Effi cacy of partial and complete resuscitative endovascular balloon occlusion of the aorta in the hemorrhagic shock model of liver injury

BACKGROUND:Resuscitative endovascular balloon occlusion of the aorta(REBOA)can temporarily control traumatic bleeding.However,its prolonged use potentially leads to ischemia-reperfusion injury(IRI).Partial REBOA(pREBOA)can alleviate ischemic burden;however,its security and eff ectiveness prior to operative hemorrhage control remains unknown.Hence,we aimed to estimate the effi cacy of pREBOA in a swine model of liver injury using an experimental sliding-chamber ballistic gun.METHODS:Twenty Landrace pigs were randomized into control(no aortic occlusion)(n=5),intervention with complete REBOA(cREBOA)(n=5),continuous pREBOA(C-pREBOA)(n=5),and sequential pREBOA(S-pREBOA)(n=5)groups.In the cREBOA and C-pREBOA groups,the balloon was inflated for 60 min.The hemodynamic and laboratory values were compared at various observation time points.Tissue samples immediately after animal euthanasia from the myocardium,liver,kidneys,and duodenum were collected for histological assessment using hematoxylin and eosin staining.RESULTS:Compared with the control group,the survival rate of the REBOA groups was prominently improved(all P<0.05).The total volume of blood loss was markedly lower in the cREBOA group(493.14±127.31 mL)compared with other groups(P<0.01).The pH was significantly lower at 180 min in the cREBOA and S-pREBOA groups(P<0.05).At 120 min,the S-pREBOA group showed higher alanine aminotransferase(P<0.05)but lower blood urea nitrogen compared with the cREBOA group(P<0.05).CONCLUSION:In this trauma model with liver injury,a 60-minute pREBOA resulted in improved survival rate and was effective in maintaining reliable aortic pressure,despite persistent hemorrhage.Extended tolerance time for aortic occlusion in Zone I for non-compressible torso hemorrhage was feasible with both continuous partial and sequential partial measures,and the significant improvement in the severity of acidosis and distal organ injury was observed in the sequential pREBOA.

Endovascular treatment of ruptured lobulated anterior communicating artery aneurysms:A retrospective study of 24 patients

BACKGROUND Lobulated intracranial aneurysm is a special type of aneurysm with at least one additional cyst in the neck or body of the aneurysm.Lobulated intracranial aneurysm is a complex aneurysm with complex morphology and structure and weak tumor wall,which is an independent risk factor for rupture and hemorrhage.Lobular aneurysms located in the anterior communicating artery complex account for 36.9%of all intracranial lobular aneurysms.Due to its special anatomical structure,both craniotomy and endovascular treatment are more difficult.Compared with single-capsule aneurysms,craniotomy for lobular intracranial aneurysms has a higher risk and complication rate.AIM To investigate the efficacy and safety of endovascular treatment for ruptured lobulated anterior communicating artery aneurysm(ACoAA).METHODS Patients with ruptured lobulated ACoAA received endovascular treatment in Sanming First Hospital Affiliated to Fujian Medical University from June 2020 to June 2022 were retrospectively included.Their demographic,clinical and imaging characteristics,endovascular treatment methods and follow-up results were collected.RESULTS A total of 24 patients with ruptured lobulated ACoAA were included,including 9 males(37.5%)and 15 females(62.5%).Their age was 56.2±8.9 years old(range 39-74).The time from rupture to endovascular treatment was 10.9±12.5 h.The maximum diameter of the aneurysms was 5.1±1.0 mm and neck width were 3.0±0.7 mm.Nineteen patients(79.2%)were double-lobed and 5(20.8%)were multilobed.Fisher's grade:Grade 2 in 16 cases(66.7%),grade 3 in 6 cases(25%),and grade 4 in 2 cases(8.3%).Hunt-Hess grade:Grade 0-2 in 5 cases(20.8%),grade 3-5 in 19 cases(79.2%).Glasgow Coma Scale score:9-12 in 14 cases(58.3%),13-15 in 10 cases(41.7%).Immediately postprocedural Raymond-Roy grade:grade 1 in 23 cases(95.8%),grade 2 in 1 case(4.2%).Raymond-Roy grade in imaging follow-up for 2 wk to 3 months:grade 1 in 23 cases(95.8%),grade 2 in 1 case(4.2%).Followup for 2 to 12 months showed that 21 patients(87.5%)had good functional outcomes(modified Rankin Scale score≤2),and there were no deaths.CONCLUSION Endovascular treatment is a safe and effective treatment for ruptured lobulated AcoAA.

