Procedimiento para la infusión de mitocondrias autólogas por la arteria carótida en el cerebro porcino

Las mitocondrias son organelas complejas que desempeñan un papel fundamental en la célula, la disfunción mitocondrial puede ocasionar daños celulares significativos o la muerte. Estudios previos han demostrado los prometedores efectos terapéuticos del trasplante de mitocondrias autólogas a un tejido cardiaco isquémico, sin embargo, pocos estudios han evaluado los efectos in vivo de la infusión de mitocondrias en el cerebro. El presente trabajo tiene como objetivo dar a conocer el procedimiento para la infusión vía carótida de mitocondrias autólogas en cerebros porcinos. Mediante esta técnica de infusión, proponemos que una administración selectiva y mínimamente invasiva es factible y puede proporcionar beneficios en el tratamiento de diversas patologías del sistema nervioso central.

Mitochondria are complex organelles that play a critical role within the cell; mitochondrial dysfunction can result in significant cell damage or death. Previous studies have demonstrated the promising therapeutic effects of autologous mitochondria transplantation into ischemic cardiac tissue; however, few studies have examined the in vivo effects of mitochondria infusion into the brain. The aim of this study is to report a procedure for carotid infusion of autologous mitochondria into porcine brains. By using this infusion technique, we propose that a selective and minimally invasive administration is feasible and may provide benefits in the treatment of various central nervous system disorders.

Clinical observation of microcatheter assisted trabeculotomy on the treatment of childhood glaucoma / 中华实验眼科杂志

Objective To investigate the clinical efficacy and safety of microcatheter assisted trabeculectomy on the treatment of childhood glaucoma.Methods A prospective case series method was performed.Sixteen childhood glaucoma with 22 eyes were enrolled in Henan Eye Hospital and Zhengzhou Second People's Hospital from December 2016 to August 2017.Nine males with 12 eyes and 7 females with 10 eyes were included,and the age ranged from 6 months to 8 years (median 4 years).All the subjects underwent microcatheter assisted trabeculectomy.The intraocular pressure changes were observed preoperation and 7 days,1 month and 6 months after surgery,and the postoperative complications were analyzed.This study was approved by the Ethics Committee of Henan Eye Hospital (2018KS-01) and Zhengzhou Secord People's Hospital (No.20161202001),and adhered to the tenets of the Declaration of Helsinki.Written informed consent was obtained from each guardia prior to any medical examination.Results Twenty eyes of 14 patients underwent microcatheter assisted trabeculectomy,the success rate was 90.91％.Twelve eyes were operated with full incision (incision range was 360°),8 eyes were performed with subtotal incision (incision range was 180°-330°),while the microcatheter could not pass over 90° in 2 eyes and was switch to traditional Harms knife trabeculotomy-trabeculectomy intraoperatively.The intraocular pressures of the 20 eyes that underwent microcatheter assisted trabeculectomy preoperation,7 days,1 month and 6 months after surgery were (26.55 ±4.38),(20.48 ± 3.62),(13.71 ± 6.35) and (12.67 ± 5.37) mmHg,respectively.The intraocular pressures in patients at different time points were statistically significant (F=112.771,P＜0.001).At the last follow-up,the intraocular pressures of 18 eyes were controlled.Among them,16 eyes achieved completely controlled intraocular pressure while 2 eyes returned to normal intraocular pressure after using ocular hypotensive drugs.The intraocular pressure of 2 eyes increased again after operation,and the intraocular pressure could not be controlled after combined use of anti-hypertensive drugs.All patients had no serious complications during and after the operation.Different degrees of anterior chamber hemorrhage occurred in 16 eyes during the surgery,and all the hemorrhages were absorbed within 1 week after surgery.Conclusions For children with glaucoma,microcatheter assisted trabeculectomy can achieve good intraocular pressure reduction effect without serious complications.

