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@#Currently, transcatheter intervention has emerged as a first-line treatment for coarctation of the aortic. Due to the radiation exposure associated with catheter interventional therapy, there are numerous restrictions, which harms both patients and medical personnel and is dependent on sizable radiation apparatus. Here, we report for the first time a case of echo-guiding percutaneous aortic stent implantation for a 27 years female patient of reproductive age. After discharge, the patient's aortic coarctation pressure decreased to 18 mm Hg, and the surgical results were satisfactory.
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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 strategies of perioperative antithrombotic therapy in the patient undergoing revision total hip arthroplasty after coronary stent implantation. Methods The antithrombotic therapy in one patient undergoing revision total hip arthroplasty after coronary stent implantation was analyzed with the review of related literatures. Results The patient developed non-ST segment elevated myocardial infarction due to the stop of aspirin three days before operation and no low molecular weight heparin was used. The antithrombotic treatment and prevention of venous thromboembolism were analyzed. Conclusion Antithrombotic therapy should be selected reasonably in patients undergoing revision total hip arthroplasty after coronary stent implantation.
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OBJECTIVE To syste matically evaluate the prevention effects of nicorandil on contrast-induced nephropathy in patients underwent coronary angiography （CAG）or stent implantation （CSI），and to provide evidence-based reference for clinical drug use. METHODS Retrieved from PubMed ，Embase，Cochrane library ，Wanfang database ，CBM and CNKI ，randomized controlled trial （RCT）about nicorandil （trial group ）versus normal saline or placebo （control group ）prevented contrast-induced nephropathy in patients underwent CAG or CSI were collected during the inception to Nov. 2021. After extracting literature that met the inclusion criteria ，the bias risk assessment tool of RCT in Cochrane manual was used for quality evaluation ，and meta-analysis was performed by using RevMan 5.3 software. RESULTS A total of 17 RCTs were included ，involving 3 279 patients. Among them，there were 1 587 patients in trial group ，and 1 692 patients in control group. Results of meta-analysis showed that the incidence of contrast-induced nephropathy in trial group was significantly lo wer than control group [RR ＝0.40，95％CI（0.31，0.51）， P＜0.000 1] . Results of subgroup analysis showed that the incidence of contrast-induced nephropathy in trial group was significantly lower than control group ，whether intravenous administration [RR ＝0.47，95％CI（0.29，0.74），P＝0.001] or oral administration [RR ＝0.37，95％CI（0.28，0.50），P＜0.000 01]，whether patients with normal renal function [RR ＝0.42，95％CI（0.30， 0.59），P＜0.000 01] or with renal insufficiency [RR ＝0.38， 95％ CI（0.26，0.54），P＜0.000 01]. Scr of 24 h[SMD＝ －1.38，95％CI（－2.32，－0.44），P＝0.004]，48 h[SMD＝ －0.81，95％CI（－1.19，－0.43），P＜0.000 1] and 72 h[SMD＝ －0.24，95％CI（－0.43，－0.05），P＝0.01] after surgery in trialgroup were significantly lower than control group ；the 163.com decrease of creatinine clearance rate of 48 h[SMD＝1.27， 95％CI（0.48，2.07），P＝0.001] and 72 h[SMD＝0.37，95％CI（0.07，0.67），P＝0.02] after surgery in trial group were significantly lower than control group ；cystatin C of 24 h[SMD＝－0.93，95％CI（－1.72，－0.14），P＝0.02]，48 h[SMD＝－1.72，95％CI （－2.33，－1.10），P＜0.000 01] and 72 h[SMD＝－0.36，95％CI（－0.62，－0.10），P＝0.006] after surgery in trial group were significantly lower than control group. CONCLUSIONS Pretreatment of nicorandil can reduce the incidence of contrast-induced nephropathy in patients underwent CAG or CSI ，and reduce the damage of renal function after application of contrast.
