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ABSTRACT: To evaluate the therapeutic effect of embolization combined with endovascular stenting in the for treatment of intracranial pseudoaneurysms.
Seventeen patients with intracranial pseudoaneurysms received endovascular treatment with coil placement, NBCA glue embolization and endovascular stenting, and the therapeutic effect was evaluated according to the findings in immediate postoperative and follow-up angiography.
Fatal aneurysm rupture occurred in 1 case during embolization, and the surgical procedures were carried out smoothly in the remaining 16 cases. The aneurysm cavity dense coil packing ratio was 50% in coil embolization group and 42.9% in stent-assisted coil embolization group. In the follow-up for 3 months to 2 years, 2 patients in coil embolization group experienced pseudoaneurysm recurrence and were managed successfully with additional embolization with coils and stent. Aneurysms were not found postoperatively in stent-assisted coil embolization group.
Embolization combined with endovascular stenting is a safe and effective treatment of intracranial pseudoaneurysms with minimized risk of recurrence.
Nan fang yi ke da xue xue bao = Journal of Southern Medical University 05/2011; 31(5):836-8.
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ABSTRACT: To discuss the efficiency and safety of carotid angioplasty stenting (CAS) in patients with contralateral carotid artery occlusion.
From January 2001 to January 2010, 56 carotid artery stenosis patients with contralateral carotid artery occlusion were performed CAS and the feature and results of these cases were analyzed retrospectively. All the cases were confirmed to be carotid artery stenosis with contralateral carotid artery occlusion by digital subtraction angiography (DSA). The diameter stenosis rate was 72% ± 15%. CAS were performed with distal protection device in 56 cases.
The technique success rate of CAS were 100% in all the 56 patients with contralateral carotid artery occlusion and post-procedure stenosis rate descended to 13% ± 8%, and the symptoms of cerebral ischemia were all improved. Only 1 case occurred remote hemorrhage in the position of previous cerebral infarction in the side of CAS after the procedure, and recovered with light neurological deficit after the craniotomy to remove the hematoma. No ischemic complications or death occurred. During the following up of 6 months to 3 years, no cerebral ischemic symptoms reoccurred. The rechecking results of color Doppler of 47 cases and DSA of 2 cases showed no restenosis in-stent.
CAS is safe and effective for the patients with contralateral carotid artery occlusion. Critical election of the case, operation of skilled doctors and scrupulous postprocedure general management can decrease the rate of complication.
Zhonghua wai ke za zhi [Chinese journal of surgery] 04/2011; 49(4):303-6.
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ABSTRACT: To investigate and evaluate the effectiveness and safety of the percutaneous transluminal angioplasty (PTA) and stent placement (SP) in the treatment of left subclavian steal syndrome (SSS).
From January 2007 to December 2009, 32 patients with left SSS were selected and the digital subtracted angiography (DSA) were used to evaluate before PTA and SP. Anticoagulation and antiplatelet therapy before and after interventional treatment were taken. Then the therapeutic effect was evaluated after the procedure immediately, in the third month and the sixth month post-operatively by transcranial doppler sonography (TCD).
DSA was used to evaluate therapeutic effect after PTA and SP, the stenosis degree in average lumens diameter of the patients descended from 87.5% to 15.0%. The stenosis of subclavian steal artery was obviously improved and the contraflow of vertebral artery was disappeared without the stent's recovery and displacement by TCD. The mean systolic blood pressure difference between left and right upper limb was obvious lower than that before therapy [51.6 mmHg (1 mmHg = 0.133 kPa) vs 10 mmHg after 3 months]. No embolism and death was found.
PTA and SP are effective in the treatment of SSS. Anticoagulation and antiplatelet therapy after interventional treatment has a good therapeutic effect. TCD is a cheap, sensitive and non-invasive method for evaluating SSS.
Zhonghua wai ke za zhi [Chinese journal of surgery] 11/2010; 48(21):1642-5.
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ABSTRACT: To study the feasibility, safety and validity of percutaneous angioplasty and stenting (PTAS) for symptomatic atherosclerotic stenosis of basilar artery.
