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Efficacy of Acupuncture Combined with Local Anesthesia in Ischemic Stroke Patients with carotid artery stenting:A Prospective Randomized Trial

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Chinese Journal of Integrative Medicine 2020年第8期26卷 609-616页

作者： XIONG Wei ZHAO Chun-mei AN Li-xin XIE Si-ning JIA Chun-rong Department of Anesthesiology Beijing Tiantan HospitalCapital Medical UniversityBeijing 100015China Department of Anesthesiology Beijing Friendship HospitalCapital Medical UniversityBeijing 100050China Department of Traditional Chinese Medicine Beijing Tiantan HospitalCapital Medical UniversityBeijing 100015China

Objective:To evaluate the efficacy of electro-acupuncture(EA)or transcutaneous electrical acupoint stimulation(TEAS)on perioperative cerebral blood flow(CBF)and neurological function in ischemic stroke(IS)patients undergoing carotid artery stenting(CAS).Methods:In total,124 consecutive IS patients were randomly allocated to the EA,TEAS,and sham groups(groups A,T,and S;41,42,and 41 cases,respectively)by softwarederived random-number *** A and T received EA and TEAS,respectively,at the Shuigou(GV 26)and Baihui(GV 20),Hegu(LI4)and Waiguan(TE 5)*** S received sham *** stimulation was started from 30 min before surgery until the end of the *** primary outcome was the CBF at 30 min after surgery,which was measured by transcranial Doppler *** secondary outcomes included hyperperfusion incidence and neurological *** Institutes of Health Stroke Scale(NIHSS)and General Evaluation Scale(GES)scores were recorded at 1 week,1 month,and 3 months ***:Mean CBF velocity at 30 min after surgery in groups A and T was much lower than that in Group S(P<0.05);the incidence of hyperperfusion in Groups A and T was also lower than that in group S(P<0.05).Acupuncture was an independent factor associated with reduced incidence of hyperperfusion(OR=0.042;95%CI:0.002–0.785;P=0.034).NIHSS and GES scores improved significantly at 1 week postoperatively in Groups A and T than in Group S(P<0.05).Relative to Group S,groups A and T exhibited significantly lower incidences of moderate pain,as well as higher incidences of satisfaction with anesthesia,at 1 day postoperatively(P<0.05).Conclusion:EA or TEAS administered in combination with local anesthesia during CAS can inhibit transient increases in CBF,reduce the incidence of postoperative hyperperfusion,and improve neurological function.

关键词： electro-acupuncture transcutaneous electrical acupoint stimulation carotid artery stenting cerebral blood flow neurological function

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Evaluation of ischemic lesions after carotid artery stenting with diffusion-weighted imaging

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World Journal of Clinical Cases 2020年第10期8卷 1859-1870页

作者： Murat Beyhan Berat Acu Erkan Gokce Mehmet Murat Firat Department of Radiology Tokat Gaziosmanpasa University Faculty of MedicineTokat 60100Turkey Department of Radiology Eskisehir Osmangazi University Faculty of MedicineEskisehir 26480Turkey Department of Radiology Guven HospitalAnkara 06540Turkey

BACKGROUND Almost 90%of cerebral thromboembolism cases are caused by *** atherosclerosis is often observed at the carotid bifurcation and is responsible for 20%-30%of all stroke *** course of atherosclerotic carotid artery stenosis varies depending on the grade of stenosis and characteristics of the *** artery stenting(CAS)can be used as a less invasive method in patients with symptomatic and asymptomatic high-grade carotid artery ***-weighted imaging(DWI)is an effective method for detection of silent or symptomatic acute ischemic lesions that may arise due to CAS or carotid *** number and volume of new ischemic lesions are determined using *** To evaluate the number and volume of ischemic lesions and their cerebral parenchymal and vascular distribution after CAS using *** Forty-seven male(73.4%)and seventeen female(26.6%)patients(total,n=64)aged 42-84 years(mean 67.96±8.03 years)diagnosed with carotid stenosis between October 2006 and July 2012 were included in this retrospective *** of the cases(18.8%)were asymptomatic,while fifty-two(81.2%)were *** area where the stenosis was highest was measured,and the stenosis rate was determined using the North American Symptomatic carotid Endarterectomy Trial *** of the cases was evaluated by two radiologists experienced in neuroradiology(*** more than 15 years of experience,*** more than 10 years of experience).Routine DWI examinations were carried out by a 1.5 T MR device 1 h before and after the *** the ischemic lesions that developed in the first hour and in the follow-up period of 5-24 h were assumed to be due to CAS,all lesions within the first 24 h were considered as new *** In the present study,39 new ischemic lesions were detected in 20 *** average number of new lesions after all CAS operations was *** were mostly located in the occipital lobes,followed by

