Cerebral Aneurysms In Patients Research Articles

Intraoperative neurophysiological monitoring in patients with delayed cerebral ischemia after clipping of ruptured arterial aneurysms

Aim. Research of significant changes in parameters (SCP) by intraoperative neurophysiological monitoring (IONM) during clipping of ruptured cerebral aneurysms in patients with delayed cerebral ischemia (DCI) in the postoperative period.Materials and methods. The study included 16 patients, 7 (43.8 %) men and 9 (56.2 %) women, aged 51.1 ± 9.3 years, who underwent clipping of ruptured cerebral aneurysms for the period 2016–2021, in which the neurological deficit (ND) remained at the preoperative level on the first postoperative day, but increased by the end of hospitalization. In order to study the factors leading to the development of DCI, 2 groups were identified with transient SCP according to IONM: with the development of DCI – 7 patients out of the above 16 patients, including 3 men (42.9 %) and 4 women (57.1 %), aged 49.6 ± 8.5 years; and control group – 19 patients, including 9 men (47.4 %) and 10 women (52.6 %), aged 46.2 ± 10.9 years, in whom ND did not increase on the first postoperative day and by the time of discharge. The groups did not differ significantly in age, sex, aneurysm location, rupture period, and baseline ND.Results. In patients with DCI, in 9 cases (56.2 %), during the operation, SCP from the side of somatosensory evoked potentials (SSEP) and transcranial motor evoked potentials (TcMEP) was not registered, in 7 cases (43.8 %) transient SCP was registered, of which 3 patients (42.8 %) had TcMEP and SSEP, in 2 patients (28.6 %) – only TcMEP and in 2 patients (28.6 %) – only SSEP. In the control group, transient SCR of TcMEPs and SSEPs were registered in 4 patients (21.6 %), only TcMEPs – in 9 patients (47.4 %), only SSEPs – in 6 patients (31.6 %). When comparing two groups of patients with transient SCR (DCI‑group and control group), a statistically significant predominance was revealed in the first group of patients with severity 3 according to the Hunt–Hess scale (42.9 % vs 5.2 %), while in the second group patients of severity 1 and 2 prevailed (94.8 % vs 57.2 %) (p <0.05). When analyzing the data of ultrasonic duplex scanning of extra- and intracranial arteries in both groups, a statistically significant increase in peak systolic blood flow velocity in the middle cerebral artery was revealed (in the group with DCI before surgery – 100 (80–139) cm/s, after surgery – 175 (139–278) cm/s (p = 0.001), in the control group before surgery – 100 (100–118) cm/s, after surgery – 150 (116–194) cm/s (p = 0.0001)), as well as the Lindegaard index (in the group with DCI before surgery – 2.5 ± 0.7, after surgery – 3.5 ± 1.1 (p = 0.01), in the control group before surgery – 2.1 ± 0.3, after surgery 2.9 ± 1.1 (p = 0.0002)), but the differences between the groups were not statistically significant (p = 0.092).Conclusion. At this stage, it cannot be unequivocally stated that transient SCP according to IONM may be one of the risk factors for the development of DCI after clipping of ruptured cerebral aneurysms. However, patients with transient SCR according to IONM, whose severity at admission is estimated at 3 points on the Hunt–Hess scale, are statistically significantly more likely to develop DCI.

Discontinuation of antiplatelet therapy after stent-assisted coil embolisation of cerebral aneurysm: a nationwide cohort study

IntroductionStent-assisted coil embolisation (SACE) for the treatment of unruptured cerebral aneurysms has been increasingly used. Long-term advantages of antiplatelet therapy (APT) post-SACE treatment are still not well understood. We investigated...

Retracted: DSA Image Analysis of Clinical Features and Nursing Care of Cerebral Aneurysm Patients Based on the Deep Learning Algorithm

Retracted: DSA Image Analysis of Clinical Features and Nursing Care of Cerebral Aneurysm Patients Based on the Deep Learning Algorithm

CD68 Antigen and Cerebral Aneurysms: A Case-Control Study.