The efficacy comparison of spring coil embolization under auxiliary technology and stent implantation spring coil embolization in the treatment of intracranial aneurysms / 中华内分泌外科杂志

Objective To compare the clinical effect of spring coil embolization under auxiliary technology and stent implantation spring coil embolization in treatment of intracranial aneurysms.Methods The medical records of 102 patients with intracranial aneurysms who were treated by endovascular embolization were retrospectively analyzed.These patients were divided into stent implantation spring coil embolization (n=58) and aux iliary spring coil embolization group(n=44) according to different treatment methods.The therapeutic effect of postoperative aneurysm embolization for patients of the two groups was evaluated.The postoperative hospitalization time,NIHSS score,ADL score and prognosis of patients in the two groups 6 months after treatment were compared.The incidence of complications of patients in the two groups was compared.Results There was no significant difference between the two groups about complete embolization rate,sub-total embolization rate and partial embolization rate after aneurysm surgery(72.73％,20.45％,6.82％ vs 68.97％,25.86％,5.17％)(P＞0.05).The postoperative hospitalization time of patients in the assistive coil embolization group (10.45±2.32) d was significantly less than that in the stent-assisted coil embolization (12.97±2.56) d (P＜0.05),but there was no significant difference in postoperative NIHSS score and ADL score between the two groups [(6.63±3.81),(60.12±9.80) vs (8.35±4.03),(59.63±9.47)(P＞0.05)].The recovery rate of patients in the assistive coil embolization group (68.18％) was significantly higher than that in the stent-assisted coil embolization group (55.17％) (P＜0.05),while the mortality rate (0％) was significantly lower than that in the stent-assisted coil embolization group (6.90％) (P＜0.05).The incidence of complications such as intraoperative cerebral vasospasm,postoperative gastrointestinal bleeding and postoperative cerebral infarction (9.09％,6.82％,4.55％) was significantly lower in the assistive coil embolization group than that in the stent-assisted coil embolization group (25.86％,20.69％,17.24％) (P＜0.05),while there was no significant difference in aneurysm recurrence rate between the two groups (13.64％ vs 10.34％)(P＞0.05).Conclusion Compared with stent implantation spring coil embolization,the spring coil embolization under auxiliary technology can significantly shorten the postoperative hospitalization time,improve the prognosis and reduce the incidence of postoperative complications.

Utilidad de la angiografía intracoronaria con microcatéter para evitar fenómeno de no reflujo en la angioplastia primaria / Utility of the intracoronary angiography with microcatheter to avoid no reflow phenomenon in primary angioplasty

Resumen Introducción La oclusión coronaria aguda, asociada a alta tasa de morbimortalidad en el infarto agudo del miocardio con elevación del segmento ST (IAMCEST), representa un desafío para el intervencionista cuando desconoce el importe de carga de trombo y las características distales a la oclusión (obstrucción microvascular (OMV), estenosis distal) que complican la angioplastia primaria (ACTP) y el fenómeno de no reflujo (FNR), el cual tiene una incidencia reportada de 20 a 40%. Objetivos Evaluar la eficacia de la angiografía distal con microcatéter al orientar una estrategia terapéutica individualizada con la finalidad de prevenir el FNR en oclusión coronaria aguda por IAMCEST en ACTP. Material y métodos Se incluyeron 70 pacientes con IAMCEST. Se realizó angiografía con microcatéter distal a la obstrucción y se eligió la estrategia terapéutica en la angioplastia de conformidad con hallazgos: estenosis, carga de trombo y OMV. Posteriormente se evaluó la incidencia de FNR al finalizar la ACTP. Resultados Reporte de 70 pacientes, la mayoría hombres (80%), clase Killip-Kimball I (95%), con afección de la arteria coronaria derecha en 57% de ellos y de la descendente anterior en 37%. Trombo distal presente en 47% de los pacientes estudiados, se observó en 21% de los casos que la longitud de obstrucción fue mayor de 30 mm, disección de las arterias también en 21%, OMV presente en 41% y 25% con estenosis distal. Estrategias terapéuticas utilizadas: se aplicó stent con fármaco en 81% de los pacientes, balón largo en 93% y trombolítico en 30%. Se observó una incidencia del FNR de 18.6%. Conclusiones En IAMCEST la técnica propuesta disminuye el FNR en comparación con lo reportado. La obstrucción > 30 mm es factor independiente de FNR, por lo que en estos casos recomendamos el uso de esta técnica y balón largo.

