An unusual etiology of subarachnoid hemorrhage,basilar artery perforator aneurysms,in Macao:Three case reports and review of literature

BACKGROUND Subarachnoid hemorrhage is a severe neurological condition that requires prompt and appropriate treatment to prevent complications.Aneurysms are the most common cause of spontaneous subarachnoid hemorrhage.Conversely,basilar artery perforator aneurysms(BAPAs)are a rare etiology.There is no consensus on the optimal management of ruptured BAPAs in the acute setting.CASE SUMMARY We present a case series of 3 patients with ruptured BAPAs who were treated at our institution.Two patients had a modified Fisher grade of I,and one had a grade of IV on initial presentation.The aneurysms were detected by computed tomography angiography in two cases and conventional angiography in one case.The 3 patients underwent endovascular treatment with Guglielmi detachable coils.Post-treatment,the patients had good clinical outcomes,and follow-up brain computed tomography scans showed reduced subarachnoid hemorrhage without any new hemorrhage.However,one patient experienced a cerebral infarction 2 months later and eventually succumbed to the condition.The other 2 patients showed progressive recovery,and no aneurysm recurrence was observed at the 2-year follow-up.CONCLUSION Endovascular treatment may be a preferable approach for managing ruptured BAPAs compared with surgical intervention or conservative management.Early detection and prompt treatment is important to achieve favorable patient outcomes.

Differential Effect of Calcium-Activated Potassium and Chloride Channels on Rat Basilar Artery Vasomotion

Spontaneous, rhythmical contractions, or vasomotion, can be recorded from cerebral vessels under both normal physiological and pathophysiological conditions. We investigated the cellular mechanisms underlying vasomotion in the cerebral basilar artery （BA） of Wistar rats. Pressure myograph video microscopy was used to study the changes in cerebral artery vessel diameter. The main results of this study were as follows： （1） The diameters of BA and middle cerebral artery （MCA） were 314.5±15.7 μm （n=15） and 233.3±10.1 μm （n=12） at 10 mmHg working pressure （P〈0.05）, respectively. Pressure-induced vasomotion occurred in BA （22/28, 78.6%）, but not in MCA （4/31, 12.9%） from 0 to 70 mmHg working pressure. As is typical for vasomotion, the contractile phase of the response was more rapid than the relaxation phase; （2） The frequency of vasomotion response and the diameter were gradually increased in BA from 0 to 70 mmHg working pressure. The amplitude of the rhythmic con- tractions was relatively constant once stable conditions were achieved. The frequency of contractions was variable and the highest value was 16.7±4.7 （n=13） per 10 min at 60 mmHg working pressure; （3） The pressure-induced vasomotion of the isolated BA was attenuated by nifedipine, NFA, 181]-GA, TEA or in Ca2＋-free medium. Nifedipine, NFA, 18^-GA or Ca2＋-free medium not only dampened vasomotion, but also kept BA in relaxation state. In contrasts, TEA kept BA in contraction state. These results sug- gest that the pressure-induced vasomotion of the isolated BA results from an interaction between Ca2＋-activated C1- channels （CaCCs） currents and Kca currents. We hypothesize that vasomotion of BA depends on the depolarizing of the vascular smooth muscle cells （VSMCs） to activate CaCCs. Depolarization in turn activates voltage-dependent Ca2＋ channels, synchronizing contractions of adjacent cells through influx of extracellular calcium and the flow of calcium through gap junctions. Subsequent calcium-induced calcium release from ryanodine-sensitive stores activates Kca channels and hyperpo- larizes VSMCs, which provides a negative feedback loop for regenerating the contractile cycle.

