To clarify the safety and efficacy of flow diverter (FD) treatment for aneurysm in small cerebral vessels, we conducted a systematic review of the literature analyzing perioperative and long-term ...clinical and angiographic outcomes.
A comprehensive review of the up-to-date literature for studies with ≥10 patients related to FD treatment of small vessel aneurysms published was performed. Random-effects meta-analysis was used to pool the following outcomes: complete occlusion, technical procedural success, perioperative mortality, perioperative stroke, procedure-related morbidity and mortality, all complications, long-term mortality, and overall good outcome.
We included 26 noncomparative studies with 572 target aneurysms. The technical procedural success rate was 96% (95% confidence interval CI 0.93–1.00). At final follow-up, the complete occlusion rate was 70% (95% CI 0.64–0.76). The all-cause morbidity rate was 20% (95% CI 0.14–0.25). Procedure-related morbidity and mortality rates were 9% (95% CI 0.07–0.12) and 4% (95% CI 0.00–0.08), respectively. Overall long-term good outcome rate was 96% (95% CI 0.93–0.99). In the 3 subgroup analyses, complete occlusion rate of saccular aneurysms was lower than that of nonsaccular aneurysms (55% vs. 73%, respectively; odds ratio 0.40, 95% CI 0.17–0.98, P = 0.04). The procedure-related morbidity rate and the good outcome rate were not significantly different in this subgroup. In the other 2 subgroups in which we compared anterior circulation aneurysms with posterior circulation aneurysms and single FD strategy with overlapped FD strategy, the rates were also not significantly different.
Our meta-analysis demonstrated that FD treatment of small vessel aneurysms is technically feasible and effective with a high rate of complete occlusion. Although the comorbidities of patients cannot be neglected, the FD approach was associated with an acceptable rate of procedure-related morbidity and a satisfactory rate of overall good outcome.
•FD treatment for aneurysm in small vessels is technically feasible and effective with a high rate of complete occlusion.•Complete occlusion rate of saccular aneurysms mostly located at artery bifurcations was lower than nonsaccular aneurysms.•FD treatment for these lesions had a relatively high rate of complications, but the long-term outcomes was satisfactory.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
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.
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.
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.
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.
•Flow diverters (FDs) can be safe and effective in treating blood blister–like aneurysms.•A single FD strategy may result in a higher rate of good outcomes compared with an overlapped FD strategy.•Treatment of blood blister–like aneurysm (BBA) should be considered on a case-by-case basis.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Stent-assisted coiling (SAC) of acutely ruptured aneurysms with antiplatelet therapy has been controversial. Tirofiban has been used for the treatment of thromboembolism of ruptured aneurysms with a ...stent. However, there are few comparative studies of a reasonable dosage for the prophylactic use of tirofiban. This study evaluated the safety and efficacy of reducing the dosage of tirofiban for the ruptured aneurysms with SAC. Patients with ruptured intracranial aneurysms in our institution from January 2014 to June 2018 were retrospectively reviewed. Three hundred and nine patients were treated using SAC within 72 h of onset. Patients were divided into either a standard group (211 patients, 10 μg/kg intravenous bolus within 3 min, maintained with 0.15 μg/kg/min) or a half-dose group (98 patients, 5 μg/kg intravenous bolus within 3 min, maintained with 0.075 μg/kg/min) according to the dose of tirofiban received intraoperatively. Medical records including clinical and radiological details were reviewed. No significant differences in demographic information or aneurysm characteristics existed between the two groups. Thromboembolic complications were found in 15 patients (4.9%), including 11 patients (5.2%) in the standard group and four patients (4.1%) in the half-dose group, without significant difference (
P
= 0.782). Intracranial hemorrhage was found in 13 patients (4.2%), and all occurred in the standard group, which was significantly different (6.2% vs 0%,
P
= 0.011). Of these 13 patients, four were left disabled and five died. Except for three patients who had intraoperative aneurysm rupture, the incidence of postoperative early rebleeding (10 patients) was significantly different between the two groups (4.7% vs 0%,
P
= 0.034). The rate of initial complete occlusion in the half-dose group was significantly higher than that in the standard group (55.1% vs 39.8%). The rate of a good outcome (modified Rankin Scale 0–2) was not significantly different between the standard group and half-dose group (78.7% vs 87.8%,
P
> 0.05). Intravenous tirofiban for SAC of acutely ruptured intracranial aneurysms is feasible and safe. The half-dose tirofiban treatment was associated with a decrease in the prevalence of intracranial hemorrhage but no increase in thromboembolic events compared with those in standard-dose tirofiban treatment.
Full text
Available for:
EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
The prevention of pneumonia is critical for patients with acute ischaemic stroke (AIS). The six subscales in the Braden Scale seem to be related to the occurrence of pneumonia. We aimed to evaluate ...the feasibility of using the Braden Scale to predict the occurrence of pneumonia after AIS.
