Zhi-gang Yang

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.

A fusiform aneurysm of a persistent trigeminal artery variant: case report and literature review

A 48-year-old man suffered from spontaneous subarachnoid hemorrhage. Emergent right internal carotid angiography showed the presence of a persistent trigeminal artery (PTA) variant with a fusiform aneurysm on its proximal segment where it branched from the internal carotid artery. This artery supplied the territory of the anterior inferior cerebellar artery. After consideration of the adequacy of the cerebellar circulation without this anomalous artery, intraluminal occlusion of the aneurysm together with the PTA variant was performed using detachable coils. The patient recovered uneventfully without any neurologic deficits.

Treatment of Supratentorial Spontaneous Intracerebral Hemorrhage Using Image-Guided Minimally Invasive Surgery: Initial Experiences of a Flat Detector CT–Based Puncture Planning and Navigation System in the Angiographic Suite

BACKGROUND AND PURPOSE: The intracerebral hemorrhage drainage through minimally invasive approach is emerging as an alternative for traditional craniotomy, due to its improved survival rate and reduced complication rate. In this study, we investigated the feasibility and safety of a flat detector CT–based puncture planning and navigation system for minimally invasive hematoma drainage on patients with intracerebral hemorrhage. MATERIALS AND METHODS: The minimally invasive hematoma drainage was performed on 21 hypertensive patients with intracerebral hemorrhage in the angiographic suite with the guidance of a flat detector CT–based puncture planning and navigation system. This system is integrated in the angiographic machine, and was used for 1) planning the needle path based on a preprocedural flat detector CT scan, 2) advancing the catheter with real-time fluoroscopic guidance, and 3) confirming the procedure outcome based on an immediate postprocedural flat detector CT. The surgery efficiency, accuracy, and the treatment outcome were measured and compared with the published data. RESULTS: All procedures were successfully completed with the catheter placed 4 ± 1 mm from the planned position. The average surgery time was 40 ± 7 minutes. The volume of the hematoma was reduced to 28 ± 4% of the original volume. The Glasgow Coma Scale score was significantly improved from 10 ± 1 at the admission to 14 ± 1 at the discharge. The Extended Glasgow Coma Scale score also improved from 5 ± 1 at the discharge to 6 ± 1 at the 6-month follow-up. No major complication, rebleeding, and mortality were observed in this study. CONCLUSIONS: This flat detector CT–based needle guidance system provided a feasible, convenient, and safe way to perform the puncture and drainage of brain hematoma in the angiographic suite.

China's Growing Contribution to Global Intracranial Aneurysm Research (1991–2012): A Bibliometric Study

Background We sought to analyze the growing worldwide trends of intracranial aneurysm research, investigate Chinas recent contribution, and compare the contributions of mainland China, Taiwan, and Hong Kong. Methods Global and China intracranial aneurysm-related publications were retrieved from the Web of Science database from 1991 to 2012. Excel 2007, Matlab, and Thomson Data Analyzer (TDA) software were used to analyze the search results for number of publications, cited frequency, h-index, and organization contributions. Results 16468 global papers were identified that were cited 273500 times until 2013-08-15. The United States accounted for 31.497% of the articles, 58.64% of the citations, and the highest h-index (127). Japan and Germany followed in frequency. Chinas articles ranked eighth (third in 2012) in total number, with most of the contributions occurring since 2002 (91.33%). China was at the early stage of the logic growth curve (exponential growth), with the citation frequency and h-index per year increasing. The quality of the publications was low. The main research centers were located in Beijing, Shanghai, Taiwan, and Hong Kong. The main Asian funding body was the National Natural Science Foundation of China. The number of publications and frequency of citations of papers from mainland China was greater than that of Taiwan or Hong Kong. Conclusion Global intracranial aneurysm research has been developing swiftly since 1991, with the United States making the largest contribution. Research in China started later, in 2002. Since then, China has increased its rate of publication, and became the third largest contributor by 2012.

Plasma MicroRNA-16 Is a Biomarker for Diagnosis, Stratification, and Prognosis of Hyperacute Cerebral Infarction

