Publications by authors named "Guoli Duan"

14 Publications

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Endovascular treatment of vertebro-vertebral arteriovenous fistula in neurofibromatosis type I: A report of two cases and literature review with a focus on endovascular treatment.

Clin Neurol Neurosurg 2021 08 14;207:106806. Epub 2021 Jul 14.

Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China. Electronic address:

Vertebro-Vertebral arteriovenous fistula (VV-AVF) associated with neurofibromatosis Type I (NF-1) is rare. We presented two female NF-1 patients with a diagnosis of VV-AVF treated with endovascular approach. The fistula was completely obliterated with balloon assisted embolization and covered stent separately and VA patency was preserved in both cases. Reviewing the literature with a focus on endovascular treatment, endovascular occlusion of VV-AVF in NF-1 patients is safe and effective. To preserve the parent VA patency and obliterate the fistula simultaneously is challenging generally, but feasible in some cases.
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http://dx.doi.org/10.1016/j.clineuro.2021.106806DOI Listing
August 2021

Comparison of Low-Profiled Visualized Intraluminal Support Stent-Assisted Coiling and Coiling Only for Acutely Ruptured Intracranial Aneurysms: Safety and Efficacy Based on a Propensity Score-Matched Cohort Study.

Neurosurgery 2020 09;87(3):584-591

Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China.

Background: Low-profiled visualized intraluminal support (LVIS) is suggested as a promising stent for complex intracranial aneurysms. However, the safety and efficacy of LVIS-assisted coiling of acutely ruptured wide-necked intracranial aneurysms have not been well reported.

Objective: To evaluate the safety and efficacy of LVIS-assisted coiling of acutely ruptured wide-necked intracranial aneurysms compared with contemporary coiling-only strategy via propensity score matching in a high-volume center.

Methods: A retrospective review of patients with acutely ruptured intracranial aneurysms who underwent LVIS stent placement or coiling only from November 2013 to October 2017 was performed. Perioperative procedure-related complications and clinical and angiographic follow-up outcomes were compared.

Results: All baseline characteristics were equivalent between the 2 groups except for neck size. The immediate angiographic results, procedure-related complications, procedure-related mortality, and clinical outcomes between the 2 groups demonstrated no significant differences (P = .087, P = .207, P = .685, and P = .865, respectively). The angiographic follow-up outcomes of the LVIS-assisted coiling group showed a significantly higher complete occlusion rate and lower recurrence rate compared with the coiling-only group (92.3% vs 59.9%, 4.8% vs 26.1%, P < .001). Multivariable analysis showed no significant predictors for the overall perioperative procedure-related complications, hemorrhagic complications, and ischemic complications.

Conclusion: The LVIS stent is a safe and effective device for stent-assisted coiling of acutely ruptured wide-necked intracranial aneurysms, with comparable procedure-related complication rates, higher complete occlusion rates, and lower recurrence rates at follow-up compared with coiling only.
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http://dx.doi.org/10.1093/neuros/nyaa110DOI Listing
September 2020

Outcome and Prognostic Factors of Ruptured Middle Cerebral Artery Aneurysms Treated via Endovascular Approach: A Single-Center 11-Year Experience.

World Neurosurg 2020 Jan 4;133:e187-e196. Epub 2019 Sep 4.

Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, P.R. China. Electronic address:

Objective: To investigate outcomes and prognostic factors of ruptured middle cerebral artery (MCA) aneurysms, treated via endovascular approach, with improving treatment materials and techniques.

Patients And Methods: A total of 185 consecutive patients, admitted with acutely ruptured MCA aneurysms and treated by endovascular methods between 2006 and 2016, were retrospectively reviewed. Their baseline characteristics, procedure-related complications, and angiographic and clinical outcomes were collected. Univariate analysis and logistic regression analysis were completed to identify any association between procedure-related complications or clinical outcomes and potential risk factors.

