BACKGROUND Due to improvements in living standards,people are now paying more attention to their health.In China,more patients choose to go to large or well-known hospitals,which leads to constant crowding of outpatie...BACKGROUND Due to improvements in living standards,people are now paying more attention to their health.In China,more patients choose to go to large or well-known hospitals,which leads to constant crowding of outpatient clinics in these hospitals.AIM To establish precision valuation reservation registration aimed at shortening waiting time,improving patient experience and promoting the satisfaction of outpatients and medical staff.METHODS On the basis of the implementation of a conventional appointment system,more reasonable time intervals were set for different doctors by evaluating the actual capacity of each doctor to receive patients,and appointment times were made more accurate through intervention.The change in consultation waiting time of patients was then compared.Correlations between the consultation waiting time of patients and the satisfaction of patients or satisfaction of medical staff were analyzed.RESULTS After precision valuation reservation registration,the average consultation waiting time of patients reduced from 18.47 min to 10.11 min(t=8.90,P<0.001).The satisfaction score of patients increased from 91.33 to 96.27(t=-8.62,P<0.001),and the satisfaction score of medical staff increased from 90.51 to 96.04(t=-10.50,P<0.001).The consultation waiting time of patients was negatively correlated with their satisfaction scores(γ=-0.89,P<0.001).The consultation waiting time of patients was also negatively correlated with medical staff satisfaction scores(γ=-0.96,P<0.001).CONCLUSION Precision valuation reservation registration significantly shortened outpatient waiting times and improve the satisfaction of not only patients but also medical staff.This approach played an important role in improving outpatient services,provided a model that is supported by relevant evidence and could continuously improve the quality of management.Precision valuation reservation registration is worth promoting and applying in the clinic.展开更多
Endovascular coil embolisation continues to evolve and remains a valid modality in managing ruptured and unruptured cerebral aneurysms.Technological advances in coil properties,adjunctive devices and interventional te...Endovascular coil embolisation continues to evolve and remains a valid modality in managing ruptured and unruptured cerebral aneurysms.Technological advances in coil properties,adjunctive devices and interventional techniques continue to improve long-term aneurysm occlusion rates.This review elaborates on the latest advances in next-generation endovascular coils and adjunctive coiling techniques for treating cerebral aneurysms.展开更多
background Acute in situ thrombosis is an ischaemic phenomenon during Pipeline embolisation device(PED)procedures with potentially high morbidity and mortality.There is controversy regarding the role of platelet funct...background Acute in situ thrombosis is an ischaemic phenomenon during Pipeline embolisation device(PED)procedures with potentially high morbidity and mortality.There is controversy regarding the role of platelet function testing with P2Y12 assay as a predictor of intraprocedural thromboembolic events.There is limited knowledge on whether procedural complexity influences these events.Methods Data were collected retrospectively on 742 consecutive PED cases at a single institution.Patients with intraprocedural acute thrombosis were compared with patients without these events.results A cohort of 37 PED cases with acute in situ thrombosis(mean age 53.8 years,mean aneurysm size 8.4 mm)was matched with a cohort of 705 PED cases without intraprocedural thromboembolic events(mean age 56.4 years,mean aneurysm size 6.9 mm).All patients with in situ thrombosis received intra-arterial and/or intravenous abciximab.The two groups were evenly matched in patient demographics,previous treatment/subarachnoid hemorrhage(SAH)and aneurysm location.There was no statistical difference in postprocedural P2Y12 reaction unit(PRU)values between the two groups,with a mean of 156 in the in situ thrombosis group vs 148 in the control group(p=0.5894).Presence of cervical carotid tortuosity,high cavernous internal carotid artery grade,need for multiple PED and vasospasm were not significantly different between the two groups.The in situ thrombosis group had statistically significant longer fluoroscopy time(60.4 vs 38.4 min,p<0.0001),higher radiation exposure(3476 vs 2160 mGy,p<0.0001),higher rates of adjunctive coiling(24.3% vs 8.37%,p=0.0010)and higher utilisation of balloon angioplasty(37.8% vs 12.2%,p<0.0001).Clinically,the in situ thrombosis cohort had higher incidence of major and minor stroke,intracerebral haemorrhage and length of stay.Conclusions Predictors of procedural complexity(higher radiation exposure,longer fluoroscopy time,adjunctive coiling and need for balloon angioplasty)are associated with acute thrombotic events during PED placement,independent of PRU values.展开更多
Endovascular treatment of cerebral aneurysm continues to evolve with the development of new technologies.This review provides an overview of the recent major innovations in the neurointerventional space in recent years.
