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1.
Chinese Journal of Radiology ; (12): 252-258, 2023.
Artigo em Chinês | WPRIM | ID: wpr-992956

RESUMO

Objective:To explore the significance of four-dimensional CT angiography(4D CTA) and CT perfusion (CTP) imaging in evaluating collateral circulation grades in patients with moyamoya disease and moyamoya syndrome and their relationship with cerebral hemodynamics.Methods:The clinical and imaging data of 32 patients with moyamoya disease and moyamoya syndrome in Beijing Hospital from January 2017 to January 2022 were retrospectively analyzed. All patients underwent 4D CTA-CTP imaging. Collateral circulation was scored on CTA images by using Alberta stroke program early CT score system, and on digital subtraction angiography (DSA) images by using American society of interventional and therapeutic neuroradiology/Society of interventional radiology score system, respectively. The patients were divided into Ⅰ-Ⅲ circulation compensation grades based on collateral circulation score. Regions of interest were delineated at basal ganglia on perfusion maps and the perfusion parameters were obtained including cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), mean transit time (TTP) and delay time (DLY). The Kruskal-Wallis test was used to compare the perfusion parameters in different collateral circulation grades, and pairwise comparison was performed with Bonferroni correction. Kappa and Spearman tests were used to analyze the consistency and correlation of 4D CTA and DSA in the classification of collateral circulation.Results:4D CTA and DSA had a moderate consistency (Kappa=0.693, P<0.001) and a strong correlation ( r=0.805, P<0.001) in evaluating collateral grades. There were statistically significant differences in CBF, MTT and TTP among collateral compensation grade Ⅰ, grade Ⅱ and grade Ⅲ ( H values were 7.91, 11.69, 8.93; P values were 0.019, 0.003 and 0.012, respectively). Further pairwise comparison showed that the CBF of collateral compensation grade Ⅰ was lower than that of grade Ⅲ ( P=0.015), MTT of grade Ⅱ was higher than that of grade Ⅲ ( P=0.005), and TTP of grade Ⅰ was higher than that of grade Ⅲ ( P=0.015). There was no statistical significance of other indicators in pairwise comparison. There were no significant differences in CBV and DLY among collateral compensation grade Ⅰ, grade Ⅱ and grade Ⅲ ( P>0.05). Conclusions:4D CTA-CTP is equivalent to DSA in evaluating collateral circulation in patients with moyamoya disease and moyamoya syndrome. It can also evaluate the cerebral hemodynamics comprehensively, which has high clinical significance for disease monitoring.

2.
Chinese Journal of Geriatrics ; (12): 417-422, 2022.
Artigo em Chinês | WPRIM | ID: wpr-933097

RESUMO

Objective:To investigate the risk factors of infarct growth rate of elderly acute ischemic stroke(AIS)patients with endovascular treatment(EVT)and its influence on prognosis.Methods:Elderly AIS patients who underwent EVT at Beijing hospital from June 2016 to October 2020 were retrospectively included.Infarct growth rate(ml/h)=infarct core volume(ml)/time from stroke onset to CTP examination(h).Based on the rate of infarct growth and the patient's clinical severity, ROC curve was established, and the cut-off value of the ROC curve was obtained.By the cut-off value of the rate of infarct growth, the patients were divided into cerebral infarct slow-growth group and rapid-growth group.Predictors of rapid growth in infarct were analyzed by univariate and multivariate analysis.The patients were divided into good prognosis group(mRS score 0-2)and poor prognosis group(mRS score 3-6)according to the mRS score at the day 90 and the predictors of poor prognosis were analyzed separately.Results:A total of 67 elderly AIS patients were included with age ranging from 65-96 years and an average of(78.8±7.6)years.(1)The cut-off value of the optimal infarct growth rate for patients with good and poor prognosis was 8.89 ml/h.The patients were divided into fast-growth group(26 patients)and slow-growth group(41 patients)according the cut-off value.(2)Multivariate logistic regression showed that only poor collateral circulation was an independent predictor for fast infarct growth( OR=0.162, 95% CI: 0.053-0.489).(3)Faster infarct growth rate( OR=1.173, 95% CI: 1.044-1.318)and high NIHSS score( OR=1.146, 95% CI: 1.018-1.291)were predictors of poor prognosis. Conclusions:Collateral circulation status is a major influencing factor for the infarct growth rate, and a faster infarct growth rate is a predictor of poor prognosis for elderly AIS patients after endovascular treatment.

