Vertebral artery orifice stenting may improve blood supply of the posterior circulation of the brain to regions such as the cerebellum and brainstem. However, previous studies have mainly focused on recovery of cerebr...Vertebral artery orifice stenting may improve blood supply of the posterior circulation of the brain to regions such as the cerebellum and brainstem. However, previous studies have mainly focused on recovery of cerebral blood flow and perfusion in the posterior circulation after interventional therapy. This study examined the effects of functional recovery of local brain tissue on cerebellar function remodeling using blood oxygen level-dependent functional magnetic reso- nance imaging before and after interventional therapy. A total of 40 Chinese patients with severe unilateral vertebral artery orifice stenosis were enrolled in this study. Patients were equally and randomly assigned to intervention and control groups. The control group received drug treat- ment only. The intervention group received vertebral artery orifice angioplasty and stenting ＋ identical drug treatment to the control group. At 13 days after treatment, the Dizziness Handicap Inventory score was compared between the intervention and control groups. Cerebellar function remodeling was observed between the two groups using blood oxygen level-dependent functional magnetic resonance imaging. The improvement in dizziness handicap and cerebellar function was more obvious in the intervention group than in the control group. Interventional therapy for severe vertebral artery orifice stenosis may effectively promote cerebellar function remodeling and exert neuroprotective effects.展开更多
BACKGROUND Hepatic artery stenosis is a complication of orthotopic liver transplant occurring in 3.1%-7.4%of patients that can result in graft failure and need for retransplantation.Endovascular therapy with angioplas...BACKGROUND Hepatic artery stenosis is a complication of orthotopic liver transplant occurring in 3.1%-7.4%of patients that can result in graft failure and need for retransplantation.Endovascular therapy with angioplasty and stenting has been used with a high degree of technical success and good clinical outcomes,but tortuous hepatic arteries present a unique challenge for intervention.Suitable stents for this application should be maneuverable and conformable while also exerting adequate radial force to maintain a patent lumen.CASE SUMMARY Herein we report our experience with a neurovascular Wingspan stent system in a challenging case of recurrent hepatic artery stenosis and discuss the literature of stenting in tortuous transplant hepatic arteries.CONCLUSION Wingspan neurovascular stent is self-expanding,has good conformability,and adequate radial resistance and as such it could be added to the armamentarium of interventionalists in the setting of a tortuous and stenotic transplant hepatic artery.展开更多
Vertebral artery dissection is a rare pathology that can cause ischemic stroke in young people.Cervical massage,especially improper pulling manipulation,is a cause of vertebral artery dissection.We present a case of 3...Vertebral artery dissection is a rare pathology that can cause ischemic stroke in young people.Cervical massage,especially improper pulling manipulation,is a cause of vertebral artery dissection.We present a case of 32-year old woman who developed acute multiple posterior circulation ischemic cerebral infarctions as a result of left vertebral artery V4 segment dissection after receiving neck massage.She underwent emergency vertebral artery stent implantation at the site of the dissection.Symptoms were relieved the day after treatment.The patient recovered without adverse complications or endovascular restenosis in the following year.展开更多
Percutaneous angioplasty and stenting for the treatment of extracranial vertebral artery(VA) stenosis seems a safe,effective and useful technique for resolving symptoms and improving blood flow to the posterior circul...Percutaneous angioplasty and stenting for the treatment of extracranial vertebral artery(VA) stenosis seems a safe,effective and useful technique for resolving symptoms and improving blood flow to the posterior circulation,with a low complication rate and good long-term results.In patients with severe tortuosity of the vessel,stent placement is a real challenge.The new coronary balloon-expandable stents may be preferred.A large variability of restenosis rates has been reported.Drug-eluting stents may be the solution.After a comprehensive review of the literature,it can be concluded that percutaneous angioplasty and stenting of extracranial VA stenosis is technically feasible,but there is insufficient evidence from randomized trials to demonstrate that endovascular management is superior to best medical management.展开更多
