Etiological diagnosis of CTPI hypoperfusion and ischemic penumbra indices in patients undergoing acute thrombectomy / 中华老年心脑血管病杂志

Objective To evaluate the value of perfusion imaging mismatch and low perfusion ratio(HIR)based on CT perfusion imaging in predicting acute intracranial large vessel occlusion(LVO)associated with intracranial atherosclerotic stenosis(ICAS).Methods A total of 82 pa-tients with acute intracranial LVO who underwent emergency thrombectomy in our hospital from February 2019 to December 2020 were enrolled in this study.According to the etiology,they were divided into ICAS-related LVO group(ICAS-LVO,65 cases)and cardiogenic embolism group(17 cases).ROC curve was plotted to analyze the predictive value of CT perfusion imaging parame-ters.Results Compared with the cardiogenic embolism group,the ICAS-LVO group had signifi-cantly larger male ratio,higher BMI and TG level,more severe progression of disease,longer time from onset to surgery,larger proportion of ischemic penumbra and higher mismatch ratio,and ob-viously less ratio of atrial fibrillation,lower BNP and HDL levels,smaller infarct volume,and lower HIR(P＜0.05,P＜0.01).ROC curve analysis showed that HIR and mismatch ratio had good predictive value for the etiology of ICAS-LVO.The optimal cut-off value of HIR was 0.26,with an AUC value of 0.74,a specificity of 0.88,and a sensitivity of 0.54.The optimal cutoff for the mismatch ratio was 3.84,with an AUC value of 0.84,a specificity of 0.75,and a sensitivity of 0.90.Generalized linear model revealed that HIR and cerebral blood volume index had no signifi-cant difference in prognostic performance(P=0.175).Conclusion HIR and mismatch ratio are helpful to identify the pathogenesis earlier and formulate surgical strategies more accurately,thereby reducing iatrogenic injury to a greater extent,increasing the effective reperfusion rate,re-ducing the disability and mortality,and improving the prognosis of clinical outcomes.

Individualized thrombolysis-assisted comprehensive intervention for deep vein thrombosis in the lower limbs / 中国基层医药

Objective:To evaluate the clinical efficacy of individualized thrombolysis-assisted comprehensive intervention for deep vein thrombosis (DVT) in the lower limbs.Methods:This study included 32 patients with acute lower limb DVT diagnosed by angiography who received treatment at the Jianhu Clinical Medical College of Yangzhou University from March 2012 to November 2021. These patients first received implantation of an inferior vena cava filter. Then they were divided into a control group and an observation group based on treatment methods. The control group received thrombolytic catheterization and a routine infusion of urokinase. In the observation group, balloon dilation was performed first, and a large lumen catheter was used to draw blood clots. Subsequently, urokinase at a dose based on fibrinogen measurement was injected through a thrombolytic catheter. Swelling reduction, venous patency, and complications of the affected limbs were monitored.Results:In the control group, the difference in thigh circumference before treatment was (4.65 ± 1.06) cm, and after treatment, it was (2.76 ± 1.25) cm. In the observation group, the difference in thigh circumference before treatment was (4.73 ± 1.03) cm, and it was (1.40 ± 0.83) cm after treatment. In the control group, the difference in calf circumference before treatment was (2.24 ± 0.90) cm, and it was (1.56 ± 0.86) cm after treatment. In the observation group, the difference in calf circumference before treatment was (2.40 ± 0.83) cm, and it was (0.80 ± 0.73) cm after treatment. After treatment, the differences in thigh circumference and calf circumference between the healthy and affected sides were statistically significant ( t = 3.58, 2.67, both P < 0.05). After treatment, there was a significant difference in venous patency between the control and observation groups (34.02% [33/97] vs. 68.18% [60/88], t = 3.44, P < 0.05). After 12 months of follow-up, the Villalta scale score, which was used to evaluate post-thrombotic syndrome, was (9.23 ± 4.07) points in the control group, which was significantly different from (5.73 ± 3.39) points in the observation group ( t = 2.62, P < 0.05). Conclusion:Individualized thrombolysis-assisted comprehensive intervention is highly effective in the treatment of DVT in the lower limbs and results in few complications.