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Objective To evaluate the clinical efficacy of percutaneous transluminal angioplasty (PTA) combined with stent implantation in the treatment of transplant renal artery stenosis (TRAS) after renal transplantation. Methods Clinical data of 21 patients with TRAS after renal transplantation undergoing PTA combined with stent implantation were retrospectively analyzed. The incidence of TRAS in renal transplant recipients was summarized. The changes of relevant indexes in patients with TRAS were statistically compared before and after interventional treatment. Clinical prognosis of patients with TRAS was evaluated. Results The incidence of TRAS in renal transplant recipients was 4.1%(21/507). TRAS was diagnosed at postoperative 5 (4, 7) months, and 67% (14/21) of patients developed TRAS within postoperative 6 months. Compared with the values before interventional therapy, the serum creatinine level, systolic and diastolic blood pressure and peak flow velocity of transplant renal artery of patients with TRAS were significantly decreased, and the estimated glomerular filtration rate (eGFR) and interlobar arterial resistance index were significantly increased at 1 week and 1 month after interventional therapy (all P < 0.05). During postoperative follow-up after PTA combined with stent implantation, 1 patient suffered re-stenosis of the transplant renal artery, which was improved after simple balloon dilatation. One patient developed pseudoaneurysm formation at the puncture site of the right femoral artery. One patient presented with renal atrophy and loss of function due to atresia of the transplant renal artery. All the remaining 18 patients were well recovered after surgery. Conclusions PTA combined with stent implantation is the optimal treatment of TRAS after renal transplantation, which can significantly improve the function of transplant kidney and considerably prolong the survival time of transplant kidney.
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Lung transplantation is the only effective treatment of most end-stage lung diseases. Airway anastomotic complications are the main obstacles affecting the postoperative survival and quality of life of lung transplant recipients. Airway anastomotic stenosis is the most common airway anastomotic complication after lung transplantation. In recent years, improvements in the recipient selection, organ preservation, surgical techniques, postoperative intensive care management, immunosuppression, antifungal and endoscopic treatment have decreased the incidence of airway anastomotic stenosis and improved the surgical efficacy of lung transplantation and the survival of the recipients. In this article, the pathogenesis, risk factors, diagnosis and treatment of airway anastomotic stenosis after lung transplantation were reviewed, aiming to provide novel ideas for clinical research, diagnosis and treatment of airway anastomotic stenosis following lung transplantation.
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Objective To observe the efficacy of endoscopic nasal dacryocystoma anastomosis combined with stent implantation in the treatment of chronic recurrent dacryocystitis. Methods Thirty patients (30 eyes) with chronic dacryocystitis who had relapsed after traditional endoscopic nasal dacryocystorhinostomy were hospitalized in the Department of Otolaryngology Head and Neck Surgery department of Gansu Provincial People's Hospital from January 2010 to January 2019. Nasal lacrimal anastomosis under endoscope, intraoperative combined stent implantation, 3 months after operation, the lacrimal duct stent was removed, the patient ' s tearing symptoms were observed, the lacrimal duct was flushed to determine the lacrimal duct obstruction, and the follow-up period was 12 months. Results Twelve months of follow-up to 12 months, 14 eyes of 30 patients had no complaints of tearing, tearing, and lacrimal tract flushing; The ostomy fistula was unobstructed under nasal endoscope and the fistula was not significantly reduced. There was no complaint of tears in the eyes, tears overflowed, and the lacrimal duct was flushed, but the fistula opening was reduced.; Four eyes showed granulation hyperplasia next to the fistula, which blocked the fistula again. The overall effective rate was 87%. Conclusion Endoscopic dacryocystorhinostomy combined with stent implantation is an effective method for the treatment of chronic recurrent dacryocystitis with good clinical result.
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Superior vena cava syndrome (SVCS), which is characterized by facial edema and congestion of the head, upper extremities, and neck, is a life-threatening oncologic emergency. Although a combination of chemotherapy and radiation therapy has been considered as the standard treatment for SVCS, stent implantation to the superior vena cava (SVC) has been recently developed to alleviate edema or dyspnea caused by SVCS. On the other hand, stent implantation to the SVC requires skilled interventional cardiologists or radiologists. In general, those specialists reside in university hospitals or large hospitals in an urban area. In this case report, an 86-year-old man underwent stent implantation to a stenosed SVC in a rural area. Because the patient refused the transfer to the core, urban hospital, we invited a skilled interventional cardiologist from the core hospital and performed stent implantation to the SVC in a small, rural hospital. It is generally difficult to perform stent implantation for SVCS in a small hospital, because skilled operators in the field of interventional cardiology or radiology do not usually perform operations in smaller facilities. Our case indicates the importance of cooperation between rural generalists and urban specialists.