Intracranial aneurysms are more commonly associated with inflammation as a cause of their development, progression, and rupture. Macrophages and other cells can express the CD68 antigen. The aim of this study was to assess the CD68 antigen levels in cerebral aneurysm (CA) patients compared to a control group at a referral center in Iran. A case-control investigation was undertaken on 88 individuals (44 of whom were cases and 44 were controls). Individuals with CA as the case group consisted of 28 ruptured and 16 unruptured subgroups. Clinical, radiographic, and CD68 levels were evaluated and registered. The average age of the participants was 49 years. Males comprised 43.2% of the patients, while 56.8% were females (p = 0.002). There was a statistically significant difference in the CD68 levels between the two groups. There was no significant difference (p = 0.42) between the ruptured and unruptured subgroups (23.66 and 20.47, respectively) in this comparison. No significant correlation was seen between the patients' CD68 and Glasgow Coma Scale (GCS) levels and their aneurysm diameter (p = 0.74 and 0.45, respectively). A link between CD68 levels and age was found, but it was not statistically significant (r = 0.44 and p = 0.002). A possible involvement of CD68 as an inflammatory agent in the development of CAs but not in aneurysm rupture has been suggested. Inflammation and CD68 were positively associated with age. The CD68 antigen should be studied further in population-based cohort studies.

The first coil embolization ratio is the key factor for retreatment for unruptured cerebral aneurysms.

In coil embolization, a high volume embolization ratio prevents recanalization that may require retreatment. However, patients with a high volume embolization ratio may also require retreatment. Patients with inadequate framing with the first coil may experience recanalization of the aneurysm. We analyzed the relationship between embolization ratio of the first coil and recanalization requiring retreatment. We reviewed data from 181 patients with unruptured cerebral aneurysms who underwent initial coil embolization between 2011 and 2021. We retrospectively analyzed the correlation between neck width, maximum aneurysm size, width, aneurysm volume, volume embolization ratio of the framing coil (first volume embolization ratio [1st VER]), and final volume embolization ratio (final VER) of cerebral aneurysms in patients and their retreatment. Recanalization requiring retreatment was observed in 13 patients (7.2%). The factors related to recanalization were neck width, maximum aneurysm size, width, aneurysm volume, and 1st VER, but not the final VER. Multivariate analysis of the five factors showed a significant difference in the 1st VER (P = 0.002). The cutoff value for recanalization was a 1st VER of 5.8%. There were 162 cases with a VER ≥ 20% or higher, and the same analysis yielded similar results. The 1st VER was significantly correlated with recanalization of cerebral aneurysms requiring retreatment. In coil embolization of unruptured cerebral aneurysms, it is important to achieve an embolization rate of at least 5.8% using a framing coil to prevent recanalization.

The Prevalence of Cerebral Aneurysms in Patients with Polycystic Liver Disease

"Background: It is well known that patients with polycystic kidney disease (PKD) are at increased risk of developing cerebral aneurysms, however, this association has not been well studied for patients with polycystic liver disease (PLD). Material and methods: Cross-sectional descriptive study, which included 15 adult patients diagnosed with polycystic liver disease at the Gastroenterology and Hepatology Department of Fundeni Clinical Institute. Standard neurological exam and brain MRI were performed in all patients on a 1.5 Tesla MRI. Brain imaging protocol included T1/T2, T1SE, T2-FLAIR, DWI, SWI, 2D-TOF, 3D-TOF. Results: The majority of patients (93%) were females. The mean age was 53 ± 5 years old. Patients with AD-PKD and polycystic hepatic disease predominated (60%). Aneurysms were found in only one patient diagnosed with AD-PKD (in whom three aneurysms were described). The overall prevalence of cerebral aneurysms in our patient group was 7%. However, none of the patients with isolated PLD was found to have intracranial aneurysms. Other brain imaging abnormalities were frequent but nonspecific (mostly attributable to vascular-degenerative changes). Conclusions: Given these results, and due to the small number of patients in our study, it is hard to appreciate if polycystic liver disease is indeed associated with an increased risk of cerebral aneurysms. "

Analysis of Cerebrovascular Events after Coil Embolization of Unruptured Cerebral Aneurysms in Patients Taking Anticoagulants.