Application of multi-planar reconstruction technique in endovascular repair of aortic dissection

BACKGROUND Endovascular repair of aortic dissection is an effective method commonly used in the treatment of Stanford type B aortic dissection.Stent placement during the operation was one-time and could not be repeatedly adjusted during the operation.Therefore,it is of great significance for cardiovascular physicians to fully understand the branch status,position,angle,and other information regarding aortic arch dissection before surgery.AIM To provide more references for clinical cardiovascular physicians to develop treatment plans.METHODS Data from 153 patients who underwent endovascular repair of aortic dissection at our hospital between January 2021 and December 2022 were retrospectively collected.All patients underwent multi-slice spiral computed tomography angiography.Based on distinct post-image processing techniques,the patients were categorized into three groups:Multiplanar reconstruction(MPR)(n=55),volume reconstruction(VR)(n=46),and maximum intensity projection(MIP)(n=52).The detection rate of aortic rupture,accuracy of the DeBakey classification,rotation,and tilt angles of the C-arm during the procedure,dispersion after stent release,and the incidence of late complications were recorded and compared.RESULTS The detection rates of interlayer rupture in the MPR and VR groups were significantly higher than that in the MIP group(P<0.05).The detection rates of De-Bakey subtypesⅠ,Ⅱ,andⅢin the MPR group were higher than those in the MIP group,and the detection rate of typeⅢin the MPR group was significantly higher than that in the VR group(P<0.05).There was no statistically significant difference in the detection rates of typesⅠandⅡcompared to the VR group(P>0.05).The scatter rate of markers and the incidence of complications in the MPR group were significantly lower than those in the VR and MIP groups(P<0.05).CONCLUSION The application of MPR in the endovascular repair of aortic dissection has improved the detection rate of dissection rupture,the accuracy of anatomical classification,and safety.

Central nervous injury risk factors after endovascular repair of a thoracic aortic aneurysm with type B aortic dissection

Aortic dissection is the deadliest disease of the cardiovascular system.Type B aortic dissection accounts for 30%-60%of aortic dissections and is mainly treated by endovascular repair of thoracic endovascular aneurysm repair(TEVAR).However,patients are prone to various complications after surgery,with central nervous system injury being the most common,which seriously affects their prognosis and increases the risk of disability and death.Therefore,exploring the risk factors of central nervous system injury after TEVAR can provide a basis for its prevention and control.AIM To investigate the risk factors for central nervous system injury after the repair of a thoracic endovascular aneurysm with type B aortic dissection.METHODS We enrolled 306 patients with type B aortic dissection who underwent TEVAR at our hospital between December 2019 and October 2022.The patients were categorized into injury(n=159)and non-injury(n=147)groups based on central nervous system injury following surgery.The risk factors for central nervous system injury after TEVAR for type B aortic dissection were screened by comparing the two groups.Multivariate logistic regression analysis was performed.RESULTS The Association between age,history of hypertension,blood pH value,surgery,mechanical ventilation,intensive care unit stay,postoperative recovery times on the first day after surgery,and arterial partial pressure of oxygen on the first day after surgery differed substantially(P<0.05).Multivariate logistic regression analysis indicated that age,surgery time,history of hypertension,duration of mechanical ventilation,and intensive care unit stay were independent risk factors for central nervous system injury after TEVAR of type B aortic dissection(P<0.05).CONCLUSION For high-risk patients with central nervous system injury after TEVAR of type B aortic dissection,early intervention measures should be implemented to lower the risk of neurological discomfort following surgery in high-risk patients with central nervous system injury after TEVAR for type B aortic dissection.