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@#Objective To explore the influence of applying the fast-track surgery (FTS) to optimize the process in the perioperative period of cardiac intervention on the rehabilitation of patients with radial artery stenting surgery. Methods A total of 190 patients with radial artery stenting surgery in the Department of Cardiology, West China Hospital from June 2017 to May 2018 were enrolled. They were randomized into a control group (n=95) and a FTS group (n=95) by random umber table. There were 60 males and 35 females aged 35-88 (65.2±9.6) years in the control group as well as 62 males and 33 females aged 34-86 (61.5±11.3) years in the FTS group. Patients in the control group received routine perioperative care, but patients in the FTS group received individual precision interventions by applying the FTS concept to optimize the process of perioperative care, including individual care management before being admitted into hospital, during hospital, and after discharge from hospital. Duration of hospital stay, satisfaction scores, number of comorbidities after surgery, disease self-management ability, and readmission rates were compared between the two groups. Results Compared to the control group, the FTS group had significantly shorter duration of hospital stay, less comorbidities, higher satisfaction scores and disease self-management ability, and lower readmission rate to hospital (P<0.05). Conclusion Applying FTS into the perioperative period of cardiac interventions to optimize its process can help patients recover from radial artery stenting surgery, increase patients’ self-management abilities, shorten duration of hospital stay and decrease comorbidities and cardiac adverse events.
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Objective To evaluate the clinical effect of endovascular therapy with covered stent in treating aortoiliac occlusive disease. Methods The clinical data of 20 patients with aortoiliac occlusive disease, who received endovascular therapy with covered stent during the period from January 2014 to December 2016, were collected. According to Rutherford standard of clinical symptom classification, gradeⅢ, grade Ⅳ and grade V were seen in 9, 7 and 4 patients respectively. Based on the Trans-Atlantic Society Coalition (TASC) treatment guidelines Ⅱ classification, B type, C type and D type were observed in 4, 7 and 9 patients respectively. The postoperative primary patency and secondary patency of the stent as well as the clinical efficacy were analyzed. Results Endovascular treatment was successfully accomplished in all 20 patients. After the treatment, the clinical symptoms were significantly relieved. Two patients developed complications (10％). One patient developed thrombus at the distal end of stent, which was improved after thrombolytic therapy. Another patient developed hematoma at puncture site, which was absorbed after conservative therapy. No perioperative death occurred. The patients were followed up for 5-37 months, with a mean of (17±10) months. The primary patency rate was 95％ and the secondary patency rate was 100％. Conclusion For the treatment of aortoiliac occlusive disease, endovascular therapy with covered stent has excellent clinical efficacy.
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Objective To investigate the clinical effect of endovascular stent implantation and medical treatment in the treatment of symptomatic vertebral artery stenosis. Methods Eighty patients with symptomatic vertebral artery stenosis admitted from January 2013 to May 2015 in the Department of Neurology of Wuhan Puren Hospital were selected. The patients were randomly divided into the observation group and the control group,with 40 cases in each group. The control group was given aspirin enteric?coated tablets 100 mg/ time,1 time /d,clopidogrel bisulfate bablets 75 mg/ time,1 time /d,atorvastatin calcium 10 mg/ time,1 time/d. The observation group was treated with intravascular stent implantation. After 1 years of follow?up, the degree of vascular stenosis,the occurrence of ischemic cerebrovascular time and the clinical effect of the two groups were compared. Results (1) The stenosis degree of the observation group and the control group before treatment was (72. 81±11. 99)％ and (68. 31±12. 35)％ respectively,after treatment,it was (24. 58±1. 24)％ and (56. 01 ±3. 30)％ respectively. There was no significant difference between the two groups before treatment (t=0. 121,P>0. 05). After treatment,vascular stenosis degree in two groups were significantly improved,compared with that before treatment,the differences were statistically significant (t=0. 790,P<0. 05; t=0. 457,P<0. 05); the degree of vascular stenosis after treatment in the observation group was significantly lower than that in the control group ( t=0. 842,P<0. 05);( 2) during follow?up,the total occurrence rate of ischemic cerebrovascular events in the observation group was 17. 5％ (7/40),compared to 37. 5％ (15/40) in the control group,the difference between the two groups was statistically significant (χ2=4. 065,P<0. 05) . ( 3) At 1 years of follow?up,the total effective rate of the observation group was 97. 5％ ( 39/40) ,while that of the control group was 60％ ( 24/40) , and the difference between the two groups was statistically significant ( P=0. 017) . Conclusion Endovascular stent implantation can effectively improve the clinical efficacy of symptomatic vertebral artery, reduce the incidence of ischemic cerebrovascular time,and improve the degree of vascular stenosis.
