Extracorporeal membrane oxygenation states basilar artery thrombectomy and left posterior cerebral artery stent thrombectomy:A case report

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.

Cerebral fat embolism following autologous fat injection in facial reconstruction:A case report

BACKGROUND Autologous fat injection in facial reconstruction is a common cosmetic surgery.Although cerebral fat embolism(CFE)as a complication is rare,it carries serious health risks.CASE SUMMARY We present a case of a 29-year-old female patient who developed acute CFE following facial fat filling surgery.After the surgery,the patient experienced symptoms including headache,nausea,vomiting,and difficulty breathing,which was followed by neurological symptoms such as slurred speech and left-sided weakness.Comprehensive physical examination and auxiliary investigations,including blood tests,head and neck computed tomography angiography,and cranial magnetic resonance diffusion-weighted imaging,were performed upon admission.The clinical diagnosis was acute cerebral embolism following facial fat filling surgery.Treatment included measures to improve cerebral circulation,dehydration for intracranial pressure reduction,nutritional support,and rehabilitation therapy for left limb function.The patient showed a significant improvement in symptoms after 2 weeks of treatment.She recovered left limb muscle strength to grade 5,had clear speech,and experienced complete relief of headache.CONCLUSION Our case highlights the potential occurrence of severe complications in patients undergoing fat injection in facial reconstruction.To prevent these complications,plastic surgeons should enhance their professional knowledge and skills.

Manual aspiration thrombectomy for acute and subacute inferior vena cava thrombosis and lower extremity deep venous thrombosis

Deep vein thrombosis(DVT), which can lead to pulmonary embolism(PE), is a major contributor to the global disease burden and is the third most common cardiovascular pathology after coronary artery disease and stroke. Venous thromboembolic disease, which encompasses the disease entities of DVT and PE, affects up to 10 million cases every year and represents a serious and potentially life-threatening condition. Standard anticoagulation therapy alone is ineffective at promoting deep venous system thrombus removal. Many patients develop postthrombotic syndrome(PTS) despite being on adequate anticoagulation therapy. Aggressive therapy for rapid thrombus removal is important to prevent the development of PTS. Besides impeding the onset of PTS, rapid clearance of the thrombus is also required in the treatment of phlegmasia cerulea dolens, an uncommon but life-threatening complication of acute DVT that can lead to arterial insufficiency, compartment syndrome, venous gangrene, and limb amputation. Manual aspiration thrombectomy(MAT) can provide rapid and effective therapy that could be compared to the open surgical thrombectomy approach with minimal risk of morbidity, mortality, or recurrence after surgery. Though many devices have been developed to date for pharmacomechanical thrombolysis, the cost of the treatment using these devices is very expensive. MAT is simple to perform, easy to learn, inexpensive, and rapid. This review will outline and dissect several studies and case reports, sourced from the Pub Med database, on the subject of the use of MAT in treating inferior vena cava thrombosis and lower extremity DVT, including in patients with compression of the iliac vein and phlegmasia cerulea dolens.

Manual aspiration thrombectomy in acute ST elevation myocardial infarction:New gold standard?

Percutaneous coronary intervention(PCI) is the preferred method to treat ST segment myocardial infarction(STEMI).The use of thrombus aspiration(TA) may be particularly helpful as part of the PCI process,insofar as the presence of thrombus is essentially a universal component of the STEMI process.This article reviews evidence favoring the routine use of TA,and the limitations of these data.Based on current evidence,we consider TA to be an important maneuver during STEMI PCI,even in the absence of visible angiographic thrombus,and recommend it whenever the presence of thrombus is likely.