Comprehensive classifications for the endovascular recanalization of vertebral artery stump syndrome

Background:and purpose:To share our single-center vertebral artery stump syndrome(VASS)treatment experience and assess the role of comprehensive classification based on anatomic development,proximal conditions,and distal conditions(PAD).Materials and methods:Data were retrospectively collected from patients who underwent endovascular thrombectomy(EVT)at the Stroke Center of the First Hospital of Jilin University between January 2016 and December2021.Among patients with acute ischemic stroke in the posterior circulation,those with acute occlusion of the intracranial arteries and occlusion at the origin of the vertebral artery confirmed by digital subtraction angiography were selected.The clinical data were summarized and analyzed.Results:Fifteen patients with VASS were enrolled in the study.The overall success rate of surgical recanalization was 80%.The successful proximal recanalization rate was 70.6%,and the recanalization rates for P1,P2,P3,and P4 were 100%,71.4%,50%,and 66.67%,respectively.The mean operation times for the A1 and A2 types were124 and 120 min,respectively.The successful distal recanalization rate was 91.7%,and the recanalization rates for types D1,D2,D3,and D4 were 100%,83.3%,100%,and 100%,respectively.Five patients experienced perioperative complications(incidence rate:33.3%).Distal embolism occurred in three patients(incidence rate:20%).No dissection or subarachnoid hemorrhage occurred in any patient.Conclusion:EVT is a technically feasible treatment for VASS,and comprehensive PAD classification can,to a certain extent,help initially estimate the difficulty of surgery and provide guidance for interventional procedures.

Safety and Efficacy of Endovascular Aortic Repair for Abdominal Aortic Aneurysms with a Hostile Neck Anatomy

Objective This study aimed to investigate the safety and efficacy of endovascular aortic repair(EVAR)for the treatment of an abdominal aortic aneurysm(AAA)with a hostile neck anatomy(HNA).Methods From January 1,2015 to December 31,2019,a total of 259 patients diagnosed with an AAA who underwent EVAR were recruited into this study.Based on the morphological characteristics of the proximal neck anatomy,the patients were divided into the HNA group and the friendly neck anatomy(FNA)group.The patients were followed up for up to 4 years.Results The average follow-up time was 1056.1±535.5 days.Type I endoleak occurred in 4 patients in the HNA group,and 2 patients in the FNA group.Neither death nor intraoperative switch to open repair occurred in either group.The time of the operation was significantly longer in the HNA group(FNA vs.HNA,99.2±51.1 min vs.117.5±63.8 min,P=0.011).There were no significant differences in short-term clinical success rate(P=0.228)or midterm clinical success rate(P=0.889)between the two groups.The overall mortality rate was 10.4%,and Kaplan-Meier survival analysis indicated that the two groups had similar cumulative survival rates at the end of the follow-up period(P=0.889).Conclusion EVAR was feasible and safe in patients with an AAA with a proximal HNA.The early and midterm results were promising;however,further studies are needed to verify the long-term effectiveness of EVAR.

52例症状性颅内动脉粥样硬化性狭窄患者个体化血管内治疗的回顾性分析

目的评估症状性颅内动脉粥样硬化性狭窄(sICAS)患者个体化血管内治疗的安全性和有效性。方法回顾性收集2019年1月至2022年12月在我院接受个体化血管内治疗的sICAS患者的临床资料,分析血管重建成功率、围手术期并发症发生率和死亡情况,以及随访期间复发性缺血性脑卒中(IS)、短暂性脑缺血发作、死亡和血管再狭窄的发生率。结果52例sICAS患者共有55处病变,均接受血管内治疗。患者平均年龄为(62.94±9.04)岁。术前病变血管狭窄程度为90%(80%,99%),狭窄长度为8(5,11)mm。采用的手术方式分别为球囊扩张式支架植入术(25例,27个病变)、自膨式支架植入术(19例,20个病变)、单纯球囊扩张血管成形术(8例,8个病变)。术后残余狭窄程度为10%(0,20%),较术前降低且差异有统计学意义(P<0.001)。血管重建成功率为94.23%(49/52),围手术期并发症发生率为3.85%(2/52)。临床随访12(12,18)个月,影像学随访10(6,12)个月,血管再狭窄发生率为7.69%(4/52),复发性IS发生率为1.92%(1/52),无患者死亡。结论个体化血管内治疗对sICAS安全、有效,其可提高血管重建成功率,降低围手术期并发症、远期IS复发和再狭窄风险。

