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Objective:To study the safety and feasibility of laparoscopic surgery for treatment of hepaticojejunostomy strictures after cholangiectasis surgery in children.Methods:The clinical data of 12 children was retrospectively analysed. There were 5 males and 7 females, aged 4 (range 0.45 to 9.00) years old, who developed hepaticojejunostomy strictures after cholangiectasis surgery and underwent reoperative treatment at Anhui Provincial Children's Hospital from January 2013 to January 2021. These patients were divided into the laparoscopic surgery group ( n=5) and the open surgery group ( n=7) based on the mode of reoperation. The children were followed-up by outpatient review and the relevant clinical data of the children in the 2 groups was analyzed. Results:The reoperations were completed successfully in the 2 groups. The maximum preoperative dilated common hepatic duct diameter was significantly larger in the laparoscopic group (1.26±0.23) cm than the open group (0.64±0.19) cm ( P<0.05). The alkaline phosphatase and glutamyltransferase levels in the laparoscopic surgery group were significantly lower before the operation (all P<0.05), and the total bilirubin, direct bilirubin, alkaline phosphatase, and glutamyltransferase levels were significantly lower in the laparotomy group than before the operations (all P<0.05). In the laparoscopic group, the time of the reoperations, postoperative hospital stay, and blood loss were 268(117, 340) min, (9.0±2.9) d and (14.0±5.5) ml, respectively, while those in the open group were 180(150, 205) min, (9.7±3.4) d and (13.3±2.6) ml, respectively. There were no significant differences between the two groups (all P>0.05). On follow-up, all children were well except for one child who showed mild elevation levels of alanine aminotransferase and aspartate aminotransferase. Conclusion:Laparoscopic surgery for hepaticojejunostomy strictures after cholangiectasis surgery in children was safe and feasible. Its curative effect was no less than that of open surgery.
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Objective:To compare the effect of middle meningeal artery embolization (MMAE) versus conventional therapy for chronic subdural hematoma (CSDH).Methods:Retrospective analysis of 38 patients with 48 CSDHs treated with MMAE from May 2019 to May 2021 was performed. Comparisons were made with a conventional treatment for 126 patients with 126 CSDHs from January 2016 to May 2021. The MMAE and conventional treatment patients were matched by the propensity score matching method, and a total of 25 pairs of patients (31 pairs of CSDHs) were successfully matched. The CSDH recurrence, rescue treatment, radiographic follow-up outcome, clinical improvement and complication between the two groups were compared by t test, χ 2 test or Fisher exact probability methods. Results:The rescue treatment rate in MMAE group was significantly lower than that in conventional treatment group [0 (0/31) vs 19.4% (6/31), P=0.024] and the complete resolution rate at 6 months follow-up in MMAE group was significantly higher than that in conventional treatment group [96.8 (30/31) vs 74.2% (23/31), P=0.026]. In terms of CSDH recurrence, there was a trend of lower recurrence in the MMAE group [3.2%(1/31) vs 22.6% (7/31), P=0.053]. The complete resolution rate at 3 months follow-up was 61.3% (19/31) in MMAE group and 45.2% (14/31) in conventional treatment, clinical improvement rate was 92.0% (23/25) in MMAE group and 88.0% (22/23) in conventional treatment, good outcome rate (mRS≤2) was 92.0% (23/25) in MMAE group and 84.0% (21/25) in conventional treatment, complication rate was 0(0/25) in MMAE group and 4.0% (1/25) in conventional treatment, and there were no significant differences in all above-mentioned parameters ( P>0.05). Conclusions:The MMAE may be considered as a safe and effective treatment for CSDH, and MMAE for CSDH is associated with lower trend of recurrence, lower rescue treatment rate and better radiographic follow-up outcome than conventional therapy.