Antiplatelet therapy is advised to prevent thrombotic complications during endovascular coil embolization of unruptured cerebral aneurysms. Due to multiple antithrombotic treatments, bleeding risk is a concern in patients using oral anticoagulants for existing comorbidities. We investigated the hemorrhagic and ischemic events following endovascular treatment (EVT) of unruptured cerebral aneurysms in patients taking anticoagulation and antiplatelet therapy. Between March 2013 and February 2019, 262 patients undergoing EVT for unruptured cerebral aneurysms and having at least 6 months of postoperative follow-up data were included in this retrospective study. Patients taking oral anticoagulants and antiplatelet drugs for cerebral vascular events following EVT were compared with those taking only antiplatelet agents. Of the 262 patients, 12 (4.6%) used anticoagulants before EVT for a preexisting condition. Cerebrovascular events after coil embolization were observed in 3 patients taking both anticoagulant and antiplatelet drugs and in 14 patients taking only antiplatelet drugs (25% vs. 5.6%, respectively, p = 0.035). Vitamin K antagonist (VKA) was administered in five patients and direct oral anticoagulants (DOACs) in seven patients. Patients taking VKA experienced cerebrovascular events, whereas those taking DOACs did not (p = 0.045). Our study showed that patients using oral anticoagulants and antiplatelet drugs experienced more cerebrovascular events after EVT for unruptured cerebral aneurysms. These results suggest that in patients requiring oral anticoagulants, DOACs may be more beneficial than VKA for preventing stroke occurrences after EVT.

DSA Image Analysis of Clinical Features and Nursing Care of Cerebral Aneurysm Patients Based on the Deep Learning Algorithm.

Objective A deep learning algorithm was developed for automatic detection and localization of intracranial aneurysms in DSA, and its clinical characteristics were analyzed, and targeted nursing measures were formulated. Methods Using a retrospective multicenter study method based on radiology reports, DSA images of aneurysms were randomly divided into 75 cases in the training set, 20 cases in the internal test set, and 35 cases in the external test set. Using a computer-aided detection method based on the three-dimensional U-Net (3D U-Net), after preprocessing DSA images, automatic segmentation of intracranial blood vessels is performed to obtain regions of interest, and based on the segmentation results, physicians' annotations are introduced. The 3D U-Net network model is trained and adjusted, and the obtained model is used to automatically detect the cerebral aneurysm area. Results Fivefold cross-validation was used for the training set and the internal test set, and a sensitivity of (94.4 ± 1.1)% was obtained. Automatic detection of aneurysms was performed on the external test set, and the average false positive rate was 0.86 FPs/case (false positives/case). The resulting sensitivity was 82.9%. The classification comparison of external test sets showed that the sensitivity of the method for detecting aneurysms with sizes of 5.00~<10.00 mm and ≥10.00 mm (88.2% and 100.0%) was higher than that for aneurysms with sizes of <3.00 mm and 3.00~<5.00 mm (50.0% and 72.7%). The sensitivity of patients aged 50-60 years and >60 years (90.0% and 87.5%) was higher than that of patients aged <50 years (66.7%), and there was little difference between different genders (84.6% in males and 81.8% in females). Conclusion The deep learning algorithm has high diagnostic performance in detecting intracranial aneurysms, which is verified by external datasets.

Inter–rater reliability of the simplified Modified Rankin Scale as an outcome measure for treated cerebral aneurysm patients

BackgroundThe modified Rankin scale (mRS) is commonly used as a clinical outcome measure in aneurysm trials, but inter–observer reliability in treated patients has not been tested. MethodsWe reviewed the literature on inter–observer reliability studies of the mRS. Sixty patients with ruptured (n=47) or unruptured (n=13) aneurysms treated with endovascular methods (n=34) or surgical clipping (n=26) were independently evaluated by a neurosurgeon, a stroke neurologist, and a novice research assistant, and a simplified mRS score assigned. Results were analyzed using Gwet's AC1/2 reliability coefficients (KG). ResultsNo previous reports validating the reliability of the mRS in treated aneurysm patients were identified. Using the mRS 0–5, inter–rater agreement was almost perfect (KG=0.89 [0.86–0.93]). Agreement between raters remained almost perfect regardless of the rater's expertise. Agreement was almost perfect (KG=0.87 [0.77–0.96] when the mRS was dichotomized 0–2 vs 3–5, but fell to moderate when dichotomized 0–1 vs 2–5 (KG=0.59 (0.42–0.75). Agreement using the 0–2 vs 3–5 dichotomized mRS remained almost perfect for coiled (KG=0.90), clipped (KG=0.82), ruptured (KG=0.84), and unruptured (KG=0.95) aneurysms. Dichotomization of results at 0–1 vs 2–5 would have resulted in an (undesirable) significant difference in good outcomes between raters (P=.003), but not at 0–2 vs 3–5 (P=.52). ConclusionThe simplified mRS appears to be a reliable clinical outcome measure for treated cerebral aneurysm patients. When needed, dichotomization is more reliable at mRS 0–2 vs 3–5 than at 0–1 vs 2–5. The simplified mRS is a promising tool in the functional assessment of aneurysm patients recruited in pragmatic care trials.