Combined thrombectomy and intracoronary administration of glycoprotein IIb/IIIa inhibitors improves myocardial reperfusion in patients undergoing primary percutaneous coronary intervention： a meta-analysis

Background Suboptimal myocardial reperfusion is common in patients with ST-segment elevation myocardial infarction （STEMI） undergoing primary percutaneous coronary intervention （PPCI）. Furthermore, it results in increased infarct size and mortality rates. We performed a meta-analysis to evaluate the role of aspiration thrombectomy （AT） combined with intracoronary administration of glycoprotein IIb/IIIa inhibitors （GPI） in the improvement of myocardial reperfusion and clinical outcomes. Methods PubMed, Embase, Web of Science, and CENTRAL databases were searched for randomized controlled trials （RCTs） investigating combined AT and intracoronary GPI treatment versus AT alone. Outcomes of interest were thrombolysis in myocardial infarction myocardial perfusion grade （TMPG）, infarct size （IS） assessed by cardiac magnetic resonance imaging, left ventricular ejection fraction （LVEF）, major adverse cardiac events （MACE） at short-term （〈 1 month） and long-term （6-12 months） follow-up, and bleeding complications during the hospital stay. Results Eight trials involving 923 patients were included. Compared with AT alone, combined AT and intracoronary GPI significantly increased TMPG 3 flow （RR： 1.15, 95% CI： 1.04 to 1.26）, reduced IS [mean difference （MD）： -3.46, 95% CI： -5.18 to -1.73], and improved LVEF （MD： 1.44, 95% CI： 0.54 to 2.33）. Furthermore, GPI use decreased the risk of MACE at long-term follow-up （RR： 0.60, 95% CI： 0.37 to 0.98）. There was no significant difference between the two groups in the incidence of minor and major bleeding complications. Conclusions Our findings showed that compared with AT alone, combined AT and intracoronary GPI treatment resulted in improved myocardial reperfusion, better cardiac function, and MACE-free survival benefits at the long-term follow-up for patients with STEMI undergoing PPCI.

Combined cavo-atrial thrombectomy and hepatectomy in hepatocellular carcinoma

To the Editor： Hepatocellular carcinoma （HCC） remains one of the commonest cancers worldwide especially in hepatitis B endemic regions. Its aggressive behavior is characterised by the natural history of increasing size, a tendency for vascular invasion into the hepatic veins and portal veins. Further growth into the inferior vena cava （IVC） and right atrium （RA） is an infrequent finding but signifies a pre-terminal event with a dismal prognosis.

Admission Motor Strength Grade Predicts Mortality in Patients with Acute Ischemic Stroke Undergoing Mechanical Thrombectomy

Background: The mortality due to mechanical thrombectomy (MT) in the acute treatment of intracranial arterial occlu- sions can be up to 45%. The SWIFT (Solitaire FR with the Intention for Thrombectomy) and Multi MERCI (mechani- cal embolus removal in cerebral ischemia) trials have evaluated the safety and efficacy of MT. It may be important to determine pre-procedural factors that help predict post-intervention prognosis. We sought to determine if admission medical research council (MRC) motor strength grade along with other factors can be used as predictor of mortality after MT for acute ischemic stroke. Methods: Retrospective analysis of stroke database assessing outcomes in all 62 patients who underwent MT as an intervention for acute ischemic stroke, with or without concurrent intravenous thrombolysis was done. Five baseline variables were included in univariate and multivariate analyses to define the in- dependent predictors of mortality during current hospitalization. The medical research council (MRC) motor grade (0 - 5);modified collateral flow (CS) grading (0 - 3);age;acute and chronic co-morbidities were used as the baseline vari- ables. If motor strength grade were different in upper and lower extremities, then the lower grade was used. Age was analyzed independently as well as dichotomized using 80 as cut-off value. Relevant stroke related acute and chronic co-morbidities were given 1 point each and mean calculated. Results: In the univariate analysis, low (0 - 1) motor strength grade (OR, 0.11;95% CI, 0.021 - 0.33;p = 0.001) and age (OR, 1.06;95% CI, 1.02 - 1.12;p = 0.011) was sig- nificantly associated with mortality. The presence of collateral flow, acute and chronic co-morbidities were not signifi- cantly associated with mortality. In the multivariate analysis, motor grade retained its statistical significance for morta- lity (OR, 0.09;95% CI, 0.01 - 0.32;p = 0.003) along with chronic co-morbidity (OR, 1.52;95% CI 1.05 - 2.43;

