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Intra-arterial tenecteplase during thrombectomy for acute stroke(BRETIS-TNK II):rationale and design

Stroke & Vascular Neurology 2024年第1期9卷 59-65页

作者： Zi-Ai Zhao Jing Qiu Wei Li Thanh Nguyen Shouchun Wang huaizhang shi Ming Wei Feng Wang Di Li Hui-Sheng Chen Department of Neurology General Hospital of Northern Theater CommandShenyangLiaoning ProvinceChina Neurology RadiologyBoston Medical CenterBostonMassachusettsUSA Department of Neurology First Affiliated Hospital of Jilin UniversityChangchunJilinChina Department of Neurosurgery First Affiliated Hospital of Harbin Medical UniversityHarbinHeilongjiangChina Department of Neurosurgery Tianjin Huanhu HospitalTianjinTianjinChina Department of Interventional Therapy First Affiliated Hospital of Dalian Medical UniversityDalianChina Neurological Intervention Department Dalian Municipal Central HospitalDalianLiaoningChina

Background Our recent pilot study suggests intra-arterial tenecteplase(TNK)during the first pass of endovascular treatment(EVT)seems safe,may increase first-pass reperfusion and good outcome in acute ischaemic stroke(AIS)patients with large-vessel occlusion(LVO).Aims To determine the efficacy and safety of intra-arterial TNK administration during EVT in AIS-LVO patients presenting up to 24 hours from symptom *** size estimates A maximum of 380 patients are required to test the superiority hypothesis with 80%power according to a two-side 0.05 level of significance,stratified by age,gender,baseline systolic blood pressure,prestroke modified Rankin Scale(mRS),baseline National Institute of Health stroke scale,baseline ASPECTS,time from onset to groin puncture,intravenous thrombolysis before EVT,stroke territory and stroke *** Intra-arterial TNK during thrombectomy for acute stroke(BRETIS-TNK II)study is a prospective,randomised,adaptive enrichment,open-label,blinded end point,multicentre *** AIS-LVO patients are randomly assigned into the experimental group and control group with a ratio of 1:*** experimental group will be treated with intra-arterial infusion of TNK during *** control group will be treated with standard *** The primary end point is a favourable outcome,defined as an mRS score of 0–2 at 90 *** primary safety end point is symptomatic intracranial haemorrhage within 48 hours,which is defined as an increase in the National Institutes of Health Stroke Scale score of≥4 points as a result of the intracranial *** The results of BRETIS-TNK II will provide evidence for the efficacy and safety of intra-arterial TNK administration during EVT in AIS patients with LVO.

关键词： rational stratified TNK

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Comparison of the Pipeline embolisation device alone or combined with coiling for treatment of different sizes of intracranial aneurysms

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Stroke & Vascular Neurology 2022年第4期7卷 345-352,I0051-I0055页

作者： Chao Wang Bin Luo Tianxiao Li Aisha Maimaitili Guohua Mao Donglei Song Yunyan Wang Wenfeng Feng Yang Wang huaizhang shi Jieqing Wan Jianmin Liu Sheng Guan Yuanli Zhao Hongqi Zhang Department of Interventional Neuroradiology Beijing Neurosurgical Institute and Beijing Tiantan HospitalCapital Medical UniversityBeijingChina Neurosurgery Departement Peking University International HospitalBeijingChina Zhengzhou University People′s Hospital ZhengzhouHenan ProvinceChina Department of Neurosurgery Xinjiang Medical University Affiliated First HospitalUrumqiXinjiangChina Department of Neurosurgery Nanchang University Second Affiliated HospitalNanchangJiangxiChina Department of Neurosurgery Shanghai Donglei Brain HospitalShanghaiChina Department of Neurosurgery Qilu Hospital of Shandong University QingdaoJinanShandongChina Department of Neurosurgery Southern Medical University Nanfang HospitalGuangzhouGuangdongChina Department of Neurosurgery First Affiliated Hospital of Nanchang UniversityNanchangJiangxiChina Department of Neurosurgery First Affiliated Hospital of Harbin Medical UniversityHarbinHeilongjiangChina Department of Neurosurgery Shanghai Jiao Tong University School of Medicine Affiliated Renji HospitalShanghaiChina Department of Neurosurgery Changhai Hospital Affiliated to Naval Medical UniversityShanghaiChina Department of Neurointerventional Surgery First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina Department of Neurosurgery Xuanwu HospitalCapital Medical UniversityBeijingChina

