. Three months after the operation, angiography was performed on the 3 patients with residual shunting. Two of them had angiographic cure, the other had residual drainage through the pterygoid plexus. CONCLUSIONS: Transvenous catheterization and embolization of the cavernous sinus is a safe and efficient way to treat complicated cavernous dural arteriovenous fistulae. It is an alternative to the patients with spontaneous cavernous dural arteriovenous fistulae or those in whom transarterial embolization failed.

A novel arterial pouch model of saccular aneurysm by concomitant elastase and collagenase digestion.

BACKGROUND: An ideal aneurysm model of cerebral aneurysm is of great importance for studying the pathogenesis of the lesion and testing new techniques for diagnosis and treatment. Several models have been created in rabbits and are now widely used in experimental studies; however, every model has certain intrinsic limitations. Here we report the development of a novel saccular aneurysm model in rabbits using an arterial pouch that is subject to in vitro pre-digestion with combined elastase and collagenase. METHODS: A segment of right common carotid artery (CCA) was dissected out and treated with elastase (60 U/ml, 20 min) followed by type I collagenase (1 mg/ml, 15 min) in vitro. The graft was anastomosed to an arterial arch built with the left CCA and the remaining right CCA, while the other end of the graft was ligated. The dimension and tissue structure of the pouch were analysed immediately, 2 or 8 weeks after operation. FINDINGS: Ten terminal aneurysms were produced. The gross morphology of the aneurysm resembles the human cerebral terminal aneurysms. We have observed the following pathological changes: (1) growth of the aneurysm (mean diameter increased from (2.0+/-0.1) to (3.2+/-0.3) mm at 2 weeks, P<0.001, n=7-10); (2) thinning of the aneurysmal wall (the mean wall thickness decreased to 44% at 2 weeks), which was accompanied by significant losses of elastic fibres, collagen and the cellular component; and (3) spontaneous rupture (3 out of 9, one aneurysm ruptured 24 h after operation with the other two at 2 and 4 weeks respectively). CONCLUSION: This rabbit arterial pouch model mimics human cerebral aneurysms in relation to morphology and histology. In particular, this model exhibited an increased tendency of spontaneous rupture.

[Treatment of chronic and painful vertebral compressive fractures with vertebroplasty in senior patients].

OBJECTIVE: To evaluate the efficiency of treatment of chronic and painful compressive fractures of vertebral bodies with vertebroplasty in senior patients. METHODS: 98 patients of chronic and painful compressive fractures of vertebral bodies suffering from severely back pain and activity of daily living, 33 males and 65 females, aged 71 +/- 12, with the average medical history of 12 months, underwent vertebroplasty. Follow-up was conducted for 3 - 40 months. Six-point Behavioral Rating Scale and Activity of Daily Living (ADL) Scale were used to evaluate the efficacy. RESULTS: 123 affected compressive vertebral bodies in the 98 cases were treated with vertebroplasty. After 3.5 - 7 ml of bone cement was injected into the lesions, complete relief was got in 20 cases, obvious relief was achieved in 59 cases, improvement was made in 14 cases, and no progress was seen in 5 case. The score of 6-point Behavioral Rating Scale decreased from 4.2 +/- 1.1 before vertebroplasty to 1.2 +/- 0.9 (P < 0.01). The ADL score decreased from 4.2 +/- 1.1 before vertebroplasty to 1.9 +/- 0.6 (P < 0.01). CONCLUSION: Vertebroplasty significantly improves the painful symptoms and ability of daily life in senior patients with chronic painful vertebral compressive fractures.

[Endovascular stent implantation in treatment of intracranial wide-necked aneurysms].

OBJECTIVE: To evaluate the effectiveness and feasibility of treatment of intracranial wide-necked aneurysms with a new technique of Neuroform self-expanding stent combined with detachable coil. METHODS: A retrospective analysis of thirty patients with intracranial wide-necked aneurysms, 14 males and 16 females, aged 48 (18-68), wide-necked aneurysms, underwent occlusion of aneurysms using Neuroform self-expanding stent combined with detachable coil. RESULTS: 21 of the 30 aneurysms were completely occluded (70%) and 9 of the 30 aneurysms were incompletely occluded (30%) after initial coils embolization. Thromboembolic events were found in one case and migration of stent in two cases. Clinical follow-up performed in 29 patients showed that only one patient had permanent mild hemi-paralysis. Twenty-one patients were followed up for 6-12 months, 7 of which needed second treatment and 4 of which showed complete occlusion. CONCLUSION: A flexible device, Neuroform self-expanding stent can be safely maneuvered through tortuous intracranial vessels, enabling the endovascular treatment of complex wide-necked aneurysms. The new technique of Neuroform stent combined with detachable coil increases the early outcome of intracranial wide-necked aneurysm.

