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Objective To analyze and investigate the risk factors for intraoperative and postoperative bleeding complications of stent implantation for ruptured intracranial aneurysms(from rupture to operation time ≤14 d). Methods A total of 249 consecutive patients with aneurysmal subarachnoid hemorrhage (aSAH)treated with stent intravascular interventional therapy at the Department of Neurosurgery,Tangdu Hospital,the Second Hospital Affiliated to Air Force Medical University(the Fourth Military Medical University)from August 2014 to July 2017 were enrolled retrospectively.According to whether having intraoperative and postoperative bleeding complications,they were divided into either a hemorrhage complication group(n=33)or a non-complication group(n=216).The baseline data,clinical data,and aneurysm characteristics,including age,sex,hypertension,Glasgow Coma Scale(GCS)score,aSAH to the patients were documented and analyzed,and multivariate logistic regression analysis was used to analyze the risk factors for bleeding complications. Results (1)The incidence of perioperative bleeding complications was 13. 3% (33 /249). (2)There was significant difference in GCS scores between the bleeding complication group and the non-complication group (P < 0. 05). There were no significant differences in age,male,hypertension,and aSAH to operation time between the two groups (all P >0. 05). (3)There were significant differences in Hunt-Hess grade (χ2 = 10. 392,P = 0. 001),Fisher score (χ2 = 7. 370,P =0. 007),number of aneurysms (χ2 = 4. 825,P = 0. 028),and aneurysm location (χ2 = 6. 818, P = 0. 033)between the bleeding complication group and the non-complication group. There were no significant differences in Raymond grade between the two groups (P > 0. 05). (4)Taking the occurrence of bleeding complications as a dependent variable,a further multivariate logistic regression analysis on Hunt- Hess grades Ⅲ-Ⅴ and multiple aneurysms was performed after variable screening,the results showed that Hunt-Hess grades Ⅲ-Ⅴ(OR,3. 658,95% CI 1. 660 -8. 061)and multiple aneurysms (OR,2. 667,95% CI 1.178-6.036)were the independent risk factors for stent placement in the treatment of bleeding complications of ruptured intracranial aneurysms(all P <0.05). Conclusions The single stent and stent-assisted coils can be used for endovascular treatment of rupture intracranial aneurysms,but preoperative Hunt-Hess grades Ⅲ-Ⅴ and multiple aneurysms are easy to cause perioperative bleeding complications in patients with aSAH.
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<p><b>OBJECTIVE</b>To investigate the therapeutic effect of cranial-cervical aneurysms with stent-graft.</p><p><b>METHODS</b>Clinical data of 20 patients with cranial-cervical aneurysm treated with stent-graft in Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University from November 2006 to November 2015 were retrospectively analyzed. There were 15 male and 5 female patients with a mean age of 40 years (ranging from 22 to 67 years). There were 10 spontaneous cases, 5 trauma history cases and 5 surgery history cases. Postoperative follow-up were made by telephone, CT angiography or digital subtraction angiography, evaluating therapeutic effect.</p><p><b>RESULTS</b>Twenty-four stent-grafts placement were carried out in 20 patients and all of them were successfully deployed in the parent artery. Intraoperative stent malapposition induced endoleak occurred in 3 cases, incomplete coverage of distal stent segment in 2 cases, acute thrombosis in 1 case and vessel lesion in 1 case. Eighteen cases were radiographically cured while the other 2 cases improved through additional stent placement, coil embolization or artery thrombolysis. Clinical symptoms of post-operative patients were improved to varying degrees. Follow-up of 1 to 96 months (average of 19 months) were accomplished. Delayed parent artery occlusion were encountered in 2 cases while endoleak still existed in 1 case.</p><p><b>CONCLUSION</b>Application of stent-graft for cranial-cervical aneurysms is safe and effective and the short-term follow-up results are satisfied.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Angiography , Arterial Occlusive Diseases , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation , Endoleak , Follow-Up Studies , Intracranial Aneurysm , General Surgery , Retrospective Studies , Stents , Treatment OutcomeABSTRACT
Objective To observe the clinical efficacy and safety of Shenxiong glucose injection and lipo PGE1 injection in treating the lower extremity arteriosclerotic occlusive disease (LEAOD).Methods 80 patients with LEAOD were randomly divided into control group and treatment group. Both groups were given conventional therapy, including reducing blood pressure, blood sugar, blood lipid and anti-infection therapy.Control group was additonally given intra-femoral arterial infusion with urokinase 150000 units plus 15mL 0.9% sodium chloride and 10 mg anisodamine alternately every other day, 5 days for one course, stopping 3 days after another course.Treatment group was treated with intravenous injection Lipo PGE1 injection plus 10 mL 0.9% sodium chloride and intravenous Shenxiong glucose injection per day for 14 days.Clinical efficacy, changes in clinical symptoms, whole blood viscosity, high sensitivity C-reactive protein(hs-CRP), fibrinogen, ankle-brachial index(ABI), the inner diameter of the dorsalis pedis and the peak systolic velocity( PSV) of dorsalis pedis were compared and analyzed pre and post-treatment.Adverse drug reactions were recorded during the treatment.ResuIts The efficiency for the patients in the treatment group (90.0%) was higher than that in control groups(72.5%) (P<0.05).The symptoms of numbness and cold limbs, whole blood viscosity, ABI, hs-CRP improved more significantly in the treatment group (P<0.05).No adverse event occurred in the treatment group and 2 patients in control group had mild dry mouth.ConcIusion Shenxiong glucose injection combined with lipo PGE1 injection for the treatment of LEAOD is effective and safe and should be introduced in clinical practice.
