Prediction of outcomes in patients with acute basilar artery occlusion using 24 h NIHSS score after endovascular treatment / 国际脑血管病杂志

Objective:To investigate the predictive value of the National Institutes of Health Stroke Scale (NIHSS) score at 24 h after endovascular treatment on the outcomes in patients with acute basilar artery occlusion (ABAO).Methods:Consecutive patients with ABAO received endovascular treatment at the Department of Neurology, Shengli Oilfield Central Hospital from January 2019 to December 2020 were retrospectively included. According to the modified Rankin Scale scores at 90 days after onset, the patients were divided into a good outcome group (0-3) and a poor outcome group (4-6), as well as a survival group and a death group. The demographic and clinical data between the groups were compared respectively. Multivariate logistic regression analysis was use to identify independent influencing factors for clinical outcomes and mortality. The predictive value of postprocedural 24 h NIHSS score on the outcomes was evaluated using the receiver operating characteristic (ROC) curves. Results:A total of 35 patients with ABAO were included. Their age was 62 years (interquartile range, 56-66 years), and 28 patients were males (80%); 19 (54.3%) had a good outcome, 16 (45.7%) had a poor outcome, and 7 (20.0%) died. Univariate analysis showed that there were statistically significant differences in hypertension, low-density lipoprotein cholesterol, fasting blood glucose, collateral circulation grading, vascular recanalization, and postprocedural 24 h NIHSS scores between the good outcome group and the poor outcome group (all P<0.05). Multivariate logistic regression analysis showed that the postprocedural 24 h NIHSS score was independently correlated with the poor outcome (odds ratio 1.131, 95% confidence interval 1.017-1.258; P=0.023). Multivariate analysis did not find the independent influencing factors for death. ROC curve analysis showed that the area under the curve of the postprocedural 24 h NIHSS score for predicting poor outcome was 0.814 (95% confidence interval 0.668-0.960; P=0.011). The optimal cutoff value was 19 points, and the corresponding sensitivity and specificity were 85.7% and 71.4% respectively. Conclusions:In patients with ABAO receiving endovascular treatment, the postprocedural 24 h NIHSS score has good predictive value for poor outcomes at 90 d after procedure.

Predictors of delayed function independence in patients with acute vertebrobasilar artery occlusion achieved successful recanalization after endovascular therapy / 国际脑血管病杂志

Objective:To investigate the prevalence and predictors of delayed function independence (DFI) in patients with acute vertebrobasilar artery occlusion (VBAO) achieved successful recanalization after endovascular therapy.Methods:Patients with acute VBAO received endovascular treatment in the Departments of Neurology, the First Affiliated Hospital of University of Science and Technology and General Hospital of Eastern Theater Command, PLA from December 2015 to December 2018 were retrospectively enrolled. The demographic, clinical, laboratory and imaging data were collected. Early functional independence (EFI) was defined as the modified Rankin Scale score 0-2 at discharge, and DFI was defined as the modified Rankin Scale score 0-2 at 90 d after discharge for non-EFI patients. Multivariate logistic regression analysis was used to determine the independent predictors of DFI. Results:A total of 122 patients with acute VBAO were included. Their age was 61.8±11.9 years old and 91 (74.6%) were male. The median Glasgow Coma Scale (GCS) score was 7, the median National Institutes of Health Stroke Scale (NIHSS) score was 26.5, and the median posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS) score was 9. Twenty-four patients (20.0%) had EFI; of the 98 patients with non-EFI, 18 (18.4%) had DFI. Multivariate logistic regression analysis showed that male (odds ratio [ OR] 0.038, 95% confidence interval [ CI] 0.002-0.658; P=0.025), cardiogenic embolism ( OR 0.116, 95% CI 0.023-0.579; P=0.009), baseline NIHSS score ( OR 1.136, 95% CI 1.040-1.242; P=0.005) and lung infection ( OR 6.089, 95% CI 1.451-25.562; P=0.014) were the independent predictors of DFI. Conclusions:Nearly 1/5 of the non-EFI patients have DFI. Male, cardiogenic embolism, lower baseline NIHSS score and without pulmonary infection are the independent predictors of DFI.