[Endovascular treatment of posterior cerebral artery aneurysm: analysis of 21 patients].

OBJECTIVE: To investigate the effect of endovascular treatment on posterior cerebral artery (PCA) aneurysm. METHODS: The clinical data of 21 patients with PCA aneurysm, 12 males and 9 females, aged 3 - 60, totally 22 aneurysms, 3 located in the P1 segment, 16 (in 15 patients) on the P2 segment, and 3 being serpentine aneurysms and involving P2-3 segment, were analyzed. One patients gave up treatment, 6 patients, with 7 aneurysms, underwent aneurysm sac occlusion, and 14 patients underwent parent vessel occlusion. RESULTS: Complete aneurysm sac occlusion was achieved in 5 patients with 6 aneurysms, and incomplete occlusion was achieved in 1 patient who died of bleeding of aneurysm the next day after the operation. All 14 patients undergoing parent vessel occlusion survived without aneurysm detected by angiography, among which 3 presented hemianesthesia of the contralateral side and 2 recovered completely. CONCLUSION: Endovascular treatment is safe and effective for PCA aneurysm.

[Transvenous embolization in treatment of refractory carotid-cavernous sinus fistula].

OBJECTIVE: To investigate the effects of transvenous embolization in treatment of refractory carotid-cavernous sinus fistula (CCF). METHODS: Twenty-five patients of refractory CCF with 28 foci underwent transvenous embolization, femoral vein-inferior petrosal sinus approach was used in 12 of which, and femoral vein-facial vein-superior ophthalmic vein approach was used in 12 of which. The embolizing materials included controllable coils (GDC, EDC), free coil, and silk. Three to twenty-four months after the treatment angiography was conducted on 10 patients and telephone follow-up was conducted on the other 15 patients. RESULTS: Immediate complete angiographic obliteration of the fistula was achieved in 20 patients. Residual shunting was left in 5 patients, 2 with pterygoid drainage and 3 with inferior petrosal sinus drainage. Headache and vomiting were the common symptoms after embolization. The angiography during follow-up showed that there were residual shunting in 4 patients, residual inferior petrosal drainage in 1 patient, and residual pterygoid drainage in 1 patient, and that no reoccurrence was found in the 6 patients with complete angiographic obliteration. The patients undergoing telephone follow-up reported that they had not any symptom. CONCLUSION: Safe and effective, transvenous embolization can be the first choice after the failure in treatment of the carotid-cavernous sinus fistula.

[Evaluation of oxidative stress in experimental rabbit aneurysms].

OBJECTIVE: To evaluate the roles of oxidative stress in the generation and development of aneurysms. METHODS: Five terminal aneurysms and 8 lateral aneurysms were rebuilt on rabbits, and 6 normal artery vessels were prepared as control. The levels of malondialdehyde (MDA), superoxide dismutase (SOD), and anti-reactive oxygen species unit (anti-ROS unit) were measured with chemical methods. RESULTS: The levels of MDA in terminal and lateral aneurysms were (33.85 +/- 8.66) and (27.87 +/- 5.78) nmol/mg prot, respectively, which were significantly higher than (10.91 +/- 2.72) nmol/mg prot in control group (P < 0.01). The levels of SOD in terminal and lateral aneurysms were (28.30 +/- 3.58) and (33.00 +/- 8.09) U/mg prot, respectively, which were significantly lower than (127.27 +/- 38.72) U/mg prot in control group (P < 0.01). The levels of anti-ROS unit in terminal and lateral aneurysms were (47.86 +/- 5.00) and (62.64 +/- 13.87) U/ mg prot, respectively, which were significantly lower than (116.94 +/- 9.22) U/mg prot in control group (P < 0.01). No significant differences were shown between terminal aneurysm and lateral aneurysm in MDA and SOD except anti-ROS unit (P = 0.014). MDA had negative correlations with both SOD and anti-ROS unit, and the correlation coefficients were -0. 830 and -0. 852, respectively. CONCLUSION: Oxidative stress may play an important role in the development of aneurysms. Oxidative stress seems similar among various aneurysms.

