Efficacy of endovascular therapy for cerebral vasospasm following aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis.

Background: Cerebral vasospasm (CV) is a common complication of aneurysmal subarachnoid hemorrhage (aSAH), leading to increased morbidity and mortality rates. Endovascular therapy, particularly intra-arterial vasodilator infusion (IAVI), has emerged as a potential alternative treatment for CV. Methods: A systematic review and meta-analysis were conducted to compare the efficacy of endovascular therapy with standard treatment in patients with CV following aSAH. The primary outcomes assessed were in-hospital mortality, discharge favorable outcome, and follow-up favorable outcome. Secondary outcomes included major infarction on CT, ICU stay duration, and total hospital stay. Results: Regarding our primary outcomes of interest, patients undergoing intervention exhibited a significantly lower in-hospital mortality compared to the standard treatment group, with the intervention group having only half the mortality risk (RR = 0.49, 95% CI [0.29, 0.83], p = 0.008). However, there were no significant differences between the two groups in terms of discharge favorable outcome (RR = 0.99, 95% CI [0.68, 1.45], p = 0.963) and follow-up favorable outcome (RR = 1.09, 95% CI [0.86, 1.39], p = 0.485). Additionally, there was no significant difference in major infarction rates (RR = 0.79, 95% CI [0.34, 1.84], p = 0.588). It is important to note that patients undergoing endovascular treatment experienced longer stays in the ICU (MD = 6.07, 95% CI [1.03, 11.12], p = 0.018) and extended hospitalization (MD = 5.6, 95% CI [3.63, 7.56], p < 0.001). Subgroup analyses based on the mode of endovascular treatment further supported the benefits of IAVI in lowering in-hospital mortality (RR = 0.5, 95% CI [0.27, 0.91], p = 0.023). Conclusion: Endovascular therapy, particularly IAVI, holds promising potential in reducing in-hospital mortality for patients with CV following aSAH. However, it did not show significant improvement in long-term prognosis and functional recovery. Further research with larger sample sizes and randomized controlled trials is necessary to validate these findings and optimize the treatment strategy for cerebral vasospasm in aSAH patients. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42023451741.

Blood-Blister Aneurysms of the Internal Carotid Artery in Tibetan and Han Populations : A Retrospective Observational Study.

Objective: Blood-blister aneurysms (BBAs) of the internal carotid artery (ICA) are challenging lesions with high morbidity and mortality rates. Although research on BBAs is well documented in different populations, the study of BBAs in the Tibetan population is extremely rare. This study aimed to evaluate the characteristics of BBAs and analyze the treatment modalities and long-term outcomes in the Tibetan population in comparison with the Han population. Methods: The characteristics of patients with BBAs of the ICA from January 2009 to January 2021 at our institution were reviewed. The features of aneurysms, treatment modalities, complications, and follow-up outcomes were retrospectively analyzed. Results: A total of 130 patients (41 Tibetan and 89 Han patients) with BBAs of the ICA who underwent treatment were enrolled. Compared with the Han group, the Tibetan group significantly demonstrated a high ratio of BBAs among ICAs (8.6%, 41/477 vs. 1.6%, 89/5563; p<0.05), a high ratio of vasospasm (34.1%, 14/41 vs. 6.7%, 6/89; p=0.001), a high risk of ischemic events (43.9%, 18/41 vs. 22.5%, 20/89; p<0.05), and a low ratio of good outcomes (modified Rankin Scale, 0-2) at the 1-year follow-up (51.2%, 21/41 vs. 74.2%, 66/89; p<0.05). The multivariate regression model showed that ischemic events significantly contributed to the prediction of outcomes at 1 year. Further analysis revealed that microsurgery and vasospasm were associated with ischemic events. Conclusion: In comparison with Han patients, the Tibetan population had a high ratio of BBA occurrence, a high incidence of ischemic events, and a high ratio of poor outcomes. The endovascular approach showed more benefits in BBA patients.

