Chronic occlusion of large intracranial arteries is the main cause of ischemic stroke in China.Patients with symptomatic intracranial artery occlusion and hemodynamic impairment are at high risk of recurrent stroke.Ch...Chronic occlusion of large intracranial arteries is the main cause of ischemic stroke in China.Patients with symptomatic intracranial artery occlusion and hemodynamic impairment are at high risk of recurrent stroke.Chronic occlusion of the intracranial segment of the internal carotid artery is a common type of intracranial artery occlusion.Medical management is regarded as the standard treatment for this disease.With the development of endovascular treatment,some patients with chronic cerebral artery occlusion have achieved satisfactory results with endovascular therapy.We reported a patient with symptomatic chronic occlusion of the ophthalmic segment of the internal carotid artery.Simple balloon angioplasty was performed,and the occluded ophthalmic segment of the internal carotid artery was successfully recanalized without perioperative complications.At 4 months followup,the internal carotid artery remained patent and perfusion of the right cerebral hemisphere improved dramatically.In addition,we briefly reviewed the relevant literature.展开更多
Background:The development of carotid-cavernous fistulas(CCFs)during surgical recanalization of chronic internal carotid artery occlusion(ICAO)may be secondary to severe ICA dissection rather than a focal tear of the ...Background:The development of carotid-cavernous fistulas(CCFs)during surgical recanalization of chronic internal carotid artery occlusion(ICAO)may be secondary to severe ICA dissection rather than a focal tear of the cavernous ICA seen in typical traumatic CCFs.The purpose of this study is to investigate the causal relationship between the CCFs and severe ICA dissections and to characterize technical outcomes after treatment with stenting.Methods:Five patients underwent treatment with self-expanding stents due to intraprocedural CCF and ICA dissection following surgical removal of ICAO plaque.The stents were telescopically placed via true channel of the dissection.Safety of the procedure was evaluated with 30-day stroke and death rate.Procedural success was determined by the efficacy of CCF obliteration and ICAO recanalization with angiography.Results:All CCFs were associated with spiral and long segmental dissection from the cervical to cavernous ICA.After stenting,successful dissection reconstruction with TICI 3 was achieved in all patients,with complete(n=4)or partial CCF(n=1)obliteration.No patient had CCF syndrome,stroke,or death during follow-up of 6 to 37 months;but one patient had pulsatile tinnitus,which resolved 1 year later.Angiography at 6 to 24 months demonstrated CCF obliteration in all 5 patients and durable ICA patency in 4 patients.Conclusions:Intraprocedural CCFs with spiral and cervical-to-cavernous ICA dissection during ICAO surgery are dissection-related because of successful obliteration after stenting for dissection reconstruction.Self-expanding stenting through true channel of the dissection,serving as implanting stent-autograft,may be an optimal therapy for the atypical CCF complication from ICAO surgery.展开更多
目的:探讨髂内动脉球囊预置阻断术在植入型凶险性前置胎盘中的临床价值。方法:选取2021年7月—2024年1月阳江市人民医院收治的60例植入型凶险性前置胎盘患者。根据随机数表法将其分为对照组与观察组,各30例。两组均行剖宫产,对照组应用...目的:探讨髂内动脉球囊预置阻断术在植入型凶险性前置胎盘中的临床价值。方法:选取2021年7月—2024年1月阳江市人民医院收治的60例植入型凶险性前置胎盘患者。根据随机数表法将其分为对照组与观察组,各30例。两组均行剖宫产,对照组应用常规止血措施,观察组应用双侧髂内动脉球囊预置术。比较两组围手术期指标、新生儿情况、子宫切除率、并发症。结果:观察组术中出血量少于对照组,手术时间与住院时间均短于对照组,差异有统计学意义(P<0.05)。两组新生儿出生1 min、5 min、10 min Apgar评分比较,差异无统计学意义(P>0.05)。观察组子宫切除率、并发症发生率均低于对照组,差异有统计学意义(P<0.05)。结论:双侧髂内动脉球囊预置术应用于植入型凶险性前置胎盘患者中效果显著,能够减少产妇术中出血量,降低大出血风险,缩短手术时间和住院时间,降低患者子宫切除率与术后并发症发生率。展开更多
目的采用meta分析方法对比远端腹主动脉球囊阻断和双侧髂内动脉球囊阻断在辅助凶险型前置胎盘(PPP)患者剖宫产术的安全性和有效性。方法计算机系统检索中国知网、万方和维普数据库并手工检索PPP预置球囊阻断治疗相关文献,检索时限均自...目的采用meta分析方法对比远端腹主动脉球囊阻断和双侧髂内动脉球囊阻断在辅助凶险型前置胎盘(PPP)患者剖宫产术的安全性和有效性。方法计算机系统检索中国知网、万方和维普数据库并手工检索PPP预置球囊阻断治疗相关文献,检索时限均自建库至2018年8月30日。由2名独立评价者对纳入文献进行质量评价,采用Review Manager 5.0 for Mac软件进行meta分析。结果共有11篇文献纳入分析,结果显示腹主动脉球囊阻断组患者在术中胎儿射线接触量、手术时间、术中出血量、子宫切除率方面优于双侧髂总动脉球囊阻断组,OR(95%CI)分别为-2.57(-2.85^-2.29)、-13.28(-16.56^-10.00)、-0.35(-0.53^-0.17)、0.70(0.50~0.78),P值均<0.05。结论PPP患者剖宫产术中远端腹主动脉球囊阻断技术在术中胎儿射线接触量、总体手术时间、术中出血量和子宫切除率方面优于双侧髂内动脉球囊阻断技术,为临床治疗方式选择提供依据。展开更多
文摘Chronic occlusion of large intracranial arteries is the main cause of ischemic stroke in China.Patients with symptomatic intracranial artery occlusion and hemodynamic impairment are at high risk of recurrent stroke.Chronic occlusion of the intracranial segment of the internal carotid artery is a common type of intracranial artery occlusion.Medical management is regarded as the standard treatment for this disease.With the development of endovascular treatment,some patients with chronic cerebral artery occlusion have achieved satisfactory results with endovascular therapy.We reported a patient with symptomatic chronic occlusion of the ophthalmic segment of the internal carotid artery.Simple balloon angioplasty was performed,and the occluded ophthalmic segment of the internal carotid artery was successfully recanalized without perioperative complications.At 4 months followup,the internal carotid artery remained patent and perfusion of the right cerebral hemisphere improved dramatically.In addition,we briefly reviewed the relevant literature.