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Objective To assess the efficacy and feasibility of Wingspan stents for symptomatic atherosclerotic stenosis of the bas-ilar artery.Methods Clinical data of 40 patients with symptomatic atherosclerotic stenoses in the basilar artery were analyzed retro-spectively.The operative successful rate,the degree of stenosis,perioperative complications and the results of clinical and imaging follow-up were analyzed.Results The technical success rate was 95.35%.The rate of procedure-related complications during the perioperative period (30 days)was 20.0% (eight of 40 patients).There were two patients with no permanent neurological sequelae. Ipsilateral stroke or death occurred in six patients(1 5%).Thirty-six patients(92.3%)were available for a clinical follow up.The mean follow-up period was 36.3 months (range 12-75 months).Seventeen patients (47.2%)were available for follow-up imaging with DSA or CTA.The mean imaging follow-up period was 9.4 months (range 4-41 months).Symptomatic in-stent restenosis (ISR)was documented in two (1 1.76%)of these patients.Three ischemic events occurred during the follow-up period in 12 months.The adverse event rate was 8.33% at 1 year.Conclusion Wingspan stents for symptomatic atherosclerotic stenosis of the basilar artery was an effective and feasible technique,but we should carefully grasp the operation indications.
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Objective To evaluate the hemodynamic changes in patients with middle cerebral artery (MCA) stenosis pre- and post-stenting by transcranial color-coded and pulsed-Doppler sonography.Methods Thirty patients with middle cerebral artery stenosis were included.Two-dimensional,color-coded and pulsed-Doppler sonography were used to monitor the morphologic and hemodynamic changes of the MCA before,in the middle of,and after the endovascular stenting operation.All patients were verified by digital substract angiography.Results The hyper-echoic stent grafts and also the size and location of the stent were clearly shown by two-dimensional ultrasonography in 28 patients.The systolic,diastolic and the timeaveraged maximal flow velocities significantly decreased both instantly and 3 - 7 d after the stenting.Specifically,the systolic peak flow velocity of the MCA dramatically decreased immediately after the stenting [(151.43 ± 25.14) cm/s vs (286.13 ± 57.38)cm/s,P ＜0.05],and showed a further decrease after 3 - 7 d [(108.80 ± 9.95) cm/s vs (151.43 ± 25.14) cm/s,P ＜0.05].Conclusions Transcranial color-coded and pulsed-Doppler sonography could be used to evaluate the hemodynamic changes after MCA stenting,and could be considered as the first choice of method for evaluating the therapeutic outcome of stenting.
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Objectire:To explore and evaluate the predictors for the prognosis of acute besilar artery occlusion(BAO)and the clinical efficacy of intra-arterial thrombolysis and stenting for BAO.Methods:Intra-arterial thrombolysis was administered with recombinant tissue plasminogen activator or urokinase in 52 patients with BAO within 3 to 48 hours.Stenting was performed in patients whose partial recanalization of residual stenosis＞50%after the thrombolysis.National Institutes of Health Stroke Scale(NIHSS)score was measured before the procedure,and the modifled Rankin scale(mRS)score was obtained at 3 months after the procedure.The clinical data were evaluated with the multivariable stepwise logistic regression analysis and Fisher's exact test.Results:Complete recanalization achieved in 24 patients(46.2%),partial recanalization in 16 patients(30.7%),and non-recanalization in 12 patients(23.1%).mRS scores:22 patients(42.3%)had a favorable outcome,32 survived(61.5%),and 20 died (38.5%).The prognosis of BAO was significantly correlated with the NIHSS score(P＜0.01),therapeutic time window (P ＜0.05) and recanalization level (after the thrombolysis and stenting)(P＜0.01 );the good recanalization after the intra-arterial thrombolysis was significantly correlated with the NIHSS score (P ＜0.01) and therapeutic time window (P ＜0.05).Multivariate analysis showed that the NIHSS score ＜ 14 (P ＜ 0.01 ) and good recanalization could independently predict the favorable prognosis of BAO.Conclusions:The NIHSS score ＜ 14 and good recanalization were the independent predictors for good prognosis of BAO.The rapid and timely treatment of BAO with intra-arterial thrombolysis and stenting is a safe and effective measure.
