Usefulness of Stent Implantation for Treatment of Intracranial Atherosclerotic Stenoses / 신경중재치료의학

PURPOSE: We evaluated the usefulness of intracranial stent implantation for treating patients with atherosclerotic stenosis and with recurrent, ischemic, neurological symptoms despite having undergone medical therapy. MATERIALS AND METHODS: Between March 2004 and April 2010, we attempted intracranial, stent-assisted angioplasty in 77 patients with 85 lesions (anterior circulation 73 cases, posterior circulation 12 cases) and who had ischemic neurological symptoms with more than 50% major cerebral artery stenosis. We analyzed the results regarding the technical success rate, complication rate, and restenosis rate during the mean 29.4 month follow-up period. RESULTS: Intracranial stent implantation was successfully performed in 74 cases (87.1%). In nine cases among the 11, failed cases, stent implantation failure was due to the tortuosity of the target vessel. One patient experienced middle cerebral artery rupture during the procedure, and we embolized the vessel using a microcoil. Five patients developed cerebral infarction in three weeks after the procedure, three of whom improved using conservative management, although the other, two patients expired. The mean number of residual stenoses decreased from 72.3% to 14.7%. Three patients demonstrated significant in-stent restenosis, i.e. more than 50%, during the follow-up period. CONCLUSION: As stent-assisted angioplasty in intracranial, atherosclerotic stenosis is effective and relatively safe, it can be considered as an alternative treatment for patients with recurrent, ischemic, neurologic symptoms despite having undergone medical therapy.

Transarterial embolization with low concentration of n-butyl cyanoacrylate in VX2 hepatic tumor rabbit: an experimental study / 中华放射学杂志

Objective To investigate the feasibility, safety and efficacy of transarterial embolization with low concentration of n-butyl cyanoacrylate(NBCA) in rabbit VX2 liver tumor models. MethodsTwenty-four rabbits were implanted with VX2 hepatic tumors into the left hepatic lobes, and were scanned with CT to measure the volume of the tumor after 14 days. They were randomly divided into three groups with 8 rabbits assigned to each group. Transarterial embolization was conducted with physiological saline in control group A, with pure Lipiodol in group B, with 2.5% NBCA in group C. Hepatic toxicity was evaluated by blood biochemical analysis of the plasma alanine aminotransferase (ALT) and aspartate aminotransferase (AST). One week later, the volumes of the tumors were measured by CT again. Tumor growth rate was the ratio of tumor's volume at 7th day after embolization to the tumors' volume before embolization. The survival periods of the rabbits of the three groups after treatment were also recorded. The data of ALT and AST mean values from each group were analyzed with repeated measurement analysis of variance (ANOVA). Tumor growth rates and survival periods were analyzed by using one-way ANOVA. Results All animal models were successfully established and underwent interventional catheterization. Both ALT and AST mean values of the rabbits in group A, B and C at each time point before and after embolization were significantly different (ALT F=10.508, 16.443, 19.828, respectively; AST F=23.696, 23.334, 15.594, respectively)(P＜0.05). ALT in group A, B, C were (49.4±13.5), (115.2±48.8), (124.7±49.4)U/L, while AST in group A, B, C were (52.3±12.0), (128.3±50.1), (137.0±66.9)U/L 4 days after embolization. The ALT and AST mean values were significantly elevated 4 days after embolization in group B and group C compared with those before embolization and those of group A 4 days after treatment(P＜0.05). However, the ALT and AST mean values showed no statistically significant difference in all the groups before embolization and 7 days after embolization. On the other hand, the growth rates of the tumors differed significantly among the three groups(F=110.865, P=0.000). The group C showed significantly lower tumor growth rate (0.839±0.144)% than the group A(2.978±0.547)%(P=0.000), but no significantly different tumor growth rate compared with group B(0.871±0.0725)%( P=0.845). Consequently, the survival period of the animals in group C(38.9±4.0) days was significantly longer than that in group A(32.1±3.1)days (P=0.006), while it was not significantly different from that in group B(36.9±4.8)days(P=0.366). ConclusionsTransarterial embolization with low concentration of NBCA was feasible and safe. It could be a new option of treatment for HCC and might have potential further clinical value.

