Analysis of therapeutic effects on endovascular recanalization of symptomatic non-acute middle cerebral artery occlusion / 中国综合临床

Objective:To investigate the preoperative evaluation, safety and clinical efficacy of intravascular recanalization for patients with symptomatic non-acute middle cerebral artery occlusion .Methods:Twenty-six patients with symptomatic non-acute middle cerebral artery occlusion admitted between January 2018 to June 2021 were retrospectively analyzed. The clinical symptoms, cerebral perfusion, occlusive site, occlusive length, collateral circulation and distal capillary were evaluated. There were 17 cases accorded with intravascular recanalization. The cerebral blood flow , cerebral blood volume, MTT, peak time and scores of 17 patients before and after revascularization were compared by paired t test.Results:Endovascular recanalization was performed in 17 patients and extracranial-intracranial artery bypass grafting was performed in 9 patients. Among the 17 cases, there were 7 cases of hemiplegia of contralateral limbs, 6 cases of recurrent cerebral infarction, 4 cases of paroxysmal contralateral limb numbness or weakness, 3 cases of cognitive dysfunction and 3 cases of headache. The cerebral perfusion of the occluded side of the middle cerebral artery in 17 cases was significantly lower than that of the healthy side. One patient failed to pass through the occlusion with micro guide wire, and gave up the operation after repeated attempts. The occluded vessels were successfully recanalized in 16 cases (thrombolytic grade of cerebral infarction=2b-3), and recanalized in 16 cases, including 9 cases of simple balloon dilatation and 7 cases of stent implantation. Three months after the operation, the National Institute of Health Stroke Scale (NIHSS) score of 17 patients decreased from (9.57±2.32) to (3.75±1.42). The cerebral blood flow, cerebral blood volume, mean transit time and peak time were also significantly improved compared with those before the operation（ t value was 9.08，5.54，4.26，8.56，6.00，respectively，all P<0.001）. The Montreal Cognitive Assessment (MoCA) score of cognitive function was (22.70±1.70) before the operation, and there months after operation (26.30±2.30) points ( t=6.66, P<0.001) were statistically significant. After operation, CT cerebral angiography or whole cerebral angiography showed that 1 case was occluded, 15 cases had good recanalization, no intracranial hemorrhage occurred during the perioperative period, and no new stroke occurred during the 6-month follow-up period. Conclusion:For patients with symptomatic non acute middle cerebral artery occlusion, the patients who may benefit from multi-dimensional evaluation are selected for intravascular recanalization treatment. There are few complications and high recanalization rate. The short-term follow-up clinical effect is good, but the long-term effect needs to be further observed.

Therapeutic effect of intervention therapy for central venous stenosis in maintenance hemodialysis patients / 第二军医大学学报

Objective To explore the efficacy of interventional therapy for central venous stenosis in maintenance hemodialysis patients. Methods The general clinical data of the maintenance hemodialysis patients with central venous stenosis, who received interventional therapy in Changzheng Hospital of Naval Medical University (Second Military Medical University) from Jan. 2014 to Mar. 2018, were retrospectively analyzed, and the patency of vascular access of interventional therapy were followed up. Results A total of 82 maintenance hemodialysis patients with central venous stenosis were enrolled. Six-eight patients (82.93%) had a history of temporary central venous catheterization. Among the 82 patients, 13 (15.85%) had double lesions of central vein and 69 (84.15%) had single lesion; and 5 (6.10%) had mild lesions, 17 (20.73%) had moderate lesions, 35 (42.68%) had severe lesions and 25 (30.49%) had complete occlusion. Of the 82 patients, 57 were treated by percutaneous transluminal angioplasty and 9 by percutaneous transluminal stenting. The follow-up period ranged from 12 to 62 months after operation. The patency rate of vascular access was 75.76% (50/66) at 6 months postoperatively and 68.18% (45/66) at 12 months postoperatively. The overall patency rate of vascular access was 59.09% (39/66). Conclusion Central venous stenosis of the maintenance hemodialysis patients can affect the life of vascular access. For the patients with symptoms that can not be alleviated, active intervention is recommended. Intervention therapy is safe and effective for the patients with central venous stenosis. Meanwhile, the central venous catheterization shall be avoided if possible to reduce central venous stenosis in the patients with chronic kidney disease.