Endovascular treatment of cerebral arteriovenous malformations with Onyx embolization.

BACKGROUND: In the past 5 years, new treatment materials and techniques offering a different concept in endovascular treatment have been described for cerebral arteriovenous malformations (CAVMs). The aim of this study was to assess the endovascular treatment of CAVMs by using a liquid embolic material, Onyx (Micro Therapeutics. Inc., Irvine, CA, USA). METHODS: From September 2003 to September 2004, Onyx was used to treat 22 patients with CAVMs. Ten AVMS were located in functional areas, 8 in deep cerebral areas, and 4 in the cerebellar hemisphere. The size of CAVMs was about 3 cm in diameter in 5 patients, 3-6 cm in 11, and more than 6 cm in 6. RESULTS: In the 22 patients, Onyx embolization was successful. Nidus occlusion was complete in 3 patients, > 90% in 8, > 80% and < 90% in 6, and > 50% and < 80% in 5. Complications included transient neurological deficits in 2 patients, and adherence of microcatheter to the site of injection in 2. CONCLUSIONS: Being non-adhesiveness, Onyx is a safe and satisfactory embolic material in the treatment of CAVMs. But its long-term efficacy awaits further follow-up.

[A grading scale for endovascular treatment of intracranial aneurysms].

OBJECTIVE: To investigate the factors influencing the embolizing plan and result of intracranial aneurysms, and to establish a new grading scale for endovascular treatment of intracranial aneurysms. METHODS: The clinical data of 156 aneurysms in 151 patients, 67 males and 84 females, aged 4-80, were prospectively collected to analyze the influences of sex, age, aneurysmal DSA manifestation (including location, shape, longest diameter, neck width and sac-neck ratio) and whether or not embolizing in acute phase on the therapeutic alternatives and immediate embolizing results. RESULTS: Logistic regression analyses showed that aneurysmal location (OR = 3.734, P = 0.018), neck width (OR = 16.279, P = 0.000) and sac-neck ratio (OR = 4.090, P = 0.003) were predictive factors of the therapeutic alternatives, and the longest diameter (OR = 2.725, P = 0.024), neck width (OR = 2.600, P = 0.033) and sac-neck ratio (OR = 3.144, P = 0.003) were predictive factors of the embolizing results. Aneurysmal location (0 for internal carotid system, and 1 for vertebro-basilar system), the longest diameter (0 for < 8 mm, and 1 for > or = 8 mm), neck width (0 for < 4 mm, and 1 for > or = 4 mm or without neck) and sac-neck ratio (0 for > 1.2, and 1 for < or = 1.2 or without neck) were regarded as grading items to establish the intracranial aneurysm endovascular scale (IAES), which ranked the intracranial aneurysms into four grades. The zero and first grades were ordinary aneurysms, and the second to fourth grades were complicated aneurysms. CONCLUSION: IAES helps the clinicians to determine the individualized embolizing plan and predict the embolizing effect.

[Transvenous occlusion of carotid cavernous fistula].

OBJECTIVE: To evaluate the treatment of carotid cavernous fistula with the transvenous approaches. METHODS: Seventeen patients (14 males and 3 males) with carotid cavernous fistula (CCF) were retrospectively analyzed. RESULTS: Totally 18 cavernous sinus of 17 patients were occluded. Nine operations were performed via inferior petrosal sinus approaches and 6 via the facial vein. One patient (bilateral fistula) received both two approaches. The fistula were completely occluded immediately after the procedures in 12 patients. Small shunts remained in four of other patients (2 pterygoid drainage and 2 inferior petrosal sinus, respectively). Facial vein catheterization failed because of vein vasospasm in one patient; his symptoms relieved 5 days later and angiography showed the CCF disappeared another 2 days later. CONCLUSION: Transvenous embolization of CCF is effective, safe, and easy to perform.

[Treatment of severe vertebral compressive fractures in the elderly with percutaneous vertebroplasty].