Bacterial cellulose biomaterials for the treatment of lower limb ulcers / Biomateriais de celulose bacteriana para o tratamento de úlceras de membros inferiores

ABSTRACT Chronic ulcers of the lower limbs are common and recurrent, especially in the elderly population, they are disabling injuries that generate a great socioeconomic burden. This scenario encourages the development of new, low-cost therapeutic alternatives. The present study aims to describe the use of bacterial cellulose in the treatment of lower limb ulcers. This is an integrative literature review, carried out in the PubMed and Science Direct databases by associating the descriptors, with the inclusion criteria being clinical studies in the last 5 years, available in full in English, Portuguese and Spanish. Five clinical trials were analyzed and the main therapeutic effects obtained in the experimental groups that used bacterial cellulose dressings were a reduction in the area of the wounds, one of the studies showed a reduction of 44.18cm2 in the area of the wound, the initial lesions measured on average 89.46cm2 and at the end of the follow-up, they had an average of 45.28cm2, since the reduction in pain and the decrease in the number of exchanges were advantages described in all groups that used the BS. It is concluded that BC dressings are an alternative for the treatment of lower limb ulcers, their use also reduces operational costs related to the treatment of ulcers.

RESUMO As úlceras crônicas de membros inferiores são comuns e recorrentes principalmente na população idosa, são lesões incapacitantes e que geram grande ônus socioeconômico. Tal cenário incentiva o desenvolvimento de novas alternativas terapêuticas e de baixo custo. O presente estudo tem como objetivo descrever o uso da celulose bacteriana no tratamento de úlceras de membros inferiores. Trata-se de uma revisão integrativa da literatura, realizada nas bases de dados PubMed e Science Direct por meio da associação dos descritores, tendo como critério de inclusão estudos clínicos nos últimos 5 anos, disponíveis na integra em inglês, português e espanhol. Cinco ensaios clínicos foram analisados e os principais efeitos terapêuticos obtidos nos grupos experimentais que utilizaram os curativos de celulose bacteriana foram redução da área das feridas, um dos estudos apontou uma redução de 44,18cm2 da área da ferida, as lesões iniciais mediam em média 89,46cm2 e ao término do acompanhamento apresentaram uma média de 45,28cm2, já a redução da dor e diminuição do número de trocas foram vantagens descritas em todos os grupos que utilizaram a CB. Conclui-se que os curativos de CB são uma alternativa para o tratamento das úlceras de MMII, sua utilização reduz também os custos operacionais relacionados ao tratamento de úlceras.

Efeito da nitroglicerina no espasmo e na oclusão da artéria radial em cateterismos transradiais realizados em mulheres / Effect of nitroglycerin on radial artery spasm and occlusion in transradial catheterizations performed in women

Introdução: O benefício do cateterismo transradial já foi confirmado em pacientes do sexo feminino. Mulheres submetidas a exames por cateterismo transradial apresentam desafios únicos. A ocorrência de espasmo e oclusão da artéria radial após o procedimento é maior em mulheres. Objetivamos avaliar o benefício da nitroglicerina na redução de espasmo e oclusão da artéria radial em mulheres submetidas a cateterismo transradial. Métodos: Estudo multicêntrico, prospectivo, randomizado 2x2 fatorial, duplo-cego. Participantes foram randomizados para nitroglicerina 500mcg ou placebo em dois momentos: após colocação do introdutor hemostático e antes da retirada. A avaliação de espasmo da artéria radial foi clínica, por meio de escala dor. A avaliação da oclusão da artéria radial foi realizada com Doppler, nas primeiras 12 horas. Resultados: Foram incluídos 2.040 pacientes, sendo 774 (37,5%) mulheres. A média de idade foi similar entre os sexos (62,2 anos versus 61,5 anos; p=0,27). A incidência de espasmo da artéria radial foi maior nas mulheres (21,2% versus 6,6%; p<0,01), bem como a incidência de oclusão da artéria radial (3,4% versus 1,8%; p=0,03). O uso da nitroglicerina no início do procedimento não reduziu a incidência de espasmo da artéria radial em mulheres quando comparado com o placebo (19,7% versus 22,6%; p=0,34), tampouco as taxas de oclusão da artéria radial (4,3% versus 2,5%; p=0,17). O uso da nitroglicerina ao fim do procedimento não reduziu a incidência de oclusão da artéria em mulheres (2,8% versus 3,9%; p=0,37). Conclusões: O espasmo e a oclusão da artéria radial são mais frequentes em mulheres submetidas a cateterismo transradial quando comparadas aos homens. O uso da nitroglicerina não apresenta efeito benéfico na redução dessas incidências.

