Bu-Lang Gao

The Stent-Assisted Coil-Jailing Technique Facilitates Efficient Embolization of Tiny Cerebral Aneurysms

Objective Tiny cerebral aneurysms are difficult to embolize because the aneurysms sac is too small for a single small coil, and coils within the aneurysm may escape from the confinement of a stent. This study was performed to introduce the stent-assisted coil-jailing technique and to investigate its effect on the coil embolization of tiny intracranial aneurysms. Materials and Methods Sixteen patients with tiny intracranial aneurysms treated with the stent-assisted coil-jailing technique between January 2011 and December 2013 were retrospectively reviewed and followed-up. Results All aneurysms were successfully treated with the coil-jailing technique, and at the end of embolization, complete occlusion of the aneurysm was achieved in 9 cases (56.3%), incomplete occlusion in 6 (37.5%), and partial occlusion in 1 (6.3%). Intraprocedural complications included acute thrombosis in one case (6.3%) and re-rupture in another (6.3%). Both complications were managed appropriately with no sequela. Follow-up was performed in all patients for 3-24 months (mean, 7.7 months) after embolization. Complete occlusion was sustained in the 9 aneurysms with initial complete occlusion, progressive thrombosis to complete occlusion occurred in the 6 aneurysms with initial near-complete occlusion, and one aneurysm resulted in progressive thrombosis to complete occlusion after initial partial occlusion. No migration of stents or coils occurred at follow-up as compared with their positions immediately after embolization. At follow-up, all patients had recovered with no sequela. Conclusion The stent-assisted coil-jailing technique can be an efficient approach for tiny intracranial aneurysms, even though no definite conclusion regarding its safety can be drawn from the current data.

Microcatheter looping facilitates access to both the acutely angled parent artery and cerebral aneurysms for effective embolization.

Aneurysms with an acutely angled parent artery are difficult to access for coiling. This study aimed to investigate the safety and effectiveness of microcatheter looping for embolization of cerebral aneurysms with access difficulty. Ten patients (male:female=5:5) with cerebral aneurysms treated with the microcatheter looping technique were analyzed retrospectively. The parent artery formed an acute angle with the major artery in five aneurysms. The microcatheter was looped into a “α” loop for treatment in the anterior temporal artery aneurysm and a “U” loop in the remaining nine aneurysms. All ten aneurysms were successfully treated with the microcatheter looping technique. The microcatheter tip was successfully navigated into the aneurysm sac and remained stable throughout the embolization process. All aneurysms were occluded with total occlusion in five and near-total occlusion in five, and the parent artery remained patent in all cases. No complications occurred peri-procedurally. The Glasgow Outcome Scale was 5 in all patients before discharge. Follow-up angiography six to 12 months later revealed a good occlusion status of the aneurysms. The microcatheter looping technique is effective when the conventional embolization technique fails to treat cerebral aneurysms with difficult access especially when the parent artery forming an acute angle with the major artery exacerbates difficult access to the aneurysms.

Evaluation of left gastric vein in Chinese healthy adults with multi-detector computed tomography

ABSTRACT Objectives: To evaluate the classification and diameter of left gastric vein (LGV) in healthy Chinese adults with multi-detector computed tomography (MDCT). Methods: MDCT angiography was performed in 234 healthy adults for the portal venous system. CT cross-sectional thin-layer reconstruction combined with maximum intensity projection, volume rendering and multiplanar reconstruction were applied. The diameter of LGV was measured at the point within 2 cm from LGV origination. Results: Of 234 subjects, 11 subjects (4.70%) who did not have clear images were excluded, and 223 subjects (95.30%) with excellent images were included. The LGV was originated from the portal vein in 46.15%, splenic vein in 30.77%, portal splenic angle in 14.53%, and the left branch of the portal vein in 3.85%. The maximal diameter of LGV was 4.74 ± 0.84 mm with a 95% confidence interval of 4.63–4.85 mm, and the LGV diameter was positively correlated with the weight of patients (R = 0.26, P = 0.006). No significant difference existed in the maximal diameter of LGV at different origination sites (P = 0.35). The diameter of LGV was significantly greater in males than in females (4.90 ± 0.85 vs. 4.56 ± 0.80 mm, P = 0.002), and the maximal diameter of LGV was significantly (P = 0.02) greater in the age range of 30–39 and 40–49 years than in the range of >70 years. No statistical significance (P = 0.36) was detected in the other groups. Conclusion: MDCT can clearly display the detailed anatomy and variation of LGV in healthy adults, providing a normal range of LGV diameter for clinical reference for diagnosing possible portal hypertension and for possible intervention.