Abstract Introduction The acute coronary occlusion associated with a high valuation of morbimortalidad in the acute infarction of the myocardium with elevation of the ST segment (STEMI), represents a challenge for the interventionist, due the unknown amount of thrombus load and its characteristics beyond the occlusion (microvascular obstruction (MVO), distal stenosis), which leads to complicate the primary angioplasty (PTCA) and to the no reflow phenomenon (NFP), which has an overall incidence reported from 20 to 40%. Objectives To evaluate the efficacy of the distal coronary angiography with microcatheter, that leads to an individualized therapeutic strategy, with the purpose of prevent the NFP in the accute coronary occlusion in STEMI treated with PTCA. Material and methods 70 patients were included with STEMI. We performed coronary angiography with microcatheter distal to the obstruction, and the therapeutic strategy was chosen in accordance with findings: stenosis, thrombus amount or MVO. After the PTCA were performed, we evaluated the NFP incidence. Results Report of 70 patients, the majority men (80%), class Killip Kimbal I (95 %), with disease of the right coronary artery in 57%, and anterior descending coronary artery in 37%. Distal thrombus was present in 47% of the studied patients. An obstruction length of more than 30 mm was observed in 21% of the cases, also we observed dissection of the arteries in a 21%, MVO was presented in 41%, and distal stenosis in 25%. Used therapeutic strategies: It was applied medicated stent in 81% of the patients, long balloon in 93%, and thrombolytic therapy in 30%. We observed a NFP incidence of 18.6 %. Conclusions The diagnostic and therapeutic approach for STEMI that this study recommends, diminishes the NFP in comparison with reported. An obstruction > 30 mm is an independent factor for NFP, therefore in these cases we recommend use the described diagnostic approach and long balloon.

Dual microcatheter "cross-regional" embolization technique for the treatment of intracranial irregular aneurysms / 介入放射学杂志

Objective To evaluate the feasibility of dual microcatheter "cross-regional" embolization technique in treating intracranial irregular aneurysms. Methods The clinical data of 19 patients with intracranial irregular aneurysms, who were treated with "cross-regional" embolization technique at authors' hospital during the period from May 2016 to May 2017, were retrospectively analyzed. The embolization strategy formulation, selection of embolization materials, surgical process and embolization effect were summarized. Results Successful treatment of intracranial irregular aneurysm was accomplished in all the 19 patients. In one patient, during the embolization process of the neck of aneurysm the steel coil was over-protruded into the parent artery, and stent implantation had to be carried out to rescue the therapy, and finally successful treatment was achieved. The technical success rate of "cross-regional" embolization was 95％. Complete embolization was obtained in 15 patients and subtotal embolization in 3 patients. Conclusion For the treatment of some specified intracranial irregular aneurysms, dual microcatheter "cross - regional" embolization technique is technically simple, and it is a safe and effective treatment option. (J Intervent Radiol, 2018, 27: 199-202)

Use of double lumen microcatheter in interventional treatment of chronic total occlusion lesions at bifurcation / 中国介入心脏病学杂志

Objective To evaluate the efficacy and safety of double lumen microcatheters in chronic coronary artery total occlusion(CTO)lesions at bifurcation during percutaneous coronary intervention(PCI).Methods From October 2013 to March 2015,we retrospectively analysed the application of double lumen microcatheter with bifurcation CTO lesions and reviewed the patients' clinical features,coronary angiography,intervention operation success rate,complications rates and incidence of major adverse cardiac events(including all-cause death,nonfatal myocardial infarction and target vascular remodeling).Results Twenty-three CTO lesions at bifurcation were treated with double lumen microcatheters,stenting were performed in 21 lesions and 2 lesions only received PTCA due to small blood vessel size.The operation success rate was 100％.All the 11 right coronary lesions and 3 left coronary lesions were managed using single stenting technique.Double stenting strategy was used in 9 left coronary lesions including 4 cases with mini-crush technique,4 cases with modified culottes technique and one case with modified T technique.All double stenting procedures were completed by kissing balloon expansion.There was no major adverse cardiac event occured during and after operation.Conclusion Double lumen microcatheters are useful in PCI treatment of bifurcation CTO lesions.

