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Yu Z, Qi J, Wang L, Yang X, Liu Z, Chen X, Xu H, Li Y, Chen Y, Dai C, Gu Z. Managing intraoperative rupture of internal carotid pseudoaneurysms during endoscopic transnasal optic canal decompression: a case report. Front Neurol 2024; 15:1382793. [PMID: 38962479 PMCID: PMC11220115 DOI: 10.3389/fneur.2024.1382793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/10/2024] [Indexed: 07/05/2024] Open
Abstract
Background Endoscopic transnasal optic canal decompression is widely used in the treatment of traumatic optic neuropathy (TON) following head and craniofacial trauma. Intraoperative hemorrhage is a catastrophic surgical complication during optic canal decompression. Case description We present two cases of patients with TON who suffered unexpected intra-operative massive bleeding during endoscopic transnasal optic canal decompression. After intraoperative hemostasis was achieved, emergent cerebral angiograms demonstrated the formation of internal carotid pseudoaneurysms, which were immediately embolized with coils combined with or without Onyx with balloon assistance. One of these cases was also complicated by a postoperative cerebrospinal fluid leak, which failed to be treated with lumbar drainage but was successfully repaired with endoscopic transnasal surgery. Conclusion The intra-operative rupture of ICA pseudoaneurysm is a rare but catastrophic complication in TON patients. Intraoperative massive bleeding indicates rupture of ICA pseudoaneurysm. Postoperative emergency angiography and endovascular therapy should be arranged to evaluate and repair the cerebral vascular injury. Endoscopic trans-nasal surgery repairing CSF leaks resistant to lumbar drainage could be efficient and safe following pseudoaneurysm embolization.
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Affiliation(s)
- Zeran Yu
- Department of Neurosurgery, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
- Department of Neurosurgery, Beijing Tiantan Hospital Yunnan, Kunming, China
- The Center of Stroke, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Junhui Qi
- Department of Neurosurgery, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
- Department of Neurosurgery, Beijing Tiantan Hospital Yunnan, Kunming, China
- The Center of Stroke, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
| | - Lei Wang
- Department of Neurosurgery, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
- Department of Neurosurgery, Beijing Tiantan Hospital Yunnan, Kunming, China
- The Center of Stroke, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
| | - Xiang Yang
- Department of Obstetrics, The First People’s Hospital of Yunnan, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Zhengqiao Liu
- Department of Neurosurgery, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
- Department of Neurosurgery, Beijing Tiantan Hospital Yunnan, Kunming, China
- The Center of Stroke, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
| | - Xu Chen
- Department of Neurosurgery, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
- Department of Neurosurgery, Beijing Tiantan Hospital Yunnan, Kunming, China
- The Center of Stroke, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
| | - Hongling Xu
- Department of Neurosurgery, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
- Department of Neurosurgery, Beijing Tiantan Hospital Yunnan, Kunming, China
- The Center of Stroke, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
| | - Yajie Li
- Department of Neurosurgery, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
- Department of Neurosurgery, Beijing Tiantan Hospital Yunnan, Kunming, China
- The Center of Stroke, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
| | - Yuyun Chen
- Department of Neurosurgery, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
- Department of Neurosurgery, Beijing Tiantan Hospital Yunnan, Kunming, China
- The Center of Stroke, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
| | - Chengguo Dai
- Department of Neurosurgery, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
- Department of Neurosurgery, Beijing Tiantan Hospital Yunnan, Kunming, China
- The Center of Stroke, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
| | - Zhen Gu
- Department of Neurosurgery, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
- Department of Neurosurgery, Beijing Tiantan Hospital Yunnan, Kunming, China
- The Center of Stroke, The Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan, Kunming, China
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Zheng F, Qiao X. Bilateral extracranial internal carotid artery pseudoaneurysm: A case report. Asian J Surg 2024:S1015-9584(24)01107-2. [PMID: 38834456 DOI: 10.1016/j.asjsur.2024.05.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 05/23/2024] [Indexed: 06/06/2024] Open
Affiliation(s)
- Fuhao Zheng
- Department of Neurointervention, Weihai Central Hospital Affiliated to Qingdao University, Weihai, China
| | - Xiaohong Qiao
- Department of Neurology, Weihai Central Hospital Affiliated to Qingdao University, Weihai, China.
