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Background: The insertion of a double-J (DJ) stent is considered a routine and necessary urological procedure. The symptoms produced by the stent are predominantly irritative in nature and the use of alpha blockers like tamsulosin have shown considerable in treating the stent associated symptom. Aim of the study was to assess tamsulosin's impact on ureteral stent-associated morbidity. Methods: A comparative cross-sectional study. All the patients with ureteric calculi admitted in the department of urology, Narayana Hospital, Nellore, Andhra Pradesh. Results: A total of 80 patients who met the inclusion criteria, were divided into two groups. Group A receiving placebo and group B receiving tamsulosin 0.4 mg. Among the study population, there was statistically significant difference between the means of parameters between the groups during the stent removal. The means of group B were significantly lower than the means of group A which shows that tamsulosin is very effective in managing the pain and also the stent related morbidity. Conclusions: Tamsulosin is very effective in managing the pain and also the stent related morbidity, which was measured by international prostate symptom score (IPSS) score – both obstructive and irritative. The quality of life was suggestively better in tamsulosin group.
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Spontaneous rupture of brain aneurysmal subarachnoid hemorrhage (aSAH) is a debilitating disease, half of which occurs in individuals under 50 years old. Challenges in its management arise from the decision-making process regarding the preferred method of definitive aneurysm obliteration, whether through surgical intervention or endovascular approach. This study described the role of flow diverter stent as an effective endovascular approach to obliterate aSAH in the acute phase. A 70-yearold female presented with thunderclap headache, slight right hemiparesis, and pupillary-sparing left oculomotor palsy corresponding with ruptured brain aSAH. Endovascular management of flow diverter stent was preferred and inserted within the third day onset. Double antiplatelet was administered prior to and following the procedure. Three-day follow-up showed resolution of brain aSAH with no neurological sequelae. Flow diverter stent offers several advantages over coiling when treating wide-neck, giant, saccular, or fusiform aneurysm. It is also safer for elderly, especially with multiple comorbids, compared with clipping. However, it has risks of either parent/ distal artery occlusion due to its thrombogenic properties or the potential for rebleeding following dual antiplatelet administration. Effective management and thorough evaluation are essential to maximize the likelihood of favorable outcomes when employing this approach. Flow diverter stent is a promising endovascular management for ruptured brain aSAH, particularly in elderly with many comorbids and wide neck/ giant aneurysm at anterior circulation which is not candidate for coiling or clipping. It is also crucial to monitor, evaluate, and manage risk of rebleeding and thrombosis to ensure long-term success of this management approach.
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Objetivo: Describir morbimortalidad asociada al uso de prótesis colorrectales (PC) e identificar factores asociados a sus complicaciones durante los años 2007 a 2022 en Clínica INDISA. Material y Método: Estudio transversal retrospectivo basado en registro clínico. Resultados: Se instalaron 49 PC con un 100% de éxito de desobstrucción. El 87,8% en colon izquierdo. La etiología principal fue la patología maligna 91,8% y el 85,7% de ellos fueron primarios colorrectales. Se instalaron 34 como tratamiento paliativo (TP), 12 como puente a cirugía electiva (PCE) y 3 por patología benigna. La tasa de complicaciones fue de 26,5% (7 estenosis, 4 perforaciones y 2 migraciones). La mortalidad asociada fue de 4,1% (2 pacientes). El grupo de complicados fue más joven, con etapas oncológicas más avanzadas y con estenosis en rectosigmoides(p < 0,005). Los menores de 50 años tuvieron 5 veces más riesgo de alguna complicación (OR = 5,0;IC95%:1,09-23,0; p = 0,039). Discusión: El uso de PC tiene baja morbimortalidad. Su uso principal es como TP o PCE en obstrucción colorrectal maligna, con alta tasa de desobstrucción. Está asociado con menor morbilidad que la cirugía de urgencia, menor tasa de ostomía y mayor cosecha ganglionar. La instalación como puente se asocia además a mayor tasa de anastomosis primaria. Nuestra serie mostró mayor tasa de complicación en aquellos con tumores avanzados y más jóvenes. Conclusión: El uso de PC es seguro y con baja morbimortalidad. La principal indicación es en neoplasia colorrectal obstructiva como TP. Tienen mayor riesgo de complicación los pacientes jóvenes y los tumores colorrectales avanzados con ganglios peri tumorales.
