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To evaluate the safety and efficacy of mechanical thrombectomy with stent-retriver for anterior circulation small vessel occlusion in patients with acute ischemic stroke (AIS).Methods:From a prospectively collected thrombectomy database of consecutive patients with AIS between January 2017 and November 2018, 311 angiographic images were analyzed to assess small vessel occlusions (A 2 and M 2 segments). Patients were categorized into alteplase with thrombectomy group and thrombectomy alone group. The primary outcome was a favorable outcome (modified Rankin Scale scores 0-2) at 90 days. Secondary outcomes were successful recanalization (modified thrombolysis in cerebral infarction 2b or 3), symptomatic intracranial hemorrhage, and 90-day mortality. Results:Small vessel occlusions were identified in 19 patients, including 14 M 2occlusions, two A 2occlusions, and three M 2+A 2 occlusions. Six patients were in the alteplase with thrombectomy group and 13 patients in the thrombectomy alone group. Favorable outcome was achieved in eight of 19 patients at 90 days. Successful recanalization was achieved in 18 patients (18/19), symptomatic intracranial hemorrhage was observed in one patient (1/19), and death was recorded in five patients (5/19). No statistically significant difference was detected between the two groups with regard to successful recanalization (6/6 in the alteplase with thrombectomy group vs 12/13 in the thrombectomy alone group), symptomatic intracranial hemorrhage (0/6 vs 1/13), favorable outcome (2/6 vs 6/13) and death (1/6 vs 4/13; all P>0.05). Conclusion:As to anterior circulation small vessel occlusions, the combination-therapy within 4.5 hours or mechanical thrombectomy alone in extended time window with perfusion evaluation may be both safe and effective.
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Objective To establish an easily reproducible rabbit model of acute pulmonary embolism (APE) with right ventricular dysfunction (RVD).Methods Two gelfoam strips (5 rnm×5 mm× 10 mm) were squeezed and were introduced into the pulmonary arteries of each healthy rabbit (n=12).Pulmonary and systemic hemodynamic function were recorded.All rabbits underwent CT pulmonary angiography (CTPA) and pathological examination after the introduction of APE.Results All gelfoam strips located in the bilateral lower lobe arteries.Compared with baseline mean pulmonary artery pressure (mPAP) ([9.75±1.75] mmHg),mPAP increased to (20.58 ± 5.86) mmHg immediately after embolism (P ＜ 0.001),and then decreased to (18.78 ±4.80) mmHg 1 h after embolism (P＜0.001).Right ventricle/left ventricle diameter ratio (RV/LV) increased from baseline (0.67±0.09) to (1.90±0.28) 45 min after embolism (P＜0.001).Conclusion An easily reproducible rabbit model of APE with RVD are established and may be suitable for study of APE pathophysiology.
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Objective The goal of this study is to compare the prognosis of recombinant tissue plasminogen activator (rt-PA) thrombolysis for middle cerebral artery (MCA) occlusion with patients with good and poor cerebral collateral circulation.Methods This retrospective study included 49 patients diagnosed with acute MCA occlusion and treated with rt-PA in the First Affiliated Hospital of Nanjing Medical University between October 1,2014 and February 1,2016.Patients were divided into good collaterals group (n =31) and poor collaterals group (n =18) according to their distribution of leptomeningeal arteries with CTA.Thirty day mortality rate,the incidence of symptomatic intracranial hemorrhage,24h and 30 day Stroke scores with National Institute of Health Stroke Scale (NIHSS) were compared between the two groups.Corrected chi-squared test,Fisher's exact test,or t test was used to statistical analysis as appropriate.Results The 30 day mortality rate of good collaterals group was significantly lower than that of poor collaterals group (0％ vs.16.7％,P ＜ 0.05).There were no significant differences in the incidence of symptomatic intracranial hemorrhage and 24h NIHSS score between the two groups (P ＞ 0.05),however,30 day NIHSS score of good collaterals group was significantly lower than that of poor collaterals group (7.2 ± 3.1 vs.9.6 ± 2.7,P ＜ O.05).Conclusion For patients with MCA occlusion and receiving intravenous thrombolysis,good cerebral collateral circulation may reduce their mortality and improve their clinical outcome after thrombolysis.However,good cerebral collateral circulation does not reduce the risk of symptomatic intracranial hemorrhage in those patients.
