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ObjectiveToanalyzetheclinicalandimagingcharacteristicsinpatientswithcarotidsteal syndrome ( CSS ) and to investigate its compensatory pathw ays, diagnosis, and treatment. Methods The medical history and imaging data of the patients with CSS were colected. Their vascular lesions, colateral circulation, treatment, and prognosis w ere analyzed. Results A total of 11 patients w ith CSS (8 males and 3 females, mean age 66.7 ±5.1 years) were enroled in the study. Their clinical manifestations were posterior circulation transient ischemic attack (TIA) ( n=9, 81.8%), posterior circulation infarction ( n=1, 9.1%), and anterior circulation TIA ( n=1, 9.1%). A total of 19 pathological arteries w ere found:12 (63.1%) w ith occlusion, 2 (10.5%) w ith subtotal occlusion, 4 (21.0%) w ith severe stenosis and 1 (5.2%) w ith artery dissection. Seven patients (63.6%) w ere bilateral internal carotid artery lesions, 3 (27.2%) w ere unilateral bilateral internal carotid artery lesions, and 1 (9.1%) w as bilateral common carotid artery occlusion. Eleven patients had primary col ateral circulation, including posterior communicating artery patency in 10 patients (90.9%) and anterior communicating artery patency in 1 patient (9.1%). Four patients (36.3%) had secondary col ateral circulation and 1 (9.1%) had tertiary col ateral circulation. Al patients w ere treated w ith medication on the basis of the management of risk factors. Three patients w ere treated w ith stenting and tw o were treated with carotid endarterectomy. No stroke occurred in al patients during folow -up til September 2014. Conclusions The vascular lesions of patients w ith CSS often occur in the extracranial segment of internal carotid artery. Usual y the compensatory blood is through the circle of Wil is. The presentation is ischemia in the stolen arteries. Its diagnosis needs to be examined by digital subtraction angiography. On the basis of medication therapy, some patients may be treated w ith surgery or endovascular intervention.
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Objective To analyze the basal conditions of 5 patients with cerebrovascular fibromuscular dysplasia (FMD),and explore the clinical presentation,imaging features,therapies and outcomes of cerebrovascular FMD.Methods Five patients with cerebrovascular FMD,admitted to our hospital from January 2012 to April 2013,were chosen in our study; their medical history and imaging features were collected,and their clinical presentation,imaging features,therapies and outcomes were retrospectively analyzed when combining with literature review.Results Five patients all presented with stroke,including four having hemiplegia as the initial symptom,and one having headache with nausea and vomiting as the main performance.One was diagnosed as having subarachnoid hemorrhage by CT scan,and four had different infarction lesions in lobes and basal ganglia on MRI.Artery dissection was discovered in all patients by cerebral digital substraction angiography,including two with right internal carotid artery dissection,one with right vertebral artery dissection combined with aneurysm in anterior communicating artery associated with "string-of-beads" appearance on C1 segment of right internal carotid artery and left vertebral artery,one with bilateral vertebral artery dissection,and the last one with bilateral internal carotid artery dissection and moyamoya disease-like vessels.No abnormality was discovered in two patients by renal artery angiography.The patient with anterior communicating artery aneurysm was treated with endovascular aneurysm embolization,having poor prognosis.In the remaining 4 patients with cerebral infarction,two were treated with carotid artery stenting,and the other 2 were only given antiplatelet therapy.No patient suffered cerebrovascular accidents during the 12-month follow-up.Conclusions Cerebrovascular FMD is a rare cause of young stroke,and patients with cerebrovascular FMD often manifest headache,neck bruit,carotid artery dissection and stroke.It is particularly important to make definitive diagnosis by performing cerebrovascular imaging examinations and give treatment accordingly.The long term outcome of FMD is not clear now.
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Chronic total occlusion of the left main coronary artery [LMCA] is a rare condition, and the information on surgical experiences is limited. Although total occlusion of the LMCA is accompanied by well-developed collateral circulation, the condition of circulation is unstable during manipulation of the heart. We report our experience with revascularization in cases with total occlusion of the LMCA using the on-pump beating-heart [OnP-BH] technique. Retrospective case review of patients treated at The First Affiliated Hospital of China Medical University over a 10-year period [1999 to 2009]. The on-pump coronary artery bypass grafting with the beating heart was applied to 8 patients with chronic total occlusion of the LMCA. The extracorporeal circulation period, intubation duration, intensive care unit stay period, discharge period, preoperative and postoperative treatments, and follow-up were observed. The mean extracorporeal circulation period was 80.4 [19.7] minutes. The mean intubation duration was 13.0 [4.6] hours. The mean intensive care unit stay period was 3.2 [0.7] days, and the mean discharge period was 16.8 [3.3] days. No perioperative myocardial infarction occurred. The mean follow-up period was 50.9 [34.8] months. All patients were asymptomatic, and no deaths were recorded during the follow-up period. The results of echocardiography showed improvement in the left ventricular function. The OnP-BH myocardial revascularization seems to be a valid alternative for chronic total occlusion of the LMCA