Assessing the rate, natural history, and treatment trends of intracranial aneurysms in patients with intracranial dural arteriovenous fistulas: a Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) investigation.

There is a reported elevated risk of cerebral aneurysms in patients with intracranial dural arteriovenous fistulas (dAVFs). However, the natural history, rate of spontaneous regression, and ideal treatment regimen are not well characterized. In this study, the authors aimed to describe the characteristics of patients with dAVFs and intracranial aneurysms and propose a classification system. The Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) database from 12 centers was retrospectively reviewed. Analysis was performed to compare dAVF patients with (dAVF+ cohort) and without (dAVF-only cohort) concomitant aneurysm. Aneurysms were categorized based on location as a dAVF flow-related aneurysm (FRA) or a dAVF non-flow-related aneurysm (NFRA), with further classification as extra- or intradural. Patients with traumatic pseudoaneurysms or aneurysms with associated arteriovenous malformations were excluded from the analysis. Patient demographics, dAVF anatomical information, aneurysm information, and follow-up data were collected. Of the 1077 patients, 1043 were eligible for inclusion, comprising 978 (93.8%) and 65 (6.2%) in the dAVF-only and dAVF+ cohorts, respectively. There were 96 aneurysms in the dAVF+ cohort; 10 patients (1%) harbored 12 FRAs, and 55 patients (5.3%) harbored 84 NFRAs. Dural AVF+ patients had higher rates of smoking (59.3% vs 35.2%, p < 0.001) and illicit drug use (5.8% vs 1.5%, p = 0.02). Sixteen dAVF+ patients (24.6%) presented with aneurysm rupture, which represented 16.7% of the total aneurysms. One patient (1.5%) had aneurysm rupture during follow-up. Patients with dAVF+ were more likely to have a dAVF located in nonconventional locations, less likely to have arterial supply to the dAVF from external carotid artery branches, and more likely to have supply from pial branches. Rates of cortical venous drainage and Borden type distributions were comparable between cohorts. A minority (12.5%) of aneurysms were FRAs. The majority of the aneurysms underwent treatment via either endovascular (36.5%) or microsurgical (15.6%) technique. A small proportion of aneurysms managed conservatively either with or without dAVF treatment spontaneously regressed (6.2%). Patients with dAVF have a similar risk of harboring a concomitant intracranial aneurysm unrelated to the dAVF (5.3%) compared with the general population (approximately 2%-5%) and a rare risk (0.9%) of harboring an FRA. Only 50% of FRAs are intradural. Dural AVF+ patients have differences in dAVF angioarchitecture. A subset of dAVF+ patients harbor FRAs that may regress after dAVF treatment.

An Audacious Voyage during COVID-19 Pandemic in Management of Patients with Aneurysmal Subarachnoid Hemorrhage at Annapurna Neurological Institute and Allied Sciences

Introduction: Aneurysmal Subarachnoid Hemorrhage(SAH) is a neurosurgical emergency for which testing for COVID PCR was not an option and was unlikely to change the management of the case. Hence, all surgeries were performed without COVID PCR and Rapid Diagnostic Test (RDT) at our center for the welfare of the patient despite risks involved for the surgeons and supporting staff.&#x0D; Methods: Data were collected retrospectively of all cerebral aneurysm patients who received treatment at Annapurna Neurological Institute and Allied Sciences during the covid pandemic between February 2020 to May 2021. Their demographic profile, clinical and imaging characteristics, treatment decision, postoperative complication, postoperative functional status in terms of Modified Rankin Scale were taken into consideration and analyzed.&#x0D; Result: 63 patients were enrolled in study with patient age ranging from 9 years to 81 years. Male to female ratio was 1:3. Amongst them, 28% had hypertension. 82% underwent microsurgical clipping while three patients underwent coiling. Basilar Top aneurysm, Para clinoid aneurysm, PICA aneurysm underwent simple coiling. Wrapping, bypass and trapping were performed in 1,1, and 3 cases respectively. At the time of discharge, most of the patients (77%) achieved good functional recovery (mRS ≤ 2) while mortality was reported in 8% of patients. Based on our experience and limited dataset, posterior location of aneurysm, increasing HuntHess Grade and modified fisher grade had poor prognosis, related with degree of cerebral vasospasm, and delayed cerebral ischemia.&#x0D; Conclusion: Results from our study showed outcomes in surgical patients with aneurysmal SAH at par with international standards. COVID pandemic although posed initial difficulties, with proper guidelines and protocols in place, we were able to perform the emergency surgeries without compromising our standards.&#x0D;

