ABSTRACT
In recent years,mechanical thrombectomy has been the most important research progress in the treatment of acute cerebral infarction,especially the positive results of five endovascular therapy studies in 2015 has rewritten its clinical guidelines.However,the focus of these studies was mainly on the small vessel infarction(SVI),and the inclusion criteria of these studies include the following aspects:ASPECTS ≥6 points,Alberta Stroke Program Early CT Score within 6 hours after stroke onset,the infarct volume＜70 mL within 6-24 hours after stroke onset,and the presence of image mismatch or the presence of mismatch between clinical condition and perfusion imaging.The above studies excluded patients with ASPECTS＜6 points or infarct volume ≥70 mL of large core infarction(LCI).With the continuous progress of the endovascular treatment of acute ischemic stroke(AIS),the mechanical thrombectomy therapy strategy has crossed from the"time window"to the"tissue window",meanwhile,the therapeutic goal of mechanical thrombectomy has also moved from treating SVI to a new era of treating LCI that has been a very hot topic recently.Whether endovascular treatment is beneficial for patients with LCI remains uncertain.This paper aims to make a comprehensive review concerning the relevant research progress in endovascular therapy for anterior circulation large core ischemic stroke,including the imaging determination and study inclusion criteria of LCI,the postoperative blood pressure management,and the factors influencing ineffective recanalization and prognosis.(J Intervent Radiol,2023,32:1256-1262)
ABSTRACT
Objective To discuss the clinical effect of Penumbra aspiration system combined with Trevo thrombectomy device in treating acute intracranial main artery infarction.Methods The clinical data of a total of 5 patients with acute intracranial main artery infarction,who were treated with ACETM thrombectomy device combined with Trevo visible thrombectomy stent,were retrospectively analyzed.The lesions included anterior circulation infarction (n=2) and posterior circulation infarction (n=3).The mean age of patients was (60.4±11.6) years old.The operation time spent for thrombectomy,the recanalization time of occluded vessels,and the recovery of neural function were assessed.Results The puncture-recanalization intervals in the 5 patients were 29 min,32 min,35 min,33 min and 30 min respectively,with a mean time of (31.8±2.4) min.After intraoperative cerebral infarction thrombolysis treatment,the cerebral blood flow grading reached level 3.NIHSS score was remarkably improved from preoperative (11.0±7.4) points to 24 hpostoperative(4.2±1.1) points,to 7 days-postoperative(1.8±1.3) points,and to 30 days-postoperative (0.9±0.6) points (P＜0.05).Modified Rankin scale (mRS) score was 0-2 points in all patients.No intracranial hemorrhage transformation occurred.Conclusion In treating acute intracranial main artery infarction,ACETM thrombectomy device combined with Trevo visible thrombectomy stent can achieve the best recanalization effect with less times of thrombectomy procedure and short operation time.The clinical prognosis is satisfactory.
ABSTRACT
Alzheimer′s patients bring heavy burden to their family and society, causing potential safety prob-lems unable to escort for a long time with the family, physical constraints between protection and between self-es-teem and the mental health law,the quality of life and life values produce a series of contradiction and ethical is-sues,also make close contact with their nursing staff have to face the moral and ethical dilemma.The suggestions are:Hospital provides professional full-time, professional pension caregivers of alzheimer′s patients for long-term care, Strengthen the communication of nursing staff and patients′families, Reasonable and legitimate use tools, Perfect medical system construction, buildMedical support combinedcare system, Carry out the comprehensive rehabilitation nursing intervention, improve the patients quality of life, Change service concept, strengthening the study of ethical knowledge and application to promote the doctor-patient relationship.