Morphological features and endovascular repair for type B multichanneled aortic dissection: A case report

BACKGROUND Among the various types of aortic dissection,multichanneled aortic dissection(MCAD)differs from classic double-channeled aortic dissection and involves the formation of an additional false lumen in the aortic wall or the flaps.It is considered a relatively rare condition with high perioperative mortality and morbidity.However,the morphological characteristic and the optimal therapeutic strategy for MCAD has not been fully determined.CASE SUMMARY A 64-year-old man presented to our hospital with severe epigastric abdominal pain radiating to the back that was associated with nausea without emesis.A computed tomography angiogram was performed that revealed a type B aortic dissection with multiple channels extending from the level of the left subclavian artery to the bilateral femoral arteries.We used a medical three-dimensional modeling(3D)modeling system to identify the location and extension of multiple lumens from different angles.It also precisely located the two primary entries leading to the false lumens,which helped us to exclude the two false lumens with one stent-graft.CONCLUSION By applying medical 3D modeling system,we discover the fragility of aortic wall and the collapse of true lumen caused by the multiple false lumens are the two morphological features of MCAD.

Endovascular Therapy of Internal Carotid Artery Tandem Occlusions and Literature Review

Acute large vessel occlusion is a common cause of acute ischemic stroke (AIS), with high rates of disability and lethality. The incidence of tandem occlusion of the internal carotid artery accounts for about 20% of patients with large vessel occlusion of the anterior circulation in acute ischemic stroke. The low rate of recanalization by intravenous thrombolysis in AIS due to internal carotid artery tandem occlusion, the poor establishment of collateral circulation within a short time, and the complex pathogenesis often suggest a poor prognosis for patients. Mechanical thrombectomy (MT) is beneficial for the opening of intracranial large vessel occlusion with internal carotid artery tandem occlusion, there are many problems regarding the emergency management of carotid artery occlusion or stenosis after mechanical thrombectomy, and there are currently no standardized treatment recommendations;The sequential approach to the management of carotid tandem occlusion, the timing of carotid stenting, and the use of antiplatelet agents remain controversial. The current state of research on carotid tandem occlusion is analyzed in the literature to promote clinical understanding of endovascular treatment for patients with acute ischemic stroke due to carotid tandem occlusion.

Subintimal recanalization for non-acute occlusion of intracranial vertebral artery in an emergency endovascular procedure:A case report

BACKGROUND Endovascular recanalization of non-acute intracranial artery occlusion is technically difficult,particularly when the microwire enters the subintima.Although the subintimal tracking and re-entry technique has been well established in the endovascular treatment of coronary artery occlusion,there is limited experience with its use in intracranial occlusion due to anatomical variations and a lack of dedicated devices.CASE SUMMARY A 74-year-old man was admitted to the hospital two days after experiencing acute weakness in both lower extremities,poor speech,and dizziness.After admission,imaging revealed acute ischemic stroke and non-acute occlusion of bilateral intracranial vertebral arteries(ICVAs).On the fourth day of admission,the patient's condition deteriorated and an emergency endovascular recanalization of the left ICVA was performed.During this procedure,a microwire was advanced in the subintima of the vessel wall and successfully reentered the distal true lumen.Two stents were implanted in the subintima.The patient's Modified Rankin Scale was 1 at three months postoperatively.CONCLUSION We present a technical case of subintimal recanalization for non-acute ICVA occlusion in an emergency endovascular procedure.However,we emphasize the necessity for caution when applying the subintimal tracking approach in intracranial occlusion due to the significant dangers involved.

Carotid-subclavian bypass and endovascular aortic repair of Kommerell’s diverticulum with aberrant left subclavian artery:A case report

