BACKGROUND Extracorporeal membrane oxygenation(ECMO)is a new type of extracorporeal respiratory and circulatory assistance device.It can drain venous blood out of the body and inject it into veins or arteries after be...BACKGROUND Extracorporeal membrane oxygenation(ECMO)is a new type of extracorporeal respiratory and circulatory assistance device.It can drain venous blood out of the body and inject it into veins or arteries after being oxygenated by an oxygenator(membrane lung)to replace lung and heart functions in a short time.ECMO can provide tissue blood perfusion and gas exchange almost equivalent to cardiac output and extend the effective treatment time window for patients with acute circulatory failure to restore cardiopulmonary function.CASE SUMMARY We report a case of an 81-year-old woman who underwent whole cerebral angiography,basilar artery thrombectomy and stent thrombectomy in the posterior artery of the left brain after implantation of ECMO.The patient was admitted to the hospital due to myocardial infarction.Considering that the cause of the patient’s disturbance of consciousness was unknown and cerebrovascular accident could not be ruled out after the implantation of ECMO,the department of Radioactive Intervention performed cerebral angiography.And the result of the angiography indicated vascular occlusion.After the basilar artery thrombectomy and stent thrombectomy in the posterior artery of the left brain,the patency of the occlusive vessel was achieved.CONCLUSION Although the patient eventually died of circulatory failure,the result of this case verifies the feasibility of cerebral angiography and thrombectomy in patients with implanted ECMO in the intubated state.展开更多
BACKGROUND Mechanical thrombectomy is the most effective treatment for great cerebral artery embolization within a set time window.Typically,an arteriogram does not show the localization of the stent after release and...BACKGROUND Mechanical thrombectomy is the most effective treatment for great cerebral artery embolization within a set time window.Typically,an arteriogram does not show the localization of the stent after release and whether a thrombus is captured or not.Thus,improving the visualization of a stent in interventional therapy will be helpful for clinicians.AIM To analyze stent imaging findings to enhance clinicians’understanding of a special circumstance,wherein a Solitaire AB retrievable stent was visible during the imaging of a thrombus capture that improved the success rate of stent-based mechanical thrombectomy.METHODS This was a retrospective study with four acute ischemic stroke(AIS)patients who underwent stent-based mechanical thrombectomy.RESULTS Patient 1 was a 64-year-old man admitted after 5 h of confusion;angiography revealed basilar artery occlusion.We inserted a stent into the left posterior cerebral artery-P2 segment and visualized the expanded stent that successfully captured a thrombus.Patient 2 was a 74-year-old man admitted with confusion,which lasted approximately 3 h.Angiography revealed a left middle cerebral artery(MCA)-M1 segment occlusion.A stent was deployed in the distal M2 segment,and we could visualize the stent by capturing the thrombus.Patient 3 was a 74-year-old woman admitted after experiencing left hemiplegia for 3 h.We deployed a stent at the distal right MCAM2 segment,and the developing stent captured a large thrombus.Patient 4 was an 82-year-old man who presented with confusion for 3 h.A developing stent was placed in the distal left MCA-M1 segment,which captured a large thrombus and several fragmented thrombi.CONCLUSION To the best of our knowledge,this is the first report of stent imaging in patients with AIS.We demonstrated the usefulness and substantial potential of stent imaging in stent-based mechanical thrombectomy for AIS.展开更多