OBJECTIVE: To evaluate the efficacy of treating severe and chronic vertebral compressive fractures in the elderly with percutaneous vertebroplasty. METHODS: Sixteen patients who suffered from severe back pain and whose daily living was badly affected were retrospectively reviewed. The average age was 72.5 years, the average disease history was 19 months, and the average compressive rate of the affected vertebral bodies was 74.1%. RESULTS: Nineteen affected compressive vertebral bodies in 16 cases were treated with percutaneous vertebroplasty. All the procedures were successful without any complication. After 3.5-7 ml of cement was injected into the lesions, complete relief was achieved in 3 cases, remarkable relief was achieved in 11 cases, and improvement was observed in 2 cases. The scores of 6-point Behavioral Rating Scale and Activity of Daily Living (ADL) declined significantly after the treatment (P < 0.001). CONCLUSION: Percutaneous vertebroplasty can significantly improve the symptoms and quality of life in the elderly patients with severe and chronic vertebral compressive fractures.

Endovascular Treatment of the Huge Dissecting Aneurysms Involving the Basilar Artery by the Internal Trapping Technique: Technical Note.

BACKGROUND: The endovascular strategy of the huge dissecting aneurysms involving the basilar artery (BA) is controversial and challenging. This study was to investigate the clinical and angiographic outcomes of the treatment of the huge dissecting aneurysms involving the BA by the internal trapping (IT) technique. METHODS: We retrospectively studied 15 patients with the huge dissecting aneurysms involving the BA treated by the IT technique between September 2005 and September 2014 in Department of Interventional Neuroradiology of Beijing Tiantan Hospital. Clinical and angiographic data were reviewed and evaluated. RESULTS: All patients were treated by the IT technique. That meant the dissecting artery and aneurysm segments were completed occlusion. After the procedure, the angiography demonstrated that all the dissecting artery and aneurysm segments were completed occlusion. Follow-up angiography was performed at 3-6 months or 12-18 months after the endovascular treatment (median 8 months), 14 patients had a good recovery. Re-canalization occurred in one patient whose aneurysm involved in bilateral vertebral arteries and the two third of the middle-lower BA. After the second treatment, the patient died by the ventricular tachycardia. CONCLUSIONS: The IT technique is a technically feasible and safe alternative for the treatment of BA dissecting aneurysms, but it is not necessarily the safest or most definitive treatment modality. The ideal treatment of the huge dissecting aneurysms involving the BA remains debatable and must be investigated on a case-by-case basis.

Neuronic autophagy contributes to p-connexin 43 degradation in hippocampal astrocytes following traumatic brain injury in rats.

Connexins, gap junction proteins, have short half­lives of only a few hours; therefore, degradation of these proteins can rapidly modulate their function. Autophagy is a type of degradation pathway that has been implicated in several diseases and was reported to be induced following traumatic brain injury (TBI). The aim of the present study was to investigate the involvement of neuronic autophagy in proteolysis of phosphorylated connexin 43 (p­Cx43) in hippocampal astrocytes following TBI in rats. Western blot analysis and immunofluorescence showed a TBI­induced increase in levels of astrocytic p­Cx43 following treatment with 3­methyladenine, an inhibitor of autophagy, in the hippocampus. Internalized gap junctions were observed in the neuronic cytoplasm using transmission electron microscopy. These results demonstrated that neuronic autophagy may regulate cellular levels of p­Cx43 in hippocampal astrocytes following TBI. This therefore indicated that the persistence of p­Cx43 accumulation was due to insufficient degradation capacity of constitutive autophagy.

[Embolization of intracranial aneurysms with new mechanically detachable coils].

OBJECTIVE: To primarily embolize intracranial aneurysms with new-developed mechanically detachable coils, which is called Detachable Coil System (DCS). METHODS: Five intracranial aneurysms were embolized with DCS, in which 2 were giant aneurysms. DCS with J coils were initially used to make baskets in giant aneurysms, and then other kinds of coils were utilized to pact the aneurysmal cavity. Whereas, spiral coils were mostly used in smaller aneurysms. Coils of DCS were detached by rotating the delivering wire after the coils were satisfactorily positioned in aneurysms. RESULTS: Two of the 5 cases were totally occluded with DCS. Two was sub-totally embolized. Pushing, withdrawal, and adjusting of DCS were safe and efficient. Detachment of DCS was fast. In one case of wide-necked giant aneurysm, coils could not stay inside the aneurysm, which was treated by occlusion of the parent artery. CONCLUSIONS: DCS is a new addition to the interventional radiologist's armamentarium. Detachment is faster. J coils are suitable for giant aneurysms for its unique way of coiling. But more evaluation depends on accumulation of the clinical usage.