Safety and effectiveness of bridging therapy in elderly acute stroke patients with posterior circulation large vessel occlusion / 中华老年心脑血管病杂志

Objective To explore the safety and effectiveness of bridging therapy in elderly patients with acute stroke due to posterior circulation large vessel occlusion.Methods A total of 160 eld-erly patients with acute stroke caused by posterior circulation large vessel occlusion admitted to our department were prospectively recruited and randomly divided into bridging group(n=80)and control group(n=80).The bridging group received thrombolysis treatment and then mechan-ical thrombectomy.The control group received mechanical thrombectomy directly.Prognosis and adverse reactions were compared between the two groups.Results The NIHSS score and BATMAN score after treatment were significantly decreased in both groups(P＜0.01),and the two scores were obviously lower in the bridging group than the control group(6.54±1.23 vs 7.12± 0.98,2.12±0.34 vs 2.87±0.44,P＜0.01).There was no statistical difference in the conversion rate of bleeding after cerebral infarction between the two groups(5.00％vs 3.75％,P＞0.05).The number of intraoperative thrombus removal was significantly lower in the bridging group than the control group(2.43±0.33 vs 2.98±0.41,P＜0.01).Remarkable difference was observed in the mRS score between the two groups after treatment(P＜0.05),with the proportion of mRS score ranging from 0 to 1 larger in the bridging group than the control group(52.50％vs 27.50％,P＜0.05).Conclusion Bridging thrombolysis can significantly improve the neurological function in elderly patients with acute stroke due to posterior circulation occlusion.

Efficacy and safety of intravascular intervention therapy in patients with mild stroke and acute large vessel occlusion / 中华老年心脑血管病杂志

Objective To investigate the effectiveness and safety of EVT in mild stroke patients with ALVO.Methods A total of 124 mild stroke patients with ALVO treated in our hospital were enrolled and randomly divided into control group(n=64)and observation group(n=60).The control group was given routine treatment,while the observation group received EVT treat-ment besides routine treatment.NIHSS score,BI score,and mRS score were compared between the two groups to evaluate the postoperative safety of EVT treatment.Results The NIHSS scores on the 7th and 14th days,and at discharge were significantly lower in the observation group and control group than those at admission(P＜0.05),and those of the former group were obvi-ously decreased than those of the latter group at the corresponding time points(P＜0.01).On the 7th,14th,and discharge days,the BI score of both groups were significantly increased compared to those at admission(P＜0.05),with the scores in the observation group higher than those of the control group at above time points(P＜0.01).The ratio of the patients having mRS score ≤2 point was larger in the observation group than the control group(96.67％vs 84.38％,P＜0.05).One case in the observation group experienced asymptomatic intracranial hemorrhage,and no oth-er adverse events were observed.Conclusion EVT can improve the prognosis of mild stroke pa-tients with ALVO,but does not significantly increases the incidence of adverse events.

Results of treatment of acute occlusions of limb arteries at a university hospital - retrospective study.

