Stent angioplasty of narrowed right ventricular outflow conduits and pulmonary arteries consistently reduces right ventricular systolic pressures and delays subsequent surgeries

Objectives Narrowed right ventricular (RV) outflow conduits and pulmonary arteries (PA) increase RV pressures and warrant interventions. Stent angioplasty is an alternative to more morbid redo-surgery in developing countries. We evaluate the efficacy and safety of stenting and assess need for redo-surgical reinterventions on midterm follow-up after stent angioplasty. Methods Patients who underwent conduit, main PA and bilateral branch PA stenting for elevated RV pressures were analyzed retrospectively. Success was defined as 20% reduction in RV pressures or RV-aortic pressure ratio; 50% reduction in gradients or 50% increase of luminal diameter. Procedural results, complications and need for redo surgeries on follow-up were assessed. Results Among 60 patients aged 1–46 years, 57 were post-operative patients, who needed stenting at a median period of 48 months after surgery. Stenting succeeded in 98% and reduced RV pressures from 105.42 ± 28.39 mmHg to 54.46 ± 16.89 mmHg. Direct major procedural complications in five (8%) patients included procedural failure in one, stent migration in three and lung hemorrhage in one. None of the stented conduits needed a surgical change on a follow-up ranging 3–120 months. Following bilateral PA stenting in twenty-four patients, only two needed a repeat open-heart surgery during follow-up ranging 3–108 months. Catheter reinterventions on follow-up included elective percutaneous pulmonary valve implantation in nine patients and stent redilation in seven patients. Conclusions Stent angioplasty was safe and effective. Surgery was postponed in all stenosed conduits. Elective redilation of stents after bilateral PA stenting may be needed for somatic growth; but open-heart repeat surgeries can be avoided in a majority.

Carotid stent angioplasty for severe carotid artery stenosis: analysis of curative effect in 25 patients / 介入放射学杂志

Objective To discuss the surgical characteristics,safety and perioperative management of carotid stent angioplasty (CSA) for the treatment of severe carotid artery stenosis (＞85％).Methods From December 2011 to May 2016,a total of 25 patients with carotid artery stenosis (＞85％) were treated with CSA.According to the stenotic characteristics of the lesion,distal cerebral protection device was employed in performing CSA.During the operation,attention was paid to individualized and detailed surgical management and perioperative management program;the revascularization and the dropping-off of thrombus in cerebral protection device were under close observation,while effort was made to control the occurrence of complications.The patients were followed up for one year to observe the occurrence of ischemic cerebrovascular events.Results The cerebral protection device was successfully deployed after it passed over the severe carotid artery stenosis.After balloon pre-dilation the stent was deployed,and the stent showed satisfactory shape.North America Symptomatic Carotid Endarterectomy Testing (NASCET) showed that the average degree of carotid artery stenosis was decreased from preoperative (91.0±3.1)％ to postoperative (21.0±5.1)％.The protective umbrella was successfully retrieved in all patients,and deciduous tissue fragments were observed in 6 retrieved protective umbrellas.During the perioperative period no severe complications,such as cerebral hemorrhage,cerebral infarction,hyper-perfusion syndrome or death,were observed.All the 25 patients were followed up for one year,and no transient ischemic attack,stroke or death occurred.Conclusion In treating severe carotid artery stenosis with CSA,in order to ensure a successful surgery and patient's safety the following points are very important:in-operative individualized and detailed management,perioperative preventive measures,and use of appropriate cerebral protection device.

