Application of double-stent assisted coil embolization in intracranial vertebral artery dissecting aneurysms with mass effect.

BACKGROUND: Unruptured intracranial vertebral artery dissecting aneurysms (IVADAs) with mass effect have an extremely poor natural course, and treatment of these aneurysms remains a challenge for endovascular and surgical strategies. The aim of this study was to analyze the role of double-stent-assisted coil embolization in preventing rupture and bleeding of intracranial vertebral artery dissecting aneurysm with brainstem compression by reducing mass effect and preventing the recurrence of the aneurysm. METHODS: A total of 25 patients (mean age, 56.04±13.0 years) with unruptured IVADAs with mass effect received dual-stent-assisted coil embolization. The baseline characteristics, the change of aneurysm size on MR, the rate of retreatment, and the improvement rate of clinical symptoms and signs were analyzed retrospectively. RESULTS: All patients completed the surgical procedures successfully. No aneurysm bleeding or perforating artery occlusion occurred during the perioperative and follow-up periods. The initial maximum diameter of the aneurysm on MR was 17.5±3.6 mm. One year after treatment, the maximum diameter of the aneurysm on MR was 15.8±4.9 mm. The reduction rate of the maximum diameter of the aneurysm was 10.7±12.7%. The change of the maximum diameter before and after treatment of aneurysm was statistically significant (P<0.001). In terms of the improvement rate of clinical symptoms, 15 cases were completely improved (60.0%), 6 cases were partially improved (24.0%), and the total clinical improvement rate was 84%. Four cases (16.0%) showed no improvement or even had aggravation of clinical symptoms. In 5 cases (20.0%), aneurysms recurred. Among 4 cases involving posterior inferior cerebellar artery origin, 3 cases had the recurrence (75%). 5 recurred cases were treated with single-stent-assisted coil embolization. No residual aneurysm and recurrence were found on the follow-up angiography. CONCLUSIONS: The double-stent-assisted coil embolization procedure is very safe and reliable. It can effectively prevent the aneurysm from continuing to grow and rupture and thereby reduce the clinical symptoms caused by the mass effect.

Activation of SIRT1 Alleviates Ferroptosis in the Early Brain Injury after Subarachnoid Hemorrhage.

Ferroptosis is a regulated cell death that characterizes the lethal lipid peroxidation and iron overload, which may contribute to early brain injury (EBI) pathogenesis after subarachnoid hemorrhage (SAH). Although Sirtuin 1 (SIRT1), a class III histone deacetylase, has been proved to have endogenous neuroprotective effects on the EBI following SAH, the role of SIRT1 in ferroptosis has not been studied. Hence, we designed the current study to determine the role of ferroptosis in the EBI and explore the correlation between SIRT1 and ferroptosis after SAH. The pathways of ferroptosis were examined after experimental SAH in vivo (prechiasmatic cistern injection mouse model) and in HT-22 cells stimulated by oxyhemoglobin (oxyHb) in vitro. Then, ferrostatin-1 (Fer-1) was used further to determine the role of ferroptosis in EBI. Finally, we explored the correlation between SIRT1 and ferroptosis via regulating the expression of SIRT1 by resveratrol (RSV) and selisistat (SEL). Our results showed that ferroptosis was involved in the pathogenesis of EBI after SAH through multiple pathways, including acyl-CoA synthetase long-chain family member 4 (ACSL4) activation, iron metabolism disturbance, and the downregulation of glutathione peroxidase 4 (GPX4) and ferroptosis suppressor protein 1 (FSP1). Inhibition of ferroptosis by Fer-1 significantly alleviated oxidative stress-mediated brain injury. SIRT1 activation could suppress SAH-induced ferroptosis by upregulating the expression of GPX4 and FSP1. Therefore, ferroptosis could be a potential therapeutic target for SAH, and SIRT1 activation is a promising method to inhibit ferroptosis.

Neuroprotective Effect of Ultrasound Triggered Astaxanthin Release Nanoparticles on Early Brain Injury After Subarachnoid Hemorrhage.

Subarachnoid hemorrhage (SAH) is a fatal disease. Within 72 h of SAH, the intracranial blood-brain barrier (BBB) is destroyed, and the nerve cells have responses such as autophagy, apoptosis, and oxidative stress. Antioxidation is an essential treatment of SAH. Astaxanthin (ATX) induces cells' antioxidant behaviors by regulating related signal pathways to reduce the damage of brain oxidative stress, inflammation, and apoptosis. Because of its easy degradability and low bioavailability, ATX is mainly encapsulated with stimulus-responsive nanocarriers to improve its stability, making it rapidly release in the brain and efficiently enter the lesion tissue. In this study, the ultrasonic cavitation agent perfluorocarbon (PFH), ATX, and fluorescent dye IR780 were loaded with polydopamine (PDA) to prepare a US triggered release nanoparticles (AUT NPs). The core-shell structure of AUT NPs formed a physical barrier to improve the bioavailability of ATX. AUT NPs have high ATX loading capacity and US responsiveness. The experimental results show that the AUT NPs have high stability in the physiological environment. Both US and pH stimuli can trigger the release. Under US, PFH breaks through the rigid shell. The structure of AUT NPs is destroyed in situ, releasing the loaded drugs into neuronal cells to realize the antioxidant and antiapoptotic effects. The in vivo experiment results show that the AUT NPs have good biosafety. They release the drugs in the brain under stimuli. The in vivo treatment results also show that AUT NPs have an excellent therapeutic effect. This approach presents an experimental basis for the establishment of Innovative SAH treatments.