The results of treatment and follow-up of 40 cases with symptomatic atherosclerotic stenosis of basilar artery performed PTAS from August 2003 to December 2009 were studied retrospectively, who had either recurrent transient ischemic attacks (TIAs) or obvious ischemic symptoms and resistant to medical therapy.
PTAS were successfully performed in all the 40 cases and the post-operative average residual stenosis descended to 14% ± 11% from pre-operative 82% ± 14%. After operation the patients were administrated with antiplatelet drugs. After procedure the clinic symptoms and signs of ischemia were improved obviously in 38 cases and deteriorated in 2 cases whose CT scanning showed that the range of infarction in brain stem enlarged. The symptoms improved after treatment but 2 patients had neurological deficit. No hemorrhagic complications occurred in the group. During the follow-up for 2 months to 7 years, transcranial doppler ultrasonography in 26 cases demonstrated the blood flow was faster than normal in 2 cases, and digital subtraction angiography (DSA) in 6 cases showed restenosis in-stent in 1 case. The second stent was implanted because of the symptomatic restenosis. In another case the follow-up DSA showed occlusion of basilar artery in-stent but there was no ischemia of post circulation because the generation of anastomoses.
PTAS is a feasible, safe and effective therapeutic method for the patients with symptomatic atherosclerotic stenosis of basilar artery. Further study in large number of patients is needed for long-term outcome.
Zhonghua wai ke za zhi [Chinese journal of surgery] 10/2010; 48(19):1466-9.
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ABSTRACT: To study the surgical principles and treatment options of intracranial aneurysms.
One hundred and thirty nine patients with intracranial aneurysms were retrospectively studied, including 80 open-surgery cases and 59 endovascular-treated cases from January to December in 2009. Open surgical methods included clipping, trapping or wrapping and interventional methods included simple coiling or stent-assisted coiling. Intra-operative electroencephalogram and somatosensory evoked potentials monitoring were regularly used. Microvascular doppler ultrasonography and indocyanine green videoangiography were used to assess blood flow in parent and branch vessels.
Seventy-three aneurysms were directly clipped, 6 were trapped and 1 was wrapped. Thirty-three aneurysms were coiled and 26 were coiled assisted with stents. At discharge, 71 of the 80(88.8%) surgical treated patients had Glasgow Outcome Scale score of 4 or 5 points, 3 points in 6 patients (7.5%), 2 points in 1 patient (1.2%), and 1 point in 2 patients (2.5%). Fifty-four out of 59 cases underwent endovascular treatment scored 4 or 5 points (91.5%) and 3 points in 5 patients (8.5%).
Surgical clipping and endovascular coiling are two major treatment choices for intracranial aneurysms. The treatment option should be individualized based on the patients' specific conditions, which could have a safe, effective and durable outcome.
Zhonghua wai ke za zhi [Chinese journal of surgery] 10/2010; 48(19):1496-9.
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ABSTRACT: To reconstruct and affix symptomatic giant and fusiform aneurysms of vertebrobasilar artery by using self-expandable stents in 5 cases with an average volume 5.5 mm × 5.0 mm × 60.0 mm.
The clinical data of 5 patients who were suffered from giant and fusiform aneurysms of vertebrobasilar artery between October 2007 and October 2009 were retrospectively analyzed. Under instructing of digital subtraction angiography (DSA) images deployed the LEO and Neuroform stents for reconstructing and affixing the deferent 5 giant fusiform aneurysms of vertebrobasilar artery. And assisted embolized with 3 Orbit coils for a ruptured aneurysm to stop bleeding at the same time.
The operative procedures were succeeded in all five cases. The damaged signs and symptoms of posterior group of cranial nerves disappeared in 3 cases by following 3 to 26 months. Trigeminal neuralgia in one case was markedly improved but a hemiparesis. One case with subarachnoid hemorrhage (SAH) showed no relapse evidence. Follow up DSA images in 3 cases demonstrated one case with a more rule modality in the part of aneurysm affixed by stent and proximal part of aneurysm in which no covering by stent revealed a mild to expand after 26 months review. And the images of postoperative DSA following 1 month and 4 months in another 2 cases displayed the imaging enlargement of part of the original aneurysm body shrink and shape the rules than the previous view.
