Background: Several pharmacological pathways have revealed statin to have a positive role in patients with for intracranial aneurysms. However, prior studies regarding the association between statin use and patients’ outcomes after pipeline embolization device (PED) treatment were not completely supportive. Objectives: To investigate whether statin medication following PED treatment would improve the outcomes of intracranial aneurysm patients in a real-world setting. Design: A retrospective multicenter cohort study. Methods: Patients were selected from the PLUS registry study conducted from November 2014 to October 2019 across 14 centers in China. The population was divided into two groups: those who received statin medication after the PED treatment and those who did not receive statin medication after PED treatment. Study outcomes included angiographic evaluation of aneurysm occlusion, parent arteries stenosis, ischemic and hemorrhage complications, all-cause mortality, neurologic mortality, and functional outcome. Results: 1087 patients with 1168 intracranial aneurysms were eligible; 232 patients were in the statin user group and the other 855 were in the non-statin user group. For the statin user group versus the non-statin user group, no significant difference was found for the primary outcomes of complete occlusion of aneurysm (82.4% versus 84.2%; p = 0.697). Of the secondary outcomes, none had a significant difference including stenosis of parent arteries ≥ 50% (1.4% versus 2.3%; p = 0.739), total subarachnoid hemorrhage (0.9% versus 2.5%; p = 0.215), all-cause mortality (0.0% versus 1.9%; p = 0.204), neurologic mortality (0.0% versus 1.6%; p = 0.280), excellent (95.5% versus 97.2%; p = 0.877), and favorable (98.9% versus 98.4%; p = 0.933) functional outcomes. The total ischemic complication rate (9.0% versus 7.1%; p = 0.401) was higher but not significant in the statin user group. The propensity score-matched cohort showed similar results. Results of binary multivariable logistic regression analysis and propensity score-matched analysis both showed that statin usage was not independently associated with an increased rate of complete occlusion or any other secondary outcomes. Subgroup analysis found the same result in patients who did not use statin before the procedure. Conclusion: Among patients with intracranial aneurysms, statin use after the PED treatment was not significantly associated with better angiographic and clinical outcomes. Well-designed studies are needed to further confirm this finding.
Objectives To compare the diagnostic value of transcranial color‐coded real‐time sonography and contrast‐enhanced color‐coded sonography in detection and characterization of intracranial arteriovenous malformations. Methods Thirty‐one patients highly suspected to have an intracranial arteriovenous malformation were imaged with real‐time and contrast‐enhanced sonography. With digital subtraction angiography as the reference standard, the ability to detect the malformations and accurately determine their size and location was compared between the two imaging techniques. Results One cavernous hemangioma and 30 intracranial arteriovenous malformations were imaged with real‐time and contrast‐enhanced sonography, which were confirmed by angiography. The detectability of contrast‐enhanced sonography, especially for optimizing visualization of malformations located in the frontal, parietal, and occipital lobes, was higher than that of real‐time sonography, although the overall number of malformations was too small to demonstrate significance. The sizes of the malformations (6 in the frontal lobe, 1 in the parietal lobe, and 1 in the occipital lobe) were underestimated by real‐time sonography compared to angiography, whereas there was agreement in the sizes between contrast‐enhanced sonography and angiography. The detection rates for the 30 arteriovenous malformations on contrast‐enhanced and real‐time sonography were 96.7% (29 of 30) and 70.0% (21 of 30), respectively ( P = .008). Moreover, contrast‐enhanced sonography was significantly superior to real‐time sonography for detection of feeding arteries (59.5% [22 of 37] versus 83.7% [31 of 37]; P = .004). Although the feeding arteries showed increased peak systolic and end‐diastolic velocities after contrast agent injection, there were no statistically significant differences in the velocities before and after injection. Conclusions Transcranial contrast‐enhanced color‐coded sonography is superior to color‐coded real‐time sonography for detection of intracranial arteriovenous malformations, particularly for lesions located in the frontal, parietal, and occipital lobes of the brain.
In this study, we determined the expression levels of matrix metalloproteinase-2 and -9 and matrix metalloproteinase tissue inhibitor-1 and -2 in brain tissues and blood plasma of patients undergoing surgery for cerebellar arteriovenous malformations or primary epilepsy (control group). Immunohistochemistry and enzyme-linked immunosorbent assay revealed that the expression of matrix metalloproteinase-9 and matrix metalloproteinase tissue inhibitor-1 was significantly higher in patients with cerebellar arteriovenous malformations than in patients with primary epilepsy. The ratio of matrix metalloproteinase-9 to matrix metalloproteinase tissue inhibitor-1 was significantly higher in patients with hemorrhagic cerebellar arteriovenous malformations compared with those with non-hemorrhagic malformations. Matrix metalloproteinase-2 and matrix metalloproteinase tissue inhibitor-2 levels were not significantly changed. These findings indicate that an imbalance of matrix metalloproteinase-9 and matrix metalloproteinase tissue inhibitor-1, resulting in a relative overabundance of matrix metalloproteinase-9, might be the underlying mechanism of hemorrhage of cerebellar arteriovenous malformations.
