Delayed Management of Popliteal Artery Injury Following Knee Dislocation—A Case Report

Knee dislocations frequently involve vascular injuries that demand early diagnosis and timely intervention. Time of ischemia is pivotal in determining the outcome for the limb, delays in treatment beyond 8 hours significantly increase the risk of limb loss. Unfortunately, this critical window is often missed in resource-limited settings. Here we report a 25-year-old female sustained a left knee injury after falling into a trench. She was diagnosed with an open knee dislocation accompanied by a popliteal artery injury. However, revascularization was delayed for 18 hours due to limited resources, including the unavailability of a thrombectomy catheter. Postoperatively, the patient received anticoagulation therapy with serial limb assessments and after 3 weeks the laceration healed and the limb was still viable. Knee dislocations frequently result in vascular injury (popliteal artery most common), making prompt diagnosis and intervention essential for limb preservation. In settings with limited resources, like ours, delayed presentation and transfer to specialized centers contribute to prolonged ischemic times. Nonetheless, viable limbs should be revascularized in stable patients, even with prolonged ischemia. This case highlights the importance of limb revascularization despite delay. Efforts should be made to improve prompt diagnosis, timely referral, and availability of necessary equipment for vascular repair to optimize outcomes in similar cases.

Mirizzi syndrome:Problems and strategies

Mirizzi syndrome is a serious complication of gallstone disease.It is caused by the impacted stones in the gallbladder neck or cystic duct.One of the features of Mirizzi syndrome is severe inflammation or dense fibrosis at the Calot’s triangle.In our clinical practice,bile duct,branches of right hepatic artery and right portal vein clinging to gallbladder infundibulum are often observed due to gallbladder infundibulum adhered to right hepatic hilum.The intraoperative damage of branches of right hepatic artery occurs more easily than that of bile duct,all of which are hidden pitfalls for surgeons.Magnetic resonance cholangiopancreatography(MRCP)and endoscopic retrograde cholangiopancreatography(ERCP)are the preferable tools for the diagnosis of Mirizzi syndrome.Anterograde cholecystectomy in Mirizzi syndrome is easy to damage branches of right hepatic artery and bile duct due to gallbladder infundibulum adhered to right hepatic hilum.Subtotal cholecystectomy is an easy,safe and definitive approach to Mirizzi syndrome.When combined with the application of ERCP,a laparoscopic management of Mirizzi syndrome by well-trained surgeons is feasible and safe.The objective of this review was to highlight its existing problems:(1)low preoperative diagnostic rate,(2)easy to damage bile duct and branches of right hepatic artery,and(3)high concomitant gallbladder carcinoma.Meanwhile,the review aimed to discuss the possible therapeutic strategies:(1)to enhance its preoperative recognition by imaging findings,and(2)to avoid potential pitfalls during surgery.

Optimal stimulation parameters for Renzhong (DU 26) electro-acupuncture for improving motor function in a rat model of middle cerebral artery occlusion

The selection of electro-acupuncture parameters remains poorly unified between clinical studies. The present study observed the effects of electro-acupuncturing Renzhong （DU 26） with different stimulation parameters on motor function recovery following middle artery occlusion injury in rats. Results showed an optimal stimulation parameter for Renzhong electro-acupuncture that was low frequency and mild current （2 Hz, 1 mA） significantly improved cortical excitability and conductive function, and promoted recovery in a rat model of motor function in middle artery occlusion. Frequency had a greater impact than current or interaction, and played a critical role in electro-acupuncture therapy.

Spontaneous internal carotid artery pseudoaneurysm complicated with ischemic stroke in a young man:A case report and review of literature

BACKGROUND Carotid artery pseudoaneurysm(PSA)is infrequently encountered in clinical settings.Internal carotid artery(ICA)PSA complicated with ischemic stroke is rare.PSAs are typically caused by iatrogenic injury,trauma,or infection.The underlying mechanisms of spontaneous PSA formation are not well characterized.We report a healthy young man who presented with stroke as a complication of spontaneous PSA of the left ICA.CASE SUMMARY A 30-year-old man working as a ceiling decoration worker was hospitalized due to sudden-onset speech disorder and right lower extremity weakness.Medical history was unremarkable.Brain computed tomography revealed ischemic stroke.Digital subtraction angiography showed a left ICA PSA with mild stenosis.The patient was conservatively managed with oral anticoagulation and antiplatelet therapy.He recovered well and was discharged.The patient was in good condition during follow-up.CONCLUSION The occupational history of patient should be taken into consideration while evaluating the etiology of spontaneous ICA PSA in young people with stroke.