3.
Chinese Journal of Geriatrics ; (12): 1232-1236, 2019.
Artigo em Chinês | WPRIM | ID: wpr-801253

RESUMO

Objective@#To observe the safety and long-term efficacy of carotid artery stenting(CAS)in octogenarians with carotid stenosis.@*Methods@#Clinical data of patients aged 80 years or older undergoing CAS for carotid stenosis in our hospital between July 2008 and October 2017 were retrospectively analyzed.The perioperative treatment outcomes and mid- and long-term follow-up results were analyzed.@*Results@#A consecutive series of 61 patients(a median age of 81 years, 54 males)were enrolled.Of 61 patients, 23(37.7%)patients had symptomatic carotid artery stenosis.Sixty patients underwent unilateral CAS, one patient underwent bilateral CAS, and 26(42.6%)underwent other cerebrovascular interventional therapy during the same period.The technical success rate was 100.0%.During the perioperative period, the incidence of stroke was 6.6%(4/61), and no patient died.Eight(13.1%)patients had contrast-induced nephropathy, 4(6.6%)patients suffered from cardiac dysfunction, and 30(49.2%)patients had hypotension requiring vasopressor support postoperatively, and all of them recovered well when discharged from hospital.All patients were followed up for a median of 42 months(range 2-108 months, with an interquartile interval of 44 months). The incidence of stroke and death was 8.2%(5/61)within 30 days to 1 year after surgery.The median stroke-free survival was 72 months in patients with symptomatic carotid stenosis, and was 93 months in asymptomatic patients, with the statistically significant difference between the two groups(χ2=4.258, P=0.039).@*Conclusions@#Carotid artery stent implantation in octogenarians with carotid stenosis has a favorable safety and feasibility when performed in experienced centers, and the outcome of a mid- and long-term follow-up is good.

4.
Chinese Journal of Geriatrics ; (12): 635-639, 2019.
Artigo em Chinês | WPRIM | ID: wpr-755380

RESUMO

Objective To explore the safety and effectiveness of mechanical thrombectomy in patients ≥80 years old,and to analyze the causes of poor prognosis.Methods The data of twenty consecutive patients ≥ 80 years old with acute ischemic stroke who underwent mechanical thrombectomy in our hospital from January 2017 to June 2018 were retrospectively reviewed.Baseline information,imaging data,thrombectomy procedures,complications,and clinical prognosis were collected.The causes of poor prognosis were analyzed.Results A total of 20 advanced age patients were included,with an average age of (83.3±4.1)years(range 80 to 96 years).All patients underwent mechanical thrombectomy,and the successful recanalization rate(mTICI 2b-3)was 70 %.The incidence of technical complications was 15%,of which the rate of symptomatic intracranial hemorrhage was 5%.Among the 11 patients with poor prognosis,the causes included the severe diseases and later revascularization in 2 patients,unsuccessful recanalization or complications in 3 cases,and advanced age-related factors in 6 cases,among which there were accompanied multiple severe stenoses,poor collaterals and the rapid progress of stroke in 3 cases and the aggravation of previous comorbidities in 3 cases.Conclusions The advanced age patients ≥80 years old often have more comorbidities,higher prevalence rates of multiple severe vascular stenosis except the occluded vessels,poor collateral compensation and the aggravation of original comorbidities.And all of them may be important factors for the poor prognosis after mechanical thrombectomy.