Objective: To describe morbidity and mortality associated with colorectal prostheses (CP) and identify factors associated with their complications during the 2007 to 2022 at INDISA Clinic. Material and Method: Retrospective cross-sectional study based on clinical registry. Results: 49 CPs were installed with 100% clearing success. 87.8% in left colon. The main etiology was malignant 91.8% and 85.7% were primary colorectal. 34 were installed with palliative intention, 12 as a bridge to elective surgery (BTS) and 3 for benign pathology. There were 13 (26.5%) patients with adverse effects (7 strictures, 4 perforations and 2 migrations). Associated mortality was 4.1% (2 patients). The complicated group was younger, with more advanced oncological stages and rectosigmoid stenosis (p < 0.005). Those under 50 years of age had 5 times higher risk of some complication (OR = 5.0; 95% CI: 1.09-23.0; p = 0.039). Discussion: The use of CPs has low short-term morbidity and mortality. Its main use is as palliative treatment or BTS in malignant colorectal obstruction. It's a high clearance rate. It is associated with less morbidity than emergency surgery, a lower ostomy rate, and a higher lymph node harvest. Installation as a bridge is also associated with a higher rate of primary anastomosis. Our group showed a higher complication rate in those with advanced and younger tumors. Conclusion: The use of CPs is safe, with low morbidity and mortality. The main indication is in obstructive colorectal neoplasia as palliative treatment. Young patients and advanced colorectal tumors with peritumoral nodes have a higher risk of complications.
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Background: Retrograde intrarenal surgery (RIRS) is the standard of care for renal stones of less than 1.5 cm and less than 1000 Hounsfield units (HU). Most virgin ureters do not allow the flexible ureteroscope in the first setting. Placement of a D-J stent in the ureter dilates the ureter. Therefore, our study aimed to compare stone clearance rates and symptom complex of passive ureteral dilation following 4.5 French/Fr versus 6 French/Fr double J (DJ) stent placement. Methods: After obtaining ethics approval and written informed consent, 100 patients satisfying the inclusion and exclusion criteria were included and data recorded. patients were randomized into group A (4.5 Fr) and group B (6 Fr). Stent was placed. After 4 weeks, symptoms were assessed by the ureteral stent symptom questionnaire (USSQ). Following retrograde intrarenal surgery (RIRS) successful passage of ureteric access sheath (UAS) and stone clearance rates were assessed. Results: The surgical success rate, stone clearance rate was similar in the two groups (p value: more than 0.05). The USSQ score was significantly lower in group A (p value: 0.001). Conclusions: Stent of smaller diameter (4.5 Fr) is associated with less patient discomfort with similar surgical completion rates and stone clearance.
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This study aimed to create, develop, and optimize a biodegradable stent made of poly lactic co glycolic acid (PLGA) that contained clopidogrel and atorvastatin for the management of asthma. Solvent casting was used to create biodegradable stents. In particular, PLGA 75:25 polymer films were used to create stents using the solution-casting method. The base material was created by dissolving the polymer in isopropyl alcohol and adding PEG 400 as a plasticizer. As the active pharmaceutical ingredients in the stents, clopidogrel and atorvastatin were used. To avoid air bubbles, the resulting mixture was homogenized before being poured onto metal pans and allowed to gently evaporate in a refrigerator. The polymer films were then cut into strips, wound around cylindrical rods to form helical stents, and baked in an oven to guarantee that all of the isopropyl alcohol had evaporated. The biodegradable polylactic acid stents that included clopidogrel and atorvastatin demonstrated an impressive 99.34±0.44% encapsulation efficiency. Differential scanning calorimetry (DSC) analysis revealed that there were no chemical interactions between the stent's component parts. Significant water absorption over 80% was seen over a period of 8 days, which is remarkable. A thorough effect on disrupting plaque was seen at day 21, and on day 22, the stent began to biodegrade. Over the course of 20 days, the cumulative medication release percentage rose to 99.92%. According to the study's findings, treating atherosclerosis with an optimized biodegradable polymeric stent made of PLGA and combining atorvastatin and clopidogrel is a novel and promising treatment option.