Detrimental Effects of Endovascular Intervention in Active Rheumatoid Vasculitis

Balloon angioplasty can cause shear stress and tear of the vascular endothelium during mechanical dilatation, leading to increased inflammation and coagulation reactions of the vascular endothelium. Herein, a worst case of active rheumatoid vasculitis is described, where due to progressing ischemic necrosis of the leg, endovascular intervention was unavoidably performed in the presence of active rheumatoid vasculitis. After percutaneous balloon angioplasty, the patient developed recurrent thrombotic occlusion of the leg arteries, and finally, limb amputation resulted in despite vigorous treatment including medication, immunosuppression, catheter-directed thrombolysis, and post-thrombolysis anticoagulation. This case report indicates that endovascular intervention may be detrimental to the active rheumatoid vasculitis. Until the development of treatment guideline to prevent or control inflammatory reaction, endovascular intervention for the active rheumatoid vasculitis may not be appropriate as a first line therapy even though there is progressing ischemic necrosis.

Clinical study of endovascular interventional therapy for the symptomatic high-grade basilar artery stenosis / 中国神经精神疾病杂志

Objective To explore the efficacy,safety and short-term effects of endovascular therapy in the treatment of the symptomatic high-grade basilar artery stenosis.Methods Two hundred thirteen patients with the symptomatic high-grade basilar artery stenosis (＞90％) confirmed by MRA,CTA or DSA was treated by endovascular intervention,the changes of clinical symptoms,the success rate and short-term follow-up results was analyzed.Results Endovascular stent was successfully placed in 209 patients with symptomatic high-grade basilar artery stenosis and the success rate was 98.12％.The degree of vascular stenosis was significantly reduced after stenosis (Before vs After:93.70％±2.51％ vs 11.60％±3.90％).Eight patients had complications (3.76％) including 7 cases of ischemic stroke and 1 case of subarachnoid hemorrhage.The average follow-up duration was 18.70±3.80 months.Two hundred two patients underwent a second DSA and the mean vascular stenosis was (13.80％±4.20％).Five patients developed in-stent restenosis (ISR),of which one was symptomatic.Conclusion Endovascular therapy of the symptomatic high-grade basilar artery stenosis is safety and efficacy.The 1.5 years follow-up results reveal good patency rate and excellent prevention of posterior circulation ischemia.

Clinical observation on intravenous thrombolytic bridging and vascular intervention for treatment of patients with acute intracranial large arterial occlusion: a report of 7 cases / 中国中西医结合急救杂志

Objective To evaluate the efficacy and safety of using alteplase for intravenous thrombolysis combined with vascular intervention for treatment of patients with acute intracranial large arterial occlusion.Methods Clinical data of 7 patients with acute intracranial large arterial occlusion treated by using alteplase for intravenous thrombolysis combined with intravascular intervention admitted to Department of Neurosurgery in Affiliated Hospital of the Logistics University of Cinese People's Armed Police Force from July 2015 to August 2016 were retrospectively analyzed.All the 7 patients were treated by alteplase dry powder (50 mg or 20 mg each ampule),solvent dose was 0.9 mg/kg,the maximum dose being ＜ 90 mg,firstly 10％ dose was intravenously injected,and the remaining dose was continuously infused into a vein in 60 minutes,during or after intravenous thrombolysis,digital subtraction angiography (DSA) was performed immediately,and according to the results of the angiography,at least one of the 3 kinds of intravascular mechanical intervention therapy,thrombectomy,balloon dilatation or stent placement,were chosen,and 24 hours after surgery,the anti-platelet aggregation drug and calcium channel antagonists were given,The effect of interventional therapy was analyzed,and the clinical outcome of 90-day treatment was evaluated.Results The mean age of the patients was (60.0 ± 12.6) years.Seven patients all successfully completed the treatment,and satisfactory re-canalization was achieved [they all obtained grade 3 or 2b in accord with the gradation of Thrombolysis in Cerebral Ischemia Scale (TICI)] in all the 7 cases (100％),after treatment,the National Institutes of Health Stroke Scale (NIHSS) score was significantly lower than that before treatment (5.86 ±4.10 vs.19.71 ± 5.56,P ＜0.01).Clinical outcome of 90-day follow up was excellent [Modified Rankin Scale (mRS) score 0-2] in 3 cases (42.8％).Conclusion Using alteplase for intravenous thrombolysis combined with endovascular intervention for treatment of patients with acute intracranial large arterial occlusion can achieve good re-canalization rate.