Bridging therapy and direct mechanical thrombectomy in the treatment of cardiogenic cerebral infarction with anterior circulation macrovascular occlusion

BACKGROUND Intravenous thrombolysis is an important treatment for cerebral infarction.However,it is difficult to achieve good results if the patient is complicated with anterior circulation macrovascular occlusion.In addition,the vascular recanalization rate is low,so mechanical thrombectomy,that is,bridging therapy,is needed AIM To investigate the efficacy and safety of bridging therapy and direct mechanical thrombectomy in the treatment of cardiogenic cerebral infarction with anterior circulation macrovascular occlusion.METHODS Ninety-six patients in our hospital with cardiogenic cerebral infarction with anterior circulation macrovascular occlusion from January 2017 to July 2020 were divided into a direct thrombectomy group(n=48)and a bridging group(n=48).Direct mechanical thrombectomy was performed in the direct thrombectomy group,and bridging therapy was used in the bridging treatment group.Comparisons were performed for the treatment data of the two groups(from admission to imaging examination,from admission to arterial puncture,from arterial puncture to vascular recanalization,and from admission to vascular recanalization),vascular recanalization rate,National Institutes of Health Stroke Scale(NIHSS)and Glasgow Coma Scale(GCS)scores before and after treatment,prognosis and incidence of adverse events.RESULTS In the direct thrombectomy group,the time from admission to imaging examination was 24.32±8.61 min,from admission to arterial puncture was 95.56±37.55 min,from arterial puncture to vascular recanalization was 54.29±21.38 min,and from admission to revascularization was 156.88±45.51 min,and the corresponding times in the bridging treatment group were 25.38±9.33 min,100.45±39.30 min,58.14±25.56 min,and 161.23±51.15 min;there were no significant differences between groups(P=0.564,0.535,0.426,and 0.661,respectively).There was no significant difference in the recanalization rate between the direct thrombectomy group(79.17%)and the bridging group(75.00%)(P=0.627).There were no significant differences between the direct thrombectomy group(16.69±4.91 and 12.12±2.07)and the bridging group(7.13±1.23) and(14.40±0.59)in preoperative NIHSS score and GCS score(P=0.200 and 0.203,respectively).After the operation,the NIHSS scores in both groups were lower than those before the operation,and the GCS scores were higher than those before the operation.There was no significant difference in NIHSS and GCS scores between the direct thrombectomy group(6.91±1.10 and 14.19±0.65)and the bridging group(7.13±1.23 and 14.40±0.59)(P=0.358 and 0.101,respectively).There was no significant difference in the proportion of patients who achieved a good prognosis between the direct thrombectomy group(52.08%)and the bridging group(50.008%)(P=0.838).There was no significant difference in the incidence of adverse events between the direct thrombectomy group(6.25%)and the bridging group(8.33%)(P=0.913).CONCLUSION Bridging therapy and direct mechanical thrombectomy can safely treat cardiogenic cerebral infarction with anterior circulation macrovascular occlusion,achieve good vascular recanalization effects and prognoses,and improve the neurological function of patients.

Evaluation of using a double helical, closed-cell stent-retriever(Skyflow) for thrombectomy procedures in acute arterial occlusion: A preclinical study and a clinical trial