Paying attention to radiofrequency ablation therapy for neoplasms / 介入放射学杂志

Radiofrequency ablation is an effective treatment for malignant tumors. With the development of imaging technique, it has been widely used in treating different kinds of malignant tumors, such as liver cancer, lung cancer, kidney carcinoma, etc. Radiofrequency ablation has a lot of advantages. As a minimally-invasive, safe and effective treatment with less sufferings and fewer complications, this technique has attracted more and more attention of the experts both at home and abroad.

Deepening the reform of medical education, strengthening the training of reserve specialists in interventional radiology: a profound rethinking based on a survey of medical students / 介入放射学杂志

Although the interventional radiology, a rapidly expanding medical specialty, has already been widely popularized and generally accepted for many years, it is still facing lots of challenges and turf wars, such as the brain drain, understaffed and the gap between the old and the young. This article attempts to analyze the reasons through investigating the current teaching situation of interventional radiology in medical coUeges and finding out the undergraduates' attitude to interventional radiology, in order to explore possible paths for solving the imbalance between supply and demand of qualified personnel.

Percutaneous mechanical thrombectomy for the treatment of acute massive pulmonary embolism: its preliminary clinical application / 介入放射学杂志

Objective Acute massive pulmonary embolism(PE)is a clinical emergency requiring rapid and supportive measures.With the development of interventional technology and devices,percutaneous mechanical thrombectomy(PMT)is considered to be an alternative for the treatment of PE,though there is still relative lack of clinical experience.The purpose of this study is to evaluate the clinical efficacy and safety of PMT in the management of acute massive PE.Methods The clinical data of massive PE patients treated with interventional methods were collected and analyzed in a retrospective way.From Jan.2003 to Jan.2008,6 patients(5 males and one female,with a mean age of 62 years)with acute massive PE,which was initially diagnosed by computed tomography and finally confirmed by pulmonary angiography,were treated with percutaneous catheter fragmentation and/or Straub Rotarex thrombectomy device.Results The improvement of clinical status and restoration of blood flow in the main branches of pulmonary artery were obtained in all patients.Oxygen saturation(SaO2)increased from preoperative(79.5±5.3)%to postoporative (92.8±3.4)%,with P＜0.01.Partial arterial oxygen pressure(PaO2)increased from preoperative(58.0±9.8)mmHg to postoperative(88.7±4.1)mmHg(P＜0.01).After PMT treatment,the mean pulmonary artery pressure(PAP)decreased from preoperative(40.8±7.8)mmHg to postoperative(29.8±8.0)mmHg (P＜0.01).Miller index decreased from preoperative 0.54±0.03 to postoperative 0.18±0.07(P＜0.01).During a clinical follow-up period ranged from 1 to 5 years,four patients showed no recurrence of PE,the other two patients lost touch with the authors.Conclusion The preliminary experience in onr series suggests that PMT is an easy,effective and safe therapy in the clinical management of acute massive PE,especially when thrombolysis is contraindicated.

The clinical value of treatment for hepatocellular carcinoma complicated with arterio-portal fistula wing N-butyl 2-cyanoacrylate / 中华放射学杂志

