To describe the successful endovascular treatment in a nonagenarian with symptomatic internal carotid artery stenosis using direct carotid artery access. An independent 98 year-old man was admitted to our hospital for...To describe the successful endovascular treatment in a nonagenarian with symptomatic internal carotid artery stenosis using direct carotid artery access. An independent 98 year-old man was admitted to our hospital for symptoms of progressive weakness with disorientation and dysphasia. Carotid Duplex ultrasonography was performed which revealed a totally occluded right internal carotid artery and high grade stenosis of the left internal carotid artery by velocities of 608/240 cm/sec. The patient refused surgical endarterectomy and thus he was referred for carotid artery stenting. Using the femoral artery approach and multiple catheter techniques, access to the common carotid artery could not be accomplished safely. The procedure was aborted and he was therefore brought back to the catheterization laboratory the following day for direct carotid access. Carotid artery stenting was accomplished by using of a 6F sheath percutaneously in the left common carotid, cerebral protection device (CPD) and a Nitinol stent. The patient was discharged the following day without complications. At 14 months follow-up the patient is functional and independent without recurrence of symptoms. Carotid artery stenting via direct access can be accomplished in patients when the femoral artery approach is anatomically prohibitive. In this case of advanced age and the patient’s refusal for surgery, direct carotid access was his only option.展开更多
Carotid artery stenting (CAS) is an alternative treatment for patients with severe carotid artery stenosis, especially those with prohibitively high surgical risks.……
BACKGROUND Cerebral infarction is an extremely rare postoperative complication of anterior cervical discectomy and fusion(ACDF),particularly in the delayed setting.We present a case who had a sudden stroke on day 18 a...BACKGROUND Cerebral infarction is an extremely rare postoperative complication of anterior cervical discectomy and fusion(ACDF),particularly in the delayed setting.We present a case who had a sudden stroke on day 18 after surgery.By sharing our experience with this case,we hope to provide new information about stroke after anterior cervical surgery.CASE SUMMARY We present the case of a 61-year-old man with more than 20 years of hypertension and 14 years of coronary heart disease who had suffered a stroke 11 years ago.The patient was admitted for a multiple ACDF due to symptoms of cervical spondylotic myelopathy and had a sudden stroke on day 18 after surgery.Imaging findings showed a large-area infarct of his left cerebral hemisphere and thrombosis in his left common carotid artery.With the consent of his family,the thrombus was removed and a vascular stent was implanted through an interventional operation.Forty days later,the patient was transferred to a rehabilitation hospital for further treatment.He had normal consciousness but slurred speech at the 1-year follow-up evaluation.The motor and sensory functions of his hemiplegic limbs partially recovered.CONCLUSION This case illustrated that a postoperative stroke related to anterior cervical surgery may be attributed to prolonged carotid retraction and might have a long silent period.Preventive measures include careful preoperative and postoperative examination for high-risk patients as well as gentle and intermittent retraction of carotid artery sheath during operation.展开更多
目的探讨与分析颈部血管超声在早期颈内动脉闭塞患者侧支循环判断中的应用效果。方法2018年2月—2022年5月选择在镇巴县人民医院诊治的早期颈内动脉闭塞患者88例作为研究对象,所有患者都给予颈动脉超声检查,记录超声特征。同时所有患者...目的探讨与分析颈部血管超声在早期颈内动脉闭塞患者侧支循环判断中的应用效果。方法2018年2月—2022年5月选择在镇巴县人民医院诊治的早期颈内动脉闭塞患者88例作为研究对象,所有患者都给予颈动脉超声检查,记录超声特征。同时所有患者都给予脑血管数字减影检查,记录侧支循环形成并判断诊断价值。结果在88例患者中,脑血管数字减影判断为侧支循环形成38例(形成组),占43.18%。形成组性别、身体质量指数、收缩压、舒张压病程、性别、空腹血糖等与非形成组对比差异无统计学意义(P>0.05)。形成组颈部血管超声椎动脉与基底动脉血流速度明显高于非形成组(P<0.05)。形成组入院时国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分明显低于非形成组(P<0.05)。在88例患者中,颈部血管超声判断为侧支循环形成36例,Kappa=0.907(P<0.001)。颈部血管超声在早期颈内动脉闭塞患者侧支循环形成诊断的敏感性与特异性为92.11%(35/38)和98.00%(49/50)。结论早期颈内动脉闭塞患者多伴随有侧支循环形成,可改善患者的病情,提高椎动脉与基底动脉血流速度,颈部血管超声在早期颈内动脉闭塞患者侧支循环判断中具有重要价值。展开更多