The treatment of symptomatic huge fusiform vertebrobasilar aneurysms by using self-expandable stents is feasible, aneurysm growth is under control, short-term effects are positive.
Zhonghua wai ke za zhi [Chinese journal of surgery] 06/2010; 48(12):904-7.
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ABSTRACT: To discuss the possible cause of intracranial hemorrhage and treatment after carotid artery stenting (CAS) in patients with carotid artery stenosis.
From January 2003 to August 2009, 403 patients with carotid artery stenosis that were performed CAS, intracranial hemorrhage occurred in 5 cases after the procedure. We analyzed the feature of these cases and perioperative management retrospectively to summarize the possible cause of intracranial hemorrhage and preventive measure.
Cerebral hemorrhage were found 30 min after CAS in 2 cases, 5 days in 2 cases and 3 days in 1 case. One patient was treated conservatively whose hemorrhage was about 2 ml, one was performed draining of ventricle and the other three cases were all performed craniotomy to remove the hematoma and to depress. The position of hemorrhage were all in the side of carotid artery stenosis, and in 2 cases of them the hemorrhage were at the region of previous cerebral infarction. One patient was cured conservatively, the one who was performed draining of ventricle died. Among the other three cases performed craniotomy, one recovered with light neurological deficit and two died of multiple organ failure.
Intracranial hemorrhage is the most serious complication of CAS of carotid artery, and general measure should be taken to prevent it from occurring.
Zhonghua wai ke za zhi [Chinese journal of surgery] 04/2010; 48(8):582-4.
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ABSTRACT: To study the feasibility, security and validity of percutaneous angioplasty (PTA) or percutaneous angioplasty and stenting (PTAS) for symptomatic stenosis of middle cerebral artery.
The results of treatment and follow-up of 39 cases with symptomatic stenosis of middle cerebral artery who had either recurrent transient ischemic attacks (TIAs) or resistant to medical therapy and were performed PTA or PTAS were studied retrospectively.
Among the 39 cases with stenosis of middle cerebral artery (23 in left, 13 in right, 3 in bilateral side and 5 cases combining with stenosis of carotid artery) PTA were successfully performed in 9 cases and PTAS in 30 (whose post-operative residual stenosis were less than 10%). After operation the patients were administrated with antiplatelet drugs. The clinic symptom and sign of ischemia were improved obviously after operation. During the procedure the contrast could be seen outside the vessel in 2 cases, the patients had no obvious symptom of hemorrhage and got well rapidly. But in another case her consciousness changed 1 h after PTAS and the limbs could not move in right side. Emergency CT scan showed cerebral hemorrhage in left basic node area. The patient suffered language barrier and incomplete hemiplegy in right side. No complication was occurred in the others. During 5 to 60 months follow-up, the symptom of weakness in right arm reoccurred but lighter than before in only one case. TCD rechecked in 26 cases and demonstrated the blood beam speed was faster than normal in two case. DSA rechecked in 14 cases showed restenosis in-stent in the 2 cases and they were treated by medicine.
PTA and PTAS is a feasible, safe and effective therapeutic method for the patients with symptomatic stenosis of middle cerebral artery. Further study in large number of patients is needed for long-term outcome.
Zhonghua wai ke za zhi [Chinese journal of surgery] 05/2009; 47(8):613-6.
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ABSTRACT: To evaluate the operation method and prevention from complications of extracranial carotid stenosis.
Three cases of carotid angioplasty and stenting for 271 patients with extracranial carotid stenosis were performed from October 2001 to June 2008. Before the operation, take Clopidogrel for 75 mg/d, Aspirin Delayed-Release Capsules for 100 200 mg/d, Simvastatin for 40 mg 1/night, for 5 - 10 d. Then treat continuous vein infusion Heparin 50 mg/d for 2 d. After the operation, continue antiplatelet and reduce blood fat therapy.