Background: The benefit of transradial catheterization is well established in female patients. Women undergoing transradial catheterization exams present with unique challenges. The occurrence of radial artery spasm and occlusion after the procedure is higher in women. The objective of this study was to evaluate the benefit of nitroglycerin in reducing radial artery spasm and occlusion in women undergoing transradial catheterization. Methods: This was a 2x2 factorial randomized, multicenter, prospective, double-blinded study. Participants were randomized to nitroglycerin 500mcg or placebo at two time points: after placement of the hemostatic introducer and before its removal. The evaluation of the radial artery spasm was clinical, using a pain scale The evaluation of the radial artery occlusion was performed with Doppler, in the first 12 hours. Results: A total of 2,040 patients were included, of which 774 (37.5%) were female. Mean age was similar between sexes (62.2 years versus 61.5 years; p=0.27). The incidence of radial artery spasm was higher in women (21.2% versus 6.6%; p<0.01), as well as the incidence of radial artery occlusion (3.4% versus 1.8%; p=0.03). The use of nitroglycerin at the beginning of the procedure did not reduce the incidence of radial artery spasm in women when compared with placebo (19.7% versus 22.6%; p=0.34), nor did the rates of radial artery occlusion (4.3% versus 2.5%; p=0.17). The use of nitroglycerin at the end of the procedure did not reduce the incidence of artery occlusion in women (2.8% versus 3.9%; p=0.37). Conclusions: Radial artery spasm and occlusion are more frequent in women undergoing transradial catheterization when compared to men. The use of nitroglycerin does not have a beneficial effect in reducing these incidences.

Predictive value of collateral scores in acute basilar artery occlusion patients treated with endovascular therapy / 国际脑血管病杂志

The mortality and disability of patients with acute basilar artery occlusion (ABAO) are extremely high without endovascular therapy. However, there is a lack of clear criteria for screening people who benefit from endovascular therapy for patients with ABAO. A large number of studies have shown that the collateral circulation status is crucial to judge the clinical outcome of patients with ABAO after endovascular therapy. The posterior circulation collateral scoring systems have been proposed according to different imaging methods. This article reviews the posterior circulation collateral scores and thier predictive value in ABAO patients treated with endovascular therapy.

Pathophysiological mechanisms of futile recanalization following endovascular therapy for acute ischemic stroke due to large vessel occlusion and potential targeted therapeutic strategy / 中华神经科杂志

Endovascular therapy is the standard treatment for acute ischemic stroke due to large vessel occlusion. However, an increasing number of studies have demonstrated that about half of patients had poor functional recovery despite successful recanalization, namely futile recanalization. Previous studies suggested that tissue no-reflow (lack of reperfusion despite recanalized large vessel), early re-occlusion, poor collateral status, hemorrhagic transformation, impaired cerebral autoregulation and large hypoperfusion volume may all contribute to futile recanalization. Targeted treatment strategies for these mechanisms have been attempted in pre-clinical researches but failed to translate into clinical practices. This review aimed to summarize the mechanisms of futile recanalization and potential targeted treatment strategies, particularly focus on the no-reflow phenomenon and its mechanisms, clinical evaluation, and treatment approaches, hoping to promote translational research and improve the status of stroke treatment.

Application of imaging evaluation in endovascular recanalization of non-acute symptomatic intracranial large artery occlusion / 国际脑血管病杂志

Many studies have shown that endovascular recanalization is feasible for the treatment of non-acute symptomatic intracranial large artery occlusion. However, its incidence of perioperative complications is relatively high. Appropriate imaging evaluation can better observe the occluded segments of the vessels before procedure, thereby guiding the choice of clinical treatment.

Risk score elaboration for stroke in cardiac surgery

Abstract Introduction: Stroke is a complication that causes considerable morbidity and mortality during the heart surgery postoperative period (incidence: 1.3 to 5%; mortality: 13 to 41%). Models for assessing the risk of stroke after heart surgery have been proposed, but most of them do not evaluate postoperative morbidity. The aim of this study was to develop a risk score for postoperative stroke in patients who undergo heart surgery with cardiopulmonary bypass. Methods: A cohort study was conducted with data from 4,862 patients who underwent surgery from 1996 to 2016. Logistic regression was used to assess relationships between risk factors and stroke. Data from 3,258 patients were used to construct the model. The model's performance was then validated using data from the remainder of the patients (n=1,604). The model's accuracy was tested using the area under the receiver operating characteristic (ROC) curve. Results: The prevalence of stroke during the postoperative period was 3% (n=149); 59% of the patients who exhibited this outcome were male, 51% were aged ≥ 66 years, and 31.5% of the patients died. The variables that remained as independent predictors of the outcome after multivariate analysis were advanced age, urgent/emergency surgery, peripheral arterial occlusive disease, history of cerebrovascular disease, and cardiopulmonary bypass time ≥ 110 minutes. The area under the ROC curve was 0.71 (95% confidence interval 0.66 - 0.75). Conclusion: We were able to develop a risk score for stroke after heart surgery. This score classifies patients as low, medium, high, or very high risk of a surgery-related stroke.

