The authors are reporting on a study drawn from unpublished dissertation done by the corresponding author when he completed his neurosurgical training in Paris, France in 2004, few years before the advent of flow dive...The authors are reporting on a study drawn from unpublished dissertation done by the corresponding author when he completed his neurosurgical training in Paris, France in 2004, few years before the advent of flow diverters. The study was a retrospective review of giant intracranial aneurysms treated by superficial temporal artery to middle cerebral artery bypass combined with endovascular occlusion of the parent artery. From 1990 to 2003, 29 consecutive cases of giant cerebral aneurysms, not suitable to selective treatment were managed in that way. Twenty-one medical records had enough data to allow objective evaluation. Sixteen female and five male patients bearing 21 giant aneurysms were involved. Their mean age was 46 years. The aneurysm was revealed by mass effect in 13 cases and subarachnoid hemorrhage in one case. On admission 19 patients presented with unruptured aneurysms and two have sustained a subarachnoid hemorrhage. The balloon occlusion test before the bypass operation was not tolerated in 18 patients. The treatment was completed in 19 patients and 17 of them had parent artery occlusion with latex detachable balloons. The only death of the series occurred before the endovascular treatment. The mean follow-up period was 30 months. After completion of the treatment, 16 (84%) patients had no symptom. Aneurysm recanalization or rupture was not observed after the parent artery occlusion. With the combination of superficial temporal artery to middle cerebral artery bypass + endovascular parent artery occlusion, 90% of giant intracranial aneurysms untreatable selectively were permanently excluded with a good outcome in 95%.展开更多
Essential thrombocytosis (ET) is a rare myeloproliferative disorder, which is a major risk factor for thrombosis and bleeding, which complicates cardiovascular surgery. ET is a risk factor for coronary artery disease ...Essential thrombocytosis (ET) is a rare myeloproliferative disorder, which is a major risk factor for thrombosis and bleeding, which complicates cardiovascular surgery. ET is a risk factor for coronary artery disease that should be treated. We present a case of a male with ET who underwent coronary artery bypass grafting (CABG) at the University Hospital of the West Indies, and died post-surgery. Post mortem revealed early graft thrombosis. We believe that post<span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">operative aspirin therapy maybe would have prevented this fatal outcome.</span>展开更多
Background:Superficial temporal artery(STA)-middle cerebral artery(MCA)bypass surgery is now being widely used in moyamoya disease,and its therapeutic value in SICAO remains divergent.Methods:A systematic search was p...Background:Superficial temporal artery(STA)-middle cerebral artery(MCA)bypass surgery is now being widely used in moyamoya disease,and its therapeutic value in SICAO remains divergent.Methods:A systematic search was performed in PubMed,EMBASE,and Cochrane Databases in Feb.2020 and updated in Jun.2019.We have strict inclusion and exclusion criteria.Cochrane Bias Risk Assessment Tool was used to assess the quality of included RCTs.Review Manager 5.3 was used for analysis results in terms of comparing the STA-MCA bypass and BMT.For dichotomous variable outcomes,risk ratios(RRs)and 95%confidence intervals(95%CIs)were calculated for the assessment.Results:The total patient cohort consisted of 2419 patients,of whom 1188(49.1%)patients had been grouped in STA-MCA bypass and 1231(50.9%)patients had been divided into the BMT group.Mean follow-up of included patients was 29 months.The RR of the seven studies was 1.01,and the 95%confidence interval was.89–1.15,with statistical significance,Z=.13,P=.89,sustaining that STA-MCA bypass was not superior to BMT in symptomatic carotid artery occlusion disease.Conclusions:STA-MCA bypass and BMT were associated with similar rates of a composite of long-term stroke.And the risk of long-term overall stroke was mildly higher with BMT.At present,each patient should receive more precise treatment,by reasonably assessing the individual differences of each patient to reduce the recurrence rate of stroke.展开更多
BACKGROUND Percutaneous coronary intervention(PCI)of diseased saphenous vein grafts(SVG)continues to pose a clinical challenge.Current PCI guidelines give a class III recommendation against performing PCI on chronical...BACKGROUND Percutaneous coronary intervention(PCI)of diseased saphenous vein grafts(SVG)continues to pose a clinical challenge.Current PCI guidelines give a class III recommendation against performing PCI on chronically occluded SVG.However,contemporary outcomes after SVG intervention have incrementally improved with distal protection devices,intracoronary vasodilators,drug-eluting stents,and prolonged dual antiplatelet therapy.AIM To reassess the procedural and long-term outcomes of PCI for totally occluded SVG with contemporary techniques.METHODS This was a retrospective observational study conducted at a single university hospital.The study population consisted of 35 consecutive patients undergoing PCI of totally occluded SVG.Post-procedure dual antiplatelet therapy was continued for a minimum of one year and aspirin was continued indefinitely.Clinical outcomes were assessed at a mean follow-up of 1221±1038 d.The primary outcome was freedom from a major adverse cardiac event(MACE)defined as the occurrence of any of the following:death,myocardial infarction,stroke,repeat bypass surgery,repeat PCI,or graft reocclusion.RESULTS The study group included 29 men and 6 women with a mean age of 69±12 years.Diabetes was present in 14(40%)patients.All patients had Canadian Heart Classification class III or IV angina.Clinical presentation was an acute coronary syndrome in 34(97%)patients.Mean SVG age was 12±5 years.Estimated duration of occlusion was acute(<24 h)in 34%of patients,subacute(>24 h to 30 d)in 26%,and late(>30 d)in 40%.PCI was initially successful in 29/35 SVG occlusions(83%).Total stent length was 52±35 mm.Intraprocedural complications of distal embolization or no-reflow occurred in 6(17%)patients.During longer term follow-up,MACE-free survival was only 30%at 3 years and 17%at 5 years.CONCLUSION PCI of totally occluded SVG can be performed with a high procedural success rate.However,its clinical utility remains limited by poor follow-up outcomes.展开更多
