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Background: Stent-assisted coiling (SAC) in the treatment of ruptured intracranial aneurysms (RIAs) remains controversial.Aims: In this study, we report our experience of SAC of wide-necked RIAs and evaluate the risk factors contributing to periprocedural complications.Materials and Methods: 218 patients underwent SAC for ruptured, wide-necked saccular intracranial aneurysms at our center between 2011 and 2014. Multivariate logistic regression analysis was performed to evaluate the risk factors contributing to the periprocedural complications. Follow-up angiography was available in 178 (84.8%) patients. Clinical outcome was measured using the Glasgow Outcome Scale (GOS) through telephonic interviews.Results: Periprocedural complications occurred in 33 (15.1%) patients out of which 17 were thromboembolic (7.8%) and the remainder were hemorrhagic complications (n = 16, 7.3%). Multivariate logistic regression analysis showed that a positive history of hypertension (odds ratio [OR] 4.899, 95% confidence interval [CI] 1.266-18.951; P = 0.021), and daughter blebs (OR 12.165, 95% CI 3.247-45.577; P = 0.0001) were the major risk factors for the periprocedural hemorrhagic complications, but not for the thromboembolic complications. Angiographic follow-up (mean, 19.5 ± 11.9 months) showed Raymond scale (RS) 1 in 158 (88.8%) patients and RS2 in 20 (11.2%) patients without any angiographic recurrence. At a mean clinical follow-up of 29.1 ± 16.2 months, 201 out of the 210 surviving patients had a good functional outcome (GOS score of 4 or 5).Conclusions: SAC is an effective treatment option for selected ruptured wide-necked aneurysms, especially in patients who do not require external ventricle drainage for acute hydrocephalus. The periprocedural hemorrhagic complications tend to be more common in the hypertensive patients and in those with daughter blebs in the aneurysm sac. [ABSTRACT FROM AUTHOR]

Background and Purpose: The major determinants of hemorrhage in an arteriovenous malformation (AVM) include its angioarchitecture, as well as the patient's age and clinical presentation. The aim of this study was to determine whether or not the risk of hemorrhage in an AVM differs based on the different clinical presentations and the initial age at diagnosis.Methods: A consecutive case series of 496 patients having a brain AVM was retrospectively analyzed. The radiological evidence of hemorrhage was established in 84 of these cases after the initial diagnosis of AVM had been made. These cases were analyzed using univariate analysis and Kaplan-Meier curves with respect to age at diagnosis, the clinical presentation of patients harboring the AVM as well as the Spetzler-Martin grade of the AVM.Results: Hemorrage occurred in 84 patients with an AVM during a mean duration of 2.5 years (range, 1month-28 years). In univariate analysis, a subsequent hemorrhage within an AVM was associated with the following factors: When the patients initially presented with a hemorrhage, and, had a younger age (<30 years), female gender, and Spetzler-Martin III and IV grades. By analysis of the Kaplan-Meier curves, it was estimated that the annual hemorrhage rate was 12.3% in those cases who initially presented with hemorrhage, compared with 3.5% for those cases whose initial presentation was not associated with AVM bleed. In the latter category (i.e., patients who did not have hemorrhage as the initial presentation), the annual rate of subsequent hemorrhage was lower for those patients who initially presented with seizures than those who had other initial presentations (such as those having neurological deficits, headaches, or those incidentally detected to be having an AVM) (with the bleeding rate being 1.9% in those with seizures as the initial presentation vs. 4.6% for the other presentations or those with incidentally detected AVMs, P = 0.002).Conclusions: The subsequent occurrence of hemorrhage in an AVM was associated with the initial presentation of hemorrhage, a younger patient's age (<30 years), the female gender, and Spetzler-Martin grades III and IV. The risk of subsequent hemorrhage in patients with an initial presentation of a seizure was lower than the risk of hemorrhage that occurred with other presentations. Patients with an AVM who present with recurrent headaches, and those in whom the AVM has been detected incidentally, should also be kept under surveillance as they too manifest a risk of a subsequent hemorrhage. [ABSTRACT FROM AUTHOR]

Background and purpose To investigate the efficacy of endovascular treatment (EVT) for neurovascular conflicts (NVCs) in the cerebellopontine angle (CPA) caused by intracranial aneurysms (IAs) and intracranial arteriovenous malformations (AVMs), including trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia. Materials and methods From January 2010 to January 2014, 14 consecutive patients presenting with three NVCs caused by IAs or intracranial AVMs were admitted to our department. The clinical outcomes of these NVCs after EVT were retrospectively analyzed. Results For four patients with IAs, angiographic followup confirmed total occlusion of the lesion in all, and the clinical outcomes of NVC were as follows: gradual relief in two (50%), transient partial relief but recurrence in one (25%), and no palliative effect in one (25%). For the 10 patients with intracranial AVMs, one (10%) experienced transient relief of NVC after angiogram examination (no EVT was performed). Of the other nine patients who received EVT, angiographic follow-up was obtained in seven (70%), demonstrating total obliteration of the lesion in three (30%), subtotal obliteration in two (20%), and partial obliteration in two (20%). Clinical outcomes included immediate relief of NVCs after single EVT in two cases (20%), gradual relief after single EVT in five (50%, one of them experienced transient aggravation), and complete relief after two sessions of EVT in two (20%). Complications of transient cranial nerve paresis related to EVT occurred in two cases (20%) with intracranial AVMs. In all, complete lasting relief of the NVCs was obtained finally in 11 cases (78.6%). Conclusions EVT is a feasible and less invasive approach for relief of NVCs in the CPA caused by IA or intracranial AVM and could be considered as a therapeutic option in these situations. [ABSTRACT FROM AUTHOR]