Nível de atividade física, qualidade do sono e de vida em pacientes com doença arterial periférica / Level of physical activity, quality of sleep and life in patients with peripheral arterial disease

Introdução: a Doença Arterial Periférica (DAP) decorre do estreitamento ou oclusão arterial, que interfere no aporte sanguíneo das extremidades inferiores. A DAP pode levar a um repouso prolongado, causando prejuízos à qualidade de vida e do sono dos pacientes, devido à dor e receio de lesão. Objetivo: descrever o nível de atividade física, a qualidade de vida e do sono em pacientes com DAP. Metodologia: trata-se de um estudo observacional, epidemiológico e transversal, realizado no Hospital Geral de Camaçari-BA. Foram incluídos pacientes com diagnóstico de DAP, ambos os sexos, com idade superior a 18 anos, internados no referido hospital. Foram excluídos os pacientes com distúrbios psiquiátricos e dificuldade de compreensão dos questionários. Para a avaliação do nível de atividade física foi utilizado o Questionário Internacional de Atividade física, para Qualidade de Vida o questionário Short Form Health Survey 36, para qualidade do sono Índice de Qualidade do Sono de Pittsburgh e para Claudicação Intermitente o Questionário de Edimburgo. Resultados: dos 27 pacientes analisados, 55,6% (15/27) eram do sexo feminino e 44,4% (12/27) masculino, 37% (10/27) de cor/raça preta. A média de idade foi de 62,6±8,3 anos, peso 71,8±16,2kg, altura 164,8±8,3cm e IMC 26,3±5. A maioria relatou ser ativo, 33,3% (9/27). Segundo a SF-36 o domínio mais limitante foi "dor" (28,6), o escore global do PSQI foi de 10,4 e a maioria (81,5%) não apresentava claudicação intermitente. Conclusão: a presença de DAP foi mais frequente nos idosos e foram identificados a presença de distúrbios do sono e diminuição da qualidade de vida.

Introduction: peripheral Arterial Disease (PAD) is due to narrowing or arterial occlusion, which interferes with the blood supply of the lower extremities. PAD can lead to prolonged rest, causing damage to the quality of life and sleep of patients, due to pain and fear of injury. Objective: to describe the level of physical activity, quality of life and sleep in patients with PAD. Methodology: this is an observational, epidemiological and cross-sectional study, carried out at the Hospital Geral de Camaçari-BA. Patients diagnosed with PAD, both sexes, aged over 18 years, admitted to the hospital were included. Patients with psychiatric disorders and difficulty in understanding the questionnaires were excluded. To assess the level of physical activity, the International Physical Activity Questionnaire was used, for Quality of Life the Short Form Health Survey 36 questionnaire, for sleep quality Sleep Quality Index of Pittsburgh and for Intermittent Claudication the Edinburgh Questionnaire. Results: of the 27 patients analyzed, 55.6% (15/27) were female and 44,4% (12/27) were male, 37% (10/27) were black / colored. The mean age was 62.6 ± 8.3 years, weight 71.8 ± 16.2 kg, height 164.8 ± 8.3 cm and BMI 26.3 ± 5. The majority reported being active, 33.3% (9/27). According to SF-36, the most limiting domain was "pain" (28.6), the global PSQI score was 10.4 and the majority (81.5%) did not have intermittent claudication. Conclusion: the presence of PAD was more frequent in the elderly and the presence of sleep disorders and decreased quality of life was identified.

Síntomas neurológicos motores de inicio súbito en el síndrome de Leriche / Sudden onset motor neurological symptoms in Leriche's syndrome

Resumen El síndrome de Leriche es una enfermedad poco frecuente, con gran morbilidad y mortalidad, que ocurre debido a oclusión de las ramas principales de la aorta abdominal por debajo de la bifurcación de las arterias renales. Clínicamente, se caracteriza por la tríada de claudicación, impotencia y disminución de los pulsos femorales. El diagnóstico se confirma por ecografía Doppler abdominal o angiografía por tomografía computarizada y el tratamiento se basa en el restablecimiento del flujo por debajo del nivel de la oclusión. Se presenta el caso de un paciente con cuadro clínico atípico de dolor lumbar, paraparesia y livideces de miembros inferiores de inicio súbito, con rápido deterioro de su estado general que requirió intervención endovascular urgente. En esta ocasión, los síntomas neurológicos pueden ser explicados por la reducción del flujo sanguíneo de la arteria espinal magna, que en el 25 % de la población se origina en L1 o por debajo de ella y puede generar isquemia de la médula espinal. La presentación atípica de este reporte lo convierte en un desafío clínico de gran importancia.

