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Objective:To investigate the safety and efficacy of intravascular intervention in ruptured intracranial vertebral artery dissecting aneurysm (IVADA).Methods:A retrospective analysis was performed; 25 patients with ruptured IVADA (25 aneurysms) admitted to Department of Neurosurgery, First Affiliated Hospital of University of Science and Technology of China from January 2020 to June 2023, were chosen. Aneurysm and parent artery occlusion or stent-assisted spring coil embolization were performed according to location of the aneurysms, degrees of aneurysm immediate embolization were evaluated by Raymond grading, and perioperative adverse events were recorded. The patients were followed up for 6-48 months, and aneurysm recurrence was determined according to DSA results; prognoses were assessed by modified Rankin Scale (mRS), with scores of 0-2 as good prognosis and scores of 3-6 as poor prognosis.Results:All 25 patients had unilateral ruptured IVADA, 10 (40%) received aneurysm and parent artery occlusion (occlusion of dissection segment) and 15 (60%) received stent-assisted embolization. Immediately after surgery, 19 patients (76%) had grading I embolization, 4 (16%) grading II embolization, and 2 (8%) grading III embolization. No aneurysm rupture or stent related thrombosis was observed during procedure; 3 patients (12%) died after procedure, with postoperative rebleeding in 1, postoperative cerebellar infarction with respiratory failure in 1, and severe pneumonia in 1. In the 22 survivals, 18 had good prognosis and 4 had poor prognosis. In the 5 relapsed patients (all accepted stent-assisted embolization), 4 underwent re-intervention, and one with visualization at aneurysm neck was relatively stable on re-examination and accepted regular follow up.Conclusion:Aneurysm and parent artery occlusion can be used for non-dominant vertebral artery aneurysms not involving posterior inferior cerebellar artery, whose recurrence rate is lower than that of stent-assisted coil embolization.
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Objective:To observe the short-term efficacy and complications of flow diverter device Tubridge in the treatment of complex intracranial aneurysms, and to summarize the indications and experience of Tubridge in treatment of complex intracranial aneurysms.Methods:Thirty-one patients with complex intracranial aneurysms accepted treatment with assistance of Tubridge in our hospital from January 2020 to December 2020 were enrolled. Raymond grading was used to evaluate the degrees of aneurysm embolization immediately after surgery. Modified Rankin scale (mRS) was used to evaluate the prognoses 6 months after surgery. The embolization of aneurysms was determined in these patients by DSA 6 and 12 months after surgery.Results:Thirty-seven aneurysms were noted in these 31 patients. A total of 32 diverters (Turbridge) were implanted into these 37 aneurysms, and all of which were successfully delivered and released. Thirteen aneurysms were filled with spring coils (8 with Raymond grading I, 2 with Raymond grading II, 3 with Raymond grading III by DSA immediately after surgery), and 24 aneurysms were not filled with spring coils. Postoperative ischemic complications occurred in 1 patient, and no hemorrhagic complications or death were noted. All 31 patients had good prognosis at follow-up. Six months after surgery, DSA re-examination in 24 patients (77.4%) showed that complete occlusion of aneurysms was achieved in 17 patients (70.8%). DSA re-examination 12 months after surgery showed complete occlusion of aneurysms in 19 of the 25 patients (76%).Conclusion:The new domestic flow diverter device Tubridge has a high success rate, less perioperative complications, high safety, and good recovery in the treatment of complex intracranial aneurysm.
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Objective To observe the effect of brain-derived microvesicles (BDMVs) on cytoskeleton in human umbilical vein endothelial cells (HUVECs).Methods BDMVs were prepared in vitro and identified by transmission electron microscopy and particle size identification.HUVECs were co-cultured with PKH26-1abeled BDMVs for 0.5,1,and 2 h;flow cytometry was used to detect the phagocytosis of HUVECs for BDMVs at different time points.HUVECs cultured in vitro were divided into control group,BDMVs treatment group and nimodipine treatment group;cells in the BDMVs treatment group were given 1.5× 107/mL BDMVs;cells in the nimodipine treatment group were pretreated with 2 μg nimodipine (0.2 mg/mL) for 10 min,and then,given 1.5×107/mL BDMVs.After being stained with rhodamine-labeled phalloidin,the fluorescence intensity and number of stress fibers of fibroactin in HUVECs were observed by laser confocal microscopy.Results BDMVs had complete membrane structure with a diameter of 100-1000 nm under transmission electron microscopy.The proportion of cells phagocytizing BDMVs increased significantly with prolonged incubation time,enjoying significant differences (0.5h:22.7％±1.2％;1 h:52.3％±1.3％;2h:71.6％±1.9％,P＜0.05).Laser confocal microscopy showed that,as compared with the control group,the fluorescence intensity ofcytoskeletal protein was obviously increased and the number of stress fibers increased was obviously larger in the BDMVs treatment group.As compared with those in the BDMVs treatment group,the fluorescence intensity of cytoskeletal protein was decreased and the number of stress fibers was obviously smaller in the nimodipine group.Conclusion The role of BDMVs in phagocytosis of HUVECs becomes stronger as time being prolonged,and BDMVs phagocytosis leads to cytoskeletal remodeling,which can be partially blocked by nimodipine.
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Objective To investigate the effect of astrocyte-derived microparticles on intracellular free calcium concentration in umbilical vein endothelial cells (UVECs).Methods Brain astrocytes were first isolated from 24 h new-born Sprague-Dawley rats and cultured in vitro.Then,they were stimulated with calcium ionophore,A23187,and microparticles were extracted by fractional centrifugation and verified by electron microscopy.UVECs cultured in vitro were divided into control group,nimotop group,and low,median and high concentrations ofmicroparticles groups;cells from nimotop group were pretreated with 10 μL nimotop for 10 min;cells from the later 4 groups were given 1×108,0.5×108,1×108,and 2× 108/mL microparticles respectively;cells from the control group were given the same volume of medium.Ten min after cultivation,they were loaded with fluorescent probe Fluo3-AM,respectively.Later,the concentration of Ca2+ in UVECs was measured by confocal laser scanning microscope and flow cytometry.Results The isolation and in vitro culture methods for rat astrocytes provided stable and reliable results.With A23187 stimulation and fractional centrifugation,astrocyte derived microparticles were available for extraction.Laser scanning confocal microscope indicated that the intracellular fluorescence intensity in the control group was the lowest;after incubating UVECs with low,median and high concentrations of astrocyte-derived microparticles,the intracellular fluorescence intensity increased,and it increased following the concentrations of astrocyte-derived microparticles;pretreatment with nimotop could moderately decrease the intracellular fluorescence intensity,but that in the nimotop group was still higher than that in the control group.The mean fluorescence values for intracellular free Ca2+ were 51 866,57 996 and 73 630,respectively,in the low,median and high concentrations of microparticles groups,which showed statistically significant increase as compared with that from the control group (45 759,P＜0.05).When nimotop was applied to the cells,it blocked the influx of calcium ions and the measured value was significantly changed to 49843,enjoying significant difference as compared with that from the low,median and high concentrations of microparticles groups (P＜0.05).Conclusion Astrocyte-derived microparticles are capable of increasing the intracellular free calcium concentration in UVECs,and the effects can be blocked by nimotop.
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Cerebral amyloid angiopathy is closely associated with intracerebral hemorrhage. In recent years, a further understanding of etiology, pathogenesis, diagnosis and treatment on cerebral amyloid angiopathy-related intracerebral hemorrhage has been achieved.