Treatment efficacy of intracoronary microcatheter agents in the patients with no-reflow phenomenon:a Meta analysis / 中国介入心脏病学杂志

Objective To systematically review the effects of intracoronary microcatheter agents in the treatment of patients with no-refl ow phenomenon. Methods Databases including Medline, EMbase, the Cochrane Library, CBM, CNKI, VIP and WanFang Data were searched electronically f rom inception to April 2017 for randomized controlled trials (RCTs) about intracoronary agents for no-reflow phenomenon. Two reviewers independently screened literatures, extracted data and assessed the risk of bias of the studies included. Meta-analysis was then performed using RevMan 5.3 software. Results A total of 8 RCTs involving 424 patients were included. The results of Meta-analysis showed that the microcatheter group had significantly better TIMI flow grade[RR=0.38,95%CI(0.27,0.52), P<0.000 01],TIMI myocardial perf usion grade[RR=0.35,95%CI(0.23,0.55),P<0.000 01],corrected TIMI f rame count[MD=-9.99,95%CI(-13.22,-6.76)P<0.000 01]and hypotension[RR=0.57,95%CI(0.35, 0.90),P=0.02] than those of the guiding catheter group. There was no statistical difference between the two groups in short period major adverse cardiovascular events and left ventricular ejection fraction.Conclusions Current evidence shows that intracoronary microcatheter agents could improve blood flow in patients with no-reflow phenomenon and has good safety. Due to the limited quantity and quality of the included studies, the above conclusion still needs to be verified by carrying out more high-quality RCTs.

The application of 3D printing-assisted microcatheter shaping in the embolization of intracranial aneurysms / 介入放射学杂志

Objective To discuss the feasibility of using 3D printing-assisted precise microcatheter shaping technology in the embolization of intracranial aneurysms.Methods From November 2015 to April 2016,a total of 13 patients with intracranial aneurysm were treated with interventional embolization therapy.During the performance of the procedure,3D printing-assisted precise microcatheter shaping technology was employed.The accuracy of microcatheter position and the stability of the microcatheter were used to evaluate the shaping effect.Results During the performance of interventional embolization,the microcatheter was precisely placed to the right site in all 13 patients with intracranial aneurysm,the catheter tip position remained stable and the aneurysm was densely obstructed.In ten patients,no complications such as rupture of aneurysm occurred,and postoperative recovery was fine.One patient,whose Hunt-Hess classification was grade V,died after the treatment.One patient developed rupture of aneurysm during the procedure,which was considered to occur probably during the anesthesia induction process.One patient developed bleeding due to re-rupture of the aneurysm before the procedure.Conclusion With the help of 3D printing-assisted precise microcatheter shaping technology,the precisely shaped microcatheter can be smoothly inserted to,and can keep stable in,the right site,which is helpful for successfully accomplishing the operation and effectively reducing the occurrence of procedure-related complications.

Easy Advancement of a Large-Profile Microcatheter (Excelsior XT27(TM)) by Parallel Use of Two Microguidewires For Stent Delivery / 신경중재치료의학

PURPOSE: In the endovascular treatment of cerebral aneurysms, navigating a large-bore microcatheter for delivery of an open-cell stent can be challenging, especially in wide-necked bifurcation aneurysms. We were able to overcome this difficulty by parallel use of two microguidewires through the stent-delivery microcatheter. MATERIALS AND METHODS: From December 2014 to April 2015, we treated 15 patients with wide-necked bifurcation aneurysms. For stent delivery, we used a 300-cm 0.014-in microguidewire (Transend), which was placed into the target branch using an exchange technique. A 0.027-in microcatheter (Excelsior XT-27), which was designed for the stent, was advanced over the exchange microguidewire. If we had trouble in advancing the microcatheter over the exchange microguidewire, we inserted a regular microguidewire (Traxcess), into the microcatheter lumen in a parallel fashion. We also analyzed the mechanism underlying microcatheter positioning failure and the success rate of the 'parallel-wire technique'. RESULTS: Among the 15 cases, we faced with navigation difficulty in five patients. In those five cases, we could advance the microcatheter successfully by applying the parallel-wire technique. There were no procedure-related complications. CONCLUSION: Simply by using another microguidewire together with pre-existing microguidewire in a parallel fashion, the stent-delivery microcatheter can be easily navigated into the target location in case of any advancement difficulty.

