A single-center experience in the endovascular treatment of carotid siphon aneurysms using the Willis covered stent: a retrospective analysis.

OBJECTIVE: To report the clinical results and initial clinical experience of endovascular isolation with the Willis covered stent for carotid siphon aneurysms. METHODS: Between November 2013 and December 2016, a total of 57 patients who presented with carotid siphon aneurysms were treated with the Willis covered stent. Results of the procedures, technical events, and complications were recorded. Clinical and imaging follow-ups were performed at 3 months following the endovascular procedures. RESULTS: Placement of the Willis covered stent was successful in all patients. Immediate angiography revealed complete exclusion of aneurysms in 48 patients (84%), while endoleak occurred in nine patients (16%). Procedure-related complications occurred in three cases, including displacement of the covered stent in one patient, acute in-stent thrombosis in one patient, and microwire-related intracranial hemorrhage in one patient. Angiographic follow-ups were done in 49 patients, with complete exclusion of aneurysms in 47 patients. Endoleak was present in two patients. No aneurysm recurrence occurred. Forty-four patients showed good parent artery patency, while the other five patients showed mild to moderate asymptomatic in-stent stenosis. During the follow-up period, no ischemic or hemorrhagic event occurred. The modified Rankin Scale scores at follow-up were 0-2 in 56 patients and >2 in one patient. CONCLUSIONS: The treatment of siphon aneurysms with Willis covered stent implantation resulted in satisfactory clinical outcomes. The Willis covered stent seems safe and feasible for the treatment of siphon aneurysms, which still needs to be confirmed by longer follow-up periods and controlled studies with larger samples.

Endovascular isolation of intracranial blood blister-like aneurysms with Willis covered stent.

OBJECTIVE: Intracranial blood blister-like aneurysm (BBA) is a rare type of aneurysm that lacks all layers of the arterial wall. These fragile aneurysms have the propensity to rupture with minimal manipulation, which makes them hazardous and difficult to treat. The present study evaluated the safety and feasibility of endovascular treatment of BBAs with the Willis covered stent. MATERIALS: Thirteen patients (7 men and 6 women, age range 28-68 years) who presented with ruptured BBAs and were treated with the Willis covered stent were retrospectively reviewed. Results of the procedures and treatment-related complications were recorded. Angiographic and clinical follow-ups were performed 4-6 months after the procedure. RESULTS: Placement of the covered stent was successful in all patients. Immediate angiography showed complete aneurysm occlusion in 12 patients while one patient showed a mild endoleak. This high rate of aneurysm exclusion ensured the security of postoperative antiplatelet treatment. Occlusion of the ophthalmic artery occurred in two patients and occlusion of the anterior choroidal artery occurred in one patient; however, none of them showed acute or delayed clinical symptoms. Thrombosis, aneurysm rupture, and other complications did not develop in any case. Angiographic follow-up showed complete aneurysm exclusion without aneurysm recurrence in any patients. Only two patients showed asymptomatic mild to moderate in-stent stenosis. All patients had satisfactory clinical outcomes (modified Rankin Scale score ≤1). CONCLUSIONS: Willis covered stent implementation may be safe and feasible for BBAs. This strategy might be a promising option for this high-risk type of aneurysm.

Polyoxometalate-based nickel clusters as visible light-driven water oxidation catalysts.

Three new polyoxometalate(POM)-based polynuclear nickel clusters, Na24[Ni12(OH)9(CO3)3(PO4)(SiW9O34)3]·56H2O (1), Na25[Ni13(H2O)3(OH)9(PO4)4(SiW9O34)3]·50H2O (2), and Na50[Ni25(H2O)2OH)18(CO3)2(PO4)6(SiW9O34)6]·85H2O (3) were synthesized and structurally characterized. Compounds 1-3 contain {Ni12}, {Ni13} and {Ni25} core, respectively, connected by the inorganic {OH}, {PO4} and/or {CO3} linkers and encapsulated by the lacunary A-α-{SiW9O34} POM units. Compound 3 represents the currently largest POM-based Ni clusters. All three compounds contain {Ni3O3} quasi-cubane or {Ni4O4} cubane units, which are similar to the natural oxygen-evolving center {Mn4O5Ca} in photosystem II (PSII). Visible light-driven water oxidation experiments with compounds 1-3 as the homogeneous catalysts indicate that all three compounds show good photocatalytic activities. The O2 evolution amount corresponds to a high TON of 128.2 for 1, 147.6 for 2, and 204.5 for 3, respectively. Multiple experiments including dynamic light-scattering, UV-vis absorption, catalysts aged experiments, tetra-n-heptylammonium nitrate (THpANO3) toluene extraction, and capillary electrophoretic measurements results confirm that compounds 1-3 are dominant active catalysts but not Ni(2+) ions(aq) or nickel oxide under the photocatalytic conditions. The above research results indicate a new and all-inorganic polynuclear Ni-based structural model as the visible light-driven water oxidation catalysts.