Indices for the diagnosis of hyperacute cerebral infarction (HACI) and the prediction of prognosis are essential for timely and appropriate management. MicroRNAs (miRNAs) that regulate gene expression following stroke have potential use as prognostic markers of HACI. Here, we explored whether concentrations of circulating miRNAs correlate with clinical outcomes and thus form a system of stroke stratification. Plasma samples from patients with HACI (n = 7) and age-matched healthy volunteers (HVT, n = 4) were screened by microarray to find differentially expressed miRNAs, some of which were further verified by quantitative reverse transcription polymerase chain reaction (qRT-PCR) (HACI:HVT = 33:23). The target genes of the miRNAs with verified differential expression were investigated by GO and KEEG analyses. Using the TOAST (OCSP) criteria and the 3-month modified Rankin Score (mRS), relationships among the expression patterns of specific miRNAs, stroke stratification, and clinical prognosis were determined. The microarray analysis revealed 12 differentially expressed miRNAs. Among seven selected miRNAs verified with qRT-PCR, miR-16 expression in the HACI group was the most significantly different from the HVT group (P < 0.01). Bioinformatics analysis showed that the potential target genes of miR-16 were mainly involved in programmed cell death and the p53 signaling pathways. Receiver operating characteristic (ROC) analysis showed that the area under the curve (AUC) of miR-16 was 0.775 (sensitivity 69.7% and specificity 87%) and 0.952 (sensitivity 100% and specificity 91.3%) in overall patients and patients with large artery atherosclerosis (LAAS), respectively. Elevated miR-16 expression was associated with the stroke subtype of LAAS, total anterior circulation infarction, partial anterior circulation infarction, and poor prognosis (P < 0.05). A diagnostic method based on rapid measurement of plasma miR-16 has the potential to identify hyperacute cerebral infarction with LAAS with high sensitivity and specificity, which would inform and improve early treatment decisions and disease management.

Decreased plasma decorin levels following acute ischemic stroke: Correlation with MMP-2 and differential expression in TOAST subtypes

Accumulating evidence suggests that extracellular matrix (ECM) remodeling plays a significant role following acute ischemic stroke (AIS). Decorin (DCN) is a well-recognized molecule present in the ECM; however, the role of DCN in AIS remains unknown. The present study aimed to investigate whether plasma concentrations of DCN are altered in patients following an AIS and whether they are correlated with matrix metalloproteinase-2 (MMP-2) levels and other laboratory and clinical variables. Plasma concentrations of DCN were assessed in 102 patients with AIS (less than 7 days) and 120 control subjects using ELISA assays. The correlation between DCN concentrations and MMP-2 levels, Trial of Org 10172 in Acute Stroke Treatment (TOAST) subtypes, stroke severity and risk factors were evaluated. The expression of DCN was significantly decreased in patients with AIS (P<0.001), particularly in the large-artery atherosclerosis (LAAS) group. The levels of DCN were positively correlated with MMP-2 (R=0.332; P<0.001), thus MMP-2 is an independent predictor of DCN concentration (P<0.001). DCN levels below 8,500 pg/ml had sensitivity and specificity values of AIS of 79.4 and 62.8%, respectively and DCN below 8,500 pg/ml was associated with AIS (OR=4.8; 95% CI: 2.1-11.1; P<0.001) following adjustment for potential confounders. In conclusion, for the first time, a reduction in DCN was detected in patients following AIS and these altered plasma concentrations were correlated with MMP-2. Larger studies are required to further investigate whether DCN is involved in the pathogenesis of ischemic stroke.

Novel Minimally Invasive Treatment Strategy for Acute Traumatic Epidural Hematoma: Endovascular Embolization Combined with Drainage Surgery and Use of Urokinase

BACKGROUND Hematoma evacuation is regular treatment for acute traumatic epidural hematoma (ATEDH) patients meeting with surgery indications. However, it is an invasive approach performed under general anesthesia. Here, a novel minimally invasive method of endovascular embolization with subsequent drainage surgery and use of urokinase was established to treat ATEDH under local anesthesia. METHODS A novel minimally invasive method of endovascular embolization with subsequent drainage surgery and use of urokinase was established to treat ATEDH under local anesthesia. Firstly, 23 ATEDH patients with hematomas in the temporal area underwent digital subtraction angiography detecting the bleeding point. Next, embolization was performed. After embolization, drainage surgery was taken and urokinase was injected into the hematoma cyst by drainage tube to lyse hematoma twice per day. RESULTS The results showed that the middle meningeal artery was the bleeding source. Embolization immediately ceased bleeding. Most clots were resolved and drained after treatment. No recurrence of hematoma or infection was observed. CONCLUSION The findings suggest that the combined treatments can be an alternative minimally invasive option for ATEDHs, especially for elderly patients or those contraindicated for general anesthesia.

A novel proximal end stenting technique for assisting embolization of a complex true posterior communicating aneurysm

Stent-assisted coiling has been widely used for endovascular treatment in recent years with satisfying clinical outcomes. The implantation of a stent using the regular approach, however, may not be safe or effective for certain aneurysms with complex structures. In this study, we report a novel stenting technique utilizing the proximal end of the stent for assisting embolization of a wide-neck irregular true posterior communicating aneurysm. This new method is a potential treatment strategy for wide-neck aneurysms located at the origin of a tortuous and thin vessel.