A Clinical Study on the Effect of Yinxing Damo (银杏达莫) Combined with Betahistine Hydrochloride Injection on Vertebral Basilar Artery Ischemic Vertigo

To evaluate the therapeutic efficacy of Yinxing Damo （银杏达莫, YXDM） combined with Betahistine Hydrochloride Injection （BHI） on vertebra basilar artery ischemic vertigo （VBIV）. Methods： Ninety patients with VBIV were randomly divided into two groups; 45 patients （the treated group） were treated with YXDM and BHI intravenous dripping, once a day for 14 days. Another 45 patients （control group） were treated with Xueshuantong （血栓通） and BHI intravenous dripping, once daily for 14 days. The clinical syndromes and the index of the transcranial Doppler （TCD） and hemorheology were observed. Results： The total effective rate was 100% in the treated group, which was better than that in the control group 90.5%, （P〈0. 05）. The indexes of TCD and hemorheology in the treated group were obviously improved after treatment, （P〈0.01）. Conclusion： YXDM combined with BHT injection had better effect in treating patients with VBIV is an ideal drug for VBIV.

Convulsive-like movements as the first symptom of basilar artery occlusive brainstem infarction:A case report

BACKGROUND Convulsive-like movements are rare in basilar artery occlusive cerebral infarction(BAOCI).These manifestations may easily be mistaken for epileptic seizures caused by compromised anterior circulation or by cortical lesions.Delayed diagnosis of this condition affects its subsequent treatment and prognosis.Therefore,it is critical to recognize this type of phenomenon in the early stage.CASE SUMMARY A 55-year-old male patient presented with unconsciousness,rigidity,and a paroxysmal twitch in both lower limbs.These conditions lasted for nearly 2 h and resembled status epilepticus.After the initial conditions subsided,hemiplegia occurred and then subsided rapidly.The family refused thrombolytic therapy because the symptoms were similar to Todd paralysis after epilepsy.However,magnetic resonance imaging showed left pontine infarction.No abnormality was observed in a video electroencephalogram during the interictal period.Digital subtraction angiography revealed that the basilar artery was occluded and that the posterior communicating arteries were patent.Fortunately,the patient received a good prognosis after antiplatelet therapy,lipid regulation,balloon dilatation of the basilar artery,and rehabilitation.CONCLUSION Convulsive-like movements may be an early sign of basilar artery occlusive brainstem infarction.It is important to identify this phenomenon in a timely manner.

By regulating IP3/PKC/TRPV4 pathway hyperoside induces endothelium-dependent vasodilatation in rat basilar artery following four vessel occlusion ischemia reperfusion

OBJECTIVE To investigate regulatory effects of hyperoside(Hyp)on IP3/PKC/TRPV4 pathway in rat cerebral basilar artery(CBA)subjected to global cerebral ischemia-reperfusion(I/R).METHODS The model of global cerebral I/R in rats was established by four-vessel occlusions methods.The treated rats were administrated with Hyp(50 mg·kg^-1)group,Hyp(50 mg·kg^-1)+HC-067047(10 mg·kg^-1),Hyp(50 mg·kg^-1)+2APB(2 mg·kg^-1),Hyp(50 mg·kg^-1)+BisI(2.5 mg·kg^-1),Hyp(50 mg·kg^-1)+2APB(2 mg·kg^-1)+BisI(2.5 mg·kg^-1).Hematoxylin-eosin(HE)and Nissl staining were performed and the contents of methane dicarboxylic aldehyde(MDA),neuron-specific enolase(NSE),S100β and the activity of lactic dehydrogenase(LDH)in serum were measured by enzyme-linked immunosorbnent assay(ELISA).The specific blocker N-nitro-L-arginine-methyl-ester(L-NAME)and indomethacin(Indo)were used to delete the prostacyclin(PGI2)and nitric oxide(NO)dependent relaxation.The protein expression level of TRPV4 was detected by Western blotting.Ca2+intensity in vascular smooth muscle cells was measured by confocal laser scanning microscope and flow cytometry was performed to observe the apoptosis of CBA endothelial cells after in vivo administration.RESULTS Hyp induced a dose-dependent relaxation of CBA in IR rats via a PGI2 and NO independent manner,as evidenced by alleviated patho⁃logical changes and up-regulated expression of TRPV4 protein in the endothelial cells from cerebral vessels.Hyp signifi⁃cantly reduced the contents of MDA,NSE,S100βand the activity of LDH in serum and decreased the fluorescence intensity of Ca2+in cerebral vascular smooth muscle cells by in vivo administration.The apoptotic rate of endothelial cells in Hyp treated group was significantly less than that in IR group.CONCLUSION Hyp does in fact ameliorate I/R injury by regulatingIP3/PKC/TRPV4 pathway.

