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Objective@#To evaluate the feasibility, safety and efficacy of the treatment of chronic symptomatic internal carotid artery long-segmental occlusion.@*Methods@#Fifty-one cases of chronic symptomatic internal carotid artery long-segmental occlusion (arterial occlusion more than 2 anatomical segments) who were treated with hybrid surgery (plaque located at the carotid sinus) or endovascular revascularization (plaque located at the distal end of the internal carotid artery occlusion) from May 2015 to May 2018 were reviewed. Recanalization, perioperative complications, stroke events, and reocclusion events during the follow-up period were recorded.@*Results@#The occlusion was recanalized successfully in 45 of 51 patients (88.2%, 45/51), 6 patients failed because the guidewire could not cross the distal arterial occlusion. And the technical success rate was 96.0% (24/25) in hybrid surgery and 80.8% (21/26) in endovascular revascularization. Perioperative complications occurred in 2 patients who underwent combined endovascular treatment. One patient had a small branch embolism due to intraoperative thrombus shift, and 1 patient had large area cerebral infarction. The complications occurred in 2 patients who underwent thybrid surgery, including 1 case of internal carotid cavernous fistula and 1 case of acute reocclusion of internal carotid artery. Forty-four patients with successful operation received clinical follow-up, with the median follow-up time of 24 months (7-43 months). No recurrent stroke and death occurred during the follow-up period. Clinical symptoms were improved in 34 cases. Totally 44 patients received imaging follow-up, and during the median imaging follow-up time of 8 month (4-28 months), 6 cases had reocclusion, and 2 cases had restenosis.@*Conclusion@#The treatment of chronic symptomatic internal carotid artery long-segmental occlusion is technically feasible and safety with good short-term efficacy. However, its exact efficacy remains to be confirmed by long-term follow-up studies with large samples.
ABSTRACT
Objective To evaluate the feasibility, safety and efficacy of the treatment of chronic symptomatic internal carotid artery long?segmental occlusion. Methods Fifty?one cases of chronic symptomatic internal carotid artery long?segmental occlusion (arterial occlusion more than 2 anatomical segments) who were treated with hybrid surgery (plaque located at the carotid sinus) or endovascular revascularization (plaque located at the distal end of the internal carotid artery occlusion) from May 2015 to May 2018 were reviewed. Recanalization, perioperative complications, stroke events, and reocclusion events during the follow?up period were recorded. Results The occlusion was recanalized successfully in 45 of 51 patients (88.2%, 45/51), 6 patients failed because the guidewire could not cross the distal arterial occlusion. And the technical success rate was 96.0% (24/25) in hybrid surgery and 80.8% (21/26) in endovascular revascularization. Perioperative complications occurred in 2 patients who underwent combined endovascular treatment. One patient had a small branch embolism due to intraoperative thrombus shift, and 1 patient had large area cerebral infarction. The complications occurred in 2 patients who underwent thybrid surgery, including 1 case of internal carotid cavernous fistula and 1 case of acute reocclusion of internal carotid artery. Forty?four patients with successful operation received clinical follow?up, with the median follow?up time of 24 months (7-43 months). No recurrent stroke and death occurred during the follow?up period. Clinical symptoms were improved in 34 cases. Totally 44 patients received imaging follow?up, and during the median imaging follow?up time of 8 month (4-28 months), 6 cases had reocclusion, and 2 cases had restenosis. Conclusion The treatment of chronic symptomatic internal carotid artery long?segmental occlusion is technically feasible and safety with good short?term efficacy. However, its exact efficacy remains to be confirmed by long?term follow?up studies with large samples.
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Objective To explore the feasibility,safety and effect of endovascular revascularization for chronic long segment internal carotid artery occlusion. Methods The cases of chronic long segment internal carotid artery occlusion who were treated by endovascular revascularization in our center from May 2015 to April 2017 were reviewed. Eleven cases met the inclusion criteria:the duration of the occlusion was more than three weeks and the segment of the occlusion was beyond the petrosal segment of internal carotid arteries from the initial segment. All of the cases had the related symptoms and had declining cerebral perfusion. The analysis index included:baseline information,radiological information,perioperative results, clinical follow-up and imaging follow-up. The imaging follow-up index were the re-stenosis or re-occlusion of the revascularized artery. Results The occlusion was recanalized successfully in 9 of 11 patients,the two procedures were abandoned after repeated attempts and the guide wire could not reach the true lumen when navigating in the cavernous segment. Six cases of the nine successfully recanalized cases accepted perfusion-weighted imaging scan. Cerebral perfusion of all the cases were improved. Thrombus shifting was observed in one case and occluded a subbranch,mechanical thrombectomy was performed successfully,the case was recovered well without sequela. No symptomatic stroke or death was happened in the perioperative period. All of the nine cases who successfully recanalized acquired clinical follow-up,median follow-up time was ten months(4—28 months). No ischemic stroke and death happened after the procedures. Seven of nine cases improved in the clinical symptoms. Five cases accepted the imaging follow-up. The meantime was six months. No re-occlusion was happened. Conclusions Endovascular revascularization for chronic long segment internal carotid artery occlusion is feasible,safe,and short-term effective. More clinical research is needed to verify the long-term effect.