Objectives The aim of this study was to compare complications and outcomes between intracranial aneurysms treated with the Pipeline embolisation device(PED)alone or with PED combined with coiling for different-sized *** Patients with aneurysms treated by PED were collected from the PED in China postmarket multicentre registry *** performed a propensity match analysis to compare the efficacy and safety between PED alone and PED combined with coiling treatment,and then aneurysms were organised into three groups based on their size:small(≤7 mm),medium(≤15 mm to>7 mm)and large/giant(>15 mm).Complications and aneurysm occlusion rates in the aneurysm size groups were compared between PED alone and PED combined with coiling *** A total of 1171 patients with 1322 aneurysms were *** patients received clinical follow-up,while angiographic follow-up was available in 967 *** small aneurysms,there was no difference in the aneurysm occlusion rate between two groups(79.1%vs 88.4%,respectively),while there was a significant increase in the ischaemic complication rate(8.3%vs 19.3%,respectively,p=0.0001).For medium and large/giant saccular aneurysms,PED combined with coiling significantly improved the occlusion rate(medium aneurysms:74.7%vs 88.8%,respectively,p<0.0001;large/giant saccular aneurysms:72.9%vs 86.9%,respectively,p=0.018),while there were no differences in the total complication *** large/giant non-saccular aneurysms,two groups showed no *** Use of the PED with adjunctive coils can significantly improve the occlusion rate of medium aneurysms,without increasing the total complication rate.

关键词： alone treatment sizes

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Pipeline Embolization Device for intracranial aneurysms presenting with mass effect:a large Chinese cohort

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Stroke & Vascular Neurology 2024年第1期9卷 50-58页

作者： Yang Zhao Junlin Lu Hongqi Zhang Tianxiao LI Donglei Song Sheng Guan Aisha Maimaitili Yunyan Wang Wenfeng Feng Yang Wang Jieqing Wan Guohua Mao huaizhang shi Xinjian Yang Jianmin Liu Yuanli Zhao Department of Neurosurgery Beijing Tiantan HospitalCapital Medical UniversityBeijingChina Department of Neurosurgery Peking University International HospitalBeijingChina Department of Neurosurgery West China HospitalSichuan UniversityChengduSichuanChina Department of Neurosurgery Xuanwu HospitalCapital Medical UniversityBeijingChina Department of Interventional Neuroradiology Zhengzhou University People's HospitalZhengzhouHenanChina Department of Neurosurgery Shanghai Donglei Brain HospitalShanghaiChina Department of Interventional Neuroradiology The First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina Department of Neurosurgery The First Affiliated Hospital of Xinjiang Medical UniversityUrumqiXinjiangChina Department of Neurosurgery Qilu Hospital of Shandong University QingdaoJinanShandongChina Department of Neurosurgery Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina Department of Neurosurgery The First Affiliated Hospital of Nanchang UniversityNanchangJiangxiChina Department of Neurosurgery Renji HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghaiChina Department of Neurosurgery The Second Affiliated Hospital of Nanchang UniversityNanchangJiangxiChina Department of Neurosurgery The First Affiliated Hospital of Harbin Medical UniversityHarbinHeilongjiangChina Department of Neurosurgery Changhai HospitalNaval Medical UniversityShanghaiChina

