Jingbo Zhang

Endovascular treatment of high-risk tentorial dural arteriovenous fistulas: clinical outcomes

IntroductionAn 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.Materials and methodsClinical 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.ResultsTransarterial 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%.ConclusionHigh-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.

A complex cavernous sinus dural arteriovenous fistula secondary to covered stent placement for a traumatic carotid artery-cavernous sinus fistula: case report.

Authors present the case of a patient with a direct carotid artery-cavernous sinus fistula caused by head trauma in whom a self-expanding covered stent was successfully used to obliterate the fistula. However, at the 9-month follow-up an angiogram revealed a complex caroticocavernous fistula that was completely obliterated with Onyx 18 transarterially.

Endovascular treatment of cerebral aneurysms with the use of stents in small cerebral vessels

Abstract Objective: To report the results of the Neuroform, Leo and Wingspan stents used to treat cerebral aneurysms in vessels of small caliber. Materials and methods: We reviewed 12 cases of wide-necked aneurysms treated with stent deployment into small cerebral vessels with diameter range from 1·0 to 2·5 mm. All stents were deployed for aneurysm treatment in combination with coiling. Aneurysm locations were as follows: A1 (n = 4), anterior communicating artery (n = 2), A2 (n = 1), M1 (n = 2), M2 (n = 1) and P1 (n = 2). Clinical follow-up ranged from 3 to 12 months. Imaging follow-up (range: 3-6 months) was performed with cerebral angiography. Results: Twelve self-expanding stents (six Neuroform stents, three Leo stents and three Wingspan stents) were deployed for 12 wide-necked cerebral aneurysms arising from vessels measuring 2·5 mm in diameter. Eleven procedures were successfully performed without immediate or delayed device-related complications with one stent misplacement. Intraprocedural thrombus developed within the stent in one patient. There were no clinical neurological symptoms related to the treated vessel territory at clinical follow-up. Conclusion: Development of newer small endovascular devices, such as Neuroform, Leo and Wingspan stents, allow access and ability to treat lesions farther out in the smaller cerebral vessels.

Cerebral Arteriovenous Malformations Associated with Flow-Related and Circle of Willis Aneurysms

BACKGROUND To evaluate the characteristics of brain arteriovenous malformations (AVMs) with coexisting flow-related and Willis circle aneurysms. METHODS The 302 consecutive retrospectively reviewed patients from the Beijing Tiantan Hospital were analyzed in this study. The presence of cerebral aneurysms was confirmed by pretreatment selective and superselective angiography. Univariate and multivariate analyses were performed for patient age, sex, history of rupture, associated aneurysms, AVM size, and deep and superficial venous drainage. RESULTS Of the 302 patients, 41 (13.6%) had AVMs associated with intranidal aneurysms, and 33 (10.9%) had AVMs associated with extranidal aneurysms. Of the 33 patients, 24 (72.7%) had a flow-related and 9 (27.3%) had a Willis circle aneurysm. Flow-related and Willis circle aneurysms correlated positively with intracranial hemorrhage (P = 0.003), patient age (P = 0.003), and infratentorial AVMs (P = 0.040) in multiple univariate analysis. CONCLUSIONS Flow-related and Willis circle aneurysms coexisting with cerebral AVMs frequently are associated with initial hemorrhage presentation, patient age, and infratentorial AVM location.

Treatment of Giant Intracranial Aneurysms

We report on report the clinical outcome obtained in treatment of giant intracranial aneurysms (GAs). Between 2005 and 2007, 51 patients with 51 GAs presented at our hospital. Twenty-nine were treated with primary parent vessel occlusion without distal bypass and ten underwent treatment preserving the parent artery. Twelve patients could not be treated endovascularly. Selective embolization (including two remodeling techniques and two stent-coil embolizations) resulted in only one cure. Two patients died as a result of subarachnoid hemorrhage periprocedurely. Twenty-nine patients treated primarily with parent vessel occlusion and three patients treated with covered stent were considered cured after their treatments. Only one patient treated with parent vessel occlusion experienced ischemia during follow-up, which resulted in a mild neurological deficit. Of the twelve patients who could not be treated endovascularly, one succumbed to surgery, four died while being treated conservatively, and three were lost to follow-up. Parent artery occlusion, covered stent and coil occlusion provide effective protection against bleeding. In treatment of paraclinoid GAs of the internal carotid artery, the use of a stent, and stent-assisted coil embolization may be a pitfall.

miR-23b improves cognitive impairments in traumatic brain injury by targeting ATG12-mediated neuronal autophagy.