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Objective:To investigate the correlation between fluid attenuated inversion recovery vascular hyperintensities (FVH) -diffusion weighted imaging (DWI) mismatch and the outcomes after endovascular mechanical thrombectomy (EMT) in patients with acute middle cerebral artery M1 segment occlusive stroke.Methods:Patients with middle cerebral artery M1 segment occlusive stroke who received EMT treatment and whose FLAIR images showed FVH in the Affiliated Hospital of Yangzhou University from January 2016 to June 2020 were enrolled retrospectively. The demographics and basic clinical information of the patients were collected. The modified Rankin Scale was used to evaluate the outcomes at 3 months after the onset of symptoms. 0-2 was defined as a good outcome, and >2 was defined as a poor outcome. Multivariate logistic regression analysis was used to determine the independent influencing factors of clinical outcome. Results:A total of 77 patients were enrolled in the study. Their age was 67.16±9.63 years, 51 were males (66.23%). The baseline National Institutes of Health Stroke Scale (NIHSS) score was 14.16±7.49. Forty patients (51.95%) had a good outcome, and 37 (48.05%) had a poor outcome. Univariate analysis showed that the proportion of patients with FVH-DWI mismatch in the good outcome group was significantly higher than that in the poor outcome group (60.00% vs. 29.73%; χ2=7.103, P=0.008), and baseline NIHSS score (11.60±4.44 vs. 16.92±9.05; t=-3.312, P=0.001) and the proportion of patients with hypertension (65.00% vs. 86.49%; χ2=4.774, P=0.029) were significantly lower than those in the poor outcome group. Multivariate logistic regression analysis showed that FVH-DWI mismatch was independently associated with the good outcomes (odds ratio [ OR] 0.345, 95% confidence interval [ CI] 0.121-0.984; P=0.047), baseline NIHSS score was independently associated with the poor outcomes ( OR 1.133, 95% CI 1.036-1.239; P=0.006). Conclusion:FVH-DWI mismatch was independently associated with the good outcomes after EMT treatment in patients with acute middle cerebral artery M1 segment occlusive stroke.
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Objective@#To explore the relationship between cerebral hemorrhagic transformation (HT) and angiographic early venous filling (EVF) following mechanical thrombectomy for acute ischemic stroke.@*Methods@#A retrospective imaging analysis was performed in the consecutive patients treated from January 2015 to November 2018 for acute anterior circulation large vessel occlusion using mechanical thrombectomy on the Affiliated Hospital of Yangzhou University. The demography, vascular risk factors and other clinical data of the patients were also collected. According to the experimental study of European Cooperative Acute Stroke Study Ⅱ (ECASS Ⅱ), the modified classification of HT after mechanical thrombectomy was divided into HT negative, HT-Ⅰ type and HT-Ⅱ type. The differences in EVF, clinical and demographic characteristics were compared. Multivariate logistic regression analysis was used to identify the independent risk factors for HT and clinical outcome. Diagnostic test characteristics of EVF for HT-Ⅱ type were determined using a receiver operating characteristic curve (ROC) analysis.@*Results@#A total of 98 patients with acute ischemic stroke who received mechanical thrombectomy were enrolled, including HT negative in 48 cases (49.0%, 48/98), HT-Ⅰ in 40 cases (40.8%, 40/98) and HT-Ⅱ in 10 cases (10.2%, 10/98). Significant differences were noted in age, and incidence of atrial fibrillation, EVF and poor outcomes among three groups (P<0.05). Multivariate logistic regression analysis showed that EVF [odds ratio (OR) 5.960, 95%CI 1.750-8.960, P=0.001] and atrial fibrillation (OR 3.485, 95%CI 1.962-18.986, P=0.028) were risk factors for the occurrence of HT-Ⅱ after mechanical thrombectomy. No risk factor for HT-Ⅰ was noted. Baseline National Institute of Health Stroke Scale (NIHSS) score (OR 1.162, 95%CI 1.021-1.345, P=0.038), EVF (OR 5.358, 95%CI 1.665-13.653, P=0.006) and HT-Ⅱ (OR 1.326, 95%CI 1.226-2.038, P=0.032) were independent risk factors for poor outcomes. And the sensitivity and specificity of EVF in prediction for HT-Ⅱ were 80.0% and 86.4% respectively, with the area under the ROC curve of 0.832.@*Conclusion@#Presence of EVF after mechanical thrombectomy may be the predictor for HT-Ⅱ, which indicates the poor clinical outcomes for acute ischemic stroke patients.