BACKGROUND Kommerell’s diverticulum(KD)with aberrant left subclavian artery is a rare congenital deformity and also has very little research literature about it(35%of case study).There are three types of aortic arch diverticulum.Even literature concerning the treatment options are limited.CASE SUMMARY We present a case report of a 50-year-old male with KD in the right aortic arch with aberrant left subclavian artery.We conducted a total endovascular repair procedure,which is innovative and will spread more light in the medical world.Our patient has no past medical history and is a non-smoker and non-alcoholic.Patient presented with shortness of breath,chest pain and dizziness for six months.Blood tests were done and computerized tomography(CT)angiogram of the chest confirmed the diagnosis,illustrating showed a 3.9 cm KD.On Day 1,the CT angiogram showed mild dilatation of the thoracic aorta,adjacent esophagus,trachea was compressed and displaced.Surgery was planned as the treatment modality.Carotid-Subclavian artery bypass and endovascular aortic repair was conducted.We used prolene 5-0 C1 sutures to precisely anastomose a 6-mm Dacron graft to the left subclavian artery.Haemostasis was secured and wounds were closed.Protamine was administered and patient was shifted to intensive care unit.Post-operative,patient responded favorably and was discharged.Regular follow-up is done.CONCLUSION The procedure we performed is novel.This will help the cardio-thoracic surgeons a better insight about the full procedures we conducted,thereby bringing more light and better treatment options in managing KD with aberrant subclavian artery.

Endovascular Treatment of Ischemic Stroke due to Acute Carotid Dissection: A Report and Review of the Literature

The efficacy of endovascular therapy in patients with acute ischemic stroke due to tandem occlusion is comparable to that for isolated intracranial occlusion in the anterior circulation. Definitive treatment of carotid dissection-related strokes is currently unproved. The best endovascular technique in this setting remains to be established, but emergency carotid artery stenting (CAS) is frequently considered. We investigated the safety and efficacy of emergency CAS for carotid dissection in patients with acute stroke in current clinical practice.

Appearance of aseptic vascular grafts after endovascular aortic repair on[(18)F]fluorodeoxyglucose positron emission tomography/computed tomography

BACKGROUND Diagnosis of prosthetic vascular graft infection with[(18)F]fluorodeoxyglucose positron emission tomography/computed tomography(18F-FDG PET/CT)allows for early detection of functional changes associated with infection,based on increased glucose utilization by activated macrophages and granulocytes.Aseptic vascular grafts,like all foreign bodies,can stimulate an inflammatory response,which can present as increased activity on 18F-FDG PET/CT.Consequently,distinguishing aseptic inflammation from graft infection,though important,can be difficult.In the case of endovascular aneurysm repair(EVAR),a minimally invasive procedure involving the transfemoral insertion of an endoprosthetic stent graft,the normal postoperative appearance of these grafts on 18F-FDG PET/CT can vary over time,potentially confounding study interpretation.AIM To investigate the visual,semiquantitative,and temporal characteristics of aseptic vascular grafts in patients status post EVAR.METHODS In this observational retrospective cohort study,patients with history of EVAR who underwent 18F-FDG PET/CT for indications other than infection were identified retrospectively.All patients were asymptomatic for graft infection-no abdominal pain,fever of unknown origin,sepsis,or leukocytosis-at the time of imaging and for≥2 mo after each PET/CT.Imaging studies such as CT for each patient were also reviewed,and any patients with suspected or confirmed vascular graft infection were excluded.One hundred two scans performed on 43 patients(34 males;9 females;age=77±8 years at the time of the final PET/CT)were retrospectively reviewed.All 43 patients had an abdominal aortic(AA)vascular graft,40 patients had a right iliac(RI)limb graft,and 41 patients had a left iliac(LI)limb graft.Twentytwo patients had 1 PET/CT and 21 patients had from 2 to 9 PET/CTs.Grafts were imaged between 2 mo to 168 mo(about 14 years)post placement.Eight grafts were imaged within 6 mo of placement,including three that were imaged within three months of placement.The mean interval between graft placement and PET/CT for all 102 scans was 51±39 mo.PET/CT data was reconstructed with region-of-interest analysis of proximal,mid and distal portions of the grafts and background ascending aorta.Maximum standardized uptake value(SUVmax)was recorded for each region.SUVmax-to-background uptake ratios(URs)were calculated.Visual assessment was performed using a 2-pattern grading scale:Diffuse(homogeneous uptake less than liver uptake)and focal(one or more areas of focal uptake in any part of the graft).Statistical analysis was performed.RESULTS In total,there were 306 AA grafts,285 LI grafts,282 RI grafts,and 306 ascending aorta background SUVmax measurements.For all 102 scans,mean SUVmax values for AA grafts were 2.8-3.0 along proximal,mid,and distal segments.Mean SUVmax values for LI grafts and RI grafts were 2.7-2.8.Mean SUVmax values for background were 2.5±0.5.Mean URs were 1.1-1.2.Visual analysis of the scans reflected results of quantitative analysis.On visual inspection,98%revealed diffuse,homogeneous 18F-FDG uptake less than liver.Graft URs and visual pattern categories were significantly associated for AA graft URs(F-ratio=21.5,P<0.001),LI graft URs(F-ratio=20.4,P<0.001),and RI graft URs(F-ratio=30.4,P<0.001).Thus,visual patterns of 18F-FDG uptake corresponded statistically significantly to semiquantitative URs.The age of grafts showing focal patterns was greater than grafts showing diffuse patterns,87±89 vs 50±37 mo,respectively(P=0.02).URs were significantly associated with graft age for AA grafts(r=0.19,P=0.001).URs were also significantly associated with graft age for LI grafts(r=0.25,P<0.0001),and RI grafts(r=0.31,P<0.001).Quartiles of similar numbers of graft(n=25-27)grouped by graft age indicated that URs were significantly higher for 4th quartile vs 2nd quartile URs(F-ratio=19.5,P<0.001).When evaluating URs,graft SUVmax values within 10%-20%of the ascending aorta SUVmax is evident in aseptic grafts,except for grafts in the oldest quartiles.In this study,grafts in the oldest quartiles(>7 years post EVAR)showed SUVmax up to 30%higher than the ascending aorta SUVmax.CONCLUSION Characteristics of an aseptic vascular stent graft in the aorta and iliac vessels on 18F-FDG PET/CT include graft SUVmax values within 10%-20%of the ascending aorta background SUVmax.The SUVmax of older aseptic grafts can be as much as 30%above background.The visual uptake pattern of diffuse,homogeneous uptake less than liver was seen in 98%of aseptic vascular grafts,making this pattern particularly reassuring for clinicians.