关键词： carotid artery stenosis carotid artery stenting Diffusion-weighted imaging Ischemia Stroke

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Ileal hemorrhagic infarction after carotid artery stenting:A case report and review of the literature

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World Journal of Clinical Cases 2021年第22期9卷 6410-6417页

作者： Xue-Yu Xu Wei Shen Gang Li Xi-Feng Wang Yang Xu Department of Neurology Wuhan Fourth HospitalWuhan 430000Hubei ProvinceChina Department of Pharmacy Wuhan Fourth HospitalWuhan 430000Hubei ProvinceChina

BACKGROUND Ileal hemorrhagic infarction after carotid artery stenting(CAS)is a fatal *** prognosis of ileal hemorrhagic infarction after CAS is very poor if not treated in a timely *** describe a rare case of ileal hemorrhagic infarction due to acute embolism of the mesenteric artery after *** SUMMARY A 67-year-old man with acute ischemic stroke underwent CAS via the right femoral artery approach 21 d after intensive medical *** the first day after surgery,the patient had abdominal distension and abdominal *** enhanced computed tomography revealed intestinal obstruction,severe stenosis of the superior mesenteric artery,and poor distal *** exploratory laparotomy was performed,and pathological examination showed hemorrhagic ileal *** was subsequently found that the patient had intestinal *** the guidance of an ultrasound scan,the patient underwent abdominal puncture,drainage,and *** 58 d of treatment,the patient was discharged from hospital with a National Institutes of Health Stroke Scale score of 2 points,and a Modified Rankin Scale score of 1 *** the 6-mo follow-up,the patient had an excellent functional outcome without stroke or mesenteric ***,computed tomography angiography showed that the carotid stent was *** Ileal hemorrhagic infarction is a fatal complication after CAS,usually caused by mesenteric artery ***,more attention should be paid to the complications of embolism in the vascular system as well as the nervous system after CAS,and the complications should be identified and treated as early as possible.

关键词： Ileal hemorrhagic infarction carotid artery stenting Complication Embolism Mesenteric artery Case report

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carotid artery stenting in patients with coexistent carotid and coronary artery disease

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Chinese Medical Journal 2007年第7期120卷 608-610页

作者： LUO Jian-fang HUANG Wen-hui WANG Shuo DAI Cheng-bo LI Guang CHEN Ji-yan ZHOU Ying-ling WANG Li-juan Department of Cardiology Guangdong Provincial Cardiovascular Institute Guangdong Provincial People＇s Hospital Guangzhou 510100 China Department of Neurology Guangdong Provincial People＇s Hospital Guangzhou 510100 China

Atherosclerotic disease, as a systemic process, affects all arteries to varying degrees. In particular,coexistent carotlid aria coronary artery diseases are common; Management of such patients has been a point of continuing controversy. Current American Heart Association （AHA） guidelines recommend carotid endarterectomy （CEA） in symptomatic patients with carotid artery stenosis of 50%-99% and in asymptomatic patients with stenosis of 60%-99%. carotid artery stenting （CAS） has become a reasonable alternative to CEA, particularly in patients at high risk for CEA. We sought to assess feasibility, safety and midterm outcome of carotid artery stenting in patients with coexisting symptomatic coronary disease and carotid artery stenosis.

关键词： carotid artery stenting carotid artery disease coronary artery disease

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Intravascular ultrasonography assisted carotid artery stenting for treatment of carotid stenosis: Two case reports

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World Journal of Clinical Cases 2023年第29期11卷 7127-7135页