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Objective:To explore the relationship between cerebral hemorrhagic transformation (HT) and angiographic early venous filling (EVF) following mechanical thrombectomy for acute ischemic stroke.Methods:A retrospective imaging analysis was performed in the consecutive patients treated from January 2015 to November 2018 for acute anterior circulation large vessel occlusion using mechanical thrombectomy on the Affiliated Hospital of Yangzhou University. The demography, vascular risk factors and other clinical data of the patients were also collected. According to the experimental study of European Cooperative Acute Stroke Study Ⅱ (ECASS Ⅱ), the modified classification of HT after mechanical thrombectomy was divided into HT negative, HT-Ⅰ type and HT-Ⅱ type. The differences in EVF, clinical and demographic characteristics were compared. Multivariate logistic regression analysis was used to identify the independent risk factors for HT and clinical outcome. Diagnostic test characteristics of EVF for HT-Ⅱ type were determined using a receiver operating characteristic curve (ROC) analysis.Results:A total of 98 patients with acute ischemic stroke who received mechanical thrombectomy were enrolled, including HT negative in 48 cases (49.0%, 48/98), HT-Ⅰ in 40 cases (40.8%, 40/98) and HT-Ⅱ in 10 cases (10.2%, 10/98). Significant differences were noted in age, and incidence of atrial fibrillation, EVF and poor outcomes among three groups ( P<0.05). Multivariate logistic regression analysis showed that EVF [odds ratio (OR) 5.960, 95%CI 1.750-8.960, P=0.001] and atrial fibrillation (OR 3.485, 95%CI 1.962-18.986, P=0.028) were risk factors for the occurrence of HT-Ⅱ after mechanical thrombectomy. No risk factor for HT-Ⅰ was noted. Baseline National Institute of Health Stroke Scale (NIHSS) score (OR 1.162, 95%CI 1.021-1.345, P=0.038), EVF (OR 5.358, 95%CI 1.665-13.653, P=0.006) and HT-Ⅱ (OR 1.326, 95%CI 1.226-2.038, P=0.032) were independent risk factors for poor outcomes. And the sensitivity and specificity of EVF in prediction for HT-Ⅱ were 80.0% and 86.4% respectively, with the area under the ROC curve of 0.832. Conclusion:Presence of EVF after mechanical thrombectomy may be the predictor for HT-Ⅱ, which indicates the poor clinical outcomes for acute ischemic stroke patients.
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Objective To investigate the effect of different treatment regimens guided by magnetic resonance angiography (MRA) and diffusion weighted imaging (DWI) mismatch on the outcomes of patients with mild ischemic stroke caused by acute middle cerebral artery (MCA) M1 segment occlusion. Methods From January 2013 to February 2018, the clinical data of patients with mild ischemic stroke caused by acute MCA M1 segment occlusion and admitted to the Department of Neurology, the Affiliated Hospital of Yangzhou University were analyzed retrospectively. Mild stroke was defined as the National Institutes of Health Stroke Scale (NIHSS) score ≤5, and the MRA-DWI mismatch was defined as MCA M1 segment occlusion confirmed by MRA and the DWI-Alberta Stroke Program Early Computed Tomography Score ≥6. According to the clinical decision, they were divided into endovascular treatment group and intravenous thrombolytic therapy group. The primary outcome measure was the modified Rankin Scale score at 90 days after onset, ≤2 was defined as good outcome. The secondary outcome measure was the incidence of symptomatic intracranial hemorrhage (sICH) within 7 days after treatment and the mortality rate at 90 d. Multivariate logistic regression analysis was used to determine the independent effects of different treatment regimens on outcomes. Results A total of 38 patients were enrolled, 19 (50. 00％) in the intravenous thrombolytic therapy group, and 19 in the endovascular treatment group (50. 00％, including 5 patients with intratracheal thrombectomy after intravenous thrombolysis); 27 patients had good outcomes (71. 05％) and 11 had poor outcomes (28. 95％). Except for total cholesterol level, there were no significant differences in demography, vascular risk factors, and all baseline clinical data between the endovascular treatment group and the intravenous thrombolytic therapy group. The rate of good outcome in the endovascular treatment group was significantly higher than that in the intravenous thrombolytic therapy group (89. 47％ vs. 2. 63％; P = 0. 029), and there was no significant difference between the incidence of sICH within 7 days (15. 79％ vs. 5. 26％; P = 0. 604) and 90-day mortality (0％ vs. 10. 53％; P = 0. 486). The proportion of patients who underwent endovascular treatment in the good outcome group was significantly higher than that in the poor outcome group (62. 96％ vs. 18. 18％; P = 0. 029). Multivariate logistic regression analysis showed that endovascular treatment was an independent predictor of good outcome (odds ratio 0. 103, 95％ confidence interval 0. 015-0. 714; P = 0. 021). Conclusion Endovascular treatment is an independent predictor of good outcome in patients with mild ischemic stroke caused by acute MCA M1 segment occlusion.