Results: Procedure-related complications occurred in 28 patients (15.1%), including aneurysm rebleeding in 7 (3.8%), hematoma expansion in 10 (5.4%), and ischemia in 13 (7.0%) (concurrent hemorrhage and ischemia in 2 patients), which resulted in morbidity/mortality of 7% and 1.4%. Final evaluations indicated that 153 patients (82.7%, 153/185) had a good outcome (modified Rankin Scale score 0-2). Among 120 (69.4%) who underwent angiographic follow-up, 89 (74.2%) were completely occluded and 20/120 (16.7%) were recanalized. Multivariate analysis of clinical outcome indicated that a high preoperative Hunt and Hess grade (IV-V), intrasylvian/intracerebral hematoma, and early period treatment (2006-2013) were associated with unfavorable outcomes.

Conclusions: Endovascular treatment for patients with ruptured middle cerebral artery aneurysms may offer favorable clinical and angiographic outcomes. With the evolution of treatment materials and updated techniques, treatment complications have become less common than previously reported in literature, and clinical outcomes have been improved in recent years.
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http://dx.doi.org/10.1016/j.wneu.2019.08.189DOI Listing
January 2020

Dual Stent-Assisted Coil Embolization for Intracranial Wide-Necked Bifurcation Aneurysms: A Single-Center Experience and a Systematic Review and Meta-Analysis.

World Neurosurg 2019 Jun 28;126:e295-e313. Epub 2019 Feb 28.

Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China. Electronic address:

Objective: To evaluate the safety and efficacy of dual stent-assisted coiling in treatment of intracranial complex and wide-necked bifurcation aneurysms, we have reported our own center experience and performed a systematic review and meta-analysis of the reported data.

Methods: The experience in our center was reviewed and a comprehensive search of the reported data on dual stent-assisted treatment of intracranial complex and wide-necked bifurcation aneurysms was performed using the databases PubMed, Ovid EMBASE, and Ovid MEDLINE before October 1, 2018. Information was extracted regarding patient demographic data, clinical characteristics, radiographic data, treatment outcomes, complications, and clinical and angiographic follow-up data. The data were analyzed using random effects and fixed effects meta-analyses.

Results: Including our series of 26 patients, the data from 21 studies with 721 patients were analyzed. The procedure was technically successful in 97.6% (95% confidence interval [CI], 96.5%-98.7%). The complete occlusion rate was 61.6% (95% CI, 47.3%-75.8%) immediately after the procedure compared with 88.4% (95% CI, 84.6%-92.2%) at the last follow-up examination. The rate of periprocedural complications, total complications, procedure-related mortality was 8.8% (95% CI, 5.8%-11.9%), 9.5% (95% CI, 6.2%-12.9%), and 1.1% (95% CI, 0.3%-1.8%), respectively. The recurrence rate, retreatment rate, and good neurologic outcome rate was 3.3% (95% CI, 2.0%-4.7%), 2.7% (95% CI, 1.5%-4.0%), and 96.6% (95% CI, 95.0%-98.1%), respectively.

Conclusions: The dual stent-assisted coiling technique is a feasible and effective option for the treatment of intracranial complex and wide-necked bifurcation aneurysms. It results in a relatively low rate of procedure-related complications and mortality and recurrence and a high rate of mid-term complete occlusion and good neurologic outcomes.
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http://dx.doi.org/10.1016/j.wneu.2019.02.047DOI Listing
June 2019

Endovascular Treatment of Ruptured Middle Cerebral Artery Aneurysms: A Single-Arm Meta-Analysis and Systematic Review.

World Neurosurg 2019 Jul 24;127:559-566. Epub 2019 Jan 24.

Department of Neurosurgery, Changhai Hospital, Naval Medical University, Shanghai, China. Electronic address:

Objective: The use of endovascular treatment for ruptured middle cerebral artery (MCA) aneurysms, which have been more likely to be recommended for neurosurgical clipping because of the complex anatomic configuration, remains controversial. In the present study, the angiographic and clinical outcomes of endovascularly treated ruptured MCA aneurysms were systematically reviewed.

Methods: Online databases, including Cochrane, Medline, Web of Science, and Embase, were retrospectively and systematically searched. The primary outcomes were the immediate complete occlusion rate, mortality, complication-related mortality, and procedure-related complication rate. Meta-analysis was performed using a random or fixed effect model based on heterogeneity.