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Objective To study the efficacy of percutaneous transhepatic cholangiodrainage (PTCD),percutaneous gallbladder drainage,and percutaneous transhepatic biliary stent implantation for the treatment of malignant obstructive jaundice in patients who are observed to fail endoscopic drainage. Methods We retrospectively analyzed 17 patients diagnosed with obstructive jaundice between August 2015 and July 2017 who were observed to have failed endoscopic drainage. Percutaneous puncture drainage had been performed in all patients-different methods were chosen based on the type of lesion and the patient's intraoperative condition. Among these patients, 9 underwent percutaneous transhepatic biliary stent implantation (53％),5 underwent PTCD (29％),and 3 underwent percutaneous gallbladder drainage (18％). The serum levels of total bilirubin (TBIL) and alanine aminotransferase (ALT) were assessed a day preoperatively and a week postoperatively. The postoperative decrease (or drop) in the serum TBIL and ALT levels was used as a parameter to assess the efficacy of treatment. Patients were divided into a stent and a tube group. The therapeutic effects were compared between the groups in terms of the drop in the serum TBIL and ALT levels and the survival time of patients. Results The postoperative serum TBIL and ALT levels were significantly decreased in all patients (P < 0. 05). No statistically significant difference was observed between the stent and the tube group in terms of the decrease in serum TBIL and ALT levels (P > 0. 05). However,a statistically significant difference was observed between the stent and the tube group in terms of the survival time of patients (P < 0. 05). Conclusion Percutaneous puncture is an effective treatment modality to manage malignant obstructive jaundice in patients who fail endoscopic drainage. Compared to tube drainage,stent placement can prolong patient survival time. Regarding the decrease in serum TBIL and ALT levels,we conclude that stent implantation is not significantly better than tube drainage.
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PURPOSE: The efficacy of percutaneous stent implantation for congenital heart disease (CHD) in Korea, where stent availability is limited, has not been determined. This study evaluated the acute and midterm results of stent implantation in different CHD subgroups. METHODS: Stents were implanted in 75 patients with 81 lesions: (1) pulmonary artery stenosis (PAS) group, 56 lesions in 51 patients; (2) coarctation of the aorta (CoA) group, 5 lesions in 5 patients; (3) Fontan group, 13 lesions in 12 patients; (4) ductal stent group, 3 lesions in 3 patients; and (5) other CHD group, 4 lesions in 4 patients. Mean follow-up duration was 2.1 years (0.1–4 years). Medical records were reviewed retrospectively. RESULTS: The minimum lumen diameter (MLD) in PAS and CoA increased from 5.0±1.9 mm and 8.4±1.6 mm to 10.1±3.6 mm and 12.3±2.5 mm, respectively (P<0.01). In the PAS group, pressure gradient decreased from 25.7±15.6 mmHg to 10.4±10.1 mmHg, and right ventricular to aortic pressure ratio from 0.56±0.21 to 0.46±0.19. In the CoA group, the pressure gradient decreased from 50±33 mmHg to 17±8 mmHg. In the ductal stent group, the MLD of the ductus increased from 2.3 mm to 4.3 mm and arterial oxygen saturation from 40%–70% to 90%. No deaths were associated with stent implantation. Stent migration occurred in 3 patients, but repositioning was successful in all. Stent redilation was performed successfully in 26 cases after 29±12 months. CONCLUSION: Percutaneous stent implantation was safe and effective, with acceptable short and mid-term outcomes in Korean CHD patients.
