BACKGROUND Early hepatic artery thrombosis(E-HAT)is a serious complication after liver transplantation(LT),which often results in graft failure and can lead to patient deaths.Treatments such as re-transplantation and ...BACKGROUND Early hepatic artery thrombosis(E-HAT)is a serious complication after liver transplantation(LT),which often results in graft failure and can lead to patient deaths.Treatments such as re-transplantation and re-anastomosis are conventional therapeutic methods which are restricted by the shortage of donors and the patient’s postoperative intolerance to re-laparotomy.Due to the advances in interventional techniques and thrombolytics,endovascular treatments are increasingly being selected by more and more centers.This study reviews and reports our single-center experience with intra-arterial thrombolysis as the first choice therapy for E-HAT after deceased donor LT.AIM To evaluate the feasibility and reasonability of intra-arterial thrombolysis for EHAT after deceased donor LT.METHODS A total of 147 patients who underwent deceased donor LT were retrospectively reviewed in our hospital between September 2011 and December 2016.Four patients were diagnosed with E-HAT.All of these patients underwent intraarterial thrombolysis with alteplase as the first choice therapy after LT.The method of arterial anastomosis and details of the diagnosis and treatment of EHAT were collated.The long-term prognosis of E-HAT patients was also recorded.The median follow-up period was 26 mo(range:23 to 30 mo).RESULTS The incidence of E-HAT was 2.7%(4/147).E-HAT was considered when Doppler ultrasonography showed no blood flow signals and a definite diagnosis was confirmed by immediate hepatic arterial angiography when complete occlusion of the hepatic artery was observed.The patients were given temporary thrombolytics(mainly alteplase)via a 5-Fr catheter which was placed in the proximal part of the thrombosed hepatic artery followed by continuous alteplase using an infusion pump.Alteplase dose was adjusted according to activated clotting time.The recanalization rate of intra-arterial thrombolysis in our study was 100%(4/4)and no thrombolysis-related mortality was observed.During the follow-up period,patient survival rate was 75%(3/4),and biliary complications were present in 50%of patients(2/4).CONCLUSION Intra-arterial thrombolysis can be considered first-line treatment for E-HAT after deceased donor LT.Early diagnosis of E-HAT is important and follow-up is necessary even if recanalization is successful.展开更多
Objective:To study the different effects of mechanical embolus removal and intra-arterial thrombolysis on neural functional recovery in patients with acute middle cerebral artery occlusion.Methods: Patients with acute...Objective:To study the different effects of mechanical embolus removal and intra-arterial thrombolysis on neural functional recovery in patients with acute middle cerebral artery occlusion.Methods: Patients with acute middle cerebral artery occlusion who were treated in the First Hospital of Yulin between September 2013 and October 2017 were selected and retrospectively studied, and the differences in reperfusion therapies in history data were referred to divide them into study group A and study group B who underwent mechanical embolus removal and intra-arterial thrombolysis respectively. The levels of neurocyte damage markers, apoptosis markers and stress markers in serum as well as the expression of Wnt pathway molecules in peripheral blood were determined before treatment and 24 h after treatment.Results: Compared with those of same group before treatment, serum NSE, S100B, VILIP1, sFas, sFasL, ET-1 and MDA levels as well as peripheral blood GSK3β, LC3-II and Beclin1 expression intensity of both groups were decreasing whereas serum BDNF, NTF, sLivin and SOD levels as well as peripheral bloodβ-catenin and mTOR expression intensity were increasing, and serum NSE, S100B, VILIP1, sFas, sFasL, ET-1 and MDA levels as well as peripheral blood GSK3β, LC3-II and Beclin1 expression intensity of study group A after treatment were lower than those of study group B whereas serum BDNF, NTF, sLivin and SOD levels as well as peripheral bloodβ-catenin and mTOR expression intensity were higher than those of study group B.Conclusion: Mechanical embolus removal for acute middle cerebral artery occlusion can be more effective than intra-arterial thrombolysis to reduce the nerve function damage as well as the corresponding oxidative stress and apoptosis.展开更多
