Carotid-cavernous fistula following mechanical thrombectomy of the tortuous internal carotid artery:A case report

BACKGROUND A carotid-cavernous fistula(CCF)is an abnormal connection between the internal carotid artery(ICA)and the cavernous sinus.Although direct CCFs typically result from trauma or as an iatrogenic complication of neuroendovascular procedures,they can occur as surgery-related complications after mechanical thrombectomy(MT).With the widespread use of MT in patients with acute ischemic stroke complicated with large vessel occlusion,it is important to document CCF following MT and how to avoid them.In this study,we present a case of a patient who developed a CCF following MT and describe in detail the characteristics of ICA tortuosity in this case.CASE SUMMARY A 60-year-old woman experienced weakness in the left upper and lower limbs as well as difficulty speaking for 4 h.The neurological examination revealed left central facial paralysis and left hemiplegia,with a National Institutes of Health Stroke Scale score of 9.Head magnetic resonance imaging revealed an acute cerebral infarction in the right basal ganglia and radial crown.Magnetic resonance angiography demonstrated an occlusion of the right ICA and middle cerebral artery.Digital subtraction angiography demonstrated distal occlusion of the cervical segment of the right ICA.We performed suction combined with stent thrombectomy.Then,postoperative angiography was performed,which showed a right CCF.One month later,CCF embolization was performed,and the patient’s clinical symptoms have significantly improved 5 mo after the operation.CONCLUSION Although a CCF is a rare complication after MT,it should be considered.Understanding the tortuosity of the internal carotid-cavernous sinus may help predict the complexity of MT and avoid this complication.

Overexpression of centromere protein H is significantly associated with breast cancer progression and overall patient survival

Breast cancer is one of the leading causes of cancer death worldwide.This study aimed to analyze the expression of centromere protein H(CENP-H) in breast cancer and to correlate it with clinicopathologic data,including patient survival.Using reverse transcription-polymerase chain reaction and Western blotting to detect the expression of CENP-H in normal mammary epithelial cells,immortalized mammary epithelial cell lines,and breast cancer cell lines,we observed that the mRNA and protein levels of CENP-H were higher in breast cancer cell lines and in immortalized mammary epithelial cells than in normal mammary epithelial cells.We next examined CENP-H expression in 307 paraffin-embedded archived samples of clinicopathologically characterized breast cancer using immunohistochemistry,and detected high CENP-H expression in 134(43.6%) samples.Statistical analysis showed that CENP-H expression was related with clinical stage(P = 0.001),T classification(P = 0.032),N classification(P = 0.018),and Ki-67(P < 0.001).Patients with high CENP-H expression had short overall survival.Multivariate analysis showed that CENP-H expression was an independent prognostic indicator for patient survival.Our results suggest that CENP-H protein is a valuable marker of breast cancer progression and prognosis.