This trial showed an obviously higher rate of large and giant aneurysm obliteration with the Tubridge FD over Enterprise stent-assisted coiling. However, this higher obliteration rate came at the cost of a nonsignificantly higher rate of complications. Investigational site comparisons suggested that a learning curve for flow-diverter implantation should be recognized and factored into trial designs.
IntroductionFew studies focused on predictors of unfavorable outcomes (modified Rankin Scale, 2–6) after reconstructive treatment of the ruptured intracranial spontaneous vertebral artery dissection aneurysms (ris-VADAs), which was evaluated based on 57 reconstructed lesions in this study.MethodsResults of 57 consecutive patients (M:F = 29∶28; median age, 48 years; range, 27 to 69 years) harboring 57 ris-VADAs, which were treated with coils combined with single stent(n = 32), double overlapping stents (n = 16), and triple overlapping stents (n = 9) between October 2000 to March 2011, were retrospectively reviewed and analyzed.ResultsThe available (n = 54) mean durations of angiographic and clinical follow-ups were 27 months (range, 12 to 78) and 62 months (range, 12 to 132), respectively. The involvement of PICA (p = 0.004), size of lesions (p = 0.000), quantity of stent (p = 0.001), and coil type (p = 0.002) affected the immediate obliteration grade, which was only risk factor for angiographic recurrences (p = 0.031). Although the post-treatment outcomes did not differ between single stent and multiple stents (p = 0.434), 5 angiographic recurrences, 1 rebleeding and 1 suspected rebleeding, all occurred in partial obliteration after single-stent-assisted coiling. Progressive thrombosis and in-stent obliteration were not detected on follow-up angiograms. Older age (odds ratio [OR] = 1.090; 95% confidence interval [CI], 1.004–1.184; p = 0.040) and unfavorable Hunt-Hess scale (OR = 4.289; 95%CI, 1.232–14.933; p = 0.022) were independent predictors of unfavorable outcomes in the reconstructed ris-VADAs.ConclusionsImmediate obliteration grade was only risk factor for angiographic recurrence after reconstructive treatment. Unfavorable Hunt-Hess grade and older age were independent predictors of unfavorable outcomes in ris-VADAs.
ObjectivesWe aimed to evaluate risk factors of sis-VADAs recurrence after reconstructive treatment based on 113 reconstructed lesions.MethodsA total of 111 patients (M:F = 68:43; median age, 47 years) with 113 sis-VADAs underwent reconstruction from October 2000 to March 2011, using stent(s) and coils. Treatments and predictors of recurrence were retrospectively analysed.ResultsFifty-eight sis-VADAs underwent single-stent treatment, and the remaining 55 sis-VADAs underwent treatment with 2-4 overlapping stents. Follow-up angiography was available for 94 sis-VADAs 12 -78 months, with recurrence in ten patients, including seven angiographic recurrences and three post-treatment haemorrhagic recurrences. A higher rate of post-treatment recurrence was observed in the single stent group than in the multiple stents group (p = 0.010). The interaction between stent (s) implantation and immediate occlusion degree (odds ratio [OR] =3.152; 95 % confidence interval [CI], 1.293-7.686; p = 0.012), between stent (s) implantation and the posterior inferior cerebellar artery (PICA) involvement (OR = 4.607; 95 % CI, 1.172-18.113; p = 0.029), and between PICA involvement and immediate occlusion degree (OR = 5.018; 95 % CI, 1.263-19.933; p = 0.022) affect recurrence in the reconstructed sis-VADAs.ConclusionsThis single centre cohort study indicated that the interaction effect between stent (s) implantation, PICA involvement, and immediate occlusion degree were closely associated with recurrence after reconstructive treatment of sis-VADA.Key Points• The interaction between stent (s) and immediate occlusion degree affect aneurysmal recurrence• The interaction between stent and PICA involvement affect aneurysmal recurrence• The interaction between PICA involvement and immediate occlusion degree affect aneurysmal recurrenceElectronic supplementary materialThe online version of this article (doi:10.1007/s00330-014-3225-7) contains supplementary material, which is available to authorized users.
Objectives: To quantify microRNA-9 (miR-9) concentrations in the serum of patients with osteosarcoma; to explore its relationship with clinicopathological characteristics and prognosis of osteosarcoma. Method: Serum miR-9 was quantified via real-time reverse transcription-polymerase chain reaction in patients with osteosarcoma and healthy control subjects. Overall survival was evaluated using the Kaplan-Meier method. Results: Serum miR-9 was significantly upregulated in patients with osteosarcoma (n ¼ 118) compared with healthy control subjects (n ¼ 60); its upregulation was significantly associated with advanced tumour-node-metastasis stage, larger tumour size and presence of distant metastasis. Overall survival duration was significantly shorter in patients with relatively high miR-9 concentrations compared with those with relatively low miR-9 concentrations. Conclusions: Serum miR-9 concentrations are significantly increased in patients with osteosarcoma compared with healthy controls. Upregulation of miR-9 is associated with tumour stage, size and metastasis. Serum miR-9 quantification may represent a useful diagnostic and prognostic marker of osteosarcoma.
