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Objective To investigate the safety and effectiveness of intravenous thrombolysis bridging intra-arterial thrombectomy for opening the acute occlusion of intracranial large artery.Methods Theclinical data of 63 patients with acute intracranial large artery occlusion treated with intravenous thrombolysis bridging intra-arterial thrombectomy in Beijing Xuanwu Hospital,Capital Medical University from January to September 2016 were analyzed retrospectively. The initiation time of intravenous thrombolysis was within 4. 5 h after onset. The initiation time of endovascular therapy (femoral artery puncture)was within 6 h after onset. They were divided into either a simple stent mechanical thrombectomy group (n=41)or a stent mechanical thrombectomy combined with catheter suction group (n=22)according to the ways of thrombectomy. There were no significant differences in the gender composition,average age,occlusion site and National Institutes of Health Stroke Scale (NIHSS)score on admission between the two groups of patients (all P <0. 05). The modified Thrombolysis in Cerebral Infarction (mTICI)was used evaluate the effect of vascular patency. The vascular recanalization time,number of thrombectomy,NIHSS scores on admission,at 72 h after procedure and at day 90,and intraoperative and postoperative complications treated with two kinds of intra-arterial treatment under the intravenous thrombolysis bridging were analyzed. Results (1)In the simple stent mechanical thrombectomy group,there were 37 patients with anterior circulation occlusion (90. 2%)and 4 with posterior circulation occlusion (9. 8%). In the stent mechanical thrombectomy combined with catheter suction group, there are 20 patients with anterior circulation occlusion (90. 9%)and 2 with posterior circulation occlusion (9. 1%). There were no significant differences between the two groups of patients (P<0. 05). After treatment, the large vessels achieved good recanaliazation (mTICI grade:Ⅱb-Ⅲ). (2)The mean recanalization time of the simple stent mechanical thrombectomy group was 86 ± 11 min and the mean number of arterial embolectomy was 2. 8 ± 0. 9 times. The complication rate after procedure was 14. 6%(5 symptomatic intracranial hemorrhages and 1 cardiac death). The patients of mRS 0-2 accounted for 51. 2%(21/41)at 90 days of follow-up. The mean recanalization time of the stent mechanical thrombectomy combined with catheter suction group was 83 ± 11 min and the mean number of arterial embolectomy was 2. 2 ± 0. 8 times. The compli-cation rate after procedure was 13. 6%(2 symptomatic intracranial hemorrhages and 1 cardiac death). The patients of mRS 0-2 accounted for 59. 1%(13/22)at 90 days of follow-up. There were significant differ-ences in the above indices between the two groups(all P<0.05).Conclusion Both intravenous throm-bolysis bridging simple stent mechanical thrombectomy and stent mechanical thrombectomy combined with catheter suction can quickly make the recanalization of intracranial occlusion of large artery,and the stent mechanical thrombectomy combined with catheter suction has a better recanalization rate. However, both techniques need to be further studied in improving the clinical prognosis of patients.
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Objective To investigate the safety and effectiveness of Solitaire FR stent mechanical thrombectomy combined with 5F Navien catheter aspiration technique for the treatment of acute middle cerebral artery occlusion.Methods From February 2016 to May 2016,the case data of 11 consecutive patients with acute middle cerebral artery occlusion treated with Solitaire FR stent mechanical thrombectomy combined with 5F Navien catheter aspiration technique at the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University were enrolled retrospectively.The age,gender,National Institutes of Health Stroke Scale (NIHSS) score on admission,thrombolysis in cerebral infarction (TICI) grade,operation-related complications,NIHSS score at 24 h after operation,and modified Rankin Scale (mRS) score at day 90 after operation were documented.The relevant data differences before and after treatment were analyzed with the SPSS software.Results Among the 11 patients with acute middle cerebral artery occlusion,7 were men and 4 were women,the age ranged from 44 to 78 years,and the mean age was 66 ± 11 years.The preoperative and postoperative NIHSS scores were 18 ± 3 and 8 ±4 respectively.There was significant difference before and after treatment (t =5.327,P ＜ 0.01).The recanalization of occluded middle cerebral artery achieved successfully.The follow-up at day 90 after operation,the good prognosis of the patients (mRS 0-2) was in 7 cases.No complications associated with severe M1 segment catheter operation occurred.Conclusion The preliminary experience showed,Solitaire FR stent mechanical thrombectomy combined with 5F Navien catheter aspiration technique for the treatment of acute middle cerebral artery occlusion was a safe and effective endovascular mechanical thrombectomy method.
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Objective ToexploretheapplicationofVasoCT,astentimagingtechnique,instent-assisted coilaneurysmembolization.Methods Twentyconsecutivepatientswith23intracranialaneurysmswere treated with stent-assisted aneurysm embolization in the General Hospital of Armed Police Forces from December 2013 to November 2014 were enrolled. The patients performed VasoCT scan immediately after procedure. Then all the available images were used for stent-optimized reconstruction respectively. Under the XpertCT mode,the available images were observed with both volume imaging and maximum intensity projection. The available images were analyzed and they were divided into very clear,less clear,and not clearaccordingtothestentdevelopingclarity.Results Ofthe22aneurysmstreatedwithstent-assisted embolization,16 were occluded completely,6 were occluded partially. All the stents were expanded completely and were released to the expected locations;11 aneurysm stents developed clearly,9 developed less clearly,and 2didnotdevelopclearly.Conclusion VasoCTcanbeusedinthestent-assistedaneurysmembolization.It can clearly reveal the microscopic structure of the stents,location,relationship with the artery wall,and relationship between stents and coils. The clarity of stent development is associated with the diameters of the packed coils,and the stents are also affected by the metal artifacts projecting direction and the dense degree of the packing coils.
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Objective To assess the diagnostic value of 99Tcm-ECD SPECT for hyperacute cerebral ischemia using rats models.Methods A stable and permanent acute cerebral ischemia model using unilateral middle cerebral occlusion was tested in 24 healthy SD rats.The rats were randomly divided into 6 groups according to the time duration between imaging and induced-ischemia (1,2,3,4,5 and 6 h,respectively).The rats were sacrificed immediately after 99Tcm-ECD SPECT/CT imaging and then the brain tissue was dissected for triphenyl tetrazolium chloride (TTC) and HE staining.The count ratio of affected cortex to the contralateral cortex of ＜ 50％ was defined as ischemia on micro SPECT/CT.The volume of the ischemic area was calculated on both SPECT/CT and TTC images.Paired t test was used to determine the statistical difference between the volumes on SPECT/CT and TTC staining.Results The ischemia volume evaluated by TTC staining at 1,2,3,4,5 and 6 h after occlusion was (73.98 ± 27.76),(90.75 ±29.00),(135.00±40.83),(136.25±22.51),(158.50±32.72) and (168.00±32.75) mm3,respectively.The corresponding ischemia volume evaluated by micro SPECT/CT was (98.50 ± 27.77),(110.40±26.80),(157.00±36.82),(165.50±26.54),(175.75±31.16) and (177.25 ±34.33) mm3,respectively,which was concordant with that by TTC staining at each time point (t:-1.681 to-0.390,all P ＞0.05).The ischemic area on micro SPECT/CT imaging was consistent with the pink area by TTC staining.The volume evaluated by micro SPECT/CT tended to be constant 3 h after the occlusion.The ischemia volume showed no significant difference among 3,4,5 and 6 h (all P ＞ 0.05).Conclusions Micro SPECT/CT may have an haemodynamic value for evaluating in vivo cerebral ischemia applied in a rat model.It might have clinical value for the evaluation and decision-making of ultra acute cerebral infarctions.