Cervical and intracranial angioplasty and stenting is an effective and safe method of reducing the risk of ischemic stroke, but it may be affected by in-stent restenosis. The present study in-vestigated serum level of...Cervical and intracranial angioplasty and stenting is an effective and safe method of reducing the risk of ischemic stroke, but it may be affected by in-stent restenosis. The present study in-vestigated serum level of matrix metalloproteinase 9 as a predictor of restenosis after 40 patients underwent cervical and/or intracranial angioplasty and stenting. Results showed that resteno-sis occurred in 30% （3/10） of patients when the serum level of matrix metalloproteinase 9 at 3 days after surgery was 2.5 times higher than preoperative level. No restenosis occurred when the serum level of matrix metalloproteinase 9 at 3 days after surgery was not 2.5 times higher than preoperative level. Restenosis occurred in 12% （2/17） of patients when the serum level of matrix metalloproteinase 9 was higher than preoperative level for more than 30 days after surgery, but only occurred in 4% （1/23） of patients when the serum level of matrix metalloproteinase 9 was higher than preoperative level for less than 30 days after surgery. However, the differences observed were not statistically signiifcant （P 〉 0.05）. Experimental ifndings indicate that when the serum level of matrix metalloproteinase 9 is 2.5 times higher than preoperative level at 3 days after cervi-cal and intracranial angioplasty and stenting, it may serve as a predictor of in-stent restenosis.展开更多
Two cases with a pancreaticoduodenal arterial aneurysm accompanied with superior mesenteric artery(SMA) stenosis were previously described and both were treated surgically.However,for interventional treatment,securing...Two cases with a pancreaticoduodenal arterial aneurysm accompanied with superior mesenteric artery(SMA) stenosis were previously described and both were treated surgically.However,for interventional treatment,securing a sufficient blood supply to the SMA should be a priority of treatment.We present the case of a 71-year-old male with a 20 mm diameter pancreaticoduodenal arterial aneurysm accompanied by SMA stenosis at its origin.The guidewire traverse from SMA to the aneurysm was difficult because of the tight SMA stenosis;however,the guidewire traverse from the celiac artery was finally successful and was followed by balloon angioplasty using a pull-through technique,leading to stent placement.Thereafter,coil packing through the SMA achieved eradication of the aneurysm without bowel ischemia.At the last follow-up computed tomography 8 mo later,no recurrence of the aneurysm was confirmed.The pull-through technique was useful for angioplasty for tight SMA stenosis in this case.展开更多
BACKGROUND Fishbone is the most common esophageal foreign body and tends to migrate after piercing the esophagus to nearby structures.Vascular injury around the esophagus is a serious complication and has a high morta...BACKGROUND Fishbone is the most common esophageal foreign body and tends to migrate after piercing the esophagus to nearby structures.Vascular injury around the esophagus is a serious complication and has a high mortality rate,especially in the case of multiple vascular injuries.CASE SUMMARY We report an extremely rare case of successive vertebral artery and subclavian artery pseudoaneurysms caused by swallowing a fishbone in a previously healthy 29-year-old female.She was transferred to the emergency department of our hospital because of hemorrhagic shock due to a vertebral artery pseudoaneurysm.We successfully managed the vertebral artery pseudoaneurysm with endovascular stent implantation and the patient's vital signs as well as hemodynamics once became stable.However,the patient died of the second subclavian artery pseudoaneurysm occurring within a short time,which was thought be related to the obvious displacement of the fishbone in the mediastinum.CONCLUSION Surgery and endovascular stent implantation may be the best choice for treating such complications.Early removal of the fishbone is of great significance in improving the survival of such patients.展开更多
Stent implantation in acute myocardial infarction(AMI)has been shown to improvethe acute angiographic outcomes.So far few data on long-term angiographic follow-up are avallble.Methods:We studied 130 consecutive patien...Stent implantation in acute myocardial infarction(AMI)has been shown to improvethe acute angiographic outcomes.So far few data on long-term angiographic follow-up are avallble.Methods:We studied 130 consecutive patients(mean age 58±11,24 women)betweenOctober 1993 and October 1997,in whom coronary stonts were implanted afterunsuccessful percutaneous transluminal coronary angioplasty (PTCA)in AMI.Quantitative coronary angiography(QCA)was performed and residual stenosis wasmesuremesured for all patients immediately and for 74 patients at a mean of 6 months afterthat procedure.Results:The infarct related artery was the left anterior dascending in 60(46%)pts,the circumflex in 15(12%)and the right coronary artery in 55(42%).At baseline,72(55%)pts had a totally occluded artery(TLMI0)and 11(8%)TIMI 1 flow. Eight(6%) pte were given aboiximab(ReoPro) or thrombolyais to deal with acute slantthrombosis during the intervention.Immedately after stent implantation,angiographicsuccess(TLMI 3)was obtained in 113(87%)pts,TLMI2 in 14 (11%)and TLMI 1 intwo (2%). Only three pts had residual stonosis(≥50% stenosis)immediately aftertreatment.Except the patients who had coronary artery bypass grafting(CABG)ordied coronary angiographic follow-up was performed in 74(70%)pts at a mean of 6months following the intervention(Table).Conclusion:Rescue stent implantation after failed PTCA in AMI may improve initialangiographic results,but we found a higher restenosis-rate and reintervention-rate inthe long-term run as compared with selectiv stent implantation.展开更多