The Interference Phenomenon of Microcatheters in the Jailing Treatment for Internal Carotid Artery Side Wall Aneurysms with an Open Cell Stent System

OBJECTIVE: Excelsior XT-27 (Stryker Neurovascular, Fremont, CA, USA) or Rebar 27 (eV3 Covidien, Irvine, CA, USA) microcatheters have recently been used to overcome the limitations of the Renegade Hi-Flo microcatheter such as interference between two microcatheters (one for stent delivery and the other for cerebral aneurysm coiling) during the jailing technique. We evaluated differences and influential factors related to the interference phenomenon according to these two microcatheters group. MATERIALS AND METHODS: Between June 2011 and September 2013, the jailing technique was applied to 94 internal cerebral artery (ICA) aneurysms. The jailing technique with the Neuroform EZ stent system was performed using Renegade (n = 22), Rebar (n = 35), and XT-27 microcatheters (n = 37). In the Renegade Hi-Flo microcatheter group, the jailing technique was successful in 19/22 patients (86.4%) and interference between the two microcatheters occurred in 6/21 patients (28.6%). In the Rebar and XT-27 microcatheter group, the jailing technique was successful in 71/72 patients (98.6%) and interference between the two microcatheters occurred in 1/72 patients (1.4%). RESULTS: There was a significant difference in the interference between the two delivered microcatheters group (p-value < 0.000) and the carotid siphon angle (p-value: 0.004) in the univariate analysis. In the multiple logistic regression analysis, the Rebar and XT-27 microcatheter group (odds ratio [OD] [95% confidence interval (CI)]; 31.277 [3.138-311.729], p-value: 0.003) and the carotid siphon angle (OD [95%CI]; 0.959 [0.922-0.997], p-value: 0.035) were found to be influential factors in the interference phenomenon. CONCLUSION: The Rebar 27 and XT-27 microcatheters were more successful and exhibited less interference between the two microcatheters than the Renegade Hi-Flo microcatheter.

Double micro-catheter technique embolization for cerebral aneurysm / 局解手术学杂志

Objective To explore the clinical effect of double micro-catheter technique for detachable coil treatment of intracranial an-eurysms. Methods From January 2010 to April 2014,there were a total of 83 patients with cerebral aneurysms treated with double micro-catheters,and the ratio of neck/body was 1/3~1. The double micro-catheters were positioned within aneurysm. The detachable coils were in-troduced to satisfactory position by different ways. There was always one undetached coil to hold the stability of detached coils till aneurysm compactly embolized. Results 83 cases were instantly compactly embolized with double micro-catheter technique. No coils out of aneurysm. There were two cases of ischemic complication during clinical treatment,one of them was died. One case ruptured during operation. Conclu-sion The double micro-catheter technique may be an optional and safe method during embolization of some cerebral aneurysms.

Microcatheter Looping to Facilitate Aneurysm Selection in Coil Embolization of Paraclinoid Aneurysms

OBJECTIVE: Described herein is a microcatheter looping technique to facilitate aneurysm selection in paraclinoid aneurysms, which remains to be technically challenging due to the inherent complexity of regional anatomy. MATERIALS AND METHODS: This retrospective study was approved by our Institutional Review Board, and informed consent was waived. Microcatheter looping method was employed in 59 patients with paraclinoid aneurysms between January 2012 and December 2013. In the described technique, construction of a microcatheter loop, which is steam-shaped or pre-shaped, based on the direction of aneurysms, is mandatory. The looped tip of microcatheter was advanced into distal internal carotid artery and positioned atop the target aneurysm. By steering the loop (via inner microguidewire) into the dome of aneurysm and easing tension on the microcatheter, the aneurysm was selected. Clinical and morphologic outcomes were assessed with emphasis on technical aspects of the treatment. RESULTS: Through this looping technique, a total of 59 paraclinoid aneurysms were successfully treated. After aneurysm selection as described, single microcatheter technique (n = 25) was most commonly used to facilitate coiling, followed by balloon protection (n = 21), stent protection (n = 7), multiple microcatheters (n = 3), and stent/balloon combination (n = 3). Satisfactory aneurysmal occlusion was achieved through coil embolization in 44 lesions (74.6%). During follow-up of 53 patients (mean interval, 10.9 +/- 5.9 months), only one instance (1.9%) of major recanalization was observed. There were no complications related to microcatheter looping. CONCLUSION: This microcatheter looping method facilitates safe and effective positioning of microcatheter into domes of paraclinoid aneurysms during coil embolization when other traditional microcatheter selection methods otherwise fail.

