Background In recent years,a growing number of stents and stent-like devices have become available to facilitate the treatment of challenging aneurysms.However,the need for dual antiplatelet therapy can limit their us...Background In recent years,a growing number of stents and stent-like devices have become available to facilitate the treatment of challenging aneurysms.However,the need for dual antiplatelet therapy can limit their use,especially in ruptured aneurysms.The hydrophilic polymer coating(pHPC,phenox)is a novel glycan-based multilayer polymer that reduces platelet adhesion.This study aims to report our initial experience using the pCONUS HPC device for the treatment of unruptured wide-necked bifurcation aneurysms(WNBA)using acetylsalicylic acid(ASA)as single antiplatelet therapy(SAPT).Methods We retrospectively identified all patients who were treated with the pCONUS HPC for unruptured WNBA in a multi-staged procedure using ASA as SAPT.Records were made of periprocedural complications,clinical outcome and angiographic and clinical follow-up.Results We identified 15 patients with 15 WNBA.The average age was 69 years old(range,41-76).Seven aneurysms were located in the middle cerebral artery,five in the anterior communicating artery,two at the basilar tip and one in the posterior communicating artery.Immediate post-treatment angiography showed five aneurysms with modified Raymond-Roy classification(mRRC)grade Ⅰ and four aneurysms with mRRC grade Ⅱ.There were no haemorrhagic complications.Four patients developed thrombus formation during the second treatment session,all of them completely resolving after administration of glycoprotein Ⅱb/Ⅲa antagonists.Angiographic follow-up data were available for 10 patients and showed adequate occlusion(mRRC Ⅰ or Ⅱ)in eight aneurysms(80%).In-stent stenosis was observed in one patient whereas two patients showed de novo stenosis in one of the efferent branches.Conclusions This early experience on the use of the pCONUS HPC device suggests that it can be useful for treating unruptured WNBA under ASA as SAPT.Further investigation with a randomised treatment registry and larger cohort is needed.展开更多
Background Paediatric arterial ischaemic stroke is an important cause of morbidity and mortality among children.Currently,there are no recommendations regarding mechanical thrombectomy in children despite overwhelming...Background Paediatric arterial ischaemic stroke is an important cause of morbidity and mortality among children.Currently,there are no recommendations regarding mechanical thrombectomy in children despite overwhelming evidence of improved outcomes in adults.Therefore,the need for individual case reports and case series is important to highlight potential advantages and disadvantages in this approach.Case descriptions We retrospectively searched our prospectively maintained database of patients undergoing mechanical thrombectomy for ischaemic stroke.We describe five children,aged between 7 and 17,who underwent mechanical thrombectomy for acute ischaemic stroke.We provide an account of their clinical presentations,operative treatment and postoperative outcome.Discussion Mechanical thrombectomy in children,especially older children,can be performed safely and with existing devices.Although a randomised controlled trial would provide compelling evidence of the potential advantages to this technique,the lack of this should not prevent the use of this procedure by trained neurointerventionists.展开更多
文摘Background In recent years,a growing number of stents and stent-like devices have become available to facilitate the treatment of challenging aneurysms.However,the need for dual antiplatelet therapy can limit their use,especially in ruptured aneurysms.The hydrophilic polymer coating(pHPC,phenox)is a novel glycan-based multilayer polymer that reduces platelet adhesion.This study aims to report our initial experience using the pCONUS HPC device for the treatment of unruptured wide-necked bifurcation aneurysms(WNBA)using acetylsalicylic acid(ASA)as single antiplatelet therapy(SAPT).Methods We retrospectively identified all patients who were treated with the pCONUS HPC for unruptured WNBA in a multi-staged procedure using ASA as SAPT.Records were made of periprocedural complications,clinical outcome and angiographic and clinical follow-up.Results We identified 15 patients with 15 WNBA.The average age was 69 years old(range,41-76).Seven aneurysms were located in the middle cerebral artery,five in the anterior communicating artery,two at the basilar tip and one in the posterior communicating artery.Immediate post-treatment angiography showed five aneurysms with modified Raymond-Roy classification(mRRC)grade Ⅰ and four aneurysms with mRRC grade Ⅱ.There were no haemorrhagic complications.Four patients developed thrombus formation during the second treatment session,all of them completely resolving after administration of glycoprotein Ⅱb/Ⅲa antagonists.Angiographic follow-up data were available for 10 patients and showed adequate occlusion(mRRC Ⅰ or Ⅱ)in eight aneurysms(80%).In-stent stenosis was observed in one patient whereas two patients showed de novo stenosis in one of the efferent branches.Conclusions This early experience on the use of the pCONUS HPC device suggests that it can be useful for treating unruptured WNBA under ASA as SAPT.Further investigation with a randomised treatment registry and larger cohort is needed.
文摘Background Paediatric arterial ischaemic stroke is an important cause of morbidity and mortality among children.Currently,there are no recommendations regarding mechanical thrombectomy in children despite overwhelming evidence of improved outcomes in adults.Therefore,the need for individual case reports and case series is important to highlight potential advantages and disadvantages in this approach.Case descriptions We retrospectively searched our prospectively maintained database of patients undergoing mechanical thrombectomy for ischaemic stroke.We describe five children,aged between 7 and 17,who underwent mechanical thrombectomy for acute ischaemic stroke.We provide an account of their clinical presentations,operative treatment and postoperative outcome.Discussion Mechanical thrombectomy in children,especially older children,can be performed safely and with existing devices.Although a randomised controlled trial would provide compelling evidence of the potential advantages to this technique,the lack of this should not prevent the use of this procedure by trained neurointerventionists.