Comparison of Micro-Clamping Stent-Retriever Thrombectomy with Conventional Stent-Retriever Thrombectomy in Intracranial Large Vessel Embolism.

OBJECTIVE: To evaluate the effectiveness of micro-clamping stent-retriever thrombectomy (MSRT) in patients with acute ischemic stroke with intracranial large vessel embolism (ILVE), and compare it with that of conventional stent-retriever thrombectomy (CSRT). METHODS: We retrospectively evaluated 108 patients with ILVA treated by MSRT (n = 52) or CSRT (n = 56) from the 2 participating institutions between January 2016 and November 2017. The rates of successful (Modified Thrombolysis in Cerebral Infarction [mTICI] grade 2b or 3) and complete reperfusion (mTICI grade 3), time from guide catheter placement to reperfusion, rates of first-pass success, and the number of passes for reperfusion were compared between the MSRT and CSRT groups. RESULTS: The complete reperfusion (mTICI 3) rates by MSRT were significantly higher than those achieved with CSRT (78.8% [41/52] vs. 57.1% [32/56], respectively; P = 0.016). Successful reperfusion (mTICI 2b or 3) rates were 92.3% (48/52) in the MSRT group and 83.9% (47/56) in the CSRT groups (P = 0.181). The mean number of passes for reperfusion was significantly lower with MSRT compared with CSRT (1.5 ± 0.2 vs. 2.5 ± 0.5, respectively; P = 0.001). The first-pass success rates were significantly higher in the MSRT group than in the CSRT group (65.4% [34/52] vs. 28.6% [16/56]; P = 0.0001). The mean time from guide catheter placement to reperfusion was significantly shorter in the MSRT group (20.5 ± 6.6 minutes vs. 46.3 ± 7.6 minutes; P = 0.001). CONCLUSIONS: These findings suggest that the complete reperfusion rates and mechanical thrombectomy efficiency in patients with ILVE are better after MSRT compared with CSRT.

Thrombectomy Using "Clamping Embolus with Semi-Retrieval" Technique in Acute Ischemic Stroke.

BACKGROUND: Embolization of thrombus fragments in new or downstream vascular territories is a potential adverse event in neurothrombectomy, requiring additional repeated thrombectomy attempts. This study aims to describe technical results of the thrombectomy with clamping embolus technique (TCET) method in acute ischemic stroke. This study also aims to evaluate the efficiency of mechanical thrombectomy by TCET, and to compare it with conventional stent retriever thrombectomy (CSRT). MATERIALS AND METHODS: A retrospective analysis was performed in 52 consecutive patients treated between January 2015 and October 2016 for intracranial large vessel occlusion by stent retriever thrombectomy. Recanalization rates, procedure durations, and thrombectomy attempts were compared between the TCET and the CSRT groups. RESULTS: Successful recanalization (thrombolysis in cerebral infarction [TICI] 2b or 3) with TCET was achieved in 91.7% (22 of 24) versus 92.9% (26 of 28) in the CSRT group (P = .921). To preserve the restored patency of severely affected atherosclerotic intracranial vessels, 7 and 8 patients received angioplasty or stenting in the TCET and CSRT groups, respectively. In embolic cases, the number of thrombectomy attempts with TCET was significantly lower than that obtained with CSRT (1.7 ± .2 versus 2.6 ± .5, respectively; P = .001); the one-pass thrombectomy rate was significantly higher in the TCET group than in the CSRT-treated patients (58.8% versus 25.0%, respectively; P = .014). Procedure duration was significantly shorter by TCET than by CSRT (35.8 ± 5.8 minutes versus 55.5 ± 7.2 minutes, respectively; P = .001). CONCLUSIONS: The efficiency of mechanical thrombectomy by TCET in acute ischemic stroke might be improved compared with CSRT.

Blood Oxygenation Level-Dependent Functional Magnetic Resonance Imaging in Early Days: Correlation between Passive Activation and Motor Recovery After Unilateral Striatocapsular Cerebral Infarction.