脑血容量指数预测急性缺血性卒中患者血管内治疗远期预后的价值分析

目的探讨CT灌注指数与急性缺血性卒中(AIS)患者血管内治疗(EVT)远期预后的相关性。方法纳入64例诊断AIS且经EVT的患者并进行1年随访。主要结局指标包括术后1年改良Rankin量表(mRS)评分0~2分(良好预后)。所有患者根据低灌注强度比(HIR)(<0.3 vs≥0.3)和脑血容量(CBV)指数(>0.7 vs≤0.7)进行分组,将组间临床资料及术后1年mRS评分进行比较;通过Logistic回归分析术后1年良好预后的影响因素。结果61例患者完成随访,其中术后1年达到良好预后的有34例(55.7%)。高CBV组良好预后率明显高于低CBV组(76.9%vs 40%),低HIR组良好预后率明显高于高HIR组(73.9%vs 44.7%)(P<0.05)。CBV指数是术后1年良好预后的保护因素(P=0.046)。结论CBV指数可预测AIS患者EVT远期预后情况,有望为患者EVT提供临床依据。

Custom Made Fenestrated Stent Graft Collapse after Thoracic Endovascular Aortic Repair: A Case Report

We present a case of stent graft collapse after performing thoracic endovascular aortic repair with a custom-made fenestrated stent graft. The patient was a 70-year-old woman with an asymptomatic aneurysm of the distal aortic arch, and thoracic endovascular aortic repair was performed. The patient showed a blood pressure difference between the left arm and the right arm on postoperative day (POD) 17 prompting the performance of a chest computed tomography scan which revealed stent graft collapse. She then underwent staged debranching of thoracic endovascular aortic repair. Stent graft collapse is a rare but well-described complication of thoracic endovascular repair. Therefore, patients who undergo such a procedure should be carefully monitored for signs and symptoms, which suggest the possibility of stent collapse.