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Objective To investigate the clinical effect of low/low pressure drainage radical resection in the treatment of high perianal abscess.Methods Eighty-six patients with high perianal abscess treated in Tangshan Traditional Chinese Medicine Hospital from Octorber 2014 to Octorber 2016 were selected and randomly divided into the observation group(44 cases)and the control group(42 cases).The observation group was treated with decompression and drainage radical surgery,while the control group was treated with one-stage incision and thread drawing radical surgery.The postoperative conditions of the two groups were observed, including pain,anal function,healing time and clinical effect,and statistical analysis was made on the quantitative scores of the above indexes.Results The cure rate of the observation group was 100%(44/44), significantly higher than that in the control group(90.47%(38/42)),and the difference between the two groups was statistically significant(χ2=4.395,P=0.036).The postoperative pain score of the observation group was(1.681±0.945)points,significantly lower than that in the control group((3.328±1.300)points),and the difference was statistically significant(t=-4.504,P=0.000); The number of recurrence(0 cases)was significantly lower than that in the control group(4 cases)(P=0.036).The healing time of the observation groups was(22.08± 2.12)d, significantly lower than that in the control group((37.552± 2.61)d),and the difference between the two groups was statistically significant(t=29.0411,P=0.000);The anal function score of the observation group was(1.681±0.838)points,significantly lower than that in the control group((2.809 ±0.928)points),and the difference between the two groups was statistically significant(t = -3.217,P=0.000).Conclusion Low pressure drainage radical is an effective surgical method for sphincter preserving radical treatment of high perianal abscess,which not only preserves the sphincter and anus straight ring,but also reduces the postoperative anal function and the degree of morphological damage and the surgery the pain and length of hospital stay and cost saving.
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Objective To evaluate the safety and efficiency of thrombectomy with clamping embolus technique ( TCET ) by partial retrieving stent comparing with conventional stent retrievers thrombectomy (CSRT) for acute ischemic stroke.Methods Retrospective analysis was performed in 42 consecutive patients treated by stent retrievers thrombectomy between January 2015 and November 2016 for acute intracranial large vessel embolism . Data on recanalization rates , procedure duration , thrombectomy attempts, one-pass rate, postoperative subarachnoid hemorrhage (SAH),and modified Rankin Scale (mRS) score during 90 days follow-up were compared between TCET and CSRT groups .Results Recanalization rate was 90.0%(18/20) in TCET group and 90.9% (20/22) in CSRT group, post-procedural SAH was 10.0%(2/20) in TCET group and 13.6% (3/22) in CSRT group, good outcome (mRS score≤2) was 60.0%(12/20) in TCET group and 59.1% (13/22) in CSRT group, all without significant differences (P>0.05).The number of thrombectomy attempts with TCET was significantly lower than that with CSRT (1.7 ±0.5 vs 2.6 ±0.8, t=2.118, P=0.040), the procedure duration with TCET was significantly shorter than that with CSRT ( (36.8 ±8.6) min vs (55.5 ±10.5) min, t=-3.493, P=0.001) and one-pass thrombectomy rate with TCET was significantly higher than that with CSRT ( 60.0% ( 12/20 ) vs 22.7%(5/22), χ2 =6.041,P=0.014) .Conclusion TCET is safe and feasible for acute ischemic stroke and might improve the efficiency of thrombectomy comparing with CSRT .
