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Objective:To evaluate the safety and efficacy of carotid artery stenting (CAS) in the treatment of non-circumferential severe calcification using the distal embolic protection device.Methods:Clinical data of patients with severe calcification lesions in cervical carotid artery treated by CAS from Jan 2018 to Dec 2020 at our center was analyzed retrospectively.Results:226 consecutively admitted patients of cervical carotid artery stenosis and non-circumferential severe calcification (CR>270°) underwent CAS using the distal embolic protection device. The technical success rate was 90.26%. No death or myocardial infarction occurred during the perioperative period. Two patients had ipsilateral hemiparesis ischemic stroke during post-dilatation. The incidence of perioperative bradycardia/hypotension was 25.34%. Patients were followed up for 6-36 months, with median follow-up period of 17.3 months. The incidence of mild or moderate in-stent restenosis (<70%) was 16.59%, and the incidence of severe in-stent restenosis or occlusion (>70%) was 3.22%.Conclusions:For carotid artery stenosis with non-circumferential severe calcification in high risk for CEA patients, carotid artery stenting is safe and effective with the aggressive pre-dilation strategies, strict stent selections and implantation standards. The incidence of perioperative death, myocardial infarction or ipsilateral hemiparesis ischemic stroke was low. The patency rate of the carotid stent in the calcification lesion is satisfactory during the mid-term follow-up.
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Objective To evaluate the closed-cell stents in the treatment of carotid pseudo-occlusion.Methods From Jan 2014 to Dec 2017,clinical data of 34 patients undergoing carotid artery recanalization with closed-cell stents for pseudo-occlusion were analyzed retrospectively.Results The technical success rate was 97.1％ (33/34) and the intracranial blood supply improved in 91.2％ patients (31/34).The 30-day perioperative ipsilateral symptomatic ischemic stroke rate was 2.9％ (1/34).All the patients were discharged with no peri-operative hyperperfusion syndrome,myocardial infarction.The average follow-up time was 15.2 ±7.6 months.The incidence of carotid artery restenosis was 17.6％.There was no stroke-related mortality.Ultrasound or CTA found luminal dilatation of the distal internal carotid artery.The diameter increased from (2.5 ±0.5) mm to (4.1 ±0.6) mm after intervention (P ＜0.001).Conclusion Closed-cell stents for carotid artery pseudo-occlusion is safe and effective,decreasing cerebral stroke and carotid occlusion.
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Objective To evaluate the safety,effectivity and feasibility of Video-assisted thoracoscopic surgery(VATS) for the treatment of bronchiectasis.Methods The data of patients with bronchiectasis treated by surgery from January 2010 to September 2016 in Tangdu hospital,the Forth Military Medical University,were reviewed and analyzed retrospectively.Results There were 343 cases enrolled in this study,which were divided into Thoracotomy group(230 cases) and VATS group(113 cases,17 of them were converted into open surgery).There were 125 males and 105 females in Thoracotomy group,with the average age of(46.1 ± 14.4) years,and 45 males and 68 females in VATS group with the average age of(45.8 ± 13.4) years.Four patients died during the perioperative period and all of them were from Thoracotomy group.Compared with the Thoractomy group,the blood loss [(292.1 ± 301.7) ml vs(475.7 ± 525.4) ml,P =0.001],length of hospitalization [(6.4 ± 2.4) dvs.(9.1 ±6.6)d,P＜0.001],drainage time[(6.4 ±2.4)d vs.(9.1 ±6.6)d,P ＜0.001] were significantly lower in VATS group,but no difference in operation time.The cost in VATS group was higher [(4.5 ± 1.3) ten-thousand yuan vs (3.9 ± 1.8) ten-thousand yuan,P =0.001].For patients without comorbidities,the incidence of postoperative complications was lower in VATS group compared with that in Thoractomy group (P =0.003).There was no significant difference between two groups for patients with comorbidities (P =0.274),but there was a trend of declining in VATS group.Conclusion VATS is safe,effective and feasible to treat bronchiectasis,and should be a priority.
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<p><b>BACKGROUND</b>Crossover stenting across the origin of the profunda femoral artery (PFA) and occasionally into the common femoral artery (CFA) is commonly used after suboptimal balloon angioplasty of ostial occlusive lesions of the superficial femoral artery (SFA) involving the bifurcation. Late stent occlusion at the bifurcation is not rare and results in severe lower extremity ischemia. Therefore, we tried to assess its possible causes, prevention and reintervention.</p><p><b>METHODS</b>Using a prospectively maintained single-center database, 12-month femoral bifurcation patency was retrospectively compared and lesion and procedural predictors of stent occlusion were determined among 63 patients (64 lesions) who between July 2011 and February 2013 underwent crossover (36 non-jailed and 15 jailed SFA, and 12 distal and 1 complete CFA) stenting of de novo ostial SFA lesions.</p><p><b>RESULTS</b>Twelve-month overall patency rate at the femoral bifurcation was 88%, with no significant difference between jailed-ostial SFA (80%) and distal CFA (67%) stenting (P = 0.731), and significant differences between either and non-jailed ostial stenting (100%, P = 0.035 and 0.002). When PFA ostium was jailed by the stent, patients with preexisting CFA or PFA lesions had a 12-month bifurcation patency rate of 20%, significantly lower than those with simple ostial SFA lesions (83%, P = 0.015). Stent induced intimal hyperplasia caused bifurcation occlusion in 6 surgical reintervention cases.</p><p><b>CONCLUSIONS</b>In crossover stenting of ostial lesions in SFA, bifurcation patency loss was significantly higher in distal CFA and jailed ostial SFA stenting than non-jailed ostial SFA stenting. Preexisting CFA or PFA lesion is a significant risk factor for bifurcation patency loss when PFA ostium is jailed by crossover stenting.</p>