Results: A total of 14 studies with 1004 ruptured MCA aneurysms were included. The procedure-related mortality rate at discharge was 1.8% (95% confidence interval [CI], 0.9%-2.7%; I = 0.0%; P = 0.623). The favorable clinical outcome rate at discharge was 65.4% (95% CI, 54.8%-76.0%; I = 94.2%; P < 0.001) and had progressively increased to 73.2% (95% CI, 59.9%-86.5%; I = 80.9%; P < 0.001). The overall complication rate was 22.7% (95% CI, 15.1%-30.3%; I = 75.5%; P < 0.001).

Conclusion: Endovascular treatment of MCA aneurysms was related to a high incidence of procedure-related complications but a low rate of procedure-related mortality. The overall angiographic and clinical outcomes were comparable and warrant further investigation comparing clipping versus coiling for ruptured MCA aneurysms.
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http://dx.doi.org/10.1016/j.wneu.2019.01.066DOI Listing
July 2019

Risk factors for hyperperfusion-induced intracranial hemorrhage after carotid artery stenting in patients with symptomatic severe carotid stenosis evaluation.

J Neurointerv Surg 2019 May 27;11(5):474-478. Epub 2018 Oct 27.

Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China.

Background: Analyzing risk factors for hyperperfusion-induced intracranial hemorrhage (HICH) after carotid artery stenting (CAS) in patients with symptomatic severe carotid stenosis.

Methods: This study retrospectively analyzed clinical data of 210 patients, who had symptomatic severe carotid stenosis (70-99%) and received CAS treatment between June 2009 and June 2015, and evaluated the relationship of HICH with patients' clinical baseline data, imaging features, and treatment strategies.

Results: Seven patients (3.3%) developed HICH after CAS. The incidence of HICH among patients with near total occlusion was significantly higher than among those without (10.1% vs 0%, P<0.001). Out of the seven, five had no development of either anterior or posterior circulations, and two had no development of anterior circulation and poor development of posterior circulation. Results showed that patients with poor compensation of Willis' Circle were more likely to develop HICH compared with other patients (P<0.001). All patients received preoperative CT perfusion. TTP index was defined as the TTP ratio between the affected and contralateral side. The results showed that the TTP index was significantly different between the HICH group and non-HICH group (1.15±0.10 vs 1.30±0.15, P<0.001). An analysis of the ROC curve indicated that patients with TTP index >1.22 were more likely to develop HICH compared with other patients (sensitivity 100%, specificity 75.9%).

Conclusions: Patients with severe unilateral carotid stenosis, the presence of near total occlusion, poor compensation of Willis' Circle, and preoperative TTP index>1.22, have a higher risk of developing HICH after CAS.
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http://dx.doi.org/10.1136/neurintsurg-2018-013998DOI Listing
May 2019

Safety of coiling with stent placement for the treatment of ruptured wide-necked intracranial aneurysms: a contemporary cohort study in a high-volume center after improvement of skills and strategy.

J Neurosurg 2018 08;131(2):435-441

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.
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http://dx.doi.org/10.3171/2018.3.JNS172199DOI Listing
August 2018

Safety and Efficacy of Flow Diverter Treatment for Blood Blister-Like Aneurysm: A Systematic Review and Meta-Analysis.

World Neurosurg 2018 Oct 23;118:e79-e86. Epub 2018 Jun 23.

Department of Neurosurgery, Changhai Hospital, The Second Military Medical University, Shanghai, China. Electronic address:

Objective: To clarify the safety and efficacy of flow diverter (FD) treatment for blood blister-like aneurysm (BBA) through a systematic review and literature analyzing perioperative and long-term clinical and angiographic outcomes.

Methods: We performed a comprehensive review of the current literature for studies with >2 patients related to FD treatment of BBAs published. A random-effects meta-analysis was used to pool the following outcomes: complete occlusion, technical success, aneurysm recurrence, rebleeding, perioperative mortality, perioperative stroke, procedure-related morbidity and mortality, long-term neurological morbidity and mortality, and overall good neurologic outcome.