Introduction: Endovascular treatment is an effective treatment for large vessel occlusive ischemic stroke. The number of Stent Retriever passes is an important link in the strategy of endovascular treatment, and is cl...Introduction: Endovascular treatment is an effective treatment for large vessel occlusive ischemic stroke. The number of Stent Retriever passes is an important link in the strategy of endovascular treatment, and is closely related to the clinical outcome and prognosis of patients with acute ischemic stroke, but there is still a lack of unified understanding. In order to provide reference for clinical practice and related research, this paper reviewed the recent important literatures. Methods: We searched PubMed, Embase, and Cochrane databases, using the terms “stents”, “stroke” and “thrombectomy”. Priority was given to human studies. Only English language papers were accepted. Analyze the articles by title and abstract. Results: The number of Stent Retriever passes is closely related to the rate of recanalization, hemorrhagic transformation, recanalization time, surgical procedures and clinical prognosis. Along with the increase of the number of Stent Retriever passes, the vascular recanculation rate decreased successively, in turn, reduced the rate of blood vessels, 3 times may be the target vascular occlusion which should try the best of times, ≥4 times may not improve the opportunity of recanalization and not conducive to the prognosis, at the same time, increase the risk of HT and related complications occurred. Conclusion: It is necessary to avoid unplanned, additional attempts at EVT. The number of Stent Retriever passes has significant effects on the outcome of EVT of AIS in many aspects. How to better personalized EVT strategy is the focus of future research.展开更多
BACKGROUND Mechanical thrombectomy(MT)has been demonstrated to be useful for the treatment of ischemic stroke in patients with large vessel occlusions.However,recanalization by MT is not recommended for distal vessels...BACKGROUND Mechanical thrombectomy(MT)has been demonstrated to be useful for the treatment of ischemic stroke in patients with large vessel occlusions.However,recanalization by MT is not recommended for distal vessels such as second-order branches of the middle cerebral artery and posterior inferior cerebellar artery(PICA).Because of the small size and tortuosity of these arteries,the risks of using the available endovascular devices outweigh the benefits of treatment.However,MT appears to be effective in patients with primary distal vessel occlusion in eloquent areas,those with a high National Institutes of Health Stroke Scale score,and those ineligible for recombinant tissue plasminogen activator therapy.Here,we report the use of MT for treating acute occlusion of the PICA using a directaspiration first-pass technique(ADAPT).CASE SUMMARY In this case,the patient received acute occlusion of the PICA with ADAPT when right internal carotid artery stenting was performed.CONCLUSION With the introduction of advanced endovascular devices,MT may now be a feasible treatment for acute occlusion of the PICA.展开更多
基金Supported by Joint Projects of the Medical Science and Technology Research Program of Henan Province,No.LHGJ20210255.
文摘BACKGROUND Extracorporeal membrane oxygenation(ECMO)is a new type of extracorporeal respiratory and circulatory assistance device.It can drain venous blood out of the body and inject it into veins or arteries after being oxygenated by an oxygenator(membrane lung)to replace lung and heart functions in a short time.ECMO can provide tissue blood perfusion and gas exchange almost equivalent to cardiac output and extend the effective treatment time window for patients with acute circulatory failure to restore cardiopulmonary function.CASE SUMMARY We report a case of an 81-year-old woman who underwent whole cerebral angiography,basilar artery thrombectomy and stent thrombectomy in the posterior artery of the left brain after implantation of ECMO.The patient was admitted to the hospital due to myocardial infarction.Considering that the cause of the patient’s disturbance of consciousness was unknown and cerebrovascular accident could not be ruled out after the implantation of ECMO,the department of Radioactive Intervention performed cerebral angiography.And the result of the angiography indicated vascular occlusion.After the basilar artery thrombectomy and stent thrombectomy in the posterior artery of the left brain,the patency of the occlusive vessel was achieved.CONCLUSION Although the patient eventually died of circulatory failure,the result of this case verifies the feasibility of cerebral angiography and thrombectomy in patients with implanted ECMO in the intubated state.
基金The Clinical Research Project of The First Affiliated Hospital of Shenzhen University,No.20223357030 and No.20223357021the“Double-First Class”Application Characteristic Discipline of Hunan Province(Pharmaceutical Science).