Segmental artery injury during transforaminal percutaneous endoscopic lumbar discectomy:Two case reports

BACKGROUND Since Kambin experimentally induced arthroscopy to treat herniated nucleus pulposus,percutaneous endoscopic lumbar discectomy(PELD)has been developed.The branch of the segmental artery around the neural foramen may be damaged during PELD using the transforaminal approach.We report 2 rare cases in which segmental artery injury that occurred during PELD was treated with emergency embolization.CASE SUMMARY In case 1,a 31-year-old man was transferred to our emergency department with left lower quadrant abdominal pain after PELD at a local hospital.Lumbar spine magnetic resonance imaging after the surgery showed a hematoma of the left retroperitoneal area and the psoas muscle area.Under suspicion of vascular injury,arteriography was performed.Pseudoaneurysm and blood leakage from the left 4th lumbar segmental artery into the abdominal cavity were identified.Emergency transarterial embolization was performed using fibered microcoils for bleeding of the segmental artery.In case 2,a 75-year-old woman was transferred to our emergency department with low blood pressure,right flank pain,and drowsy mental status after PELD at a local hospital.When the patient arrived at the emergency room,the blood pressure decreased from 107/55 mmHg to 72/47 mmHg.Low blood pressure persisted.Under suspicion of vessel injury,arteriography was performed,and the right 4th lumbar segmental artery rupture was confirmed.Emergency transarterial embolization was performed for bleeding of segmental artery.CONCLUSION We were able to find the bleeding focus by angiography and treat the injury of the segmental artery successfully through emergency transarterial embolization.

Update in combined musculoskeletal and vascular injuries of the extremities

Combined musculoskeletal and vascular injuries of the extremities are conditions in which a multidisciplinary approach is a sine qua non to ensure life initially and limb viability secondarily.Vascular injuries as part of musculoskeletal trauma are usually the result of the release of a high energy load in the wound site so that the prognosis is determined by the degree of soft-tissue damage,duration of limb ischemia,patient’s medical status and presence of associated injuries.The management of these injuries is challenging and requires a specific algorithm of action,because they are usually characterized by increased morbidity,amputation rate,infection,neurological and functional deficits,and they could be life threatening.Although vascular injuries are rare and occur either isolated or in the context of major combined musculoskeletal trauma,the high index of suspicion,imaging control,and timely referral of the patient to organized trauma centers ensure the best functional outcome of the extremity in such challenging cases.Even after a successful initial treatment of a combined trauma pattern,long-term follow-up is crucial to prevent and detect early possible complications.The purpose of this manuscript is to provide an update on diagnosis and treatment of combined musculoskeletal and vascular injuries of the extremities,from an orthopedic point of view.

Risk factors for acute kidney injury following coronary artery bypass graft surgery in a Chinese population and development of a prediction model

BACKGROUND Acute kidney injury(AKI)after coronary artery bypass graft(CABG)surgery is associated with significant morbidity and mortality.This retrospective study aimed to establish a risk score for postoperative AKI in a Chinese population.METHODS A total of 1138 patients undergoing CABG were collected from September 2018 to May 2020 and divided into a derivation and validation cohort.AKI was defined according to the Kidney Disease Improving Global Outcomes(KDIGO)criteria.Multivariable logistic regression analysis was used to determine the independent predictors of AKI,and the predictive ability of the model was determined using a receiver operating characteristic(ROC)curve.RESULTS The incidence of cardiac surgery–associated acute kidney injury(CSA-AKI)was 24.17%,and 0.53%of AKI patients required dialysis(AKI-D).Among the derivation cohort,multivariable logistic regression showed that age≥70 years,body mass index(BMI)≥25 kg/m2,estimated glomerular filtration rate(eGFR)≤60 mL/min per 1.73 m2,ejection fraction(EF)≤45%,use of statins,red blood cell transfusion,use of adrenaline,intra-aortic balloon pump(IABP)implantation,postoperative low cardiac output syndrome(LCOS)and reoperation for bleeding were independent predictors.The predictive model was scored from 0 to32 points with three risk categories.The AKI frequencies were as follows:0-8 points(15.9%),9-17 points(36.5%)and≥18 points(90.4%).The area under of the ROC curve was 0.730(95%CI:0.691-0.768)in the derivation cohort.The predictive index had good discrimination in the validation cohort,with an area under the curve of 0.735(95%CI:0.655-0.815).The model was well calibrated according to the Hosmer-Lemeshow test(P=0.372).CONCLUSION The performance of the prediction model was valid and accurate in predicting KDIGO-AKI after CABG surgery in Chinese patients,and could improve the early prognosis and clinical interventions.

