Intra-arterial thrombolysis for early hepatic artery thrombosis after liver transplantation

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.

Different effects of mechanical embolus removal and intra-arterial thrombolysis on neural functional recovery in patients with acute middle cerebral artery occlusion

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.

Neoadjuvant intra-arterial infusion chemotherapy followed by surgery in patients with locally advanced cervical cancer

Objective： The aim of this study was to investigate the role of preoperative neoadjuvant intra-arterial infusion chemotherapy （NAIC） in treating locally advanced cervical caner. Methods： Nineteen locally advanced cervical cancer （LACC） patients from November 2003 to November 2005 were analyzed retrospectively. NAIC was administrated 2 courses every 2 weeks using a combination of 30 mg/m^2 bleomycin and 50 mg/m^2 cisplatin via bilateral femur artedes. The response to NAIC was assessed by pelvic examination and imaging diagnostics and histological analysis. Two weeks after NAIC radical hysterectomy with pelvic lymphadenectomy was performed. Results： Radical hysterectomy with pelvic lymphadenectomy were performed in 18 patients successfully. The mean tumor reduction rate was 73.04%. The overall clinical response rate of NAIC was 84.2% with 2 complete responses and 16 partial responses. Only 1 nonresponder. Six of 7 cases who had parametrial infiltration had a absence after chemotherapy, no significant change was observed in 1 case who followed by radiotherapy. Multivariate logistic regression analysis indicated that tumor volume prior to treatment was determining factor affecting the efficacy of NAIC in LACC. Conclusion： pre-operative NAIC inhibited the growth of LACC, minimized the size, eliminate effectively the pathologic dsk factors in the pelvic cavity, to improve the operability in cervical cancer patients with stage lib or above, considered inoperable.

Effect of local massage on prevention and treatment of intra-arterial polymethyl methacrylate embolism complications:An experimental animal study

Background:Massage is generally believed to be a simple and effective method for preventing necrosis when intravascular injection emboli are suspected.Due to its good dispersive properties,polymethyl methacrylate(PMMA)was used as the test filler.The main purpose of this study was to observe whether local massage as a simple remedial measure can promote the diffusion of filler and reduce the necrosis rate for intra-arterial embolism.Methods:Rabbit ears with the central ear artery(CEA)main trunk totally or segmentally obstructed 5 min after PMMA injection were studied.In order to simulate the massage effect of the fingers,the massage group was treated with a small beauty massage bar with a fixed vibration frequency along the direction of the blood flow.CEA blood flow and skin lesions were also analyzed.Results:The baseline data were similar between the control and massage groups.Compared to the control group,the recanalization rate of the CEA trunk in the treatment group increased significantly after massage.However,there was no significant difference in the visible rate of transparent embolus on the 1st day after treatment,nor in the necrosis degree or area of soft tissue damage on the 7th day after treatment.Further analysis showed that massage tended to have a positive effect on segmentally obstructed cases at 5 min after injection but a negative effect on totally obstructed ears at 5 min.Conclusion:Local massage cannot reduce the complications of tissue necrosis after intra-arterial PMMA injection.Prevention is key to reducing complications.

A hybrid technique： intra-arterial catheter-directed thrombolysis following the recanalization of superior mesenteric artery in acute mesenteric ischemia

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,

Localized Administration of Tissue Plasminogen Activator through the Ophthalmic Artery in the Setting of Central Retinal Artery Occlusion

Treatment of central retinal artery occlusion (CRAO) has been an ambiguous entity in the medical community. Many interventions have been explored;however, a standard of care has yet to be defined. Recent studies have suggested localized intra-arterial fibrinolysis as a promising method;however, a timeframe for optimal treatment initiation continues to be investigated. This case demonstrates an instance of CRAO treated with local fibrinolysis, however, what could be due to delayed time-to-treat, final visual outcomes were unfavorable. In conjunction with supporting literature, we believe optimization of thrombolytic protocols should be sought after to facilitate successful treatment outcomes. In addition, we encourage community awareness of the signs and symptoms of CRAO in hopes that earlier patient presentations will lead to swifter interventions and overall preservation of ocular function.