Research advances in heparin-induced thrombocytopenia / 介入放射学杂志

Clinically,heparin-induced thrombocytopenia (HIT) is an uncommon but serious disease,which is induced by the use of immune unfractionated heparin or low-molecular-weight heparin.The overall incidence of HIT is about 0.6％-5.0％.Nevertheless,in clinical practice it is profoundly dangerous,especially for patients who are receiving cardiovascular surgery or interventional therapy.At present,HIT is a hot clinical research subject.This paper aims to make a brief review about HIT pathogenesis,epidemiology,clinical evaluation and treatment,etc.

Effects of Embolization and Clipping Therapy on Cognitive Function in Patients with Intracranial Aneurysms / 现代生物医学进展

Objective:To evaluate the effects of endovascular embolization and microsurgical clipping on cognitive function in patients with intracranial aneurysm.Methods:A total of 80 patients with intracranial aneurysms,who were treated in Chongqing Hospital of Traditional Chinese Medicine from March 2014 to September 2015,were selected and randomly divided into control group(n=40) and experimental group (n=40).The control group was treated with microsurgical clipping,and the experimental group,with endovascular embolization.The postoperative cognitive function was assessed by the mini mental state examination scale (MMSE),and length of stay,in-hospital mortality rate,mortality rate in 1 year and the incidence of postoperative adverse reactions were compared between the two groups.Results:The total score (26.78± 0.85) of MMSE in the experimental group was higher than that (22.25± 0.63) of the control group (P＜0.05).The cognitive dysfunction rate (37.50％) of the experimental group was lower than that (55.00％) of the control group (P＜0.05).The length of stay [(6.7± 3.9) days] of the experimental group was lower than that [(9.6± 4.5) days] of the control group(P＜0.05).There were no significant differences in in-hospital mortality rate and mortality rate in 1 year,and the incidence of adverse reactions between the two groups (P＞0.05).Conclusion:Endovascular interventional therapy can improve the cognitive function of the patients with intracranial aneurysms and shorten the length of hospital stay.

Popliteal artery pseudoaneurysm successfully treated with amplatzer vascular plug

Popliteal artery pseudoaneurysm is uncommon. They usually result from penetrating or blunt trauma, arterial reconstructive surgery, invasive diagnostic or surgical orthopedic procedures. They can cause arterial thrombosis and limb ischeamia. We report a 53 year old Chinese gentleman with popliteal artery pseudoaneurysm who presented with right lower limb numbness and paralysis in toes extension. He gave a history of acupuncture treatment around the popliteal fossa of the affected limb. Clinical examination revealed a pulsatile mass in the popliteal fossa. Computed tomography angiography showed a large, 5 cm, pseudoaneurysm arising from the popliteal artery. A diagnostic angiogram was performed and revealed that there is no run off from the popliteal artery and the tibial vessels were reconstructed from collaterals. Endovascular intervention was carried out with an Amplatzer Vascular Plug to embolise the pseudoaneurysm. The pseudoaneurysm was successfully excluded and post-op follow up revealed no more pulsatile mass and improving lower limb function. To the best of our knowledge this is first reported case of pseudoaneurysm of the popliteal artery secondary to acupuncture in Malaysia.