Acute retinal arterial ischemia,which includes transient monocular vision loss(TMVL),branch retinal artery occlusion(BRAO),central retinal artery occlusion(CRAO)and ophthalmic artery occlusion(OAO),is most commonly th...Acute retinal arterial ischemia,which includes transient monocular vision loss(TMVL),branch retinal artery occlusion(BRAO),central retinal artery occlusion(CRAO)and ophthalmic artery occlusion(OAO),is most commonly the consequence of an embolic phenomenon from the ipsilateral carotid artery,heart or aortic arch,leading to partial or complete occlusion of the central retinal artery(CRA)or its branches.Acute retinal arterial ischemia is the ocular equivalent of acute cerebral ischemia and is an ophthalmic and medical emergency.Patients with acute retinal arterial ischemia are at a high risk of having further vascular events,such as subsequent strokes and myocardial infarctions(MIs).Therefore,prompt diagnosis and urgent referral to appropriate specialists and centers is necessary for further work-up(such as brain magnetic resonance imaging with diffusion weighted imaging,vascular imaging,and cardiac monitoring and imaging)and potential treatment of an urgent etiology(e.g.,carotid dissection or critical carotid artery stenosis).Since there are no proven,effective treatments to improve visual outcome following permanent retinal arterial ischemia(central or branch retinal artery occlusion),treatment must focus on secondary prevention measures to decrease the likelihood of subsequent ischemic events.展开更多
Objective.To analyze the clinical efficacy of neurointerventional catheter thrombolysis for cerebral infarction.Methods.A total of 56 patients with cerebral infarction admitted to our hospital from April 2018 to June ...Objective.To analyze the clinical efficacy of neurointerventional catheter thrombolysis for cerebral infarction.Methods.A total of 56 patients with cerebral infarction admitted to our hospital from April 2018 to June 2019 were enrolled for the experimental study.Two different treatments were applied to patients,and patients were divided into observation groups and controls according to different treatment methods.After grouped into two groups the control group was treated with intravenous thrombolysis.The observation group was treated with neurointerventional arterial catheter thrombolysis.The treatment effect,NIHSS score and BI index,neurological deficit score before and after treatment,and coagulation index were compared between the two groups.Results.The therapeutic effect of the observation group(92.86%)was significantly different from that of the control group(67.86%),and the observation group was higher than the control group.The data of the observation group in the NIHSS score and the BI index were 5.42±1.77 and 95.64±2.15,respectively,which were better than the control group.The neurological deficit scores of the observation group before and after treatment were 19.88±6.24 and 9.14±5.81,respectively.After treatment,the difference was significant compared with the control group,P<0.05.The coagulation indexes of the observation group in FIB,PT,TT,etc.were respectively 3.68±1.04,11.46±1.62,15.37±2.46,all were better than the control group(2.13±0.47,13.72±2.72,19.85±2.62),P<0.05.Conclusion.the clinical efficacy of neurointerventional arterial catheter thrombolysis for cerebral infarction is significant,it can effectively promote the recovery of various functional conditions of patients with cerebral infarction,which is worthy of further application and promotion.展开更多
Acute mesenteric ischemia is a deadly process withoverall mortality rate of 40%. Acute thrombosis of an atherosclerotic lesion with previous partial occlusion isone of the common causes. Peri-operative mortality ofsu...Acute mesenteric ischemia is a deadly process withoverall mortality rate of 40%. Acute thrombosis of an atherosclerotic lesion with previous partial occlusion isone of the common causes. Peri-operative mortality ofsuperior mesenteric artery （SMA） thrombosis is higherbecause of the difficulty in diagnosis,展开更多
目的 探讨不同性别急性缺血性卒中神经影像及预后差异。方法 回顾性分析在我院就诊的急性前循环脑卒中患者200例。所有患者均于治疗前行多模MRI检查。按治疗方法将患者分为静脉溶栓治疗组及动脉取栓组。收集患者临床资料和神经影像资料...目的 探讨不同性别急性缺血性卒中神经影像及预后差异。方法 回顾性分析在我院就诊的急性前循环脑卒中患者200例。所有患者均于治疗前行多模MRI检查。按治疗方法将患者分为静脉溶栓治疗组及动脉取栓组。收集患者临床资料和神经影像资料,并评估治疗后结果及3个月预后(mRS评分)。统计学方法分析不同性别急性卒中患者神经影像及预后差异。结果 100例静脉溶栓治疗患者女性组(n=50)Tmax>6s体积(65.48±32.15 vs 89.13±34.77;t=9.431,P=0.036)、PWI/DWI不匹配体积(57.14±23.95 vs 77.12±36.73;t=7.569,P=0.044)及低灌注强度比值(HIR)(0.33±0.32 vs 0.37±0.31;t=8.274,P=0.044)低于男性组(n=50);女性组3个月预后良好比例明显高于男性组(72.00%vs 48.00%;χ^(2)=6.000;P=0.024)。与静脉溶栓治疗组相仿,动脉取栓治疗后女性组(n=50)Tmax>6s体积(109.35±27.49 vs 127.16±21.55;t=4.4 3 1;P=0.041)、 PWI/DWI不匹配体积(75.31±25.14vs90.19±20.48;t=6.993;P=0.039)及HIR(0.29±0.22vs0.40±0.34;t=7.530;P=0.029)同样低于男性组;女性组3个月预后良好比例同样明显高于男性组(64.00%vs 42.00%;χ^(2)=4.857;P=0.045)。结论 女性较男性急性卒中患者具有较小的灌注异常、较小的缺血半暗带、较好的侧枝循环及较好的功能预后。展开更多