Objective To evaluate the clinical application of embolization therapy using N-butyl 2-cyanoacrylate(NBCA)for hepatocellular carcinoma(HCC)complicated with arterio-portal fistula(APF).Methods Eighty patients with HCC and APF underwent embolothempy with NBCA(NBCA group,26 patients)or absolute alcohol(alcohol group,54 patients).The APF wag first treated with liquid embolic agent during the TACE procedure.We used NBCA-Lipiodol mixtures in concentration of 20%-50% according to tlle different circulation times of these APF in NBCA group,Absolute alcohol plus gelfoam or other materisis were used for embolization of APF in alcohol group.The pain reaction during the procedure,influence for liver function(X2 test).occlusive suceessfxil rate after single embolization(Fisher's exact test)and the survival rate of 1 year(log-rank analysis)between two groups were compared after the embolotherapy.Results Four patients in NBCA group and 52 patients in alcohol group felt painful during the pmcedures.There wag statistically significant difference between two groups(x2=58.86,P＜0.001).The APF disappeared after only sin~e embolization in 24(92.3%,24/26)cages of NBCA group and in 37(68.5%,37/54)patients of alcohol group.There wag also significant difference between two groups (P=0.024).There were no statistical ditierence in the post.embolization liver function change and 1 year survival rate between two groups.Conclusions The embolization therapy using NBCA for HCC complicated with APF is safe.effective and more accurate.It can be used as a new technique for these patients.

New era of the relationship between Chinese Interventional Radiology Sub-society and Journal of Interventional Radiology / 介入放射学杂志

The past decades have witnessed interventional radiology in China to go from a very initial clinical practice to an important medical player in modem medicine. Recently, a friendly collaboration has been successfully established between the Chinese Interventionai Radiology Sub-society and the Journal of Interventional Radiology. The Chinese Interventional Radiology Sub-society will take the full responsibility for the academic governance of the Journal of Interventional Radiology and the Journal of Interventional Radiology will formally become the sole interventional academic periodical of the Chinese Interventional Radiology Sub-society in China. This collaboration will surely make Chinese interventional radiology to initiate a new era, promote the further development of interventional radiology at home and enable the Journal of Interventional Radiology to step into the international medical circle.

Neuroform stent-assisted coil embolization for the treatment of intracranial wide-necked aneurysms / 介入放射学杂志

Objective To discuss the technique of Neuroform stent-assisted coil embolization for the treatment of intracranial wide-necked aneurysms and to evaluate its clinical efficacy and complications.Methods Neuroform stent-assisted technique was used for coil embolization treatment in 31 patients with intracranial wide-necked aneurysms, all aneurysms were ruptured and the patients suffered from subarachnoid hemorrhage (SAH). Of the total 43 aneurysms, 39 were wide-necked and 4 were narrow-necked. Results Thirty-five stents were inserted in 31 patients. The stents were implanted in both internal carotid arteries in 3 patients and in both middle cerebral arteries in one patient, Intra-arterial embolization with coils was successfully performed in 41 of 43 aneurysms. Intraoperative hemorrhage occurred in 2 patients, which probably resulted from the rupture of middle cerebral artery branch due to microwire damage. The cerebral isehemic symptom happened in 1 patient with posterior communicating artery aneurysm due to the shifting of the coil from the original site to M2 segment of middle cerebral artery. During a follow-up period of 24.7 months in average, neither death nor recurrent hemorrhage occurred in 29 cases. Twenty-eight patients were in good living condition and the remaining one patient showed obvious disturbance of neural function.Conclusion For the treatment of intracranial wide-necked aneurysms, intra-arterial coil embolization with Neuroform stent-assisted technique is a safe and effective clinical therapy. It can effectively broaden the extent of indications in treating intracranial aneurysms by using interventional technique.

Experimental study of intra-arterial and intravenous recombinant staphylokinase in canine model with acute ischemic stroke / 中华放射学杂志