Case report: Delayed quadriplegia from traumatic carotid cavernous fistula: a rare case with perimedullary venous drainage.

Background: Carotid cavernous fistula (CCF) refers to the abnormal arteriovenous communication between the carotid system at the skull base and the sphenoid cavernous sinus, which is caused by trauma in almost 75% of cases. The drainage of venous blood to the spinal cord represents a distinctive mechanism, which is commonly observed in dural arteriovenous fistula (DAVF), and typically manifests clinically as progressive myelopathy. However, it is a rare occurrence in clinical practice that traumatic carotid cavernous fistula (TCCF) causes delayed quadriplegia through perimedullary venous drainage. Case presentation: We report the case of a 29-year-old male patient who was admitted to the hospital with a sudden onset of headache and quadriplegia. The patient had previously lost his right eye in a traffic accident 5 years ago. Cerebral angiography showed a high-flow direct CCF on the right side, accompanied by obvious drainage of cerebellar and perimedullary veins. We successfully performed coil embolization for the CCF, and the symptoms of the patient gradually improved after the operation. During follow-up at sixth-months, the patient regained the ability to walk independently. Conclusion: We experienced a rare case of TCCF with quadriplegia. Utilizing coil embolization, we achieved successful improvement in the patient's condition. However, the mechanism and the best treatment of CCF drainage through the perimedullary vein are still unclear. We need to further explore the pathophysiological information of CCF venous drainage.

Design of an open-shell nitrogen-centered diradicaloid with tunable stimuli-responsive electronic properties.

Organic diradicaloids usually display an open-shell singlet ground state with significant singlet diradical character (y0) which endow them with intriguing physiochemical properties and wide applications. In this study, we present the design of an open-shell nitrogen-centered diradicaloid which can reversibly respond to multiple stimuli and display the tunable diradical character and chemo-physical properties. 1a was successfully synthesized through a simple and high-yielding two-step synthetic strategy. Both experimental and calculated results indicated that 1a displayed an open-shell singlet ground state with small singlet-triplet energy gap (ΔES-T = -2.311 kcal mol-1) and a modest diradical character (y0 = 0.60). Interestingly, 1a was demonstrated to undergo reversible Lewis acid-base reaction to form acid-base adducts, which was proven to effectively tune the ground-state electronic structures of 1a as well as its diradical character and spin density distributions. Based on this, we succeeded in devising a photoresponsive system based on 1a and a commercially available photoacid merocyanine (MEH). We believe that our studies including the molecular design methodology and the stimuli-responsive organic diradicaloid system will open up a new way to develop organic diradicaloids with tunable properties and even intelligent-responsive diradicaloid-based materials.

Hierarchical Self-Assembly of Nanowires on the Surface by Metallo-Supramolecular Truncated Cuboctahedra.

Parastichy, the spiral arrangement of plant organs, is an example of the long-range apparent order seen in biological systems. These ordered arrangements provide scientists with both an aesthetic challenge and a mathematical inspiration. Synthetic efforts to replicate the regularity of parastichy may allow for molecular-scale control over particle arrangement processes. Here we report the packing of a supramolecular truncated cuboctahedron (TCO) into double-helical (DH) nanowires on a graphite surface with a non-natural parastichy pattern ascribed to the symmetry of the TCOs and interactions between TCOs. Such a study is expected to advance our understanding of the design inputs needed to create complex, but precisely controlled, hierarchical materials. It is also one of the few reported helical packing structures based on Platonic or Archimedean solids since the discovery of the Boerdijk-Coxeter helix. As such, it may provide experimental support for studies of packing theory at the molecular level.

Acid-Activated Motion Switching of DB24C8 between Two Discrete Platinum(II) Metallacycles.