This study evaluated patients' preoperative platelet function and the relation between acute embolic or hemorrhagic complications in unruptured intracranial aneurysm patients undergoing stent treatment. From September 2013 to December 2013 we prospectively collected clinical data in all unruptured intracranial aneurysm patients undergoing stent-assisted coiling. All patients received a dual antiplatelet therapy (aspirin and clopidogrel) protocol. Diffusion-weighted 3-T MRI was performed for cerebral aneurysm patients within 24 hours after treatment. Platelet function was tested by thromboelastography. Forty-six patients with 50 intracranial aneurysms treated by stent-assisted coiling were included. Fifty-three stents were deployed in 46 procedures, including 39 Enterprise stents and 14 Solitaire stents. Acute ischemia was detected in the territory of the stented vessel in 25 of 46 patients (54.3%), but did not cause permanent disability. There was a significant difference between groups with and without thromboembolism in terms of percentage platelet inhibition and ADP-induced clot strength (MAADP) for clopidogrel, but no significant difference with aspirin. MAADP had a predictive value yielding an area under the ROC curve of 0.67 (95% CI: 0.57-0.81, P<0.05). Anterior circulation aneurysms were also associated with ischemic events (P=0.034). Silent acute embolism may be frequent in unruptured intracranial aneurysm treated with stent-assisted coiling even when dual antiplatelet therapy is given. The antiplatelet inhibition parameter (MAADP) was a predictor for acute thromboembolism in unruptured intracranial aneurysm patients treated by stent-assisted coiling. [ABSTRACT FROM AUTHOR]

Background and purpose: Dissections and dissecting aneurysms involving the basilar artery (BA) are rare lesions with a poor prognosis, and controversies exist on treatment strategy. We describe the clinical presentation, radiologic features, and clinical outcomes of 11 consecutive patients with these lesions, treated using stent alone placement. Materials and methods 11 patients were studied (10 men, one woman), with a mean age of 51 years (range 30-68 years). Clinical and angiographic data were reviewed retrospectively. Results It was technically feasible to place stents in all 11 cases, and a multiple stents technique was used in nine patients. Procedure related posterior circulation ischemic complications occurred in two cases. One patient presenting with locked-in syndrome died of a pulmonary embolism 3 months after treatment although the clinical condition was gradually improving after stent placement. In the other eight cases, improvement in initial symptoms or a stable condition was observed on follow-up at 1-48 months. Angiographic follow-up was obtained in nine cases using DSA (n=8) or CT angiography (n=1). Successful occlusion of the aneurysm or dissection sac was noted in two cases, BA occlusion in one case, disappearance of double lumen sign in one case, and delayed retention of contrast medium in one case. For the remaining four patients there was no change in the configuration of the lesions on follow-up angiographic results. Conclusions Stent alone treatment as a potential and disputable alternative therapeutic option for the treatment of BA dissection and dissecting aneurysms, although technically feasible, was effective in only certain lesions, and this treatment carries substantial risks of complications and a high failure rate. The true effect of this strategy is questionable. A study involving larger populations and a longer follow-up is necessary to evaluate the efficacy of this treatment modality. [ABSTRACT FROM AUTHOR]

This article has been retracted. Please see the Retraction Notice for more detail: https://doi.org/10.1186/1471-2407-11-527.

We describe three cases of technical failure in patients with giant supraclinoid aneurysm treated with internal carotid artery (ICA) occlusion. Case 1 was a 65-year-old woman who presented with a two-month history of headache accompanied by blurred vision of the left eye. Case 2 was a 43-year-old woman who presented with a six-month history of headache accompanied by blurred vision of the right eye. Case 3 was a 21-year-old man admitted due to headache and blurred vision of the left eye, accompanied by left oculomotor nerve palsy for three months. Cerebral angiography revealed giant supraclinoid aneurysms in these patients. All of them were treated with ICA occlusion. One case had recurrent headache symptoms after the first procedure and was retreated. Two cases suffered from post-procedural intracranial hemorrhagic complications. Before ICA occlusion for giant supraclinoid aneurysm, balloon occlusion test was used to evaluate the collateral anastomosis between the external carotid artery (ECA) and the ICA, and still plays an important role in preventing treatment failure. [ABSTRACT FROM AUTHOR]