Background Percutaneous transluminal renal angioplasty with stent is an effective procedure for atherosclerotic renal artery stenosis. However, the decision to perform this procedure has recently raised considerable d...Background Percutaneous transluminal renal angioplasty with stent is an effective procedure for atherosclerotic renal artery stenosis. However, the decision to perform this procedure has recently raised considerable debate. The aim of this study was to assess the effects of percutaneous transluminal renal angioplasty with stent in atherosclerotic renal artery stenosis patients, especially as it relates to blood pressure control and renal function improvement. Methods A retrospective analysis was made of the clinical data from 125 atherosclerotic renal artery stenosis patients who underwent percutaneous transluminal renal angioplasty from July 2004 to June 2008 in the Department of Vascular Surgery of Beijing Chaoyang Hospital. We compared blood pressure, number of oral antihypertensive medications, and renal function changes pre and post-procedure at 24 months follow-up. Results A total of 125 atherosclerotic renal artery stenosis patients underwent percutaneous transluminal renal angioplasty and 143 stents were placed. At 24 months follow-up, both systolic and diastolic blood pressure and the number of oral antihypertensive medications were significantly reduced （P 〈0.05）. Overall, the estimated glomerular filtration rate did not change significantly （P〉0.05）; however, a significant increase in estimated glomerular filtration rate was observed in the subgroup of patients with a lower baseline estimated glomerular filtration rate and in the subgroup of patients with bilateral renal artery stenosis （P 〈0.05）. Conclusion Percutaneous transluminal renal angioplasty patients, providing a significant improvement in blood antihypertensive medications. s a safe procedure for atherosclerotic renal artery stenosis pressure control and reduction in the number of oral展开更多
Renal artery stenosis(RAS) with a bifurcation lesion is a challenge for interventional therapy.The aim of this study is to summarize our experience in RAS with a bifurcation lesion.Five patients with RAS involving bif...Renal artery stenosis(RAS) with a bifurcation lesion is a challenge for interventional therapy.The aim of this study is to summarize our experience in RAS with a bifurcation lesion.Five patients with RAS involving bifurcation lesion are described.In cases 1 to 3,a single-stent strategy was first adopted.However,these three patients were converted to a two-stent strategy for bailout stent implantation in the side branches.In cases 4 and 5,a simultaneous kissing stent technique was performed.Angiography showed that the reference vascular diameter of the main branch was much larger than those of the side branches.Although obvious residual stenosis existed in cases 1 to 3 after stent implantation,no obvious residual stenosis was seen in cases 4 and 5.Renal artery duplex sonography was performed in cases 1 through 5 at 6,7,7,8,and 6 months,respectively,after the procedures.No evidence of restenosis or occlusion was seen.In conclusion,stent implantation with the simultaneous kissing stent technique may result in more simple and more satisfactory immediate angiographic results.展开更多
基金supported by the Natural Science Foundation of Yongchuan District of Chongqing in China,No.Ycstc,2013nc8031the Foundation of Chongqing Municipal Health Bureau in China,No.2010-2-250+1 种基金the Foundation of Chongqing Health and Family Planning Commission in China,No.20143001the Soft Science Foundation of Yongchuan District of Chongqing in China,No.Ycstc,2011BE5004
文摘Vertebral artery orifice stenting may improve blood supply of the posterior circulation of the brain to regions such as the cerebellum and brainstem. However, previous studies have mainly focused on recovery of cerebral blood flow and perfusion in the posterior circulation after interventional therapy. This study examined the effects of functional recovery of local brain tissue on cerebellar function remodeling using blood oxygen level-dependent functional magnetic reso- nance imaging before and after interventional therapy. A total of 40 Chinese patients with severe unilateral vertebral artery orifice stenosis were enrolled in this study. Patients were equally and randomly assigned to intervention and control groups. The control group received drug treat- ment only. The intervention group received vertebral artery orifice angioplasty and stenting ＋ identical drug treatment to the control group. At 13 days after treatment, the Dizziness Handicap Inventory score was compared between the intervention and control groups. Cerebellar function remodeling was observed between the two groups using blood oxygen level-dependent functional magnetic resonance imaging. The improvement in dizziness handicap and cerebellar function was more obvious in the intervention group than in the control group. Interventional therapy for severe vertebral artery orifice stenosis may effectively promote cerebellar function remodeling and exert neuroprotective effects.