急性肺栓塞患者静脉溶栓与导管碎栓取栓联合局部溶栓117例的临床观察

目的分析静脉溶栓和导管碎栓取栓联合局部溶栓2种方法治疗急性肺栓塞（PE）患者的有效性和安全性。方法回顾性分析2005—01～2011—10我院住院收治的117例急性PE患者经静脉溶栓和导管碎栓取栓联合局部溶栓2种方法的临床资料，综合判断溶栓疗效和安全性。结果静脉溶栓组和导管碎栓取栓联合局部溶栓组的住院总有效率分别为89．2％、96．9％，其中住院显效＋好转率分别为42．8％、90．9％；住院病死率分别为3．5％、0；较大出血率分别为3．6％、0，无颅内出血发生。结论静脉溶栓和导管碎栓取栓联合局部溶栓2种方法治疗急性PE均有效，治疗应个体化。

周围动脉急慢性闭塞疾病的综合介入治疗

目的:探讨血管内局部溶栓,血栓碎吸,经皮血管成形(percutaneous transcatheter angioplasty,PTA)和内支架置入,联合治疗急慢性动脉闭塞性疾病的临床效果和应用价值。方法:周围动脉阻塞接受了介入治疗共259例。急性动脉血栓性闭塞58例,局部溶栓+血栓碎吸;动脉狭窄合并急性血栓闭塞61例,局部溶栓+PTA;慢性动脉狭窄阻塞140例,局部溶栓+PTA+内支架置入。结果:全组总的介入治疗成功率98.8%(256/259)。局部溶栓+血栓碎吸成功率100%(58/58),血管完全开通91.4%(53/58),部分开通8.6%(5/58)。局部溶栓+PTA治疗成功率85.2%(52/61),9例辅以内支架置入治疗获得成功;PTA+内支架置入治疗成功率97.8%(137/140)。并发症发生率7.7%(20/259),局部溶栓+血栓碎吸8.6%(5/58),局部溶栓+PTA14.8%(9/61),PTA+内支架置入4.2%(6/140)。结论:经皮经腔综合介入治疗周围动脉急慢性闭塞疾病是安全有效的方法。恰当选用局部溶栓、血栓碎吸、PTA和内支架置入技术并个体化有机地组合应用,可显著提高成功率和疗效并减少并发症发生。

尿激酶介入性治疗急性脑血栓的应用研究

目的:应用尿激酶超选择性脑动脉内灌注治疗急性脑血栓,评价溶栓效果,观察溶栓价值,确定溶栓法的最佳时间窗和适应证。材料与方法:设研究组30例,应用尿激酶20～40万 U,插管脑动脑内灌注溶栓,对照组30例中应用尿激酶20～40万 U 静脉滴注25例,颈动脉穿刺注入尿激酶5例。两组均应用综合治疗。结果:研究组基本治愈21例,显效5例,有效2例,无效2例。对照组基本治愈6例,有效8例,显效8例,无效6例。结论:动脉溶栓明显优于静脉溶栓治疗,超选择插管溶栓优于颈动脉穿刺溶栓。