Results: We included 15 noncomparative studies with a total of 165 target BBAs. Complete occlusion rates were 72% (95% confidence interval [CI], 0.59-0.85). Recurrence occurred in 13% (95% CI, 0.04-0.29) and rebleeding in 3% (95% CI, -0.02 to 0.07) of patients. Procedure-related morbidity and mortality were 26% (95% CI, 0.19-0.33) and 3% (95% CI, -0.01 to 0.07), respectively. The rate of long-term good outcomes was 83% (95% CI, 0.77-0.89). Subgroup analysis indicated that a single FD strategy for BBA seemed to have a higher rate of good outcomes compared with an overlapped FD strategy (89.9% vs. 61.9%; odds ratio, 1.42; 95% CI, 1.25-14.98, P = 0.02). Complete occlusion rate and procedure-related morbidity rate did not see any significant difference between these 2 strategies.

Conclusions: Our meta-analysis suggests that in selected cases, FD can be safe and effective. A single FD strategy may result in a higher rate of good outcomes compared with an overlapped FD strategy. Ultimately, treatment of BBA should be considered on a case-by-case basis to maximize patient benefits and limit the risk of perioperative complications.
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http://dx.doi.org/10.1016/j.wneu.2018.06.123DOI Listing
October 2018

Rupture Risk of Cerebral Arteriovenous Malformations During Pregnancy and Puerperium: A Single-Center Experience and Pooled Data Analysis.

World Neurosurg 2018 Mar 16;111:e308-e315. Epub 2017 Dec 16.

Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China. Electronic address:

Objective: Whether rupture risk of cerebral arteriovenous malformation (AVM) is higher during pregnancy and puerperium remains controversial. This study aimed to compare risk of rupture in pregnant and nonpregnant female patients with AVM in a singer-center series and assess current evidence regarding rupture risk of AVM during pregnancy and puerperium by pooled data analysis.

Methods: We retrospectively reviewed female patients with AVM in our center from January 2006 to August 2017. Hemorrhage events and patient-years were calculated during exposure period and nonexposure period, which was defined as either the interval from birth until AVM obliteration or last follow-up after subtracting the exposure period. Poisson rate ratio analysis was used to compare hemorrhage rate between the 2 periods. Pooled data analysis was performed by up-to-date literature review via PubMed and EMBASE databases.

Results: In 264 female patients with AVM, overall annual hemorrhage rate for 222 total hemorrhages during an average of 7484 patient-years was 2.97%. Eight hemorrhages occurred in exposure periods, 214 hemorrhages occurred in nonexposure periods, and 155 hemorrhages occurred in nonexposure periods of reproductive-age patients, translating to annual hemorrhage rates of 5.40% in exposure periods, 2.92% in nonexposure periods, and 3.82% in nonexposure periods of reproductive-age patients. Pooled data analysis showed a higher annual hemorrhage rate in exposure periods than in nonexposure periods (5.59% vs. 2.52%; 95% confidence interval 1.52-6.70, P = 0.002).

Conclusions: This study demonstrated an increase in annual rate of cerebral AVM hemorrhage during pregnancy and puerperium. Female reproductive-age patients with cerebral AVM may have higher risks of AVM rupture. Further evaluation by well-designed prospective or randomized cohort studies is needed.
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http://dx.doi.org/10.1016/j.wneu.2017.12.056DOI Listing
March 2018

Development and Validation of the Procedure-Related Neurologic Complications Risk Score for Elderly Patients with Ruptured Intracranial Aneurysm Undergoing Endovascular Treatment.

World Neurosurg 2017 Apr 31;100:648-657.e2. Epub 2017 Jan 31.

Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China. Electronic address:

Objectives: Our aim was to develop and validate a procedure-related neurologic complications (PNC) risk score for individual elderly patients with ruptured intracranial aneurysms undergoing endovascular treatment (EVT).

Methods: Preoperatively collected data, including clinical, lesion, and procedure characteristics of consecutive elderly patients (≥60 years), were used to develop a PNC risk predictive score based on the coefficients (β) of a multivariable logistic regression analysis. The PNC included intraprocedural rupture, thromboembolic events, and rebleeding within 30 days after EVT.

