Microsurgical efficacy in 326 children with tethered cord syndrome: a retrospective analysis

Tethered cord syndrome is a progressive disease with a typically insidious onset in infants and children, and which can lead to persistent progress of neurological deficits and a high rate of disability without timely intervention. The purpose of this study was to investigate the curative effect of microsurgery in children with different types of tethered cord syndrome. In this study, we analyzed 326 patients with tethered cord syndrome, aged from 2 months to 14 years old, who were followed for 3-36 months after microscopic surgery. Based on clinical manifestations and imaging findings, these patients were classified into five types： tight ilium terminale （53 cases）, lipomyelome- ningocele （55 cases）, lipomatous malformation （124 cases）, postoperative adhesions （56 cases）, and split cord malformation （38 cases）. All patients underwent microsurgery. Curative effects were measured before and 3 months after surgery by Spina Bifida Neurological Scale based on sensory and motor functions, reflexes, and bladder and bowel function. The results showed that Spina Bifida Neurological Scale scores improved in all five types after surgery. Overall effective rates in these patients were 75%. Effective rates were 91% in tight ilium terminale, 84% in lipomyelomeningocele, 65% in lipomatous malformation, 75% in postoperative adhesion, and 79% in split cord mal- formation. Binary logistic regression analysis revealed that types of tethered cord syndrome （lipoma-type or not） and symptom duration before surgery were independent influencing factors of surgical outcome. These results show that therapeutic effect is markedly different in patients with different types of tethered cord syndrome. Suitable clinical classification for tethered cord syndrome will be helpful in predicting prognosis and guiding treatment. This trial has been registered in the Chinese Clinical Trial Registry （registration number： ChiCTR1800016464）.

Optimized strategy of rotational atherectomy of underexpanded coronary stents in patients with acute coronary syndrome

BACKGROUND:Stent under-expansion is a main cause of acute coronary syndrome(ACS),which can lead to serious clinical outcomes.The rotational atherectomy of underexpanded coronary stents(academically called stent ablation,SA)by intravascular ultrasound(IVUS)may provide more visual reference in the intervention.We aim to analyze the procedural and long-term outcomes of the optimized strategy of SA in patients with ACS and to provide real-world data on this technique.METHODS:A total of 11 patients with ACS who underwent SA between April 2017 and January 2019 were analyzed.Clinical follow-ups were obtained either by telephone call or by scheduled visit.Clinical end-points included periprocedural and postprocedural myocardial infarction,stent thrombosis,target lesion revascularization,and major adverse cardiac events.RESULTS:The mean age of patients was 69.6±6.5 years,and five(45.5%)patients were males.All cases presented with unstable angina and were admitted with ACS.All patients required at least two burrs during the intervention and the size of the burr was selected based on the data of minimum lumen diameter(MLD),and the fi rst and the second burr/stent MLD ratios were 0.93(0.88-0.99)and 1.09(1.02-1.14),respectively.Nine patients were treated with drug-eluting stents and two were treated with drug-coated balloons.There were no complications including no fl ow,perforation,or burr entrapment during the intervention.No in-hospital deaths or major adverse cardiac events were documented during the follow-up period.In our study,less contrast agent and a lower dose of radiation were used during the intervention.CONCLUSIONS:SA guided by IVUS can reduce the risk of complications,assess the results of surgery,inform the selection of stent size,and decrease the required dose of radiation and contrast.