主动脉近端破口腔内隔绝术治疗A型主动脉壁内血肿伴心包积液近期效果观察

目的观察腔内隔绝治疗A型主动脉壁内血肿(AIH)伴心包积液的近期效果,探讨A型AIH伴心包积液腔内隔绝治疗策略。方法选取湖南中医药大学第一附属医院2018年2月至2021年11月收治的12例A型AIH伴心包积液患者。所有患者术前升主动脉内膜均完整,主动脉弓部或胸降主动脉近端内膜有破口,均接受腔内隔绝术封闭治疗。4例发病1周内手术,8例保守治疗1周后择期手术,术后随访12个月。结果发病1周内手术患者术后1例恢复顺利,2例术后3个月内出现A型夹层,1例早期死亡;保守治疗1周后手术8例患者均恢复顺利。结论A型AIH伴少至中量心包积液患者经保守治疗减轻升主动脉血肿后,择期行腔内隔绝治疗的效果理想。

血管内治疗鼻咽癌放疗后颈内动脉假性动脉瘤破裂出血

目的探讨鼻咽癌放疗后颈内动脉假性动脉瘤破裂出血的血管内治疗方式、疗效及安全性。方法 回顾性分析福建医科大学附属协和医院收治的21例鼻咽癌放疗后颈内动脉假性动脉瘤破裂出血患者的临床资料,其中8例行覆膜支架植入,6例行支架辅助弹簧圈栓塞,7例直接行载瘤动脉闭塞治疗。分析手术策略、治疗结果以及临床与影像学随访结果。结果 21例患者均成功接受血管内治疗。术后即刻止血效果均良好,瘤颈残留2例,瘤体残留1例。术后出血复发5例,其中4例再次行载瘤动脉闭塞后出血停止,1例为覆膜支架植入后发生内漏,予球囊扩张后血止,但1个月后不明原因死亡;1例覆膜支架植入术后出现昏迷,CT示蛛网膜下腔出血、脑肿胀,治疗后未好转自动出院;3例在随访中发现颈内动脉闭塞;2例术后未随访。随访的19例患者中mRS评分0分9例,1分6例,2分2例,5分1例,6分1例。结论 针对鼻咽癌放疗后颈内动脉假性动脉瘤破裂出血,血管内治疗效果确切,安全性较高。覆膜支架短期疗效好,但也存在着动脉瘤复发、内漏等问题,载瘤动脉闭塞可能远期疗效更可靠。

症状性前循环颅内动脉重度狭窄患者急性期血管内治疗效果分析

目的观察对症状性前循环颅内动脉重度狭窄患者急性期实施血管内治疗的可行性。方法回顾性纳入2019年6月至2023年6月广东省中医院脑血管病科连续收治的30例症状性前循环颅内动脉重度狭窄患者的临床资料,应用危险分层评分对其进行评估,并探讨实施急性期(≤72.0 h)血管内治疗的安全性及有效性。血管内治疗包括球囊扩张+自膨式支架置入、球囊扩张式支架置入、球囊扩张治疗。危险分层评分为本研究根据临床经验,在短暂性脑缺血发作(TIA)ABCD3-I评分基础上增加对分水岭梗死的评分内容,用于症状性颅内动脉中重度狭窄急性期卒中进展或复发风险的筛选,其中危险分层评分0~3分定义为低危,4~7分定义为中危,8~13分定义为高危。以术后残留狭窄率≤50%且血流拓展脑梗死溶栓(eTICI)分级>2c级判定为血运重建成功。记录接受血管内治疗患者的人口学信息及临床资料,包括年龄、性别、脑血管病危险因素(高血压病、糖尿病、高脂血症、高同型半胱氨酸血症、饮酒史、吸烟史)、起病资料(发病至血管内治疗时间、症状、进展情况)、病变血管、危险分层评分、术前及术后90 d美国国立卫生研究院卒中量表(NIHSS)评分、术后90 d改良Rankin量表(mRS)评分、术中脑血管事件(颅内出血、责任血管闭塞)及术后90 d内脑血管事件(颅内出血、脑梗死、TIA、支架内再狭窄)、死亡事件。结果30例症状性前循环颅内动脉重度狭窄患者中,排除发病至血管内治疗的时间>72.0 h患者3例、因其他疾病需长期服用抗凝药物1例、失访1例、并存其他心源性脑栓塞疾病3例、非动脉粥样硬化导致动脉狭窄4例、拒绝急性期血管内治疗7例,最终纳入符合纳入与排除标准患者11例。(1)11例患者均成功实施血管内治疗,其中男7例;年龄52~76岁,中位数年龄64岁;高血压病9例,糖尿病3例,高脂血症7例,高同型半胱氨酸血症2例(仅9例完善了该项检查),吸烟史2例,饮酒史1例;发病至血管内治疗4.0~72.0 h,中位数时间12.0 h;左、右侧大脑半球梗死分别为3、8例,伴前后分水岭、内分水岭、前内后分水岭梗死分别为4、3、2例,伴内后、前内分水岭梗死各1例。(2)11例患者中,危险分层评分10~13分,中位数评分11分;术前NIHSS评分0~11分,中位数评分7分。(3)11例患者中,10例病变血管位于大脑中动脉,1例位于颈内动脉C7段;术前狭窄率70%~99%,中位数狭窄率86%;术前eTICI分级2a级7例,2b50级4例(存在远端血流缓慢);9例接受球囊扩张+自膨式支架置入,1例接受球囊扩张式支架置入,1例行球囊扩张治疗;术后狭窄率10%~20%,中位数狭窄率15%;术后eTICI分级2c级3例,3级8例。(4)11例患者中,术后第1天发生颅内出血1例,术后第3天新发脑梗死1例。完成术后90 d影像学随访患者8例,其中支架内再狭窄2例;术后90 d NIHSS评分0~20分,中位数评分2分;术后90 d mRS评分0~4分,中位数评分1分。mRS评分≤2分患者8例,未发生死亡事件。结论初步分析表明,症状性前循环颅内动脉重度狭窄实施急性期血管内治具有一定的有效性,但安全性有待继续观察。危险分层评分对高危患者的筛选仍需大样本、多中心研究进一步探讨。