Predictors of unfavorable outcome at 90 days in basilar artery occlusion patients

BACKGROUND In a previous study,basilar artery occlusion(BAO)was shown to lead to death or disability in 80%of the patients.The treatment for BAO patients in the acute stage includes thrombolysis and intra-arterial thrombectomy,but not all patients benefit from these treatments.Thus,understanding the predictors of outcome before initiating these treatments is of special interest.AIM To determine the predictors related to the 90-d clinical outcome in patients with BAO in an Asian population.METHODS We performed a retrospective case review of patients admitted to a tertiary stroke center between 2015 and 2019.We used the international classification of diseases-10 criteria to identify cases of posterior circulation stroke.A neurologist reviewed every case,and patients fulfilling the criteria defined in the Basilar Artery International Cooperation Study were included.We then analyzed the patients’characteristics and factors related to the 90-d outcome.RESULTS We identified a total of 99 patients as real BAO cases.Of these patients,33(33.3%)had a favorable outcome at 90 d(modified Rankin Scale:0–3).Moreover,72 patients received intra-arterial thrombectomy,while 13 patients received intravenous tissue-type plasminogen activator treatment.We observed a favorable outcome in 33.3%of the cases and an unfavorable outcome in 66.7%of the cases.We found that the initial National Institutes of Health Stroke Scale(NIHSS)score and several BAO symptoms,including impaired consciousness,tetraparesis,and pupillary abnormalities,were significantly associated with an unfavorable outcome(P<0.05),while cerebellar symptoms were associated with a favorable outcome(P<0.05).In the receiver operating characteristic(ROC)analysis,the areas under the ROC curve of initial NIHSS score,impaired consciousness,tetraparesis,cerebellar symptoms,and pupillary abnormalities were 0.836,0.644,0.727,0.614,and 0.614,respectively.Initial NIHSS score showed a higher AUROC(0.836)compared to BAO symptoms.CONCLUSION The most important predictor of an unfavorable outcome was the initial NIHSS score.BAO symptoms,including tetraparesis,impaired consciousness,and pupillary abnormality were also related to an unfavorable outcome.

Treatment of patients older than 60 years with symptomatic vertebrobasilar artery stenosis

Background Vertebrobasilar artery stenosis is an important cause of ischemic posterior circulation strokes. This study aimed at evaluating the safety and efficacy of treatment including conservative therapy alone and conservative plus endovascular therapy for elderly patients with symptomatic vertebrobasilar artery stenosis.Methods Patients older than 60 years with symptomatic vertebrobasilar artery stenosis （ ≥50%） confirmed by cerebral angiography were enrolled. All of them were treated with medical therapy and some with additional stent-assisted angioplasty （the stenting subgroup）. Their clinical, imaging, intervention and follow-up data were analyzed.Results One hundred and seventeen consecutive elderly patients （100 men, mean age （68.1 ±5.1） years） were enrolled and followed up for a mean time of 28.4 months; 81.7% of them were symptomatically resolved or improved; a stroke rate of 5.1% and a stroke-related death rate of 1.7% were found among them during the hospitalization and follow-up. In the stenting subgroup, 78 balloon expandable stents were employed in the 70 patients with a technical success rate of 98.7% and the mean degree of stenosis was significantly reduced from （81.7±14.3）% before stenting to （8.3±4.2）% after stenting （P 〈0.001）. Four （5.7%） periprocedural strokes occurred, of whom two led to death within 30 days after the procedure. During the follow-up （mean 27.7 months）, sixty of the surviving 68 patients in the stenting subgroup were symptomatically resolved or improved. Only one （1.5%） posterior circulation stroke occurred, while duplex ultrasound scan of 34 patients demonstrated 10 （29.4%） in-stent restenosis.Conclusions Appropriate utilization of conservative therapy alone and conservative plus endovascular therapy may improve short-term clinical outcomes for elderly patients with symptomatic vertebrobasilar artery stenosis. Furthermore, stent-assisted angioplasty is technically feasible and relatively safe in elderly patients.