作者： Peng-Cheng Fu Jing-Yi Wang Ying Su Yu-Qi Liao Shao-Ling Li Ge-Lin Xu Yan-Jiao Huang Ming-Hua Hu Li-Ming Cao Department of Neurology The First Affiliated Hospital of Shenzhen UniversityShenzhen 518000Guangdong ProvinceChina Faculty of Chinese Medicine Macao University of Science and TechnologyMacao 999078China Graduate School Guangzhou Medical UniversityGuangzhou 511495Guangdong ProvinceChina School of Medicine Shenzhen UniversityShenzhen 518000Guangdong ProvinceChina Medical Department Baise People’s HospitalBaise 533000Guangxi Zhuang Autonomous RegionChina Hunan Provincial Key Laboratory of the Research and Development of Novel Pharmaceutical Preparations Changsha Medical UniversityChangsha 410219Hunan ProvinceChina Clinical College of the Shenzhen Second People’s Hospital Anhui Medical UniversityShenzhen 518000Guangdong ProvinceChina

BACKGROUND Digital subtraction angiography(DSA),the gold standard of cerebrovascular disease diagnosis,is limited in its diagnostic ability to evaluate arterial *** ultrasonography(IVUS)has advantages in assessing stenosis and plaque nature and improves the evaluation and effectiveness of carotid artery sten-ting(CAS).CASE SUMMARY Case 1:A 65-year-old man presented with a five-year history of bilateral lower limb weakness due to *** examination showed decreased strength(5-/5)in both lower *** artery ultrasound,magnetic resonance angiography,and computed tomography angiography(CTA)showed a right proximal internal carotid artery(ICA)stenosis(70%-99%),acute cerebral infarction,and severe right ICA stenosis,*** performed IVUS-assisted CAS to measure the stenosis and detected a low-risk plaque at the site of stenosis prior to stent ***-stent balloon dilatation was performed and postoperative IVUS demonstrated successful expansion and *** six months postoperatively showed no significant increase in in-stent *** 2:A 36-year-old man was admitted with a right common carotid artery(CCA)dissection detected by *** examination showed no positive neurological *** ultrasound and CTA showed lumen dilation in the proximal CCA with an intima-like structure and bulging in the proximal segment of the right CCA with strip-like low-density shadow(dissection or carotid web).IVUS-assisted DSA confirmed right CCA *** was performed and intraoperative IVUS suggested a large residual false ***-stent balloon dilatation was performed reducing the false *** three months postoperatively indicated good stent expansion with mild *** IVUS aids decision-making during CAS by accurately assessing carotid artery wall lesions and plaque nature preoperatively,dissection and stenosis morphology intraoperatively,and visualizing and confirming CAS postoperati

关键词： Intravascular ultrasonography carotid artery stenting carotid stenosis Arteriosclerotic stenosis carotid artery dissection Case report

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Fracture of a cerebral protection device wire in carotid artery stenting： an unexpected complication

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Chinese Medical Journal 2008年第12期121卷 1148-1149页

作者： QU Le-feng Wolfgang Ritter Dieter Raithel Department of Vascular Surgery Changhai Hospital Second Military Medical University Shanghai 200433 China Department of Radiology Nuernberg Southern Hospital Nuernberg 90471 Germany Department of Vascular and Endovascular Surgery Nuernberg Southern Hospital Nuernberg 90471 Germany

There are very few reports concerning the failure of devices used in carotid artery stenting. Here we report a fracture of the distal part of the guiding wire of a cerebral protection device during carotid artery sten... 详细信息

关键词： carotid artery stenting cerebral protection device wire, fracture complication

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Perioperative Evaluation of Cerebral Blood Flow Using ^123I-labeled N-isopropyl-p-iodoamphetamine Single-Photon Emission Computed Tomography without Blood Sampling in Patients Who Underwent carotid artery stenting

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Chinese Medical Journal 2016年第13期129卷 1616-1618页

作者： Naoki Matsumoto Rei Enatsu Yasuzumi Matsui Hiroyuki Ikeda Norikazu Yamana Masashi Oda Masaaki Saiki Osamu Narumi Department of Neurosurgery National Hospital Organization Himeji Medical Center Himeji 670-8520 Hyogo Japan

The evaluation of regional cerebral vascular reserve （rCVR） with single-photon emission computed tomography （SPECT） is useful for predicting cerebral hyperperfusion following carotid artery stenting （CAS） and ca... 详细信息

关键词： carotid artery Stenosis carotid artery stenting N-isopropyl-p-iodoamphetamine-Rest and True Acetazolamide Images Estimated Method Using Dynamic Acquisition Single-Photon Emission Computed Tomography

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Transcervical access,reversal of flow and mesh-covered stents:New options in the armamentarium of carotid artery stenting