Background Unruptured intracranial aneurysm treatment aims to reduce the risk of aneurysm rupture and bleeding,relieves symptoms and improve the quality of life for *** study aimed to assess the safety and efficacy of Pipeline Embolization Device(PED,Covidien/Medtronic,Irvine,CA)treatment for intracranial aneurysms presenting with mass effect in real-world *** We selected patients from the PED in China Post-Market Multi-Center Registry Study with mass effect *** study endpoints included postoperative mass effect deterioration and mass effect relief at follow-up(3–36 months).We conducted multivariate analysis to identify factors associated with mass effect *** analyses by aneurysm location,size and form were also *** This study included 218 patients with a mean age of 54.3±11.8 years and a female predominance of 74.0%(162/218).The postoperative mass effect deterioration rate was 9.6%(21/218).During a median follow-up period of 8.4 months,the mass effect relief rate was 71.6%(156/218).Notably,immediate aneurysm occlusion following treatment was significantly associated with mass effect relief(OR 0.392,95%CI,0.170 to 0.907,p=0.029).Subgroup analysis demonstrated that adjunctive coiling contributed to mass effect relief in cavernous aneurysms,while dense embolism impeded symptom relief in aneurysms<10mm and saccular *** Our data confirmed the efficacy of PED in relieving mass *** findings of this study provide support for endovascular treatment to alleviate mass effect in unruptured intracranial *** registration number NCT03831672.

关键词： aneurysm intracranial Irvine

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Thrombus migration in patients with acute ischaemic stroke undergoing endovascular thrombectomy

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Stroke & Vascular Neurology 2024年第2期9卷 126-133,I0006-I0395页

作者： ZeFeng Tan Lei Zhang Li'an Huang Hongyu Qiao Min Guan Bing Yang Pengfei Yang Yongwei Zhang Hongjian Shen Yu Zhou Bo Hong huaizhang shi Hongxing Han Xinyi Leng Yi Dong Changlin Lian Wenhuo Chen Anding Xu Jianmin Liu Neurology First People's Hospital of FoshanFoshanGuangdongChina Department of Neurology Jinan University First Affiliated HospitalGuangzhouGuangdongChina Neurovascular Center Changhai HospitalNaval Medical UniversityShanghaiChina Department of Neurosurgery First Affiliated Hospital of Harbin Medical UniversityHarbinChina Department of Neurology Linyi People's HospitalLinyiShandongChina Medicine&Therapeutics The Chinese University of Hong KongHong KongChina Neurology Huashan Hospital Fudan UniversityShanghaiChina Neurology Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical UniversityZhangzhouFujianChina Stroke Center Jinan University First Affiliated HospitalGuangzhouGuangdongChina

Objective The impact of thrombus migration(TM)prior to endovascular thrombectomy(EVT)on clinical outcomes and revascularisation rates remains *** aimed to examine whether preinterventional TM modifies the treatment effects of direct EVT versus bridging EVT in acute large vessel occlusion *** All patients undergoing catheter angiography in the Direct Intra-arterial thrombectomy in order to Revascularise acute ischaemic stroke patients with large vessel occlusion Efficiently in Chinese Tertiary hospitals:A Multicentre randomised clinical Trial were *** was determined by radiologists unaware of the study by analysing discrepancies between computed tomographic angiography at baseline and first-run digital subtraction angiography before *** primary outcome was the score on the modified Rankin scale(mRS)assessed at 90 *** Of 627 included patients,the TM rate was 11.3%(71/627).In the multivariable logistic regression model,baseline National Institutes of Health Stroke Scale score(adjusted OR 0.956,95%CI 0.916 to 0.999;p=0.043)and intravenous thrombolysis(adjusted OR 2.614,95%CI 1.514 to 4.514;pshift analysis(p=0.687)or mRS scores of 0 to 1(p=0.436).Conclusion Preinterventional TM does not modify the treatment effects of direct versus bridging EVT on functional outcomes in patients with acute ischaemic stroke with anterior large vessel *** leads to a lower complete recanalisation rate.