超选择性动脉溶栓并术后局部亚低温对急性脑梗死患者血清NSE和S-100蛋白的影响

目的探讨超选择性动脉溶栓并术后局部亚低温治疗急性脑梗死的临床疗效及其对血清NSE和S-100蛋白的影响。方法选取具备溶栓指征的急性脑梗死患者120例，随机分为观察组与对照组，每组各60例。对照组予以尿激酶静脉溶栓，观察组予以超选择性动脉溶栓并术后局部亚低温治疗。于溶栓前后不同时点比较NIHSS评分及血清NSE和S-100蛋白含量，比较两组血管再通及临床疗效。结果溶栓后两组血清NSE均逐渐降低（t观察组=5．46—7．10，P〈0．01；t对照组=3．52～5．71，P〈0．05或P〈0．01），且观察组血清NSE均低于对照组相应时点（t=3．23～4．12，P〈0．05）。对照组溶栓前～溶栓后第1天、第3—7天血清S-100蛋白含量变化有统计学意义（t=3．41、4．50，P〈0．05）；观察组血清S-100蛋白含量逐渐降低（t=3，40—5．52，P〈0．05或P〈0．01），溶栓后第7、14天均低于对照组（t=3．79、4．83，P〈0．05）。溶栓后30min观察组与对照组NIHSS评分均显著降低（t观察组=6．83，t对照组=5．92，P〈0．01）；溶栓后各时点观察组NIHSS评分均低于对照组相应时点（t=3．81～6．77，P〈0．05或P〈0．01）。观察组与对照组血管再通率分别为88．33％、73．33％，临床总有效率分别为93．33％、78．33％，差异均有统计学意义（x^2=4．21，P〈0．05）。结论超选择性动脉溶栓并术后局部亚低温治疗急性脑梗死具有较好的临床疗效，溶栓后血管再通率较高，术后患者神经损伤恢复较快，血清NSE和S-100蛋白含量快速降低，效果显著优于单纯静脉溶栓。

急性脑梗塞的动物实验及临床应用研究

目的 通过建立脑梗塞动物模型 ,为介入溶栓治疗提供可靠依据。方法 对 10只杂种犬进行常温和加温到 5 0℃后自体血凝块注入致急性脑梗塞形成 ,经导管脑动脉灌注溶栓 ,观察血管狭窄、阻塞和再通的情况。结果 常温自体血凝块组 ,1～ 4h血管再通率为 91%。 6～ 12h溶栓占 89% ,12～ 2 4h溶栓为 76 % ,总复通率占 86 %。加温至5 0℃组 ,1～ 4h溶栓血管再通率为 31.5 %。 6～ 12h溶栓占 2 0 % ,12～ 2 4h溶栓为 5 % ,总复通率 5 3.6 %。结论 常温自体血凝块组溶栓后血管再通率高。 6h之内溶栓速度快 。

急性肺动脉血栓栓塞症局部溶栓与静脉溶栓的比较研究

目的 :研究经皮导管肺动脉局部溶栓和外周静脉给药溶栓两种溶栓方式在急性肺栓塞治疗中的作用。方法 :急性肺栓塞 3 6例患者分别予经皮导管肺动脉局部溶栓 (局部溶栓组 )和经外周静脉给药溶栓 (静脉溶栓组 ) ,溶栓前和溶栓后 48小时测动脉血气和肺血管造影。结果 :两组治疗后动脉氧分压 (PaO2 )均增加 ,肺泡动脉氧分压差 (AaDO2 )均降低 ,与治疗前相比差异非常显著 (P <0 0 1)。局部溶栓组PaO2 上升幅度高于静脉溶栓组 ,但差异无显著性。局部溶栓组肺动脉造影血管阻塞改善率较静脉溶栓组高 ( 82 4%和 66 7% ) ,但差异无显著性。结论 :溶栓治疗有效 ,局部溶栓与静脉溶栓效果相似。

局部溶栓加抗凝对急性肺栓塞性肺高压的疗效观察

目的 研究经导管肺动脉局部溶栓加抗凝治疗在急性肺栓塞性肺动脉高压的作用。方法 2 0只小猪自体血栓注入建立急性肺栓塞性肺动脉高压模型。随机分2组,经导管肺动脉局部溶栓加抗凝(A组10只)、局部溶栓不加抗凝(B组10只)。溶栓前、溶栓后2h测肺动脉收缩压(SPAP)、股动脉收缩血压(SABP)、心率(HR)、心输出量(CI)、血气分析(PaO2 、PaCO2 、pH)、纤溶酶 抗纤溶酶复合物(PAP)、DD二聚体(DD)、一氧化氮(NO)。结果 两组SPAP、CI、PaO2 、PaCO2 、PAP、DD、NO均较治疗前有显著变化(P <0 0 5 ) ,A组的SPAP、PAP的变化较B组的变化更显著(P <0 .0 5 )。结论 肺栓塞治疗中,局部溶栓加抗凝的疗效优于单纯局部溶栓。