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Vertebrobasilar dolichoectasia (VBD) is a rare vascular anomaly of increased diameter, length, and tortuosity of vertebral and/or basilar artery, but debilitating due to its risk of ischemia, hemorrhage, and nerve or brain compression. The management is also controversial due to various possible clinical manifestation and outcome. This study aimed to describe a combined approach of multiple scaffolding Leo stents and nondominant vertebral artery occlusion as a definitive approach to reconstruct vertebrobasilar arteries. A 40-year old male presented with severe headache and reduced consciousness, which was explained with brain CT findings of subarachnoid hemorrhage and hydrocephalus. Further etiologic approach until digital subtraction angiography revealed VBD. An endovascular reconstruction approach was considered one month following the event onset using multiple scaffolding Leo stents from left vertebral to basilar artery with right vertebral artery occlusion. This stent had the best radial strength, lowest bending stiffness, highest kink resistance, highest bending wall coverage, and lowest cell size, which provided strong vascular reconstruction properties. Combined nondominant vertebral artery occlusion was also performed to avoid the disturbance of flow-diverting pathway by the stents. Double antiplatelet was administered from three weeks following the event onset afterwards. The patient抯 condition improved at three-month follow-up. This case report presented that combined multiple Leo stents and nondominant vertebral artery occlusion may be considered as an approach to successful endovascular reconstruction for symptomatic VBD.
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Iatrogenic bile duct injury has caused increased incidence of biliary stricture, caused by various surgeries of open, laparoscopic cholecystectomy, and transplantation procedures. Several standard procedures have been suggested to minimalize biliary tract injury and the associated morbidity from bile leakage and stricture. Endoscopic retrograde cholangiopancreatography (ERCP) has an essential role in treating biliary strictures by relieving symptoms of jaundice and cholangitis. We analyzed three cases with complaints of jaundice, itchiness, and occasional redness all over the body. The first patient had previously undergone laparoscopic cholecystectomy bile duct exploration (LCBDE) followed by stone extraction. The second patient had jaundice all over the body for two weeks before being admitted to the hospital. The patient also had a reactive hepatitis B and a history of cholecystectomy five months ago. The third patient had jaundice all over the body for the last week before being admitted to the hospital. Previously, the patient had complaints of abdominal pain and normal abdominal ultrasound. Management of benign biliary stricture (BBS) using ERCP with ballooning and plastic stent placement is effective, although repeat treatment is needed several times every 3-4 months for 1.5-2 years. Complications during follow-up were not reported, and clinical improvement was reported.
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Objectives:To compare the efficacy of the combination of excimer laser coronary angioplasty(ELCA)and drug-coated balloon(DCB)for in-stent restenosis(ISR)and to evaluate the impact of neointimal tissue characteristics on treatment outcomes. Methods:A total of 96 ISR lesions from 86 patients who underwent optical coherence tomography(OCT)evaluation and DCB with or without ELCA treatment at The First Medical Center of Chinese PLA General Hospital from January 2019 to May 2023 were retrospectively analyzed.ISR lesions were divided into ELCA+DCB group(n=30)and DCB group(n=66).Additionally,ISR lesions were classified as homogeneous and non-heterogeneous patterns based on the OCT characteristics of the neointimal tissue,and the impact on acute lumen gains was compared between different ISR patterns.Acute lumen gain(ΔMLA)was defined as the changes in minimum lumen area before and after the intervention. Results:The ELCA+DCB group had a significantly greater ΔMLA than the DCB group([3.2±0.8]mm2 vs.[2.6±1.4]mm2,P=0.015).Among the ISR with a homogeneous pattern,the ΔMLA of the ELCA+DCB group was significantly greater than that of the DCB group([3.0±0.9]mm2 vs.[2.2±1.1]mm2,P=0.030).There was no significant difference in ΔMLA between the two ISR groups with the non-homogeneous pattern([3.4±0.7]mm2 vs.[3.2±1.5]mm2,P=0.533).There was no death,the rate of target lesion revascularization was similar between the patients with lesions receiving DCB treatment and patients receiving ELCA +DCB treatment(7.4%vs.4.2%,P＞0.05). Conclusions:The combination of ELCA and DCB is an effective strategy for treating ISR,which can achieve greater acute lumen gain compared to DCB treatment alone,especially for the treatment of homogenous ISR pattern characterized by OCT.