The precise operation of molecular motion for constructing complicated mechanically interlocked molecules has received considerable attention and is still an energetic field of supramolecular chemistry. Herein, we reported the construction of two tris[2]pseudorotaxanes metallacycles with acid-base controllable molecular motion through self-sorting strategy and host-guest interaction. Firstly, two hexagonal Pt(II) metallacycles M1 and M2 decorated with different host-guest recognition sites have been constructed via coordination-driven self-assembly strategy. The binding of metallacycles M1 and M2 with dibenzo-24-crown-8 (DB24C8) to form tris[2]pseudorotaxanes complexes TPRM1 and TPRM2 have been investigated. Furthermore, by taking advantage of the strong binding affinity between the protonated metallacycle M2 and DB24C8, the addition of trifluoroacetic acid (TFA) as a stimulus successfully induces an acid-activated motion switching of DB24C8 between the discrete metallacycles M1 and M2. This research not only affords a highly efficient way to construct stimuli-responsive smart supramolecular systems but also offers prospects for precisely control multicomponent cooperative motion.

A chromosome-level reference genome of non-heading Chinese cabbage [Brassica campestris (syn. Brassica rapa) ssp. chinensis].

Non-heading Chinese cabbage (NHCC) is an important leafy vegetable cultivated worldwide. Here, we report the first high-quality, chromosome-level genome of NHCC001 based on PacBio, Hi-C, and Illumina sequencing data. The assembled NHCC001 genome is 405.33 Mb in size with a contig N50 of 2.83 Mb and a scaffold N50 of 38.13 Mb. Approximately 53% of the assembled genome is composed of repetitive sequences, among which long terminal repeats (LTRs, 20.42% of the genome) are the most abundant. Using Hi-C data, 97.9% (396.83 Mb) of the sequences were assigned to 10 pseudochromosomes. Genome assessment showed that this B. rapa NHCC001 genome assembly is of better quality than other currently available B. rapa assemblies and that it contains 48,158 protein-coding genes, 99.56% of which are annotated in at least one functional database. Comparative genomic analysis confirmed that B. rapa NHCC001 underwent a whole-genome triplication (WGT) event shared with other Brassica species that occurred after the WGD events shared with Arabidopsis. Genes related to ascorbic acid metabolism showed little variation among the three B. rapa subspecies. The numbers of genes involved in glucosinolate biosynthesis and catabolism were higher in NHCC001 than in Chiifu and Z1, due primarily to tandem duplication. The newly assembled genome will provide an important resource for research on B. rapa, especially B. rapa ssp. chinensis.

Reactive in-stent stenosis of a pipeline embolization device in a child: A case report.

RATIONALE: Pipeline embolization device pipeline embolization device (PLED) is one of the most preferred flow-diverting devices used in treating giant and complex intercranial aneurysms. The occurrence of in-stent stenosis (ISS), which is a partially reversible complication, has been associated with PLED. Trauma around the neck of the aneurysm during our attempts to implant the PLED across the aneurysm resulted into inflammatory reactions, endotheliazation, granular tissue formation, and subsequent ISS. PATIENT CONCERNS: We present an 11-year-old girl with dizziness of 6 days duration on account of which she was admitted at our institution. Physical as well as neurological examinations did not yield much. DIAGNOSES: Cerebral angiography revealed a right cavernous segment giant aneurysm. INTERVENTIONS: We initially implanted Pipeline embolization devices (PLEDs) (ev3, Irvine, California, USA) across the neck of the aneurysm which resulted into ISS 6 months after the operation. OUTCOMES: We also attempted balloon angioplasty which failed during our second operation. She was finally treated with Neuroform stent (Stryker Neurovascular, USA) with no further complication and two years follow-up revealed no ISS. LESSONS SUBSECTIONS AS PER STYLE: A combination of multiple kinds of flow diverting devices could reduce the incidence of ISS in selected patients with complex aneurysms. Minimal trauma caused by PLED at aneurysm site could also reduce incidence of ISS.

Complete obliteration of a spontaneous pediatric vertebral arteriovenous fistula with patency of the parent vertebral artery: A case report.