We studied a series of consecutive patients with AIS who were admitted to the hospital. The cohort was subdivided into pneumonia and no pneumonia groups. The scores on the Braden Scale, demographic characteristics and clinical characteristics were obtained and analysed by statistical comparisons between the two groups. We investigated the predictive validity of the Braden Scale by receiver operating characteristic (ROC) curve analysis.
A total of 414 patients with AIS were included in this study. Of those 414 patients, 57 (13.8%) patients fulfilled the criteria for post-stroke pneumonia. There were significant differences in age and histories of chronic obstructive pulmonary disease (COPD), dysphagia and Glasgow Coma Scale (GCS) score between the two groups, and the National Institutes of Health Stroke Scale (NIHSS) score in the pneumonia group was significantly higher than that in the no pneumonia group (P < 0.01). The mean score on the Braden Scale in the pneumonia group was significantly lower than that in the no pneumonia group (P < 0.01). The six subscale scores on the Braden Scale were all significantly different between the two groups. The area under the curve (AUC) for the Braden Scale for the prediction of pneumonia after AIS was 0.883 (95% CI = 0.828-0.937). With 18 points as the cutoff point, the sensitivity was 83.2%, and the specificity was 84.2%.
The Braden Scale with 18 points as the cutoff point is likely a valid clinical grading scale for predicting pneumonia after AIS at presentation. Further studies on the association of the Braden Scale score with stroke outcomes are needed.
With the continuous development of aesthetic surgery, a large number of excellent publications have been reported on aesthetic surgery. However, no relevant studies have reported the latest ...advancements and hot trends in aesthetic surgery in recent years. In this study, we extracted relevant publications from four authoritative aesthetic surgery journals (
Plastic and Reconstructive Surgery
,
Aesthetic Surgery Journal
,
Aesthetic Plastic Surgery
, and
Journal of Cosmetic Dermatology
) and used bibliometrics to comprehensively analyze current hot trends. We found a significant increase in the number of quality studies in aesthetic surgery, and the USA was the leading country in the field of aesthetic surgery, as evidenced by the fact that it ranks first worldwide for the total number of publications and citations. Currently, the prevention and treatment of complications related to aesthetic surgery remain research hotspots. Meanwhile, androgenetic alopecia, hyperplastic scarring, and stem cell research are hot directions for future research, and more research is required for exploration.
Full text
Available for:
EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
In modern society, intracranial aneurysms have seriously affected people’s life. To better study and treat intracranial aneurysm, animal models are ideal candidates to perform biological research and ...preclinical endovascular device testing. Rabbit aneurysm model is one of the most commonly used animal models, and the rabbit aneurysms share similarities in histology, morphology, and hemodynamic aspects with human intracranial aneurysms, which is an ideal model for intracranial aneurysm pre-clinical and basic research. In this review, we will summarize the main methods of establishing rabbit aneurysms model and will further discuss the current biological mechanisms of intracranial aneurysms based on rabbit model. Further improvements of rabbit aneurysm model and more deep studies based on this model are needed to provide new insights into studying and clinical treating intracranial aneurysm.
To explore the construction and application in the practice of green channel in No. 971 Naval Hospital of PLA (No. 971 Hospital mode) for the treatment of acute ischemic stroke (AIS).
This ...retrospective study involved a cohort of 694 suspected stroke patients from December 2022 to November 2023 undergoing emergency treatment for stroke at our institution. Among them, 483 patients were treated with standard green channel (the control group), and 211 patients adopted the No. 971 Hospital mode for treatment (the study group). The biggest difference between the two groups was that the treatment process started before admission. We compared the effectiveness of the emergency treatment between the two groups and the thrombolysis treatment.
Compared with control group, the accuracy rate of determining stroke and the rate of thrombolysis were significantly higher (
= 0.002, 0.039) and the door to doctor arrival time (DAT) and the door to CT scan time (DCT) of the study group was significantly shorter (all
< 0.001). There were 49 patients (10.1%) and 33 patients (15.6%) from the control group and study group receiving thrombolysis, respectively. The DAT, DCT, imaging to needle time (INT), and door to needle time (DNT) of patients receiving thrombolysis in the study group were significantly shorter than that in the control group (all
< 0.01). The NIHSS in the study group after the thrombolysis was lower than that in the control group (
= 0.042).
No. 971 Hospital model can effectively shorten DAT, DCT, INT, and DNT, and improve the effectiveness of thrombolysis and prognoses of AIS patients.
Background and purpose
Treatment of blood blister-like aneurysms (BBAs) has been a significant challenge mainly due to their high recurrence rate even after stent-assisted coiling (SAC) embolization. ...This study aims to evaluate the safety and efficacy of treating recurrent BBAs after SAC with a flow diverter (FD).
Methods
A retrospective series of patients with recurrent BBAs who underwent the retreatment with the FD from June 2018 to December 2021 was included to analyze perioperative safety and immediate postoperative and follow-up outcomes.