Quantitative evaluation of left ventricular volume and function in middle-aged healthy chinese people with 3 Tesla MRI.

To quantitatively investigate left ventricular volume and function in middle‐aged healthy subjects.

Comparison of surgical and endovascular approaches in the management of multiple intracranial aneurysms

OBJECTIVE To investigate the outcomes and safety of endovascular compared with surgical clipping for multiple intracranial aneurysms. MATERIAL AND METHODS 98 patients with 260 multiple intracranial aneurysms were treated with endovascular, surgical clipping, combined treatment, and observation. Data were retrospectively studied following treatment and at follow-up. RESULTS In the endovascular group, 44 aneurysms were treated with coils only and 29 aneurysms were treated with stent deployment. The complete occlusion rate was 65%, and the total complication rate was 12% with no permanent deficit. After angiographic follow-up for 1-90 (mean 62) months, the total recurrence rate was 18.3%. In the clipping group, 65 aneurysms were clipped. The complete occlusion rate was 90.8%, and the complication rate was 10.9% with 1 permanent deficit. After follow-up for 11-71 (mean 49) months, the angiographic recurrence rate was 1.5%. In the combination group, 20 aneurysms were treated endovascularly. The complete occlusion rate was 78.9%, and the complication rate was 15.8% with no permanent deficit. Twenty-eight aneurysms were treated surgically with the complete occlusion rate of 89.3%, the complication rate of 20% and 3 permanent deficits. After follow-up for 1-93 (mean 58) months, the angiographic recurrence rate was 33.3% for embolization and 3.6% for clipping. Seventy-four aneurysms for observation had 2.7% regrowth rate within 1-3 years. CONCLUSION Endovascular embolization has an accepted complication rate but no neurological deficits compared with surgical clipping and may be a better approach for multiple intracranial aneurysms than surgical clipping.

Endovascular Stent Deployment in the Management of Lesions Related to Internal Carotid Artery Redundancy

OBJECTIVE To investigate the endovascular treatment (stenting with or without coiling) of cervical and intracranial lesions associated with internal carotid artery (ICA) redundancy. METHODS Nine patients harboring 12 lesions of dissections, pseudoaneurysms, and aneurysms in the presence of ICA redundancy were treated using stent deployment with or without coiling. There were 8 female and 1 male patients with an age range of 31-89 years (mean, 55 years). RESULTS Two patients with ICA dissections were treated with stenting alone while all the other pseudoaneurysms and aneurysms were managed with both stenting and coiling. Fourteen stents were deployed, and the success rate of stent deployment was 100%. All the lesions were successfully occluded with subtotal occlusion in 3 lesions and total occlusions in the remaining lesions. Mean follow-up was 7.3 months (range, 3-25 months), during which time the lesions remained occluded with patent stents. No symptoms existed at follow-up. CONCLUSIONS Vascular lesions related to the internal carotid artery redundancy can be successfully managed endovascularly, and the redundancy can no longer represent an obstacle in modern era with advanced techniques and materials.

Pericardial Fat is a Risk Factor for Severe Coronary Artery Stenosis in Young People: A Study with 256-Slice Computed Tomography

Purpose: The volume of pericardial fat in young people with and without severe coronary artery stenosis is currently unknown. This study was to investigate the volume of pericardial fat in young people with and without severe coronary artery stenosis with multi-detector computed tomography (MDCT). Materials and methods: Seventy-five patients younger than 45 years with severe coronary artery stenosis (>75%) who underwent cardiac MDCT angiography were enrolled in this study. Seventy-five healthy young people were also enrolled. The height, body weight, body mass index (BMI) and the volume of the epi-, para- and pericardial fats on the MDCT imaging were evaluated and compared. Results: The body weight and BMI were significantly (P<0.001) greater for the patient group than for the control group. The epi-, para- and pericardial fats were all significantly greater (P<0.0001) in the patient group (126.4 ± 32.0, 52.3 ± 27.1, and 178.7 ± 55.3 ml, respectively) than in the control group (77.8 ± 20.8, 21.2 ± 13.9 and 99.1 ± 32.2 ml, respectively). In the patient group, the male had significantly (P<0.05) greater volume in the epi-, para- and pericardial fats than the females (131.7 ± 33.3 versus 115.9 ± 26.9, 58.1 ± 29.4 versus 40.6 ± 17.1 and 189.8 ± 58.2 versus 156.5 ± 41.9, respectively). A significantly (P<0.0001) positive linear correlation existed either between epi-, para- and pericardial fats or between weight and the epicardial fat in either group. Multivariate regression analysis demonstrated the body weight (R=0.34, P=0.003) and height (R=0.41, P=0.0003) were significantly positively associated with epicardial fat volume. Conclusions: The pericardial fat is a risk factor for severe coronary artery stenosis in young people.