Endovascular Treatment of the Huge Dissecting Aneurysms Involving the Basilar Artery by the Internal Trapping Technique： Technical Note

Background： The endovascular strategy of the huge dissecting aneurysms involving the basilar artery （BA） is controversial and challenging. This study was to investigate the clinical and angiographic outcomes of the treatment of the huge dissecting aneurysms involving the BA by the internal trapping （IT） technique. Methods： We retrospectively studied 15 patients with the huge dissecting aneurysms involving the BA treated by the IT technique between September 2005 and September 2014 in Department of Interventional Neuroradiology of Beijing Tiantan Hospital. Clinical and angiographic data were reviewed and evaluated. Results： All patients were treated by the IT technique. That meant the dissecting artery and aneurysm segments were completed occlusion. After the procedure, the angiography demonstrated that all the dissecting artery and aneurysm segments were completed occlusion. Follow-up angiography was performed at 3-6 months or 12-18 months alter the endovascular treatment （median 8 months）, 14 patients had a good recovery. Re-canalization occurred in one patient whose aneurysm involved in bilateral vertebral arteries and the two third of the middle-lower BA. After the second treatment, the patient died by the ventricular tachycardia. Conclusions： The IT technique is a technically feasible and safe alternative for the treatment of BA dissecting aneurysms, but it is not necessarily the safest or most definitive treatment modality. The ideal treatment of the huge dissecting aneurysms involving the BA remains debatable and must be investigated on a case-by-case basis.

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

EFFECT OF ACUPUNCTURE ON BLOOD FLOW OF VERTEBRAL AND BASILAR ARTERIES IN STROKE PATIENTS

Objective: To observe the short-term effect and long-term effect of acupuncture on blood flow of vertebral and basilar arteries in stroke patients. Methods: A total of 58 stroke patients (34 males and 24 females) were agreed to participate in this study, and changes of blood flow of the vertebral and basilar arteries were detected after one week’s and 45 days’ continuous acupuncture treatment by using a Doppler’s ultrasonic diagnosis apparatus. Bilateral Fengchi (GB 20), Wangu (GB 12), Tianzhu (BL 10), etc. were punctured and stimulated with small amplitude, high frequency and twirling-reinforcing method for 3 min. The treatment was conducted once daily. Results: Following one week’s and 45 days’ acupuncture treatment, diastolic velocity (DV), systolic velocity (SV) and mean velocity (MV) of the basilar artery increased significantly in comparison with pre-treatment (P<0.05～0.01). After one week’s acupuncture treatment, DV, SV and MV of the vertebral artery on the affected side of the brain and after 45 days’ treatment, DV, SV and MV of the vertebral artery on the bilateral sides of the brain all increased considerably compared with their individual basic levels of pre-treatment (P<0.05～0.01). No significant differences were found between pre-treatment and post-treatment in pulse index (PI) of the basilar artery and bilateral vertebral arteries (P> 0.05). Results indicated that acupuncture treatment could effectively improve blood supply of the basilar artery and regulate the uneven blood flow of the bilateral vertebral arteries. Conclusion: Acupuncture treatment can raise blood flow of the brain in stroke patients.