BACKGROUND ST-elevation myocardial infarction(STEMI)refers to a clinical syndrome that features symptoms of myocardial ischemia with consequent ST-elevation on electrocardiography and an associated rise in cardiac bio...BACKGROUND ST-elevation myocardial infarction(STEMI)refers to a clinical syndrome that features symptoms of myocardial ischemia with consequent ST-elevation on electrocardiography and an associated rise in cardiac biomarkers.Rapid restoration of brisk flow in the coronary vasculature is critical in reducing mortality and morbidity.In patients with STEMI who could not receive primary percutaneous coronary intervention(PCI)on time,pharmacoinvasive strategy(thrombolysis followed by timely PCI within 3-24 h of its initiation)is an effective option.AIM To analyze the role of delayed pharmacoinvasive strategy in the window period of 24-72 h after thrombolysis.METHODS This was a physician-initiated,single-center prospective registry between January 2017 and July 2017 which enrolled 337 acute STEMI patients with partially occluded coronary arteries.Patients received routine pharmacoinvasive therapy(PCI within 3-24 h of thrombolysis)in one group and delayed pharmacoinvasive therapy(PCI within 24-72 h of thrombolysis)in another group.The primary endpoint was major adverse cardiac and cerebrovascular events(MACCE)within 30 d of the procedure.The secondary endpoints included major bleeding as defined by Bleeding Academic Research Consortium classification,angina,and dyspnea within 30 d.RESULTS The mean age in the two groups was comparable(55.1±10.1 years vs 54.2±10.5 years,P=0.426).Diabetes was present among 20.2%and 22.1%of patients in the routine and delayed groups,respectively.Smoking rate was 54.6%and 55.8%in the routine and delayed groups,respectively.Thrombolysis was initiated within 6 h of onset of symptoms in both groups(P=0.125).The mean time from thrombolysis to PCI in the routine and delayed groups was 16.9±5.3 h and 44.1±14.7 h,respectively.No significant difference was found for the occurrence of measured clinical outcomes in the two groups within 30 d(8.7%vs 12.9%,P=0.152).Univariate analysis of demographic characteristics and risk factors for patients who reported MACCE in the two groups did not demonstrate any significant correlation.Secondary endpoints such as angina,dyspnea,and major bleeding were non-significantly different between the two groups.CONCLUSION Delayed PCI pharmacoinvasive strategy in a critical diseased but not completely occluded artery beyond 24 h in patients who have been timely thrombolyzed seems a reasonable strategy.展开更多
基金The Science and Technology Department of Jilin Province,No.20180622004JC and No.20190101002JHthe Finance Department of Jilin Province,No.2017F004 and No.2018SCZWSZX-044.
文摘BACKGROUND Early hepatic artery thrombosis(E-HAT)is a serious complication after liver transplantation(LT),which often results in graft failure and can lead to patient deaths.Treatments such as re-transplantation and re-anastomosis are conventional therapeutic methods which are restricted by the shortage of donors and the patient’s postoperative intolerance to re-laparotomy.Due to the advances in interventional techniques and thrombolytics,endovascular treatments are increasingly being selected by more and more centers.This study reviews and reports our single-center experience with intra-arterial thrombolysis as the first choice therapy for E-HAT after deceased donor LT.AIM To evaluate the feasibility and reasonability of intra-arterial thrombolysis for EHAT after deceased donor LT.METHODS A total of 147 patients who underwent deceased donor LT were retrospectively reviewed in our hospital between September 2011 and December 2016.Four patients were diagnosed with E-HAT.All of these patients underwent intraarterial thrombolysis with alteplase as the first choice therapy after LT.The method of arterial anastomosis and details of the diagnosis and treatment of EHAT were collated.The long-term prognosis of E-HAT patients was also recorded.The median follow-up period was 26 mo(range:23 to 30 mo).RESULTS The incidence of E-HAT was 2.7%(4/147).E-HAT was considered when Doppler ultrasonography showed no blood flow signals and a definite diagnosis was confirmed by immediate hepatic arterial angiography when complete occlusion of the hepatic artery was observed.The patients were given temporary thrombolytics(mainly alteplase)via a 5-Fr catheter which was placed in the proximal part of the thrombosed hepatic artery followed by continuous alteplase using an infusion pump.Alteplase dose was adjusted according to activated clotting time.The recanalization rate of intra-arterial thrombolysis in our study was 100%(4/4)and no thrombolysis-related mortality was observed.During the follow-up period,patient survival rate was 75%(3/4),and biliary complications were present in 50%of patients(2/4).CONCLUSION Intra-arterial thrombolysis can be considered first-line treatment for E-HAT after deceased donor LT.Early diagnosis of E-HAT is important and follow-up is necessary even if recanalization is successful.