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Objective:To study the changes of patient-related costs and the use of stents and other consumables before and after the centralized procurement of coronary stents.Methods:The inpatient medical insurance settlement case data of 1,973 patients with coronary stent implantation admitted to Daping Hospital of Army Medical University from December 2019 to October 2021 were selected.Among them,the data of 1,317 cases of percutaneous cardiovascular surgery and coronary stent implantation with serious or complications and accompanying disease group were slected according to disease diagnosis related groups(DRG),which were divided into the pre-centralized procurement group(667 cases)and the post-centralized procurement group(650 cases)according to the centralized procurement of coronary stents before and after.The costs of patients'medical consumables with the consumption of patients'medical consumables and the impact of the use of consumables such as coronary stents on the costs of medical consumables were compared.Results:There was no significant statistical difference in the hospitalization days and the average number of stents used in patients undergoing percutaneous cardiovascular procedures and coronary stent implantation with centralized procurement of coronary stents.There was a statistically significant difference in the total diagnosis and treatment cost,medical consumables cost,medicines and consumables cost and medicines cost between the pre-centralized procurement group and the post-centralized procurement group(Z=-22.316,-23.546,-22.917,-5.724,P<0.05).The cost of stents[16 260(13 300,32 272)yuan],the number of catheter guidewire balloon sheaths consumables[5(4,8)sets(pieces)],and the cost of catheter guidewire balloon sheaths consumables[8 719(5 805,15 372)yuan]in the pre-collection group were collected.There were statistically significant differences in the stent cost[1 059(590,1 770)yuan],the number of catheter guidewire balloon sheaths consumables[8(7,12)sets(pieces)],and the cost of catheter guidewire balloon sheaths consumables[5 708(3 392,12 871)yuan]between the two groups(Z=-30.452,16.582,-7.670,P<0.05).There was a statistical correlation between the cost of coronary stents and the cost of catheter guidewire balloon sheaths before and after centralized volume procurement on the cost of medical consumables for patients(r=0.903,0.473,0.785,0.953,P<0.05).The correlation coefficient between the cost of coronary stents and the cost of medical consumables for patients in the post-centralized procurement group decreased compared to the pre-centralized procurement group,the correlation coefficient between the cost of catheter guidewire balloon sheath and the cost of medical consumables for patients increased.Conclusion:The centralized procurement of coronary stents has a significant cost control effect on patients in the disease groups,and affects the cost structure of medical consumables.Combined with DRG reform,it can continuously improve the standardization and scientificity of clinical use of medical consumables.
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Objective To analyze the changes of the cost and structure of coronary intervention patients before and after the centralized procurement of coronary stents in Zhejiang Province.Methods It was conducted on the medical expenses of patients in the FM1 group(percutaneous coronary stent implantation)of a Class A tertiary hospital in Zhejiang Province from February to December in each 2020 and 2021.The number of cases was 1 403 and 1 698,re-spectively.A nonparametric test was conducted on the patient expenses before and after the reform.Results There are significant differences in total medical expenses,material expenses,treatment expenses,operation expenses and drug expenses before and after centralized purchase(P＜0.01);After the implementation of centralized procure-ment,material cost of patients decreased significantly,while the treatment cost increased;At the same time,the more coronary stents were placed,the greater the decrease in the total medical expenses and material expenses.Conclusion The centralized procurement of coronary stents can reduce the medical burden of patients,improve the structure of medical expenses,enhance the value of technical labor services of medical personnel,and promote DRG cost control.
