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ObjectiveIn the study, we explored the safety and effectiveness of staged stenting strategy for acutely wide-neck ruptured intracranial aneurysms.MethodsOnline databases, including PubMed, EMBASE, the Cochrane database, and Web of Science, were retrospectively and systematically searched. The main observation indicators were the procedure-related complication rate, complete occlusion rate, and favorable clinical outcome. Meta-analysis was performed using a random or fixed effect model based on heterogeneity.ResultsA total of 5 studies with 143 patients were included. The hemorrhagic complication rate of the initial coiling and staged stenting was 2.8% (4 of 143) and 0, respectively. The ischemic complication rate of the coiling and supplemental stenting was 3.5% (5 of 143) and 2.9% (4 of 139), respectively. There were no deaths due to procedure-related complications in two stages. The aneurysm complete occlusion rate was 25% (95% CI, 0.13–0.03; I2 = 4.4%; P = 0.168) after initial coiling, 54% (95% CI, 0.63–0.64; I2 = 0%; P = 0.872) after staged stenting, and 74% (95% CI, 0.66–0.81; I2 = 56.4%; P = 0.562) at follow-up, respectively. Favorable clinical outcome rate 74% (95% CI, 0.61–0.86; I2 = 50.5%; P = 0.133) after discharge of initial coiling treatment, and 86% (95% CI, 0.80–0.92; I2 = 0; P = 0.410) after discharge from stenting, and 97% (95% CI, 0.93–1.01; I2 = 43.8%; P = 0.130) at follow-up.ConclusionStaged stenting treatment of wide-neck RIA with coiling in the acute phase followed by delayed regular stent or flow-diverter stent had high aneurysm occlusion rate, favorable clinical outcome rate and low procedure-related complication rate. A more dedicated and well-designed controlled study is warranted for further evaluation of staged stenting treatment compared to SCA in wide-neck RIA.

PurposeThis study aimed at investigating a novel standby microwire technique to facilitate revascularization of large vessel occlusion due to underlying long-segment dissection.MethodsPatients with acute ischemic stroke with emergent large vessel occlusion (ELVO) due to underlying long-segment dissection were screened from the prospectively established database between January 2021 and May 2022. The clinical and radiological data of eligible patients who underwent endovascular treatment by using a standby microwire technique were investigated.ResultsOf the 165 acute ischemic stroke patients who underwent mechanical thrombectomy, the standby microwire technique was used in five patients aged 33–55 years old with occlusion due to underlying long-segment dissection. Of them, three patients were diagnosed with tandem lesions and three were located at the anterior circulation. A 300 cm exchange microwire was used as the standby microwire. Stent deployment was performed in all five patients. Groin puncture to reperfusion time ranged from 10–68 min. Technical success and favorable clinical outcomes were achieved in all five patients (100%). No technique-related complication was observed.ConclusionOur preliminary experience showed that the standby microwire technique was a useful ancillary approach to facilitate the revascularization of large vessel occlusion due to underlying long-segment dissection.

background The low profile visualized intraluminal support (LVis) device is being increasingly used for the treatment of intracranial aneurysms. its application in the basilar artery (Ba) has not yet been reported. Objective To evaluate the safety and early efficacy of the LVis device for the treatment of Ba aneurysms. Methods a prospectively maintained database was retrospectively reviewed for all patients with Ba aneurysms treated by LVis stents at our institution. angiographic results were evaluated using the modified raymond'roy classification (mrrC). results 23 patients (mean age 52.8 years) with a Ba aneurysm that was treated by LVis stent implantation, with (n=21) or without (n=2) adjunctive coiling, were included in our study. 7 aneurysms were treated in the setting of subarachnoid hemorrhage (saH). 10 aneurysms were located at the basilar tip, 10 at the basilar trunk, and 3 at the superior cerebellar artery. Procedure related complications developed in three patients (13%), including two perforator infarction and one worsening mass effect. Complications resulted in permanent morbidity (4%) in one case. One fatality was related to severe poor grade saH. at a mean followup of 6.9 months, 13 of the 20 patients were mrrC i closure, 3 were mrrC ii closure with an improvement from class llla, 3 were observed to be recanalized from class llla to lllb, and 1 with stenting only was still patent similar to the immediate angiography. Conclusion The LVis stent represents a feasible and safe option for endovascular embolization of Ba aneurysms. although recanalization may occur after LVis treatment, the mid term complete occlusion rate was acceptable. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the feasibility, safety, and efficacy of Solitaire stent placement after balloon angioplasty for the treatment of complex symptomatic intracranial atherosclerotic stenosis (ICAS). Methods We retrospectively reviewed the clinical data from 44 patients who underwent Solitaire stent placement for complex symptomatic ICAS at our department between November 2010 and March 2014, with focus on the clinical factors, lesion characteristics, treatment results, and periprocedural complications. We also summarized the early outcomes and imaging findings during the follow-up period. Results Overall, the technical success rate was 100% (44/44). Post-stenting residual stenosis ranged from 0% to 40% (mean 15.00±12.94%). The overall 30-day rate of procedure-related complications was 9.09% (4/44). The incidence of recurrent ischemic events related to the territory artery was 4.55% during a mean clinical follow-up period of 25.5 months. Five patients (11.36%) developed in-stent restenosis during a mean angiographic follow-up period of 9.3 months. Conclusions This is the first case series study of ICAS treated by Solitaire stent placement. Deployment of a Solitaire stent with balloon angioplasty in the treatment of complex severe intracranial stenosis appears safe and effective, with a high technical success rate, relatively low periprocedural complication rate, and favorable outcome during follow-up. [ABSTRACT FROM AUTHOR]

Background: Wingspan stenting for the treatment of complex intracranial atherosclerotic stenosis (ICAS), i.e., that involving tortuous vascular pathways, long (>15 mm) lesions or arterial bifurcations, has a relatively high risk of complications. This retrospective study assessed the safety and efficacy of undersized balloon angioplasty followed by deployment of the more flexible Enterprise stent for the treatment of complex symptomatic ICAS.Methods: Forty-four patients on combined antiplatelet therapy and intensive risk factor management and a symptomatic 70-99% stenosis of a major intracranial artery in complex settings that was treated with balloon angioplasty and Enterprise stent deployment between July 2009 and August 2013 were enrolled. Primary outcome was occurrence of ischemic or hemorrhagic stroke or death within 30 days after intervention. Secondary outcomes included procedural success (defined as achievement of <50% immediate residual stenosis), and follow-up clinical and angiographic outcomes.Results: With a procedural success rate of 100%, stenosis was reduced from 79.3 ± 8.1-14.9 ± 2.3%. Three (6.8%) ischemic and 1 (2.2%) hemorrhagic strokes occurred during the periprocedural period, with no further transient ischemic attacks or strokes in the 42 patients available at median 25.6 (range, 12-57) months follow-up. Of the 38 (86.4%) patients who underwent angiographic follow-up, 3 (6.81%) developed >50% in-stent restenosis after mean 22 months follow-up.Conclusion: In this retrospective, single-center experience, undersized balloon angioplasty followed by Enterprise stent deployment appears technically feasible with a relatively low rate of complications for the treatment of complex symptomatic ICAS. Prospective, multicenter, randomized controlled trials against optimal medical management are warranted. [ABSTRACT FROM AUTHOR]