急性前循环动脉粥样硬化性串联闭塞患者球囊扩张与支架置入的效果

目的比较颈内动脉起始段粥样硬化性串联闭塞患者颈内动脉颅外段行球囊扩张或支架置入的安全性和有效性。方法纳入2018年1月至2022年10月海南医学院第一附属医院和广州医科大学附属第三医院收治的发病24 h内行血管内治疗的急性前循环串联闭塞脑卒中患者91例,分为球囊扩张组51例,支架置入组40例,比较两组基线和临床资料。mTICI 2b~3定义为血管良好再通,术后90 d改良Rankin量表(mRS)评分0~2分定义为临床预后良好。结果支架组患者术后血管良好再通率和90 d良好临床预后率较球囊组高,分别为70%比60.8%和60%比52%,但差异无统计学意义(P=0.361、0.391)。两组症状性颅内出血发生率、无症状性颅内出血发生率和病死率分别为10%比11.8%、32.5%比41.2%、22.5%比17.7%,差异均无统计学意义(P=1.000、0.396、0.564)。结论颈内动脉起始段动脉粥样硬化性病变所致的急性前循环串联闭塞患者,急性期颅外段行球囊扩张或支架置入可能均安全有效。

多期CT血管成像对急性缺血性卒中血管内治疗短期预后的价值

目的:探讨多期CT血管成像对急性缺血性卒中(AIS)血管内治疗短期预后的价值。方法:回顾性分析183例接受血管内治疗的AIS患者,按随访90 d改良Rankin量表(mRS)评分分为预后良好(mRS评分≤2)组和预后不良(mRS评分>2)组。通过改良Tan评分评估多期CT血管成像显示的侧支循环情况,侧支循环不良为闭塞大脑中动脉区域的侧支循环小于对侧1/2,侧支循环良好为闭塞大脑中动脉区域的侧支循环大于对侧1/2。采用多变量logistic回归,曲线下面积(AUC)评价模型性能,DeLong检验比较AUC间的差异。结果:Logistic回归显示,较低入院NIHSS评分和动脉晚期侧支循环良好是AIS患者短期预后良好的独立预测因素,AUC分别为0.72(0.65~0.79)和0.75(0.68~0.81)。两者联合时AUC可达0.79,显著高于单一预测因素(DeLong检验,均P<0.05)。结论:动脉晚期侧支循环良好和较低入院NIHSS评分是血管内治疗短期预后良好的独立预测因素。联合预测模型具有较高的诊断效能,可为临床治疗方案选择提供参考。