Results
The study enrolled 13 patients with recurrent BBAs previously treated with SAC. Within previous stents, an FD was deployed for retreatment, including eight Tubridge FDs and five PEDs. The time interval between initial treatment and FD implantation was 14–90 days. A total of 11 cases were treated with a single FD alone; two cases were treated with further endovascular coiling embolization, followed by FD implantation. The angiographic follow-up (6–12 months) was available in 12 patients, and all 12 recurrent BBAs were completely occluded. No perioperative complication was detected, and no rebleeding was found during the clinical follow-up (6–36 months).
Conclusion
The use of the FD to manage recurrent BBAs after SAC is technically feasible, safe, and effective. The key to the success of the procedure is to ensure that the FD stent is fully open and has good apposition with the previously implanted stent.
A notable prevalence of subarachnoid hemorrhage is evident among patients with anterior choroidal artery aneurysms in clinical practice. To evaluate the risk of rupture in unruptured anterior ...choroidal artery aneurysms, we conducted a comprehensive analysis of risk factors and subsequently developed two nomograms.
A total of 120 cases of anterior choroidal artery aneurysms (66 unruptured and 54 ruptured) from 4 medical institutions were assessed utilizing computational fluid dynamics (CFD) and digital subtraction angiography (DSA). The training set, consisting of 98 aneurysms from 3 hospitals, was established, with an additional 22 cases from the fourth hospital forming the external validation set. Statistical differences between the two data sets were thoroughly compared. The significance of 9 clinical baseline characteristics, 11 aneurysm morphology parameters, and 4 hemodynamic parameters concerning aneurysm rupture was evaluated within the training set. Candidate selection for constructing the nomogram models involved regression analysis and variance inflation factors. Discrimination, calibration, and clinical utility of the models in both training and validation sets were assessed using area under curves (AUC), calibration plots, and decision curve analysis (DCA). The DeLong test, net reclassification index (NRI), and integrated discrimination improvement (IDI) were employed to compare the effectiveness of classification across models.
Two nomogram models were ultimately constructed: model 1, incorporating clinical, morphological, and hemodynamic parameters (C + M + H), and model 2, relying primarily on clinical and morphological parameters (C + M). Multivariate analysis identified smoking, size ratio (SR), normalized wall shear stress (NWSS), and average oscillatory shear index (OSI
) as optimal candidates for model development. In the training set, model 1 (C + M + H) achieved an AUC of 0.795 (95% CI: 0.706 ~ 0.884), demonstrating a sensitivity of 95.6% and a specificity of 54.7%. Model 2 (C + M) had an AUC of 0.706 (95% CI: 0.604 ~ 0.808), with corresponding sensitivity and specificity of 82.4 and 50.3%, respectively. Similarly, AUCs for models 1 and 2 in the external validation set were calculated to be 0.709 and 0.674, respectively. Calibration plots illustrated a consistent correlation between model evaluations and real-world observations in both sets. DCA demonstrated that the model incorporating hemodynamic parameters offered higher clinical benefits. In the training set, NRI (0.224,
= 0.007), IDI (0.585,
= 0.002), and DeLong test (change = 0.089,
= 0.008) were all significant. In the external validation set, NRI, IDI, and DeLong test statistics were 0.624 (
= 0.063), 0.572 (
= 0.044), and 0.035 (
= 0.047), respectively.
Multidimensional nomograms have the potential to enhance risk assessment and patient-specific treatment of anterior choroidal artery aneurysms. Validated by an external cohort, the model incorporating clinical, morphological, and hemodynamic features may provide improved classification of rupture states.
Background:
Diabetes mellitus (DM) is a metabolic disease that endangers human health, and its prevalence is exploding and younger. Stem cell-derived extracellular vesicles (SC-EVs) have a repair ...function similar to SCs and no risk of tumor formation, which have been widely used in the repair of DM and its complications. We aim to map the hot trends of SC-EVs for the treatment of DM and providing directions for future research.
Methods
We screened all relevant publications on SC-EVs for DM from the Web of Science (Wos) during 2017–2021, and research trends in this field were analyzed by VOSviewer and CiteSpace.
Results
A total of 255 articles related to SC-EVs for DM were screened out according to the search strategy. China (122 publications and 2,759 citations) was the most productive country, followed by the USA (50 publications and 1,167 citations) and Italy (16 publications and 366 citations). The top five institutions with the most publications were located in Italy and China, with Turin University being the most productive. The journals Stem Cell Research and Therapy and International Journal of Molecular Sciences published most of the studies on SC-EVs for DM. ASHOK KUMAR published the majority of articles in this field, while QING LI was the most cited. Cluster analysis indicated that the current research trend is more focused on the repair mechanism and clinical translation of exosomes and their related preparations in promoting DM and its complications.
Conclusion
In this study, a comprehensive summary and analysis of the global research trends of SC-EVs used in DM and its complications was performed. In the past 5 years, relevant high-quality publications in this field have increased significantly, and SC-EVs have a good prospect for development in the treatment of DM and its complications.
PDF
