Peng-Fei Yang

Avoidance and management of surgical and hardware-related complications of deep brain stimulation.

Objective: Although deep brain stimulation (DBS) is nonablative, it may give rise to many complications. In order to identify and reduce factors contributing to the complications, we performed a retrospective analysis of patients who received DBS in our institution over a 9-year period from March 2000 to December 2008. Methods: Included in this study were 161 patients (85 male and 76 female). Data from these patients were collected and analyzed with respect to the complications and factors potentially related to these complications. Results: A total of 25 surgical and hardware-related complications occurred in 24 patients, including confusion in 11 cases (6.83%), asymptomatic intracranial hemorrhage in 1 case (0.62%), electrode misplacement in 2 cases (1.24%), infection of the subcutaneous pocket receiving the pulse generator in 1 case (0.62%), skin erosion in 2 cases (1.24%), pulse generator seroma formation in 6 cases (3.72%), and device malfunction in 1 case (0.62%). There was no permanent neurological deficit. Conclusion: Confusion is the most common complication in simultaneous bilateral DBS targeting the subthalamic nucleus, especially in patients with severe Parkinson’s disease. With increasing experience of surgeons, complete obedience to intraoperative surgical routines and reasonable application of the microelectrode recording technique, other complications could also be reduced.

Stent-assisted Coil Placement for the Treatment of 211 Acutely Ruptured Wide-necked Intracranial Aneurysms: A Single-Center 11-Year Experience

In our series of 211 patients with acutely ruptured wide-necked aneurysms, the results achieved by using stent-assisted coil placement were comparable to those reported by using simple coil placement or balloon-assisted coil placement.

Overlapping stents for blood blister-like aneurysms of the internal carotid artery.

OBJECTIVE Blood blister-like aneurysms (BBAs) are unique due to their high risk of recurrent bleeding associated with their fragile neck. The best treatment for BBAs is still controversial. This paper sought to evaluate the safety and efficacy of stent-assisted coiling and subsequent overlapping stents (SAC+OS) in the treatment of BBAs. METHODS Fifteen consecutive patients with ruptured BBAs managed with SAC+OS were enrolled in this study. The clinical characteristics, procedural data, angiographic outcome, and follow-up results were reviewed. RESULTS SAC+OS were successfully performed in all 15 cases. The instant angiographic result was total occlusion in 6 cases, residual neck in 7 cases, and residual aneurysm in 2 cases. Angiographic follow-ups revealed total occlusion in all 6 cases treated by triple or quadruple stents, and 6 of 9 cases treated by double stents. Major recanalization was detected in 3 cases treated by double stents. The modified Rankin Scale score at 4-52 months follow-up (23.8 months on average) was 0 in 6 cases, 1 in 8 cases, and 3 in one case. CONCLUSION Stent-assisted coiling and subsequent overlapping stents are feasible and safe for BBAs. It can be helpful to further decrease the risk of recanalization with more stents. Early angiographic follow-up within 2 weeks is recommended.

Endothelial Progenitor Cells Contribute to Neointima Formation in Rabbit Elastase‐Induced Aneurysm after Flow Diverter Treatment

Endothelial progenitor cells (EPCs) are involved in vascular repair and homeostasis after vascular injuries. In this study, we aimed to explore whether bone marrow (BM)‐derived EPCs contribute to neointima formation and reendothelialization in rabbit elastase‐induced aneurysm after flow diverter treatment.

Serum miRNA Signature in Moyamoya Disease

Moyamoya disease (MMD) is a cerebrovascular disease characterized by progressive stenosis of the intracranial internal carotid arteries and their proximal branches. However, the etiology of this rare disease remains unknown. Serum microRNA (miRNA) profiles have been screened to identify novel biomarkers of prognostic values. Here, we identified serum miRNAs that might play an important role in the pathogenesis of MMD. A genome-wide miRNA array analysis of two pooled serum samples from patients with MMD and controls revealed 94 differentially expressed serum miRNAs, including 50 upregulated and 44 downregulated miRNAs. In an independent MMD cohort, real-time PCR confirmed that miR-106b, miR-130a and miR-126 were significantly upregulated while miR-125a-3p was significantly downregulated in serum. GO analysis showed that the differentially expressed serum miRNAs were enriched in metabolic processes, transcription and signal transduction. Pathway analysis showed that the most enriched pathway was mTOR signaling pathway with 16 potential, functional targets. Finally, we found that 16 and 13 aberrant serum miRNAs coordinately inhibited RNF213 and BRCC3 protein expression at the posttranscriptional level, respectively, resulting in defective angiogenesis and MMD pathogenesis. To our knowledge, this is the first study to identify a serum miRNA signature in MMD. Modulation of the mechanism underlying the role of serum miRNAs in MMD is a potential therapeutic strategy and warrants further investigations.

Angiocentric glioma with rich blood supply

Angiocentric glioma (AG) was recognized as a distinct clinicopathological tumor in 2007, but it is rarely reported. We report a patient with AG who presented with dizziness, and whose MRI images revealed a circumscribed lesion with heterogeneous contrast enhancement and evidence of previous bleeding. Thirty-three patients with AG have been reported to date. Most AG patients present with intractable seizures, usually in childhood and as young adults. However, the presentations reported are diverse, therefore the final diagnosis of AG should depend on the histopathological examination.