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Zhou B, Hua Z, Li C, Jiao Z, Cao H, Xu P, Liu S, Li Z. Classification and management strategy of spontaneous carotid artery dissection. J Vasc Surg 2024:S0741-5214(24)01210-2. [PMID: 38777158 DOI: 10.1016/j.jvs.2024.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/02/2024] [Accepted: 05/12/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE Spontaneous carotid artery dissections (sCADs) are the common cause of stroke in middle-aged and young people. There is still a lack of clinical classification to guide the management of sCAD. We reviewed our experience with 179 patients with sCAD and proposed a new classification for sCAD with prognostic and therapeutic significance. METHODS This is a retrospective review of prospectively collected data from June 2018 to June 2023 of patients with sCAD treated at a large tertiary academic institution in an urban city in China. Based on imaging results, we categorize sCAD into four types: type Ⅰ, intramural hematoma or dissection with <70% luminal narrowing; type Ⅱ, intramural hematoma or dissection with ≥70% luminal narrowing; type Ⅲ, dissecting aneurysm; type ⅣA, extracranial carotid artery occlusion; and type ⅣB, tandem occlusion. We compared the clinical data and prognostic outcomes among various types of sCADs. RESULTS A total of 179 patients and 197 dissected arteries met the inclusion criteria. The mean age of the 179 patients with sCAD was 49.5 years, 78% were male, and 18 patients (10%) had bilateral sCAD. According to our classification, there were 56 type Ⅰ (28.4%), 50 type Ⅱ (25.4%), 60 type Ⅲ (30.5%), and 31 type Ⅳ (15.7%) dissections. During a mean hospitalization length of 11.4 ± 47.0 days, there were nine recurrent strokes (4.6%) after medical treatment, two type Ⅲ dissections (1.0%), seven type Ⅳ dissections (3.6%), all ipsilateral, and one death. Overall, there were seven (3.6%, 1 type Ⅰ dissection, 3 type Ⅱ dissections, 2 type Ⅲ dissections, and 1 type Ⅳ dissection) recurrent strokes and three (1.5%, all type Ⅲ dissections) recurrent transient ischemic attacks in patients treated with just medical therapy during the follow-up period, all ipsilateral, with a mean follow-up of 26 months (range, 3-59 months). These patients did not undergo further intervention due to the high difficulty associated with endovascular treatment (EVT) or the mild nature of recurrent cerebral ischemic symptoms. Twenty-nine type I dissections (51.8%) were completely recanalized after antithrombotic therapy. A total of 19 type II dissections (38%) and 44 type III dissections (73%) received EVT for persistent flow-limited dissections, enlargement of dissecting aneurysms, or aggravation of neurological symptoms despite antithrombotic therapy. Type Ⅳ dissections are more likely to lead to the occurrence of ischemic stroke and presented with more severe symptoms. Eight type IVB dissections (33%) received acute phase intervention due to distal thromboembolism or aggravation of neurological symptoms after medical treatment. In terms of cerebral ischemic events and mortality, there were no statistically significant differences among the four types of sCAD (all P > .05). Favorable outcome was achieved in 168 patients (93.9%). CONCLUSIONS This study proposed a novel and more comprehensive classification method and the modern management strategy for sCAD. Antithrombotic therapy is beneficial to reduce the risk of recurrent stroke for stable sCAD. Non-emergent EVT can be an alternative therapeutic approach for patients who meet indications as in type II to IVA dissections. Urgent procedure with neurovascular intervention is necessary for some type IVB dissections. The short-term results of EVT for sCAD are encouraging, and long-term device-related and functional outcomes should undergo further research.
