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bridging therapy and direct mechanical thrombectomy in the treatment of cardiogenic cerebral infarction with anterior circulation macrovascular occlusion

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World Journal of Clinical Cases 2021年第27期9卷 8051-8060页

作者： Hong-Ju Ding Cong Ma Fu-Ping Ye Ji-Fang Zhang Department of Emergency Qingdao Jiaozhou Central HospitalQingdao 266300Shandong ProvinceChina Department of Neurology Qingdao Jiaozhou Central HospitalQingdao 266300Shandong ProvinceChina Department of Gastrointestinal Surgery Qingdao Jiaozhou Central HospitalQingdao 266300Shandong ProvinceChina Department of Neurosurgery Qingdao Municipal HospitalSchool of MedicineQingdao UniversityQingdao 266071Shandong ProvinceChina

BACKGROUND Intravenous thrombolysis is an important treatment for cerebral ***,it is difficult to achieve good results if the patient is complicated with anterior circulation macrovascular *** addition,the vascular recanalization rate is low,so mechanical thrombectomy,that is,bridging therapy,is needed AIM To investigate the efficacy and safety of bridging therapy and direct mechanical thrombectomy in the treatment of cardiogenic cerebral infarction with anterior circulation macrovascular *** Ninety-six patients in our hospital with cardiogenic cerebral infarction with anterior circulation macrovascular occlusion from January 2017 to July 2020 were divided into a direct thrombectomy group(n=48)and a bridging group(n=48).Direct mechanical thrombectomy was performed in the direct thrombectomy group,and bridging therapy was used in the bridging treatment *** were performed for the treatment data of the two groups(from admission to imaging examination,from admission to arterial puncture,from arterial puncture to vascular recanalization,and from admission to vascular recanalization),vascular recanalization rate,National Institutes of Health Stroke Scale(NIHSS)and Glasgow Coma Scale(GCS)scores before and after treatment,prognosis and incidence of adverse *** In the direct thrombectomy group,the time from admission to imaging examination was 24.32±8.61 min,from admission to arterial puncture was 95.56±37.55 min,from arterial puncture to vascular recanalization was 54.29±21.38 min,and from admission to revascularization was 156.88±45.51 min,and the corresponding times in the bridging treatment group were 25.38±9.33 min,100.45±39.30 min,58.14±25.56 min,and 161.23±51.15 min;there were no significant differences between groups(P=0.564,0.535,0.426,and 0.661,respectively).There was no significant difference in the recanalization rate between the direct thrombectomy group(79.17%)and the bridging group(75.00%)(P=0.627)

关键词： bridging therapy Direct mechanical thrombectomy Cardiogenic cerebral infarction Anterior circulation macrovascular occlusion

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High-intensity focused ultrasound ablation as a bridging therapy for hepatocellular carcinoma patients awaiting liver transplantation

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Hepatobiliary & Pancreatic Diseases International 2012年第5期11卷 542-544页

作者： Tan To Cheung Kenneth SH Chok Regina CL Lo William W Sharr See Ching Chan Ronnie TP Poon Sheung Tat Fan Chung Mau Lo Department of Surgery The University of Hong Kong Department of Pathology The University of Hong Kong State Key Laboratory for Liver Research The University of Hong Kong

The scarcity of liver grafts in Asia leads to a significant dropout of patients from liver transplant waiting lists, particularly patients with hepatocellular carcinoma and a low model for end-stage liver disease score. In order to reduce dropping out, different bridging therapies are employed. We report the use of high-intensity focused ultrasound ablation as a bridging therapy for a patient with hepatocellular carcinoma of stage two and an extremely low platelet count (20×10 9 /L). The ablation was successful. Blood tests showed that his liver function was similar before and after the treatment. No adhesion was encountered in the liver transplantation performed six months later.