Sujets)
Humains , Coarctation aortique , Pression artérielle , Sténose pathologique , Études de suivi , Cardiopathies congénitales , Corée , Dossiers médicaux , Oxygène , Artère pulmonaire , Études rétrospectives , EndoprothèsesRésumé
Objective To investigate the effect of aspirin and ticagrelor or clopidogrel anticoagulant therapy on platelet aggregation,endothelial function and levels of inflammatory mediators in patients with acute coro-nary syndrome(ACS)after coronary stent implantation(PCI).Methods 100 cases of patients with ACS who underwent coronary stent implantation in our hospital from April 2014 to May 2016 were enrolled in the stud-y.The patients were randomly divided into the observation group and the control group by random number ta-ble method,50 cases in each group.The observation group were treated with aspirin and ticagrelor anticoagu-lant therapy after operation,while the control group were treated with aspirin and clopidogrel anticoagulant therapy.All patients were followed up for 1 year.The platelet aggregation rate within 1 year of medication, levels of serum endothelin-1(ET-1),nitric oxide(NO),plasminogen activator inhibitor-1(PAI-1),high-sen-sitivity C reactive protein(hs-CRP),interleukin-6(IL-6)and soluble CD40 ligand(sCD40L)were compared between the two groups.The outcome events and adverse reactions were recorded.Results 1 month,6 months and 1 year after treatment,the platelet aggregation rates in the observation group were lower than those in the control group(P<0.05).After treatment,levels of serum ET-1,PAI-1,hs-CRP,IL-6 and sCD40L were sig-nificantly lower in the observation group than the control group(P<0.05),while NO level was higher than the control group(P<0.05).The incidence rates of outcome events and adverse reactions in the observation group were slightly lower than those in the control group(6.00% and 8.00% vs.10.00% and 10.00%,P>0.05).Conclusion The effect of aspirin combined with ticagrelor anticoagulant therapy is better than that of aspirin combined with clopidogrel anticoagulant therapy in patients with ACS after PCI.The former can signif-icantly improve platelet aggregation,endothelial function and levels of inflammatory mediators,and it is safe and reliable.
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Objective To evaluate the success rate,vascular patency time and their influencing factors of percutaneous transluminal angioplasty (PTA) in treating swollen hand syndrome in hemodialysis patients.Methods The clinical data of 16 hemodialysis patients with swollen hand syndrome,who were admitted to authors' hospital during the period from May 2015 to March 2017 to receive PTA,were retrospectively analyzed.The technical success rate,the follow-up primary vascular patency time and primary patency rate were calculated,and the factors influencing technical success rate and vascular patency time were analyzed.Results Venography with DSA revealed that a total of 16 segments of venous stenosis or occlusion were found in 16 patients,including 6 stenotic lesions and 10 occlusive lesions.Successful PTA was obtained in 14 patients,including one patient whose angiography performed immediately after PTA with balloon dilatation showed that the stenosis was still over 50％,and stent implantation had to be carried out.The technical success rate was 87.5％,in 2 patients PTA failed as the guide wire could not pass through the long segment of vascular occlusion.The 14 patients were followed up for 3-24 months,and the median patency time was 10.5 months.The 3-,6-and 12-month primary patency rates were 71.4％ (10/14),57.1％ (8/14) and 42.9％ (6/14) respectively.Univariate analysis indicated that the length of occlusive segment and the balloon pressure required for angioplasty were the potential factors that affected the postoperative vascular patency time.Conclusion For the treatment of swollen hand syndrome in hemodialysis patients,PTA is safe and effective,although long-term vascular patency rate needs to be further improved.