Background and purpose:Stent retriever thrombectomy is the standard therapeutic approach for ischemic stroke with acute large-vessel occlusion.This study evaluated the safety and efficacy of a new thrombectomy device(Skyflow)in the treatment of acute ischemic stroke.Methods:After an arterial occlusion model was established,stent-retriever thrombectomy was performed.Digital subtraction angiography(DSA)and autopsy were carried out immediately after thrombectomy in six animals in the acute experimental group.Simulated stent-retriever thrombectomy was performed for three animals in the subacute experimental group,and follow-up angiography and vascular pathological examination were assessed 90 days after the operation.In the clinical trial,192 patients with intracranial anterior circulation large vessel occlusion,within 8 h of symptom onset,were included to undergo thrombectomy with either Skyflow or Solitaire FR stent retriever.Efficacy and safety endpoints were recorded(including successful reperfusion,favorable clinical outcomes,time from puncture to reperfusion,instrument operation success rates and National Institutes of Health Stroke Scale(NIHSS)scores at 7 days for efficacy endpoints,and symptomatic intracranial hemorrhage(sICH),subarachnoid hemorrhage(SAH)and all-cause mortality rates for safety endpoints).Results:All blood vessels achieved successful recanalization in the animal models.In the clinical trial,successful recanalization was attained in 88.4%of patients of the Skyflow group,which was comparable to that of the Solitaire FR group(82.5%)in the full analysis set of the clinical trial.There were no severe complications on DSA,an animal autopsy,or vessel pathological examination in animal experiments.Additionally,no statistically significant difference was observed between the Skyflow and Solitaire FR groups in the clinical trial regarding the safety endpoints.Conclusion:This study showed that the new Skyflow stent retriever is safe and effective for the treatment of acute large vessel occlusion,as demonstrated in our animal study and human trial.

Gelfoam embolization for distal, medium vessel injury during mechanical thrombectomy in acute stroke: A case report

BACKGROUND Arterial perforation has inevitably increased as endovascular treatments have become more common for intracranial large vessel occlusions,and even distal,medium vessel occlusions.A distal,medium vessel has a tortuous course and thinner wall compared to large arteries,making it more susceptible to damage.Here,we review the treatment strategies for arterial perforation during mechanical thrombectomy,and we report the case of a patient treated with gelfoam embolization.CASE SUMMARY A 63-year-old woman presented to the emergency department with sudden neurologic symptoms of right hemiparesis and global aphasia.The initial National Institutes of Health Stroke Scale score was 15.Computed tomography(CT)and CT angiography revealed hyperacute infarction and emergent arterial occlusion of the left middle cerebral artery M2-3 portion.During endovascular mechanical thrombectomy,arterial rupture occurred.The patient’s vital signs were stable,but delayed angiography showed persistent active bleeding.Therefore,selective embolization of the injured artery was performed using gelfoam.Subsequent left vertebral and internal carotid angiography was performed to confirm hemostasis.A localized subarachnoid hemorrhage(SAH)was confirmed on a follow-up CT scan.A repeated CT scan after 12 d showed resolution of the SAH,and rebleeding did not occur.CONCLUSION Rescue embolization with gelfoam could be considered an additional option in distal,medium vessel perforation.

Clinical outcomes of Angio Jet pharmacomechanical thrombectomy versus catheter-directed thrombolysis for the treatment of filter-related caval thrombosis