Object: Patients with aneurysmal subarachnoid hemorrhage (aSAH) have an increased incidence of cardiac events and short-term unfavorable neurological outcomes during the acute phase of bleeding. We studied whether troponin I elevation after ictus can predict future major adverse cardiac events (MACEs) and long-term neurological outcomes after 2 years. Methods: Consecutive aSAH patients within 3 days of bleeding were eligible for review from a prospective observational cohort ( ClinicalTrials.gov Identifier: NCT04785976). Potential predictors of future MACEs and unfavorable long-term neurological outcomes were calculated by Cox and logistic regression analyses. Additional Kaplan–Meier curves were performed. Results: A total of 213 patients were enrolled with an average follow-up duration of 34.3 months. Individuals were divided into two groups: elevated cTnI group and unelevated cTnI group. By the last available follow-up, 20 patients had died, with an overall all-cause mortality rate of 9.4% and an annual all-cause mortality rate of 3.8%. Patients with elevated cTnI had a significantly higher risk of future MACEs (10.6 vs. 2.1%, p = 0.024, and 95% CI: 1.256–23.875) and unfavorable neurological outcomes at discharge, 3-month, 1-, 2-years, and last follow-up ( p = 0.001, p < 0.001, p = 0.001, p < 0.001, and p < 0.001, respectively). In the Cox analysis for future MACE, elevated cTnI was the only independent predictor (HR = 5.980; 95% CI: 1.428–25.407, and p = 0.014). In the multivariable logistic analysis for unfavorable neurological outcomes, peak cTnI was significant (OR = 2.951; 95% CI: 1.376–6.323; p = 0.005). Kaplan–Meier analysis indicated that the elevated cTnI was correlated with future MACE (log-rank test, p = 0.007) and subsequent death (log-rank test, p = 0.004). Conclusion: cTnI elevation after aSAH could predict future MACEs and unfavorable neurological outcomes.
Abstract Background and objectiveOptic nerve sheath diameter (ONSD) and ONSD/ eyeball transverse diameter (ETD) ratio have been proved to be related to intracranial pressure. This study aimed to evaluate ONSD and ONSD/ETD ratio in comatose patients with supratentorial lesions and determine the relationship of these two indexes with the prognosis of these patients.MethodsA total of 54 comatose patients with supratentorial lesion and 50 cases of normal controls were retrospectively included in this study. ONSD and ETD was messured on un-enhanced computed tomography(CT). The difference of ONSD, ONSD/ETD ratio between the two groups was compared. The prognosis of comatose patients were scored unsing Glasgow outcome scale (COS) at 3-month follow-up and classified into good (score ≥ 3) and poor (score < 3) prognosis. The differences of ONSD and ONSD/ETD ratio between good and poor prognosis of comatose patients were compared statistically.ResultONSD and ONSD / EDT in the comatose group were 6.30 ± 0.60 mm and 0.27 ± 0.03, respectively, both were significantly greater than that in normal controls (5.10 ± 0.47 mm, t = 11.426, P < 0.0001 ; 0.22 ± 0.02, t = 11.468, P < 0.0001 ; respectively). ONSD in poor prognosis was siginificantly greater than that in good prognosis (6.40 ± 0.56 mm vs. 6.03 ± 0.61 mm, t = 2.197, P = 0.032). ONSD / EDT raito in poor grognosis was significantly higher than that in good gronosis (0.28 ± 0.02 vs 0.26 ± 0.03, t = 2.622, P = 0.011). The area under the responder operating charateristic curve to predict prognosis of comatose patients were 0.650 ( 95% CI : 0.486–0.815, P = 0.078) for ONSD and 0.711( 95% CI : 0.548–0.874, P = 0.014) for ONSD/ETD ratio, respectively.ConclusionsONSD and ONSD / EDT raito increased in comatose patients. ONSD / EDT raito may be more valuable than ONSD in evaluation for prognosis of comatose patients with Supratentorial lesions.
Abstract Objective Our study aims to investigate the association between the Hounsfield unit (Hu) value of the insular cortex (IC) during emergency admission and the subsequent occurrence of post‐operative neurocardiogenic injury (NCI) among patients afflicted with aneurysmal subarachnoid hemorrhage (aSAH). Methods Patients baseline characteristics were juxtaposed between those with and without NCI. The significant variables were incorporated into a multivariable stepwise logistic regression model. Receiver operating characteristic (ROC) curves were drafted for each significant variable, yielding cutoff values and the area under the curve (AUC). Subgroup and sensitivity analyses were performed to assess the predictive performance across various cohorts and ascertain result stability. Propensity score matching (PSM) was ultimately employed to redress any baseline characteristic disparities. Results Patients displaying a right IC Hu value surpassing 28.65 exhibited an escalated risk of postoperative NCI upon confounder adjustment ( p < 0.001). The ROC curve eloquently manifested the predictive capacity of right IC Hu in relation to NCI (AUC = 0.650, 95%CI, 0.591–0.709, p < 0.001). Further subgroup analysis revealed significant interactions between right IC Hu and factors such as age, history of heart disease, and Graeb 5–12 score. Sensitivity analysis further upheld the results' significant ( p = 0.002). The discrepancy in NCI incidence between the two groups, both prior ( p < 0.002) and post ( p = 0.039) PSM, exhibited statistical significance. After PSM implementation, the likelihood of NCI displayed an ascending trend with increasing right IC Hu values, from the Hu 1 cohort onward, receding post the Hu 4 cohort. Conclusion This study definitively establishes an elevated right IC Hu value in the early stages of emergency admission as an autonomous predictor for ensuing NCI subsequent to aSAH.
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