Overlapping Stents-Assisted Coiling for Vertebral Artery Dissecting Aneurysm : LVIS Stent within Neuroform EZ Stent

Objective@#: To evaluate the safety and efficacy of an overlapped stenting-assisted coiling technique in treating vertebral artery dissecting aneurysm (VADA) via Low-profile Visualized Intraluminal Support (LVIS) stent-within-Neuroform EZ stent. @*Methods@#: From January 2017 to June 2019, 18 consecutive patients with VADAs (ruptured : unruptured=5 : 13) were treated with the overlapping stents assisted-coiling technique in our center. The overlapping manner was a Neuroform EZ stent being deployed first, followed by LVIS stents placement using the ‘shelf’ technique. The patients’ clinical characteristics, technical feasibility and safety, and immediate and follow-up angiographic results were retrospectively reviewed. @*Results@#: Seventeen (94.4%) procedures were technically successful with an exact deployment of the stents and patent parent or perforator arteries. The immediate angiographies after procedure confirmed Raymond class I, II, and III occlusion of VADAs were in 12 (66.7%), two (11.1%), and four cases (22.2%), respectively. Post-procedural complications developed in one patient (5.6%) with minor brainstem infarctions, which resulted from an in-stent thrombosis during the procedure. Angiographic follow-up at 5.7 months (range 3 to 9 months) demonstrated Raymond class I and II occlusion were in all cases (100%). The modified Rankin Scale scores at 21.3 months (range 15 to 42 months) 0–2 in 17 cases (94.4%) and three in one case (5.6%). @*Conclusion@#: Overlapping stents via LVIS stent-within-Neuroform EZ stent combined with coiling is safe and effective for patients with VADA in the midterm results.

Effect of rgs4 overexpression on related protein expression of mglur5-mediated signaling pathway in methamphetamine-dependent rat striatum / 中国药理学通报

Aim To investigate the effect of the regulator of G-protein signaling 4(RGS4) overexpression in rat striatum on the related protein expression of metabolic glutamate receptor 5(mGluR5) signaling pathway and the conditioned place preference(CPP) behavior in rats, by establishing the METH-dependent CPP model. Methods Rats were divided into five groups: Normal, normal saline(NS), METH, Ad5-RGS4-EGFP and Ad5-EGFP group. Normal group was without any administration, while the striatum of the other groups were respectively stereotactic injected with phosphate buffer methamphetamine (METH)-depardent soline (PBS), PBS, overexpressed adenovirus vector Ad5-RGS4-EGFP and negative control adenovirus vector Ad5-EGFP. The CPP behavior of rats in each group was analyzed. The expression of RGS4, mGluR5, Gαq, PLC1 was measured in rat striatum tissue by Western blot. Results The difference of CPP in Ad5-RGS4-EGFP group decreased compared with that in METH group and Ad5-EGFP group(P 0.05). PLCβ1 expression changed with no significant difference. Conclusions RGS4 overexpression in striatum is able to alleviate the CPP behavior in METH-dependent rats, and its mechanism may be associated with the overexpression of RGS4 in METH-dependent rat striatum, which could down-regulate the mGluR5-mediated Gαq and PLCβ1 signaling pathway.

Balloon dilation of epidermolysis bullosa-related esophageal strictures: A report of two cases

Epidermolysis bullosa (EB) is a very rare inherited disease featured with skin blistering resulting from minor trauma. Sometimes the esophageal mucosa could also be involved, which leads to esophageal strictures. Here we report two cases of EB-related esophageal strictures who were successfully treated with esophageal balloon dilations. The two cases with EB had severe dysphagia. Clinical examination showed signs of malnutrition, skin blisters and loss of toenails due to EB. They underwent careful fluoroscopic balloon dilation with 10- and 16-mm-sized balloon catheters, respectively. They could ingest soft and some solid foods after the procedure and maintained during the 20 months and 16 months follow-up periods.