BACKGROUND: Acute arterial occlusions (AAO) in limbs have been increasing in parallel with population longevity. OBJECTIVE: To assess risk factors, limb salvage rates, and survival of patients with AAO treated at a University Hospital. METHODS: Retrospective cohort study of consecutive patients. Outcomes included: patency, symptoms, comorbidities, Rutherford category, arteries occluded, postoperative complications, and 30-day limb salvage and mortality rates. RESULTS: Medical records were evaluated from 105 patients, predominantly males (65.7%), with ages ranging from 46 to 91 years. Etiology: thrombotic (54.3%), embolic (35.2%), and undefined (10.5%). About 2/3 of the patients were assessed as Rutherford category II or III. Associated symptoms: pain (97.1%), coldness (89.5%), pallor (64.7%), sensory loss (44.7%), paralysis (30.5%), anesthesia (21.9%), edema (21.9%), and cyanosis (15.2%). Associated comorbidities: hypertension (65.0%), smoking (59.0%), arrhythmias (26.6%), dyslipidemia (24.0%), and diabetes (23.8%). The distal superficial femoral-popliteal segment was the most affected (80%). Thromboembolectomy with a Fogarty catheter was performed in 73.3% of cases (81.0% of embolic cases, 71.9% of thrombotic cases, and 54.5% of cases with undefined etiology) and was the only treatment used in 41 cases (39.05%), among which there were 11 reocclusion, 20 amputations, and 14 deaths. Arterial reocclusion was more frequent in thrombosis cases (12.9%, p = 0.054). Within 30 days of treatment, total mortality was 14.6%, and 19.8% of cases underwent major amputation, which was less frequent among Rutherford Class I patients (p = 0.0179). CONCLUSION: Treatment of AAO was primarily performed by thromboembolectomy with a Fogarty catheter, either alone or in combination with other treatments, achieving amputation and complication rates compatible with the best results in the literature and were progressively lower in less advanced Rutherford categories.

Resultados do tratamento das oclusões arteriais agudas de membros em hospital universitário - estudo retrospectivo / Results of treatment of acute occlusions of limb arteries at a university hospital - retrospective study

Resumo Contexto As oclusões arteriais agudas (OAA) de membros vêm crescendo paralelemente com a longevidade da população. Objetivos O objetivo deste estudo foi avaliar fatores de risco, salvamento de membros e sobrevida dos pacientes com OAA tratados em instituição universitária. Métodos Este é um estudo coorte retrospectivo de pacientes consecutivos. Os desfechos incluíram: sucesso técnico, sintomas, comorbidades, categoria Rutherford, artérias acometidas, complicações pós-operatórias, taxa de salvamento de membros em 30 dias e óbitos. Resultados Avaliou-se 105 prontuários, havendo predomínio do sexo masculino (65,7%) e idade entre 46 a 91 anos. As etiologias identificadas foram trombóticas (54,3%), embólicas (35,2%) e indefinidas (10,5%). Cerca de dois terços apresentavam-se nas Categorias II e III de Rutherford. Os sintomas associados encontrados foram dor (97,1%), esfriamento (89,5%), palidez (64,7%), parestesias (44,7%), paralisias (30,5%), anestesias (21,9%), edema (21,9%) e cianose (15,2%); e as comorbidades associadas observadas foram hipertensão (65,0%), tabagismo (59,0%), arritmias (26,6%), dislipidemias (24,0%) e diabetes (23,8%). O segmento femoral superficial-poplíteo-distal foi o mais acometido (80%). A tromboembolectomia com cateter Fogarty foi realizada em 73,3% dos casos (81,0% nas embolias, 71,9% nas tromboses e 54,5% nos indefinidos), sendo isoladamente em 41 pacientes (39,05%), nos quais ocorreram 11 reoclusões, 20 amputações e 14 óbitos. A reoclusão arterial foi mais frequente nas tromboses (12,9%; p = 0,054). Até 30 dias após tratamento, o óbito total foi de 14,6% e a amputação maior foi de 19,8%, sendo menos frequente na Classe I Rutherford (p = 0,0179). Conclusão O tratamento da OAA feito prioritariamente por meio de tromboembolectomia com cateter Fogarty, isolado e/ou associado, proporcionou taxas de amputação e complicações compatíveis com as apresentadas na literatura e progressivamente menores nas categorias Rutherford menos avançadas.