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Objective To evaluate the safety and efficiency of thrombectomy with clamping embolus technique ( TCET ) by partial retrieving stent comparing with conventional stent retrievers thrombectomy (CSRT) for acute ischemic stroke.Methods Retrospective analysis was performed in 42 consecutive patients treated by stent retrievers thrombectomy between January 2015 and November 2016 for acute intracranial large vessel embolism . Data on recanalization rates , procedure duration , thrombectomy attempts, one-pass rate, postoperative subarachnoid hemorrhage (SAH),and modified Rankin Scale (mRS) score during 90 days follow-up were compared between TCET and CSRT groups .Results Recanalization rate was 90.0%(18/20) in TCET group and 90.9% (20/22) in CSRT group, post-procedural SAH was 10.0%(2/20) in TCET group and 13.6% (3/22) in CSRT group, good outcome (mRS score≤2) was 60.0%(12/20) in TCET group and 59.1% (13/22) in CSRT group, all without significant differences (P>0.05).The number of thrombectomy attempts with TCET was significantly lower than that with CSRT (1.7 ±0.5 vs 2.6 ±0.8, t=2.118, P=0.040), the procedure duration with TCET was significantly shorter than that with CSRT ( (36.8 ±8.6) min vs (55.5 ±10.5) min, t=-3.493, P=0.001) and one-pass thrombectomy rate with TCET was significantly higher than that with CSRT ( 60.0% ( 12/20 ) vs 22.7%(5/22), χ2 =6.041,P=0.014) .Conclusion TCET is safe and feasible for acute ischemic stroke and might improve the efficiency of thrombectomy comparing with CSRT .
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Objective To explore the prognostic effect of hyperintense vessel sign (hyperintense vessel sign,HVS) in fluid-attenuated inversion recovery (FLAIR) on endovascular recanalization of acute ischemic stroke.Methods The clinical and imaging data of the patients with acute middle cerebral artery (MCA) occlusion treated by endovascular therapy from January 2013 to october 2015 were analyzed retrospectively.The inclusion criteria:(1)＜8 h after symptom onset;(2) The preoperative MRI included conventional non-enhanced MR,FLAIR,diffusion-weighted imaging (DWI),magnetic resonance angiography (MRA) and DWI-ASPECTS (Alberta Stroke Program Early CT Score) ≥7;(3) acute MCA occlusion verified by conventional angiography and recanalizations (TICI score of 2b and 3) were obtained after endovascular therapy;(4) postoperative similar MR examinations were performed within one week.The patients were divided into group A (HVS score＜5) and B (HVS score≥5).The clinical outcomes and radiological characteristics were compared between two groups.Results There were 15 patients in group A and 33 patients in group B.No significant differences were noted in onset-to-MRI interval (4.8±0.7 h vs 4.6± 0.6 h),MRI-to-recanalization interval (2.1 ±0.5 h vs 2.2±0.5 h) and preoperative DWI-ASPECTS score (7.8± 0.9 score vs 8.2± 1.0 score) between the two groups (all P＞0.05).Significant differences were noted in NIHSS score at admission (14.6±2.6 score vs 10.1±2.2 score),grade of collateral circulation (1.6±0.3 score vs 2.4± 0.4 score),postoperative DWI-ASPECTS score (5.6±0.8 score vs 7.3±0.9 score),postoperative extension of DWI-ASPECTS score (2.2±0.4 score vs 0.9±0.2 score),the incidence of cerebral hemorrhage transformation (26.7％ vs 12.1％) and mRS score at 3 months (3.2±0.5 score vs 2.3±0.4) score between the two groups (all P＜0.05).Conclusion HVS score is clearly associated with collateral circulation and high HVS score indicates better functional outcomes than low HVS score.