Objective To discuss the safety,efficacy and time window of thombolysis using recombinant staphylokinase(r-Sak).Methods The model of acute cerebral infarction was established with interventional embolization technique in 24 adult beagle dogs,which were randomly divided into 3 groups including control group,6 h intra-arterial group and 3 h intravenous group.Angiography was performed before thrombolysis.We administered r-Sak for thrombolysis(10 ml of saline in control group,0.2 mg/kg of r-Sak in the intra-arterial group through left internal carotid artery 6 h after embolization,and 0.2 mg/kg of r-Sak in the intravenous group through femoral vein 3 h after embolization).Follow-up angiography was repeated half,1 and 2 hours after thrombolysis.The plasma levels of PT,APTT and D-dimer were assayed at the time points of 30 min before thrombolysis,30 min,60 min and 120 min after thrombolysis.These canines were sacrificed,and their brains were taken out for pathological study at 24 hours after embolization.Results The recanaled vessels at 2 hours after thrombolysis was 11(11/13) in the intra-arterial group,8(8/11) in r-Sak intravenous group and 1(1/10) in control group,and the vessels of complete recanalization was 6(6/13),2(2/11) and 0(0/10),respectively.There were statistically significant differences among the three groups (P=0.001 and P=0.035 respectively),but there were no statistically significant differences between the intra-arterial and the intravenous groups (P=0.630 and P=0.211).The PT and APTT are significantly prolonged in the thrombolytic groups.The levels of D-dimer was not changed after thrombolysis (P＞0.05). All dogs were alive 24 h ours after embolization.The clinical presentations in the thrombolytic groups were better.Pathologically,there were no cerebral hemorrhage in all groups.Conclusion r-Sak has strong effect of thrombolysis,and its complication of intracerebral hemorrhage is rare.The intra-arterial thrombolysis 6 h after embolization using r-Sak is safe and effective.

How to treat medical papers in a proper way:illustrated with the subject of splenic artery steals syndrome after hepatic transplantation / 介入放射学杂志

When reading or writing a medical paper involving clinical practice or fundamental research, it is necessary to read or review other correlative ones published in specially journals. Medical papers are always the fastest and most authorized way of reporting the latest achievements ,innovation and discoveries in medicine. However, viewpoints expressed by different authors and different periodicals varied considerably, sometimes were similar, sometimes were contradicted and even poles apart in one subject. It is worthwhile to think about facing with different conclusions, as how to make one’s papers choice. In this article, we took the example for analysis of medical papers about "The complication of post hepatic transplantation: splenic artery steals syndrome" written by different authors and talking about how to treat medical papers properly.

Interventional therapy of complications after liver transplantation:complications of portal vein / 介入放射学杂志

The insufficient blood supply to the portal vein after liver transplantation, mainly caused by portal vein stenosis (PVS)or portal vein thrombosis(PVT), occurs low in incidence but would be serious enough to lead to graft failure. Prompt diagnosis and treatment is critical to allow graft salvage. The color Doppler flow image (CDFI) could be the first choice for testing portal venous flow, and angiography is reliable for further accurate diagnosis on meaningful functional change of the stenosis. The interventional therapy , including percutaneous balloon angioplasty and stent placement, is safe and effective in lowering the portal venous pressure after hepatic transplantation with portal vein stenosis. Thrombolysis, percutaneous mechanical fragmentation and stent placement ,as the treatments of early portal vein thrombosis, are effective therapeutic methods, and TIPS is also a proper management if necessary.

Interventional therapy of complications after liver transplantation:arterial steal syndrome / 介入放射学杂志

Arterial steal syndrome(ASS),a scarce complication after liver transplantation,is charac-terized by hepatic arterial hypoperfusion of the graft caused by a shifting of blood flow into the splenic,left gastric,or gastroduodenal arteries. It can lead to stricture formation of biliary system and transplanted liver function exhaustion. The early diagnosis and treatment are important for protecting the transplanted liver function. Dynamic CDFI after liver transplantation as a routine is necessary to find out the suspected lesions,and transcatheter angiography as the gold standardization can give clear dignosis. Embolization of splenic artery is minimally invasive,successful and less complication treatment for ASS and especially the coil embolization of middle segment of splenic artery is the best choice.