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Affiliation(s)
- Baoning Zhou
- Department of Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhaohui Hua
- Department of Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | | | - Zhouyang Jiao
- Department of Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hui Cao
- Department of Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Peng Xu
- Department of Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shirui Liu
- Department of Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhen Li
- Department of Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Dong L, Liu Q, Chen X, Zhang L, Wang J, Peng Q, Li J, He H, Liu P, Lv M. Methylprednisolone is related to lower incidence of postoperative bleeding after flow diverter treatment for unruptured intracranial aneurysm. Front Aging Neurosci 2023; 15:1029515. [PMID: 37143689 PMCID: PMC10151685 DOI: 10.3389/fnagi.2023.1029515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 03/29/2023] [Indexed: 05/06/2023] Open
Abstract
Background and objectives Regarding the anti-inflammatory effect, methylprednisolone is a candidate to prevent patients with unruptured intracranial aneurysms (UIAs) from postoperative bleeding (PB) after flow diverter (FD) treatment. This study aimed to investigate whether methylprednisolone is related to a lower incidence of PB after FD treatment for UIAs. Methods This study retrospectively reviewed UIA patients receiving FD treatment between October 2015 and July 2021. All patients were observed until 72 h after FD treatment. The patients receiving methylprednisolone (80 mg, bid, for at least 24 h) were considered as standard methylprednisolone treatment (SMT) users, otherwise as non-SMT users. The primary endpoint indicated the occurrence of PB, including subarachnoid hemorrhage, intracerebral hemorrhage, and ventricular bleeding, within 72 h after FD treatment. This study compared the incidence of PB between SMT users and non-SMT users and investigated the protective effect of SMT on PB after FD treatment using the Cox regression model. Finally, after controlling the potential factors related to PB, we performed subgroup analysis to further confirm the protective effect of SMT on PB. Results This study finally included 262 UIA patients receiving FD treatment. PB occurred in 11 patients (4.2%), and 116 patients (44.3%) received SMT postoperatively. The median time from the end of surgery to PB was 12.3 h (range: 0.5-48.0 h). SMT users had a lower incidence of PB comparing with non-SMT users (1/116, 0.9% vs. 10/146, 6.8%, respectively; p = 0.017). The multivariate Cox analysis demonstrated that SMT users (HR, 0.12 [95%CI, 0.02-0.94], p = 0.044) had a lower risk of PB postoperatively. After controlling the potential factors related to PB (i.e., gender, irregular shape, surgical methods [FD and FD + coil] and UIA sizes), the patients receiving SMT still had a lower cumulative incidence of PB, comparing with patients receiving non-SMT (all p < 0.05). Conclusion SMT was correlated with the lower incidence of PB for patients receiving FD treatment and may be a potential method to prevent PB after the FD treatment.
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Affiliation(s)
- Linggen Dong
- Department of Neurosurgery Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Qingyuan Liu
- Department of Neurosurgery Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiheng Chen
- Department of Neurosurgery Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Longhui Zhang
- Department of Neurosurgery Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Jiejun Wang
- Department of Emergency, The Affiliated Wuxi No. 2 People’s Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Qichen Peng
- Department of Neurosurgery Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Jiangan Li
- Department of Emergency, The Affiliated Wuxi No. 2 People’s Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Hongwei He
- Department of Neurosurgery Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Peng Liu
- Department of Neurosurgery Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Peng Liu,
| | - Ming Lv
- Department of Neurosurgery Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- *Correspondence: Ming Lv,
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Flow diversion device for the management of an extracranial internal carotid artery aneurysm. J Vasc Surg Cases Innov Tech 2022; 8:75-76. [PMID: 35128219 PMCID: PMC8799991 DOI: 10.1016/j.jvscit.2021.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/18/2021] [Indexed: 11/24/2022] Open
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Liu C, Shen Y, Qian K, Hu Y, Hu X, Wu X. Application of covered stent graft in the treatment of complex carotid artery lesions: A single center experience. Vascular 2021; 30:1034-1043. [PMID: 34459287 DOI: 10.1177/17085381211040991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess the clinical efficiency and imaging outcome of applying covered stent grafts for the treatment of complex carotid artery lesions. METHOD A total of 39 consecutive patients with carotid artery lesions treated with covered stent grafts at our institution from December 2016 to December 2019 were reviewed. Two kinds of stent including self-expandable covered stent (Viabahn; W. L. Gore & Associates) and balloon-expandable covered stent (Willis; Microport) were applied. The angiograms immediately after the procedure, perioperative complications, and follow-up outcomes were recorded. RESULT Based on imaging features, 11 patients exhibited pseudoaneurysms, 23 patients had blood blister-like aneurysms (BBAs), and five patients were carotid cavernous fistulas. A total of 40 stent implantations were performed, including nine Viabahn stents and 31 Willis stents. Two patients received double implants of Willis stents. Stent failed to perform for one patient due to tortuous parent artery. The angiography reports immediately after the procedure showed that the lesions in 36 patients were completely occluded, whereas two patients had minimal endoleaks. With respect to the occurrence of procedural complications, an aneurysm ruptured during the procedure in one case, which resulted in CCF, and acute in-stent thrombosis occurred in another case. Clinical and angiographic follow-up (11.2±2.4 months) sessions were conducted for 38 patients and a complete lesion exclusion was achieved in 36 patients. The minimal endoleak persisted in one patient and another patient experienced recurrence with stent migration, leading to ipsilateral blepharoptosis. However, none of the patients developed hemorrhage or ischemia and in-stent stenosis was not observed. CONCLUSION Covered stent grafts appear to be a safe and feasible for the treatment of complex carotid artery lesions. Despite the potential for stent delivery failure as well as endoleak and procedure-related complications, covered stent grafts should be considered when selecting the optimal treatment strategy.
