Evaluation of the efficacy of restricted bare stent in the treatment of acute stanford A aortic dissection / 中华胸心血管外科杂志

Objective To observe the effect of restrictive bare stent release on the distal end of Stanford type A aortic dissection.Methods From November 2016 to February 2018,20 patients with Stanford type A aortic dissection requiring aortic arch replacement and trunk surgery were selected for restrictive bare stent placement.Among them,there were 17 males and 3 females,aged 34-68 years old with an average age of(50.85 ± 8.49) years.The bare stent was released in the descending thoracic aorta,and the frozen elephant trunk was placed in the bare stent.The CTA of the great vessels was reviewed before discharge and the stent position and complications were observed.And compared with 42 patients with acute aortic arch replacement and stent-like nasal surgery in the acute Stanford type A aortic dissection from December 2013 to June 2015.Of the 42 patients,32 were males and 10 were females,aged 20-78 years,with an average of(49.36 ± 8.02) years.Results One patient in the bare stent group had greater resistance when the bare stent was placed,and the patient was disengaged and abandoned.The remaining 19 patients successfully completed the restrictive bare stent placement.One patient died of a large cerebral infarction during hospitalization.All 18 patients who survived and successfully placed the bare stent were followed up regularly.There was no stroke or death during the follow-up period.The computed tomography angiography of the computed tomography showed good shape and position,no displacement and type lⅢ endoleak,and no new fracture of the distal end of the elephant trunk was observed.In the conventional surgery group,2 patients died,1 patient died of large-scale cerebral infarction,and 1 patient died of perioperative myocardial infarction.No paraplegia cases.In 2 cases,a new rupture of the distal eud of the elephant trunk was performed,and the stent was placed again.Conclusion Compared with the conventional surgery group,the use of the restricted bare stent is safe,can effectively reduce the occurrence of stent-graft induced new entry and can significantly expand the diameter of the distal vessel,and the aortic remodeling effect is good.

Efficacy of restrictive bare stent in the treatment of acute Standford type A aortic dissection / 中国胸心血管外科临床杂志

@#Objective    To observe the efficacy of restrictive bare stent released on the distal end of the trunk of Standford type A aortic dissection. Methods     The clinical data of 22 patients with Standford type A aortic dissection requiring aortic arch replacement and trunk surgery and selected for restrictive bare stent placement from November 2016 to February 2018 in our hospital were retrospectively analyzed. Among them, there were 19 males and 3 females, aged 34-68 (49.72±8.05) years. The bare stent was released in the descending thoracic aorta, and the stented elephant trunk was placed in the bare stent. The aortic computerized tomography angiography was reviewed before discharge and the stent position and complications were observed. Results    One patient failed to be implanted with bare stents due to a greater resistance and prolapse during implantation. Bare stents were successfully implanted in the remaining 21 patients. One patient died of large-area cerebral infarction after surgery and one patient suffered paraplegia. Twenty patients who survived and successfully implanted bare stents were followed up at regular intervals for 4-21 (13.00±6.14) months. No stroke or death occurred during the follow-up. The computerized tomography angiography showed good stent morphology and position, and no displacement or type Ⅲ endoleak. No stent graft-induced new entry was found. Conclusion    As an adjunct to stented elephant trunk, the use of restrictive bare stents can reduce the possibility of recurrence of a distal stent fracture, significantly expand the narrowest segment and true lumen caliber near the endoluminal graft. Aortic remodeling works well.

Transjugular intrahepatic portosystemic shunt and hepatic encephalopathy / 肠外与肠内营养

Transjugular intrahepatic portosystemic shunt (TIPS) has been developed for two decades in order to treat portal hypertension accompanying with upper gastrointestinal hemorrhage and refractory ascites.TIPS may cause the development of hepatic encephalopathy (HE).TIPS induces portalsystemic shunt and leads to hemodynamics chaos. Hepatic encephalopathy belongs to the complications of the portal hypertension. There are many possible predictors of the post-TIPS HE. The relationship between TIPS and HE was reviewed.

Usefulness of Drug-Eluting Stents in Angioplasty and Stenting of the Vertebral Artery Origin : Comparison with Bare Stents: Clinical Research / 대한뇌혈관외과학회지

OBJECT: In the treatment of coronary atherosclerosis, drug-eluting stents are effective in decreasing the rate of major adverse cardiac events and angiographic restenosis compared with bare metal stents. However, the benefits and safety of using these new devices in the cerebral vasculature have not been evaluated. To assess the effectiveness of drug-eluting stents in the cerebral vasculature, the authors analyzed clinical and angiographic results after percutaneous transluminal angioplasty and stenting in patients with vertebral artery origin stenosis. METHODS: Ninety-one patients with 99 vertebral origin stenoses treated with percutaneous endovascular balloon angioplasty and stent placement during a period of 5.1 years (September 1999-October 2004). Follow-up angiograms were obtained from 38 patients with 42 lesions (24 men, 14 women ; mean age, 61.9 yrs ; mean follow-up period, 9.1 months). We reviewed the clinical and radiological records of these patients. RESULTS: Bare stents were implanted in 30 lesions, while drug-eluting stents were implanted in 12 lesions, with a mean residual stenosis of 5.1 %. The overall rate of moderate-to-severe restenosis (> or =50%) was 31.0 % (13 of 42 cases). The restenosis rate in the bare stent group was 36.7 %, compared with 16.7 % in the drug-eluting stent group (p=0.282). Comparing the restenosis rate in stented lesions with reference diameters less than 3.5 mm (11 with bare stents, 12 with drug-eluting stents), the restenosis rates were 63.6 % in the bare stent-group and 16.7 % in the drug-eluting stent-group (p=0.029). CONCLUSION: Drug-eluting stents placed in vertebral artery origin stenosis have lower restenosis rate than bare stents, particularly in small-sized vessels.

Usefulness of Drug-Eluting Stents in Angioplasty and Stenting of the Vertebral Artery Origin : Comparison with Bare Stents: Clinical Research / 대한뇌혈관외과학회지

OBJECT: In the treatment of coronary atherosclerosis, drug-eluting stents are effective in decreasing the rate of major adverse cardiac events and angiographic restenosis compared with bare metal stents. However, the benefits and safety of using these new devices in the cerebral vasculature have not been evaluated. To assess the effectiveness of drug-eluting stents in the cerebral vasculature, the authors analyzed clinical and angiographic results after percutaneous transluminal angioplasty and stenting in patients with vertebral artery origin stenosis. METHODS: Ninety-one patients with 99 vertebral origin stenoses treated with percutaneous endovascular balloon angioplasty and stent placement during a period of 5.1 years (September 1999-October 2004). Follow-up angiograms were obtained from 38 patients with 42 lesions (24 men, 14 women ; mean age, 61.9 yrs ; mean follow-up period, 9.1 months). We reviewed the clinical and radiological records of these patients. RESULTS: Bare stents were implanted in 30 lesions, while drug-eluting stents were implanted in 12 lesions, with a mean residual stenosis of 5.1 %. The overall rate of moderate-to-severe restenosis (> or =50%) was 31.0 % (13 of 42 cases). The restenosis rate in the bare stent group was 36.7 %, compared with 16.7 % in the drug-eluting stent group (p=0.282). Comparing the restenosis rate in stented lesions with reference diameters less than 3.5 mm (11 with bare stents, 12 with drug-eluting stents), the restenosis rates were 63.6 % in the bare stent-group and 16.7 % in the drug-eluting stent-group (p=0.029). CONCLUSION: Drug-eluting stents placed in vertebral artery origin stenosis have lower restenosis rate than bare stents, particularly in small-sized vessels.