文摘The authors are reporting on a study drawn from unpublished dissertation done by the corresponding author when he completed his neurosurgical training in Paris, France in 2004, few years before the advent of flow diverters. The study was a retrospective review of giant intracranial aneurysms treated by superficial temporal artery to middle cerebral artery bypass combined with endovascular occlusion of the parent artery. From 1990 to 2003, 29 consecutive cases of giant cerebral aneurysms, not suitable to selective treatment were managed in that way. Twenty-one medical records had enough data to allow objective evaluation. Sixteen female and five male patients bearing 21 giant aneurysms were involved. Their mean age was 46 years. The aneurysm was revealed by mass effect in 13 cases and subarachnoid hemorrhage in one case. On admission 19 patients presented with unruptured aneurysms and two have sustained a subarachnoid hemorrhage. The balloon occlusion test before the bypass operation was not tolerated in 18 patients. The treatment was completed in 19 patients and 17 of them had parent artery occlusion with latex detachable balloons. The only death of the series occurred before the endovascular treatment. The mean follow-up period was 30 months. After completion of the treatment, 16 (84%) patients had no symptom. Aneurysm recanalization or rupture was not observed after the parent artery occlusion. With the combination of superficial temporal artery to middle cerebral artery bypass + endovascular parent artery occlusion, 90% of giant intracranial aneurysms untreatable selectively were permanently excluded with a good outcome in 95%.
文摘Essential thrombocytosis (ET) is a rare myeloproliferative disorder, which is a major risk factor for thrombosis and bleeding, which complicates cardiovascular surgery. ET is a risk factor for coronary artery disease that should be treated. We present a case of a male with ET who underwent coronary artery bypass grafting (CABG) at the University Hospital of the West Indies, and died post-surgery. Post mortem revealed early graft thrombosis. We believe that post<span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">operative aspirin therapy maybe would have prevented this fatal outcome.</span>
文摘Background:Superficial temporal artery(STA)-middle cerebral artery(MCA)bypass surgery is now being widely used in moyamoya disease,and its therapeutic value in SICAO remains divergent.Methods:A systematic search was performed in PubMed,EMBASE,and Cochrane Databases in Feb.2020 and updated in Jun.2019.We have strict inclusion and exclusion criteria.Cochrane Bias Risk Assessment Tool was used to assess the quality of included RCTs.Review Manager 5.3 was used for analysis results in terms of comparing the STA-MCA bypass and BMT.For dichotomous variable outcomes,risk ratios(RRs)and 95%confidence intervals(95%CIs)were calculated for the assessment.Results:The total patient cohort consisted of 2419 patients,of whom 1188(49.1%)patients had been grouped in STA-MCA bypass and 1231(50.9%)patients had been divided into the BMT group.Mean follow-up of included patients was 29 months.The RR of the seven studies was 1.01,and the 95%confidence interval was.89–1.15,with statistical significance,Z=.13,P=.89,sustaining that STA-MCA bypass was not superior to BMT in symptomatic carotid artery occlusion disease.Conclusions:STA-MCA bypass and BMT were associated with similar rates of a composite of long-term stroke.And the risk of long-term overall stroke was mildly higher with BMT.At present,each patient should receive more precise treatment,by reasonably assessing the individual differences of each patient to reduce the recurrence rate of stroke.
文摘BACKGROUND Percutaneous coronary intervention(PCI)of diseased saphenous vein grafts(SVG)continues to pose a clinical challenge.Current PCI guidelines give a class III recommendation against performing PCI on chronically occluded SVG.However,contemporary outcomes after SVG intervention have incrementally improved with distal protection devices,intracoronary vasodilators,drug-eluting stents,and prolonged dual antiplatelet therapy.AIM To reassess the procedural and long-term outcomes of PCI for totally occluded SVG with contemporary techniques.METHODS This was a retrospective observational study conducted at a single university hospital.The study population consisted of 35 consecutive patients undergoing PCI of totally occluded SVG.Post-procedure dual antiplatelet therapy was continued for a minimum of one year and aspirin was continued indefinitely.Clinical outcomes were assessed at a mean follow-up of 1221±1038 d.The primary outcome was freedom from a major adverse cardiac event(MACE)defined as the occurrence of any of the following:death,myocardial infarction,stroke,repeat bypass surgery,repeat PCI,or graft reocclusion.RESULTS The study group included 29 men and 6 women with a mean age of 69±12 years.Diabetes was present in 14(40%)patients.All patients had Canadian Heart Classification class III or IV angina.Clinical presentation was an acute coronary syndrome in 34(97%)patients.Mean SVG age was 12±5 years.Estimated duration of occlusion was acute(<24 h)in 34%of patients,subacute(>24 h to 30 d)in 26%,and late(>30 d)in 40%.PCI was initially successful in 29/35 SVG occlusions(83%).Total stent length was 52±35 mm.Intraprocedural complications of distal embolization or no-reflow occurred in 6(17%)patients.During longer term follow-up,MACE-free survival was only 30%at 3 years and 17%at 5 years.CONCLUSION PCI of totally occluded SVG can be performed with a high procedural success rate.However,its clinical utility remains limited by poor follow-up outcomes.