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Objective:To compare the efficacy and safety of Castor single-branch stent and in vitro fenestration stent in treating thoracic aortic diseases with insufficient landing zone.Methods:The clinical data of patients with thoracic aortic diseases treated with Castor single-branch stent or in vitro fenestrated stent between December 2017 and June 2021 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. A total of 184 patients were included, 99 patients were treated with Castor branch stent, and 85 patients with in vitro fenestration stent. All patients′ general clinical data, surgical data, perioperative and follow-up clinical and imaging data, and postoperative complications were collected. The χ2 test was used to compare the incidence of complications between the two groups, and the Kaplan-Meier method was used to plot the survival rate without adverse events between the two groups. Results:Stent placement was successful in all patients, and the success rate of the technique was 100%. Other branches were reconstructed in 2 patients in the Castor group and double fenestrated stent were reconstructed in 12 patients in the fenestrated group. The mean operation time of the Castor group was significantly shorter than that of the fenestrated group, the number of patients who received local anesthesia was significantly lower than that of the fenestrated group, and the endoleak rate during follow-up was significantly lower than that of the fenestrated group ( P<0.05). There was no significant difference in the postoperative hospital stay, the incidence rate of perioperative complications, mortality, the incidence rate of neurological complications, new dissection or aneurysm rate, branch stent stenosis rate, second surgical intervention rate, and false lumen thrombosis between the two groups ( P>0.05). The adverse event-free survival rate of the Castor group was slightly higher than that of the fenestrated group, but its difference was not statistically significant ( P>0.05). Conclusion:Castor branch stent and in vitro fenestration stent have good short-term and mid-term efficacy in the treatment of aortic diseases with insufficient landing zone, which are safe and effective options for reconstruction of LSA and other branch arteries.
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Objective:To investigate the image quality, radiation dose, and diagnostic efficiency of the regimen of GE 256-slice Revolution CT low-dose scanning, combined with an individualized contrast agent, in the assessment of coronary in-stent restenosis.Methods:A total of 120 patients (with 142 stents) treated with coronary stent implantation at the Beijing Renhe Hospital from August 2020 to August 2022 were enrolled in this study. They were randomly divided into an observation group (60 cases with 70 stents) and a conventional group (60 cases with 72 stents) using the random number table method. Both groups received GE 256-slice Revolution CT examinations. Patients in the conventional group were injected with 70 ml of iopromide as a contrast agent each, while those in the observation group were given individualized doses based on their body mass indices (BMIs). A tube voltage of 120 kV and a tube current of 534 mA were applied to the conventional group, whereas the tube voltage and current for the observation group were adjusted within the ranges of 80-120 kV and 150-534 mAs based on patients’ BMIs. Both groups received coronary angiography 7-14 d after coronary computed tomography angiography (CCTA). Finally, the CT image quality, radiation dose, iodine intake, and diagnostic efficiency were compared between the two groups.Results:Both groups exhibited no significant differences in CT values, contrast-to-noise ratios, blooming artifacts, and stent diameters of the left main coronary artery ( P > 0.05). The conventional group manifested higher CT dose index, CT dose length product, effective dose, and iodine intake compared to the observation group ( t = 10.30, 8.75, 10.27, 4.60, P < 0.05). With coronary angiography result as the gold standard, the observation and conventional groups yielded Kappa values of 0.904 and 0.879, respectively, suggesting high consistency in diagnostic performance. Additionally, the two groups demonstrated nonsignificant differences in sensitivity and specificity ( P > 0.05). Conclusions:The regimen of GE 256-slice Revolution CT low-dose scanning, combined with an individualized contrast agent, yielding image quality and diagnostic efficiency equivalent to those of the conventional regimen, can effectively reduce radiation dose and iodine intake. Therefore, this regimen merits wide applicability.
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Objective To explore the effect of flexible cystoscope in the extraction of male ureteral stents in the daytime operation mode.Methods A total of 200 male patients with ureteral stents who came to the hospital for extubation from January 2019 to December 2022 were selected as the study objects,among which 100 cases of day operation extubation were the experimental group and 100 cases of inpatient extubation were the control group.The operation time,length of stay,hospitalization cost and patient satisfaction of the two groups were compared.Results The hospital expenses,operation time,hospital stay and satisfaction of the experimental group were better than those of the control group,the difference was statistically significant(P<0.05).Conclusions The application of flexible cystoscope in male ureteral stents extraction under the daytime surgery mode has low cost,short operation time and average hospital stay,and high patient satisfaction,which can be popularized in clinical practice.