文摘BACKGROUND Hepatic artery stenosis is a complication of orthotopic liver transplant occurring in 3.1%-7.4%of patients that can result in graft failure and need for retransplantation.Endovascular therapy with angioplasty and stenting has been used with a high degree of technical success and good clinical outcomes,but tortuous hepatic arteries present a unique challenge for intervention.Suitable stents for this application should be maneuverable and conformable while also exerting adequate radial force to maintain a patent lumen.CASE SUMMARY Herein we report our experience with a neurovascular Wingspan stent system in a challenging case of recurrent hepatic artery stenosis and discuss the literature of stenting in tortuous transplant hepatic arteries.CONCLUSION Wingspan neurovascular stent is self-expanding,has good conformability,and adequate radial resistance and as such it could be added to the armamentarium of interventionalists in the setting of a tortuous and stenotic transplant hepatic artery.
文摘Vertebral artery dissection is a rare pathology that can cause ischemic stroke in young people.Cervical massage,especially improper pulling manipulation,is a cause of vertebral artery dissection.We present a case of 32-year old woman who developed acute multiple posterior circulation ischemic cerebral infarctions as a result of left vertebral artery V4 segment dissection after receiving neck massage.She underwent emergency vertebral artery stent implantation at the site of the dissection.Symptoms were relieved the day after treatment.The patient recovered without adverse complications or endovascular restenosis in the following year.
文摘Percutaneous angioplasty and stenting for the treatment of extracranial vertebral artery(VA) stenosis seems a safe,effective and useful technique for resolving symptoms and improving blood flow to the posterior circulation,with a low complication rate and good long-term results.In patients with severe tortuosity of the vessel,stent placement is a real challenge.The new coronary balloon-expandable stents may be preferred.A large variability of restenosis rates has been reported.Drug-eluting stents may be the solution.After a comprehensive review of the literature,it can be concluded that percutaneous angioplasty and stenting of extracranial VA stenosis is technically feasible,but there is insufficient evidence from randomized trials to demonstrate that endovascular management is superior to best medical management.
基金supported by the Fund for Distinguished Young Doctors from Fujian Provincial Health Department,No.2011-1-7
文摘Cervical and intracranial angioplasty and stenting is an effective and safe method of reducing the risk of ischemic stroke, but it may be affected by in-stent restenosis. The present study in-vestigated serum level of matrix metalloproteinase 9 as a predictor of restenosis after 40 patients underwent cervical and/or intracranial angioplasty and stenting. Results showed that resteno-sis occurred in 30% （3/10） of patients when the serum level of matrix metalloproteinase 9 at 3 days after surgery was 2.5 times higher than preoperative level. No restenosis occurred when the serum level of matrix metalloproteinase 9 at 3 days after surgery was not 2.5 times higher than preoperative level. Restenosis occurred in 12% （2/17） of patients when the serum level of matrix metalloproteinase 9 was higher than preoperative level for more than 30 days after surgery, but only occurred in 4% （1/23） of patients when the serum level of matrix metalloproteinase 9 was higher than preoperative level for less than 30 days after surgery. However, the differences observed were not statistically signiifcant （P 〉 0.05）. Experimental ifndings indicate that when the serum level of matrix metalloproteinase 9 is 2.5 times higher than preoperative level at 3 days after cervi-cal and intracranial angioplasty and stenting, it may serve as a predictor of in-stent restenosis.
文摘Two cases with a pancreaticoduodenal arterial aneurysm accompanied with superior mesenteric artery(SMA) stenosis were previously described and both were treated surgically.However,for interventional treatment,securing a sufficient blood supply to the SMA should be a priority of treatment.We present the case of a 71-year-old male with a 20 mm diameter pancreaticoduodenal arterial aneurysm accompanied by SMA stenosis at its origin.The guidewire traverse from SMA to the aneurysm was difficult because of the tight SMA stenosis;however,the guidewire traverse from the celiac artery was finally successful and was followed by balloon angioplasty using a pull-through technique,leading to stent placement.Thereafter,coil packing through the SMA achieved eradication of the aneurysm without bowel ischemia.At the last follow-up computed tomography 8 mo later,no recurrence of the aneurysm was confirmed.The pull-through technique was useful for angioplasty for tight SMA stenosis in this case.
