Blood blister-like aneurysms(BBAs)are fragile and difficult to treat.However,the optimal treatment has yet to be determined.Pipeline embolization devices and Willis covered stent implementation are still controversial...Blood blister-like aneurysms(BBAs)are fragile and difficult to treat.However,the optimal treatment has yet to be determined.Pipeline embolization devices and Willis covered stent implementation are still controversial strategies for treating BBA.Herein,we report a case of recurrent BBA successfully treated with a Willis covered stent.A long-term follow-up angiography after the procedure indicated complete occlusion of the aneurysm.This case demonstrates the safety and efficacy of applying the Wills cover stent in the treatment of recurrent BBA after Pipeline implantation.展开更多
Objective:To evaluate the efficacy of a novel coated stent in the treatment of intracranial pseudoaneurysm.Methods:MEDLINE,EMBASE,and PubMed databases were searched for literature published between 1990 and April 2022...Objective:To evaluate the efficacy of a novel coated stent in the treatment of intracranial pseudoaneurysm.Methods:MEDLINE,EMBASE,and PubMed databases were searched for literature published between 1990 and April 2022 according to PRISMA guidelines.All studies with≥10 patients reporting successful implantation of Willis covered stent,therapeutic effect,complications,and postoperative follow-up were included.The combined incidence and corresponding 95%confidence intervals were assessed using a generalized linear mixed method and random effects model.Results:Five studies(116 patients with pseudoaneurysms)were included.The experimental groups in the selected studies showed a combined technical success rate of 81.03%(OR=18.31,95%CI=9.39-35.69,I^(2)=79%,P<0.001).Clinical follow-up showed that the complete cure rate was as high as 94.4%after the follow-up(OR=106.81,95%CI=39.08-291.88,I^(2)=0%,P=0.71).Conclusions:Willis covered stent is feasible,safe,and effective in the treatment of intracranial pseudoaneurysm.展开更多
The anterior system of the polygon of Willis plays an anastomotic role between the carotid territories and communicates with the posterior system. It ensures adequate cerebral blood flow in the event of internal occlu...The anterior system of the polygon of Willis plays an anastomotic role between the carotid territories and communicates with the posterior system. It ensures adequate cerebral blood flow in the event of internal occlusion. Its ability to redistribute blood flow depends on its morphology, the presence and size of the vessels that constitute it and their variants, knowledge of which is essential. The morphology of the carotid system is not constant and a number of variants are well recognized with greater hemodynamic importance. In this context, we undertook this work which aims to seek the anatomical variants of the anterior part of the PW;to determine the diameters of the vessels of the latter and to correlate these results with epidemiological data. We carried out a retrospective, descriptive and analytical study over a period of 4 months at Fann University Hospital, targeting patients who had undergone brain MRI with a 3D TOF sequence whatever the indication. Patients with lesions of cerebrovascular pathologies such as ischemia, hemorrhage, aneurysm, arteriovenous malformations or presenting a limited analysis examination due to the presence of kinetic or other artifact, were not included. Demographic data and anatomical variants were studied as well as the measurements of any continuous arterial segment greater than 0.8 mm in diameter. Those less than 0.8 mm in diameter were considered hypoplastic. The C3 segment of the internal carotid arteries, the A1 segment of the anterior cerebral arteries, the anterior communicating artery, constituted our main measurement sites. The sex ratio was 1.06, the mean age of the patients was 43 years ± 17.9 with extremes of 11 and 85 years. The anterior configuration of the polygon was complete in 57.5% representing 50% of men and 65.5% of women, in 56% of subjects under 40 years old and 58% in subjects over 40 years old. We noted a predominance of type a in 47% of patients followed by type g found in 35% of patients. The morphology of the anterior system of the Willis polygon is a function of its variants, some of which have greater hemodynamic importance than others. Its knowledge is essential for the management of cerebrovascular diseases.展开更多