Value of thromboelastography in predicting thromboembolic complications in patients with intracranial an-eurysms after stent-assisted coiling / 医学研究生学报

Objective Few researches have been reported about thromboelastography(TEG)in detecting the complications after stent-assisted coiling for intracranial aneurysms. This study aimed to investigate the value of TEG in predicting thromboembolic complications in patients with intracranial aneurysms after stent-assisted coiling. Methods We retrospectively analyzed the clinical data on 152 cases of intracranial aneurysms undergoing stent-assisted coiling in our department,18 with and 134 without thrombosis. We assessed the effects of antiplatelet drugs by TEG,recorded the general data and postoperative complications,and identified the po-tential risk factors for thromboembolic complications by multivariate logistic regression analysis. Results The incidence rate of aspi-rin resistance was significantly lower than that of clopidogrel resistance(10.5% vs 30.3%,P<0.05). Thromboembolic complications were observed in 18 patients during the perioperative and follow-up periods. Multivariate logistic regression analysis showed that the in-dependent risk factors for thromboembolic complications were the maximum amplitude of TEG(OR=1.152,95% CI:1.002-1.300, P=0.021)and aspirin resistance(OR=4.945,95% CI:1.408-17.375,P=0.013). Conclusion TEG is effective in evaluating the effects of antiplatelet drugs in patients with intracranial aneurysms undergoing stent-assisted coiling. Elevated maximum amplitude of TEG and aspirin resistance may increase the risk of thromboembolic complications.

Two Microcatheter Technique for Embolization of Arteriovenous Fistula with Liquid Embolic Agent / 신경중재치료의학

Problem with embolization of arteriovenous fistula (AVF) with liquid embolic agent is its over-penetration into the veins or regurgitation to the proximal feeder without reaching the shunt point. We present a technique that controls the flow of AVF during embolization. Two microcatheter technique consists of positioning one microcatheter close to the AVF for embolization, and with another microcatheter at the proximal feeding artery to control the AVF flow by coiling. Selective angiograms obtained using a distally positioned microcatheter before and after coiling, were compared how much stagnant effect was achieved. Using two microcatheter technique, AVF occlusion was achieved with good penetration of glue to the venous side of the AVF. Its advantage is the ability to push glue into the shunt without causing over-penetration of glue or its reflux along the feeder. Two microcatheter technique was safe and effective in glue embolization of AVF and also expected to be applied with other liquid embolic agent like Onyx.

Comparison of Medical Education and Requirements for Training in the Interventional Neuroradiology in China, Japan and Korea / 신경중재치료의학

The interventional neuroradiology (INR, or neurointerventional surgery) became a rapidly emerging specialty since the first Working group in Interventional Neuroradiology (WIN) meeting was held in Santa Barbara in 1980 by 15 pioneers. Although the specialty has been led by neuroradiologists, other specialists of neurosurgery and neurology have become involved. Due to diverse background of the specialties with inadequate requirement of education and training, proper level of training standard and quality assurance may be achieved for outcomes of treated patients with neurovascular diseases. In East Asia, there are less inter-relationship of education and training among China, Japan and Korea when compared to the learning opportunities in western countries from the three nations. Therefore, we present the current status and difference of medical education system and compare INR training to improve understanding of INR development in the adjacent countries.

Follow-Up of 58 Traumatic Carotid-Cavernous Fistulas after Endovascular Detachable-Balloon Embolization at a Single Center

BACKGROUND AND PURPOSE: This study evaluated the clinical value of detachable-balloon embolization for traumatic carotid-cavernous fistula (TCCF), focusing on the frequency, risk factors, and retreatment of recurrence. METHODS: Fifty-eight patients with TCCF underwent transarterial detachable-balloon embolization between October 2004 and March 2011. The clinical follow-up was performed every 3 months until up to 3 years postprocedure. Each patient was placed in either the recurrence group or the nonrecurrence group according to whether a recurrence developed after the first procedure. The relevant factors including gender, fistula location, interval between trauma and the interventional procedure, blood flow in the carotid-cavernous fistula, number of balloons, and whether the internal carotid artery (ICA) was sacrificed were evaluated. RESULTS: All 58 TCCFs were successfully treated with transarterial balloon embolization, including 7 patients with ICA sacrifice. Recurrent fistulas occurred in seven patients during the follow-up period. Univariate analysis indicated that the interval between trauma and the interventional procedure (p=0.006) might be the main factor related to the recurrence of TCCF. The second treatments involved ICA sacrifice in two patients, fistula embolization with balloons in four patients, and placement of a covered stent in one patient. CONCLUSIONS: Detachable balloons can still serve as the first-line treatment for TCCFs and recurrent TCCFs despite having a nonnegligible recurrence rate. Shortening the interval between trauma and the interventional procedure may reduce the risk of recurrence.