下肢深静脉血栓介入治疗局部肝素化的疗效

目的观察下肢深静脉血栓介入治疗局部肝素化的治疗效果。方法选取本院收治的单侧下肢深静脉血栓患者30例,给予腘静脉介入导管溶栓治疗。经腘静脉置入溶栓导管和血管鞘,持续给予微量尿激酶和肝素,采溶栓导管及手臂静脉血检测凝血功能。结果患者不同时段全身与局部的活化部分凝血活酶值存在较大差异(P <0.05)。30日后随访患者疼痛以及肿胀均有显著好转。结论检测局部肝素化对治疗静脉血栓有显著的疗效,同时又可以降低抗凝并发症的发生率。

超声局部介入治疗下肢深静脉血栓效果观察

目的探讨和观察超声影像在局部溶栓介入治疗下肢深静脉血栓的应用效果。方法选择2018年2月-2019年2月在我院诊疗的48例行局部溶栓介入治疗下肢深静脉血栓患者作为研究对象,所有患者均采取局部插管溶栓治疗,并通过超声影像引导,使用微泵向导管中无间断注入尿激酶,然后在24 h之后对患者行超声监测。结果通过超声影像定位,穿刺针均较为顺利的进入到患者的腘静脉,一次穿刺成功率为100%;通过超声引导,所有溶栓导管均置入指定位置,超声引导均获得成功,超声引导成功率为100.00%;术后46例患者痊愈,2例好转,治愈率达95.83%,总有效率可达100.00%。结论超声影像可在局部溶栓介入治疗下肢深静脉血栓过程中得到有效应用,应用价值良好。

局部溶栓联合贝前列素治疗肺栓塞合并肺动脉高压症

目的 探析局部溶栓联合贝前列素对肺栓塞合并肺动脉高压患者的疗效及出血风险。方法 选择我院2011年4月～2015年4月收治的103例肺栓塞合并肺动脉高压患者作为研究对象,随机数字表法分为观察组（n=52）与对照组（n=51）。对照组采取全身溶栓联合贝前列素进行治疗,观察组采取局部溶栓联合贝前列素进行治疗,比较两组治疗有效率、治疗前后D二聚体（D-D）与一氧化氮（NO）的变化及并发症发生率。结果 观察组治疗总有效率为96.2%（50/52）,对照组为84.3%（43/51）,观察组明显更高,差异有统计学意义（P〈0.05）。两组治疗前D-D与NO的差异无统计学意义（P〉0.05）,治疗后两组的D-D与NO水平均获得改善,组内前后差异均有统计学意义（P〈0.05）,同时观察组治疗后的D-D与NO水平均低于对照组,组间差异有统计学意义（P〈0.05）,提示观察组D-D与NO指标改善幅度更大。两组并发症均以心率失常、胸腔积液、出血为主,其中观察组为7.6%（4/52）,对照组为23.5%（12/51）,其中两组心律失常与胸腔积液发生率接近,但观察组出血发生率低于对照组,差异有统计学意义（P〈0.05）。结论 局部溶栓联合贝前列素为肺栓塞合并肺动脉高压患者的有效治疗方案,疗效满意,且安全性高。