RATIONALE: Vertebral arteriovenous fistulas (VAVFs) are depicted with anomalous connections between the vertebral artery, or its branches, and the adjacent venous system. Most VAVFs occur as a result of direct trauma during accidents, whereas others have iatrogenic origin. PATIENT CONCERNS: We report a case of 11-year-old male who presented with right limb weakness and walking instability. DIAGNOSIS: Magnetic resonance angiography as well as digital subtraction angiogram (DSA) of the neck demonstrated a right VAVF. The cervical medulla was compressed by a dilated vein in vertebral canal. The blood supply of the fistula was from the right vertebral artery, whereas drainage was via epidural and paraspinal venous plexus. INTERVENTIONS: We introduced the TransForm Occlusion Balloon Catheter into right vertebral artery, identified the VAVF, and occluded it with the balloon. OUTCOMES: We successfully obliterated the VAVF with patency of parent vertebral artery with a balloon. The symptoms of the patient were relieved after the procedure. Two years' follow-up revealed no recurrence of the fistula. The patient is currently well. LESSONS: Patency of the parent artery following obliteration a VAVF is still a challenge. Obliteration of the VAVF with a balloon while the parent vertebral artery is still patent is very possible.

Obstructive hydrocephalus associated with spontaneous dural arteriovenous fistula: A case report.

RATIONALE: Dural arteriovenous fistulae (DAVF) are vascular disorders depicted with direct interconnection between dural arteries and cerebral venous sinuses and/or cortical veins. Only a hand full of cases have been reported in literature. DAVF obstructing the 3rd ventricle and quadrigeminal cistern resulting in hydrocephalus is very rare. PATIENT CONCERNS: We present a 55-year-old female with 2 years history of headaches and blurring of vision. Cranial nerves examinations were unremarkable. DIAGNOSES: Magnetic Resonance Imaging (MRI) and digital subtraction angiography showed multiple tortuous vascular malformation in the 3rd ventricle and quadrigeminal cistern resulting in obstructive hydrocephalus (OHC). INTERVENTIONS: We utilized endovascular embolization treatment option to obliterate the lesion. We used Onyx embolization agent (ev3 Neurovascular, Irvine, CA) to embolize the lesion via the transarterial route. OUTCOMES: The OHC resolved spontaneously after the endovascular embolization of the DAVF. The patient recovered with no further neurologic complication. Two years follow-up reveal no recurrence of the DAVF as well as hydrocephalus. LESSONS: Adequate knowledge on the vascular anatomy is very crucial in managing DAVF.

Dural Arteriovenous Fistulas with Perimedullary Venous Drainage Successfully Managed Via Endovascular Electrocoagulation.

BACKGROUND: Dural arteriovenous fistulas (DAVFs) with perimedullary venous drainage are very rare intracranial DAVFs. Treating DAVF via an endovascular electrocoagulation technique, to the best of our knowledge, has not been reported in the literature. We therefore report the first successful case. CASE DESCRIPTION: We report a rare case of Cognard type V DAVF. The feeding arteries were the middle meningeal artery, the recurrent meningeal branch of ophthalmic artery, and the meningohypophyseal trunk. The patient presented with paresthesia and weakness in the lower limbs. T2-weighted magnetic resonance imaging revealed a high signal in the medulla oblongata and upper cervical spinal cord. Our first procedure via the middle meningeal artery with Onyx 18 (ev3 Neurovascular) as the embolization agent failed to occlude the fistula. We finally occluded the fistula with the endovascular electro-coagulation technique. Two-year follow-up revealed total disappearance of the fistula and relieve of patient's symptoms. CONCLUSIONS: The endovascular electrocoagulation technique is very effective in the management of complex DAVFs with perimedullary venous drainage.

Application of the Willis Covered Stent in the Treatment of Ophthalmic Artery Segment Aneurysms: A Single-Center Experience.