Abstract Background Acute arterial occlusions (AAO) in limbs have been increasing in parallel with population longevity. Objective To assess risk factors, limb salvage rates, and survival of patients with AAO treated at a University Hospital. Methods Retrospective cohort study of consecutive patients. Outcomes included: patency, symptoms, comorbidities, Rutherford category, arteries occluded, postoperative complications, and 30-day limb salvage and mortality rates. Results Medical records were evaluated from 105 patients, predominantly males (65.7%), with ages ranging from 46 to 91 years. Etiology: thrombotic (54.3%), embolic (35.2%), and undefined (10.5%). About 2/3 of the patients were assessed as Rutherford category II or III. Associated symptoms: pain (97.1%), coldness (89.5%), pallor (64.7%), sensory loss (44.7%), paralysis (30.5%), anesthesia (21.9%), edema (21.9%), and cyanosis (15.2%). Associated comorbidities: hypertension (65.0%), smoking (59.0%), arrhythmias (26.6%), dyslipidemia (24.0%), and diabetes (23.8%). The distal superficial femoral-popliteal segment was the most affected (80%). Thromboembolectomy with a Fogarty catheter was performed in 73.3% of cases (81.0% of embolic cases, 71.9% of thrombotic cases, and 54.5% of cases with undefined etiology) and was the only treatment used in 41 cases (39.05%), among which there were 11 reocclusion, 20 amputations, and 14 deaths. Arterial reocclusion was more frequent in thrombosis cases (12.9%, p = 0.054). Within 30 days of treatment, total mortality was 14.6%, and 19.8% of cases underwent major amputation, which was less frequent among Rutherford Class I patients (p = 0.0179). Conclusion Treatment of AAO was primarily performed by thromboembolectomy with a Fogarty catheter, either alone or in combination with other treatments, achieving amputation and complication rates compatible with the best results in the literature and were progressively lower in less advanced Rutherford categories.

Endovascular management of cerebral venous sinus thrombosis.

Cerebral venous sinus thrombosis (CVST) is characterized by formation of widespread thrombus within the cerebral venous sinus system. CVST can cause venous hypertension, venous infarcts, hemorrhage and seizures. It is managed in most cases with systemic anticoagulation through the use of heparin to resolve the thrombus. Patients that demonstrate clinical deterioration while on heparin are often treated with endovascular strategies to recanalize the sinuses. We present the case of a patient with widespread CVST, involving his superior sagittal sinuses and bilateral transverse sigmoid sinuses, who was treated with a combination of endovascular therapies. The video can be found here: http://youtu.be/w3wAGlT7h8c .

Hybrid therapeutic procedures for patients with acute lower limb ischemia / 中华普通外科杂志

Objective To compare surgical hybrid procedures (open thromboembolectomy/bypass,transluminal angioplasty/stenting) and endovascular hybrid procedures (percutaneous mechanical thrombectomy,catheter-directed intra-arterial thrombolysis,transluminal angioplasty/stenting) in patients with acute lower limb ischemia.Methods From June 2011 to June 2012,the clinical data and the six month follow-up data of patients with acute (less than 14 days) lower limb ischemia were collected and analyzed,who have underwent the endovascular modality hybrid procedures (endovascular modality group)or surgery modality of hybrid procedures (surgery modality group).The combined incidence of perioperative (30 days) death (POD) and major adverse limb event (MALE,include amputation or major intervention again) was defined as the primary end-point,and the secondary efficacy end-point was major adverse cardiovascular event (MACE) consisted of myocardial infarction,stroke and death from any cause.Results There were 105 and 95 cases respectively in the endovascular modality group and the surgery modality group.96 patients (99.0％) in the surgery modality group and 97 patients (92.4％) in the endovascular modality group were successfully completed with vascular reconstruction.The incidence of the primary end-point (combined POD and MALE) in the surgery modality group (7.2％) was significantly less than the endovascular modality group (17.1％).Hemorrhagic complications occurred more in the endovascular modality group (6.7％) than the surgery modality group (0％).The surgery modality group had more postoperative pulmonary complications (9.3％) than the endovascular modality group (1.0％).Conclusions Surgical hybrid procedures offer better immediate and mid-term results for patients with acute lower limb ischemia.