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AIM:To study the expression of signal transduction molecules in the striatum G protein protein 4 (RGS4) and dopamine D2 receptor (D2) in conditioned place preference (CPP) rats treated with methamphetamine (meth).METHODS:METH dependence CPP model was established (1 week and 2 weeks of METH dependence groups),The protein expression of RGS4 and D2,inhibitory G protein alpha-subunit (Gαi),mitogenactivated protein kinase (MAPK) in striatum were determined by Western blotting (WB).The changes of cyclic adenosine monophosphate (cAMP) content in striatum of rats were determined by enzyme linked immunosorbent assay (ELISA).RESULTS:Compared with saline control group,the average time of rats in the methamphetamine-paired chamber for two groups was increased (P ＜ 0.05).Compared with saline control group,RGS4 protein expressions in the two METH dependent groups were reduced (P ＜0.01);compared with 1 week of METH dependence group,that of 2 weeks group was reduced significantly(P ＜ 0.05).D2,Gαi,MAPK protein and cAMP expressions in the two METH dependent groups were increased (P ＜ 0.01);compared with 1 week of METH dependence group,those of 2 weeks were increased significantly (P ＜ 0.05).CONCLUSION:RGS4 and D2 receptor signaling pathways in striatum have changed in METH dependent rats,RGS4 may be involved in the regulation of METH-dependent D2 receptor signaling pathway in METH dependent rats.
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The insufficient blood supply to the portal vein after liver transplantation, mainly caused by portal vein stenosis (PVS)or portal vein thrombosis(PVT), occurs low in incidence but would be serious enough to lead to graft failure. Prompt diagnosis and treatment is critical to allow graft salvage. The color Doppler flow image (CDFI) could be the first choice for testing portal venous flow, and angiography is reliable for further accurate diagnosis on meaningful functional change of the stenosis. The interventional therapy , including percutaneous balloon angioplasty and stent placement, is safe and effective in lowering the portal venous pressure after hepatic transplantation with portal vein stenosis. Thrombolysis, percutaneous mechanical fragmentation and stent placement ,as the treatments of early portal vein thrombosis, are effective therapeutic methods, and TIPS is also a proper management if necessary.
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Arterial steal syndrome(ASS),a scarce complication after liver transplantation,is charac-terized by hepatic arterial hypoperfusion of the graft caused by a shifting of blood flow into the splenic,left gastric,or gastroduodenal arteries. It can lead to stricture formation of biliary system and transplanted liver function exhaustion. The early diagnosis and treatment are important for protecting the transplanted liver function. Dynamic CDFI after liver transplantation as a routine is necessary to find out the suspected lesions,and transcatheter angiography as the gold standardization can give clear dignosis. Embolization of splenic artery is minimally invasive,successful and less complication treatment for ASS and especially the coil embolization of middle segment of splenic artery is the best choice.
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The occurrence rate of the obstruction of the hepatic vein or the inferior vena cava is very low. Obstruction can develop acutely as a result of technical problems or can present itself much later after the transplantation due to intimal hyperplasia or perianastomotic fibrosis. Clinically, the common presentations include hepatic dysfunction, liver engorgement, ascites, abdominal pain, etc. Percutaneous endovascular treatment with balloon dilation or stent placement is a safe and effective alternative treatment, which can keep the vessels open for a long period of time. Angioplasty can achieve technical success in restoring anastomotic patency almost to 100% of cases, but, unfortunately, restenosis occurs frequently. For adult patients or pediatric patients with adult-sized hepatic veins, stenting seems to be the optimal choice.