OBJECTIVE: The purpose of this study is to introduce our initial experience with the evaluation of the feasibility of using Willis covered stents (WCSs) in the treatment of complicated ophthalmic artery (OA) segment aneurysms. METHODS: Of the 162 patients with OA segment aneurysms treated by endovascular techniques in West China Hospital from January 2015 to August 2017, a total of 26 patients treated with WCSs were included in the study. RESULTS: Twenty-six patients with 26 aneurysms were included (mean age, 57.0 years; range, 22-76 years). The cohort had 20 patients with large or giant aneurysms, 3 patients with blood blister aneurysms, and 3 patients with pseudoaneurysms. Ten aneurysms were OA type, and 16 were internal carotid artery (ICA) type. Twenty-four patients were treated with 1 stent, and 2 patients were treated with 2 stents. Among the 26 patients, 2 patients had minimal endoleak, and 24 patients had complete occlusion after immediate postoperative angiography. One patient who had complete occlusion experienced contrast agent extravasation, and this phenomenon disappeared by balloon compression during the procedure. The 3- to 15-month angiographic follow-up showed that all patients experienced complete occlusion, including 2 patients with minimal endoleak during immediate postprocedural angiography. Two patient showed signs of in-stent stenosis. Clinical follow-up demonstrated that no delayed thromboembolic or ischemic events were recorded in the stent-grafted vascular region and no bleeding occurred in any of the patients (except 1 patient who experienced subarachnoid hemorrhage, left frontal lobe hemorrhage, and hydrocephalus 10 days after the procedure). CONCLUSIONS: WCSs may provide an alternative solution for treating complex OA segment aneurysms by reconstruction and preservation of the ICA. Our study also confirms the safety, efficacy, and midterm durability of WCSs for complex OA segment aneurysms.

Separation of polyprenols from Ginkgo biloba leaves by a nano silica-based adsorbent containing silver ions.

Polyprenols extracted from Ginkgo biloba leaves is a kinds of unsaturated compound containing double bonds. Traditionally, the separation methods for the polyprenols are lack of selectivity and their separation efficiency are low. We synthesized two kinds of functional nano-silica containing silver ions materials (AgTCM and AgTCN) which have selectivity for unsaturated compounds to separate Ginkgo biloba leaves polyprenols for the first time. AgTCN displays exceptionally high selectivity for polyprenols and high stability under extended heat and light exposure, while silver is virtually immobile during solvent elution. Importantly, the exceptional stability of AgTCN gives rise to much higher polyprenols recovery than conventional silica gel during the chromatographic elution. In addition, we found that the adsorption of polyprenols onto the AgTCN conforms to pseudo-second-order kinetic model and AgTCN has strong affinity with polyprenols by analyzing Langmuir, Freundlich, Temkin-Pyzhev, and Dubinin-Radushkevich isotherms. The calculation results of thermodynamic parameters demonstrate that decrease of temperature in favor of increasing the adsorbing capacity of polyprenols onto the AgTCN, and the adsorption process of which is exothermic reaction. Our results pave the way for the novel separation methods of polyprenols from Ginkgo biloba leaves.

Application of the Willis Covered Stent in the Treatment of Carotid-Cavernous Fistula: A Single-Center Experience.