BACKGROUND The inferior vena cava filter is utilized worldwide to intercept thrombi and to reduce the risk of fatal pulmonary embolism(PE).However,filter-related thrombosis is a complication of filter implantation.Endovascular methods such as AngioJet rheolytic thrombectomy(ART)and catheter-directed thrombolysis(CDT)can treat filter-related caval thrombosis,but the clinical outcomes of both treatment modalities have not been determined.AIM To compare the treatment outcomes of AngioJet rheolytic thrombectomy vs catheter-directed thrombolysis in patients with filter-related caval thrombosis.METHODS In this single-center retrospective study,65 patients(34 males and 31 females;mean age:59.0±13.43 years)with intrafilter and inferior vena cava thrombosis were enrolled between January 2021 and August 2022.These patients were assigned to either the AngioJet group(n=44)or the CDT group(n=21).Clinical data and imaging information were collected.Evaluation measures included thrombus clearance rate,periprocedural complications,urokinase dosage,incidence of PE,limb circumference difference,length of stay,and filter removal rate.RESULTS Technical success rates were 100%in the AngioJet and CDT groups.In the AngioJet group,grade II and grade III thrombus clearance was achieved in 26(59.09%)and 14(31.82%)patients,respectively.In the CDT group,grade II and grade III thrombus clearance was accomplished in 11(52.38%)patients and 8(38.10%)patients,respectively(P>0.05).The peridiameter difference of the thigh was significantly reduced in patients from both groups after treatment(P<0.05).The median dosage of urokinase was 0.08(0.02,0.25)million U in the AngioJet group and 1.50(1.17,1.83)million U in the CDT group(P<0.05).Minor bleeding was shown in 4(19.05%)patients in the CDT group,and when it was compared with that in the AngioJet group,the difference was statistically significant(P<0.05).No major bleeding occurred.Seven(15.91%)patients in the AngioJet group had hemoglobinuria and 1(4.76%)patient in the CDT group had bacteremia.There were 8(18.18%)patients with PE in the AngioJet group and 4(19.05%)patients in the CDT group before the intervention(P>0.05).Computed tomography angiopulmonography(CTA)showed that PE was resolved after the intervention.New PE occurred in 4(9.09%)patients in the AngioJet group and in 2(9.52%)patients in the CDT group after theintervention(P>0.05).These cases of PE were asymptomatic.The mean length of stay was longer in the CDT group(11.67±5.34 d)than in the AngioJet group(10.64±3.52 d)(P<0.05).The filter was successfully retrieved in the first phase in 10(47.62%)patients in the CDT group and in 15(34.09%)patients in the AngioJet group(P>0.05).Cumulative removal was accomplished in 17(80.95%)out of 21 patients in the CDT group and in 42(95.45%)out of 44 patients in the ART group(P>0.05).The median indwelling time for patients with successful retrieval was 16(13139)d in the CDT group and 59(12231)d in the ART group(P>0.05).CONCLUSION Compared with catheter-directed thrombolysis,AngioJet rheolytic thrombectomy can achieve similar thrombus clearance effects,improve the filter retrieval rate,reduce the urokinase dosage and lower the risk of bleeding events in patients with filter-related caval thrombosis.

Anticoagulant treatment for pulmonary embolism in patient with cerebral hemorrhage secondary to mechanical thrombectomy: A case report

BACKGROUND Cerebral hemorrhage secondary to cerebral embolism after mechanical thrombectomy is characterized by high morbidity,disability and mortality.If the patient also has severe pulmonary embolism(PE)at the same time,the treatment becomes more complex.This report describes the treatment strategy for a patient with PE and cerebral hemorrhage secondary to cerebral embolism after mechanical thrombectomy.CASE SUMMARY A 70-year-old woman presented to our emergency department with right-sided hemiplegia and mixed aphasia of 2.5 h duration.She was diagnosed with left cerebral embolism,left internal carotid artery occlusion,PE and left calf intramuscular vein thrombosis.Following mechanical thrombectomy,brain magnetic resonance imaging showed cerebral infarction with basal ganglia hemorrhage.We observed changes in cerebral hemorrhage on serial monitoring of brain computed tomography and adjusted the dose of anticoagulant drugs.After 3 wk of treatment,the patient’s neurological and respiratory symptoms significantly improved,and a favorable prognosis was obtained.CONCLUSION Anticoagulation could be a potential option for PE accompanied by hemorrhagic transformation of an ischemic infarct.

Contemporary techniques and outcomes of surgery for locally advanced renal cell carcinoma with focus on inferior vena cava thrombectomy:The value of a multidisciplinary team

