Cerebral lipiodol embolism following transcatheter arterial chemoembolization for hepatocellular carcinoma

Cerebral lipiodol embolism (CLE) is an extremely rare complication of transcatheter arterial chemoembolization for hepatocellular carcinoma (HCC). The authors present a case of CLE that occurred after the second hepatic arterial chemoembolization for HCC, and attempt to introduce several plausible mechanisms of CLE, after reporting the clinical and radiological findings and reviewing the medical literature.

Neuroprotective effect of bispectral index-guided fast-track anesthesia using sevoflurane combined with dexmedetomidine for intracranial aneurysm embolization

Dexmedetomidine has sedative, anxiolytic, analgesic, anti-sympathetic, and anti-shivering effects. Dexmedetomidine might be effective in combination with sevoflurane for anesthesia, but prospective randomized controlled clinical trials with which to verify this hypothesis are lacking. In total, 120 patients who underwent embolization of an intracranial aneurysm were recruited from Anhui Provincial Hospital and Renmin Hospital of Wuhan University of China and randomly allocated to two groups. After intraoperative administration of 2% to 3% sevoflurane inhalation, one group of patients received pump-controlled intravenous injection of 1.0 ~tg/kg dexmedetomidine for 15 minutes followed by maintenance with 0.3 ~tg/kg/h until the end of surgery; the other group of patients only underwent pump-controlled infusion of saline. Bispectral index monitoring revealed that dexmedetomidine-assisted anesthesia can shorten the recovery time of spon- taneous breathing, time to eye opening, and time to laryngeal mask removal. Before anesthetic induction and immediately after laryngeal mask airway removal, the glucose and lactate levels were low, the S100~ and neuron-specific enolase levels were low, the perioperative blood pressure and heart rate were stable, and postoperative delirium was minimal. These findings indicate that dexmedetomidine can effectively assist sevoflurane for anesthesia during surgical embolization of intracranial aneurysms, shorten the time to consciousness and extubation, reduce the stress response and energy metabolism, stabilize hemodynamic parameters, and reduce adverse reactions, thereby reducing the damage to the central nervous system. This trial was registered at the Chinese Clinical Trial Registry （http：//www.chictr.org. cn/） （registration number： ChiCTR-IPR- 16008113）.

Endovascular coil embolization of parent artery for giant intracranial basilar dissection:a case report and literature review

Objective The purpose of the current study was to evaluate the method and result of endovascular treatment for a giant unruptured dissection of the basilar artery (BA) . Methods A 14-year-old boy underwent computed tomography (CT) scan following a minor head trauma was incidentally found a lesion located

Clinical evaluation of timing of endovascular embolization treatment for intracranial aneurysm

Objective To evaluate the effects of endovascular embolization treatment for intracranial aneurysms in different time. Methods The clinical data of 165 cases of ruptured intracranial aneurysm treated by endovascular treatment were analysed retrospectively. The patients were divided into 3 groups accrodding to

EFFECTS OF ELECTRO-ACUPUNCTURE ON SOMATOSTATIN AND PANCREATIC POLYPEPTIDE IN ISCHEMIC CEREBROVASCULAR DISEASES

The levels of somatostatin(SS)in CSF and blood and pancreatic polypeptide(PP)inplasma were measured by radioimmunoassay in 64 patients with acute ischemiccerebrovascular diseases(ICVD),randomly divided into two groups:group 1(n=31,bothelectro-acupuncture and routine treatments given)and group 2(n=33,routine treatment)and 26 non-ICVD patients were used as controls.The points of electro-acupuncture wereQuchi(LI 12),Waiguan(SJ 5)and Huantiao(GB 30)and Zusanli(St 36).After a courseof treatment,the SS levels in plasma and CSF were significantly increased in the patientsof group 1 with good result and their plasma PP level had no significant change.In thepatients with poor result,however,the PP level was significantly decreased.The resultssuggested that electro-acupuncture might play an active role in alleviating the SSmetabolic disturbance in CNS of ICVD patients.

Delayed cerebral lipiodol embolism after transcatheter arterial chemoembolization of hepatocellular carcinoma

Transcatheter arterial chemoembolization （TACE） has been an effective mean in treating hepatocellular carcinoma for nearly 30 years. The reported complications associated with TACE mainly include acute hepatic failure （accounting for 0.26%）, liver abscess （0.22%）, multiple intrahepatic aneurysms （0.17%）, hepatic artery occlusion （1.52%）, spontaneous rupture of tumor （0.15%）, gallbladder infarction （0.3%）, perforation of duodenum （0.05%）, acute renal failure （0.05%）,

Safety and efficacy of stent placement for treatment of intracranial aneurysms： a systematic review

Objective To evaluate the safety and efficacy of stent placement for the treatment of complex intracranial aneurysms. Data sources We searched six databases, including Pubmed, Embase, SCI-expanded, the Cochrane Library, ISI Proceedings and ProQuest Dissertations ＆ Theses for the relevant studies using multiple key words from December, 1997 to February, 2009. Study selection Thirty-three studies about stent placement for intracranial aneurysms were identified, which reported data from a total of 1069 patients with 1121 intracranial aneurysms. Data extraction We prepared a standardized data extraction form （DEF）, which was used by two independent researchers to extract data from the included 33 studies. Results The overall initial complete occlusion rate was 52.5% （456/869, 95% CI： 49.2%-55.8%）. The overall complication rate was 14.3% （162/1130, 95% CI： 12.3%-16.4%）, of which 3.6% （38/1044, 95% CI： 2.5%-4.8%） were permanent. Clinical follow-up showed a dependence rate of 8.4% （39/465, 95% CI： 5.9%-10.9%）. Angiographic follow-up showed an improvement rate of 24.3% （117/481, 95% CI： 20.5%-28.2%） and a recurrence rate of 12.9% （62/481, 95% CI： 9.9%-15.9%）. Chi-squared tests were performed to compare the following subgroups： self-expandable vs. balloon-expandable stents, unruptured vs. acutely ruptured aneurysms, and with vs. without pre-medication. Statistical significance was reached in eight tests. Conclusions Intracranial stent is a safe and effective tool for embolizing complex intracranial aneurysms. Self-expandable stents are significantly easier and safer than balloon-expandable stents with respect to navigation and deployment through the tortuous cerebral vasculature. Patients with acutely ruptured aneurysms are more likely to be dependent, but not more likelv to suffer more orocedure-related comolications.