BACKGROUND: The purpose of the present study was to describe our single-institutional experience of treating direct carotid-cavernous fistulas (DCCFs) with Willis covered stents (WCSs). METHODS: Of a total of 31 DCCFs, 10 were treated with WCSs (Microport, Shanghai, China) at West China Hospital from January 2015 to December 2016. The indications for treatment, perioperative findings, and postoperative and follow-up results were collected and analyzed. RESULTS: All 10 patients had successful deployment of WCSs. Complete exclusion of the fistula was achieved in 6 patients immediately after deployment of 1 stent. Endoleak was observed in 4 patients (patients 2, 4, 5, and 9). Thus, repeat dilation of the stent with greater pressure was performed, which resolved the endoleak in 2 patients (patients 2 and 9). The endoleak of the other 2 patients persisted after repeat dilation of the balloon. Hence, a second stent was deployed in these 2 patients (patients 4 and 5), which eliminated the endoleak in patient 4. However, patient 5 continued to have a minimal endoleak. Nine patients had fistulas successfully occluded by WCSs during the follow-up period. One patient experienced recurrence of a DCCF at the 10-day follow-up point. We chose coil embolization to address this DCCF. No stenosis of the internal carotid artery or DCCF recurrence, except that in the abovementioned patient, was observed. CONCLUSIONS: WCS was proved to be an alternative treatment method for complex DCCFs through reconstruction and preservation of the internal carotid artery. Our study also confirmed the safety, efficacy, and midterm durability of WCSs for complex DCCFs without any serious delayed complications.

Application of the Willis Covered Stent in the Treatment of Blood Blister-Like Aneurysms: A Single-Center Experience and Systematic Literature Review.

OBJECTIVE: The purpose of the present study was to introduce our initial experience with the use and feasibility of the Willis covered stent (WCS) in the treatment of blood blister-like aneurysms (BBAs) and to present a systematic review of the reported data on the treatment of BBAs with covered stents. METHODS: Fourteen consecutive patients with BBAs had been treated with WCSs at West China Hospital from January 2015 to August 2017. The patient medical records, angiographic findings, and endovascular treatment reports were reviewed by interventional neuroradiologists and neurosurgeons to obtain relevant clinical and angiographic information. We conducted a systematic review of all reports of BBAs treated with covered stents. We searched the reported data using PubMed, Embase, China National Knowledge Infrastructure, and Wanfang databases and commercial Internet search engines. We included BBAs located at nonbranching portions of the internal carotid artery (ICA). RESULTS: The present study included 9 men and 5 women, with a mean age of 54.5 years (range, 30-79). All patients had complete occlusion found on immediate postoperative angiography. The ophthalmic artery was occluded in 2 patients (14.3%). No mortality or morbidity had occurred during the procedure. Two patients (14.3%) experienced a mild recurrence. One patient (7.1%) had developed mild in-stent stenosis. The clinical follow-up period was 6-15 months for all the patients. Of the 14 patients, 11 (78.6%) had a modified Rankin scale score of 0, and 1 (7.1%) had a modified Rankin scale score of 1 during the follow-up period. One patient (7.1%) experienced subarachnoid hemorrhage at 7 days postoperatively and had died 10 days after surgery. None of the patients experienced visual defects. Of our 14 patients, 13 (92.9%) survived, as determined by outpatient department visits or telephone interviews. A total of 8 reports, including 38 patients, met our criteria. Of these 38 patients, 37 (97.3%) had successful delivery to the diseased ICA, and 34 (89.5%) had experienced complete occlusion during follow-up. The overall rate of complete occlusion was 83.0% (95% confidence interval, 68%-91%). CONCLUSIONS: Patients with ruptured BBAs treated with WCSs can achieve satisfactory clinical results. Therefore, for BBAs, the implementation of the WCS could be safe and feasible. This strategy could be a promising option for this type of high-risk aneurysm. However, patients with tortuous ICAs or aneurysms close to essential branch arteries should be carefully evaluated before the WCS is used.

Traumatic Penetrating Neck Injury with Right Common Carotid Artery Dissection and Stenosis Effectively Managed with Stenting: A Case Report and Review of the Literature.