文摘To describe the successful endovascular treatment in a nonagenarian with symptomatic internal carotid artery stenosis using direct carotid artery access. An independent 98 year-old man was admitted to our hospital for symptoms of progressive weakness with disorientation and dysphasia. Carotid Duplex ultrasonography was performed which revealed a totally occluded right internal carotid artery and high grade stenosis of the left internal carotid artery by velocities of 608/240 cm/sec. The patient refused surgical endarterectomy and thus he was referred for carotid artery stenting. Using the femoral artery approach and multiple catheter techniques, access to the common carotid artery could not be accomplished safely. The procedure was aborted and he was therefore brought back to the catheterization laboratory the following day for direct carotid access. Carotid artery stenting was accomplished by using of a 6F sheath percutaneously in the left common carotid, cerebral protection device (CPD) and a Nitinol stent. The patient was discharged the following day without complications. At 14 months follow-up the patient is functional and independent without recurrence of symptoms. Carotid artery stenting via direct access can be accomplished in patients when the femoral artery approach is anatomically prohibitive. In this case of advanced age and the patient’s refusal for surgery, direct carotid access was his only option.
文摘 Carotid artery stenting (CAS) is an alternative treatment for patients with severe carotid artery stenosis, especially those with prohibitively high surgical risks.……
基金Capital’s Funds for Health Improvement and Research,No.2020-2-4091.
文摘BACKGROUND Cerebral infarction is an extremely rare postoperative complication of anterior cervical discectomy and fusion(ACDF),particularly in the delayed setting.We present a case who had a sudden stroke on day 18 after surgery.By sharing our experience with this case,we hope to provide new information about stroke after anterior cervical surgery.CASE SUMMARY We present the case of a 61-year-old man with more than 20 years of hypertension and 14 years of coronary heart disease who had suffered a stroke 11 years ago.The patient was admitted for a multiple ACDF due to symptoms of cervical spondylotic myelopathy and had a sudden stroke on day 18 after surgery.Imaging findings showed a large-area infarct of his left cerebral hemisphere and thrombosis in his left common carotid artery.With the consent of his family,the thrombus was removed and a vascular stent was implanted through an interventional operation.Forty days later,the patient was transferred to a rehabilitation hospital for further treatment.He had normal consciousness but slurred speech at the 1-year follow-up evaluation.The motor and sensory functions of his hemiplegic limbs partially recovered.CONCLUSION This case illustrated that a postoperative stroke related to anterior cervical surgery may be attributed to prolonged carotid retraction and might have a long silent period.Preventive measures include careful preoperative and postoperative examination for high-risk patients as well as gentle and intermittent retraction of carotid artery sheath during operation.
文摘目的探讨与分析颈部血管超声在早期颈内动脉闭塞患者侧支循环判断中的应用效果。方法2018年2月—2022年5月选择在镇巴县人民医院诊治的早期颈内动脉闭塞患者88例作为研究对象,所有患者都给予颈动脉超声检查,记录超声特征。同时所有患者都给予脑血管数字减影检查,记录侧支循环形成并判断诊断价值。结果在88例患者中,脑血管数字减影判断为侧支循环形成38例(形成组),占43.18%。形成组性别、身体质量指数、收缩压、舒张压病程、性别、空腹血糖等与非形成组对比差异无统计学意义(P>0.05)。形成组颈部血管超声椎动脉与基底动脉血流速度明显高于非形成组(P<0.05)。形成组入院时国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分明显低于非形成组(P<0.05)。在88例患者中,颈部血管超声判断为侧支循环形成36例,Kappa=0.907(P<0.001)。颈部血管超声在早期颈内动脉闭塞患者侧支循环形成诊断的敏感性与特异性为92.11%(35/38)和98.00%(49/50)。结论早期颈内动脉闭塞患者多伴随有侧支循环形成,可改善患者的病情,提高椎动脉与基底动脉血流速度,颈部血管超声在早期颈内动脉闭塞患者侧支循环判断中具有重要价值。