关键词： patients throm acute

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重叠支架技术与血流导向装置在椎动脉夹层动脉瘤中的应用

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中国脑血管病杂志 2020年第11期17卷 701-706页

作者：张永智史怀璋哈尔滨医科大学附属第一医院神经外科 150001

椎动脉夹层动脉瘤的治疗目前以血管内介入治疗占绝大多数,但尚无统一方式。重叠支架技术及血流导向装置的出现,给椎动脉夹层动脉瘤的治疗提供了更多的选择。但两种技术的临床应用适应证尚无统一标准。作者对这两种治疗方式的病例报道、... 详细信息

椎动脉夹层动脉瘤的治疗目前以血管内介入治疗占绝大多数,但尚无统一方式。重叠支架技术及血流导向装置的出现,给椎动脉夹层动脉瘤的治疗提供了更多的选择。但两种技术的临床应用适应证尚无统一标准。作者对这两种治疗方式的病例报道、应用原理、对动脉瘤的血流动力学影响以及术后并发症的防治经验等方面进行综述,为临床医师治疗方式的应用提供一定的参考。

关键词：支架椎动脉夹层夹层动脉瘤血流导向装置综述

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Staged angioplasty versus regular carotid artery stenting in patients with carotid artery stenosis at high risk of hyperperfusion:a randomised clinical trial

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Stroke & Vascular Neurology 2021年第1期6卷 95-102页

作者： Dapeng Mo Baixue Jia huaizhang shi Yaxuan Sun Qingan Liu Chengzhe Fan Jianping Deng Jinglin Yuan Wei Wu Changchun Jiang Guilian Zhang Hanjun Du Ning Ma Feng Gao Xuan Sun Ligang Song Lian Liu Guangge Peng Yongjun Wang Yilong Wang Zhongrong Miao the STEP Study Group Interventional Neuroradiology Beijing Tiantan HospitalBeijingChina Neurosurgery First Affiliated Hospital of Harbin Medical UniversityHarbinChina Neurology Shaanxi Provincial People's HospitalXi'anChina Neurosurgery Harbin Medical University Fourth HospitalHarbinChina Neurology Beijing An Zhen HospitalBeijingChina Neurosurgery Tangdu HospitalThe Second Affiliated HospitalFourth Military Medical UniversityXi'anChina Neurology Daxing Teaching HospitalCapital Medical UniversityBeijingChina Neurology Shandong University Qilu HospitalJinanChina Neurology Baotou Central HospitalBaotouChina Neurology Xi'an Jiaotong University Second Affiliated HospitalXi'anChina Neurology Peking University Shougang HospitalBeijingChina China National Clinical Research Center for Neurological Diseases Beijing Tiantan HospitalBeijingChina Neurology Beijing Tiantan HospitalBeijingChina 不详

Background and purpose Hyperperfusion(HP)is a devastating complication associated with carotid artery stenting(CAS)or *** efficacy and safety of staged angioplasty(SAP)in patients with CAS at high risk of HP remains *** sought to determine whether SAP is superior to regular CAS in patients with high risk of *** A randomised,multicentre open-label clinical trial with blinded outcome assessment(STEP)was *** with severe carotid stenosis at high risk of HP were randomly assigned(1:1)to the SAP or regular CAS *** primary endpoint was hyperperfusion syndrome(HPS)and intracerebral haemorrhage(ICH)within 30 days after the *** From November 2014 to January 2017,a total of 64 patients were enrolled in 11 centres.33 patients were allocated to the SAP group and 31 to the regular CAS *** 30 days,the rate of primary endpoint was 0.0%(0/33)in the SAP group and 9.7%(3/31)in the regular CAS group(absolute risk reduction(ARR),9.7%;95%CI−20.1% to 0.7%;p=0.11).As one of the secondary endpoints,the incidence of HP phenomenon(HPP)was lower in the SAP group than the regular CAS group(0.0%vs 22.6%,ARR,−22.6%;95% CI−36.8%to−10.2%;p=0.04).Conclusion The rate of HPS and ICH was not significantly lower in SAP group;the extended secondary endpoint of HPP,however,significantly reduced,which suggested that SAP may be a safe and effective carotid revascularisation procedure to prevent HP.

