Endovascular treatment of acute M1 occlusions due to underlying intracranial atherosclerotic severe stenosis

Background:Endovascular treatment(EVT)for acute ischemic stroke with an occlusion of the M1 segment due to intracranial atherosclerotic severe stenosis(ICASS)remains challenging.This study aimed to evaluate the safety and efficacy of EVT for ICASS-related M1 acute occlusion.Methods:We retrospectively reviewed all patients with an ICASS-related M1 acute occlusion who underwent EVT at our institution between January 2015 and December 2020.Clinical presentation,baseline characteristics,angiographic and clinical results,technical feasibility,perioperative complications,and follow-up results were evaluated.Results:Twenty-two patients with ICASS-related M1 acute occlusion were included.Eight patients(36.4%)received bridging therapy,and the other 14 patients(63.6%)directly underwent EVT.Fifteen patients(68.2%)treated with balloon dilations and stenting as rescue treatment.Six patients(27.3%)received single balloon angioplasty,and 5 of these patients were treated with staged stenting.One case(4.5%)failed recanalization at the first EVT,and successful revascularization was achieved a month later.The mean procedure time was 67.2±20.8 min.Successful revascularization(mTICI≥2b)was achieved in 95.5%(21/22)of patients.Perioperative complications developed in two patients(9.1%)including one hemorrhagic event and one thromboembolic event.Angiographic follow-up was available in 20 patients(90.9%)at an average of 8.6±3.0 months.The degree of stenosis was worse(10-30%)in 6 cases(30%)compared with the initial outcomes.The favorable outcomes(mRS≤2)at 3-month follow-up was achieved in 19 patients(86.4%).Conclusions:ICASS-related occlusion in the M1 segment often required a rescue therapy including balloon angioplasty with/without stenting,and this treatment strategy was safe and effective.But single balloon angioplasty at the first EVT generally cannot achieve satisfactory results and often needed staged stenting treatment.

CAS and CEA in the Treatment of Severe Internal Carotid Artery Stenosis

Objective:To explore the clinical value of carotid artery stent implantation(CAS)and carotid endarterectomy(CEA)in the treatment of patients with severe internal carotid artery stenosis.Methods:88 patients with severe carotid artery stenosis who underwent CAS and CEA in the First People's Hospital of Changde City(hereafter referred as "our hospital")from January 2018 to December 2020 were selected as the research objects and divided into CAS group(n=43)and CEA group(n=45).To understand the clinical application value and feasibility of the two surgical schemes by comparing the general situation,cerebral blood flow,MMSE scale,MOCA scale score and serum miR-145,IGF1R levels of the two surgical schemes.Conclusions:CAS and CEA in the treatment of patients with severe internal carotid artery stenosis,have good curative effect,can effectively improve the patient's cerebral blood flow,regulate serum miR-145,IGF 1R levels,promote the recovery of cognitive function,but relatively speaking,the incidence of stroke and hypotension after CAS is higher,and the incidence of hypertension after CEA is higher.

Medical management of symptomatic severe aortic stenosis in patients non-eligible for transcatheter aortic valve implantation

1 Transcatheter aortic valve implantation in symptomatic severe aortic stenosis: where do we stand? Aortic stenosis occurs in 2%-9% of patients over the age of 65, the most common cause being degenerative.^([1,2]) The preferred treatment in symptomatic severe aortic stenosis(SAS) is surgical aortic valve replacement(SAVR), but in the elderly, the surgical risk can be greater than the benefit.([3]).

Application of extracorporeal membrane oxygenation in the endoscopic treatment of severe benign airway stenosis:A case report and literature review

Ventilation strategies in patients with severe tracheal stenosis should be tailored to the patient according to the underlying cause and narrowing location.This report is on a case of a 68-year-old male patient,who was admitted for radiotherapy because of esophageal cancer and then developed severe stenosis at the cervical trachea.We used venovenous extracorporeal membrane oxygenation to secure the airway and ensure adequate oxygenation.Then urgent endoscopic balloon dilation of airway stenosis was successfully performed under general anesthesia.This case shows that venovenous extracorporeal membrane oxygenation can be used in endoscopic tracheal procedures for patients with severe benign stenosis in the upper-trachea who are unable to tolerate conventional ventilation.

Emergency Treatment of Acute Decompensated Severe Aortic Stenosis with Transcatheter Aortic Valve implantation under the Coplane View Using J-Tipped Wires Fluoroscopy

Patients experiencing severe aortic stenosis with acute decompensation often face elevated surgical aortic valve replacement risks,leading to high postoperative mortality rates.However,for some patients eligible for transcatheter aortic valve implantation(TAVI),computed tomography angiography for assessing the aortic root and coronary artery might be challenging before the TAVI procedure.This case highlights a patient who underwent emergency TAVI guided by coplane view generated using J-tipped wires fluoroscopy without computed tomography evaluation before the TAVl.This approach reduces contrast usage during the TAVI procedure,significantly mitigating the risks of renal injury and heart function deterioration.

Incidence of coronary artery disease before valvular surgery in isolated severe aortic stenosis

Background Angina pectoris has been recognized as one of the principal symptoms of aortic valve stenosis （AS）,even in patients without significant coronary artery disease （CAD）.However,the incidence of angina pectoris and related CAD in such patients is controversial.There is continuing debate as to whether coronary angiography is necessary before aortic valve replacement （AVR） in patients with severe AS.The purpose of this study was to evaluate the incidence and predictors of CAD in patients with severe AS in a Korean population.Methods Data from all consecutive patients with severe AS undergoing AVR at a major tertiary cardiac and vascular center in Korea were entered in a prospective registry beginning in 1995.Clinical and echocardiographic follow-up data were recorded into the database annually.Significant CAD was defined as one or more major coronary arteries having an estimated narrowing of ≥70％ and left main coronary arteries having an estimated narrowing of ≥50％ on coronary angiography.We excluded patients with multiple valve disease,significant aortic regurgitation,or prior CAD or valve surgery.Results Totally 574 patients with severe AS （mean age,（65.9±9.6） years） were enrolled in this study.Significant CAD was found in 61 patients （10.6％）.Factors associated with increased likelihood of CAD were age,hypertension,diabetes mellitus,chronic renal failure,carotid disease,and aorta calcification.In Logistic regression analysis,the independent predictor of the presence of CAD was age （P=0.011）.The incidence of CAD increased significantly at 69.2 years of age.Having two risk factors for cardiovascular disease was the most useful cutoff to predict whether a patient was going to have significant CAD.Conclusions There was a low incidence of significant CAD in a population of Korean patients with severe AS.Therefore,coronary angiography before AVR will be considered in patients with multiple risk factors for cardiovascular disease or in patients more than 69 years of age without risk factors for cardiovascular disease.

A Comprehensive Analysis of a Case of Internal Carotid Artery Stenting

With the development of science and technology and the continuous progress of interventional equipment,internal carotid artery stenting has become increasingly popular among patients in view of its advantages,which include high efficiency,minimally invasive,and fast postoperative recovery.It has grown importance as a surgical method for the treatment of severe internal carotid artery stenosis.This paper discusses a rare case of severe internal carotid artery stenosis and its management,where various types of pre-dilatation balloons were not able to be positioned in the stenting process.Relevant solutions have also been proposed in hope to provide a more theoretical and practical basis for clinical work.