Emergency treatment and anesthesia management of internal carotid artery injury during neurosurgery:Four case reports

BACKGROUND During skull base surgery,intraoperative internal carotid artery(ICA) injury is a catastrophic complication that can lead to fatal blood loss or secondary cerebral ischemia.Appropriate management of ICA injury plays a crucial role in the prognosis of patients.Neurosurgeons have reported multiple techniques and management strategies;however,the literature on managing this complication from the anesthesiologist’s perspective is limited,especially in the aspect of circulation management and airway management when patients need transit for further endovascular treatment.CASE SUMMARY We describe 4 cases of ICA injury during neurosurgery;there were 3 cases of pathologically proven pituitary adenoma and 1 case of cavernous sinus endothelial meningioma.After the onset of ICA injury,all four patients were immediately transferred for endovascular therapy under general anesthesia with vital signs monitored and mechanical ventilation.Three patients were transferred to the hybrid operating room,and one patient was transferred to the catheter operating room.Three patients underwent covered stent implantation,and one patient underwent embolization.All four patients experienced hypovolemic shock and received blood products infusion and vasoactive drugs to maintain stable circulation.After the neurosurgery,one patient was extubated and returned to the ward,and the other three were delayed tracheal extubation and returned to the intensive care unit.One patient died from serious neurological complications after 62 d in the hospital,but the other three showed good clinical outcomes.CONCLUSION ICA injury imposes a high risk of massive hemorrhage and subsequent infarction.Immediate treatment is critical and requires interdisciplinary collaboration among neurosurgeons,anesthesiologists,and interventional neuroradiologists.Effective hemostatic methods,stable hemodynamics sufficient to ensure perfusion of vital organs,airway safety during transit,rapid localization and implementation of appropriate measures to occlude the damaged vessel are strong guarantees of patient safety.

Endovascular treatment of traumatic renal artery pseudoaneurysm with a Stanford type A intramural haematoma:A case report

BACKGROUND Aortic intramural hematoma(IMH) associated with aortic branch tear and intramurally located pseudoaneurysm after blunt trauma has not been reported.Here,we report a case of progressive type A aortic IMH associated with a pseudoaneurysm arising from the injured proximal renal artery after blunt trauma.CASE SUMMARY During logging operations,a 66-year-old man experienced blunt force trauma after being injured by a fallen tree.He arrived at our trauma center with a left flank pain complaint.Computed tomography(CT) revealed a pseudoaneurysm arising from the proximal renal artery(localized within the aortic media) and Stanford type A IMH.A covered stent was deployed along the left main renal artery,bridging the pseudoaneurysm and covering the parent artery,successfully excluding the pseudoaneurysm as confirmed using aortography.However,although the degree of the pseudoaneurysm decreased,follow-up CT revealed remnant pseudoaneurysm,likely caused by an endoleak.Subsequently,a covered stent was additionally installed through the previously deployed covered stent.Successful exclusion of the pseudoaneurysm was confirmed using final aortography.In the 7-mo follow-up CT scan,the IMH and pseudoaneurysm completely disappeared with no evidence of stent-related complications.CONCLUSION Endovascular treatment such as stent-graft placement can be an effective and safe treatment for traumatic renal artery injury.

