A Novel Risk-Predicted Nomogram for Perioperative Ischemic Complications of Endovascular Treatment Among Ruptured Anterior Communicating Artery Aneurysms.

OBJECTIVE: To establish and validate a risk prediction model for perioperative ischemic complication (PIC) of endovascular treatment for ruptured anterior communicating artery aneurysms (ACoAAs). METHODS: The general clinical and morphologic data, operation schemes, and treatment outcomes of patients with ruptured ACoAAs treated with endovascular treatment in our center from January 2010 to January 2021 were retrospectively analyzed and assigned to primary (359 patients) and validation (67 patients) cohorts. A risk-predicted nomogram for PIC was developed through multivariate logistic regression analysis in the primary cohort. The discrimination ability, calibration accuracy, and clinical usefulness of the established PIC prediction model were evaluated and verified based on the receiver operating characteristic curves, calibration curves, and decision curve analysis in the primary and external validation cohorts, respectively. RESULTS: A total of 426 patients were included, 47 of whom had PIC. The multivariate logistic regression analysis showed that hypertension, Fisher grade, A1 conformation, use of stent-assisted coiling, and aneurysm orientation were independent risk factors for PIC. Then, we developed a simple and easy-to-use nomogram to predict PIC. This nomogram has a good diagnostic performance (area under the curve, 0.773; 95% confidence interval, 0.685-0.862) and calibration accuracy; we then further validated this nomogram by external validation cohort and showed an excellent diagnostic performance and calibration accuracy. Besides, the decision curve analysis confirmed the clinical usefulness of the nomogram. CONCLUSIONS: A history of hypertension, high preoperative Fisher grade, complete A1 conformation, use of stent-assisted coiling, and aneurysm orientation (pointing upward) are risk factors for PIC for ruptured ACoAAs. This novel nomogram might serve as a potential early warning sign of PIC for ruptured ACoAAs.

A single-center comparative study with large sample size on stent-assisted coiling versus coiling alone for the ruptured anterior communicating artery aneurysms: Analysis of safety, efficacy, and prognosis based on propensity score matching.

OBJECTIVE: To compare the safety, efficacy, and prognosis of stent-assisted coiling (SAC) versus coiling alone (CA) in the treatment of ruptured anterior communicating artery aneurysms (ACoAAs). METHODS: The clinical and follow-up data of ruptured ACoAAs treated with endovascular treatment in our center from January 2011 to January 2021 were retrospectively collected. Patients were divided into an SAC group and a CA group based on whether stents were used, after which the two groups were matched for propensity scores. The general clinical data, embolization effect, perioperative complications, clinical, and follow-up results after matching were compared. RESULTS: A total of 354 patients were enrolled, of whom 147 patients (41.5%) received SAC and the rest received CA. Comparison baseline of two groups showed that patients with a larger diameter, wide neck, irregular morphology, and anterior direction were more likely to receive SAC. After propensity score matching, 113 patients were included in each group. Immediately postoperative angiography results showed that the complete embolization rate of patients in the SAC group was significantly lower than that in the CA group (62.8% vs. 76.1%, p = 0.03). There were no significant differences between the two groups in the incidence of perioperative complications, mortality, poor prognosis at discharge or follow-up, mid-term complete occlusion rate and recurrence rate. CONCLUSION: The stent-assisted treatment of ruptured ACoAAs did not increase the risk of perioperative complications or the probability of poor prognosis, indicating that SAC treatment of ruptured ACoAAs is safe and feasible and has a reliable mid-term cure rate.

Risk factors for intraprocedural rupture during emergency endovascular treatment of ruptured anterior communicating artery aneurysms.

BACKGROUND: Anterior communicating artery aneurysms are the second most common type of intracranial aneurysm and have a high incidence of rupture. Intraprocedural rupture can lead to a high mortality and morbidity rate, representing a major challenge in emergency endovascular treatment of ruptured anterior communicating artery aneurysms. METHODS: We performed a retrospective review of 344 consecutive patients with emergency endovascular treatment of ruptured anterior communicating artery aneurysms. Patients were grouped into intraprocedural rupture and non-intraprocedural rupture groups according to whether intraprocedural rupture occurred. Demographic and clinical factors, vessel-related factors and therapy-related factors were compared between the two groups. RESULTS: Intraprocedural rupture occurred in 11 patients (3.2%). Univariate analysis showed that hypertension, the occurrence of vasospasm, aneurysm size, aneurysm angle and a high aspect ratio value were significantly associated with intraprocedural rupture (P < 0.05). Multivariate analysis showed that hypertension odds ratio (OR, 9.799; P = 0.007), the occurrence of vasospasm (OR, 10.121; P = 0.002) and a high aspect ratio value (OR, 10.571; P = 0.006) were independent risk factors for intraprocedural rupture. CONCLUSIONS: A history of hypertension, the occurrence of vasospasm and a high aspect ratio value are independent risk factors for intraprocedural rupture among patients with ruptured anterior communicating artery aneurysms.

Noble gas insertion compounds of hydrogenated and lithiated hyperhalogens.

Based on density functional theory (DFT) calculations, hydrogenated hyperhalogen HM(BO2)2, lithiated hyperhalogen LiM(BO2)2 (M = Cu, Ag, Au), and their compounds with xenon were studied. Different insertion sites of Xe resulted in various isomers. According to the natural population analysis, the Xe atom donated 0.12-0.77 electrons to HM(BO2)2 and 0.14-0.41 electrons to LiM(BO2)2 when they combined, leading to metastable charge-transfer compounds in most cases. The nature of bonding between xenon and HM(BO2)2/LiM(BO2)2 was found to be related to its location. Covalent bonds were formed when Xe bound with hydrogen atoms, as indicated by the large Wiberg bond indices of the Xe-H bonds. The same was true for most Xe-M bondings. When an Xe-O connection was formed, it was either an ionic or van der Waals force in nature depending on the specific structural feature of the isomer. A parallel study on hyperhalogen-supported Ar and Kr compounds indicated that they were not very stable and were less likely to exist at room temperature, which was in accordance with the high inertness of both Ar and Kr atoms.