Interventional therapy of complications after liver transplantation: hepatic artery thombosis / 介入放射学杂志

Resolution of the complications after liver transplantation is one of the important factors related to prognosis. Hepatic artery thombosis (HAT) after liver transplantation can lead directly to trans- planted liver undergone necrosis, biloma formation and liver functional exhaustion. The early diagnosis with Color Doppler which should be the first method of choice, CTA, MRA and angiography could lead to exact demonstration, and proper treatment can result in better prognosis. The microinvasive techniques such as local thrombolysis, balloon dilatation and stent placement are safe and effective for treatment of hepatic artery thombosis. The vascular reconstruction and oxygen hyperbaric are effective therapeutic methods. Repeat liver transplantation is still the last important choice for survival.

Preoperative transarterial embolization of hypervascular vertebral tumor with permanent particles / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the safety and value of preoperative transarterial embolization of hypervascular vertebral tumors.</p><p><b>METHODS</b>Sixteen patients with hypervascular vertebral tumors underwent transarterial embolization before surgery. The lesions were located between the middle cervical and lower lumbar spine. Forty-one arteries were embolized with permanent particles injected through a microcatheter, including polyvinyl alcohol (PVA) particles (150 - 500 micro m) in 25 arteries and Dextran particles (150 - 350 micro m) in 16. Of these, 31 had pieces of gelatin sponge added for proximal pedicled embolization. The criteria for judging the effectiveness of embolization were completeness of tumor removal and estimated blood loss during surgery.</p><p><b>RESULTS</b>The particles were injected into the tumor feeders through superselection in 17 arteries or flow control in 24. Tumor embolization was defined as "total" in five patients, "nearly total" in eight, "subtotal" in two, and "partial" in another. There were no symptomatic complications associated with embolization. Tumors were entirely removed in all patients. The average estimated blood loss during surgery was 1510 ml (range of 200 - 6000 ml) for all 16 patients.</p><p><b>CONCLUSION</b>Preoperative embolization of hypervascular vertebral tumors is safe and effective. It can make complete resection of a tumor possible and can make a previously unresectable tumor resectable. Superselection or flow control is necessary to achieve effective devascularization and to avoid complications.</p>

Animal experimental study of safety for a self-made vena cava stent-filter / 介入放射学杂志

Objective To evaluate the safety of a self-made vena cava stent-filter(VCSF)for prevention of pulmonary embolism.Methods Fusiform unmbrella-like vena cava filter was made of Nitinol wires and stainless steel metal pole,and then ten mongrel dogs were implanted with these self-made filters and divided into 5 groups according to the different periods(2,3,4,5 and 6 w) of filter placement,with 2 dogs in each group.After the VCSFs were placed in inferior vena cava via the right femoral vein approach,the dogs in each group were bred for 2-6 weeks,respectively.The blood flow of inferior vena cava and the position of the filters were inspected by inferior vena-cavography according to the indwelling periods.Finally the metal pole was retrieved via the femoral vein,leaving the VCSF as permanent venous stent.The feasibility of retrieval and the free state of filter net with the adhering vascular wall were evaluated.Laparotomies were performed to remove the inferior vena cava from the animals for gross and electron microscopic examinations of the inferior vena cava intimal changes of the involved segment.Results All 10 VCSFs were placed at the right positions of the dogs successfully.Angiography showed patent inferior vena cava without filter thrombosis at 2-6 weeks.There were no tilting and migration of the filter and all the metal poles were successfully retrieved.The superior and inferior extremities of filter nets could be set free with all the filters turning into venous stents.Postmortem displayed retroperitoneal hemorrhage and caval thrombosis.The barbs of the filters penetrated over the caval adventitial coat.Under electron microscope,a thin layer of neointima already covered the braiding net of VCSFs at 2 weeks after the deployment.The tunica intima became slightly thick at 3-4 weeks and with moderate proliferation at 5-6 weeks.Conclusions The self-made vena cava stent-filter possesses rather long indwelling period according to the necessity of treatment with simultaneously keeping patent caval flow,stability of the position and easy for displacement and retrieval.