Delayed pseudoaneurysm formation of the carotid artery following the oral cavity injury in a child:A case report

BACKGROUND An impalement injury of the oral cavity is a common traumatic injury in children.In most cases,it is not accompanied by sequelae,but if foreign body residues are not found due to a minor injury,they may result in inflammatory responses and delayed vascular injuries in the surrounding tissues.Without early diagnosis and appropriate initial management,residual foreign bodies can cause serious complications and even mortality in some cases.CASE SUMMARY A 9-year-old boy suffered an intra-oral injury by a wooden chopstick,and the patient was discharged from the hospital after receiving conservative treatment for the injury.However,the patient was readmitted to the hospital due to intraoral bleeding,and since neck hematoma and right internal carotid artery pseudoaneurysm formation were detected on computed tomography,emergency surgery was performed.A remnant fragment of a wooden chopstick was found during the operation,and a delayed rupture of the internal carotid artery caused by the foreign body was also found.CONCLUSION The failure of early detection and diagnosis of a residual foreign body may result in delayed vascular rupture.

Viabahn Stent Graft for Inadvertent Insertion of a Central Venous Catheter in the Subclavian Artery

Subclavian artery (SCA) injuries associated with central venous catheter (CVC) insertion are uncommon yet lethal complications that typically require surgical treatment. This case report presents the case of a 94-year-old man with an iatrogenic right SCA injury resulting from a misplaced CVC. Computed tomography revealed the catheter piercing the right internal jugular vein to enter the right SCA and then reaching the aortic arch. Emergent endovascular treatment was performed, and a 13-mm × 50-mm self-expanding Viabahn stent graft (W.L. Gore & Associates, Flagstaff, AZ, USA) was placed via the right brachial artery. The misplaced catheter was successfully removed under simultaneous postdeployment balloon dilatation. This case highlights the utility of the Viabahn stent graft for iatrogenic right SCA injury caused by a misplaced CVC and presents some insights and tips for a safer procedure.

Subclavian Artery Pseudoaneurysm following Stab Injury and Its Surgical Approach: A Case Report and Literature Review

Penetrating injuries to the subclavian arteries as well as post traumatic pseudoaneurysm involving Subclavian artery (SCA) are very much uncommon. We present one case of a 21 year-old male sustained a physical assault with a post stab injury left subclavian artery pseudoaneurysm. He was referred to our facility, two days after sustaining a penetrating chest trauma over left infraclavicular area of the chest. The presentation, diagnostic procedures and surgical approach for management of this very rare injury are discussed.

Orthogonal design to sift the optimal parameter of Neiguan acupuncture for cerebral infarction

The individual difference and non-repeatability in acupuncture have not only restricted the devel- opment of acupuncture, but have also affected the specificity of acupoints. The present study used instruments to control needle depth, lifting and thrusting frequency, and the duration of acupuncture. Effects of the quantified acupuncture were observed at Neiguan （PC6） with different stimulation parameters. A frequency of 1, 2, or 3 Hz and duration of 5, 60, or 180 seconds were used to observe cerebral blood flow and ratio of infarct volume recovery. Results showed that stimulation at Neiguan with a frequency of 1 Hz and long duration of 180 seconds or 2/3 Hz and long duration of 5/60 seconds significantly increased cerebral blood flow and decreased the ratio of infarct volume. In- teractions between frequency and duration play a critical role in quantified acupuncture therapy.

Relationship of gelatinases-tight junction proteins and blood-brain barrier permeability in the early stage of cerebral ischemia and reperfusion

Gelatinases matrix metalloproteinase-2 and matrix metalloproteinase-9 have been shown to mediate claudin-5 and occludin degradation, and play an important regulatory role in blood-brain barrier permeability. This study established a rat model of 1.5-hour middle cerebral artery occlusion with reperfusion. Protein expression levels of claudin-5 and occludin gradually decreased in the early stage of reperfusion, which corresponded to the increase of the gelatinolytic activity of matrix metalloproteinase-2 and matrix metalloproteinase-9. In addition, rats that received treatment with matrix metalloproteinase inhibitor N-[（2R）-2-（hydroxamidocarbonylmethyl）-4-methylpenthanoyl]-L- tryptophan methylamide （GM6001） showed a significant reduction in Evans blue leakage and an inhibition of claudin-5 and occludin protein degradation in striatal tissue. These data indicate that matrix metalloproteinase-2 and matrix metalloproteinase-9-mediated claudin-5 and occludin degradation is an important reason for blood-brain barrier leakage in the early stage of reperfusion. The leakage of the blood-brain barrier was present due to gelatinases-mediated degradation of claudin-5 and occludin proteins. We hypothesized that the timely closure of the structural component of the blood-brain barrier （tight junction proteins） is of importance.