5.
Chinese Journal of Geriatrics ; (12): 1232-1236, 2019.
Artigo em Chinês | WPRIM | ID: wpr-824541

RESUMO

Objective To observe the safety and long-term efficacy of carotid artery stenting (CAS)in octogenarians with carotid stenosis.Methods Clinical data of patients aged 80 years or older undergoing CAS for carotid stenosis in our hospital between July 2008 and October 2017 were retrospectively analyzed.The perioperative treatment outcomes and mid-and long-term follow-up results were analyzed.Results A consecutive series of 61 patients (a median age of 81 years,54 males) were enrolled.Of 61 patients,23 (37.7%)patients had symptomatic carotid artery stenosis.Sixty patients underwent unilateral CAS,one patient underwent bilateral CAS,and 26 (42.6 %)underwent other cerebrovascular interventional therapy during the same period.The technical success rate was 100.0%.During the perioperative period,the incidence of stroke was 6.6% (4/61),and no patient died.Eight (13.1%) patients had contrast-induced nephropathy,4 (6.6%) patients suffered from cardiac dysfunction,and 30 (49.2%)patients had hypotension requiring vasopressor support postoperatively,and all of them recovered well when discharged from hospital.All patients were followed up for a median of 42 months(range 2-108 months,with an interquartile interval of 44 months).The incidence of stroke and death was 8.2% (5/61)within 30 days to 1 year after surgery.The median stroke-free survival was 72 months in patients with symptomatic carotid stenosis,and was 93 months in asymptomatic patients,with the statistically significant difference between the two groups(x2 =4.258,P=0.039).Conclusions Carotid artery stent implantation in octogenarians with carotid stenosis has a favorable safety and feasibility when performed in experienced centers,and the outcome of a mid-and long-term follow-up is good.

6.
Chinese Journal of Surgery ; (12): 458-463, 2018.
Artigo em Chinês | WPRIM | ID: wpr-810002

RESUMO

Objective@#To explore the safety and short-term efficacy of sole angioplasty with tiny balloon for symptomatic intracranial atherosclerotic stenosis (ICAS) patients with complex lesions refractory.@*Methods@#Consecutive 11 patients with complex ICAS lesions treated by sole angioplasty with tiny balloon (diameter≤2 mm) from September 2016 to November 2017 at Department of Neurosurgery, Beijing Hospital were retrospectively reviewed. Patients′ demographics, lesions characteristics, procedures, complications, and clinical and imaging follow-up data were collected. There were 6 male and 5 female patients with mean age of 63.6 years (range: 45 to 77 years). Clinical manifestations were transient ischemia attack (TIA) in 4 cases, progressive ischemic stroke in 3 cases, recurrent stroke in 3 cases, and 1 case for preparation of scheduled radical resection of colon cancer. ICAS locations were middle cerebral artery M1 segment in 5 cases, M2 segment in 1 case, anterior cerebral artery A1 segment in 2 cases, and intracranial vertebral artery in 3 cases. Mean degree of ICAS stenosis was 92%. Lesion morphology was type A in 3 cases, B in 4 cases and C in 4 cases by Mori classification. Forward flow by modified thrombolysis in cerebral infarction (mTICI) was grade 1 to 2a in 8 cases, 2b in 3 cases. Collateral compensation grading was grade 2 in 5 cases, grade 3 in 6 cases.@*Results@#Technique success rate was 10/11, peri-procedural complication rate was 1/11. Post-procedural forward flow in all cases had been enhanced and 10 cases obtained mTICI 2b to 3. Ten patients got favorable outcomes (modified Rankin score 0 to 2) at discharge. With a mean clinical follow-up time of 5.4 months, 1 patient was found to have TIA recurrence. With a mean clinical follow-up time of 7.4 months, 1 patient was found to have TIA recurrence. Eight in 11 cases obtained imaging follow-up during 3 months, and none restenosis was found.@*Conclusion@#For symptomatic ICAS complex lesions, sole angioplasty with tiny balloon demonstrates relatively high safety with satisfactory short-term clinical and imaging results.

