摘要
Objective To explore the efficacy and safety of stent-assisted coil embolization of acutely ruptured wide-necked intracranial aneurysms. Methods One hundred and sixty patients with acutely ruptured wide-necked intracranial aneurysms (160 ruptured aneurysms), admitted to and underwent stent-assisted coil embolization in our hospital from January 201l to May 2018, were chosen. The clinical data, outcomes and complications of these patients were retrospectively analyzed. The differences of clinical data between patients with and without complications were compared. Modified Rankin scale (mRS) was used to evaluate the prognoses of these patients. Univariate and multivariate Logistic regression analyses were conducted to analyze the risk factors of prognoses. Results All 160 stents were successfully released. Complete occlusion after endovascular procedures was achieved in 127 patients (79.4％); 17 aneurysms (10.6％) had neck residual and 16 aneurysms (10.0％) had aneurysm residual. Surgery-related complications occurred in 17 patients (10.6％), of which, 6 (3.8％) showed hemorrhagic events and 11 (6.9％) had ischemic events. The distributions of aneurysm sites between patients with ischemia related complications and those without ischemia related complications were statistically different (P<0.05). Poor prognosis was noted in 24 patients (15％) and good prognosis was noted in 136 (85％). The mRS scores, preoperative Hunt-Hess grades and distributions of stent types between patients with good prognosis and patients with poor prognosis were statistically different (P<0.05). Logistic regression analysis indicated that baseline mRS scores ≥4 (OR=39.000, 95％ CI:10.861-140.038, P=0.000), preoperative Hunt-Hess grading IV-V (OR=13.000, 95％CI: 4.063-41.596, P=0.015), and Solitaire stents placement (OR=3.333, 95％CI: 1.332-8.339, P=0.028) were the independent risk factors for poor clinical outcomes in patients with acutely ruptured wide-necked intracranial aneurysms. Conclusion Stent-assisted coil embolization is suggested to be a safe and efficacious way to treat acutely ruptured wide-necked intracranial aneurysms, and patients with baseline mRS scores≥4, preoperative Hunt-Hess grading IV-V and Solitaire stents placement are more prone to having poor clinical outcomes.
摘要
Objective To investigate the effect of bone marrow mesenchymal stem cells (BMSCs) transplantation on recovery of neurological functions and Nogo-A expression in cerebral ischemia rats at recovery stage.Methods BMSCs were isolated and cultured by whole bone marrow adherence method.Thirty-six SD rats were randomized into sham-operated group,ischemia group and BMSCs transplantation group (n=12).The middle cerebral artery occlusion (MCAO) models in the ischemia group and BMSCs transplantation group were established with Zea Longa line embolism.After 21 d of MCAO,one mL ofBMSCs (3×106) were transplanted into rats of the BMSCs transplantation group,and same amount of phosphate buffer was given to the rats of the sham-operated group and ischemia group.After 14 and 28 d of treatment,neurological functions of the rats were evaluated by modified neurological severity scale (mNSS);the brain infarct sizes were tested by TTC staining;the pathological alterations were tested by HE staining,and the Nogo-A expression was determined by immunofluorescence.Results After 14 and 28 d of treatment,as compared with the ischemia group,BMSCs group had significantly lower mNSS scores (14 d∶ 7.50±0.55 vs.6.17±0.75;28 d∶ 7.33±0.52 vs.5.67±0.82),statistically smaller brain infarct sizes (14 d∶ 31.38％±1.02％ vs.26.32％±1.19％;28 d∶27.71％±0.55％ vs.21.68％±1.09％),and significantly lower Nogo-A expression (14 d∶ 39.33％±2.08％ vs.33.67％±2.52％;28 d∶ 30.33％±0.58％ vs.25.67％±4.39％,P＜0.05).What's more,rats in the BMSCs group had milder cell damage and decreased scar tissues as compared with those in the ischemia group.Conclusion BMSCs transplantation can improve the neurological function of cerebral ischemia rats at recovery stage,and it may work via regulation of Nogo-A expression.