Use of the Sundt Clip Graft in a Previously Coiled Internal Carotid Artery Blister-Like Aneurysm

Owing to the focal wall defect covered with thin fibrous tissues, an aneurysm arising from the dorsal wall of the internal carotid artery (ICA) is difficult to manage either surgically or endovascularly and is often associated with high morbidity and mortality. Unfortunately, the definitive treatment modality of such highly risky aneurysm has not yet been demonstrated. Upon encountering the complex intracranial pathophysiology of such a highly precarious aneurysm, a neurosurgeon would be faced with a challenge to decide on an optimal approach. This is a case of multiple paraclinoid aneurysms including the ICA dorsal wall aneurysm, presented with spontaneous subarachnoid hemorrhage. With respect to treatment, direct clipping with a Sundt graft clip was performed after multiple endovascular interventions had failed. This surgical approach can be a treatment modality for a blood blister-like aneurysm after failed endovascular intervention(s).

Clinical effect observation of angioplasty for symptomatic intracranial atherosclerotic stenosis / 中国脑血管病杂志

Objective To investigate the clinical effect of angioplasty for symptomatic intracranial atherosclerotic stenosis. Methods Eighty-two patients with symptomatic intracranial atherosclerotic stenosis whom underwent angioplasty after the failure of standard medical therapy were enrolled from Nan-jing Stroke Registry Program from September 2010 to June 2013.Nine of them underwent routine balloon angioplasty alone and 73 underwent intracranial stenting.The median time from onset to surgery was 24.5 days.The occurrence of endpoint events (any stroke ≤30 d after procedure,death and ischemic stroke >30 d in guilty vessels or original stenosis had restenosis and needed to be treated again)was assessed. The incidence of restenosis was followed up with imaging (CTA or DSA). Results (1)In the 82 patients, the success rate of operation was 92.7%(n=72 ),and 78 (95.1%)received follow-up,4 were lost to follow-up.The median follow-up time was 22.5 months (range 9 to 29 months ).Ten patients had an endpoint event,7 of them were ischemic stroke,1 was cerebral hemorrhage,and two were severe asymptomatic restenosis who underwent stenting again.The endpoint events of 3 patients occurred at day 30 after procedure (at ≤24 h after procedure).Kaplan-Meier curves showed that the incidences of cumulative endpoint events at 1,6,12,and 24 months were 3.7%,8.6%,11%,and 13%,respectively.(2)60 patients (73.2%)received imaging examination (11 CTA and 49 DSA ).Restenosis occurred in 17 patients (28.3%),among them the incidence of symptomatic restenosis was 5%(n =3 ),and asymptomatic restenosis was 23.3%(n=14). Conclusion After a comprehensive assessment and a rigorous screening, the safety is high and the mid- and long-term efficacy are satisfactory in patients with symptomatic intracranial arterial stenosis who are treated with angioplasty when their medical treatment is invalid.

Hemispheric Differences in Ischemic Stroke: Is Left-Hemisphere Stroke More Common?

BACKGROUND AND PURPOSE: Understanding the mechanisms underlying stroke can aid the development of therapies and improve the final outcome. The purposes of this study were to establish whether there are characteristic mechanistic differences in the frequency, severity, functional outcome, and mortality between left- and right-hemisphere ischemic stroke and, given the velocity differences in the carotid circulation and direct branching of the left common carotid artery from the aorta, whether large-vessel ischemia (including cardioembolism) is more common in the territory of the left middle cerebral artery. METHODS: Trial cohorts were combined into a data set of 476 samples. Using Trial of Org 10172 in Acute Stroke Treatment criteria, ischemic strokes in a total 317 patients were included in the analysis. Hemorrhagic stroke, stroke of undetermined etiology, cryptogenic stroke, and bilateral ischemic strokes were excluded. Laterality and vascular distribution were correlated with outcomes using a logistic regression model. The etiologies of the large-vessel strokes were atherosclerosis and cardioembolism. RESULTS: The overall event frequency, mortality, National Institutes of Health Stroke Scale (NIHSS) score, Glasgow Coma Scale score, and rate of mechanical thrombectomy interventions differed significantly between the hemispheres. Left-hemispheric strokes (54%) were more common than right-hemispheric strokes (46%; p=0.0073), and had higher admission NIHSS scores (p=0.011), increased mortality (p=0.0339), and higher endovascular intervention rates (p< or =0.0001). ischemic strokes were more frequent in the distribution of the left middle cerebral artery (122 vs. 97; p=0.0003) due to the higher incidence of large-vessel ischemic stroke in this area (p=0.0011). CONCLUSIONS: Left-hemispheric ischemic strokes appear to be more frequent and often have a worse outcome than their right-hemispheric counterparts. The incidence of large-vessel ischemic strokes is higher in the left middle cerebral artery distribution, contributing to these hemispheric differences. The hemispheric differences exhibit a nonsignificant trend when strokes in the middle cerebral artery distribution are excluded from the analysis.