7.
Chinese Journal of Cerebrovascular Diseases ; (12): 231-235,封3, 2018.
Artigo em Chinês | WPRIM | ID: wpr-703008

RESUMO

Objective To investigate the safety and efficacy of endovascular reconstruction for ruptured and unruptured vertebral artery fusiform aneurysms (VAFAs).Methods The clinical,imaging and follow-up data of 26 consecutive patients with VAFA treated with endovascular reconstruction at the Department of Neurosurgery,Beijing Hospital between October 2009 and September 2017 were analyzed retrospectively.Results (1) Twenty-six patients had 26 VAFAs.Their age ranged from 38 to 69 years old.Nine patients had ruptured aneurysms and 17 had unruptured aneurysms.The diameter of the aneurysms ranged from 5 to 12 mm.The success rate of reconstruction technology was 100%.(2)In 9 patients of the rupture group,8 were embolized by stent-assisted coils,1 was treated with stent-assisted coil embolization alone.Five patients were treated with multiple-stent reconstruction and 4 were treated with stent reconstruction alone.Of the 17 patients in the unrupture group,13 were treated with stent-assisted embolization and 4 were treated with stent implantation alone;7 were treated with multiple-stent reconstruction,and 10 were treated with stent reconstruction alone.No perioperative complications occurred.(3) The patients were followed up for 8.0-97.5 months with a median time of 39.5 months.No new cerebral infarction or cerebral hemorrhage occurred.The patients with good prognosis (the modified Rankin scale scale 0-2) was 100%.Twenty-two patients were followed up for 3.5 to 34.0 months with a median time of 10.3 months.Fourteen patients (63.6%) were cured,4 (18.2%) were stable or improved,and 4 (18.2%) had recurrence;Five of 8 patients were cured in the rupture group;9 of 14 were cured in the unrupture group.There were 2 cases of relapse in each of the two groups.Conclusions Endovascular reconstruction for ruptured and unruptured VAFAs is clinically feasible and the safety is higher.The efficacy of mid-term and long-term follow-up is better.The recurrence rate of ruptured VAFAs has an increasing trend,and close follow-up is required after procedure.

8.
Chinese Journal of Cerebrovascular Diseases ; (12): 77-82, 2018.
Artigo em Chinês | WPRIM | ID: wpr-702992

RESUMO

Objective To establish an animal model suitable for neurosurgeons for the comprehensive training of microvascular anastomosis using rat abdominal aorta and common iliac artery. Methods Twelve adult SD rats were selected,they were generally anesthetized and laparotomized.The abdominal aortas and bilateral common iliac arteries were exposed and fully separated.The lengths and diameters of abdominal aortas and common iliac arteries of each segment were measured.The end-to-end anastomosis were performed choosing the main trunk of the abdominal aorta without a branching artery and longer segment.The unilateral common iliac artery and the sacral median artery were used for end-to-side anastomosis.The bilateral common iliac arteries were used for end-to-side and side-to-side anastomosis.The micro Doppler ultrasound probe was used to detect the blood flow patency of each anastomotic stoma. Results Anatomical separation of the abdominal aortas and the common iliac arteries was successfully performed in 12 SD rats.Each rat could provide 4 vascular anastomosis exercises.The length of abdomen aorta trunk was 15.6 ± 2.5 mm and the diameter was 1.6 ±0.2 mm between the lower left renal artery and right iliolumbar artery.The side-to-side anastomosis was performed.The mean diameter of the median sacral arteries was 0.80 ±0.08 mm.After the fish mouth-like cutting,the end-to-side anastomosis of the right common iliac arteries were conducted.The lenth of left common iliac artery was 9.0 ± 1.5 mm,the diameter was 1.0 ± 0.1 mm,and was cut off at its origin and then the end-to-side anastomosis of the right common iliac arteries were conducted.After end-to-side anastomosis of bilateral common iliac arteries,its distal segment was arranged in parallel with a length of 5.1 ± 0.3 mm,and then the side-to-side anastomosis could be conducted. Conclusions The rat abdominal aorta and iliac artery model can be comprehensively used to simulate the commonly used neurosurgery bypass graft.It is suitable for neurosurgeons with a certain microsurgical basis to conduct a preliminary vascular anastomosis training.