HighlightsMiR‐23b was frequently downregulated in TBI patients and experimental TBI model.Overexpression of miR‐23b attenuated brain injury in rat model of TBI.Overexpression of miR‐23b improved TBI‐induced neurological and cognitive impairmentss.Overexpression of miR‐23b inhibited TBI‐induced the activation of neuronal autophagy in the rat hippocampus CA1 region.Autophagy‐related gene, ATG12, was a novel target of miR‐23b.miR‐23b improved TBI‐induced cognitive impairments by directly targeting ATG12 to suppress neuronal autophagy. ABSTRACT Dysregulated microRNAs (miRNAs) have been reported to involve in the pathophysiological process of traumatic brain injury (TBI), and modulate autophagy‐related genes (ATGs) expression. Our previous studies showed that neuronal autophagy was activated in the injury hippocampus post‐ TBI and associated with neurological and cognitive impairments. The present study was designed to investigate the possible role of miR‐23b in TBI‐induced cognitive impairments. We found the overexpression of miR‐23b conferred a better neuronprotective effects after TBI by decreasing lesion volume, alleviating brain edema, inhibiting neuron apoptosis and attenuating long‐term neurological deficits, and most interestingly, improving cognitive impairments. To further explore the molecular underlying this neuronprotection, we evaluated autophagic activity and ATG12 expression in the injury hippocampus CA1 region. The results identified that miR‐23b directly targeted to the 3′UTR region of ATG12 mRNA to suppress the activation of neuronal autophagy by a dual‐luciferase reporter system. Notably, overexpression of ATG12 abrogated the neuronprotective effects of miR‐23b on TBI‐induced neurological and cognitive impairments. Taken together, these date revealed inhibition of ATG12‐mediated autophagic activity by miR‐23b overexpression might be involve in cognitive improvement after TBI, indicating that miR‐23b might be a potential therapeutic target for TBI.

Transarterial and Transvenous Embolization for Cavernous Sinus Dural Arteriovenous Fistulae

We report on the safety and efficacy of transarterial and transvenous Onyx embolization in the treatment of dural arteriovenous fistulae (DAVFs) of the cavernous sinus. We reviewed the findings from a retrospectively database for 22 patients with cavernous sinus DAVFs who were treated with either transarterial Onyx embolization alone (n = 8) or transarterial and transvenous Onyx embolization (n = 14) over a four year period. The mean follow-up period after endovascular treatment was 21.6 months (range 3–42 mths). Total number of embolizations was 27 for 22 patients. Two patients were treated transvenously after transarterial embolization. All 22 patients (100%) experienced improvement of their clinical symptoms. All 22 patients (100%) experienced total obliteration of their DAVFs, as documented by angiography performed at a mean follow-up of 5.8 months after the last treatment. No patient experienced a recurrence of symptoms after angiography showed DAVF obliteration. One patient exhibited temporary deterioration of ocular symptoms secondary to venous hypertension after near total obliteration; one had transient V cranial nerve deficit related to transarterial embolization, and two patients exhibited transient III and VI cranial nerve weakness related to transvenous embolization. Two patients experienced recurrent symptoms after incomplete transarterial embolization and underwent transvenous embolization at three and four months. Both patients achieved clinical and angiographic cures. Transarterial and transvenous embolization with Onyx, whenever possible, proved to be a safe and effective management for patients with cavernous sinus DAVFs.

Stent-assisted coil embolization of intracranial aneurysms using Solitaire stent

OBJECTIVE To report patients with intracranial wide-necked or complex aneurysms who underwent Solitaire stent-assisted coil embolization. MATERIALS AND METHODS Retrospective analysis of 28 patients with intracranial wide-necked or complex aneurysms. Eighteen of the patients presented with an acute subarachnoid hemorrhage. Thirty-one aneurysms were treated with the support of different applications (n = 32) of the Solitaire AB stents followed by the standard coiling procedure (n = 30). RESULTS Successful positioning of the remodeling device was obtained in all the cases. One stent required repositioning after full deployment. There were four thromboembolic complications (12.5%) and two hemorrhagic complications (6.25%), which caused three deaths. No permanent procedural morbidity was observed in the surviving patient. Angiographic results included 26 complete occlusions (83.9%), three neck remnants (9.7%) and two incomplete occlusions (6.4%). CONCLUSION Although the initial technical and clinical results of Solitaire stent-assisted coiling of aneurysms was reported to be encouraging in recent reports, we had encountered higher thromboembolic and hemorrhagic complications in our patients.

Parent artery occlusion for peripheral anterior inferior cerebellar artery aneurysm. A case report and review of the literature.

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.

MiR-29b Downregulation Induces Phenotypic Modulation of Vascular Smooth Muscle Cells: Implication for Intracranial Aneurysm Formation and Progression to Rupture

Background/Aims: Our previous microarray results identified numerous microRNAs (miRNAs), including miR-29b, that were differentially expressed in the serum of intracranial aneurysm (IA) patients. The current study aimed to investigate whether miR-29b downregulation in IA could promote the phenotypic modulation of vascular smooth muscle cells (VSMCs) involved in the pathogenesis of aneurysm by activating ATG14-mediated autophagy. Methods: First, the levels of miR-29b and autophagy related genes (ATGs) between IA patients and normal subjects were compared. Next, we modified the level of miR-29b via lentivirus particles in the VSMCs and examined the effects of miR-29b on proliferation, migration, and phenotypic modulation of VSMCs from a contractile phenotype to a synthetic phenotype, as well as the levels of autophagy. Finally, the binding of miR-29b to the 3’UTR of ATG14 mRNA and its effects on ATG14 expression were analysed by a luciferase reporter assay and Western blot, respectively. Results: The level of miR-29b was decreased, and autophagy markers were increased in the IA patients compared to that of the normal subjects. Knockdown of miR-29b significantly promoted VSMCs proliferation and migration and, more importantly, induced the phenotypic modulation associated with autophagy activation, whereas miR-29b overexpression showed the opposite effects. The luciferase reporter assay demonstrated that ATG14 was a functional target gene of miR-29b. Notably, knockdown of ATG14 by siRNA apparently abrogated miR-29b inhibition-mediated phenotypic modulation. Conclusion: Downregulation of miR-29b induced VSMCs phenotypic modulation by directly activating ATG14-mediated autophagy, which is associated with the formation, growth and rupture of IAs.