Enhancing hippocampal blood flow after cerebral ischemia and vasodilating basilar arteries:in vivo and in vitro neuroprotective effect of antihypertensive DDPH

1-（2,6-Dimethylphenoxy）-2-（3,4-dimethoxyphenylethylamino）-propane hydrochloride （DDPH） is a novel antihypertensive agent based on structural characteristics of mexiletine and verapamine. We investigated the effect of DDPH on vasodilatation and neuroprotection in a rat model of cerebral ischemiain vivo, and a rabbit model of isolated basilar arteriesin vitro. Our results show that DDPH （10 mg/kg） significantly increased hippocampal blood flowin vivo in cerebral ischemic rats, and exerted dose-dependent relaxation of isolated basilar arteries contracted by histamine or KCl in thein vitro rabbit model. DDPH （3 × 10–5 M） also inhibited histamine-stimulated extracellular calcium inlfux and intracellular calcium release. Our ifndings suggest that DDPH has a vasodilative effect bothin vivo andin vitro, which mediates a neuropro-tective effect on ischemic nerve tissue.

Effects of 3，4－Dihydroxyacetophenone on Hypoxic Vasoconstriction in Isolated Pulmonary and Basilar Arterial Rings

The effects of 3, 4-DHAP on hypoxic vasoconstriction response in pulmonary (PA) and basilar arterial(BA) rings of rabbits and their mechanism were compared in vitro.3,4-DHAP in different concentration (2.64×10-4,7.92×10-4,2.376×10-3mol/L) decreased the basal tone of PA rings by 32. 39±9.4 mg, 68. 96±26. 54 mg and 145. 60±58.07 mg respectively,while the tension of the BA rings was decreased by 13. 80±5. 08 mg,17.18±3.36 mg and 25. 00±4.02 mg respectively.In PA rings it also decreased the percentage increase in tension induced by hypoxia(TIH%)from the control value 48. 82±5.75% to 10.02±3. 62%,2.14±0.96%, and 0.00% respectively, while in BA rings from 27.27±5.78% to 11. 23±2.71%,7.49±1. 62%, and 1.45±1.13% respectively. The effects of 3,4-DHAP on TIH% were partially blocked by indomethacin 10 M and L-NWE 10 M.The results showed that 3, 4-DHAP can decrease the hypoxic pulmonary and basilar vasoconstriction in vitro. which can be partially inhibited by cyclooxygenase inhibitor and NO/EDRF inhibitor.

Incidental Finding of a Fenestrated Vertebrobasilar Junction Aneurysm

Basilar artery fenestration is a rare anatomical variation resulting from the failed fusion of the two vertebral arteries during embryonic life. In order of frequency, it is the second most common location of vascular fenestrations after the anterior communicating artery. Vertebrobasilar junction aneurysms are uncommon but often associated with basilar artery fenestration. We report the case of a fenestrated vertebrobasilar junction saccular aneurysm in a 57-year-old woman. The diagnosis was incidentally made on CT angiography which found the anatomical variant and the aneurysm. The radiological features illustrating this association are detailed here and a brief discussion of its pathogenesis and management was made. Vertebrobasilar junction aneurysms are rare and their presence should suggest an associated basilar fenestration.

what drives progressive motor deficits in patients with acute pontine infarction?

Progressive motor deficits are relatively common in acute pontine infarction and frequently associated with increased functional disability. However, the factors that affect the progression of clinical motor weakness are largely unknown. Previous studies have suggested that pontine infarctions are caused mainly by basilar artery stenosis and penetrating artery disease. Recently, lower pons lesions in patients with acute pontine infarctions have been reported to be related to progressive motor deficits, and ensuing that damage to the corticospinal tracts may be respon- sible for the worsening of neurological symptoms. Here, we review studies on motor weakness progression in pontine infarction and discuss the mechanisms that may underlie the neurologic worsening.