Combined stent and coil in endovascular treatment of intracranial wide-necked and fusiform aneurysms

Background Wide-necked and fusiform aneurysms are challenges for interventional neuroradiologists and neurosurgeons since they may involve entire vessels or be irregular in shape,making is possible for Guglielmi detachable coil to protrude into the parent arteries. This study was to evaluate the endovascular treatment of intracranial wide-necked and fusiform aneurysms by using a combination of stents and coils. Methods From October 2000 to July 2001,eighteen patients with intracranial wide-necked or fusiform aneurysms were treated with intraluminal stenting in combination with endosaccular coiling. Results Stent placement and coil packing were technically successful in all patients. There were no complications related to the procedure except for the migration of the stent in four cases. The aneurysms were embolized with the coils after precise stenting,and total occlusion was obtained in 13 cases,neck remnants in 3,and loose occlusion in 2. All the patients recovered well. Short-term follow-up angiograms suggested patency of the parent arteries without recanalization. Conclusions A combination of endovascular stenting and coil packing may be a favorable alternative for the treatment of intracranial aneurysms that are unsuitable for surgical clipping or coil embolization. Further study is necessary to assess the long-term outcome.

Expression of recombinant adeno-associated virus in the brain of rats with a focal embolic stroke via carotid artery

OBJECTIVE: To study whether recombinant adeno-associated virus (rAAV) mediated foreign gene, LacZ, could pass the blood brain barrier by intra-carotid artery delivery and express in vivo in ischemic brain of the focal embolic stroke rats to investigate a possibility of delivering foreign gene through carotid artery to treat acute ischemic stroke. METHODS: The carotid artery territory in 41 rats was embolized with or without arterial-like fibrin rich clots to make a model of focal embolic stroke rat. rAAV containing LacZ gene (rAAV-LacZ) was constructed in 293 cells by calcium phosphate cotransfection. The rats were assigned to one of the following treatments: 1 control (without embolism) groups, including PBS treated (n = 6), pLacZ treated (n = 6 ) and rAAV-LacZ treated (n = 6): 2 embolic groups, including embolism + PBS (n =7),embolism + pLacZ (n = 8) and embolism + rAAV-LacZ (n = 8). Brains were cryosectioned and kappa-Gal stain was performed at 2, 4, and 8 weeks, respectively, after transfection, and then infarct volume was measured and the percentage of LacZ staining-positive cells was calculated. RESULTS: In all the control groups and embolism + PBS treated animal, no kappa-Gal staining-positive cells were found, but in embolism + pLacZ (n = 8) and embolism+rAAV-LacZ groups a lot of kappa-Gal staining-positive cells were found. The expression cells were in the tissues around the infarction. The gene expression persisted only nearly four weeks in embolic group with pLacZ. In the embolic group with rAAV-LacZ the expression was very stable during the experiment course (eight weeks) and the percentage of the expressed cells was significantly higher than that of its contralateral areas at the same time points, respectively. CONCLUSIONS: The plasmid vector and rAAV could enter the brain through the ischemia-damaged blood barrier and foreign gene can be expressed in brain. The positive gene expression is mainly in the peripheral areas of the infarction. rAAV as a permanent expression vector may ultimately be used for gene therapy of human ischemia cerebravascular diseases.

Aortic arch and intra-/extracranial cerebral arterial atherosclerosis in patients suffering acute ischemic strokes

OBJECTIVE: To determine the distribution of aortic arch and intra/extracranial cerebral arterial atherosclerosis in Chinese patients who had suffered acute ischemic strokes. METHODS: Eighty-nine patients with acute ischemic strokes were included in this study. Transesophageal echocardiography (TEE) was used to evaluate potential sources of embolisms in the aortic arch and in the heart; duplex ultrasound was used for the carotid artery; and intracranial Doppler (TCD) imaging was used for the middle cerebral artery (MCA), anterior cerebral artery (ACA), posterior cerebral artery (PCA), and basilar artery (BA). An atherosclerotic lesion in the aortic arch was defined as normal (0); mild plaque (1); moderate plaque (2); and protruding plaque or mobile plaque (3). A lesion in the carotid artery was considered a plaque if the maximal carotid plaque thickness was 1.2 mm. TCD results were deemed abnormal if flow velocity was either greater or lower than normal, and, in the case of the MCA, if an asymmetry index above 21% was measured. RESULTS: Of the 89 patients, 52 (58.43%) patients showed evidence of aortic arch atherosclerosis (AAA), including 11 (12.36%) patients graded mild, 18 (20.22%) patients graded moderate, and 23 (25.84%) patients graded severe. Of the 23 patients with severe AAA, AAA was determined to be an important potential embolic source in 14 patients. Forty-nine (50.56%) patients had carotid arterial plaques (CAPs). The incidence of carotid plaques was higher among patients with AAA than among patients without AAA (71.15% vs 21.62%, OR = 3.291, 95% CI = 1.740 - 6.225, P