Endovascular Aneurysm Treatment with the Numen Coil Embolization System: A Prospective Randomized Controlled Open-Label Multicenter Noninferiority Trial in China.

OBJECTIVE: We investigated the safety and efficacy of the Numen coil compared with the Axium coil in the treatment of intracranial aneurysms. METHODS: Because CATCH (Coil Application Trial in China) is a prospective randomized controlled open-label noninferiority trial conducted in 10 centers across China, patients who fulfilled the inclusion and exclusion criteria were randomized 1:1 to either a test group (Numen) or a control group (Axium). The primary outcome was based on successful aneurysm occlusion at 6 months follow-up, whereas secondary outcomes included technical success, the recanalization and retreatment rates, and the rate of serious adverse events (SAEs) at 6 months and 12 months follow-up. RESULTS: Between August 2017 and December 2019, 350 patients presenting with 350 aneurysms were enrolled and randomized. Per-protocol analysis showed that the successful aneurysm occlusion rate at 6 months was 91.18% for the test group compared with 91.85% in the control group, with a difference of -0.68% (P = 0.8419), and the overall mortality during the 30-day follow-up period was 1.19% and 1.81% in the test and control group, respectively, showing no significant difference between the 2 groups (P = 0.6837), whereas the SAE incidence during the 12-month follow-up period was 12.50% and 17.47% in the test and control groups, respectively, which was not statistically significant (P = 0.2222). CONCLUSIONS: This trial showed that the Numen coil was noninferior to the Axium coil in terms of intracranial aneurysm embolization and can be considered as a safe and effective coil for treating patients with intracranial aneurysm in clinical practice.

Imaging Predictors for Endovascular Recanalization of Non-acute Occlusion of Internal Carotid Artery Based on 3D T1-SPACE MRI and DSA.

Objectives: To investigate the predictive factors for successful recanalization based on digital subtraction angiography and three-dimensional T1W sampling perfection with application-optimized contrasts using different flip angle evolutions (3D T1-SPACE) high-resolution magnetic resonance imaging (MRI) signal features. Methods: Consecutive internal carotid artery occlusion cases with ipsilateral ischemic stroke refractory to therapy who visited our institution between February 2017 and August 2020 were retrospectively analyzed. Epidemiology, symptomatology, imaging morphology on angiography and MRI, peri-procedural complications, technical success rate, and follow-up results were summarized. Factors related to technical success were analyzed using univariate and multivariate analyses. Results: In total, 75 cases (53 men, mean age 57.51 ± 9.71 years) were included. The total successful recanalization rate was 72.00% (54/75), with a complication rate of 13.33% (9/75). Through multivariate analysis, first ischemic stroke in <3 months (OR: 2.57; 95% CI: 1.13-4.58), tapered stump (OR: 4.31; 95% CI: 1.37-13.55), reversed flow of the ophthalmic artery (OR: 2.99; 95% CI: 1.06-8.49), high intraluminal signal on unenhanced T1-SPACE sequence (OR: 16.15; 95% CI: 3.40-76.72), no vessel wall collapse (OR: 17.00; 95% CI: 3.57-81.02), short occlusion length (OR: 9.87; 95% CI: 2.09-46.64), and primary occlusion site at the cervical internal carotid artery (OR: 8.42; 95% CI: 1.04-68.19) were associated with successful recanalization. Conclusion: Besides traditional features such as short ischemic event time, tapered stump, and distal ICA reconstitution by the ophthalmic artery, our study demonstrates that luminal and mural changes determined by 3D SPACE high-resolution MRI could also predict successful endovascular recanalization. Endovascular recanalization for non-acute internal carotid artery occlusion is feasible, but prudent case selection is mandatory considering the high periprocedural complication rate.

Effects of chronic and acute training on glucocorticoid receptors concentrations in rats.

The effects of chronic endurance training and acute exercise on glucocorticoid receptors were investigated in rats. For chronic endurance training, rats were exposed to progressive running training on a motor-driven treadmill for 3, 5 and 7 weeks, twice a day and 6 days a week. The samples were taken, 34-36 hours after the last exercise bout. Some of the 7-week training rats were killed by decapitation 7 days following the last exercise bout. The glucocorticoid receptors in hepatic cytosol in 5-week and 7-week rats decreased as compared to the sedentary control. There was no significant difference between the glucocorticoid receptors in hepatic cytosol in some of the 7-week rats those who had stopped training for 7 days and those in the controls. The chronic endurance training did not lead to change of the apparent dissociation constant (Kd). The changes of glucocorticoid receptors after acute exercise have also been investigated and it showed profound decreases of glucocorticoid receptors in renal and myocardial cytosol in low intensity (swimming without an extra weight for 60 minutes) and high intensity (swimming with a weight equal to 6% of body mass for 60 minutes) training groups. The decreases in glucocorticoid receptors in renal and myocardial cytosol were less prominent after low intensity training. These results demonstrated that both acute exercise training and chronic endurance training could lead to a decrease in glucocorticoid receptors, which was in a training intensity- and training load volume-dependent manner, and the changes in glucocorticoid receptors during exercise training were reversible.