Results: Overall, 520 elderly patients who underwent EVT were enrolled. At 30 days, the PNC rate was 13.08%. Six risk factors were independently associated with PNC and comprised the PNC score (PNC score, 0-16 points): hypertension (2 points), Hunt-Hess grade ≥4 (3 points), Fisher grade ≥3 (2 points), wide-necked aneurysm (2 points), with a bleb on the aneurysm sac (3 points), and aneurysm size (3-10 mm, 1 point; <3 mm, 4 points). The PNC score model predicted the risk of PNC at a sensitivity of 63.22% and specificity of 84.79%. Moreover, the PNC score demonstrated significant discrimination (area under curve, 0.799; P < 0.001) and calibration (Hosmer-Lemeshow test, P = 0.319). Excellent prediction, discrimination, and calibration properties were reproduced by the internal validation group with bootstrapping techniques.

Conclusions: The PNC score can be an easily applicable tool for predicting the risk of PNC for individual elderly patients with ruptured intracranial aneurysms undergoing EVT. Our study provides large case-based evidence supporting the integration of individual clinical, lesion, and procedure characteristics to predict PNC risk.
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http://dx.doi.org/10.1016/j.wneu.2017.01.085DOI Listing
April 2017

Prognosis Predicting Score for Endovascular Treatment of Aneurysmal Subarachnoid Hemorrhage: A Risk Modeling Study for Individual Elderly Patients.

Medicine (Baltimore) 2016 Feb;95(7):e2686

From the Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China.

The elderly patients with aneurysmal subarachnoid hemorrhage (aSAH) have a greater risk of poor clinical outcome after endovascular treatment (EVT) than younger patients do. Hence, it is necessary to explore which factors are associated with poor outcome and develop a predictive score specifically for elderly patients with aSAH receiving EVT. The aim of this study was to develop and validate a predictive score for 1-year outcomes in individual elderly patients with aSAH underwent EVT.In this 10-year prospective study, 520 consecutive aSAH elderly (age ≥ 60 years) patients underwent EVT in a single center were included. The risk factors, periprocedural, and 1-year follow-up data of all patients were entered in a specific prospective database. The modified Rankin scale was used for evaluating clinical outcome. To optimize the model's predictive capacity, the original matrix was randomly divided in 2 submatrices (learning and testing). The predictive score was developed using Arabic numerals for all variables based on the variable coefficients (β) of multivariable logistic regression analysis in the learning set and the predictive performance evaluation was assessed in the testing set. The risk classes were constructed using classification criteria based on sensitivity and specificity. The poor outcome rate at 1 year was 26.15%. Six risk factors, including age, hypertension, Hunt-Hess scale, Fisher scale, aneurysm location, and periprocedural complications, were independently associated with poor outcome and assembled the Changhai score. The discriminative power analysis with the area under the receiver operating characteristic curve (AUC) of the Changhai score was statistically significant (0.864, 0.824-0.904, P < 0.001). The sensitivity and specificity of the Changhai score were 82.07% and 78.06%, respectively. Our study indicated that age, hypertension, Hunt-Hess scale, Fisher scale, aneurysm location, and periprocedural complications were independent risk factors of poor outcome for elderly aSAH patients underwent EVT. In combination with these risk factors, the Changhai score can be a useful tool in the prediction of clinical outcome but needs to be validated in various centers before it can be recommended for application.
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http://dx.doi.org/10.1097/MD.0000000000002686DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4998607PMC
February 2016

Enterprise stent for the treatment of symptomatic intracranial atherosclerotic stenosis: an initial experience of 44 patients.

BMC Neurol 2015 Oct 8;15:187. Epub 2015 Oct 8.

Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Rd, Shanghai, 200433, China.

Background: Wingspan stenting for the treatment of complex intracranial atherosclerotic stenosis (ICAS), i.e., that involving tortuous vascular pathways, long (>15 mm) lesions or arterial bifurcations, has a relatively high risk of complications. This retrospective study assessed the safety and efficacy of undersized balloon angioplasty followed by deployment of the more flexible Enterprise stent for the treatment of complex symptomatic ICAS.

Methods: Forty-four patients on combined antiplatelet therapy and intensive risk factor management and a symptomatic 70-99% stenosis of a major intracranial artery in complex settings that was treated with balloon angioplasty and Enterprise stent deployment between July 2009 and August 2013 were enrolled. Primary outcome was occurrence of ischemic or hemorrhagic stroke or death within 30 days after intervention. Secondary outcomes included procedural success (defined as achievement of <50% immediate residual stenosis), and follow-up clinical and angiographic outcomes.