Arterial wall degeneration plus hemodynamic insult cause arterial wall remodeling and nascent aneurysm formation at specific sites in dogs.

To determine whether arterial wall degeneration, in combination with hemodynamic insult, causes cerebral artery aneurysms in a dog model, we simulated the geometry and hemodynamics of a human artery by surgical reconstruction of both common carotid arteries in 12 dogs. The dogs were then randomly assigned to one of the following groups: hemodynamic insult + elastase insult group ( n = 6), hemodynamic insult group (n = 6), or elastase control group (n = 3), in which the straight common carotid arteries were subjected to elastase alone. Angiography and hemodynamic analysis were performed immediately and at 12 weeks after surgery; the animals were then killed for histologic evaluation. The 12 surgically reconstructed distal internal carotid arteries simulated the human artery well with respect to geometric and hemodynamic measurements, with the intended aneurysm sites exposed to higher wall shear stress and velocity, lower pressure, turbulent flow, and changes in wall shear stress gradient. Nascent aneurysms developed in 4 hemodynamic insult + elastase insult group dogs at 12 weeks; blood flow analysis demonstrated decreased wall shear stress, increased pressure, and wall shear stress gradient from the neck to the dome. Arterial wall remodeling or nascent aneurysm formation in the hemodynamic insult + elastase insult group versus the other groups was indicated by internal elastic lamina/elastic fiber disruption, muscular layer thinning, increased smooth muscle cell proliferation, macrophage infiltration, and high expression of matrix metalloproteinase-2 and matrix metalloproteinase-9 in the media. These data suggest that nascent aneurysms were caused by the combination of arterial wall degeneration and hemodynamic perturbations in this distal internal carotid artery dog model.

Frequency and predictors of endoleaks and long-term patency after covered stent placement for the treatment of intracranial aneurysms: a prospective, non-randomised multicentre experience.

OBJECTIVE: We investigated immediate/late endoleaks and long-term patency following stent-graft placement for treatment of intracranial aneurysms located within the distal internal carotid artery (ICA) or vertebral artery (VA). METHODS: Forty-five aneurysms in 41 patients receiving covered stents in three centres were followed. Outcome measures included aneurysm occlusion rate, endoleaks, late in-stent stenosis rate, clinical improvement, neurological deficiencies and death. RESULTS: Total aneurysm exclusion was achieved in 69.2% (n = 27), with 30.8% (n = 12) experiencing immediate residual endoleaks. Angiographic follow-up (mean 43.5 ± 14.3 months) revealed that 87.2% (n = 34) were completely occluded with only 12.8% (n = 5) showing residual endoleaks. Predictors of immediate endoleaks in our patient group were stent number (P = 0.023) and stent diameter (P = 0.022), while predictors of late endoleaks in our patient group were stent diameter (P = 0.035) and stent angulation (P = 0.021). Late in-stent stenosis rates were 18.0 ± 13.3 and 29.0 ± 18.5% compared with the period immediately following implantation at 2- and 6-year follow-ups respectively. Smoking (P = 0.017) and stent angulation (P = 0.020) were predictors of late in-stent stenosis. CONCLUSION: Treating intracranial aneurysms with Willis stent-grafts has an acceptable immediate and late occlusion rate and long-term stented artery patency rate.

Anticoagulation with warfarin for Budd-Chiari syndrome with chronic inferior vena cava thrombosis: an initial clinical experience.

BACKGROUND: To evaluate the initial clinical safety and feasibility of anticoagulation using warfarin for Budd-Chiari syndrome (BCS) with chronic inferior vena cava (IVC) thrombosis. METHODS: Between October 2005 and June 2009, a total of 16 consecutive BCS patients with chronic IVC thrombosis were treated with warfarin. Warfarin was administered orally at 2.5 mg/d for approximately 3-12 months. Transluminal balloon dilatation of the IVC with a 30-mm balloon catheter was applied for the patients with complete resolution of the thrombus. Data relating to the technical success, angiographic results, complications, and final clinical outcome were collected retrospectively and follow-ups were performed at 1, 3, 6, and 12 months after the stent placement, and annually thereafter. RESULTS: Warfarin was successfully used for anticoagulation in all patients without any complications. Patients were followed up as outpatients for 6.43 ± 2.19 months, and in 14 cases, complete disappearance of the thrombosis was achieved with successful treatment by balloon dilation. In two patients with partial resolution of the thrombosis, Z-stent placement was initiated to compress the thrombus to prevent migration of the thrombosis, followed by dilation of the IVC. During the follow-up for 20.94 ± 10.31 months after the procedure, all the IVC remained patent without complications or pulmonary embolus, and all patients were alive with resolution of symptoms at the time of this study. CONCLUSIONS: The use of warfarin for anticoagulation proved to be simple, safe, and feasible for BCS with chronic IVC thrombosis.