Scutellarin Reduces Cerebral Ischemia Reperfusion Injury Involving in Vascular Endothelium Protection and PKG Signal

Flavonoid glycoside scutellarin(SCU)has been widely applied in the treatment of cerebral ischemic diseases in China.In this article,we conducted research on the working mechanisms of SCU in hypoxia reoxygenation(HR)injury of isolated cerebral basilar artery(BA)and erebral ischemia reperfusion(CIR)injury in rat models.In isolated rat BA rings,HR causes endothelial dysfunction(ED)and acetylcholine(ACh)induces endothelium-dependent vasodilation.The myography result showed that SCU(100μM)was able to significantly improve the endothelium-dependent vasodilation induced by Ach.However,SCU did not affect the ACh-induced relaxation in normal BA.Further studies suggested that SCU(10-1000μM)dose-dependently induced relaxation in isolated BA rings which were significantly blocked by the cGMP dependent protein kinase(PKG)inhibitor Rp-8-Br-cGMPs(PKGI-rp,4μM).Pre-incubation with SCU(500μM)reversed the impairment of endothelium-dependent vasodilation induced by HR,but the reversing effect was blocked if PKGI-rp(4μM)was added.The brain slice staining test in rats’model of middle cerebral artery occlusion(MCAO)induced CIR proved that the administration of SCU(45,90 mg/kg,iv)significantly reduced the area of cerebral infarction.The Western blot assay result showed that SCU(45 mg/kg,iv)increased brain PKG activity and PKG protein level after CIR surgery.In conclusion,our findings suggested that SCU possesses the ability of protecting brain cells against CIR injury through vascular endothelium protection and PKG signal.

Effect of HX0507,a water-soluble propofol pro-drug,on subarachnoid hemorrhage-induced cerebral vasospasm in rabbits

BACKGROUND： Propofol has been shown to attenuate neuronal injury in a number of experimental conditions. However, its effect in models of cerebral ischemia after subarachnoid hemorrhage （SAH） remains controversial. OBJECTIVE： To explore the effects of intracisternal injection of HX0507, a water-soluble propofol prodrug, on basilar artery vasospasm and brain tissue injury in a rabbit model of SAH. DESIGN, TIME AND SETTING： A randomized, controlled, in vivo animal experiment based on behavior and morphology. The study was performed at the Laboratory of Anesthesiology and Critical Care Medicine, West China Hospital, Sichuan University from April to December 2007. MATERIALS： HX0507 was provided by the Laboratory of Anesthesiology and Critical Care Medicine, West China Hospital of Sichuan University. METHODS： A total of 30 healthy, male, New Zealand rabbits were randomly assigned to sham-operation, SAH-control, and SAH-HX0507 groups, with 10 animals in each group. The single-hemorrhage SAH model was established by injecting autologous arterial blood （1.0 mL/kg） into the cisterna magna in the SAH-control and SAH-HX0507 groups, while the sham-operation group was injected with normal saline （1.0 mL/kg）. Thirty minutes after injection, the sham-operation and SAH-control groups were injected with normal saline （0.1 mL/kg） into the cisterna magna, while the SAH-HX0507 group received an injection of HX0507 （4.8 mg/kg）. MAIN OUTCOME MEASURES： The cross-sectional area and corrugation coefficients of basilar arteries and hippocampal CA1 neuronal densities were measured 48 hours after SAH （peak stage of vasospasm） using the Computer-Assisted Stereological Toolbox system. The ultrastructural structure of the basilar artery wall was examined by transmission electron microscopy. In addition, neurological behavioral impairment was evaluated by appetite score at pre-SAH, and 1 and 2 days after SAH. RESULTS： The cross-sectional area of basilar arteries and hippocampal CA1 neuronal densities, as well as ultrastructural structure scores of the SAH-control group were significantly less than the other groups （P 〈 0.01 or P 〈 0.05）, while the corrugation coefficients of basilar arteries and appetite score 2 days after SAH were significantly greater than the other groups （P 〈 0.01 or P 〈 0.05）. The appetite score 1 day after modeling was remarkably greater than the SAH-control group （P 〈 0.05）. However, no significant difference was determined between the sham-operation and SAH-HX0507 groups （P 〉 0.05）. CONCLUSION： Intracisternal administration of HX0507 attenuated basilar artery vasospasm and hippocampal ischemic injury in a rabbit model of SAH.