关键词： high-intensity focused ultrasound hepatocellular carcinoma liver cirrhosis liver transplantation bridging therapy

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Neo-adjuvant therapy for hepatocellular carcinoma before liver transplantation:Where do we stand?

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World Journal of Gastroenterology 2014年第18期20卷 5308-5319页

作者： Masato Fujiki Federico Aucejo Minsig Choi Richard Kim Transplant Center Cleveland ClinicClevelandOH 44195United States Department of Gastrointestinal Oncology Wayne State University/Karmonos Cancer Center DetroitMI 48202United States Department of Gastrointestinal Oncology H Lee Moffitt Cancer CenterTampaFL 33612United States

Liver transplantation (LT) for hepatocellular carcinoma (HCC) within Milan criteria is a widely accepted optimal therapy. Neo-adjuvant therapy before transplantation has been used as a bridging therapy to prevent dropout during the waiting period and as a down-staging method for the patient with intermediate HCC to qualify for liver transplantation. Transarterial chemoembolization and radiofrequency ablation are the most commonly used method for locoregional therapy. The data associated with newer modalities including drug-eluting beads, radioembolization with Y90, stereotactic radiation therapy and sorafenib will be discussed as a tool for converting advanced HCC to LT candidates. The concept “ablate and wait” has gained the popularity where mandated observation period after neo-adjuvant therapy allows for tumor biology to become apparent, thus has been recommended after down-staging. The role of neo-adjuvant therapy with conjunction of “ablate and wait” in living donor liver transplantation for intermediate stage HCC is also discussed in the paper.

关键词： bridging therapy Neo-adjuvant therapy Locoregional therapy Intermediate stage Living donor liver transplantation Ablation Transarterial chemotherapy Transarterial radioembolization External beam radiotherapy

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High rate of complete histopathological response in hepatocellular carcinoma patients after combined transarterial chemoembolization and stereotactic body radiation therapy

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World Journal of Gastroenterology 2021年第24期27卷 3630-3642页

作者： Ulrike Bauer Sabine Gerum Falk Roeder Stefan Münch Stephanie E Combs Alexander B Philipp Enrico N De Toni Martha M Kirstein Arndt Vogel Carolin Mogler Bernhard Haller Jens Neumann Rickmer F Braren Marcus R Makowski Philipp Paprottka Markus Guba Fabian Geisler Roland M Schmid Andreas Umgelter Ursula Ehmer Internal Medicine Ⅱ Klinikum rechts der IsarTechnical University of MunichMunich 81675Germany Department of Radiotherapy and Radiation Oncology University of SalzburgSalzburg 5020Austria Department of Radiation Oncology University Hospital of MunichCampus GroßhadernLMU MunichMunich 81377Germany Department of Radiation Oncology Klinikum rechts der IsarTechnical University of MunichMunich 81675Germany Department of Medicine II Liver CentreUniversity HospitalLMU MunichMunich 81377Germany Department of Gastroenterology Hepatology and EndocrinologyHannover Medical SchoolHannover 30625Germany Institute of Pathology Technical University of MunichMunich 81675Germany Institute of Medical Informatics Statistics and EpidemiologyKlinikum rechts der IsarTechnical University of MunichMunich 81675Germany Institute of Pathology Faculty of MedicineUniversity Hospital of MunichMunich 81377Germany Institute of Diagnostic and Interventional Radiology Klinikum rechts der IsarTechnical University of MunichMunich 81675Germany Institute of Diagnostic and Interventional Radiology Section for Interventional RadiologyKlinikum rechts der IsarTechnical University of MunichMunich 81675Germany Department of General- Visceral-Vascular-and Transplant-SurgeryUniversity hospital of MunichCampus GroßhadernLMU MunichMunich 81377Germany Emergency Department Vivantes hospital groupHumboldt hospitalBerlin 13509Germany