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Hepatic alveolar echinococcosis (HAE) is a common zoonotic endemic parasitic disease in western China. It lacks of typical clinical manifestations in the early stage, and symptoms become prominent during the end stage, with an alarmingly high mortality rate. Among the treatment of end-stage HAE (es-HAE), orthotopic liver transplantation is almost the only radical treatment due to insufficient remnant liver volume, uncontrollable bleeding and difficulty in vascular reconstruction in vivo. However, the shortage of donor liver and long-term postoperative use of immunosuppressants limit its application. The introduction of ex vivo liver resection and autotransplantation (ELRA) resolves this dilemma and significantly broadens the indications of es-HAE. In addition, multiple centers in China have optimized and modified ELRA to further improve the treatment system of es-HAE. At present, liver transplantation (including ELRA) of es-HAE remains a hot topic for clinicians. In this article, orthotopic liver transplantation, ELRA, auxiliary ELRA and other surgical treatment of es-HAE were reviewed, aiming to further enhance the diagnosis and treatment of es-HAE and improve clinical prognosis of the patients.
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In recent years, with the development of organ preservation, surgical techniques, perioperative management and immunosuppression regimens, the success rate of liver transplantation and survival rate of the recipients have been significantly enhanced. Liver transplantation has become the optimal treatment for patients with end-stage liver disease. However, biliary complications still commonly occur after liver transplantation, especially biliary anastomotic stricture. Severe biliary anastomotic stricture will not only increase the cost of treatment, but also lead to graft loss and even affect the survival rate of recipients. Therefore, timely diagnosis and treatment of biliary anastomotic stricture play a significant role in improving the survival rate of liver transplant recipients. In this article, the risk factors, clinical symptoms, diagnosis and treatment of biliary anastomotic stricture after liver transplantation were reviewed, aiming to provide novel ideas for the research, diagnosis and treatment of biliary anastomotic stricture after liver transplantation, and further enhance clinical efficacy of liver transplantation and the quality of life of recipients.
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Objective To explore the effects of intravenous thrombolysis combined with Solitaire FR stent thrombectomy on vascular recanalization,neurologic function and prognosis in patients with acute cerebral infarction(ACI)due to large artery occlusion(LAO).Methods A total of 172 patients with ACI-LAO treated in our department between October 2020 and March 2023 were retrospectively enrolled.According to treatment regimens,they were assigned into control group(86 cases,alteplase intravenous thrombolysis)and study group(86 cases,alteplase intravenous thrombolysis combined with Solitaire FR stent thrombectomy).Vascular recanalization,neurolog-ic function,cerebral perfusion and occurrence of adverse events were compared between the two groups.After 90 d of follow-up,their prognosis was evaluated with modified Rankin scale.Results There was no significant difference in success rate of vascular recanalization between the two group(P＞0.05),but complete recanalization rate was statistically higher in the study group than the control group(68.60％vs 50.00％,P＜0.05).The study group had obviously lower NHISS scores at 7 and 14 d after treatment,higher cerebral blood volume and cerebral blood flow,but shorter mean transit time when compared with the control group(P＜0.05,P＜0.01).No notable difference was observed in the total incidence of adverse events between them(P＞0.05).After 90 d of follow-up,the proportion of good prognosis was higher in the study group than the control group(80.23％vs 63.95％,P＜0.05).Conclusion Intravenous thrombolysis combined with Soli-taire FR stent thrombectomy shows better efficacy in ACI-LAO patients,with better vascular re-canalization and great improvements in neurologic function and prognosis.