A Preliminary Study of the Therapeutic Role of Human Early Fetal Aorta-derived Endothelial Progenitor Cells in Inhibiting Carotid Artery Neointimal Hyperplasia

Background： Endothelial cell damage is an important pathophysiological step of restenosis after angioplasty and stenting. Cell transplantation has great therapeutic potential for endothelial recovery. We investigated the effect of transplanting endothelial progenitor cells （EPCs） derived from human early fetal aortas in rat injured arteries. Methods： The carotid arterial endothelium of Sprague-Dawley rats was damaged by dilatation with a 1.5 F balloon catheter, and then EPCs derived from human early fetal aortas （〈14 weeks） were injected into the lumen of the injured artery in transplanted rats, with an equal volume of normal saline injected into control rats. Rats were sacrificed at 2 and 4 weeks after treatment and transplanted cells were identified by immunohistochemical staining with anti-human CD31 and anti-human mitochondria antibodies. Arterial cross-sections were analyzed by pathology, immunohistochemistry, and morphometry. Results： Green fluorescence-labeled EPCs could be seen in the endovascular surface of balloon-injured vessels after transplantation. The intimal area and intimal/medial area ratio were significantly smaller in the transplanted group than in the control （P 〈 0.05） and the residual lumen area was larger （P 〈 0.05）. After EPC transplantation, a complete vascular endothelial layer was formed, which was positive for human yon Willebrand factor after immunohistochemical staining, and immunohistochemical staining revealed many CD31- and mitochondria-positive cells in the re-endothelialized endothelium with EPC transplantation but not control treatment. Conclusion： EPCs derived from human early fetal aorta were successfully transplanted into injured vessels and might inhibit neointimal hyperplasia after vascular injury.

Pulmonary oligemia maneuver can alleviate pulmonary artery injury during pulmonary thromboendarterectomy procedure

Background Pulmonary thromboendarterectomy （PTE） has evolved as a treatment of choice for chronic thromboembolic pulmonary hypertension （CTEPH）. This study aimed to characterize if pulmonary oligemia maneuver （POM） can alleviate pulmonary artery injury during PTE procedure. Methods A total of 112 cases of CTEPH admitted to Beijing Anzhen Hospital from March 2002 to August 2011 received PTE procedure. They were retrospectively classified as non-POM group （group A, n=55） or POM group （group B, n=57）. Members from group B received POM during rewarming period, whereas members from group A did not. Results There were three （5.45%） early deaths in group A, no death in group B （0） （Fisher＇s exact test, P=0.118）. Six patients in group A needed extracorporeal membrane oxygenation （ECMO） as life support after the PTE procedure, no patients in group B needed ECMO （Fisher＇s exact test, P=0.013）. The patients in group B had a shorter intubation and ICU stay, lower mean pulmonary arterial pressure （mPAP） and pulmonary vascular resistance （PVR）, higher partial pressure of oxygen in artery （PaO2） and arterial oxygen saturation （SaO2） and less medical expenditure than patients in group A. With a mean follow-up time of （58.3 ± 30.6） months, two patients in group A and one patient in group B died. The difference of the actuarial survival after the procedure between the two groups did not reach statistical significance. Three months post the PTE procedure, the difference of residual occluded pulmonary segment between the two groups did not reach statistical significance （P=0.393）. Conclusion POM can alleviate pulmonary artery injury, shorten ICU stay and intubation time, and lower down the rate of ECMO after PTE procedure.

Flexible Subclavian Artery Closure for an Inadvertent Injury to the Internal Mammary Artery During Internal Jugular Vein Catheterization

Central vein catheter （CVC） placement, which is widely utilized in clinical departments, is also highly important in preoperative preparations for radiofrequency catheter ablation （RFCA）. The internal jugular vein or subclavian vein is the routine target. Arterial injury is not uncommon during the procedure but is potentially devastating in spite of the safety and advantages of the Seldinger technique. Compressing of the airway by a hematoma, as well as hemothorax, pseudoaneurysm, arteriovenous fistula, stroke, and even death, has been well-described.