Diabetes is not protective against the formation of unruptured cerebral aneurysm

ObjectivesDiabetes appears to decrease the risk of subarachnoid hemorrhage. However, it is not clear whether diabetes decreases the risk of aneurysm formation. The aim of our study to evaluate the risk of unruptured cerebral aneurysm in patients with diabetes mellitus. MethodsWe used data from participants who underwent brain magnetic resonance angiography (MRA) and laboratory tests at the Healthcare System Gangnam Center of Seoul National University Hospital between January 2010 and December 2013. From the 17,368 participants who underwent brain MRA, we analyzed 16,337 subjects whose diabetes status could be identified. ResultsThe number of participants with diabetes was 2299 (14.1%). The proportion of participants with cerebral aneurysms was 2.3% in the diabetic group and 2.7% in the non-diabetic group, which was not significantly different (P = 0.225). There were no significant differences in the size, location, and multiplicity of aneurysms between the diabetes and control groups. In multivariate logistic regression, older age showed significant risk effects on cerebral aneurysms, but female sex, hypertension, diabetes, obesity, and smoking did not show significant risk effects. ConclusionIn this study, diabetes did not affect the risk of cerebral aneurysm formation. In addition, neither smoking, nor hypertension was a significant risk factor for unruptured cerebral aneurysms. The lack of association between cerebral aneurysm and the traditional risk factors for subarachnoid hemorrhage requires further study. Risk factors for cerebral aneurysm development and those for cerebral aneurysm rupture may be different.

Computed Tomography Images under Optimized Iterative Reconstruction Algorithm for Blood Flow Field Characteristics in Cerebral Aneurysm before and after Stent Implantation

In order to study the analysis of blood flow field characteristics of cerebral aneurysm patients before and after stent implantation based on CT images of ART-TV-PI, this paper firstly improved the ART-TV algorithm of algebraic reconstruction technology and obtained the ART-TV-PI algorithm, which was compared with the ART algorithm and ART-TV algorithm. Afterwards, the CT images based on the above three algorithms were used to analyze the changes of average blood flow velocity, average wall pressure, average wall deformation, and average shear force of 48 cases of cerebral aneurysm patients before and after stent implantation. The results showed that the mean square error and radiation dose of the ART-TV-PI algorithm (0.00012 and 1.65 mSv) were significantly lower than those of the ART algorithm (0.0031 and 3.09 mSv) and ART-TV algorithm (0.00082 and 2.52 mSv), and the signal-to-noise ratio (23.94) was significantly higher than those of the ART algorithm (11.32) and ART-TV algorithm (16.89), with statistically significant differences ( P &lt; 0.05 ). The differences of mean blood flow velocity, mean wall pressure, mean wall deformation, and mean shear force before and after stent implantation among the three algorithms were not statistically significant ( P &gt; 0.05 ), and the average index of the ART-TV-PI algorithm was the highest. Under the ART-TV-PI algorithm, the mean blood flow velocity (0.044 m/s), the mean wall pressure (71.7 Pa), the mean wall deformation (0.057 mm), and the mean shear force (889 Pa) after stent implantation were significantly lower than those before stent implantation (0.165 m/s, 160.8 Pa, 0.721 mm, and 2690 Pa), with average decreases of 73.3%, 55.4%, 92.1%, and 64.3%, respectively, and the differences were statistically significant ( P &lt; 0.05 ). In conclusion, the images reconstructed by the ART-TV-PI algorithm have good image quality, which provides great convenience for surgical examination of cerebral aneurysm stent implantation and is worthy of clinical application.

