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

Chinese Neurosurgical Journal 2022年第4期8卷 215-220页

作者： Yazhou Yan Li Du Xiliang He Qinghai Huang Yuan Pan Tao Xin Stroke Center of 971 Hospital of PLA Qingdao 266071China Department of Neurosurgery of Changhai Hospital affiliated to the Naval Military Medical University ShanghaiChina

Background:endovascular treatment(EVT)for acute ischemic stroke with an occlusion of the M1 segment due to intracranial atherosclerotic severe stenosis(ICASS)remains *** study aimed to evaluate the safety and efficacy of EVT for ICASS-related M1 acute ***:We retrospectively reviewed all patients with an ICASS-related M1 acute occlusion who underwent EVT at our institution between January 2015 and December *** presentation,baseline characteristics,angiographic and clinical results,technical feasibility,perioperative complications,and follow-up results were ***:Twenty-two patients with ICASS-related M1 acute occlusion were *** patients(36.4%)received bridging therapy,and the other 14 patients(63.6%)directly underwent *** patients(68.2%)treated with balloon dilations and stenting as rescue *** patients(27.3%)received single balloon angioplasty,and 5 of these patients were treated with staged *** case(4.5%)failed recanalization at the first EVT,and successful revascularization was achieved a month *** mean procedure time was 67.2±20.8 *** revascularization(mTICI≥2b)was achieved in 95.5%(21/22)of *** complications developed in two patients(9.1%)including one hemorrhagic event and one thromboembolic *** follow-up was available in 20 patients(90.9%)at an average of 8.6±3.0 *** degree of stenosis was worse(10-30%)in 6 cases(30%)compared with the initial *** 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 *** single balloon angioplasty at the first EVT generally cannot achieve satisfactory results and often needed staged stenting treatment.

关键词： endovascular treatment M1 occlusion Intracranial severe stenosis Rescue therapy

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Transileocolic endovascular treatment by a hybrid approach for severe acute portal vein thrombosis with bowel necrosis:Two case reports

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World Journal of Clinical Cases 2022年第6期10卷 1876-1882页

作者： Sayaka Shirai Tatsuo Ueda Fumie Sugihara Daisuke Yasui Hidemasa Saito Hiroyasu Furuki Shiei Kim Hiroshi Yoshida Shoji Yokobori Hiromitsu Hayashi Shin-ichiro Kumita Department of Radiology Nippon Medical School HospitalBunkyo-ku 113-8603TokyoJapan Department of Radiology Nippon Medical School Musashi Kosugi HospitalKawasaki-shi 211-8533KanagawaJapan Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery Nippon Medical School Tamanagayama HospitalTama-shi 206-8512TokyoJapan Department of Emergency and Critical Care Medicine Nippon Medical School HospitalBunkyo-ku 113-8603TokyoJapan Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery Nippon Medical School HospitalBunkyo-ku 113-8603TokyoJapan

BACKGROUND Acute portal vein thrombosis(PVT)with bowel necrosis is a fatal condition with a 50%-75%mortality *** report describes the successful endovascular treatment(EVT)of two patients with severe *** SUMMARY The first patient was a 22-year-old man who presented with abdominal pain lasting 3 *** second patient was a 48-year-old man who presented with acute abdominal *** contrast-enhanced computed tomography,both patients were diagnosed with massive PVT extending to the splenic and superior mesenteric *** treatment(simultaneous necrotic bowel resection and EVT)was performed in a hybrid operating room(OR).EVTs,including aspiration thrombectomy,catheter-directed thrombolysis(CDT),and continuous CDT,were performed via the ileocolic vein under *** portal veins were patent 4 and 6 mo posttreatment in the 22-year-old and 48-year-old patients,*** Hybrid necrotic bowel resection and transileocolic EVT performed in a hybrid OR is effective and safe.

关键词： Bowel necrosis endovascular treatment Hybrid operating room Hybrid treatment Portal vein thrombosis Transileocolic approach Case report

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Ruptured splenic artery aneurysms in pregnancy and usefulness of endovascular treatment in selective patients:A case report and review of literature

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World Journal of Clinical Cases 2022年第25期10卷 9057-9063页

作者： Sang Hun Lee Songsoo Yang Inkyu Park Yeong Cheol Im Gyu Yeol Kim Department of Obstetrics and Gynecology Ulsan University and Ulsan University HospitalUlsan 44033South Korea Department of Surgery Ulsan University and Ulsan University HospitalUlsan 44033South Korea