Color Doppler ultrasound follow-up for patients of femoropopliteal arteriosclerosis undergoing endovascular intervention therapy / 中华普通外科杂志

Objective To evaluate Color Doppler ultrasonography follow up for patients of femoropopliteal arteriosclerosis after interventional therapy.Methods We used Color Doppler ultrasound (CDU) in 57 cases' follow-up of endovascular intervention therapy of femoropopliteal arteriosclerosis lesion to monitor and analyze arterial hemodynamics after endovascular intervention therapy.Results An average follow-up of 13 months( range:3 -33 ) was achieved.31 of the 57 cases were found with mild stenosis,8 cases were moderate stenosis,6 cases were severe stenosis,12 cases were complete occlusion.In these 57 cases there were 7 in Fontaine stage Ⅰ,42 cases in Fontaine stage Ⅱ,6 cases were Fontaine stage Ⅲ,2 cases were Fontaine stage Ⅳ.Ankle brachial index (ABI) ABI≥I.0 in 2 cases,0.8≤ABI ＜ 1.0 in 10 cases,0.8≤ABI ＜ 1.0 in 31 cases,and ABI ＜0.5 in 14 cases.There was significant correlation between stenosis and Fontaine stage ( r =0.47,P ＜ 0.01 ),so was between stenosis and ABI ( r =0.66,P ＜ 0.01 ).In this series 29 cases also underwent DSA,and the results between CDU and DSA were significandy consistent ( Kappa value =0.61,P ＜ 0.01 ).The sensitivity of CDU was 92％,the specificity was 75％ and the accuracy was 89.2％.Conclusions CDU can continuously monitor hemodynamics after endovascular intervention therapy.It is a sensitive,non-invasive and effective method to evaluate the clinical efficacy of endovascular intervention.

Exploration of diagnosis and treatment for intracranial aneurysm / 中国综合临床

Objective To discuss the selection of diagnosis for intracranial aneutysms,and to analyze thera-peutic efficacy of microsurgical treatment and endovascular embolizafion in the treatment of intracranial aneurysms.Methods 190 pailents suffeming from intracranial aneurysms experienced brain CT examination.37 cases detected by MRI.31 cases detected by MRA,134 were confirmed by computered tomographic angiography(CTA)or 3D-CTA,and 142 cases were confirmed by digital subtract angiography(DSA).96 patients underwent microsurgical treatment,4 of whom failed in endovascular embolization.92 cases underwent endovascufar therapy,2 of whom were embolized by ONYX,and the other were embolized by guglielmi detachable coil(GDC).Results 9 patients died,2 of whorn died of re-hemorrhage,3 died of severe vasospasm,4 died of pneumonia and other complications,and the others were cured.Conclusion CT is the first choice for the subarachniod hemorrhage;MBA could be a choice for the detection of intracranial aneurysm without hemorrhage,but is not suit for the aneurysm clipping.The size-form,relationship with patent arteries,and even the raptured point of aneurysms can be clearly demonstrated by CTA-and CTA can be used to the operation for intracranial aneurysms directly.DSA-especially 3D-DSA Call display the blood supply of the complicated aneurysms clearly,and can guide the treatment for intracnmial aneurysms directly.Endo-vascular therapy and aneurysm clipping seem like complimentary than competitive,patients with acute cerebral edema should try to undergo endovascular therapy,while the patients with severe vasespasm should be treated with microsur-gical operation immediately and resolutely.The ruptured aneurysms in multiple intracraniul aneurysm should be iden-tified correctly and treated in the early stage.