INTRODUCTION: Penetrating neck injuries (PNI) are common and associated with arterial and other neuronal injuries. Although many authors have written on penetrating and blunt carotid artery injuries as a result of PNI or traumatic neck injuries, no one has reported a case or case series on PNI that resulted in blunt carotid dissection and stenosis. CASE PRESENTATION: We present a case of 40-year-old building and construction male worker who slipped and fell on an iron rod that resulted in penetrating wound on the right side of the anterior neck a week prior to presenting at our facility. He pulled out the iron rod immediately. Computer tomography angiography (CTA) done revealed C2-C4 transverse process fractures on the right side and a fracture at the right lamina of C3 and right common carotid artery dissection with stenosis. He was successfully treated with stenting via endovascular approach. CONCLUSIONS: We adopt the view that patient should never pull out objects that result in PNI because of complex neurovascular architecture of the neck. The mortality rate of our patient will have doubled if the iron rode penetrated the common carotid artery. The gold standard treatment option for carotid artery dissection and stenosis is endovascular approaches.

Posttraumatic Trigeminal-Cavernous Fistula.

INTRODUCTION: Persistent trigeminal artery is the most frequent embryonic communication between the vertebrobasilar and carotid systems. To the best of our knowledge, posttraumatic trigeminal-cavernous fistula is rarely reported in the literature. CASE PRESENTATION: We present a 47-year-old man with posttraumatic trigeminal-cavernous fistula, which we treated using Onyx embolization. CONCLUSION: Even though preservation of the parent artery is generally considered a desirable goal in fistula treatment, in special cases such as Salzmann type 2 anatomy plus a unique fistulous orifice accompanied by external carotid-cavernous fistula, it is required to embolize the persistent trigeminal artery and cavernous sinus.

Microsurgical versus Endovascular Treatments for Blood-Blister Aneurysms of the Internal Carotid Artery: A Retrospective Study of 83 Patients in a Single Center.

BACKGROUND: Blood-blister aneurysms (BBAs) of the internal carotid artery (ICA) are challenging lesions with high morbidity and mortality. Both surgical and endovascular approaches have been used to treat BBAs; however, little is known about their safety and efficacy. OBJECTIVE: To review our experience with the treatment of BBAs and explore the optimal treatment strategy. METHODS: A total of 83 patients with BBAs were reviewed retrospectively. The characteristics of the patients and the aneurysms, treatment results, and follow-up outcomes were analyzed. RESULTS: The cohort comprised 52 females and 31 males with a mean age of 46.6 years; 33 patients were assigned to the microsurgical therapy. Subsequently, 27/33 patients underwent surgical clipping, 4/33 underwent trapping without bypass, 2/33 underwent wrapping, and 50 patients underwent endovascular therapy, including stent-assisted coiling (49 patients) and coiling (1 patient). Intraoperative rupture occurred in 14 and 4 patients in the microsurgical and endovascular groups, respectively. Ischemic events occurred in 16 and 8 patients in the microsurgical and endovascular groups, respectively. At 1-year follow-up, a favorable clinical outcome was achieved in 18 (54.5%) and 38 (76.0%) patients in the microsurgical and endovascular groups, respectively. The multivariate regression model showed that the treatment strategies, Fisher grade, and vasospasm contributed significantly to the prediction of outcome for 1 year. CONCLUSIONS: BBAs are challenging vascular lesions with poor prognosis. Endovascular treatment may be more effective and safer with better outcomes than surgical approaches.

Construction of π-Surface-Metalated Pillar[5]arenes which Bind Anions via Anion-π Interactions.

By simple ligand exchange of the cationic transition-metal complexes [(Cp*)M(acetone)3 ](OTf)2 (Cp*=pentamethylcyclopentadienyl and M=Ir or Rh) with pillar[5]arene, mono- and polynuclear pillar[5]arenes, a new class of metalated host molecules, is prepared. Single-crystal X-ray analysis shows that the charged transition-metal cations are directly bound to the outer π-surface of aromatic rings of pillar[5]arene. One of the triflate anions is deeply embedded within the cavity of the trinuclear pillar[5]arenes, which is different to the host-guest behavior of most pillar[5]arenes. DFT calculation of the electrostatic potential revealed that the metalated pillar[5]arenes featured an electron-deficient cavity due to the presence of the electron-withdrawing transition metals, thus allowing encapsulation of electron-rich guests mainly driven by anion-π interactions.