OBJECTIVE: This study aimed to investigate the correlation between the functional magnetic resonance imaging (fMRI) pattern and the motor function recovery of an affected limb during the passive movement of the affected limb at an early stage of the striatocapsular infarction (SCI). METHODS: A total of 17 patients with an acute stage of SCI and 3 healthy volunteers as controls were included in this study. fMRI scans of passive movement were performed on the affected limbs of stroke patients within 1 week of onset. Follow-ups were carried out for the motor functions of the affected limbs (before fMRI scan, 1 month, and 3 months after the scan). RESULTS: The control group showed that the activation was mainly located in the contralateral sensorimotor cortex (SMC) and the bilateral supplementary motor area (SMA). The fMRI scan region of interest for stroke patients can be divided into 3 types: type I includes mainly the affected side, bilateral SMC, and SMA with activation; type II includes SMC on the affected side and SMA with activation; type III includes only SMC on the affected side or M1 with activation. The recovery of type I patients was better and faster, while the recovery of type II patients was better but slower, but recovery of type III patients was poorer and slower. CONCLUSIONS: Multiple cortical activation patterns were noted during the passive movement of the affected limbs at an early stage of SCI, and a correlation was found between the different activation patterns and the clinical prognosis of patients.

Sufficient collateral blood supply from accessory middle cerebral artery in a patient with acute ischemic stroke.

We reported a case of acute embolic occlusion of the middle cerebral artery with a patent accessory middle cerebral artery. Because of the presence of sufficient collateral blood supply from the accessory middle cerebral artery, the patient only underwent transient ischemic attack and did not need endovascular treatment. There was mild infarction in the basal ganglia and temporal lobe, NIHSS score of the patient at discharge seven days after stroke onset was 0, and modified Rankin scale score at 90 days was 0.

Diffusion tensor imaging change in crus cerebri in striatocapsular infarction and correlation with upper extremity motor dysfunction.

PURPOSE: There is limited information about the secondary changes in the pyramidal tract after some specific types of deep brain infarction including striatocapsular infarction. The aims of the current study were to investigate diffusion changes in the crus cerebri in patients with striatocapsular infarction using diffusion tensor imaging (DTI), and analyze the relationship between such changes and upper extremity motor dysfunction. MATERIALS AND METHODS: Fifteen patients with acute onset of striatocapsular infarction and unilateral upper extremity motor dysfunction for the first time were studied prospectively. DTI was performed 2 weeks after disease onset, fractional anisotropy and mean diffusivity values of the bilateral crus cerebri were measured, the asymmetry indices of bilateral fractional anisotropy were calculated, and the relationship between the asymmetry index value and the Fugl-Meyer assessment score for the affected upper extremity function was evaluated. RESULTS: Two weeks after disease onset, the fractional anisotropy value of the affected crus cerebri was reduced significantly compared with that of the unaffected crus cerebri (0.69 vs. 0.77; p < 0.001); there was no significant difference between bilateral mean diffusivity values. After correction for infarct size (448.93 ± 227.67 mm(2)) there was a negative correlation between the asymmetry index value and the Fugl-Meyer assessment score of the affected upper extremity (r = -0.78, p = 0.001). CONCLUSIONS: DTI can detect the diffusion change in the crus cerebri in patients with striatocapsular infarction during the early stage of the disease and the integrity of the pyramidal tract in the crus cerebri is closely related to the motor function of the affected upper extremity.

Massive hemoptysis from pulmonary ligament artery supplying abnormal basal segments of the lower lobe.

BACKGROUND: Non-bronchial systemic arteries can be a significant source of massive hemoptysis in patients with marked pleural involvement. However, in some cases without pleural involvement, the pulmonary ligament artery (PLA) can also enter the abnormal lung parenchyma and be responsible for hemoptysis. PURPOSE: To discuss the factors influencing the development of a blood supply from the PLA in patients with hemoptysis. MATERIAL AND METHODS: Seventy-five consecutive patients who underwent bronchial artery embolization (BAE) for massive hemoptysis were evaluated between January 2006 and December 2011 retrospectively. Selective arteriography showed an enlarged and tortuous PLA in five patients. CT was done to determine the site and extent of the underlying diseases before BAE in all patients. Angiographic and CT images were analyzed to determine if there was a relationship between PLA supply and location of the underlying disease or mediastinal pleural involvement. RESULTS: The underlying lesions of six patients involved the basal segments of the lower lobe without marked mediastinal pleural thickening or adhesion, but diaphragmatic and lateral pleural thickening was observed in one case. Of these six patients, the PLA supplied blood to the lesions related to the hemoptysis in five patients. No patient with massive hemoptysis whose underlying lesions involved other segments of lung had a PLA supplying the lesions. CONCLUSION: Even though pleural involvement is absent, underlying lesions involving the basal segments of the lower lobe could be a good indicator that the PLA is the cause of bleeding in patients with massive hemoptysis.