All 300 carotid stenting were successfully accomplished. DSA showed that the diameter of stenosed segment of carotid artery was markedly enlarged, and all clinical ischemia signs were improved remarkably. Seven cases suffered from complications in one week after operation and one died. Following up 3 - 24 months in 226 patients, restenosis were found in 5 cases, among which 45 patients were evaluated at follow-up by means of ultrasonic examination for 36 months or so, no restenosis was found. No ischemic attack occurred at follow-up.
The satisfactory effect and safety are achieved in the therapy of carotid stenosis by carotid angioplasty and stenting. Correct intraoperative treatment and skilled techniques are the key points of success.
Zhonghua wai ke za zhi [Chinese journal of surgery] 04/2009; 47(6):415-8.
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ABSTRACT: To investigate the effects of individualized endovascular treatment on cerebral venous thrombosis of different types.
168 patients with cerebral venous thrombosis underwent individualized endovascular treatment: direct thrombolysis via internal jugular vein in 26 cases, injection of urokinase via common carotid artery in 98 cases, stent angioplasty in venous sinus in 9, simple anticoagulant therapy in 20 cases, and treating combined intracranial hemorrhage simultaneously in 15 cases. Follow-up was conducted for 6-168 months.
Follow-up showed that the effective rate was 97.6%, recurrence rate was 6.6%, complication incidence rate was 1.2%, and death rate was 0.6%. Venous sinus recanalization occurred and primary drainage rebounded in most eases. Lateral drainage was strengthened in some cases whose venous sinuses did not recover ideally. The symptoms of most cases were alleviated along with the decrease of intracranial pressure.
Individualized endovascular treatment based on the characteristics of the disease is effective in treatment of cerebral venous thrombosis.
Zhonghua yi xue za zhi 02/2009; 89(3):164-6.
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ABSTRACT: To evaluate the validity of different treatment for minimizing the complications caused by hemodynamic changes during stenting angioplasty of carotid stenoses.
There was no special measure for 80 of 205 cases during angioplasty. General blood pressure was controlled strictly to normal lower limit for avoiding intracranial reperfusion bleeding and angioplasty was done after elevated heart rate to 80 per minute in the remaining 125 cases.
There were 8.8% complications in 80 cases and no obviously complication occurred in 125 cases controlling hemodynamic changes. Follow-up period from 1 months to 5 years, there was no marked restenosis.
Regulating hemodynamic changes should be emphasized for reducing complications and improving the effect of carotid artery stenting.
Zhonghua wai ke za zhi [Chinese journal of surgery] 03/2007; 45(4):230-2.
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ABSTRACT: To study the effects of injection of urokinase via carotid artery in treatment of cerebral venous sinus thrombosis.
Thirty-nine New Zealand white rabbits were made into models of cerebral venous sinus thrombosis with the superior sagittal sinus ligated and injected with suspension of cephalin kaolin and cephalin, and then were randomly divided into three groups: control group (n = 15), anticoagulation group (n = 12, infused with heparin 2 mgxkg(-1)xd(-1) via external carotid venous for 5 days), and thrombolysis group (n = 12, injected with urokinase 4000 Uxkg(-1)xd(-1) via carotid artery for 5 days). Laser Doppler scanning was used to determine the local cerebral blood flow before ligation, 20 and 90 min after ligation, and at the end of experiment. Five rabbits of the control group per each of the 3 time points (before ligation, 12 h after ligation, and at the end of experiment) were killed to collect the tissues of cerebral cortex in front of the ligated part to determine the brain water content. All the remaining rabbits were killed within 24 hours after the end of experiment to determine the brain water content and undergo microscopy.
The local cerebral blood flow of the thrombolysis group was 94.8% +/- 0.3%, significantly higher than those of the anticoagulation group (88.6% +/- 0.3%) and control group (80.9% +/- 0.3%) (both P < 0.01). The brain water content of the thrombolysis group was 78.9% +/- 0.3%, significantly lower than those of the anticoagulation group (81.8% +/- 0.7%) and control group (82.1% +/- 1.0%) (both P < 0.05).
Improving the local blood flow and reducing the brain water content, injection of urokinase via carotid artery is effective in treatment of cerebral venous sinus thrombosis.
Zhonghua yi xue za zhi 04/2006; 86(11):745-8.