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World Journal of Cardiology 2017年第5期9卷 416-421页

作者： Kosmas I Paraskevas Frank J Veith Northern Vascular Centre Freeman Hospital Divisions of Vascular Surgery New York University Langone Medical Center the Cleveland Clinic

In the last 25 years, the very existence of carotid artery stenting(CAS) has been threatened on a number of occasions. The initial disappointing results that even lead to the discontinuation of an early randomized controlled trial have improved considerably with time. Novel devices, advanced stent and equipment technology, alternative types of access and several types of filters/emboli protecting devices have been reported to reduce stroke/death rates during/after CAS and improve CAS outcomes. The present review will provide a description of the various technology advances in the field that aim to reduce stroke and death rates associated with CAS. Transcervical access, reversal of flow and mesh-covered stents are currently the most promising tools in the armamentarium of CAS.

关键词： carotid artery stenting Stroke carotid artery stenosis Filters

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Comparison of carotid artery Endarterectomy and carotid artery stenting in Patients With Atherosclerotic carotid Stenosis

Comparison of Carotid Artery Endarterectomy and Carotid Arte...

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2014浙江省神经外科学学术年会

作者：张建民 Dong Xiao Shao Anwen Zhou Jingyi Liu Fuyi Hong Yuan Department of Neurosurgery Second Affiliated HospitalSchool of MedicineZhejiang University

Background:The choice of carotid artery endarterectomy(CEA)or carotid artery stenting(CAS),as surgical and interventional treatment of atherosclerotic carotid stenosis,respectively,has been controversial in decades,especially for asymptomatic patients with carotid *** and the diameter of impaired carotid artery might be 2 important factors to decide whether CEA or CAS should be ***,contrast-enhanced ultrasound(CEUS)has been confirmed as an effective method to predict the risk of stroke by classifying the carotid plaque into 4 *** role of CEUS in the choice of CEA or CAS still remains ***:A retrospective analysis of 38 patients who underwent CEA with primary closure and 36 patients who underwent CAS in our hospital from October 2008 to January2013 is *** CEUS was performed to all patients,and data were collected and *** CEAs were performed with transverse ***:The hospital stay was longer for the endarterectomy group than the stenting group(15.39 versus 10.91 d,Pcarotid artery greater than or equal to5 mm and in the group with internal carotid artery less than 5 mm(9.1%versus 6.3%,P=0.75).No restenosis occurred in either of the subgroups during the *** patients older than 70 years,the perioperative complications were 0%in CEA and10.53%in CAS(P=0.42);the long-term restenosis was 0%in CEA and 5.26%in CAS(P=0.67).In patients younger than 70 years,the perioperative complications were 11.5%in CEA and 23.53%in CAS(P=0.31);the long-term restenosis was 0%in CEA and 0%in CAS(P>0.01).For patients with grade 4 plaque in CEUS,the incidence of adverse events in the CAS group was significantly higher than that in the CEA group(7.14

关键词： carotid artery endarterectomy carotid artery stenting the diameter of ICA age contrast-enhanced ultrasound

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Topical anaesthesia before transradial approach for supraoartic vessels angiography and stenting in the elderly： a feasible alternative

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Journal of Geriatric Cardiology 2017年第10期14卷 644-648页

作者： Gianluca Rlgatelli Marco Zuin Fabio Dell'Avvocata Dobrin Vassiliev Section of Cardiovascular Diagnosis and Endoluminal Interventions Rovigo General Hospital Rovigo Italy Section of Internal and Cardiopulmonary Medicine Department of Medical Science University of Ferrara Ferrara Italy Department of Cardiology Rovigo General Hospital Rovigo Italy Head Cardiology Department Alexandroska University Hospital Sofia Bulgaria

Over the years, the use of transradial approach （TRA） for carotid artery stenting （CAS） with distal embolic protection has been recognized as a valid alternative to the conventional femoral approach, improving the outcomes compared to carotid endoatherectomy.0-33 Indeed, despite the femoral artery remains the conventional access site for the endovascular treatment of supraoartic vessels, concomitant anatomical variations and/or peripheral vascular disease could complicate the cannulation of such arteries. Moreover, the TRA has been related with a lower incidence of bleeding complications and a shorter bed rest after the interventional procedure.

关键词： carotid artery stenting Stenosis Transradial approach

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