Plaques of Nonstenotic Basilar Arteries with Isolated Pontine Infarction on Three-dimensional High Isotropic Resolution Magnetic Resonance Imaging

Background： There are few studies for evaluating plaque characteristics of nonstenotic basilar arteries （BA）. Our aim was to determine entire BA plaques with a three-dimensional volumetric isotropic turbo spin-echo acquisition （VISTA） and investigate the differences between the patients with and without isolated pontine infarction （IPI）. Methods： Twenty-four consecutive symptomatic patients with nonstenotic BA on time of flight magnetic resonance angiography （TOF MRA） were enrolled from China-Japan Friendship Hospital between January 2014 and December 2014. BA was classified as ＂normal＂ or ＂irregular＂ based on TOF MRA, and ＂normal wall＂, ＂slight wall-thickening＂, and ＂plaque＂ based on three-dimensional VISTA images. Outcomes from MRA and VISTA were compared. Patients were categorized as IPI and non-lPl groups based on the diffusion-weighted imaging. Clinical and plaque characteristics were compared between the two groups. Results： A total of 1024 image slices including 311 （30.37%） plaque slices, 427 （41.70%） slight wall-thickening slices, and 286 （27.93%） normal wall slices for the entire BA from 23 patients were finally included for analysis. VISTA images detected plaques in all the 9 （100%） irregular MRA patients and 7 of 14 （50%） normal MRA patients. IPl was found in 11 （47.83%） patients. Compared to non-IPI group, the IPI group had a higher percentage of plaque slices （P = 0.001 ） and lower percentage of normal wall slices （P = 0.014） than non-IPl group. Conclusions： Three-dimensional V1STA images enable detection of BA plaques not visualized by MRA. BA plaques could be found in both the IPl and non-IPl group. However, IPI group showed plaques more extensively in BA than the non-IPI group.

Different treatment modalities of fusiform basilar trunk aneurysm： study on computational hemodynamics

Background Unclippable fusiform basilar trunk aneurysm is a formidable condition for surgical treatment.The aim of this study was to establish a computational model and to investigate the hemodynamic characteristics in a fusiform basilar trunk aneurysm.Methods The three-dimensional digital model of a fusiform basilar trunk aneurysm was constructed using MIMICS,ANSYS and CFX software.Different hemodynamic modalities and border conditions were assigned to the model.Thirty points were selected randomly on the wall and within the aneurysm.Wall total pressure （WTP）,wall shear stress （WSS）,and blood flow velocity of each point were calculated and hemodynamic status was compared between different modalities.Results The quantitative average values of the 30 points on the wall and within the aneurysm were obtained by computational calculation point by point.The velocity and WSS in modalities A and B were different from those of the remaining 5 modalities; and the WTP in modalities A,E and F were higher than those of the remaining 4 modalities.Conclusions The digital model of a fusiform basilar artery aneurysm is feasible and reliable.This model could provide some important information to clinical treatment options.

Clinical Study on Massage in Treating Cervical Spondylosis of Vertebral Artery Type

Objective： To observe the clinical efficacy of combined massage and traction technique in the treatment of cervical spondylosis of vertebral artery type （CSA）. Methods： Ninety-eight cases of cervical spondylosis of vertebral artery type were randomized into two groups, a treatment group in which 50 cases were treated by traditional massage and traction technique, and a control group in which 48 cases were treated by traditional massage. Results： After treatment, the mean velocity （Vm） of vertebral artery （VA） and basilar artery （BA） were improved markedly in the treatment group （P〈0.05）; and there was a significant difference between the two groups after treatment （P〈0.01）. In the treatment group, 17 cases were cured and 22 cases obviously improved; and the rate of cure and marked effective was 78.0%, the total effective rate was 98.0%. In the control group, 8 cases were cured and 10 cases obviously improved, the rate of cure and marked effective was 37.5% and the total effective rate was 89.6%. There was a significant difference in the rate of cure and marked effective between the two groups （P〈0.01）. Conclusion： Combined massage and traction technique has better results than single traditional massage in the treatment of CSA.