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Objective To investigate the significance of change of fluid-attenuated inversion recovery(FLAIR) hyperintense vessel sign(HVS) after endovascular recanalization in acute ischemic stroke. Methods The clinical and imaging data of the patients with acute middle cerebral artery(MCA) occlusion treated by mechanical thrombectomy with Solitaire AB from January 2013 to october 2014 were analyzed retrospectively. The inclusion criteria: (1) The preoperative MRI included conventional non-enhanced MR, diffusion-weighted imaging (DWI), magnetic resonance angiography(MRA) and perfusion-weighted imaging (PWI), and HVS was observed on preoperative FLAIR images; (2) acute MCA occlusion verified by conventional angiography;(3) postoperative similar MR images examination was performed within 48 hours. The relationships among postoperative changes in the HVS, DWI and Thrombolysis In Cerebral Ischemia (TICI) scale (1—3) were assessed. Results After endovascular therapy, HVS of the 11 cases were showed to be disappeared(n = 9) and decreased (n = 2). All the 9 patients with disappeared HVS achieved high grade flow (TICI 3), and minor decrease of ischemic area on DWI in 1 case, minor progression in 6, and significant progression in 2. However, of the 2 patients with decreased HVS, one achieved relatively low grade flow (TICI 2a) and the other was found to be relatively high grade flow (TICI 2b), but severe MCA stenosis. DWI demonstrated significant progression in both two cases. Conclusion Our data indicate that endovascular recanalization of acute MCA occlusion was effective for decreasing HVS. Postoperative decrease and disappear in HVS can be considered as a marker for hemodynamic improvement.
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Objective To evaluate the safety and efficacy of the endovascular treatment of anterior circulation multiple occlusions (AMO) in acute ischemic stroke.Methods The clinical data of 10 patients with AMO treated by endovascular method from January 2011 to August 2013 were retrospectively analyzed.The proximal internal carotid artery (ICA) occlusion was treated using angioplasty in order to achieve ideal location of the guiding catheter.When necessary,stenting was performed after the reconstitution of the intracranial vessel.Recanalization was assessed according to the thrombolysis in cerebral ischemia (TICI) grade.Clinical prognosis was assessed using mRS at 3 months.The National Institutes of Health Stroke Scale (NIHSS) on admission and at discharge was compared using t test.Results The intracranial vessel was recanalized successfully (TICI ≥ 2b) in 9 cases and cervical carotid was stented in 8 cases.Adverse events were recorded in 3 patients,including one case of asymptomatic subarachnoid hemorrhage and two cases of symptomatic intra-cerebral hemorrhage.Mortality rate was 10 ％ (n=1).At the three-month follow up,mRS ≤ 2 was observed in five patients.The mean NIHSS scores was 15.7±2.2 on admission and 9.6±4.7at discharge,and the difference was statistic significant(t=2.86,P=0.02).Conclusion Endovascular therapy of AMO is technically feasible,and relatively safe and effective.
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Objective To quantitatively analyze the correlation between stenosis ratio and cerebral perfusion in patients with solely symptomatic M1 stenosis of middle cerebral artery.Methods All the patients with solely symptomatic M1 stenosis of middle cerebral artery were selected to this study from consecutive 203 patients with elective stenting of symptomatic intracranial artery stenosis.Brain CT, CT perfusion (CTP) and DSA examinations were performed in all cases.The CTP parameters of mean transit time (MTT), cerebral blood flow (CBF) and cerebral blood volume (CBV) were measured in regions of interest (ROIs) including bilateral frontal lobe, anterior watershed, opercula of the insula (including parsopercluaris and part of insula), temporal lobe, posterior watershed and occipital lobe.Compared with the unaffected side as control, the change of CTP and their relative CTP parameters in these ROIs at affected side were analyzed.Based on DSA data, the ratio of M1 stenosis was measured manually and blindly, the source of collateral branch of compensative artery was estimated and the blood flow was graded.Correlation between the ratio of M1 stenosis and the CTP parameters including the absolute and the relative values was investigated.Results Twenty patients were selected into this study; their average M1 stenosis ration of the affected side was 70.5% ± 10.6% (53% to 91%).Compared with the unaffected side, MTT and CBF were no significant change but CBV increased in the affected frontal lobe; MTT prolonged, CBF was normal and CBV increased in the affected anterior watershed and opercula of the insula; MTT prolonged, CBF and CBV had no significant difference in the affected temporal lobe; MTT prolonged, CBF decreased and CBV had no significant difference in the affected posterior watershed; MTT, CBF and CBV were normal in occipital lobe.Tissue perfusion gradually decreased from the front to the backward in all the M1 stenosis affected cerebral regions and the posterior watershed area was the only region at hemodynamic failure stage.Leptomeningeal vessels of the anterior cerebral artery were the major sources of compensative arteries shown in the DSA in all cases.The ratio of M1 stenosis was positively correlated (r =0.66, P =0.002) with the rCBV in posterior watershed and there is no significant correlation between the ratio and any other CTP parameters in any regions.Conclusions Associated with distribution of collateral compensative artery,tissue perfusion showed obvious spatial distribution at different level in different cerebral region.M1 stenosis ratio is positively correlated with rCBV in hemodynamic failure regions, and there is no correlation with tissue perfusion in hemodynamic compromise regions.
