Flow Diverter Combined with Coil Embolization for Acutely Ruptured Intracranial Aneurysms: A Single Center Experience.

BACKGROUND: Extensive research has confirmed the safety and effectiveness of flow diverters in the treatment of unruptured intracranial aneurysms. However, their use in cases of acute rupture remains a subject of debate. METHODS: This study was conducted as a single-center retrospective investigation from January 2018 to January 2022 and included patients with acutely ruptured intracranial aneurysms (within three days of rupture) who were treated using the Pipeline Embolization Device with adjunctive coil embolization. Patient demographics, operative procedures, and outcomes were analyzed. Antiplatelet therapy included intra-arterial tirofiban and postoperative dual therapy with clopidogrel and aspirin. RESULTS: A total of 21 patients (5 males, 16 females) diagnosed with acutely ruptured intracranial aneurysms were included in this study. The aneurysm types included 7 blood blister-like aneurysms (30.0%), 3 dissecting (14.3%), and 1 fusiform aneurysm (4.8%). Perioperative complications occurred in 2 patients (9.5%), and both cases involved thrombogenesis. Nineteen patients completed digital subtraction angiography during follow-up, with an average follow-up time of 8.7 months (5 - 18 months). Results showed a complete embolization rate of 94.7% (18/19), with a partial aneurysm still present in 1 patient. A total of 90.4% (19/21) of patients had a favorable prognosis (modified Rankin Scale score = 0 - 2). CONCLUSIONS: The Pipeline Embolization Device with adjunctive coil embolization proved to be a viable option for managing acutely ruptured intracranial aneurysms, notwithstanding the potential for ischemic complications.

Retreatment with a pipeline embolization device for recanalized aneurysms following stent-assisted coiling embolization.

Background and purpose: Flow diverters have emerged as viable alternatives for the retreatment of recanalized aneurysms following stent-assisted coiling embolization. In this study, we aim to present our experience of retreatment for such aneurysms using the pipeline embolization device (PED). Materials and methods: This case series presents a retrospective single-center analysis of patients with recanalized aneurysms who underwent retreatment using the PED between July 2019 and April 2023, subsequent to stent-assisted coiling embolization. Results: The study includes five female patients, whose relevant clinical data were recorded. All patients had aneurysms located in the internal carotid artery, comprising two blood blister-like aneurysms and two giant aneurysms. Prior to the retreatment, two LVIS stents, two enterprise stents, and one solitaire stent were implanted. Among the five patients, one experienced a fatal post-operative subarachnoid hemorrhage, while two patients achieved complete embolization, and another patient achieved near-complete embolization during the last follow-up. Furthermore, one patient faced challenges during the placement of the PED and was unable to achieve successful deployment. We propose four overlapping relationships between a newly implanted PED and a previously deployed stent: (1) PED covering only the proximal end of the previous stent, (2) PED covering only the distal end of the previous stent, (3) PED covering both the proximal and distal ends of the previous stent, and (4) PED deployed within the previous stent. Antiplatelet therapy at our center involved daily dual therapy with aspirin (100 mg/day) and clopidogrel (75 mg/day) for at least 5 days before PED placement. Intra-arterial bolus administration of tirofiban (5 mcg/kg) was administered during or immediately after PED deployment, followed by a maintenance dose of 0.08 mcg/kg/min IV infusion for at least 24-48 h if necessary. Postprocedural dual antiplatelet therapy included clopidogrel (75 mg/day) for 6 months and aspirin (100 mg/day) for 12 months. Conclusion: The findings of this study support the efficacy of the PED for the retreatment of recanalized aneurysms following stent-assisted coiling embolization.

IER3 (IEX-1) dysregulation serves as a potential prognostic factor in acute myeloid leukemia patients.

INTRODUCTION: Immediate early response 3 (IER3) has association with hematological malignancies' risk and prognosis, such as myelodysplastic syndrome, while its relation to acute myeloid leukemia (AML) is not clear. This study aimed to explore the correlation of IER3 with AML risk, clinical characteristics, complete remission (CR), event-free survival (EFS), and overall survival (OS). METHODS: A total of 93 de novo AML patients were included in this study. In addition, 30 patients with non-hyperplasia hematologic malignancies requiring bone marrow testing (as disease controls) and 30 health donors (as health controls) were also recruited. Bone morrow samples of AML patients (before treatment), disease controls (before treatment), and health controls (at donation) were collected. IER3 in bone marrow mononuclear cells was detected by reverse transcription-quantitative polymerase chain reaction. RESULTS: IER3 was increased in AML patients compared with disease controls and health donors (both P < .001), and receiver operating characteristic (ROC) curve showed that IER3 had certain capability of distinguishing AML patients from disease controls (area under curve (AUC): 0.735, 95% confidence interval (CI): 0.650-0.820), and health donors (AUC: 0.789, 95% CI: 0.712-0.866). Meanwhile, IER3 was correlated with FLT3-ITD mutation (P = .030) and poor NCCN risk stratification (P = .031) in AML patients. Moreover, IER3 had negative association with CR in AML patients (P = .022), and showed certain potential in discriminating CR patients from non-CR patients (AUC: 0.655, 95% CI: 0.533-0.777). Besides, IER3 was negatively associated with EFS (P = .033), but not OS (P = .083) in AML patients. CONCLUSION: IER3 dysregulation serves as a potential prognostic factor in AML patients.