Abstract Leriche syndrome is a rare disease with high morbidity and mortality that occurs due to occlusion of the main branches of the abdominal aorta below the bifurcation of the renal arteries. Clinically, it is characterized by the triad of claudication, impotence and decreased femoral pulses. Diagnosis is confirmed by abdominal Doppler ultrasound or computed tomography angiography and treatment is based on restoration of arterial flow below the level of occlusion. We present the case of a patient with an atypical clinical presentation of sudden onset of low back pain, paraparesis and lividity of the lower limbs, with rapid deterioration of his general condition that required urgent endovascular intervention. On this occasion, the neurological symptoms can be explained by reduced blood flow in the magna spinal artery, which in 25% of the population originates at or below L1 and can generate spinal cord ischemia. The atypical presentation of this report makes it a clinical challenge of great importance.

Correlation between white matter hyperintensities and collateral circulation in patients with stroke caused by anterior circulation large vessel occlusion / 国际脑血管病杂志

Objective:To investigate the correlation between white matter hyperintensities (WMHs) and collateral circulation in patients with stroke caused by anterior circulation large vessel occlusion (aLVO).Methods:Patients with stroke caused by aLVO treated with endovascular mechanical thrombectomy in the Department of Neurology, Zhengzhou People's Hospital from December 2017 to April 2021 were retrospectively enrolled. Their demography, vascular risk factors, baseline clinical data and Fazekas scale score were collected. Multivariate logistic regression analysis was used to determine the independent correlation between WMHs and the collateral circulation status in patients with aLVO. Results:During the study, 166 patients with aLVO were included (77 males, 46.39%; aged 69.62±5.91 years). Their baseline National Institutes of Health Stroke Scale (NIHSS) score was 9.33±4.42. There were 120 patients (72.29%) in the good collateral circulation group and 46 (27.71%) in the poor collateral circulation group. Univariate analysis showed that there were significant differences in baseline NIHSS score, total Fazekas score and periventricular Fazekas score between the good collateral circulation group and the poor collateral circulation group (all P<0.05). Multivariate logistic regression analysis showed that total Fazekas score (odds ratio 2.583, 95% confidence interval 1.445-4.619; P=0.001) and periventricular Fazekas score (odds ratio 2.190, 95% confidence interval 1.022-4.692; P=0.044) were the independent risk factors for the poor collateral circulation. Conclusion:The severity of WMHs is associated with the poor collateral circulation in patients with aLVO.

Clinical significance of FLAIR vascular hyperintensities in patients with chronic atherosclerotic middle cerebral artery occlusion / 国际脑血管病杂志

Objective:To investigate the clinical significance of fluid-attenuated inversion recovery (FLAIR) vascular hyperintensities (FVHs) in patients with chronic atherosclerotic middle cerebral artery occlusion.Methods:From July 2016 to November 2020, patients admitted to the Department of Neurology, Jiangdu People's Hospital of Yangzhou and first found chronic atherosclerotic middle cerebral artery occlusion were enrolled. The demographic, clinical and MRI imaging data were collected. According to the presence or absence of acute cerebral infarction, they were divided into the non-acute cerebral infarction group and the acute cerebral infarction group. According to the modified Rankin Scale score at 3 months after the onset, patients with acute cerebral infarction were further divided into the good outcome group (≤2) and the poor outcome group (>2). A multivariate logistic regression model was used to analyze the independent correlation between FVHs and the risk of cerebral infarction in patients with chronic atherosclerotic middle cerebral artery occlusion and the outcome in patients with cerebral infarction. Results:A total of 94 patients with chronic atherosclerotic middle cerebral artery occlusion were enrolled, including 38 with non-acute cerebral infarction (40.4%) and 56 with acute cerebral infarction (59.6%). In patients with acute cerebral infarction, 13 (23.2%) had a poor outcome, and 43 (76.8%) had a good outcome. The fibrinogen level, the proportion of patients with FVHs and the FVHs score in the cerebral infarction group were significantly higher than those in the non-cerebral infarction group (all P<0.05). Multivariate logistic regression analysis showed that the FVHs score was significantly, independently, and positively correlated with the risk of acute cerebral infarction (odds ratio 2.524, 95% confidence interval 1.400-4.552; P=0.002). The National Institutes of Health Stroke Scale score at admission, the modified Rankin Scale score at admission, and FVHs score in the poor outcome group were significantly higher than those in the good outcome group (all P<0.05). Multivariate logistic regression analysis showed that there was a significant independent negative correlation between the FVHs score and the outcome of patients with cerebral infarction (odds ratio 0.144, 95% confidence interval 0.045-0.459; P=0.001). Conclusions:FVHs suggest that the blood supply is in a state of decompensation. When FVHs are present, the risk of cerebral infarction in patients with chronic middle cerebral artery occlusion is significantly increased; the wider the range of FVHs, the higher the risk of poor outcome after cerebral infarction.