Mechanism of Procedural Failure Related to Wingspan / 신경중재치료의학

PURPOSE: Wingspan is the only FDA approved self-expanding stent for intracranial artery and known to have better delivery compared to balloon expandable stent. However, some delivery failure has been reported but incidence and mechanism of the failure have not been completely elucidated. We present the cause and mechanism of Wingspan deployment failure experienced in our Institute. MATERIALS AND METHODS: We experienced deployment failure in seven patients (8.8%) out of 80 patients who underwent Wingspan stenting since 2007. Mean age of the patients was 62 (range 47~78) and male to female ratio was 6:1. We evaluated the cause and mechanism why the deployment was not successful and how we could manage it subsequently. RESULTS: We categorized failures occurred in seven patients into three categories: delivery failure (n = 3), deployment failure of stent (n = 3), retrieval failure of dual tapered (olive) tip of the inner body through the deployed the stent (n = 1). The technical failure in using Wingspan stent (delivery, deployment and retrieval failures) are related to tortuousness of the proximal (n =4) as well as distal (n =1) cerebral vessels to the stenotic lesion and bulky profile of the olive tip (n =2). CONCLUSION: The technical failure in using Wingspan stent (delivery, deployment and retrieval failures) are related to tortuousness of the proximal as well as distal cerebral vessels to the stenotic lesion and bulky profile of the olive tip. To avoid device-related complication, complete understanding of the stent design is mandatory before using the stent.

Value of percutanous catheter fragmentation in the management of massive pulmonary embolism / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Acute massive pulmonary embolism (PE) is a clinical emergency requiring rapid and supportive measures. Percutanous mechanical thrombectomy is considered as a treatment option. The purpose of this study was to evaluate the clinical efficacy and safety of peructaneous mechanical catheter fragmentation in the management of acute massive PE.</p><p><b>METHODS</b>From January 2003 to June 2007, 28 patients (20 men, 8 women; mean age 64 years) with acute massive PE initially diagnosed by computed tomography and confirmed by pulmonary angiography were treated with inferior vena caval filter placement and percutaneous catheter fragmentation. Twenty-six patients received thrombolytic agents after embolus fragmentation.</p><p><b>RESULTS</b>Technical success was achieved in all patients. The improvement of clinical status and restoration of blood flow in the main branches of the pulmonary artery were seen in 27 patients. Only one case did not benefit from the percutaneous therapy and died from the failure of the surgery. Oxygen saturation increased from (86.2 +/- 4.5)% to (96.1 +/- 3.2)% (P < 0.001) after the interventional procedure. The post-procedure mean pulmonary artery pressure decreased from (34.2 +/- 4.8) mmHg to (25.2 +/- 5.1) mmHg (P < 0.001). During clinical follow-up (range, 1 - 5 years), no patients had recurrence of PE.</p><p><b>CONCLUSION</b>Percutaneous catheter fragmentation combined with thrombolysis is an effective and safe therapy in the clinical management of acute massive PE.</p>

Interventional therapy of complications after liver transplantation:hepatic artery stricture / 介入放射学杂志

Hepatic artery stricture (HAS) after liver transplantation can lead directly to transplanted liver function exhaustion and complications of biliary system. The early diagnosis and treatment are crucial for better prognosis. Doppler ultrasound is the first method of choice, and angiography can give further clear dignosis. The balloon dilatation is still effective for hepatic arterial stenosis. With the more adaptable usage of oronary stent, if possible, would reveal more promising result especially for tortuous stenotic hepatic artery. The vascular reconstruction or repeated liver transplantation is still the effective therapeutic methods.