文摘Objective:To study the different effects of mechanical embolus removal and intra-arterial thrombolysis on neural functional recovery in patients with acute middle cerebral artery occlusion.Methods: Patients with acute middle cerebral artery occlusion who were treated in the First Hospital of Yulin between September 2013 and October 2017 were selected and retrospectively studied, and the differences in reperfusion therapies in history data were referred to divide them into study group A and study group B who underwent mechanical embolus removal and intra-arterial thrombolysis respectively. The levels of neurocyte damage markers, apoptosis markers and stress markers in serum as well as the expression of Wnt pathway molecules in peripheral blood were determined before treatment and 24 h after treatment.Results: Compared with those of same group before treatment, serum NSE, S100B, VILIP1, sFas, sFasL, ET-1 and MDA levels as well as peripheral blood GSK3β, LC3-II and Beclin1 expression intensity of both groups were decreasing whereas serum BDNF, NTF, sLivin and SOD levels as well as peripheral bloodβ-catenin and mTOR expression intensity were increasing, and serum NSE, S100B, VILIP1, sFas, sFasL, ET-1 and MDA levels as well as peripheral blood GSK3β, LC3-II and Beclin1 expression intensity of study group A after treatment were lower than those of study group B whereas serum BDNF, NTF, sLivin and SOD levels as well as peripheral bloodβ-catenin and mTOR expression intensity were higher than those of study group B.Conclusion: Mechanical embolus removal for acute middle cerebral artery occlusion can be more effective than intra-arterial thrombolysis to reduce the nerve function damage as well as the corresponding oxidative stress and apoptosis.
文摘Acute retinal arterial ischemia,which includes transient monocular vision loss(TMVL),branch retinal artery occlusion(BRAO),central retinal artery occlusion(CRAO)and ophthalmic artery occlusion(OAO),is most commonly the consequence of an embolic phenomenon from the ipsilateral carotid artery,heart or aortic arch,leading to partial or complete occlusion of the central retinal artery(CRA)or its branches.Acute retinal arterial ischemia is the ocular equivalent of acute cerebral ischemia and is an ophthalmic and medical emergency.Patients with acute retinal arterial ischemia are at a high risk of having further vascular events,such as subsequent strokes and myocardial infarctions(MIs).Therefore,prompt diagnosis and urgent referral to appropriate specialists and centers is necessary for further work-up(such as brain magnetic resonance imaging with diffusion weighted imaging,vascular imaging,and cardiac monitoring and imaging)and potential treatment of an urgent etiology(e.g.,carotid dissection or critical carotid artery stenosis).Since there are no proven,effective treatments to improve visual outcome following permanent retinal arterial ischemia(central or branch retinal artery occlusion),treatment must focus on secondary prevention measures to decrease the likelihood of subsequent ischemic events.
文摘Objective.To analyze the clinical efficacy of neurointerventional catheter thrombolysis for cerebral infarction.Methods.A total of 56 patients with cerebral infarction admitted to our hospital from April 2018 to June 2019 were enrolled for the experimental study.Two different treatments were applied to patients,and patients were divided into observation groups and controls according to different treatment methods.After grouped into two groups the control group was treated with intravenous thrombolysis.The observation group was treated with neurointerventional arterial catheter thrombolysis.The treatment effect,NIHSS score and BI index,neurological deficit score before and after treatment,and coagulation index were compared between the two groups.Results.The therapeutic effect of the observation group(92.86%)was significantly different from that of the control group(67.86%),and the observation group was higher than the control group.The data of the observation group in the NIHSS score and the BI index were 5.42±1.77 and 95.64±2.15,respectively,which were better than the control group.The neurological deficit scores of the observation group before and after treatment were 19.88±6.24 and 9.14±5.81,respectively.After treatment,the difference was significant compared with the control group,P<0.05.The coagulation indexes of the observation group in FIB,PT,TT,etc.were respectively 3.68±1.04,11.46±1.62,15.37±2.46,all were better than the control group(2.13±0.47,13.72±2.72,19.85±2.62),P<0.05.Conclusion.the clinical efficacy of neurointerventional arterial catheter thrombolysis for cerebral infarction is significant,it can effectively promote the recovery of various functional conditions of patients with cerebral infarction,which is worthy of further application and promotion.
