Efficacy of Willis covered stent of intracranial pseudoaneurysms in the internal carotid artery: A systematic review and meta-analysis

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.

Prolonged parasite clearance in a Chinese splenectomized patient with falciparum malaria imported from Nigeria

Background:The spleen plays a pivotal role in the rapid clearance of parasitized red blood cells in patients with falciparum malaria after artemisinin treatment.Prolonged parasite clearance can be found in patients who have had a splenectomy,or those with hemoglobin abnormalities and/or reduced immunity,which are all distinguishable from artemisinin resistance.This paper reports on a case of prolonged parasite clearance in a Chinese splenectomized patient with falciparum malaria imported from Nigeria.Case presentation:A 35-year-old Chinese male suffered 2 days of febrile illness after returning to Zhumadian city of Henan province from Nigeria on October 1,2014.The main symptoms were febrile,including the highest axillary temperature of 40℃,headache,and chills.A peripheral blood smear showed parasitemia(53913 asexual parasites/μl)of Plasmodium falciparum.The patient had not used any chemoprophylaxis against malaria in Nigeria when he worked there as a construction worker between 2009 and 2014.The patient had three episodes of malaria in Nigeria and had a splenectomy due to a traffic accident 8 years ago from the time he was admitted to hospital.The patient was orally administrated a total of 320 mg/2.56 g dihydroartemisinin-piperaquine for 2 days and intravenously administrated a total of 3000 mg artesunate for 18 days.The axillary temperature of the patient ranged between 37.0 and 37.7℃ from Day 0 to Day 3,and blood microscopy revealed falciparum malaria parasitemia(26674 asexual parasites/μl)on Day 3.The patient was afebrile on Day 4,falciparum malaria parasitemia was continuously present and then gradually decreased on the next days,and was negative on Day 21.The patient was cured and left hospital on Day 24 after no plasmodium falciparum was found in the blood on Day 21 to Day 23.No mutation was found in the K13 propeller gene when compared with the PF3D7_1343700 K13 propeller gene reference sequence.Conclusions:This is the first reported case in China of prolonged parasite clearance in a splenectomized patient with imported falciparum malaria.Artemisinin resistance should be distinguished when prolonged parasite clearance is found in a malaria patient who has had splenectomy.