The liquid embolic agents currently used for embolization of cerebral arteriovenous malformations are Onyx and NBCA. Glubran 2, a cyanoacrylate-based synthetic glue, has recently been applied for embolization of cerebral arteriovenous malformations (AVMs). We report the clinical results of selected cerebral AVMs treated with Glubran 2 targeting for curative embolization. Between October 2011 and March 2013, 31 patients with cerebral AVMs were selected for curative embolization with Glubran 2. There were 19 men and 12 women with a mean age of 32 years (range 4-65 years). Initial clinical presentation included hemorrhage in 28 and seizures in three patients. AVM location was frontal in eight patients, parietal in four, occipital in eight temporal in six, cerebellar in two and cerebellar vermis in three patients. Follow-up was performed clinically and with angiography examination at three to six months. Clinical outcomes were evaluated based on the modified Rankin Scale (mRS). A mean of 2.5 (range, 1-12) feeding pedicles were embolized per patient. Complete angiographic obliteration of AVM was achieved in 27 patients. A hemorrhagic complication was observed in one patient, an ischemic complication in one patient and technical complications in four patients. There was no procedure-related disabling neurological deficit or death at discharge. Additional gamma knife radiosurgery was performed in five patients, including one patient with recurrent AVM. All of the patients had favorable clinical outcomes at three to six month follow-up (mRS⩽2). The curative embolization technique with Glubran 2 for selected cerebral AVMs achieved a high initial complete obliteration rate with an acceptable complication frequency. [ABSTRACT FROM AUTHOR]

This study reports the natural history of unruptured brain arteriovenous malformations (AVMs) and the risks involved in their endovascular management. A total of 242 patients at our center were enrolled in the study, which had retrospective and prospective components. We retrospectively assessed the morbidity and mortality related to endovascular management in 125 patients with unruptured AVMs. We prospectively assessed the natural history of unruptured AVMs in 117 patients with newly diagnosed unruptured AVMs; 48 of the patients had no history of seizure (Group 1), whereas 69 had a history of seizure from the lesion (Group 2). The retrospective group was also divided into patients with and without seizures. The cumulative rate of rupture of AVMs in Group 2 was less than 0.8% per year, while the rate was approximately sixfold higher (5.1% per year) in Group 1. The overall cumulative rate of rupture of AVMs was less than 3.0% per year. The overall rate of endovascular managementrelated morbidity and mortality was 10.6% in Group 2 and 11.9% in Group 1 at 30 days and was 25.9% and 13.6%, respectively, at one year. There was no independent predictor of a poor endovascular outcome. The likelihood of rupture of unruptured AVMs was exceedingly low among patients in Group 2 and was substantially higher among those in Group 1. The risk of morbidity and mortality related to endovascular management greatly exceeded the six-year risk of rupture among patients in Group 2. Endovascular management of an AVM should not be performed to eliminate or to improve seizure frequency. [ABSTRACT FROM AUTHOR]

Background and purpose Cognard type IV anterior cranial fossa dural arteriovenous fistulas (DAVFs) are rare lesions with a high risk of intracranial hemorrhage. We present our experience with the use of Onyx via the arterial route in these aggressive lesions. Materials and methods Between October 2009 and October 2011, six consecutive patients diagnosed with Cognard type IV anterior cranial fossa DAVFs were treated transarterially with Onyx in our department. All patients were male; mean age was 55 years (range 38- 68). Four patients presented with intracranial hemorrhage as the initial manifestation; one patient presented with seizures at the time of diagnosis and experienced intracranial hemorrhage during the antiepileptic therapy; and the other patient was asymptomatic. Results In five patients, complete obliteration was achieved with transarterial Onyx injection in a single treatment session; in the remaining patient, subtotal occlusion was achieved and gamma knife treatment was followed. The average time of injection was 19 min (range 5-28) for every pedicle catheterized and the average amount of Onyx was 3.2 ml (range 0.4-6.3) for each lesion. All patients recovered uneventfully after embolization. No mortality or permanent morbidity was observed in this series. Follow-up digital subtraction or MR angiography confirmed durable obliteration of the fistulas in five cured cases. No patients suffered intracranial hemorrhage during the follow-up period. Conclusions In this small series, our experience with the use of Onyx for arterial embolization of Cognard type IV DAVFs is encouraging, with durable complete cure in most lesions without severe complications. [ABSTRACT FROM AUTHOR]

This study evaluated the outcome of endovascular and conservative treatment for giant cavernous carotid artery aneurysms (CCAAs). We retrospectively reviewed a series of 35 consecutive giant CCAAs treated with endovascular and conservative treatment. All patients were evaluated by balloon occlusion test (BOT) before treatment. Patients who could tolerate BOT were treated by parent artery occlusion (PAO), those who could not tolerate BOT were treated by stent/coil or conservative methods. Eight patients were treated conservatively, symptoms were worsened in four patients (50%), unchanged in three, and improved in one at 33.6±19.9 months (6~65 months) follow-up. In 27 aneurysms treated with endovascular methods, 17 aneurysms were treated by PAO, eight aneurysms were treated with stent-assisted coil embolization, and two aneurysms were embolized with coils. The initial post-procedure angiogram revealed complete occlusion, neck remnant, and incomplete occlusion in 81.5 %, 11.1 %, and 7.4 %, respectively. Procedure-related mortality and morbidity were 0 and 7.4 %, respectively. At 33.1±17.4 months (4~71 months) follow-up, a good clinical outcome (mRS 0-1) was observed in 25 (92.6%) patients, symptoms were resolved or improved in 20 (74.1%). Statistical analysis showed that risk factors for poor clinical outcome included age of 60 years and older (P=0.006), and conservative treatments (P=0.038). Risk factors for poor clinical outcome of giant CCAAs included conservative treatment and age older than 60 years. A symptomatic giant cavernous carotid aneurysm should be treated. The outcome of endovascular treatment of giant CCAAs is promising. [ABSTRACT FROM AUTHOR]