9.
Chinese Journal of Geriatrics ; (12): 528-532, 2017.
Artigo em Chinês | WPRIM | ID: wpr-609941

RESUMO

Objective To investigate the relationship of age,gender,carotid artery atherosclerosis with carotid artery tortuosity.Methods The data of patients with carotid computed tomography angiography (CTA)at Beijing Hospital from January 2014 to June 2016 were retrospectively reviewed.A total of 100 patients aged ≥50 years with normal carotid arteries and 100 patients with atherosclerotic carotid artery diseases were selected with age-and gender-stratified and random sampling method.Three-dimensional images of bilateral carotid arteries were reconstructed by using Mimics software.The common carotid artery(CCA)tortuosity index,extracranial internal carotid artery(EICA) tortuosity index,and the CCA-ICA bifurcation angle were measured.Association of laterality,age and gender with carotid artery tortuosity was analyzed and the differences in parameter values of carotid artery tortuosity were compared between normal carotid artery subjects and patients with atherosclerotic carotid artery.Results In normal carotid artery group,the EICA tortuosity index and ICA angle were larger in left-side than in right side(P<0.001),and CCA tortuosity index was less in left side than in right side(all P<0.001).The bilateral EICA and CCA tortuosity index were positively correlated with age(the left ICA:rs=0.284,P =0.004;the right ICA:rs =0.308,P =0.002;the left CCA..rs=0.371,P<0.001;the right CCA:rs=0.243,P=0.015).The EICA and CCA were more tortuous in women than in men[the left EICA:1.180(0.200)vs.1.105(0.140),Z=-2.996,P=0.003;the right EICA:1.150(0.128)vs.1.105(0.123),Z=-2.189,P=0.029;the left CCA:1.060(0.073)vs.1.045(0.060),Z=-2.145,P=0.032;the right CCA:1.145(0.158)vs.1.080(0.083),Z=2.324,P=0.020].The ICA angle was not related with advanced age or gender(P>0.05).Manne-Whitney tests showed no statistically significant differences in EICA tortuosity,ICA angle or CCA tortuosity between patients with versus without atherosclerotic carotid artery stenosis(P >0.05).Conclusions The tortuosity in both EICA and CCA increases with age,and the EICA and CCA are more tortuous in female.There is no significant correlation between carotid artery tortuosity and atherosclerotic carotid artery disease.

10.
Chinese Journal of Surgery ; (12): 608-612, 2017.
Artigo em Chinês | WPRIM | ID: wpr-809114

RESUMO

Objective@#To investigate the correlation between carotid artery tortuosity and atherosclerotic carotid artery stenosis.@*Methods@#A total of 73 patients who underwent carotid computed tomography angiography with unilateral atherosclerotic carotid artery stenosis at Department of Neurosurgery of Beijing Hospital from January 2011 to June 2016 were retrospectively reviewed. There were 51 males and 22 females ranging from 48 to 90 years old, the average age was (65.9±9.5) years. There were 38 patients with carotid stenosis in the left carotid artery and 35 in the right, the stenosis degree of carotid artery ranged from 30% to 90% with the median was 44.0% (25.5%). According to the degree of carotid artery stenosis, the patients were classified into mild stenosis group and moderate/severe stenosis group. There were 43 patients in the mild stenosis group with an average stenosis degree of (37.5±5.4)%, there were 30 patients in moderate/severe stenosis group with an average stenosis degree of (65.6±10.9)%. The carotid artery (CCA) tortuosity, extracranial internal carotid artery (EICA) tortuosity and CCA-ICA bifurcation tortuosity were quantified by measuring the CCA tortuosity index, EICA tortuosity index and the internal carotid artery (ICA) angle, respectively. Comparison of diseased and normal carotid arteries was performed using t test or Wilcoxon signed-ranked test.@*Results@#There were no statistically significant differences in CCA tortuosity index (Z=-0.584, P=0.559), ICA angle (t=0.278, P=0.781), and EICA tortuosity index (Z=-0.377, P=0.706) between diseased and normal carotid arteries in 73 patients. The diseased carotid arteries showed larger ICA angles (39.0° (19.0°) vs. 30.0° (15.0°)) (Z=-2.439, P=0.015) in the mild stenosis group, but smaller ICA angles ((31.5±11.7)° vs. (39.1±16.2)°) (t=-2.529, P=0.017) in the moderate/severe stenosis group, compared with the contralateral normal carotid arteries. There was no statistically significant difference in CCA (Z=-0.720, P=0.472; Z=-0.013, P=0.990) and EICA tortuosity index (Z=-0.349, P=0.727; Z=-0.114, P=0.909) between diseased and normal carotid arteries.@*Conclusions@#Compared with normal carotid arteries, carotid arteries with mild atherosclerotic stenosis demonstrate a more tortuous CCA-ICA bifurcation, while those with moderate/severe stenosis demonstrate a straighter CCA-ICA bifurcation. There is no correlation between CCA, EICA tortuosity and carotid artery stenosis.

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