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Affiliation(s)
- Changya Liu
- Department of Neurology, 575473Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, Hubei, China.,Hubei Province Academy of Traditional Chinese Medicine, Wuhan, Hubei, China
| | - Yin Shen
- Department of Neurosurgery, Union Hospital, Tongji Medical College, 36630Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Kang Qian
- Department of Neurosurgery, Union Hospital, Tongji Medical College, 36630Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yueyun Hu
- Department of Neurosurgery, Union Hospital, Tongji Medical College, 36630Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xuebin Hu
- Department of Neurosurgery, Union Hospital, Tongji Medical College, 36630Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xinxin Wu
- 66322LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Kang H, Luo B, Liu J, Zhang H, Li T, Song D, Zhao Y, Guan S, Maimaitili A, Wang Y, Feng W, Wang Y, Wan J, Mao G, Shi H, Wang K, Yang X. Mortality after treatment of intracranial aneurysms with the Pipeline Embolization Device. J Neurointerv Surg 2021; 14:neurintsurg-2020-017002. [PMID: 33627503 DOI: 10.1136/neurintsurg-2020-017002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/12/2021] [Accepted: 01/22/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The Pipeline Embolization Device (PED) is reported to be a safe treatment tool for aneurysms. However, mortality occurs in a few cases, and this has not been clearly studied. We conducted a multicenter study to retrospectively evaluate the causes of, and risk factors for, mortality in patients with intracranial aneurysms treated with the PED. METHODS We retrospectively reviewed the prospectively maintained databases of patients with intracranial aneurysms treated by PED placement at 14 academic institutions from 2014 to 2019. Patients' data, including clinical and radiographic information, were analyzed with an emphasis on mortality-related complications. RESULTS A total of 1171 consecutive patients underwent 1319 PED procedures to treat 1322 intracranial aneurysms. The mortality rate was 1.5% (17/1171), and in 1.3% of the patients (15/1171), deaths were caused by delayed aneurysmal rupture, distal intraparenchymal hemorrhage, and neurological compression symptoms associated with PED procedures. Multivariate analysis showed that previous treatment (OR, 12.657; 95% CI, 3.189 to 50.227; P<0.0001), aneurysm size ≥10 mm (OR, 4.704; 95% CI, 1.297 to 17.068; P=0.019), aneurysm location (basilar artery) (OR, 10.734; 95% CI, 2.730 to 42.207; P=0.001), and current subarachnoid hemorrhage (OR, 4.505; 95% CI, 0.991 to 20.474; P=0.051) were associated with neurological complications resulting in mortality. CONCLUSIONS Delayed aneurysm rupture, distal intraparenchymal hemorrhage, and neurological compression were the main causes of mortality in patients with intracranial aneurysms treated with the PED. Large basilar aneurysms are associated with an increased risk of postoperative death and require increased attention and caution.
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Affiliation(s)
- Huibin Kang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bin Luo
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jianmin Liu
- Changhai Hospital Affiliated to Naval Medical University, Shanghai, China
| | - Hongqi Zhang
- Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tianxiao Li
- Zhengzhou University People's Hospital, Zhengzhou, China
| | - Donglei Song
- Shanghai Donglei Brain Hospital, Shanghai, China
| | - Yuanli Zhao
- Peking University International Hospital, Beijing, China
| | - Sheng Guan
- First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Aisha Maimaitili
- First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Yunyan Wang
- Qilu Hospital of Shandong University, Jinan, China
| | - Wenfeng Feng
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yang Wang
- First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jieqing Wan
- Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Guohua Mao
- Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Huaizhang Shi
- First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Kun Wang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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