Construction of an in vivo carotid siphon model for testing endovascular devices for neuro-interventions

Objective The aim of this study was to construct an in vivo carotid siphon model for testing neurovascular devices for endovascular interventions. Methods A model of a human carotid siphon was pre-shaped using a glass tube from a human cadaver and used to confine a segment of one side of the common carotid artery (CCA) in canines. This segment of CCA with the glass carotid siphon on was interposed end-to-end onto the contralateral CCA so as to simulate a human carotid artery siphon in vivo. Two weeks later, the siphon model was evaluated using computed tomography angiography and digital subtraction angiography, and the covered stent specially designed for intracranial vasculature was navigated through the siphon model for a longitudinal flexibility test. Results All dogs tolerated the procedures well, and the artificial siphon model in vivo provided realistic conditions for device testing. Two weeks later, the in vivo carotid siphon model remained patent with no thrombosis. Five covered stents were navigated to pass through five siphon models successfully, with vasospasm occurring in two siphons. Conclusion Construction of an in vivo siphon model in dogs with a glass tube is feasible and useful for the test of endovascular devices for treating neurovascular diseases.

Progesterone down-regulates SLIT/ROBO expression in mouse corpus luteum

BACKGROUND Progesterone produced by the corpus luteum (CL) is essential for preparation, implantation and maintenance of gestation. Furthermore, progesterone plays a protective role against luteolysis in rodents. It has been reported that Slit/Robo family members expressed in the CL and involved in prostaglandin F2α (PGF2α) induced luteolysis. However, the interactions between progesterone and Slits/Robos in CL are not clear. This study was designed to examine whether or not luteolysis is regulated by the interaction of progesterone and Slits/Robos in mouse CL. METHODS In the current study, we used Real-time PCR to identify the effect of progesterone on Slit2/Robo1 expression in cultured luteal cells in vitro, and the exogenous progesterone injection on mouse luteolysis and Slit/Robo expression in vivo was studied via Real-time PCR and Western bolt. RESULTS Our in vitro experiment revealed that 1μM progesterone significantly decreased Slit2/Robo1 mRNA levels at 6h, 12h and 24h. Our in vivo experiment showed that the mRNA and protein levels of Slit2 and Robo1 decreased significantly 7days after progesterone supplement. CONCLUSION These findings indicate that progesterone maintains CL function and resists luteolysis possibly through down-regulating Slit/Robo signaling pathway in the CL.

Correlation of the leucocyte count with traditional and non-traditional components of metabolic syndrome

ABSTRACT Objectives: To investigate correlation of the white blood cell (WBC) and its subtype count with the traditional and non-traditional components of the metabolic syndrome. Methods: Between January 2012 and December 2013, 18,222 people were enrolled in this study. The height, weight, body mass index (BMI) and blood pressure were measured, and blood samples were tested for all subjects after an overnight fast. The count of WBC and its subtypes, total cholesterol, triglyceride, high density lipoprotein (HDL), low-density lipoprotein, aminotransferases, fibrinogen, uric acid, and fasting blood glucose were all assessed. Results: Metabolic syndrome was found in 2502 of 18,222 healthy Chinese people (16.41%). The prevalence of metabolic syndrome was 22.61% for men significantly (P < 0.05) greater than for women (6.83%). The prevalence of obesity, hypertension, hyperglycemia and hyperlipidemia was significantly (P < 0.001) higher in people with than without metabolic syndrome. With increase of the WBC count, BMI, systolic and diastolic pressure, fasting blood glucose, triglyceride, glutamic-oxaloacetic transaminase, glutamic-pyruvic transaminase, glutamyltranspetidase, blood urea nitrogen fibrinogen and uric acid all went up significantly (P < 0.001) while HDL decreased significantly (P < 0.05). The creatinine remained relatively sTable After adjustment of age, sex, alcoholic drinking and education, the metabolic components of obesity, hypertension, diabetes and hyperlipidemia rose significantly (P < 0.05) positively with increased counts of the total WBC, neutrophil and lymphocyte, and the WBC and its subtypes were an independent risk factor for metabolic syndrome. Conclusion: Aminotransferases, fibrinogen and uric acid all significantly increase with increased WBC count in a dose-dependent manner. Increased counts of the total WBC and its subtypes are positively associated with presence of metabolic syndrome.