Correlation of fluid-attenuation inversion recovery vascular hyperintensity and clinical outcome in patients with middle cerebral artery M1 occlusive stroke / 国际脑血管病杂志

Objective:To investigate the correlation of fluid-attenuation inversion recovery (FLAIR) vascular hyperintensity (FVH) and clinical outcome in patients with middle cerebral artery M1 occlusive stroke.Methods:Patients with acute middle cerebral artery M1 occlusive stroke admitted to the Department of Neurology, the Second Affiliated Hospital of Anhui Medical University from June 2018 to September 2019 were enrolled retrospectively. The demographic and clinical data were collected. Diffusion-weighted imaging (DWI)-Alberta Stroke Program Early CT Score (ASPECTS) and FVH score were performed with MRI images. The modified Rankin Scale (MRS) was used to evaluate the clinical outcome at 90 d after onset. 0-2 was defined as good outcome, and >2 was defined as poor outcome. Multivariate logistic regression analysis was used to determine the independent correlation between FVH and the outcome. Results:A total of 65 patients with acute middle cerebral artery M1 occlusive stroke were enrolled, including 37 males (56.9%). Their age was 64.35±12.13 years. Twenty-nine patients (44.6%) had a good outcome, and 36 (55.4%) had a poor outcome. There were significant differences in triglyceride ( P=0.037), antihypertensive drug treatment ( P=0.037), baseline National Institutes of Health Stroke Scale (NIHSS) score ( P<0.001), DWI-ASPECTS ( P=0.017) and FVH score ( P<0.001) between the poor outcome group and the good outcome group. Multivariate logistic regression analysis showed that FVH score (odds ratio 6.477, 95% confidence interval 1.570-26.716; P=0.010) and NIHSS score (odds ratio 1.869, 95% confidence interval 1.326-2.635; P<0.001) were significantly independently correlated with the poor outcome. However, there was no significant independent correlation between DWI-ASPECTS and the outcome (odds ratio 0.451, 95% confidence interval 0.068-2.988; P=0.410). Conclusions:FVH score is an independent risk factor for poor outcome in patients with acute middle cerebral artery M1 occlusive stroke.

Comparison of short and long term curative effect between conservative and interventional therapy in Fontaine stage Ⅱ patients with lower extremity arteriosclerosis obliterans / 中华普通外科杂志

Objective:To compare the short-and long-term effects of conservative and interventional treatment in patients with lower extremity arteriosclerosis obliterans of Fontaine stage Ⅱ.Methods:This is a retrospective analysis,184 patients (219 limbs) admitted to the Department of Vascular Surgery, First Affiliated Hospital of Shandong First Medical University from Jun 2014 to Jun 2017, were divided into the conservative treatment group (93 limbs) and interventional treatment group (126 limbs).Results:The short-term effective rate in the intervention group was better than that of the conservative group (83.33% vs. 45.16%, P<0.05). After one year follow-up, the total effective rate in the groups was similar (60.32% vs. 53.76%, P>0.05). While the total effective rate of the conservative group was better than that of the intervention group (60.21% vs. 53.17%) after the 3-year follow-up,though the differences were not statistically significant ( P>0.05). The rates of all-cause death, amputation, and cardiovascular events in the conservative group were lower; though the difference was not significant ( P>0.05). However, the intervention group had a significantly higher rate of restenosis and re-intervention rate during the 3-year follow-up period ( P<0.05). Conclusion:Compared to intervention group,the conservative treatment is more economical ,effective and safe for patients with lower extremity arteriosclerosis obliterans of Fontaine stage Ⅱ.