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Objective: To observe the effects of tetramethylpyrazine on the content of tumor necrosis factor?(TNF?) and the activity of myeloperoxidase(MPO) after cerebral ischemia/reperfusion in rats,and to investigate its mechanism of protective effects on cerebral ischemia/reperfusion.Methods: Thirtysix male SD rats were randomly divided into shamoperated group,model group and(tetramethylpyrazine) group.The thread with embolus was(inserted) in the cerebral(middle) artery in shamoperated group,but the artery was not(embolized).The cerebral ischemia/reperfusion models of rats were established in model group and(tetramethylpyrazine) group,while in the latter group,33 mg/kg of tetramethylpyrazine was(injected)(intraperitoneally) 30 minutes before ischemia.The methods of radioimmunoassay and pectrophotometry were used respectively to detected the content of TNF? and the activity of MPO in brain tissues of rats.(Results): Compared with those in shamoperated group,the content of TNF?((0.601?0.089) ?g/L vs.(1.576?0.153) ?g/L) and the activity of MPO((0.026?0.008) U/g vs.(0.409?0.044) U/g) in brain tissues(increased) markedly in model group(both P
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Objective To sustain drug concentration of papaverine in subarachnoid for treatment of vasospasm following subarachnoid hemorrhage and confirm whether controlled releasing system is appropriate for the prevention of vasospasm following subarachnoid hemorrhage.To prepare appropriate gelatin microspheres by optimizing experiment conditions,load them with papaverine and observe its release characteristics in vitro.Methods Degradable gelatin was used as a carrier with liquid paraffin as oil phase and Span-80 as emulsifier.Orthogonal experimental design was introduced to optimize the preparation conditions of the blank gelatin microspheres.Furthermore,papaverine gelatin microspheres were prepared using improved emulsified cold-condensation method.Results After optimizing,microspheres with good shape,smooth surface and narrow size distribution were prepared.The amount of drug carried by microspheres was 28%.Studies on the release in vitro showed that newly no initial burst release could be seen,the drug could be released slowly in two weeks.Conclusion The preparation procedure established was stable and practical,and the microspheres obtained showed good sustained-release characteristics.
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Objective To study the causes and protection of intracranial aneurysms uncompletely embolized with micro-coils. Methods 47 cases of intracranial aneurysms were treated with micro-coils to embolize the aneurysaml sac via femoral artery approach to endovascular embolization.The aneurysms were located on AcoA in 19,on MCA in 7,on PcoA in 16 and on ICA in 5,2 aneurysms were foundin each of 2 cases. Results The uncompletely occuluded in 12 of them,aneurysms were completely occluded in 35,9 aneurysms wereoccluded to 95%,2 aneurysms were occluded to 90%,1 neurysms were occluded to 80%. Conclusion The wide neck intracranialaneurysms,hugeness intracranial aneurysms and ophidian,irregular intracranial aneurysms are of high rate of uncompletely occluded.Usingbasket-technique,remodel technique,vein rebuild technique and nibble subdivision endovascular embolization can decrease the rate ofuncompletely embolize intracranial aneurysm.
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Objective To study neuroprotective machanisms of Mannitol combined with Nimodipine in treatment of ischemic reperfusion injury in rats. Methods Seventy-two SD rats were randomly divided into six groups (Group A:sham-operated group;Group B:model group;Group C:low-dose Mannitol group;Group D:high-dose Mannitol group;Group E:Nimotop group;Group F:Mannitol combined with Nimotop group). Both nitrate reductase and TUNEL methods were respectively used to measure NO content and apoptotic neurons in the brains.Results NO content and apoptotic neurons were higher in group B than those in group A (P0.05). NO content and apoptotic neurons were lower in group F than in group C,D and E (all P
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Objective To investigate the safety and efficacy of carotid angioplasty and stenting(CAS)for the treatment of carotid stenosis with filter cerebral protection devices(CPD).Methods The filter CPD was used in treating carotid artery stenosis by angioplasty and stenting in 19 cases.Cerebral thromboembolic events were noted and the filter devices were observed.All patients were followed-up for short-term.Results The placement of filter CPD and CAS were successfully administered in all patients.Tissue debris could be found in 8 out of 19 with naked eyes in the CPD.There was no death or symptomatic cerebral thromboembolic events during theropy procedure.Short-term follow-up showed excellent results.Conclusion CAS under the filter CPD is a safe and effective method in treating carotid stenosis.The effect of long-term follow-up needs to be further observed and the materials need to be further improved.