文摘目的使用颅颈一体化的高分辨率磁共振血管成像(magnetic resonance angiography,MRA)检查,对前循环缺血性脑卒中患者的Willis环完整性、颅颈动脉粥样硬化斑块特征进行分析,探寻与复发性卒中独立相关的影像特征。材料与方法回顾性分析前循环缺血性脑卒中患者87例,均在症状出现14 d内接受高分辨率磁共振血管壁成像检查,并根据临床及影像资料将其分为卒中初发组和复发组。记录斑块总数、颅颈动脉斑块特征及Willis环完整性。比较初发组、复发组之间及Willis环完整组、不完整组之间的颅颈动脉斑块特征。采用多因素logistic回归分析评估与前循环缺血性脑卒中复发相关的独立危险因素。结果共纳入87例患者。初发组54例,复发组33例。两组间性别(P=0.223)、年龄(P=0.779)差异无均统计学意义。与初发组相比,复发组的颅内斑块强化(P=0.010)、颅内动脉狭窄程度(P=0.002)、斑块总数(P<0.001)、颅内斑块强化合并颅外斑块(P=0.006)、颅内(或颅外)动脉狭窄>50%合并颅外(或颅内)斑块(P=0.001)及Willis环后循环症状侧不完整(P<0.001)与复发性卒中显著相关。与Willis环前循环完整组相比,Willis环前循环不完整组颅内斑块强化(P=0.012)更多见。多因素logistic回归分析显示:斑块总数[比值比(odds ratio,OR)=2.14,95%置信区间(confidence interval,CI):1.182~3.869,P=0.012]和Willis环后循环症状侧不完整(OR=4.58,95%CI:1.496~14.041,P=0.008)为前循环缺血性脑卒中复发的独立危险因素。logistic回归模型的整体预测效能最佳[曲线下面积(area under the curve,AUC)=0.811,95%CI:0.711~0.910]。结论斑块总数和Willis环后循环症状侧不完整与前循环缺血性脑卒中复发独立相关。颅颈一体化的高分辨率磁共振血管壁成像检查可为前循环缺血性脑卒中复发预测模型的构建提供新指标。
文摘Blood blister-like aneurysms(BBAs)are fragile and difficult to treat.However,the optimal treatment has yet to be determined.Pipeline embolization devices and Willis covered stent implementation are still controversial strategies for treating BBA.Herein,we report a case of recurrent BBA successfully treated with a Willis covered stent.A long-term follow-up angiography after the procedure indicated complete occlusion of the aneurysm.This case demonstrates the safety and efficacy of applying the Wills cover stent in the treatment of recurrent BBA after Pipeline implantation.
基金supported by China Natural Science Funding(No.81902937)Hubei University of Science and Technology ENT special project(No.2020WG06)+1 种基金Hubei University of Science and Technology ENT special project(No.2)and Hubei province Key R&D plan(2022BCE011)and(No.2020XZ30)for SDWHubei University of Science and Technology the Second Affiliated Hospital Scientific project(No.2020LCZ001)and ENT special project(No.2021WG10).
文摘Objective:To evaluate the efficacy of a novel coated stent in the treatment of intracranial pseudoaneurysm.Methods:MEDLINE,EMBASE,and PubMed databases were searched for literature published between 1990 and April 2022 according to PRISMA guidelines.All studies with≥10 patients reporting successful implantation of Willis covered stent,therapeutic effect,complications,and postoperative follow-up were included.The combined incidence and corresponding 95%confidence intervals were assessed using a generalized linear mixed method and random effects model.Results:Five studies(116 patients with pseudoaneurysms)were included.The experimental groups in the selected studies showed a combined technical success rate of 81.03%(OR=18.31,95%CI=9.39-35.69,I^(2)=79%,P<0.001).Clinical follow-up showed that the complete cure rate was as high as 94.4%after the follow-up(OR=106.81,95%CI=39.08-291.88,I^(2)=0%,P=0.71).Conclusions:Willis covered stent is feasible,safe,and effective in the treatment of intracranial pseudoaneurysm.
文摘The anterior system of the polygon of Willis plays an anastomotic role between the carotid territories and communicates with the posterior system. It ensures adequate cerebral blood flow in the event of internal occlusion. Its ability to redistribute blood flow depends on its morphology, the presence and size of the vessels that constitute it and their variants, knowledge of which is essential. The morphology of the carotid system is not constant and a number of variants are well recognized with greater hemodynamic importance. In this context, we undertook this work which aims to seek the anatomical variants of the anterior part of the PW;to determine the diameters of the vessels of the latter and to correlate these results with epidemiological data. We carried out a retrospective, descriptive and analytical study over a period of 4 months at Fann University Hospital, targeting patients who had undergone brain MRI with a 3D TOF sequence whatever the indication. Patients with lesions of cerebrovascular pathologies such as ischemia, hemorrhage, aneurysm, arteriovenous malformations or presenting a limited analysis examination due to the presence of kinetic or other artifact, were not included. Demographic data and anatomical variants were studied as well as the measurements of any continuous arterial segment greater than 0.8 mm in diameter. Those less than 0.8 mm in diameter were considered hypoplastic. The C3 segment of the internal carotid arteries, the A1 segment of the anterior cerebral arteries, the anterior communicating artery, constituted our main measurement sites. The sex ratio was 1.06, the mean age of the patients was 43 years ± 17.9 with extremes of 11 and 85 years. The anterior configuration of the polygon was complete in 57.5% representing 50% of men and 65.5% of women, in 56% of subjects under 40 years old and 58% in subjects over 40 years old. We noted a predominance of type a in 47% of patients followed by type g found in 35% of patients. The morphology of the anterior system of the Willis polygon is a function of its variants, some of which have greater hemodynamic importance than others. Its knowledge is essential for the management of cerebrovascular diseases.