Safety, feasibility, and mid-term follow-up of Willis stent graft placement in the treatment of symptomatic complicated intra- or extra-cranial aneurysms: a multicenter experience.

We report the technical success rate and mid-term follow-up results after deploying stent-grafts to treat a cohort of patients with symptomatic complicated intra- or extracranial aneurysms (SCIEAs). This study was a retrospective review of 58 patients (39 male; mean age 40.4 ± 12.3 years) with 60 SCIEAs treated by 67 Willis covered stents at three medical centers in China between April 2005 and January 2010. The locations of the SCIEAs were as follows: Intracranial internal carotid artery (ICA) in 54 patients, extracranial ICA in one, intracranial vertebral artery (VA) in three and extra-cranial VA in two. Surgery was successful in 59 (98.3%) SCIEAs. Total exclusion was immediately achieved in 48 SCIEAs, and minor endoleaks were present in 11. Acute thrombosis occurred in two patients and hemorrhage in one. Follow-up angiography (mean 13.8 ± 8.9 months) revealed that 49 of 52 (94.2%) aneurysms were completely isolated, with mild in-stent stenosis in only two patients and in-stent occlusion in one patient. Willis stent-graft application is an alternative therapy to treat SCIEAs in either intra- or extracranial ICAs or VAs. In the case of a tortuous intracranial ICA or potential side branch coverage, however, it is still not a first choice.

Combined endovascular and vascular surgical therapy of a blister-like distal internal carotid aneurysm in a patient with a right-sided aortic arch.

Blood blister-like aneurysms (BBAs) are rare but challenging to treat owing to their fragile, thin walls and poorly defined necks. A right-sided aortic arch is an uncommon congenital cardiac anomaly with an estimated incidence of only 0.1% and presents a challenge to intubation at vessels above the aortic arch. This represents an extremely rare case of a BBA at the left internal carotid artery with a right-sided aortic arch treated with combined endovascular and vascular surgical therapy. We report the case and provide a short review of the relevant literature.

Batroxobin for prevention of restenosis in diabetic patients after infrapopliteal arterial angioplasty: a small randomized pilot trial.

BACKGROUND: We designed a small randomized clinical trial to prospectively test the hypothesis that batroxobin is more effective than aspirin alone to prevent restenosis in patients with diabetes undergoing angioplasty of infrapopliteal arteries. METHODS: After a successful angioplasty, a total of 52 diabetic patients with symptomatic infrapopliteal obstructions were randomized to either the treated group (n = 26) or the control group (n = 26). Patients in the treated group received 5 IU batroxobin through an intravenous drip once every alternate day, for a total of six doses. The primary end point was restenosis and reocclusion, which was documented by magnetic resonance angiography or duplex scanning at 12-month follow-up. The clinical symptoms relief and ankle-brachial index (ABI) were compared before and after the procedure, and during follow-up. Kaplan-Meier curves were constructed to evaluate restenosis or reocclusion-free, limb salvage, and amputation-free rates. RESULTS: Restenosis and reocclusion occurred in 22.0% and 34.5% lesions in the treated and the control group, respectively (p = 0.0307). Statistical differences were observed between the ABI before the angioplasty procedure(p < 0.05) and the ABI at the 12-month follow-up (p = 0.0094) of the two groups. Clinical symptoms improvement and tissue healing occurred in 23 and 19 patients in the batroxobin group and the control group, respectively (p = 0.0544). Twelve months after angioplasty, Kaplan-Meier analysis showed that the restenosis and reocclusion-free rate was 74.0% and 54.8%, the limb salvage rate was 96.2% and 92.3%, and the amputation-free rate was 84.6% and 84.6%, in the treated and control group, respectively. CONCLUSION: This pilot trial revealed that batroxobin usage was effective in preventing restenosis and reocclusion after infrapopliteal arterial angioplasty, and it might provide better clinical symptoms relief; however, it did not report preferable limb salvage or amputation-free rates.

The effectiveness and feasibility of endovascular coil embolization for very small cerebral aneurysms: mid- and long-term follow-up.