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Objective To explore the influencing factors for long-term poor prognosis of patients with acute ischemic stroke with large vessel occlusion(LVO-AIS)in the course of intravascular treatment.Methods A total of 123 LVO-AIS patients undergoing vascular recanalization in Department of Neurology of Tianmen First People's Hospital from January 2021 to December 2022 were consecutively recruited,and according to their modified Rankin Scale(mRS)score at 90 d after surgery,they were divided into good prognosis group(mRS≤2,n=58)and poor prognosis group(mRS＞2,n=65).Their general clinical data were compared between the two groups.Multi-variate logistic regression analysis was applied to identify the risk factors of poor prognosis in LVO-AIS patients.Results The good ratio of collateral circulation in good prognosis group was higher than that in poor prognosis group(94.83％vs 47.69％,P＜0.01).Multivariate logistic regression analysis showed that age(OR=1.092,95％CI:0.989-1.205,P=0.046),diabetes(OR=0.122,95％CI:0.026-0.561,P=0.007),symptomatic intracranial hemorrhage(OR=0.038,95％C I:0.002-0.656,P=0.024),and poor collateral circulation(OR=0.037,95％CI:0.007-0.196,P=0.000)were independent risk factors for poor prognosis in LVO-AIS patients after intravascular treatment.Conclusion For the LVO-AIS patients,those with advanced age,di-abetes,symptomatic intracranial hemorrhage and poor collateral circulation are prone to poor prognosis after intravascular treatment.
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Objective To investigate the efficacy and safety of Rotarex mechanical thrombectomy combined with drug-coated balloon(DCB)dilatation for the treatment of in-stent restenosis(ISR)in femoropopliteal atherosclerotic occlusive disease.Methods A total of 53 patients with in-stent restenosis after stent implantation(9 covered stents and 44 bare stents)from March 2020 to March 2022 were retrospectively analyzed.All the cases were treated with Rotarex mechanical thrombectomy combined with DCB dilatation.Antiplatelet and anticoagulant therapy were used after operation.Results All the 53 patients had successful recanalization of the lower limb arteries.Imaging after Rotarex mechanical thrombectomy combined with DCB dilatation showed 3 cases of residual thrombus in the stent treated with indwelling thrombolytic catheters for thrombolysis,with follow-up angiography showing blood flow recovery,and 5 cases of embolism of the below-knee arteries intraoperatively,including 3 cases at the opening of the tibiofibular trunk artery,which were opened with 6F peripheral thrombus aspiration catheter until unobstructed blood flow,and 2 cases of proximal occlusion of the posterior tibial artery,which were opened with balloon dilatation.Three cases of residual stenosis>30%were treated with remedial stents placement.There were no postoperative complications related to the puncture point,cardiovascular or cerebrovascular accidents,or deaths.The ankle brachial index(ABI)was0.33±0.06 preoperatively and0.84±0.07 postoperatively at the time of discharge(t =-39.443,P<0.001).All the 53 cases completed 3-month follow-ups,52 cases completed 6-month follow-ups,and 49 cases completed 12-month follow-ups.The phaseⅠpatency rates were 100%(53/53)at 3 months,92%(48/52)at 6 months,and 84%(41/49)at12 months,postoperatively.Recurrence of lower limb ischemic symptoms happened in 2 cases,which were given DCB dilatation at 9 and 10 months postoperatively,respectively.The 12-month freedom from clinically-driven target vessel reintervention was 95.9%(47/49).There were 4 deaths(1 case of gastrointestinal hemorrhage,2 cases of COVID-19,and 1 case of unknown cause)and 3 cases of amputation beyond the ankle joint.Conclusion The Rotarex mechanical thrombectomy combined with DCB is safe and effective in treating ISR of the femoropopliteal artery with satisfactory patency and reintervention rates.
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In recent years, endovascular treatment has emerged as the preferred approach for aortic aneurysms. From an anatomical perspective, the current focus of research remains on the reconstruction of iliac artery branches, multiple branches of visceral arteries, and branches of the aortic arch. Substantial clinical evidence has been accumulated in these areas. Simultaneously, future research is expected to explore the reconstruction of the aortic root involving coronary arteries openings and the inhibition of small arterial aneurysm progression through pharmacological means. This article aims to provide a review of significant research data in recent years related to the treatment of aortic aneurysms, offering insights and prospects for future research directions.