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      Endovascular treatment of middle cerebral artery aneurysm with a (LVIS) device: Comparison of LVIS stent and non-LVIS stent

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          Abstract

          Middle cerebral artery (MCA) aneurysm is a serious medical condition mainly occurring in the proximal and bifurcation tracts. Evidence has indicated that endovascular treatment is an effective surgical method for patients with MCA aneurysm. In the present study, the efficacy of endovascular treatment with low-profile visualized intraluminal support (LVIS) stent for MCA aneurysms was evaluated in comparison with that using a non-LVIS stent device. A total of 92 patients who underwent endovascular treatment of MCA aneurysms with LVIS stent or non-LVIS stent were included in the present study. The clinical presentation, aneurysmal characteristics, technical feasibility, procedural complications, as well as angiographic and clinical follow-up results were analyzed. The computed tomography scan demonstrated that endovascular treatment with LVIS stent markedly reduced pre-operative and intra-operative ruptures. It was indicated that endovascular treatment with LVIS stent resulted in less post-operative symptoms and cases of disability according to the modified Rankin scale score. In conclusion, the present outcomes provide evidence that endovascular treatment with an LVIS stent is an efficient method for the treatment of MCA aneurysm.

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          Flow diverter effect of LVIS stent on cerebral aneurysm hemodynamics: a comparison with Enterprise stents and the Pipeline device

          Background The aim of this study was to quantify the effect of the new Low-profile Visualized Intraluminal Support (LVIS®D) device and the difference of fluid diverting effect compared with the Pipeline device and the Enterprise stent using computational fluid dynamics (CFD). Methods In this research, we simulated three aneurysms constructed from 3D digital subtraction angiography (DSA). The Enterprise, LVIS and the Pipeline device were virtually conformed to fit into the vessel lumen and placed across the aneurysm orifice. Computational fluid dynamics analysis was performed to compare the hemodynamic differences such as WSS, Velocity and Pressure among these stents. Results Control referred to the unstented model, the percentage of hemodynamic changes were all compared to Control. A single LVIS stent caused more wall shear stress reduction than double Enterprise stents (39.96 vs. 30.51 %) and velocity (23.13 vs. 18.64 %). Significant reduction in wall shear stress (63.88 %) and velocity (46.05 %) was observed in the double-LVIS stents. A single Pipeline showed less reduction in WSS (51.08 %) and velocity (37.87 %) compared with double-LVIS stent. The double-Pipeline stents resulted in the most reduction in WSS (72.37 %) and velocity (54.26 %). Moreover, the pressure increased with minuscule extent after stenting, compared with the unstented model. Conclusions This is the first study analyzing flow modifications associated with LVIS stents. We found that the LVIS stent has certain hemodynamic effects on cerebral aneurysms: a single LVIS stent caused more flow reductions than the double-Enterprise stent but less than a Pipeline device. Nevertheless, the double-LVIS stent resulted in a better flow diverting effect than a Pipeline device.
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            Association of intracranial aneurysm rupture with smoking duration, intensity, and cessation.

            Although smoking is a known risk factor for intracranial aneurysm (IA) rupture, the exact relationship between IA rupture and smoking intensity and duration, as well as duration of smoking cessation, remains unknown.
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              Simple and reliable determination of the modified rankin scale score in neurosurgical and neurological patients: the mRS-9Q.

              The modified Rankin Scale (mRS) is a 6-level outcome scale used to assess level of function in neurological disease. We examined the interobserver reliability and intraobserver reliability of the mRS-9Q, a 9-question "yes/no" survey that measures the mRS score in neurosurgical and neurological patients. The mRS-9Q was administered in person or by telephone, and a Web-based tool was used to calculate the mRS score and to perform error checking. Part 1 compared the mRS-9Q with an mRS structured interview (n = 80). Part 2 compared mRS-9Q administration by telephone and by hard copy (n = 80). Part 3 compared mRS-9Q administration by an expert interviewer with administration by a nonexpert (n = 83). Part 4 examined reproducibility of the mRS-9Q over a 2-week period (n = 84). Agreement was very good in all study parts. In Part 1 (mRS-9Q vs mRS with structured interview), κ = 0.80 and κw = 0.96. In Part 2 (mRS-9Q telephone vs hard copy), κ = 0.83 and κw = 0.95. In Part 3 (mRS-9Q expert vs nonexpert), κ = 0.73 and κw = 0.93. In Part 4 (mRS-9Q reproducibility), κ = 0.76 and κw = 0.93. The mRS-9Q is a simple, easy-to-administer survey with a custom Web-based mRS calculation and error-checking tool. The mRS-9Q can reliably determine the mRS by hard copy survey or by telephone and can be administered by experts or nonmedical study personnel. The mRS-9Q can be used to measure functional outcome in a broad population of patients with neurosurgical and neurological diseases.
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                Author and article information

                Journal
                Exp Ther Med
                Exp Ther Med
                ETM
                Experimental and Therapeutic Medicine
                D.A. Spandidos
                1792-0981
                1792-1015
                March 2019
                28 December 2018
                28 December 2018
                : 17
                : 3
                : 1656-1662
                Affiliations
                [1 ]Department of Neurosurgery, Ningbo Second Hospital, Ningbo, Zhejiang 315312, P.R. China
                [2 ]Department of Ophthalmology and Otorhinolaryngology, Ningbo Yinzhou Second Hospital, Ningbo, Zhejiang 315040, P.R. China
                Author notes
                Correspondence to: Professor Feiyu Chen, Department of Neurosurgery, Ningbo Second Hospital, 41 Xibei Street, Ningbo, Zhejiang 315312, P.R. China, E-mail: chenfeiyuprof@ 123456outlook.com
                Article
                ETM-0-0-7139
                10.3892/etm.2018.7139
                6364188
                30783434
                dcca561e-3cbd-4e7c-9d49-44bff38cd6db
                Copyright: © Chen et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

                History
                : 07 November 2017
                : 06 June 2018
                Categories
                Articles

                Medicine
                middle cerebral artery,low-profile visualized intraluminal support stent,endovascular treatment

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