文摘BACKGROUND Fishbone is the most common esophageal foreign body and tends to migrate after piercing the esophagus to nearby structures.Vascular injury around the esophagus is a serious complication and has a high mortality rate,especially in the case of multiple vascular injuries.CASE SUMMARY We report an extremely rare case of successive vertebral artery and subclavian artery pseudoaneurysms caused by swallowing a fishbone in a previously healthy 29-year-old female.She was transferred to the emergency department of our hospital because of hemorrhagic shock due to a vertebral artery pseudoaneurysm.We successfully managed the vertebral artery pseudoaneurysm with endovascular stent implantation and the patient's vital signs as well as hemodynamics once became stable.However,the patient died of the second subclavian artery pseudoaneurysm occurring within a short time,which was thought be related to the obvious displacement of the fishbone in the mediastinum.CONCLUSION Surgery and endovascular stent implantation may be the best choice for treating such complications.Early removal of the fishbone is of great significance in improving the survival of such patients.
文摘Stent implantation in acute myocardial infarction(AMI)has been shown to improvethe acute angiographic outcomes.So far few data on long-term angiographic follow-up are avallble.Methods:We studied 130 consecutive patients(mean age 58±11,24 women)betweenOctober 1993 and October 1997,in whom coronary stonts were implanted afterunsuccessful percutaneous transluminal coronary angioplasty (PTCA)in AMI.Quantitative coronary angiography(QCA)was performed and residual stenosis wasmesuremesured for all patients immediately and for 74 patients at a mean of 6 months afterthat procedure.Results:The infarct related artery was the left anterior dascending in 60(46%)pts,the circumflex in 15(12%)and the right coronary artery in 55(42%).At baseline,72(55%)pts had a totally occluded artery(TLMI0)and 11(8%)TIMI 1 flow. Eight(6%) pte were given aboiximab(ReoPro) or thrombolyais to deal with acute slantthrombosis during the intervention.Immedately after stent implantation,angiographicsuccess(TLMI 3)was obtained in 113(87%)pts,TLMI2 in 14 (11%)and TLMI 1 intwo (2%). Only three pts had residual stonosis(≥50% stenosis)immediately aftertreatment.Except the patients who had coronary artery bypass grafting(CABG)ordied coronary angiographic follow-up was performed in 74(70%)pts at a mean of 6months following the intervention(Table).Conclusion:Rescue stent implantation after failed PTCA in AMI may improve initialangiographic results,but we found a higher restenosis-rate and reintervention-rate inthe long-term run as compared with selectiv stent implantation.
文摘Background Percutaneous transluminal renal angioplasty with stent is an effective procedure for atherosclerotic renal artery stenosis. However, the decision to perform this procedure has recently raised considerable debate. The aim of this study was to assess the effects of percutaneous transluminal renal angioplasty with stent in atherosclerotic renal artery stenosis patients, especially as it relates to blood pressure control and renal function improvement. Methods A retrospective analysis was made of the clinical data from 125 atherosclerotic renal artery stenosis patients who underwent percutaneous transluminal renal angioplasty from July 2004 to June 2008 in the Department of Vascular Surgery of Beijing Chaoyang Hospital. We compared blood pressure, number of oral antihypertensive medications, and renal function changes pre and post-procedure at 24 months follow-up. Results A total of 125 atherosclerotic renal artery stenosis patients underwent percutaneous transluminal renal angioplasty and 143 stents were placed. At 24 months follow-up, both systolic and diastolic blood pressure and the number of oral antihypertensive medications were significantly reduced （P 〈0.05）. Overall, the estimated glomerular filtration rate did not change significantly （P〉0.05）; however, a significant increase in estimated glomerular filtration rate was observed in the subgroup of patients with a lower baseline estimated glomerular filtration rate and in the subgroup of patients with bilateral renal artery stenosis （P 〈0.05）. Conclusion Percutaneous transluminal renal angioplasty patients, providing a significant improvement in blood antihypertensive medications. s a safe procedure for atherosclerotic renal artery stenosis pressure control and reduction in the number of oral
文摘Renal artery stenosis(RAS) with a bifurcation lesion is a challenge for interventional therapy.The aim of this study is to summarize our experience in RAS with a bifurcation lesion.Five patients with RAS involving bifurcation lesion are described.In cases 1 to 3,a single-stent strategy was first adopted.However,these three patients were converted to a two-stent strategy for bailout stent implantation in the side branches.In cases 4 and 5,a simultaneous kissing stent technique was performed.Angiography showed that the reference vascular diameter of the main branch was much larger than those of the side branches.Although obvious residual stenosis existed in cases 1 to 3 after stent implantation,no obvious residual stenosis was seen in cases 4 and 5.Renal artery duplex sonography was performed in cases 1 through 5 at 6,7,7,8,and 6 months,respectively,after the procedures.No evidence of restenosis or occlusion was seen.In conclusion,stent implantation with the simultaneous kissing stent technique may result in more simple and more satisfactory immediate angiographic results.