Objective: To present a case of VGAM in children referred late according to the same scale with already impaired function and retardation, we have attempted to improve her quality of life. Clinical Presentation: A 7-year-old girl with a history of a brief period congestive cardiac failure at 20-day age in her neonate caused by a VGAM and improved with appropriate medical management. Her Bicêtre neonatal score was 20, but no intervention was undertaken until she suffered mental retardation or neurological deficits 1 month ago. At admission, she had hemiparesis of the left limbs and mildly retarded psychomotor development and her Bicêtre admission Score was 2. CT scanning showed subcortical calcifications. She got a remarkable recovery at 1-month follow-up after transarterial embolization using coils and Onyx. Conclusion: The congestive cardiac failure in VGAM can be present during the neonatal period. Use of Bicêtre score to determine aggressiveness and timing of treatment may help in achieving appropriate treatment and aid in prognostication. Hemorrhage and mental retardation are the part of the natural history of untreated VGAM. In children referred late with already impaired functions or severe retardation, endovascular treatment can achieve satisfactory results. [ABSTRACT FROM AUTHOR]

Objective To investigate warning effect of serum miRNA for intracranial aneurysm rupture through microarray hybridization. Methods 24 were selected from 560 patients in our department and divided into group A, B, C and D. They are aneurysms with daughter aneurysms group, aneurysm without daughter aneurysms group, ruptured aneurysms group and angiography negative group. Then a microarray study was carried out using serum miRNA. Differentially expressed miRNAs were identified. Cluster analysis was performed in order to make the results looks more intuitive and potential gene targets were retrieved from miRNA target prediction databases. Results Microarray study identified 86 miRNAs with significantly different(p < 0.05)expression levels between three experimental groups and control group. Among them 69 are upregulated and 17 are down-regulated. All miRNAs in group A are up-regulated, while there are up and down-regulated in group B and C. A total of 8291 predicted target genes are related to these miRNAs. Bioinformatic analysis revealed that several target genes are involved in apoptosis and activation of cells associated with function of vascular wall. Conclusion Our gene level approach reveals several different serum miRNAs between normal people and aneurysm patients, as well as among different phases of aneurysm, suggesting that miRNA may participate in the regulation of the occurrence and development of intracranial aneurysm, and also have warning effect for intracranial aneurysm rupture. All differently expressed miRNA in group A are up-regulated, which may suggesting protective function of miRNA for intracranial vascular wall. [ABSTRACT FROM AUTHOR]

Background: Current endovascular techniques have been widely used to treat paraclinoid aneurysms. Methods: From January 2009 to December 2011, 126 consecutive patients with 142 saccular paraclinoid aneurysms were treated with endovascular embolizationat our institute. A retrospective review of the clinical and imaging data was performed.Results: Of the 142 aneurysms, 121 (86.2%) had small while 21 (14.8%) had large fundus size. 83 aneurysms (58.5%) were narrow necked and 59 (41.5%) were wide necked. The dome–neck ratio was favorable in 26 aneurysms (18.3%) and unfavorable in 116 (81.7%). 24 aneurysms (16.9%) were managed with coil embolization and 118 (83.1%) with a stent assisted coiling technique. Immediate angiography demonstrated complete occlusion in 62 (43.7%), neck remnant occlusion in 47 (33.1%), and residual aneurysm occlusion in 33 (23.2%) aneurysms. The overall recurrence rate in the 112 aneurysms with angiographic follow-up (8.88±3.40 months, mean±SD) was 12.5%. Of the 14 recurrent aneurysms, 10 were managed with endovascular treatment (six by stent assisted coiling, four by coiling) while four are under observation. There were six (4.3%) procedural complications during 137 procedures. Clinical follow-up was available for 119 patients (94%) with a follow-up time of 16.6 ±13.6 months, and the majority (98%) had a modified Rankin scale score of 0–1. Conclusions: The stent assisted coiling technique is effective for the treatment of paraclinoid aneurysms. Small paraclinoid aneurysms (≤10 mm) are suitable for endovascular treatment, with a low rate of recurrence. In contrast, large paraclinoid aneurysms (>10 mm) treated with current endovascular techniques exhibited a high rate of recurrence. [ABSTRACT FROM AUTHOR]

This study aimed to report the results and outcome of stent-assisted coiling of ruptured widenecked intracranial aneurysms. We retrospectively reviewed 19 consecutive patients (11 men, eight women; mean age, 59.5 years; range, 43-78 years) with acutely ruptured wide-necked intracranial aneurysms who were treated with stentassisted coil embolization. The mean length of angiographic follow-up was 5.2 months (range, 3-10 months). There was no technique-related complication and the 30-day mortality rate was 10.5% (two of 19). There was one case of rebleeding, and clinical outcome was poor for the patient (5.3% [one of 19] who had a Glasgow Outcome Scale score of 2 at the end of the study period). Stent-assisted coiling is a feasible treatment for ruptured wide-necked intracranial aneurysms that are difficult to treat surgically or with balloon-assisted embolization. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the characteristics of six patients with dural arteriovenous fistula (DAVF) with drainage directly into the perimedullary venous system. In five patients with subarachnoid hemorrhage (SAH), cerebral angiography revealed a DAVF with spinal venous drainage located at the petrosal sinus in one, at the tentorium in one, and at the craniocervical junction in four. In the patient with myelopathy, angiographic exploration began with a spinal angiogram. Bilateral vertebral angiography initially failed to demonstrate the fistula, and a tentorial DAVF was established with carotid artery angiography. Patients had no myelopathy when the venous drainage was limited to the cervical cord; myelopathy was present when the venous drainage descended toward the conus medullaris. Diagnosis of a DAVF presenting with myelopathy is more challenging than of those presenting with SAH. [ABSTRACT FROM AUTHOR]