Pulmonary artery injury management during pulmonary thromboendarterectomy

Pulmonary thromboendarterectomy （PEA） is the recommended treatment for chronic thromboembolic pulmonary hypertension （CTEPH）.1 Pulmonary artery injury is a major risk factor during PEA performed at less experienced surgical centers and is associated with adverse short-term consequences.In-hospital mortality may be as high as 15% in some PEA case series,with pulmonary artery injury and persistent pulmonary hypertension as the principal etiologies.2 Many techniques have been used to prevent pulmonary artery injury during PEA,but once the injury occurs,the prognosis is poor and may even result in death.Out of 202 PEA procedures performed at our surgical center,we successfully managed two cases of severe pulmonary artery injury and report our experience in the present case series.Keywords：chronic thromboembolic pulmonary hypertension; pulmonary thromboendarterectomy; pulmonary artery injury

A novel method of defective vascular reconstruction using 2-octyl-cyanoacrylate and homemade prosthetic component

Background Currently,adhesive technique is popular in vascular repair but not widely used for defective vessels.This study aimed to determine the feasibility and effectiveness of repairing defective vessels with 2-octyl-cyanoacrylate and a homemade prosthetic component.Methods Homemade prosthetic component consisting of expanded polytetrofluoroethylene （ePTFE）,terylene film,and homemade soluble hollow stent mixed with adhesive can replace autologous graft and suture in repairing defective vessels,can fix vessels better using the stent without occlusive bleeding.Forty male mongrel dogs were used,20 for biomechanical tests and 20 for animal experiments.In the biomechanical test,dogs were randomly divided into two groups （n=10 each）,one group repaired on the two sides of the carotid arteries with 2-octyl-cyanoacrylate and homemade component and another group repaired with suture and ePTFE.Of the 40 specimens,10 were used for adhesive and 10 for suture specimens for tension strength test,whereas the remaining specimens were used for bursting pressure test.In animal experiments,dogs were also divided into adhesive and suture groups （n=10）,only of the left carotid artery.Recording the operational time,bleeding or not.Vessels were tested using color Doppler ultrasound,the inner diameter was measured,and the degree of stenosis at 8 weeks was evaluated digital subtraction angiography （DSA） were also performed.Specimens were then analyzed histologically.Results In the adhesive and suture groups,the specimens could afford atension strength of （23.80±1.51） N versus （24.60±1.08） N （P ＞0.05）,the bursting pressure was （52.03±.2.43） kPa versus （50.04±3.51） kPa （P ＞0.05）,and the mean time of anastomosis was （15.20±0.55） minutes versus （25.97±0.58） minutes （P ＜0.05）.One dog in the adhesive group was bleeding from the suture.One dog from each group presented with thrombosis at 1 week.After measuring using ultrasound,the stenosis degree of all dogs were no more than 30％ except the two thromboses.DSA and histological observation showed no obvious difference between the two groups.Conclusion Defective vascular anastomosis with 2-octyl-cyanoacrylate and our homemade prosthetic component is feasible,effective,timesaving,and easy to master.

Effect of Aloe Emodin on Proliferation of Vascular Smooth Muscle Cells after Arterial Injury

Objective: To study the effect of Aloe emodin (AE), an active ingredient of Rhubarb,on the kinetics of proliferation of smooth muscular cells (SMCs) cultured in vitro after rabbit iliac arterial injury. Methods: Forty-eight hours after de-endothelialization (balloon endothelial denudation), the iliac arteries of the Japanese white rabbits were isolated and the smooth muscle cells were cultured primarily.AE was added to culture medium containing 10% fetal calf serum (FCS ). The cultures were pulse-labeled with 3H-TdR and TdR uptake into VSMC were measured and the cell cycle of the cultures were analyzed by using flow cytometer. Results: Compared with control, when the concentration gradient ranged from 10 - 1 to 10-5 g/L, the amount (cpm,count per minute) of 3H-TdR uptake into SMCs has significant differences (P < 0. 05 )and 10 -1 and 10 -2 g/L AE showed strong inhibitory effects on TdR uptake into VSMC and the percentage of inhibition [% inhibition =(cpm without AE-cpm with AE)/cpm without AE] was more than 90%. AE displayed concentration dependent inhibitory effects. The percentage of cells in G0/G1 phase was increased, but the percentage of cells in S phase was decreased in AE group, the transition of SMC cycle phase from G0 to S was blocked.Conclusion: AE is a strong inhibitor to the proliferation of SMCs and the pharmacological action of AE may reduce SMC proliferation in vivo and decrease intimal hyperplasia of restenosis.Original article on CJIM(Chin) 1998; 18(7): 420