Interventional Treatment of Venous Thrombosis

Thrombosis can develop in any veins from vena cavae to peripheral extremity veins. It can develop from underlying steno-occlusive diseases of the vein such as May-Thurner syndrome, Budd-Chiari syndrome, thoracic outlet syndrome, etc. or with hypercoagulable diathesis due to various causes. When venous thrombosis develops, it can be managed medically or surgically. However, recent advances of endovascular interventional radiological procedures, more cases of venous thrombosis can be dealt with radiological interventions. Catheter-directed thrombolysis is the most commonly-used radiologic intervention for venous thrombosis, which has been proven safe and effective during the past years. Other radiological interventions encompass mechanical thrombectomy, balloon angioplasty and/or stenting, or combinations of each method. Owing to these radiological interventions, more patients can be treated in minimally invasive manners with less procedure-related discomfort, while with higher therapeutic efficacies and more improved safety. Still the standard treatment algorithm has not been accomplished for venous thrombotic diseases, and the best treatment protocol is warranted by cooperation of each expertise in internal medicine, surgery, and interventional radiology.

The Study Category and Method of Cerebrovascular Intervention / 国际脑血管病杂志

Cerebrovascular Intervention is to study the subject of diagnosing and treating cerebrovascular disease with interventional endovascular techniques monitored and guided by neuroimaging. With the continuous development of computer, imaging and angiography techniques, their study method and category are being innovated and expanded continuously in recent years. This article reviews the novel techniques of imaging diagnosis, intra-arterial thrombolysis, angioplasty and endovascular embolization in cerebrovascular diseases, and also evaluates their clinical applications.

Advances in the Treatment of Cerebral Venous Thrombosis / 国际脑血管病杂志

Cerebral venous thrombosis is a rare cerebral venous occlusive disease. Its clinical manifestations are variable, and this may lead to misdiagnosis or mistreatment. Prompt treatment is essential to improve its prognosis. This article reviews the recent treatment methods, especially the interventional endovascular treatment.

Contrast Media-Related Complications and Their Management in Cerebrovascular Intervention / 国际脑血管病杂志

Endovascular intervention is an effective method in the treatment of cerebrovascular stenosis. With the advancement of techniques and improvement of equipment, the application area of this treatment is expanding and the number of patients treated is increasing. Accordingly, the use of contrast media is improving continuously in endovascular intervention. An increasing number of contrast media-related complications have also been reported. This paper briefly reviews the contrast media-related complications and their management in endovascular intervention.

The Treatment of Posterior Circulation Ischemia / 国际脑血管病杂志

Posterior circulation iscbemia refers to the transient iscbemic attack and the cerebral infarction in vertebrobasilar artery system,its prognosis is not as good as anterior circulation ischemia,and its treatment is similar to that of anterior circulation ischemia.However,because of the mortality of basilar artery occlusion is higher,usually more aggressive treatment should be considered,such as thromholytic therapy(especially intra-arterial thromholysis)and endovas- cular therapy,and the therapeutic time window is much longer.This article reviews the treatment of anterior circulation ischemia.

Treatment of an Iliac Artery Anastomotic Pseudoaneurysm Managed with a Stent-Graft / 日本心臓血管外科学会雑誌

A 85-year-old man was admitted to our hospital with a right iliac artery anastomotic pseudoaneurysm after aorto-biiliac Y-shaped graft replacement for the treatment of abdominal aortic and biiliac aneurysms. We performed an endovascular intervention of this anastomotic pseudoaneurysm with an ePTFE-covered stent-graft. This method seemed to be very useful even in such a high-risk patient, because it can be done under local anesthesia.