Flow diverters and flow disruption technology,alongside nuanced endovascular techniques,have ushered in a new era of treating cerebral aneurysms.Here,we provide an overview of the latest flow modulation devices and hi...Flow diverters and flow disruption technology,alongside nuanced endovascular techniques,have ushered in a new era of treating cerebral aneurysms.Here,we provide an overview of the latest flow modulation devices and highlight their clinical applications and outcomes.展开更多
The pathophysiology of giant cerebral aneurysms renders them difficult to treat.Advances in technology have attempted to address any shortcomings associated with open surgery or endovascular therapies.Since the introd...The pathophysiology of giant cerebral aneurysms renders them difficult to treat.Advances in technology have attempted to address any shortcomings associated with open surgery or endovascular therapies.Since the introduction of the flow diversion technique,the endovascular approach with flow diversion has become the first-line modality chosen to treat giant aneurysms.A subset of these giant aneurysms may persistent despite any treatment modality.Perhaps the best option for these recurrent and/or persistent giant aneurysms is to employ a multimodal approach-both surgical and endovascular-rather than any single technique to provide a curative result with favourable patient outcomes.This paper provides a review of the histopathology and treatment options for giant cerebral aneurysms.Additionally,an illustrative case is presented to highlight the unique challenges of a curative solution for giant cerebral aneurysms that persist despite initial treatment.展开更多
Introduction Internal carotid artery termination(ICAT)and proximal A1 aneurysms can be challenging for open surgical clipping or endovascular coiling.Treatment with flow diversion covering the middle cerebral artery(M...Introduction Internal carotid artery termination(ICAT)and proximal A1 aneurysms can be challenging for open surgical clipping or endovascular coiling.Treatment with flow diversion covering the middle cerebral artery(MCA),an end vessel supplying a terminal circulation,has not been reported.Methods A prospective,Institutional Review Board-approved database was analysed for patients with pipeline embolisation device(PED)placement from the anterior cerebral artery(ACA)to the ICA during cerebral aneurysm treatment.Results Nine cases were identified,including five proximal A1,three posterior communicating artery and one ICAT aneurysm locations.Average aneurysm size was 8.3 mm(range 3-17),with 67%saccular and 78%right-sided.Primary indication for treatment was significant dome irregularity(44%),recurrence or enlargement(33%),underlying collagen vascular disorder(11%)and traumatic pseudoaneurysm(11%).Preservation of the ipsilateral ACA(with PED placed in A1)was performed when the anterior communicating artery(67%)or contralateral A1(33%)were absent on angiography.Adjunctive coiling was done in four cases(44%).There was one major stroke leading to mortality(11%)and one minor stroke(11%).Clinical follow-up was 27 months on average.Follow-up digital subtraction angiography(average interval 15 months)showed complete aneurysm obliteration(88%)or dome occlusion with entry remnant(12%).The jailed MCA showed minimal or mild delay(primarily anterograde flow)in 75%of cases and significant delay(reliance primarily on ACA and external carotid artery collaterals)in 25%.Conclusions Covering the MCA with a flow diverting stent should be reserved for select rare cases.Strict attention to blood pressure augmentation during the periprocedural period is necessary to minimise potential ischaemic compromise.展开更多
Background An estimated 2%-3%of the population harbour an intracranial aneurysm.Concomitant atherosclerotic cervical carotid disease is not uncommon.The management of these two entities remains a challenge within the ...Background An estimated 2%-3%of the population harbour an intracranial aneurysm.Concomitant atherosclerotic cervical carotid disease is not uncommon.The management of these two entities remains a challenge within the field.Case presentation We report a single case of concomitant carotid stenosis and two ipsilateral unruptured intracranial aneurysms treated with a single-staged cervical carotid stenting and cerebral aneurysm embolisation with the Pipeline embolisation device.Discussion No consensus currently exists to guide endovascular treatment of intracranial aneurysms associated with asymptomatic ipsilateral stenosis.Here,we present a case of asymptomatic moderate carotid stenosis with two ipsilateral intracranial aneurysms and suggest carotid artery stenting takes procedural priority over aneurysm embolisation in single-stage treatment.The rationale for the sequence of neurointerventions is based on the tracking a robust distal access system beyond a stenotic proximal carotid lesion and stabilisation of the ulcerated plaque to avoid thromboembolic complications associated with plaque irritation during aneurysm embolisation.Additional cases and longer follow-up will be needed to further assess the efficacy of this technique.展开更多