Impact of Aneurysm Care Oriented Program on Knowledge Regarding Post-Operative Care of Cerebral Aneurysm Patients Among Nurses in a Tertiary Care Hospital of North India for Consideration for Publication

Introduction: Early intervention and timely nursing management in the post-operative period can improve functional outcomes in post-operative cerebral aneurysm patients. Nurses need to be aware of the specific interventions to be carried out for these patients. Method: Pre-experimental study design was used for the present study and one hundred twenty nurses working in neurosurgical units of a tertiary care hospital were enrolled in the study. A pre-validated questionnaire of 20 items was used to collect the data. The educational method employed in this study was a one-day aneurysm care workshop program. Participants (n=120) completed a multiple choice question (MCQ) test, derived from topics covered in the workshop, before the intervention. The MCQ test was repeated immediately after the workshop and at one month to assess retention and application of knowledge. Ethical aspects were given due considerations and data was analysed using descriptive and inferential statistics. Results: The mean age of the nurses was 31.83 ± 7.49 with the range of 24 -50 years. The mean knowledge score before the intervention was 10.18 ± 2.02, it was 17.79 ± 5.84 immediately after intervention and 15.63 ± 2.07 after one month. There was a statistically significant association of knowledge with the educational status of nurses at p-value <0.05. Conclusion: The workshop method was found feasible and effective in terms of improvement of the knowledge of nurses. There is a need to organize such a type of educational program to update the knowledge of nurses. The workshop intervention can also help to guide improvements in the implementation of policies for improved management of the care provided to post-operative cerebral aneurysm patients.

Antiplatelet Loading Effects Prior to Endovascular Treatment: Carotid Artery Stenosis versus Unruptured Cerebral Aneurysms.

Carotid artery stenosis and cerebral aneurism may have different platelet functions and antiplatelet responses because these diseases have different etiologies. In this study, we compared the antiplatelet loading effects prior to endovascular treatment between carotid artery stenosis and unruptured cerebral aneurysm (UCA) patients. Nine patients with asymptomatic carotid artery stenosis (ACS), 14 with symptomatic carotid artery stenosis (SCS), and 20 with unruptured cerebral aneurysms were enrolled in this study. Antiplatelet (aspirin + clopidogrel) loading effects prior to endovascular treatment were evaluated using light transmission aggregometry and platelet aggregate detection methods. Although there are differences in the prevalence of atherosclerosis risk factors, maximum aggregation rates in light transmission aggregometry and platelet aggregation-prone properties were not different in the three disease groups. Preoperative dual antiplatelet therapy with aspirin and clopidogrel may be appropriate for both carotid artery stenosis and cerebral aneurism patients even though their conditions and background factors differ.

Usefulness of 3 Tesla Ultrashort Echo Time Magnetic Resonance Angiography (UTE-MRA, SILENT-MRA) for Evaluation of the Mother Vessel after Cerebral Aneurysm Clipping: Case Series of 19 Patients.

It is important to assess the cerebral arteries near the clip after cerebral aneurysm clipping. Contrast-enhanced computed tomography angiography has side effects of contrast medium and radiation exposure. Time-of-flight magnetic resonance angiography (TOF-MRA) is a fast and non-invasive method, but clip-induced artifact limits the assessment around the clip. Recently, 3 tesla MRA with ultrashort echo time called SILENT MRA (GE Healthcare Life Sciences, UK) has been reported to have the potential to overcome these disadvantages. We herein present consecutive 19 cerebral aneurysm patients treated by clipping and evaluated using SILENT MRA. The 19 patients (15 women and 4 men) underwent TOF-MRA and SILENT MRA during the same scan session. Two neurosurgeons independently assessed the visibility of the mother vessel at the clipping site in TOF-MRA and SILENT MRA. We also investigated the factors related to visibility in SILENT MRA. All patients’ mother vessels were not described in TOF-MRA, and that of 16 patients (84%) were described in SILENT MRA. Overall agreement was 100% in the two neurosurgeons, and the fixed marginal kappa = 1.00 (95% CI: 0.36–1.00). Univariate analysis revealed that larger aneurysm dome and long clip blade length contributed to the visibility of the mother vessel in SILENT MRA. (p = 0.023, 0.007, each). In conclusion, SILENT MRA can be applied for the assessment of the arteries and aneurysm neck remnants near the clip. Using clips with long blade and ligation with its tip would be related to the visibility of the mother vessels in SILENT MRA.