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Objective To evaluate the function of clinical-diffusion mismatch (CDM) in intraarterial thrombolysis treatment for acute middle cerebral artery occlusion (MCAO) and to evaluate specialty of CDM in predicting the putative penumbra.Methods All 106 acute MCAO patients within 6 hours after onset and examined by magnetic resonance angiography (MRA) were assigned into two groups:the intraartery thrombolysis group (n =36) and without thrombolysis group ( n =70).Both groups were subdivided into CDM sub-group and non-CDM sub-group based on the criteria of CDM:National Institutes of Health Stroke Scale (NIHSS) score ≥8 and ischemic volume on DWI ≤25 ml upon admission.NIHSS scores at the day 30 and 3 month after onset,and infarct volumes on T2 weighted imaging (T2 WI)at day 14 after onset were analyzed and compared between each sub-groups.Results The NIHSS scores in the CDM sub-group at both day 30 and the 3 month were significantly lower than the scores in the non-CDM sub-group among the patients having thrombolysis(3.20 ± 2.40 vs 6.76 ± 4.00,t =- 3.330,P =0.002 ; 2.20 ± 1.70 vs 6.05 ± 4.06,t =3.895,P =0.001 ),but not among the non-thrombolysis patients (5.22 ± 2.95 vs 5.66 ± 3.21,t =- 1.756,P =0.084 ;4.34 ± 2.53 vs 5.34 ± 3.42,t =1.234,P =0.353 ).Among the patients having CDM,the thrombolysis group resulted significant lower NIHSS scores at both day 30 and 3 month follow-up than non-thrombolysis group did (3.20 ±2.40 vs 5.22 ±2.95,t =- 2.210,P =0.034;2.20 ± 1.70 vs 4.34 ± 2.53,t =-3.128,P =0.003 ).However,among the patients of non-CDM,there was no difference in the NIHSS score between the thrombolysis group and the non-thrombolysis group at day 30 and 3 month (6.76±4.00 vs 5.66±3.21,t=1.209,P=0.231;6.05 ± 4.06 vs 5.34 ± 3.42,t =1.234,P=0.460).Among the CDM patients,the T2 WI infarct volume in the thrombolysis group was significantly smaller than that in the non-thrombolysis at day 14 onset ( ( 6.29 ± 4.41 ) ml vs ( 60.25 ± 49.23 ) ml,Z =- 4.848,P =0.001 ).Conclusion CDM may predict the putative penumbra with high specificity and can be applied in the therapy of intra-artery thrombolytic for acute MCAO patients.