基金support from the National Science foundation of China(No.81503041)the Science Research Projects of Chinese Pharmacopoeia(No.Z18)+2 种基金the Science Research Projects of the Hunan Provincial Department of Education(No.17C1213)the Science Research Projects of the Hunan Provincial Department of Education(No.14C0860)and the Key Projects of the Changsha Municipal Science and Technology Bureau(No.K1406030-31)
基金funding support from the National Natural Science Foundation of China (No. 81503041)Project Foundation of Changsha Science and Technology Bureau (No. kq1701073)
文摘BACKGROUND Due to improvements in living standards,people are now paying more attention to their health.In China,more patients choose to go to large or well-known hospitals,which leads to constant crowding of outpatient clinics in these hospitals.AIM To establish precision valuation reservation registration aimed at shortening waiting time,improving patient experience and promoting the satisfaction of outpatients and medical staff.METHODS On the basis of the implementation of a conventional appointment system,more reasonable time intervals were set for different doctors by evaluating the actual capacity of each doctor to receive patients,and appointment times were made more accurate through intervention.The change in consultation waiting time of patients was then compared.Correlations between the consultation waiting time of patients and the satisfaction of patients or satisfaction of medical staff were analyzed.RESULTS After precision valuation reservation registration,the average consultation waiting time of patients reduced from 18.47 min to 10.11 min(t=8.90,P<0.001).The satisfaction score of patients increased from 91.33 to 96.27(t=-8.62,P<0.001),and the satisfaction score of medical staff increased from 90.51 to 96.04(t=-10.50,P<0.001).The consultation waiting time of patients was negatively correlated with their satisfaction scores(γ=-0.89,P<0.001).The consultation waiting time of patients was also negatively correlated with medical staff satisfaction scores(γ=-0.96,P<0.001).CONCLUSION Precision valuation reservation registration significantly shortened outpatient waiting times and improve the satisfaction of not only patients but also medical staff.This approach played an important role in improving outpatient services,provided a model that is supported by relevant evidence and could continuously improve the quality of management.Precision valuation reservation registration is worth promoting and applying in the clinic.
文摘Endovascular coil embolisation continues to evolve and remains a valid modality in managing ruptured and unruptured cerebral aneurysms.Technological advances in coil properties,adjunctive devices and interventional techniques continue to improve long-term aneurysm occlusion rates.This review elaborates on the latest advances in next-generation endovascular coils and adjunctive coiling techniques for treating cerebral aneurysms.
文摘background Acute in situ thrombosis is an ischaemic phenomenon during Pipeline embolisation device(PED)procedures with potentially high morbidity and mortality.There is controversy regarding the role of platelet function testing with P2Y12 assay as a predictor of intraprocedural thromboembolic events.There is limited knowledge on whether procedural complexity influences these events.Methods Data were collected retrospectively on 742 consecutive PED cases at a single institution.Patients with intraprocedural acute thrombosis were compared with patients without these events.results A cohort of 37 PED cases with acute in situ thrombosis(mean age 53.8 years,mean aneurysm size 8.4 mm)was matched with a cohort of 705 PED cases without intraprocedural thromboembolic events(mean age 56.4 years,mean aneurysm size 6.9 mm).All patients with in situ thrombosis received intra-arterial and/or intravenous abciximab.The two groups were evenly matched in patient demographics,previous treatment/subarachnoid hemorrhage(SAH)and aneurysm location.There was no statistical difference in postprocedural P2Y12 reaction unit(PRU)values between the two groups,with a mean of 156 in the in situ thrombosis group vs 148 in the control group(p=0.5894).Presence of cervical carotid tortuosity,high cavernous internal carotid artery grade,need for multiple PED and vasospasm were not significantly different between the two groups.The in situ thrombosis group had statistically significant longer fluoroscopy time(60.4 vs 38.4 min,p<0.0001),higher radiation exposure(3476 vs 2160 mGy,p<0.0001),higher rates of adjunctive coiling(24.3% vs 8.37%,p=0.0010)and higher utilisation of balloon angioplasty(37.8% vs 12.2%,p<0.0001).Clinically,the in situ thrombosis cohort had higher incidence of major and minor stroke,intracerebral haemorrhage and length of stay.Conclusions Predictors of procedural complexity(higher radiation exposure,longer fluoroscopy time,adjunctive coiling and need for balloon angioplasty)are associated with acute thrombotic events during PED placement,independent of PRU values.