The Features of the Circle of Willis and Cerebral Aneurysm in Patients with Cerebral Aneurysms through Films of Multi- slice Computed Tomography

This paper studies the features of the circle of Willis and cerebral aneurysm in patients with cerebral aneurysms through films of Multi-slice Computed Tomography (MSCT) at the Department of Radiology, Bach Mai Hospital, from March 2017 to March 2018. The study results show that female/male ratio was 2.37: 1; the number of patients with only one aneurysm accounted for 90.68%; Saccular aneurysm was more common than lozenge-shaped aneurysm; the rate of aneurysm ruptures was 82.35%; the bulge was mainly distributed in the carotid artery (94.6%). The very small bulge (less than 3mm) and the small bulge (3-7mm) were most common and accounted for 33.33% and 49.62%, respectively. The variations of the circle of Willis were very diverse and complex, including 13 forms, four of which were the circle of Willis anterior part variants and nine transformations were the circle of Willis posterior variants. Abnormalities (aplasia, hypoplasia) of the anterior communicating arterial were 8.48% and abnormalities of the posterior communicating arterial were 82.6%. The paper concludes that the abnormal anatomical variations in the circle of Willis can facilitate the early diagnosis and treatment of cerebral aneurysm disease.&#x0D; Keywords&#x0D; Circle of Willis, cerebral aneurysm, MSCT.&#x0D; References&#x0D; [1] C.S. Hee, L.J. Ye, R.K. Hwa, et al. Diagnosis of Cerebral Aneurysm Via Magnetic Resonance Angiography Screening: Emphasis on Legal Responsibility Increases False Positive Rate, Neurointervention 13(1) (2018) 48-53. [2] T.A. Tuan, Research the value of the diagnosis of cerebral aneurysm by 64 slices computer tomography, Graduate thesis in resident doctor, Hanoi Medical University, 2008 (in Vietnamese).[3] M.W. Son, J.W. Park, K.J. Park, et al, Prognostic Factors of Clinical Outcome after Aneurysmal Clipping in the Aged Patients with Unruptured Intracranial Aneurysm, Journal of Neurointensive Care 3(1) (2020) 20-25. [4] H.M. Tu, N.X. Khoa, Study on the anatomical changes of the cerebral arteries on the MSCT 64 imaging, Thesis Master of Medicine, Hanoi Medical University, 2012 (in Vietnamese).[5] Z. Molnar, W. Thomas (1621-1675), the founder of clinical neuroscience, Nat Rev Neurosci 5(4) (2004) 329-335. [6] Q. Li, J. Li, F. Lv, et al., A multidetector CT angiography study of variations in the circle of Willis in a Chinese population, J Clin Neurosci. 18(3) (2011) 379–383.[7] A. Karatas, G. Coban, C. Cinar, et al., Assessment of the Circle of Willis with Cranial Tomography Angiography, ed Sci Monit. 21 (2015) 2647–2652, [8] S.A. Gunnel, M.S. Farooqui, R.N. Wabale, Anatomical variations of the circulus arteriosus in cadaveric human brains, Neurol Res Int.: 687281, http://doi.org/10.1155/2014/687281, indexed in Pubmed: 24891951 (2014).[9] I.Ö. Yeniçeri, Circle of Willis variations and artery diameter measurements in the Turkish population, Via Medica 76 (3) (2017) 420–425.&#x0D;

MicroRNA-29b targeting of cell division cycle 7-related protein kinase (CDC7) regulated vascular smooth muscle cell (VSMC) proliferation and migration