Background: We present our findings concerning the laterocavernous sinus (LCS) drainage of cavernous region dural fistulas, focusing our attention on the anatomy of LCS as it may have important implications in the treatment. Patients and Methods: Thirty-one consecutive patients with cavernous region dural fistulas treated endovascularly between 2005 and 2008 were reviewed. Five patients had angiographic features such as cavernous region dural fistulas draining with superficial middle cerebral vein (SMCV) via LCS. Clinical records of these 5 patients were focused upon to determine their presenting symptoms, angiographic features, endovascular treatments and clinical outcomes. Results: Among 31 cases of cavernous dural arteriovenous fistula (DAVF), 5 (16%) cases with leptomeningeal veins [SMCV, petrosal vein] reflux via LCS were noted. The 5 cavernous region dural fistulas were defined as Cognard type III and Barrow type A (1/5), B (1/5), C (1/5) and D (2/5). All 5 patients underwent immediate obliteration of the cavernous region dural fistulas in 3 sessions of transarterial and 2 sessions of transvenous embolization. An angiographic obliteration and clinical cure was achieved in all patients. We encountered one minor complication of local hair loss induced by X-ray radiation. A complete resolution of the initial presenting symptoms was observed within a few days to weeks. Six-month follow-up angiogram in 5 patients showed obliteration and no recanalization of CCF. Conclusion: It is very important to diagnose the presence of laterocavernous sinus in dural arteriovenous fistulas during diagnostic angiography. It is believed that the knowledge of the existence of laterocavernous sinus might be relevant for the understanding and treatment of dural fistulas involving the cavernous sinus and its lateral wall. [ABSTRACT FROM AUTHOR]

Background: Large and giant aneurysms still remain a therapeutic challenge both surgically and endovascularly. Objective: The authors report their clinical experience and follow-up results using Neuroform stent, as an adjunct in the treatment of large and giant aneurysms. Materials and Methods: A total of 71 consecutive patients with 72 large or giant intracranial aneurysms were treated with the Neuroform stent-assisted coiling. Both sequential technique and parallel technique were used. In all cases, embolization was completed by packing the aneurysm sac with a variety of commercially available coils. The technical feasibility of the procedure, procedure-related complications, angiographic results, clinical outcome, and follow-up angiography were evaluated. Results: In all the patients, the Neuroform stent system was delivered and deployed accurately, and occlusion was achieved. Immediate angiography demonstrated complete occlusion of the aneurysm in 59.7% of the patients, neck remnant in 26.4%, and incomplete occlusion in 13.9%. Procedure-related complication, morbidity, and mortality were 15.3, 4.2, and 1.4%, respectively. Favorable clinical outcome (modified Rankin Scale score 0-2) was observed in 83.3% of the patients (average follow-up time: 37.1 months). None of the treated aneurysm had rebleeding. Angiography follow-up was obtained in 81.7% (58/71 patients; 59/72 aneurysms; average follow-up time, 43.2 months). The overall recanalization rate was 28.8%. No delayed coil or stent migration was found. In-stent stenosis occurred as a delayed complication in one patient. Conclusions: The Neuroform stent-assisted coiling for large and giant intracranial aneurysms is safe and feasible with comparable incidences of morbidity and mortality. [ABSTRACT FROM AUTHOR]

The purpose of this study is to report the characteristics and outcomes of pediatric patients with intracranial aneurysms. From 1998 to 2005, 25 pediatric patients (aged ≤17 years) with intracranial aneurysm were treated at our institute. Eleven of 25 patients had subarachnoid hemorrhage. In ten patients, the aneurysm was an incidental finding. One patient presented with cranial nerves dysfunction and three with neurological deficits. The locations of the aneurysms were as follows: vertebral artery (VA; n = 9), middle cerebral artery (MCA; n = 5), posterior cerebral artery (PCA; n = 4), basilar artery (BA; n = 2), anterior communicating artery ( n = 2), anterior cerebral artery ( n = 2), and internal carotid artery ( n = 1). Five patients were treated with selective embolization with coils. Sixteen patients were treated with parent vessel occlusion (PVO). Eight PVOs were performed with balloons and eight were performed with coils. One patient with a VA aneurysm was spontaneously thrombosed 4 days after the initial diagnostic angiogram. In three patients treated with stent alone or stent-assisted coiling, one with BA trunk aneurysm died. One aneurismal recurrence occurred and was retreated. At a mean follow-up duration of 23.5 months, 96% of patients had a Glasgow Outcome Scale score of 4 or 5. Pediatric intracranial aneurysms occur more commonly in male patients and have a predilection for the VA, PCA, and MCA. PVO is an effective and safe treatment for fusiform aneurysms. Basilar trunk fusiform aneurysms were difficult to treat and were associated with a high mortality rate. [ABSTRACT FROM AUTHOR]