Solitaire支架半释放保护技术联合局部溶栓治疗重型颅内静脉窦血栓形成临床研究

目的:探索Solitaire支架半释放保护(Solitaire stent-retriever half-release protection,SHARP)技术联合局部溶栓治疗重型颅内静脉窦血栓形成(Cerebral venous sinus thrombosis,CVST)临床价值。方法:整理我院2016年4月至2020年4月收治的143例重型CVST患者的临床资料,按照其治疗方案,将接受抗凝+局部溶栓治疗的74例患者纳入对照组,将接受抗凝+局部溶栓+SHARP技术取栓治疗的69例患者纳入研究组。对比两组患者溶栓治疗时间、住院时间、血管再通情况、并发症发生情况,以及治疗前后Glasgow昏迷量表(Glasgow coma scale,GCS)、Glasgow结局量表(Glasgow outcome scale,GOS)、改良Rankin量表(Modified rankin scale,mRS)评分,凝血纤溶功能变化,并根据治疗后6个月mRS评分评价患者预后。结果:研究组溶栓治疗时间低于对照组,差异有统计学意义(P<0.05)。研究组血管再通率为95.65%,高于对照组的77.03%,差异有统计学意义(P<0.05)。研究组并发症发生率为4.35%,对照组并发症发生率为18.92%,研究组并发症发生率低于对照组,差异有统计学意义(P=0.007)。两组出院前1d GCS评分、GOS评分均较治疗前升高,mRS评分均较治疗前下降;研究组出院前1d GCS评分、GOS评分升高值均高于对照组,其mRS评分降低值大于对照组,差异有统计学意义(P<0.05)。两组出院前1d APTT、PT、TT均较治疗前升高,FIB、D-D较治疗前下降;研究组出院前1d APTT、PT、TT升高值均高于对照组,其FIB、D-D降低值均大于对照组,差异有统计学意义(P<0.05)。两组患者均获得有效随访。术后6个月,研究组预后良好率为65.22%,高于对照组的32.43%,差异有统计学意义(P=0.001)。结论:在抗凝及局部溶栓的基础上,联合SHARP技术治疗重型CVST能够缩短溶栓时间、提高血管再通率、降低并发症发生率并改善患者预后。

Successful recanalization with multimodality endovascular interventional therapy in acute ischemic stroke

Stroke is an important cause of death and disability in adults. However, effective treatments for patients with acute ischemic stroke are limited. Intravenous recombinant tissue plasminogen activator(iv rtPA) within 4.5 h after onset has been approved as a standard treatment for patients with acute ischemic stroke. However, due to time constraints, less than one percent of acute ischemic stroke patients in Thailand are able to obtain iv rtPA. Although endovascular interventional therapy has not yet been approved as standard treatment in acute ischemic stroke, it is the one of the potentially effective treatment options. There are several reliable methods of endovascular therapy for acute ischemic stroke patients. Endovascular interventional therapy has rarely been done in Thailand. We report seven patients with successful recanalization after endovascular treatment in acute large vessel stroke from a single stroke center in Thailand. Patient screening and selection with multimodal imaging protocol and multimodality methods of endovascular interventional therapy are described.

单纯抗凝与局部溶栓联合抗凝治疗下肢深静脉血栓形成的疗效比较

目的比较局部溶栓加抗凝治疗与单纯抗凝治疗对中央型下肢深静脉血栓形成(急性期)的疗效。方法选取中央型下肢深静脉血栓形成(急性期)患者40例。按照治疗方法均分为局部溶栓加抗凝组(A组,n=20)和单纯抗凝组(B组,n=20)。比较2组疼痛消失时间、肿胀消失时间、住院时间及总有效率。结果局部溶栓加抗凝治疗方法具有平均起效时间快、疗程短等优点,总有效率优于单纯抗凝组,差异有统计学意义(P<0.05)。结论局部溶栓加抗凝治疗方法优于单纯抗凝治疗,值得临床推广应用。

循证护理在局部尿激酶溶栓术治疗动静脉内瘘血栓护理中的应用

[目的]分析局部尿激酶溶栓术治疗动静脉内瘘病人应用循证护理进行干预的效果。[方法]将60例接受局部尿激酶溶栓治疗的病人采用随机数字表法分为对照组和观察组,对照组采用常规护理,观察组采用循证护理,比较两组病人干预前、干预后14 d凝血功能、肝功能、血流动力学参数及不良反应发生率的差异。[结果]干预后观察组病人凝血功能、肝功能、血流动力学参数均优于对照组,不良结局发生率低于对照组,经比较差异均有统计学意义(P<0.05)。[结论]在局部尿激酶溶栓术治疗动静脉内瘘血栓护理中应用循证护理可有效维持凝血功能的稳定,保护肝功能,降低血栓和不良反应发生率。