Objective:To report the outcomes of surgery for a contemporary series of patients with locally advanced non-metastatic renal cell carcinoma(RCC)treated at a referral academic centre,focusing on technical nuances and on the value of a multidisciplinary team.Methods:We queried our prospective institutional database to identify patients undergoing surgical treatment for locally advanced(cT3-T4 N0-1 M0)renal masses suspected of RCC at our centre between January 2017 and December 2020.Results:Overall,32 patients were included in the analytic cohort.Of these,12(37.5%)tumours were staged as cT3a,8(25.0%)as cT3b,5(15.6%)as cT3c,and 7(21.9%)as cT4;6(18.8%)patients had preoperative evidence of lymph node involvement.Nine(28.1%)patients underwent nephron-sparing surgery while 23(71.9%)received radical nephrectomy.A template-based lymphadenectomy was performed in 12 cases,with evidence of disease in 3(25.0%)at definitive histopathological analysis.Four cases of RCC with level IV inferior vena cava thrombosis were successfully treated using liver transplant techniques without the need for extracorporeal circulation.While intraoperative complications were recorded in 3(9.4%)patients,no postoperative major complications(Clavien-Dindo3)were observed.At histopathological analysis,2(6.2%)patients who underwent partial nephrectomy harboured oncocytoma,while the most common malignant histotype was clear cell RCC(62.5%),with a median Leibovich score of 6(interquartile range 5e7).Conclusion:Locally advanced RCC is a complex and heterogenous disease posing several challenges to surgical teams.Our experience confirms that provided careful patient selection,surgery in experienced hands can achieve favourable perioperative,oncological,and functional outcomes.

Thrombosis in ST-elevation myocardial infarction:Insights from thrombi retrieved by aspiration thrombectomy

In patients with ST-elevation myocardial infarction, recurrent cardiovascular events still remain the main cause of morbidity and mortality, despite significant improvements in antithrombotic therapy. We sought to review data regarding coronary thrombus analysis provided by studies using manual aspiration thrombectomy(AT), andto discuss how insights from this line of investigation could further improve management of acute coronary disease. Several studies investigated the fresh specimens retrieved by AT using techniques such as traditional morphological evaluation, optical microscopy, scanning electron microscopy, magnetic resonance imaging, and immunohistochemistry. These approaches have provided a better understanding of the composition and dynamics of the human coronary thrombosis process, as well as its relationship with some clinical outcomes. Recent data signaling to new antithrombotic therapeutic targets are still emerging.

Successful recanalization of acute superior mesenteric artery thrombotic occlusion with primary aspiration thrombectomy

Prompt revascularization of the superior mesenteric artery(SMA) thrombotic occlusion can prevent intestinal infarction and decrease necrosis of the bowel segment.Herein,we describe two cases who underwent successful endovascular recanalization for acute SMA thrombosis using a primary aspiration thrombectomy because of possible consequent laparotomy for survey of bowel viability.The two patients had dramatic pain reliefimmediately after the procedure and remained symptomfree during the follow-up period.

Simple mechanical thrombectomy with intrapulmonary arterial thrombolysis in pulmonary thromboembolism： a small case series

Pulmonary thromboembolism （PTE） is a life-threatening condition with a high early mortality rate caused by acute right ventricular failure and cardiogenic shock. We report a series of three patients who presented with acute and subacute submassive PTE. They were suc-cessfully treated by simple catheter-based mechanical thrombectomy and intrapulmonary arterial thrombolysis. Mechanical fragmentation and aspiration of thrombus was performed by commonly used J-wire, multi-purpose and Judkin Right guiding catheters and this obviated the need of specific thrombectomy devices.

Robotic-assisted Laparoscopic Nephrectomy with Vein Thrombectomy:Initial Experience and Outcomes from a Single Surgeon

