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Objective:To investigate the application of side branch protection technique in interventional treatment of intracranial arteriosclerosis stenosis.Methods:We reviewed the patients who underwent interventional treatment of intracranial arteriosclerosis stenosis from November 2018 to May 2021 in Affiliated Drum Tower Hospital of Nanjing University Medical School, and analyzed the role of side branch protection technique in the prevention and treatment of complications. Relevant evaluation indicators including: (1) imaging: patency of blood flow in target vessels and branch vessels; (2) clinical presentation: ischemic stroke or transient ischemic attack (TIA) events within 72 hours and one month follow-up results.Results:A total of 9 patients underwent side branch protection during interventional treatment for intracranial arteriosclerosis stenosis, the blood flow of target vessels was improved obviously after operation, and the blood flow of the affected branches was not affected; no stroke or TIA events occurred in 72 hours after operation and one month follow up.Conclusions:Proper application of side branch protection technique can reduce the perioperative complications effectively during the interventional treatment for intracranial arteriosclerosis stenosis.
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Objective To investigate the clinical features, treatment strategies and outcomes of patients with Moyamoya disease and lenticulostriate artery (LSA) aneurysm rupture. Methods Patients with moyamoya disease and LSA aneurysm rupture admitted to Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medicine School from October 2012 to March 2015 were analyzed retrospectively. They were followed up for 1 year. The modified Rankin Scale (mRS) was used to evaluate the outcomes, and 0-2 was defined as good outcome. The demographic characteristics, image anatomical features, treatment schemes, and outcomes of the patients were summarized. The Pubmed database was used to retrieve other similar studies, which combined with this group of cases for analysis. Results A total of 10 patients were enrolled, 2 males and 8 females, aged 29-72 years, with an average of 43. 6 years. All cases were intracranial hemorrhage, including 3 cases of cerebral hemorrhage, 6 cases of ventricular hemorrhage, and 1 case of subarachnoid hemorrhage. At the time of admission, 7 patients had disturbance of consciousness, and 3 patients underwent emergency extraventricular drainage. Among them, 5 patients received endovascular embolization, 4 had good outcome, 1 had mild neurological deficit (mRS score 3); 2 received surgical treatment, all had good outcome; 3 received conservative treatment, all had re-bleeding, 2 died, and 1 had severe disability (mRS score 4). Fourteen eligible articles were included, and a total of 18 patients were included in the analysis: surgical treatment in 7 cases, endovascular treatment in 6 cases, and conservative treatment in 5 cases (self-healing in 1 case). According to the data of this group of patients and literature reports, the good outcome rate of the patients with early interventional embolization or craniotomy clipping treatment was significantly higher than that of conservative treatment (70. 6％vs. 22. 2％; P = 0. 038). Conclusion There is a certain risk of conservative treatment of Moyamoya disease complicated with LSA aneurysm rupture and requires active treatment. Interventional embolization of the parent artery or surgically clipping of aneurysm can effectively improve the clinical outcome of such patients. Interventional embolization of the parent artery and aneurysm can be selected simultaneously if the condition of the parent artery is allowed. Surgery can be selected when the condition of parent artery is poor and the aneurysm is located in the superficial part.
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Objective To investigate the strategy and efficacy of enteral nutrition support of patients with spontaneous intraventricular hemorrhage-induced coma.Methods 139 patients were randomly divided into study group (treated with enteral nutrition mixed suspension,n =67) and control group (treated with normal full nutritional homogenized product,n =72) with a random number generating software.Enteral nutrition support was administered in 6-48 hours after admission.The total daily intake of enteral nutrition preparation was 1 000 ml (4 186.8 kJ),supplemented by liquid food.Body weight,serum albumin,serum total protein,hemoglobin,lymphocyte count,incidence of infection,level of consciousness and incidence of complications were compared between the two groups.Results In the third week after onset,the serum albumin [(32.1 ± 3.3) g/Lvs.(30.5±2.3) g/L,P=0.041],total protein [(62.2±3.2) g/Lvs.(56.9±2.7) g/L,P=0.039],and hemoglobin [(125.5 ±5.7) g/Lvs.(120.7 ±6.4) g/L,P=0.027] were significantly higher in the study group than in the control group.The Glasgow score in the second week in the study group was 13.1 ± 1.9,significantly higher than that in the control group (11.0 ±2.3) (P =0.037);the incidence of nosocomial infection was significantly lower in the study group than in the control group [17.9％ (12/67) vs.29.2％ (21/72),P =0.021];the proportion of patients with abnormal blood test results and that of patients having fever for more than 7 consecutive days were both significantly lower in the study group than in the control group [31.3％ (21/67) vs.38.8％ (28/72),P=0.042;37.3％ (25/67) vs.41.7％ (30/72),P =0.047].The two groups showed no significant difference in the incidence of intracranial infection after external ventricular drainage (P =0.235).Conclusion For patients with spontaneous intraventricular hemorrhage-induced brain dysfunction,enteral nutrition support with enteral nutrition suspension could effectively improve nutritional status,reduce complications,therefore conducive to recovery.
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To investigate the clinical characteristics and angio-architecture features of patients with dural arteriovenous fistulas (DAVF).The clinical data of 48 patients with DAVF were analyzed retrospectively.All patients were diagnosed by digital subtract angiography and 43 cases were also examined by MRI.Patients were divided into the bleeding group and non-bleeding group,whose clinical features and angio-architecture were compared.Of 48 cases,13 patients demonstrated intracranial bleeding,and men were more common in bleeding group (M/F:10/3) than in non-bleeding group (M/F:15/20) (P =0.036).The Cognard scores of bleeding group and nou-bleeding group were 3.77 ±0.28 and 2.49 ±0.21,respectively (P =0.002) ; however,there was no significant difference in age and the number of feeding artery between two groups.The results indicate that male patients with high Cognard scores tend to intracranial bleeding.