Curative effect analysis of intravascular stent angioplasty for extracranial internal carotid artery dissection / 局解手术学杂志

Objective To explore the clinic effect of intravascular stent angioplasty for extracranial internal carotid artery dissection(ICAD).Methods From July 2015 to December 2016, 25 cases of patients with extracranial ICAD were admitted into our hospital.Among them, there were 15 cases of head and neck pain,12 cases with transient ischemic or cerebral infarction symptoms (limb hemiplegia.etc.),6 cases of Horner syndrome,1 case with pulsatile tinnitus and syncope,2 cases with no obvious clinical symptoms which were found by the neck vascular ultrasound accidentally.All patients were treated with intravascular stent angioplasty.Calculated the degree of stenosis through digital subtraction angiography(DSA),measured the blood flow velocity with transcranial doppler(TCD),and observed the clinical manifestations.Reviewed those patients after six months.Results Totally 24 patients with ICAD fulfilled the intravascular stent angioplasty with no complications such as lining damage,bleeding and embolism.And one patient with ICAD abandoned intravascular stent angioplasty for the vascular is too circuity.DSA showed the average artery stenosis decreased from (76.70±10.57)% preoperatively to (11.07±4.18)% immediately after operation,and the difference was statistically significant(P<0.01).TCD measured the peak systolic velocity (PSV) of internal carotid artery stenosis segment,and the PSV changed from (189.55±54.27)cm/s averagely before operation to (88.41±17.06)cm/s on average one week after operation.The difference was statistically significant (P<0.01).Reviewed the head and neck CT angiography (CTA) after 6 months.There were 23 cases without new stenosis and 1 case had stent restenosis compared with CTA immediately after operation.Symptoms of 19 cases obviously remitted or disappeared,4 cases partially remitted,and recurrence occured in 1 patient.There was no appearance of infarction and other serious complications.Conclusion The intravascular stent angioplasty is relatively safe and effective for extracranial ICAD, which can remit the degree of stenosis,slow down the blood flow and relieve the clinical symptoms with low recent recurrence rate and adverse reaction.But it does not apply to patients with severe vascular circuity.

A clinical study of perforating artery occlusion occurring after stent implantation of intracranial branch of vertebral artery / 天津医药

Objective To explore the methods to reduce the occlusion of perforating arteries after intracranial stenting of the vertebral artery. Methods Clinical data of 32 cases of Gateway-Wingspan stent implantation for intracranial branch of vertebral artery were retrospectively analyzed. The postoperative stricture and perfusion improvement situation were evaluated, the reason of perforating artery occlusion was analyzed. Results Thirty-two patients were implanted with 33 pieces of Wingspan stent and 1 piece of Apollo bracket. The operation success rate were 100%, and the stenosis rate reduced from (76.6±6.1)%to (27.9±5.2)%. After three months, the transcranial doppler sonography (TCD) and CT angiography were checked, showing no in-stent restenosis in all patients. Two patients occurred the perforating artery occlusion within 24 hours after operation. The possible reason was the change of stability of atherosclerotic plaque at the stenosis and the plaque displacement caused by the mechanical action of the balloon or stent, which may lead to medulla oblongata artery block. After drug and rehabilitation treatment, the symptoms in patients were improved significantly. Conclusion The perforating artery occlusion after stent implantation in intracranial branch of vertebral artery can be prevented by strict evaluation and preoperative preparation, the right selection of intraoperative balloon and stent, which still needs larger sample data to prove.

Efficacy analysis of stent angioplasty on symptomatic stenoses of vertebral arteries origins / 中国基层医药

Objective To evaluate the safety and efficiency of endovascular stenting on symptomatic stenosis of vertebral artery origin .Methods 62 patients with symptomatic stenosis of vertebral artery origin received vertebral stenting.Before and after operation ,vascular stenosis rate and clinical symptoms were observed ,and follow-up on all cases.Results The stents was successfully performed in 62 patients.The symptomatic stenosis and clinical symptoms were significantly improved.The stenosis rate decreased from (77.4 ±15.3)%to (12.2 ±6.5)%.The postoperative follow-up lasted for 6-42months.5 cases developed restenosis .Conclusion Endovascular stenting for symptomatic stenosis of vertebral artery origin is safe and effective ,but the long-term curative effect of this technique should be further observed .

