Safety and efficacy of stent-assisted coiling for acutely ruptured wide-necked intracranial aneurysms:comparison of LVIS stents with laser-cut stents

Background:To compare the safety and efficacy of LVIS stent-assisted coiling with those of laser-cut stent-assisted coiling for the treatment of acutely ruptured wide-necked intracranial aneurysms.Methods:Patients with acutely ruptured wide-necked intracranial aneurysms treated with LVIS stent-assisted coiling(LVIS stent group)and laser-cut stent-assisted coiling(laser-cut stent group)were retrospectively reviewed from January 2014 to December 2017.Propensity score matching was used to adjust for potential differences in age,sex,aneurysm location,aneurysm size,neck width,Hunt-Hess grade,and modified Fisher grade.Perioperative procedure-related complications and clinical and angiographic follow-up outcomes were compared.Univariate and multivariate analyses were performed to determine the associations between procedure-related complications and potential risk factors.Results:A total of 142 patients who underwent LVIS stent-assisted coiling and 93 patients who underwent laser-cut stent-assisted coiling were enrolled after 1:2 propensity score matching.The angiographic follow-up outcomes showed that the LVIS stent group had a slightly higher complete occlusion rate and lower recurrence rate than the laser-cut stent group(92.7%vs 80.6%;3.7%vs 9.7%,P=0.078).The clinical outcomes at discharge and follow-up between the two groups demonstrated no significant differences(P=0.495 and P=0.875,respectively).The rates of intraprocedural thrombosis,postprocedural thrombosis,postoperative early rebleeding,and procedure-related death were 0.7%(1/142),1.4%(2/142),2.8%(4/142),and 2.1%(3/142)in the LVIS stent group,respectively,and 4.3%(4/93),2.2%(2/93),1.1%(1/93),and 3.2%(3/93)in the laser-cut stent group,respectively(P=0.082,0.649,0.651,and 0.683).Nevertheless,the rates of overall procedure-related complications and intraprocedural rupture in the LVIS stent group were significantly lower than those in the laser-cut stent group(5.6%vs 14.0%,P=0.028;0.7%vs 6.5%,P=0.016).Multivariate analysis showed that laser-cut stent-assisted coiling was an independent predictor for overall procedurerelated complications(OR=2.727,P=0.037);a history of diabetes(OR=7.275,P=0.027)and other cerebrovascular diseases(OR=8.083,P=0.022)were independent predictors for ischemic complications,whereas none of the factors were predictors for hemorrhagic complications.Conclusions:Compared with laser-cut stent-assisted coiling,LVIS stent-assisted coiling for the treatment of acutely ruptured wide-necked intracranial aneurysms could reduce the rates of overall procedure-related complications and intraprocedural rupture.

The biology of bone morphogenetic protein signaling pathway in cerebrovascular system

Bone morphogenetic protein belongs to transcription growth factor superfamilyβ;bone morphogenetic protein signal pathway regulates cell proliferation,differentiation,and apoptosis among different tissues.Cerebrovascular system supplies sufficient oxygen and blood into brain to maintain its normal function.The disorder of cerebrovascular system will result into serious cerebrovascular diseases,which is gradually becoming a major threat to human health in modern society.In recent decades,many studies have revealed the underlying biology and mechanism of bone morphogenetic protein signal pathway played in cerebrovascular system.This review will discuss the relationship between the two aspects,aiming to provide new perspective for non-invasive treatment and basic research of cerebrovascular diseases.

Underlying mechanism of hemodynamics and intracranial aneurysm

In modern society,subarachnoid hemorrhage,mostly caused by intracranial aneurysm rupture,is accompanied by high disability and mortality rate,which has become a major threat to human health.Till now,the etiology of intracranial aneurysm has not been entirely clarified.In recent years,more and more studies focus on the relationship between hemodynamics and intracranial aneurysm.Under the physiological condition,the mechanical force produced by the stable blood flow in the blood vessels keeps balance with the structure of the blood vessels.When the blood vessels are stimulated by the continuous abnormal blood flow,the functional structure of the blood vessels changes,which becomes the pathophysiological basis of the inflammation and atherosclerosis of the blood vessels and further promotes the occurrence and development of the intracranial aneurysm.This review will focus on the relationship between hemodynamics and intracranial aneurysms,will discuss the mechanism of occurrence and development of intracranial aneurysms,and will provide a new perspective for the research and treatment of intracranial aneurysms.

Treatment delay from aneurysmal subarachnoid hemorrhage to endovascular treatment:a high-volume hospital experience

Background:Early treatment for patients with aneurysmal subarachnoid hemorrhage(aSAH)could significantly reduce the risk of re-bleeding and improve clinical outcomes.We assessed the different time intervals from the initial hemorrhage,admission,and endovascular treatment and identified the risk factors contributing to delay.Methods:Between February 2017 and December 2019,422 consecutive aSAH patients treated in a high-volume hospital were collected and reviewed.Risk factors contributing to admission delay and treatment delay were analyzed with univariate and multivariate analysis.Results:One hundred twenty-two(28.9%)were admitted to the high-volume hospital at the day of symptom onset and 386(91.5%)were treated with endovascular management at the same day of admission.The multivariate analysis found that younger age(P=0.022,OR=0.981,95%CI 0.964–0.997)and good Fisher score(P=0.002,OR=0.420,95%CI 0.245–0.721)were independent risk factors of admission delay.None was found to be related with treatment delay.Multivariate analysis(OR(95%CI))showed that higher age 1.027(1.004–1.050),poorer Fisher score 3.496(1.993–6.135),larger aneurysmal size 1.112(1.017–1.216),and shorter interval between onset to admission 1.845(1.018–3.344)were independent risk factors of poorer clinical outcome.Conclusion:Treatment delay was mainly caused by pre-hospital delay including delayed admission and delayed transfer.Our experience showed that cerebrovascular team could provide early treatment for aSAH patients.Younger age and good Fisher score were significantly related with admission delay.However,admission delay was further significantly correlated with better clinical outcome.