Large intracranial aneurysms represent huge therapeutic challenges for neurosurgeons and endovascular therapists. Since they may involve entire vessels or be irregular in shape, the ratio of complete obliteration of these aneurysms with detachable coils is low and the incidence of recanalisation is very high. So the technique of stent-assisted coil placement was designed for the treatment of large intracranial aneurysms. We report our experience in the treatment of large or complex and wide-necked aneurysms using Neuroform stent-assisted coil placement. Thirty-six patients harboring large intracranial aneurysms were treated by Neuroform stent -assisted coil placement. Thirty-five Neuroform stents were delivered and deployed at the desired location. Of the 35 aneurysms successfully stented, all the aneurysms were occluded with stent -assisted coiling. Twenty-six were totally occluded, four achieved subtotal occlusion, and five incomplete occlusion at the end of the procedure. There were no complications related to the procedure except the migration of stents in two cases. All the patients recovered well. Though Neuroform stent-assisted coil placement may be a favorable technique for treatment of large intracranial aneurysms, further study is necessary to assess the long-term outcome. [ABSTRACT FROM AUTHOR]

An increasing number of intracranial dural arteriovenous fistulas (DAVFs) are amenable to endovascular treatment with Onyx-18. We reviewed our experience with the endovascular management of tentorial dural arteriovenous fistulas (TDAVFs) treated transarterially and transvenously. Clinical records for 19 consecutive patients (three women, 16 men) with TDAVFs treated endovascularly between 2005 and 2008 were reviewed to determine their presenting symptoms, angiographic features, endovascular treatments, and clinical outcomes. Most patients (78.9%) presented with intracranial hemorrhage (ICH). All patients had high-risk angiographic features such as leptomeningeal venous varix. Transarterial embolization was performed in 19 patients. Transvenous embolization was additionally performed in two patients and caused one death. At the time of the last follow-up evaluation, 16 (84.2%) patients had good or excellent outcomes (modified Rankin score, 0 or 1) and one (5.3%) was deceased. Six patients had a residual fistula and were treated with gamma knife radiosurgery. The overall morbidity and mortality rate was 10.5%. High-risk TDAVFs can be successfully managed with good outcomes. When anatomic features can be accessed endovascularly, endovascular treatment is indicated. Patients with residual filling of the DAVF should be considered for adjuvant therapy, including further radiosurgery. [ABSTRACT FROM AUTHOR]

This study evaluated angiographic and clinical results in patients with a dural arteriovenous fistula (DAVF) who underwent percutaneous transvenous embolization. Retrospective chart analysis and radiographic studies were performed in 23 patients (aged 11- 70 yrs) with a DAVF treated with percutaneous transvenous embolization in the past five years. Lesions were located in the anterior cranial fossa, cerebellar tentorium, transverse-sigmoid sinus and cavernous sinus. All procedures were analyzed with regard to presentation, delivery, angiographical and clinical outcome. Data for 23 patients (age range, 11-70 yrs, mean age 49.5yrs) with DAVFs (cavernous sinus[CS], n=17; transverse-sigmoid sinus, n=3; anterior cranial fossa, n=2; cerebellar tentorium, n=1) were retrospectively reviewed. The DAVFs were treated with coils or a combination with Onyx via different transvenous approaches, in 28 procedures. Cerebral angiography was performed to confirm the treatment. The mean clinical follow-up period was 22.1 months. Transvenous treatment of intracranial DAVFs can be safe and effective if various transvenous approaches are attempted. Percutaneous transvenous embolization with detachable platinum coils or a combination with Onyx is effective in the treatment of DAVFs. [ABSTRACT FROM AUTHOR]

Dural arteriovenous fistulas (DVAFs) have been reported to be treated transarterially with Onyx 18. We present a series of tentorial DAVFs treated by transarterial embolization with Onyx 18 over an 18-month period. Eight patients with tentorial DAVFs were treated between September 2005 and February 2007. All patients were treated transarterially with Onyx 18. The clinical presentation, treatment strategies and results were studied. Eight patients presented with intracranial hemorrhage or progressive neurological deficits. Retrograde leptomeningeal venous drainage was documented in every patient, classifying the lesions as Cognard Type IV. Post treatment angiography demonstrated complete obliteration in six cases. Clinical follow up ranged from six to 14 months. One patient experienced neurological decline after endovascular treatment and exhibited clinical improvement. There were no episodes of rehemorrhage or new neurological deficits. Outcomes were excellent in seven patients, fair in one case. Transarterial embolization of tentorial DAVF is feasible and may result in complete occlusion of the fistulous connection with liquid nonadhesives. [ABSTRACT FROM AUTHOR]