Perioperative complications of stent angioplasty for intracranial arterial stenosis：clinical analysis and therapeutic strategy / 介入放射学杂志

Intracranial artery stenosis is one of the main causes inducing transient ischemic attack (TIA) or cerebral ischemic stroke. Being a minimally-invasive and reliably-effective technique, intracranial artery stent angioplasty has brought about a new approach for the treatment of intracranial artery stenosis , and thus provides more opportunities to the patients who are not suitable for intracranial vascular bypass surgery. However, the higher occurrence of perioperative complications caused by stent angioplasty should be seriously taken into consideration by clinical physicians. In order to reduce the occurrence of complications , in this paper the perioperative complications of stent angioplasty for intracranial artery stenosis are analyzed , and the therapeutic strategies as well as the proper approaches are discussed.

Study of relationship between levels of hs-CRP and IL-6 with restenosis after stent angioplasty in cerebral arterial stenosis / 重庆医学

Objective To investigate the relationship between the dynamic changes of hs-CRP and IL-6 with restenosis after stent angioplasty in cerebral arterial stenosis .Methods 65 patients with cerebral artery stenosis stent angioplasty in Nanyang Mu-nicipal Central Hospital from March 2011 to March 2013 were retrospectively analyzed .The changes of hs-CRP and IL-6 levels be-fore operation and at different postoperative time points were observed and their correlation with vascular restenosis was anlyzed . Results (1)The cerebral artery stenosis degree and serum hs-CRP and IL-6 levels were positively correlated(P0 .05);△hs-CRP and △IL-6 had sta-tistically significant differences between the patients with restenosis and the patients without restenosis (P<0 .05) .Conclusion hs-CRP and IL-6 may play an important role in the process of restenosis after stent angioplasty in cerebral arterial stenosis .Monitoring the dynamic changes of hs-CRP and IL-6 has certain value for evaluating vascular restenosis .

The Difference of Each Angiographic Finding After Multiple Stent According to Stent Type in Bilateral Vertebral Artery Dissection

We report a case of spontaneous bilateral intracranial vertebral artery dissecting aneurysms with subarachnoid hemorrhage. One dissecting lesion was treated with a coronary balloon-mounted stent (BMS) technique; however, due to differences in access route tortuosity, the other lesion was treated with a self-expandable stent (SES) technique. After 2 months, the angiographic outcome showed complete healing of the dissected segment on the side that was treated with BMS; in contrast, the dissection lesion appeared to be re-growing on the side that was treated with SES. Complete treatment of the aggravated lesion was achieved by additional deployment of BMSs. Therefore, we have provided a discussion of the possible reasons for this difference in outcome according to the stent type.

The Difference of Each Angiographic Finding After Multiple Stent According to Stent Type in Bilateral Vertebral Artery Dissection

We report a case of spontaneous bilateral intracranial vertebral artery dissecting aneurysms with subarachnoid hemorrhage. One dissecting lesion was treated with a coronary balloon-mounted stent (BMS) technique; however, due to differences in access route tortuosity, the other lesion was treated with a self-expandable stent (SES) technique. After 2 months, the angiographic outcome showed complete healing of the dissected segment on the side that was treated with BMS; in contrast, the dissection lesion appeared to be re-growing on the side that was treated with SES. Complete treatment of the aggravated lesion was achieved by additional deployment of BMSs. Therefore, we have provided a discussion of the possible reasons for this difference in outcome according to the stent type.

Comparison of Drug-eluting Coronary Stents, Bare Coronary Stents and Self-expanding Stents in Angioplasty of Middle Cerebral Artery Stenoses