Remote endarterectomy for complex lower extremity ischemia / 中华普通外科杂志

Objective:To evaluate the effect of remote endarterectomy in the treatment of complex lower extremity ischemia.Methods:Twenty-one limb ischemic patients underwent remote endarterectomy in Beijing Hospital from Sep 2016 to Feb 2020. Clinical data including general condition, the lesion of lower artery before operation and follow up outcomes were collected. Then the patency rate and limb salvage rate were calculated.Results:The technique success rate was 71.4% (15/21). The 3, 6, 12 month patency rate were 93.3%, 85.6% and 74.1%, respectively. The 1-year limb salvage rate was 93.3% (14/15). In the 6 patients converted to artificial vessel bypass, the 3,6,12 months patency rates were 76.7%, 66.7% and 46.8%, respectively. The 1-year limb salvage rate was 66.7%.Conclusions:Remote endarterectomy of the lower extremity artery is an alternative option in the treatment of complex ischemic lesions of the lower extremity artery, other than artificial vessel bypass.

Selective stent implantation for treatment of severe residual stenosis of intracranial target artery after successful mechanical thrombectomy / 中国介入影像与治疗学

Objective: To investigate the feasibility of selective stent implantation for treatment of severe residual stenosis of intracranial target artery after successful mechanical thrombectomy (MT). Methods: Selective stent implantation was successfully performed for treatment of severe residual stenosis of the intracranial target artery after MT in 4 patients, and the data of patients were analyzed retrospectively. Results: The occluded arteries of 4 patients were all successfully recanalized after MT, and all the target arteries remained severe stenosis (≥70%) with antegrade blood flow stable. Two patients with major acute infraction on MRI within 72 h underwent stent implantation 48 days and 27 days after thrombectomy, while the other two with minor infraction and little neural deficits underwent stent implantation 4 days and 12 days after thrombectomy, respectively. The blood flows were all satisfying after stenting, no complication occurred, and modified Rankin scale (mRS) of all patients were ≤2 after 90 days. No stent migration was observed at the end of follow-up, and all target arteries remained patent. Conclusion: Selective stent implantation is an alternative, relatively safe and effective treatment method for residual severe intracranial stenosis after the reexamination of cerebral infarction and the neurological function.

Research progress of drug-coated balloon therapy for lower extremity atherosclerotic disease / 中国介入影像与治疗学

Lower extremity artery disease (LEAD) is a kind of disease caused by atherosclerosis, which leads to narrowing and occlusion of lower extremity artery and causes ischemia symptoms of corresponding limbs. Endovascular intervention has become the main treatment method for LEAD, mainly including percutaneous transluminal angioplasty (PTA) and stent implantation, but high restenosis rate is still unavoidable after treatment. Drug-coated balloon (DCB) can inhibit intimal hyperplasia and inflammation while avoid the retention of foreign bodies, having good therapeutic effects on both primary lesions and in-stent restenosis. The principle of DCB therapy, application status and research advancements of DCB for LEAD were reviewed in this article.

Comparison on radiation dose of direct aspiration one-time thrombectomy and stent thrombectomy in treatment of acute middle cerebral artery occlusion / 中国介入影像与治疗学

Objective: To compare the radiation dose of direct aspiration first-pass thrombectomy (ADAPT) and conventional stent thrombectomy in treatment of acute middle cerebral artery occlusion. Methods: Totally 54 middle cerebral artery occlusion patients were retrospectively analyzed. The patients were divided into ADAPT group (n=29) and stent group (conventional stent removal, n=25) according to interventional treatment method. The intraoperative fluoroscopy time, air kerma (AK), dose area product (DAP), the number of photographic sequences and photographic frames were recorded and compared between 2 groups, and the correlations of the above indicators were analyzed. Results: The fluoroscopy time, AK, DAP, the number of photographic sequences and photographic frames in ADAPT group were all lower than those in stent group (all P<0.05). There were 25 cases (25/29, 86.21%) in ADAPT group and 13 cases (13/25, 52.00%) in stent group AK value <1.0 Gy, and the rate of patients with DAP value <1.0 Gy in ADAPT group was higher than that in stent group (P<0.01). There were 22 cases (22/29, 75.86%) in ADAPT group and 11 cases (11/25, 44.00%) in stent group DAP value <100 Gy•cm2, and the rate of patients with DAP value <100 Gy•cm2 in ADAPT group was higher than that in stent group (P=0.01). The fluoroscopy time was positively correlated with DAP (r=0.60, P<0.01) and AK (r=0.69, P<0.01), so was DAP and AK (r=0.81, P<0.01). Conclusion: The radiation dose of ADAPT technology was lower than conventional stent removal for treatment of acute middle cerebral artery occlusion.