We report on patients with cavernous dural arteriovenous fistulae (CDAVFs) who underwent transvenous embolization via different transvenous approaches with Onyx and coils. Twelve patients presenting with clinically symptomatic CDAVFs who were treated between August 2005 and November 2007 at Beijing Tiantan Hospital were reviewed. The approach routes, angiographic results and clinical outcome were assessed. Retrospective analysis of data for 12 patients (age range 36-75 yrs, mean age 59.3 yrs) with CDAVFs was performed. The CDAVFs were treated with Onyx and coils via different transvenous approaches in 14 procedures. Cerebral angiography was performed to confirm the treatment and diagnosis. The mean clinical follow-up period was 5.5 months. A total of 13 transvenous procedures and one transarterial procedure were performed for 12 CDAVFs. Eleven patients with CDAVFs of the CS were cured with respect to clinical symptoms, and one patient experienced improvement. The approach via the internal jugular vein and inferior petrosal sinus (n=10) was possible, with complete occlusion of the fistula in all cases. With the approach via the facial vein (n=2), there was a good success rate. We encountered no complications in any of the cases. Transvenous treatment of CDAVFs with Onyx and coils can be an effective option for different transvenous approaches. [ABSTRACT FROM AUTHOR]

We describe the technique and results of the endovascular treatment of anterior cranial fossa dural arteriovenous fistulas (DAVF) in four symptomatic patients. Catheterization was via the superior sagittal sinus in two patients and via the ophthalmic artery in two patients. Embolization was performed using detachable platinum coils in the former two patients and a liquid embolic system (Onyx-18, MTI) in the latter. We were able to reach the fistula site and to embolize the arteriovenous shunting zone in all of the patients. The final angiogram showed complete occlusion of the DAVFs, and all patients recovered completely. No complications related to either approach were observed. Endovascular treatment of anterior cranial fossa DAVFs is feasible by either transvenous or transarterial access. [ABSTRACT FROM AUTHOR]

Most cases of aneurysms associated with the distal portion of the anterior inferior cerebellar artery resulted in a hearing disturbance from the surgical procedure, although aneurysms far from the auditory artery had no deficit from trapping. We describe a patient with an aneurysm at the distal segment of the anterior inferior cerebellar artery (AICA) treated endovascularly by parent artery occlusion. [ABSTRACT FROM AUTHOR]

Aneurysms arising from the fenestration of the basilar artery are rare. We describe a patient with two aneurysms originating from the fenestration of the basilar artery and the middle cerebral artery. Endovascular treatment with detachable platinum coils was performed, and two aneurysms were cured at the same time. Endovascular treatment of aneurysms associated with fenestrated basilar artery appears to offer advantages over traditional open surgical techniques. [ABSTRACT FROM AUTHOR]

Aneurysms arising from the fenestration of the basilar artery are rare. We describe a patient with two aneurysms originating from the fenestration of the basilar artery and the middle cerebral artery. Endovascular treatment with detachable platinum coils was performed, and two aneurysms were cured at the same time. Endovascular treatment of aneurysms associated with fenestrated basilar artery appears to offer advantages over traditional open surgical techniques. [ABSTRACT FROM AUTHOR]

Previous reports of outcome after endovascular treatment of posterior cerebral artery (PCA) aneurysms have been limited. This study aimed to describe the clinical outcome and angiographic results obtained in the endovascular therapy of PCA aneurysm over a six year period. Endovascular treatment strategies were determined. A retrospective analysis was performed on 18 patients with PCA aneurysms evaluated at Beijing Tiantan Hospital between December 2000 and December 2006. Nine patients presented with subarachnoid hemorrhage (SAH): one of these patients had additional seizure and hemiparesis, one had additional memory loss and oculomotor palsy and one had additional vitreous hemorrhage. One patient had an intracerebral hematoma causing hemipalsy. Nine patients demonstrated unruptured PCA aneurysms. Ten aneurysms were = or >15 mm and the other eight were <15 mm. Ten aneurysms were saccular, four were fusiform and four were giant serpentine. Eighteen aneurysms were successfully treated with one patient deceased and one with a permanent deficit, 11 with selective occlusion of the aneurysm with platinum coils, one with NBCA and five with simultaneous occlusion of the aneurysm and parent PCA with detachable coils. One patient underwent complete spontaneous thrombosis after angiography. One patient had recanalization one year after coiling and one patient (patient 13) had persistent homonymous hemianopsia and mild hemipalsy. Five patients had parent vessels were occluded with intact visual field. Clinical presentation of PCA aneurysms varied with SAH, oculomotor palsy, heminumbness, hemiparalysis, memory loss, seizure or a combination. Various aneurysms of the posterior cerebral artery can be managed effectively with endovascular treatment. [ABSTRACT FROM AUTHOR]