文摘Acute mesenteric ischemia is a deadly process withoverall mortality rate of 40%. Acute thrombosis of an atherosclerotic lesion with previous partial occlusion isone of the common causes. Peri-operative mortality ofsuperior mesenteric artery （SMA） thrombosis is higherbecause of the difficulty in diagnosis,
文摘目的 探讨不同性别急性缺血性卒中神经影像及预后差异。方法 回顾性分析在我院就诊的急性前循环脑卒中患者200例。所有患者均于治疗前行多模MRI检查。按治疗方法将患者分为静脉溶栓治疗组及动脉取栓组。收集患者临床资料和神经影像资料,并评估治疗后结果及3个月预后(mRS评分)。统计学方法分析不同性别急性卒中患者神经影像及预后差异。结果 100例静脉溶栓治疗患者女性组(n=50)Tmax>6s体积(65.48±32.15 vs 89.13±34.77;t=9.431,P=0.036)、PWI/DWI不匹配体积(57.14±23.95 vs 77.12±36.73;t=7.569,P=0.044)及低灌注强度比值(HIR)(0.33±0.32 vs 0.37±0.31;t=8.274,P=0.044)低于男性组(n=50);女性组3个月预后良好比例明显高于男性组(72.00%vs 48.00%;χ^(2)=6.000;P=0.024)。与静脉溶栓治疗组相仿,动脉取栓治疗后女性组(n=50)Tmax>6s体积(109.35±27.49 vs 127.16±21.55;t=4.4 3 1;P=0.041)、 PWI/DWI不匹配体积(75.31±25.14vs90.19±20.48;t=6.993;P=0.039)及HIR(0.29±0.22vs0.40±0.34;t=7.530;P=0.029)同样低于男性组;女性组3个月预后良好比例同样明显高于男性组(64.00%vs 42.00%;χ^(2)=4.857;P=0.045)。结论 女性较男性急性卒中患者具有较小的灌注异常、较小的缺血半暗带、较好的侧枝循环及较好的功能预后。
文摘BACKGROUND ST-elevation myocardial infarction(STEMI)refers to a clinical syndrome that features symptoms of myocardial ischemia with consequent ST-elevation on electrocardiography and an associated rise in cardiac biomarkers.Rapid restoration of brisk flow in the coronary vasculature is critical in reducing mortality and morbidity.In patients with STEMI who could not receive primary percutaneous coronary intervention(PCI)on time,pharmacoinvasive strategy(thrombolysis followed by timely PCI within 3-24 h of its initiation)is an effective option.AIM To analyze the role of delayed pharmacoinvasive strategy in the window period of 24-72 h after thrombolysis.METHODS This was a physician-initiated,single-center prospective registry between January 2017 and July 2017 which enrolled 337 acute STEMI patients with partially occluded coronary arteries.Patients received routine pharmacoinvasive therapy(PCI within 3-24 h of thrombolysis)in one group and delayed pharmacoinvasive therapy(PCI within 24-72 h of thrombolysis)in another group.The primary endpoint was major adverse cardiac and cerebrovascular events(MACCE)within 30 d of the procedure.The secondary endpoints included major bleeding as defined by Bleeding Academic Research Consortium classification,angina,and dyspnea within 30 d.RESULTS The mean age in the two groups was comparable(55.1±10.1 years vs 54.2±10.5 years,P=0.426).Diabetes was present among 20.2%and 22.1%of patients in the routine and delayed groups,respectively.Smoking rate was 54.6%and 55.8%in the routine and delayed groups,respectively.Thrombolysis was initiated within 6 h of onset of symptoms in both groups(P=0.125).The mean time from thrombolysis to PCI in the routine and delayed groups was 16.9±5.3 h and 44.1±14.7 h,respectively.No significant difference was found for the occurrence of measured clinical outcomes in the two groups within 30 d(8.7%vs 12.9%,P=0.152).Univariate analysis of demographic characteristics and risk factors for patients who reported MACCE in the two groups did not demonstrate any significant correlation.Secondary endpoints such as angina,dyspnea,and major bleeding were non-significantly different between the two groups.CONCLUSION Delayed PCI pharmacoinvasive strategy in a critical diseased but not completely occluded artery beyond 24 h in patients who have been timely thrombolyzed seems a reasonable strategy.