基金This work was supported by the National Natural Science Foundation of China(grant no.81471767,81871464).
文摘Background:The development of carotid-cavernous fistulas(CCFs)during surgical recanalization of chronic internal carotid artery occlusion(ICAO)may be secondary to severe ICA dissection rather than a focal tear of the cavernous ICA seen in typical traumatic CCFs.The purpose of this study is to investigate the causal relationship between the CCFs and severe ICA dissections and to characterize technical outcomes after treatment with stenting.Methods:Five patients underwent treatment with self-expanding stents due to intraprocedural CCF and ICA dissection following surgical removal of ICAO plaque.The stents were telescopically placed via true channel of the dissection.Safety of the procedure was evaluated with 30-day stroke and death rate.Procedural success was determined by the efficacy of CCF obliteration and ICAO recanalization with angiography.Results:All CCFs were associated with spiral and long segmental dissection from the cervical to cavernous ICA.After stenting,successful dissection reconstruction with TICI 3 was achieved in all patients,with complete(n=4)or partial CCF(n=1)obliteration.No patient had CCF syndrome,stroke,or death during follow-up of 6 to 37 months;but one patient had pulsatile tinnitus,which resolved 1 year later.Angiography at 6 to 24 months demonstrated CCF obliteration in all 5 patients and durable ICA patency in 4 patients.Conclusions:Intraprocedural CCFs with spiral and cervical-to-cavernous ICA dissection during ICAO surgery are dissection-related because of successful obliteration after stenting for dissection reconstruction.Self-expanding stenting through true channel of the dissection,serving as implanting stent-autograft,may be an optimal therapy for the atypical CCF complication from ICAO surgery.
文摘目的:探讨髂内动脉球囊预置阻断术在植入型凶险性前置胎盘中的临床价值。方法:选取2021年7月—2024年1月阳江市人民医院收治的60例植入型凶险性前置胎盘患者。根据随机数表法将其分为对照组与观察组,各30例。两组均行剖宫产,对照组应用常规止血措施,观察组应用双侧髂内动脉球囊预置术。比较两组围手术期指标、新生儿情况、子宫切除率、并发症。结果:观察组术中出血量少于对照组,手术时间与住院时间均短于对照组,差异有统计学意义(P<0.05)。两组新生儿出生1 min、5 min、10 min Apgar评分比较,差异无统计学意义(P>0.05)。观察组子宫切除率、并发症发生率均低于对照组,差异有统计学意义(P<0.05)。结论:双侧髂内动脉球囊预置术应用于植入型凶险性前置胎盘患者中效果显著,能够减少产妇术中出血量,降低大出血风险,缩短手术时间和住院时间,降低患者子宫切除率与术后并发症发生率。
文摘目的采用meta分析方法对比远端腹主动脉球囊阻断和双侧髂内动脉球囊阻断在辅助凶险型前置胎盘(PPP)患者剖宫产术的安全性和有效性。方法计算机系统检索中国知网、万方和维普数据库并手工检索PPP预置球囊阻断治疗相关文献,检索时限均自建库至2018年8月30日。由2名独立评价者对纳入文献进行质量评价,采用Review Manager 5.0 for Mac软件进行meta分析。结果共有11篇文献纳入分析,结果显示腹主动脉球囊阻断组患者在术中胎儿射线接触量、手术时间、术中出血量、子宫切除率方面优于双侧髂总动脉球囊阻断组,OR(95%CI)分别为-2.57(-2.85^-2.29)、-13.28(-16.56^-10.00)、-0.35(-0.53^-0.17)、0.70(0.50~0.78),P值均<0.05。结论PPP患者剖宫产术中远端腹主动脉球囊阻断技术在术中胎儿射线接触量、总体手术时间、术中出血量和子宫切除率方面优于双侧髂内动脉球囊阻断技术,为临床治疗方式选择提供依据。