关键词： patients carotid perfusion

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颅内动脉瘤破裂风险形态学与血流动力学预测因素的研究进展

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中国脑血管病杂志 2021年第5期18卷 334-338,343页

作者：孔繁毅史怀璋哈尔滨医科大学附属第一医院神经外科 150001

颅内动脉瘤破裂是蛛网膜下腔出血最常见的原因。蛛网膜下腔出血常伴有血管痉挛,具有较高的病死率和致残率。研究表明,动脉瘤破裂风险与动脉瘤的形态学和血流动力学存在显著相关性。筛选特定的形态学与血流动力学参数可以作为评估动脉瘤... 详细信息

颅内动脉瘤破裂是蛛网膜下腔出血最常见的原因。蛛网膜下腔出血常伴有血管痉挛,具有较高的病死率和致残率。研究表明,动脉瘤破裂风险与动脉瘤的形态学和血流动力学存在显著相关性。筛选特定的形态学与血流动力学参数可以作为评估动脉瘤破裂风险的指标,进而指导临床未破裂动脉瘤的治疗。该文就颅内动脉瘤破裂风险的形态学与血流动力学预测因素的研究进展进行了综述。

关键词：颅内动脉瘤破裂风险形态学血流动力学综述

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Safety of endovascular therapy for symptomatic intracranial artery stenosis:a national prospective registry

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Stroke & Vascular Neurology 2022年第2期7卷 166-171页

作者： Yabing Wang Tao Wang Adam Andrew Dmytriw Kun Yang Liqun Jiao huaizhang shi Jie Lu Tianxiao Li Yujie Huang Zhenwei Zhao Wei Wu Jieqing Wan Qinjian Sun Bo Hong Yongli Li Liyong Zhang Jianfeng Chu Qiong Cheng Yiling Cai Pengfei Wang Qi Luo Hua Yang Baijing Dong Yang Zhang Jun Zhao Zuoquan Chen Wei Li Xiaoxin Bai Weiwen He Xueli Cai Maimai Ti Osama O Zaidat Department of Neurosurgery Xuanwu HospitalBeijingChina Neuroendovascular Program Massachusetts General HospitalBostonMassachusettsUSA Department of Evidence-Based Medicine Xuanwu HospitalBeijingChina Department of Neurosurgery First Affiliated Hospital of Harbin Medical UniversityHarbinHeilongjiangChina Department of Radiology Xuanwu HospitalBeijingChina Center of Neurointerventional Therapy Henan Provincial People's HospitalZhengzhouChina Department of Neurology Nanjing Drum Tower HospitalNanjingJiangsuChina Department of Neurosurgery Tangdu Hospital Fourth Military Medical UniversityXi'anShaanxiChina Department of Neurology Shandong University Qilu HospitalJinanShandongChina Department of Neurosurgery Shanghai Jiao Tong University School of Medicine Affiliated Renji HospitalShanghaiShanghaiChina Department of Neurology Shandong Provincial HospitalJinanShandongChina Neusurgery Changhai HospitalShanghaiChina Department of Neurosurgery Second Affiliated Hospital of Harbin Medical UniversityHarbinHeilongjiangChina Department of Neurosurgery Liaocheng People's HospitalLiaocheng CityShandongChina Department of Neurosurgery Jining First People's HospitalJiningShandongChina Department of Neurology Fujian Provincial HospitalFuzhouFujianChina Department of Neurology 306 Hospital of People's Liberation ArmyBeijingChina Department of Neurosurgery Tianjin Huanhu HospitalTianjinTianjinChina Department of Neurosurgery Jilin University First HospitalChangchunJilinChina Department of Neurology Affiliated Hospital of Guiyang Medical CollegeGuiyangGuizhouChina Department of Neurosurgery Fourth Affiliated Hospital of Harbin Medical UniversityHarbinHeilongjiangChina Department of Neurosurgery Peking University First HospitalBeijingBeijingChina Department of Neurology Liaocheng Second People's HospitalLiaochengChina Department of Neurology Shanghai Tenth People's HospitalShanghaiChina Department of Neurosurgery Tianjin Medical University General HospitalTianjinTianjin