Aneurysm Coil Embolization Using a 1.5-Fr Distal Outer Diameter Microcatheter / 신경중재치료의학

The current assortment of microcatheters widely used for aneurysm coil embolization may not be well suited for several anatomic variants, including excessive vascular tortuosity and small aneurysms less than 3 mm. Longer microcatheters designed with a smaller caliber that can accommodate and deliver coils may be of use in these situations. This case series and literature review illustrates the advantages and limitations of the Marathon microcatheter (Covidien, Irvine, CA, USA) when used for coil embolization of cerebral aneurysms. Despite some technical compromises including the distal marker, length, and the risk of buckling, the Marathon microcatheter was able to adequately deliver coils to achieve satisfactory occlusion of cerebral aneurysms. We found unique advantages with regards to length and smaller distal outer diameter (OD). These results may serve as a guide for the further development of a microcatheter used for coil embolization that has the features of a smaller distal OD and longer length.

Application of retrograde intervention in chronic total occlusion with calcification / 中国基层医药

Objective To evaluate the efficacy and safety of retrograde wire in chronic total occlusion with calcification.Methods 4 patients with chronic total occlusion with calcification were selected.3 RCA and 1 LAD as CTO target vessel.Side branches proximal to the occlusion waspresent in all patients,2 of 4 with extreme tortuosity,1 of 4 with ostial occlusion in LAD.At the support of 150cm Finecross microcatheter,all patients were treated with the retrograde technique,with 3 of 4 as primary strategy,1 of 4 as immediately after antegrade failure.Results Retrograde wire crossed the collaterals and successfully delivered distal to the occlusion in all patients.Epicardial collateral from LCX to RCA was accessed in 1 patient,and septal in 3 of 4 patients.Reverse CART technique was applied in 2 of 4 patients,and subsequent exteriorization of the retrograde wire via the antegrade guide was completed.Kissing of antegrade and retrograde microcatheters inside antegrade guide was completed and antegrade wire crossed the CTO lesion via retrograde microcatheter in 1 patient.Both retrograde and antegrade wires could not cross the CTO lesion in 1 patient with extreme tortuosity and severe calcification,and the RCA CTO lesion was not opened in this patient.Overall successful rate was 75％.Drug eluting stents were implanted in 3 successfully recanalized vessels.All patients had no complications during procedure and subsequent hospitalization.Conclusion The retrograde approach was used with high degree of success and safety in chronic total occlusion with calcification.

Jailing Technique Using a Catheter-based Open-cell Stent System in Internal Carotid Artery Sidewall Aneurysms Unfeasible to Simple Coiling

OBJECTIVE: An open cell stent system may offer better apposition of cell struts to vessel wall than a closed cell stent system in acute vasculature. The purpose of this study was to evaluate the feasibility of coiling using the jailing technique with the Neuroform EZ stent system. METHODS: The jailing technique using the open-cell stent system of the Neuroform EZ stent was planned in 22 consecutive patients with 22 cerebral aneurysms. We retrospectively evaluated the technical success of the jailing technique and the occurrence of interference between two microcatheters as well as the factors influencing this interference. RESULTS: The jailing technique was successful in 19/22 patients (86.4%), and interference between two microcatheters occurred in 6/21 (28.6%). The jailing technique failed in 3/22 patients, with problems that included failure of the stent delivery system to advance into the positioned microcatheter in one, interference between the microcatheters during the advancement of the stent delivery system in one, and failure of microcatheter insertion into the aneurysm sac in the remaining patient. Interference between the two microcatheters developed during the advance of the stent delivery system into the positioned microcatheter in all cases. One factor that influences interference between two microcatheters more than expected by chance is the carotid siphon angle (p = 0.019). CONCLUSION: The acuteness of the carotid siphon angle influences the interference between two microcatheters. Therefore, the jailing technique using the Neuroform EZ stent should be performed carefully in cerebral aneurysms with an acute carotid siphon angle because the procedure may possibly fail.