BACKGROUND: Endovascular embolization for very small cerebral aneurysms (VSCAs) is still controversial. We report our experience with endovascular coil embolization for these lesions and assess the feasibility and effectiveness. METHODS: We conducted a review of our experience with endovascular treatment of a series of 19 patients with 20 VSCAs, located at the supraclinoid segment of the internal cranial artery (ICA) in seven, the cavernous ICA segment in three, the anterior communicating artery in five, vertebral artery-posterior inferior cerebellar artery in two, bifurcation of the middle cerebral artery in one, the pericallosal artery in one, and the P2 segment in one. The World Federation of Neurosurgical Societies classification before treatment was grade I in 14 patients and grade II in five patients. The strategy of endovascular treatment included coil occlusion, balloon-assisted coiling, and stent-assisted coiling. Occlusion rate was divided into (1) total/near total, occlusion rate 95-100%; (2) subtotal, occlusion rate 80-95%; and (3) partial, occlusion rate<80%. Clinical outcome of patients with ruptured aneurysm was ascertained according to the Glasgow Outcomes Scale. RESULTS: All patients were successfully treated with coil embolization; immediate angiography determined occlusion of the aneurysm, including total occlusion in five, subtotal occlusion in nine, and partial occlusion in six. During 1-2 years of follow-up, all aneurysms were confirmed as complete occlusion by control angiography. No recurrence or coil compaction occurred. No rehemorrhage or ischemic stroke occurred. CONCLUSION: Endovascular coil embolization for VSCAs is effective and feasible. Initial subtotal or partial aneurysm occlusion might progress to total occlusion.

Surgical construction of a novel simulated carotid siphon in dogs.

OBJECT: The development and preclinical assessment of new endovascular devices necessitate readily available and reproducible animal models. The purpose of this study was to develop an in vivo carotid siphon model for testing the properties of covered stents specially designed for the intracranial vasculature. METHODS: Six carotid siphon-shaped devices were created. Six dogs underwent surgery to expose and isolate both common carotid arteries (CCAs). The right CCA origin was ligated and incised distal to the ligation point after temporary constriction of the distal right CCA. The distal left CCA was ligated and incised proximal to the ligation point after the left CCA origin was temporarily clamped. The proximal isolated left CCA was passed through the shaped device and then anastomosed end-to-end to the distal isolated right CCA. Finally, the shaped device was fixed and embedded in the neck. Intraarterial digital subtraction angiography was performed at 7 days, 2 weeks, and 1 month postprocedure. All models underwent endovascular interventional simulation. The carotid siphon models were evaluated. RESULTS: The animals tolerated the surgical procedure well. The mean time for surgical construction of the model was 90 minutes. The morphology and endovascular manipulation of the siphon models were similar to those in humans. Stenosis of anastomotic stoma occurred in 2 models, and mural thrombosis of anastomotic stoma occurred in 1 model; however, all models were patent at postprocedural follow-up angiography. CONCLUSIONS: Surgical construction of an in vivo carotid siphon model in dogs with carotid siphon-shaped devices is feasible and potentially useful for testing neurovascular devices.

Percutaneous vertebroplasty for eosinophilic granuloma of the cervical spine in a child.

We report a case of eosinophilic granuloma at the fourth cervical vertebra in a 10-year-old girl presenting with a 1-month history of cervical pain and stiffness. This lesion was histologically diagnosed by needle biopsy and then treated by percutaneous vertebroplasty. After the procedure, the cervical pain and stiffness resolved rapidly. The height of the vertebral body remained stable without further collapse over a 6-month follow-up period.

[Radiological features of primary pulmonary non-Hodgkin lymphoma: report of three cases].

OBJECTIVE: To describe the radiographic and CT findings of primary pulmonary non-Hodgkin lymphoma (PPL),and to evaluate percutanous transthoracic needle biopsy (PTNB) in the diagnosis of PPL. METHODS: Chest radiographs and CT scans of three patients with histologically proven PPL were reviewed. The diagnosis of PPL was confirmed histologically with specimens obtained by means of PTNB. RESULTS: Consolidation with air bronchograms on the chest X-ray films and CT scans was found in all cases. Multiple ill-defined nodules of various size in both lungs and a mass with air bronchogram in the right lower lobe on the CT scan were present in one case. Ground-glass opacity or reticular lesions were present in both lung fields. Hilar/mediastinal adenopathy and pericardial/pleural effusion were not features of these cases. PTNB was diagnostic in all three cases. No complications occurred during these procedures. CONCLUSIONS: PPL has some specific imaging features. Radiographic and CT findings are helpful in the diagnosis of primary pulmonary malignant lymphoma. A specific diagnosis can be obtained by means of PTNB.