Introduction The safety outcomes of endovascular therapy for intracranial artery stenosis in a real-world stetting are largely *** Clinical Registration Trial of Intracranial Stenting for Patients with Symptomatic Intracranial Artery Stenosis(CRTICAS)was a prospective,multicentre,real-world registry designed to assess these outcomes and the impact of centre *** 1140 severe,symptomatic intracranial arterial stenosis(ICAS)patients treated with endovascular therapy were included from 26 centres,further divided into three groups according to the annual centre volume of intracranial angioplasty and stent placement procedures over 2 years:(1)high volume for≥25 cases/year;(2)moderate volume for 10–25 cases/year and(3)low volume for<10 cases/*** The rate of 30-day stroke,transient ischaemic attack or death was 9.7%(111),with 5.4%,21.1%and 9.7%in high-volume,moderate-volume and low-volume centres,respectively(p<0.05).Multivariable logistic regression confirmed high-volume centres had a significantly lower primary endpoint compared with moderate-volume centres(OR=0.187,95%CI:0.056 to 0.627;p≤0.0001),while moderate-volume and low-volume centres showed no significant difference(p=0.8456).Conclusion Compared with the preceding randomised controlled trials,this real-world,prospective,multicentre registry shows a lower complication rate of endovascular treatment for symptomatic ***-uniform utilisation in endovascular technology,institutional experience and patient selection in different volumes of centres may have an impact on overall safety of this treatment.

关键词： intracranial prospective stenosis

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血流导向装置治疗颅内动脉瘤的现状和展望

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中国脑血管病杂志 2023年第7期20卷 433-440页

作者：孙博文徐善才史怀璋哈尔滨医科大学附属第一医院神经外科 150001

血流导向装置的出现为颅内动脉瘤传统的瘤内栓塞提供了新的理念,治疗策略转至重建载瘤动脉并促进动脉瘤的愈合。近年来,血流导向装置的广泛应用将其适应证从最初的未破裂、大型或巨大型颈内动脉瘤拓展到多种类型颅内动脉瘤。但是,目前... 详细信息

血流导向装置的出现为颅内动脉瘤传统的瘤内栓塞提供了新的理念,治疗策略转至重建载瘤动脉并促进动脉瘤的愈合。近年来,血流导向装置的广泛应用将其适应证从最初的未破裂、大型或巨大型颈内动脉瘤拓展到多种类型颅内动脉瘤。但是,目前血流导向装置治疗仍存在诸如高围手术期并发症、远期支架内再狭窄等亟待解决的问题。随着更多的抗血小板聚集药物、药物涂层乃至生物可吸收血流导向装置的出现,未来动脉瘤治疗的方向与发展将逐渐明朗。

关键词：颅内动脉瘤药物疗法血管内治疗血流导向装置生物可吸收装置

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激光治疗神经系统肿瘤的进展

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中国激光医学杂志 2000年第3期9卷 158-160页

作者：史怀璋岳武哈尔滨医科大学第一临床医学院神经外科

自1966年Rosomoff和Carroll首次将激光应用于脑肿瘤治疗以来,随着激光器的不断完善及人们对激光与神经组织相互作用的认识的不断深入,激光在神经系统肿瘤治疗中的应用迅速发展,激光与手术显微镜、立体定向技术及神经系统内窥镜的有机结... 详细信息

自1966年Rosomoff和Carroll首次将激光应用于脑肿瘤治疗以来,随着激光器的不断完善及人们对激光与神经组织相互作用的认识的不断深入,激光在神经系统肿瘤治疗中的应用迅速发展,激光与手术显微镜、立体定向技术及神经系统内窥镜的有机结合,为神经系统肿瘤的治疗提供了更多的方法.现就激光在神经系统肿瘤治疗应用现状及进展综述如下:

关键词：激光疗法脑室镜神经系统肿瘤

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