Percutaneous fenestration for ischemic complications of aortic dissection / 介入放射学杂志

Objective The evaluation and possibility of percutaneous fenestration for ischemic complications of aortic dissection were disccused. Methods A male patient with aortic dissetion (type: DeBakey Ⅲb) accompanyed by lower extremities pararises was undertaken percutaneous fenestration. Results Both the lower leg's blood flow was recovered with symptom free. Bilateral femoral and dorsal foot pulsations could be feeled. Conclusion Percutaneous fenestration for ischemic complications of aortic dissection is a safe and effective management, but should be done earlier.

Long term effectiveness of interventional polyurethane stent placement for nasolacrimal duct obstruction / 介入放射学杂志

Objective To evaluate the safety、feasibility and the long-term effectiveness of polyurethane stent placement for treatment of nasolacrimal duct obstruction. Methods Fifty-three cases (64 eyes) with complete nasolacrimal duct obstruction received the lacrimal stent placement. Dacryocystography was performed before and after the procedure. The average follow-up period was 48.3 months (range, 13-78months), the long-term patency and the effectiveness after stents removal were analyzed. Results Stent placement was technically successful in 62eyes, and the success rate was 96.9% with no severe complications. On long-term follow up, the stent patency rate was 76.8% at 1 year. However, it decreased to 33.3% at 3 years and 28.6% at 5 years. Nine stents were removed when the symptoms recurred, including granulation tissue in 4 stents and mucous material in 5. After removal, 2 nasolacrimal ducts were patent, and 2 kept patent after stents replacement, but all reoccluded within 6 months. Conclusions Interventional placement of polyurethane stent in the obstructed nasolacrimal duct is a simple and safe outpatient procedure, but the long-term patency is not encouraging, and the right stent removal time has not yet been approved.

Percutaneous biliary drainage for treatment of malignant biliary obstruction / 介入放射学杂志

Objective To introduce the technique of percutaneous biliary drainage for treatment of malignant biliary obstruction and to eveluate its therapeutic effect. Methods Percutaneous biliary drainage was performed in 47 patients with malignant biliary obstruction. The biliary obstruction occurred in the common bile duct of 10 patients, in the common hepatic duct for 13, at the conjuction of right and left hepatic ducts in 24. The inner outer draining catheter, the metallic stent or plastic endoprosthesis was placed to drain the bile internally if the obstruction could be passed with guide wire after percutaneous transhepatic cholangiography, or the outer drainage could only be carried out. Results The internal drainage was done with stent in 15 patients and with plastic endoprosthesis in 3, the inner outer drainage in 15, and the external drainage in 14. The serum total bilirubin decreased from 514.1?204.3?mol/L before the procedure to 238.4? 142.8 ?mol/L one week after the procedure( P

Deepening the reform of medical education, strengthening the training of reserve specialists in interventional radiology:a profound rethinking based on a survey of medical students / 介入放射学杂志

Although the interventional radiology, a rapidly expanding medical specialty, has already been widely popularized and generally accepted for many years, it is still facing lots of challenges and turf wars, such as the brain drain, understaffed and the gap between the old and the young.This article attempts to analyze the reasons through investigating the current teaching situation of interventional radiology in medical colleges and finding out the undergraduates' attitude to interventional radiology, in order to explore possible paths for solving the imbalance between supply and demand of qualified personnel.

Interventional treatment of biliary complications after liver transplantation / 介入放射学杂志

Biliary tract complications occurred after liver transplantation have been the well-known causes of the substantial morbidity and mortality. It has been widely accepted that biliary drainage, balloon dilation and stent placement are useful interventional techniques for the treatment of biliary tract complications. Biliary tract complications are more likely to be complex and to have multiple causes. For the interventional radiologists, a further understanding of the mechanism, pathology, classification and diagnosis of the biliary complications is very helpful in reasonably working out the appropriate therapeutic strategy in order to improve the clinical success rate of liver transplantation.