This study was designed to explore the safety and feasibility of robotic-assisted laparoscopic nephrectomy with vein thrombectomy (RAL-NVT) for the treatment of renal cell carcinoma (RCC)with venous tumor thrombus (VTT).Clinical data of 6 patients treated with RAL-NVT between July 2016 and November 2017 in our hospital were retrospectively collected and analyzed.There were 5 males and 1 female with their age ranging from 48 years to 68 years.Five renal tumors were right-sided and one left-sided. Three cases fell in level 0 VTT,one in level I and two in level Ⅱ.preoperative imaging revealed lymph node involvement in 1 case and distant metastasis in 2 cases.For RCC with level 0 VTT,the renal vein of the affected side was adequately and carefully dissected around the thrombus to the proximity of inferior vena cava (IVC)and was ligated with Hem-o-loks without cross-clamping the IVC.For level Ⅰ and Ⅱ VTT,the IVC was cross-clamped cephalically and caudally around the tumor thrombus and all tributaries were sequentially blocked to ensure the safe retrieval of VTT.All operations were successfully completed without conversion to open operation.The mean operative time was 150(115-230)min.Cross-clamping of the IVC happened in 3 cases,and the blocking time was 14, 19 and 20min,respectively.The mean estimated blood loss during the operation was 400 (200-580)mL.The peritoneal drainage tube was removed 5 to 9 days after the operation, and all patients were postoperatively discharged at 6 to 11 days.Postoperative pathological analysis confirmed that the RCCs were comprised of 4 clear cell RCCs,1 papillary cell RCC,and 1 medullary cell RCC;2 cases were Fuhrman grade Ⅱ,3 cases grade Ⅲ,and 1 case undefined grade.No recurrence or progression was observed during the follow-up of 4.2(3-6)months.We concluded that RAL-NVT is highly challenging but safe and feasible for the treatment of RCC with VTT.

Current Considerations of Thrombectomy for Acute Myocardial Infarction

Management of thrombus in coronary lesions remains a challenge that is frequently encountered during primary percutaneous coronary intervention(PCI)for ST-elevation myocardial infarction(STEMI)and is usually associated with poor clinical outcomes.At the same time,the optimum management of such lesions remains a dilemma.Multiple thrombus removal procedures have emerged with the short-term aim of improving myocardial perfusion and a longer-term aim of decreasing the incidence of both major adverse cardiac events(MACE)and all-cause mortality.In this review,we will highlight the main procedures utilized for thrombus removal during primary PCI for STEMI,with particular emphasis on aspiration thrombectomy.We will also approach possible theories that might explain the apparent lack of clinical benefit recently shown with such procedures.

Recurrent thrombosis in the lower extremities after thrombectomy in a patient with polycythemia vera:A case report

BACKGROUND Acute arterial embolism of the extremities is a surgical emergency. Atrialfibrillation is the major etiology of acute arterial embolism of the extremities.Emergency femoral artery thrombectomy can successfully treat this issue.However, polycythemia vera (PV) may sometimes explain this medicalemergency. Recurrent thrombosis in the lower extremities after thrombectomycan be found in patients with PV, and reoperation is needed for this condition.CASE SUMMARY A 68-year-old man in China suffered from sudden pain in the left lower extremityfor 14 h. The examination in the emergency department showed a diagnosis ofacute arterial embolism of the extremities combined with PV. The patient’scomplaint disappeared after repeat emergency thrombectomy.CONCLUSION Patients with acute arterial embolism of the extremities should be treatedcarefully, especially those who have recurrent thrombosis after emergencythrombectomy. Clinicians should be aware of PV, a rare cause of acute arterialembolism of the extremities. The combination of thrombectomy, phlebotomy, andantiplatelet and anticoagulant drugs may be a suitable therapeutic regimen forthese patients.

Giant Serpentine Aneurysm Treated with Double EC-IC Bypass with Thrombectomy and Excision of Aneurysm: A Case Review and Technical Note

Objective and Importance: The authors report a case of a symptomatic giant serpentine MCA aneurysm treated with double STA-MCA bypass with thrombectomy and excision of aneurysm. This is the first reported case of a double bypass with concomitant thrombectomy and excision of aneurysmal segment. Clinical Presentation/Methods: We report the case of a 27-year-old Hispanic male with severe acute decline in mental status with a giant serpentine MCA aneurysm with significant mass effect and midline shift trapping the lateral ventricular system. Intervention/Results: Patient presented initially to an outside hospital for altered mental status and confusion. Patient was diagnosed with a giant serpiginous aneurysm and hydrocephalus. A left ventriculoperitoneal shunt was placed at the outside hospital and patient was transferred to University of New Mexico. At this time, his mental status declined rather abruptly. He was treated with a double STA-MCA bypass procedure with aneurysm resection.