For large-scale bioproduction, thermal stability is a crucial property for most industrial enzymes. A new method to improve both the thermal stability and activity of enzymes is of great significance. In this work, the novel chaperones RrGroEL and RrGroES from Rhodococcus ruber, a nontypical actinomycete with high organic solvent tolerance, were evaluated and applied for thermal stability and activity enhancement of a model enzyme, nitrilase. Two expression strategies, namely, fusion expression and co-expression, were compared in two different hosts, E. coli and R. ruber. In the E. coli host, fusion expression of nitrilase with either RrGroES or RrGroEL significantly enhanced nitrilase thermal stability (4.8-fold and 10.6-fold, respectively) but at the expense of enzyme activity (32−47% reduction). The co-expression strategy was applied in R. ruber via either a plasmid-only or genome-plus-plasmid method. Through integration of the nitrilase gene into the R. ruber genome at the site of nitrile hydratase (NHase) gene via CRISPR/Cas9 technology and overexpression of RrGroES or RrGroEL with a plasmid, the engineered strains R. ruber TH3 dNHase::RrNit (pNV18.1-Pami-RrNit-Pami-RrGroES) and TH3 dNHase::RrNit (pNV18.1-Pami-RrNit-Pami-RrGroEL) were constructed and showed remarkably enhanced nitrilase activity and thermal stability. In particular, the RrGroEL and nitrilase co-expressing mutant showed the best performance, with nitrilase activity and thermal stability 1.3- and 8.4-fold greater than that of the control TH3 (pNV18.1-Pami-RrNit), respectively. These findings are of great value for production of diverse chemicals using free bacterial cells as biocatalysts.

A letter to the editor is presented concerning a novel approach for the treatment of small vessel hemorrhage disease.

The article presents a case study of a 22-year-old woman persistent premitive trigeminal artery (PPTA) and carotid-trigeminal cavernous fistula (CTCF) treated by a combination of onyx and coils. The use of onyx, a liquid embolic mixture lessens significantly the number of coils needed to tightly pack the fistula. The patient suffered from hemiparesis and mild dysarthria after the transarterial and transvenous coil embolization of the PPTA and cavernous sinus.

The experience with respect to the treatment of giant intracranial aneurysms with flow-diversion devices is limited. The aim of the present systematic review was to evaluate the effect of the pipeline embolization device (PED) on giant intracranial aneurysms. Eligible related articles were identified by searching the PubMed, Web of Science, Springer, ScienceDirect, and OVID databases using "giant aneurysm" and "pipeline" as the search items. The date of the last search was November 20, 2015. This systematic review adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In a total of 9 eligible studies with 200 patients and 215 aneurysms, 40 (18.6%) giant (aneurysm diameter >25mm) intracranial aneurysms treated with PED were analyzed. During a 6 to 34 month follow-up, complete occlusion was achieved in 23 (57.5%) cases. Seven patients (17.5%) developed intracranial hemorrhage, 5 developed ischemic attack (12.5%), and 13 (32.5%) developed a mass effect after PED treatment. The complication rate was 77.8% in PED for giant vertebrobasilar artery aneurysms. The cumulative mortality rate for giant paraclinoid carotid artery and middle cerebral artery aneurysms was 13.3% and increased up to 50% for giant vertebrobasilar artery aneurysms. The complete obliteration rate of PED for giant intracranial aneurysms was approximately 60%. Mass effect is the most mechanism of complications. Complication and mortality rates associated with PED for giant vertebrobasilar artery aneurysms are still extremely high. [ABSTRACT FROM AUTHOR]

Objectives: The aim of our study was to determine whether stent assisted coiling may promote progressive occlusion of an incompletely occluded aneurysm. Methods: From March 2009 to December 2012, 177 patients with ruptured wide-necked aneurysms (58 patients in the stent group and 109 in the nonstent group) treated by endovascular coiling were retrospectively enrolled. All patients included in this study had follow up angiographic results. Enterprise stents were used for coiling in the stent group. Simple coiling and balloon-assisted coiling technique were used for coiling in the nonstent group. No significant difference in Patient demographics and aneurysmal characteristics (patient age, aneurysm diameter, neck size, and dome-to-neck ratio) were observed between the 2 study groups. Angiographic follow-up results for stented and nonstented aneurysms were compared. Results: With a mean follow-up time of 8 month, progressive occlusion rates was significantly higher in the stent group (16/29, 55.2%) than in the nonstent group (10/34, 29.4%)(P=0.03). Recurrence rate was not significantly different between two groups (13.8% (8/58) in the stent group compared with 17.4% (19/109) in the nonstent group) (P=0.54). Conclusion: We conclude that Enterprise stent-assisted coiling significantly promotes progressive occlusion of incompletely occluded aneurysms at initial treatment compared with nonstent-assisted coiling. [ABSTRACT FROM AUTHOR]

Aim: The present stent-assisted coil technique has many limitations especially in treating fusiform aneurysms. We aimed to introduce stenting following coiling technique to treat fusiform aneurysms., Material and Methods: From January 2009 to December 2010, we treated 6 patients with fusiform aneurysms in basilar artery (BA) by stenting following coiling technique. The 6 patients included four men and two women (age from 20 to 78 years, mean age 51 years). Two patients had subarachnoid hemorrhage, whereas 4 had unruptured aneurysms with progressive brainstem symptoms. In the procedure of endovascular treatment, the stent was delivered after coiling to compress the coils against the aneurysm wall and form a lumen in basilar artery., Results: Five patients had an excellent recovery with a satisfactory clinical result with an average 15.4 months follow-up. Four patients received follow-up angiographic imaging with an average 13 months, whereas 3 patients demonstrated complete aneurysm occlusion with reconstructive BA patency. Re-growth occurred in one patient, although clinically stable. None had angiographic evidence of in-stent stenosis., Conclusion: Stenting following coiling technique may be a feasible and effective method to reshape parent arteries and to embolize fusiform aneurysms safely. However, this technique may be considered in selected patients.