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Objective To evaluate the safety and efficacy of stent implantation used as a rescue measure for acute ischemic stroke.Methods The clinical data of 13 patients with acute ischemic stroke caused by large artery occlusion of anterior c erebral circulation that occurred within 8 hours before clinical visit,who had received rescue stent implantation at authors' hospital,were retrospectively analyzed.Before stent implantation,all patients failed to respond to other recanalization treatments,including intravenous thrombolysis,intra-arterial thrombolysis,mechanical thrombec tomy with Penumbra device,and Solitaire stent thrombectomy.Angiography was performed immediately after stent implantation.Vascular recanalization condition was evaluated with blood flow grading that was based on thrombolysis in cerebral infarction (TICI) criterion.Perioperative bleeding and complications were recorded.National Institutes of Health Stroke Scale (NIHSS) score was used to assess the improvement of neurological function at one week after operation.Modified Rankin scale (mRS) score was used to evaluate the prognosis at 3 months after operation.Results A total of 16 stents were implanted in 13 patients.Before stent implantation,thrombectomy by using Solitaire retrievable stent was employed in 10 patients,mechanical thrombectomy with Penumbra device was adopted in 3 patients,intravenous thrombolysis with urokinase was used in one patient,and intra-arterial thrombolysis with urokinase was conducted in one patient.After stent implantation,partial or complete recanalization was achieved in 12 patients (TICI≥2b/3).NIHSS score was improved from preoperative (16.15±5.81) points to postoperative (8.08±5.61) points,the difference was statistically significant (P＜0.05).Three months after stenting treatment,good prognosis (mRS ≤2) was obtained in 7 patients (53.8％) and 2 patients died.Intracranial hemorrhage occurred in 2 patients and procedure-related embolism was observed in 3 patients.Conclusion For the treatment of acute ischemic stroke,intracranial stenting angioplasty,used as a rescue measure for thrombolytic therapy with different combinations of drugs,is safe and effective.
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Malignant obstructive jaundice is caused by biliary obstruction due to malignant tumor,and in clinical practice percutaneous transhepatic biliary metal stent implantation has already become one of the main measures to relieve malignant obstructive jaundice.Nevertheless,postoperative complications severely affect the life quality and survival of patients,especially the stent restenosis seriously influences the patient's prognosis,therefore,after percutaneous transhepatic biliary metal stent implantation the use of active preventive measures and the correct treatment of stent restenosis are particularly important.The causes of stent restenosis include tumor growth,cholestasis and proliferation of granulation tissue,and the main measures to prevent stent restenosis at present are re-implantation of the stent,reformation of the stent structure and combination therapy.This article aims to make a comprehensive reviewabout the causes of postoperative stent restenosis and the effective preventive measures.
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Objective To investigate the clinical characteristics and treatment of spontaneous isolated superior mesenteric artery dissection (SISMAD).Methods The retrospective cross-sectional study was conducted.The clinical data of 80 patients with SISMAD who were admitted to the Wuhan Union Hospital Affiliated to Huazhong University of Science and Technology from February 2002 to March 2017 were collected.All the patients underwent computed tomographic angiography (CTA) and digital subtraction angiography (DSA) examinations,and then received conservative medical treatment,endovascular interventional treatment or exploratory laparotomy and revascularization.Observation indicators:(1) clinical features;(2) treatment;(3) follow-up.Follow-up using outpatient examination and telephone interview was performed once at 1,6 and 12 months after discharge and once every year after 1 year up to March 2017.Follow-up included recurrence of abdominal pain,changes of superior mesenteric artery (SMA) dissection or changes of SMA and remodeling of dissection after stent implantation.Measurement data were represented as average (range).Results (1) Clinical features:①) Clinical manifestation:75 of 80 patients had symptoms,and 5 without symptoms were diagnosed during health examination.Of 75 patients with symptoms,abdominal pain was the first symptom,with the main of the peri-umbilicus and epigastric pains,without peritoneal irritation sign,including 14 with nausea and vomiting and 4 with bloody stool.②) Results of imaging examination:80 patients were confirmed by CTA examination.CTA showed that there was local thickening of SMA,true and false double-lumen formation,thinner true arterial lumen with visible intimal flap shadow and thrombosis in the false lumen.Results of CTA showed that the first break was located within 1-6 cm from opening of SMA in 77 patients and in the middle and distal segment of SMA in 3 patients,without aortic dissection (AD).