OBJECTIVE: The purpose of this study is to investigate the results of treatment using stent-angioplasty for symptomatic middle cerebral arterial (MCA) stenosis and comparison of in-stent restenosis between drug-eluting stents (DES), bare metal coronary stents (BMS) and self-expanding stents (SES). MATERIALS AND METHODS: From Jan. 2007 to June. 2012, 34 patients (mean age +/- standard deviation: 62.9 +/- 13.6 years) with MCA stenosis were treated. Inclusion criteria were acute infarction or transient ischemic attacks (TIAs) and angiographically proven symptom related severe stenosis. Stents used for treatment were DES (n = 8), BMS (n = 13) and SES (n = 13). National Institutes of Health Stroke Scale (NIHSS) at admission was 2.5 +/- 3.1 and mean stenosis rate was 79.0 +/- 8.2%. Assessment of clinical and angiographic results was performed retrospectively. RESULTS: Among 34 patients, periprocedural complications occurred in four cases (11.8%), however, only two cases (6.0%) were symptomatic. All patients were followed clinically (mean follow-up period; 40.7 +/- 17.7 months) and 31 were followed angiographically (91.2%. 13.4 +/- 8.5 months). There was no occurrence of repeat stroke in all patients; however, mild TIAs related to restenosis occurred in three of 34 patients (8.8%). The mean NIHSS after stent-angioplasty was 1.7 +/- 2.9 and 0.8 +/- 1.1 at discharge. The modified Rankin score (mRS) at discharge was 0.5 +/- 0.9 and 0.3 +/- 0.8 at the last clinical follow-up. In-stent restenosis over 50% occurred in five of 31 angiographically followed cases (16.1%), however, all of these events occurred only in patients who were treated with BMS or SES. Restenosis rate was 0.0% in the DES group and 20.8% in the other group (p = 0.562); it did not differ between BMS and SES (2/11 18.2%, 3/13 23.1%, p = 1.000). CONCLUSION: Stent-angioplasty appears to be effective for symptomatic MCA stenosis. As for restenosis, in our study, DES was presumed to be more effective than BMS and SES; meanwhile, the results did not differ between the BMS and SES groups.

Bilateral Superior Cerebellar Artery Infarction after Stent-Angioplasty for Internal Carotid Artery Stenosis

Spontaneous bilateral cerebellar infarction in the territory of the superior cerebellar arteries is extremely rare. Occasionally there have been reports of bilateral cerebellar infarction due to vertebrobasilar atherosclerotic occlusion or stenosis, whereas no report of bilateral cerebellar infarction due to complicated hemodynamic changes. In this report, we present a patient with bilateral cerebral infarctions related to stenoses of bilateral internal carotid arteries, in whom vertebrobasilar system was supplied by multiple collaterals from both posterior communicating arteries and right external carotid artery. We performed stent-angioplasty of bilateral internal cerebral arterial stenosis, and then acute infarction developed on bilateral superior cerebellar artery territories. The authors assumed that the infarction occurred due to hemodynamic change between internal carotid artery and external carotid artery after stent-angioplasty for stenosis of right internal carotid artery.

Nursing in Period of Surrounding Operation for Carotid Artery Stenting Angioplasty / 中国康复理论与实践

@# ObjectiveTo study the nursing characteristics in surrounding period of operation for treating carotid artery stenosis with stenting angioplasty. MethodsThe nursing procedure for 78 cases with carotid artery stenosis were reviewed to form the duties and items of nursing, including cooperation between doctors and nurses, mentality nursing, instruction of convalescence in the pre-operation, during operation and post-operation. ResultsAll the cases has successfully finished their operative procedure and none serious complication has been found. ConclusionThe nursing play a important role in the stenting angioplasty of carotid artery.

Therapeutic effect observation of endovascular stent assisted angioplasty for symptomatic intracranial arteriostenosis / 临床神经病学杂志

Objective To observe the effectiveness and safety of endovascular stent assisted angioplasty for symptomatic intracranial arteriostenosis.Methods 4 patients with symptomatic intracranial arteriostenosis were treated with endovascular angioplasty using balloon expandable stents. Therapeutic effects were evaluated by clinical manifestations, digital subtraction angiography (DSA) and transcranial Dopple (TCD) before and after the operation. Follow up was made for 7~10 months.Results Technical success was achieved in all patients, with no complication of cerebral embolism and hemorrhage except one of transient seizure during operation. Angiographic results immediately after stenting suggested that the residual postoperation stenosis was 8%(0%~17%), with significant reduction from preoperation stenosis of 75%(70%~80.7%). No recurrent TIA and stroke occurred and no restenosis was found with serial TCD in all 4 patients during follow up of 7~10 months.Conclusions Endovascular stenting is a safe and effective therapeutic tool for symptomatic intracranial arteriostenosis.