BACKGROUND The rupture of a splenic artery aneurysm(SAA)in pregnancy is an uncommon ***,it is associated with high mortality rates in pregnant women and fetuses even after surgical *** the endovascular treatment of SAAs is currently preferred as it can improve the outcomes even in emergent cases,the endovascular treatment of a ruptured SAA during pregnancy has not been reported until *** SUMMARY We report a case of a 33-year-old woman with the sudden onset of epigastric pain due to a ruptured SAA at the mid-portion of the splenic artery at 18 wk of *** emergent initial resuscitation,the patient was diagnosed with a ruptured SAA through digital *** upon diagnosis,she underwent emergent endovascular embolization of the splenic artery for the rupture on the ***,surgery was performed to remove the hematoma under stable *** the fetus was found to be dead during resuscitation,the woman recovered without complications and was discharged 15 d *** endovascular treatment might be a valuable alternative to surgery/lead to safer surgery for selected pregnant patients with ruptured SAAs.

关键词： Splenic artery Aneurysm Pregnancy endovascular treatment Case report

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Risk factors for periprocedural ischemic stroke following endovascular treatment of intracranial aneurysms

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Chinese Neurosurgical Journal 2022年第1期8卷 45-50页

作者： Yisen Zhang Chao Wang Zhongbin Tian Wei Zhu Wenqiang Li Xinjian Yang Jian Liu Ying Zhang Department of Interventional Neuroradiology Beijing Neurosurgical Institute and Beijing Tian Tan HospitalCapital Medical UniversityNo.119South 4th Ring West RoadFengtai DistrictBeijing 100070China

Background:The aim of this study was to comprehensively evaluate the risk factors of periprocedural ischemic stroke associated with endovascular treatment of intracranial aneurysms using a real-world ***:From August 2016 to March 2017,167 patients were *** analysis and multivariate logistic regression analysis were used to examine the risk factors for periprocedural ischemic ***:Among the 167 cases,periprocedural ischemic stroke occurred in 20 cases(11.98%).After univariate analysis,the ischemic group had a higher proportion of large(≥10 mm)aneurysms than the control group(45.0%vs.23.1%,p=0.036).The incidence of periprocedural ischemic stroke was higher in cases treated by flow diverter(21.6%)or stent-assisted coiling(11.8%)than in cases treated by coiling only(2.7%),and the differences were statistically significant(p=0.043).After multivariate logistic regression analysis,treatment modality was the independent risk factor for periprocedural ischemic *** with the coiling-only procedure,flow diverter therapy was associated with a significantly higher rate of periprocedural ischemic stroke(OR 9.931;95%CI 1.174-84.038;p=0.035).Conclusions:Aneurysm size and treatment modality were associated with periprocedural ischemic *** aneurysms were associated with increased risk of periprocedural ischemic *** diverter therapy was associated with significantly more periprocedural ischemic stroke than the coiling procedure alone.

关键词： Periprocedural ischemic stroke endovascular treatment Intracranial aneurysms Aneurysm size treatment modality

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Plaque characteristics after endovascular treatment in patients with intracranial Plaque characteristics after endovascular treatment in patients with intracranial atherosclerotic disease

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Chinese Neurosurgical Journal 2023年第1期9卷 1-8页

作者： Shun Zhang Junjie Wang Jun Lu Peng Qi Shen Hu Ximeng Yang Kunpeng Chen Daming Wang Department of Neurosurgery Beijing HospitalNational Center of GerontologyDongchengBeijingChina Graduate School of Peking Union Medical College DongchengBeijingChina

Background:endovascular treatment(EVT)is an alternative option for symptomatic intracranial atherosclerotic disease(ICAD).However,the effect of EVT treatment on ICAD plaques is still *** study describes the ICAD plaque characteristics after EVT treatment and analyzes the effect of different EVT treatments on plaque ***:From 2017 January to 2022 January,ICAD patients who underwent endovascular treatment and had follow-up high-resolution magnetic resonance image(HRMRI)were enrolled in the *** plaque characteristics,including plaque enhancement,plaque burden,were measured based on preoperative,and follow-up *** characteristics and postoperative plaque changes were analyzed between different treatment ***:Finally,50 intracranial atherosclerotic plaques in 45 patients were *** 28 male patients and 17 female,media age 63.0 years *** 50 plaques,41 received percutaneous angioplasty(including 22 plain balloons and 19 drug-coated balloons(DCB))and the other 9 underwent *** rate,plaque burden and eccentricity index at the lesion site were significantly decreased after EVT compared with preoperative periods(ptreatment could compromise the characteristics of intracranial periarterial atherosclerotic plaques,and DCB treatment may result in a reduction in plaque enhancement after treatment.