Results: With a procedural success rate of 100%, stenosis was reduced from 79.3 ± 8.1-14.9 ± 2.3%. Three (6.8%) ischemic and 1 (2.2%) hemorrhagic strokes occurred during the periprocedural period, with no further transient ischemic attacks or strokes in the 42 patients available at median 25.6 (range, 12-57) months follow-up. Of the 38 (86.4%) patients who underwent angiographic follow-up, 3 (6.81%) developed >50% in-stent restenosis after mean 22 months follow-up.

Conclusion: In this retrospective, single-center experience, undersized balloon angioplasty followed by Enterprise stent deployment appears technically feasible with a relatively low rate of complications for the treatment of complex symptomatic ICAS. Prospective, multicenter, randomized controlled trials against optimal medical management are warranted.
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http://dx.doi.org/10.1186/s12883-015-0443-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4598959PMC
October 2015

Solitaire stents for the treatment of complex symptomatic intracranial stenosis after antithrombotic failure: safety and efficacy evaluation.

J Neurointerv Surg 2016 Jul 3;8(7):680-4. Epub 2015 Jun 3.

Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China.

Objectives: To evaluate the feasibility, safety, and efficacy of Solitaire stent placement after balloon angioplasty for the treatment of complex symptomatic intracranial atherosclerotic stenosis (ICAS).

Methods: We retrospectively reviewed the clinical data from 44 patients who underwent Solitaire stent placement for complex symptomatic ICAS at our department between November 2010 and March 2014, with focus on the clinical factors, lesion characteristics, treatment results, and periprocedural complications. We also summarized the early outcomes and imaging findings during the follow-up period.

Results: Overall, the technical success rate was 100% (44/44). Post-stenting residual stenosis ranged from 0% to 40% (mean 15.00±12.94%). The overall 30-day rate of procedure-related complications was 9.09% (4/44). The incidence of recurrent ischemic events related to the territory artery was 4.55% during a mean clinical follow-up period of 25.5 months. Five patients (11.36%) developed in-stent restenosis during a mean angiographic follow-up period of 9.3 months.

Conclusions: This is the first case series study of ICAS treated by Solitaire stent placement. Deployment of a Solitaire stent with balloon angioplasty in the treatment of complex severe intracranial stenosis appears safe and effective, with a high technical success rate, relatively low periprocedural complication rate, and favorable outcome during follow-up.
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http://dx.doi.org/10.1136/neurintsurg-2015-011734DOI Listing
July 2016

Morphological and hemodynamic analysis of posterior communicating artery aneurysms prone to rupture: a matched case-control study.

J Neurointerv Surg 2016 Jan 17;8(1):47-51. Epub 2014 Nov 17.

Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China.

Objectives: We evaluated the correlation between posterior communicating artery (PcomA) aneurysm rupture and morphological and hemodynamic parameters to assess related rupture risk indices.

Methods: Six patients with PcomA aneurysms that ultimately ruptured (cases) were studied after initially being included in a prospective database including their three-dimensional (3D) imaging before rupture. For each case, four incidental stable unruptured aneurysms (controls) were randomly selected and matched based on clinical factors. The 3D images from all patients were reconstructed to establish the patient-specific model. Six morphologic parameters and three hemodynamic parameters were measured and calculated. A conditional logistic regression analysis was used to assess the individual risk of rupture.

Results: The analysis demonstrated a larger aneurysm size (p=0.001), higher aspect ratio (p=0.018), ellipticity index (p<0.001), undulation index (p=0.005), percentage of low wall shear stress (WSS) area (LSA%) (p=0.010), and a lower normalized WSS (p=0.005) in the case group. The multivariate conditional logistic regression analysis demonstrated that only normalized WSS was significantly associated with the rupture of PcomA aneurysms (OR 0.151; 95% CI 0.025 to 0.914; p=0.040).

Conclusions: Hemodynamics and morphology are closely associated with aneurysm rupture, and WSS may be a more reliable parameter characterizing the rupture status of PcomA aneurysms.
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http://dx.doi.org/10.1136/neurintsurg-2014-011450DOI Listing
January 2016
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