BACKGROUND AND PURPOSE:The Y-stent technique, including crossing-Y and kissing-Y, is a promising therapeutic option for some complex bifurcation aneurysms. Here, its efficacy and safety are evaluated on the basis of 11 bifurcation aneurysms.
Purpose:To evaluate the safety and angiographic and clinical outcome of stent-assisted coil placement (SACP) for acutely ruptured wide-necked intracranial aneurysms treated in a single center during an 11-year period. Materials and Methods:According to an institutional review board-approved protocol, the angiographic and clinical data of 211 patients (52 men, 159 women; median age, 56 years; age range, 31-83 years) with acutely ruptured wide-necked intracranial aneurysms (neck . 4 mm and/or dome-to-neck ratio 2) treated with SACP from September 2000 to December 2011 were reviewed retrospectively. Baseline characteristics, procedure-related complications, angiographic follow-up results, and clinical outcome were analyzed statistically. A Mann-Whitney U test was performed for non-normally distributed continuous variables. A Pearson x 2 or Fisher exact test was performed for categorical variables. Univariate analysis and logistic regression analysis were performed to determine the association of procedure-related complications and clinical outcome with potential risk factors. Results:Procedure-related complications occurred in 30 patients (14.2%). They were more common in the anterior communicating artery (26.7%, 12 of 45) and middle cerebral artery bifurcation (40%, four of 10) aneurysms than in aneurysms at other locations (9.0%, 14 of 156). Clinical outcome (median, 33 months) was good in 175 patients (82.9%) with a modified Rankin Scale score of up to 2. Older age (P = .013, odds ratio = 1.054) and higher Hunt and Hess grade (P , .001, odds ratio = 15.876) were independent risk factors for unfavorable outcome. One hundred fifty-two of 190 patients who survived (80%) underwent angiographic follow-up at least once (median, 12 months). The complete occlusion rate improved from an immediate 45.5% to 75.7% at follow-up (115 of 152 patients). Conclusion:Angiographic and clinical outcomes in our series were comparable to those reported by using coil placement alone or balloon-assisted coil placement techniques. SACP for the treatment of acutely ruptured middle cerebral artery bifurcation and anterior communicating artery aneurysms was associated with a significantly higher incidence of complications than was the case for treatment of aneurysms at other locations.q RSNA, 2015
OBJECTIVE The authors compared the contemporary perioperative procedure-related complications between coiling with stent placement and coiling without stent placement for acutely ruptured aneurysms treated in a single center after improvement of interventional skills and strategy. METHODS In an institutional review board-approved protocol, 133 patients who underwent coiling with stent placement and 289 patients who underwent coiling without stent placement from January 2012 to December 2014 were consecutively reviewed retrospectively. Baseline characteristics, procedure-related complications and mortality rate, angiographic follow-up results, and clinical outcomes were compared between the two groups. Univariate analysis and logistic regression analysis were performed to determine the association of procedure-related complications of coiling with stent placement with potential risk factors. RESULTS The coiling/stent group and coiling/no-stent group were statistically comparable with respect to all baseline characteristics except for aneurysm location (p < 0.001) and parent artery configuration (p = 0.024). The immediate embolization results and clinical outcomes between the two groups showed no significant differences (p = 0.807 and p = 0.611, respectively). The angiographic follow-up results of the coiling in stent group showed a significant higher occlusion rate and lower recurrence rate compared with the coiling/no-stent group (82.5% vs 66.7%, 3.5% vs 14.5%, p = 0.007). Procedure-related intraoperative rupture and thrombosis, postoperative early rebleeding and thrombosis, and external ventricular drainage-related hemorrhagic event occurred in 3.0% (4 of 133), 2.3% (3 of 133), 1.5% (2 of 133), 0.7% (1 of 133), and 0.8% (1 of 133) of the coiling/stent group compared with 1.0% (3 of 289), 1.4% (4 of 289), 1.4% (4 of 289), and 0.7% (2 of 289) of the coiling/no-stent group, respectively (p = 0.288, p = 0.810, p = 1.000, p = 0.315, and p = 1.000, respectively). One patient presented with coil protrusion in the group of coiling without stent. The procedure-related mortality was 1.5% (2 of 133) in the coiling/stent group and 0.7% in the coiling/no-stent group (p = 0.796). Multivariable analysis showed no significant predictors for the total perioperative procedure-related complications, hemorrhagic complications, or ischemic complications. CONCLUSIONS The perioperative procedure-related complications and mortality rate did not differ significantly between the coiling/stent group and the coiling/no-stent group for patients with acutely ruptured aneurysms. Considering the better angiographic follow-up results, coiling with stent placement might be a feasible, safe, and promising option for treatment in the acute phase of selected wide-necked ruptured intracranial aneurysms.
Owing to the area, length and width of the largest axial hematoma slice clearly marked in CT imaging, the formula 2/3Sh in comparison with other methods was a precise, simple and convenient estimation technique.
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