(2) Treatment:of 75 patients with symptoms,53 received conservative medical treatment with an effective rate of 70.7％ (53/75),average time of symptomatic remission was 5 days (range,1-12 days);22 received stent imnplantation via right femoral artery approach using self-expanding bare stent or covered stent,with a success rate of implantation of 95.5％ (21/22),including 21 with successful implantations and 1 with false implantation.One patient with false implantation had symptomatic remission after 1-week conservative medical treatment,and there was no exploratory laparotomy and revascularization.Five patients without symptom were required to control blood pressure and get regular follow-up,without other intervention.(3) Follow-up:75 patients with symptoms were followed up for 36 month (range,1-60 months).During follow-up,of 53 patients with conservative medical treatment,2 patients had significant progressions of SMA dissection by CTA examination,1 had recurrence and exacerbation of abdominal pain accompanied with bloody stool at 2-month follow-up,showing an aneurism of SMA dissection by DSA examination,and 1 had recurrence of abdominal pain at 1-year follow-up,both patients were improved after stent implantation;other 51 had no recurrence.Of 22 patients with stent implantation,1 had repeated abdominal pain during follow-up and the symptom became aggravated at 1-year follow-up,showing a thrombosis fonnation and proximal stenosis by CTA examination,and then underwent stent implantation in the proximal stenosis after anticoagulant therapy;SMA dissection of 1 patient completely healed at 2-year follow-up by CTA examination;other 20 patients had stent patency.Five patients without symptom had regular follow-up,showing no disease progression.Conclusions The symptoms of SISMAD are different,and abdominal pain is the one of main symptoms.At present,treatment regimens include conservative medical treatment,endovascular interventional treatment and surgery,and individualized treatment is decided according to clinical symptoms and physical signs of patients and imaging examinations.
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Objective To compare the safety and efficacy of endovascular brachytherapy (EVBT)with those of sequential three-dimensional conformal radiotherapy (3-D CRT) in treating main portal vein tumor thrombus (MPVTT).Methods The clinical data of a total of 176 hepatocellular carcinoma (HCC)patients complicated by MPVTT,who were treated with portal vein stenting and TACE during the period from May 2012 to June 2014,were retrospectively analyzed.Of the 176 patients,additional EVBT by using 125I seeds strand was carried out in 123 patients (group A) at the same time,and in the remaining 53 patients (group B) sequential 3-D CRT was conducted.The overall survival,progression free survival,stent patency period and the incidence of treatment-related complications were compared between the two groups.Results No serious treatment-related complications occurred after therapy.During a mean of (11.7±8.3) months followup period,the mean survival was (11.7±1.2) months in group A and (9.5±1.8) months in group B (P=0.002).The mean progression free survival in group A and in group B was (5.3±0.7) months and (4.4±0.4)months respectively (P=0.010).The mean stent patency period in group A and in group B was (10.3±1.1)months and (8.7±0.7) months respectively (P=0.003).Conclusion Compared to sequential 3-D CRT,EVBT combined with portal vein stenting and TACE can significantly improve the overall survival of patients with HCC complicated by MPVTT.
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Objective To assess the risk of hyperperfusion induced intracranial hemorrhage (HICH) after carotid artery stenting (CAS) in patients with symptomatic severe carotid stenosis.Methods From June 2009 to June 2015,the clinical data of 210 patients with symptomatic severe carotid stenosis (70％-99％) treated with CAS at Department of Neurosurgery,Changhai Hospital,the Second Military Medical University,were analyzed retrospectively.Seven of them (3.3 ％) developed HICH after operation.The relationship between the clinical baseline and imaging characteristics and HICH were assessed.All patients received the evaluation of cerebral CT perfusion examination.The time to peak (TTP) index of cerebral blood flow was defined as the TTP ratio of the affected and contralateral sides,t test was used to conduct the comparison of measurement data,and Poisson test was used to conduct the comparison of the enumeration data.Results There was significant difference in the TTP index between the HICH group and non-HICH group (1.15 ± 0.10 vs.1.30 ± 0.15,t =4.461,P ＜ 0.01).The receiver operating characteristic (ROC)curve analysis results suggested that the TTP index ＞ 1.22 could be used as a risk factor for predicting HICH (sensitivity 100％,specificity 75.9％).Conclusion Under the condition of prompting the preoperative TTP index ＞ 1.22,the risk of HICH may be higher after CAS in patients with severe carotid stenosis.