BACKGROUND Liver transplantation(LT)presents a curative treatment option in patients with early stage hepatocellular carcinoma(HCC)who are not eligible for resection or ablation *** to a risk of up 30%for waitlist drop-out upon tumor progression,bridging therapies are used to halt tumor *** chemoembolization(TACE)and less commonly stereotactic body radiation therapy(SBRT)or a combination of TACE and SBRT,are used as bridging therapies in ***,it remains unclear if one of those treatment options is *** analysis of explant livers after transplantation provides the unique opportunity to investigate treatment response by *** To analyze histopathological response to a combination of TACE and SBRT in HCC in comparison to TACE or SBRT *** In this multicenter retrospective study,27 patients who received liver transplantation for HCC were *** received either TACE or SBRT alone,or a combination of TACE and SBRT as bridging therapy to liver *** explants of all patients who received at least one TACE and/or SBRT were analyzed for the presence of residual vital tumor tissue by histopathology to assess differences in treatment response to bridging *** analysis was performed using Fisher-Freeman-Halton exact test,Kruskal-Wallis and Mann-Whitney-U *** Fourteen patients received TACE only,four patients SBRT only,and nine patients a combination therapy of TACE and *** were no significant differences between groups regarding age,sex,etiology of underlying liver disease or number and size of tumor ***,analysis of liver explants revealed that almost all patients in the TACE and SBRT combination group(8/9,89%)showed no residual vital tumor tissue by histopathology,whereas TACE or SBRT alone resulted in significantly lower rates of complete histopathological response(0/14,0%and 1/4,25%,respectively,P value<0.001).CONCLUSION Our data suggests th

关键词： Hepatocellular carcinoma Transarterial chemoembolization Stereotactic body radiation therapy bridging therapy Liver transplantation

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Different strategies for ultra-early reperfusion therapy in anterior circulation acute ischemic stroke safety and effectiveness of the comparative observation

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Clinical Research Communications 2023年第2期6卷 33-38页

作者： Wen-Jing Zhou Lu Yang Yan-Chao Huo Meng Geng Meng Zhang Chuan-Hui Li Na Shang Yao-Ming Xu Department of Neurology Tongliao City HospitalTongliao 028000China Tongliao Clinical Medical College Inner Mongolia Medical UniversityTongliao 028000China Emergency Department Xuanwu HospitalCapital Medical UniversityBeijing 100032China Department of Chronic Disease Management and Control Tongliao Municipal Center for Disease Control and PreventionTongliao 028000China.

Background:To compare the safety and effectiveness of direct mechanical thrombectomy and bridging therapy for stroke with acute anterior circulation large vessel occlusion within 4.5 hours of ***:Retrospectively collected from 66 patients with acute ischemic stroke admitted to the Department of Neurology of Tongliao Hospital and Xuanwu Hospital from August 2019 to November 2021 within 4.5 *** to the different recanalization methods,30 patients were assigned to the direct thrombectomy treatment group,and 36 patients in the bridging treatment group(i.e.,the intravenous thrombolysis bridging mechanical thrombectomy treatment group).The primary outcome measure was the neurological outcome at the onset of *** outcome measures were intraoperative vascular recanalization and reperfusion,and the US National Institute of Health Stroke Scale score at 24 hours after *** primary safety indicators are intracranial hemorrhage,including symptomatic intracranial hemorrhage and non-symptomatic intracranial hemorrhage,and 90d ***:The direct thrombectomy group had lower body mass index,hypertension and baseline Alberta early computed tomography score than the bridging treatment group,and longer time from onset to visit than the bridging group(206.5(119.5,256.25)min vs.150.5(25.205,212.75)min),the above difference were statistically significant(P0.05).Conclusion:Similar clinical efficacy and safety of direct mechanical thrombectomy and bridging therapy for acute anterior circulation large vessel occlusive stroke within 4.5 hours of onset,direct thrombectomy can be used as an alternative scheme for acute anterior

关键词： anterior circulation direct thrombectomy therapy bridging therapy intracranial large vessel occlusion acute ischemic stroke

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