文摘BACKGROUND Mechanical thrombectomy is the most effective treatment for great cerebral artery embolization within a set time window.Typically,an arteriogram does not show the localization of the stent after release and whether a thrombus is captured or not.Thus,improving the visualization of a stent in interventional therapy will be helpful for clinicians.AIM To analyze stent imaging findings to enhance clinicians’understanding of a special circumstance,wherein a Solitaire AB retrievable stent was visible during the imaging of a thrombus capture that improved the success rate of stent-based mechanical thrombectomy.METHODS This was a retrospective study with four acute ischemic stroke(AIS)patients who underwent stent-based mechanical thrombectomy.RESULTS Patient 1 was a 64-year-old man admitted after 5 h of confusion;angiography revealed basilar artery occlusion.We inserted a stent into the left posterior cerebral artery-P2 segment and visualized the expanded stent that successfully captured a thrombus.Patient 2 was a 74-year-old man admitted with confusion,which lasted approximately 3 h.Angiography revealed a left middle cerebral artery(MCA)-M1 segment occlusion.A stent was deployed in the distal M2 segment,and we could visualize the stent by capturing the thrombus.Patient 3 was a 74-year-old woman admitted after experiencing left hemiplegia for 3 h.We deployed a stent at the distal right MCAM2 segment,and the developing stent captured a large thrombus.Patient 4 was an 82-year-old man who presented with confusion for 3 h.A developing stent was placed in the distal left MCA-M1 segment,which captured a large thrombus and several fragmented thrombi.CONCLUSION To the best of our knowledge,this is the first report of stent imaging in patients with AIS.We demonstrated the usefulness and substantial potential of stent imaging in stent-based mechanical thrombectomy for AIS.
文摘Introduction: Endovascular treatment is an effective treatment for large vessel occlusive ischemic stroke. The number of Stent Retriever passes is an important link in the strategy of endovascular treatment, and is closely related to the clinical outcome and prognosis of patients with acute ischemic stroke, but there is still a lack of unified understanding. In order to provide reference for clinical practice and related research, this paper reviewed the recent important literatures. Methods: We searched PubMed, Embase, and Cochrane databases, using the terms “stents”, “stroke” and “thrombectomy”. Priority was given to human studies. Only English language papers were accepted. Analyze the articles by title and abstract. Results: The number of Stent Retriever passes is closely related to the rate of recanalization, hemorrhagic transformation, recanalization time, surgical procedures and clinical prognosis. Along with the increase of the number of Stent Retriever passes, the vascular recanculation rate decreased successively, in turn, reduced the rate of blood vessels, 3 times may be the target vascular occlusion which should try the best of times, ≥4 times may not improve the opportunity of recanalization and not conducive to the prognosis, at the same time, increase the risk of HT and related complications occurred. Conclusion: It is necessary to avoid unplanned, additional attempts at EVT. The number of Stent Retriever passes has significant effects on the outcome of EVT of AIS in many aspects. How to better personalized EVT strategy is the focus of future research.
基金Youth Innovation Project of Medical Research in Sichuan Province,No.Q18012.
文摘BACKGROUND Mechanical thrombectomy(MT)has been demonstrated to be useful for the treatment of ischemic stroke in patients with large vessel occlusions.However,recanalization by MT is not recommended for distal vessels such as second-order branches of the middle cerebral artery and posterior inferior cerebellar artery(PICA).Because of the small size and tortuosity of these arteries,the risks of using the available endovascular devices outweigh the benefits of treatment.However,MT appears to be effective in patients with primary distal vessel occlusion in eloquent areas,those with a high National Institutes of Health Stroke Scale score,and those ineligible for recombinant tissue plasminogen activator therapy.Here,we report the use of MT for treating acute occlusion of the PICA using a directaspiration first-pass technique(ADAPT).CASE SUMMARY In this case,the patient received acute occlusion of the PICA with ADAPT when right internal carotid artery stenting was performed.CONCLUSION With the introduction of advanced endovascular devices,MT may now be a feasible treatment for acute occlusion of the PICA.