关键词： Intracranial atherosclerotic disease endovascular treatment Plaque characteristics Follow-up HRMRI

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endovascular treatment of the Huge Dissecting Aneurysms Involving the Basilar Artery by the Internal Trapping Technique： Technical Note

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Chinese Medical Journal 2015年第14期128卷 1916-1921页

作者： Shi-Qing Mu Xin-Jian Yang You-Xiang Li Chu-Han Jiang Zhong-Xue Wu Department of Interventional Neuroradiology Beijing Neurosurgical Institute and Beijing Tiantan Hospital Capital Medical University Beijing 100050 China

Background： The endovascular strategy of the huge dissecting aneurysms involving the basilar artery （BA） is controversial and challenging. This study was to investigate the clinical and angiographic outcomes of the treatment of the huge dissecting aneurysms involving the BA by the internal trapping （IT） technique. Methods： We retrospectively studied 15 patients with the huge dissecting aneurysms involving the BA treated by the IT technique between September 2005 and September 2014 in Department of Interventional Neuroradiology of Beijing Tiantan Hospital. Clinical and angiographic data were reviewed and evaluated. Results： All patients were treated by the IT technique. That meant the dissecting artery and aneurysm segments were completed occlusion. After the procedure, the angiography demonstrated that all the dissecting artery and aneurysm segments were completed occlusion. Follow-up angiography was performed at 3-6 months or 12-18 months alter the endovascular treatment （median 8 months）, 14 patients had a good recovery. Re-canalization occurred in one patient whose aneurysm involved in bilateral vertebral arteries and the two third of the middle-lower BA. After the second treatment, the patient died by the ventricular tachycardia. Conclusions： The IT technique is a technically feasible and safe alternative for the treatment of BA dissecting aneurysms, but it is not necessarily the safest or most definitive treatment modality. The ideal treatment of the huge dissecting aneurysms involving the BA remains debatable and must be investigated on a case-by-case basis.

关键词： Basilar Artery endovascular treatment Huge Dissecting Aneurysms Internal Trapping Technique

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endovascular treatment of pseudo-aneurysm occurring after embolization of traumatic carotid cavernous fistula with detachable balloons

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Chinese Medical Journal 2008年第15期121卷 1487-1491页

作者： FANG Chun LI Ming-hua TAN Hua-qiao ZHANG Pei-lei ZHOU Bin Department of Radiology Sixth People's Hospital Shanghai Jiao Tong University Shanghai 200233 China

Traumatic carotid-cavemous fistula （CCF） is an abnormal passageway between the intracavemous carotid artery and the cavernous sinus after a head injury. Most CCFs have direct high flow. Clinical presentations primarily depend on the pressure inside the cavernous sinus and on the direction of the venous drainage. The ideal goal for the treatment of direct CCF is the obliteration of the fistula while preserving the internal carotid artery （ICA）. Transarterial embolization of direct CCF with detachable balloons has been proven to be the best option for an initial treatment, although transarterial embolization by detachable balloons is frequently associated with pseudo-aneurysm formation. Many treatment options such as coiling, stent-assisted coiling, and covered stent have been proposed to treat pseudo-aneurysm. However, the best management for a pseudo-aneurysm occurring after an embolization of a CCF with detachable balloons remains unknown. In this article, we will report our successful attempt in treating the said pseudo-aneurysm. We initially dealt with a pseudo-aneurysm occurring after an embolization of a CCF with stent-assisted coiling; then, the pseudoaneurysm recanalized, and eventually a covered stent was placed for the recanalized pseudoaneurysm.

关键词： carotid-cavernousfistula pseudo-aneurysm covered stent endovascular treatment

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endovascular treatment of wide-necked intracranial aneurysms using of ＂remodeling technique＂ with the HyperForm balloon

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Chinese Medical Journal 2008年第8期121卷 725-729页

作者： MU Shi-qing YANG Xin-jian LI You-xiang ZHANG You-ping LU Ming WU Zhong-xue Department of Neuroradiosugery Beijing Neurosurgical Institute Capital Medical University Beijing 100053 China