BackgroundProliferation and migration of vascular smooth muscle cells (VSMCs) are vital processes in vascular remodeling and pathology. This study aimed to explore the expression of miR-29b and cell division cycle 7-related protein kinase (CDC7) in patients with cerebral aneurysm (CA) and their effects on the proliferation and mobility of human umbilical artery smooth muscle cells (HUASMCs).MethodsRNA levels of miR-29b and CDC7 were evaluated in the CA tissues and adjacent normal cerebral arteries from 18 patients undergoing surgery for CA rupture. The targeting of CDC7 by miR-29b was verified with luciferase reporter assay. Both CDC7 and miR-29b overexpression and silencing vectors were introduced to validate their effects on the proliferation and mobility of HUASMCs.ResultsThe mRNA level of miR-29b was down-regulated (P<0.05), while the mRNA level of CDC7 was markedly elevated in CA patients (P<0.05). A Luciferase reporter assay showed CDC7 is a target gene of miR-29b, and miR-29b mimic down-regulated the mRNA and protein levels of CDC7 (P<0.05). Furthermore, miR-29b mimic inhibited, while miR-29b inhibitor or CDC7 over-expression promoted the proliferation and mobility of HUASMCs (P<0.05).ConclusionsmiR-29-3p inhibits cell proliferation and mobility via directly targeting CDC7, which could be a potential therapeutic target for vascular dysfunction related diseases, including atherosclerosis and CA.

Circulating Treg cells from patients with cerebral aneurysms displayed deficiency in ICOS expression and function.

Inducible costimulator (ICOS) is a member of the CD28 family. When activated, ICOS signalling promotes FOXP3 CNS2 gene demethylation and stabilizes Treg differentiation. Cerebral aneurysm (CA) is the local ballooning of the cerebral vasculature, characterized by higher levels of inflammation mediators and tissue remodelling. FOXP3+ Treg cell dysfunction may contribute to CA pathogenesis. In this study, the expression and function of ICOS in Treg cells was investigated. Circulating CD4+ CD25hi T cells from CA subjects demonstrated significantly lower levels of ICOS expression than circulating CD4+ CD25hi T cells from healthy subjects. In both healthy subjects and CA subjects, FOXP3+ Treg cells were highly concentrated in the ICOS+ fraction of CD4+ CD25hi T cells. Anti-ICOS costimulation, in combination with anti-CD3 and IL-2, significantly increased FOXP3 expression in CD4+ CD25hi ICOS+ T cells but not in CD4+ CD25hi ICOS- T cells. In addition, anti-CD3/IL-2 and anti-ICOS costimulation significantly elevated the expression of IL-10 and TGF-β, decreased the expression of IL-17, and enhanced CD4+ CD25hi ICOS+ T cell-mediated suppression of autologous CD4+ CD25- Tconv proliferation. Interestingly, CD4+ CD25hi ICOS+ T cells from CA subjects presented lower responsiveness toward anti-ICOS costimulation than CD4+ CD25hi ICOS+ T cells from healthy subjects. Overall, these results demonstrated that ICOS signalling could significantly improve FOXP3 expression and enhance Treg functional potency. However, circulating Treg cells from CA patients displayed reduced ICOS expression and lower responsiveness toward anti-ICOS stimulation.

What is the hemodynamic effect of the Woven EndoBridge? An in vivo quantification using time-density curve analysis

PurposeUsing the Woven EndoBridge (WEB) for aneurysm treatment has emerged as endovascular approach aiming for flow disruption in aneurysm sac. Since quantifiable data confirming the hemodynamic effect are lacking, we investigated in vivo aneurysmal flow alterations using time-density curve (TDC) analysis. Additionally, we evaluated whether flow parameters could be identified as independent factor to predict aneurysm occlusion.MethodsForty cerebral aneurysm patients treated with WEB were enrolled. Pre- and postinterventional digital subtraction angiography series were postprocessed and TDCs generated. TDCs were quantified calculating the parameters aneurysmal inflow velocity, outflow velocity, mean flow velocity, and relative time-to-peak (rTTP) of aneurysm filling. Pre- and postinterventional values were compared and related to occlusion rate.ResultsWEB implanting induced highly significant rTTP prolongation by 52% (p = 0.001) and highly significant decrease of aneurysmal inflow, outflow, and mean flow velocity (p < 0.001). While outflow velocity was reduced by 49%, inflow velocity was reduced by 33% only. No statistically significant difference between the occluded and the non-occluded group was observed. No flow parameter reached significance level concerning predicting aneurysm occlusion.ConclusionFlow quantification confirms a significant flow-disrupting effect of WEB reducing more the outflow than the inflow velocity. In our small cohort, no flow parameter reached statistical significance to show predictive value regarding complete aneurysm occlusion. The hemodynamic effect of WEB is on comparable level to flow-diverting stents meaning that aneurysm closure can be delayed. In case of only slight inflow changes and high aneurysmal hemodynamic stress, some aneurysms might not be adequately protected in the short term.