Cardiac and extra-cardiac pathologies in patients with acute arterial occlusion

SUMMARY OBJECTIVE: We aimed to investigate cardiac and extra-cardiac pathologies in patients who were operated for acute arterial occlusion. METHODS: Between March 2010 and March 2018, a total of 120 patients who underwent surgical treatment for acute arterial occlusion were included in this retrospective study. RESULTS: 84 (70%) and 27 (22. 5%) of the patients had cardiac and extra-cardiac pathologies, respectively. In 9 (7. 5%) of the cases, no reason for arterial occlusion could be found. Pure atrial fibrillation was found in 39 (32. 5%) patients. Atrial fibrillation and cardiac valvular pathologies were detected in 45 patients (37. 5%). Among those with a cardiac valvular pathology, 9 patients (7. 5%) had pure mitral stenosis, 21 patients (17. 5%) had moderate to advanced mitral stenosis with tricuspid regurgitation, 9 patients (7. 5%) had 20-30 mitral regurgitation with 30 tricuspid regurgitation, 3 patients (2. 5%) had moderate mitral stenosis, 30-40 tricuspid regurgitation and 20-30 aortic stenosis, and 3 patients (2. 5%) had 30 mitral regurgitation, 10- 20 tricuspid regurgitation, calcific moderate aortic stenosis, and coronary artery disease. Among those 27 patients with an extra-cardiac pathology, 21 patients (22. 5%) had peripheral artery disease, 3 patients (2.5%) had an abdominal aortic aneurysm, and 3 patients (2. 5%) had Behçet's Disease. CONCLUSION: Cardiac and extra-cardiac pathologies should be kept in mind in patients with acute arterial occlusion. Thus, detected pathologies could be treated, and the development of additional peripheral emboli could be prevented.

RESUMO OBJETIVO: O objetivo do estudo é investigar patologias cardíacas e extracardíacas em pacientes operados por oclusão arterial aguda. MÉTODOS: Entre março de 2010 e março de 2018, um total de 120 pacientes submetidos a tratamento cirúrgico para oclusão arterial aguda foram incluídos neste estudo retrospectivo. RESULTADOS: Dos pacientes incluídos, 84 (70%) e 27 (22.5%) apresentavam, respectivamente, patologias cardíacas e extracardíacas. Em 9 (7.5%) dos casos, nenhuma cause para a oclusão arterial foi encontrada. Fibrilação atrial isolada foi encontrada em 39 (32.5%) pacientes. Fibrilação atrial e valvopatias cardíacas foram detectadas em 45 pacientes (37.5%). Entre aqueles com valvopatias cardíacas, 9 (7.5%) tinham estenose mitral isolada, 21 (17. 5%) tinham estenose mitral moderada a avançada com regurgitação tricúspide, 9 (7. 5%) tinham 2°-3° de regurgitação mitral com 3o regurgitação tricúspide, 3 (2. 5%) tinham estenose mitral moderada, 3°-4° regurgitação tricúspide e 2°-3° estenose aórtica, e 3 (2.5%) tinham 3o mitral, 1°- 2° regurgitação tricúspide moderada, estenose aórtica moderada calcificada e doença coronariana. Entre os 27 pacientes com patologia extracardíaca, 21 (22.5%) tinham doença arterial periférica, 3 (2,5%) tinham aneurisma da aorta abdominal, e 3 (2.5%) tinham Doença de Behçet. CONCLUSÃO: Patologias cardíacas e extracardíacas devem ser consideradas em pacientes com oclusão arterial aguda. Assim, patologias detectadas podem ser tratadas e o desenvolvimento de trombos periféricos adicionais pode ser evitado.

Sclerosing mediastinitis causing unilateral pulmonary edema due to left atrial and pulmonary venous compression. a case report and literature review

Abstract Sclerosing mediastinitis (SM), previously named chronic fibrosing mediastinitis, is an inflammatory process that in its end-stage results to sclerosis around the mediastinal structures. SM is quite rare and has been correlated with inflammatory and autoimmune diseases, as well as malignancy. SM may either present in a mild form, with minor symptoms and a benign course or in a more aggressive form with severe pulmonary hypertension and subsequent higher morbidity and mortality. The diagnosis of SM may be difficult and quite challenging, as symptoms depend on the mediastinal structure that is mainly involved; quite often the superior vena cava. However, practically any mediastinal structure may be involved by the fibrotic process, such as the central airways, as well as the pulmonary arteries and veins, leading to obstruction or total occlusion. The latter may be impossible to undergo proper surgical excision of the lesion, and is considered to be a real challenge to the surgeon. We herein report a case of SM that presented with arterial and venous compression. The imaging appearance was that of unilateral pulmonary edema, associated with lung collapse. The case is supplemented by a non-systematic review of the relevant literature.