Retained Microcatheter after Onyx Embolization of Intracranial Arteriovenous Malformation

Endovascular embolization is being increasingly used to treat intracranial arteriovenous malformations (AVMs). However, we experienced two patients with retained microcatheters after AVM embolization using Onyx.

Endovascular Management of the Wide-neck Aneurysms: the Applications of the Coils and Catheter / 신경중재치료의학

The endovascular treatment of aneurysms with wide-neck or the incorporated branch can be technically very challenging. Various neck protecting devices, such as temporary balloons or self-expanding stents are effective for management of the wide-neck aneurysm. However, these devices are not amenable to successful management of aneurysms with unfavorable configurations, because the introduction of additional devices into small intracranial vessels is technically demanding. Without the support of these neck protecting devices, the use of three-dimensional (3D) coils or coil delivery technique with the application of microcatheter can help to overcome the unfavorable configuration of the aneurysm. This article presents 3D coils, double catheter method, and catheter-assisted method for coil embolization of the wide-neck aneurysm independently with neck protecting device. These methods are considered as viable alternatives for management of wide-neck aneurysms. To make the strategy of the endovascular treatment of the wide-neck aneurysm, neurointerventionists should consider the aneurysm configuration, relationship between the aneurysm and parent artery, the presence of incorporated branch, proximal approach route, technical availability, the risk of thromboembolic complications, and antiplatelet therapy.

Application of closed thoracic drainage with micro-catheter in treatment of tuberculous pleural effusion / 中国基层医药

Objective To observe the effect and safety of pleural effusion treated by closed thoracic drainage with micro-catheter. Methods A total of 64 cases with pleural effusion were randomly divided into conventional therapy group ( control group ) and closed thoracic drainage with micro-catheter group ( treatment group) , each group including( 32 cases ). Control group were treated with drainage of thoracic puncture interruptedly while treatment group treated by closed thoracic drainage with micro-catheter. Results Both two therapeutic methods could reduce pleural effusion, but obvious effective rate of treatment group was higher than that of control group( P ＜ 0.05 ). Meanwhile, the rate of pleural reaction and treatment cost in treatment group were lower than that in control group. Conclusion Closed thoracic drainage with micro-catheter was effective, lower treatment cost and lower complications. Moreover, it could reduce medical risk.

Microcatheter-assisted Coil Embolization of Distal Vertebral Artery Wide-Necked Aneurysm: A Case Report / 신경중재치료의학

Endovascular treatment of wide-necked intracranial aneurysms remains challenging despite continuing instrumental and technical advances. A 67-year-old woman visited us for an asymptomatic unruptured aneurysm at the right distal vertebral artery and was planned to undergo endovascular coil embolization. During a second coil placement through a single microcatheter, the first coil frame was deformed and protruded into the parent artery. We decided to jack-up the protruded coil using an additional microcatheter because the tortuous vertebral artery path didn't allow a balloon or stent device to approach this aneurysm for parent artery protection. Using that microcatheter-assisted technique, the parent artery could be preserved and the aneurysm could, moreover, be excluded.

An evaluation of ultrasound-guided microcatheter pericardiocentesis for malignant pericardial effusion / 中国微创外科杂志

Objective To investigate the value of ultrasound-guided microcatheter pericardiocentesis in the management of malignant pericardial effusion.Methods A total of 13 patients with malignant pericardial effusion entered the study.Under the guidance of ultrasonography, the pericardial puncture was performed to introduce an epidural catheter(microcatheter).Through the microcatheter,the pericardial fluid was drawn out and chemotherapy drugs were injected into.Results Pericardial puncture and microcatheter implantation was conducted successfully in all the 13 patients.The total drainage volume was 400~780 ml(mean,530 ml).The survival rates at 3,12,and 24 months after the treatment were 92.3%(12/13),77.8%(7/9),and 60%(3/5),respectively.No recurrence of pericardial effusion was found. Conclusions Ultrasound-guided microcatheter pericardiocentesis in the treatment of malignant pericardial effusion is safe,minimally invasive,effective,and feasible.