文摘Endovascular treatment of cerebral aneurysm continues to evolve with the development of new technologies.This review provides an overview of the recent major innovations in the neurointerventional space in recent years.
文摘Flow diverters and flow disruption technology,alongside nuanced endovascular techniques,have ushered in a new era of treating cerebral aneurysms.Here,we provide an overview of the latest flow modulation devices and highlight their clinical applications and outcomes.
文摘The pathophysiology of giant cerebral aneurysms renders them difficult to treat.Advances in technology have attempted to address any shortcomings associated with open surgery or endovascular therapies.Since the introduction of the flow diversion technique,the endovascular approach with flow diversion has become the first-line modality chosen to treat giant aneurysms.A subset of these giant aneurysms may persistent despite any treatment modality.Perhaps the best option for these recurrent and/or persistent giant aneurysms is to employ a multimodal approach-both surgical and endovascular-rather than any single technique to provide a curative result with favourable patient outcomes.This paper provides a review of the histopathology and treatment options for giant cerebral aneurysms.Additionally,an illustrative case is presented to highlight the unique challenges of a curative solution for giant cerebral aneurysms that persist despite initial treatment.
文摘Introduction Internal carotid artery termination(ICAT)and proximal A1 aneurysms can be challenging for open surgical clipping or endovascular coiling.Treatment with flow diversion covering the middle cerebral artery(MCA),an end vessel supplying a terminal circulation,has not been reported.Methods A prospective,Institutional Review Board-approved database was analysed for patients with pipeline embolisation device(PED)placement from the anterior cerebral artery(ACA)to the ICA during cerebral aneurysm treatment.Results Nine cases were identified,including five proximal A1,three posterior communicating artery and one ICAT aneurysm locations.Average aneurysm size was 8.3 mm(range 3-17),with 67%saccular and 78%right-sided.Primary indication for treatment was significant dome irregularity(44%),recurrence or enlargement(33%),underlying collagen vascular disorder(11%)and traumatic pseudoaneurysm(11%).Preservation of the ipsilateral ACA(with PED placed in A1)was performed when the anterior communicating artery(67%)or contralateral A1(33%)were absent on angiography.Adjunctive coiling was done in four cases(44%).There was one major stroke leading to mortality(11%)and one minor stroke(11%).Clinical follow-up was 27 months on average.Follow-up digital subtraction angiography(average interval 15 months)showed complete aneurysm obliteration(88%)or dome occlusion with entry remnant(12%).The jailed MCA showed minimal or mild delay(primarily anterograde flow)in 75%of cases and significant delay(reliance primarily on ACA and external carotid artery collaterals)in 25%.Conclusions Covering the MCA with a flow diverting stent should be reserved for select rare cases.Strict attention to blood pressure augmentation during the periprocedural period is necessary to minimise potential ischaemic compromise.
文摘Background An estimated 2%-3%of the population harbour an intracranial aneurysm.Concomitant atherosclerotic cervical carotid disease is not uncommon.The management of these two entities remains a challenge within the field.Case presentation We report a single case of concomitant carotid stenosis and two ipsilateral unruptured intracranial aneurysms treated with a single-staged cervical carotid stenting and cerebral aneurysm embolisation with the Pipeline embolisation device.Discussion No consensus currently exists to guide endovascular treatment of intracranial aneurysms associated with asymptomatic ipsilateral stenosis.Here,we present a case of asymptomatic moderate carotid stenosis with two ipsilateral intracranial aneurysms and suggest carotid artery stenting takes procedural priority over aneurysm embolisation in single-stage treatment.The rationale for the sequence of neurointerventions is based on the tracking a robust distal access system beyond a stenotic proximal carotid lesion and stabilisation of the ulcerated plaque to avoid thromboembolic complications associated with plaque irritation during aneurysm embolisation.Additional cases and longer follow-up will be needed to further assess the efficacy of this technique.