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Objective To evaluate the feasibility of transvenous embolization treatment for cerebral arteriovenous malformations(bAVM). Methods From November 2016 to April 2017, the information of 6 patients with brain arteriovenous malformation in our center accepting the intravenous radical embolization were collected, who were ruptured bAVM, bAVM with a single drainage vein, not suitable for surgery confirmed by neurosurgeon consultation or explicitly refused craniotomy. The modified Rankin Scale score of five patients were smaller than three before treatment.The location of draining vein flowing venous sinus was shown by rotational DSA and 3D reconstructed images.A liquid embolic agent was injected via Sonic catheter to completely embolism the brain arteriovenous malformation under controlling blood pressure and blocking the blood provisionally.The perioperative complications and modified Rankin Scale score were observed and recorded 30 days after treatment. Results The transvenous embolization treatment was successfully performed in six patients with 7 embolization procedures.There were no definite operation-related complications. the mRS of all cases were ≤1 within 30 days after operation. Conclusion The embolization technique via the internal jugular vein is feasible for bAVM patients with a single drainage vein,while the long-term outcome need more evaluations.
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Objective To discuss the clinical value of interventional treatment for Klippel-Trenaunay syndrome complicated by spinal arteriovenous fistula and subarachnoid hemorrhage, and to report 1 patients with this disease who were successfully treated with interventional treatment. Methods One female children patient with clinically confirmed Klippel-Trenaunay syndrome complicated by spinal arteriovenous fistula and subarachnoid hemorrhage were enrolled in this study, who was underwent the embolization of arteriovenous fistula in the spinal. Results The interventional procedure was successfully accomplished in this case. The patient's clinical symptoms was disappeared gradually. No complications occurred. Conclusion For the treatment of Klippel-Trenaunay syndrome complicated by spinal arteriovenous fistula and subarachnoid hemorrhage, interventional management is minimally-invasive, safe and Reliable.
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Objective To compare the perioperative complications of prophylactic use of three antiplatelet strategies in unruptured intracranial aneurysms treated by stent assisted coiling. Methods A total of 203 consecutive patients were brought into this retrospective study including the following three groups:the loading group (n=54), with a loading dose of 300 mg to 600 mg clopidogrel at 2 h to 24h before the stenting; tirofiban group (n=50), a loading dosage of tirofiban (8 μg/kg/min over 3 min) followed by a 0.1μg/kg/min maintenance dosage; dual antiplatelet group (n=99), dual oral antiplatelet drugs (clopidogrel 75 mg + aspirin 100 mg) pretreated for 3-5 days before the operation. Events of hemorrhage and thromboembolism were recorded and the complications were compared to assess the safety and efficacy of various antiplatelet strategies. Chi-square or Fisher exact tests were used for categorical variables. Results The hemorrhagic rates were 11.1% in loading group, 2.0% in dual antiplatelet group, and 0% in tirofiban group, respectively, while the thromboembolic rates were 7.4% in loading group, 4.0% in dual antiplatelet group, and 0% in tirofiban group, respectively. For total complications, significant difference (P0.05). The hemorrhagic rate in loading group was significantly higher than that of the dual group (P=0.023) and tirofiban group (P=0.027), while there was no significant difference between tirofiban group and dual antiplatelet group (P>0.05). In subgroup analysis of the loading group, the postoperative thromboembolic rate was significantly higher in those exposed to low molecular weight heparin than those not (P=0.039) with no increase of hemorrhagic events (P>0.05). Conclusions When compared with the dual antiplatelet strategy, tirofiban strategy may be used as a new prophylactic protocol in unruptured intracranial aneurysms treated by stent assisted coiling. Those treated by low molecular weight heparin postoperatively after receiving dual antiplatelet therapy may increase the hemorrhagic risk, although there was a significant decrease in thromboembolic events postoperatively.