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Objective To assess the feasibility of arterial blood bypass using microcatheter in intraarterial thrombolysis for acute cerebral ischemic stroke.Methods Six patients with acute cerebral infarction within 6 hours underwent intraarterial thrombolysis,in which arterial blood bypass was used.A 2.3 F microcatheter was advanced through the clot and two milliliters of contrast was injected beyond the clot that remained stagnant in the major branches.At this point,20 ml of oxygenated blood from femoral artery was injected for 2 minutes through the microcatheter past the occluding clot Then,conventional intraarterial thrombolysis,including fibrinolytic agents infusion and mechanical disruption,was performed.Intraarterial thrombolysis and oxygenated blood infusion alternated every 30 minutes.Results Every patient received arterial blood bypass with average three times(from 1 to 5 times)in the process of the intraarterial thrombolysis,which cost(8.0±3.2)min.Recanalization was achieved in all 6 patients,but minor subarachnoid hemorrhage developed in one patient All the patients got favorable clinical outcome.The life conditions is excellent in 4 cases and good in 2 cases.Conclusions Arterial blood bypass using microcatheter in intraarterial thrombolysis for acute cerebral ischemic stroke might be feasible,which did not interfere with conventional intraarterial thrombolysis and prolong the operation time significantly but could protect ischemic penumbra.
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Objective To investigate the radiation dose to the lens of patients in temporal bone CT scanning with different protocols. Methods With the same values of kV and effective mAs, the tranaxial and coronal scans of exsomatize cadaveric head was performed with conventional sequential scan mode,routine multi-slice helical scan and modified multi-slice helical scan, respectively. The values of CT volume dose index (CTDIvol) and dose length product (DLP) at various scanning mode were anylyzed, and effective doses of subject were calculated. Organ doses of the lens were measured with thermoluminescence dosimetry (TLD). Results When sequential scan mode was selected, gross effective dose was 1.21 mSv,while organ doses to lens were 50.96 and 1.73 mGy separately in axial and coronal slice scan,respectively. Effective dose was 0. 803mSv at helical scanning, while dose to lens was 40. 17 mGy. With modified helical scan mode, the effective dose was similar to routine helical scan, but dose to lens was 10.33 mGy which was significant lower than that of routine helical scan (40.17 mGy). Conclusions With the same values of kV and effective mAs, the effective doses and lens dose obtained in sequential axial and coronal scan were 1.51 times and 1.31 times higher than helical scan, respectively. With modified helical scan mode thinner slice images could be used to reformat axial, coronal and sagittal plane images, and lens dose was reduced by 74.3%. The modified helical CT scan mode of temporal bone could be selected in the clinical application.
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Objective To assess the prediction value of nonbronchial systemic arterial supply in hemoptysis patients with non-enhanced CT. Methods Fifty-six consecutive patients with hemoptysis underwent non-enhanced CT. Thickness of pleural adjacent to parenchymal lesion larger than 3 mm was regarded as index of nonbronchial systemic arterial supply. Conventional angiography was used as the standard of reference. CT findings were compared with those of conventional angiography. The sensitivity, specificity, and accuracy of CT for predicting nonbronchial systemic arterial supply were assessed. Results The sensitivity, specificity and accuracy of CT for predicting nonbronchial systemic arterial supply were 72.73%, 95.00% and 91.11%, respectively. Sensitivity was higher when nonbronchial systemic arterial supply located in superolateral and posterolateral lung, and lower in anteromedial and inferior lung. Specificity and accuracy were high for predicting nonbronchial systemic arterial supply in every locations. Conclusion Non-enhanced CT can predict nonbronchial systemic arterial supply in patients with hemoptysis, which is helpful for selecting angiography and embolization.
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Objective To assess the feasibility, safety, and efficacy of balloon disruption of thrombus by using a deflated balloon catheter combined with intraarterial thrombolysis for the treatment of acute middle cerebral artery(MCA) occlusion. Methods Five consecutive patients with acute MCA occlusion underwent balloon disruption combined with intra-arterial thrombolysis. The microballoon was inflated in the distal carotid artery and then deflated and advanced just distal to the occlusion site in the MCA. Thereafter, intra-arterial thrombolysis of the MCA was applied and the maximum dosage of urokinase was 500,000 U. Results Complete recanalization was achieved in 3 patients and partial recanalization in 2. All patients got favourable clinical outcome. There was no major intracerebral hemorrhage. Conclusion The penetration of the MCA with a deflated balloon catheter combined with an intra-arterial thrombolysis may be a safe and effective treatment for acute ischemic stroke.