Background Aneurysms with wide-necked or a large neck/fundus ratio, especially located on an arterial bifurcation or a small artery, are challenges for interventional neuroradiologist because of the risk of coil migration or coil protrusion into the parent vessels. Our study was designed to improve the efficacy and safety of the ＂remodeling technique＂ with the HyperForm balloon for these difficult aneurysms and was confirmed by a follow-up result. Methods From June 2004 to September 2006, forty-two patients （20 men, 22 women） with wide-necked or large neck/fundus ratio aneurysms were treated by using the ＂remodeling technique＂ with the HyperForm balloon. Results Forty wide-necked aneurysms were successfully treated with the HyperForm balloon remodeling technique with only two failed cases. Final results consisted of total occlusion in 34 cases （80.9%）, subtotal in 4 （9.5%） and incomplete in 2 （4.8%）. One aneurysmal rupture occurred, but no clinical consequence was shown. No thromboembolic events were observed during treatment. Final angiographic follow-up time ranged from 3 to 18 months. Conclusions The ＂remodeling technique＂ with the HyperForm balloon is a very useful tool in the treatment of wide-necked or unfavorable neck/fundus ratio intracranial aneurysms - located on an arterial bifurcation or a small artery and, especially, located on the bifurcation of a large artery and a small one. In our experience, this technique provided a safe and efficient treatment for difficult aneurvsms when the standard remodelina techniaue miaht have failed.

关键词： aneurysms remodeling technique HyperForm balloon endovascular treatment

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endovascular treatment of diabetic foot ischemic ulcer–Technical review

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Journal of Interventional Medicine 2020年第1期3卷 17-26页

作者： Yew Toh Wong Flinders Medical Centre Bedford ParkSouth AustraliaAustralia

This article is a technical review of the common techniques used in the treatment of lower-limb occlusive arterial disease associated with *** techniques described here reflect the author’s own practice and are methods that the author finds helpful in avoiding complications and in making the technical aspects of the procedures easier.

关键词： Diabetes Foot ulcer Ischemia endovascular treatment Angioplasty Stenting Retrograde access Subintimal Intraluminal Pedal arch Perfusion

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Trans-cranial Doppler predicts early neurologic deterioration in anterior circulation ischemic stroke after successful endovascular treatment

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Chinese Medical Journal 2020年第14期133卷 1655-1661页

作者： Yan-Bo He Ying-Ying Su Gary BRajah Ying-Bo Zhang Un-Lin Fan Gang Liu Hong-Bo Chen Department of Neurology Xuanwu HospitalCapital Medical UniversityBeijing 100053China Department of Neurology The Beijing Moslem People's HospitalBeijing 100054China Department of Neurosurgery Jacobs School of Medicine and Biomedical SciencesUniversity at BuffaloBuffaloNY 14201USA Department of Neurosurgery Gates Vascular Institute at Kaleida HealthBuffaloNY 14201USA.

Background:Early neurologic deterioration(END)may occur in patients with anterior circulation ischemic stroke(ACIS)after receiving endovascular treatment(EVT).Hemodynamic insufficiency,re-occlusion,and post-re-canalization hyper-perfusion are likely to play a critical role in *** hypothesized that hemodynamic changes can predict END in patients with ACIS postsuccessful EVT using trans-cranial Doppler(TCD).Methods:We utilized a prospectively maintained database of ACIS patients treated with EVT between September 2016 and June 2018 in the Xuanwu Hospital,Capital Medical *** parameters including peak systolic velocity(PSV),bilateral mean flow velocity(MFV),and pulse index(PI)were determined via the middle cerebral arteries within 72 h post-EVT.A logistic regression model was applied to detect independent predictors for ***:Totally,112 EVT patients were included in this study and 80/112 patients experienced successful re-canalization with<50%residual stenosis,while 17/80(21.3%)patients suffered END,for which vasogenic cerebral edema(11/17)was considered as a leading role and followed by symptomatic intra-cranial hemorrhage(4/17)and ischemia progression(2/17).For the 80 patients,the PSV(median:127 cm/s vs.116 cm/s,P=0.039),the ratio of ipsilateral-MFV/contra-lateral-MFV(iMFV/cMFV)(median:1.29 vs.1.02,P=0.036)and iMFV/mean blood pressure(MBP)(median:0.97 vs.0.79,P=0.008)in END patients were higher than those of *** the receiver-operating characteristic curve to obtain cut-off values for PSV,PI,iMFV/cMFV,and iMFV/MBP for END,we found that PI≥0.85(odds ratio:11.03,95%confidence interval:1.92–63.46,P=0.007)and iMFV/MBP≥0.84(odds ratio:9.20,95%confidence interval:2.07–40.84,P=0.004)were independent predictors of END in a multivariate logistic regression model,with a sensitivity of 82.4%and 76.5%and a specificity of 42.9%and 66.7%,respectively,and had the positive predictive values of 29.0%and 38.2%,and negative predictive values of 90.0%and 91.

关键词： Cerebrovascular disease/acute ischemic stroke endovascular treatment Thrombectomy Diagnostic methods Transcranial Doppler

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