Endovascular treatment of acutely ruptured, wide-necked anterior communicating artery aneurysms using the Enterprise stent.

The treatment of anterior communicating artery (AcomA) wide-necked aneurysms with the Enterprise stent (Codman, Miami Lakes, FL, USA) has not been commonly described, due to the complexity of the vascular anatomy and the small vessels of the AcomA complex. To evaluate the feasibility, effectiveness and safety of Enterprise stent placement in AcomA aneurysms, we performed this retrospective study. Between November 2008 and December 2010, 27 wide-necked AcomA ruptured aneurysms were treated within 72 hours of ictus with the Enterprise stent. Data collected and analyzed were: demographic data, morphologic features of the aneurysm, treatment results and follow-up results. Twenty-nine Enterprise stents were successfully deployed in all 27 aneurysms, including Y-configuration stent deployment in two patients. The initial embolization degrees were Raymond class I in 20 patients, class II in five and class III in the other two. The angiographic follow-up of 21 patients (mean, 8.4 months) showed that all aneurysms remained stable or improved; there was no in-stent stenosis, recurrence or retreatment. The clinical follow-up of 26 patients (mean, 12.6 months) showed that 23 patients displayed no symptoms and no or mild disability; three patients remained with severe or moderately severe disability. The Enterprise stent is feasible and safe for endovascular embolization of wide-necked AcomA ruptured aneurysms. Further follow up is needed to assess the long-term efficacy of Enterprise stent placement in AcomA.

Preliminary experience and short-term follow-up results of treatment of wide-necked or fusiform cerebral aneurysms with a self-expanding, closed-cell, retractable stent

The Cordis Enterprise stent (Cordis Corporation; Miami, FL, USA), is a novel self-expanding, closed-cell, retractable stent with a low profile, good navigability and flexibility, which has been recently introduced into China. We retrospectively analyzed the clinical data of 84 consecutive patients who presented to our institution from December 2008 to June 2009. They had a total of 90 wide-necked or fusiform aneurysms that were treated using Enterprise stents. A total of 97 stents were implanted into the parent arteries without technical failure. A total of 14 aneurysms were stented alone, while the remaining 76 aneurysms were treated using a combination of stent and coils, resulting in complete occlusion of 43 aneurysms, a residual neck in 11 and a residual aneurysm in 22. Procedure-related complications occurred in two patients, which resulted in one procedure-related mortality. The clinical follow-up (1-7 months) results demonstrated no neurological deterioration or re-bleeding. The short-term angiographic follow-up (3-6 months) results revealed one recurrence and no in-stent stenosis. Our results suggest that the Cordis Enterprise stent is easy to manipulate, and is safe and effective in the treatment of complex intracranial aneurysms.

Endovascular treatment of ruptured tiny intracranial aneurysms

Endovascular treatment of ruptured tiny intracranial aneurysms (RTIA) is technically challenging. We retrospectively collected and analyzed the clinical data of 51 patients with RTIA who underwent attempted endovascular treatment at our institution between November 2000 and April 2009. Forty-nine patients were successfully treated by coiling alone (29 patients), stent-assisted coiling (11 patients) or stent placement alone (nine patients). Procedural complications occurred in five patients. One patient died from a severe initial hemorrhage and poor clinical condition. At the time of discharge, 44 patients (89.8%) had recovered in good condition (Glasgow Outcome Scale [GOS] score 5), two were moderately disabled (GOS score 4) and two were severely disabled (GOS score 3). Angiographic follow-up (mean follow-up time=14 months) was available for 33 patients, and two were re-treated. None of the 46 patients who were clinically followed up (mean=54.2 months) experienced re-bleeding. Our results suggest that RTIA is not uncommon and can be safely treated endovascularly.

Safety and long-term efficacy of endovascular treatment of small posterior communicating artery aneurysms by coiling with or without stent: a single center retrospective study.

OBJECTIVES Endovascular stents have been widely used in intracranial aneurysm embolization. In this work, we compared the safety and long-term efficacy of stent-assisted coiling with those of conventional coiling for small posterior communicating artery aneurysms, aiming at a better understanding of the related safety and efficacy profiles. METHODS Between January 2008 and December 2011, 114 small PcomA aneurysms (defined as 3mm≤maximum diameter<10mm in this study) in 108 patients were treated by endovascular treatment in our department. Patient demographics, aneurysm characteristics, angiographic results (initial and follow-up), and procedural complications were assessed. RESULTS Embolization was successfully performed in all the patients. Complications occurred in 7.4% of patients in both groups. There was no associated mortality. Based on initial post-procedural angiography, the rate of complete aneurysm occlusion, neck remnant and residual sac in the stented group were 37.9%, 24.1%, and 37.9%, while in the conventional group the figures were 42.9%, 48.2%, and 8.9%, respectively. The initial angiographic results were significantly better in the conventional group, compared with the stented group (P=0.038). The follow-up results showed that the rate of improvement in the stented group was significantly higher (53.3% vs. 14.0%; P<0.001) and the recurrence rate was significantly lower than that in the conventional group (4.4% vs. 3.02%; P=0.001). CONCLUSION Compared with conventional coiling, stent-assisted coiling of the small posterior communicating artery aneurysms does not increase the risk. Stents bear an advantage in reducing the recurrence rate, increasing progressive occlusion rate, and improving long-term prognosis in endovascular treatment of intracranial aneurysms.